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Analysis, background reports and updates from the PBS NewsHour putting today's news in context.

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    A poll worker places a mail in ballot into a voting box as voters drop off their ballot in the U.S. presidential primary election in San Diego, California. Photo by Mike Blake/Reuters

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    JUDY WOODRUFF: But first: President Trump continues to repeat the unsubstantiated claim that millions of illegal votes were cast in the 2016 election. The commission he set up to look into this has sparked its own controversy.

    William Brangham reports.

    PRESIDENT DONALD TRUMP: Every time voter fraud occurs, it cancels out the vote of a lawful citizen and undermines democracy.

    WILLIAM BRANGHAM: The first meeting of the Commission on Election Integrity convened with a presidential defense of its mission.

    PRESIDENT DONALD TRUMP: Throughout the campaign, and even after, people would come up to me and express their concerns about voter inconsistencies and irregularities which they saw, in some cases having to do with very large numbers of people in certain states.

    WILLIAM BRANGHAM: So far, those allegations remain unproven, but the commission is pressing ahead.

    Last month, it sent letters to every state, asking for voter information, including names, birthdays and partial Social Security numbers.

    Seventeen states, governed by Republicans and Democrats, as well as the District of Columbia, refused to comply. Many others said they will provide only limited information that’s already publicly available.

    Today, the president criticized those states who’ve refused to go along.

    PRESIDENT DONALD TRUMP: One has to wonder what they’re worried about. And I ask the vice president and I ask the commission, what are they worried about? There’s something. There always is.

    WILLIAM BRANGHAM: Just after the election, when Hillary Clinton won the popular vote by 2.8 million votes, Mr. Trump tweeted, again, with no evidence whatsoever, that the vote count was skewed — quote — “I won the popular vote if you deduct the millions of people who voted illegally.”

    The commission co-chair, Kansas Secretary of State Kris Kobach, who is a Republican, says the country deserves a hard, dispassionate look at the issue.

    KRIS KOBACH, Secretary of State, Kansas: For a long time, there has been lingering doubt among many Americans about integrity and fairness of elections. And it’s not a new issue at all. If you look at polling data, it goes back decades.

    WILLIAM BRANGHAM: The panel is chaired by Vice President Pence, and in addition to Kobach, members include current and former secretaries of state from Indiana, New Hampshire, Maine and Ohio, among others.

    But critics of the commission warn that stoking fears of alleged fraud will be used later to justify a crackdown on voting rights.

    Rick Hasen is a law professor at the University of California, Irvine, and an election law expert.

    RICK HASEN, University of California, Irvine: I’m concerned that it’s going to be something that is just going to try to support the president’s agenda, claiming that there’s a lot of voter fraud, and use that to make it harder for people to be able to register to vote.

    WILLIAM BRANGHAM: Already, the commission is facing at least seven lawsuits questioning its transparency, conduct and even its existence.

    We turn now to two officials who actually run elections in their states.

    Matthew Dunlap is the secretary of state for Maine. He is a Democrat, and he’s also a member of the president’s commission. And he was at today’s meeting.

    We’re also joined by Michele Reagan. She is a Republican and she is Arizona’s secretary of state.

    Welcome to you both.

    MATTHEW DUNLAP, Secretary of State, Maine: Thank you for having us.

    MICHELE REAGAN, Secretary of State, Arizona: Thank you for having us.

    WILLIAM BRANGHAM: Matthew, I would love to start with you first.

    What is your general hope that this commission — what do you hope it will accomplish?

    MATTHEW DUNLAP: Well, my general hope is that actually we do something to bolster voter confidence in how we conduct elections in this country.

    I think we have an awful lot to be proud of. No one is questioning the legitimacy of the outcome of the 2016 election. There are some lingering questions about how elections have been conducted, who was able to vote legally or not.

    And I think, and based on my experience in the state of Maine, I think we can very, very proud of what our local election officials have done to make sure that their neighbors get to exercise their democratic right of self-governance.

    WILLIAM BRANGHAM: Michele Reagan, I know you are a supporter broadly of this commission and its aims.

    As you know, the commission was set up in part because of the president’s concern that there had been some voter fraud in the past election. I’m curious. You were running the election in Arizona back in 2016. Did you have any instances of fraud in your state?

    MICHELE REAGAN: Well, I can’t speak, obviously, for other states, but I know, in Arizona, we have a number of measures that we use to prevent fraud.

    And that’s not to say fraud never happens. Certainly, when we hear allegations of that, we take it very seriously. But it’s important to note Arizona has some laws on the books that keep it very safe from fraud, massive fraud.

    One is the showing proof of I.D. at the polling places. Another is proof of citizenship when registering to vote. A lot of states don’t have these laws. And so, speaking from Arizona’s point of view, coupled with the fact that we also participate, already, in interstate cross-check systems, for instances, of double voting or double registration, we’re pretty confident in Arizona that we run a really good election.

    WILLIAM BRANGHAM: Matthew Dunlap, as I mentioned in the report prior to this, the commission asked all the states for some types of voter information.

    And there was a lot of concern. Many states pushed back. I understand Maine didn’t share its information.

    Explain to me, what is the concern? What are you worried about?

    MATTHEW DUNLAP: Well, we’re not really worried about anything. We just follow the law.

    The request that came from the commission, which, as commission members, we did not review the full text of the letter that went out. We did agree that the information that should be requested should be requested, not demanded, and it should only be that information that would be publicly available to anyone legally entitled to obtain it under those particular state laws.

    When we got the request, the letter said that be advised that any information that you provide will be made publicly available for anyone to inspect.

    Maine election law specifies that anyone who is qualified to access the voter file must keep it confidential. And that is directory language. Making the list available is discretionary under the law. So, with that direction, it was a mathematical equation for us. We simply could not provide it under those circumstances. And so we didn’t.

    WILLIAM BRANGHAM: Michele Reagan, do you have concerns about this database being compiled here in Washington, D.C.?

    MICHELE REAGAN: Well, absolutely we have concerns.

    And, again, in Arizona, we just looked to the statutes and the law to tell us exactly what we were going to have to do or not do. And the law is pretty clear that, again, just like in Maine, you can’t take the information via a public records request with the intent of sharing it or posting it publicly or disseminate, you know, giving it out.

    WILLIAM BRANGHAM: Matthew Dunlap, what about this larger concern that has been raised by some people that this commission and its mission is going to be used to justify further national crackdown on voting rights? What do you make of that?

    MATTHEW DUNLAP: That’s one of my favorite questions to get out of all of this, is that somehow we’re trying to undo the electoral process.

    My position is, is that you have these lingering questions that have been around for a while now about illegal activity around elections. Sunshine is the greatest disinfectant. I have full confidence that everything that’s been claimed will probably be largely debunked.

    And what we will find will probably be the product of mistakes and errors and unintended actions that were never meant to become felonies. So I think, you know, with that understanding, I think we’re going to find that we have a really pretty good system that’s very, very decentralized, which actually adds to its level of security against some of the allegations that we have heard about, like the Russian Federation getting involved in hacking our elections.

    I think the systems that we have in place, which are run by local election officials, actually will be found to work very, very well, and that American voters should feel pretty good about the systems that help us elect our leadership and decide issues.

    WILLIAM BRANGHAM: Michele Reagan, you heard Matthew here say that he believes the commission will largely debunk many of these claims.

    But just today, the co-chairman of the commission, Kris Kobach, said on MSNBC that he says, we may never know whether or not Hillary Clinton in fact won the popular vote. That is an implication that is very likely the potential that three million illegal votes were cast.

    Is the head of the commission is making that kind of a statement, does that concern you at all about the thrust of this commission?

    MICHELE REAGAN: What really concerns me is the good work that the commission could be doing. And I hope — and I have high hopes that they will look forward to some of these suggestions that states are making.

    I would hope that this commission takes what states are doing and determines what is working best, so they can share it with other states.

    WILLIAM BRANGHAM: All right, Michele Reagan, Matthew Dunlap, thank you both very much.

    MATTHEW DUNLAP: Thank you for having us.

    The post How state election officials see Trump’s voter fraud probe appeared first on PBS NewsHour.

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    JUDY WOODRUFF: On July the 7th, President Trump sat down for a highly anticipated meeting with Russia’s President Vladimir Putin at the G20 summit in Hamburg, Germany.

    But, last night, it was disclosed that there was a second lengthy conversation later that day between the two leaders, one that the White House had not spoken of at the time.

    Nick Schifrin reports.

    NICK SCHIFRIN: It was a three-hour dinner party for the world’s most powerful people, 20 leaders, and their spouses. On the menu, turbot fish fillet, Friesian beef cheeks, and chitchat.

    President Trump worked the room, and then took his seat. Diagonally across the table, first lady Melania Trump and Russian President Vladimir Putin. The two talked to each other with the help of Putin’s translator.

    And as a dessert of raspberries and cheese was served, Mr. Trump walked over to Putin.

    White House spokeswoman Sarah Sanders today called their talk brief and informal.

    SARAH HUCKABEE SANDERS, Deputy White House Press Secretary: To try to create that there was some sort of private conversation in a room with 40-plus people seems a little bit ridiculous.

    NICK SCHIFRIN: Nick Burns is a former U.S. ambassador to NATO and veteran diplomat who participated in dozens of U.S.-Russia meetings.

    NICHOLAS BURNS, Former U.S. Ambassador to NATO: This is not a bad thing. Vladimir Putin and Donald Trump are the two most powerful people in the world. They barely know each other. They’d only met once before this G20 dinner, and it’s really important that they get to know each other and develop some capacity to have an effective relationship.

    NICK SCHIFRIN: Last night, Trump blasted the media coverage, tweeting: “Fake news story of secret dinner with Putin is sick.”

    The pro-Kremlin Russian lawmaker Alexei Pushkov used the exact same language, describing reports about a — quote — “secret dinner” as sick.

    And, today, German Chancellor Angela Merkel’s spokesman called these dinner conversations normal.

    STEFFEN SEIBERT, Spokesman, German Chancellor Angela Merkel (through interpreter): It is the fundamental point of the G20 meeting that, alongside working meetings, there is room and opportunity for multiple informal contacts. And that is certainly the point of such a dinner.

    NICK SCHIFRIN: But what is unusual is that, since there were no other U.S. officials present, and the translator was Putin’s, the U.S. officials who work on Russia have no official notes.

    NICHOLAS BURNS: The people down the line cannot do their job if they don’t have an exact sense of what our president said, what the other guy said, and how they can then pursue these issues with the Russian government.

    NICK SCHIFRIN: The dinner talk came on the same day as Trump and Putin’s only official meeting. That talk lasted more than two hours. The next day, having spoken with Trump at least twice, Putin praised Trump personally.

    PRESIDENT VLADIMIR PUTIN, Russia (through interpreter): As for personal relations, I think that they have been established. I don’t know how this will sound, but I will say it how I see it: The Trump on television is very different from the real person. He’s very direct. He perceives his conversation partner very well. He’s a fairly quick thinker.

    NICK SCHIFRIN: It is that kind of praise that many here in Washington find strange and concerning. Multiple administration officials tell the NewsHour they have still not received a report from the official Trump-Putin meeting, let alone the dinner conversation. That is not business as usual.

    NICHOLAS BURNS: President Trump has put together, I think, the weakest policy on Russia in 70 years. It’s why you have seen so many people concerned by this one conversation. What did President Trump say to President Putin? People in our government need to know the answers to those questions, and we as citizens need those answers as well.

    NICK SCHIFRIN: A dinnertime conversation might not be out of the ordinary, except the president’s 2016 campaign is under investigation for possibly colluding with Russia. And the man he was talking to is accused by U.S. intelligence of ordering the covert effort to help Trump get elected.

    For the PBS NewsHour, I’m Nick Schifrin in Washington.

    JUDY WOODRUFF: Late today, the Senate Judiciary Committee said that Donald Trump Jr. and former Trump campaign manager Paul Manafort will testify next Wednesday about their meeting with a Russian lawyer last summer. The president’s son-in-law, Jared Kushner, goes before the Senate Intelligence Committee on Monday.

    The post Why Trump and Putin’s undisclosed conversation is noteworthy appeared first on PBS NewsHour.

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    FILE PHOTO - White House senior advisor Jared Kushner arrives to join U.S. President Donald Trump and the rest of the U.S. delegation to meet with Saudi Arabia's King Salman bin Abdulaziz Al Saud at the Royal Court in Riyadh, Saudi Arabia May 20, 2017. REUTERS/Jonathan Ernst/File Photo TPX IMAGES OF THE DAY - RTX37TM2

    White House senior advisor Jared Kushner will speak with the Senate intelligence committee on Monday in the ongoing Russia investigation. Photo by REUTERS/Jonathan Ernst/File Photo.

    Members of the Trump campaign’s inner circle are being scheduled to talk to Senate committees next week.

    President Donald Trump’s son-in-law, Jared Kushner, will speak with the Senate intelligence committee on Monday. That’s according to his lawyer, Abbe Lowell. He says Kushner is voluntarily cooperating with congressional probes. That interview will likely take place behind closed doors.

    READ MORE: Meet the lawyers on Trump’s growing legal team

    Donald Trump Jr. and former campaign manager Paul Manafort are scheduled to testify before the Senate Judiciary Committee next Wednesday. They are among witnesses the panel has announced for a hearing on foreign influence in elections.

    All three men are almost certain to be asked about recent revelations they attended a June 2016 meeting with a Russian lawyer and others in the expectation of receiving incriminating information about Hillary Clinton.

    The post 3 Trump associates scheduled to testify in Russia probe appeared first on PBS NewsHour.

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    JUDY WOODRUFF: And Senator Roger Wicker of Mississippi was also at the White House today.

    I started by asking him if the president’s engagement adds more pressure on Republicans.

    SEN. ROGER WICKER, R-Miss.: Well, I guess there is some pressure on some of the people who are sort of still doubtful about this.

    I don’t feel the pressure, because I have been a yes vote for quite some time. But let me tell you, there are two schools of thought on moving forward. The majority leader, Senator McConnell, would like to get to a vote on the motion to proceed and see where people are. And, if we win, great, we proceed to the bill. If not, at least people have voted, and we know what the target is, if we lose by two or three votes.

    The president, on the other hand, really thinks that, over the next few days, we can get 50 votes to yes. And he was all about today getting into the details of what’s keeping various members from being able to say 100 percent that they can support this legislation and deciding what levers to pull to get the bill to a place where 50 of us can say yes.

    JUDY WOODRUFF: Well, the reason I’m asking about pressure is because, a couple of weeks ago, when Senator Dean Heller of Nevada indicated he was having problems with the legislation, there was a political action group supporting the president that ran ads against him.

    Is that the kind of …


    SEN. ROGER WICKER: And I think that was generally considered to be bad form and counterproductive among people in the Republican Conference.

    JUDY WOODRUFF: Well, let me ask you a little bit about the substance of this.

    As you know, a lot of discussion about what this bill would mean for coverage, including Medicaid. The vice president of your home state — a Mississippi state hospital association quoted this week as saying they are opposed to anything that increases the number of uninsured in Mississippi.

    SEN. ROGER WICKER: Well, for one thing, I don’t think it would increase the number of uninsured.

    These changes are based on projections of people that will be covered, if the estimates are correct. So, I would just challenge that.

    But let me also say — and I don’t mean to be critical, or I don’t mean this to be taken wrong — but there’s never been a provider who came to us and said, we need you to slow the growth rate of these entitlement programs.

    I mean, that’s just not something that they’re going to say. But the fact is we can make health care better for Mississippians, and we can make coverage better for the average American, while, at the same time, saving a system that is not sustainable for future generations. And we can do that.

    And, at the end of the day, I think people in the health care business, in the hospital business in future years will say, you have saved the system and good for you.

    JUDY WOODRUFF: So, when I read that there are almost half-a-million children in Mississippi who depend on Medicaid, are you saying they don’t have anything to worry about?

    SEN. ROGER WICKER: I think — well, for one thing, we are not a Medicaid expansion state.


    SEN. ROGER WICKER: Our state didn’t choose to do that. And so it’s completely inaccurate to say that these 500,000 children are going to lose their coverage. They’re not.

    As a matter of fact, there will be a tradition — I mean, there will be a transition — I’m sorry — and states that expanded Medicaid will have a seven-year period and there will be an extra incentive for those states who chose not to do that.

    But those 500,000 children that you talk about are not going to have their coverage threatened.

    JUDY WOODRUFF: All right.

    Senator Roger Wicker joining us from the Capitol, we thank you.

    SEN. ROGER WICKER: Thank you.

    JUDY WOODRUFF: And a quick postscript: We don’t know yet what the latest revisions to the Senate bill to repeal and replace the Affordable Care Act will include, but, for the record, the Congressional Budget Office already estimated what would happen with the first version of the bill.

    It concluded there would be 15 million fewer Medicaid enrollees in a decade than projected under current law. It also said that, over the long haul, states would likely have to either spend more money, cut payments, eliminate services or limit who’s eligible for Medicaid. It is not clear how many children would be affected.

    The post Sen. Wicker: Trump believes health care bill can get 50 votes appeared first on PBS NewsHour.

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    JUDY WOODRUFF: Now we return to the battle over health care and President Trump’s meeting with Senate Republicans at the White House.

    We hear from two people who were in the room, first Senator Pat Roberts of Kansas. He is a member of the Health, Education, Labor and Pensions Committee.

    I spoke with him a short time ago and started by asking what the president changed today in his pitch to senators.

    SEN. PAT ROBERTS, R-Kan.: We had a meeting that I thought was highly productive.

    I thought the president made a very good case that if you simply have a repeal and, in two years, you’re going to see further deterioration, if that’s the right word, for Obamacare. In Kansas, our premiums continue to soar. We’re up now $3,000.

    This is a little like being in the back seat of a convertible with Thelma and Louise and we’re headed toward the canyon. We’re about at the edge. So, we have got to do something. Number one, we have to get out of the car. Number two, we have got to get into a new car.

    And that’s what the president was talking about. We had the entire Republican Conference. I think he did a good message. There was a good — I think he did a good job.

    JUDY WOODRUFF: But what has changed with your Republican colleagues? Because, yesterday, there weren’t going to be enough votes to do this. Today, there are? Is that simply because of an argument the president made?

    SEN. PAT ROBERTS: Well, the first thing is, Judy, is that we have got to get over this business of denying the leadership of our party, Mitch McConnell, at least a motion to proceed.

    I think the American people want us to debate it. I think the American people want us to vote on several different items that people would be presenting. This is a vote-a-rama anyway. You’re probably going to have 150 votes,. But we need a debate and we need to vote.

    Now, this business of stopping the motion to proceed, that has to quit. And that was one of the main messages that the president indicated, to give Mitch McConnell the — obviously, the number of votes he needed to go ahead with this kind of an exercise.

    I think the president really listened. We had at least 35 people, maybe 40, make suggestions with regards to the bill. There was a lot of consensus.


    SEN. PAT ROBERTS: And the other thing — and I think he mentioned this is much larger than health care — is whether or not Republicans can actually govern.

    JUDY WOODRUFF: So, you’re saying — let me just clarify. So, you’re saying whether Republicans can get together as a group is more important than health care legislation?

    SEN. PAT ROBERTS: No, it’s not more important. It’s another consideration, that, if we can’t do this, maybe you can’t do tax reform or, for that matter, anything else on the table. Both are very important.

    Obviously, you have to get health care right. That was the whole intent of the meeting. He listened very carefully. He stated his position very forcefully. And I think it was a good meeting.

    JUDY WOODRUFF: Well, let me ask you about the fact that the criticisms of this legislation are the same today as they were yesterday.

    And I’m just looking at the state of Kansas. Your hospital association had — had looked at the changes you had proposed directing more money to the hospitals. And they said, that’s great, but they said, even with that, it doesn’t make up for the deep cuts to Medicaid and other problems with the bill.

    What would you say today to your hospital association?

    SEN. PAT ROBERTS: Well, as a matter of fact, I’m meeting with them just as I get through talking with you.

    I will point out to them that Obamacare will continue to deteriorate. We have already lost one insurance company; 42,000 Kansans don’t have insurance anymore. And if we lose our remaining insurer, we’re really going to be in trouble.

    So, it isn’t so much what we would like to have as what is happening to Obamacare. Now, working with the Kansas Hospital Association, I think there are going to be some new ideas presented in whatever bill that comes up with — or we come up with. And the president was doing a lot of listening. The White House was doing a lot of listening, Tom Price, Seema Verma, all the people within the administration, that they’re going to come up with something new.

    JUDY WOODRUFF: Senator, I also was reading that 70 percent of all Medicaid enrollees in the state of Kansas are children.

    SEN. PAT ROBERTS: Right.

    JUDY WOODRUFF: Three hundred thousand Kansas children. What’s going to happen to them?

    SEN. PAT ROBERTS: Well, they’re going to be covered. We are increasing Medicaid every year.

    There may be some more wrap-around amendments or different opportunities for Medicaid for us. And we were a non-Medicaid state. I think one of the reasons the Kansas Hospital Association was so upset with this is that, twice, they really supported efforts on Medicaid funding, and not to make it a non-Medicaid expansion state.

    But that ship has sailed. The Kansas state legislature didn’t approve that, and the governor vetoed it. And they were not able to override the veto. We have to work with what we have. They’re going to be in my office in about 30 minutes, and we are going to go over that and what the president said.

    JUDY WOODRUFF: Well, we look forward to hearing about the outcome of that meeting.

    Senator Pat Roberts of Kansas, thank you very much.

    SEN. PAT ROBERTS: My privilege. Thank you.

    The post Sen. Roberts: We need to debate and vote on the health care bill appeared first on PBS NewsHour.

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    JUDY WOODRUFF: Senate Republicans are trying again to see if there is a way forward on health care reform. Their latest bill to replace Obamacare collapsed yesterday, but party leaders say it may not be dead yet, after a repeal-only option also ran into opposition.

    President Trump called the caucus to the White House today. He said he is now ready to act, and insisted that inaction is not an option.

    PRESIDENT DONALD TRUMP: Frankly, I don’t think we should leave town unless we have a health insurance plan, unless we can give our people great health care, because we’re close. We’re very close.

    Any senator who votes against starting debate is really telling America that you’re fine with Obamacare.

    JUDY WOODRUFF: Afterward, Senate Majority Leader Mitch McConnell said he still aims to hold a vote next week, but it’s not clear on what.

    SEN. MITCH MCCONNELL, R-Ky., Majority Leader: I think we all agree it’s better to both repeal and replace. But we could have a vote on either. And if we end up voting on repeal only, it will be fully amendable on the Senate floor. And if it were to pass without any amendment at all, there’s a two-year delay before it kicks in.

    JUDY WOODRUFF: We will be talking to two Republican senators about the state of play on health care reform after the news summary.

    Separately, there’s word that President Trump is ending a CIA program to arm and train moderate rebels in Syria. The goal was to fight the regime of President Bashar al-Assad, but it had only limited effects after Russia intervened to aid Assad.

    The Washington Post reports the president made the decision nearly a month ago, before he met with Russian’s President Putin at the G20 summit. Afterward, the U.S. and Russia announced a limited cease-fire in Syria. The Post account says that the aid decision is part of a strategy to negotiate more such deals.

    Iran today stepped up its defiant response to the latest round of U.S. sanctions. They target 18 individuals and companies assisting the Iranian ballistic missile program.

    In Tehran, President Hassan Rouhani charged that the U.S. measures are inconsistent with the 2016 nuclear deal. And he warned of reciprocal acts.

    PRESIDENT HASSAN ROUHANI, Iran (through interpreter): If Americans pass new sanctions in any form, or under any pretext in Congress or elsewhere, the great nation of Iran will have an appropriate answer. We won’t ignore violations by the United States, and will stand up to them.

    JUDY WOODRUFF: Also, the head of the hard-line Revolutionary Guards warned that the U.S. had better pull its military forces back at least 1,000 kilometers, or 600 miles, from Iran.

    The U.S. Supreme Court has issued a split ruling on enforcing the president’s travel ban. The court today allowed the administration to strictly enforce a ban on refugees while an appeal moves through lower courts. But the justices expanded the list of people from six mostly Muslim nations who are allowed to visit the U.S.

    Back in this country, the Justice Department is restoring authority to local police to seize money and property on suspicion they come from criminal activity. The assets can be taken even without criminal charges being brought. The Obama administration had curbed the practice, but Attorney General Jeff Sessions today eased the restrictions.

    On Wall Street, tech and health care stocks fueled a day of record highs across the board. The Dow Jones industrial average gained 66 points to close at 21640. The Nasdaq rose 40, and the S&P 500 added 13.

    And Salem, Massachusetts, today marked 325 years since five women were hanged in the infamous witch trials. They were among 19 people condemned and hanged for witchcraft in Salem in 1692. A descendant of one of them said it brings justice to the fact that they were wrongly accused.

    The post News Wrap: Trump reportedly ending CIA program to train Syrian rebels appeared first on PBS NewsHour.

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    U.S. President Donald Trump waves as he leaves a Made in America roundtable meeting in the East Room of the White House in Washington, U.S. July 19, 2017. REUTERS/Carlos Barria - RTX3C4VE

    The White House said Tuesday that President Donald Trump has declined an invitation to speak at the NAACP’s annual convention next week in Baltimore. Photo by REUTERS/Carlos Barria – RTX3C4VE

    WASHINGTON — The White House said Tuesday that President Donald Trump has declined an invitation to speak at the NAACP’s annual convention next week in Baltimore, leading the nation’s oldest civil rights organization to question the president’s commitment to his African American constituents.

    “During his campaign, President Trump asked us ‘what do you have to lose?'” NAACP Board Chairman Leon Russell said. “We get the message loud and clear. The president’s decision today underscores the harsh fact: we have lost – we’ve lost the will of the current administration to listen to issues facing the black community.”

    White House spokeswoman Sarah Huckabee Sanders made the announcement to reporters that the president declined the NAACP’s invitation to speak at its 108th annual convention. Trump also did not speak to the NAACP convention last year, citing scheduling conflicts with the Republican National Convention.

    The NAACP found out from reporters that Sanders had announced that Trump would not attend.

    Russell called Trump’s decision a “historic departure from past presidents’ engagements with the association,” saying former Presidents Barack Obama, George W. Bush, Bill Clinton and Ronald Reagan all addressed the NAACP.

    “When President Trump is ready to listen to us and the people we serve, we will be here,” Russell said. “Until then, the NAACP will continue to strive for an America free from racism and continue to speak truth to power.”

    Trump was the first GOP presidential nominee in years not to address the NAACP last year. Republican nominees John McCain in 2008 and Mitt Romney in 2012 both addressed the NAACP convention before losing to Obama in the general elections.

    The post Trump turns down invitation to deliver speech at NAACP convention appeared first on PBS NewsHour.

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    President Donald Trump concludes remarks to reporters during his meeting with Ukraine's President Petro Poroshenko in the Oval Office at the White House in Washington, D.C. Photo by Jonathan Ernst/Reuters

    President Donald Trump made an extraordinary statement about Attorney General Jeff Sessions in an interview with the New York Times Wednesday. File Photo by Jonathan Ernst/Reuters

    WASHINGTON — President Donald Trump says he never would have appointed Jeff Sessions as attorney general had he known Sessions would recuse himself from overseeing the Russia investigation.

    Trump makes the extraordinary statement about Sessions in an interview with the New York Times Wednesday.

    He tells the paper that Sessions’ decision to recuse himself from all matters related to Russia was “very unfair to the president.”

    Trump also addresses the conversation he had with Russian President Vladimir Putin during a dinner for world leaders at a summit in Germany.

    Trump says the brief conversation consisted of “pleasantries more than anything else,” but says the two also discussed adoption.

    That’s the same topic Donald Trump Jr. says he discussed with a Russian lawyer at a meeting that has drawn criticism.

    The post Trump rages at Sessions over Russia recusal in interview appeared first on PBS NewsHour.

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    WASHINGTON — Doctors say Arizona Sen. John McCain has a brain tumor associated with a blood clot that was removed last week.

    In a statement late Wednesday, doctors reveal that McCain has been diagnosed with glioblastoma, an aggressive cancer. The statement says the 80-year-old senator and his family are reviewing further treatment, including a combination of chemotherapy and radiation.

    The senator has been recovering at his Arizona home after doctors at the Mayo Clinic removed a blood clot above his left eye.

    The doctors say McCain is recovering from his surgery amazingly well and his underlying health is excellent, according to the statement.

    McCain was the GOP’s presidential nominee in 2008. A Navy pilot, he was shot down over Vietnam and held as a prisoner for five and a half years.

    McCain’s daughter Meghan also released a statement on Twitter.

    Arizona’s other senator, Sen. Jeff Flake, praised McCain’s resilience.

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    Protesters demonstrate the Republican healthcare bill outside Republican Congressman Darrell Issa's office in Vista, California, June 27, 2017. REUTERS/Mike Blake

    Protesters demonstrate the Republican healthcare bill outside Republican Congressman Darrell Issa’s office in Vista, California, June 27, 2017. REUTERS/Mike Blake

    WASHINGTON — Americans aren’t enthralled with “Obamacare” and they definitely don’t like the Republican plans offered in Congress, so what does the public want the government to do about health care?

    A new poll suggests the country may be shifting toward the political left on the issue, with 62 percent saying it’s the federal government’s responsibility to make sure that all Americans have health care coverage, while 37 percent say it is not.

    The survey findings from the Associated Press-NORC Center for Public Affairs Research indicate a change in public attitudes over the past few months, as concerns mounted about GOP legislation estimated to leave tens of millions without coverage.

    “Nobody should be without insurance,” said Louise Prieto of Fort Lee, New Jersey, a retiree covered by Medicare. She said she’s most concerned about seniors, children and people with pre-existing medical conditions. The latest Republican legislation — repealing “Obamacare” with no replacement— would increase the number of people who are uninsured by 32 million in 2026, according to the Congressional Budget Office.

    As recently as March, the AP-NORC poll had found Americans more ambivalent about the federal government’s role, with a slim 52 percent majority saying health coverage is a federal responsibility, and 47 percent saying it is not.

    The survey didn’t specify how the government might make sure that people have coverage, but a true guarantee entails something like the “Medicare for all” plan that was a rallying cry for Vermont Sen. Bernie Sanders’ presidential campaign last year. And that would involve hard-to-swallow tax increases.

    “There is a significant increase in people who support universal coverage.”

    “There is a significant increase in people who support universal coverage,” said Robert Blendon of the Harvard T.H. Chan School of Public Health, who tracks opinion trends on health care. “The impact of the debate over dropping coverage looks like it has moved (more) people to feel that the government is responsible for making sure that people have coverage.”

    Currently the U.S. has a hybrid system of paying for medical care, with employers, federal and state governments, and individuals sharing responsibility. Government at all levels pays close to half the annual $3 trillion cost, and federal tax breaks support employer-provided coverage.

    READ MORE: Most Americans disapprove of GOP’s treatment of health care

    Employers cover more than 170 million workers, dependents, and retirees. Medicare, the federal government’s flagship health care program, covers about 56 million retirees and disabled people. Medicaid, a federal-state Medicaid partnership, covers more than 70 million low-income people, from newborns, to severely disabled people, to many elderly nursing home residents. About 28 million people remain without coverage although former President Barack Obama’s health care law has brought the uninsured rate to a historic low of about 9 percent.

    The latest AP-NORC found that more than 8 in 10 Democrats and 3 in 10 Republicans say health coverage is a federal responsibility. Political independents were divided, with 54 percent saying coverage is a federal responsibility and 44 percent saying it is not.

    In the poll, Americans didn’t find much to like about the Republican legislation offered in Congress.

    Seventy-three percent opposed giving states the option to let insurers charge some people higher premiums because of their medical history. And 57 percent opposed allowing states to reduce the types of benefits that federal law now requires insurers to cover. Similarly, 64 percent opposed allowing states to permit some health plans to omit coverage for mental health and drug addiction treatment. There was also solid opposition to Medicaid cuts (62 percent) and overwhelming disapproval (78 percent) for allowing insurers to raise premiums for older adults beyond what is currently permitted.

    In the poll, Americans didn’t find much to like about the Republican legislation offered in Congress.

    Republicans have argued that allowing states to loosen such insurance rules, particularly for people who let their coverage lapse, would result in lower premiums all around. The poll also found that Americans disapprove of various strategies that the Obama law and the GOP bills rely on to nudge healthy people to buy coverage, from the current tax penalties for those who don’t have insurance, to waiting periods and premium penalties proposed by Republicans.

    The poll was conducted as the GOP “repeal and replace” plan floundered in the Senate during the past week. With the seven-year Republican campaign against the Affordable Care Act now verging on collapse, a strong majority said lawmakers should try to negotiate on health care.

    In the poll, 8 in 10 said Republicans should approach Democrats with an offer to negotiate if the current GOP overhaul effort fails, rather than sticking with their own “repeal and replace” campaign of the past seven years. And nearly 9 in 10 said Democrats should take Republicans up on such an offer.

    READ MORE: The nation’s biggest drug lobby remains silent on GOP health care bill

    A foundation for common ground seems to be this: Nearly everyone wants changes to the Obama law, while hardly anyone wants to see it abolished without a substitute in place.

    Among Democrats, only 22 percent actually want the ACA kept just as it is; 64 percent want it kept but with changes. Among Republicans, 27 percent want immediate repeal, while 54 percent favor repealing the law when a replacement is ready.

    Relatively few partisans want their side to turn down an offer to negotiate. Sixty-six percent of Republicans said the congressional GOP should negotiate with the other party, and 81 percent of Democrats said their own representatives should accept an offer to negotiate, if it comes.

    The AP-NORC poll of 1,019 adults was conducted July 13-17 using a sample drawn from NORC’s probability-based AmeriSpeak panel, which is designed to be representative of the U.S. population. The margin of sampling error for all respondents is plus or minus 4.1 percentage points.

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    U.S. President Donald Trump speaks during a lunch meeting with Senate Republicans to discuss healthcare at the White House in Washington, U.S., July 19, 2017. From left are U.S. Senators Shelley Moore Capito (R-WV), Dean Heller (R-NV), Tim Scott (R-SC) and Lisa Murkowski (R-AK). REUTERS/Kevin Lamarque TPX IMAGES OF THE DAY - RTX3C4S7

    U.S. President Donald Trump speaks during a lunch meeting with Senate Republicans to discuss healthcare at the White House in Washington, U.S., July 19, 2017. From left are U.S. Senators Shelley Moore Capito (R-WV), Dean Heller (R-NV), Tim Scott (R-SC) and Lisa Murkowski (R-AK). REUTERS/Kevin Lamarque

    WASHINGTON — Republican senators are hunkering down in a last-ditch attempt to prevent their own divisions from pushing their health care bill to oblivion.

    Yet after a face-to-face lecture from President Donald Trump, around two dozen of them staged a nearly three-hour bargaining session Wednesday night to resolve disputes over repealing and replacing President Barack Obama’s health care law. And no one offered specific examples of any progress.

    “We still do have work to do to get to a vote of 50, but people are committed to continuing that work,” said Sen. John Barrasso, R-Wyo., a member of the GOP leadership who hosted the meeting in his office.

    “We still do have work to do to get to a vote of 50, but people are committed to continuing that work.”

    Reviving the legislation will require party leaders to win support from at least 50 of the 52 GOP senators, a threshold they’ve been short of for weeks. Aiming to finally resolve the issue, Senate Majority Leader Mitch McConnell says he’ll force a vote on the legislation early next week.

    Also attending Wednesday’s private meeting were health secretary Tom Price and Seema Verma, the Medicaid and Medicare administrator. It was interrupted by prayer after the lawmakers learned that their 80-year-old colleague, Sen. John McCain, R-Ariz., had a cancerous brain tumor.

    Earlier Wednesday at the White House, Trump told them they must not leave town for their August recess without sending him an “Obamacare” repeal bill to sign.

    READ MORE: 62 percent of U.S. want federal government to ensure health care for all, poll says

    “I’m ready to act,” Trump said, foisting the responsibility on Republican lawmakers, not himself. During last year’s presidential campaign he had declared repeatedly it would be “so easy” to get rid of the Obama law.

    Earlier in the week, the latest Senate GOP health care plan collapsed, leading Trump to call for simply letting Obama’s law fail.

    McConnell indicated he was prepared to stick a fork in the Republican bill and move on to other issues including overhauling the tax code. But plunging into the issue after a period of lackadaisical involvement, Trump pressured McConnell to delay the key vote until next week, and he invited Republican senators to the White House for lunch.

    There, with the cameras rolling in the State Dining Room, Trump spoke at length as he cajoled, scolded and issued veiled threats to his fellow Republicans, all aimed at wringing a health care bill out of a divided caucus that’s been unable to produce one so far.

    “He wants to remain a senator, doesn’t he?”

    “For seven years you promised the American people that you would repeal Obamacare. People are hurting. Inaction is not an option and frankly I don’t think we should leave town unless we have a health insurance plan,” he said.

    Seated next to Nevada Sen. Dean Heller, who is vulnerable in next year’s midterm elections, Trump remarked: “He wants to remain a senator, doesn’t he?” as Heller gave a strained grin.

    McConnell has failed repeatedly to come up with a bill that can satisfy both conservatives and moderates in his Republican conference. Two different versions of repeal-and-replace legislation fell short of votes before coming to the floor, pushing him to announce Monday night that he would retreat to a repeal-only bill that had passed Congress when Obama was in office.

    But that bill, too, died a premature death as three GOP senators announced their opposition on Tuesday, one more than McConnell can lose in the closely divided Senate. Further complicating that approach, the Congressional Budget Office released an analysis Wednesday reaffirming its earlier findings that the repeal-only bill would mean 32 million additional uninsured people over a decade and average premiums doubling.

    And a new AP-NORC poll found that Americans overwhelmingly want lawmakers of both parties to work out health care changes, with only 13 percent supporting Republican moves to repeal the Obama law absent a replacement.

    At the White House lunch, the discussion was not simply about repealing “Obamacare” but also how to replace it as Republicans said that after seven years of promises, they could not let their efforts die without one last fight.

    “Failure on this would be catastrophic, and we’re not going to fail.”

    “Failure on this would be catastrophic, and we’re not going to fail,” said Sen. Ted Cruz, R-Texas.

    McConnell announced that the Senate would vote next week to open debate, and “I have every expectation that we will be able to get on the bill” — although no one seemed quite sure what bill it will be.

    Trump’s sudden re-resolve to get “Obamacare” repeal-and-replace passed came after he’s been on all sides of the issue in a whiplash-inducing series of remarks over recent days and weeks, supporting repeal and replace, straight repeal, and finally doing nothing so “we’ll just let Obamacare fail,” as he declared on Tuesday.

    Yet for all the determined rhetoric Wednesday, the basic divisions haven’t changed in the Senate, where conservatives like Rand Paul of Kentucky want legislation that fully repeals the Obama law while moderates like Susan Collins of Maine want something incompatible with that, a more generous bill that provides for Americans including those who gained Medicaid coverage under the Affordable Care Act.

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    WOLFRATSHAUSEN, GERMANY – NOVEMBER 15: Two female inhabitants of a residential care home for Alzheimer’s disease and dementia patients walk hand-in-hand in the corridor of the residential home on November 15, 2011 in Wolfratshausen, Germany. (Photo by Alexandra Beier/Getty Images)

    In a landmark report, scientists have endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure.

    This is the first time experts convened by the National Academies of Sciences, Engineering and Medicine have deemed scientific evidence strong enough to suggest that preventing dementia and age-related cognitive decline might be possible.

    Seven years ago, in a separate report issued by the Agency for Healthcare Research and Quality, scientists said they couldn’t recommend any interventions to forestall or slow cognitive deterioration because state-of-the-art science at that time didn’t offer enough support.

    This is the first time experts convened by the National Academies of Sciences, Engineering and Medicine have deemed scientific evidence strong enough to suggest that preventing dementia and age-related cognitive decline might be possible.

    Now there’s a considerably larger body of research to draw upon. And while findings are still far from definitive, “we found encouraging evidence that supports the value of several interventions,” said Story Landis, vice chair of the 17-member panel that prepared the report and director emeritus of the National Institute of Neurological Disorders and Stroke.

    That doesn’t mean the strategies are guaranteed to protect brain health. “You can do everything right and still get dementia in later life,” said Dr. Kenneth Langa, a panel member and professor of internal medicine, gerontology and health management and policy at the University of Michigan School of Public Health.

    Nor does it mean these are the only interventions that offer promise. Managing depression, controlling diabetes and high cholesterol, engaging in social activities, getting adequate sleep, eating a healthful diet, taking disease-modifying treatments for dementia (if and when they become available) and getting enough vitamin B12 and folic acid also appear worthwhile, though more research is needed before those tactics can be formally recommended, the NAS report said.

    Addressing lifestyle factors that raise the risk of cognitive impairment could help prevent more than one-third of dementia cases across the globe, according to a separate comprehensive analysis published in The Lancet on Thursday.

    The NAS panel proposed that its findings be shared with the public and physicians, but stopped short of proposing a major public health campaign, citing the need for further research.

    Here are insights from the report, based on interviews with panel members and outside experts:

    Strategies work in some cases, not others
    As people age, mental processing becomes slower and memory becomes less reliable — a normal condition known as age-related cognitive decline.

    Two of the interventions recommended in the NAS report — cognitive training and physical activity — appear to have the potential to delay age-related cognitive decline. But there’s no evidence that they can prevent dementia or mild cognitive impairment, an intermediate condition that sometimes progresses to dementia.

    “Prevention really needs to start in people who don’t show any sign of the disease — probably when people reach their 40s.”

    Managing high blood pressure is the only strategy thought to have the potential to prevent or delay the onset of Alzheimer’s disease. But it wasn’t shown to have an impact on age-related cognitive decline.

    Once the hallmarks of Alzheimer’s are detected — notably amyloid beta plaques and tau tangles in the brain — some interventions might not be effective, said Dr. Ronald Petersen, a member of the NAS panel and director of the Mayo Clinic’s Alzheimer’s Disease Research Center.

    Start early
    It’s now known that biological changes associated with Alzheimer’s and related dementias begin a decade or more before any symptoms become evident. So it’s best to make recommended lifestyle changes early and sustain them over time.

    “Prevention really needs to start in people who don’t show any sign of the disease — probably when people reach their 40s,” said Jeffrey Keller, director of the Institute for Dementia Research and Prevention at Louisiana State University, who was not involved in the NAS study.

    Controlling high blood pressure, a strategy that helps preserve the health of blood vessels in the brain, is most effective if begun in middle age, the NAS report explained. But if you’ve reached age 65 and your blood pressure isn’t well managed, you’re still well advised to bring it under control, Landis said.

    The same applies to physical activity: It’s best if you start in middle age, but becoming more active in later life is still good for your health. While it’s not yet known which type of activity is most effective, for what duration and how often it should be pursued for maximum brain benefit, walking briskly for 150 minutes a week or about 20 minutes a day is a good idea, Petersen said.

    On cognitive training
    Probably the best cognitive training you can get is a good education and ongoing mental stimulation. “There’s growing evidence that the ways in which your brain is challenged all through your life matter,” noted Langa, whose research has documented a decline in dementia rates in high-income countries over the past 25 years.

    But the impact of education on brain health is very difficult to quantify. So the NAS panel endorsed cognitive training based largely on a randomized controlled trial known as Advanced Cognitive Training for Independent and Vital Elderly, which studied several thousand older adults over the course of 10 years.

    ACTIVE had certified trainers work with seniors in small group sessions on various cognitive exercises for 10 sessions lasting an hour or more over five to six weeks. Feedback was an essential part of the intervention and booster sessions were offered. At 10 years, there was evidence of a positive effect on seniors’ independence and ability to perform daily tasks.

    “The data supporting their efficacy just isn’t there.”

    What was responsible for this effect? The training? Social interactions? Feedback? Booster sessions? All or some of the above? It’s not yet clear.

    It’s important to note that the panel insisted that commercially sold computer-based brain games can’t be assumed to have the same effect. So far, research about brain games has failed to prove that this type of training improves broad-based cognitive functioning and people’s ability to function independently.

    “The data supporting their efficacy just isn’t there,” said Petersen of the Mayo Clinic.

    Try several things, not just one
    When scientists examine the brains of people with Alzheimer’s disease, they find amyloid beta plaques and tangles, but also changes in blood vessels, evidence of microbleeds, and lesions in the brain’s white matter. “It’s mixed dementia, due to multiple factors — not just one thing,” Landis said.

    The corollary: Mix it up and try several ways to reduce age-related cognitive decline or dementia, not just one.

    “If we think of Alzheimer’s as a multifactorial disease, it makes sense to reduce multiple risk factors simultaneously,” said Rong Zhang, associate professor of neurology and neurotherapeutics at University of Texas Southwestern Medical Center. Zhang is also the principal investigator for a five-year study investigating whether aerobic exercise combined with intensive control of hypertension and cholesterol can help prevent Alzheimer’s. That study, the Risk Reduction for Alzheimer’s Disease trial, is currently enrolling participants at six medical centers.

    “The brain is complicated and its response to interventions is complex,” Langa said. “Therefore, the more strategies that you use to try to improve the brain’s health long term, the more likely they’re going to work.”

    Don’t bother
    The NAS report found no evidence supporting the use of ginkgo biloba and vitamin E, which are widely marketed to people concerned about brain health. And it questioned the value of other supplements, noting that overall dietary patterns appear more important than any single substance.

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    Dr Lee Cantrell, who helps run the California Poison Control System, in his office with a collection of vintage expired medications, at the University of California San Diego Hospital in San Diego, CA on Friday, July 7, 2017.(Photo by Sandy Huffaker for ProPublica)

    The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

    But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

    Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

    “This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

    The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t. Pharmacies across the country — in major medical centers and in neighborhood strip malls — routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

    Gerona and Cantrell, a pharmacist and toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.

    ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted.  We’ve documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients pass away or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

    What if the system is destroying drugs that are technically “expired” but could still be safely used?

    The dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.

    In his lab, Gerona ran tests on the decades-old drugs, including some now defunct brands such as the diet pills Obocell (once pitched to doctors with a portly figurine called “Mr. Obocell”) and Bamadex. Overall, the bottles contained 14 different compounds, including antihistamines, pain relievers and stimulants. All the drugs tested were in their original sealed containers.

    The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations.

    “Lo and behold,” Cantrell says, “The active ingredients are pretty darn stable.”

    Cantrell and Gerona knew their findings had big implications. Perhaps no area of health care has provoked as much anger in recent years as prescription drugs. The news media is rife with stories of medications priced out of reach or of shortages of crucial drugs, sometimes because producing them is no longer profitable.

    Tossing such drugs when they expire is doubly hard. One pharmacist at Newton-Wellesley Hospital outside Boston says the 240-bed facility is able to return some expired drugs for credit, but had to destroy about $200,000 worth last year. A commentary in the journal Mayo Clinic Proceedings cited similar losses at the nearby Tufts Medical Center. Play that out at hospitals across the country and the tab is significant: about $800 million per year. And that doesn’t include the costs of expired drugs at long-term care pharmacies, retail pharmacies and in consumer medicine cabinets.

    After Cantrell and Gerona published their findings in Archives of Internal Medicine in 2012, some readers accused them of being irresponsible and advising patients that it was OK to take expired drugs. Cantrell says they weren’t recommending the use of expired medication, just reviewing the arbitrary way the dates are set.

    “Refining our prescription drug dating process could save billions,” he says.

    But after a brief burst of attention, the response to their study faded. That raises an even bigger question: If some drugs remain effective well beyond the date on their labels, why hasn’t there been a push to extend their expiration dates?

    It turns out that the FDA, the agency that helps set the dates, has long known the shelf life of some drugs can be extended, sometimes by years.

    In fact, the federal government has saved a fortune by doing this.

    For decades, the federal government has stockpiled massive stashes of medication, antidotes and vaccines in secure locations throughout the country. The drugs are worth tens of billions of dollars and would provide a first line of defense in case of a large-scale emergency.

    Maintaining these stockpiles is expensive. The drugs have to be kept secure and at the proper humidity and temperature so they don’t degrade. Luckily, the country has rarely needed to tap into many of the drugs, but this means they often reach their expiration dates. Though the government requires pharmacies to throw away expired drugs, it doesn’t always follow these instructions itself. Instead, for more than 30 years, it has pulled some medicines and tested their quality.

    The idea that drugs expire on specified dates goes back at least a half-century, when the FDA began requiring manufacturers to add this information to the label. The time limits allow the agency to ensure medications work safely and effectively for patients. To determine a new drug’s shelf life, its maker zaps it with intense heat and soaks it with moisture to see how it degrades under stress. It also checks how it breaks down over time. The drug company then proposes an expiration date to the FDA, which reviews the data to ensure it supports the date and approves it. Despite the difference in drugs’ makeup, most “expire” after two or three years.

    Once a drug is launched, the makers run tests to ensure it continues to be effective up to its labeled expiration date. Since they are not required to check beyond it, most don’t, largely because regulations make it expensive and time-consuming for manufacturers to extend expiration dates, says Yan Wu, an analytical chemist who is part of a focus group at the American Association of Pharmaceutical Scientists that looks at the long-term stability of drugs. Most companies, she says, would rather sell new drugs and develop additional products.

    Various old and expired pharmaceutical bottles in Dr Lee Cantrell’s office at the University of California San Diego Hospital in San Diego, CA on FRiday, July 7, 2017.(Photo by Sandy Huffaker for ProPublica)

    Pharmacists and researchers say there is no economic “win” for drug companies to investigate further. They ring up more sales when medications are tossed as “expired” by hospitals, retail pharmacies and consumers despite retaining their safety and effectiveness.

    Industry officials say patient safety is their highest priority. Olivia Shopshear, director of science and regulatory advocacy for the drug industry trade group Pharmaceutical Research and Manufacturers of America, or PhRMA, says expiration dates are chosen “based on the period of time when any given lot will maintain its identity, potency and purity, which translates into safety for the patient.”

    That being said, it’s an open secret among medical professionals that many drugs maintain their ability to combat ailments well after their labels say they don’t. One pharmacist says he sometimes takes home expired over-the-counter medicine from his pharmacy so he and his family can use it.

    The federal agencies that stockpile drugs — including the military, the Centers for Disease Control and Prevention and the Department of Veterans Affairs — have long realized the savings in revisiting expiration dates.

    In 1986, the Air Force, hoping to save on replacement costs, asked the FDA if certain drugs’ expiration dates could be extended. In response, the FDA and Defense Department created the Shelf Life Extension Program.

    Each year, drugs from the stockpiles are selected based on their value and pending expiration and analyzed in batches to determine whether their end dates could be safely extended. For several decades, the program has found that the actual shelf life of many drugs is well beyond the original expiration dates.

    A 2006 study of 122 drugs tested by the program showed that two-thirds of the expired medications were stable every time a lot was tested. Each of them had their expiration dates extended, on average, by more than four years, according to research published in the Journal of Pharmaceutical Sciences.

    Some that failed to hold their potency include the common asthma inhalant albuterol, the topical rash spray diphenhydramine, and a local anesthetic made from lidocaine and epinephrine, the study said. But neither Cantrell nor Dr. Cathleen Clancy, associate medical director of National Capital Poison Center, a nonprofit organization affiliated with the George Washington University Medical Center, had heard of anyone being harmed by any expired drugs. Cantrell says there has been no recorded instance of such harm in medical literature.

    Marc Young, a pharmacist who helped run the extension program from 2006 to 2009, says it has had a “ridiculous” return on investment. Each year the federal government saved $600 million to $800 million because it did not have to replace expired medication, he says.

    An official with the Department of Defense, which maintains about $13.6 billion worth of drugs in its stockpile, says that in 2016 it cost $3.1 million to run the extension program, but it saved the department from replacing $2.1 billion in expired drugs. To put the magnitude of that return on investment into everyday terms: It’s like spending a dollar to save $677.

    “We didn’t have any idea that some of the products would be so damn stable — so robustly stable beyond the shelf life,” says Ajaz Hussain, one of the scientists who formerly helped oversee the extension program.

    Hussain is now president of the National Institute for Pharmaceutical Technology and Education, an organization of 17 universities that’s working to reduce the cost of pharmaceutical development. He says the high price of drugs and shortages make it time to reexamine drug expiration dates in the commercial market.

    “It’s a shame to throw away good drugs,” Hussain says.

    Some medical providers have pushed for a changed approach to drug expiration dates — with no success. In 2000, the American Medical Association, foretelling the current prescription drug crisis, adopted a resolution urging action. The shelf life of many drugs, it wrote, seems to be “considerably longer” than their expiration dates, leading to “unnecessary waste, higher pharmaceutical costs, and possibly reduced access to necessary drugs for some patients.”

    Citing the federal government’s extension program, the AMA sent letters to the FDA, the U.S. Pharmacopeial Convention, which sets standards for drugs, and PhRMA asking for a re-examination of expiration dates.

    No one remembers the details — just that the effort fell flat.

    “Nothing happened, but we tried,” says rheumatologist Roy Altman, now 80, who helped write the AMA report. “I’m glad the subject is being brought up again. I think there’s considerable waste.”

    At Newton-Wellesley Hospital, outside Boston, pharmacist David Berkowitz yearns for something to change.

    On a recent weekday, Berkowitz sorted through bins and boxes of medication in a back hallway of the hospital’s pharmacy, peering at expiration dates. As the pharmacy’s assistant director, he carefully manages how the facility orders and dispenses drugs to patients. Running a pharmacy is like working in a restaurant because everything is perishable, he says, “but without the free food.”

    Federal and state laws prohibit pharmacists from dispensing expired drugs and The Joint Commission, which accredits thousands of health care organizations, requires facilities to remove expired medication from their supply. So at Newton-Wellesley, outdated drugs are shunted to shelves in the back of the pharmacy and marked with a sign that says: “Do Not Dispense.” The piles grow for weeks until they are hauled away by a third-party company that has them destroyed. And then the bins fill again.

    “I question the expiration dates on most of these drugs,” Berkowitz says.

    One of the plastic boxes is piled with EpiPens — devices that automatically inject epinephrine to treat severe allergic reactions. They run almost $300 each. These are from emergency kits that are rarely used, which means they often expire. Berkowitz counts them, tossing each one with a clatter into a separate container, “… that’s 45, 46, 47 …” He finishes at 50. That’s almost $15,000 in wasted EpiPens alone.

    7/27/17 Newton, MA — Pharmacy Technician Nikki Wong, replaces expired medication in drug boxes throughout Newton-Wellesley Hospital, April 27, 2017. Photo by Erik Jacobs for ProPublica

    In May, Cantrell and Gerona published a study that examined 40 EpiPens and EpiPen Jrs., a smaller version, that had been expired for between one and 50 months. The devices had been donated by consumers, which meant they could have been stored in conditions that would cause them to break down, like a car’s glove box or a steamy bathroom. The EpiPens also contain liquid medicine, which tends to be less stable than solid medications.

    Testing showed 24 of the 40 expired devices contained at least 90 percent of their stated amount of epinephrine, enough to be considered as potent as when they were made. All of them contained at least 80 percent of their labeled concentration of medication. The takeaway? Even EpiPens stored in less than ideal conditions may last longer than their labels say they do, and if there’s no other option, an expired EpiPen may be better than nothing, Cantrell says.

    At Newton-Wellesley, Berkowitz keeps a spreadsheet of every outdated drug he throws away. The pharmacy sends what it can back for credit, but it doesn’t come close to replacing what the hospital paid.

    Then there’s the added angst of tossing drugs that are in short supply. Berkowitz picks up a box of sodium bicarbonate, which is crucial for heart surgery and to treat certain overdoses. It’s being rationed because there’s so little available. He holds up a purple box of atropine, which gives patients a boost when they have low heart rates. It’s also in short supply. In the federal government’s stockpile, the expiration dates of both drugs have been extended, but they have to be thrown away by Berkowitz and other hospital pharmacists.

    The 2006 FDA study of the extension program also said it pushed back the expiration date on lots of mannitol, a diuretic, for an average of five years. Berkowitz has to toss his out. Expired naloxone? The drug reverses narcotic overdoses in an emergency and is currently in wide use in the opioid epidemic. The FDA extended its use-by date for the stockpiled drugs, but Berkowitz has to trash it.

    On rare occasions, a pharmaceutical company will extend the expiration dates of its own products because of shortages. That’s what happened in June, when the FDA posted extended expiration dates from Pfizer for batches of its injectable atropine, dextrose, epinephrine and sodium bicarbonate. The agency notice included the lot numbers of the batches being extended and added six months to a year to their expiration dates.

    The news sent Berkowitz running to his expired drugs to see if any could be put back into his supply. His team rescued four boxes of the syringes from destruction, including 75 atropine, 15 dextrose, 164 epinephrine and 22 sodium bicarbonate. Total value: $7,500. In a blink, “expired” drugs that were in the trash heap were put back into the pharmacy supply.

    Berkowitz says he appreciated Pfizer’s action, but feels it should be standard to make sure drugs that are still effective aren’t thrown away.

    “The question is: Should the FDA be doing more stability testing?” Berkowitz says. “Could they come up with a safe and systematic way to cut down on the drugs being wasted in hospitals?”

    Four scientists who worked on the FDA extension program told ProPublica something like that could work for drugs stored in hospital pharmacies, where conditions are carefully controlled.

    Greg Burel, director of the CDC’s stockpile, says he worries that if drugmakers were forced to extend their expiration dates it could backfire, making it unprofitable to produce certain drugs and thereby reducing access or increasing prices.

    The 2015 commentary in Mayo Clinic Proceedings, called “Extending Shelf Life Just Makes Sense,” also suggested that drugmakers could be required to set a preliminary expiration date and then update it after long-term testing. An independent organization could also do testing similar to that done by the FDA extension program, or data from the extension program could be applied to properly stored medications.

    ProPublica asked the FDA whether it could expand its extension program, or something like it, to hospital pharmacies, where drugs are stored in stable conditions similar to the national stockpile.

    “The Agency does not have a position on the concept you have proposed,” an official wrote back in an email.

    Whatever the solution, the drug industry will need to be spurred in order to change, says Hussain, the former FDA scientist. “The FDA will have to take the lead for a solution to emerge,” he says. “We are throwing away products that are certainly stable, and we need to do something about it.”

    ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.

    The post Is it safe to take expired medications? appeared first on PBS NewsHour.

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    Attorney General Jeff Sessions and Deputy Attorney General Rod Rosenstein are announcing plans to launch an international cybercrime enforcement effort at 10 a.m. ET in Washington, D.C. Watch live here on PBS.org/newshour.

    WASHINGTON — Justice Department officials are announcing a takedown of an internet marketplace for drugs, counterfeit goods, weapons, hacking tools and other illicit items.

    Prosecutors say AlphaBay had 200,000 members and 40,000 vendors before it was taken offline. They say it was the largest of many illegal marketplaces that operate in hidden corners of the internet.

    The site operated on the Tor network, which helps users browse the internet anonymously. Visitors to the online marketplace paid through digital currencies such as Bitcoin. Officials say hundreds of vendors advertised either fentanyl or heroin.

    Attorney General Jeff Sessions and other federal officials announced an indictment in California on Thursday of a suspected administrator of the site, and the Justice Department filed a forfeiture complaint to seize assets connected to the operation.

    The Associated Press reported this story.

    The post WATCH: Sessions, Rosenstein to launch international cybercrime effort appeared first on PBS NewsHour.

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    Christopher Wray testifies before a Senate Judiciary Committee confirmation hearing on his nomination to be the next FBI director on Capitol Hill in Washington, D.C. Photo by Carlos Barria/Reuters

    Christopher Wray testifies before a Senate Judiciary Committee confirmation hearing on his nomination to be the next FBI director on Capitol Hill in Washington, D.C. Photo by Carlos Barria/Reuters

    WASHINGTON — The Senate Judiciary Committee has approved the nomination of President Donald Trump’s choice to head the FBI.

    Christopher Wray’s nomination will now move to the Senate floor.

    Republican Sen. Chuck Grassley of Iowa praised Wray, who promised at his hearing last week to never let politics get in the way of the bureau’s mission.

    Wray would replace James Comey, who was abruptly fired by President Donald Trump in May amid the investigation into Russia’s meddling in the 2016 election and possible ties to Trump’s campaign.

    The post Senate to vote on Christopher Wray as next FBI director appeared first on PBS NewsHour.

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    U.S. Attorney General Jeff Sessions testifies before a Senate Intelligence Committee hearing on Capitol Hill in Washington, U.S., June 13, 2017. REUTERS/Jonathan Ernst - RTS16Y7C

    U.S. Attorney General Jeff Sessions testifies before a Senate Intelligence Committee hearing on Capitol Hill in Washington, U.S., June 13, 2017. REUTERS/Jonathan Ernst – RTS16Y7C

    Attorney General Jeff Sessions says he will remain in office, a day after President Donald Trump rebuked him for recusing himself from the probe into Russian meddling in the 2016 campaign.

    Sessions said Thursday he will stay in office “as long as that is appropriate.”

    Sessions said Thursday he will stay in office “as long as that is appropriate.”

    A former senator from Alabama, Sessions was one of Trump’s earliest supporters and became attorney general in February. A month later, he stepped aside from the Justice Department-led inquiry after revelations that he failed to disclose meetings with the Russian ambassador to the U.S.

    Trump has privately fumed about the recusal, which led to the appointment of a special counsel to lead the investigation.

    Trump told The New York Times Wednesday he never would have picked Sessions had he known a recusal was coming. The president calls it “extremely unfair” to him.

    The post Jeff Sessions says he’ll remain in office despite Trump’s rebuke over Russia appeared first on PBS NewsHour.

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    Chairman and chief executive officer Rex W. Tillerson speaks at a news conference following the Exxon Mobil Corporation Shareholders Meeting in Dallas, Texas, May 28, 2008.  REUTERS/Mike Stone (UNITED STATES) - RTX69ED

    Chairman and chief executive officer Rex W. Tillerson speaks at a news conference following the Exxon Mobil Corporation Shareholders Meeting in Dallas, Texas, May 28, 2008. REUTERS/Mike Stone (UNITED STATES) – RTX69ED

    The Treasury Department hit Exxon Mobil Corp. with a $2 million fine Thursday for violating Russia sanctions while Secretary of State Rex Tillerson was the oil company’s CEO.

    Treasury said in a statement that Exxon under Tillerson’s leadership had shown “reckless disregard” for sanctions that the Obama administration imposed on Russian entities in 2014 over Russia’s annexation of Crimea.

    Treasury said in a statement that Exxon under Tillerson’s leadership had shown “reckless disregard” for sanctions that the Obama administration imposed on Russian entities in 2014 over Russia’s annexation of Crimea. And, it said the company’s “senior-most executives” were aware of the sanctions when two of its subsidiaries signed deals with Russian oil magnate Igor Sechin. Sechin is the chairman of Russian oil giant Rosneft and is on a U.S. blacklist that bars Americans from doing business with him.

    In a statement, Exxon countered that it had done nothing wrong and complained that the fine was “fundamentally unfair.” The State Department declined to comment on Tillerson’s role, referring all questions to Exxon.

    Treasury’s Office of Foreign Assets Control, or OFAC, said Exxon caused “significant harm” to the sanctions program by engaging in transactions with a person who is “an official of the government of the Russian Federation contributing to the crisis in Ukraine.”

    OFAC said it had considered and rejected Exxon’s explanation that it had believed from press accounts of the sanctions that there was a distinction between Sechin acting in a “professional” rather than a “personal” capacity. It also determined that Exxon had not voluntarily disclosed the violations, which it said was “an egregious case.” It leveled the statutory maximum civil penal of $2 million for the breaches.

    In its statement, Exxon maintained its innocence, saying that it had “followed clear guidance” from the White House and Treasury Department when it went ahead with the deals with Rosneft that Sechin then countersigned. It noted that Rosneft was not subject to sanctions at the time and maintained it understood transactions with Sechin in his personal capacity as an individual were not covered.

    In a statement, Exxon countered that it had done nothing wrong and complained that the fine was “fundamentally unfair.”

    “Based on the enforcement information published today, OFAC is trying to retroactively enforce a new interpretation of an executive order that is inconsistent with the explicit and unambiguous guidance from the White House and Treasury issued before the relevant conduct and still publicly available today,” it said. “OFAC’s action is fundamentally unfair.”

    OFAC said it considered several aggravating factors when reaching its decision. Those included “reckless disregard for U.S. sanctions requirements when it failed to consider warning signs associated with dealing in the blocked services of (a sanctioned person), that “Exxon Mobil’s senior-most executives knew of Sechin’ s status … when they dealt in the blocked services of Sechin,” that the deals “caused significant harm to the Ukraine-related sanctions program objectives” and that the company “is a sophisticated and experienced oil and gas company that has global operations and routinely deals in goods, services and technology subject to U.S economic sanctions and U.S. export controls.”

    Tillerson has taken a tough line with Ukraine-related sanctions as secretary of state, saying earlier this month on a trip to Kiev that the sanctions would not be lifted until Russia met its obligations.

    But while he was at Exxon, Tillerson opposed the sanctions levied on Moscow for its annexation of Crimea. Those sanctions cost his company hundreds of millions of dollars.

    “We do not support sanctions, generally, because we don’t find them to be effective unless they are very well implemented comprehensibly and that’s a very hard thing to do.”

    The same year that Exxon is accused of breaching the sanctions, Tillerson was unambiguous about his opposition to the penalties.

    “We do not support sanctions, generally, because we don’t find them to be effective unless they are very well implemented comprehensibly and that’s a very hard thing to do,” Tillerson said at Exxon’s 2014 annual meeting.

    Sechin was Tillerson’s main partner in Exxon’s bid to drill in the Arctic’s Kara Sea, with its vast untapped potential. Tillerson knew both Sechin and Russian President Vladimir Putin for more than a decade before he became secretary of state.

    After the Ukraine-related sanctions put in place under President Barack Obama, Tillerson saw Exxon’s stake in a lucrative offshore drilling project with Rosneft come under threat. Tillerson visited the White House numerous times as CEO to protest the sanctions, but they remained in place.

    The post Treasury Department fines Exxon Mobil $2 million for Russia violations on Rex Tillerson’s watch appeared first on PBS NewsHour.

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    UNITED STATES - AUGUST 3: Sen. John McCain, R-Ariz., holds a news conference on the stimulus oversight report on Tuesday, Aug. 3, 2010. (Photo By Bill Clark/Roll Call via Getty Images)

    UNITED STATES – AUGUST 3: Sen. John McCain, R-Ariz., holds a news conference on the stimulus oversight report on Tuesday, Aug. 3, 2010. (Photo By Bill Clark/Roll Call via Getty Images)

    Arizona Sen. John McCain says he’s grateful for the outpouring of support after his brain cancer diagnosis. He’s promising to be back soon.

    In a tweet Thursday, McCain says: “I greatly appreciate the outpouring of support – unfortunately for my sparring partners in Congress, I’ll be back soon, so stand-by!”

    READ MORE: Sen. John McCain has a brain tumor, doctors say

    McCain’s office said late Wednesday that the 80-year-old senator had been diagnosed with cancer. Doctors in Arizona removed a blood clot above his left eye last Friday. Pathology tests revealed a brain tumor associated with the clot.

    McCain has been recuperating at his home in Arizona.

    The post Senator John McCain says he’ll ‘be back soon, so stand-by’ appeared first on PBS NewsHour.

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    Protestors gather during a demonstration against the Republican repeal of the Affordable Care Act, outside the U.S. Capitol in Washington, U.S., June 21, 2017. REUTERS/Aaron P. Bernstein - RTS182LP

    Protestors gather during a demonstration against the Republican repeal of the Affordable Care Act, outside the U.S. Capitol in Washington, U.S., June 21, 2017. REUTERS/Aaron P. Bernstein – RTS182LP

    CHICAGO — President Donald Trump’s administration has ended Affordable Care Act contracts that brought assistance into libraries, businesses and urban neighborhoods in 18 cities, meaning shoppers on the insurance exchanges will have fewer places to turn for help signing up for coverage.

    Community groups say the move, announced to them by contractors last week, will make it even more difficult to enroll the uninsured and help people already covered re-enroll or shop for a new policy. That’s already a concern because of consumer confusion stemming from the political wrangling in Washington and a shorter enrollment period. People will have 45 days to shop for 2018 coverage, starting Nov. 1 and ending Dec. 15. In previous years, they had twice that much time.

    Some see it as another attempt to undermine the health law’s marketplaces by a president who has suggested he should let “Obamacare” fail. The administration, earlier this year, pulled paid advertising for the sign-up website HealthCare.gov, prompting an inquiry by a federal inspector general into that decision and whether it hurt sign-ups.

    “There’s a clear pattern of the administration trying to undermine and sabotage the Affordable Care Act.”

    Now insurers and advocates are concerned that the administration could further destabilize the marketplaces where people shop for coverage by not promoting them or not enforcing the mandate compelling people to get coverage. The administration has already threatened to withhold payments to insurers to help people afford care, which would prompt insurers to sharply increase prices.

    “There’s a clear pattern of the administration trying to undermine and sabotage the Affordable Care Act,” said Elizabeth Hagan, associate director of coverage initiatives for the liberal advocacy group Families USA. “It’s not letting the law fail, it’s making the law fail.”

    Two companies — McLean, Virginia-based Cognosante LLC and Falls Church, Virginia-based CSRA Inc. — will no longer help with the sign-ups following a decision by Centers for Medicare and Medicaid Services officials not to renew a final option year of the vendors’ contracts. The contracts, awarded in 2013, were never meant to be long term, said CMS spokeswoman Jane Norris in an email.

    “These contracts were intended to help CMS provide temporary, in-person enrollment support during the early years” of the exchanges, Norris said. Other federally funded help with enrollment will continue, she said, including a year-round call center and grant-funded navigator programs. The existing program is “robust” and “we have the on-the-ground resources necessary” in key cities, Norris said.

    But community advocates expected the vendors’ help for at least another year. “It has our heads spinning about how to meet the needs in communities,” said Inna Rubin of United Way of Metro Chicago, who helps run an Illinois health access coalition.

    “These contracts were intended to help CMS provide temporary, in-person enrollment support during the early years.”

    CSRA’s current $12.8 million contract expires Aug. 29. Cognosante’s $9.6 million contract expires the same date.

    Together, they assisted 14,500 enrollments, far less than 1 percent of the 9.2 million people who signed up through HealthCare.gov, the insurance marketplace serving most states. But some advocates said the groups focused on the healthy, young adults needed to keep the insurance markets stable and prices down.

    During the most recent open enrollment period, they operated in the Texas cities of Dallas, Houston, San Antonio, Austin, McAllen and El Paso; the Florida cities of Miami, Tampa and Orlando; Atlanta; northern New Jersey; Phoenix; Philadelphia; Indianapolis; New Orleans; Charlotte, North Carolina; Cleveland and Chicago.

    The insurance exchanges, accessed by customers through the federal HealthCare.gov or state-run sites, are a way for people to compare and shop for insurance coverage. The health law included grant money for community organizations to train people to help consumers apply for coverage, answer questions and explain differences between the insurance policies offered.

    In Illinois, CSRA hired about a dozen enrollment workers to supplement a small enrollment workforce already in the state, Rubin said. The company operated a storefront enrollment center in a Chicago neighborhood from November through April.

    “What is the goal of the Trump administration here? Is it to help people? Or to undermine the Affordable Care Act?”

    “It was a large room in a retail strip mall near public transit with stations set up where people could come in and sit down” with an enrollment worker, Rubin said.

    CSRA spokesman Tom Doheny in an email said the company “is proud of the work we have accomplished under this contract.” He referred other questions to federal officials.

    Cognosante worked on enrollment in nine cities in seven states, according to a June 6 post on the company’s website. The work included helping “more than 15,000 Texas consumers” and staffing locations “such as public libraries and local business offices.” A Cognosante spokeswoman referred questions to federal officials.

    The health care debate in Congress has many consumers questioning whether “Obamacare” still exists, community advocates said.

    “What is the goal of the Trump administration here? Is it to help people? Or to undermine the Affordable Care Act?” said Rob Restuccia, executive director of Boston-based Community Catalyst, a group trying to preserve the health care law.

    The post Trump administration ends Affordable Care Act assistance contracts in 18 cities appeared first on PBS NewsHour.

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    The new budget bill could reduce the lifetime benefits of millions of Americans by tens of thousands if not hundreds of thousands of dollars, Larry Kotlikoff writes. Photo by PeopleImages.com and Getty Images

    Elisabeth Rosenthal, author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back,” responds to Ivy Austin’s health insurance nightmare. Photo by PeopleImages.com and Getty Images

    Editor’s note: Yesterday, we published the health care cost nightmare of singer Ivy Austin, “My health insurance nightmare and what I’m doing from now on.” Today, we publish the outraged response of Elisabeth Rosenthal, author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back,” featured recently on our Thursday Making Sen$e broadcast segment. She also wrote one of the year’s most popular posts here on Making Sen$e: “6 questions to ask at every doctor’s appointment.”

    Please let us know if you’ve had similar experiences to Ivy’s. We plan to publish excerpts from the responses we get.

    — Paul Solman, economics correspondent

    Ivy is a heroic customer and patient, trying mightily to make this work. As many patients who’ve done so, she’s wasted hours of her time and come away with few answers. We are constantly told we should be better consumers of health care, that we should shop for insurance and high-value care.

    In many countries, knowing the cost of your procedure or your medicine in advance is a patient’s right and should be a patient right here too.

    Well, how can we be expected to do that if the prices are unknowable and we get contradictory answers from every expert we ask? This system is so maddeningly complex, there is no real price for anything — the price is what the market will bear and what your insurer — or, increasingly, you — can be backed into paying. Frankly, at a personal level, it smells a bit like extortion.

    And Ivy is an exceptionally smart, energetic patient-consumer. What happens to the average person who doesn’t ask or is embarrassed to ask about price in advance? They just get stuck with big bills ex post facto.

    On financial issues, there’s no informed consent, which is a basic principle of medicine and legal systems and contracts. That’s just wrong. Oh sure, there are transparency web sites where you can get some idea of the price of different medical services in your area — generally through crowdsourcing or by reviewing insurance claims. In my book, I suggest that everyone should look at them to see the huge variation in price and to find lower-cost providers. But I don’t really see why this kind of detective work is even necessary.

    In many countries, knowing the cost of your procedure or your medicine in advance is a patient’s right and should be a patient’s right here too. That way you can plan for the financial hit or seek out something cheaper or decide, as many patients do, that the study or procedure just isn’t worth it. As I sometimes say, I don’t have to crowdsource the price of a baguette at Whole Foods, so why can I expect a lot more transparency in health care? In France, prices are posted in doctors’ offices. In Australia, a written estimate before hospitalization is a patient’s right — and that idea is supported by doctors.

    The post Column: ‘Maddeningly complex’ health care costs force patients to become detectives appeared first on PBS NewsHour.


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