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- 11/18/13--13:12: _Tax credit helps en...
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- 11/18/13--13:25: _Silicon Valley entr...
- 11/18/13--13:30: _Teen scientist inve...
- 11/18/13--13:32: _Boosting 'health' o...
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- 11/18/13--13:48: _Poet Naomi Shihab N...
- 11/18/13--13:57: _Happy 130th birthda...
- 11/18/13--14:00: _'Selfie' named Oxfo...
- 11/18/13--11:33: _Promiscuous mouse m...
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- 11/19/13--05:28: _Ask The Headhunter:...
- 11/19/13--05:30: _Celebrate World Toi...
- 11/19/13--06:54: _Remembering Preside...
- 11/19/13--12:46: _Why Does Health Car...
- 11/18/13--12:39: Rob Ford, mayor in name only
- 11/18/13--13:08: News Wrap: New health calculator may overestimate cholesterol risk
- 11/18/13--13:12: Tax credit helps end one family's search for health insurance
- 11/18/13--13:30: Teen scientist invents life-saving cancer test
- 11/18/13--13:57: Happy 130th birthday to the timezones
- 11/18/13--14:00: 'Selfie' named Oxford Dictionaries' Word of the Year
- 11/18/13--11:33: Promiscuous mouse moms have sexy sons
- 11/19/13--04:05: Health care report new problem for White House
- 11/19/13--05:28: Ask The Headhunter: How Much Would You Pay for a Job?
- 11/19/13--05:30: Celebrate World Toilet Day with a potty
- 11/19/13--06:54: Remembering President John F. Kennedy, 50 years after assassination
Photo by Flickr user David B. Gleason
The 2013 budget for the Defense Department after sequestration is $565.8 billion dollars. A new Reuters investigation says, however, there is no way to account for how much of that money is spent as appropriated.
In a two-part investigation, reporters Scot J. Paltrow and Kelly Carr uncovered a widespread practice of "plugging in" lost or missing accounting numbers in an effort to match Pentagon spending to Treasury reports. The practice essentially institutionalized accounting fraud across the Navy, Army, Air Force and other defense agencies. According to Reuters, the Pentagon has spent 8.5 trillion dollars since 1996, without ever completing a required annual audit.
"In a May 2011 speech, then-Secretary of Defense Robert Gates defense Robert Gates described the Pentagon's business operations as "an amalgam of fiefdoms without centralized mechanisms to allocate resources, track expenditures, and measure results. ... My staff and I learned that it was nearly impossible to get accurate information and answers to questions such as 'How much money did you spend' and 'How many people do you have?'"
Furthermore, Reuters found that disorganization in the Defense Logistics Agency, which is responsible for buying and storing weapons, ammunition and many other supplies, caused repeated expenditure on supplies it already possessed. The report uses an example from 2008, where the DLA had 15,000 "vehicular control arms" (part of the front suspension of a military Humvee) in stock. Although the quantity was equal to a 14-year supply, the agency reportedly bought 7,437 more of these parts between 2010 and 2012.
The Pentagon has not responded to the report, which comes as the second in a series titled "Unaccountable: The High Cost of the Pentagon's bad bookkeeping". After the release of the first report in July, Sen. Tom Carper, Chairman of the Senate Committee on Homeland Security and Governmental Affairs, said that he would examine the issue of Pentagon payroll problems in a hearing later this year.
Photo by Shaun Merritt/Flickr
Toronto City Council's 44 members voted Monday to effectively strip Mayor Rob Ford of all his legislative powers, The Associated Press reports. The mayor will no longer chair the executive committee and his office's budget has been slashed by 60 percent. But Ford still retains his title and ability to represent the city during official events.
The council had planned to cut the mayor's budget even deeper, however the council scaled back their proposals in response to legal concerns, Canada's National Post reports.
In a phone interview with radio station AM 640, Ford said that the council should call an election rather than strip him of all his powers. "If they want me out they should just call a snap election," he said.
Listen to the full AM 640 interview, broadcast Monday:
Ford got into a screaming match during the session Monday, when his brother, Doug Ford, began yelling at others in the crowd. "We're dealing with a mayor that has a bit of a problem," said Councillor Giorgio Mammoliti. "Do you expect any different than any other addict who is put up against the wall and someone is trying to take their job away?"
On Friday, the council voted to strip the mayor of his right to appoint and fire committee chairs and his authority to govern the city unilaterally during an emergency. Deputy Mayor Norm Kelly advised Ford earlier in November "that he could protect his family, himself health-wise, his political career and the vitality of his administration if he took a pause and re-grouped and re-entered the fray later this year or early next year." Ford did not head Kelly's advice.
GWEN IFILL: They searched for victims and tallied the damage today, after a barrage of tornadoes hit the Midwest on Sunday. At least eight people were killed, and scores more were hurt. The most powerful storm cut a path roughly an eighth-of-a-mile-wide, clear across one Illinois town of 16,000 people.
Terrified townspeople watched and prayed as the giant funnel ripped through Washington, Illinois, Sunday. Winds of almost 200 miles per hour tore at trees and blasted homes to bits.
MAN: This is what my house looks like after a tornado came through.
GWEN IFILL: In a matter of minutes, it was all over. Then, residents surveyed the damage, up to 500 homes damaged or destroyed and cars crushed into mangled metal.
Today, an emotional Mayor Gary Manier vowed, his town will recover.
GARY MANIER, mayor of Washington, Ill.: That is what this community is about. We love our neighbors, and we're going to bounce back from this. And I want to thank the surrounding communities that have reached out in droves of people. We looked like a parking lot last night, so many people trying to get into our community to help us. And we had to finally shut the community down and say, no more. We can't have any more help.
GWEN IFILL: Deadly storms from the same weather front raged across the Midwest throughout the day on Sunday, pulling trees out of the ground and flipping cars.
DAVID FRAWLEY, tornado survivor: It's hard. I couldn't even walk out here last night. I kept wanting to be inside. You kind of get like a little depression mode. So I don't have that drive just of yet to, let's go and rebuild again.
GWEN IFILL: Illinois Governor Pat Quinn ultimately declared disasters in seven counties. He too visited the town of Washington today.
GOV. PAT QUINN, D-Ill.: It's very, very important that at this time, we finish our search-and-rescue efforts all across our state to make sure there is no one in harm's away. But, upon completion of that, our mission now is to recover. And we will recover. We will prevail over these -- these tornadoes.
GWEN IFILL: In addition to Illinois, twisters and damaging winds hit a dozen states. In this image from the National Weather Service, red dots symbolize more than 80 tornado reports across the region. The blue dots stand for high winds from thunderstorms.
Those storms knocked down power lines in town after town, and 800,000 homes and businesses were still in the dark this morning. Forecasters have sounded an early alert, but it was still highly unusual to see that many storms with that much power this late in the year. With winter quickly approaching, the focus is now on cleaning up and making neighborhoods livable, as the mayor of Washington pointed out.
GARY MANIER: The unfortunate thing is, this thing hit in November. November is not the construction season that we build homes in this part of our state and part of our country. So it's going to be a longer process than if it happened in March.
GWEN IFILL: For now, though, police are keeping people out of the worst-hit areas until they are declared safe.
GWEN IFILL: The tragedy left many questions about the questions about the intensity and the volume of the twisters, as well as the unusual timing.
For answers, we turn to Howard Bluestein, a professor of meteorology at the University of Oklahoma.
Thank you for joining us, Professor.
We just saw that map in which -- all of those reported tornadoes throughout the entire Midwest. How unusual was it to see a wave of storms like this?
HOWARD BLUESTEIN, University of Oklahoma: Well, it's very unusual to see a wave of storms like this, this time of year.
This is something that we expect might happen in march or April. But it's extremely unusual to have such a widespread outbreak in the Midwest in November.
GWEN IFILL: Well, let's walk through some of the unusual features here. When was the time of day when these tornadoes struck? We're kind of used to hearing about late-afternoon warnings that come, touchdowns of tornadoes, but not an early morning one.
HOWARD BLUESTEIN: Yes, this was extremely unusual. I believe the storms began around 9:00 in the morning. And, usually, we need to get the sun's heating during the day to get the storms going.
But, in this case, a very, very powerful storm system came through that lifted the air very, very early. And we didn't need to get to be very warm for the storms to be triggered.
GWEN IFILL: How about the time of year? We just heard the mayor of Washington, Illinois, saying,it's not construction see son, it's not the time when they are usually building houses. In fact, it's -- we're on the lip of winter.
How unusual was it for to us to see tornadoes like this touch down this time of year?
HOWARD BLUESTEIN: Well, I think this sets an Illinois record for the number of tornadoes in November. This time of the year, in mid-November, we expect to see snow starting to fall. But, instead, the very, very warm air came up from the Gulf of Mexico. The moisture came up from the Gulf of Mexico.
And, this time of year, it usually doesn't make it that far north.
GWEN IFILL: So do we have any reason understanding -- way of understanding why it did this time?
HOWARD BLUESTEIN: Well, I think this may have been just one unusual event.
A storm system came in on Friday, an upper-level storm system, moved in from Canada into the Pacific Northwest. It tracked across the country. And just before it hit Illinois, when it was over Iowa, it rapidly amplified and intensified. And so I think that was what was mainly responsible for producing this particular outbreak.
GWEN IFILL: I have seen reports of everything from a couple of dozen to 42. We just saw 80 reported tornadoes touching down in that region, all those dozen states. Do we have a count? Is there any way to know what the count is?
HOWARD BLUESTEIN: We don't have a good count right now yet. There may have been 80 or more reports of tornadoes. But many of those reports were from the same tornado as it moved along a path.
So I expect that the National Weather Service will probably go out and do damage surveys, and after the damage surveys, we should know how many tornadoes there actually were.
GWEN IFILL: In terms of intensity and speed and scope, how does this compare to other weather events like this we have seen, especially tornadoes in the Midwest?
HOWARD BLUESTEIN: Well, this is not one of the most intense outbreaks we have ever seen. There were no EF-5 tornadoes, as far as I know, although after the damage survey, it's possible that they may find some evidence of EF-5 damage.
But one thing that was special about these particular tornadoes was that they were moving very quickly from southwest to northeast. And if they are moving at 50 miles an hour, that adds 50 miles an hour on to whatever speeds are of the tornado vortex. So that may have also contributed to the intensity of the tornadoes being relatively high.
GWEN IFILL: Even though eight people, sadly, died, there was a lot of damage. Was there a lot of alerts that went out in advance that prevented this from having been worse?
HOWARD BLUESTEIN: This particular event was extremely well forecast by the National Weather Service. The night before, the National Weather Service issued a public statement warning the public of a possible severe weather outbreak.
And early in the morning, very early in the morning, a high risk of severe weather was issued. This is the highest level that can be forecast and issued.
GWEN IFILL: Well, it's good that they had some warning, at least.
Professor Howard Bluestein of the University of Oklahoma, thank you so much.
HOWARD BLUESTEIN: You're welcome.
GWEN IFILL: There's word today that a new online calculator appears to greatly overestimate cholesterol risks. The new tech tool was unveiled last week by the American Heart Association and the American College of Cardiology.
But The New York Times reported today the calculator can mistakenly suggest that millions of people take statin drugs when they don't need them. The medical groups defended their overall guidelines and said they will look into the calculator issue.
In Japan, workers began a major step toward a full cleanup of a ruined nuclear power plant at Fukushima. Tokyo Electric Power Company began removing radioactive fuel rods from a reactor damaged during the 2011 earthquake and tsunami. To prevent overheating, the rods were placed in a steel cask before being lifted from a storage pool.
The utility's president said the process is off to a good beginning.
MAN: Today, we reached an important milestone in our work at the Fukushima Daiichi nuclear power station. I'm pleased to report to you the extraction of fuels from the unit four spent fuel pool has started on time and progressed safely.
GWEN IFILL: The operation involves moving more than 1,500 sets of fuel rods to a safer location. It's expected to last until the end of 2014.
The man acquitted of killing Florida teenager Trayvon Martin is in trouble with the law again. George Zimmerman was charged today with assault and battery in Apopka, Florida. He'd been arrested at a home he shared with his girlfriend. Last July, Zimmerman was found not guilty in the Martin shooting. Since then, he's been stopped for driving violations, and had a domestic dispute with his estranged wife.
NASA's latest mission to Mars lifted off from Cape Canaveral this afternoon. The goal is to help explain why the Martian climate evolved from warm and wet in its first billion years to cold and dry today. As this NASA animation shows, the Maven explorer is to enter the red planet's orbit in 10 months' time, carrying eight scientific instruments to analyze Mar's upper atmosphere.
Wall Street passed a couple of milestones today, then retreated. The S&P 500 crossed 1,800 at one point, before finishing the day with a loss. And the Dow Jones industrial average traded above 16,000 for the first time. But, by day's end, it gained just 14 points to close at 15,976. The Nasdaq fell 39 points to close at 3,949. It was led by sell-offs of Facebook and Twitter stock.
JUDY WOODRUFF: The White House said today 20 percent of Americans will still not be able to buy health insurance on the federal exchange website by the end of the month. Instead, they will need to sign up by phone or in person, in many cases because of the complexity of their situation.
But, in advance of a congressional hearing, a senior Obama administration official was quoted as saying healthcare.gov is improving, and said they are working on making it easier for people to understand whether they are eligible for subsidies. That's been a problem for many up to now.
It brings us to our series on reactions to the Affordable Care Act. Tonight, we hear from a couple in Colorado who are finally able to buy coverage after years of being uninsured. They do with the help of a subsidy through the state's exchange.
JOAQUIN MONTEZ, father: My name is Joaquin Dominges Montez III.
ROSALEE MONTEZ, mother: And my name is Rosalee Montez.
We will get you a smaller cup, OK?
JOAQUIN MONTEZ: We live in Arvada, Colo., and we have three kids.
ROSALEE MONTEZ: Our oldest is a daughter, and she's in college. And we have a middle, and he is a son and he's 13, and he's an eighth grader. And then our little one is 4 years old. We met in high school in the ninth grade, I think was. And we have been together 24 years?
JOAQUIN MONTEZ: Twenty-five.
ROSALEE MONTEZ: Twenty-five?
JOAQUIN MONTEZ: I work in a warehouse, and I do not get health benefits.
ROSALEE MONTEZ: I work in a warehouse as well doing commercial signage. And they don't offer any benefits. It's too small of a company.
JOAQUIN MONTEZ: We haven't had insurance because it's pretty expensive for us. You know, even though we have a two-income household, it gets really expensive.
ROSALEE MONTEZ: And then that's the water.
JOAQUIN MONTEZ: We have looked into health insurance before, and it ranges from about $450 to $600, depending on who you go through and what kind of deductibles you have and stuff like that. So it's kind of expensive for us, on top of a house payment, a car payment, as well as making sure our kids and fed and stuff like that.
So, normally, what we do when our kid does get really, really, really, really sick, we take them to urgent care, you know, because we can't afford any hospital bills and stuff.
And it's kind of a flat rate. You pay as you go. And...
ROSALEE MONTEZ: But it gets pretty pricey.
Our son was in football and he has broken his collarbone twice, one right after the other, same spot. We had to go to urgent care both times.
JOAQUIN MONTEZ: There was another time too where my oldest daughter had got real sick from something she had ate. And, you know, there was really nothing we could do to help her out. We tried to wait it out as much as we could, but she was really in pain. So we took her to the hospital. And it was pretty expensive.
ROSALEE MONTEZ: She got E. coli.
JOAQUIN MONTEZ: So I think that bill ended up being close to $17,000.
GIRL: How was your day today?
ROSALEE MONTEZ: I was always worried and anxious. I just -- I try to do the best I can when they are sick here to remedy them at home. But there's things you can't do. It's such a big load to carry because you're just -- on a daily basis, you're wondering if your kids are healthy.
And then, when they're not, you're just trying to figure out different ways to get them healthy without the insurance.
JOAQUIN MONTEZ: We first heard about the Obamacare through Servicios de La Raza, which is a community outreach program.
One of the guys that I talked there, he kept mentioning to me about -- that there was other people in his program that could help us out with Obamacare. So we called the lady that worked there. And she didn't hesitate. I think, two days later, we actually met with her, got into her office. She sat us down. We filled out the applications, and that's how we went about applying for it.
ROSALEE MONTEZ: We kind of got split up in our insurance. The kids are on CHP Plus, a government program that insures children. And they're separate from what we qualified for. We qualified for basic insurance.
JOAQUIN MONTEZ: With the Obamacare, the main cost will be $450 per month. Obamacare, the tax credits will give us $287 a month to apply towards that bill, so our final bill will be $155 a month. Now that the tax credit is helping us out, we're able to afford it.
Dear lord, we thank you for blessing us with another day, father.
ROSALEE MONTEZ: And knowing that we have that, and that we can qualify for something, because there's been so many times we have been turned down to be qualified for anything, but to have somebody actually say, yes, you qualify for this and this is what you are able to get, it was just -- we were like, we could actually breathe now, you know, actually say, we got insurance, you know? So, it was awesome.
JUDY WOODRUFF: As we have throughout, we try to fill out the bigger picture.
Tonight, Julie Rovner of NPR is back to help us out.
Julie, welcome back to the NewsHour.
JULIE ROVNER, National Public Radio: Thanks, Judy.
JUDY WOODRUFF: So, we just saw the story of the Montez family in Colorado. But, generally, who is eligible to apply for and get a subsidy like the one they got?
JULIE ROVNER: Well, it's people between -- who earn between 100 percent and 400 percent of poverty. People don't realize there is actually a floor. If you earn under 100 percent of poverty, you are not eligible to purchase on the exchange. It was assumed that those people would be getting the expanded Medicaid. And in the half of states that are doing that, they will.
In the other half of the states, they could fall between the cracks, but if you earn up to 100 -- excuse me -- up to 400 percent of poverty -- that is about $46,000 for an individual, up to about $94,000, so well into the middle class for a family of four -- you will be eligible for some subsidy. Obviously, the subsidies are larger the lower your income is and smaller as your income gets higher.
JUDY WOODRUFF: But if you are not clear about it, when you go to the website and you start to put in information, that's when you find out whether you are eligible.
JULIE ROVNER: That's how it is supposed to work. And that's been a lot of where the problem has been is trying to figure out exactly how big your subsidy is.
And there's this data hub that you are supposed to put in your income and it's supposed to go and look at your income from -- through the IRS and figure out exactly what your subsidy is going to be and come back and tell you that. And then it's supposed to show you these plans with your subsidy applied. So you are supposed to see how much it will cost you with that subsidy included.
JUDY WOODRUFF: So, when it works correctly -- and I hear you saying it doesn't always -- it hasn't always been working correctly -- what is supposed to happen?
You go to the site or you're on the phone, and what happens?
JULIE ROVNER: You go to the site or you're on the phone. You're supposed to qualify -- you're supposed to get qualified, basically, find out what kind of subsidy you are eligible for.
And then you go and choose a plan. And, basically that discount, it becomes a discount. And so you pay -- as we just saw in the piece, the family is only going to pay the subsidized price. It's not like you have to ask for the tax credit at tax time. That tax credit get applied on a month-to-month basis.
Then, at tax time, you reconcile. If you have underpaid, then you pay a little more. If you have overpaid, then you get a little bit of money back.
JUDY WOODRUFF: So, that was my question. This was in the form of -- it's not just that you pay a lower premium. It's that this literally comes off your tax -- your income taxes, right?
JULIE ROVNER: That's right. It's a tax credit. That's essentially -- but it is what we call an advanceable, refundable tax credit, so it gets applied to your monthly premium.
But then, when you file your taxes, you basically have to make sure that you got the right amount, based on your income.
JUDY WOODRUFF: And, again, it's not this year, 2013. It will start to take effect in 2014, when they would start to pay the premium.
JULIE ROVNER: That's right. And you would basically -- so you will file it in April of 2015, when do your 2014 taxes.
JUDY WOODRUFF: So, as people have tried to sign on, what kinds of things have they run into as they have tried to apply for this?
JULIE ROVNER: Well, a lot of people have had trouble basically getting, you know, this estimate of what their subsidy will be.
That was the biggest difficult for a lot of people was finding out what that subsidy is. It's also the biggest difficulty in people outside trying to sign up. A lot of outside groups, the insurance companies, some outside private exchanges like eHealthInsurance, have wanted to sign up what they call the subsidy-eligible people. And there are a lot of them.
And they haven't been able to because the federal government hasn't been able to find a way to take these people, find out what their -- determine their subsidy and let them then go back to these outside places and sign up for these health insurance plans.
So they have been basically stuck in the federal website that doesn't work that well.
JUDY WOODRUFF: And remind us, why did the Obama administration feel the need to do these subsidies in the first place?
JULIE ROVNER: Well, basically, the basic part of this was that the individual health insurance system didn't work. It kept a lot of people with preexisting health conditions out.
So the first thing was to let everybody who wanted insurance to get in. But, of course, if you have sick people in this pool, now you want to have a lot more healthy people in the pool. In order to get healthy people in the pool, you basically had to require a lot of people in the pool. If you are going to require people in there, what were you going to do about people who couldn't afford it?
Well, you were going to have to give them help. That is what the subsidies are for. They are to get people in who otherwise couldn't afford it.
JUDY WOODRUFF: And do we know, just quickly, Julie, what percentage or how many people they believe are eligible for these subsidies?
JULIE ROVNER: Well, the estimates vary, but the Congressional Budget Office and others have estimated that somewhere between 18 and 20 million people total -- this is over the next several years -- will be eligible for some sort of financial help inside the exchanges.
JUDY WOODRUFF: And, just finally, broaden it out to the overall problems the administration has been having. They have been giving daily updates, reports on how it's going. What -- what are they saying right now?
JULIE ROVNER: Well, they keep saying it's getting better, that the error rates are going down, that people are getting on faster, that they're having an easier time, for instance, determining what kind of subsidy they're eligible for.
They're still working what they say on the back end of the exchange, which is getting people actually enrolled in plans and getting that information to the insurance plans. They still say they're aiming to have this all working well at the end of the month. But they do keep redefining what working well at the end of the month actually means.
There's going to be a big crunch because there's a lot of people who are going to want to sign up, as they have been waiting for the end of the month, by December 15, the date you need to be signed up in order to have coverage start January 1.
JUDY WOODRUFF: Starting January 1. And that is just days away.
JULIE ROVNER: It certainly will be by the end of the month.
JUDY WOODRUFF: Julie Rovner of NPR, thank you.
JULIE ROVNER: You're welcome.
GWEN IFILL: There were some slow signs of recovery in the typhoon-ravaged Philippines today, as some markets and gas stations reopened. But UN officials warned some islands still haven't even been reached.
We have a report from Angus Walker of Independent Television News.
ANGUS WALKER: They're living with the dead. They found sanctuary in a cemetery, sleeping on top of tombs.
These crypts are now homes for nine families. Tess Tate tells me she used to live in Scotland. Her British husband died 11 years ago and she returned to the Philippines. Now she's lost everything. She sees the bodies recovered from the typhoon being brought in for burial.
WOMAN: Really terrible, but nothing we can do.
ANGUS WALKER: In two of the fresh graves, Christian, again 7, and Jim Philip, 4 years old. The boys had been told they'd be safer in this car before the typhoon hit. In all, eight children and two adults squeezed inside. Only one child survived, their 9-year-old brother.
Their father, Noel Baguyan, tell its me believes it was God's will that he lost two of his three sons.
A new life, a week-old, her family living hand-to-mouth in the ruins of their house they now share with homeless neighbors, among them, Imelda Britencio, a mother of seven. Her husband was killed.
WOMAN (through interpreter): Really difficult. Very painful. I miss him very much.
ANGUS WALKER: In a city of death, signs of life return every day. Survival goes on, searching for things to sell. Market stalls offered scavenged stock, repairs and recovery now clearly under way.
JUDY WOODRUFF: For decades, when Americans have talked about exploring space, the government agency NASA has been front and center in every conversation.
NASA, in fact, launched its latest mission to Mars just today. But the private sector is stepping up to the plate,too, increasingly in California's prosperous Silicon Valley.
Thuy Vu of KQED Public Television in San Francisco narrates our report.
THUY VU, KQED: One hundred miles north of Los Angeles, in the dusty desert town of Mojave, the world's first commercial rocketship is gearing up to launch citizen astronauts to the edge of space. No, this isn't a movie. It's real.
GEORGE WHITESIDES, Virgin Galactic: For 50 years, space has been the domain of professionals, right, NASA astronauts, Russian astronauts, Chinese astronauts. And so what we want to do is to make space available and open to other people.
THUY VU: But to experience the thrill of a few minutes of weightlessness, you will have to pay Virgin Galactic $250,000 for a two-and-a-half-hour ride 60 or so miles above Earth. Sure, it's a luxury, but Virgin Galactic CEO George Whitesides thinks that price will fall eventually.
GEORGE WHITESIDES: But, long-term, you know, I think the price can come down, around the SUV price point, you know, where then you get down to that level. It's still expensive, but I think a lot of people would be willing to do this sort of once in their lives.
THUY VU: Since billionaire tycoon Richard Branson founded Virgin Galactic in 2005, more than 600 people have placed deposits for the first commercial supersonic flights. They're scheduled to lift off in 2014.
Today, dozens of companies are launching new commercial space ventures, ranging from space tourism to mining the moon, fueled by the risk-taking startup culture of Silicon Valley.
Bob Richards is the CEO of Moon Express, a startup in Mountain View. He and his team of young engineers are planning an unmanned mission to the moon at a cost of $50 million to $100 million.
BOB RICHARDS, Moon Express: So, and getting to the moon, like any business, it's really about balancing risk and cost. This is a supercomputer in my pocket, a billion times more powerful than what NASA designed to land the first landers on the moon. We can use that technology today. And we can use technology largely from the commercial sector.
THUY VU: Sure, a privately funded mission to the moon sounds risky, but Richard thinks it's a gold mine of a business opportunity.
BOB RICHARDS: Moon Express is a lunar resources company. That means we will eventually be mining the moon. Asteroids have been bombarding both the Earth and the moon for billions of years, and every asteroid contains billions or maybe even trillions of dollars worth of valuable resources, platinum group metals, or gold, OR silver.
THUY VU: But before Moon Express can mine the moon, it has to get there, which it's trying to do with a lunar landing being tested and developed inside a hangar at NASA Ames Research Center.
MAN: Let me show you the test from this morning. This is kind of like driver's ed for the spacecraft. We're teaching it over and over how to land safely.
THUY VU: The lander is scheduled to launch in 2015, with later commissions to prospect and eventually mine the moon. But can a company even legally do that? The law isn't entirely clear, according to aviation and spaceflight attorney Douglas Griffith.
DOUGLAS GRIFFITH, aviation and spaceflight attorney: The Outer Space Training of 1967 is addressed to nations. It says that nations cannot own the moon. It doesn't say anything about whether private companies can settle on the moon or extract the moon's resources, because people just weren't thinking about that back then.
MAN: One minute, 35 seconds.
THUY VU: The for-profit space ventures of today are a far cry from the big government-led efforts that thrust a nation to exceptional new heights.
MAN: Tranquility Base here. The eagle has landed.
STEVE JURVETSON, Draper Fisher Jurvetson: During the space race, NASA as a government entity would farm out projects to many companies. It may be a single-use mission to the moon. And they would fund it. In the new model, companies look for business opportunities.
THUY VU: Steve Jurvetson is a venture capitalist whose firm has invested tens of millions of dollars in SpaceX, a California rocket maker and provider of launch services founded by tech entrepreneur Elon Musk. NASA is paying SpaceX more than a billion dollars for resupply missions to the International Space Station.
In May 2012, SpaceX became the world's first private company to launch a mission to the space station. The milestone proved the company could build and launch rockets reliably and cheaply.
MAN: And capture is confirmed of this Dragon spacecraft.
(CHEERING AND APPLAUSE)
STEVE JURVETSON: Many of these new space companies are being built by software engineers. And folks like Elon Musk, the founder of SpaceX, didn't come from an aerospace background. He was a computer scientist by training.
Time and time again, Silicon Valley has proven that is the hotbed of entrepreneurship. It invents new industries, and part of it is the culture, the willingness to take risk.
THUY VU: Part of it may also be a high-tech approach to innovate industries, as Dan Berkenstock and his team at Skybox Imaging are trying to do with satellites.
DAN BERKENSTOCK, Skybox Imaging: A typical imaging satellite today costs between half-a-billion and $1 billion, with a B. They're about the size of a suburban and they take five to eight years, roughly, to build.
We're trying to build the iPhone of satellites. We take processors off the shelf so that we can fly the latest and greatest components in space that are available in the commercial marketplace. The beauty of this approach is that for less than the cost of a single imaging satellite in today's world, we can launch an entire constellation of satellites.
What excites us is really taking that very good foundation of the mapping industry of today and helping to turn that into the monitoring industry of tomorrow, where we're not just getting that picture once a year, once every couple of years. We're getting that picture every day, and multiple times per day.
The satellites we build at Skybox are about the size of a dorm room refrigerator. They weigh about a hundred kilograms. And we have tried to pack as much high performance into the smallest box possible.
THUY VU: With the first Skybox satellite scheduled to launch in late 2013, the startup founders think there's a big market for rapid on-demand Earth monitoring.
MAN: I think, over San Francisco, this would be awesome.
MAN: You will be able to see the Bay Bridge, the Golden Gate Bridge, you know, how is your commute to work, all the shipping traffic throughout the channel.
MAN: And all the various ports throughout the bay.
THUY VU: But big, bold ideas carry risk, especially in the high-stakes, unforgiving frontier of space.
STEVE JURVETSON: And there were times when this nation took some risks and lives were at stake, flying humans in orbit, that would lead to phrases like failure is not an option. But we all know in our heart failure has to be an option. You can't innovate if failure is not an option. How much risk do you want to take to push the ball forward?
THUY VU: In the digital age, that push may be a leap that radically expands our presence in space.
GWEN IFILL: To hear more from these new space entrepreneurs, you can watch KQED's entire documentary, "Silicon Valley Goes to Space," at KQED.org/science.
When he was 15, Jack Andraka developed an early detection test for pancreatic, ovarian and lung cancers. He won the top prize in the 2012 Intel Science Fair for his invention -- which costs only three cents and works in five minutes -- and has since been recognized around the world for his accomplishment.
Jack wrote to NewsHour Extra about how he came up with his idea and how other students can get involved in scientific research:
When a close family friend who was like an uncle to me passed away from pancreatic cancer I was sad and confused. I didn't even know what a pancreas was so I turned to any teen's go-to sources: Wikipedia and Google. There I learned that 85 percent of pancreatic cancers are diagnosed late, when people have a two percent chance of survival. The current blood test for pancreatic cancer costs $800 and misses 30 percent of cancers - reading this, I knew there had to be a better way!
Armed with teenage optimism, I began reading everything I could online about pancreatic cancer and how it is detected.
Learn more about Jack's story here.
JUDY WOODRUFF: Now to part two of our newsmaker interview with B. Todd Jones, the new director of the federal Bureau of Alcohol, Tobacco, Firearms, and Explosives.
The first half of our conversation focused on the agency's responsibility for keeping track of the nation's 300 million firearms.
Tonight, we discuss urban violence, Fast and Furious, and illegal cigarette profits going to terrorists.
We talked late last week at the bureau's headquarters here in Washington.
Todd Jones, the director of the Bureau of Alcohol, Tobacco, Firearms and Explosives, thank you for talking with us.
B. TODD JONES, Bureau of Alcohol, Tobacco, Firearms and Explosives: Thank you, Judy.
JUDY WOODRUFF: So, how do you describe what the priorities are today, 2013, for this agency?
B. TODD JONES: Well, I think, it's digested down to three things for me. One is to get the organization healthy, both from a morale standpoint, from a human resources standpoint, from a policies and procedures standpoint.
We need to get healthier. We're about to lose a generation of agents, and that's creating some challenges for us in terms of that knowledge transfer that we're going to need.
Second is to implement our new business practices, which is really driven around risk management and intelligence. We're not big enough to be everywhere and do everything well. And so this business model that we're implementing really allows us to focus in on the worst of the worst on the regulatory front and assisting our state, local and federal partners on identifying those trigger-pullers and traffickers around the country who are creating havoc in our community.
And, lastly, to bring ATF fully into the Department of Justice. It's only been in the department for 10 years, with five acting directors in the last seven years. It hasn't been a consistent implementation to make sure that we are completely in sync, both operationally and procedurally, with our brother and sister agencies at the FBI, the DEA, and the Marshals Service.
JUDY WOODRUFF: You mentioned trigger-pullers and traffickers. What does that -- what does that mean? What does that focus mean?
B. TODD JONES: Well, there are pockets of violence around this country that continue to exist and are tragedies, tragedies on a daily basis.
And a lot of the coverage is on the mass shootings. And those are tragedies too. But, to a certain degree, there's slow-motion mass shootings happening in urban areas in particular around this country that are equal tragedies, young folks killing young folks, people in the crossfire getting hurt.
And so what that means for us is, working with state local and federal colleagues, we are doing what we do best in terms of identifying trafficking patterns and identifying the worst trigger-pullers, armed career criminals wrecking havoc in those communities and bringing them into federal court.
JUDY WOODRUFF: And yet I read that even though one of the mandates is to inspect gun dealers at least once every five years, that more than half the gun dealers in this country don't get that kind of an inspection within every five years. Why is that?
B. TODD JONES: Well, one of it is a resource issue. We have about 700, 800 investigators on our regulatory side.
They literally have tens of thousands of FFLs that they have to inspect. But what we have done...
JUDY WOODRUFF: Federally...
B. TODD JONES: Federally -- firearms licenses that they are required to inspect. And I think that's one of the stats.
But, you know, 95 percent of FFLs around this country are doing business lawfully, are paying attention to who they're doing business with, and, quite frankly, require less attention from us as regulators. And so our challenge has been to identify through our tracing mechanism, NIBIN and other tools that we have.
Where are those federal firearms licensees who continue to dump firearms into that illegal crime gun pool? Where are they? Are they obeying with the regs? And, if they're not, to pull their license. And that's where our focus should be, given its resources that we have.
JUDY WOODRUFF: You have a large mandate here. One of the -- one of it has -- the mandates has to do with tobacco.
Reporting recently having to do with cigarette smuggling makes it clear that's another headache for you. And we read that in the past few years, smugglers with ties to terrorist groups have acquired millions of dollars from illegal cigarette sales. They funnel that cash, reportedly to al-Qaida, to Hezbollah. How big a concern is this?
B. TODD JONES: Well, tobacco smuggling and tobacco trafficking cases that have a terrorist hook or involved organized crime are something that we do pay attention to. Again, there's only so much we can do.
JUDY WOODRUFF: Is this an area that you're beefing up or feeling that you need to pass and let other agencies worry more?
B. TODD JONES: You know, when it comes to terrorism or organized crime involved in cigarette trafficking, we will work with our colleagues in other law enforcement agencies, including the FBI, to do some of those investigations.
JUDY WOODRUFF: We know that the bureau has had some high-profile controversies in recent years, most notably Fast and Furious, this exercise where ATF agents, in effect, were standing by while drug cartels were taking -- trafficking in guns and moving them across the border.
The cigarette smuggling ring, we mentioned, other problems. How confident are you that this kind of thing is now a part of the past of the bureau and not the future?
B. TODD JONES: Again, I have been a trial lawyer most of my life and a prosecutor, and I have learned never say never, because we operate in a business that is chockful of risk.
But what I do have a high level of confidence, given some of the fixes that we put in, the leadership team we have in place, and our institutionalization of really the core flaws as to what happened on the southwest border, I have a higher level of confidence now 24 months on the job than I did when I came to this organization for the first time in September of 2011.
We have done a fair amount of work to make sure that cases are monitored, that there's appropriate leadership involved in decision-making, and that the communications between what's happening out in the field and what the knowledge of headquarters here in Washington, D.C., knows is much, much better than it was when I arrived here.
JUDY WOODRUFF: Todd Jones, the director of the Bureau of Alcohol, Tobacco, Firearms and Explosives, thank you very much.
B. TODD JONES: Thank you.
GWEN IFILL: A recently released movie about the peculiar institution known as slavery in America is drawing attention and praise for an emotional and brutal portrayal largely unseen in Hollywood.
"12 Years a Slave," directed by Steve McQueen, is based on an 1853 autobiography of free man turned slave Solomon Northup.
Jeffrey Brown has our conversation with one of the filmmakers.
JEFFREY BROWN: When we first meet Northup, he's a well-educated carpenter and musician living with his wife and children in Saratoga Springs, New York. The film follows as he's kidnapped and sold into slavery, experiencing all its brutality and forced to hide his identity and education, for fear of punishment or death.
In this scene, he encounters the wife of a cruel Louisiana plantation owner.
ACTRESS: This is a list of goods and sundries. You will take it to be filled and return immediately. Take the tag. Tell Bartholomew to add it to our debt.
CHIWETEL EJIOFOR, actor: Yes, missus.
ACTRESS: Where you from?
CHIWETEL EJIOFOR: I told you.
ACTRESS: Tell me again.
CHIWETEL EJIOFOR: Washington.
ACTRESS: Who were your master?
CHIWETEL EJIOFOR: Master name of Freeman.
ACTRESS: Was he a learned man?
CHIWETEL EJIOFOR: I suppose so.
ACTRESS: He learn to you read?
CHIWETEL EJIOFOR: A word here or there, but I have no understanding of the written text.
ACTRESS: Well, don't trouble yourself with it. Same as the rest, master brought you here to work. That's all. Any more will earn you a hundred lashes.
JEFFREY BROWN: John Ridley wrote the screenplay for "12 Years a Slave." He's also written for television, authored several novels, and directed two films of his own.
Well, welcome to you.
Tell us first about this person, Solomon Northup, and the book it is based on, and your own experience of encountering it for the first time.
JOHN RIDLEY, "12 Years a Slave": Solomon is a truly remarkable individual.
And one of the interesting things is, after he was freed from slavery for 12 years, his story, his memoir called "12 Years a Slave" was really quite well-known here in America. It sold nearly 30,000 copies. He toured. He talked about it. Many abolitionists credit his story with helping drive their movement.
And then it really -- it disappeared from the cultural consciousness. Steve McQueen and I, the director of the film, we sat down about four or five years ago and had breakfast, talked about many things. And in the course of this discussion, he stumbled upon the book. He gave it to me.
I read it and thought it was a really singular document in how evocative it was, how the clarity of how Solomon talked about his experience. And we both decided that this story in particular was worth telling and in a way that really introduced in some ways America to slavery, in the sense that it had not been excavated the way that Steve in particular wanted to do with this film and the story.
JEFFREY BROWN: Well, tell us a little bit more about that, because what were you -- what were you after in telling the story, what kind of portrait that you felt needed to be told?
JOHN RIDLEY: I think two things.
For me, as a writer, there was an emotional honesty and emotional velocity with Solomon and his story. You have to understand, at that time, for a lot of people of color, particularly slaves, as you saw in that clip, to read and write was a death sentence. So, comparatively, there were very few first-person narratives of what it was like to live through and to survive slavery.
I think, for Steve as a filmmaker, he wanted to render these images, the beautiful ones, the difficult ones, with a level of authenticity that for a lot of people has not been seen in film or in television. For most people, their visual experiences with slavery were "Gone With the Wind,' things like that, or "Django," which may be an entertaining film, but went at slavery with a very -- a different mind-set.
For us, again, we wanted an emotional honesty. And that's what we tried to achieve in every step of the way in every department, with the look, with the performances, and certainly for me from the script.
JEFFREY BROWN: You mentioned something like "Gone With the Wind."
A lot of people have noted the -- there is a long history here and a tradition of looking at the Civil War and at slavery in particular. Were you consciously working for it again in some case or against that portrayal in others?
JOHN RIDLEY: For me, it was trying to be honest to the source material.
But since the film has started to roll out -- and we're just reaching a national density at this point -- one of the things that has really surprised me -- and this is not for any kind of person in particular or any race of people -- but I was shocked at how many people really didn't understand how brutal the system of slavery was, how pervasive it was in its indoctrination of all individuals.
And I think that's because, here in Hollywood, we have done a really poor job of representing the facts of slavery. So, yes, you go to big costume dramas like "Gone With the Wind' that over the decades has really reached a point that that is folks' reference force slavery. Slavery was not a bad day on the job. It was not your boss yelling at you. It was not hard work for little pay.
This was a full system of human subjugation. And to do that, you have to get everyone to be complicit. And, look, we're not prisoners to the past, but when you see where we are in 2013 and why some of our views about race are so calcified, you have to understand that the indoctrination of slavery in this country for such a long time, it's the reason we are, unfortunately, still where we are about race relations.
JEFFREY BROWN: Well, and having seen the film, I know that you do not spare the audience. You do not spare us much of the -- it's the daily violence, the whippings, the rape that were almost routine.
I wonder, were there discussions among you and Steve McQueen and others about how far to go? I mean, you're trying to be realistic, but you also -- it's a film that people are going to see.
JOHN RIDLEY: Yes, I think in some ways you have to compare where the language of cinema is.
We have just come out of a summer season -- and I don't say this in an overly disparaging way -- but where entire cities were torn down and people just shrugged because of the level of violence and the scale of destruction and within that language of cinema.
With this film, I think it's because you care about the people and because we take so much time to show these lives and show these individuals as humans that, on the occasion -- and, really, when you break down the film, there are three or four moments that are very difficult -- it means that much more because we see these individuals as people.
And we never wanted to flinch from these moments either, the beauty, the humanity, the family nature that is going on here, or things that are difficult, by the way, that aren't very barbaric in terms of the physicality. But when you see a mother being torn away from her children and somebody's response is, have a meal and you will forget about them, that hurts because we care.
And that was our objective at every moment, to humanize these very dehumanizing moments in the history of slavery.
JEFFREY BROWN: Just in our last 30 seconds here, but I am wondering, given the response to it, the very positive response, do you think this signals a new openness to looking at difficult parts of our history?
JOHN RIDLEY: I think it's an openness to looking at our history and looking at history at not just being African-American history or white American history. This is our history.
And to move forward in it, we have got to learn and we have got to grow. And I'm very gratified that people are willing to sit and learn.
JEFFREY BROWN: John Ridley is screenwriter of "12 Years a Slave."
Thanks so much.
JOHN RIDLEY: Thank you for having me.
JUDY WOODRUFF: Finally tonight, another in our occasional series on poets and poetry.
Naomi Shihab Nye is author of more than 25 volumes and winner of numerous awards. She was recently elected to the Board of Chancellors of the Academy of American Poets, and, as we will hear, regularly conducts writing workshops around the country for young people.
NAOMI SHIHAB NYE, poet: My name is Naomi Shihab Nye. I live in San Antonio, Texas.
I have been working with students of all ages for 38 years, encouraging them to write their own poems and stories and discover how much material they have.
I took the title for my recent book, "Transfer," from an actual airlines baggage tag, but I was thinking about all the different kinds of transfers we make in our lives from one stage of our lives to another. My mother, Miriam Shihab, exposed her children to art and culture as much as she could. And our father, Aziz Shihab, was an immigrant from Palestine, a refugee.
I was lucky to be told stories as a little child. Our father brought tales out of his Palestinian background to our bedsides. And the minute I could write, when I was 6 years old, I wanted to start writing little detailed stories, poems of my own.
It seemed that telling a story helped us focus, helped us figure out who we were anyway, where were we in the world.
"Where is the door to the story? Is the door left open? When he sat by our beds, the days rushed past like water, driftwood, bricks, heavy cargoes disappearing downstream, no matter, no matter. Even the trees outside our screens tipped their cooling leaves to listen."
My father was very disappointed by war and fighting. And he thought language could help us out of cycles of revenge and animosity. And so, as a journalist, he always found himself asking lots of questions and trying to gather information. He was always very clear to underscore the fact that Jewish people and Arab people were brother and sister. That was in every story that he told.
He would say, this conflict came about because of political decisions or decisions made by powers in different countries, and it's not the fault of Jewish people and Arab people. He was convinced all through his life that resolution was possible.
"Many asked me not to forget them. Where do you keep all these people, the shoemaker with his rumpled cough, the man who twisted straws into brooms? My teacher, oh, my teacher. I will always cry when I think of my teacher. The olive farmer who lost every inch of ground, every tree, who sat with head in his hands in his son's living room for years after."
In the poem "Many Asked Me Not to Forget Them," I found the line, that actual line in my father's notebooks after he died, and then the poem I wrote came out in his voice. And when he died, and I really couldn't imagine how I would continue to live without this voice, until I realized I would always have that voice in my days. It was in my DNA, it was in my memory.
"I tucked them into my drawer with cufflinks and bow ties, touched them each evening before I slept, wished them happiness and peace, peace in the heart. No wonder we all got heart trouble."
I do think that all of us think in poems. I think of a poem as being deeper than headline news. You know how they talk about breaking news all the time, that -- if too much breaking news, trying to absorb all the breaking news, you start feeling really broken. And you need something that takes you to a place that's a little more timeless, that kind of gives you a place to stand to look out at all these things. Otherwise, you just feel assaulted by all of the tragedy in the world.
"We swam so easily to the stone village, women in thick dresses, men with smoky breath. We sat around the fire pitching in our own twigs. The world curled around us, sizzled and popped. We dropped our troubles into the lap of the storyteller, and they turned into someone else's."
JUDY WOODRUFF: That was Naomi Shihab Nye reading from her book of poems called "Transfer."
You can watch her read more of her work on our Art Beat page at NewsHour.PBS.org.
Today in 1883: The United States and Canada adopt a system of standard time zones: http://t.co/jcCDySfpWi— amhistorymuseum (@amhistorymuseum) November 18, 2013
Today in 1883 four standard time zones were introduced for the U.S. at the instigation of the railroads, which improved mail delivery times.— Postal Museum (@PostalMuseum) November 18, 2013
First Daughters Sasha and Malia Obama take a selfie to commemorate their dad's inauguration in January. Photo by Joe Klamar/AFP/Getty Images
Infographic by Oxford DictionariesThere's no telling when the first "selfie" was taken. You could argue that the self-portrait -- think Vincent Van Gogh with a painter's palette or Frida Kahlo surrounded by monkeys -- is its original form, and that the artists from centuries ago influenced a contemporary trend popularized on social media sites like MySpace and Instagram.
But according to Oxford Dictionaries, the word "selfie" was first used on an Australian online forum in 2002. More than a decade later, the dictionary has decided that now is the time to recognize "selfie" as an official member of the English language. Monday, it announced that selfie will be its word of 2013, joining 2012's "GIF" and beating out the likes of "bitcoin" and "twerk."
Though it's not yet in the Oxford English Dictionary (it's currently being considered for future inclusion), selfie was added to OxfordDictionaries.com in August.
At arm's length and with a tilt of the head, nearly everyone has perfected the art of the selfie. So with Monday's news, we decided to revisit some of our favorite selfies of the year.
In August, Pope Francis posed with a group of Vatican visitors. This might have been the holiest of selfie photographs to date.
First Lady Michelle Obama and First Dog Bo posed on the White House lawn to help National Geographic earn a Guinness World Record in early August.
In the realm of virtual selfies, Grand Theft Auto takes the cake, albeit a very twisted, warped-looking kind of cake. As a player, you have the option of taking a selfie with one of the game's impressive scenes behind you.
Anonymous Grand Theft Auto player takes a selfie with ... a shark.
Yes, those fads may be bizarre, but they're not as out of this world as astronaut Luca Parmitano's selfie from space.
And finally, one of our personal favorites (we promise we're not biased), comes from PBS NewsHour's Gwen Ifill and Judy Woodruff, one day before their co-anchorship became official.
Male mouse pheromones released in urine attract female mice and increase the male's chance of mating and producing offspring. In that way, mouse pheromones act much like a peacock's tail to attract mates. Illustration by Sarah Bush/University of Utah.
Female mice with multiple sexual partners have sexy sons, according to a new study from the University of Utah published in the Proceedings of the National Academy of Sciences on Wednesday. The male offspring of promiscuous females gave off stronger sex pheromones than the descendents of mice with only one partner.
"If your sons are particularly sexy, and mate more than they would otherwise, it's helping get your genes more efficiently into the next generation," said Wayne Potts, biology professor at the University of Utah and senior author of the study. "Only recently have we started to understand that environmental conditions experienced by parents can influence the characteristics of their offspring. This study is one of the first to show this kind of 'epigenetic' process working in a way that increases the mating success of sons."
The researchers at the University of Utah raised ten generations of mice in groups of monogamous mice - 23 male-female pairs - and promiscuous mice - 20 males and 40 female, which competed for partners and territory. Then mice bred in four combinations: mother and father from promiscuous environment; both from monogamous environment; mother from promiscuous environment and father from monogamous environment; and vice versa.
The sons of promiscuous females produced 31 percent more urinary pheromones than the offspring of the domesticated pairs. But the male lotharios had the opposite effect on their sons. Potts and his team found that sons from polyamorous fathers inherited 5 percent fewer pheromones than the offspring of monogamous dads.
"Fathers are competing with their sons and usually drive them out of the territory quickly, while they let daughters stay," says Potts. "If you're worried about your sons impinging on your own reproductive success, then why make them sexy?"
Male mice with stronger pheromones attracted more female mates, and sired a third more babies. But a sexier smell meant the mice play hard and die young, Potts said. Only 48 percent of those mice lived to the end of the experiment, compared to 80 percent of the sons of monogamous pairings.
Understanding how a parent's social environment shapes genetics could make a difference in reintroducing captive species to the wild. Often captive-bred animals fail to compete with their wild counterparts for mates as well as territory, and knowing how something like pheromone production changes with environment may improve their success rates.
"It's amazing how often reintroduction of captive-breed endangered species fails - it's estimated to be as high as 89 percent," says Potts. "Domestication stimulates epigenetic mechanisms that make animals less fit for nature."
Insurance agents with Sunshine Life and Health Advisors in Hialeah, Florida help people with information about insurance policies under the Affordable Care Act . Photo by Joe Raedle/Getty Images
Another day, another rough patch for the Affordable Care Act.
House Republicans released documents suggesting that President Barack Obama's White House had early and direct warnings about the anticipated problems with HealthCare.gov, and new poll figures find Mr. Obama at the lowest point in his presidency.
A Washington Post-ABC survey indicated that some voters might even be rethinking their 2012 choice in the presidential race.
The poll found 49 percent of respondents said they would vote for Republican nominee Mitt Romney if the election were held today, and 45 percent said they would back Mr. Obama.
Opposition to the 2010 law, upheld in 2012 by the Supreme Court, also reached a record high in the survey, with 57 percent opposing the Affordable Care Act. Of those, 46 percent are "strongly" against it. That's down from a survey one month ago, before the website rollout went awry, when the public was about split.
The Post's Dan Balz and Peyton M. Craighill write that the problems are spilling over as lawmakers approach the 2014 midterm elections, in addition to putting the president's second-term agenda in jeopardy.
The health-care law has become a political burden for elected officials who support it. Almost four in 10 Americans say they are more likely to oppose a politician who backs the legislation, while just over a fifth say they would be more likely to support such a politician. That's the biggest gap recorded in Post-ABC polling during the entire debate over the law.
And Obama is the chief target. His overall approval rating has fallen to 42 percent, having dropped six percentage points in a month, and equals his record low in Post-ABC polls. His disapproval rating stands at 55 percent, which is the worst of his presidency. Forty-four percent say they strongly disapprove of the way he is handling his job, also the worst of his presidency.
The damage to the president raises questions about whether improvements to the law alone could boost his standing significantly and, if not, the implications for the rest of his second-term agenda. White House officials have said they recognize that the president's problems will not be cured quickly. They think that as the health-care Web site improves and as the economy grows, he will recover. For now, however, as support for the law drops, so, too, does Obama's standing.
And a Gallup poll found 56 percent saying that ensuring Americans have health coverage is not the responsibility of the federal government, while 42 percent of respondents said they believed the government is responsible for making sure all Americans have insurance.
The Washington Post was the first to post the news Monday that the Obama administration brought in a private consulting team to independently assess how the federal online health care enrollment system was developing. McKinsey and Co. warned as early as late March about likely problems with the online hub for insurance exchanges set to open Oct. 1.
House Republicans told the Post that the McKinsey report was provided to senior officials at the White House and the Department of Health and Human Services over four briefings between March 28 and April 8.
The New York Times' Sharon LaFraniere and Eric Lipton have more detail about the report, prepared at HHS' request. It suggests "management indecision and a 'lack of transparency and alignment on critical issues' were threatening progress, despite the tight deadline," they write. From the story:
The McKinsey report found that the effort was at risk because of issues including "significant dependency on external parties/contractors," as well as "insufficient time and scope of end-to-end testing," and "parallel stacking of all phases," all predictions that have turned out to be accurate. Briefings on the report were held in the spring at the White House and at the headquarters of the Health and Human Services Department and for leaders at the Centers for Medicare and Medicaid, congressional investigators said.
For his part, the president on Monday night joined supporters on a conference call organized by the Organizing for Action spinoff of his re-election campaign.
He spoke for 12 minutes, and sounded "subdued," but defended the rollout and said the GOP hasn't been helpful, writes Justin Sink of The Hill. From his story:
"The good news is it's getting better every single week," Obama said. "I am confident that by the end of this month it is going to be functioning for the vast majority of folks."
The president conceded that the botched rollout "created and fed a lot of this misinformation" about the law. He said that some individuals would still need to be enrolled by phone or in person, even after repairs to the website were complete. And he accused Republicans of complicating efforts to get the program off the ground.
"Obviously, we haven't been getting a lot of cooperation from the other party," he said.
Obama encouraged supporters to talk face-to-face with neighbors, friends, and family members about the law. He also suggested that proponents of ObamaCare should use holiday parties and family gatherings to encourage their loved ones to purchase insurance.
"We have to remember the conversations we're having around the dinner table," Obama said.
Politico's Reid Epstein notices a shift in the president's terminology, with the word "Obamacare" not popping up as much.
At a fundraiser for Senate Democrats Monday, First Lady Michelle Obama applauded her husband's work in passing the Affordable Care Act, but didn't delve into the problems plaguing the White House on the issue over the last month.
Vice President Joe Biden addressed HealthCare.gov Monday when chatting with volunteers working to help people sign up for health insurance. "The truth is, we're going to fix it," Mr. Biden said, according to a pool report. He added: "God willing."
All of these issues will receive a fresh look Tuesday on Capitol Hill when Medicare officials testify at a House subcommittee hearing.
The NewsHour profiled a Colorado family that has been living without insurance, forcing them to avoid care and pay for medical expenses out of pocket. They are now able to afford a health care plan under the Affordable Care Act. We also spoke with Julie Rovner of NPR about how tax subsidies are helping families get coverage. Watch the piece by producer Mary Jo Brooks and the interview here or below:
When you're out of work and desperate, paying for a job seems worth it, but it's probably just more money down the drain. Photo courtesy of Emile Wamsteker/Bloomberg via Getty Images.
In this special Making Sense edition of Ask The Headhunter, Nick shares insider advice and contrarian methods about winning and keeping the right job, on one condition: that you, dear Making Sense reader, send Nick your questions about your personal challenges with job hunting, interviewing, networking, resumes, job boards, or salary negotiations. No guarantees -- just a promise to do his best to offer useful advice.
It's astonishing how readily even smart people fall prey to career scams. But when you're looking for a job, scammers know that your normal defenses are down and almost any help is welcome. Perhaps it's no surprise that when help costs a lot of money, desperate job seekers think it must be good help. Suddenly, they think they can pay for a job. Think again.
A reader asked:
MORE FROM NICK CORCODILOS: Ask The Headhunter: How To Conquer Interview Butterflies
Do you have experiences with [XXX Enterprises] in Atlanta? They are in the "executive marketing" business and say they can help me land a good job. They want $2,400 down and $2,400 in the next six months for a one-year contract, with a guarantee. They claim to have their own list of people that they have placed inside of local companies, and that for the most part they use these to get recommendations and, of course, interviews. And, yes, they will re-write my resume, put me through interview rehearsals and use their skill at going through the Atlanta business databases for companies that would hire someone like me. Sounds good, but...
Get three references from them: people they have placed. Three more: managers who have hired their clients. Call them all. The firm's claim implies the people they have placed in turn hire other clients from them. But it's a kind of a Ponzi scheme. My bet: They will never give you references. It sounds good, yes, but check the references before you give them any money. (By the way, is the guarantee of the "money back" variety? I'm guessing they guarantee nothing but all the "services" you are willing to swallow.)
The reader did what I suggested and wrote back:
Thanks for the suggestions. I've asked for references and a copy of the contract with the guarantee. I am waiting for a reply. Meanwhile, I'm reading your advice online.
I offered a little more advice to this job hunter:
Talk to the hiring managers who are provided as references, then call the HR department at each company. Be frank with them. Ask HR to confirm the hires and their satisfaction. Sorry to be so cynical, but the career management business can be a real racket. It costs little to start one of these outfits. It seems the courts can do little to stop them from shutting down one operation and re-opening under another name just down the street. So the obvious other step is to Google the owners, not just the firm's name. You may find the owners started their racket elsewhere, with bad press in their wake.
It was that last bit of advice that saved this reader $4,800.
He sent me this final note:
This was the reply I got from [XXX Enterprises]: "We will prepare an agreement for you to review tomorrow. Please take a look at the success stories on our website. Providing personal contact information would violate the rules of confidentiality and privacy which we provide our clients."
The "success stories" are listed by client number (0020100 and so on), hardly legitimate references. And the corporate managers or companies they worked with? Nowhere. The Better Business Bureau notes the business was started in 1977. The website states 1986. There were four consumer cases against [XXX Enterprises] with the local BBB. Three were closed administratively, as the BBB felt the complaints could not be resolved through them or through mediation.
Although the [XXX Enterprises] website states the owner, (Mr. Z), has been interviewed by several national cable networks of note, I can't find any references on Google or Yahoo. What did show up, interestingly enough, is that the address for [XXX Enterprises] is the same as a former business for one Bernard Haldane, with whom you are familiar. I then found an article that used a quote from "(Mr. Z), Atlanta-based regional President for Bernard Haldane Outplacement..." You're right: They change the company name, keep the game going. Oh, well. Thanks again for walking through this with me.
I love it when the executive marketing rackets lose a customer. Don't get desperate in this lousy economy, and don't get taken for thousands. The idea that anyone can guarantee you a job in exchange for money is very costly wishful thinking.
Nick Corcodilos invites Making Sense readers to subscribe to his free weekly Ask The Headhunter© Newsletter. His in-depth "how to" PDF books are available on his website: "How to Work With Headhunters...and how to make headhunters work for you," "How Can I Change Careers?", "Keep Your Salary Under Wraps" and "Fearless Job Hunting."
Send your questions to Nick, and join him for discussion every week here on Making Sense. Thanks for participating!
Copyright © 2013 Nick Corcodilos. All rights reserved in all media. Ask the Headhunter® is a registered trademark. This entry is cross-posted on the Rundown -- NewsHour's blog of news and insight. Follow @PaulSolman
A child washes himself in Kallyanpur, a neighborhood in Bangladesh's capital, Dhaka. U.N. photo by Kibae Park
Did you know that Tuesday is the first World Toilet Day designated by the United Nations? Imagine the party favors.
The aim of the cheeky designation is to raise awareness about the critical need for global sanitation. Dozens of advocacy groups around the world are inviting the public to start an online fundraiser, sign a virtual bathroom wall and watch a singing toilet video.
Of the world's 7 billion people, about 6 billion have mobile phones, but only 4.5 billion have access to toilets or latrines, according to the United Nations. That leaves about 2.5 billion people without basic sanitation, making them vulnerable to disease.
New York City resident John Kluge wanted to address that gap. Several years ago on a trip to Darfur in western Sudan, he was surprised to see the refugee camps had better sanitation than the next town over in the Central African Republic, where fighting between the army and rebel groups had displaced more than 200,000 people. He looked into the issue more and realized how massive the needs were.
John Kluge, center, collaborates with other sanitation advocates John Feighery of mWater, left, and John Sauer of Water for People. Photo by Laura Hajar for Toilet Hackers.
In September 2012, Kluge co-founded the nonprofit Toilet Hackers to bring "dignified sanitation" to all.
"Sanitation is really the largest global health challenge we're facing today, yet it is the most neglected," he said.
The reluctance of people to talk about human waste has had an effect even in advocacy circles, where NGOs tend to focus on the clean water aspect of the problem, rather than sanitation and hygiene, he said. "It's easy to identify with what we drink every day. It's harder to identify with the thing that we don't talk about every day but we all do."
Kluge, who besides being co-founder of Toilet Hackers is also its chief disruption officer, admits that although sanitation might be an unsavory topic, it's one of life and death. "One child dies every 17 seconds due to lack of sanitation, unclean water and poor hygiene," notes his website.
But the solution isn't to give everyone a toilet, he said. Traditional sewage systems that run on water aren't practical in places where water is scarce.
Therefore, more innovation is needed in areas such as waterless technologies and the use of mobile phones for monitoring sanitation systems, said Kluge. Toilet Hackers holds "hackathons" to bring together sanitation specialists to try to think of new solutions to the problem.
People have been working on the problem for decades, he noted, but "sometimes when you're in a space for a long time, you tend to get blinders on. So we need some fresh blood and we need some new thinking to work together with those who have been doing this for so long."
Kluge cited as an example of waterless technology a special kind of toilet where the waste goes into a bag. Then the person steps on a pedal to seal the bag, which is stored in a compartment under the toilet, where it is composted and disposed.
Another opportunity for innovation is in India, where an estimated 600 million people defecate in the open, he said. That's "a lot of waste that is literally being wasted. If you can capture a small fraction of that and start harvesting it to produce methane-based electricity -- if done right, you can produce pretty good power."
Toilet Hackers helped with a school latrines and hygiene training program for 800 students in the town of Isiolo in central Kenya.
Kluge's group also works with other established organizations in the field to test new products, and organizes concerts and art exhibits to try to make the issue less taboo.
In 10 years, said Kluge, if even 10 percent of the problem can be addressed with new models, governments could use that information to scale up projects in their own countries and attract investors who already are aware of the tremendous need.
Once the solution is in the can, so to speak, "I would like to go home in 10 years and switch out and do something else," he said. "I don't think of myself as a plumber for the rest of my life."
Photo portrait by White House Press Office
PBS NewsHour continues coverage of the 50th anniversary of the assassination of President John F. Kennedy. Watch the player below on Nov. 21 and 22 for a live stream of events, including a wreath-laying ceremony at Arlington National Cemetery attended by President Barack Obama and First Lady Michelle Obama.
And check out events from D.C. to Dallas commemorating the legacy of JFK:
Wednesday, Nov. 20: Obamas, Clintons visit grave of President John F. Kennedy and the eternal flame at Arlington National Cemetery
Organizer: The White House Place: Arlington National Cemetery Time: TBD The president and first lady will be accompanied by former U.S. President Bill Clinton and former first lady and secretary of state Hillary Rodham Clinton.
Wednesday, Nov. 20: Bill Clinton receives Medal of Freedom at the White House
Organizer: The White House Place: White House East Room Time: 11 a.m. JFK established the Presidential Medal of Freedom only months before he was killed. President Obama will award Bill Clinton the Presidential Medal of Freedom on Wednesday. In addition to Clinton, baseball star Ernie Banks, activist Gloria Steinem, media mogul Oprah Winfrey and several others will receive the medal, the highest honor given to a civilian. The three posthumous awardees are Sen. Daniel Inouye, astronaut Sally Ride and civil rights and gay rights activist Bayard Rustin.
Wednesday, Nov. 20: President Obama delivers speech about JFK
Organizer: The White House Place: Smithsonian's National Museum of American History, Washington Time: Wednesday evening President Obama plans to deliver remarks on JFK and his legacy during a dinner, in remembrance of the 35th U.S. president. Some Kennedy family members will also attend.
Tuesday, Nov. 19: "JFK: Breaking the News"
Organizer: PBS Where: Nationwide Time: 9:00 p.m. EST (Check your TV listings for your local PBS station's schedule.) A look back at how Dallas reporters covered the assassination of President John F. Kennedy. Included: how the limited technology hindered their efforts; and the journalistic decisions reporters faced when reporting the news. Jane Pauley narrates. This documentary originally aired in 2004. Tuesday, Nov. 19: "Who Was Lee Harvey Oswald?"
Organizer: PBS' FRONTLINE Where: Nationwide Time: 10:00 p.m. EST (Check your TV listings for your local PBS station's schedule.) FRONTLINE re-airs its 2003 documentary about Lee Harvey Oswald, who was either the lone gunman in the John F. Kennedy assassination (Warren Commission), part of a conspiracy (House Select Committee on Assassinations) or a patsy (Oswald himself).
Wednesday Nov. 20: "JFK"
Where: Nationwide Organizer: PBS' American ExperienceThis biography provides a fresh look at an enigmatic man who has become one of the nation's most beloved and most mourned leaders. The newest addition to The Presidents collection, the documentary explores Kennedy's childhood years as the overlooked second son of a multimillionaire exploding with ambition, his early political career as a lackluster congressman, his subsequent successful run for senate, and the election victory that turned him into the youngest elected president in U.S. history.
Saturday, Nov. 23: JFK Day of Service
Organizer: JFK Day of Service Place: Nationwide Time: Starting at 8:00 a.m. Volunteer for this national day of service and follow the Twitter account @jfkday2013 and the hashtag #JFKDAY to be up to date with the cross-country volunteer efforts of this nonpartisan, citizen-led initiative. Working in counties across the nation, this day of service will be devoted to Kennedy's call to public service epitomized by his famous quote, "ask not what your country can do for you, but what you can do for your country."
Friday, Nov. 22: New exhibit of artifacts from JFK's funeral goes on display
Organizer: The John F. Kennedy Presidential Library and Museum Place: John F. Kennedy Presidential Library & Museum, Boston Time: 12:30 to 2:30 p.m. EST Visitors will gather in Stephen Smith Hall, a glass pavilion at the Kennedy Library, to watch the musical tribute via live broadcast. In an effort to allow anyone in the world to join this remembrance, this event will be broadcast to an online audience. A new exhibit for the museum will be open called A Nation Remembers, displaying artifacts from the president's funeral. Additionally, there will be a moment of silence at 2:00 p.m. EST, when the President's death was announced to the nation 50 years ago.
Friday, Nov. 22: Wreath laying ceremony and press conference
Organizer: John F. Kennedy Hyannis Museum Foundation Place: John F. Kennedy Memorial, Ocean Street, Hyannis, Mass. Time: 10-11 a.m. EST The trustees of the John F. Kennedy Hyannis Museum will remember the legacy of JFK.
Saturday, Nov. 23: Wreath-laying ceremony and reflections at the John Fitzgerald Kennedy National Historic Site
Organizer: John Fitzgerald Kennedy National Historic Site Place: John Fitzgerald Kennedy National Historic Site, Brookline, Mass. Time: 12:30 to 2:30 p.m. EST The John Fitzgerald Kennedy National Historic Site, which includes the house where Kennedy was born, will open to the public on Saturday, Nov. 23 and Sunday, Nov. 24. At 2:00 p.m. on Sunday, Nov. 24, the site will hold a brief memorial ceremony with a wreath-laying, a reading of President Johnson's 1963 National Day of Mourning Proclamation, reflections by local religious leaders and a rendition of "America the Beautiful," performed by students from Brookline's Edward Devotion School
Thursday, Nov. 21: President John F. Kennedy memorial concert
Organizer: Dallas Symphony Orchestra Place: AT&T Performing Arts Center, Dallas Time: 8 p.m. CST The Dallas Symphony, conductor Jaap van Zweden and violinist Joshua Bell pay tribute with Jean Sibelius' Violin Concerto, Darius Milhaud's Murder of a Great Chief of State and Ludwig van Beethoven's Symphony No. 3, Eroica.
Friday, Nov. 22: Memorial Service
Organizer: John F. Kennedy University Place: John F. Kennedy University, Pleasant Hill, Calif. Time: 10 a.m. PST John F. Kennedy University, the only university in the country with his name, will hold a memorial Friday that will include an unveiling of a bust of Kennedy and the announcement of a project for students to honor the president's service legacy.
John F. Kennedy drives by in his motorcade in Dallas, Texas, on Nov. 22, 1963. This picture was taken minutes before he was shot. Photo by Victor Hugo King/Library of Congress
Friday, Nov. 22: View the 1961 Lincoln Continental that President Kennedy was sitting in when shot in Dallas
Organizer: The Henry Ford Museum, Dearborn, Mich. Time: 9:30 a.m.-5 p.m. EST Take time to reflect and see the limousine the president was riding in on that fateful day in Dallas.The museum offers special programs this week, including sold-out events with newscaster Dan Rather, who covered the assassination, and former Secret Service agent Clint Hill, who was on duty that day in Dallas.
Know of any other events? Share them with PBS NewsHour in the discussion section below.
By David Cutler
The American health care system is structured differently from systems in other countries, making it more expensive. Photo courtesy of Joe Raedle/Getty Images.
Paul Solman: Harvard's David Cutler is among the country's foremost health economists, famous for -- among other research -- a controversial paper arguing that even our exorbitant health care industry, in terms of increased productivity and life span outcomes, delivers more than what we pay for it.
Cutler, who was profiled by Roger Lowenstein in the New York Times Magazine in 2005, subsequently worked for President Barack Obama on health care issues, and talked to us recently for a story about cost savings. Tune into the PBS NewsHour Tuesday to see that Making Sen$e segment. But far more of what he had to say seemed worthwhile than what we have time to air. Here is some of it.
Paul Solman: Why does health care cost so much in America?
David Cutler: Let me give you three reasons why. The first one is because the administrative costs of running our health care system are astronomical. About one quarter of health care cost is associated with administration, which is far higher than in any other country.
Paul Solman: What's the next highest?
David Cutler: About 10, 15 percent. Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks. Single-payer systems have fewer administrative needs. That's not to say they're better, but that's just on one dimension that they clearly cost less. What a lot of those people are doing in America is they are figuring out how to bill different insurers for different systems, figuring out how to collect money from people, all of that sort of stuff.
The second reason health care costs so much in America is that the U.S. spends more than other countries do on many of the same things. Drugs are the most commonly noted item, where a branded drug will cost much more in the U.S. than in other countries. But, for example, doctors also earn more for doing the same thing in the U.S. than they do in other countries, and a lot of suppliers charge more for things like durable medical equipment in the U.S. than in other countries.
Paul Solman: And that's not only doctors being paid more in this country, but the United States making the decision as a government not to buy drugs in bulk and therefore to bid down the price that pharmaceutical companies can charge.
David Cutler: The lowest prices for pharmaceuticals, and a variety of other medical devices and payments to physicians, are in government plans. So Medicaid gets the best prices on pharmaceuticals. In terms of physician payments, Medicaid payments are the lowest. Medicare payments are above that and private payments are above that. The more leverage the buyer has, the lower the price they get. That's true in every industry. In health care, the United States doesn't utilize that leverage as much as other countries do.
Paul Solman: Okay, so that's two and what's the third reason?
David Cutler: The third one is Americans receive more medical care than people do in other countries, not so much in terms of doctor visits, but if a person has a heart attack in the United States, they're much more likely to get open heart surgery than they are in most other countries.
Go back to Canada. In all of Ontario there are 11 hospitals that can do open heart surgery. Pennsylvania has roughly the population of Ontario and it has a bit over 60 hospitals that can do open heart surgery. So there's no way you can operate on as many people in Ontario as you can in Pennsylvania even if you operated around the clock.
Paul Solman: But that means that the people in Canada or in Ontario have to wait longer right?
David Cutler: Sometimes they wait longer. What's much more common is that there's a lot of gray area where it's not clear if you need the open heart surgery or not, and in the U.S., people will get it and in Canada, they don't. The interesting thing about it is that life expectancy or one-year mortality after a heart attack is the same in the two countries.
Is The Rise of Costs Inevitable?
Paul Solman: Are medical costs going to inevitably go up because there will always be new technologies and new technologies are always expensive?
David Cutler: Technology is the underlying driver and there will always be some of that, which is why health care will not be like other industries in terms of always, always going down in price.
On the other hand, there's so much waste in the system -- our best guess is that about a third of medical spending is not associated with improved outcomes -- that for the next 15 to 20 years people believe that costs could be stable or falling as a share of the economy without cutting into necessary services -- just by eliminating the things that are not necessary...
What we've done in Massachusetts is we've said, don't just give people very high cost-sharing in general; do what's called tiering it -- that is, tell people that if you look for basic levels of care, you're not going to face very high costs, but if you want to go to the teaching hospital for the routine procedure, you're going to have to pay a lot for that. And we mandate that insurance companies have to tell people the price of any service. So if your doctor says you need an MRI, you can go on the computer and your insurance company's website and figure out exactly your cost sharing at each place where they would do the MRI.
Paul Solman: So that will provide comparison shopping.
David Cutler: That's on the demand side. Give people more skin in the game and give them the information so they can do real shopping.
Paul Solman: More skin in the game, meaning higher co-pays?
David Cutler: Higher co-pays. We know that people respond to co-payments and they like cheaper care. So the hope is to steer people to less expensive sites. We've also pushed very strongly that insurance payments to doctors and hospitals and other care providers not be based on volume (so-called "fee for service"), but instead be value-based payments.
So say, here's a person with coronary artery disease. Pay a fixed amount for that person and let the medical professionals figure out how to treat that person, not with the incentive to do more and earn more, but with the incentive to figure out how to do what's right and keep them from using very expensive services.
Paul Solman: But doesn't that provide an incentive or a prod to the provider to stint on the services, stint on the MRI, say, that I might otherwise get?
David Cutler: What that's being coupled with is a very aggressive approach to measuring quality. ... Really what we're doing is two things: one is on the demand side trying to make people smarter consumers, and the second is on the provider side, eliminating the monetary incentives to do more testing and procedures. Instead, let's move to a system that says, "do what's appropriate, make the patients better and you'll get rewarded for it."
What If I Want a Certain Procedure?
Paul Solman: Well it sounds ideal, but I just keep thinking that I'd want to go to the dermatologist every six months, say, just to check out every possible discoloration. I'm a little crazy that way, but also, I feel, maximally prudent.
David Cutler: A lot of provider organizations are putting the doctors on a salary basis. Let's gather our doctors together to figure out what the evidence says is right. If the literature is clear, let's make sure we do that 100 percent of the time. If the literature is not clear, let's go through our records and see how we can do better. If the patient then wants more, then say, "Okay, fine, you can have that, but you're going to pay a little more because that's not what the literature says is necessary in your case."
Paul Solman: Well, of course, presumably my insurance company is already trying to do that.
David Cutler: Typically they're very bad at it though, and when they tell the doctors they've imposed this, it goes poorly.
Paul Solman: So right now, I go to a dermatologist on a regular basis -- I've always had some skin difficulties, but I've never had a melanoma -- and that's covered by my insurance. You're saying, hey, if I'm a little paranoid with regard to discolorations, fine, let me go, but then I ought to pay to do that?
David Cutler: Increasingly, I believe insurers will make you pay more for care that you want to do that's not medically necessary.
Paul Solman: Well medically necessary by what standards?
David Cutler: Care that's ordered; that's not following some accepted standard. You see this in certain parts of the country where the insurers say, "We'll pay only a fixed amount for a knee replacement. We've determined that high quality knee replacement can be had for $8,000 nearby you. So we'll give you $8,000. Now if you want to go to someone else who charges $20,000, fine, but you're gonna pay the extra $12,000."
Paul Solman: And my insurer did that recently with regard to a bronchial inhaler and said, "No, you can't get that one; you can only get this cheaper one."
David Cutler: Exactly, it's what they've been doing with drugs for quite a long time. The generic version is very cheap; the branded drug is much more expensive.
In a lot of parts of the country, they're just saying, "Look, if you want this service at all, you're going to pay a lot of money." The trend in health care nationally is to put more and more on the patient.