Colorado’s ski resort areas in Summit County have a high cost of living, among the highest in the country. The people who visit these places — Keystone, Breckenridge and Copper Mountain — can afford it.
Many of those who live and work there can’t, especially when they get sick.
In addition to expensive rent, they pay some of the steepest health insurance premiums in the nation. Hospital costs are also pricey, with most business generated by tourists, skiers and outdoors enthusiasts.
But locals may soon get a break after a group, fed up with the costs, negotiated a deal with the hospital system. The group, which came to be known as the Peak Health Alliance, expects to be able to offer its members premiums next year that are at least 20% less than current rates.
About 6,000 people, among them individuals as well as employees of local businesses and the county government, can buy coverage through the alliance, which cut a deal for a discount of about one-third off the local hospital’s list prices (although at least one expert thinks they could have done a lot better).
“It wasn’t for the faint of heart,” said Tamara Drangstveit, who ran a county social services organization before becoming Peak’s executive director and, effectively, one of the lead negotiators.
Fed up with high hospital prices even after insurers’ negotiated discount, more employers are cutting out insurance middlemen and engaging in what is known as “direct contracting” with medical providers. They cut their own deals.
Direct contracting is a hot topic among employers because they are “up in arms about insurers not keeping prices in check,” said Chapin White, a Rand Corp. researcher who studies the tremendous variation in hospital prices. The citizens here in Colorado are taking the approach to the grassroots level.
What Peak did — starting with painstakingly gathering data about exactly what hospitals in the region were being paid by insurers, employers and consumers — might be an answer for some.
Such efforts may be helped by Congress, which is considering barring secrecy clauses in hospital and insurance contracts that can prevent employers from learning exactly how much insurers pay. The Trump administration is also considering proposals to require more public disclosure of negotiated hospital prices.
And, according to press reports, the experience with Peak may go statewide. Colorado’s insurance commissioner and Gov. Jared Polis say they are considering an alliance that could bring together state employees, individuals and private employers in a similar health care purchasing network.
“It feels like the curtain is going up on health care costs and prices,” said Cheryl DeMars, CEO of The Alliance, a group of 240 self-insured private sector employers that directly contracts with hospitals in Wisconsin, northern Illinois and eastern Iowa.
While interest is growing, experts caution that direct contracting won’t work in many places.
“It won’t have impact in urban areas where no one has significant market share, but it could work in rural areas where there is a dominant employer or some other large group,” said Gerard Anderson, a professor at Johns Hopkins University in Baltimore who researches health care costs.
First Step: Get Price Information
It takes a great deal of effort — and some luck — to peer behind the curtain.
“The people buying the plans, employers and workers, are often barred from viewing the contracts insurers have negotiated on their behalf … so they don’t know if they are reasonable,” said White at Rand.
The Peak Health Alliance in Colorado was lucky that the state is one of at least 18 that have made public some medical care price information from insurers. It also gathered similar information from local self-insured employers’ insurance plans.
Peak was able to compare the payments made to Centura Health, which owns the local hospital and others in the state, to what Medicare would pay.
“We found the average emergency room claim was 842% of what Medicare would pay — and our outpatient rates were 505% higher than Medicare,” Drangstveit said.
That helps drive up premium costs. It isn’t unusual, Drangstveit said, for families who don’t qualify for a federal subsidy through the Affordable Care Act to face $2,500 monthly premiums with an $8,000 annual deductible. Many area residents go uninsured or are forced to make hard financial choices.
“The stories we hear are heartbreaking,” said Drangstveit.
Second Step: Negotiate With The Hospital
Lee Boyles, CEO of Centura Health’s St. Anthony Summit Medical Center in Frisco, said he wasn’t surprised by the findings of Peak’s analysis.
Charges are high, he said, reflecting the cost of living, as well as the need to maintain round-the-clock trauma coverage, emergency helicopter service and physicians who specialize in the kind of head and limb injuries that can result from mountain sports.
Plus it’s the only hospital in town. Others are a 70-mile drive down the mountain in Denver.
Unlike some hospitals elsewhere with similar exclusivity, Centura was willing to bargain.
“We were going to do what’s right for our community,” said Boyles.
It also helped that granting discounts to locals wouldn’t affect the bottom line much.
Residents account for only about 15% of the hospital’s business, Boyles said, which is a far smaller portion than at a typical hospital.
Tourists and sports enthusiasts — many well-heeled, with good insurance — make up the largest share of the hospital’s business. Thus, any new prices negotiated with Peak would not apply to most of the hospital’s business.
The deal reached with Peak, Boyles said, represents a discount of about one-third off the hospital’s “list prices.”
Third Step: Keep Pushing
Anderson at Johns Hopkins said shaving this amount from already high charges isn’t much of a break. A discount pegged to Medicare rates, plus a bit for overhead and profit, would be better, he said.
In a report released in May, Rand used claims data from employers in 25 states to show a huge variation in prices paid to specific hospitals and show a huge variation between the prices paid by employers to those facilities and how much Medicare would allow for the same services.
To be sure, hospitals have long argued that Medicare doesn’t cover their costs. The Rand study found that employers paid an average of 241% of Medicare rates in 2017, but some saw rates three times those paid by the federal program or more.
Gloria Sachdev, CEO of the Employers’ Forum of Indiana, a group working to lower health care spending there, cautioned that price transparency alone is not a panacea.
Her organization, which commissioned the study, is pressing for more quality and cost data as well as tougher negotiations by its insurers.
“We need to take the driver’s seat,” said Sachdev.
“The most interesting man in the world.” “Reach out and touch someone.” “Finger-lickin’ good.” Such advertising slogans have become fixtures of American culture, and each year millions now tune into the Super Bowl as much for the ads as for the football.
While no single person can claim exclusive credit for the ascendancy of advertising in American life, no one deserves credit more than a man most of us have never heard of: Edward Bernays.
I first encountered Bernays through an article I was writing on propaganda, and it quickly became clear that he was one of the 20th century’s foremost salesmen of ideas. The fact that 20 years have elapsed since his death provides a fitting opportunity to reexamine his legacy.
Bernays pioneered public relations
Often referred to as “the father of public relations,” Bernays in 1928 published his seminal work, Propaganda, in which he argued that public relations is not a gimmick but a necessity:
The conscious and intelligent manipulation of the organized habits and opinions of the masses is an important element in democratic society. Those who manipulate this unseen mechanism of society constitute an invisible government which is the true ruling power of our country. We are governed, our minds are molded, our tastes formed, and our ideas suggested, largely by men we have never heard of…. It is they who pull the wires that control the public mind.
Bernays came by his beliefs honestly. Born in Austria in 1891, the year Sigmund Freud published one of his earliest papers, Bernays was also Freud’s nephew twice over. His mother was Freud’s sister Anna, and his father, Ely Bernays, was the brother of Freud’s wife Martha.
The year after his birth, the Bernays family moved to New York, and Bernays later graduated from Cornell with a degree in agriculture. But instead of farming, he chose a career in journalism, eventually helping the Woodrow Wilson Administration promote the idea that US efforts in World War I were intended to bring democracy to Europe.
Bernays rebrands ‘propaganda’
Having seen how effective propaganda could be during war, Bernays wondered whether it might prove equally useful during peacetime.
Yet propaganda had acquired a somewhat pejorative connotation (which would be further magnified during World War II), so Bernays promoted the term “public relations.”
Drawing on the insights of his Uncle Sigmund – a relationship Bernays was always quick to mention – he developed an approach he dubbed “the engineering of consent.” He provided leaders the means to “control and regiment the masses according to our will without their knowing about it.” To do so, it was necessary to appeal not to the rational part of the mind, but the unconscious.
Bernays acquired an impressive list of clients, ranging from manufacturers such as General Electric, Procter & Gamble, and the American Tobacco Company, to media outlets like CBS and even politicians such as Calvin Coolidge. To counteract President Coolidge’s stiff image, Bernays organized “pancake breakfasts” and White House concerts with Al Jolson and other Broadway performers. With Bernays’ help, Coolidge won the 1924 election.
Bernays’ publicity campaigns were the stuff of legend. To overcome “sales resistance” to cigarette smoking among women, Bernays staged a demonstration at the 1929 Easter parade, having fashionable young women flaunt their “torches of freedom.”
He promoted Lucky Strikes by convincing women that the forest green hue of the cigarette pack was among the most fashionable of colors. The success of this effort was manifested in innumerable window displays and fashion shows.
In the 1930s, he promoted cigarettes as both soothing to the throat and slimming to the waistline. But at home, Bernays was attempting to persuade his wife to kick the habit. When would find a pack of her Parliaments in their home, he would snap every one of them in half and throw them in the toilet. While promoting cigarettes as soothing and slimming, Bernays, it seems, was aware of some of the early studies linking smoking to cancer.
Bernays used the same techniques on children. To convince kids that bathing could be fun, he sponsored soap sculpture competitions and floating contests. These were designed to prove that Ivory bars were more buoyant than competing products.
Bernays also used fear to sell products. For Dixie cups, Bernays launched a campaign to scare people into thinking that only disposable cups were sanitary. As part of this campaign, he founded the Committee for the Study and Promotion of the Sanitary Dispensing of Food and Drink.
Bernays’ ideas sold a lot more than cigarettes and Dixie cups
Even though Bernays saw the power of propaganda during war and used it to sell products during peacetime, he couldn’t have imagined that his writings on public relations would become a tool of the Third Reich.
In the 1920s, Joseph Goebbels became an avid admirer of Bernays and his writings – despite the fact that Bernays was a Jew. When Goebbels became the minister of propaganda for the Third Reich, he sought to exploit Bernays’ ideas to the fullest extent possible. For example, he created a “Fuhrer cult” around Adolph Hitler.
Bernays learned that the Nazis were using his work in 1933, from a foreign correspondent for Hearst newspapers. He later recounted in his 1965 autobiography:
They were using my books as the basis for a destructive campaign against the Jews of Germany. This shocked me, but I knew any human activity can be used for social purposes or misused for antisocial ones.
What Bernays’ writings furnish is not a principle or tradition by which to evaluate the appropriateness of propaganda, but simply a means for shaping public opinion for any purpose whatsoever, whether beneficial to human beings or not.
This observation led Supreme Court Justice Felix Frankfurter to warn President Franklin Roosevelt against allowing Bernays to play a leadership role in World War II, describing him and his colleagues as “professional poisoners of the public mind, exploiters of foolishness, fanaticism, and self-interest.”
Today we might call what Bernays pioneered a form of branding, but at its core it represents little more than a particularly brazen set of techniques to manipulate people to get them to do your bidding.
Its underlying purpose, in large part, is to make money. By convincing people that they want something they do not need, Bernays sought to turn citizens and neighbors into consumers who use their purchasing power to propel themselves down the road to happiness.
Without a moral compass, however, such a transformation promotes a patronizing and ultimately cynical view of human nature and human possibilities, one as likely to destroy lives as to build them up.
The active ingredient responsible for these psychedelic visions is a molecule called dimethyltryptamine (DMT). For the first time, a team led by Michigan Medicine has discovered the widespread presence of naturally-occurring DMT in the mammalian brain. The finding is the first step toward studying DMT– and figuring out its role — within the brains of humans.
“DMT is not just in plants, but also can be detected in mammals,” says Jimo Borjigin, Ph.D., of the Department of Molecular and Integrative Physiology. Her interest in DMT came about accidentally. Before studying the psychedelic, her research focused on melatonin production in the pineal gland.
In the seventeenth century, the philosopher Rene Descartes claimed that the pineal gland, a small pinecone-shaped organ located deep in the center of the brain, was the seat of the soul. Since its discovery, the pineal gland, known by some as the third eye, has been shrouded in mystery. Scientists now know it controls the production of melatonin, playing an important role in modulating circadian rhythms, or the body’s internal clock. However, an online search for notes to include in a course she was teaching opened Borjigin’s eyes to a thriving community still convinced of the pineal gland’s mystical power.
The core idea seems to come from a documentary featuring the work of researcher Rick Strassman, M.D. with the University of New Mexico School of Medicine. In the mid-1990s, he conducted an experiment in which human subjects were given DMT by IV injection and interviewed after its effects wore off. In a documentary about the experiment, Strassman claims that he believed the pineal gland makes and secretes DMT.
“I said to myself, ‘wait, I’ve worked on the pineal gland for years and have never heard of this,’” she said. She contacted Strassman, requesting the source of his statement. When Strassman admitted that it was just a hypothesis, Borjigin suggested they work together to test it. “I thought if DMT is an endogenous monoamine, it should be very easy to detect using a fluorescence detector.”
Using a process in which microdialysis tubing is inserted into a rat brain through the pineal gland, the researchers collected a sample that was analyzed for — and confirmed — the presence of DMT. That experiment resulted in a paper published in 2013.
However, Borjigin was not satisfied. Next, she sought to discover how and where DMT was synthesized. Her graduate student, Jon Dean, lead author of the paper, set up an experiment using a process called in situ hybridization, which uses a labeled complementary strand of DNA to localize a specific RNA sequence in a tissue section.
“With this technique, we found brain neurons with the two enzymes required to make DMT,” says Borjigin. And they were not just in the pineal gland.
“They are also found in other parts of the brain, including the neocortex and hippocampus that are important for higher-order brain functions including learning and memory.”
Her team’s work has also revealed that the levels of DMT increase in some rats experiencing cardiac arrest. A paper published in 2018 by researchers in the U.K. purported that DMT simulates the near death experience, wherein people report the sensation of transcending their bodies and entering another realm. Borjigin hopes to probe further to discover the function of naturally occurring levels of DMT in the brain — and what if any role it plays in normal brain functions.
“We don’t know what it’s doing in the brain. All we’re saying is we discovered the neurons that make this chemical in the brain, and they do so at levels similar to other monoamine neurotransmitters.”
Historic Castle House in Brumley, MO
The Historic Castle House in Brumley, Missouri is bursting with supernatural activity from shadows in the cemetery to apparitions in the mirrors. The house was built in 1850 by owners Dr. Walter Dixon and his wife, Martha. During the Civil War, the Castle House became a center for injured soldiers who were treated by Dixon under a truce. Some of the past patients are said to stick around the house, especially the ghost of Dixon’s wife, Martha, who suffered a stroke at the top of the stairway and is said to roam the second floor, still dolled up in a party dress.