On August 2, 2017, The Nation published an article by Joshua Holland, “Medicare for All isn’t the Solution for Universal Health Care,” chastising Improved Medicare for All supporters because, in his view, the single payer movement has “failed to grapple with the difficulties of transitioning to a single-payer system.” The article, which doesn’t quote anyone involved in the movement for Improved Medicare for All, begs a response because it shows what liberals opposed to single payer believe. Holland dredges up the same arguments used to keep single payer off the table during the creation of the Affordable Care Act (ACA). He even dusted off a few that were used to try to stop Medicare from coming into existence in the 1960s. And then he attempts to distract single payer supporters away from supporting Improved Medicare for All and settling for something less, as was done successfully in 2009.

The first error that Holland makes is confusing the term “Medicare for All” as meaning that advocates would simply take the current Medicare system, with both traditional and ‘Advantage’ plans, and expand that. This is why it is important to use the phrase “Improved Medicare for All.” As outlined in HR 676: The Expanded and Improved Medicare for All Act, the new system would be based on the current Medicare system, which is already national, but it would be a single public plan that is comprehensive in coverage and does not have out-of-pocket costs or caps. It would ban investor-owned facilities and ban private insurers from selling policies that duplicate what the system covers. A single system is the simplest for patients and health professionals because there is one transparent set of rules.

Most people who purchase health insurance have no idea which plan is best for them because nobody can anticipate what their healthcare needs will be in the future. A study of the Massachusetts health exchange plans done by the Center for American Progress showed that some plans were best for patients with cancer and other plans were best for people with heart disease or diabetes, but that isn’t something that can be advertised up front. Even if it were, people can’t predict if they will be diagnosed with cancer, heart disease or diabetes in the future. HR 676: The Expanded and Improved Medicare for All Act solves this problem by creating a single public plan designed to cover whatever our healthcare needs will be.

A second error that Holland makes is saying that HR 676 calls for the new system to start within a single year. The bill will take effect “on the first day of the first year that begins *more than* [emphasis added]1 year after the date of the enactment of this Act.” This means that if HR 676 were to be signed by the President in July of 2018, then it would take effect in January of 2020. Holland raises the concern that we can’t move the whole country into the new Improved Medicare for All system that quickly. In fact, HR 676 has transition periods for the Veteran’s Administration, the Indian Health Service, displaced workers and buying out for-profit health providers.

When Medicare was enacted in 1965, more than 50% of seniors were uninsured and the rest had some form of health insurance. Without computers and without a national health system in place, all 19 million seniors were enrolled in the first year (almost twice as many as were enrolled in the ACA in the first four years). At present, the United States has Medicare infrastructure in place and all practicing health professionals have a National Provider Identifier issued to them by the Centers for Medicare and Medicaid Services (CMS). When the new Improved Medicare for All system takes effect, enrollment will be very simple because there is only one plan that is universal and paid for up front though taxes. All health professionals will be in it. Every person could be sent a card, much as CMS does now for people who are turning 65. For those who do not receive a card, HR 676 has a solution – when they present for care at a health facility, they are assumed to be in the system, are treated first and then are enrolled in the system afterwards.

Next, Holland brings up the same arguments used to prevent universal health care attempts in the past. He states that people don’t want to give up what they have. This is called ‘loss aversion.’ It is a task of the single payer movement to build the public support for Improved Medicare for All necessary to overcome any potential loss aversion. Public figures and elected officials can play a role in building support as well.

Holland raises concerns that employers and seniors won’t want to give up their private plans, but that is based on his mistaken belief that Improved Medicare for All will be the same as current Medicare. The reality is that people will be less worried about giving up what they have if they know that it will be replaced with something better and that they will no longer fear losing their doctor as they will all be in the new system. Improved Medicare for All will provide more comprehensive benefits, no out-of-pocket costs and an unrestricted network of health professionals from which to choose. Employers will no longer be burdened with the high costs of health insurance. People with pre-existing health conditions will no longer worry about losing coverage or having to pay more. Unions and employers can offer supplemental plans for extras not covered by the new system, as is done in countries like France, if they choose to do so.

Holland also raises the concern that people will lose their doctor because they will opt out of the system due to low reimbursements. We are already losing doctors because of the current system. Physician burnout was listed as the second biggest concern by the Surgeon General last year. Under Improved Medicare for All, all health professionals will be in the system. There won’t be any place to opt out to. And why would they want to? Health professionals will save tens of thousands of dollars each year on billing and won’t have to worry about whether a patient has insurance or not. They can see anyone who calls for an appointment. And they will have a system with which to negotiate fair reimbursement. Private health insurance doesn’t negotiate with physicians and hospitals. Each year they make an offer and providers can either basically take it or leave it. Doctors in single payer systems that spend much less per capita than the United States are paid well, so the US can certainly afford to reimburse doctors adequately.

Every transformative change has suffered from loss aversion, but that hasn’t stopped them. When Medicare was enacted, it was called socialized medicine, a government intrusion that would take away people’s choices and freedom and become an opening to government control over our lives. The scare tactics didn’t work and Medicare is one of the most popular parts of our current healthcare system. Desegregation, women’s rights, workers’ rights and more were great changes that were successful and we are a better society for them. Why is the right to health care any different?

Finally, Holland dives into the myth that we can’t afford Improved Medicare for All because it will be too expensive. My first response when I hear this is that the same excuse wasn’t made when we spent $16 trillion to bail out the banks in 2008 and is never made when we invade another country, so why is it raised when it comes to one of the most basic necessities a society can have? The United States has the highest wealth and the highest wealth inequality of industrialized nations. The new “Commitment to Reducing Inequality Index” recommends social spending on education, health and other basic social protections as its top priority. Congress can appropriate the funds to do this. This should be a top priority in the United States as well.

The reality is that the United States is already spending the most on health care per person each year because the market has failed to control costs. That is exactly why we need a single payer system like National Improved Medicare for All. It is the only way to simplify the bloated bureaucracy of the current healthcare system, which would save around $500 billion each year, and to control the costs of medical procedures, medical devices and pharmaceuticals by having a single system that can negotiate fair prices. In addition to the bureaucracy created by a multi-payer system, the US subsidized the insurance industry with more than $300 billion last year. A system based on health, rather than profits for investors, can identify and prioritize our greatest health needs and work to address them.

For example, the US is failing when it comes to care for people with chronic diseases. There are numerous reasons why this is occurring – lack of access to consistent care, inability to afford medications, insufficient time for health education when patients see a health professional, cheap and highly processed food, environmental pollutants and more. An actual health system could take meaningful action to address these issues, and keep people healthier. Think about it: people with high blood pressure or diabetes in the US may not be able to see the doctor regularly or stay on their medicines due to cost, but when they suffer a stroke or kidney failure, and need long term care or dialysis, then they can receive disability benefits and Medicare. How much better and less expensive would it be for everyone to prevent strokes and kidney failure in the first place?

Just as many ‘progressive’ groups did during the health reform process that resulted in the ACA, Holland works to convince us that we don’t need a single payer system, and that we can work with the current system. Once again, Jacob Hacker, a leading advocate for the ACA and single payer opponent, is invoked and we are told that we can add a Medicare buy-in or another form of a public option. We are told that other countries use private insurance, so why can’t we? The Democrats, beholden to the medical industrial complex, want us to believe these false non-solutions that protect the insurance industry. It feels like 2009 all over again.

Rather than go through all of the reasons why these approaches will fail, I urge you to read articles on that topic posted on HealthOverProfit.org (Click here for a list of them). Instead, I refer to a saying used by my now-deceased mentor Dr. Quentin Young: “You can’t cross an abyss in two jumps.” The only way we can get to a universal single payer healthcare system in the United States is by creating a universal single payer healthcare system in the United States. Anything less than that will fail because it will not achieve the savings on administration and prices needed to cover everyone and it will not compete with the powerful private insurance industry.

Throughout time, every great social movement has been told that it was asking for too much. Advocates for worker’s rights, women’s rights, civil rights, etc., were labelled as unreasonable radicals wishing for some pie-in-the-sky change that can’t be achieved. Holland is doing the same to the single payer movement. Don’t fall for it. We have the resources in the US to have one of the top healthcare systems in the world. We have health policy experts who have helped to design excellent systems for other countries. Single payer is a proven solution, unlike the plans being proposed by the Democratic leadership.

One thing that Holland and I do agree on is that there is more than one way to skin a cat, so to speak. We could have an excellent national debate about which type of single payer healthcare system we support – a fully socialized system like the Veteran’s Health Administration, a national health service, or a socialized payer with multiple types of providers as in the Expanded and Improved Medicare for all Act. At the basis of our discussion must be the principles that every person in the US deserves high quality health care without financial barriers. Reported by Eurasia Review 16 hours ago.

CHICAGO, Aug. 8, 2017 : Groove Health, the Chicago-based digital health company, announced today that it has raised USD 1.6 million to help health insurance companies, hospital systems, and self-insured employers improve medication adherence using predictive analytics and personalized patient engagement. Reported by newKerala.com 12 hours ago.

The Texas House of Representatives approved a bill Tuesday -- coined as “rape insurance” by its detractors -- that would force women to pay a separate health insurance premium to get covered for a non-emergency abortion. Reported by FOXNews.com 13 hours ago.

Blue Cross Blue Shield of Georgia is pulling out of the individual health insurance market in metro Atlanta in exchange for offering coverage in rural counties where insurance is unavailable. In an agreement with the Georgia Office of Insurance, Blue Cross Blue Shield will extend health insurance coverage to 85 Georgia counties – more than half of the state's 159 counties – that otherwise would be left without any coverage option, said Jay Florence, the state's deputy insurance commissioner. "Without… Reported by bizjournals 12 hours ago.

Only about half of the non-emergency care doctors in California are willing to treat patients who are on Medi-Cal — the state’s version of Medicaid, the joint federal-state health insurance program for the poor and disabled — because the state pays them too little for their services. Yet the federal... Reported by L.A. Times 10 hours ago.

LOS ANGELES--(BUSINESS WIRE)--Catasys, Inc. (NASDAQ:CATS), a provider of proprietary predictive analytics and integrated treatment solutions to health plans, announced today that it has commenced enrollment under the previously announced contract for its OnTrak-HC program in Oklahoma with the nation's second largest Blue Cross Blue Shield health insurance plan. This company is the country's largest nonpublic health insurer and the fourth-largest health insurer overall, with health plans also in Reported by Business Wire 10 hours ago.

Texas women would have to pay a separate health insurance premium to get coverage for non-emergency abortions — what an opponent dubbed “rape insurance” — under a bill given early approval by the Texas House on Tuesday. House Bill 214 requires women to pay an additional insurance premium... Reported by Raw Story 8 hours ago.

HONG KONG and SHANGHAI, Aug. 9, 2017 /PRNewswire/ -- Ping An Insurance (Group) Company of China, Ltd. (hereafter "Ping An" or the "Group", HKEx: 2318; SSE: 601318) announced that its Insurance (Life, Property & Casualty, Annuity, Health), Bank (Consumer Credit, Credit Card), Investment (Securities, Trust, Fund) and other 10 financial institutions have jointly launched an emergency initiative in the disaster area of waiving and extending the payment of premiums, as well as a rapid settlement of claims, to support the victims of the Jiuzhaigou earthquake, helping them to resume daily life as soon as possible. The waiver of premium payments is for the parents of those who lost their lives in the earthquake but had insured their children, for whom the policy renewal charge will be waived. Extension of payment refers to such accommodating measures as the extension of the payment of premiums and the extension of credit card due payment. Rapid settlement of claims refers to simplified procedures to settle claims and pre-claims. These three initiatives reflect Ping An's professional services and concern about the victims.

The waiving of premium payments mainly focuses on the customers of Ping An Life, Ping An Health and Ping An Casualty. Ping An Life has exempted the affected customers from paying the interest of the policy for one year. When the policy resumes, the interest and the resumption cost will also be waived. For parents who lost their lives in the earthquake but had insured their children, the renewal charge of the policy will be exempted. Ping An Health also launched accommodative measures for the affected customers, which exempts RMB10,000 deductible of the "E Sheng Bao" and waives the renewal charge of the policy of the following year. Ping An Casualty also provides free support and free shuttle service for damaged vehicles.

In addition, Ping An Life eased the limitations of claiming, including materials exempted or deferred, cancelling the constraints of fixed hospital, self-paid medicine and verification of extending the hospitalized period.

On the area of extension, accommodating measures include the easing of premium payment and extension of credit card payment due. To provide full support to the affected in the disaster area, Ping An's subsidiaries including Ping An Life, Ping An Health, Ping An Annuity, Ping An Bank and Ping An Securities, have all introduced measures with extensions of premium payment period or adjourned payment due date. Of these, a three-month grace period on premium payment is granted to all customers who did not manage to renew their policies at the point of the earthquake across life insurance, health insurance and annuity insurance, and Ping An will continue to provide full insurance service to the affected during this period. All cases of compensation will be paid off under special arrangement, and Ping An Property & Casualty extended payment period to its customers in the disaster area by six months. Moreover, Ping An's life insurance will grant an additional two-month grace period to the cooling-off period on newly signed policies. Telephone confirmations will be suspended to avoid causing inconvenience to customers and continue to grant customers the right to cancel policies during the cooling-off period.

Apart from insurance business, Ping An Bank has granted a three- to six-month payment notice-free period and allowing delayed payment to car insurance, consumer finance and credit card customers. Ping An Securities is granting its customers in the affected area a three- to six-month special extension period. Customers can reach the local operations department or dial extension 95511-8 for further arrangement.

The rapid settlement of claims has always been a leading service in Ping An Group. Ping An's subsidiaries including Ping An Life, Ping An Property, Ping An Annuity and Ping An Health, offer rapid claim and pre-claim settlement services to the affected customers immediately after the earthquake struck, and prioritized claim settlement from customers affected. All procedures will be streamlined and carried out in answer to the urgent needs of all customers. By facilitating a better way for the affected customers to receive emergency treatments, Ping An will arrange hospital services in its network in Sichuan, such as: hospital transfer arrangement, accompany service for doctor consultations and pre-payment services, etc. Meanwhile, Ping An will also arrange visiting and placements for the affected families.

In order to support the affected customers, Ping An Financial Services has currently deployed more than 2,000 staff online, to ensure a 100% connection rate within the disaster area to show their sympathy to those affected customers. Apart from that, the Ping An 95511 Customer Service Hotline is offering counselling to all those affected. So far, Ping An Property & Casualty has already received eight cases of car insurance, 20 cases of accident insurance and three cases for counselling. All of them were given instant response. The Life Insurance Customer Service Center received 21 calls for earthquake-related issues, six calls for handling claims and emergency assistance. Those cases are linked to Life Insurance in the Sichuan branch at once and given top priority.

In addition, Ping An Property has set up a temporary Ping An service point to provide insurance protection to rescue workers, volunteers, and rescue medics and provide car owners "quick relief, supplies station, claims guidelines" and other services. The Ping An backup teams are on standby; with rescue cars and manpower that is ready to rush to the disaster area and provide 24-hour support and advisory services once the roads are cleared. 

Ping An said the Company will make full use of the technology and experience in emergency response, disaster assessment and disaster relief to actively mobilize all aspects of resources to participate in the disaster relief operations. Ping An's client services hotline 95511 will provide relief and advisory services for all. While ensuring Ping An's staff safety in the disaster area, Ping An called on the staff to fully carry forward the spirit of helping those who are in need, to actively participate in the golden 72 hours of rescue operations with utmost responsibility, enhancing the social power of disaster prevention.

*About Ping An*

As China's first joint stock insurance company, Ping An Insurance (Group) Company of China, Ltd. ("Ping An") is dedicated to becoming a world-leading personal financial services provider. Today, it is an integrated, compact, multi-functional financial services group with services that include insurance, banking, and investment. As at December 31, 2016, the Group had over 1.4 million employees and agents and 130 million individual customers. As at the end of 2016, the Group's consolidated total assets reached RMB5.58 trillion while equity attributable to shareholders of the parent company stood at RMB383,449 million. Ping An Life and Ping An Property & Casualty are both ranked the second largest in China, Ping An Annuity ranked top in China in their respective areas by premium income. Its subsidiary Ping An Bank is China's first joint stock bank. The Company's key areas of business include investment, with subsidiaries such as Ping An Trust, Ping An Securities and Ping An Asset Management. Further, Ping An strives to develop internet finance, including Lufax, Ping An Good Doctor, Ping An Haofang, E-Wallet, Finance One Account. It has achieved significant growth in both the scale and user base of internet finance. As at December 31, 2016, the number of internet users of the Company reached 346 million.

Ping An ranked 16th in Forbes' latest Global 2000, it ranked 39^th in Fortune Magazine's Global 500 Leading Companies. Apart from these accolades, Ping An ranked 61st in WPP Kantar Millward Brown's BrandZTM Top 100 Most Valuable Global Brands ranking.

For more information, please visit http://t.sina.com.cn/pingan, http://t.qq.com/pingan or www.pingan.com.cn.

*For enquiries, please contact:*

*Hill+ Knowlton Strategies Asia:*



Daphne Chan 

Bowen Chui

Tel: (852) 2894 6217 / (852) 6096 8656

Tel: (852) 2894 6233 / (852) 9783 0643

Email: daphne.chan@hkstrategies.com

Email: bowen.chui@hkstrategies.com Reported by PR Newswire Asia 7 hours ago.

Health insurance is expected to cost large companies $14,156 per employee next year, up from $13,482 this year.  -More-  Reported by SmartBrief 5 hours ago.

The Texas House passed this week a GOP-backed bill which requires women to pay for a separate health insurance supplement for non-emergent abortions. Reported by FOXNews.com 22 hours ago.

For those who still aren't convinced that Obamacare is trapped in an inescapable death spiral that will inevitably end in nothing short of an epic collapse of the federal and state health insurance exchanges, perhaps you should consider the following facts from the National Review and Mark Farrah and Associates.



-  Four heavily promoted open enrollments have taken place run by the Obama administration and the state exchanges.

 

-  Federal law has required people to purchase insurance or pay a fine — and the individual mandate was administered through 2016 by the Obama administration. In fact, *in 2015, 7.5 million people paid the fine, while 6.5 million paid the fine in 2016, according to the IRS.*

 

-  Every one of the people in the insurance market earning less than 400 percent of the federal poverty level were eligible for premium assistance — and those below 250 percent of the poverty level were also eligible to have their deductibles and co-pays subsidized.

 

-  After all of this, *only about 40 percent of those eligible for subsidies have signed up for coverage. *In what other business or government program would such a dismal acceptance by those it was targeted to serve be considered a success?

 

-  The *number of insurance companies participating is on track to shrink by 38 percent in 2018.*



And then there is the chart below...if people really saw "value" in Obamacare *wouldn't you expect that more than 2% of the people who don't qualify for subisidies would sign up?*



Finally, I will suggest the real test of whether a health-insurance program is stable is whether the consumers for whom it is intended believe that it provides them with value. Here is a chart of the take-up rate on the federal exchanges under the Affordable Care Act; excluding the “Over 400%” category, all of these individuals are eligible for subsidies. This chart represents data from last year, but with only a 4 percent reduction in those purchasing on the exchanges between 2016 and 2017, it should remain a fair indication of consumer approval of the program.

 

The health-insurance industry has long considered a 75 percent take-up rate to be the gold standard in evaluating whether an insurance pool is stable — i.e., whether there are enough healthy people signed up to pay the claims of the sick. While the exchanges appear to have achieved this for the lowest-income consumers — those who get the biggest premium subsidies and also have their out-of-pocket costs subsidized — only 17 percent of those making 301 to 400 percent of the poverty level have signed up.



 

Still not convinced, how about this?  *The "off-exchange market" (i.e. people who make too much money to quality for subsidies and whose premiums are required to subsidize everyone else who does qualify) contracted by 2.1mm in 2016, or a 29% drop.*  With those kind of declines, it's only a matter of time until there are no more rich fools in the pool willing to continue subsidizing a broken system.



Also, MFA published the same report in 2016, facilitating a year-over-year comparison. The on-exchange market fell from 12,681,874 to 12,216,003 individuals, a reduction of 465,871 or 4 percent. *However, the off-exchange market fell from 7,520,939 to 5,361,451, a reduction of 2,159,488 or 29 percent. In other words, enrollment is steady among those who receive subsidies but declining dramatically among those who do not.*

 

Much has been made of the question of whether the individual markets are in a “death spiral.” Given that the on-exchange market enrollment is relatively stable, there is clearly not a death spiral in the subsidized market. However, with a reduction in the unsubsidized market of 29 percent in just one year, that pattern certainly looks like one we would expect in a market spiraling down.



Meanwhile, of course, that 29% drop exactly why insurance companies are expected to hike their rates by 20-40% in certain markets again in 2018...

 

...and why rates have soared an average of 113% over the past 4 years, or nearly 30% per year.

 

*In summary, higher rates results in more people dropping out which results in higher rates...see the ponzi-ish circularity yet?* Reported by Zero Hedge 1 day ago.

Authored by Ilana Mercer via The Mises Institute,

On the eve of the federal convention, and following its adjournment in September of 1787,* the Anti-Federalists made the case that the Constitution makers in Philadelphia had exceeded the mandate they were given to amend the Articles of Confederation, and nothing more*.

*The Federal Constitution augured ill for freedom, argued the Anti-Federalists.* These unsung heroes had warned early Americans of the "ropes and chains of consolidation," in Patrick Henry's magnificent words, inherent in the new dispensation.

At the very least, and *after 230 years of just such "consolidation," it’s safe to say that the original Constitution is a dead letter.*

The natural- and common law traditions, once lodestars for lawmakers, have been buried under the rubble of legislation and statute. However much one shovels the muck of lawmaking aside, natural justice and the Founders' original intent remain buried too deep to exhume.

Consider: *America’s Constitution makers bequeathed a central government of delegated and enumerated powers*. The Constitution gives Congress only some eighteen specific legislative powers. Nowhere among these powers is Social Security, civil rights (predicated as they are on grotesque violations of property rights), Medicare, Medicaid, and the elaborate public works sprung from the General Welfare and Interstate Commerce Clauses.

*There is simply no warrant in the Constitution for most of what the Federal Frankenstein does.*

The welfare clause stipulates that "Congress will have the power … to provide for the general welfare." And even though the general clause is followed by a detailed enumeration of the limited powers so delegated; our overlords, over decades of dirigisme, have taken Article I, Section 8 to mean that government can pick The People's pockets and proceed with force against them for any perceivable purpose and project.

Today, Federal courts are in the business of harmonizing law across the nation, rather than allowing communities to live under laws they author, as guaranteed by The Tenth Amendment to the Constitution:



The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.



*In American federalism, the rights of the individual are secured through strict limits imposed on the power of the central government by a Bill of Rights and the division of authority between autonomous states and a federal government. *States had been entrusted with the power to beat back the federal occupier and void unconstitutional federal laws. States' rights are "an essential Americanism,” wrote Old Rightist Frank Chodorov. The Founding Fathers as well as the opponents of the Constitution agreed on the principle of divided authority as a safeguard to the rights of the individual."

Duly, Thomas Jefferson and James Madison perfected a certain doctrine in the Virginia and Kentucky Resolutions of 1798. "The Virginia Resolutions,” explains historian Thomas E. Woods, Jr., “spoke of the states' rights to 'interpose' between the federal government and the people of the states; the Kentucky Resolutions used the term nullification — the states, they said, could nullify federal laws that they believed to be unconstitutional." Jefferson," emphasizes Woods, "considered states' rights a much more important and effective safeguard of people's liberties than the 'checks and balances' among the three branches of the federal government."

And for good reason. While judicial review was intended to curb Congress and restrain the executive, in reality, the unholy judicial, legislative and executive federal trinity has simply colluded in an alliance that has helped to abolish the Tenth Amendment.

*You know the drill, but are always surprised anew by it. Voters pass a law under which a plurality wishes to live. Along comes a U.S. district judge and voids the law, citing a violation of the Fourteenth Amendment's Equal Protection Clause.*

For example: Voters might elect to prohibit government from sanctioning gay marriage. A U.S. district judge voids voter-approved law for violating the Fourteenth Amendment's Equal Protection Clause. These periodical contretemps around gay marriage are perfectly proper judicial activism heralded by the Fourteenth Amendment. Yet not even conservative constitutional originalists are willing to cop to the propriety of it all. If the Bill of Rights was intended to place strict limits on federal power and protect individual and locality from the national government — the Fourteenth Amendment effectively defeated that purpose by placing the power to enforce the Bill of Rights in federal hands, where it was never intended to be. Put differently, matters previously subject to state jurisdiction have been pulled into the orbit of a judiciary.

*The gist of it: Jeffersonian constitutional thought is no longer in the Constitution; its revival unlikely.*

As ardent a defender of the Constitution as constitutional scholar James McClellan was — even he conceded, sadly, that the Constitution makers were mistaken to rely on the good faith of Congress and their observance of the requirements of liberty, to rein in an Über-Presidency in the making. Nor has Congress prevented the rise of a legislating bureaucracy (the Deep State?) and an overweening judiciary — a judiciary that has, of late, found in the Constitution a mandate to compel commerce by forcing individual Americans to purchase health insurance on pains of a fine.

Meanwhile, John G. Roberts Jr., a “conservative,” rewrote Barack Obama's Affordable Care Act, and then proceeded to provide the fifth vote to uphold the individual mandate undergirding the law, thereby undeniably and obscenely extending Congress's taxing power.

*“[B]uried in the constitutional thickets” are “huge presidential powers,”* conceded historian Paul Johnson, in his History of the American People. The American president “was much stronger than most kings of the day, rivaled or exceeded only by the ‘Great Autocrat,’ the Tsar of Russia (and in practice stronger than most tsars). These powers were not explored until Andrew Jackson’s time, half a century on, when they astonished and frightened many people.”

These days, the toss-up in any given election is between submitting to the Democrats’ war on whites, the wealthy, and Wal-Mart, or being bedeviled by the Republicans’ wars on the world: Russia, China, Assad and The Ayatollahs. Or, suffering all the indignities listed — and more — in the case of candidates like Hillary Clinton.

The words of Republican office seekers notwithstanding — for most promise constitutionalism — a liberty-lover’s best hope is to see the legacy of the strongman who went before overturned for a period of time. In the age of unconstitutional government — Democratic and Republican — the best liberty lovers can look to is action and counteraction, force and counterforce in the service of liberty.

*Having prophesied that Philadelphia was the beginning of the end of the freedoms won in the American Revolution, our Anti-Federalist philosophical fathers fought to forestall the inevitable. For that we must salute them.* Reported by Zero Hedge 23 hours ago.

On July 26, 2017, the United States Court of Appeals for the Seventh Circuit in Carson v. Lake County, Indiana affirmed the district court's order granting summary judgment Reported by Mondaq 9 hours ago.

The Trump administration must decide within weeks whether to continue funding organizations that help people enroll in health insurance through the Affordable Care Act. Reported by Wall Street Journal 18 hours ago.

*NEWS RELEASE  /  REGULATED INFORMATION /* * INSIDE INFORMATION                                                 *

*IRVINE, CA, and HERSTAL, BELGIUM* - 07:00 CEST, August 10, 2017 - MDxHealth SA (Euronext: MDXH.BR) today announced that results from a study published in The Prostate further validated ConfirmMDx ^® for Prostate Cancer and showed that the test can provide treating urologists with deeper insights into a patient's risk for aggressive prostate cancer.
                                     
The ConfirmMDx clinical model combines standard clinical risk factors with DNA-methylation intensity of GSTP1, APC and RASSF1 genes to improve patient risk stratification and guide repeat prostate biopsy decisions.  Each of the 102 men enrolled in this multicenter study received a standard 12-core diagnostic biopsy, and the ConfirmMDx test was performed on all biopsy tissue cores. Histopathologic assessment revealed that 20 men had cancer-negative biopsy results, 46 men had low-grade (Gleason Score 6, GS6 or less) cancer and 36 high-grade (GS7 or greater) disease. ConfirmMDx risk scores were significantly higher in biopsy cores of men with high-grade disease. Moreover, in men with high-grade prostate cancer, the GS6 and cancer-negative biopsy cores also yielded high methylation intensities (both p
"The ConfirmMDx clinical model is a powerful molecular tool that can help compensate for prostate biopsy limitations and provide a more accurate risk assessment without conducting further invasive procedures," *said Prof. Dr. Sandra Gaston,* *Department of Pathology and Laboratory Medicine at Tufts University School of Medicine, Boston, Massachusetts.* "In addition to ConfirmMDx identifying false-negative biopsy results, the risk score can more accurately predict a patient's cancer grade upon repeat biopsy. This information is critical to determining who would benefit most from a repeat procedure."

ConfirmMDx is already included in the National Comprehensive Cancer Network (NCCN) Guidelines for Early Prostate Cancer Detection, helping urologists determine the necessity of a repeat prostate biopsy. Used in conjunction with other clinical information, ConfirmMDx also aids in the identification of men with occult high-grade disease, and may therefore help clinicians and patients to make better-informed treatment decisions.

* About ConfirmMDx for Prostate Cancer *

ConfirmMDx for Prostate Cancer is the first epigenetic, and only tissue-based test in the 2016 NCCN Guidelines for early detection of prostate cancer which addresses false negative biopsy concerns. It is the only molecular diagnostic test that provides a very high negative predictive value (NPV) of 96% for clinically significant prostate cancers, and 90% NPV for all prostate cancers, as well as prostate mapping of the test results to help guide repeat biopsies. Each year, more than 1 million American men undergo an invasive prostate biopsy with a negative result, however approximately 30% of those men have prostate cancer. The current standard of care for prostate biopsy procedures samples less than 1% of the prostate, leaving men at risk for undetected cancer and leading to a high rate of repeat biopsies, even on cancer-free men. ConfirmMDx for Prostate Cancer helps urologists identify low-risk men who may forego an unnecessary repeat biopsy and high-risk men who may benefit from intervention. ConfirmMDx has qualified for Medicare reimbursement and covered by numerous private health insurance plans.

* About MDxHealth *

MDxHealth is a multinational healthcare company that provides actionable molecular diagnostic information to personalize the diagnosis and treatment of cancer. The company's tests are based on proprietary genetic, epigenetic (methylation) and other molecular technologies and assist physicians with the diagnosis of urologic cancers, prognosis of recurrence risk, and prediction of response to a specific therapy. The Company's European headquarters are in Herstal, Belgium, with laboratory operations in Nijmegen, The Netherlands, and US headquarters and laboratory operations based in Irvine, California. For more information, visit mdxhealth.com and follow us on social media at: twitter.com/mdxhealth , facebook.com/mdxhealth and linkedin.com/company/mdxhealth .

*For more information:*

Shalon Roth, EVP Corporate Communications
MDxHealth
+44 (0)7393 906278
shalon.roth@mdxhealth.com

This press release contains forward-looking statements and estimates with respect to the anticipated future performance of MDxHealth and the market in which it operates. Such statements and estimates are based on assumptions and assessments of known and unknown risks, uncertainties and other factors, which were deemed reasonable but may not prove to be correct. Actual events are difficult to predict, may depend upon factors that are beyond the company's control, and may turn out to be materially different. MDxHealth expressly disclaims any obligation to update any such forward-looking statements in this release to reflect any change in its expectations with regard thereto or any change in events, conditions or circumstances on which any such statement is based unless required by law or regulation.  This press release does not constitute an offer or invitation for the sale or purchase of securities or assets of MDxHealth in any jurisdiction. No securities of MDxHealth may be offered or sold within the United States without registration under the U.S. Securities Act of 1933, as amended, or in compliance with an exemption therefrom, and in accordance with any applicable U.S. securities laws.

* NOTE: * The MDxHealth logo, MDxHealth, ConfirmMDx, SelectMDx , AssureMDx, PredictMDx and UrNCollect are trademarks or registered trademarks of MDxHealth SA. All other trademarks and service marks are the property of their respective owners.

ConfirmMDx clinical model press release
--------------------This announcement is distributed by NASDAQ OMX Corporate Solutions on behalf of NASDAQ OMX Corporate Solutions clients.

The issuer of this announcement warrants that they are solely responsible for the content, accuracy and originality of the information contained therein.

Source: MDxHealth (R) via GlobeNewswire

HUG#2126484 Reported by GlobeNewswire 18 hours ago.

AppRev, an industry leader in healthcare revenue cycle management, announced today that their President and CEO, Seth Avery, will be a featured speaker at the Florida Sunshine Chapter American Association of Healthcare Administrative Management (AAHAM) Health Insurance Institute.

Temple, Texas (PRWEB) August 10, 2017

Mr. Avery will present “Denials Management: From the Basics to Success,” on August 17, 2017. The presentation will cover a range of topics, including understanding the basics of denial management, denial Key Performance Indicators (KPIs), information used to understand KPIs and best practices for providers.

Using data and lessons from healthcare providers across the United States, Mr. Avery will share common KPIs used to manage their denial programs and will answer the following questions: How are KPIs collected and how are they used? How do they look at average recovery and denial rates? How are they moving the dial on these denial numbers? Participants will be encouraged to share their experiences.  

“I’m looking forward to speaking at this conference,” said Mr. Avery. “It’s an honor to be a part of the Florida Sunshine Chapter’s strong commitment to educational excellence.”

The Florida Sunshine Chapter, a healthcare finance organization that supports the national American Association of Healthcare Administrative Management, provides networking and education opportunities through conferences, webinars, scholarships and several levels of professional certification.

Seth Avery has over 25 years of experience as a healthcare executive, serving as auditor, consultant, Administrator and Chief Financial Officer (CFO). Mr. Avery has served as the CFO for a major teaching hospital in Texas and as the Executive Director of a leading New Jersey Medical School. He has worked at government, for-profit, and not-for-profit health care providers, as well as at a Big 6 organization.

Mr. Avery has been certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) and is a past member of the National Advisory Board for the AAPC. He has a B.S. from Campbell University, an M.A. in Economics from the University of New Mexico and a Juris Doctor from Texas A&M University. Seth is also a 14-year veteran of the U.S. Military, serving both as a member of 5th Special Forces Group and as a Medical Service Corps officer.

He is a frequent speaker at Healthcare Financial Management Association conferences and presents webinars providing education on various healthcare finance topics.

AppRev is a privately held Healthcare Business Intelligence company based in Temple, Texas, providing services and technology to more than 80 hospitals throughout the United States and Bermuda. AppRev delivers results through services and technology that allow hospitals and clinics to improve revenue cycle performance. The company’s solutions are provided via web delivered Service Supported Software™ and include Charge Accuracy, Charge Review, Denials Intelligence, Pricing Analytics, CDM and DSH services. All AppRev solutions employ ongoing measurement of revenue cycle improvements and can be tailored to meet customer-specific requirements. Reported by PRWeb 16 hours ago.

WASHINGTON (AP) — The Trump administration's own actions are triggering double-digit premium increases on individual health insurance policies purchased by many consumers, a nonpartisan study has found. The analysis released Thursday by the Kaiser Family Foundation found that mixed signals from President Donald Trump have created uncertainty "far outside the norm," leading insurers to seek higher premium increases for 2018 than would otherwise have been the case. Researchers from the Kaiser foundation looked at proposed premiums for a benchmark silver plan across major metropolitan areas in 20 states and Washington, D.C. Overall, they found that 15 of those cities will see increases of 10 percent or more next year. About 10 million people who buy policies through HealthCare.gov and state-run markets are potentially affected, as well as another 5 million to 7 million who purchase individual policies on their own. Consumers in the government-sponsored markets can dodge the hit with the help of tax credits that most of them qualify for to help pay premiums. "The vast majority of companies in states with detailed rate filings have included some language around the uncertainty, so it is likely that more companies will revise their premiums to reflect uncertainty in the absence of clear answers from Congress or the administration," the report said. "The Trump administration is committed to repealing and replacing Obamacare and will always be focused on putting patients, families, and doctors, not Washington, in charge of health care," Marre said in a statement. The ongoing political turmoil for people who buy individual health insurance stands in sharp contrast to relative calm and stability for the majority of Americans insured through workplace plans. Reported by SeattlePI.com 15 hours ago.

A Social Security “reform trigger” would be pulled in any year the Social Security Trustees determine the 75-year actuarial balance of the Social Security Trust Fund is in deficit. When the trigger is pulled, the House budget resolution stipulates that the Trustees would have until September 30th of the same calendar year to submit recommendations for the changes necessary to achieve a positive 75-year balance to the President.

Washington, DC (PRWEB) August 10, 2017

The House fiscal year 2018 budget resolution includes instructions for creating an unusual Social Security “reform trigger” and sets up an expedited path for ensuing legislation, says The Senior Citizens League (TSCL). “The budget resolution instructions are written in such a way that lawmakers and President Trump would almost certainly be required to take up Social Security reform within the next 12 months,” says TSCL Social Security policy analyst Mary Johnson.

While budget resolutions don’t have the force of law, the agreements set out the U.S. fiscal year budget and serve as a blueprint for subsequent legislation. The House resolution also includes reconciliation instructions for the GOP’s tax reform plan, but the resolution has been stalled due to disagreements over mandatory spending that includes Social Security, Medicare, and Medicaid among others.

Under the proposed House budget resolution, a Social Security “reform trigger” would be pulled in any year the Social Security Trustees determine the 75-year actuarial balance of the Social Security Trust Fund is in deficit. The resolution would also put any legislation on an expedited schedule for passage.

“Using that criterion, the Social Security reform trigger has already been pulled,” Johnson notes. In their latest report, the Social Security Trustees say the combined retirement, survivors, and disability Trust Funds will exceed total income by increasing amounts starting in 2022 and will be depleted in 2034, well within the 75-year period called for in the budget resolution.

Once the Social Security reform trigger has been pulled, the House budget resolution stipulates that the Trustees would have until September 30th of the same calendar year to submit recommendations for the changes necessary to achieve a positive 75-year balance to the President. The resolution would then require the President to submit legislation to Congress within 60 days of receiving the Trustees’ recommendations. President Trump promised repeatedly on the campaign trail not to touch Social Security.

“Medicare is also in the cross - hairs for massive changes,” Johnson says. The budget resolution stipulates major changes that would focus Medicare on a system of private insurers, and provide beneficiaries with premium subsidies to shop for their own health insurance. A Congressional Budget Office report has found that similar proposals in the past would shift a growing portion of costs to older Americans. In that 2013 report, the CBO estimated that Medicare beneficiaries’ premiums would be about 30 percent higher by 2020 than under current law.

“Like health care legislation to repeal and replace Obamacare, Social Security and Medicare reform proposals could become the center of a nasty political tug-of-war,” Johnson says. TSCL works to protect retirement security and to promote better adequacy of both Social Security and Medicare benefits. To learn more, visit http://www.SeniorsLeague.org.

###

With 1.2 million supporters, The Senior Citizens League is one of the nation’s largest nonpartisan seniors groups. Its mission is to promote and assist members and supporters, to educate and alert senior citizens about their rights and freedoms as U.S. Citizens, and to protect and defend the benefits senior citizens have earned and paid for. The Senior Citizens League is a proud affiliate of The Retired Enlisted Association. Visit http://www.SeniorsLeague.org for more information. Reported by PRWeb 15 hours ago.

MEDICC REVIEW goes in-depth on Autism Spectrum Disorder in Cuba, how it is diagnosed, treated and managed.

Oakland, CA (PRWEB) August 10, 2017

Autism Spectrum Disorder (ASD) in Cuba, detailing accounts of persons, family members and health care providers managing this condition, is the lead feature in the April-July 2017 issue of MEDICC Review. The 1992 Constitution contains guarantees for persons with disabilities, but health care providers note that in the case of ASD, broad efforts are still hampered by a lack of a definitive study on its prevalence in Cuba. Nevertheless, an intersectoral nationwide program is under way to foster acceptance and inclusion for ASD individuals and their families.

This issue of MEDICC Review online also uses its cover to congratulate Cuba’s volunteer Henry Reeve Medical Contingent, winner of the WHO 2017 Global Health Prize. Formed in 2005, originally destined for post-Hurricane Katrina service in New Orleans, Cuba’s offer was rejected by Washington. But several thousand specially trained disaster responders went on to serve in dozens of countries, including Haiti and Pakistan.

Our Editor’s Choice section in this issue includes a Viewpoint on the role of Personal Responsibility in Cuba’s Universal Health Model,, original research on Origin and Evolutionary History of HIV-1 Subtype B in Cuba and Chile: Health Insurance Models & Inequalities.

See the current issue for the full Table of Contents.

IMPORTANT NOTICE: MEDICC Review is accepting manuscripts until September 1, 2017, for its special April 2018 issue on The Road to US-Cuba Health Cooperation, under the guidance of two distinguished guest editors: Dr. Pastor Castell‐Florit (Director of Cuba’s National School of Public Health, accorded the PAHO Health Administration in the Americas Award 2016) and Dr. Jon Andrus (Senior Investigator at the University of Colorado’s Center for Global Health, and former PAHO Deputy Director). The aim of the special issue is to reflect work designed collaboratively to contribute to population health, health equity, social determinants of health and wellbeing, global health cooperation, disaster response, environmental health, medical research to tackle diseases, health systems research, and all bilateral programs that frame “health in all policies”. Consult Author Guidelines.

About MEDICC Review
MEDICC Review is the first peer-reviewed journal in English dedicated to publishing original manuscripts by Cuban health and related professionals on topics of medical research, population health, and policies and practice of health in Cuba. The journal also publishes international authors on subjects related to health equity and vulnerable populations. Over 40,000 articles are accessed monthly by readers in 140+ countries.

Published by Medical Education Cooperation with Cuba (MEDICC), Oakland, California, USA, MEDICC Review articles are available open access, free online and available through MEDLINE/PubMed and other indexing services: http://www.medicc.org/mediccreview

About MEDICC
Founded in 1997, MEDICC is a US non-profit organization working to promote US-Cuba health collaboration and highlight Cuban public health contributions to global health equity and universal health. MEDICC  facilitates mutual learning opportunities in several ways: its documentary film ¡Salud!; the open-access, MEDLINE-indexed English journal, MEDICC Review; insightful trips to Cuba for US health policymakers, educators and practitioners; a national network of US communities whose leaders have been inspired to innovate for better health, thanks to their MEDICC-organized experiences in Cuba; and by serving as an institutional bridge-builder between US, Cuban and global health institutions and organizations. MEDICC also assists US graduates of Havana’s Latin American Medical School to return home to practice in provider-shortage areas, and supports US policies that facilitate greater health cooperation with Cuba for the benefit of people in both countries. To achieve our vision of health for all, MEDICC works with a global alliance of people who care about how others in the world live, learn, work, eat, play, and receive health care. Reported by PRWeb 10 hours ago.

· *John Sculley is the former CEO of Pepsi and Apple. He was brought on by Steve Jobs to be the then-young founder's "adult supervision."*
· *Sculley started his career at Pepsi driving its trucks and eventually became its CEO. *
· *He stayed at Apple for 10 years, and had a tense relationship with Jobs that led to Jobs' temporary departure from the company.*
· *After Apple, Sculley became a tech investor and he's now a founding member of a healthcare startup that he thinks could one day generate even more revenue than Apple.*

John Sculley remembers the first time he met Steve Jobs. He was CEO of Pepsi at the time, and he flew to California to meet with the then-26-year-old cofounder of Apple about a potential CEO role there.

Jobs had met about 20 other candidates and been unimpressed. But after 5 months of getting to know Sculley, he was sold and offered him the job. Sculley initially turned it down. Then Jobs dropped a now-famous line on him that made Sculley change his mind:

"Do you want to sell sugar water for the rest of your life? Or do you want to come with me and change the world?"

Sculley spent a decade at Apple, and it was a roller coaster ride. So was his relationship with Jobs. During one particularly tense moment, Jobs planned a coup to unseat Sculley. When Sculley learned about Jobs' plan, he held a board meeting that resulted in Jobs running from the room crying and taking a long sabbatical. It's a moment Sculley now regrets.

"In hindsight, now that I have decades of perspective, I didn't appreciate how important founders are," Sculley said in an interview for Business Insider's podcast, "Success! How I Did It."

"This was not a power struggle; this was two different points of view of how do you make the company sustainable. I can't change it, that's history, but it's actually beautiful that Steve did eventually come back to Apple, and of course he ended up becoming a very successful CEO. Steve Jobs 2.0 had matured tremendously from Steve Jobs 1.0."

After Sculley left Apple, he became a tech investor. He's now the cofounder of a healthcare startup that he thinks could become even bigger than Apple someday, RXAdvance. He says 5% of the US population — the chronically ill — accounts for $1.5 trillion in spending. And he thinks he's figured out a way to solve it.

"It turns out that the avoidable drug impacted medical costs —this is out of that $3 trillion of health spending —adds up to about $840 billion. That's many times bigger than most industries, certainly in high tech, and of that $840 billion, it's estimated that $350 billion is avoidable expense," Sculley explained.  

Sculley discussed his career, his friendship and eventual falling out with Steve Jobs, and his new healthcare initiative on the podcast, which you can  listen to below.

Subscribe to "Success! How I Did It" on Acast or iTunes. Check out previous episodes with:

· Angel investor Jason Calacanis
· Former Microsoft CEO and Clippers owner Steve Ballmer
· Box founder and CEO Aaron Levie
· Robinhood founder and CEO Vlad Tenev

Below is a transcript of the conversation, which has been lightly edited for clarity and length.

*Alyson Shontell:* We're so happy to have you, John.

*John Sculley:* Thank you.

*Shontell:* I want to go back to the beginning. Tell me about growing up.

*Sculley:* I was born in New York City, and when I was 5 or 6 years old, I never wanted toys; I wanted electrical parts so I could build things. And I was better at taking things apart and putting them back together, but I always had extra pieces left over, so I think it was an early warning that I was a better designer than an engineer.

I went to Brown, studied architectural design, and then I also went to RISD at the same time, and then I went on to the graduate school of architecture at the University of Pennsylvania. I never actually completed it. I moved over to the business school, the Wharton Business School, and got my MBA. I wanted to be an industrial designer, so I went to business school for that, and I then went on to marketing at Interpublic Group of Companies, which was one of the first organizations to actually think about brand marketing. I worked on Coca Cola's account, and then I was recruited by Pepsi, and I ended up being Pepsi's first MBA. I was called the High Wire Act because I was in my 20s and I was given jobs of increasing responsibility that I was totally unqualified for.

*From driving Pepsi trucks to becoming Pepsi's CEO in 10 years*

*Shontell:* So talk about your first job at Pepsi and what it was like.

*Sculley:* I was the first MBA and they didn't know what to do with me, so they put me out in Pittsburgh, in a bottling plant, and I worked in the bottling lines, and then I was sent on to Phoenix, Arizona, where I also drove trucks and I put up signs, Pepsi signage, in various neighborhoods in 120-degree heat and I was then sent on to Las Vegas for a month of training, and then I finally ended up in Milwaukee. So I got a really hands-on introduction to the soft-drink industry. I was so appreciative of the fact that I was able to not only learn a business through what I learned at business school, but I was able to learn it with hands-on learning. I'm a huge believer in hands-on learning.

*Shontell:* So you drove the Pepsi delivery trucks?

*Sculley:* I did, yeah.

*Shontell:* So from there all the way on up to CEO.

*Sculley:* I learned some amazing things, and I'll give you a perfect example of it. I was appointed marketing VP when I was just turning 30 years old and the first assignment I was given was to design a bottle that could compete with the little 6.5-ounce returnable bottle that Coke had that was a classic design. And we thought about that and we said, so why are we trying to design another little glass bottle? We make our money selling liquid ounces — why not design a really big bottle? And out of that came the development work of the first plastic bottle, the first 2-liter plastic bottle, and Pepsi brought that to market several years before Coca-Cola. It was a huge thing for us because, at the time I became marketing VP, we were outsold by Coke in the US, 10 to 1, in 50% of the country, so we were really a regional brand, and when we came out with the 2-liter plastic bottle, it completely changed the way in which soft drinks were merchandised. Because I was a designer, I designed the merchandising equipment and all the various things around it to help introduce the 2-liter bottle, and then we followed that on with the Pepsi Challenge.

*Shontell:* You hopped around all over the country for Pepsi and you were the youngest VP in Pepsi by age 30, eventually became its CEO within 10 years of being there. What do you think are the most important things you did during that first 10 years to take you from driving trucks to becoming CEO of the whole thing?

*Sculley:* I was always insatiably curious. I still am. I kept observing — when I was working in bottling plants, resetting shelves in supermarkets, out on the trade, talking to other Pepsi bottlers, observing, thinking, asking questions, you know. Why is it done this way? I think that, while I didn't know what the word "entrepreneur" was at that time, it's exactly the characteristics that I look for when I'm looking for really good entrepreneurs to lead companies because you have to have an inquiring mind, you have to say there must be a better way to do things, and now with technology at a point where everything is possible, how do we turn the possible into the probable? And it all starts with a passion to do something really well, to solve a problem in a way that's never been solved before, and to have just an incredible work ethic, to be persistent.

*Shontell:* One thing you also touched on was the famous Pepsi Challenge. It helped you guys take market share over Coca-Cola, which was this behemoth in the space, especially in Texas, where people had no idea really what Pepsi even was. They didn't think about drinking it.

*Sculley:* Yeah, the first market we introduced to the Pepsi Challenge in was San Antonio, Texas. It was one of those markets we were outsold by 10 to 1. The idea that someone would even think about having a different soft drink than Coca-Cola didn't even cross their minds, so we had to do something outrageous to get their attention and we knew from some of the research that we'd been doing a consumer taste test, that Pepsi actually had a slight preference over Coke — not much, but a slight preference of a few points over Coke.

*Shontell:* In terms of taste?

*Sculley:* In terms of taste, as long as you didn't put the brand label on it. As soon as you put the brand label on it, people always chose Coca-Cola. So the Pepsi Challenge was built on a blind taste test. My favorite one was in San Antonio. It was a grandmother with her little granddaughter looking over her shoulder. The grandmother said, “Well, I don't know why I'm here. I've never had a Pepsi before.” And as they do the reveal and the grandmother could see what she picked, the little granddaughter says, "Grandma, you picked Pepsi." And the grandma says, “I can't believe it. I've never had one before. I guess I really do like Pepsi better than Coke.” Bang, that was our commercial. And we did that over and over again because it was a brand-new tool, so it really caught everybody, including Coca-Cola, off guard. Coke was outraged, and that was the beginning of the Pepsi Challenge.

*Shontell:* And is it true that you chose Coca-Cola in a blind taste test?

*Sculley:* Oh, I wish you wouldn't bring that up! I was in Hawaii because we would introduce market by market, and fortunately those days we didn't have cable television so that you could see something that happened in Hawaii all the way back on the mainland. But I was being interviewed live in Honolulu and the lady interviewing me as people were taking the Pepsi Challenge taste test said, “Well, why don't you take the challenge test?” And I sort of hesitated, but there wasn't much I could say, so, unfortunately, I picked Coca-Cola.

*Meeting Steve Jobs*

*Shontell:* Well, it was an authentic test then, I guess.

So Steve Jobs grew very interested in this idea that you had helped build this huge promotional campaign for Pepsi and you were really focused on perception marketing. What was the first time you met Jobs? Do you remember?

*Sculley:* I do. Apple had been looking for a new CEO. They had fired their first CEO, and they were looking for a new CEO. Steve wanted the job. They said he was 26 years old, he was too young, and he was considered a little bit disruptive in those days. So they said, OK, you're the largest shareholder, you're the chairman of the board, you get a veto, right, but you're not ready to be the CEO. So they went through about 20 different candidates and Steve vetoed every one of them. They had exhausted the obvious candidates in the high-tech industry in California, and they went to executive recruiter Jerry Roach and Jerry Roach said, well, I want Steve to meet John Sculley. So I went out to Apple. Most people I knew had never even heard of Silicon Valley. We're now back in 1982. I showed up in Silicon Valley and when I got to Apple — remember, there was no GPS, just a map and a rented car — I wasn't even sure I was in the right place because there were no commercial buildings around, it was just houses and a few tilt-up structures, and it turned out that Steve was upstairs in the second floor of a converted house, and that's where he and I met for the first time.

*Shontell:* And so you go and meet this 26-year-old. What was Apple like in those days?

*Sculley:* The time that I joined, which was the following year in 1983, we were $569 million in revenue, the company had gone public a couple of years earlier, and it was really about as far from what any company looks like in corporate America. The building where Steve was building the Macintosh — it was still over a year away from being introduced — had a pirate flag flying from the flagpole on top of the building, a one-story building. When I went in, there were motorcycles and a Bösendorfer piano, which is one of the highest-end pianos, because Steve loved beautifully designed products.

The average age of the Mac team was 22 and Steve never wanted more than 100 people working in the Mac group, because he said he couldn't remember their names. So if you wanted to add somebody, somebody had to go, and those were the rules that Steve laid out. He was not an engineer: He was a brilliant individual with this ability to see around corners, to see things that other people couldn't see. I've learned over the years that there are some really talented people who can take the same evidence, the same facts, and look at them and see them in a way that interprets those facts entirely different than most people do.

The reason I got recruited to come to Apple — the board wanted adult supervision, Steve wanted someone who could teach him this experience marketing, because he used to say, “I'm going to build something that the world's never seen before. I'm going to build a computer for creative people to be able to create and do things that they didn't imagine they were able to do.” The rest of the world was focused on business machines, engineering work stations, how many bits and bytes of technology was involved. And Steve was focused on design. I had studied to be a designer and I didn't consider myself an engineer. I was comfortable around electronics, but I thought of myself more a designer. It was really design, curiosity, wanting to do things that had never been done before that brought us together.

*Shontell:* So you meet him and at this point he's turned down every other CEO option in tech and he's gone outside of tech now to find you. How did you win him over? What was that first meeting like? How did you not blow it like all the other guys did?

*Sculley:* I decided to talk to him about things that I knew he knew nothing about.

*Shontell:* So you made him feel dumb?

*Sculley:* No. I wanted him to realize that he didn't have all the answers. So I took him to the Metropolitan Museum of Art in New York and I took him through the Greek sculpture and showed him what Praxiteles did with the Praxitelean curve. I showed him how the Parthenon was designed and the mathematics used behind it, and I started teaching him about all these things that he had never been exposed to before. And I think it was, in hindsight, a good way for us to talk to each other. Let's get to know each other on a subject that I thought I could spark his curiosity and something he didn't know anything about.

*Shontell:* And it worked.

*Sculley:* It worked.

*Shontell:* And originally you said no to the offer?

*Sculley:* The most memorable moment was about five months after we had met. We were together every weekend, either in California or New York as we were getting to know one another. And finally it was March of 1983 and we were standing on the terrace of the new apartment Steve had just bought.

It was a triplex with a fabulous view and we were looking out over the Hudson River and as the sun was starting to go down, I said Steve, “I've been thinking about it a lot and I'm not coming to Apple. I'm going to stay here in the East Coast doing what I'm doing. I'll be an adviser for free. Let's just be friends, but I'm not coming to Apple.”

And he stood right up close to me, maybe 20 inches away, and looked up at me and he said, “Do you want to sell sugar water for the rest of your life? Or do you want to come with me and change the world?” Steve Jobs was one of these people who always knew what to say at exactly the right moment to get what he wanted. So even then I didn't change my mind, but a week later I was working for Apple.

*The moment that made Steve Jobs cry*

*Shontell:* Was it hard working with Steve those first few years? Because he wanted your job, the board told him no, and then you come in. How was working with him?

*Sculley:* The first year was spectacular — the board was very happy because they had some adult supervision. Turned out that the Apple 3, the next product after the Apple 2, failed, and then they followed with another product called Lisa, and that was failing, and the reality was that the only cash flow for the company was the Apple 2 when I joined. The Macintosh was still more than a year away and nobody expected to be cash flow positive for probably three years. So my job became managing the Apple 2. It didn't take any special knowledge of computers. It was all about marketing and sales, and we were able, in that year, to turn the Apple 2 around, we got back on a growth path, and it just was churning out cash flow, so Steve was happy about that.

A lot of the things we did after the first year were around, how do we grow the Macintosh into a sustainable business? And those were the things which actually laid the foundation for a lot of the things that even Apple uses today as first principles. But it also was what led to the breakdown in my relationship with Steve.

*Shontell:* Yeah, so talk a little bit about what happened there.

*Sculley:* When the Macintosh was first introduced, it was considered a brilliant conception but an impractical solution for anyone other than kids learning how to do simple things like draw images on a computer screen and simple word processor. So the next year, Steve came up with this idea he called the Macintosh Office, and by then Apple had developed a laser printer, the first commercial laser printer, and the processors that ran the laser printer were just not powerful enough to make it work very quickly. The Macintosh Office was a big disappointment and Steve was really down in the dumps, so he decided it was my fault and I said, “Steve, the Macintosh, I'm told by the engineers, is just not ready yet to do all the things we're claiming it can do and that another year or two, microprocessors will be powerful enough.”

He said, “No, it's your fault, John. You made me price the Macintosh too high at $2,495 when we launched it” — he wanted to launch it at $1995 — and he said, “You've got too much advertising and marketing going on the Apple 2. I want you to take the advertising down on the Apple 2 and put it behind the Macintosh and lower the price.”

And I said, “Steve, if we do that, we run the risk of throwing the company into a loss. We can't do that unless we go talk to the board.” He said “I don't think you'll do that” and I said “Watch me.”

And so the two of us went and we explained our different positions to the board, they ended up meeting with us individually, and at the end of it, the board said, we want the third cofounder, Mike Markkula, to go and do his own investigation, talk to the engineers, talk to the executives, and come back and make a recommendation to the board, which he did about a week and a half later.

And when he came back, he said, “I've done my investigation, and everybody agrees with John, not with Steve.” And so the board said, "Steve, you can still be the chairman of the board, you're the largest shareholder, but we want you to step down from the Macintosh group as head of it because you're too disruptive."

Steve was very much in shock; he never thought that that would happen, and he was furious at me. He went off on sabbatical for a while, and then about a month and a half later. I was supposed to go to China on a trip and one of the executives came to me and he said, “John, if you get on that plane tomorrow, you'll never come back as CEO. Steve's planning a coup while you're in China.”

And so I canceled my trip to China. I called a meeting of the executive staff and Steve was at one end of the table and I was at the other and I said, “Look, Steve, I heard that you're planning a coup when I go to China.”

He said, “Yes, I am. I think you're the wrong guy to be running Apple.”

I said, “Well, I clearly can't run it if I don't have the support of the team, so let's go around the room and ask each of the members” — I didn't know what they were going to say — “each of the exec staff members what they think.”

Each of them said, “Steve, you're the visionary, you're the genius, there wouldn't be an Apple without you, but we don't agree with what you want to do. We agree with John.”

Steve burst into tears and ran out of the room and that was really what led to him going off on a long sabbatical for about almost four months. He was never actually fired, but I have to say in hindsight now that I have decades of perspective, I didn't appreciate how important founders are. This was not a power struggle; this was two different points of view of how do you make the company sustainable.

I can't change it, that's history, but it's actually beautiful that Steve did eventually come back to Apple, and of course he ended up becoming a very successful CEO. Steve Jobs 2.0 had matured tremendously from Steve Jobs 1.0.

*Shontell:* So let's talk about what Apple was like after Jobs while you were there. Revenues grew tremendously. One of your big projects was Newton. So talk about some of your big projects there and what those years were like after Jobs.

*Sculley:* I was actually there for 10 years as CEO, and if you repeat something long enough people believe it's what happened. A lot of people think that after Steve, the company crashed and then Steve came back and saved the company. Steve did come back and save the company — 15 years later.

What happened in between was we grew the Macintosh into the largest-selling personal computer in the world. It passed every other hardware product in the world. By the time I left Apple, in the beginning of 1993, we were the most profitable computer company in the world, more profitable than IBM or HP, and we had $2 billion in cash and we had $200 million of debt. So the company was actually in a very good place.

The challenge was that Microsoft under Bill Gates' leadership and Intel under Andy Groves' leadership — Moore's law, the processors kept getting faster and more powerful — Intel could build a huge business selling processors and Microsoft could build a huge business selling software operating systems and apps and it was as good as the Macintosh. Everyone started to panic at Apple, the board panicked, the executives panicked, and they said, "What are we going to do?" We'd have to lay off over 80% of our people, even if we doubled the price that Windows was selling their operating system at, it would take us a very high risk path that we could ever get to break even, so I was adamantly against it. I said, “If we do that, we'll bankrupt the company, and I don't want to be a part of it.” So I was fired and then Apple went through, for the next four and a half years, two CEOs before Steve came back, and the company almost went bankrupt.

The part of the story that most people don't know is that we were working on a new product, an entirely different field. We called them personal digital assistants and we were developing a new product along that idea called Newton. Newton was going to be our entrée into this handheld market where you just have a touchscreen. This is before the worldwide web. It's before digital cellphones. None of this stuff existed at that time, and I remember going to a computer electronics show in January of 1993 and giving a keynote speech about the future of computing and that it would be about handheld devices and that they'd be sold in the billions. I got ridiculed because people said that is the most ridiculous statement we've ever heard anyone in technology say.

When we launched the product, there was very little that the Newton could do, and people weren't particularly excited about it, and Newton was not a market success and eventually was dropped from the market. But what is important in Apple's history is that the 43% of ownership of that microprocessor that was developed for the Newton eventually became worth $800 million. When Gil Amelio, who was the CEO just before Steve Jobs returning, needed to make a payroll and then had the wise decision to acquire Steve Jobs' next software company that he was able to pay for it with the 43% of the technology that Apple had codeveloped, which is known as the ARM processor. The ARM processor is in every smartphone, every mobile device in the world. It was recently sold to SoftBank for $32 billion. It is one of the foundation technologies of these devices, which were ridiculed as never going to happen.

*Shontell:* Do you see parallels between your reign at Apple and Tim Cook's?

*Sculley:* Not really. I think Tim Cook is doing a brilliant job. He's a far better manager than I could ever hope to be. He is exactly what Steve Jobs needed. Steve was the visionary, Steve was the one who would take the risk. Tim is a more cautious executive and he is an evolutionary leader who has grown the market value of Apple into the most valuable company in the world. He never compromised on the quality of the products, he has great integrity, he's highly admired by everybody, so Tim Cook is a superstar, but he is very different from the Steve Jobs that I knew.

**Starting a "noble cause" that could become bigger than Apple**

*Shontell:* And so take me into the time after Apple. I think someone said to you that you needed to reinvent yourself every 10 years. So have you reinvented yourself?

*Sculley:* Well, after Apple, I went into a regulated industry. I was part of the founding team of a company called MetroPCS. I've been in financial services. A decade ago, when I thought about what I'd learned from Steve Jobs and Bill Gates and the noble cause, and a good friend of mine, Bob Metcalfe, who invented Ethernet, he said, “You know, we have to reinvent ourselves,” and as I thought about that, I said, “Well, I'm going to reinvent myself around a noble cause,” which was healthcare.

Here's a $3 trillion industry that's not sustainable in the US in its present form. There's all this incredible talent that is inventing new ways to do things in other industries and somehow, healthcare got left behind. The most exciting thing that I've been involved with since Apple is a company that I'm part of, the cofounding group and chairman of the board, but most importantly, the chief marketing officer of, and just a fabulously talented CEO-founder named Ravi Ika. Ravi realized that he could fundamentally change the way that we serve the most expensive population in the country for healthcare. Five percent of the population accounts for $1.5 trillion of health spending. That's half the health spending in America.

*Shontell:* And what is that 5% of the population?

*Sculley:* These are the chronically ill. They are often low-information people. They may live in trailer homes or they may live in single-room apartments. They may live in assisted living. They are probably going to be older. They typically have nine chronic-care diseases.

How do you avoid additional medical procedures that are time-consuming and expensive? It turns out that the avoidable drug impacted medical costs, this is out of that $3 trillion of health spending, adds up to about $840 billion, that's many times bigger than most industries, certainly in high tech, and of that $840 billion, it's estimated that $350 billion is avoidable expense. McKinsey Global Institute is one of the people who've tried to document what this opportunity is and if you could take just a percentage of that avoidable expense for medications and the impact of wrong medications or overprescribed medications or people not adhering to taking their medications routinely, if you could take just a few percentage out of that $350 billion of waste abuse, of medications, prescribed medications, you could pay for health insurance for every American.

*Shontell:* So how do you do that? It sounds easy, but it also sounds impossibly hard.

*Sculley:* Well, it takes a really granular understanding of the domain of that sector of healthcare because there are precedents, there are protocols, there are rules, regulations that have no logic to them. It's an industry that spends more money on lobbying than any other industry in America, so there is lots of political pressure to do things to the benefit of different parts of the healthcare economy. So it can be not just adjudicating the benefits between pharmaceutical companies and health plans where this information is traditionally used, but he takes it all the way across to the specialist physicians, to the other health professionals, all the way out to point of care. So the result is that we founded the company in 2013.

*Shontell:* And what's it called?

*Sculley:* It's called RXAdvance. This year we'll do $500 million of contracted revenue. Next year we expect to be at $2.2 billion contracted revenue and by 2020 we're pretty confident that we'll be somewhere between $10 billion and $12 billion of revenue. We'll be nicely profitable in 2018.

Ravi Ika and I were recently out meeting with Gov. Kasich from Ohio and Gov. Scott Walker from Wisconsin and showing them that there's opportunity to take hundreds and hundreds of millions of dollars out of the cost of Medicaid, because Medicaid is not sustainable with the opioid epidemic that's going on now. We were down meeting with six different senators in Washington before the vote on the healthcare bill, saying, look, what you're debating has very little consequence on improving the life quality of the most seriously ill patients.

There's no way to come up with a better healthcare system unless you get bipartisan support. So it may be fortunate, in hindsight, that the bill was rejected, because it may force us, whether it happens in 2017 or after the elections in 2018, to bring in innovation as part of the solution. There may actually be ways to bring innovation into this industry as it's been brought into the automotive industry and the transportation industry and into ecommerce and social media, all these other industries are getting completely disintermediated. Why not healthcare?

*Advice for the next generation*

*Shontell:* I just had one more question for you. You wrote a book, "Moonshot." And it was about career lessons from a bunch of founders and entrepreneurs and CEOs, including yourself. Looking back now on your career, what advice would you give to someone who's just starting theirs out?

*Sculley:* Be curious. Insatiable curiosity is infectious to everyone around you. To find something to become passionate about, to constantly ask the right questions. We live in an era today where we can get the answers for everything. In my generation, going to school meant learning the answers. Today, education should be more about knowing what the right questions are. The answers come for free. Having a passion, willing to be persistent even if you stumble and make mistakes, pick yourself back up, never give up, never ever give up. It's tempting to give up, you know, when you embarrass yourself, and we've all done it. But it's an amazing time to be an entrepreneur because not only is the stuff getting more capable and powerful, but it's becoming more reliable and the costs are coming down dramatically. So you can go out as an entrepreneur and start a company on a credit card and go to AWS and a few other services and be pretty virtual and, who knows, you may be the next Steve Jobs.

*Shontell:* Great, thank you so much, John. It's been a pleasure.

*Sculley:* Thank you.

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