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Torture? Venezuela Press Shows Leopoldo Lopez in Good Health

On Saturday, Venezuelan press published images proving that right-wing opposition leader Leopoldo Lopez hadn’t been tortured in prison.

Venezuela Opposition Leader Tries to Foment Military Uprising

Lopez’s wife, Lilian Tintori, previously tweeted that her husband was allegedly being tortured. She also released a video where Lopez is heard shouting: “Lilian, they are torturing me, denounce it.”

However, Ultimas Noticias published exclusive photos showing Lopez receiving a routine medical check-up. The images, which show Lopez in good health, revealed that he had not been tortured. 

Images of his wife delivering him food on Friday were also published.

Responding to mainstream media’s echoing of Tintori’s claims, Venezuelan President Nicolas Maduro insisted that corporate news outlets report on the broader truth about what’s going on in Venezuela. He added that participating in false reports only incites violence and hatred toward his country.

In 2014, Leopoldo Lopez, one-time mayor of the wealthy Caracas district of Chacao, made international headlines when he called for, planned and then promoted violent blockades in Venezuela. The blockades, which became known as “Guarimbas,” claimed the lives of 43 people, injured hundreds and caused billions of dollars in damage to public buildings and infrastructure. He was arrested, tried, condemned and sent to prison that same year.

Lopez and his wife Tintori have been outspoken opponents of Maduro and the Bolivarian Revolution launched by late President Hugo Chavez. Since her husband’s imprisonment, Tintori has embarked on an international campaign to smear the government of Maduro, including meeting with figures such as U.S. President Donald Trump.

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The Good, The Bad, And The Senate Health-Care Bill

The health-care bill now before the Senate has been shaped by a number of lessons that Republicans have learned in the course of a six-month, bicameral legislative process. It is a function of some things they’ve come to prioritize about the individual health-insurance market and Medicaid, and some things they’ve learned about the intricacies of the Byrd rule and Senate procedural constraints. But mostly it is a function of something they have learned about themselves: After seven years of saying they want to repeal and replace Obamacare, congressional Republicans have been forced to confront the fact that many of them, perhaps most, actually don’t quite want to do that.

That doesn’t mean that most of them never did. The case for repeal was strongest in the three or four years between the enactment and implementation of Obamacare. As more time passes since the beginning of implementation three and a half years ago, and more people’s lives become intertwined with the program for good and bad, the case for addressing Obamacare’s immense deficiencies by repeal weakens as a practical matter in favor of a case for taking them on by alteration. 

I don’t think it has weakened as much as congressional Republicans do. And so I still think it is very much the case that the cause of good policy (almost regardless of your priorities in health care) would be better served by a repeal and replacement, with appropriate transition measures, than by this sort of tinkering—you’d get more coverage, a better health-financing system, and a more appropriate role for government. 

Various conservative health-care wonks have proposed various ways of doing this over these seven years (I like this one, but I’m not objective, and most if not all would have made for serious improvements). Various Republican politicians have patted these wonks on the head and said “someday,” but everyone has understood that if and when an opportunity presented itself it would be shaped by its own unpredictable political exigencies. 

At first this year, congressional leaders tended to describe these exigencies in terms of the limits of the reconciliation process. But with each step it has turned out that reconciliation can bear much more than they first suggested. It is surely a constraint, but if the bulk of this Senate bill passes muster under the Byrd rule then reconciliation is not nearly as tight a constraint as it was said to be a few months ago. 

The president has been an additional unpredictable political constraint—as the more coherent of his musings on health care have all suggested he is not comfortable with repealing and replacing the law, or at least is unfamiliar with the tradeoffs involved and unhappy when he learns about them. This probably had some effect on congressional Republican attitudes, at least early on. But another thing Republicans have learned in these six months is that Donald Trump is an exceptionally weak president, probably the weakest of their lifetimes, and he is likely to accept whatever they do. He’ll celebrate it, sitting himself front and center while they stand around him awkwardly. He’ll praise it wildly and inaccurately. And he’ll sign it—even if pretty soon thereafter, in the wake of bad press, he tries to distance himself from it on Twitter and calls them names.  

So the most significant lesson Republicans have learned in this period is that what they—as a congressional conference guided by the sentiments of a majority of its members—want to do about Obamacare doesn’t begin with repeal. Whether they individually hold this view or not, congressional Republicans should not deny that this is the premise that they as a group have decided to start from, because the bill they passed in the House and the one they are now pursuing in the Senate wouldn’t make sense under any other premise. They are choosing to address discrete problems with Obamacare within the framework it created and to pursue some significant structural reforms to Medicaid beyond that, and they should want the merits of their proposal judged accordingly. Their premise is politically defensible—it is probably more so than my premise—and the proposal they have developed makes some sense in light of it. 

On the substantive particulars, I would say the bill is mostly better than the House version passed last month. We will see what CBO and other modelers ultimately say (understanding the limits of such modeling), but it seems to me it will probably cover more people, reduce premiums more, and allow for a greater reassertion of state regulatory control over health insurance. Better than the House bill isn’t extravagant praise, of course, but it is certainly one bar such a bill ought to clear. 

The tax credit in the Senate bill differs from Obamacare’s premium subsidies only modestly, but in ways that, again, make sense in light of what Republicans are after. It is pegged to a less comprehensive insurance model and will both cost less and leave more room for more variation in insurance design—though this obviously means it will be less valuable and helpful to some of the people now getting subsidies. Will less help in a more functional market be better than more help in a less functional market? There’s a good case to be made for that, but no one should pretend to know for sure. 

The credit also reaches all the way down to the bottom of the income scale, which I think of as an element of the bill’s Medicaid reform. Where today, people newly covered by Obamacare’s Medicaid expansion (who tend to be childless adults with relatively higher incomes than the non-expansion population) are funded by the federal government on much better terms than the traditional Medicaid population (which tends to include more women with children and people with even lower incomes), the Senate bill would gradually equalize funding for the two groups, effectively shifting Medicaid’s focus back to the most vulnerable of its beneficiaries. In states that respond to that by pulling back the expansion—and for states that have not pursued an expansion—the fact that the credit now goes all the way down means the Senate bill would provide an income and age-based subsidy that would allow these lowest-income individuals to afford at least modest insurance coverage in the individual market. 

That’s an improvement over the House bill and Obamacare, though I think it would make sense to provide some additional help to this lowest-income group. Some pre-funding of health savings accounts, for instance, could go a long way. The states could do that too, and should, but it’s not how congressional Republicans tend to think about the purpose of such accounts, alas. The portions of the conservative approach to health care that require spending public funds have never been as appealing as the rest on Capitol Hill. 

The bill’s broader Medicaid reform and the move to per-capita caps or (for states that choose them) block grants is otherwise very similar to that proposed by the House bill. It would take effect more gradually, though will ultimately also likely reduce federal spending more, but would follow the same basic structure. 

These Medicaid reforms probably won’t happen as written, because they are stretched out over a long span of time and yet are also highly controversial. But while the decline in the spending trajectory (which becomes particularly steep and unrealistic in the latter years of the budget window) would probably need to be moderated some by a future Congress, the structural reform would not be so easy to reverse—and any change would have to be paid for in ways that wouldn’t be so easy either. We will have to see how CBO scores the proposal, but eyeing it very generally I would say the Senate bill as written would probably mean that Medicaid would cost the federal government about 30 percent more 10 years from now than it does today (as opposed to about 65 percent more under current law), and would cover something like the same number of people at that point as today (as opposed to 10 million more under current law). All of that would be likely to change with future legislation, but the core structural reform—a move away from the horrendous state-match system—could well survive, and would be an important improvement almost regardless of spending levels.    

But the biggest change from the House bill, and from Obamacare, might prove to be the way in which the Senate bill tries to give states regulatory flexibility and control over the individual insurance market. Here we see how more explicitly embracing the premise of this legislation—that Republicans are not repealing Obamacare, but they are addressing some of its biggest problems—can actually enable them to move more aggressively rather than less. 

The federalization of health-insurance regulation is the core of Obamacare, and of the problem with it. The House bill sought to reverse it partially by allowing the states to obtain waivers from a couple of elements of Title I of the law—particularly the definition of essential health benefits, and the age-bands that govern how widely premiums can vary between younger and older people. The Senate bill pursues similar goals within the framework of Obamacare, by vastly expanding the range of permissible state waivers under Section 1332 of the law. 

Under Obamacare, these waivers technically allow states to pursue different insurance-regulation regimes, but they are very limited in scope because a state has to show that it would achieve exactly the same thing the federal Obamacare rules would achieve, which means states can’t really do anything all that different. The Senate bill removes most of these “guardrails” on the waivers, requiring only that a state show that its proposed alternative would not increase the federal deficit. So while a state could not, for instance, end community rating rules (because the 1332 waivers have to operate within the framework of community rating created by Obamacare), it could very significantly change other kinds of rules and requirements within its borders—to a far greater degree than anything the House waivers envisioned. And the bill requires that these waivers be more or less automatically approved. 

States could not only roll back essential health benefit definitions and broaden age bands to where they were before Obamacare, but also alter the uses to which federal dollars are put. They could take the amount their residents are eligible to receive in premium-subsidizing tax credits, for instance, and use it instead to create a new state benefit designed very differently. They could combine it with the stabilization fund dollars provided under this bill and with a state Medicaid reform to experiment with a different approach to providing access to insurance for their residents. They could alter the balance of benefits between younger and older people in the individual market, or change or eliminate the exchange in the state. If this were enacted, and once states got their bearings about just how much it would allow them to do, we could see some genuinely different approaches to health-insurance regulation among the different states—with blue and red models, rural and urban approaches, and more and less competitive systems. 

The limits of this provision are a function of the fact that it alters a portion of a broader pre-existing statute. But it is very broad. In its scope and structure, this redesigned waiver would be unlike anything else in American federalism—which also means we don’t know how it would work. Those of us inclined to look favorably upon a bottom-up, experimental mindset in policy design will be inclined to think the best of the possibilities here. I am very much in the grip of this prejudice myself. Those inclined to think the state governments are filled with bumbling fools while Washington overflows with subtle expertise will think the worst of this idea. But these different expectations are all rooted in roughly equal ignorance, and the results will probably be mixed enough to leave us all feeling mostly confirmed in our presuppositions in time—just as the performance of Obamacare has. But for better or worse, if this bill were enacted I think this waiver approach could prove to be one of its most significant elements in practice. 

Assuming, that is, that it survives the reconciliation process. And here to conclude we get to some big open questions about this bill that will need to be answered in the coming days if Republicans are able to bring it to a vote. Republicans began this process six months ago talking about the Byrd rule in the Senate as an immense obstacle to their ambitions. Now they are planning to take a bill to the floor of the Senate that assumes it to be a much lesser obstacle. And we will find out. One interesting test will be these expanded 1332 waivers. It’s not clear to me why they should pass muster with the parliamentarian, but their authors do seem very confident. 

Another Byrd rule question will surely arise over the Senate Republicans’ alternative to the 30 percent premium surcharge for people not continuously insured, that had been in the House bill. It was intended, in the absence of the individual mandate, to dissuade people from waiting until they are sick to buy coverage. In the version of the bill released last week, senators removed the surcharge but proposed no alternative and therefore did nothing to address the risk of adverse selection. If the version of this bill scored by the CBO is that version released last week, this will mean the score will be a total train wreck, and also largely useless to assessing the bill the Senate will ultimately vote on. It has since become clear that senators plan to add a provision to address this problem: subjecting people who have not been continuously insured to a six-month waiting period before they can buy coverage. In order to comply with the Byrd rule, I assume they will need to frame this provision as a delay in the availability of the tax credit, rather than an actual waiting period to buy coverage. Either way, it will be interesting to see if the parliamentarian allows it. 

A third and bigger Byrd rule problem will surely arise around the anti-abortion provisions in the bill. The Senate bill as released last week includes the House language imposing Hyde Amendment protections on the tax credit, so that it can’t be used to subsidize insurance that covers abortion. I think the likelihood that this provision will survive a Byrd-rule challenge is pretty much zero. 

But the bill also does something else: In creating the new state stability fund—to be used by the states for reinsurance or otherwise to shore up the individual market so badly damaged by Obamacare—it establishes the fund within the existing Children’s Health Insurance Program. CHIP was created in the 1990s, and the law that established it applies Hyde Amendment restrictions to the program in its entirety, and several times over. That means that, as a matter of statutory construction and placement, the new state stability fund would be covered by the Hyde Amendment without now having to get Hyde language past the parliamentarian. 

If this works it would establish a new kind of application for the Hyde Amendment language that has long prohibited federal dollars from paying for abortion in various programs. If I read it correctly, it looks like this provision would render any insurer who offers an individual-market plan that covers abortion in a given state ineligible to benefit from the stability fund in that state. It seems to me, though I can’t say I’m sure, that this would effectively mean that no insurance plans in the individual market would cover abortion. It could easily even mean that California, which has a state law requiring individual-market plans to cover elective abortion, would have to repeal that law or else forgo access to the stability fund. This, too, will prove quite a test of the Byrd rule, but I think the case for its qualifying for reconciliation is pretty strong. 

These are only a few of the more significant provisions of the Senate bill. But they suggest the pattern for any broader assessment of the bill. It is the product of a decision not to repeal Obamacare but to improve things where possible—moving incrementally in the direction of a more functional and more market-oriented system—within the framework Obamacare established. 

So while I don’t share the enthusiasm for this bill that my friend Avik Roy exhibits (and you should certainly read his view), I do think it is probably more good than bad on net—and could be readily improved and made more generous in years to come while retaining some important structural reforms and innovations, should further advances in Republican self-knowledge point in that direction. 

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Regulators see good news in health care reform survey

Green Mountain Care Board

Green Mountain Care Board members, from left, Con Hogan, Maureen Usifer and Robin Lunge. Photo by Erin Mansfield/VTDigger

Members of the Green Mountain Care Board said Thursday that a recent survey of primary care providers shows the state is making progress on health care reform.

The comments came days after its staff published results of a survey showing that 9 out of 10 primary care providers who responded thought the most recent forms of health care reform were not improving care or lowering costs.

The board commissioned the survey as part of its yearslong effort to implement health care reform through companies called accountable care organizations, or ACOs, which serve as intermediaries between insurance companies and doctors and encourage the doctors to coordinate patient care.

Vermont has encouraged a single ACO to form to be a regulated monopoly that encompasses Vermont’s whole health care system, including 15 hospitals, community health centers and private doctors’ offices. The ACO is the basis for the all-payer model agreement with the federal government.

On Thursday, board members discussed some of the major questions their staff, who have been working for more than three years on ACO reform, posed to primary care providers. The providers who answered were 325 doctors, nurse practitioners and physician assistants, out of about 956 who were asked to complete the survey.

The Vermont Department of Health estimates that in 2015 there were 636 doctors and 103 physician assistants working in primary care. In 2014, the department estimated there were 276 nurse practitioners working in primary care. That adds up to a bit more than the number of people who were surveyed.

Amanda Richardson, a survey researcher at Castleton University who wasn’t involved in this survey, said the questionnaire’s 34 percent response rate did not raise concerns. She said the real question is whether surveyors thought the 325 people were representative of the sample.

Kate O'Neill

Kate O’Neill, a payment reform evaluator for the Green Mountain Care Board. Photo by Erin Mansfield/VTDigger

That survey’s three main questions asked primary care providers how recent health reform initiatives involving ACOs have helped improve the quality of the care they provide, improve patient outcomes or lower costs, respectively.

About 9 out of 10 providers who responded to the survey said ACO reform has either had no effect or worsened the effect, or they didn’t know what the effect was.

Kate O’Neill, who worked on the survey for the Green Mountain Care Board, told board members that a large portion of people who responded to the overall survey did not respond to those three questions, even though they responded to everything else.

O’Neill said the relevant questions were in the middle of the survey, and the providers answered all the other questions, so it wasn’t possible that they simply forgot to finish the last few questions.

Richardson, in an interview, said that raised concern about whether the surveyors used language that made sense to the providers. “It might be that they don’t know, or it may be a really difficult question that they didn’t feel like answering,” she said.

During the public comment portion of the meeting, Dr. Deb Richter, a primary care physician, told the board that she was one of the providers who answered the survey, and she was one of just two people who knew what an ACO was.

Richter said the problem with ACO reform is that the premise assumes that if ACOs, which act a lot like health insurance companies, change financial incentives, doctors will improve care.

Deb Richter

Dr. Deb Richter, a primary care physician. Photo by Erin Mansfield/VTDigger

“If we were motivated by money, we would not be primary care physicians. We’d be opthamologists,” she said. “The whole premise of this that money motivates physicians is actually insulting.”

The providers did answer questions asking how the “hub and spoke” care coordination program for substance abuse, which started in 2012, and the Blueprint for Health — a care coordination program for primary care that started in 2003 — affected care.

In those cases, the results were much higher for quality: 76 percent thought “hub and spoke” increased the quality of services they deliver, and 66 percent thought the Blueprint for Health increased the quality of their services.

The results were also higher on those two programs for patient outcomes: 74 percent thought the hub and spoke program improved outcomes, and 54 percent thought the Blueprint for Health improved outcomes.

The numbers were lower for providers thinking the programs reduced costs, with 27 percent saying that about hub and spoke, and 26 percent saying that about Blueprint for Health.

However, only 27 percent who responded thought the hub and spoke program helped reduce health care costs, and only 26 percent thought the Blueprint for Health helped lower health care costs.

Jessica Holmes, a board member, asked O’Neill if the response rate was so low on those three questions that the data could be “invalidated.”

O’Neill said that was an important question to answer in the future.

Holmes also asked if there was a correlation between a provider’s response and whether the person worked for a private practice, a hospital-owned practice or a community health center.

O’Neill said her team could look at that question in the future.

Con Hogan, another board member, said: “This is a really encouraging chart because, at least on the paper, it’s saying that 76 percent of the providers felt that the hub and spoke either made a difference or was made somewhat better. Hub and spoke hasn’t been around that long. I think that is a very strong statement.”

Robin Lunge, another member of the Green Mountain Care Board, said: “I was actually somewhat surprised about how high these numbers were.” Before sitting on the board, Lunge was closely involved in setting up ACOs for then-Gov. Peter Shumlin.

Lunge explained the survey like this: When the state started setting up ACOs, they wondered whether the perception of the reform primary care providers, who are on the front lines of delivering care, mattered in changing the health care system.

“It’s an area for us to keep a focus on,” Lunge said. “If changing the payment doesn’t actually change things on the ground, then we know we’re not actually making a difference.”

Hogan described more of what he considered positive results.

“I’m coming up on my sixth year here” at the board, he said. “This stuff is so slow. It’s a big culture. It’s 18 and 19 percent of our economy. And cultures are hard to change, big time, but very preliminarily, it looks like the time cycle … it takes time.”

Hogan said a survey of providers is a look at health care reform internally. In comparison, he said, if members of the public had to answer the survey, almost none of them would be able to speak positively.

“We haven’t made that connection to the public now,” Hogan said. “They’re just receivers at the end of the line at a very superficial level.”

Ken Libertoff

Ken Libertoff, a mental health advocate. Photo by Erin Mansfield/VTDigger

During the meeting’s public comment period, Ken Libertoff, a mental health advocate, told the board that he thought, based on a VTDigger story about the survey, that the survey showed poor results from providers.

Libertoff said that based on the comments he heard at the meeting, he didn’t know whether board members were talking about the same survey.

“Clearly that survey, or the report of the survey, indicates a continuing concern about whether or not the health care reform effort is improving on quality or cost,” Libertoff said.

Hogan said he sees good news in the survey, but reform takes time.

“There is a sense that this data may be — may be — taking us in the right direction,” Hogan said. “The results on the ACO (questions) weren’t good, at all, but that’s because it’s a brand new, in the scope of health care, it’s a brand new program.”

“I’m not discouraged about this, but again, I think it takes so damn long, you forget where you started,” he said.

Lunge said the board should be careful in judging provider perception versus empirical results. She said members should look at whether there is data showing that the type of reforms they are doing make a difference, rather than if providers have a positive perception of reform.

Kevin Mullin, the board chair, said: “Surveys measure perceptions, but the empirical data on the quality measurements may be more indicative of reality.”

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Trump calls GOP senators who oppose health care bill "good guys" and "friends of mine"

President Trump has an optimistic outlook on the future of the Senate’s health care bill on Thursday, calling the four senators who are currently in opposition to the bill “good guys” and “friends of mine.”

“Well they’re also four good guys and they are four friends of mine – and I think that they’ll probably get there, we’ll have to see,” Mr. Trump said in an from an interview with Fox News’ “Fox and Friends” recorded Thursday. 

“You know healthcare is a very difficult situation,” the president continued. “If you look, the Clintons tried to get it and after years and years and years they couldn’t get it. Obamacare was murder for them to get and now it is failed, it is virtually out of business. Obamacare is a disaster, and we are trying to do something in a very short period of time.”

Mr. Trump on Thursday night tweeted that he is “very supportive” of the Senate’s health care proposal, introduced Thursday morning as a “draft discussion.” The four senators who said they cannot support the bill in its current form, but are open to negotiations, are Sen. Rand Paul (R-Kentucky), Sen. Mike Lee (R-Utah), Sen. Ron Johnson (R-Wisconsin) and Sen. Ted Cruz (R-Texas). Their opposition puts the bill in jeopardy, as the Republicans can only afford to lose two votes for the bill to pass. Cruz and Lee were on the 13-member working group that helped draft the legislation. 

“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor,” the four senators said in a Thursday statement. “There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”

That puts the Senate in a time crunch because Senate Majority Leader Mitch McConnell has said he wants to vote on the legislation, which was kept secret until Thursday, before the Senate recesses next week for the July 4th holiday.

White House deputy press secretary Sarah Huckabee Sanders on Thursday said the White House will work with the House and Senate to negotiate the path forward for health care.

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A journey to good health

Cycling has given retired Thai businessman Tawatchai Eakturapakal a new lease of life. This has driven Tawatchai to promote cycling for health tirelessly. The 69-year-old philanthrophist is the president of a provincial cycling club who organises weekend cycling trips to different parts of Thailand.

Last year, he was awarded a royal insignia by the Ministry of Tourism and Sports of Thailand, in recognition of his services to the country.

Tawatchai has come a long way from the days when he was suffering and struggling from a multitude of health issues. He has survived a few heart atttacks and chronic diseases such as kidney failure, tuberculosis, prostate cancer, lymphoma and an enlarged heart.

A father of three daughters, Tawatchai used to lead a stressful life.

“I worked too hard and led an unhealthy lifestyle. I ate unhealthy food and consumed too much alcohol and meat. Most of all, I also did not exercise,” he said.

In 1991, he was diagnosed with chronic kidney disease. For three years, he was on dialysis treatment. “In the beginning, I had to go for dialysis twice a month, then gradually once a week and then on alternate days,” recalled Tawatchai. But in 1994, he received a donated kidney, which meant that he no longer needed to go for dialysis.

Receiving the donated organ was a turning point for Tawatchai who vowed to look after his health. “After that, I try to live healthily and watch my diet,” he said.

Besides cutting down on meat, he eats everything but avoids oily, salty and sweet foods. These days, he also takes life easy.

“It’s hands off from business. My family and friends are helping to run these businesses. However, I will be there for them whenever they need my advice.”

But Tawatchai’s most significant resolve was to get fit and active.


Tawatchai Eakturapakal is 69 and in peak form because he is an avid cyclist.

Pedal power

At first, he tried running as a form of exercise.

“I ran in the park near my home, thinking it would be the easiest thing. Unfortunately, I had Achilles tendonitis and had to stop. After I recovered, I switched to cycling,” shared Tawatchai, who found that cycling suited him better than running.

At first, Tawatchai cycled 1km a day. Although it was tiring initially, he also began to feel good too. And so, he began to increase the distance he did, month after month.

These days, he cycles every morning. On weekends, he cycles up to 150km, from morning to evening with breaks for meals.

He also goes on long-distance biking tours, in convoys of between 15 and 30 cyclists. So far, they have toured Myanmar and Laos.

Tawatchai is absolutely convinced of cycling’s healing powers; he says it is “like magic medicine. It felt good and I also recovered fully from my knee pain after I started cycling.”

He even recommended cycling to his friends who were struggling with ill health.


Tawatchai (centre, foreground) cycling with members of NP Cycling Association in Thailand.

His friend who was in his 70s was told he needed to go for balloon angioplasty of the coronary artery, and Tawatchai encouraged him to join his cycling group for short rides every morning.

“He joined us for about six months and later discovered that he need not go for the operation,” said Tawatchai.

“I’m happy if I managed to convince friends of my age, who never thought they could cycle long distance, to join me. After they started cycling, they looked fitter,” he said.

Promoting cycling is a good move towards building a health-conscious society but Tawatchai said taking up any form of exercise is just as good.

“Just opt for the sport you like.”

For those who want to take up cycling, his advice is to start small.

“You don’t need to invest in an expensive bike; just get one that can bring you from one point to another. That’s a good start!” said Tawatchai, who actively promotes cycling for good health in his home province, Nakhon Pathom, in central Thailand.

“When I revived the Nakonpathom Cycling For Health Club which was started by my senior friend, it only had 15 members. Today, the association, now called the NP Cycling Association, has 120 members,” said Tawatchai, the club president since 1997. They have members ranging from age 10 to 75.

Cycling, he said, has become one of the trendiest sports for the younger generation in Thailand too.

These days, he regards cycling as his full time activity. From time to time, he will initiate a cycling campaign with some charitable foundations or cycling trips with the Tourism Authority of Thailand to promote good causes.

“It can be anything from raising funds for needy charity organisations or donating bicycles to needy children in remote villages in Thailand who have to walk a long distance to school every day. We also organise short training courses to equip children or adults with basic knowledge on how to change bicycle tyres or worn out parts,” he said.


Members of the NP Cycling Association posed for a group photo during a long distance cycling trip.

Competing in the World Transplant Games

Apart from cycling for leisure, Tawatchai will also be competing at the World Transplant Games in Malaga, Spain from June 25 to July 2. This is the third time he has been selected by the Transplant Sports Association of Thailand to compete in the games, which draws over 2500 participants from 55 nations.

“I will be competing in badminton and petanque,” he said.

In 2013, Tawatchai came in ninth for cycling and third in badminton (doubles category) at the 19th World Transplant Games in Durban, South Africa.

In 2015, he came in fifth in cycling and third in badminton (singles) in the 20th World Transplant Games in Mar Del Plata, Argentina.

The elderly athlete is keen to inspire other transplant patients to emulate his healthy lifestyle, as receiving an organ transplant is tantamount to being given a second chance to live.

“Many sportsmen in the association have built their confidence and morale to live healthy lives through sports. Winning in the World Transplant Games is not my objective but a bonus.

“To compete in the games is to realise our capabilities, forge friendships with other sportsmen and live life to the fullest,” said Tawatchai.

Ride For Malaysia

Ride For Malaysia, which is jointly organised by Star Media Group with property developer Sunsuria Berhad, also offers other prizes including cash.

For the 30km fun ride, the cash prizes are: first prize: RM3,800; second prize: RM2,800; third prize: RM1,800; fourth prize: RM1,000; fifth prize: RM500; sixth to 10th prize: RM300; 11th to 15th prize: RM200; 16th-30th prize: RM100; and 31st to 50th prize: RM50. There are also 10 units of folding bicycles to be given away.

For the 5.5km family ride, the cash prizes are: first prize: RM2,000; second prize: RM1,000; and third prize: RM500.

Come in fancy dress, glamour get-ups, or outlandish costumes and you might also win prizes for best fancy dress (overall-individual/couple/family), most sporting family (family of four); and best looking couple.

Ride For Malaysia will flag off at 6.30am on July 30 at Sunsuria City in Sepang, Selangor. For more information and registration, go to the website.

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Coconut oil’s health benefits are a myth — here’s what you should buy instead

coconut oil
coconut oil to everything won’t make it


Most of us are familiar with a handful of “health” foods that
we’ve either heard about on the news or seen friends eat — almond
milk, agave nectar, granola.

But many of these items
aren’t actually as good for you
as you might assume.

One such trendy food item is coconut oil, which is high in
saturated fat, a type of fat that most nutritionists agree is
unhealthy. Essentially, its ratio of “bad” to “good” fats is the
opposite of what experts recommend.

The American Heart Association recently
updated its guidelines on fats
to include the
suggestion that people avoid saturated fats. Although
these fats are primarily found in things like butter, beef,
and other animal products, they can also be found in some plant
products including palm and coconut oil.

If you’re looking to curb your intake of saturated fats, plenty
of alternatives exist. Olive oil has essentially the opposite
ratio of bad to good fats, but is virtually identical to coconut
oil in its calorie and overall fat content. While a tablespoon of
olive oil has just one gram of saturated fat, the same amount of
coconut oil has 12 grams.

The AHA says the high saturated fat content in animal products
like butter and plant products like coconut oil can raise levels
of unhealthy cholesterol. Several
that swapping
saturated fats with polyunsaturated or monounsaturated ones is
linked with a number of positive
health outcomes
, from a reduced risk of death to decreased
incidences of heart disease, cancer, and neurodegenerative
disease. Aside from the folks at the AHA, other experts have also
avoiding saturated fats
because they have been linked with an
risk of Type 2 diabetes

Still, some smaller
have suggested that some people on strict diets may
be able to safely consume more fats — including saturated ones —
than people who eat a regular amount of carbs. This includes
people on a strict low-carb diet like the Atkins Diet
who eat very few foods that contain bread, potatoes, or

If you’re like most people, however, and your diet includes
carbohydrates, fats, vegetables and fruits, olive oil is likely
your best bet for a healthy oil.

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Trump calls four GOP senators opposed to Republican health care bill ‘good guys’

US President Donald Trump is pictured. | Getty Images

President Donald Trump struck an optimistic tone for the prospects of the controversial health care bill in an interview that aired Friday morning. | Getty

The four Republican senators who have announced their opposition to Senate legislation that would repeal and replace Obamacare are “four good guys and they’re four friends of mine,” President Donald Trump said in an interview that aired Friday morning, striking an optimistic tone for the prospects of the controversial bill.

“I think that they’ll probably get there. We’ll have to see,” Trump said Friday in an interview on Fox News’s “Fox Friends” that was taped a day earlier. “I think we’re going to get there. We have four very good people that – it’s not that they’re opposed. They would like to get certain changes. And we’ll see if we can take care of that.”

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The four lawmakers – Sens. Ron Johnson (R-Wis.), Rand Paul (R-Ky.), Mike Lee (R-Utah) and Ted Cruz (R-Texas) – announced together on Thursday that they could not support the repeal-and-replace legislation as written, but all left open to some extent the possibility that they could end up backing the bill with some changes.

Republicans, who hold a slim majority in the Senate, can afford to lose the support of just two members and still have their healthcare bill pass, potentially with the tie-breaking vote of Vice President Mike Pence. The legislation is almost certain to receive no Democratic support.

Should the Senate successfully pass its repeal-and-replace proposal, it would move Congressional Republicans and the president one step closer to making good on a campaign promise to undo Obamacare. The House passed its own legislation to do so last month, although Senate Republicans opted to craft their own legislation that would have to be melded with the House version before making its way to the president’s desk.

Trump told Fox News that successful healthcare reform is a policy goal that has eluded his predecessors, noting that the administration of former President Bill Clinton was unable to accomplish it and Obamacare, the signature legislation of former President Barack Obama, has “failed” and it “virtually out of business.”

“You know, healthcare is a very difficult situation. If you look, the Clintons tried to get it and after years and years they couldn’t do it. Obamacare was murder for them to get, and now it’s failed.” he told Fox News host Ainsley Earhardt. “Well, I’ve done in five months what other people haven’t done in years. People have worked on healthcare for many years. It’s a very complicated situation from the standpoint you do something that’s good for one group but bad for another. It’s that very, very narrow path.”

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Your health may be in Susan Collins’ hands, and that’s not good news

Susan Collins says she’s disturbed.

That’s not exactly news. The Republican senator from Maine is frequently disturbed. She was disturbed by the Benghazi raid; by the Republican shutdown of the government in 2015; by the “cruel comments” of Republican nominee and now president Donald Trump; by political polarization; and most recently by Republican plans to repeal Obamacare and strip tens of millions of Americans of their health insurance.

To be disturbed when nearly all one’s Republican colleagues are sanguine about injustice is not a bad thing. Collins, though, could have something to say about this last matter, Obamacare, beyond hollow expressions of concern. When the 13-man cabal of her fellow Republicans, who have been crafting a new repeal bill, finally emerges, she could announce that she will refuse to vote for any bill in which Americans would lose their insurance. She could say that Trump’s cruel comments are nothing against the cruelty of putting poor Americans’ lives at risk. She could say that since Obamacare provided insurance for millions, she is going to side with the Democrats against her own party.

Because Senate Republicans have only a three-vote majority margin, this wouldn’t necessarily be hot air. She could say all of these things, but I would wager that she won’t do any of them. In the end, Susan Collins is likely to retreat and join the conservatives in trashing health insurance.

Of course, that is not how she is portrayed in the media. Collins is often introduced as Exhibit A of Republican moderation, a throwback to the way things used to be in Washington when the GOP had Jacob Javits, Clifford Case, Ed Brooke, Kenneth Keating, Charles Mathias, Lowell Weicker and other empathetic lawmakers in its ranks, reaching across the aisle. In truth, Collins is no anachronism. For all her apparent personal compassion, she may well be Exhibit A of what is wrong in Washington: the triumph of party ideology over common decency, conscience and even political expediency. Collins knows better than most of her benighted Republican colleagues. It doesn’t make any difference.

Polarization isn’t the problem. Orthodoxy is the problem.

Collins is certainly not the worst offender, which is largely the point. In fact, she may be the best of the Senate Republicans. From 1997 through 2015, she voted with her party just 60 percent of the time — hardly lockstep.

The conservative group Heritage Action gave her only a 16 percent score last Congress, the lowest among congressional Republicans, and the American Conservative Union scored her 23 percent on bills of importance to the organization, while on the whole, Republicans averaged 75 percent. (Dems averaged 4 percent.)

Already, she has voted against Trump more than any other Senate Republican, including votes against the confirmation of Education Secretary Betsy DeVos and EPA head Scott Pruitt, and she voiced disapproval of Trump’s travel ban. So what is the problem?

The problem is that Collins all too often stands up to her fellow Republicans on the small issues, while she shakes her head and frets about the big ones, only to toe the party line in the end. Yes, she wrote an op-ed declaring that she could not vote for Trump, and then said she wrote in on her ballot the name of Paul Ryan (!), one of the few party figures worse than Trump. Yes, she voted against DeVos and Pruitt, but introduced attorney general-designate Jeff Sessions at his confirmation hearings and gave him full-throated support, despite his long record of racism. Yes, she opposes Trump more than her fellow Republicans, but she still votes with him 85 percent of the time. She has a checkered record on immigration, opposed net neutrality, and got only a 38 percent rating from the Leadership Conference on Human Rights.

Newsmax CEO Christopher Ruddy, challenging the characterization of Collins as some apostate conservative, assured his readers that she is “one of us.”

But it is on health insurance where Collins could arguably make her biggest political mark and establish a legacy as a defender of the vulnerable, including the vulnerable among her own constituents, who have benefited enormously from Obamacare in a state that has the oldest population in the nation. But don’t hold your breath. Collins has been as doggedly resistant to Obamacare as any Republican. She voted against Obamacare in 2009 and then against the Senate-House reconciliation act. She voted for repeal in 2011 and 2015 and again this past January.

When her fellow Republicans shut down government in 2013, insisting that they wouldn’t approve funding without an Obamacare repeal, she claimed, disingenuously, to have bucked her party. What she really did, according to Mother Jones, is vote three times to keep the government running but if and only if Democrats defunded or delayed Obamacare.

“There is no denying that the Affordable Care Act has made insurance available to millions of Americans and allowed people to leave corporate jobs and start businesses,” she told The New York Times. But Collins claims that she worries about instability in the health markets, rising premiums and the dearth of facilities in Maine — all of which might be legitimate concerns if the instability of the markets wasn’t largely the result of Republican sabotage, if premiums had risen anywhere near as much as critics contend, and if access to facilities had anything to do with Obamacare. Oh, and one more thing. Collins opposed Obamacare before it was implemented, so none of these criticisms makes much sense.

To shore up her moderate credentials, Collins, who opposed the House Republican bill, has introduced her own replacement bill along with Louisiana Republican Bill Cassidy. She calls it a “compromise,” but it is clever window-dressing. Its big features are Health Savings Accounts instead of direct subsidies, a Republican panacea for all ills, and waivers for states to construct their own insurance systems. Without getting into details, the first has been largely discredited as a sop to the wealthy, since everyone knows Republicans would never adequately fund these accounts, and the second is already a feature of Obamacare as well as an exit strategy for Republican governors.

Meanwhile, Collins has said she agrees with a letter signed by Republicans Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Linda Murkowski of Alaska promising not to support a plan that “does not include stability for Medicaid expansion populations or flexibility for states” — two things that might very well be mutually exclusive. In any case, I wouldn’t bet on them following through on the threat.

None of this is to pick on Collins. Rather, it is to state the unfortunately obvious. Republicans are likely to pass a repeal bill with weak provisions for existing conditions and no provision for long-term Medicaid. It is almost certain to receive the votes of the entire caucus — yes, every last one, including Collins, unless Rand Paul, who opposes government insurance of any sort, sticks to his guns. And it definitely will not be an attempt to improve upon Obamacare, as we so often hear, but to remove it.

The Republican health plan may be top secret, but their real motives aren’t. What Republicans want, what they lust after, is to destroy Medicaid and any government effort to aid the vulnerable while wiping their fingerprints from the scene of the crime. This has never been about policy. This has always been about an unholy blend of ideology and partisanship — an ideology that boasts about harming the powerless to fellow conservatives and a partisanship that opposes anyone who tries to help the powerless.

Collins talks a good game. She said she came to politics when, as a high school student, she visited Maine’s Republican Sen. Margaret Chase Smith, who gave her a copy of a 1950 speech in which Smith lacerated red-baiting Sen. Joseph McCarthy for relying on the “four horsemen of calumny — fear, ignorance, bigotry and smear.” Smith called it her “Declaration of Conscience,” and it dealt a blow against McCarthy when others were loath to do so.

Conscience is in short supply now, and Collins sadly hasn’t exhibited much, her exemplar notwithstanding. Every major medical organization opposes Obamacare repeal. So does every organization that represents the aged, the sick and the poor. According to The New York Times, the majority of every single state opposes it, so there is no political gain, other than the gain of appealing to the worst elements of the party and the country. Everyone knows that lives are at stake. And yet, Republicans are determined to eviscerate health insurance, regardless of the political consequences, which could be severe.

As for Collins, she would probably not face any consequences at all were she to demonstrate a conscience like Margaret Chase Smith’s. Even if she were “primaried” from the right — that great terror among Republican incumbents — she would almost certainly win, and in any case, she reportedly is considering a run for governor.

So: If not now, when? If not on this issue, on which? If not her, who? The answers are likely never, none and no one. The best, indeed, “lack all conviction,” as Yeats wrote.

And that is why the ever-disturbed, much-dismayed Susan Collins is an object lesson in the failure of our politics. She will express her concerns. She will propose empty compromises. She will take no evident joy in hurting the defenseless like most Republicans. But in the end, even when the country is nearly uniform in opposition, she will fall in line because that is what Republicans always do, if only to prove they don’t have bleeding hearts, or any hearts at all.

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Obama Chiefs of Staff: The Senate Health Care Bill Could Devastate Americans

U.S. Senate is rushing to vote next week on a health care bill that no one has seen. But we know what Republicans are promising — something “better than” the House bill — would still make health care worse for Americans. And that is not good enough.

Under the American Health Care Act (AHCA), which passed the House in May, 23 million Americans would lose health insurance coverage according to the Congressional Budget Office (CBO). It would cause premiums and out-of-pocket costs to go up for every type of health coverage. The American people and health professionals condemned the bill for the consequences it will reap on Americans, and Republican Senators assured the public they would develop something different.

But that isn’t what the Senate is doing. Its bill has been drafted behind closed doors, without the benefit of public hearings or expert input. Its bill will have immediate, inevitable and widespread impacts, which are not fully understood. Republican leadership probably suspects that its bill cannot withstand debate and scrutiny. And while text may be released soon, we do not know whether that version is what CBO has scored and will be ultimately brought to a final vote. There will likely be last minute changes, the impact of which will also be unclear but, as in the House debate, overstated and not able to be fact-checked in a way that gives Americans confidence their health care will not be worsened.

So the American people — who are rightly skeptical when their leaders do something in secret rather than use a well-established, open process — are left to guess how their families’ health care and financial security and one-sixth of the American economy will be affected.

Before the Affordable Care Act became law, President Obama and Members of Congress spent over a year listening to people in community discussions, town hall meetings and publicly aired White House sessions with members of both parties. Congressional Democrats held hearings, accepted Republican amendments and spent 25 days debating the bill on the Senate floor. What resulted was a bill that — while not perfect — extended health care to millions, began to control health care costs, protected 130 million Americans with pre-existing conditions from discrimination, strengthened Medicare and reduced the deficit.

Because there is still more work to do to, President Obama suggested a simple test for any legislation: Does it make things better, or does it make things worse? President Trump has claimed that his health reform bill would cover more people and lower deductibles, as well as protect Americans with pre-existing conditions. But there is no evidence to support this.

For the sake of argument, let’s take Republicans at their word. Senator John Cornyn said that “80% of what the House did, we’re likely to do.” Let’s suppose that Senate bill would do 80% of the harm of the House bill. Eighty percent of the coverage loss would mean over 18 million people losing coverage and a record-high spike in the nation’s uninsured rate.

A bill that’s 80% as bad would cut off Medicaid treatment for over 1 million people with opioid addiction and other behavioral health disorders at a time when the opioid crisis is ravaging communities from Alaska to Ohio to West Virginia. And 80% of the coverage impact would still contribute to the preventable deaths of 19,000 Americans.

A bill that’s 80% as bad would still cause costs to skyrocket. A low-income 64-year-old would pay $9,500 in higher individual market premiums, if the rate shock is 80% of CBO’s 2026 estimates. People with pre-existing conditions would still be left without coverage for the treatment they need. Deductibles and copays would go up, not down, at a time when out-of-pocket costs are a top concern for many Americans, including those with job-based coverage.

Economic damage would ensue as well. A bill that is 80% as bad would result in job loss for nearly 740,000 Americans. It would increase state and local costs by billions. And it would be a tipping point for rural hospitals whose low margins depend on patients being insured.

But this 80%-bad bill is only a hypothetical. The actual Senate bill is likely to be largely the same rather as the House bill, and potentially worse. The reason is simple: Republicans can’t dramatically reduce their coverage losses because they won’t dramatically reduce their tax cuts. And this will make health care in America worse not better, failing this test.

There is still time for Republican Senators to abandon their partisan, secretive and potentially devastating plan. If it is a good enough law to govern the land, it is good enough for real discussion in the light of day. The door is open to sensible, bipartisan solutions. It’s time to walk through it.

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TO YOUR GOOD HEALTH: Remove mass parotid gland sooner rather than later

DEAR DR. ROACH: I recently was diagnosed with a benign pleomorphic adenoma of the parotid gland. My surgeon says that the mass should be removed, and explained many of the risks. The risks terrify me: Frey’s syndrome, facial paralysis, numbness.

My mass is 11 mm. Is that considered large? Could this mass be slow-growing, with little chance of it becoming cancerous? How long could I wait before agreeing to the surgery? — J.M.

ANSWER: I think I agree with your surgeon: Most masses like this should be removed. As with any procedure, there are risks and benefits. One risk is Frey’s syndrome (sweating around the face), which is a possible complication of the surgery. Another risk is damage to the facial nerve, which runs through the parotid, and damage to it during surgery can cause facial weakness and numbness.

That’s the bad news. The good news is that 11 mm is a small tumor, and the risks of complications are fairly low. For example, temporary facial nerve damage happens in 10 to 60 percent of surgeries (depending on size and proximity to the facial nerve), but 90 percent recover within one month. Permanent facial nerve damage occurs in 0 to 8 percent of cases in different studies.

Balanced against the risks of surgery are the risks of not doing surgery. Untreated, the tumor is likely to grow, making it harder and more dangerous to remove. However, there is always a small chance of transformation to a malignant tumor. If I had a patient in your situation, I likely would recommend surgery. If you are going to do surgery, it’s better to do so sooner.

DEAR DR. ROACH: What is insulin resistance? Is there such a thing? Does it cause belly fat? How do we get rid of it?

My husband and I are in our 70s, have belly fat, are overweight and are Type 2 diabetics. I take metformin, while my husband is on insulin. We take medications for cholesterol and blood pressure. No matter what we do, we cannot lose weight.

We hear about belly fat being caused by insulin resistance and the pills that remove it. Do doctors know about insulin resistance and treat their patients for it? — G. and B.

ANSWER: Insulin resistance is the primary defect of Type 2 diabetes, but insulin resistance happens before diabetes is diagnosed. The exact mechanism that causes it is not clear. However, it is clear that belly fat is strongly associated with insulin resistance, and that behaviors that reduce belly fat tend to reduce insulin resistance. The preponderance of the evidence is that belly fat is a major cause.

Doctors are increasingly aware of insulin resistance, but some medications we use tend to worsen it. It can happen because of weight gain, but some medicines, especially some of the ones used in psychiatry, can cause insulin resistance by themselves. Some medicines used for blood pressure, including some beta blockers and thiazide diuretics, can worsen insulin resistance as well. Niacin, used for cholesterol, worsens insulin resistance and makes blood sugar higher in a large number of people who take it. There usually are alternatives to these medications.

Exercise improves insulin resistance, even if you don’t lose weight. Avoiding excess dietary sugars, even “natural” sugars in fruit juices and honey, decreases your need for insulin. Some diabetes medications help reverse insulin resistance. One of them, metformin, is increasingly used to prevent diabetes in people with insulin resistance.

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