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Amazon Opens Brick-And-Mortar Stores Meant To Emphasize Convenience

Amazon is opening new stores — in the real world. And in true Big Tech fashion the experience is meant to emphasize convenience. All you need to do is walk in, grab your stuff, and go.



ARI SHAPIRO, HOST:

Amazon’s move from the digital to the physical world started with brick-and-mortar bookshops. Now the company is opening convenience stores. As you would expect, there is a high-tech twist. In these stores, you don’t have to take out your wallet to pay. Cardiff Garcia and Sally Herships from our daily economics podcast The Indicator From Planet Money look at what this development means for the market.

SALLY HERSHIPS, BYLINE: In the new stores, there are no cashiers. There are no checkout counters. You take stuff off the shelf and out of the store. And somehow, Amazon figures out what you have, and it charges you.

CARDIFF GARCIA, BYLINE: Amazon’s system represents a tradeoff that we often make when we use technology. As consumers, we supply our data in return for convenience. When we shop at Amazon and other online retailers, those companies are collecting information on you, which they think they can sell or use to bombard you with targeted ads or ideas for what to buy next.

HERSHIPS: So far, shopping in the real world has been a holdout, right? It’s a place where you can still use cash. You can still buy stuff that maybe you don’t want tracked.

GARCIA: Amazon told us that they only hold onto customers’ data just long enough to send them a receipt. So if humans are no longer checking us out at the register, what’s going to happen to all those jobs – all those cashier jobs? Heidi Shierholz is senior economist at the Economic Policy Institute.

HEIDI SHIERHOLZ: In the early 1800’s, over 80% of our labor market was in agriculture. So if you would have been sort of a futurist at that time, you would have gone, oh, my goodness. We’re going to lose all of these jobs. And you would have, in some ways, been absolutely right.

GARCIA: Instead, they now work in other industries. Heidi says that what we find is that automation has never caused sustained decline in the overall number of jobs. And you might be wondering, how is that possible? Well, think about it. When a company like Amazon uses tech instead of human workers, it can now sell its products more cheaply to consumers, and that starts a process where consumers have more leftover cash to buy other things. And when they buy those other things, that generates economic activity, and that brings new jobs to those sectors.

HERSHIPS: Which brings us to a question – how are small business owners, the kind that often run convenience stores, going to be impacted by Amazon moving in on their turf?

GARCIA: Jonathan Bowles is executive director at the Center for an Urban Future.

JONATHAN BOWLES: We survived 7-Eleven. We survived the expansion of all these national drugstore chains, and now we’ve got to deal with this.

HERSHIPS: Right around the corner from Amazon’s new store is a local deli. It’s a small business. And, Cardiff, you know, they told us they didn’t want to go on tape, but they were not psyched about Amazon. The company represents major competition for them.

BOWLES: When you shop at a bodega or a small business, your money is staying in the community. Oftentimes, that small business or bodega owner is sponsoring a Little League team or being part of the community, investing or spending money on local workers. They’re putting money into the community by spending things that they earn at the business.

GARCIA: Jonathan says that if too many national chains move in and displace small businesses, that could cause another problem.

BOWLES: When it tips too far in that direction – when the unique independent small businesses are so crowded out – it’s just a much less interesting place to be.

HERSHIPS: For now, I think I’m going to head to my local deli for lunch.

Sally Herships.

GARCIA: Cardiff Garcia, NPR News.

SHAPIRO: And we should say Amazon is an NPR sponsor.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Instagram Head Adam Mosseri Discusses App’s New Features Meant To Fight Bullying

NPR’s Audie Cornish speaks with Instagram head Adam Mosseri about how it is adding protections for users, while preserving influencers’ ability to make money through the platform.



AUDIE CORNISH, HOST:

With All Tech Considered.

(SOUNDBITE OF MUSIC)

CORNISH: The head of Instagram, Adam Mosseri, knows what it’s like to be bullied. He also knows that today kids are likely to be bullied on Instagram. That’s why he says he wants to lead the industry in the fight against online bullying.

ADAM MOSSERI: I had, like, Coke bottle, Corbusier glasses at 5 years old that made my eyes as big as – I don’t know – lemons.

CORNISH: I can picture that.

MOSSERI: I had a haircut that made me look like Harry Potter long before Harry Potter existed or was cool. It was not a good look. I was made fun of a lot. But yeah, I probably would have been made fun of on Instagram.

CORNISH: Yeah, there would have been an Instagram account that was like Adam’s Glasses.

MOSSERI: Yeah. Oh, man. You’re really bringing me back.

CORNISH: (Laughter) I’m just saying.

MOSSERI: (Laughter) I got to find those glasses.

CORNISH: I had a rough time of it, too. And I have to admit, I look at social media; I look at things like Instagram. And I say – thank God it wasn’t around when I was a kid. It would have been worse.

MOSSERI: I don’t quite feel that way. Obviously, I’m biased given that I’m sitting in the situation that I’m sitting in. I have two kids. They’re too young to use Instagram. They’re 3 and 1 right now, but they will use Instagram when they get older.

I think that certain things would absolutely be worse. Other things would be better. For me right now, the way my kids appear on Instagram is they have private accounts. They don’t use them; they’re literally 3 and 1 years old. But I manage them, and I share basically their upbringing with my family who lives all around the world. I have family in Pittsburgh. I have family in New York. I have family in Israel. I have family in Germany. I have family in LA. And they can stay up to date on what my boys are doing and how they’re growing in a way that they wouldn’t have been able to do just 15 years ago.

And so there’s good and there’s bad that comes from connecting people. Technology is not inherently good, and it’s not inherently bad. For those of us who work in the industry, it’s our responsibility to magnify the good and address the bad as effectively as we can.

CORNISH: Mosseri took the helm of Instagram almost a year ago, coming from its big brother Facebook. Shortly after, The Atlantic published a story headlined “Instagram Has A Massive Harassment Problem.” People said it was too easy to set up anonymous pages just to taunt someone. They said the company wasn’t responsive when they tried to sound the alarm about abuse, so now Mosseri is overseeing a rollout of new features that Instagram hopes will protect its users from bullying and keep them on the site.

I asked him what he learned about bullying on the platform over the past year.

MOSSERI: A few different things. One – a lot of it happens. Actually, most of it seems to happen between people who know each other in real life. Another is that the controls that we had before or have today are insufficient. So specifically, I and our researchers talked to a bunch of teens and we asked them, why don’t you just block someone who is bullying you on the platform? Because you can block someone right now – they can’t see you. You essentially don’t exist on Instagram to them.

And there were two reasons that came back. One was – often, that can actually escalate the situation. They’ll figure that out. They’ll know, and they will bully more, either on Instagram or elsewhere. And two is that you need, as a target of bullying, to see what the actor is actually doing. Teens would often say, like, they’re talking about me. If I blocked them, I won’t be able to see that.

So I need to track what’s actually happening. Which is why we’ve been developing this new control called restrict, which allows you to restrict an individual – it means that if they comment on your post, you’ll see it, and it’ll look to them as if they’ve – it’s actually been commented on, but you have to approve it before anybody else sees it. It means that their messages are going to go into your other inbox, and you have to go there to see them and that they won’t actually get read receipts – a whole bunch of different little nuanced ways to give a target of bullying a bit more power over the experience, which allows….

CORNISH: So it’s not about changing their behavior. Right? It’s about giving the person who’s the victim a few more tools to protect themselves.

MOSSERI: Yeah. Restrict is not about changing their behavior. There are other things we’re doing to try and adjust people’s behavior by changing incentives.

CORNISH: One of them is very interesting. It’s an alert that flags a mean-spirited post. Right? It essentially asks you – hey, are you sure you want to post this?

MOSSERI: Yes.

CORNISH: It’s very polite (laughter).

MOSSERI: It is.

CORNISH: Why do you think that will be effective? I mean, if someone’s about to say something cruel (laughter), saying think about it – like, I don’t know.

MOSSERI: I think it’s going to be somewhat effective but not very effective. I actually think that’s true of all of the work that we’re going to do. All of these problems are not solved by any one solution. They are complicated. I’ve also seen in the actual data that a minority but a significant minority of people do rewrite their comments, and they rewrite them in a much more pleasant way. Now, do most people rewrite their comments? No – because if you have an intent that’s really intense to harass an individual, a polite comment from Instagram is not going to prevent you from doing so.

But sometimes people get caught up in the moment, and a lightweight reminder can actually help them rethink what they’re doing or what they’re saying. And so it’s not supposed to be the solution that we hang our hat on for all of bullying. It’s supposed to be one of many tools to try to prevent bullying from happening in the first place.

CORNISH: One controversial idea that I know you are thinking about is the idea of making the number of likes private. Right?

MOSSERI: Yeah.

CORNISH: So when a person posts to Instagram their image, lots of people can click on a little heart that shows I love this thing. And some people get a high off of that – right? – when they – ’cause it’s a big popularity contest in a way. If you make that private, doesn’t that get to the heart of what Instagram is?

MOSSERI: In some ways, yeah. When I said before that…

CORNISH: That sounds bad for business.

MOSSERI: It might be. But ultimately, if we make decisions that are bad for business but that keep people safe or are good for well-being more broadly, I have to believe that those are going to be good for the business over the long run, and so I’m going to make those decisions. The idea with making like counts private is to try and depressurize the experience a bit. It can sometimes feel like a popularity contest, which is why we…

CORNISH: How likely is this to actually happen, though? Am I speculating with you right now, or is this something you’re going to do?

MOSSERI: I’m bullish on it. It’s a big change. We’re working through all the challenges. One challenge is for creators. They use Instagram to make a living. Likes are a sign of how relevant they are, so we have to figure out some way to make sure we preserve that.

CORNISH: You’re talking about influencers. Right? I mean, there are people who now essentially make a living off of their social media presence. And the way they show potential advertisers – look, I’m a good bet – is how many likes I get.

MOSSERI: Absolutely. We’ve actually had a pretty mixed response from influencers. So I think – I’m optimistic to answer your question very directly. We aren’t there yet. We’re still iterating on the experience. But I am personally optimistic and really personally invested in making it work.

CORNISH: So the boss is bullish. (Laughter) That’s the take so far.

MOSSERI: The boss is bullish, yes.

CORNISH: Well, Adam Mosseri, thank you so much for speaking with us.

MOSSERI: Absolutely. Thank you so much for the time.

CORNISH: Adam Mosseri, head of Instagram. We should note Facebook, which owns Instagram, is among NPR’s financial supporters.

Tomorrow Mosseri tells us what his time leading Facebook’s News Feed taught him about social media abuse.

(SOUNDBITE OF MUSIC)

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Sheila Pereira Gets Location Of Half Marathon Mixed Up

When the Worcester, Mass., woman learned of the Worcester City Half Marathon, she signed up online. She realized too late that the race was in Worcester, England. She ran her own half marathon.



STEVE INSKEEP, HOST:

Good morning. I’m Steve Inskeep with sympathy but also congratulations to Sheila Pereira. The Worcester, Mass., woman learned of the Worcester City Half Marathon. She signed up online and realized too late the race was in Worcester, England. But Ms. Pereira was not deterred. She ran her own darn half-marathon in Massachusetts, 13.1 miles in just over two hours. The Boston Globe reports the organizers in England sent her a medal.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Pakistan’s Pink Himalayan Salt Has Become A Matter Of National Pride

Most pink Himalayan salt comes from one source: Pakistan. And that country now would like everybody to know.



MELISSA BLOCK, HOST:

You may have spotted pink salt in your supermarket. Himalayan pink salt is used to season food and is believed to have health benefits. It’s used in spa treatments. You can even buy lamps made of the stuff. Well, now the country that produces most pink salt wants to claim it as its own. NPR’s Diaa Hadid reports.

DIAA HADID, BYLINE: In Pakistan, Himalayan salt is shrouded in legend.

SHAHID IQBAL: When Alexander the Great invaded the Indian subcontinent…

HADID: That’s Shahid Iqbal, a Pakistani geologist. He says Alexander’s horses began licking the rocks.

IQBAL: The army was curious what they are licking at. And they found it was salt.

HADID: Himalayan pink salt. And folks here believe it’s been mined ever since. But it really took off a few years ago…

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: In today’s video, we’re going to be talking all about Himalayan pink salt. It’s really good for your body, your aches and pains, cramps.

HADID: …When it found popularity as a wellness product because it contains dozens of trace minerals giving it that pink hue. But the salt’s actual origins are rarely highlighted or even mentioned. Iqbal, the geologist, says the salt overwhelmingly comes from Pakistan. And we drove there. You see red brick hills emerge from marshlands. These are the furthest tendrils of the Himalayas. We’re hundreds of miles from the iconic snowy peaks.

It’s hot here. An engineer takes us inside a mine shaft, and a mile in, we meet miners in a soaring chamber. Their methods are basic. They crank levers to bore a hole in the rock face. Another miner packs the hole with gunpowder. The engineer lights a fuse, and a miner calls out, beware.

UNIDENTIFIED PERSON #2: (Speaking foreign language).

(SOUNDBITE OF EXPLOSION)

UNIDENTIFIED PERSON #3: OK. OK.

HADID: That’s terrifying.

(LAUGHTER)

HADID: Boulders of pink rock tumble down, and miners hurl them into trolleys. Until quite recently, much of that salt was exported just across the border to India, Pakistan’s enemy and neighbor.

Qaisar Mahmood is a salt exporter.

QAISAR MAHMOOD: (Through interpreter) India buys salt from here. They process it and export it to Europe. They say it’s made in India, and they charge people like you 10 times the price.

HADID: He used to sell his salt for $40 a ton to India. He could make $300 a ton selling it to Europe. But it’s not that easy for a man like him.

MAHMOOD: This language problem also.

HADID: He doesn’t speak English well. He doesn’t have contacts. And he can’t navigate his way around Pakistan’s complicated bureaucracy for exporting products, and he can’t meet European standards.

MAHMOOD: (Through interpreter) If they find even a strand of hair, they will reject the entire batch.

HADID: Those sales recently became controversial in Pakistan. It’s hard to imagine salt as a matter of national pride, but that’s what happened. A social media campaign against the sales to India went viral in June, and then it became a national issue.

SHIBLI FARRAZ: It was being sold for a song.

HADID: That’s Senator Shibli Farraz. Pakistan made just over $50 million exporting salt last year, and he believes they can triple that with reforms.

FARRAZ: There was lot of concern as to – we were exporting it at a very, very low price, and most of it was going to India.

HADID: So when tensions flared in August over the disputed territory of Kashmir, Pakistan banned all trade with India, including salt. Farraz is now advocating legislation to discourage crude salt sales and encourage the production on high-value finished products.

FARRAZ: Let this be an opportunity to kind of diversify and substitute for imports.

HADID: Farraz says in coming months, he’ll introduce legislation that will trademark Himalayan pink salt and force companies to list it as a Pakistani product. Farraz says that will allow Pakistan to accrue revenue when companies use the name, and it will tie Pakistan’s name to an upmarket product.

But traders like Mahmood, whose business has been devastated by the ban on exports to India, says that could hurt business. He says Pakistan doesn’t have a good reputation as a producer of high-end goods, and the country is associated with violence.

MAHMOOD: (Through interpreter) India works on its image; we don’t. We have neglected our branding.

HADID: But one Pakistani salt producer says things can be different. He’s built a rare business selling high-end products to the United States. Niaz Siddiqui shows me around his showroom. There’s lamps, tequila shot glasses, sushi platters and his most popular product.

NIAZ SIDDIQUI: They are called the Zen Cubes.

HADID: This is a Zen Cube.

SIDDIQUI: This is a Zen Cube.

HADID: It’s a cube of salt, and it costs 16 bucks. He says profits like this should be going to Pakistan. And it’s possible, he says, if the country improves its branding, to have a world where Himalayan pink salt is proudly Pakistani.

Diaa Hadid, NPR News, Kherwa.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Saturday Sports: Antonio Brown, Soccer Vs. Politics, WNBA Playoffs

The New England Patriots have released receiver Antonio Brown. Apparently politics and Major League Soccer do not mix. And, we’re down to the semi-finals of the WNBA playoffs.



SCOTT SIMON, HOST:

And now it’s time for sports.

(SOUNDBITE OF MUSIC)

SIMON: Antonio Brown is cut. And apparently politics and Major League Soccer don’t mix. Down to the semifinals of the WNBA playoffs. NPR’s Tom Goldman joins us.

Hello there, Tom.

TOM GOLDMAN, BYLINE: You and I mix, Scott.

SIMON: Yeah, you and I mix, my friend. The Patriots have said goodbye – don’t let the door hit you on your way out – to Antonio Brown. But it’s – I mean, he was OK for one game for them. What happened?

GOLDMAN: They cut him yesterday, less than two weeks after signing him. You know, it was always a risk to sign him, Scott. He had this rocky ending to his nine years in Pittsburgh and his very short stay in Oakland this offseason. But as you know, the Patriots pride themselves on bringing in troubled players and having them snap to under the mythical Patriot Way, so they brought him in.

And after they signed him, the story got gravely serious. A lawsuit filed by Brown’s former personal trainer accused him of rape. Then another woman who alleges Brown made an unwanted sexual advance toward her in 2017 says Brown sent her a threatening – threatening text messages this week while he was a Patriot. And that reportedly was the last straw for New England. His agent said in a statement sorry things didn’t work out. Antonio hopes to play for another team soon.

SIMON: Also in the NFL, starting quarterbacks have been falling like trees in a forest. Drew Brees, Ben Roethlisberger, Nick Foles and, of course, Andrew Luck retired before he could be felled. Should Colin Kaepernick be waiting by the phone?

GOLDMAN: You’re hearing more and more people say no. And that’s after three years out of league with another batch of quarterbacks going down, as you say. And the calls are, you know, not going to come. Maybe teams think he’s too expensive to sign. And they can trot out lesser and cheaper quarterbacks, or there’s still concerned that he is politically toxic, even though the protests during the anthem issue has cooled down from what it was two, three years ago. Whatever the reasons, he’s still not playing. And you wonder if he ever will.

SIMON: I have to point out – I’m sure some people will ask. So Antonio Brown with these very serious charges could be signed by another team. It looks like Colin Kaepernick won’t.

GOLDMAN: Don’t try and…

SIMON: Oh, we’ll get to that if and when it happens.

GOLDMAN: Don’t try and get logic out of the NFL, Scott.

SIMON: All right. I want to ask you about Major League Soccer fans in the Pacific Northwest. Seattle and Portland have made their own political demonstration.

GOLDMAN: It’s very interesting. You know, we’ve been talking a lot about athletes making political demonstrations, like Colin Kaepernick. But now as you say, it’s the fans doing it. An interesting story, a new Major League Soccer policy this season prohibits political displays by fans. And some fans in Seattle and Portland don’t like that.

The fans have been displaying a symbol of the Iron Front. That was an anti-Nazi paramilitary group in Germany in the 1930s. Soccer fans say the symbol now is a statement against fascism and for human rights. MLS doesn’t like it because the league says the Iron Front symbol also is used by Antifa, the antifascist group that sometimes engages in violence. So MLS and fan groups met this week to try to resolve the dispute. They didn’t. They’re going to continue the conversation this coming week.

SIMON: WNBA semifinals, Washington Mystics versus the Las Vegas Aces and the LA Sparks versus the Connecticut Sun, how do you see things?

GOLDMAN: Right now, Washington and Connecticut looking very good, appear headed to the finals, which would be appropriate. They were the top two teams in the regular season, and they’re both up two games to none in their series. They’re both playing very well. Washington has this year’s MVP, Elena Delle Donne. It would be an entertaining final if they met.

SIMON: NPR’s Tom Goldman, thanks so much. Talk to you soon.

GOLDMAN: You’re welcome, Scott. Bye.

(SOUNDBITE OF CLEVER GIRL’S “JUMBO”)

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Twitter Removes Thousands Of Accounts For Manipulating Their Platform

In 2018, Twitter released an archive of thousands of accounts that the platform determined were involved in potentially state-backed information campaigns. Since then, it has continued to make announcements of its efforts to remove accounts spreading disinformation.

Denis Charlet/AFP/Getty Images


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Denis Charlet/AFP/Getty Images

Twitter permanently suspended thousands of accounts in its ongoing effort to fight the spread of disinformation and political discord on its platform, the company announced Friday.

The accounts originated from six different countries. And they included the Twitter account used by Saud al-Qahtani, a former adviser to Saudi Arabia’s crown prince and suspected of being involved in the killing of journalist Jamal Khashoggi.

It’s all a part of Twitter’s seemingly endless task of fighting disinformation.

The Twitter accounts came from the United Arab Emirates, Egypt, Saudi Arabia, Spain, Ecuador and China, according to Twitter’s blog post. Groups of suspended accounts were involved in various information campaigns, using tactics like spreading content through fake accounts and spamming through retweets.

The accounts were suspended for violating Twitter’s policy on platform manipulation, which Twitter defines as large-scale aggressive or deceptive activity that misleads or disrupts people’s social media activity.

Twitter has been suspending or removing accounts linked to this sort of activity throughout the year. In August, the company suspended around 200,000 accounts it reported were used to discredit pro-democracy protests in Hong Kong.

Tech companies like Facebook, Twitter and Google have been combating disinformation campaigns for a few years in response criticism in the wake of reports that foreign governments exploit their platforms for their own agendas.

So far, the companies’ progress has been slow, said Nina Jankowicz, a global fellow at the Wilson Center’s Kennan Institute in Washington D.C.

She said shutting down disinformation campaigns will take both tech-based solutions and educating people through digital literacy.

“It doesn’t matter how many of these accounts we delete, they’re just going to keep cropping back up,” Jankowicz said.

Twitter didn’t just suspend or remove the accounts. The company also put many of them into an archive of millions of tweets the platform identified as part of “state-backed information operations.” The idea is to house all the disinformation in one place for research purposes.

Twitter’s release of this information is a step toward self-policing and transparency. But Jankowicz said the move only offers a glimpse of what’s out there. She said researchers estimate the percent of fake accounts on Twitter and Facebook accounts are much higher than what the social media platforms say.

“Access to data is the linchpin to everything in terms of understanding how social media is really affecting our day to day lives,” she said.

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New England Patriots Cut Antonio Brown

The New England Patriots have cut Antonio Brown after just 11 days with the team. The wide receiver is accused of sexual assault and his future in the NFL is now in doubt.



AUDIE CORNISH, HOST:

To the NFL now. The New England Patriots have released receiver Antonio Brown. Pressure had been building on the Patriots after allegations surfaced that Brown sexually assaulted a former trainer. From member station WGBH in Boston, Esteban Bustillos has more.

ESTEBAN BUSTILLOS, BYLINE: Eleven days – that’s how long the professional relationship between Antonio Brown and the New England Patriots lasted. And although the time was short, it was filled with strife from the beginning. Brown came in as something of a character whose antics forced the Oakland Raiders to release him. But the conversation became serious when Brown’s former trainer Britney Taylor accused him of sexual assault and rape in a lawsuit. When the allegations became public, Patriots head coach Bill Belichick remained stoic.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER: Were you aware of the lawsuit when you signed Antonio Brown?

BILL BELICHICK: I’m not going to be expanding on the statements that have already been given.

UNIDENTIFIED REPORTER: Don’t you think the fans deserve to hear a little more from you on…

BELICHICK: When we know more, we’ll say more.

UNIDENTIFIED REPORTER: …Such a major development that, you know, could impact the team?

BELICHICK: I just said that.

BUSTILLOS: But the Patriots didn’t really say much more at all, and neither did Brown when he talked to reporters for the first time as a Patriot just yesterday. He answered a question about whether the NFL had told him anything about his playing status.

(SOUNDBITE OF ARCHIVED RECORDING)

ANTONIO BROWN: I appreciate that question. You know, I’m just here to just focus on ball and look forward to getting out there in the home stadium and being with the team.

BUSTILLOS: The pressure’s been on the NFL to do something. The league has battled image problems with multiple players over the past few years being accused of violence against women. During the past week, the NFL reportedly spoke to his accuser, Taylor, and Sports Illustrated reported that another unnamed woman had also accused him of sexual misconduct. Brown’s agent tweeted this afternoon that Brown wants to play the game he loves and hopes to play for another team soon, which would be his fourth in less than a year.

For NPR News, I’m Esteban Bustillos in Boston.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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A New Way Of Paying For Maternity Care Aims To Reduce C-Sections

Some insurers using this new payment model offer a single fee to one OB-GYN or medical practice, which then uses part of that money to cover the hospital care involved in labor and delivery. Other insurers opt to cut a separate contract with the hospital.

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The thrill of delivering newborns helped pull Dr. Jack Feltz into the field of obstetrics and gynecology.

More than 30 years later, he still enjoys treating patients, he says. But now Feltz is also working to change the way doctors are paid for maternity care.

Feltz’s New Jersey-based practice, Lifeline Medical Associates, recently partnered with the insurer UnitedHealthcare to test a new payment model. The insurer sets a budget with the practice to pay doctors one lump sum for prenatal services, delivery and 60 days of care afterward. If the costs come in below that amount, the medical practice gets to keep some of the savings. (Hospitals aren’t a part of this contract; the insurer pays them separately for their services.)

“We’ve always been taught to take care of patients as if they were our mothers and our daughters,” says Feltz, who also leads a coalition of obstetricians called the U.S. Women’s Health Alliance that advocates for high-quality, affordable care. “But now we have to take care of our patients as if they were our mothers and our daughters — and as if it was our money.”

This new program, announced in May, is a first step by the insurer to bundle physician payments for maternity care into a single flat fee that covers all care and procedures. A handful of insurers and state Medicaid programs are experimenting with similar models, sometimes incorporating hospitals and other health providers as well.

By moving from paying for maternity care in a piecemeal way to relying on bundled payments, insurers and doctors say they hope to cut costs and improve the quality of care for pregnant women.

But even fans of such a model acknowledge there are still significant obstacles to be worked out before this sort of flat-fee system could be implemented broadly.

The payment model is relatively new and still rare in maternity care; its structure can differ by insurer. Some insurers could pay a single amount to one doctor, who then uses part of it to cover hospital care. Other plans opt to cut a separate contract with the hospital. Insurers also vary in whether they make the lump sum payment before or after patients receive services. And the length of care, eligibility and services included in the bundle also vary.

In addition to, perhaps, reducing the overall cost of maternity care, the lump sums are seen by doctors and insurers as a possible way to improve health outcomes, including driving down the number of unnecessary cesarean sections in the United States.

About one-third of all deliveries in the U.S. occur via C-section, even though the World Health Organization estimates they are medically required in only 10% to 15% of births. The ratio of C-sections to live births varies dramatically among individual hospitals.

These surgeries can increase the risk of infections or other medical problems for the mother and baby. And they are more expensive than a vaginal delivery.

“The way we’ve been doing things is just not justifiable,” says David Lansky, a senior adviser at the Pacific Business Group on Health, a San Francisco-based coalition of private and public organizations that collectively purchase health care for 10 million Americans.

“The shift we’re talking about,” Lansky says, “is to say, ‘Someone is accountable for all the care that needs to be provided to support a family through this experience.’ “

Already, in traditional coverage, insurance payments for some women are delivered as bundled payments for some portions of their prenatal care, says Suzanne Delbanco, executive director of Catalyst for Payment Reform, a nonprofit organization that advises employers and other organizations that buy health coverage. However, she says, the new bundled payment models are different because insurers are adding quality measures that increase accountability to the bundle, as well as additional services such as labor and delivery.

Patients generally are not even aware their care is being handled under a bundled payment.

UnitedHealthcare, which announced its program in May, began testing the option with Feltz’s practice and another in Texas. The insurer says it hopes to expand to as many as 20 practices by the end of the year. Cigna and Humana are also piloting bundled maternity care programs. A few Medicaid programs, including those in Arkansas, Ohio and Tennessee, have experimented with it, too, in recent years.

Expanding the rarely used model to include maternity care could represent a major shift in health care finance. Births were the most common reason for hospitalizations among U.S. patients discharged in 2016, according to government data.

“Maternity care is kind of the sleeper of health care services,” says Dr. Neel Shah, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.

The change in payments is being made as the quality of maternity care in the United States comes under renewed scrutiny. An estimated 700 women in the U.S. die each year because of pregnancy-related complications, the federal Centers for Disease Control and Prevention reports. The rate of deaths in the U.S. is worse than in many other affluent countries, NPR and ProPublica reported in 2017.

C-sections also cost more than vaginal deliveries. In the Denver area, for instance, the average vaginal delivery costs $7,716 while the average C-section costs $14,274, according to 2019 data from the Health Care Cost Institute. On average, commercial and Medicaid insurers pay 50% more for C-sections than for vaginal deliveries, according to a 2013 report by Truven Health Analytics, a health industry consulting group.

Lansky’s group provided funding, data and oversight in 2014 for a project to test bundled payments for births in a variety of Southern California hospitals. According to their report, the rate of C-sections in first-time, low-risk pregnancies dropped by nearly 20% in less than one year among the first three participating hospitals.

However, some of the bundled-payment models have fallen short of aspirations. Tennessee saved money in 2017 after adopting the payment model for Medicaid beneficiaries. But the rate of C-sections remained unchanged, according to a report by the Medicaid and CHIP Payment and Access Commission, a nonpartisan advisory group for Congress.

In Ohio, where the Medicaid program covered complicated pregnancies as well as those that were low-risk, bundling payments into a lump sum for OB-GYNs cost the state more than expected, the advisory group found.

Bundling raises other concerns, too. Because some bundled-payment programs assign the total cost of care to a single physician, the financial burden falls on that physician. Dr. Lisa Hollier, the immediate past president of the American College of Obstetricians and Gynecologists, is concerned that these models may discourage team-based care.

If the physician providing prenatal care overlooks a problem that a different doctor must treat during delivery, for example, it wouldn’t be fair for the OB-GYN delivering the baby to bear the financial burden, Hollier says.

How payers define a low-risk pregnancy is also unclear, she says. If the target price for the suite of services in the model is not risk-adjusted for the cost of treating conditions like gestational diabetes, she says, doctors could be penalized for treating these patients.

Gestational diabetes occurs in up to 10% of pregnancies in the U.S. annually, according to the CDC, and patients with the condition need additional tests, checkups and insulin.

Julianne Pantaleone, national director of bundled payments and strategy at UnitedHealthcare, says that as the insurer works through its pilot program, it will cover the cost of physician care beyond the initial budget.

The lack of robust data systems built for handling bundled payments also poses a potential barrier for some medical practices, says Blair Barrett Dudley, a senior manager at the Pacific Business Group on Health.

Insurers and doctors need real-time data to ensure they are meeting the model’s quality measures, she says. However, these information banks are expensive to build, and many of the existing ones aren’t designed to handle this payment structure.

Feltz agrees that getting such data will be imperative to a successful bundled payment program. Without the information, he says, “it’s like launching a ship and not knowing where it’s going to go.”


Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

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How An ‘International Price Index’ Might Help Reduce Drug Prices

A pharmacist collects packets of boxed medication from the shelves of a pharmacy in London, U.K. A proposal announced by House Speaker Nancy Pelosi Thursday would allow the government to directly negotiate the price of 250 U.S. drugs, using what the drugs cost in Australia, Canada, France, Germany, Japan, and the United Kingdom as a baseline.

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In gridlocked Washington, both Democrats and Republicans have signaled there’s potential for a deal when it comes to lowering prescription drug prices. Now, there’s an idea both Congressional Democrats and the White House seem to like: They want to base U.S. prices on something called an international price index.

“The basic idea is to peg what the United States pays for a particular drug to the price paid in some set of other countries,” says Rachel Sachs, an associate professor of law at Washington University in St. Louis who specializes in drug pricing policy. “There are many different ways to identify other countries, and there are many different ways in which that international reference price could be used to negotiate for a price here.”

House Speaker Nancy Pelosi unveiled her sweeping plan to reduce drug prices Thursday, which included an international price index. There are lots of differences between that plan and the one the White House floated last fall, but the basics — and the appeal of the concept — are the same.

“It stops drug companies from ripping off Americans while charging other countries less for the drug,” Pelosi said in a press conference announcing the House plan, which would use drug prices in Australia, Canada, France, Germany, Japan, and the United Kingdom to create a baseline in negotiating prices.

She’s speaking President Trump’s language. Here’s what he told reporters in July: “Why should other nations like Canada — why should other nations pay much less than us? They’ve taken advantage of the system for a long time, pharma.”

Earlier this summer, the Department of Health and Human Services sent its own IPI proposal to the White House for review, though the details haven’t been made public. The idea of establishing an IPI is the only element of the administration’s plan to lower prescription drug prices still on the table — other ideas, like displaying list prices in TV ads and ending secret rebates for middlemen have been withdrawn or blocked in the courts.

A glimpse of what the HHS proposal might look like can be found in the outline of a Medicare model HHS released last fall. Like the House Democrats’ plan, the HHS model uses an index of countries to generate an average price. But, unlike the House plan, it would not let the secretary of HHS use that average to negotiate directly with drugmakers.

The HHS outline is also more limited in the drugs that would be eligible for this sort of price-setting. Medications eligible would be only a subset of drugs used by Medicare patients — mostly injections given in doctor’s offices — whereas the House plan would extend to a wider group of 250 brand-name drugs.

Another difference? “The House Democrats’ proposal envisions a non-compliance fee that would financially penalize drug companies who won’t bargain in a good-faith way with the administration,” Sachs says. “There’s no such enforcement mechanism in the administration’s IPI proposal.”

Both plans would use the average price internationally for each drug as a benchmark in negotiations, so that Americans don’t pay more than about 20% above what people in other countries pay. That’s still more than what people pay outside the U.S., but less than they pay now.

“The prices the U.S. is currently paying today can be two or three times as much, [though it] varies a lot by product,” says Stacie Dusetzina, a professor of health policy at Vanderbilt University School of Medicine. “This would be a major price reduction.”

One example of a drug priced much higher in the U.S. than elsewhere is Humira, a brand name rheumatoid arthritis drug. In 2015, it cost $2,669 a month in the U.S., while the list price in the U.K. was about half that — $1,362. The same drug cost only $552 in South Africa, according to the International Federation of Health Plans.

“I believe that the price of Humira now in the U.S. is about $63,000 a year,” says Ben Wakana, executive director of the advocacy group Patients for Affordable Drugs. “And [the drugmaker] AbbVie has raised the price eleven times between 2014 and 2018.” Wakana has a personal connection to Humira — his brother. In the U.S., there’s no generic competition that might push the price down, he notes.

“For patients like my brother and like the thousands of people who take Humira every year, that price is simply too high,” Wakana says. “We need competition. And if we can’t get competition, then we need to be able to negotiate with AbbVie for a fair price — like they are offering in other countries.”

So, would establishing an international price index actually work to lower drug prices?

The Trump administration projects that, in five years, using its IPI would save Medicare patients $3.4 billion. Policy analysts have argued that the amount patients would save is actually a bit murkier because many Medicare patients who use these drugs also have supplemental insurance. In addition, because so many countries — 24 in Europe alone — use this kind of indexing, there’s the risk of a circular effect, with everybody looking to their neighbor instead of basing the cost of the drug on concrete measures of the medicine’s clinical value or the costs of developing and producing it.

In Canada, the government already uses international drug list prices in negotiations, and has recently made moves to go even further.

“The comparison of our list prices in Canada to the list prices in other countries has proven to be not very effective at controlling the real price of medicines in this country,” says Steve Morgan, a professor of health policy at the University of British Columbia. One reason for that, he says, is that list prices don’t reflect real prices after drugmaker rebates. So now, he says, “Canada is trying to implement further price regulations that would make sure that the final negotiated prices are reasonable.”

In the United States, many Republican lawmakers and conservative groups have opposed the idea of an international index — arguing that it runs against free market principles.

Unsurprisingly, drugmakers also object. “Speaker Pelosi’s radical plan would end the current market-based system that has made the United States the global leader in developing innovative, lifesaving treatments and cures,” Stephen Ubl, CEO of lobbying group PhRMA, says in a written statement. “We do not need to blow up the current system to make medicines more affordable.”

But Pelosi and her allies seem to be betting there is political will to go against drugmakers this time. Despite the huge sums spent on lobbying, the pharmaceutical industry is now the most unpopular industry in the country, according to a recent Gallup poll. And with a presidential election coming up, Americans polled say lowering drug prices is a top priority.

This could mean there’s room for the House and the White House to work together, especially on an idea like an international price index that they’ve both proposed.

“We do hope to have White House buy-in,” Pelosi said Thursday. “That seems to be the route to getting any votes in the United States Senate, and certainly we want as strong a bipartisan vote as we can in the House and the Senate. So we would hope that they would support this.”

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Amazon Makes ‘Climate Pledge’ As Workers Plan Walkout

Amazon CEO Jeff Bezos announces the company’s climate initiative Thursday at the National Press Club in Washington, D.C.

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Amazon is “done being in the middle of the herd” when it comes to climate-focused company policies, CEO Jeff Bezos said Thursday.

The company is pledging to power its global infrastructure with 100% renewable energy by 2030 and to be carbon-neutral by 2040. To help get there, it plans to buy 100,000 electric delivery vans from Michigan-based company Rivian, in which Amazon previously invested.

Amazon says its Climate Pledge will meet the Paris climate agreement 10 years ahead of schedule. The company is also inviting other companies to sign onto the pledge.

“It’s a difficult challenge for us because we have deep large physical infrastructure. We’re not only moving information around … we deliver more than 10 billion items a year,” Bezos told reporters Thursday. “And so we can make the argument — and we plan to do so passionately — that if we can do this, anyone can do this.”

Amazon’s announcement marks the most sweeping climate-related action from the company, one day before more than 1,500 corporate workers planned a walkout to draw attention to their criticisms of the company’s climate policies. Amazon has lagged behind other companies — including tech giants like Facebook and Google — in reaching the goal of 100% renewable energy and sharing data about its emissions.

The Amazon workers’ planned walkout Friday is part of a series of rallies called the Global Climate Strike ahead of Monday’s U.N. Climate Action Summit. Workers complained that the company known for its obsession with data and measurable goals would not share data on its own carbon footprint, calling on Amazon to get to zero emissions by 2030.

“Today, we celebrate. Tomorrow, we’ll be in the streets to continue the fight for a livable future,” the group Amazon Employees for Climate Justice said in a statement Thursday. The walkout also is expected to draw some workers from Google, Facebook and Microsoft.

Thousands of Amazon employees earlier this year signed a shareholder resolution to set a climate change plan, which did not pass. More than 8,000 workers had also signed an open letter to Bezos, calling for Amazon to set measurable goals, to end contracts with oil and gas companies and to stop donating to lawmakers who deny climate change.

“I think it’s totally understandable people are passionate about this issue,” Bezos said, adding that Amazon would review its campaign donations. The company will also invest $100 million to restore and protect forests, grasslands and wetlands.

However, Bezos said he disagreed with the employees’ call to end contracts with energy companies and stop providing them with cloud computing tools. “To ask oil and energy companies to do this transition with bad tools is not a good idea and we won’t do that,” he said.

Elizabeth Sturcken, a managing director at the Environmental Defense Fund, called Amazon’s Climate Pledge an encouraging step in the right direction.

“They were in danger of being left behind as a laggard,” she said. “There’s a lot of hard work ahead for Amazon. But these ambitious, aspirational goals need to be turned into meaningful milestones, and they need to act transparently.”

Bezos said Amazon will measure and regularly report online information about its carbon footprint and work toward reducing it.

Editor’s note: Amazon is one of NPR’s recent financial supporters.

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