HHS Inspector General Finds Serious Flaws In 20% Of U.S. Hospice Programs
From 2012 through 2016, federal health inspectors cited 87% of U.S. hospices for deficiencies. And 20% percent had lapses serious enough to endanger patients, according to two new reports from the HHS Inspector General’s office.
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We all hope for some peace and comfort at the end of life. Hospices are designed to make that possible, relieving pain and providing emotional and spiritual support. But two new government studies released Tuesday morning find that the vast majority of hospices have sometimes failed to do that.
And there’s no easy way for consumers to distinguish the good hospices from the bad.
The reports are the government’s first to look at hospice deficiencies nationwide. The Office of the Inspector General in the Department of Health and Human Services found that from 2012 through 2016, health inspectors cited 87% of hospices for deficiencies. And 20% percent of hospices had lapses serious enough to endanger patients.
Deputy Regional Inspector General Katherine Harris cites the case of a patient who had untreated bed sores, or pressure ulcers, on both heels.
“These ulcers rapidly worsened,” says Harris. “The patient developed gangrene and needed a leg amputation.”
In the dry terminology of government reports, this is called “poor care planning.” And having plans of care developed in conjunction with the patient and the patient’s family, Harris says, is a fundamental requirement of hospice,.
“So when we discover that hospices are not doing them, there is reason for concern,” she says.
For example, there’s the case of Karen Bishop Collings and her 85-year-old dad, Dean Bishop. Though Bishop had chronic lung disease, he’d been doing OK and living independently. Then, last winter, he was hospitalized with pneumonia. When he was transferred to a residential care facility to recuperate, he began receiving hospice services. That was a surprise to his daughter.
“We only agreed to pre pre-assessment of his conditions, to even see if he qualified for hospice or palliative care,” she says.
Collings has shared some of her father’s medical records with NPR, and they verify her recollection. The hospice never held a meeting with Bishop or the family to establish a care plan. So Collings was shocked when hospice workers gave her father two new medications: morphine and the anti-anxiety drug Ativan.
“We knew something distressing had happened,” she says. “His whole physicality and mental capacity was completely altered.”
Dean Bishop died a couple of days later.
If this hospice had previously been cited for deficiencies, Collings would have had a hard time finding out. The Centers for Medicare and Medicaid Services, or CMS, doesn’t make that information available on Hospice Compare, its website for consumers, even though the agency has the authority to post at least some of that data.
“We live in a time when we don’t even think about booking a hotel without checking its ratings and reviews,” says Harris. “Why do we demand less for hospices?”
The reports also highlight the the options CMS has for disciplining hospices are few. The agency can drop substandard hospices from the Medicare program altogether. But it lacks the legal authority to assess fines. It would take an act of Congress to give CMS that power.
In response to the Inspector General’s reports, CMS issued a written statement that the agency “has zero tolerance for abuse and mistreatment of any patient.” The statement also says that the agency has added consumer feedback to the Hospice Compare website. Katherine Harris thinks that’s not enough.
“There are a lot of great hospices out there,” Harris says. “There are a lot of highly skilled, committed professionals who are dedicated to helping others leave this life in comfort and with dignity — and the public should know about them.”
The amount of money that Medicare spends on hospice services has roughly doubled since 2006. But Harris says this isn’t just a matter of taxpayer dollars.
You’re only going to die once, she says. It’s important that things go right.
U.S. Women To Resume ‘Equal Pay For Equal Pay’ Fight After Winning 4th World Cup
The U.S. Women’s National Team won the Women’s World Cup championship for a fourth time. As the players return home, they’re ramping up their fight for “equal pay for equal play.”
ARI SHAPIRO, HOST:
The celebration for the U.S. Women’s National Soccer Team shifts this week from France to New York City. On Wednesday, the World Cup champs will get a ticker-tape parade and keys to the city. Then the players will turn their focus back to a more serious matter. In a lawsuit filed before the tournament, they demanded equal pay to their male counterparts. As NPR’s Tom Goldman reports, many U.S. women’s team supporters say a fourth World Cup title makes the case even stronger.
TOM GOLDMAN, BYLINE: In the stadium in Lyon yesterday, it didn’t take long for the pivot from joy to indignation. As U.S. players hugged and celebrated their hard-earned victory over a tough Netherlands team, the chants bubbled up from the stands.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED SOCCER FANS: (Chanting) Equal pay, equal pay, equal pay.
GOLDMAN: And then the booing…
(BOOING)
GOLDMAN: …For members of FIFA, soccer’s international governing body, which reportedly will pay the U.S. women a $4 million bonus, compared to the 38 million it paid to last year’s men’s World Cup winners.
Megan Rapinoe, the outspoken U.S. winger, won the Golden Ball award given to the tournament’s most valuable player. But after the match, she assumed her other role as outspoken plaintiff in the class-action suit filed against the U.S. Soccer Federation in March. The suit was brought by U.S. players, but Rapinoe says everyone at this World Cup helped push the fight forward.
(SOUNDBITE OF ARCHIVED RECORDING)
MEGAN RAPINOE: Every player at this World Cup put on the most incredible show that you could ever ask for, and we can’t do anything more to impress, more to be better ambassadors, to take on more, to play better, to do anything. It’s time to move that conversation forward to the next step.
GOLDMAN: The next step is mediation, as the U.S. women and their federation try to resolve issues of equal pay and better working conditions. On the surface, resolution seems easy; pay the U.S. women what the U.S. men make. Look at the women’s success versus the men’s lack thereof. The men didn’t even qualify for their last World Cup. Look at what the teams make for their federation. The Wall Street Journal reports in the last three years, U.S. women’s games generated more revenue than the U.S. men.
Still, sports law expert Michael McCann says resolving the issues is tricky.
MICHAEL MCCANN: It’s a complex topic. It’s not as straightforward as I think it’s depicted.
GOLDMAN: McCann is a law professor at the University of New Hampshire. He says there’s debate about how revenue is attributed to the men’s and women’s teams. There’s debate about how sponsorships are awarded. The two teams have different pay structures. The men are paid when they play. The women have guaranteed pay. And McCann wonders what happens if the women are successful in their efforts.
MCCANN: Here, this is an entire group of players bringing in a case over pay. That complicates it in the sense that – how would any increases be distributed?
GOLDMAN: McCann says the lawsuit is suspended during mediation. But if talks fail, the women will resume litigation. Emily Martin says women everywhere in this country should pay attention to this case over pay inequality. Martin is with the National Women’s Law Center. She says when you compare women and men who work full time, women are paid about 80 cents for every dollar paid to men.
EMILY MARTIN: I do think it will inspire individual women to come forward and say, pay me what you owe me. I also think that when you see this kind of high-profile excellence fighting for equal pay, that that is an important prompt for lawmakers to do the same.
GOLDMAN: Martin adds, considering the U.S. women’s sustained excellence, maybe pay equality is aiming too low and it’s time to ask for better pay.
Tom Goldman, NPR News.
(SOUNDBITE OF MUSIC)
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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.
How João Gilberto’s Music Sparked An Aesthetic Revolution
João Gilberto in 1970
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From a casual distance, the music of João Gilberto sounds like it might belong to that ancient realm known as “easy listening.”
Everything’s calm, for starters. Even at fast tempos, Gilberto’s voice demands nothing — hushed, thin, confession-booth quiet. His rhythm guitar anchors the music with accompaniment that can seem almost hypnotically repetitive. The melodies rarely beg for attention, instead basking in that sublime mix of contentedness and yearning common throughout Brazilian music. There are strings rising up in wave-like swells from time to time, and lamenting love calls from the low brass.
Beneath that smooth and pleasant veneer, Gilberto built a quiet (and still misunderstood) aesthetic revolution – a lithe, strikingly modern approach to rhythm and melody that became the blueprint for bossa nova.
Gilberto, who died at home in Rio de Janeiro on Saturday, was best known for his contributions to Getz/Gilberto, the 1964 album that, through its single “The Girl From Ipanema,” made bossa nova a worldwide sensation (and won the Grammy for album of the year). But Gilberto deserves to be remembered more broadly, as a kind of patron saint of understatement, whose early recordings transformed the boisterous celebration of samba parades into music of arresting intimacy.
The rare instrumentalist (i.e., not a composer) to define and shape a musical genre, Gilberto developed an austere, steady-handed revolution that opened up lanes of exploration for subsequent generations. And it swept like wildfire, becoming pervasive before he could even be properly acknowledged as its spark plug. (“Eventually the culture caught up to him, and despite his reputation as a recluse, he became a revered figure in Brazil — referred to as “O Mito/The Master” and “O Rei da Bossa/The King of Bossa” and “Ill Mastro Supremo,” and, perhaps most fittingly, “O Zen-Baiano/The Zen Master of Bahia.”)
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Those early recordings, particularly his 1958 take on Antonio Carlos Jobim’s “Chega de Saudade/No More Blues,” had a meteor-like impact on the musicians of Brazil; Gilberto’s blend of whispering vocals and exactingly precise guitar accompaniment represented a radical break from the schmaltzy pop balladry (Nelson Gonçalves, for example) on the radio at the time. Guitarist Oscar Castro-Nieves recalled hearing that single for the first time as a teenager: “It changed everything, for every young musician in Brazil … all I can say is that it was like the first time I heard Charlie Parker.”
The singer and songwriter Caetano Veloso, another legendary Brazilian singer and songwriter whose discography elaborates on Gilberto’s basic themes, was even more effusive in an L.A. Times interview: “I owe João Gilberto everything I am today. Even if I were something else and not a musician, I would say that I owe him everything.”
Gilberto’s stealth approach was born after several unsuccessful attempts to establish himself as a musician for hire in Rio, where, according to legend (as relayed in Ruy Castro’s authoritative history of bossa nova, Chega de Saudade), he overstayed his welcome on the couches of friends. He fled to his sister’s house, in a town called Diamantina, where, in a tile bathroom with favorable acoustics, he began to experiment with a sound built around brooding, vibrato-free and leisurely, long-toned vocals.
In a rare interview with the New York Times in 1968, Gilberto explained that his process involved editing out all but the most essential information. “It has to be very quiet for me to produce the sounds I’m thinking of.”
Gilberto’s central innovation, overall, was in the guitar accompaniment. Gilberto took the massive rhythm of the samba schools he heard growing up in Bahia – a thrilling sensory experience involving hundreds of drums, superloud shakers and clanging metal bells locked together in endlessly propulsive polyrhythm – and distilled it down to stark human scale. Music centered around one voice and one acoustic guitar.
“Rosa Morena”
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Typically, such a reduction of forces diminishes — but Gilberto’s reduction had the opposite effect, opening up a new resonance for samba, using the form’s rhythmic intensity to uncover hidden directions and nuances. First, Gilberto caught the whomp of the samba bass drum with his thumb. Then, with his other fingers moving independently, he’d stab against the time with crisply articulated chords, forming an artful, unpredictable syncopation. These patterns can sound like recurring loops (Gilberto’s time is astonishingly steady) but as you listen more closely, they register as constantly evolving codes. You can hear him varying the cadences, the length of the patterns, the voicings. The result: An ever-changing, mosaic-style backdrop, a guitar-powered perpetual motion machine. (“Rosa Morena” is a good example of this.)
“Brigas, Nunca Mais”
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“Doralice”
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Over this, Gilberto sang in a placid, straightforward style that sometimes masked the turbulence underneath (as on “Brigas, Nunca Mais”), and sometimes sharpened it (as on “Doralice”). Having turned the extroversion of samba inward, he went about exploring distinct shades of emotion, adding dimension and richness to beloved early samba classics by subtracting the pageantry.
In performances and recordings from the 1970s, Gilberto began stretching out melodic phrases in whimsical, sometimes radical ways; it could be disarming to hear such a languid, vapor-like voice creating tension just by reconfiguring the commonly understood shape of a familiar melody.
Those explorations align Gilberto with artists like Bob Dylan, whose ad-libbing confounded expectations in the quest for newly resonant interpretations. More broadly, Gilberto’s austere, modernist approach connects to artistic movements outside of Brazil, most notably jazz. In both his guitar work and his singing, Gilberto was a master improviser, and his less-is-more philosophy mirrors those of Miles Davis and Thelonious Monk. As they did, Gilberto pared excess language and stylistic flourishes to the bare minimum, on a quest to uncover nuances by subtraction.
As the “new” trend of bossa nova rose in the early ’60s, Gilberto became popular with a rising generation of songwriters. He introduced hundreds of songs that drew from samba while adding richly literary perspective on romance and devotion. These form the core of an extraordinary multi-generational Brazilian songbook that begins with the work of the prolific Antonio Carlos Jobim in the 1950s and ’60s, along with tunes by Veloso, Edu Lobo and others active in the late ’60s as well as stars of the ’70s like Milton Nascimento and Djavan. All of these share a common thread — the neatly syncopated performance style of Joao Gilberto. His crystalline renditions of “Corcovado” and “Caminhos Cruzados” (and countless other Jobim gems) taught subsequent generations of singers and instrumentalists how to approach the composer’s sophisticated harmonies, how to convey meaning with the slightest of gestures, how to create the kind of openness that draws the listener into the deep poignance of a tune.
The remarkable thing about João Gilberto is how often he managed this sublime art, under all kinds of musical conditions. His discography includes quietly transfixing recordings across a range of hues, from the upbeat to the meditative. And whether he’s working with a lush studio orchestra or playing alongside a lone percussionist, he rarely sounds like he’s exerting himself. Everything flows, effortlessly. He approaches the music as though sneaking or sliding into it. He’s coy, and wily, sculpting drop-dead gorgeous melodies out of shallow breath, dispensing intricate staccato samba codes with the grace of a dancer.
It is, from a distance, easy listening – the sound of serenity and calm, as steady as the sea. Let it get under your skin for a while, and the nuances blossom into complexities, the complexities breed more levels of nuance… and, pretty soon, it’s like being flattened by a feather.
U.S. Takes A Record 4 Women’s World Cup Titles
The United States won the Women’s World Cup after a thrilling 2-0 victory against the Netherlands. With the win, the U.S. has won the World Cup a record four times.
MICHEL MARTIN, HOST:
Well, they did it. The U.S. women proved once again they are the best in the world, defeating the Netherlands 2-0 in the Women’s World Cup final today. The U.S. has now won the tournament a record four times. NPR’s Eleanor Beardsley was at the final in Lyon, France, and she is with us now.
Hi, Eleanor.
ELEANOR BEARDSLEY, BYLINE: Hi, Michel.
MARTIN: Well, Eleanor, let me contain – or try to contain – my jealousy that you are there and I am not. But it was tense enough to watch from here. What was it like inside the stadium?
BEARDSLEY: Michel, it was amazing. I’ve been to some of the games during this past month, and they just built up and built up. And today, it was the buildup of a whole month of the tournament. The stadium was at a fevered pitch. There were 60,000 people. It was filled to capacity for, you know, these two teams. The U.S. has been like a well-oiled machine all month, just rolling through France, steamroller. And, you know, the Netherlands is No. 8, but they’ve been really scrappy. They won the European Championship last year. So this was a great game. The U.S. was a favorite team, but the Netherlands was good.
In the six previous games, the U.S. has scored within the first 12 minutes, so everyone was waiting for that. But it didn’t happen. In fact, we didn’t score, Michel, until the 62nd minute, into the second half. So people were just on tenterhooks. It was the most tense game that I’ve been to. And Megan Rapinoe scored then in a penalty kick. And then, seven minutes later, Rose Lavelle scored. And then by then, we had two goals to nil. The momentum was with us. The Dutch really defended their goal, but they couldn’t score after that.
MARTIN: So talk about that run, if you would. I mean, this capped this really amazing month-long run for the U.S. Why was the U.S. so dominant?
BEARDSLEY: The U.S. is has so much talent. It’s almost like two teams came to play. There was the team out on the field that played, and there was another one ready to go on the bench. You know, coach Jill Ellis played 21 out of the 23 players. Only the two, you know, backup goalies didn’t play. We have so many talented players, and I think that speaks to the way the game is just so successful in the U.S. It’s so supported. It has funding. And it’s not really – doesn’t have that depth in Europe. You know, the Europeans’ teams have caught up, the rest of the world is catching up, but we’re still really dominant.
MARTIN: To the question of funding, there was a moment after this game where fans were chanting equal pay, and that is a reference to the lawsuit that the women’s team has filed against U.S. Soccer demanding pay at least comparable to the men’s team, particularly given their success both on the pitch and in attracting supporters and fans. So do you have a sense that this is an issue that actually really resonated with the fans?
BEARDSLEY: Yes, it really does. You know, the women earn supposedly 30 million for this while the men in their World Cup got 400 million. It’s just too big of a gap. People were chanting that here. You can hear it.
UNIDENTIFIED CROWD: (Chanting) Equal pay, equal pay, equal pay…
BEARDSLEY: And then also what was really telling is when the president of FIFA came in, the entire stadium booed.
UNIDENTIFIED CROWD: (Booing).
BEARDSLEY: People such as Mr. Kenneth Lloyd (ph), who I spoke to from Austin, Texas, who brought his family for the World Cup – they want the women to earn what they deserve. Listen to what he says.
KENNETH LLOYD: It should inspire the men, and it should inspire the United States to level – to pay these women what they deserve to be paid because they are the champions of the world more than one time.
BEARDSLEY: He brought his son and daughter out, and he said, you know, these women are phenomenal. They’re doing an incredible job. Let’s pay them.
MARTIN: That is NPR’s Eleanor Beardsley in Lyon, France.
Eleanor, thank you so much.
BEARDSLEY: You’re welcome, Michel.
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.
Microsoft Closes The Book On Its E-Library, Erasing All User Content
A man reads a book on his e-book reader device. In July, Microsoft will be deleting its e-book library and ceasing all e-book sales.
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Coffee poured. Pillow fluffed. E-book loaded. You’re ready to begin a delightful afternoon on your e-reader when, poof, the book disappears.
Starting in July, Microsoft will be closing its e-book library and erasing all content purchased through the Microsoft e-bookstore from devices. Consumers will receive a refund for every e-book bought.
The company is able to shutter its store – which it launched in 2017 to compete with industry leaders Amazon, Apple and Barnes & Noble – due to a tool called Digital Rights Management or DRM.
DRM allows companies to control content to protect copyright holders and prevent piracy.
“One of the things that I think people don’t realize that’s crucially important is that DRM and related software tools are embedded in all sorts of devices that we buy,” Aaron Perzanowski, the author of The End of Ownership: Personal Property in the Digital Economy, tells NPR’s Lulu Garcia-Navarro.
“Your car, your smart home appliances, your home security system – all of these systems have software that allows for this kind of control over how the devices are used, and I think we’re going to see these same sorts of situations crop up in the context of physical devices that are being used in people’s homes.”
It’s time for @FTC to consider whether a refund is really sufficient when a seller confiscates your media or bricks your device. https://t.co/DaO73bLoti
— Aaron Perzanowski (@APerzanowski) June 30, 2019
The way DRM is widely employed has been criticized by consumers and earned calls for regulation of Big Tech companies.
“The initial vision for DRM was that it was going to allow for the sale of digital goods online in a way that reduced the risk of copyright infringement,” Perzanowski says.
“As this technology has been deployed what we’ve seen is that the big beneficiaries of DRM have not been copyright holders. They have been technology companies like Amazon, like Microsoft, who are able to control these ecosystems to make it harder for consumers to switch over to new platforms.”
In a University of Pennsylvania Law Review article, Perzanowski found that users are often misled when they click the “Buy Now” button, thinking that they’ve gained permanent ownership of digital content.
Other companies, like Amazon and Walmart, have run into DRM-related troubles in the past, wiping out digital content to the chagrin of consumers.
The e-book and online shopping giant, Amazon, obtained eye rolls when it deleted some George Orwell books from the Kindle’s DRM server, including 1984. Apparently, the company did not understand the irony of erasing a book that famously details the dangers of thought control.
Perzanowski worries that DRM erodes personal property rights and that the scope extends beyond digital media.
“You can go out and buy a car and you think you own the car because it’s parked in your garage,” Perzanowski says. “But in reality – how it functions, who can repair it, what replacement parts are compatible with it – all of that is controlled through software code. And, so I think that line between the physical and the digital is getting increasingly blurry.”
In an explainer posted to its website, Microsoft adds that anyone who wrote notes or marked-up e-books will receive an additional $25 credit. The company has not provided a reason for the closure.
Frank Scardera, a Reddit user, is one of the many Microsoft consumers affected by the e-book purge.
“I was disappointed when Microsoft announced they were shutting the service down…” Scardera says. “In the future, I’ll be buying books from sources that use DRM-free formats, so that if a service is shut down I don’t lose my books or other media.”
NPR’s Peter Breslow and Barrie Hardymon produced and edited this story for broadcast.
With Rural Health Care Stretched Thin, More Patients Turn To Telehealth
After a difficult time in her life, Jill Hill knew she needed therapy. But it was hard to get the help she needed in the rural town she lives in, Grass Valley, Calif., until she found a local telehealth program.
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Telehealth turned Jill Hill’s life around.
The 63-year-old lives on the edge of rural Grass Valley, an old mining town in the Sierra Nevada foothills of northern California. She was devastated after her husband Dennis passed away in the fall of 2014 after a long series of medical and financial setbacks.
“I was grief-stricken and my self-esteem was down,” Hill remembers. “I didn’t care about myself. I didn’t brush my hair. I was isolated. I just kind of locked myself in the bedroom.”
Hill says knew she needed therapy to deal with her deepening depression. But the main health center in her rural town had just two therapists. Hill was told she’d only be able to see a therapist once a month.
Then, Brandy Hartsgrove called to say Hill was eligible via MediCal (California’s version of Medicaid) for a program that could offer her 30-minute video counseling sessions twice a week. The sessions would be via a computer screen with a therapist who was hundreds of miles south, in San Diego.
Hartsgrove co-ordinates telehealth for the Chapa-de Indian Health Clinic, which is a 10-minute drive from Hills’s home. Hill would sit in a comfy chair facing a screen in a small private room, Hartsgrove explained, to see and talk with her counselor in an otherwise traditional therapy session.
Hill thought it sounded “a bit impersonal;” but was desperate for the counseling. She agreed to give it a try.
Coordinator Brandy Hartsgrove demonstrates how the telehealth connection works at The Chapa-de Indian Health Clinic in Grass Valley, Calif. Via this video screen, patients can consult doctors hundreds of miles away.
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Hill is one of a growing number of Americans turning to telehealth appointments with medical providers in the wake of widespread hospital closings in remote communities, and a shortage of local primary care doctors, specialists and other providers.
Long-distance doctor-to-doctor consultations via video also fall under the “telehealth” or “telemedicine” rubric.
A recent NPR poll of rural Americans found that nearly a quarter have used some kind of telehealth service within the past few years; 14% say they received a diagnosis or treatment from a doctor or other health care professional using email, text messaging, live text chat, a mobile app, or a live video like FaceTime or Skype. And 15% say they have received a diagnosis or treatment from a doctor or other health professional over the phone.
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Those survey findings are part of the second of two recent polls on rural life and health conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.
The Chapa-de clinic offers telehealth services not only for consultations in behavioral health and psychiatry, but also in cardiology, nephrology, dermatology, endocrinology, gastroenterology and more.
The Chapa-de Indian Health Clinic in Grass Valley, Calif., offers telehealth services for various specialties, including dermatology, gastroenterology and psychiatry.
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Hill feels fortunate; she knows most rural health facilities don’t include telehealth services, which means most patients living in remote areas would need their own broadband internet access at home to get therapy online.
And that’s out of reach for many, says Robert J. Blendon, co-director of NPR’s poll and professor of health policy and political analysis at the Harvard Chan School.
The poll found that one in five rural Americans say getting access to high-speed internet is a problem for their families.
Blendon says advances in online technology have brought a “revolution” in healthcare that has left many rural patients behind.
“They lose the ability to contact their physicians, fill prescriptions and get follow-up information without having to go see a health professional,” he says.
Critical care pediatrician James Marcin at UC Davis Children’s Hospital, directs the University of California, Davis, Center for Health and Technology and regularly consults via a telehealth monitor with primary care doctors in remote hospitals in rural areas.
“We’re able to put the telemedicine cart [virtually] at the patient’s bedside,” Marcin says, “and within minutes our physicians are able to see the child and talk with the family members and help assist in the care that way.”
If not for telehealth, Marcin says, the costs of getting what should be routine care “are significant barriers for those living in rural communities.”
“We have patients that drive to our Sacramento offices and they have to drive the night before,” he says, “and spend the night in a hotel because it’s a five-hour trip each way.” And there are additional costs for many patients, he says, such as childcare services, and missed days of work.
With telehealth, “a video is truly worth a thousand words,” he says; it can mean patients don’t have to make costly time-consuming trips to see a specialist.
Though Hill initially had reservations about meeting with a therapist online, she says she’s been amazed by how helpful the sessions have been.
“She gives me assignments and works me really hard,” Hill says, “and I have grown so much — especially just in the last few months.”
Her latest assignment in therapy: writing down positive characteristics of herself. Initially, she could only come up with three: loyalty, compassion and resilience. But the therapist questioned that, and encouraged Hill to consider that there might be more.
Hill says she’s in a ‘super growth” mode these days psychologically, and says the support she’s received in therapy has been key to that. She speaks with a clinical psychologist via a telehealth session twice a week for 30 minutes, and completes assigned homework in between those appointments.
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“She wanted 10,” says Hill, who proceeded to work through some other issues and talk more with therapist. “Now I’ve got like 15 at least,” Hill says, “and I keep adding to the list; once I started writing things down, I started really seeing that I have a lot of strengths I didn’t even know I had.”
Attorney Mei Kwong, executive director of the Center for Connected Health Policy in Sacramento, says telehealth services have the potential to remove many barriers to good health care in rural America.
But policies that regulate which telehealth services get paid for “lag way behind the technology,” Kwong says. Many policies are 10 to 15 years behind what the technology is able to do, she says.
For example, high-resolution photos can now be taken – and sent anywhere digitally — of skin conditions that many doctors say are better than “the naked eye looking at the condition,” she says. But the policies on the books of what Medicare, Medicaid and private insurers will pay for often means these services are not fully covered.
That’s unfortunate, Kwong says, especially for underserved communities where there is a shortage of specialists.
Changes are starting to be made in state, federal and private insurance policies, Kwong says. But it’s “slow going.”
João Gilberto, Master Of Bossa Nova, Dies At 88
Michael Ochs Archives/Getty Images
Updated at 9:34 p.m. on Saturday, July 6.
João Gilberto, one of the principal architects of the Brazilian musical style bossa nova, has died at his home in Rio de Janeiro, according to a FaceBook post by his son. João Marcelo Gilberto wrote that his father, who was 88 years old, died following an undisclosed illness.
João Gilberto is credited some with writing the first bossa nova, or new beat. This mid-20th century musical gift to the world drew on Brazil’s African-influenced samba tradition, but was performed without the usual battery of drums and rhythm instruments, and at much lower volumes. Gilberto’s intimate and nuanced style of guitar playing and singing, eventually central to the bossa nova sound, were reportedly developed in 1955 when he sequestered himself inside of a bathroom at his sister’s house so as not to disturb her family and to take advantage of the acoustics provided by the bathroom tiles.
In the mid-1950s, Brazil was in the midst of a post-WWII modernization inspired by a new president who wished to move the country out of third world economic status. Gilberto’s “Bim-Bom,” often named as the first bossa nova song, came from that period, and soon thereafter, the style began to sweep Rio’s cafe’s and bars. Bossa nova’s sophisticated sound became popular with a new moneyed class eager to move away from the more traditional samba sound of explosive drums and group singing. Rio de Janeiro was ground zero of the country’s cultural explosion; Gilberto, composer Antonio Carlos Jobim and poet Vinicius de Moraes were the key architects of a culture shift that forever changed their country’s musical point of reference.
The breakthrough came just before the end of the decade. In 1958 Jobim and de Moraes had collaborated on a recording of the song “Chege de Saudade” by another vocalist, but the song didn’t become a phenomenon until Gilberto’s version, with his softly percussive finger picking technique on an acoustic guitar and breathy vocals that matched the soft curves of the music. Gilberto’s version became a hit in Rio and internationally, and launched the bossa nova movement.
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Brazilian born pianist Jovino Santos Neto described the influence Gilberto’s technique had on the music of that era as profound. “His uncanny ablity to syncopate his vocal delivery, while keeping a simple groove was his trademark sound,” Neto wrote to NPR from his home in California. “Several others tried to imitate him, with no success”.
Over three years Gilberto recorded three albums that were the blueprints for a musical revolution: Chega de Saudade (Odeon, 1959), O Amor, o Sorriso e a Flor (Odeon, 1960), and João Gilberto (Odeon, 1961).
In 1961 the U.S. State Department had organized one of its goodwill musical ambassador tours to Rio and jazz guitarist Charlie Byrd caught some of the music and took the style back home, where he shared it with jazz saxophonist Stan Getz. Their 1962 album Jazz Samba was an immediate success in the US. The next year, Getz invited Gilberto to record together. The resulting album, Getz/Gilberto, featured compositions by the Jobim/de Moraes writing team, many of which became jazz standards over the decades, including “Corcovado,” “Desafinado” and “Doralice.”
The album’s breakout hit featured Gilberto’s then-wife Astrud on a sultry vocal of the song “Garota de Ipanema (Girl From Ipanema).” João sang the lyrics in Portuguese, Astrud repeated them in English and Getz added an now-iconic tenor sax solo. It was a worldwide hit and won the 1965 Grammy for record of the year. Getz/Gilberto won album of the year and would go on to become one of the highest-selling jazz albums of all time, helping to cement bossa nova’s soft, lulling beats and intimate vocals across the global musical landscape.
In the mid-1960s, less than a decade after the movement started, the music was pretty much silenced by a military dictatorship that clamped down an all outside political and cultural influences. Gilberto, who had moved to the United States after recording Getz/Gilberto, remained until 1980. Upon his return to Brazil he was heralded for his contributions and recorded with many of the younger musicians who had been part of the Tropicalia movement that incorporated rock and psychedelia into the subversive music aimed at the dictatorship.
Pianist Jovino Santos Neto says that Gilberto’s restless musical spirit was reflected in the music he made upon his return: “When people started to think that he was a bossa nova singer of Brazilian tunes, he challenged their assumptions by applying his style to boleros, Italian songs, Gershwin and later to the pop music of Brazil.”
Gilberto continued to perform well into the 21st century and has been recognized by every generation since his debut as a Brazilian musical pioneer. Well known to be a recluse, he spent the last years of his life alone in his apartment in Rio, trying to sort out various legal problems that had accumulated over the course of his storied career, while still holding a place of highest honor in his country’s cultural legacy.
Barbershop: Nike Recalls ‘Racist’ Air Max Shoe
NPR’s Michel Martin speaks about the controversy with journalist Alyssa Rosenberg, professor Joseph Cooper and fashion blogger Eugene Rabkin.
MICHEL MARTIN, HOST:
There’s another sports-related story we wanted to talk about – or at least it speaks to the fact that sports figures and companies are about more than – well, sports. We wanted to talk about that special-edition sneaker that Nike had planned to release in honor of Independence Day featuring the so-called Betsy Ross flag with 13 stars in a circle representing the 13 original colonies. According to several news outlets, beginning with The Wall Street Journal, Nike pulled the shoes after former NFL quarterback Colin Kaepernick privately advised Nike executives to do so.
Kaepernick, of course, is the activist famous for kneeling during the national anthem during his playing days to protest police violence, which evidently ended his playing days. He’s also a Nike brand ambassador. Now, it’s not exactly clear what he said to Nike, but it’s been reported that he noted that the flag has been adopted by some white supremacist groups, along with a Confederate flag, to celebrate a time when slavery was legal and the country was supposedly more white or white people had all the power. Nike said in a statement that it pulled the shoes based on concerns it could, quote, “unintentionally offend and detract from the nation’s patriotic holiday” – unquote.
But then other people criticized that decision, including the Arizona governor, Doug Ducey, who said that Nike has, quote, “bowed to the current onslaught of political correctness and historical revisionism” – unquote. He claimed that he would pull back support for financial incentives that were promised to Nike for opening a manufacturing plant in Arizona.
So we figured the Barbershop would be a good place to talk about all this because that’s where we talk with interesting people about what’s in the news and what’s on their minds. So joining us today are Alyssa Rosenberg. She’s an opinion writer who covers culture for The Washington Post. She wrote about this recently. Welcome.
ALYSSA ROSENBERG: Thanks so much for having me.
MARTIN: Joseph Cooper is a professor at the University of Connecticut, where his research focuses on sport, education, race and culture. Professor Cooper, welcome to you.
JOSEPH COOPER: Thank you for having me.
MARTIN: And Eugene Rabkin is the founder of StyleZeitgeist, which is a fashion blog. Eugene, welcome to you as well.
EUGENE RABKIN: Thank you.
MARTIN: So let me just read something that Alyssa wrote in her piece. She said that few things are more American than a giant company’s efforts to turn a profit off a patriotic emblem, then see the product flare into a cultural bonfire. Duly noted. Duly noted, Alyssa. I’m going to actually go to professor Cooper first on this because I take it you agree with Nike’s decision to pull the shoes. Is that right?
COOPER: That is correct.
MARTIN: Because?
COOPER: I agree because, one, we live in a highly politicized climate. And when we think about understanding what the meaning of certain symbols historically meant and what they mean in contemporary terms, I think it’s important that if we are moving towards becoming a more perfect union and respecting the positionalities of diverse groups, then we consider maybe certain symbols that we used to celebrate – i.e., the Confederate flag, i.e., the original 13 colonies flag – that symbol isn’t a symbol of unity for all Americans.
And so, taking into account groups that have been historically oppressed, such as African-Americans during that time period when that flag was created, I think that it was a very appropriate gesture for Nike to pull that particular style of shoe.
MARTIN: So, Alyssa, I’m going to go to you here because, you know, unlike some people for whom, you know, Kaepernick is just the gift that keeps on giving – I mean, there are people who just are outraged by everything he does, and there are those who want to turn this into a referendum on people who love America versus the people who don’t. But one of the things that interests us about your piece is you took a different tack. You were saying you’re not denying that perhaps this flag has been co-opted by these white supremacist groups. The point you made is that we shouldn’t be so quick to capitulate when racists try to taint symbols of our national story.
ROSENBERG: Well, and I think it’s a really interesting question. At what point has something been so thoroughly co-opted that it can’t return to any semblance of its original meaning? And because a couple of obscure Klan groups or some guy from Identity Evropa or some jerks at a Michigan high school football game try to use a historical symbol like the Betsy Ross flag, who gets to say they win? You know, why do jerks who want to imbue something with a new meaning that it may not necessarily have had – why do we get to say that they’re right, that they get to poison this and then none of the rest of us can have it?
I mean, I think part of what was very interesting about this debate is that clearly, this is a conversation about a symbol that has happened in some quarters but has not reached a broad audience. And so I don’t know that there is a consensus on whether or not the flag is tainted.
I respect anyone who says that because the symbol has been used this way, it no longer has an uncomplicated meaning. But I am really opposed to just ceding space to white supremacists simply because they touch something, therefore it’s poison. Why not fight back? Why not try to have an actual conversation about who gets to decide the meaning of these things?
MARTIN: Now, Eugene, one of the reasons we called you is that – I want to mention you didn’t write about this particular story, but you’ve been writing as a fashion blogger about images and fashion that a lot of people have found offensive, and you’re saying that, you know, fashion is meant to provoke and that fashion that fails to provoke loses its power. So where do you come out on this argument, on this issue – you know, recognizing that I don’t think you were born in the U.S., so perhaps the whole history of the Betsy Ross flag and all this isn’t as present for you as it is for other people. But what do you think?
RABKIN: Well, first, I couldn’t agree with Alyssa more. I think that we should not allow white supremacists to reclaim the symbol that is not theirs to claim in the first place, you know? there is – there are examples like that that have happened before. There’s a London brand of boxing gear called Lansdale, you know, and neo-Nazis in London, in the U.K., used to wear their T-shirts because if you cover Lansdale up to a certain point with a jacket, you get to see NSDA, which was the name of Hitler’s party. You know, Lansdale did not stop making clothing. You know, they put out a statement saying that we did not – you know, we do not agree with these values. And that was that, you know?
So I don’t think you should allow that – these symbols to be claimed. But also, you know, for me, the bigger issues here is stifling creativity, you know? And the sneaker is a sneaker, you know? But Nike here – what happened was Nike engaged in self-censorship, you know, because we are living in a time that is so volatile, and moral outrage is stoked so easily both on the left and on the right that it produces atmosphere of self-doubt and self-censorship. And that, to me, is a real problem because fashion is a creative discipline, just like art, and it should have that freedom to provoke and to challenge people’s assumptions.
MARTIN: Joseph, what do you say about that? Professor Cooper, what do you think?
COOPER: Yeah. I mean, I think there’s varying views on – this isn’t the first time that fashion and politics have collided. A few years ago, Gucci put out a style or image on one of their pieces of clothing that was resembling of the minstrel show, which was highly offensive to African Americans in the United States. So as opposed to viewing it as a form – and large – a large contingency of the hip-hop community boycotted Gucci and said, you know, this was culturally insensitive.
So as opposed to viewing it as censorship, I look at this has become a more democratic society whereby traditionally, certain groups – their views and perspectives on certain symbols and images have been silenced or largely marginalized. And now organizations and companies such as Nike are taking into account those voices because they understand that these constituents, these consumers, are major stakeholders for their company. And so to me, I look at it as being more culturally sensitive, more culturally inclusive as opposed to a form of censorship.
MARTIN: So, Alyssa, I’m going to go back to this question of, how do you engage with something that has been co-opted by, for example, white supremacists? Like, there’s a brand of – I’m sure – I don’t want to give more credence to it, but there’s a brand of outerwear that a lot of kids like, and the initials are initials that some of the white supremacist groups also like because it’s – it is a reference to a salute to Hitler, right? So they’re not going to stop making clothes either, but then some people would rather their kids not have that – those clothes.
So what do you suggest? I know you raised a number of examples where, you know, people have used the American flag for heinous things, but other people have said, no, it’s not just yours. What do you say about how to engage with something like this?
ROSENBERG: I think you have a vigorous dialogue about it, and you put it in context. I mean, the African-American lawyer who was almost stabbed by the American flag during the Boston busing protests always said that the flag wasn’t tainted for him and that as long as it was used in a context where sort of positive values were raised vigorously that it could be a symbol of what America could be. And so if it’s your kids, talk to your kids about why certain people feel this way, why they might end up associating themselves with something that they don’t intend…
MARTIN: OK.
ROSENBERG: …You know?
MARTIN: We have to leave it there for now, but there’s more to say because, you know, I want to ask all of you if you’d buy the shoes if they actually came back on the market, right?
RABKIN: (Laughter).
MARTIN: Would you buy it? Eugene, quickly, yes or no – would you buy it?
RABKIN: Absolutely not. I don’t wear sneakers.
MARTIN: Oh, OK. Well…
RABKIN: (Laughter) I’m the wrong person.
MARTIN: That’s Eugene Rabkin. He’s the founder of StyleZeitgeist. That’s a fashion blog. Also with us, Alyssa Rosenberg, opinion writer for The Washington Post, and Joseph Cooper, professor at the University of Connecticut. Thank you all so much for talking to us.
ROSENBERG: Thanks so much.
RABKIN: Thank you.
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.
California Pay-To-Play Bill Pushes College Athlete Compensation
NPR’s Michel Martin speaks with College Athletics Players Association founder Ramogi Huma about a California bill that will allow compensation for college athletes.
MICHEL MARTIN, HOST:
The U.S. Women’s National Soccer Team is contending for a fourth Women’s World Cup tomorrow. At the same time, its team members have been fighting for pay comparable to that of their male colleagues. Meanwhile, the debate over how college athletes are treated recently reached a new level as well. A bill that allows athletes to be compensated for their names, images and likenesses is now making its way through the California Assembly. The so-called Fair Pay to Play Act passed the state Senate in May. And it’s gotten national attention after being criticized by the president of the National Collegiate Athletic Association, Mark Emmert.
We wanted to know more about it, so we called Ramogi Huma. He was behind the 2014 attempt to unionize Northwestern football players. He is the founder and executive director of the College Athletes Players Association. And we started our conversation by asking how this bill is different from past efforts to compensate college players.
RAMOGI HUMA: This is state legislation, and state legislation is different than some of the major pushes in the past. If you look at some of the most compelling battlefronts, you’re looking at lawsuits. And some of the lawsuits were – are successful to a certain degree but have not provided what we see as equal rights and protections. I think that right now, this is probably the best leverage that college athletes have ever had in terms of breaking through that threshold.
MARTIN: I’m thinking – the analogy that you draw here is – would be, say, Mark Zuckerberg and Facebook, which is that if he started working on Facebook in his dorm room at Harvard, Harvard doesn’t think they have a right to a piece of Facebook. But I think the analogy that the universities might use is a student using the lab facilities to work on some breakthrough cure for cancer, let’s say, the university would think, because you’re using my facilities to advance your talent, they then deserve a piece of your breakthrough. Do you understand what I’m saying?
HUMA: Yeah. There’s a couple aspects to that argument. Number one is the players already had a reputation. Otherwise, they would not be competing in college sports. Does the college seek to enhance that image? Yes. And athlete’s reputation – yes. But when a player goes and signs an autograph, does the school somehow have the right to literally just own that player’s name, image and likeness? Is that player property of the university? Our answer is no.
Another anecdote was – it was really interesting. David Drummond, who’s a vice president of Google – he used to play football at Santa Clara University. And in a keynote address at a symposium, he talked about the fact that Google was developed at Stanford, in part by student researchers. Stanford paid those student researchers very well. So it’s not some kind of a rule or moral high ground that says the university has to monopolize every bit of talent whether or not the student is advancing gains using the university’s computers or not.
MARTIN: The NCAA president, Mark Emmert, sent a letter to lawmakers urging them to delay the bill, suggesting that the players would be harmed by this. I mean, that was kind of the language that he used. But he said that players, for example, could be ruled ineligible for competition. What’s the basis of that? And is that a credible threat?
HUMA: You can never protect someone by stripping them of their rights. The premise is that unless California lawmakers become complicit in denying California athletes equal rights, then somehow those players will be harmed. And that’s just a false premise.
MARTIN: And before we let you go, do you feel like you’re making headway? Like, you know, part of the reason you got started with this – you were a former UCLA football player yourself. You saw the NCAA suspend your teammate for accepting a bag of groceries when he had no food. You know, you’ve seen a lot over the course of time that you’ve been working on this. And I’m just wondering if you feel like your arguments are making headway. Are people starting to take the questions around how college athletes are treated more seriously?
HUMA: I do think there’s progress. Not as fast as I would like – you know, you look at the multi-year scholarships are now available, the name, image and likeness lawsuit from Ed O’Bannon that resulted in stipends. There’s still a ways to go. Let’s put it that way. But I do think there’s reform. I think a lot of key people are listening, especially lawmakers.
MARTIN: That is Ramogi Huma. He is the founder and executive director of the National College Players Association, an organization founded to advocate for college athletes.
Ramogi, thanks so much for talking to us once again.
HUMA: Thanks for having me.
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.
Why Cash Transfer Apps Don’t Always Let You Hit ‘Undo’ On Transactions
Phone-based apps are offering people many new ways to pay, and many of them are wondering about chargebacks, and why some apps allow people to hit undo and why others don’t.
AUDIE CORNISH, HOST:
Cash transfer apps, like Venmo, let you pay a friend back $5 for popcorn. They let you post fun messages about late-night bar tabs. One thing they don’t always let you do, undo transactions. Elah Feder from our Planet Money podcast explains why.
ELAH FEDER, BYLINE: A couple of months ago, I accidentally sent $1,500 to a stranger on Venmo. I was trying to send a security deposit to my new landlord. But, thanks to a typo, I sent it to some guy in Alabama instead. So Venmo is an app on your phone that lets you pay your friends, pulls money from your bank account. Really easy to use – until you mess up when you find out that just hitting undo and getting your money back is not an option.
But the whole idea that we could even instantly get our money back is actually an invention, and not even a very old one. Back in the ’60s, when credit cards were the cool, new payment technology, people had nightmares like this all the time.
CHI CHI WU: They would be charged the wrong amount. They would be double charged. There would be some sort of math error.
FEDER: Chi Chi Wu is a staff attorney at the National Consumer Law Center.
WU: Or someone would take their card and use it without their consent. And they would try to battle with the credit card companies to get them to fix the error. And the problem was the credit card companies would just ignore them and, in fact, would just, you know, keep demanding payment without addressing the consumer’s complaint.
FEDER: So eventually, Congress kicks into action, starts passing laws. And in 1974, they give us the all-mighty chargeback, which is…
WU: When you challenge something on your credit card and it gets reversed. It’s charged back to the merchant.
FEDER: That’s right, we can get a chargeback because of the law. And now we can get our money back with just one call. We’re used to that kind of safety net. But along come apps like Venmo, where if you make a mistake there is no undo. Why not? Well, maybe because like all good things, the power to undo comes at a cost. When we have it, we go wild. Katie Cover (ph) has seen her fair share of ridiculous credit card chargebacks.
KATIE COVER: There was somebody who had taken golf lessons and then at the end had disputed that their score hadn’t improved a sufficient amount, and they were dissatisfied.
FEDER: Solution – chargeback. Katie works for Square, a company that helps businesses process credit cards. If a business gets a chargeback they think is unfair, Katie’s team helps them fight it. Like the time a baker got a chargeback for an $800 wedding cake. The baker was upset, but luckily…
COVER: She had posts from social media where she had taken screenshots, and it was the couple and they were with their guests celebrating and eating the cake. And there were comments on social media from their guests saying how much they enjoyed it and from the couple saying that they were thrilled and wasn’t it a wonderful cake?
FEDER: With Katie’s help, the baker got to keep the money. But it doesn’t always end well for businesses. Katie told us about a family business that had to shut down after they lost a chargeback case. Venmo didn’t want to talk on tape for this. Instead, they sent an email listing all the ways that they prevent people from making mistakes in the first place. They also said, quote, “making funds instantly available to recipients is part of why customers love using PayPal and Venmo,” end quote. By the way, Venmo is owned by PayPal.
Bottom line, Venmo isn’t a credit card, and there is no undo button. I was lucky. I did get my money back, and the person I sent it to was super nice. But lesson learned. If you send money on these apps, you’d better get your spelling right. For NPR News, I’m Elah Feder.
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.
