- Associated Press - Friday, July 14, 2017

VERMONT

The Rutland Herald

July 14

Independent doctors in Vermont have dwindled in number over the years as the University of Vermont Medical Center and other large providers have extended their reach, incorporating physician practices with the aim of developing better coordinated, seamless, efficient care in the state.

And yet independent doctors argue that private practices are less costly than the large hospitals. It’s partly because of Medicare reimbursement rates, which are lower for independent practices. It is in this context that a group of physicians proposed to build an independent, for-profit surgical center in Colchester.

But first they had to obtain a certificate of need from the Green Mountain Care Board, and the large hospitals in the region were opposed to the idea. It is the job of the board to prevent costly redundancy from burdening the health care system with extra costs that provide a profit to providers while driving up the price of health care. The hospitals were concerned that the surgical center would siphon off patients, reducing revenues to the hospitals while leaving them with the expense of maintaining more costly facilities.

It was a closely watched case, and no one knew what the Green Mountain Care Board would decide. The decision came earlier this week, approving the project but attaching 29 conditions designed to ensure that it does not lead to profiteering and does not damage the large hospitals. Additionally, the board said the ruling in this case should not be viewed as an open door to a proliferation of for-profit health care facilities in the state.

The power and reach of the University of Vermont Medical Center are immense. It is part of the One- Care Vermont accountable care organization that is working to transform the financing of health care in the state. It has long been the aim of health care reformers to forge the state’s fragmented, helter-skelter, disorganized health care system into a large single system that would provide care more efficiently while containing costs.

And yet the creation of a large monolithic system raises concerns of its own. Might small, cost-conscious entrepreneurs be able to provide readier access at a lower cost? That is what the new surgical center hopes to do.

Then again, it’s possible that a proliferation of private practices could cherry-pick cases that are suitable for an out-of-hospital setting while leaving the costlier and more complicated cases to the hospital. It’s another version of the problem created when insurance companies are allowed to cherrypick healthy customers.

The Green Mountain Care Board was aware of these problems, and its 4-1 ruling reflected it s awareness. Con Hogan, a knowledgeable and experienced member of the board, was the dissenter, warning that the decision would harm the hospitals’ trust in the board and create an adversarial relationship in the future. Another board member, Robin Lunge, approved the surgical center but with reservations. Among them, she was concerned that the center would be overbuilt, thus wasteful.

The 29 conditions address in detail the potential problems that might be created by an independent surgical center. Significantly, the board requires that the center take part in an accountable care organization, such as OneCare Vermont, which would tie it into the cost-saving structure of the UVM Medical Center. Also, the center will have to negotiate prices with insurance companies that are below those of the hospitals and must accept patients regardless of their ability to pay. These provisions seem directed at the potential problem of overcharging or cherry-picking.

It appears that the board wants to hold the line against profiteering in health care while allowing that this group of physicians might be able to provide a useful option. No one likes to wait in line for treatment, and maybe an additional surgical center would help alleviate that problem.

The lead investor for the new surgical center was pleased by the board’s decision. She saw the group of participating physicians as part of the solution, suggesting that the independent doctors in Vermont want to have a role in keeping costs under control.

The board seems willing to give it a try, but it intends to watch closely to see if the project works.

Online: http://bit.ly/2uZlVvO

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NEW HAMPSHIRE

Foster’s Daily Democrat

July 13

The new playground in Dover’s Henry Law Park is so much more than a fun place for the city’s children and visitors.

It’s a sign of how much people can accomplish when they pull together, and a significant barometer of where the community is headed.

The Dover Adventure Playground, as it is officially called, sits next to the Children’s Museum of New Hampshire on Washington Street. The park is an amazing place for children and their parents and, with the museum next door, adds to the city’s reputation as a destination for children.

The park opened on June 24 and is already a busy venue where you can hear the delighted squeals and chatter of children playing on new equipment that is uniquely a Dover play place with more than a nod to local history.

For example: There is a life-sized replica of the Capt. Edward H. Adams gundalow to explore. Gundalows were flat-bottom boats that were used to transport goods up and down the river from Dover centuries ago.

There is also a mini-Garrison Hill Tower painted Dover green. The tower had long stood as a symbol of the Garrison City. Granite blocks and cobbles found during early work on the playground were incorporated into the project.

There are swings of many designs, including one that allows young children and their parents to swing together face-to-face.

A splash pad is keeping children cool this summer and there are other park staples such as slides, climbing nets and musical instruments kids can touch to create sounds.

Visitors can also view a sculpture of a native alewife created by Kittery, Maine, artist Thomas Berger. A contest running through August invites the community to name the fish.

And, the pièce de résistance planned for installation a couple months from now is the 18-foot whale tail sculpture that will be mounted atop the Dover Indoor Pool building. It will look like the gigantic marine mammal is diving straight into the building.

The park’s spectacular features and local flavor show what can be done when the community works together. Dover Recreation Director Gary Bannon has worked tirelessly on the concept since it was introduced in the city’s 2009 master plan. Resident David Bamford, and museum board President Jane Bard were among a long list of movers and shakers whose names Bannon read at the park’s dedication.

Martha Richard Cox, who died in 2014, had a big hand in the project and the park was dedicated to her. She helped with the mini-Garrison Tower and picked out the musical instruments for the park.

The Foster family, including the late Robert H. Foster and his wife, Therese Durnin Foster, received a dedication for their longtime support of the city and park projects. And, a red maple tree on the edges of the playground honors Natalie Richardson, who died as a child.

The point is locals, teaming with the City of Dover, stepped up to create a magical, welcoming space for children and families in the heart of the downtown.

And that may be the most important legacy of this bright, new attraction. The joy the park creates is not just for kids. It’s also about building a community.

The project showcases the city’s strong commitment to children and families. If each city and town is, in fact, in charge of its own fate and the direction it takes toward shaping the future, Dover has chosen its priorities wisely.

Concentrating on building a community that cares about children and families will make Dover a most desirable place in which to live and work - the kind of place where families settle, businesses thrive and education is valued.

The Dover Adventure Playground is much more than a park. It’s a road map to the city’s future.

Online: http://bit.ly/2umfKUI

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MAINE

Portland Press Herald

July 12

There should be no question now that Russia interfered in last year’s election on behalf of Donald Trump, and that, despite vehement and self-righteous denials, the Trump campaign was fully aware.

The counterargument built atop a year’s worth of lies and cries of “fake news” collapsed Tuesday under the weight of hard facts. Emails show Donald Trump Jr. and two other high-ranking members of the Trump campaign were told in no uncertain terms that the Kremlin supported their candidate and had information damaging to their opponent, Hillary Clinton. Rather than call the authorities - as campaigns have done before in such situations, and as is required by patriotism and, perhaps, the law - they eagerly set up a meeting.

At the very least, this indicates that the campaign was open to receiving information damaging to Clinton from a foreign power hostile to the United States, and that the denials and constant complaints that the investigation into the Russian meddling is nothing more than a “witch hunt” were themselves outright lies.

It also raises questions about whether the meeting described in the emails was the only one of its kind, or whether it was just the beginning at some level of a cooperative enterprise that also included the Russian government’s hacking and release of emails from top Democratic officials and targeted dissemination of false “news” stories.

For one thing, it is absurd to think that then-candidate Donald Trump was not made aware of the opportunity to smear Clinton, putting the lie to the president’s claims last week that “nobody really knows” if Russia interfered in the election, and making even more worrisome his attempts to limit the FBI’s investigation into the matter.

On an appearance Tuesday night on Fox News Channel, Trump Jr. downplayed the importance of the meeting, saying it produced nothing worth passing on to his father. But how can anyone possibly believe him now?

Last year and again in March, Trump Jr. angrily denied meeting with Russian representatives, calling such reports “phony” and “disgusting.” When first confronted by The New York Times about the meeting with the Russian lawyer, he said it was only about the adoption by Americans of Russian babies. Then, he conceded it was about information that may be helpful to the campaign, but that he wasn’t told who the meeting would be with.

On Tuesday, however, with the Times ready to release the emails, Trump Jr. tweeted them out himself, revealing nearly every word he had said in his defense to be a lie or minimization.

The subject line of the emails was “Russia - Clinton - private and confidential.” He was told by the friend setting up the meeting - someone with close connections to Russian President Vladimir Putin - that it would be with a “Russian government lawyer” on behalf of “Russia and its government’s support” for candidate Trump, with information to “incriminate Hillary.” Trump Jr. replied, “I love it.”

The email chain was forwarded to Paul Manafort, then the campaign chairman, and Jared Kushner, the president’s son-in-law and now a senior White House adviser, both of whom also attended the meeting.

At each point in the story’s development, Trump Jr. lied, misled and grandstanded, copping only to information that the Times had independently verified, just as other Trump administration officials have handled their contacts with Russian officials.

Which makes us wonder what else they aren’t saying. The only question now is, as Sen. Angus King said Tuesday on MSNBC, “Is this the tip of an information iceberg, or is this an isolated event?”

Online: http://bit.ly/2uZ2547

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CONNECTICUT

The Connecticut Post

July 13

Gov. Dannel P. Malloy’s news release responding to the Federal Railroad Administration’s vision for the Northeast corridor could be edited to five words “Malloy: They listened to me!”

Here’s the longer version from the governor’s office: “Governor Dannel P. Malloy today is commending the Federal Railroad Administration’s (FRA) decision on the NEC Future program for responding to his consistent urging to focus on upgrading and maintaining the Northeast Corridor (NEC) in a ‘state of good repair’ and postponing consideration of any new alignment of the tracks through Connecticut.”

Given the wayward status of the Connecticut budget impasse, Malloy can hardly be blamed for trumpeting that the FRA seems to be following his road map.

As federal regulators worked in recent months to tailor a strategy for modernizing service, Malloy persistently implored them to focus on upgrading existing challenges and hold off on fantasies it had to create a pair of bypasses.

Yes, there is more than a little irony that this is coming from a governor who crafted a 30-year transportation plan that looks toward the mid-point of the century.

But it’s hard to argue with the logic of catching up with an estimated $38 billion in repairs that have been stuck on back order year after year after year.

Some of the FRA’s new ideas are intriguing, but you don’t devote energies to waxing a car that has an unreliable engine. The first priorities are always safety and efficiency.

So the FRA is instead encouraging the expansion of tracks and increasing the number of commuter trains. The hope is to shave 45 minutes off the Boston to New York trip and 35 off the route between New York and Washington, D.C.

Those may be defining U.S. cities, but routes along the 457-mile Northeast Corridor travel through Connecticut, so it’s encouraging that our small state’s voice was not ignored. As Connecticut goes, so goes the corridor. None of the other seven states are expected to be impacted as much as Connecticut in the next quarter century of upgrades.

As FRA officials agreed, this was not the time to invest in adding a bypass from Old Saybrook to Rhode Island. No train could be swifter than the river of rebellion that flowed through smaller towns, as a tide of objections were raised over surrendering New England character.

Malloy, of course, was just a leading lobbyist and cheerleader among hundreds of Connecticut residents who spoke out against some of the FRA’s more fanciful proposals.

The FRA heard them. Malloy didn’t waste time catching his breath Wednesday before starting his next crusade: To find the federal dollars to invest in the repairs. The isn’t merely about commuting times. A better transportation model means a better economic model.

Commuters throughout Connecticut would be wise to demand they be heard on that matter as well.

Online: http://bit.ly/2v0d8Ke

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MASSACHUSETTS

The Telegram & Gazette

July 14

There’s a heated debate in certain circles with potentially profound implications for the future of humanity - or, potentially, with as little import as those medieval considerations of how many angels can dance on the head of a pin.

It revolves around a core existential question: Are we alone in the universe? And its logical outgrowth: Should we step out of the shadows to find out by beaming signals into the cosmos.

The issue is explored by Steven Johnson in the July 2 edition of The New York Times Magazine.

A figure as notable as Stephen Hawking (not to mention Elon Musk) is convinced we’re not alone and has been warning against efforts to ramp up our interstellar calls, as it were, in hopes that E.T. will pick up the phone and answer. While it would be a singular moment in human history, the British cosmologist’s concern is that a civilization capable of detecting and responding to our existence might be millions or even billions of years more advanced. And his fear is that actions we take today might doom humans hundreds or even thousands of years in the future - assuming we survive that long - in encountering alien visitors who might view us the way we view bacteria. Just consider the history of our own planet, replete with bad things that happened, even inadvertently, when more technologically advanced cultures encountered those less advanced.

It could be a benevolent E.T. But do we want to risk sending an electronic “yoo-hoo” to the Borg?

Until now, most - but not all - of our efforts have involved passive listening, or even watching, for signs of extraterrestrial transmissions - radio waves captured by radio telescopes or laser flashes captured by optical telescopes. Until now, we haven’t experienced the sort of eureka moment portrayed in Carl Sagan’s novel “Contact” and the 1997 movie based on the book. At least, no eureka moment that we can confirm.

There are, however, 37 unexplained signals detected in a scan of the northern sky - noted as “37 candidate events” - outlined in a 1993 paper by Paul Horowitz and Carl Sagan in The Astrophysical Journal. These signals, which could not be detected in later observations, were first observed in Worcester County, at the Harvard University-Smithsonian radio telescope that once operated in the town of Harvard. (When you consider Robert Goddard’s launching the space age in Auburn with the first liquid-fueled rocket, Worcester County has a bit of notable history related to the exploration of space - physically in Auburn, and virtually in Harvard.)

Professor Horowitz, a Harvard University researcher now retired but still active in the Search for Extra Terrestrial Intelligence, said in a telephone and email exchange this week that he views efforts to reach out to life elsewhere to be harmless, but also rather pointless. Because of the likely technological disparity, it would be akin to ants making little circles in the sand hoping we’d notice. He counsels passive listening for now, but not from fear of an alien invasion. He said it wouldn’t make sense for a civilization advanced enough to go through the bother of hurtling across the interstellar vastness in some sort of advanced tin can just to eat us or harvest our resources. A civilization wouldn’t have survived that long without overcoming its worst aggressive impulses.

More likely, it would be an exchange of data - like beaming our respective Wikipedias - in transmissions that could take perhaps 500 years to arrive, he said.

But Professor Horowitz feels it’s more appropriate to just keep listening for now, until we have something engaging to contribute. Although he points out that signals from radio and television broadcasts have been leaking into space for the better part of a century - well before a 1974 blast from the giant dish in Puerto Rico’s Arecibo Observatory, an event that opens Steven Johnson’s article.

The professor’s view is to listen longer until we get our footing on what’s out there, and have more to offer. And we agree.

Online: http://bit.ly/2tTEzFq

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RHODE ISLAND

The Providence Journal

July 13

A word of warning to those who drive and speak on a cellphone at the same time: your days of risky behavior are coming to an end.

As of June 1, 2018, Rhode Island drivers will be banned from using hand-held “personal wireless communication” devices in their vehicles. Anyone caught breaking this traffic law, other than in an emergency, could face a fine of up to $100.

If drivers want to use a cellphone while behind the wheel in Rhode Island next year, they will have to purchase a “hands-free” device. These items are readily available at electronics stores, both brick-and-mortar and online. In fact, showing proof of purchase of one of these devices will put a first-time violator in a position to have a fine waived.

Was this a good decision by state lawmakers, and Gov. Gina Raimondo, who signed the legislation this week? We believe so.

We firmly believe in states’ rights, and that each level of government should have the freedom to discuss, debate and pass its own set of laws. However, it’s impossible to ignore the fact that there has been a noticeable increase in traffic deaths in the United States in recent years. The National Highway Traffic Safety Association has noted that 3,477 people died due to distracted driving in 2015 alone.

One factor is surely the increased use of hand-held devices in vehicles, which should be taken seriously by all states.

Rhode Island has already banned texting while driving, and it will soon be joining the majority of states, including California, Connecticut, Nevada, New Hampshire, New York and Vermont, that ban the use of hand-held devices while driving. That being said, Alaska, Arizona, Missouri, Montana and Nebraska are among the vocal minority of states that allow for either unrestricted or limited use of hand-held devices in vehicles.

Given that dynamic, it would be wise for Washington to encourage states to work together to help create some type of uniformity for talking and driving on roads and highways. This would reduce confusion for many out-of-state (and out-of-country) drivers, and reduce wasted time and resources that police officers and the courts face on a regular basis.

In the meantime, Rhode Island and other states must confront the fact that there is no uniformity across the country when it comes to the use, or non-use, of hand-held devices in vehicles. In the absence of that, states have an obligation to take the lead.

It goes without saying that the safest thing to do is to not use any potentially distracting device while driving. People should keep their hands on the steering wheel and their eyes and ears focused on the roads, traffic and pedestrians at all times.

If you must use a hands-free device, that’s acceptable - and it will still be legal to do so when the law in Rhode Island changes next year. But we encourage people not to abuse this privilege, and to do their part to help keep our roads and highways safe.

Online: http://bit.ly/2uhKJSg

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