by John McClaughry In this election season almost every candidate is promising to deliver “more affordable health care!” Most of them are at least subconsciously thinking “I’ll support legislation to have the government compel somebody else to pay more of your health care costs. That ‘somebody else’ includes, variously, the taxpayers, your employer, others in your insurance pool, and the providers themselves.”Let’s ask this question: “where can I get more affordable prices for high quality medical services, at a facility that does a lot of the procedure I require, gets above average results, and knows how to cope with every complication?” Let’s focus on commonplace coronary artery bypass graft surgery (“CABG”), as opposed to continuing treatment for chronic conditions, and let’s compare the quoted all-in bundled price (not including post-operational physical therapy sessions).According to one not atypical 2018 survey, your U.S. CABG operation will cost $123,000 on average, or in the best case as little as $80,000 if you negotiate payment in cash.Now look at Surgery Center of Oklahoma, which pioneered the bundled price. You can get your CABG done there by experts for $12,000. That’s mainly because SCO specializes in a small number of types of operations, keeps overhead low, takes only cash payments, and practices low markup on pharmaceuticals. That’s impressive. Of course you have to fly to Oklahoma City and back, and do your post-op recovery back home.Now let’s look at the bundled price of the same procedure, at a medical center that does thousands of that procedure, with British and U.S. board-certified surgeons. Let’s go on past Thailand and Singapore to the world’s extreme example: Narayana Institute of Cardiac Sciences in Bengaloru, in India’s Silicon Valley, the flagship of a group of 23 Indian private medical centers.At Narayana you can get your arteries repaired for $2,000. A lung transplant is yours for $7,000, and a heart transplant for $11,000. And this is not a back-alley discount operation. Its glistening modern equipment is maintained to world standards. Narayana’s coronary artery bypass fatality rate within 30 days is 1.4%. The US average is 1.9%.Its founder, Dr. Devi Shetty, got his surgical training at Guy’s Hospital, London and was the doctor for Mother Teresa. His son Viren (34, Stanford Business School) heads the world class data management operation. It’s designed to identify unproductive effort and inflated costs, which are eliminated.Instead of throwing away tubes, they are sterilized and reused. An in-house equipment repair team keeps CT and MRI machines in use long after their warranties expire, when many U.S hospitals send for new ones. Perhaps most important, the staff is “upskilled”- everyone performs at the highest level of their capabilities. Thus junior surgeons do patient prep and open the chest. A senior surgeon comes in, installs the graft, and moves on to another operating room leaving the juniors to sew up.Narayana’s cost-cutting business model is designed for high throughput, with a low margin per operation. Practiced turnaround teams clean, sterilize, recondition and reequip the operating rooms for their next patients in 15 minutes. For the more affluent inpatient, the hospital offers a premium package: private rooms and, for a measly $5US per hour extra, amenities akin to the first class section on an airplane.Narayana is one of many private hospitals in India. It makes a profit because of its low prices and efficiency, high volume, good results, largely cash operation, and relative freedom from India’s notorious British-created bureaucracies. As a specialty surgical hospital it does not offer care by primary care physicians, who generally work in clinics funded and controlled by the government.Narayana’s wages are of course at Indian levels, not American. Its model can’t be packed up and dropped into New England (although it operates a clone in the Cayman Islands catering to North Americans.) And the two 22-hour flights between New York and Bengaloru will set you and your companion back $10,000. Just the same, like the Surgery Center of Oklahoma Narayana offers an impressive example of how an entrepreneurial surgical hospital can deliver high quality services at strikingly low prices. American hospitals should emulate Narayan’s model, although American government regulations to protect the many interests within our health care systems would likely eat up a lot of the potential savings. John McClaughry is vice president of the Ethan Allen Institute (www.ethanallen.org(link is external))
Local authorities locked down a sitio (hamlet) in Barangay Hoskynin, Jordan, Guimaras for two weeks due to confirmed cases of coronavirus disease 2019. WIRE PHOTO As of Sept. 18, the sitio has three confirmed cases of coronavirus disease 2019 (COVID-19). All residents are not allowed to go out from thier respective households and direct contact shall have undergo strict home quarantine for 14 days. Here’s the breakdown of the confirmed COVID-19 cases in Sitio Sambag. According to the mayor, the lockdown took effect around 12 p.m. on Sept. 18, 2020 until 11:59 p.m. on Oct. 2. Meanwhile, frontliners such as health personnel and employees are allowed to leave and stay outside of the barangay in the duration of the lockdown, given that they are not identified as direct contact of the COVID-19 positive patients ILOILO City – Local authorities locked down a sitio (hamlet) in Barangay Hoskynin, Jordan, Guimaras for two weeks. The mayor also implement a liquor ban shall in the duration of the lockdown to secure that there will be no gatherings in the respective households and other related activities. * 41-year-old male (asymptomatic and quarantined at the Isolation Area of the Rural Health Unit). * 72-year-old male (recovered) Under Corpuz’s EO, barriers/checkpoints in the boundaries of Sitio Sambag, Barangay Hoskyn were set up to ensure that there shall no inbound or outbound movement in the area. * 76-year-old male (isolated at a quarantine facility in Jordan). “Upon the recommendation of the Municipal Health Team on the management of COVID-19 in Municipality of Jordan, it is deemed necessary that Sitio Sambag, Hoskyn should be put on lockdown” read part of Corpuz’s directive released on Sept. 18. Town mayor Ruben Corpuz issued Executive Order (EO) No. 50 Series of 2020 enforcing stringent quarantine measure in Sitio Sambag. As of Sept. 18, Jordan recorded 15 COVID-19 cases, two of which are active and 13 already recovered./PN
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They were dangerous on almost every shift. While Henrik was held pointless (for the fourth straight game), the line generated a ton of chances and when they play like this, it’s only a matter of time before the puck starts going in the net with more frequency.While it might appear the twins need some rest, they will unfortunately not get as much as the rest of the team as they are both headed to this weekend’s All-Star game in Ottawa. I won’t go into a big diatribe about the All-Star game, but as a Canuck fan, I’d much rather that the players weren’t obligated to attend this useless excuse for a hockey game. CANUCKS’ TOP DEFENSIVE PAIRING STELLARThere’s only one word to describe the play of the Canucks’ top defensive pair of Dan Hamhuis and Kevin Bieksa tonight – spectacular. While it wasn’t the flashiest game you’ll see NHL players put on the ice, these two were rock solid all night long, had great speed and quickness, and were a dominant force throughout the game. Both players wound up plus-2, and Hamhuis got a key assist on the game’s first goal. This is an important development for the Canucks, as the pair had been struggling somewhat in recent games.Every time it seemed like the talented young Oiler forwards were about to generate something, Hamhuis and Bieksa just seemed to make a good, smart play. Whether it was outracing their opponent to the puck, putting their stick in the right passing lane, or getting the right angle on the puck carrier coming over the blue line, it was just perfect. While the game didn’t feature much hitting, they played a good physical game in their own zone and were often had good body position on the Oilers. They also excelled at moving the puck tonight, clearing the zone with relative impunity and getting the forwards the puck, who were generally able to do something with it tonight (case in point was the Canucks’ second goal, the rush started on a stellar outlet pass from Hamhuis to Kesler).When these guys are on their game, the Canucks are difficult to beat. Hopefully we’ll see this kind of effort on more consistent basis moving forward. DAVID BOOTH CONTINUES TO IMPRESSTonight was Booth’s fourth game since returning from his knee injury, and he put another great effort on the ice. Since his return, the second line has been great, and again tonight they caused a lot of problems for the Oilers. His speed is very good and while he’s not an excessively physical player, his size matches up well with other players and he’s able to use his body position to shield the puck and get it to his linemates in the offensive zone.At first blush, his goal tonight was a dirty, goal-mouth scramble type of goal. However, I think it was much more than that – he was able to outmuscle Hall near the Oiler net (as he should be able to do), but he actually showed a lot of skill as he used his skate to touch the puck back to his stick before sweeping it in the net, all while being knocked to the ice by Hall. Make no mistake, this was a very skilled goal scored by a skilled player. Seeing him and Kesler forming this kind of chemistry in limited time makes me excited to see what they will be able to do with another 20 games together under their belts. PARTING SHOTSQuick Comments: This game’s scoreline was much closer than it should have been and was not indicative of the run of the play. The Canucks were the better team for most of the night, certain sections of the second period notwithstanding, and they generated far more quality scoring chances. The four goalposts helped Edmonton’s cause, but that said, hockey can just be like that. Next time, those pucks will hopefully go in. On the flip side, I have never seen Jordan Eberle this invisible in any game, ever. He was on a line with Sam Gagner (who was noticeable and played well, strangely enough). The Oilers’ line of Horcoff-Hall-Hemsky had a very good night. I haven’t seen Hemsky play this well in ages – he was back to his old self, it seemed, the puck glued to his stick and him able to make some slick passes. That said – Hall was by far Edmonton’s best player. All over the ice, fast, skilled, good size – he’s going to be a beast in the NHL for many years. While they didn’t appear on the scoresheet, the third line had a strong outing as well for Vancouver. Hodgson just seems to get better and better, and Hansen was responsible for one of the crossbars. Mason Raymond hasn’t scored much at all, lately, but was all over the ice tonight and as always played well defensively. Credit the Oilers for sticking with it – knowing the score was close, they never quit and were twice able to come back and tie the game. Luongo made a couple of very good saves in the shootout. He also made a great save in overtime on Gagner. He wasn’t called upon to make a ton of phenomenal saves tonight, but he played well at the end of the game. He could not be blamed for either Edmonton goal.Broadcast Observation of the Day: In general, I prefer the Sportsnet games to our other options. That said, I’m not the biggest fan of Shorthouse. Instead of calling the game, he often attempts to get Garrett involved in conversations about silly things like food, or jokingly makes fun of him and his NHL career. It’s all in good fun, but for the TV viewer, it’s not that funny nor interesting. I’d much rather have some proper analysis done of the game.Two nice touches tonight: in his first intermission interview, Hamhuis told the residents of Burns Lake that the team’s thoughts were with them as they deal with the devastating fire in that small community’s lifeblood, its sawmill. Hamhuis was raised in nearby Smithers. Also, GM Mike Gillis was with Dan Murphy in both intermissions, and the first segment was dedicated to the Canucks’ support of the re-launch of mental illness website, www.mindcheck.ca. The site is dedicated to awareness of mental health issues and is meant to provide resources for youth and young adults in need. The Canucks are behind this initiative primarily in memory of and tribute to Rick Rypien.Looking ahead: The Canucks will take six days off before returning next Tuesday night to play the Chicago Blackhawks. Stay tuned to www.fightingforstanley.ca for mid-season reviews of all the Canadian-based NHL teams over the All-Star break, including an analysis of the Canucks, their season to date, their prospects in the playoffs, and what their trade deadline needs, if any, are. Sami Salo returned to the lineup for the Canucks after missing the last seven game with a concussion. He wasn’t that noticeable, however, you did notice the lack of problems with the Canucks’ D as Ballard and Rome could play third-pairing minutes. The game was a no-hitter, it seemed like both teams wanted to get to the break without any physical confrontation. There were only three penalties called, all for hooking or interference. Leigh Ramsden lives in Vancouver and is an avid Canucks fan, having been a partial season ticket holder for over 10 years. He’s old enough to have witnessed all three Stanley Cup losses, as such, his prime goal is to remove those scars by seeing a Cup brought to Vancouver. Leigh is Fighting For Stanley’s (www.fightingforstanley.ca/vancouver) west coast correspondent, and will also blog after all Canuck games for The Nelson Daily.The Vancouver Canucks concluded their pre-All-Star break schedule on Tuesday night at Rogers Arena, defeating the Edmonton Oilers 3-2 by way of a shootout.The Canucks had a tremendous first period, as they came at the Oilers in waves and spent entire shifts possessing the puck in the Oilers’ zone. They were able to break through on a beautiful goal by Daniel Sedin, his line having cycled the puck in Edmonton’s goal for approximately 90 seconds. Inexplicably, the Oilers actually outshot the Canucks in the first period, but Vancouver had the lion’s share of the chances.This trend continued in the second period, but Edmonton played much better in what has been the Canucks’ worst period on a night to night basis. Shawn Horcoff scored on a tremendous feed from young Oiler Taylor Hall, after a defensive breakdown in the Canucks’ end while the bottom defensive pairing and the fourth line were on the ice. While Edmonton had a much better period, the Canucks hit a post late in the second (having hit one in the first as well) and this goal might have been the back breaker for the Oilers, who had played the previous night in Edmonton.The Canucks came out determined in the third to end the game favourably. Buoyed by strong play from the top two lines, the Canucks returning to their swashbuckling ways, trading chances with Edmonton and for the most part, getting the better of the play. The effort was rewarded on a goal by David Booth, the result of hard work in front of the net after a 3-on-2 where Oiler netminder Devan Dubnyk lost the puck to his side, next to the crease. The Canucks were unfortunate to hit the crossbar twice in the third period as well. The resilient Oilers tied the game up a second time after a Hall deflection on a late power play, sending the game into an extra session.Overtime featured end to end play, and a couple of good saves by each goaltender, but didn’t solve anything. Canuck rookie Cody Hodgson scored the winning goal in the fifth round of the shootout, to deliver the Canucks two points heading into the break.Vancouver is happy the break has now arrived. Their play in the last couple of weeks has been very up and down – they have played their best against the tougher teams (Boston, San Jose, L.A., St. Louis), but have struggled against their weaker opponents (Anaheim, Edmonton, Tampa Bay, Florida). There have been times recently that they just look tired, and the six-day break coming up for all but four of the players should be a good tonic for them both physically and mentally. Now that everyone is again healthy, the team needs to refocus and set their sights on the stretch drive into the playoffs. TWINS RETURN FROM MIA STATUSIn recent outings, the Sedins have not been their normal, dangerous selves, often relatively invisible. In addition, the Canuck power play has been struggling, due at least partially to the Sedins’ lack of production. Tonight, they appeared to be much more “Sedin-like” – they were toying with Edmonton on many shifts, including the one that resulted in the first Canuck goal.
Another overtime. But this time the Good Guys won.Captain Sawyer Hunt got the last laugh on this former mates from the Bavarian City, scoring with 1:36 remaining in overtime to spark the Nelson Leafs to a 3-2 Kootenay International Junior Hockey League victory over the Kimberley Dynamiters Wednesday night at the NDCC Arena.The win, the first of the season for the Leafs over the Eddie Mountain squad, allows Nelson to leapfrog over the Castlegar Rebels and Grand Forks Border Bruins and into second place in the Murdoch Division standings.
1 Jose Mourinho, Frank de Boer and Ronald Koeman are contenders for the Everton job Joey Barton has spoken to talkSPORT to share his thoughts on Everton’s managerial search, on the day Roberto Martinez was sacked by the Merseyside club.The Spaniard was dismissed the day after a humiliating defeat at the hands of Sunderland, which guarantees the Toffees will finish in the bottom half of the Premier League table this term.After a record points total in his debut season, and an excellent fifth placed finish, things have only been going downhill for Martinez, and Everton need to ensure they bring in the correct manager to fix his mistakes.Frank de Boer is considered front-runner for the job, having confirmed his exit from Ajax this week, while both Jose Mourinho and Ronald Koeman have been touted as potential managers for the Goodison Park club.It is Mourinho who Barton believes has to be hired, as he has a proven record in English football, although Southampton boss Koeman is also thought of highly by the midfielder.Speaking as Drive co-host, the boyhood Everton fan said: “You need tried and tested in the Premier League. No disrespect to De Boer, he is a good manager, and will prove that in time, but I don’t think he’s for Everton now.“If you could get Koeman, I think he’s proven himself in the Premier League. If you look at his track record as a player and as a coach, he has a track record of winning.“If you can get Mourinho, you’ve got to get Mourinho. He has to be first choice, just because he’s as good as anyone. You’ve got to forget what’s happened this year at Chelsea, if Mourinho is given the right money and assurances he’s one of the best out there.”Barton, who has just helped Burnley back into the top flight, places De Boer last in his wishlist, suggesting that his lack of Premier League experience could mean the Dutch boss sends the Toffees into a relegation scrap if appointed manager.He added: “Failing that [hiring Mourinho] I would go Koeman, and if all else fails, take a chance on De Boer. But if you take a chance on De Boer you could be sitting very close to a relegation battle next season. It’s not guaranteed that you’ll get an upturn in form.”