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And how does one predict the future silver price anyway? That’s a good question, because it turns out that forecasting the shiny metal is different than predicting where a stock or even other metals are headed. I’ve compiled silver price predictions from a number of analysts, both inside and outside the precious metals industry. I’ll then give you the secret to determining where it’s headed, the three factors to predict its price, and finally my predictions for 2022 and the next five years. This will be fun, so let’s jump in! Bulls and Bears and Turtles, Oh My! Like most predictions, the ones for silver in 2022 vary. Some are bullish, some are bearish, and some see only slow-moving change. Silver averaged $25.03 in 2021, and ended the year at $23.08. Here’s where a dozen analysts think the price is headed this year… You can see the great disparity, the extremes being it will average 23% lower ($17.60), or climb as much as 116% ($50) this year. I’ve seen other predictions that have even higher and lower price targets, showing there really isn’t a consensus about where silver is headed this year. So who’s right? How does one make a reasonable prediction where silver is headed? To answer those questions we first have to understand that silver is… The Hybrid Metal, with Dual Purposes and Dual Catalysts Silver serves two primary functions. It’s a precious metal with a monetary role, and also an industrial metal with numerous and growing applications. Predicting the price, therefore, has to include analyzing both of these functions… Industrial Demand Because of silver’s chemical make-up, it is one of the best electrical and thermal conductors of all the metals. It also has growing use in the medical field, due to its antibacterial properties. In fact, it has so many industrial uses that the Silver Institute calls it “the indispensable metal.” And industrial demand for silver is going nowhere but up. One big reason is that many “green” technologies require silver. Electric vehicles use almost twice as much silver as internal combustion engines… solar panels contain silver and their installation is growing… 5G/mobile phone technology uses silver. And it’s clear that green infrastructure is a government priority. The Silver Institute says industrial demand for silver will rise in 2022. They project a… • 13% jump in photovoltaic demand (and triple by 2030). • 10% gain in the electrical/electronic sector. • 10% increase in brazing, alloy and solder demand. Much of this demand has not yet hit the silver market, but now that the senate has passed the $1 trillion infrastructure bill, the jump in demand for silver is about to kick in. And demand is already at record highs… total silver demand in 2021 reached 1.029 billion ounces, the first time it exceeded 1 billion ounces since 2015. Investment Demand Investment demand for silver fluctuates each year, sometimes wildly. But after industrial use, it is silver’s second-biggest source of demand, ahead of jewelry, silverware, and photography. So to accurately predict where the price might be headed, one must take into account what level of investment demand is expected. That in itself requires a prediction, but we’ll point out that in 2021 demand for physical silver investment jumped 32% and hit a 6-year high, according to Metals Focus. And silver ETFs rose by 150 million ounces to close at a record high of 1.21 billion ounces. In other words, demand for silver’s two main functions—industrial and investment—is growing. This means… • We should expect higher silver prices in 2022. Now that we understand this base about silver, let’s look at the… Three Ways to Predict the Silver Price Lots of things can impact the silver price—the US dollar, economic health, among others—but historically the following three have the biggest influence… #1: Investment Demand While demand for all of silver’s uses fluctuates each year, they don’t change dramatically. Greater industrial demand will support the market, but any big spike in the silver price has historically come from one source, where demand fluctuates the most. Investors. This long-term chart shows that as investment demand goes, so goes the silver price.   You’ll notice, however, there is typically a lag effect. Price movements tend to follow changes in investment demand, up or down. What does this mean for predicting the silver price in 2022? • We showed above that investment demand was elevated in 2021, so it would be historically normal to expect higher prices in 2022. #2. Gold/Silver Ratio The gold/silver ratio is simply the price of gold divided by the price of silver. Since both are considered monetary metals, they usually move together—which can give us clues when the ratio gets stretched in one direction or the other. The higher the ratio the more undervalued silver tends to be relative to gold; the lower the ratio the more overvalued silver is to gold. And when readings get stretched, they tend to correct themselves, as this chart shows… notice the ratio roughly corresponds to the highs and lows in precious metals cycles.   As 2022 began, the ratio was about 80, and you can see this reading is typically near a cycle low for precious metals prices. Meaning, the ratio is likely to fall and thus the silver price rise. The ratio is also 28% above its 50-year average. These facts suggest silver is more likely to rise this year than fall. Leigh Goehring of Goehring & Rozencwajg Associates is emphatic about the long-term price of silver, based on the ratio. “It’s hard to believe that in January 1980, on a very brief basis, the gold-silver ratio was 17:1. I wouldn't be surprised if we see that ratio again at some point in this bull market… if gold gets to $10,000 in this decade and the gold-silver ratio gets down to 20:1, that's $500 silver.”. • The gold/silver ratio suggests the silver price is likely to rise in 2022. #3. Silver TRAILS Gold One frustration of silver investors is that the price can, at times, be dormant, even when gold is trending higher. But this is actually historically normal. This chart shows that silver usually trails gold in bull markets. But then it catches up and outruns gold. You’ll see silver popped higher than gold in the current bull market—but it would be historically abnormal for the bull market to be over, as it would be one of the smallest gains on record. What this means for 2022 is that if one believes precious metals are in a bull market—and the gold price suggests we have been since late 2018—then we should expect silver to pass gold in fair time. If not this year, then 2023. Either way it suggests that silver prices are more likely to rise in 2022 than fall. Some analysts believe this trend corresponds to silver’s delayed reaction to inflation. According to Perth Mint manager Jordan Eliseo, “The inflation driver is likely to kick in only this year, as the market was convinced inflation was transitory until only two months ago. We also saw more money pour into equity strategies this year than pretty much the last 20 years combined—that's held gold and silver back. The U.S. dollar index was up and that is a natural headwind, too. But gold has a history of performing well once the Fed commences a rate hike cycle—and silver follows gold.” Many analysts have pointed out another fact about this tendency. In bull markets 90% of the move higher happens in the last 10% of time. This highlights both its nature to initially trail gold and also catch up and pass it. Once the gold price begins its next upleg, then the fuse will be lit for silver to move higher. • The natural tendency for silver to lag gold but then catch up and pass it suggests silver is more likely to rise in 2022 or 2023. My 2022 and 5-Year Silver Predictions Based on the three primary ways to forecast the silver price, here are my predictions for 2022 and the next five years. The odds favor a higher silver price this year. And over the next few years. If this prediction is correct, then accumulating silver now would be wise. By Jeff Clark, Senior Analyst, Hard Assets Alliance Website WealthCare Connect may receive a referral fee from Hard Asset Alliance.  

SMA stands for Separately Managed Account. And UMA stands for Unified Managed Account. So far, so good. But what do they mean, precisely?     It’s a trick question. There’s not one, but many answers. We know from experience that the terms SMA and UMA mean different things to different people. Which, of course, causes confusion. We think we can help. Previously, we wrote about the multiple meanings of “model.” Here we do the same for UMA and SMA.     SMA   SMAs are basically unbundled mutual funds. Like mutual funds, SMAs are professionally managed. Unlike mutual funds, investors directly hold individual securities, e.g. IBM, F, etc.     Traditional SMAs To make sense of how the term SMA is used, a bit of history is useful. SMAs were introduced as a way for individual investors to invest like large institutions, understood as the practice of first deciding on an asset allocation, then hiring different specialists to manage the funds allocated to each asset class.     With true institutional accounts, the third-party managers were typically just sent money. Creating consolidated holdings and performance reports was a manual and expensive process. To serve individual investors, something simpler was needed. APL and others introduced systems that divided a client’s holdings into sub-accounts (also called partitions or sleeves). Each of the third-party specialists would get its own sub-account to manage, free of the interference of other third-party specialists, and the sub-accounting systems simplified the process of generating holdings and performance reports. The results were the first generation of SMAs, which we’ll call “traditional SMA”.   Model-based overlay SMAs Unfortunately, even with sub-accounting, SMAs were still burdened with high costs and high minimums. There was no standard protocol to communicate with the third-party managers, so much of it was done by phone and email. There was no practical way to coordinate the activity of the different managers to prevent wash sales, or even avoid buying/selling of the same security on the same day in different accounts. Transferring assets between managers (necessary when rebalancing at the asset class level) was time consuming and tax-inefficient.     In response to these limitations of traditional SMAs, the workflow was further simplified. Instead of directly managing assets, the third party specialists simply provide a portfolio model to the primary client advisor, who takes on responsibility for all trading. Call this “models-based SMA.” Not all strategies lend themselves to a models-based approach. It only works if the underlying securities are highly liquid. If efficient trading is a key component of the specialist’s skill set — as with, say, muni-bonds and micro-cap stocks — a models-based approach is not appropriate.   Will the real SMA please stand up? For some, the term SMA is synonymous with what we’ve called “Traditional SMA.” Others use the term SMA more broadly to mean Traditional SMA or models-based SMA. We don’t have any strong opinions about the “right” usage. To avoid confusion, we usually avoid using the standalone term SMA in favor of the more descriptive “traditional SMA” or “models-based SMA.”     UMA   While models-based SMAs were a step forward, they still suffered from major limitations. In particular, SMAs were managed separately from the rest of the client’s portfolio, which might also contain mutual funds, ETFs and in-house equity portfolios (where your advisor buys/sells stocks based on his or her own research). This made it difficult to manage the client’s portfolio as a whole.   UMAs were created to address some of these problems. The term UMA (Unified Managed Account) is meant to describe a single account that contains any combination of SMAs, mutual funds and ETFs, with consolidated holdings and performance reporting. There are two basic ways to accomplish this.   Sub-account (sleeve-based) UMAs Sleeve-based UMAs are modest extensions of SMAs, in which, basically, you add extra sleeves to hold mutual funds and/or proprietary (in-house) equity holdings. This sounds trivial, but when SMAs were first rolled out, the sub-accounting system was usually separate from the main accounting and trading system used for mutual funds and in-house equities. Creating UMAs required consolidating all these systems.   Blended-model (holistic) UMAs Sleeve-based UMAs are more efficient than predecessor SMA programs. However, that’s a little bit damning with faint praise. Sleeve-based UMAs, even models-based SMAs, are still expensive and unwieldy. The problem stems from the whole idea of sub-accounts. First, the systems that keep track of the different sub-accounts are expensive to maintain. Second, and more fundamentally, dividing up an account makes it difficult to manage the portfolio as a whole. Certain characteristics of a portfolio, risk especially, are not properties of individual securities. They’re properties of the portfolio as a whole. Managing risk, especially in the presence of customization and tax optimization, requires a holistic approach, which means no sub-accounts.   Like other model-based SMAs, blended-model (holistic) UMAs start with the idea of having third-party specialists hand over models. But they dispense with the whole idea of sub-accounts, treating them as a vestigial remnant of the whole institutional approach from which SMAs sprang. Instead, the various models from third-party specialist are blended together into a single composite (or “blended”) model. The client’s (unpartitioned) account is then managed to this one composite model — holistically.   Note that if an SMA is implemented this way (with blended models), it’s automatically a UMA. There are no extra steps needed to include mutual funds and proprietary models, and no extra sleeve that needs to be created. Instead, the mutual funds, ETFs, proprietary models, etc. are just added to the composite model in proportion to their desired weight in the portfolio.     Will the real UMA please stand up? As with the term SMA, we don’t think there’s a single correct definition of UMA. To avoid confusion, we just refer directly to the two different types: “sleeve-based” (or “sub-account-based”) UMA and “blended model” (or “holistic”) UMA.     We’ve presented the evolution of SMAs to UMAs, from “traditional SMA” to “blended model UMA,” as a straight progression. The actual history is a bit more convoluted — some of these systems evolved in parallel, not in succession. And not everyone shares our view that blended model UMA is the best approach (we’re a blended-model UMA systems provider, so we can’t claim to be neutral). What everyone can agree on, though, is that the terminology can be confusing. Regardless of the type of system you want, we hope this guide will help. Gerard Michael President & Co-Founder, Smartleaf

We are here for surviving family members when a worker dies. In the event of your death, certain members of your family may be eligible for survivors’ benefits. These include widows and widowers, divorced widows and widowers, children, and dependent parents. The amount of benefits your survivors receive depends on your lifetime earnings. The higher your earnings, the higher their benefits. That’s why it’s important to make sure your earnings history is correct in our records. That starts with creating your personal my Social Security account. A my Social Security account is secure and gives you immediate access to your earnings records, Social Security benefit estimates, and a printable Social Security Statement. The Statement will let you see an estimate of the survivors benefits we could pay your family. You may also want to visit our Benefits Planner for Survivors to help you better understand Social Security protections for you and your family as you plan for your financial future. Please visit our website or read our publication, Survivors Benefits, for more information. You can also help us spread the word by sharing this information with your family and friends. By Dawn Bystry, Deputy Associate Commissioner, Office of Strategic and Digital Communications Source

                                    <h1>The Case of the $489,000 Air Ambulance Ride</h1> <div>    <span class="byline">Julie Appleby, Kaiser Health News</span>         <time class="posted-on" datetime="2022-03-25T05:00:00-04:00">             March 25, 2022        </time>         </div> <p>Sean Deines and his wife, Rebekah, were road-tripping after he lost his job as a bartender when the pandemic hit. But while visiting his grandfather in a remote part of Wyoming, Sean started to feel very ill.</p>    <p>Rebekah insisted he go to an urgent care center in Laramie.</p><p>“‘Your white blood count is through the roof. You need to get to an ER right now,’” Deines, 32, recalls a staffer saying. The North Carolina couple initially drove to a hospital in Casper but were quickly airlifted to the University of Colorado Hospital near Denver, where he was admitted on Nov. 28, 2020.</p><p>There, specialists confirmed his diagnosis: acute lymphoblastic leukemia, a fast-growing blood cancer.</p><p>“Literally within 12 hours, I needed to figure out what to do with the next step of my life,” said Deines.</p><p>So, after he was started on intravenous treatments, including steroids and antibiotics, in Colorado to stabilize him, the couple decided it was prudent to return to North Carolina, where they could get help from his mother and mother-in-law. They selected Duke University Medical Center in Durham, which was in his insurance network.</p><p>His family called Angel MedFlight, part of Aviation West Charters of Scottsdale, Arizona, which told Rebekah Deines that it would accept whatever the couple’s insurer would pay and that they would not be held responsible for any remaining balance.</p><p>Sean Deines was flown to North Carolina on Dec. 1, 2020, and taken by ground ambulance to Duke, where he spent the next 28 days as an inpatient.</p><p>By his discharge, he felt better and things were looking up.</p><p>Then the bills came.</p><p><strong>The Patient:</strong> Sean Deines, 32, who purchased coverage through the Affordable Care Act marketplace with Blue Cross Blue Shield of North Carolina.</p><p><strong>Medical Service:</strong> A 1,468-mile air ambulance flight from Colorado to North Carolina, along with ground transportation between the hospitals and airports.</p><p><strong>Service Provider:</strong> Aviation West Charters, doing business as <a href="https://www.angelmedflight.com/">Angel MedFlight</a>, a medical transport company.</p><p><strong>Total Bill:</strong> $489,000, most of which was for the flight from Denver, with approximately $70,000 for the ground ambulance service to and from the Denver and Raleigh-Durham airports.</p><p><strong>What Gives:</strong> Insurers generally get to decide what care is “medically necessary” and therefore covered. And that is often in the eye of the beholder. In this case, the debate revolved first around whether Deines was stable enough to safely take a three-plus-hour commercial flight to North Carolina during a pandemic or required the intensive care the air ambulance provided. Second, there was the question of whether Deines should have stayed in Denver for his 28-day treatment to get him into remission. Insurers tend not to consider patient stress or family convenience in their decisions.</p><p>Also, both air and ground ambulance services have been center stage in the national fight over huge surprise bills, since the for-profit companies that run them frequently do not participate in insurance networks.</p><p>Angel MedFlight, which was not in Deines’ insurance network, sought prior authorization from Blue Cross Blue Shield of North Carolina. The request was dated Nov. 30, but the insurer said the fax arrived in the predawn hours the same day as the flight, Dec. 1, 2020.</p><p>On that day, Angel MedFlight flew Deines to North Carolina in an airplane, along with a nurse to oversee his IV medications and oxygen levels.</p><p>Angel MedFlight spokesperson Kimberly Halloran did not answer a specific written question from KHN about why the flight went ahead without prior approval; often medical interventions are postponed until it has been obtained. But in an emailed statement, she said the company “satisfied each step in the health insurance process and transported Sean to his long-term health care providers in good faith.”</p><p>According to the review of the case done months later by an independent evaluator, Blue Cross on Dec. 3 denied coverage for the air ambulance services because medical records did not support that it was an emergency and Deines was already in an appropriate medical facility.</p><p>At the end of December, an appeal was filed against that decision on behalf of Deines by Angel MedFlight.</p><p>Then, in March 2021, Blue Cross sent Deines a check for $72,000 to cover part of the $489,000 bill, which he forwarded to the air ambulance company. The explanation of benefits showed the majority of the charges were ruled “not medically necessary.”</p><p>Angel MedFlight, through a revenue management firm it hires called MedHealth Partners, continued to appeal to Blue Cross to overturn the denial of the flight portion of the bill.</p><p>Then, three months after Blue Cross sent the check that Deines then sent on to Angel MedFlight, the insurer demanded Deines pay back the $72,000.</p><p>“The initial thought was ‘I can’t believe this is happening,’” said Deines.</p><p>Medical necessity criteria are set by insurers, with North Carolina Blue Cross covering air ambulances in “exceptional circumstances,” such as when needed treatment isn’t available locally.</p><p>When Deines, who was still unemployed and undergoing treatment, couldn’t pay, the debt was sent to collections.</p><p>In late June, Deines’ representatives at Angel MedFlight took the next step allowed under the Affordable Care Act, appealing the insurer’s internal determination that the flight wasn’t medically necessary to an independent third party through the state.</p><p>On July 29, the evaluator ruled in favor of Blue Cross.</p><p>Normally, such a flight would be appropriate because the patient was “medically unfit to travel via commercial airflight,” the review noted. But, it went on to say, there was actually no need to travel, as the University of Colorado Hospital — a member of the National Comprehensive Cancer Network — could have managed Deines’ treatment.</p><p>His health plan “clearly stipulates their indications for medical flight coverage and, unfortunately, this case does not meet that criteria,” the review concluded.</p><p><strong>Resolution:</strong> The bill disappeared only after the press got involved. Shortly after a KHN reporter contacted the communications representatives for both the insurer and Angel MedFlight, Deines heard from both of them.</p><p>The $72,000 payment was made in error, said Blue Cross spokesperson Jami Sowers.</p><p>“We apologize for putting the member in the middle of this complicated situation,” she said in an email that also noted “the air ambulance company billed more than $70,000 just for ground transportation to and from the airport — more than 30 times the average cost of medical ground transport.”</p><p>Such a situation would “typically” be flagged by internal systems but for some reason was not, Sowers said.</p><p>“I have never heard of a ground transport that costs that much. That’s shocking,” said Erin Fuse Brown, director of the Center for Law, Health & Society at Georgia State University College of Law, who studies patient billing and air ambulance costs.</p><p>Still, there’s good news for Deines: Both the insurer and the air ambulance company told KHN he will not be held responsible for any of the charges. (None of the charges stemmed from his first air ambulance flight from Casper to Denver, which was covered by the insurer.)</p><p>“Once North Carolina Blue engages in our formal inquiries about its refund request, the status of the funds will be resolved,” the ambulance spokesperson wrote in her email. “One thing is certain, Sean will not have to pay for North Carolina’s wavering coverage decision.”</p><p>In an email, Sowers said Blue Cross had “ceased all recoupment efforts” related to Sean’s case.</p><p><strong>The Takeaway:</strong> If the flight had happened this year, the couple might have received more price information before they took the flight.</p><p>A law called the No Surprises Act took effect Jan. 1. Its main thrust is to protect insured patients from “balance bills” for the difference between what their insurance pays and what an out-of-network provider charges in emergencies.</p><p>It also covers nonemergency situations in which an insured patient is treated in an in-network facility by an out-of-network provider. In those cases, the patient would pay only what they would owe had the service been fully in-network.</p><p>Another part of the law, called a good faith estimate, might have provided Deines with more transparency into the costs.</p>        <h4>        Related Links    </h4>            <ul><li>                    <a href="https://khn.org/news/article/nicu-surprise-bill-loophole-no-surprises-act/">                                                    An $80,000 Tab for Newborns Lays Out a Loophole in the New Law to Curb Surprise Bills                                            </a>                </li>                            <li>                    <a href="https://khn.org/news/article/the-doctor-didnt-show-up-but-the-hospital-er-still-charged-1012/">                                                    The Doctor Didn’t Show Up, but the Hospital ER Still Charged $1,012                                            </a>                </li>                            <li>                    <a href="https://khn.org/news/article/nicu-bill-installment-plan-thatll-be-45843-a-month-for-12-months-please/">                                                    NICU Bill Installment Plan: That’ll Be $45,843 a Month for 12 Months, Please                                            </a>                </li>                            <li>                    <a href="https://khn.org/news/article/bill-of-the-month-emergency-room-surprise-billing-6500-dollars-for-six-stitches/">                                                    The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER.                                            </a>                </li>                    </ul><p>That portion says medical providers, including air ambulances, must give upfront cost estimates in nonemergency situations to patients. Had the law been in effect, Deines might have learned before the flight that it could be billed at $489,000.</p><p>Insured patients in similar situations today should always check first with their insurer, if they are able, to see if an air transport would be covered, experts said.</p><p>Even if the law had been in effect, it likely would not have helped with the big hang-up in Deines’ case: the disagreement over “medical necessity.” Insurers still have leeway to define it.</p><p>For his part, Deines said he’s glad he took the flight to be closer to home and family, despite the later financial shock.</p><p>“I would not change it, because it provided support for myself and my wife, who needed to take care of me; she was keeping my sanity,” he said.</p><p><em>Stephanie O’Neill contributed the audio portrait with this story.</em></p><p><em>Bill of the Month is a crowdsourced investigation by </em><a href="https://khn.org/news/tag/bill-of-the-month/"><em>KHN</em></a><em> and </em><a href="https://www.npr.org/sections/health-shots/2018/02/16/585549568/share-your-medical-bill-with-us"><em>NPR</em></a><em> that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? </em><a href="https://khn.org/send-us-your-medical-bills/"><em>Tell us about it</em></a><em>!</em></p><p><a href="https://khn.org/about-us">KHN</a> (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at <a href="https://www.kff.org/about-us/">KFF</a> (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.</p><h3>USE OUR CONTENT</h3><p>This story can be republished for free (<a href="https://khn.org/news/article/radonda-vaught-nurse-drug-error-vanderbilt-guilty-verdict/view/republish/">details</a>).</p><p><a href="https://khn.org/morning-briefing/">Subscribe</a> to KHN's free Morning Briefing.</p><img src="https://ssl.google-analytics.com/collect?v=1&t=event&ec=Republish&tid=UA-53070700-2&z=1648311397259&cid=0e06e327-3319-43ea-8957-0a3376a7f71a&ea=https%3A%2F%2Fkhn.org%2Fnews%2Farticle%2Fthe-case-of-the-489000-air-ambulance-ride%2F&el=The%20Case%20of%20the%20%24489%2C000%20Air%20Ambulance%20Ride"/>                               

Welcoming a baby to your family is an exciting time. Doing paperwork – even for something as important as a Social Security number for your newborn – is probably one of the last things you want to do. We’ve made it easy. If your child is born in a hospital, the most convenient way to apply for a Social Security number is at that hospital before you leave. When you give information for your child’s birth certificate at the hospital, you’ll be asked whether you want to apply for a Social Security number for your child. If you answer “yes,” you will be asked to provide both parents’ Social Security numbers. Even if you don’t know both parents’ Social Security numbers, you can still apply for a number for your child. There are many reasons why your child should have a Social Security number. You need a Social Security number to claim your child as a dependent on your income tax return. You may also need a number for your child if you plan to do the following for your child: Open a bank account. Buy savings bonds. Get medical coverage. Apply for government services. You can find more information by reading our publication, Social Security Numbers for Children. Please share this information with people who are having a baby. Applying for a Social Security number at the hospital will save them time and let them focus on their new bundle of joy. By Dawn Bystry, Deputy Associate Commissioner, Office of Strategic and Digital Communications

The Golden Constant Is Back It used to be a doctrine. When inflation picks up, so does the gold price. Generations have figured this out, and gold has never gone away as the go-to safe haven asset. After 40 years of relatively low inflation, it’s become perhaps unfashionable, but the fundamentals that have made it a safe haven for thousands of years are still with us.   It used to be the case that you would follow the inflation numbers, and adjust one’s portfolio based on the outlook by buying gold and mining stocks. Today, it might be wise to reverse that: follow the gold price and you gain great insight into the future of inflation. Gold has come alive, reaching $1,800. Central bank purchases, consumer demand, shifts in portfolios by individual account holders all play a role here. The conviction that inflation is bad and getting worse all play a role here. Fiat money has not in our lifetimes had such a bad reputation and prognosis. At the same time, the best way to understand the rise of an inflation hedge is to view it in real terms, which is to say adjusted for the manner in which the dollar itself has depreciated. Here you get a different picture. In real terms, by today’s dollar, gold of October 1979 was running $489. By the end of the year, in today’s dollars with adjustment, gold reached $1,800. That is where we sit today. In other words, in real terms, and depending on how you calculate inflation today, we are nearing or at a high.   For some people, this development is inevitable. Gold has been called a “constant” for a reason. It is a hedge, not a means of profiting as such but as a protection against the chaos of the world. That’s saying something important. It is a wise move, but not necessarily a means of gaining riches — unless and to the extent that we really face an out-of-control hyperinflation. For other people, the activity in gold today might be a bit of a surprise. The only serious competitor that gold has had in our times has been the advent of cryptocurrency. It has all the features of gold. It is scarce, indestructible, fungible, and has an even quality across all possible units. Bitcoin and others add two features that make it even more attractive. It is weightless and instantly transferable without the cost of physically moving the stuff from place to place. There is a downside to crypto. Using it requires access to the Internet under general conditions. If your cell phone dies because the electricity is out, you are out of luck. If the government shuts down the Internet, you are also stuck. All of that is true, but there are several confusions people have here as well. Myth and Fact First, it is possible to have physical bitcoin. You can print out your wallet on a piece of paper. You have it and can use it, even if you go years without internet access. Many high-end holders do this and keep it in a safe. That way, there is no way to gain access to it merely by getting access to the online wallet that stores your encrypted key.   Second, even if you lose access for however long (let’s say you get shipwrecked on a deserted island), that does nothing to change your ownership status. If you have your passphrase stored somewhere (or, more implausibly, memorized) you can recreate your access merely by typing that code in at some point: tomorrow, next year, or in a hundred years. Your money is still there. Third, if you die, even then your ownership is not in question, since none of it exists under your personal identity as such. Your access is controlled by whomever has access to your private key. Therefore, you can store your codes in an email or program somewhere or on paper, and put the instructions on how to get to it in a will or some other method. Whomever gains access to that is now the owner of your holdings. For this reason, it is not really possible to enforce some legal action against anyone who “steals” your bitcoin. In some sense, it is a free-for-all. Anyone who hacks your wallet, or anyone to whom you send you units whether on purpose or by mistake, is now the owner. This is the “law” of cryptocurrency. This is why it is a huge issue to maintain tight security protocols. This problem is not unique to crypto. Gold too had this issue. When FDR demanded that everyone turn in his gold in 1933, only a portion of the population complied. The rest —I’m thinking of very wealthy families mostly in the Northeast at the time and some in the West — had to figure out a way to hide it in their backyards or find a trusted third party who would hold it for decades until it became legal again. There were such options available, but they were kept super secret. Estates around the country in remote locations fashioned themselves as safe houses for gold storage. They kept the secret through the whole of the Great Depression, World War II, and all the way until 1974 when owning gold became legal again. Then their descendants took off to pick up what had been left behind. In this way, gold and Bitcoin both face a problem of security. It is up to the individuals to solve it. The Big Question For the last 13 years, the question people have asked is whether and to what extent crypto has replaced gold as the favored safe haven asset. I’ve seen fierce debates on this. I’ve always believed that they were silly debates. Both serve that purpose.   From a market point of view, gold is going to be more stable, whereas crypto is still in the early stages of price/value discovery. It very likely has a long way to go on the upside. It will eventually settle at some range of price and then respond to inflationary trends in a way that is similar to gold. For this reason, it attracts speculation in a way that gold does not. The bottom line is that we do not have to choose between them. Both are better assets than dollars right now, or at least perform well enough to suggest that a readjustment of the portfolio is in order, given existing trends. They play well together. There is no reason for a war between gold and Bitcoin, or between Bitcoin and every other crypto alternative. What seems increasingly certain is that the dollar, and other fiat currencies, are facing extremely challenging times. Whether that alternative is real estate, hard money, or crypto assets, or even oil and other commodities is in question. That the dollar faces a serious threat to its value is no longer in doubt. By Jeffrey Tucker Jeffrey Tucker is an independent editorial consultant who served as Editorial Director for the American Institute for Economic Research. He is the author of many thousands of articles in the scholarly and popular press and eight books in 5 languages, most recently Liberty or Lockdown. Signing up is easy. It only takes 5 minutes to set up and start precious metals investing on our secure platform that gives you competitive pricing, fully allocated ownership, with optional secure international storage or delivery and full transparency and safety. Open Hard Assets Alliance Account Today For more postings by Hard Asset Alliance, click HERE Website WealthCare Connect may receive a referral fee from Hard Asset Alliance.

Why is this important? To help young people understand how to manage their money, it’s important to gauge what they know, understand, and can do. The “Map your money journey” survey is a self-assessment designed for students in grades 3–12. It assesses the attitudes, skills, and habits a young person has by measuring their development of three interconnected building blocks of financial capability. The building blocks are: Executive function, called “Planning and self-control” in the survey Financial habits and norms, called “Money habits and values” in the survey Financial knowledge and decision-making skills, called “Money knowledge and choices” in the survey Managing money takes more than adding and subtracting. Having strong money skills and knowledge can help you make choices that are best for you. Remember, your money journey will last your entire life and everyone can always improve! ElementarySchool Grades 3-5 Middle School Grades 6-8 High School Grades 9-12   The Consumer Financial Protection Bureau (CFPB) is a U.S. government agency that makes sure banks, lenders, and other financial companies treat you fairly.

• Never in human history has “fake” money like the fiat U.S. dollar survived… • It’s tempting to think the Fed can keep up the game forever… • But the evidence suggests the dollar’s days are numbered... • Which means you need to protect the wealth you build from inflation by buying gold.   Dear Reader,   For more than a decade I traveled the world looking for gold and silver mines. It was an incredible education, working with Frank Crerie to take these mines public. I remember looking at the side of a hill in the Peruvian Andes at a line of holes, small gold mines, and following a gold vein in that hill. My mining geologist told me those tiny holes produced gold for the Incas, long before Francisco Pizarro arrived from Spain, killing their leaders and then stealing their gold. One of our most successful mines was an old silver deposit in a remote part of southern Argentina. Our group took that mine public on the Toronto Stock Exchange when silver was less than $3 an ounce. We did very well once silver broke $7 per ounce. Today, silver bounces at around $15 an ounce. Too bad we sold at $7! Our biggest acquisition was an old mine in China. We got the Chinese mine for “nothing down.” The agreement was that the Chinese government would give us the mine if we would raise money by taking the company public on the Toronto Stock Exchange, which we did. The good news is that we found a massive deposit. Millions of ounces, “proven.” For about a year, we knew we were billionaires. Our Chinese goldmine had a Spanish portmanteau: Mundoro Mining, or a world of gold. Then one day, a government official notified us that the Chinese government was not going to renew our business license. Today, that mine is in the hands of friends of the Chinese elites, who are billionaires. The lasting impression left by my years of searching for gold was just how lasting it’s value has been throughout history. From the time of the Incas, when the Spanish stole that treasure… to our era when the Chinese stole mine. Humans have always valued God’s money. And they will continue to. But at the same time, we’ve lost our way by putting to much faith in fiat money. Why do we trust people we don’t even know? Why do we believe the elites just because they write the words “In God We Trust” on our fake money? In fact, we have every reason not to. Look at this chart below: Now, look at the chart of what happens to fake money, when our leaders print more fake money. The bad news is, never in human history has fake money survived.     Which means, the odds are that all of today’s paper money will return to its true value: zero. Savers Are Losers Many people believe it’s smart to save money. The problem is that today, “money” is no longer money. Today, people are saving counterfeit dollars, money that can be created at the speed of light.   In 1971 President Nixon took the U.S. dollar off the gold standard, and money became debt. The primary reason why prices have risen since 1971 is simply because the United States now has the power to print money to pay its bills. Today, savers are the biggest losers. Since 1971, the U.S. dollar has lost 95% of its value when compared to gold. It will not take another 40 years to lose its remaining 5%. Remember, in 1971, gold was $35 an ounce. Today, it’s $1,830 an ounce. That’s a massive loss of purchasing power for the dollar. The problem grows worse as the U.S. national debt escalates into trillions of dollars and the U.S. continues to print more “counterfeit” money. As the Federal Reserve Bank and central banks throughout the world print trillions of dollars at high speed, every printed dollar means higher taxes and more inflation. Despite this fact, millions of people continue to believe saving money is smart. It used to be smart when money was money. The biggest market in the world is the bond market. “Bond” is another word for “savings.” There are many different types of bonds for different types of savers. There are U.S. Treasury bonds, corporate bonds, municipal bonds, and junk bonds. For years, it was assumed that U.S. government bonds and government municipal bonds were safe. Then the financial crisis of 2007 began. As many of you know, the crisis was caused by mortgage bonds such as mortgage-backed securities, a type of derivative asset. Millions of these mortgage bonds were made up of subprime mortgages, which were loans to subprime or high-risk borrowers. You may recall that some of those borrowers had no income and no job. Yet, they were buying homes they could never pay for. The Wall Street bankers took these subprime loans and packaged them into bonds, magically got this subprime bond labeled as prime, and sold them to institutions, banks, governments, and individual investors. To me, this is fraud. But that is the banking system. Once the subprime borrower could no longer pay the interest on their mortgages, these bonds began blowing up all over the world. Interestingly, it was Warren Buffett’s firm, Moody’s, that blessed these subprime mortgages as AAA prime debt, the highest rating for bonds. Today, many people blame the big banks, such as Goldman Sachs and J. P. Morgan, for the crisis. Yet if anyone should be blamed for this crisis, it should be Warren Buffet. He is a smart man, and he knew what he was doing. Moody’s was blessing rotting dog meat as Grade A prime beef. That is criminal. Is China the Biggest Loser of All? China could be the biggest loser of all. China holds a trillion dollars in U.S. bonds. Every time the U.S. government devalues the dollar by printing more money and issuing more bonds, the value of China’s trillion-dollar investment in the United States goes down. If China stops buying U.S. government bonds, the world economy will stop and crash.   Millions of retirees are just like China. Retirees in need of a steady income after retirement believed government bonds were safe. Today, as governments, big and small, go bust and inflation rises, retirees are finding out that savers who saved money in bonds are losers. Bet on Gold and Silver As the dollar declines in value, I’m betting on gold and silver instead of dollars. The Rich Get Richer With Real Assets Robert Kiyosaki is the author of the bestselling book Rich Dad Poor Dad as well as 25 others financial guide books, has spent his career working as a financial educator, entrepreneur and successful investor. The wealth gap has never been wider than it is today. In order to protect and grow your wealth you must own real assets. If you rely solely on paper assets you’ll wake up one day and realize that Wall Street and the government have stolen all your wealth. The easiest way to get started with real assets is NOT real estate. The easiest way to get started owning real assets is with gold and silver. You can still get silver eagles for less than $40 a piece… but maybe not for very long. If you’re looking to own physical gold and silver, the Hard Assets Alliance has the products and the services you need. You can get a stack of silver delivered to your home. Or you can invest in gold through your IRA for long-term wealth preservation. No matter how you want to own your gold, the Hard Assets Alliance has you covered. Robert Kiyosaki Editor, Rich Dad Poor Dad Daily   Hard Assets Alliance was created as a cooperative of investment professionals who believe there's a better way to invest in precious metals. This is a guest perspective on the markets from one of these partners; we hope you enjoy it. For more postings by Hard Asset Alliance, click HERE Website WealthCare Connect may receive a referral fee from Hard Asset Alliance.

                                    <h1>Readers and Tweeters Find Disadvantages in Medicare Advantage</h1> <div>        <time class="posted-on" datetime="2021-11-12T05:00:00-05:00">             November 12, 2021        </time>         </div> <p><em><a href="https://khn.org/news/tag/letter-to-the-editor/">Letters to the Editor</a> is a periodic feature. We <a href="http://khn.org/contact-us/">welcome all comments</a> and will publish a selection. We edit for length and clarity and require full names.</em></p><p><em>— Dr. Atul Grover, Baltimore</em></p><p><strong>Reading the Fine Print on Medicare Advantage Plans</strong></p><p>With Medicare Advantage open enrollment open until Dec. 7, millions of seniors will consider costs, benefits and networks when selecting a new plan (“<a href="https://khn.org/news/article/medicare-plans-free-dental-vision-hearing-benefits-come-at-a-cost/">Medicare Plans’ ‘Free’ Dental, Vision, Hearing Benefits Come at a Cost</a>,” Oct. 27).</p><p>Many consumers may not be aware that some health plans have frustrating restrictions buried deep within that limit access to critical procedures. For example, Aetna recently began requiring prior authorization for cataract surgeries across all its health plans — including Medicare Advantage. Tens of thousands of Americans covered by Aetna have had their sight-restoring surgeries delayed or canceled, while insurance company representatives decide who gets to see better — and who must wait for their cataract to get worse before insurance will cover cataract surgery.</p><p>Congress is working to put guardrails around prior authorization abuse in Medicare Advantage through the Improving Seniors’ Timely Access to Care Act, which now has 239 co-sponsors in the House and was recently introduced in the Senate.</p><p>In the meantime, seniors should beware of prior authorization requirements in Medicare Advantage plans and press insurance representatives to be upfront about obstacles that can lead to care delays or denials.</p><p><em>— Dr. Tamara R. Fountain, president of the American Academy of Ophthalmology, Chicago</em></p><p><em> — Julie Carter, Las Vegas </em></p><p>Your recent article on Medicare Advantage plans provided a good overview but omitted essential information.</p><p>Traditional Medicare coverage includes a well-defined set of benefits, rules and regulations with regards to coverage. Adverse coverage determinations can be appealed. The appeals process is well defined.</p><p>Medicare Advantage plans claim to cover services that traditional Medicare covers and “more.” The problem is that there is no means to ascertain the validity of such claims. Additionally, coverage under such plans is conditional and at the discretion of such plans. Denials of care have no standardized means of appeal. The appeal is to the plan itself. There is no means to override an adverse coverage decision and the plans tend to uphold their adverse decisions upon appeal as there is no external oversight mechanism that can be used to reverse the plans’ decisions.</p><p>Few individual providers have the resources to challenge adverse coverage decisions from the big health insurance companies running the Medicare Advantage plans. I am a provider. If a commercial health plan will not resolve a coverage dispute, I can contact the Texas Department of Insurance to resolve the issue. TDI has no jurisdiction over the Medicare Advantage Plans.</p><p>I have made numerous inquiries to determine who has jurisdiction over adverse coverage decisions by Medicare Advantage plans, including to the Centers for Medicare & Medicaid Services. No responses!</p><p>My warning to those turning 65 is “caveat emptor.” Unfortunately, the public is not provided with the comprehensive information they need to make informed choices.</p><p><em>— Dr. Ed Davis, San Antonio</em></p><p><strong>The Barest of Necessities</strong></p><p>My mother raised nine kids with cloth diapers and a washing machine (“<a href="https://khn.org/news/article/down-to-my-last-diaper-the-anxiety-of-parenting-in-poverty/">‘Down to My Last Diaper’: The Anxiety of Parenting in Poverty</a>,” Oct. 22). We were raised in poverty. My father worked two jobs and my mother even made soap in the basement for much of our early years. Jeans were patched, hand-me-downs might just as well have been a brand, and one pair of shoes a year … well, that was a good year. Yes, we grew up poor, but at the same time we were given a strong work ethic by example. All nine children are now successful, productive contributors to society.</p><p>It is impossible, therefore, that disposable diapers are an “essential.”</p><p>That leaves this article in the realm of political rhetoric rather than health news. Weakens your brand, don’t you think?</p><p><em>— Steve Meyer, Cincinnati</em></p><p><em>— Bradford Pearson, Philadelphia</em></p><p><strong>How Covid Had the Run of Hospitals</strong></p><p>As a former registered nurse at a hospital in southwest Florida, I can attest positively to the facts presented in Christina Jewett’s article about hospital “safety” and how it relates to the retired pharmacist who died from covid-19 (“<a href="https://khn.org/news/article/hospital-acquired-covid-nosocomial-cases-data-analysis/">Patients Went Into the Hospital for Care. After Testing Positive There for Covid, Some Never Came Out,”</a> Nov. 4). My observations and personal experiences in the hospital during the early days of this infection were just as she stated, with one additional caveat, which may be of interest. Our med-surg unit became an overflow unit for suspected and/or positive cases. What is not being told (yet is accurate) is that when our negative-pressure rooms were occupied (there were only two on our floor), patients were being put into regular rooms with the door closed.</p><p>Although on the surface this may sound like a “great” plan, I noticed a failure in management’s solution immediately: The room doors have a 1- to 2-inch gap underneath them. The patients in those rooms were not masked. This means, as is intuitively obvious, that the patients’ infected respirations were escaping from their rooms and into the hallways. Additionally, this “air” was then potentially capable of traveling into other patients’ rooms and thereby potentially infecting them with covid-19 as well. Needless to say, before too long, our floor had a couple of infected nurses.</p><p>My belief is that it is extremely possible and likely that many, many hospitals “reacted” this way during the earlier days of the pandemic. I wasn’t employed at this hospital far enough into the pandemic to observe where or how patients who were suspicious or positive for this virus were assigned rooms once researchers discovered that transmission was of the airborne variety rather than of the droplet variety, as initially thought.</p><p>Finally, as a nurse, I know of many other nurses here in Florida who absolutely refused to get vaccinated early, midway or late into this pandemic. I agree 100% that these nurses and various other “holdout” employees could very easily have “carried without knowledge” the virus to their patients, like the man spoken about in the article. There is no doubt in my mind that a “carrier” (likely unsymptomatic and unvaccinated) carried and infected the retired pharmacist. Great story, well-written.</p><p><em>— Janet M. Konikow, Fort Myers, Florida</em></p><p><em>— Jen Weidinger, Loudonville, Ohio</em></p><p><strong>‘Daily’ Pill vs. Flushing Out Covid Risks</strong></p><p>With luck, molnupiravir may work as well as acyclovir for herpes  “<a href="https://khn.org/news/article/oral-antiviral-covid-treatment-on-horizon/">A Daily Pill to Treat Covid Could Be Just Months Away, Scientists Say</a>” (Sept. 24). However, as the Centers for Disease Control and Prevention points out on its website: “These [antiviral] drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences.” At the same time, the CDC posts clear and unequivocal warnings about sharing a bathroom used by a covid-19 patient. Don’t.</p><p>Their unspoken message is covid could very well be an infectious enterovirus, with flush toilet micro-plume a vector. Cities are studying sewage for presence of the virus and the clinical trials for niclosamide are testing the participants’ stool on schedule for elimination of the pathogen. Why?</p><p>Merck’s trial makes no mention of fecal viral load or describes a goal of eliminating the presence of covid in a patient. Will this drug really be a “game changer”? It took over 30 years to recognize polio’s fecal mode of transmission; are we repeating a historical mistake?</p><p><em>— Tom Heusel, Eugene, Oregon</em></p><p><em>— Peter Zeihan, Denver</em></p><p><strong>Dental Health at the Root of U.S. Productivity</strong></p><p>Dental care, like medical care, should be seen as a human right. The idea that support for dental care should be limited to older patients with major dental care issues is shortsighted. To this end, one estimate is that $45 billion of worker productivity is lost yearly because of tooth decay. This affects us all. Provision of good preventive dental care to all young people would increase productivity and thus benefit both the individuals at risk and society at large. (See: <a href="https://jada.ada.org/article/S0002-8177(20)30672-3/fulltext">doi.org/10.1016/j.adaj.2020.09.019</a>.)</p><p>Oral disease and systemic diseases such as cardiovascular disease, Type 2 diabetes and osteoporosis are linked. These conditions obviously are of enormous cost to society. Severe periodontal (gum) disease is associated with increased risk of cardiovascular disease. It is likely that gum disease actually causes cardiovascular disease. Substances produced either by germs infecting the teeth or by our bodies responding to the germs cause systemic disease. Mouth disease is clearly one cause of many systemic diseases. The cost to us of those diseases is obvious.</p><p>Including dental care in the health care package is a win for all. “Medicare for All” is the optimal solution.</p><p><em>— Dr. Marc H. Lavietes, board member for Physicians for a National Health Program, Bradley Beach, New Jersey</em></p><p> <em>— Barbara DiPietro, Baltimore</em> </p><p><strong>On Oral Health and a Dental Hygienist’s Scope</strong></p><p>A recent article published by KHN spotlighted licensed Illinois dental hygienists who also hold public health dental hygienist (PHDH) certification (“<a href="https://khn.org/news/article/hygienists-brace-for-pitched-battles-with-dentists-in-fights-over-practice-laws/">Hygienists Brace for Pitched Battles With Dentists in Fights Over Practice Laws</a>,” Oct. 19).</p><p>The Illinois Dental Hygienists’ Association (IDHA) has diligently initiated legislation to bring affordable direct preventive oral health services to those who live in skilled nursing facilities and other confined settings. Dave Marsh, lobbyist for the Illinois State Dental Society (ISDS), was quoted as saying, “I just don’t feel anybody with a two-year associate’s degree is medically qualified to correct your health.”</p><p>IDHA would like to inform ISDS that the entry-level degree of a registered nurse is also a two-year associate’s degree. Does this mean that registered nurses are also unqualified to care for the elderly? Of course not! This is just another clear example of how ISDS continues to battle licensed dental hygienists and suppress their ability to work to their highest scope.</p><p>Illinois dentists claim they cannot afford to provide care for citizens who have state-funded dental insurance, are uninsured or poor. Yet they do not want dental hygienists to care for them either. Why? As the article clearly points out, ISDS illustrates the power that lobbying groups have in shaping policies on where health professionals can practice and who keeps the profits. And who suffers? Illinois’ most vulnerable citizens.</p><p>The Illinois State Dental Society also claims that after the Illinois Dental Practice Act was modified to allow direct preventive services by a public health dental hygienist, it took the hygiene association years to develop the PHDH curriculum. Conveniently missing was that legislation was tied up in the administrative rules process from 2015 to 2019. Once this process was completed, the hygienists’ association developed, implemented and graduated the first class of PHDHs within nine months.</p><p>The article accurately states that Illinois trails many states. To be exact, 38 other states allow dental hygienists unsupervised contact with patients. The article also accurately states that, politically, the Illinois State Dental Society is rich and powerful. This allows them to donate generously to lawmakers.</p><p>The Illinois Dental Hygienists’ Association wishes to thank KHN for uncovering the fact that profits and control is what motivates the Illinois State Dental Society, not increasing access to care. Now lawmakers can see ISDS’ true motives for suppressing the scope of practice of Illinois dental hygienists and pass legislation so that all Illinois citizens can receive the oral health care they need, want and deserve.</p><p><em>— Sherri Foran, president of the Illinois Dental Hygienists’ Association, Chicago</em></p><p><em>— Chris Lempa, Park Ridge, Illinois</em></p><p><strong>Socially Constructed vs. Biologically Determined</strong></p><p>The Oct. 20 <a href="https://khn.org/morning-breakout/if-youre-pregnant-your-babys-gender-influences-your-response-to-covid/">morning briefing</a> states “If You’re Pregnant, Your Baby’s Gender Influences Your Response To Covid.” “Gender” is not the accurate terminology here; “sex” is. Sex is a biological characteristic, whereas gender is a social construction. As the source article states “Sex of the fetus,” KHN’s usage of the word “gender” is not only inaccurate but also unnecessary. The distinction between gender and sex is small, but it is extremely important.</p><p> <em>—</em> <em>Jade del Vecchio, Decatur, Georgia</em></p><p><em>— Joanne Spetz, San Francisco</em></p><p><strong>A Shortage of Funds, Not Caregivers</strong></p><p>I am wanting to comment on the article concerning caregiver shortages (“<a href="https://khn.org/news/article/desperate-for-home-care-seniors-often-wait-months-with-workers-in-short-supply/">Desperate for Home Care, Seniors Often Wait Months With Workers in Short Supply</a>,” June 30). It is a fact that there is a substantial shortage of caregivers in the industry. The problem will only increase in the foreseeable future. I’ve worked at a nurse registry in Florida for seven years. I believe the focus and terminology that is used in all national articles concerning this issue needs a redirection. You did a tremendous job covering this in your article. I find the layman interprets terms such as “caregiver shortage” in ways that could be misleading and overshadow the core problem.</p><p>For example, when I speak to a family member seeking care for a loved one and they hear “caregiver shortage,” they naturally think there are not enough caregivers. Technically speaking, that is true when taking the ratio of elderly to caregivers into account. But the true problem is not a shortage of caregivers. It’s a shortage of funds available, especially Medicaid funds, to pay caregivers what they are worth. Statistically speaking, for the company I work for, there are plenty of caregivers in the system open to work. So, we are not short on caregivers. There’s actually not enough work available for all of our caregivers matching their requested reimbursement rate.</p><p>I believe the main tone of this issue should not be “caregiver shortage” but “caregiver reimbursement increase.” Hearing the problem “caregiver shortage” automatically leads to seeking a solution to increasing the quantity of caregivers. Though the quantity of caregivers does need to increase, it will not solve this issue. Being able to utilize caregivers who are available and willing to assist, in my opinion, is the first step to solving this nationwide issue. I thank you for your time.</p><p><em>— Michael Asche, Stuart, Florida</em></p><p><em>— Democratic state Rep. David Meuse, Portsmouth, New Hampshire</em></p><p><strong>‘Dopesick’ Misses the Big Picture</strong></p><p>I think it’s quite deplorable that you promote a program and its creators where no citations are made referencing our nation’s leading medical authorities. No mention of studies that do, indeed, support the <1% addiction rates. Dr. Scott Hadland, whose research was published in BMJ, shows rates well below 1%. These numbers can go higher depending on a patient’s prior risk factors. But Hadland’s study, with a cohort of over 3.2 million, was, I believe, opioid-naive patients ages 11-25 — understandably, a demographic of great concern.</p><p>There is no mention of National Institutes of Health Director Dr. Francis Collins’ views that dependence and addiction are different, with addiction being more severe but with lower rates of addiction present. [Collins <a href="https://www.medscape.com/viewarticle/894004">said</a>: “Physical dependence will develop in most individuals who take opioids chronically, resulting in withdrawal symptoms if the drug is taken away. Addiction is more severe and happens in only a small percentage of those who take opioids chronically.”] No mention of the views of National Institute on Drug Abuse Director Dr. Nora Volkow, who expressed great concern for the treatment of chronic pain patients. Both of those doctors said that while nobody is thrilled with the long-known downsides of opioids, there is currently nothing more effective.</p><p>There is no mention of the American Medical Association’s letter to the Centers for Disease Control and Prevention in June 2020 or the subsequent AMA statements since then, decrying the use of morphine milligram equivalents (MME).</p><p>No mention of the Department of Health and Human Services’ Pain Management Best Practices report of 2019 with its chapter on the 2016 guidelines, where it challenges some of the claims that are echoed in “Dopesick.”</p><p>Recently, in California, the California Department of Public Health issued a workgroup action notice regarding the closure of 29 Lags pain management clinics, setting adrift over 20,000 pain patients. Part of the state’s response was in the form of a video webinar on YouTube featuring San Francisco Public Health addiction physician Dr. Phillip Coffin. He was an original member of the core expert group that drafted the 2016 CDC guidelines. He again reiterated the plea of the CDC and many other medical authorities that the guidelines not be misinterpreted — that they are intended only for new patients and that if someone has been at 400 MME for 25 years, in general, just let them be.</p><p>Beth Macy herself wrote an endorsement for the cover of a new book by Ryan Hampton, a former White House staffer and presidential campaign official who became a heroin addict. Hampton’s new book, “Unsettled,” is about his experience on the committee that negotiated the Purdue/Sackler settlement. He is no fan of the Sacklers. But he reiterates that he has learned much in recent years and believes that chronic pain patients should be protected, that the interests of both pain and substance use disorder communities are aligned. He co-authored an article in the Los Angeles Times with Kate Nicholson, president and founder of National Pain Advocacy Center. Nicholson was an attorney for the Justice Department for 20 years, in the civil/disability rights division. She authored the current regs under the Americans with Disabilities Act and is a chronic pain patient, using opioids to relieve enough pain for her to do her job at DOJ. As the L.A. Times article quipped, “Our stories are two sides of the same pill. Serious pain and addiction are public health conditions that are widespread, stigmatized and misunderstood.”</p><p><em>— Tom Hayashi, Santa Rosa, California</em></p><p><em>— Sema Sgaier, Washington, D.C.</em></p><p><strong>In-Network Care Can Help Curb Hospitalizations</strong></p><p>I would quarrel with Loren Adler’s comment that once the law takes effect, “it’s completely irrelevant whether an emergency room doctor is in network or not” (“<a href="https://khn.org/news/article/surprise-billing-rule-puts-a-thumb-on-the-scale-to-keep-arbitrated-costs-in-check/">Surprise-Billing Rule ‘Puts a Thumb on the Scale’ to Keep Arbitrated Costs in Check</a>,” Oct. 14). It matters to get those hospital-based physicians into global budget arrangements with insurers, like ACOs, so their incentives can be realigned to prevent return trips to the emergency department rather than to profit from them. Chronically ill patients attributed to such programs need all their providers pulling in the same direction to avoid unnecessary hospitalizations. The out-of-network business model has dangers to consumers beyond the fees, and it will be interesting and important to monitor utilization going forward to see if improved care coordination results.</p><p><em>— Jackson Williams, Lancaster, Pennsylvania</em></p><p><em>— Erica Socker, Alexandria, Virginia</em></p><p><strong>To Top It Off, a Headline Can Steer Readers Wrong</strong></p><p>I am really surprised to see this otherwise trustworthy site feeding false information about covid-19 vaccines. You published an article today with the outrageous headline “<a href="https://khn.org/news/article/a-colorado-town-is-about-as-vaccinated-as-it-can-get-covid-still-isnt-over-there/">A Colorado Town Is About as Vaccinated as It Can Get. Covid Still Isn’t Over There</a>” (Oct. 1), clearly suggesting that the story would contain information about the ineffectiveness of vaccinations. Since most people will only see this headline in one or another news aggregator or on social media, this is the message they will get. It turns out, when we read the story, that the individuals representing San Juan County’s serious covid-19 cases “all were believed to be unvaccinated” and the five hospitalized or dead people were all “summer residents.” The story should have been headlined something like “high vaccination rates protect residents of this Colorado county from unvaccinated visitors bringing covid to town.”</p><p><em>— Ira Abrams, Chicago</em></p><p><a href="https://khn.org/morning-briefing/">Subscribe</a> to KHN's free Morning Briefing.</p><img src="https://ssl.google-analytics.com/collect?v=1&t=event&ec=Republish&tid=UA-53070700-2&z=1636732240644&cid=e32bfc5b-d046-4bf7-97ba-3cf433a25718&ea=https%3A%2F%2Fkhn.org%2Fnews%2Farticle%2Fletters-to-editor-november-2021-readers-find-disadvantages-in-medicare-advantage%2F&el=Readers%20and%20Tweeters%20Find%20Disadvantages%20in%20Medicare%20Advantage"/>       Source For more postings by Kaiser Health News, click HERE Website                         

Every year on Veterans Day, we honor the people who risk their lives to protect our country. Our disability program is part of our obligation to wounded warriors and their families. Social Security is an important resource for military members who return home with injuries. If you know a wounded veteran, please let them know about our Wounded Warriors webpage. Our Wounded Warriors webpage answers many questions commonly asked about Social Security and shares useful information about disability benefits. On this page, you can learn how Social Security benefits are different from benefits available through the Department of Veterans Affairs and require a separate application. We also explain how veterans can expedite the processing of their Social Security disability claims if they become disabled while on active military service on or after October 1, 2001, regardless of where the disability occurs. Active duty military service members who continue to receive pay while in a hospital or on medical leave should consider applying for disability benefits if they’re unable to work due to a disabling condition. Active-duty status and receipt of military pay doesn’t necessarily prevent payment of Social Security disability benefits. We honor veterans and active-duty members of the military every day by giving them the respect they deserve. Please let these heroes know they can count on us when they need us most. They’ve earned these benefits! Our webpages are easy to share on social media and by email with your friends and family. Please consider passing this information along to someone who may need it. By Dawn Bystry, Deputy Associate Commissioner, Office of Strategic and Digital Communications Source

The chart shows how your Constitutional Power works! Print the chart. Study it. Understand it. The power to enforce your Constitutional rights is IN THE COURTS. Individual rights are NOT enforced by casting your vote at the polls. Individual rights are NOT enforced by carrying signs in the street. Individual rights are NOT enforced by sending out a few hundred emails. Individual rights are enforced IN THE COURTS! Most of you took an oath to uphold the Constitution, yet many have no idea how to enforce your Constitutional Rights in court. Course Information WealthCare Connect may receive a referral fee from Juris Dictionary.

Giving to charity feels good and there’s even a financial benefit. You can deduct any charitable donations from your taxable income. However, there are many rules that govern these donations. Cash gifts are handled differently than non-cash gifts, and different rules apply depending upon the amount of the donation.   Tax laws can be complicated, but you can easily find out the details for everything you need to know with some online research or from your local tax professional.   Check out these 8 tips to ensure you’re getting the most out of your charitable donations:   Ensure the organization qualifies before claiming a tax deduction. For example, contributions made to political candidates or to a specific person are non-deductible. There’s a process an organization goes through to acquire the proper status with the IRS and become qualified.   Any organization you contribute to financially can provide information about their status regarding tax deductions.   If you’re donating anything other than cash, the value is claimed at the fair-market value. These values would be similar to what you would pay if you bought something at a thrift store or yard sale.   Look at the prices on www.craigslist.org. Those are typically fair-market values.   There are also special rules when you’re donating a vehicle.   Maintain accurate records. A receipt is an excellent way to keep track of your donations. In lieu of a receipt, your own banking records are also sufficient. For any amounts over $250, it’s best to have both a receipt and a banking record.   Reduce your deduction by any value you receive. If you’re receiving any benefit from your donation, like tickets to sporting events, you’re required to subtract that amount from your donation when claiming a deduction on your taxes.   For example, if you donate $500, but benefit by receiving “free” carpet cleaning worth $200, your tax deduction would be $300.   Contributions above certain amounts have different rules. A single donation of $250 or more has certain reporting rules. Another set of rules, primarily an appraisal by an expert, comes into play when the amount is $5,000 or more. If you’re making non-cash donations that total $500 or more, there are other rules. See www.irs.gov for more information.   Consider giving assets that have appreciated. Gifts of stock, for example, that have appreciated in value have an added benefit. You get to deduct the full value, and you’re not taxed on the capital gains, since you didn’t benefit from it.   The extra money comes off of your taxes and goes directly to the charity. Everyone wins, except the IRS.   You can deduct your costs for helping the charity, too. You can deduct mileage and any other out-of-pocket expenses related to any direct service you provide to a charity. This can include parking, tolls, travel expenses, lodging, and food.   Proceed with caution when you’re claiming these types of deductions. The IRS tends to scrutinize anyone who takes advantage of this opportunity. Honesty is the best policy!   The limit is 20%. You can certainly give away every last cent to the charitable organization of your choice. However, your charitable tax deductions are limited to 20% of your adjusted gross income. But, you might be able to carry over excessive contributions to the following tax year. See a tax expert if your contributions exceed this limit.   There are many great causes that could use your support, and it feels wonderful to be able to help them! It’s even better when you can reduce your tax burden in the process! Use these tips to claim the tax deductions you deserve.   The Tax Professor recommends that you consult your tax advisor before making any tax-related decisions.