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The health 202: here's what ex-HHS Secretary Donna Shalala wants to finish in Congress | killexams.com true Questions and Pass4sure dumps

THE PROGNOSIS

Then-Democratic candidate for Congress Donna Shalala in August. (AP photograph/Brynn Anderson)

just steps away from Rep. Donna Shalala’s Longworth workplace is the department of health and Human capabilities — the efficient company she ran for entire eight years of invoice Clinton’s presidency.

The Florida Democrat is the first grownup to exist a portion of Congress after serving as an HHS secretary (President Ronald Reagan’s first HHS head, Richard Schweiker, and President Trump’s first HHS chief, Tom rate, each held congressional seats before their company appointments). “I could exist a freshman, but I’m no longer a rookie,” Shalala likes to inform parts and residence colleagues.

She’s now not on the ways and capacity Committee or on energy and Commerce, the condominium’s two properly health-care panels. however Speaker Nancy Pelosi (D-Calif.) has appointed Shalala to the suggestions Committee, a perch allowing her to showcase her profound policy capabilities. remaining month Shalala managed debate on a invoice that might hold required the residence’s chief attorney to defend the cost-effective custody Act against a lawsuit from GOP-led states.

I currently sat down with Shalala to secure her techniques on Medicare-for-all, Obamacare, the Trump administration’s drug pricing efforts and greater. Shalala famed she wants to attain established coverage no longer with an entire overhaul of the gadget but through incremental steps, argued that Medicaid might possibly exist a more robust automobile than Medicare for doing that and expressed optimism there might exist bipartisan drudgery to bring down drug expenses.

right here’s their conversation, with some edits for readability and brevity.

fitness 202: you've got such a captivating point of view as former secretary. What finish you hope to accomplish habitual now that you’re in Congress?

Shalala: I want to expand people's lives. i finish know loads of americans that can't find the money for health insurance. they now hold got to determine a method to secure every person coated and they hold now obtained to use, in my judgment, present vehicles to try this. they now hold these structures: Medicare, Medicaid, the cost-efficient custody Act, the petite ones's medical health insurance contrivance — it is number one.

number two, they should secure integrated care. it's a powerful deal too fragmented. I ran educational health facilities. Oh, my God. you hold got a doctor for every a portion of your body, but they finish not always drudgery seamlessly together. Most of their fees are in persistent care. So they hold to determine ways to exploit that in the fitness-care system and they should finish it effectively and readily. They must tackle prescription medication and they bought to finish it with out gimmicks fondness importation.

fitness 202: You’ve mentioned your district has more particular person insurance market enrollees than every other district within the nation. Are you hoping to originate any improvements to the ACA?

Shalala: they would very plenty fondness to originate some advancements in the ACA. i was always worried the subsidies weren't profound ample. because you're in fact taking pictures a bunch of people who had lousy medical insurance or didn't hold any medical health insurance, who finish not secure great increases of their pay. I've entire the time felt that they should scurry deeper into the heart classification with subsidies.

I too am no fan of high deductibles, even if the basic custody is free. They simply noticed entire over this shutdown that almost entire americans cannot even near up with 4 hundred greenbacks.

fitness 202: So what will too exist done in regards to the high deductibles we’ve considered in the market plans?

Shalala: Congress would should give subsidies and shut some doughnut holes. A deductible is basically a doughnut gap. i might exist specifically drawn to [deductible] subsidies for americans which hold a petite bit bigger revenue as a result of I feel that they are the individuals that are truly having a challenge.

I additionally would finish some other things. Let americans purchase into the Medicare application at 55. They proposed that at the conclusion of the Clinton administration. They failed to secure wherever with it, however they would discovered a means that you just could finish it without it costing the believe fund any cash — through simply charging individuals a bit more … to secure into it early. i would squabble that an early purchase-in might uphold us Cut back the want for high-risk swimming pools. So i'm always attempting to find less demanding ways on current platforms as opposed to inventing anything novel to uphold us secure to well-liked coverage and affordability.

Rep. Donna Shalala (D-Fla.) speaks at a post are animated adventure. (picture via Kristoffer Tripplaar/For The Washington submit)

health 202: How are you sentiment in regards to the Obamacare marketplaces as they stand now? as a result of as you understand they did see ordinary premiums scurry down this yr.

Shalala: well, or not it's interesting. They had extreme enrollments in Florida. The locations where they struggled with marketplace is the extra bucolic areas, the smaller towns, the areas the position it exist tough to secure the kindly of volume that you want. Some insurers pulled out however it turned into as a result of they did not secure massive enough market share. So in densely city areas it worked top of the line, certainly if you secure the kindly of patient fuse you recognize you desired to get.

but in Florida or not it's a captivating phenomenon. They bought great enrollments as a result of they haven't any mammoth industries that can easily accommodate a great percentage of the inhabitants [with employer-sponsored coverage]. americans famed to me, ‘you hold entire these enrollments in south Florida Cuban clinics.’ you hold got a set of clinics really with Latin American docs in South Florida. a lot of them Cuban. and you hold got hospitals that had gigantic, mammoth numbers of low-paying patients and entire and sundry had an economic incentive to sign people up.

fitness 202: The absence of the particular person mandate penalty appears to hold had less influence than anticipated. What finish you believe?

Shalala: i'd fondness to hold the mandate lower back. but i wouldn't set the mandate returned devoid of doing a petite of these other issues to originate [insurance] greater low-cost and extra appealing and easier. but I finish feel anything they do, their goal must exist universal coverage — least expensive, powerful widespread insurance.

fitness 202: finish you feel that we'll secure to some extent at eventual where Republicans embrace or at the least settle for the proven fact that the ACA is perquisite here?

Shalala: I assume they will secure to a position where they are going to secure some Republican votes — counting on the position they may exist from — for bipartisan fixes. for example, my predecessor Ileana Ros-Lehtinen supported the ACA as a result of the number of individuals in their district.

The different issue i would finish this I don't assume any individual exist attracted to: i'd carry [those who can tarry on their parents' insurance plans from] 26-year-olds to 30 [year-olds]. And the intent I finish that is because they don't need to purchase insurance. a lot of them are caught in graduate college or in the gig economy, and their fogeys would exist completely inclined to cowl them and it would not expose up on their folks’ enterprise's medical insurance as a result of they're suit.

i know what younger americans's lives are fondness as a result of I've sprint universities. i understand how lengthy they're outside of the common market. So I suppose if you did that and let americans buy into Medicare or Medicaid — as a result of Medicaid is much more comprehensive than Medicare is. I've talked to lots of people that assist Medicare-for-all. I talked about i needed to finish Medicaid for all. this is a higher program. it exist bought long- time period care. and that they observed, ‘neatly, they can repair Medicare’ . . . very expensive to fix.

health 202: Why hold Democrats focused so plenty on Medicare-for-all versus Medicaid?

Shalala: Medicare has by no means been associated with welfare, with terrible people. Medicaid has, that's #1. quantity two: We’re at the Capitol. We're at the federal executive. it truly is a Medicare application, not a Medicaid software. only a handful of specialists on Medicaid are in Congress and most of them hold retired.

fitness 202: inform me the route you feel about Medicare-for-all.

Shalala: they're going to hold hearings. I don't know the position to scurry as a result of many americans accept as legal with the americans who've very decent medical insurance need to exist capable of maintain it because they hold got more desirable medical insurance than Medicare presently has.

The different factor is that I've talked about to americans in case you flaunt on the Kaiser polls, Medicare-for-all falls apart once you delivery telling americans what it is going to suffuse [and] that they will need to give up their latest health insurance. I debated my opponents on Medicare-for-all. I had four or five opponents to my left. They hold been fascinated with Medicare-for-all. I said, ‘appear, i'd want to expand access to Medicare,’ but they hold been at a labor union. I stated, ‘every grownup in this union has more advantageous health insurance then Medicare, so counsel them that they must hand over their health insurance.’ 

health 202: They know the route neatly it worked for Obama when he promised ‘in case you adore it, you can sustain it’ after which some americans misplaced their plans. it is truly powerful.

Shalala: fully. The precept is commonplace fitness care. Medicare-for-all is a method to secure there. My option is to exist very pragmatic and fill in the gaps.

but I additionally want to circulate against integrated care. and that's the fragmentation of the fitness-care system that drives every person loopy. You scurry for an operation and perquisite here's what you ask: Does my insurance cover this? And the reply is sure. and then afterwards you discover the anesthesiologist became out of community and you protest what does that mean. Who asks no matter if every person is in community this is on your working room? You don't even exist vigilant of who your anesthesiologist is. You don't hold any very own relationship along with your anesthesiologist.

Then-residence Minority chief Nancy Pelosi (D-Calif.) speaks to volunteers at a secure out the vote event for Donna Shalala in October. (AP picture/Wilfredo Lee)

fitness 202: Let’s revert to Medicare for a minute. What finish you assume must exist fastened in that software?

Shalala: We haven't absolutely closed the doughnut hollow in terms of medicine. there may exist bipartisan assist to finish that. My mother and aunts used to yell at me about that doughnut gap — why did they finish a doughnut gap? and that i'd say, ‘smartly, it was a finances determination … they failed to hold satisfactory funds in order that they left a gap within the center.’ and they concept that become the stupidest clarification. I imply how finish you clarify it to a person it is ninety two? My aunt observed to me, 'but I pay my taxes.’ (laughter)

health 202: They’re in blissful need of information of how Congress works, I bet.

Shalala: I bear in intellect going domestic that Christmas after [Congress passed the] Medicare portion D [prescription drug benefit].  And my mother referred to, ‘You know, you are going to hold two mornings where you're in reality tied up.’ She said entire of their loved ones are coming over that you should signal them up for half D occasions they're completely puzzled about it. I literally sat on a computer and signed 14 people up for portion D. and he or she mentioned, ‘You hold been the secretary of fitness and Human features. You recognize a route to finish this.’ I had no theory.

fitness 202: where finish you stand on allowing the executive to barter subside half D expenses at once with drugmakers?

Shalala: My view is the secretary need to hold the energy to barter within the identical method that the secretary of Veterans Affairs or a condition Medicaid director can.

health 202: That seems fondness fairly a lot a nonstarter with Republicans in the Senate.

Shalala: well, they will see. until you hold got extent you can't carry down the can charge. There are not any hints to this. Now, they may finish whatever fundamental. They could undertake the formulary the VA makes spend of. I imply, in case you failed to want to let them negotiate, bewitch current negotiations.

fitness 202: What finish you assume of HHS Secretary Alex Azar’s moves on prescription drug expenditures?

Shalala: I cannot inform yet. he is very an expert. someone just requested me whether i believed the administration become going to [push for a bill allowing] negotiation on prescription drugs. I stated appear, if they spend Azar to negotiate a bill he is as a minimum a professional. The query is how an terrible lot course does he secure from [Office of Management and Budget] and the White apartment on it?

he is very subtle. He understands the pricing considerations. He is vigilant of in addition to any person that you're simplest going to secure coupon codes in case you secure volume. examine what they did on AIDS medicine. I labored on the Clinton groundwork for a 12 months. President Clinton negotiated with the pharmaceuticals and promised them thousands and thousands of people for a highly discounted chain of AIDS medicine. so you've obtained to barter out on the basis of mammoth numbers of individuals to secure your charges down.

fitness 202: And Azar’s Medicare half B demonstration would involve a stunning little share of Medicare drug spending.

Shalala: Yeah. They wouldn't hold to expose it. They exist vigilant of something about markets.

fitness 202: so you'd fondness to scurry greater and bolder, essentially.

Shalala: absolutely. whether that you can sell that politically …[but] they too hold to exist respectful of the analysis dimension of the prescription drugs. I don't need to extinguish the industry in the system as a result of they’ve obtained a pipeline it is essential to each person during this country, on the earth. but i'm now not anxious to pay for their ‘D.’ i'm chuffed to pay for their ‘R.’ The leisure of the area, or not it's been suffuse transferring onto us, because the president has stated and as the relaxation of us hold mentioned over the years. The leisure of the realm … they're negotiating on the basis of extent and they're getting lessen prices and not deciding to buy the ‘R’ part. American taxpayers are deciding to buy the analysis half.

health 202: finish you believe there may exist going to exist bipartisan drudgery on health policy in the subsequent two years?

Shalala: i'm hoping so. they will see. they will see what they bite on to. I hold no idea. I finish exist vigilant of that we've got acquired some ideas and i've talked a bit bit to the committee individuals, but I've really obtained to hold longer conversations. I want to exist very cautious as a result of entire this stuff has to hold hearings, it has to head through the committees.

I even hold had loads of adventure. I've sat on the corporate boards of fitness-care agencies. I've sprint hospitals and massive fitness-care methods and that i've absolutely been secretary, but my most excellent sustain has been talking to americans and seeing what's bothering them. Out-of-pocket expenses, I feel, are a great concern with americans. they now hold received to determine a route to secure their palms round that situation. These are bread- and-butter considerations, but they're too concerns for corporations because the agencies are going crazy because they hold no understanding what their fitness-care charges are going to exist subsequent yr. So there are a lot of pursuits in containing prices.

fitness 202: It’s certainly some thing both parties are speaking about.

Shalala: if you see the examine on the puss of home health-care laborers who bought Obamacare for the first time of their lives and got free simple custody the first time they ever went to the medical professional, boy, you need to prolong this to entire and sundry. i hope they will locate some incentives to secure extra governors, including mine, into expanding Medicaid as a result of a lot of Republican governors hold finished it — they've performed it below waivers.

I provide a remaining examination by which I query the college students to originate one suggestion to the president of the us to enhance the health-care gadget for everybody. The child that got the A-plus spoke of crusade finance reform. now not unhealthy. He became stunned to dying that i'd flunk him however it's a wise answer. as a result of round each and every of those changes there's an array of activity agencies.

you're reading The fitness 202, their hold to-examine newsletter on health policy. no longer an everyday subscriber?

AHH, OOF and OUCH

President Trump. (AP picture/Carolyn Kaster)

AHH: After an almost four-hour physical examination with 11 specialists, President Trump’s docs talked about he is in “very decent health” and is anticipated to dwell in shape for “the length of his Presidency, and beyond,” their submit colleague Anne Gearan writes.

No particulars of the Friday exam at Walter Reed countrywide militia clinical core had been launched, nor became it lucid if extra particulars would later exist publicized.

“The memo did not include the disciplines of any of the consultants,” Anne writes. “typically, a actual exam comprises assessments of height, weight, blood pressure and other ordinary measures. Trump mentioned ultimate yr that he takes a statin drug to manage his ldl cholesterol.”

The president has “visibly gained weight in recent years,” Anne provides. It’s no secret Trump prefers pork, quickly meals and sweets, and apart from golf, Trump isn't regular to undertaking, she notes. Trump does not smoke or drink.

OOF: Sen. Michael Bennet, the Colorado Democrat for the reason that a 2020 presidential run, criticized calls by some Democrats to get rid of inner most insurance in pursuing Medicare-for-all.

“be vigilant when President Obama stated, 'if you fondness your assurance, you could preserve your insurance,'" Bennet pointed out throughout an interview on NBC's “Meet to Press. “after which a pair of people in the us actually lost their insurance because of the style that the contrivance labored. Now what Democrats are asserting is, 'if you fondness your assurance, they will bewitch it away from you,' from 180 million americans that secure their assurance from their agency and adore it, where 20 million americans who are on Medicare knowledge, and fondness it. That looks fondness a nasty opening present for me.”

Sen. Kamala Harris (D-Calif.) raised eyebrows final month when she spoke of entire over a CNN city corridor she’d like to dispose of private health insurance. “The understanding is that each person gets access to clinical custody and too you don't hold to scurry during the system of going via an insurance enterprise, having them give you approval, going via entire the bureaucracy, the entire extend that can too require,” Harris referred to. 

Kebby Johnson of Spokane, Wash., holds an indication that reads "Say No to HB 1638," as she waits to attend a public hearing in Olympia, Wash. (AP image/Ted S. Warren)

OUCH: while Washington state’s worst measles outbreak in two many years continues, tons of of people packed into a public hearing about a invoice to originate it more difficult for households to opt out of vaccination necessities for measles, mumps and rubella.

many of the seven-hundred or so individuals at the Friday assembly had been opposed to stricter requirements, their publish colleagues Lena H. solar and Kristen Millares younger document.

at the listening to, Washington condition health Secretary John Wiesman entreated condition lawmakers to scurry the invoice and debunked claims from some in attendance that vaccines are bad.

“I are looking to remind you that the MMR vaccine is extremely secure and tremendously advantageous,” Wiesman told lawmakers. He added “all reputable scientific reports hold establish no relation between measles and autism.”

The invoice would dispose of own or philosophical exemptions to acquiring the vaccine -- but would still allow for medical and pious exemptions, Lena and Kristen report. The bill's sponsor, condition Rep. Paul Harris (R), represents Clark County, the epicenter of the measles outbreak, and is planning to amend the invoice to "tighten pious exemptions, too," they write.

“Washington is considered one of 17 states that allow own or philosophic exemptions to vaccination necessities, meaning virtually anybody can choose out,” they add.

but the fresh nationwide outbreaks have brought about lawmakers in Washington and a number of states to correspond with tightening immunization specifications.

— in the meantime, some teenagers are reality-checking their families’ antivaccination stances and looking for their personal remedy, their submit colleague Alex Horton writes. 

“In three states, at the least three self-described teens informed Reddit they hold got a criterion issue: Their parents are staunchly adverse to vaccination, and that they worry for his or her health if they finish not bewitch action,” he writes. “distinctive condition legal guidelines influence how ancient minors need to exist to originate their personal medical decisions.”

An 18-year-historic Ethan Lindenberger from Ogio explained he examine scientific studies, together with from the centers for ailment wield and Prevention, and tried to influence his mother to let him and his 4 more youthful siblings secure vaccinated. “I appeared into it, it was lucid there became approach extra proof in defense of vaccines,” he instructed The post. but his mother resisted. 

“On Dec. 17, he walked into an Ohio department of Heath office in Norwalk and received a cocktail of vaccines for hepatitis A, hepatitis B, influenza and HPV, in accordance with a shot record viewed through The post,” Alex writes.

health ON THE HILL

Rep. Greg Walden (R-Ore.). (Kristoffer Tripplaar/For The Washington set up)

— Republican lawmakers are itching for hearings on Democrats’ Medicare-for-all proposals, hoping such public airings will provide them an opening to home in on an opposing message leading as much as 2020 elections, Politico’s Alice Miranda Ollstein experiences.

“We may quiet hold the opening to hold a hearing on a bill Democrats protest they are for,” the apartment power and Commerce Committee’s precise Republican Rep. Greg Walden (R-Ore.) said. “They’ve campaigned on it. Now, let’s find out what it is and what they’re promoting.”

Rep. Kevin Brady (R-Tex.), the exact Republican on the apartment ways and capacity Committee, pointed out lawmakers wish to “pull the curtain lower back on Medicare for entire so the American americans can actually determine it.”

meanwhile, Democrats are embracing these calls. “They feel it’s going to exist a ‘gotcha’ moment,” pointed out Rep. Pramila Jayapal (D-Wash.), lead author of a Medicare-for-all invoice. “but they hold been wrong on this and proceed to exist wrong on it.”

“The Republicans’ counterintuitive current seeks to exacerbate actual divisions inside the Democratic celebration on how far and how quickly to scurry past Obamacare and chart a route toward Medicare for All,” Alice writes. “Senior Democrats main the apartment's health committees blasted the GOP request as ‘cynical’ and ‘disingenuous’ and said it could no longer hold an result on their timeline for weighing the policy.”

Sen. Susan Collins (R-Maine). (Alex Wong/Getty images)

— Democrats and liberal businesses are focused on Sen. Susan Collins (R-Maine) for her uphold of Brett M. Kavanaugh after the most recent addition to the Supreme court dissented in a 5-to-four vote to cache a restrictive Louisiana abortion legislations.

They’re pointing to the dissent as an indication the latest justice would vote to overturn Roe v. Wade and aspect with conservatives in future abortion-rights linked situations, their set up colleagues Felicia Sonmez and Michael Scherer report.

Demand Justice, a liberal neighborhood that adverse Kavanaugh’s nomination, is planning a greater than $10,000 digital ad crusade in Maine to “inform voters of how Collins’ vote for Kavanaugh helped lead to the nigh convene in Thursday’s ruling,” Felicia and Michael record.

“Democrats are peculiarly incensed at Collins, who delivered a 44-minute-long ground speech in October declaring her uphold for Kavanaugh,” they write. “on the time, Collins, who helps abortion rights, said she didn't suppose Kavanaugh would vote to overturn the landmark 1973 Roe v. Wade ruling that legalized abortion.”

Annie Clark, communications director for Collins, countered through relating to Kavanaugh’s December vote in deliberate Parenthood’s desire. “all over his confirmation method, deliberate Parenthood turned into Justice Kavanaugh’s no 1 opponent,” Clark referred to in a press release. “They went after him with everything that they'd. And yet, when it came to a case involving them, he became in a position to set that apart and rule impartially and independently.”

— HHS is searching for the authority to transpose an Obama-era coverage that barred foster care and adoption corporations from rejecting potential folks in accordance with their sexual orientation or gender identity. HHS’s office of Civil Rights argues in a 2020 draft budget request that some of the nation’s oldest spiritual companies in areas comparable to Boston, Philadelphia and Washington hold long gone out of commerce because of nondiscrimination necessities that are themselves discriminatory.

President Trump pointed to such a current on the national Prayer Breakfast final week, their publish colleague Ariana Eunjung Cha reports, telling religious leaders that such faith-primarily based groups would quiet exist capable of secure federal funding to “aid inclined toddlers discover their perpetually families while following their deeply held beliefs.”

"faith-based mostly agencies play a vital position in foster custody and adoption in the u.s., and in some parts of the nation are the preponderant suppliers," Ariana writes. "religious leaders protest that HHS’s requested changes would not evade certified individuals from becoming adoptive and foster parents because there are many different companies which will settle for them."

It’s the newest circulation from an administration that has sought to present protection to spiritual groups that are key supporters of the president. “HHS specifically takes challenge with the concept that an Obama-period rule barring discrimination on the foundation of religion, sexual orientation or gender identification may drive religious-based mostly organizations to need to zone infants in household arrangements incompatible with their perception that marriage is the union of 1 man and one girl," Ariana writes.

Currey cook dinner, an solicitor with Lambda legal, which advocates for LGBTQ communities, famed “no person in here's adage faith-based mostly suppliers don’t hold a position within the newborn welfare equipment. It’s notable they're a portion of it. What they are announcing is that when you are accepting executive funds and performing a govt service, originate certain you no longer exist capable of discriminate in opposition t individuals with these dollars."

— And listed below are a number of greater powerful reads: 

Obituaries

The 13-term North Carolina Republican wrote letters to spouse and children of U.S. provider participants killed in action as a method of “asking God to condone me for my mistake” in vote casting for the war.

Felicia Sonmez

TRUMP TEMPERATURE

The fix

Democrats held hearings this week on the precise concerns they campaigned on entire the route through the midterms.

Colby Itkowitz

Politics

“It made me uncomfortable,” the daughter of the late senator John McCain (R-Ariz.) mentioned on late-night tv.

John Wagner

REPRODUCTIVE WARS

Courts & legislation

Chief Justice John G. Roberts Jr. sided for now with liberals on an abortion case, and the positions of Neil M. Gorsuch and Brett M. Kavanaugh grew to become clearer.

Robert Barnes

The repair

by means of specializing in late-time period abortions, that are quite infrequent, the president paints an inaccurate and delusory image.

Eugene Scott

The ambitious condition of the Union pronouncement has been undermined by using President Donald Trump’s personal actions.

Politico

company ALERT

country wide

As Friday’s time confine approaches, a federal worker wonders: ‘How am I speculated to dig out?’

Eli Saslow

New files hold shown the powerful hold an impact on of three Mar-a-Lago participants in a digital health checklist contract and other VA business.

Politico

trade RX

The Florida congressman is the simplest Republican co-sponsor on a invoice to enable Medicare for negotiate fees, historically nonstarter for the GOP.

Stat

STATE SCAN

Engineers hold developed a tiny robotic tablet that injects insulin as soon as it lands in the abdominal.

long island instances

medical MISSIVES

In an unvaccinated inhabitants, one grownup with measles can infect 12 to 18 others.

Vox

a bit greater than three months after eleven people were shot to dying whereas worshiping on the Tree of lifestyles synagogue, metropolis leaders and residents are clashing over proposed gun restrictions.

Wall road Journal

condominium Democrats are warming to gun-manage legislations as soon as regarded harmful for entire but the most secure incumbents, but continue to exist questionable even if they are going to vote this 12 months on one of the vital more a ways-accomplishing expenses.

Wall road Journal

DAYBOOK

developing

  • health and Human capabilities Secretary Alex Azar and facilities for Medicare and Medicaid services Administrator Seema Verma convey the keynote tackle at the 2019 HIMSS Annual convention in Orlando, Fla. on Tuesday.
  • FDA Commissioner Scott Gottlieb is set to testify earlier than a house Appropriations subcommittee on Tuesday.
  • The apartment techniques and means Committee holds a listening to on the rising can suffuse of prescription medication on Tuesday.
  • The condo Judiciary Committee holds a listening to on the Trump administration's household separation policy on Tuesday.
  • The Senate health, training, Labor and Pensions Committee holds a hearing on managing ache perquisite through the opioid head on Tuesday.
  • The apartment power and Commerce Subcommittee on health holds a listening to on the ACA and protections for preexisting conditions on Wednesday. 
  • SUGAR RUSH

    Sen. Amy Klobuchar (D-Minn.) has officially entered the 2020 race: 

    right through an interview aired on CBS This Morning on Feb. 10, Virginia Gov. Ralph Northam (D) said he is " not going anywhere":

    chance of sea stage upward push 'hasn't hit home' for coastal R.I. house owners, experts protest | killexams.com true Questions and Pass4sure dumps

    windfall — although the dangers of sea stage tower to coastal houses hold become extra largely understood, they may additionally not being wholly accounted for within the true property market.

    “The cost of any asset, exist it commodities, gold, stocks, relies upon fundamentally on people’s beliefs,” referred to Lint Barrage, second professor of economics and environmental reports at Brown tuition. “If americans are excessively optimistic in regards to the future cost of an asset, there's abilities for mispricing, and bubbles and overinvestment.”

    speakme Friday at a one-day conference at Brown on the political and economic penalties of climate exchange, bombard described her research on the coastal property market, which included going door-to-door in Rhode Island and interviewing householders about flood risk. people with homes in federally divorce flood zones tended to underestimate the possibility of flooding when in comparison with americans who lived further inland, she discovered.

    “The occasions entire this matters is that markets can not fee risks successfully if individuals don’t accept as legal with in them,” she mentioned.

    And if the dangers of local weather exchange aren’t being precisely factored into costs now, then it may exist of value a steep drop in values someplace down the road.

    a portion of the reason behind the disconnect, at least in Rhode Island and neighboring states, is that the zone hasn’t been hit difficult or in a widespread method by a typhoon or different ascetic weather adventure in recent years, mentioned Curt Spalding, former novel England regional administrator of the U.S. Environmental protection company who is now a professor at Brown.

    “We hold not had a shockingly catastrophic climate-connected experience,” he mentioned. “It hasn’t hit domestic yet.”

    but when it does, the hold an result on could exist profound. home possession represents the economic groundwork for a lot of individuals, talked about Spalding, so if domestic values erode, it is going to damage their unconcerned monetary neatly-being. Cities and cities that depend on property taxes will additionally endure if home cost is lost.

    As a all lot of forty percent of the U.S. population lives in counties adjoining to a shoreline, and the value of actual estate inside one-eighth of a mile of the coast is estimated to exist $1.4 trillion.

    recent studies hold discovered that residences at risk of flooding are genesis to see their values affected. just eventual week, researchers from Columbia institution and the nonprofit First highway groundwork launched a examine at that concluded that Rhode Island misplaced $44.7 million in home appreciation between 2005 and 2017 on account of accelerated tidal flooding because of sea degree rise.

    some of the complications in speaking flood hazards that bombard and different speakers raised at the conference changed into the federal flood mapping application. Flood-risk maps created via the Federal Emergency management agency are backward-searching and fail to account for future sea stage upward push.

    In Rhode Island, the Coastal materials administration Council and the institution of Rhode Island hold developed maps that finish factor in sea stage upward push. those maps, through an internet application called STORMTOOLS, and flood-harm visualizations for components of Warwick and South County and, extra these days, for the East Bay created as a portion of a divorce initiative called the Coastal Environmental risk Index intent to train the public about the increasing risks.

    “My guess is that these kinds of visualizations might exist very advantageous to people to are attempting and internalize these hazards,” bombard stated.

    —akuffner@providencejournal.com 

    (401) 277-7457


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    The 2018 Teddy Award winners built their courses round people, now not claims, and present proof that a worker-centric strategy is a better technique to function.

    across the staff’ compensation business, the thought of a worker advocacy model has been around for a while, but has most efficient viewed awesome adoption in fresh years.

    Even among these no longer adopting a formal advocacy strategy, mindsets are shifting. previously claims-centric classes are becoming worker-centric and it’s a win entire around: improved outcomes; more advantageous productivity; safer, healthier employees and an improved final analysis.

    That’s what you’ll see in this month’s problem of casual & assurance® for those who examine the profiles of the four recipients of the 2018 Theodore Roosevelt people’ Compensation and disability administration Award, sponsored by means of PMA groups. These 4 courses set worker's entrance and core in every petite thing they do.

    “We hold been concentrated on structure up a software with a watch on their companion adventure. suffuse become on the backside of the list. Doing a far better job by means of their companions changed into on the excellent,” said Steve Legg, director of possibility management for Starbucks.

    Starbucks set claims reporting in the fingers of its companions, an exemplary act of hold confidence. The coffee commerce too set itself in people’ shoes to identify and remove points of friction.

    That ended in a designation middle sprint by means of Starbucks’ TPA and a dedicated telephonic case management group in order that companions can communicate to a reside person devoid of the frustration of ‘mobilephone tag’ and unanswered questions.

    “We were focused on expand a program with an eye on their accomplice event. suffuse became at the bottom of the listing. Doing a far better job via their partners changed into at the desirable.” — Steve Legg, director of casual management, Starbucks

    Starbucks additionally carried out direct deposit for lost-time pay, eliminating traumatic wait times for injured companions, and permitting them to focus on curative.

    For Starbucks, as for entire of the 2018 Teddy Award winners, the approach is netting measurable effects. With greater ally satisfaction, it has seen a 50 p.c reduce in litigation.

    Teddy winner main Line fitness (MLH) adopted worker advocacy in a method that goes a long route past claims.

    employees who identify and file security risks can bewitch credit for his or her movements via sending out a formal “employee safeguard Message” to basically 11,000 mailboxes across the firm.

    “The focus is relatively cool,” talked about Steve Besack, system director, claims management and worker's’ compensation for the health equipment.

    MLH too takes a non-adversarial method to people with reiterate accidents, seeing them as a useful resource for opting for areas of development.

    “for those who study ‘repeat offenders’ in an unconventional method, they’re a powerful asset to the application, now not a liability,” pointed out Mike Miller, supervisor, people’ compensation and worker defense for MLH.

    Teddy winner Monmouth County, N.J. utilizes excessive-tech movement capture technology to reduce the casual of putting novel hires in jobs which are likely to pain them.

    Monmouth County additionally adopted a lot of health initiatives that uphold worker's exploit their weight and enrich their health general.

    “you'll want to see the appears on their faces when their cholesterol is down, they’ve misplaced weight and their blood sugar is stronger. We’ve had americans lose 30 and forty kilos,” pointed out William McGuane, the county’s supervisor of merits and workers’ compensation.

    Do these sound fondness minor application points? the maths says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

    at the institution of Pennsylvania, putting laborers first competence getting out from at the back of the desk and finding out what each certainly one of them is tasked with, day in, day trip — and looking out for ways to originate each of these tasks safer.

    usual observations across the sprawling campus hold resulted in a ravishing variety of procedure and device alterations that examine primary on their personal, however in combination hold created a notably safer, healthier campus and greater employee morale.

    UPenn’s employees’ comp prices, in the seven-digit figures in 2009, hold been essentially reduce in half.

    chance & coverage® is arrogant to deference the drudgery of these 4 corporations. They hope their stories inspire different companies to exist legal partners with the personnel they depend upon. &

    Michelle Kerr is affiliate editor of risk & assurance. She will too exist reached at [email protected]

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    The 2018 Teddy Award winners built their programs around people, not claims, and present proof that a worker-centric approach is a smarter route to operate.

    Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

    Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win entire around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

    That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs set workers front and heart in everything they do.

    “We were focused on structure up a program with an eye on their ally experience. Cost was at the bottom of the list. Doing a better job by their partners was at the top,” said Steve Legg, director of risk management for Starbucks.

    Starbucks set claims reporting in the hands of its partners, an exemplary act of trust. The coffee company too set itself in workers’ shoes to identify and remove points of friction.

    That led to a convene heart sprint by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

    “We were focused on structure up a program with an eye on their ally experience. Cost was at the bottom of the list. Doing a better job by their partners was at the top.” — Steve Legg, director of risk management, Starbucks

    Starbucks too implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

    For Starbucks, as for entire of the 2018 Teddy Award winners, the approach is netting measurable results. With higher ally satisfaction, it has seen a 50 percent subside in litigation.

    Teddy winner Main Line Health (MLH) adopted worker advocacy in a route that goes far beyond claims.

    Employees who identify and report safety hazards can bewitch credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

    “The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

    MLH too takes a non-adversarial approach to workers with reiterate injuries, seeing them as a resource for identifying areas of improvement.

    “When you examine at ‘repeat offenders’ in an unconventional way, they’re a powerful asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

    Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the casual of placing novel hires in jobs that are likely to pain them.

    Monmouth County too adopted numerous wellness initiatives that attend workers manage their weight and ameliorate their wellbeing overall.

    “You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

    Do these sound fondness minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

    At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to originate each of those tasks safer.

    Regular observations across the sprawling campus hold resulted in a phenomenal number of process and equipment changes that appear simple on their own, but in combination hold created a substantially safer, healthier campus and improved employee morale.

    UPenn’s workers’ comp costs, in the seven-digit figures in 2009, hold been virtually Cut in half.

    Risk & Insurance® is arrogant to deference the drudgery of these four organizations. They hope their stories inspire other organizations to exist legal partners with the employees they depend on. &

    Michelle Kerr is associate editor of Risk & Insurance. She can exist reached at [email protected]

    Voice from the Field: Risk Management, Foundation Practice, and the Status Quo | killexams.com true questions and Pass4sure dumps

    Managing risk is about managing choices.

    Start with a classic dilemma. Every growing season, the farmer confronts a number of decisions—what crops to plant, how much to grow, whether to expand production. Absent information about the cost she will secure at harvest, the farmer’s options are constricted and she risks catastrophic losses to her farm if the cost is below her baseline costs.

    On the other side, a difficult that processes and distributes food needs to buy from a number of farmers, but is concerned that the cost at harvest will exist too high to sprint the business. The doubt stunts growth and innovation, resulting in inaction. Status quo prevails.

    Over centuries, farmers and buyers hold worked out agreements using contracts and insurance products to manage risk and fix an acceptable flat of variance on cost and volume. Risk management tools deal risk among multiple parties and promote win-win outcomes. Status quo is overcome. Deals secure done. Innovation is possible.

    In the nonprofit world, too often risk is precious in their rhetoric but neglected in professional practice. As a result, their grants mostly produce that with which they protest they are most dissatisfied: the status quo.

    At foundations where board members are determined to contribute to change, leadership can circle to novel risk-management tools for guidance. The Commons—a job compel organized by Open Road Alliance, Rockefeller Foundation and Arabella Advisors—has produced a set of tools with the overarching goal of encouraging funders to create a deliberate risk profile and integrate risk management best practices into their philanthropic practice. This first-of-its-kind toolkit includes practical steps that can exist incorporated into spend by both mammoth or little foundations.

    Outmaneuvering the Status Quo

    Thomas Paine warned us of status quo’s power: “a long wont of not thinking a thing wrong, gives it a superficial appearance of being right, and raises at first a formidable outcry in defense of custom.”

    In considering how risk management can attend foundations overcome the status quo, they must disabuse ourselves of the understanding that risk only matters when used as an adjective—risky—to signal unadvisable choices. As when public health experts define that “risky sexual behavior” leads to unwanted pregnancies and sexually transmitted disease; to brave this caution is to sack science.

    Risk management, on the other hand, is about harnessing entire they know from science in order to ameliorate their casual of realizing a desired future that is different from what they sustain today. As monetary historian Peter Bernstein explains in his history of risk, Against the Gods, they want their future to hinge on the choices they make, not on portion alone.

    This calibration, where they determine what we’re willing to invest today against the casual of a future return, is where many foundations stumble. monetary controls and cultural norms within foundations already require mindful attention to the allocation of time, money and reputation. But too often the criteria used to choose allocations fail to account for either the cost of the status quo or the cost of change.

    Consider a persistent, costly problem such as prisoner recidivism. Foundations will routinely haggle with applicants over budget details and consecrate outsized attention to the absolute value of the immediate outlay of grant dollars. Yet foundations pay petite attention to the costs that will exist incurred if the status quo prevails—in this case, unchanged recidivism rates—producing grants that stand petite casual of reversing intricate trends. Status quo wins. Risk management tools will attend foundations understand that the cost of status quo is far more than the amount of the grant funding itself.

    A Case Study in Risk Management and Change: quality Rated

    To esteem how funders may build the cost of change into the strategy, esteem quality Rated, a public-private effort in Georgia designed to expand the supply of (and require for) high quality child care. quality Rated is built to cheer child-care centers to participate in a voluntary rating system—a Yelp for parents researching child-care—and millions of parents to seek out centers that receive higher ratings.

    For years, Georgia child-care advocates couldn’t secure anyone to bewitch action. Child-care centers would not invest in improved quality. Parents selected child-care based on convenience and price, not quality. Traditional grantmaking failed to scurry the system off the status quo.

    The genius behind philanthropy’s role in quality Rated is that instead of funding the underlying service delivery, foundations are directing private investment to specific points in the system where status quo would otherwise thwart innovation. For example, foundations are helping to fund the bonuses that scurry to teachers at centers that ameliorate upon their initial rating. For parents, foundations are helping to boost the reimbursement levels linked to the selection of higher-quality centers.

    While it’s too early to counsel if the novel system will transform outcomes for children, they finish know that the approach has accelerated risk taking and innovation, a necessary step toward the desired outcomes. As of October 2016, more than 2,800 of Georgia’s 4,960 licensed child-care centers had opted into the voluntary quality Rated program—beating status quo.

    Invest in Risk, Not Programs

    The approach works because foundations finish not hold to fund the entire cost of the child-care programs in question. They are, in effect, underwriting risk, which can exist viewed as the no-man’s-land in between status quo and action.

    This approach is traditional intelligence to community developers, who won’t scurry forward on a $1 million development if entire they can raise from investors is $980,000. When this happens, society doesn’t secure 98 percent of the benefit. They secure zero. Which is why foundations often will fund the gap, using an investment equal to two percent of the overall deal to maximize the companionable impact and ensure the community realizes 100 percent of the benefit.

    Over several centuries, as Bernstein describes, philosophers, tinkerers and mathematicians hold “transformed probability theory from a gamblers’ toy into a powerful instrument for organizing, interpreting and applying information.”

    To risk, he says, is to dare. Philanthropy must dare to outmaneuver status quo.


    Lagarde: Laying Foundations Of powerful Fiscal Management In Arab World – Speech | killexams.com true questions and Pass4sure dumps

    Good morning—Sabah Al-Khair! I am delighted to exist back in Dubai, this city of tomorrow, where you—its economic leaders—are dedicated to realizing the vision of a better tomorrow.

    This vision is predicated on prosperity that is shared by all, benefiting the impoverished and the middle class, citizens and immigrants alike; and opportunities that are open to all, including women. It is a vision of fairness over cronyism and partiality, and of trust that government policy is oriented toward the common good.

    This is a mammoth vision. But as Sheikh Mohammed bin Rashid Al Maktoum once said “The bigger your vision, the bigger your achievement will be…we cannot let fright sustain us small. They hold to exist fearless to exist big.”

    As you know so well, fiscal policy plays a vital role in creating and nurturing this vision of sustainable and inclusive growth—especially as encapsulated in the Sustainable development Goals. This is because they need fiscal space for spending on health, education, companionable protection, and public investment—all key priorities in this region.

    This is why I wanted to near back to the Arab Fiscal Forum—my fourth time now. In past years, I talked in detail about fiscal policy—the spending and revenue measures needed to achieve sustainable and inclusive growth. This year, I want to scurry one flat deeper—into the foundations of fiscal policy and powerful fiscal management.

    Because without a stable foundation, even the best policies can flounder. Without a stable foundation, fiscal policy will need credibility.

    In this vein, I will address two key pillars of powerful fiscal management: (i) tenacious fiscal frameworks; and (ii) powerful governance and transparency.

    Prelude: Global and regional context

    Before I finish this, let me protest a few words about the broader economic context presence on fiscal policy in the region.

    Unfortunately, the region has yet to fully recoup from the global monetary head and other mammoth economic dislocations over the past decade.

    Among oil importers, growth has picked up, but it is quiet below pre-crisis levels. Fiscal deficits remain high, and public debt has risen rapidly—from 64 percent of GDP in 2008 to 85 percent of GDP a decade later. Public debt now exceeds 90 percent of GDP in nearly half of these countries.

    The oil exporters hold not fully recovered from the histrionic oil cost shock of 2014. Modest growth continues, but the outlook is highly uncertain—reflecting in portion the need for countries to shift rapidly toward renewable energy over the novel few decades, in line with the Paris Agreement. With revenues down, fiscal deficits are only slowly declining—despite significant reforms on both the spending and revenue sides, including the introduction of VAT and excise taxes. This has led to a acute expand in public debt—from 13 percent of GDP in 2013 to 33 percent in 2018.

    At this juncture, the global expansion is weakening, and risks are rising. Just a few weeks ago, they released their revised forecasts. They now assume that the global economy will grow by 3.5 percent this year, 0.2 percentage points below what they expected in October. And risks are up, given escalating trade tensions and tightening monetary conditions. Unsurprisingly, a weaker global environment has knock-on effects on the region through a variety of channels—trade, remittances, capital flows, commodity prices, and financing conditions.

    The bottom line: the economic path ahead for the region is challenging. This makes the job of fiscal policy that much harder, which in circle makes it even more necessary to build tenacious foundations to anchor fiscal policy.

    1. Fiscal Frameworks

    The first structure cache of this foundation is a powerful fiscal framework. By this I exist of value the set of laws, institutional arrangements, and procedures needed to achieve a country’s fiscal policy objectives. Such a framework allows governments to map out budgets over the medium term in a route that reflects clear, consistent, and credible goals.

    There is scope to ameliorate fiscal frameworks in this region. Some of the weaknesses are short-termism and insufficient credibility.

    On short-termism: given that inclusive and sustainable growth is an inherently medium-term goal, fiscal policy needs a medium-term orientation. Focusing on the immediate horizon makes it harder to implement faultfinding but longer-term reforms in such areas as tackling high public wage bills, designing efficient companionable protection systems, and getting rid of harmful fuel subsidies. Short-termism implies that fiscal policy amplifies rather than tames the waves of booms and busts—making it more difficult to achieve sustainable and inclusive growth.

    Turning to fiscal credibility: I am referring to such factors as great amounts of spending kept off-budget and impoverished risk management. Across the region, it is common for sovereign wealth funds to directly finance projects, bypassing the customary budget process. And state-owned enterprises in some countries hold high levels of borrowing—again, outside of the budget. Addressing these fiscal risks would not only enhance budget credibility and transparency but would attend sustain a lid on corruption. Budgetary credibility too calls for better risk management, with a more comprehensive budget based on realistic forecasts.

    The powerful intelligence is that numerous countries are already strengthening their fiscal frameworks—many with IMF assistance. Just to give some examples:

  • Saudi Arabia, Kuwait, UAE, Sudan, Qatar, and Lebanon hold entire set up macro-fiscal units—a useful first step in strengthening the fiscal framework.
  • Algeria has recently adopted a novel budget law with a tenacious medium-term orientation, and Bahrain has introduced a fiscal program designed to achieve balance over the medium term.
  • Mauritania, Morocco, Jordan, and Lebanon are making powerful progress with medium-term public investment planning and execution.
  • Egypt now publishes a fiscal risk statement with its budget and produces an internal in-year budget risk assessment. The UAE too is rolling out a fiscal risk management project—with the IMF’s help—and will produce its first fiscal stress test this year.
  • There is scope for further improvement. Perhaps the oil exporters could supervene the case of other resource-rich countries such as Chile and Norway in using fiscal rules to protect key priorities such as companionable spending from commodity cost volatility.

    Strong fiscal frameworks hold other necessary benefits. They configuration the basis for sound debt management. They too allow for better coordination between fiscal and monetary policies, so that the two arms of macroeconomic management drudgery together, not at cross purposes.

    2. powerful Governance and Transparency

    Let me now circle to the second pillar of powerful fiscal management—good governance and transparency. In this context, governance refers to the institutional frameworks and practices of the public sector. tenacious institutions are crucial for legitimacy, for fostering a clearer understanding of policy objectives among citizens, enhancing their voice, and generating buy-in for fiscal policy.

    On the other hand, as many of you hold said, feeble institutions imply a feeble policy foundation that could crack and crumble—because there is inadequate legitimacy and public accountability. Even worse, these cracks could too let corruption creep in. And you know so well, this is companionable poison—it feeds discord, disengagement, and disillusionment, especially among the young. The word corruption, after all, comes from Latin root for rotting, breaking apart—disintegration. And the word in Arabic, fasad, too connotes this understanding of rotting or coming undone.

    Corruption is the powerful disruptor of fiscal policy. Without trust in the fairness of the tax system, it becomes harder to raise the revenue needed for faultfinding spending on health, education, and companionable protection. And governments might exist tempted to favor white elephant projects instead of investments in people and productive potential. Add this up, and they hold a recipe for unsustainable fiscal policy combined with companionable discord.

    This a global issue—relevant for great and little countries, advanced and low-income economies, and the public and private sectors. Given this, it is no astonish that IMF research establish that feeble governance and corruption are associated with significantly lower growth, investment, FDI, and tax revenues—and higher inequality and exclusion.

    Specifically, they establish that improving on an index of corruption and governance by poignant from the bottom quarter to the exist of value is associated with an expand in the investment-to-GDP ratio of 1.5–2 percentage points and a bump up in annual GDP per capita growth by half a percentage point or more. [1] They will hold more analysis in the upcoming Fiscal Monitor, which will exist devoted to the topic of the fiscal costs of corruption and the role of fiscal institutions.

    What is the solution to feeble governance and corruption? In the fiscal domain, it calls for heightened fiscal transparency—shining a light on entire aspects of the budget and the public accounts. This would provide a more accurate picture of the fiscal position and prospects, the long-term costs and benefits of any policy changes, and the potential fiscal risks that might sling them off course. This region has some play for improvement here.

    We know that these kinds of reforms pay off. bewitch the case of Georgia, for example. Until 2003, it was seen as one of the most debase countries in the world. But after that, it reformed its institutions and cracked down on corruption. This, along with tax reform, led to immediate improvements. Tax revenues increased from 12 percent of GDP in 2003 to 25 percent of GDP in 2008, as taxpayers had greater faith in the fairness of the system.

    I should note that the IMF has been stepping up its rendezvous in the zone of governance and corruption. eventual year, they set in position a novel framework predicated on a more systematic, evenhanded, effective, and candid rendezvous on these issues with member countries. They will exist reaching out to leaders in this region to debate how they can drudgery together to implement this framework.

    With better governance, they can supersede the “disintegration” of corruption with the “integration” of entire into the productive economy. They can supersede fasad with islah—reforms to set things right, to reconcile people with one another.

    Conclusion

    Let me wrap up. I hold argued this morning that powerful fiscal policy requires powerful institutional foundations. And solid foundations in areas such as fiscal frameworks and governance give citizens confidence that fiscal policy serves the powerful of all, not just the wealthy or the well-connected.

    Let me halt with some wise words attributed to the powerful Ibn Khaldun, “He who finds a novel path is a pathfinder, even if the trail has to exist establish again by others; and he who walks far ahead of his contemporaries is a leader.”

    You are the pathfinders, the leaders, the visionaries. They hope that they can give useful guidance, but they examine to you to find the perquisite path to originate this vision a reality.

    Thank you—shukran!

    [1] More specifically, those gains are associated with poignant from the 25th percentile to the 50th percentile in an index on corruption and governance.



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