Personal Health: When Daily Stress Gets in the Way of Life

I was about to give an hourlong talk to hundreds of people when one of the organizers of the event asked, “Do you get nervous when you give speeches?” My response: Who, me? No. Of course not.

But this was a half-truth. I am a bit of a worrier, and one thing that makes me anxious is getting ready for these events: fretting over whether I’ve prepared the right talk, packed the right clothes or forgotten anything important, like my glasses.

Anxiety is a fact of life. I’ve yet to meet anyone, no matter how upbeat, who has escaped anxious moments, days, even weeks. Recently I succumbed when, rushed for time just before a Thanksgiving trip, I was told the tires on my car were too worn to be driven on safely and had to be replaced.

“But I have no time to do this now,” I whined.

“Do you have time for an accident?” my car-savvy neighbor asked.

So, with a pounding pulse and no idea how I’d make up the lost time, I went off to get new tires. I left the car at the shop and managed to calm down during the walk home, which helped me get back to the work I needed to finish before the trip.

It seems like such a small thing now. But everyday stresses add up, according to Tamar E. Chansky, a psychologist in Plymouth Meeting, Pa., who treats people with anxiety disorders.

You’ll be much better able to deal with a serious, unexpected challenge if you lower your daily stress levels, she said. When worry is a constant, “it takes less to tip the scales to make you feel agitated or plagued by physical symptoms, even in minor situations,” she wrote in her very practical book, “Freeing Yourself From Anxiety.”

When Calamities Are Real

Of course, there are often good reasons for anxiety. Certainly, people who lost their homes and life’s treasures — and sometimes loved ones — in Hurricane Sandy can hardly be faulted for worrying about their futures.

But for some people, anxiety is a way of life, chronic and life-crippling, constantly leaving them awash in fears that prevent them from making moves that could enrich their lives.

In an interview, Dr. Chansky said that when real calamities occur, “you will be in much better shape to cope with them if you don’t entertain extraneous catastrophes.”

By “extraneous,” she means the many stresses that pile up in the course of daily living that don’t really deserve so much of our emotional capital — the worrying and fretting we spend on things that won’t change or simply don’t matter much.

“If you worry about everything, it will get in the way of what you really need to address,” she explained. “The best decisions are not made when your mind is spinning out of control, racing ahead with predictions about how things are never going to get any better. Precious energy is wasted when you’re always thinking about the worst-case scenarios.”

When faced with serious challenges, it helps to narrow them down to specific things you can do now. To my mind, Dr. Chansky’s most valuable suggestion for emerging from paralyzing anxiety when faced with a monumental task is to “stay in the present — it doesn’t help to be in the future.

“Take some small step today, and value each step you take. You never know which step will make a difference. This is much better than not trying to do anything.”

Dr. Chansky told me, “If you’re worrying about your work all the time, you won’t get your work done.” She suggested instead that people “compartmentalize.” Those prone to worry should set aside a little time each day simply to fret, she said — and then put aside anxieties and spend the rest of the time getting things done. This advice could not have come at a better time for me, as I faced holiday chores, two trips in December, and five columns to write before leaving mid-month. Rather than focusing on what seemed like an impossible challenge, I took on one task at a time. Somehow it all got done.

Possible Thinking

Many worriers think the solution is positive thinking. Dr. Chansky recommends something else: think “possible.”

“When we are stuck with negative thinking, we feel out of options, so to exit out of that we need to be reminded of all the options we do have,” she writes in her book.

If this is not something you can do easily on your own, consult others for suggestions. During my morning walk with friends, we often discuss problems, and inevitably someone comes up with a practical solution. But even if none of their suggestions work, at least they narrow down possible courses of action and make the problem seem less forbidding. “If other people are not caught in the spin that you’re in, they may have ideas for you that you wouldn’t think of,” Dr. Chansky said. “We often do this about small things, but when something big is going on, we hesitate to ask for advice. Yet that’s when we need it most.”

Dr. Chansky calls this “a community cleanup effort,” and it can bring more than advice. During an especially challenging time, like dealing with a spouse’s serious illness or loss of one’s home, friends and family members can help with practical matters like shopping for groceries, providing meals, cleaning out the refrigerator or paying bills.

“People want to help others in need — it’s how the world goes around,” she said. Witness the many thousands of volunteers, including students from other states on their Thanksgiving break, who prepared food and delivered clothing and equipment to the victims of Hurricane Sandy. Even the smallest favor can help buffer stress and enable people to focus productively on what they can do to improve their situation.

Another of Dr. Chansky’s invaluable tips is to “let go of the rope.” When feeling pressured to figure out how to fix things now, “walk away for a few minutes, but promise to come back.” As with a computer that suddenly misbehaves, Dr. Chansky suggests that you “unplug and refresh,” perhaps by “taking a breathing break,” inhaling and exhaling calmly and intentionally.

“The more you practice calm breathing, the more it will be there for you when you need it,” she wrote.

She also suggests taking a break to do something physical: “Movement shifts the moment.” Take a walk or bike ride, call a friend, look through a photo album, or do some small cleaning task like clearing off your night table.

When you have a clear head and are feeling less overwhelmed, you’ll be better able to figure out the next step.


This is the first of two columns about anxiety.

Read More..

Personal Health: When Daily Stress Gets in the Way of Life

I was about to give an hourlong talk to hundreds of people when one of the organizers of the event asked, “Do you get nervous when you give speeches?” My response: Who, me? No. Of course not.

But this was a half-truth. I am a bit of a worrier, and one thing that makes me anxious is getting ready for these events: fretting over whether I’ve prepared the right talk, packed the right clothes or forgotten anything important, like my glasses.

Anxiety is a fact of life. I’ve yet to meet anyone, no matter how upbeat, who has escaped anxious moments, days, even weeks. Recently I succumbed when, rushed for time just before a Thanksgiving trip, I was told the tires on my car were too worn to be driven on safely and had to be replaced.

“But I have no time to do this now,” I whined.

“Do you have time for an accident?” my car-savvy neighbor asked.

So, with a pounding pulse and no idea how I’d make up the lost time, I went off to get new tires. I left the car at the shop and managed to calm down during the walk home, which helped me get back to the work I needed to finish before the trip.

It seems like such a small thing now. But everyday stresses add up, according to Tamar E. Chansky, a psychologist in Plymouth Meeting, Pa., who treats people with anxiety disorders.

You’ll be much better able to deal with a serious, unexpected challenge if you lower your daily stress levels, she said. When worry is a constant, “it takes less to tip the scales to make you feel agitated or plagued by physical symptoms, even in minor situations,” she wrote in her very practical book, “Freeing Yourself From Anxiety.”

When Calamities Are Real

Of course, there are often good reasons for anxiety. Certainly, people who lost their homes and life’s treasures — and sometimes loved ones — in Hurricane Sandy can hardly be faulted for worrying about their futures.

But for some people, anxiety is a way of life, chronic and life-crippling, constantly leaving them awash in fears that prevent them from making moves that could enrich their lives.

In an interview, Dr. Chansky said that when real calamities occur, “you will be in much better shape to cope with them if you don’t entertain extraneous catastrophes.”

By “extraneous,” she means the many stresses that pile up in the course of daily living that don’t really deserve so much of our emotional capital — the worrying and fretting we spend on things that won’t change or simply don’t matter much.

“If you worry about everything, it will get in the way of what you really need to address,” she explained. “The best decisions are not made when your mind is spinning out of control, racing ahead with predictions about how things are never going to get any better. Precious energy is wasted when you’re always thinking about the worst-case scenarios.”

When faced with serious challenges, it helps to narrow them down to specific things you can do now. To my mind, Dr. Chansky’s most valuable suggestion for emerging from paralyzing anxiety when faced with a monumental task is to “stay in the present — it doesn’t help to be in the future.

“Take some small step today, and value each step you take. You never know which step will make a difference. This is much better than not trying to do anything.”

Dr. Chansky told me, “If you’re worrying about your work all the time, you won’t get your work done.” She suggested instead that people “compartmentalize.” Those prone to worry should set aside a little time each day simply to fret, she said — and then put aside anxieties and spend the rest of the time getting things done. This advice could not have come at a better time for me, as I faced holiday chores, two trips in December, and five columns to write before leaving mid-month. Rather than focusing on what seemed like an impossible challenge, I took on one task at a time. Somehow it all got done.

Possible Thinking

Many worriers think the solution is positive thinking. Dr. Chansky recommends something else: think “possible.”

“When we are stuck with negative thinking, we feel out of options, so to exit out of that we need to be reminded of all the options we do have,” she writes in her book.

If this is not something you can do easily on your own, consult others for suggestions. During my morning walk with friends, we often discuss problems, and inevitably someone comes up with a practical solution. But even if none of their suggestions work, at least they narrow down possible courses of action and make the problem seem less forbidding. “If other people are not caught in the spin that you’re in, they may have ideas for you that you wouldn’t think of,” Dr. Chansky said. “We often do this about small things, but when something big is going on, we hesitate to ask for advice. Yet that’s when we need it most.”

Dr. Chansky calls this “a community cleanup effort,” and it can bring more than advice. During an especially challenging time, like dealing with a spouse’s serious illness or loss of one’s home, friends and family members can help with practical matters like shopping for groceries, providing meals, cleaning out the refrigerator or paying bills.

“People want to help others in need — it’s how the world goes around,” she said. Witness the many thousands of volunteers, including students from other states on their Thanksgiving break, who prepared food and delivered clothing and equipment to the victims of Hurricane Sandy. Even the smallest favor can help buffer stress and enable people to focus productively on what they can do to improve their situation.

Another of Dr. Chansky’s invaluable tips is to “let go of the rope.” When feeling pressured to figure out how to fix things now, “walk away for a few minutes, but promise to come back.” As with a computer that suddenly misbehaves, Dr. Chansky suggests that you “unplug and refresh,” perhaps by “taking a breathing break,” inhaling and exhaling calmly and intentionally.

“The more you practice calm breathing, the more it will be there for you when you need it,” she wrote.

She also suggests taking a break to do something physical: “Movement shifts the moment.” Take a walk or bike ride, call a friend, look through a photo album, or do some small cleaning task like clearing off your night table.

When you have a clear head and are feeling less overwhelmed, you’ll be better able to figure out the next step.


This is the first of two columns about anxiety.

Read More..

European Union Officials Accept Nobel Peace Prize





OSLO — Besieged by economic woes and insistent questions about its future, the European Union accepted the Nobel Peace Prize on Monday with calls for further integration and a plea to remember the words of Abraham Lincoln as he addressed a divided nation at Gettysburg.







Suzanne Plunkett/Reuters

Leaders of the European Union member countries attended the Nobel Peace Prize ceremony at City Hall in Oslo on Monday.






The prize ceremony, held in Oslo’s City Hall and attended by 20 European leaders as well as Norway’s royal family, brought a rare respite from the gloom that has settled on the European Union since the Greek debt crisis exploded three years ago, unleashing doubt about the long-term viability of the euro and about an edifice of European institutions built up over more than half a century to promote an ever closer union.


Unemployment — now at over 25 percent in Greece and Spain — and sputtering economic growth across the 27-nation bloc are “putting the political bonds of our union to the test,” Herman Van Rompuy, president of the European Council, said in his acceptance speech. “If I can borrow the words of Abraham Lincoln at the time of another continental test, what is being assessed today is whether that union, or any union so conceived and so dedicated, can long endure.”


The European Union, said Mr. Van Rompuy, will “answer with our deeds, confident we will succeed.”


“We are working very hard to overcome the difficulties, to restore growth and jobs,” he continued.


Aside from economic misery, the most serious threat to the bloc so far is growing pressure in Britain for a referendum on whether to pull out of the union. The British prime minister, David Cameron, did not attend the ceremony, but most other European leaders showed up, including Chancellor Angela Merkel of Germany and the French president, François Hollande, who sat next to each other and whose countries, once bitter enemies, have been the main motors driving European integration.


Mr. Van Rompuy’s comparison of the European Union to the United States is likely to irritate critics of the European Union, who reject efforts to push European nations to surrender more sovereignty in pursuit of what champions of a federal European state hope will one day be a United States of Europe.


Just how far Europe is from such a goal, however, was made clear by the presence of three Union presidents in Oslo. In addition to Mr. Van Rompuy, whose European Council represents the leaders of the union’s member states, there was José Manuel Barroso, president of the European Commission, the bloc’s main administrative and policy-making arm, and Martin Schulz, president of the European Parliament.


Instead of the customary Nobel lecture delivered by the winner, Mr. Van Rompuy and Mr. Barroso each read parts of what Thorbjorn Jagland, chairman of the Norwegian Nobel Committee, described as “one speech but two chapters.”


Hailing the European Union for helping bring peace to Europe after repeated wars, Mr. Jagland said, “What this continent has achieved is truly fantastic, from being a continent of war to becoming a continent of peace.”


Mr. Barroso spoke of the horrors of past wars and tyranny and Europe’s efforts to overcome them through the building of supranatural institutions, which began in 1951 with the establishment of the European Coal and Steel Community by France, Germany and four other countries. But he also cited the current conflict in Syria, describing it as a “stain on the world’s conscience” that other nations have “a moral duty” to address. The European Union’s member states are themselves divided about how far to go in supporting opponents of Bashar al-Assad, the Syrian president.


The decision to honor the European Union with the Nobel Peace Prize stirred widespread criticism in Norway, whose citizens have twice voted not to join the union. On the eve of Monday’s award ceremony, peace activists and supporters of left-wing political groups paraded through the streets of Oslo, carrying flaming torches and chanting, “The E.U. is not a worthy winner.”


Many peace activists say they have no problem with European integration but question whether the union has lived up to conditions laid down by Alfred Nobel, the 19th-century Swedish industrialist who bequeathed the peace prize and four other Nobel Prizes.


Read More..

John Silva, Maker of ‘Telecopter’ Camera, Dies at 92





Helicopter news footage is common today. But until myriad problems in sending live pictures from a moving aircraft were solved, television broadcasters could not show an eagle’s-eye view of a forest fire, or contemplate aerial coverage of, say, a famous man fleeing the police in a white Ford Bronco.




John Silva made that now-familiar vantage possible in 1958, when he converted a small helicopter into the first airborne virtual television studio.


The KTLA “Telecopter,” as it was called by the Los Angeles station where Mr. Silva was the chief engineer, became the basic tool of live television traffic reporting, disaster coverage and that most famous glued-to-the-tube moment in the modern era of celebrity-gawking, the 1994 broadcast of O. J. Simpson leading a motorcade of pursuers on Los Angeles freeways after his former wife and a friend of hers were killed.


Mr. Silva, who later earned two Emmy Awards for his pioneering technical work, died in Camarillo, Calif., on Nov. 27. His death was confirmed by a spokesman for KTLA-TV, where he worked from 1946 until leaving to become an electronics design consultant in 1978. He was 92.


Mr. Silva, an electronics engineer trained in radar science during World War II, faced three main roadblocks to transmitting black-and-white images live from helicopters. Rotor vibrations distorted the pictures, and sometimes even cracked the transmitter’s vacuum tubes. Directional antennas went haywire when helicopters changed direction suddenly, as helicopters sometimes do. And the camera equipment weighed a ton.


With help from fellow KTLA engineers, though mainly working alone to keep the project secret from competitors, Mr. Silva stabilized onboard cameras with a system of shock absorbers and cushions, designed aluminum parts to replace heavier metals in his equipment and commissioned an antenna that would extend below the chopper and rotate to maintain uninterrupted contact with KTLA’s mountaintop transmitter. By paring and remachining a basic set of broadcast equipment, he reduced it to 368 pounds from 2,000 pounds and distributed the load with precise symmetry throughout the tiny Bell 47G2 chopper leased for the project to prevent listing.


KTLA, the first commercially licensed television station west of the Rockies, faced growing competition in the late ’50s. New network-affiliated stations were scoring scoops with mobile broadcast units like ones Mr. Silva had pioneered, and everyone was fighting to get through increasingly clogged Los Angeles freeways.


The Telecopter was intended to kill the competition.


“If we could build a news mobile unit in a helicopter,” Mr. Silva recalled in a 2002 interview for the Archive of American Television, “we could get over it all, get there first, avoid the traffic and get to all the stories before anybody in the competition.”


“It’d be a wonderful thing,” he said.


By the time he began work on his airborne live television, Mr. Silva had already achieved a landmark in ground-level television history. In 1949, he was the technical director at KTLA who rigged the electronic connections — using duct-tape ingenuity and a borrowed generator — that carried what historians consider the first live television broadcast of a breaking news event.


The 27-hour rescue operation in San Marino, Calif., to save Kathy Fiscus, a 3-year-old trapped in an abandoned water pipe 94 feet below ground, was unsuccessful; but the station’s coverage was the precursor to every wall-to-wall television event broadcast since.


The Telecopter’s first flight took place at Los Angeles City Hall on July 24, 1958. It re-established KTLA’s dominance (until competitors put their own helicopters up). And for better and worse, it brought a Hollywood-style excitement to television news.


In the archive interview, Mr. Silva was asked what the first live helicopter pictures showed. They were panning shots, he said — zooming in and out of the L.A. landscape between the station’s Sunset Boulevard studio and City Hall.


Most of what they showed, he added, “was the freeway.”


John Daniel Silva was born in San Diego on Feb. 20, 1920, the youngest of three children of a commercial fisherman, Guy Silva, and his wife, Lottie, a homemaker. He attended M.I.T. for two years, and graduated with a bachelor’s degree after two years more at Stanford.


During World War II, he was a Naval officer who positioned radar defenses in the Pacific.


After the war, he worked for Paramount Pictures as an engineer for an experimental television station, W6XYZ, that later became KTLA.


Mr. Silva’s survivors include his wife, Mary Lou Steinkraus-Silva; three daughters, Patricia Vawter, Kathleen Silva and Karen Samaha; and a granddaughter.


The Telecopter had its greatest moments, predictably, at news events of Cecil B. DeMille dimensions: The 1963 dam break at the Baldwin Hills Reservoir in Los Angeles that sent 250 million gallons of water into surrounding neighborhoods, destroying many homes and claiming five lives. The 1965 Watts riots. The 1961 brush fire that swept through Bel Air, sending Hollywood stars scrambling to their roofs with garden hoses.


In his three-hour interview with the television archive, Mr. Silva never mentioned the 1994 O. J. Simpson freeway pursuit footage he made possible. But in answering a question about the future of helicopter reporting, he made clear that he had no regrets about the Telecopter’s role in creating an increasingly graphic television sensibility.


He would just like the lenses to get longer and the close-ups tighter, he said.


“When they’re doing freeway chases, they need to have a system that can come down in front, and be able to get pictures of suspects in the front windshield,” he said, describing one improvement he hoped to see.


Smiling, he added, “To fill the screen with their wonderful faces.”


Read More..

Bloomberg Weighs Making a Run for Financial Times





Not long ago, The Financial Times would have been the crown jewel of any media company, instantly conferring prestige and influence on its owner. Now, given the likely bidders, one of the world’s most respected and distinctive financial newspapers could end up as a trophy to help sell more computer terminals.




Michael R. Bloomberg is weighing the wisdom of buying The Financial Times Group, which includes the paper and a half interest in The Economist, according to three people close to Mr. Bloomberg who spoke on the condition of anonymity to divulge private conversations.


Mr. Bloomberg has long adored The Economist, and his affinity for the paper, at least as a reader, has deepened lately. Its bisque-colored pages, once rarely seen in the thick stack of newspapers Mr. Bloomberg carries under his arm all day, have become a mainstay. Friends say he favors its generally short, punchy and to-the-point articles, which match his temperament.


In October, Mr. Bloomberg visited the London headquarters of The Financial Times, a few blocks away from Bloomberg L.P.’s giant new London complex, which is still under construction. When an editor asked if he would buy the paper, Mr. Bloomberg replied, “I buy it every day.”


He has spoken openly with friends and aides about the potential benefits and pitfalls of making such a costly acquisition in an industry he admires deeply as a reader but sneers at as a businessman, these same people said. And he has recently taken to rattling off circulation figures and “penetration” rates for the paper.


“It’s the only paper I’d buy,” he has said to one associate. “Why should I buy it?” he has asked another.


His ambivalence speaks to the troubles facing the newspaper business, and to the complex motivations of the mayor himself. Drawn to power and prominence, Mr. Bloomberg is wrestling with his affection for the paper as its potential publisher and his wariness of an investment that could mar his company’s reputation for achieving outsize profits. Pearson, the parent company of The Financial Times Group, does not break out separate financial results for the paper, but analysts estimate that it loses money. A spokesman for the mayor declined to comment on his conversations about the paper.


For Thomson Reuters, the other likely bidder, the calculation is somewhat different. Unlike Mr. Bloomberg, who started his financial information company in 1982, James C. Smith, president and chief executive of Thomson Reuters, came up through Thomson’s regional newspapers and has ink in his veins. A replica of an old-fashioned printing press is on display in his corner office overlooking Times Square.


But the company has been hurt financially after its newest desktop terminal product struggled to catch on. In the first nine months of 2012, the company reported revenue of $9.88 billion, a 3 percent decrease from the period a year earlier. A company spokesman declined to comment.


The Financial Times could expand the Thomson Reuters brand and give its reporters additional exposure since, unlike Bloomberg, which bought Businessweek in 2009, the company does not own a regular magazine. Thomson Reuters, partly a British company, and The Financial Times also have large footprints in Asia.


But first, the paper needs to be put on the block. Pearson is about to lose two of its top executives, raising speculation the paper could be for sale. Analysts value The Financial Times Group at about $1.2 billion, well within the reach of Bloomberg L.P., which in 2011 had revenue of $7.6 billion, and Thomson Reuters, which posted revenue of $13.8 billion.


The paper has a successful digital strategy, and analysts have said that its strict online pay wall is considered a financial success. But like most newspapers, it is struggling in an industrywide decline in print advertising revenue. In the three months ending Oct. 1, the paper’s total paid circulation exceeded 600,000, more than half of which was from digital subscriptions. In its most recent earnings report, Pearson said it expected profit to decline because of a sluggish advertising market and “the shift from print to digital.”


Marjorie Scardino, Pearson’s longtime chief executive, who once said the paper would be sold “over my dead body,” is departing on Dec. 31. Rona Fairhead, chief executive of The Financial Times Group, will leave at the end of April. Both executives had championed the print businesses. A successor to Ms. Fairhead has yet to be named, though one person close to the company pointed to John Ridding, the chief executive of the paper.


Read More..

Interest Groups Push to Fill Margins of Health Coverage





The chiropractors were out in force, lobbying for months to get their services included in every state’s package of essential health benefits that will be guaranteed under the new health care law.




“We’ve been in constant contact with our state chapters, just telling them, ‘Look, you’ve got to get in the room,’ ” said John Falardeau, senior vice president of government relations at the American Chiropractic Association.


The acupuncturists were modest by comparison, ultimately focusing on a few states, like California, where they had the best odds of being included.


“Our profession really didn’t have a million dollars to spend on a lobbyist,” said Jeannie Kang, the immediate past president of the American Association of Acupuncture and Oriental Medicine. Instead, they mobilized 20,000 acupuncturists and their patients in a letter-writing campaign.


Both efforts seem to have shown results. Most of the roughly two dozen states that have chosen their essential benefits — services that insurance will have to cover under the law — have decided to include chiropractic care in their package. Four states — California, Maryland, New Mexico and Washington — included acupuncture for treating pain, nausea and other ailments. It is also likely to be an essential benefit in Alaska and Nevada, according to the Department of Health and Human Services.


“To me, six is huge,” said Ms. Kang, an acupuncturist in Los Angeles, who helped coordinate the lobbying effort.


The main goal of the health care law has always been to guarantee medical coverage to nearly all Americans, but as states finalize their benefits packages, it is becoming clear that what is received will depend partly on location.


According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in Massachusetts, but not in Arizona.


Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state.


The Obama administration originally planned to impose a single set of essential benefits nationwide, so groups like Ms. Kang’s lobbied federal officials at first. But last year, amid accusations that the health care law was too rigid, it decided to allow each state to choose its own guaranteed benefits within the 10 broad categories.


The law stipulates that starting in January 2014, the essential benefits will have to be covered by insurance plans offered in individual and small-group markets. These are the plans that people will shop for to comply with the law’s mandate that almost everyone have health coverage or pay a penalty. They will be available through health insurance exchanges, online markets where the uninsured can shop for coverage, often with federal subsidies to help pay for it.


The essential benefits will not be guaranteed to people who get coverage through large employers, but such plans already tend to be relatively generous. In comparison, many plans currently sold on the individual market do not cover maternity care, for example, or mental health services.


For the most part, states are defining their essential benefits as those provided by the largest health plan in their small-group insurance market. In Washington State, for example, that plan covers 12 acupuncture visits and 10 chiropractic visits per year. It does not cover in vitro fertilization, weight-loss programs or routine foot care for anyone except diabetics.


“Everybody really was conscious of the cost impact that the plan was going to have,” said Stephanie Marquis, a spokeswoman for the state’s insurance commissioner. “That’s something we’re working very hard at keeping an eye on and making sure we’re not adding benefits unnecessarily.”


Alan Weil, executive director of the National Academy for State Health Policy, said that while the essential benefit packages vary at the margins, they are similar over all. Every state’s package will cover visits to primary care doctors and specialists, for example, and diagnostic tests like X-rays and blood work.


“To people who care about particular diseases or conditions or provider groups, these don’t feel like the margins,” Mr. Weil said. “But at the end of the day, the core benefits are very standardized, and the differences are at the periphery.”


Some states have declined to choose an essential benefits package, saying that the law does not give them enough latitude. In those states, the default will be the largest plan available in their small-group insurance market, according to the Department of Health and Human Services.


Gov. Dave Heineman, Republican of Nebraska, chose an insurance plan with a high deductible as his state’s benchmark, reasoning that such lower-cost plans were popular in the state. But the Obama administration recently informed him that the plan did not meet the requirements of the law, he said.


“The point we were trying to make is that the minimum coverage should not be above what people need,” Mr. Heineman said. “The overriding concern is that the cost will be too great.”


Other states delayed choosing a benchmark plan on the grounds that the Obama administration had not provided enough guidance. Last month, the administration published a proposed rule that sought to answer outstanding questions.


The rule makes clear, for example, that insurers can substitute one covered service for another as long as they are in the same broad category and “substantially equal.” It clarifies that pediatric services, one of the 10 required categories, must be provided to everyone 18 and under.


States can still change or choose a benchmark plan, but they are running out of time. They generally have until Dec. 26, when the comment period for the proposed rule will end. So far, 23 states and the District of Columbia have chosen plans, according to Avalere Health, a consulting company.


Interest groups that did not succeed in getting a particular service covered may have another chance to do so. States will most likely be able to change their benchmark plans after 2015. So groups like the Obesity Action Coalition will keep making their case.


“There’s going to be a great deal more effort on this issue,” said Chris Gallagher, a policy consultant for the coalition. “At a minimum, if plans are going to try to exclude obesity treatment services, there must be some kind of exception for medically necessary treatment. It’s a serious medical condition that affects one in three Americans.”


Likewise, Ms. Kang’s group will keep presenting state decision makers with patient testimonials and research studies on the benefits of acupuncture. Its next targets are New York and Florida, which have more licensed acupuncturists than any state except California.


The chiropractors, meanwhile, are focused on California, where the essential benefits package that Gov. Jerry Brown signed into law in September does not include chiropractic services. Mr. Falardeau said the American Chiropractic Association was still hoping for a change.


“We’re ready, if we have to, to go to war on it,” he said.


This article has been revised to reflect the following correction:

Correction: December 10, 2012

An article on Thursday about the way in which benefits under the new health care law will vary from state to state, using information from the Department of Health and Human Services, misidentified a state that has proposed making infertility treatment a required benefit. It is Massachusetts, not New Hampshire.



Read More..

Interest Groups Push to Fill Margins of Health Coverage





The chiropractors were out in force, lobbying for months to get their services included in every state’s package of essential health benefits that will be guaranteed under the new health care law.




“We’ve been in constant contact with our state chapters, just telling them, ‘Look, you’ve got to get in the room,’ ” said John Falardeau, senior vice president of government relations at the American Chiropractic Association.


The acupuncturists were modest by comparison, ultimately focusing on a few states, like California, where they had the best odds of being included.


“Our profession really didn’t have a million dollars to spend on a lobbyist,” said Jeannie Kang, the immediate past president of the American Association of Acupuncture and Oriental Medicine. Instead, they mobilized 20,000 acupuncturists and their patients in a letter-writing campaign.


Both efforts seem to have shown results. Most of the roughly two dozen states that have chosen their essential benefits — services that insurance will have to cover under the law — have decided to include chiropractic care in their package. Four states — California, Maryland, New Mexico and Washington — included acupuncture for treating pain, nausea and other ailments. It is also likely to be an essential benefit in Alaska and Nevada, according to the Department of Health and Human Services.


“To me, six is huge,” said Ms. Kang, an acupuncturist in Los Angeles, who helped coordinate the lobbying effort.


The main goal of the health care law has always been to guarantee medical coverage to nearly all Americans, but as states finalize their benefits packages, it is becoming clear that what is received will depend partly on location.


According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in Massachusetts, but not in Arizona.


Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state.


The Obama administration originally planned to impose a single set of essential benefits nationwide, so groups like Ms. Kang’s lobbied federal officials at first. But last year, amid accusations that the health care law was too rigid, it decided to allow each state to choose its own guaranteed benefits within the 10 broad categories.


The law stipulates that starting in January 2014, the essential benefits will have to be covered by insurance plans offered in individual and small-group markets. These are the plans that people will shop for to comply with the law’s mandate that almost everyone have health coverage or pay a penalty. They will be available through health insurance exchanges, online markets where the uninsured can shop for coverage, often with federal subsidies to help pay for it.


The essential benefits will not be guaranteed to people who get coverage through large employers, but such plans already tend to be relatively generous. In comparison, many plans currently sold on the individual market do not cover maternity care, for example, or mental health services.


For the most part, states are defining their essential benefits as those provided by the largest health plan in their small-group insurance market. In Washington State, for example, that plan covers 12 acupuncture visits and 10 chiropractic visits per year. It does not cover in vitro fertilization, weight-loss programs or routine foot care for anyone except diabetics.


“Everybody really was conscious of the cost impact that the plan was going to have,” said Stephanie Marquis, a spokeswoman for the state’s insurance commissioner. “That’s something we’re working very hard at keeping an eye on and making sure we’re not adding benefits unnecessarily.”


Alan Weil, executive director of the National Academy for State Health Policy, said that while the essential benefit packages vary at the margins, they are similar over all. Every state’s package will cover visits to primary care doctors and specialists, for example, and diagnostic tests like X-rays and blood work.


“To people who care about particular diseases or conditions or provider groups, these don’t feel like the margins,” Mr. Weil said. “But at the end of the day, the core benefits are very standardized, and the differences are at the periphery.”


Some states have declined to choose an essential benefits package, saying that the law does not give them enough latitude. In those states, the default will be the largest plan available in their small-group insurance market, according to the Department of Health and Human Services.


Gov. Dave Heineman, Republican of Nebraska, chose an insurance plan with a high deductible as his state’s benchmark, reasoning that such lower-cost plans were popular in the state. But the Obama administration recently informed him that the plan did not meet the requirements of the law, he said.


“The point we were trying to make is that the minimum coverage should not be above what people need,” Mr. Heineman said. “The overriding concern is that the cost will be too great.”


Other states delayed choosing a benchmark plan on the grounds that the Obama administration had not provided enough guidance. Last month, the administration published a proposed rule that sought to answer outstanding questions.


The rule makes clear, for example, that insurers can substitute one covered service for another as long as they are in the same broad category and “substantially equal.” It clarifies that pediatric services, one of the 10 required categories, must be provided to everyone 18 and under.


States can still change or choose a benchmark plan, but they are running out of time. They generally have until Dec. 26, when the comment period for the proposed rule will end. So far, 23 states and the District of Columbia have chosen plans, according to Avalere Health, a consulting company.


Interest groups that did not succeed in getting a particular service covered may have another chance to do so. States will most likely be able to change their benchmark plans after 2015. So groups like the Obesity Action Coalition will keep making their case.


“There’s going to be a great deal more effort on this issue,” said Chris Gallagher, a policy consultant for the coalition. “At a minimum, if plans are going to try to exclude obesity treatment services, there must be some kind of exception for medically necessary treatment. It’s a serious medical condition that affects one in three Americans.”


Likewise, Ms. Kang’s group will keep presenting state decision makers with patient testimonials and research studies on the benefits of acupuncture. Its next targets are New York and Florida, which have more licensed acupuncturists than any state except California.


The chiropractors, meanwhile, are focused on California, where the essential benefits package that Gov. Jerry Brown signed into law in September does not include chiropractic services. Mr. Falardeau said the American Chiropractic Association was still hoping for a change.


“We’re ready, if we have to, to go to war on it,” he said.


This article has been revised to reflect the following correction:

Correction: December 10, 2012

An article on Thursday about the way in which benefits under the new health care law will vary from state to state, using information from the Department of Health and Human Services, misidentified a state that has proposed making infertility treatment a required benefit. It is Massachusetts, not New Hampshire.



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Fear of Fighting Haunts Once-Tranquil Damascus


Muzaffar Salman/Reuters


A portrait of President Bashar al-Assad outside the venue of a charity concert by the Syrian National Symphony Orchestra in Damascus on Nov. 21.







DAMASCUS, Syria — Business has been terrible for Abu Tareq, a taxi driver, so last week, without telling his wife, he agreed to drive a man to the Damascus airport for 10 times the usual rate. But, he said later, he will not be doing that again.




On the airport road, he could hear the crash of artillery and the whiz of sniper fire. Dead rebels and soldiers lay on the roadsides. Abu Tareq saw a dog eating the body of a soldier.


“I will never forget this sight,” said Abu Tareq, 50, who gave only a nickname for safety reasons. “It is the road of the dead.”


Damascus, Syria’s capital, is one of the world’s oldest continuously inhabited cities, a touchstone of history and culture for the entire region. Through decades of political repression, the city preserved, at least on the surface, an atmosphere of tranquillity, from its wide downtown avenues to the spacious, smooth-stoned courtyard of the Umayyad Mosque and the vine-draped alleys of the Old City, where restaurants and bars tucked between the storehouses of medieval merchants hummed with quiet conversation.


Now, though, the rumble of distant artillery echoes through the city, and its residents are afraid to leave their neighborhoods. Cocooned behind rows of concrete blocks that close off routes to the center, they huddle in fear of a prolonged battle that could bring destruction and division to a place where secular and religious Syrians from many sects — Sunni, Shiite, Alawite, Christian and others — have long lived peacefully.


For more than a week, Syrian rebels and government forces have fought for the airport road, as the military tries to seal off the capital city, the core of President Bashar al-Assad’s power, from a semicircle of rebellious suburbs. Rebels have now kept the pressure on the government for as long as they did during their previous big push toward Damascus last summer. This time, improved supply lines and tactics, some rebels and observers say, may provide a more secure foothold.


But the security forces wield overwhelming firepower, and while it has been unable to subdue the suburbs, some rebel fighters say they lack the intelligence information, arms and communication to advance. That raises the specter of a destructive standoff like the one that has devastated the commercial hub of Aleppo.


“Damascus was the city of jasmine,” Mahmoud, 40, a public-school teacher, said in an interview in the capital. “It is not the city I knew just a few weeks ago.”


Car bombs have ripped through neighborhoods, their targets and perpetrators only guessed at. Checkpoints choke traffic, turning 20-minute jaunts into three-hour ordeals. Wealthy residents find it quicker and safer to drive to Beirut, Lebanon, for a weekend trip than to the Old City.


Shells have been fired from Mount Qasioun overlooking Damascus, a favorite destination from which to admire the city’s sparkling lights. West of downtown, where the palace stands on a plateau, things are relatively quiet. But from the mountain, puffs of smoke can now be seen over suburbs in an arc from northeast to southwest.


Mahmoud, unable to find heating oil and medicine for his sick wife, said his grocer has lectured him daily on shortages and soaring prices. The once-ubiquitous government, he said, now appears to have no role beyond flooding streets with soldiers and security officers, “who are sometimes good and sometimes rude.”


People with roots in other towns have left, he said, “but what about me, who is a Damascene, and has no other city?”


The sense of claustrophobia has grown as rebels have declared the airport a legitimate target and the government has blocked Baghdad Street, a main avenue out of the city. On Sunday, it blocked the highway south to Dara’a.


In some outlying neighborhoods and nearby suburbs, the front lines seem to be hardening.


On the route into Qaboun, a neighborhood less than two miles from the center of Damascus, the last government checkpoint in recent days was near the municipal building. Less than a quarter-mile on, rebels controlled the area around the Grand Mosque.


An employee of The New York Times reported from Damascus, Syria, and Anne Barnard from Beirut, Lebanon. Neil MacFarquhar contributed reporting from Beirut.



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Bits Blog: Facebook Likely to End Experiment With Democracy

A half-million Facebook users have told the social network they do not want the company to change its privacy policy. Sounds impressive, right? Well, the only way that crowd will get its way and the status quo remain intact is if an additional 300 million people vote thumbs down before Monday. Odds of that happening? About zero.

Facebook says the changes to the policy are minor and beneficial for users. One concerns the integration of Instagram data with Facebook; another changes the filters for managing incoming messages. Privacy watchdogs disagree. So do those who bothered to vote: Shortly before noon Pacific time on Friday, 476,718 were against the proposed changes. A mere 68,884 were in favor.

But the really interesting change is that Facebook is proposing to end this system of direct voting, which was implemented in early 2009 after a major privacy flap. “If we are trying to move the world to being more open and transparent and to get people to share more information, having an open process around this is ultimately the only way to do that,” Mark Zuckerberg, Facebook’s founder, said at the time in a conference call.

The problem was that more than 30 percent of all Facebook users had to vote against a proposal for it to be binding. In the last vote, in June, the no’s outweighed the yeses by a ratio of six to one, but the total votes were less than one half of 1 percent of the users. That made the vote simply advisory. And so Facebook went ahead and implemented the changes anyway.

There has been relatively little commentary, much less outrage, about the new changes. One notable exception was Michael Phillips, who wrote a much-quoted piece in BuzzFeed, “The End of the Facebook Democracy”: “By repealing Facebook Suffrage, Facebook abandons a fundamental norm — that its users are citizens in a community, and not simply datapoints on an advertising algorithm. The vote may be quixotic, but if Facebook remains the indispensable social network, you’ll want to be able to tell your grandchildren you fought for Facebook freedom.”

Some users are trying to take their privacy into their own hands. They are reproducing the following text as a status update:

“In response to the new Facebook guidelines, I hereby declare that my copyright is attached to all of my personal details, status updates, messages, photos, videos and all other personal content that I post or have posted, online, as a result of the Berne Convention, on my personal profile page, or anyone else’s page, For commercial use of the above, MY WRITTEN CONSENT IS NEEDED AT ALL TIMES WITH NO EXCEPTION.”

Perhaps this makes them feel better. But in reality, it has no legal standing at all.

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Financiers Bet on Rental Housing





DAVID N. MILLER, a master of bailouts, steps to the dais and coolly explains how the financial world went crazy.




It is February 2010. The anger behind Occupy Wall Street is building. Flicking through slides, Mr. Miller, a Treasury official working with the department’s $700 billion Troubled Asset Relief Program, lays out what caused the housing bubble: easy credit, shoddy banking, feeble regulation, and on and on.


“History has demonstrated that the financial system over all — not every piece of it, but over all — is a force for good, even if it goes off track from time to time,” Mr. Miller tells a symposium at Columbia University in remarks posted on YouTube. “As we’ve experienced, sometimes this system breaks down.”


But, it turns out, sometimes when the system breaks down, there is money to be made.


Mr. Miller, who arrived at the Treasury after working at Goldman Sachs, described himself as a “recovering banker” in the video.


Today, he has slipped back through the revolving door between Washington and Wall Street. This time, he has gone the other way, in a new company, Silver Bay Realty, which is about to go public. He is back in the investment game and out to make money with a play that was at the center of the financial crisis: American housing.


As the foreclosure crisis grinds on, knowledgeable, cash-rich investors are doing something that still gives many ordinary Americans pause: they are leaping headlong into the housing market. And not just into tricky mortgage investments, collateralized this or securitized that, but actual houses.


A flurry of private-equity giants and hedge funds have spent billions of dollars to buy thousands of foreclosed single-family homes. They are purchasing them on the cheap through bank auctions, multiple listing services, short sales and bulk purchases from local investors in need of cash, with plans to fix up the properties, rent them out and watch their values soar as the industry rebounds. They have raised as much as $8 billion to invest, according to Jade Rahmani, an analyst at Keefe Bruyette & Woods.


The Blackstone Group, the New York private-equity firm run by Stephen A. Schwarzman, has spent more than $1 billion to buy 6,500 single-family homes so far this year. The Colony Capital Group, headed by the Los Angeles billionaire Thomas J. Barrack Jr., has bought 4,000.


Perhaps no investment company is staking more on this strategy, and asking stock-market investors to do the same, than the one Mr. Miller is involved with, Silver Bay Realty Trust of Minnetonka, Minn. Silver Bay is the brainchild of Two Harbors Investment, a publicly traded mortgage real estate investment trust that invests in securities backed by home mortgages.


In January, Two Harbors branched out into buying actual homes and placed them in a unit called Silver Bay. It offered few details at the time, leaving analysts guessing about where it was headed.


“They were not very forthcoming,” says Merrill Ross, an analyst at Wunderlich Securities. As of Dec. 4, Two Harbors had acquired 2,200 houses. Ms. Ross says she couldn’t find out how much Two Harbors paid or the rents it was charging. Two Harbors shares, which recently traded at $11.66, are up about 25 percent in 2012.


Two Harbors now plans to spin off Silver Bay into a separately traded public REIT. The new company will combine Silver Bay’s portfolio with Provident Real Estate Advisors’ 880-property portfolio. Silver Bay will focus on homes in Arizona, California, Florida, Georgia, North Carolina and Nevada, states where prices fell hard when the bottom dropped out.


In a filing with the Securities and Exchange Commission last week, Silver Bay said it planned to offer 13.25 million shares at an initial price of $18 to $20 a share. But it’s no slam dunk. While home prices nationwide have begun to recover — they were up 6.3 percent in October, according to a report last week from CoreLogic, a data analysis firm — prices could fall again if the economy falters anew. Millions of Americans are still struggling to hold onto their homes and avoid foreclosure.


“Recent turbulence in U.S. housing and mortgage markets has created a unique opportunity,” Silver Bay said in an S.E.C. filing. The company, which will be the first publicly traded REIT to invest solely in single-family rental homes, says its investment plan will help clear foreclosed homes from the market, spruce up neighborhoods and renovate vacant homes, presumably while enriching its new shareholders. Its portfolio will be managed by Pine River Capital Management, a hedge fund in Minnetonka that has reportedly been buying bonds backed by risky subprime mortgages. Mr. Miller is a managing director at Pine River and chief executive of Silver Bay.


Mr. Miller, through a spokesman, declined to comment for this article, citing the pending stock offering.


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