What's the sneaker of the year? Sneaker of the year? Sneaker of the year. Let's go with the Lost and Found Jordan 1s. What is the sneaker of the year? I would say either Lost and Founds or Fire Red 3s. But that's just my style in my opinion. What is the sneaker of the year? Jordan 4 military blue. Blacks. Okay. I like it, I like it. I appreciate it.  Appreciate it, bruh. What is the sneaker of the year? The neck face! I already told you the neck face! The baby? Ebay, right on the mouth to sneaker on the neck face.


Let us look at the typical components of hybrid airship. You have these multiple lobed envelope. The multiple lobing is going to give you a larger width lower height for a given envelope volume that you need and this shape also gives you higher L over D lift over drag. So the L over D which gives you the aerodynamic performance is also improved. Applications are many. You can just imagine wherever you need heavy lift or wherever you need to cruise for long distance. You could also use it for things like disaster relief by dousing the forest fires or for providing medical facilities at disturbed areas. So these are the four basic limitations of the cargo airships. First of all they will not be as maneuverable as aircraft because they are bulky in shape and because they are buoyant body and secondly their large size will require totally new infrastructure. It is very difficult to expect that you make these airships and you can operate them from existing hangars because existing hangars are not so large in size. So you require very large hangars and secondly you cannot actually climb to very high altitudes. So while transporting cargo if in the way there are very high altitudes you have to skirt it rather than going over it because with heavy cargo if you want to go over an obstacle or a mountain or some such high structure then the volume and size will become very large. Now last thing I will do today very very briefly is I will try to show you a comparison between how the performance of an aircraft is estimated along with the performance of airship. There are a series of four very interesting papers on performance estimation of hybrid airships. So the first such paper appeared in 0.9 for what is called as the airship which is basically a winged airship either you have a wing and a tail mounted below or you have just the wing with engines mounted below. So a hybrid flight platform was proposed by these researchers and then they carried out performance estimation for that. So what they have done is they basically done a first order analysis of aerodynamic interaction between airship wing and production system I mean the interaction is in electric so it is a first order analysis and therefore and also the drag on the lift is decoupled. So you have a CL and a CD and you are not going to use it for coupling. Now for an airship you will get the buoyant lift as L ship which will be density into volume into difference of density difference into volume correct the G is only meant for the units. For airship there will be a airship lift coefficient which will be L by G rho V because for an airship volume of the V ship is the volume of the airship envelope. So lift available per unit so you just divide this and therefore that will be simply 1 minus density ratio rho H by rho A which is sigma or not sigma it is like it is a relative density R D rho H mean density of helium and rho A means density of air you could have helium or hydrogen. Similarly you have an airship drag coefficient which is the drag obtained divided by half rho V square S. So U basically is velocity. So now you can see on the aircraft and the airship there are 2 sides on the aircraft side we have only the aerodynamic lift so we have just CL which is L by half rho V square we have drag which is CD D by half rho V square but what is the V area? So what do we take as the S wing in the analysis so can someone tell me this what is the answer to this question on the aircraft side what is the S wing in this formula plan from area of the wing. So how do you define the plan from area of the wing? Correct. So this is basically so it is called as the wing reference area not plan from area but wing reference area which includes the area inside the fuselage projected from the wing route to the centre line. Is this one clear to everybody? Yes or no? In the airship you have buoyancy which is and also you have which is basically the density difference into volume and as I already showed you there are there is an efficient of lift coefficient but now what will be used as the area for the airship for the drag estimation of the airship what will you do as the area? What are the justification for that? It does not make sense exactly it does not give you a proper scaling parameter it does not make sense what makes sense is to use volume of the scaling parameter and therefore to get the units of area from volume you just do volume power 2 by 3. So the reference area in the case of airships will be volume power 2 by 3 and therefore the drag coefficient will be also called as CDV volumetric drag coefficient. So this is what we have already seen in the last couple of minutes for aircraft we have this cross sectional area including the not across an area reference area including the area inside the fuselage and for the airship we have volume power 2 by 3. Now no need to really get psyched I do not have animation in this unfortunately but my suggestion to you will be that this is essentially taken from 3 or 4 papers which I am going to upload. So it is nothing but bringing in an aircraft like coefficient into the airship formulae. So you basically say that there is something called as CD total which is CDO wing plus CDO airship. Similarly for lift you have the dynamic lift plus the lift acting because of the airship size okay and then there are force this is of not much relevance.  Now finally just to conclude you will get an expression like this which will say L by D max is equal to 1 by K times some function F of P and X which is this this is P this is X and P is CD0 by K and X is CL of airship. Now my question to you is how do you find the optimum value of X which maximizes L by D for a fixed P.  So you can use any optimization method to obtain the optimum X or I used a simple graphical method. So what I have done is for various values of P as I have plotted this curve. So we notice that as P increases the peak is coming down it is flattening as if somebody is pulling this on this side. So for various values one can get the values of the peak and then one can easily create a correlation between X and P which is just almost like a line of course it is a power series curve and then you can do a L by D comparison for both aircraft and airship. I am going to skip this in detail because I think you will be able to appreciate this only and only if you go through these papers. Now what you see are basically two general papers and two conference papers. The conference papers have been updated as general papers. So once you read these two papers the first one is 11 and 9 where this concept is introduced airship or a typical wind aerostat and in the second paper the flight performance formulae have been given. So that is all I think with this we will end today.


Short-chain fatty acids, SCFAs, such as acetic acid, propionic acid, peteric acid, valeric acid, and caproic acid, can be produced through anaerobic fermentation of lignocellulosic waste products. These acids are more cost-effective than chemical synthesis, which uses fossil fuels and toxic catalysts. Additionally, they can be used as a source of bioproducts, contributing to the development of a circular economy. Biosynthetic production of SCFAs from waste products has been studied extensively, and several applications have been identified. Micro-organisms such as bacteria and oleogenous yeast can convert SCFAs into biomass, biopolymers, and biofuels. Furthermore, microbial electrolytic cells can be used to convert SCFAs into valuable products. Finally, SCFAs can be used to produce biodegradable plastic polymers, such as polyhydroxyalkanoates. This article was authored by Elia Thomas Pejo, Christina Gonzalez-Fernandez, Sylvia Grises, and others. We are article.tv, links in the description below.


So, you got your color map completely done, but you don't know how to add detail. Not a problem. Now, if you followed my last few videos, your character will have two maps on it. The Albedo, which we just finished, and the Ambien Occlusion, which at the moment should be completely white. If you're doing Guilty Gear or Granblue Anime style, then the only thing that should ever be on this map are straight black lines. In my opinion, the easiest way to draw these lines is directly in Blender. To do that, in the UV Editor, make sure Sync is on, then click the object that you want to add detail to, tap the Edit Mode, press A, then go to Texture Paint Mode. From here, go to the Image Editor, make sure it's set to Paint, and change the map to your AO. Set the mode to Brush, and if you go to Active Tools, make sure that you're on the AO map. Not the color map.  So, always double-check. Detail only goes on the Ambien Occlusion. Now, from here, it's pretty simple. Anything you draw here will show up on the model, and conversely, if you draw directly onto the model, it will be drawn right onto the map. Usually what I do is draw directly onto an area in order to see where it is on the map, and once I know where that area is, I'll undo and hold Alt to draw a perfectly straight line on the map.  Alright, you're done. Hope that helps, and as always, I'll be the other fantastic day, and I'll see you around.


The move by the People's Democratic Party's senators to impeach President Muammar Dubuwari is currently gaining more backing from concerned Nigerians. Recall that the PDP senators' caucus take the work out from the upper chamber in protest of the heightening security in the country. The minority leader, Senator Philip Aduda, said that the PDP senators issued President Muammar Dubuwari six weeks to resolve terrorist attacks in the country or risk impeachment.


Well, let's not arm over the stock. So we're doing this five. So the Fed came out. They're raising rates by a quarter point. No shock there. That's what everyone expected. And again, the market really isn't reacting much to this.  I think we're gonna close here pretty much down a little bit or up a little bit. Market's just gonna wait for the big earnings. Tonight's Facebook and tomorrow's Apple. Market isn't really gonna do much of anything here in this reaction because what they're saying is what they expected. You can't take much more away from this. A quarter percent hike. They said they're still gonna continue to raise rates where they're gonna watch stuff. So again, people that want the Fed to back off rates, that is not what they said today. People that think that they're going to slow down or stop raising rates in the summer are gonna continue to say that despite what they said today, which is really nothing different than they've said it all. Their goal for inflation is a 2% rate. Well, we're nowhere near there. Like I know people are saying we're at 7% of the last report, but to me that's ridiculous because I go shopping at the store and particularly food costs have gone up astronomically. So I mean to say that we're at a 7% rate of inflation, I don't believe that number number one. And number two, even if that's true, the 2% target rate is so far away from there.  So end of story for the market here today is that we're not reacting bullishly, okay? We rally yesterday, now we're selling off, but we're not selling off like a hot cake. And I don't know how we close exactly. So it's clear to me, the market expected, whatever they said today is gonna take away whatever it was to take away from it. And it's a way to see here for rates in the Fed going forward into really the spring of 2023. As far as what happens tonight and tomorrow though, with the big earnings that are coming out, I do think that that will rock markets. It could rock markets to the upside and it could rock markets to the downside. Now, what would that take to blow out earnings to the upside and both the things Facebook and Apple that are gonna affect the market or to blow out things to the downside? They may not be both the same. They may not both react the same, do you know what I mean? But I think that's what it's gonna take for any kind of blowout.  So we will see, but, you know, well, we're selling off here a little bit. Let's see if we're selling anything right now. It's just, this is not what I say.  It's like a nothing burger. Pretty much the way we've been. We've been training in a range now for weeks, weeks that we've been training in a range for January. Why everyone's saying, oh my God, we're so bullish. I don't see it that way. It really, we were range brown and just we tightened up in the range. Just see here. Do, do, do, do, do. Yeah, see, look at this. Full effects of rapid tightening so far have yet to be felt and we have more work to do. That's what the Fed share just said. But, you know, we're really not. We're really not going anywhere too much here this afternoon. So I will be watching Facebook tonight and Apple tomorrow morning. We'll see, or no, Apple's tomorrow night. That's right. It's tomorrow night. Ooh, so that's right. So Thursday night into Friday. Well, it could be a long two days here for the market. Could be a long two days here for the market. All right, good luck everyone. If you're interested and you would like more information about what I do, feel free to email me at melissathesockswush.com. Have a great day.


Hey guys, welcome to another watercolor Wednesday now I was looking around on the internet today, and I saw a new to me YouTube channel by the name of Tillith I will link the particular video that caught my attention this morning in the description below Where she uses watercolors to create a sort of a nebula or galaxy scene was really intrigued by that So I thought we would give it a try inspired by Tillith So the first thing that we're going to do is put a circle on our page now in her video She just did it with a pencil and worked around it. I really want to introduce the idea of using masking fluid This is one of my palette plates, and I am going to get out My masking fluid as soon as I find it I have one here that's in this bottle. I poured it into this bottle This is a bottle with a brush on it that I got from American Science and Surplus So I'm going to just use the plate as a guide and I'm going to brush this around the edge and Then let it dry and that'll keep should keep our edge nice and crisp and clean If I do it right Because this is like a resist So the watercolor paint won't go past this as a barrier You could do a square Or another shape And you could probably try masking tape, but or painters tape, but I think that masking fluid works better It's pretty good. I'll make sure I get it well covered Okay, the trick is to pick the plate up without messing it up. Let's see. Let's grab a palette knife There we go There we go, so we're going to let that dry and we'll be back and we're going to paint a nebula Hey, I can't decide if it looks like a planet or a nebula, but either way I love it I love the way it turned out. It was so much fun And I can see this coming up on an upcoming episode of watercolor Wednesday live Because this is a great exercise and it was just fabulous now I know somebody's going to ask me about this. This is by Sakura and It's some kind of a white crayon. I believe it's like an oil Pastel crayon anything. I'm pretty sure I got it at JetPens and it says Hold on. I'll get my glasses. It does have a UPC number on it, but everything's in Japanese It says Sakura color products Japan and it's some kind of a white crayon That says Sakura SC 5 It looks like 5 4 5 0 or s number 50 and Then it says UPC number PJ 1 0 0 0 1 3 8 1 and it must be SCS number 50 Because it says SCS here Down here. It says number 50 White I'm pretty sure I got it at JetPens. It's some kind of a white crayon So anyway, that's all I can tell you. I mean if somebody out there can read Japanese. There you go. I Don't know what it says That's the end the oops, but it was a lot of fun in it I forgot I had this I saw it in my pen bucket and it I like putting it on here and it smudges really easily So anyway And that's it. Have a great day. Don't forget to like share and subscribe if you Have any questions comments or concerns you can leave a comment on the video or you can contact me via Social media or my email address Which are in the description below if you want to send me happy mail, which I enjoy Or a product to try and review my PO box is also in the description below along with links to crazy Allen University where I teach online and My Facebook group and all that stuff. So anyway, don't forget to go out and have a great day Everybody do something nice for yourself because you deserve it. Maybe paint a nebula. All right. I'll talk to you later. Bye


So I'll go ahead and read John 15.5. And it says, Jesus said, I'm the vine. You are the branches. He who abides in me and I in him bears much fruit. For without me, you can do nothing. You know, I read a story about a father who watched through his kitchen window his son struggling to pick up a rock out of his sandbox. He was a big rock and he could tell that his son was struggling. He was having a hard time trying to lift it up. He wasn't really getting the leverage he needed to lift this thing up to the side of his sandbox. So as he struggled and struggled, he gave up.  He couldn't do anything about it. Well, his dad went out and he said to his son, son, what is the problem? And he told his dad, I can't get this rock out of this sandbox. He says, are you not strong enough? And he says, I'm not. It's too hard. And his father then asked him, have you used all the strength that is available to you? And his son said, yes, I have. No, you haven't replied his father. You haven't asked me to help you. You see, self-reliance was that little boy's problem. He didn't want to ask for help. It was something that he wanted to do himself. He wanted to accomplish himself and yet he had a little bit more strength outside of his own strength and that's his daddy. And it's interesting to me because this kind of reminds me of what we're looking at today. Self-reliance, dependence, trust. I mean, when we talk about trust, I think trust is perhaps one of the most unnatural things for human beings, don't you? Don't you think? I mean, when it comes to trust, we are prone to trust in ourselves. We are prone to trust in others, in money, in our strength, and sometimes in our own fame. And when we talk about dependence, dependence is something that has to be relearned on a regular basis for us as Christians. You know, it's easy to fall into the trap of thinking that I've already learned that lesson. If you ever get there, be careful as a Christian because if you don't know by now as a Christian that you relearn things over and over. You may think you got it the first time, but then a month later, two months later, God puts you to that test again and you wonder, wait a minute, help me, what's going on? And you've learned that lesson. Well, no, you haven't. It's something you learn on a daily basis. Dependence on God is one of those lessons that we will never fully grasp once and for all. It's something that we learn on a daily basis. In fact, just a couple of weeks ago I was there, something that I had to rely God on and I can tell you I've learned this lesson before. But it was, to me, it was brand new. It was like, okay, I got to learn this again. It's not something that sticks with you. Tonight we continue in the series, Identity, Who Are You Really? And we're going to look at what it means to be dependent people of God, because that's who you are. You are dependent, but on God. That's what we're supposed to be when it comes to the Christian life. Our dependence on God is on Him alone. And what we need to do is develop a God-dependent life. That's what we really need to learn, is how do we live a God-dependent life? How do we learn to depend on God? Well, here I think Jesus in John chapter 5, just in this verse 5, shows us something very, very important about dependence. And notice what he says in verse 5. He starts it by saying, I am the vine, right away. Now, if you go to verse 1 of chapter 15, Jesus added an important word called true, or it's true. He says, I am the true vine. What does that mean? Well, I am the genuine vine. The real one is what he's saying here in verse 1, and as he goes into verse 5, it's interesting because he's trying to reveal himself to his disciples of who he really is, one of his attributes. It was A.W. Tozer who once said, the most important thought anyone can have is a correct understanding of God's attributes. When you don't have God's attributes down, or understand them, when you go through trials in your life, you're going to have a hard time.  It's because they don't understand who God is. That's what happens. And I think it's important here for us to understand what is Jesus saying when he says, I am the true vine. This is what he's saying. That I am your life source. Just what Jesus is saying. He is our life source. Right away, he makes that clear to his disciples, listen, I am the vine. But he doesn't stop there. Now he identifies as disciples by saying this. Notice, you are what? The branches. So he says, I am the vine. You are the branches. A great vine was a little twig. It's interesting to me that when Jesus describes his children, he uses sheep and now a twig. You know, I find it interesting because I believe there are Christians today who have this inflated view of themselves as these big messengers of God.   You're not going to find anywhere in the Bible that God is calling you a lion. He's not matching you to Michael the Archangel or Gabriel.   You know, it's interesting because when we see this here and we look in Scripture, I mean, Paul the Apostle, who would you...  He didn't consider himself this big wig. What did he say? He says, I am the chief of what? Sinners. Paul the Apostle. And if you go in the Old Testament, Isaiah the Prophet. What did he say? I'm a man of unclean lips. That is the correct view. And we see here that a branch was utterly useless when it was off the vine. In fact, it was so useless that we had nothing with it. And the only thing they can actually do is actually use it to help kindling to start the real wood. That's what it was actually used for. That branch, that little twig, took on real significance when it was connected to the vine. And let me apply this to us. Your life will take real significance when you're connected to Jesus. When you are dependent on Christ, that is when life takes on real significance for you and for me. Did you know that? What do you mean by that? Well, you find purpose in Jesus. Not only do you find purpose in Jesus, you find fulfillment in Jesus. You find satisfaction in Jesus. You know how it is to be without Christ. In our secular world today, our humanistic world today, we don't look at what people are into and what's going on outside of Christ. People are left very empty. People that are into this humanistic culture, they pursue many things, thinking that in these things they're pursuing, they're going to find some kind of meaning. What kind of things do people pursue? Well, they pursue business success, wealth, good relationships, sex, entertainment, and doing good to others. And they think that in those things, I'm going to find some kind of satisfaction, but you know what? People that have tested, or actually have testified that while they achieved these goals, they were still left empty. I mean, you probably have seen interviews of these celebrities who have made a lot of money, and when they interview them, they're like, I'm still empty. I mean, I can go on with a list of different people that you would probably know. I'm just going to move this down a little bit. But we know that this is something that happens to even famous people, that in their pursuit of fame and all the wealth that they have, they're still left empty. So it doesn't work. And then, so Jesus here, as he's speaking to his disciples, and to us, he says, I'm the true vine, you're the branches, and notice what he says here. Here's where it really hits us between the eyes. Notice. Verse 5, for without me you can do nothing. That's pretty bold, huh? Like, excuse me? What do you mean? Without you, I can do nothing? What is he saying here?  I mean, how many of you guys here have tried to do something just on your own without God's help? Raise your hand. Be honest with me here. I should see every person here and if you haven't done that, you're going to do it. What was that like? I'll tell you what it was like. For me, I felt flat on my face. When we decide to say, okay, God, listen, you've helped me here and there, but today I'm going to take this on my own. Watch me. Check it out. It doesn't work. Something happens. There's a problem that happens. It's important for us because we think that God is depending on us. God wants us to depend on him, but we think sometimes, no, he's depending on me. So watch this, Lord. Look how I'm going to help you. You know who did that in the Old Testament? It was Moses. Remember Moses? 40 years, right? He went out and he thought he was the deliverer. He just said, Lord, you're depending on me. I'm going to do it. Here we go. And he did it wrong, didn't he? And then buried him under the sand. That wasn't the way God wanted him to deliver his own people. That was the wrong way. But Moses wanted to do it himself. It didn't work. It didn't work out in what happened to him.  You have to be dependent on me. And at 80 years old, God came to Moses and he spoke to him through a burning bush. Moses, Moses. And right there, that's where he started the ministry. That's where Moses, as an 80-year-old person, finally leaned on God. And he learned his lesson in that. I love what he said in Exodus 33-15. Notice this. This is not the same Moses when he was in his 40s. If your presence does not go with us, do not bring us up from here. Isn't that cool? It's like, God, if you're not in this, please don't make me move forward. Don't let me move forward. If you don't go with us, I am depending on you. That means that if you're not with me here, if you're not going in this direction, Lord, then shut this door. That's what we need to do. And we'll talk about this here in a moment. That we are so dependent on God that we want him included in what we do in this life. Because God, if you're not in this job, Lord, if you're not in this relationship, then Lord, get me out of this. Because that's what means, what it means to be dependent on God. We want his way. So I love what he said there in Exodus 33-15. So our identity in Christ is basically, I am a branch. I'm a branch. I'm a twig. I'm a piece of wood. I am dependent upon God is what I'm trying to say here. I am dependent upon God. And remember, we are dependent upon Jesus. It's not the other way around. He is not dependent upon us. That is why Jesus said, I am divine. You're the branches. You're the one connected to me. When we talk about depending on God, depending on God is a basic to the Christian life. It really is. When we think about trusting God and being dependent on God, think about this. We depend on God for salvation. Ephesians chapter 2 verses 8 and 9. I cannot save myself. You cannot save yourself. Therefore, all of us here who are born again have dependent on God to save us. And now we stand saved. That's the very first dependent. The first thing we trusted God with is our salvation. Very basic, very practical, but yet very powerful and very important. We trusted Him. So we see that not only that, but we also trust God in regards to wisdom. We depend on Him for wisdom. When we lack wisdom, we ask for it according to James chapter 1 verse 5. And we depend on God for everything.  In John chapter 6, they didn't Jesus say, don't worry about tomorrow. Don't worry about tomorrow. He didn't say, don't worry about next week or next month. Just don't worry about tomorrow. Don't go beyond tomorrow. Sometimes we're worried about tomorrow. Some of you are probably worried about tomorrow right now. You're wondering, how am I going to do this tomorrow? What am I going to do that? Listen, Jesus said, I am already taking care of tomorrow. Just trust me. Depend on me here. I'll take care of things. We see very clearly, not only do we depend on God for everything, but we depend on God in everything. I love what Acts chapter 17, 28 says. It says, for in Him we live and move and have our being. You're all here breathing because of God.  And if the roof fell on your head overnight and it's what happens, then hey, you wake up in heaven.  You depended on Him. How many of you here, as you're sleeping, are worried about, like, am I still breathing? Am I still breathing? Honey, honey, am I breathing? Yes, you are. Okay, good, good, good. None of us, right? We go right in there, we sleep, we're done. Next, you know, we're waking up at 4 or 5, whatever time you wake up, and you're like, whoa, that was a quick night. Imagine all that time sleeping. God is there watching you. Your organs are moving. Your organs are working.  Everything is going on. You're not going to get a slab or coming out.  But it's like, you depend on God in everything. Your body, your health, everything. So we see here that dependence on God is important. Proverbs 3, 5 and 6, one of my favorite verses, trust in the Lord with all your hearts. Lean not on your own understanding. In all your ways, acknowledge him and he will direct your paths. Trust in the Lord with all your heart. All your heart. There's not even room for you to be like, I don't know if I want to trust them here. No, trust them with all your hearts. And then lean not on your own understanding. Here's where we get in trouble, right? We can trust God, but then all of a sudden we start thinking too much. And we're thinking, wait, let's see. Okay, Lord, I know I'm supposed to trust you in this, but here we go. There's where we get in trouble. But the Bible makes it clear that God wants us to trust him with all of our hearts and to not lean on our own understanding, to be very careful, because sometimes we get ourselves in trouble. We make things worse when we do that. So the Lord wants us to depend on him alone. And depending on God alone does not mean we act foolishly, okay? Let me just add that. Jesus is a great example of this. Turn with me to Matthew chapter 4 verses 5 and 7. Matthew 4. Let me just show you quickly here. Matthew chapter 4. When Jesus was tempted or attacked by Satan himself, we see something interesting that happened here. Remember, depending on God alone does not mean we act foolishly. Chapter 4 of Matthew verse 5 and 7. Then the devil took him up into the holy city, set him on the pinnacle of the temple and said to him, if you are the son of God, throw yourself down. For it is written, he shall give his angels charge over you.  Did Jesus say, okay, here we go. No. Jesus said it is written again, you shall not tempt the Lord your God. I mean, right there, he just stopped it. Very, very clearly, Jesus is basically saying basically here in this attack is what he's saying. He's like, listen, I don't need to jump off the pinnacle to prove that I am dependent on God. And neither should you.  What's the difference? Well, putting God to the test is like saying, closing your eyes while you're driving home tonight and saying something like this, I am going to depend on God alone to drive me home. Please don't try that. That's putting God to the test. And we see that we can still depend on God in those things and we can trust him. Or here's another example. Let's say you cut your hand in a very deep way and you're bleeding. I mean, you're bleeding really bad.  Again, that's putting God to the test. You have an ER. You have a hospital. See, sometimes we think that we lack faith or that we're being, you know, or God's going to get mad at us because we're not trusting in him. No, no, that's acting foolishly. That's not what the Bible supports. When you get into these things, we can still depend on God while we visit the doctor because we know that all healing ultimately comes from God and we can depend on God as we drive home because we know that God has given us the ability to steer a car, right? We went to DMV. We took the test. God expects us to use that. So there's a difference in that. When it comes to the depending on God you can put God to the test. We depend on God all the time and sometimes there are times that we depend on God and that's all you can do.  Is nobody there to help you? There's nothing you can do. It's just, I just got to trust you here. There's many examples in the scriptures where God gave them the faith they needed to make it through those times. Daniel chapter 3, if you remember Shadrach, Meshach and Abednego those three young Hebrew boys were put to the test and Nebuchadnezzar erected this image and at the sound of all these instruments he said, I want every person to bow down to this image to bow down, to submit to it and if they don't they are going to be thrown into a fiery furnace. Well when that happened again all these people were there and the instruments went up and then all of a sudden the only three that were left standing up were the three boys a young Hebrew boys, Shadrach, Meshach and Abednego were the ones kind of like this standing up. When they go down well they were basically they got in trouble. The magistrates and the officials went to Nebuchadnezzar and said hey you know those three guys guess what when you did all the instruments they stayed standing up bring them over let's throw them in, barbecue them that's what they did, they brought them over he threatened them again who is your God he's mocking God and all of this and that and he's got that furnace going he says well you're going to go down in this furnace like I said and Nebuchadnezzar Shadrach, Meshach and Abednego they weren't afraid they were totally depending on God for deliverance amazing and this is what they told him as before they were thrown into the furnace listen to this Daniel chapter 3 verse 17 if this is the case speaking to Nebuchadnezzar our God whom we serve is able to deliver us from the burning furnace and will deliver us from your hand oh king and of course they said but if not he said we will not worship your idols and then he just got upset he threw them in right and these guys went down and this guy was so upset he even cranked up the heat even more like that's going to do anything right they're already burning in fire another 20 more degrees hotter it doesn't matter they're dead it didn't happen right see these guys were at a place in their life where they were depending on God just alone on God there was nothing else they could do they could have run away but they were there it's us and God Lord we are at your mercy and there are times in your life that you're going to be in that place all you can do is just depend on God depend on God for the outcome because that's exactly what happened with these guys they said Lord we are going to trust you with the outcome either you can deliver us which we believe you can or listen if we go down and we die then hey we'll see you and we see here that life has those times where all you can do is just depend on God alone for that outcome whatever it is God of your control no one can help you but yet God will give you the faith to make it through those times and maybe you've gone through those times before and you're like I know what you're talking about Robert I know exactly what you're talking about I've been cornered before and I have nowhere else to go no one else to look to but it's only to God and the outcome and he took care of it and here I am sitting smiling been there done that and we see here that this is exactly where Jesus is kind of encouraging us about depending on him these guys are thrown in this fiery furnace here's another example and this example is even worse turn with me I want you guys to actually see this yourself turn to act 16 verse 22 act 16 verse 22 a lot of you are familiar with this story but it's really it's a good reminder of how these guys were so dependent on God for the outcome there's nothing else they could do they literally couldn't go anywhere else act 16 verse 22 I'll read verses 22 through 26 Paul and Silas are imprisoned for preaching Jesus they were beaten and they were thrown into the inner dungeon the stinking hole basically is what it was and it says in verse 22 the multitude rose up together against them and magistrates tore off their clothes and commanded them to be beaten with rods and they had laid many stripes on them they threw them into prison commanding the jailer to keep them securely having received such a charge he put them into the inner prison and fastened their feet in the stocks but at midnight Paul and Silas were praying and singing hymns to God and the prisoners were listening to them suddenly there was a great earthquake so that the foundations of the prison were shaken and immediately all the doors opened and everyone's chains were loosed isn't that crazy what would you do in that moment God where are you these guys were singing and praying I wish look you know posted the song they were singing what was this song what was that hymn what were they praying what were they saying to God in this uncomfortable spot see they trusted God they depended on him and the outcome was in God's hands it's like we're just gonna pray and sing follow me Silas you ready let the Lord what was it I mean awesome listen when you're going through those dark times in your life here's a good thing to do begin to sing and practice practice that worship the Lord pray and worship pop in a CD or whatever it is on your iPhone or what not and just start singing put in your favorite song and just start singing to Jesus watch how quickly that issue disappears from your mind it's like it just fleas why because your heart and mind is centered on Jesus Satan wants you to focus on the issue because he wants to drag you down he wants to scare you he wants to tell you that problem that you're going through is so huge that not even your God can bail you out the moment you get your mind off of that and you do something different like that pray and sing you're going to see victory big time that's exactly what happened to these guys they were not going to allow Satan to destroy the work that God was doing in their lives so they just said Lord let's do it and God responded in a very powerful way so powerful that everybody's chains lose were lost the jailer, if we read on wanted to commit suicide because it was his life there that was put on and on the spot to guard these guys but yet he stopped them and that man got right with God it's interesting here going back to our text here that this is something that we need to understand again that life has those times where all you can do is depend on God alone for the outcome and those two examples I gave you so how can you and I be more dependent on God when we talk about being dependent on God and a lot of us in our head we think yeah of course I depend on God I trust them but what does that look like in your life do you really really really depend on God can you well how can you well let me give you some practical things here one put God first in your life start there put him first in your life you know Jesus said I am the vine you're the branches stay connected well what does that look like when it comes to putting God first in your life well doing this let his will be done not yours let his will be done not yours Matthew 633 listen to this Jesus said seek first the kingdom of God and his righteousness in all these things shall be added to you seek first the kingdom of God and his righteousness he said that's where you start put God first you know that Jesus's life was characterized by submission to the Father's will I mean it was very clear his service to others prayer everything Jesus did was according to the Father's will that's the way it should be for us as Christians you know when we make decisions in life we actually should want to make those decisions based on what God's will is for us what is your will Lord in this decision that I am making praying through it talking to God about it we want his will we desire his will in our decisions because why because he knows what's best and he knows what tomorrow brings he knows the future we see what we see in front of us we can guesstimate we can forecast and think well maybe if I go this way this is what's going to happen but it's God who really knows exactly what's going to happen if you make that decision begin to allow God to come into those decisions and ask for his will you know when when they lost Judas they were missing a partner a minister partner so they went to God because obviously they wanted this decision to be according to God's will and this is what they said in Acts 124 they prayed and said you oh Lord who know the hearts of all show which of these two you have chosen do you see that which of these two you have chosen that's the way that we should approach decisions on this side of heaven Lord which way do you want me to go Lord if you have a job Lord which job do you want me to take Lord I'm praying for this person to marry you know their heart so Lord you let me know are they my husband are they going to be my wife and if so let's go for it if not then tell me sometimes you don't pray that way we don't want to hear the answer right right I mean we're like I'm going to take a chance on this Lord because there's a lot of grays you know and then all of a sudden you get married to the wrong person and then you're just going through a long you know I mean I've seen that happen a lot unfortunately I remember one time a friend of ours my wife and I Kareens we have this friend who was engaged to this guy and man we saw red flags like this big you know what I mean we've learned her about it don't it's not happening this is not good didn't care she did it she got married marriage only lasted I don't remember a couple years three years maybe with that because of those red flags and unfortunately she's like I knew that I just did not want to hear the truth we see here that we want God His will on these things what school do you want me to attend Lord what do you want me to say in this situation Lord we want His will we want His our decisions to be part of His will what do you think Lord which brings me to the next thing not only put God first but also pray more pray more talk to God more prayer shows our dependence on God I mean more so in this day and age with the whole thing that's going on with terrorism now it's official we should be on our knees even more Lord help us Father please help us I'm dependent on God I mean thank God for our law enforcement people out there totally awesome I have a brother in law who's a CHP I have a good friend of mine in the county love those guys thankful that they do their job and that they're protecting us but they're very limited in what they can do my true dependence is on God it's totally on God and I want to be more connected to him especially in these days to be prayed up to be totally prayed up because it's important how important is prayer in the Bible 650 prayers listed in the Bible and out of those 650 prayers listed in the Bible 450 are recorded answers to those prayers God speaks that's cool it encourages me did you know that prayer is one of our powerful weapons of warfare we could use that against the enemy we could do some damage if we learned how to pray we could do some damage the enemy hates it when Christians pray oh he hates it a lot of us don't pray and I can be guilty of the same thing get busy at home with kids and whatnot that I don't realize the importance of prayer the privilege of prayer as God says in Hebrews 4 16 let us come boldly to the throne of grace let us come boldly to the throne of grace we have free access to God we're always looking for free access free wifi we find it we're like yes I got free wifi and you're on the internet for hours listen you have free access to God's throne you can talk to God anytime he's not charging you maybe he should charge us to make it worthy right I mean we have the privilege to pray to the God of heaven the creator of the heavens and the earth just destroy this earth and bring up a whole new heaven and new Jerusalem a God that you see just raining bowls of wrath and trumpets of wrath and revelation that's the same God that you're talking to that's pretty cool and guess what you're on his side now you're not an enemy to him we have a strong God don't forget that he's powerful we have the privilege to pray pray without seizing the Bible says pray without seizing well what do you come to God for what do you pray for I know in my life I've come to God for help protection direction wisdom, peace, strength boldness to love others seeking his will for my life those are things that I have gone to God over and over and I'm going to continue that list over and over until the day I die it repeats it over and over and over and over the only God can provide those things for me man is limited nobody can give me that I love what David said in Psalm 118 it is better to trust in the Lord than to put confidence in man that's pretty cool it is better to trust in the Lord than to put confidence in man how many of you have been let down by somebody listen God will never let you down isn't that cool he's never going to let you down you can trust him that's what the Bible says here you can trust him it is better to trust God than your next neighbor that didn't bring you those eggs that you asked for seriously it's important but let me conclude part of who we are in Christ Jesus made it very clear that he's divine were the branches significance when it comes to life it has to be connected we have to be connected to Jesus you cannot try to live your life apart from Christ's you will not find true satisfaction true fulfillment and you will always be left empty and it's important for us to understand that we have we have surrendered our lives to Christ because we want him to take over our lives let me say this self-reliance shuts out God self-reliance shuts out God if you want to shut God out of your life then do it yourself just do things on your own that's how you're going to shut God out of your life and it's important for us to understand that without God we are powerless defenseless and helpless a branch can't really even be a branch without the vine and the same thing a Christian can't even be a genuine Christian without being connected to Christ it's not going to produce the fruits that Jesus is even wanting we need Jesus every single day don't we every single day apart from him what did Jesus say we can do nothing so you have to answer the question are you dependent on him where is your dependence who do you depend on


Okay, so next up is Atul Gawande and before I, where's Atul? Come on up. Before I introduce him, I just want to comment on some of this young talent you're seeing up here. Two of our, obviously Dan and How Woo and Louisa who just asked the question and Emily Parker who's gotten a number of shout outs. These are our fellows. This is the New America Fellows Program. It was one of our hallmarks from the very beginning. We fund 10 to 20 brilliant thinkers and writers. We try to find them relatively undiscovered and help them put out books that are actually as one of the audience members from the publishing industry said to me, New America is the best incubator for nonfiction books in the country. So I wish we're going to quarter on that. But just to say, you should introduce yourself to the fellows as you meet them. These young voices you may not have heard are going to be the marquee names of the future. So with that, let me introduce another one of our board members. You can see we take great pride in our board members and we also put them to work. Atul Gawande, you know well. He is going to talk about health in America and there's probably nobody or a few people in the country better place to do that. He's known for many different things. His book Checklist Manifesto has been enormously important in looking at the rate of error in American hospitals and actually recommending how you do something about it. He's a staff writer for the New Yorker, which for many people would be a full-time job. For him, it's one of the things he does as he's a professor at Harvard Medical School and the School of Harvard School of Public Health. He's a surgeon at the Brigham and Women's Hospital. And as I said, most importantly, he's a board member for New America. Thank you, Anne-Marie. So I'm going to add big idea number 11 just for a chance to try to add something in there. You can't have thinking about where the U.S. is without thinking about health care. And I think the core, if I can get anything off in the next 20 minutes or so, it's understanding that the sickest people in the country is how you fix health care. Understanding the sickest people in America is how you fix health care. And I think we just keep losing sight of that. The coverage battle is over in a certain way. With the now four years of Obamacare, we've reached the point that even though it's still a debate over whether we repeal coverage or don't repeal coverage, it's now sort of, it's been implemented far enough that on both sides of the aisle, you're seeing the behind the scenes discussions are really about how to accommodate where we are and how to move forward. We do have this enormous divergence in the country between the places that have accepted money for Medicaid to cover the expansion of coverage in those places. And so, you know, right now we get to run this tremendously interesting scientific experiment for all us health policy researchers where we can look at the consequences of coverage in two places, parts of the country that are enormously different. But on the whole, you know, we describe a place like France, for example, as having had universal coverage for decades. In fact, they did not get their last coverage group under their system until 2004. That there is always in many places the left out and it's the effort over time to bring them in. What is going to be the deepest threat to whether we have coverage for the sickest people and all of us at some point become the sickest people. The deepest threat is going to be what happens to the health care costs. It's already been a major underlying factor in the economy and I could not help but hear Steve Ratner's talk without seeing all the health care numbers that I know about underlying some of those patterns of inequality. In the last decade, an insured family has seen its income rise $23,000. But in the end, all but $95 a month of that income has ended up going for health care costs. State and federal debt are largely driven by health care costs and we know the ways in which New America has been talking about for a long time the way as it's destroying the American dream. I think the central confounding fact that we haven't come to grips with yet is that it's only 5% of the population that accounts for 50% of the costs. About 10% of the population that accounts for 80% of the cost. It's the sickest folks. And the whole concept of insurance has been built around the idea that it's fairly unpredictable who those folks are going to be. But both the change in the ways we get sick because we can control illness and then have chronic illness which is a growing part of what it is to simply live in America and because our data is getting phenomenally better. The number of people as we understand genomics and also understand social patterns of people we can now predict with increasing regularity what is going to happen to people and that makes it exceedingly difficult to insure people, very difficult to allow for the huge swings in the costs that people have unless you have everybody under the system. As we do get everybody under the system though you start having an opportunity to look at what actually happens to people and you see how our policies run completely against what the reality is. There's a variety of analytics companies out there that look at healthcare data. Here after all is closing in on 20% of our economy, about one in five people in the country are employed in the healthcare sector and so the analytics companies that are exploding are pretty interesting. I visited one called Verisk. They work especially with businesses that self insure and therefore want to understand what's happening to the health of their population. The employer for privacy reasons can't dig in and actually figure out which of their people are the ones that as AOL's CEO inappropriately put it, their million dollar baby that was born to somebody at their company which of course happened to be someone who could write for Slate and say I'm that person. When you start to drill down, when I went with Verisk I sat down with a guy named Nate Gunn who's an internist to go through the numbers from an employer that was a 4,000 employee firm and they are doing what all employers are doing across the country, what the experience of being insured in America is like and that is that they are increasing their co-pays and deductibles. All of you are experiencing this, right? So we are moving in the last three years or so to a place where it's become increasingly commonplace to have 3,000, 4,000, 5,000 dollar deductibles and very large co-pays. The whole idea is to have skin in the game and the pattern that has occurred across the country is that people are responding to that. They are cutting down across the board because the economy and their co-pays, they're cutting down across the board on the medicines they take, on the ER visits they make, on the doctor visits they make, the number of hospital visits that they make. So this company which went through this policy saw this happening across the board. Every use of service went down and their costs went up. So their question for Nate Gunn was, dig into our data as a doctor with data capabilities and figure out what's going on and what he found was it's the story of the sickest. As we ran the numbers on this particular company you could pull out for me that the number one high-cost patient was a middle-aged man who had hypertension, cholesterol, elevation, coronary artery disease and he stopped taking his drugs and he saved money and then he had his $100,000 event, a heart attack. It was in fact because he ended up in the ICU and there were complications, his was higher than the cost of the average $100,000 heart attack. And so this 5% accounts, ends up accounting for more than half of the cost of this firm, the 5% sickest folks. We played around with the computer data to say, okay, let's take a look at the number one ER patient. And that's where the second lesson came up about for us, which is that the sickest actually get the worst care. So the number one ER visits patient for this company is a 25-year-old woman who in 10 months had 29 emergency room visits, 51 doctor visits, one hospital admission, total cost $52,000 for the year. And so we start drilling down into the data like, what is going on with this woman? So it's all these ER visits and headache visits and you know, Nate Gunn, he's a pretty reverent guy, he's like, this is just drug seeking.  But then we start looking at the drugs she's taking. Yes, she's going into the ER, she's getting a head CT scan every time she gets a headache. And the story is that she's on a migraine medication and it's the wrong migraine medication. And so she's getting her migraines over and over and over again and it turns out there's a group of people with severe migraines who are in and out of the hospital and they're a group of folks, here was someone who was inappropriately treated, would go to the ER, get the same, you know, everyone would notice the medication she was on, give her the narcotic, fix her headache for the day and ship her out again. But no one fixed the problem that she had. No one was looking at the big picture. And that's where the big picture emerges, I think. It's about people who are suffering and whether we meet their needs. I'm at a young physician in South Jersey who's doing what I think is right now happening across the country. And this is kind of the story outside the Beltway, which is a radical transformation in the ways that we are taking care of people. It used to be that these folks were the ones we avoided if you were an insurer or you were someone who was in the healthcare business because you just saw them as a straight out cost. But this physician said, I think these people are getting the worst care and it's an opportunity. And there's a number of people who have begun doing that. So he made a map for fascinating reasons after seeing how hotspotting was done in the police world while he was on a citizen reform commission that got kicked off or digging into the data too much. He poked at the data to look at, well, who are the 1% of people who account for the highest cost in the city? 1%, 100,000 people in the city. It was 1,035 people. They accounted for 30% of the costs in the city. They accounted also for 39,000 visits to the hospital and ER in five years. The lowest had 24 visits. The highest had 324 visits. They had $375 million in bills. Could have paid for the amount of money that actually was forked over for them for more than 100 family physicians for just that 1,000 people. The typical family physician has 2,000 people on their panel. And so he said, I will be their doctor. And he started tracking them down one by one. And he found a blind diabetic, for example, who hadn't been taught how to inject their insulin. And so he'd go to the doctor and his sugars were through the roof. But when you visited his home and he said, show me how you draw your medicines, as this doctor did, he found that he would put it on the table in order to feel where it was, stick his syringe in, draw up, and then inject himself with air. And so no wonder his diabetes was out of control and one thing after another. How would you design a world that began to change that? Well, what you see around the country are a huge number of innovators who are designing solutions that go into the home. Sometimes they're sending a pharmacist in the home. Sometimes they're sending a doctor in the home. Sometimes it's a nurse. Or they are putting someone on staff whose job is to help everyone in that family practice figure out how to stop smoking. But these kinds of programs are lowering costs, 20, 30, and 40% in numbers. It's still at a very innovative phase. People aren't sure how to scale and drive these forward. But what we're seeing is that you have an explosion and a shift in investments from just drug and device in healthcare to how you innovate and make healthcare services change. We know now that healthcare is of a completely wrong design. We've had three main ways that you interact with the system. You go for a 20-minute office visit. If they can't fix you or address the problem or they aren't open, it's an ER visit.  We know that's relevant to only a fraction of people. It doesn't address any of these kinds of people that I just talked to you about. And we're starting to see a tremendous amount of innovation that comes from, can we use email? Can we use the web? Can we call them on the phone? Can we do things in off hours? All things that are currently not paid for, generally not paid for, either under government insurance or private insurance. We are starting to see that there are ways that this begins to change. That you have innovators from a variety of different sources that are realizing that you can make those kinds of approaches viable. The question is whether we have payment systems that allow for it. Some of the most powerful changes are going to come from beginning to be able to pay for what you would call non-visit based care that is not based on your eyeball to eyeball sitting down with your physician. And no think tank in the city is tracking that ability to make that transformation. We're going from what I would call the century of the molecule to the century of the system. For the 20th century there was tremendous power in science from reducing our problems to their finest atomic components, to the gene, to the neuron, to the molecule, or to the subspecialists that you see, you know, the right finger of the right ring finger surgeon for your problem. But what we discover is we now in the 21st century are much more interested in the results that come out of these different components is that it's the networks of genes that lead to how genes work. Or it's the ways that the neurons are connected together that lead to behavior. And in a similar way it's how the drugs, the devices, and all of these specialists with only pieces of the knowledge fit together to produce the effects that we have. But we have a system that was made for the molecules, not made for the systems, in fact. We're seeing lots of folks begin to recognize this. Among them are employers. BMW, for example, taking a look at its numbers, found that the top two reasons their employees visited the emergency room were mental health visits and dental visits. So they put on site a dental clinic and a primary care clinic with behavioral health capability. But when I talked to them, why would BMW decide to do this? They were actually running a health care clinic and system in South Carolina. It's not exactly their domain of expertise. And they told me a bumper story, which is that they were building bumpers. They thought it would be more efficient to outsource the building of bumpers. And for a while it really was more efficient. And then as the bumpers started to be the same color as the car itself, they needed to bring the bumpers on the inside and figure out how to go into the bumper business. But as soon as somebody figures out how to do the bumper business properly again, they will be glad to get out of the bumper business and put it out. And that's what they're waiting for the health care system to do as well. I think our area of work and innovation is how to create success through building relationships with people in crisis. That the sickest people are largely people in crisis. They are the elderly, they are the disabled, and they are often the poor. And who will do that and be able to provide the innovations that make it possible to reach these folks? I think in many ways it opens a lot of questions about some of the limits of policy. We are at two diametric opposite poles that we're debating. Do you just leave the doctor alone, or do you mandate through Medicare exactly what they need to do? But in fact, the most effective approaches have been the building of organizations that are in the middle that make the doctor do things they may not want to do, but are close enough to the care, they're local and they're regional, they're close enough to the reality of care that they're much closer than any government can manage to be. So in Camden, New Jersey, where I told you about this doctor, it started out as a bunch of saintly do-gooders, four people on small grants at the Camden Coalition. They did in a year cut costs of that 1% group of patients, they took 100 of them and they cut their costs 56%. But two years later now, they're 55 staff, they have a $5 million year budget, and they have contracts with Center for Medicaid and Medicaid Services, UnitedHealthcare, and the state Medicaid program. And they're not stopping that growth. And it's going to come from working with these organizations that would give you, be able to create policies that give them the ability to use dollars outside of the standard office visit, generate accountable results, and then be able to be rewarded for that kind of success. I will just say there's probably over 100 cities now where these kinds of programs are really starting to take off and thrive in various combinations. And in many ways, it's a map that's parallel to a kind of debate we're having in education. We know you can't run education from Washington, but if you do nothing about it and simply leave teachers and principals with no pressure whatsoever, you just get an enormous amount of variation, failure, and high cost. And I think in the ways in which New America has been pioneering some work in education that starts to hold accountability at the local and regional level, feedback data and understanding, and be able to drive resources to the places that are successful, it's a similar map of what we're starting to do in healthcare and can be done. So thank you. So, time for questions. All right. She's got her hand up. We'll let her get the microphone, and then we'll go over there. There's one coverage right next to you. Meredith Wadman with New America Foundation. There was a really illuminating piece in the Washington Post a week or two ago about a Medicare, or not a Medicare clinic, a pain clinic in Huntsville, Alabama that was billing, I don't remember the exact number, it was something like an order of magnitude more per capita than the average for the nation for pain medication. And this came about because Medicare records are now becoming publicly available. But it raised the question of how do you get control of runaway costs without addressing provider incentives, as long as doctors make more money to do more procedures than all the good stuff going on in New Jersey doesn't seem an adequate counter to that. No, absolutely, you can't. So there's two things about it. First of all, the initiatives that opened up government data have hit healthcare in a big way over the last two, three years. And part of the fascination to me is that docs grumble about it, but there has not been the kind of screaming in the streets that you would have expected when you put on the front page of the New York Times the highest physician earners in the country from Medicare and other steps like that. I think it's mostly been used as a way that has produced more transparency and exposure of these problems and the incentives that are behind it. So there is no question that you cannot, that we're not going to be successful in a world of a fragmented fee-for-service system in which you're paying people for their components for what they do. And there's no better example than when the New York Times and everybody else published the highest earners, that when you scraped away the sort of mistakes in the data, that in the top 10 earners, half of them were in oncology and the other half were in ophthalmology, and they were all about drugs, drug called Lucentus in ophthalmology and a handful of cancer drugs. And it's because in those two specialties you get 6% of the drug price goes into your own pocket as a doctor. So it's just a crazy incentive. It's one that does not belong there. And so the, you know, the recognition that in fact doctors do respond inappropriately and aren't completely professional monks about the reality of the ways in which we're paid plays into what is going on. The experiments that have created various forms of bundled payment, whether it's at the price of the service or an entire organization, an accountable care organization, that gets a fixed amount for the patients per year, is increasingly the way that people believe we can move in this direction. No one, you know, I just would submit that it's a radical experiment. We've never actually had major sectors of the economy where you have to pay for results in that same way when the individual, when there's market failure. You know, so the blind patient as the shopper who can shop around or the elderly Alzheimer's patient who's a shopper who can shop around, I mean these sickest people are the folks that we have to figure out how to govern care for. So as we move to those kinds of payment systems we are seeing that damped down costs in those systems. It requires a lot of data and to some extent possible size and so the concerns are that these big organizations that are taking contracts for a whole payment for 500,000 people and their care, that they are becoming monopolies and that that will end up driving the prices back up. So we're in this experimental phase where we're moving away from fee for service. We're giving big med a budget to lower the costs but will it produce quality and will it still control the costs and still the debate that we're under now. Here comes the mic, why don't you go with that? Why didn't the legacy insurance system not already deal with this? I mean presumably United Healthcare could see that some physical therapist in New York's billing $10 million or that somebody is going to the emergency room 110 times and they would have had an incentive to intervene and figure out the system. Why didn't they? So there's a cynical take and then there's the sort of maybe economist take. So the cynical take is so you get, it's like a hedge fund, you get X percent of your revenue that you have coming in so why do you want to keep cutting the revenue? So that's the cynical take. If you're an insurer trying to cut your total premiums and the revenue there, then why would you want to do that in the long run? Now the argument that I hear from the executives, of course we want to cut our costs because we can try to improve our margins that way. But at the end of the day, in order to do that you have a choice. You either fight with the people who are paying the bills, the employers and others over what the price of the premiums are or you fight with the doctors to lower what they're charging. They lost that battle in the 1980s and 1990s that when they fought with the doctors over what the costs were going to be we handed them their heads and so they found it much more comfortable to battle with employers and say, yeah I'm sorry we're going to force you to pay 12% more this year than it was to tell a doctor I'm going to pay you 12% less this year. As we move into this arena the prospect of being able to make contracts that hold the providers accountable for their costs, introduce transparency and make those more visible, they've generally been on board with but very cautious about how much they think they can do. The most interesting group are really the Medicare Advantage firms which are the ones that are the one-third of Medicare now where they take a fixed amount of money for the care of Medicare patients. Those companies those insurers used to avoid the sickest now they see them as a possible profit center and are in fact competing to take those folks and are driving hard bargains with physicians or deciding to employ them in a completely new model which rewards them for spending more time with the sickest patients really keeping them out of the hospital keeping out of the emergency room and helping them be as well as possible and so we are starting to see some corners of that insurance world where the incentives line up in ways that drive them in this direction. How are we doing for time? Okay, we'll go to the middle here and then I'll keep bouncing. What do you think explains the recent slowdown in healthcare costs and do you think any of it has to do with experimentation with these new payment models? Really hard to know, there's huge debates going on and I'm certainly not an economist to be able to adjudicate on it but the description is first of all to understand for the last five years, six years we've had the last four years has been the lowest growth in healthcare costs in 50 years. That last quarter however there was what would be annualized 10% increase in costs and the reason why probably over the last quarter is that Obamacare coverage has started really kicking in and a whole bunch of people are getting healthcare that they didn't have before. Another possible explanation is that as the economy starts to improve people are spending again and spending it attending to the problems that they didn't their medicines that they didn't fill visits to the doctor that they didn't make the operations that they put off for the last years because of the economic recession. The other argument is that in fact this is a blip and that overall healthcare costs are moderating because we're making structural changes in healthcare like the ones I've described that are starting to work and there's some evidence to suggest that that might be the case. The lowest cost increases have been in the parts of the country that have been moving the fastest into these new models of delivering healthcare and arguably you probably have a mix of both of all of the above going on that it's become very clear to people inside medicine that we aren't going to be able to practice and have a system that paid us the same way we did and that we're having to move to being cost-conscious as part of what providing good care is about. People in medicine are becoming very conscious of something that is called the financial toxicity of our care that is the ways in which what we prescribe can end up bankrupting people or hurting their care because I mean hurting their well-being because we've hurt them financially and as a side effect of actually having these high deductibles and copays that cost consciousness becoming part of the professional ethos of medicine is starting to happen. No question though the last four or five years I think of the economic recession has also pinched people's wallops in ways that made them less likely to get care that they've been looking for and so it might be a mix of both. I'm Wendy Parris. I'm a fellow with New America. I have two questions. You said that a hundred cities have something like the Camden Coalition. Is that specifically doctors going and visiting high cost patients and figuring out if there's some mistake going on there? Is that what that is? My second question is I'm wondering about the impact of these urgent care centers that people go to instead of the emergency room. When I talk about more than a hundred cities what I was talking about is some variation on that because of a shift in the ways that they're being paid for care. Accountable care organizations which is what the Camden Coalition has actually become are now there's more than a hundred of them it's probably closer to three or four hundred of them that are shared savings models that is if they are able to save the money save money on the care for people and improve their quality they will be financially rewarded for doing so rather than the old way or really the way it is for still 85% of people in healthcare when you do the more you get paid regardless of whether it's for a good result or not. So as we see more and more organizations in different parts of the country begin to do this we're seeing lots of experiments and they may be sending teams into the home and really tracking them they all involve what people call population management instead of just thinking about the one patient that you have one at a time and that is they're being rewarded for the ways in which the overall population of their patients whether it's 10,000 or a million patients how well they're doing overall are they having fewer ER visits than they used to are they having fewer hospital admissions are they having their blood pressure and their diabetes better controlled those kinds of questions are going to emerge and even move into the specialty level are we making back surgery less frequent are we taking good care you know by some arguments back pain alone is almost 1% of our GDP so if we think about how we move people out of what we know to be unnecessary early surgery for a large percentage of those but a great number of people who never can find physical therapy in the first 48 hours of a severe back pain that then relates into surgical care that many of these systems are the ones that are starting to figure out oh yeah we should make physical therapy appointments available instantly within the first 48 hours for anybody with a severe back pain rather than just the spine surgeon appointment being the one you can get Lenny this is of course what some of the stuff you got to do when you were at McKinsey right so I was going to ask you a policy related question though if a large portion of the answer of restraining health costs is effectively scaling the accountable care organizations that work what are the top two or three things on your mind that would help make that happen at the policy level either at the federal level at the state level or any of those practical without having to go to congress so I generalize a little more that it's yet sure that it's the accountable care organization specific model that has to work but it is the ways in which you start to reward non-visit based care so you know I think very powerful are ideas like how you pay primary care physicians and paying primary care physicians there's some innovations now around being able to pay for a flat fee for handling people by email handling people by the web and other steps like that so I think those are going to become the sort of powerful mechanisms moving forward it's at the less glamorous level of just how do you pay the individual doctor for what they do than necessarily these large contracts with the organizations I get the sign now that we're ready to move on so thank you very much


Guys guys guys the new trailer for camp Cretaceous season 3's drop. Shall we watch it? Let's go Chotto chotto chotto chotto matei kudasai nihongo Nihongo toster zahi Isho ni ima shouka. Hey ima all right welcome everyone. Oh sure say minasai We are gonna be watching season 3 of camp Cretaceous Weirdly it is in Japanese now before you do a say anything. I don't really know that much Japanese And I haven't actually been doing my lessons for oh God the guy either a long time so most of what I remember in Japanese is Muscle memory out of all the languages that it could have been Japanese. You know what I'll take it I'll take it could have been anything Japanese The school see what I must I think when it comes to What they're saying you can break down without knowing what the characters are saying so what we're gonna do We're gonna watch it all the way through and then we'll we'll sort of break it down First we're going to watch it all the way through without like you know So we'll take it in and then we'll break it down scene by scene So first off should we just just watch it just get get straight out of bam Oh wait So that was their attempt I assumed to get off the island didn't go what didn't go well So saying this time will be different or something. They try to escape many times apparently That's a monlopasaurus He's got me. He's got me going on here. Oh E sympathy right so this is a sympathy. This is the big thing this is there like They're in Dominus Rex Okay, oh is that the raptor squad that could have been blue. I mean it well has to be blue right cuz they're all dead Okay, this is 750 but they have power they made an electric fence crazy Yeah, I got the claw that it would have if it's a Raptor hybrid Is when this is gonna come out interesting, okay Right well, so I mean the stuff all the I don't remember the the main characters are called He just says goodbye Jurassic World here. Yeah I loved it the way and it's just like it's English He just says goodbye. Oh, this is interesting. Okay, so we have them trying to escape I assume that this might be like yeah, why does Kenji have my facial hair? What's going on here? You can't grow any new can I So this is obviously one of their final attempts or one of many attempts that they have They've they've tried to escape down if we skip ahead here. This seems to be crashed helicopter. Oh Interesting, I never even knows that. I mean, what what does she actually say? Like I said, my Japanese is not the best. I assume it's they've tried many different. I mean with they've tried many different things says something about this time You've got like what seems to be Spheres which I've crossed through you've obviously got the helicopter that she's just cropped out crossed out Which I think is that one you've got a kayak so this is obviously loads of their escape plans that happen I mean they can't just stay on the island and definitely And obviously this is all still taking place between Jurassic World and Fallen Kingdom because the volcano has erupted and everything's still there Are their character models looking a bit different? I don't know. I think they might be changing it was just Kenji that's got like Got facial hair. So they obviously step like stumble upon now. This isn't the visitor center I wouldn't assume this is the visitors center because anybody who knows it would know that it does not have big glass Windows at the side of the door So this could be a mansion or something kind of gives me trespasser feels you just need John Hammond whispering in your ear now How bad it all went I get the feeling that this might be Kenji's because I think somebody some people have mentioned it about Kenji's Like dad or something had a villa on the island or something like that. However, it's overgrown So why would he own an overgrown building? It could be the visitor center from a different angle or they've just retconned it slightly and forgot about it Because it's overgrown that the the architecture on the door is is pretty much the same as it would be With with the old Jurassic Park style. It's a suri tatimono as old building So Totemo Very old And then so we've got the characters that they saw move in why was now doing this with DLC player?  This is way better. Okay. Now now we can actually scroll through. Oh, it's brighter. Oh, that's interesting Okay, so when they're in this mansion, we get the first preview of a monolophosaurus Very strange hallway very reminiscent of course of Jurassic Park with the raptor and Lex and Tim with the Jello So we're gonna see we're seeing three new dinosaurs minimum. We're seeing monolophosaurus. We're seeing Dr. We were Soros We're seeing E 750 and we're also seeing The demorphodons so maybe this is another one of their escape attempts But I don't I don't understand how it could be an escape attempt. Well, you're gonna just paraglide over the ocean for miles So obviously they've tried to escape from somewhere And they've had to adopt this paraglider steel steel the power guy. I can't remember the actual name Abraham, but I don't think that's the right word and then this is them at their makeshift house, which I I don't know. This is either midway through or I would say at the end this could be the final showdown between E 750 now the weird thing is we get a Video of dr. Woo over here if we just watch a little bit all the teaser shots the incubator The the the door with the monorail sign and then if we slow this frame by frame Yeah, that's E 750. Okay, so weird We have E 750 What seems like kills dr. Woo now? We know that's not the case Dr. Woo doesn't that layer that I that I is E 750 it could be interrupted But I don't I don't know if interruptor has the eye But from what we've seen so far especially at the end, I think we get to see E 750s eye. Yeah, there it is Okay, so this is the Scorpius Rex First ever look at it in Camp Cretaceous people have drawn concept art Mattel has already been in touch with me about the toy video and it said would you mind please taking that down However, the original video you didn't ask to take down and other youtubers have made videos on the toys have not taken it down But you know what Mattel? I'll do it for you. I'll take it down So we've got the we've got the Scorpius Rex there first ever look at it Having the I mean we don't get to see much more of it than we already have which is just like a closer View of the Ike's over this time. We get to see it spikes. It's black Bit like indoor raptor which I don't even know if I can say about the toy other people have now got the toy that shows In the back. Oh, but anyway like this whole situation with the toy of E 750 It's just left a really bitter taste in my mouth when it comes to Scorpius Rex And the way it's just been handled. I know no not only didn't Mattel get in touch with me But they got good they got in touch with a couple of other uh dinosaur tubers and you know cover drastic part content about taking it down and it really felt like Uh, Mattel would just I don't know. It's like it's already out there. What are you doing? And the original video we've we got our stuff from is still up and you're letting it be up. It's either some favoritism by Mattel and universal which I feel like wouldn't be hard to see because I feel like they're definitely are certain creators That universal are favoring over others me not being included Mattel have reached out to me I've worked with Mattel in the past but universal it's strange because I've met somebody from universal and they said Oh, we know all about you Uh, you know and I didn't get a chance to really talk to them But I was oh they in universal do know exist yet Never reached out and it's just like I don't know like I don't want to feel like I'm too my own horn It's just like it just feels a bit like Oh, okay. I mean you just don't care Cheers, oh brilliant But anyway, I like I'm not saying they need to get in touch with me It just feels like a bit, you know when you've been supporting something for so long And you have received zero acknowledgement for it Um by by the people not that I'm saying, you know just because you support something they need to get in touch with you But I don't know it just feels like if you type in Jurassic World on youtube At least one of my videos will come up. But anyway, um, I still love this franchise and I will keep on I will keep on I will keep on covering it without getting a little budge of participation from universal Will still do it So we have the introduction to the demorphid on not not just one demorphid on freaking tons of them I don't know where they where they all came from I mean we've seen in a clip that isn't in this one actually that they stumble upon a nesting ground of demorphid on So I'm assuming this is where they all come from the reason that's the reason why there is no tyrannodons um I think we did see tyrannodons in the last season or was it the end of season one When they were they were attacking the monorail. I think that's when we saw them Maybe we haven't seen them since the end of season one, but um, we're on demorphidons now guys demorphidons Uh, we're obviously going to see monolopersaurus. Oh What is that? That looks like a makeshift taser. We've got like a battery cell attached to it and it looks like it looks like a gun But I assume it's it could be a speargun Maybe but I I I mean they're just turning kenshin to me now. I think I think that's I think that's um metal and universals and netflix's way of getting me in the uh We'll just make them look like they gave me I'm talking i'm talking. I also got somebody here w 60 m 6 a zero So we had e 750 so we've got w 60 so I wonder if in the future We're gonna see these addressed in a little way like I mean basically what they're doing now the way E 750 has been built up has been very clever throughout the whole series has been little hints of this hybrid I'm assuming this is canon if you're a diehard fan then obviously it means a lot to you um But in another way this like I said if this is canon they could just say oh this They could bring another hybrid up from nowhere and just say there it is. That's the hybrid And maybe that's what they're planning on doing. What is this player? This isn't vlc. What's going on? So they obviously seem to go somewhere and find out and this might be in the mansion Now if we have a look a little look around we've got a some posters or a window and then some leaves So it could be when they they enter this and actually I think it's yeah So we've got they they enter the mansion Inside the mansion they find a model of a source or it could be just a hybrid. Okay. This kind of has looks like the emergency shed that um ellie sattler came down to find uh Arnold is it richard? Arnold? Uh, so this is actually kind of a lab. This is separate from the um the mansion It appears to be um, but I'm looking forward to this. This this looks awesome um When obviously no indomitable specs we have Now if we go frame by frame with this raptor, I don't know if I've left it too late Uh, yeah, that's blue. That's blue. You see it for for like one frame Right there. Oh, it may be even more. Yeah It could it looks like it's gonna be blue right because you've got this There's bluish tint here on the eye and it what looks like a little bit up here So let me see I mean that that's this is probably gonna be below. I mean it can't be any other raptor, right? Um Unless one of them survived. It's kind of the same color I think if you had a side-by-side of what we've seen blue look like in this franchise You'd probably be able to easily determine that this is definitely blue. I wonder what this car is Are they still driving around? Do they still have cars? I don't even know about that. Okay. That looks weird That little clip is just like, yeah, it's a clip obviously running away from something. Don't know what she's running away from Um, could be more baryonyx could be a serratosaurus like we've seen before this. This is really interesting They've made their own compound Um, and we see e750 sort of brush up against it Uh, and actually no sign of bumpy No sign of bumpy whatsoever Now that could be the reason why they have this little outer Electric fence is you know, but we can't go in the tree house is a bit too big So they have like a secure bit for bumpy to live in so there we go It rubs up now. It does not look like it's very stable So we have the they've obviously tried to reinforce it somewhat putting the uh putting planks of two by fours against the fence, which Wouldn't really do much Uh, so obviously they turn out they put that and they turn on they tied some rope around the uh The fence to keep it keep it upright Uh, keep it together now. I don't know about you, but I cannot see for the life of me Doko, where is it? And then of course We get the teaser now universal know that the hybrids are the main selling points of Any franchise? Oh, sorry. Yeah franchise any movie it appears to be. Um, which is why Um, the last of the movie in the franchise dominion Is going to be interesting because with Jurassic world we had interrupter Sorry indominus rex which fallen kingdom we had interrupter and with camp cretaceous now This is the big one. This is the one they've been building towards the whole time And it feels like it's a bit like disney in a way the That just stuck in a rut. It's like I was to remix They sell money remake remake remake remake all the disney's and now with uh Jurassic world. It's like hybrids Hybrids make the money hybrid hybrid hybrid. You get one. You get one falling kingdom. Oh interrupter come gracious Scorpius rex.  Who cares? Um, uh, so I don't I I get the feeling that we might get hybrid with the final movie like But who knows? I mean this is seems to be what's working and for a reason kids love the The hybrid thing the mystery. What could it be? You know, maybe it's this fuse with this Theories and and that's what drives a lot of it. I think but from this trailer, um I think it's it doesn't feel like it's gonna end. It doesn't feel like there's any escape For the characters so far unless what they did they showed at the beginning because this is what happens We've got we've got the the the costumes of the characters. I mean, of course, we got ben who I don't know. It's like my least favorite character now just because they tried Too hard with ben to make him, you know, because he was all because I completely 180 with his character Now he's Rambo for whatever reason. I don't know why because he survived a little bit by himself and therefore became Tough as nails. Um, let's go and have a quick look at the costumes because I think yeah, they're always dirty That's interesting. Okay. Okay. Okay. I just thought maybe if it was at the end then maybe there was something we could gather From the they're sort of overall costumes that they didn't have Now that they do have during, you know, the rest of this so we could conclude that maybe this could be Afterwards, but it doesn't look like it. It looks like this could be That it'll probably start with this scene that that's why the trailer's starting with it And there you go. The sail has ripped it flies away and they get washed up back on the island and say Oh, it looks like they were trying to get to a downed helicopter That's interesting. Maybe that's what they were trying to do. I don't know But anyway, maybe they do get the helicopter. They get something they get access codes They get into this new place they find the file of dr. Henry Wu telling them about the hybrid and that Maybe it can only be controlled a certain way. They find some sort of tidbit of information about it through that That's why they set up the electric fence. Maybe it doesn't like electricity or electricity Deactivates its camo or god knows what And just the rest of this in shoes then now they have they I would assume they kill it. Um, I feel like this isn't going to be the end of camp cretaceous There's probably going to be a season four. I mean, let's be honest This is the only real thing that's tidying us over between the the last movie and falling kingdom Because we're getting nothing no support from frontier when it comes to Jurassic world evolution because pretty much the mods have taken over and I think frontier knows that And they're happy just turn a blind eye and let the moderate and the mods just make good content for the game And they're probably busy working on the next Jurassic game And the movie is still being made uh in post and all that jazz But anyway guys just a short little video even though probably hasn't been that short has it. Um, Yeah, interesting interesting. Look again, like I said when this comes out We'll uh, we'll have a watch party like we do with the season one and season two It's it will probably binge it all in one day all in one session And I'll leave that up on the channel so you guys can watch it So if you enjoyed this video leave a like uh until next time kondo ja mata ne