Philadelpha Phillies Sue To Keep Beloved ‘Phanatic’ Mascot From Free Agency

The Phillie Phanatic during a baseball game against between the Philadelphia Phillies and the Colorado Rockies in May in Philadelphia.
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Laurence Kesterson/AP
Major League Baseball’s Philadelphia Phillies are suing the creators of “The Phillie Phanatic,” to prevent them from making the green and furry mascot a “free agent,” available to root for and promote other teams.
The Phanatic debuted at a Phillies game in April 1978 with the help of Harrison and Erickson, Inc., which designed and created it.
According to a lawsuit filed in New York, the firm’s principals, Wayde Harrison and Bonnie Erickson, were paid over $200,000 by the end of 1980. In 1984, after it was clear that the Phanatic was a hit, Harrison and Erickson terminated the original licensing agreement and renegotiated a deal for $215,000. The Phillies say the 1984 agreement gave the team the rights to the mascot forever.
The 39-page lawsuit says the firm “has threatened to obtain an injunction against the Phillies’ use of the Phanatic and to ‘make the Phanatic a free agent’ if the Club does not renegotiate the 1984 Assignment and pay H/E millions of dollars.”
The Phillies claim that the team has a 41-year investment in the mascot and that it is a “co-author of the Phanatic costume” and “author of the Phanatic character.”
In addition to the Phillie Phanatic, Bonnie Erickson is also known for her work with The Muppets creator, Jim Henson. She has created mascots for other pro sports teams. But none caught on like the Phillie Phanatic.
As the Victory Journal reported:
“As Harrison/Erickson see it, three elements determine the success of a mascot character: ‘A good design, a good performer, and the support of the team,’ says Harrison. ‘None of those three things is easy. Nobody really executed the program as well as Philadelphia. The Phillies, they got it 100 percent.'”
Homeland Security’s Civil Rights Unit Lacks Power To Protect Migrant Kids
A Guatemalan teen asylum-seeker (left), who isn’t able to hear or speak, signs with his mom in Florida. He was brusquely separated from her and held in a shelter for nearly three months, unable to readily communicate, according to a civil rights complaint filed with the Department of Homeland Security.
Susan Ferriss/Center for Public Integrity
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Susan Ferriss/Center for Public Integrity
The children’s lawyer was incensed. Her two tiny clients — one of them blind — had been in a shelter for three months, separated from their mother.
The family had traveled from Mexico to the United States, reaching Nogales, Arizona, on March 1, 2018. Officials at the border found that the mother, Nadia Pulido, had “credible” reasons for seeking asylum from an ex-partner who, she says, beat her and stalked her after their relationship ended.
But U.S. Customs and Border Protection still sent Pulido into an adult detention center run by U.S. Immigration and Customs Enforcement. She had an hour to say goodbye and try to assure her blind daughter, 6, and sobbing 3-year-old son that she’d see them in a couple of hours.
“A couple of hours turned into months. Painful months,” Pulido recalled in an interview.
To help the children, pro bono attorney Maite Garcia turned to the U.S. Department of Homeland Security’s Office for Civil Rights and Civil Liberties. She filed a complaint with the office on June 7 of last year, explaining that Pulido’s daughter was “completely blind and requires assistance for daily living” and would be better off with her stepfather, a U.S. citizen.
Nearly two weeks went by before the civil rights office replied.
“The issues you raise are very important to us,” CRCL finally said in its emailed response. Then came a disclaimer: “Please be advised that our complaint process does not provide individuals with legal rights or remedies. … Instead, we use complaints like yours to find and address problems in DHS policy and its implementation.”

The Office for Civil Rights and Civil Liberties was created within the Department of Homeland Security in 2002. The office’s mission is to advise the department and prevent civil rights violations. But some insiders say the unit has always lacked teeth.
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That was the last Garcia heard from the nearly 100-person office in Washington, D.C.
The tepid response from the department’s civil rights office bolsters objections — not least from former staff — that the DHS watchdog is failing to stop rights abuses as they’re happening inside a detention system that’s expanding rapidly under the Trump administration.
The ineffectual handling of individual complaints adds to criticism that DHS leaders no longer heed recommendations from the agency’s own civil rights experts.
“Put yourself in the shoes of the person who’s sitting in the cell or who’s separated from their parent or who’s wondering where their child is,” former CRCL staff attorney and adviser Ellen Gallagher said.
A recent whistleblower, Gallagher has accused the civil rights office of failing to investigate multiple individual complaints alleging unjustified solitary confinement of detainees in ICE custody. Gallagher is now with DHS’ Office of Inspector General, a separate internal watchdog specializing in issuing reports after lengthy investigations.
“It seems to mislead the public, to invite complaints involving specific information about the individual or the family and the alleged violation, if Civil Rights and Civil Liberties had no intention of specifically investigating or resolving those individual complaints,” Gallagher said.
Acting Homeland Security Secretary Kevin McAleenan has insisted that DHS has “layers of oversight” to correct abuses. “We have good supervisory oversight, and we hold people accountable,” he said during a July 9 interview on CNN in response to questions about filthy conditions in CBP holding facilities.
Gallagher’s impression, however, is that the civil rights office “was actually fairly intimidated by ICE and CBP and did not want to engage in activity that might offend either. That is an odd and even disturbing posture for an oversight authority.”
Internal CRCL log: a flood of complaints
Some CRCL staff members say that individual employees contact CBP or ICE to try to informally resolve civil rights complaints. But they can only advise agencies, they say, because their office isn’t set up to halt abuses as they happen.
Cameron Quinn, chief of the civil rights office and an appointee of President Trump, declined a request for an interview. Another CRCL official responded in writing to questions, asking not to be quoted by name.
“CRCL does not have authority to remedy individual complaints but instead focuses on systemic issues” at DHS, the official wrote. The office does have authority, however, to seek “remedies” for people facing disability discrimination, the official said, declining to elaborate.
“With regard to family separations,” the official said, “CRCL investigated the issue from a policy and process standpoint.” The civil rights office then sent its recommendations to ICE and Customs and Border Protection in a memo. CRCL declined to release the memo, calling it a “deliberative” document.
CRCL, the official added, still has “open investigations” into the separations of children under age 5, the separations of children with disabilities and standards for separating families based on parental criminal history.
The Office for Civil Rights and Civil Liberties was created along with the Department of Homeland Security in 2002. The office’s mission is to advise the powerful federal department and prevent civil rights violations such as the post-Sept. 11 roundups of Muslims without due process. But some insiders say CRCL has always lacked teeth.
Last year, the civil rights office proved especially weak as complaints about due process concerns and family separations began pouring in — nearly 850 in the first half of 2018 alone, logged into a CRCL database. An independent journalist obtained a copy through a Freedom of Information Act request and then shared it with the Center for Public Integrity and NPR.
The complaints referenced more than 380 separated children 10 years old or younger, of which more than 120 children were age 5 or younger.
More than 140 complaints arrived before the Trump administration announced its “zero tolerance” policy on April 6, 2018. More than 160 cases of separation referenced in the log were carried out before that date. The zero-tolerance policy required separating families so that CBP could hold all adults for prosecution, even for a first-time misdemeanor illegal entry.
Former and current staff in the civil rights office say their colleagues were so upset by allegations in the complaints that they openly wept at desks as they reviewed the cases.
By May of last year, senior staff in the office had urged Quinn, in an internal memo, to challenge the separations. “CRCL should express great concern over our exclusion from these critical decisions,” which CRCL has the authority to review, the memo said. “Deliberately harming children to deter parental behavior would require an exceedingly strong justification to pass muster as a reasonable seizure under the Fourth Amendment, among other concerns.”
Lawyer and former CRCL senior adviser Scott Shuchart, who resigned from the office last year, said his and other advisers’ concerns were “blown off” by CBP and other DHS leadership in meetings.
One complaint to CRCL in January 2018 reported that CBP separated a 4-month-old infant from a Mexican father who had prior immigration violations but feared being sent back to Mexico.
Another reported that an 8-year-old said CBP officers “kicked him and/or hit him with a shoe” to wake him. Dozens of other complaints described children upset about their parents’ uncertain whereabouts and abrupt disappearance — including a 14-year-old in CBP custody who said he was separated after a meal break and was then “told by officers that his father would be deported.”
About 95% of all complaints logged came from the federal Office of Refugee Resettlement, a unit within the U.S. Department of Health and Human Services that’s responsible for migrant-children shelters.
Former senior staff in this federal resettlement office say the volume of complaints is unprecedented. Robert Carey, ORR director during the final two years of Barack Obama’s presidency, said he thinks ORR employees were trying to stop separations by filing complaints.
“You probably have a deeply traumatized, possibly hysterical child that you’re trying to care for,” Carey said. “I’m guessing some of those cases would require … the intervention of a therapist, particularly if you’re talking about, in some instances, young children.”
HHS officials declined to make leaders in its Office of Refugee Resettlement available for an interview.
Most other complaints came from nonprofit legal aid groups — including 18 filed by the Phoenix-based Florence Immigrant and Refugee Rights Project, where Maite Garcia works.
The complaint about Pulido’s blind daughter and toddler son appears on page 276 of CRCL’s 366-page document.
Another Florence complaint filed on June 14 of last year appears on page 321. It raises objections to CBP’s separation of a Guatemalan mother from her 17-year-old son — who is unable to hear or speak — without regard for his disability. The boy could have qualified to be “paroled” into the U.S., a conditional form of humanitarian release. But that never happened — and the case shows how a formal complaint can wither in the Department of Homeland Security’s Office for Civil Rights and Civil Liberties.
Deaf boy’s mom taken away

The story of the mother and her deaf son “exhibits the cruelty, the chaos” of how migrants are treated, the mother’s attorney said. The teen had long been bullied in Guatemala, and thieves had robbed him at gunpoint. When mother and son got to Arizona and requested asylum, U.S. Customs and Border Protection separated them into cages segregated by gender and age.
Susan Ferriss/Center for Public Integrity
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Susan Ferriss/Center for Public Integrity
The story of the mother and her deaf son “exhibits the cruelty, the chaos” of how migrants are treated, said Elizabeth Jordan, an attorney with Denver’s Civil Rights Education and Enforcement Center. She represented the mother while the woman was in ICE lockup in Colorado.
On April 25 of last year, the mother and her 17-year-old deaf son approached CBP officers after crossing the Arizona border and asked to apply for asylum.
The boy and his mother now live in Florida, where they are in the process of applying for asylum. In an interview, the mother, who asked that her name not be disclosed, said she’d worked previously in the state, sending money to Guatemala to rent a room for her son and pay his tuition at a school for the deaf there. She eventually returned to Guatemala to care for her son and her own frail mother.
Three months after she got there, her mother died, and her deaf son lost his primary caregiver. He’d long been bullied in Guatemala, and thieves had robbed him at gunpoint. Mother and son both set out for the United States some months later.
“I don’t do this for me. I do it for him,” she said, “because I’m not going to be alive for all of his life.”
After Customs and Border Protection took her and her son into custody near San Luis, Ariz., the mother said, officers ignored her pleas to keep them together rather than place them in cages segregated by age and gender. Her son, she told the officers, needed her to interpret. When she protested further that her son was mute, she said an officer answered, “He won’t need to do much talking where he’s going.”
At some point, while her son was asleep, guards took her out of her cage, the mother said, and transported her to an ICE detention center pending prosecution. She said she was told “you have to pay for what you did” because she’d been turned away at the border the year before. She was sentenced to 30 days in an Arizona jail for reentry and then transferred to an ICE detention center in Colorado, pending deportation.
Meanwhile, U.S. Customs and Border Protection had sent her son on a long bus ride to an Office of Refugee Resettlement shelter in Arizona, where his only means of communication was drawing pictures.
For more than a month, the mother pleaded in vain with detention guards, first in Arizona and then in Colorado, to arrange a video call so she could at least see and sign with her son. Medical records from the boy’s time in the shelter indicate he was distraught: He struck his head against walls and cut himself with a paper clip. In an interview in Florida, interpreted by his mother, he said that to prevent him from getting out of bed one night, he was physically restrained.
“She was profoundly distressed and so worried about him,” lawyer Jordan said of the mother. “This is a person who has devoted her life to keeping him safe and getting the best she can for him. And then, for her to be totally unable to check in on him for weeks …”
A round of emails between the boy’s attorneys and DHS’ civil rights office ultimately went nowhere.
Initially, a CRCL adviser seemed to be working on the Florence project’s June 2018 complaint, arguing that the deaf boy merited humanitarian parole and that for two months the shelter hadn’t “provided him with the appropriate accommodations” for his disability. The adviser wrote that the civil rights office was “reviewing your concerns”; he asked for proof the boy was deaf.
In July 2018, one of the boy’s lawyers emailed CRCL to write that when CBP held the boy in custody, he “was able to understand that the agents were mocking him” because they didn’t believe he was deaf.
The lawyer further argued that CBP, ICE and the Office of Refugee Resettlement, the federal agency in charge of shelters, were all in violation of disability rights because they had failed to arrange a video call between the boy and his mother.
The official from the civil rights office then replied that he was “unable to look into [the boy’s] ongoing concerns” because the teenager had been transferred by CPB, which is within DHS’ jurisdiction, to ORR, which is not.
Instead, he suggested, the civil rights office could investigate the mother’s concerns because she was in ICE custody, which, like CBP and CRCL, falls under DHS. The boy’s attorneys gave the civil rights official contact information for Jordan, the mother’s Colorado lawyer.
By that time, Jordan had already been emailing local ICE officials repeated pleas to set up a video call. The call finally happened — nearly three months after U.S. Customs and Border Protection officers had separated the mother and her son. But it wasn’t because of action by DHS’ civil rights office, Jordan said. It was because DHS was by then under court order to put separated migrant family members in touch with one another by phone and then reunite them.
“In my interactions with individual CRCL officers,” Jordan said, “I don’t get the sense that they’re out to lunch or bad people. I think that they just ultimately can’t get much done. I think it comes from being really hamstrung by the fact that they have to work with ICE and get ICE to concur in their recommendations and actually make changes.”
In the children’s interest
Although Trump ended his zero-tolerance policy in June 2018 after a public outcry, U.S. border agents have continued to separate families due to parents’ criminal records, even for minor offenses, or because of prior deportations.
Immigrant rights groups have long pressed DHS to consider the children’s interests, and they’ve noted that family separation “causes great harm, disrupting emotional and psychological well-being.”
For failed asylum-seeker Nadia Pulido, the groups’ pressure came too late.
Pulido was born in Mexico but is a fluent English-speaker who arrived in California as an undocumented child and was raised by relatives. She could have qualified for a special visa for abandoned children, but no one sought such a visa on her behalf. When she was “literally just young, stupid and hanging around the wrong crowd,” she said, she was convicted of robbery and deported.
Because of that history, U.S. Customs and Border Protection and ICE chose to send her children to a shelter and keep her in detention last year while her asylum case went forward.
ICE could have released her on humanitarian parole. Instead, she was held in detention for eight months, until she lost her asylum bid. She could have appealed, but that would have meant more detention — and more time apart from her young children. In the end, Pulido agreed to be deported to Mexico.
After four months in a shelter, Pulido’s blind daughter and toddler son were finally released to her husband, a U.S. citizen. Attorneys for the children and Pulido believe a federal lawsuit that led to a court order unifying migrant families was likely a factor. And they doubt their complaint to DHS’ civil rights office did anything to hasten the children’s release.
In Mexico, where the kids have now joined her, Pulido said she’s still scared. To support her need for refuge, she presented Mexican police reports about incidents involving her ex-partner; and in her asylum application, she wrote that he assaulted her while she was pregnant and held a gun to her head.
“We were leaving Mexico to seek help in the United States,” she said, “to stay free of danger.”
Susan Ferriss is a reporter with the Center for Public Integrity, a nonprofit investigative newsroom in Washington, D.C. Alison Kodjak reported this story for NPR, and independent journalist Joshua Phillips did so for the Center for Public Integrity. Journalists Madeline Buiano and Pratheek Rebala also contributed to this story.
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$2,733 To Treat Iron-Poor Blood? Iron Infusions For Anemia Under Scrutiny

Plump red blood cells — tumbling amid infection-fighting white blood cells and purple platelets in this colorized, microscopic view — need adequate levels of iron to be able to carry and deliver oxygen around the body. Iron-deficiency anemia is sometimes remedied with IV iron infusions — and the bill can vary by thousands of dollars.
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Shannon Wood Rothenberg walked into her annual physical feeling fine. But more than a year later, she’s still paying the price.
Routine bloodwork from that spring 2018 medical visit suggested iron-deficiency anemia. The condition runs in Rothenberg’s family and is often treated with over-the-counter iron pills, which typically cost under $10 for a month’s supply. Her doctor advised exactly that.
But after two months with no change, the doctor told Rothenberg to see a hematologist who could delve into the source of her problem and infuse an iron solution directly into her veins.
So, the 48-year-old public school teacher went twice in July 2018 to a cancer center, operated by Saint Joseph Hospital in Denver, to get infusions of Injectafer, an iron solution.
When the bill arrived in March, after prolonged negotiations between the hospital and her insurer, Rothenberg and her husband were floored.
The hospital initially had billed more than $14,000 per vial of Injectafer. Since her treatment was in network, Rothenberg’s insurance plan negotiated a much cheaper rate: about $1,600 per vial. She received two vials. Insurance paid a portion, but Rothenberg still owed the hospital $2,733, based on what was still unpaid in her family’s $9,000 deductible.
“I have twins who are going to college next year. I’m already a bit freaked out about upcoming expenses,” she says. “I don’t have $2,700 sitting around.”
Anemia, the principal outgrowth of low iron levels, can cause headache, fatigue and an irregular heartbeat. People with certain medical conditions, including a history of heavy menstrual periods, inflammatory bowel disease and kidney failure, among others, are prone to low iron levels and anemia, which can be severe.
Crunching the national data
Although Rothenberg had private health insurance, a close look at Medicare data suggests her experience with pricey iron infusions is pretty common. Since 2013, the first year for which data are available, about 9 million Americans in the federal government’s health plan for people 65 and above have gotten iron infusions each year. That’s almost one infusion for every five Medicare recipients.
In other countries, doctors usually would not be so quick to resort to iron infusions for anemia — especially in healthy patients like Rothenberg, who have no underlying disease and no obvious symptoms.
In Great Britain, for example, “it would be extremely unlikely that IV iron would be administered,” says Richard Pollock, a health economist at London-based Covalence Research, who studies the use of iron products.
But one key difference between the United States and other countries is that American physicians and hospitals can profit handsomely from infusions. Under Medicare, a doctor’s payment is partly based on the average sales price of the prescribed drug. Critics say that gives health practitioners an incentive to pick the newer, more expensive option.
For patients who have private insurance, hospitals and doctors can mark up prices even more. Intravenous infusions, generally administered in a hospital or clinic, also generate a “facility fee.”
That creates a financial incentive to favor the most expensive infused treatments, rather than pills or simple skin injections that patients can use readily at home.
Indeed, a Kaiser Health News analysis of Medicare claims found that Injectafer and Feraheme — the two newest (and priciest) infusions on the American market — made up more than half of IV iron infusions in 2017, up from less than a third in 2014. Cheaper, older formulations — which can go for as little as a tenth the cost — have seen their share of Medicare claims fall dramatically.
Situations like these, which drive up Medicare spending, are why the Trump administration has suggested changing how Medicare pays for intravenous drugs. The administration would tie Medicare reimbursements for some IV drugs to the price paid in countries that set drug prices at a national level — prices that are partly based on an estimate of each drug’s comparative value. This plan has generated sharp backlash from conservative lawmakers and the medical and pharmaceutical industries.
Physicians argue that they simply prescribe the most effective medication for patients, regardless of what the payment system would suggest.
But the government’s own Medicare claims data, research and stories like Rothenberg’s paint a different picture.
“When there’s a financial incentive … that might move the physician away from the choice the patient would optimally make, we might be concerned,” says Aditi Sen, a health economist at Johns Hopkins Bloomberg School of Public Health, who is researching how doctors prescribe and are paid for intravenous iron treatments.
The example of iron infusions, she adds, suggests “a clear financial incentive to prescribe more expensive drugs.”
Iron-poor “tired blood” and the marketing of iron supplements
Treatments for iron deficiency are nearly 100 years old. Geritol, a decades-old dietary iron supplement for iron-poor “tired blood,” was among the first medicines widely advertised on TV in the 1950s and ’60s.
The first federally approved iron infusion didn’t hit the U.S. market until 2000, but the treatments have since surged in popularity. For one thing, infusions carry fewer side effects than do pills, which can cause constipation or nausea. And scientific advances have mitigated the risks of intravenous iron, although getting infusions still comes with inconvenience, some discomfort, the risk of infection at the IV site and, rarely, serious allergic reactions.
Five branded products now dominate the American market for IV iron, and three have generic counterparts. They have different chemical formulations but, by and large, are considered mostly medically interchangeable.
“There’s not a huge amount of difference in the efficacy of iron formulations,” Pollock says. So, for value, “the question really does come down to cost.”
Doctors are supposed to recommend infusions only if patients don’t respond to iron pills or dietary changes, Pollock says. Instead of steering patients toward “unnecessarily costly” infusions, physicians should determine the underlying cause of low iron and treat that directly.
Injectafer, which Rothenberg received, is one of the most expensive infusions, retailing for more than $1,000 a vial. And, as Rothenberg learned the hard way, hospitals can charge privately insured patients whatever they choose. Insurers then negotiate that hospital “list price” down.
An analysis of private insurance claims conducted by the Health Care Cost Institute, an independent research group funded by insurers, found that in 2017, private health plans paid $4,316 per visit, on average, if a patient received Injectafer infusions. Feraheme, the next most expensive infusion drug, cost private plans $3,087 per visit, while the other three on the market were considerably cheaper. Infed was $1,502, Venofer $825 and Ferrlecit $412, the institute found, in an analysis for Kaiser Health News.
The share of newer, pricier infusions has crept up in the private market too. In 2017, 23% of privately billed iron infusion visits involved Injectafer or Feraheme, compared with 13% in 2015, according to the institute’s data.
Nobody told Rothenberg that cheaper options might exist or warned her about her treatment’s price, she says. The hematologist who treated her did not respond directly to our repeated requests for comment.
But Alan Miller, the chief medical director of oncology for SCL Health (Saint Joseph’s umbrella organization), says the hospital stopped using Injectafer in August 2018 — a month after Rothenberg’s visit — because of the relatively high cost to patients. The hospital now turns to Venofer and Feraheme instead.
There are some other, nonmedical reasons doctors might choose the more expensive drug. Newer, more expensive drugs are more likely to be heavily marketed directly to doctors, says Stacie Dusetzina, an associate professor of health policy at Vanderbilt University.
Walid Gellad, an associate health policy professor at the University of Pittsburgh, says some formulations may be more convenient in terms of how many doses they require or how long patients have to sit for an infusion. Or a certain patient might have a distinctive profile that makes one drug an obviously better fit.
None of those explanations sit particularly well with Rothenberg, whose iron levels are now fine — but who is still paying off her $2,700 bill in installments over two years.
“If they had said, ‘This is going to cost you $3,000,’ I would have said, ‘Oh, never mind,’ ” Rothenberg now says. “It’s a big mental shift for me to say, ‘I’m supposed to weigh the costs against the health benefits. I’m not supposed to necessarily do what the doctor says.’ “
Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.
1,300 Wait For Free Dental Care In Pittsburgh
More than a thousand people waited in line to see a dentist at an annual free clinic in Pittsburgh. Some had never been to a dentist before.
DAVID GREENE, HOST:
In the city of Pittsburgh, over a thousand people waited in line – some overnight – for the opportunity to see a dentist at a free dental clinic. Millions of Americans lack access to dental care. Katie Blackley with member station WESA reports.
KATIE BLACKLEY, BYLINE: Gregory Pflumm closes his eyes as the dental chair he sits in reclines. He’s been waiting outside Pittsburgh’s downtown hockey arena since 4:00 a.m. for this chance and says he’s going to take advantage of all the dental care he can today.
GREGORY PFLUMM: Surprisingly, I’m a – pretty much a medical experiment. Anything that they can help me out with helps me maybe later on being able to actually afford the rest of whatever I need.
BLACKLEY: Pflumm’s an Army veteran who receives his medical care at the VA hospital. But dental coverage is limited at the VA, and he says he’s been putting off a lot of this work for decades.
Beside him, oral surgery resident Valentina Zahran lowers a tool into Pflumm’s mouth and explains that it might go numb soon.
VALENTINA ZAHRAN: Open real big, and say ah. Perfect.
BLACKLEY: Pflumm and more than 1,300 others attended the weekend clinic. He got here early but says others were camped out overnight.
PFLUMM: There’s so many people out there that either don’t have insurance, don’t have a job, can’t afford insurance. Once a year, you can get at least something done.
BLACKLEY: The floor of the clinic is dotted with volunteers and dentists in pastel blue, yellow, pink and green scrubs. Once they’re inside the arena, patients are triaged and sent to these color-coded sections, which indicate departments like oral surgery, pediatric care and fillings.
Dentist Dave Sullivan says the clinic isn’t able to treat every oral issue but tries to give patients the best care possible. And if they can’t do it here, they’ll find somewhere else that does.
DAVE SULLIVAN: Patients can get their teeth cleaned in the hygiene department. They can get a root canal or endodontic therapy done. They can have fillings done. They can get teeth extracted. We even make removable partial dentures for them if they’re missing teeth.
BLACKLEY: This is the clinic’s third year, and it’s become one of the largest of its kind in the U.S. The dentists and volunteers try to put the patients at ease as best they can. They crack jokes and ask goofy questions and try to maintain a casual vibe. After all, many patients have never been to the dentist before.
UNIDENTIFIED DENTIST: I only want to hurt people on Wednesdays. What’s today?
UNIDENTIFIED PERSON: Not a Wednesday.
UNIDENTIFIED DENTIST: Today’s Friday. No hurting today.
BLACKLEY: Dentist Keith Young has been with the clinic since the beginning. He says everyone who talks with the patients is trained to make the experience comfortable. It’s a long day. But for many patients, this will probably be their only visit this year.
KEITH YOUNG: They’re coming in. They’re waiting in line four or five hours. They’re in this big arena. And they’re going to have teeth pulled. That’s scary. I mean, that really is. And that’s – so we try to make it as comforting as we possibly can when they come through.
BLACKLEY: Young says each year, organizers ask participants how long they’ve had dental pain. Last year, 45% of patients said they’d had a toothache or a problem with their dentures for more than a year. About a quarter of those surveyed said they visited the emergency room for temporary tooth relief.
YOUNG: They have nowhere else to go, so they go to the emergency room. And they don’t get treated. All they get is pain meds or some antibiotics, and they leave. So the problem still exists.
BLACKLEY: After the clinic, Young says patients meet with people in the health care industry who can connect them to a regular dentist and follow-up care. Providers offer preventative services and talk with patients about how to manage their oral health going forward. Patient Darlene Allen says after her visit today, she plans to schedule more.
DARLENE ALLEN: Well, I learned that a lot of other stuff can happen to you if you don’t keep your teeth in good condition. And I don’t want that.
BLACKLEY: Clinic organizers say it’s unfortunate that so many people can’t afford to go to the dentist, but they’ll continue to provide what they can until that changes. For NPR News, I’m Katie Blackley in Pittsburgh.
(SOUNDBITE OF MUSIC)
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The Sisters Of A-WA Share Their Great-Grandmother’s Refugee Story
VuHaus
“Hana Mash Hu Al Yaman”
“Mudbira”
“Malhuga”
Tair, Liron, and Tagel Haim are three sisters who record as A-WA. They are Arab Jews who live in Israel and spread the Yemeni folk traditions of their heritage around the world through electronic music. On the group’s latest album, Bayti Fi Rasi, the sisters tell the story of their great-grandmother, Rachel, who fled Yemen and arrived in Israel as a refugee as part of Operation Magic Carpet in 1949. Many of the songs, like “Hana Mash Hu Al Yaman” (meaning “Here Is Not Yemen”) address the difficulties Rachel faced on both sides of her journey as a refugee.
The sisters dropped by World Cafe to perform inviting and unique songs from Batyi Fi Rasi and to talk about their own journey as musicians from a small desert village in Israel to the international stage.
The Thistle & Shamrock: More New Summer Sounds
Trump Team’s Bid To Make Hospital Costs More Transparent Is Data-Heavy

“As deductibles rise, patients have the right to know the price of health care services so they can shop around for the best deal,” says Seema Verma, who heads the Centers for Medicare & Medicaid Services and announced the Trump administration’s plan this week.
Kevin Wolf/AP
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Kevin Wolf/AP
Shopping around for the best deal on a medical X-ray or a new knee? The Trump administration has a plan for that.
This week, the administration proposed new rules that would provide consumers far more detail about the actual prices hospitals charge insurers. The proposal comes amid growing calls from consumer advocates, who argue transparency can help tackle rising health care costs. But the plan also has the potential to overwhelm patients with data.
Under the proposal, hospitals would be required to post the prices they negotiate with every insurer for just about every service, drug and supply they provide to patients, starting Jan. 1, 2020.
The move follows an executive order issued by the president in June. It immediately drew sharp opposition from hospitals and insurers, who made it clear they plan to fight the proposal — all the way to court if necessary.
Final rules might differ from the proposal — and the courts will be asked to weigh in. But the move could help lift the secrecy that has long surrounded what patients, employers and insurers actually pay for medical services.
“As deductibles rise, patients have the right to know the price of health care services so they can shop around for the best deal,” said Seema Verma, administrator of the Centers for Medicare & Medicaid Services, who announced the proposal Monday.
The plan, however, raises at least three questions:
Will consumers use it?
Some consumers will take advantage of price information, although maybe not many, say experts who have studied patient behavior.
The amounts would be different from what currently exists on websites run by some insurers, hospitals and private businesses because they would be actual negotiated prices, not area averages, estimates or hospital-set “charges,” which are amounts set by hospitals and usually far higher than the negotiated rates.
Even so, “a lot of things can get in way of patients using the data,” says Lovisa Gustafsson, assistant vice president at the Commonwealth Fund.
There may be only one hospital in town, for example, or patients might be reluctant to switch if they have a relationship with a specific hospital. Incentives to shop might be hampered, too, if a patient’s share of the cost of a procedure or test is small. Finally, only a portion of medical care is “shoppable,” meaning patients have time to look around and compare prices before they undergo the procedure or receive the treatment.
Still, when price data is available, some patients — particularly those with high deductibles that haven’t been met — will shop and choose a lower priced provider, Gustafsson says.
Experts point to consumer behavior in New Hampshire, which posts price information by insurer online. Only a small percentage took advantage of the online look-up tool, but those who did saved money, according to a recent study by Zach Brown, an assistant professor of economics at the University of Michigan.
Still, the new dataset proposed by the Trump administration might simply be too overwhelming for many consumers.
Although the proposal requires the information be presented so it can be searched online, it will be a huge dataset.
Start with the fact that each hospital has tens of thousands of charges, from room fees to suture costs to the price of each tablet of aspirin. Then multiply that by the number of insurers that contract with each hospital and the total amount of data could be staggering.
Patients would need to know what tests, procedures, supplies and even drugs they might need for a given hospitalization, then add them up — for every hospital they are considering.
To help consumers, the proposal would also require hospitals to provide information on 300 “shoppable services” — say a knee replacement — and include the price of all the related services that go with it, rather than expecting patients to somehow try to add them up a la carte.
But will it lower prices?
The short answer to whether the plan will reduce prices is maybe. But no one knows for sure.
“We’ve never had price transparency, so there is no evidence to point to exactly what it would do,” says Gustafsson.
In retail, having price information from shopping websites like Amazon has helped drive prices down. But when the Danish government required concrete manufacturers to disclose negotiated prices, those prices went up, according to a study trotted out by skeptics of the price transparency approach.
So, is health care like retail or cement?
On one hand, having actual price information can give self-insured employers and health insurers a stronger hand in negotiations, so they could demand better deals from hospitals. But it could also spur some hospitals to raise their prices if they think competitors are getting a better deal from insurers.
Business professor George Nation, who studies hospital pricing at Lehigh University, lands on the side of the argument that more price information can help lower prices, especially if employers and insurers use it to demand steeper discounts.
“This money is coming out of employers’ pockets,” he says. “They’re going to say, why, if Hospital B can do this for $300, why are you charging me $600? Justify your charge.”
While that won’t work in areas with a strong hospital monopoly, it’s a start, Nation says.
“You can’t have price competition without knowing the price. And that’s where we have been living.”
Is Trump’s plan likely to become law?
Again, the answer to whether the proposal will become law is maybe.
It could be modified after the administration reviews public comments, which are due Sept. 27.
And after it’s finalized, there may well be a legal battle.
Hospitals and insurers didn’t wait to take the first shots.
Shortly after the proposed rule was released late Monday, their trade organizations released sharply critical statements. They’ve long opposed efforts to reveal their negotiated prices, which they say are trade secrets.
The Trump plan will backfire, America’s Health Insurance Plans predicted: “Posting privately negotiated rates will make it harder to bargain for lower rates, creating a floor — not a ceiling — for the prices that hospitals would be willing to accept.”
We’ll see you in court, was the not too thinly veiled threat that came from the American Hospital Association, which said the proposal “misses the mark, exceeds the administration’s legal authority and should be abandoned.”
But Medicare administrator Verma was unfazed. When asked by reporters about the potential for a legal battle over the proposal, she said, “We’re not afraid of that.”
Still, on the legal front, matters could get complex.
Currently, the administration is backing a lawsuit from 18 red states that are seeking to have the entire Affordable Care Act overturned, including, presumably, any authority it gives the administration to require hospitals to post prices.
Again, Verma was not worried: “If there are any changes to the ACA, we would work with Congress to keep what’s working and get rid of what’s not,” she said at the press conference.
Nation says the attention the proposal is getting from industry backs his contention that there might must be something to it.
“The strength of the opposition is indication this may work to lower prices,” he says.
Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.