A blog covering the health/care ecosystem and people.

On the demand side of U.S. health care economics, patients are now payors as health consumers with more financial skin in paying medical bills. As consumers, people have great expectations from the organizations on the supply side of health care — providers (hospitals and doctors), health insurance plans, pharma and medical device companies. But as payors, health consumers face challenges in getting care, so great expectations are met with frustration and eroding trust with the system, according to the latest Connected Healthcare Consumer report from Salesforce published today as the company announced expansion of their health cloud capabilities. This is

“Bold thinking is great. Bold doing is better,” Dr. Eric Topol introduced his talk yesterday at Medecision’s Liberation 2019 conference. I have the opportunity, for which I’m so grateful, of not only attending this meeting but playing a role as a speaker, a sometimes stage “emcee,” and a keynote speaker. And as an attendee, I learn so much from other speakers, fellow attendees, and Medecision staff all sharing perspectives during breakouts and networking breaks. In mode of attendee (and self-confessed collegial-groupie of Dr. Topol’s), I took in his remarks taking notes as fast as I could thanks to Mom teaching

As patients have taken on more financial responsibility for first-dollar costs in high-deductible health plans and medical bills, hospitals and health care providers face growing fiscal pressures for late payments and bad debt. Those financial pressures are on both sides of the health care payment transaction, stressing patients-as-payors and health care financial managers alike. I’m speaking to health industry stakeholders on patients-as-payors at Cerner’s Now/Next conference today about the patient-as-payor, a person primed for engagement. That’s as in “Amazon-Primed,” which patients in their consumer lives now use as their retail experience benchmark. But consumers-as-patients don’t feel like health care today

As patients continue to morph into health care payers, they’re increasingly expecting value-for-money, transparency, and customer experiences that show respect, bolster trust, and deliver quality services. Is that so much to ask from health care providers? Sure is, as it turns out, based on this year’s annual report from Kaufman Hall, the 2019 State of Consumerism in Healthcare: The Bar is Rising. For several years, Kaufman Hall have developed an Index of healthcare consumerism based on several pillars that, together, gauge health care providers’ performance on consumer health engagement. Providers fall into one of four tiers, ranging from Tier 1

Looking at this photo of the 2020 Democratic Party Presidential candidate debater line-up might give you a déjà vu feeling, a repeat of the night-before debate. But this was Round 2 of the debate, with ten more White House aspirants sharing views — sometimes sparring — on issues of immigration, economic justice, climate change, and once again health care playing a starring role from the start of the two-hour event. The line-up from left to write included: Marianne Williamson. author and spiritual advisor John Hickenlooper, former Governor of Colorado Andrew Yang. tech company executive Pete Buttigieg, Mayor of South Bend,

Health care is the top issue facing the U.S. today, one in three Americans says, with another one-fourth pointing to the economy. Together, health care + the economy rank the top issues for 62% of Americans. Health care and the economy are, in fact, intimately tied in every American’s personal household economy I assert in my book, HealthConsuming: From Health Consumer to Health Citizen. This poll from RealClear Politics, conducted in late April/early May 2019, makes my point that the patient is the consumer and, facing deductibles and more financial exposure to footing the medical bill, the payor.   Fully

People who are in poor health or use more health care services are more likely to report multiple unmet social needs, such as food insecurity, unsafe neighborhoods, lack of good housing, social isolation, and poor transportation access, found through a survey conducted by McKinsey. The results are summarized in Addressing the Social Determinants of Health. The growing recognition of the influence of social determinants reached a tipping point last week with the news that Kaiser-Permanente would work with Unite US to scale services to people who need them. The mainstreaming of SDoH speaks to the awareness that health is made

There’s no denying the growth of telehealth, virtual visits, remote health monitoring and mHealth apps in the healthcare landscape. But these growing technologies don’t replace the role of real estate in health, wellness and medical care. Health care is a growing force in retail real estate, according to the ICSC, the acronym for the International Council of Shopping Centers, which has been spending time analyzing, in their words, “what landlords should know in eyeing tenants from a $3.5 trillion industry.” Beyond the obvious retail clinic segment, the ICSC points out a key driving growth lever for its stakeholders, recognizing that,

“ATA” is the new three-letter acronym for the American Telemedicine Association, meeting today through Tuesday at the Convention Center in New Orleans.  Ann Mond Johnson assumed the helm of CEO of ATA in 2018, and she’s issued a call-to-action across the health/care ecosystem for a delivery system upgrade. Her interview here in HealthLeaders speaks to her vision, recognizing, “It’s just stunning that there’s such a lag between what is possible in telehealth and what is actually happening.” I’m so keen on telehealth, I’m personally participating in three sessions at #ATA19. On Monday 15th April (US Tax Day, which is relevant

There’s little agreement between Democrats and Republicans on a plethora of issues in American public life. But one issue that brings U.S. citizens together is agreement that the cost of health care is too high in the country, and that pharma, health plans, and providers are to blame. Welcome to health politics in America as of March 2019, according to The Public and High U.S. Health Care Costs, a poll conducted by POLITICO and the Harvard T.H. Chan School of Public Health. The first chart illustrates the common ground shared by Americans by party affiliation, with vast majorities across parties playing

National health spending in the U.S. is expected to grow by 5.7% every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth, published yesterday by Health Affairs. For context, note that general price inflation in the U.S. was 1.6% for the 12 months ending January 2019 according to the U.S. Bureau of Labor Statistics. This growth rate for health care costs exceeds every period measured since the high of 7.2% recorded in 1990-2007. The bar chart illustrates the

Talk to me, patients are demanding in unison. Most health consumers expect providers to communicate about routine health care and prevention; this is especially true among those patients trying to manage chronic conditions we learn from 10 Ways to Fulfill Patients’ Communication Wish List, a report based on a consumer survey from West, the communications and network infrastructure company. Four in five patients say that talking to “me” means they want personalized recommendations to their unique needs – but only one-third of patients say they’re getting that level of service from their healthcare providers. Most health consumers expect providers to communicate about

Health begins at home. I found evidence for that, beyond my own N of 1 understanding, in a research article published in the UK in 2000 by Lyn Harrison and Frances Heywood. Lyn and Frances tested three assumptions that they believed linked housing and health: that housing contributes to health; that housing is not routinely included in health or social planning;’ and that the potential contribution of primary care is wasted. Their conclusion: that the housing-health link was not receiving the recognition that connection needs. Nearly two decades later, that housing-health link still isn’t universally embraced by health care stakeholders. But

The future of healthcare is not about being sick, Prof. Dr. Koen Kas believes. Having spent many years in life sciences in both research and as an entrepreneur, Koen now knows that getting and staying healthy isn’t about just developing medicines and med-tech: optimally, health requires a tincture of delight, Koen advises in his breakthrough, innovative book, Your Guide to Delight. Healthcare must go beyond traditional user-centered design, Koen’s experience has shown, and aspire toward design-to-delight. The concept of “delight” in healthcare, such as we experience in hospitality, grocery stores, and entertainment, is elusive. I’ve observed this, too, in my

People dealing with chronic conditions are keener to share personally-generated data than people that don’t have a chronic disease, Deloitte’s 2018 Survey of U.S> Health Care Consumers learned. This and other insights about the patient journey are published in Inside the patient journey, a report from Deloitte that assesses three key touch points for consumer health engagement. These three patient journey milestones are searching for care, using new channels of care, and tracking and sharing health data, Deloitte maps. What drives people to engage on their patient journeys has a lot  more to do with practical matters of care like convenience,

Patients are the new healthcare payors, and as such, taking on the role of health consumers. In fact, health and wellness consumers have existed since a person purchased the first toothpaste, aspirin, heating pad, and moisturizing cream at retail. Or consulted with their neighborhood herbalista, homeopathic practitioner, therapeutic masseuse, or skin aesthetician. Today, the health and wellness consumer can DIY all of these things at home through a huge array of products available in pharmacies, supermarkets, Big Box stores, cosmetic superstores, convenience and dollar stores, and other retail channels – increasingly, online (THINK, of course, of Amazon — more on

Most Americans have been surprised by a medical bill, a NORC AmeriSpeak survey found. Who’s responsible? Nearly all Americans (86% net responsible) first blame health insurance companies, followed by hospitals (82%). Fewer U.S. patients blamed doctors and pharmacies, although a majority of consumers still put responsibility for surprise healthcare bills on them (71% and 64% net). Most of the surprise bills were for charges associated with a physician’s service or lab test. Most surprise charges were not due to the service being excluded from a health plans provider network. The poll was conducted among 1,002 U.S. adults 18 and over

Hospital and healthcare providers are getting real about improving patient and health consumer experience, the latest Kaufman Hall research finds. The company’s 2018 State of Consumerism in Healthcare report is out, subtitled, “Activity in Search of Strategy.” Kaufman Hall has developed a Healthcare Consumerism Index for healthcare providers based on four pillars: access to care, consumer experience, pricing, and a strong foundation of consumer insights. Based on their assessment of providers on these components, Kaufman Hall found identified four tiers of performance: The top-performing group, Tier 1, includes only 8% of providers. These are the early adopters who allocate resources

When it comes to healthcare costs, lines that decline over time are generally seen as good news. That’s how media outlets will cover the top-line of PwC’s report Medical cost trend: Behind the numbers 2019. However, there are other forces underneath the stable-looking 6.0% medical trend growth projected for 2019 that will impact healthcare providers, insurers, and suppliers to the industry. There’s this macro-health economic story, and then there’s the micro-economics of healthcare for the household. Simply put: the impact of growing financial risk for healthcare costs will be felt by patients/consumers themselves. I’ve curated the four charts from the

Less can lead to more for so many things: eating smaller portions, lowering sugar consumption, and driving less in favor of walking or cycling come to mind. When it comes to healthcare utilization, doing less can also result in equal or even better outcomes. Groundbreaking research presented at this week’s ASCO meeting found that some women diagnosed with certain forms of cancer do not benefit from undergoing chemotherapy. The American Society of Clinical Oncology (ASCO) is one of the largest medical meetings annually, and at this huge meeting these research results for the TAILORx trial were huge news with big

One-third of Americans are following a specific eating pattern, including intermittent fasting, paleo gluten-free, low-carb, Mediterranean diet, and Whole 30, among dozens of other food-styles in vogue in 2018. It’s mainstream now that Americans are shopping food for health, with eyes focused on heart health, weight, energy, diabetes, and brain health, according to the 2018 Food & Health Survey from IFIC, the International Food Industry Council Foundation. But underneath these healthy eating intentions are concerns about the cost of nutritious foods, IFIC reports. And this aspect of home health economics can sub-optimize peoples’ health. Consider the first graph on consumers’

Three-fourths of healthcare providers experienced a data breach in 2017, according to the HIMSS 2018 Cybersecurity Survey. Health data insecurity is the new normal. A big piece of addressing the cybersecurity healthcare challenge is educating people who work in healthcare settings, and that has been under-funded. Only 41% of healthcare workers say they receive security training, a Forrester study learned in January 2018. Forrester also found that while healthcare organizations have experienced some of the most egregious cyberattacks, the industry allocates a smaller proportion of IT budgets to security compared with than other organizational types at a rate of 22%

The U.S. spent nearly twice as much as other wealthy countries on healthcare, mostly due to higher prices for both labor and products (especially prescription drugs). And, America spends more on administrative costs compared to other high-income countries. What do U.S. taxpayers get in return for that spending? Lower life spans, higher maternal and infant mortality, and the highest level of obesity and overweight among our OECD peer nations. These sobering statistics were published in Health Care Spending in the United States and Other High-Income Countries this week in JAMA, the Journal of the American Medical Association. The study analyzes

Let’s change the conversation and put healthcare over  politics.  Sounds just right, doesn’t it? If you’re reading Health Populi, then you’re keen on health policy, health economics, most of all, patients: now playing starring roles as consumers, caregivers, and payors in their own care. Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), has assembled a diverse group of health care leaders who care about those patients/people, too, appropriately named the United States of Care. Founders include Dr. Bill Frist, former Republican U.S. Senator from Tennessee, Dave Durenberger, former Republican U.S. Senator from Minnesota, and

Picture this scenario: you, the consumer, take a dollar and spend it, and you get 90 cents back. In what industry is that happening? Here’s the financial state of healthcare in America, explained in the 2016 Health Care Cost and Utilization Report from the Health Care Cost Institute (HCCI). We live in an era of Amazon-Primed consumers, digital couponing, and expectations of free news in front of paywalls. We are all in search of value, even as the U.S. economy continues to recover on a macroeconomic basis. But that hasn’t yet translated to many peoples’ home economics. In this personal

Connecting Life’s Dots, the organization Living in Digital Times partners with CES to deliver conference content during the show. At CES 2018, LIDT is connecting a lot of dots to help make health streamline into daily living. Robin Raskin, founder, kicked off LIDT’s press conference setting the context for how technology is changing lifestyles. Her Holy Grail is to help make tech fun for everybody, inclusive for everybody, and loved by everybody, she enthused. LIDT has been a presence at CES for many years, conceiving the contest the Last Gadget Standing, hosting  tech-fashion shows with robots, and supporting a young innovators

As 2018 approaches, consumers will gather healthy New Year’s Resolutions together. Entering the New Year, most Americans are also dealing with concerns about healthcare costs, cybersecurity, and caring – for physical health, mental stress, and the nation. Healthcare costs continue to be top-of-mind for consumer pocketbook issues. Entrenched frugality is the new consumer ethos. While the economy might be statistically improving, American consumers’ haven’t regained confidence. In 2018, frugality will impact how people look at healthcare costs. 88% of US consumers are likely to consider cost when selecting a healthcare provider, a Conduent survey found. Physicians know this: 81% of

The biggest healthcare spenders in the United States are households and the Federal government, each responsible for paying 28% of the $3.3 trillion spent in 2016. Private business — that is, employers covering healthcare insurance — paid for 20% of healthcare costs in 2016, based on calculations from the CMS Office of the Actuary’s report on 2016 National Health Expenditures. The positive spin on this report is that overall national health spending grew at a slower rate in 2016, at 4.3% after 5.8% growth in 2015. This was due to a decline in the growth rates for the use of

U.S. consumers’ most-valued brands include Apple, Google, Amazon, Netflix, Pinterest, Android, Spotify, PIXAR, Disney and Samsung, according to  the 2017 Brand Relevance Index from Prophet. The top 50 are shown in the first chart. On the second chart, I’ve circled in red the brands that have reach into healthcare, health, fitness, and wellness. Arguably, I could have circled every brand in the top 50 because in one way or another, depending on the individual, people find health “everywhere” that’s relevant to them based on their own definitions and value-systems. This is Prophet’s third year conducting this study, and I was

Driven by price increases, costs for the prescription drug benefit carve-out will increase 11.6% this year, based on Segal Consulting’s survey report, High Rx Cost Trends Projected to Be Lower for 2018, published today. The report is accessible on the Segal Co. website. While the Segal team expects prescription drug (Rx) benefit plan cost trends to be “less severe” in 2018, Rx cost increases is a top priority for many sponsors of health plans as their rate of increase far exceeds those for inpatient hospital claims or physician expense. Drug costs continue to be the fastest-growing line item in health

9 in 10 hospitals and health systems prioritize improving the consumer/patient experience, but only 30% of providers are building these capabilities. This consumer experience gap was found by Kaufman Hall in their survey research published in the report, 2017 State of Consumerism in Healthcare: Slow Progress in Fast Times. Digital health innovations will play big roles in supporting that consumer health experience for most health providers: 58% prioritize offering digital tool and information for consumer engagement, and 56% of providers look to develop a range of virtual/telehealth access points. But it appears that while healthcare providers’ spirits are willing, their flesh

Technology should serve people, and Accenture has identified five major key trends that, together, could forge a person-centered, -friendly, -empowering healthcare system. This is Accenture’s Digital Health Technology Vision for 2017. “Should” and “could” are the important adverbs here, because if tech doesn’t deliver, driving efficiency and effectiveness, personalizing medical treatments, and inspiring people to become more health literate and health-engaging, then tech is just a Field of Dreams being built and available, with no people taking advantage of the potential benefits. The five new-new tech trends are: AI is the new UI, where healthcare experience is everything Ecosystem power

Between 2014 and 2015, death rates increased for eight of the ten leading causes; only death rates caused by cancer fell, and mortality rates for influenza and pneumonia stayed flat. The first chart paints this sobering portrait of Americans’ health outcomes, presented in the CDC’s data-rich 488-page primer, Health, United States, 2016. Think of this publication as America’s annual report on health. Every year, it is prepared and submitted to the President and Congress by the Secretary of the Department of Health and Human Services. This year’s report was delivered by DHHS Secretary Tom Price to President Trump and the

Patient satisfaction should be baked into healthcare provider service goals, according to Prioritizing the Patient Experience from West Corporation, the communications company. West is in the business of improving communications systems, and has a vested interest in expanding comms in health. This research polled patients and providers to assess how each healthcare stakeholder perceives various patient satisfaction issues, which when done well are grounded in sound communications strategy and technologies. Patient satisfaction is directly linked to the bottom lines of healthcare organizations, West contends, due to two key drivers: Evolving payment models are increasingly tying patient satisfaction to reimbursements; and,

U.S. consumers consider Consumer Electronics to be the most innovative industry they know. But people believe that Health & Wellness should be the most innovative sector in the economy. Welcome to the 2017 Klick Health Consumer Survey, which focuses on health innovation in the context of peoples’ hopes for technology to improve health and healthcare. 1 in 2 people say that technology has had a positive impact on their health and wellness, skewing slightly more toward younger people (although 45% of people 55 years of age and older agree that tech positively contributes to health. 41% of consumers say they’ve

“Overall, Council members express pessimism about the health are landscape in the wake of the Trump administration’s proposed plans, citing no clear winners, only losers: patients, clinicians, and provider organizations.” This is the summary of the Leadership Survey report, Anticipating the Trump Administration’s Impact on Health Care, developed by the New England Journal of Medicine‘s NEJM Group. The first chart illustrates the “biggest healthcare losers” finding, detailed on the bottom three bars of patients, clinicians, and provider organizations. The stakeholders that will fare best under a President Trump healthcare agenda would be drug companies, payers, and employers. The biggest loser

Most Americans do not believe that TrumpCare, the GOP plan to replace the Affordable Care Act (the ACA, aka  ObamaCare), will make things better for U.S. health citizens when it comes to peoples’ health insurance coverage, the premium costs charged for those health plans, and protections for people with pre-existing medical conditions. The March 2017 Kaiser Family Foundation Health Tracking Poll examined U.S. adults’ initial perceptions of AHCA, the American Health Care Act, which is the GOP’s replacement plan for the ACA. There are deep partisan differences in perceptions about TrumpCare, with more Republicans favorable to the plan — although not

Nine in 10 U.S. consumers think pharma and biotech put profits above patient interests, according to the latest Harris Poll studying reputation equity across organizations serving health care. Notice the relatively low position of the green bars in the first chart (with the exception of the impression for “strong financial performance); these are the pharma/biotech consumer impressions. The health industry stakeholders consumers believe would more likely place them above making money are health care providers, like doctors and nurses, hospitals, and pharmacists. Health insurance companies fare somewhat better than pharma and biotech in this Poll, although rank low on social

In President Donald Trump’s preliminary thoughts about health care in America, the landscape would feature a mix of tax credits, health savings accounts, high-risk pool, state Medicaid block grants, and regulatory control shifting from the Federal government to the states, according to PwC’s forecast for the new year, Top health industry issues of 2017. PwC frames the 2017 top healthcare issues under the overall strategic imperative of value, with three categories: Adapting for value Innovating for value Building for value. The ten top issues that will shape U.S. healthcare for the next year, PwC expects, will be: An uncertain fate for the

Health care spending grew 4.6% in 2015, higher than the rise in either 2013 or 2014, according to the 2015 Health Care Cost and Utilization Report published by HCCI, the Health Care Cost Institute. The key contributors to health care spending by percentage were, first and foremost, prescription drugs which rose 9% in the year — notably, specialty medicines like anti-infective drugs (such as those for Hepatitis C and HIV) costing on average $83 per “filled day.” This cost doubled from $53 per person in 2012 to $101 per person in 2015. Hospital costs saw the second greatest percentage price increase

Most U.S. hospitals have not put consumerism into action, a new report from KaufmanHall and Caden’s Consulting asserts from the second paragraph. Patient experience is the highest priority, but has the biggest capability gap for hospitals, the report calls out. KaufmanHall surveyed 1,000 hospital and health system executives in 100 organizations to gauge their perspectives on health consumers and the hospital’s business. KaufmanHall points out several barriers for hospitals working to be consumer-centered: Internal/institutional resistance to change Lack of urgency Competing priorities Skepticism Lack of clarity (vis-a-vis strategic plan) Lack of data and analytics. The key areas identified for consumer centricity

Retail clinics are a growing source of primary care for more U.S. health consumers, discussed in a review of retail clinics published by Drug Store News in July 2016. There will be more than 2,800 retail clinics by 2018, according to Accenture’s tea leaves. Two key drivers will bolster retail clinics’ relevance and quality in local health delivery systems: Retail clinics’ ability to forge relationships with legacy health care providers (physicians, hospitals); and, Clinics’ adoption and effective use of information technology that enables data sharing (e.g., to the healthcare provider’s electronic health records system) and data liquidity (that is, securely moving

When consumers consider the many stakeholder organizations in healthcare, a majority trust pharmacists first, then doctors and dentists. Hospital and health insurance execs, and members of Congress? Hardly, according to a survey from Meyocks, a marketing consultancy. Meyocks conducted the survey via email among 1,170 US adults, 18 years of age and older. This survey correspondends well with the most recent Gallup Poll on most ethical professions, conducted in December 2015. In that study, pharmacists, nurses and doctors come out on top, with advertisers (“Mad Men”), car salespeople, and members of Congress at the bottom, as shown in the second

  “Our goal is to create an aware and engaged, irritating set of patients who create a dialogue with health care providers once they’ve had a [blood] clot,” explained Randy Fenninger, CEO of the National Blood Clot Alliance (NBCA). NBCA’s tagline and hashtag is “Stop the Clot.” Welcome to the multi-stakeholder community involved with deep vein thrombosis (DVT) and, clinically speaking, Venous Thromboembolism (VTE). We’re talking blood clots, and the public health burden of this condition is big: it’s a leading cause of death and disability. One in 4 people in the world die of conditions caused by thrombosis. I had

In the future, a hospital won’t be a hospital at all, according to 9 in 10 hospital executives who occupy the c-suite polled in Premier’s Spring 2016 Economic Outlook. Among factors impacting their ability to deliver health care, population health and the ACA were the top concerns among one-half of hospital executives. 1 in 4 hospital CxOs think that staffing shortages have the biggest impact on care delivery, and 13% see emerging tech heavily impacting care delivery. Technology is the top area of capital investment planned over the next 12 months, noted by 84% of hospital execs in the survey.

Rural hospitals operating in the U.S. have a higher risk of mortality — closure — than other hospitals in America. The U.S. health care landscape is littered with examples of health disparities among the nation’s health citizens – for example, women’s lower access to heart-health care, Latinos’ higher rates of Type 2 Diabetes, and African-Americans’ greater risks of stroke, many cancers, maternal mortality, and many other causes of mortality and diminished health. A report from iVantage, Rural Relevance – Vulnerability to Value, documents the fiscally challenging environment for rural hospitals in America. There are at least 673 facilities at-risk of closure

There’s an overall feeling of angst about healthcare in America among both health care consumers and the people who provide care — physicians and administrators. On one thing most healthcare consumers and providers (can agree: that the U.S. health care system is on the wrong track.  Another area of commonality between consumers and providers regards privacy and security of health information: while healthcare providers will continue to increase investments in digital health tools and electronic health records systems, both providers and consumers are concerned about the security of personal health information. In How We View Healthcare in America: Consumer and Provider Perspectives,

Reluctantly accepting the Affordable Care Act, health executives and their architects now see opportunities for re-imagining the hospital and health care services, according to Healthcare Industry Trends, a publication that’s part of the 2015 Building & Development Leadership Series provided by Mortenson, a construction services firm that’s active with healthcare organizations. Mortenson conducted a survey at the 2015 ASHE Planning, Design, and Construction Summit, the results of which were published in this report. The over 300 respondents included healthcare executives, facilities managers, and healthcare architects. Thus the lens on the data in this survey is through the eyes of physical

I lost a best friend last week. His memorial service, held this past weekend, was a celebration of his life. And part of that well-lived life was a very conscious planning of his last days. The Economist published its 2015 Quality of Death Index, a data-driven treatise on palliative care, the very week my dear friend Rick died. This gives me the opportunity to discuss palliative care issues with Health Populi readers through The Economist’s lens, and then in the Hot Points below through my personal context of this remarkable man’s end-of-life choices. The Economist ranks 80 countries on several