TASK DEFINITION: Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.
PROBLEM: Paragraph: The story does not talk about costs, which was disappointing. The costs of intensive medical therapy can easily be identified. Using an online pharmacy we calculated the costs to be about $1,500 to $2,000 annually for medical therapy, using generic drugs. Using the Health Care Blue Book, we found the average cost of coronary artery bypass sugery and hospitalization to be about $62,000. We think that this is important information for readers that should have been included. The quantification here was presented in such a way to make it clear to readers that there was no significant benefit found to surgical intervention, which is a fair conclusion to draw from the study. The story says, “In the Stich study, 41% of patients assigned to treatment with drugs alone died during the follow-up period, which averaged five years. That compared with a mortality rate of 36% among patients who received bypass surgery plus medication. Although the relative reduction in risk of death was 14%, the result didn’t meet tests for statistical significance, meaning it could have resulted from chance alone.” That’s a great way to describe the lack of statistical significance. It would have been even more powerful to show readers the actual number of patients who died in each group. The story provides great information about the study itself and about the overall state of the evidence supporting heart surgery. “How best to treat these patients has been fraught with uncertainty,” is one of the more notable phrases from the story. It also says, “Many patients aren’t evaluated for heart surgery to treat diseased arteries because they don’t suffer classic chest pain or because doctors worry that hearts weakened by heart failure won’t benefit from the procedure. Other doctors recommend immediate bypass surgery despite a lack of vigorous studies to support that strategy.” The story does not engage in disease-mongering and takes a very careful approach to describing the types of patients who would be affected by this study’s results. We also like the way they provided snapshots of patients who were in both arms of the study — surgery and non-surgery — at the end of the story, making it clear, as the study did, that both routes can be equally successful. The story brings in some strong independent voices who help make sense of this complicated study: James Fang, a cardiologist at University Hospitals Case Medical Center in Cleveland, who wrote an editorial accompanying the study, Raymond Gibbons, a cardiologist at the Mayo Clinic, and Clyde Yancy, chief of cardiology at Northwestern University’s Feinberg School of Medicine. Rarely do you see a story that spends as much time with independent experts as it does with the authors of the study. The story does a great job showing how the standard interventions for heart disease stacked up against each other in this study. We wish that some mention had been made of diet and exercise and that at least a sentence had been included about whether there might be differences in outcomes seen as a result of different medication patterns. The story doesn’t make it clear what exactly the patients were taking. The story makes it clear that the range of treatments studied by the authors are widely available. The story makes it clear that there is a great need for more evidence in this field and that this study will be surprising to many clinicians because of a long-held assumption that surgery is the superior option. tudies published in the early 1990s supported the view that bypass surgery provided a better long term outcome. The story does not rely on a news release. Claim: More Options Before Bypass Surgery, Study Finds

SOLUTION: The piece gave readers some powerful information to help them sort through the range of factors that should be considered for any medical intervention. The only weakness our reviewers found with the story is the lack of comment about cost. Too often stories present medical options as false choices of best versus worst. They don’t take into consideration the very real differences between patients’ medical histories, diagnoses and expectations. This story should be applauded for giving readers a clear understanding of the complexities of shared decision-making between providers and patients. As noted by one of the experts quoted in the story, “You don’t have a good therapy and a bad therapy, you have a choice.” This is a message that the story gets across very well and is an important one for readers.

PROBLEM: Paragraph: The governor, who is also a pediatric neurologist, worked to comfort victims of Friday’s shooting and their families, while helping coordinate the massive government response. He discussed the shooting with President Donald Trump in a private phone call, stood shoulder to shoulder with other elected officials at a news conference and pressed for tighter gun control to national audiences. The subject of widespread mockery after the racist photo from his medical school yearbook surfaced, the Democratic governor appears determined to project that he’s up to the task. “Actions speak a lot louder than words. And I will have the leadership that’s needed,” Northam said in an interview with NPR after the shooting, while discussing potential plans to push for increased gun regulations. Police said 12 people were killed and several others injured when DeWayne Craddock, an engineer with the city’s utilities department, opened fire inside a municipal building Friday afternoon. Northam quickly left Richmond after the shooting and drove to Virginia Beach, speaking to local, state and other officials on the way down to coordinate responses and share information. After a news conference Friday evening, Northam took a call from Trump to discuss the shooting, with the president offering the federal government’s full support. Michael Berlucchi, a Virginia Beach City Council member, praised the governor and other officials for their work to address the shooting’s aftermath from the city’s emergency operations center. “Nobody carried their baggage into that room,” Berlucchi said Sunday. “The only thing I saw was public servants coming together to address the worst tragedy in the history of our city.” On Saturday, Northam attended a vigil at a church where he told those gathered that “God is in control.” He visited a hospital to meet with survivors and thank doctors and staff. In broadcast interviews with national media, Northam stressed the need for action to prevent similar deadly shootings. “We lost 12 lives yesterday. If you look at the commonwealth of Virginia, we lost over 900 lives over the past two years to gun violence, gun-related accidents,” Northam said on CNN. “So I will make decisions in the upcoming days but we need to look at our laws: are they safe, do they keep people protected in the Commonwealth of Virginia?” The governor has long been an advocate for stricter gun control. He made the issue a top priority of his 2017 gubernatorial campaign, drawing from his experience as a pediatrician and Army doctor who has treated children and soldiers wounded by firearms. But a package of bills Northam pushed this year, including legislation to limit gun magazine size and give local governments broader authority to ban guns in city buildings, went nowhere in a staunchly pro-gun Republican-controlled Virginia General Assembly. Northam hinted Saturday in media interviews that he may be considering some kind of executive action related to gun control efforts that would bypass the legislature, but his office declined to say what specific actions he may take. Any dramatic moves by the governor would face stiff resistance from his political opponents. Philip Van Cleave, president of the Virginia Citizens Defense League, said Northam doesn’t have any real power to impose new gun limits and any efforts to do so would be an attempt to deflect attention away his scandal. “He’d be very happy to try and change the focus away from the blackface stuff,” Van Cleave said. Northam has been battling for months to regain a sense of normalcy in office after a picture surfaced in February of man in blackface and another person wearing a Ku Klux Klan outfit on his medical school yearbook page. Northam has denied being in the picture, and investigators recently said they can’t conclusively establish the identities of either person in the 35-year-old photo. The governor withstood widespread pressure for him to resign, which weakened after scandal soon enveloped his potential successors . Two women publicly accused Lt. Gov. Justin Fairfax of sexual assault, which he denies, and Attorney General Mark Herring announced he’d also worn blackface in college, just days after calling on Northam to resign. Both Fairfax and Herring have also resisted calls to resign. Fairfax was also in Virginia Beach after the shooting. He attended a church service Sunday where and pledged to take “serious action” to prevent future mass shootings. “I think that thoughts and prayers from politicians are not enough,” Fairfax said. “We’ve had too many thoughts and prayers over the years and we’ve not acted in the ways to prevent these mass shootings in the future.” ___ This story has been corrected to say pediatrician, not pedestrian. ___ Contributors include Associated Press writer Ben Finley. Claim: Shooting poses Virginia governor’s first test since scandal.

SOLUTION: Virginia Gov. Ralph Northam wasted little time getting to Virginia Beach after a gunman killed a dozen people in a city office building, the first major test of his leadership since a blackface scandal almost forced him from office four months ago.

PROBLEM: Paragraph: She is in a bind because of her persistent refusal during two straight presidential debates to say whether she would raise taxes on the middle class to pay for the universal health insurance plan known as “Medicare for All.” By not acknowledging taxes would almost certainly increase for a wide range of income earners, Warren avoids becoming a caricature of a Democrat itching to raise them. But she also threatens to undermine the image she’s fostered of a plainspoken former professor ready to tackle any issue in her quest to protect the middle class from the excesses of corporations and the wealthy. Warren’s progressive rival, Bernie Sanders, has said middle-class taxes would have to rise to pay for Medicare for All. Other White House hopefuls said Wednesday that Warren should be just as direct. “Look, I’m not picking on Elizabeth Warren, but this is ridiculous,” said former Vice President Joe Biden, currently Warren’s chief competitor for the Democratic nomination. Warren “is going to have to tell the truth” or face questions about her willingness “to be candid and honest with the American people.” Minnesota Sen. Amy Klobuchar said Warren “needs to come forward and say” how she’d pay for a new health insurance system. “I’m sure she will eventually,” Klobuchar said. Pete Buttigieg, the mayor of South Bend, Indiana, echoed that thought from the campaign trail in Ames, Iowa. “Everybody should be prepared to defend their plans,” he said Wednesday. “It’s serving us well to be very clear about how our plan works and to lay out the fact that it’s paid for.” Warren argues pundits are missing the point by focusing on taxes instead of the bottom-line cost that Americans pay for their health care. She insists that eliminating premiums and co-pays under Medicare for All would lower overall costs for all but wealthy Americans. Her top supporters say she should keep pressing that message. “Democratic voters are actually very appreciative that, on the substance, she wants to bring down health care costs, and, on the politics, she’s not taking the bait and giving Republicans and the insurance industry the TV ad moment that they want to deceive voters,” said Adam Green, a liberal activist and close Warren ally. Still, the lack of specificity on paying for Medicare for All is tricky since Warren famously is the candidate who “has a plan” for everything and proudly sweats even the smallest, wonkiest details. On health care, she says that she’s “with Bernie,” referring to the Vermont senator who authored the Medicare for All legislation in Congress. Warren’s campaign says that no one yet knows Medicare for All’s final price tag — but that Warren is still “reviewing the revenue options” previously suggested by Sanders and that she has been very consistent and clear in saying she’ll pay for it by adhering to the principles of lowering overall costs for middle-class families and raising them for rich people and major corporations. Democratic presidential candidates traditionally go to great lengths to avoid the idea that their party is tax happy. But being blunt about raising taxes is not necessarily an election loser, as long as their effect is targeted. President Barack Obama was reelected in 2012 following a pledge to raise taxes on top earners and did so by allowing previous tax cuts on the wealthy to expire. And Warren’s promises of a 2% wealth tax on households with a net worth of more than $50 million elicits chants of “2 cents!” at her rallies, bolstering her reputation as an economic populist. The generous benefits Warren is promising — surpassing other countries with government-run health care — would require tax increases of a historic magnitude to guarantee cradle-to-grave care for every U.S. resident, however. And that will make it harder to finance the program with surgically targeted tax increases on corporations and the wealthy. A study released Wednesday from the Commonwealth Fund and the Urban Institute estimated the government would need $2.7 trillion in additional revenues if Medicare for All were fully implemented next year. That’s more than half the current federal budget, and Washington is already borrowing heavily to meet its obligations. “It’s a huge tax increase,” said Urban Institute health economist John Holahan. “If you just lay it on a small group of people, how do you get those numbers?” Targeting income brackets also means necessarily picking winners and losers — and a person’s health status at any given time could determine what side of the ledger they wind up on. “The success or failure of major health reform plans always hinges on who would win and who would lose, and we don’t have the detail for the Medicare for All plans to judge that,” said Larry Levitt, a senior health policy expert with the Kaiser Family Foundation. Support for Medicare for All has fallen slightly since the beginning of the year, even as Warren and Sanders have championed it. An October poll by the Kaiser Foundation found 51% of Americans favor the plan, while 73% said they support a public option that would compete with private health insurance. Among Democrats, support for a public option has outpaced support for Medicare for All, 85% to 71%. A public option is backed by more moderate Democratic hopefuls, including Biden and Buttigieg. Traditionally, the U.S. has paid for social insurance programs with broad-based taxes. Medicare’s financing includes a payroll tax, money from the Treasury’s general fund and premiums paid by seniors. Sanders has laid out some options for Medicare for All, including a payroll tax on employers, a “premium” tax on households making more than $29,000 for a family of four and higher taxes on the wealthy — which is further than Warren has gone in explaining where the funding will come from. Releasing a more detailed health care proposal of her own could at least start to address these issues for Warren. But her advisers have long maintained that, while she may eventually do so, it isn’t imperative. “What resonates is not an academic version of her plan — it’s her personal story of struggle connecting with the real-world impact of her plan on everyday families,” Green said. “Medicare for All is about the principles, not the micro-mechanisms for putting it altogether.” ___ Associated Press writers Emily Swanson in Washington, Hunter Woodall in Keene, N.H., Thomas Beaumont in Ames, Iowa, and Julie Carr Smyth in Columbus, Ohio, contributed to this report. Claim: Warren, candidate with the answers, dodges tax hike question.

SOLUTION:
Elizabeth Warren is rising to the top of the Democratic pack with ambitious promises to reshape the political and economic system. But as she faces growing scrutiny, the Massachusetts senator is opening herself to criticism that she’s just another politician dodging the tough questions.