Global finance leaders find a more temperate Trump in Washington

By Howard Schneider and Jan Strupczewski

WASHINGTON (Reuters) - Donald Trump took power in January pledging to overhaul a global order that he said cheated middle-class Americans with a promise to tear up trade agreements and impose tariffs on China and Mexico.

Some of Trump's policy advisers named allies like Germany and Japan as possible targets for economic retaliation.

Fast-forward almost 100 days into Trump's presidency and the world's most powerful finance officials, gathered in Washington for the International Monetary Fund spring meetings, have found an administration that is far from the disruptive force Trump promised.

Although Trump did act on his campaign promise to tear up a 12-nation Pacific trade pact that had been the cornerstone of President Barack Obama's Asian pivot, he has taken a much softer stance on other issues. He has refrained from pulling out of the North American Free Trade Agreement, did not carry out a pledge to label China a currency cheat, and his administration has signaled the United States may stay in the Paris climate accord.

Constraints being put on Trump by Congress and the courts on issues ranging from healthcare to immigration that would have filtered into the economy and the slow pace with which he is filling key administration jobs have played a role. And some foreign policy makers say they are still not sure who their counterparts are in the Trump administration.

But these policy makers said that important initial decisions have been far more centrist than might have been expected. The European Union's commissioner for economic and financial affairs, Pierre Moscovici, summed up a widely shared sentiment as he highlighted how two people at the top of Trump's economic team - Treasury Secretary Steven Mnuchin and Gary Cohn, director of the National Economic Council - have curbed the worst fears over the young U.S. presidency.

"We have the feeling that Mnuchin and Cohn are sensible people with whom we can discuss things, who are conscious of what an open economy requires," Moscovici told Reuters in an interview.

The European Union's view of a more pragmatic administration was shared by Mexico, which attracted some of Trump's greatest ire. Trump's threat to impose punitive tariffs on Mexican exports sent the peso currency tumbling, but it has since recovered.

Mexico's finance undersecretary, Vanessa Rubio Marquez, said  discussions with the Trump administration so far have become "anchored" around a handful of issues "that Mexico would be able to deal with."

"There is still a lot of uncertainty," she said in a seminar on Wednesday. But "dialogue has been more structured, more constant."



"FREE TRADE WILL CONTINUE"

What Trump might mean for the U.S. and world economies has preoccupied central bankers, investors and analysts since the new president took office promising a virtual revolution in the way the United States relates to the rest of the world.

Though much about Trump's policies remain unformed as the administration approaches the 100-day mark, the more extreme risks - such as a trade war or a budget-busting fiscal program that unhinges inflation - seem to have receded.

"My belief is that a multilateral framework promoting free trade will continue. There won't be huge changes to that," Bank of Japan Governor Haruhiko Kuroda told reporters on Thursday.

In remarks on Thursday, Mnuchin said tax reform remained a priority as are other steps to boost U.S. growth. But he said the hope for faster growth would mean a stronger world economy, and that it was constructive to coordinate policies through international organizations like the Group of 20.

"This administration is willing to reach out and get ideas from the outside," Mnuchin told top-level bankers at a conference organized in parallel with the IMF meeting.

There are still risks. The Trump administration said on Thursday it would embark on a study of whether cheap steel imports from China and other countries were damaging national security. And there are still huge gaps in personnel at key bodies like Treasury and Commerce.

"Many of the top jobs are still vacant," said one European diplomat who was attending the IMF meetings and spoke on condition of anonymity.

"Nobody outside the U.S. really knows who is the most powerful or influential one at moment," the official said.



 (Reporting by Howard Schneider and Jan Strupczewski; Additional reporting by Leika Kihara and Gernot Heller)

Florida state senator resigns after racial slur

By Bernie Woodall

FORT LAUDERDALE, Fla. (Reuters) - A Florida state senator resigned on Friday after coming under pressure for yelling obscenities and racial slurs inside a lounge frequented by lawmakers at the state capital in Tallahassee.

Senator Frank Artiles, a Republican from Miami-Dade County, made the comments on Monday night to two Democratic senators, both of whom are black, at the members-only Governor's Club, the Miami Herald reported on Tuesday.

"I am responsible and I am accountable and effective immediately, I am resigning from the Florida State Senate," Artiles wrote in a resignation letter delivered to the state Senate Majority Leader Joe Negron on Friday.

Artiles yelled at Democratic Senator Audrey Gibson, who earlier that day had questioned some bills Artiles sponsored, according to the Miami Herald. He called the Jacksonville senator a "bitch" and a "girl."

Artiles also called Democrat Perry Thurston, a black senator from Fort Lauderdale, an "asshole."

He also said Negron had risen to majority leader because of the support of six Republican senators he called "niggas," the newspaper reported.

Artiles on Wednesday apologized on the state Senate floor. He did not directly mention the comments he made on Monday night, but admitted he made offensive comments.

Thurston on Thursday filed a formal complaint to have Artiles expelled from the legislative body. He could not be reached for comment on Friday.

Gibson issued a statement on Friday, saying, "This has been an ordeal that no one should have to endure."

On Tuesday, Negron said in a statement that he has been informed of Artiles' comments by the senate's minority leader, Democrat Oscar Braynon.

"Racial slurs and profane, sexist insults have no place in conversation between senators and will not be tolerated," Negron's statement said.

Public protests followed, including one at Artiles' Miami-area headquarters where signs were posted on his office windows demanding that he resign.

Artiles, a former Marine, was elected in November to the senate after serving six years in the Florida House of Representatives.

"My actions and my presence in government is now a distraction to my colleagues, the legislative process and the citizens of our great state," he said in his resignation letter.





(Reporting by Bernie Woodall; Editing by Colleen Jenkins and Richard Chang)

The Bad Manners of the Campus Left

It snowed last Thursday (April 20) in Colorado.

It’s not unusual for folks in the Centennial State to witness snow in April if the snowflakes are outside. But on this occasion, they appeared inside a university classroom, which, it turns out, is not unusual either.

Having been invited by the local chapter of the student organization, Turning Point USA, I arrived on the campus of the University of Colorado-Denver to deliver a lecture on “Lessons from Ancient Rome.” The subject was 2,500-year-old history with a sprinkling of observations about what we today might learn from it all. Not exactly a hot-button topic such as abortion, immigration, Trump, or the most recent season of The Walking Dead.

What I saw from a minority of radicalized students in the audience, however, was an appalling microcosm of the smug, arrogant, self-righteous, politically-correct, campus insanity that you see on TV with increasing frequency these days.

About a dozen of the students at last Thursday’s event interrupted my lecture repeatedly with lengthy diatribes. One held up a sign that read, “Bullshit!” They heckled me. When that failed, they accused me of racism. I was able to deal with the interruptions and conclude my speech, but that was due to a failure in the protesters’ organizing capabilities rather than any generosity in their intent. They exhibited far more “selfishness” than the conservatives and libertarians they think of as “selfish” and seek to silence. It certainly helped that the rest of the audience wanted me to speak, and enthusiastically applauded each time I put a protester in his place.

For me, next year will mark 50 years in the “liberty movement.” It was in 1968, a month shy of my 15th birthday and prompted by the Soviet invasion of Czechoslovakia, that I participated in a public demonstration in Pittsburgh. So I know and appreciate the importance of protest. In the right places and at the proper times and for noble causes, it’s a healthy and necessary thing. In Mellon Square in downtown Pittsburgh that day forty-nine years ago, we protested the vicious deployment of tanks, guns and troops by a communist regime to crush the rights and freedoms of a neighboring country.

What the hooligans last Thursday at my lecture in Colorado were objecting to was a very different kind of invasion—a peaceful, voluntary offering of ideas they were unaware of, didn’t want to hear, and thought it was their right to prevent others from hearing. Their intent was to intimidate, to harass, to silence, to dominate. This is not conduct that a citadel of education should tolerate for an instant.

Interesting, isn’t it, that what some go to college for, others find “offensive.” As I watched the incident occur, I thought to myself, “I’m standing in a taxpayer-funded institution of supposedly ‘higher’ education, not a Khmer Rouge re-education camp, for crying out loud!”

The disruptions commenced a mere five minutes into my lecture on Roman history, before I had progressed much beyond about 300 B.C. So it was hardly anything I could have said that the disrupters truly found indecent. They had come voluntarily but were annoyed—deeply and personally aggrieved, it seemed—for no more reason than the speaker and the sponsoring organization possessed viewpoints they knew little about, didn’t understand, couldn’t articulate, and don’t like.

Far-left students derailing speakers with whom they disagree have been in the news a lot. Sometimes they’ve resorted to violence. Many times, the speech being protested was canceled before it happened or protesters forcibly prevented the speaker from finishing his job. My encounter was small potatoes by comparison and fortunately, never descended into fisticuffs. And I did push back, and I did finish speaking.

When I taught college classes 40 years ago, I didn’t tolerate a sleeper or a ball cap, let alone a bad-mannered brat with no respect for the rights of his fellow students. So I wasn’t about to let these “progressive” brownshirts shut me up.

Writing in The Wall Street Journal, Manhattan Institute scholar Heather Mac Donald explained where this tawdry deportment is coming from:

Campus intolerance is at root not a psychological phenomenon but an ideological one. At its center is a worldview that sees Western culture as endemically racist and sexist. The overriding goal of the educational establishment is to teach young people within the ever-growing list of official victim classifications to view themselves as existentially oppressed. One outcome of that teaching is the forceful silencing of contrarian speech…The silencing of speech is a massive problem, but it is a symptom of an even more profound distortion of reality.

Like Mac Donald, I doubt that many of the anti-free speech bullies in today’s colleges and universities enter those institutions with the intent to shut people up. It’s not typically their parents who teach them intolerance, it’s a handful of their professors—the very professors their parents are bankrolling with their hard-earned tax and tuition dollars. They are besmirching the entire profession, which neither the serious students who want to learn or the good professors who want to teach deserve.

I’m guessing that UC-Denver's course on “Problematizing Whiteness: Educating for Racial Justice” is not helping matters.

My FEE colleague Jeffrey Tucker recently shed light on the influence of Herbert Marcuse, a key Marxist intellectual from whom the troublemakers draw inspiration. In a similar vein, I wrote four years ago about how ugly ideas permeating British academia contributed to ugly behavior in the streets in the wake of Margaret Thatcher’s death in 2013.

Here are some highlights of the exchange at the University of Colorado-Denver last week:

A few minutes into my lecture, a student raised his hand and started speaking. I politely said, “Please let me get through my lecture and then we’ll have a Q & A period.” He muttered something that only those around him could hear, but I doubt it was “Thank you.”

A minute or two later, I mentioned that ancient Roman road-building was so massive that nothing would compare in magnitude until the 20th Century. One of the snowflakes found that offensive.

“Not true! The Mayans built roads too!” that same student rudely interjected from the back of the room.

“Yes, the Mayans built roads too, but nothing on the scale of the Romans,” I responded.

“Not true!” he insisted. “We have professors who have researched this!”

Well, here are the cold, hard facts: Roman road mileage totaled 250,000. By contrast, the most extensive road system in pre-Columbian South America was constructed by the Incas, not the Mayans, and it amounted to a mere 25,000 miles. Mayan civilization (everything, not just the roads) covered about 125,000 square miles at its height, compared to Rome’s 2.5 million square miles. You could fit all of the Mayan Empire into just half of the Roman province of Egypt. So the student who felt so put upon and so sure of himself that he had to interrupt the speaker didn’t actually have a clue of what he was babbling about.

There’s another point worth making here. Why do you suppose the student was so indignant that I didn’t give inflated road-building credit to the Mayans in a lecture on Rome? Answer: Because Romans were white Europeans and in the official Newspeak of far-Left academia, white Europeans are barely a notch above persona non grata. Mayans, on the other hand, were “indigenous, native peoples” who must be elevated and celebrated.

Never mind that the state religion of the Mayan Empire incorporated idol worship, human sacrifice, hallucinogenic rituals and decapitations. Let’s not talk about the pandemic internecine warfare of the Mayan Empire, or its severe environmental degradation and enslavement of subjugated peoples, either. That would not be politically correct.

Again, I asked that I be allowed to make my presentation and take questions afterwards. Mumblings and a few brief outbursts persisted but I mostly ignored them.

Fifteen or so minutes later, another student raised his voice from the back row, “You haven’t allowed any questions yet!”

I replied, “I already said I would take questions when the lecture is over, and I promise I’ll call on you first.” He insisted on speaking then and there, whereupon one of the Turning Point students asked him to leave the room. He did, but returned moments later.

In the video clip above, you can observe a part of this student’s Second Coming. As promised, I called on him during the Q & A. Do you suppose his question was about Roman history? Of course not. Here, slightly abbreviated, is how it unfolded:

Student: “You wouldn’t take my question when I wanted to ask it. Why should I listen to anything you say if you won’t listen to what I say? Why should I bother?”

Me: “What am I doing right now but listening to you?” A few incoherent mumblings in response, which prompted me to then assert, “This has happened before on some campuses and I’m guessing that you just can’t stand the fact that somebody might have a viewpoint different from yours.” Vigorous applause followed from the great majority of the audience, boos and catcalls from the minority.

The video clip, unfortunately, doesn’t quite capture a subsequent moment that I regard as the high point of the whole affair. I raised my voice to convey an important observation to the disrupter: “You have a character problem!” I doubt he understood that I was informing him that his rude intolerance was not only indefensible, it was a manifestation of something wrong inside, something flawed about his personal choices and conduct.

“Now you’re calling me an idiot!” he exclaimed, to which I instantly shot back, “I did NOT say you were an idiot. I said you have a character problem!”

That’s when some shouting and epithets began to pour forth from the know-it-all snowflakes: “You’re a racist! “Bullshit!” Nazi!” And a few F-bombs as well, the first of several aimed at me both during the event and while I was walking to my car. It was amazing how swiftly and seamlessly these wise guys toggled between “offended“ and “offensive”!

And oh, the sanctimony was so thick you could cut it with a knife! The slogans that rolled off those immature tongues were what Anthony Esolen refers to in his superb book, Out of the Ashes: Rebuilding American Culture as “cant”—the insincere or hypocritical use of pious language to cover up for one’s ignorance while making a pretense to moral superiority. In Esolen’s words,

You have to be educated into cant; it is a kind of stupidity that surpasses the capacity of unaided Nature to confer…

People are especially prone to cant when they describe their feelings in public. When someone says, “I am offended by that remark,” the first thing you must think, in our time, is that the remark has broken upon the person’s day like the bright sun through a week of rain and gloom. An owl is not offended by the little field mouse; it is just what the owl is on the lookout for. If the offended person loses any sleep that night, it will not be for sorrow, but for delightful dreams of vengeance and public displays of virtue. The cannibal rolls up his sleeves and whets the knife. For truly tolerant people are hard to offend. They do not seek occasion to bring others into ill repute. They do not put the worst construction on someone else’s words or deeds.

Disturbingly, this lowering of the most basic standards of interpersonal communication makes a mockery of “higher” education in this troubled age of ours.

Blake Scott from Littleton, Colorado was there last Thursday evening (and provided the video clip). In his words, “I was shocked at how the students attacked Mr. Reed with unwarranted claims. Rather than derailing from his speech that he was invited to give, he respectfully took the moral high ground. Hecklers accused him of racism during the question and answer session, claiming he selectively picked students for questions by racial profile, without any evidence whatever. The students constantly attempted to disrupt the speech but he calmly rebutted their outbursts.”

Bradley Beck of Erie, Colorado, another eyewitness, says, “The whole time, Mr. Reed smiled and stayed professional, calm and in charge.”

So the good news is that this time, the bad guys didn’t get away with it.

The increasing frenzy of the campus Left may be an indication that, in the words of Robert Tracinski in The Federalist, we are approaching “peak leftism.” We should certainly hope Tracinski is right.

Writing in The Washington Post on April 20 (the same day as my Colorado speech, coincidentally), Catherine Rampell advised, “Don’t blame college students for their hostility to free expression. The fault ultimately lies with cowardly school administrations, who so often cave to student demands for censorship.” (In that same article, she recounted a crazy episode at American University in Washington. It’s worth your attention. Also, check out the headlines to commentary at The College Fix and you’ll get the drift.)

Rampell makes a good point. Cowardly school administrators are indeed partly at fault, and not just because they coddle reprehensible student conduct. When they hire barbarians to teach in their classrooms and collaborate with them to blackball serious scholars of a different viewpoint, they are accomplices in the degradation of education and the decay of civilization.

But I don’t let the students off the hook. They are young adults. Even if they act like toddlers in a temper tantrum, nothing will nip this stuff in the bud quicker than treating them as adults. That means one fair warning before a second offense. Then you get expelled and perhaps fined and maybe even a night or two in the slammer, if I had my druthers. Unlike the barbarian Left, I take freedom of speech seriously, and assaults on it even more seriously. Let’s stand up to these bullies. Civilization depends on it.

The students from the UC-Denver Turning Point chapter suffer through intimidation tactics from the campus Left all the time, as do courageous students from TPUSA chapters elsewhere, along with students in similar organizations like Young Americans for Liberty, Students for Liberty, Young Americans for Freedom, and the Intercollegiate Studies Institute. At FEE, we are proud to work with them, provide literature and speakers and moral support, and we applaud their efforts to resist the barbarians in their midst. If anything, the incident last week only emboldens us to assist them all the more.

Lawrence W. Reed

Lawrence W. Reed is President of the Foundation for Economic Education and the author of the book Real Heroes: Inspiring True Stories of Courage, Character and Conviction. Follow on Twitter and Like on Facebook.

This article was originally published on FEE.org. Read the original article.

It’s Almost Impossible to Find Out the Cost of a Medical Procedure. This Company Is Trying to Change That.

For a patient looking to see a doctor for any given medical procedure, costs often vary wildly based on the facility or physician.

Take non-surgical repair for a broken ankle.

For a 26-year-old female insured by Cigna who chooses a top-rated orthopedic surgeon in Washington, D.C., such a procedure costs $1,729.

But if she chooses another top-rated orthopedic surgeon in nearby College Park, Maryland, the procedure costs $1,199.

That’s according to a company called Amino, which mines data from billions of health insurance claims from the private and public sectors. Amino then gives patients access to information on the cost of various procedures and how much experience doctors nationwide have in those procedures.

And in the age of rising deductibles and out-of-pocket costs for health care, this Silicon Valley-based company is working to put more of such information in the hands of  patients.

An alumnus of Zillow, a real estate company that provides data on the housing market, Amino CEO David Vivero decided to start the company in 2013 based on what he personally had gone through in searching for a new insurance plan.

Because Vivero has a pre-existing condition, he realized he probably would have trouble finding a good insurance plan and a good doctor.

“I realized just having the consumer experience that health care had offered me was really frustrating,” Vivero says in an interview with The Daily Signal. “So I decided to build Amino to solve that.”

The company provides consumers with access to specifics about procedures, doctors, and costs generated by its massive database of health insurance claims from government and private-sector partners.

Users head to its website, Amino.com, and click through five screens—procedure, gender, age, location, and insurer, which is optional—before they’re presented with results for doctors based on quality and prices for more than 90 procedures.

Need a chest X-ray in the Arlington, Virginia, area?

For a 26-year-old female enrolled with UnitedHealthcare, the nation’s largest insurance provider, the procedure will cost $662 at Virginia Hospital Center, the top-billed facility.



Need to repair a broken ankle in the Sarasota, Florida, region?

For a 48-year-old male insured by Blue Cross and Blue Shield of Florida, the procedure will cost $2,029 to see the top-rated doctor for fixing a broken ankle.



The website doesn’t have any ads or sponsorships, and because of this, Vivero says, he hopes Amino can offer “truth” to health care consumers.

“By committing to not taking advertisements or allowing for providers of care to bid up, we can promise the results are data-driven for consumers,” he says.

Vivero says he believes that having access to this information helps consumers make more informed choices about their health care:

Transparency can really change markets. Having an empowered consumer was really something that would really create both a competent set of choices, and also solve problems for insurance plans and providers who are now dealing with the realities of this emerging consumer class in health care.

And as deductibles on health care plans have continued to rise, leaving consumers to pay more out of their own pockets, more companies see a market for showing patients the costs of medical procedures.

“When people pay their own way, they’ll start to shop and demand prices,” Twila Brase, president of the consumer group Citizens’ Council for Health Freedom, tells The Daily Signal. “Lots of people wanted to force doctors to be transparent about their prices, but it didn’t matter until people pay their bills.”

When it first launched, Amino provided users with information on the quality of doctors featured on the site.

In October 2015, the company introduced a service allowing users to tap into its database of doctors nationwide to determine which they like based on how much experience doctors have with specific conditions and the insurance accepted. It also allows users to book an appointment.

And last year, the health care company unveiled its cost estimates, allowing patients to find the costs of 49 different services or procedures and estimate what they may have to pay based on their insurer.

Today, Amino provides cost estimates for more than 90 procedures.

“They’ve been able to finally compare and understand the prices that are available for them, which is a huge opportunity for the average consumer,” Vivero says of users.

‘The Pioneers’

As of 2015, health care spending in the United States reached $3.2 trillion, according to the federal government, and health insurance data has been used by others in the industry to build actuarial models and combat fraud.

But Vivero says his company is the first to marry access to that data with patients’ desire for transparency.

“As it relates to using this data to empower consumers to feel informed and confident in their health care choices, we feel we’re the pioneers,” Vivero says.

The company is one of several ushering in a new era of transparency in health care, fueled by higher deductibles and the increased amount patients pay out of their own pockets.

“As deductibles rise in health care, more and more decisions become the sole financial responsibility of that head of household or that individual insured member,” Vivero says. “As a result of that, the information appetite that people have has grown substantially.”

According to the Kaiser Family Foundation, the size of deductibles increased 12 percent in 2016 for consumers in the group market.

For employers with fewer than 200 employees, 65 percent of workers are in high-deductible plans, with the average deductible totaling $2,000.

In the individual market, deductibles have continued to rise as well.

According to an Avalere study of plans sold on Obamacare’s exchanges, combined deductibles—which include medical and drug deductibles—for silver-level plans jumped 20 percent from 2016 to 2017.

In 2016, for example, the average combined deductible for a silver-level plan was $3,075. In 2017, that rose to $3,703.

Though many patients began noticing a rise in deductibles after implementation of the Affordable Care Act, the Kaiser Family Foundation notes that this trend began before Obamacare was signed into law.

Still, as consumers move toward health insurance plans with lower premiums in exchange for higher deductibles, they tend to desire more information on health care services.

“Private-sector companies see an opening because people are now forced to pay cash to meet their deductibles,” Brase, of the Citizens’ Council for Health Freedom, says. “[Obamacare] has returned a cost-consciousness to a fair amount of people.”

Brase and her organization advocate a cash-based system of health care, where patients don’t have to rely on insurers to pay their bills. Removing insurers from the equation allows patients to negotiate prices directly with providers, she says.

But those with insurance, Brase says, are becoming more aware of the impact medical procedures will have on their pocketbooks:

Transparency is really important because it moves us back to true sensitivity about prices. Because of Obamacare, it forced people into paying for their own bills, [and] they then naturally gravitated toward transparency. They started asking for prices, shopped around, and went on the internet.

Brase warns that in today’s system of health care, it’s difficult to know what the “true cost” of any given procedure is, since insurance companies negotiate prices directly with providers.

That means that even within the same hospital or medical facility, costs may vary.

But the push for more transparency in the health care industry can help get patients closer to solving that puzzle, Brase says.

“It brings us closer to the true cost,” she says. “It also brings the prices down because then there’s competition between the posted costs.”

‘Nuanced Choices’

Vivero says he has heard from many Amino users who use his company’s website for different purposes.

Some report that Amino helped save “tens of thousands of dollars,” he says. Other consumers praise the company for helping to avoid misdiagnoses, since they were able to find experienced doctors to get a second opinion.

And others changed their habits of health care consumption based on the information Amino provided.

“Being able to see that information up front is incredibly empowering,” Vivero says of consumers, adding:

What they do with that is either to choose a physician, or sometimes they budget differently. Or they might decide to get that procedure done in one calendar year versus another. But at the very least, you have the information you need to make that informed choice.

To provide patients with cost estimates, Amino partnered with more than a dozen companies across the health care supply chain—health IT companies, payment processors, insurers—to compile data on patients’ health insurance claims.

That gave the company access to a trove of insurance information from the private sector.

Then, in 2014, the Centers for Medicare and Medicaid Services—the federal agency that also oversees Obamacare—named Amino a “qualified entity,” making it the first for-profit company to receive the designation. As a qualified entity, the company received claims data from Medicare Parts A, B, and D.

Amino removed all identifying information from the data it received and, with the claims, built a database with information on which doctors take which insurers, how much different procedures cost, and how much consumers will pay.

Vivero says his company now has data from more than 9 billion health insurance claims, and Amino users can book appointments online with more than 900,000 doctors and facilities.

The company recently added Amino Plus, a service for insurance companies or employers that gives members access to additional information on their insurance plans, including plan documents, network data, and the current status of their deductibles and out-of-pocket maximum fees.

“The effect of that is to drive even greater use of in-network services so that … the consumer gets fewer surprise bills and so the employer gets fewer surprise bills and out-of-network charges,” Vivero says.

In March, Amino released a study with Ipsos, a market research company, exploring Americans’ attitudes about health care costs.

The study found that 63 percent of Americans said that receiving a medical bill they can’t afford is worse than or as bad as being diagnosed with a serious illness.

Additionally, 55 percent said they received a medical bill they couldn’t afford, and 1 in 5 said they avoid high medical bills by avoiding the doctor.

Vivero says Amino’s mission is to help patients make more informed decisions that save money.

“We hope to give them the information they need to make smart choices that in the long run are better for their wallets and better for their health,” he says.

Why Record Numbers of Americans Are Renouncing Their Citizenship

Would you give up your citizenship in order to keep your bank account?

That’s a question few Americans would ever want to confront, yet many Americans living abroad are now having to answer.

A little-known tax law, known as the Foreign Account Tax Compliance Act, has resulted in some foreign banks no longer serving Americans.

The law, signed in 2010 by President Barack Obama, was intended to make it harder for Americans to keep money overseas and out of the reach of the IRS. The primary target was rich Americans allegedly hiding money from tax collectors.

To find tax avoiders, foreign banks are conscripted by the U.S. government to serve as a compliance arm of the IRS. As a result, many of these stranded Americans have had to make the undoubtedly difficult decision to give up their citizenship just to continue to access their banking services.

Last year, 5,411 people renounced their U.S. citizenship, the largest number of published expatriates in one year, continuing a four-year streak of record-breaking numbers.

The Foreign Account Tax Compliance Act requires foreign financial institutions, such as banks, to identify and report to the United States most types of transactions for all American clients.

These new regulations are enforced by the threat of applying a 30 percent withholding tax on revenues generated in the United States by the noncompliant foreign financial institution.

The reporting burden and withholding penalty faced by foreign banks trying to comply with the new regulations has made it easier for some Americans to renounce their citizenship than to find a bank that is willing to bear the bureaucratic costs of complying with the law.

These penalties are not just hitting the rich, and they are not just harming tax dodgers. The cost of complying with this law hits every American living overseas, not just those targeted by the original legislation.

Middle-class Americans living abroad who are fully compliant with U.S. tax laws are losing their mortgages, business bank accounts, and personal banking services. The Foreign Account Tax Compliance Act has unintentionally ruined some Americans’ livelihoods.

To add insult to injury, the cost of implementing this law may soon outpace the money that it brings in.

Furthermore, the direct cost to taxpayers does not include the compliance costs to financial institutions. A legal challenge to the law in 2015 estimated compliance costs alone were on track to total more than the 10-year revenue estimates.

These regulatory costs can discourage international business, slow investment, and hamper the global economy.

The root of the problem is more than just compliance costs, it’s the U.S. government’s presumption that it is entitled to your money even if it’s earned in another country.

The U.S. is one of just a few countries that claims taxing rights on labor income earned abroad. Such a system of worldwide taxation hurts the American economy and makes it much harder for Americans to live abroad

Hopefully, relief from this law is around the corner. Rep. Mark Meadows, R-N.C., and Sen. Rand Paul, R-Ky., recently released a bill that would repeal the onerous regulations.

Congress and the IRS should focus on the U.S. domestic tax system and leave Americans living abroad alone. The Foreign Account Tax Compliance Act is yet another example of continued government overreach.

Hopefully, tax reform will bring with it relief for all Americans—including those living overseas.