A new report from the Arizona PIRG Education Fund finds that Arizonans are getting hit with what are known as facility fees, leading to higher costs for medical care.

Maribeth Guarino, health-care advocate with PIRG, said facility fees can be thought of as a flat charge, added to a patient's bill only for stepping through the door of a doctor's office to seek care. She said facility fees are arbitrary and cost anywhere between a few dollars and thousands of dollars.

"We're seeing them more because hospitals are buying up independent clinics, physician's offices and other independent provider care settings and then charging these fees as though they're hospital locations, even though nothing has changed except the logo and the letterhead," she explained.

According to Guarino, 15 states around the country, including Florida and Texas, have laws on the books relating to facility fees, but Arizona isn't one of them. She noted states could better prioritize patient protections by ensuring they're informed about the fee before receiving care. And while several federal proposals have been introduced to address the issue, none has made it to the president's desk.

Guarino said the Federal Trade Commission has issued a rule to prohibit what she terms "junk" fees, and hopes the Federal Trade Commission will apply that rule to items such as facility fees. And for patients, she recommends reviewing your bill after you have received care.

"And do your best to shop around, if you can, before you get services," she advised, "because even though there aren't always laws in place to protect patients, sometimes you'll be surprised how much information is out there if you just ask directly."

Guarino added there is no guarantee you'll get that answer, but it doesn't hurt to ask. She said patients should only pay for the services they receive, and providers need to be transparent about the fees they charge.

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By Tim Marema for The Daily Yonder.
Broadcast version by Mike Moen for Wisconsin News Connection for the Public News Service/Daily Yonder Collaboration

Rural residents are less likely to be worried about the health risks of drinking unpasteurized milk, but they are just as likely as other Americans to understand the effectiveness of pasteurization to kill germs without changing milk’s taste or nutritional value.

A public opinion survey conducted by the University of Pennsylvania’s Annenberg Public Policy Center found that only a third of rural respondents thought raw milk was less safe to drink than pasteurized milk. Of urban respondents, about half said raw milk is less safe. The difference between urban and rural respondents was significant when researchers controlled for other factors such as age and education.

But the study found there was no statistical difference between rural and urban respondents’ knowledge that pasteurization eliminates milk-borne bacteria and viruses without affecting taste or nutrition.

“We did find that people living in rural areas thought that raw milk was safer overall than people living in the suburbs or in urban environments,” said Shawn Patterson Jr., a research analyst with the public policy center in a Daily Yonder interview.

Patterson said the center will conduct more research to see if they can pin down the cause of the different attitudes toward pasteurization. 

One possibility is that rural people understand the process of pasteurization but think raw milk is safer because they are more aware of managing livestock and milk production, he said. Or they might feel more confident about raw milk because they are closer to the milk source or raise the milk-producing animals themselves.

Patterson said he was not aware of studies that confirmed that consumers could mitigate the risks associated with drinking raw milk if they were more aware of where it came from. “But what we do know is that [raw milk] is still significantly less safe than pasteurized milk.”

A 2017 study found that unpasteurized milk was responsible for nearly all reported illnesses and hospitalizations linked to milk-borne infections. While under 4% of the U.S. drinks raw milk and under 2% eats cheese made with raw milk, those consumers experienced 96% of the illnesses caused by contaminated milk, the study showed.

Bird Flu and Raw Milk

While reported milk-related illnesses are low compared to other diseases (an average of 760 reported illnesses a year and 22 hospitalizations, the 2017 study said), milk safety has been in the news since an outbreak of bird flu H5N1 was reported in U.S. dairy cattle earlier this year. 

Infected cows can shed H5N1 into their milk, the CDC reported, and mice that consumed infected milk showed signs of developing the flu. This has led to fear that raw milk from infected cows could transmit H5N1 flu to humans. 

Currently, this influenza is not transmittable between humans. Out of 14 reported cases of H5N1 flu in humans this year, four were among dairy workers and nine were among poultry workers.

The Food and Drug Administration prohibits the inter-state sale of unpasteurized milk. States make their own rules for milk that doesn’t cross state lines. 

Pasteurization has been the norm for a century. But Patterson said there has been an uptick in demand for unpasteurized milk in recent years. He said that social media could be one reason and that future research would test that hypothesis.

Beth Ann Mayer in Healthline reported in June that profit motives from social media producers are part of the push for raw milk. 

Unpasteurized milk can transmit pathogens such as listeria, campylobacter, salmonella, and E. coli. People who are pregnant or have weakened immune systems are especially vulnerable to such infections, according to the FDA.

Mainstream scientists have found no evidence that pasteurization alters the nutritional value of milk, but myths persist that it does, Patterson said. 

“Pasteurization doesn’t change the nutritional value of milk; it doesn’t significantly change the taste of milk,” he said. “And so the risks really don’t outweigh any of the benefits.”

Other key findings in the public opinion poll on the safety of raw milk were the following:

• People over 65 were more likely than other age groups to think raw milk was less safe than pasteurized milk.


• Awareness of the health risks associated with unpasteurized milk increased as education levels increased. 


• Men were more likely than women to think raw milk was less safe than pasteurized milk. 


• Democrats were more likely than Republicans or independents to think raw milk was less safe.


• White, non-Hispanics were more likely than Hispanics or Blacks to think raw was less safe. 

The poll was conducted in June 2024 using the SRSS Opinion Panel. Rural was defined as respondents who lived in a nonmetropolitan county, based on the Office of Management and Budget Metropolitan Statistical Area system.




Tim Marema wrote this article for The Daily Yonder.


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In Georgia, the demand for Social Security cards is soaring, with nearly 34,000 residents in Gwinnett County alone requesting appointments for new cards in 2023.

While a Social Security number is crucial for many life milestones such as opening a bank account or applying for a driver's license, the Social Security Administration wants Georgians to know the physical card itself is often unnecessary.

Abigail Zapote, senior adviser for the Social Security Administration, said in many cases, simply knowing your Social Security number is sufficient and can help protect against the rising threat of identity theft.

"We do ask that folks first and foremost not carry their Social Security card around with them, whether it's in their purse or their wallet," Zapote advised. "Usually that's an easy way to be able to lose their Social Security card."

With identity theft on the rise, especially in high-demand areas such as Georgia, the agency urged residents to keep their Social Security card in a safe place and to use online resources for verification whenever possible.

Zapote noted the Social Security Administration is making it easier for people to request cards online. She pointed out the process can now be initiated online, an option particularly beneficial for Georgians given the high demand for in-person services.

"They can report a stolen Social Security number to the Federal Trade Commission at identitytheft.gov," Zapote explained. "Then go through our replacement process at ssa.gov/number-card to ensure that they can get that replacement card if they need it."

Zapote warned Georgia residents to stay vigilant against scams and only provide their Social Security number when absolutely necessary.


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Groups fighting for safer roads are urging Gov. Gavin Newsom to sign a bill requiring new vehicles to have a speed-monitoring system to warn drivers when they go more than 10 miles per hour over the speed limit.

Senate Bill 961 has already passed both houses of the state Legislature.

Marc Vukcevich, director of state policy for the advocacy organization Streets for All, said pedestrian deaths are epidemic.

"Pedestrian deaths have increased 68% since 2011," Vukcevich pointed out. "With traffic violence as a whole being the number one cause of death for all people from the age of five to 44 in the state of California."

Several big car manufacturers have come out in opposition to the bill, arguing the warnings could annoy and distract drivers. The change would only apply to new cars sold after 2030 and would add an estimated $60 to $100 to the cost of a car.

Vukcevich noted if drivers slow down even a few miles per hour, it would greatly reduce both the number of accidents and the suffering and death that result.

"The actual physical effect of getting hit by a car at that speed is substantially different from, let's say, 23 to 30 miles per hour," Vukcevich pointed out. "It's really a substantial difference on how likely someone actually lives or dies."

The European Union has already passed a similar measure. California would be the first state in the U.S. to require speed-warning systems.


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