STLDs, Video Games, Vaccinations


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Opinion: Short-Term Limited Duration Insurance Plans Are Not a Free-Market Alternative

By Conna Craig

Over the next few months, Americans will be hearing a lot about STLDs, which are being touted as a free-market alternative to the Affordable Care Act. Short-term limited duration insurance plans have been around for years, but what’s new about STLDs is that, under a final rule published August 3 in the Federal Register, the definitions of “short-term” and “limited duration” have been dramatically altered.

The Trump administration’s new rule will allow state insurance commissioners to expand the use of STLDs for people during a lapse in coverage. The final rule re-defines “short-term” from the current three-month limit to 364 days; duration extends to just days shy of three years, as the plans can be renewed twice. The rule goes into effect October 2.

The Trump administration’s plan returns power to the states, which is a good thing. Members of the National Association of Insurance Commissioners appear to be moving into high gear in response to the new rule. Earlier commentary from NAIC had requested that the rule allow states until 2020 “to facilitate a smooth transition.”

There’s no time for that now. The New York Times reported that while state regulators from the NAIC met in Boston recently, two Republican governors have already issued rules to limit the short-term plans.

STLDs are not the same as other insurance plans. Paul Spitalnic, chief actuary of Centers for Medicare & Medicaid Services explains: “STLD plans are not considered individual market insurance policies, and therefore they are exempt from the statutory coverage requirements of the individual market. Moreover, they do not need to meet the essential health benefits requirements or the actuarial value requirements, they can be medically underwritten, and they are not eligible for federal subsidies in the Health Insurance Marketplace. As a result, insurance companies would be able to offer these policies to individuals who are in good health at a substantially lower premium than available in the individual market.”

Indeed, healthy people are flocking to STLD plans. And why wouldn’t they? Average premiums on the federal exchange more than doubled from 2013 to 2017. Once the individual mandate penalty drops to zero next year, we can expect the use of STLD plans to skyrocket.

The cost to purchase these plans will be lower, yes, but the requirements of STLDs are not the same as for other policies. This is not a factor of a free market. It was Obamacare that “exempted short-term policies from market rules” like excluding pre-existing conditions and requiring minimum coverage.

STLDs simply aren’t held to the same standards as other types of policies. STLDs:

(a) can turn down applicants based on health conditions, gender or age; (b) are not required to cover “essential benefits” like prescription drugs, maternity care and mental health care; (c) and can retroactively cancel policies.

Medicare’s chief actuary estimates that 1.4 million people could sign up for STLD plans in 2019, with enrollment reaching 1.9 million by 2022. He estimates that the new plan could cost the government $1.2 billion next year and a total of $38.7 billion over 10 years.

As long as some health care policies are required to meet ACA requirements, there is no “free market” in America’s health care system.

I am certainly not advocating against sensible requirements, including essential health benefits. What we will have come October of this year is a mix of ACA-compliant policies and free-wheeling STLDs. As I reviewed some of the comments submitted in response to a then-proposed rule, I was struck by this passage from the American Academy of Family Physicians:

All commercial and private health insurance plans should adhere to the ACA’s essential health benefits requirements to prevent insurance discrimination against any individual based on their health status, age or gender.

This precept appeared again and again in commentaries on what was then a proposed rule, and is now the law of the land: we can’t have it both ways. As long as the ACA remains in place, the expectation is that all the players will abide by its rules.

To create a truly free market in health care would require the type of level playing field that cannot exist concurrently with Obamacare. Dismantling Obamacare piece by piece appears to be futile and costly — both in taxpayer dollars, which we can measure, and in human suffering, which is difficult to tally and impossible to recompense.


Conna Craig is director of outreach for The Bridge Restoration Ministry, a faith-based recovery program in Pacific Grove, California. She has worked as an adviser to governors and policy leaders of two White House administrations. She wrote this for

The Conversation

Finding nostalgia in the pixelated video games of decades past

August 15, 2018

Nicholas Bowman

Associate Professor of Communication Studies, West Virginia University

Tim Wulf

Ph.D. student in Media Psychology, University of Cologne

Disclosure statement

Tim Wulf receives funding (PhD Scholarship) from the foundation of German Business (Stiftung der Deutschen Wirtschaft).

Nicholas Bowman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.


West Virginia University

West Virginia University provides funding as a member of The Conversation US.

Every day, it seems, new ultra-high-resolution video games are released, syncing with players’ social media accounts and ready for virtual reality headsets. Yet old games from the 1970s and 1980s are still in high demand. The Nintendo Corporation has moved recently to both quash and exploit that popularity, shutting down websites hosting old games’ code while planning to release its own back catalog on a new platform.

Fans of Nintendo-made games may end up OK, but fans of other legacy games may lose much more than a retro way to have fun: They could find themselves without a powerful link to their personal pasts.

Playing old video games is not just a mindless trip down memory lane for lonely and isolated gamers. The average age of a U.S. gamer is 34, and many popular retro game titles have been around for 20 years or more. It seems Generation X-ers could be returning to their cherished childhood properties.

In fact, emerging media psychology research, including our own work, suggests that video game nostalgia can make people feel closer to their past, their friends and family, and even themselves.

The popularity of retro video games

The earliest video game consoles emerged in the 1970s, marked by the 1972 release of the Magnavox Odyssey. The arcade classic “Pong” was so popular in 1973 that machines each collected about US$200 a week in quarters. Many 1990s gamers remember fondly the “console wars” in which major game developers would battle publicly – for example Sega claiming to do what “Nintendon’t.”

It may be a bit of a surprise to find out how popular retro and classic games are. Older games feature pixel-based graphics that can look fuzzy on modern televisions and can be frustrating to play for even experienced gamers. Yet in 2016, Nintendo released a NES Classic Edition console and sold out all 2.3 million of them in just three months. The company made more and began selling them in June 2018.

Other similar retro consoles are popular too. A quick search of eBay and Amazon reveals hundreds of retailers selling original and refurbished older video game systems. These older games pale in comparison to modern games that immerse players in lush, photo-realistic and smoothly interactive worlds. And yet they’re very popular. The people who play them are clearly getting something compelling – though it’s probably not graphics or a deep storyline.

The psychology of nostalgia

As a psychological principle, nostalgia can be best understood as a bittersweet mix of positive and negative emotions that arises when thinking of meaningful events in one’s own past, and tends to be tied intimately to social relationships.

So far, researchers have identified two ways to trigger nostalgia: external triggers and internal distress. External triggers might include things such as smells and tastes and even references to media content, such as movie titles or music. Internal triggers are brought about by feelings of loneliness or even boredom.

Regardless of the trigger, nostalgia has a number of psychological benefits. It can help people feel better about themselves and make them feel less alone. For these reasons, nostalgia can promote mental health and well-being. Clinical studies have suggested that nostalgia might help protect against dementia.

Nostalgia in video games

Can video games really evoke nostalgia? Forums online debate the issue furiously, museums chronicle the history of video games with an eye toward bygone days, and the topic comes up in popular podcasts.

Players’ relationships with the characters they’ve played in the past – Mario, Sonic and scores of others – can play an important role in invoking nostalgia. One reason for this is players have complex social relationships with those characters, either by seeing them as their friends, or even as extensions of themselves.

In our own research, we asked 582 participants, mostly from the United States, to respond to a survey on “how people think about certain gaming experiences.” Specifically, gamers were randomly assigned to write one of four essays: about past or recent video game experiences, playing either alone or with others. The essays were designed to help participants immerse themselves in the memories, so that they could later answer questions about the intrinsic psychological needs satisfied by those experiences.

As we expected, people who wrote about the older memories experienced stronger feelings of nostalgia than the people who wrote about recent ones. Those essays about older, more nostalgic memories were also more likely to have discussions of challenge and enjoyment as core to their experience, and tended to recall memories from the writer’s childhood. Social memories essays were also more nostalgic, but only when those memories were associated with a greater sense of belonging with people from the past. Some of these essays, especially those about family and friends, were emotionally powerful – one participant wrote (edited slightly, to protect their identity) that “My dad died when I was 10 so playing Mario Kart with him is one of my best memories that I have.”

Nostalgic gaming and well-being

Perhaps more interesting? Memories of video games were enough to induce nostalgia that, in turn, made those people feel a little closer to those around them right now.

The study has limitations – the largest being that participants did not get to play their older games, so we don’t know if their nostalgic memories would be the same if they actually replayed the games – but it helped us better understand gaming nostalgia and its potential effects. Our findings have also been corroborated by other research on gaming nostalgia, such as work on active players of “Pokémon Go.” In that study, playing the game resulted in feelings of nostalgic reverie, which in turn was positively connected to resiliency, or the ability to cope with challenging times in life.

Research into the psychology of video game nostalgia is relatively new. However, the results of this work suggest that games can be nostalgic, and that this nostalgia can be therapeutic. For example, we already know that playing games at work can aid in psychological recovery from stress; it might be that playing nostalgic games could intensify this process. It could also be possible to use the popular video games of yesterday as health interventions to delay the onset of dementia, following a line of research showing video games to have cognitive and physical health benefits for older populations.

As gamers age, understanding gaming nostalgia will help us better examine the wide range of experiences that they have with one of the most profitable and popular form of entertainment media today.

Overcoming vaccination myths: Could addressing the facts during prenatal visits help?

August 15, 2018

Amanda Sams Bradshaw

Ph.D. candidate in advertising, University of Florida

Disclosure statement

Amanda Sams Bradshaw does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.


University of Florida provides funding as a founding partner of The Conversation US.

During pregnancy, expectant parents spend countless hours sifting through online resources to make the “right” medical choices for their baby. In addition to decorating a nursery and playing baby shower games, pregnant women often are glued to their smartphones, seeking advice from friends and strangers.

A pregnant woman’s Facebook news feed provides one window into motherhood, and the connections, articles and advice delivered by a Facebook news feed offer suggestions – both wanted and unwanted.

Despite expressing skepticism of the accuracy of digital resources and a pervasive fear of “fake news,” pregnant women “Google it up” to gain information and health advice. Mothers-to-be have been found to rely on social media more frequently and with greater intensity at the transition to parenthood.

However, the internet has been dubbed a “postmodern Pandora’s box.” Misinformation and rumors abound on many health topics, but particularly in regards to childhood vaccinations. False claims and widely perpetuated myths, such as the discredited assertion that vaccinations cause autism, have been declared a threat to modern society. According to the Centers for Disease Control and Prevention, community immunity requires that a certain percentage of the population be vaccinated to maintain coverage against dangerous diseases for all.

I study health communication, and I have analyzed some of these trends. I see problems when expectant parents accept medical myths. I also see opportunities to change the narrative to an accurate one.

Persistent falsehoods

Although overall vaccination rates in the United States remain high, social networks sometimes support grassroots mobilization of mothers against childhood vaccines. This allows personal narratives to take root and be shared more.

My recent study, not yet published, found that more than 30,000 members in the largest closed anti-vaccination Facebook group influence first-time, pregnant and new mothers in their decision-making process for their own children. In some instances, I found that a mother’s expressed concern would transition from fear of protecting her child from measles to a more intense fear of more than 200 alleged side effects.

Another recent study analyzed 2.6 million Facebook users’ interactions over more than seven years, identifying distinct, opposing pro- and anti-vaccination narratives. Users self-select the content they wish to view based on their own belief systems, ignoring all other content. Researchers found that posts from anti-vaccination advocates received more user comments. And anti-vaccination groups are growing more rapidly in comparison to pro-vaccination groups.

Similarly, another study identified that the majority of YouTube videos about infant vaccination showed babies in pain and distress. Videos that disapprove of vaccinations received the most likes, views and shares. In contrast, pro-vaccination YouTube videos received far fewer likes, shares and views.

Put simply, anti-vax videos are increasingly playing up the risks of vaccination, which mainly include redness and swelling where the shot is given and, in very rare cases, other side effects. These anti-vax videos consistently downplay the benefit of protection from life-threatening diseases.

A large study in New York state identified one in four students following an alternate, nonscientifically based vaccination schedule. An alternate schedule may include selectively vaccinating or delaying certain vaccines. Essentially, parents of these children are following their own schedule, or a schedule found in a book or magazine, but not the CDC recommended schedule. Students in private schools, or those who come from more affluent families with parents who have received higher levels of education, are more likely to opt out.

Physicians such as Robert Sears provide advice contrary to consensus by the medical community and use digital channels, including propaganda videos, to raise concerns about the safety of vaccinations. The Medical Board of California recently placed Sears on probation for allegedly writing inappropriate medical exemptions for vaccinations.

Causing a cluster

Parental refusal to vaccinate typically increases in geographic clusters, and when that happens, outbreaks of once-eliminated diseases, such as measles, occur. In 11 states, the number of kids not being vaccinated for nonmedical reasons has exceeded any point in the past five years. Infants, the elderly and immuno-compromised individuals are particularly vulnerable.

While women get a lot of information on birth plans and breastfeeding during standard prenatal care, my qualitative research suggests that they do not get much information about childhood vaccinations. In interviews and focus groups with more than 20 expectant mothers, some in their third trimester, all reported that providers had not initiated dialogue about childhood vaccinations. For first-time mothers, they reported our conversation was the first they had formally discussed this particular issue. Yet the American Academy of Pediatrics recommends that the first dose of the hepatitis B vaccination be administered within the first 24 hours of life.

The American College of Obstetricians and Gynecologists and the National Association of Certified Professional Midwives do not recommend that practitioners broach the subject of childhood vaccinations during pregnancy, focusing instead on maternal vaccinations during pregnancy and referring any childhood vaccination dialogue to the child’s pediatrician.

But what might happen if this changed? Could this be a solution? I strongly believe it could.

A full-term medical press

Even though 90 percent of expectant mothers report making childhood vaccination decisions before the birth of the baby, a full one-third of expectant mothers expressed feeling uninformed, with first-time mothers identifying as more vaccine hesitant.

As one expectant mother in her third trimester in Gainesville, Florida recently said in an interview with me:

“I think that there’s extreme lack of communication. I think that childhood vaccination information should be relayed. That way you have the information you need before something happens, and then it’s too late to make an informed decision.”

In a survey, 98 percent of OB-GYNs revealed they believe childhood vaccinations to be important, but less than half believed they could influence expectant mothers.

In an interview, a midwife in Gainesville stated childhood vaccination discussions are not in her “standard scope of practice,” explaining that beyond a basic handout, she typically refers questioning mothers-to-be to a pediatrician.

Although the American Academy of Pediatrics recommends finding a pediatrician during the third trimester of pregnancy, a 2018 survey showed that only 5 to 39 percent of first-time parents actually attend a prenatal visit with their baby’s chosen pediatrician. Urban poor pregnant women and pregnant women in rural areas are less likely to attend a prenatal pediatric visit.

In the absence of comprehensive information about childhood vaccinations, Dr. Google may take over.

I believe the following things would help to get the truth out:

• A more active physician voice on social networking sites, connecting patients with evidence-based sources as opposed to anti-vaccination propaganda.

• Standard policy by the American College of Obstetricians and Gynecologists recommending childhood vaccination discussions to occur during the third trimester of pregnancy, particularly surrounding the first vaccine. Research has suggested that this could help educate parents.

• Standard policy by National Association of Certified Professional Midwives to include more information about childhood vaccinations during prenatal care.

• Increased efforts to orchestrate prenatal pediatrician’s visits to connect mothers-to-be with their child’s future doctor to discuss vaccination, with a special emphasis on connecting first-time mothers with a pediatrician during the third trimester.

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