Senin, 31 Oktober 2016

Candidates make health care a key part of closing pitch - Politico

Joe Biden says Obamacare's "not as good as it should be," and D.C. brings up in the rear in today's new Leapfrog safety scores. But first: how health care issues are playing a key role in the election's final stretch.

CANDIDATES MAKE HEALTH CARE PART OF CLOSING PITCH — With Election Day just eight days away, both Donald Trump and Hillary Clinton have ramped up the health care focus in their stump speeches, albeit in very different ways.

Story Continued Below

Trump vows he's 'never going to forget' Jonathan Gruber. Since HHS announced significant rate hikes for Obamacare plans last week, the Republican candidate has been hitting the health law hard — and has been invoking a so-called Obamacare architect on the trail as a symbol of what's wrong with Washington politics.

"We're catching all of these people," Trump said at a New Hampshire rally on Friday, where he invoked Gruber's name five times in 45 seconds. "I said I am never going to forget Jonathan Gruber, the architect of Obamacare and what he said. So we did not forget … . it's like a little more than a week before the election. We didn't forget the name Jonathan Gruber."

… Trump also implied that HHS is understating the premium hike. "They sent out a director from the White House, they were trying to say 25 percent," Trump said at a Colorado rally on Saturday. "You should be so lucky," he added, alluding to his team's review of rate increases. "We haven't found too many" premium hikes that match HHS's statement.

… While in New Hampshire, Trump also took part in a roundtable discussion about opioids, two weeks after his campaign released a more formal policy on how the Republican nominee would address the opioid epidemic. More[1].

Clinton hits trail with abortion rights advocates. The Democratic candidate was joined by Planned Parenthood's Cecile Richards and NARAL's Ilyse Hogue at an Iowa rally this weekend, seeking to emphasize women's health issues in the election.

"Make no mistake — women's health and rights, our futures, and the futures of our daughters and granddaughters, are on the ballot," the Democratic candidate said on Friday. "We were reminded of that in the last debate when [Trump] pledged to overturn Roe v. Wade and end safe and legal abortion."

Is California Nurses Association sitting out Clinton v. Trump? The powerful labor union, which backed Sen. Bernie Sanders in the Democratic primary, hasn't endorsed a candidate in the general election. One issue: While Clinton supports coverage expansion, she hasn't come around to Sanders' advocacy for single-payer.

"Our position is still under consideration," union spokesman Chuck Idelson told[2] the San Francisco Chronicle. Although Idelson suggested that CNA wouldn't support the Republican nominee — "we know that nurses are not going to vote for Trump," he said — the union's leader RoseAnn DeMoro explicitly blasted the Clinton campaign on Twitter last week.

"#PodestaLeaks show Clinton camp trying to get press to attack #Nurses supporting Bernie," DeMoro tweeted, pointing to an internal campaign email released by Wikileaks. "Never happened in Obama era." [3][4]

WELCOME TO MONDAY PULSE — Where your author watched 10 recent Trump speeches and was fascinated by how the Republican nominee consistently went off-script on Obamacare, whether praising his deceased uncle or resurrecting his vague argument about "the lines." Trump also used a convenient line to talk about premium hikes: "The number is so big that I refuse to tell you what it is because I want you to leave here happy," he told one crowd in Colorado. Send tips and your own big numbers to ddiamond@politico.com[5] or @ddiamond[6] on Twitter.

With help from Adam Cancryn (@AdamCancryn[7])

DAYS UNTIL ACA OPEN ENROLLMENT: 1

FROM THE HUMPHREY BUILDING

CMS sets 2017 pay rates for kidney disease. The agency on Friday finalized a slight increase in 2017 Medicare payments for dialysis facilities treating end-stage renal disease patients.

According to the agency's final rule[8], facilities will see a 0.73 percent average increase in payments next year. Hospital-based dialysis facilities should see the biggest bump, at a 0.9 percent increase. Medicare expects to pay about $9 billion total to 6,000 facilities treating the debilitating kidney disease in 2017. More[9] .

ON THE TRAIL

Where medical marijuana is on the ballot. Voters in three states — Arkansas, Florida and North Dakota — will consider whether to legalize medical marijuana, while Montana has a ballot measure that would remove restrictions from the state's current medical marijuana law. Success in those states would make medical marijuana legal in a clear majority of states. More[10].

Health care super PAC makes Spanish-language ad buy in Nevada. Working Americans for Affordable Health Care on Friday announced a $150,000 investment in Spanish-language ads targeting GOP Reps. Joe Heck and Cresent Hardy. Heck is running for Senate Minority Leader Harry Reid's seat, while Hardy is running for reelection. The super PAC was launched by labor organization UNITE HERE.

Health care leaders send cash to Hillary Clinton, shun Donald Trump. That's according to a Modern Healthcare review of 100 prominent health care leaders and federal election records. Overall, one-quarter of the leaders reviewed had donated to Clinton … and zero had given to Trump, despite having a history of donating to conservative causes.

— The biggest donors. Five executives in the publication's sample gave the maximum — $5,400 — to Clinton. Those executives were Geisinger Health System CEO David Feinberg, Independence Blue Cross CEO Daniel Hilferty, Adventist Health System's retiring CEO Donald Jernigan, Centene CEO Michael Neidorff and Duke Health System CEO Eugene Washington. More[11].

** A message from PhRMA: Insurance coverage does not necessarily mean access to care. More medicines are being excluded from coverage, deductibles and copays are going up and insurance companies are increasingly imposing other barriers to access. Know the 4 things[12] to think about when you choose your health plan. Learn more at AccessBetterCoverage.org[13]. **

OBAMACARE

Why the FTC is poised to play even bigger role in Obamacare's future. Health care providers are continuing to consolidate, and that puts even more pressure on the Federal Trade Commission to scrutinize and regulate a rising number of deals, Harvard's Ashish Jha writes at the JAMA Forum. Many of those deals have implications for the Affordable Care Act, Jha argues, citing evidence that provider consolidation:

1. Can raise overall costs for patients, hurting the perception that care is affordable.
2. Limits the available provider networks in ACA exchanges, which could lead to an "erosion of confidence" in Obamacare plans as narrow networks increase and media attention focuses on lack of access to key doctors and hospitals
3. May directly affect the success of the Accountable Care Organization model. Many independent physician groups are saving money under the ACO model, but consolidated health systems are not, Jha points out.

"If the ACA is to thrive under the next president, he or she must ensure that we have a dynamic health care marketplace," Jha argues. "The ability of the ACA to fulfill its promise of greater access at an affordable price will depend as much on the effectiveness of the FTC as it will on the effectiveness of the CMS." More[14].

Joe Biden says Obamacare is 'not as good as it should be.' The vice president said the law needs fixes, but added that "I don't think it's in peril," he told John Dickerson on "Face the Nation" yesterday. "There's a whole range of things that still justify [the law]," Biden added, pointing to the law's protections for pre-existing conditions and expanded coverage to younger Americans.

One change that Biden would like to see: Ramping up subsidies to lure younger, healthier Americans into the marketplace. "We should be in a position where we are providing a greater subsidy for young people to get into the marketplace that can't afford to get in," he said

… Biden also said that the next president must quickly address Obamacare's woes. "It's going to be very high on … assuming it's Hillary, on her priority list," Biden added. "It has to be. I think it's important."

ON THE HILL

Research!America and United for Medical Research want action on Cures. The groups are pushing Congress to pass the 21st Century Cures package in the looming lame-duck session. "Putting this bill off until the next Congress likely means putting it off for the foreseeable future — a terrible outcome for our country," said UMR's Friday's letter to House and Senate leaders. "This is a rare opportunity to make a real difference in the lives of all Americans."


ZIKA VIRUS

Puerto Rico reports first case of Zika-related microcephaly in newborn. The case, which was reported on Friday, is expected to be the first in a wave, according to The Associated Press. The baby's severe brain defect was not identified until the mother was nearly eight months pregnant, raising concerns that the scope of Zika and related microcephaly on the island is not fully known. More for Pros[15].

2,980. That's how many pregnant women across the United States and territories showed evidence of Zika infection as of October 20, according to CDC. The actual total is almost certainly higher, public health experts caution; a recent study suggested that the number of pregnant women infected with Zika in Puerto Rico could be four times larger than recorded.

AROUND THE NATION

D.C. brings up the rear on hospital safety. That's according to new grades from the Leapfrog Group, which ranked the District of Columbia among the worst in the nation for hospital safety and quality. Alaska, Delaware and North Dakota also received the lowest possible score, with no hospitals in those states earning "A" grades.

Hawaii, meanwhile, topped the list with eight of its 12 hospitals receiving an "A." See Leapfrog's full list of safety scores out today: More[16].

STATE WEEK: New Mexico considers Medicaid co-payments. The state is considering asking CMS for authority to add co-payments and other costs for beneficiaries, the Associated Press reports. The announcement — which comes ahead of federal approval — comes as New Mexico is grappling with a budget crisis. More,[17]

At this hospital, heart patients are banned from talking Clinton v. Trump. Worried about exacerbating patients' stress, staff at Southampton Hospital's cardiopulmonary rehabilitation gym have taken an unusual step: They've asked them to stop arguing over the election. "Due to the fact that we have patients with heart conditions we cannot allow political debates in the gym," a sign reads in the New York hospital. More[18].

CANCER MOONSHOT

Joe Biden: What I've learned since starting the moonshot. The vice president, who delivered the White House's weekly address this weekend, touted how the White House's moonshot initiative is working to "break down silos" that have hindered cancer care research and delivery.

Biden pointed to the effort to get more cancer patients enrolled in clinical trials through trials.cancer.gov[19] and reiterated the call for would-be volunteers to visit cancer.serve.gov[20]. "The private sector is also reimagining what it can and should do," he added, citing how firms like Microsoft and IBM have offered their support and technical services.

"Most of you assume we've already been doing this," Biden said. "We weren't before, but now we are."

WHAT WE'RE READING

The Obama administration's argument that ACA subsidies will defray consumers' costs overlooks many crucial caveats, NYT's Robert Pear writes, like the eventual impact on taxpayers and the millions of Americans who don't stand to benefit. More[21].

WSJ's Denise Roland looks at how drug makers are combining cheap generics in order to produce expensive pills. More[22].

Aaron Carroll has a pessimistic read on a JAMA study that debunks some health effects of cranberry juice: "Nothing works. Nothing." More[23].

The director of a ferret association writes at Vox that Obamacare's premium hikes — while "bad" — shouldn't take away from how the law has been a "godsend" for people who work unusual jobs and need health insurance, like her. More[24].

At Healthcare Dive, Jeff Byers runs through the tactics that ACA advocates will use this enrollment period. More[25].

POLITICO's Dan Goldberg flags that roughly 18 percent of New Yorkers chose a platinum plan in 2016, compared to just 2 percent across the nation. More[26].

** A message from PhRMA: Open enrollment is upon us once again. Whether you are picking a plan through your employer or a health insurance marketplace, whether you are getting coverage for the first time or changing to a new plan, understanding your coverage options can help with your decision process. Even if you like your plan, it is always smart to spend a little time doing research to make sure your plan is the right one for you, especially as plans change year to year. Here are four helpful things to consider when choosing your health plan. (1) Where can you go for treatment? (2) Review the plan deductible and premium. (3) Find out if and how your medicines are covered. (4) Learn about your potential out-of-pocket costs. These 4 things [27] can help you be a better engaged and empowered health care consumer. Get our quick tips at AccessBetterCoverage.org[28]. **

References

  1. ^ More (www.nh1.com)
  2. ^ told (www.sfchronicle.com)
  3. ^ #PodestaLeaks (twitter.com)
  4. ^ tweeted (twitter.com)
  5. ^ ddiamond@politico.com (www.politico.com)
  6. ^ @ddiamond (www.twitter.com)
  7. ^ @AdamCancryn (www.twitter.com)
  8. ^ rule (go.politicoemail.com)
  9. ^ More (www.politicopro.com)
  10. ^ More (www.politicopro.com)
  11. ^ More (www.modernhealthcare.com)
  12. ^ 4 things (onphr.ma)
  13. ^ AccessBetterCoverage.org (bit.ly)
  14. ^ More (newsatjama.jama.com)
  15. ^ More for Pros (www.politicopro.com)
  16. ^ More (www.hospitalsafetyscore.org)
  17. ^ More, (www.politicopro.com)
  18. ^ More (easthamptonstar.com)
  19. ^ trials.cancer.gov (trials.cancer.gov)
  20. ^ cancer.serve.gov (cancer.serve.gov)
  21. ^ More (www.nytimes.com)
  22. ^ More (www.wsj.com)
  23. ^ More (theincidentaleconomist.com)
  24. ^ More (www.vox.com)
  25. ^ More (www.healthcaredive.com)
  26. ^ More (www.politico.com)
  27. ^ These 4 things (onphr.ma)
  28. ^ AccessBetterCoverage.org (bit.ly)
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Iraqi troops to enter Mosul in 'matter of hours' - CNN

Mosul operation: Iraqi-led forces push toward key city

Shiite fighters from the Hashed al-Shaabi launch missiles on the village of Salmani, south of Mosul, on Sunday, October 30. An Iraqi-led offensive is underway to reclaim Mosul, Iraq's second-largest city and the last major stronghold for ISIS in the country.

Mosul operation: Iraqi-led forces push toward key city

Iraqi families who were displaced by the ongoing operation are seen on the road near Qayyarah, south of Mosul, on Saturday, October 29.

Mosul operation: Iraqi-led forces push toward key city

Displaced Iraqi families flee from the ongoing conflict between Iraqi forces and jihadists of the Islamic State between Makhmour and Qayyarah on October 29.

Mosul operation: Iraqi-led forces push toward k ey city

U.S. military personnel take cover in a bunker after a mortar alarm was sounded at a coalition air base in Qayyara, Iraq, on Friday, October 28.

Mosul operation: Iraqi-led forces push toward key city

An Iraqi forces member stands on top a military vehicle near the village of Sin al-Dhuban, south of Mosul, on Thursday, October 27. The coalition against ISIS includes Iraqi, Kurdish and American forces.

Mosul operation: Iraqi-led forces push toward key city

Iraqi forces advance toward Sin al-Dhuban on October 27.

Mosul operation: Iraqi-led forces push toward key city

Women and children grieve over the grave of a family member at a Qayyara cemetery damaged by ISIS on October 27.

Mosul operation: Iraqi-led forces push toward key city

Iraqis who fled Mosul reunite with relatives at a refugee camp in the Khazir area on Wednesday, October 26.

Mosul operation: Iraqi-led forces push toward key city

A family walks near billowing smoke from burning oil wells and sulfur fires that were set by ISIS fighters on October 26.

Mosul operation: Iraqi-led forces push toward key city

An Iraqi federal police vehicle clears a checkpoint in Qayyara on October 26.

Mosul operation: Iraqi-led forces push toward key city

Residents of Qayyara wait for distribution of food and water rations on October 26. Local water sources have been contaminated by the burning oil and sulfur.

Mosul o peration: Iraqi-led forces push toward key city

A woman wears a mask to alleviate her difficulty breathing due to the contaminated air in Qayyara on October 26.

Mosul operation: Iraqi-led forces push toward key city

A suspected ISIS member sits handcuffed outside his home during an operation by Iraq's counterterrorism forces in Tob Zawa, Iraq, on Tuesday, October 25.

Mosul operation: Iraqi-led forces push toward key city

Iraqi forces patrol the Kirkuk area for members of ISIS on October 25. The terror group has launched surprise attacks in other parts of Iraq, including Kirkuk, to distract coalition forces from the Mosul campaign and to tie up their resources elsewhere.

Mosul operation: Iraqi-led forces push toward key city

Iraq's counterterrorism forces advance toward ISIS positions in Tob Zawa on October 25.

Mosul operation: Iraqi-led forces push toward key city

Soldiers give first aid to an injured boy in Tob Zawa on October 25.

Mosul operation: Iraqi-led forces push toward key city

Children dance and play inside the Baharka camp outside Irbil, Iraq, on October 25.

Mosul operation: Iraqi-led forces push toward key city

Iraqi families walk at a camp for displaced people near Qayyara on Monday, October 24.

Mosul operation: Iraqi-led forces push toward key city

Families displaced by the Mosul operation wait for food near Qayyara on October 24.

Mosul operation: Iraqi-led forces push toward key city

Displaced families gather near Qayyara on October 24.

Mosul operation: Iraqi-led forces push toward key city

The displaced receive food near Qayyara on October 24.

Mosul operation: Iraqi-led forces push toward key city

Kurdish Peshmerga forces take po sitions as they start to move toward the Imam Reza and Tizxirab villages of the Bashiqa district on Sunday, October 23.

Mosul operation: Iraqi-led forces push toward key city

Iraqi forces distribute fruit to children in the village of al-Khuwayn, south of Mosul, after recapturing it from ISIS on October 23.

Mosul operation: Iraqi-led forces push toward key city

Iraqi forces talk with a family in al-Khuwayn on October 23.

Mosul operation: Iraqi-led forces push toward key city

Kurdish security forces detain a suspected member of ISIS in the eastern suburbs of Kirkuk on Saturday, October 22.

Mosul operation: Iraqi-led forces push toward key city

Spent bullet cartridges litter the stree t around the Jihad Hotel on October 22, where ISIS militants battled Iraqi security forces in Kirkuk the previous day.

Mosul operation: Iraqi-led forces push toward key city

An Iraqi forces member helps a man push a car as they arrive at a refugee camp in Qayyara on October 22.

Mosul operation: Iraqi-led forces push toward key city

Iraqi special forces hold a cross found in the Christian town of Bartella on October 22. Iraqi forces recaptured Bartella but still faced some resistance in the area.

Mosul operation: Iraqi-led forces push toward key city

An Iraqi boy who lost an eye in fighting between government forces and ISIS poses for a photograph in the Debaga refugee camp on October 22.

Mosul operation: Iraqi-led forces push toward key ci ty

Iraqi forces hold a position on the front line, near the village of Tall al-Tibah, on Friday, October 21.

Mosul operation: Iraqi-led forces push toward key city

Gen. Abdel Ghani al-Asadi, who leads Iraq's counterterrorism forces, sits in Bartella on October 21 after the town was reclaimed.

Mosul operation: Iraqi-led forces push toward key c ity

A Kurdish Peshmerga soldier mans a post on the outskirts of Mosul on Thursday, October 20. The coalition is advancing closer to Mosul, an ISIS stronghold since 2014.

Mosul operation: Iraqi-led forces push toward key city

Peshmerga fighters look over a village during an assault near Bashiqa on October 20.

Mosul operation: Iraqi-led forces pus h toward key city

A coalition fighter covers his ears before another fires artillery on ISIS positions in Nawaran on October 20.

Mosul operation: Iraqi-led forces push toward key city

Coalition fighters hold a position near Bashiqa on October 20.

Mosul operation: Iraqi-led forces push toward key city

Peshmerga forces are seen during an attack on ISIS targets in the village of Naveran.

Mosul operation: Iraqi-led forces push toward key city

A flag flies as Peshmerga fighters prepare to fire a rocket near Bashiqa on October 20.

Mosul operation: Iraqi-led forces push toward key city

A Peshmerga fighter takes aim near Naveran on Octobe r 20.

Mosul operation: Iraqi-led forces push toward key city

Iraqi soldiers travel along a road near Qayyara as clouds of black smoke rise in the sky on Wednesday, October 19.

Mosul operation: Iraqi-led forces push toward key city

Iraqi special forces advance toward Mosul on Wednesday.

Mosul operation: Iraqi-led forces push toward key city

Displaced people flee their homes on October 19.

Mosul operation: Iraqi-led forces push toward key city

Iraqi forces fire a howitzer toward the village of Tall al-Tibah on October 19.

Mosul operation: Iraqi-led forces push toward key city

Iraqi soldiers raise their weapons in celebration on the outskirts of Qayyara on October 19.

Mosul operation: Iraqi-led forces push toward key city

A man stands in front of a fire from oil that had earlier been set ablaze by members of ISIS in the Qayyara area on October 19.

Mosul operation: Iraqi-led forces push toward key city

Iraqi soldiers look on as smoke rises from the Qayyara area.

Mosul operation: Iraqi-led forces push toward key city

A street is covered with smoke from the Qayyara fire.

Mosul operation: Iraqi-led forces push t oward key city

Iraqi forces head toward the front lines near Qayyara on Tuesday, October 18.

Mosul operation: Iraqi-led forces push toward key city

Iraqi forces in Bajwaniyah on October 18.

Mosul operation: Iraqi-led forces push toward key city

People flee their homes amid the fighting on O ctober 18.

Mosul operation: Iraqi-led forces push toward key city

Smoke rises from an ISIS position after a coalition airstrike in Mosul on October 18.

Mosul operation: Iraqi-led forces push toward key city

Civilians herd sheep from a village near Mosul on October 18. The smoke came from oil wells ISIS set on fire to limit the visibility of coa lition pilots.

Mosul operation: Iraqi-led forces push toward key city

Kurdish Peshmerga forces are on the front line in Nineveh, Iraq, on October 18.

Mosul operation: Iraqi-led forces push toward key city

A Peshmerga fighter peers up from an underground tunnel in the liberated town of Badana on October 18. ISIS fighters have built tunnels below residential streets to escape from airstrikes.

Mosul operation: Iraqi-led forces push toward key city

Armored vehicles driven by Peshmerga forces move along the Hazir front on October 18.

Mosul operation: Iraqi-led forces push toward key city

Kurdish security forces take up a position near ISIS-controlled villages on Monday, October 17.< /p>

Mosul operation: Iraqi-led forces push toward key city

Peshmerga forces attack ISIS militants with howitzers from Zardak mountain on October 17.

Mosul operation: Iraqi-led forces push toward key city

Smoke rises from a suicide car bomb attack carried out by ISIS in the village of Bedene on October 17.

Mosul operation: Iraqi-led forces push toward key city

A Kurdish Peshmerga convoy drives towards the Khazer front line, about 30 kilometers (19 miles) east of Mosul on October 17.

Mosul operation: Iraqi-led forces push toward key city

Members of the Iraqi coalition gather around a fire at Zardak mountain ahead of the offensive.

Mosul operation: Iraqi-led forces push toward key city

Peshmerga forces deploy in the dark near the village of Wardak early on October 17.

Mosul operation: Iraqi-led forces push toward key city

A Sunni Iraqi police officer prays at the Qayyara airbase on October 16.

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NFL needs Cowboys' star power, and Dallas is providing it - ESPN

ARLINGTON, Texas -- The patriarch of one of America's great sports families, Calvin Hill, was standing outside the Dallas Cowboys[1] locker room shaking his head in wonderment. He was comparing the rookie quarterback Dak Prescott[2] to the 1971 version of Hill's old teammate, Roger Staubach, who won a Super Bowl that season after taking over as Tom Landry's guy.

"Roger was 29," said Hill, a four-time Pro Bowl running back, "and this kid is 23. Roger wasn't ready to play continually in his first year [in 1969]. Dak? I'm amazed at this young guy, amazed at his presence in the pocket."

Amazed at Prescott's ability to make something out of nothing against the Philadelphia Eagles[3] on Sunday night, when the quarterback spun left out of trouble in overtime and found a wide open Jason Witten[4] in the end zone for the Cowboys' sixth consecutive victory.

"Dak reminds me of Roger in terms of being able to extend the play," Hill said, "but he also reminds me some of [Tom] Brady in how he manages the game. I don't think Dak managed it well tonight, but [Jim] Schwartz is a really good defensive coordinator for Philadelphia. That front put so much p ressure on Dak and yet he never lost his composure."

For a change, Prescott didn't play a clean ballgame. He made some throws against Philly that, frankly, looked like fourth-round throws. But this is good news for Dallas, and maybe even better news for the NFL. The Cowboys won even when Prescott walked into AT&T Stadium with his B-minus game, which means the Cowboys are for real as a Super Bowl contender.

And when the Dallas Cowboys are in the championship mix, the league benefits in a big way.

"It's like the Yankees," Hill said. "There's so much passion around the country for and against them. The Cowboys are back, we have two young stars in Dak and Ezekiel Elliott[5], and that's good for the National Football League."

Of course Hill is biased. He put together back-to-back 1,000-yard seasons in the franchise's America's Team era, and he works as a Cowboys consultant in player development. But as the father of Grant, a two-time national basketball champ at Duke who lost his near-certain place among the NBA's all-time greats to injury, Hill knows a thing or three about winners, and how much sports needs marquee programs like the Blue Devils, the Yankees, and the Cowboys.

Hill was a student at Yale in the '60s when the Cowboys first started to win, when he would join his classmates in front of a frat house TV to watch Don Meredith and Bob Hayes. "Looking for Bullet Bob to catch a bomb," Hill said.

Those were the days, my friend. Into the '70s, football fans up and down the Eastern Seaboard would wait breathlessly for lesser 1 p.m. games to end to watch the Dallas Cowboys in the 4 p.m. national game or, better yet, the marquee game on Monday night.

"Now you've got NFL games on all the time," Hill said through a sigh. "Thursday ni ght, Sunday, Sunday night, Monday night, and sometimes you have teams in these night games that nobody really follows except their own fans. We used to have national teams. The Redskins of George Allen and Joe Gibbs. Landry's Cowboys. It's been a long time for the Cowboys, but having a national team back is good for the sport."

The sport needs it now like never before. Ratings are down[6] and uninspiring play is up. Peyton Manning has left the building, Aaron Rodgers[7] isn't winning big, Russell Wilson[8] isn't running, and Cam Newton[9] and Andrew Luck[10] are losing. Brady and the New England Patriots[11] could use a little help, you know. They can't carry this business on their shoulder pads forever.

The Cowboys are arriving in the nick of time. They haven't won the big one in two decades; in fact, they've only won three playoff games in that period. But now they have a monster offensive line and a rookie running back, Elliott, who summons the memories of the signature Dallas backs before him, the likes of Hill, Tony Dorsett and Emmitt Smith.

They have Dez Bryant[12], who returned from injury Sunday night to catch the tying 22-yard touchdown pass from Prescott late in the fourth quarter and to finish with 113 big-play yards on four catches. They have old man Witten, who wasn't a factor against the Eagles until he needed to be in overtime.

They have the 135th player chosen in April's draft, Prescott, who did enough to beat the No. 2 player chosen in the draft, Carson Wentz[13]. Prescott was smacked around by Philly before he reminded everyone why he should keep Tony Romo[14] on the bench even when Romo's healthy enough to play.

In a recent conversation with ESPN The Magazine, the Dallas coach who started Romo in 2006, Bill Parcells, described the calls for Prescott to become the permanent starter "a rush to judgment." The Hall of Fame coach explained that a half-dozen games represented a painfully small sample size, and that Prescott first needed to stare down a late deficit, some real adversity.

"He hasn't thrown four interceptions yet," Parcells said, "and then had the press and the fans getting restless and the players looking at him sideways, and maybe his nose is broken too. That's when you find out about a quarterback."

Prescott survived his brutal end-zone interception near the end of the first half, and needed a 30-yard run by Chris Jones[15], the Dallas punter, of all people, to get through the night.

But the great ones -- or the great ones-to-be -- find ways to score more points than the other guys one way or another. When this 29-23 victory[16] was complete, Cowboys owner Jerry Jones called it "one of the best wins I've ever been a part of" and declared Prescott the starter for the next game against Cleveland.

"I know that Romo can make chicken salad out of chicken whatever," Jones sai d, "but so can Dak."

Calvin Hill, always cutting a dignified figure, put it like this:

"I think we're learning how to win."

The Dallas Cowboys are back in business, which is always good for the business of the NFL.

References

  1. ^ Dallas Cowboys (www.espn.com)
  2. ^ Dak Prescott (www.espn.com)
  3. ^ Philadelphia Eagles (www.espn.com)
  4. ^ Jason Witten (www.espn.com)
  5. ^ Ezekiel Elliott (www.espn.com)
  6. ^ Ratings are down (www.espn.com)
  7. ^ Aaron Rodgers (www.espn.com)
  8. ^ Russell Wilson (www.espn.com)
  9. ^ Cam Newton (www.espn.com)
  10. ^ Andrew Luck (www.espn.com)
  11. ^ New England Patriots (www.espn.com)
  12. ^ Dez Bryant (www.espn.com)
  13. ^ Carson Wentz (www.espn.com)
  14. ^ Tony Romo (www.espn.com)
  15. ^ Chris Jones (www.espn.com)
  16. ^ 29-23 victory (www.espn.com)
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Aroldis' entrance: The moment this World Series got interesting - ESPN

Cubs fan, Indians fan, neutral observer, homesick beat writer, wayward channel surfer, sleepy dog -- doesn't matter who you are, or why you're with us this October. When Joe Maddon walked out to the mound in the seventh inning Sunday night, pointed his left hand to the bullpen, and summoned hell and fire and filth and chaos into the fifth game of the World Series, you felt things.

You felt confidence. You felt fear. You felt like you were seeing baseball players pushed to the brink of their abilities, and that something just might snap. You felt like a manager was choosing this moment to make a final stand. It was Neo stopping bullets, it was Anton Chigurh flipping a coin, it was Rocky drinking raw eggs, it was Danny Ocean laying out the plan. I submit that those feelings, our feelings, are going to make baseball managers smarter in the next 30 years than they have been in the past 30, because those feelings are every person on the field's feelings, too.

Some b ackground: What Maddon did -- bringing in his closer, Aroldis Chapman[1], to protect a one-run lead for eight whole outs -- is not unprecedented. I have in my hands a list of everything that has ever happened in a baseball game[2], and it says here that just two and a half weeks ago the Dodgers brought Kenle y Jansen[3] into the seventh inning to try to save Game 4 of the National League Championship Series. (He gassed out, setting up Clayton Kershaw's save.) Brad Lidge[4] attempted an eight-out save in the 2004 NLDS (but blew it), and there was Norm Charlton[5] in the '95 American League Division Series (blew it), and, well, if you go back to the 1970s Rollie Fingers ...

The list of recent examples d rops off quickly, because this is an unconventional move. Controversial, even. It might have even been controversial within the small group of people standing on the mound at Wrigley Field when Joe Maddon handed over the baseball. Coming in to get a save of even four outs, Chapman said earlier this year[6], is "not my favorite thing." To which Maddon said at the time, "I did not know that. Not that it would matter."

If it's not Chapman's favorite thing, though, I suspect it is every one of his teammates' favorite thing. I suspect every one of them was cheering.

A lot of the decisions analysts wish teams would make are complica ted sells. For instance, over the past few offseasons I've spent a lot of time arguing against managers who go to their aces on short rest in the postseason, even in must-win games. The argument is simple: We have many dozens of examples of great pitchers going on short rest in recent years[7], and a convincing record of them being much worse than aces in those starts. So much worse that, for most pitching staffs, the fourth starter is probably a better option than a tired ace. (Kluber and the Indians' three-man rotation are excepted.)

This is a simple argument, but a complicated sell, because it's an emotionally unappealing one. I can try to convince you with what the Greeks called Logos -- a logic al appeal -- or I can try to convince you with what they called Ethos -- my sterling character -- but I will lose the argument soundly if it comes down to Pathos: emotional appeal. It's just more emotionally satisfying to go with the ace. The team wants it, the ace wants it, the fans want it -- the manager wants it.

With Chapman in the seventh, though, I don't need charts with an appendix explaining leverage index to convince anybody. The argument is simple -- the game is on the line, and Chapman is the best, most exciting, most dominant, most intimidating option we have -- and so, too, is the sell: Wouldn't it be fun to see him here? You don't have to convince anybody to eat their dessert, and you don't have to convince them that Chapman's good and fun as heck.

Maddon's quote from August -- "not that it matters" -- is great, but for many managers, it does matter. For one thing, rigid and clear bullpen roles are often necessary for getting through a long season. They limit how often a reliever has to warm up for a game he isn't called into, they help relievers manage the emotions of exhausting high-leverage work. The hierarchy of the roles might have some benefit to the workplace politics, and so on.

But managers over the past three decades haven't just preferred rigid roles in their bullpens. They've built those roles around the save statistic. They do this in ways that are almost farcical sometimes[8]: Not bringing the best reliever into the ninth inning of a tie game on the road, when a save situation might emerge later, but bringing him into the ninth inning of a tie game at home, because a save has become impossible. Or immediately bringing a closer into a five-run game with two outs in the ninth once the tying run is on deck -- that being, by the rulebook, a save situation, even though it's also roughly 99.4 percent likely that this "close" game has already been decided.

There's nothing in it personally for the manager to collect his closer saves, and it seems suspicious that a half-century-old definition of a close game perfectly aligns with how almost every manager today determines closeness. So why do they follow the save's rules so close? They manage for the save because they're managing people, and the people -- the closer and his teammates -- want to see him get those saves. To convince him otherwise, you can try Logos or you can try Ethos, but it's probably going to require Pathos most of all. And if we start seeing enough games like this -- where it's obvious that everybody is having fun, and where it works -- we'll see more of them. Mostly in the postseason, when the schedule allows it and the stakes demand it, but more frequently in the regular season so that relievers are prepared to do it in October.

Maddon, for his part, prepared Chapman early in the day for what he'd be asked to do. He talked to him before the game and told the closer he should be ready for the seventh inning. Chapman, once he took over, strutted around the mound and cheered along with the rest of Wrigley Field, clapping his fist into his glove after outs. When he ended the eighth with a strikeout -- stranding the ty ing run at third -- he straightened up and stood perfectly still for just a moment, as though posing. As though posing for a statue. As though posing to be remembered as a god.

He seemed to be in good spirits after the game:

He had reason to be happy. Besides the win, he starred in the most dramatic moments of this Series, and did something Mariano Rivera[9], Billy Wagner[10], Craig Kimbrel[11] and Francisco Rodriguez[12] never did. He saved not only the Cubs but the Series itself.

Until Game 5, this Series had been one of the least memorable in recent history. In the past decade, 54 individual World Series games had been played before Sunday. By leverage index -- a measure for the relative stakes of each plate appearance -- three of this year's games were snoozers, with two ranking in the bottom 10. Worse, the Indians were threatening to end the Series at five games. Th ere might have been some non-Clevelanders[13] exhausted enough to root for this outcome, but it would have guaranteed one of the most forgettable Series in recent decades.

When Chapman came in, it meant that the Cubs would push this back to Cleveland for a sixth game, or the Indians would at least have to produce an instant classic to seal the victory. "From an entertainment perspective if you're a baseball fan or looking to become a baseball fan, it was wonderful tonight," Maddon said after the game.

If there was anything it was missing, from an entertainment perspective, it was Andrew Miller [14], for which we might also credit the natural human desire to want to see the best pitcher in the game at all times. On Saturday, Francona went to Miller in the seventh inning, with Cleveland up by three. It was probably an overreach -- with that sort of lead, and Miller perhaps running on fumes after a long and extraordinary month. It might have paid to gamble on Dan Otero[15] or another reliever to try to avoid using Miller. (He'd pitched 1&frac13; innings on Friday.) When Cleveland scored three more runs in the bottom of the seventh, Francona still sent him back out for the eighth, and he ultimately threw 27 pitches in a relative blowout. Miller was available on Sunday, but certainly not for one of the 46-pitch outings that he's built his legend around this month. Had he been -- had he taken Saturday off entirely -- it's not inconceivable that Francona could have gotten as many as six innings out of Miller and Cody Allen[16], rather than trying to get Trevor Bauer[17] through the fourth inning.

Alas, that wasn't an option . More likely, Allen and Miller could have handled three or four at the most. It's hard to be too mad at Francona, though. Bringing in Miller on Saturday probably felt like putting a boot on the Cubs in Game 4. Probably felt good. When you have an Andrew Miller -- or an Aroldis Chapman -- any sane person wants to use him until he can't.

References

  1. ^ Aroldis Chapman (www.espn.com)
  2. ^ a list of everything that has ever happened in a baseball game (www.baseball-reference.com)
  3. ^ Kenley Jansen (www.espn.com)
  4. ^ Brad Lidge (www.espn.com)
  5. ^ Norm Charlton (www.espn.com)
  6. ^ Chapman said earlier this year (www.chicagotribune.com)
  7. ^ dozens of examples of great pitc hers going on short rest in recent years (www.baseball-reference.com)
  8. ^ are almost farcical sometimes (www.espn.com)
  9. ^ Mariano Rivera (www.espn.com)
  10. ^ Billy Wagner (www.espn.com)
  11. ^ Craig Kimbrel (www.espn.com)
  12. ^ Francisco Rodriguez (www.espn.com)
  13. ^ non-Clevelanders (twitter.com)
  14. ^ Andrew Miller (www.espn.com)
  15. ^ Dan Otero (www.espn.com)
  16. ^ Cody Allen (www.espn.com)
  17. ^ Trevor Bauer (www.espn.com)
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