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Jimmy Kimmel eviscerates GOP, Fox News host with fiery health care bill takedown

It’s difficult to pull just one soundbite from Jimmy Kimmel‘s explosive takedown of the Graham-Cassidy health care bill and those hawking it, because the late-night host had choice words for Senator Bill Cassidy (the bill’s co-sponsor), Fox News’ Brian Kilmeade, New Jersey governor Chris Christie, and President Donald Trump.

“So last night on our show, a senator from Louisiana, Bill Cassidy, I took him to task for promising to my face that he would oppose any health care plan that allowed insurance companies to turn people with pre-existing conditions away, and any health care plan that had an annual or lifetime cap on how much they would pay out for medical care,” Kimmel began on his show Wednesday night. “He said anything he supported would have to pass what he named ‘The Jimmy Kimmel Test,’ which was fine, it was good, but unfortunately — and puzzlingly — he proposed a bill that would allow states to do all the things he said he would not let them do. He made a total about-face, which means that he either doesn’t understand his own bill or he lied to me. It’s as simple as that.”

Cassidy went on CNN Wednesday morning and said of Kimmel’s initial remarks, “I’m sorry he does not understand [the bill].” What ensued was Kimmel’s epic rebuttal.

“Oh, I get it. I don’t understand because I’m a talk-show host, right? Well then, help me out. Which part don’t I understand?” he said. “Is it the part where you cut $243 billion from federal health-care assistance? Am I not understanding the part where states would be allowed to let insurance companies price you out of coverage for having pre-existing conditions? Maybe I don’t understand the part of your bill in which federal funding disappears completely after 2026; or maybe it was the part where the plans are no longer required to pay for essential health benefits, like maternity care or pediatric visits; or the part where the American Medical Association, The American College of Physicians, The American Academy of Pediatrics, The American Hospital Association, The American Cancer Society, The American Diabetes Association, The American Heart Association, Lung Association, Arthritis Foundation, Cystic Fibrosis, ALS, The National Multiple Sclerosis Society, and The March of Dimes, among many others, all vehemently oppose your bill.”

“Which part of that am I not understanding?” he continued. “Or could it be, Senator Cassidy, that the problem is that I do understand and that you got caught with your G-O-Penis out? Is that possible? Because it feels like it is.”

Kimmel then turned his attention to Kilmeade, who called the late-night personality one of the “Hollywood elites” “pushing their politics on the rest of the country.” The reason Kimmel found this remark “particularly annoying,” he claimed, was because Kilmeade “kisses my ass like a little boy meeting Batman” whenever they see each other.

“Oh, he’s such a fan. I think he’s been to the show, he follows me on Twitter, he asked me to write a blurb for his book — which I did — he calls my agent looking for projects. He’s dying to be a member of the ‘Hollywood elite.’ The only reason he’s not a member of the ‘Hollywood elite’ is that no one will hire him to be one,” Kimmel said. “And you know, the reason I’m talking about this is because my son had an open-heart surgery and has to have two more, and because of that, I’ve learned that there are kids with no insurance in the same situation. I don’t get anything out of this, Brian, you phony little creep. Oh, I’ll pound you when I see you. That is my blurb — that would be my blurb for your next book: ‘Brian Kilmeade is a phony little creep.’”

Christie also criticized Kimmel for his remarks on the health care bill, but the comedian said the governor can get away with it because, as he joked of Christie earlier, he too got his head “stuck in a bucket of fried chicken.” But he reasons that Trump, who’s hellbent on repealing ObamaCare, hasn’t read the Graham-Cassidy bill.

“He just wants to get rid of [ObamaCare] because Obama’s name is on it,” Kimmel said. “The Democrats should just rename it ‘Ivankacare.’ Guaranteed he gets on board. Can you imagine Donald Trump actually sitting down to read a health care bill? It’s like trying to imagine a dog doing your taxes. It just doesn’t compute.”

And for those confused, as Kimmel was initially, about what the new bill stipulates, the host has a simple coffee barista sketch to boil down the big points. Watch above.

Article source: http://ew.com/tv/2017/09/21/jimmy-kimmel-health-care-bill-cassidy-fox-news-chris-christie/

CVS Health Moves to Limit Access to Opioid Painkillers

One of the largest managers of pharmaceutical benefits in the U.S. says it will start limiting the duration and dose of some prescriptions for opioid painkillers, in an effort to combat widespread addiction.

CVS Health Corp., which administers drug benefits for employers, insurers and some state Medicaid programs, said it would limit opioid prescriptions to seven days or less for certain patients with acute pain who haven’t previously taken an opioid painkiller. That will be a big change, given that many CVS-covered…

Article source: https://www.wsj.com/articles/cvs-health-moves-to-limit-access-to-opioid-painkillers-1505986204

For moms, mental health is everything

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Mom Alia Dastagir encourages moms to talk about parenting struggles.
USA TODAY

I love my daughter. I don’t always love being a mother.

I’m exhausted most days. The bulk of the games my 2-year-old demands I play are so boring I could cry. She’s diminutive, but still puts me in a firm headlock when I try to leave her room each night. Getting her into the bath is practically a hostage negotiation. And that look she gives me when she dumps her dinner on the floor — what is that? I swear it’s voodoo.

Loving Atika is visceral, chemical, exquisite. But raising her can be tedious and depleting. If we suggest being a mother means we must be joyful all, or even most, of the time, we do all mothers a disservice. Motherhood is remarkably difficult. Acknowledging that and taking care of our mental health is as important as taking care of our babies.

More: Mom of twin boys says this keeps her stress, anxiety under control

More: Mom shares 3 tips for becoming more confident

More: ‘Breast is best’ mom confesses she uses formula

The facts:

Mental health won’t look the same for every mom, especially if there’s a clinical diagnosis. I didn’t have PPD nor am I suffering from depression, but I do struggle with anxiety. (I’m not taking medication, but if I felt I needed it, I would.) Here are three ways I try to keep myself mentally healthy:

If I’m not fine, I don’t pretend to be: Recognize it’s OK to talk candidly about the hard stuff. The guilt. I have guilt right now, writing a column that will live in perpetuity which my daughter may one day read and misunderstand. I feel guilty for missing the life I had before she was born. I feel guilty for missing the moments of levity between me and her dad that are so much less frequent since she arrived.

I’ve got my spirit mamas: It doesn’t have to be a tribe, but you do need people in your life you can be vulnerable with. Mom friends. An online community. A therapist. If you’re raising your kid(s) with a partner, lean on him or her. The more you talk, the more you realize you’re not alone.

I try to keep perspective: On days when it feels like you’re failing at everything (you missed a deadline, the toddler ate Werther’s Originals for dinner), remember that even when you’re down on yourself, your kids likely aren’t down on you. Unconditional love goes both ways.

Moms deal with a lot — and not just in the realm of discovering poop in peculiar places. We struggle with everything from poor parental leave policies to motherhood penalties at work to stigmas around breastfeeding. To survive in this world, and to have the energy to better it for our kids, we need to care for ourselves.

I might not always love being a mother, but I love myself. There’s no better way to show it, than by prioritizing my mental health.

If you’re struggling with postpartum depression (PPD), seek help from a health care professional right away. If you’re not sure if you have PPD, take this online quiz and bring it with you to your appointment.

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CLOSEPRACTICAL VIDEOS ABOUT HEALTH… FOR MOMS BY MOMS
Mom Bod: Confessions of a breastfeeding mom | 1:00

Ashley May, a journalist at USA TODAY, shares how she’s meeting her breastfeeding goals.
USA TODAY

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Mom Bod: Tips for getting those recommended daily steps | 0:56

Michelle Washington, managing editor for STUDIO Gannett, makes time for walking 5 miles a day by getting a good night’s sleep, joining fitness challenges and making herself a priority.
Mom Bod

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Mom Bod: How to balance work and parenting responsibilities | 0:56

Nanci Bergman, mom to 9-year-old Dalton and CEO of ACCENT, says prioritized to-do lists help her stay on task.

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Mom Bod: Mom of toddler shares her secret to confidence | 0:59

A South Carolina mom says her side business gave her a boost of confidence she needed.

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Mom Bod: Babywearing can be its own workout | 1:10

Mary Nahorniak says babywearing helped her lose post-baby weight. She demonstrates three real-world movements she incorporates into her walks with Alice.
Ashley May

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Mom Bod: Mother of twins shares her stress-relieving secret | 0:51

Cynthia Robinson, senior operations editor at USA TODAY, advises moms of all ages to find their happy place.
Ashley May

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Mom Bod: These meal prep tips will save your weeknights | 1:00

Cara Richardson, senior digital editor at USA TODAY, tells how she saves time through the week by planning and preparing meals ahead.
Ashley May, Mom Bod

  • Mom Bod: Confessions of a breastfeeding mom
  • Mom Bod: Tips for getting those recommended daily steps
  • Mom Bod: How to balance work and parenting responsibilities
  • Mom Bod: Mom of toddler shares her secret to confidence
  • Mom Bod: Babywearing can be its own workout
  • Mom Bod: Mother of twins shares her stress-relieving secret
  • Mom Bod: These meal prep tips will save your weeknights

Mom Bod is a USA TODAY video series featuring tips from moms on fitness, nutrition and mental health. The goal? Let’s be real about the struggle to “healthy” and learn to love our mom bods.

Article source: https://www.usatoday.com/story/news/nation-now/2017/09/21/moms-mental-health-everything/677653001/

Article about health care company included inaccuracies

On behalf of the dedicated staff and caregivers of Reliant Care Management Co., I want to express our deep disappointment in a number of inaccuracies and mischaracterizations of our company in the article “McCaskill friend beset by nursing home problems” (Sept. 19).

The article portrays me and the Reliant organization as having engaged in fraud. Given no such evidence, other than pointing to a civil False Claims Act settlement that is fairly common in the health care industry, I find such a characterization to be patently offensive and irresponsible.

Despite our numerous efforts to educate, provide context and correct misperceptions in advance of the article, the reporters ignored pertinent information and simply took what they wanted that fit their predetermined narrative, and discarded the rest.

Reliant was dragged into what was obviously a politically motivated article, presented with callous disregard to me and the compassionate care Reliant provides to our geriatric and mental health patients from throughout Missouri. We, however, know the truth.

We, our patients and their families know that Reliant and the facilities it manages remain wholly and tirelessly dedicated to continuing our 27-year track record of providing quality care for our patients.

Rick DeStefane  •  Maryland Heights

Article source: http://www.stltoday.com/opinion/mailbag/article-about-health-care-company-included-inaccuracies/article_b95aa9f1-34df-55a6-99ae-4a6b5d4b8dbc.html

DC Health Department Cracks Down on Dogs on Bar and Restaurant Patios

Andy Pants has been evicted from his beer garden dog house. Peyton Sherwood, owner of the Midlands in Park View, says a DC Department of Health inspector paid him a visit yesterday and told him that his bar dog, and all other dogs, would no longer be allowed at the outdoor drinking spot.

And it’s not just there. Last week, the same inspector also visited the Wonderland Ballroom, Popville reported. “They came by and left a flyer and said absolutely no animals on premise except for service animals,” the bar told the blog.

It turns out that this has long been the law. It’s just not often enforced.

“The DC Food Code prohibits animals in commercially licensed food establishments. This is not a new regulation and DOH has enforced when observed,” says DOH spokesperson Jasmine Gossett in an email. “We inspected several locations based on consumer complaints about the presence of dogs, of which Midlands was included in.”

“It’s very disappointing, because everyone loves bringing their dogs out to the patio,” Sherwood says. While he understands why it might be a good idea not to have pets inside a restaurant or bar, he doesn’t get why they should also be banned from outdoor spaces. “There are rats. There are opossums. There are raccoons and squirrels and pigeons that are all over patios in Washington, DC. But having a well taken care of, loved, and vaccinated animal on a leash is not OK.”

Sherwood says the inspector told him that someone recently complained about dogs at bars in the Washington Post. But he wasn’t able to find such an article.

Sherwood is now calling on people to contact their councilmembers and DOH Director LaQuandra Nesbitt. He’s also going to be talking with one of his Advisory Neighborhood Commission reps about starting a petition to change the law.

As for Andy Pants?

“He’s going to have to stay home in his air-conditioned apartment with his giant bed,” Sherwood says.

UPDATE (2 PM):  After hearing from a number of constituents, Councilmember Brianne Nadeau is working on emergency legislation with health committee chair Vincent Gray to address dogs on patios. “There aren’t any details to share yet,” says Tom Fazzini, Nadeau’s deputy chief of staff. “The earliest it could be up would be the Oct 3 session.”

UPDATE (4:45 PM): DOH sends a new statement: “We are aware of the concerns about the enforcement of the current health code and will review best practices and evaluate the agency’s posture on the matter.”


Jessica Sidman

Jessica Sidman covers the people and trends behind D.C.’s food and drink scene. Before joining Washingtonian in July 2016, she was Food Editor and Young Hungry columnist at Washington City Paper. She is a Colorado native and University of Pennsylvania grad.

Article source: https://www.washingtonian.com/2017/09/20/dc-health-department-cracks-down-on-dogs-on-bar-and-restaurant-patios/

Only One of the Two New Health-Care Proposals Qualifies as ‘Extreme’

Will the real moderate party please stand up?

On the same day that socialist Senator Bernie Sanders (I., Vt.) introduced his “Medicare for All” health-care plan, Senators Lindsey Graham (R., S.C.) and Bill Cassidy (R., La.) introduced a last-ditch effort to sorta-kinda repeal and replace Obamacare. Despite having zero chance of being passed any time soon, Sanders’s bill grabbed the limelight for two reasons.

First, it’s a beacon of hope for the demoralized base. As a Rolling Stone headline put it, “Single-Payer Movement Shows: Life After Trump May Not Suck.” Second, Sanders got 15 co-sponsors — including some Democratic senators with presidential ambitions. The fact that so many contenders signed on to a bill that, if enacted, would throw 100 million Americans off their employer-provided health care and cost taxpayers an estimated $32 trillion over a decade revealed just how far to the left the Democratic party has moved.

And yet, to listen to Democrats and many of the journalists who love them, you’d think it was the Republican proposal that’s extreme. “In reality, Graham–Cassidy is the opposite of moderate,” New York Times columnist Paul Krugman pronounced. “It contains, in exaggerated and almost caricature form, all the elements that made previous Republican proposals so cruel and destructive.”

The news section of the Times was more even-handed: “Medicare for All or State Control: Health Care Plans Go to Extremes.”

Are they really both “extreme”? Graham–Cassidy ’s chief goal is to pare back the federalization of health-care policy by getting rid of the individual and employer insurance mandates and letting governors waive out of some regulations. More important, it block-grants Medicaid — a long-sought dream for those wanting to get a handle on out-of-control spending and debt.

A main driver of exploding health-care costs has been the way the federal reimbursement system discourages thrift. Obamacare made that problem much worse. Under Obamacare, Medicaid rolls were vastly expanded, adding millions to a faltering program. And in order to seduce states into signing up, the Feds promised to cover 100 percent of the additional costs for the first three years and no less than 90 percent in later years. If you had an expense account where someone else covered most of the tab, how eager would you be to control costs?

By giving states a lump sum, the hope is that they would experiment with cost-saving reforms that improve health-care results. Opponents of giving states the money and flexibility to innovate often seem to work from the assumption that governors and state legislatures want to harm their own citizens. Maybe they just have a better appreciation of how to help their own citizens than Washington does?

The choice for Republicans isn’t between this and a better reform. It’s between this or letting Obamacare continue intact, violating all of those repeal-and-replace promises entirely.

Graham–Cassidy is by no means perfect, and odds are it won’t pass. Democrats are locked into the position that health-care reforms can only involve more government spending and regulation. With 52 GOP senators, Graham–Cassidy can only pass if at least 50 of them vote for it, and they must do so before September 30, when the arcane budget window known as “reconciliation” closes. Because some Republican states would lose money on the deal, squishy senators such as Alaska’s Lisa Murkowski might balk, as she did with previous attempts. This is why it would be smart to emulate Obamacare (and welfare reform) and be overly generous up front with the block grants, to essentially bribe politicians into voting for it.

Meanwhile, Kentucky senator Rand Paul, who has mastered the art of supporting the status quo by voting against piecemeal improvements in the name of purity, has already indicated he will continue to play that game.

Heritage Action for America has grumbled, rightly, that Graham–Cassidy doesn’t repeal all of the Obamacare taxes. But the choice for Republicans isn’t between this and a better reform. It’s between this or letting Obamacare continue intact, violating all of those repeal-and-replace promises entirely.

That’s what’s so silly about the claim that Graham–Cassidy is as “extreme” as Sanders’s radical and shoddily written proposal (the bill is totally silent on how to pay for any of it). Graham–Cassidy is very close to the kind of legislation we would have ended up with if Republicans had an idea of what they wanted from the get-go and the Democrats were interested in compromise. But we live in a time when extremism is defined as not getting everything you want.

READ MORE:
NR Editors: Graham-Cassidy is Worth Passing
Graham-Cassidy Is a Too-Mild Improvement on Obamacare
No to Single-Payer

— Jonah Goldberg is a fellow at the American Enterprise Institute and a senior editor of National Review. © 2017 Tribune Content Agency, LLC

Article source: http://www.nationalreview.com/article/451517/health-care-reform-graham-cassidy-bill-less-extreme-media-pretends

US appeals court blocks San Francisco ordinance on soda health warnings

SAN FRANCISCO (Reuters) – A U.S. appeals court sided with the beverage industry on Tuesday, granting its request to block a San Francisco ordinance mandating health warnings for soda and other sugary drinks.

The 9th U.S. Circuit Court of Appeals ruled that San Francisco’s ordinance unfairly targeted one group of products. The plaintiffs, including the American Beverage Association and the California Retailers Association, were likely to succeed with their claim that the ordinance was unjustified and violated commercial speech under the First Amendment, the court ruled.

The San Francisco ordinance is part of a growing national movement seeking to curb consumption of soft drinks and other high-calorie beverages that medical experts say are largely to blame for an epidemic of childhood obesity. Many localities also have moved to tax sugary beverages.

John Cote, a spokesman for San Francisco’s city attorney office, said the city is disappointed and evaluating all options.

“San Francisco remains committed to being a leader when it comes to protecting the health of our residents, especially our children,” Cote said.

San Francisco passed an ordinance in June 2015 requiring advertisers within the city to include a warning statement that said drinking high-sugar beverages contributed to obesity, diabetes and tooth decay.

A growing body of research has identified sugary drinks as the biggest contributors to added, empty calories in the American diet, and as a major culprit in a range of costly health problems associated with being overweight.

A federal judge had rejected the industry’s request for a pretrial injunction but had put the ordinance on hold pending the result of the appeal. A three-judge 9th Circuit panel on Tuesday unanimously decided that the lower court was wrong to deny the injunction.

San Francisco’s warning requirement is misleading and deceptive by focusing on a single product, the 9th Circuit ruled.

“The warning is required exclusively on advertisements for sugar-sweetened beverages, and not on advertisements for other products with equal or greater amounts of added sugars and calories,” the court wrote.

The California State Outdoor Advertising Association is also among the plaintiffs.

Reporting by Dan Levine and Ben Klayman, editing by Marcy Nicholson and Cynthia Osterman

Article source: https://www.reuters.com/article/us-california-soda-ruling/appeals-court-blocks-san-franciscos-ordinance-for-soda-health-warnings-idUSKCN1BU24U

Latest GOP Effort To Replace Obamacare Could End Health Care For Millions

Sen. Lindsey Graham, R-S.C. (right), and Rick Santorum, former senator from Pennsylvania, listen during a health reform news conference on Capitol Hill last week.

Andrew Harrer/Bloomberg/Getty Images


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Andrew Harrer/Bloomberg/Getty Images

Sen. Lindsey Graham, R-S.C. (right), and Rick Santorum, former senator from Pennsylvania, listen during a health reform news conference on Capitol Hill last week.

Andrew Harrer/Bloomberg/Getty Images

It wasn’t that long ago that the effort to repeal and replace the Affordable Care Act died once and for all in the Senate.

Or so many thought.

But like the killer robot in The Terminator or the undead fighters in Game of Thrones, the repeal effort has risen once again from the ashes in the form of a bill known as Cassidy-Graham.

The bill, introduced Sept. 13 by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., with little hope of going anywhere, has gained steam in its short life and now looks like it may actually come to a vote in the Senate in the coming days.

Many opponents say the bill will result in millions of people losing their insurance coverage.

“The Graham-Cassidy plan would take health insurance coverage away from millions of people, eliminate critical public health funding, devastate the Medicaid program, increase out-of-pocket costs and weaken or eliminate protections for people living with pre-existing conditions,” says Georges Benjamin, executive director of the American Public Health Association, in a statement.

Here’s what it does:

Cassidy-Graham essentially deconstructs all of the major programs created by the Affordable Care Act, gathers up the money and hands it over to states to run their own health care programs.

It gets rid of both the subsidies that help people buy individual health insurance policies and the reimbursements to insurance companies for offering price breaks on copayments and deductibles to the lowest-income customers.

Her Own Medical Future At Stake, A Child Storms Capitol Hill

It rolls back the Obamacare Medicaid expansion that was adopted by 31 states and Washington, D.C., and it eliminates the Basic Health Program that was created under the ACA and implemented in New York and Minnesota.

All the money that currently goes to those initiatives would instead be distributed to the states as block grants that would particularly benefit those states that did not expand Medicaid earlier and those states with lower health care costs.

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“Overall, this is a resuscitation of past bills aimed at repealing the Affordable Care Act,” says Daniel Dawes, author of the book 150 Years of Obamacare, who recently moved from Morehouse School of Medicine to Nova Southeastern University. “It would have the same, if not a worse, effect on vulnerable populations across the United States.”

Graham and Cassidy say they want to get the federal government out of the health care business.

“If we give the states the flexibility to come up with their own solutions, they will find solutions that will work better for their states than the Affordable Care Act,” Cassidy said in a speech in the Senate last week.

There’s no official government analysis of the plan. The Congressional Budget Office hasn’t completed one yet.

But many experts say the bill would have an impact similar to earlier Republican proposals for repealing the Affordable Care Act. Cassidy-Graham would eliminate coverage for many low-income people who gained insurance through the Medicaid expansion and could gut protections for people with existing medical conditions because states would be encouraged to seek waivers from the federal government’s rules on what must be covered.

Those cuts to Medicaid were one of the main reasons that some Republican senators refused to vote for a similar bill last time around.

The left-leaning Center on Budget and Policy Priorities says in its own analysis that Cassidy-Graham would lead to 32 million people losing coverage over 10 years. It would cut federal funding for health care by more than $400 billion over 10 years, the groups says.

And the liberal Center for American Progress says premiums for people with pre-existing conditions could rise by thousands of dollars because states could let insurers charge that population more.

Graham and Cassidy say their plan restores fairness to a system where currently more than a third of the money spent on the Affordable Care Act goes to just four states: Massachusetts, Maryland, New York and California.

Those states now get a disproportionate share of federal money because they have large populations, have expanded Medicaid and have high health care costs in general.

“We equalize how much each American receives toward her care, irrespective of where she lives,” Cassidy said on Sept. 14.

Timothy Jost, a professor at Washington Lee University School of Law who wrote a widely used textbook on health law, says the proposed change also has political benefits for Republicans.

“In general, the legislation would over time move money away from states, predominantly Democratic, that have expanded Medicaid and aggressively pursued enrolling their lower income populations in Medicaid and exchange coverage,” he wrote in a Health Affairs blog post. “Money would move toward states, predominantly Republican, that have not expanded Medicaid.”

States could use the block grant money to offer their residents subsidies to buy insurance, create high-risk pools to cover people with expensive medical conditions, lower out-of-pocket costs, and help pay for more care for Medicaid recipients.

At two hearings earlier this month at the Senate Committee on Health, Education, Labor and Pensions, governors and insurance commissioners from several states said they support giving more power to states to run their own health care systems.

But a few balked at the cuts in funding that would very likely go along with the bill.

The path to passage of this bill is narrow. If three senators vote no, it can’t proceed. And that vote has to happen before Sept. 30, when the bill authorizing Senate Republicans to work on ACA repeal expires.

Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska opposed earlier repeal bills because they did too much damage to Medicaid. And Sen. John McCain, R-Ariz., voted no because lawmakers didn’t go through the normal hearing and consideration process.

This bill doesn’t fix any of those problems.

Article source: http://www.npr.org/sections/health-shots/2017/09/19/552044236/latest-gop-effort-to-replace-obamacare-could-end-health-care-for-millions

Bill and Melinda Gates Grade the World’s Health

At 61, he could speak with the avuncular magniloquence of a professor emeritus; instead, he layers on supporting data like a star pupil seeking an A-plus. He rebuts skeptical inquiries and insists on teaching from his own syllabus — and on flicking his own birch switch.

The report card will be issued annually, Mr. Gates said. He gave himself only a C+ on the first draft, promising sharper analytics in the future.

He isn’t actually handing out grades to the world’s health authorities — but is sending them home with a note for mom. Your kid has real potential but is becoming a discipline problem.

In some areas, like infant mortality, he considers the progress made “pretty miraculous.” In 1990, more than 11 million children died before their fifth birthday; now, fewer than 6 million do.

AIDS deaths have plummeted since 2004, and malaria deaths since 2005. Rates of childhood stunting, mothers dying in childbirth, and the miseries wrought by rare tropical diseases all have gone steadily down.

In poor countries, vaccine use is way up, though only about 75 percent of children get all the shots they need. More people have toilets these days.

Progress in other areas has been slower. Smoking is down, but tobacco companies are fighting back. Contraceptive availability is up, but almost half the women who want birth control still lack it.

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Access to basic health care is up, according to the new report. But the gap between rich and poor countries remains vast, because too much money goes to top hospitals instead of rural clinics.

One key finding: Most of the progress was not bought by donors, but came organically as hundreds of millions of people scrambled out of the most abject tiers of penury.

In 1990, 35 percent of the world lived below the international poverty line (currently $1.90 a day); now, only 9 percent do. Most of the great leap upward was in just two economic powerhouses: China and India.

The report’s scarier themes lie in its projections for the next 15 years.

Assuming economic progress continues, improvements in most health categories will churn dutifully on, or at worst plateau. But since the 2008 economic crisis, donors have been losing their will to give.

If that persists, the report says, chaos threatens. H.I.V. infections could double, returning to levels not seen since the 1990s. And malaria could climb back to the peak hit in 2005.

H.I.V. and malaria are particularly vulnerable to fluctuations in funding because they are concentrated in Africa, where economic progress has been slower than in Asia or Latin America and where birthrates remain high, producing a big pool of potential victims each year. Malaria has a history of rebounding as soon as pressure is eased; both the mosquitoes and the parasites quickly evolve resistance genes.

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The world’s birthrate is now peaking — probably forever — at about 134 million babies a year. “But it’s mind-blowing how much the shift in where kids are being born makes things hard for us,” Mr. Gates said.

Keeping infants alive gets tougher when they are born in lands with civil wars, dirt roads and healers who reject Western medicine.

Surprisingly, the new report was not a reaction to Mr. Trump’s threats to slash the foreign aid budget by 32 percent.

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According to Dr. Christopher J.L. Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation, which gathered the data, it was initiated three years ago because Mr. Gates feared the world was losing its focus on health.

“Goalkeepers” refers to a metric that the world ignores but the Gateses do not: the targets periodically set by the United Nations, namely the 2000 Millennium Development Goals and the 2015 Sustainable Development Goals.

The first sharply emphasized poverty and health. But the latter comprise 169 targets for everything from reducing overfishing to bringing clean energy and decent jobs for all — they have an “I-want-a-pony-too” air about them.

The world prefers simple goals, like declaring war on smallpox. But war talk has stung Mr. Gates. Calls for an “AIDS-free generation” – all the rage six years ago — were “premature,” he said, and he was “embarrassed” by claims that malaria could be eliminated by 2015.

He prefers “Microsoft-type thinking” to set realistic goals. “People expect a certain degree of honesty,” he said. “They want to know, do Bill and Melinda track this stuff?”

Essentially, he is tracking the world’s pursuit of his own goals as he helps it reach them.

In early interviews, Mr. Gates refrained from criticizing Mr. Trump but gave the clear impression that he believed Congress would ignore most of the president’s proposed cuts. Congress appears to be doing just that.

To hear Mr. Gates tell it, even the staunchest backers of an America First ideology, which he called “selfish,” succumb to his fusillades of data.

Before Stephen K. Bannon, the president’s chief strategist, resigned, Mr. Gates met him in the White House. “He said, ‘Africa has always been a mess,’” Mr. Gates said. “I went through the numbers on its progress with him. He was impressed.”

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The new report’s weakness is that it cannot, for example, foretell how many more Ugandans would die of AIDS if American donations dropped 20 percent, in the way that the Congressional Budget Office can calculate how many Americans will lose insurance under a particular health care bill.

There are too many unpredictables in global health. A country would not just brutally take 20 percent of its H.I.V. patients off treatment, Mr. Gates noted. It might cut its military budget; it might try to stretch supplies of the drugs it got, triggering shortages.

Buried in the graphics-heavy report are some fun anecdotes that show how ingenuity can be just as important in the field as money.

In Ethiopia, for example, pregnant women were given a special stretcher to help them reach birth clinics; they had feared regular stretchers because villagers carried away on them usually died.

And an imam in Senegal described how he got other imams to accept birth control: by citing a saying from the Prophet Muhammad implying that children should be born about two years apart.

Correction: September 19, 2017

An earlier version of a picture caption in this article misstated the location where Bill and Melinda Gates were speaking. It was in Manhattan, not in the headquarters of the Gates Foundation (which is not in Manhattan)


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Article source: https://www.nytimes.com/2017/09/18/health/bill-melinda-gates-global-health-report-card.html

The Best Health Care System in the World: Which One Would You Pick?

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    Article source: https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html