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Liberal Sen. Bernie Sanders is ready to unveil his bill for creating a system where the government provides health insurance for everybody. Republican senators are ready to release details of a last-ditch effort to repeal and replace President Barack Obama's health care law. Besides focusing on health, the rival packages have something else in common. Neither is likely going anywhere soon. (Fram, 9/13)

Sanders’s bill, the Medicare for All Act of 2017, has no chance of passage in a Republican-run Congress. But after months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates — if not by most senators facing tough reelection battles in 2018. (Weigel, 9/12)

Single-payer refers to a government-run health insurance system, though details can vary. Mr. Sanders’s bill would create a national Medicare-like insurance system and eliminate most out-of-pocket costs for individuals. The surge in support rests on several factors, political analysts said, including a rise in populist sentiment and a growing acceptance of the 2010 Affordable Care Act’s principle that the government should provide coverage if necessary. Backers of a single-payer plan have also been emboldened by the faltering of the Republicans’ push to repeal the 2010 law, commonly known as Obamacare, which polls suggest grew more popular as a result. (Armour and Hackman, 9/13)

Sen. Bernie Sanders rode his impassioned liberal army of supporters through a tumultuous 2016, fighting to snatch the Democratic presidential nomination from Hillary Clinton. Now he's disrupting the party anew, forcing Democrats to take sides over his plan to provide government-financed health care for all. (Fram, 9/12)

Connecticut Sen. Chris Murphy, one of the few Democrats subject to 2020 speculation who has not signed on to the Sanders bill, warned against letting the party’s attention slip to “longer-term health care policy” while the future of the Affordable Care Act remains up for debate. “I think the risk is that we get distracted,” Murphy told reporters. “September’s not done. They can still ram through a repeal bill.” (Schor, 9/13)

Democratic support for a single-payer health-care system has grown by bounds this year, attracting more lawmaker endorsements than any time in the past. But one group is conspicuously not on board: party leaders. Senate Minority Leader Charles Schumer (D-N.Y.) and House Minority Leader Nancy Pelosi (D-Calif.) on Tuesday previewed the much-anticipated release of Sen. Bernie Sanders’s (I-Vt.) “Medicare for all” bill by taking the notable step of refusing to throw their weight behind it. (Lillis, 9/12)

House Minority Leader Nancy Pelosi said Tuesday that single-payer health insurance is not a litmus test for Democrats and that she is focused on protecting health-care coverage under the Affordable Care Act. Pelosi (D-Calif.) declined to endorse “Medicare for All” legislation backed by Sen. Bernie Sanders (I-Vt.) and instead called on Democrats to release a wide range of proposals to fix and improve President Barack Obama’s signature health-care law. Her position on health care is the latest evidence that Democrats in the House are willing to ignore pressure from liberal factions aiming to drive the party further to the left. (Snell and Weigel, 9/12)

"Right now, I’m protecting the Affordable Care Act," Pelosi told reporters Tuesday, according to the Los Angeles Times. "None of these other things, whether it’s Bernie’s [bill], can really prevail unless we have the Affordable Care Act protected." (Hellmann, 9/12)

Senate Minority Leader Charles Schumer (D-N.Y.) is staying on the sidelines on a single-payer health care bill being rolled out this week by Sen. Bernie Sanders (I-Vt.). "Democrats believe that health care is a right for all, and there are many different bills out there. There are many good ones," Schumer told reporters during a weekly leadership press conference. (Carney, 9/12)

Here’s where Senate Democrats stand so far; check back for updates. (Roubein, 9/12)

More than a dozen Senate Democrats are flirting with a single-payer health-care system, marking a shift within the party on what was once viewed as a politically treacherous issue that attracted little support from lawmakers. Thirteen senators are co-sponsoring a measure to be proposed Wednesday by Senator Bernie Sanders, a Vermont independent, that would expand Medicare coverage to all Americans. That’s a significant change from 2013 when Sanders, who lost the 2016 Democratic presidential nomination to Hillary Clinton, attracted no co-sponsors. (John, 9/13)

The Senate’s most conservative Democrat said Tuesday Congress should consider adopting a single-payer health-care system, a sign of how fast politics are shifting on what was once seen as a fringe issue on the left. "It should be explored," said West Virginia Senator Joe Manchin, who faces re-election next year in a state President Donald Trump carried by 42 points. "I want to know what happens in all the countries that have it -- how well it works or the challenges they have." (Kapur, 9/12)

Senators who have said they would sign on to the plan include Sens. Kamala Harris, D-Calif.; Elizabeth Warren, D-Mass;, Jeff Merkley, D-Ore.; Cory Booker, D-N.J.; Tammy Baldwin, D-Wis.; Kirsten Gillibrand, D-N.Y.; Mazie K. Hirono, D-Hawaii; Sheldon Whitehouse, D-R.I.; and Richard Blumenthal, D-Conn. “It’s an idea whose time is come,” Blumenthal told reporters on Tuesday. “It’s not in any way a litmus test, it’s not in any way critical of the Affordable Care Act. It’s just the next step.” (McIntire, 9/13)

Even as federal lawmakers consider short-term repairs to the Affordable Care Act, a growing number of Democrats including Sen. Al Franken are looking more long-term. The Minnesota Democrat announced Tuesday that he has signed on as a cosponsor of Vermont Sen. Bernie Sanders’ “Medicare for All” single-payer health care plan, calling health care “a right for all Americans.” (Brooks, 9/12)

Sen. Marty has put forward a proposal called the Minnesota Health Plan. It's a single-payer health care system in which the state finances basic health care costs for all residents through taxation. (Weber, 9/12)

A Democratic candidate for governor is proposing a Medicaid-for-all health care system in Colorado, endorsing a public option at the state level amid the gridlock on health care in Congress. Cary Kennedy said she wants to allow anyone on the individual market to join the Medicaid system or the state employee health care plan to provide more affordable and high-quality health care options. (Frank, 9/12)

The chairman of the Senate Finance Committee and the top Democrat on the panel announced on Tuesday night that they had reached agreement on a plan to prevent the imminent exhaustion of federal funds for the Children’s Health Insurance Program. The current appropriation runs out at the end of this month, and many states will exhaust their allotments of federal money later this year or early next year. (Pear, 9/12)

In a concession to Republicans, the agreement would phase out extra federal funds that have gone to states for the program since the additional money was mandated as part of President Barack Obama's 2010 health care law. Money for the federal-state program is due to expire at the end of September. The program provides health coverage to around 8 million low-income children and pregnant women. It was initially unclear how the agreement would fare in the Senate and the House. (Fram, 9/12)

"Not only does this proposal provide uninterrupted funding for CHIP, but it also provides certainty and increased flexibility for states to administer the program," Hatch said in a statement. The proposed legislation would maintain Obamacare's 23 percent increase in the federal matching rate to states for 2018 and 2019 and begin to ratchet it down in 2020, according to GOP and Democratic aides. The bump is set at 11.5 percent in 2020 and would be totally eliminated starting in 2021. (Pradhan, 9/12)

A committee aide said Tuesday night that the proposal would provide additional protections for low-income people and flexibility from a requirement in the health care law that some states keep the eligibility levels in their CHIP programs the same as when the law passed in March 2010. Because funding for the program will expire in two weeks, children’s advocacy groups have been emphasizing the urgency of taking action immediately. “The chairman and I are very much committed in moving and moving quickly. I want a multi-year bill. I want generous funding,” said Wyden earlier this week. (Raman, 9/12)

A two-year CHIP reauthorization passed in April 2015, months before the program was set to expire, and the provision was included in a larger Medicare reform package. (Weixel, 9/12)

The senior Republican and Democrat on the Senate health committee courteously clashed Tuesday over how much freedom Congress should give states to modify the Affordable Care Act's benefit rules in order to make individual coverage more affordable. Most of the senators and expert witnesses speaking in the third of four planned hearings agreed Congress should swiftly fund payments to insurers for the ACA's cost-sharing reductions for lower-income enrollees, though it wasn't clear that Republicans supported insurers' calls for long-term funding. (Meyer, 9/12)

Flexibility for state waivers under the 2010 health care law is a sticking point between Democrats and Republicans as a key health panel considers how to shore up the individual insurance marketplace. State flexibility was the main focus of a Tuesday hearing before the Senate Health, Education, Labor and Pensions Committee, the third of four planned meetings focused on stabilizing the individual health insurance market as the upcoming open enrollment period approaches. There appears to be consensus from both parties to make it easier for states to get certain waivers approved. But Democrats say they won’t budge on the health care law’s consumer protections while Republicans are pushing for states to have more sway over such policies. (McIntire, 9/12)

The U.S. Congress was wrestling with healthcare again on Tuesday, as lawmakers from both parties considered some approaches beyond simply repealing and replacing Obamacare. The widened healthcare discussion appeared unlikely to yield dramatic changes soon, but marked a shift from the long-running, Republican effort to gut 2010's Patient Protection and Affordable Care Act, as Obamacare is formally known. (Cornwell, 9/12)

Senate Finance Committee Chairman Orrin G. Hatch of Utah emphasized Tuesday that funding health care law subsidies without long-term changes would be a “mistake" — a position at odds with Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, who was holding a separate hearing just two floors above. However, Hatch added, "I want to find a bipartisan path forward through this mess.” Hatch's comments came in a wide-ranging hearing where insurance experts discussed funding the insurance exchanges' consumer subsidies as well as transparency in drug pricing. (Clason, 9/12)

Senate Finance Committee Chairman Orrin Hatch (R-Utah) on Tuesday derided bipartisan efforts to shore up ObamaCare's insurance market as a "bailout." "At this point, it’s pretty clear that the parties will need to work together if any of this is going to improve. That said, I am concerned that many of the proposals for a bipartisan solution would amount to little more than a bailout of the current system," Hatch said in his opening remarks at his committee's health-care hearing Tuesday. (Hellmann, 9/12)

Republican Ron Johnson is expected to sign on as a co-sponsor of the GOP's latest attempt to replace the Affordable Care Act, known as Obamacare. Meanwhile, Democrat Tammy Baldwin said in an opinion piece for the Milwaukee Journal Sentinel that she supports Medicare-for-all legislation that will be introduced by independent U.S. Sen. Bernie Sanders of Vermont. (Glauber, 9/12)

After a summer of flame-throwing over the Affordable Care Act’s repeal, Republicans and Democrats are now engaged in a serious collaborative effort to find a legislative solution that would ward off predicted premium rate hikes this year. Sen. Lamar Alexander, who chairs the Senate Health, Education, Labor and Pensions (HELP) Committee, and his colleagues are up against a tight deadline to craft a bill to steady premiums in the Affordable Care Act’s shaky markets. Insurers must nail down plans late this month for the coming enrollment season. (Bluth, 9/12)

Republican leaders want to move past Obamacare repeal, but most GOP voters aren't ready to let them do it. That's a key finding of the latest POLITICO-Harvard T.H. Chan School of Public Health poll, which finds the Trump administration's messaging on health care is clearly resonating with the party's base. (Diamond, 9/13)

Republicans are paralyzed over what to do about health care, caught between a bipartisan effort to shore up Obamacare and the opportunity to take one last swing at their years-long promise to repeal the law. Leaders of both efforts have less than three weeks to gather enough support to persuade Senate Majority Leader Mitch McConnell to either take another partisan shot at the Affordable Care Act or begin bipartisan reforms. Key procedural powers for the GOP to repeal the law expire on Sept. 30, and insurance companies desperate for certainty have until Sept. 27 to decide whether to participate in Obamacare markets next year. (Everett and Haberkorn, 9/12)

Two Senate bills aimed at shaping the future of the Affordable Care Act are facing uncertainty, as the White House voices tepid support for an ACA repeal effort and opposition to a bipartisan bill to shore up insurance markets. Republican senators Bill Cassidy of Louisiana and Lindsey Graham of South Carolina on Wednesday plan to release the text of a bill letting states largely decide what to do about the 2010 health law known as Obamacare, following the collapse of a Republican bid to undo it. The senators see their proposal as the party’s last hope to fulfill a pledge to strike much of the law and enact conservative proposals in its place. (Radnofsky and Armour, 9/13)

The White House gave a subtle nudge to a long-shot bill from two Republican senators that would overhaul the 2010 health care law as a Sept. 30 deadline to take up the measure quickly approaches. ... “We’ve not had any questions about Sen. Graham and Sen. Cassidy’s efforts … about progress they’re making on an effort to still keep that alive so we can complete that effort before that Sept. 30 window closes,” Marc Short, White House legislative affairs director, told reporters at the Christian Science Monitor breakfast Tuesday morning. (Bennett, 9/12)

Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) met on Tuesday afternoon with Senate Majority Leader Mitch McConnell (R-Ky.) to discuss their last-ditch ObamaCare repeal bill. Leaving the meeting in McConnell's Capitol office, Cassidy said the leader's message was that Graham and Cassidy need to find 50 votes for the bill on their own. (Sullivan, 9/12)

The people who put together Tennessee's open enrollment events and power the state's hotline are devising a last minute, grassroots strategy to let people know when and how they can buy individual health insurance. The final six weeks before enrollment kicks off on Nov. 1 will be frantic for navigators, the people certified to help. The Affordable Care Act didn't get repealed but a last minute funding decision by the Trump administration is altering plans that were nearly cemented. (Fletcher, 9/12)

A group of Democratic lawmakers are calling on the Trump administration to pay millions of dollars to outside groups that help people sign up for ObamaCare. The letter from 31 House Democrats, led by Rep. Carol Shea-Porter (N.H.), pressed the Centers for Medicare and Medicaid Services to release funding for navigator groups, which also help with ObamaCare education and outreach. (Weixel, 9/12)

Anthem Inc, which has trimmed the number of states and counties in which it will sell individual Obamacare plans in 2018, said on Tuesday it is still working with some state regulators on its market participation for next year. Anthem and other insurers have a deadline of Sept. 27 to finalize their 2018 role in the individual insurance program created as part of former President Barack Obama's national healthcare law, often called Obamacare. Anthem is the No. 2 U.S. health insurer. (Humer, 9/12)

Blue Cross and Blue Shield of Illinois will no longer offer group plans for small businesses through the Affordable Care Act health insurance exchange, the company announced this week. ...When Obamacare went into effect, the federal government predicted that 4 million people would be covered through its Small Business Health Options Program, or SHOP. It hit less than 6 percent of that goal. As of January 2017, just 27,000 employers nationwide had SHOP plans covering about 230,000 people, according to the federal Department of Health and Human Services. (Armentrout, 9/12)

The U.S. Department of Health and Human Services cut funding by more than 40 percent this fiscal year for counselors, or "navigators," who provide in-person enrollment help to those signing up for the Affordable Care Act — or "Obamacare" — insurance and Medicaid for low-income and disabled residents. The funding cuts mean two Arizona entities that received navigator grants — the Arizona Alliance for Community Health Centers (AACHC) and the University of Arizona — don't knowif, or how much, they'll receive to pay for these positions during the coming enrollment period. (Alltucker, 9/12)

Iowa’s insurance commissioner told legislators Tuesday he’s become “a lot less optimistic” about the prospects of his plan to shore up the state’s individual health-insurance market, because he still hasn’t received approval from federal officials. Commissioner Doug Ommen said he had hoped to hear by now whether federal administrators would go along with his "stopgap" proposal. As things stand, the only carrier planning to offer individual health insurance in Iowa for 2018 plans to raise premiums by nearly 58 percent. Some consumers could see their premiums more than double. (Leys, 9/12)

The share of people in the U.S. who lacked health insurance for the whole of 2016 declined to 8.8%, the Census Bureau said Tuesday, down from 9.1% the previous year, largely due to Americans aging into the federal Medicare program for people 65 and older. The rate reflects around 28.1 million people without health coverage, a decrease from 29 million a year earlier, hitting a new low that has also been reflected in other government and private surveys. (Radnofsky, 9/12)

Three years after the Affordable Care Act’s coverage expansion took effect, the number of Americans without health insurance fell to 28.1 million in 2016, down from 29 million in 2015, according to a federal report released Tuesday. The latest numbers from the U.S. Census Bureau showed the nation’s uninsured rate dropped to 8.8 percent. It had been 9.1 percent in 2015. Both the overall number of uninsured and the percentage are record lows. (Galewitz, 9/12)

The percentage of Massachusetts residents without health insurance fell again last year, to a new low of 2.5 percent, the US Census Bureau said Tuesday. That’s down from 2.8 percent of Massachusetts residents who went without health insurance in 2015, and 3.7 percent who were uninsured in 2013. (Dayal McCluskey, 9/12)

The number of people in Illinois without health insurance has dropped again — though some worry that trend is about to reverse amid uncertainty over the future of Obamacare. About 6.5 percent of Illinois residents — or about 817,000 people — were uninsured in 2016, according to the U.S. Census Bureau. That's a drop from the year before, when about 900,000 residents lacked insurance. It's also a big dip from 2013, before many provisions of the Affordable Care Act took effect, when 1.6 million people were uninsured. (Schencker, 9/12)

A new United States Census Bureau report shows the percentage of uninsured Texans dropped from 22.1 percent in 2013 to 16.6 percent in 2016. Despite the drop, Texas still reported the highest uninsured rate of all 50 states — and almost double the national uninsured rate of 8.8 percent. (Arriaga, 9/12)

Texas still has the highest rate of people lacking health insurance in the country, but overall, rates in the state and across the nation have been on the decline, new Census data show. ... At 16.6 percent, about one in every six Lone Star State residents did not have health coverage in 2016, the American Community Survey data released Tuesday found. Texas and Alaska were the only two states that had rates that were over 14 percent of their populations. (Rice, 9/12)

The U.S. Census Bureau reported Tuesday that the rate of uninsured in Texas fell to 16.6 percent last year, down from 22.1 percent in 2013 when the Affordable Care Act's individual market plans first became available. ... "We were finally gaining traction," said Elena Marks, president and CEO of Houston's Episcopal Health Foundation, which focuses on health policy and access to care for the poor and uninsured. She characterized the Census figures as "real and consistent improvement year after year - something that had not previously happened in Texas for a very long time." Still, she worried about the toll from the divisive politics that surrounds all things about the health-care law. (Deam, 9/12)

The uninsured rates in Kansas and Missouri continue to drop, but not as fast as those in states that have expanded their Medicaid programs. New numbers from the U.S. Census Bureau show the uninsured rate in Kansas dropped to 8.7 percent in 2016 from 9.1 percent the year before. That is not a statistically significant change. Approximately 249,000 Kansans lacked health coverage in 2016, down from about 261,000 the previous year. (McLean, 9/12)

The number of Mainers without health insurance held steady in 2016, as the national uninsured rate fell to a record low, according to new U.S. Census data. Eight percent of Maine residents, or 106,000 people, lacked health insurance last year, the Census report released Tuesday shows. That’s down slightly from 8.4 percent in 2015, though within the report’s margin of error. (Farwell, 9/12)

Even though South Carolina leaders chose not to expand eligibility for the low-income Medicaid program under the Affordable Care Act, the uninsured rate in the state still dropped significantly between 2013 and 2016, new census numbers show. In 2013, before coverage was available to purchase through the federal health insurance marketplace, the uninsured rate in South Carolina was 15.8 percent. By 2016, it had dropped to 10 percent. (Sasser, 9/12)

North Carolina experienced another drop in the number of individuals without health insurance to a record low of 10.4 percent in 2016, according to data released Tuesday by the U.S. Census Bureau. However, the rate could be significantly lower if the Republican-controlled General Assembly approved expanding Medicaid coverage to more than 500,000 of the 1.04 million North Carolinians who still lack health insurance. (Craver, 9/12)

Continuing its rapid expansion, Centene Corp. said it would take over nonprofit insurer Fidelis Care in a $3.75 billion deal, vaulting the company to a leading position in the New York Medicaid market. The acquisition announced Tuesday would give Centene, already a giant in the Medicaid managed-care business, more than 1.6 million members in New York, enrolled in product lines including Medicaid, Affordable Care Act exchange plans, and Medicare. In the first half of the year, Fidelis Care generated $4.8 billion in revenue, Centene said Tuesday, and Fidelis Care said its operations have been profitable. (Wilde Mathews and Armental, 9/12)

Centene is making a big move into New York state, with a deal to acquire non-profit insurer Fidelis Care's plans for $3.75 billion. The asset purchase will bring Centene more than 1.6 million new members in the state, spread across the Medicaid, Medicare Advantage and Obamacare exchange markets. (Coombs, 9/12)

Natural disasters like hurricanes Harvey and Irma can displace people and leave them scrambling to find stability and routine. But during catastrophes, victims of domestic violence face a unique challenge: seeking safety from their abusers. Most evacuees are seeking shelter but domestic violence survivors face a “double whammy” of escaping the danger of their abuser and finding safety from the looming disaster, said Ruth Glenn, the executive director of the National Coalition Against Domestic Violence. (Salam, 9/12)

The more than 250 people in Georgia who became medical evacuees because of Hurricane Irma are expected to stay in place until Wednesday at the earliest. ... She said 104 hospital patients, as well as 149 nursing home residents, were evacuated by the state before Irma hit Georgia on Monday. (Miller, 9/12)

Two people overdosed on opioids while in shelters in Palm Beach County during Hurricane Irma, officials said. Palm Beach County State Attorney Dave Aronberg says the two victims were revived with an overdose reversal drug. (Haden, 9/12)

Three people died of carbon-monoxide poisoning on Tuesday from a generator that was running inside their Orange County home after Hurricane Irma, the Sheriff’s Office said. Four other members of the multigenerational family were taken to Florida Hospital in very serious condition. (Tziperman Lotan and Padró Ocasio, 9/12)

House Energy and Commerce Committee chairman Rep. Greg Walden (R-Ore.) is calling on lawmakers to "redouble" efforts to address the opioid epidemic as the committee prepares to hold a hearing on the crisis next month. “President Donald Trump recently declared the epidemic a national emergency,” Walden wrote in a Morning Consult op-ed published Tuesday. (Roubein, 9/12)

Opioids aren’t widely overused by the general population, as often presumed. Rather, more than three-quarters of opioid prescriptions are written for just 10 percent of patients, according to an analysis by Dr. Eric Sun of Stanford University Medical Center, published in the latest issue of the Annals of Internal Medicine. (Krieger, 9/12)

A controversial proposal to allow certain California counties and cities to establish sites where people could inject drugs without legal consequences stumbled in the state Senate on Tuesday night. The measure, by Assemblywoman Susan Talamantes Eggman (D-Stockton), would establish a first-in-the-nation program in which users of heroin and other intravenous drugs could inject in settings with clean needles and under the supervision of trained staff. The goal: to stave off overdoses in an era in which heroin use is on the rise. (Mason, 9/12)

Cincinnati and Hamilton County will soon spend another $400,000 on the fight against heroin addiction, investing in public outreach, a hotline for drug users seeking help and life-saving medical treatment for people who overdose. City council members and county commissioners agreed weeks ago to increase spending by an additional $200,000 each, but they talked Tuesday for the first time about how those tax dollars will be spent. (Horn, 9/12)

U.S. Sen. Claire McCaskill (D., Mo.) took aim during a hearing Tuesday at marketing practices by the pharmaceutical industry generally and the behavior of one company in particular: Insys Therapeutics Inc., which made the powerful opioid believed to have played a role in the death of 32-year-old Sarah Fuller in Camden County last year. ... Also testifying at the hearing was a pain patient named Jeffrey Buchalter, a veteran of four tours in Iraq, who now lives in Maryland. Insys allegedly paid his physician $34,000 as part of a “speakers program” about Subsys, after which his doctor prescribed inappropriate amounts of the drug, making him into what he called a “full-blown addict.” (Sapatkin, 9/12)

After running the Centers for Disease Control and Prevention for eight years under President Obama, Dr. Thomas R. Frieden is starting a global health initiative that will focus on two big areas: heart health and epidemic preparedness. Called Resolve, it is funded with $225 million over five years by Bloomberg Philanthropies, the Chan Zuckerberg Initiative and the Bill and Melinda Gates Foundation. The program will be based at Vital Strategies, a public health nonprofit in New York, the city where Dr. Frieden served as health commissioner under Mayor Michael Bloomberg. (Belluck and Hoffman, 9/12)

Tom Frieden, former director of the Centers for Disease Control and Prevention, is starting a new initiative to tackle some of global health’s thorniest issues: cardiovascular disease and epidemics. Frieden, a former New York City health commissioner who spent seven years leading the CDC during the Obama administration, said he chose those two issues based on his “unique vantage point of surveying the world and seeing where there were areas that really are at a tipping point.” Strategic investment and action in each of these areas can make substantial differences, he said. (Sun, 9/12)

Melinda Gates is calling on world leaders to step up global aid funding, saying “a loss of U.S. leadership” is resulting in “confusion and chaos” in some of the most vulnerable corners of the planet. The billionaire philanthropist and her husband, Bill, who spoke in separate interviews at the offices of their charitable foundation last week, have deep concerns about the global repercussions of the federal budget debate in Washington. The Trump administration has recommended that the United States — which contributes $12 billion out of the $34 billion spent on foreign assistance each year — reduce its support in almost all areas of public health, including infectious diseases and family planning. (Cha, 9/13)

Conventional vaccines prevent people from getting sick in the first place. Now scientists are testing a new type of vaccine that treats existing cancers by spurring immune cells to go on the attack. These drugs—known as therapeutic vaccines—hold the potential to plunge cancers into remission without causing the side effects of treatments such as chemotherapy. (Gormley, 9/12)

For people who believe myths about vaccines, the facts aren’t very convincing. That’s the result researchers got when they tested if people could be persuaded to change their incorrect beliefs that certain vaccines cause autism or have lesser but still harmful side effects on children. The test subjects stuck to their opinions even after being shown facts about the matter. In fact, their beliefs were stronger afterward, according to Sergio Della Sala, a neuroscience professor at the University of Edinburgh and one of three researchers who conducted the study. (Dizik, 9/12)

The 2017 report hails the 25 percent fall in  U.S. cancer death rates from 1991 to 2014, while five-year survival rates for all cancers rose from 49 percent in the mid-1970s to 69 percent in 2013. Moreover, in the past year, the FDA has approved nine new cancer drugs and expanded the approved uses for eight more. Two of the new drugs are in the revolutionary class of immunotherapies, called “checkpoint inhibitors,” that includes Keytruda. (McCullough, 9/12)

Sage Therapeutics’ closely watched drug, brexanolone, did not do much better than a placebo in helping patients with a severe type of epilepsy, data from a phase 3 clinical trial show. Sage, which is based in Cambridge, Mass. expected brexanolone to lead to its first-ever drug approval. Instead, its shares dropped 25 percent to $66 in pre-market trading. (Feuerstein, 9/12)

To prevent falls that cause injuries, hospitals often encourage patients who haven’t undergone surgery to stay in bed. But some medical experts say that may be a big mistake. Numerous studies have shown that immobility increases the likelihood of muscle atrophy, blood clots, bed scores and delirium. For elderly or very sick patients, the danger is even greater: Being immobilized even for a few days can lead to a permanent functional decline, making it more difficult for patients to return home. (Ward, 9/12)

There are few federal food policies as contentious as the U.S. Dietary Guidelines, developed every five years after a report by the independent U.S. Dietary Guidelines Advisory Committee. The guidelines not only inform individual consumers about what’s healthy and what isn’t but are also used to develop approaches to everything from food labeling regulations to school lunch menus and food stamp benefits. ... So it’s not surprising that following the 2015 committee report, which had recommended that Americans reduce their consumption of red and processed meat and sugar-sweetened foods and beverages, the food and beverage industry scrambled to respond. (Shanker, 9/13)

Early results from an ongoing study from the University of Massachusetts Amherst provide a new window into how chemicals in the environment might be affecting men’s sperm. The study suggests that a man’s environment might cause changes in how genes are expressed in his sperm. (Eppolito, 9/12)

Researchers studying the impact of the flu vaccine in pregnancy have found a possible link between miscarriage early in pregnancy in women who received the flu vaccine two years in a row. It’s the first study to identify a potential link between miscarriage and the flu vaccine and the first to assess the effect of repeat influenza vaccination and risk of miscarriage. The findings suggest an association, not a causal link, and the research is too weak and preliminary, experts said, to change the advice that pregnant women should get a flu vaccine to protect them from influenza, a deadly disease that can cause serious birth defects. But the study is likely to raise questions about the safety of the vaccine as flu season gets underway. (Sun, 9/13)

Britney Stewart was nervous at first when her obstetrician told her she’d like her to see a specialist in high-risk pregnancies. “Once I know a doctor I like to stick with that doctor,” says the 27-year-old, whose high blood pressure and weight issues put her and her unborn baby at risk. Now she says those appointments—conducted by video link with the specialist, Anne Patterson in Atlanta, a two-hour drive away—saved her baby’s life. (McKay, 9/12)

Women ages 30 to 65 may decide how often they want to get screened for cervical cancer depending on the test they choose, according new draft recommendations for cervical cancer screening from the U.S. Preventive Services Task Force. Testing every three years requires a Pap smear, and testing every five years requires a test for human papillomavirus (HPV), the virus that causes nearly all cervical cancers. (Haelle, 9/12)

For decades now, women navigating menopause have been buffeted by shifting research findings on the risks and possible benefits of hormone-replacement therapy. Now, a landmark clinical trial that followed more than 27,000 subjects for roughly 18 years has offered some conclusive evidence that neither the hype nor the grim warnings about hormone-replacement therapy were warranted. (Healy, 9/12)

Breast-feeding rates are increasing each year, but a gaping disparity between Black women and women of other races remains. Nationally, according to recent federal data, there is an 18 percent gap between white and black mothers who have ever breast-fed. (McEntire, 9/13)

[Del.] Gov. John Carney is signing legislation aimed at ensuring that individuals with mental and physical disabilities are not denied access to organ transplant procedures based solely on their disability. The bill being signed Wednesday prohibits health care providers from deeming a person ineligible to receive an anatomical gift or organ transplant, related medical services, or referrals based solely on a physical or mental disability. (9/13)

Hospitals around Washington appear to be falling short in their charity-care duties, according to a report by Columbia Legal Services (CLS), which helped Andres-Juan get her pay back, and Attorney General Bob Ferguson, who announced last week a lawsuit against St. Joseph Medical Center in Tacoma. St. Joseph has withheld charity care from tens of thousands of low-income patients since 2012, Ferguson alleged. Senior managers at the hospital, part of the CHI Franciscan chain along with Highline Medical Center, knew about the problems but did nothing, he said. (Young, 9/12)

New renovations to United Hospital revealed Tuesday are designed to curb wait times and promote patient safety. A ribbon cutting for the St. Paul hospital’s $1.4 million emergency care center expansion was held Tuesday morning. Improvements include: six new care spaces, a shared welcome desk for United and Children’s Hospital and security personnel, larger triage areas and hybrid rooms for medical and mental health patients. (Faircloth, 9/12)

After months of protests from families, city supervisors and public health officials, California Pacific Medical Center (CPMC) announced that it will continue to care for 28 patients with complex medical needs, instead of transferring them to other facilities outside the city. In June, the patients and their families received letters from CPMC saying that the skilled nursing unit where they lived at St. Luke’s Hospital, known as a “subacute” unit, was closing permanently. (Klivans, 9/12)

[Richard] Wilson is the executive director of the Institute for Genomic Medicine at Nationwide Children’s Hospital in Columbus. He opened his labs last week to give hospital employees and others a peek at the machines and researchers who are taking the first steps to help find new cancer treatments, reveal rare diseases and change the way medicine is practiced. (Viviano, 9/13)

A conference held in conjunction with Worldwide Suicide Prevention Day drew mental health professionals and lay people to USC Verdugo Hills Hospital where they learned about the biology of the suicidal brain, how genetics are involved, and ways one can support a deeply depressed individual. The Sept. 9 event, which carried the theme, “Shattering the Silence,” was the hospital’s second annual Suicide Awareness and Prevention Conference, and attendance was up this year. (Sanderson, 9/12)

When health policy expert and pediatrician Mark Schuster searched for a book to help parents speak easily and accurately with their children about sex and sexual health, he couldn’t find one he liked. So, the Harvard professor — a leader in research on child, adolescent and family health — enlisted the help of a medical school classmate to write the 2003 guide for parents  “Everything You Never Wanted Your Kids To Know About Sex (But Were Afraid They’d Ask).” (O'Neill, 9/12)

The first gene therapy treatment in the United States was approved recently by the Food and Drug Administration, heralding a new era in medicine that is coming faster than most realize — and that perhaps few can afford. The treatment, Kymriah, made by Novartis, is spectacularly effective against a rare form of leukemia, bringing remissions when all conventional options have failed. It will cost $475,000. (Kolata, 9/11)

What does it really cost to bring a drug to market? The question is central to the debate over rising health care costs and appropriate drug pricing. President Trump campaigned on promises to lower the costs of drugs. (Kolata, 9/11)

The analysis, published in the current issue of JAMA Internal Medicine, concludes that it costs, on average, $650 million to develop a new cancer drug. The authors add in another $100 million or so to account for income those companies could have had if that money had been invested in the stock market instead of in new products. That total is far lower than the $2.7 billion figure that the drug industry frequently points to when it justifies the soaring cost of medicine. (It's far higher than $320 million — an inflation-adjusted figure from a 2001 study by the consumer group Public Citizen). (Harris, 9/11)

Developing new drugs is a costly business. So, too, is paying for the ever more expensive therapies that come to market each year. Statutorily, neither of those things is the Food and Drug Administration’s problem. But the agency’s new commissioner argues forcefully that the FDA can bring down drug prices for patients — by making life a little easier for Big Pharma. (Garde, 9/11)

Amid rising complaints that drug makers are exploiting loopholes to win approval of so-called orphan drugs, the Food and Drug Administration plans to close at least one of them. In a blog post, FDA Commissioner Scott Gottlieb acknowledged concerns that the Orphan Drug Act, which allows the agency to approve medicines for treating rare diseases affecting fewer than 200,000 people, needs fixing. As he put it, some drug makers are using orphan designations “as a way to sidestep other important public health goals set out by Congress.” (Silverman, 9/12)

FDA Commissioner Scott Gottlieb on Monday laid out new clinical trial approaches and digital techniques that he said could get medicines to patients sooner and at a lower price by moving away from the time-honored, traditional three phases of clinical trials. (Karlin-Smith, 9/11)

For decades, health insurers and patients have paid for prescription drugs based on the volume of pills or vials purchased—whether or not the medicines helped individual patients as intended. Now the outcry over high drug prices has raised the profile of a different approach to paying for prescription drugs. Pharmaceutical companies increasingly are offering to tie a portion of their reimbursements from insurers to how well drugs work in patients. (Loftus, 9/12)

Cleveland Clinic is one of the most prolific users of the heart drugs nitroprusside and isoproterenol, so when their respective prices surged 30-fold and 70-fold over a three-year span, it caught the provider's attention. Doctors have long relied on the widely used drugs during life-threatening situations. They use nitroprusside to lower blood pressure and treat critical hypertension and congestive heart failure, as well as to keep blood pressure low during surgery. Isoproterenol is used primarily for treating low heart rate and heart block and is used to increase a patient's heart rate while doctors operate. Valeant Pharmaceuticals acquired the rights to the off-patent drugs in 2015 and drastically increased the prices. (Kacik, 9/11)

If you invent a wonder pill, you get a patent and thus a monopoly. The catch is that the patent must one day expire, opening the door to cheap generics and forcing inventors back to the well to start the cycle all over again. But it can be quite hard to say goodbye to a monopoly and the riches it brings. And so drug companies tend to get creative in the waning days of patent exclusivity, stretching the law to translucent lengths in the name of protecting profits. That became quite evident (again) last week, when Allergan surprised the pharma world by announcing it had sold patent rights on a lucrative eye drug to a Native American tribe to avoid facing certain legal challenges by generics. (Garde, 9/11)

The drugmaker Allergan announced Friday that it had transferred its patents on a best-selling eye drug to the Saint Regis Mohawk Tribe in upstate New York — an unusual gambit to protect the drug from a patent dispute .Under the deal, which involves the dry-eye drug Restasis, Allergan will pay the tribe $13.75 million. In exchange, the tribe will claim sovereign immunity as grounds to dismiss a patent challenge through a unit of the United States Patent and Trademark Office. The tribe will lease the patents back to Allergan, and will receive $15 million in annual royalties as long as the patents remain valid. (Thomas, 9/8)

Allergan has taken a novel step to protect top-selling drug Restasis from generic competition: The company has sold the drug’s patents to an Indian tribe in upstate New York. The aim is to block rivals from challenging the patents for the dry-eye drug at the U.S. Patent and Trademark Office based on the tribe’s special legal status as a sovereign government, which the tribe says gives it immunity from patent-office review. (Rockoff, 9/8)

Humira, a treatment for inflammatory diseases such as rheumatoid arthritis and psoriasis made by AbbVie Inc., is the planet’s best-selling drug. It’s also been around almost 15 years. Those two facts alone would normally have rival drugmakers eagerly circling, ready to roll out generic versions that could win a piece of the aging medicine’s $16 billion in annual sales. Yet last year, when the patent on Humira’s main ingredient expired, not a single competitor launched a copycat version. Figuring out how to manufacture it wasn’t the obstacle. The real challenge was the seemingly impregnable fortress of patents AbbVie has methodically constructed around its prized moneymaker. (Koons, 9/7)

The Food and Drug Administration recently approved the first U.S. treatment for childhood cases of Chagas disease — a parasite-driven illness that, over time and unless treated early, can cause serious heart problems in about a third of the people it infects. There are perhaps 300,000 cases in the U.S., according to the Centers for Disease Control and Prevention; the illness is much more common in Latin America, where it affects millions. (Columbus, 9/10)

An updated analysis of Amgen’s (AMGN) Repatha, which is one of the newest cholesterol drugs, has been released and suggests the price would have to drop a whopping 85 percent to 88 percent off the existing list price of $14,500 in order to be considered cost effective. This works out to between $1,725 and $2,240, which is still substantially less than the $8,970 price after Amgen gives rebates and discounts to payers, according to sales data cited in the new report from the Institute for Clinical and Economic Review, a non-profit that assesses the value of medicines. (Silverman, 9/11)

A pharmaceutical company accused of downplaying the potential cancer risk of a best-selling diabetes drug will pay about $60 million to settle lawsuits, the U.S. Justice Department has announced. Novo Nordisk was supposed to make sure that physicians and patients knew that its drug Victoza had an unknown risk of a certain type of thyroid cancer. (Norder, 9/8)

Almost one-third of people have stopped taking a prescription drug at some time without telling their health care provider, according to the latest NPR-Truven Health Analytics Health Poll. And while cost certainly influences whether and how people take their drugs, only 10 percent of people in this poll cited it as the reason for their behavior. A separate question asked people who filled a prescription recently whether they missed at least one dose. A full quarter said they had. (Hobson, 9/8)

A California bill that would require drug makers to report and justify price hikes took a big step toward reality on Monday night. The state Assembly overwhelmingly passed the legislation and it now goes to the Senate for approval, which legislative sources say may occur as soon as today. The bill, which has been vociferously fought by the pharmaceutical industry, could become one of the most comprehensive state efforts to address pricing transparency. For instance, drug makers would have to provide 60-day notice to insurers and government health plans before increasing list prices of a medicine that costs more than $40, by 16 percent in a two-year period. (Silverman, 9/12)

The California State Assembly on Monday overwhelmingly approved Senate Bill 17, controversial legislation that could soon become the nation’s most comprehensive law aimed at shining a light on prescription drug prices. ... It would enable health insurers to negotiate lower prices for drugs or, in many cases, replace those drugs with cheaper alternatives, according to its supporters. (Seipel, 9/11)

Vertex Pharmaceuticals (VRTX) terminated a small clinical trial involving an important, long-acting version of its cystic fibrosis drug Kalydeco that was acquired from Concert Pharmaceuticals (CNCE) earlier this summer. An update to a listing on the government web site ClinicalTrials.gov shows Vertex shut down the study of the drug known as CTP-656 on Sept. 10. No reason other than “decision by sponsor” is given. (Feuerstein, 9/11)

Teva Pharmaceutical Industries, on Monday agreed to sell its contraceptive brand Paragard to a unit of Cooper Cos for $1.1 billion (834.91 million pounds), on a day the struggling Israeli drugmaker named industry veteran Kare Schultz as CEO. (Kuber, 9/11)

Alexion Pharmaceuticals Inc. is cutting its workforce by 20%, relocating its headquarters to Boston and closing sites as it works to reduce its overhead and move on from a sales-practices controversy. The rare-disease drugmaker has seen a slew of management changes during the past year, including hiring a new chief executive, after an internal investigation showed senior management pressured staff to persuade customers to order its flagship drug earlier than needed to meet financial targets. (Hufford, Rockoff and de Avila, 9/12)

A judge is set to hear arguments about whether the provocative online antics of former pharmaceuticals company CEO Martin Shkreli are bad enough to put him behind bars. The hearing before U.S. District Judge Kiyo Matsumoto on a government demand to revoke the convicted Shkreli’s bail was scheduled for Wednesday in federal court in Brooklyn. (Hays, 9/13)

Lawsuits in the pharmaceutical industry are as common as TV ads promoting wonder drugs, never mind the horrific side effects relegated to a breathless, fast-talking voice over at the end. Typically, however, the plaintiffs in these lawsuits accuse the defendants of patent infringement. (The defendants typically strike back by claiming the patents should never have been issued in the first place.) (Michael Hiltzik, 9/12)

We should have seen the drug price crisis coming. Over thirty years ago Robert Bork, chief architect of modern antitrust law, warned “predation by abuse of government procedures, including administrative and judicial procedures, presents an increasingly dangerous threat to competition.” (David Balto, 9/6)

Despite totaling more than $100 billion, reimbursement for generic drugs has received relatively little policy attention. The combination of a complex distribution system and limited information about actual prices artificially inflates what patients and insurers pay retail pharmacies for generic drugs. A recent study by the Washington State Office of the Insurance Commissioner confirms that retail pharmacies profit more when dispensing generic versus brand drugs. (Steven Lieberman, Margaret Darling, and Paul B. Ginsburg, 9/12)

n the last several months, individual companies have begun to take actions in an attempt to address pricing concerns and demonstrate their ability to “self-police” — especially in the face of bad actors that have fueled hatred of the pharmaceutical industry by taking significant price increases on single-source products. These actions have ranged from taking pledges to limit annual price increases to improving transparency of pricing — including disclosing price increases, entering into value-based pricing schemes and devising innovative partnerships to lower the cost of certain medicines for patients — to entering into new partnerships to provide discounts on the medicines they sell at the pharmacy. (Christine Zacherau and April Claassen, 9/6)

In May, Maryland became the first state to take action against the alarming trend of price gouging of off-patent brand-name and generic drugs. The state’s concise new law, which permits the attorney general to argue in front of a court when the price of an older essential medication increases so precipitously as to “shock the conscience,” passed with overwhelming bipartisan votes and broad popular support. Other state legislatures are looking to introduce similar laws across the country. The generic pharmaceutical industry would prefer to see it overturned. (Jeremy A. Greene, 9/8)

Americans pay, by far, the highest prices for prescription drugs in the entire world. Couple this with skyrocketing prices for health services, and you have a growing health care crisis. Everyone should be able to afford the medicine their health care providers prescribe. (Nina Turner, 9/11)

Roger Pickar was diagnosed with a rare cancer in December 2014. A chef, comedian, husband, father and champion of the local arts community, he was successfully treated for more than a year with standard therapies. When the cancer eventually returned, his oncologist prescribed an “off label” drug—one the Food and Drug Administration had approved for other types of cancer, but not the one that afflicted Roger. That meant it wouldn’t necessarily be covered by insurance. (Amy Abernethy and Sean Khozin, 9/12)

There’s an obvious problem with moving Americans to a single-payer system: Most people with private health insurance are pretty happy with their current arrangements. They are not looking to trade in that coverage for a new government program of uncertain quality, along with unknown higher taxes. When President Barack Obama was selling the Affordable Care Act, he promised Americans that they could keep their health insurance if they wanted to. When this didn’t turn out to be true for everyone, there was a significant backlash. (Tyler Cowen, 9/12)

This is a pivotal moment in American history. Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right? Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers? We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can’t get the health care they need. This is not what the United States should be about. (Sen. Bernie Sanders, 9/13)

Every American should have affordable health coverage, and there is more we can do to make that a reality. I always have believed that our goal must be universal health care coverage for everyone, and my support for Sen. Bernie Sanders’ Medicare for All legislation being introduced this week is a statement of that belief. (Sen. Tammy Baldwin, 9/12)

Are Democratic advocates for single-payer health care the mirror image of repeal-and-replace Republicans, substituting a feel-good slogan for actual policy development? Probably not. It's tempting to believe that's a likely outcome of Bernie Sanders's crusade for single-payer, which is picking up momentum within the party despite the fact that Sanders seems mostly indifferent to the details of the issue. But I think it's a big mistake to equate Sanders with repeal-and-oh-we'll-figure-it-out-later Republicans. (Jonathan Bernstein, 9/12)

One of the most important political trends of the last couple of decades is what is often referred to as “asymmetric polarization,” which means that while Democrats were getting more liberal, Republicans were getting much, much more conservative. That trend, however, may be entering a new phase. In many policy areas, it’s almost impossible for the GOP to get any more conservative than it has become, while Democrats are continuing to move left. Nowhere is this clearer than on health care. (Paul Waldman, 9/12)

Single-payer universal health care — once cast as a radical daydream — has moved with staggering swiftness from purported fantasy to palpable possibility. Today, Sen. Bernie Sanders (I-Vt.) released his long-awaited single-payer bill, and a slew of senators now numbering in the double digits have announced their support. This bill will serve as a potent Senate counterpart to Rep. John Conyers Jr.’s (D-Mich.) single-payer bill, now co-sponsored by 117 representatives — a historic and unprecedented majority of House Democrats. Far from being an impossibility, the idea that we might create a right to health care is starting to feel like an inevitability. (Adam Gaffney, 9/13)

Sarai was 25 years old when she died of Wilson’s disease, an inherited disorder that causes liver failure. A liver transplant could have cured her, but she was uninsured and was denied an appointment at two prominent Chicago transplant hospitals, including my own. ... Her death certificate named liver disease as her cause of death, but that’s not true. The real cause was inequality. If the United States had a Medicare-for-all health insurance system, she might have been saved. (David A. Ansell, 9/13)

Time is rapidly running out before health insurers have to commit to the policies and premiums they’ll offer next year to roughly 20 million Americans not covered by an employer-sponsored health plan. Although those premiums are expected to jump 10% or more in many states, Congress can rein in that increase significantly — if it acts quickly. Doing so, however, will require Senate Republicans to stop flirting with yet another partisan proposal to “repeal and replace” the Affordable Care Act, and start focusing instead on steps to make coverage more affordable that can win broad support. (9/12)

The coming crisis is as predictable as it is worrying. Nearly a fifth of every dollar spent in this country is spent on health care. Without reform, that number will only rise as the baby boomers retire. Younger generations will suffer, as money is taken from building roads and educating children to paying for Medicare to cover boomers’ health costs. ... Yet waste scored a victory when Health and Human Services Secretary Tom Price decided to stop or scale back “bundled payment” experiments the Obama administration had begun. (9/12)

As baby boomers age into long-term care facilities, Medicaid costs will go through the roof. Americans already spend—counting both public and private money—more than $310 billion a year on long-term support services, excluding medical care, for the elderly and the disabled. Medicaid accounts for about 50% of that, according to a 2015 report from the Kaiser Commission on Medicaid and the Uninsured. Other public programs cover an additional 20%. ... There’s an urgent need to find ways of providing good long-term care at a lower cost. One fix would be to deregulate important aspects of home care. (Paul Osterman, 9/12)

For several decades, specialists in the U.S. have been paid considerably more than primary-care physicians. On average, orthopedic surgeons, cardiologists, radiologists and plastic surgeons make about twice as much as internists, pediatricians and family medicine doctors. True, most specialists train for a longer period of time than primary-care providers, but the degree of divergence in compensation has little to do with market forces or input costs. The difference has consistently been tied to how we pay for care with our emphasis on volume, procedures and technology, rather than prevention, care coordination, evaluation expertise and outcomes. (Howard Forman, 9/12)

Remember the telephone book? That giant, multi-thousand-page behemoth that used to land on your doorstep once a year? Well, neither do we, barely. The heyday of the phone book is long gone, and yet communications with friends and businesses is easier than it’s ever been before. Can it be that California officials haven’t noticed that? A new federal rule that took effect in July allows health insurance plans to stop automatically printing and mailing lengthy Medi-Cal provider directories, some of which are the size of phone books, to all new enrollees and make the information available digitally. Anyone without online access or who preferred having a hard copy could still request one. (9/12)

Poverty fell, middle-class incomes rose, and the share of Americans without health coverage ticked down to a historical low last year, according to data released Tuesday morning by the Census Bureau. This trifecta of gains for poor and middle-income households, as well as the uninsured, shows that the seven-year expansion, along with the Affordable Care Act, has continued to lift the living standards of many American households. However, last year’s gains were even stronger for those at the top of the income scale, suggesting that the inequality of economic outcomes continues to grow in America. (Jared Bernstein, 9/12)

Lawmakers and the media have devoted much of their attention recently to deaths from opioid overdoses, as well as to the broader “deaths of despair” that include suicides and deaths from alcoholic liver disease and cirrhosis. But despite the intense focus on the topic, misinformation about the epidemic runs rampant. By conventional wisdom, tackling this crisis would require extending Medicaid and improving how it functions, cracking down on prescription painkillers and getting more health-care resources into rural communities. (Anne Case and Angus Deaton, 9/12)

Like [Mike] Gerardo, thousands are discharged from the military though the behaviors that got them this attention are service connected. Suffering from PTSD, for instance, often means self-medicating with drugs and alcohol. These service members are deemed problems and are discharged without being provided the services other “wounded” vets are accorded. (9/12)

School’s back in session, and parents ushering kids to college for the first time will undoubtedly deliver some emotional nuggets of advice. But they should also have a potentially life-saving talk with their kids in the first semester of college to avert a possible tragedy — suicide. (Nancy Rappaport, 9/13)

I sit facing the young German neurologist, across a small table in a theater in Hamburg, Germany. I’m here giving one-on-one talks called “The Unenhanced: What Has Happened to Those Deemed ‘Unfit’,” about my research on Aktion T4, the Nazi “euthanasia” program to exterminate the disabled. “I’m afraid of what you’re going to tell me,” the neurologist says. (Kenny Fries, 9/13)