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Trump Infrastructure Plan Would Pay For A Fraction Of Investment

It’s a year later than first promised, but President Trump finally announced his long-awaited infrastructure plan at the White House today, flanked by governors, mayors, and other state and local leaders. Calling the condition of the country’s roads, bridges, ports, tunnels and water systems “horrendous,” Trump says his plan “will spur the biggest and boldest infrastructure investment in American history. The framework will generate an unprecedented $1.5- to $1.7-trillion investment in American infrastructure.”

But the word “generate” is not the same as “spend,” as the Trump administration’s plan proposes to allocate just a fraction of that ambitious goal, $200 billion over 10 years, with most of the rest of the funding burden shifted onto states and local governments.

It’s a radical departure from how federal transportation and infrastructure programs have doled out funding in the past.

Chicago Transit Authority President Dorval Carter, who served in high-ranking positions in the Federal Transit Administration and the U.S. Dept. of Transportation, says when building new transit projects, “historically you look to get about 50 percent of that from the federal government.”

But as the CTA looks to expand one of its busiest train lines and extend its Red Line rapid transit service 5.3 miles into neighborhoods on Chicago’s South Side that are currently underserved by transit at a cost of an estimated $2 billion, Carter may come up nearly empty-handed in Washington.

That’s because if Congress approves the Trump infrastructure plan, that historical 50-50 funding model for transit projects would be thrown out the window, and most projects would require states and local agencies like the CTA to come up with at least 80 percent of the revenue, in order to get, at most, a 20 percent federal match.

For highways, that means the White House plan would completely flip the current 80-20 federal to state and local funding split for many projects.

That flip in financing “probably is not going to work,” former Transportation Secretary and ex-Rep. Ray LaHood, R-Ill., told us on NPR’s Morning Edition Monday. “That idea just probably won’t work because the states and local governments don’t have any money,” LaHood said.

“The lack of federal investment is nothing new,” says Columbia, S.C., Mayor Steve Benjamin, who was at the White House for today’s announcement.

“I would love to see a more significant and robust investment in water and sewer infrastructure, in roads and bridges and schools and hospitals coming from the federal government, and anything short of that, yes, is a disappointment.”

But Benjamin says he’s looking at the bright side, that at least a conversation about investing in infrastructure is now beginning, and he hopes Congress will beef up the federal involvement. He’s also encouraged by the effort to streamline the federal environmental review and permitting process, which the president says his plan will cut from 5-10 years, to just two.

But what worries Benjamin most of all is that the $200 billion that is in the Trump plan comes from budget cuts to transit, community development block grants, and other programs that cities like his rely upon.

“It’s important to build roads and bridges,” says Benjamin, but “it’s also important to give people ladders of opportunity so they can earn a living and house their families and feed their families. So cutting those programs is a non-starter for us.”

The American Society of Civil Engineers, which gives the country a near-failing grade of D+ for the shoddy condition of highways, railways, seaports, airports and water and sewer systems, is another group encouraged that there finally is a detailed infrastructure proposal. ASCE president Kristina Swallow, a civil engineer and program manager for the city of Las Vegas, says “it’s great to know that the leadership of our country recognizes the fact that we have been underspending on infrastructure for decades and that it’s hurting our families economically.”

But she, too, is disappointed with the size of the president’s proposed investment.

“$200 billion is a good starting point for a conversation but it is insufficient,” Swallow says, noting that the nation needs an investment of $2 trillion more than what’s currently budgeted just get the nation’s infrastructure into decent shape. “We are going to figure out a way to find additional funding if we’re really going to meet the needs of our communities.”

Swallow and others point out that cities, counties and states have already been boosting funding for infrastructure on their own because of a lack of adequate federal funds. More than 30 states have raised their gasoline or other taxes in recent years to try to meet infrastructure needs.

Swallow is also concerned about what’s missing in the Trump proposals — a plan to ensure future spending builds more sustainable infrastructure to withstand the impacts of climate change.

“We don’t have enough funding to build it twice,” Swallow says, “And so we have to have a long term view when we build out infrastructure and we have to look at what we’re dealing with today but what we might be looking at tomorrow.”

Many Democrats in Congress are already dismissing the Trump infrastructure plan.

Sen. Tom Carper of Delaware, the top Democrat on the Senate Public Works Committee, says Trump’s “infrastructure plan is unrealistic, inadequate and irresponsible.”

Oregon Congressman Peter DeFazio, the top Democrat on the House Transportation and Infrastructure Committee, calls the president’s plan “embarrassingly small,” and one that “shifts the (financial) burden to cash-strapped States and local governments.”

DeFazio also critizes the Trump plan for cutting “more than $168 billion from existing transportation and infrastructure programs to pay for Wall Street and foreign investors to toll our roads,” and worries that “it would gut bedrock environmental, clean water, and clean air protections under the guise of speeding up projects.”

Republicans might not be so willing to go with a plan that shifts the infrastructure funding burden to state and local taxpayers, but some members of the GOP caucus are also loathe to raise federal revenues, especially the gas tax, which hasn’t been increased in 25 years and currently falls short of raising enough money for existing transportation programs.

But some members of Congress might be willing to embrace the Trump administration’s plan, if it’s truly supplemental to current infrastructure funding programs, as White House aides say it is intended to be.

“This is an interesting dynamic of additional money where they’re trying to change behavior through a different way of supporting more state, local and private” investment in infrastructure, says Mike Friedberg, a former top Republican staffer on Transportation and Appropriation Committees, who is now a lobbyist and advisor on transportation and infrastructure issues in Washington.

He says the administration is making a concerted effort to shift away from a system in which Washington dictates what projects are funded and how they are funded.

“We need to come up with something that’s different and this is a good attempt,” Friedberg says.

But he acknowledges the effort won’t get far if the current funding shortfall in the Highway Trust Fund isn’t addressed and this plan doesn’t bring in new money.

He’s also encouraged by senior White House officials saying that this is not “a take it or leave it proposal,” but rather, “This is the start of a negotiation.”

“You’re seeing there’s an appetite for fixing structural problems,” says Friedberg, “and this president, he’s not an idealogue about this and wants to get stuff done with infrastructure.”

As for whether the infrastructure plan is dead on arrival on Capitol Hill, as some suggest, Friedberg says “it’s not dead (but) it has a steep hill to climb.”

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Chloe Kim Wins Gold In Olympic Snowboarding's Half-Pipe

Chloe Kim won the gold medal in the snowboard women’s halfpipe final at Phoenix Snow Park in the Winter Olympics in Pyeongchang, South Korea.

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Chloe Kim blew away the field and the crowd at the Pyeongchang Games in South Korea, winning the gold medal in the women’s snowboard half-pipe. The win ticks another box in the career of Kim, who at 17 is already regarded as one of the best snowboarders in U.S. history.

Kim won with a score of 98.25, in a competition that never saw her trail another snowboarder. Her fellow American Arielle Gold won bronze, and Kelly Clark narrowly missed the podium after sitting in third place for two runs.

“I was tearing up, I wanted to cry,” Kim said of her mindset when she began her third run. “But I didn’t.”

Kim wowed from the start, putting together complicated tricks to begin her first run and leading the field. That got her a 93.75 — good enough to win. But after falling on the third trick of her second run, Kim showed why she’s regarded as the best in the world, flirting with a perfect score in the third run.

Her first-run score would have brought her the gold, but Kim wasn’t satisfied. She wanted to put down a run that met her expectations, she said.

The snowboarder also said that between her second and third runs, she found out that her grandmother — who had never seen her compete — had traveled from Seoul to Pyeongchang watch her.

“This one’s for grams,” Kim recalled thinking, provoking a round of “Awwws” in the post-competition news conference.

Here’s what she did on that epic run: Method; Front 10; Cab 10; Front 9; McTwist; Crippler 7 — that’s according to the list she reeled off at a news conference afterwards.

“Going to my third run I knew I had the gold,” Kim said. “But I also knew I wouldn’t be satisfied taking the gold and knowing that I hadn’t put down my best. That third run was for me — to put down the best run I could do. “

After scoring just below the 100 mark, Kim said the run wasn’t quite perfect — but we’ll note that it was closer to perfection than anything the thousands of spectators and media had ever seen.

Kim also tallied the music she listened to. On the first run: “Paparazzi” by Lady Gaga; for her third, she said, it was “MotorSport,” by Migos, Cardi B, and Nicki Minaj.

Afterwards, Kim was asked about the practice in Pyeongchang of handing winning athletes a stuffed mascot toy rather than a medal after they’ve won. The medal ceremonies at these Winter Games have been held hours after some events.

“I mean, mascot’s really cute,” Kim said. “But just standing on top of the podium” was a special feeling, she added.

China’s Jiayu Liu mounted a challenge to Kim, but it wasn’t quite enough, and she won silver with a high score of 89.75 from her three runs. She secured her spot with a strong second run that had perfect pacing and control in the halfpipe at Phoenix Snow Park.

After a fall like Kim’s in the second run — she slid on her rear after a landing — most snowboarders zig-zag down the half-pipe; some don’t wait for their scores. But Kim pulled a trick at the bottom of her run, suggesting that she means it when she says that she snowboards not to win, but for fun.

All the same, it seems like she’ll keep winning.

Kim has been aiming at the Olympics for a long time. Back in 2014, she couldn’t go to Sochi because she was too young.

“When I couldn’t make the team in Sochi due to my age – it felt like such a long journey,” she said after Monday’s qualifying runs, according to a transcript from the Olympics’ news service. “You know, going from 13 to 17 is such a big time gap. But at the end of the day, I’m here — and I’m so happy.”

Two years ago, Kim became the first woman to land back-to-back 1080 tricks in competition. She’s won big on the World Cup circuit, and at the X Games.

Now she has an Olympic gold medal, in the half-pipe event that was run Tuesday morning in Pyeongchang – that’s Monday night in the U.S.

Her strong qualifying runs meant that Kim had the luxury of going last in the field of 12 snowboarders at Phoenix Snow Park.

Three other Americans joined Kim in the final: Gold, Clark, and Maddie Mastro. For Clark, 34, this was a chance to add to her medal collection – she already has a gold from Salt Lake City in 2002 and bronzes from Vancouver and Sochi.

Kim was not quite two years old when Clark won her first Olympic gold medal – a testament both to Kim’s precociousness and Clark’s talent and resolve.

Gold said it was “bittersweet” to knock Clark out of third place, saying that in addition to admiring Clark as a teammate and athlete, “She’s someone I’ve looked up to ever since I started snowboarding.”

The only thing that could possibly stop Kim’s drive to the podium, it seemed as Tuesday’s event loomed, was the wind — bad conditions had shortened the women’s snowboard slopestyle event one day earlier, and athletes said their performances were affected by the strong gusts. But the weather cooperated, with a clear and sunny sky, moderately cold temperature, and light winds.

In Monday’s two qualifying runs, Kim dominated. She was the only athlete to post scores above 90 points, and one run in particular was a string of perfectly executed tricks. But she still found time to tweet about wanting ice cream.

Could be down for some ice cream rn

— Chloe Kim (@chloekimsnow) February 12, 2018

“Could be down for some ice cream rn,” Kim said on Twitter in the midst of the action.

Later, she told reporters simply, “I want my ice cream.”

Regular mortals are often fascinated by what elite athletes eat to fuel their bodies as they try to do what no one else can. In Pyeongchang, Kim also sent out a word of advice on Monday, about what to eat when you’re nervous.

After admitting she was nervous about the qualifying runs, Kim said, “I also had two churros today and they were pretty bomb so if you ever get nervous go eat a churro.”

By the time Tuesday rolled around, it was all focus.

“Let’s do this thing!” Kim tweeted early this morning.

Chloe Kim’s parents are originally from Seoul, and she said she’s been reconnecting with relatives here in Pyeongchang. Wither her new medal, the celebration will be a family affair. She might even get that ice cream.

Although after her win, Kim said she was starving: “I really want like a burger and some fries, maybe some Hawaiian pizza.”

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OxyContin Manufacturer Says It Will Stop Promoting Opioid Painkiller To Doctors

NPR’s Ari Shapiro talks with journalist Sam Quinones about Purdue Pharma’s announcement that it would stop promoting its blockbuster opioid painkiller OxyContin to doctors. Purdue’s move comes as it faces dozens of lawsuits.

ARI SHAPIRO, HOST:

Effective today, Purdue Pharma is no longer promoting its blockbuster painkiller OxyContin to doctors. In an open letter, the company has said it is doing more to fight the opioid crisis. The letter concludes, this is our fight too. Purdue faces lots of fights. States and cities across the U.S. have sued the drug company for contributing to the addiction epidemic. Sam Quinones has reported on Purdue Pharma for years. He’s author of the book “Dreamland: The True Tale Of America’s Opioid Epidemic.” Welcome.

SAM QUINONES: Thanks for having me.

SHAPIRO: Purdue Pharma used to market OxyContin really aggressively. It’s been less of that recently. What exactly is the change that’s starting today?

QUINONES: My impression is that they are simply not going to be promoting it to doctors at all. They have been promoting it as a reasonable painkiller. And my impression is now that they will be ceasing that, which would be a big step for them – considering that I think it’s one of the few drugs they actually have.

SHAPIRO: Why do you think they’re doing it right now?

QUINONES: I think they are seeing a groundswell of concern across the country and communities everywhere because this is a problem. Opiate addiction is a problem all across the country from coast to coast. They’re also seeing, of course, as you mentioned, dozens of lawsuits filed by states’ attorneys general, by counties, by towns alleging that several companies, Purdue foremost among them, lead a kind of a campaign to dupe the public into believing that their drug was not addictive. And these lawsuits, particularly in the last – I would say – year and a half, have really gained steam as local entities, counties and towns, have seen themselves buckling under the cost of paying for the consequences of this epidemic and having done nothing to really create it – are looking for ways of paying for the increase in foster care that they now have to provide, the full jails, the courts that are that are overwhelmed with new addicts.

SHAPIRO: So do you think this change is likely to affect those lawsuits?

QUINONES: I doubt it. The lawsuits were filed based on what has gone on up to now. A lawyer could tell you better. But my feeling is that these lawsuits were – are based on evidence or facts they say they have that show that the company did this in the past – not what’s going on today. I think it may be more a PR move, as a way of kind of softening feelings toward the company, because I can tell you in many parts of the country this company is very roundly hated.

SHAPIRO: Well, I was going to ask. Purdue Pharma is not ending sales of OxyContin. They just say they’re going to stop marketing oxy. How much of a difference will that make?

QUINONES: It’s hard to say because by now Purdue Pharma and OxyContin, they’re household names. In any doctor’s office, certainly everybody knows the drug. Most pain patients know the drug. It’s not clear to me how much more promoting they actually have to do to get this drug well-known. It’s also got a very bad reputation too. A lot of people are very wary of it. Doctors are very wary of it now, I think. And so what exactly is – how this will help? I’m not sure. They may have their own calculations as to what effect it will have.

SHAPIRO: How much money has this drug made for Purdue Pharma over the years?

QUINONES: Well, it’s a private company. I’m not sure exactly. But estimates that I have read – between $35 and $40 billion in sales since the drug came out in 1996. It’s basically the reason why the Sackler family, which owns Purdue, is one of the wealthiest families in America. Forbes magazine pegged it as one of the wealthiest families in America due almost entirely to the sales of OxyContin.

SHAPIRO: OxyContin is not the only addictive opioid out there. Other drug companies continue to sell addictive painkillers. How much of a difference does it make that this one company will no longer market this one drug? Do you think other drug companies will follow?

QUINONES: I suspect they may. I think it’s more of a – kind of a bellwether of where this issue is going because when you talk about how we got into this, really Purdue Pharma is the company that led the way. Their promotions and their sales and their aggressive marketing really led the way into all this. And so people are now looking to say, well, look. We are turning away from that. We have learned our lesson. We want to be part of the solution – I think as they said in that statement that you read. I’m not sure how much effect it will actually have. And I think time will tell that this is a problem that is not going away. It’s very deeply rooted now in American culture. And will this change in marketing and promotion mean much after the company’s gone to such lengths to root this in America? I don’t know. I guess we’ll see.

SHAPIRO: Journalist and author Sam Quinones, thanks a lot.

QUINONES: My pleasure.

Copyright © 2018 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

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Jamie Anderson Repeats, Winning Olympic Gold In Slopestyle

Gold medalist Jamie Anderson of the United States celebrates during the victory ceremony for the snowboard slopestyle, at the Pyeongchang 2018 Winter Olympics.

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U.S. snowboarder Jamie Anderson won the women’s snowboard slopestyle competition at the Winter Olympics in South Korea on Monday, successfully defending the gold medal she won at the Sochi Olympics in 2014.

Anderson won after high winds delayed the competition at Phoenix Snow Park — and the conditions almost wrecked her medal-winning performance.

“I wanted to do a double nine [trick] on my first run and I went for it and realized I wasn’t going to clear the jumps. Thankfully somehow I connected with my lion power and found [my] feet,” Anderson said, in comments transcribed by the Olympics’ news service.

The strong wind also forced a change in format: instead of having three runs to attain a best score, the athletes were given just two tries. It turned out that Anderson, 27, needed only one: her first run netted a score of 83.00 – easily the best of the field, with the other podium finishers scoring below 75 points.

“It’s hard. We have to be so intuitive with the weather, the course, with how you feel,” Anderson said. “I’m just so happy I put one down and I really didn’t think it was going to last over to the second run. I was planning on doing a better run and cleaning everything up, but honestly, I’m ecstatic.”

Canada’s Laurie Blouin won silver, and Finland’s Enni Rukajarvi won bronze. Two of Anderson’s fellow Americans in the field, Jessika Jenson and Haley Langland, finished in the top six. Julia Marino was 11th.

“I’m feeling so happy,” Anderson said. “I’ve gone through so much this last year just preparing for the Games and defending the gold is definitely not an easy position to be in. I had a lot of pressure and I’m just so proud of myself. It was really tough conditions today and a lot of people were struggling.”

Anderson has bounced back from several injuries since her win in Sochi, including a broken elbow she suffered last year.

With the win, Anderson joins Red Gerard as America’s two Olympic gold medalists in slopestyle; the U.S. also swept the event in Sochi, where it was held for the first time at the Winter Olympics.

“I could have cried seeing my dad and mom and all my siblings, and family and friends being so happy,” Anderson said. “You know, that’s what it’s all about. I don’t think we can do anything without the support of each other and it’s not just me, it’s all these people around me that keep my spirits lifted and help me to be my best self.”

Anderson is now tied with four other athletes as the only snowboarders to win two gold medals at the Olympic Winter Games. That list includes Shaun White, who will try to add to his medal total here in Pyeongchang.

In addition to the shorter final, the snowboarders’ two qualifying runs were canceled, as organizers tried to adjust the crowded schedule. Those qualifying runs had originally been scheduled for Sunday afternoon — but high winds changed that plan.

Windy conditions in Pyeongchang have forced the postponement of events at other venues as well, including the women’s giant slalom and men’s downhill.

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Trump To Unveil Long-Awaited $1.5 Trillion Infrastructure Plan

President Donald Trump.

Evan Vucci/AP

President Trump will finally be unveiling his long-awaited $1.5 trillion plan to repair and rebuild the nation’s crumbling highways, bridges, railroads, airports, seaports and water systems Monday. But, the proposal will not be one that offers large sums of federal funding to states for infrastructure needs, but it is instead a financing plan that shifts much of the funding burden onto the states and onto local governments.

Critics say that will lead to higher state and local taxes, and an increased reliance on user fees, such as tolls, water and sewer fees, transit fares and airline ticket taxes.

Senior White House officials who briefed reporters over the weekend say the plan is aimed at fixing the current system of funding infrastructure that they say is broken in two ways.

The first is that the country has been under-investing in infrastructure, leading a state of growing disrepair. The American Society of Civil Engineers gives the nation a grade of D+ for the condition of transit, highway, bridge, rail, water and other infrastructure, and says the country is in need of an investment of $2 trillion more than is currently budgeted.

The second way the White House says the system is broken is in the lengthy federal permitting process, which officials say can take five to 10 years or longer, driving up costs.

A program that would flip funding burden

Administration officials say the president’s plan addresses the funding shortfall by committing $200 billion in federal funding over 10 years to stimulate state and local spending and private investment. Half of the funding, $100 billion, will be used as incentives to entice cities, counties and states to raise at least 80 percent of the infrastructure costs themselves.

So, for example, if a state has a project or need identified and can come up with 80 or 90 percent of the funding for it through increased state or local taxes, like the gas tax, or with user fees like tolls, then under this plan, the federal government would kick in the rest.

Critics worry that would lead to only projects that could generate revenue, such as toll roads or bridges, getting funded.

That’s a radical departure from the way many projects are funded now. Funding for federal-aid highways, including interstates, is usually allocated in an 80-20 federal-state split. This program would flip that funding burden. Major mass transit projects are often funded on a 50-50 federal-local basis. Again, this plan puts a much greater burden on local taxpayers and users.

The White House last month at sunset.

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Alex Brandon/AP

To address concerns that projects in rural areas don’t have the ability to generate much in user fees, the White House plan calls for spending $50 billion of the $200 billion on rural infrastructure needs. That funding would go to states in the form of block grants, giving governors and state legislatures the authority to figure out the best way to spend that money.

And $20 billion would go to federal loan programs that are aimed at attracting private investment in infrastructure, and into private activity bonds.

Projects with an eye to the future

The White House also wants to earmark $20 billion in funding for “transformative” projects, which a White House official says “have a vision towards the future.” These would be “projects that can lift the American spirit, that are the next-century-type of infrastructure as opposed to just rebuilding what we have currently.”

The remaining $10 billion would go into a capital financing fund, which the administration says would go toward funding federal government office building infrastructure.

The $200 billion in federal funding would not be new revenue but would come from cuts “in other areas of the federal budget,” some of which will be outlined in the president’s budget plan that will also be released Monday. That includes funding cuts to existing federal transit programs, the TIGER grant program “and things where the administration thinks that infrastructure funds haven’t been spent efficaciously,” said a senior administration official.

But the White House officials say this new infrastructure plan “is a program that sits on top of existing programs. So we’re not proposing eliminating the Highway Trust Fund, or changing the state revolving funds. So to the extent that communities are eligible for federal funds already, that eligibility remains.”

Trump wants to streamline federal environmental review

The president’s plan does not address a huge yearly shortfall in the federal Highway Trust Fund, which is funded by the federal gasoline tax. That tax of 18.4 cents a gallon for unleaded, 24.4 cents a gallon for diesel, hasn’t been raised in 25 years and because of improvements in fuel efficiency and inflation, it raises less money now than it did when last raised in 1993. So Congress is already using deficit spending to pay for some transportation infrastructure needs funded by existing programs.

In addition to the financing component of the plan, Trump wants to significantly streamline the federal environmental review and permitting process for infrastructure construction projects, which they say can often involve several different federal agencies that can drag the process out. The president’s plan will call for the creation of “One Agency, One Decision” type of process that would put one lead federal agency in charge of completing an environmental review within 21 months.

President Trump will outline some of these principles in a meeting with mayors and other state and local leaders at the White House Monday. Trump will work with Congress to make changes, if needed. The infrastructure spending plan would need 60 votes to pass in the Senate so it will need democratic support, but the White House officials say this is one issue on which there should be room to compromise, because they say the president’s infrastructure plan is in line with priorities and objectives outlined by members of both parties in Congress, even if not in the way it would be funded.

“This is in no way, shape or form … a take it or leave it proposal,” said one senior administration official. “This is the start of a negotiation.”

“The president has said he is open to new sources of funding,” the White House aide said. “We want it to be bipartisan.”

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Can A Patient Gown Makeover Move Hospitals To Embrace Change?

The new hospital garment ties in the front, like a robe, allowing the patient more modesty than the standard gown.

Sophie Sahara Barkham/courtesy Care+Wear

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Sophie Sahara Barkham/courtesy Care+Wear

A medical company is trying to make hospital gowns less terrible — maybe even good. The company is called Care+Wear and it’s currently testing out the new gowns at MedStar Montgomery in Olney, Md.

You know the old gown, sometimes called a “johnny“: It’s got the flimsy ties and the exposed back.

The new gown from Care+Wear ties at the front like a robe. It’s got color coded ties and a pocket for your phone. Maybe most importantly, it covers the butt without sacrificing bedpan access for the bedridden.

A new hospital gown isn’t a completely original thought. Back in 1999, a hospital in Hackensack, N.J., asked designer Nicole Miller to make gowns, robes, and pajama bottoms. In 2010 The Cleveland Clinic recruited Diane Von Furstenberg to help design a new gown modeled after her famous wrap around dresses. In 2014, the Henry Ford Health System in Detroit teamed up with Carhartt to make a robe they dubbed the Model G. While these designs may have been successful on the small scale, none of them have usurped the johnny gown as the industry standard, say industry experts.

Why not? “Hospitals are not designed for patients,” says Dr. Bridget Duffy, the chief medical officer of Vocera, a hospital communications company. More importantly for this story, she was the chief experience officer at the Cleveland Clinic — the one with the Diane Von Furstenburg gown that they still use today — and she helped consult on the new Care+Wear gown. She says a big reason hospitals don’t move toward a more patient-friendly gown is due to your usual bureaucratic inertia, as well as a habit of focusing more on health care provider needs than patients’ needs.

“In the past we’ve never had patients in the room at the very beginning of the design process,” she says.

Instead of flimsy ties, the back of the new gown has a flap to cover the patient’s behind.

Sophie Sahara Barkham/courtesy Care+Wear

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Sophie Sahara Barkham/courtesy Care+Wear

Dr. Fredrick Finelli, surgeon and vice president at MedStar Montgomery, sums up the gown design conflict: “For me as a doctor, it would be best to have the patient naked,” he says. “Then I wouldn’t have to deal with any gowns or cloth in my way. But for the patient, they basically want the opposite. They’d like to be covered up.”

Care+Wear teamed up with a class at the Parsons School of Design to iron out the kinks of making a new robe that works for both patient and provider. Irene Lu was a student in the class who says they took each step of their design to both clinicians and patients.

“Working with these patients with different opinions on the gowns really helped inform our design,” she says. They took notes on how people felt about the neckline, the buttons, the ties, and how it fit on people of different sizes and mobility.

Jimena Ryan was a patient at MedStar Montgomery who was wearing the new gown when I spoke to her. She was into it. The gown works more or less like a robe, so it felt familiar to her.

“I have many dresses for work that come together the same way, so it’s intuitive to put it together,” she says. “And the fact that it’s not open in the back is a big relief, especially when you’re up and around,” she adds.

Part of Ryan’s recovery was walking around the halls of the hospital. With the old gown, “you’re always wondering what is open and what is flapping, what view am I giving,” she says.

Professor Traci Lamar is less optimistic about any robe overtaking the johnny gown. She teaches at North Carolina State University in the college of textiles, and had a hand in a hospital gown re-design herself back in 2009.

“There are number of pressures in the hospital environment that influence what they purchase and when they purchase. Cost management, inventory management, storage space, all of those kinds of things come into play as factors when they start looking at changing a garment that’s widely used,” she says.

To her, the cost-benefit analysis isn’t going to tip in favor of more hospitals changing gowns until the gowns have something more to offer than coverage.

“There’s more value coming with the apparel item if it also becomes something that replaces or enhances other equipment that’s used in the hospital environment,” she says. Like a gown that can also keep an eye on your blood pressure, or measure your heart rate.

Who knows when textiles can be smart enough to pull that off, so we might be stuck with the old johnny gown for a while.

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Amid Olympic Détente, Pence Snubs North Koreans In Visit To Pyeongchang

Kim Yong Nam, top left, president of the Presidium of North Korean Parliament, and Kim Yo Jong, sister of North Korean leader Kim Jong Un, top right, sit behind U.S. Vice President Mike Pence, bottom left, and Japanese Prime Minister Shinzo Abe, bottom right, as they watch the opening ceremony of the 2018 Winter Olympics in Pyeongchang, South Korea.

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Patrick Semansky/AP

Vice President Mike Pence is facing backlash for his staunch efforts to ignore North Korean officials at the Winter Olympic Games, even as the two Koreas continued their temporary truce, marching and competing as one team.

Pence’s cold demeanor toward the North Koreans at the Pyeongchang games was overshadowed by friendly cooperation between the North and South. The vice president also drew criticism from some openly gay members of Team USA, who questioned his role at the Olympics due to his anti-LGBT views.

Pence continued his tough rhetoric even after South Korean officials announced North Korean leader Kim Jong Un had invited President Moon Jae-in to Pyongyang for talks. He insisted on Saturday that the U.S., South Korea and Japan were united in their goal of isolating North Korea over the country’s nuclear weapons program.

“There is no daylight between the United States, the Republic of Korea and Japan on the need to continue to isolate North Korea economically and diplomatically until they abandon their nuclear and ballistic missile program,” Pence told reporters aboard a flight back to the U.S.

In the days leading up to the Olympics, Pence warned that the North was trying to “hijack the message and imagery” of the event with a propaganda campaign, according to Reuters.

Prior to the opening ceremony on Friday night, Pence arrived late to a dinner reception between the two Koreas and greeted everyone at a main table except for Kim Yong Nam, North Korea’s nominal head of state, Reuters reports. He left the reception five minutes later.

“South Korea has some difficult homework to solve regarding some countries,” President Moon said in a speech before Pence arrived. “There are some who would not want to be in the same room together if it wasn’t for the Pyeongchang Winter Olympics. But what is more important than anything is that we are together.”

In a rare public moment, President Moon shook hands with Kim Yo Jong, the younger sister of Kim Jong Un, at start of the opening ceremony. Pence, who was seated just a few feet away from Kim, did not appear acknowledge her. Then when the Korean team entered the stadium under a unified flag, Pence sat stone-faced while Moon and North Korean officials stood together in applause.

A senior White House official said Pence was not trying to avoid the delegation from North Korea but rather ignore them, according to the AP. Asia experts said Pence’s sour conduct toward the North Koreans could be seen as disrespectful to the South Korean hosts, who were demonstrating a moment of harmony with the North.

“The grievances that the world has about North Korea are very legitimate,” Frank Jannuzi, an expert on East Asia at the Mansfield Foundation told the AP. “But the Olympic moment that President Moon is trying to generate here is not a time to nurse those grievances. It’s a time to focus on messages of reconciliation and peace.”

The vice president’s visit was also marked by bad blood between Pence and some U.S. athletes. Openly gay American freestyle skier Gus Kenworthy took a swipe at Pence in an Instagram post, posing with fellow openly gay figure skater Adam Rippon.

“I feel incredibly honored to be here in Korea competing for the US and I’m so proud to be representing the LGBTQ community alongside this amazing guy! Eat your heart out, Pence,” Kenworthy wrote.

In January, Rippon criticized Pence’s role in the Olympics, citing the widespread belief that the vice president supports gay conversation therapy. In an appearance on Ellen earlier this month, Kenworthy called out Pence, saying he has “directly attacked the LGBT community.”

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What The Budget Deal Means For Medicare Drug Prices

The new budget will likely lower the cost of expensive prescription drugs for Medicare patients. Elisabeth Rosenthal of Kaiser Health News talks with NPR’s Scott Simon.

SCOTT SIMON, HOST:

The new budget passed late this week includes changes for Medicare patients. It will require drug companies to give deeper discounts to Medicare on expensive prescriptions. That should reduce the cost of drugs for patients. The skyrocketing cost of prescription drugs is something followed closely by Elisabeth Rosenthal, a veteran healthcare reporter and editor-in-chief of Kaiser Health News, who joins us from her offices. Thanks so much for being with us.

ELISABETH ROSENTHAL: Thanks for having me.

SIMON: Will this and other features you see in the budget help reduce the cost of prescription drugs?

ROSENTHAL: Well, to a small number of people, it will. I mean, this really targets the Medicare-age population and Medicare plans. And for people who have very high drug costs within Medicare, it will definitely help them. But it, of course, doesn’t solve the much larger problem of the very high prescription drug prices that everyone pays in this country. And P.S., what we’re talking about for Medicare patients, even, are discounts on these very high initial prices. So, you know, a discount of a really high price still isn’t a very good deal.

SIMON: Why do we have a problem with this in the United States?

ROSENTHAL: Well, we’re the only country that doesn’t in some way directly negotiate prescription drug prices with manufacturers – the only developed country, that is. I mean, most other countries in some form either evaluate the cost-benefit ratio of a new drug and decide what they’re willing to pay or, you know, very aggressively negotiate with drug manufacturers, particularly for older drugs, as they age.

SIMON: Insulin in one form or another has been saving lives for – what? – 80 years.

ROSENTHAL: Yeah.

SIMON: Why has the price gone up in recent years?

ROSENTHAL: Prices will rise to whatever the market will bear, right? We see that uniquely in the U.S. One vial of insulin in the U.S. costs seven times what it does in Germany. So there’s a huge disparity there. Some of the reasons have to do with reformulations of insulin that are, in fact, better than some of the older ones. Although, when I’m talking about that 1 in 7 price comparison, that’s the same exact insulin.

In the U.S., what’s happened – and this is something that I know the Trump administration is looking at and many experts in the field have decried – the slow arrival of biosimilars or generic insulins onto the market, which are on the market in other countries. The problem in this country is the lowering of prices of insulin. And insulin patents have been held up in the courts for years now in suits and countersuits between the three big insulin drug makers, including by Eli Lilly, which is the former employer of our new HHS Secretary.

SIMON: That’s Alex Azar – has been appointed Secretary of Health and Human Services.

ROSENTHAL: Yes.

SIMON: Is he the kind of choice that gives you optimism that prescription drug prices will come down?

ROSENTHAL: Well, there’s a certain argument to be made that Alex Azar of all people on Earth understands how the games are played and how these suits and countersuits about making generics or making biosimilars have held up the arrival on the U.S. market and have raised prices for everyone. On the other hand, there’s ongoing concern about the revolving door between government and pharmaceutical companies such that you wonder, is their loyalty to the American people, or is their loyalty to the pharmaceutical world from which they came?

SIMON: I don’t think I can think of any politician who says, and if you elect me, I promise prescription drugs will cost more.

ROSENTHAL: (Laughter).

SIMON: I mean, on the contrary, every politician says, elect me, and I’ll do something to bring down the cost of prescription drugs. Why doesn’t that get done?

ROSENTHAL: Yeah. Everyone agrees that our prescription drug costs are too high – both right and left – you know, Democrat, Republican. It’s one of the few points of information, points of fact that everyone agrees on. The problem is everyone disagrees on how best to tackle that. And there are a lot of forces that are resisting any change at all.

The bipartisan solution which Senator Klobuchar and Senator John McCain have proposed is allowing prescription drug imports from other countries, so we allow for a global competition in the sense of, you know, if everyone else is getting a better deal than us, why can’t we buy our prescription drugs from there the same way we buy our, you know, refrigerators and cars?

SIMON: Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and author of “An American Sickness: How Health Care Became Big Business And How You Can Take It Back.” Thanks so much for being with us.

ROSENTHAL: Thanks for having me.

(SOUNDBITE OF THE JAZZ MANDOLIN PROJECT’S “SPIDERS”)

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Canadian Ice Dancers Step Down The Heat To Step Up At The Podium

Two Canadian retirees have taken time out of their schedule to make it to the Olympics. They’re celebrating 20 years together and are eager for their favorite event: Ice dancing free dance (a part of the figure skating category). At 28 and 30 years old, athletes Tessa Virtue and Scott Moir came out of retirement for one last skate on the Olympic stage. After the disappointment of a silver medal in Sochi, they’ll leave it all on the ice. Within good taste, that is.

Canadians Tessa Virtue and Scott Moir perform their Moulin Rouge program at the ISU Grand Prix of Figure Skating Final in Japan in December.

Koji Sasahara/AP

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Koji Sasahara/AP

The pair has honed a free program to a medley from the 2001 movie Moulin Rouge!, starring Nicole Kidman and Ewan McGregor. It’s the love story of a poor writer and a beautiful courtesan in Belle Epoque Paris. There’s intrigue, jealousy, deception — and lots of raw passion. And the athletes originally included a lift that really leaned in to that passion.

Virtue and Moir performed the routine at last month’s Canadian championships. The national news agency The Canadian Press found it risqué enough to hesitate before circulating images, according to The Toronto Star. (NPR could not find such photos from the outlet.)

The lift begins when Virtue dips her leg underneath her upright body, then extends it at full speed to launch herself, twisting and flipping up Moir’s torso. She lands with her legs on Moir’s shoulders, one leg on each side. They spin as she straddles his head for a moment before she gracefully floats back down, touching her skates to the ice.

It takes just a few seconds, but it was too long for comfort for some (despite much of the crowd erupting in standing applause).

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Moir and Virtue perform at the Canadian skating national competition with a routine that includes the original lift.

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(Caution: 2001 movie spoiler ahead.)

“I think edgy would probably summarize most of the program quite well and that’s what we were going for,” Virtue told The Toronto Star. “We knew that taking the ice at an Olympic Games again meant that we needed to have a different style. We wanted to make a bit of a different statement. If that was bringing an edge or sexuality or darkness, or a contemporary feel to it, then mission accomplished I guess.”

Though they won first place in the championships, Moir and Virtue chose to make a change for the decidedly more conservative international Olympic crowds. Not only have they toned down the lift, The Toronto Star reports, but they’ve also tweaked the ending to make it even more dramatic.

The pair skate their free dance to win the gold at the world figure skating championships in Helsinki, Finland in April 2017.

Ivan Sekretarev/AP

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Ivan Sekretarev/AP

“Of course, my character dies and that was the original ending we’d gone with, sort of faltering to this dramatic death,” Virtue told the outlet. “This is a little bit, perhaps, more triumphant in a way … because our love story gets to linger a little bit longer, with more depth to it. But there’s still some sort of heartbreak in the end and there’s still some desperation. We’re clinging on to something.”

The pair is coming back from what many perceived to be a heartbreaking loss to Americans Meryl Davis and Charlie White in Sochi 2014. When asked about it in an interview with Canadian magazine Maclean’s, they said they were proud of their performance, but decided it was time to leave the field. The two stoke a comfortable and extremely close vibe. They even wrote a book together about their long working relationship.

Virtue and Moir were the designated flag bearers for the 225 athletes competing as part of Team Canada. The ice dancing free dance medal competition is scheduled for 12:20 p.m. Monday in South Korea — which is 10:20 p.m. Sunday on the East Coast.

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The Week in Movie News: New 'Star Wars' Movies and TV Shows Announced, First 'Solo' Trailer and More

Need a quick recap on the past week in movie news? Here are the highlights:

BIG NEWS

Netflix dropped The Cloverfield Paradox out of the blue: Movie fans got a surprise treat on Super Bowl Sunday as Netflix debuted its first trailer for the new Cloverfield movie, The Cloverfield Paradox, and revealed that it would start streaming immediately after the game. Check out the trailer here, how it ties to the other movies here and what’s next for the franchise here.

GREAT NEWS

More Star Wars movies and TV series in the works: In addition to debuting the first Solo: A Star Wars Story trailer (see below), Disney and Lucasfilm made two big announcements this week, one being that Game of Thrones creators David Benioff and D.B. Weiss are writing and producing a series of Star Wars movies and the other being that multiple TV series are in development for Disney’s new streaming servivce. Read more here and here.

SURPRISING NEWS

Joaquin Phoenix is the next Joker: Oscar-nominated actor Joaquin Phoenix has agreed to play The Joker in the standalone origin story movie about the DC Comics villain that’s being produced by Martin Scorsese and directed by Todd Phillips. Read more here.

EXCLUSIVE BUZZ

Annihilation director Alex Garland talks new TV series: We talked to Alex Garland about his new movie, Annihilation, and his planned sci-fi TV series that he says will be more like Ex Machina. Check out our interview here.

COOL CULTURE

The Marvel Cinematic Universe turns 10: Marvel managed to get 79 actors and filmmakers from the first 10 years of the MCU together for a “class photo” shoot. Watch a video of the gathering below.

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MUST-WATCH TRAILERS

Solo: A Star Wars Story takes us back: The first trailer for the standalone prequel Solo: A Star Wars Story arrived with exciting peeks at young Han Solo and Lando Calrissian. Watch it below and find answers to all your questions here.

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Mission: Impossible – Fallout teases some wildy entertaining stunts: The first trailer for the sixth Mission: Impossible movie arrived during the Super Bowl with promise of some stunning set pieces. Watch it below, check out a behind the scenes look at one of the big stunts, and see more Super Bowl trailers here.

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Deadpool 2 humorously introduces Cable: The new trailer for Deadpool 2 showcases the debut of Cable and his team-up with the titular goofball mercenary. Check it out here:

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Venom showcases a supervillain without his superhero: The first teaser for Sony’s Venom, about the iconic Spider-Man villain, arrived with barely a glimpse of the monstrous antihero that star Tom Hardy will become. Watch it here:

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