Science & Health

Maxwell Kruzic said he was in such “crippling” stomach pain on Oct. 5, 2023, that he had to pull off the road twice as he drove himself to the emergency room at Mercy Regional Medical Center in Durango, Colorado. “It was the worst pain of my life,” he said.

Kruzic was seen immediately because hospital staff members were pretty sure he had appendicitis. They inserted an IV, called a surgeon, and sent him off for a scan to confirm the diagnosis.

But the scan showed a perfectly normal appendix and no problems in his abdomen. Doctors racked their brains for other possible diagnoses. Could it be a kidney stone? Gallstones? Here was a 37-year-old man in agony, but nothing really fit.

Then, someone asked what Kruzic had eaten the night before. He said he’d consumed tacos with some hot sauce that he’d made from a kind of scorpion pepper, grown from seeds he ordered from a chile pepper research institute.

The peppers measure over 2 million Scoville heat units on the spiciness scale, he noted, compared with a jalapeño at up to 8,000 or a habanero at 100,000 to 350,000.

The peppers are among “the world’s hottest, incredibly hot,” Kruzic said. “Delicious.” He loves spicy food and had never had a problem with it, but apparently this was just too much burn for his digestive system.

Kruzic spent much of the night on a gurney in the ER. After about four hours, the pain decreased, and he was sent home with medicine to treat nausea and vomiting.

Then the bill came — about two years later.

The Medical Procedure

Kruzic underwent blood work and a CT scan of his abdomen during his ER visit for acute abdominal pain.

Consuming very spicy foods can cause painful inflammation and irritation of the digestive system. The discomfort typically resolves on its own.

The Final Bill

$8,127.41, including $5,820 for the CT scan. Kruzic paid $97.02 during his visit to the hospital, which was in-network under his insurance. After insurance payments and discounts, he owed $2,460.46 — the remainder of the $1,585.26 he owed toward his plan’s deductible and $972.22 he owed in coinsurance.

The Problem: Ghost Bills From Visits Past

This September, Kruzic received a bill for his pepper-induced ER visit in 2023.

Unfortunately for patients, there are no uniform rules for timely billing.

Anticipating a bill, Kruzic repeatedly checked the hospital’s online portal, as well as that of his insurer, UnitedHealthcare. He noted that the insurer said the claim had been processed shortly after his treatment. For about eight months, he kept checking the hospital portal’s billing section, which indicated he owed “$0.” He called UnitedHealthcare, and Kruzic said a representative assured him that if the hospital said he owed nothing, that was the case.

It is unclear what caused the nearly two-year delay. At least part of the problem seems to have involved protracted disagreements between the insurer and the hospital over how much his visit should have cost.

Lindsay Radford Foster, a spokesperson for CommonSpirit Health, the hospital system, said in a statement to KFF Health News: “United Healthcare, the insurer responsible for the medical claim, underpaid the account based on the care provided. As a result, CommonSpirit contacted UnitedHealthcare’s Payer Relations Department to rectify the underpayments.”

Asked why it had taken two years, she cited a reorganization at UnitedHealthcare and a change in the insurer’s representative assigned to the case.

But UnitedHealthcare contested that view. “This was paid accurately,” said Caroline Landree, a spokesperson for the insurer.

But those explanations don’t satisfy Kruzic, a geological consultant: “Receiving a bill two years after the service wouldn’t fly in any other industry. We could never contact a client two years after we completed a project and say, ‘By the way, we missed this charge.’”

“How could this be considered anything but surprise billing?” he added.

The federal No Surprises Act doesn’t protect against all types of medical bills that patients find surprising. It primarily protects patients from out-of-network charges when they visit an in-network hospital, or in an emergency.

But in medical billing, what’s legal and what’s reasonable are two very different issues.

“The bill certainly sounds outrageous,” said Maxwell Mehlmen, co-director of the Law-Medicine Center at the Case Western Reserve University School of Law. “The question is whether it’s legal.”

That, he said, “is a matter of state law and the terms of the insurance policy and the agreement between the hospital and the insurer.”

In Colorado, there are extensive regulations about how long health care providers have to file a claim and bill a patient. For instance, claims for Medicaid patients must be filed within 120 days from the date of service. For patients with private insurance, the terms may be outlined in their insurers’ contracts with individual providers.

If a hospital submitted a proper claim and the provider and insurer were working out payment in good faith, then a patient can be billed for their share of the costs years later.

The Resolution

Within hours of KFF Health News contacting the hospital’s media relations department for this article, Kruzic got a call from a hospital executive telling him his bill had been adjusted to zero.

Blaming administrative changes at the insurer, Radford Foster of CommonSpirit said that UnitedHealthcare had taken so long to properly pay the bill that the hospital couldn’t collect from the patient. She said that Kruzic’s statement balance “was to be adjusted to zero, but due to a clerical error, a statement was sent to the patient in error.”

UnitedHealthcare’s Landree said that “given the significant delay, we are addressing this issue directly with the physician’s office.”

“Mr. Kruzic will not be responsible for any additional costs related to this bill,” she said.

The Takeaway

KFF Health News’ “Bill of the Month” series receives complaints every year about ghost bills — bills that arrive long after a service is rendered.

Sometimes it’s because the insurer and hospital are haggling over payment, and the patient’s responsibility — usually a percentage of that number — can’t be calculated until the dispute is resolved. Other times, insurers audit old bills and, determining they overpaid, try to claw back the money, resulting in the patient (or even the patient’s surviving spouse) being billed for the difference.

For now, the legality of billing long after treatment depends primarily on the fine print of insurance contracts.

An insurer’s word that a claim has been “processed” doesn’t mean that the insurer has agreed to pay and that the billing is resolved. It could also mean that the insurer balked at the bill or completely denied payment.

As for Kruzic and his affinity for hot peppers? He said he still loves spicy food, but in his cooking, “I will not use scorpion peppers again.”

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Six days after a senior FDA official sent a sweeping internal email claiming that covid vaccines had caused the deaths of “at least 10 children,” 12 former FDA commissioners released an extraordinary warning in the Dec. 3 issue of the New England Journal of Medicine.

They wrote that the claims and policy changes in the memo from Vinay Prasad, the head of the FDA’s Center for Biologics Evaluation and Research, pose “a threat to evidence-based vaccine policy and public health security” and break sharply from long-standing scientific norms.

What is unfolding inside the FDA is not a narrow dispute over covid vaccines. It is an attempt, according to critics and vaccine scientists, to rewrite the rules governing the entire U.S. vaccine system — how risks are weighed, how benefits are proved, and how quickly lifesaving shots reach the public. Former agency leaders warn that if these changes take hold, the consequences could be lasting: fewer vaccines, slower updates, weakened public trust, and more preventable outbreaks.

Prasad made clear he sees the moment as corrective. “Never again will the US FDA commissioner have to himself find deaths in children for staff to identify it,” he wrote, telling employees the agency’s mission, and its “worldview,” would change.

Prasad’s email reopened old arguments about covid vaccines, using what is generally considered weak and misleading science in the peer-reviewed research community. He claimed that FDA staff had found “at least 10” deaths in children that happened “after and because of” covid vaccination, using reports from the Vaccine Adverse Event Reporting System.

The VAERS system is notoriously crowdsourced, meaning anyone can contribute, and scientists say it serves only as a clearinghouse for reports. For example, a person could file a report saying that after getting a flu shot, their hair turned purple. Though that report would remain in the database until it was reviewed, it cannot prove the cause of medical events. But Prasad argued that the true number of deaths was likely higher because many cases go unreported.

On Substack, Inside Medicine reported Dec. 11 that Prasad used incomplete information and that a Dec. 5 internal FDA memo set the pediatric death toll from covid shots somewhere between zero and seven. Department of Health and Human Services spokesperson Emily Hilliard wrote, “The FDA’s investigation into deaths caused by Covid vaccines is still ongoing and there’s no final count yet of those deaths.”

Prasad also accused the FDA and the Centers for Disease Control and Prevention of downplaying the risk of heart inflammation, called myocarditis, in young men; criticized the agency for approving shots for teenagers; and suggested that school and workplace vaccine mandates may have “harmed more children than we saved,” adding that “we do not know if we saved lives on balance.”

By comparison, more than 2,100 American children died of covid itself since the pandemic began, the CDC reported.

Based on his erroneous and misleading claims about covid vaccines, Prasad proposed a major overhaul of how vaccines are approved. He said the FDA should stop relying on immune markers to establish the efficacy of shots, such as antibody levels, and instead require large placebo-controlled randomized trials that track hospitalizations and deaths before approving most new vaccines.

Many immunologists and vaccine experts say it’s unethical to test vaccines known to be effective against disease with a control group that would receive a placebo, exposing them to infection.

“There is a rock-solid principle in bioethics that it is unethical to test any drug or vaccine against a placebo if it is known to be safe and effective. The reason is that such placebo-controlled trials would effectively deny patients access to a vaccine that could prevent a dangerous infectious disease,” said Lawrence Gostin, a professor of global health law at Georgetown University.

Prasad called the current flu vaccine system an “evidence-based catastrophe,” questioned the approval of vaccines for pregnant women based on immune response alone, and raised concerns about giving multiple vaccines at once. He told staff to rewrite FDA guidelines to match his new “worldview” and said anyone who disagreed with his “core principles” should resign.

The former FDA leaders expressed alarm in the NEJM article. They said Prasad is exploiting public frustration over the federal response to covid to spark doubt about the entire childhood vaccine system, which could undo decades of success in protecting children from deadly diseases.

“This is really different. And it’s really dangerous. And people will be hurt, particularly by the vaccine decisions,” former FDA commissioner Robert Califf said in an interview. He also warned that Prasad’s proposed policies — which he noted echo positions on vaccines held by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist — could shake the entire vaccine market.

“The goal of RFK seems to be to make it impossible for vaccines to be available in the U.S.,” he said. If the proposals advance, he added, “it won’t be a viable business.”

Hilliard pushed back sharply on those concerns, writing: “The American people deserve evidence-based science. Prasad’s email lays out a philosophical framework that points us toward that higher standard. We will soon release documents laying out that framework and data confirming how the COVID vaccine resulted in children’s deaths that previous leadership failed to properly investigate.”

For generations, the childhood vaccine program has depended on clear rules, strong safety systems, and public trust. Experts say Prasad’s ideas, based on claims they argue are not supported by real evidence, could make it much harder to test, approve, and deliver vaccines to families.

Fueling Parental Doubt

Prasad’s memo indicates he considers VAERS reports as proof that vaccines caused children’s deaths. The system, though, is designed to be only an “early warning system” for potential safety issues with vaccines that can be investigated further.

“VAERS signals should never be taken as proof of true vaccine risks without careful, confirmatory studies,” said Katherine Yih, an epidemiologist and longtime investigator with the Vaccine Safety Datalink, a CDC program.

Doing so, scientists say, directly feeds public fear at a time when many parents are already unsure whom to trust.

“Causation requires converging evidence, not just one report or coincidence,” said Robert Hopkins, medical director of the National Foundation for Infectious Diseases.

Prasad’s framework, however, treats uncertainty as a reason to halt development entirely.

Experts fear this doubt won’t stay limited to covid vaccines. Once parents start to question the FDA’s honesty, they may begin doubting long-standing vaccines for measles, polio, or whooping cough — shots that have protected children for decades.

“Science must be transparent,” Gostin said. If families believe the FDA is misusing data or silencing experts, confidence in the entire vaccine system can collapse, he said. “There’s a public narrative that people have lost trust in science, but that’s not true. The vast majority want the FDA to make decisions based on the best scientific evidence. Once they believe that the agency is marginalizing scientists and cherry-picking evidence, their trust will plummet.”

Delicate Vaccine Pipeline

Prasad’s new framework will likely make it far harder for companies to produce or update vaccines. The 12 former FDA commissioners warned that requiring clinical trials for all new or updated shots would slow vaccine improvements and leave people unprotected. His plan, they wrote, “would impede the ability to update vaccines in a timely fashion, especially for respiratory viruses.”

For fast-changing viruses like flu and covid, this could be disastrous. There’s simply not enough time to run full clinical trials every time a virus mutates.

There are also major business effects. Vaccine development is costly, and companies may decide the U.S. is no longer worth the risk. If companies slow down or leave the market, families could face shortages, fewer innovations, and fewer protections for their kids.

‘Checks and Balances’

Science depends on open and public debate. Prasad’s memo warned his employees against it. In addition to demanding that FDA staff members who disagree with him resign, he said their disputes should stay private and called leaks “unethical” and “illegal.”

Susan Ellenberg, a former director of the FDA’s Office of Biostatistics and Epidemiology, warned that Prasad risks destroying the process that makes science credible. “If disagreement is treated as disloyalty, you lose the only mechanism that keeps science honest,” she said.

Without strong internal debate, safety reviews become weaker. “You lose the checks and balances that make vaccine safety science credible,” said Kathryn Edwards, a pediatric infectious disease specialist at Vanderbilt University Medical Center who served on the Clinical Immunization Safety Assessment Network during the covid pandemic.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

As the year comes to a close, 2025 looks like a turning point in the world’s fight against climate change. Most conspicuously, it was the year the U.S. abandoned the effort. The Trump administration pulled out of the 2015 Paris Agreement, which unites virtually all the world’s countries in a voluntary commitment to halt climate change. And for the first time in the 30-year history of the U.N.’s international climate talks, the U.S. did not send a delegation to the annual conference, COP30, which took place in Belém, Brazil.

This story was originally published by Grist. Sign up for Grist's weekly newsletter here.

The Trump administration’s assault on climate action has been far from symbolic. Over the summer, the president pressed his Republican majority in Congress to gut a Biden-era law that was projected to cut U.S. emissions by roughly a third compared to their peak, putting the country within reach of its Paris Agreement commitments. In the fall, Trump officials used hardball negotiating tactics to stall, if not outright derail, a relatively uncontroversial international plan to decarbonize the heavily polluting global shipping industry. And even though no other country has played a larger role in causing climate change, the U.S. under Trump has cut the vast majority of global climate aid funding, which is intended to help countries that are in the crosshairs of climate change despite doing virtually nothing to cause it.

It may come as no surprise, then, that other world leaders took barely veiled swipes at Trump at the COP30 climate talks last month. Christiana Figueres, a key architect of the 2015 Paris Agreement and a longtime Costa Rican diplomat, summed up a common sentiment.

“Ciao, bambino! You want to leave, leave,” she said before a crowd of reporters, using an Italian phrase that translates “bye-bye, little boy.”

These stark shifts in the U.S. position on climate change, which President Donald Trump has called a “hoax” and “con job,” are only the latest and most visible signs of a deeper shift underway. Historically, the U.S. and other wealthy, high-emitting nations have been cast as the primary drivers of climate action, both because of their outsize responsibility for the crisis and because of the greater resources at their disposal. Over the past decade, however, the hopes that developed countries will prioritize financing both the global energy transition and adaptation measures to protect the world’s most vulnerable countries have been dashed — in part by rightward lurches in domestic politics, external crises like Russia’s invasion of Ukraine, and revolts by wealthy-country voters over cost-of-living concerns.

The resulting message to developing countries has been unmistakable: Help is not on the way.

In the vacuum left behind, a different engine of global climate action has emerged, one not political or diplomatic but industrial. A growing marketplace of green technologies — primarily solar, wind, and batteries — has made the adoption of renewable energy far faster and more cost-effective than almost anyone predicted. The world has dramatically exceeded expectations for solar power generation in particular, producing roughly 8 times more last year than in 2015, when the Paris Agreement was signed.

China is largely responsible for the breakneck pace of clean energy growth. It now produces about 60 percent of the world’s wind turbines and 80 percent of solar panels. In the first half of 2025, the country added more than twice as much new solar capacity as the rest of the world combined. As a result of these Chinese-led global energy market changes and other countries’ Paris Agreement pledges, the world is now on a path to see 2.3 to 2.5 degrees Celsius (4.1 to 4.5 degrees Fahrenheit) of warming by 2100, compared to preindustrial temperatures, far lower than the roughly 5 degrees C (9 degrees F) projections expected just 10 years ago.

These policies can be viewed as a symbol of global cooperation on climate change, but for Chinese leadership, the motivation is primarily economic. That, experts say, may be why they’re working. China’s policies are driving much of the rest of the world’s renewable energy growth. As the cost of solar panels and wind turbines drops year over year, it is enabling other countries, especially in the Global South, to choose cleaner sources of electricity over fossil fuels — and also to purchase some of the world’s cheapest mass-produced electric vehicles. Pakistan, Indonesia, Vietnam, Saudi Arabia, and Malaysia are all expected to see massive increases in solar deployment in the next few years, thanks to their partnerships with Chinese firms.

“China is going to, over time, create a new narrative and be a much more important driver for global climate action,” said Li Shuo, director of the China climate hub at the Asia Society Policy Institute. Shuo said that the politics-and-rhetoric-driven approach to solving climate change favored by wealthy countries has proved unreliable and largely failed. In its place, a Chinese-style approach that aligns countries’ economic agendas with decarbonization will prove to be more successful, he predicted.

Meanwhile, many countries have begun reorganizing their diplomatic and economic relationships in ways that no longer assume American leadership. That shift accelerated this year in part due to Trump’s decisions to withdraw from the Paris Agreement, to impose tariffs on U.S. allies, and more broadly, to slink away into self-imposed isolation. European countries facing punishing tariffs have looked to deepen trade relationships with China, Japan, and other Asian countries. The EU’s new carbon border tax, which applies levies to imports from outside the bloc, will take effect in January. The move was once expected to trigger conflict between the EU and U.S., but is now proceeding without outright support — or strong opposition — from the Trump administration.

African countries, too, are asserting leadership. The continent hosted its own climate summit earlier this year, pledging to raise $50 billion to promote at least 1,000 locally led solutions in energy, agriculture, water, transport, and resilience by 2030. “The continent has moved the conversation from crisis to opportunity, from aid to investment, and from external prescription to African-led,” said Mahamoud Ali Youssouf, chairperson of the African Union Commission. “We have embraced the powerful truth [that] Africa is not a passive recipient of climate solutions, but the actor and architect of these solutions.”

The U.S. void has also allowed China to throw more weight around in international climate negotiations. Although Chinese leadership remained cautious and reserved in the negotiation halls in Belém, the country pushed its agenda on one issue in particular: trade. Since China has invested heavily in renewable energy technology, tariffs on its products could hinder not only its own economic growth but also the world’s energy transition. As a result the final agreement at COP30, which like all other United Nations climate agreements is ultimately non-binding, included language stipulating that unilateral trade measures like tariffs “should not constitute a means of arbitrary or unjustifiable discrimination or a disguised restriction on international trade.”

Calling out tariffs on the first page of the final decision at COP30 would not have been possible if negotiators for the United States had been present, according to Shuo. “China was able to force this issue on the agenda,” he said.

But Shuo added that other countries are still feeling the gravitational pull of U.S. policies, even as the Trump administration sat out climate talks this year. In Belém last month, the United States’ opposition to the International Maritime Organization’s carbon framework influenced conversations about structuring rules for decarbonizing the shipping industry. And knowing that the U.S. wouldn’t contribute to aid funds shaped climate finance agreements.

In the years to come, though, those pressures may very well fade. As the world pivots in response to a U.S. absence, it may find it has more to gain than expected.

This article originally appeared in Grist at https://grist.org/international/2025-trump-climate-change-paris-agreement-china/.

Grist is a nonprofit, independent media organization dedicated to telling stories of climate solutions and a just future. Learn more at Grist.org

Sarah Monroe once had a relatively comfortable middle-class life.

She and her family lived in a neatly landscaped neighborhood near Cleveland. They had a six-figure income and health insurance. Then, four years ago, when Monroe was pregnant with twin girls, something started to feel off.

“I kept having to come into the emergency room for fainting and other symptoms,” recalled Monroe, 43, who works for an insurance company.

The babies were fine. But after months of tests and hospital trips, Monroe was diagnosed with a potentially dangerous heart condition.

It would be costly. Within a year, as she juggled a serious illness and a pair of newborns, Monroe was buried under more than $13,000 in medical debt.

Part of the reason: Like tens of millions of Americans, she had a high-deductible health plan. People with these plans typically pay thousands of dollars out of their own pockets before coverage kicks in.

The plans, which have become common over the past two decades, are getting renewed attention thanks to President Donald Trump and his GOP allies in Congress.

Many Republicans are reluctant to extend government subsidies that help cover patients’ medical bills and insurance premiums through the Affordable Care Act.

And although GOP leaders have yet to coalesce around an alternative, several leading Republican lawmakers have said Americans who don’t get insurance through an employer should get cash in a special health care account, paired with a high-deductible health plan. In such an arrangement, someone could choose a plan on an ACA marketplace that costs less per month but comes with an annual deductible that can top $7,000.

“A patient makes the decision,” Sen. Bill Cassidy (R-La.) said at a recent hearing. “It empowers the patient to lower the cost.”

In a post on Truth Social last month, Trump said, “The only healthcare I will support or approve is sending the money directly back to the people.”

Conservative economists and GOP lawmakers have been making similar arguments since high-deductible health plans started to catch on two decades ago.

Back then, a backlash against the limitations of HMOs, or health maintenance organizations, propelled many employers to move workers into these plans, which were supposed to empower patients and control costs. A change in tax law allowed patients in these plans to put away money in tax-free health savings accounts to cover medical bills.

“The notion was that if a consumer has ‘skin in the game,’ they will be more likely to seek higher-quality, lower-cost care,” said Shawn Gremminger, who leads the National Alliance of Healthcare Purchaser Coalitions, a nonprofit that works with employers that offer their workers health benefits.

“The unfortunate reality is that largely has not been the case,” Gremminger said.

Today, deductibles are almost ubiquitous, with the average for a single worker with job-based coverage approaching $1,700, up from around $300 in 2006.

But even as high deductibles became widespread, medical prices in the U.S. skyrocketed. The average price of a knee replacement, for example, increased 74% from 2003 to 2016, more than double the rate of overall inflation.

At the same time, patients have been left with thousands of dollars of medical bills they can’t pay, despite having health insurance.

About 100 million people in the U.S. have some form of health care debt, a 2022 survey showed.

Most, like Monroe, are insured.

Although Monroe had a health savings account paired with her high-deductible plan, she was never able to save more than a few thousand dollars, she said. That wasn’t nearly enough to cover the big bills when her twins were born and when she got really ill.

“It’s impossible, I will tell you, impossible to pay medical bills,” she said.

There was another problem with her high-deductible plan. Although these plans are supposed to encourage patients to shop around for medical care to find the lowest prices, Monroe found this impractical when she had a complex pregnancy and heart troubles.

Instead, Monroe chose the largest health system in her area.

“I went with that one as far as medical risk,” she said. “If anything were to happen, I could then be transferred within that system.”

Federal rules that require hospitals to post more of their prices can make comparing institutions easier than it used to be.

But unlike a car or a computer, most medical services remain difficult to shop for, in part because they stem from an emergency or are complex and can stretch over numerous years.

Researchers at the nonprofit Health Care Cost Institute, for example, estimated that just 7% of total health care spending for Americans with job-based coverage was for services that realistically could be shopped for.

Fumiko Chino, an oncologist at the MD Anderson Cancer Center in Houston, said it makes no sense to expect patients with cancer or another chronic disease to go out and compare prices for complicated medical care such as surgeries, radiation, or chemotherapy after they’ve been diagnosed with a potentially deadly illness.

“You’re not going be able to actually do that effectively,” Chino said, “and certainly not within the time frame that you would need to when facing a cancer diagnosis and the imminent need to start treatment.”

Chino said patients with high deductibles are often instead slammed with a flood of huge medical bills that lead to debt and a cascade of other problems.

She and other researchers found in a study presented last year that cancer patients who had high-deductible health insurance were more likely to die than similar patients without that kind of coverage.

For her part, Monroe and her family were forced to move out of their house and into a 1,100-square-foot apartment.

She drained her savings. Her credit score sank. And her car was repossessed.

There have been other sacrifices, too. “When families get to have nice Christmases or get to go on spring break,” Monroe said, hers often does not.

She is thankful that her children are healthy. And she continues to have a job. But Monroe said she can’t imagine why anyone would want to double down on the high-deductible model for health care.

“We owe it to ourselves to do it a different way,” she said. “We can’t treat people like this.”

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As farmers face historic headwinds and market hardships, calls to the national Farm Aid hotline and the Iowa Concern hotline — where farmers can get support in times of mental health crisis or need — are increasing.

This fall, the Iowa Concern hotline saw four to five times the number of calls it had in the same months last year, said Tammy Jacobs, the hotline’s manager.

The Farm Aid hotline is also seeing a change in the urgency of calls.

“We’re seeing more established farmers calling in — people who know how to play the game and how to access programs. They’re calling more often now, because even with all that institutional knowledge, they’re still running into issues for the first time that are more complex and difficult to solve,” said Lori Mercer, a Farm Aid hotline operator. “The system that’s in place is simply letting them down. There’s just no further safety net.”

Research shows farmers die by suicide at least twice as often as people in the general population, so there’s urgency to address the uptick in need.

“It’s a huge issue. I mean, we’ve known at least three families this year whose loved ones died by suicide,” said Emma Yerkey, who’s part of the Ag Chapter of Gray Matters, a monthly meetup for ag producers around the Quad-Cities to talk about their struggles.

Farmers experience a lot of stressors and uncertainty that they can’t control — isolation, weather changes, and financial pressures — along with low access to mental health care in rural areas and stigma that may make them keep their pain to themselves. Market conditions made worse by a trade war and inflation are adding to the stress. Mental health professionals are thinking outside the box to get producers care.

Understanding the stress

Yerkey’s family farms corn, soybeans, and hay in Geneseo, Illinois, on land they’ve owned since the Civil War. The farm is filled with memories, especially of her dad, Tim Yerkey.

She played baseball with him in their driveway, the family ate meals together in the home, and, one year, her father helped her raise a ribbon-winning calf.

“That was a really good memory that I have with him,” Yerkey said.

But the farm could be stressful, too. Tim Yerkey worked the land with his family, but at times had to take outside jobs to make ends meet. In 2011, he’d been struggling for about a year when spring floods left fields underwater. He’d reached out to friends and visited the emergency room seeking help, only to be told there were no beds, Yerkey said. He died by suicide in June 2011.

“I miss my dad, and I don’t want anybody else — or any other family — to go through that,” Yerkey said.

But many farming families experience similar pain. Between 2003 and 2017, more than 1600 farmers died by suicide, the majority older white men.

Experts say factors that contribute to stress and higher suicide rates among farmers include isolation, easy access to guns, a cultural expectation of toughness, stigma around seeking mental health care, worries about who will take over the farm, and a lack of recognition for their hard work.

Financial losses and stress are also significant risks for depressive symptoms. And right now, times are tough for farmers.

Producers have endured high inflation and growing input costs on farms since at least 2020. The spread of COVID and, more recently, policy decisions like President Donald Trump’s tariffs and increases in immigration enforcement have all increased operating costs. At the same time, prices for major commodities are low — lower than the cost to grow them. Corn prices are about $0.85 below the break even point and soybeans are about $2 below.

This year, many states are expecting a record corn crop, but farmers aren’t celebrating.

“It’s very discouraging for farmers to think that they’ve done all the things right in their fields and have put innovations in place and made good decisions, but yet, even with strong yields, they’re gonna be facing a loss on what they’re producing,” said Aaron Lehman, president of the Iowa Farmers Union.

In 2024, the U.S. exported about 42% of its soybeans, most of it to China. With China not buying in the midst of the trade war, some farmers who usually send their crop abroad have struggled to find new markets. The U.S. in November struck a new deal with China, potentially extending a lifeline to producers still scrambling to move their harvest, but it remains to be seen what China will actually buy.

Some programs that helped connect farmers to domestic markets, like the Local Food Purchase Assistance initiative, have also been cut by the USDA.

“Since the beginning of the year, the farmers have just been thrown into a different level of uncertainty with policy things like losing access to some markets through tariffs, losing access to staff and programming with the government shutdown, and the funding freezes. A big one we’re hearing about is losing access to labor with the ICE raids, etcetera,” said Mercer, with Farm Aid. “I was just speaking to a farmer the other day who was basically watching his crops rot on the vines because his usual labor support was just too afraid to show up this year.”

In addition to all of the financial stress, farmers say they feel the work can be thankless.

“This work is incredibly hard, and nobody understands where their food comes from. Nobody knows that [farmers] work 20 hours a day so that they can have a strawberry,” said Anna Scheyett, a retired professor of social work who studied farmer stress and suicide at the University of Georgia.

Meeting farmers where they are

Despite the many struggles, some families are finding hope and community in turbulent times. To honor her dad, Yerkey joined the new Ag Chapter of Gray Matters, a Quad-Cities nonprofit that provides mental health resources, education, and safe spaces.

Gray Matters hosts monthly Barn Talks, where participants can share what’s weighing on them, whether it’s stress, depression, anxiety, or other struggles, and receive support from others. The organizers hope to build a sense of community and normalize talking about mental health.

“Feeling comfortable and safe to say that — ‘Hey, I am stressed out, or I am really hurting right now. Maybe I am depressed, maybe I have some anxiety,’ — whatever it might be,” said Heather Gritton, one of the group leaders.

Offering spaces where farmers can meet and take some of that load off their shoulders can help break down the stigma around getting help, said Sara Kohlbeck, assistant professor of psychiatry and behavioral medicine at the Medical College of Wisconsin.

It’s key for those spaces to be easily accessible to farmers.

“Bringing that support to the farmers — or to the rural communities — rather than expecting those folks to come and get those resources for themselves is really important,” Kohlbeck said. “Otherwise, you know, we’ve got folks that are kind of suffering in silence because they just don’t have the time. Sometimes there’s stigma, and there’s kind of that pride issue.”

There are also practical barriers. Telehealth isn’t a viable option for many farmers, as cell and internet reception in rural areas are limited. Driving long distances to see a counselor can also be impractical, especially during the busy harvest season.

Another approach to reaching farmers has been to train people who farmers trust and regularly interact with — such as suppliers, lenders, large animal veterinarians, and spouses — to recognize when someone may be dealing with mental health challenges and teach them how to support them and direct them to resources.

For example, Scheyett has trained agricultural lenders to recognize warning signs of suicide ideation and taught them how to respond. She’s also trained extension agents to take a few minutes at the beginning of agricultural production meetings to talk about stress and offer resources, something she says can make a real difference for farmers.

In one study, Scheyett and her co-authors found that farmers who were present at meetings where about 10 minutes were dedicated to talking about stress management walked away with new ideas for managing stress and a higher level of commitment to doing it.

Sometimes, offering practical and logistical solutions to big problems can be a part of mental health services, too.

“If a farmer has not really looked and done a deep dive into their farm financial system, we have a program that’s called farm financial associates, and they’ll come out to the farm, do a big evaluation over the farming operation to see where the hard points are and is there a way to switch things around, diversify, in order to help offset some of the farming losses and costs,” Jacobs, with the Iowa Concern hotline, said.

For farmers facing grain storage challenges, Jacobs suggested partnering with other farmers as an alternative to traditional co-op arrangements.

Scheyett suggests everybody can help by thanking farmers the same way we do with the military.

“Every time I see a farmer, I say thank you — thank you for your service, because what you do keeps us healthy, fed, and clothed,” Scheyett said.

It’s all in the hopes of providing care and saving lives.

“Even if you can save one life, I mean, that’s so worth it,” Yerkey said. “I feel very passionate about it.”

This story is a product of the Mississippi River Basin Ag & Water Desk, an independent reporting network based at the University of Missouri in partnership with Report for America, with major funding from the Walton Family Foundation.

A report published Wednesday by Greenpeace exposes the plastics industry as “merchants of myth” still peddling the false promise of recycling as a solution to the global pollution crisis, even as the vast bulk of commonly produced plastics remain unrecyclable.

“After decades of meager investments accompanied by misleading claims and a very well-funded industry public relations campaign aimed at persuading people that recycling can make plastic use sustainable, plastic recycling remains a failed enterprise that is economically and technically unviable and environmentally unjustifiable,” the report begins.

“The latest US government data indicates that just 5% of US plastic waste is recycled annually, down from a high of 9.5% in 2014,” the publication continues. “Meanwhile, the amount of single-use plastics produced every year continues to grow, driving the generation of ever greater amounts of plastic waste and pollution.”

Among the report’s findings:

• Only a fifth of the 8.8 million tons of the most commonly produced types of plastics—found in items like bottles, jugs, food containers, and caps—are actually recyclable;
• Major brands like Coca-Cola, Unilever, and Nestlé have been quietly retracting sustainability commitments while continuing to rely on single-use plastic packaging; and
• The US plastic industry is undermining meaningful plastic regulation by making false claims about the recyclability of their products to avoid bans and reduce public backlash.

“Recycling is a toxic lie pushed by the plastics industry that is now being propped up by a pro-plastic narrative emanating from the White House,” Greenpeace USA oceans campaign director John Hocevar said in a statement. “These corporations and their partners continue to sell the public a comforting lie to hide the hard truth: that we simply have to stop producing so much plastic.”

“Instead of investing in real solutions, they’ve poured billions into public relations campaigns that keep us hooked on single-use plastic while our communities, oceans, and bodies pay the price,” he added.

Greenpeace is among the many climate and environmental groups supporting a global plastics treaty, an accord that remains elusive after six rounds of talks due to opposition from the United States, Saudi Arabia, and other nations that produce the petroleum products from which almost all plastics are made.

Honed from decades of funding and promoting dubious research aimed at casting doubts about the climate crisis caused by its products, the petrochemical industry has sent a small army of lobbyists to influence global treaty negotiations.

In addition to environmental and climate harms, plastics—whose chemicals often leach into the food and water people eat and drink—are linked to a wide range of health risks, including infertility, developmental issues, metabolic disorders, and certain cancers.

Plastics also break down into tiny particles found almost everywhere on Earth—including in human bodies—called microplastics, which cause ailments such as inflammation, immune dysfunction, and possibly cardiovascular disease and gut biome imbalance.

A study published earlier this year in the British medical journal The Lancet estimated that plastics are responsible for more than $1.5 trillion in health-related economic losses worldwide annually—impacts that disproportionately affect low-income and at-risk populations.

As Jo Banner, executive director of the Descendants Project—a Louisiana advocacy group dedicated to fighting environmental racism in frontline communities—said in response to the new Greenpeace report, “It’s the same story everywhere: poor, Black, Brown, and Indigenous communities turned into sacrifice zones so oil companies and big brands can keep making money.”

“They call it development—but it’s exploitation, plain and simple,” Banner added. “There’s nothing acceptable about poisoning our air, water, and food to sell more throwaway plastic. Our communities are not sacrifice zones, and we are not disposable people.”

Writing for Time this week, Judith Enck, a former regional administrator at the US Environmental Protection Agency and current president of the environmental justice group Beyond Plastics, said that “throwing your plastic bottles in the recycling bin may make you feel good about yourself, or ease your guilt about your climate impact. But recycling plastic will not address the plastic pollution crisis—and it is time we stop pretending as such.”

“So what can we do?” Enck continued. “First, companies need to stop producing so much plastic and shift to reusable and refillable systems. If reducing packaging or using reusable packaging is not possible, companies should at least shift to paper, cardboard, glass, or metal.”

“Companies are not going to do this on their own, which is why policymakers—the officials we elected to protect us—need to require them to do so,” she added.

Although lawmakers in the 119th US Congress have introduced a handful of bills aimed at tackling plastic pollution, such proposals are all but sure to fail given Republican control of both the House of Representatives and Senate and the Trump administration’s pro-petroleum policies.

It’s often said that Donald Trump’s power base in the MAGA movement has contributed to the radicalization of the Republican party. Political scientists worry about the implications of this for the future of American democracy itself.

US Sen. Rick Scott, former CEO of the company that was at the center of the biggest Medicare fraud scheme in American history, has emerged as the most vocal Republican proponent of healthcare reform, warning his fellow GOP lawmakers that continued refusal to engage with the issue risks a “slow creep” toward single-payer healthcare.

On Thursday, according to Axios, Scott (R-Fla.) is “convening a group of House and Senate conservatives on Capitol Hill to pore over fresh polling to develop GOP alternatives to the Affordable Care Act.”

Late last month, Scott unveiled his own proposal titled the More Affordable Care Act, which would keep ACA exchanges intact while creating “Trump Health Freedom Accounts” that enrollees could use to pay for out-of-pocket costs. Scott’s plan, as the health policy group KFF explained, would allow enhanced ACA tax credits to expire and let states replace subsidies in the original ACA with contributions to the newly created health savings accounts.

“Unlike ACA premium tax credits, which can only be used for ACA Marketplace plans, the accounts in the Scott proposal could be used for any type of health insurance plan, including short-term plans that can exclude people based on preexisting conditions,” KFF noted. “States could also waive certain provisions of the ACA, including the requirement to cover certain benefits.”

“While ACA plans would still be required to cover people with preexisting conditions under the Scott proposal,” the group added, “it is likely that the ACA marketplace would collapse in states that seek a waiver under his approach.”

Last month, amid the longest government shutdown in US history, Scott leapt at the opportunity to champion possible Republican alternatives to the healthcare status quo, despite his ignominious record.

In 2003, the US Justice Department announced that the hospital chain HCA Inc.—formerly known as Columbia/HCA—had agreed to pay hundreds of millions of dollars in penalties and damages to settle what the DOJ characterized as the “largest healthcare fraud case in US history.”

Scott resigned as CEO of Columbia/HCA in 1997, days after federal agents raided company facilities as part of the sweeping fraud probe. The federal government and company whistleblowers said the hospital giant “systematically defrauded” Medicare, Medicaid, and other healthcare programs through unlawful billing and other ploys.

“In 2000, Scott invoked the Fifth Amendment 75 times in a deposition as part of a civil case involving his time leading the company,” Florida Phoenix reported last year. A former HCA accountant accused Scott, who was never directly charged in the case, of leading “a criminal enterprise.”

Scott later served two terms as governor of Florida and is now one of the wealthiest members of Congress, and he maintains he was the victim of a politically motivated DOJ investigation.

“The Clinton Justice Department went after me,” Scott complained during his 2024 Senate reelection campaign.

It’s unclear whether Scott’s healthcare ideas will gain sufficient traction with President Donald Trump and Republican lawmakers, who have seemed content to bash the existing system without proposing anything concrete or viable to replace it. Trump was supposed to unveil his own healthcare proposal last month, but the White House pulled the plug amid GOP pushback.

Some members of the Democratic caucus, meanwhile, are making the case for the very system Scott is warning his colleagues about.

“Let’s finally create a system that puts your health over corporate profits,” Sen. Chris Van Hollen (D-Md.) said earlier this week. “We need Medicare for All.”

Maddy Olcott plans to start a career once she graduates from college. But the junior at the State University of New York-Purchase College is so far not planning to start a family — even with the Trump administration dangling inducements like thousand-dollar “baby bonuses” or cheaper infertility drugs.

“Our country wants us to be birthing machines, but they’re cutting what resources there already are,” said Olcott, 20. “And a $1,000 baby bonus? It’s low-key like, what, bro? That wouldn’t even cover my month’s rent.”

The Trump administration wants Americans to have more babies, and the federal government is debuting policy initiatives to reverse the falling U.S. fertility rate. In mid-October, the White House unveiled a plan to increase access to in vitro fertilization treatment. President Donald Trump has heralded such initiatives, calling himself “the fertilization president.”

But reproductive rights groups and other advocacy organizations say these efforts to buttress the birth rate don’t make up for broader administration priorities aimed at cutting federal programs such as Medicaid, its related Children’s Health Insurance Program, and other initiatives that support women and children. The pro-family focus, they say, isn’t just about boosting procreation. Instead, they say, it’s being weaponized to push a conservative agenda that threatens women’s health, reproductive rights, and labor force participation.

Some predict these efforts could deter parenthood and lead to increases in maternal mortality.

“The religious right wants more white Christian babies and is trying to curtail women’s reproductive freedom in order to achieve that aim,” said Marian Starkey, a spokesperson for Population Connection, a nonprofit that promotes population stabilization through increased access to birth control and abortion. “The real danger is the constant whittling down of reproductive rights.”

The White House did not respond to repeated interview requests.

A slate of federal programs that have long helped women and children are also being targeted by Trump and Cabinet members who say they champion pronatalist policies.

Medicaid work requirements, for instance, put in place by the Republicans’ One Big Beautiful Bill Act, a budget law enacted in July, will lead to extra paperwork and other requirements that, according to the Congressional Budget Office, will cause millions of eligible enrollees to lose coverage. Medicaid covers more than 4 in 10 births in the U.S.

The measure also cuts federal funding for a national program that provides monthly food benefits. Almost 40% of recipients in fiscal 2023 were children.

GOP spending cuts and staffing freezes have hampered Head Start, a federal education program that provides day care and preschool for young, low-income children, even as U.S. adults implore the government to curtail ballooning child care costs.

And the GOP halted Medicaid funding to Planned Parenthood of America for one year because it provides abortion services, forcing roughly 50 clinics around the country to close since the beginning of 2025. Planned Parenthood provides a wide range of women’s health services, from wellness exams to breast cancer screenings and initial prenatal care.

Groups that advocate for women’s health and reproductive rights say the actions by the administration and congressional Republicans to attack these programs are making it harder for families to get the support and medical care they need.

“There is a lot of rhetoric about who is worthy of public assistance, and to many policymakers, it’s not the single mother,” said Allyson Crays, a public health law and policy analyst at the Milken Institute School of Public Health at George Washington University.

The pronatalist perspective generally supports government intervention to encourage procreation and is rooted in a belief that modern culture has failed to celebrate the nuclear family. The movement’s supporters also say policies to encourage childbearing are an economic necessity.

A Declining Birth Rate

The national birth rate has largely been on a downward trajectory since 2007, with the number of births declining by an average 2% per year from 2015 through 2020, according to the Centers for Disease Control and Prevention, although the rate has fluctuated since.

The concepts that shape the movement can be found in Project 2025, a political initiative led by the conservative Heritage Foundation that has seen many of its proposals adopted by Trump. The document asserts that children fare best in a “heterosexual, intact marriage.”

“Married men and women are the ideal, natural family structure because all children have a right to be raised by the men and women who conceived them,” it says.

Project 2025 also includes many proposals that critics say aren’t friendly toward women’s health. For instance, it calls for eliminating access to mifepristone, a drug commonly used in abortions as well as in the management of miscarriages, and encourages states to block Planned Parenthood facilities from receiving Medicaid funding.

The “more babies” mantra is being embraced at the highest levels of the federal government.

“I can’t remember any other administration being so tied to the pronatalist movement,” said Brian Dixon, Population Connection’s senior vice president for government and political affairs.

Just days after he was sworn in, Vice President JD Vance declared, “I want more babies in the United States of America.” He has also criticized the decision-making of women and men who opt not to start families.

The White House in October did announce a discount on certain drugs used in IVF treatments through TrumpRx, a yet-to-debut government website that aims to connect consumers with lower-priced drugs. Mehmet Oz, who heads Medicare and Medicaid, heralded a possible future of “Trump babies,” resulting from the lower-priced infertility drugs.

The administration also announced it would encourage employers to move to a new model for offering fertility benefits as a stand-alone option in which employees can enroll. But that is far from Trump’s earlier pledge to make infertility treatments free and may not be enough to overcome other long-term financial worries that often guide decisions about whether to have children.

Angel Albring, a mother of six, says her dream of having a big family always hinged on her ability to work and avoid child care costs. Her career as a freelance writer enabled her to do so while still contributing to the family’s income, working during nap times and at night, while the rest of her household slept.

“The whole thing of ‘sleep when the baby sleeps’ never applied to me,” Albring said.

Some of her friends, though, aren’t so fortunate. They fear they cannot afford children because of climbing costs for day care, groceries, and housing, she said.

Delivering on ‘Baby Bonuses’?

The Trump administration, meanwhile, has advanced another policy aimed at giving children a future financial boost.

The One Big Beautiful Bill Act establishes a tax-advantaged “Trump account” seeded with $1,000 in federal funds — often called a “baby bonus” — on behalf of every eligible American child. The initial deposits are scheduled to start in 2026 with the federal government automatically opening an account for children born after Dec. 31, 2024, and before Jan. 1, 2029.

Parents could contribute up to $5,000 a year initially to the account, with employers able to annually contribute up to $2,500 of that amount. The accounts reportedly would be vehicles for long-term savings. Details are still being ironed out, but funds could not be withdrawn before the child turns 18. After that, the accounts would likely become traditional IRAs.

On Tuesday, billionaires Michael and Susan Dell of Dell computer fame said they would give $250 to 25 million children age 10 and under in the U.S. The donations will be aimed at encouraging participation in the Trump accounts.

Pronatalism extends to other parts of the federal government, too.

Transportation Secretary Sean Duffy, who has nine children, instructed his department to prioritize federal funds for communities with high marriage and birth rates, though it has not yet announced any projects directly related to the initiative. For a time, the administration considered bestowing national medals on mothers with six or more children.

Except there’s one hitch: Data suggests the policies and programs the Trump administration has proposed won’t necessarily work.

Other countries have offered more robust programs to encourage childbearing and ease parenting but haven’t seen their birth rates go up, noted Michael Geruso, an economist for the University of Texas-Austin who hopes to see the global population increase. Israel, for example, has offered free IVF treatment for roughly three decades, yet its birth rates have stayed statistically stagnant, at just under three children for every woman, he said.

France and Sweden have extensive social safety-net programs to support families, including paid time off and paid paternity and maternity leave, and subsidized child care and health care, but their fertility rates are also falling, said Peggy O’Donnell Heffington, a University of Chicago assistant senior instructional professor in the history department who wrote a book on non-motherhood.

“Nobody yet knows how to avoid depopulation,” Geruso said.

Some point to a different solution to reverse the United States’ declining population: boost immigration to ensure a younger labor force and stronger tax base. The Trump administration, however, is doing the opposite — revoking visas and creating an environment in which immigrants who are in the U.S. legally feel increasingly uncomfortable because of heavy-handed policies, analysts say.

The country’s immigrant population this year fell for the first time since the 1960s, according to a Pew Research Center analysis.

Meanwhile, to critics of the administration, the focus on encouraging childbirth allows the Trump administration and Republicans to sound as if they support families.

“You’re not seeing policies that support families with children,” said Amy Matsui, vice president of income security and child care at the National Women’s Law Center, a nonprofit focused on gender rights. “It’s a white, heterosexual, fundamentalist Christian, two-parent marriage that’s being held up.”

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A 1956 book favored by UFO believers that is considered "an enduring classic in the fields of new religious studies, cult research, and social psychology," is being called into question as a potential lie, according to Anna Merlan in Mother Jones.

When Prophecy Fails, written by Leon Festinger, Henry W. Riecken, and Stanley Schachter, details a study of a UFO cult known as the Seekers that predicted the end of the world.

The book also introduced the theory of cognitive dissonance, which explains the psychological mechanisms for how people cope when their deeply held beliefs are contradicted by reality.

"The book is gripping, an in-depth social and psychological study of Martin’s group and how they behaved, both as it was forming and after their prophetic visions failed to take place," Merlan explains, adding that "it has served as a key basis for the psychological concept of cognitive dissonance."

That theory "was taken further by Festinger, who wrote a widely-cited followup book on cognitive dissonance and how people try to engage in 'dissonance reduction' to reduce the psychological pressure and unease they experience when confronted with conflicting information," she notes.

But a new study that examined Festinger’s recently unsealed papers claims that the book "leans on lies, omissions and serious manipulation," Merlan says.

"The article, published this month in the peer-reviewed Journal of the History of the Behavioral Sciences, also argues that, contrary to the researchers’ longstanding narrative, the group members all showed clear signs of quickly abandoning their beliefs when the UFOs failed to arrive, and that the group soon dissolved," Mother Jones reports.

Thomas Kelly, the author of the article, says "while core members of the group stayed active in UFO spaces, they did not keep insisting on a world-ending flood, or that aliens would land and take them away."

The Seekers, Kelly notes, were quick to disavow those beliefs and eventually rebranded.

The group's leader Dorothy Martin "distanced herself completely from these events, even rewriting the story of how she developed her psychic powers," Kelly writes.

"Kelly’s paper not only undercuts the researchers’ claims and their application of the theory developed from them, but also alleges they committed scientific misconduct, including 'fabricated psychic messages, covert manipulation, and interference in a child welfare investigation,'" Merlan explains.

Kelly says that researchers "twisted the group’s behavior to fit their thesis, downplaying the proselytization they did before the prophecy failed and playing up any proselytization that occurred after."

Merlan notes that this interpretation is key, "because the thesis of When Prophecy Fails is clear: after Martin’s failed prophecy, her group doubled down, not only by refusing to acknowledge that their core predictions had utterly failed, but banding together with a new zeal to spread them."

"The interference Kelly uncovered goes beyond manipulation," Merlan notes, but not everyone agrees with Kelly's interpretation.

Poulomi Saha, a University of California-Berkeley associate professor in critical theory who is writing a book on the cultural fascination with cults, says Kelly used a narrow reading of limited materials to draw his conclusion.

"This author ends up doing what he accuses the authors of When Prophecy Fails of doing, which is cherrypicking evidence," Saha says of Kelly, adding, “if we want to critique the methods and think about how methodology has changed in 70 years, I would encourage that. We’re talking about different academic and scholarly methods 70 years ago around things like participant observation.”

Saha also says that Kelly was “very dismissive” of the fact that group members continued to believe in UFOs.

Thibault Le Texier, an associate researcher at France’s European Centre for Sociology and Political Science, says that "There are findings that people want to hear and findings that people don’t want to hear,” and regardless of what people believe, the book will probably continue to "gain a lot of attention in spite of being debunked."

"It’s also because these are fascinating stories, as riveting as a great movie," he adds.

Merlan agrees, saying, "For now, at least, Prophecy continues to be widely referred to as a classic of the genre. The aliens, it must be said, have not yet landed."

In an ever-changing world, it’s nice to know that some things stay the same – my annual health insurance premium increase just came through for the 20th year in a row! For 2026, my company’s small-group policy will rise roughly 10%. And believe it or not, in the world of American health care, that’s considered a modest increase.

For my own family — myself, my wife, and our four kids — our health insurance plan costs about $1,800 per month with a $12,000 annual deductible. That is about $34,000 per year.

If your household earns around $110,000 a year, you’re actually doing extremely well: that puts you in the top 15% of earners in states like Wisconsin.

But even at that income, a $34,000 annual healthcare bill eats up 40% of your post-tax income.

Let’s put that in perspective:

• That $34,000 is almost six times what that same family pays in Medicare taxes — taxes that help cover the oldest, sickest people in the country.
• That $34,000 is more than my family spends on food, mortgage, property taxes, and utilities combined.
• And the gap between what we pay and what we use has become downright comical: I’m at Hy-Vee four times a week, but I haven’t been to a doctor in over three years.

But here’s the bigger problem: When premiums go up 7% per year — again, considered “moderate” — the magic of compound interest turns that into a doubling of price in just a decade.

At only 7% increases, by 2037, a family earning $110,000 will be paying a $45,000 annual premium for a small-group plan. Add a $15,000 deductible, and private insurance would consume 80% of their after-tax take-home pay.

No household, no matter how responsible or hard-working, can withstand that.

We’ve been promised reform for nearly a decade. Donald Trump began talking about fixing healthcare back in 2016. By 2024, the country still had nothing more than “concepts of a plan.” And temporary patches — tweaked subsidies, tinkering with tax credits, or tossing out $2,000 checks — are not even in the neighborhood of a real solution.

At the very least, Congress should make sure those price spikes don’t devastate families on Jan. 1, but the fact that those tax credits are needed speaks to out of control costs within the health care system.

We are out of time for small fixes. The system doesn’t need polishing — it needs structural change.

What we need is bold leadership and big ideas. And in my view, the fastest, most practical path forward is a public option — Medicare-for-all-who-want-it. Let individuals and small businesses buy into Medicare. If my family could get coverage for anything less than $34,000 a year, that’s an immediate savings! And we’re far from alone. That’s why I’m advocating with other small business owners, including those at the Main Street Alliance, to get it done.

You can’t solve an economic problem with partisan politics. That’s why Rep. Derrick Van Orden must come to the table to negotiate on health care. He said he would protect rural health care earlier this year, then turned his back on folks on Western Wisconsin and voted for the ‘Big Ugly Law’. The system is broken and we need serious people to address health care in a serious way. The math has already made the case. Now we need you to have the courage to follow it.

Mike Draper is the founder and owner of RAYGUN, a company that makes clothing, home goods and time travel supplies, and a member of the Main Street Alliance.

As the cost of insuring our houses escalates around the United States and the world, it appears that property insurance is acting like a canary in a coal mine.

Canaries used to be taken into coal mines because they served as an early warning system if dangerous gases were building up. Since the canaries were more sensitive to these gases than people, they protected the miners from life-threatening conditions. When the canary dropped dead, the miners could still get out.

Like the canaries, the actuaries who interpret data for insurance companies are more sensitive than most individual people to changes going on in the world. Actuaries earn big salaries because the financial health of their employers depends on them.

Things have already gotten so bad that the National Academies of Sciences, Engineering, and Medicine (NASEM) recently sponsored a webinar panel discussion: “Extreme Weather Events and Insurance: Households, Homeowners, and Risk.” (This link will take you to a video of the event.)

Any coal miner who refused to evacuate a mine when the mine’s canary keeled over—perhaps saying, “I don’t believe there is any real danger here”—would not have been long for this world.

The panelists were located in the United States (Washington, DC and Madison, Wisconsin) and England (London and Cambridge). Climate changes are not limited to the United States, nor is awareness that we need to do something about them if we can.

The panelists were not grinding particular political axes. They were discussing the measured fact that an increasing number of extreme weather events are destroying valuable property—housing, commercial buildings, streets, bridges, etc.—requiring insurance company payouts to policyholders.

These insurance payouts must be financed by the premiums charged to people who are insuring their property. As damages increase, the premiums also have to increase. Although premiums may be regulated by state regulators, if they do not allow the needed increases insurance companies will pull out of doing business in that state.

As insurance companies pull out, it may become more and more difficult—perhaps even impossible—for people to insure their houses. But if a house cannot be insured, banks won’t finance a mortgage on it, and if it cannot be financed the owner may be unable to sell it.

For many people, their home is their primary investment, and they cannot afford to live in it if they cannot insure it. If it burned down or was otherwise destroyed, they would be wiped out financially. But if they cannot sell it, then the homeowner is a real pickle.

Disrupted housing markets can produce disastrous results for a country’s economy in general, as we Americans discovered during the recession beginning around 2008.

The impact of a world that is heating up is not being felt as much in the United States as in many other countries in Europe, Africa, and Asia which are suffering from unusually long bouts of very hot weather, flooding downpours alternating with extreme droughts, forest fires, etc. Some island nations may be literally wiped out as melting icebergs and glaciers increase sea level, putting them underwater.

But enough extreme weather events are already occurring in the United States that the insurance companies must make major increases in their prices.

Any coal miner who refused to evacuate a mine when the mine’s canary keeled over—perhaps saying, “I don’t believe there is any real danger here”—would not have been long for this world.

Americans who continue to politicize discussion of global warming—either denying its existence, its extent, its speed, or its seriousness—will be like that coal miner. We too have a little bird trying to call our attention to a major problem. That bird is the insurance industry with its army of actuaries. We ignore that warning at our own risk, and at the risk of our children and grandchildren.

A Chinese plant scientist at the University of Michigan who drew national attention in June 2025 when she was arrested and accused along with another Chinese scientist of smuggling a crop-damaging fungus into the U.S. pleaded guilty on Nov. 12, 2025, to charges of smuggling and making false statements to the FBI. Under her plea agreement, Yunqing Jian, 33, was sentenced to time served and expected to be deported. She wrote in a statement for the court that she was working on ways to protect crops from disease.

I’ve been a vegetarian for over a decade. It’s not because of my health, or because I dislike the taste of chicken or beef: It’s a lifestyle choice I made because I wanted to reduce my impact on the planet. And yet, twice a day, every day, I lovingly scoop a cup of meat-based kibble into a bowl and set it down for my 50-pound rescue dog, a husky mix named Loki.

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Until recently, I hadn’t devoted a huge amount of thought to that paradox. Then I read an article in the Associated Press headlined “People often miscalculate climate choices, a study says. One surprise is owning a dog.”

The study, led by environmental psychology researcher Danielle Goldwert and published in the journal PNAS Nexus, examined how people perceive the climate impact of various behaviors — options like “adopt a vegan diet for at least one year,” or “shift from fossil fuel car to renewable public transport.” The team found that participants generally overestimated a number of low-impact actions like recycling and using efficient appliances, and they vastly underestimated the impact of other personal decisions, including the decision to “not purchase or adopt a dog.”

The real objective of the study was to see whether certain types of climate information could help people commit to more effective actions. But mere hours after the AP published its article, its aim had been recast as something else entirely: an attack on people’s furry family members. “Climate change is actually your fault because you have a dog,” one Reddit user wrote. Others in the community chimed in with ire, ridiculing the idea that a pet Chihuahua could be driving the climate crisis and calling on researchers and the media to stop pointing fingers at everyday individuals.

Goldwert and her fellow researchers watched the reactions unfold with dismay. “If I saw a headline that said, ‘Climate scientists want to take your dogs away,’ I would also feel upset,” she said. “They definitely don’t,” she added. “You can quote me on that.”

The study set out to understand how to shift behavior by communicating climate truths. Instead, its media coverage revealed a troubling psychological trade-off: When climate-related messaging strikes a nerve, it may actually turn people off from the work of shifting societal norms.

It’s an instinct I understand on some level. I love Loki, and my knee-jerk reaction is to defend the very personal choice of sharing one’s life with a dog. I also sympathize with redirecting the blame toward the biggest polluters: billionaires and fossil fuel companies (not Bon-Bon, the pet Chihuahua in question). But is it irresponsible to shrug off any conversation about the environmental impact of our pets — something far more within our control than, say, the overthrow of capitalism?

Is there a way to have a frank discussion about the climate impact of our personal lives without it going to the dogs?

Oftentimes, when I’m questioning how a particular climate behavior might fit into my life, I try to imagine how it looks in my vision of a sustainable future. It’s why, for instance, I don’t own a car and am dedicated to riding public transit, even though it isn’t always super convenient. I’m keen to be an early adopter of systems I believe in. But I struggle to imagine a future without companion animals, even knowing about their environmental impact — which is admittedly substantial.

Dogs and cats eat meat-heavy diets, which is where the bulk of their carbon pawprint comes from. A 2017 study from UCLA found that dogs and cats are responsible for about 25 to 30 percent of the environmental impact of meat consumption in the United States. That’s equivalent to a year’s worth of driving by 13.6 million cars. For pets that eat traditional kibble or wet food, that protein may come from meat byproducts — otherwise-wasted animal parts, such as organs and bones, not approved for human consumption. But an increasing number of pet owners are opting to feed their fur babies “human-grade” meat products, which requires additional resources and generates extra emissions.

After they eat, of course, they poop. A lot. At least for dogs, that poop typically gets bagged in plastic and sent to the landfill. And it turns out all the biodegradable poop bags I’ve diligently bought over the years don’t help matters much; they also release greenhouse gases in landfills, and most composting programs don’t accept pet waste.

With more dogs around than ever before — the U.S. dog population has steadily increased from 52.9 million in 1996 to a new peak of 89.7 million in 2024 — their overall climate toll is more than a Chihuahua-sized issue. But pets are also more than just sources of carbon pollution. According to a 2023 Pew Research poll, 97 percent of owners say they consider their pets to be part of their families, with 51 percent of respondents saying they are on the same level as a human family member. So whenever their climate impact crops up in the discourse, as it has periodically, it makes sense that people tend to get defensive.

For some climate advocates, the solution has been to shift messaging away from individual responsibility and focus instead on big, systemic changes like overhauling our electricity and transit systems through governmental investment in clean energy. In her essay “I work in the environmental movement. I don’t care if you recycle,” author and podcaster Mary Annaïse Heglar wrote: “The belief that this enormous, existential problem could have been fixed if all of us had just tweaked our consumptive habits is not only preposterous; it’s dangerous … It’s victim blaming, plain and simple.”

Heglar and others have taken a strong stance against environmental purity — the idea that you can’t care about or advocate for systems-level change if you aren’t first changing your own habits. But not everyone agrees that individual actions should be completely deemphasized in the climate conversation. Kimberly Nicholas, a climate scientist and author of the popular book Under the Sky We Make, has argued that wealthy people living in wealthy countries — and globally, “wealthy” is a lower bar than you might think — do have a responsibility to slash their outsize carbon emissions. And particularly for those of us living in democracies, personal action isn’t just about the choices we make as consumers.

“There’s still an ongoing tension between personal and system change, or individual and collective action,” Nicholas said. “It’s really hard to get that right — to get the right balance there that acknowledges the role and the importance of both, and to talk about and study and describe both in a way that motivates people to take high-impact actions.”

Goldwert saw that tension play out in her maligned climate communications study. In the experiment, participants reviewed 21 individual climate actions (like eating less meat) and five systemic actions (like voting) and rated their commitments to taking each action. Two test groups then received clarifying information about the relative impact of the 21 individual actions — one group was asked to estimate their ranking before learning how they actually ranked, the other group received the information straight-up. But participants didn’t receive any data about the carbon-mitigation potential of the five collective actions, which would be far more difficult to quantify.

What Goldwert’s team found surprised them: The teachings did nudge people toward higher-impact personal actions, but their stated likelihood of engaging in collective ones actually went down — a backfire effect that hints at the perils of focusing too much on personal lifestyle choices.

“It might be kind of like a mental substitution,” Goldwert said. “People feel like, ‘OK, I’ve done my part individually. I kind of checked the box on climate action.’”

Participants were also asked to rate the “plasticity” of each of the actions, or how easy it would be to adopt. And those measurements revealed another nuance in how people view different forms of climate action. For the individual-focused options, participants were more likely to commit to actions they saw as requiring little effort. For the systemic actions, they were more interested in whether it would have an impact — something researchers are still working on quantifying.

“If you think voting or marching is just symbolic or ineffective, you’re not going to engage,” Goldwert said. “We have to show people evidence that their voice or their vote can shift policy, corporate practices, or social norms.”

I, for one, was surprised to see that participants rated the commitment to “not purchase or adopt a dog” as easy. When I asked Goldwert what might be behind that, she noted that dog ownership is a decision people don’t make very often. It also doesn’t require any action at all for people who already don’t own dogs. The results surely would have been different if the listed action was “get rid of your existing dog.” (Which it was not — a point that readers seemed to miss, based on Reddit comments about the study and the “crazy emails” Goldwert said she received.)

Still, for an animal lover like me, the idea of never adopting another dog doesn’t feel easy to commit to at all. It feels like an immense sacrifice. The sadness I feel at the thought of a future without dogs points me to another important factor when it comes to motivation for climate action: joy.

Actions we take to try and mitigate the climate crisis may be partially driven by how easy they are for us or how effective we believe them to be — but any choice we make is also driven by what we find joy in. It’s an essential part of staying committed and resilient in the fight for a better future. In this way, carbon-intensive activities like dog ownership have value beyond their weight in emissions.

“People have an emotional attachment to the people and animals and creatures that we love,” Nicholas said. “And that is actually, I think, very powerful. We’re not only going to solve climate change by lining up all the numbers — we certainly need to do that, but we have to tap into what people really care about and realize all those things are on the line and threatened by the amount of climate change we’re heading for with current policies.”

Would I fight to ensure that dogs, like my beloved Loki, can continue wagging happily on this planet? Heck yes, I would. I’ve always felt that being a pet person goes hand-in-hand with a sense of altruism and responsibility. And if not giving up our pets means fighting climate change by voting, marching, donating, advocating, and consuming like our pets’ lives depend on it, I think we can all get on board.

That might also mean adjusting our pets’ diets. While making my dog a full vegetarian seems challenging (though technically possible), just cutting out beef has a significant impact — shifting to “lower-carbon meats” was even one of the high-impact actions included in Goldwert’s study. That’s one Loki can easily commit to. And we already buy insect-based treats, which leave a pungent odor in my pockets but seem to please his taste buds.

There are also ways that dog ownership intersects with other climate-related behaviors. Anecdotally, I would say I travel less because I have a dog whose care I need to think about. Walking him every day has also made me vastly more connected to my local environment, the goings-on in my neighborhood, and my neighbors themselves — all of which are important aspects of building climate resilience. Some dogs have even been trained to sniff out invasive species and help identify environmental contaminants. (Not Loki, who has never worked a day in his life.)

Though I’d never thought about it quite this way before I read Goldwert’s study, the climate actions I take have a lot to do with the love I feel for Loki. Not because I want to leave a better world for him — I recognize the reality that I will almost certainly outlive him — but because my feelings for him bring me closer to the love I feel for all living things on this planet. This “ice age predator” who shares my home, as the anthropologist and comedian David Ian Howe puts it, is a living reminder of the relationship humans have with other species, going back many thousands of years.

As the saying goes, “Be the person your dog thinks you are.” And next time you get a little worked up about the realities of the climate crisis and your accountability within it, consider taking yourself on a walk.

This article originally appeared in Grist at https://grist.org/culture/the-climate-paradox-of-having-a-dog/.

Grist is a nonprofit, independent media organization dedicated to telling stories of climate solutions and a just future. Learn more at Grist.org

The Trump administration came under fire on Sunday after sending Dr. Mehmet Oz, the Administrator of the Centers for Medicare and Medicaid Services, onto CNN‘s weekend news show to try to explain the Republican Party’s elusive “solution” to the nation’s healthcare crisis, a topic of much interest in recent weeks amid the longest government shutdown in the nation’s history and growing fears over massive premium increases or loss of coverage for tens millions of Americans.

Asked during his appearance to explain what Republicans are considering to address the surging cost of healthcare, Oz talked about direct cash payments—something Trump himself has floated in recent weeks—as well as the idea of health saving accounts (or HSAs) which allow for personalized accounts set up to help pay for out-of-pocket medical needs, though not premium payments.

“If you had a check in the mail, you could buy the insurance you thought was best for you,” Oz stated without explaining in what way that is different from people who received tax credits to purchase plans on the insurance exchanges established by the Affordable Care Act signed into law by former President Barack Obama.

Pushing such empty ideas while claiming them as viable solutions to soaring costs is partly what led critics like Sen. Patty Murray (D-Wash.) this week to issue a public service announcement which stated flatly: “There is no Republican health care plan”—despite repeated claims to the contrary by GOP lawmakers, including Speaker of the House Mike Johnson (R-La.).

“Dr. Oz a few years ago was pitching Medicare Advantage for All—a scheme to put every person on the corporate health insurance plans he used to sell,” said Andrew Perez, a politics editor for Zeteo, in response to the interview. “Now, he’s saying let’s take away insurance from millions and give them a few bucks for their health care instead. Insane.”

In a blog post published last week, Nicole Rapfogel, a senior policy analyst with the Center on Budget and Policy Priorities (CBPP), a nonpartisan policy think tank, explained why expanded HSAs, backed by the government or otherwise, would do little to nothing to improve access or lower costs for healthcare.

“Expanding HSAs has been a consistent theme, including in the House-passed version of the Republican megabill, though those provisions didn’t pass the Senate,” explained Rapfogel. “But these policies are misguided and would do little to preserve access to affordable, comprehensive coverage.”

She further explains that HSAs generally are better for wealthier people who have spare income to direct into such accounts, but of little use to poorer Americans who are already struggling to make ends meet each month. According to Rapfogel:

Most people do not have spare cash to set aside in HSAs; an estimated 4 in 10 people are in debt due to medical and dental bills.People in lower tax brackets also benefit less from HSA tax savings. For example, a married couple making $800,000 saves 37 cents for each dollar contributed to an HSA, more than three times the 12 cents per dollar a married couple making $30,000 would save.
Further, HSAs do not promote efficient use of health care services. Research has shown that HSAs do not reduce health care spending, but rather shield more of that spending from taxes.

Given that understanding of the well-known limitations of HSAs or other avenues of government backstopping of private insurance, the level of bullshitting or straight up ignorance by Oz on Sunday morning, for many, was hard to take.

It’s “pretty amazing,” said economist Dean Baker on Sunday, “that Dr. Oz doesn’t know that people choose their insurance under Obamacare, but no one ever said Dr. Oz knew anything about healthcare.”

In an interview with Newsmax earlier this month, Johnson—who has argued that the GOP has reams of policy proposals on the topic—accused Democrats of having no reform solutions to the nation’s healthcare crisis other than permanently fighting to save the status quo, including the “subsidizing the insurance companies” which is at the heart of the Affordable Care Act.

Taxpayer subsidies for private insurance giants “is not the solution,” Johnson admitted at the time, though his party has refused to offer anything resembling a departure from the for-profit model which experts have demonstrated is the central flaw in the US healthcare system, one that spends more money per capita than any other developed nation but with the worst outcomes.

Meanwhile, as Republicans show in word and deed that they have nothing to offer people concerned about healthcare premiums in the nation’s for-profit system, only a relative handful of Democratic Party members have matched renewed focus on the nation’s long-simmering healthcare crisis with the popular solution that experts and economists have long favored: a single-payer system now commonly known as Medicare for All.

Sen. Bernie Sanders, the Independent from Vermont who caucuses with the Senate Democrats, made the demand for Medicare for All a cornerpost of his two presidential campaigns, first in 2016 and then again in 2020. On the heals of those campaigns, which put the demand for a universal healthcare system before voters in a serious way for the first time in several generations, a growing number of lawmakers in Congress embraced the idea even as the party’s establishment leadership treated the idea as toxic.

While a 2018 study by the Political Economy Research Institute (PERI) at the University of Massachusetts at Amherst detailed why it is “easy to pay for something that costs less,” people in the United States exposed to the arguments of Medicare for All over the last decade a majority have shown their desire for such a system in poll after poll after poll.

A single-payer system like Medicare for All would nullify the need for private, for-profit insurance plans and the billions of dollars in spending they waste each year in the form of profits, outrageous pay packages for executives, marketing budgets, and administrative inefficiences.

Despite its popularity and the opportunity it presents to show the working class that the Democratic Party is willing to turn its back on corporate interests by putting the healthcare needs of individuals and families first, the party leadership continues to hold back its support.

Lawmakers like Rep. Ro Khanna (D-Calif.), who served as national co-chair to Sanders’ second presidential run, has been arguing in recent weeks, amid the government shutdown fight, that Democrats should be “screaming” their support for universal healthcare “from the rooftops” in order to seize on a moment in which voters from across the political spectrum are more atuned than usual to the pervasive and fundamental failures of the for-profit system.

Rep. Pramila Jayapal (D-Wash.), lead sponsor of the Medicare for All Act in the US House, on Thursday reiterated her support for universal coverage by saying, “Instead of raising premiums for millions, how about we just get rid of them? Medicare for All!!”

As former Ohio state senator and progressive organizer Nina Turner said on Saturday, “This is a moment to mobilize for Medicare for All.”

Dr. Abdul El-Sayed, another former Sanders surrogate now running for the Democratic nomination in Michigan’s US Senate race, has been another outspoken champion of Medicare for All in recent weeks.

“While MAGA slowly suffocates our healthcare system, we’re watching corporate health insurance choose profits—and corporate Democrats capitulating,” El-Sayed said last week, expressing frustration over how the shutdown fight came to end. “Who suffers? The rest of us. It’s time for a healthcare system that doesn’t leave our insurance in the hands of big corporations—but guarantees health insurance for all of us.”

Following Dr. Oz’s remarks on Sunday, El-Sayed rebuked the top cabinet official as emblematic of the entire healthcare charade being perpetrated by the Republican Party under President Donald Trump.

“They think we’re dumb,” said El-Sayed of Oz’s convoluted explanation of direct payments. “They know that no check they send will cover even a month of the healthcare Trump bump we can’t afford—but they think we’re not smart enough to know the difference. Healthcare is becoming unsustainable under Trump. Medicare for All would fix it.”

In Maine on Sunday, another Democratic candidate running for the US Senate, Graham Platner, also championed the solution of Medicare for All.

After watching Oz’s peformance on CNN, Tyler Evans, creative director who works for Rep. Alexandria Ocasio-Cortez (D-N.Y.) declared in a social media post: “If we had Medicare for All, you could simply go to the doctor.”

Republicans are obsessed with taking your health care away. This spring, they cut $1 trillion from Medicaid, all to give massive tax handouts to billionaires. For the last month and a half they shut down the government rather than prevent premiums from doubling on average for 24 million people in the Affordable Care Act marketplace. And they “won.”

The number of uninsured Americans is about to skyrocket, which is exactly what Republicans want. It is what they fight for every day: to steal your health care.

These cuts are devastating for seniors, who rely on Medicaid to pay for nursing homes and other long-term care (which typically isn’t covered by Medicare). They are also disastrous for Americans aged 50 to 64, many of whom are in the ACA marketplaces and will have the largest premium increases. Many will have no choice but to drop their health insurance and pray they don’t get too sick before they turn 65 and become eligible for Medicare — literally gambling with their lives.

Even if you’re not on Medicaid or the ACA, the Republican cuts will make your health care worse. Without the Medicaid dollars they need to survive, hospitals and nursing homes across the country are already closing their doors. Far more will close in the next few years, with rural areas and inner cities hit hardest.

The hospitals that remain open will have to cut staff due to lower revenue — even as their ERs are flooded with newly uninsured patients who have nowhere else to go. That means if you get hit by a car, you’ll likely have to go to a hospital further away and wait longer to see a doctor. All thanks to Republicans.

The only people in America whose health care isn’t about to get much worse are billionaires, who can hop into their private helicopters to see their private doctors.

Democrats are demanding that Republicans back off their draconian health care cuts. That’s what the just-concluded government shutdown was all about — Democrats refusing to vote for a budget that doesn’t fix the coming health care apocalypse.

Some Democrats thought that Republicans would come to the negotiating table and figure out a health care fix, if only out of political self-interest. But Republicans are ideologically committed to destroying health care at the behest of their billionaire donors.

House Republican Leader Mike Johnson is refusing to bring an extension of the ACA subsidies, which would prevent premiums from skyrocketing, up for a vote.

This refusal is why House Democratic Leader Hakeem Jeffries has put forward a discharge petition to obtain a three-year extension of the ACA subsidies. If the petition gets 218 signers, it forces a floor vote which also needs 218 to pass. There are 214 Democrats in the House.

That means we need only FOUR Republicans to cross the aisle and we can get the subsidies to pass the House, putting pressure on the Senate.

It comes down to these 25 Republicans, who are in extremely tight races and whose constituents are getting hammered by spiking premiums and disastrous Medicaid cuts:

• Juan Ciscomani (AZ-06)
• Kevin Kiley (CA-03)
• David Valadao (CA-22)
• Darrell Issa (CA-48)
• Gabe Evans (CO-08)
• Cory Mills (FL-07)
• María Elvira Salazar (FL-27)
• Mariannette Miller-Meeks (IA-01)
• Zach Nunn (IA-03)
• Bill Huizenga (MI-04)
• Tom Barrett (MI-07)
• Nicole Malliotakis (NY-11)
• Tom Kean Jr. (NJ-07)
• Mike Lawler (NY-17)
• Mike Turner (OH-10)
• Brian Fitzpatrick (PA-01)
• Ryan Mackenzie (PA-07)
• Rob Bresnahan (PA-08)
• Scott Perry (PA-10)
• Andy Ogles (TN-05)
• Monica De La Cruz (TX-15)
• Rob Wittman (VA-01)
• Jen Kiggans (VA-02)
• Bryan Steil (WI-01)
• Derrick Van Orden (WI-03)

Republicans are betting that by dividing Americans against each other, they can duck the blame for the health care apocalypse they created. Let’s prove them wrong. That starts with flooding the phone lines of these Republicans and protesting outside their offices, to demand they save our health care.

Alex Lawson is the Executive Director of Social Security Works, the convening organization of the Strengthen Social Security Coalition -- a coalition made up of over 340 national and state organizations representing over 50 million Americans.

Americans have developed a unique “disdain for pain,” leading to the excessive use of opioids and other unproductive treatments, neurosurgeon Sanjay Gupta said Saturday at The Texas Tribune Festival’s closing keynote, during which he urged people to focus instead on the key driver of chronic pain: the brain.

That was among the core findings of Gupta’s research presented in his recent book, “It Doesn’t Have to Hurt: Your Smart Guide to a Pain-Free Life,” which promotes a mix of conventional approaches — like foam rolling and stretching — and unconventional fixes, such as psychedelics and other new-age pain products. Those can provide more enduring pain relief by tapping into the brain’s built-in endogenous opioid system, Gupta argues.

“For decades, the body was being treated as totally separate from the brain and I think that has been the biggest misconception,” he said. “We have learned that someone might have pain associated with isolation or loneliness, and it’s remarkable how similar that might look to physical pain.”

The brain, Gupta continued, “doesn’t really distinguish the difference in pain. It's not to say that it's all in your head, but the brain is making these determinations.” It does so by treating chronic pain “like a memory that keeps getting played over and over again,” he said, akin to post-traumatic stress disorder.

This revelation is still being studied, and while its future implications are still coming into focus, Gupta said it might eventually lead to more pain management that doesn’t rely on opioids.

Gupta has had plenty of experience witnessing how drugs can have both positive and negative effects on users. He said that in the early 1990s, the message became that it was no longer acceptable to live in pain, and opioids developed as the go-to solution.

“It was very effective, to be fair, in terms of treating pain — in the short term,” Gupta said.

Opioid medications are highly addictive and have produced deadly consequences for Texans and others across the country over the past decade.

The state’s drug overdose deaths spiked by more than 75% from 2017 to 2021, prompting state leaders to create a campaign dedicated to stopping the No. 1 killer, a synthetic opioid known as fentanyl. Deaths involving fentanyl have made up an increasing share of overdose fatalities, climbing from 3.7% of Texas’ 2,111 drug-related deaths in 2014 to 44% of 4,931 drug-related deaths in 2022, according to a report from the Texas Department of State Health Services.

Texas has seen a more recent decline in overdose deaths, with such fatalities decreasing by 18% from the 12 months leading up to April 2024 compared to the same months before April this year, according to provisional data from the federal Centers for Disease Control and Prevention.

For many years, Gupta said, the rise of opioids also suffocated the desire to search for new solutions for pain management. He noted that, while the U.S. Food and Drug Administration approves around 40 to 50 new drugs annually, this year saw the approval of the country’s first new pain medication since 1998.

“Think about it — chronic pain is one of the fastest growing conditions in the country, and yet, not a single new therapeutic in 27 years for that,” Gupta said.

Gupta also spoke about the state of public health in Texas and across the country, citing pessimism and mistrust of the nation’s health care system as one of his primary concerns. Those sentiments are tied to the high cost of care, he argued.

“If you look at the type of health care system that we have and how fragmented it is — how many people still don’t have access to healthcare, insurance or can access healthcare? — the inequity there is remarkable,” Gupta said. “So I think that is a source of great despair.”

In Texas, Affordable Care Act premiums are set to rise by an average of 35 next year if Congress does not renew expiring health care tax credits. The subsidies were at the center of the record-long shutdown of the federal government, which ended this week after lawmakers approved a funding deal that did not address the tax credits.

Texas is expected to be disproportionately affected by the expiration of the subsidies because it has more ACA enrollees — nearly 4 million — than every state but Florida. As one of 10 states that never expanded Medicaid to people earning over 100% of the federal poverty limit, Texas has significantly relied on the ACA to increase coverage for lower-income residents. Nearly two-thirds of Texans who get coverage through the ACA earn under 150% of the federal poverty limit — $23,475 for an individual or $48,225 for a family of four.

Gupta contended that dissatisfaction with the health care system is the main driver of vaccine skepticism being seen in Texas and across the nation.

School immunization rates have declined in recent years as more parents have sought to exempt their kids from required vaccines. Requests for a vaccine exemption form from the Texas Department of State Health Services have doubled since 2018, from 45,900 to more than 93,000 in 2024.

Gupta said he has spent the past few years battling misinformation over the safety of vaccinations and the Trump administration’s rollback of health mandates.

“I am not sitting it out,” he said. “I think a lot of people are sitting it out. I think now is the time to redouble efforts and put good truthful content out there that people can rely on.”

The challenge with battling misinformation, Gupta said, is that it often contains a kernel of truth. For example, he said, it is important to live a healthy lifestyle, as advocated by Health Secretary Robert F. Kennedy Jr. and some in the conservative Make America Healthy Again movement. But a healthy lifestyle alone cannot replace the need for vaccines and other proven public health measures.

“We do eat too much processed foods. We do spend too much on healthcare,” Gupta said. “But at what point do you say, hey, these things work, they provide benefit that are greater than risks and harms, and they’re good for society. I feel like we are going backwards in regards to this.”

This article first appeared on The Texas Tribune.

Everyone has looked up at the clouds and seen faces, animals, objects. Human brains are hardwired for this kind of whimsy. But some people – perhaps a surprising number – look to the sky and see government plots and wicked deeds written there. Conspiracy theorists say that contrails – long streaks of condensation left by aircraft – are actually chemtrails, clouds of chemical or biological agents dumped on the unsuspecting public for nefarious purposes. Different motives are ascribed, from weather control to mass poisoning.

For years, the two patients had come to the Penn Memory Center at the University of Pennsylvania, where doctors and researchers follow people with cognitive impairment as they age, as well as a group with normal cognition.

Both patients, a man and a woman, had agreed to donate their brains after they died for further research. “An amazing gift,” said Edward Lee, the neuropathologist who directs the brain bank at the university’s Perelman School of Medicine. “They were both very dedicated to helping us understand Alzheimer’s disease.”

The man, who died at 83 with dementia, had lived in the Center City neighborhood of Philadelphia with hired caregivers. The autopsy showed large amounts of amyloid plaques and tau tangles, the proteins associated with Alzheimer’s disease, spreading through his brain.

Researchers also found infarcts, small spots of damaged tissue, indicating that he had suffered several strokes.

By contrast, the woman, who was 84 when she died of brain cancer, “had barely any Alzheimer’s pathology,” Lee said. “We had tested her year after year, and she had no cognitive issues at all.”

The man had lived a few blocks from Interstate 676, which slices through downtown Philadelphia. The woman had lived a few miles away in the suburb of Gladwyne, Pennsylvania, surrounded by woods and a country club.

The amount of air pollution she was exposed to — specifically, the level of fine particulate matter called PM2.5 — was less than half that of his exposure. Was it a coincidence that he had developed severe Alzheimer’s while she had remained cognitively normal?

With increasing evidence that chronic exposure to PM2.5, a neurotoxin, not only damages lungs and hearts but is also associated with dementia, probably not.

“The quality of the air you live in affects your cognition,” said Lee, the senior author of a recent article in JAMA Neurology, one of several large studies in the past few months to demonstrate an association between PM2.5 and dementia.

Scientists have been tracking the connection for at least a decade. In 2020, the influential Lancet Commission added air pollution to its list of modifiable risk factors for dementia, along with common problems like hearing loss, diabetes, smoking, and high blood pressure.

Yet such findings are emerging when the federal government is dismantling efforts by previous administrations to continue reducing air pollution by shifting from fossil fuels to renewable energy sources.

“‘Drill, baby, drill’ is totally the wrong approach,” said John Balmes, a spokesperson for the American Lung Association who researches the effects of air pollution on health at the University of California-San Francisco.

“All these actions are going to decrease air quality and lead to increasing mortality and illness, dementia being one of those outcomes,” Balmes said, referring to recent environmental moves by the White House.

Many factors contribute to dementia, of course. But the role of particulates — microscopic solids or droplets in the air — is drawing closer scrutiny.

Particulates arise from many sources: emissions from power plants and home heating, factory fumes, motor vehicle exhaust, and, increasingly, wildfire smoke.

Of the several particulate sizes, PM2.5 “seems to be the most damaging to human health,” Lee said, because it is among the smallest. Easily inhaled, the particles enter the bloodstream and circulate through the body; they can also travel directly from the nose to the brain.

The research at the University of Pennsylvania, the largest autopsy study to date of people with dementia, included more than 600 brains donated over two decades.

Previous research on pollution and dementia mostly relied on epidemiological studies to establish an association. Now, “we’re linking what we actually see in the brain with exposure to pollutants,” Lee said, adding, “We’re able to do a deeper dive.”

The study participants had undergone years of cognitive testing at Penn Memory. With an environmental database, the researchers were able to calculate their PM2.5 exposure based on their home addresses.

The scientists also devised a matrix to measure how severely Alzheimer’s and other dementias had damaged donors’ brains.

Lee’s team concluded that “the higher the exposure to PM2.5, the greater the extent of Alzheimer’s disease,” he said. The odds of more severe Alzheimer’s pathology at autopsy were almost 20% greater among donors who had lived where PM2.5 levels were high.

Another research team recently reported a connection between PM2.5 exposure and Lewy body dementia, which includes dementia related to Parkinson’s disease. Generally considered the second most common type after Alzheimer’s, Lewy body accounts for an estimated 5% to 15% of dementia cases.

In what the researchers believe is the largest epidemiological study to date of pollution and dementia, they analyzed records from more than 56 million beneficiaries with traditional Medicare from 2000 to 2014, comparing their initial hospitalizations for neurodegenerative diseases with their exposure to PM2.5 by ZIP codes.

“Chronic PM2.5 exposure was linked to hospitalization for Lewy body dementia,” said Xiao Wu, an author of the study and a biostatistician at the Mailman School of Public Health at Columbia University.

After controlling for socioeconomic and other differences, the researchers found that the rate of Lewy body hospitalizations was 12% higher in U.S. counties with the worst concentrations of PM2.5 than in those with the lowest.

To help verify their findings, the researchers nasally administered PM2.5 to laboratory mice, which after 10 months showed “clear dementia-like deficits,” senior author Xiaobo Mao, a neuroscientist at the Johns Hopkins School of Medicine, wrote in an email.

The mice got lost in mazes that they had previously dashed through. They had earlier built nests quickly and compactly; now their efforts were sloppy, disorganized. At autopsy, Mao said, their brains had atrophied and contained accumulations of the protein associated with Lewy bodies in human brains, called alpha-synuclein.

A third analysis, published this summer in The Lancet, included 32 studies conducted in Europe, North America, Asia, and Australia. It also found “a dementia diagnosis to be significantly associated with long-term exposure to PM2.5” and to certain other pollutants.

Whether so-called ambient air pollution — the outdoor kind — increases dementia because of inflammation or other physiological causes awaits the next round of research.

Although air pollution has declined in the United States over two decades, scientists are calling for still stronger policies to promote cleaner air. “People argue that air quality is expensive,” Lee said. “So is dementia care.”

President Donald Trump, however, reentered office vowing to increase the extraction and use of fossil fuels and to block the transition to renewable energy. His administration has rescinded tax incentives for solar installations and electric vehicles, Balmes noted, adding, “They’re encouraging continuing to burn coal for power generation.”

The administration has halted new offshore wind farms, announced oil and gas drilling in the Arctic National Wildlife Refuge in Alaska, and moved to stop California’s plan to transition to electric cars by 2035. (The state has challenged that action in court.)

“If policy goes in the opposite direction, with more air pollution, that’s a big health risk for older adults,” Wu said.

Last year, under the Biden administration, the Environmental Protection Agency set tougher annual standards for PM2.5, noting that “the available scientific evidence and technical information indicate that the current standards may not be adequate to protect public health and welfare, as required by the Clean Air Act.”

In March, the EPA’s new chairman announced that the agency would be “revisiting” those stricter standards.

The New Old Age is produced through a partnership with The New York Times.

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