18 June 22
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I have lived in a world where I quickly came to learn that almost anything was possible, where I was never surprised by the propensity of events to surprise me. But I never could have imagined the United States would find itself in its current position.
With each significant chapter in the candidacy and presidency of Donald Trump, we have experienced a rising tide of outrage, disgust, and disbelief, as well as a pervasive queasiness — is this really happening? What are we not seeing, behind the scenes? How bad can this get?
The events around the last election, building toward the coup attempt of January 6, were obviously dire and significant as we tried to process them in real time. We knew we had come close to losing something precious, but how close, and how much was really at risk? The unknowns and “what ifs” spiraled in our imaginations.
With the inauguration of Joe Biden, there was a sense of a return to at least a precarious order — in that the winner of the election had indeed become president. But the threat continued, and it still does. We will consider the specifics of these threats more fully in future posts.
But here now, in the wake of yet another jaw-dropping day of hearings by the January 6 committee, we can say that as bad as we knew it was at the time, it could have been worse. A lot worse. The Capitol could have been the scene of a bloodbath, with senior political leaders hunted and killed by a mob whipped up by the president and bent on vengeance. We might have sensed that before, but today made it chillingly clear how close we came to this outcome.
We know how hell-bent Trump was on having Vice President Mike Pence blow up the Constitution, and leaving him to the mob if he didn’t. To his everlasting credit, Pence bucked the pressure from a would-be autocrat skulking and plotting in the White House. The president’s enablers were warned of carnage in the streets and in the halls of Congress. They didn’t care. The president didn't care. The evidence suggests that that was what he wanted.
We are still learning more, and a story is emerging that still shocks many of us to a place of disbelief. I suspect that the committee members, as expertly as they have produced these hearings for maximum impact, are unsure where this will eventually lead. Case in point is the call for Ginni Thomas, wife of Supreme Court Justice Clarence Thomas, to testify for her role in the insurrection.
The twists and turns to come will likely still force us to contemplate that which is now beyond the limits of our imagination. Yesterday’s hyperbole is tomorrow’s old news. One thing we can all be thankful for is that truth is being served and history will know that a president attacked his own country. What that means for the man or the nation remains to be seen. It can get worse, a lot worse. But that might also be the path by which we get better.
Agricultural products were Ukraine's primary source of export revenue, and accounted for nearly 10% of the country's GDP. (photo: Fadel Dawood/Getty Images)
Unprecedented food shortages could spark riots in dozens of countries as Black Sea blockade adds to pressures, says WFP chief
Speaking in Ethiopia’s capital, Addis Ababa, on Thursday, David Beasley, director of the UN World Food Programme (WFP), said the world faced “frightening” shortages that could destabilise countries that depend on wheat exports from Ukraine and Russia.
“Even before the Ukraine crisis, we were facing an unprecedented global food crisis because of Covid and fuel price increases,” said Beasley. “Then, we thought it couldn’t get any worse, but this war has been devastating.”
Ukraine grows enough food every year to feed 400 million people. It produces 42% of the world’s sunflower oil, 16% of its maize and 9% of its wheat. Somalia relies on Ukraine and Russia for all of its wheat imports, while Egypt gets 80% of its grain from the two countries.
The WFP sources 40% of the wheat for its emergency food-relief programmes from Ukraine and, after its operating costs rose by $70m (£58m) a month, it has been forced to halve rations in several countries.
Citing increases in the price of shipping, fertiliser and fuel as key factors – due to Covid-19, the climate crisis and the Ukraine war – Beasley said the number of people suffering from “chronic hunger” had risen from 650 million to 810 million in the past five years.
Beasley added that the number of people experiencing “shock hunger” had increased from 80 million to 325 million over the same period. They are classified as living in crisis levels of food insecurity, a term he described as “marching towards starvation and you don’t know where your next meal is coming from”.
Beasley said that after the economic crash of 2007-09, riots and other unrest erupted in 48 countries around the world as commodity prices and inflation rose.
“The economic factors we have today are much worse than those we saw 15 years ago,” he said, adding that if the crisis was not addressed, it would result in “famine, destabilisation of nations and mass migration”.
“We are already seeing riots in Sri Lanka and protests in Tunisia, Pakistan and Peru, and we’ve had destabilisation take place in places like Burkina Faso, Mali, Chad,” said Beasley. “This is only a sign of things to come.”
Ukraine’s agriculture ministry says more than 20m tonnes of grain that would normally be exported is trapped in the country because of Russia’s blockade of its Black Sea ports.
European leaders, including the French president, Emmanuel Macron, have urged Russia to ease its blockade of Odesa, Ukraine’s main port, to allow exports of grain.
In the long term, Beasley called on the world’s richest people to commit more of their wealth to tackling global hunger, while also urging Vladimir Putin to open up Odesa.
“It is a very, very frightening time,” said Beasley. “We are facing hell on earth if we do not respond immediately. The best thing we can do right now is end that damn war in Russia and Ukraine and get the port open.”
The Guantanamo Bay Detention Camp. (photo: CNN)
At least four detainees who have not been charged with any crime contracted Covid-19 at the notorious maximum security prison base.
The outbreak occurred in Camp Six, a communal block built in 2006 that houses low-value detainees who have never been charged with any crime. Lawyers said the detainees are now living under tightened restrictions.
“We’re worried because there is no clarity about the conditions in which they’re living,” said Mansoor Adayfi, a former detainee at the prison, speaking in his capacity as Guantánamo project coordinator for the London-based advocacy group CAGE. “Are they being treated? How bad is their infection? Have they been taken to the hospital? Nine brothers died at Guantanamo — two, I can tell you, died of medical negligence.”
The Covid outbreak was confirmed by two sources who spoke to The Intercept — one of whom requested anonymity in order to protect people held at the prison from retaliation — as well as a social media post from the sister of a detainee. According to one source, at least one detainee tested positive more than a week ago. (The Department of Defense did not immediately respond to a request for comment.)
“We were saddened by the news that a number of brothers in Guantánamo were infected with the coronavirus,” the sister of one of the sick detainees wrote on Facebook in Arabic.
Adayfi, the former detainee and author of the memoir “Don’t Forget Us Here,” described the camp where the outbreak happened: “Camp Six doesn’t have any windows, except for small slits of light near the high ceilings. You feel like you’re in a deep pit. It’s a building within a building.”
Built by a Halliburton subsidiary and initially used for solitary confinement, Camp Six is now used for communal living. Adayfi said once the communal areas are closed, the cells become isolated from each other and communication is only possible by shouting. “It feels like solitary confinement,” he said. “Camp Six is really terrible. Terrible.”
“I’m concerned not only because of the Covid, but in general,” said Beth Jacob, an attorney working with Guantánamo detainees, of the general health of her five clients in the prison. Two of the men she represents have fallen ill with Covid, she said.
Jacob said the history of brutality faced by Guantánamo detainees could contribute to poor health outcomes. “Their health is bad because of the conditions under which they’ve been held,” she said. “My guys both were held by the CIA, one for a year, one for two years. That was not gentle. It was a long time ago, but it’s still lasting physical damage.”
In 2002, in the wake of the 9/11 attacks, the prison camp at the U.S. base in Guantánamo Bay, Cuba, was opened to hold suspected militants of the “war on terror.” Since then, nearly 800 men and boys have passed through the prison. It became notorious for torture and its extrajudicial detention and treatment of prisoners.
In recent years, the number of detainees dwindled as men — the vast majority of whom never faced charges — were repatriated, released to third countries, or died in detention. Today, 37 men remained imprisoned at the camp, 25 of whom are considered low-risk detainees, and 10 of whom are in active military commission cases.
While all the detainees at Guantánamo have been vaccinated against the coronavirus, how many doses they’ve now received is unknown.
People participate in the annual LA Pride Parade in West Hollywood, California, in 2019. (photo: Agustin Paullier/AFP/Getty Images)
Anti-trans politics spurred by lawmakers and far-right news outlets has renewed fears over community’s safety
Further west, a crew of Proud Boys interrupted a drag queen event in California, intimidating parents and children and screaming transphobic and homophobic insults. In Texas, a state plagued by anti-trans politics, a group of rightwingers screamed abuse and threatened attendees at an adults-only drag brunch.
The incidents, which led to multiple arrests, took place over just one weekend. It was a concentration of anti-LGBTQ+ hate in America that came as a shock to some – but not to the advocates and groups who have been warning of an alarming rise in anti-trans and gay speech over the past year, especially from the far right.
It’s an increase, they warn, that has been spurred by Republican politicians and rightwing media, who have pushed anti-LGBTQ+ talking points and legislation that has seen the rights and safety of an already marginalized group threatened.
“While there is always a fringe, extremist element that opposes LGBTQ equality, there has been an enormous increase in misinformation and lies about LGBTQ people entering mainstream discourse,” said Sarah Kate Ellis, president and CEO of Glaad, one of America’s largest LGBTQ+ rights organizations.
“When you have networks like Fox News and anti-LGBTQ outlets like Daily Wire, Brietbart, and Daily Caller broadcasting horrific lies about LGBTQ people to millions of people, an increase in threats and violence is the natural result.
“When you have lawmakers like Governor Ron DeSantis, Representative Marjorie Taylor-Greene, and Governor Greg Abbott not only spreading misinformation, but targeting LGBTQ families with unbased and harmful legislation and policies, it empowers anti-LGBTQ extremists.”
In March DeSantis, considered a frontrunner for the Republican party’s presidential nomination in 2024, signed a controversial “don’t say gay” bill that prevents teachers from discussing sexual orientation or gender identity in public schools. This month DeSantis moved to ban transition care for transgender youth, and this week suggested he may order Florida’s child protective services to investigate parents who take their children to drag shows.
Taylor-Greene has spoken of drag performers as “child predators” – and has accused Democrats of being “the party of killing babies, grooming and transitioning children, and pro-pedophile politics”. In using the term “groomer”, Taylor-Greene was not alone.
Groomer has become a go-to term for many conservatives – “the most recent scare tactic of choice for the right”, as FiveThirtyEight described it. The news outlet traced the use of the term to early March, when Republicans began using the term in reaction to Democrats criticizing anti-LGBTQ+ education laws.
“The right has manufactured a narrative that gay and trans people are ‘grooming’ children, fueled in large part by Libs of TikTok and magnified by Fox News,” Media Matters for America, a media watchdog, reported in June.
Tucker Carlson, Fox News’ most-watched host, has said discussion of gender identity in schools was tantamount to “grooming seven-year-olds”. “When did our public schools, any schools, become what are essentially grooming centers for gender identity radicals?” Ingraham asked in April, as she discussed Democratic opposition to DeSantis’s “Don’t say gay” law.
The situation has echoes of violence prompted by the QAnon conspiracy theory, which states that a cabal of Democrats and celebrities run a child sex ring. A number of believers of the theory have been arrested for committing crimes based on the made-up theory.
The Anti-Defamation League said the claim that members of the LGBTQ+ community are pedophiles has helped fuel extremism in recent weeks, and it has not escaped notice that many of the threats against LGBTQ+ people have come from white nationalist groups.
“The thing that people kind of miss in the name when we talk about white supremacy is that it’s not just about whiteness, like white people being better than everyone else. It’s about a certain kind of white person being better,” said Victoria Kirby York, deputy executive director of the National Black Justice Coalition, which advocates for Black LGBTQ+ people in the US.
“And unfortunately LGBTQ people fit into that. Whether we’re LGBTQ people of color, like those who were targeted at the night of Pulse, or your white LGBTQ people like those targeted at some of the events last week.
“You’re not the right kind of white person. They’re not the kind of white person that these groups want to be holding power and want to feel safe in this country.”
At the national level, LGBTQ+ rights could be under threat from the expected reversal of Roe v Wade, the supreme court decision that legalized abortion, given the right to same-sex marriage relied on a similar legal basis to that case, and from a wave of anti-LGBTQ+ state bills – more than 320 of which have been introduced so far this year, according to the Human Rights Campaign.
But despite the noise generated by the right wing, polls suggest they are at odds with the general population.
In March, a survey by the Public Religion Research Institute found that 76% of Americans – including 62% of Republicans – favor laws that would protect lesbian, gay, bisexual and transgender Americans from discrimination in jobs, housing and public accommodation.
On Wednesday Joe Biden appeared to recognize this, citing “hateful attacks” as he signed an executive order aimed at curbing discrimination against transgender youth and drying up federal funding for the discredited practice of “conversion therapy”.
The order falls short, however, of the Equality Act, which would place a federal ban on discrimination based on sexual orientation or gender identity in public spaces and federal programs. The legislation passed the House in 2021, but has stalled in the Senate.
Kirby York said proper prosecution of people who attack LGBTQ people or communities, or use hate speech, is important.
“But more than just the laws, we have to have more societal conversations,” she said.
“We have to have some of these hard conversations at the dinner table, at Thanksgiving.
“I’ve seen way too many people just saying I give up, but you are probably the best-equipped person to talk to your family about a different way of seeing people, especially if you know people who look in love and are different than your family. So it really takes all of it.”
Allyson Ward's twin sons were born 10 weeks early with cerebral palsy, and their health insurer denied tens of thousands of dollars in claims that she and her husband are still working to pay off. (photo: Taylor Glascock/KHN/NPR)
Here are their stories — how they got into debt, what they've given up for it and how they're living with the burden.
Double shifts, credit card debt and family loans when twins were born early
Allyson Ward, 43, Chicago
Approximate medical debt: $80,000
Medical issue: childbirth
What happened
There were times after her sons were born 10 years ago when Allyson Ward wondered whether she and her family would lose their home.
On some days, she would tick through a list of friends and family, considering who could take them in. "We had a plan that we were not going to be homeless," Ward recalled.
Ward is a nurse practitioner who works at a neonatal intensive care unit in Chicago. Her husband, Marcus Ward, runs a small nonprofit.
But when the couple's boys, Milo and Theo, were born 10 weeks prematurely, their lives were upended financially.
The twins were diagnosed with cerebral palsy. One required multiple surgeries to fix a breathing disorder. The babies spent more than three months in a NICU.
Ward and her husband scrambled to get the boys the care they needed, including years of physical and occupational therapy. The bills, which topped out at about $80,000, overwhelmed them.
Much of it at first was from hospital care. Then their health plan denied thousands of dollars in claims for the boys' therapies, deeming some unnecessary.
Desperate, Ward and her husband loaded up credit cards, borrowed from relatives and delayed repaying student loans. They moved back to the Midwest from Dallas to be closer to family members who could help them.
In Chicago, Ward took on extra nursing shifts, working day and night several times a week. Her husband, who was finishing a master's degree, watched the babies.
"I wanted to be a mom," she said. "But we had to have the money."
What's broken
Ward and her husband had health insurance through her employer in Texas.
But that's often not enough to protect patients when they have a major medical event. Most Americans who have medical debt had coverage, according to a Kaiser Family Foundation survey.
Even with health insurance, childbirth can be very expensive. One in eight Americans who have health care debt say it was at least partially caused by pregnancy and childbirth.
Ward and her husband are also among tens of millions of Americans who end up with medical debt because their health plan didn't pay for something they believed would be covered. Such insurance issues are the most common form of billing problem cited by Americans with debt.
What's left
Since moving back to the Midwest, Ward and her husband have been slowly paying down the debt.
They bought a small house in Chicago in 2016. And Milo and Theo have been able to stay on grade level at school.
Although cerebral palsy can be severely disabling, the boys can run, ride bikes and go rock climbing, which Ward credits to the many therapists who have worked with them.
Ten years later, though, the family is still paying off nearly $10,000 in medical debt that's on their credit cards.
Ward said sometimes at work she looks sadly at new parents in the NICU, thinking about their financial strains ahead. "They have no idea," she said.
A surgery shatters retirement plans and leads to bankruptcy
Sherrie Foy, 63, Moneta, Virginia
Approximate medical debt: $850,000
Medical issue: colon surgery
What happened
Sherrie and Michael Foy thought they'd made all the right preparations when they moved to rural southwestern Virginia after Michael retired from Consolidated Edison, New York's largest utility.
Sherrie Foy loved horses and had started to rescue unwanted animals. The couple had diligently saved. And they had retiree health insurance through Con Edison.
"We were never rich," Sherrie said. "But we had what we wanted."
Then in 2016, Sherrie, who had lived for years with persistent bowel irritation, had her colon removed. After the surgery, she contracted a dangerous infection and barely survived.
The complications produced nearly $800,000 in bills from the University of Virginia Health System for services that weren't covered by the Foys' health insurance.
When the couple couldn't pay, the university sued Sherrie. The only way past it, the Foys concluded, was to declare bankruptcy.
The nest egg they'd carefully built so her husband could retire early was wiped out. They cashed in a life insurance policy to pay a lawyer and liquidated savings accounts they'd set up for their grandchildren.
"They took everything we had," Foy said. "Now we have nothing."
What's broken
Foy fell victim to a gap in her husband's retiree health insurance plan that capped lifetime coverage at $1 million.
Such caps were more common before the 2010 Affordable Care Act, though some plans with these caps were grandfathered in.
Relatively few patients with medical debt are sued, and some medical centers have been forced to scale back the practice in recent years after news reports about the lawsuits. (The University of Virginia Health System changed its policies following a 2019 KHN investigation.)
But hospitals and other medical providers still rely on the courts to collect from patients.
More broadly, bankruptcy caused directly or partially by medical debt remains a significant problem.
A nationwide KFF poll conducted for this project found about 1 in 8 adults with health care debt have been forced to declare bankruptcy.
What's left
Sherrie said her health has improved.
After the complications from her surgery in Virginia, she returned to New York to seek care at a hospital she said saved her life. That hospital never billed her, she said. She doesn't know why, but she believes she may have qualified for charity care.
The bankruptcy has been devastating. The Foys get by on Michael's pension and their Social Security checks.
The same year they declared bankruptcy, Michael also had a heart attack, and their daughter was diagnosed with breast cancer.
"It was a disaster of a year," Sherrie said. "No one should have to go through this."
Sherrie has no health insurance. She hopes there won't be more major medical bills before she turns 65 and qualifies for Medicare.
A sexual assault and years of calls from debt collectors
Edy Adams, 31, Austin, Texas
Approximate medical debt: $131
Medical issue: sexual assault
What happened
Edy Adams had just graduated from college when she was sexually assaulted in 2013. She was living in Chicago, and believes she was drugged while at a bar.
Adams doesn't remember what happened. When she woke up the next morning bruised and confused, she contacted the police and was directed to get an exam at a local hospital emergency room, which confirmed the assault.
Police never found the perpetrator. Then two years later, Adams started getting calls from debt collectors saying she owed $130.68.
At first, Adams was confused. The hospital had told her that Illinois law prohibited medical providers from charging rape victims for a medical exam.
"I thought someone didn't put in the proper billing code or something," said Adams, who is now a medical student in Texas.
She explained the situation to the debt collector, who said the company would put a note in her file.
Nevertheless, about six months later, another call came from another debt collector seeking the same $130.68.
Adams again explained the situation. A few months later, there was yet another call. It kept going on for years, as her small debt was passed from one collector to another.
Adams tried to contact the hospital, but the bill was not theirs. It had originated with a physicians' practice that had closed.
Sometimes when the debt collectors called, Adams would break down in tears on the phone. "I was frantic," she recalled.
With each call, Adams said, she was forced to relive the worst day of her life and explain her trauma to a disembodied voice in a call center somewhere in America.
"I was being haunted by this zombie bill," she said. "I couldn't make it stop."
What's broken
Federal regulators and consumer advocates for years have documented widespread problems across the debt collection industry, calling out collectors for not doing enough to verify and document bills before pursuing consumers.
The problems are particularly acute in medical debt collection. From 2018 to 2021, people contacted about a medical debt complained most frequently to the Consumer Financial Protection Bureau about being hounded for a debt they did not owe, the agency found.
And in a nationwide poll conducted by KFF, a third of Americans who had been contacted by a collection agency because of a medical or dental bill said the debt was not theirs.
What's left
Adams found relief only after the last debt collector reported the bill to a credit reporting agency, which lowered her credit score. Adams petitioned the agency to have the debt removed, which it quickly did.
Adams said she didn't begrudge most of the people who called her over the years. "It seemed like they were only cogs in this giant debt machine," she said.
Hospital lawsuits and garnished wages on top of diabetes
Nick Woodruff, 37, Binghamton, New York
Approximate medical debt: $20,000
Medical issue: diabetes
What happened
Nick Woodruff's wages were garnished for the first time in 2016.
Woodruff, who was diagnosed with diabetes in his 20s, had a good job. He worked for a truck dealership in this small city 175 miles northwest of New York while his wife, Elizabeth, completed her degree in social work. His job had health benefits. The couple had recently bought a home.
But a small infection on Nick's foot related to the diabetes set off a cascade of medical emergencies and financial struggles that the Woodruffs are still laboring to put behind them.
First Nick's infection spread to the bone and threatened to overwhelm his immune system. He was hospitalized and suffered damage to his heart and kidneys.
More complications followed. Nick slipped going down the stairs, shattering his foot. Doctors had to later amputate it.
Then came thousands of dollars of medical bills, followed by debt collectors.
"We were drowning in medical debt, and he was not doing well," Elizabeth recalled.
The bills were overwhelming and often incomprehensible. "There's a lot that we owe that we don't even know," Elizabeth said.
The Woodruffs withdrew money from their retirement accounts. Their siblings kicked in to pay off some bills.
Elizabeth got a job as a social worker at the hospital, Our Lady of Lourdes Memorial Hospital, a Catholic institution that is now part of the Ascension chain. But that did little to forestall the debt collectors.
The hospital sued Nick, and he was ordered to pay an additional $9,391 before Elizabeth persuaded the hospital to lower the bill by several thousand dollars.
What's broken
The Woodruffs' struggles with debt are a common experience for Americans who have chronic illnesses such as diabetes, heart disease, and cancer.
These people are more likely to end up with medical debt than those who are healthy, a nationwide poll conducted by KFF found.
In fact, illness is the strongest predictor of medical debt, according to an analysis by the Urban Institute, which looked at county-level debt and disease data across the country.
In the 100 U.S. counties with the highest levels of chronic disease, nearly a quarter of adults have medical debt on their credit records. By contrast, in the healthiest counties fewer than 1 in 10 have debt.
What's left
The Woodruffs have managed to pay down some of their debt, and Nick is on disability benefits because he's no longer able to work.
Elizabeth has a new job, so she doesn't have to work for the hospital that sued them.
They said they feel lucky to have been able to pay many of their bills. "I feel sorry for the people who don't have the resources that we did," Nick said.
But the couple remains shocked by the aggressive debt collections.
"This hospital boasts Catholic values and states they take pride in their charity work," Elizabeth said, "but I am taken aback by how callous they have been."
Denied care for a dangerous infection because of past-due bills
Ariane Buck, 30, Peoria, Arizona
Approximate medical debt: $50,000
Medical issue: infection
What happened
Ariane Buck knew it was important to stay on top of his health care.
The young father, who lives with his wife and three children outside Phoenix, had survived cancer when he was a child.
But making ends meet hasn't always been easy for Ariane, who sells health insurance, and his wife, Samantha, a therapist who cares for people with autism.
At times the family has fallen behind on medical bills. Still, they never expected to be denied care.
Just before Father's Day in 2016, Ariane grew very sick. He couldn't hold down food without vomiting. There was blood in his stool.
Samantha called the family's primary care doctor seeking an appointment. But the office turned the Bucks away.
"They said they wouldn't see him because of past due bills," Samantha said, estimating they owed a few hundred dollars.
Ariane's only choice was to go to a hospital emergency room. There he was diagnosed with a serious intestinal infection that required intravenous fluids and antibiotics.
The Bucks were also hit with thousands of dollars of additional bills they couldn't pay.
What's broken
Hospitals for decades have been required by federal law to provide emergency medical care to any patients who need it, regardless of their ability to pay.
But many medical providers, including physicians, have policies that allow them to turn away patients with past-due bills for nonurgent care.
The practice is surprisingly common. Nationwide, 1 in 7 Americans with health care debt say they have been denied care because of money they owe, a poll conducted by KFF found.
On top of that, tens of millions of Americans ration their care. About two-thirds of U.S. adults with debt from medical or dental bills say they or a member of their household have put off getting care they needed because of costs.
What's left
Buck recovered from the infection and is now in good health. But the family's medical debt has swelled to more than $50,000, from Ariane's bills and Samantha's.
Samantha went to the emergency room twice in the past several years with painful cases of endometriosis.
The Bucks have taken out loans, loaded up their credit cards, and sought help from charities.
"We've all had to cut back on everything," Buck said. The kids wear hand-me-downs. They scrimp on school supplies and rely on family for Christmas gifts. A dinner out for chili is an extravagance.
"It pains me when my kids ask to go somewhere, and I can't," Buck said. "I feel as if I've failed as a parent."
The couple is preparing to file for bankruptcy.
Nineteen surgeries over five years. Then they lost their house.
Cindy Powers, 52, Greeley, Colorado
Approximate medical debt: $250,000
Medical issue: twisted intestine
What happened
Cindy Powers was 34 when doctors discovered she had a twisted intestine, a potentially life-threatening condition that doctors told her required immediate surgery.
She and her husband, Jim, were living outside Dallas at the time, where Jim had a job with a school district.
They had health insurance. But it couldn't protect them from the flood of medical bills that swamped them after Cindy's diagnosis.
Cindy's first surgery, which lasted nine hours, would be followed by 18 more operations at hospitals across the Dallas-Fort Worth area. "Nobody was able to come up with a solution," Jim said.
Cindy had recurring infections and hernias. Persistent pain left her addicted to the opioids she'd been prescribed.
"It was five years of hell," Jim said of his wife's medical ordeal.
By the time a surgeon finally repaired Cindy's intestines in 2009, the couple had some $250,000 in medical debt. They declared bankruptcy.
The Powers also ended up losing their home when their mortgage was sold and the new lender rejected the payment plan set up through the bankruptcy.
A few years later, their adult daughter died. And in 2017, Cindy and Jim moved back to Colorado, where Cindy was from.
What's broken
How much medical debt contributes to housing insecurity is difficult to measure, as many people forced out of their homes face a mix of financial challenges.
But a recent nationwide poll by KFF suggests that the debt from health care is forcing millions of people from their homes.
About 1 in 12 Americans with health care debt say they have lost their home to eviction or foreclosure at least in part because of what they owed, the survey found.
And about 1 in 5 say they or someone in their household have moved in with family or friends or made some other change in their living arrangement because of health care debt.
What's left
After the bankruptcy and the move, the couple slowly got back on their feet financially.
Jim began work at an animal welfare group. Cindy, whose health has improved, got a job as well. The couple adopted their daughter's girl, who's now in sixth grade.
Then Jim needed prostate surgery. As he worked to scrape together the $1,100 he owed, he was sued by a debt collector.
"Things have got to change," Jim said.
Damaged credit delays dream of buying a home
Joe Pitzo, 42, Brookfield, Wisconsin
Approximate medical debt: $350,000
Medical issue: cancer
What happened
Joe Pitzo and his wife, Amanda, had been married only five months when Joe was diagnosed with brain cancer in 2018. He would need brain surgery and extensive rehab.
They'd been planning to buy a house for their blended family of five children. Instead, they shifted their attention to doctor's visits, insurance paperwork, and hospital bills. And their finances fell apart.
"This just took a major toll on my credit," Joe said. "It went down to next to nothing."
Joe had insurance through his employer. Prior to his brain surgery, the couple confirmed that the surgeon and hospital were in their insurer's network. But around 4 p.m. the day before the procedure, their insurer said a device the surgeons planned to use was medically unnecessary. It was not covered.
Joe and Amanda proceeded with the surgery, figuring they could deal with the bills later.
The bills, it turned out, topped $350,000.
Joe said the debt dragged down his credit score by several hundred points.
Their best hope for a home loan became Amanda, who didn't have much credit, she said. She'd never taken out a mortgage or a car loan.
What's broken
Difficulties with health insurance are a common feature of medical debt in the U.S.
Two-thirds of Americans with health care debt say they haven't fully paid a bill because they were expecting their health plan to cover it, according to a nationwide survey conducted by KFF.
But health insurance rules and restrictions are often so complex that even diligent patients struggle to make sense of them.
It's also not uncommon for medical debts to hurt patients' credit scores. There's growing pressure to change that.
This spring, the three leading credit agencies announced they would stop using small past-due medical bills in credit score calculations. And the federal Consumer Financial Protection Bureau plans to investigate whether any health care bills should be counted.
What's left
The Pitzos managed to get the hospital to reduce their charges to about $30,000.
They worked to build Amanda's credit so she could apply for the loan and were finally able to buy a house in spring 2022. They're still making payments on about $19,000 in medical bills.
"It makes me sick about medical costs and how this whole thing is done," Amanda said.
Saudi Crown prince Mohammed bin Salman. (photo: Getty Images)
US president is travelling to Saudi Arabia next month, where he is expected to engage in some capacity with Crown Prince Mohammed bin Salman
Biden's first trip to the Gulf region as president has been seen by rights activists as being at odds with his promise to put human rights at the heart of US foreign policy.
During a four-day trip from 13 to 16 July, Biden is planning to visit Israel, the occupied West Bank and the kingdom. The visit will culminate with a major gathering of regional leaders in Jeddah, the Saudi port city, where Biden is expected to engage in some capacity with the crown prince.
"I'm not going to meet with MBS. I'm going to an international meeting and he's going to be part of it," Biden told reporters when asked how he will handle the topic of the 2018 murder of Jamal Khashoggi.
President Biden on how he will handle Khashoggi killing during Saudi Arabia trip: "The same way I've been handling it. I'm not going to meet with MBS. I'm going to an international meeting and he's going to be part of it..." pic.twitter.com/mD2cKtRAM2
— CSPAN (@cspan) June 17, 2022
A US resident and former columnist for Middle East Eye, Khashoggi was assassinated and dismembered at the Saudi consulate in Istanbul on 2 October 2018, after going there to get paperwork for his upcoming marriage. His remains have never been found.
As a presidential candidate, Biden condemned US-Saudi Arabia relations under the Trump administration and pledged to make the kingdom a "pariah", joining much of his Democratic Party in calling for a rethinking of Washington's ties with the kingdom.
But since taking office, he has refused to impose sanctions on Mohammed bin Salman, following the release of a US intelligence report that described the Saudi crown prince's alleged involvement in Khashoggi's murder.
'Betrayal'
Amid skyrocketing oil prices and record inflation at home, Biden - who had once characterised the "battle between democracies and autocracies" as the central guiding principle of his foreign policy - has been forced into a sharp U-turn.
As Europe looks to cut its energy dependence on Russia, following the invasion of Ukraine, the Biden administration has reached out to old adversaries including Iran, Saudi Arabia and Venezuela to plug the US oil gap.
Keeping gas prices low has been a major priority for Biden and the Democrats, especially ahead of the pivotal midterm elections in November.
According to several media reports, Biden's trip to the region is also an attempt to forge closer ties between Saudi Arabia and Israel. White House Middle East coordinator Brett McGurk has been trying to broker economic and security agreements as the two countries work toward establishing ties.
In the run-up to the trip, US lawmakers have urged the president to ensure that Washington's ties with Riyadh advance American interests, and not the other way around.
A letter to Biden earlier this month from the heads of multiple House committees said: "Until Saudi Arabia shows signs of charting a different course, and in light of deliberations regarding a potential visit to the Kingdom during which you may have an opportunity to meet with King Salman and other regional heads of state, we encourage you to redouble your efforts to recalibrate the US-Saudi relationship."
The trip has been denounced by Saudi dissidents and activists, with several accusing Biden of "hypocrisy" and "betrayal".
"President Biden came into office promising accountability for the crown prince's reign of terror. But with one fell swoop, Biden is gambling all hope of justice for MBS's countless victims like my father," Abdullah Alaoudh, the son of jailed Islamic scholar Salman al-Awda, told Middle East Eye earlier this month.
"It was salt in the wound when Trump bragged about 'saving [MBS’s] @$$.’ But how is Biden any better if he kisses the ring of this murderer, this torturer, this war criminal and autocrat?
A polar bear. (photo: Keith Ladzinski/NatGeo)
Global warming is still threatening polar bears, but new research complicates the story.
Decades ago, powerful images like these came to represent the wrath of climate change. They tell a compelling story: Global warming is melting Arctic sea ice, which polar bears need to survive. Without it, they’ll perish.
This is a true story. In the last two decades, the Arctic has lost about a third of its winter sea ice, and it continues to melt at a rate of about 13 percent each decade. As a result, polar bears are at risk of extinction. One 2020 study found that if polluters don’t curb their greenhouse gas emissions — the primary driver of modern global warming — all but a few populations of polar bears will vanish by the end of the century.
But there is a very small glimmer of hope for these iconic predators, revealed today in a study published in the journal Science. It finds that a newly documented population of polar bears in Greenland seems to be surviving without much sea ice for most of the year. Instead of hunting only on ice that forms in the sea, these bears are also using ice that breaks off of glaciers that flow into fjords from land, which is available year-round. Not many studies have documented this behavior before.
The authors suggest that in a warming world, regions with glacial ice might be strongholds for the species, helping them hang on.
“These areas might see polar bears persist for longer,” said Steven Amstrup, the chief scientist at Polar Bears International, who is not affiliated with the new study. If the bears didn’t have abundant glacial ice, he said, “we wouldn’t have polar bears in that area right now.”
This is big news for an animal with so much symbolism, but experts warn that it’s not exactly good news. Instead, it foreshadows the final act of a tragedy, revealing where the last remnants of a species could live.
Polar bears need fat, and so they also need sea ice
The life of a polar bear depends on fat. They need body fat to stay warm in the frigid Arctic, and they also need fat to stay hydrated. Because most of the freshwater around them is frozen for much of the year, they often rely, instead, on metabolic water — a byproduct of the breakdown of the fat they consume.
That’s why seals are an ideal food source — they’re basically one big pile of calorie-dense blubber. Polar bears hunt them nearly exclusively for food, and can chow down on 100 pounds of blubber in a single sitting.
But there’s a catch: This fatty feast is typically only possible when there’s sea ice. The bears snatch seals when they come onto the ice to molt or have babies, or when seals poke their heads through it to breathe.
In a typical year, Arctic sea ice shrinks during the summer (when bears in some regions will fast) and then forms again in the winter (allowing the bears to hunt). Climate change, however, is blasting the Arctic with heat — it has warmed about twice as fast as the global average — drastically shortening the number of days available to hunt.
“There’s no food without ice,” said Andrew Derocher, a professor and polar bear expert at the University of Alberta, who is also not affiliated with the paper.
The new study doesn’t contradict any of this. “As Arctic sea ice goes away, we see consequences for polar bears,” said Kristin Laidre, the paper’s lead author and an associate professor at the University of Washington. But the study does suggest that some populations of bears might be less sensitive to shrinking sea ice.
Scientists documented an unusual population of polar bears in Greenland
It’s hard to imagine an animal more challenging to study than the polar bear, especially in a place like Greenland. Beyond a tolerance for cold weather, researchers often need a helicopter or two just to find the animals, which have evolved to remain hidden so they can sneak up on prey.
That’s one reason why this study is such a big deal: It reveals a never-before-documented population of polar bears in southeast Greenland, which is largely distinct from populations in the northeast. It’s the most genetically distinct polar bear population in the world, Laidre says, suggesting that it’s been isolated for a while.
The most intriguing results, however, have more to do with these animals’ lifestyles than with their genetics. In this part of Greenland, sea ice is especially scarce. There’s no usable sea ice for more than 250 days of the year, the authors write, and polar bears can’t fast that long. They lose about two pounds of body fat per day of fasting, Derocher said.
Yet this population of bears has survived for hundreds of years, Laidre says, so clearly they’re finding food. The question is, how?
First, a pedantic yet important breakdown of ice: There’s sea ice, which is frozen seawater, but there are also glaciers, which are made of snow (freshwater) compressed over time into large sheets of ice that flow like a slow-moving river.
In a few parts of the world home to polar bears — including Svalbard and southeast Greenland — large glaciers run into the sea, where they crumble into pieces. They’re a bit like conveyer belts, said Twila Moon, a study co-author and scientist at the National Snow and Ice Data Center. As one piece breaks off into the sea, there’s another to replace it.
What the researchers found is that polar bears in southeast Greenland can use these glacial chunks to hunt seals, even though icebergs are much more varied and jagged than sea ice. The finding suggests that these bears can hunt on any ice surface if there’s food underneath. (Some polar bears in northern Europe likely also use glaciers to live and hunt, for at least part of the year, Derocher said.)
And this approach may be key to their survival. Even in the summer, there’s still plenty of glacial ice available after the sea ice has melted away. The glaciers here are huge and incredibly thick, Moon said, so although they melt, they continue to dump ice into the fjords. That’s the glimmer of hope: Habitats with glacial ice could be refuges for polar bears in a warming world.
No polar bears are safe as the planet heats up
Despite the new evidence, Derocher, of the University of Alberta, doesn’t see this study as good news. For one, there aren’t many polar bear habitats that have glacial ice, he said. So even if these habitats become refuges, they won’t be able to support many bears. (And as of yet, researchers don’t have plans to ship polar bears to these regions.)
Plus, glaciers are melting quickly, too — including the ones in Greenland, which is home to one of only two ice sheets on the planet. The country is losing roughly 234 billion tons of its glacial ice sheet per year, which is melting seven times faster than it was in the 1990s. (Remarkably, melting Greenland ice alone contributes to roughly 0.5 millimeters of sea-level rise globally.)
It’s also not clear that the polar bears in the study are thriving, Derocher says. The researchers found that female bears have a lower birth rate and less body mass compared to some other populations — those are “red flags,” he said. Because the bears are so isolated, they could also be at risk of genetic problems that arise from inbreeding, he added.
“If the bears are not in a very good condition in southeast Greenland already, that’s an indicator of potential vulnerability to warming,” he said.
Laidre explains that we don’t know much about the health of these bears — after all, her team only just documented them. “I think people are tempted to give it a hopeful spin, but we just don’t know how they’re doing,” she said. The logical next step, she added, is to monitor the new population to determine whether it’s healthy and stable or in decline, such as from a lack of food.
Ultimately, as many wildlife stories go, the only way to save this species is by quickly cutting back carbon emissions, experts say. Those images of polar bears seemingly suffering as the ice melts are dramatic, but they’re not wrong. The benefit of glacial ice complicates but doesn’t change the story of their plight.
“Glacial ice is something that we have to consider when we think about where polar bears might be in an ice-free Arctic,” Laidre said. Southeast Greenland might be something of a stronghold, she said, but “these bears are subject to climate warming, just like all of the other bears.”
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