Category: Academic Reportage

Source: The Conversation – USA – By Carly Thomsen, Associate Professor of English and Creative Writing, Rice University

The latest Supreme Court case related to abortion is not technically about the legal right to have one. When the court heard oral arguments on Dec. 2, 2025, the word “abortion” came up only three times. The first instance was more than an hour into the 82-minute hearing.

Instead, First Choice Women’s Resource Centers Inc. v. Platkin hinges on whether First Amendment rights to freedom of speech and association give a chain of five crisis pregnancy centers in New Jersey the right to protect its donor records from disclosure to state authorities. The centers are Christian nonprofits that try to stop pregnant women from obtaining abortions.

There are more than 2,500 of them across the United States.

I’ve done extensive research regarding crisis pregnancy centers, and I’ve written about that work in more than a dozen articles in academic journals, books and the media.

Resembling doctors’ offices in appearance only

Many critics of the centers call them “fake clinics” because the centers appear to be medical facilities when they are not.

Often, their waiting rooms look like those at doctors’ offices, and their volunteers wear white lab coats or medical scrubs. And they offer free services that people think of as medical, such as pregnancy tests and ultrasounds. But these pregnancy tests are typically the same kind that drugstores sell over the counter.

They’re able to function without medical professionals because it’s generally legal in the U.S. to operate ultrasound machines without any specialized training. They ask clients to read their own pregnancy tests so they can avoid laws regarding medical licensing.

Under current law, crisis pregnancy centers don’t need to tell their clients that they are not medical clinics. Nor must they disclose that they don’t provide abortions or birth control.

After California enacted a law that would force the centers to provide their clients with accurate information, the Supreme Court ruled in 2018 that it was unconstitutional.

The centers also don’t have to tell their clients that they are not bound by the Health Insurance Portability and Accountability Act, or HIPAA, or other patient privacy laws. They don’t have to say that few, if any, members of their staff are licensed medical professionals or that their ultrasounds are not typically intended to diagnose anything.

Crisis pregnancy centers far outnumber the 765 abortion clinics operating across the United States as of 2024 – two years after the Supreme Court allowed states to ban abortion in its Dobbs v. Jackson ruling.

Deceptive by design

The centers’ deceptive tactics appear before clients walk through their doors.

A team of researchers found that 91.3% of crisis pregnancy center websites misleadingly imply that they provide medical services.

In many cases, as I’ve previously explained, these centers are branded confusingly, with names suggesting they are clinics that provide abortions.

Their websites and mobile vans are often emblazoned with medical imagery.

Many operate near abortion clinics, adding to the confusion.

Researchers found that 80% of crisis pregnancy center websites include false information about abortion, including that it is linked to mental health issues, infertility and breast cancer.

All of these claims have been disproved. Many major medical organizations have issued statements to this effect, including the American College of Obstetricians and Gynecologists, the American Psychological Association and the Mayo Clinic.

In response to these concerns, crisis pregnancy centers often reference the goods and services they offer to women in need. But the resources they offer are often slim – far less than what is necessary to care for a baby – and may be contingent on participation in the Christian centers’ classes on parenting and other topics.

First Choice, when asked for comment, said that it “provides women and families free, compassionate care, including ultrasounds, educational resources, baby clothes and food.”

First Choice’s practices

First Choice, the organization that brought this case, uses many of these tactics.

Four of its five centers in New Jersey are located within one mile of an abortion clinic.

Its homepage includes a photo of a woman dressed like a medical professional, wearing teal scrubs with a stethoscope around her neck.

The chain’s name, First Choice Women’s Resource Center, uses the language of “choice,” which has long been associated with the abortion rights movement.

First Choice’s website suggests that abortion can lead to depression, eating disorders and addiction. It makes claims about the prevalence of what it calls “post-abortion stress disorder,” a nonmedical term used by anti-abortion activists who have sought to falsely frame abortion as if it is something most women regret.

In reality, long-term studies show that 95% of women who have had abortions believe they made the right decision.

State consumer fraud investigation

In November 2023, New Jersey Attorney General Matthew Platkin began investigating First Choice Women’s Resource Center to see whether the nonprofit had violated state consumer fraud laws by misrepresenting its services to clients, donors and the public.

Part of that probe, which was interrupted by the litigation that culminated in this Supreme Court case, included requesting documents about the center’s donors.

The next month, First Choice sued Platkin in federal court.
The lawsuit asserted that the First Amendment protects the privacy of First Choice’s donors.

A district court and appeals and court determined that this case should be heard in state court.

But instead of pursuing the case at the state level, First Choice appealed directly to the Supreme Court, which decided in June 2025 to take the case.

New Jersey’s fraud investigation and the “sweeping subpoena” it issued “may chill First Amendment freedoms,” said attorney Erin Hawley, when she argued the case before the Supreme Court on behalf of First Choice.

Following oral arguments, Platkin released a statement that said “First Choice – a crisis pregnancy center operating in New Jersey – has for years refused to answer questions about its operations in our state and the potential misrepresentations it has been making.”

Analyzing training manuals

Many crisis pregnancy centers like First Choice are affiliated with large networks that provide training materials.

For example, First Choice is affiliated with Heartbeat International, a Christian anti-abortion global network, which says that it has 45,000 active volunteers. Because those volunteers undergo training, I’ve been learning more about the centers by examining the network’s volunteer and staff manuals.

I’ve analyzed nearly 1,600 pages of these materials put together by large anti-abortion networks, including Heartbeat International. Along the way, I’ve tracked medical misinformation and references to confidentiality, privacy and data retention.

These training guides instruct volunteers to highlight the “medical services” their center provides and to omit “Christian language” from their branding and materials.

But the manuals I examined indicate that advancing their religious beliefs, rather than providing health care, is the centers’ primary goal. One manual says, “Heartbeat International is convinced that the loving outreach of a pregnancy center in the name of Jesus Christ is the most valuable ‘service’ provided, no matter what else is on the list of services.”

Heartbeat International’s Talking About Abortion manual includes medical misinformation about the supposed risks of having an abortion, such as cancer and mortality risks. It encourages volunteers to share these claims with clients.

None of that information, which includes official-sounding statistics, is backed by peer-reviewed scientific research.

Client privacy not protected

Although First Choice sued in part due to concerns about its donors’ privacy, crisis pregnancy centers do not necessarily protect the privacy of the health data they collect from their clients.

The training manuals use the language of HIPAA, referencing the policy itself or its protections of private medical data. At the same time, the manuals inform volunteers that crisis pregnancy centers are “not governed by HIPAA” precisely because they are not medical clinics.

Instead, the manuals make clear that the centers can offer clients the opportunity to request confidentiality. But as stated in Heartbeat International’s Medical Essentials training manual, they “are under no obligation to accept or abide” by that request.

To New Jersey Attorney General Platkin, these kinds of approaches seemed worthy of investigation.

Fewer obstacles ahead?

Should the Supreme Court majority rule in favor of First Choice, I believe states may have more trouble trying to investigate crisis pregnancy centers’ practices, while anti-abortion networks may face even fewer obstacles to their efforts to publicize medical misinformation.

Indeed, Aimee Huber, First Choice’s executive director, has said she hopes other states would “back off” any other efforts to probe crisis pregnancy centers.

But based on my 20 years of experience researching crisis pregnancy centers, I also believe that this case can be helpful for abortion rights supporters because it shows that the crisis pregnancy center industry understands that greater public awareness of its practices may restrict its power.

Heartbeat International did not respond to a request for comment by The Conversation.

Carly Thomsen consults for Reproductive Health and Freedom Watch. She has contributed to the Public Leadership Institute’s policy playbook regarding crisis pregnancy centers and she has testified in support of Vermont’s legislation regulating crisis pregnancy centers.

– ref. Supreme Court case about ‘crisis pregnancy centers’ highlights debate over truthful advertising standards – https://theconversation.com/supreme-court-case-about-crisis-pregnancy-centers-highlights-debate-over-truthful-advertising-standards-271254

Source: The Conversation – USA – By Arlene Stein, Distinguished Professor of Sociology, Rutgers University

Masked officers conduct immigration raids. National Guard troops patrol American cities, and protesters decry their presence as a “fascist takeover.” White supremacists openly proclaim racist and antisemitic views.

Is the United States sliding into fascism? It’s a question that divides a good portion of the country today.

Embracing a belief in American exceptionalism – the idea that America is a unique and morally superior country – some historians suggest that “it can’t happen here,” echoing the satirical title of Sinclair Lewis’ 1935 book about creeping fascism in America. The social conditions required for fascism to take root do not exist in the U.S., these historians say.

Still, while fascist ideas never found a foothold among the majority of Americans, they exerted considerable influence during the period between the first and second world wars. Extremist groups like the Silver Shirts, the Christian Front, the Black Legion and the Ku Klux Klan claimed hundreds of thousands of members. Together they glorified a white Christian nation purified of Jews, Black Americans, immigrants and communists.

During the 1930s and early ’40s, fascist ideas were promoted and cheered on American soil by groups such as the pro-Nazi German American Bund, which staged a mass rally at New York’s Madison Square Garden in February 1939, displaying George Washington’s portrait alongside swastikas.

The Bund also operated lodges, storefronts, summer camps, beer halls and newspapers across the country and denounced the “melting pot.” It encouraged boycotts and street brawls against Jews and leftists and forged links to Germany’s Nazi party.

Yet the Bund and other far-right groups have largely vanished from public memory, even in communities where they once enjoyed popularity. As a sociologist of collective memory and identity, I wanted to know why that is the case.

The Bund in New Jersey

My analysis of hundreds of oral histories of people who grew up in New Jersey in the 1930s and ’40s, where the German American Bund enjoyed a particularly strong presence, suggests that witnesses saw them as insignificant, “un-American” and unworthy of remembrance.

But the people who rallied with the Bund for a white, Christian nation were ordinary citizens. They were mechanics and shopkeepers, churchgoers and small businessmen, and sometimes elected officials. They frequented diners, led PTA meetings and went to church. They were American.

When they were interviewed decades later, many of those who had seen Bundists up close in their communities remembered the uniforms, the swastika armbands, the marching columns. They recalled the local butcher who quietly displayed sympathy for Nazism, the Bund’s boycotts of Jewish businesses, and the street brawls at Bund rallies.

German American interviewees, who remember firsthand the support the Bund enjoyed before the U.S. entered World War II, 50 years later laughed at family members and neighbors who once supported the organization. Even Jewish interviewees who recalled fearful encounters with Bundists during that period tended to minimize the threat in retrospect. Like their German American counterparts, they framed the Bund as deviant and ephemeral. Few believed the group, and the ideas for which it stood, were significant.

I believe the German Americans’ laughter decades after the war was over, and after the revelations of the mass murder of European Jews, may have been a way for them to distance themselves from feelings of shame or discomfort. As cognitive psychologists show, people tend to erase or minimize inconvenient or painful facts that may threaten their sense of self.

Collective memories are also highly selective. They are influenced by the groups – nation, community, family – in which they are members. In other words, the past is always shaped by the needs of the present.

After World War II, for example, some Americans reframed the major threat facing the U.S. as communism. They cast fascism as a defeated foreign evil, while elevating “reds” as the existential threat. Collectively, Americans preferred a simpler national tale: Fascism was “over there.” America was the bulwark of democracy “over here.” This is one way forgetting works.

Communities will remember what they have forgotten or minimized when history is taught, markers are erected, archives are preserved and commemorations are staged. The U.S. has done that for the Holocaust and for the Civil Rights Movement. But when it comes to the history of homegrown fascism, and local resistance to it, few communities have made efforts to preserve this history.

Remembering difficult pasts

At least one community has tried. In Southbury, Connecticut, community members erected a small plaque in 2022 to honor townspeople who in 1937 organized to keep the Bund from building a training camp there. The inscription is simple: “Southbury Stops Nazi Training Camp.”

The story it tells provides more than an example of local pride – it’s a template for how communities can commemorate the moments when ordinary citizens said “no.”

When Americans insist that “it can’t happen here,” they exempt themselves from vigilance. When they ignore or discount extremism, seeing it as “weird” or “foreign,” they miss how effectively such movements borrowed American idioms, such as patriotism, Christianity and law and order, to further hatred, violence and exclusion.

Research shows that some Americans have been drawn to movements that promise purity, unity and order at the expense of their neighbors’ rights. The point of remembering such histories is not to wallow in shame, nor to collapse every political dispute into “fascism.” It is to offer an accurate account of America’s democratic vulnerabilities.

Arlene Stein does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. America faced domestic fascists before and buried that history – https://theconversation.com/america-faced-domestic-fascists-before-and-buried-that-history-268978

Source: The Conversation – USA (2) – By Toni Lyn Morelli, Adjunct Full Professor of Environmental Conservation, UMass Amherst; U.S. Geological Survey

The idea began in California’s Sierra Nevada, a towering spine of rock and ice where rising temperatures and the decline of snowpack are transforming ecosystems, sometimes with catastrophic consequences for wildlife.

The prairie-doglike Belding’s ground squirrel (Urocitellus beldingi) had been struggling there as the mountain meadows it relies on dry out in years with less snowmelt and more unpredictable weather. At lower elevations, the foothill yellow-legged frog (Rana boylii) was also being hit hard by rising temperatures, because it needs cool, shaded streams to breed and survive.

As we studied these and other species in the Sierra Nevada, we discovered a ray of hope: The effects of warming weren’t uniform.

We were able to locate meadows that are less vulnerable to climate change, where the squirrels would have a better chance of thriving. We also identified streams that would stay cool for the frogs even as the climate heats up. Some are shaded by tree canopy. Others are in valleys with cool air or near deep lakes or springs.

These special areas are what we call climate change refugia.

Identifying these pockets of resilient habitat – a field of research that was inspired by our work with natural resource managers in the Sierra Nevada – is now helping national parks and other public and private land managers to take action to protect these refugia from other threats, including fighting invasive species and pollution and connecting landscapes, giving threatened species their best chance for survival in a changing climate.

Across the world, from the increasingly fire-prone landscapes of Australia to the glacial ecosystems at the southern tip of Chile, researchers, managers and local communities are working together to find and protect similar climate change refugia that can provide pockets of stability for local species as the planet warms.

A new collection of scientific papers examines some of the most promising examples of climate change refugia conservation. In that collection, over 100 scientists from four continents explain how frogs, trees, ducks and lions stand to benefit when refugia in their habitats are identified and safeguarded.

Saving songbirds in New England

The study of climate change refugia – places that are buffered from the worst effects of global warming – has grown rapidly in recent years.

In New England, managers at national parks and other protected areas were worried about how species are being affected by changes in climate and habitat. For example, the grasshopper sparrow (Ammodramus savannarum), a little grassland songbird that nests in the open fields in the eastern U.S. and southern Canada, appears to be in trouble.

We studied its habitats and projected that less than 6% of its summer northeastern U.S. range will have the right temperature and precipitation conditions by 2080.

The loss of songbirds is not only a loss of beauty and music. These birds eat insects and are important to the balance of the ecosystem.

The sand plain grasslands that the grasshopper sparrow relies on in the northeastern U.S. are under threat not only from changes in climate but also changes in how people use the land. Public land managers in Montague, Massachusetts, have used burning and mowing to maintain habitat for nesting grasshopper sparrows. That effort also brought back the rare frosted elfin butterfly for the first time in decades.

Protecting Canada’s vast forest ecosystems

In Canada, the climate is warming at about twice the global average, posing a threat to its vast forested landscapes, which face intensifying drought, insect outbreaks and destructive wildfires.

We have been actively mapping refugia in British Columbia, looking for shadier, wetter or more sheltered places that naturally resist the worst effects of climate change.

The mapping project will help to identify important habitat for wildlife such as moose and caribou. Knowing where these climate change refugia are allows land-use planners and Indigenous communities to protect the most promising habitats from development, resource extraction and other stressors.

British Columbia is undertaking major changes to forest landscape planning in partnership with First Nations and communities.

Lions, giraffes and elephants (oh, my!)

On the sweeping vistas of East Africa, dozens of species interact in hot spots of global biodiversity. Unfortunately, rising temperatures, prolonged drought and shifting seasons are threatening their very existence.

In Tanzania, working with government agencies and conservation groups through past USAID funding, we mapped potential refugia for iconic savanna species including lions, giraffes and elephants. These areas include places that will hold water in drought and remain cooler during heat waves. The iconic Serengeti National Park, home to some of the world’s most famous wildlife, emerged as a key location for climate change refugia.

Combining local knowledge with spatial analysis is helping prioritize areas where big cats, antelope, elephants and the other great beasts of the Serengeti ecosystem can continue to thrive – provided other, nonclimate threats such as habitat loss and overharvesting are kept at bay.

The Tanzanian government has already been working with U.S.-funded partners to identify corridors that can help connect biodiversity hot spots.

Hope for the future

By identifying and protecting the places where species can survive the longest, we can buy crucial decades for ecosystems while conservation efforts are underway and the world takes steps to slow climate change.

Across continents and climates, the message is the same: Amid our rapidly warming world, pockets of resilience remain for now. With careful science and strong partnerships, we can find climate change refugia, protect them and help the wild things continue to thrive.

Toni Lyn Morelli receives funding from U.S. Geological Survey.

Diana Stralberg receives funding from Natural Resources Canada, the Governments of the Northwest Territories and British Columbia, Canada, and the Wilburforce Foundation.

– ref. Where the wild things thrive: Finding and protecting nature’s climate change safe havens – https://theconversation.com/where-the-wild-things-thrive-finding-and-protecting-natures-climate-change-safe-havens-270350

Source: The Conversation – USA (2) – By Barbara Kates-Garnick, Professor of Practice in Energy Policy, The Fletcher School, Tufts University

Everyone – politicians and the public – is talking about energy costs. In particular, they’re talking about data centers that drive artificial intelligence systems and their increasing energy demand, electricity costs and strain on the nation’s already overloaded energy grid.

As a former state energy official and utility executive, I know that many of the underlying questions involving energy affordability are very complex and have been festering for decades, in part because of how many groups are involved. Energy projects are expensive and take a long time to build. Where to build them is often also a difficult, even controversial, question. Consumers, regulators, utilities and developers all value energy reliability but have different interests, cost sensitivities and time frames in mind.

The problem of high energy prices is not new, but it is urgent. And it comes at a time when the U.S. is deeply divided on its approaches to energy policy and the politics of solving collective problems.

Rising costs

From September 2024 to September 2025, average U.S. residential electricity prices have risen 7.4%, from 16.8 to 18 cents per kilowatt-hour. Government analysts expect prices will continue to rise and outpace inflation in 2026.

With household earnings basically flat when adjusted for inflation, these increases hit consumers hard. They take up higher percentages of household expenses – especially for lower-income households. Electricity prices have effects throughout the economy, both directly on consumers’ budgets and indirectly by raising operating costs for business and industry, which pass them along to customers by raising prices for goods and services.

The problem

By 2030, energy analysts expect U.S. electricity demand to rise about 25%, and McKinsey estimates that data centers’ energy use could nearly triple from current levels by that year, using as much as 11.7% of all electricity in the U.S. – more than double their current share.

The nation’s current electricity grid is not ready to supply all that energy. And even if the electricity could be generated, transmission lines are aging and not up to carrying all that power. Their capacity would need to be expanded by about 60% by 2050.

Orders of key generating equipment often face multiyear delays. And construction of new and expanded transmission lines has been very slow.

A Brattle Group analysis estimates all that new and upgraded equipment could cost between US$760 billion and $1.4 trillion in the next 25 years.

The reasons

The enormous scale of the work needed is a result of a lack of investment over time and delays in the investments that have been made.

For instance, since at least 2011 there has been an effort to bring Canadian hydropower to the New England electricity grid. Political opposition to cutting a path for a transmission line through forestland meant the project was subjected to a statewide referendum in Maine – and then a court case that overturned the referendum results. During those delays, inflation raised the estimated price of the project by half, from $1 billion to $1.5 billion – an added cost that will be paid by Massachusetts electricity customers.

That multiyear effort is just one example of how the vast web of companies that generate power, transmit it from power plants to communities, and distribute it to homes and businesses complicates attempts to make changes to the power grid.

State and federal government agencies have roles in these processes. States’ public utilities commissions oversee the utility companies that distribute power to customers. The Federal Energy Regulatory Commission oversees connections of power generators to the grid and the transmission lines that move electricity across state lines.

Often, those efforts aren’t aligned with each other, leading to delays over jurisdiction and decision-making.

For instance, as new generators prepare to operate, whether they are solar farms or gas-fired power plants, they need permission from FERC to connect to the transmission grid. The commission typically requests technical engineering studies to determine how the project would affect the existing system. Delays in this process increase the timeline and cost of development and postpone adding new capacity to the grid.

The costs

A key question for regulators and consumers alike is who should pay for adding more electricity to the grid and making the system more reliable.

Utilities traditionally charge customers for the costs of generating and delivering power. And it’s not clear how much power the data centers will ultimately require.

Some large data centers have taken to paying to build their own on-site power plants, though often they can supply energy to the grid as well.

In some states, efforts have begun to address public concern about electricity bills. In November 2025, two utility commissioners in Georgia, who had consistently approved electricity rate hikes over the previous two years, were voted out of office in a landslide.

New Jersey’s Gov.-elect Mikie Sherrill has pledged to declare a utility-price emergency and freeze costs for a year.

In New York, Gov. Kathy Hochul has paused implementation of state law, driven by environmental concerns, requiring that all new buildings over seven stories tall only use electricity and not natural gas or other energy sources. Hochul has said that requirement would increase electricity demand too much, raising prices and making the grid less stable.

In Massachusetts, Gov. Maura Healey has filed legislation seeking to provide energy affordability, including eliminating some charges from utility bills, capping bill increases and barring utility companies from charging customers for advertisement costs.

The solutions

Clearly, there are no quick fixes or easy solutions to this complex situation.

However, innovation in regulation, combined with new technologies and even AI itself, may enable creative regulatory and technical solutions. For instance, devices that can be programmed to use energy efficiently, time-sensitive pricing and demand monitoring to smooth out peaks and valleys in electricity use can potentially ease both grid load and customers’ bills. But those solutions will work only if all the players are willing to cooperate.

There are a lot of ideas about how to lower the public’s burden of paying for data centers’ power. New ideas like this need careful scrutiny and possible revisions to ensure they are effective at lowering costs and increasing reliability.

As the country grapples with the effort to upgrade the grid, perform long-deferred maintenance and build new power plants, consumers’ costs are likely to continue to rise, further increasing pressure on Americans. Existing regulations and government oversight may no longer lower electricity costs immediately or help people plan for the rising costs over the long term.

Barbara Kates-Garnick receives funding from

I received funding from the Mass Clean Energy Center through Tufts University for a grant on Offshore wind..
I serve on the board of Resources for the Future

– ref. Rising electricity prices and an aging grid challenge the nation as data centers demand more power – https://theconversation.com/rising-electricity-prices-and-an-aging-grid-challenge-the-nation-as-data-centers-demand-more-power-271465

Source: The Conversation – USA (2) – By Bedassa Tadesse, Professor of Economics, University of Minnesota Duluth

As Americans gather for holiday celebrations, many will quietly thank the health care workers who keep their families and friends well: the ICU nurse who stabilized a grandparent, the doctor who adjusted a tricky prescription, the home health aide who ensures an aging relative can bathe and eat safely.

Far fewer may notice how many of these professionals are foreign-born, and how immigration policies shaped in Washington today could determine whether those same families can get care when they need it in the future.

As an economist who studies how immigration influences economies, including health care systems, I see a consistent picture: Immigrants are a vital part of the health care workforce, especially in roles facing staffing shortages.

Yet current immigration policies, such as increased visa fees, stricter eligibility requirements and enforcement actions that affect legally present workers living with undocumented family members, risk eroding this critical workforce, threatening timely care for millions of Americans. The timing couldn’t be worse.

A perfect storm: Rising demand, looming shortages

America’s health care system is entering an unprecedented period of strain. An aging population, coupled with rising rates of chronic conditions, is driving demand for care to new heights.

The workforce isn’t growing fast enough to meet those needs. The U.S. faces a projected shortfall of up to 86,000 physicians by 2036. Hospitals, clinics and elder-care services are expected to add about 2.1 million jobs between 2022 and 2032. Many of those will be front-line caregiving roles: home health, personal care and nursing assistants.

For decades, immigrant health care workers have filled gaps where U.S.-born workers are limited. They serve as doctors in rural clinics, nurses in understaffed hospitals and aides in nursing homes and home care settings.

Nationally, immigrants make up about 18% of the health care workforce, and they’re even more concentrated in critical roles. Roughly 1 in 4 physicians, 1 in 5 registered nurses and 1 in 3 home health aides are foreign-born.

State-level data reveals just how deeply immigrants are embedded in the health care system. Consider California, where immigrants account for 1 in 3 physicians, 36% of registered nurses and 42% of health aides. On the other side of the country, immigrants make up 35% of hospital staff in New York state. In New York City, they are the majority of health care workers, representing 57% of the health care workforce.

Even in states with smaller immigrant populations, their impact is outsized.

In Minnesota, immigrants are nearly 1 in 3 nursing assistants in nursing homes and home care agencies, despite being just 12% of the overall workforce. Iowa, where immigrants are just 6.3% of the population, relies on them for a disproportionate share of rural physicians.

These patterns transcend geography and partisan divides. From urban hospitals to rural clinics, immigrants keep facilities operational. Policies that reduce their numbers – through higher visa fees, stricter eligibility requirements or increased deportations – have ripple effects, closed hospital beds.

While health care demand soars, the pipeline for new health care workers could struggle to keep pace under current rules. Medical schools and nursing programs face capacity limits, and the time required to train new professionals – often a decade for doctors – means that there aren’t any quick fixes.

Immigrants have long bridged this gap – not just in clinical roles but in research and innovation. International students, who often pursue STEM and health-related fields at U.S. universities, are a key part of this pipeline. Yet recent surveys from the Council of Graduate Schools show a sharp decline in new international student enrollment for the 2025-26 academic year, driven partly by visa uncertainties and global talent competition.

If this trend holds, the smaller cohorts arriving today will mean fewer physicians, nurses, biostatisticians and medical researchers in the coming decade – precisely when demand peaks. Although no major research organization has yet modeled the full impact that stricter immigration policies could have on the health care workforce, experts warn that tighter visa rules, higher application fees and stepped-up enforcement are likely to intensify shortages, not ease them.

These policies make it harder to hire foreign-born workers and create uncertainty for those already here. In turn, that complicates efforts to staff hospitals, clinics and long-term care facilities at a moment when the system can least afford additional strain.

The hidden toll: Delayed care, rising risks

Patients don’t feel staffing gaps as statistics – they feel them physically.

A specialist appointment delayed by months can mean worsening pain. Older adults without home care aides face higher risks of falls, malnutrition and medication errors. An understaffed nursing home turning away patients leaves families scrambling. These aren’t hypotheticals – they’re already happening in pockets of the country where shortages are acute.

The costs of restrictive immigration policies won’t appear in federal budgets but in human tolls: months spent with untreated depression, discomfort awaiting procedures, or preventable hospitalizations. Rural communities, often served by immigrant physicians, and urban nursing homes, reliant on immigrant aides, will feel this most acutely.

Most Americans won’t read a visa bulletin or a labor market forecast over holiday dinners. But they will notice when it becomes harder to get care for a child, a partner or an aging parent.

Aligning immigration policy with the realities of the health care system will not, by itself, fix every problem in U.S. health care. But tightening the rules in the face of rising demand and known shortages almost guarantees more disruption. If policymakers connect immigration policy to workforce realities, and adjust it accordingly, they can help ensure that when Americans reach out for care, someone is there to answer.

Bedassa Tadesse does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. The US already faces a health care workforce shortage – immigration policy could make it worse – https://theconversation.com/the-us-already-faces-a-health-care-workforce-shortage-immigration-policy-could-make-it-worse-271586

Source: The Conversation – USA (2) – By Ray Madoff, Professor of Law, Boston College

Ray Madoff, a Boston College law professor, has written a new book: “The Second Estate: How the Tax Code Made an American Aristocracy.” She recently spoke to Kara Miller, host of the podcast “It Turns Out,” about how the American tax system has changed over the past 40 years, widening inequality. Below is a condensed and edited version of the interview.

Miller: Mark Zuckerberg was the lowest-paid employee at Meta in 2024, and he made US$1. But he is not the only very rich person who has collected $1 for a year’s work. Why would incredibly rich CEOs make only $1 a year when they could pay themselves millions?

Madoff: The reason is taxes. Income from work is the most heavily taxed type of income, as it is subject to both income and payroll taxes. A self-employed person who makes a modest income of $60,000 will pay over $13,000 of it in payroll and income taxes. Meanwhile, high-income earners who earn a $400,000 salary can pay about 30% of their income in payroll and income taxes.

So the first step in avoiding taxes is avoiding salary, and that is what our richest Americans often do.

Elon Musk received a salary of $0 from Tesla in 2024. Jeff Bezos earns $81,840 a year of income, low enough to get the child tax credit, which he took in 2021. One of our higher-paid billionaires is Warren Buffett, and he only gets $100,000 a year in salary and bonus combined.

All of these people are keeping their taxes down by keeping their salaries down. They are not avoiding compensation altogether, however, as they are well paid through the growing value of their stock. In 2024, Bezos’ wealth increased by $80 billion, Zuckerberg’s by $113 billion, Musk’s by $213 billion. Even better, they can enjoy this growing wealth entirely free of income tax and reporting.

You make the case that part of the reason that these individuals have been able to accumulate wealth so quickly is because of the tax system. How has the tax system enabled their wealth to continue to grow so quickly?

Historically, the tax system has operated as a bulwark against concentrations of wealth. And in this way, it has served to legitimate our capitalist system by showing how it can work to extract large amounts of money from our wealthiest citizens for the common good.

However, over the past 40 years or so there have been a number of changes that have allowed the wealthy to avoid taxes altogether on their investments and inheritances. One area where this has particularly been the case is when it comes to investment in stocks. Prior to 1982, companies could only directly share profits with shareholders by issuing dividends. These dividends were taxed at the highest rate. In 1982, however, a subtle change to the SEC rules allowed companies to purchase their own stock on the open market. This may sound innocuous, but it led to a massive transformation.

Now, instead of issuing dividends, companies can purchase shares, which boosts the value of the stock. So any shareholders who do not need to sell can make a profit from their stock going up in value and do not need to pay taxes on this profit.

At some point, one might expect that the ultrawealthy would have to sell their shares to finance their lifestyle. Do they? In selling those shares, wouldn’t they have to pay a capital gains tax?

For most of us, when we own property or stock that has increased in value, it doesn’t mean anything to us unless we sell it. But those with great wealth can access that wealth without paying taxes by simply borrowing against their assets. And that is what our richest Americans do.

Billionaires like Larry Ellison and Elon Musk borrow huge sums of money to support their lifestyle, pledging their stock as collateral. This borrowing is entirely tax-free and comes at good rates. In addition, in recent years the growth in stock value more than compensates for any interest that might accrue. To pay the interest and pay back the loans, they simply borrow again.

Does this mean the people with the most money are not contributing to the common expenses of the government? What about through the estate tax?

One would think that the estate tax would do a good job here. After all, it is a 40% tax on all transfers by gift or at death in excess of approximately $15 million. However, this tax no longer accomplishes what it once did.

During the George W. Bush presidency, 18 wealthy families launched a campaign to repeal the federal estate tax. It labeled the estate tax the “death tax,” calling it an unfair double-taxation that harms family farms and businesses. Chester Thigpen, who owned a Christmas tree farm, was the face of this movement. He argued that the estate tax took away his right to pass his Christmas tree farm to his children.

This narrative was completely false. The estate tax has many provisions to protect family farms and businesses. And Thigpen was misled; he was never subject to the estate tax, as his estate was much smaller than the exclusion amount.

But much of the public began to believe that the estate tax – or the “death tax” – was unfair. Though there is nominally an estate tax today, Congress has not enacted a single provision to close loopholes in 35 years. As a result, loopholes abound that allow the wealthy to shelter their money from taxation. These mechanisms are so effective that even though the wealthiest 1% of Americans own $50 trillion, the entire amount collected by the estate tax in 2024 was about $30 billion, an amount that Musk has gained and lost in a day.

Now, the estate tax serves as a cover for the richest Americans, who are served better by preserving a tax that makes it look like they pay taxes.

If the richest Americans do not pay taxes, who does the brunt of the burden fall to?

In terms of our yearly income tax, the brunt of the burden falls on high-income earners, people earning hundreds of thousands of dollars a year. These people can be paying up to 50% of what they make in payroll and income taxes. Confused, they think their interests align with the ultrawealthy more than regular workers. In fact, people who earn a lot through their job – from doctors to executives – are carrying the largest burden, alongside lower-wage workers.

Popular statistics make it seem as though the richest Americans are paying the majority of taxes. One such statistic is that the top 1% pay 40% of the income taxes, while 40% of Americans pay no income tax at all. The top 1% here refers to income earners.

Remember, the very richest Americans do not acquire their wealth through taxable income and are just as likely to be a part of the 40% of the lowest earners who pay no income tax.

In reality, 30% of U.S. wealth is now controlled by the richest 1% of Americans, and our current rules provide no assurances that they will ever pay taxes on their growing wealth.

Ray Madoff does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Billionaires with $1 salaries – and other legal tax dodges the ultrawealthy use to keep their riches – https://theconversation.com/billionaires-with-1-salaries-and-other-legal-tax-dodges-the-ultrawealthy-use-to-keep-their-riches-271714

Source: The Conversation – USA (3) – By Jen Zamzow, Instructor, University of California, Los Angeles; Concordia University Irvine

As child care costs outpace wages, more families are facing difficult decisions about whether to scale back work in order to care for loved ones. Caregiving remains the top reason women ages 25-54 leave the workforce.

And it’s not just parents who struggle. Nearly 60 million Americans provide care for an adult family member, and two-thirds say they have trouble balancing their jobs with their caregiving responsibilities. Nearly 1 in 4 working caregivers reported either missing work or being less productive because of their care duties.

When the demands become too much to juggle, some people quit their jobs, cut back on their hours or turn down promotions in order to provide unpaid care. For many households, that’s a financial strain; others save money that way. But even so, the decision can feel heavy – like leaving behind a sense of purpose that extends beyond the family.

These choices force deeper questions: What counts as meaningful work? What do we owe to others, and what’s reasonable to expect of any one person?

For many people, work and family are central to identity and how they hope to make a difference in the world. Men and women struggling with whether to step back from a career may wonder whether doing so is the best use of skills or training. Do we owe the world something “bigger”? As much as we care about loved ones, caregiving can feel too small and personal to matter.

As someone who writes and teaches about ethics and social policy, I believe philosophy can help people see these decisions more clearly. Ethics doesn’t give tidy answers or eliminate the tension between work and care, but it can help us understand their moral value.

‘Too small’?

Today, American culture often measures moral worth in terms of results and impact – where doing good means doing more. In this context, stepping back from a professional career to care for a loved one can feel like a failure of ambition or responsibility.

If ambition is measured by observable progress, caregiving is especially vulnerable to being misread as “leaning out.” Many of the daily tasks of caregiving – feeding, bathing, dressing and driving to appointments – can seem inconsequential. The end result of much of this work is invisible: You wind up in the same place you were before. For all the work that goes into sustaining life, there aren’t many “impressive outcomes” to point to.

In fact, one of care’s most important benefits lies in preventing outcomes: avoiding injuries, medication errors, hospital admissions, developmental delays, cognitive decline, loneliness, depression and so on. These “nonevents” are easy to overlook. In public health, this is sometimes referred to as the “preparedness paradox”: The better prevention works, the less visible its effects.

Appreciating the full value of care means considering what would happen without it. If the answer is that there would be more risk, more crises or more downstream costs, then care is making a difference. Health care ethicists, for example, use this kind of counterfactual reasoning to evaluate harm and benefit, asking how a patient would have fared without an intervention. Caregiving that reduces vulnerability and prevents suffering is a genuine moral achievement.

Still, helping a handful of people can look minor compared to careers measured by reach or scale. Good care requires a level of presence and attentiveness that just can’t be scaled.

But that isn’t a failure. “Smallness” is actually part of the point: Care is personal – and “personal” doesn’t mean morally trivial.

In fact, there’s a rich philosophical tradition that puts meeting the needs of the people we’re responsible for at the very heart of moral life. Relationships are core to who we are. In care ethicists’ view, attachments to other people are not distractions from morality but expressions of what it means to live a good human life.

Close relationships make special claims on us. Ties with particular people carry moral weight, not just emotions – they give genuine reasons to act. As philosopher Samuel Scheffler notes, it makes little sense to say we value a relationship if we don’t think it places any demands on us. Caring about another person’s needs is part of what it means to care about them.

Attending to a loved one’s needs and interests honors those special claims and imbues care tasks with extra meaning – showing someone that we believe they’re worth our time and attention. Caring for loved ones might be modest in reach, but making another person feel truly seen and valued can make a deep impact.

‘Too personal’?

Even if care isn’t “too small” to matter, it might still seem too personal to matter much to the wider world. But while care is certainly personal, it’s also socially significant.

As care ethicists like Joan Tronto and Eva Kittay argue, caring for particular people reveals something universal about the human condition: Everyone is dependent and sustained by care at different points in our lives. Former first lady Rosalynn Carter captured it simply: “There are only four kinds of people in the world – those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers.”

Understanding dependency as a shared human condition helps explain why care is foundational to collective well-being. Unpaid caregiving in the U.S. is worth an estimated US$1.1 trillion annually, making it one of the largest sources of social support.

However, care has value beyond its economic impact. Care makes family, community and civic life possible, with benefits that reach well beyond the household. As economist Nancy Folbre writes in “The Invisible Heart”: “Parents who raise happy, healthy, and successful children create an especially important public good” – one that will benefit employers, neighbors and fellow citizens.

Treating care as a private matter rather than a shared social good has consequences. It places the moral and practical weight of caregiving on individual families – most often on women. I believe this narrow view unfairly shifts responsibility and also distorts value, limiting society’s sense of what matters.

Policy changes could ease the strain on caregivers but wouldn’t remove the personal choices families face every day. Even in a more supportive system, I believe Americans would need ways of thinking about work and care that give a fuller account of their value. Caregiving’s broader public benefits are diffuse and hard to measure. But recognizing that care sustains not only families but communities too is a reminder that paid work and unpaid care are not opposites. They are both ways to contribute to the common good.

Of course, loved ones’ needs can often be met without career changes. But when families need to make tough choices, it helps to have a fuller picture. Care ethics is not a demand for perfect caregiving or self-sacrifice; it’s an argument that care matters and that people deserve support as they respond to real limits. Stepping back from work to care doesn’t have to mean stepping back from contributing to the world – it changes where contribution happens.

Jen Zamzow has received funding from UC Berkeley’s Greater Good Science Center, as part of its “Spreading Love Through the Media” initiative, supported by the John Templeton Foundation.

– ref. Unpaid caregiving work can feel small and personal, but that doesn’t take away its ethical value – https://theconversation.com/unpaid-caregiving-work-can-feel-small-and-personal-but-that-doesnt-take-away-its-ethical-value-265025

Source: The Conversation – USA – By Alaina Vandervoort Burns, Assistant Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles

A young woman starts to become suspicious of her cellphone. She notices it listing Wi-Fi networks she does not recognize, and the photos on her contact cards seem to mysteriously change at random times. One day she tries to make a call and just hears static on the line. She begins to think that someone – or an entire organization – has hacked her phone or placed spyware in it, and she wonders what crime she is being framed for.

Built-in laptop webcams, unfamiliar Wi-Fi networks, targeted ads on search engines and personalized algorithms on social media sites: Most people have come to accept and ignore the quirks and drawbacks of daily contact with the internet and devices such as cellphones and computers. But for people with severe mental illness, new technologies are fertile ground for the start of false ideas that can lead eventually to a break with reality.

Psychiatrists like me help people who are bothered by their thoughts, behaviors or emotional states. For the past 10 years I’ve been working closely with people who have schizophrenia.

Schizophrenia, sometimes referred to as a type of thought disorder, is a chronic condition in which alterations in brain function change the way one perceives the world. People with schizophrenia can become hyperaware of their surroundings, often interpreting things they see or hear as being hostile and directed toward them even when there’s no real danger.

Over time, people with schizophrenia can develop delusions: beliefs that are fully held even though they are not based in reality and even when there is evidence to the contrary.

With technology and the internet now such an integral part of daily life, it’s no wonder that people with schizophrenia have incorporated new technologies into their delusional beliefs. In my recent research, my colleagues and I set out to explore the ways modern tech influences the content of delusions for people today.

Old delusional themes expressed in new ways

Most delusions are persecutory, meaning a person believes they are being watched, followed or monitored. Other delusional forms involve the belief that a person has special powers, is being controlled by outside forces, or that a spouse is unfaithful even when they are not.

Prior research has shown that these themes are consistent among people with schizophrenia, but the sociopolitical context in which a person lives shapes the form in which they are expressed.

For example, Americans living during World War II developed persecutory delusions involving Germans, while those living during the Cold War focused on communists. People with thought disorders have incorporated important events such as the fall of the Berlin Wall and the O.J. Simpson trial into delusional frameworks.

The past three decades have seen incredible strides in technological advances and easy access to the internet. How have these old themes become repackaged and expressed in the digital age?

For this research, my colleagues and I reviewed medical records of 228 people with thought disorders who participated in a specialized day treatment program between 2016 and 2024.

We identified any mention of delusional thought content and examined the ways in which these beliefs incorporated new technology. We also analyzed the data to see whether certain people were more likely to express delusions tied to technology, or if there was a change in the frequency of these delusions over time.

Delusions of persecution via common tech

Over half of our study’s participants mentioned new technology or the internet when describing delusional beliefs. Most commonly, people felt they were being persecuted via their electronics – that their Wi-Fi networks, computers or cellphones had been hacked or implanted with tracking devices. One person reported believing that neighbors had access to their Wi-Fi network and were monitoring their activities, while another worried that family members had put tracking devices on their phone.

About a quarter of participants reported delusional beliefs surrounding social media. For example, people believed that celebrities were communicating with them directly through social media posts, that they were receiving encoded messages through suggested playlists, or that social media algorithms were linked directly to their thoughts.

Some participants felt they were being monitored through hidden cameras or microphones implanted in their homes or even in their bodies. Several reported what’s known as the “Truman Show delusion” – the belief that their lives are staged and recorded, their daily activities broadcast as a reality TV show.

With each passing year of the 21st century, we found participants were significantly more likely to express delusions connected to technology.

Stretching the bounds of past realities

Our study confirms that common delusional themes, such as persecution, have become repackaged for the digital age. Interestingly, people often described fears that were based on misunderstanding how technology works – or fails to work. A Wi-Fi router that needed to be reset, a familiar app with a new logo, and text messages that disappeared over time were all cause for suspicion.

The issue that has become hardest for me to grapple with as a psychiatrist is how any of us can distinguish delusional beliefs from reality, given things we never could have imagined would be possible just 10 years ago are now commonplace. Although social media algorithms are not currently linked to our thoughts, is it such a stretch to imagine that in a few short years they may be?

Given recent advances in AI, our collective perception of reality is likely to be further distorted in the years to come. We will all need to find ways to anchor ourselves in a common truth and determine what’s real – and what isn’t.

Alaina Vandervoort Burns does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Hacked phones and Wi-Fi surveillance have replaced Cold War spies and radio waves in the delusions of people with schizophrenia – https://theconversation.com/hacked-phones-and-wi-fi-surveillance-have-replaced-cold-war-spies-and-radio-waves-in-the-delusions-of-people-with-schizophrenia-271620