Category: The Conversation – USA

Source: The Conversation – USA – By Laura Aull, Professor of English and Linguistics, University of Michigan

Suspicion and affection. Apprehension and excitement. Most people have mixed feelings about AI English, whether or not they always recognize it. When reading text generated by AI, people feel it sounds off, or fake. When reading English by a human, people are more likely to feel it has a characteristic voice or a personal touch.

What exactly makes English sound human, or sound like AI? And does it matter if AI English never truly achieves a human feel?

I research the institutionalization of English. There is a long, problematic history of people feeling positively or negatively toward different kinds of English, rewarding how it is spoken or written by some sectors of society and devaluing how it is used by others.

When generative AI language tools came along, they scaled up these problems. English-based large language models are trained on text from the public internet. Human instructions tell the models to sound like formal English. Because of that, large language models end up trained on all the bias baked into standardized human texts and ideas.

In my work, I encounter people who would never trust the internet to tell them what is right and wrong, yet they trust generative AI to tell them how to write.

Human vs. AI

The first step to becoming a more informed user of AI English is to try to understand what people mean when they say writing sounds human. This understanding will improve your AI literacy. Most importantly, it will allow you to learn to recognize two qualities that make human English different from AI English: variation and readability.

Human English contains persistent, if subtle, linguistic patterns of variation and readability. By contrast, AI uses what I call exam English – a rather formal, dense English that is favored in academic tests and papers. It is less varied and less readable. People perceive it as robotic, but they also perceive it as smart.

Here’s a quick test: Read the two text messages below and guess which one is by a human and which one is by ChatGPT.

“i’m not sure how to break this to you. there’s no easy way to put it…i can’t make the friday-night fun. sorry. however, feel free to text me during the evening if there are any lulls in conversation. anyway, hope ur exotic trip goes well. see u next term.”

“Hey! I’m really sorry, but I won’t be able to make it Friday night. I hope you all have a great time, and I’ll see you next term!”

A human reader would probably notice several patterns right away. The first message has more “textese”: It defaults to lowercase and includes phonetic spellings “ur” and “u.” The second text has exam English capital letters, commas and spelling.

People are likely to have other impressions, too. Perhaps the first text feels more personal, and less sure of itself. Maybe the second text feels stiff, like it was written by an acquaintance. The first text contains different kinds of phrases and clauses, while the second text repeats the same clause structure four times.

On some level, human readers pick up on such patterns. Most people would say that the first text is by a human and the second is by AI. Indeed, the second passage was generated by ChatGPT.

Even this basic illustration shows that human English includes variation in word usage and grammatical structures that breaks up information and conveys personal meaning. AI English has less variation and more dense noun phrases. In research studies, these patterns appear repeatedly across genres and registers.

Some AI English patterns change

AI writing tools evolve, and large language models vary. GPT 5 was infamously cold-sounding compared with its predecessor GPT 4, for example.

But the patterns I am talking about are likely to persist. AI English favors what exam English has always rewarded: homogeneity and information density. And thus far, instructional tuning – training AI models to follow human instruction – only makes AI English less like human English. It doesn’t help that AI writing is part of what AI bots train on.

The net effect today is that AI English has been trained on English that is much more narrow than actual, collective human English in practice. Humans, by contrast, don’t just use language that is probable, but language that is possible – based on the varied language use they have observed, their creative capacity for new utterances and their propensity to blend personal and impersonal language patterns.

How AI and human English can coexist

If you can become more aware of differences between AI and human English, those insights can help you use both language forms more productively. Here are a few steps to take:

Use language labels. When describing a given passage, use labels like “dense,” “plain,” “interpersonal” or “informational”, not social labels like “sounds smart” or “sounds off.” Consider exploring the actual patterns in human and AI English and trying to describe language patterns, not feelings about them, in other words.

Use AI tools selectively. Not only does human English have more accessible and varied patterns, it also engages the brain more than using AI language tools. To help prevent AI English from overshadowing human varied language in the world, use AI selectively.

Use curated tools. Tools like small language models and programs that you can add to a web browser to root out bias, such as Bias Shield, can help people make principled choices about AI English use. Tools such as translingual chatbots can also bring to AI English much more of the global variation in human English.

Be conscious of what sounds smart, and why. A century and a half of exam English makes it easy to think that dense, impersonal writing patterns are smart. But like any language patterns, they have pros and cons. They are not particularly personable or readable, especially for diverse audiences, and they are not representative of the range of global English in use today.

There can be good reasons to use exam English, but not just because AI bots generate it, or because people have learned to perceive it as smarter.

At its best, AI English is a language database driven by statistics. It’s big, but it’s canned. History tells us that a full range of global human English gives people the greatest possibilities for expression and connection.

Laura Aull 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. How AI English and human English differ – and how to decide when to use artificial language – https://theconversation.com/how-ai-english-and-human-english-differ-and-how-to-decide-when-to-use-artificial-language-277455

Source: The Conversation – USA – By Jeffrey Tully, Associate Clinical Professor of Anesthesiology, University of California, San Diego

HBO Max’s enormously popular television series “The Pitt” is receiving plaudits for its realistic depiction of the trials and tribulations of health care in an urban emergency room.

Now in its second season, which premiered on Jan. 8, 2026, the show follows Dr. Michael “Robby” Robinavitch (played by Noah Wyle) and his colleagues through a single 15-hour clinical shift, divided into one-hour episodes. The team treats patients against a backdrop of all-too-common American societal plagues, from substance use disorder to medical bankruptcies and mass shootings.

Spoiler alert: About halfway through the season, Dr. Robby and the staff at the fictional Pittsburgh Trauma Medical Center grapple with chaos ensuing from a less commonly depicted disaster – a hospital cyberattack. The hospital’s network and computers were incapacitated, resulting in scenes of millennial residents struggling with fax machines, laboratory orders disappearing in a shuffle of papers, and constant communication breakdowns culminating in a missed life-threatening diagnosis.

All this might prompt viewers to wonder: Does this actually happen in real life?

As physicians who study cyberattacks and their impact on patient care, we have seen many of the same events depicted in “The Pitt” play out in the real world.

These attacks have severe clinical consequences. In an unfortunate case of art imitating life, the show’s cyberattack story arc began on the same day that the University of Mississippi Medical Center suffered the same fate, resulting in the sudden closure of more than 30 affiliated clinics across the state while also disrupting Mississippi’s only Level I trauma center.

Modern health care is critically dependent on digital technologies, such as electronic health records, laboratory machines and radiology platforms, that shut down when hospital networks are taken offline. Losing access to these tools for prolonged periods of time puts patients’ lives at grave risk.

What’s at stake

The most dire real-life cyberattacks on hospitals involve ransomware, a class of malicious software that encrypts data and locks down computers and networks, demanding significant amounts of cash for the promise of relief. Unfortunately, these events are not rare. Comparitech, a cybersecurity research firm, recorded 445 ransomware attacks on hospitals and clinics in 2025 – a new peak following several years of annual increases.

Such attacks are especially dangerous for patients with time-sensitive emergencies like strokes, heart attacks or sepsis, but they affect hospital outcomes broadly. For example, a 2026 analysis of Medicare data found that hospitalized patients had a 38% higher risk of death during a ransomware attack.

Moreover, the health impacts of ransomware are not confined to the hospitals under attack. “The Pitt” demonstrates this phenomenon well in earlier episodes. When Westbridge, another hospital in the community, is struck first, a wave of patients arriving by ambulance strains Pittsburgh Trauma Medical Center’s already packed emergency room, leading to delays in care and overwhelming already-strained clinicians. Our team found that a hospital cyberattack cut the odds of surviving a cardiac arrest without devastating brain damage by nearly 90% at nearby hospitals, not just the one that was attacked.

And even when a hospital’s computer systems are restored and normal care resumes, a cyberattack leaves enormous financial damage in its wake. Class action lawsuits, fragmented billing and steep regulatory fines due to patient privacy breaches and other issues often result in tens to hundreds of millions of dollars of losses.

In the worst cases, hospitals or clinics in rural areas have been forced to shutter their doors, leaving their communities with one less place to receive care and exacerbating existing health care deserts.

Protecting cyber infrastructure

We have no doubt that Dr. Robby will rally his team to ultimately save the day from malicious cyberattacks on “The Pitt.” But what is the prognosis for the rest of us, in the real world?

The good news is that a number of efforts are underway to improve the cybersecurity of the U.S. health care system.

The federal government has recognized the particular risk posed to rural and critical access hospitals and has identified increased investment in cybersecurity technologies as one of the goals of the Rural Health Transformation Program, a US$50 billion package distributed across all 50 states.

Several states, including New York and Connecticut, have taken further action, enshrining new bills in 2025 and 2026 mandating hospitals develop specific cybersecurity plans to protect patients. And the Food and Drug Administration now evaluates the cybersecurity of new medical devices prior to their arrival to market, and can issue recalls of those found to have significant vulnerabilities.

Cybersecurity remains one of the few bipartisan issues on Capitol Hill. A health care cybersecurity bill co-sponsored by Senators Bill Cassidy, R-La., and Mark Warner, D-Va., introduced in December 2025, would require hospitals to adopt security practices, including multifactor authentication and data encryption, allocate additional grants for hospitals and clinics, and strengthen the pipeline for cybersecurity professionals working in the health care sector, among other provisions.

However, this problem isn’t going away. Artificial intelligence and the expansion of remote and virtual care mean that malicious hackers have sophisticated new tools and increased opportunities to target hospitals. Researchers like us will have to find new ways to prevent cyberattacks when possible and protect patients when they inevitably erupt.

Jeffrey Tully is the co-founder of Inoculum Labs. He receives funding from the Advanced Research Projects Agency for Health. He is affiliated with the Healthcare and Public Health Sector Coordinating Council Cybersecurity Working Group.

Christian Dameff co-founded inoculum labs. He receives funding from ARPA-H.

– ref. HBO’s ‘The Pitt’ nails how hospital cyberattacks create chaos, endanger patients and disrupt critical care – https://theconversation.com/hbos-the-pitt-nails-how-hospital-cyberattacks-create-chaos-endanger-patients-and-disrupt-critical-care-278795

Source: The Conversation – USA – By Mehrzad Boroujerdi, Vice Provost and Dean of College of Arts, Sciences, and Education, Missouri University of Science and Technology

The Trump administration announced a US$10 million reward on March 15, 2026, for information leading to the capture of several senior Iranian figures.

While two of these leaders have since been killed by Israeli strikes, they are included here to provide a more complete picture of Iran’s powerful elite – people deeply embedded in the Islamic Republic’s political, intelligence and security architecture.

As an international affairs scholar, I know their careers reflect the institutional pillars of the regime – clerical authority, intelligence coordination, military power – and help explain why they are considered high-value targets.

Seyyed Mojtaba Khamenei

The son of former Supreme Leader Ali Khamenei, who was killed in a U.S.-Israeli strike in February 2026, Seyyed Mojtaba Khamenei, 56, was chosen as Iran’s new supreme leader in early March.

Long viewed as a powerful behind-the-scenes figure, he operated within his father’s inner circle. He has cultivated strong relationships with Iran’s security and intelligence institutions and earned a reputation as a political fixer and enforcer.

Despite never holding formal elected or senior appointed office, Khamenei had been widely perceived as a potential successor to his father. Such a transition would have been controversial under normal circumstances, given his lack of experience and the ideological sensitivity around hereditary succession in a system born from anti-monarchical revolution.

Khamenei has also been linked to political controversies. During the 2005 presidential election, reformist candidate Mehdi Karroubi accused him of involvement in electoral manipulation. Former President Mahmoud Ahmadinejad later alleged that Khamenei engaged in financial misconduct.

Public opposition to his perceived rise was visible during the 2022–23 protests, when demonstrators explicitly rejected the prospect of his leadership by shouting “Mojtaba, may you die and never see leadership.”

Seyyed Ali-Asghar (Mir) Hejazi

A cleric with long-standing ties to Iran’s intelligence apparatus, Seyyed Ali-Asghar Hejazi had been among the closest aides to Ali Khamenei. He began his political career in 1980 as part of a “purification committee” tasked with firing perceived opponents from state institutions in the aftermath of the Iranian Revolution in 1979.

Hejazi later served as deputy for foreign affairs in the Ministry of Intelligence in the early 1980s and, more recently, as deputy chief of staff in the Office of the Supreme Leader. In this role, he has functioned as a key intermediary between various branches of government as well as religious and political personalities – transmitting Khamenei’s directives, shaping high-level policy and coordinating Iran’s complex intelligence and security networks.

He was sanctioned by the U.S. Treasury in 2013 for alleged human rights violations, including involvement in the suppression of the 2009 Green Movement, and by the European Union in 2019. He apparently survived an Israeli attack on March 6, 2026.

Seyyed Esmail Khatib

Seyyed Esmail Khatib, 64, who was killed on March 18, 2026, had built his career within Iran’s intelligence and security establishment. He joined intelligence operations linked to the Islamic Revolutionary Guard Corps in 1980 and was wounded during the Iran–Iraq War.

Following the war, this cleric held a series of senior intelligence roles, including director general of intelligence for Qom province, starting in 1991. He also held positions within the supreme leader’s security office from 2009–11 and was head of the judiciary’s Protection and Intelligence Center, a counterintelligence body within Iran’s judiciary, from 2012–19. He later served as a senior official within Astan Quds Razavi, a major religious and economic conglomerate controlled directly by Iran’s supreme leader.

Sanctioned by the U.S. Treasury in 2020 for alleged human rights abuses, Khatib became Iran’s minister of intelligence in 2021.

Ali Larijani

Ali Larijani, who was assassinated on March 17, 2026, was one of the Islamic Republic’s most experienced political insiders. Born into a prominent clerical family, he rose through both military and civilian institutions, beginning with roles linked to the Revolutionary Guard in the early 1980s.

Over the decades, Larijani, 68, held numerous senior positions. Those include minister of culture from 1992–94 and head of state broadcasting from 1994–2004. He was also secretary of the Supreme National Security Council from 2004–08 and again from 2025–26. Larijani also served as Iran’s chief nuclear negotiator from 2005-07.

From early January 2026, and more clearly following the Feb. 28 killing of Ayatollah Khamenei, Larijani emerged as a central decision-maker within the system before his death.

Brig. Gen. Eskandar Momeni

A Revolutionary Guard-affiliated security official, Eskandar Momeni, 64, is a veteran of the Iran–Iraq War and participated in counterinsurgency operations against leftist groups in northern Iran.

He later held a range of senior law enforcement roles, including head of the Police Emergency Center, a dispatch center that directs emergency response units, from 2004–05, deputy for operations of the national police from 2005–08, and chief of traffic police from 2009–14. He also holds a doctorate in national security.

As deputy commander of Iran’s Law Enforcement Force, responsible for public security, from 2015–18, Momeni oversaw security responses during the 2017-18 protests, which were met with force. Since becoming minister of interior in August 2024, he has remained a central figure in domestic security policy, including the lethal response to unrest in early 2026 in which an estimated 7,000 to 30,000 Iranians were killed.

Maj. Gen. Yahya Rahim Safavi

A senior Revolutionary Guard commander and longtime military strategist, Yahya Rahim Safavi, 73, received military training in Syria prior to the 1979 revolution and later became a key figure during the Iran–Iraq War.

He served as commander of the Revolutionary Guard ground forces, from 1985–89, deputy commander in chief from 1989–97 and commander in chief of the Revolutionary Guard from 1997–2007. During his tenure, he reportedly also earned a Ph.D. in geography.

In December 2006, the U.N. Security Council put Safavi on its sanctions list for his involvement in Iran’s nuclear and ballistic missile programs. After stepping down as Revolutionary Guard commander, Safavi was appointed senior military adviser to the supreme leader and is still serving in that role. He remains under U.S. sanctions.

Mehrzad Boroujerdi 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. Who are Iran’s new leaders? A look at 6 the US placed a bounty on – 2 of whom are already dead – https://theconversation.com/who-are-irans-new-leaders-a-look-at-6-the-us-placed-a-bounty-on-2-of-whom-are-already-dead-278509

Source: The Conversation – USA – By Logan S. James, Research Associate in Animal Behavior, The University of Texas at Austin; McGill University

Animals do all sorts of things to attract each other as potential mates. Many birds, for example, produce feathers with elaborate color patterns – from the iridescent plumage of many hummingbirds to the famously brilliant tail of a peacock. Charles Darwin, an early pioneer in the theory of evolution, saw these colors and concluded that they exist because other birds find them attractive.

But this raised a peculiar question: Why did Darwin himself find these colors beautiful too?

Indeed, he noted that some animals have “nearly the same taste for the beautiful as we have,” a simple observation with radical implications. Our sense of beauty might be something we humans share with other animals, rooted in biology.

Over a century after Darwin made his observations, my colleagues and I decided to actually test this idea.

I am an expert in animal communication, with a focus on sound production and perception. I have worked with species such as zebra finches, fringe-lipped bats and túngara frogs. For example, late at night in Panama, I have watched remote video feeds of female túngara frogs as they listened to calls that I played from different speakers. Eventually a female will hop toward one speaker, revealing which of the calls she preferred.

Could it really be possible that this tiny frog and I are attracted to some of the same sounds? What might shared preferences say about what animals and people have in common? We needed data to find out.

A global experiment

To test Darwin’s idea properly, we needed two things: a large collection of animal sounds that had already been tested on animals, and a large number of human listeners willing to give their opinions.

For the sounds, we drew on decades of published research, including some of our own as well as studies from generous colleagues who let us use their recordings. We ended up with 110 pairs of sounds from 16 different species, including frogs, insects, birds and mammals. In each pair, the sounds are used to attract potential mates; scientists had already found which of the two versions that animals tended to prefer.

For the human listeners, we built a gamified online experiment played by over 4,000 participants from around the world. The task was quite simple: We played each pair of sounds in random order, and then asked which one the human participant liked more.

What we found

The results were striking. Across our dataset, including animals separated from human beings by hundreds of millions of years of evolution, people tended to agree with the animals about which sound was more pleasant.

Amazingly, the stronger the animal’s preference, the more likely humans were to agree. We also found that people were measurably faster to click or tap on the sound that animals found more attractive, suggesting a subconscious aspect of these preferences.

People particularly agreed with animals when it came to what researchers call “adornments”: the extra trills, chucks, clicks and flourishes that animals can add to their calls. These sounds were more appealing to both animal and human listeners alike.

Why do we share these preferences?

This is a key question, and it will take many more studies to piece together. Our current work suggests that the architecture of the nervous system may help drive shared preferences. Despite the enormous diversity of life on Earth, many basic structures of sensory systems are similar across species. Shared mechanisms of sound perception may lead to shared biases in sound preference.

We also found a lot of factors that didn’t predict agreement. Participants with expertise in animal sounds or highly trained musicians were no different than other human judges. Intriguingly, those who reported spending more time listening to music on a daily basis agreed with animals more, a surprising finding worth investigating.

More to investigate

We focused on sound, while Darwin’s original observation was about color and visual beauty. Do humans share visual preferences with animals too? What about smell? And what’s happening in our brains when we make these snap aesthetic judgments? Are the same neural circuits at work when a human and a frog both choose the same call?

Preferences in animals are often subtle and variable across individuals and populations. I would love to ask birds what they think of different frog calls and vice versa, but it’s only humans that we can directly ask such questions.

We also found cases where humans disagreed with animals. Our results show a tendency, not a rule, and understanding where this variation comes from will be fascinating to discover.

My favorite takeaway from this research is a simple reminder.

People find so much beauty in nature, from the dazzling colors of butterflies to the melodious songs of birds and the aromas of flowers. Yet all of these evolved to attract other species, not us. Perhaps it’s because we humans share something fundamental with other animals that we too find these to be beautiful.

Logan S. James is affiliated with Earth Species Project.

– ref. You probably agree with the animals on which bird calls, frog noises and cricket chirps are most attractive – new research – https://theconversation.com/you-probably-agree-with-the-animals-on-which-bird-calls-frog-noises-and-cricket-chirps-are-most-attractive-new-research-276958

Source: The Conversation – USA (2) – By Beth Kania-Gosche, Professor of Education, Missouri University of Science and Technology

I live in the small city of Rolla, Missouri, where half the child care centers have closed in the past six years. In the past year, my state has lost 1,771 child care slots due to closures.

This problem isn’t isolated to Rolla – child care providers are closing in other rural areas. Some of the challenges these centers face are widespread. U.S. child care workers typically earn little money, yet child care costs are high for many families.

Approximately 1.4 million children whose families are low-income benefit from child care subsidies, which means the federal and state government partially cover the cost of child care. States typically receive federal funding that they match and then give to subsidize individual children’s care at child care centers.

In early January 2026, the Trump administration announced that it had temporarily frozen federal child care subsidy payments to all states because of fraud concerns in Minnesota.

A group of states – Minnesota, New York, California, Illinois and Colorado – then sued the Trump administration. A federal judge ruled on Jan. 26 that the administration must deliver nearly US$10 billion in federal child care subsidies to these states.

The new policy also creates new verification rules – like stricter proof of parents’ employment – that are making it more time-consuming and complicated to receive subsidies.

Despite the lawsuit, these other new subsidy rules remain in place – meaning that, among other things, child care providers have to do more paperwork and receive reimbursement from the federal government later than they typically do.

An already tough situation

Already, many child care providers are struggling to keep their doors open.

I am a professor and the chair of the education department at Missouri University of Science and Technology. I help prepare my students – future teachers – to become the next generation of educators. Part of my job is also supporting our campus child development center, which cares for babies and young children of staff, faculty and students.

Across the nation, over 14 million children potentially need child care, but only 10 million slots exist.

Even if parents can find child care, its high cost can be prohibitive, sometimes leading to young parents with low-paying jobs leaving the workforce.

How child care subsidies work

Placing an infant in an early childhood or day care center can cost parents annually an average of $15,000. These costs can rise up to more than $28,000 in places like Washington, D.C.

While subsidies can help offset the high cost of child care, only approximately 15% of children whose families are eligible for subsidies receive them.

The federal government distributes subsidies to designated state agencies that are responsible for contracting with providers and verifying family eligibility. States must match some of these funds. Parents then apply through their state to receive a subsidy.

Families generally pay the rest of their child care center costs on a sliding scale.

The exact requirements for receiving child care subsidies vary across states, both when it comes to families and providers. Often, states require that parents are working or are in school, and that they make less than a certain income.

In New York, a family of four could qualify if they earn up to nearly $110,000 each year. In Florida, a family of four could earn as much as about $56,000 a year and qualify.

The amount families receive in subsidies also varies, but getting them could save a family approximately $10,000 a year in a place like Seattle.

Getting a child care spot isn’t a guarantee

It can be difficult for families to apply for and receive child care subsidies. It requires extensive paperwork, and families often have to spend hours on the phone and deal with confusing instructions about how to receive the benefits.

In some states, there is a wait list to receive a child care subsidy.

In March 2026, Missouri started a child care subsidy waitlist. Before, families used to be able to receive child care subsidies immediately after approval, if they could find a provider. Now, families must wait until funding becomes available.

Providers may be reluctant to accept subsidies to help pay for a child’s care, in part because of the additional work of submitting a child’s attendance records to the state and verifying other information. Some providers simply cannot afford to gamble on delayed payments, which happened during the 2025 federal shutdown, for example.

In Missouri, child care center providers had their subsidy payments delayed for months when the state simply switched to a new system to process payments in 2023 and 2024.

Some states, including Arkansas and Oregon, have also cut their own funding for child care subsidies over the past few years.

Rural and other underserved communities are particularly hard hit by any subsidy delays and cuts.

When there is high demand for child care, there is little incentive for providers to accept subsidies and receive state reimbursement six weeks later, after they file extensive paperwork. The alternative for some providers is to largely enroll wealthier families to pay the full cost of care.

The math doesn’t work

The child care industry faces other challenges.

Despite some recent wage increases, child care workers are among the lowest-paid professionals in the U.S. They earn, on average, about $15 an hour, depending on where they live. They often do not receive other benefits like insurance or retirement.

Child care workers earn so little in part because child care centers typically run on thin margins. They often do not make a profit, unless they are part of a large, national chain, like Bright Horizons.

Most child care providers are small businesses, whether they are run out of a designated center or someone’s private home. Unlike K-12 public school districts, these child care providers typically do not receive any government funding.

If a child care provider raises the wages of child care workers too much, and subsequently increases its tuition rates, most families cannot afford to send their kids there – especially babies.

At the child care center on my campus, for example, raising child care worker wages from $15 to $17 an hour would cost over $85,000 annually. We would need to raise tuition rates by $1,000 per year, per child, to offset that cost.

The younger the children that a center has in a program, the more child care workers it needs to employ. In Missouri, for example, state regulations require that there is one caregiver for every four babies in a child care center.

No clear way forward

There are 16,000 fewer child care providers in the country than there were before the COVID-19 pandemic.

The federal government distributed $53 billion to support the child care industry during the pandemic in 2020 and 2021. Nearly all child care providers received money as part of this funding. But the money that kept some centers afloat during that time has now been spent.

Now, it remains difficult for many families to find affordable child care within a reasonable distance.

While the Trump administration’s freeze on child care subsidies may never take effect, the stricter verification rules are already making an impossible situation for families a whole lot worse. And if subsidies are cut off as well, more American families will simply be unable to afford child care.

Beth Kania-Gosche is the Missouri University of Science & Technology education department chair. Part of the department includes the on campus Child Development Center, which is contracted with Missouri DESE to receive childcare subsidy. The Child Development Center also received state covid relief funds for childcare. She is the current president of the Missouri Association of Colleges for Teacher Education.

– ref. Trump’s new child care subsidy rules compound an already dire situation for providers and families – https://theconversation.com/trumps-new-child-care-subsidy-rules-compound-an-already-dire-situation-for-providers-and-families-275295

Source: The Conversation – USA (2) – By Morgan Bazilian, Professor of Public Policy and Director of the Payne Institute, Colorado School of Mines

Demand for copper is surging because of demand from new technologies, but suppliers are struggling to keep up, and they are likely to fall further behind in the coming years, resulting in shortfalls globally. Even though copper prices are at historically high levels, the financial risk involved in mining means that prices will need to go much higher before mining companies see profit in addressing the supply shortage.

Those are the key findings from our March 2026 analysis of the global copper market.

Copper is an essential material that is used in generating and distributing electrical power; cables, wires, motor windings, transformers and cooling equipment in data centers; and advanced manufacturing of consumer and defense products.

It’s so important that in 2025, the U.S. Geological Survey designated copper as a mineral “vital to the U.S. economy and national security.”

Copper is abundant in the ground, but there’s not enough being extracted to be able to meet the demand. That’s because investors want higher and more reliable returns than copper mines currently offer, and the industry faces complex permitting processes and can’t find enough workers. Our analysis found that for new technologies to continue to develop, and for the global economy to continue to grow, even higher prices are ahead.

Few options other than mining

In the United States, the increased effort to build data centers for artificial intelligence systems has created a massive need for copper. Car manufacturers require some copper for internal combustion vehicles and four to five times more for the batteries and other parts of electric vehicles. In addition, as global temperatures increase, demand for power-hungry air conditioning in many emerging and developing economies has been growing, too, requiring copper inside the equipment and more wiring to power them.

Recycling existing copper could help reduce the amount needed from new mines, but it would not be enough to meet the rising demand. Even under generous assumptions, we found that recycling might provide 35% of the global copper supply by 2050, with mining producing the remaining 65%.

Substituting another material for copper won’t really work either – at least in the short-to-medium term. Copper has an unmatched combination of physical properties such as electrical conductivity, durability and flexibility – which is why it became popular for so many purposes in the first place.

Aluminum could replace it in some cases, but not all – and that would amount to only about 2% of total copper use.

Fiber optics can also replace copper at times. Their glass fibers can carry more data more quickly than copper wires, but they can’t also carry power. New copper substitutes, like ultra-conductive aluminum, carbon nanotubes, and niobium phosphide, are promising but still in their infancy.

Complicated circumstances

The only other way to get more copper is to mine more of it. But building a new mine can take 20 to 30 years – a period during which investors are spending money but not yet getting returns, and a time when costs can rise significantly from preliminary estimates.

If industrial and economic growth is to stay on track in the 2030s, new mines would need to be in the financing and permitting processes right now. But they aren’t.

Even Resolution Copper, which started decades ago trying to develop a mine in Arizona outside Phoenix, has more work to do before being able to start mining. Since 1995, the project’s developers have spent several billion dollars on planning, permitting and legal cases.

Once in place, it could meet as much as 25% of U.S. copper demand from a high-concentration body of ore located near existing truck and rail lines.

Evaluating the environmental and community effects of proposed mining projects is essential, but in many countries there are overlapping levels of review that have different, and variable, timelines. And many parts of the process can be appealed to courts by opponents or supporters. That increases costs and imposes time delays for mine developers – and means consumers will have to wait longer, and pay more, for copper-intensive products and services.

Yet even though copper prices are near historic highs – over US$13,000 per ton on the London Metals Exchange – the profit margins are still too low and price swings are too volatile for companies to forecast reliable returns on the risky investment of building new mines.

Global inequalities

Copper is produced in a handful of countries but used widely around the world.

That leaves copper vulnerable to national policies about imports and exports, leading to trade disruptions and price shocks.

Countries with low and middle per-capita income are likely to require substantial amounts of copper to grow their economies. Right now, wealthy countries like the U.S. and members of the European Union have about 440 pounds (200 kilograms) per person in existing physical infrastructure – electrical wiring, plumbing systems, architectural elements and transportation. But that figure is 20 pounds (9 kilograms) per person in Africa and less than 2 pounds (1 kilogram) per capita.
in India.

Shortages are likely

To get a picture of what might be possible if there were a significant global effort to increase copper availability, we evaluated several optimistic scenarios. We looked at faster permitting for new mines, higher recycling rates and smoother mining processes than those currently in place. But even then, economic development drove demand to grow far faster than the available supply.

Existing mines will have decreasing amounts of ore available and will produce less copper in 2050 than they do in 2025. Yet even if all known copper deposits with known mine-opening dates go into production as scheduled copper supplies will not keep up with demand.

Our best-case scenario has global mine production at about 30 million metric tons of copper a year by 2050. But to keep pace with global economic development, the world will need 37 million metric tons of mined copper a year by then.

To meet that additional need, more mines will need to be opened, and extra production developed – including extracting residual copper from old mine debris that was previously viewed as having too little copper to be worth processing.

A role for government

We found that more copper could be made available more quickly if permitting were streamlined in ways that preserve environmental standards but offer companies proposing new mines some predictability for regulatory approval.

If society wants more copper, faster, then people must accept that higher, more stable prices are part of the solution. Speculative trading contributes to price volatility, which complicates financial projections that are central to deal-making and makes it more expensive to invest in the large, long-term and irreversible expenses that new mines require.

Higher copper prices will ripple through the economy, raising costs for construction, energy and technology. But pretending those costs can be avoided doesn’t make them disappear. Underinvestment across the supply chain from mines to processing today shows up as bottlenecks tomorrow, including delayed grid upgrades and constrained digital growth.

Adam Charles Simon is a co-founder of VectOres Science, Inc.

Morgan Bazilian 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. Global copper demand outstrips supply, threatening electrification and industrial growth – https://theconversation.com/global-copper-demand-outstrips-supply-threatening-electrification-and-industrial-growth-276843

Source: The Conversation – USA (2) – By Philip Landrigan, Professor of Biology, Boston College

In October 1948, a thick haze rolled into Donora, Pennsylvania, a steel town in the Monongahela Valley, south of Pittsburgh. For five days, toxic fumes from a zinc smelter – a plant that turns zinc ore into pure zinc metal – poured out of the factory’s stacks, became trapped in the valley and thus blanketed Donora. The air was filled with sulfur oxides, heavy metal dust and airborne particulates.

Firefighters carried 60-pound oxygen tanks door to door to relieve elderly and asthmatic victims. Nurses attended to mill workers in the infirmary, laying patients on the floor as hospital beds filled to capacity. Funeral homes ran out of space. The disaster eventually claimed 20 lives and caused chronic lung disease in many more.

This was one of the first clear demonstrations in the U.S. that air pollution could kill. Today, new global health research quantifying the risks of pollution exposure helps explain why disasters like Donora were so deadly, and why similar health threats persist.

As a public health researcher and a public health physician, we recently published a study in the journal Annals of Global Health on the health impacts of air pollution in southwestern Pennsylvania that shows the Pittsburgh area as a hot spot for pollution.

A turning point

Research triggered by the Donora disaster uncovered that air pollution causes serious health issues, including chronic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer and diabetes in adults, and can lead to premature birth, low birth weight, stillbirth, asthma and impaired lung development in children.

Emerging evidence indicates that air pollution is also associated with dementia in adults and with IQ loss, attention-deficit/hyperactivity disorder and autism spectrum disorder in children.

Before the Donora disaster, the federal government did not regulate air quality. Pollution was legally viewed as a local nuisance – the unavoidable price of progress.

But the tragedy in Donora forced policymakers, scientists and the public to recognize that air pollution is a serious threat to health. Donora thus laid the groundwork for the Clean Air Act, the federal air pollution law initially enacted in 1963, then strengthened in 1970 and again in 1990. It also catalyzed the nation’s first air pollution research programs.

Pollution persists

Despite this progress, air pollution is still responsible for an estimated 200,000 deaths across the U.S. each year. These deaths are not evenly distributed. Instead, they are concentrated in pollution hot spots.

Our research shows southwestern Pennsylvania, the region around Donora and including Pittsburgh, is one of these hot spots.

Because of its steel mills, coke ovens – which burn coal to produce fuel for steel production – steep valleys that trap pollution and a history of inadequate local enforcement of the Clean Air Act, the Pittsburgh metropolitan area continues to rank among the nation’s most polluted regions.

Breaking down the new data

Fine particle air pollution, known as PM2.5, doesn’t just dirty the air in Pittsburgh and surrounding communities. It can kill people and harm children before they are even born.

To understand the full toll, we conducted an epidemiological study. Using NASA satellite images to measure pollution levels in each census tract, we linked that data to death and birth records from the Pennsylvania Department of Health.

The findings were stark. In 2019, between 3,085 and 3,467 deaths in southwestern Pennsylvania – roughly 11% to 12.5% of all adult deaths that year – were likely attributable to PM2.5 pollution. The damage extended to newborns as well: We estimated pollution caused 229 premature births, 177 infants with low birth weight and 12 stillbirths.

Using existing scientific data showing that every small increase in air pollution is linked to a measurable drop in children’s IQ, we applied that formula to Pittsburgh’s pollution levels across all 24,604 children born there in 2019. That calculation produced an estimated collective loss of more than 60,000 IQ points across the group. That’s an average of approximately 2.5 IQ points per child.

Importantly, many of the harms we saw in Pittsburgh occurred at PM2.5 levels below EPA’s air quality standard of 9 micrograms per cubic meter. This indicates that even low-level PM2.5 exposures carry significant risks to health.

Our findings arrive at a pivotal moment for U.S. air policy. EPA Administrator Lee Zeldin has announced his intention to raise the allowable limit for PM2.5, relax enforcement of the Clean Air Act and repeal the greenhouse gas endangerment finding, which allows the EPA to regulate the emissions that drive climate change.

The EPA has also eliminated its long-standing practice of counting the economic benefits of pollution control. According to new calculations, the EPA will count only the costs of pollution control while stripping out the economic value of lives saved – a metric known as the “value of a statistical life” that agencies have long used to justify health regulations.

What happens next?

During the first Trump administration, environmental rollbacks and a lack of pollution prevention efforts led to an estimated 20,000 deaths per year, according to the Environmental Protection Network, a nonprofit organization consisting of EPA alumni who volunteer their expertise to protect environmental integrity and public health. The deaths were clustered mostly in Southern and Midwestern states with heavy industry and lax pollution rules. States that had already put strong pollution controls in place were able to cushion the blow of the federal cutbacks.

Public health researchers point to local enforcement of the Clean Air Act as a way to limit health impacts of federal agency rollbacks. Allegheny County has legal authority under the Clean Air Act to set and enforce pollution standards stricter than federal minimums, but has not consistently used that authority.

Community and advocacy groups, including the Clean Air Council and PennEnvironment, have pushed the county health department to adopt stricter standards and increase permit enforcement. The Allegheny County Health Department holds regular public meetings where air quality rules and enforcement priorities are subject to review.

As the regulatory landscape shifts, the data from communities like southwestern Pennsylvania will be critical to understanding and documenting what is lost due to air pollution.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Pittsburgh’s air pollution estimated to claim 3,000+ lives per year − and EPA rollbacks aren’t helping – https://theconversation.com/pittsburghs-air-pollution-estimated-to-claim-3-000-lives-per-year-and-epa-rollbacks-arent-helping-277461

Source: The Conversation – USA – By Adam Stanaland, Assistant Professor of Psychology, University of Richmond

Many people have felt the subtle pressure to be “man enough” or “woman enough” in the eyes of others. And research has shown this pressure can have personal and social consequences.

When men feel their manhood is challenged, they can respond with compensatory aggression and other harmful behaviors. When women step outside stereotypical femininity – or even just consider doing so – they often receive backlash.

As researchers who study how gender stereotypes and norms affect people in often unexpected ways, we wondered about the processes by which children feel motivated to conform to stereotypical gender norms. When does this start, and how might it manifest?

In recently published research we conducted with our colleague Andrei Cimpian, we found that when children perceive that their sense of being a “normal” or “proper” member of their gender group is threatened, they feel pushed to conform to stereotypical gender roles in different ways, with lasting consequences.

Girl questions and boy questions

Borrowing from research on adults, we decided that the best way to assess children’s motivation to conform to gender norms was to challenge their status as a “typical” member of their gender group.

To do this, we asked 147 children ages 5 to 10 in New York City to play two games: a “Girl Questions Game” and a “Boy Questions Game.” Each featured difficult trivia about topics that are stereotypically gendered, such as “Which of these flowers is a poppy flower?” (Girl Questions Game) and “Which of these football teams was the 2016 champion?” (Boy Questions Game).

We randomly assigned children to receive feedback suggesting their performance was either gender-typical or gender-atypical, the latter of which was our version of a threat to their gender conformity. For example, a boy in this threat condition received feedback that he had aced the Girl Questions Game but flopped the Boy Questions Game.

Next, we assessed how they responded to this feedback. Would the boy publicly share or hide his achievement in a “Girl Questions Game Book of Winners”? Would he proudly wear a “Girl Questions Game Winner” sticker, or would he prefer to switch stickers? Would he be worried about what his peers would think?

Responding to gender conformity threats

We found three distinct ways children responded to threats to their gender conformity.

First, girls and boys of all ages were extra concerned about not fitting in with their gender group. This means they anticipated more rejection from their peers and reported lower self-esteem.

Second, certain children actively tried to demonstrate that they fit in with their gender group. Younger girls ratcheted up their femininity, while older boys ratcheted up their masculinity. For example, older boys would tell us they liked action figures more than dolls, or that they wanted to retry the Boy Questions Game over the Girl Questions Game.

This is in line with previous research showing that many young girls are immersed in “princess culture” and are especially motivated to prove their femininity, though this declines with age. In contrast, older boys increasingly learn as they age that masculinity is a precarious social status that is hard-won and must be actively proven.

Third, boys of all ages avoided seeming atypical from their gender group, actively distancing themselves from anything feminine. We didn’t see girls distancing themselves from anything masculine in the same way.

This response mirrors a cultural double standard in the U.S.: Girls are often encouraged to be athletic, assertive or like “tomboys,” while boys face no socially acceptable equivalent in the other direction. There is no benign male version of tomboy. The closest word is “sissy,” which is not typically considered a compliment.

Building secure gender identities

Our findings show that the seeds of adult gender conformity – including some of its most harmful expressions, such as certain men’s aggression and some women’s anxiety around pursuing careers in male-dominated fields – are planted early.

Boys as young as 5 already recognize that femininity is something to avoid. By middle childhood – around age 7 – they seem to understand that masculinity is a status that must be actively proven and defended, a mindset that can manifest as aggression, sexual violence and resistance to seeking help in adulthood.

For girls, our findings suggest that they are motivated to prove stereotypical femininity at younger ages, but this may dissipate with age. This may be because girls are sometimes encouraged to pursue achievement in historically “masculine” domains, such as sports and in STEM. Or they may realize that masculinity affords men – and boys – success in these fields, so they seek to move away from femininity and toward masculinity.

However, it’s possible that girls in other settings are more pressured to perform femininity and avoid masculinity – that is, to engage in feminine stereotypes – in ways we were not able to capture in our study. It’s also unclear to us why girls’ responses to perceived threats to gender conformity may weaken with age, given that adult women are affected by these threats. Our future goal is to further test how gender conformity develops in more diverse geographic and cultural contexts, as well as among more gender-diverse children.

All said, we believe middle childhood may thus present a critical window for intervention. Programs that help children, especially boys, build secure identities that don’t depend on gender performance could help them have a healthier relationship with gender norms. In this way, children may be less vulnerable to responding to perceived threats to their gender conformity in ways that harm them through adulthood.

Nevertheless, what’s clear is that children don’t simply observe gender norms – they internalize them, actively defend them, and begin to do this earlier than people think.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Gender conformity starts young – and boys and girls fall in line in different ways – https://theconversation.com/gender-conformity-starts-young-and-boys-and-girls-fall-in-line-in-different-ways-275996

Source: The Conversation – USA – By Andrea Hickerson, Dean and Professor, School of Journalism and New Media, University of Mississippi

Historically, when the U.S. has undertaken military action against foreign governments, journalists have relied heavily on government sources and rallied “’round the flag,” often uncritically sharing official narratives about U.S involvement. This has been evident during periods of U.S. military engagements in Vietnam, Iraq and Afghanistan.

Recently, however, the Pentagon has restricted access for legacy news organizations. And on March 14, 2026, Brendan Carr, chairman of the Federal Communications Commission, replied to a social media post from President Donald Trump complaining about reporting on U.S. involvement in Iran. Carr threatened to deny license renewals to broadcasters not operating in the “public interest.”

“The People of our Country understand what is happening far better than the Fake News Media!” Trump asserted in his original Truth Social post.

This hostile relationship between journalists and a presidential administration is only part of the story about what is or isn’t happening on the ground in Iran and the Middle East.

In times of conflict, information about military activity can be seen as another domain of conflict, much like air, land and sea. Countries, including Iran, have long tried to manipulate information to persuade or influence what people think outside the region.

A preprint, not yet peer-reviewed study authored by academics affiliated with the U.S. Air Force and the U.S. Air Force Academy describes increased government funding and attention to “cognitive warfare,” or efforts to influence what people think through strategic messaging.

A common call to action from advocacy and educational groups in politicized situations where misinformation weighs heavy is to teach media literacy. Conventional wisdom holds that if people only knew how to read the news and look for bias, they would understand a situation more clearly.

As a journalism scholar and educator, I agree that media literacy is valuable. But it’s also time-consuming. It’s impractical to complete a full training or curriculum when faced with immediate current events. As an abbreviated measure to assess the current Middle East conflict, readers can start with the premise that information is contested and an extension of the battlefield.

Key questions to ask

This assumption reframes news not as something that finds a reader by chance, but as something someone wants a reader to see. It primes readers’ critical thinking.

Then readers can consider some key questions:

Why does the author of this information want me to see this?

The obvious answer is that they think it’s important, but what are they focused on? Military progress? One actor in the conflict? Civilian responses? Public opinion? Diplomacy? Asking these questions helps assess what is left out and helps readers resist the temptation to extrapolate details they can’t know from a single news story.

What information does this person or organization have access to?

Because Iran is inaccessible to many journalists, readers must be especially careful about reporting purporting to know or show what is going on inside Iran. For sure, information is coming out via citizen reports and social media, but it is hard to verify and interpret.

Relatedly, and especially when consuming content from social media, readers can ask:

What about an author’s personal experience may inform their interpretation of events?

Media produced for and by diasporas – people displaced from their country of origin by choice or force – is a good source for contextualized and expert information about conflicts in their country of origin. But diasporas can also be deeply political and strategic in what they share. As a general consumer, readers don’t need to get to the bottom of the veracity of the information they share. Readers can simply be aware of disaporas’ positions so they can factor this into their interpretation and understanding of the conflict.

What do different people or organizations have to gain or lose by people widely seeing specific information?

If information is a battlefield, actors will make strategic choices in what they will share with the public. Sometimes they will shield information from the public or deny information. However, undesirable and unflattering information occasionally gets out and circulated, as was the case when a missile struck an Iranian elementary school.

Politicians will want to show they are winning. Journalists may want to show they are being a watchdog on the government. Readers can consider the goals of both the authors and the sources they cite when trying to orient themselves around the information they share.

Transparent fact-checking

Beyond media literacy, there are several potential short cuts to finding accurate information about immediate events in Iran.

First, readers can look for opinions and commentary from established experts on the Middle East, Iran, oil, the military and other related fields. Too many readers claim expertise after reading a few popular articles or listening to a podcast.

Instead, they can look for people who have been observing and researching the region for years – people whose work has been already validated by peer review. As a starting place, readers can look for subject matter experts on the social network LinkedIn or search for research on Google Scholar. Readers can also see whether authors of older popular books are writing about contemporary events on websites or blogs.

Think tanks that produce research reports may also be helpful, but sometimes think tanks with neutral-sounding names are politically affiliated. A close read of the “About Us” page and perusing the list of funders can offer some helpful clues.

Finally, perhaps the most efficient way to evaluate what is happening in Iran is to follow fact-checking and open-source reporting organizations. These groups often do a better job showing their assessment work and linking to evidence than do traditional news outlets, which focus on narrative structure and a cohesive final product.

Poynter, a nonprofit journalism institute, recently detailed the work of Factnameh, run by an Iranian fact-checker in exile. Bellingcat and Indicator are two excellent open-source reporting organizations that use public data to investigate whether actual events match circulating narratives.

And sometimes traditional news organizations do similar types of investigations, such as this example of The Associated Press debunking video misinformation in Iran.

The transparent methods of fact-checking and open-source sites can also serve as interactive exercises in media literacy. Both Bellingcat and Indicator regularly showcase information validation tools that readers can use.

Regardless of how much effort readers choose to spend on evaluating the accuracy of reporting on Iran, none of us are watching the battle from the sidelines.

Andrea Hickerson 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. Information is a battlefield: 4 questions you can ask to judge the reliability of news reports and social posts about the US-Iran war – https://theconversation.com/information-is-a-battlefield-4-questions-you-can-ask-to-judge-the-reliability-of-news-reports-and-social-posts-about-the-us-iran-war-278384

Source: The Conversation – USA (3) – By Jamie Hartmann-Boyce, Assistant Professor of Health Promotion and Policy, UMass Amherst

Since the Affordable Care Act subsidies expired at the end of 2025, Americans have undoubtedly been encountering a great deal of confusing information surrounding health care costs and insurance plans.

From five-figure deductibles to premiums higher than people’s mortgages, costs are rising across the board.

With this comes difficult decisions around health care plan enrollment. No one can know exactly what their health care needs will be in any given year, so people are forced to hedge their bets in choosing plans.

What plan you pick has a huge impact on what you will end up paying.

However, many Americans don’t understand key health insurance terms. For example, people who’ve completed fewer levels of education and people without health insurance are less likely to understand the jargon. This can get in the way of picking the right plans.

As scholars of health policy, evidence-based health care and health economics, we believe understanding these terms can help you pick what plan might be the best for you.

Frequently encountered health insurance terms

The first of these is your health insurance premium. This is the amount you pay each month for having health insurance coverage, whether or not you use any services. Premiums can be expensive, but they are predictable. Once your premium is set for the year, it won’t change.

What’s much harder to predict is how much of each medical bill you will have to pay yourself, known as out-of-pocket costs. These are sometimes also referred as “patient cost-sharing” or “copays.” These typically come in three forms: deductibles, coinsurance and copayments.

A deductible is how much you need to spend on your health care in a given year before your insurance starts covering any costs. Under plans with a deductible, you pay the full cost of health care services first – essentially as if you did not have health insurance – until your total spending reaches the deductible amount. Once you reach that threshold, your insurance will start paying for your additional medical costs.

But in most plans, even once you hit your deductible, your insurance will still not cover the full cost of your care. You will continue to pay a portion of the bill through coinsurance, which is the percentage of the cost of care that you are responsible for paying. For example, if your coinsurance rate is 20% and you receive care that costs US$500, you would pay $100 (20% of $500).

What often makes coinsurance confusing is that while the coinsurance rate – the percentage – is usually listed on your health insurance card, you still need to know the total cost of your care to calculate how much you will owe. That cost is difficult to know in advance because reliable health care prices are difficult to find and health care needs – and the services required to treat them – can be unpredictable.

Then there are copayments. This is a fixed amount you pay for a health care encounter, such as $20 for a primary care visit or $150 for an emergency department visit. In everyday language, people sometimes use copay to refer to any amount a patient pays out of pocket. Technically, however, a copayment refers only to a fixed fee paid for a health care service.

Whether through deductibles, coinsurance or copayments, these out-of-pocket amounts can add up quickly. To protect patients, especially those who need a lot of care and could otherwise face devastating medical bills, federal regulations require health insurers to limit how much patients can be asked to pay out of pocket each year for covered services.

This amount is called the out-of-pocket maximum. This is sometimes also called the out-of-pocket cap or out-of-pocket limit. Once your total out-of-pocket spending reaches that limit, your insurance must pay 100% of the cost of additional covered services for the rest of the year.

Additional factors to consider

These insurance rules can become even more complicated. Many plans have multiple different deductible amounts, coinsurance rates, copayments and even out-of-pocket maximums, depending on several factors. For example, in family plans, each person may have their own deductible or out-of-pocket maximum, but there may also be thresholds and limits that apply to the family as a whole. Cost-sharing can also vary by the type of care you receive. For instance, inpatient hospital care may be subject to a different set of cost-sharing rules than outpatient care.

Another important factor is whether your health care provider has a contract with your insurance company. Providers who have such a contract are called in-network providers. Those who do not are called out-of-network providers. Some insurance plans further divide in-network providers into tiers.

Providers in Tier 1 are the most preferred by the insurance plan, often because they agreed to provide services at relatively lower prices. Other in-network providers may be placed in Tier 2. Costs to you tend to be lowest for services from Tier 1 providers, higher for services from Tier 2 providers and highest for services from out-of-network providers. Some insurance plans may not cover out-of-network care at all.

There are often trade-offs between these elements – low premiums look great on the face of it, but any money you save by paying lower premiums is often offset by significant out-of-pocket costs, limited options for in-network providers, or both.

The problem, of course, is that it’s impossible to predict how much health care you might need. If you could somehow know you weren’t going to need much health care in the following year, then a low-premium, high-deductible plan would make sense.

If, on the other hand, you knew you were going to receive a catastrophic diagnosis or be in a life-altering car accident, you would want to opt for a plan that might include higher premiums but lower copays.

Gambles and trade-offs

If everyone knew all the medical care they needed could be provided by any general doctor, they might not care much about what or who was in-network. But if they knew they were going to need specialist surgery for a rare type of tumor, for example, offered at only one center out of state, they would want to consider what counts as in-network – or the costs of going out of network – in substantially more detail.

In many other countries, people don’t face the same burden. In nations with universal health coverage, understanding health insurance jargon isn’t a matter of financial survival. Because coverage is guaranteed, people do not have to agonize every year over choosing a health plan based on countless variables.

But until meaningful change comes about in the U.S., the best many Americans can do is understand health insurance jargon so they can choose plans that work best for them.

Jamie Hartmann-Boyce receives research funding from the National Institutes of Health, the Food and Drug Administration, the Truth Initiative, and Cancer Research UK.

Michal Horný consults to VBID Health. He receives funding from Arnold Ventures and the National Institutes of Health. He received speaker honoraria and/or travel support from Health Care Cost Institute, Georgetown University, Brown University, Charles University (Czech Republic), Masaryk University (Czech Republic), and the Czech Academy of Sciences (Czech Republic).

– ref. Health insurance jargon can be frustrating and confusing – here’s how to navigate it – https://theconversation.com/health-insurance-jargon-can-be-frustrating-and-confusing-heres-how-to-navigate-it-277355