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    They Barter and Trade in Rural America. How Will They Vote?

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    Many rural Americans engage in cashless barter systems to get food and firewood for heating and cooking. They value self-sufficiency, making them wary of government intervention.When Miki Shiverick needs firewood to heat her home, or help clearing the rusted appliances and vehicles from her property, she doesn’t go to a store or pay for services. Instead, she trades for it.For instance, preparing her land in Bergholz, Ohio for livestock over the last four years required hauling away piles of salvage, old tools and antiques from the rundown property she bought from the family of an old tinker. The place, with its barn house and five outbuildings, resembled a 12-acre junkyard.Ms. Shiverick, 56, found local scrappers willing to keep the profits from selling the rusted cars, campers, tractor parts, buried gas tanks and aluminum ingots at the local scrap yard. She also found woodsmen willing to clear trees for her in exchange for most of the wood.On this newly blank canvas, she dreams of creating a clean, natural retreat for her family with gardens that support wildlife and livestock, which she raises to promote food self-sufficiency and land stewardship.Bergholz is a rural town with a population of fewer than 600. For centuries, rural communities like Bergholz have operated in cashless barter systems built on mutual trust and neighborly relationships — a culture of self-sufficiency that has also shaped political views toward a kind of bootstrap conservatism.“People around here don’t do welfare, it’s not who we are,” Ms. Shiverick said.Ms. Shiverick bartered a bolt of linen with an Amish neighbor for a chicken coop.Rebecca Kiger for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      CVS Ousts Karen Lynch as C.E.O. and Shares Fall

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      Shares of the health care conglomerate dropped after the sudden departure of Karen Lynch and a downbeat update on the state of the company’s finances.CVS Health abruptly ousted its chief executive, Karen S. Lynch, on Friday as the pharmacy and health care conglomerate struggled with sluggish growth and faced pressure from investors.The company appointed David Joyner, the head of CVS Caremark, its successful unit overseeing prescription drug benefits, as the new chief. The management change was accompanied by a dour financial update, with the company scrapping its previous forecasts because of “elevated medical cost pressures.” Shares of CVS fell sharply in early trading.The company’s earnings have disappointed investors in recent quarters, in part because of rising costs at Aetna, the company’s insurance arm. Activist investors have pushed the company for changes, prompting CVS to explore breaking itself up, potentially by separating its pharmacy business from its insurance unit.CVS employs about 300,000 people. Its sprawling portfolio includes the branded pharmacy chain, with more than 9,000 retail locations; Aetna, which it acquired in 2018, which has nearly 40 million policyholders and other customers; Caremark, the country’s largest pharmacy benefit manager, hired by employers and governments to oversee prescription drug benefits; and Oak Street Health, which runs more than 200 primary care centers for Medicare recipients.Ms. Lynch took over as the group’s chief executive in February 2021, after running Aetna. “I don’t want people to think about CVS Health as just that drugstore,” she told The New York Times in 2022. “I want them to think about it being a health care company.”Roger Farah, the chairman of CVS Health, said in a statement on Friday that “the board believes this is the right time to make a change.” He added that Mr. Joyner’s “deep understanding of our integrated business” would help steer the company through its challenges.During his tenure at Caremark, which he rejoined in 2023 after a few years away from the company, Mr. Joyner faced increased scrutiny of pharmacy benefit managers. He appeared at a Congressional hearing this summer, facing questions from lawmakers about the role of pharmacy benefit managers in rising drug costs for millions of Americans.This month, CVS said it would cut almost 3,000 jobs, mostly corporate employees. Its rival chains are also under pressure to cut costs: This week, Walgreens said it would close about 1,200 stores over the next three years.Shares of CVS, which dropped 7 percent on Friday, have fallen more than 25 percent this year. More

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      Held Involuntarily in a Psychiatric Hospital

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      More from our inbox:The Debate Over Taxing TipsNonpartisan ElectionsSitting Still in SchoolAcadia Healthcare’s Park Royal hospital in Fort Myers, Fla., and Florida is among those that wrongly held some patients against their will.Michael Adno for The New York TimesTo the Editor:Re “Patients Held Against Will by Hospitals” (front page, Sept. 2):Thank you for your hard-hitting exposé of Acadia Healthcare, a chain of psychiatric hospitals, which revealed Acadia’s corrupt financial practices. The authors report on the toxic effects — including but not limited to driving people away from treatment — of these unscrupulous procedures.But even when hospitals have pure motives, inpatient psychiatric care — especially when it is involuntary — can be traumatizing, and may lead to an increased risk of suicide: In one meta-analysis, “the postdischarge suicide rate was approximately 100 times the global suicide rate during the first 3 months after discharge.”The key to helping people is funding community-based, evidence-based programs. For example, “Peer-run respites provide a voluntary alternative to an emergency department visit or inpatient hospitalization for people experiencing a psychiatric crisis,” as was noted in a recent article in Psychiatry Online.With so much evidence to support the benefits of community-based mental health care, I believe that a paradigm shift in the mental health system — away from hospitalization and toward community-based treatment, including peer support — is long overdue.Susan RogersCherry Hill, N.J.The writer is the director of the National Mental Health Consumers’ Self-Help Clearinghouse.To the Editor:The motivation for this atrocious behavior is cited in the first paragraph of the article, where it is noted that Acadia Healthcare’s stock price has more than doubled. This is an example of the perverse results of the use of private equity to finance health care. There are other such examples.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Elizabeth Warren: Don’t Be Fooled. Donald Trump Has a Plan.

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      During the presidential debate on Tuesday, Donald Trump was pressed on the details of his plan to repeal Obamacare and replace it with something “better.” The question should’ve been a softball. After all, Mr. Trump has been promising the American people a plan for nine years, so he’s had time to prepare. His answer? After ducking and weaving, he came up with: “I have concepts of a plan.” Uh, that’s not a plan.Plans translate values into action. They test the quality of the ideas and the seriousness of the people advancing them. Plans reveal for whom candidates will fight and how effective they are likely to be. And in a presidential race, if either party’s nominee is asked about his or her plans for something as fundamental as health care, voters should get a straight answer.The problem is not that Mr. Trump can’t think up a way to put his values into action. The problem is that when he and other Republican leaders produce plans with actual details, they horrify the American people.Mr. Trump’s health care values have been on full display for years. In 2017, Republicans controlled Congress, and their first major legislative undertaking was a bill to repeal the Affordable Care Act. Every time they drafted something, independent experts would point out that their plan would toss tens of millions of people off their health insurance, jack up premium costs and slash benefits for those with ongoing health problems.After months of wrangling, Mr. Trump and Republican lawmakers voted a bill through the House to repeal the A.C.A. That night, Mr. Trump hosted a party at the White House to celebrate their big step toward taking away health care from millions of people.A.C.A. repeal then moved to the Senate. Republicans had the majority, so if they all stuck with Mr. Trump, the A.C.A. would die. As senators gathered to vote, nearly all of the Democrats — including Kamala Harris, then a senator from California — remained standing, too anxious even to sit down. We murmured stories about who would be affected by this vote: the uncle who had cancer and would lose coverage, the kid diagnosed with a heart anomaly whose parents wouldn’t be able to find new insurance, the college students who would just go without coverage and hope they didn’t fall on ice or get in a car accident. We felt the weight of people’s lives on the line.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Boeing Workers Go on Strike: What to Know

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      Thousands of Boeing workers in Washington State and Oregon walked off the job on Friday in the first strike at the plane maker in 16 years.Boeing is facing a strike that threatens to disrupt plane production, after workers overwhelmingly voted to reject a tentative contract their unions had reached with the company.Thousands of workers walked off the job in the Seattle and Portland, Ore., regions on Friday, a move that is likely to stall operations at factories where Boeing manufactures most of its commercial planes. While the deal their unions struck with the company on Sunday included double digit pay raises and improvements to benefits, 95 percent of workers rejected the proposed contract, opting instead to leverage a strike to push for more.Here’s what else to know about the company’s first strike since 2008:How many workers are on strike?Boeing, one of the largest exporters in the United States, employs a total of nearly 150,000 people across the country — almost half of them in Washington State — and more than 170,000 people worldwide. The contract that spurred Friday’s strike covers about a fifth of the company’s employees.A vast majority of the 33,000 workers under the contract are represented by District 751 of the International Association of Machinists and Aerospace Workers, Boeing’s largest union. Most of that union’s members work on commercial airplanes in the Seattle area. Workers in the Portland, Ore., area, who are represented by the union’s smaller District W24, are also on strike.What prompted them to walk off the job?The leaders of the unions representing the workers on strike reached a tentative deal with Boeing on Sunday that would have secured raises of 25 percent over four years, along with improvements to health care and retirement benefits. The company also committed to building its next commercial plane in the Pacific Northwest.But workers’ overwhelming rejection of that tentative contract reflects their willingness to fight for more, in large part to make up for concessions made in past talks, including the loss of pension benefits a decade ago. The unions started the talks by asking for raises of 40 percent.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Young Americans Can’t Keep Funding Boomers and Beyond

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      You know the expression “OK, Boomer”? Better said as “Boomer OK.” That’s because the social safety net in the United States is increasingly favoring the old over the young. And this affects our political views and the security of future generations.Younger Americans have valid reason for disgruntlement: Big shifts in income and wealth are dramatically favoring their elders. Under almost every president since 1980, 80 percent of the real growth in domestic spending has gone to Social Security and health care, with Medicare the most expensive health program, according to calculations based on federal data. As a share of GDP, all other domestic outlays combined have declined.Our current tax system also largely does not help Americans, most of whom are younger, pay for their higher education. That wasn’t as big a deal in the 1960s or 1970s, when the average college graduate most likely had little or no student debt. Today, the average taken out each year is about seven times that in 1971, in part because state governments have stripped colleges and universities of funding. This is happening at a time when owning a house is increasingly out of reach. The median price has risen from about 3.5 times median annual income in 1984 to 5.8 times in 2022.So it shouldn’t come as a surprise that today, younger generations are more likely to fall into lower-income classes than their parents or grandparents. Nearly a half century ago, it was the reverse. And in 1989, the median net worth of Americans aged 35 to 44 was nearly 75 percent of those aged 65 to 74. By 2022, that ratio had fallen to one-third.The why is simple. Unlike most other spending, Congress effectively designed Medicare in 1965 and Social Security in the 1970s in such a way that outlays would increase forever faster than our national income. That’s partly because Medicare costs keep rising along with medical prices and new treatments and because Social Security benefits are designed to increase for each new generation along with inflation and wages. And we’re living longer, which means more years of benefits.Today, tax revenues are so committed to mandatory spending, largely for older Americans, and to interest on the national debt (which has quadrupled as a share of G.D.P. since 1980) that few revenues are left for everything else. So, unless we borrow to pay for it, there’s little for education, infrastructure, environment, affordable housing, reducing poverty, or the military.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Trump propuso que la fertilización in vitro fuera gratuita. ¿Es posible?

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      Conseguir que se cubran los costosos tratamientos de fertilidad sería algo que no puede hacer un presidente solo, dijeron los expertos en políticas de salud.[Estamos en WhatsApp. Empieza a seguirnos ahora]El expresidente Donald Trump dijo el jueves en campaña que quiere que el tratamiento de fertilización in vitro (FIV) sea gratuito para todos los estadounidenses.“Bajo un gobierno de Trump, tu gobierno pagará o tu compañía de seguros estará obligada a pagar todos los costos asociados con el tratamiento de fertilización in vitro”, dijo Trump el jueves en un mitin en Potterville, Míchigan.La fecundación in vitro suele costar decenas de miles de dólares. Las políticas para cubrir esos costos serían difíciles de implementar, dijeron los expertos.Exigir a las aseguradoras que paguen estos procedimientos probablemente significaría aprobar leyes en el Congreso o persuadir a un panel de expertos para que añadan la FIV a una lista de servicios preventivos gratuitos de salud femenina establecidos por la Ley de Asistencia Asequible, la ley de cobertura de salud que Trump trató de derogar.Si el gobierno pagara directamente la FIV, se crearía un sistema de pagador único para una sola condición. El enfoque requeriría que el Congreso financie una nueva división del gobierno federal para supervisar el programa.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Congress Presses Health Insurance Regulators on ‘Troubling’ Billing Tactics

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      Lawmakers are zeroing in on MultiPlan, a firm that has helped insurers cut payments while sometimes leaving patients with large bills.Lawmakers on Tuesday called on health insurance regulators to detail their efforts against “troubling practices” that have raised costs for patients and employers.In a letter to a top Labor Department official, two congressmen cited a New York Times investigation of MultiPlan, a data firm that works with insurance companies to recommend payments for medical care.The firm and the insurers can collect higher fees when payments to medical providers are lower, but patients can be stuck with large bills, the investigation found. At the same time, employers can be charged high fees — in some cases paying insurers and MultiPlan more for processing a claim than the doctor gets for treating the patient.The lawmakers, Representatives Bobby Scott of Virginia and Mark DeSaulnier of California, both Democrats in leadership positions on a House committee overseeing employer-based insurance, highlighted MultiPlan as an example of “opaque fee structures and alleged self-dealing” that drive up health care costs. In their letter, they pressed the department for details on its efforts to enforce rules meant to promote transparency and expose conflicts of interest.MultiPlan’s business model focuses on the most common way Americans get health coverage: through an employer that “self-funds,” meaning it pays medical claims with its own money and uses an insurance company to process claims. Insurers such as Aetna, Cigna and UnitedHealthcare have pitched MultiPlan’s services as a way to save money when an employee sees a provider out of network.In many cases, MultiPlan uses an algorithm-based tool to generate a recommended payment. Employers typically pay insurers and MultiPlan a percentage of what they call the “savings” — the difference between the recommendation and the original bill.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More