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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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      What to Know About CKM, the Link Between Heart Health, Diabetes and Kidney Disease

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      And they’re increasingly common. Here’s what to know about the shared risk factors for these diseases.Heart disease, diabetes and kidney disease are among the most common chronic illnesses in the United States — and they’re all closely connected.Adults with diabetes are twice as likely to have heart disease or a stroke compared with those who don’t have diabetes. People with diabetes — Type 1 and Type 2 — are also at risk of developing kidney disease. And when the kidneys don’t work well, a person’s heart has to work even harder to pump blood to them, which can then lead to heart disease.The three illnesses overlap so much that last year the American Heart Association coined the term cardiovascular-kidney-metabolic syndrome to describe patients who have two or more of these diseases, or are at risk of developing them. A new study suggests that nearly 90 percent of American adults already show some early signs of these connected conditions.While only 15 percent of Americans meet the criteria for advanced stages of C.K.M. syndrome, meaning they have been diagnosed with diabetes, heart disease or kidney disease or are at high risk of developing them, the numbers are still “astronomically higher than expected” said Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Women’s Hospital in Boston and co-author of the study.The research suggests that people should pay attention to shared risk factors for these diseases early on — including excess body fat, uncontrolled blood sugar, high blood pressure and high cholesterol or triglyceride levels.A Dangerous CycleYour kidneys, heart and metabolic system (which helps process the food you eat into energy and maintains your blood sugar levels) work closely together. If something goes awry with one, it can lead to problems with the others.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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      How Ozempic Is Changing Diabetes Treatment

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      Millions of patients rely on insulin. But with new drugs, some have been able to lower their doses or stop taking it altogether.For over 20 years, Betsy Chadwell carried her insulin pens everywhere. Day in and day out, she carefully calibrated the doses needed to keep her Type 2 diabetes in check. “Every meal, and every morning and every night — it controls your life,” she said.In late 2021, she started on the diabetes drug Ozempic. Within months, she was able to stop taking the short-acting insulin she typically took before each meal altogether, and she has substantially reduced the dose of long-acting insulin she uses daily. Scaling back on insulin has given her a sense of freedom, she said. She still uses a continuous glucose monitor to track her blood sugar, meticulously watching for slumps and spikes — but even as she took less insulin, she said, Ozempic has helped keep her glucose levels more under control.Millions of Americans rely on some form of insulin, a lifesaving drug that has long been a mainstay of diabetes treatment. But it can also be a burden to patients like Ms. Chadwell, who must juggle different formulations and doses, and often must have insulin on hand at all times. “I really feel for those patients, because you can never stop having it in the back of your mind,” said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity. But in recent years, Ozempic and a similar drug, Mounjaro — both weekly shots that can lower blood sugar, in part by mimicking a hormone that stimulates insulin production — have offered patients an enticing new option to try managing their Type 2 diabetes without relying as heavily on insulin.And drugmakers are examining other ways these drugs might work alongside insulin: Novo Nordisk, the company that makes Ozempic, is studying a new drug called IcoSema, a weekly shot that combines insulin icodec (an ultra long-acting version of insulin) and semaglutide, the compound in Ozempic.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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      PCOS Diets Are Unlikely to Ease Symptoms

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      Patients were told for years that cutting calories would ease the symptoms of polycystic ovary syndrome. But research suggests dieting may not help at all.For years, people who had polycystic ovary syndrome and were also overweight were told that their symptoms would improve if they lost weight via a restrictive diet. In 2018, a leading group of PCOS experts recommended that overweight or obese women with the hormonal disorder consider reducing their caloric intake by up to 750 calories a day. That guidance helped to spawn questionable diet programs on social media, and reinforced an impression among people with PCOS that if only they could successfully alter their diets, they would feel better.But the recommendations were not based on robust PCOS studies, and researchers now say that there is no solid evidence to suggest that a restrictive diet in the long-term has any significant impact on PCOS symptoms. Dieting rarely leads to sustained weight loss for anyone, and for people with PCOS, losing weight is particularly difficult. Beyond that, the link between sustained weight loss and improved symptoms is not very clear or well-established, said Julie Duffy Dillon, a registered dietitian specializing in PCOS care.In 2023, the same group, called the International PCOS Network, revised its guidance based on a new analysis of the research and dropped all references to caloric restriction. The group now recommends that people with PCOS maintain an “overall balanced and healthy dietary composition” similar to the Mediterranean diet, which is associated with a reduced risk of the health issues that are linked to the disorder, like cardiovascular disease and diabetes. It’s not known whether eating this way might improve symptoms of PCOS. The changes in the guidelines reflect “the PCOS literature and the lived experience of people with the condition,” said Dr. Helena Teede, an endocrinologist at Monash Health in Australia and lead author of the 2023 guidelines. “It’s no longer about blaming people or stigmatizing them, or suggesting that it’s their personal behavioral failure that they have higher weight.”What is PCOS?PCOS is a hormonal disorder that affects as many as five million women in the United States. It’s characterized by irregular periods, infertility, excessive facial hair growth, acne and scalp hair loss — symptoms that are common with other health conditions, too, making diagnosis tricky. People with PCOS usually ovulate less than once a month and often also have higher levels of androgens (male sex hormones) or multiple underdeveloped follicles on their ovaries (not, as the name suggests, cysts) or both.Typically, when a woman is experiencing symptoms, a doctor will either scan the ovaries to look for those follicles or draw blood to test hormone levels. There is no cure for PCOS; the first line of treatment is often some form of birth control to help regulate the menstrual cycle.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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      A Resonant Topic in Georgia’s Senate Runoff: Insulin Prices

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      The cost of insulin is nowhere near as contentious as just about everything else raised in the runoff, but in a state with a high diabetes rate, it has proved a powerful issue.MACON, Ga. — The runoff election for Senate in Georgia has not lacked for drama, with a fresh round of attack ads, a fevered get-out-the-vote effort and both sides casting the outcome as pivotal for the nation’s future even though control of the chamber is no longer at stake.But one campaign issue relevant to many voters has little to do with the highly partisan horse race. Rather, it involves one of the most common chronic diseases in America, diabetes, and the soaring cost of the medicine used to treat it, insulin. In both the general and runoff campaigns, Senator Raphael Warnock, the Democratic incumbent, has made much of his efforts in Congress to cap the price of insulin at $35 a month, talking them up in ads, debates and speeches.“It has resonated with just about everyone,” said Dr. Kris Ellis, a physician who also owns the Bearfoot Tavern in Macon, where Mr. Warnock made a recent campaign stop. “If you don’t have diabetes, you know someone with diabetes.”He was describing an unsettling reality in Georgia, as in much of the South, where diabetes rates are staggeringly high and the escalating cost of insulin over the years has led to painful choices and, for some, catastrophic consequences.“I have someone in my family with diabetes who couldn’t afford insulin,” Tony Brown, 57, said on a recent afternoon as he walked into a building in downtown Macon where he works as an engineer. For that reason, he said, he would turn out one more time to vote for Mr. Warnock in Tuesday’s runoff.As campaign issues go, the price of insulin is nowhere near as contentious as just about everything else raised in the four-week runoff between Mr. Warnock and Herschel Walker, the former football star who is his Republican challenger. Even so, interviews with Dr. Ellis and a number of other voters suggested it had broken through the noise of the high-decibel contest, which Georgia requires because neither candidate won a majority of the vote in the general election.“I have someone in my family with diabetes who couldn’t afford insulin,” Mr. Brown said.Nicole Craine for The New York TimesMr. Warnock has focused on lowering insulin prices since arriving in the Senate nearly two years ago, motivated in part by hundreds of letters that have poured into his office, pleading with him to do something. He has also described seeing the ravaging impacts of diabetes, including losing limbs and eyesight, on congregants at Ebenezer Baptist Church in Atlanta, where he is the senior pastor.“This isn’t an ideological matter, it’s a practical one — and it has broad support across the political spectrum,” Mr. Warnock wrote last spring in an opinion essay published in The Atlanta Journal-Constitution.Earlier this year, he introduced legislation that would require both Medicare and private insurers to cap out-of-pocket costs for insulin at $35 a month. The average out-of-pocket cost per prescription reached $54 in 2020, according to an analysis by the Kaiser Family Foundation, which also found that many patients pay significantly more for diabetes care.What to Know About Georgia’s Senate RunoffCard 1 of 6Another runoff in Georgia. More