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When Weyrich samples tartar from teeth, she’s careful to pick jaws that have more than one tooth and to always leave some tartar behind. You don’t want to destroy it all, she explains, because you never know what techniques might come along in the future.

"This is the wealthiest country in the history of the world. It is time we got our national priorities right," Sanders told the Michigan rally.

Britt Waligorski, 31, a health care administrator for a dental practice, said she didn't get health insurance through work but has been covered through the health law for three years. While the premiums have gone up, she said she is concerned that services for women will be taken away if it is repealed.

About 2,000 people cheered and held rainbow and American flags and signs that read "Don't Make America Sick Again" and "Health Care For All" at the rally.

Republicans want to end the fines that enforce the requirement that many individuals buy coverage and that larger companies provide it to workers.

With eager anticipation, the Kremlin is counting the days to Donald Trump's inauguration and venting its anger at Barack Obama's outgoing administration, no holds barred.

At the same time, Russian officials are blasting the outgoing U.S. administration in distinctly undiplomatic language, dropping all decorum after Obama hit Moscow with more sanctions in his final weeks in office.

On Sunday, Vice President-elect Mike Pence insisted the Trump presidential campaign had no contacts with Russia and denied that the incoming national security adviser spoke with Russian officials in December about sanctions. He added that such questions were part of an effort to cast doubt on Trump's victory.

In an interview Friday with The Wall Street Journal, Trump said he might do away with Obama's sanctions if Russia works with the U.S. on battling terrorists and achieving other goals.

"We and many analysts believe that the (agreement) is consolidated. The new U.S. administration will not be able to abandon it," Araqchi told a news conference in Tehran, held a year after the deal took effect.

Trump, who will take office on Friday, has threatened to either scrap the agreement, which curbs Iran's nuclear programme and lifts sanctions against it, or seek a better deal.

"It's quite likely that the U.S. Congress or the next administration will act against Iran and imposes new sanctions."

But Iran is still subject to an U.N. arms embargo and other restrictions, which are not technically part of the nuclear agreement.

The event was marked by tense exchanges as Trump repeated his refusal to release his tax returns and denounced media outlets that published stories based on unverified allegations about his ties to the Kremlin

Trump began his remarks on Tuesday by blaming “inaccurate news” for his decision not to take questions from the press more often.

Trump went on to address a pair of reports published Tuesday night that touched on unverified accusations about his relationship with Russia. The first report, which came from CNN, said intelligence officials had presented information to Trump alleging that the Russian government had an ongoing relationship with members of his campaign — and, more sensationally, possessed compromising information about him that could be used for blackmail.

“I want to thank a lot of the news organizations … some of whom have not treated me very well over the years. …

“It’s all fake news. It’s phony stuff. It didn’t happen, and it was gotten by opponents of ours, as you know, because you reported it and so did many of the other people.

“No, no, no,” Jones said with a sly grin that barely disguised his evident hostility. Sitting back in his barber chair, he shook his head and narrowed his eyes. “That’s not why you are here. You’re here because of the billboards, because of the KKK. That’s why you are here.”

When the controversial billboards were ripped down and defaced, they were replaced almost immediately.

“While Trump wants to make America great again, we have to ask ourselves, ‘What made America great in the first place?

The Trump campaign quickly disavowed the endorsement

It was yet another success for Project RECOVER, an organization that blends old-school archival research with new-school sonar technology to find aircraft of Americans MIA, or missing in action.

For two months, the sonar scanned. And then, success.

The process began, as all the searches do, with intensive research at the National Archives, interviews with veterans, and a dig through old military photographs.

"This is more than reconnecting with history; it's about locating the missing to enable the U.S. government to bring them home for a proper burial,

The government will use personal items, such as dog tags, dental records and DNA to identify them

Let’s push for home visitation programs that encourage parents to speak to children and read to them; many low-income homes don’t have a single kid’s book. We also need initiatives to reduce exposure to lead and other toxins. Finally, how about screenings for problems like hearing and visual impairment — all followed by a good prekindergarten.

all young children should have a primary care physician who screens them for eight barriers to learning: vision problems, hearing deficits, undertreated asthma, anemia, dental pain, hunger, lead exposure and behavioral problems.

Let’s broaden the conversation about opportunity, to build not just safety nets for those who stumble but also to help all American kids achieve lift-off.

The study authors acknowledge that S. enterica may have interacted with other circulating pathogens. The method does not rule them out. In particular, the team can only detect DNA, but some viruses carry RNA instead. “If all these people died from RNA viruses, we will never know, at least not with these techniques,

under 230,000 foreigners are currently subject to deportation and more than 60,000 of them don't even have a temporary residency permit and technically have to leave the country immediately.

Reports of refugees who have raped or even killed women leave a more lasting impression than features about Syrians who are quickly able to establish themselves as dental technicians in Germany or about successful second-generation entrepreneurs from Turkey

This has led to an additional problem: Terminology. Terms like immigrant, German, foreigner or "immigration background" no longer work particularly well in a country of immigration.

many immigrant children are still far away from reaching their potential. The share of second-generation immigrants from Turkish families with a university-prep high school diploma, for example, is 25 percent while for Germans it is 43 percent

many immigrants pass down their limited education to their children,"

the comparison is of only limited utility due to the fundamental differences between Canadian and German immigration policy. Canada carefully chooses its immigrants and they tend to be well-educated and fluent speakers of English. In 2016, the country only took in around 50,000 refugees

the German government does need to muster sufficient courage to impose more regulation on immigration, reform the European asylum system and find effective ways to send rejected asylum applicants back to their home countries more expeditiously.

"From the moment I get a job in Germany, it is generally well enough paid that it is possible to build up a life on that basis." Work is the great equalizer, Schneider believes. "Socialization via work did wonders for the guest workers and it still works today."

But after weeks of work, administration officials have closed in on the final version of what will be the second half of Mr. Biden’s sweeping economic agenda, which also includes the $2.3 trillion American Jobs Plan the president described last month.

It also seeks to extend through 2025 an expanded tax credit for parents — which is essentially a monthly payment from the government for most families — that was created on a temporary basis by the $1.9 trillion economic aid package Mr. Biden signed into law last month.

Democrats on Capitol Hill have urged Mr. Biden to instead make permanent that credit, which analysts say will drastically cut child poverty this year.

“Expansion of the child tax credit is the most significant policy to come out of Washington in generations, and Congress has an historic opportunity to provide a lifeline to the middle class and to cut child poverty in half on a permanent basis,” the lawmakers said this week in a joint statement.

The president will also propose eliminating a provision of the tax code that reduces taxes for wealthy heirs who sell assets they inherit, like art or property, that have gained value over time.

All of the tax provisions would keep with Mr. Biden’s campaign promise not to raise taxes on individuals or households earning less than $400,000 a year.

Mr. Biden’s team was under pressure from Senator Bernie Sanders, independent of Vermont and the chairman of the Budget Committee, to instead focus his health care efforts on a plan to expand Medicare.

Mr. Sanders has pushed the administration to lower Medicare’s eligibility age and expand it to cover vision, dental and hearing services.

she is not surprised at the robust increase in the number of people enrolling in ACA insurance since President Biden reopened enrollment in January. As of last month, the administration says, more than 1 million people had signed up.

"Over the last couple of years, I've worked with a lot of the state-based marketplaces and we could see the difference in enrollment when the states were actively pushing coverage," Brooks-LaSure said. A former congressional and Obama administration health staffer, she most recently worked as managing director at the consulting firm Manatt Health.

Brooks-LaSure also suggested that the Biden administration would support efforts in Congress to ensure coverage for the millions of Americans who fall into what's come to be called the Medicaid gap. Those are people in the dozen states that have not expanded Medicaid under the Affordable Care Act who earn too little to qualify for ACA marketplace coverage.

Brooks-LaSure said she would prefer that states use the additional incentive funding provided in the recent American Rescue Plan toward expanding their Medicaid programs "because, ideally, states are able to craft policies in their own states; they're closest to the ground."

Last year's economic downturn — and the resulting drop in tax revenue from employees' paycheck withholdings — is likely to accelerate the date when Medicare's hospital insurance program will not be able to cover all of its bills.

Democrats in Congress are looking at both lowering Medicare's eligibility age and adding benefits the program now lacks, including dental, hearing and vision coverage.

"I hope that we, when we are looking at solvency, really focus on making sure we keep the Medicare program robust," said Brooks-LaSure. "And that may mean some changes that strengthen the program."

as the production of food and material goods centralized and rapidly expanded, commerce reached a scale that the country’s existing stores were ill-equipped to handle, according to the historian Susan Strasser, the author of Satisfaction Guaranteed: The Making of the American Mass Market. Manufacturers needed ways to distribute their newly enormous outputs and educate the public on the wonder of all their novel options. Americans, in short, had to be taught how to shop.

In 2019, one in five American workers was employed in retail, food service, or hospitality; even more are now engaged in service work of some kind.

This dynamic is exacerbated by the fact that the United States has more service workers than ever before, doing more types of labor, spread thin across the economy

Customers might not have been able to afford a household staff to do their bidding like the era’s truly wealthy, but corporate stores offered them a little taste of what that would be like. The middle class began to see itself as the small-time beneficiaries of industrialization’s barons.

With these goals in mind, Leach writes, customer service was born. For retailers’ tactics to be successful, consumers—or guests, as department stores of the era took to calling them—needed to feel appreciated and rewarded

From 1870 to 1910, the number of service workers in the United States quintupled. It’s from this morass that “The customer is always right” emerged as the essential precept of American consumerism—service workers weren’t there just to ring up orders

they were there to fuss and fawn, to bolster egos, to reassure wavering buyers, to make dreams come true.

they were also quite intentionally building something far grander: class consciousness. Leach writes that the introduction of shopping was fundamental to forming middle-class identity at a particularly crucial moment, as the technological advances of the Gilded Age helped create the American office worker as we now know it.

Retailers won over this growing middle class by convincing its members that they were separate from—and opposed to—industrial workers and their distrust of corporate power,

For many of these workers, the difficulty of finding non-service employment enables companies to pay low wages and keep their prices artificially low, which consumers generally like as long as they don’t have to think about what makes it possible. In theory, these conditions are supposed to encourage better performance on the part of the worker; in practice, they also encourage cruelty on the part of the consumer.

Previously confined to a few lavish European-owned hotels in America, tipping “aristocratized consumption,

Department-store magnates alleviated these concerns by linking department stores to the public good. Retailers started inserting themselves into these communities as much as possible, Leach writes, turning their enormous stores into domains of urban civic life. They hosted free concerts and theatrical performances, offered free child care, displayed fine art, and housed restaurants, tearooms, Turkish baths, medical and dental services, banks, and post offices. They made splashy contributions to local charities and put on holiday parades and fireworks shows. This created the impression that patronizing their stores wouldn’t just be a practical transaction or an individual pleasure, but an act of benevolence toward the orderly society those stores supported.

In the 150 years that American consumerism has existed, it has metastasized into almost every way that Americans construct their identities. Today’s brands insert themselves into current events, align themselves with causes, associate patronage of their businesses with virtue and discernment and success.

Most Americans now expect corporations to take a stand on contentious social and political issues; in return, corporations have even co-opted some of the language of actual politics, encouraging consumers to “vote with their dollars” for the companies that market themselves on the values closest to their own.

For Americans in a socially isolating culture, living under an all but broken political system, the consumer realm is the place where many people can most consistently feel as though they are asserting their agency.

Being corrected by a salesperson, forgotten by a bartender, or brushed off by a flight attendant isn’t just an annoyance—for many people, it is an existential threat to their self-understanding.

“The notion that at the restaurant, you’re better than the waiters, it becomes part of the restaurant experience,” and also part of how some patrons understand their place in the world. Compounding this sense of superiority is the fact that so many service workers are from historically marginalized groups—the workforce is disproportionately nonwhite and female.

Because consumer identities are constructed by external forces, Strasser said, they are uniquely vulnerable, and the people who hold them are uniquely insecure

If your self-perception is predicated on how you spend your money, then you have to keep spending it, especially if your overall class status has become precarious, as it has for millions of middle-class people in the past few decades

Although underpaid, poorly treated service workers certainly exist around the world, American expectations on their behavior are particularly extreme and widespread, according to Nancy Wong, a consumer psychologist and the chair of the consumer-science department at the University of Wisconsin. “Business is at fault here,” Wong told me. “This whole industry has profited from exploitation of a class of workers that clearly should not be sustainable.”

Tipping ratcheted up the level of control that members of the middle class could exercise over the service workers beneath them: Consumers could deny payment—effectively, deny workers their wages—for anything less than complete submission.

Modern businesses have invented novel ways to exacerbate conflicts between their customers and their workers.

A big problem at airlines and hotels in particular, Wong said, is what’s called the “customer relationship management” model. CRM programs, the first and most famous of which are frequent-flyer miles, are fabulously profitable; awarding points or miles or bucks encourages people not only to increase the size and frequency of their purchases, but also to confine their spending to one airline or hotel chain or big-box store.

Higher-spending customers access varying levels of luxury and prestige, often in full view of everyone else. Exposure to these consumer inequalities has been found to spark antisocial behavior in those who don’t get to enjoy their perks, the classic example of which is air rage

Workers must do what the sociologist Arlie Russell Hochschild, in her 1983 book, The Managed Heart, identified as “emotional labor.”

Workers must stifle their natural emotional reactions to, in the case of those in the service industry, placate members of the consumer class. These workers are alienated from their own emotional well-being, which can have far-reaching psychological consequences—over the years, research has associated this kind of work with elevated levels of stress hormones, burnout, depression, and increased alcohol consumption.

But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost.

by next year, more than half of Medicare recipients will be in a private plan.

a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.

The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.

The government now spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a small increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.

Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.

The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers

Medicare Advantage plans can limit patients’ choice of doctors, and sometimes require jumping through more hoops before getting certain types of expensive care.

At conferences, companies pitched digital services to analyze insurers’ medical records and suggest additional codes. Such consultants were often paid on commission; the more money the analysis turned up, the more the companies kept.

they often have lower premiums or perks like dental benefits — extras that draw beneficiaries to the programs. The more the plans are overpaid by Medicare, the more generous to customers they can afford to be.

Many of the fraud lawsuits were initially brought by former employees under a federal whistle-blower law that allows them to get a percentage of any money repaid to the government if their suits prevail. But most have been joined by the Justice Department, a step the government takes only if it believes the fraud allegations have merit. Last year, the department’s civil division listed Medicare Advantage as one of its top areas of fraud recovery.

In contrast, regulators overseeing the plans at the Centers for Medicare and Medicaid Services, or C.M.S., have been less aggressive, even as the overpayments have been described in inspector general investigations, academic research, Government Accountability Office studies, MedPAC reports and numerous news articles,

Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. has never chosen to do so. A regulation proposed in the Trump administration to force the plans to refund the government for more of the incorrect payments has not been finalized four years later. Several top officials have swapped jobs between the industry and the agency.

The popularity of Medicare Advantage plans has helped them avoid legislative reforms. The plans have become popular in urban areas, and have been increasingly embraced by Democrats as well as Republicans.

“You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,”

Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than who can provide the best care.

“Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,”

In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care, or otherwise improving their health — their patients would cost less and the insurers would make more money.

But some insurers engaged in strategies — like locating their enrollment offices upstairs, or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients.

Almost immediately, companies saw ways to exploit that system. The traditional Medicare program provided no financial incentive to doctors to document every diagnosis, so many records were incomplete

Under the new program, insurers began rigorously documenting all of a patient’s health conditions — say depression, or a long-ago stroke — even when they had nothing to do with the patient’s current medical care.

But for insurers that already dominate health care for workers, the program is strikingly lucrative: A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance.

The insurers also began hiring agencies that sent doctors or nurses to patients’ homes, where they could diagnose them with more diseases.

Cigna hired firms to perform similar at-home assessments that generated billions in extra payments, according to a 2017 whistle-blower lawsuit, which was recently joined by the Justice Department. The firms told nurses to document new diagnoses without adjusting medications, treating patients or sending them to a specialist

Nurses were told to especially look for patients with a history of diabetes because it was not “curable,” even if the patient now had normal lab findings or had undergone surgery to treat the condition.

Adding the code for a single diagnosis could yield a substantial payoff. In a 2020 lawsuit, the government said Anthem instructed programmers to scour patient charts for “revenue-generating” codes. One patient was diagnosed with bipolar disorder, although no other doctor reported the condition, and Anthem received an additional $2,693.27, the lawsuit said. Another patient was said to have been coded for “active lung cancer,” despite no evidence of the disease in other records; Anthem was paid an additional $7,080.74. The case is continuing.

The most common allegation against the companies was that they did not correct potentially invalid diagnoses after becoming aware of them. At Anthem, for example, the Justice Department said “thousands” of inaccurate diagnoses were not deleted. According to the lawsuit, a finance executive calculated that eliminating the inaccurate diagnoses would reduce the company’s 2017 earnings from reviewing medical charts by $86 million, or 72 percent.

Some of the companies took steps to ensure the extra diagnoses didn’t lead to expensive care. In an October 2021 lawsuit, the Justice Department estimated that Kaiser earned $1 billion between 2009 and 2018 from additional diagnoses, including roughly 100,000 findings of aortic atherosclerosis, or hardening of the arteries. But the plan stopped automatically enrolling those patients in a heart attack prevention program because doctors would be forced to follow up on too many people, the lawsuit said.

Kaiser, which both runs a health plan and provides medical care, is often seen as a model system. But its control over providers gave it additional leverage to demand additional diagnoses from the doctors themselves, according to the lawsuit.

At meetings with supervisors, he was instructed to find additional conditions worth tens of millions of dollars. “It was an actual agenda item and how could we get this,” Dr. Taylor said.

Last year, the inspector general’s office noted that one company “stood out” for collecting 40 percent of all Medicare Advantage’s payments from chart reviews and home assessments despite serving only 22 percent of the program’s beneficiaries. It recommended Medicare pay extra attention to the company, which it did not name, but the enrollment figure matched UnitedHealth’s.

Even before the first lawsuits were filed, regulators and government watchdogs could see the number of profitable diagnoses escalating. But Medicare has done little to tamp down overcharging.

Several experts, including Medicare’s advisory commission, have recommended reducing all the plans’ payments.

Congress has ordered several rounds of cuts and gave C.M.S. the power to make additional reductions if the plans continued to overbill. The agency has not exercised that power.

The agency does periodically audit insurers by looking at a few hundred of their customers’ cases. But insurers are fined for billing mistakes found only in those specific patients. A rule proposed during the Trump administration to extrapolate the fines to the rest of the plan’s customers has not been finalized.

Ted Doolittle, who served as a senior official for the agency’s Center for Program Integrity from 2011 to 2014, said officials at Medicare seemed uninterested in confronting the industry over these practices. “It was clear that there was some resistance coming from inside” the agency, he said. “There was foot dragging.”

few analysts expect major legislative or regulatory changes to the program.

“Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. Their C.E.O.s should come to the table with Medicare as they did for the Affordable Care Act, end the coding frenzy, and let providers focus on better care, not more dollars for plans.”