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Secretary of State Mike Pompeo announced the reversal of decades of American policy that may doom any peace efforts.

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Pompeo Announces Shift in U.S. Stance on Israeli Settlements

Secretary of State Mike Pompeo said that the United States will not consider Israeli settlements in the West Bank as violation of international law, a move that could destroy peace efforts with Palestinians.

The Trump administration is reversing the Obama administration's approach towards Israeli settlements. U.S. public statements on settlement activities in the West Bank have been inconsistent over decades. In 1978, the Carter administration categorically concluded that Israel's establishment of civilian settlements was inconsistent with international law. However, in 1981 President Reagan disagreed with that conclusion, and stated that he didn't believe that the settlements were inherently illegal. Subsequent administrations recognized that unrestrained settlement activity could be an obstacle to peace, but they wisely and prudently recognized that dwelling on legal positions did not advance peace. Calling the establishing of civilian settlements inconsistent with international law hasn't worked. It hasn't advanced the cause of peace. The hard truth is there will never be a judicial resolution to the conflict and arguments about who is right and wrong as a matter of international law - will not bring peace. This is a complex political problem that can only be solved by negotiations between the Israelis and the Palestinians.

Secretary of State Mike Pompeo said that the United States will not consider Israeli settlements in the West Bank as violation of international law, a move that could destroy peace efforts with Palestinians. Credit Credit... Sergey Ponomarev for The New York Times

WASHINGTON - The Trump administration declared on Monday that the United States does not consider Israeli settlements in the West Bank a violation of international law, reversing four decades of American policy and removing what has been an important barrier to annexation of Palestinian territory.

The announcement by Secretary of State Mike Pompeo was the latest political gift from the Trump administration to Prime Minister Benjamin Netanyahu, who has vowed in two elections this year to push for the annexation of the West Bank. His chief opponent, Benny Gantz, has until Wednesday night to gather a majority in Israel's Parliament or he will relinquish his chance to form a new government, raising the prospect of a third round of elections.

The United States has in the past described the settlements as illegitimate, and Palestinians have demanded the land for a future state, a goal that has been backed by the United Nations, European governments and American allies across the Middle East.

But President Trump has been persistent in changing United States policy on Israel and the Palestinian territories - moves aimed at bolstering political support for Mr. Netanyahu, who has failed to form a government after two rounds of elections with razor-thin outcomes.

Monday's decision reversed a 1978 legal opinion by the State Department concluding that the settlements were inconsistent with international law. Mr. Pompeo said that ruling "hasn't advanced the cause of peace."

"We've recognized the reality on the ground," Mr. Pompeo told reporters at the State Department. (President Ronald Reagan also told reporters shortly after taking office in 1981 that he did not believe the settlements were illegal but called new Israeli communities in Palestinian territory "unnecessarily provocative.")
[The West Bank settlements explained: Are they illegal? Who decides?]
The settlements have been a main sticking point in peace negotiations that have failed to find a solution for generations. They are home to Israelis in territory that Palestinians have fought to control, and their presence makes negotiations for a two-state solution all the more difficult. The two-state solution has been a primary focus of past peace plans, calling for a separate state for Palestinians.

Mr. Netanyahu praised the decision and said it reflected "historical truth - that the Jewish people are not foreign colonialists in Judea and Samaria," a term for the West Bank. He said Israeli courts were better suited to decide the legality of the settlements, "not biased international forums that pay no attention to history or facts."

Mr. Gantz, a former army chief and centrist candidate who has the support of the Israeli left and some Arab lawmakers, politely welcomed the announcement but said that the fate of West Bank settlements "should be determined by agreements that meet security requirements and that can promote peace."

Palestinian officials, by now used to unwelcome policy shifts from Mr. Trump, nonetheless summoned new outrage.

"We cannot express horror and shock because this is a pattern, but that doesn't make it any less horrific," said Hanan Ashrawi, a veteran Palestine Liberation Organization official. "It sends a clear signal that they have total disregard for international law, for what is right and just, and for the requirements of peace."

And Saeb Erekat, the chief Palestinian negotiator, said the Trump administration's decision was the latest of "unceasing attempts to replace international law with the 'law of the jungle.'"

Within hours of the announcement, the State Department issued a travel alert to Americans planning to visit Jerusalem, the West Bank or the Gaza Strip. "Those opposed to the Secretary of State's announcement may target US govt facilities, interests, and citizens," the department said on Twitter.

In Washington, Mr. Pompeo said the decision would provide greater space for the Israelis and Palestinians to negotiate over the status of the settlements. He said that the issue could be largely left to Israeli courts to decide, and that it had no bearing on legal conclusions regarding similar situations elsewhere in the world.

Instead, Mr. Pompeo said, the issue must be solved by the Israelis and the Palestinians. "And arguments about who is right and wrong as a matter of international law will not bring peace," he said.

The timing of Mr. Pompeo's announcement is almost certain to bolster Mr. Netanyahu's political fortunes should Israel be headed to a third round of elections this year. He denied that the decision was tied to Israel's political stalemate, saying, "We conducted our review, and this was the appropriate time to move forward."

If Mr. Gantz fails to form a government by midnight Wednesday, the Israeli Parliament has 21 days to come up with a candidate who can command a majority of 61 of the 120 seats. And if that effort falls short, Israel will call a new election.

Before the first vote, in April, Mr. Trump officially recognized the contested Golan Heights as Israeli territory. It then was widely expected that the Trump administration would soften its stance on the Israeli settlements in the West Bank before the second round of elections, which were held in September.

And earlier, in December 2017, Mr. Trump formally recognized Jerusalem as Israel's capital and ordered the United States Embassy to move there from Tel Aviv, a symbolic decision that outraged Palestinians who also claim territory in the city.

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Secretary of State Mike Pompeo, right, at the White House in September. Credit... Doug Mills/The New York Times

The European Union's foreign policy chief, Federica Mogherini, criticized the American policy shift and maintained that the settlements were illegal and eroded the chances for peace. She called on Israel to "end all settlement activity, in line with its obligations as an occupying power."

Foreign Minister Ayman Safadi of Jordan, which is the custodian of Muslim holy sites in Jerusalem, said on Twitter that the settlements " kill 2-state solution " efforts.

A prime mover in the policy change was David Friedman, the United States ambassador to Israel, who has pushed each of the Trump administration's major policy gifts to Mr. Netanyahu.

Mr. Friedman signaled a shift in United States policy toward settlements in occupied Palestinian territory in June, in an interview with The New York Times. He said that Israel had the right to annex some, but "unlikely all," of the West Bank.

Oded Revivi, a spokesman for the Yesha Council, an umbrella group of West Bank settlements, said he believed the timing of the announcement sought to both help Mr. Netanyahu remain in power and also bolster Mr. Trump among evangelical and Jewish voters in the United States who support the current right-wing government in Israel. He said it also served as a reminder to right-wing Israelis to reap whatever more windfalls the Trump administration might supply.

"It's an indication to the Israeli public, look where you can go with this president - you're wasting time," said Mr. Revivi, the mayor of Efrat, a West Bank settlement near Jerusalem.

He said the policy shift was a move toward endorsing annexation and also served as a clear indication to the Palestinians who have resisted reopening negotiations with the Trump administration.

Opponents of annexation, however, warn that it puts Israel's status as a Jewish democracy at risk in two ways: If the West Bank's Palestinians are made Israeli citizens, the country's Arabs could quickly outnumber its Jews. If they are not given full citizenship rights, Israel would become an apartheid state.

"We are strong enough to deter and defeat our enemies," said Nimrod Novik, an aide to Shimon Peres, a former Israeli prime minister who shared a Nobel Peace Prize in 1994 for his efforts to end the conflict.

Referring to Israel's air-defense system, Mr. Novik added: "What we don't have is an Iron Dome system to defend us from friends who threaten to end the Zionist vision."

A secretive Trump administration plan to revive peace negotiations has been delayed repeatedly, but it is widely believed to bolster Mr. Netanyahu and fail to break a stalemate between Israel and the Palestinians. Few details have been released beyond a call for major new economic development in Palestinian areas.

The Trump administration's peace effort is run by Jared Kushner, Mr. Trump's son-in-law and senior adviser, to deliver what the president has described as the "ultimate deal."

Lara Jakes reported from Washington, and David M. Halbfinger from Jerusalem. Edward Wong contributed reporting from Washington, and Isabel Kershner from New York.

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In Shift, U.S. Says Israeli Settlements in West Bank Do Not Violate International Law

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Secretary of State Mike Pompeo announced the reversal of decades of American policy that may doom any peace efforts. WASHINGTON - The Trump administration declared on Monday that the United States does not consider Israeli settlements in the West Bank a violation of international law, reversing four decades of American policy and removing what has been an important barrier to annexation of Palestinian territory.

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(10) 11/11/19 With Medical Bills Skyrocketing, More Hospitals Are Suing for Payment 

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(10) 11/11/19 With Medical Bills Skyrocketing, More Hospitals Are Suing for Payment 

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Similar to the banking system lending money and adding high interest rates, patients owe hospitals money and they are struggling to pay it back. "Wage seizures have led patients to sign up for public assistance programs, fall behind on bills, give up their insurance and take on credit card debt, according to interviews".

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Amanda Sturgill sorts through legal notices and statements from bill collectors. She was sued over nearly $2,500 in medical debt after her teenage daughter's back surgery. Credit... Kristian Thacker for The New York Times

WISE, Va. - When a judge hears civil cases at the courthouse in this southwest Virginia town two days a month, many of the lawsuits have a common plaintiff: the local hospital, Ballad Health, suing patients over unpaid medical bills.

On a Thursday in August, 102 of the 160 cases on the docket were brought by Ballad. Among the defendants were a schoolteacher, a correctional officer, a stay-at-home mother and even a Ballad employee - all of whom had private insurance but were still responsible for a large share of their bill, the result of large deductibles and co-payments.

Ballad, which operates the only hospital in Wise County and 20 others in Virginia and Tennessee, filed more than 6,700 medical debt lawsuits against patients last year. Ballad's hospitals have brought at least 44,000 lawsuits since 2009, typically increasing the volume each year.

In nearly all such cases, the hospitals prevail. Only about a dozen patients showed up for the August court date in Wise, hoping to work out a payment plan or contest the claims.

"There is this new group of people who, on paper, look like they should be able to afford their bills," said Craig Antico, founder of the nonprofit RIP Medical Debt, which buys and forgives outstanding bills. "They're middle-class, they have relatively good credit ratings, they're not transient. But they have these big deductibles, and they can't afford their bills."

From Delaware to Oregon, hospitals across the country are increasingly suing patients for unpaid bills, a step many institutions were long unwilling to take.

In some places, major hospitals now file hundreds or even thousands of lawsuits annually. Those cases strain court systems and often end in wage garnishments for patients.

In Milwaukee, for example, a nonprofit children's hospital has sued 1,101 patients since the beginning of 2018 - more cases than it brought in the entire previous decade. The city's only top-level trauma center filed 2,074 suits last year, more than double the prior year's number.

And some of the country's most prominent academic hospitals, including Johns Hopkins in Baltimore and NewYork-Presbyterian, also have sued more patients in recent years.

The hospitals say that they are turning to the courts more frequently as deductibles rise and patients owe more, but that this practice affects a small fraction of their patients. They defend the suits as necessary to recouping outstanding bills and keeping health systems afloat. "We're only pursuing patients who have the means to pay but choose not to pay," said Anthony Keck, vice president for system innovation at Ballad Health.

But patient and consumer advocates say hospitals are making faulty assumptions about insured patients' ability to pay. They also argue that the lawsuits and wage garnishments hit middle- and low-income populations, who struggle to keep up with the lost income. A cashier at a Providence Health hospital in Oregon reported having wages garnished for outstanding medical debt to her own employer. For one paycheck for 80 hours of work, she took home 54 cents after a garnishment and other deductions.

Wage seizures have led patients to sign up for public assistance programs, fall behind on bills, give up their insurance and take on credit card debt, according to interviews.

"I know I owe it, which is fine, and of course I want to pay it," said Amanda Sturgill, 41, whom Ballad took to court. "It just seems like they want their money no matter what my situation is."

Ms. Sturgill earns $12.70 an hour and gets health benefits working full time as an order processor for an audio equipment manufacturer. She is going through a divorce and supports four children.

Ballad sued her in June over $2,498 in outstanding debt for her teenage daughter's back surgery. Ms. Sturgill set up a $150-a-month payment plan, but often struggles to come up with the money.

"Sometimes, if I'm getting close to the payment date and don't have the money, I'll go to the flea market and sell some of my things," she said. "We get by on a lot of cheap soup beans and sandwiches. It terrifies me because I don't know what they'll do if I fall behind."

This type of medical debt collection has come under increased scrutiny from judges and state lawmakers. New York is considering legislation that would significantly reduce the statute of limitations on medical debt. Connecticut may reform its system to make it easier for patients, who rarely have legal representation, to navigate.

Some hospitals that have drawn media attention for suing large numbers of patients, including one nonprofit health system in Memphis and another owned by the University of Virginia, have sharply reduced their use of medical debt litigation.

Others are ramping up the practice, often to patients' surprise. "I am used to hospitals sending collection notices," Ms. Sturgill said. "But I am not used to a sheriff coming to my door to deliver a court summons."

Over a decade ago, hospital executives could safely assume that patients with health insurance probably could pay their medical bills. In 2006, only about half of employer-sponsored health plans involved a deductible that workers had to pay out of pocket before their coverage would kick in, according to the nonprofit Kaiser Family Foundation.

Today, 82 percent of employers' health plans have a deductible, and the average amount has nearly tripled, to $1,655 from $584. Low-wage workers are more likely to be offered high-deductible insurance, which is less expensive for employers.

Soaring costs are also common for those who buy their own coverage. Plans sold through the Affordable Care Act marketplace can have high caps on out-of-pocket spending: as much as $8,200 for an individual in 2020, and $16,400 for a family.

Ms. Edwards was making $300 monthly payments to the hospital. But after some unanticipated expenses - a $450 exterminator bill for bed bugs was a big setback - she began sending smaller amounts, she said, acknowledging that she had not first cleared the lower payments with Children's.

The hospital took her to court last fall and recently began garnishing a quarter of her wages: $420 from her biweekly paycheck. Ms. Edwards worked 14-hour shifts to make up for the lost income, but still fell behind on her mortgage.

"It makes you think twice about going to the doctor," she said. "I haven't been feeling well for a couple of months, there's something wrong with my stomach, and everyone is like, 'Go in, go in.' But I just can't. There will be more doctor bills."

The children's hospital cited two factors driving up its litigation: higher deductibles and a growing patient population. It says the lawsuits are a last resort, after other attempts to collect on patients' debt.

The goal is "to seek a solution that avoids legal action," the hospital said in a statement. "However, if the account remains unpaid and the family's employment is verified, the account may be placed with an attorney."

In New York, medical debt lawsuits are rare but on the rise, as at NewYork-Presbyterian, the city's top-ranked hospital chain. Its medical debt lawsuits doubled to 515 between 2015 and 2016. In 2017, the hospital sued 779 patients over unpaid bills.

A NewYork-Presbyterian spokeswoman, Kate Spaziani, said the hospital's "practices and policies have remained constant: We actively work with eligible patients to help them access our Charity Care and patient advocacy programs."

Public officials have become increasingly concerned about the proliferation of medical debt lawsuits, which have drawn media attention to the practice at a nonprofit hospital chain in Memphis, a for-profit hospital in New Mexico and the University of Virginia health system.

A University of Connecticutreport in June found that hospitals and doctors in the state had sued 80,000 patients for medical debt between 2011 and 2016. Consumer advocates and a state judge are now pursuing reforms, such as simplifying the process to request itemized bills, that would make the court more accommodating to patients, who typically represent themselves.

New York lawmakers introduced legislation last month that would cap the interest hospitals can recoup on medical debt at 3 percent, instead of 9, and would shorten the statute of limitations to two years from six. The proposed changes could result in fewer and smaller judgments against patients.

The American Hospital Association, an industry trade group, has taken no official position on medical debt lawsuits. But in a statement, the group's executive vice president, Tom Nickels, said, "As a field, we will always continue to look for new and better ways to work with patients who need help paying their bills."

Some hospitals are creating financial-support policies aimed at patients with high deductibles. This year, St. Luke's University Health Network in Pennsylvania introduced an assistance program for insured patients who can't afford their medical bills.

"Two years ago we were not doing this, and now we're getting 50 applications a week," said Richard Madison, the network's vice president for revenue cycle. "We don't want people to go into bankruptcy because of us."

St. Luke's decision not to pursue medical debt in court reflects both its nonprofit mission and a desire to stay out of the headlines.

"It would be bad press, and we don't want to be the organization that does that to people," Mr. Madison said.

At the same time, he worries that St. Luke's may become overwhelmed by requests for help.

"The program might have to be discontinued if too many people were using it," he said. "We want the people who are truly burdened by our hospital bill and can't afford to pay it."

Ballad Health does not plan to change its litigation strategy. But Mr. Keck, the vice president, said the network was increasing its income limit for charity care, which could reduce lawsuits.

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With Medical Bills Skyrocketing, More Hospitals Are Suing for Payment

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WISE, Va. - When a judge hears civil cases at the courthouse in this southwest Virginia town two days a month, many of the lawsuits have a common plaintiff: the local hospital, Ballad Health, suing patients over unpaid medical bills. On a Thursday in August, 102 of the 160 cases on the docket were brought by Ballad.

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(9) 10/31/19 Despair for Many and Silver Linings for Some in California Wildfires

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(9) 10/31/19 Despair for Many and Silver Linings for Some in California Wildfires

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After the disaster of the fires in California, the divide of upper class to middle/lower class is further amplified. The rich who have insurance and the means can afford to rebuild and repair their homes. The poor don't have that luxury. "people with lower incomes were less prepared for natural disasters and were more likely to live in homes vulnerable to them". Some people have to take out loans to restore their house, many have to move away.

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Firefighters burned fuel around a home in Windsor, Calif., in an effort to save it from the Kincade fire. The ability to rebuild after a natural disaster is another prism through which California's vast income inequalities can be viewed. Credit... Max Whittaker for The New York Times

Natural disasters are another prism through which California's vast income inequalities can be viewed.

Firefighters burned fuel around a home in Windsor, Calif., in an effort to save it from the Kincade fire. The ability to rebuild after a natural disaster is another prism through which California's vast income inequalities can be viewed. Credit... Credit Max Whittaker for The New York Times

SANTA ROSA, Calif. - After a wildfire razed his spacious suburban home in the Sonoma hills two years ago, Pete Parkinson set out to rebuild. This time it would be an even better one. He reoriented the house toward vistas of a nearby mountain and designed a large kitchen with hickory floors and 16-foot windows under vaulted ceilings.

"We are now living the silver lining," said Mr. Parkinson, a retired civil servant who moved into his new home 10 days ago. "It is a beautiful, brand-new home."

California's catastrophic wildfires have not discriminated between rich and poor. In recent years tens of thousands of people lost their homes, from trailer parks to mansions. But the aftermath of the fires has produced a spectrum of misery and recovery, ranging from the wealthy, who with insurance money rebuilt houses sometimes worth more than the ones that burned, to those who lost everything and years later still have nothing.

Like access to quality education and clean water, natural disasters are another prism through which California's vast income inequalities can be viewed.

A lawyerly knowledge of the peculiarities of the insurance industry, a pool of savings to fall back on and the time and grit to deal with the state's labyrinthine regulations have helped some in California bounce back from the infernos. Others have not been so lucky.

Jenn Wilcox worked at a residential care facility in the town of Paradise until Nov. 8, when the town was incinerated by fire last year. After she narrowly escaped, the uninsured cabin where she was living was destroyed; she also lost her job. Her life upside down, she split up with her boyfriend and returned to her home state of Georgia, where she is struggling to make ends meet as a home health aide.

"I'm a refugee," Ms. Wilcox said. "I'm broke."

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Pete Parkinson had a new home rebuilt after the Tubbs fire destroyed his previous one. Credit... Jim Wilson/The New York Times

On Tuesday, firefighters in Northern California braced for the return of strong winds, hoping to avoid the further spread of the Kincade fire, which has burned 75,000 acres in Sonoma County and was 15 percent contained. In Southern California, the Getty fire still burned while residents braced for extreme winds expected to reach 80 miles per hour. Thousands of structures are threatened.

Karen Orlando, a real estate agent in the Sonoma Valley, has seen the rebuilding process in Sonoma County play out in distinct ways between "the really wealthy and then those who are just getting by."

Ms. Orlando said that for those with insurance and the means, rebuilding has been a kind of therapy after the trauma of losing a home; reclaiming those spaces is a way to soldier through grief, she said.

"Some people have decided to buy a lot maybe with a better view than what they had," she said. "Some people want to rebuild on the lot but now they get the chance to build the home of their dreams. They get to pick out all the finishes and fixtures and imagine all the landscaping."

After the Wine Country fires in 2017 destroyed their hillside home with a priceless mountain view, Joan and Nick Flint received $1 million for the rebuild, not enough to match what they once had. They ended up paying another $1 million out of pocket.

Standing outside their new home on Tuesday - white brick with an Escalade in the garage - Ms. Flint said she realized how lucky they were that they could afford to do that.

"We're not a hard-luck story by any means," she said. "We feel blessed."

Fires this week in Southern California forced evacuations of celebrities like LeBron James and Arnold Schwarzenegger. Mr. James tweeted that he was driving around trying to find a hotel room after he fled his home. (His home did not burn, nor did Mr. Schwarzenegger's.)

Less visible has been the fate of those hard hit in towns like Paradise in the Sierra foothills, razed by fire last year, and Lake County, where around 2,000 homes have burned over the past four years. In both places incomes were strained even before the fires.

Jim Steele, a former supervisor in Lake County, estimated that about 60 percent of residents in the county lacked insurance or were severely underinsured. Insurers are raising rates in areas vulnerable to fire and in some cases have declined to write policies.

"There's a lot of risk and a lot of poverty," he said. Many people were forced to move away after their homes burned down, especially older people who retired in picturesque but fire-prone hills surrounding Clear Lake.

"It has a lot to do with your age and where you are in your career," Mr. Steele said. "Retired people have trouble - they just don't have the resilience."

A report published by the federal government two years ago said people with lower incomes were less prepared for natural disasters and were more likely to live in homes vulnerable to them. Low-income Americans are also more likely to become homeless after a disaster and have more difficulty obtaining loans after one, the report said.

Another study released by the Federal Reserve Banks of San Francisco, New York, Dallas and Richmond focused on small businesses affected by natural disasters. Insurance coverage for those businesses "appeared to be mismatched to the actual damage that occurred," the report said.

Often disasters trigger a cascade of woes. For Gina Wheeler, whose grandparents moved her family to the Sierra Nevada from the Bay Area in the 1960s, the Paradise fire sent her into depression and financial peril. Ms. Wheeler, 44, was hospitalized for intestinal surgery in the days before the disaster. Then she lost her uninsured trailer that she rented on family land in the fire.

"Every place I've ever set foot in has been touched by fire," Ms. Wheeler said. "I don't think anybody that's not gone through this will ever, ever understand what it's like to lose your entire community."

This fall, Ms. Wheeler moved into a trailer in a camp for fire survivors in the remote farm town of Gridley, where she must stretch a fixed income of $850 a month to rebuild her life. She struggles to pay for food and gas, sometimes turning to Facebook groups for help.

"I can't even describe the empty feeling that we have," Ms. Wheeler said. "I talk friends and family members out of suicide, and they talk me out of it."

Mr. Parkinson, the resident of the Sonoma hills, says about 40 percent of his neighbors have not started to rebuild their homes, many of them because they cannot afford to. Although his new house is more hardened to fire, the area remains vulnerable, a dozen or so miles away from where the Kincade fire is burning.

Mr. Parkinson counts himself lucky not only because he was able to construct a 2,200-square-foot dream home but because he had the mental fortitude to deal with the disappearance of all but a handful of his possessions. When he fled his home with his wife and son in 2017 he carried only electronics, two guitars, photo albums and some clothing.

"There was something about walking up to the pile of ashes that my house was reduced to and understanding the absolute finality of it," he said.

His insurance money was insufficient to completely furnish the house so he went to Ikea with a pickup truck and held a furniture-assembly party with friends.

"I don't have a lifetime's worth of stuff anymore," he said. "Everything is two years old and less."

Thomas Fuller and Julie Turkewitz reported from Santa Rosa, Calif., and Jose A. Del Real from San Francisco. Lauren Hepler contributed reporting from Paradise, Calif. Alain Delaquérière contributed research.

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Despair for Many and Silver Linings for Some in California Wildfires

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Natural disasters are another prism through which California's vast income inequalities can be viewed. Firefighters burned fuel around a home in Windsor, Calif., in an effort to save it from the Kincade fire. The ability to rebuild after a natural disaster is another prism through which California's vast income inequalities can be viewed.

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Students and workers are continuing to take to the streets in Santiago and other parts of Chile, in major protests and planned union strikes against economic inequality in the South American country.

The demonstrations began Oct. 14, when crowds of students refused to pay the recent metro fare increase by storming various stations and jumping over the turnstiles in Chile's capital city. By Friday, what had been largely peaceful protests gave way to bouts of violence, destruction and looting, in which at least 15 people have died, according to officials.

President Sebastián Piñera quickly suspended the modest subway fare hike and, on Monday, he proposed a new " social contract" to benefit all Chileans. This has so far failed to stop one of Chile's biggest public upheavals in a decade. The conservative president's sharp initial response - declaring "we are at war with a powerful enemy" and deploying the military to impose order - has provoked further unrest.

Demonstrators say the troop presence on the streets triggers painful memories of the country's 17-year military dictatorship that ended in 1990. Thousands of Chileans were imprisoned, tortured or killed by Gen. Augusto Pinochet's regime.

"It was like a slap in the face for all of us," says protester Paz Lagos, 54. "This history is still alive and we haven't forgotten what happened when the military took over the streets. It was a very hard time - many died. We do not want the same thing here."
The wealthy 10%
Protesters are angry that many Chileans have been left behind in the country's economic development. Although overall poverty has gone down since the 1990s, the top 10% of earners make 26.5 times the average income, according to the Organization for Economic Cooperation and Development. The OECD says Chile is one of its most unequal member countries.

President Piñera has been widely criticized for having dinner with his family Friday night in a wealthy part of the city while protests raged. According to Forbes, the former businessman has a net worth of about $2.8 billion.

The scenes of unrest and armed forces have been stunning in a country often considered one of Latin America's most peaceful and stable democracies.

Most of the 15 deaths occurred during fires set by looters, officials say. Interior Deputy Minister Rodrigo Ubilla said on Tuesday a few people were killed at the hands of security officials and that the incidents are under investigation.

About 10,500 police and soldiers are deployed in Santiago, according to Interior Minister Andrés Chadwick.

During one of the protests on Monday, police clad in riot gear shot tear gas and water cannons to disperse protests. Many of the demonstrators refused to run - carrying signs reading "They even took fear away from us."

As of late Monday, more than 1,500 people had been arrested during the unrest of a few days, the interior minister told reporters.

Troops seem to be everywhere in Santiago: metro stations, major plazas, shopping centers and throughout the streets.

On top of the strong military presence, three consecutive nights of curfews and long lines at the few open supermarkets have made many Chileans say it is reminiscent of the dictatorship.
"Not at war"
When President Piñera referred to the violence and destruction on Sunday by saying "We are at war," it enraged protesters. Many have carried signs all over the city reading, "We are not at war, we are united."

Protester Rosa Hueraleo, 56, denies there's a "war" and stresses that most Chileans do not support violence.

"The president isn't giving any solutions - all he does is criminalize the movement nothing more," she says. "Although the metro fare is suspended, it's not enough - we want better education, health care, higher wages."

As part of his call for a "social contract" on Monday, Piñera said he is working on proposals with party leaders to improve job opportunities, salaries and pensions, lower medicine prices and better public services.

He also announced that the 4% metro fare hike is officially reversed. But if the leader thinks the modest price cut is sufficient, Hueraleo says, it shows he is not capable of understanding what the people really want.

Damages to the metro system alone have reached $300 million, according to Metro President Louis De Grange.

Most of the metro system is expected to be closed through the week, the government said. So far this week in Santiago, classes have been canceled and only limited stores and supermarkets have been open.

Javier Aguilo, 25, says he plans to protest all week until things change.

"There's two Chiles here," he says. "The one where people go to beautiful schools, have nice homes, can go on vacations everywhere, and then there is the other Chile where people have to live with $500 a month and pay for food with credit."

These protests come just weeks before the city is due to host two major international conferences. Meetings of the Asia-Pacific Economic Cooperation group, or APEC, are set for mid-November and the United Nations climate conference known as COP25 is in December.

Aguilo says he's glad the world will finally be able to see the real Chile, and not the perfect one the president has been selling abroad.

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In Chile, Protesters Decry Troop Deployment As A Pinochet Tactic

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Students and workers are continuing to take to the streets in Santiago and other parts of Chile, in major protests and planned union strikes against economic inequality in the South American country. The demonstrations began Oct. 14, when crowds of students refused to pay the recent metro fare increase by storming various stations and jumping over the turnstiles in Chile's capital city.

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(8) 10/17/19 China's Economic Growth Slows as Challenges Mount

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(8) 10/17/19 China's Economic Growth Slows as Challenges Mount

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Though China's economic growth has doubled over the last decade, it is now starting to slow down from July- Sep. The Tarde war is slowing it's pace down. Additionally, China's exports is dwindling down, aiding the economic slowdown.

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The U.S. trade war is only part of the problem, as Beijing grapples with weakening investment and falling car sales.

A suitcase factory in Shanghai. While the trade war with Washington has hit growth, exports to the United States make up only part of China's economic output. Credit Lam Yik Fei for The New York Times

SHANGHAI - China's economic slowdown worsened in the July-to-September period, according to data released on Friday, as the trade war with the United States and a host of other problems leave Beijing struggling to meet its goals.

The figures show China continues to grow at its slowest pace in nearly three decades of modern record-keeping. While China is still expanding faster than any other major economy, Friday's data suggest that the pace could come in at the low end of Beijing's official target, which could add to worries about broader prospects for global growth.

China's efforts to tame its addiction to lending and the deepening impact of the trade war have been major drags on the economy. Other problems are worsening, as the country's vast automotive sector shrinks, as its real estate sector levels off and as its pigs die in vast numbers from a swine fever epidemic.

China's economic output grew 6percent in the third quarter compared with a year earlier, according to official statistics, the bottom end of Beijing's full-year target of 6 percent to 6.5 percent. In the first three-quarters of the year, its output grew 6.2 percent compared with a year ago.

China's growth was set to slow down from the torrid pace of past years. Its economy is now twice the size it was about a decade ago. Its labor force is shrinking, and the country is already full of roads, rails and factories, limiting potential new investment.

The question is whether there are any sharp dips along the path to ever-slower growth.

"What policymakers want is to make the process as long and as gradual as possible," said Larry Hu, the head of China economics at the Macquarie Group, a big Australian financial services company. "The biggest challenge is to find new growth drivers from consumption and technology, as old ones such as property and globalization are fading out."

Mao Shengyong, the spokesman of the National Bureau of Statistics, said at a news briefing in Beijing that the economy was not faring so badly given global difficulties like slowing international trade. "The national economy is generally stable, the economic structure is continuously optimized, and people's livelihood and welfare are continuously improved," he said.

Despite the reassuring words, China is grappling with a number of economic problems. Trade is only one of them.

The conflict heated up in the third quarter of this year, when President Trump broadened his tariffs at the start of September to hit many consumer goods from China. Its exports to the United States plunged 22 percent in September compared with September 2018, when exporters were racing to ship their goods ahead of a previous set of tariffs.

Still, American tariffs account for only part of China's overall economic slowdown. Exports to the United States are about 4 percent of the Chinese economy. Roughly half the value of those exports stems from imported goods like semiconductors and oil, said Nicholas Lardy, a longtime China specialist at the Peterson Institute for International Economics, so the net importance of exports to the United States is even less.

China also has ramped up exports to the developing world. As a result, its overall exports in September were down only 3.8 percent.

In fact, much of the slowdown has been domestic. China has been reluctant to force its debt-ridden financial system to lend even more money to sustain short-term economic growth.

With the conspicuous exception of the auto sector, industrial production and retail sales were fairly strong in September. As consumer confidence has eroded, however, car sales have fallen.

Car sales are 5 percent of China's economic output, according to official statistics, meaning they play a bigger role in China's growth than exports to the United States. Even foreign companies like General Motors assemble practically all their cars locally, with almost entirely Chinese-made parts.

But these days, households in China just aren't buying cars the way they used to.

Retail car sales dropped 6.6 percent in September from a year earlier, a sharp drop for an industry once accustomed to double-digit annual percentage growth.

The car sales slump started in the summer of 2018 and became severe by winter. An expected improvement this summer has not happened.

Cui Dongshu, the secretary general of the Chinese Passenger Car Association, said September at least was not as bad as some recent months. "The sales are recovering but very slowly, due to weak consumption," he said. "The purchasing power of families is still not enough."

Chinese automakers had planned to export a lot of cars to the United States starting this winter. But Mr. Trump's tariffs have made that much harder and have prompted one carmaker, Guangzhou Auto, to suspend indefinitely its plans to enter the American market.

Property market weakness has also pinched growth, hurting consumer sentiment. A decades-long run-up in home prices gave many in China, where the homeownership rate is high, the feeling that they were becoming prosperous enough to splurge on other purchases. But prices have mostly stabilized, and even fallen in some smaller cities, and many families are struggling with large mortgage payments.

China's biggest challenge may be slower investment, which weakened further in September. Although state-owned enterprises continue to pour money into new projects, foreign investment has faltered, especially in September; some companies are diversifying away from China.

"We have seen a significant divestment by multinationals in this part of the world in the past 18 months," said Mark Webster, a partner in the Shanghai office of BDA Partners, a New York investment bank that specializes in Asia deals.

The trade war is just part of the problem. Multinationals complain of much tighter regulatory actions in China, particularly antitrust cases. They also encounter extensive overcapacity in many industrial sectors, forcing companies to cut prices repeatedly to stay in business and destroying profit margins.

The volume of mergers and acquisitions by foreign companies investing in China tumbled 89 percent in the first half of this year from the same period last year, to just $6.3 billion, Mr. Webster said.

Ailin Tang contributed research.

Keith Bradsher is the Shanghai bureau chief of The Times. He previously served as Hong Kong bureau chief, Detroit bureau chief, Washington correspondent covering international trade and then the United States economy, telecommunications reporter in New York and airlines reporter. Follow him on Twitter: @KeithBradsher

A version of this article appears in print on , Section B, Page 8 of the New York edition with the headline: Domestic Malaise, as Well as Trade Woes, Retards China Growth. Order Reprints | Today's Paper | Subscribe

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China's Economic Growth Slows as Challenges Mount

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The U.S. trade war is only part of the problem, as Beijing grapples with weakening investment and falling car sales. SHANGHAI - China's economic slowdown worsened in the July-to-September period, according to data released on Friday, as the trade war with the United States and a host of other problems leave Beijing struggling to meet its goals.

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7) 10/10/19 Forever 21 Files for Bankruptcy 

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7) 10/10/19 Forever 21 Files for Bankruptcy 

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Forever 21 files for bankruptcy due to loss of popularity for "fast fashion". They have been under investigation for years due to their sweatshop- powered labor force. The unjust wages of $6 an hour are direct exploitation of the workers. This applies to Marx's theory on Conflict Theory. The workers are seen as commodities and are replaceable. (additional article: https://www.latimes.com/projects/la-fi-forever-21-factory-workers/

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Forever 21 files for Chapter 11 bankruptcy protection

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The troubled US fashion retailer says it will close most international operations in Asia and Europe.

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1) 9/4/19- Climate Change Won't Create As Many Jobs As Promised

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1) 9/4/19- Climate Change Won't Create As Many Jobs As Promised

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While Climate change will increase green-friendly jobs, but it also diminishes coal miners, etc. There is an economic struggle to provide jobs for people. The Social Progress Index rates if everyone has basic human needs, the foundations of well being and opportunities. Employment and the ability to support oneself is one of those goals.

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Senator Bernie Sanders of Vermont at a Green New Deal event at Howard University in Washington this year. Credit Credit Alex Wong/Getty Images

Want climate news in your inbox? Sign up here for Climate Fwd:, our email newsletter.
WASHINGTON - The Democratic presidential candidates are rolling out their plans to fight climate change, and one thing is clear: Averting catastrophe is only one selling point. So far, nearly every presidential candidate claims that cutting greenhouse gases will also lead to an economic bonanza.

Senator Elizabeth Warren of Massachusetts said her climate policies would create 1.2 million jobs in "green manufacturing." Pete Buttigieg, the mayor of South Bend, Ind., said he intends to create 3 million jobs. Former Vice President Joseph R. Biden Jr. and Julián Castro have claimed that their plans would each lead to 10 million jobs. Senator Bernie Sanders of Vermont, though, beat them all last month when he said his plan would generate 20 million jobs.

President Trump, on the other hand, has claimed that policies to slow the pace of climate change would be " totally disastrous, job-killing."

Economists generally agree that inaction on climate change would result in deep economic pain for the United States. A government report in November, for instance, warned that, unless significant steps are taken to rein in global warming, it could knock as much as 10 percent off the size of the American economy by century's end.

But will the candidates' proposals to fight climate change really spur job growth and if so, is there an accurate way to tally it?

Experts say Democrats' assertions are accurate, to a point. Fighting climate change will create jobs. Yet the rosy net numbers, some warned, don't tell the far more complicated story of what that green growth could look like.

"Some of the rhetoric around creating 'green jobs' is intended to rebut that false narrative that we sacrifice our economy if we try to become greener," said Douglas W. Elmendorf, dean of the Harvard Kennedy School and a former director of the Congressional Budget Office.

But, he added, "In general, economists are skeptical of claims of big numbers of jobs gained or lost from policies that are really about shifting sectors."

Democratic candidates are expected to trumpet their plans when they appear on a CNN climate-change forum on Wednesday. Here are three important things to know about their job claims.

Most of the job-creation claims that come with Democratic climate plans are vague.

Senator Cory Booker of New Jersey unveiled a plan this week he said will create "millions of jobs where they are needed most." Beto O'Rourke, the former Democratic congressman from Texas, promises that his plan to inject $5 trillion into clean energy infrastructure and research "will create jobs, support communities, and strengthen our economy." Senator Amy Klobuchar of Minnesota on Tuesday released a package that includes $1 trillion to modernize energy infrastructure and "create good-paying union jobs."

Mr. Biden, Ms. Warren, Mr. Castro, Mr. Buttigieg and Mr. Sanders have attached specific numbers to their promises. But the candidates often arrive at their numbers in very different ways.

T.J. Ducklo, a spokesman for Mr. Biden, said the former vice president's estimate of "10 million well-paying jobs in the United States" was based on several studies linking infrastructure spending with job creation, including a Council on Economic Advisors study that found every $1 billion in highway spending translates into 13,000 jobs. Mr. Biden's plan calls for $1.7 trillion in federal spending over 10 years into clean energy, which suggests a possible 22.1 million jobs.

But Mr. Ducklo said the campaign chose to cite a more conservative number, in part because much of the spending under Mr. Biden's plan would go toward research, and also because the job-multiplier studies were conducted in an economy in recovery, resulting in more jobs per dollars spent.

Ms. Warren is the only candidate to detail how she intends to pay for her proposed $1.5 trillion clean energy investment: an increase of 7 percent in the corporate tax rate. She is also the only one who commissioned an independent economic analysis, which found the plan would lead to 1.2 million new jobs in the coming decade.

Jon Erickson, a professor of sustainability policy and science at the University of Vermont who advised Mr. Sanders's campaign, said the senator's prediction of 20 million jobs was based on a widely used economic modeling tool. Mr. Erickson said he had run simulations based on all the ways Mr. Sanders intends to spend $16.3 trillion over 15 years, from wind-power development to weatherizing homes, and added up the jobs that were likely to created both directly and indirectly.

Tess Whittlesey, a spokeswoman for Mr. Buttigieg's campaign, said his figure of 3 million jobs also is a rough estimate. His plan calls for spending between $1.5 and $2 trillion over 10 years on clean energy development and modernizing energy infrastructure, while also putting a price on carbon dioxide emissions.

Ms. Whittlesey said the campaign used a formula calculating $33,000 in infrastructure spending per job, which came to 4.5 million jobs, and then the campaign rounded down.

Mr. Castro's campaign did not respond to a request to discuss his job numbers.

Jobs do follow the dollars, so it's no surprise that a plan to inject trillions into the economy for any specific purpose - be it the development of wind farms, electric-vehicle charging stations or solar-panel production - would lead to new employment in those fields.

That said, more solar panel installers and wind turbine manufacturers would also mean fewer jobs in other fields, such as coal mining. According to a 2019 Department of Energy report, the natural-gas, wind and energy-efficiency sectors were the fastest job-growth areas in the United States between 2017 and 2018, increasing 7 percent, 3.5 percent and 7.4 percent respectively. Employment in coal-fired power generation, by contrast, declined by 7.2 percent.

That shift can be politically perilous. Hillary Clinton discovered that when she told a CNN town hall " we're going to put a lot of coal miners and coal companies out of business " in 2016.

After the Democratic debates in Detroit in July, Mr. Trump's campaign manager, Brad Parscale, apparently tried to leverage that when he wrote on Twitter: "Bye bye coal, Democrats & @JoeBiden just said they are done with you. How do you feel about that Pennsylvania?"

Robert N. Stavins, a professor of environmental economics at Harvard University, said politicians were understandably loathe to acknowledge the inevitable elimination of jobs in fossil fuel industries. "They have to come up with these stories about 'win-win,' and 'it's all good news,'" he said. "Unfortunately, that's not true."

Republicans say they are skeptical of the Democrats' job claims. Grover Norquist, the founder and president of the conservative anti-tax group Americans for Tax Reform, likened the plans to a shell game. Spending trillions of tax dollars on clean energy may create jobs, but the politicians fail to mention what that money could have done if it had been left in the hands of consumers and entrepreneurs.

"They want you to take a dollar out of your left pocket, put it in your right and then they say 'Hey, I gave you a dollar,'" Mr. Norquist said of Democrats.

Mr. Elmendorf said he thought the bigger problem was that even the most robust plans do not necessarily ensure the Americans who most need an economic boost will get one. After all, the unemployment rate is currently about 3.6 percent, the lowest in nearly five decades.

"Our economic challenge in this country is not creating jobs," Mr. Elmendorf said. "It is creating good jobs for people without college degrees in the places they live," adding: "Whether a green-jobs plan or any other kind of plan will create those types of jobs is very difficult to know."

Josh Bivens, director of research at the Economic Policy Institute, said job creation is a positive byproduct of climate change policies, but he believes it shouldn't be the focal point.

"I understand why politicians talk about it," Mr. Bivens aid. Regardless, he added, "It's obvious that climate change is a horrifying reality that is worth a lot of money to spend to ameliorate."

For more news on climate and the environment, follow @NYTClimate on Twitter.

Lisa Friedman reports on climate and environmental policy in Washington. A former editor at Climatewire, she has covered nine international climate talks. @LFFriedman

A version of this article appears in print on , Section A, Page 16 of the New York edition with the headline: Climate Plans May Spur Job Growth, but the Math Isn't So Simple. Order Reprints | Today's Paper | Subscribe

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Democrats Say Their Climate Plans Will Create Jobs. It's Not So Simple.

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Want climate news in your inbox? Sign up here for Climate Fwd: , our email newsletter. WASHINGTON - The Democratic presidential candidates are rolling out their plans to fight climate change, and one thing is clear: Averting catastrophe is only one selling point.

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2) 9/9/19- Juul Falsely Claims They Are Saer Than Cigarettes 

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2) 9/9/19- Juul Falsely Claims They Are Saer Than Cigarettes 

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In relation to the Nixon Global Governance that an issue that much be governed globally are global finance. Juul marketed their products as being safer than tobacco cigarettes. These false claims result in not only health concerns to their customers, but is also market manipulation.

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Juul Labs, the dominant e-cigarette company, violated federal regulations by selling its vaping products as a safe alternative to traditional tobacco cigarettes without approval from the Food and Drug Administration, the agency said in a warning letter on Monday.

The F.D.A. issued its warning amid a public health crisis over more than 400 cases of vaping-related lung illnesses that have hospitalized many young teenagers and adults, andpossibly five deaths. Public health investigators have yet to determine a specific cause, but have cited the use of both cannabis-related and nicotine vaping products from a number of companies as possible suspects.

The agency's warning letter to Juul follows a lengthy inquiry into the company's marketing and sales practices, as well as a review of congressional testimony from Juul executives, consumers - including students and parents - and antismoking advocates.

Under federal law, companies are not permitted to market products as safer than cigarettes or a safe alternative without proving those claims to the F.D.A.

But, the agency pointed to specific allegations that would show Juul in violation, including congressional testimony that a Juul representative spoke at a school presentation and told students that Juul "was much safer than cigarettes," and Juul was "totally safe."

The F.D.A. letter also warned Juul about a statement that had appeared on the Juul website, written by the company CEO, stating that the Juul vaping system is designed to "heat nicotine liquid and deliver smokers the satisfaction that they want without the combustion and harm associated with it."

The F.D.A. stated that company "has engaged in labeling, advertising, and/or other activities directed to consumers, in which JUUL explicitly and/or implicitly has represented that JUUL products are free of a substance, have a reduced level of or exposure to a substance, and/or that JUUL products present a lower risk of tobacco-related disease or are less harmful than one or more other commercially marketed tobacco products."

In a statement, a company spokesman said, "We are reviewing the letters and will fully cooperate."

The F.D.A. also said it was especially concerned that testimony before Congress indicated that company representatives had appeared at schools, telling students that its e-cigarettes (electronic nicotine delivery systems) were safer than tobacco products. "Our concern is amplified by the epidemic rate of increase in youth use of ENDS products, including JUUL's products, and evidence that ENDS products contribute to youth use of, and addiction to, nicotine, to which youth are especially vulnerable," the agency's general counsel, Anthony Villa, senior regulatory counsel, wrote in the letter.

The agency ordered the company to submit its plan to correct the regulations within 15 days.

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Juul Violated Federal Rules by Marketing Vaping Products as Safer Than Cigarettes, F.D.A. Says

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Juul Labs, the dominant e-cigarette company, violated federal regulations by selling its vaping products as a safe alternative to traditional tobacco cigarettes without approval from the Food and Drug Administration, the agency said in a warning letter on Monday. The F.D.A.

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(3) 9/29/19 Images of children being sexually abused has increased- what went wrong?

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(3) 9/29/19 Images of children being sexually abused has increased- what went wrong?

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This article explains the increasing amount of sexual abuse towards children. It relates back to how we measure development and the UN's Sustainable Development Goals. This relates to the goal of peace, justice and strong institutions which prevent abuse. The UN's goals specifically talks about child exploitation and sexual abuse.

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The images are horrific. Children, some just 3 or 4 years old, being sexually abused and in some cases tortured.

Pictures of child sexual abuse have long been produced and shared to satisfy twisted adult obsessions. But it has never been like this: Technology companies reported a record 45 million online photos and videos of the abuse last year.

More than a decade ago, when the reported number was less than a million, the proliferation of the explicit imagery had already reached a crisis point. Tech companies, law enforcement agencies and legislators in Washington responded, committing to new measures meant to rein in the scourge. Landmark legislation passed in 2008.

Yet the explosion in detected content kept growing - exponentially.

An investigation by The New York Times found an insatiable criminal underworld that had exploited the flawed and insufficient efforts to contain it. As with hate speech and terrorist propaganda, many tech companies failed to adequately police sexual abuse imagery on their platforms, or failed to cooperate sufficiently with the authorities when they found it.

Law enforcement agencies devoted to the problem were left understaffed and underfunded, even as they were asked to handle far larger caseloads.

The Justice Department, given a major role by Congress, neglected even to write mandatory monitoring reports, nor did it appoint a senior executive-level official to lead a crackdown. And the group tasked with serving as a federal clearinghouse for the imagery - the go-between for the tech companies and the authorities - was ill equipped for the expanding demands.

A paper recently published in conjunction with that group, the National Center for Missing and Exploited Children, described a system at "a breaking point," with reports of abusive images "exceeding the capabilities of independent clearinghouses and law enforcement to take action." It suggested that future advancements in machine learning might be the only way to catch up with the criminals.

The Times reviewed over 10,000 pages of police and court documents; conducted software tests to assess the availability of the imagery through search engines; accompanied detectives on raids; and spoke with investigators, lawmakers, tech executives and government officials. The reporting included conversations with an admitted pedophile who concealed his identity using encryption software and who runs a site that has hosted as many as 17,000 such images.

In interviews, victims across the United States described in heart-wrenching detail how their lives had been upended by the abuse. Children, raped by relatives and strangers alike, being told it was normal. Adults, now years removed from their abuse, still living in fear of being recognized from photos and videos on the internet. And parents of the abused, struggling to cope with the guilt of not having prevented it and their powerlessness over stopping its online spread.

Many of the survivors and their families said their view of humanity had been inextricably changed by the crimes themselves and the online demand for images of them.

"I don't really know how to deal with it," said one woman who, at age 11, had been filmed being sexually assaulted by her father. "You're just trying to feel O.K. and not let something like this define your whole life. But the thing with the pictures is - that's the thing that keeps this alive."

The Times's reporting revealed a problem global in scope - most of the images found last year were traced to other countries - but one firmly rooted in the United States because of the central role Silicon Valley has played in facilitating the imagery's spread and in reporting it to the authorities.

While the material, commonly known as child pornography, predates the digital era, smartphone cameras, social media and cloud storage have allowed the images to multiply at an alarming rate. Both recirculated and new images occupy all corners of the internet, including a range of platforms as diverse as Facebook Messenger, Microsoft's Bing search engine and the storage service Dropbox.

In a particularly disturbing trend, online groups are devoting themselves to sharing images of younger children and more extreme forms of abuse. The groups use encrypted technologies and the dark web, the vast underbelly of the internet, to teach pedophiles how to carry out the crimes and how to record and share images of the abuse worldwide. In some online forums, children are forced to hold up signs with the name of the group or other identifying information to prove the images are fresh.

With so many reports of the abuse coming their way, law enforcement agencies across the country said they were often besieged. Some have managed their online workload by focusing on imagery depicting the youngest victims.

"We go home and think, 'Good grief, the fact that we have to prioritize by age is just really disturbing,'" said Detective Paula Meares, who has investigated child sex crimes for more than 10 years at the Los Angeles Police Department.

In some sense, increased detection of the spiraling problem is a sign of progress. Tech companies are legally required to report images of child abuse only when they discover them; they are not required to look for them.

After years of uneven monitoring of the material, several major tech companies, including Facebook and Google, stepped up surveillance of their platforms. In interviews, executives with some companies pointed to the voluntary monitoring and the spike in reports as indications of their commitment to addressing the problem.

But police records and emails, as well as interviews with nearly three dozen local, state and federal law enforcement officials, show that some tech companies still fall short. It can take weeks or months for them to respond to questions from the authorities, if they respond at all. Sometimes they respond only to say they have no records, even for reports they initiated.

And when tech companies cooperate fully, encryption and anonymization can create digital hiding places for perpetrators. Facebook announced in March plans to encrypt Messenger, which last year was responsible for nearly 12 million of the 18.4 million worldwide reports of child sexual abuse material, according to people familiar with the reports. Reports to the authorities typically contain more than one image, and last year encompassed the record 45 million photos and videos, according to the National Center for Missing and Exploited Children.

All the while, criminals continue to trade and stockpile caches of the material.

The law Congress passed in 2008 foresaw many of today's problems, but The Times found that the federal government had not fulfilled major aspects of the legislation.

The Justice Department has produced just two of six required reports that are meant to compile data about internet crimes against children and set goals to eliminate them, and there has been a constant churn of short-term appointees leading the department's efforts. The first person to hold the position, Francey Hakes, said it was clear from the outset that no one "felt like the position was as important as it was written by Congress to be."

The federal government has also not lived up to the law's funding goals, severely crippling efforts to stamp out the activity.

Congress has regularly allocated about half of the $60 million in yearly funding for state and local law enforcement efforts. Separately, the Department of Homeland Security this year diverted nearly $6 million from its cybercrimes units to immigration enforcement - depleting 40 percent of the units' discretionary budget until the final month of the fiscal year.

Alicia Kozakiewicz, who was abducted by a man she had met on the internet when she was 13, said the lack of follow-through was disheartening. Now an advocate for laws preventing crimes against children, she had testified in support of the 2008 legislation.

"I remember looking around the room, and there wasn't a dry eye," said Ms. Kozakiewicz, 31, who had told of being chained, raped and beaten while her kidnapper live-streamed the abuse on the internet. "The federal bill passed, but it wasn't funded. So it didn't mean anything."

Further impairing the federal response are shortcomings at the National Center for Missing and Exploited Children, which reviews reports it receives and then distributes them to federal, state and local law enforcement agencies, as well as international partners.

The nonprofit center has relied in large measure on 20-year-old technology, has difficulty keeping experienced engineers on staff and, by its own reckoning, regards stopping the online distribution of photos and videos secondary to rescuing children.

"To be honest, it's a resource and volume issue," said John Shehan, a vice president at the center, which was established 35 years ago to track missing children. "First priority is making sure we're assessing the risk of the children. We're getting this information into the hands of law enforcement."

Representative Debbie Wasserman Schultz, a Democrat from Florida who was an author of the 2008 law, said in an interview that she was unaware of the extent of the federal government's failures. After being briefed on The Times's findings, she sent a letter to Attorney General William Barr requesting an accounting.

Stacie B. Harris, the Justice Department's coordinator over the past year for combating child exploitation, said the problem was systemic, extending well beyond the department and her tenure there. "We are trying to play catch-up because we know that this is a huge, huge problem," said Ms. Harris, an associate deputy attorney general.

The fallout for law enforcement, in some instances, has been crushing.

When reviewing tips from the national center, the Federal Bureau of Investigation has narrowed its focus to images of infants and toddlers. And about one of every 10 agents in Homeland Security's investigative section - which deals with all kinds of threats, including terrorism - is now assigned to child sexual exploitation cases.

"We could double our numbers and still be getting crushed," said Jonathan Hendrix, a Homeland Security agent who investigates cases in Nashville.

The videos found on the computer of an Ohio man were described by investigators as among "the most gruesome and violent images of child pornography."

One showed a woman orally forcing herself on a girl who was then held upside down by the ankles in a bathroom while "another child urinates" on her face, according to court documents.

Another showed a woman "inserting an ice cube into the vagina" of a young girl, the documents said, before tying her ankles together, taping her mouth shut and suspending her upside down. As the video continued, the girl was beaten, slapped and burned with a match or candle.

"The predominant sound is the child screaming and crying," according to a federal agent quoted in the documents.

The videos were stored in a hidden computer file and had also been encrypted, one common way abusive imagery has been able to race across the internet with impunity.

Increasingly, criminals are using advanced technologies like encryption to stay ahead of the police. In this case, the Ohio man, who helped run a website on the dark web known as the Love Zone, had over 3 million photos and videos on his computers.

The site, now shuttered, had nearly 30,000 members and required them to share images of abuse to maintain good standing, according to the court documents. A private section of the forum was available only to members who shared imagery of children they abused themselves. They were known as "producers."

Multiple police investigations over the past few years have broken up enormous dark web forums, including one known as Child's Play that was reported to have had over a million user accounts.

The highly skilled perpetrators often taunt the authorities with their technical skills, acting boldly because they feel protected by the cover of darkness.

"People who traffic in child exploitation materials are on the cutting edge of technology," said Susan Hennessey, a former lawyer at the National Security Agency who researches cybersecurity at the Brookings Institution.

Offenders can cover their tracks by connecting to virtual private networks, which mask their locations; deploying encryption techniques, which can hide their messages and make their hard drives impenetrable; and posting on the dark web, which is inaccessible to conventional browsers.

The anonymity offered by the sites emboldens members to post images of very young children being sexually abused, and in increasingly extreme and violent forms.

"Historically, you would never have gone to a black market shop and asked, 'I want real hard-core with 3-year-olds,'" said Yolanda Lippert, a prosecutor in Cook County, Ill., who leads a team investigating online child abuse. "But now you can sit seemingly secure on your device searching for this stuff, trading for it."

Exhibits in the case of the Love Zone, sealed by the court but released by a judge after a request by The Times, include screenshots showing the forum had dedicated areas where users discussed ways to remain "safe" while posting and downloading the imagery. Tips included tutorials on how to encrypt and share material without being detected by the authorities.

The offender in Ohio, a site administrator named Jason Gmoser, "went to great lengths to hide" his conduct, according to the documents. Testimony in his criminal case revealed that it would have taken the authorities "trillions of years" to crack the 41-character password he had used to encrypt the site. He eventually turned it over to investigators, and was sentenced to life in prison in 2016.

The site was run by a number of men, including Brian Davis, a worker at a child day care center in Illinois who admitted to documenting abuse of his own godson and more than a dozen other children - aged 3 months to 8 years - and sharing images of the assaults with other members. Mr. Davis made over 400 posts on the site. One image showed him orally raping a 2-year-old; another depicted a man raping an infant's anus.

Mr. Davis, who was sentenced to 30 years in prison in 2016, said that "capturing the abuse on video was part of the excitement," according to court records.

Some of his victims attended the court proceedings and submitted statements about their continuing struggles with the abuse.

The surge in criminal activity on the dark web accounted for only a fraction of the 18.4 million reports of abuse last year. That number originates almost entirely with tech companies based in the United States.

The companies have known for years that their platforms were being co-opted by predators, but many of them essentially looked the other way, according to interviews and emails detailing the companies' activities. And while many companies have made recent progress in identifying the material, they were slow to respond.

Hemanshu Nigam, a former federal prosecutor in cybercrime and child exploitation cases, said it was clear more than two decades ago that new technologies had created the biggest boon for pedophiles since the Polaroid camera.

The recent surge by tech companies in filing reports of online abuse "wouldn't exist if they did their job then," said Mr. Nigam, who now runs a cybersecurity consulting firm and previously held top security roles at Microsoft, Myspace and News Corporation.

Hany Farid, who worked with Microsoft to develop technology in 2009 for detecting child sexual abuse material, said tech companies had been reluctant for years to dig too deeply.

"The companies knew the house was full of roaches, and they were scared to turn the lights on," he said. "And then when they did turn the lights on, it was worse than they thought."

Federal law requires companies to preserve material about their reports of abuse imagery for 90 days. But given the overwhelming number of reports, it is not uncommon for requests from the authorities to reach companies too late.

"That's a huge issue for us," said Capt. Mike Edwards, a Seattle police commander who oversees a cybercrimes unit for the State of Washington. "You've got a short period of time to be able to get the data if it was preserved."

Most tech companies have been quick to respond to urgent inquiries, but responses in other cases vary significantly. In interviews, law enforcement officials pointed to Tumblr, a blogging and social networking site with 470 million users, as one of the most problematic companies.

Police officers in Missouri, New Jersey, Texas and Wisconsin lamented Tumblr's poor response to requests, with one officer describing the issues as "long-term and ongoing" in an internal document.

A recent investigation in Polk County, Wis., that included an image of a man orally raping a young child stalled for over a year. The investigator retired before Tumblr responded to numerous emails requesting information.

In a 2016 Wisconsin case, Tumblr alerted a person who had uploaded explicit images that the account had been referred to the authorities, a practice that a former employee told The Times had been common for years. The tip allowed the man to destroy evidence on his electronic devices, the police said.

A spokeswoman for Verizon said that Tumblr prioritized time-sensitive cases, which delayed other responses. Since Verizon acquired the company in 2017, the spokeswoman said, its practice was not to alert users of police requests for data. Verizon recently sold Tumblr to the web development company Automattic.

The law enforcement officials also pointed to problems with Microsoft's Bing search engine, and Snap, the parent company of the social network Snapchat.

Bing was said to regularly submit reports that lacked essential information, making investigations difficult, if not impossible. Snapchat, a platform especially popular with young people, is engineered to delete most of its content within a short period of time. According to law enforcement, when requests are made to the company, Snap often replies that it has no additional information.

A Microsoft spokesman said that the company had only limited information about offenders using the search engine, and that it was cooperating as best as it could. A Snap spokesman said the company preserved data in compliance with the law.

Data obtained through a public records request suggests Facebook's plans to encrypt Messenger in the coming years will lead to vast numbers of images of child abuse going undetected. The data shows that WhatsApp, the company's encrypted messaging app, submits only a small fraction of the reports Messenger does.

Facebook has long known about abusive images on its platforms, including a video of a man sexually assaulting a 6-year-old that went viral last year on Messenger. When Mark Zuckerberg, Facebook's chief executive, announced in March that Messenger would move to encryption, he acknowledged the risk it presented for "truly terrible things like child exploitation."

"Encryption is a powerful tool for privacy," he said, "but that includes the privacy of people doing bad things."

"In a recent case, an offender filmed himself drugging the juice boxes of neighborhood children before tricking them into drinking the mix," said Special Agent Flint Waters, a criminal investigator for the State of Wyoming. "He then filmed himself as he sexually abused unconscious children."

Mr. Waters, appearing before Congress in Washington, was describing what he said "we see every day."

He went on to present a map of the United States covered with red dots, each representing a computer used to share images of child sex abuse. Fewer than two percent of the crimes would be investigated, he predicted. "We are overwhelmed, we are underfunded and we are drowning in the tidal wave of tragedy," he said.

Mr. Waters's testimony was delivered 12 years ago - in 2007.

The following year, Congress passed legislation that acknowledged the severity of the crisis. But then the federal government largely moved on. Some of the strongest provisions of the law were not fulfilled, and many problems went unfixed, according to interviews and government documents.

Today, Mr. Waters's testimony offers a haunting reminder of time lost.

Annual funding for state and regional investigations was authorized at $60 million, but only about half of that is regularly approved. It has increased only slightly from 10 years ago when accounting for inflation. Senator Richard Blumenthal, a Democrat of Connecticut who was a sponsor of the law's reauthorization, said there was "no adequate or logical explanation and no excuse" for why more money was not allocated. Even $60 million a year, he said, would now be "vastly inadequate."

Another cornerstone of the law, the biennial strategy reports by the Justice Department, was mostly ignored. Even the most recent of the two reports that were published, in 2010 and 2016, did not include data about some of the most pressing concerns, such as the trade in illicit imagery.

The Justice Department's coordinator for child exploitation prevention, Ms. Harris, said she could not explain the poor record. A spokeswoman for the department, citing limited resources, said the reports would now be written every four years beginning in 2020.

When the law was reauthorized in 2012, the coordinator role was supposed to be elevated to a senior executive position with broad authority. That has not happened. "This is supposed to be the quarterback," said Ms. Wasserman Schultz, one of the provision's authors.

Even when the Justice Department has been publicly called out for ignoring provisions of the law, there has been little change.

In 2011, the Government Accountability Office reported that no steps had been taken to research which online offenders posed a high risk to children, and that the Justice Department had not submitted a progress assessment to Congress, both requirements of the law.

At the time, the department said it did not have enough funding to undertake the research and had no "time frame" for submitting a report. Today, the provisions remain largely unfulfilled.

The National Center for Missing and Exploited Children, which testified in favor of the 2008 law, has also struggled with demands to contain the spread of the imagery.

Founded in 1984 after the well-publicized kidnapping and murder of a 6-year-old Florida boy, Adam Walsh, the center has been closely affiliated with the federal government since the Reagan administration.

But as child exploitation has grown on the internet, the center has not kept up. The technology it uses for receiving and reviewing reports of the material was created in 1998, nearly a decade before the first iPhone was released. To perform key upgrades and help modernize the system, the group has relied on donations from tech companies like Palantir and Google.

The center has said it intends to make significant improvements to its technology starting in 2020, but the problems don't stop there. The police complain that the most urgent reports are not prioritized, or are sent to the wrong department completely.

"We're spending a tremendous amount of time having to go through those and reanalyze them ourselves," said Captain Edwards, the Seattle police official.

In a statement, the national center said it did its best to route reports to the correct jurisdiction.

Despite its mandate by Congress, the center is not subject to public records laws and operates with little transparency. It repeatedly denied requests from The Times for quarterly and annual reports submitted to the Justice Department, as well as for tallies of imagery reports submitted by individual tech companies.

Mr. Shehan, the vice president, said such disclosures might discourage tech companies from cooperating with the center. He said the numbers could be misinterpreted.

The Times found that there was a close relationship between the center and Silicon Valley that raised questions about good governance practices. For example, the center receives both money and in-kind donations from tech companies, while employees of the same companies are sometimes members of its board. Google alone has donated nearly $4 million in the past decade, according to public testimony.

A spokeswoman for the center said it was common to expect corporations to provide financial assistance to charities. But the practice, others working in the area of child protection say, could elevate the interests of the tech companies above the children's.

"There's an inherent conflict in accepting money from these companies when they also sit on your board," said Signy Arnason, who is a top executive at the equivalent organization in Canada, known as the Canadian Center for Child Protection.

This close relationship with tech companies may ultimately be in jeopardy. In 2016, a federal court held that the national center, though private, qualified legally as a government entity because it performed a number of essential government functions.

If that view gains traction, Fourth Amendment challenges about searches and seizures by the government could change how the center operates and how tech companies find and remove illegal imagery on their platforms. Under those circumstances, if they were to collaborate too closely with the center, the companies fear, they could also be viewed as government actors, not private entities, subjecting them to new legal requirements and court challenges when they police their own sites.

It was a sunny afternoon in July, and an unmarked police van in Salt Lake City was parked outside a pink stucco house. Garden gnomes and a heart-shaped "Welcome Friends" sign decorated the front yard.

At the back of the van, a man who lived in the house was seated in a cramped interrogation area, while officers cataloged hard drives and sifted through web histories from his computers.

The man had shared sexually explicit videos online, the police said, including one of a 10-year-old boy being "orally sodomized" by a man, and another of a man forcing two young boys to engage in anal intercourse.

"The sad thing is that's pretty tame compared to what we've seen," said Chief Jessica Farnsworth, an official with the Utah attorney general's office who led a raid of the house. The victims have not been identified or rescued.

The year was barely half over, and Chief Farnsworth's team had already conducted about 150 such raids across Utah. The specially trained group, one of 61 nationwide, coordinates state and regional responses to internet crimes against children.

The Utah group expects to arrest nearly twice as many people this year as last year for crimes related to child sexual abuse material, but federal funding has not kept pace with the surge. Funding for the 61 task forces from 2010 to 2018 remained relatively flat, federal data shows, while the number of leads referred to them increased by more than 400 percent.

Much of the federal money goes toward training new staff members because the cases take a heavy emotional and psychological toll on investigators, resulting in constant turnover.

"I thought that I was in the underbelly of society - until I came here," said Ms. Lippert, the prosecutor with the task force in Illinois, who had worked for years at a busy Chicago courthouse.

While any child at imminent risk remains a priority, the volume of work has also forced the task forces to make difficult choices. Some have focused on the youngest and most vulnerable victims, while others have cut back on undercover operations, including infiltrating chat rooms and online forums.

"I think some of the bigger fish who are out there are staying out there," Ms. Lippert said.

The internet is well known as a haven for hate speech, terrorism-related content and criminal activity, all of which have raised alarms and spurred public debate and action.

But the problem of child sexual abuse imagery faces a particular hurdle: It gets scant attention because few people want to confront the enormity and horror of the content, or they wrongly dismiss it as primarily teenagers sending inappropriate selfies.

Some state lawmakers, judges and members of Congress have refused to discuss the problem in detail, or have avoided attending meetings and hearings when it was on the agenda, according to interviews with law enforcement officials and victims.

Steven J. Grocki, who leads a group of policy experts and lawyers at the child exploitation section of the Justice Department, said the reluctance to address the issue went beyond elected officials and was a societal problem. "They turn away from it because it's too ugly of a mirror," he said.

Yet the material is everywhere, and ever more available.

"I think that people were always there, but the access is so easy," said Lt. John Pizzuro, a task force commander in New Jersey. "You got nine million people in the state of New Jersey. Based upon statistics, we can probably arrest 400,000 people."

Common language about the abuse can also minimize the harm in people's minds. While the imagery is often defined as "child pornography" in state and federal laws, experts prefer terms like child sexual abuse imagery or child exploitation material to underscore the seriousness of the crimes and to avoid conflating it with adult pornography, which is legal for people over 18.

"Each and every image is a depiction of a crime in progress," said Sgt. Jeff Swanson, a task force commander in Kansas. "The violence inflicted on these kids is unimaginable."

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The Internet Is Overrun With Images of Child Sexual Abuse. What Went Wrong?

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The images are horrific. Children, some just 3 or 4 years old, being sexually abused and in some cases tortured. Pictures of child sexual abuse have long been produced and shared to satisfy twisted adult obsessions. But it has never been like this: Technology companies reported a record 45 million online photos and videos of the abuse last year.

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(4) 9/30/19 What Happens When You Give Immigrants Access to Healthcare? 

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(4) 9/30/19 What Happens When You Give Immigrants Access to Healthcare? 

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Speaking on the definition of development, there is a connection between economics and social well-being. America is one of the "richest" countries, but not everyone has access to healthcare. This article, people who are here illegally are barred for being enrolled in Medicare.

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Nearly every Democrat running for president supports the idea, a sharp change from even a few years ago. Here's a look at the policy behind the politics.

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Dr. Evan Ashkin treating an undocumented immigrant at a community health center in North Carolina. Credit Credit Michael Kirby Smith for The New York Times

Providing comprehensive health coverage to undocumented immigrants has long been nothing more than a wouldn't-it-be-nice item on the far left's wish list. But in the crowded field of candidates vying for the 2020 Democratic presidential nomination, nearly everyone supports it.

Almost all of the 19 candidates who responded to a recent New York Times survey on health care positions said "yes" to a question about whether undocumented immigrants should be covered under a "Medicare for all" system, a public option or other government health programs. And during the second night of the Democratic debates last week, the idea received a unanimous show of hands in support.

President Trump was gleeful, predicting that the response would prove politically toxic for his opponents.

"All Democrats just raised their hands for giving millions of illegal aliens unlimited healthcare," he wrote on Twitter. "How about taking care of American Citizens first!? That's the end of that race!"

Politics aside, here's what health care for unauthorized immigrants looks like now, and what providing comprehensive coverage to them might involve.
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People in the country illegally are generally barred from enrolling in Medicaid or Medicare. They are also prohibited from buying insurance through the marketplaces set up by the Affordable Care Act, or Obamacare. Undocumented children do not qualify for the Children's Health Insurance Program, commonly known as CHIP.

But six states and the District of Columbia have expanded their Medicaid programs to cover children through 18 years old (California recently approved coverage through age 25), regardless of immigration status. About 16 states cover income-eligible pregnant women, also regardless of residency status.

Many illegal immigrants receive primary care and prescription drugs for a sliding-scale fee at 1,400 federally funded health care centers spread across 11,000 communities. Those centers are required to treat anyone, regardless of ability to pay, and administrators do not ask patients about their citizenship status.

The centers serve some 27 million people, but do not have estimates on how many are undocumented.

Of course, when undocumented immigrants arrive at hospitals for medical emergencies, they will be treated.

Some undocumented residents receive coverage through their own or a spouse's employer-provided plan, though they are less likely than legal residents or citizens to have jobs with employer coverage.

If the United States were to begin providing comprehensive health coverage to undocumented immigrants, it would be an outlier, health policy experts say. Even countries with universal, government-run coverage like Norway place tough restrictions on health care for undocumented immigrants. Most immigrants can get emergency care but have to pay other costs. Thailand, with waves of migrant workers, is considered to offer one of the most generous program s, screening immigrants for diseases and allowing them to buy into the national health insurance.

According to the Pew Research Center, in 2017 there were about 10.5 million undocumented immigrants in the United States. According to estimates, 5.5 to 6 million still need coverage.

Neither the Congressional Budget Office nor independent experts have worked up a cost estimate. Some economists say that the expense of providing primary care would eventually pay off, because it would keep people from waiting until they were very sick to seek treatment.

Some studies have found that undocumented immigrants tend to be younger and healthier (therefore potentially cheaper) than the overall American population, particularly because they were able to survive arduous travel for weeks to come to the United States.

Other research suggests that they are disproportionately poor, with high rates of diabetes, obesity and hypertension.

On the debate stage last week, Mayor Pete Buttigieg of South Bend, Ind., said that unauthorized immigrants contributed to society by paying property and sales taxes. Although many undocumented workers are paid off the books, others do have taxes withheld by employers and therefore help fund health care programs for which they are ineligible.

They tend to underuse health care, especially since the Trump administration has cracked down through raids and deportations. Fear has been keeping them away.

"The majority of their children are United States-born citizens who may qualify for Medicaid and CHIP coverage," said Samantha Artiga, who directs the disparities policy project for the Henry J. Kaiser Family Foundation. "But parents are often fearful of enrolling their children, even though they are eligible, because they don't want to put the rest of the family in jeopardy."

The federal government can deny legal residency status (commonly known as a green card) to anyone considered likely to become a "public charge"- meaning a drain on public resources.

Under longstanding policy, Medicaid, the federal-state health program for low-income people, was not considered a public benefit for these purposes. But last year, the Trump administration proposed a rule, now in its final stages, saying that Medicaid use would be a "heavily negative factor" counting against someone trying to obtain a green card.

No one seems to have envisioned a program that would allow for medical tourism. Some independent experts have suggested a residency requirement before people can apply for Medicaid, to prevent the appearance of health care as an immigration incentive.

Randy Capps, a senior researcher at the Migration Policy Institute, said: "They are driven primarily by work opportunities and, more recently, dire climate, economic and security conditions. Health coverage is unlikely to change the equation given these much bigger migration push and pull factors."

But Linda J. Blumberg, a health policy fellow at the Urban Institute, argued that a single- payer system, such as the one proposed by Senator Bernie Sanders of Vermont, could indeed create "strong incentives for people with serious health problems to enter the country or remain longer than their visas allow in order to get government-funded care."

The devil is in the details, and the details seem to be in short supply: No candidate has yet offered a blueprint.

"As good-hearted as anyone is, it's very challenging," Dr. Blumberg said.

Instead, she said, a more pragmatic approach would be to identify providers, hospitals and community centers that disproportionately serve these populations: "Giving them additional funds to make that care more accessible seems to me an important place to start."

Jan Hoffman is a health behaviors reporter for Science, covering law, opioids, doctor-patient communication and other topics. She previously wrote about young adolescence and family dynamics for Style and was the legal affairs correspondent for Metro. @JanHoffmanNYT

A version of this article appears in print on , Section A, Page 15 of the New York edition with the headline: A Look at Health Care For Illegal Immigrants. Order Reprints | Today's Paper | Subscribe

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What Would Giving Health Care to Undocumented Immigrants Mean?

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Nearly every Democrat running for president supports the idea, a sharp change from even a few years ago. Here's a look at the policy behind the politics. Providing comprehensive health coverage to undocumented immigrants has long been nothing more than a wouldn't-it-be-nice item on the far left's wish list.

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(5) 10/7/19- Johnson's Baby Powder Can Cause Cancer- Market Manipulation 

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(5) 10/7/19- Johnson's Baby Powder Can Cause Cancer- Market Manipulation 

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Johnson's Baby Power causes cancer- “For over 40 years, Johnson & Johnson has covered up the evidence of asbestos in their products." This market manipulation is related to Nixon Global Governance, which are problems which need global attention.

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Johnson's baby powder. (Jeff Chiu/AP)

A jury in Missouri ordered Johnson & Johnson to pay $4.69 billion in damages to 22 women who claim the company's talcum powder products caused ovarian cancer.

Following an eight-hour deliberation Thursday, jurors awarded the women $550 million in compensatory damages and another $4.14 billion in punitive damages, their attorney, Mark Lanier, said in a news release. At issue were claims that the pharmaceutical giant sold powder products that were contaminated with asbestos - once a pollutant in talc that has been linked to lung cancer - though there is much debate about whether talcum powder can lead to ovarian cancer.

Johnson & Johnson said in a statement that it is "deeply disappointed in the verdict."

"Johnson & Johnson remains confident that its products do not contain asbestos and do not cause ovarian cancer and intends to pursue all available appellate remedies," it said. "Every verdict against Johnson & Johnson in this court that has gone through the appeals process has been reversed and the multiple errors present in this trial were worse than those in the prior trials which have been reversed."
Does talcum powder cause ovarian cancer?
For decades, talcum powder has been used on babies. Women sometimes use it, too, particularly on genital areas to absorb moisture and reduce odors.

According to the complaint filed last year in the Circuit Court of the City of St. Louis, the women routinely used Johnson's Baby Powder and Shower to Shower, an absorbent body powder, to "dust their perineum for feminine hygiene purposes."

They said they later developed ovarian cancer.

Following Thursday's ruling, the women's lawyer said that the case led to the first talc- and asbestos-included ovarian cancer verdict in the United States.

"For over 40 years, Johnson & Johnson has covered up the evidence of asbestos in their products," Lanier said in the press release. "We hope this verdict will get the attention of the J&J board and that it will lead them to better inform the medical community and the public about the connection between asbestos, talc, and ovarian cancer. The company should pull talc from the market before causing further anguish, harm, and death from a terrible disease.

"J&J sells the same powders in a marvelously safe corn starch variety. If J&J insists on continuing to sell talc, they should mark it with a serious warning."

But Johnson & Johnson said in its statement that the trial was "a fundamentally unfair process," noting most of the women were not from Missouri, where the testimonies were heard. The company added that the verdict "which awarded the exact same amounts to all plaintiffs irrespective of their individual facts, and differences in applicable law, reflects that the evidence in the case was simply overwhelmed by the prejudice of this type of proceeding."

As The Washington Post's Laurie McGinley reported, there is a debate about whether talcum powder can cause ovarian cancer, with many experts, including government researchers, contending the evidence is thin.

Talc is a mineral used in cosmetics and personal-care products, McGinley reported. According to the American Cancer Society, in its natural form, it may contain asbestos, which, when inhaled, may cause cancer in the lungs. However, there are questions about whether asbestos-free talc, which is the form used in modern products, poses a similar risk, according to the association. Regarding ovarian cancer, in particular, the American Cancer Society states that studies have shown mixed results, "with some studies reporting a slightly increased risk and some reporting no increase."

"For any individual woman, if there is an increased risk, the overall increase is likely to very be small," it said.

And the National Cancer Institute states that the "weight of evidence does not support an association between perineal talc exposure and an increased risk of ovarian cancer."

McGinley explained:

The debate over talc began decades ago. In the early 1970s, scientists discovered talc particles in ovarian tumors. In 1982, Harvard researcher Daniel Cramer reported a link between talcum powder and ovarian cancer. His study was followed by several more finding an increased risk of ovarian cancer among regular users of talcum powder. Cramer, who at one point advised J&J to put a warning on its products, has become a frequent expert witness for women suing the company.

His studies and the many others that found a relationship used a case-control approach: A group of women diagnosed with ovarian cancer and a group without it were asked to recall their past diet and activities, and the results were then compared.

Critics say these kinds of studies have serious drawbacks, particularly "recall bias." Women may forget what they did or, if diagnosed with cancer, might inadvertently overestimate their use of a suspect substance. People without a serious disease may be less motivated to remember details.

Three other studies - considered cohort studies - did not find any overall link. Unlike the case-control studies, these efforts began with a large group of women who did not have cancer and followed the progress of their health, with participants recording what they were doing in real time. The results of this approach, most scientists say, are stronger because they aren't subject to the vagaries of memory.

Experts agree that more research needs to be done.
Read more:'Approved by Donald Trump': Asbestos sold by Russian company is branded with the president's face Years ago when my twin got breast cancer I took drastic action and am grateful I did
'Do not eat this cereal': CDC issues blunt warning about Honey Smacks as outbreak grows to 100

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Johnson & Johnson ordered to pay $4.7 billion to women who say baby powder gave them cancer

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A jury in Missouri ordered Johnson & Johnson to pay $4.69 billion in damages to 22 women who claim the company's talcum powder products caused ovarian cancer. Following an eight-hour deliberation Thursday, jurors awarded the women $550 million in compensatory damages and another $4.14 billion in punitive damages, their attorney, Mark Lanier, said in a news release.

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(6) 10/9/19 Rebellion Against Privatization 

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(6) 10/9/19 Rebellion Against Privatization 

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Looking into a pharmaceutical company, there was backlash concerning the privatization of goods. The idea of privatization relates to Adam Smith's ideas of Liberalization and privatization leading to sustainable growth.

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The rebellion against privatisation is growing, with the tide moving towards greater public control of key services.

The pushback can be seen everywhere. In an excoriating assessment of a flagship government policy, the chief inspector of probation, Dame Glenys Stacey, has used her final annual report to condemn the part privatisation of the probation service for a "deplorable diminution of the probation profession".

The fatal mistake was to try to reduce what is a complex social service to a series of contractually defined transactions. Stacey makes clear that the government's recovery plan - to terminate contracts early and retender - is largely a waste of time, because it will not fix the underlying problem that running probation commercially won't work.
Capita's NHS deal was founded on guesswork. It was doomed to fail | Richard Vize
NHS England has abandoned a bizarre scheme to force cancer patients at the renowned Churchill hospital in Oxford to be loaded into an ambulance and driven four miles down the road to use private sector scanners rather than be scanned on site by NHS staff.

The retreat came as Jeremy Corbyn joined the backlash and Labour revealed plans to ban private companies from providing services that deal with vulnerable people. NHS England has already used its long-term plan to call for legislation to repeal automatic tendering in the health service. Water, energy companies and the railways are in the sights of the renationalisation lobby. Outsourcing companies are collapsing.

Now Lord Jim O'Neill - an authority on the policy implications of antimicrobial resistance - has massively escalated the debate about public control of vital services by arguing that a state-run pharmaceutical company may be the only answer to the private sector's failure to invest sufficiently in new antibiotics. There have been no new classes of antibiotics since the 1980s, and only three firms are believed to be in the game.

The Association of the British Pharmaceutical Industry responded by saying how many billions its members were investing in research, failing to address the central point that however much or little they are spending, it is clearly not working.

The stakes could hardly be higher. While hundreds of thousands of people can be the collateral damage for a dysfunctional benefit system or failed probation service, the rise of antimicrobial resistance poses a catastrophic threat to us all, and is already compromising treatments for illnesses such as pneumonia, bloodstream infections and gonorrhoea.

Confronted by private sector lassitude in response to this impending disaster, the balance of risks and potential benefits is clear. Government needs to intervene decisively. The question is how.

Merely nationalising a pharmaceutical company is no more likely to deliver a solution to antimicrobial resistance than privatising a public service is going to make it more effective. Simplistic solutions to complex questions don't work, no matter who is carrying the placard.

O'Neill admits he is unsure what a publicly owned or led pharmaceutical operation would look like or how it should be incentivised to deliver. One idea he has floated would be to run a pharmaceutical company as a public utility.
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But despite the formidable practical difficulties it justifies some serious planning. Assuming it happened under a Labour government, one of the biggest challenges would be to avoid getting bogged down in issues - such as worker representation on boards or getting squeamish about paying big salaries to key staff - and to focus relentlessly on the goal of developing antibiotics.

Labour's current leadership is facing the same problems that Tony Blair and Gordon Brown were confronting as they watched the Conservative party crumble in the 1990s - how to create the conditions for progressive, productive, affordable public services. Simply reversing Tory policies will not be enough.

While Labour is keen on the Preston model for reinvigorating local services, it will have to be far more creative if it is to start dabbling in high-tech industries. But with private sector pharma companies unwilling to commit the resources on anything like the required scale to tackle antimicrobial resistance, there is an opportunity for a bold, imaginative alternative.

* Richard Vize is a public policy commentator and analyst
Topics

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The tide is turning against public service privatisation | Richard Vize

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The rebellion against privatisation is growing, with the tide moving towards greater public control of key services. The pushback can be seen everywhere. In an excoriating assessment of a flagship government policy, the chief inspector of probation, Dame Glenys Stacey, has used her final annual report to condemn the part privatisation of the probation service for a "deplorable diminution of the probation profession".