I recently saw a patient complaining of shortness of breath and a persistent cough. Worried he was developing pneumonia, I ordered a chest X-ray — a standard diagnostic tool. He refused. He hadn’t met his $3,000 deductible yet, and so his insurance would have required him to pay much or all of the cost for that scan. He assured me he would call if he got worse.

For him, the X-ray wasn’t a medical necessity, but it would have been a financial shock he couldn’t absorb. He chose to gamble on a cough, and five days later, he lost — ending up in the ICU with bilateral pneumonia. He survived, but the cost of his “savings” was a nearly fatal hospital stay and a bill that will quite likely bankrupt him. He is lucky he won’t be one of the 55,000 Americans to die from pneumonia each year.

As a physician associate in primary care, I serve as a frontline witness to this failure of the American approach to insurance. Medical professionals are taught that the barrier to health is biology: bacteria, viruses, genetics. But increasingly, the barrier is a policy framework that pressures insured Americans to gamble with their lives. High-deductible health plans seem affordable because their monthly premiums are lower than other plans’, but they create perverse incentives by discouraging patients from seeking and accepting diagnostics and treatments — sometimes turning minor, treatable issues into expensive, life-threatening emergencies. My patient’s gamble with his lungs is a microcosm of the much larger gamble we are taking with the American public.

The economic theory underpinning these high deductibles is known as “skin in the game.” The idea is that if patients are responsible for the first few thousand dollars of their care, they will become savvy consumers, shopping around for the best value and driving down healthcare costs.

But this logic collapses in the exam room. Healthcare is not a consumer good like a television or a used car. My patient was not in a position to “shop around” for a cheaper X-ray, nor was he qualified to determine if his cough was benign or deadly. The “skin in the game” theory assumes a level of medical literacy and market transparency that simply doesn’t exist in a moment of crisis. You can compare the specs of two SUVs; you cannot “shop around” for a life-saving diagnostic while gasping for air.

A 2025 poll from the Kaiser Family Foundation points to this reality, finding that up to 38% of insured American adults say they skipped or postponed necessary healthcare or medications in the past 12 months because of cost. In the same poll, 42% of those who skipped care admitted their health problem worsened as a result.

This self-inflicted public health crisis is set to deteriorate further. The Congressional Budget Office estimates roughly 15 million people will lose health coverage and become uninsured by 2034 because of Medicaid and Affordable Care Act marketplace cuts. That is without mentioning the millions more who will see their monthly premiums more than double if premium tax credits are allowed to expire. If that happens, not only will millions become uninsured but also millions more will downgrade to “bronze” plans with huge deductibles just to keep their premiums affordable. We are about to flood the system with “insured but functionally uninsured” patients.

I see the human cost of this “functional uninsurance” every week. These are patients who technically have coverage but are terrified to use it because their deductibles are so large they may exceed the individuals’ available cash or credit — or even their net worth. This creates a dangerous paradox: Americans are paying hundreds of dollars a month for a card in their wallet they cannot afford to use. They skip the annual physical, ignore the suspicious mole and ration their insulin — all while technically insured. By the time they arrive at my clinic, their disease has often progressed to a catastrophic event, from what could have been a cheap fix.

Federal spending on healthcare should not be considered charity; it is an investment in our collective future. We cannot expect our children to reach their full potential or our workforce to remain productive if basic healthcare needs are treated as a luxury. Inaction by Congress and the current administration to solve this crisis is legislative malpractice.

In medicine, we are trained to treat the underlying disease, not just the symptoms. The skipped visits and ignored prescriptions are merely symptoms; the disease is a policy framework that views healthcare as a commodity rather than a fundamental necessity. If we allow these cuts to proceed, we are ensuring that the American workforce becomes sicker, our hospitals more overwhelmed and our economy less resilient. We are walking willingly into a public health crisis that is entirely preventable.

Joseph Pollino is a primary care physician associate in Nevada.

The U.S. Department of Health and Human Services announced sweeping changes to the pediatric vaccine schedule on Monday, sharply cutting the number of diseases U.S. children will be regularly immunized against.

Under the new guidelines, the U.S. still recommends that all children be vaccinated against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and varicella, better known as chickenpox.

Vaccines for all other diseases will now fall into one of two categories: recommended only for specific high-risk groups, or available through “shared clinical decision-making” — the administration’s preferred term for “optional.”

These include immunizations for hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), bacterial meningitis, influenza and COVID-19. All these shots were previously recommended for all children.

Insurance companies will still be required to fully cover all childhood vaccines on the CDC schedule, including those now designated as optional, according to the Department of Health and Human Services.

Health Secretary Robert F. Kennedy Jr., a longtime vaccine critic, said in a statement that the new schedule “protects children, respects families, and rebuilds trust in public health.”

But pediatricians and public health officials widely condemned the shift, saying that it would lead to more uncertainty for patients and a resurgence of diseases that had been under control.

“The decision to weaken the childhood immunization schedule is misguided and dangerous,” said Dr. René Bravo, a pediatrician and president of the California Medical Assn. “Today’s decision undermines decades of evidence-based public health policy and sends a deeply confusing message to families at a time when vaccine confidence is already under strain.”

The American Academy of Pediatrics condemned the changes as “dangerous and unnecessary,” and said that it will continue to publish its own schedule of recommended immunizations. In September, California, Oregon, Washington and Hawaii announced that those four states would follow an independent immunization schedule based on recommendations from the AAP and other medical groups.

The federal changes have been anticipated since December, when President Trump signed a presidential memorandum directing the health department to update the pediatric vaccine schedule “to align with such scientific evidence and best practices from peer, developed countries.”

The new U.S. vaccination guidelines are much closer to those of Denmark, which routinely vaccinates its children against only 10 diseases.

As doctors and public health experts have pointed out, Denmark also has a robust system of government-funded universal healthcare, a smaller and more homogenous population, and a different disease burden.

“The vaccines that are recommended in any particular country reflect the diseases that are prevalent in that country,” said Dr. Kelly Gebo, dean of the Milken Institute School of Public Health at George Washington University. “Just because one country has a vaccine schedule that is perfectly reasonable for that country, it may not be at all reasonable” elsewhere.

Almost every pregnant woman in Denmark is screened for hepatitis B, for example. In the U.S., less than 85% of pregnant women are screened for the disease.

Instead, the U.S. has relied on universal vaccination to protect children whose mothers don’t receive adequate care during pregnancy. Hepatitis B has been nearly eliminated in the U.S. since the vaccine was introduced in 1991. Last month, a panel of Kennedy appointees voted to drop the CDC’s decades-old recommendation that all newborns be vaccinated against the disease at birth.

“Viruses and bacteria that were under control are being set free on our most vulnerable,” said Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health. “It may take one or two years for the tragic consequences to become clear, but this is like asking farmers in North Dakota to grow pineapples. It won’t work and can’t end well.”

Yes, Oprah Winfrey has discussed her weight loss and weight gain and weight in general before — many, many times before. The difference this time around, she says, is how little food noise there is in her daily life, and how little shame. It’s so quiet, in fact, that she can eat a whole croissant and simply acknowledge she had breakfast.

“Food noise,” for those who don’t experience it, is a virtually nonstop mental conversation about food that, according to Tufts Medicine, rarely shuts up and instead drives a person “to eat when they’re not hungry, obsess over meals and feel shame or guilt about their eating habits.”

“This type of obsessive food-related thinking can override hunger cues and lead to patterns of overeating, undereating or emotional eating — especially for people who are overweight,” Tufts said.

Winfrey told People in an exclusive interview published Tuesday that in the past she would have been thinking, “‘How many calories in that croissant? How long is it going to take me to work it off? If I have the croissant, I won’t be able to have dinner.’ I’d still be thinking about that damn croissant!”

What has changed is her acceptance 2½ years ago that she has a disease, obesity, and that this time around there was something not called “willpower” to help her manage it.

The talk show host has been using Mounjaro, one of the GLP-1 drugs, since 2023. The weight-loss version of Mounjaro is Zepbound, like Wegovy is the weight-loss version of Ozempic. Trulicity and Victroza are also GLP-1s, and a pill version of Wegovy was just approved by the FDA.

When she started using the injectable, Winfrey told People she welcomed the arrival of a tool to help her get away from the yo-yo path she’d been on for decades. After understanding the science behind it, she said, she was “absolutely done with the shaming from other people and particularly myself” after so many years of weathering public criticism about her weight.

“I have been blamed and shamed,” she said elsewhere in that 2023 interview, “and I blamed and shamed myself.”

Now, on the eve of 2026, Winfrey says her mental shift is complete. “I came to understand that overeating doesn’t cause obesity. Obesity causes overeating,” she told the outlet. “And that’s the most mind-blowing, freeing thing I’ve experienced as an adult.”

She isn’t even sharing her current weight with the public.

Winfrey did take a break from the medication early in 2024, she said, and started to regain weight despite continuing to work out and eat healthy foods. So for Winfrey the obesity prescription will be renewed for a lifetime. C’est la vie seems to be her attitude.

“I’m not constantly punishing myself,” she said. “I hardly recognize the woman I’ve become. But she’s a happy woman.”

Winfrey has to take a carefully managed magnesium supplement and make sure she drinks enough water, she said. The shots are done weekly, except when she feels like she can go 10 or 12 days. But packing clothes for the Australian leg of her “Enough” book tour was an off-the-rack delight, not a trip down a shame spiral. She’s even totally into regular exercise.

Plus along with the “quiet strength” she has found in the absence of food noise, Winfrey has experienced another cool side effect: She pretty much couldn’t care less about drinking alcohol.

“I was a big fan of tequila. I literally had 17 shots one night,” she told People. “I haven’t had a drink in years. The fact that I no longer even have a desire for it is pretty amazing.”

So back to that croissant. How did she feel after she scarfed it down?

“I felt nothing,” she said. “The only thing I thought was, ‘I need to clean up these crumbs.’”