How the War With Iran Is Widening, and U.S. Hospitals See a Surge of Uninsured Patients

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0:39Today's Thursday, July 30th. Here's what we're covering.

0:46We're going to be hitting them very hard because it's our turn to hit them. They know it's coming. They're asking us not to do it. In the Middle East, what had been a short pause in direct fighting is now over, as the conflict between the U.S. and Iran has reignited. It's our turn, and we'll see if we get there with an agreement at some point, but we're going to hit them very hard. This week, Iran fired multiple ballistic missiles on American bases in Jordan. And last night in response, the Pentagon said it carried out a heavy wave of strikes on Iran, hitting command centers, missile and drone sites, and surveillance facilities.

1:23The escalation comes as more and more countries are being pulled into the war. In recent weeks, Iran-linked groups across the region have helped draw Jordan, along with Saudi Arabia, Iraq, and Yemen, further into the conflict. Now, there's also Egypt, where two ships were hit and caught fire yesterday in what appeared to be a drone strike, according to marine tracking companies. One of the ships was a U.S.-owned natural gas tanker. It wasn't immediately clear who was behind the apparent attack, but analysts say that Iran has been increasingly trying to extend the battlefield. And they say that while the U.S.

2:01and Israel went into the war promising a quick, decisive victory, Iran is trying to prove that it now has control of the conflict. One expert at the Middle East Institute, a nonpartisan think tank, told The Times that Iran is, quote, trying to seize the initiative, or at the very least, keep the U.S. and Israel on their back foot.

2:30Over the past few years, the Times has been investigating how American soldiers are at risk of serious brain injuries, not from combat, but from routine parts of their jobs. The Times has found, for example, that there were signs of brain damage in artillery crews who fired thousands of mortar rounds during training, and in Navy SEALs who used shoulder-fired rockets, and fighter pilots who were catapulted off of aircraft carriers. Now, my colleague Dave Phillips, who has led this reporting, has been looking into the Coast Guard's elite rescue teams, whose job it is to rush into rough waters. I was really surprised to learn that there could be a serious injury just from riding through the waves.

3:13But when someone explained the physics to me, it made total sense. When a body standing on a boat slams down into a wave, the body actually acts like a whip crack. And so a force that might be only six times the force of gravity on the deck, pretty manageable, by the time it whips up to the head is 60 times the force of gravity, which really is the equivalent of a car crash. When I started talking to rescue crews that are on these boats, many of them talked to me about having headaches or feeling hungover for days after. And over years of being exposed to this, people developed really serious problems.

3:53It started with sleeplessness and headaches and progressed into anxiety and really serious mood swings. And some people, as this injury continued to progress, actually died by suicide. Dave says the symptoms crew members described are all classic signs of brain injury. But he found that unlike other branches of the military, the Coast Guard had no regular testing for that and no formal briefings about the dangers of the pounding waves. There is a section about brain injuries on the Coast Guard's website, but it's more than a decade out of date. And when you try to click on the links under the header where to get help, many of them don't work.

4:32When I reached out to the Coast Guard, all of a sudden they started discussing this and very quickly realized it was a thing, that there's a good chance that their small boat crews are getting brain injured, that they're not tracking it, that they don't have a program in place to help these guys. And so really in the last couple weeks, they've started looking at people to make sure they're not getting too much exposure and watching for the symptoms that might be signs of a brain injury. You can find Dave's full investigation in the Times app or at nytimes.com.

5:09Around the country, executives running some of the biggest hospital systems are sounding the alarm that more and more patients are showing up to their emergency rooms with no insurance. For some hospitals, the number of uninsured patients jumped 20 % in a single year, with unpaid medical bills piling up. A number of health care executives attribute that to the fact that Republicans in Congress ended enhanced Obamacare subsidies last year that were helping many people pay for insurance. Facing higher costs, many Americans have now dropped their coverage altogether. Government data shows that since January, Obamacare enrollment has dropped by about 3 million people.

5:52The Trump administration says the decrease is largely due to a crackdown on fraud, but the rise in unpaid bills underscores how many Americans are struggling to pay for their health care. Hospitals say the result is that they're the ones absorbing more and more of the costs, since they're required by federal law to treat people dealing with medical emergencies, regardless of those patients' ability to pay. And beyond ER care, the rising number of uninsured Americans is having other knock-on effects. Health systems are reporting that patients are putting off elective surgeries, and industry experts say hospitals are starting to shutter individual clinics and cut services like maternal care and behavioral health.

6:35Going forward, insurance companies expect the number of uninsured Americans to keep growing. And to offset the losses, experts say hospitals will likely end up raising prices for those who are covered.

6:52In California, the state has spent decades and decades building its reputation as a wine powerhouse. It produces about 80 % of all wine made in the U.S. But after a long boom, that industry is now taking a sharp turn. Wine sales in the U.S. are at their lowest level in two decades, as people drink less or turn to other options like canned cocktails and hard seltzers. And California's vineyards are feeling the pain. I recently went to a vineyard south of San Francisco where wine producers were actually pulling out their grapes, like tearing their grapes from the ground and burning the grape vines because there's just no way for them to make any money anymore.

7:35My colleague Salmia Carlamangla went out into the field with one winery owner who was shutting down his 50-year-old family business and clearing out the vines. She says he's not alone. Other growers are expected to leave hundreds of thousands of tons of grapes to rot this harvest season because there's already so many unsold bottles of wine filling up storerooms and wine shops. The industry is expected to bottom out in the next couple of years, but by that time, hundreds of wineries are expected to have closed. And this is a really dramatic change for an industry that is really fundamental to California, fundamental to the image of what people think about when they think about the state, and just an industry that for years had been growing and had been really successful.

8:27And finally, for years, the tiny town of St. Mary's, Newfoundland, way out on the eastern edge of Canada, has been tormented by a noxious smell. In the 2000s, a factory for the Atlantic Seafood Sauce Company shut down there. Maybe you can see where I'm going with this. Since then, over a hundred giant tanks, we're talking 3 ,000 gallons each, have just been sitting there filled with fish sauce. Fish sauce does not smell better with time. Over the years, it's only gotten worse. With the company out of business, no one has taken responsibility for the factory, and the building has been falling apart.

9:07Parts of the roof have blown off, the walls have been damaged, leaving the fish sauce more and more exposed, wafting in the wind. As the town Brown's mayor said, take the worst rotten fish you've ever smelled in your life and times it by a hundred. At one point, people hatched a plan to dump a bunch of the sauce into the ocean, but Canadian authorities put a stop to that after only a few dozen tanks were removed. This week, finally, a full cleanup started, thanks to some new government funding. It is a big logistical undertaking. The tanks are now going to be cut open, spilling the fish sauce, now more like fish sludge, onto the old factory floor.

9:50That will be sopped up with peat moss, which will then be trucked away and buried. The whole process will likely take a few months. As the operation got underway, a local Newfoundland official declared, We couldn't be more proud than to be standing here today and watching this fish sauce leave this community. Those are the headlines. Today on The Daily. why this year's fire season in Europe has been so intense. You can listen to that in the New York Times app or wherever you get your podcasts. I'm Tracy Mumford. We'll be back tomorrow with the latest and the Friday News Quiz.