2026-03-20 06:15:46
《告白者》（The Bachelorette）第22季原本计划在周日首播，但现已取消。这档节目原本旨在开启一个新时代，因为其主持人泰勒·弗兰基·保罗（Taylor Frankie Paul）是《摩门教妻子的秘密生活》（The Secret Lives of Mormon Wives）的明星，而非《告白者》的常客。此外，节目还从常规的周晚时段转到了黄金时段播出。然而，在节目首播前夕，有关保罗涉嫌家暴的指控再次浮出水面。尽管ABC试图通过让保罗在《早安美国》（Good Morning America）节目中发言来挽回形象，但当 TMZ 在周四发布了一段2023年的视频，显示保罗在与前伴侣达科塔·莫滕森（Dakota Mortensen）争吵时扔椅子，而孩子在一旁哭泣，节目随即被取消。随后，莫滕森还向保罗申请了人身保护令。
《告白者》自2002年开播以来，曾引领真人秀的黄金时代，但近年来却因争议和观众兴趣下降而陷入困境。2019年，科顿·安德鲁伍德（Colton Underwood）的赛季中，他因压力过大而跳过围栏逃离现场，这一情节令人震惊且难忘。然而，该赛季也引发了后续的争议，包括安德鲁伍德与卡西·兰道夫（Cassie Randolph）的关系迅速破裂，兰道夫指控他跟踪她并安装GPS追踪器，最终申请了人身保护令。
《告白者》一直以传统的性别角色和性观念为背景，强调将年轻异性情侣在短时间内推向婚姻。然而，随着社会观念的进步，尤其是“Me Too”运动的兴起，观众对这类内容的兴趣逐渐减少。此外，节目长期缺乏多样性，尤其在种族问题上表现得尤为不敏感。例如，2024年，首位非裔美国男主角马特·詹姆斯（Matt James）选择的未婚妻拉切尔·基尔康内尔（Rachel Kirkconnell）曾参加过以种植园为主题的派对，而节目主持人克里斯·哈里森（Chris Harrison）在为她辩护时，也发表了种族歧视的言论。这引发了强烈反弹，最终导致哈里森被迫辞职。
2024年，节目曾因主角詹妮·特兰（Jenn Tran）在与德文·斯特拉德（Devin Strader）的订婚破裂后被安排了一系列令人尴尬的剧情，而被观众广泛批评。特兰是该节目首位亚裔美国主持人，她的遭遇让节目显得愈发不可挽回。如今，保罗的加入本意是为节目带来新的关注，但因她曾因家暴被捕，以及粉丝对其情感状态的猜测，最终导致节目提前取消。
《告白者》一直是一个充满问题的闹剧，但其最佳时刻往往低风险、高戏剧性，比如围绕虾子的争执，有时甚至令人着迷。然而，随着争议不断积累，尤其是当节目主持人被拍到涉嫌家暴时，观众已无法再单纯地享受节目带来的混乱，而忽视其背后的真实伤害。也许，这个节目已经不再被需要了。
The newest Bachelorette season is canceled, right on the cusp of its premiere — and it may inadvertently spell the end of the franchise.
It probably should.
This season was slated to debut on Sunday with Taylor Frankie Paul, star of the Hulu reality show The Secret Lives of Mormon Wives, in the title spot. Everything about the 22nd season’s marketing signaled that it was a new era: Paul is an established reality TV star on another Disney-owned franchise, not a veteran of The Bachelor, as almost all of her predecessors were. And the show was moving from its typical weeknight slot to a coveted Sunday primetime airing.
Then allegations against Paul of domestic violence resurfaced in the week leading up to the premiere. ABC appeared to be doing its best to salvage the season, sending Paul out on Good Morning America on Wednesday morning. (“I’m a person that will always speak my truth,” she told host Lara Spencer in the interview. “That’s what I’m known for. So when the time is right, I will be.”) But after TMZ published a 2023 video on Thursday that showed Paul throwing a chair during an argument with her former partner Dakota Mortensen while her child cried nearby, the network decided to cancel the season three days before it was supposed to start. (Later on Thursday, Mortensen filed for a restraining order against Paul.)
So what was supposed to be a fresh start for The Bachelor franchise — a series that helped usher in reality TV’s golden era when it debuted in 2002 — has instead spiraled into one of the worst PR debacles yet for a show that seems to specialize in them. As its ratings fall and other shows take up the mantle of must-see reality TV, I find myself as a viewer asking: Is it time for the Bachelor to be over?
The first season of the Bachelor franchise that I watched was Colton Underwood’s in 2019 — in which the lead became so exasperated by the pressure he was under that he literally leaped over a fence to try to escape. It was riveting television and so memorable that it was still inspiring thoughtful essays from high-minded cultural websites like Bright Wall/Dark Room years later.
But, with the benefit of hindsight, Colton’s season may have also been the beginning of the end of a franchise that has become too toxic to continue.
He ended the season with Cassie Randolph, but their relationship quickly ended and the situation then turned dark: Randolph alleged Underwood had been stalking her, even putting a tracker on her car, and she filed a restraining order. The Bachelor universe was always premised on a fairly traditional view of gender roles and sexuality — it was, after all, centered on pushing young heterosexual couples into an engagement within a matter of weeks — and audience interest dwindled as the world moved forward, particularly once we entered the Me Too era that challenged long-held relationship norms.
Meanwhile, the show had always been blindingly white, and in the years that followed Colton’s season, the Bachelor’s uncomfortable relationship with race also made it seem increasingly out of touch. The season with the franchise’s first Black Bachelor, Matt James, ended with him choosing Rachel Kirkconnell…who, as it turned out, had attended a plantation-themed party while in college. Longtime host Chris Harrison came to Kirkconnell’s defense and made his own racially insensitive comments in the process, in an interview with franchise veteran Rachel Lindsay, the first Black Bachelorette, who herself has accused the show of being a toxic environment. A fierce backlash followed — and Harrison was forced to step down.
The last time I wrote about The Bachelorette was in 2024, when the show put its lead, Jenn Tran, through an embarrassing and shameful spectacle after her engagement to Devin Strader disintegrated. The treatment of Tran, the first Asian American lead of the show, made it feel like the show was nearing the point of no return.
Paul’s casting was, in my eyes, a desperate last grasp for relevance. The culture that franchise helped to create seemed to have passed it by. Love Is Blind and Love Island command much more attention. The audience for the Bachelor shows has shrunk to less than half the size they were a decade ago and a fraction what they were back in the 2000s. Meanwhile, The Secret Lives of Mormon Wives had such a strong debut after its first eight episodes dropped on Hulu in 2024 that the network renewed it and ordered 20 more within a month of the premiere. It makes sense that ABC thought Paul could pull in viewers, despite the fact that she was arrested for domestic violence in 2023, and despite rampant fan speculation that she was secretly in a relationship or at least emotionally unavailable while filming The Bachelorette.
Now that franchise reboot is over before it had even begun. The Bachelor franchise has always been a problematic farce, but at its best, the drama was low stakes — over shrimp, for example — and, at times, riveting. I’ll never forget watching Colton leap that fence. It was raw and captivating, everything we ask reality TV to be for our entertainment.
But as the controversies have piled up, and now a lead contestant’s alleged domestic violence caught on camera, it’s become impossible to simply enjoy the mess and ignore the real-life trauma behind it. Maybe the world doesn’t need The Bachelor anymore.
2026-03-20 06:05:00
2026年3月4日，德克萨斯州众议员詹姆斯·塔拉里科（民主党人，也是美国参议员候选人）在德克萨斯州初选之夜的活动上发表讲话。| 摄影：乔丹·冯德黑尔/彭博社，经盖蒂图片社授权
本月早些时候，塔拉里科在激烈的竞选中胜出，成为德克萨斯州民主党参议员候选人。自1988年以来，德克萨斯州尚未选出过民主党参议员，因此许多人寄希望于塔拉里科的竞选能改变这一局面。然而，本周一段意外浮现的旧视频引发了巨大争议，塔拉里科在24小时内迅速作出回应。这段视频并非涉及常见的政治丑闻，如婚外情或贿赂，而是他支持“素食主义”。虽然塔拉里科本人并未声称自己是素食主义者，但在2022年支持加强动物虐待法律的筹款活动上，他曾表示他的竞选团队已正式成为“非肉类”竞选，并只购买本地素食企业的产品，还提到了一家当地的植物基披萨店。他称减少肉类消费是“关乎生存的大事”，因为这是“对抗气候变化”的必要手段，同时也是“尊重社会中所有动物”的方式。现场观众对此表示热烈支持。
塔拉里科并非唯一一位倡导植物性饮食的政界人士。例如，新泽西州参议员柯里·布克、前纽约市市长埃里克·亚当斯以及马里兰州众议员杰米·拉斯基等人都曾表达过类似观点。然而，在以畜牧业闻名的德克萨斯州，这种言论却引发了强烈反弹。德克萨斯州参议员泰德·克鲁兹称塔拉里科是“怪胎”，想要“禁止烧烤”（塔拉里科从未说过此类话）。另一位参议员约翰·科恩恩则呼吁选民在11月投票，因为“牛排的诱惑更大”（双关语）。左翼和右翼的政治声音都表示，塔拉里科的竞选可能“泡汤”了。
塔拉里科的竞选团队在24小时内发布了一张图片作为回应，图片中他穿着德克萨斯州旗帜图案的衬衫，咬了一口肉。这张图片的意图尚不明确，可能是为了安抚选民，表明他不会威胁德克萨斯州的传统，也可能是讽刺意味的表达，抑或两者兼有。
类似事件并非首次发生。2021年，科罗拉多州州长贾雷德·波利斯宣布3月20日为“MeatOut”日，鼓励人们尝试植物性饮食。尽管波利斯本人也吃肉，但科罗拉多州的畜牧业团体对此极为不满，于是波利斯又设立了“科罗拉多州畜牧业自豪日”，并分享了自己的烧烤调味料配方。这些事件表明，塔拉里科的“非肉类”竞选宣言可能是一次危险的举动，尤其对于德克萨斯州的政治人物而言。如果他的政治野心超出奥斯汀地区，这一言论可能会带来严重后果。
然而，这些反应也揭示了一个更深层次的问题：尽管已有大量证据表明美国肉类产业的残酷性，但美国人仍难以就肉类在饮食、文化和政治中的角色展开深入、诚实的讨论。许多政客、评论员和特殊利益集团倾向于将任何关注肉类的人视为异类，并用幼稚的侮辱和空洞的说辞来回应，而非认真探讨肉类饮食对土地、空气、河流和数以十亿计动物的影响。
变化正在畜牧业大州悄然发生。奥斯汀和休斯顿拥有美国最出色的植物性美食，而我曾品尝过最美味的素食肉干，来自德克萨斯州达拉斯以北一小时车程的一家小公司。但没有人比蕾妮·金-森嫩和汤米·森嫩夫妇更彻底地颠覆了德克萨斯州作为“无尽烧烤爱好者的不可动摇的堡垒”的形象。这对夫妇曾经营一家位于德克萨斯州墨西哥湾沿岸的牧场。然而，随着时间推移，蕾妮与动物之间建立了深厚的情感联系，并对母牛在幼崽被运走时的哀鸣感到震惊。她最终成为素食主义者，并发起了一项筹款活动，将牧场转变为动物庇护所。如今，超过100只被救出的牲畜——包括牛、火鸡、山羊和猪——在那里过着更加自然的生活。这或许对某些德克萨斯人来说是异端，但它表明，许多德克萨斯人乃至美国人对动物的看法远比一条讽刺推文复杂。
森嫩夫妇的故事也让我想起了塔拉里科最动人的演讲内容，包括他对同情、爱、个人转变和保护弱势群体的呼吁。这些信息帮助他走向了全国政治舞台。然而，美国显然还未准备好将动物，尤其是我们食用的动物，纳入这一叙事，也未准备好公开讨论每年工业化养殖100亿只动物的现实。但我希望有一天我们能够做到，也希望政客们能降低情绪化的温度，进行诚实的对话。
Earlier this month, Texas state Rep. James Talarico eked out victory in a heated race to become Texas’s Democratic nominee for the US Senate race this November. Texans haven’t elected a Democrat to the Senate since 1988, and a lot of hopes are riding on Talarico’s longshot campaign to change that.
But this week, an unexpected video from Talarico’s past resurfaced that caused so much uproar he issued a hefty rebuttal within 24 hours.
The video didn’t revolve around the typical political scandal fodder, like allegations of an affair or bribery. In the eyes of his opponents, it would seem, he had committed a far graver offense: Talarico had endorsed…veganism.
For the record, Talarico has never claimed to be vegan himself, but at a 2022 fundraiser event in support of strengthening animal abuse laws, he said that his campaign — at the time for reelection in the Texas House of Representatives — had officially become a “non-meat” campaign. Talarico stated that the campaign would only buy “vegan products from our local vegan businesses,” and mentioned a local plant-based pizzeria. He said it was an existential matter to try to reduce meat consumption because “it’s necessary to fight climate change” but also as a means to “respect animals in all aspects of society.” The crowd cheered.
In advocating for plant-based eating, Talarico joined a handful of other politicians: New Jersey Sen. Cory Booker, former New York City Mayor Eric Adams, and Maryland Rep. Jamie Raskin, among others. But the message hit different in Texas, which raises more cattle than any other state by far, and where the mascot of the state’s second largest university is the longhorn steer.
The responses to the resurfaced post have been fast and furious. Texas Sen. Ted Cruz called Talarico a “freak” who wants to “ban BBQ” (Talarico has said no such thing). Texas’s other senator, John Cornyn — who Talarico might face off against in November’s election — urged Texans to vote this November because “the steaks couldn’t be higher” (get it?). Voices on the political left and right agreed his election bid might just be cooked, as the kids say.
But within 24 hours, Talarico’s campaign responded with a “press release” that was just a picture of him wearing a Texas flag button-down shirt while taking a bite out of a hunk of meat, though it’s hard to tell if it was meant to reassure voters he doesn’t pose a threat to the state’s identity, a satirical bit, or both.
We’ve seen this movie before. In 2021, Colorado Gov. Jared Polis proclaimed March 20 as “MeatOut” day, encouraging Coloradans to give plant-based eating a try. Like Talarico, Polis eats meat, too. Nonetheless, Colorado’s livestock lobby was incensed, and to appease them, Polis designated another day as “Colorado Livestock Proud Day” and shared his own brisket rub recipe.
It doesn’t take a political strategist to conclude that Talarico’s “non-meat” campaign announcement was a potentially reckless move for a Texas politician and that it could’ve easily come back to haunt him if his political ambitions were to grow beyond the greater Austin area, which they now have. But the response to the 2022 video highlighted how, despite years of evidence mounting about the depravity of the US meat industry, Americans on both sides of the aisle are still unable to have a nuanced, honest debate about meat’s role in our diets, culture, and politics.
If you look long and hard enough at how meat gets to our plates, Talarico’s 2022 campaign position was a sensible response.
The vast majority of the 10 billion animals raised for meat in the US are kept on factory farms, where horrific practices — which would be illegal if done to a pet cat or dog — are business as usual: ripping out piglets’ testicles without anesthesia, cramming hens and pigs in tiny cages, starving breeding chickens, burning out calves’ horn buds (also without anesthesia).
Americans of all political stripes overwhelmingly oppose these bedrock practices of US meat production, but they remain legal because industry lobbyists and their allied politicians keep it that way.
While beef cattle tend to have higher welfare than pigs, chickens, and turkeys, undercover investigations into some Texas cattle operations have revealed stomach-churning cruelty. And to be sure, Texas’s livestock industry is a lot more than just cows; it’s also a top producer of eggs and chicken meat, industries notorious for terrible treatment of animals.
On the climate change front, more than 200 agricultural and environmental scientists surveyed in 2021 concluded that rich countries need to reduce their consumption of animal products to meet global climate targets. But even those unconcerned with climate change still have plenty to worry about; meat production is a leading cause of America’s water and air pollution, contributing to the declining quality of life in rural areas.
But most Americans would rather not think too long or too hard about where meat, milk, and eggs come from. Meanwhile, many politicians, pundits, and special interest groups seek to turn anyone who does into an example. They often resort to childish insults and hollow platitudes about how meat is essential to be a real American (or Texan) instead of seriously grappling with what our meat-heavy diets have done to our land, our air, our rivers and streams, and billions of animals who can suffer — and experience a range of other emotions — just the same as our cats and dogs.
They also narrow the window of debate. While some might argue Talarico is guilty of this, too, by staking out an explicitly non-meat campaign policy, in actuality there’s a whole range of options to address the ills of meat production beyond the binaries of all-out veganism and full-throated defense of the status quo. Some lawmakers push for bills to ban particularly cruel practices on farms, or to reduce air and water pollution from the trillion pounds of manure generated by livestock. Others try to expand plant-based food choices in schools.
Change is even afoot in cattle country. Austin and Houston are home to some of the finest plant-based cooking in the US, and some of the best vegan jerky I’ve ever tasted came from a small company based an hour’s drive north of Dallas. But perhaps no one shatters the self-image of Texas as an immutable BBQ-loving monolith more than Renee King-Sonnen and Tommy Sonnen.
For years, the husband and wife operated a cattle ranch near the Texas Gulf Coast. But over time, Renee formed emotional bonds with their animals and grew increasingly distraught by the sound of the mother cows wailing as their babies were hauled off for sale. She eventually became vegan herself and launched a fundraising campaign to turn their ranch into an animal sanctuary. Today, more than 100 rescued livestock — cows, but also turkeys, goats, and pigs — live out their much more natural lives there.
That might amount to heresy to some Texans, but it shows that many Texans’ — and Americans’ — views about animals are too complex to condense into a snarky tweet. The Sonnens’ story also reminds me of some of Talarico’s most stirring messages about compassion, love, personal transformation, and protecting the vulnerable — messages that helped to launch him onto the national political stage.
America clearly isn’t yet ready to put animals, especially the ones we eat, into that narrative, or to openly and clearly argue the merits of factory-farming 10 billion animals each year. But I hope one day we will — and that politicians will be able to turn down the temperature and engage in honest discourse, too.
2026-03-20 05:57:35
2025年8月26日，美国得克萨斯州埃尔帕索市正在建设中的东蒙大拿拘留中心。| Paul Ratje/Bloomberg via Getty Images
这则新闻出现在《Logoff》每日通讯中，该通讯旨在帮助您了解特朗普政府的动态，同时不让政治新闻占据您的生活。欢迎来到《Logoff》：目前，有记录显示，ICE（美国移民与海关执法局）拘留人员的死亡率创下了历史新高。发生了什么？
本周早些时候，我们得知一名来自墨西哥的19岁青年Royer Perez-Jimenez在ICE拘留期间“疑似自杀”身亡。据该机构称，这是2026年报告的至少第13起死亡事件，距离今年开始还不到三个月。Perez-Jimenez的死亡消息紧随阿富汗难民Mohammad Nazeer Paktiawal之后，后者曾在阿富汗与美军并肩作战，于2021年来到美国。据称，Paktiawal在周六去世，此前一天他被戴着面罩的移民官员逮捕，当时他正在送孩子上学。他的家人表示，他们仍不清楚他死亡的具体原因。
背景是什么？根据CBS报道的ICE数据，2004年——ICE成立后的第一个完整年份——有32人在拘留期间死亡。直到2025年，死亡人数才再次达到31人。而如今，2026年，ICE报告的拘留死亡人数已经超过了过去16个完整年份的总和，且是2025年同期的三倍以上。
大局如何？目前，约有69,000人被ICE拘留，而去年特朗普重返白宫时，这一数字不到40,000人。根据路透社报道，越来越多的被拘留者仅因移民违规而被捕。这类逮捕在特朗普上任时是最少的，但现在却超过了因犯罪被定罪或面临刑事指控的被拘留者数量。此外，ICE拘留的儿童数量也创下了近年来的新高。许多被拘留者被关押在条件恶劣的设施中，面临拥挤、不卫生的环境，缺乏医疗护理，以及移民官员的指控性虐待。其中一名被关押在臭名昭著的营地中的被拘留者告诉美联社，那里的条件“比监狱糟糕1000%”。
好了，现在是时候结束今天的阅读了……亲爱的读者们，这期《Logoff》内容格外黑暗，即使在近期的报道中也是如此，但我仍想遵守我们的承诺，以积极、有用或远离特朗普政府的内容作为结尾。因此，这里有一篇来自作家兼狗拉雪橇选手Blair Braverman的纽约时报杂志精彩文章。它比描述更值得阅读，所以请相信我，您可以通过赠品链接访问。祝您有一个美好的夜晚，我们明天再见！
This story appeared in The Logoff, a daily newsletter that helps you stay informed about the Trump administration without letting political news take over your life. Subscribe here.
Welcome to The Logoff: People are dying in ICE custody at a record pace.
What’s happening? Earlier this week, we learned that Royer Perez-Jimenez, a 19-year-old from Mexico, died in ICE custody by a “presumed suicide,” according to the agency. His death is at least the 13th to be reported in 2026, not even three full months into the year.
News of Perez-Jimenez’s death follows that of Mohammad Nazeer Paktiawal, an Afghan refugee who fought alongside US forces in Afghanistan before coming to the US in 2021. Paktiawal, who died on Saturday, was reportedly arrested by masked immigration agents while dropping his children off at school the day before. His family says they still don’t know why he died.
What’s the context? In 2004 — the first full year ICE existed — 32 people died in custody. No other year had more than 20 deaths until 2025, when 31 people died, according to ICE data reported by CBS.
Now, in 2026, ICE has reported more deaths in custody than 16 previous full years — and more than three times as many as at this point in 2025.
What’s the big picture? There are nearly 70,000 people currently in ICE detention, compared to fewer than 40,000 when Donald Trump returned to office last year.
Increasingly many of those detainees are now being arrested solely for immigration violations, according to Reuters. Those arrests were by far the smallest category when Trump took office, but now outstrip both detainees convicted of crimes and those facing criminal charges.
ICE is also detaining far more children than at any recent point.
Many of those detainees are being held in appalling conditions, where they face overcrowded and unsanitary facilities, lack of access to care, and alleged abuse by immigration officers. One detainee at a particularly notorious camp told the AP it was “1,000% worse than a prison.”
Hi readers — this was a particularly dark newsletter, even by recent standards, but I want to stick with our promise to end with something good, useful, or otherwise far away from the Trump administration. So here’s a beautiful, transportive New York Times Magazine story, from author and dogsled racer Blair Braverman. It’s better read than described, so just trust me; you can access it with a gift link here. Have a great evening, and we’ll see you back here tomorrow!
2026-03-20 04:00:00
与医生谈论医疗费用可能会让人感到尴尬，但其实并不需要。也许你也有过这样的经历：医生正在和你讨论你的健康状况，说你需要做一项检查或服用某种药物，而你的大脑却突然跳到一个与医疗需求无关的问题：这要花多少钱？在美国，医疗费用过高已成为普遍问题。根据本月发布的一项盖洛普民意调查，约三分之一的美国人（相当于超过8200万人）表示，为了支付医疗费用，他们不得不削减其他开支，如食品、汽油甚至水电费。根据凯撒家庭基金会（KFF）的调查，36%的美国人表示在过去12个月内因为费用问题而推迟了医疗护理。因此，我们自然会在这些时刻想到钱的问题。
理想情况下，你的医生会成为你应对复杂保险福利、预先授权和处方药目录的盟友。但现实是，虽然美国人希望与医生讨论这些费用问题，但很多人并没有这么做。一项2024年针对1500名癌症或自身免疫疾病患者的调查发现，62%的人希望与医生讨论费用问题，但只有32%的人实际上进行了这样的讨论。2023年一项针对1000名美国成年人的调查也显示，41%的人表示他们的医生从未提及医疗费用。
我们的政治健康环境已经发生了变化：新领导人、可疑的科学、矛盾的建议、信任破裂以及令人困惑的系统。面对这一切，我们该如何理解？Vox的高级记者Dylan Scott长期关注健康领域，每周他会深入探讨棘手的议题，回答合理的问题，并解释美国医疗政策的现状。点击此处注册。
不可否认的现实是，我们每个人在面对健康问题时，都必须成为自己的倡导者。如果医生没有主动提及费用问题，我们就需要自己提出。但这样做可能会让人感到不安：我们常常担心医生会因此评判我们。我自己也曾经有过这样的感受。其实，医生在成为患者时，也会有这种担忧。“在我的个人经历中，我发现医疗账单常常不一致、令人意外，并且充满谜团，”托莱多市的儿科医生、美国儿科学会成员Cailly Howell-McLean告诉我，“因此，我很难想象对于那些没有这种角色的人来说，这会是怎样的体验。”
为了帮助人们更好地应对这些困难的谈话，我采访了两位医生——Howell-McLean和美国家庭医师学会主席Sarah Nosal，以获取他们的建议。以下是他们给出的建议。
我曾有一个假设：有时候，询问医生关于费用的问题可能并不合适。但其实，这种想法是错误的。Howell-McLean和Nosal都告诉我，如果医生不知道你有经济困难，他们就无法帮助你。“最终，作为医生，我们无法帮助那些我们不知道的问题，”Howell-McLean说，“所以，最好还是主动提出。如果医生无法帮助你，他们也会告诉你，但主动询问总是更好的。”
许多诊所都有专门处理账单或财务问题的工作人员。即使没有，你的医生也能帮你联系到这些人。但前提是你要主动询问。
“我们每个人都不完美，医生也不完美，”Nosal说，“我确实遇到过一些患者，他们因为费用问题没有拿到药物，而他们的糖尿病控制不住了。我感到非常内疚，因为我没有提前告诉他们可以联系我们。”
你向医生提出的问题会根据你的具体情况而有所不同，包括你的保险覆盖情况、医疗需求以及整体经济状况。在你第一次走进医生办公室之前，可以问一个问题：你是否在我们保险计划的医疗服务提供者网络中？你所使用的血液或影像实验室是否也在网络内？
当你和医生讨论新的治疗方案（如扫描、专科就诊或新药）时，可以提出一些常见问题：
每次拿到新处方时，Nosal建议你都要询问是否有该药物的通用版本。医生可能习惯性地开品牌药，而实际上存在更便宜的通用药，可以帮你节省一大笔费用。如果你在药店发现处方药价格比预期高，不要就此放弃，应该联系你的医生。你也可以请求医生在其他方面帮你减轻负担。
Howell-McLean特别提到了哮喘药物沙丁胺醇（albuterol），她会帮助患者获取这种药物。保险公司通常限制每月只能获得一次处方，但拥有多个沙丁胺醇吸入器（例如在学校、家里各一个）对患者来说会更方便。为了简化流程，她会在一次就诊中同时开具当前月份和下一个月的处方，这样患者就无需再次联系医生。
你的医生很可能有类似的好点子，可以帮你减轻负担并节省费用。最好的办法就是主动询问他们。
理想情况下，医生会主动提及你的医疗费用，或者至少对你的提问表现出积极关注。但现实并非如此，有时即使你试图与医生讨论费用问题，他们也可能显得不感兴趣或不愿参与。那该怎么办呢？
Nosal建议，如果你能将问题与你的医疗护理联系起来，可能会更容易获得医生的帮助。例如，不要直接说“我负担不起这个新处方”，而是说“我可能无法按时服用这个药”。这种细微的差别更容易引起医生的注意。
“医生最担心的是给你正确的临床治疗，”Nosal告诉我，“当这两个方面交汇时，可能更容易开启这场对话，让医生意识到‘我需要考虑这个问题’。”
最终，每个人都应该能够坦诚地与医疗提供者交流，这是建立健康、信任的医患关系的基础。如果你觉得目前的医生无法与你讨论财务问题，或许可以考虑寻找新的医生。
另一个我向Nosal和Howell-McLean提到的噩梦场景是：你或你的亲人需要立即治疗。这时，财务压力同样巨大：尽管有努力防止医院产生意外账单，但这种情况仍然会发生，而且账单可能高达数万美元。想要获得最好的紧急医疗护理，又不想因此破产，这种矛盾非常尖锐。
但不要惊慌。在紧急情况发生之前，你可以先研究一下你所在地区的医院。哪些医院在你的保险网络内？哪些不在？如果发生严重车祸，你可能无法选择医院，但如果情况允许你自行前往医院，提前了解这些信息可能会在紧急时刻减少你的压力。
如果你有医疗问题需要处理，但还有一定的时间安排，可以在上车或叫出租车之前先联系护理转介服务。一些健康计划已经开始拒绝覆盖他们认为不必要的急诊科（ER）就诊。提前打电话让临床医生确认你是否真的需要前往医院，可以避免之后与保险公司打交道时的麻烦。
然而，Nosal指出，如果你出现严重且即将发生的医疗紧急情况，比如胸痛可能预示心脏病发作，你应该直接前往急诊科，之后再考虑费用问题。一旦你到达医院，许多医疗机构都有专门的账单支持人员，他们可以回答你的问题或解决你的担忧。尽早与他们沟通是关键。
总体建议是：即使你感到尴尬或害怕，也要主动询问。在大多数情况下，你的医生真的站在你这边。Howell-McLean说：“我们希望帮助你，我们希望治疗方案成功，我们希望你和你的家人尽可能健康。”
Maybe this has happened to you: Your doctor is talking to you about your health, saying you need a test or a medication, and suddenly your brain leaps to a question that has nothing to do with your medical needs:
How much is this going to cost?
Health care in America is too expensive. According to a Gallup poll released this month, about one-third of Americans, equivalent to more than 82 million people, said that they had cut back on other expenses — groceries, gas, even utilities — in order to afford medical services. According to KFF, 36 percent of Americans say they have put off medical care in the past 12 months due to the costs.
So of course many of us think about money in those moments. It would be nice if your provider, the person tasked with looking out for your well-being, could be an ally in navigating the complex web of insurance benefits, prior authorization, and prescription drug formularies that ultimately determine how much you pay for medical care.
But unfortunately, while Americans wish they were having these conversations with their physician, many of them aren’t. A 2024 survey of 1,500 people who have cancer or autoimmune conditions found that 62 percent said they wanted to have a cost discussion — but only 32 percent of them had. In a 2023 survey of 1,000 US adults, 41 percent said their doctor never brought up the financial side of their care.
Our political wellness landscape has shifted: new leaders, shady science, contradictory advice, broken trust, and overwhelming systems. How is anyone supposed to make sense of it all? Vox’s senior correspondent Dylan Scott has been on the health beat for a long time, and every week, he’ll wade into sticky debates, answer fair questions, and contextualize what’s happening in American health care policy. Sign up here.
The unavoidable reality is, we each have to act as our own advocate when it comes to our health. If our provider isn’t bringing it up, we need to. But that can be intimidating: Many of us already fear being judged by a physician. I’ve certainly felt that way. Here’s a secret: Even doctors feel that way sometimes when they are the patient.
“I have found health care billing in my own experience to be inconsistent and to be surprising and to be shrouded in a lot of mysteries,” Dr. Cailly Howell-McLean, a Toledo, Ohio pediatrician and member of the American Academy of Pediatrics, told me. “So I can’t imagine for someone who is not in that kind of role that I am.”
To help people with how they can approach those tough talks, I spoke to two doctors — Howell-McLean and Dr. Sarah Nosal, president of the American Academy of Family Physicians — to get their advice.
Here’s what I learned.
Here’s one assumption I had: There might be some times when it doesn’t make sense to ask your doctor about finances. But that’s really the wrong way to think about it. As both Howell-McLean and Nosal put it to me, the doctor can’t help you if they don’t know there’s a problem.
“At the end of the day, as providers, we can’t assist with concerns we aren’t aware of,” Howell-McLean said. “So err on the side of bringing it up. And if it’s not something your doctor can help you with, they’ll tell you that. But better to ask.”
Many clinics have staff dedicated to handling billing or financing questions. If nothing else, your doctor will be able to connect you with those people — but, again, you have to ask.
“None of us are perfect as humans or doctors. I have definitely had patients where I only found out that they didn’t get a medication because of cost when their, for instance, diabetes was out of control,” Nosal said. “And I feel so bad that I didn’t explain to them that they can get in touch with us.”
Some of the questions you’ll need to ask will partly depend on your own circumstances: your insurance coverage, your medical needs, your overall financial situation. One question to ask before you ever step foot inside the doctor’s office: Are you in my health insurance plan’s provider network? What about the blood or imaging labs you work with?
Then when you’re seeing a doctor and they are proposing new treatment — a scan, a specialist visit, a new medication — there are some stock questions that are usually worth asking:
Every time you get a new prescription, Nosal said you should ask about a generic version of the drug. Doctors may write you a prescription for the brand-name version without thinking about it, while there is a cheaper generic available that can save you a chunk of money.
If you get to the pharmacy and discover a prescription is more expensive than you expected, don’t just let it go. Call your doctor.
You can also ask your provider to try to make your life easier in other ways. Howell-McLean singled out albuterol, the asthma inhaler medication, as one drug that she tries to assist patients with. Insurers limit the prescription to one per month, but it can be helpful to have multiple inhalers (one at school, one at home; one at mom’s house, one at dad’s house).
To make things simpler for her patients, she will simultaneously write one prescription for the current month and another for the following month during one visit. That way, her patients can get what they need without the hassle of having to get back in touch with their physician.
There’s a good chance your provider will have ideas like this that will make your life easier and save you money, and the best way to know for certain is to ask them.
In an ideal world, your doctor would proactively bring up the cost of your care or, at the least, take an active interest if you bring it up. But we do not live in an ideal world and sometimes, even if you try to initiate a cost conversation with your doctor, they might seem uninterested or reluctant to engage. What do you do then?
First, you might have better luck getting your doctor’s help if you frame the question around your medical care, Nosal told me, rather than strictly finances. So instead of saying you don’t think you can afford your new prescription, say you don’t think you’ll be able to take it. It’s a subtle difference, but it’s more likely to send up a red flag to your provider.
“The doctor is most worried about getting you the right clinical care,” Nosal told me. “Where those two things meet might be an easier way to open that conversation and [get] the doctor to realize, ‘Oh, I need to think about that.’”
And at the end of the day, everyone should be able to be honest with their health care provider; that’s the foundation of a healthy and trusting doctor-patient relationship. If you don’t feel comfortable talking to the provider you’re currently seeing about your financial concerns, you might want to consider finding a new one.
This is the other nightmare scenario that I brought up to Nosal and Howell-McLean: You or your loved one needs treatment right now. The financial stakes are high, too: While there have been efforts to make sure people don’t get surprise bills from the hospital, it still happens, and those bills can be tens of thousands of dollars.
The tension between wanting the best emergency care and not wanting to go bankrupt is acute. But don’t panic.
One thing to do right now, before you’re in an emergency situation, is research the hospitals in your area. What’s in your insurance network and what isn’t? If you’re in a bad car crash, you may not have a say about where you get treated, but if it’s a situation when you’re taking yourself or a family member, checking around ahead of time could save you a lot of stress in a high-pressure moment.
If you have a medical situation that demands attention but you have a little wiggle room in terms of time, you might want to call a nursing referral service before getting into your car or calling the taxi. Some health plans have started denying coverage for ER visits they deem to be unnecessary. A quick call to have a clinician confirm that you actually need to go to the hospital could save you some headaches with your insurer later. However, Nosal noted, if you’re having signs of a serious imminent medical event — like chest pains that suggest a heart attack — you should head straight to the ER and worry about the costs later.
And once you’re at the hospital, many facilities actually have billing support staff who might be able to answer your questions or address your concerns. Ask to talk to one of them as soon as possible.
That’s the overarching advice here: Even if you’re intimidated or embarrassed or think there’s nothing they can do, ask. In most cases, your providers really are on your side.
“We want to help,” Howell-McLean said. “We want our treatment plans to be successful. We want our patients and families to be as healthy as they can be.”
2026-03-19 20:00:00
桃子是美国最知名的水果之一。在美国，每年生产数以百万吨计的桃子，而其中与一个地方特别紧密相连：佐治亚州。佐治亚桃出现在车牌、路牌，甚至县名中。但如今，该州并不是桃子的最大产地，甚至远不如从前。本视频探讨了桃子如何成为州象征，这种声誉是如何通过积极的神话构建传播开来的，以及为什么“佐治亚桃”的形象在产业发生变化后依然得以延续。了解更多关于佐治亚桃的历史：
Peaches are one of America’s most recognizable fruits. In the US, hundreds of thousands of tons are produced each year, and the fruit is closely tied to one place in particular: Georgia.
The Georgia peach is on license plates, road signs, and even county names. But today, the state doesn’t grow the most peaches. Not even close.
This video explores how peaches became a state symbol, how that reputation spread through active mythmaking, and why the Georgia peach identity has lasted even as the industry changed.
Read more about the history of the Georgia peach:
This video is presented by Stonyfield Organics. Stonyfield Organics doesn’t have a say in our editorial decisions, but they make videos like this one possible.
2026-03-19 19:00:00
理解詹姆斯·费希巴克（James Fishback）并不容易。这位来自佛罗里达州的共和党 gubernatorial（州长）候选人看似是个“长 shot”（不被看好的候选人），他既是移民之子，又是一个极端排外主义者，从自封的金融成功人士转变为经济民粹主义者，同时他也是支持特朗普的，却在与特朗普选定的候选人竞争。此外，他公开表现出种族主义和反犹太主义倾向。但可以肯定的是，他正获得越来越多的关注。
费希巴克“原本我认为他根本不可能当选狗 catcher（狗市长），但现在他似乎开始受到关注了。”《Bulwark》的高级记者威利·索默（Will Sommer）告诉《Today, Explained》节目主持人肖恩·拉梅萨拉姆（Sean Rameswaram）。“他在民调中逐渐上升，虽然他可能最终不会赢得选举，但我认为他代表了共和党可能的一个未来。”索默与肖恩讨论了费希巴克的背景、他所代表的运动以及他在共和党政治中的未来。以下是他们对话的节选，已进行删减和润色。完整节目内容更丰富，因此请在各大播客平台收听《Today, Explained》，包括 Apple Podcasts、Pandora 和 Spotify。
这个家伙到底从哪儿来的？几乎可以说是无名之辈。他原本从事金融行业，据法院文件显示，他似乎只是在对冲基金中担任一个低级别职位。然后，他自称是金融专家，甚至编造了自己的头衔，这在金融界成了一个笑话。但通过这种方式，他成功地出现在福克斯商业频道上，并借此塑造出一个专家形象。更复杂的是，他虽然是一个白人至上主义者，但他的种族并不那么“纯白”。这正是他引人注目的地方。他对被特朗普支持的众议员拜伦·唐纳德斯（Byron Donalds）表现出极端的种族主义，而他的母亲是哥伦比亚人，因此他有一半的哥伦比亚血统。这反映出佛罗里达州越来越多的拉丁裔年轻人参与了这种种族极端主义。
最近，有消息称迈阿密的一些年轻共和党人（拉丁裔）表现出极端的种族主义倾向，而费希巴克则成为了白人至上主义运动（即所谓的“Groyper”）的代表人物之一。为了提醒那些不关注 Nick Fuentes 和 Groypers 的人，他们是什么样的人，Nick Fuentes 是一位20多岁的白人至上主义者，曾在夏洛茨维尔游行中出现。他公开承认自己是种族主义者和反犹太主义者，并在查理·基尔（Charlie Kirk）遇害后，填补了这一空白，成为年轻共和党人中“种族主义面孔”的代表。
那么，Nick Fuentes、种族主义的 Groypers 和佛罗里达州长候选人詹姆斯·费希巴克之间的交集是怎样的？我认为这三者之间的交集几乎就是一个圆圈。费希巴克非常欢迎 Groypers 的支持，而 Nick Fuentes 也对他表示赞赏。费希巴克会与穿着 Nick Fuentes 服饰的人合影。他与一位右翼媒体人物关系密切，这位人物表示她打算生更多孩子，培养更多的年轻 Groypers。费希巴克与这些右翼媒体人物关系密切，我认为他是目前最接近 Nick Fuentes 和 Groypers 类型的政治人物。
他的相对成功表明，这种类型的候选人可能在 Z 世代共和党人中具有一定的吸引力。Nick Fuentes 之所以值得关注，是因为他虽然是白人至上主义者，却表示希望在下一次选举中支持民主党。这对他所代表的群体有什么影响？费希巴克在意识形态光谱中处于什么位置？
费希巴克代表了年轻共和党人对特朗普政府日益增长的不满，尤其是对特朗普对以色列的支持以及与伊朗的战争。更广泛地说，他们认为特朗普没有采取任何措施来帮助年轻人买房和组建家庭。这是一种民粹主义（甚至可以说是准法西斯主义）的政府理念，试图控制家庭和企业。他的一项提议是，如果夫妻一方出轨，那么他们将失去所有的共同财产，这在我看来，可能会激励配偶谋杀，因为离婚后你将一无所有。他提出的这些想法虽然听起来很疯狂，但确实有人觉得“这话说得对”。
他谈论佛罗里达州的住房负担问题，但他的许多想法要么是对任何搬到佛罗里达州的人都征收重税，要么是禁止人们搬到佛罗里达州。这反映出他所倡导的是一种非常强硬的政府干预政策。
《纽约时报》的专栏作家米歇尔·戈德伯格（Michelle Goldberg）曾参加费希巴克在佛罗里达州的活动。她遇到一位注册民主党人，这位民主党人是 Zohran Mamdani 的粉丝，表示她正在考虑改注册以支持费希巴克参加初选。他到底在和谁沟通？他的支持基础有多大？
费希巴克之所以能获得关注，有几个原因。一方面，确实有一些人对传统政治感到不满，而他作为一位不寻常的候选人，吸引了他们的注意。另一方面，他也受益于一个被污染的信息生态系统。在戈德伯格的文章中，有人表示他们是因为看到肯伊·威斯特（Kanye West）在社交媒体上发布了一张关于犹太人控制媒体的图片，才开始关注费希巴克。这种疯狂的网络环境倾向于吸引眼球，而费希巴克正是这样的人。他组织了一些人去炸鸡店（Waffle House）参加活动，提出一些引人注目的想法，比如对与杰弗里·爱泼斯坦（Jeffrey Epstein）有关联的人实施公开处决，或者对 OnlyFans 创作者征收50%的收入税，这导致他与一些 OnlyFans 明星发生冲突。尽管他的竞选活动资金有限，他仍然能够通过各种方式获得大量关注。
你之前说过他几乎不可能获胜，但他获得的关注足以让他成为一个值得关注的人物，因为看起来他确实有一定的影响力。如果他不参选佛罗里达州长，他还能做什么？如今，成为一名右翼媒体人物在很多方面比成为政治人物更有影响力——也许不是州长，但像前 FBI 副局长丹·邦吉诺（Dan Bongino）这样的例子就说明了这一点。如果你想影响公众，拥有像坎达丝·欧文斯（Candace Owens）或梅根·凯利（Megyn Kelly）这样的 YouTube 平台影响力，可能比一个普通的国会议员更有优势。在某种程度上，詹姆斯·费希巴克正是在利用这一点。而且他很年轻，未来可能还有机会参选公职。
有一种感觉是，尽管他很多时候看起来像个大骗子，但他却在利用年轻人的不满情绪。年轻人是否认为他是真诚的？从他的经历来看，似乎他只是利用了当下的社会氛围来提升自己的知名度。有些人你遇到时，他们甚至会流泪，因为他们觉得他是个大明星，他们非常喜爱费希巴克。另一方面，我认为很多 Groypers 类型的人物对政治本身持非常冷嘲热讽的态度。他们希望看到一个法西斯式的美国，但同时也认为费希巴克是一个有用的工具。他有一定的魅力，吸引了一些人，这些人认为他能够捕捉到共和党内部的不满情绪。
It can be hard to make sense of James Fishback. The longshot Florida Republican gubernatorial candidate is the son of an immigrant and fiercely nativist, a self-proclaimed finance success story turned economic populist, and both pro-Trump and running against President Donald Trump’s chosen candidate. He’s also openly racist and antisemitic.
But one thing is for sure: He’s getting a lot of attention.
Fishback is “someone who I think typically couldn’t be elected for dog catcher. But he’s kind of catching on,” Will Sommer, a senior reporter at the Bulwark, told Today, Explained co-host Sean Rameswaram recently. “He’s gaining in the polls, and while he still probably won’t win, I think he’s offering us a face of one potential future for the Republican Party.”
Sommer spoke with Sean about Fishback’s history, the movement he represents, and what could be next for him in Republican politics. Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full episode, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.
Where did this dude come from?
Just about nowhere. He was in finance. He was, apparently, according to court documents, a pretty low-level employee at a hedge fund. And then, he styled himself as this real hedge-fund expert.
They claim he made up his title, and that kind of became a meme in the finance community, because it was just so ridiculous. But through that, he managed to get on Fox Business a lot and leverage that into appearing that he’s this expert financier type.
And to further complicate the shape-shifting identity of this white supremacist candidate: He’s not… super… white.
This is one of the fascinating things about him. He’s extremely racist to Byron Donalds, the congressman who’s been endorsed by Trump, who’s the frontrunner in the Florida governor’s race.
At the same time, his mother is Colombian, and so he’s half Colombian. This is something we’re seeing more of, I think: this racial extremism in Florida among Hispanic people.
There was recently a leak of young Republicans who are Hispanic in Miami being extremely racist, and he’s become the face of, or one of the faces of, the white nationalist — the so-called “Groyper” — movement that surrounds the podcaster Nick Fuentes.
Remind people who don’t pay attention to Nick Fuentes and the Groypers what they’re all about.
Nick Fuentes is a young man in his late 20s who marched in Charlottesville. [He’s an] avowed racist and antisemite who has styled himself — particularly after the murder of Charlie Kirk, which created a vacuum — as the racist face of young Republicanism.
What does the Venn diagram look like between Nick Fuentes, and the racist Groypers, and this longshot candidate for Florida governor, James Fishback?
I would say that the Venn diagram is just about a circle.
James Fishback has really welcomed the Groypers’ support. Nick Fuentes has been very complimentary towards him. Fishback will pose for pictures with people in Nick Fuentes merchandise. He’s very close with this right-wing media figure who said she’s going to have some more kids and make some more young Groypers.
They’re very closely aligned, and I think Fishback is interesting, because he is probably the closest we’ve come to a Nick Fuentes/Groyper-type political candidate. And his relative success suggests that that kind of candidate has some runway among Gen Z Republicans.
Nick Fuentes is interesting to talk about this moment because he’s a white supremacist, but he also says he wants to vote for Democrats in the next election. How does that affect someone like Fishback? Where does he sit in the ideological spectrum?
Fishback represents this growing discontent among young Republicans with the Trump administration — particularly over support for Israel and the war with Iran, but more broadly this sense that Trump isn’t doing anything about affordability to help young people own homes and start families.
It’s this populist — to be frank, quasi-fascist — kind of government stepping in to control families, to control businesses. One of his proposals is that, in a marriage, if someone cheats, they should lose all of the marital assets, which, to me, I think would just incentivize spousal murder, if you’re going to be a pauper if you get divorced.
He has these ideas where people go, Oh, yeah, that’s true, even though it’s crazy.
To underline one more, he talks about housing affordability in Florida, but a lot of his ideas are either onerous taxes on anyone who moves to Florida or somehow banning people from moving to Florida. [It’s a] really heavy-handed government vision that he’s proposing.
The New York Times opinion writer Michelle Goldberg went and hung out at Fishback events in Florida. She met a registered Democrat, a Zohran Mamdani fan, who said that she was thinking of changing her registration to vote for Fishback in the primary.
Who is he speaking to? How big is his tent?
Fishback is benefiting from a couple of things. One is you do have people who are legitimately alienated from normal politics, and because he’s this unusual candidate, they’re latching onto him.
On the other hand, he’s also benefiting from this poisoned information ecosystem. Someone else in the Michelle Goldberg piece says they got into Fishback because they saw Kanye West post a graphic about Jews controlling the media.
There’s just this crazy online ecosystem that favors seeking attention, and Fishback certainly does that. He has these mobs that go to Waffle Houses for events. He’ll say these eye-catching ideas like public executions for anyone associated with Jeffrey Epstein or taxing OnlyFans creators at 50 percent of their income, and this then creates a feud with some OnlyFans stars.
He’s been able to get attention in a lot of different ways despite running sort of a shoestring campaign.
You said earlier he doesn’t really have a shot, but he’s getting enough attention to be worth talking about, because he appears to have some influence here. What does he parlay that into, if not running Florida?
These days, being a right-wing media figure is in many ways better than being a politician — maybe not governor, but we’ve seen someone like deputy FBI director Dan Bongino quit to go back to podcasting.
If you want influence, in a lot of ways it’s better to be someone like Candace Owens or Megyn Kelly with a huge YouTube platform than a random congressman.
In some ways, James Fishback is trying to play on that. And he’s young; he could run for office in the future. There’s this sense that he, despite being frankly just a big-time charlatan in many ways, is harnessing this discontent among young people.
Do the young people think he’s genuine? Because hearing you talk about his experience, or lack thereof, it seems like he’s just someone who’s taken advantage of whatever zeitgeist is in front of him to increase his own popularity.
Some people you’ll meet, they’re just weeping. They’re meeting a huge celebrity. They just love Fishback.
On the other hand, I think a lot of these Groyper-type figures, they’re very cynical about politics in general. They would love to see a fascist America, but they see Fishback as a useful vehicle.
He’s a guy who has a certain amount of charisma that appeals to some people, and they see him as someone who’s able to capture some energy and also show this discontent within the Republican Party.