‘We’d Really Prefer Affordable Healthcare’: Trump ‘Lake America’ Order Ridiculed as Inane Distraction

“The American people don’t want to rename Lake Ontario Lake America,” said Sen. Bernie Sanders. “They want affordable healthcare, childcare, housing, education, nutrition assistance—all of which you have massively cut.”


US President Donald Trump, alongside Interior Secretary Doug Burgum, displays an executive order renaming Lake Ontario to Lake America in the Oval Office of the White House on August 27, 2026.
(Photo by Jim Watson/AFP via Getty Images)

Jake Johnson
Aug 27, 2026
COMMON DREAMS


The United States is locked in another Middle East quagmire, the American economy is shedding jobs, wage growth is decelerating, and the costs of essentials are rising, but President Donald Trump on Thursday took time to hold an Oval Office event for the signing of an executive order renaming Lake Ontario to “Lake America,” as his damaging trade war with Canada intensifies.

“We’d really prefer affordable healthcare,” the consumer advocacy group Public Citizen wrote in response to the president’s order, which was widely derided as idiotic and pointless, particularly amid skyrocketing health insurance premiums, large-scale loss of food aid, and other crises sparked by Trump and his Republican allies in Congress.

“No, President Trump,” Sen. Bernie Sanders (I-Vt.) wrote following the White House event. “The American people don’t want to rename Lake Ontario Lake America. They want affordable healthcare, childcare, housing, education, nutrition assistance—all of which you have massively cut in order to pay for your $1 trillion tax break to the top 1%.”

Trump—who recently admitted that he doesn’t “think about Americans’ financial situation” when considering the impacts of waging war on Iran—said Thursday that the “Lake America” name change was something he had been “thinking about for a long time, actually.”



Trump’s order instructs the US interior secretary to, within 30 days, “take all appropriate actions to rename as ‘Lake America’ the body of water currently named as Lake Ontario.”

“We’re on it, Mr. President!” Interior Secretary Doug Burgum wrote on social media in response to Trump’s directive.

After Trump floated the name change earlier this week, Canadian Industry Minister Mélanie Joly responded that “we’ll always call it Lake Ontario.”

“We’re proud of the Great Lakes... and we’ll stand up for what we have,” said Joly. “I really think that, with all these shenanigans happening, we’ll just be smart and we’ll be strategic, and we’ll fight back.”

New York Gov. Kathy Hochul, who leads the only US state that touches Lake Ontario, said Wednesday that the Trump administration “should be focusing on ways to mend relationships with Canada so our farmers and our consumers and our families do not continue suffering from this inane war over tariffs.”

“The fact that [the name change] is even part of the conversation shows how absurd the Trump administration is,” said Hochul.

'Can you imagine?' Trump hurls tantrum as Dem dubs 'Lake America' rename a 'SHAME'

Kathleen Culliton
August 29, 2026 

RAW STORY

President Donald Trump admitted to befuddlement late Friday night when he took to Truth Social to rage at a political foe.

Trump lashed out at New York Gov. Kathy Hochul (D) after she refused to start calling Lake Ontario "Lake America" and cast blame on the president for prioritizing semantics over serious issues such as inflation.

"Governor Kathy Hochul is for Canada, a Country that has been ripping off New York State for years, especially under her Administration, instead of the good ‘ol U.S.A," Trump raged. "Can you imagine her saying that she won’t respect or acknowledge LAKE AMERICA."

While Trump argued "Dumocrats" such as Hochul were "bad for our country," Hochul argued his mounting war with Iran and trade war with Canada were worse.

"New York families are being hit with higher costs for energy, groceries, and prescription drugs because of Trump's actions," Hochul wrote on X. "Instead of fixing these issues, the president is trying to rename Lake Ontario. Shame on him for deflecting from the real needs of Americans.

Hochul also argued Trump's rename was telling, as it changed the acronym students use to remember the great lakes (Huron, Ontario, Michigan, Erie and Superior) from HOMES to SHAME.

Trump's Thursday order to rename Lake Ontario has drawn much criticism from analysts who say it's risky to antagonize one of the nation's top trading partners with a rehash of a past move that was deeply unpopular ahead of the midterm elections.

'It gets dumber': Jim Acosta Show dumbfounded as Trump floats renaming oceans

Erik De La Garza
August 28, 2026 

RAW STORY


U.S. President Donald Trump wears a "Gulf of America" hat as he departs en route to Florida, at Joint Base Andrews, Maryland, U.S., July 1, 2025. REUTERS/Evelyn Hockstein

President Donald Trump’s push to slap America’s name on major bodies of water could soon expand to the Atlantic and Pacific oceans, an idea that left The Jim Acosta Show dumbfounded.

Trump floated renaming one or both oceans Thursday while celebrating his decision to change Lake Ontario to “Lake America” amid escalating tensions with Canada.

“As you know, we took something called the Gulf of Mexico and we changed it, and now it’s very routinely the Gulf of America,” Trump said. “So, if you think about it, we have a gulf and we have a lake, now all we need is an ocean.”

“Maybe we’ll have to change the name of the Atlantic and/or the Pacific,” he added. “Maybe we’ll change them both.”

Writing Friday for The Jim Acosta Show’s morning newsletter, Tommy Christopher warned readers: “It gets dumber.”

Christopher described Trump as having gone “MAXIMUM toddler” and went on to call his White House an “idiot admin.”

Multiple media outlets highlighted Trump’s suggestion that the Atlantic or Pacific could be next, although no replacement names for the two oceans have been floated by the president.

Illinois Gov. J.B. Pritzker responded to Trump’s lake announcement with a renaming decision of his own.

“EFFECTIVE IMMEDIATELY: Trump Tower is renamed to NATALIE TOWER!” Pritzker wrote, invoking Trump aide Natalie Harp.

Trump's Lake Ontario gambit provokes shocking CNN theory: 'Even Republicans are balking'

Kathleen Culliton
August 28, 2026 
RAW STORY

U.S. President Donald Trump holds up an executive order to rename Lake Ontario as Lake America after signing it at the Oval Office of the White House in Washington, D.C., U.S., August 27, 2026. REUTERS/Evan Vucci

President Donald Trump's desperate attempt to engage his MAGA base with a terrible rehash of a previously unpopular move provoked a strange theory from a prominent political analyst Friday morning.

Trump's executive order renaming Lake Ontario as Lake America will underline to conservative voters his obsession with trivialities and remind them of one the most unpopular moves he made at the beginning of his second term, CNN's Aaron Blake argued.

"The move recalls one of Trump’s splashiest (so to speak) moves on his first day back in office last year, when he signed an order renaming the Gulf of Mexico as the 'Gulf of America,'" wrote Blake. "That went over like a lead balloon."

Polls show Trump's decision to rename the Gulf was more unpopular than his pardons of Jan. 6 defendants with 70 percent of Americans opposing it in multiple polls.

Blake noted those polls were taken before Trump's renaming spree.

"Americans have taken a pretty dim view of Trump’s penchant for renaming things — including after himself," he wrote. After his handpicked board of loyalists tried to rename the Kennedy Center after Trump, Americans said by a 2-to-1 margin that he had 'gone too far.'"

Trump faces shorter odds of winning approval for "Lake America" considering the current political context — prices are rising as his war with Iran wages on, Blake argued.

Also — Americans like Canada, he wrote.

"These kinds of stunts might have felt a little cuter when Trump was riding higher early in his term, they now risk reinforcing how preoccupied he is with not just trifles, but things that Americans decidedly do not want," he wrote.

"Even some Republicans are balking, with the GOP nominee for Wisconsin governor, Rep. Tom Tiffany, saying Thursday that the name should stay the same."

So why did Trump decide to escalate hostilities with Canada? Blake has a surprising theory.

"You could say he’s playing the hits. But it’s really playing the flops," wrote Blake. "It increasingly feels as though President Donald Trump is trying to do unpopular things."

A Nuclear Bomb Took My Arms Before I Was Born; We Must Not Let One Take Our Future

I want to be among the last people whose bodies carry the legacy of the nuclear age; whether I am depends on decisions that are still within our reach.


A crater from nuclear tests in former Soviet Union nuclear test site Semipalatinsk is shown in Kazakhstan.
(Photo by the Official CTBTO Photostream - Crater/ CC BY 2.0)

Karipbek Kuyukov
Aug 29, 2026

Common Dreams

I paint with a brush held between my teeth or my toes. I was born without arms in 1968 about 100 kilometers from the Semipalatinsk nuclear test site in eastern Kazakhstan. My parents’ generation watched mushroom clouds rise over the steppe without being told what the explosions could do to their bodies or their children.

For four decades, the Soviet Union conducted more than 450 nuclear tests at Semipalatinsk. The fallout left cancers, disabilities, trauma, and contaminated land. Today, when leaders discuss nuclear weapons in the language of “deterrence” and “strategic balance,” I think of families paying for decisions in which they had no voice. The bomb is not an abstraction to me. Its history is written on my body.

August 29 carries two memories. On that date in 1949, the Soviet Union detonated its first atomic device at Semipalatinsk. On the same date in 1991, Kazakhstan closed the test site. At Kazakhstan’s initiative, the United Nations later proclaimed August 29 the International Day against Nuclear Tests. It is not simply a day of commemoration. It is a warning from the past about choices being made now.

In 2026, that warning is urgent. The Stockholm International Peace Research Institute estimates that the world began this year with 12,187 nuclear warheads. All nine nuclear-armed states continued strengthening their arsenals last year, while up to 2,200 warheads remained on high operational alert. In February, New START, the last treaty limiting the strategic arsenals of the United States and Russia, expired without a successor. In May, the review conference of the Nuclear Non-Proliferation Treaty (NPT) ended without consensus for the third consecutive time.

I paint the future I want to see: clean land, an unthreatened sky, and children born without the burden my generation inherited.

The world is not merely failing to disarm. It is learning to rely on the bomb again. There is growing rhetoric that nuclear weapons are the ultimate guarantor of peace and security. In moments of heightened tension, some states and strategic thinkers argue that only nuclear capability can prevent coercion, deter conflict, or preserve sovereignty. This logic of “nuclear reassurance” is being normalized not only in official doctrine but in public debate, where deterrence is recast as stability and restraint is portrayed as risk. Yet this framing erodes the very foundation of non-proliferation. It suggests that safety flows from the possession of the most destructive weapons ever created, rather than from law, diplomacy, and mutual restraint.

A non-proliferation system cannot endure if abstinence is portrayed as vulnerability while possession is equated with safety and status. The NPT rests on a bargain: Non-nuclear states agree not to acquire nuclear weapons, while nuclear-weapon states undertake to pursue disarmament. Both sides must keep their word. Rules cannot bind the weak and excuse the powerful.

Kazakhstan chose another logic. When we became independent, 1,410 Soviet strategic nuclear warheads remained on our territory, giving us what was then the world’s fourth-largest nuclear arsenal. We could have treated them as a shortcut to status or a shield against an uncertain future. Instead, a society that knew the price of radiation demanded a different kind of security. We closed Semipalatinsk, relinquished the weapons, and joined the NPT as a non-nuclear state. That choice did not erase the damage, but it showed that renunciation can be an act of sovereignty and strength.

Kazakhstan has tried to turn that experience into institutions. We helped establish the Central Asian Nuclear-Weapon-Free Zone, signed and ratified the Comprehensive Nuclear-Test-Ban Treaty, joined the Treaty on the Prohibition of Nuclear Weapons, and host the International Atomic Energy Agency (IAEA) Low Enriched Uranium Bank.

Our message is not “no” to nuclear science. Peaceful nuclear energy, subject to rigorous safeguards, can serve human development. It is “no” to weapons whose effects no border, hospital, or government can control.

The immediate path is clear. The nine remaining states whose ratification is required must bring the test-ban treaty into force. The United States and Russia must negotiate new verifiable limits, and all nuclear-armed states must join the work of reduction. Iran and the United States must restore full IAEA access through an enforceable agreement. More countries should join the prohibition treaty, while nuclear-armed states should engage with it even before they are ready to accede. Nations must also fund healthcare, victim assistance, and environmental repair. Disarmament cannot speak only about the future while abandoning those living with the past.

Some will call a world without nuclear weapons naive. I have learned what is truly naive: believing that thousands of warheads can remain ready for use indefinitely without error, miscalculation, rage, or technical failure. Deterrence requires every leader to remain rational, every warning system to be accurate, and every crisis to stay controlled—forever. Humanity has never met such a standard.

An artist begins with a blank canvas and believes another reality can be created. I paint the future I want to see: clean land, an unthreatened sky, and children born without the burden my generation inherited.

I want to be among the last people whose bodies carry the legacy of the nuclear age. Whether I am depends on decisions that are still within our reach. Kazakhstan turned away from the bomb. The world can do so too.


Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.


Karipbek Kuyukov
Karipbek Kuyukov is a Kazakh artist and nuclear non-proliferation activist born without arms as a result of exposure to radiation from nuclear weapons testing at Semipalatinsk. Kuyukov is a global advocate for worldwide nuclear disarmament.
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‘Break Up Big Medicine’: Taking On Healthcare Industry Greed Could Save US Families $6,000+ a Year

One expert said the options are to “watch the US healthcare system spiral into profit-driven chaos or finally treat the Big Medicine disease to create a healthcare system that puts patients and clinicians in control of care.”

A doctor and a nurse hook up monitoring equipment for an injured patient in the United States on July 29, 2024.
(Photo by SDI Productions/Getty Images)

Jessica Corbett
Aug 28, 2026
COMMON DREAMS

As millions of working-class Americans suffer from President Donald Trump and congressional Republicans’ cuts to the already dysfunctional US healthcare system, a leading anti-monopoly group this week released a report with recommendations to restore “affordability and control to patients, clinicians, and communities across the country.”

“The healthcare crisis didn’t happen by accident, it is the direct result of decades of neoliberal policy choices that handed more power to corporate healthcare giants while families paid the price,” said Morgan Harper, director of policy and advocacy at the American Economic Liberties Project (AELP).




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‘Utterly Unsustainable’: Employer-Sponsored Healthcare Costs Set to Keep Surging

“The choice now is clear: Continue to watch the US healthcare system spiral into profit-driven chaos or finally treat the Big Medicine disease to create a healthcare system that puts patients and clinicians in control of care,” she explained. “This agenda presents a roadmap for how to do it.”

Harper and Emma Freer, AELP’s senior policy analyst for healthcare, co-authored the new report, “Break Up Big Medicine,” with contributions from a trio of other experts. One of them is Dr. Will Flanary, an independent ophthalmologist in Portland, Oregon.

“The US healthcare system, once made up of mostly independent practices like mine, is now dominated by Big Medicine behemoths—including private insurance conglomerates, Big Pharma manufacturers, pharmaceutical middlemen, megahospitals, and private equity-backed practices—whose only fiduciary duty is to executives and investors,” he wrote in the foreword. “This makes it increasingly difficult to keep my practice afloat and uphold my oath, resulting in moral injury.”

“So, I now have a second career as an advocate,” who goes by “Dr. Glaucomflecken” on social media. “What my patients need most is bold policy reforms to break up Big Medicine and build a better healthcare system, one where they can access affordable, high-quality care and independent physicians like me can thrive.”

The report notes that “between 2005 and 2025, the annual cost of employer-sponsored family coverage nearly tripled, from $12,214 to $35,119,” US patients pay nearly three times as much for prescription drug prices as people in other countries, and “the United States spends more than $15,000 per person on healthcare each year—roughly one-fifth of our entire economy, and more than twice what peer nations spend, in return for worse patient outcomes on a variety of metrics.”



Costs continue to rise, with The Wall Street Journal reporting last week that, according to benefits consulting giant Aon, US workers with employer-sponsored insurance are expected to spend an average of $5,297 on healthcare this year, or $388 more than last year. Another consultant, WTW, found that US employers expect their healthcare costs will rise 11.1% next year.

Meanwhile, six “corporate behemoths” in the sector—Cardinal Health, Cencora, Cigna, CVS Health, McKesson, and UnitedHealth Group—“now rank among the Fortune 15, making nearly $34 billion in annual profit,” collectively, as AELP detailed Thursday. “Big Medicine now employs more than four in five US doctors,” and practices must spend time completing, “on average, 40 prior authorizations per physician per week, time that would be better spent on patient care.”



“Our current healthcare crisis is the result of several decades of federal policymaking by both political parties based on the flawed premise that empowering private insurers to ration access to healthcare, rather than addressing the underlying root causes of high prices, would effectively contain costs,” the AELP report says.

The publication lays out a four-part “treatment plan” to save Americans $795 billion annually, or more than $6,000 per household: break up Big Medicine, bring down healthcare prices, build capacity, and bolster enforcement of existing laws.



The first section highlights how some solutions already exist in Congress, pointing to various bills, including Sens. Elizabeth Warren (D-Mass.) and Josh Hawley’s (R-Mo.) Break Up Big Medicine Act, their Patients Before Monopolies Act with Reps. Diana Harshbarger (R-Tenn.) and Jake Auchincloss (D-Mass.), Sen. Jeff Merkley (D-Ore.) and Rep. Val Hoyle’s (D-Ore.) Patients Over Profits Act, Sen. Chris Murphy (D-Conn.) and Rep. Mary Gay Scanlon’s (D-Pa.) Take Back Our Hospitals Act, and the Corporate Crimes Against Health Care Act, introduced by Rep. Maggie Goodlander (D-NH) and Sens. Richard Blumenthal (D-Conn.), Peter Welch (D-Vt.), Merkley, and Warren.

The second section calls for standardizing and capping “healthcare prices across public and private payers using traditional Medicare reimbursement rates for inpatient and outpatient services and negotiated drug prices as benchmarks.” It urges a ban on prior authorization, an end to patient cost-sharing obligations, investments “in public options that eliminate Big Medicine administrative waste,” and passage of Rep. Rashida Tlaib’s (D-Mich.) Medicines for the People Act.

The third section calls for investments in the US prescription drug manufacturing base as well as in providers, “especially safety-net hospitals in rural and low-income metro areas, independent medical and dental practices, community pharmacies, and primary care physicians.”

The final section calls on Congress to “close loopholes that allow anti-competitive business practices, which Big Medicine uses to drive up prescription drug costs,” specifically promoting the repeal of the 1987 safe harbor for pharmacy benefit managers (PBMs) and other pharmaceutical middlemen, and the prohibition of “price discrimination, spread pricing, self-preferencing, network discrimination, and sole-source or exclusive contracting terms across all payers.” It further advocates for an increase in funding for antitrust enforcers at the Federal Trade Commission and the US Department of Justice.

“For decades, healthcare reform has focused on expanding private coverage and putting more money into a broken system while allowing corporate giants to consolidate power and drive up costs,” said Freer. “Working families have paid more only to receive lower-quality care.

“Americans need a new policy paradigm that actually takes on the root causes of the crisis: consolidation, corporate control, and lack of competition,” she argued. “This agenda is about moving beyond the status quo to build a healthcare system where patients come first, clinicians can thrive, and every American can afford the care they need.”

The report comes amid renewed scrutiny of the president’s “most favored nation” deals with Big Pharma, with Peter Maybarduk, access to medicines director for the watchdog Public Citizen, saying last week that “Trump has three kinds of drug pricing policy: fake, exaggerated, and not-real-yet, probably-won’t-happen.”

After pointing out on social media Wednesday that Health and Human Services Secretary Robert F. Kennedy Jr. in April agreed to publicize the deals for medicines listed on the direct-to-consumer website TrumpRx, and “months later, still crickets,” Warren wondered, “Why should Americans believe this isn’t just another Trump handout to fatten Big Pharma’s pockets?”

Additionally, as Americans have started contending with the Medicaid cuts in the One Big Beautiful Bill Act passed by Republicans in Congress and signed by Trump last year, as well as the GOP’s refusal to extend Affordable Care Act subsidies, which has caused premiums to skyrocket, there have also been renewed calls for shifting the United States to a universal healthcare system.

A study published earlier this month by researchers at Yale University suggests the Medicare for All Act that’s been repeatedly introduced by Sen. Bernie Sanders (I-Vt.) would save more than $1 trillion and over 114,000 lives annually.

“At a time when 15 million Americans are being thrown off the healthcare they have and 20 million Americans have already seen their premiums double, on average, as a result of Trump’s so-called ‘Big Beautiful Bill,’ we need Medicare for All now more than ever,” Sanders said in response to the study. “The time is now to end the greed of the big insurance and drug companies and pass Medicare for All.”

David Dayen, executive editor of The American Prospect and the author of books including Monopolized: Life in the Age of Corporate Power, noted in his Thursday coverage of AELP’s report that “while it’s complementary to a Medicare for All approach, single-payer insurance is not mentioned.”

“In tandem with moving toward a Medicare for All system, we have to address consolidation that is the cause of healthcare being so expensive, with degraded quality, and the squeezing of healthcare professionals,” Freer told Dayen. “Otherwise we end up with something like Medicare Advantage for All, which would be disastrous.”

The sick scam to rob your Social Security and give it to Wall Street

(REUTERS)

Dean Baker

August 28, 2026   

ALTERNET

An extreme position does not become less extreme just because someone can put forward one that’s even more extreme. Massacring 100 children doesn’t become a moderate position just because someone is advocating killing 200 children.

This is how we should view the line being pushed by “moderate” voices that we have to deal with the $40 trillion debt with both spending cuts and tax hikes. The reality is that, apart from the military and Homeland Security, there is little fat in spending to be cut, as even Elon Musk inadvertently acknowledged. Insofar as we have a deficit problem, the issue is on the tax side, as can be easily shown. The rich have been taking an ever-larger share of national income over the last half-century, and they don’t feel like paying taxes on their winnings.The major media outlets, which are all controlled by rich people, are pretending to be moderate by saying that we need to both raise taxes and cut spending. But there is nothing moderate about saying that we have to cut programs like Social Security, Medicare, and Medicaid because Republicans have given big tax breaks to their campaign contributors.

Republicans pushed these tax cuts, knowing they would increase the deficit, but did not make any corresponding cuts in spending because the cuts would be incredibly unpopular. Now they are using their control over the media to insist that these cuts are now absolutely necessary to offset all the lost tax revenue from tax cuts put in place by Reagan, Bush II, and Trump.


The Jeff Bezos-owned Washington Post gave us a great example of this fake moderate position in its editorial, “To get the national debt under control, start with the retirement state.” The piece makes its case by taking the example of a two-earner couple, with average earnings of $100,000 a year. It shows that the couple, turning 65 in 2025, can expect lifetime Social Security benefits of $739k compared with tax contributions of just $597k. A couple with the same income retiring in 2045 can expect lifetime benefits of $987k compared to tax contributions of $735k.

After laying out this disparity for Social Security (it has a similar story for Medicare, which I’ll come to), it then makes an argument for reducing Social Security for high-income people. This is three-card Monte level deception.


If the idea is that we should reduce the benefits of high-income workers, honest people would look at the relative taxes and benefits for high-income workers. Social Security is explicitly designed to have a progressive payback structure, which means that relatively moderate-income workers, like the ones highlighted in the WaPo editorial, have higher paybacks relative to their taxes.

If the editors were interested in doing an apples- to-apples comparison, here’s what the picture would look like. (This is taken from the exact same source.)

As can be seen, high-income people pay considerably more in taxes than they get back in benefits. For a high-income woman retiring in 2025, the gap is $263k. For a high-income man, the gap is $336k. (The gap is larger for men than women because their life expectancy is shorter.) For a high-income woman retiring in 2045, the gap is $259k. For a high-income man, the gap is $346k.


If the point is to make an argument for reducing the benefits of high-income retirees, then show the taxes and benefits for high-income retirees. No one disputes that Social Security looks like a pretty good deal for more moderate-income retirees, but these people don’t typically have much income in retirement. I guess Jeff Bezos’ paper would have been too embarrassed to argue that we have to reduce the average monthly Social Security benefit of $2,071.

The Post’s editorial makes the push that while cutting Social Security, we should expect people to be more reliant on private 401(k)s. In addition to increasing risk, this is also enormously inefficient. Private 401(k)s cost more than 40 times as much to administer per dollar of benefits as Social Security. It is understandable that Mr. Bezos would be happy to see more money going to his rich friends in the financial industry, but most of us would rather see the money going to ordinary workers.

Medicare Benefits: Big Bucks to Hospitals and Drug Companies Are Not Benefits to Workers


The Post’s graphs do show a huge imbalance between the taxes paid out for Medicare and the cost of the benefits received. This is also deceptive.

In the United States, we pay almost twice as much per person for healthcare as the average for other wealthy countries. This is not because we get more or better healthcare. Our life expectancy ranks near the bottom for wealthy countries.

The big bucks for healthcare go to the income of drug companies, insurers, hospitals, medical equipment makers, and doctors. In each case, we pay two times as much, or more, than people in other wealthy countries. A paper that was not answerable to one of the richest people in the world would suggest bringing our payments in line with the rest of the world. But instead, the WaPo wants to beat up on the country’s retirees.

No one should be confused: cutting Social Security and Medicare benefits to reduce the deficit is not a moderate position. It’s one that attacks hundreds of millions of ordinary workers to avoid taxing the rich or reducing waste in our health care system. That is extreme, but the rich media owners pushing this position will do everything they can to convince us they are being fair and balanced.

 

New consensus reshapes care for childhood bed-wetting

Zhejiang University

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Updated framework for childhood NE management.

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Credit: World Journal of Pediatrics

Nocturnal enuresis (NE) in school-age children is more than a nighttime inconvenience: when persistent, it can affect self-esteem, sleep, family life and social functioning. An updated expert consensus now offers a practical roadmap for recognizing and treating childhood NE, with 18 recommendations spanning diagnosis, classification, evaluation, first-line therapy, comorbidity management and referral. The framework lowers the diagnostic frequency threshold to at least one involuntary nighttime void per month for three months in children aged five years or older, and places greater emphasis on tailoring treatment to the child’s clinical pattern. The goal is to help clinicians move from symptom-based treatment toward more standardized, individualized and family-centered care.

Nocturnal enuresis (NE) is common in childhood and arises from multiple interacting factors, including excess nighttime urine production, reduced functional bladder capacity and difficulty waking to bladder signals. Effective treatments are available, yet underdiagnosis, inconsistent clinical practice and poor adherence continue to limit outcomes. In China, care is further complicated by regional differences in access, cultural perceptions of bedwetting and uneven coordination between primary and specialist services. Since the previous Chinese consensus was issued in 2014, international standards and the evidence base have changed substantially, while domestic clinical experience has expanded. Given these challenges, an updated, locally applicable framework was needed to align diagnosis, treatment and referral with current evidence and frontline practice.

Researchers from the Department of Nephrology, Children’s Hospital of Fudan University, National Children's Medical Center, together with the Chinese Cooperative Group for the Management of Pediatric NE and the Pediatric Nephrology Committee of the Chinese Medical Doctor Association, published (DOI: 10.1007/s12519-026-01051-4) an updated expert guidance in the World Journal of Pediatrics. The consensus establishes 18 recommendations for diagnosing, classifying, and managing childhood NE, emphasizing symptom-based classification, voiding diaries, individualized first-line treatment, management of daytime urinary symptoms and comorbidities, and referral pathways for refractory cases.

The consensus introduces several key updates. First, it lowers the diagnostic threshold: children aged five years or older who experience at least one involuntary nighttime void per month for three months now qualify for diagnosis—a shift from the previous weekly standard that enables earlier intervention. Second, it mandates a clear clinical distinction between monosymptomatic NE (MNE), without daytime lower urinary tract symptoms (LUTS), and non‑monosymptomatic NE (NMNE), where daytime symptoms such as urgency, frequency or incontinence are present. This classification drives all subsequent treatment decisions. Third, the voiding diary becomes a diagnostic cornerstone—patients must record at least two daytime charts and seven consecutive nights of fluid intake and voids, allowing clinicians to phenotype children as having nocturnal polyuria, reduced bladder capacity, or both. For MNE, the consensus specifies phenotype‑driven first‑line therapy: desmopressin for nocturnal polyuria and the enuresis alarm for reduced bladder capacity, with combination therapy for mixed types. For NMNE, management must prioritize daytime LUTS and comorbidities—especially constipation, which affects 36–80% of these children—before addressing nighttime wetting. The framework also outlines clear referral criteria: primary care may manage MNE, but non‑responders or suspected NMNE require specialist evaluation with urodynamics and lumbosacral magnetic resonance imaging (MRI). For refractory cases, defined as less than 50% improvement after three months, the consensus advises systematic re‑evaluation of adherence, diary findings and underlying causes before escalating treatment.

The authors said the central message is that NE should not be managed as a single, uniform disorder. They said the updated pathway asks clinicians to identify the child’s specific pattern, look for daytime symptoms and comorbidities, and match treatment to the likely underlying mechanism while keeping the family involved. They also stressed that apparent treatment failure should trigger a careful review—of adherence, voiding records and possible missed conditions—before stronger or more complex therapy is added. In this way, they said, the consensus is designed to make care both more systematic and more responsive to individual children.

In practice, the recommendations could help pediatricians and primary‑care clinicians identify children who can be managed locally and those who need specialist assessment. Clearer use of voiding diaries and symptom‑based classification may reduce trial‑and‑error treatment, while earlier attention to constipation, sleep‑disordered breathing, attention‑deficit/hyperactivity disorder (ADHD) and daytime urinary symptoms could improve response rates. The framework also encourages timely referral when first‑line therapy fails or NMNE is suspected, supporting better coordination across levels of care. The authors acknowledge that some recommendations reflect Chinese practice patterns and that evidence remains limited for areas such as desmopressin withdrawal strategies. Future trials and multidisciplinary care models could further refine individualized treatment.

###

References

DOI

10.1007/s12519-026-01051-4

Original Source URL

https://doi.org/10.1007/s12519-026-01051-4

About World Journal of Pediatrics

World Journal of Pediatrics (WJP) is an international, peer-reviewed academic journal dedicated to advancing pediatric medicine and child health. Published monthly, WJP publishes original research, reviews, and special reports covering all aspects of pediatrics. It welcomes contributions from pediatricians and researchers worldwide, focusing on the latest developments in pediatric clinical practice, pediatric surgery, preventive child healthcare, pharmacology, stomatology, and biomedicine, as well as basic and experimental sciences. The journal provides a global platform for academic exchange and dissemination of medical research findings. WJP currently has an Impact Factor of 7.3 and a CiteScore of 8.5.

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Journal

World Journal of Pediatrics

DOI

10.1007/s12519-026-01051-4 

Subject of Research

Not applicable

Article Title

Expert consensus on the management of nocturnal enuresis in children

 

New philosophical framework reframes moral distress in healthcare

Researchers propose a new understanding of moral distress that links ethical awareness with clinician well-being, organizational culture, and patient care

Tokyo University of Science

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This type of suffering arises when professionals recognize the ethically appropriate course of action but are prevented from acting because of external constraints.

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Nurses and physicians often recognize what kind of care a patient deserves in a given moment, be it more time at the bedside, a change in pain management, or a detailed conversation about the goals of a specific treatment. However, these healthcare professionals sometimes find themselves unable to follow through due to external factors, ranging from understaffing and resource shortages to institutional policies and regulations. This gap between what clinicians believe is right and what they are able to do is called “moral distress” in the field of healthcare ethics. Moral distress has been associated with burnout, staff turnover, and challenges in delivering ethically responsive patient care. 

First introduced by ethicist Andrew Jameton, the concept of moral distress has been studied for over 40 years. Most existing research has assumed that clinicians already recognize what they ought to do, without fully examining how that recognition is formed. Far less attention has gone to a more basic question: How do healthcare professionals come to recognize that a situation is ethically significant in the first place? By overlooking this issue, the concept of moral distress remains somewhat blurry and hard to distinguish from ordinary workplace stress occupational burnout, disagreements about the appropriate course of care, or conflicts over professional roles. 

Seeking to address this gap, a research team consisting of Professor Tomohide Ibuki from the Institute of Arts and Sciences, Tokyo University of Science, Japan, and Dr. Keiichiro Yamamoto from the Department of Clinical Research Management, Center for Clinical Sciences, Japan Institute for Health Security, Japan, revisited the foundations of moral distress from a philosophical perspective. Their study, published online in Nursing Ethics journal on July 9, 2026, draws on the work of philosopher John McDowell to propose a new way of understanding how healthcare professionals develop moral sensitivity and why moral distress arises.  

Drawing on McDowell’s account of perception, second nature, and the space of reasons, including his discussion of Bildung, or ethical formation, the authors argue that moral sensitivity in healthcare is a cultivated capacity to perceive ethically significant features of a clinical situation as reasons for action. Through education and clinical experience, professionals learn to perceive a patient’s pain, compromised dignity, or need for care as ethical reasons for action rather than neutral facts. On this basis, the paper philosophically reconstructs moral distress not merely as psychological stress or frustration at being blocked from acting, but as a form of normative suffering that occurs when a morally sensitive professional recognizes ethically significant reasons for action but is prevented by external constraints from responding to them. Unlike general psychological distress, moral distress specifically arises when clinicians recognize ethical reasons for action but are unable to respond because of institutional or organizational constraints. 

This reframing leads to one of the main points of the paper, which the authors call the “paradox of moral distress.” As the authors explain: “Paradoxically, healthcare professionals with greater moral sensitivity may be more likely to recognize ethical problems and, under organizational and institutional constraints, more likely to experience moral distress.” Thus, moral distress may sometimes be a sign of strong ethical awareness rather than personal weakness or an inability to cope. 

This relationship is a conceptual proposal that remains to be examined empirically, but the framework offers a clearer foundation for future research. If supported by future studies, this work could reshape how healthcare organizations approach moral distress. Rather than focusing only on helping individuals become more resilient or better able to cope with stress, healthcare systems should also examine whether clinicians are given the opportunity, resources, and institutional support to act on the ethical concerns they identify. Rather than discouraging healthcare professionals from recognizing or expressing ethical concerns, hospitals should combine ethics education with organizational support, including opportunities for ethical discussion, accessible ethics consultation, responsive leadership, adequate staffing and resources, and decision-making processes, that ensure clinicians' ethical concerns are heard and addressed. Similarly, ethics education should cultivate the ability to recognize ethically significant situations while being paired with organizational cultures that encourage ethical discussion and shared decision-making. 

Ultimately, the researchers hope their work will encourage healthcare institutions to rethink moral distress and see it as a sign that organizational conditions might be standing in the way of ethical care. “Our framework could help create workplaces where healthcare professionals can more readily express ethical concerns and could inform educational and organizational improvements that support better patient care.” The authors also suggest that addressing moral distress requires greater attention to organizational ethics and institutional reforms, rather than relying solely on individual coping strategies. 

 

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Reference  
DOI: 10.1177/09697330261465866 

 

About The Tokyo University of Science  
Tokyo University of Science (TUS) is a well-known and respected university, and the largest science-specialized private research university in Japan, with four campuses in central Tokyo and its suburbs and in Hokkaido. Established in 1881, the university has continually contributed to Japan's development in science through inculcating the love for science in researchers, technicians, and educators.      

With a mission of “Creating science and technology for the harmonious development of nature, human beings, and society," TUS has undertaken a wide range of research from basic to applied science. TUS has embraced a multidisciplinary approach to research and undertaken intensive study in some of today's most vital fields. TUS is a meritocracy where the best in science is recognized and nurtured. It is the only private university in Japan that has produced a Nobel Prize winner and the only private university in Asia to produce Nobel Prize winners within the natural sciences field.   

Website: https://www.tus.ac.jp/en/mediarelations/  

  

About Professor Tomohide Ibuki from Tokyo University of Science  
Professor Tomohide Ibuki obtained a PhD degree from The University of Tokyo in 2014. He currently serves as Full Professor at the Institute of Arts and Sciences of Tokyo University of Science, Japan. He specializes in bioethics, research ethics, medical ethics, and environmental ethics. Prof. Ibuki has published over 30 peer-reviewed papers. He is a member of the Japan Association for Bioethics.   

  

About Dr. Keiichiro Yamamoto from the Japan Institute for Health Security  
Dr. Keiichiro Yamamoto is the Director of the Department of Clinical Research Management at the Center for Clinical Sciences, Japan Institute for Health Security, Japan. He specializes in bioethics, clinical ethics, research ethics, and moral philosophy. His research focuses on ethical issues in healthcare practice, including moral distress, clinical research governance, and the ethical implications of emerging medical technologies. He also serves on the Editorial Board of BMC Medical Ethics.  

  

Funding information  
This work was supported by the Japan Society for the Promotion of Science (JSPS) under Grant-in-Aid for Scientific Research (A), “A Comprehensive Study on Moral Distress” [Grant number 23H00005].  

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Journal

Nursing Ethics

DOI

10.1177/09697330261465866 

Method of Research

Literature review

Subject of Research

Not applicable

Article Title

A philosophical reconstruction of moral distress: Its paradox and significance in healthcare practice