The next ranking member of the House Oversight Committee will reportedly be nine-term Democrat Gerry Connolly of Virginia.

Connolly, 74, beat out his competitor, 35-year-old Rep. Alexandria Ocasio-Cortez (D-N.Y.), 131-84 at a closed-door meeting on Tuesday, the Associated Press reports. The current Oversight ranking member, Rep. Jamie Raskin (D-Md.), is vacating the post to replace Rep. Jerry Nadler (D-N.Y.) as ranking member of the House Judiciary Committee, as my colleague Pema Levy reported last month. The Oversight Committee—which is now controlled by Republicans and chaired by Rep. James Comer (R-Ky.)—played a key role in holding President-elect Donald Trump and members of his administration accountable during his first term.

The news comes as Democrats have been grappling with how to move forward in the face of their losses of both the White House and the Senate last month, and their failure to recapture the House. While some pundits, and Democrats themselves, have called for a generational change in leadership—and some younger Democrats have indeed managed to oust their elders from committee leadership roles—that did not seem to have been enough of a concern to propel AOC to victory here. Lawmakers told Axios that while Connolly—who revealed last month he was recently diagnosed with esophagus cancer—campaigned on his experience, AOC emphasized her far-reaching platform and her role as an effective communicator for the party.

“Tried my best,” AOC wrote in a post on Bluesky after the vote. “Sorry I couldn’t pull it through everyone—we live to fight another day.”

“I think my colleagues were measuring their votes by who’s got experience, who is seasoned, who can be trusted, who’s capable and who’s got a record of productivity and I think that prevailed,” Connolly reportedly told journalists after the vote.

Rep. Becca Balint (D-Vt.) told Axios she was “disappointed” by the outcome, adding, “I know Gerry will do a great job. But there’s no substitute for having someone in that position that literally has millions of Americans following her [on social media].” (AOC has 12.8 million followers on X and 8.1 million on Instagram; Connolly has just over 87,000 followers on both platforms combined.)

“I think that the seniority issue in this building gets in the way,” Balint added. “Our people back home, they don’t care about seniority.”

Dani Izzie, a wheelchair user with quadriplegia, tried to take public transit, as she usually does, when visiting Miami in 2022. Heading to catch a bus, Izzie came to the end of a street without curb cuts—meaning she couldn’t safely cross it to the bus stop. She tried to get an accessible taxi; none were available. The door-to-door paratransit service wasn’t an option, since it needs advance scheduling. It ultimately took a call to police, who helped her down the curb.

This wasn’t the first time, says Izzie, that “the absurdity of one little oversight” limited her autonomy and mobility. The real estate website Redfin’s Walk Score rates Miami the sixth-most walkable large city in the United States. But its methodology, Redfin confirmed to me, does not account for accessibility.

Since the 1990s, there’s been a push among urbanists to reduce city driving and its hazards: American pedestrian fatalities number more than 7,000 a year, and with each car in a city releasing close to 5 metric tons of carbon dioxide annually, car reliance harms everyone else, too.

The rate of vehicle-pedestrian deaths among wheelchair users was 36 percent higher than that of the overall population.

Some US cities—including Los Angeles; Tempe, Arizona; and Jersey City, New Jersey—have made great strides toward limiting cars, mainly by designating car-free streets or areas. But car-free zones have met opposition, and not just from irate conservatives. Opponents of such initiatives have called them “exclusionary,” “not progressive or inclusive,” and bound to “hurt people with disabilities,” pointing out that many disabled people simply need cars to get around.

But Anna Zivarts, director of Disability Rights Washington’s Disability Mobility Initiative and author of the book When Driving Is Not an Option, points out that disabled people are actually less likely to drive than nondisabled people “and more likely to get around [by] walking and rolling and taking transit.” Car-heavy cities are also disproportionately dangerous for disabled folks: A 2015 study by Georgetown University researchers found that the rate of vehicle-pedestrian deaths among wheelchair users was 36 percent higher than that of the overall population.

Zivarts herself bikes, not drives, around her city of Seattle: She lives with the eye condition nystagmus, as does her son, which makes operating a car unsafe. Fighting for greater accessibility, she says, would also “make the world more accessible for him.” That doesn’t just mean car-free zones, but issues like sidewalk safety: One of her initiative’s first major successes was helping to get an additional $83 million added to a levy on Seattle’s November ballot to fix and expand sidewalks for accessibility, which ultimately passed with 66 percent support.

Maddy Ruvolo, a disabled transportation planner for the San Francisco Municipal Transportation Agency, focuses on mobility and accessibility. Ruvolo acknowledges that some disabled people find car ownership “important for their mobility”: It “wouldn’t be fair to say that no disabled people need cars,” she says. But she’s concerned to see “accessibility used as a political football.”

In Vancouver, opponents argued that a bike lane hurt disabled drivers’ ability to get to a public park—though some disabled people themselves supported the initiative—and got most of the lane removed by the Vancouver Park Board. And vice versa: Ruvolo says it’s also harmful for people to throw “statistics around disability and transportation as a way of arguing for active transportation projects that don’t necessarily take accessibility into account.”

Evidence shows that walkable communities are good for disabled people—even beyond simply letting them enjoy the considerable benefits of being outdoors. A 2022 study in the Journal of Transport Geography scored walkability across six Southern ­California counties by housing density, street connectivity, and land use mix: An area with abundant sidewalks and, say, pharmacies and grocery stores was rated more walkable. It found that a modest increase in walkability meant disabled people took transit 33 percent more often than before—likely because better walkability made transit stops easier to get to.

Making cities accessible is also an equity issue. Ruvolo is a member of the US Access Board, an independent federal agency that works toward better accessibility for people with disabilities. Disabled people, she notes, are more likely to have lower incomes—they’re twice as likely to live below the poverty line—and to rely on public transit by necessity. In San Francisco, for example, low-income people with certain disabilities have qualified for free bus and subway rides since 2015. Paris does the same for many aging adults and some disabled people. That’s much cheaper than gas and auto maintenance.

Retrofitting sidewalks and adding shuttles can make a dent in a city’s budget. But in theory, as pointed out by Sarah Kaufman, executive director of New York University’s Rudin Center for Transportation Policy and Management, in a Scientific American opinion piece, you can solve that problem by linking accessibility to congestion pricing. Before it was blocked for months by Gov. Kathy ­Hochul, New York City’s charge on Manhattan traffic was set to help fund accessibility upgrades, like elevators, to its subways. Hochul decided to restore that plan in November, ahead of a possible ban on such charges under Donald Trump’s administration.

As Kaufman wrote in August, when Hochul was still preventing its implementation, “the defeat of this measure—meant to bolster public transit use and reduce city traffic—served as yet another accelerant down the road to a looming crisis across the US: the growing inability of aging boomers to travel.” London has had congestion prices since 2003—disabled people who qualify are exempt from its costs—and just four years later, reports showed that the system had generated tens of millions of dollars annually for transit improvement.

Better public transit improves quality of life for disabled people, Ruvolo says, “as long as accessibility is baked in there.”

There are undeniably cases in which walkability and accessibility come head-to-head: Take some historic pedestrian-­only alleyways in Charleston, South Carolina, which can be hard to navigate with a walker due to their unevenness. Yet there’s often an affordable solution to be found. In 2022, when San Francisco’s Golden Gate Park permanently closed a major boulevard to cars, opponents, including city Supervisor Connie Chan, said it was disabled and aging folks who would pay the price. But free shuttles, ­accessible to anyone, now bridge the gap. Other roads throughout the park remain open to drivers.

For Ruvolo, the key to solving accessibility problems is soliciting disabled residents’ input—and using it. She and her team meet regularly with disability groups in San Francisco, incorporating their ideas into new and existing initiatives. In 2023, for example, the team had disabled students test electric scooters for the city’s scooter-share program. Their feedback helped make the program better for disabled people: Officials picked more scooters with backrests and larger wheels that keep them stable. Better public transit improves the quality of life for disabled people, Ruvolo says, “as long as accessibility is baked in there.”

This story was originally published by High Country News and is reproduced here as part of the Climate Desk collaboration.

In Southern California, December wildfires are somewhat uncommon, but not completely out of the norm. And this year, extremely dry conditions and strong Santa Ana winds created the perfect recipe for dangerous late-year fires.

On the night of December 9, the Franklin Fire sparked in the hills above Malibu, tearing through about 3,000 acres in just 24 hours. As of midday on December 12, the fire was less than 10 percent contained, burning just over 4,000 acres and destroying at least seven structures.

Last month, the Mountain Fire ignited under similar conditions in Ventura County, growing to 1,000 acres in the first hour alone. Within two days, it was over 20,000 acres; 240 structures were destroyed before firefighters contained it in early December.

And it still hasn’t rained—not since the Mountain Fire, nor throughout the entire fall.

It’s true that Santa Ana winds—dry winds that blow from the high desert out to the coast and bring low humidity, at times under 10 percent—routinely pick up in the fall and winter. But what’s less normal is the lack of precipitation gripping Southern California right now, even though the region isn’t technically in a drought yet.

A downtown Los Angeles weather station has only recorded 5.7 inches of rain this year, and not even a quarter-inch has fallen in December, which is usually the middle of the region’s wet season. Most years would have seen three or more wet days by this time, enough to curb some wildfire risk; about 90 percent of the region’s rainfall falls between October and the end of April.

“We are still waiting for the onset of the wet season in that part of the state, which would meaningfully wet the fuels and put the threat of large fires to bed,” said John Abatzoglou, a climatology professor at the University of California, Merced.

In wetter years, the windy season presents a lower fire risk. But now, “when ignitions and wind collide,” as Abatzoglou put it, the landscape is primed for fire. Dry grass and shrubs are ready to burn, and the fire danger forecast by the Los Angeles County Fire Department on Dec. 11, the day the fire grew significantly, was high or very high throughout the Los Angeles Basin, Santa Monica Mountains, and Santa Clarita Valley.

High winds coinciding with bone-dry vegetation is not just a problem for Southern California. Dry conditions raise wildfire risk across the country—during the East Coast’s spring and fall fire seasons, for example. And winter fires have erupted elsewhere in the West: Colorado’s fast-moving Marshall Fire sparked on December 30 in 2021, morphing from a small grass fire to a suburban conflagration—one that ultimately burned over 1,000 homes—in just an hour.

The winds will die down and rain will eventually return to Southern California, but this one-two punch of high wind and parched landscapes will recur and intensify in the future. Climate change projections suggest Southern California’s wet season will narrow, and its rainy season arrive later. In fact, this is already happening: Rainfall data from the past six decades documents an increasingly delayed rainy season.

“There is already an observed trend towards a later onset of the rainy season, not just in Southern California, but also in other parts of the state,” Swain said.

While this trend won’t repeat itself every year—California received record-breaking rain from a tropical storm in August 2023, short-circuiting the wind/dryness pattern—it’s becoming increasingly prominent. This year, Southern California and the Southwest experienced a September heatwave instead.

Some preliminary evidence suggests that the Santa Ana winds may decrease as the climate warms, but researchers are still figuring out the details. So far, though, that doesn’t appear to be true in early winter, before the wet season starts and when fires are most worrisome. Subsequent research by the same scientists found that while cold winds may decrease, hot winds show no shifts in a warming world. Bottom line: Californians can’t count on slower wind speeds to save them from winter wildfire risk, especially in a hotter, drier world.

This year echoed the fall and winter of 2017 in Southern California, when an unusually warm fall and near record-low precipitation dried out vegetation just in time for the winds to arrive. Six wildfires sparked in four days, burning nearly a quarter-million acres in Ventura and Santa Barbara. The Thomas Fire—at the time, the state’s largest wildfire—burned over 280,000 acres and raged into the winter. The later the rains start, the more likely wind events will produce extreme fire risk well into December. “We do expect to see that more in a warming climate, and with greater intensity in terms of the dryness,” Swain said.

This story was originally published by High Country News and is reproduced here as part of the Climate Desk collaboration.

In Southern California, December wildfires are somewhat uncommon, but not completely out of the norm. And this year, extremely dry conditions and strong Santa Ana winds created the perfect recipe for dangerous late-year fires.

On the night of December 9, the Franklin Fire sparked in the hills above Malibu, tearing through about 3,000 acres in just 24 hours. As of midday on December 12, the fire was less than 10 percent contained, burning just over 4,000 acres and destroying at least seven structures.

Last month, the Mountain Fire ignited under similar conditions in Ventura County, growing to 1,000 acres in the first hour alone. Within two days, it was over 20,000 acres; 240 structures were destroyed before firefighters contained it in early December.

And it still hasn’t rained—not since the Mountain Fire, nor throughout the entire fall.

It’s true that Santa Ana winds—dry winds that blow from the high desert out to the coast and bring low humidity, at times under 10 percent—routinely pick up in the fall and winter. But what’s less normal is the lack of precipitation gripping Southern California right now, even though the region isn’t technically in a drought yet.

A downtown Los Angeles weather station has only recorded 5.7 inches of rain this year, and not even a quarter-inch has fallen in December, which is usually the middle of the region’s wet season. Most years would have seen three or more wet days by this time, enough to curb some wildfire risk; about 90 percent of the region’s rainfall falls between October and the end of April.

“We are still waiting for the onset of the wet season in that part of the state, which would meaningfully wet the fuels and put the threat of large fires to bed,” said John Abatzoglou, a climatology professor at the University of California, Merced.

In wetter years, the windy season presents a lower fire risk. But now, “when ignitions and wind collide,” as Abatzoglou put it, the landscape is primed for fire. Dry grass and shrubs are ready to burn, and the fire danger forecast by the Los Angeles County Fire Department on Dec. 11, the day the fire grew significantly, was high or very high throughout the Los Angeles Basin, Santa Monica Mountains, and Santa Clarita Valley.

High winds coinciding with bone-dry vegetation is not just a problem for Southern California. Dry conditions raise wildfire risk across the country—during the East Coast’s spring and fall fire seasons, for example. And winter fires have erupted elsewhere in the West: Colorado’s fast-moving Marshall Fire sparked on December 30 in 2021, morphing from a small grass fire to a suburban conflagration—one that ultimately burned over 1,000 homes—in just an hour.

The winds will die down and rain will eventually return to Southern California, but this one-two punch of high wind and parched landscapes will recur and intensify in the future. Climate change projections suggest Southern California’s wet season will narrow, and its rainy season arrive later. In fact, this is already happening: Rainfall data from the past six decades documents an increasingly delayed rainy season.

“There is already an observed trend towards a later onset of the rainy season, not just in Southern California, but also in other parts of the state,” Swain said.

While this trend won’t repeat itself every year—California received record-breaking rain from a tropical storm in August 2023, short-circuiting the wind/dryness pattern—it’s becoming increasingly prominent. This year, Southern California and the Southwest experienced a September heatwave instead.

Some preliminary evidence suggests that the Santa Ana winds may decrease as the climate warms, but researchers are still figuring out the details. So far, though, that doesn’t appear to be true in early winter, before the wet season starts and when fires are most worrisome. Subsequent research by the same scientists found that while cold winds may decrease, hot winds show no shifts in a warming world. Bottom line: Californians can’t count on slower wind speeds to save them from winter wildfire risk, especially in a hotter, drier world.

This year echoed the fall and winter of 2017 in Southern California, when an unusually warm fall and near record-low precipitation dried out vegetation just in time for the winds to arrive. Six wildfires sparked in four days, burning nearly a quarter-million acres in Ventura and Santa Barbara. The Thomas Fire—at the time, the state’s largest wildfire—burned over 280,000 acres and raged into the winter. The later the rains start, the more likely wind events will produce extreme fire risk well into December. “We do expect to see that more in a warming climate, and with greater intensity in terms of the dryness,” Swain said.

On Monday, President-elect Donald Trump said that he would consider pardoning Eric Adams if the New York City mayor is convicted on charges related to accepting bribes and soliciting illegal foreign campaign donations.

“I think that he was treated pretty unfairly,” Trump told reporters from his Florida resort, Mar-a-Lago. Despite admitting to not knowing “the gravity of it all, that is, the specifics of Adams’ case, that didn’t stop Trump from downplaying the mayor’s alleged crimes to “being upgraded on an airplane.”

But anyone who has taken even the briefest glance at Adams’ long and comical indictment would know that charges levied against the embattled mayor are far more serious than Trump’s characterization. Those charges include bribery, wire fraud, conspiracy, and soliciting campaign contributions from foreign nationals. As my colleague, Anna Merlan, reported:

The indictment alleges Adams has been accepting “improper value benefits,” from wealthy Turkish nationals and officials connected to the Turkish government for at least a decade, going back to his time as Brooklyn Borough President.

Those benefits included luxury hotel stays, upgraded plane tickets, free meals at high-end restaurants, and “luxury entertainment” during his frequent trips to Turkey.

It also alleges that he and his mayoral campaign baldly and happily took what a reasonable person would construe as bribes from Turkish nationals, accepting large sums of illegal contributions through straw donors and giving favorable treatment in return, including pressuring the fire department to approve a luxury high-rise which houses the Turkish consulate, ceasing his association with a Turkish community center in Brooklyn that Turkey claimed was hostile to the government, and declining to make a statement on Armenian Genocide Remembrance Day simply because a “Turkish official” asked him not to.

“I think he was treated, you know, it’s very interesting when he essentially went against what was happening with the migrants coming in. And he made some pretty strong statements like this is not sustainable,” Trump said, suggesting that Adams’ response to migrants arriving in New York prompted the Justice Department to retaliate. “I said he would be indicted soon.”

Trump levied similar accusations against the DOJ when Adams was initially indicted earlier this year. (Not true, by the way.)

Adams, for his part, has been openly ingratiating himself to Trump, actions that have been widely interpreted as a naked effort to secure a pardon. “President Biden and President-elect Trump now agree on one thing,” Adams said after Joe Biden pardoned his son, Hunter. “The Biden Justice Department has been politicized. Does that sound familiar? I rest my case.”

It’s unclear if the president-elect will follow through on a pardon should Adams get convicted. Either way, Adams joins the very long list of MAGA loyalists and accused insurrectionists that Trump has promised to pardon once he’s inaugurated come January.

After being released from prison in October, Steve Bannon seemingly did everything in his power to get Donald Trump back in the White House. Now he appears interested in helping the president-elect remain in the Oval Office—even beyond what is constitutionally allowed.

At an event hosted by the New York Young Republican Club on Sunday, Bannon reportedly floated the idea of a third Trump term, which if attempted, would be in direct violation of the 22nd Amendment of the Constitution. But to Bannon, that seems to be a mere technicality to overcome.

“I don’t know, maybe we do it again in ’28. Are you guys down for that?” Bannon asked the crowd which cheered in response. “Trump ’28!”

According to Bannon, GOP lawyer and Trump defender Mike Davis had told him that because the Constitution “doesn’t actually say ‘consecutive,'” Trump may be able to run for a third term.

BREAKING: Steve Bannon calls for Trump 2028 pic.twitter.com/bcPHFsNobu

— RSBN (@RSBNetwork) December 16, 2024

It may be tempting to dismiss such remarks as Bannon being Bannon. But Trump himself has also pointed to the possibility of staying in power beyond another four years. At a July event hosted by the conservative political nonprofit Turning Point Action, Trump told the Christian audience that if he won reelection, “you won’t have to vote anymore,” as my colleague Arianna Coghill covered at the time. A few days later, he declined to walk back or clarify those comments, even doubling down on them in an interview with Fox News.

Bannon also has a record of accurately characterizing Trump’s moves. As I reported last month, just after Trump’s reelection, Bannon on his War Room podcast promoted a social media post from right-wing podcast host Matt Walsh that said, “Now that the election is over I think we can finally say that yeah actually Project 2025 is the agenda. Lol.” After reading the post on air, Bannon chuckled, saying, “Fabulous. We might have to put that everywhere.” Trump would eventually confirm as much. In an interview with Time Magazine published just last week, Trump told the magazine, “I don’t disagree with everything in Project 2025, but I disagree with some things.”

Spokespeople for the Trump campaign did not immediately respond to questions on Monday afternoon about whether Bannon speaks for Trump or whether the president-elect will commit to vacating office at the end of his next term in accordance with the Constitution.

Davis, the lawyer Bannon claimed proposed the idea that a third Trump term was possible, tried to dismiss the comments as a joke. “Steve Bannon is obviously trolling,” he wrote in a post on X on Monday. “Only Obama gets a third term, with his puppet Biden.”

In his litany of complaints about the federal government, Elon Musk has reserved special ire for the Federal Aviation Administration, which regulates SpaceX, one of his companies. With Donald Trump on the way back into the White House, FAA head Michael Whitaker announced on Thursday that he’ll step down in January, despite having years left on his term. His decision to quit represents a tremendous potential gift to Musk, who has maintained that the agency treats his companies unfairly, and who has tried in the past to limit its power.  

Musk has complained the FAA is keeping “humanity… confined to Earth.”

Whitaker announced in a note to his staff that he’d step down on January 20, which will clear the path for Donald Trump to make his own pick for FAA head. Whitaker began work in October 2023 and FAA heads generally serve five-year terms. Much of his term has been dominated by responding to Boeing’s safety woes, including by stepping up monitoring and inspection of the company’s facilities after a door plug on a Boeing plane infamously blew out during an Alaska Airlines flight in January. 

Musk, who is set to co-lead a purported Department of Government Efficiency alongside Vivek Ramaswamy, has not yet commented on Whitaker’s move. But he’s complained many times about the FAA, lashing out at the agency in September after it fined SpaceX and delayed a license for a launch on safety grounds.

Whitaker said at the time that SpaceX wasn’t following safety and permitting regulations, and sought to fine the company $633,000 in civil penalties. The agency had previously fined Starlink, the satellite internet company that is a SpaceX subsidiary, $175,000 for failing to submit safety data before launching satellites in 2022. In a House Transportation and Infrastructure hearing, Whitaker explained that the FAA’s civil penalties were “the only tool we have to get compliance on safety matters.”

Musk, meanwhile, complained on X that the FAA was “harassing SpaceX about nonsense that doesn’t affect safety while giving a free pass to Boeing,” before adding a call for “resignations from the FAA leadership.”  

Musk also complained that the FAA was interfering with his grander visions: “The fundamental problem is that humanity will forever be confined to Earth unless there is radical reform at the FAA!” He also vowed to file a lawsuit against the agency for “regulatory overreach,” adding, “I am highly confident that discovery will show improper, politically-motivated behavior by the FAA.”

SpaceX did not ultimately sue the FAA. But instead, in his DOGE role, Musk could soon be empowered to shape its future. Whatever his designs on the FAA, Musk has at least signaled that he understands its role in making commercial air travel safer, tweeting in April of last year that “flying on an airliner in America is super safe” because of the agency’s creation.

Amid the frenzied coverage of UnitedHealthcare CEO Brian Thompson‘s assassination and the public’s troubling reaction to it were references to various polls, including one conducted in 2016 by the Kaiser Family Foundation, whose results suggested that Americans were content with their private health plans.

Similar stats had crept into the debate over Medicare for All—a proposed national health insurance program to cover all Americans, and with which private insurers would have to compete. A few weeks before Thompson was murdered, AHIP, the primary trade group for commercial health insurers, published a new survey it had commissioned. About three-quarters of respondents, a “strong majority,” the group said, were satisfied with their employer-provided plans and preferred getting their coverage this way, as opposed to through any government program.

“We’re living in a country where we have people who literally can’t afford to breathe.”

I found these numbers hard to square with the nonchalant—even celebratory—response to Thompson’s death. Until, that is, I spoke with Ed Weisbart. A veteran medical doctor, now retired, Weisbart serves as national board secretary for Physicians for a National Health Program (PNHP), a nonpartisan organization of some 25,000 doctors founded in 1987 to advocate for a public health insurance program. (Disclosure: My late mother was a member.)

So long as you’re healthy, he told me, it is in your insurer’s best interest to keep you happy by delivering on small claims. It’s only when it looks as though you’re going to cost them lots of money that the denials start coming—and maybe by then you’re too sick to fight. This interview was edited for length and clarity.

What compelled you to join PNHP?

I was a practicing physician for decades and got fed up with seeing patients unable to afford health care—not in the broad, abstract way, but in the very real, nitty-gritty way. The Type 1 diabetic who has uncontrolled disease, and I prescribe insulin for him, and it would make a huge difference in his life expectancy, but he comes back a month later and his blood sugars are no better. And I ask him why, and he would say, “Well, because I’m taking my insulin every other day. It’s all I can afford.” I know he’s barreling toward dialysis.

A patient with end-stage emphysema came into the office without her oxygen, huffing and puffing, unable to breathe. She’s had portable oxygen at home and we know this because she had it previous visits. And I said, “Where’s your oxygen? Why are you so short of breath?” She says, “Oh, I can’t afford my oxygen anymore.”

We’re living in a country where we have people who literally can’t afford to breathe. I’ve got hundreds if not thousands of stories like that. It just drives me crazy, realizing you have to advocate for patients outside of the exam room as well, and then understanding that the reason it’s like this is because of the profiteers just leeching the blood and soul of everyday human beings so they can have the best returns on Wall Street.

What did you make of the reaction to the Brian Thompson killing?

It’s obviously a tragedy and a very wrongheaded move. I was aghast. And yet it was also not hard to understand the dynamics, when there are tens of thousands of people dying because of the profiteering—people constantly running into having some bureaucrat say they can’t get the lifesaving care they need. So, I was not surprised, but I was surprised.

What do you consider the biggest flaws of our health system?

As a medical director at various places, I'd say the biggest problem is that the system is designed to return profits rather than to improve health. And the programs that you would want to design to improve health are contrary to the business model of the people that could put those programs in place.

Related to that is the fragmentation of the system. That's a consequence of the first problem. It means comprehensive solutions can't be put in place. It means people are thrust into gaps in between care. So it creates its own set of expenses and driving up the cost.

The third piece is our inability to negotiate prices on behalf of Americans, which other countries do. Those costs are borne all across the system in ways that are obvious, like the overhead of the insurance industry—13 percent to 18 percent depending on where you look. But then they hide more than that by transferring some of the overhead onto hospitals, hospital infrastructure, and medical practices. Milliman estimated the average physician pays $100,000 for office staff to deal with the insurance industry, and where does that money come from? It comes from jacking up prices. All the fee schedules have to be adjusted so physicians can afford to pay this overhead.

This is unique to America. In Canada, the overhead of running a practice to deal with the national health insurance they have there is more like $20,000 or $25,000 per doctor.

In any other industry, auto repair for instance, you get an estimate in advance of what it'll cost you. Why isn’t that the case with health care?

Well, I would argue that's not the correct solution, anyway. Because in the auto repair industry, you can shop around and make an intelligent choice, and you know whether the car is going to work right afterward. In health care, it's the exact opposite.

“We spend roughly a third of the health care dollar propping up the bloated, Byzantine insurance industry.”

You can shop for prices for [commodity services like LASIK], but that kind of thing is a tiny fraction. In health care, a very large percentage [of the total cost of care] is spent in the last six months of life by people who are desperately sick, and they are not in a position to start shopping around. And even if you had the prices, how do compare that to quality? If an insurance company with six floors full of actuaries can't do the price-versus-quality equation so that you they can direct you to the best quality care for the price, how is the person who works at the gas station on the corner supposed to make that determination?

I'm also curious about situations in which a patient gets a crazy bill, just totally unrealistic, and they kick up a fuss and the insurer suddenly reduces the cost or even wipes it out entirely. Is the whole system premised on people giving up and not fighting claim denials?

Yes. There's data about this for Medicare. If Medicare denies a claim, it's usually because the claim is for something that's legally not a covered benefit. It's extraordinary for it to be any reason other than that, and so when Medicare denies claims—which they almost never do—and someone appeals, there's about a 1 percent chance that appeal will get reversed.

Now, with Medicare Advantage, which is the for-profit, typically proprietary, insurance industry version of Medicare, its the exact opposite. If somebody appeals a denial, I think around 80 to 85 percent of those denials get reversed, because when Medicare Advantage does a denial it's because it wasn't in the company's business interest to pay for it. But nobody appeals it because they don't know that they can—or that it would work.

Fascinating. So it's actually easy—well, not easy, because it's a total headache—but you can get these things reversed if you persist.

I wouldn’t call it easy by any means. The patient has to spend significant time collecting things and going through the process. And you need a physician who's willing to help, and who's going to pay the physician for that? That's a chunk of the physician’s time that is not reimbursed. Plus, most people in a situation where they need to do that are sick. They're not at their best to begin with. It's really hard, really time-consuming. And there's a long delay from when you do the appeal to when you get a favorable decision.

Tell me more about the for-profit model, and how delaying and denying claims plays into it.

The commercial insurance industry collects a premium. So that's a prepayment. The Medicare Advantage industry is prepaid by the government. That's money in their pocket, and every time they pay a claim, that's money that they're spending.

They have this term, “medical loss ratio,” which is a carryover from the fire loss ratio and property loss ratio, but they call it a loss when they pay. So, they don't want to pay, and it manifests in a couple of ways. First, if they don't pay the claim, that's money they can retain. Secondly, even if they just delay the care, they have sophisticated systems managing how they invest the money they're not paying.

I once worked in a part of the insurance world where they did exactly that. They had contracts that required them to pay their bills within a certain timeframe, and if they paid long after they were contractually obliged to, there was a penalty, and they had sophisticated systems to analyze the return on their investments in the market vs. how big the penalties are for delaying the payment for care. And they would delay until they hit the right point on the curve where it was more sensible financially to pay the claim than to keep investing it in the market.

So basically you collect a big pile of money and invest it and then avoid paying claims so you can keep that money invested as long as possible to maximize your returns in the market?

That's exactly right.

What are the kinds of procedures insurers are most likely to deny or delay, and the most common reasons people fall into medical debt?

I can't give you a quantitative answer, but the more expensive a procedure is, the more likely they are to want to put in a barrier to payment. Insurers typically don't want to put barriers to things that low-expense patients get, like a blood pressure medication that's very inexpensive and that healthier populations use. It's to their advantage to get you to use the insurance a little bit because the people that are the most likely to disenroll from a specific company are the people who never use it. They want you to maybe get your eyeglasses or something.

But if you're sick and you need home oxygen, or you need a CT scan or an MRI, or something that's both expensive and predictive that you're probably a higher risk person—that you're going to be a more expensive patient to take care of—they don't want to spend that money. So if you call them and say, “I'm so mad at you. You got in the way of my CT scan. I'm thinking of going to different insurance company,” the company has a win! They don’t want you in their plan.

You mention CT scans. I know imaging is among the things medical practices tend to overprescribe because it’s a cash cow, and you get a fair bit excessive testing and overtreatment. Can certain denials then be to a patient's benefit?

There is obviously a significant percentage of what we do in medicine that is not evidence-based and could probably be avoided. But if you compare the United States to other modern nations, our utilization of those kinds of services is roughly average. The problem with the high cost of care in the US is not overutilization. Is there overutilization? Absolutely. Is that the driver of health care costs? No, it's not.

The driver of health care costs is two things: It's the overhead, the managing, the cost of the complexity of administering this. Most estimates are that we spend roughly a third of the health care dollar propping up the bloated, Byzantine insurance industry. The second piece is the failure to negotiate prices effectively because we're so fragmented. That's where the money is.

How big a cost is the failure to negotiate prices?

I can’t tell you overall, but the average prescription drug in the United States is about twice as expensive as it is in the rest of the modern world.

How does the cost of a public insurance bureaucracy compare with the cost of a private one?

The commercial insurance industry has a roughly 15 percent overhead. Traditional Medicare, parts A and B, operates with a roughly 2 percent overhead.

Wendell Potter, a former Cigna PR guy, just wrote a Bloomberg piece on the role of Wall Street, and how executives at giants like UnitedHealthcare and Cigna go to these investor conferences where there’s no mention at all of patient care. It's all about the returns, and that's what's driving a lot of the misery we're seeing.

Oh, that's exactly right. I mean, the root issue is greed.

But don't public systems also have their drawbacks? The Veterans Administration has weathered scandals. And I saw a CTV News piece from last fall about how Canadians fed up with long wait times for surgeries in their public system were turning to private providers.

If you go down the street in Canada and ask people, they all have a story like that. But then they'll say, “But there's no way I would change to the United States system where I have to have a bake sale to have my knee replaced.” They don't want this system.

More importantly, US life expectancies were the same as Canadian life expectancies within a few months up until the early 1970s. That's when we passed the HMO Act, creating managed care, and Canada finally finished implementing their national health insurance plan, and then there was a fork in the road. Our costs continued to go up along the same curve. Their costs started to really flatten out, and our life expectancy did not begin to keep pace with the improvements in life expectancy in Canada. Fifty-some years later, they live three to five years longer than we do and spend half as much.

Have you seen any notable pivot points for the United States in terms of the cost of care and deterioration of quality?

They've been on a steady, relentless curve. There's a whole list of things that we have tried, and none have really bent the curve. There's one obvious solution.

You mean single-payer?

Correct. But I'm not stupid enough to say that sometime in the next four years or six years that's going to magically pass. One of the things PNHP has been really good about the last three or four years is thinking about a strategy of how do we pave the road to that? What has to happen? Our strategy to get the bills passed is far more robust than just pass the bill. The single-payer community five years ago, 10 years ago, would literally say you can only cross a chasm in a single leap. You know, I've looked at the bottom of chasms and there's dead people who couldn't make the jump. You cross the chasm by building a bridge slowly.

Do you think for-profit insurers play any positive role in our system, or would you like to see them go away entirely?

I would like to see them go away entirely.

I mean, it's probably never going to happen here.

Everything looks impossible until it's already happened.

My skepticism comes from watching Obama try to implement single-payer and having it demonized as socialism—and "death panels" and so forth.

I don't think people care whether it's single payer or quadruple payer. Those words mean nothing to people. You know, Medicare for All. That's not what they care about. People want health care. They don't care about health insurance. They're angry at the profiteering, the outrageous prices. They're angry they can't afford their care. They're much more focused on solve this problem than they are on which exact tool or mechanism you go to.

That's what I think, too. What I care about is that everybody in the country has unfettered access to high-quality health care that they control the decisions for. I think single-payer is the smartest way to do it. But if we went to an "all payer" or some other model that accomplished that, I'm fine. I just don't want people dying like they are today.

ABC News will pay $15 million to settle a defamation lawsuit that president-elect Donald Trump brought against the network, centered on incorrect comments that anchor George Stephanopoulos made about the civil lawsuit against Trump brought by writer E. Jean Carroll.

The details of the settlement are concerning for anyone who cares about press freedom in the next Trump administration. And, in particular, it shows again how New York state’s definition of “rape”—that has since been changed—has allowed Trump to wiggle out of criticism for sexual assault allegations.

The lawsuit focused on a March 10 interview that Stephanopoulos conducted on the network’s Sunday morning show, “This Week,” with Rep. Nancy Mace (R-S.C.). In that interview, Stephanopoulos confronted Mace—who has said she’s a rape survivor—about her endorsement of Trump, falsely noting that “judges and two separate juries have found him liable for rape, and for defaming the victim of that rape.”

Stephanopoulos was referring to the lawsuit brought by E. Jean Carroll, who alleged that Trump raped her in 1996 in the dressing room of a New York City department store; as my colleague Russ Choma reported, while the jury found that Carroll’s attorneys did not prove the rape allegation, they did agree that Trump forcibly sexually abused and defamed her, and ruled that Trump had to pay Carroll $5 million.

Still, it is even more complicated than that. As my former colleague Katie Herchenroeder reported, the judge in the Carroll case went to great lengths to clarify that while Trump was not found liable for “rape” under New York’s strict definition—vaginal penetration by a penis—his alleged actions of forcible penetration with his fingers meet the definition of what many people broadly understand as “rape.”

As Katie wrote:

That the jurors did not find that Carroll had proven rape, [Judge Lewis] Kaplan explained, “does not mean that she failed to prove that Mr. Trump ‘raped’ her as many people commonly understand the word ‘rape.’” “Indeed,” he continued, “as the evidence at trial recounted below makes clear, the jury found that Mr. Trump in fact did exactly that.” 

Federally, rape is defined as “penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” This broader explanation, while still dependent on penetration, would include assaults using fingers. 

Lawyers for ABC and Stephanopoulos referenced this context from the judge’s statements in their unsuccessful motion to dismiss the lawsuit they filed earlier this year, court records show.

As Katie wrote, New York wound up passing a law that expanded the law to include nonconsensual anal, oral, and vaginal sexual contact. When she signed the bill into law, Gov. Kathy Hochul (D-N.Y.) recognized Carroll “for her courageous efforts to make sure justice was done.”

As part of the settlement, ABC will pay the $15 million to the Trump presidential library—which currently only exists online—plus another $1 million in Trump’s attorney fees, court records show. The network also added a note to the online story about the interview, noting that both ABC and Stephanopoulos “regret” the comments.

Mace—who accused Stephanopoulos of “shaming” her during the original interview—celebrated the ruling on Saturday, writing in a post on X: “Let this be a warning to all haters: Defamation is real, and your free trial of badmouthing just expired.” In another post, she wrote: “2025 will be the year of [mainstream media] apologies.”

Media scholars and experts have been sounding the alarm about journalists’ and media companies’ capitulation to Trump—who just last month said he would be ok with someone shooting through a crowd of journalists—ahead of his second term.

And they have good reason to be worried: While Trump has claimed he now believes a free press is “vital,” there are fears that he and his acolytes could use baseless lawsuits to go after journalists whose coverage is unfavorable to him—particularly after Sen. Tom Cotton (R-Ark.) this week blocked a federal shield bill that, if passed, would protect journalists from being forced to reveal their confidential sources.

Devin Nunes, the ex-California congressman and current head of Trump’s struggling social media platform, Truth Social, is getting his prize for being the next president’s long-serving yes-man.

On Saturday, Trump announced that he would appoint Nunes as chairman of the President’s Intelligence Advisory Board, a group of up to 16 private citizens who get high-level security clearance to advise the president on “the effectiveness with which the [intelligence community] is meeting the nation’s intelligence needs.”

In his Truth Social post announcing the news, Trump said Nunes would assume the role “while continuing his leadership of Trump Media & Technology Group,” the company that runs Truth Social. The role reportedly does not require Senate confirmation.

As my colleague David Corn has reported, as former chairman of the House Intelligence Committee Nunes attacked the investigation into Russia’s meddling in the 2016 election as a baseless partisan smear by Democrats—which, in Trump’s eyes, made him uniquely qualified to receive top-level security clearance.

“Devin will draw on his experience as former Chairman of the House Intelligence Committee, and his key role in exposing the Russia, Russia, Russia Hoax, to provide me with independent assessments of the effectiveness and propriety of the U.S. Intelligence Community’s activities,” Trump wrote in the announcement.

Nunes will draw on a robust track record of foot entering mouth. He compared homeless people to a “zombie apocalypse”; created a fake news site that insisted male privilege doesn’t exist; sued both the Fresno Bee, a local newspaper in California’s Central Valley, and a satirical Twitter account purporting to be his cow.

The Bee famously once called him “Trump’s stooge.” That seems to be the main qualification needed for the next admin.

Annoyed with time changes in the fall and spring? So is President-elect Donald Trump. On Friday, Trump posted on Truth Social that the “Republican Party will use its best efforts to eliminate Daylight Saving Time” because it is “inconvenient, and very costly to our Nation.”

Ending daylight saving time would also not be that original—two thirds of countries do not have it. Americans do seem to be split on the issue. In a 2019 poll, 7 out of 10 Americans said they did not like the biannual switches, but 4 in 10 wanted a fixed standard time and 3 in 10 wanted daylight saving time.

Even putting aside the economic argument for ending daylight saving time, some research suggests that the practice of putting the clock one hour ahead in the spring can negatively impact peoples’ mental health. When our internal clock is thrown off and we get less sleep, our mood can be impacted, leading us to feel less focused and potentially more depressed. This lack of focus can also be deadly—a February 2020 study that looked at two decades’ worth of traffic accidents found that there was a 6 percent increase in the risk of fatal traffic accidents in the week following daylight saving time in the United States.

In October 2020, the American Academy of Sleep Medicine, a professional society that represents medical specialists who focus on sleep medicine, even issued a statement in support of ending daylight saving time in favor of a fixed year-round schedule:

It is the position of the AASM that the U.S. should eliminate seasonal time changes in favor of a national, fixed, year-round time. Current evidence best supports the adoption of year-round standard time, which aligns best with human circadian biology and provides distinct benefits for public health and safety.

Unlike Trump’s recent false claims linking vaccines with autism diagnoses, his support of ending daylight saving time is actually backed by science.

Every summer, 50 of the nation’s best and brightest teenage girls gather in Mobile, Alabama, to embark on two of the most intense weeks of their lives. Everybody wants the same thing: to walk away with a $40,000 college scholarship and the title of Distinguished Young Woman of America.

Reporter Shima Oliaee competed for Nevada when she was a teenager, and was invited back as a judge more than 20 years later. Oliaee accepted, and recorded the experience for a six-part audio series called The Competition.

In the final days of the competition, there was news from Washington that had big implications for women across the nation: Roe v. Wade had fallen. 

The girls are faced with a tough decision: Do they speak up for their political beliefs or stay focused on winning the money? And what might this mean for their futures—and their friendships?

“This series changed how I view America,” Oliaee said. “I came away from it thinking, damn. American teen girls are the canaries in the coal mine.”

This week, Reveal is partnering with The Competition podcast, from Wondery and Pineapple Street Studios and hosted by Oliaee, to explore the dreams of young women, America’s promise, and what it takes to survive being a teen girl today.

Subscribe to Mother Jones podcasts on Apple Podcasts or your favorite podcast app.

On Monday, President-elect Donald Trump said that he would consider pardoning Eric Adams if the New York City mayor is convicted on charges related to accepting bribes and soliciting illegal foreign campaign donations.

“I think that he was treated pretty unfairly,” Trump told reporters from his Florida resort, Mar-a-Lago. Despite admitting to not knowing “the gravity of it all, that is, the specifics of Adams’ case, that didn’t stop Trump from downplaying the mayor’s alleged crimes to “being upgraded on an airplane.”

But anyone who has taken even the briefest glance at Adams’ long and comical indictment would know that charges levied against the embattled mayor are far more serious than Trump’s characterization. Those charges include bribery, wire fraud, conspiracy, and soliciting campaign contributions from foreign nationals. As my colleague, Anna Merlan, reported:

The indictment alleges Adams has been accepting “improper value benefits,” from wealthy Turkish nationals and officials connected to the Turkish government for at least a decade, going back to his time as Brooklyn Borough President.

Those benefits included luxury hotel stays, upgraded plane tickets, free meals at high-end restaurants, and “luxury entertainment” during his frequent trips to Turkey.

It also alleges that he and his mayoral campaign baldly and happily took what a reasonable person would construe as bribes from Turkish nationals, accepting large sums of illegal contributions through straw donors and giving favorable treatment in return, including pressuring the fire department to approve a luxury high-rise which houses the Turkish consulate, ceasing his association with a Turkish community center in Brooklyn that Turkey claimed was hostile to the government, and declining to make a statement on Armenian Genocide Remembrance Day simply because a “Turkish official” asked him not to.

“I think he was treated, you know, it’s very interesting when he essentially went against what was happening with the migrants coming in. And he made some pretty strong statements like this is not sustainable,” Trump said, suggesting that Adams’ response to migrants arriving in New York prompted the Justice Department to retaliate. “I said he would be indicted soon.”

Trump levied similar accusations against the DOJ when Adams was initially indicted earlier this year. (Not true, by the way.)

Adams, for his part, has been openly ingratiating himself to Trump, actions that have been widely interpreted as a naked effort to secure a pardon. “President Biden and President-elect Trump now agree on one thing,” Adams said after Joe Biden pardoned his son, Hunter. “The Biden Justice Department has been politicized. Does that sound familiar? I rest my case.”

It’s unclear if the president-elect will follow through on a pardon should Adams get convicted. Either way, Adams joins the very long list of MAGA loyalists and accused insurrectionists that Trump has promised to pardon once he’s inaugurated come January.

After being released from prison in October, Steve Bannon seemingly did everything in his power to get Donald Trump back in the White House. Now he appears interested in helping the president-elect remain in the Oval Office—even beyond what is constitutionally allowed.

At an event hosted by the New York Young Republican Club on Sunday, Bannon reportedly floated the idea of a third Trump term, which if attempted, would be in direct violation of the 22nd Amendment of the Constitution. But to Bannon, that seems to be a mere technicality to overcome.

“I don’t know, maybe we do it again in ’28. Are you guys down for that?” Bannon asked the crowd which cheered in response. “Trump ’28!”

According to Bannon, GOP lawyer and Trump defender Mike Davis had told him that because the Constitution “doesn’t actually say ‘consecutive,'” Trump may be able to run for a third term.

BREAKING: Steve Bannon calls for Trump 2028 pic.twitter.com/bcPHFsNobu

— RSBN (@RSBNetwork) December 16, 2024

It may be tempting to dismiss such remarks as Bannon being Bannon. But Trump himself has also pointed to the possibility of staying in power beyond another four years. At a July event hosted by the conservative political nonprofit Turning Point Action, Trump told the Christian audience that if he won reelection, “you won’t have to vote anymore,” as my colleague Arianna Coghill covered at the time. A few days later, he declined to walk back or clarify those comments, even doubling down on them in an interview with Fox News.

Bannon also has a record of accurately characterizing Trump’s moves. As I reported last month, just after Trump’s reelection, Bannon on his War Room podcast promoted a social media post from right-wing podcast host Matt Walsh that said, “Now that the election is over I think we can finally say that yeah actually Project 2025 is the agenda. Lol.” After reading the post on air, Bannon chuckled, saying, “Fabulous. We might have to put that everywhere.” Trump would eventually confirm as much. In an interview with Time Magazine published just last week, Trump told the magazine, “I don’t disagree with everything in Project 2025, but I disagree with some things.”

Spokespeople for the Trump campaign did not immediately respond to questions on Monday afternoon about whether Bannon speaks for Trump or whether the president-elect will commit to vacating office at the end of his next term in accordance with the Constitution.

Davis, the lawyer Bannon claimed proposed the idea that a third Trump term was possible, tried to dismiss the comments as a joke. “Steve Bannon is obviously trolling,” he wrote in a post on X on Monday. “Only Obama gets a third term, with his puppet Biden.”

In his litany of complaints about the federal government, Elon Musk has reserved special ire for the Federal Aviation Administration, which regulates SpaceX, one of his companies. With Donald Trump on the way back into the White House, FAA head Michael Whitaker announced on Thursday that he’ll step down in January, despite having years left on his term. His decision to quit represents a tremendous potential gift to Musk, who has maintained that the agency treats his companies unfairly, and who has tried in the past to limit its power.  

Musk has complained the FAA is keeping “humanity… confined to Earth.”

Whitaker announced in a note to his staff that he’d step down on January 20, which will clear the path for Donald Trump to make his own pick for FAA head. Whitaker began work in October 2023 and FAA heads generally serve five-year terms. Much of his term has been dominated by responding to Boeing’s safety woes, including by stepping up monitoring and inspection of the company’s facilities after a door plug on a Boeing plane infamously blew out during an Alaska Airlines flight in January. 

Musk, who is set to co-lead a purported Department of Government Efficiency alongside Vivek Ramaswamy, has not yet commented on Whitaker’s move. But he’s complained many times about the FAA, lashing out at the agency in September after it fined SpaceX and delayed a license for a launch on safety grounds.

Whitaker said at the time that SpaceX wasn’t following safety and permitting regulations, and sought to fine the company $633,000 in civil penalties. The agency had previously fined Starlink, the satellite internet company that is a SpaceX subsidiary, $175,000 for failing to submit safety data before launching satellites in 2022. In a House Transportation and Infrastructure hearing, Whitaker explained that the FAA’s civil penalties were “the only tool we have to get compliance on safety matters.”

Musk, meanwhile, complained on X that the FAA was “harassing SpaceX about nonsense that doesn’t affect safety while giving a free pass to Boeing,” before adding a call for “resignations from the FAA leadership.”  

Musk also complained that the FAA was interfering with his grander visions: “The fundamental problem is that humanity will forever be confined to Earth unless there is radical reform at the FAA!” He also vowed to file a lawsuit against the agency for “regulatory overreach,” adding, “I am highly confident that discovery will show improper, politically-motivated behavior by the FAA.”

SpaceX did not ultimately sue the FAA. But instead, in his DOGE role, Musk could soon be empowered to shape its future. Whatever his designs on the FAA, Musk has at least signaled that he understands its role in making commercial air travel safer, tweeting in April of last year that “flying on an airliner in America is super safe” because of the agency’s creation.

Amid the frenzied coverage of UnitedHealthcare CEO Brian Thompson‘s assassination and the public’s troubling reaction to it were references to various polls, including one conducted in 2016 by the Kaiser Family Foundation, whose results suggested that Americans were content with their private health plans.

Similar stats had crept into the debate over Medicare for All—a proposed national health insurance program to cover all Americans, and with which private insurers would have to compete. A few weeks before Thompson was murdered, AHIP, the primary trade group for commercial health insurers, published a new survey it had commissioned. About three-quarters of respondents, a “strong majority,” the group said, were satisfied with their employer-provided plans and preferred getting their coverage this way, as opposed to through any government program.

“We’re living in a country where we have people who literally can’t afford to breathe.”

I found these numbers hard to square with the nonchalant—even celebratory—response to Thompson’s death. Until, that is, I spoke with Ed Weisbart. A veteran medical doctor, now retired, Weisbart serves as national board secretary for Physicians for a National Health Program (PNHP), a nonpartisan organization of some 25,000 doctors founded in 1987 to advocate for a public health insurance program. (Disclosure: My late mother was a member.)

So long as you’re healthy, he told me, it is in your insurer’s best interest to keep you happy by delivering on small claims. It’s only when it looks as though you’re going to cost them lots of money that the denials start coming—and maybe by then you’re too sick to fight. This interview was edited for length and clarity.

What compelled you to join PNHP?

I was a practicing physician for decades and got fed up with seeing patients unable to afford health care—not in the broad, abstract way, but in the very real, nitty-gritty way. The Type 1 diabetic who has uncontrolled disease, and I prescribe insulin for him, and it would make a huge difference in his life expectancy, but he comes back a month later and his blood sugars are no better. And I ask him why, and he would say, “Well, because I’m taking my insulin every other day. It’s all I can afford.” I know he’s barreling toward dialysis.

A patient with end-stage emphysema came into the office without her oxygen, huffing and puffing, unable to breathe. She’s had portable oxygen at home and we know this because she had it previous visits. And I said, “Where’s your oxygen? Why are you so short of breath?” She says, “Oh, I can’t afford my oxygen anymore.”

We’re living in a country where we have people who literally can’t afford to breathe. I’ve got hundreds if not thousands of stories like that. It just drives me crazy, realizing you have to advocate for patients outside of the exam room as well, and then understanding that the reason it’s like this is because of the profiteers just leeching the blood and soul of everyday human beings so they can have the best returns on Wall Street.

What did you make of the reaction to the Brian Thompson killing?

It’s obviously a tragedy and a very wrongheaded move. I was aghast. And yet it was also not hard to understand the dynamics, when there are tens of thousands of people dying because of the profiteering—people constantly running into having some bureaucrat say they can’t get the lifesaving care they need. So, I was not surprised, but I was surprised.

What do you consider the biggest flaws of our health system?

As a medical director at various places, I'd say the biggest problem is that the system is designed to return profits rather than to improve health. And the programs that you would want to design to improve health are contrary to the business model of the people that could put those programs in place.

Related to that is the fragmentation of the system. That's a consequence of the first problem. It means comprehensive solutions can't be put in place. It means people are thrust into gaps in between care. So it creates its own set of expenses and driving up the cost.

The third piece is our inability to negotiate prices on behalf of Americans, which other countries do. Those costs are borne all across the system in ways that are obvious, like the overhead of the insurance industry—13 percent to 18 percent depending on where you look. But then they hide more than that by transferring some of the overhead onto hospitals, hospital infrastructure, and medical practices. Milliman estimated the average physician pays $100,000 for office staff to deal with the insurance industry, and where does that money come from? It comes from jacking up prices. All the fee schedules have to be adjusted so physicians can afford to pay this overhead.

This is unique to America. In Canada, the overhead of running a practice to deal with the national health insurance they have there is more like $20,000 or $25,000 per doctor.

In any other industry, auto repair for instance, you get an estimate in advance of what it'll cost you. Why isn’t that the case with health care?

Well, I would argue that's not the correct solution, anyway. Because in the auto repair industry, you can shop around and make an intelligent choice, and you know whether the car is going to work right afterward. In health care, it's the exact opposite.

“We spend roughly a third of the health care dollar propping up the bloated, Byzantine insurance industry.”

You can shop for prices for [commodity services like LASIK], but that kind of thing is a tiny fraction. In health care, a very large percentage [of the total cost of care] is spent in the last six months of life by people who are desperately sick, and they are not in a position to start shopping around. And even if you had the prices, how do compare that to quality? If an insurance company with six floors full of actuaries can't do the price-versus-quality equation so that you they can direct you to the best quality care for the price, how is the person who works at the gas station on the corner supposed to make that determination?

I'm also curious about situations in which a patient gets a crazy bill, just totally unrealistic, and they kick up a fuss and the insurer suddenly reduces the cost or even wipes it out entirely. Is the whole system premised on people giving up and not fighting claim denials?

Yes. There's data about this for Medicare. If Medicare denies a claim, it's usually because the claim is for something that's legally not a covered benefit. It's extraordinary for it to be any reason other than that, and so when Medicare denies claims—which they almost never do—and someone appeals, there's about a 1 percent chance that appeal will get reversed.

Now, with Medicare Advantage, which is the for-profit, typically proprietary, insurance industry version of Medicare, its the exact opposite. If somebody appeals a denial, I think around 80 to 85 percent of those denials get reversed, because when Medicare Advantage does a denial it's because it wasn't in the company's business interest to pay for it. But nobody appeals it because they don't know that they can—or that it would work.

Fascinating. So it's actually easy—well, not easy, because it's a total headache—but you can get these things reversed if you persist.

I wouldn’t call it easy by any means. The patient has to spend significant time collecting things and going through the process. And you need a physician who's willing to help, and who's going to pay the physician for that? That's a chunk of the physician’s time that is not reimbursed. Plus, most people in a situation where they need to do that are sick. They're not at their best to begin with. It's really hard, really time-consuming. And there's a long delay from when you do the appeal to when you get a favorable decision.

Tell me more about the for-profit model, and how delaying and denying claims plays into it.

The commercial insurance industry collects a premium. So that's a prepayment. The Medicare Advantage industry is prepaid by the government. That's money in their pocket, and every time they pay a claim, that's money that they're spending.

They have this term, “medical loss ratio,” which is a carryover from the fire loss ratio and property loss ratio, but they call it a loss when they pay. So, they don't want to pay, and it manifests in a couple of ways. First, if they don't pay the claim, that's money they can retain. Secondly, even if they just delay the care, they have sophisticated systems managing how they invest the money they're not paying.

I once worked in a part of the insurance world where they did exactly that. They had contracts that required them to pay their bills within a certain timeframe, and if they paid long after they were contractually obliged to, there was a penalty, and they had sophisticated systems to analyze the return on their investments in the market vs. how big the penalties are for delaying the payment for care. And they would delay until they hit the right point on the curve where it was more sensible financially to pay the claim than to keep investing it in the market.

So basically you collect a big pile of money and invest it and then avoid paying claims so you can keep that money invested as long as possible to maximize your returns in the market?

That's exactly right.

What are the kinds of procedures insurers are most likely to deny or delay, and the most common reasons people fall into medical debt?

I can't give you a quantitative answer, but the more expensive a procedure is, the more likely they are to want to put in a barrier to payment. Insurers typically don't want to put barriers to things that low-expense patients get, like a blood pressure medication that's very inexpensive and that healthier populations use. It's to their advantage to get you to use the insurance a little bit because the people that are the most likely to disenroll from a specific company are the people who never use it. They want you to maybe get your eyeglasses or something.

But if you're sick and you need home oxygen, or you need a CT scan or an MRI, or something that's both expensive and predictive that you're probably a higher risk person—that you're going to be a more expensive patient to take care of—they don't want to spend that money. So if you call them and say, “I'm so mad at you. You got in the way of my CT scan. I'm thinking of going to different insurance company,” the company has a win! They don’t want you in their plan.

You mention CT scans. I know imaging is among the things medical practices tend to overprescribe because it’s a cash cow, and you get a fair bit excessive testing and overtreatment. Can certain denials then be to a patient's benefit?

There is obviously a significant percentage of what we do in medicine that is not evidence-based and could probably be avoided. But if you compare the United States to other modern nations, our utilization of those kinds of services is roughly average. The problem with the high cost of care in the US is not overutilization. Is there overutilization? Absolutely. Is that the driver of health care costs? No, it's not.

The driver of health care costs is two things: It's the overhead, the managing, the cost of the complexity of administering this. Most estimates are that we spend roughly a third of the health care dollar propping up the bloated, Byzantine insurance industry. The second piece is the failure to negotiate prices effectively because we're so fragmented. That's where the money is.

How big a cost is the failure to negotiate prices?

I can’t tell you overall, but the average prescription drug in the United States is about twice as expensive as it is in the rest of the modern world.

How does the cost of a public insurance bureaucracy compare with the cost of a private one?

The commercial insurance industry has a roughly 15 percent overhead. Traditional Medicare, parts A and B, operates with a roughly 2 percent overhead.

Wendell Potter, a former Cigna PR guy, just wrote a Bloomberg piece on the role of Wall Street, and how executives at giants like UnitedHealthcare and Cigna go to these investor conferences where there’s no mention at all of patient care. It's all about the returns, and that's what's driving a lot of the misery we're seeing.

Oh, that's exactly right. I mean, the root issue is greed.

But don't public systems also have their drawbacks? The Veterans Administration has weathered scandals. And I saw a CTV News piece from last fall about how Canadians fed up with long wait times for surgeries in their public system were turning to private providers.

If you go down the street in Canada and ask people, they all have a story like that. But then they'll say, “But there's no way I would change to the United States system where I have to have a bake sale to have my knee replaced.” They don't want this system.

More importantly, US life expectancies were the same as Canadian life expectancies within a few months up until the early 1970s. That's when we passed the HMO Act, creating managed care, and Canada finally finished implementing their national health insurance plan, and then there was a fork in the road. Our costs continued to go up along the same curve. Their costs started to really flatten out, and our life expectancy did not begin to keep pace with the improvements in life expectancy in Canada. Fifty-some years later, they live three to five years longer than we do and spend half as much.

Have you seen any notable pivot points for the United States in terms of the cost of care and deterioration of quality?

They've been on a steady, relentless curve. There's a whole list of things that we have tried, and none have really bent the curve. There's one obvious solution.

You mean single-payer?

Correct. But I'm not stupid enough to say that sometime in the next four years or six years that's going to magically pass. One of the things PNHP has been really good about the last three or four years is thinking about a strategy of how do we pave the road to that? What has to happen? Our strategy to get the bills passed is far more robust than just pass the bill. The single-payer community five years ago, 10 years ago, would literally say you can only cross a chasm in a single leap. You know, I've looked at the bottom of chasms and there's dead people who couldn't make the jump. You cross the chasm by building a bridge slowly.

Do you think for-profit insurers play any positive role in our system, or would you like to see them go away entirely?

I would like to see them go away entirely.

I mean, it's probably never going to happen here.

Everything looks impossible until it's already happened.

My skepticism comes from watching Obama try to implement single-payer and having it demonized as socialism—and "death panels" and so forth.

I don't think people care whether it's single payer or quadruple payer. Those words mean nothing to people. You know, Medicare for All. That's not what they care about. People want health care. They don't care about health insurance. They're angry at the profiteering, the outrageous prices. They're angry they can't afford their care. They're much more focused on solve this problem than they are on which exact tool or mechanism you go to.

That's what I think, too. What I care about is that everybody in the country has unfettered access to high-quality health care that they control the decisions for. I think single-payer is the smartest way to do it. But if we went to an "all payer" or some other model that accomplished that, I'm fine. I just don't want people dying like they are today.

Two weeks after the election, I met Dianela Rosario in Huntington Park, California—an almost entirely Latino city that swung hard to the right this year. A 51-year-old Dominican American shopkeeper, Rosario told me that before this year she had never voted for a Republican presidential candidate. But, in 2024, inflation and the prices of groceries were front of mind. President Joe Biden and Democratic nominee Kamala Harris were not fully responsible for the cost of living crisis, she said, but she still wanted someone new.

“If she’s been vice president and there’s been no change, then I wasn’t sure she was going to be able to change things as president,” Rosario, who identifies as Afro-Latina, explained in Spanish about why she had not voted for Harris. “That’s what influenced me the most—that things might stay the same as they are now.”

Earlier that afternoon, a Guatemalan shopkeeper shared a similar perspective. She told me she missed the lower prices of Trump’s first term and that she hoped the incoming president would deport people she saw as causing problems in the area. Unlike Rosario, though, she hadn’t been able to cast a vote. “Soy ilegal,” the shopkeeper explained of her own immigration status.

In 2016, stories like these would have been hard to find in cities in Southeast Los Angeles like Huntington Park, where 97 percent of residents are Latino. That year, Trump lost by huge margins. In 2016, Hillary Clinton received 84 percent of votes in the area, compared to only 8 percent for Trump. Sometimes, Trump even came in third; in several precincts, Jill Stein was the runner-up to Clinton.

Eight years later, a Mother Jones analysis of precinct-level voting data shows that Democrats have lost more support in Southeast Los Angeles than any other part of Los Angeles County. Democrats’ combined margin of victory in nine cities in the area, which are more than 90 percent Latino on average, has declined by nearly 40 percent since 2016. Trump has gone from getting less than 10 percent of votes to nearly 30 percent.

This is not just a function of Democrats staying home. Trump received more than three times as many votes this year in Southeast Los Angeles than he did during his first presidential run.

“That’s what influenced me the most—that things might stay the same as they are now.”

While the data makes clear that voters in largely working-class Latino areas have moved right, the results do not reveal how individual Latinos who live in more mixed (and often richer) parts of Los Angeles voted. Compared to Southeast Los Angeles, Democrats’ have lost less support since 2016 in more middle-class majority-Latino cities, although those cities remain more conservative overall.

Still, a national trend—working-class Asian and Latino voters shifting to Republicans, and upper-class voters choosing Democrats—can be seen in miniature in Los Angeles County.

The results in Southeast Los Angeles mirror the dramatic drops in Democratic support in heavily Asian and Latino areas across the country, ranging from the border counties of Texas' Rio Grande Valley to the rural towns of California's Central Valley to urban areas of New York and New Jersey. While some of these losses have been offset by gains among affluent college graduates who once voted Republican, it was not enough for Harris to win.

The voting records analyzed by Mother Jones include results for roughly 170 communities. Since 2016, Democrats’ margin of victory has dropped by at least 25 points in about 40 of those places, which is well above the countywide shift of about 17 points during the period. In nearly every single community with that large of a drop, Latinos and Asians comprise a majority of residents. The main exception is Beverly Hills, a famously affluent area with a large Jewish population. (Most of the shift in Beverly Hills happened between 2016 and 2020—meaning that it was not primarily a reaction to how Democrats discussed October 7 and Israel's military campaign in Gaza.)

Karina Macias, the mayor of Huntington Park, said in a phone interview that the shift to the right among her constituents reflected concerns with issues that voters across the country prioritized: price increases, crime, and immigration. Macias noted a significant uptick in the number of families in Huntington Park who rely on food distributions, including among residents who probably would have never considered seeking help in the past.

"The Democrats had the opportunity to help us. They didn't do it. "

“I think a lot of people were looking at their current economic situation, and [were] pissed off about it," Macias said. "Can you blame them? No, right? Especially in a community like Huntington Park, they feel it. They’re paying a lot more for things and are not necessarily being paid a lot more. If they work two jobs, maybe somebody in the household needs to go and get another job, right? We have a lot of families here that are doubling up in an apartment, and that’s how they get by."

The nearly 40-point shift in Southeast Los Angeles is far different from what has happened in some of the wealthier communities in Los Angeles. In the affluent coastal cities of Manhattan Beach, Redondo Beach, and Hermosa Beach, Democrats have maintained or slightly improved their margin of victory since 2016.

But these voters did not necessarily back Democratic candidates all the way down the ballot. In 2020, Los Angeles County voters elected George Gascón, a progressive Cuban-American district attorney defeated his more moderate opponent by seven points. After the win, a backlash began almost immediately. This year, Gascón still managed to secure the endorsement of the Los Angeles Times. But he ended up losing to Nathan Hochman, a comparatively tough-on-crime challenger who became an independent after running as a Republican for California attorney general office in 2022. Hochman won by 20 points—a 27 point swing from 2020.

Wealthier cities like Manhattan Beach and Santa Monica moved harder against Gascón than most of the county, despite being the areas where Democrats had some of their best results at the top of the ticket. Santa Monica residents went from supporting Gascón by a nearly 2-to-1 margin in 2020 to backing Hochman. In Manhattan Beach, Gascón lost by about 50 points—nearly 40 points worse than he did there four years ago. It meant that there was an almost 80-point gap in the city between Harris and Gascón, even though both are Democrats.

Some of Democrats’ most reliable voters in Los Angeles now seem to be rich people who disdain Trump but also recoil to an unusual degree at the left’s approach to criminal justice reform. This new base leaves Democrats in a complicated place as a party that has long thought of itself as fighting for working people.

It is not hard to imagine a less inflammatory Republican than Trump winning the wealthy back to the GOP. Doing that while keeping most of the party’s inroads among working-class voters intact could be challenging—but such cohesion would be a way for the GOP to upend California, and national, politics.

The Los Angeles data make clear how much Democrats are struggling with Asian voters as well. Those challenges appear to be most severe among working-class Asians. That can be seen by looking at the results in San Marino, a majority-Asian city that is one of the 10 wealthiest communities in the county. It has a median home sale price of $2.3 million and is known for attracting wealthy investors from mainland China. Unusually for a majority Asian city, Democrats have lost no support in San Marino since 2016.

Meanwhile, in Monterey Park, which is also about two-thirds Asian but more middle class compared to San Marino, the Democrats’ margin has shrunk by 20 points. Similarly, Rosemead, which includes a significant Vietnamese American population, has shifted about 35 points to the right.

Still, the loss in support has been most intense in working-class Latino communities, despite Trump's rhetoric about immigrants. Macias mentioned a cousin who told her that he was planning to vote for Trump. When Macias reminded him that they have family members who are undocumented, he argued that Trump's promises about mass deportation were just rhetoric. (Macias stressed that despite her cousin's comment there is a "palpable fear" among many people in Huntington Park about what Trump might do.)

Another dynamic is a belief among some Latino voters that Venezuelans, who crossed the border in record numbers in recent years, and other people arriving today are different from them and their ancestors. Gustavo Arellano, a Los Angeles Times writer who covered the recent political history of Southeast Los Angeles earlier this year, told me before the election about how his cousins objected to "these new immigrants" and were turning Venezuelans into scapegoats.

"Venezuelans they get free everything," Arellano said, paraphrasing his cousins. "Our parents, when they came here illegally, didn't get anything at all. They did it on their own." Arellano tells his relatives that "these immigrants are just like our parents" but they insist otherwise. Macias didn't hear this perspective too often, but did recall someone saying about recent arrivals: "They're demanding things, and we work for them."

It also doesn't help that Democrats—largely as a result of Republican opposition—have been unable to deliver on their promises to provide legal status to family members of some of the voters now turning against them. An undocumented Salvadoran immigrant named Sam made that clear when we spoke in Huntington Park—even though he was one of the strongest Kamala Harris supporters I interviewed.

"The Democrats had the opportunity to help us," Sam explained in Spanish. "They didn't do it. As a result, all the Hispanics that are scattered throughout the United States, who are now citizens, who can now vote, are making them pay."

His partner argued that Americans aren't prepared for the world Republicans are vowing to bring into being through mass deportation: "It's laughable that if you go around Bakersfield, or around where the crops are, there are no Americans there. There's none of that there. I don't think that a person like you, who is a professional who works, let's say, at a different level, is going to go there and pick strawberries. And those strawberries don't pick themselves. So what's going to happen?"

Like most people in Southeast Los Angeles, Sam still favored the Democrats. And the voters who abandoned the party aren't necessarily lost, either.

Rosario, the Dominican shopkeeper, said she considered herself an independent, even though she'd recently voted for Trump. I asked her if she might have voted Democrat if another candidate had been on the ballot. It was possible, she said.

At the start of the campaign, she had leaned Democrat because that was the party she had always supported. But Biden "didn't seem well" so she switched to Trump. After Harris got into the race, she stayed with Trump because Harris was part of the current administration.

It was more about the candidate than the party as a whole. "I think that if Obama’s wife had been running, I would have voted Democrat,” Rosario explained. “I like her a lot.”

ABC News will pay $15 million to settle a defamation lawsuit that president-elect Donald Trump brought against the network, centered on incorrect comments that anchor George Stephanopoulos made about the civil lawsuit against Trump brought by writer E. Jean Carroll.

The details of the settlement are concerning for anyone who cares about press freedom in the next Trump administration. And, in particular, it shows again how New York state’s definition of “rape”—that has since been changed—has allowed Trump to wiggle out of criticism for sexual assault allegations.

The lawsuit focused on a March 10 interview that Stephanopoulos conducted on the network’s Sunday morning show, “This Week,” with Rep. Nancy Mace (R-S.C.). In that interview, Stephanopoulos confronted Mace—who has said she’s a rape survivor—about her endorsement of Trump, falsely noting that “judges and two separate juries have found him liable for rape, and for defaming the victim of that rape.”

Stephanopoulos was referring to the lawsuit brought by E. Jean Carroll, who alleged that Trump raped her in 1996 in the dressing room of a New York City department store; as my colleague Russ Choma reported, while the jury found that Carroll’s attorneys did not prove the rape allegation, they did agree that Trump forcibly sexually abused and defamed her, and ruled that Trump had to pay Carroll $5 million.

Still, it is even more complicated than that. As my former colleague Katie Herchenroeder reported, the judge in the Carroll case went to great lengths to clarify that while Trump was not found liable for “rape” under New York’s strict definition—vaginal penetration by a penis—his alleged actions of forcible penetration with his fingers meet the definition of what many people broadly understand as “rape.”

As Katie wrote:

That the jurors did not find that Carroll had proven rape, [Judge Lewis] Kaplan explained, “does not mean that she failed to prove that Mr. Trump ‘raped’ her as many people commonly understand the word ‘rape.’” “Indeed,” he continued, “as the evidence at trial recounted below makes clear, the jury found that Mr. Trump in fact did exactly that.” 

Federally, rape is defined as “penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” This broader explanation, while still dependent on penetration, would include assaults using fingers. 

Lawyers for ABC and Stephanopoulos referenced this context from the judge’s statements in their unsuccessful motion to dismiss the lawsuit they filed earlier this year, court records show.

As Katie wrote, New York wound up passing a law that expanded the law to include nonconsensual anal, oral, and vaginal sexual contact. When she signed the bill into law, Gov. Kathy Hochul (D-N.Y.) recognized Carroll “for her courageous efforts to make sure justice was done.”

As part of the settlement, ABC will pay the $15 million to the Trump presidential library—which currently only exists online—plus another $1 million in Trump’s attorney fees, court records show. The network also added a note to the online story about the interview, noting that both ABC and Stephanopoulos “regret” the comments.

Mace—who accused Stephanopoulos of “shaming” her during the original interview—celebrated the ruling on Saturday, writing in a post on X: “Let this be a warning to all haters: Defamation is real, and your free trial of badmouthing just expired.” In another post, she wrote: “2025 will be the year of [mainstream media] apologies.”

Media scholars and experts have been sounding the alarm about journalists’ and media companies’ capitulation to Trump—who just last month said he would be ok with someone shooting through a crowd of journalists—ahead of his second term.

And they have good reason to be worried: While Trump has claimed he now believes a free press is “vital,” there are fears that he and his acolytes could use baseless lawsuits to go after journalists whose coverage is unfavorable to him—particularly after Sen. Tom Cotton (R-Ark.) this week blocked a federal shield bill that, if passed, would protect journalists from being forced to reveal their confidential sources.

Devin Nunes, the ex-California congressman and current head of Trump’s struggling social media platform, Truth Social, is getting his prize for being the next president’s long-serving yes-man.

On Saturday, Trump announced that he would appoint Nunes as chairman of the President’s Intelligence Advisory Board, a group of up to 16 private citizens who get high-level security clearance to advise the president on “the effectiveness with which the [intelligence community] is meeting the nation’s intelligence needs.”

In his Truth Social post announcing the news, Trump said Nunes would assume the role “while continuing his leadership of Trump Media & Technology Group,” the company that runs Truth Social. The role reportedly does not require Senate confirmation.

As my colleague David Corn has reported, as former chairman of the House Intelligence Committee Nunes attacked the investigation into Russia’s meddling in the 2016 election as a baseless partisan smear by Democrats—which, in Trump’s eyes, made him uniquely qualified to receive top-level security clearance.

“Devin will draw on his experience as former Chairman of the House Intelligence Committee, and his key role in exposing the Russia, Russia, Russia Hoax, to provide me with independent assessments of the effectiveness and propriety of the U.S. Intelligence Community’s activities,” Trump wrote in the announcement.

Nunes will draw on a robust track record of foot entering mouth. He compared homeless people to a “zombie apocalypse”; created a fake news site that insisted male privilege doesn’t exist; sued both the Fresno Bee, a local newspaper in California’s Central Valley, and a satirical Twitter account purporting to be his cow.

The Bee famously once called him “Trump’s stooge.” That seems to be the main qualification needed for the next admin.