The promise of GLP-1 drugs has always depended on people being able to afford them. These drugs still cost hundreds of dollars per month if you’re paying cash, at which point access becomes a privilege: The higher-income executive who wants to trim a few pounds might be able to afford them either way, but the low-income worker who needs the drug to lose significant weight might not be able to afford them — unless their health insurance covers it.

For a while, the trend lines for GLP-1 insurance coverage were positive. As of 2026, roughly two-thirds of private employer plans, which insure half of Americans, were covering GLP-1 medications for weight loss to treat obesity. Over the summer, Medicare launched a new $50-per-month prescription program. The US has struggled with an obesity epidemic for decades, but it looked like powerful drugs to treat it were finally starting to be more seamlessly integrated into the health system.

At least that’s how things appeared earlier this year. But now, private plans are pulling back from GLP-1 coverage. People are being left in the lurch, debating whether to try to pay for these drugs on their own or stop taking medicines they feel are making a real difference for their health.

The dilemma reveals one of the structural flaws in American healthcare. For working-age adults, your insurance depends on your job. Unfortunately, because people no longer stay at the same job for decades, there is not a strong financial incentive for employers to make investments that will benefit your health in the long term — but there is a strong incentive to minimize short-term costs as much as possible. It’s the kind of perverse rationale that could compel employer-sponsored health plans to stop covering a drug that, if taken over the full course of a person’s life, could help them not only lose weight but ultimately reduce their risk of heart disease, kidney disease and other chronic health problems, improving their health and saving all of us money as they get older.

“An employer or an insurer making coverage decisions doesn’t necessarily care if they’re saving Medicare money,” said Dan Sacks, a healthcare economist at the University of Wisconsin-Madison. “That’s a classic problem with the American health insurance system, and it’s certainly salient here.”

This mismatch between what’s good for people’s health and what’s good for the corporate bottom line has long been one of the underlying flaws in the US health system. Now access to GLP-1 drugs is shrinking just as these drugs were starting to make a real dent in the US obesity crisis. The stakes couldn’t be higher.

Why employer-sponsored health plans are suddenly dropping GLP-1 coverage

From the beginning, insurance coverage was the big question hanging over GLP-1s and their potential to revolutionize US healthcare. But recently, it looked like we’d turned a corner.

When I attended the Aspen Ideas: Health festival over the summer, pharmaceutical reps seemed visibly relieved that GLP-1 coverage had been picking up among private insurers. In 2026, about two out of every three employer-sponsored plans were covering some of these drugs for weight management, up from about 20 percent just the year before.

“They’re recognizing that this is an investment in their workforce,” said Laura Steele, who leads the cardiometabolic health unit at Eli Lilly, which manufactures Zepbound and Foundayo. “Yes, there is a budget, and there is a benefit design that every employer has. That’s real. That’s not going away. But they’re also recognizing the overall cost that they’re experiencing by not dealing with this too.”

But as employers and private insurers make coverage decisions for next year, they are suddenly pulling back. At least 10 percent of employer plans that currently cover GLP-1s for weight loss say they are likely to discontinue coverage in 2027, according to one survey by the Business Group on Health — and that number may still increase. A Mercer survey of large employers found that 6 percent had dropped coverage in 2026 and another 5 percent were planning to in 2027 or actively considering it. A separate report from the Health Policy Commission in Massachusetts found that the number of commercially insured people in the state taking a GLP-1 drug had fallen by 50 percent between 2025 and the first quarter of 2026 as private coverage started to drop off. 

Some of the biggest brands in the US are reportedly eliminating or reducing their coverage: PepsiCo, Starbucks, and Lowe’s among them. And their reasons are simple: It’s too expensive. The drugs still carry a high net price tag — $600 or more for a 30-day supply — and potential demand is high (two in every five American adults have obesity). 

When a lot of people start taking an expensive medication all at once, it’s going to raise costs for employer insurance plans — and they have to figure out how to adapt. Insurers set premiums at the start of each year, based on how many people are on the plan and how much healthcare they are expected to need. But if those estimates are off — say, if more people take an expensive GLP-1 drug than the insurer expected — they have to offset those costs somehow, and raising premiums the following year is a common solution. According to one estimate, premiums are projected to grow by 5 to 13 percent due to GLP-1 costs — and the burden of paying those higher premiums is likely to fall on the workers. The employer can also try to limit GLP-1 use by, for example, asking workers to pay more out of pocket for these drugs; according to Mercer, 27 percent of large US employers instituted some kind of utilization controls for GLP-1 drugs over the past year or plan to next year.

They also have the option to simply stop covering these drugs for weight loss altogether — and that’s the route more and more of them are deciding to take. The abrupt reversal has even caught economists like Sacks off guard.

“I was surprised that anyone would do an about-face because I thought they understood the trade-offs well,” Sacks said. “My guess is that it turned out to be more expensive than they anticipated: Take-up is higher, and possibly more people are sticking with it. That’s one reason that you might not want to continue to offer it.”

For employers, the short-term costs of covering a drug often outweigh the long-term benefits that medication may confer, at least from the employer’s POV. One analysis — notably produced by Blue Cross Blue Shield Kansas — concluded that covering GLP-1s for weight loss increased average employee health costs by $7,000 in the first year and another $4,200 in the second, largely due to the cost of the drugs themselves. And yet at the same time, there were no decreases in obesity-related medical events in that time period. Another study from Sacks and his colleagues at Indiana University and the University of South Carolina found that GLP-1 use did not lead to any cost savings over five years.

So in the short term, these employers are arguably making an economically rational decision — but one that may still come at their employees’ expense. “I’m completely screwed,” said one person on Reddit about Cigna’s plans to drop GLP-1 coverage for their own employees. They’re looking at at least $300 for one month’s supply at cash prices. 

They weren’t alone either: “I’m devastated,” said another person, commenting on Starbucks’s decision to stop covering GLP-1 drugs. They said they had an autoimmune condition that had made it difficult to lose weight — until this new class of medicines came along.

Where GLP-1 coverage goes from here

How could we end up here, where it makes good business sense for companies to make a decision that could potentially harm their workers’ health in the long term? It is at least in part a result of the haphazard way the US has ended up insuring people.

When employer-sponsored insurance started to arise in the mid-20th century, eventually becoming the primary way to cover the working-age population, people tended to stay at the same job for a long period of time. In theory, there was a synergy: Companies wanted their workers to stay productive, and so it was worth it for the company to invest in their long-term health via their insurance benefits. And research has found that people who stay with the same company — and the same insurance plan — tend to have better health than those who switch a lot.

But these days, people change jobs all the time or work various gigs to piece together an income. You probably don’t expect to stay at your job for 10 years — and your employer doesn’t expect you to either. Instead, they want to keep their own costs as low as possible in the short term. This leads them to cut GLP-1 coverage, even though doctors do believe that people could benefit tremendously long term from the weight loss these drugs help them achieve and all of its potential health benefits. 

“There are very real health benefits of these drugs,” Sacks told me. “The fact that we don’t find offsets or they’re even more expensive than we thought doesn’t necessarily mean that we shouldn’t cover them.”

In theory, the market is supposed to fix the price problem: Drug companies get a period of exclusivity for the drugs they develop, and then, once that time elapses, cheaper generic versions can come onto the market. But generic semaglutide won’t be available in the US until at least 2031 — and for some versions, the generic competitors aren’t going to debut until the 2040s. Offering GLP-1 coverage could become a competitive advantage for employers, a perk they can offer to entice potential workers as part of their benefits package.

Beyond that, though, the path to more affordable GLP-1s is not immediately obvious right now. A lot of people are already willing to pay cash for these drugs — and that may continue as long as people can afford to do it. But with inflation still steadily rising, these drugs could slip out of reach for more and more Americans.

The government could get involved, but, for now, the federal government’s negotiating authority only covers Medicare, not the private plans that are dropping coverage. Serious healthcare reform is probably off the table until at least 2028, and then only if Democrats win both Congress and the White House and decide to make a healthcare package their legislative priority.

But the lesson of these recent developments is that, at some point, the US may have to look seriously at the underlying problem creating this mess in the first place. A patchwork method of insuring people that privileges short-term cost-cutting over people’s long-term health isn’t a real healthcare system.

No, Rome was not built in a day, but it was built at breathtaking speed, its temples, amphitheaters, and aqueducts rising with the help of a magical blend of volcanic ash and lime. Today, that miraculous mortar has a less than enchanting name: concrete.

“Romans lived through a true architectural revolution, and at the foundation of this revolution, literally, was a concrete discovery,” said Admir Masic, a materials science professor at MIT who made waves a few years ago for unearthing the fast-hardening secret sauce for why Roman concrete is so durable. “They were able to take a pile of dirt and mix it together, add water, and turn it into solid rock of any arbitrary size. It literally changed everything.” 

And yet, for a millennia after the fall of Rome, the world largely forgot about concrete, until, in the 18th century, an English mason found that mixing limestone and clay could form a paste that hardened underwater. Another few decades later, concrete as we now know it was reborn, and once again, it changed everything. 

In the centuries since, concrete has come to reshape our way of life, with disastrous results for the climate. What early concrete evangelists didn’t realize was that the modern way of producing the substance released giant amounts of carbon dioxide into the atmosphere. As it has become increasingly central to modernity, it has helped fuel environmental catastrophe.

Today, however, a new generation of concretophiles like Masic have pored over the poured mixture in search of another miracle, a greener, more durable kind of concrete. And they’ve found multiple answers, from concrete that can heal its own cracks — as the Pantheon has for millennia — to electroconductive concrete capable of storing energy to a blend that allows concrete to soak up more CO2 than it emits. 

Together, they suggest that in a not-so-distant future, concrete — yes, concrete — one of the dirtiest substances ever concocted, could help save the planet, transforming our built environment while actually intervening in the climate for the better. 

How concrete built (and polluted) the modern world

It’s no wonder that luminaries of the neo-concrete age, Thomas Edison among them, marveled at the stuff just as their Roman predecessors had. They saw it as a harbinger of utopia, of a world in which anything and everything — a home, an interstate highway, a water pipe, a subway system, or a grand piano — could be molded and poured for a fraction of ordinary costs. 

“As to concrete dogs to stand warningly in the front yard and concrete cats to purr stonily under a concrete kitchen range,” the New York Times teased Edison in 1911 when he described his plans for a concrete home finished with concrete furnishings, “he made no announcement.”

The beguiled inventor’s utopian vision of a world remade by concrete would come true in more ways than he realized. Yes, it changed the way we build forever. Muddy roads and rotting wooden sidewalks gave way to smooth gray pavement, and newly cast sewer systems saved millions of lives in the deathly dirty cities of the early industrial era. Concrete, when poured over rods of steel, proved strong enough to prop up colossal skyscrapers that Julius Caesar could only have dreamed of. 

But there was a trade-off: Every time Edison fired up his trademark 150-foot kilns, scorching the limestone inside into blistering pebbles of cement clinker, he released hundreds of tons of carbon dioxide into the atmosphere. 

Yankee Stadium was built not by Babe Ruth’s swing alone, but with around 30,000 cubic yards of Edison concrete, whose creation released at least 5,400 tons of CO2, the equivalent of driving a gas-powered car 12.5 million miles, or to the moon and back more than two dozen times. But this is nothing compared with the roughly 30 billion tons of concrete the world now uses each year, enough to have turned the gluey gray goo into the second-most used material on Earth. (The first is water. Glug glug.) 

The Anthropocene has been built atop a foundation of concrete, its weight eclipsing the biomass of all living things, and its annual carbon tab responsible for up to 8 percent of global emissions, the equivalent of the entire country of India. Critically, unlike the astonishingly enduring remnants of Rome, our modern concrete decays quickly, so it must be repoured time and time again, which only makes it more environmentally catastrophic. 

But it doesn’t have to be this way, not anymore. 

“The future of concrete is to think differently, to go away from claiming that cement is bad,” Masic told me. “Our goal is to turn this around and make concrete part of the solution instead of being a problem.”

This is why we can have nice concrete

Per ton, concrete actually emits far less CO2 by volume than other materials like aluminum, steel, plastic, or glass. 

The problem is that we use so much of it, even a slightly negative footprint can quickly become enormous. But “the upside is,” said Sabbie Miller, a professor at UC Davis who focuses on sustainable concrete, “if you’re able to come up with some small change, then those small changes will also scale” in ways “that could have a huge effect on modern society and its burdens on the environment.” 

One of those solutions takes a cue from the Romans, who made concrete differently than we do today. Their once-mysterious method ensured that hulking structures like the Colosseum or the Aqua Virgo, an aqueduct built during Augustus’ reign and still in use today, could survive for millennia while New York City’s Brooklyn-Queens Expressway or the Washington Bridge crumble after just a few decades of use. 

It’s not just that we drive cars over our concrete freeways while the Colosseum has been mostly free of even the bulkiest chariot wheels for millennia. The answer, according to Masic’s research, lies in the Romans’ ingenious recipe for cement, the glue that binds concrete together. When the ancients brewed a batch of cement, they left big white chunks of dormant lime in the final mixture. Later, if a crack formed, any water would react with the idle lime, filling the fissure with new stone. Our modern concrete has no such lime clasts, meaning that if water seeps into a crack, it degrades the structure from within, rusting the rebar that made our big towers possible, leading to a grim condition known as “concrete cancer.” 

Masic has recently turned his research into a startup called DMAT that reserves unreacted lime in concrete, giving it self-healing properties he says could extend a structure’s lifespan by about 50 percent, which in and of itself would reduce its carbon footprint by 40 percent. If the construction industry normalized such concrete or other mixtures that emit, say, half as much CO2 as usual, it would keep hundreds of millions of tons of it out of the atmosphere each year. 

But why stop there? Some startups have gotten much better in recent years at producing concrete capable of quite literally breathing in more CO2 than it emits in a process that takes advantage of concrete’s natural porousness. It could, in theory, turn our cities into concrete rainforests by turning the material into a storage reservoir. As Miller put it, “what if we can use our concrete to undo some of our environmental damages that we’ve already caused?” 

In the Bahamas, the startup Partanna has already built what it’s called the world’s first carbon net-negative home, an unassuming 1,250-square-foot abode that the company claims will sequester 182.6 tons of CO2 in its lifetime, the equivalent of hundreds of trees. Meanwhile, Masic’s lab has been piloting ways to turn concrete into a giant battery, capable of storing solar power during the day and releasing it at night, a green innovation that could cancel out its own carbon footprint within a few years of use. 

Masic believes that electroconductivity could be key to catalyzing a new era of concrete — more so even than his neo-Roman ventures. “It might hold the secret,” he said,  “for turning a bad guy into something amazing.” 

But as promising as these innovations are, it will take time for them to ripple out from model homes and into the concrete that actually surrounds us. American concrete startups have lost billions of dollars in federal funding and expected procurement contracts under the Trump administration. Some states, most notably California, are helping to pick up the slack, but investment still lags behind potential. There’s also the challenge of convincing builders running on paper thin margins that their old ways of doing things might fit better in a new mould. 

But concrete’s staggering scale means that we can’t afford to keep pouring it without considering its ugly trade-offs. More importantly, perhaps, we can’t afford to miss out on the opportunity that such a mammoth, transformative material presents to change everything yet again. 

Welcome to The Midterms, Actually. Every week I’ll be writing about two things: one big idea or trend I see forming across the 2026 primaries, and one thing I’m hearing from a voice on the ground. Let’s get into it.

One big idea: How much can Democrats slow down Trump?

A tricky thing to communicate about the upcoming midterms is that, at the federal level, the impact may not be what’s expected, at least when it comes to slowing President Donald Trump’s agenda.

Hear me out. Say the blue wave predicted by most polling materializes on November 3, and Democrats take the House and even squeak out a slim Senate majority. What happens next? Does that stop Trump from executing his agenda? Does the White House moderate its message in response to an electoral backlash?

The evidence suggests no.

Because the backlash is real, the political incentives aren’t.

Let me explain: The numbers do look rough for Trump. Pew had his approval rating at 30 percent in a survey conducted September 28 to October 4, the lowest of his second term, with Democrats up eight on the generic House ballot. Reuters/Ipsos had him at 32 percent in early October. Polling averages are a bit higher, roughly 37 percent to 39 percent depending on the aggregator. Ballotpedia’s September average put Democrats at 50 percent on the generic ballot to Republicans’ 43 percent.

But none of that is moving him. Trump is fundamentally shameless, untethered to traditional political incentives, and increasingly unhinged in his second term. He initiated a war with Iran that quite literally no one wanted. He’s plowing ahead with renewed mass deportation efforts even as Republicans urge him to abort the mission. He’s more unpopular by the month, and more consumed by vanity projects in Washington: the White House ballroom, a federal takeover of a DC golf course, whatever’s happening at the reflecting pool.

More importantly, he’s been quietly preparing for this moment of backlash, legally and politically. If there’s one theme of Trump’s second term, beyond the promises of retribution, it’s his drive to grow executive power to the point where he’s insulated from political consequences. And the courts have largely backed him.

Let’s run the tape

The legacy of Elon Musk’s Department of Government Efficiency was less about finding waste, fraud, and abuse than about asserting presidential power over the federal bureaucracy. Trump has brought independent agencies to heel, firing members of the National Labor Relations Board and the Federal Trade Commission. In Trump v. Slaughter, the Supreme Court sided with him 6-3, overturning the 90-year-old Humphrey’s Executor precedent that had limited when presidents could remove agency heads. (The one notable exception: The Court refused, 5-4, to let him remove Fed governor Lisa Cook for now.)

His immigration push included federalizing National Guard troops for domestic purposes. He’s pursued unilateral military action that breaks precedent, like the Caribbean boat strikes on suspected drug smugglers. And he’s picked another fight with Congress that’s headed to court, unilaterally withholding roughly $800 million in congressionally approved funds from 11 programs supporting refugees and asylum-seekers, minority business development, housing counseling, and more.

To be clear, I don’t believe this anti-democratic throughline is happenstance. Trump has systematically used his first two years back in office to grow the power of the presidency and find ways to execute his agenda without Congress, as he did with his many tariffs — which he also claims, wrongly, that he can use to personally authorize $5,000 checks. His MAGA base has always believed the ends justify the means, but this White House has gone a step further, making clear it won’t be constrained by pesky things like federal law, separation of powers, and checks and balances. More explicitly, it openly subscribes to the “unitary executive” theory advanced in Project 2025, which argues, in essence, that the president has total control over the executive branch, including agencies like the FBI and Justice Department that have traditionally exercised some independence. 

Don’t believe me? Here’s Trump at a Turning Point conference in 2019: “Then I have an Article II, where I have the right to do whatever I want as president.” Or early in his second term: “He who saves his Country does not violate any Law.”

Stephen Miller said the quiet part out loud last year, too. In an interview on CNN’s News Central, he froze after asserting that the president has “plenary authority,” meaning Trump’s power is unreviewable and unquestioned.

And here’s a line from Project 2025, which basically foretold our current constitutional crisis: The next Republican White House “must take seriously the duty to protect the powers and privileges of the President from encroachments by Congress, the judiciary, and the administrative components of departments and agencies.” 

Is that how democracy works? 

So what does that mean for the midterms?

Of course, it’s tricky to be predictive. But when I hear Democrats say a new congressional majority will hold Trump accountable, I wonder if they should qualify those promises with a reality check.

No blue wave can overcome the structural realities of gerrymandering, which has collapsed the number of competitive districts and disincentivized compromise. Cook Political Report found that mid-decade redistricting cut the number of competitive House seats from 87 to 77, meaning Democrats now need to win 57 of those 77 to take the chamber, up from 59 of 87 under the old lines. Cook projected Republicans gaining roughly eight seats from the redraws, Democrats two. Cook’s David Wasserman has noted that fewer than 5 percent of Americans are living in the districts that will truly decide House control. Control of the House is still up for grabs, but the narrower playing field makes sweeping change much harder.

No wave can overcome conservative control of the courts, which has only grown in Trump’s second term. And most crucially, a wave matters less to a White House that thinks in such absolute terms, and sees Congress as something to be overcome, not worked with.

In a typical administration, all the conditions for Trump’s last two years would point toward de-escalation. The public has fallen out of love with the administration’s priorities, he won’t be on the ballot in 2028, and Republicans would theoretically be freer to chart their own course.

But as Trump has proven time and again, there’s no guarantee those rules apply to him, or to this version of the GOP. If anything, the 2024 presidential primary showed that Republicans are more likely to rally around Trump when they feel he’s being targeted by liberal Democrats.

That doesn’t mean the midterms don’t matter

Far from it. As we explored on America, Actually last week, there are important state and local races that will determine Americans’ access to healthcare, abortion rights, and more. The results will shape how each party approaches 2028. And a Democratic-led House or Senate could certainly make Trump’s life harder, particularly through investigations or impeachment efforts or by blocking cabinet picks and judicial nominees.

Trump will go down fighting to make Project 2025 our reality, and no matter what happens in November, the first two years were just the start.

But the question I get most often on the road is: Will November stop Trump’s agenda? To that, I think it’s important to be skeptical.

Politically, Trump is unlikely to exit stage left gracefully, and will likely hog the spotlight even as the GOP kicks off its primary to replace him. More importantly, he’s spent two years showing his hand, prioritizing an all-powerful executive branch that can thumb its nose at anyone who interferes.

The lame-duck stretch of a presidency is typically its sleepiest, as the administration focuses on limiting damage to its legacy and setting up a smooth succession. With Trump, I expect the opposite. He’ll go down fighting to make Project 2025 our reality, and no matter what happens in November, the first two years were just the start.

One thing I’m hearing

This week, we talked to Estefanía Pinto Ruiz, a democracy‚ immigration, and rural communities reporter for Enlace Latino NC. Considering how central Latino voters are to this year’s midterm elections, I wanted to ask her about her coverage of that community in North Carolina, an important battleground state. 

You reported on Latino voters’ exposure to political misinformation in Spanish. What did you learn about how language and platforms shape the information voters encounter?

One key lesson I learned from my reporting is that language and other media-related factors affect access to and understanding of political information․

A survey conducted by Marisa Abrajano‚ a political science professor at the University of California San Diego‚ found that Latinos who got news from Spanish-language social media were 11 percentage points more likely to believe political falsehoods in the survey than Latinos who got news from English-language social media․

But a major distinction is that the research found a correlation but not a causal link between the two behaviors․ Reading news in Spanish doesn’t mean people are more likely to be exposed to misinformation․

Another important takeaway is the role of social media and video sites like WhatsApp and YouTube․ Many Latino adults rely on these sites along with or in place of Spanish-language media sources for political news․ News they receive on WhatsApp from family and friends can shape their views of information from other sources․

Your newsroom has asked readers to share election information they’re unsure about. What questions or claims are coming in, and what do they reveal about the confusion voters are facing?

Oftentimes people are unsure about the basic mechanism of voting: where they are supposed to vote, what their ballot will look like, or what happens if they encounter an issue at the polls. The confusion can also often come from information shared by official sources. For example, we’ve covered voters who received letters from the State Board of Elections asking them to review their registration information and worried about what that meant for their right to vote. We’ve also reported on allegations of misinformation during voter registration drives, including cases in which canvassers were falsely presented as election officials.

Beyond those stories, what are you hearing locally about the midterms that you think the national political conversation is missing?

First, the top issue is the cost of living: groceries, rent, utilities, and gas. Immigration enforcement comes close behind, but voters hold both worries at once, and they don’t vote as a monolithic bloc. Conservative and progressive groups here both say voters judge candidates on tangible outcomes, not party loyalty.

Second, this electorate is young, and that youth is often mistaken for apathy. Roughly a third of eligible Latino voters in North Carolina are under 25, and the median age is 35, compared with 48 for the state’s electorate overall. In my reporting at Enlace Latino NC, I see many first-generation citizens whose parents stayed away from US politics because of experiences with corruption or violence in their home countries. Emanuel Ramirez, 20, an NC State student, said his father fled a military coup in Guatemala and his mother violence in Colombia, and that his parents avoided US politics because they knew how dangerous political involvement could be. Emanuel taught himself the process and pre-registered at 16. Grassroots groups are using peer-to-peer outreach, often in Spanglish, to make voting less intimidating for families navigating it for the first time.

Third, national attention tends to center on federal policy, but state and local decisions are directly shaping how this election is run. Voters and advocates tell us that changing rules can create real hurdles, especially for first-time voters. Wake County replaced the long-standing Talley Student Union polling site at NC State with the Business Services Center as part of a record 18 early voting sites. While officials say they have expanded access countywide, students note that far more people voted early at Talley in 2020 and 2024 than at the replacement site.

Meanwhile, state election guidelines for processing mail-in ballots have tightened: Mail-in ballots will not be counted if the inner envelope is unsealed or signatures do not match, among other changes. Additionally, the State Board of Elections is sending letters asking 1,599 registered voters, flagged as potential noncitizens by a federal database, to confirm their citizenship or face removal from the rolls. While officials clarify that letter recipients can still vote, critics note the database is prone to errors, and advocates worry the notices could discourage eligible citizens right before early voting.

Donald Trump started his second term in office with a plan: Project 2025. 

The document — a detailed policy blueprint put together by the right-wing Heritage Foundation — outlined not just a hardline policy agenda, but a novel theory of how to wield power to get it done. Its chapters showed how a conservative president could aggressively use executive authority to strengthen the parts of the government he liked, like immigration enforcement, and smash the parts he didn’t, like foreign aid and the civil service.

During his presidential campaign, Democrats attacked Project 2025 as a nightmarish glimpse into what Trump would do if reelected, while Trump dismissed it as an outside plan irrelevant to his presidency. We now know Democrats had it right: Trump embraced Project 2025 for real. After winning, he appointed Russell Vought — the intellectual force behind Project 2025 — to lead his Office of Management and Budget (OMB) and put its ideas into practice.

By now, its slash-and-burn tactics have fundamentally broken many parts of the federal government. The administration has managed to fire or push out hundreds of thousands of its employees and tear up the procedures that govern policymaking and implementation. It has also demolished the guardrails that protect democracy from power: bulling through constraints on executive authority, usurping Congress’s core responsibilities, and attacking the civil rights and electoral rules that underpin American democracy. 

As a result, the next president will not just inherit whatever policy messes Trump leaves behind. They will also be leading a government that may be structurally incapable of enacting appropriate fixes to those problems.

Democrats have bemoaned the results, but it’s long been unclear if they actually understood the real lesson here. Project 2025 showed that wielding power now requires not just policy vision, but also a theory of government — a plan to manipulate and reshape the very structure of the state to make sure new laws can be more than just words on paper.

With the Trump administration collapsing in popularity, and Democrats surging in the polls, we may see a test as soon as 2029. If they indeed win the next presidential election, will Democrats have anything as potent as Project 2025 in store?

The most prominent Democratic response to Project 2025 — an effort from a leading think tank, officially called “Project 2029” — seems undersized. A grab-bag series of conventional policy proposals, addressing issues like kids’ online safety and “the annoyance economy,” it does not even seek to grapple with the fundamental problem of a broken government.

But after months of reporting, I’ve learned that there is a quieter effort underway to build a true equivalent to Project 2025: a set of ideas for remaking the government just as sharply as Trump and Vought did — and perhaps more permanently.

The real Project 2029, as I’ve taken to calling it, isn’t yet a public document. But its broad agenda has become a point of consensus across the Democratic Party’s major factions. And importantly, its core ideas have real buy-in among both congressional Democrats and the top 2028 presidential hopefuls.

Unlike with Project 2025, no one organization is leading the charge. Rather, the real Project 2029 has been emerging from collaboration between loose groupings of NGOs, ex-Obama and Biden officials, and academics. Unlike the official Project 2029, they have no interest in developing campaign-trail-ready proposals on issues like childcare. Instead, they are laser-focused on responding to the Trump-Vought assault on democracy and the state.

“If you’re focused on the outcomes, you’re missing the real work that’s going on,” a top Democratic policy mind involved in these efforts told me.

The brain trust involved does not see its goal as simply restoring the pre-Trump status quo. Quite the opposite: Their central premise is that the government was broken before Trump’s second term. The hope now is to use Trump’s demolition derby as an opportunity to (ahem) build back better: to take the federal government, at once a tangled mess and an authoritarian menace, and turn it into a 21st-century democracy.

Where Project 2025 was dedicated to breaking the administrative state — firing bureaucrats and destroying entire agencies — the Democratic counterstrategy aims to create a government that can implement duly enacted policies with speed and competence. And where Project 2025 aimed to demolish democratic guardrails, Project 2029 aims to right-size the presidency and put in new barriers to prevent abuse of power.

This renovated federal government would be simultaneously more efficient and more constrained: capable of reacting to economic crises and delivering benefits at lightning speed, while simultaneously incapable of prosecuting the president’s political enemies or wielding ICE against peaceful protesters.

These general goals are increasingly being sharpened into concrete proposals. While there isn’t an authoritative policy document at Project 2025’s level of specificity, some key ideas include:

• A new, vastly simpler and politically protected set of rules for hiring and promotion in the civil service;
• Creating entire agencies and Cabinet positions dedicated to battling corruption and inefficiency;
• Overhauling federal privacy laws to facilitate legitimate information-sharing while constraining DOGE-style data theft;
• Reviving a never-passed bill that would cap the president’s ability to declare emergencies at a 30-day duration;
• Eliminating barriers that block policies at the front end, like the Paperwork Reduction Act, while creating new judicial remedies for federal abuses — like permitting citizens to personally sue government officials who violate their rights;
• A rewrite of the 1946 law that governs the basic rules about how the executive implements policy; 
• Funding community-based organizations that can both assist in effective policy implementation and organize against federal overreach;
• Rewriting the basic structures of US government by blowing up the filibuster; Washington, DC, and Puerto Rico statehood; and overhauling the Supreme Court — though these remain far more contentious than the others.

While most of these ideas sound hyper-wonky, so did much of Project 2025. And experts on federal policymaking say that changes like these could have a transformative effect. Moreover, the degree to which Democrats are prioritizing government overhaul in their planning process is unprecedented — with clear evidence suggesting their interest extends across factional divides and up to its top leaders. 

“These are themes that are motivating people, that people genuinely care about [and] are putting time, energy, and money behind,” Don Moynihan, a political scientist at the University of Michigan, told me. “They see the stakes as paramount — we have to do this or our democracy is imperiled.”

Policy advocates who have been toiling away on these issues, for their part, believe that there’s a unique window for their ideas to become reality. “It feels like there has been a turning point,” said Jen Pahlka, a former Obama official who has become one of the leading lights of the government reform movement. “I think people see, in their own lives…the way that [government] is just breaking down.”

This new Democratic approach is beset by internal contradictions. There are some difficult trade-offs between efficiency and restraining power, a tension the movement is only beginning to grapple with. And there’s a major question of whether Congress, even when dominated by Democrats, is capable of passing reforms on this level of ambition.

But if these problems can be worked out, and its ideas turned into practical legislation and executive orders, the next Democratic administration could accomplish far more than anyone might expect. 

What the real Project 2029 is

If one person embodies the real Project 2029’s vision, it would be K. Sabeel Rahman.

Rahman, who has a PhD in political theory, with a focus on the relationship between democracy and capitalism, emerged as a leading Democratic thinker in the mid-2010s — ascending to the leadership of Demos, a think tank associated with the party’s progressive wing. After Joe Biden won the presidency, he tapped Rahman to help lead the Office of Information and Regulatory Affairs (OIRA), an obscure but exceptionally important White House bureau governing policy implementation.

Today, Rahman is a professor at Cornell Law School and, though he modestly suggests otherwise, one of the central figures in the Democratic project to reconceive American government. His forthcoming book, Remaking the State, will be an unofficial debut for many of its ideas.

This effort functions very differently from its conservative predecessor. While Heritage’s Project 2025 was a specific, dedicated group that produced a big blueprint document, the Democrats’ equivalent is more diffuse: a thinly connected network of people at think tanks, advocacy groups, and universities. Some involved organizations, like the Roosevelt Institute, are already prominent groups with a seat at the Washington table; others are obscure even by think tank standards. 

“There is no one plan — this is the biggest thing I want to convey,” Rahman said. “We desperately keep wanting a central planner, and we keep not having one. So instead, let’s stop trying to have one.”

Rahman and a handful of others have been trying to direct a process that can be — like a lot of Democratic Party processes — a little scattered and out of public view. He describes people coming together at conferences and convenings; collaborating on writing projects and sharing ideas through group chats and email chains.

“Efforts…have been happening below the water line, so to speak, with a lot of overlapping but often slightly distinct casts of characters,” said Alexander Hertel-Fernandez, a political scientist at Columbia University and former Biden official who held high-level positions in OIRA and the Department of Labor. 

A core task for this effort has been unifying ideas from two somewhat separate prongs of the Democratic brain trust. The first group focuses on restoring the power of the government to do useful things, quickly. The second aims to make democracy itself stronger, so future would-be autocrats can’t seize the reins the way Trump is trying to.

Both of those groups are responding to the Project 2025 agenda of blowing up the federal bureaucracy while empowering Trump. But they arise from different parts of the Democratic policy universe — and in some ways, the biggest challenge is making them cohere.

The focus on building a more effective federal government has its roots in a set of ideas often called “state capacity,” a major intellectual influence on the abundance movement. Its leading thinkers, like Pahlka, believe that the US government has been unable to function properly for decades due to bureaucratic hurdles — strict rules on data sharing, extensive multiagency review processes, and a glacially cumbersome hiring-and-firing process that protects incompetent workers and deters talented ones from going into public service. This bureaucratic mess, they argue, is the common thread underpinning liberal governance failures, from the healthcare.gov rollout debacle under Barack Obama to the disastrously slow and partial implementation of Biden’s Inflation Reduction Act.

Like many conservatives, this group is very interested in cutting red tape and adopting a more corporate level of efficiency. But they staunchly oppose Vought-style demolition of the administrative state. Instead, their ultimate aim is creating a more empowered government, one that is more nimble so it can deliver services and enforce regulation quickly and effectively. 

The ideas for constraining executive power, by contrast, come from what might be termed the pro-democracy movement. Originating largely in response to widespread alarm about Trump’s rise a decade ago, this movement thinks about government reform from the broadly opposite lens from the state capacity types. Looking at cases of democratic collapse abroad, they see an overly empowered executive branch as one of the chief threats to the republic’s survival — and have spent the past decade developing ways to constrain it.

Until very recently, the two groups’ work has almost exclusively operated on separate tracks. State capacity people often work in different think tanks, activist organizations, and academic fields than pro-democracy types. Their visions for policy reform have mostly proceeded independently, with virtually nobody trying to combine them.

The catalyst for change was the second Trump term — or, more specifically, Russell Vought and Elon Musk.

The twinned assaults on the structure of government from Vought’s OMB and Musk’s DOGE, their mass firings, and blatant power grabs, tore apart the policymaking basics Democrats had long taken for granted. Both the brokenness of the federal government and the health of democracy suddenly became immediately urgent concerns for the American left — and money and energy began pouring into developing a bold response.

Since then, the movements have begun to build out their respective policy visions. In October 2025, the Roosevelt Institute — the leading think tank for the party’s economic progressives — released a report essentially aligning itself with much of the state capacity movement’s vision of government repair. In January 2026, the center-left Searchlight Institute announced a new project involving Obama vet Mikey Dickerson, called Tech Viaduct, aimed at coming up with actionable reforms in this area. The Vanderbilt Policy Accelerator, an academic project led by longtime Elizabeth Warren adviser Ganesh Sitaraman, published a paper on civil service reform in February that made the Trump-driven subtext of this new energy explicit.

On the democracy side, the Brennan Center for Justice — a longstanding voting rights group — debuted a comprehensive plan for democracy reform, including multiple specific reforms for topics ranging from restoring congressional authority to reining in executive branch corruption. In October 2025, Vanita Gupta, an associate attorney general under Biden, became the director of a new center at NYU aimed at developing “blueprints” for rebuilding “institutions that have been so core to our democracy.”

While most of the people and institutions involved still focus primarily on their policy silo, government efficiency or democratic guardrails, Rahman and others have worked to develop a consensus that pulls these ideas into one big agenda — not by issuing a single document but by getting people with compatible ideas on how to fix the problem into the same (literal and digital) rooms. 

Hertel-Fernandez, for example, focuses on the democracy side of the question — leading something called the Empowering Democracy Initiative (EDI) that develops ideas for changing the distribution of political power in American society. But he’s in close contact with other progressive outfits, like Roosevelt, that focus much more on state capacity.

“There is a lot more alignment on the overall vision,” Hertel-Fernandez said. “We see ourselves as working on different parts of this broader effort.”

The real Project 2029’s vision

Project 2025 was, from the outset, a very public undertaking. Think tank ideas don’t accidentally become major issues in a presidential election: Heritage wanted its ideas out there, using publicity to claim its role as the defining voice in the GOP’s future.

Project 2029’s key leaders, for the most part, have a different theory. Topics of vital importance to them, like restoring the independence of inspectors general and reforming interagency review processes, are not liable to capture most people’s attention. Instead, they aim primarily to build elite consensus in private conversations. Key figures in the effort insisted on speaking with me anonymously or off the record to avoid attracting unwanted attention.

That being said, there are a few venues where you can see their ideas breaking containment. Multiple sources pointed to The Reconstruction Papers, an essay collection published by the magazine Liberal Currents, as a place containing specific policy proposals that people in 2029 circles are taking seriously. EDI has also published a series of relevant policy papers.

But perhaps the single best publicly available guide to Project 2029 thinking is a recent series of policy papers published on the website Just Security called the “Reinvention Blueprints,” edited jointly by Rahman and Sam Berger (another Biden OIRA vet, who also works with Hertel-Fernandez at EDI).

In their inaugural essay in the series, Rahman and Berger explicitly synthesize the work of both the government efficiency reformers and the pro-democracy advocates into a coherent and unified agenda. They claim that the efforts of these two camps are not opposed, as they might seem, but actually two sides of the same coin.

Drawing on an influential article by law professors Emily Chertoff and Jessica Bulman-Pozen, Rahman and Berger argue the federal government is actually two “faces” rolled into one. There’s a civil state, which delivers benefits and promulgates regulations, and a coercive state, which arrests, prosecutes, and makes war. While the civil state is bogged down by endlessly procedural hoops, the coercive state can move at lightning speed — using broadly worded emergency and national security powers to sidestep any checks designed to safeguard democracy and human rights. Vought has done much to break or politicize the civil state liberals prize, while further empowering its coercive sibling.

“The levers of state power most unrestrained,” they write, “are the ones most prone to abuse.”

In this view, there’s also a crucial difference between government efficiency and executive discretion. On paper, Congress is supposed to set policy, and the president is supposed to implement it. In practice, however, the president has usurped a lot of policymaking authority. It’s possible to give some of that back to Congress by (for example) limiting presidential emergency powers, while simultaneously eliminating barriers to swift implementation of duly passed laws.

An emerging goal of the real Project 2029 is to turn these theoretical syntheses into policy: to build a plan for speeding up “good” government and slowing down “bad” government at the same time.

Berger and Rahman believe this could create a virtuous feedback loop between government efficiency and democratic health. Part of the reason that the Biden administration failed in its central purpose — preventing Trump from returning to power — is because its attempts to provide benefits to the American public were hamstrung by the government’s inability to implement policy swiftly and effectively. A state that works better is also one that (in theory) should enjoy greater support from the public — and thus be less vulnerable to anti-system demagoguery.

So how do you fix all this in practice? Here, the answer is a bit murkier. Without a central hub that can authoritatively say “this is the agenda,” it takes a long time to translate political principles into consensus policy proposals. It’s also somewhat early: Project 2025’s final document wasn’t released till after the April after Biden’s midterm elections. But some concrete ideas are nonetheless gaining traction.

As part of the Reinvention Blueprint series, two former high-level Biden officials working on personnel — Loren DeJonge Schulman and Rob Shriver — published a detailed proposal for fixing the civil service. This is one of the clearest areas where the efficiency and democracy concerns intersect. It is both the case that the slow and hidebound federal bureaucracy is a key reason that policy implementation fails, and that political interference with the civil service has been one of Trump’s most effective tools for enacting unlawful and authoritarian policies.

Their piece is thus focused on recommending efficiency reforms that do not create dangerous room for executive interference. They call for reform of Title 5, the provision governing civil service hiring, to cut through the thicket of contradictory rules governing personnel onboarding — shortening hiring processes that currently take months or years. They call for a new merit-based assessment of civil service performance. And they call for a reform of the federal pay scale, increasing the top-level salaries of civil servants to allow the government to compete with the private sector for top talent. All of this, in their view, can be done without creating more avenues for political interference with the bureaucracy — so long as there are clear safeguards written in to insulate civil service decisions from presidential dictates.

This proposal shows how the two theoretically contradictory approaches to fixing government can, with a little policy creativity, be accomplished at the same time — and even as part of the same legislative reform package or executive order.

You can see similar thinking at work in the EDI papers. Collectively, they focus on proposals for “power-shifting” — which means, among other things, using public policy to build up constituencies like organized labor that can check abuses of state (and corporate) power. But they also are deeply interested in power-shifting as a way to provide better services; one paper, by Biden Department of Labor vet Rajesh Nayak, focuses explicitly on how strengthening certain civil society groups could improve state capacity.

And there are plenty of other ways, often implicitly stated in the existing literature, in which the two areas of concern overlap. Democrats could, in a single bill, eliminate widely hated barriers to swift implementation — like the ironically named Paperwork Reduction Act, which mostly increased bureaucratic hurdles to policy implementation — while also curtailing executive discretion over declaring emergencies. They could reform the Privacy Act of 1974, the key act governing data-sharing inside the federal government, to get rid of months-long holdups for key information (like database access passwords) while empowering citizens to sue if their rights were violated.

Most of the prior ideas require legislation, which obviously makes them harder to implement, but also ensures they would persist. While many have been awed by the blitz of unilateral executive action during the Trump administration, his many reversals of Biden’s executive actions have also demonstrated the long-term fragility of this approach. Indeed, much of what seems like Trump’s legacy today could be just as swiftly undone the next time Democrats take the White House.

Understanding this dynamic, as well as the legal limits on the presidency, the most impactful Democratic ideas for transforming government are designed as new legislation. The danger of this approach is veto points: the Senate filibuster and a Supreme Court override. As such, many of the people I’ve spoken to are — following the new consensus among congressional Democrats — open to ideas for radically changing the balance of political power. Ideas here include filibuster abolition, Washington, DC, and Puerto Rico statehood, expanding the size of the House, and various ideas for Supreme Court reform ranging from court-packing to jurisdiction-stripping.

“To do the things we all want to do, you just need to pass massive sweeping legislation,” Adam Jentleson, president of the Searchlight Institute, told me. “You’re going to need a lot of Senate seats to do it. And you’re also going to need to shift the balance of the courts.”

Not everyone involved is on board with steps this radical. The emerging consensus, inasmuch as it exists, is on executive branch reform. Ideas beyond that remain deeply contentious.

Its ideas, despite their shaggy structure, have penetrated nearly every corner of the party — and even brought people together across entrenched factional lines.

But the need for aggressive procedural moves was a major point of conversation at a conference I attended at Cornell in May, where I heard core elements of the Project 2029 vision floated for the first time. The event, titled “Rebuilding Democracy After Backsliding,” was held under Chatham House rules, meaning I can’t report the names of individuals attending nor attribute any remarks to specific individuals.

But it was clear to most of the attendees that the Senate and Supreme Court would be the biggest barriers to any kind of reform agenda — and that if Democrats win in 2028, they should be ready with ideas for muscling past veto points.

“A confrontation with the Court is coming,” one conferencegoer, a key figure in the Project 2029 conversations, said during their panel.

How this could happen for real

Given how loose this Democratic policy apparatus’ organizational structure is, it’s easy to be skeptical about its actual, real-world influence. What does it matter what a bunch of people are writing in obscure white papers or chatting about at conferences when none of them are going to be in Congress (let alone the next president)?

But what’s remarkable about the real Project 2029 is that its ideas, despite their shaggy structure, have penetrated nearly every corner of the party — and even brought people together across entrenched factional lines. They are widely popular among the people who will staff any future administration; in fact, they are already showing up in the rhetoric of party leaders and top 2028 candidates.

There is, in short, every sign that Democrats are actually serious about making dual-track government reform a central part of their next president.

Elizabeth Wilkins, president of the Roosevelt Institute, is the person who helped me appreciate this point most fully. An attorney and former Supreme Court clerk, she served in two senior roles in the Biden administration — first with Chief of Staff Ron Klain, and then with Federal Trade Commission chair Lina Khan. She joined Roosevelt shortly after the 2024 election, putting her in charge of what is arguably the most influential policy shop on the Democrats’ left flank.

On paper, Wilkins looks like she should be a factional knife fighter. Khan’s FTC was the nerve center of the neo-Brandeisian movement, a subfaction of the progressive movement (in)famous for assailing intra-party rivals as corporate shills. Neo-Brandesians have a special hatred for the abundance and state capacity types — the Pahlkas of the world — and have spent much of the past year trying to paint them as neoliberal sellouts whose efficiency agenda is really Republican-style deregulation in drag.

Yet under Wilkins’ leadership, Roosevelt has embraced many state capacity ideas. In the past year, they have formally partnered with both Searchlight and the Niskanen Center, a centrist think tank that serves as a hub for state capacity thinking, on events designed to build a shared left-center vision for fixing government.

“There is, at least in some corners, a useful consensus to be had about some of these reforms,” Wilkins said. “If you’re anywhere on the center-left to left-spectrum, there’s an opening to talk about what it looks like to [better] design and implement policy.”

Making government work should, in her view, quite obviously be a left-wing priority. She points to New York City Mayor Zohran Mamdani, who has made cutting red tape central to his democratic socialist mayoralty, as proof of the left’s seriousness here.

“Mamdani is probably the most abundance-pilled mayor we have in America,” she said. “He’s got this idea that if you want the state to have a major role in public life, you should be most laser-focused on making government work.”

If state capacity reforms seem controversial but quietly aren’t, pro-democracy reform is universally and loudly agreed upon by virtually everyone. Obama, Kamala Harris, and nearly every top congressional leader have called for new policy changes designed to rein in the power of the presidency and restore Congress’s power. The Democratic congressional delegation has proposed detailed legislation on multiple different related fronts, ranging from protecting civil service independence to imposing restrictions on ICE activity.

The flag-carriers may be running for president

It’s tempting to see support for this whole program as wide but shallow — something Democrats talk about, but won’t actually care about acting on once they regain power. Yet the top-polling 2028 candidates have demonstrated real personal interest in some aspects of this, and some have gone even further.

California Gov. Gavin Newsom is deeply invested in both sides of the coin: making government efficiency and abundance-style reforms a majority policy priority, as well as using California’s state resources to challenge Trump’s efforts to consolidate power in his own hands. Rep. Alexandria Ocasio-Cortez of New York co-founded House Democrats’ anti-corruption caucus, and Sen. Jon Ossoff (D-GA) has made challenging Trump’s self-interested abuse of power the centerpiece of his political identity. 

Former Transportation Secretary Pete Buttigieg has gone the furthest in embracing the Project 2029 worldview, making institutional reform pretty much his central pitch in interviews and public appearances. While his specific policy ideas tend to focus on some broader structural reforms — like expanding the Supreme Court and ending partisan gerrymandering — his general diagnosis is strikingly similar to the Project 2029 synthesis of state capacity and executive branch limitations (building on related ideas in his 2020 presidential run).

In one interview, he defined “the foundational issue” in American politics as figuring out “what it’s going to take for our democracy to function properly.” Proper functioning, in his mind, consists of two things: “a government that can provide basic services, and that can protect you from anyone who would make you unfree, including itself.” In another, he echoed the democracy reformers in putting executive branch overreach at the center of America’s problems: “If you have an executive branch that has shredded any institutions — even in the private sector — that could hold it accountable, you’re going to get really bad outcomes in your day-to-day life.”

When I spoke with him in May, he told me that the abundance and state capacity crowd “identified a bunch of things that are inarguably part of the [problem] with trying to build anything.” He also agreed with the basic view of his fellow Biden vets involved in Project 2029 — that their experience proved more radical reform to governing structures is the only path forward.

“If return to normal could be done, and could succeed, the last administration would have done it,” Buttigieg said.

This institutional message has become so central to his political identity that he’s turned it into a stump speech applause line. “I have come to believe that the kitchen table cannot be improved unless we are also reforming the institutional and political floor on which that kitchen table sits,” he said in an August address at a Black church in South Carolina.

There is, in short, both wide and deep investment in Project 2029-style ideas across the Democratic Party — which gives good reason to think that they will make up a pretty significant part of the next Democratic president’s agenda.

Will it really work?

The notion that Democrats are united around a set of policies that would, in a stroke, address the central pathologies of both the Biden and second Trump administrations almost sounds too good to be true. Alex Mechanick worries that it might be.

A professor at Johns Hopkins and a senior fellow at the Niskanen Institute, where he has become one of the leading voices in the state capacity movement, Mechanick has thought deeply about the interplay between these issues and constraining authoritarian power, and earlier this year he published the first academic paper to address the relationship in real depth. When we spoke, he expressed concern that much of the thinking in Project 2029 circles might be skating over some pretty significant conflicts.

Start with the premise, articulated by Rahman and Berger, that you can draw a useful distinction between authoritarian and beneficial forms of state capacity. Mechanick points out that many of the most worrying abuses of the Trump administration — like its use of the Federal Communications Commission and antitrust law to attack the free press, or its use of tariff exemptions to make corporations dependent on the president’s personal goodwill  — all involve traditional areas of economic policymaking that liberal state capacity types want to make more efficient. Liberating the civic state to deliver better policy, he worries, could just as easily turn it into a more effective tool for political repression.

“If you go down the line of the things the government ordinarily does, and you cross-reference them against abuses of power, I’m not sure that you get a clean separation,” he told me.

Nor does he think this problem can be solved merely by empowering Congress and constraining executive discretion. Even a well-functioning legislature cannot write self-executing laws. You also need the executive branch to have real latitude to decide how Congress’s general guidance applies in specific cases. In fact, he argues, doing Congress’s will almost requires a strong executive branch to carry it out. “You cannot run an effective state demanding constant legislative micromanagement,” he said.

If he’s right on both counts, then there is a real problem for the Project 2029 thinkers: They are minimizing the degree to which their two objectives — a more effective government and a constrained White House — are competing objectives.

“The frustrating reality is that there probably isn’t a solution that is going to eliminate all trade-offs,” Moynihan, the Michigan professor, tells me.

To see this in specific, look at debates over an issue that fascinates wonks on both sides of the project: the data-sharing provisions of the Privacy Act of 1974. It was initially passed to protect against the misuse of government data in Richard Nixon’s era. The law creates barriers to agencies cross-referencing information on citizens, like Social Security records being shared with the White House to facilitate political attacks on the opposing party.

Clearly, the regulation of government data use has become more important rather than less. But should it be made stricter — or looser? 

When democracy reformers talk, as in the third essay in the Reinvention Blueprints series, they tend to call for a strengthening of data-sharing rules — treating them as necessary to prevent rogue actors like DOGE and ICE from building data-powered tools for corruption or repression. But when state capacity thinkers like Pahlka talk about the law, they see it primarily as a barrier to good government — adding friction to efforts to swiftly implement policy in the internet-and-AI age. 

These kinds of specific tensions could pull apart the broad Project 2029 alignment.

“It’s a mistake to think that guardrails that will make it harder for us to deliver benefits will somehow stop an authoritarian,” Jentleson of Searchlight Institute said. “If I was faced with a trade-off [between efficiency and guardrails], I would generally — probably almost always — opt for the version that made it easier to deliver benefits.”

Mechanick’s paper suggests some thoughtful solutions to dilemmas like this, most notably empowering courts to respond more aggressively to executive aggrandizement. But many of the other 2029 thinkers I’ve spoken with have been pretty hostile to judicial power, seeing a system ultimately controlled by a 6-3 conservative majority as more of a danger to their vision than a potential ally.

Which raises another question: Is everyone a little too sanguine about the politics here?

It’s easy to say today that Democrats will pass whatever legislation they want come 2029. But it’s hardly guaranteed that Democrats win a trifecta in the 2028 election. And even if they do, their Senate majority may depend on the type of moderates who are unwilling to abolish the filibuster — let alone admit new states or expand the Supreme Court. There is a chance, maybe even a big chance, that the optimism about getting the real Project 2029 agenda passed is wishful thinking.

Bipartisan legislation isn’t out of the question here. Some, like Mechanick and Pahlka, think this might actually be more viable than a party-line push. Republicans have historically been quite willing to cut red tape; on the democracy side, they might be more amenable to new laws constraining the executive with a Democrat in the White House. This isn’t just conjecture: In 2022, Democrats and Republicans worked together to pass the Electoral Count Reform Act, a bill explicitly designed to cut off the avenues Trump used to try and overturn the 2020 election.

The problem is that this route might require untenable amounts of compromise. Already, the current policy package needs to bring together the center-left and left — leading them to skate over areas of reform, like the influence of public sector unions, that divide the Democratic coalition. Try to bring in Republicans, and it’s possible the entire thing becomes too unwieldy to get across the finish line.

That both key policy and political strategy issues remain so unsettled illustrates just how far the real Project 2029 has to go before it’s ready for prime time. 

Yet it is only 2026. Democrats have two and a half years, at the earliest, before they’d be able to retake power and win the White House. And the amount of intellectual firepower being brought to bear on these questions, along with major institutional backing and high-level political interest, shows that they are serious about finding answers — and implementing them once they retake power.

“When you have a next president in, there will be a set of plans for how we actually try and fix things,” a senior policy adviser involved in these efforts tells me. “Not just fix things, but make them better.”

Correction, October 15, 12:45 pm ET: A previous version of this post misstated Alex Mechanick’s job title.

This story appeared in The Logoff, a daily newsletter that helps you stay informed about the Trump administration without letting political news take over your life. Subscribe here.

Welcome to The Logoff: Is Trump turning on Ukraine? 

What’s happening? Ukraine says its access to Starlink, the satellite internet system run by Elon Musk’s SpaceX company, and Starshield, the military version of the same technology, is being throttled as President Donald Trump’s animosity toward the country mounts.

Why is Trump angry with Ukraine? Trump has been hot and cold on Ukraine since he returned to office, but his current anger is driven by oil prices and successful Ukrainian strikes on Russian oil refineries — particularly ahead of the US midterm elections. 

Last week, Trump announced a US-Russia diesel deal, which has elicited bipartisan anger and probably won’t do much, if anything, for diesel prices in the US. Ukrainian President Volodymyr Zelenskyy has criticized the deal, leading Trump to lash out and call for Zelenskyy’s replacement.

Over the weekend, Trump also announced an “ENERGY CEASEFIRE” between Ukraine and Russia that doesn’t really seem to exist. “Both parties have agreed,” he wrote. “Do not break it!” (Russia appears to have broken it the same day, while Ukraine is complying for now.)

Is Ukraine actually to blame for high oil prices? Partially, but not primarily; as the BBC explains, while Ukrainian refinery strikes play a role, ongoing disruptions to the Strait of Hormuz and the Gulf oil industry from Trump’s war with Iran have had a greater impact (though Trump has tried to shift the blame to Ukraine).

Why is Starlink so important? Starlink and Starshield provide vital communications infrastructure in Ukraine, especially on the battlefield. The technology is also used to control offensive and defensive Ukrainian drones, which have emerged as a key part of Ukraine’s military efforts against Russia.

What’s next? Despite the fact that neither Russia nor Ukraine seemingly signed on to Trump’s “ENERGY CEASEFIRE” and Russia is still attacking Ukrainian energy facilities, Trump is trying to bind Ukraine to it: The US has reportedly threatened to suspend US intelligence sharing, which has helped give Ukraine early warning of Russian missile attacks, if Ukraine strikes more Russian refineries.

And with that, it’s time to log off…

I appreciated this New York Times story, pegged to Pope Leo XIV’s diagnosis yesterday, about all of the ways that science has made lung cancer massively more survivable than in years past, with a fatality rate half of what it was in the 1990s. You can read it here with a gift link.

Thanks for reading, have a great evening, and we’ll see you tomorrow!

This story appeared in Today, Explained, a daily newsletter that helps you understand the most compelling news and stories of the day. Subscribe here.

Flu season is starting earlier than usual this year, which I know from reviewing federal data. But I also know it because I woke up with body aches and chills last night, mere days before I’d planned to get my flu vaccination (!).

Already, some parts of the country are seeing levels of flu activity typically associated with late fall or early winter. In Washington state, for instance, doctors are reporting seeing as much flu now as they usually would around Christmas. 

Flu activity overall is still low, to be clear. But as of October 7, infections were rising in all 50 states. And flu is spreading before many people — like, say, me — have received their annual vaccine.

Epidemiologists don’t yet know why the flu arrived early this year, or why cases first started rising in Western states like Washington, California, and Nevada. It’s possible that a mutation is helping this year’s flu variants evade existing immunity, one virologist told NPR. International travel could play a role, too: Flu cases also spiked early in Japan and other parts of Asia.

We don’t need to know why the flu arrived early to take some basic precautions, though. So today, we’re talking through some practical tips for coping with an early flu season.

Go a little deeper

An early flu season doesn’t necessarily mean a worse season — but even a moderate season can do serious damage. Last year, influenza sent hundreds of thousands of people to the hospital and caused tens of thousands of deaths, including almost 200 among children.

The first and best way to avoid those kinds of harms is by getting the flu shot, which reduces the risk of serious illness by an average of 40 to 60 percent. In the US, people aged 6 months and older are typically told to get the vaccine by October’s end. 

In light of the early onset, however (it takes two weeks to build up full immunity), you might instead want to get your shot ASAP.

There are some everyday precautions you can take, too — many of them familiar from the Covid-19 era. Wash your hands thoroughly with soap and warm water, for slightly longer than feels appropriate. Mask when you’re sick or might encounter someone else who is. 

And don’t neglect the good habits that support your overall health: getting enough sleep, drinking a lot of water, and eating a balanced diet. (There’s very little evidence for trendier interventions, like supplements, saunas, cold plunges, or the infused herbal baths that my kooky former yoga teacher used to recommend.) 

If you do get flu symptoms, reach out to your doctor early — especially if you’re older, pregnant, immunocompromised, or otherwise at higher risk for complications. Prescription antiviral medications, like Tamiflu, prevent the flu virus from spreading inside your body so that your immune system can clear it. But they work best within 48 hours of symptom onset. 

To be clear, you needn’t take my word on any of this; I’m just another voice in the public health cacophony! Besides, recent polling suggests that my particular voice — that is, the voice of someone who works in media — is not quite as persuasive as it used to be. (Ditto medical websites and government health agencies.)

But if you have doubts or questions about vaccines, there is someone much closer to home you can consult: Ask your doctor (or nurse or pharmacist) about the flu shot’s risks and benefits. They’re best positioned to break the science down and apply it to your health. In hindsight, mine surely would have told me to stop delaying my shot for a more convenient weekend.

One link for later

➨ Get creative in the fight against inflation. The latest inflation numbers are out today, and they are pretty bad. The cost of many goods and services is rising more quickly than both consumers’ incomes and economists’ expectations. For me, this news brought to mind a question that Vox’s former personal finance columnist tackled a few years ago: Namely, am I cursed to keep spending more money on more things forever?! Her answer was essentially “yes,” but she offered a few ways to help offset those costs: things like moving to a cheaper area or pooling resources via initiatives like tool libraries and community gardens. 

Before you go…

• Did you know…that Colombia is home to almost 20 percent of all the avian species on Earth? That’s the most of any country, at nearly 2,000 birds.
• Today’s trivia: Which percussion instrument is famously played by Mississippi State University fans at home football games? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in tomorrow’s edition.)
• Yesterday’s trivia: We asked you for the name of the 2025 Pixar film set in the “Communiverse.” That would be Elio, a movie you may well never have heard of: It had the worst opening weekend of any Pixar film, ever.

For some couples, surrogacy is a miracle: an opportunity to have a child even if they’re unable to conceive one naturally. But it’s also big business. Not only is surrogacy expensive — think six figures — but it’s also largely unregulated. And that last part is becoming a bigger problem. 

Just last week, a California couple was arrested on child abuse charges after it was revealed that they had over 20 children from different surrogate mothers living in a large mansion in Arcadia, a city near Los Angeles. Many of the surrogates are currently fighting for custody through the courts of the children they carried.

The Arcadia case, however, is only the most recent example of how surrogacy can go wrong. Every case is different, but every one illuminates how opaque — and often ripe for abuse or legal issues — the American surrogacy industry is. 

Emi Nietfeld is a reporter at Washington Sun who writes about surrogacy, IVF, and how we build families. She spoke with Today, Explained co-host Noel King about what’s kept lawmakers from regulating the surrogacy industry, the recent high-profile cases bringing these problems to light, and why more regulation doesn’t necessarily offer a straightforward fix. 

Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify. 

The United States does not regulate the surrogacy industry seemingly at all. What is going on? Why not?

The lack of federal regulation is both political and financial. Politically, this goes all the way back to the start of IVF. Anti-abortion Republicans were not comfortable with the idea of creating and destroying embryos during IVF, and so they fought against efforts to regulate it. 

People on the left were worried that limiting what kinds of technology you could access would lead to the government controlling who could have families. You still see these arguments today. People who think that IVF is murder don’t want to have any surrogacy. And people on the left don’t want the government saying who can and cannot have a family.

One of the issues raised by the New Yorker story is that there are surrogacy agencies that connect parents and potential surrogates. And it makes you wonder who gets to do that? Who can own and operate a surrogacy agency in the US today?

Anyone.

Oh. Oh no.

Only one state, New York, requires a special license. And everywhere else it’s easier to open an agency than a hot dog stand or a nail salon. This has resulted in the rise of so-called pop-up agencies where businesses come onto the scene, and nobody really knows who owns them or who’s running them. That has led to many people who aren’t experienced, who sign up with these agencies, then feeling like they weren’t prepared or that they were deceived in entering the agreement.

Have we ever tried in the past to regulate this better? Have there been efforts made?

In the 1980s, there was the case of Baby M. That was called traditional surrogacy where Mary Beth Whitehead was the surrogate, but it was also her egg. So the child she delivered was genetically related to her. After she gave birth, she changed her mind. She kidnapped the child, went on the run for several months, and it was a national crisis where this was all over the news. 

Ultimately, a judge in New Jersey ruled that the surrogacy arrangement was unenforceable. Commercial surrogacy arrangements became illegal in New Jersey, and they stayed illegal in New York until 2020.

Part of why regulation looks the way it does is because in 1995, Congress passed a piece of legislation saying that there would be no federal funding for embryo research, which means no federal funding for IVF. That left all of the research, development, innovation up to the free market. And so while that could be seen as an attempt to regulate IVF, it actually meant that those things would no longer be under the government’s purview.

In the US, we’ve seen over the past few years some really high-profile cases that are making lawmakers reckon with the fact that we do not have laws around this. Tell me about some of those cases.

There’s the Mark surrogacy case in California, which is both a really unique case and also illustrates some of the fears around Chinese intended parents coming to the United States to have their kids. This is part of larger geopolitical tensions between the US and China, which are playing out in the surrogacy industry.

There’s the case of Xu Bo, the Chinese video gaming billionaire who is rumored to have more than 100 children via surrogacy in America. His story taps into fears of birth tourism and people from other countries, especially China, coming to the United States to do surrogacy so that their kids are American citizens. 

Republican lawmakers are talking a lot about the idea that people could come from enemy countries, have American citizens, and raise them with the intent that they might one day become spies or president of the United States and be double actors.

In Texas, there’s the case of McKenna West, where she learned at 20 weeks’ gestation that the baby was very sick. The intended parents asked her to get an abortion. She refused to do so. McKenna went to Texas and began fighting for custody to keep the baby while the parents objected. They wanted the baby, and she petitioned the Supreme Court, which declined to hear the case. 

And finally, there’s the case of Kyla Simpson in Florida, whom I wrote about for New York Magazine, and she gave birth for a single dad in China who wasn’t there for the birth. He hadn’t applied for a visa to come to the United States, and when he did apply, he was rejected. Kyla Simpson tried to adopt the kids and is now fighting for custody in a case that’s still working its way through the Florida courts.

These examples are extraordinary, and they point to just chaos. But how common are they? Are they outliers? Is this going on all the time?

Most of the time things go right. In the academic papers around surrogacy, surrogates are usually happy with their experience. Attorneys and surrogates tell me that it’s absolutely beautiful to hand people the baby that they’ve been working hard for. The issue is that when things do go wrong, there’s often not a lot of recourse or there’s a really big legal mess that parents and surrogates have to go through.

I wonder if there is a case against more regulation. As disastrous as some of these examples are, you said that most of the time, it does go right. And it seems like we could get into tricky territory if we start saying who can and can’t have a kid.

Surrogacy is already really time-consuming. It often takes several years, and it’s expensive, usually costing between $150,000 to $250,000 for a single pregnancy. Regulation tends to make things more expensive and take longer. A lot of people fear that if you introduce more requirements and more burdens, surrogacy will become even more out of reach to people. 

There’s also the fear of government overreach. If you ask the government how many kids a gay couple should have, the answer might be zero. And that libertarian streak is driving a lot of opposition to things that most people might consider common sense. 

For example, there’s a lot of talk around whether intended parents should go through background checks before they have kids via surrogacy. Right now, no state in America requires intended parents to go through a criminal background check before having a kid. Critics of regulation say heteros don’t need a background check to have sex in the back of a car and make a baby the old-fashioned way, so it’s unfair to require that from people who need to do surrogacy to have a family. 

Most people can agree that surrogacy could be better regulated, but like many things in our country, it’s almost impossible right now because of politics.

“We should look for love!” Transportation Secretary Sean Duffy bellowed while flanked by his nine children at the Great American State Fair in June: “Get married, and have lots of kids!”

In a brazen attempt to make Duffy’s ethos a matter of policy, the Trump administration announced a strange new plan earlier this month tying a huge tranche of federal funding for public transit to high fertility and marriage rates. 

If the plan goes into effect, then communities with a high number of traditional nuclear families could get a 10 percent funding boost to build new trains, bus routes, and ferry lines. “If you want federal funding,” Duffy’s Transportation Department said in a statement, then “your project needs to align with where communities and families are actually growing.”

Trump, who has dubbed himself the “fertilization president,” and his bevvy of neopatriarchal trad–pilled deputies have long nursed a fixation with the country’s declining birth rate. But dubious as this new policy may be, it stumbles upon a genuine pain point in the nation’s public transit systems: They are not nearly as family friendly as they should be. And regardless of whether these discomfitingly pronatalist guidelines ever go into effect as written — and they probably will — they raise important questions about how American families use our transit systems now, and the policies could actually make their lives easier in the long run.

The same woes that affect all riders — long wait times, inaccessible stations, inadequate reach, and crowded rush hours — often doubly affect families. That’s one reason why so many of them have fled the nation’s densest, most transit-oriented cities in search of suburbs where they need not lug a stroller up yet another broken escalator to reach a subway platform.

Families who can’t afford to trade in their MetroCards and bus passes for minivans may find themselves priced into housing served by especially substandard transit options, funneling them into brutal, hours-long commutes. According to one landmark study, the single strongest factor in predicting social mobility in the US is neither crime nor test scores nor the presence of “traditional” two-parent households, but access to adequate transportation. With every extra minute a child spends commuting to school, they become less likely to move out poverty as an adult.

And for that reason alone, American families with kids do deserve special attention when it comes to how and where and why we build public transit. On this, the Trump administration got something right, even if they got there for all the wrong reasons — ones that I, a childless woman of childbearing age, find vaguely ethnonationalist, and above all, personally creepy. 

But families often need public transportation most in the places where it’s otherwise hardest to raise kids — which is to say in dense cities rather than in already car-centric suburbs. In that sense, especially, In fact, it might make circumstances even worse for the families that really rely on public transit every day.

What family-friendly public transit actually looks like

Marriage and birth rates might sound like a reasonable proxy for where families live, but in reality, according to an analysis by the Urban Institute, the places with the most “traditional” nuclear families tend to be whiter and wealthier than the population at large, and are much more likely to get around by car, not trains or buses. 

We are talking about the suburbs here, which, while certainly deserving of their own transit infrastructure, rarely rely on trains or buses the way that a carless family living on the outer edges of a major city might. And yet the Trump administration has typically treated those very communities — some of which do, in fact, have high birth rates — with contempt or even outright antipathy. 

Consider Chicago’s Red Line, the busiest corridor of the city’s L rail system, which serves some 138 million people per year. The line has long been in need of expansion, and a $5.7 billion extension close to 60 years in the making finally broke ground earlier this year. It will add 5.5 more miles of track with four new stations in the city’s southernmost neighborhoods.

For over half a century, families in the far South Side of Chicago have cobbled together grueling commutes that force them to transfer from buses and trains to reach downtown Chicago, which helps explain why unemployment and poverty rates in the area remain so stubbornly high. Communities like Roseland, where many of the new stations will be built, are considered to be among the most challenging places in the nation to raise a child, but thousands of local families still find ways to do so.

Roseland has a much higher birth rate than the national average, meaning that in theory, Duffy’s transportation department should be itching to send extra funds to transit projects there. But first they have to be willing to fund it at all, and if past policies hold, they may be reluctant to do just that. Just last year, the Trump administration opted to freeze federal funds already allocated to the Red Line extension, plunging the long-awaited project into yet another prolonged period of infrastructural purgatory. 

That move plays into a broader pattern: The Trump administration has hampered dozens of transit projects like the Red Line, seemingly in its broader push to starve Democratic-led cities of federal infrastructure dollars. While a federal judge eventually intervened to allow the Red Line extension to proceed, if the Trump administration’s new guidelines go into effect after public comments close in November, then more projects like it in other urban communities will likely be deprioritized. 

Ultimately, it is the suburbanites who are most poised to benefit from the Trump administration’s proposed policy.

An example is FrontRunner 2X in Utah, a commuter rail project that will slash travel time for Utahns traveling across the state, and will also help Salt Lake City shoulder an influx of tourists when it hosts the Olympics in 2034. It received federal support through the same tranche of funding as Chicago’s Red Line extension. In stark contrast with that more urban initiative, FrontRunner 2X has been the rare public transit project to receive continued support under the Trump administration.

Utah has some of the highest birth and marriage rates in the country, so it’s not a stretch of the imagination to say that if the Trump administration has its way, then the United States will see more projects like FrontRunner 2X get funded, while others like the Red Line extension face bureaucratic bottlenecks and funding freezes. Roseland’s high birth rate notwithstanding, the neighborhood has some of the lowest marriage rates in the country, meaning that even if a project there did manage to eke out federal support, then according to this new calculus, it would still receive significantly less funding from the federal government than a place like the suburbs of Salt Lake City where married families with children are more common.   

Trump’s new pronatalist transit agenda is, at the very least, an indication that after two years spent twiddling their thumbs, firing Amtrak executives, and venerating cars big and small, he may finally be building a semi-coherent transit strategy. And his Transportation Department has allowed a few genuinely family-friendly upgrades for the country’s transit infrastructure to proceed, including grants to add space for strollers on trains and buses.

But you can’t claim to support American families while siphoning federal dollars away from the projects that could actually be transformational to their lives. I am not one to decry a commuter rail renaissance, but it shouldn’t come at the expense of places where American families — the ones Duffy says he’s so keen on having more babies — don’t have any other choice but to wait an hour for the bus to get to work. 

In late September, Democratic Rep. Ro Khanna of California introduced the Free Child Care for America Act, an $80 billion-a-year proposal to make childcare free for nearly every family with kids under six. The bill would let families choose between sending their child to a daycare center, having a relative, friend, or neighbor paid a living wage to care for them, or taking a $1,000 monthly stipend to keep the child home for the first three years. It comes from a lawmaker who openly says he’s considering a run for president. “I want 2028 to be a big-ideas primary,” Khanna told ABC. “A contest on who’s going to have ideas of the future that meet the moment.”

Khanna’s is not the only big Democratic childcare proposal released in the last few months. In July, Project 2029 — a group of liberal policy experts developing an agenda for the next Democratic administration — proposed something similar to Khanna’s plan: giving families a choice between free daycare and $1,000 a month to provide care at home or pay a trusted caregiver. The group estimates that would cost about $200 billion annually. Third Way, a centrist Democratic think tank, unveiled its own universal childcare pitch, guaranteeing every family at least three affordable options within a 15-minute drive of home or work by expanding home-based, infant, and after-hours care, and leveraging employers as partners. 

Early childhood policy is quickly becoming a defining issue for 2028 hopefuls. On the right, Vice President JD Vance has staked out an early and controversial position, to pay married stay-at-home parents roughly $9,000 per child annually using existing federal childcare funds. On the left, Rep. Alexandria Ocasio-Cortez is spearheading a new House working group to develop a federal childcare plan. Kentucky Gov. Andy Beshear has been pushing free pre-K for all 4-year-olds, something California Gov. Gavin Newsom has already enacted in his state. And New York City Mayor Zohran Mamdani, who can’t run for president but is widely seen as an influential voice in the party’s future, has made universal childcare one of the top goals of his administration.

Michelle Lujan Grisham, the Democratic governor of New Mexico, recently told Semafor that any politician seeking to run for president in 2028 “absolutely should” run on universal childcare proposals. Last year New Mexico became the first state to offer free childcare to families regardless of income. Her advice echoed David Plouffe, a Democratic strategist who managed Barack Obama’s 2008 campaign, who said that universal childcare should be in the Democrats’ 2028 party platform.

This new wave of enthusiasm marks a pivot for an idea that has long been seen as a distant pipe dream in American politics. It wasn’t always that way: When women filled factories during World War II, the federal government funded thousands of daycare centers to watch their kids. In 1971, Congress actually passed a bipartisan childcare bill, though President Richard Nixon vetoed it, saying it would weaken the family. In the 50 years since, Washington lawmakers have focused their energies on other big battles, offering little on childcare beyond subsidies for some low-income families. Over that time, the US has fallen out of step with nearly all its peer nations around the world, which help parents pay for childcare, on top of offering paid parental leave after birth.

It’s not hard to understand why the idea is finally getting a serious look in the US. With voters citing affordability as a top concern, politicians are looking for ways they can bring down costs facing families. After paying rent or a mortgage, childcare often stands as many parents’ biggest monthly expense. Businesses have started to care too, as access to reliable care affects both people’s ability to hold down jobs and businesses’ ability to attract and retain workers. It’s why organizations like the Chamber of Commerce have taken up the issue and why red, blue, and purple states alike have been elevating childcare in recent years.

In Congress and in the Democratic campaign world, there’s a strong sense that childcare, long overshadowed by climate, infrastructure, voting rights, and health care, is now at the front of the line should Democrats regain power. Insiders credit both donor influence and a feeling that childcare advocates have duly waited their turn.

But as Democrats begin jockeying for 2028 and universal childcare becomes a rallying cry, it’s also become clear that there’s a big unanswered question at the heart of the politicking: No one yet agrees on what “universal childcare” actually means. Does it refer to care that’s totally free, or just affordable? Is it for everyone, like public school, or targeted at families below an income line? Does it start at birth, and include parents who stay home? Are employers involved, or neighbors and grandparents? 

The answers will determine who benefits, how much it costs, and whether the party’s next big promise to families is one it can actually keep.

What is universal childcare?

When I asked Rep. Khanna how he defines universal childcare, he said that it means “childcare should be free” and that families should have flexibility and choice of how to get that care. Workers, he added, should also be paid a living wage in a universal childcare system. 

Later, he described the vision for universal childcare as a public good, akin to public school. “From the time a child is born to the time they’re finished college,” he argued, America has the wealth to provide for kids’ education and development. 

Others, however, are defining the idea differently. Linda Smith, who leads Child Care Trust, a national policy think tank, helped design the military’s well-regarded childcare system and oversaw federal early childhood programs under Obama. Earlier this summer, she released a framework for universal childcare that emphasized it does not inherently mean free care.

Smith says she wrote it after realizing that even the legislative staffers drafting childcare bills didn’t mean the same thing by the term. “After some candid conversations with congressional staff this summer working on child care policy, it became clear that there are many interpretations of ‘universal child care,’” she wrote on LinkedIn. “If we can’t agree on what the term means, we can’t build durable policy around it.”

She argues the “universal childcare” slogan tends to blur three separate goals: universal access, universal affordability, and universal free care. To Smith, the urgent priority is access. Her vision for universal childcare policy would be a system where all families have access to “affordable, high-quality options” that reflect their needs. Her organization estimates that about 4.2 million children under six with all available parents in the workforce lack a childcare slot within a reasonable distance of home, and she warns that cutting costs without adding new supply could worsen shortages and leave families without available options.

Her answer is a mix of building more supply and sharing the cost. She recommends families paying what they can and employers and government covering the rest. Spreading the cost across several payers, she argues, is likelier to sustain the full mix of care families actually use — including home-based care — than leaning on government or parents alone.

Chris Herbst, a childcare policy expert and professor at Arizona State University, told me he agrees with Smith that there’s no consensus regarding what universal childcare means today. Even in New Mexico, he pointed out, which is regularly touted as an example of universal childcare, a light work requirement exists for families to be eligible. “These are fluid definitions, and as such they are a bit up for grabs at the moment,” Herbst said. 

His own view is that a universal childcare system should make the subsidy easy to get and be guaranteed by law, so eligible families get it automatically instead of landing on waitlists when funding runs short.

Another childcare expert, Elliot Haspel, has embraced a definition closer to Khanna and Sen. Elizabeth Warren, arguing that universal childcare means all families can easily secure the type of care they want, and pay no fees to do so. He acknowledged, though, that many things can be called “universal” and be technically correct. “The ambiguity of the term is both what lends it rhetorical power and what can present a major weakness,” he writes.

Some states are adding benefits — but avoiding “universal”

With federal childcare legislation stalled, many states have spent the past few years trying to patch the system themselves. Some states are investing in making care cheaper for families, others in paying childcare workers more, and most in trying to get more providers to open their doors.

The National Conference of State Legislatures has also aimed to get involved. Over the course of a year and a half, state lawmakers across 13 states worked together to hash out a bipartisan policy framework for strengthening childcare systems, a rare cross-party effort on the issue. The NCSL report, released this past summer, steers clear of the term “universal childcare,” but does describe state systems under strain and concludes that incremental fixes alone are unlikely to solve it. The lawmakers stressed there is no one-size-fits-all solution and offered a menu of options organized around seven priorities, from expanding access to investing in the childcare workforce.

In interviews with the working group’s two co-chairs, I asked why their cohort stayed away from the “universal” language. Jim Burgin, a Republican state senator from North Carolina, told me he doesn’t find it to be a helpful term because it could conjure up the image of public schools, which are mandatory and government-run. “I don’t like the term,” he said. “I think we ought to have safe, affordable childcare available to everybody and I don’t want everybody to immediately think we’re setting up government indoctrinated childcare…a lot of people would just push back from that.”

The Democratic co-chair, Washington state Sen. Claire Wilson, said her hesitation was more about precision. “When you say ‘universal’, I think that alone is a question about what do we mean by universal?” she said. In Washington, she explained, it means care open to all families regardless of income, employment status, or immigration status, “but for other states, universal may mean something different.”

Where the public stands

Polling suggests Americans do want to see lawmakers take action on childcare, even if it’s not voters’ top priority when asked to rank among different issue areas. An AP-NORC poll from last year found about three-quarters of Americans say childcare is a “major problem,” and majorities across both parties backed federally funded “free or low-cost” daycare. More recently, YouGov and the 19th News found 52 percent of Americans think the federal government should increase its spending on childcare.

The evidence that most Americans want childcare to be free rather than affordable is less clear. The recent YouGov/19th News found about 40 percent of Americans think parents and government should share in the cost of daycare, compared to 21 percent who thought the government should pay the full cost, and 26 percent who thought parents should cover it all.

A recent New America survey found similar results. When asked if K–12 public education should be a free, taxpayer-funded right, 60 percent of respondents agreed. But only 38 percent said the same of childcare. And among those who “somewhat” or “strongly agree” that childcare should be offered to families for free, paid by taxes, and considered a right, only 31 percent of independents agreed, and just 23 percent of Republicans.

Lena Bilik, a childcare researcher at the Roosevelt Institute, a progressive think tank, told me she thinks public opinion will shift more in favor of free universal childcare when public programs can demonstrate a track record of success, as the country saw with Social Security and more recently the Affordable Care Act. “If we build high-quality public goods that work, I think that with time that problem solves itself,” she said. “But they have to be well-resourced.”

The politics ahead

While states like New Mexico, Vermont, and Connecticut have taken major steps in recent years to expand access to affordable childcare, Bilik of the Roosevelt Institute said even those places vary in how explicitly they pursue the goal of universal childcare, or define it.

The last time Democrats went big on childcare, via the Build Back Better Act, they failed. The bill packaged much of the Democratic agenda into one piece of legislation — climate, healthcare, housing — with childcare bundled alongside paid family leave, elder care, universal preschool, and an expanded child tax credit. It collapsed in late 2021 after talks with West Virginia Sen. Joe Manchin fell apart. 

When I interviewed lawmakers, advocates, funders, congressional aides, and policy experts in 2024 about what lessons they drew from that experience, I found the field divided over strategy. Childcare never got a vote of its own, and the argument ever since has been whether it should have been pulled out and pursued separately. Some argued activists should have narrowed their focus to one or two care priorities. Others saw that critique as premature capitulation, a sign of a limiting “scarcity mentality.” Many of those advocates emphasized that they had come very close to passing everything, losing in the Senate by a single vote, and pointed to the climate movement, which took decades of sustained organizing and spending to win major federal legislation. Care advocates, they said, just needed to keep pushing.

Two years later, the consensus view among Congressional Democrats and national childcare advocates has shifted, with far more now saying what’s needed first and foremost are “big and bold” solutions that the party can run on — even bigger than the ideas laid out in the Build Back Better Act.

Sen. Elizabeth Warren argued this year that childcare failed in Build Back Better because not enough Democrats were “willing to fight for it” and because the $400 billion proposed spending package for childcare and universal pre-K wasn’t nearly big enough. It was “an exercise in how weak and ineffective we could make the childcare program and still call it childcare,” she said. 

Bilik has watched the same change from the research side. The coalition she works with, she told me, has moved away from programs that help only families below a certain income. “What I’m excited about is that we’ve gotten more ambitious with our proposals across the board since Build Back Better,” she said. “We’re finally having conversations about whether implementing something halfway will cause more problems than solutions, so I think the field has moved really far towards being open to a true public program.” 

These sentiments are reflected in the recently released Khanna bill, the Project 2029 proposal, and comments over the summer from Democratic Rep. Sara Jacobs, who said free childcare for all should be at the top of the House’s legislative agenda if Democrats take control after the midterms. 

How that vision translates into legislation remains an open question. Some advocates I talked to for this story, who spoke off the record to describe private coalition conversations candidly, said they worried their allies were going to make the same mistake of over-promising and then failing to prioritize goals when faced with tough budget realities. Should Democrats take power, leaders will also face pressure to restore Medicaid and SNAP funding, expand ACA subsidies, and address housing costs, all while large federal deficits make new spending harder to finance.

Khanna told me his proposals could be funded by shifting priorities away from increased military spending, particularly the $200 billion increase in the Pentagon budget and the war with Iran. The Project 2029 proposal suggests financing through raising the corporate tax rate, repealing the pass-through business tax deduction, and reforming estate taxes and the “stepped-up basis” tax break on inherited assets. Third Way would also fund its plan partly through a corporate tax increase. But those same dollars could be claimed by other Democratic priorities, which means childcare advocates may end up competing for them.

“Everyone is excited to put out the biggest idea, but there’s no real conversation about how to get there, and I feel like that’s the frustration, where ‘how to get there’ just means electing Democrats and demonizing any incremental progress,” one advocate told me. “That is not a strategy.” 

For now, think tanks, presidential hopefuls, and congressional working groups are testing the waters, floating ideas that meet families where they are and, in some cases, go further than what voters say they want. The practical details are unlikely to get settled once the 2028 race is fully underway. If a Democrat wins, the window will narrow further, with unresolved details colliding with other priorities in the first months of a new administration.

“Universal childcare” may remain an amorphous term, meaning free care to one politician, shared costs to another, and a menu of state options to lawmakers who avoid the word altogether. But all of us voters should expect to hear much more of it.

This work was supported by a grant from the Bainum Family Foundation. Vox Media had full discretion over the content of this reporting.

This story appeared in The Logoff, a daily newsletter that helps you stay informed about the Trump administration without letting political news take over your life. Subscribe here.

Welcome to The Logoff: Donald Trump’s ambassador to Greece, Kimberly Guilfoyle, is out of a job after serious corruption allegations. 

What happened? Guilfoyle resigned on Tuesday after being shown the door earlier in the day by Trump’s brand-new White House press secretary, who announced at a briefing that Guilfoyle had been asked to resign. 

Her departure comes just six days after a bombshell Wall Street Journal story, which described Guilfoyle’s efforts to solicit money from a Trump donor, including $100,000 to pay down a credit card bill, in exchange for access to Trump officials and conservative media figures. 

Guilfoyle also attempted to conceal those efforts: In one text to the donor, Eric Deters, she wrote, “What a nightmare you’ll literally cost me my ambassadorship stop writing.”

Who is Guilfoyle? Fallen MAGA royalty. Guilfoyle, a former Fox News personality, is also the ex-fiancée of Trump’s eldest son, Donald Trump Jr. (and, more distantly, the ex-wife of current California Gov. Gavin Newsom, a Democrat).

There appears to be little love lost between Guilfoyle and Trump, however. On Tuesday, he told reporters that Guilfoyle “wasn’t a member of my family. She I guess dated my son a long time ago.” (The Don Jr.-Guilfoyle relationship is thought to have ended in 2024.)

Why was she forced out? Corruption allegations are not, generally speaking, dealbreakers in Trumpworld; the president and his children are all innovators when it comes to profiting off the presidency, and there’s plenty of self-dealing going on around them.

That being said, Guilfoyle may have crossed the line in two specific ways: one, her alleged corruption benefited her and not the Trump family. And two, the allegations are embarrassingly unsubtle even by the standards of the second Trump administration. The combination appears to have been too much.

And with that, it’s time to log off…

This New York Times story, about what a potential superhabitable world elsewhere in the cosmos could look like, was a very cool, very sci-fi read — and we may find out more about the existence of such planets soon, with new space telescopes planned for next year and beyond. 

You can read the full story here with a gift link. Enjoy, have a great evening, and we’ll see you tomorrow! 

On the first day of his second term, President Donald Trump issued an executive order requiring the Bureau of Prisons to “ensure that no Federal funds are expended for any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.” Issued alongside a record 26 other orders that day, it was an unsurprising development, because Trump had made this issue one of the centerpieces of his 2024 campaign.

The fate of that executive order, as well as the US Bureau of Prisons’ (“BOP”) memoranda implementing the order, is now before the Supreme Court in a case called Trump v. Kingdom. And, while this case obviously has high stakes for incarcerated transgender people specifically, the Court’s resolution of this case could potentially have far greater reach — cutting off many cis and transgender people’s access to healthcare while they are incarcerated.

That’s because one of the central questions in Kingdom — though this issue is not yet before the justices — is when the Constitution requires prisons to provide medical care to incarcerated people. In Estelle v. Gamble (1976), the Supreme Court held that the Eighth Amendment’s ban on “cruel and unusual punishments” imposes on the government an “obligation to provide medical care for those whom it is punishing by incarceration.” People in prison, after all, cannot simply drive themselves to the hospital if they get sick. If the prison does not give them adequate medical care, they will suffer untreated and potentially die.

For procedural reasons, the Court is unlikely to opine on whether Estelle requires prisons to provide gender-affirming care to trans people right away. But the question of when the Eighth Amendment requires prisons to provide medical care to incarcerated people is front and center in the Kingdom case, which means the Court could potentially use Kingdom to limit all imprisoned people’s access to healthcare — or even to undercut the Constitution’s protections against cruel and unusual punishments more broadly.

Ironically, this case also arises out of a famous political blunder by pro-trans advocates. In 2019, when then-Sen. Kamala Harris was seeking her party’s 2020 presidential nomination, the ACLU circulated a questionnaire to candidates that asked if they would use presidential authority “to ensure that transgender and nonbinary people who rely on the state for medical care — including those in prison and immigration detention — will have access to comprehensive treatment associated with gender transition, including all necessary surgical care?” 

Harris responded that she would, and also said that she “pushed the California Department of Corrections and Rehabilitation to provide gender transition surgery to state inmates” while she was state attorney general. 

Years later, during his 2024 debate with Harris, Trump claimed that the then-vice president “wants to do transgender operations on illegal aliens that are in prison.” And not long after, his opposition to gender-affirming care for trans people in prison became a key part of his campaign.

It’s unclear why the ACLU thought it was a good idea to shine a light on this issue in 2019 because, at the time, the BOP provided gender-affirming care to people in federal prison. The ACLU — which represents the pro-trans side in the Kingdom case — now argues that transgender people in federal prison have had access to at least some forms of gender-affirming care “since at least 1992.”

Indeed, Trump’s own administration concluded in a 2018 memo that the Bureau of Prisons’ “statutory mandate to provide basic medical and mental health care” to incarcerated people obligated it to provide “pharmaceutical interventions (e.g., cross-gender hormone therapy), hair removal and surgery (if individualized assessment indicates surgical intervention is applicable)” to transgender people in prison if their doctors determined that these interventions are “medically necessary care.”

In any event, regardless of why Trump fixated on cutting off trans healthcare for people in federal prison, Kingdom is now before the Court. That means that the fate of trans people in prison — and, if the Eighth Amendment issue eventually reaches the Court, all incarcerated people — is now in the hands of a Republican Court that is often hostile to trans litigants, and that has, at times, signaled that it wants to drastically roll back the scope of the Eighth Amendment.

What are the legal issues in the Kingdom case?

At least since Estelle, the Court has held that people who are incarcerated are not also sentenced to live and die without medical care. As the Court said in Brown v. Plata (2011), “a prison that deprives prisoners of basic sustenance, including adequate medical care, is incompatible with the concept of human dignity and has no place in civilized society.”

Under Estelle and Brown, transgender people often have a right to gender-affirming care during their incarceration. As the US Court of Appeals for the Ninth Circuit held in Edmo v. Corizon (2019), such a person must show that they have a “serious medical need” for such care — typically by demonstrating that the care was prescribed to them by their health provider. But the Constitution does not permit prisons to deny medically necessary care to incarcerated people.

In Kingdom, the ACLU raised this Eighth Amendment argument in the lower courts, but those lower courts ruled in favor of transgender people in prison on different, much more technical legal grounds.

For over three decades, from at least 1992 to 2025, according to the ACLU’s brief to the justices, the BOP provided at least some gender-affirming care, including hormone therapy, to transgender people. This matters because, when a federal agency changes its policies, a federal law typically requires it to “examine the relevant data and articulate a satisfactory explanation for its action, including a rational connection between the facts found and the choice made.” This explanation often must explain the agency’s justification for “disregarding facts and circumstances” that justified the previous policy.

Both the ACLU and the lower courts that heard Kingdom argue that the Trump administration did not comply with this obligation when it cut off care for trans people in prison. 

Among other things, the district court that heard this case determined that the administration cited “zero evidence from its own medical or mental health care professionals to support its conclusions” against providing transgender healthcare. While the Trump administration argues that providing gender-affirming care makes prisons less safe, the district court also noted that “the government has not cited a single instance of gender-affirming care giving rise to safety concerns despite having provided such care for many years.”

Is this a persuasive legal argument against the Trump administration’s new policy? I think it is. And so did three federal judges that previously heard the Kingdom case. But the fate of trans people in prison is now in the hands of a Supreme Court that rarely rules in favor of transgender litigants, and that has a history of handing down legally incoherent opinions that are inconsistent with the Court’s own precedents, and that also deny legal rights to trans people.

The current Court’s uncertain commitment to the Eighth Amendment

Because the lower courts that heard Kingdom did not rule on the Eighth Amendment question, Kingdom should not currently give the justices an opportunity to roll back Estelle. But, in the likely event that this Court rejects the ACLU’s argument that the Trump administration did not adequately explain its new policy, the case will return to the lower courts and the Eighth Amendment issue will be fully litigated — teeing up the Eighth Amendment question for the justices to decide in the near future.

This issue could arise, moreover, at the exact moment that some justices are pushing for sweeping changes to how their Court understands the term “cruel and unusual punishments.” Indeed, at least some of the Supreme Court’s recent Eighth Amendment precedents suggest that the Republican justices want a wholesale rewrite of the Court’s previous precedents laying out what constitutes cruel and unusual punishment.

Since the mid-to-late twentieth century, the Court has held that, in Chief Justice Earl Warren’s words, the Eighth Amendment “must draw its meaning from the evolving standards of decency that mark the progress of a maturing society.” Thus, as certain forms of punishment grow more uncommon, they become more constitutionally dubious.

This “evolving standards of decency” framework is front and center in nearly every major Supreme Court decision interpreting the Eighth Amendment for the last five or six decades, including Estelle.

In Bucklew v. Precythe (2019), however, the Court’s Republican majority seemed to abandon this framework. Although decades worth of pre-Bucklew decisions established that a punishment is unconstitutional if it is considered cruel and unusual today, Bucklew suggested that a method of punishment is unconstitutional only if it “had fallen out of use” at “the time of the founding.” 

Bucklew did list some methods of punishment that fail this test, but they are things like “disemboweling” or “burning alive.”  

Thus, if taken seriously, Bucklew’s new approach to Eighth Amendment cases would dramatically expand the government’s power to impose harsh punishments. The late Justice Antonin Scalia, for example, argued that a Bucklew-like approach to the Eighth Amendment does not prohibit the government from executing most intellectually disabled offenders, and that it does not limit the government’s ability to impose excessive punishments for minor crimes.

In fairness, some of the Court’s post-Bucklew decisions are inconsistent with the framework the Court laid out in that case. So at least some of the justices who joined Bucklew may have since decided that it’s a bad idea to toss out the Court’s entire framework for Eighth Amendment cases. But Bucklew was one hell of a warning shot over the bow of the Eighth Amendment. And the mere fact that the Bucklew decision exists means that advocates for humane punishments must hold their breath any time this Court is asked whether a particular punishment is cruel and unusual.

In the worst-case scenario for people in prison, a case like Kingdom could inspire the Republican justices to overrule — or, at least, drastically limit — decisions like Estelle and Brown. That would mean that all incarcerated people, regardless of their gender identity, could lose access to medically necessary care unless the government decides to give it to them as an act of grace.

This story appeared in Today, Explained, a daily newsletter that helps you understand the most compelling news and stories of the day. Subscribe here.

When life gives you lemons, make it rain. Or…something like that! On Tuesday morning, Minnesota Rep. Ilhan Omar launched a fundraising drive in response to the Trump administration’s unusual predawn raid of her Washington, DC, residence.

The raid, which went down Monday, is reportedly part of a criminal investigation into Omar’s immigration history. The Democratic Congress member was born in Somalia and came to the US as a child, becoming a naturalized citizen in 2000 at age 17.

Omar has since become one of the most prominent progressive voices in Congress and a regular thorn in the side of President Donald Trump, who on Monday called her “terrible” and “totally crooked.” Vice President JD Vance has similarly claimed, without evidence, that Omar “committed immigration fraud.” On Monday, the New York Post reported that the investigation may have sprung from mistakes Omar’s late father made while filling out her citizenship application roughly 30 years ago. 

Needless to say, decades-old citizenship paperwork is not the kind of threat to public safety that typically commands the resources of the Department of Homeland Security’s investigations branch. (That same branch is charged with investigating transnational gangs and terrorists.)

And the raid is unusual for another reason, too: By longstanding practice, the Justice Department avoids taking any public steps in investigations involving political candidates within 60 days of an election. The midterms are just three weeks from now. 

This investigation is unlikely to affect Omar in the midterms, however. In the words of her longshot Republican challenger, John Nagel, Minnesota’s Fifth District is among “the ‘bluest’…in the country.” The raid may have even galvanized Omar’s supporters, dozens of whom rallied at a Minneapolis park on Monday afternoon. Some held banners that read “we stand with Ilhan.” Another sign read, simply, “see you at the polls.”

Go a little deeper

Omar now belongs to an unenviable and surprisingly populous club: political opponents of Trump whom his administration has threatened with criminal indictments and investigations. 

I initially planned to list them out for you here, but then realized that list would be perilously long. By my back-of-the-envelope count, there are at least 30 Democratic politicians, public officials, and Trump-world defectors who have been accused of, investigated for, or charged with crimes during the second Trump administration. 

It’s easy to forget the scale of that campaign, however, because many of these efforts have (thus far!) stalled out or collapsed. In several cases, the administration opened much-publicized and thinly supported investigations that have yet to yield charges. (See, for instance, the criminal probe into writer E. Jean Carroll or former New York Gov. Andrew Cuomo.) 

In at least two cases — that of then-Federal Reserve chair Jerome Powell and several Minnesota officials — federal judges tossed out subpoenas for lack of evidence. And in one high-profile instance earlier this year, a grand jury refused to indict six Democratic members of Congress who released a video reminding soldiers to refuse illegal orders. The legal bar for issuing such an indictment is actually pretty low — which makes this grand jury’s refusal a telling rebuke of the administration. 

But these judicial setbacks aren’t exactly reason for optimism. The federal court system is becoming increasingly partisan, and as long as Republicans hold the Senate, they’ll be able to stack it with ever-more conservative and deferential judges. And several of the most partisan judges already on the bench are “openly auditioning” for Supreme Court slots, as my colleague Ian Millhiser recently put it. 

In other words, in the not-so-distant future, the court system may provide a weaker check on presidential overreach. And that’s bad news not only for the Ilhan Omars of the world…but also for American democracy. 

One link for later

➨ Turn off your sleep tracker. If your sleep hygiene and underlying health are both good, but you still struggle to catch enough ZZs, then you might actually want to tone down your quest for better sleep. “What you see in people with insomnia is that they’re trying too hard,” one sleep scientist told Vox. Analyzing your sleep scores and timing your naps can create anxiety that further fuels insomnia. 

Before you go…

• Did you know…that Coke, Pepsi, and Dr. Pepper were all invented by 19th-century pharmacists? At the time, it was widely believed that carbonated water could cure illnesses. And sugary syrups made said water vastly more delicious. 
• Today’s trivia: What’s the name of the 2025 Pixar film set in the “Communiverse”? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in tomorrow’s edition.)
• Yesterday’s trivia: Last week we asked you for the three-letter successor of tube TVs. That would be LCD, which stands for liquid crystal display.

Late last month, the state of Tennessee attempted to execute Christa Pike, a woman who has been on death row for decades after killing a classmate as a teenager. 

The execution failed: Pike survived two doses of the lethal injection drug pentobarbital, making her the first person ever to do so.

The botched execution comes at a strange moment for capital punishment in America. Support for the death penalty has been declining for decades. And for a long time, the number of executions was falling, too. But since 2021, executions have been increasing again. The recent surge has been driven largely by one state: Florida.

According to Pamela Colloff, who covers the criminal justice system for ProPublica and wrote about Florida’s use of the death penalty for New York Times Magazine this summer, 40 percent of the executions conducted in the US last year were in Florida.

“There are so many things that make the administration of the death penalty interesting and unique in Florida,” Colloff explained on a recent episode of Vox’s The Gray Area podcast. “Among active death penalty states right now, Florida is unique in that one person determines, from the hundreds of men on death row, who will receive an execution date, and what that execution date is.”

I spoke with Colloff earlier this month following Pike’s failed execution about what happened in Tennessee, what’s driving Florida’s recent zeal for executions, and why victims’ families are often unsatisfied by the death penalty process. 

Below is an excerpt of our conversation, edited for length and clarity. There’s much more in the full podcast, so listen to The Gray Area wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify. (This interview also appeared more recently on Vox’s Today, Explained podcast.)

We’re taping shortly after news came out that a woman in Tennessee who was on death row, authorities attempted to put her to death. They gave her two doses of lethal injection medication, and she survived. 

How much of the decline in the use of the death penalty has to do with, in your estimation, people feeling like there’s no way to do it that’s humane? 

This is the second botched execution in Tennessee this year, just to give you a sense of things. This is more common there than in other states. They’ve changed their drug protocols and we don’t know a lot about what went wrong with Christa Pike. In May, it was an issue with accessing veins, which can be an issue with lethal injection. 

I think it’s also important for people to remember that we had the electric chair as the method of execution through the ’80s and into the ’90s in some places. While [lethal injection] is considered a far more humane, quote-unquote, way to do this, we can see that nothing is perfect. 

I will say that while the issues of botched executions are very important, and I think there are some other ones coming up to be concerned about, I am more interested in how it is that other errors are made, that other people end up with the ultimate punishment when that perhaps was not the right punishment for what occurred.

You’ve also written that death penalty convictions are just expensive, right? And on top of that, DNA evidence has made it clear that many of the people who were being convicted were not guilty, or there wasn’t strong enough evidence to convict them. How do you think about that mix of factors?

Florida, which I’ve spent a lot of time writing about, is the leading place in America by a mile in terms of the number of executions, and has a very large death row. Florida’s also the leader in wrongful death row convictions. Just to give you a sense of things, Florida holds the distinction of 30 death row exonerations.

What that means is in the modern era — the past roughly 50 years — there have been 30 men who were given dates of execution who now walk free. And for anyone who pays any attention to how the criminal justice system works and how incredibly difficult it is to overturn a wrongful conviction, if we have 30 people in Florida who have that distinction, we know that there are many more.

What’s going on in Florida? When did you realize that something was different there?

It really ramped up last year. Last year, Florida executed 40 percent of the people who were executed in the US in the last calendar year. In this year, there have been 16 men who’ve been executed in Florida so far. 

Just to give you a comparison, Texas is the next state with the highest number of executions, and they’ve executed six men in that time. We already have outlier states, primarily southern states, and then we have Florida being the ultimate outlier.

There are so many things that make the administration of the death penalty interesting and unique in Florida. The thing that fascinated me the most is, among active death penalty states right now, Florida is unique in that one person determines, from the hundreds of men on death row, who will receive an execution date, and what that execution date is.

Who is it?

Gov. Ron DeSantis. I went back and looked at what were the patterns here, what were the things guiding Gov. DeSantis’s thinking in setting these dates, and was fascinated to see and very troubled to see that there are a number of men who’ve been there so long.

They’ve been there since the 1970s. These are men who were convicted when Gerald Ford was president, just to make this real to people. But the dates are not being set among the men who are what are called death-eligible, meaning that they’ve gone through all their appeals. They aren’t being done chronologically.

There’s no rhyme or reason to the process. And so there’s this speculation game among victims’ families, prisoners, their advocates about who will be next. And men can sit there on death row for decades with that hanging over them, and that is a Florida phenomenon.

You wrote about Florida’s death row turning from something like a purgatory where people stay for a long time into something closer to an assembly line, right?

I was so struck by the fact that in Florida, in order to have this pace of executions, there were people who were receiving their dates 30 days, sometimes fewer, from their execution dates. 

Just to give people a sense of why that is unusual, there are so many things that kick into gear when a death warrant is written. There are numerous legal maneuvers and next steps that happen in the courts. To give you a quick example, there was one defendant in Florida this spring who, five days before he was scheduled to be executed, was finally granted the ability to test DNA evidence in his case that had gone untested.

He had great lawyers who didn’t sleep to make that happen, but that it came as close as five days to his execution date. I think that should give us all pause about how fast this is moving. 

You have multiple people in the queue at the same time. There’s a place — a different unit than Florida’s death row — that you’re taken to once you get your date, called death watch.

Tell me about death watch. What does it look like and what does it feel like?

Death watch is roughly 30 feet from the execution chamber. There are three cells. When you receive your date, you are taken from death row to death watch where you’re put — I don’t want to say solitary because if there are one or two other men who are held there — but you’re in a far different situation than you would be on death row where there are guards and other people you know.

From that point forward, there are roughly 30 days where you are held within steps of where this will take place. To me, it was chilling that when I was doing my reporting in the spring on the story that I published this summer, all three cells were filled, and as soon as one person was executed, the pattern was that often the next day a new death warrant would be signed, and there would be a new person in place.

Why do they do that? Why do they put these people next to the place where they’ll die?

That’s one of the many questions I had about that. We talk about not wanting to have cruel and unusual punishment. Our Constitution does not uphold that. But it’s such a unique kind of mental torture, I think, to be 30 feet from where you’ll be put to death.

The other thing I was struck by was the waiting aspect. If you’re on death row, again, you always have this hanging over you. I talked about the way in which, when you’re in that kind of sensory deprivation, you become highly attuned to sounds and smells and things like that.

I interviewed someone who’s not on death row anymore, whose sentence was commuted, who talked to me about recognizing that jangle of keys and the steps that this group of people who come to deliver the death warrant take, and knowing that someone is about to be served with a death warrant, but not knowing, “Is it me? Is it the guy next to me? Is it someone down the hall?”

I just want to say, I understand that there’s a counterargument to all of this, which is that these are people who most often committed terrible crimes. Their victims did not know when they were going to be killed.

I do think, however, as a state that administers this thing, there has to be a rhyme or reason to this. Otherwise, you have total chaos, including for victims’ families, who never know. Are they going to wait one month? Are they going to wait 15 years? They don’t know.

In November, voters in Washington, DC, and Denver will cast their ballots to decide whether their cities’ restaurants and grocery stores can continue to sell one of the world’s more controversial foods: foie gras.

French for “fatty liver,” foie gras is made by briefly force-feeding ducks a corn slurry two to three times daily with a metal tube during the final two to three weeks of their lives. It can make their livers balloon to roughly six to 10 times their natural size.

The farming practice gives the liver its signature rich, buttery taste that made it a French delicacy centuries ago and ever since, a prized menu item at upscale restaurants, particularly in Europe, the United States, and East Asia. But the apparent cruelty of force-feeding ducks has also long made it the target of those concerned with animal welfare.

While forcing a lot of food through a metal tube into ducks’ throats may not look great, foie gras companies and high-end chefs contend that it doesn’t hurt the animals because — among other reasons — ducks’ unique physiology enables them to eat fish and other animals whole, and that they naturally gorge before migrations. (More on these arguments later).

Whenever the issue is up for a vote, it touches off fierce debates over animal welfare and fine dining. While foie gras production does harm animals, producers and chefs maintain the dish is unfairly singled out when there are arguably worse practices in animal agriculture, including many that impact a far greater number of animals. Banning a product largely consumed by the 1 percent might make some voters feel good, while ignoring the animal cruelty embedded in the production of vastly more common products, like chicken and eggs.

But to animal rights advocates, a potential ban in DC — which has more foie gras-serving restaurants than almost anywhere else in the US — represents a unique opportunity to hasten the end of what spokesperson Natalie Fulton of Pro-Animal DC, the group behind the DC ballot measure, calls a “uniquely cruel” practice.

What the science says about force-feeding ducks

Foie gras producers often argue that ducks can handle force-feeding just fine because of their long, flexible necks that allow them to swallow fish whole — spines and all — and that they’ve evolved to stuff themselves before seasonal migrations. Producers also commonly say that they have no gag reflex. 

But these claims, according to research, don’t mean that force-feeding is painless. They also leave out a lot of the other problems in foie gras production. Last month, a veterinarian at Ghent University in Belgium and a team of animal welfare research consultants published a literature review in the journal Animals looking at how foie gras farming affects ducks. 

For one, there’s a big difference between ducks swallowing fish and having a rigid metal tube inserted into their throat dozens of times. A duck’s throat and beak area are particularly sensitive, and repeated insertion can cause tissue damage and irritation and inflammation in their esophagus, according to the newly published research, which was funded by the Flemish government. And while wild waterfowl might gorge before migrations, the resulting liver enlargement in the wild doesn’t come anywhere near what it does on foie gras farms. 

Beyond the arguments as to whether ducks can be humanely force-fed, there are plenty of other welfare concerns in foie gras production. Eating so much makes the ducks overweight, which makes it harder for them to move around. Liver enlargement increases their internal heat production, which can make ducks pant more, and an enlarged liver can put pressure on their air sacs, also making it harder to breathe. 

“The available evidence indicates that force-feeding creates substantial risks of welfare compromise through repeated restraint and tube insertion, possible injuries to the upper digestive tract, progressive liver enlargement, altered hepatic [liver] function, increased metabolic heat load, and impaired mobility,” the researchers concluded.

Ducks raised for foie gras aren’t given access to water — like a pond or bathing trough — which in nature they use to clean themselves and forage. And the overwhelming majority of those reared in the US even lack access to the outdoors. 

Despite some of the documented welfare concerns in foie gras farming, Jordan Ginor — a director at Hudson Valley Farms in upstate New York — told me that they’ve got “really good, clean, smiley, healthy ducks.” The company is one of the two main commercial foie gras producers in the US and raises hundreds of thousands of ducks for foie gras annually.

Ginor also said that the aforementioned literature review focuses on European foie gras production, where birds are typically force-fed larger meals, twice daily, over two weeks. But at Hudson Valleys Farms, he said, the process is slower: smaller meals, thrice daily, over three weeks. “The slow process, with significantly less food per meal, lessens any possibility of stress or negative impacts,” he said. (Though one could argue that more insertions over a longer period is worse for the ducks.)

Earlier this year, a photojournalist who took a public tour of Hudson Valley Farms documented — during the force-feeding phase — ducks confined in small pens with no bedding. In one part of the video, the ducks gather in the corner of the pen, seemingly in a fruitless attempt to escape force-feeding.

When I asked Ginor for a response to the video, he was dismissive of the investigations into his company. “We’re proud of what we do,” he said. “Anyone’s welcome to go in and see.” (To its credit, the company provides free public tours, which is highly unusual for large-scale meat producers.)

In previous investigations of the company, animal advocates alleged they documented ducks injured, lame, bloodied, heavily panting, overcrowded in large barns, and confined in small cages prior to slaughter. 

The other main commercial US farm, La Belle Farm, also in upstate New York, did not respond to an interview request for this story. La Belle has received far less attention than Hudson Valley Farms, though a 2019 news story found that its housing and practices are similar to those of its counterpart.

Why single out foie gras?

Support for a foie gras ban neared 80 percent in a small 2023 poll of Washington, DC, residents, with similar support in a 2026 Denver poll. 

“We’ve tried to diversify, given everything that’s been going on” with foie gras bans over the last 20-odd years, Ginor told me. But foie gras is still the core of Hudson Valley Farms’ business.

Ginor said his operation is more humane than a lot of other poultry farms, so why single out foie gras? “As soon as we start comparing how things work at other farms, we look much more favorably,” he told me.

He may have a point, though it’d be difficult to crunch the moral math and determine whether foie gras is much worse — or perhaps even not as bad — as the factory farming of America’s chickens, egg-laying hens, and turkeys. Around half of US egg-laying hens live in tiny cages, while turkeys and chickens raised for meat have been bred to grow so big and fast that they have difficulty walking. And they all outnumber foie gras ducks by many orders of magnitude. 

I asked Fulton of Pro-Animal DC about singling out foie gras over other issues. “Just because some things are also bad doesn’t mean that foie gras production is good,” she told me. (Pro-Animal Future, its umbrella group, is also behind the Denver ballot measure.)

Much of the issue boils down to what’s politically possible. While there’s been some progress, it’s proven difficult and expensive for animal advocates to reform poultry farming in state legislatures. Foie gras, on the other hand, is sort of a low-hanging fruit; there isn’t a large lobby group behind the US industry, and since it’s a luxury product, most consumers won’t miss it. 

And Denver and DC are just the latest in a string of fights over foie gras. Its sale has been banned in California, along with Portland, Oregon; Pittsburgh, and New York City, whose ban has been held up in court in recent years. Over the summer, Brazil banned the sale and production of foie gras, too, and around 20 other countries — mostly in Europe — prohibit its production. (Chicago’s 2006 ban was overturned two years later.)

“We have no money to fight the story,” Ginor said. “People want to attack the 1 percent luxury food.”

Bart Hutchins, head chef at Butterworth’s in Washington, DC, told me he doesn’t want his town to ban what he considers a “great culinary tradition.”

“It is a miracle that we discovered this and that we cultivated it and that we can eat it,” he told me. For his part, Hutchins would rather see animal rights activists work to improve farming conditions for animals farmed on a much larger scale, like chickens and pigs, rather than ban one niche ingredient.

But he may soon have to take foie gras off his menu. Pro-Animal Future is especially confident about DC voters’ support for the ban, which would be a blow to the small US foie gras industry. But another incremental step in advancing animal welfare — and the issue in the minds of more voters.

As rents and homelessness climbed in San Diego over the last decade, leaders watched in frustration as affordable housing projects took months to get approved. The longer a project dragged on, the more expensive it became.  

Housing in America is notoriously slow and complicated to build, so San Diego Mayor Todd Gloria decided to use one lever he had available. In January 2023, he signed an executive order to speed up project approvals, so every fully affordable project now had to be reviewed in 30 business days or less.

To meet this new goal, San Diego had to overhaul how it had been handling permitting. The city streamlined work that had been spread across multiple departments and filled positions it had budgeted for but left vacant. Within a year, fully affordable projects were clearing review in nine days on average. Citywide, 2023 marked San Diego’s biggest year for housing permits since at least 2005, with 9,691 homes approved, or an 82 percent jump from the year before.

Austin, Texas embraced a different approach to tackling its housing shortage. After years of local zoning reform, the city legalized up to three homes on most single-family lots in late 2023, then cut the minimum lot size from 5,750 square feet to 1,800 in 2024. Those changes made it easier to add homes, including backyard accessory dwelling units (ADUs), and followed a broader construction boom that has helped bring rents down. Austin, which was becoming increasingly unaffordable, is now one of the few major American cities where asking rents have fallen since the pandemic.

Atlanta adopted a third housing strategy that didn’t require changing any laws at all. Mayor Andre Dickens rallied the heads of every public agency that affects housing, from the city’s housing authority and school system to the transit agency and land bank, and convened them in one room on a regular basis. He called it a “housing strike force” and it has helped advance the city’s broader effort to build or preserve 20,000 affordable homes by 2030. Every housing deal now comes to the mayor’s office, Dickens told me, and “I just start pushing buttons to push them out the door.” 

Seen as a nationwide issue, the housing shortage is an enormously difficult problem, sitting at the nexus of the economy, the financial system, and decades of local zoning decisions. But the fixes don’t all have to be complex. A mayor can do all three of these — faster permitting, ADUs, a housing strike team — without waiting on Congress or their state legislature to act. And now one major nonprofit is betting that other cities could adopt them too.

On Tuesday, Bloomberg Philanthropies is announcing that it will fund up to 30 cities to adopt one of those three housing ideas. Each will get between $450,000 and $750,000 directly and two years of help from Accelerator for America and the digital consultancy Public Digital, also funded by Bloomberg. The philanthropy has already selected the first 15 cities, including Albuquerque, Chattanooga, Cleveland, Durham, Louisville, Miami, Nashville, Pittsburgh, and San Jose.

By housing construction standards, the money doesn’t go very far. The grants are geared toward hiring city staff, buying new software, and helping cities quickly develop the expertise that let San Diego, Austin, and Atlanta do what they did.

“You don’t need everyone to be innovating everything all the time when there are good ideas in the world that are working,” said James Anderson, who leads Bloomberg Philanthropies’ government innovation program. “They need help adapting those ideas to local contexts.”

According to Anderson, the cities were chosen because their mayors had already taken hard political votes on zoning, and wanted help now to do more. Their timing is also intentional. On the federal level, the 21st Century ROAD to Housing Act became law in July, and it creates competitive grants for cities that modernize their permitting, for preapproved housing plans, and that open up their public land. These are the same reforms Bloomberg is now funding, and cities that can show they’ve already done work around it will be better positioned to tap into new federal dollars.

Mayors say they’ve seen big federal programs pass before and then found that actually leveraging those new funding streams in practice can be quite difficult. “We saw that with the Inflation Reduction Act,” Cleveland Mayor Justin Bibb told me. “Even some of the aspects of the bipartisan infrastructure bill, there was a lot of red tape to get some of that stuff across the finish line.”

The Bloomberg bet is that figuring out what to do isn’t as hard as organizing the knowledge of how to do it. The philanthropy thinks that with enough money and hand-holding, good ideas can spread.

It’s an experiment worth testing, but even at the outset there are real limits to what kind of help a short-term infusion of cash can do in practice. San Diego, Austin, and Atlanta all had substantial housing staff in place before they started, and many cities don’t have the same depth to draw on. A two-year grant covers a few staff roles, but doesn’t guarantee they’ll stay long-term in a city where most of the local budget is already committed.

What a “housing strike force” actually is

Dickens had campaigned for office in Atlanta on building 20,000 affordable units in eight years. When he became mayor in 2022, his staff told him the city was on pace to fall 4,000 to 5,000 units short of this goal, and that the main federal subsidy for affordable housing, which gets rationed out by the state in fixed amounts each year, wasn’t going to make up the difference.

What Atlanta did have was land, spread across more than a dozen public entities, each with its own board and its own ideas about what the land was for. One 10-acre city site just northwest of downtown was being used to store trash cans before delivery to residents. “It’s not the highest and best use of the land, but we’ve been doing it for decades,” Josh Humphries, then Dickens’ senior housing adviser, told The Guardian.

So Dickens pulled the heads of those agencies into one body reporting through his chief housing officer. The transit system and school district both answer to their own boards, so his pitch was that they weren’t giving anything up by getting involved. “You are still in charge of your organization, these are your deals, but we are an accelerator,” Dickens told me.

They spent nothing setting it up and hired no new staff for the strike force itself — though when Dickens advises other mayors, he’s blunter about the pressure a mayor would need to exert in convening such a team. An agency that opts out of participating, he said, is “outside of the scope of the mayor’s vision” and “that’s not a safe place to be.”

“I didn’t need another task force,” Dickens added. “Task forces are good, but we know what we’re doing. We don’t have to describe the task. No, this is a strike force. We know the deals, we have the land, we know where the money is for most of these deals, and we have the political will.”

What Dickens did was create “a horizontal way of organizing otherwise vertical players,” as Anderson of Bloomberg Philanthropies put it.

As part of the strike force, agency leaders meet monthly, and quarterly with the mayor. Each one reports what they will produce in the next 30 days, whether that’s a signed agreement, bank financing, or a permit, in front of everyone else. The goal is to move everything as fast as possible to keep down costs.

“You’re in a meeting with 20 colleagues talking about your four or five projects, and everybody is aware of everybody’s projects,” Dickens said. “You don’t want to come back to that meeting saying nothing happened over the last 30 days.”

The limits of the model

Dickens was fairly blunt about where the model stops working. “It works best in cities that have a sizable amount of competent housing development people,” he told me. “A strike force is Army, Navy, Air Force, Marines. You all are capable.” A city still standing up its housing program, he added, should just focus on collaboration, because it would be hard for a small city without “the knowledgeable skills, the capacity” to operate like this.

Most cities can’t easily build that internal bench. Local governments pay less than state or federal employers for the same specialized work, and between half and three-quarters of a typical city’s operating budget is already locked up in salaries, pensions, debt payments, and basic services before the mayor makes a single discretionary call.

In Cleveland, they’re hoping to use the Bloomberg funding to bring in some new support. “Right now it’s a capacity game for us,” Bibb told me. “IT staff, planning staff, development staff, the list goes on. Policy staff as well.”

Cleveland also faces different challenges than Atlanta, which built its strike force for a growth market that already had projects lined up. Cleveland is an older, industrial city with an aging housing stock and a population that has only recently stopped shrinking, so Bibb needs code enforcement and rehab as well as new units. He plans to point the strike force first at a housing innovation district he launched earlier this year, an area spanning parts of three East Side neighborhoods where the city has concentrated its financing and permitting reforms.

Two-year grants can generally be a challenge for cities. Philanthropy often pays for staff long enough to prove a policy works, but when the foundation money goes away, cities can struggle to find the dollars to keep the positions going. While Atlanta’s strike force was organizing around people the city already employed, Cleveland’s will require new ongoing resources for a growing payroll.

Asked what happens when the money runs out, Bibb maintained he’s concentrating on the near term. “Right now we’re just focused on securing the grant, getting the team in place, and really seeing some positive results with the strike force team in our housing innovation district,” he said.

Can a good idea be scaled?

The 30 cities won’t be working alone. Bloomberg is running them as a cohort, meaning each city will pair with the city that pioneered the idea. The goal is to trade advice, mentorship, and opportunities for city leaders to visit and tour. Cleveland is one of roughly 10 cities that will take up the strike force model, meaning Bibb’s team will work with Dickens and his staff.

“One of the major reasons that good ideas do not spread is a lack of clarity around what it took in the original city to get the hard work done,” Anderson said. Adopting cities need to hear from the originals on both a political and a technical level, he told me, to understand “the trade-offs, the costs, the errors, and lessons learned” before they start.

Bloomberg has been testing a version of this model since 2024 through its Idea Exchange, which now includes more than 1,000 cities across 95 countries and has nearly 200 policy replications completed or underway.

Within two years, cities pursuing permitting reform are expected to cut their housing approval timelines in half, those pursuing ADUs to double their pipelines, and participants ultimately to post gains in citywide housing supply.

The housing shortage runs into millions of homes, and these proposed strategies don’t touch challenges like interest rates or the price of lumber. But across the country, they could show how quickly a good idea can spread.

To the average observer concerned with the future of American democracy, it might be easy to conclude that religion has been part of the problem — particularly over the last few years. Right-wing religious leaders, including the leading Southern Baptist televangelist Robert Jeffress, have endorsed “Christian nationalism”; other evangelical pastors and conservative Catholic intellectuals have been openly pondering if America should become more of a theocracy; Secretary of Defense Pete Hegseth, who once called for an “American crusade,” evoking bloody medieval religious campaigns, has referenced Christian theology in statements about the Iran war.

To critics, these examples show that American religion is becoming an active threat to pluralism and tolerance — the ideas that make American democracy work. 

But what if the solution to this anti-democratic slide is also religion — more religion than the US currently has?

A new book by two thinkers from opposing ends of the ideological spectrum argues that declining levels of religiosity across the board, but particularly among liberals, have deepened political polarization, which in turn has corroded democratic norms. Now, they argue, one of the most effective ways for liberals to stand up for democracy is to engage with religious communities and their scriptural traditions with more respect, openness, and curiosity. The authors also urge liberals who are believers themselves to embrace organized religion and return to it themselves.

Conservative evangelical Christian Matthew Kaemingk and liberal Muslim writer Shadi Hamid argue in Can Religion Save Democracy? that there’s a necessary and unique role that religious institutions and organized religion must play in American public life. Religion serves a fundamental regulating purpose, tempering emotions, fundamentalism, and nihilism. And when that fades away, those base instincts and emotions get channeled into our politics.

They write:

As Americans exit churches in droves, they’re not leaving behind their religious passions. Instead, they’re transferring those passions to the political battlefield. In this new post-religious context, Christian faith and Scripture function less as moral constraints within evangelical circles and more as political cudgels to use against one’s opponents.

“We’re not trying to convert [nonbelievers],” Hamid told me in an interview. “Believing is one thing, but believing that religion can play a positive role is another. And we want to encourage secular readers to embrace the second proposition, even if they don’t believe religion is true or don’t believe God exists.”

What happens when religion recedes from the public square

At the core of Kaemingk and Hamid’s argument is a simple case: There is an innate religion-shaped hole in people in the 21st century, which has been slowly replaced with politics, unbridled passions, and secular ideologies. The loss of religion hasn’t meant a loss of religious convictions, but instead has meant the rise of a new fanaticism, either secular or fundamentalist, while depriving everyone of the good things that organized and institutional religion can do.

It’s not a completely novel argument; it’s a combination of St. Augustine’s famous line that “our hearts are restless until they rest in [God]” and of the political scientist Robert Putnam’s modern case that churches and religious communities provided the third spaces that fostered civic partnership, trust, meaning, and belonging. 

But they also connect these lines of thinking to what the Dutch philosopher Abraham Kuyper used to argue around the turn of the 19th century: that all people are religious, and that something very similar to religious fervor quietly powers all political movements. Religion is “pervasive, public, and pluriform” — an essential part of being human, whose absence leaves nihilism, fear, and distrust in isolated, but still fanatical, individuals.

“If Kuyper is correct that all human beings desire ultimate belief and belonging, then erasing or sequestering religion won’t extinguish our spiritual passions. They will simply shift elsewhere,” Kaemingk and Hamid write. And that shift has been toward politics, candidates, elections, and secular “creeds” that provide identity, belonging, moral certainty, and salvific promises without the accountability, guidance, and caution that religious traditions can provide.

It’s not hard to find examples of what Kaemingk and Hamid mean here. From 2016 to 2024, many observed elements of quasi-religious fervor in movements powering Trump and Woke 1.0. Trump’s strongman appeal generated a cult of personality around him, while anti-Trump resistance efforts and progressive social movements often took on qualities people also found quasi-religious: in-group markers, language, and customs, BlueAnon theories. What’s left is a stalemate, with more conservative religious believers bunched up on one end, and nonreligious but equally passionate citizens on the other end.

Kaemingk and Hamid argue that people on the left often respond by denigrating religion and religious people, dismissing those who try to defend or practice it in the public square, or forcing them to adopt secular language and thinking instead of letting religious people bring their full selves to the public space. But the way out of this current stalemate, Kaemingk and Hamid suggest, is for people on the left to be open, curious, and respectful with the devoutly faithful, whether they’re neighbors or candidates running for office. 

“For that audience, my desire is to say, ‘Hey, you don’t have to believe in religion, but you can recognize the positive aspects of religion,’” Hamid told me.

That involves practical, daily activities and more high-minded appeals. In regular life, the authors recommend prayer, or prayer-like practices for nonbelievers, to help better understand and forgive opponents. They suggest there can be benefits for both nonreligious and religious people to meditate on scriptural and theological teachings about forgiveness, debate, disagreement, salvation, and why earthly politics shouldn’t be taken so seriously. 

And they urge liberals in particular to reengage with religious communities and congregations. Religious liberals should avoid isolation or solitary, individualized faith, the authors recommend, and instead return to congregations and specific churches or places of worship to become part of a community and find purpose. For nonreligious liberals, Kaemingk and Hamid suggest they reexamine their own ideological priorities and be open to the possibility of being wrong on some of them, and potentially engage with organized religion to better understand a religious worldview.

Kaemingk and Hamid offer a specific challenge for liberals and secular Americans that might seem a bit unsavory: They have to realize that they are not blameless for the polarization and radical religious fervor that exists right now through their dismissal of organized religion. Their earlier denigration of organized religion around the turn of this century (think of the New Atheist movement), combined with many leaving institutional churches or failing to participate in religious life, has all contributed to the capture of these institutions by unsavory political opponents, or helped in the decline of more moderate congregations. And any attempt to stop this continued slide away from pluralistic democracy hinges on a collective effort between religious and nonreligious Americans to reverse these trends.

This argument has its limitations

Here’s an obvious question: If religion is so good at moderating people, why hasn’t it been able to temper emotions among the religious already? The most loyal Republican voters over the past few cycles have tended to be evangelical and nondenominational Christians, followed by white Catholics — both of which tend to report above-average levels of religious participation. They’ve stuck with Trump and the GOP over the last decade, which has been defined by polarization, authoritarian policies, and even moments of political violence, that both Kaemingk and Hamid say religion can fix. 

Here’s an obvious question: If religion is so good at moderating people, why hasn’t it been able to temper emotions among the religious already?

More generally, while there is evidence to suggest that evangelicals who leave their churches become more cynical and individualistic — a point in Kaemingk and Hamid’s favor — there’s not much evidence to suggest that the converse is true: that religious participation has actually tempered emotions, passions, and politics. Instead, there’s a case to be made, as the writer Robert P. Jones laid out recently, that the opposite seems to be true: The most religious folks tend to still be the most likely to support harsher Trump-era policies.

Hamid acknowledged that this is a challenge, but argued this isn’t about the religion itself — rather a Trump-specific phenomenon: “Many evangelicals have let partisan loyalties take precedence over religious commitments,” he told me. “This is the distorting effect that Trump has had on the evangelical movement.”

He emphasized that evangelicalism has suffered because many of the most fervent MAGA supporters who identify with that religious movement are not actually very religious. “Evangelicals aren’t going to church as much as they used to on average,” he said. “There has been a kind of process of de-institutionalization in the kind of Protestant domain. And the people who tend to be more fervent MAGA supporters tend to go to church less.” He compared the level of evangelical support that Ted Cruz and Trump got in 2016: Trump had an upper hand among unchurched evangelicals.

Beyond this, the practical reality is that, as things stand today, religiosity does not seem likely to bounce back to the levels it was at two decades ago — at least, not without the help of secular Americans.

What the authors prescribe for politics and elections

Still, it’s an attractive idea, and it’s not hard to see why people might be open to it. Even Democrats themselves seem to understand that writing off religious voters for years was a bad idea. Some of the most promising Democratic candidates in red states in upcoming midterm elections are religious, including Texas Senate nominee James Talarico and Kansas Senate nominee the Rev. Adam Hamilton. A dozen other pastors or believers are running in down-ballot races across the country, while potential 2028 presidential candidates like Democratic Kentucky Gov. Andy Beshear and Democratic Pennsylvania Gov. Josh Shapiro talk openly about their personal faiths, the role of organized, institutional religion, and seem comfortable doing so.

“It’s promising,” Hamid told me about this trend. “Part of what we argue in the book is that Americans should be able to bring their full convictions into the public arena. If they’re editing themselves or suppressing their religiosity out of fear of alienating constituencies, that’s not good for democracy.”

And Kaemingk and Hamid also have a very influential intellectual ally in this mission: Pope Leo XIV just made a similar case in France for secular liberals to reexamine their understanding of religious liberty and how to balance it against the rise of right-wing religious politics.

“A Christian engaged in public service and guided by the light of his or her conscience, illumined by faith, cannot be considered a proselytizer or a threat to the unity of the nation,” he said in Paris, appealing directly to France’s fiercely secularized civic leaders. “Indeed, authentic secularity does not exclude religion but is capable of valuing it as an educational resource.”

Aboard a plane back to Rome, Leo continued, arguing that religion must have a role in the public square and pointing to the decline of religion in Germany as something that may have facilitated the rise of a far-right movement that cloaks itself in religious language.

“It would be interesting to study, analyze if and how there may be a relationship, for example, between the growth of these groups on the far right,” Leo said mid-flight, “…with some expression of a combination of these far-right points of view with a certain kind of religion, which…is not an authentic expression of Christianity.”

This may be an unsavory ask for liberals and secularists most upset about creeping religious nationalism in the Trump administration and around the country. The recent creation of a new Office of Religious Affairs in the Pentagon, the invocation of God and Scripture to support military action and immigration enforcement, and the attacks on the wave of religious candidates running as Democrats this year all make it understandable why there may be hesitancy in accepting this challenge. But Kaemingk and Hamid are undeniably right about one thing: In a diverse and pluralistic nation, we have no choice but to live with each other.

In early October, Vivek Ramaswamy, the Republican candidate for governor of Ohio, went for a classic “politician on the stump” move: He picked up a kid. Or at least he tried to. Ramaswamy fumbled the boy a bit, producing a clip that quickly went viral on social media. 

The next day, Ramaswamy posted a picture of himself with his son in his arms on social media. It was a cute retort. But many of the responses were ugly — racist attacks against Ramaswamy that drew on anti-Indian stereotypes.

It was the latest example of a broader shift on the right, where Indian Americans and Indian immigrants have become a conspicuous target of online conservative anger.

“The people who had negative stereotypes about Indians in their mind said, ‘Hey, look, the guy can’t even pick up a kid…he can’t even act like a normal American family man,’” freelance journalist Zaid Jilani told Today, Explained co-host Noel King.

Jilani, who recently wrote about the surge in anti-Indian racism for Vox, joined the podcast for a conversation about how he sees the bigotry as rooted in status envy, how Indian Americans and Indian immigrants are responding, and his surprisingly hopeful outlook for the future. 

Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

American racism is very interesting, always has been. And there is a type that says, immigrants are dirty, they come here, they’re uneducated, they leach off the government, they’re taking our resources. 

The stereotype of Indian immigrants to America and Indian Americans is people who go to college, people who often have advanced degrees, people who often live in nice neighborhoods, make good money, are family-values people. 

Why do you think these values that seem as if they mesh with what Republicans want are so triggering to people these days? Is it just yes, but they’re brown?

I think that is a component of it. I spoke to one Indian American advocate who told me that Indians and South Asians more broadly are visible minorities, right? If you think about other minorities who are highly successful, that’s not always the case. 

For instance, I think that Jewish Americans have been known since the late 20th century as being a successful minority group, but they’re not necessarily highly visible. You can’t always identify someone. If [Texas Railroad Commissioner candidate] Bo French saw a bunch of white people in the stadium with the Longhorns, I’m not sure he would be picking out who’s Protestant, who’s Catholic, who’s Jewish. But with Indian Americans, they are highly visible.

That being said, I think you have to think about where Indian Americans are in society and the kind of feelings that can create among everyone else. If you look, for instance, at Silicon Valley, the major tech companies, Microsoft, Google — the head of [Microsoft’s] Xbox division is an Indian American woman now.

You have a group of people who I think are in many ways a very micro minority — we’re talking about 1 percent to 2 percent of the United States — visibly rising into so many positions that I think a lot of people have typically associated with white folks. White people generally run the Fortune 500, white folks run the universities, white folks are the most successful doctors and engineers. And that was true for the 20th century. 

But when you start seeing a much larger influx of Asian immigrants, starting with liberalization of immigration laws in the ’60s, but also when there was a rapid growth of the technology sector in the early 2000s, you start to understand a little bit more where the resentment comes from because it’s more, I would say, analogically similar to antisemitism than it is to the racism that Mexican Americans face or the racism that Black Americans face. 

“It’s a much larger anti-globalization backlash on the right, not only when it comes to things like immigration, but also trade and tariffs and restrictions like that.”

It’s not that Indian Americans are necessarily being stereotyped as antisocial, criminal, coming here illegally, so on and so forth. It’s more that they’re being seen as a status threat to a lot of particularly middle-class Americans, people who want their kids to rise to the top of their school, who want their kids to have the corner office. They want their kids to be able to get the most prestigious positions. 

I think in the minds of a lot of these people, not only now does their kid have to compete with all the other normal white kids in their community, they have to compete against the entire world. It’s a much larger anti-globalization backlash on the right, not only when it comes to things like immigration, but also trade and tariffs and restrictions like that.

When you talked to Indian Americans for this piece, what did you hear from them that surprised you?

Probably the most surprising thing was how much pragmatism they responded to all of this with. Nine times out of 10, when you have stories about racism, the victims of racism are outraged — understandably and justifiably outraged. Nobody wants to be mistreated. Nobody wants to be denigrated. They certainly don’t want to see restrictions on the right to immigration, or other things to limit their numbers, which is the end point of a lot of this.

At the same time, I think a lot of the people I spoke to were very upfront. They’re like, “Hey, look, we have found a lot of success in America. We got the golden ticket to be able to come here, for our kids to study here, to be able to really seek these opportunities, but we understand what’s happening in the economy. We understand there’s a lot of people who are struggling and then they see us rising to the top of all these organizations. They see us with our kind of well-ensconced place in the economy. And I think it’s important for us not to flaunt our success that much.” At least a couple people said something to that respect. They almost empathize with the people who were hating on them.

It struck me as such a classic immigrant pragmatism that you see from the first or second wave of immigrants: people who realize that they are newcomers to a society or maybe their parents were newcomers to a society, and that there is a certain level of grappling they have to do with, “Hey, how can we continue to have success? How can we continue to grind and resist this racism, but also not rub it in people’s faces that we’re doing well because the more they do that, the tougher it can be?”

A number brought up Vivek Ramaswamy in the sense that Vivek happened to go on social media and talk about what he felt like were deficiencies in American culture when it comes to studying, when it comes to working hard.

I think that in bringing that up, they were saying that that wasn’t particularly helpful because whatever positive aspects there may be to Indian immigrant culture, we shouldn’t talk about them in ways that denigrate other people because that’s obviously going to rub people the wrong way.

You’re making the point that some of the surge in anti-Indian racism on the right is about status anxiety. I was listening to this podcast that Chris Rufo and Jonathan Keeperman did. These are two influential right-wing activists. They called it “The Indian Question” — a lot of people’s eyebrows shot up — and they seem to be making the argument that it is about status anxiety. 

They also were making less coherent arguments about how it’s un-American to study for the spelling bee, which is what South Asian kids do, and that white kids are more American because they play football, then they go to a party and get drunk, and then they get 1,500 on the SAT. 

I’m not saying any of this makes sense. I’m saying it was fascinating. I’m assuming you watched that exchange. What did you make of that?

There’s a certain level of coping mechanism being deployed there in the sense that they are trying to explain the success of Indian Americans as a deficiency: “Maybe they’re getting to the top schools, but that’s because they’re shut in all day studying.”

But it’s not really true that Indian Americans are necessarily cloistered into unhealthy habits. They’re actually finding success across society. For instance, I’ve tutored kids for five, six years. I just really enjoy working with kids. And something you’ll find with a lot of the Indian American kids, they are actually getting increasingly well-rounded. 

Part of that is because you have to, to have success, to get college admissions and so on and so forth. They almost always play sports. They’re involved in extracurriculars. You’re seeing a lot more Indian Americans go into the arts, into cultural fields, into Hollywood. I think that’s actually a very normal path for immigrants.

I think the first or second wave of immigrants has to be very pragmatic. They have to keep their heads down. They have to grind, study, and their parents encourage them to do the same thing. Indian American parents are always like, “You got to be a doctor. You got to be an engineer. Don’t be foolish and try to be a journalist or go to Hollywood.”

But as they establish themselves, as they build nest eggs, they have a little more breathing room, and so they can do different things. I know that Christopher Rufo, for instance, is an Italian American, and I believe I read one time that he even speaks Italian at home because he really values that culture so much and he wants to raise his kids in that. The first wave of Italian immigrants were no different than that. They cloistered into a few sectors where they felt they could find success that was necessary for their integration into the economy and to get their footing. But now we don’t think of Italian Americans as stereotyped into just a few parts of the country or a few parts of society — we barely notice, unless maybe you notice from someone’s name that there even are Italian Americans. 

What they’re describing about Indian Americans is very normal. It’s actually very normal for first waves of immigrants to cluster in a few areas and then they spread themselves out as they’re able to get that a little bit of breathing room and room to ground to stand on.

Barring a catastrophic midterm polling miss, Democrats are on track to win a majority in the House of Representatives next month. Come the new Congress in January, that will mean a new House speaker — and if all goes to plan, that will be current House Minority Leader Hakeem Jeffries. 

If elected, Jeffries, from New York, will be the first Black speaker of the House. Though Jeffries has been in Congress for nearly 14 years now — and many of those years have been spent in Democratic leadership — he also remains something of an enigma. 

The New Yorker’s Jason Zengerle profiled Jeffries back in May. He spoke with Today, Explained co-host Sean Rameswaram about who Jeffries really is, his path to what would be a historic speakership, and what he really stands for.  

Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get your podcasts, including Apple Podcasts, Pandora, and Spotify.

In your profile of potential future Speaker of the House Hakeem Jeffries, you start with a story that people might find surprising. And I was wondering if you could tell us said story.

[Jeffries] was in Florida, raising money, which is one of his central responsibilities as a minority leader. And he was being driven to a Democratic donor’s house in Palm Beach. And while he was being driven there, he got an alert on his phone letting him know that Donald Trump had posted a message to Truth Social in which he rehashed a bunch of the 2020 election conspiracies. More significantly, [Trump] had included a depiction of Barack Obama and Michelle Obama as apes. 

Jeffries has this reputation for being a very calm, deliberate, not angry person, oftentimes to his detriment. I think a lot of Democratic partisans wish he would be more angry. But the way he told me the story, he was legitimately pissed off. And he realized that he needed to respond in some way. And he didn’t think that a tweet would be sufficient. 

He wanted to do an Instagram post, and he looked into his aide’s iPhone, and he said, “Fuck Donald Trump.” And as soon as he was done recording the video, I think he started to have second thoughts. And they sent the video up to Washington for a social media team to edit, and he told them, “Let’s bleep out the word fuck.” And for him, it was a smashing social media success.

I was in his office in the Capitol six days later, and he was telling me this story and basking in some of the reflected glory and talking about all the social media love and talking about the real-world love. But then he kind of paused, and he said something like, “You know, but I still haven’t heard from my mom, and I’m a little worried about that.” Which I thought captured him pretty well.

“I don’t think you’re going to see a new Hakeem Jeffries if he’s speaker. I think he’s going to, especially rhetorically, perform the same way he has before.”

Why did you want to start your profile of him with that story? What does it tell us about who this individual is?

I thought it captured the dilemma he faces in some ways, just in the sense that he is this very deliberate, calculated political figure, very conventional. And he is operating in a political space these days that doesn’t really reward or appreciate that approach. 

Oftentimes that approach is not successful. I think he’s trying to adapt to the new rules of the road, and he’s kind of doing it in fits and starts, and sometimes he’s more successful than others. But I still think, even when he is successful, he has some qualms about it. 

How long has Hakeem Jeffries wanted to be speaker of the House?

When he got to Congress, in 2012, he definitely wanted to become a player. He wanted to be in leadership, chair a committee, whatever. He was someone who had his eye on that. 

But at the same time, the Congressional Black Caucus had started to think a little bit differently about what they could achieve in Congress. For a long time, they wanted their members to get chairmanships and things like that, or maybe be majority whip. But by the time Jeffries got there, they started to think that we could actually get a speaker. And his arrival kind of coincided with this realization on the part of the CBC. And I think a lot of CBC members viewed Jeffries as a potential future speaker, and they started to groom him for that. 

Pretty soon after that, Nancy Pelosi started to think of him as someone who would be a good member of her leadership team. And I think by 2018, that’s when it really became apparent that he was going to be someone who could potentially be speaker. 

What does he actually stand for as the most powerful Democrat in the House?

I think, quite intentionally, he doesn’t stand for anything. I think that in some ways has been key to his success. He has managed for the most part to avoid being kind of pigeonholed or put anywhere on the ideological spectrum. He is very critical of the far left of the party, especially the DSA. He views the DSA as college-educated young white people who are coming to Brooklyn and displacing older Black working-class people. 

I was talking to this former Democratic congressional aide and basically asking this person the question you’re asking me: What does he stand for? And this person was trying to explain it and finally just was sort of exasperated, and he said he’s intentionally trying not to stand for anything. He’s sort of like hotel art. He just is, and it’s satisfactory.

We don’t have a lot of case studies for how he manages his caucus because they haven’t been in power. But I think maybe one of the most telling examples was the shutdown, because Democrats were, in a way, the power brokers there. Tell us how Hakeem Jeffries managed that.

That was probably his greatest success as minority leader.  When Trump took office for the second time, especially for those first few months, I think all of the congressional Democrats, and Jeffries especially, were really on their heels. They could not figure out how to deal with this guy and what they were going to do to stop him. Jeffries was even complaining that he didn’t have any leverage. But then he eventually realized that a shutdown would be at least a little bit of leverage. 

The real question was, what was the shutdown going to be about? And there were a lot of Democratic members of Congress who wanted it to be about authoritarianism or corruption. They wanted it to be at all these different issues. And Jeffries was really insistent that we need to make this about one issue, and we need to make it about healthcare. 

The Democrats were the ones who caused the shutdown. And normally, the way shutdowns have worked in the past, it’s the party that causes the shutdown that gets the heat from the public. But this time around, I think because Democrats were so consistent in saying that this is about healthcare, and Republicans were so scattered in their own messaging and their own explanations of what was going on, Democrats’ polling numbers went up, Trump’s and Republicans’ went down, and that was a real victory for Jeffries.

Did that whole incident put Jeffries on the president’s radar in a way that he wasn’t? 

It comes, and it goes. For a long time, he wouldn’t mention Jeffries at all. 

I guess the way to tell if Trump is thinking about you is if he posts about you on Truth Social, and he started to post about Jeffries a lot — all the usual kind of insults he lobs, especially at Black politicians, that Jeffries was low IQ and a thug. But yeah, he does seem to be paying a little bit more to Jeffries now than he was before.

And do we think Jeffries is ready to go toe to toe with the president of the United States if that’s what voters decide he’s to do this November?

In his mind, he’s ready. And I think in his own stilted, rehearsed, steady fashion, he will go toe to toe with Donald Trump. He will talk about affordability, and he’ll talk about corruption, and he’ll talk about the “so-called president.” 

I don’t think it will necessarily be satisfying for a lot of Democratic voters out there and Democratic partisans, but I don’t think you’re going to see a new Hakeem Jeffries if he’s speaker. I think he’s going to, especially rhetorically, perform the same way he has before. But I think it’s going to take him a little while to figure out how to do the job.

In theory, getting a donor liver in the United States when you need one should be an extremely equitable process: The sickest patients with the greatest chance to benefit from a donated organ should jump to the front of the line regardless of their gender, race, or other factors. 

But in practice, things look quite different. 

One study from 2020 showed that women were 8.6 percent more likely than men to die waiting for a liver transplant and 14.4 percent less likely to receive a deceased donor liver transplant compared to men. That gap may not seem enormous, but it still represents a significant disparity. As it turns out, it’s rooted in the very system that’s supposed to make the process fairer, a process that unintentionally ranks women lower on the waitlist for livers.

The system in question is known as the Model for End-Stage Liver Disease (MELD). The scoring model has been used since 2002 to rank candidates on the waiting list based on how likely they are to survive without a liver transplant in the short term. The higher your score, the reasoning goes, the sicker you are and the more urgently you need a liver transplant.

One of the values used to calculate the score is creatinine — a waste product made by muscles as they break down proteins or other compounds to release energy. In medicine, the creatinine levels in your blood are used to determine how well your kidneys are functioning because they process and remove creatinine. 

And this is where the system designed for equity gets a little less than equitable for some patients. 

Creatinine levels are affected by muscle mass, and women typically have lower muscle mass than men. A man and woman experiencing the same level of kidney dysfunction will therefore have different levels of creatinine in the body. The MELD model doesn’t take this difference into account — and so lower levels of creatinine in a woman’s blood can make her seem healthier than she is, bumping her farther down the liver waiting list. 

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In 2023, Dr. Ray Kim, a transplant hepatologist at Mayo Clinic in Arizona who developed the original system, debuted a new model called MELD 3.0. The model not only seeks to address the sex disparity in liver access but also improve the accuracy of scores for all patients. Among other changes, it takes into account the sex of the transplant candidate and uses it to adjust the MELD score by 1.33 points for women. This is meant to address the difference in creatinine levels between men and women and provide a more accurate understanding of how sick a female patient really is.

Simple fix, right? Even though MELD 3.0 took the sex disparity in liver access seriously and developed changes to combat it, early research on its efficacy found that even this new and improved system hasn’t yet brought men and women to parity on the liver waitlist. 

And the problem may lie less with what MELD 3.0 did than with what it did not do, prompting the question: Are we focusing on the wrong problem? 

Sex matters…but so does size

Before the MELD score, liver transplants were largely conducted on a first-come, first-served basis. Those who were added to the waiting list first, received livers first. If a really sick candidate was added to the waiting list late, say because of delayed diagnosis, they would almost certainly die while waiting for a liver to become available.

The original MELD fixed that problem by creating a measure of urgency that was easy to calculate. The initial model used three main blood test values — bilirubin, creatinine, and a measure of blood clotting time — and later improvements also took into account the sodium level. 

Traditionally, the MELD model assigns a score between 6 and 40 to liver transplant candidates. MELD 3.0 adds 1.33 points to women’s scores to account for the differences in creatinine levels between the sexes. The new model also measures albumin, an additional biomarker, and adjusts for interactions between the different variables.

Sommer Gentry, a professor at NYU Grossman School of Medicine and contributor to the paper on MELD 3.0, said that using sophisticated algorithms with more biomarkers not only helps to better predict risk for women, but using a more accurate model also benefits the whole population. The researchers estimate that this fine-tuned MELD 3.0 model will reduce at least 20 waiting list deaths per year. Last year, around 800 liver transplant candidates died while waiting for a liver. 

But creatinine is only one of the two main problems that create a disparity in liver access for women. The second, Gentry says, is body size, an issue that’s not addressed by MELD 3.0. A transplanted liver has to physically fit inside the body of a recipient, and women are typically smaller than men, so a very large liver cannot be offered to a small woman. But the reverse is not necessarily true because receiving a liver that is small for the potential recipient doesn’t typically harm the candidate.    

“The smaller you are, the less likely you are to be offered something that’s actually going to work for you,” Gentry said, adding that women end up waiting longer to receive a liver that will actually fit their body. 

Part of the conversation on sex disparity in liver access is based around which of the two problems — creatinine or body-size interventions — to fix first, and whether it is possible to create equity by addressing just one of the two, Gentry said. MELD 3.0 was an attempt to remove the former barrier. 

“I think that some other papers are coming out that suggest that perhaps the other aspect of size matching is still a concern and still possibly not addressed by the resulting liver transplant system,” Gentry said. 

Why is the new model still falling short?

Gentry believes that MELD 3.0 has increased liver transplant rates for female candidates since its adoption in 2023. But early research, however, suggests that the new model falls short of fixing the problem. 

Studies done on MELD 3.0’s impact on liver transplant rates for women indicate that the model increased the number of liver transplants for female candidates — but the gains were short-lived. 

An analysis published in July of nearly 10 million daily records from over 60,000 candidates on the US liver transplant registry found that rates of completed liver transplants for women increased in the period immediately after MELD 3.0 was implemented, but the increase was temporary. Women’s estimated odds of receiving a transplant drifted back to pre-MELD 3.0 levels by the end of the study period, 15 months after the new model was implemented. Women on the waiting list and women who had received a transplant also had higher scores in the three months right after MELD 3.0 took effect, but their scores later fell back to levels comparable to those of men.

Both the successes and shortfalls of MELD 3.0 demonstrate how rethinking existing policies and standards can help reduce inequities in organ access and healthcare.

The authors think that the early surge in liver transplant rates for women was a onetime catchup. MELD 3.0 pushed a group of women who had been stuck on the list — sicker than their old scores suggested — over the priority threshold all at once, leading them to receive liver transplants. 

Notably, the one effect that did persist was that under MELD 3.0, women received more “organ offers” than before. Every time a deceased donor liver becomes available, the system generates a ranked list of the patients suitable to receive that organ. Under MELD 3.0, the number of times an available liver was offered to a female candidate increased, probably because their (more accurate) MELD 3.0 scores better reflected how sick they were. But they’re not necessarily receiving those livers, presumably because of organ size issues. 

These findings suggest that revising the MELD criteria alone may not be enough to eliminate the sex disparity, especially if the body-size disadvantage is part of the problem. 

The authors say that a patient’s sex is merely a poor proxy for the real issue — we don’t have allocation systems in place to ensure that candidates with smaller body sizes also have the same robust access to livers.

Toward liver donation equity for all

If we could figure out how to better address questions of body size in organ donation, the benefits could be enormous. According to Gentry, body-size disparity affects the organ allocation system in general. Similar issues arise with heart and lung transplants too, where the size of the organ relative to body size has to be taken into consideration during organ allocation.

She says that a size-aware organ allocation system would therefore benefit patients on the waiting list across the board. Whether an available organ is the right fit for the potential recipient should be weighed heavily in allocation algorithms, rather than just a list of ranked waitlisted candidates. 

“That should be a larger consideration in sorting the patients who will be offered a certain organ — to ask if this organ is especially suited to one kind of patient over another,” Gentry said.

Under such a system, she said, smaller livers could be offered first to the smallest candidates on a ranked list of those who are also sickest. The assumption is that a smaller candidate will have to wait longer for a viable liver that fits them, even if they have a very high MELD score. 

For such a policy to be instituted, the Organ Procurement and Transplantation Network – a nonprofit that oversees the distribution of donor organs — would have to approve it. And before such a system could be presented to the regulatory organization, more research is required.  

It is often the case in medicine that our definition of what counts as a healthy body is measured against the average white male. This too often lowers access and quality of care for both women and people of other races. For example, the standards for creatinine levels in blood reduced access to kidney transplants for Black transplant candidates for years until recent efforts were made to start correcting it. 

In that sense, both the successes and shortfalls of MELD 3.0 demonstrate how rethinking existing policies and standards can help reduce inequities in organ access and healthcare. The conversations and critiques that followed its rollout have exposed a clear gap in organ allocation strategies, one that disadvantages a large group of patients. Closing that gap, not just in liver transplantation but across the board, could bring us a step closer to equity while also making more efficient use of the organs available to save lives.

“There’s no mechanism right now, if a small liver is available, for offering it preferentially to the small women who might not be able to accept lots of other organs that are becoming available,” Gentry said. While fixing the model to rank women more accurately on the liver waiting list is a start, including body-size considerations in the organ allocation system might be the real bottleneck to address.

Hi readers! Shayla Love here, science journalist and longtime fan of Your Mileage May Vary. I’m honored to be subbing for Sigal Samuel while she’s out on parental leave. I’m diving into your questions as a way to help understand human nature and our choices through multiple lenses: philosophical, psychological, and beyond. Please send in any emotional, body/brain, sociological, perceptual, or other kind of life quandaries you might have.

My child, age 9, has decided she’s vegan. Neither of her parents are even vegetarian — we’re “free range chicken/grass fed beef” types. She has learned about veganism from friends at school, and seems to have come to her position more or less on her own. I want to encourage her ethical choices, but her mother and I agree that children should be introduced to new foods and flavors at this age. She has no allergies or intolerances that we know of. I worry that making accommodations for her dietary restriction may lead to a lifetime of picky eating, even if hers is a reasonable and ethical approach. She seems to be uncomfortable when her mother or I cook meat for meals we share, even if we make her another option. What should I do to support my daughter?

Dear Hold the Beef, 

When I was around your daughter’s age, I went to Hawaii with my parents. One night, we ate dinner on the beach, and we watched as a pig was dug up from an underground steam oven. I was horrified to see its face and nose; most of the meat I had eaten so far in my life didn’t resemble the animal it came from. A few years later, I became a vegetarian, and then in my 20s, a vegan. 

I share this story to reveal my slight bias in answering your question, but also my understanding of the ethical awakening your daughter might be experiencing. As you figure out how to talk to your child about what she decides to eat, we can at least table discussing the pros and cons of veganism itself. Instead, you should think about what amount of autonomy your child should have, and whether the moral decision-making she wants to engage in matches with her current stage of development. 

People don’t turn 18 and then suddenly start engaging morally with the world. As we grow up, we try to understand right and wrong in fits and spurts. Lawrence Kohlberg, a 20th-century American psychologist, is best known for attempting to track a person’s moral development throughout their life. 

Kohlberg presented people with hypothetical dilemmas in order to come up with six moral stages. In one example, he asked people of different ages about a dying woman who could be cured by a drug that was cheap to make, but that a manufacturer was charging an exorbitant fee for. The woman’s husband ends up stealing the drug. Is that right or wrong?

Kohlberg observed that in answering questions like this, young children have what he called a “preconventional morality”: Their notions of right and wrong are dictated by what their parents think, and the avoidance of punishment when breaking those rules. For instance, the main reason not to throw your dinner on the ground or hit your brother was to avoid consequences from parents, not a feeling that there’s something wrong about that action. 

Kohlberg thought this stage lasted until around age 9, and in the next period, children began to understand that there isn’t just one correct action, but that people could have different moral ideas based on their social context. To sum up the rest of the stages quickly, each one progresses to encompass more views — like the moral agreements necessary to make a society function — and more complexity — like the realization that a seemingly immoral action can ultimately be moral, like stealing medicine for one’s wife. 

It’s useful to pinpoint where your daughter finds herself on Kohlberg’s timeline. It sounds like she’s in the shift from the first stage and into the later ones. What you’ve decided — that it’s okay to eat meat if it’s free-range or grass-fed — is no longer sufficient for your daughter in terms of guiding her own actions. That can be a jarring moment for a parent, but at least, according to Kohlberg, it’s a sign of maturation. Your child should, at this age, start to consider her friends, as well as the experiences she’s had without you, when making an ethical choice. 

But I’m her parent, you may protest. That doesn’t necessarily mean that your job is to exclusively provide black-and-white directives. 

Alison Gopnik, a psychologist and philosopher at the University of California Berkeley, has written about the unique perspective and personhood of children (including babies). In her book The Gardener and the Carpenter, she questions how people have come to define the act of parenting as having specific goals in mind for their children. This approach is like being a carpenter, she writes, who follows instructions to assemble a predetermined piece of furniture. She argues that parenting is more like gardening: You cultivate the soil and the environment and realize that you could produce any number of different flowers, fruits, or vegetables. Growth is the point, not a by-the-book final product. 

I see Gopnik in alignment with Jean-Jacques Rousseau, the 18th-century philosopher whose novel Émile, or On Education surprised its readers by advocating for a freer and child-centered approach to teaching. Émile, a young wealthy boy, is tutored — in high contrast to the expectations of the day — without strict rules. Rousseau thought you couldn’t make a child turn into an adult any faster, and it was foolish to try. He also thought that children had to learn by having their own experiences out in the world, and learning from those, rather than just overly didactic lessons. 

As your daughter dips her toe into the morality of eating meat, Rousseau would also remind you not to expect her to have the most mature ideas about veganism or her meal plan. She is still young, and may just have come across an idea that feels ethically important to her. Your role as her parent is to help her develop her nuanced morality, a process Kohlberg suggests will continue, and not steer her towards one way of eating over another. Be Gopnik’s dietary gardener, not carpenter. 

Of course, parents do have rights over their children, and an obligation to keep them safe. When we’re young, we’re not always equipped to make the right choice (some would argue this continues into adulthood, too). If your daughter decided to take up smoking cigarettes, for instance, you would step in because her choice would negatively affect her health. As her parent, you should still guide her to build healthy habits. 

You say you’re worried about your daughter becoming too picky, or not being exposed to enough foods if she becomes a vegan. But rather than push back on the choice itself, you can explain what else her choice entails. You can do so in an age-appropriate way. Talk about the nutrients that she might be missing out on if she stops eating meat, dairy, and eggs, and find books or videos about what foods might be a good substitute. 

For me, becoming vegan actually exposed me to all kinds of foods that I might not have eaten otherwise: from Asian and Indian cuisines that are very veggie-friendly to many other protein- and iron-rich plant-based foods. You could collaborate with your daughter to cook vegan meals for the whole family; no challenge sparks a budding home cook more than making delectable tofu. 

I should add that I’m no longer a vegan. I learned a lot from committing to a diet that wasn’t always convenient or tasty, in support of my values. Then, after more than a decade, I incorporated eggs and fish back into my diet. It’s likely that your daughter will continue to change the choices she makes as she tries to align her actions with her maturing moral views about the world. 

Whether or not she eats grass-fed beef with you in her teens, you should be glad that she seems to care about what impact she’s having in the world. It means you’re raising a person whose ethics are developing strongly, even as what’s on your dinner plate may change while she figures it all out.  

Bonus: What I’m reading

• Speaking of tofu, I revisited an essay that George Stiffman (a self-proclaimed “tofu guy”) wrote for Asterisk Magazine about how soybean curds are prepared in China. Warning: This article will make you hungry! He dives into all the creative culinary preparations of tofu that are tragically absent in the West. 
• Several years ago, I bought a plant-based cooking book especially for children, The Vegan Cookbook for Kids: Easy Plant-Based Recipes for Young Chefs. It was a present for a non-vegan family, but the kid in question was interested in learning how to cook, and when kids cook vegan, parents don’t have to worry about them handling raw meat! Looking over these snacks and meals again, I see several tasty things that I wouldn’t mind making for myself, even as a non-vegan, and non-child. 
• When I was a vegan in New York City in the 2010s, I wasn’t constrained to sad tofu and sprout sandwiches. It seemed like every week a brand-new vegan restaurant opened up, covering every cuisine, and with star chefs at the helm. But lately, all my favorite vegan restaurants have been closing. Turns out I’m not imagining it, as Vox’s Marina Bolotnikova wrote in her article: “Where did all the vegan restaurants go?” She investigates why these establishments have become rarer, and what we’ll miss out on if they completely disappear.