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      Biden Campaign Sharpens Its Post-Roe Message: Abortion Is About Freedom

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      In events next week, the president and vice president will argue that abortion access is crucial to personal freedoms, and warn of what is at stake if Donald J. Trump is re-elected.President Biden and Vice President Kamala Harris will headline events next week centered around protecting abortion rights, throwing more heft behind an issue that has galvanized voters in the 18 months since the Supreme Court struck down Roe v. Wade.On Monday, Ms. Harris will visit Wisconsin to begin a national tour focused on preserving access to reproductive health care as Republicans call for more restrictions. Then on Tuesday, she will join Mr. Biden at a rally for abortion rights in Virginia, where Democrats recently took control of the state legislature and have proposed to enshrine abortion protections in the state constitution.Ms. Harris offered a preview of the administration’s election-year messaging to Americans when she visited “The View,” the most popular daytime talk show in the country.“We are not asking anyone to abandon their personal beliefs,” she said during an appearance on Wednesday, adding that “the government should not be telling women what to do with their bodies.”The idea that preserving access to abortion is tantamount to preserving personal freedoms has been embraced by Biden administration officials, lawmakers and activists who hope it will energize a flagging base and draw independent voters into the fold. They also want to contrast the administration’s policies with the political peril that the Republican Party faces by embracing hard-line measures.“I start from the place that most Americans believe that women should have the freedom to make their own decisions about health care, including abortion, without government interference,” Senator Tina Smith, Democrat of Minnesota, who traveled to the Iowa caucuses as a surrogate for Mr. Biden, said in an interview. (About 69 percent of voters think abortion should be legal in the first three months of pregnancy, according to a Gallup poll last year.)We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber?  More

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      F.D.A. to Issue First Approval for Mass Drug Imports to States from Canada

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      The agency authorized Florida to purchase medicines directly from wholesalers in Canada, where prices are far cheaper. Pharmaceutical companies oppose the plan.The Food and Drug Administration has allowed Florida to import millions of dollars worth of medications from Canada at far lower prices than in the United States, overriding fierce decades-long objections from the pharmaceutical industry.The approval, issued in a letter to Florida Friday, is a major policy shift for the United States, and supporters hope it will be a significant step forward in the long and largely unsuccessful effort to rein in drug prices. Individuals in the United States are allowed to buy directly from Canadian pharmacies, but states have long wanted to be able to purchase medicines in bulk for their Medicaid programs, government clinics and prisons from Canadian wholesalers.Florida has estimated that it could save up to $150 million in its first year of the program, importing medicines that treat H.I.V., AIDS, diabetes, hepatitis C and psychiatric conditions. Other states have applied to the F.D.A. to set up similar programs.But significant hurdles remain. The pharmaceutical industry’s major lobbying organization, the Pharmaceutical Research and Manufacturers of America, or PhRMA, which has sued over previous importation efforts, is expected to file suit to prevent the Florida plan from going into effect. Some drug manufacturers have agreements with Canadian wholesalers not to export their medicines, and the Canadian government has already taken steps to block the export of prescription drugs that are in short supply.“Canada’s drug supply is too small to meet the demands of both American and Canadian consumers,” Maryse Durette, a spokeswoman for Health Canada, wrote in an email message. “Bulk importation will not provide an effective solution to the problem of high drug prices in the U.S.”Congress passed a law allowing drug importation two decades ago, but federal health officials delayed implementing it for years, citing safety concerns, one of the main arguments drug companies have used against it. In 2020, President Donald J. Trump pushed the law forward, announcing that states could submit importation proposals to the F.D.A. for review and authorization. President Biden added momentum the following year, instructing federal officials to keep working with states on importation plans.Florida applied and later sued the F.D.A., accusing the agency of what Gov. Ron DeSantis called a “reckless delay” in approving the request. Friday’s announcement grew out of that lawsuit; a federal judge had set a Jan. 5 deadline for the F.D.A. to act on the state’s application.Dr. Robert Califf, the F.D.A. commissioner, said in a statement that the agency will be vetting additional state applications to be sure they live up to the program’s goals.“These proposals must demonstrate the programs would result in significant cost savings to consumers without adding risk of exposure to unsafe or ineffective drugs,” Dr. Califf said.Eight other states — Colorado, Maine, New Hampshire, New Mexico, North Dakota, Texas, Vermont and Wisconsin — have laws allowing for a state drug importation program, and many are seeking, or planning to seek, F.D.A. approval.Colorado’s application is pending with the F.D.A. New Hampshire’s application was rejected last year. Vermont’s was deemed incomplete; a spokeswoman said the state was waiting to see how the F.D.A. handled the applications by other states before resubmitting.Colorado officials have signaled that states may face challenges from drugmakers in Canada, among them familiar names like Pfizer, Merck and AstraZeneca. Some drugmakers have written contracts with drug-shipping companies prohibiting deliveries to the United States, Colorado officials said in a report.Drug importation has broad political and public support. A 2019 poll by KFF, a nonprofit health research group, found that nearly 80 percent of respondents favored importation from licensed Canadian pharmacies.“Importation is an idea that resonates with people,” Meredith Freed, a senior policy analyst with KFF, said. “They don’t fully understand why they pay more for the same drug than people in other countries.”With the 2024 presidential election on the horizon, candidates are looking to claim credit for efforts to reduce drug prices. President Biden is spotlighting the Inflation Reduction Act, which empowers Medicare to negotiate prices directly with drugmakers for the first time, but only for a limited number of high cost medicines. Mr. DeSantis, who is challenging Mr. Trump for the Republican nomination, is touting his import plan.Several experts in pharmaceutical policy said that importation from Canada would not address the root cause of high drug prices: the ability of pharmaceutical makers to fend off generic competition by gaming the patent system, and the federal government’s broad failure to negotiate directly with drugmakers over cost.“Seems like political theater to me, where everyone wants to say they did something to drive down the price of prescription drugs,” Nicholas Bagley, a health law expert at the University of Michigan Law School, said of Florida’s plan.Both Mr. Bagley and Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said that the Inflation Reduction Act is a more direct path to lowering prices; the law’s price negotiation provisions are expected to save the federal government an estimated $98.5 billion over a decade. Drugmakers are suing to block those provisions from taking effect.A protest outside the Pharmaceutical Research and Manufacturers of America in Washington in 2021. PhRMA is likely to file suit to prevent any plan from going into effect.Saul Loeb/Agence France-Presse — Getty ImagesWith its approval in hand, Florida has more work to do. Before it can distribute Canadian drugs, the state must send the F.D.A. details on those it plans to import. The state has to ensure that the drugs are potent and not counterfeit. It also must put F.D.A.-approved labels on medications instead of those used in Canada.The F.D.A. said it would be watching to see if the state upholds safety rules — such as the reporting of any drug side effects — and delivers significant cost savings to consumers. Florida’s approval to import lasts for two years from the date of the first drug shipment.In Canada, health officials have been casting a wary eye on the push to import from their country. In November 2020, shortly after the Trump administration announced that states could submit importation proposals, the Canadian government published its own rule to prevent manufacturers and wholesalers from exporting some drugs that are in short supply.The Canadian government is likely to further restrict exports if they begin to affect Canadians, said Amir Attaran, a law professor at the University of Ottawa. He said the numbers don’t work out for a nation of nearly 40 million to supply medications for a state with 22 million people, much less for 49 other U.S. states.“If all of a sudden Florida is able to extend a vacuum cleaner hose into this country to take what’s in the medicine chest, the supply disruption will be a completely different category,” he said. Dr. Kesselheim, of Harvard, said the F.D.A.’s authorization was unlikely to make a difference in the price of very expensive brand-name drugs, because manufacturers would block wholesalers from exporting the medicines.“I think it’s going to be hard for states to import drugs like that in any kind of scale that would make a difference in terms of lowering prices for patients,” Dr. Kesselheim said. Even so, he said, the F.D.A.’s announcement is significant because it puts to rest the notion that drug importation cannot be accomplished safely.Mr. Bagley of the University of Michigan said there was a simpler solution to high drug prices than patchwork state importation programs: Having the U.S. government negotiate with drug companies over prices, just as many other nations, including Canada, do.“This whole thing is a jerry-rigged, complicated approach to a problem that’s amenable to a pretty straightforward solution, which is that you empower the government to bargain over the price for drugs,” he said. “So instead, we’re sort of trying to exploit the machinery that Canada has created and that we were too timid to create.” More

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      Biden’s Aid, and Pointed Advice, to Israel

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      More from our inbox:How to Unify, and Save, the CountrySadly, CBC Ends a Time-Honored TraditionOver-the-Counter MedicinesPresident Biden was greeted by Prime Minister Benjamin Netanyahu on his arrival in Israel on Wednesday.Kenny Holston/The New York TimesTo the Editor:Re “U.S. Backs Israel, as Cause of Blast Remains Disputed” and “Biden Urges Caution in War on Hamas” (front page, Oct. 19):President Biden offers good advice that one hopes will be heard by all: Do not let shock, pain and rage lead to counterproductive decisions, decisions that cause unnecessary loss of innocent life and squander the world’s sympathy.Palestinians and Israelis have each been failed by their leaders. Palestinians and Israelis have each suffered unspeakable harm.We pray that Palestinians and Israelis and their respective leaders and all of the people who empathize with them will remember that in the midst of righteous anger, ill-conceived actions can make matters much, much worse for everyone.Ron BoyerEugene, Ore.To the Editor:As an American Jew, I am horrified by President Biden’s response to Hamas’s horrific murder of Israelis on Oct. 7. By providing military aid to Israel, the U.S. government is fueling the Israeli government’s vastly disproportionate response, in which it has already killed more Palestinian civilians than Israeli civilians were killed by Hamas.Mr. Biden may have urged the Israeli people not to be consumed by the rage they feel about the Hamas terror attacks, but that statement is completely contradicted by his sending the very weapons that the Israeli military is using to kill civilians.The U.S. can stop this immoral violence, but instead is fanning the flames by providing support for the autocratic Israeli government. I am joined by many other American Jews in condemning the Israeli government’s killing of thousands and threatening millions of innocent lives in the name of the Jewish people.Miriam ShakowNarberth, Pa.To the Editor:In this time of unbelievable misery and loss, it may be naïve to talk about international law. But some of the participants in the current fighting in Israel (and their allies) have represented that they are trying to respect the laws of war. Since many observers may not be familiar with those laws, I write simply to report two indisputable principles.First, the same rules of conduct apply to the “aggressor” and to its victims. “They started it” is no excuse for doing things that would otherwise be illegal.Second, the fact that the overall objective is permissible (like self-defense) or even laudatory does not excuse using methods that result in disproportionate harm to civilians.Applying these principles, it is a violation of the laws of war to knowingly cut off food, water, fuel and medical supplies to entire trapped localities. The harm would fall disproportionately on civilians who have even less access to whatever supplies exist than those in authority. It cannot be justified.Lea BrilmayerBranford, Conn.The writer is an emeritus professor of international law at Yale University.To the Editor:As an American Israeli living in Israel with a son in the Israel Defense Forces, I feel that I must speak out.It was uplifting for Israelis to hear President Biden’s remarks after the attacks on Oct. 7. Israelis everywhere felt encouraged by the president’s unequivocal support, and the unambiguous message that the events of Oct. 7 constituted “pure, unadulterated evil” — because they truly did.It is clear to Israelis that in carrying out these atrocities, Hamas was seeking to draw Israel into precisely the actions that Israel is now engaged in. The justification for those actions could be debated endlessly, but the world must know that Israel considers itself in existential peril. And in our hour of trial, we derive incredible strength from American support.The objective of Israel’s war with Hamas is not the suffering of Gazans or Palestinians but the crippling of a murderous terrorist organization that has caused unprecedented suffering for Israelis and Palestinians alike.David GilmoreHolon, IsraelHow to Unify, and Save, the Country Doug Mills/The New York TimesTo the Editor:These are unprecedented times. Democracy, national security and the world order are at stake. Our nation has never been so divided.While our young experiment in democracy faces a challenge to its very existence, our world faces heightened conflict from dangerous leaders who present existential threats, and our planet faces increased temperature extremes, violent destructive storms and devastating wildfires.Considering all that is at stake, our nation must find its way to tamp down the noise from the extreme sides of both parties, the disinformation promulgated by partisan media and the contempt for others fueled by social media.I propose a unique approach to ensure the continued success of our republic. As much as I respect and admire Vice President Kamala Harris, I would ask that for the greater good of our nation and the world, she step aside as President Biden selects a moderate Republican (such as Larry Hogan, the former Maryland governor) as his 2024 running mate.Not only would this virtually guarantee his re-election, but it would also be a giant step in uniting the country.Bradley S. FeuerWellington, Fla.Sadly, CBC Ends a Time-Honored TraditionThe “long dash,” as the CBC’s daily announcement of the official time was known to generations of Canadians, was broadcast for the final time on Oct. 9.Geoff Robins/Agence France-Presse — Getty ImagesTo the Editor:Re “After 84 Years, Time Abruptly Runs Out on Canadian Radio Tradition” (news article, Oct. 18):CBC’s dropping of its 84-year tradition of announcing the precise time at 1 p.m. day in and day out may seem like a trivial matter in the current world environment. But find me a Canadian who cannot finish the sentence “The beginning of the long dash …” (for the non-Canadian readers: “indicates exactly 1 o’clock Eastern Standard Time”).It’s as common as eight months of winter and hockey, and always saying “I’m sorry.”It was enough of a collective jolt when the middle of the announcement (“following 10 seconds of silence”) was abandoned. We grew up counting down that 10 seconds of radio silence while at the ready to instantly adjust our watches if necessary. And now we are completely on our own.Go easy on us, world, if the lone Canadian invited to the party is now always early or late. We’re sorry.Mary E. CampbellOttawaOver-the-Counter Medicines Jackson GibbsTo the Editor:Re “We’ve Known for 20 Years This Cold Medicine Doesn’t Work,” by Randy C. Hatton and Leslie Hendeles (Opinion guest essay, Oct. 1):Nonprescription, over-the-counter (O.T.C.) medicines are a cornerstone of our nation’s health care system, yet your essay draws sweeping conclusions and disregards decades of regulatory oversight, scientific review, and real-world evidence supporting their safety and efficacy.Phenylephrine, the only O.T.C. oral decongestant available without purchase restrictions, has decades of use as a safe and effective option for temporary nasal congestion relief. The Food and Drug Administration has twice determined phenylephrine to be “generally recognized as safe and effective,” the regulatory standard for O.T.C. medicines.However, the authors’ assessment discounts this history, and other evidence, while elevating their own limited research. No medicine works equally for everyone, and every medicine has unique considerations for therapeutic selection. Providing Americans with options that offer freedom of choice for personal health care needs is a core attribute of our health care system.Consumers can have confidence in their O.T.C. medicines, and the regulatory framework that oversees them.Scott MelvilleWashingtonThe writer is president and C.E.O. of the Consumer Healthcare Products Association. More

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      Biden Warns That Republicans Are Not Finished on Abortion

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      A year after the end of Roe v. Wade, Biden administration officials are working with a limited set of tools, including executive orders and the bully pulpit, to galvanize supporters on abortion rights.Minutes after the Supreme Court voted to overturn Roe v. Wade last summer, a group of West Wing aides raced to the Oval Office to brief President Biden on the decision. As they drafted a speech, Mr. Biden was the first person in the room to say what has been his administration’s rallying cry ever since.Passing federal legislation, he told the group, was “the only thing that will actually restore the rights that were just taken away,” recalled Jen Klein, the director of the White House Gender Policy Council.But if the prospect of codifying Roe’s protections in Congress seemed like a long shot a year ago, it is all but impossible to imagine now, with an ascendant far-right bloc in the House and a slim Democratic majority in the Senate.Instead, with the battle over abortion rights turning to individual states, officials in the Biden administration are working with a limited set of tools, including executive orders and the galvanizing power of the presidency, to argue that Republicans running in next year’s elections would impose even further restrictions on abortion.“Make no mistake, this election is about freedom on the ballot,” Mr. Biden said Friday at a Democratic National Committee event, where he collected the endorsements of several abortion rights groups.On Saturday, Vice President Kamala Harris was set to deliver a speech in North Carolina marking the one-year anniversary of the Supreme Court’s decision to eliminate the constitutional right to an abortion after almost 50 years. Ms. Klein, who recalled refreshing news websites on the day the decision came down last June, said that she was “shocked but not surprised” by the court’s ruling in Dobbs v. Jackson Women’s Health Organization.She added that “efforts to really take extreme action do not represent the majority of opinion of where people are on this.”The White House has argued that Mr. Biden is reaching the legal limits of his powers through executive actions. On Friday, his latest executive action in response to the Dobbs decision ordered federal agencies to look for ways to ensure and expand access to birth control.Mr. Biden previously has issued a memorandum to protect access to abortion medication at pharmacies and taken action to protect patients who cross state lines to seek care. The Justice Department has taken legal action against some states restricting abortion. And the Food and Drug Administration’s approval of the abortion-pill drug mifepristone was quickly challenged in the courts. (In April, the Supreme Court issued an order to preserve access to the pill as litigation continues.)The Biden campaign and the Democratic National Committee will make abortion a primary focus of the president’s re-election effort.Haiyun Jiang/The New York TimesAs the White House has clarified its message around abortion rights, framing the fight as one in support of privacy, safety and civil rights, so has the president. Mr. Biden, a Catholic who attends mass almost every week, has struggled throughout his career with defending abortion rights. Since Roe was overturned, he has grown more outspoken.“I think that he is somebody who really has his own personal views, and has also been quite clear that Roe v. Wade was rightly decided,” Ms. Klein said.Recent polling shows that a majority of Americans may feel similarly. A USA Today/Suffolk University poll conducted earlier this month found that one in four Americans said that restrictive abortion bans enacted at the state level have made them more supportive of abortion rights. Another poll, conducted by PBS NewsHour, NPR and Marist, said that 61 percent of American adults support abortion rights.Some activists suspect that some Republican presidential candidates are paying attention to the polling. Mike Pence, the former vice president and presidential candidate, said on Friday that he would support a 15-week national ban on the procedure. Senator Tim Scott of South Carolina has also backed such a ban.Other candidates have avoided a definitive stance. Gov. Ron DeSantis of Florida signed a six-week abortion ban into law in his state, though he has not said whether he would support a national ban.“It was the right thing to do,” Mr. DeSantis said Friday of signing the law.The G.O.P. primary front-runner, former President Donald J. Trump, takes credit for appointing the Supreme Court justices who overturned Roe v. Wade, but he has so far also resisted embracing a federal ban.As the G.O.P. field assembles, the Biden campaign and the Democratic National Committee will make abortion a primary focus of the president’s re-election effort. Earlier this month, the Biden campaign launched an advertisement campaign focused on battleground states, including the funding of billboards in Times Square that will highlight Republican efforts to restrict abortion access.The Democratic National Committee is also encouraging local Democrats to press Republicans to specify what their position is on national bans, believing it will help contrast Mr. Biden’s approach with extremist positions, according to a D.N.C. official.Inside the White House, Ms. Klein said officials are tracking court cases in individual states and bringing abortion-rights activists together to compare notes on which policies have succeeded.Still, activists are wary that court victories can be short-lived and do not take away the threat of a wider abortion ban the way legislation would.In recent months, administration officials have regularly highlighted the stories of women who have been denied emergency medical care when suffering pregnancy loss.Ms. Harris, who has made several trips and delivered speeches in defense of abortion rights, has frequently introduced medical care providers at her events to bolster the argument that the decision to end a pregnancy is a private one and not to be toyed with by local politicians.Vice President Kamala Harris, displaying a map showing abortion access, has emerged as a strong voice in the administration on abortion rights.Oliver Contreras for The New York TimesJill Biden, the first lady, has also been enlisted in the effort. On Tuesday, she hosted a group of women in the Blue Room of the White House and asked them to share their stories. One of the women, Dr. Austin Dennard, a physician in Texas, said she was forced to travel out of state for an abortion when her fetus was diagnosed with anencephaly, a condition that causes a baby to be born without parts of the brain and skull.Another, a Houston-based Democratic campaign worker named Elizabeth Weller, had gone into labor at 18 weeks and was directed to go home until she developed an infection so severe that a hospital ethics panel allowed a doctor to end the pregnancy.“Joe is doing everything he can do,” the first lady told the group.Mini Timmaraju, the president of the abortion rights group NARAL Pro-Choice America, agreed that the Biden administration is “doing everything they can,” but she said the limitations are real.“We have to give them a pro-choice majority Congress,” she said. “That’s it. They’ve done everything they can up until that point, but without the support of Congress, they are limited and we are limited in what we can do.” More

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      The Bloody Crossroads Where Conspiracy Theories and Guns Meet

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      Gail Collins: Bret, you and I live in a state that has some of the toughest gun laws in the country. But that didn’t stop a teenager with a history of making threats from getting his hands on a semiautomatic rifle and mowing down 10 people at a supermarket in a Black neighborhood in Buffalo on Saturday.Bret Stephens: It’s sickening. And part of a grotesque pattern: the racist massacre in Charleston in 2015, the antisemitic massacre in Pittsburgh in 2018, the anti-Hispanic massacre in El Paso in 2019 and so many others. There’s a bloody crossroads where easy access to weapons and increasingly commonplace conspiracy theories meet.I have diminishing faith that the usual calls for more gun control can do much good in a country with way more than 300 million guns in private hands. Please tell me I’m wrong.Gail: Sane gun control won’t solve the problem, but it’ll help turn things around — criminals and mentally ill people will have a harder time getting their hands on weapons. And the very fact that we could enact restrictions on firearm purchases would be a sign that the nation’s whole attitude was getting healthier.Bret: Wish I could share your optimism, but I’ve come to think of meaningful gun control in the United States as the ultimate Sisyphean task. Gun control at the state level doesn’t work because guns can move easily across state lines. Gun control at the federal level doesn’t work because the votes in Congress will never be there. I personally favor repealing the Second Amendment, but politically that’s another nonstarter. And the same Republican Party that opposes gun control is also winking at, if not endorsing, the sinister Great Replacement conspiracy theory — the idea that liberals/Jews/the deep state are conspiring to replace whites with nonwhite immigrants — that appears to have motivated the accused shooter in Buffalo.Bottom line: I’m heartbroken for the victims of this massacre. And I’m heartbroken for a country that seems increasingly powerless to do anything about it. And that’s just one item on our accumulating inventory of crippling problems.Gail: You know, we thought the country was going to be obsessed with nothing but inflation this election year. But instead, it’s hot-button social issues like guns, and of course we’ve spent the last few weeks reacting to the Supreme Court’s upcoming abortion decision, which probably won’t actually be out for weeks.Bret: And may not end up being what we were led to expect by the leaked draft of Justice Alito’s opinion. I’m still holding out hope — faint hope, because I fear that the leaking of the decision will make the conservative justices, including Justice Gorsuch and Chief Justice Roberts, less open to finding a compromise ruling that doesn’t overturn Roe.Gail: Is it possible things will get even more intense when it’s announced? And what’s your take on what we’ve seen so far?Bret: Much more intense and largely for the reasons you laid out in your terrific column last week: Abortion rights are about much more than abortion rights. They’re also about sex and all that goes with it: pleasure, autonomy, repression, male responsibility for the children they father and the great “who decides” questions of modern democracy. The justices will have to gird for more protests outside their homes.What do you think? And is there any chance of crafting an abortion rights bill that could get more than 50 votes in the Senate?Gail: Well, maybe if everybody hunkered down and tried to come up with something that would lure a few Republicans who say they support abortion rights like Susan Collins. Many Democrats don’t want to water down their bill and really there’s not much point in making the effort since they’d instantly run into the dreaded filibuster rule.Bret: Wouldn’t it have helped if Democrats had devised a bill that a majority could get behind, rather than one that had no chance of winning because it went well beyond Roe v. Wade by banning nearly all restrictions on abortions?Gail: Given the dispiriting reality of Senate life — 60 votes, Joe Manchin, etc., etc. — I can see why Chuck Schumer has pretty much given up the fight to change anything on that front and is just focused on drawing attention to the whole abortion issue in this year’s elections.Bret: Shortsighted. Democrats need to secure their moderate flank, including lots of voters who want to preserve abortion rights but have strong moral reservations about late-term abortions. It just makes the party seem beholden to its most progressive, least pragmatic flank, which is at the heart of the Democrats’ political problem.Gail: Now whatever happens isn’t going to directly affect folks who live in states like New York. But when I look at states that have already passed abortion bans in anticipation of a court decision, I do worry this won’t be the end of the story — that the legislatures might move further to ban at least some kinds of contraceptives, too.Am I being overly paranoid?Bret: It’s hard for me to imagine that happening, unless Republicans also intend to repeal the 19th Amendment to keep women from throwing them out of political office. Even most conservative women in America today probably don’t want to return to the fingers-crossed method of birth control.Can I go back to something we said earlier? How do you feel about the protests outside of the justices’ homes?Gail: Pretty much all in the details. The Supreme Court members have lifetime appointments and they’re immune from the normal constraints on public officials who have to run for re-election or who work for a chief executive who has to run for re-election.So I support people’s right to make their feelings known in the very few ways they have available. As long, of course, as the demonstrators are restrained and the justices and their families are provided with very good security.You?Bret: It seems like a really bad idea for a whole bunch of reasons. If the hope of the protesters is to get the justices to change their vote by making their home life unpleasant, it probably accomplishes the opposite: People generally don’t respond well to what they perceive as harassment. Those homes are also occupied by spouses and children who should have the right to remain private people. It’s also a pretty glaring temptation to some fanatic who might think that he can “save Roe” through an act of violence. And, of course, two can play the game: What happens when creepy far-right groups decide to stage protests outside the homes of Justices Kagan and Sotomayor and soon-to-be Justice Jackson?Gail: Well, I guess we’ll get to have this fight again. Meanwhile, let me switch to something even more, um, divisive. Baby formula!Bret: I wish I could joke about it, but it’s a seriously unfunny story.Gail: A plant that manufactures brands like Similac was shut down after concerns were raised about possible contamination. Things will eventually go back to normal, at least I hope they do, but in the meantime the supply dropped by about half.Lots to look into on how this happened. But it’s a reminder that parents have to rely on four companies for almost all the nation’s formula supply. Which then should remind us of the virtue of antitrust actions that break up mega-corporations.Bret: One lesson here is that when the F.D.A. decides to urge a “voluntary recall” of something as critical as baby formula, as it effectively did in February, it had better be sure of its reasons and think through the entire chain of potential consequences to public health. Another lesson is that when our regulations are so extreme that we won’t allow the formula made in Europe to be sold here commercially, something is seriously wrong with those regulations.Gail: I’ll go along with you about the imports from Europe, after noting that importation from Canada was restricted by the Trump administration.Bret: We will mark that down on the ever-expanding list of things we hate about Trump.Gail: However, recalling formula that’s given bacterial infections — some fatal — to babies doesn’t seem all that radical to me.Bret: I agree, of course, but it isn’t clear the bacteria came from the plant in question and surely there must have been a way to deal with the problem that didn’t create an even bigger problem.The broader point, I think, is that our zero-tolerance approach to many kinds of risk — whether it’s the possible contamination of formula or shutting down schools in reaction to Covid — is sometimes the riskiest approach of all. How did the most advanced capitalist country in the world become so incapable of weighing risks? Is it the ever-present fear of lawsuits or something else?Gail: Part of the problem is a general — and bipartisan — eagerness to restrict imports on stuff American companies produce.Bret: Am I hearing openness on your part to a U.S.-E.U. free trade agreement? That would solve a lot of our supply-chain problems and annoy protectionists in both parties.Gail: Yeah, but the last thing we ought to do is respond to an event like the formula shortage by saying, “Oh gosh, no more federal oversight of imports!” Really, there’s dangerous stuff out there and we need to be protected from it.Bret: Well, of course.Gail: Let’s move on to the upcoming elections. Really fascinated by that Pennsylvania Senate primary. Particularly on the Republican side, where we’re seeing a super surge from Kathy Barnette, a Black, very-very-conservative-to-reactionary activist. The other leaders are still Trump’s favorite, Mehmet Oz, and David McCormick, former head of the world’s largest hedge fund.Bret: Nice to see a genuinely competitive race.Gail: Barnette is doing very well despite — or maybe because of — her record of anti-Muslim rhetoric.A pretty appalling trio by my lights, but do you have a favorite?Bret: I’m in favor of the least crazy candidate on the ballot.Gail: Excellent standard.Bret: The problem the G.O.P. has had for some time now is that in many states and districts, not to mention the presidential contest, the candidate most likely to win a primary is least likely to win a general election. Republican primaries are like holding a heavy metal air guitar contest in order to compete for a place in a jazz ensemble, if that makes any sense.Gail: Yeah, although that particular music contest does sound sorta fascinating.Bret: Question for you, Gail: Do you really think President Biden is going to run for re-election? Truly, honestly? And can you see Kamala Harris as his successor?Gail: Well, I’m of the school that says Biden shouldn’t announce he’s not running and embrace lame duckism too early. But lately I have been wondering if he’s actually going to try to march on through another term.Which would be bad. The age thing aside, the country’s gotten past the moment when all people wanted in a chief executive was a not-crazy person to calm things down.Bret: If Biden decides to run, he’ll lose in a landslide to anyone not named Trump. Then again, if he decides to run, then he’ll also be tempting Trump to seek the Republican nomination.Gail: If Kamala Harris runs we will have to … see what the options are.Bret: I’ve always thought Harris would be a great secretary general of the United Nations. When does that job come open again?The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      In Trump’s Final Chapter, a Failure to Rise to the Covid-19 Moment

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      #masthead-section-label, #masthead-bar-one { display: none }Covid-19 VaccinesVaccine QuestionsDoses Per StateAfter Your VaccineHow the Moderna Vaccine WorksWhy You’ll Still Need a MaskAdvertisementContinue reading the main storySupported byContinue reading the main story‘Covid, Covid, Covid’: In Trump’s Final Chapter, a Failure to Rise to the MomentAs the U.S. confronted a new wave of infection and death through the summer and fall, the president’s approach to the pandemic came down to a single question: What would it mean for him?President Trump not only ended up soundly defeated by Joseph R. Biden Jr., but missed his chance to show that he could meet the defining challenge of his tenure.Credit…Doug Mills/The New York TimesMichael D. Shear, Maggie Haberman, Noah Weiland, Sharon LaFraniere and Dec. 31, 2020Updated 9:57 p.m. ETWASHINGTON — It was a warm summer Wednesday, Election Day was looming and President Trump was even angrier than usual at the relentless focus on the coronavirus pandemic.“You’re killing me! This whole thing is! We’ve got all the damn cases,” Mr. Trump yelled at Jared Kushner, his son-in-law and senior adviser, during a gathering of top aides in the Oval Office on Aug. 19. “I want to do what Mexico does. They don’t give you a test till you get to the emergency room and you’re vomiting.”Mexico’s record in fighting the virus was hardly one for the United States to emulate. But the president had long seen testing not as a vital way to track and contain the pandemic but as a mechanism for making him look bad by driving up the number of known cases.And on that day he was especially furious after being informed by Dr. Francis S. Collins, the head of the National Institutes of Health, that it would be days before the government could give emergency approval to the use of convalescent plasma as a treatment, something Mr. Trump was eager to promote as a personal victory going into the Republican National Convention the following week.“They’re Democrats! They’re against me!” he said, convinced that the government’s top doctors and scientists were conspiring to undermine him. “They want to wait!”Throughout late summer and fall, in the heat of a re-election campaign that he would go on to lose, and in the face of mounting evidence of a surge in infections and deaths far worse than in the spring, Mr. Trump’s management of the crisis — unsteady, unscientific and colored by politics all year — was in effect reduced to a single question: What would it mean for him?The result, according to interviews with more than two dozen current and former administration officials and others in contact with the White House, was a lose-lose situation. Mr. Trump not only ended up soundly defeated by Joseph R. Biden Jr., but missed his chance to show that he could rise to the moment in the final chapter of his presidency and meet the defining challenge of his tenure.Efforts by his aides to persuade him to promote mask wearing, among the simplest and most effective ways to curb the spread of the disease, were derailed by his conviction that his political base would rebel against anything that would smack of limiting their personal freedom. Even his own campaign’s polling data to the contrary could not sway him.His explicit demand for a vaccine by Election Day — a push that came to a head in a contentious Oval Office meeting with top health aides in late September — became a misguided substitute for warning the nation that failure to adhere to social distancing and other mitigation efforts would contribute to a slow-rolling disaster this winter.His concern? That the man he called “Sleepy Joe” Biden, who was leading him in the polls, would get credit for a vaccine, not him.The government’s public health experts were all but silenced by the arrival in August of Dr. Scott W. Atlas, the Stanford professor of neuroradiology recruited after appearances on Fox News.With Dr. Deborah L. Birx, the coordinator of the White House virus task force, losing influence and often on the road, Dr. Atlas became the sole doctor Mr. Trump listened to. His theories, some of which scientists viewed as bordering on the crackpot, were exactly what the president wanted to hear: The virus is overblown, the number of deaths is exaggerated, testing is overrated, lockdowns do more harm than good.The president has long seen testing not as a vital way to track and contain the pandemic but as a mechanism for making him look bad by driving up the number of known cases.Credit…William DeShazer for The New York TimesAs the gap between politics and science grew, the infighting that Mr. Trump had allowed to plague the administration’s response from the beginning only intensified. Threats of firings worsened the leadership vacuum as key figures undercut each other and distanced themselves from responsibility.The administration had some positive stories to tell. Mr. Trump’s vaccine development program, Operation Warp Speed, had helped drive the pharmaceutical industry’s remarkably fast progress in developing several promising approaches. By the end of the year, two highly effective vaccines would be approved for emergency use, providing hope for 2021.The White House rejected any suggestions that the president’s response had fallen short, saying he had worked to provide adequate testing, protective equipment and hospital capacity and that the vaccine development program had succeeded in record time.“President Trump has led the largest mobilization of the public and private sectors since WWII to defeat Covid-19 and save lives,” said Brian Morgenstern, a White House spokesman.But Mr. Trump’s unwillingness to put aside his political self-centeredness as Americans died by the thousands each day or to embrace the steps necessary to deal with the crisis remains confounding even to some administration officials. “Making masks a culture war issue was the dumbest thing imaginable,” one former senior adviser said.His own bout with Covid-19 in early October left him extremely ill and dependent on care and drugs not available to most Americans, including a still-experimental monoclonal antibody treatment, and he saw firsthand how the disease coursed through the White House and some of his close allies.Yet his instinct was to treat that experience not as a learning moment or an opportunity for empathy, but as a chance to portray himself as a Superman who had vanquished the disease. His own experience to the contrary, he assured a crowd at the White House just a week after his hospitalization, “It’s going to disappear; it is disappearing.”Weeks after his own recovery, he would still complain about the nation’s preoccupation with the pandemic.“All you hear is Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid,” Mr. Trump said at one campaign stop, uttering the word 11 times.In the end he could not escape it.Supporters of Mr. Trump outside Walter Reed National Military Medical Center, where he was treated for the coronavirus, in October. He largely rejected aides’ efforts to use his bout with the illness to demonstrate a new compassion.Credit…Oliver Contreras for The New York Times‘The Base Will Revolt’By late July, new cases were at record highs, defying Mr. Trump’s predictions through the spring that the virus was under control, and deaths were spiking to alarming levels. Herman Cain, a 2012 Republican presidential candidate, died from the coronavirus; the previous month he had attended a Trump rally without a mask.With the pandemic defining the campaign despite Mr. Trump’s efforts to make it about law and order, Tony Fabrizio, the president’s main pollster, came to the Oval Office for a meeting in the middle of the summer prepared to make a surprising case: that mask wearing was acceptable even among Mr. Trump’s supporters.Arrayed in front of the Resolute Desk, Mr. Trump’s advisers listened as Mr. Fabrizio presented the numbers. According to his research, some of which was reported by The Washington Post, voters believed the pandemic was bad and getting worse, they were more concerned about getting sick than about the virus’s effects on their personal financial situation, the president’s approval rating on handling the pandemic had hit new lows and a little more than half the country did not think he was taking the situation seriously.But what set off debate that day was Mr. Fabrizio’s finding that more than 70 percent of voters in the states being targeted by the campaign supported mandatory mask wearing in public, at least indoors, including a majority of Republicans.Mr. Kushner, who along with Hope Hicks, another top adviser, had been trying for months to convince Mr. Trump that masks could be portrayed as the key to regaining freedom to go safely to a restaurant or a sporting event, called embracing mask-wearing a “no-brainer.”Mr. Kushner had some reason for optimism. Mr. Trump had agreed to wear one not long before for a visit to Walter Reed National Military Medical Center, after finding one he believed he looked good in: dark blue, with a presidential seal.But Mark Meadows, the White House chief of staff — backed up by other aides including Stephen Miller — said the politics for Mr. Trump would be devastating.“The base will revolt,” Mr. Meadows said, adding that he was not sure Mr. Trump could legally make it happen in any case.The president removed his mask upon arriving at the White House on Oct. 5, after being hospitalized with Covid-19. He was rarely seen wearing one again.Credit…Anna Moneymaker for The New York TimesThat was all Mr. Trump needed to hear. “I’m not doing a mask mandate,” he concluded.Aside from when he was sick, he was rarely seen in a mask again.The president had other opportunities to show leadership rather than put his political fortunes first..css-fk3g7a{font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:0.875rem;line-height:1.125rem;color:#121212 !important;}@media (min-width:740px){.css-fk3g7a{font-size:0.9375rem;line-height:1.25rem;}}.css-1sjr751{-webkit-text-decoration:none;text-decoration:none;}.css-1sjr751 a:hover{border-bottom:1px solid #dcdcdc;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-zs9392{margin:10px auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-zs9392{font-size:1.25rem;line-height:1.4375rem;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.75rem;margin-bottom:20px;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-size:1.5rem;line-height:1.875rem;}}.css-121grtr{margin:0 auto 10px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-qmg6q8{background-color:white;margin:1.5rem auto 1.9rem;max-width:600px;}#NYT_BELOW_MAIN_CONTENT_REGION .css-qmg6q8{padding:0;width:calc(100% – 40px);max-width:600px;margin-right:auto;margin-left:auto;}.css-qmg6q8 strong{font-weight:700;}.css-qmg6q8 em{font-style:italic;}@media (min-width:740px){.css-qmg6q8{margin:40px auto;}}.css-qmg6q8:focus{outline:1px solid #e2e2e2;}.css-qmg6q8 a{color:#326891;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ccd9e3;}.css-qmg6q8 a:visited{color:#333;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ddd;}.css-qmg6q8 a:hover{border-bottom:none;}.css-qmg6q8[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-qmg6q8[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-qmg6q8[data-truncated] .css-5gimkt:after{content:’See more’;}.css-qmg6q8[data-truncated] .css-6mllg9{opacity:1;}.css-11uwurf{border:1px solid #e2e2e2;padding:15px;border-radius:0;margin:0 auto;overflow:hidden;}@media (min-width:600px){.css-11uwurf{padding:20px;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-11uwurf{border-top:1px solid #121212;border-bottom:none;}Covid-19 Vaccines ›Answers to Your Vaccine QuestionsWith distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.After he recovered from his bout with the virus, some of his top aides, including Mr. Kushner and Jason Miller, a senior campaign strategist, thought the illness offered an opportunity to demonstrate the kind of compassion and resolve about the pandemic’s toll that Mr. Trump had so far failed to show.When Mr. Trump returned from the hospital, his communications aides, with the help of Ivanka Trump, his daughter, urged him to deliver a national address in which he would say: “I had it. It was tough, it kicked my ass, but we’re going to get through it.”He refused, choosing instead to address a boisterous campaign rally for himself from the balcony of the White House overlooking the South Lawn.Mr. Trump never came around to the idea that he had a responsibility to be a role model, much less that his leadership role might require him to publicly acknowledge hard truths about the virus — or even to stop insisting that the issue was not a rampaging pandemic but too much testing.Alex M. Azar II, the health and human services secretary, briefed the president this fall on a Japanese study documenting the effectiveness of face masks, telling him: “We have the proof. They work.” But the president resisted, criticizing Mr. Kushner for pushing them and again blaming too much testing — an area Mr. Kushner had been helping to oversee — for his problems.“I’m going to lose,” Mr. Trump told Mr. Kushner during debate preparations. “And it’s going to be your fault, because of the testing.”Mr. Morgenstern, the White House spokesman, said that exchange between the president and Mr. Kushner “never happened.”Mr. Azar, who was sometimes one of the few people wearing a mask at White House events, privately bemoaned what he called a political, anti-mask culture set by Mr. Trump. At White House Christmas parties, Mr. Azar asked maskless guests to back away from him.Dr. Stephen M. Hahn, center, the commissioner of the Food and Drug Administration, Dr. Deborah L. Birx, the coordinator of the White House virus task force, and Alex M. Azar II, the secretary of health and human services, in the Oval Office in May. Conflicts on the president’s team only intensified as the year went on.Credit…Erin Schaff/The New York TimesDivisions and DisagreementsThe decision to run the government’s response out of the West Wing was made in the early days of the pandemic. The idea was to break down barriers between disparate agencies, assemble public health expertise and encourage quick and coordinated decision-making.It did not work out like that, and by fall the consequences were clear.Mr. Trump had always tolerated if not encouraged clashes among subordinates, a tendency that in this case led only to policy paralysis, confusion about who was in charge and a lack of a clear, consistent message about how to reduce the risks from the pandemic.Keeping decision-making power close to him was another Trump trait, but in this case it also elevated the myriad choices facing the administration to the presidential level, bogging the process down in infighting, raising the political stakes and encouraging aides to jockey for favor with Mr. Trump.The result at times was a systemwide failure that extended well beyond the president.“What we needed was a coordinated response that involved contributions from multiple agencies,” said Dr. Scott Gottlieb, who was commissioner of the Food and Drug Administration for the first two years of the Trump administration.“Someone needed to pull that all together early,” he said. “It wasn’t the job of the White House, either. This needed to happen closer to the agencies. That didn’t happen on testing, or on a whole lot of other things.”The relationship between Mr. Azar and Dr. Stephen M. Hahn, the commissioner of the Food and Drug Administration, grew increasingly tense; by early November, they were communicating only by text and in meetings.Dr. Birx had lost the clout she enjoyed early on in the crisis and spent much of the summer and fall on the road counseling governors and state health officials.Mr. Meadows was at odds with almost everyone as he sought to impose the president’s will on scientists and public health professionals. In conversations with top health officials, Mr. Meadows would rail against regulatory “bureaucrats” he thought were more interested in process than outcome.Some of the doctors on the task force, including Dr. Anthony S. Fauci and Dr. Robert R. Redfield, were reluctant to show up in person at the White House, worried that the disdain there for mask wearing and social distancing would leave them at risk of infection.Vice President Mike Pence was nominally in charge of the task force but was so cautious about getting crosswise with Mr. Trump as they battled for re-election that, in public at least, he became nearly invisible.The debates inside the White House increasingly revolved around Dr. Atlas, who had no formal training in infectious diseases but whose views — which Mr. Trump saw him deliver on Fox News — appealed to the president’s belief that the crisis was overblown.Dr. Scott W. Atlas, the Stanford professor of neuroradiology recruited after appearances on Fox News, became the sole doctor Mr. Trump listened to.Credit…Anna Moneymaker for The New York TimesHis arrival at 1600 Pennsylvania Avenue was itself something of a mystery. Some aides said he was discovered by Kayleigh McEnany, the White House press secretary. Others said John McEntee, the president’s personnel chief, had been Googling for a Trump-friendly doctor who would be loyal.Marc Short, Mr. Pence’s chief of staff, opposed hiring Dr. Atlas. But once the president and his team brought him in, Mr. Short insisted that Dr. Atlas have a seat at the task force table, hoping to avoid having him become yet another internal — and destructive — critic.Once inside, Dr. Atlas used the perch of a West Wing office to shape the response. During a meeting in early fall, Dr. Atlas asserted that college students were at no risk from the virus. We should let them go back to school, he said. It’s not a problem.Dr. Birx exploded. What aspect of the fact that you can be asymptomatic and still spread it do you not understand? she demanded. You might not die, but you can give it to somebody who can die from it. She was livid.“Your strategy is literally going to cost us lives,” she yelled at Dr. Atlas. She attacked Dr. Atlas’s ideas in daily emails she sent to senior officials. And she was mindful of a pact she had made with Dr. Hahn, Dr. Fauci and Dr. Redfield even before Dr. Atlas came on board: They would stick together if one of them was fired for doing what they considered the right thing.Health officials often had a hard time finding an audience in the upper reaches of the West Wing. In a mid-November task force meeting, they issued a dire warning to Mr. Meadows about the looming surge in cases set to devastate the country. Mr. Meadows demanded data to back up their claim.One outcome of the meeting was a Nov. 19 news conference on the virus’s dire threat, the first in many weeks. But while Mr. Pence, who led the briefing, often urged Americans to “do their part” to slow the spread of the virus, he never directly challenged Mr. Trump’s hesitancy on masks and social distancing. At the briefing, he said that “decision making at the local level” was key, continuing a long pattern of the administration seeking to push responsibility to the states.Mr. Azar had been cut out of key decision-making as early as February, when Mr. Pence took over the task force. Mr. Azar would complain to his associates that Mr. Pence’s staff and task force members went around him to issue orders to his subordinates.On tenterhooks about his job status, Mr. Azar found an opening that offered a kind of redemption, steering his attention through the summer and fall to Operation Warp Speed, the government’s effort to support rapid development of a vaccine, lavishing praise on Mr. Trump and crediting him for nearly every advance.Behind the scenes, Mr. Azar portrayed Dr. Hahn to the White House as a flailing manager — a complaint he also voiced about Dr. Redfield. In late September, he told the White House he was willing to fire Dr. Hahn, according to officials familiar with the offer.For their part, Dr. Hahn, Dr. Redfield, Dr. Birx and other senior health officials saw Mr. Azar as crushing the morale of the agencies he oversaw as he sought to escape blame for a worsening crisis and to strengthen his own image publicly and with the White House.Health officials on the task force several times took their complaints about Mr. Azar to Mr. Pence’s office, hoping for an intervention.Caitlin B. Oakley, a spokeswoman for Mr. Azar, said he had “always stood up for balanced, scientific, public health information and insisted that science and data drive the decisions.”Once eager to visit the White House, Dr. Hahn became disillusioned with what he saw as its efforts to politicize the work of the Food and Drug Administration, and he eventually shied away from task force meetings, fearing his statements there would leak.If there was a bureaucratic winner in this West Wing cage match, it was Dr. Atlas.He told Mr. Trump that the right way to think about the virus was how much “excess mortality” there was above what would have been expected without a pandemic.Mr. Trump seized on the idea, often telling aides that the real number of dead was no more than 10,000 people.As of Thursday, 342,577 Americans had died from the pandemic.Two coronavirus vaccines arrived at sites across the country this month. Mr. Trump was furious that a successful vaccine was not announced until after the election.Credit…Bryan Anselm for The New York TimesTrump vs. Vaccine RegulatorsIn an Oval Office meeting with senior health officials on Sept. 24, the president made explicit what he had long implied: He wanted a vaccine before the election, according to three people who witnessed his demand.Pfizer’s chief executive had been encouraging the belief that the company could deliver initial results by late October. But Mr. Trump’s aides tried in vain to make clear that they could not completely control the timing.Dr. Fauci and Dr. Hahn reminded West Wing officials that a company’s vaccine trial results were a “black box,” impossible to see until an independent monitoring board revealed them. A vaccine that did not go through the usual, rigorous government approval process would be a “Pyrrhic victory,” Mr. Azar told them. It would be a shot no one would take.Dr. Moncef Slaoui, the scientific leader of Operation Warp Speed, said the president never asked him to deliver a vaccine on a specific timetable. But he said Mr. Trump sometimes complained in meetings that “it was not going to happen before the election and it will be ‘Sleepy Joe’” who would ultimately get credit.In late October, science and regulations worked against Mr. Trump’s waning hopes for pre-Election Day good news. At the F.D.A., scientists had refined the standards for authorizing a vaccine for emergency use. And at Pfizer, executives realized that the agency was unlikely to authorize its vaccine on the basis of so few Covid-19 cases among its clinical trial volunteers.They decided to wait for more data, a delay of up to a week.When Pfizer announced on Nov. 9 — two days after Mr. Biden clinched his victory — that its vaccine was a stunning success, Mr. Trump was furious. He lashed out at the company, Dr. Hahn and the F.D.A., accusing “deep state regulators” of conspiring with Pfizer to slow approval until after the election.The president’s frustration with the pace of regulatory action would continue into December, as the F.D.A. went through a time-consuming process of evaluating Pfizer’s data and then that of a second vaccine maker, Moderna.On Dec. 11, Mr. Meadows exploded during a morning call with Dr. Hahn and Dr. Peter Marks, the agency’s top vaccine regulator. He accused Dr. Hahn of mismanagement and suggested he resign, then slammed down the phone. That night, the F.D.A. authorized the Pfizer vaccine.In the weeks that followed, Mr. Pence, Mr. Azar, Dr. Fauci and other health officials rolled up their sleeves to be vaccinated for the cameras.Mr. Trump, who after contracting Covid-19 had declared himself immune, has not announced plans to be vaccinated.Michael D. Shear More

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      in Elections

      Trump Claims Credit for Vaccines. Some of His Backers Don’t Want to Take Them.

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      #masthead-section-label, #masthead-bar-one { display: none }Covid-19 VaccinesVaccine QuestionsDoses Per StateHow the Moderna Vaccine WorksWhy You’ll Still Need a MaskPost-Vaccine OutlookAdvertisementContinue reading the main storySupported byContinue reading the main storyTrump Claims Credit for Vaccines. Some of His Backers Don’t Want to Take Them.A deep distrust of the government is fueling vaccine hesitancy among Republicans, who are more likely than Democrats to resist being inoculated against Covid-19.A pharmacist preparing a dose of the Pfizer vaccine for the coronavirus on Wednesday. The “anti-vaxxer movement” is not new, and it typically cuts across political parties. But partisanship plays a major role in how people view the coronavirus vaccine.Credit…Michael A. McCoy for The New York TimesDec. 18, 2020Updated 9:43 p.m. ETWASHINGTON — Elizabeth Graves, an ardent supporter of President Trump, is not opposed to vaccines. She said she had taken flu shots and pneumonia shots and, having just turned 50, was interested in being vaccinated against shingles.But Ms. Graves, a legal transcriptionist in Starkville, Miss., said she would not be taking a coronavirus vaccine — and the sight of Vice President Mike Pence rolling up his sleeve to get vaccinated on live television on Friday, she added, would not change her mind.Lawrence Palmer, 51, a field service engineer in Boiling Springs, Pa., and Brandon Lofgren, 25, who works in his family’s trucking and construction business in rural Wisconsin, said they felt the same way. All are fans of Mr. Trump, and echoed Ms. Graves, who said she was “suspicious” of government and that Mr. Pence’s vaccination “doesn’t mean a thing to me.”It is a paradox of the pandemic: Helping speed the development of a coronavirus vaccine may be one of Mr. Trump’s proudest accomplishments, but at least in the early stages of the vaccine rollout, there is evidence that a substantial number of his supporters say they do not want to get it.Until the past week, their objections were largely hypothetical. But with a second vaccine about to become available in the United States — the Food and Drug Administration on Friday authorized emergency use of the vaccine developed by Moderna, a week after the version developed by Pfizer and BioNTech won the same approval — more people will confront the choice of getting inoculated or not. The authorization will clear the way for the shipment of 5.9 million doses over the weekend and tens of millions more in coming months, greatly expanding the reach of the vaccination campaign as the nation grapples with the uncontrolled spread of the disease.For the most part, public opinion has been swinging in favor of vaccination. Seventy-one percent of Americans are willing to be vaccinated, up from 63 percent in September, according to a survey released this week by the Kaiser Family Foundation.Still, the survey found that Republicans were the most likely to be hesitant, with 42 percent saying they would probably not or definitely not be vaccinated, as compared with 12 percent of Democrats.Experts say that vaccine hesitancy may diminish over time if people see friends and relatives getting vaccinated without incident. Sheri Simms, 62, a retired businesswoman in Northeast Texas who describes herself as a “moderate conservative” supporter of the president, said that while she did not intend to get vaccinated now, that could change.“As more information comes out, and things appear to work better, then I will weigh the risks of the vaccine against the risk of the coronavirus and make a judgment,” she said.The “anti-vaxxer movement” is not new, and it typically cuts across political parties. But the coronavirus vaccine, developed against the backdrop of a bitterly fought presidential election and championed by an especially polarizing figure in Mr. Trump, has become especially associated with partisanship.During the campaign, while Mr. Trump was promising a vaccine by Election Day, some Democrats expressed concern about whether safety would be sacrificed in the rush to deliver a vaccine in time to help the president at the polls.Political leaders in both parties worked on Friday to dispel concerns about the vaccine.Mr. Pence, who took the Pfizer vaccine on Friday in a ceremony at the Eisenhower Executive Office Building in Washington, was not the only prominent public official to get vaccinated. On Capitol Hill, congressional leaders including Speaker Nancy Pelosi, a Democrat, and Senator Mitch McConnell, the Republican leader, were also inoculated against Covid-19. President-elect Joseph R. Biden Jr. and his wife, Jill Biden, are to be vaccinated on Monday..css-fk3g7a{font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:0.875rem;line-height:1.125rem;color:#121212 !important;}@media (min-width:740px){.css-fk3g7a{font-size:0.9375rem;line-height:1.25rem;}}.css-1sjr751{-webkit-text-decoration:none;text-decoration:none;}.css-1sjr751 a:hover{border-bottom:1px solid #dcdcdc;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-zs9392{margin:10px auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-zs9392{font-size:1.25rem;line-height:1.4375rem;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.75rem;margin-bottom:20px;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-size:1.5rem;line-height:1.875rem;}}.css-121grtr{margin:0 auto 10px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-qmg6q8{background-color:white;margin:1.5rem auto 1.9rem;max-width:600px;}#NYT_BELOW_MAIN_CONTENT_REGION .css-qmg6q8{padding:0;width:calc(100% – 40px);max-width:600px;margin-right:auto;margin-left:auto;}.css-qmg6q8 strong{font-weight:700;}.css-qmg6q8 em{font-style:italic;}@media (min-width:740px){.css-qmg6q8{margin:40px auto;}}.css-qmg6q8:focus{outline:1px solid #e2e2e2;}.css-qmg6q8 a{color:#326891;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ccd9e3;}.css-qmg6q8 a:visited{color:#333;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ddd;}.css-qmg6q8 a:hover{border-bottom:none;}.css-qmg6q8[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-qmg6q8[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-qmg6q8[data-truncated] .css-5gimkt:after{content:’See more’;}.css-qmg6q8[data-truncated] .css-6mllg9{opacity:1;}.css-11uwurf{border:1px solid #e2e2e2;padding:15px;border-radius:0;margin:0 auto;overflow:hidden;}@media (min-width:600px){.css-11uwurf{padding:20px;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-11uwurf{border-top:1px solid #121212;border-bottom:none;}Covid-19 Vaccines ›Answers to Your Vaccine QuestionsWith distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.In any other era, Mr. Pence’s vaccination, administered by a technician from the Walter Reed National Military Medical Center in Bethesda, Md., in images beamed across the country, would have been a moment to bring the nation together. He took the shot in front of a giant blue poster declaring in white block letters: “SAFE and EFFECTIVE.”His wife, Karen Pence, and Surgeon General Jerome Adams were also vaccinated.Vice President Mike Pence received the Pfizer vaccine on Friday in a ceremony at the Eisenhower Executive Office Building in Washington.Credit…Doug Mills/The New York Times“I didn’t feel a thing — well done,” the vice president said afterward, adding that he wanted to “assure the American people that while we cut red tape, we cut no corners.”But Mr. Trump was notably absent. One reason for the partisan divide over vaccination, experts said, is the president himself. His repeated denigration of scientists and insistence that the pandemic is not a threat, they said, have contributed to a sense among his followers that the vaccine is either not safe or not worth taking.“I just don’t feel there’s been enough research on it. I think it was sped up too fast,” said Mark Davis, 42, a disabled worker in Michigan. “You don’t even really know the side effects, what’s in it.”Mr. Lofgren agreed. “The jury’s out on whether it’s going to work,” he said, despite studies showing that the Pfizer and Moderna vaccines were more than 94 percent effective.Experts say that “herd immunity” — the point at which so many people are immune that the spread of a virus is diminished — can be achieved when roughly 75 percent of the population is vaccinated. While the Trump administration is rolling out a public relations campaign to encourage people to get vaccinated, the reluctance among even a minority of Republicans is deeply troubling to public health experts.Mr. Trump has been quick to claim credit for the manufacturing and distribution of the vaccine. “Distribution to start immediately,” he said Friday on Twitter, a day after an F.D.A. expert advisory panel recommended approval of Moderna’s vaccine.Although the president has recovered from Covid-19, he remains vulnerable to reinfection. Dr. Anthony S. Fauci, the government’s top infectious disease scientist, has recommended that Mr. Trump be vaccinated. But he has given no indication that he will actually do so, and he has said little, if anything, to encourage Americans to get vaccinated.“We need him taking a proactive role,” said Matthew Motta, a political scientist at Oklahoma State University who studies politics and vaccine views, adding, “The single best person to convince you to change your mind about something is somebody who agrees with you, somebody who you trust on other issues.”Mr. Trump’s own flirtations with vaccine skepticism are well known. He repeated the debunked theory that vaccines cause autism as far back as 2007, when he said he had slowed his son Barron’s vaccination schedule, and as recently as 2015 while first running for president.“Trump helped re-energize the anti-vaccine movement,” said Dr. Peter Hotez, an expert on vaccines, “and now he wants to pivot and make this his greatest accomplishment.”Helping speed the development of a coronavirus vaccine may be one of President Trump’s proudest accomplishments, but at least in the early stages of the vaccine rollout, there is evidence that a substantial number of his supporters say they do not want to get it.Credit…Samuel Corum for The New York TimesSome conservative news media outlets are reinforcing the skepticism, tapping into suspicion of government by raising questions about whether officials are leveling with the public about the risks of the vaccines.Tucker Carlson, the Fox News commentator, railed on Thursday against the “corporate image campaign” promoting vaccination, suggesting incorrectly that isolated instances of allergic reactions to the vaccine were being censored.In interviews, Trump supporters said they felt the pandemic had been blown out of proportion. Mr. Lofgren said several of his co-workers had recovered from Covid-19, “with really no more than just cold symptoms.” Mr. Palmer said that if he “had an issue with breathing or a heart issue or a lung issue,” he might consider it, but does not want to take a chance.Conspiracy theories — including the notion that the virus was created by the Chinese and Democrats to hurt Mr. Trump politically, or that the vaccine contains a microchip allowing the government to track people — cropped up in several conversations. Ms. Graves, who has diabetes, a risk factor for Covid-19, and has a master’s degree in library science, said such thoughts were creating doubts in the back of her mind.“There’s no, quote, evidence that there’s a microchip or that here’s something nefarious about the whole thing,” she said. “But I have a gut check about all of it, and the government pushing it, and they’re finding all these popular people to take the vaccine. And it’s weird, like why are we pushing it so hard?”AdvertisementContinue reading the main story More

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      After 4 Years of Trump, Medicare and Medicaid Badly Need Attention

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      President-elect Joe Biden has pledged to “marshal the forces of science” in his administration. Undoubtedly he needs to start by bolstering the credibility of the Food and Drug Administration and the Centers for Disease Control and Prevention.But a third health agency, central to the lives of older Americans, low-income families and the disabled, is sorely in need of his attention. Science has also been under assault at the Centers for Medicare & Medicaid Services, which provides federal health insurance to more than 130 million Americans at a cost of more than $1 trillion, nearly twice the Pentagon’s budget.C.M.S. does more than just write checks for medical care. Its scientists and analysts determine which treatments should be offered — I am the chairman of the committee that advises Medicare on those decisions — and how best to care for the patients it serves.Unfortunately, the Trump White House has steadily eviscerated the agency’s dispassionate approaches to making those determinations.Recently, for instance, the Trump administration set in motion a plan to strip C.M.S. of its ability to assess for itself whether new medical devices approved by the F.D.A. are appropriate for the older patients it covers. This is important because the benefits and risks of such devices and procedures, which range from implantable hips and cardiac stents to digital apps and laboratory tests, can vary widely based on patient age and disability.The proposed rule requires Medicare to pay for any new device so long as the F.D.A. labels it a “breakthrough.” And that word does not mean what you think it does.The F.D.A. calls a device a “breakthrough” when it is expected — though not yet proved — to be helpful to patients with serious conditions. The designation has nothing to do with how the device works in older patients, or even if it was studied in that population at all. The proposed rule would also require Medicare to cover any new drug or device if at least one commercial insurer covers it for its members, even if its members are young and healthy.Already, companies seldom generate enough data on their products for C.M.S. to assess their value for its patients. In 2019, for instance, data was insufficient in just under half of new F.D.A. drug approvals to assess benefits or side effects in older patients. The proposed rule would drain the last remaining motivation that companies have to study their treatments in the patients who are likely to ultimately receive them.C.M.S. scientists and analysts do more than evaluate new treatments. They also test alternative ways to organize and pay for patient care. The agency has found, for example, that enrolling people at risk of diabetes in gym sessions reduced how often they were hospitalized. But some seemingly obvious ways to improve health care don’t work: C.M.S. also found it could not reduce hospitalizations for cancer patients by paying their doctors to actively manage their patients’ care.The fact that so many promising ideas don’t work as expected is the reason C.M.S. needs to double down on evaluations of how medical care is delivered to its patients.This administration has gone in the other direction. Just before the election, the White House conjured up a plan to send older people a $200 prescription drug discount card in the mail. Research has already demonstrated that if you give people money to buy prescription drugs, they will buy more of them. The pharmaceutical industry knows this, too. That’s why it hands out coupons worth billions of dollars.These same studies also show that when people are indiscriminately given cash for medicines — instead of only those who need that money the most — it costs much more overall than it saves. No wonder the discount card giveaway would have cost around $8 billion. Fortunately, the president has yet to follow through with it.In another troubling development, the administration announced on Nov. 20 that it would run an experiment in which reimbursements to physicians will be cut for dozens of high-cost drugs they administer in the office, such as chemotherapies and treatments for inflammatory diseases.C.M.S. financial analysts warned that the cuts will lead many Medicare patients to lose access to these important treatments. Scientists should evaluate this prediction by including a comparison group of patients whose doctors would not receive a cut in payment. But the agency administrator made it clear that she didn’t believe the warning. No comparison group is planned. That is no way to evaluate whether our nation’s vulnerable would be helped or hurt by this significant policy change.Another example of a poorly designed experiment involved taking Medicaid coverage away from able-bodied people who are not working or going to school, under an ill-founded theory that doing so would inspire them to seek employment. Such a study is best done narrowly, so that any harms are minimized. Instead, the administration invited multiple states in 2018 to test the outcome.A Harvard study found that a work requirement in Arkansas led to a rise in the number of uninsured people and no significant changes in employment. Thousands of Medicaid beneficiaries in Michigan and New Hampshire were set to lose their coverage before work requirements in those states were ended. Given those results, the overall program should have been canceled. The administration broadened it.Through its reliance on scientific evaluation of what it should pay for, and how, C.M.S. has remained financially viable for more than half a century. As the new president plans to fix the damage done by the current president, this vital agency demands his attention.Peter B. Bach is a physician at Memorial Sloan Kettering Cancer Center. He served as a senior adviser to the administrator of the Centers for Medicare and Medicaid Services in 2005 and 2006.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More