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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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      Trump Ballot Challenges Advance, Varying Widely in Strategy and Sophistication

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      Donald J. Trump’s eligibility for the presidential ballot has been challenged in more than 30 states, but only a handful of those cases have gained traction so far.John Anthony Castro, a 40-year-old Texan, long-shot Republican presidential candidate and the most prolific challenger of Donald J. Trump’s eligibility to be president, has gone to court in at least 27 states trying to remove the former president from the ballot.On Wednesday, Mr. Castro found himself in a mostly empty courthouse in New Hampshire’s capital, where he was making a second attempt to advance his arguments; his initial case was dismissed last fall.None of Mr. Castro’s lawsuits have succeeded. But the New Hampshire case is part of a growing constellation of ballot challenges — some lodged by established groups with national reach, many others far more homemade — that have been playing out in more than 30 states. Challengers in Colorado and Maine have succeeded, at least temporarily, in getting Mr. Trump disqualified, while other lawsuits have stalled or been dismissed. In at least 22 states, cases have yet to be resolved.Tracking Efforts to Remove Trump From the 2024 BallotSee which states have challenges seeking to bar Donald J. Trump from the presidential primary ballot.All the litigation has made for an odd, diffuse process in which some of the weightiest issues of American democracy are being raised not primarily by elected officials or a political party, but by an unlikely assortment of obscure figures, everyday citizens and nonprofit groups. Even some of the players are wondering what they are doing there.“How did we get to this point, where you have random brewers in Wisconsin throwing Hail Marys to try to get Trump off the ballot?” said Kirk Bangstad, a brewing company owner and liberal activist who filed an unsuccessful challenge to Mr. Trump’s eligibility with the Wisconsin Elections Commission. Mr. Bangstad, who is now considering a lawsuit, readily admits that he wishes someone more prominent would have taken up the cause.Kirk Bangstad, a brewing company owner and liberal activist who filed an unsuccessful challenge of Mr. Trump’s eligibility with the Wisconsin Elections Commission.Chang W. Lee/The New York TimesThough the ballot challenges vary in format, venue and sophistication, they share a focus on whether Mr. Trump’s efforts to overturn his 2020 election defeat make him ineligible to hold the presidency again. The cases are based on a largely untested clause of the Constitution’s 14th Amendment, which was enacted after the Civil War. The clause bars federal or state officials who “engaged in insurrection or rebellion” from holding office.Some lawyers have argued since 2021 that the clause could preclude Mr. Trump from appearing on a presidential ballot, and lawsuits invoking that theory were filed in several states in 2023. But it was not until last month, when the Colorado Supreme Court found Mr. Trump ineligible for that state’s primary ballot because of the 14th Amendment, that the question vaulted to the center of American politics. When Maine’s Democratic secretary of state announced last week that she, too, was disqualifying Mr. Trump, it only intensified the spotlight on the issue.Steven Cheung, a spokesman for the Trump campaign, described the lawsuits in a statement last week as “bad-faith, politically motivated attempts to steal the 2024 election,” claiming that Democrats had “launched a multifront lawfare campaign to disenfranchise tens of millions of American voters and interfere in the election.” Mr. Cheung did not respond to a request for comment for this article.Mr. Trump filed a lawsuit in state court in Maine on Tuesday seeking to overturn the secretary of state’s decision, and on Wednesday he asked the U.S. Supreme Court to review the Colorado ruling.The issue could not be more urgent: Republican presidential primary elections and caucuses begin this month, and polls have shown Mr. Trump with a commanding lead over his opponents.In the meantime, other cases continue to wind their way through state and federal court systems.Those lawsuits can generally be divided into three categories: Mr. Castro’s lawsuits, almost all of which have been filed in federal court; state challenges filed by two nonprofit organizations; and one-off cases brought in state or federal courts by local residents. In a handful of places — most notably Maine, but also Illinois, Massachusetts, North Carolina and Wisconsin — voters have challenged Mr. Trump’s eligibility directly with a secretary of state or an election commission rather than in court. In California and New York, some elected officials have written letters pushing for elections officers in those states to disqualify or consider disqualifying the former president.Most establishment Democrats have not publicly embraced the cause. President Biden said after the Colorado Supreme Court ruling that it was “self-evident” that Mr. Trump had supported an insurrection, but that it was up to the judiciary to determine his eligibility for the ballot. Several Democratic secretaries of state, who in much of the country are their states’ chief election officers, have included Mr. Trump on candidate lists and deferred to the courts on the question of his eligibility. A growing constellation of challenges to Mr. Trump’s eligibility have been filed in courts across the country, including federal court in Concord, N.H.Neville Caulfield for The New York TimesThe two national groups are Citizens for Responsibility and Ethics in Washington, known as CREW, which brought the Colorado case, and Free Speech for People, which filed lawsuits in Michigan, Minnesota and Oregon, as well as complaints with election officials in Illinois and Massachusetts. Those two groups have focused on state-level challenges. The Michigan and Minnesota Supreme Courts declined to take Mr. Trump off the primary ballot in those states. The Oregon lawsuit is still pending, as are the objections in Illinois and Massachusetts, which were both filed on Thursday.Ben Clements, the chairman of Free Speech for People, said he believed challenges originating in federal court “are not helpful” to the disqualification cause because of concerns about plaintiffs not having the legal standing to bring a case. But he said the array of lawsuits in state courts — such challenges were pending this week in California, Florida, Louisiana, North Carolina, Oregon, Wisconsin and Wyoming — were welcome.“Even if we wanted to, and even if CREW had taken an approach of filing multiple suits, we’re not going to hit all 50 states,” Mr. Clements said.Many people expect the U.S. Supreme Court to ultimately decide the question of Mr. Trump’s eligibility. And outside of a few states, the challenges so far have not gained traction.Some cases have been dismissed, including a federal lawsuit in Virginia and Mr. Bangstad’s complaint in Wisconsin, both last week. Others have been withdrawn, including several of Mr. Castro’s lawsuits and a state case in New Jersey filed by John Bellocchio, a former history teacher. In an interview, Mr. Bellocchio said he was working on a second lawsuit, and that he was motivated by concern that the former president and his supporters “envision a Christian theocracy.”“You cannot have a theocracy and a democracy at the same time,” Mr. Bellocchio said in an interview.By far, the most persistent litigant is Mr. Castro, who, according to his campaign website, first ran for a county office at the age of 19 and has since run unsuccessfully at least twice for other offices, including in a special congressional election in 2021.Mr. Castro received a law degree from the University of New Mexico and a master’s degree from Georgetown’s law school. He said he had never been licensed as a lawyer by any state, but was certified by the I.R.S. to work on federal tax cases. Over the years, he has been involved in a dizzying array of legal disputes.Mr. Castro said he had hoped that someone better known would mount a Republican presidential campaign to challenge Mr. Trump’s ballot qualifications, but when no one else stepped up, he decided to do it himself.“My biggest fear was having the knowledge how to stop Trump and having to tell my grandchildren that I did nothing,” he said.At Wednesday’s federal court hearing, Mr. Castro needed to persuade Judge Samantha Elliott that he was a real candidate for the Republican nomination for president and had the legal standing to sue.Among his evidence: He had filed reports with the Federal Election Commission (as of September, records show his campaign had raised $678), and two of his relatives had driven around New Hampshire one day in October, installing a dozen yard signs, before flying home to Texas.In the courtroom on Wednesday, Mr. Castro appeared at times to be unfamiliar with court procedures. But he seemed to come to life as he cross-examined Michael Dennehy, a veteran political strategist and expert witness for Mr. Trump, who testified that it would be “impossible” for Mr. Castro to win any delegates in the state based on his nearly “nonexistent” fund-raising and campaign.If Mr. Castro’s goal is to disqualify Mr. Trump, some observers have suggested that his strategy may backfire.Derek Muller, an election law expert and professor at Notre Dame’s law school, said Mr. Castro risked creating unfavorable precedent with his failed lawsuits. Mr. Trump has already been able to use a judge’s opinion in one state — in which the judge dismissed a Castro lawsuit — to bolster his arguments in another.Mr. Castro is “single-handedly building up precedent for Trump, inadvertently,” said Mr. Muller, who has filed briefs in two state court cases analyzing the relevant election law.Mr. Castro disagreed. If anything, he said, his suits have forced Mr. Trump’s lawyers to “show their cards,” helping other challengers to hone their arguments. He said he plans to refile lawsuits in three more states this month.Tracey Tully More

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      Tracking State Efforts to Remove Trump From the 2024 Ballot

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      States with challenges to Trump’s candidacy Trump disqualified, decision appealed Decision pending Challenge dismissed or rejected Alaska Ariz. Calif. Colo. Conn. Del. Fla. Idaho Kan. La. Maine Mass. Mich. Minn. Mont. Nev. N.H. N.J. N.M. N.Y. N.C. Okla. Ore. Pa. R.I. S.C. Texas Utah Vt. Va. W.Va. Wis. Wyo. Formal challenges to Donald J. Trump’s […] More

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      Maine’s Secretary of State to Decide Whether Trump Can Stay on Ballot

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      Shenna Bellows, a Democrat, has said she would decide next week whether Maine will join Colorado in disqualifying former President Donald J. Trump from its primary ballot. Maine’s secretary of state is poised to issue a decision next week that could bolster a citizen-led movement to keep former President Donald J. Trump off primary ballots around the country — or contradict a landmark court decision in Colorado this week. In a hearing last week at Maine’s State House in Augusta, Shenna Bellows, the secretary of state, weighed three separate complaints challenging Mr. Trump’s eligibility to appear on the state’s Republican primary ballot. Two are based on the same section of the Constitution that the Colorado Supreme Court cited in its 4-to-3 decision on Tuesday that found Mr. Trump cannot hold office again because his actions leading up to the Jan. 6, 2021, attack on the Capitol amounted to engaging in an insurrection.Some form of challenge to Mr. Trump’s eligibility has been lodged in more than 30 states, but many of those have already been dismissed. Most are unfolding in the courts, but in Maine — because of a quirk in its Constitution — the secretary of state weighs in first, with voters filing petitions, not lawsuits. Her decision can then be appealed to the state’s Superior Court.The Colorado ruling was the first in history to disqualify a presidential candidate from a ballot under the 14th Amendment, which was drafted after the Civil War. One section of the amendment bars those who have taken an oath “to support” the Constitution from holding office if they “engaged in insurrection or rebellion against the same,” or had “given aid or comfort to the enemies thereof.”Mr. Trump’s campaign has said it will appeal the decision to the U.S. Supreme Court; should the high court take the case, the other challenges around the country are likely to be put on hold. After the Colorado ruling, Ms. Bellows, an elected Democrat, invited lawyers on both sides in Maine to file supplemental briefs and said that her decision was likely to come next week.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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      Trump’s Ballot Eligibility Faces Challenges in These Other States, Too

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      At least 16 states beyond Colorado currently have open legal challenges to the former president’s eligibility for office — but what happens next depends on the U.S. Supreme Court.This week’s decision by the Colorado Supreme Court to disqualify former President Donald J. Trump from holding office again was the first victory for a sprawling legal effort that is still unfolding across the country.At least 16 other states currently have pending legal challenges to Mr. Trump’s eligibility for office under the 14th Amendment, according to a database maintained by Lawfare, a nonpartisan site dedicated to national security issues. The lawsuits argue that he is barred because he engaged in an insurrection with his actions surrounding the Capitol riot on Jan. 6, 2021.Four of these lawsuits — in Michigan, Oregon, New Jersey and Wisconsin — have been filed in state courts. Eleven lawsuits — in Alaska, Arizona, Nevada, New York, New Mexico, South Carolina, Texas, Vermont, Virginia, West Virginia and Wyoming — have been filed in federal district courts.Cases in two of these states, Arizona and Michigan, were initially dismissed by a lower court but have been appealed. Another challenge has also been made in Maine.The Trump campaign has said it will appeal the ruling in Colorado, in which the State Supreme Court said it would put its decision on hold — meaning that it is not in effect — until Jan. 4, in hopes of receiving guidance from the U.S. Supreme Court.“We are also cognizant that we travel in uncharted territory, and that this case presents several issues of first impression,” the Colorado justices wrote, noting that their decision could change based on “the receipt of any order or mandate from the Supreme Court.”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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      Defeating Trump Is Just a Start

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      The easy and obvious way to understand the various Republican power grabs underway in states across the country is to look at them as attempts to secure as much unaccountable political power as possible and to curtail the expression of identities and beliefs Republicans find objectionable. That’s how we get the “Don’t Say Gay” laws and attacks on gender-affirming care and aggressive efforts to gerrymander entire state legislatures.But there is another angle you can take on the Republican use of state power to limit political representation for their opponents or limit the bodily autonomy of women or impose traditional and hierarchical gender relations on those who would prefer to live free of them. You could say the point is the cultivation of political despair.Now, it is too much to say that this is premeditated, although you do not have to look hard to find Republican officeholders expressing the belief that political participation should be made more onerous.At the same time, it is hard not to miss the degree to which attempts to nullify popular referendums or redistrict opponents into irrelevance can also work to inculcate a sense of hopelessness in those who might otherwise seek political change. Yes, it is true that many people will push back when faced with a sustained challenge to their right to participate in political life or exercise other fundamental rights. But many people will resign themselves to the new status quo, persuading themselves that nothing has fundamentally changed or concluding that it is not worth the time or effort involved to pick up the fight.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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      Georgia County Signs Up to Use Voter Database Backed by Election Deniers

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      The decision ignores warnings from voting rights groups and some election experts.A suburban county in Georgia agreed on Friday to use a new voter information database endorsed by the election denial movement, a move that defied warnings from voting rights groups, election security experts and state election officials.Columbia County, a heavily Republican county outside Augusta, is the first in the country known to have agreed to use the platform, called EagleAI. Its supporters claim the system will make it easier to purge the rolls of ineligible voters.Among the leading backers for this new system is Cleta Mitchell, a central figure in former President Donald J. Trump’s efforts to subvert the 2020 election and the leader of the Election Integrity Network, a national coalition of activists built around the false idea that the 2020 election was stolen.Ms. Mitchell and others have billed EagleAI as an alternative to the Election Registration Information Center, a widely used interstate system that made it easier for officials to track address changes and deaths as they maintain the voter rolls. That system, known as ERIC, has become the subject of conspiracy theories and misinformation that prompted nine states to withdraw with few backup plans.Ms. Mitchell declined to answer questions about the county’s decision.At an election board meeting Friday, around 40 people packed a room, with all speakers favoring the new system, according to Larry Wiggins, a Democratic member of the board who said he voted in favor.Mr. Wiggins said he was hopeful the tool would help the county handle an expected influx of voter eligibility challenges next year. A 2021 law made it easier for individuals to challenge large numbers of other voters’ registrations at once. Those challenges have often come from the same community of Republican activists now helping to push the EagleAI software.EagleAI was developed by a retired doctor in Columbia County, John Richards Jr., who did not response to a request for comment.Georgia state officials, who reviewed the EagleAI presentations, have found them riddled with errors and said the tools were unnecessary, according to documents provided by the groups American Oversight and Documented.In May, William S. Duffey Jr., the chairman of the State Election Board in Georgia, sent a letter to the county board of elections warning that EagleAI’s software might violate state privacy laws and state election statutes.The county responded in November that it would not allow access to private voter information and that the use of the tools would be limited.In a statement, the Georgia secretary of state’s office noted that the state still belonged to the Election Registration Information Center and that counties needed to follow state laws.Election experts have labeled the new system unnecessary and flawed.“EagleAI cannot be trusted to provide reliable information regarding who on the voter rolls is not eligible to remain there,” wrote seven voting rights and election organizations in a letter to Columbia County commissioners. It continued: “It will point you towards false positives and waste your staff’s time.”But Mr. Wiggins said the board wasn’t convinced. “We don’t put much faith in letters from outside groups,” Mr. Wiggins said. “We pay more attention to local individuals.” More

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      The Senate Is Getting Less Democratic by the Minute

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      Democrats and the independents who caucus with them will be playing defense in 23 of the 34 Senate seats on the ballot in the 2024 congressional elections. Four of the 23 are in swing states that President Biden won narrowly in 2020. Three are in states that Donald Trump won in both 2016 and 2020.If Democrats were to lose all seven, a catastrophic defeat, they would start the next session in Congress with a weak minority of senators — its smallest number since the days of President Herbert Hoover — who would nonetheless represent nearly half the population of the United States.Depending on where you stand in relation to partisan politics in this country, you may not find this disparity all that compelling. But consider the numbers when you take political affiliation out of the picture: roughly half of all Americans, some 169 million people, live in the nine most populous states. Together, those states get 18 of the 100 seats in the United States Senate.To pass anything under simple majority rules, assuming support from the sitting vice president, those 18 senators would have to attract another 32 votes: the equivalent, in electoral terms, of a supermajority. On the flip side, it is possible to pass an item out of the Senate with a coalition of members who represent a small fraction of the total population — around 18 percent — but hold an absolute majority of the seats. And this is before we get to the filibuster, which imposes a more explicit supermajority requirement on top of this implicit one.Last week, The Washington Post published a detailed look at the vast disparities of power that mark the Senate, which was structured on the principle of equal state representation: Regardless of population, every state gets two members. A carry-over from the Articles of Confederation, the principle of equal state representation was so controversial that it nearly derailed the Philadelphia Convention, where James Madison and others were trying to build a national government with near total independence from the states.It is not for nothing that in the Federalist Papers, neither Madison nor John Jay nor Alexander Hamilton attempts to defend the structure of the Senate from first principles. Instead, Madison wrote in Federalist No. 62, you should consider it a concession to the political realities of the moment:A government founded on principles more consonant to the wishes of the larger States, is not likely to be obtained from the smaller States. The only option, then, for the former, lies between the proposed government and a government still more objectionable. Under this alternative, the advice of prudence must be to embrace the lesser evil; and, instead of indulging a fruitless anticipation of the possible mischiefs which may ensue, to contemplate rather the advantageous consequences which may qualify the sacrifice.Today, the Senate is a distinctly undemocratic institution that has worked, over the past decade, to block policies favored by a large majority of Americans and even a solid majority of senators. And while there’s no immediate hope of changing it, a cleareyed analysis of the chamber’s structural faults can help answer one of the key questions of American democracy: Who, or what, is this system supposed to represent?As the Post piece notes, equal state representation has never been equitable: “In 1790, Virginia, the most populous state, had roughly 13 times the population of Delaware, the least populous, with a difference of about 700,000 people.” But as the country has grown larger and more diverse, the disparities have grown greater and more perverse. The population difference between the states is so large now that a resident of the least populous state, Wyoming, as many observers have pointed out, has 68 times the representation in the Senate than does a resident of California, the largest state by population. In fact, a state gets less actual representation in the chamber the more it attracts new residents.There is not just a disparity of representation; there is a disparity in who is represented as well. The most populous states — including not only California, but New York, Illinois, Florida and Texas — tend to be the most diverse states, with a large proportion of nonwhite residents. The smallest states by population — like Maine, Vermont and New Hampshire — tend to be the least diverse. And the structure of the Senate tends to amplify the power of residents in smaller states and weaken the power of those in larger states. When coupled with the potential for — and what is in truth the reality of — minority rule in the chamber, you have a system that gives an almost absolute veto on most federal legislation to a pretty narrow slice of white Americans.One response to these disparities of power and influence is to say that they represent the intent of the framers. There are at least two problems with this view. The first is that the modern Senate reproduces some of the key problems — among them the possibility of a minority veto that grinds governance to a halt — that the framers were trying to overcome when they scrapped the Articles of Confederation. The second and more important problem is that the modern Senate isn’t the one the framers designed in 1787.In 1913, the United States adopted the 17th Amendment to the Constitution, providing for the direct election of senators at the ballot box rather than their selection by state legislatures. This change disrupted the logic of the Senate. Before, each senator was a kind of ambassador from his state government. After the amendment went into effect, each senator was a direct representative of the people of that state.If each member was a kind of ambassador, then you could justify unequal voting power by pointing to the equal sovereignty of each state under the Constitution. But if each member is a direct representative, then it becomes all the more difficult to say that some Americans deserve more representation than others on account of arbitrary state borders.This brings us back to our question: Who, or what, is the American system supposed to represent? If it is supposed to represent the states — if the states are the primary unit of American democracy — then there’s nothing about the structure of the Senate to object to.It’s plain as day that the states are not the primary unit of American democracy. As James Wilson of Pennsylvania observed during the Philadelphia Convention, the new national government was being formed for the sake of individuals rather than “the imaginary beings called states.” And as we’ve expanded the scope of democratic participation, we have affirmed — again and again — that it is the people who deserve representation on an equal basis, not the states.There is no realistic way, at this moment, to make the Senate more democratic. But if we can identify the Senate as one of the key sources of an unacceptable democratic deficit, then we can look for other ways to enhance democracy in the American system.I know that, given the scale and scope of the problem, that does not sound very inspiring. But we have to start somewhere.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