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      Luigi Mangione is the median American voter | Peter Rothpletz

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      The vast majority of the US population rarely – if ever – lapses into murderous fantasies wherein they gun down an unsuspecting father of two. One need not possess the telepathic powers of Professor Charles Xavier to consider this a fact. That said, the heterodox, ostensibly incoherent potpourri of political views expressed by the alleged UnitedHealthcare CEO assassin, Luigi Mangione, is more representative of the average American than many elites would care to admit.Mangione’s Twitter/X account is a kaleidoscopic fever dream with no clear ideological rudder. It seems he has a genuine interest in health and wellness. “Wokeness” and masculinity are occasionally discussed; so too are climate change, psychedelics and the potential risks and rewards of artificial intelligence. Pornography, in Mangione’s mind, “should be regulated no less than alcohol, cigarettes, and travel” – and certain sex toys should be banned. He likes Joe Rogan but disdains Jordan Peterson. He also appears to be particularly fond of Pokémon, baby elephants, gorillas and Japan’s Indigenous religion, Shintoism.More interesting than Mangione’s posts themselves are the personalities he follows. They run the political gamut. The right-leaning “manosphere” is well-represented by folks such as Rogan, Patrick Bet-David and Andrew Huberman. The only member of Congress on the list is Representative Alexandria-Ocasio Cortez, a democratic socialist. RFK Jr serves as a conduit for both the environmental and Maga movements. Even center-left, wonkish liberalism makes a cameo with Ezra Klein.Some have voiced befuddlement as to where the connective tissue lies between all these figures. They’re confused because they still believe the dominant divide in US politics is liberalism v conservatism. It’s not, and it hasn’t been for some time. Increasingly, even if they lack the exact language to explain it, voters do not identify foremost as Democrats or Republicans, progressives or traditionalists, or even left or right. They identify as pro-system or anti-system. As put by Jeet Heer in The Nation: “Pro-system politics is the bipartisan consensus of establishment Democrats and Republicans: It’s the politics of Nato and other military alliances, of trade agreements, and of deference to economists (as when they say that price gouging isn’t the cause of inflation).” Anti-system politics, he continues, is “a general thumbing of the nose at this consensus”.Rogan, Bet-David and Huberman’s anti-system bona fides are manifest; one can argue AOC’s are too given her status as Bernie Sanders’ heir apparent. RFK Jr is the scion of a Democratic dynasty, but his musings about vaccines, chemtrails, and tap water turning children gay are miles outside the Overton window. Yes, the New York Times’s Ezra Klein feels like a pro-system figure, but one must not forget his February audio essay calling on Joe Biden to pass the torch. Not only did his call land like a bomb, it arguably provided the initial momentum for Democrats to finally force the president out of the election following his disastrous debate performance in late June. Klein was the first man in mainstream media to observe that the emperor has no clothes. Such courage earns one anti-system credibility.Considering all this, Mangione’s digital media diet is arguably quite coherent – and in line with what most non-elites consume. As explained by Rachel Kleinfeld, average Americans are far less ideologically polarized than they think they are – and misconceptions around polarization are greatest among the most politically engaged people. Unfortunately, if you’re reading this essay, you’re likely very, very out of touch.Before November’s election, Blueprint Polling conducted a number of surveys in an effort to define the views of swing voters of swing states. They found these Americans, predictably, defy conventional political categorization. They believe immigration should be decreased, abortion should be legal, the criminal justice system is not tough enough, the government should crack down on price-gouging, and same-sex marriage is just dandy. They practice hodgepodge politics, and they aren’t bothered by what elites would call ideological inconsistency.Mangione is cast in the same mold. Insofar as Mangione can even be called an “ideologue”, he merely believed the American system was fundamentally flawed. He isn’t some pinko, dolled up in Che Guevera revolutionary regalia; nor is he an SS leather fetishist. He’s a highly educated, heterodox, politically homeless moderate – and that fact should terrify us all. Unlike the political violence of old, committed by dyed in the wool radicals, the assassination of Brian Thompson was carried out by a young man with no movement encouraging his extremism. He, on his own, came to the conclusion that the US is so broken and corrupt that murder is the only solution.

      Peter Rothpletz is a freelance writer More

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      Ro Khanna: Brian Thompson killing was ‘horrific’ but people ‘aren’t getting care they need’

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      Progressive congressperson Ro Khanna has sympathy for murdered UnitedHealthcare CEO Brian Thompson – yet at the same time is not surprised that the killing reignited a national dialogue about inequities in the US healthcare system, he said in an interview Sunday.“It was horrific,” the California Democrat said on ABC This Week with respect to the slaying of Thompson, whose survivors include his widow and two sons ages 16 and 19. “I mean, this is a father we’re talking about – of two children, and … there is no justification for violence.“But the outpouring afterwards has not surprised me.”Khanna told the show’s host, Martha Raddatz, that he agreed with fellow liberal and US senator Bernie Sanders when he wrote recently on social media: “We waste hundreds of billions a year on health care administrative expenses that make insurance CEOs and wealthy stockholders incredibly rich while 85 million Americans go uninsured or underinsured. Health care is a human right. We need Medicare for all.”“After years, Sanders is winning this debate,” Khanna said, referring to the Vermont senator’s support for a single-payer national health insurance system seen in other wealthy democracies.While police have stopped short of offering a possible motive behind Thompson’s 4 December shooting death, the apparent targeted nature of the attack – as well as shell casings found at the scene of the killing displaying the words “delay”, “deny” and possibly “depose” have suggested it was maybe linked to the largely privatized US healthcare industry’s routine denial of payments to many Americans.Healthcare debt has emerged as a leading cause of bankruptcy in the US while for-profit health insurers such as UnitedHealthcare are among the country’s richest companies. Thompson, 50, who lived near UnitedHealthcare’s headquarters in Minnesota, commanded a salary of $10m annually before a gunman wearing a mask shot him dead outside a hotel in Manhattan as he prepared to attend a meeting with investors of his company.Many greeted news of Thompson’s death not with sympathy but with mockery. A widely shared example of the sentiment was a social media post from Columbia School of Social Work’s Anthony Zenkus, which read: “Today, we mourn the death of United Healthcare CEO Brian Thompson, gunned down…. wait, I’m sorry – today we mourn the deaths of the 68,000 Americans who die needlessly each year so that insurance company execs like Brian Thompson can become multimillionaires.”Khanna on Sunday said his status as a member of the US House has not immunized him from absurd insurance battles.skip past newsletter promotionafter newsletter promotionThough he acknowledged it paled in comparison to people with cancer, heart disease and diabetes being denied coverage while they battle for their lives, Khanna said: “I, as a congressperson had UnitedHealthcare deny a prescription for a nasal – a $100 pump spray, and I couldn’t get them to reverse this. So imagine what ordinary people are dealing with.”Khanna said some modest steps that the US could take to begin addressing healthcare inequities in the country is to cap out-of-pocket costs while also requiring the private insurers relied on by many Americans “to cover anything” that Medicare would.Medicare is the public US health insurance program for those older than 65 and people who are disabled.“We have to understand people with cancer, with heart disease, with diabetes, with insurance aren’t getting the care that they need. They’re getting stuck with huge medical bills.” More

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      Trump surgeon general pick involved in gun accident that killed her father at age 13

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      Donald Trump’s nominee for US surgeon general – Dr Janette Nesheiwat – accidentally knocked over a gun when she was 13 years old, causing it to fire and fatally shoot her father in the head.The death of Nesheiwat’s father occurred in February 1990 at her family home in Umatilla, Florida, as reported on Friday by the New York Times.“I was in Father’s bedroom at about 7.15am getting some scissors” out of a fishing tackle box on a shelf above her dad’s bed, she said, according to a police report reviewed by the New York Times. “I opened the … box and the whole thing tipped over”, causing a handgun to fall from inside, discharge and strike her father in the head as he slept in the bed.Nesheiwat’s father, who immigrated from Jordan, died in a hospital the following day.While avoiding discussing her role in the case, she has said her father’s death inspired her to become a doctor. Nesheiwat has spent the past 15 years as an urgent care doctor for CityMD, a for-profit chain of clinics around New York City.At the start of the Covid-19 pandemic, she began appearing regularly on Fox News as a medical contributor.Nesheiwat would replace Dr Vivek Murthy if her nomination is confirmed after Trump begins his second presidency.Murthy was the first US surgeon general to declare gun violence as a public health crisis. In an advisory, he cited that firearms are now the leading cause of death in the US among children and adolescents.A graphic accompanying the advisory explained how many of those deaths were unintentional, resulting from firearms that were stored loaded as well as unlocked.To address the crisis, Murthy called on the US to ban automatic rifles, introduce universal background checks for purchasing guns, regulate the industry, pass laws that would restrict use in public spaces and penalize individuals who fail to safely store their weapons.Republicans have opposed efforts to treat gun violence as a public health issue, with House Republicans voting in 2023 to ban the Center for Disease Control from researching gun violence. Republicans have also pushed to prevent public health agencies from citing public health emergencies to pass gun control measures and has attempted to defund programs aimed at gun violence reduction.Murthy was dismissed from his role as US surgeon general by Trump during his first presidency in 2017 before outgoing Joe Biden appointed him to the position again in 2021.The New York Times reported that a Nesheiwat memoir being published later in December mentions her father’s death in the first sentence.“When I was 13 years old, I helplessly watched my dear father dying from an accident as blood was spurting everywhere,” she writes in Beyond the Stethoscope: Miracles in Medicine. “I couldn’t save his life.“This was the start of my personal journey in life to become a physician and enter the world of healing arts.”But, according to the New York Times, nowhere in the next 260 pages of the book does she detail how her father died or say that he was shot.The Orlando Sentinel provided more detail in 1990, describing in a news item how a bullet hit Ziad “Ben” Nesheiwat in the head and killed him after his 13-year-old daughter knocked over a tackle box, causing a gun to fall out and fire.“As she says in her book, she became a physician because of her dad’s tragic accidental death,” a spokesman for Trump’s transition team, Brian Hughes, said in a statement to the New York Times after Nesheiwat did not respond for comment. “She became a physician to save lives, and that dedication to the lives of her fellow Americans is why president Trump nominated Dr Nesheiwat to be our next surgeon general.“She and her family miss their father, and hope he’s proud of them.” More

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      How did transgender children in the US become so politicized? | Moira Donegan

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      The politicization of transgender children in the US is one of the most astounding coups of propaganda and organized animus in recent history. Rarely has so much attention and rage been directed at such a minuscule number of people, and more rarely, still, have those people been the most vulnerable and blameless among us: kids and teens.The first state to pass a ban on transition-related care for minors was Arkansas, in April 2021; less than four years later, more than half of states have such a ban on the books. In 2016, North Carolina lost an estimated $3.76bn in revenue following boycotts after they passed a law banning trans people, including transgender students, from using appropriate restrooms in public facilities; now, 14 states have such bathroom bans on the books, and the boycotts have receded.These changes in public attitudes towards trans youth – from a broad if imperfect sentiment of tolerance to a widespread and politically weaponized attitude of hostility toward a small minority of kids – did not emerge by accident. It was the product of a deliberate, conscious effort to radicalize large swaths of the United States, and significant chunks of state policy, into a hostility towards a few children.That effort seems set to bear fruit now, at the US supreme court, in US v Skrmetti, a lawsuit brought by the ACLU and the Biden Department of Justice challenging Tennessee’s HB1, a sweeping ban on transition-related care for minors that was passed in 2023. The law prohibits any puberty blockers or hormones from being prescribed for the purposes of gender transition, but it does not prohibit these medications from being prescribed for any non-transition-related purpose. A minor can be prescribed puberty blockers, for instance, if their doctor believes they are experiencing early onset, or “precocious”, puberty; they cannot be prescribed puberty blockers to delay the onset of a puberty that may change their bodies in ways they do not desire for gender identity-related reasons.That means, too, that a child assigned male at birth could access, say, testosterone treatment, but a child assigned female at birth could not. In oral arguments on Wednesday, solicitor general Elizabeth Prelogar and Chase Strangio of the ACLU – the first trans attorney to argue before the supreme court – explained that this was a straightforward case of sex discrimination, and hence needed to be subjected to a heightened standard of judicial review under the 14th amendment’s equal protection clause.It will not be. A majority of the court’s conservatives seemed poised to uphold the ban on transgender healthcare, though for a variety of different reasons. Brett Kavanaugh made his usual mealy-mouthed paean to states’ rights, an argument he always makes in questions of federally guaranteed equality provisions, but not before extolling the hypothetical suffering of teenagers who may access gender-affirming care but then later come to regret it. (One wonders if there are any choices from his own adolescence that Brett Kavanaugh has come to regret.) Clarence Thomas and chief justice John Roberts, meanwhile, both advanced the idea that the physiological differences between male and female bodies could moot the equal protection clause’s reach, giving states broad leeway to regulate medicine in ways that would uphold gender hierarchy.For his part, Samuel Alito also seemed interested in the idea that states might have a right to effect gender discrimination via their regulation of medicine. He repeatedly cited the 1974 case Geduldig v Aiello, in which the supreme court ruled that states could discriminate on the basis of pregnancy, and that pregnancy discrimination was not sex discrimination – because even though only female people become pregnant, not all of them are pregnant all of the time. (At the time, Congress found the outcome in Geduldig so egregious that it passed a law clarifying that pregnancy discrimination does count as sex discrimination for the purposes of federal civil rights law, and the precedent was largely mooted, but Alito’s controlling opinion in Dobbs has revived it.)But Alito, true to form, did not confine his opining to the notion that discrimination against trans people does not count as sex-based discrimination: he went on to suggest that trans people are not quite real, peppering Strangio, in a scene that seemed intended to humiliate the trans attorney, with questions about whether trans identity was truly an “immutable” characteristic. For his part, Strangio responded with a dignity and respect that Alito’s line of questioning did not merit.It was not the only low moment. James Matthew Rice, the Tennessee solicitor general who defended the ban in court, repeatedly compared gender affirming care with suicide, as well as to lobotomies and eugenics. During his time, justices Ketanji Brown Jackson and Sonia Sotomayor, with occasional assists from Elena Kagan, tried to chase Rice down on the inconsistencies in his own argument.Tennessee claimed, after all, that the law did not discriminate on the basis of patients’ sex, but rather on the basis of the purpose of their treatment; when the liberal justices pointed out that this was a distinction without a difference, because the purpose of the treatment was dependent on the patients’ sex, Rice simply repeated his assertion that there was a difference, there, somewhere. Jackson, in particular, worked to get Rice to explain his position for some time. He declined to.To call the Tennessee ban sex-neutral is laughable, almost insulting. The statute itself makes gender conformity its explicit justification in its text, saying that it aims to prohibit “sex inconsistent treatment”, or anything that “might encourage minors to become disdainful of their sex”. The law has long included sex role stereotyping within the purview of sex discrimination; Tennessee has sought to enforce sex roles, and sexed embodiment, with the force of the state. There is no good faith reading of the law that would allow it to withstand the scrutiny that the 14th amendment requires. But luckily for Tennessee, this is not a good faith court.

      Moira Donegan is a Guardian US columnist More

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      Trump pick for US health agency proposed ‘herd immunity’ during Covid

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      Jay Bhattacharya, an unofficial Covid adviser in Trump’s first administration, has been selected as the director of the National Institutes of Health (NIH), one of the leading biomedical research institutions in the world.The choice of Bhattacharya, a Stanford economist whose proposal for widespread Covid-19 infection was backed by the White House, signals a return to controversial and scientifically questionable health policies in the second Trump administration, experts say.Bhattacharya, an economist who attended medical school, has called for an “an absolute revamping of the scientific community”.He has questioned the safety of vaccines, testified against the effectiveness of face masks, and argued that NIH officials should not be involved with scientific policy.Bhattacharya did not respond to requests for comment.In early 2020, Bhattacharya downplayed Covid’s deadliness, and he soon joined two other scientists in a recommendation to let Covid spread with “focused protection” – a proposal on the scientific fringes that soon became politically mainstream.After the Trump administration adopted the strategy of “herd immunity” through infection, millions of Americans were disabled and killed, with a vastly higher mortality rate than peer nations.In April 2020, Santiago Sanchez, then a first-year student at Stanford Medical School, wanted to do something to help as the novel coronavirus swept the nation and brought the world to a standstill.That’s how he found himself volunteering in a makeshift laboratory in the ballroom of the Palo Alto Sheraton, carefully squeezing droplets of blood samples into rapid tests for 10 to 12 hours a day.The research project was an attempt to see how many people had already gotten sick from Covid. If more people than previously known had already gotten sick and recovered, that would mean the virus wasn’t as severe as it seemed, and it might also mean there were enough people out there with immunity to help stop the virus from spreading, Sanchez hoped.But as he saw negative result after negative result, Sanchez felt his optimism curdle. After two days, the volunteers had conducted more than 3,300 tests, but fewer than two dozen turned positive, as Sanchez remembers it.That’s why he was puzzled when one of the senior researchers of the study, Jay Bhattacharya, stepped into the ballroom, saw the handful of positive tests alongside stacks of negative tests, and said, “there’s definitely signal here,” according to Sanchez’s recollection.“That was my first sinking feeling, because I was like, ‘That is not how I am interpreting this experiment,’” Sanchez said.The ensuing preprint study estimated that between 2.5% to 4% of people in the region had been infected – a rate vastly higher than previously thought, and a figure significantly higher than the number of positive tests Sanchez says he saw.Bhattacharya became a fixture on Fox News and other networks, proclaiming the opposite of what Sanchez now believed: that many more people had the virus than anyone thought, and that meant the US should reopen.“He was everywhere during the pandemic except hospitals,” said Jonathan Howard, associate professor of neurology and psychiatry at NYU Langone Health and author of the book We Want Them Infected. “He didn’t treat a single Covid patient himself and became famous despite having no real-world responsibility that way.”Scientists quickly discovered significant errors in the study: the people who gave blood weren’t a random sample; the positive tests may well have been false positives; and the study was sponsored in part by an airline founder who was an avid proponent of reopening in the midst of Covid’s strongest grip.Despite criticism, the study results “spiraled out of control”, Sanchez said. “I and many others who worked on this study had this shared feeling of being taken advantage of, like we had been pawns in an obviously ideological project that did not meet scientific muster.”A few months later, Bhattacharya and other skeptics of Covid precautions met with President Trump at the White House, at a time when Trump had stopped speaking with his chief medical adviser, Anthony Fauci.Bhattacharya and two other scientists, Sunetra Gupta and Martin Kulldorff, soon unveiled a plan, known as the Great Barrington Declaration, to let the virus spread unchecked among the general population while attempting to protect the vulnerable. The authors believed this approach could stop the pandemic within three to six months.“This is not mainstream science. It’s dangerous,” said Francis Collins, then director of the NIH.Yet the day after the proposal was released, the authors met with Alex Azar, then the secretary of Health and Human Services, who confirmed that the proposal echoed the Trump administration’s policy of reopening.Within months, the worst wave of deaths of the entire pandemic crashed into the US. The strategy of protecting the vulnerable never materialized; even Trump, perhaps the most protected person in the nation, was hospitalized with Covid.“He was a pro-infection doctor,” Howard said of Bhattacharya. “He said that parts of the country had reached herd immunity in summer 2020 … He said that one infection led to permanent, robust immunity, and he treated rare vaccine side effects as a fate worse than death.”In the past four years, Bhattacharya has testified in state and Canadian courts, as well as US congressional hearings. Bhattacharya has said that public health has become a “tool for authoritarian power … a political tool that’s been used to enforce the biosecurity state”, and that the field needs to be rebuilt.When Sanchez sees patients who say they don’t need a Covid booster, he wonders if they’ve been influenced, directly or indirectly, by Bhattacharya’s messages.And he sees a direct line from the economist’s Covid advice to his possible appointment at the NIH.“They handed Trump a huge gift. They gave him a way to talk about the pandemic that obviously reached a lot of people, that let them, in their own minds, compartmentalize what had happened and feel that it was okay to tolerate the amount of disability and death,” Sanchez said of the researchers.“It totally obfuscated people’s ability to even assess risk, to the point that we have well-established, highly efficacious childhood vaccines that are now being denied – to the point that measles is coming back in some parts of the United States.”With trust in public health greatly diminished, the repercussions could be long-lasting and tragic in coming years, particularly as Trump’s health nominees erode trust in the safety and effectiveness of vaccines and other public-health precautions, Howard said.“Every measles outbreak, every pertussis outbreak, will be on them.” More

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      Biden proposes Medicare and Medicaid cover weight-loss drugs for 7.4m people

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      The Biden administration is proposing to make “miracle” weight loss drugs free for low-income people and retirees, in a move aimed at tackling America’s chronic obesity problem but which throws down a gauntlet to the incoming president, Donald Trump.The proposal, unveiled on Tuesday, would see expensive drugs such as Ozempic, Wegovy and Zepbound covered by Medicaid and Medicare, the federal government programs for the poor and the elderly.It would come at a hefty cost to the public purse. The drugs would be covered for anyone qualifying as obese, a definition that currently fits 40% of the US population. Currently, coverage is only given when patients have other conditions that is caused by obesity, such as diabetes, heart disease and cancer.Xavier Becerra, the US health and human services secretary, called the move a “game changer”.“It helps us recognize that obesity is with us,” he told the Washington Post. “It’s severe. It’s damaging our country’s health. It’s damaging our economy.”But the proposed reform amounted to a challenge to Trump’s incoming administration, which would have to decide whether to implement the change a few days after taking office in January. Trump has sworn to slash the federal budget.It also paved the way for a likely conflict between two of Trump’s health sector nominees: Robert F Kennedy Jr, who has been proposed as the health and human services secretary, and Mehmet Oz, the celebrity physician who has been nominated to run Medicare and Medicaid.Kennedy has vowed to promote healthy eating and improve fitness in the battle against obesity, and has fiercely criticised weight loss drugs, blaming them for obscuring the causes of ill health.He recently claimed to Fox News that covering a drug like Ozempic for every overweight American would cost $3tn a year.“If we spend about one-fifth of that, giving good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight for a tiny fraction of the cost,” he said.“There’s a huge push to sell this to the American public. They’re counting on selling to Americans because we’re so stupid and so addicted to drugs.”Oz has taken a different tack, praising Ozempic on social media last year. “[F]or those who want to lose a few pounds, Ozempic and other semaglutide medications can be a big help,” he wrote. “We need to make it as easy as possible for people to meet their health goals, period.”Beccera estimated that 3.4 million people on Medicare and 4 million on Medicaid would become eligible for the drugs under the new rule.But other research suggests that far more people may qualify. The Centers for Medicare and Medicaid Services (CMS), the agency Oz has been nominated to head, has estimated that 28 million recipients suffer from obesity.A recent Congressional Budget Office analysis estimated that federal spending would rise by $35bn between 2026 and 2034 by allowing Medicare alone to cover weight-loss medications.People can lose between 15% and 25% of their body weight thanks to the drugs, which imitate the hormones that regulate appetites. A month’s supply can cost around $1,000. More

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      We must defend elective abortions, not just the most politically palatable cases | Moira Donegan

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      A Kentucky woman known by the pseudonym Mary Poe recently filed a lawsuit against her state, seeking an abortion for what was once a banal reason: because she wanted one.Poe, who was about seven weeks pregnant at the time of the lawsuit’s filing, has since had an abortion out of state. But her attorneys argue that she still has standing to sue to overturn Kentucky’s two abortion bans – a six-week ban and a separate total ban – arguing that the laws violate the state constitution. This much, at least, is typical: lawsuits challenging abortion bans have sprung up across the country since Dobbs, with women and their families seeking to overturn bans, expand exceptions, or get some compensation from the state for the graphic, distressing, disabling or deadly outcomes that the bans have made them suffer.The US supreme court justices who voted to overturn Roe in Dobbs cited the surge in activist litigation around abortion – a product of conservative investment in anti-choice legal shops – as part of their reason for doing so. Surely this must be a contentious, controversial issue that the federal bench is ill equipped to resolve, the judges from the conservative legal movement reasoned – because look how many complaints the conservative legal movement has filed against it!This rationale was always disingenuous, but it has also been proved flatly wrong: Dobbs has not got the courts out of the abortion business. Instead, lawsuits over abortion have exploded. The anti-choice camp has pounced, seeking to further restrict abortion by banning pills; targeting reproductive rights advocates, abortion funds and sexual health educators; claiming rights for fetuses or embryos; or by asserting that men who father pregnancies have a right to keep women from terminating them.But the pro-abortion rights side has been busy with litigation, too. Women who have been put at great health risk or made to suffer terrible, painful complications as a result of bans brought a class-action lawsuit in Texas. Bans have been challenged over and over again – on religious liberty grounds, on the grounds of state constitutional provisions securing the right to make individual healthcare decisions, under a federal law that guarantees emergency room treatment for patients needing stabilizing care, and under state constitutional clauses guaranteeing liberty, due process and privacy.The Kentucky lawsuit is part of this latter camp. Mary Poe has cited Kentucky’s constitutional guarantees of individual rights to both privacy and self-determination, which she says have been violated by the bans. “I feel overwhelmed and frustrated that I cannot access abortion care here in my own state,” she said in a statement delivered via her lawyers at the American Civil Liberties Union. “I am bringing this case to ensure that other Kentuckians will not have to go through what I am going through, and instead will be able to get the healthcare they need in our community.”This kind of desire for an abortion – the dignified simplicity of it – has been missing from much of the post-Dobbs abortion rights discourse. After the ruling, as trigger bans shot into effect across the country, clinics shuttered their doors, and scared women tried to discern their options, there was no shortage of tragic stories highlighting the brutality, indignity and gendered bigotry of the laws. But as the dust settled and members of the Democratic party, the major reproductive rights advocacy groups and the liberal legal movement surveyed the national scene, a consensus emerged that the face of the mainstream pro-choice movement would be the patient who experienced a medical emergency.Women who had suffered horrific medical complications became lucid, moving and highly sought after tellers of their own stories, explaining how abortion bans has risked their health: Amanda Zurawski, for example, was denied an emergency abortion at 18 weeks, subsequently went into septic shock twice, and one of her fallopian tubes was so scarred that it is now permanently closed, inhibiting her future fertility. Kate Cox was denied an abortion after discovering that her fetus has trisomy 18, a rare genetic condition which is incompatible with life, and which, because of Cox’s own medical history, also endangered her fertility and life.During her presidential run, Kamala Harris ran an ad featuring a woman identified only as Ondrea, who suffered a miscarriage at 16 weeks and was denied the standard care due to her state’s abortion ban. She developed sepsis and almost died. The ad features a shot of Ondrea in a bathroom, staring at her body in a mirror wearing only a sports bra. Her belly bears the scars of the emergency surgery that eventually saved her life – the surgery that she never would have had to have if it weren’t for the ban.It does not diminish these women’s bravery, their suffering, or the wrongness of what was done to them to say that they are only one small fraction of those who need abortions in America. These are married, middle-class women with wanted pregnancies; Zurawski and Cox are both white. Cox has spoken movingly about her hopes to meet her future child, a girl; in the ad that features Ondrea, she and her husband hold a baby blanket. These are women whose suffering at the hands of abortion bans has nothing to do with a refusal or distaste for heterosexual, married, middle-class life. Their suffering can be made visible precisely because they are so acceptable.Not so with Mary Poe. Poe may well be married, middle-class and white; from her statement, in which she talks about the difficulty of finding childcare, we can infer that she, like most abortion patients, is already a mother. But Poe is not suffering a physical emergency; she is not enduring any pain or medical misfortune that she can use to purchase social license. She is not, in other words, a woman whose claim to an abortion is based on a plea for mercy. She is merely a woman who seeks to be in control of her own life, one who believes that things like privacy and self-determination apply to her, too.“I have decided that ending my pregnancy is the best decision for me and my family,” Poe writes in her public statement. “This is a personal decision, a decision I believe should be mine alone, not made by anyone else.”This was not always a radical proposition. But in the post-Dobbs world, it has sadly become one.

      Moira Donegan is a Guardian US columnist More

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      Biden must Trump-proof US democracy, activists say: ‘There is a sense of urgency’

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      The skies above the White House were cold and grey. Joe Biden greeted the championship winning Boston Celtics basketball team, quipping about his Irish ancestry and tossing a basketball into the crowd. But the US president could not resist drawing a wider lesson.“When we get knocked down, we get back up,” he said. “As my dad would say, ‘Just get up, Joe. Get up.’ Character to keep going and keep the faith, that’s the Celtic way of life. That’s sports. And that’s America.”Such events continue to be among the ceremonial duties of a “lame duck” president with waning influence. Biden has cut a diminished figure in recent months, first surrendering his chance to seek re-election, then finding himself sidelined by the doomed presidential campaign of his vice-president, Kamala Harris.But with his legacy imperiled by Donald Trump, the president is facing calls to mitigate the oncoming storm. Advocacy groups say Biden, who turned 82 this week, can still take actions during his final two months in office to accelerate spending on climate and healthcare, secure civil liberties, and Trump-proof at least some fundamentals of US democracy.Trump’s signature campaign promise was a draconian crackdown on illegal immigration. He has nominated officials including Tom Homan and Stephen Miller, architects of family separations at the southern border during his first term, and vowed to use the US military to carry out mass deportations of undocumented immigrants.The plans include mandatory detention, potentially trapping immigrants in inhumane conditions for years as they fight deportation. The American Civil Liberties Union (ACLU) is leading an opposition effort, urging Biden to halt the current expansion of Immigration and Customs Enforcement (Ice) detention facilities, especially those with records of human rights abuses.Eunice Cho, a senior staff attorney with the ACLU national prison project, said Ice detention facilities “characterised by abusive conditions, pervasive neglect and utter disregard for the dignity of people in their custody” are key to Trump’s logistical plan.Dozens of people have died in Ice detention facilities – mostly owned or operated by private prison corporations – over the past four years, according to the ACLU, and 95% were likely preventable if appropriate medical care had been provided. Yet the Biden administration has backed new Ice detention facilities in states where they did not existed before, such as Kansas, Wyoming and Missouri.“We are calling on the Biden administration to take action now, in the final days of the administration, to halt any efforts to expand immigration detention and to shut down specifically abusive facilities once and for all,” Cho told reporters on a Zoom call this week. “We don’t need to put down runway for the Trump administration to put in place these mass detention and deportation machines.”She warned: “We know that the anti-immigrant policies of a second administration are going to be far more aggressive than what we saw in the first term, and mass arrest and detention is going to become perhaps the norm to create and carry out these deportation operations unless we can do all we can to put a halt to them.”View image in fullscreenAnother crucial area for Biden to make a last stand is criminal justice. In his first term, Trump oversaw the execution of more people than the previous 10 presidents combined. Biden’s attorney general, Merrick Garland, then imposed a moratorium on federal executions in 2021.Trump has indicated his intention to resume such executions and even expand the death penalty. His nominee for attorney general, Pam Bondi, issued a public apology in 2013 while serving as Florida’s top law enforcement officer after she sought to delay the execution of a convicted killer because it conflicted with a fundraiser for her re-election campaign.Cassandra Stubbs, director of the ACLU’s capital punishment project, told reporters via Zoom that Trump said “he will work to expand the death penalty. He’s going to try to expand it to people who do not even commit killings. He’s called for expanding the death penalty to his political opponents.“But perhaps most dangerously in Project 2025 [a policy blueprint from the Heritage Foundation thinktank] – and we believe every word of it is this – he promised to try to kill everyone on death row, and the reason why we have to believe this and take it so seriously is the record that Donald Trump left where he, in a span of six months, carried out 13 executions.”The ACLU and other groups are therefore pressing Biden to commute the sentences of all individuals on federal death row to life in prison, fulfilling a campaign promise and preventing potential executions under Trump. Commuting “is really the thing that Biden can do to make it harder for Trump to restart executions”, Stubbs added.Pastor Brandi Slaughter, a board member of the pressure group Death Penalty Action, told reporters this week: “We know what the next president plans to do if any prisoners are left under a sentence of death under the Biden administration. We’ve been there, we’ve done that.”Biden has also received 8,000 petitions for clemency from federal prisoners serving non-death penalty sentences that he could either reduce or pardon. The former senator has long been criticised for his role in drawing up a 1994 crime law that led to the incarceration of thousands of Black men and women for drug offences.This week, members of Congress including Ayanna Pressley and James Clyburn led 64 colleagues in sending a letter to Biden urging him to use his clemency power “to reunite families, address longstanding injustices in our legal system and set our nation on the path toward ending mass incarceration”.They were joined at a press conference on Capitol Hill by Maria Garza, 50, from Illinois, a prison reform advocate who spent 12 years in a state prison. She said in an interview: “There is a sense of urgency because a lot of the people that are sitting waiting for clemency are people that have de facto life sentences that will die in prison if they don’t [receive clemency]. A lot of their unjust sentencing was because of the 1994 crime bill that he was the founding father of.”skip past newsletter promotionafter newsletter promotionMitzi Wall, whose 29-year-old son Jonathan is incarcerated on a seven-and-a-half-year federal cannabis charge, called on Biden to keep a campaign promise to grant clemency to more than 4,000 people in federal prison for nonviolent cannabis crimes.“We voted for President Biden,” she said. “He gave us hope and we’re asking him to do nothing more than keep his promise.”Wall, 63, from Maryland, added: “President Biden was partly responsible for writing the 1994 crime bill that thrust families into abject poverty and pain. I know he feels bad about that and he can right that wrong with the power of the pen. I’m appealing to him as a father whose son [Hunter] could very possibly be going to prison.”In other efforts to protect civil liberties, the ACLU is recommending a moratorium on all federal government purchases of Americans’ personal data without a warrant. It is also asking Congress to pass the Fourth Amendment Is Not for Sale Act to prevent potential abuse of surveillance technologies under the Trump administration.Meanwhile, Trump has pledged to rescind unspent funds in Biden’s landmark climate and healthcare law and stop clean-energy development projects. White House officials are working against the clock to dole out billions of dollars in grants for existing programmes to minimise Trump’s ability to rescind or redirect these funds. Earlier this month, the transportation secretary, Pete Buttigieg, announced more than $3.4bn in grants for infrastructure projects across the country.Wendy Schiller, a political science professor at Brown University in Providence, Rhode Island, notes that Trump will have the power of impoundment to stall the money flowing out of the government and can order rescissions to programmes funded by Congress.“The singular thing that Joe Biden can do is expedite the flow of federal dollars in all the programmes,” Schiller said.“Any money that is supposed to leave the treasury to go to schools, food safety, environmental protection – anything that is not yet distributed needs to get distributed. It’s like emptying literally the piggy bank before you go on a trip. President Biden needs to be literally getting as much money out the door in the hands of state, local and community organisations as he can.”Another priority for the White House is getting Senate confirmation of as many federal judges as possible, given the potential impact of the judiciary in challenging Trump administration policies. The Marshall Project, a non-profit news organisation, noted: “Federal judges restricted hundreds of Trump administration policies during his first term, and will likely play a significant role in determining the trajectory of his second.”Senate Republicans forced numerous procedural votes and late-night sessions this week in attempt to stall confirmations. Eventually a deal was struck that will bring Biden within striking distance of the 234 judicial confirmations that occurred in Trump’s first term – but four of Biden’s appellate court nominees will not be considered.The outgoing president could also engage with Democratic-led states and localities to bolster protections and establish “firewalls” against Trump’s agenda, particularly in areas such as immigration. These collaborations could involve reinforcing sanctuary city policies and providing resources to states that are likely to face pressure from the Trump administration.Chris Scott, former coalitions director for Harris, said: “What will be interesting is how or what can President Biden to work with states, especially where we have Democratic leadership in place, to be able to brace themselves and arm themselves with more protection. We already have places like a Michigan or Illinois where you have governors vowing to make sure that they have protections – even in the Trump presidency.”As Barack Obama discovered before handing Trump the keys to the Oval Office in 2017, however, lame duck presidents can only do so much. Trump will come into office with a flurry of executive orders, a supportive Congress and fewer guardrails than the first time around.Bill Galston, a former adviser in the Bill Clinton administration, said: “On January 20 Donald Trump will control all the instruments of government and, at that point, it’ll be up to the courts – and public opinion – to restrain him.” More