As election day nears, the Let's Find Common Ground podcast speaks with two members of Congress, one Republican and one Democrat, who are reaching across rigid partisan divides, recognizing the value of compromise and seeking constructive change.
People gather to watch the reopening ceremony of the Notre Dame Cathedral on Dec. 7.
We witnessed a marvel in Paris this weekend.
When a devastating 2019 fire nearly brought Notre Dame Cathedral to the ground, President Emanuel Macron set the ostensibly impossible goal of restoring and reopening the 860-year-old Gothic masterpiece within five years. Restorations on that scale usually take decades. It took almost 200 years to complete the cathedral in the first place, starting in 1163 during the Middle Ages.
Could Macron’s audacious challenge — made while the building was still smoldering — be met?
In the weeks following the disaster, more than 340,000 donors responded to Macron’s clarion call by contributing over $900 million in restoration funds. Under his direction, an extraordinarily talented leadership team led by Philippe Jost marshaled 250 companies and painstakingly coordinated a vastly complex endeavor. Thousands of workers who have dedicated their entire careers to restoration came out of the woodwork.
In addition to the financial resources, Macron’s appeal ignited a passion in these 2,000 workers, many meticulously trained artisans, to rise up to the challenge. As an indication of their level of devotion, the onslaught of the devastating Covid-19 pandemic (less than a year following the commencement of the restoration work) would only hinder but not foil their efforts.
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To avoid any doubt regarding just how miraculous this feat was, please read The New York Times’ wonderfully detailed profile of the overall effort as well as an illustration of the power of Notre Dame’s symbolism throughout the world. The Times described the effort to reconstruct the lattice-like roofing structure dubbed “the forest,” originally sourced from timber of 800-year-old trees:
“Each oak tree had been selected to match the contours of the ancient beam it would replace. The tree was then carved to duplicate the peculiarities of the hand-tooled silhouette of the original, with the medieval carpenter’s mark even tattooed back onto it. ‘Faithful’ only began to describe the effort, which was not for show. The public won’t get to see the rafters that are now behind the restored ceiling vaults.”
The history of cathedral is so rich that Victor Hugo advocated for its preservation and lauded its significance in France's cultural heritage in his famous novel “The Hunchback of Notre-Dame,” published almost 200 years ago. Under its now restored roof, Mary Queen of Scots was married, Joan of Arc beatified, Napoleon crowned and Charles de Gaulle celebrated. The cathedral has been so central to France that it serves as ground zero from which all distances in the nation are measured.
We must not fail to recognize the symbolism of this astonishing and successful venture. Notre Dame is not only among France’s most cherished institutions; it is arguably one of the greatest accomplishments of western civilization. What does its miraculous rebirth represent in a 21st century ravaged by war and destruction, where zeitgeist forces seem all too eager to demolish rather than preserve and reform our institutions? As the Times reports, “For a wider world, it underscores that calamities are surmountable, that some good and true things endure — that humanity may not yet have lost touch with its best self.”
During this same past weekend a different set of activities was proceeding on this side of the Atlantic. In Palm Beach, Florida, President-elect Donald Trump’s transition team has been busy mapping out its plans for the new administration. Trump is surrounded by both loyalty-hardened advisors and a fresh group of tech-wealthy oligarchs lining up to do his bidding. We now hand over leadership of American institutions to these latest stewards.
As I have frequently written about in this series, the leaders of many of our current institutions must be held accountable for their failures. The most effective institutions need to be respected, but can only be sustained through adaptation and modernization. As David Brooks wrote recently, “Over the course of our lives, we inherit institutions, steward them and try to pass them along in better shape to the next generation. We know our institutions have flaws and need reform, but we regard them as fundamentally legitimate.”
So what concerns me is the level of disdain that Trumpism in general seems to hold for these same institutions. At almost every turn, the MAGA minions have willingly attacked both their legitimacy and the kinds of people who work for them. In a Substack essay, Damon Linker writes: “Trumpism is seeking to advance a revolutionary transvaluation of values by inverting the morality that undergirds both traditional conservatism and liberal institutionalism. In this inversion, norms and rules that counsel and enforce propriety, restraint and deference to institutional authority become vices, while flouting them become virtues.”
Admittedly, many of our nation’s institutions are led today by an elite establishment positioned left of center that has failed millions of working class Americans over recent decades. But as opposed to endeavoring to increase their representation in the ranks of such institutions with an eye towards reform, politicians in Trump’s reinvented Republican Party have openly degraded and attacked their very legitimacy in recent years. Instead of constructive critique, they openly disparage mainstream media platforms, take control of the governing boards of state university systems and prohibit the teaching of disfavored ideas in public schools. Conservative media sources portray teachers, professors, scientists, journalists and civil servants as ideological enemies to be punished or ignored.
As they sit around the conference room tables at Mar-a-Lago, I imagine many on Trump’s transition team truly believe that tearing down is easier than reforming, preserving and rebuilding. I can only hope that they also watched the reopening of Notre Dame this weekend and heeded the important message illustrated — that the latter is indeed possible if the will is tenacious and paramount.
Radwell is the author of “American Schism: How the Two Enlightenments Hold the Secret to Healing our Nation” and serves on the Advisory Council at Business for America. This is the 15th entry in what was intended to be a 10-part series on the American schism in 2024.
Sen. Marco Rubio (left), President-elect Donald Trump's nominee to be the next secretary of state, meets with Sen. Lindsey Graham on Dec. 3, in advance of Senate confirmation hearings.
This fact brief was originally published by Wisconsin Watch. Read the original here. Fact briefs are published by newsrooms in the Gigafact network, and republished by The Fulcrum. Visit Gigafact to learn more.
The average time the U.S. Senate takes to approve nominees to a president’s administration is more than six months.
The nonprofit Center for Presidential Transition reported that as of Nov. 11, 2024, the average number of days has more than doubled under presidents elected since the 1980s:
Joe Biden: 192
Donald Trump: 160.5
Barack Obama: 153.3
George W. Bush: 108.2
Bill Clinton: 100.3
George H.W. Bush: 64.7
Ronald Reagan: 69.4
The nominees include more than 1,000 leadership positions, including Cabinet posts such as attorney general.
One reason for the six-month average: Any senator can “hold” a nominee’s confirmation, sometimes to extract something in return.
An August research paper concluded it is doubtful that reducing the number of positions needing confirmation would speed up confirmations.
Trump has said he wants the Senate to allow “recess appointments,” which wouldn’t require Senate confirmation, for his next administration.
The issue was raised Nov. 21 by U.S. Sen. Ron Johnson, R-Wis., who called for streamlining confirmations.
This fact brief is responsive to conversations such as this one
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Center for Presidential Transition: Senate Confirmations Slow to a Crawl
Bipartisan Policy Center: What’s the Hold Up on Senate Nominees?
University of Chicago Center for Effective Government: Democracy Reform Primer Series Reducing the Number of Senate-Confirmed Appointees
New York Times: Could Trump Install Gaetz Without Senate Approval? A Recess Appointment Primer
Cumulus News Talk: Donald Trump's Upcoming Confirmation Battles | The Vince Coglianese Show
Pharmacies are closing all across the United States.
Pharmacies in the United States are closing at an alarming rate. The ACT Pharmacy Collaborative, a partnership between community pharmacy networks and academia, reported that 244 pharmacies closed in just the first six weeks of 2024. Similarly, Rite-Aid has closed 500 stores, CVS will close another 300 stores by the end of the year and Walgreens will close 1,200 over the next three years.
In my home state of Oregon, pharmacists are constantly facing untenable scenarios. At a recent hearing, a pharmacist from a rural community testified how a woman from a neighboring town called his pharmacy late in the day needing to urgently fill a prescription. Unfortunately, the only pharmacy in her town had permanently closed, so she was stuck frantically attempting to locate someone who took their insurance and had the medication in stock. His pharmacy had the medication, so while she drove 28 miles on rural roads, the pharmacy stayed open — 30 minutes after closing because that’s what pharmacists do. We take care of patients.
Afterwards, when the patient had the medication in hand and was counseled on how to use it correctly, the pharmacist checked to see how much was made from the prescription. To his dismay, in the end, the pharmacy was reimbursed $23 below the drug’s acquisition price. His pharmacy lost money for taking care of a patient that evening.
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Now it might be easy to chalk this up as an isolated incident — an unfortunate anomaly or glitch in our health care system. However, instances like this happen on a regular basis and it has become commonplace to have a prescription reimbursed at an amount that is less than the cost to acquire and dispense the drug. Given the high cost of medications, this may come as a surprise. However, pharmacy benefit managers currently have an outsized influence on the financial health of many community pharmacies.
PBMs are middlemen — often invisible to the patient — that are located at the interface of drug manufacturers, payers and their employer-sponsors, and community pharmacies. They began over 50 years ago as a solution to help payers manage the complexity of prescription drug benefits. PBMs were highly efficient at claims processing, and they do play a role in helping payers process a high volume of relatively small claims. However, over time, the role of PBMs has evolved and expanded to where PBMs are now engaged in negotiating drug prices and determining which medications are covered by a plan’s formulary. They also operate their own pharmacies through closely affiliated partners. This gives PBMs considerable influence on how much pharmacies are paid, which drugs are covered and where patients can fill their prescriptions.
Simultaneously, over time, the PBM market has become highly concentrated. A report released by the Federal Trade Commission in July found that in 2023 the three largest PBMs companies processed approximately 80 percent of the prescriptions dispensed by U.S. pharmacies and that percentage rises to 90 percent if expanding to the six largest PBMs. All the major players are now vertically integrated with other parts of the health sector, often resulting in massive conglomerates where PBMs simultaneously play the role of plan, pharmacy and middleman. The FTC report highlights how PBMs impose “confusing, unfair, arbitrary, and harmful” contractual terms that influence the financial health of pharmacies.
PBMs have grown in such a way that it makes it nearly impossible for the average consumer — or even seasoned policy maker — to understand the problems and propose solutions. And when things are confusing, it is easy to become paralyzed and do nothing. However, in this case, doing nothing is simply not an option. Pharmacies are in crisis. The pharmacy from above has since closed, leaving another rural Oregon town with one less access point for patients.
Momentum for federal regulation that will bring more transparency and accountability to how PBMs influence the drug supply chain has built over the last few years. Multiple bills have come out of congressional committees with unanimous bipartisan support. The chairman of the Senate Finance Committee, Sen. Ron Wyden (D-Ore.), and high-ranking Republicans have expressed support for PBM reform. Congress has now returned to Washington, creating a final and crucial opportunity to pass PBM reform in 2024. It must be done.
To be sure, as a pharmacist, I care deeply about my profession. However, I care even more deeply about the patients that my profession serves. It saddens me that if PBM reform does not pass, then many more pharmacies will close, and more communities will lose pharmacy access. It saddens me that people residing in those communities might need to hold their breath, cross their fingers and hope they are not the patient needing a pharmacy to stay open past close as they drive those 28 miles.
Irwin is a clinical associate professor at Oregon State University’s College of Pharmacy and a public voices fellow with The OpEd Project. She is also a former president of the Oregon State Pharmacy Association.
President-election Donald Trump tapped Robert F. Kennedy Jr. to lead the Department of Health and Human Services.
The American voters bought a ticket to a second Trump administration, but the ride that will be the Department of Health and Human Services might just be a bit crazy, if not downright dangerous.
While President-elect Donald Trump did not seem to follow Project 2025’s recommendations for HHS, the American people should be no less afraid of how the second Trump administration might affect their health outcomes.
Back in August, I concluded that if the Trump administration followed the Heritage Foundation’s recommendations, the United States would likely have less healthy outcomes. I wrote: “Project 2025’s chapter on the Department of Health and Human Services does little to address the health challenges to Americans nor does it advance our collective well-being.”
There is a wide chasm between Project 2025’s vision for HHS and Trump’s nominee for secretary of that department. My prediction after reading Project 2025 last year does not even come close to the future that Americans may experience if Robert F. Kennedy Jr. is confirmed by the Senate.
The Heritage Foundation, which assembled Project 2025, is a conservative think tank and its proposals were predictably right of center. It had five goals for the next “conservative” president when it comes to health care leadership: Protecting Life, Conscience, and Bodily Integrity; Empowering Patient Choices and Provider Autonomy; Promoting Stable and Flourishing Married Families; Preparing for the Next Health Emergency; and Instituting Greater Transparency, Accountability, and Oversight.
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Almost a quarter of Project 2025's 54-page chapter on HHS prioritized an anti-abortion agenda as well as recommending traditional family values. Kennedy, Trump’s pick to head the department, has been married three times and favors abortion rights.
The mission of HHS is “to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.”
Going by this mission statement alone, Kennedy is wholly unqualified to run the department due to his long history of believing and spewing conspiracy theories when it comes to matters of health.
Here is a list of just a few of the health-related conspiracies that Kennedy has publicly endorsed:
While Kennedy is committed to combating the causes of chronic disease, childhood illnesses and obesity, which should be lauded, his “Make America Healthy Again” methods are questionable at best in their scientific foundations — and potentially dangerous to the health and safety of the American public.
One example is Kennedy's call to remove fluoride from tap water and increase access to raw milk. There are reasons that we added fluoride to our water in 1950 and why milk is pasteurized — reasons Kennedy doesn’t take into account.
Neil Maniar, director of Northeastern University’s Master of Public Health Program and professor of practice in public health, says fluoridation of water was “one of the greatest public health achievements of the 20th century.” Maniar says the introduction of fluoride into drinking water has reduced cavities by 25 percent.
The American Dental Association, the American Academy of Pediatrics and the Centers for Disease Control and Prevention continue to support water fluoridation. The AAP’s Campaign for Dental Health refutes Kennedy’s accusation that fluoride causes cancer and kidney disease, stating “there is no scientifically valid evidence” to support Kennedy’s claims that fluoride causes cancer and kidney disease.
Raw milk is unsafe to consume as it may contain harmful and dangerous bacteria, such as Campylobacter, salmonella, E. coli and listeria. The FDA and CDC have strongly advised against consuming it.
Of course, the president-elect has the full authority to nominate anyone he wishes to Cabinet posts but ultimately it will be up to the Senate to determine if Kennedy is confirmed as the HHS secretary.
The irony is that Trump has rejected most of Project 2025’s HHS proposals with his pick of Kennedy, but the choice of Kennedy as the top protector of Americans' health might be even worse.
Read the complete collection of Fulcrum articles on Project 2025.
Schmidt, a columnist and editorial board member with the St. Louis Post-Dispatch, holds a degree in nursing from the University of North Carolina at Greensboro.
