2025-12-12 21:30:00
在美国爱荷华州的一家农场里，三月大的猪站在猪舍中。| Daniel Acker/Bloomberg via Getty Images 大约十年前，美国实施了新规定，以限制肉类和乳制品生产中广泛使用抗生素，从而应对国家的抗生素耐药性危机。这些规定取得了一定成效：2015年至2017年间，用于农场的抗生素销售量下降了43%，此后趋于平稳。但如今，这种进展似乎正在倒退。根据美国食品药品监督管理局（FDA）最近发布的数据，2024年用于畜牧业的抗生素销售量同比激增了15.8%。这一突然的上升让跟踪该问题的科学家感到担忧。约翰霍普金斯大学布隆伯格公共卫生学院的兽医兼环境健康与工程副教授 Meghan Davis 在电子邮件中表示：“看到如此显著的增加令人失望，食品生产动物中的抗菌药物使用对人类健康至关重要。”
抗生素是现代医学的基石，用于治疗从链球菌咽喉炎到尿路感染再到大肠杆菌等常见细菌感染。据估计，自20世纪初以来，抗生素使人类平均寿命延长了20多年。然而，在美国和全球范围内，大多数抗生素并非用于人类医疗，而是被喂给农场动物，以预防和治疗在卫生条件差、过度拥挤的工厂化农场中频繁且迅速传播的疾病。肉类行业对抗生素的依赖，反过来又导致了对抗生素治疗产生耐药性的细菌的出现。当人们感染耐药细菌，也就是所谓的“超级细菌”时，某些抗生素的效果会减弱甚至完全失效，使得常见感染更难治疗。世界卫生组织将抗菌药物耐药性视为“全球公共卫生和发展的首要威胁之一”。据估计，2019年全球因抗菌药物耐药性导致的死亡人数约为127万，其中美国有3.5万例；每年美国还发生约280万例抗菌药物耐药性感染。
一段时间内，美国似乎在对抗耐药性问题上取得了进展。十年前，畜牧业甚至自愿承诺减少抗生素的使用。但如今，这一切似乎只是空谈，监管机构也几乎没有采取措施来遏制行业的过度使用。
只有两个合理的解释可以说明2024年畜牧业为何增加抗生素购买：要么他们饲养了更多的动物，要么他们必须应对比平时更多的疾病。但这两个因素都不足以解释2024年的显著增长。去年肉类产量仅增长了0.65%，而据我采访的几位专家表示，当年并没有特别严重的疾病爆发。美国卫生与公共服务部的一位发言人表示，2024年动物养殖业面临了多种健康挑战，包括禽流感和禽副流感病毒的传播。但抗菌药物专家、前堪萨斯州公共卫生兽医 Gail Hansen 表示，这些是病毒性疾病，而不是细菌感染，因此用抗生素治疗它们并不合理。美国国家鸡肉协会的一位发言人则表示，鸡肉农场抗生素使用量的增加可能是由于治疗禽副流感病毒引发的继发感染，但这一解释无法解释整个肉类行业抗生素销售量的总体上升，因为鸡肉行业仅占一小部分。Hansen 猜测，肉类生产商“没有妥善使用抗生素”，他们可能是在预防疾病而非治疗疾病时使用抗生素。她称这是“一个疯狂的概念”，但却是肉类行业中的常见做法。
Hansen 并非唯一感到沮丧的人；公共卫生专家长期以来认为，将抗生素用于健康动物以预防疾病，而不是在动物生病时治疗，是一种危险的滥用行为，因为这增加了农场细菌产生耐药性的可能性，从而降低抗生素在人类医疗中的效果。美国国家奶业联合会的首席科学官 Jamie Jonker 在电子邮件中表示，他无法评论牛肉生产中抗生素使用量的增加，因为 FDA 并未将牛肉和乳牛的抗生素销售数据分开。他提到：“美国乳牛业中大部分抗生素使用是为了治疗乳腺炎，而用于治疗这些疾病的抗生素使用量从2023年到2024年下降了11.5%。”与此同时，美国国家养牛协会在声明中表示，抗生素的使用决策是由农民和牧场主与兽医协商后做出的，由于这些决策涉及具体因素，无法对整个行业进行概括。美国国家猪肉生产者委员会则未对相关问题作出回应。
美国的肉类和乳制品生产商并不需要大量使用抗生素来控制疾病传播。欧洲就是一个例证：几年前，欧洲每头动物的抗生素使用量大约是美国的一半。欧洲生产商通过采用更负责任的方法来预防疾病，如更频繁和彻底地清洁猪舍、改善通风、给动物更多空间以及使用更多疫苗，成功减少了对抗生素的依赖。在美国，抗生素被广泛用于规避这些成本和额外劳动力。非营利组织“食品动物关注信托”（Food Animal Concerns Trust）的 Steven Roach 在电子邮件中表示：“用抗生素来弥补不健康的养殖条件比在健康条件下饲养动物更便宜。”
在过去15年中，随着公众对耐药性危害的关注增加，数十家美国大型畜牧业公司、快餐连锁店和超市承诺减少养殖动物中的抗生素使用。但这种关注已经减弱，食品行业自2017年以来未能减少抗生素的使用量。甚至有证据表明，他们可能在误导公众。去年，美国农业部向数十家牛肉生产商——包括全球最大的几家，如JBS、Tyson和Cargill——发出警告，指出他们所宣传的“无抗生素”或“未使用抗生素”牛肉中仍含有抗生素残留。该机构检测的牛肉样本中有20%含有抗生素残留。非营利组织“Farm Forward”的执行主任 Andrew deCoriolis 在今年年初告诉Sentient：“这强烈表明，美国的无抗生素牛肉供应严重受到污染，并且对美国消费者构成了欺骗。”
Hansen 和其他专家希望 FDA 能采取更多措施限制不必要的抗生素使用，包括设定全国范围内的抗生素使用量减少目标、禁止肉类生产商预防性使用抗生素（欧洲已于2022年采取了这一措施），并设定更严格的抗生素使用时长限制。如果没有这些基本措施，FDA 实际上是在赌这些“奇迹药物”未来的有效性，以让肉类和乳制品行业略微增加利润。
Around a decade ago, the US implemented new rules to limit the widespread use of antibiotics in meat and dairy production, in an effort to combat the nation’s antibiotic resistance crisis. The regulations helped: Antibiotic sales for use on farms plunged by 43 percent from 2015 to 2017, and plateaued thereafter.
But now, that progress appears to be backsliding. According to recently published data from the Food and Drug Administration, sales of antibiotics for use in livestock surged by an alarming 15.8 percent in 2024 from the previous year.
The sudden increase worries the scientists I spoke with who track the issue.
“It’s disappointing to see such a substantial increase,” Meghan Davis, a veterinarian and associate professor of environmental health and engineering at the Johns Hopkins Bloomberg School of Public Health, told me over email. “Antimicrobial use in food-producing animals matters for human health.”
Antibiotics are a bedrock of modern medicine, used to treat common bacterial infections from strep throat to urinary tract infections to E.coli, and they’re a major reason why common infections are generally no longer extremely dangerous in the modern world. According to one estimate, antibiotics have increased average human life expectancy by over 20 years since the early 20th century.
Sign up here to explore the big, complicated problems the world faces and the most efficient ways to solve them. Sent twice a week.
But in the US and around the globe, most antibiotics aren’t used in human medicine, and instead are fed to farmed animals as a means to prevent and treat illness in unhygienic, overcrowded factory farms where disease is prevalent and spreads quickly.
The meat industry’s dependence on antibiotics has, in turn, contributed to the rise of bacteria that are resistant to antibiotic treatment. When someone becomes infected with antibiotic-resistant bacteria, also known as “superbugs,” certain antibiotics are less effective — or entirely ineffective — making common infections harder to treat.
The World Health Organization considers antimicrobial resistance to be “one of the top global public health and development threats.” In 2019, it was responsible for an estimated 1.27 million deaths globally, with 35,000 of them in the US — and 2.8 million antimicrobial-resistant infections occur in the US each year.
For a time, the US demonstrated it could make progress on the antibiotic resistance problem. Ten years ago, the livestock industry was even voluntarily pledging to reduce antibiotic use. But now that all appears to have been lip service — and regulators are doing little to rein in the industry’s overuse.
There are only two legitimate reasons why livestock producers might have ramped up their antibiotic purchases in 2024: either they raised a lot more animals or they had to fight off a lot more diseases than usual.
But neither explanation makes sense for 2024. Meat production grew by just 0.65 percent last year, and according to several experts I spoke with, there weren’t especially notable disease outbreaks that would explain the sharp increase.
A spokesperson for the US Department of Health and Human Services told me that “animal sectors experienced several health challenges in 2024,” pointing to the spread of the avian metapneumovirus in poultry birds and avian influenza, or bird flu, in poultry birds and dairy cattle. But Gail Hansen, an antimicrobial expert and former state public health veterinarian in Kansas, told me that these are viral infections, not bacterial, so using antibiotics to treat them does not make sense.
A spokesperson for the National Chicken Council said over email that the increase in antibiotic use on chicken farms is likely due to treating secondary infections from avian metapneumovirus, though that doesn’t explain the overall increase of antibiotic sales in the meat industry, because the chicken sector uses a small share.
Hansen’s guess as to what’s going on: Meat producers are “not being good stewards of antibiotics,” she said, and are likely using them to prevent, rather than treat, disease. It’s a “crazy concept,” she said, but it’s common practice in the meat industry.
Hansen’s not alone in her frustration; public health experts have long argued that feeding antibiotics to healthy animals as a way to prevent disease — as opposed to treating animals when they’re actually sick — is a dangerous misuse of the drugs because it increases the chance that bacteria on farms develop resistance, which then makes them less effective when treating humans.
Over email, the chief science officer of the National Milk Producers Federation, Jamie Jonker, said he can’t comment on the increase in antibiotics in cattle production because the FDA does not separate antibiotic sales for beef vs. dairy cattle, and that “the majority of antibiotic use in dairy is for intramammary infections, i.e. mastitis, and the use of antibiotics that treat those conditions declined 11.5% from 2023 to 2024.”
The National Cattlemen’s Beef Association, meanwhile, said in a statement that decisions about antibiotic use “are made by individual farmers and ranchers in consultation with their veterinarians. Because of those unique factors, we can’t generalize across the entire industry.”
The National Pork Producers Council did not respond to a request for comment.
US meat and dairy producers don’t actually need to use tons of antibiotics to manage disease spread. Europe is proof: As of a few years ago, antibiotic use per animal there was about half that of the US. European producers have managed to slash their reliance on antibiotics by using other, more responsible means to prevent disease, including more frequently and thoroughly cleaning barns, increasing ventilation, giving animals more space, and using more vaccines.
In the US, antibiotics are heavily used as a shortcut to avoid these costs and additional labor. “It is cheaper to compensate for unhealthy conditions with antibiotics than to raise animals under healthy conditions,” Steven Roach of the nonprofit Food Animal Concerns Trust told me over email.
Over the last 15 years, as public attention to the harms of antibiotic resistance grew, dozens of large US livestock companies, fast food chains, and supermarkets pledged to cut back on antibiotic use in farmed animals. But that attention has since faded, and the food industry has failed to decrease antibiotic use since 2017. There’s even evidence that they may be deceiving the public on the issue.
Last year, the US Department of Agriculture sent letters to dozens of beef producers — including some of the world’s largest, like JBS, Tyson, and Cargill — warning that the beef they were marketing as “antiobiotic-free,” “raised without antibiotics,” or bearing similar claims, contained traces of antibiotics. Twenty percent of beef samples tested by the agency were positive for antibiotic residues.
“This strongly suggests that the US antibiotic-free beef supply is deeply contaminated and deeply deceptive to American consumers,” Andrew deCoriolis, the executive director of the nonprofit Farm Forward, told Sentient earlier this year.
Hansen and other experts I spoke with want to see the FDA take more action to restrict unnecessary use, including setting concrete goals for national reductions in antibiotic use on farms, barring meat producers from using antibiotics preventively (something Europe did in 2022), and set more limits on the maximum duration of antibiotic use.
Without these basic steps, the FDA is essentially gambling the future effectiveness of these miracle drugs to let the meat and dairy industries marginally increase their profits.
2025-12-12 20:30:00
如果你是人，那么你很可能参与过涉及人类受试者的科研。也许你参加过临床试验、完成过关于自己健康习惯的调查，或者在大学时为了20美元参与了研究生的实验。也有可能你作为学生或专业人士自己进行过相关研究。以下是关键要点：
正如其名称所暗示的，人类受试者研究（HSR）是指对人类受试者进行的研究。联邦法规将其定义为涉及活体人类受试者的研究，要求与受试者互动以获取信息或生物样本。它还包括“获取、使用、研究、分析或生成”可能用于识别受试者的信息或生物样本。HSR主要分为两大类：社会行为教育类和生物医学类。
如果你想要进行人类受试者研究，就必须获得机构审查委员会（IRB）的批准。IRB是研究伦理委员会，旨在保护人类受试者，任何进行联邦资助研究的机构都必须设立IRB。
我们过去并不总是有对人类受试者的保护。20世纪充满了可怕的科研滥用事件。1972年对塔斯基吉梅毒研究的解密引发了公众的强烈抗议，这在一定程度上促成了1979年《贝尔蒙报告》的发表，该报告确立了指导HSR的几个伦理原则：尊重人的自主权、尽量减少潜在伤害并最大化益处，以及公平分配研究的风险和收益。这成为联邦人类受试者保护政策的基础，即《共同规则》，它规范了IRB的运作。
如今已经不是1979年了，而人工智能正在改变人类受试者研究的方式，但我们的伦理和监管框架却未能跟上。认证的IRB专业人士兼HSR保护与AI治理专家Tamiko Eto正在努力改变这一现状。她创立了TechInHSR，一家支持IRB审查涉及AI研究的咨询公司。我最近与Eto交谈，探讨了人工智能如何改变了研究领域，以及使用AI在HSR中的最大好处和风险。
以下是我们的对话内容（已略作删减和润色）：
你拥有超过二十年的人类受试者研究保护经验。人工智能的广泛采用如何改变了这一领域？
人工智能实际上彻底颠覆了传统的研究模式。我们过去是通过研究个体来了解整个人群的情况，但现在人工智能从整个人群的数据中提取巨大模式，并据此对个体做出决策。这种转变暴露出我们在IRB领域中的不足，因为我们的工作很大程度上依赖于《贝尔蒙报告》。该报告几乎半个世纪前就写成，当时并未考虑我所说的“人类数据主体”。它关注的是实际的物理个体，而不是他们的数据。人工智能则更多关注人类数据主体，他们的信息被输入到这些AI系统中，很多时候他们并不知情。因此，我们现在面临的是一个世界，即大量个人数据被多个公司反复收集和再利用，往往未经同意，也缺乏适当的监管。
你能举一个涉及人工智能的人类受试者研究的例子吗？
在社会行为教育研究领域，我们会利用学生层面的数据来识别改进或增强教学和学习的方法。在医疗保健领域，我们使用医疗记录来训练模型，以预测某些疾病或状况。随着人工智能的发展，我们对可识别数据和可再识别数据的理解也发生了变化。因此，现在人们可以声称这些数据是去标识化的，而无需任何监管，这基于我们过时的可识别性定义。
这些定义是从哪里来的？
医疗保健领域的定义基于《健康保险流通与责任法案》（HIPAA）。然而，该法律并不是基于我们当前对数据的看法，尤其是人工智能时代。本质上，它认为只要移除数据中的某些部分，个体就无法被合理地重新识别——但我们现在已经知道这并不成立。
人工智能在研究过程中有哪些可以改进的地方？大多数人可能并不清楚为什么需要IRB保护。
人工智能确实有潜力改善医疗保健、患者护理和研究本身，前提是它被负责任地构建。我们知道，当这些工具被负责任地设计时，它们可以帮助我们更早发现问题，例如通过影像和诊断技术检测败血症或某些癌症的迹象，因为我们可以将这些结果与专家临床判断进行比较。然而，在我的领域中，我发现这些工具通常设计得并不好，而且它们的持续使用计划也未经过深思熟虑。这确实会造成伤害。
我一直在思考如何利用人工智能来提升我们的工作效率。人工智能可以帮助我们处理大量数据，减少重复性任务，从而提高我们的生产力和效率。只要我们负责任地使用它，它确实可以在我们的工作流程中发挥一些作用。它可以加快研究的实际进程，例如帮助我们提交IRB申请。IRB成员可以利用它来审查和分析某些层面的风险和警示信号，并指导我们如何与研究团队沟通。
人工智能展现出巨大潜力，但再次强调，这完全取决于我们是否负责任地构建和使用它。
你认为人工智能在人类受试者研究中带来最大的短期风险是什么？
短期风险包括我们已经知道的一些问题，例如“黑箱决策”，即我们不知道人工智能是如何得出这些结论的，这使得我们难以做出知情决策。即使人工智能在理解其决策过程方面有所改进，我们当前面临的问题是数据收集过程本身的伦理问题。我们是否有授权？我们是否有许可？我们是否有权获取并利用这些数据，甚至将其商品化？我认为这引出了另一个风险，即隐私问题。其他国家可能在这方面做得比我们好，但在美国，我们缺乏很多隐私权利或数据所有权。我们无法决定我们的数据是否被收集、如何被收集、如何被使用以及与谁共享——这在美国公民目前并不具备的权利。
所有数据都是可识别的，因此这增加了对使用我们数据的人的风险，使整个过程变得不安全。有研究表明，即使没有面部、姓名或其他信息，仅凭一个人的MRI扫描，也有可能重新识别出该人。我们还可以通过Fitbit或Apple Watch上的步数，根据他们的位置来识别个人。我认为目前最大的问题之一是所谓的“数字孪生”。它基本上是基于你数据的详细数字版本。这可能包括从不同来源收集的大量关于你的信息，如你的医疗记录和生物识别数据。社交媒体、你的移动模式（如果从Apple Watch中获取）、在线行为（如聊天记录、LinkedIn资料、语音样本、写作风格等）都可能被用来构建你的数字孪生。AI系统收集了所有这些行为数据，然后创建一个与你相似的模型，以便进行一些有益的操作。它可以预测你对药物的反应。但同样，它也可能带来一些负面影响，例如模仿你的声音或在未经你同意的情况下进行操作。这种数字孪生是你未授权创建的，它在技术上代表了你，但你却无法拥有它。这在隐私领域尚未得到充分解决，因为人们往往以“如果用于改善健康，那就是正当使用”为借口。
那么，长期风险又是什么呢？
我们现在很难应对长期风险。IRB通常被禁止考虑长期影响或社会风险。我们只关注个体及其影响。但在人工智能的世界中，最重要的危害将出现在社会层面，例如歧视、不平等、数据的不当使用等。
你认为如果有人恶意使用这些数据，是否可能针对特定人群？
当然可能。由于我们缺乏完善的隐私法律，这些数据大多处于无监管状态，可能会被恶意行为者获取，甚至被出售给他们，从而对人们造成伤害。
IRB专业人士如何才能更好地了解人工智能？
我们需要认识到，人工智能素养不仅仅是理解技术。我认为，仅仅了解它如何运作并不足以成为素养，而是要明白我们需要提出哪些问题。我曾提出一个三阶段框架，用于帮助IRB更好地评估人工智能研究在不同发展阶段所面临的风险，并理解这是一个循环过程，而非线性过程。这为IRB提供了一种不同的视角来审视研究阶段并进行评估。因此，如果我们能够建立这种理解，就可以审查这些循环项目，只要我们稍微调整一下我们习惯的做法。
随着人工智能幻觉率的下降和隐私问题的解决，你认为更多人会接受人工智能在人类受试者研究中的应用吗？
有一种被称为“自动化偏见”的概念，即我们倾向于信任计算机的输出。这不仅限于人工智能，而是对任何计算工具都存在这种倾向。现在，由于我们与这些技术建立了关系，我们仍然信任它们。同时，我们生活节奏很快，希望快速完成任务，尤其是在临床环境中。临床医生没有太多时间去验证人工智能的输出是否正确。我认为IRB人员也是如此。如果我的上司告诉我“你每天必须完成X项任务”，而人工智能能加快这个过程，那么我的工作可能会受到威胁，从而更有可能接受人工智能的输出而不去验证其准确性。理想情况下，幻觉率会下降，但关键在于数据来源是否符合伦理标准，是否能惠及所有人，并且对数据的收集和使用有明确限制。我认为这将伴随着法律、法规和透明度的出现，但更重要的是，这将来自临床医生。那些开发这些工具的公司正在游说，希望在出现问题时，他们不承担任何责任或法律责任，而是将责任转嫁给最终用户，即临床医生或患者。如果我是临床医生，而且知道我需要对人工智能的错误负责，我可能不会接受它，因为我不希望承担这种责任。我会对它保持一定的谨慎态度。
请描述最坏的情况，我们该如何避免？
我认为一切都要从研究阶段开始。人工智能最坏的情况是，它会影响我们个人生活的决策：我们的工作、我们的医疗保健、是否能获得贷款或住房。目前，所有系统都是基于有偏见的数据建立的，而且几乎没有监管。IRB主要负责联邦资助的研究，但因为这些人工智能研究使用了未经同意的人类数据，IRB通常会给予豁免或根本不会审查。因此，这些保护措施将被绕过。同时，人们会如此信任这些系统，以至于不再质疑其输出。我们依赖于自己并不完全理解的工具，这将进一步将不平等嵌入到我们日常的系统中。人们通常信任研究，他们不会质疑由此产生的工具，这些工具最终会被部署到现实世界中。这将持续加剧不平等、不公正和歧视，从而伤害代表性不足的人群以及那些在这些发展过程中数据未占多数的人。
If you’re a human, there’s a very good chance you’ve been involved in human subjects research.
Maybe you’ve participated in a clinical trial, completed a survey about your health habits, or took part in a graduate student’s experiment for $20 when you were in college. Or maybe you’ve conducted research yourself as a student or professional.
As the name suggests, human subjects research (HSR) is research on human subjects. Federal regulations define it as research involving a living person that requires interacting with them to obtain information or biological samples. It also encompasses research that “obtains, uses, studies, analyzes, or generates” private information or biospecimens that could be used to identify the subject. It falls into two major buckets: social-behavioral-educational and biomedical.
If you want to conduct human subjects research, you have to seek Institutional Review Board (IRB) approval. IRBs are research ethics committees designed to protect human subjects, and any institution conducting federally funded research must have them.
We didn’t always have protection for human subjects in research. The 20th century was rife with horrific research abuses. Public backlash to the declassification of the Tuskegee Syphilis Study in 1972, in part, led to the publication of the Belmont Report in 1979, which established a few ethical principles to govern HSR: respect for people’s autonomy, minimizing potential harms and maximizing benefits, and distributing the risks and rewards of the research fairly. This became the foundation for the federal policy for human subjects protection, known as the Common Rule, which regulates IRBs.
It’s not 1979 anymore. And now AI is changing the way people conduct research on humans, but our ethical and regulatory frameworks have not kept up.
Tamiko Eto, a certified IRB professional (CIP) and expert in the field of HSR protection and AI governance, is working to change that. Eto founded TechInHSR, a consultancy that supports IRBs reviewing research involving AI. I recently spoke with Eto about how AI has changed the game and the biggest benefits — and greatest risks — of using AI in HSR. Our conversation below has been lightly edited for length and clarity.
You have over two decades of experience in human subjects research protection. How has the widespread adoption of AI changed the field?
AI has actually flipped the old research model on its head entirely. We used to study individual people to learn something about the general population. But now AI is pulling huge patterns from population-level data and using that to make decisions about an individual. That shift is exposing the gaps that we have in our IRB world, because what drives a lot of what we do is called the Belmont Report.
That was written almost half a century ago, and that was not really thinking about what I would term “human data subjects.” It was thinking about actual physical beings and not necessarily their data. AI is more about human data subjects; it’s their information that’s getting pulled into these AI systems, often without their knowledge. And so now what we have is this world where massive amounts of personal data are collected and reused over and over by multiple companies, often without consent and almost always without proper oversight.
Could you give me an example of human subjects research that heavily involves AI?
In areas like social-behavioral-education research, we’re going to see things where people are training on student-level data to identify ways to improve or enhance teaching or learning.
In health care, we use medical records to train models to identify possible ways that we can predict certain diseases or conditions. The way we understand identifiable data and re-identifiable data has also changed with AI.
So right now, people can use that data without any oversight, claiming it’s de-identified because of our old, outdated definitions of identifiability.
Where are those definitions from?
Health care definitions are based on HIPAA.
The law wasn’t shaped around the way that we look at data now, especially in the world of AI. Essentially it’s saying that if you remove certain parts of that data, then that individual might not reasonably be re-identified — which we know now is not true.
What’s something that AI can improve in the research process — most people aren’t necessarily familiar with why IRB protections exist. What’s the argument for using AI?
So AI does have real potential in improving health care, patient care and research in general — if we build it responsibly. We do know that when built responsibly, these well-designed tools can actually help catch problems earlier, like detecting sepsis or spotting signs of certain cancers with imaging and diagnostics because we’re able to compare that outcome to what expert clinicians would do.
Though I’m seeing in my field that not a lot of these tools are designed well and nor is the plan for their continued use really thought through. And that does cause harm.
I’ve been focusing on how we leverage AI to improve our operations: AI is helping us handle large amounts of data and reduce repetitive tasks that make us less productive and less efficient. So it does have some capabilities to help us in our workflows so long as we use it responsibly.
It can speed up the actual process of research in terms of submitting an [IRB] application for us. IRB members can use it to review and analyze certain levels of risk and red flags and guide how we communicate with the research team. AI has shown to have a lot of potential but again it entirely depends on if we build it and use it responsibly.
What do you see as the greatest near-term risks posed by using AI in human subjects research?
The immediate risks are things that we know already: Like these black box decisions where we don’t actually know how the AI is making these conclusions, so that is going to make it very difficult for us to make informed decisions on how it’s used.
Even if AI improved in terms of being able to understand it a little bit more, the issue that we’re facing now is the ethical process of collecting that data in the first place. Did we have authorization? Do we have permission? Is it rightfully ours to take and even commodify?
So I think that leads into the other risk, which is privacy. Other countries may be a little bit better at it than we are, but here in the US, we don’t have a lot of privacy rights or self data ownership. We’re not able to say if our data gets collected, how it gets collected, and how it’s going to be used and then who it’s going to be shared with — that essentially is not a right that US citizens have right now.
Everything is identifiable, so that increases the risk that it poses to the people whose data we use, making it essentially not safe. There’s studies out there that say that we can reidentify somebody just by their MRI scan even though we don’t have a face, we don’t have names, we don’t have anything else, but we can reidentify them through certain patterns. We can identify people through their step counts on their Fitbits or Apple Watches depending on their locations.
I think maybe the biggest thing that’s coming up these days is what’s called a digital twin. It’s basically a detailed digital version of you built from your data. So that could be a lot of information that’s grabbed about you from different sources like your medical records and biometric data that may be out there. Social media, movement patterns if they’re capturing it from your Apple Watch, online behavior from your chats, LinkedIn, voice samples, writing styles. The AI system then gathers all your behavioral data and then creates a model that is duplicative of you so that it can do some really good things. It can predict what you’ll do in terms of responding to medications.
But it can also do some bad things. It can mimic your voice or it can do things without your permission. There is this digital twin out there that you did not authorize to have created. It’s technically you, but you have no right to your digital twin. That’s something that’s not been addressed in the privacy world as well as it should be, because it’s going under the guise of “if we’re using it to help improve health, then it’s justified use.”
What about some of the long-term risks?
We don’t really have a lot we can do now. IRBs are technically prohibited from considering long-term impact or societal risks. We’re only thinking about that individual and the impact on that individual. But in the world of AI, the harms that matter the most are going to be discrimination, inequity, the misuse of data, and all of that stuff that happens at a societal scale.
“If I was a clinician and I knew that I was liable for any of the mistakes that were made by the AI, I wouldn’t embrace it because I wouldn’t want to be liable if it made that mistake.”
Then I think the other risk we were talking about is the quality of the data. The IRB has to follow this principle of justice, which means that the research benefits and harm should be equally distributed across the population. But what’s happening is that these usually marginalized groups end up having their data used to train these tools, usually without consent, and then they disproportionately suffer when the tools are inaccurate and biased against them.
So they’re not getting any of the benefits of the tools that get refined and actually put out there, but they’re responsible for the costs of it all.
Could someone who was a bad actor take this data and use it to potentially target people?
Absolutely. We don’t have adequate privacy laws, so it’s largely unregulated and it gets shared with people who can be bad actors or even sell it to bad actors, and that could harm people.
How can IRB professionals become more AI literate?
One thing that we have to realize is that AI literacy is not just about understanding technology. I don’t think just understanding how it works is going to make us literate so much as knowing what questions we need to ask.
I have some work out there as well with this three-stage framework for IRB review of AI research that I created. It was to help IRBs better assess what risks happen at certain development time points and then understand that it’s cyclical and not linear. It’s a different way for IRBs to look at research phases and evaluate that. So building that kind of understanding, we can review cyclical projects so long as we slightly shift what we’re used to doing.
As AI hallucination rates decrease and privacy concerns are addressed, do you think more people will embrace AI in human subjects research?
There’s this concept of automation bias, where we have this tendency to just trust the output of a computer. It doesn’t have to be AI, but we tend to trust any computational tool and not really second guess it. And now with AI, because we have developed these relationships with these technologies, we still trust it.
And then also we’re fast-paced. We want to get through things quickly and we want to do something quickly, especially in the clinic. Clinicians don’t have a lot of time and so they’re not going to have time to double-check if the AI output was correct.
I think it’s the same for an IRB person. If I was pressured by my boss saying “you have to get X amount done every day,” and if AI makes that faster and my job’s on the line, then it’s more likely that I’m going to feel that pressure to just accept the output and not double-check it.
And ideally the rate of hallucinations is going to go down, right?
What do we mean when we say AI improves? In my mind, an AI model only becomes less biased or less hallucinatory when it gets more data from groups that it previously ignored or it wasn’t normally trained on. So we need to get more data to make it perform better.
So if companies are like, “Okay, let’s just get more data,” then that means that more than likely they’re going to get this data without consent. It’s just going to scrape it from places where people never expected — which they never agreed to.
I don’t think that that’s progress. I don’t think that’s saying the AI improved, it’s just further exploitation. Improvement requires this ethical data sourcing permission that has to benefit everybody and has limits on how our data is collected and used. I think that that’s going to come with laws, regulations and transparency but more than that, I think this is going to come from clinicians.
Companies who are creating these tools are lobbying so that if anything goes wrong, they’re not going to be accountable or liable. They’re going to put all of the liability onto the end user, meaning the clinician or the patient.
If I was a clinician and I knew that I was liable for any of the mistakes that were made by the AI, I wouldn’t embrace it because I wouldn’t want to be liable if it made that mistake. I would always be a little bit cautious about that.
Walk me through the worst-case scenario. How can we avoid that?
I think it all starts in the research phase. The worst case scenario for AI is that it shapes the decisions that are made about our personal lives: Our jobs, our health care, if we get a loan, if we get a house. Right now, everything has been built based on biased data and largely with no oversight.
The IRBs are there for primarily federally funded research. But because this AI research is done with unconsented human data, IRBs usually just give waivers or it doesn’t even go through an IRB. It’s going to slip past all these protections that we would normally have built in for human subjects.
At the same time, people are going to be trusting these systems so much they’re just going to stop questioning its output. We’re relying on tools that we don’t fully understand. We’re just further embedding these inequities into our everyday systems starting in that research phase. And people trust research for the most part. They’re not going to question the tools that come out of it and end up getting deployed into real-world environments. It’s just consistently feeding into continued inequity, injustice, and discrimination and that’s going to harm underrepresented populations and whoever’s data wasn’t the majority at the time of those developments.
2025-12-12 19:45:00
2025年12月9日，特朗普在宾夕法尼亚州的Mount Pocono发表讲话，阐述其政府的经济议程及降低生活成本的努力。| Alex Wong/Getty Images
特朗普的第二个任期开局强劲：凭借2024年获得的大量多族裔和中产阶级选民的支持，他积极推行对律所和大学的施压政策，频繁发布行政命令和DOGE重组措施。当时，由共和党控制的国会正准备实施他的政策，包括大规模驱逐和关税措施。然而，如果快进到今天，情况却截然不同。无论是他对经济的管理，还是大规模驱逐政策，每一天似乎都在揭示特朗普2024年的联盟正在瓦解。与此同时，特朗普在社交媒体和评论界的主要支持者们要么彼此争斗，要么对他的表现感到不满。选民们也持续表达对共和党的愤怒，从新泽西到田纳西的选举中都可见一斑。换句话说，特朗普的2024联盟正在松散。但问题在于，究竟是什么原因导致了这一变化？
在报道中，我发现了三种主要的解释理论。第一种是“低参与度选民理论”，认为特朗普支持率的下降主要是因为他赢得了大量反政治的选民，而这些选民本身对政治参与度较低。第二种是“经济负担选民理论”，认为特朗普在那些最重视经济负担和生活成本的选民中失去了支持。第三种是“新加入者理论”，认为有一部分共和党选民虽然本身较为年轻、更具进步倾向，但仍然在2024年投了特朗普一票。
虽然这三种解释并非互斥，但共和党人需要确定哪一种最能解释他们当前的政治困境。如果他们认为问题出在低参与度选民身上，可能会尝试改变媒体策略或竞选信息，减少关税，或吸引更多受过高等教育的选民。如果他们认为问题出在“新加入者”身上，可能会更积极地参与关于右翼未来的网络讨论，或调整一些社会立场。
当然，民主党战略家们也会有自己的结论。双方的结论将对未来几年的美国政治产生重大影响。
低参与度选民理论
Patrick Ruffini是Echelon Insights的联合创始人，也是长期的共和党民调专家和策略师，他撰写的《Party of the People》（2023年）对2024年大选的预测非常准确。他指出，特朗普支持率的下降并非由于联盟破裂，而是因为那些低参与度、低信息量的选民，他们对政治不太关注，也不太关心当前的“丑闻”，只是偶尔听到或感受到特朗普政府的影响。这些选民过去更多支持民主党，但现在却成为特朗普选民中的一部分，因此任何选民的波动都会显得更加明显。
经济负担选民理论
然而，Jain指出，这些波动并非毫无根据。经济问题才是关键。他提出第二种理论，即特朗普在那些最重视经济负担的选民中失去了支持。在最近的民调中，他发现民主党正在获得非白人、年龄低于45岁以及非大学教育背景选民的支持，而特朗普则在失去这些群体的支持。这使得2026年的“蓝色浪潮”看起来像是2018年蓝色浪潮的反面，当时民主党在白人、年长和受过高等教育的选民中获得巨大支持。这些变化背后的核心因素是“生活成本”问题。在最新的Argument民调中，60%的受访者将生活成本列为他们最关心的两个问题之一。Jain表示，这表明选民对特朗普处理经济问题的方式非常不满。他估计，这些将生活成本列为首要问题的选民，去年对特朗普的支持率比现在高出6个百分点，而如今却比他低了13个百分点，这种波动比其他任何群体都大。民调显示，共和党人本身对经济状况越来越不满，对特朗普在其中扮演的角色也存在分歧。关注当前事件的选民普遍对不断上涨的食品、住房、公用事业和医疗费用感到不满，这也解释了过去几个月拉丁裔和年轻选民的大幅波动。许多这些选民在2024年支持特朗普，因为他们相信他能改善他们的经济状况，但现在他们发现特朗普并未兑现承诺，因此转向民主党。
“新加入者”理论
第三种理论来自保守派智库曼哈顿研究所对共和党选民的最新研究。该研究指出，2024年的联盟并不稳固，就像民主党在奥巴马时代之后发现的那样，联盟中的某些部分正在发生变化。他们将特朗普的选民分为两部分：三分之二属于“核心共和党”群体，即一贯保守的共和党选民，他们支持传统的MAGA和保守政治理念。而剩下的约30%则是“新加入者”，他们的政治观点与MAGA主导的共和党主流存在冲突。这些“新加入者”更年轻、种族更多样，且在过去更倾向于支持民主党候选人。他们对特朗普的关税政策持反对态度，也更愿意相信有关以色列和犹太人的阴谋论，更可能为政治暴力辩护。他们更可能支持提高税收和堕胎权，而反对废除DEI机构或削减福利国家。这些“新加入者”也属于低参与度、低信息量的选民，关注经济负担，且更可能属于黑人或拉丁裔群体，是新加入共和党的选民。
对于未来政治格局而言，这一群体尤为关键。Arm指出，与“核心共和党”相比，这些“新加入者”更可能在未来不支持其他共和党候选人。调查显示，70%的“核心共和党”选民表示他们“肯定会”在2026年支持共和党候选人，而“新加入者”中只有56%表示会这样做。这表明，特朗普及其政党必须维持一个稳固的联盟，否则可能会失去这些关键群体的支持。当然，前提是低参与度选民不会完全退出政治舞台。首先，特朗普必须承认选民的不满，并不再为他领导下的经济状况打高分。这可能是共和党战略家们必须首先克服的障碍。
The second Trump administration started off with a bang: riding the high of 2024’s historic levels of new multiracial and working class support, bullying law firms and universities, flinging out executive orders and DOGE restructurings like nobody’s business. A Republican-controlled Congress was ready to implement President Donald Trump’s agenda, and his deportation and tariff policies were about to roll out.
If you fast-forward to today, however, the vibes are very different.
Whether it concerns his management of the economy or his program of mass deportation, each day seems to bring more evidence that Trump’s 2024 coalition is disintegrating. Meanwhile, Trump’s biggest supporters in the online influencer space and commentariat are either at war with each other or less than thrilled about him. Voters, for their part, have consistently registered their anger at the GOP, in elections from New Jersey to Tennessee.
It’s clear, in other words, that Trump’s 2024 coalition is fraying. What is less clear is exactly why. What I found in my reporting, though, suggests that while the ultimate answer may still be beyond our reach, there are three broad theories that have taken hold among pollsters, politicos, and others with a professional focus on this central question in American politics. The three theories are as follows:
While these three explanations are hardly mutually exclusive, a lot hinges on which theory Republicans conclude best explains their recent political struggles — if they acknowledge they have a problem, that is.
If they believe their fortunes are riding on low-propensity voters, for example, they may be more likely to try different media or campaign messaging, pull back on tariffs, or try to appeal to more college-educated voters to right the ship. If they believe in the new entrant theory, on the other hand, it’s possible they might try to wade into the online debates over the future of the right, or try to moderate some social positions instead. Democratic strategists will, of course, be drawing their own conclusions, too. And the answers both parties reach could have a major influence on US politics in the years to come.
Patrick Ruffini, a founding partner at the research firm Echelon Insights, is a longtime Republican Party pollster and strategist, as well as the author of Party of the People, a 2023 book that, I admit, was remarkably prescient about what would happen in the 2024 election.
As much as there are worrying signs for Republicans, I found one statistic about affordability voters that really jumped out to me, and should be worrying Democrats. Democrats are lagging tremendously in winning over support of white affordability voters: While 77 percent of nonwhite affordability voters disapprove of Trump and 73 percent prefer Democrats, 48 percent of these white voters disapprove but only 40 percent prefer Democrats.
That big gap suggests white, moderate, and conservative affordability voters aren’t sold on Democrats yet.
More recently, however, Ruffini has been criticizing the narrative that there is a MAGA crack-up happening at all, arguing that much of the recent intra-GOP squabbling (between Trump and Marjorie Taylor Greene, for example) is an elite fixation: “The media and influencer discourse can be pretty disconnected from the voter reality,” he said on a recent New York Times podcast. “If MAGA were really cracking up, you’d see it in the polls. In our polling, Trump has been above or near a 95 percent approval rating among supporters since he took office in January.”
Instead, Ruffini argues, the drop in Trump’s support is being fueled by independent, low-propensity voters who voted for Trump in 2024 but, generally, are less connected to politics, younger, and more racially diverse. These people, Ruffini argues, aren’t keeping track of the news, don’t care for most of the big “scandals” of the era, and are only ambiently hearing or feeling the effects of the Trump administration.
This “low-propensity theory of everything” as Ruffini calls it, explains why Trump’s approval has shifted so much: As swing independents, so swings the top-line number. This is why young voters have been swinging back and forth so much over the last few years: Because they don’t have strong partisan ties, their politics are still forming and changing, and they just don’t seem to care that much about what’s happening around them. You can therefore imagine a whole segment of the electorate, beyond just young voters, who don’t really have a strong allegiance to one party or another, feeling dissatisfied and annoyed at the status quo, and thus swinging away from the incumbent party.
“People were so shocked at young voters swinging to the right and then swinging to the left again,” Lakshya Jain, the elections analyst and head of data at The Argument, told Vox. “But this is a group that is extremely disengaged in politics and has the lowest income relative to other groups in society. Obviously, the economy being bad means they’re going to get pushed away.”
These “low-propensity” and low information voters used to vote for Democrats at higher rates, but have begun to occupy a bigger subset of the Trump electorate, meaning any swings are probably going to look bigger than before.
But as Jain points out, these swingy voters aren’t swinging over nothing. It’s all about the economy. And that’s where a second theory, which Jain argues for, is helpful to layer on top: that Trump is specifically losing the most support among a cohort of 2024 voters who prioritized affordability above everything else.
Some of the split in the Trump coalition potentially transcends partisanship, likeliness of voting, or news engagement.
In polling that Jain conducted for The Argument, he found that Democrats are gaining, and Trump is losing, specifically among nonwhite voters, voters under the age of 45, and among non-college educated voters. This makes the potential blue wave of 2026 look like the inverse of the 2018 blue wave, where Democrats made huge gains with white, older, and college-educated voters.
Underlying these shifts is one thing: affordability. A full 60 percent of respondents in the latest Argument poll rank cost of living as one their top two most important issues. “Nothing else even came close,” Jain says. “What’s more, it’s clear voters absolutely detest the way Trump is handling it.”
By his estimate, these “cost-of-living as a top-2 issue” voters have swung from supporting Trump by a six-point margin last year to disapproving of him by a 13 point-margin, a bigger swing than any other kind of voter.
Poll after poll shows this: Republicans themselves are increasingly dissatisfied with the state of the economy, and are torn over how much to blame Trump for this. Some of the split in the Trump coalition, therefore, potentially transcends partisanship, likeliness of voting, or news engagement. Voters who are paying attention to current events are paying attention to the state of the economy, and report overwhelmingly negative feelings over rising costs of groceries, housing, utilities, and health care.
This also explains the large swings among Latino and young voters we’ve seen over the last few months: Many of these voters opted for voting for Trump at higher rates last year as one-off, trusting him to actually improve their economic conditions. This doesn’t seem to be happening, and they are paying attention, so they’re swinging toward Democrats.
“In 2024, Trump had promised a group of disillusioned young people that he would continue to tear everything down, but he isn’t rebuilding in a way that’s improving their quality of life,” Rachel Janfaza, a writer and analyst focused on Gen Z, told Vox. “We know that the top issues for young people are affordability, housing, and economic concerns. They’re very stressed about AI, they’re being told it’s coming for their life, their jobs, their futures. And yet they aren’t seeing him talk about it. Instead, he’s calling affordability a con job.”
Janfaza doesn’t fully agree with Ruffini and Jain’s description of “low-propensity” voters: “The young people I speak to are very well aware of what’s happening. They don’t mince words. They’re very nuanced on the topics. They’re disappointed, they’re frustrated.”
But she does buy the description of these voters as being particularly swingy over the economy. She also noted that this might mean that they run to the Democratic Party and turn out for Democrats next year, but cautioned that this shouldn’t be taken as evidence that they have returned to the progressive and liberal bona fides of previous cohorts of young voters.
The third theory comes from the conservative Manhattan Institute’s recent study of the Republican electorate.
The 2024 coalition is not a durable, lasting one — much like Democrats discovered after the Obama era, segments of it can, and are, shifting.
They divide up the Trump coalition into two parts: Two-thirds belong to the “Core Republican” identity — these are consistently conservative Republican voters who embrace the traditional tenets of MAGA and conservative politics. Then there’s the idiosyncratic mix of “New Entrants” — about 30 percent of the coalition — which holds political opinions that clash with the MAGA-fied majority of GOP voters.
“They are younger, more racially diverse, and more likely to have voted for Democratic candidates in the recent past,” Jesse Arm, the author of the Manhattan Institute study, writes.
Arm notes that these “New Entrants” are less conservative than “core” Republicans on just about every policy issue: backing abortion rights, a more pro-immigrant policy agenda, and more progressive social views. A majority do not support Trump’s tariffs. They are also more open to believing conspiracy theories, especially those concerning Israel and Jewish people, and more willing to justify political violence. They are more likely to have voted for a Democratic candidate before, and have lower approval ratings for Republican figures than the “core” group.
“They’re disgruntled Obama-to-Trump or Biden-to-Trump voters whose politics are all over the map,” Arm says. “The racist in your X mentions who thinks the moon landing was faked and that George Bush arranged 9/11 is just as likely to want higher taxes and abortion-on-demand as he is to support eradicating DEI bureaucracies or doing anything to rein in the welfare state.”
Crucially, there are overlaps between this category and the last two: These are also voters who are probably less informed or engaged in politics, who cared about affordability, who are younger, who are more likely to be Black or Latino, and who are new Republican voters. And crucially for the future of our politics, this segment of voters is much less likely to vote for another Republican candidate in the future, per Arm. The survey finds that while 70 percent of Core Republicans would “definitely” vote for a GOP candidate in 2026, only 56 percent of the New Entrants would.
But taken together, this shows the stakes of Trump and his party holding together a winning coalition. The 2024 coalition is not a durable, lasting one — much like Democrats discovered after the Obama era, segments of it can, and are, shifting. And actions that Republicans take, whether in substance or in message, to try to win back or hold support from any one of these types of voters could endanger their support from the other two types. That’s assuming, of course, that low-propensity voters don’t simply disengage from politics completely.
Of course, first Trump has to admit that voter discontent is real, and probably not give himself an A++++ rating for his stewardship of the economy. That might be the first obstacle GOP strategists must overcome as they attempt to chart their party’s future.
2025-12-12 19:00:00
美国两大政党的共同点是：他们不再像以前那样重视经济学家。拜登总统忽视了经济学家对通胀风险的警告，特朗普则无视了经济学家对关税的反对意见。如今，民主党也开始支持价格控制，尽管主流经济学家认为这种做法通常适得其反。经济学家的思维方式在政治圈中逐渐失去影响力。右翼支持特朗普的零和世界观，对专家失去信心；而左翼则拒绝经济学家对政策权衡和干预后果的分析。两党都对自由市场持怀疑态度，这与过去几十年经济学家在政策制定中占据重要地位的情况形成鲜明对比。
在过去的几十年里，经济学家的影响力贯穿了整个20世纪，并延续至21世纪初。不同时期的主流经济思想有所不同，从自由放任的保守派到凯恩斯主义的干预主义者，再到新自由主义者。但无论哪一派，经济学家都因其对解决国家问题的专业知识而受到重视。在新自由主义时代，经济学家的地位尤其高，他们的建议在1980年代和1990年代的经济繁荣中得到了验证。尽管两党经济学家在许多问题上存在分歧，但他们都共享一套分析工具和核心理念，如支持自由贸易、对工会持怀疑态度、认为政府干预市场通常适得其反、担心社会福利计划扭曲激励机制、害怕出现大额赤字和通货膨胀。
然而，2008年金融危机后，这种共识开始瓦解。奥巴马政府虽然延续了新自由主义的分析方法，但特朗普和拜登的上台标志着这一时代的真正终结。特朗普的经济政策，如广泛的关税和对美联储独立性的攻击，让经济学家感到震惊。而拜登政府则在经济政策上忽视了主流经济学家的建议，如对大规模刺激计划的担忧，以及对价格控制的反对。
对于共和党来说，特朗普是导致其与经济学家决裂的主要原因。他以“局外人”身份接管了党派和自由市场传统，虽然在一定程度上依赖金融顾问，但对经济学家的建议并不感兴趣，除非这些建议符合他的预期。特朗普的经济观是零和思维，他不相信经济学家关于自由贸易和移民能扩大经济蛋糕的观点。相反，他认为经济是零和博弈，谁获得更多的利益，谁就赢了。此外，特朗普对政府干预的怀疑与党内经济学家的立场相冲突。
在特朗普上台后，共和党内部的经济保守派机构逐渐失去影响力，要么变得无关紧要，要么适应了特朗普的思维方式。许多受过高等教育的专业人士，包括经济学家，也因特朗普的个人作风和政策立场而感到不满。例如，Mankiw表示，他更认同民主党经济学家Jason Furman，而不是特朗普。特朗普的第二任期更是让经济学家感到震惊，他的关税政策被认为会加剧通胀、抑制经济增长，而他对美联储独立性的攻击也令人不安。此外，特朗普政府还涉足企业投资并施压企业，引发了经济学家对“裙带资本主义”的担忧。
民主党并未经历像共和党那样的“局外人”崛起，而是其内部精英对经济学家失去了信心。他们认为经济学家的共识在实质和政治上都失败了，甚至可能间接导致了特朗普的当选。左翼和进步派认为，无约束的自由贸易破坏了美国中西部地区，收入不平等加剧，富人和大公司掌控了美国生活。而经济危机后，经济学家的建议被广泛接受，但最终导致了危机。
在奥巴马时期，经济学家的影响力依然存在，但随着社会媒体的兴起，经济学家的知识不再具有排他性。普通人在网络上也能获取数据并自行分析。Furman指出，在克林顿时期，经济顾问会审查新研究并提交给通讯团队；而在奥巴马时期，通讯团队更可能看到社交媒体上的一篇论文并主动联系他们。随着社交媒体的普及，民主党对许多问题的看法也向左倾斜，更倾向于道德清晰的分析和明确的“敌人”。进步派越来越不信任经济学家的警告，认为他们过于维护现状。
在拜登政府中，虽然有经济学家如耶伦担任财政部部长，但他们在实际政策制定中被边缘化。政策往往由白宫顾问和独立机构负责人主导，这些人有的是激进进步派，有的则更关注国家安全或政治。拜登本人对学术政策辩论不感兴趣，尤其是经济问题。一位前政府官员表示，拜登很少收到要求他选择不同政策路径的决策备忘录，通常是由顾问们达成共识后提交给他签署。
此外，民主党在一些重要政策上也忽视了经济分析。例如，拜登政府的托儿政策在设计上存在严重问题，直到评论员Matt Bruenig提出基本的经济学批评后才引起关注。在气候政策方面，Furman指出，拜登团队忽视了那些能有效指导减排的经济学家。民主党推动的边境政策也未充分考虑其对移民激励的影响。
对于选民来说，2010年代的所谓新自由主义“地狱”似乎比2020年代的“后新自由主义地狱”要好一些。民调显示，美国人对过去四年经济状况的不满情绪持续上升。然而，这并未促使任何一党重新接纳经济学家。原因之一是，经济学家对如何解决2025年的经济问题并不确定，甚至不清楚问题到底是什么。乔治梅森大学的经济学家Tyler Cowen认为，我们可能正进入一个“温和滞胀”时期，即通货膨胀和失业率同时上升。在这种情况下，他指出，“没有经济共识来指导行动。”降低利率可能加剧通胀，而提高利率则可能导致经济衰退。
伯克利的经济学家Brad DeLong认为，拜登的经济记录在困难情况下其实相当不错，避免了长期衰退或缓慢复苏，通胀也被工资增长所抵消。但他也指出，选民并不认同这些分析，他们希望失业率更高、实际收入更低，因此对物价上涨感到被背叛。经济学家们对此感到困惑，甚至开始怀疑“货币幻觉”是否真的影响了选民的决策。
尽管如此，经济学家们普遍认为，价格控制并不是解决高物价问题的正确方法。他们更倾向于“丰富议程”，即通过增加住房、清洁能源等供给来缓解物价上涨，而不是直接控制价格。然而，这种议程在选举中不如价格控制和廉价商品的承诺有吸引力，而这些承诺往往难以实现。
经济学家只有在被认为能解决重大问题时，才会被政治精英重视。然而，面对高物价问题，Mankiw表示，“我认为没有简单的解决方案。人们并不想听到‘我知道你很不满，但我们没有解决方案’这样的话。”
The US’s two major parties can agree on one thing: They don’t have much use for economists anymore.
President Joe Biden ignored economists’ warnings about the risks of inflation. President Donald Trump dismissed economists’ arguments against his tariffs. And now, rising Democrats are backing price controls, even though mainstream economists aligned with both parties say they typically backfire.
Economists’ way of thinking has fallen out of favor among the political class more broadly. The right has embraced Trump’s zero-sum worldview and lost faith in expertise generally. Many progressives have rejected economists’ fundamental focus on trade-offs and the unintended consequences of policy interventions. Both sides are down on the free market.
All this marks a major change from many previous decades of US policymaking, in which economists were viewed as having a special sort of status among experts. Believed to epitomize intelligence and technocratic competence, their recommendations were viewed as more high-minded than those from ideologues or grubby interest groups.
Economists were the gurus of growth — and while, of course, they weren’t always listened to, it was widely believed that a president who wanted a strong economy should take their counsel seriously.
Not so much anymore. Economists, Ezra Klein has written, were “simply far less influential” in the Biden administration, which turned instead to elite lawyers, activists, and the nonprofit world for expertise. And Trump isn’t particularly interested in economists’ recommendations — he has his own vision of how the economy works, and trusts it more than theirs.
The reasons economists fell off their lofty perch are in part personal: Neither Trump nor Biden enjoys highfalutin academic debates (in contrast to Obama and Clinton, who did). They’re in part coalitional: The free market GOP establishment was roiled by Trump’s rise, while Democrats accommodated a rising progressive faction who blamed neoliberalism for the disappointments of the Clinton and Obama presidencies. And the reasons may also be partly structural, connected to bigger-picture changes in the economy, politics, or the information environment.
“I tie it to the rise of populism on both the left and the right,” Greg Mankiw, a Harvard economist who advised George W. Bush’s administration, told me. “Both have a degree of skepticism toward traditional economic viewpoints from both the center-right and center-left.”
“There are certain commonalities between Biden and Trump, in their rejection of a technocratic approach that thinks seriously about tradeoffs,” said Jason Furman, a Harvard economist who advised the Clinton and Obama administrations. “I often find myself in despair about the direction.”
It isn’t surprising that economists would bemoan their own loss of influence. But the question remains: Can a political system that sidelines economists deliver a prosperous, growing economy?
So far, the results have not been promising. The public’s economic confidence turned sharply negative under Biden, as inflation wrecked his presidency and sunk his party’s 2024 chances. It’s remained quite negative after Trump’s return, turning what was his greatest political strength into his greatest weakness.
There’s another problem. Even if you think mainstream economists have gotten a lot wrong in recent decades, their basic toolkit — modeling that assesses incentives and market behavior — is highly useful if you want to design policies that will actually work. Sidelining economic analysis, in practice, means we’ll get more badly designed policies pleasing ideologues and interest groups — policies that will do little to help the American people or deliver the growth the country needs.
Economists’ influence pervaded the policymaking world for much of the 20th century and into the beginning of the 21st.
The dominant economic thinking varied, depending on the problems of the time and the party in power — from laissez-faire conservatives advocating noninterference with markets to Keynesian interventionists to the neoliberals who wanted to roll back that intervention. But across administrations, economists were useful to politicians when they seemed to have expertise that could help fix the country’s problems.
In the neoliberal era, especially, economists’ stature soared. Their advice for escaping the economic woes of the late 1970s — raise interest rates to cut inflation, then get government out of the way and let markets go to work — appeared, amid an economy that boomed for much of the 1980s and ’90s, to have been proven out.
Though economists aligned with the two parties disagreed on many things, they shared an analytical toolkit and many core ideas: support for free trade, skepticism of unions, a belief that government intervention in markets often backfires, a concern that social programs distort incentives, a dread of running large deficits, and a fear inflation might return. This was the neoliberal consensus.
We shouldn’t exaggerate how much sway economists had back then — politicians often rejected their advice, and individual economists couldn’t depart too much from their party line if they wanted to keep their seats at the table.
Still, they mattered. The Federal Reserve, chaired by elite economists like Alan Greenspan and Ben Bernanke, became a de facto fourth branch of government, and won glowing media coverage; presidential interference in their workings was deemed unacceptable.
In Congress, modeling from the Congressional Budget Office was deemed hugely important in estimating the economic impact of new bills. “CBO is God around here, because policy lives and dies by CBO’s word,” Sen. Chuck Grassley (R-IA) said in 2006.
And across many different issues — education, health care, environmental regulation — economists’ wonky analysis and modeling became central to policy debates, inside and outside the executive branch.
The Great Recession is often said to have ended this era, shattering confidence in economists and neoliberalism. But in practice, the Obama administration kept neoliberal wonkery alive and well. Obama thought it was important to hear out those he deemed to be the smartest economists, like Larry Summers. Meanwhile, the Romney-Ryan GOP of 2012 zealously defended free market economics. The true rupture came after that — under Presidents Trump and Biden.
For the GOP, the reason is simple enough: Trump. He carried out an outsider takeover of the party and the free-market-loving establishment. While Trump is sensitive to market reaction and relies to some extent on the advice of financiers, he is largely uninterested in the counsel of economists, unless, of course, they tell him what he wants to hear.
Trump came to office with his own intuitions and beliefs about how the economy actually works, shaped by his career in business and real estate. His worldview is fundamentally zero-sum. He rejects economists’ idea that more immigration and freer trade can grow the “pie” — the size of the economy — overall. Instead, he obsessively views the world in terms of who is winning or losing: who is getting the biggest slice. Furthermore, his desire to amass personal power clashes with economists’ skepticism, particularly within his own party, of government intervention and belief that markets tend to know best.
For the sake of his trade war, Trump often urges voters to simply make do with less, saying: Your kids don’t really need so many dolls, do they?
Immigration was likely more important than economics in powering Trump’s initial rise among GOP voters. But once he did rise, it became clear those voters didn’t actually care so much about conservative elites’ free market consensus. By maintaining those voters’ loyalty, Trump has dominated the party for a decade, and the old economically conservative institutions have either dwindled in relevance or adapted to better fit his worldview.
The breakup went both ways, as much of the party’s old economics establishment was — like many other college-educated professionals — repulsed by Trump on personal and policy grounds. “Even though I’m supposed to be associated with the right, I view myself as closer to [Democrat] Jason Furman than Donald Trump,” Mankiw told me.
And while mainstream economists had much to dislike about Trump’s first term, his second term has horrified them even more.
For one, there’s his tariff agenda. Economists think tariffs are, fundamentally, taxes that make things more expensive and suppress economic activity — and that while there are certain situations where they could be useful, Trump’s broad (and erratic) use of them makes little sense, will hurt growth, and will make many things more expensive for American consumers.
Trump’s attacks on the independence of the Federal Reserve — the citadel of economists’ influence — have also been shocking. Trump is frustrated that Fed chair Jerome Powell won’t lower interest rates. Treasury Secretary Scott Bessent, who comes from the world of finance, has made another complaint: “All these PhDs over there, I don’t know what they do,” he said in July. “This is like universal basic income for academic economists.”
Finally, this administration has purchased stakes in major companies and often pressured businesses in ways that look quite corrupt, raising economists’ fears of “crony capitalism.”
So far, the public has hated the results — Trump’s polling on the economy has been dismal this year, as voters remain irate about high prices. Rather than put forward a pro-growth agenda, though, Trump has insisted that the tariffs will continue until morale improves. For the sake of his trade war, he often urges voters to simply make do with less, saying: Your kids don’t really need so many dolls, do they?
Democrats didn’t have an outsider populist takeover of the party that chucked out their old elites. Rather, their own party elites fell out of love with economists — because they concluded that the economists’ consensus had failed both substantively and politically, and arguably brought Trump to power in the first place.
According to many leftists and progressives, the failures were obvious. Unfettered free trade had despoiled the heartland. Inequality got out of control as the ultra-rich amassed more of the gains from growth and big corporations exercised more and more power over American life. Millions of Americans faced foreclosures and unemployment, while the crooked bankers who got us in the mess got off scot free. The rot of neoliberalism had been building for years, the Great Recession finally exposed it for all to see — and it was the economists (specifically, a particular clique of well-connected elite economists) who led us there.
Critiques like these gained steam among progressive activists and thinkers in the late Obama years. When the enthusiasm for Bernie Sanders’s campaigns seemed to show there was populist energy behind this critique, Democratic elites tried to accommodate it. Still, we shouldn’t be so quick to conclude that the general public thought the economy of the late 2010s was a hellscape. Indeed, just before the beginning of the pandemic, Gallup’s Economic Confidence index hit a 20-year high, even though most of the problems above persisted.
Economists have been skeptical of the claim that economists screwed up everything. But some — for instance, Berkeley economist Brad DeLong — have argued that Obama’s team did screw up one big thing: the recovery from the Great Recession. Per this argument, policymakers were too worried about the nonexistent problem of inflation and deficits, failed to stimulate the economy sufficiently, and the resulting unsatisfactory recovery left voters unhappy. (But it’s unclear voter anger at Obama spurred Trump’s win; Obama was quite popular in 2016.)
Other changes may have played a role. The internet and social media were part of a broader decline in gatekeeping that meant economists’ knowledge was no longer exclusive. A smart person online can now obtain data and crunch numbers on their own. Furman told me that, during the Clinton administration, staff economists reviewed new economic research papers and brought some to the communications team; under Obama, it was just as likely that the comms team “would see someone tweeting a paper and come to us about it.”
With the rise of social media came a leftward shift in how Democrats thought about a host of issues. In the age of virality, analyses offering moral clarity and obvious villains tended to win out. Progressives increasingly tended to scoff at the warnings and concerns of economists, believing they were too disposed to excuse an unjust status quo.
A new counter-establishment that relied far more on elite lawyers and the nonprofit world was formed and became highly influential in the Biden administration. There were, of course, economists among Biden’s appointees, such as Treasury Secretary Janet Yellen — but in practice, she was somewhat marginalized. Policy was often driven by White House advisers and independent agency chiefs, some of whom were bold progressives and some of whom were focused on national security or politics.
Biden himself was uninterested in academic policy debates, particularly on economics. A former Biden administration official told me last year that it was “very, very rare” for Biden to be sent a decision memo asking him to choose between different courses of action; the norm was for advisers to reach consensus and send up a “joint recommendation memo” for his signature.
As Biden was taking office, he had planned on a $1.3 trillion stimulus, but this was increased to almost $2 trillion — reportedly because Senate Democrats’ policy wish list added up that high. Economists like Summers and Furman, now on the outside, warned that that was far too big and risked spiking inflation. But they were ignored, as Democrats sought to avoid what they viewed as Obama’s mistake of doing too little stimulus.
At this point, mainstream economists were viewed as the boys who cried wolf on inflation, but this time, the wolf was coming. (To be clear, inflation was primarily brought about by global circumstances and not Biden’s stimulus, but his administration was slow to recognize just how serious the problem would be, and made it somewhat worse.)
Other important policies also seemed to be set without much regard to economic thinking or analysis. Democrats’ childcare proposal — at one point, a key part of Biden’s legislative agenda — had deep design problems that only got attention after the commentator Matt Bruenig made some basic economics-informed critiques. On climate policy, Furman said, the Biden team “really ignored the economists who had the modeling capability to tell them how to maximize emissions reduction per dollar spent.” Advocates pushed border policies that paid little heed to the incentives they were giving people to come.
To voters, the purported neoliberal hellscape of the 2010s pales in comparison to the post-neoliberal hellscape of the 2020s. Polls show Americans have positively loathed the state of the economy for the past four years.
But this has not spurred either party to re-embrace economists with open arms. And in part, that’s because economists aren’t really sure about how to solve the US economy’s 2025 problems — or aren’t sure what the problems even are.
Tyler Cowen, an economist at George Mason University, speculated that we might be entering a period of “modest stagflation,” in which inflation and unemployment increase simultaneously. In that situation, he told me, “there is no economic consensus about what to do.” Lowering interest rates could worsen inflation, and raising them could cause a recession. “You’re damned if you do, damned if you don’t.”
Economist Brad DeLong of Berkeley told me that he thought Biden’s economic record was actually rather good in a very difficult situation, since it avoided a prolonged recession or a slow recovery, and inflation was generally countered with wage growth. “The problem is that voters really do not agree,” he said. “The pollsters tell me people would be happier if unemployment had been higher and real incomes had been lower. They’re feeling betrayed by the price level. So we scratch our heads and say, ‘Is money illusion a real source of utility?’”
There is, however, some economist consensus about what not to do about high prices — namely, price controls, which economists typically feel will have counterproductive or undesirable consequences. Many would prefer something more akin to the “abundance agenda,” which is focused on increasing the supply of housing, clean energy, and other things the economy needs, often by trying to reduce procedural or legal roadblocks.
Abundance has won a dedicated following among center-left wonks and certain politicians, but so far, it has been less potent as an electoral message than price controls and promises for cheaper stuff — promises that may be impossible to fulfill. “People want the price level to go back to what it used to be, which is not possible without a massive recession which would not be desirable,” Furman said.
Economists are useful to political elites when it’s believed they know how to solve major problems of the day. But when it comes to high prices, Mankiw said, “I don’t think there’s any easy solution to these problems. And people do not want to hear, ‘I know you’re not happy, but we have no solutions for you.’”
This series was supported by a grant from Arnold Ventures. Vox had full discretion over the content of this reporting.
2025-12-12 06:55:00
一份此前被否决的国会选区划分草案于2025年12月8日在印第安纳波利斯的印第安纳州议会大厦展出。| Kaiti Sullivan/Bloomberg 通过 Getty Images 提供
本文出自《Logoff》——一份每日新闻简报，帮助您了解特朗普政府的新闻，而不会让政治新闻占据您的生活。点击此处订阅。
欢迎来到《Logoff》：唐纳德·特朗普在印第安纳州的选区重划竞选再次失败。到底发生了什么？周四，印第安纳州参议院否决了一项特朗普支持的法案，该法案旨在为2026年中期选举前的共和党创造有利的国会选区划分，形成9-0的共和党优势。该法案以31票对19票被否决。最初，印第安纳州共和党人拒绝了特朗普要求召开特别会议的提议，因此几乎未举行投票。但最终，特朗普迫使共和党人进行了投票，结果却遭遇了更惨重的失败。
背景是什么？印第安纳州是全国范围内一项跨党派选区重划努力的最新焦点。这项努力始于特朗普敦促德克萨斯州立法者重新划分选区，以帮助共和党获得五个额外的国会席位。此后，事情并未如特朗普所愿。加州的民主党选区重划努力可能会抵消德克萨斯州共和党的优势，而印第安纳州则未参与竞争，因此民主党最终可能保持现状，甚至有所斩获。
为什么这很重要？特朗普、副总统JD·万斯以及政府盟友对此次选区重划行动投入了大量精力，包括发出越来越严厉的威胁。例如，周四，保守派团体“遗产行动”（Heritage Action）威胁要剥夺印第安纳州的联邦资金，如果立法者反对特朗普的提案。尽管如此，特朗普仍未能获得所需的25票，尽管共和党在50席的州参议院中拥有40席的超级多数。此外，该法案还引发了大量针对印第安纳州共和党的死亡威胁。他们未能实现预期结果，这是一件大事。
大局如何？最近几周，关于特朗普是否已失去对共和党牢固控制的讨论声越来越大。11月，众议院成员违背白宫意愿，投票决定公开埃普斯坦文件。现在，印第安纳州再次给特朗普带来失败，进一步打击了共和党明年保住众议院的微弱希望。
好了，该下线了……你知道有多少只金毛犬可以放进公园里吗？据阿根廷布宜诺斯艾利斯的居民本周创造了一个新的非正式世界纪录，答案是至少2397只。您可以通过以下链接观看一些可爱的视频。对我来说，我很期待在假期里看到我父母的金毛犬古斯。感谢阅读，祝您有一个美好的夜晚，我们明天再见！
This story appeared in The Logoff, a daily newsletter that helps you stay informed about the Trump administration without letting political news take over your life. Subscribe here.
Welcome to The Logoff: President Donald Trump’s Indiana redistricting campaign has failed — again.
What happened? On Thursday, the Indiana state Senate voted down a Trump-backed bill to redraw Indiana’s congressional maps to be more favorable to Republicans ahead of the 2026 midterms. The bill, which would have created a 9-0 Republican advantage in Indiana, was rejected resoundingly, with 31 votes to 19.
The vote almost never took place, after Indiana Republicans initially rejected Trump’s call to convene a special session. Ultimately, Trump was able to browbeat Republicans into holding the vote — only to be handed an even more striking defeat.
What’s the context? Indiana is the latest focus of a national, bipartisan redistricting effort that kicked off when Trump pressured Texas lawmakers to redraw their state maps and net Republicans five additional congressional seats. Since then, things have largely not been going his way. A Democratic redistricting effort in California should neutralize GOP gains in Texas, and with Indiana staying out of the fight, Democrats may ultimately break even — or even gain seats.
Why does this matter? Trump, Vice President JD Vance, and administration allies threw a lot of weight behind this redistricting push, including issuing increasingly drastic threats. On Thursday, for example, the conservative group Heritage Action floated stripping Indiana of federal funding if lawmakers voted against Trump. Despite all of that, Trump still failed to win — or even come close — the 25 Republican votes he needed despite the GOP holding a 40-vote supermajority in the 50-seat state Senate.
Indiana Republicans have also been deluged with death threats over the bill. It’s a big deal that they failed to produce the intended result.
What’s the big picture? The conversation about whether Trump’s previously ironclad control over the Republican Party is slipping has been getting louder in recent weeks. In November, House members bucked the White House to vote to release the Epstein files. Now, Indiana has handed Trump another defeat, and a blow, to Republicans’ already-slim chances of retaining the House next year.
How many golden retrievers can you fit in a park? At least 2,397, it turns out, after Argentines in Buenos Aires set a new unofficial world record this week for the largest golden retriever get-together. You can watch some adorable video of the event here. For my part, I’m excited to see my parents’ golden, Gus, over the holidays. Thanks for reading, have a great evening, and we’ll see you back here tomorrow!
2025-12-12 02:30:00
由于国会未能阻止保费上涨，根据《平价医疗法案》（ACA）的市场，健康保险费用即将大幅上涨。在周四，国会未能通过一项临时方案以避免保费上涨，导致多达四百万美国人可能无法负担保险而失去保障。我曾在今年早些时候与其中一些人交谈过。他们包括在职父母、企业家和退休人员，现在都因失去政府援助而陷入两难选择。他们对政府利用他们的生计进行政治操作感到不满，尤其是那些获得联邦政府补贴保险的人，他们特别指责共和党未能履行责任。最近的一项调查显示，76%的通过ACA获得保险并希望延长补贴的人，如果补贴未能延续，会将责任归咎于特朗普或国会中的共和党人。而更广泛的公众，其中大多数也希望延长援助，也持类似看法：48%的选民将责任归咎于共和党，而32%则归咎于民主党，据一项新的Morning Consult民调显示。周四，参议院未能通过两项旨在阻止保费上涨的党派提案。其中一项由民主党提出的提案旨在将财政补贴延长三年，但以51比48的结果失败，所有民主党议员和四位共和党议员支持该提案，其余共和党议员反对，而该提案需要60票才能通过。另一项由共和党提出的方案则建议将资金存入健康储蓄账户，并鼓励人们购买高免赔额的灾难性保险。该提案同样以51比48的结果失败，遭到民主党的一致反对。这些投票之所以发生，是因为两党在早些时候同意结束政府停摆，条件是参议院在12月中旬之前就一项恢复补贴的计划进行投票。民主党曾多次敦促共和党在停摆前和停摆期间解决补贴问题，但共和党当时拒绝谈判，直到距离原定投票日期仅几天时才提出一个统一方案。现在，当保险覆盖于1月1日开始时，患者将不得不支付大幅上涨的新保费。除非民主党愿意在1月30日当前拨款法案到期时再次关闭政府，否则短期内可能没有机会再次解决这个问题。美国人有理由指责共和党造成这场完全可以避免的医疗危机。即将到来的保费上涨是该党数十年来未能认真对待医疗政策的结果。## 共和党未能就真正的医疗改革方案达成共识
共和党长期以来对医疗改革缺乏兴趣。当奥巴马总统于2010年最终通过《平价医疗法案》时，他并未获得共和党的支持，尽管该法案包含了一些最初由保守派政策制定者提出的政策，如个人强制参保条款。此后，该党一直专注于推翻这一法案，而非制定一个可行的替代方案。他们多次承诺要废除并取代该医疗法案，但2017年的尝试却以混乱和尴尬告终。最近，在2024年总统竞选期间，特朗普本人也只能提供一些“医疗计划的概念”。此后，白宫在11月下旬意外提出了一项解决该问题的方案，但似乎并未与国会中的共和党人进行充分协商，很快遭到反对。特朗普在其他方面则对保持数百万选民的医疗保障负担得起的问题漠不关心，同时却声称美国人对医疗费用负担的担忧是“骗局”（并建造了一个耗资3亿美元的白宫宴会厅）。就增强ACA补贴的问题，共和党尽可能地将问题拖延，直到无路可退。他们本可以在今年夏天通过的大型医疗法案中加入补贴延长的条款，以一种更符合保守派口味的方式解决该问题。但据《Semafor》报道，由于财政保守派的压力，共和党在该法案的讨论中搁置了这一议题。（尽管该法案整体上增加了超过3万亿美元的赤字，同时削减了1万亿美元的医疗补助支出，这一举措也可能导致数百万美国人失去医疗保障。）就连共和党策略师也承认，参议院的共和党议员只是在表面上做出努力，试图解决补贴到期的问题。他们的健康储蓄账户计划注定失败，而且该党直到投票前两天才达成统一意见。这并非一项真正努力，以避免数百万选民面临巨额保费上涨。众议院议长迈克·约翰逊承诺将在未来几个月推进几项医疗法案，但国会内部人士对此持合理怀疑。保守派的下一次重大医疗改革计划已经拖延了十多年——“恰逢其时”，正如《现代医疗》副编辑杰夫·杨所说。这个笑话从2013年开始，至今仍在继续。而今天的投票也证实了，共和党似乎仍未接近制定一个真正能降低美国民众医疗费用的方案。
Health insurance premiums on the Affordable Care Act’s marketplaces are set to soar after Congress failed Thursday to pass a last-minute plan to avert the rate hikes.
As many as four million people could be forced to go uninsured, because they can no longer afford their health plan. I spoke with some of them earlier this fall. These are working parents, entrepreneurs, and retirees — all now facing impossible choices because of the loss of their government aid.
They are fed up with their livelihoods being exploited for politics, and it’s this population — those with health insurance subsidized by the federal government — who, in particular, think Republicans have dropped the ball.
A recent survey found that 76 percent of people who get their insurance through the ACA and want the subsidies extended would blame President Donald Trump or Republicans in Congress if they are not. The broader public, the vast majority of whom would also like to see the aid extended, agrees; 48 percent of voters blame the GOP, while 32 percent pin it on the Democrats, per a new Morning Consult poll.
On Thursday, the Senate failed to pass two partisan measures that were designed to avert premium spikes. One proposal from the Democrats would have extended the financial subsidies for three more years; it failed 51-48, with all Democrats and four Republican senators supporting it. The rest of the Republicans objected, and 60 votes were needed for the bill to advance. The other plan, put forward by Republicans, would’ve put money into a health savings account and pushed people to purchase catastrophic coverage with a higher deductible. It also fell short, at 51-48, with unified Democratic opposition.
The only reason these votes happened at all is that the two parties agreed to end the government shutdown earlier this fall on the condition that the Senate would hold a vote by mid-December on a then-unspecified plan to restore the subsidies.
Democrats had been pressing Republicans to address the assistance ahead of the shutdown and during the shutdown. Republicans, however, refused to negotiate at the time and failed to come up with a unified plan to fix the issue — until only a few days before the planned vote.
Now, patients will have to pay their new, much higher premiums when coverage begins on January 1. And unless Democrats are willing to shut down the government again on January 30, when the current funding bill runs out, there likely won’t be another chance to fix the problem any time soon.
Americans are right to blame the Republicans for this entirely avoidable health care catastrophe. The upcoming rate hikes are the result of the party’s failures to take health policy seriously for decades.
The Republican Party has been uninterested in health care reform for a long time.
When President Obama finally passed the Affordable Care Act in 2010, he did so without the GOP’s support — even though his plan incorporated policies, such as the individual mandate, that were originally proposed by conservative policy thinkers.
Ever since, the party has been focused singularly on dismantling it, rather than crafting a viable alternative to take its place. Their repeated pledges to repeal and replace the health care law ended in a disjointed and embarrassing failure in 2017. And, more recently, Trump himself could offer only “concepts of a plan” for health care during his second campaign for the presidency in 2024.
Since then, the White House surprisingly floated a plan to address the issue in late November, seemingly without vetting it with congressional Republicans, who quickly shut it down. Trump has otherwise been disengaged on the urgent issue of keeping health coverage affordable for millions of voters while simultaneously arguing that Americans’ concerns over affordability in general are a “hoax” (and building a $300 million White House ballroom).
On this specific question of the enhanced ACA subsidies, Republicans kicked the can down the road as much as they could — until they ran out of road.
They could have extended the assistance as part of the big, beautiful bill that passed this summer and done so in a way that would be more palatable to conservatives. But, according to Semafor, pressure from deficit hawks led the GOP to table the issue during the debate over that legislation. (Never mind that the overall bill, as passed, added more than $3 trillion to the deficit, even as it slashed Medicaid spending by $1 trillion, another move that could also lead to millions of Americans losing their health benefits.)
As even Republican strategists will acknowledge, GOP senators were only going through the motions of appearing to do something about the expiring subsidies. Their HSA plan was doomed to fail, and the party didn’t even unify around it until two days before the planned vote. This was not a serious effort to avert a huge premium increase for millions of their own constituents.
House Speaker Mike Johnson promised to advance several health care bills in the coming months, but congressional insiders are rightly skeptical.
The next great conservative health care plan has been just around the corner for more than a decade — “just in time,” in the words of Modern Healthcare deputy editor Jeff Young. It’s a joke that started in 2013. It’s still going today.
And, as today’s vote confirms, the Republicans appear no closer to coalescing around a real plan that would lower health care costs for the American people.