30 Jan 2026

Sheldon Jacobson: Free speech needs a reset in America

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The First Amendment to the U.S. Constitution, part of the Bill of Rights, guarantees each person the freedom to speak out, untethered by government, in addition to freedom of the press. Yet our society has morphed into a segregated form of free speech that erodes the very essence of such freedom.

Terms like “hate speech” and “ racism” are viewed negatively in our society. They describe beliefs and phenomena that are critical of certain groups of people based on personal traits, color of skin, or race. Yet if freedom of speech is truly a right, should people have the opportunity to make statements that may be interpreted by others as hate speech or racism?

The answer is yes, given that the Supreme Court has consistently protected hate speech under the First Amendment.

Yet all speech today is filtered. The key difference is what the filters are.

University campuses, often viewed as bastions of free speech as well as centers for healthy discourse and debate, are often caught in what some may believe to be a contradiction. The ACLU argues that all speech is protected, provided it does not lead to harassment or involve threats. People may not agree with what a person says, but that of itself does not mean that it should not be said.

The president has argued that there is a lack of free speech on campuses. Yet his focus is on speech that he disagrees with and what contradicts his ideological beliefs.

Universities in general are liberal-leaning and in many cases suppress conservative views. This is consistent with the assessment by the Foundation for Individual Rights and Expression, which noted that nearly 65 percent of the top schools in the nation earned an “F” grade for free speech friendliness. Universities have gone so far as to create “ free speech zones” as isolated areas on campus where anything may be said. Yet are such zones really needed? To maintain order and reduce risk, universities create communication codes that effectively inhibit free speech and the associated debate.

On the flip side, when conservatives are given free speech rights, they employ the same suppression tactics used by their left-leaning brethren.

If speech is to be truly free, one must separate the content of the speech from the person delivering the speech. When the two are mingled inextricably, as naturally happens, it is impossible to assess whether limitations on free speech are rooted in what is being said or who is saying it. This shines a bright light on perspective and bias that inherently colors speech.

For example, when students on campuses around the country protested the actions of the Israel Defense Forces in Gaza in 2023, this was viewed by some as antisemitic, including the president. Other viewed it as support for a suppressed group of Palestinians living in Gaza. How one interprets all such actions are based on one’s ideological beliefs and world views.

Of course, if free speech leads to intimidation and physical violence, the speech may be protected, but the hostile actions are not.

The well-known principle often attributed to Voltaire — “ I wholly disapprove of what you say — and will defend to the death your right to say it” — captures what the freedom of speech should be. Yet in today’s ideologically bifurcated society, the exact opposite is now true.

Freedom of speech is inherently fraught with bias. When one speaks openly about an issue that they support, free speech justifies such actions. When another speaks about issues that one abhors, labelling it as hate speech or racism is an easy default reaction.

If freedom of speech is to exist on college campuses, a forum for productive dialogue and peaceful disagreement is necessary. But this also must occur everywhere that people who disagree come together.

Marjorie Taylor Green once called for a “national divorce,” whereby people with diametrically opposing views are split apart into two countries. Yet even within conservative or liberal groups, there are signs that each one would eventually emerge with the same types of schisms that exist today.

Instead of finding ways to break apart, what is needed are ways to come together, despite our differences. Such differences make us stronger. If we were all the same and interchangeable, the redundancy would make us less effective. And with uncensored free speech, we can continue to remain together, even with all such differences.

Sheldon H. Jacobson, Ph.D., is a professor of computer science in the Grainger College of Engineering at the University of Illinois Urbana-Champaign. He has researched risk-based aviation security for over 25 years, which provided the technical justification for TSA PreCheck. This piece was originally published by The Hill.

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30 Jan 2026

Robert Pearl: Political and economic pressures set up a health care shift in 2026

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Health care in 2025 was consumed by chaos, conflict and relentless drama. Yet despite unprecedented political turmoil, cultural division and major technological breakthroughs, there was little meaningful improvement in how care is paid for or delivered.

That outcome was not surprising. American medicine is extraordinarily resistant to change. In most years, even when problems are obvious and widely acknowledged, the safest bet is that the care patients experience in January will look much the same in December.

But when meaningful change does occur, it is usually because motivated leaders find themselves in rare political and economic conditions. Think of President Barack Obama in 2009, with unified Democratic control of Congress and widespread voter frustration over health care costs and coverage. By contrast, President Bill Clinton’s ambitious reform effort collapsed in 1993 when it collided with powerful industry opposition and a divided political environment.

If most years prove stagnant, why should anyone expect 2026 to be different? In a word: pressure.

Congress, the president, drug manufacturers and insurers are all confronting forces that make inaction increasingly risky. Three external pressures will drive change:

For Republicans broadly, and for President Trump personally, the 2026 midterm elections present significant political risk. Even a modest shift in “purple” districts could flip control of the House, reshaping committee leadership and reviving the prospect of Trump’s impeachment.

The “Big Beautiful Bill” passed by Congress in mid-2025 locked in permanent tax cuts with a multi-trillion-dollar price tag, narrowing the universe of spending categories large enough to materially reduce the deficit.

With health care accounting for nearly 30% of the federal budget (and other categories such as Social Security and defense politically untouchable), medical spending became one of the few remaining fiscal levers. But pulling it also handed Democrats a potent midterm weapon.

The shutdown compounded the problem. By linking government dysfunction to health care funding and coverage uncertainty, Democrats spotlighted rising medical costs as a symbol of incumbent political failure.

As health care economics worsen in 2026, the pressure will intensify. Premium increases will outpace wage growth. Deductibles will remain high. Tens of millions of Americans face potential Medicaid coverage losses, while 20 million more will see sharply higher exchange premiums.

The likeliest response to pressure: Fearful of losing the House, Trump and congressional Republicans are likely to pursue targeted, high-visibility actions designed to appease voters.

Drug pricing offers a clear example. In November, the White House announced agreements with nine large pharmaceutical companies to lower prices on certain medications under a “most-favored-nation” framework. However, those deals won’t materially lower prices because they apply only to Medicaid and selected drugs, leaving most privately insured patients exposed to persistently high costs.

Other options Congress and the president are likely to pursue include a short-term extension of exchange subsidies paired with familiar proposals such as expanded health savings accounts, “catastrophic” plans and lower limits on premium support.

For decades, the pharmaceutical industry has occupied a uniquely protected position in the U.S. economy. Long patent exclusivities, limited competition from generics and biosimilars and sustained lobbying success have shielded it from price regulation. As a result, pharmaceuticals remain among the fastest growing and most profitable U.S. sectors.

Americans currently pay two to four times more for prescription drugs than patients in other wealthy nations, and roughly one in three prescriptions goes unfilled because of cost. Affordability has become a crisis for employers and voters.

The likeliest response to pressure: Given the growing political pressure, drugmakers face a strategic choice. One path is familiar: resist change through lobbying, campaign contributions and legal challenges. The other is more adaptive: accept lower margins on some products in exchange for higher volumes and reduced political risk.

Based on the recent agreements that brought 14 of the 17 largest drugmakers into voluntary pricing arrangements with the administration, most are likely to continue to follow the second path.

By shielding their most profitable products while conceding selectively on pricing, manufacturers can reduce political pressure without materially sacrificing profitability.

In 2026, employer-sponsored premiums are projected to rise at roughly twice the rate of inflation. The annual cost of coverage for a family of four will be $27,000, with employees paying roughly one-quarter of that total out of pocket.

Patients already delay or forgo care because of cost. Meanwhile, medical bills remain the leading contributor to personal bankruptcy in the United States.

Insurers, who have no control over how medicine is practiced, have relied on tighter prior-authorization requirements, narrower networks and higher rates of claims denial. While these tactics can suppress short-term spending, they have fueled widespread backlash from patients, physicians, employers and lawmakers.

In effect, insurers are being squeezed from both sides: rising costs they cannot fully pass on and a public increasingly hostile to how those costs are managed.

The likeliest response to pressure: When premiums and out-of-pocket costs exceed what payers and patients can bear, the traditional insurance model begins to fracture.

That is where capitation re-enters the conversation. Under capitation, insurers make a fixed, per-patient payment to a physician group or health system to manage most or all care for a defined population. Providers assume responsibility for utilization, coordination and cost control. In return, they gain flexibility in care delivery and the opportunity to share in savings when prevention and chronic disease management succeed.

For insurers, the appeal is straightforward: capitation shifts financial risk downstream and reduces reliance on unpopular utilization controls. But moving from fee-for-service to capitation would require major structural change. As a result, insurers in 2026 are more likely to introduce pilot programs, partial risk arrangements and expanded use of generative AI rather than pursue wholesale transformation.

A new year carries the promise of change. Look for shifting political and economic climates to make 2026 a year of health care improvement, especially compared to 2025.

Robert Pearl, the author of “ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group. He wrote this column for the Fulcrum, a nonprofit, nonpartisan news platform covering efforts to fix our governing systems.

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30 Jan 2026

Other voices: Bondi’s letter to Minnesota deserves scorn. But it’s a warning we can’t ignore.

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MIAMI — Florida woman Pam Bondi has really distinguished herself this time. The U.S. attorney general who famously botched the handling of the Jeffrey Epstein files has written a letter to Minnesota’s governor — on Saturday, the same day nurse Alex Pretti was shot dead by immigration agents — in what can only be interpreted as an extortion attempt.

Bondi — a two-time Florida attorney general before President Trump tapped her to become the top law enforcement official in the country — is suggesting that Minnesota hand over its voter rolls as a condition for ending immigration operations that have resulted in the deaths of two people at the hands of ICE.

Bondi’s letter was as subtle as a sledgehammer. She said the state could “bring an end to the chaos in Minnesota” if it would just take a few “simple steps.” Then she spelled it out: turn over to the federal government records for food assistance and Medicaid, end pro-immigrant “sanctuary” policies and cough up voter data.

That’s one step away from a mob-style threat: Nice state you have there. Be a shame if anything happened to it.

Is Bondi trying, as she said in the letter, to “bring back law and order”? Or is her letter, as an attorney for the state said in court Monday, really nothing but a “ransom note”? Some important context to consider: There have been no claims of widespread voter fraud in Minnesota. And, critically, the Justice Department is in the middle of suing nearly two dozen states, including Minnesota, for their full, unredacted voter files, which apparently would include dates of birth, driver license numbers and partial social security numbers. That’s the same information Bondi asked for in her missive to Minnesota Gov. Tim Walz.

Reminder: We’re heading toward a midterm election in November in which Republicans increasingly seem to be in trouble. This effort by Bondi certainly sounds as though the government is using the continued threat of ICE enforcement in the state as leverage to access election information — and potentially use it to sow doubts ahead of the elections. That would on brand for Trump. He already tried overturning an election.

The food assistance and Medicaid information is a reference to allegations of fraud in Minnesota. Fine — investigate fraud. But it’s an odd request to include on the list of demands amid the turbulence in Minnesota. As Walz said in a press conference Sunday: ”This has nothing to do with fraud… They’re not sending us forensic accountants.”

He also said that Minnesota already cooperates with the federal government on handing over criminals in the state’s jails — apparently an explanation of the “sanctuary” reference by Bondi. And then he offered a “pro tip” to the attorney general: “There’s two million documents we’re still waiting on in the Epstein files. Go ahead and work on those.” Hard to argue with that.

In her letter, Bondi said the federal government needs access to Minnesota voter data “to confirm that Minnesota’s voter registration practices comply with federal law.” Last year, the feds began trying to compile a national list of voters, as Trump has continued to claim that undocumented immigrants are voting — another way to undermine voters’ perception of the election.

The turmoil and violence in Minnesota is a stain on the country that has now taken two lives. The shooting death of Pretti must be investigated, openly and transparently, and the videos released so far appear to show an officer removing his gun before he was shot 10 times. Those responsible must be held accountable, That’s something that both Republicans and Democrats should be able to agree on.

Using the threat of a continuing surge of ICE agents as a bargaining chip against Minneapolis is a new low for the Justice Department — and an attempt by Bondi to weaponize the agency. But if this is about Bondi setting the stage for a challenge to the election in November, at least now we are on notice.

— The Miami Herald

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30 Jan 2026

Lisa Jarvis: The problem with that ‘Great Healthcare Plan’

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This month, as Americans who rely on Affordable Care Act plans opened their first bills of 2026 and experienced sticker shock, President Donald Trump began pitching them on an alternative: his “Great Healthcare Plan,” which would shift government support away from subsidizing insurance coverage toward putting money directly into accounts that consumers can use to pay for care.

The details, of course, are scant. But the concept of shifting government funds away from an approach that encourages comprehensive coverage to one that might leave many Americans behind is troubling.

Trump has long criticized the Biden administration-era subsidies that allowed millions of Americans to purchase better coverage at more affordable prices, arguing that they lined the insurers’ pockets while consumers’ costs rose. Although lawmakers are still exploring potential solutions to extend the subsidies, the president has threatened to veto any deal that materializes.

“I want to end this flagrant scam and put extra money straight into the health care savings accounts — in your name, and you go out and buy your own health care. And you’ll make a great deal, you’ll get better health care for less money,” he said in a video message this month.

So far, his plan to replace subsidies with Health Savings Accounts (HSAs) — tax-sheltered funds that can be invested and rolled over each year — amounts to little more than a list of bullet points. Among the unknowns are how much money people would receive each year, who would qualify for the help, and whether it would involve changes that expand the utility of HSAs, including whether they could be used to pay for care that falls outside of ACA guidelines (such as plans that can deny coverage based on preexisting conditions or fail to cover certain essential health care benefits).

That last part is important because, despite Trump’s claim that Americans will be able to “go out and buy your own health care,” current rules tightly restrict who is eligible for an HSA and how the money can be spent.

Currently, only people with a high-deductible health insurance plan can put money into an HSA, and the funds can only be used to pay for services, not premiums. That means the only ACA customers who could benefit from the government’s HSA contribution would be those enrolled in the lowest-tier (bronze) plans, which feature low monthly premiums but high deductibles. This year, people with a bronze plan will need to pay an average of $7,476 before their insurance starts covering care, according to KFF.

Diverting the money from subsidies to an HSA “is a reasonable approach for 80% of the population, and a terrible approach for 20% of the population,” says Gerard Anderson, a professor of health policy at Johns Hopkins University’s Bloomberg School of Public Health. Most of us don’t end up in the hospital or needing an expensive drug each year, meaning a savings account would likely cover our health care bills.

But that smaller group — the people who get in a car crash or are diagnosed with cancer — could be much worse off, Anderson says. And the problem is nobody has a crystal ball to predict who will wind up facing enormous health care costs.

Others agree with Anderson’s assessment. In a survey of health policy experts published last month in Health Affairs, 70% of respondents said that a plan that diverted the value of the subsidies into an HSA “would measurably worsen the affordability of health care for Marketplace enrollees.” Just 10% of those surveyed believed a shift to HSAs would improve affordability.

The rest of us could be worse off, too. Someone who is underinsured or uninsured still gets emergency care, but the cost is ultimately borne by insured people. Hospitals and providers eventually pass some of those costs on to private insurers through higher prices.

Health policy experts also point to more fundamental questions, such as, who, in the end, benefits most from HSAs? Among health care consumers, the vast majority of people with HSAs get them through their employer, and typically are wealthier, ahite or Asian, and in very good health, according to a recent analysis by the Government Accountability Office.

Meanwhile, the tax benefits of an HSA have primarily accrued to higher-income Americans, who can afford to put more money into them, not to lower-income people who have historically relied on subsidies to afford care and who might now be forced into this type of plan.

In other words, people with the most disposable income are by far the most likely to put enough money into an HSA to ensure that a health catastrophe doesn’t also lead to a financial one.

And some consumers might miss the fine print associated with their HSA. “The way HSAs are being marketed and discussed, it sounds a lot like free money to people — it’s not,” says Nicole Rapfogel, a policy analyst at the Center for Budget and Policy Priorities. A 2024 report from the Consumer Financial Protection Bureau found that many funds offered such low interest rates that the monthly fees exceeded the gains.

It’s true that the scenario would change if Trump’s plan involved overhauling the way HSA funds can be used, allowing Americans to use the payout to buy health insurance. Yet too many people might still gravitate toward cheaper, riskier plans — and that could end badly for everyone.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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