Dylan Scott

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Yes, Sean, as a millennial who is also a hypochondriac, I regret to inform you that younger people, people under 55, which is usually the definition of an early onset cancer case. are in fact getting cancer more often. There's a little couple of ways to slice it.

The Wall Street Journal ran an analysis last year of National Cancer Institute data, and the way they put it was one in five new colorectal cancer patients in the U.S. is under 55, which is twice the rate. that we saw in 1995. There was another study that found that, I think it was between 1990 and 2019, the rates overall of cancer among younger people had increased by 80%.

It seems like no matter how you look at it, and I looked at a variety of studies for my story, cancer rates among young people are increasing, which I don't know about you, I feel like fits with just my observations in the world.

Yeah, it's definitely something that's built slowly over time. I talked to a guy at Georgetown named John Marshall, and he's been in this field for decades, and he said at the beginning of his career, he never would have seen a cancer patient under the age of 50. But these days, he sees it all the time.

And the way he put it to me is that at least anecdotally, people who practice cancer medicine, who treat cancer patients, it's like everybody kind of started to notice at the same time about a decade ago, like, huh, it seems like I'm starting to get more interested. and more young people coming in with more advanced cancers and more aggressive cancers.

And so then we started to see some of this data that I'm referencing that sought to quantify how big has the change really been. And they did confirm that, yeah, this isn't just people's perceptions at the population level. There are higher rates of cancers among young people.

Colorectal cancer, I think, is the big one. It is the, like, if you look at the incident rates in some of these studies, besides breast cancer, it is the type of cancer that has the highest incidence among young adults. But it's not just colorectal cancer. It's Uterine cancers, gallbladder, kidney cancers. People might have heard about Dwayne Wade, who is like by this definition, a young adult.

It seems to be sort of up and down the digestive track where this seems to be happening, with the one exception is breast cancer, which we've continued to see a higher rate of breast cancer among young people over the same period. But if we set that aside, which is obviously like a big exception, it seems to be a lot happening, yeah, up and down the digestive track.

That's where we're seeing in particular these big increases over time among young people.

So this is maybe the most interesting thing that I learned in reporting out this study and talking to a bunch of these cancer researchers who are as befuddled by all of this as we are. So it seems that your individual risk of many different types of cancers actually depends on something that's totally out of your control, which is when you were born.

Like somebody who was born in 1975 had nearly twice the chance of developing like an intestinal cancer compared to somebody who was born in 1955, 20 years earlier. And likewise, if we look like at younger people, people born in 1990, they're at even a higher risk of developing cancers than those people born in 1955 or even 1975. a couple of things likely at work here.

One does seem to be like the the changes in food production and the proliferation of processed foods, which is obviously something that like basically if you eat in the modern world, you're consuming more processed foods than people used to. And so there have been like systematic reviews of the available literature, including one that was published just in 2022.

that have said, like, if you eat more deep fried fruits, if you eat more processed foods, if you eat foods high in fat, sugary drinks and desserts, and if you're really bad about eating fiber and things that are really good for your digestive system, you are more likely to develop cancer.

And so that tracks, when we think about the obesity crisis, we know that our diets have been getting worse and they've been contributing to all kinds of negative health outcomes like diabetes and heart disease. And it seems like cancer is another example of how these changes in our diet and our food production may be leading to adverse outcomes. There's also been a lot of focus on microplastics.

And we've likewise seen that those just have proliferated in the environment over the period from the 70s to today, where we've seen this big increase in cancer incidents among young people. And there was actually a specific paper published by a research team based in New Zealand that basically tracked the timeline of...

the multiplication of microplastics in the environment and the cancer rates among young people. And they basically found that they seem to be happening in parallel. It's an alchemy of all these things. It's a combination of we're eating worse. We're getting exposed to the stuff in our environment. We're still drinking a lot. We're not getting enough sleep.

We're probably not exercising enough either. And when you stir all of those things together, you have more young people developing cancer.

Look, it's really scary to be confronting these trends, but there is a lot of promising activity when it comes to both cancer diagnostics and cancer treatment. We are starting to make it easier for people to administer tests at home that might give them an idea of...

Either whether they, you know, there's something in their blood or their stool that indicates they may be developing cancer right now, or they can get tested for like their genetic background. And maybe they have just like those sort of built in risks because of their genes. And like, you know, there's blood tests that have been developed that are like really good at catching late stage cancers.

And now so the next, you know, the next frontier for them is trying to catch early cancers or like pre-cancerous growths. And so I think as those consumer products keep developing, that should allow us to screen more people, screen younger people, and hopefully catch some of these cancers earlier so that we can have better outcomes. And so that's on the diagnostic side.

In terms of treatment, I've been writing about this for 10 years now. There's been a ton of progress with what are called immunotherapies, which is the old way of treating cancer has been We're going to just blast this shit with as much radiation as we can find and hope that that kills the cancer because otherwise we don't know how to do it.

But it obviously has all of these really terrible side effects. People feel horrible, they lose their hair, whatever. And what we're trying to do now with these immunotherapies is like, let's remove radiation and all this chemical nastiness from the equation. Let's like train the body's immune system to fight these cancers on its own.

A lot of the improvements that we have seen to cancer prognoses, especially among older people, has been because we're developing these immunotherapies that are teaching the body how to fight the cancer by itself. And then when you combine things like

Genetic sequencing, like cancer, we talk about cancer as like one thing, but it's actually like, you know, thousands upon thousands of different diseases and being able to identify like, okay, we know you have like a tumor in your colon, but if we can test it genetically and figure out exactly what type of colon cancer it is, then we can get you, make sure we get you the exact right therapy that, you know, has these proteins or whatever that can better target that cancer.

And in fact, when they were criticized because foreign aid is such a trivial share of the overall federal budget, the defense was, yeah, it's small, but wait till you see where we get going. So it's definitely not just about USAID. This is a broader plan they have.

So I think the first step, and this is the thing that started on January 20th, as soon as Trump was inaugurated, is pulling funding. So the first thing they did was announce that they wanted a 90-day freeze on all grants, contracts, anything related to foreign aid.

I just really want to underline that they can't do this. This is money that was appropriated by Congress. Legally, the president does not have the power to stop funding that was authorized and mandated by Congress. But they did it.

And even though there have been court rulings against them doing this in general, there haven't been specific USAID rulings, but there have been rulings about this general power, they do not appear to have stopped. Step two is pulling staffing.

And so if you were trying to implement, say, like a delivery of food to Sudan in the middle of their civil war and possible famine, it's possible the person doing that is an actual federal employee. It's just as possible that that person was an institutional support contractor and they largely got furloughed by their organizations and were out of the building.

Then they started in on people who were actually in the civil and foreign service, who directly worked for the government and were important in running USAID. The Monday after the inauguration, so a week after inauguration, Trump or Trump's representatives within the aid infrastructure put about 60 people at the very top level of the civil and foreign service on administrative leave.

It's like trying to run a middle school if you've put the principal and all the vice principals on leave. And so you're in a situation of like pretty serious disarray to start with. And then the people who would have like walked you through that situation are gone. And that's, I think, when people realize this isn't just sort of a temporary funding freeze.

This is like a serious effort to dismantle this agency.

So I think a very important part of this has just been instilling a culture of fear. One question I've had throughout this is, like, why aren't the contractors suing? And I think part of why that hasn't happened is that people are terrified that if you make yourself a problem in this moment—

not only are you going to lose these contracts, you're never going to be a government contractor ever again. And not just at USAID, but across the government. And similarly, I think there was a very serious attempt to instill fear within the building. The stated purpose for putting the senior staff on administrative leave was that they were supposedly sabotaging the president's executive order.

And That was sort of a like putting ahead on a spike moment of if you try to sort of go against these executive orders because you think they're illegal or that they're going to get people killed, we're still willing to throw them on administrative leave and throw the agency into chaos. So what makes you think we won't do that to you too?

We've never seen something quite like this. I think it's a synthesis of a lot of ideas that you separately heard about on the campaign trail and that people who are now prominent in the Trump administration have been speaking about for a very long time. So one is impoundment.

This is the idea that when the Congress says, we want you to spend $45 billion on foreign aid, the president can choose to spend less of that if he wants.

This is more or less a crank theory that the Supreme Court unanimously ruled was not a thing and not constitutionally permissible in the 1970s when Richard Nixon tried to do it. Um, USAID was a test case for can we impound things and get away with it?

And I think there was a sense of a lot of people in the Trump administration that in the first term, they were frustrated again and again by what they call the deep state, which is just federal civil servants who are apolitical and, um, are responsible for saying when something is illegal or goes against existing regulation and were often a thorn in Trump's side.

And so I think they spent the four years out of power thinking a lot about how to dismantle that element of the civil service once they got back. And USAID, I think, is one interesting illustration of how that works.

In part because I think foreign aid is an incredibly important government function. I think it's important to spend every dollar as effectively as you can. And this has been a shared goal of USAID administrators during the Obama years. Trump's first USAID administrator, a guy named Mark Green, who was a former congressman from Wisconsin, said,

Under Samantha Power, who was Biden's, there's been just broad bipartisan agreement that not enough programs are grounded in high quality evidence like randomized control trials, that there's too much overhead with private contractors, that more programs should be run locally by specific countries rather than by Western contractors coming in. I think they made a lot of progress on that.

It's not perfect, but they launched sections like Development Innovation Ventures, which is a small unit within USAID that functions kind of like a venture capital fund and moves really fast and scales up sort of pilot programs.

They've done a lot to make it easier to apply for support in languages other than English or if you don't have government connections and don't know the magic words to say in your grant application.

What I think is particularly dangerous about this moment is that Trump has taken USAID, which used to be this like very bipartisan thing where there was like a broad bipartisan consensus that it's good. It needs to be reformed. We should do the following things to reform it. It'll take a while, but it's an important process.

He's taking it from something that everyone from like Lindsey Graham to every Democrat in Congress could agree on and made it a hyper-partisan political issue. That's really, really bad. When things have bipartisan consensus, they tend to get funded no matter what. When they are hyperpartisan, it fluctuates a lot.

And whether a kid in Kenya can get anti-HIV drugs depends on an election half a world away. It's a really grim situation to be in. However, the agency ends up at the end of this battle. Elon Musk said something about how it was finding the toughest guy in the prison yard and beating him up on your first day. The Musk idea really got under my skin because it's...

It's evocative because it's so much the opposite of what happened. This is like going up to the guy in a wheelchair in the prison yard and pushing him out of his wheelchair. And for no good reason. This does not meaningfully change our deficit situation. Any of the grants that they thought were dumb, sure, cancel those grants.

But they left people who were on HIV drug trials completely abandoned, cut off from drugs. There's no reason for that. It's just cruel.

So I don't know fully what's in the hearts of the Trump administration. But what I can say is that the last time around, they proposed very serious cuts to foreign aid. None of them passed Congress, but this was a very consistent proposal during Trump's first term.

I think also it's an easy target. Strong people coming in and finding the weakest part of the federal government and throwing it against a wall to make an example out of it.

I think we're starting to see that as a pattern that they're going to try to play out. And we don't really know how far it's going to go yet, but

Already, I've heard reports about Doge being in the building at the Social Security Administration, at the Treasury famously mucking with payments, at the General Services Administration, which controls like the physical buildings that a lot of the government is housed in.

They've started working at the Department of Health and Human Services on Medicare and Medicaid, which is a huge, huge chunk of federal government payments. So I think it's fair to say that this is something they want to do across the entire federal government.

Ja, genau. Es gibt eine ganze Eile an der Pharmazie, wo man für diese Über-die-Kontrolle-Medikamente für Allergien kaufen kann. Und ja, du hast Claritin, du hast Benadryl, du hast Xarelto. Diese lange Liste von Medikamenten. Aber Anihistamine können helfen, aber sie funktionieren wahrscheinlich nicht so gut, wie wir es gerne sehen würden.

Diese Allergien schlagen uns, wenn es Frühstück ist, wenn das Wetter schön wird. Alles, was wir tun wollen, ist, draußen zu sein. Anahistaminen sind besser als die, die wir vorher hatten, was im Grunde nichts war. Aber sie schneiden es nicht in diesen Tagen. Naselsprays sind furchtbar. Ich weiß nicht über dich, aber ich hasse es, Sachen auf meinen Nase zu sprayen.

I think a lot of people have been looking around for a while and thinking like, how can this be the best that we can do? This drug that maybe works like half the time or this sort of disgusting liquid that I have to shoot up my nostril. Like, we've got to be able to do better than that, right? And we're actually finally getting to the point where maybe we can't.

Sure. So there is an existing drug. It's called, I'm going to butcher the scientific name, but I'll get the brand name right. It's called Omolizumab. But it's sold by the brand name Zolaire, which is a lot easier to handle. So this was a drug. It was approved 20 years ago and it was approved for the treatment of asthma.

Now, as you can imagine, like asthma, you know, asthma reactions and allergic reactions tend to share a lot in common. And obviously people who have asthma tend to suffer more from seasonal allergies than people that don't have it. Und natürlich denken die Leute sofort, wir werden einen neuen Drogen entwickeln, wir werden von Anfang an starten und einen novelen Betrieb entwickeln.

Aber oftmals, in der Medizin, ist der erste Schritt, auf das, was du auf deiner Pharmazieschale hast, zu schauen und zu denken, okay, ist da irgendeine Art und Weise, dass das tatsächlich effektiv für das Betriebe sein könnte? Etwas, das vorher nicht genutzt wurde. Und so wurden einige präliminäre klinische Tests gehalten und sie zeigten wirklich erfreuliche Ergebnisse.

Die Leute, die Xolair genommen haben, die kurz bevor der Allergie-Saison begonnen hat, antworteten, dass sie weniger Symptome hatten, weniger Tage, in denen sie einen täglichen Antihistamin oder andere Allergie-Medikamente nehmen mussten. Sie antworteten einfach, dass sie eine bessere Lebensqualität während des Allergie-Saisons hatten.

Und so haben wir angefangen, einige Ärzte hier in den Vereinigten Staaten, Zolaire-Patienten für ihre saisonalen Allergien zu versorgen. Es wurde noch nicht von der FDA für diese Anwendung verabschiedet. Wiederum, das war eine Medikation, die zuerst für Asthma entwickelt wurde.

Aber diese Art von off-label Nutzung, wo wir einen existenten Drogen haben und herausfinden, dass es für etwas anderes funktioniert, das ist etwas, das immer passiert. Und eine Teil der Grund, warum Ärzte sich damit komfortabler fühlen, ist, dass Xolair ein Drogen ist, das seit 20 Jahren auf dem Markt ist. Und so, du weißt, es ist in den frühen Phasen.

Ich denke nicht, dass es noch weit verbreitet wird. Aber wir beginnen, ich habe mit Ärzten gesprochen, die beginnen, dies für ihre Patienten zu preskriben, speziell für saisonale Allergien.

Ja, also das ist eigentlich eine Injektion. Es ist keine tägliche Pille.

Ja, also das ist eine Art von Behandlung. Es heißt monoklonale Antibiotika. Im Grunde genommen, was monoklonale Antibiotika sind, sind diese speziell designten Proteine, die in deinen Körper gehen können und bestimmte biologische Reaktionen auslösen. Beispielsweise Allergische Reaktionen. Und so die Art und Weise, wie wir diese Proteine entwickeln, ist durch einen Schuss.

Und so wie zum Beispiel mit diesem 2022-Studium von Zolaire, haben Patienten eine 300 Milligramm Injektion ein paar Wochen vor der Pollen- und Grasallergie-Saison begonnen. So they weren't taking a pill every day. They got one injection and over the following months had much better luck with their allergy symptoms than the people who were relying on, you know, an antihistamine or a nasal spray.

Yeah, so what is really exciting about Zolaire... It can actually go in and stop your immune system from overreacting in the first place. It can stop the allergic reaction from even beginning by blocking certain receptors in your body. And so this shouldn't just stop allergic reactions from pollen or from grass or for some other like seasonal allergy, but it could also stop

Reaktionen zu Ernährungsallergien, wie Zwiebelnallergien oder Insektenallergien oder Moldallergien. Wegen der Art und Weise, wie sie funktionieren, stoppt das alle allergischen Reaktionen. Es geht nicht nur darum, dass die Histamin-Erlösung nach der Reaktion bereits begonnen hat und die Art und Weise, wie Claritin oder Benadryl.

Und so scheint es zumindest plausibel, dass man diese Injektion bekommen kann. Und zumindest für einen bestimmten Zeitraum würde es jede allergische Reaktion stoppen. Nicht nur Pollen, sondern auch Ernährungsallergien, Insektenallergien, Moldallergien. Und das macht sie fast wie ein All-in-One genügendes Allergien-Wunder-Druck, das wir noch nie gehabt haben.

Is this expensive? It is expensive. The list price especially is high. And that's why I do think going forward, health insurance coverage will be really important. So the list priced on Zolaire is $1,500 a pack. Natürlich müssen die Menschen, die diese Medikamente für ihre Asthma versorgen, nicht unbedingt diesen Preis bezahlen. Aber das ist das Problem mit off-label Nutzung.

Die Ärzte fühlen sich zufrieden, Zolaire für Allergien zu benutzen, weil sie diese Studien gesehen haben, die zeigen, dass es wirklich effektiv ist. Aber aus der Sicht der Gesundheitsversicherer ist es so, dass sie sagen, warte mal, du preskribierst nur diesen Drogen, der nicht von der FDA für diesen Nutzung verabschiedet worden ist. Das war ein Asthma-Druck.

Warum würden wir das für saisonale Allergien beantworten? Aber wir wissen es nicht. Wir sind immer noch in diesem Transitionstermin.

Ich denke, es ist wert, über die Reihe der Forschung zu denken, die zu einem neuen Drogen entwickelt wird. Und fast jeder Drogen, der in den Vereinigten Staaten je entwickelt worden ist, begann... Seine Grundlage basierte auf der Wissenschaft, die von der föderalen Regierung gefördert wurde.

In vielen Fällen für eine klinische Prüfung wie diese, ist es die pharmazeutische Firma, die den Befehl verweigert. Because they want to get a drug approved so they can eventually sell it. But if we take the longer view, we so desperately need this kind of government-funded research to give us new ideas about how we could better treat all kinds of things, including allergies.

And my fear would be that maybe not tomorrow, maybe not a year, even five years from now, but ten years from now, suddenly the pipeline for allergy treatments is drying up. Dylan Scott, thank you so much for explaining this to us. Thank you for having me, J.Q.

TSMC, the big Taiwanese chip maker, has a plant in Arizona and they're saying that their workers there are as good as their workers in Taiwan and it's all going according to plan.

That's not something that I think anyone voted on in 2024, but making sure that the world has a process to build these things that the world runs on that is not entirely located on a tiny island that is constantly on the verge of being invaded.

It's not great. The Inflation Reduction Act was all carrots and no sticks. And I think to some degree that was a smart political decision. The sticks in this case would have been something like a carbon tax, something like cap and trade, something that actually put a price on polluting. And it became clear that there weren't the votes for that.

So there was a decision made to do this entirely through compliments and roses. Instead of making it more expensive to drive a gas car, you make it cheaper to buy an electric car. Instead of making it more expensive to run a natural gas plant, you make it cheaper to run a solar plant.

The issue is loans. You just need to buy things that are really expensive upfront. And so having to pay more interest on those loans is really, really bad. And they had to pay a lot more interest because there was a lot of inflation. And to fight the inflation, the Fed had to raise interest rates.

And so it's this like one hand of the Biden administration's policymaking that sort of overheated the economy, led to inflation, raised interest rates. That is then sort of helping to strangle another part of the economy that more than the rest of the energy sector really relies on low interest rates to succeed.

Obama got a lot of crap for not being willing to do as much with executive power as a lot of sort of activists wanted him to do. And I think the experience with trying to use executive power a lot more under Biden sort of gave us one answer of why. I think a lot about the student loan situation.

They canceled a lot of debt. They did not cancel all of it. And so there was still a lot of discontent among activists who were calling for this. The Supreme Court said it was illegal for them to do this. And so sort of a lot of their efforts got overturned and just didn't happen.

And at the same time, while this was happening, there was this colossal screw up within the Department of Education around FAFSA, which is the financial aid form. Just like hundreds of thousands of people applying for college financial aid didn't get it or were severely delayed because the department was sort of backed up in processing it.

I think there's a lot of indications that that happened because all their energy was on the student loan thing. It turns out they can't do that the Supreme Court says is illegal, but they spent all their time on it and they weren't doing the normal functioning of the department of getting financial aid to people who need it right now. I think that's a real cautionary tale.

You need to just run the government well. And all these... sort of exotic uses of presidential powers to do things that Congress won't let you do. There's no magic wand.

I think his age probably has something to do with it. But I think something you hear from both admirers and critics of Joe Biden is that he goes where the party's going. In the 80s, when you had to be sort of like a moderate Democrat to get anywhere, he was talking about the death penalty and being tough on crime.

Then you move to the Obama years, and he's like a loyal Obama Democrat.

So I think there's sort of the causes of the weakness and there's the symptoms of the weakness. And I think the causes of the weakness, there's a bunch. Joe Biden is really old. Like, it's a hard thing to get around.

You move to 2020 and he sort of soaks up a lot of this like Bernie and Warren energy and moves left during the general election in a kind of surprising way.

He sort of moves with the party. And I think that is a very sensical thing to do as a safe state Democrat in the Senate. Like, that is probably the optimal strategy. It's really bad in an executive. You need someone who has opinions.

Well, nothing like Charlottesville happened when Biden was president, so I'll give him that in the very most narrow of senses. I think...

If you think more broadly as the Trump era was an era not just of sort of organized racism, but of corrupt patronage, sort of familial-based circles of nepotism and self-dealing, I found his decision to pardon Hunter predictable, but sort of the ultimate punchline on that aspiration.

If you're going to run against someone because you think that they don't believe in the rule of law and that they put their cronies and their family ahead of the common good to then go around and pardon your son for crimes that he for sure did. Like, what are we doing here?

I think there's all kinds of people who are probably going to be unduly prosecuted for their crimes in the Trump years. None of them got pardons. I guess we'll still see. But he did pardon his son. That seemed important to him. And it's not the biggest thing in the scheme of his administration, but I think a major feeling I have about the Biden years is I was lied to.

And I think being the president is a very hard and demanding job. And the amount of energy and focus you're able to bring to it really affects how impactful you can be. Bill Clinton was famous for staying up till 2, 3 in the morning, like, poring over policy documents with aides, trying to sort things out. But Biden seems like he was perhaps the opposite extreme.

I was lied to about what you were going to do. I was lied to about the extent of your mental capabilities and the degree of your aging. And that was a moment of, right, this is how it feels to be lied to. This is how it feels to be cheated. Dylan Matthews, I'll never lie to you.

There's been some reporting from the Wall Street Journal that a lot of decisions got devolved down to his national security advisor or his economic counsel that ordinarily would be decisions for the president, that he had sort of good days and bad days, days when he could hear stuff and days when he couldn't.

I admire their loyalty to their boss, but I think Biden is... a pretty mid-tier, mediocre president. I don't think he's awful. I don't think he's a horrible threat to freedom the way that you might hear on Truth Social. The main way I would describe Joe Biden is that he was an unusually weak president.

That's going to make you sort of weaker and less effective. But I think a lot of it also has to do with his position within the party. If you go back to the 2020 primary, it was not as though Joe Biden won a sweeping mandate that showed he was much more popular than everyone else running against him.

I think that left him sort of owing a lot of people a lot of favors and who had to manage a lot of different factions. And I think that that put him in less of a good position to make difficult decisions and expect people to follow him.

So let's, in our heads, go back to January 2021. Vaccine distribution.

Things are maybe starting to open up, but they kind of shouldn't. People are largely locked down, offices are not reopened. The American Rescue Plan was Biden's sort of stimulus package for that moment. And it was a mix of a lot of different things.

But there was a lot of other parts, too. They gave a lot of money to states to spend as they saw fit. There was a lot of funding for programs like food stamps, Medicaid. There was also an expansion of the child tax credit, which did a lot to cut poverty that year.

It was a very, very big package. It was about $1.9 trillion.

So Biden's line was, this is what we need to emerge from this catastrophe. It was very much like, we're in an emergency. Yes, this is a massive bill, but we need a massive bill to get out of this. I want to be clear that I was saying that in the moment. A lot of people were saying that in the moment. But there were people at the time who were saying, maybe this is too big.

Larry Summers is probably the most famous of them, but was warning that This was such a massive package that it would predictably cause inflation. And at the time, I thought that was ridiculous. I no longer think it was ridiculous.

Yeah, my brand as a journalist is I'm wrong a lot. I don't know why people keep paying me for that, but...

And he was, in many important moments, loath to decide when we really needed a president to decide. And I think that ultimately made him less effective than he could have been in the moment.

So I don't know. I know a lot of people who are very enthusiastic about the Inflation Reduction Act. I can't name a single one of them who thinks it reduced inflation. I think there's like near unanimous agreement that that was like a marketing exercise. Yeah, a good one, maybe. But yeah, I think...

The core of my critique of Biden is his handling of the Build Back Better process, that this was his big initiative domestically in the first two years. He had a congressional majority. It was like the two years when Obama passed Obamacare or George W. Bush passed the Bush tax cuts, Trump passed the Trump tax cuts.

It was this window that presidents often get where Congress is on their side and they can pass something big domestically. I think the big error of Biden is that Build Back Better from the beginning was not one thing. It was a hodgepodge of a lot of different things.

Nearly every Democratic priority. And when it became clear that they could not do all of those things just politically, that they didn't have the votes to pass everything they wanted... they never decisively made a choice to do one of them and to do it well.

And the problem was they had a very thin majority in the Senate that included sort of two problem senators in Kyrsten Sinema of Arizona and Joe Manchin of West Virginia. December 2021, Manchin made an offer that would include universal pre-K permanently, as well as expanded health care subsidies and clean energy credits. So it's a lot of what they want. It's not everything.

Biden said no and put out a statement blaming Manchin for the impasse.

And Manchin went on Fox News and told Biden the bill was dead. I cannot vote to continue with this piece of legislation. I just can't. I've tried everything humanly possible. I can't get there. And then Biden put out another statement calling Manchin a liar. Saying Manchin's comments were, quote, at odds with his discussions this week with the president. And that it all broke down.

Biden, despite decades in the Senate, knowing that senators are petulant little babies who you have to appease, just like didn't do it. And I think to some degree, this speaks to his weakness is reading accounts of this. He just comes across as a guy who could not stand people being mad at him.

And that's a person who cannot make clear decisions, because if you make clear decisions, someone is going to be disappointed by them.

So I'll disagree with one part of that, which is just to say that I think while the actual evacuation from Afghanistan was bungled, just choosing to go through with withdrawing showed more decisiveness than most American presidents had showed on Afghanistan for the previous two decades. Fair. Yeah. But I think on Israel and on Ukraine, there's definitely something to that.

Biden embarked on a strategy of sucking up pretty relentlessly to Netanyahu, even as tens of thousands of civilians were being killed by bombs. That is an important part of his legacy. On Ukraine, I do think they've been weirdly coy about releasing certain weapons that the Ukrainians need.

Things like ATAKMS and F-16s took a while for the US to agree to send them because they were worried about Russia's response. It sort of speaks to this indecisive, not willing to take a clear stand mindset that they brought to a lot of issues. Like, do you want to win or not? And similarly in Israel, like, do you want to stop the killing or do you not?

So I think I want to speak up having just trashed it for the American Rescue Plan here. What? So some movies that I think are sort of okay, I think are okay because they're like boring and fine. And others I think are okay because some parts I think are brilliant and other parts I think are terrible.

yeah and they just like exist in the same movie and the american rescue plan is like one of those movies um it's the megalopolis of bills so go back to the club wow it did i think uh increase inflation uh in in a way that proved very politically unpopular it also ended what recession existed and got us back to sub 4% unemployment, like really, really fast.

Wages started growing, especially at the bottom. You saw like a big reduction in inequality in the years like 2021 to 2024. That's a hard thing to do. We didn't do that in the 2010s. I think that's one part that I think will endure. I think the commitment to bringing chip manufacturing specifically back to the US seems like it's been more successful than I thought it would be.