Jamelle Bouie is a regular opinion columnist for The New York Times. He is an original thinker. He doesn’t run with the pundit crowd. I subscribe to his newsletter as part of my New York Times subscription.

I am grateful for his reminder that the party in power usually loses seats in the midterm. If that happens in 2026, Trump’s ability to do crazy things will be limited. But he does have time in the coming year to deliver another tax cut for billionaires.

He writes:

The annals of American political history are littered with the remains of once-great presidential mandates.

Franklin D. Roosevelt’s smashing 1936 re-election did not, to give a famous example, give him the leverage he needed to expand the Supreme Court, handing his White House a painful defeat. Lyndon Johnson’s Great Society generated immense conservative opposition, and his momentum could not survive the 1966 Republican wave. Ronald Reagan was stymied by Democratic gains in the first midterm elections of his presidency. Bill Clinton was famously cut down to size by the Newt Gingrich revolution of 1994. And Barack Obama was shellacked by Tea Party extremists in 2010.

“I earned capital in this campaign, political capital, and now I intend to spend it,” George W. Bush declared in 2004 after he became the first Republican to win re-election with a majority of the popular vote since Reagan. By the summer of 2005, Bush’s approval had crashed on the shoals of a failed effort to privatize Social Security. In the next year’s elections, Republicans lost control of Congress.

There is no evidence that Donald Trump is immune to this dynamic. Just the opposite: His first term was a case study in the perils of presidential ambition. Not only were his most expansive plans met with swift opposition, but also it is fair to say that he failed, flailed and faltered through the first two years of his administration, culminating in a disastrous midterm defeat.

Trump has even bigger plans for his second term: mass deportations, across-the-board tariffs and a campaign of terror and intimidation directed at his political enemies. To win election, however, he promised something a bit more modest: that he would substantially lower the cost of living. According to Sam Woodward in USA Today:

“Prices will come down,” Trump also told rallygoers during a speech in August. “You just watch. They’ll come down, and they’ll come down fast, not only with insurance, with everything.”

Now Trump says this might not be possible. Asked by Time magazine if he thinks his presidency would be a failure if the price of groceries did not come down, he said: “I don’t think so. Look, they got them up. I’d like to bring them down. It’s hard to bring things down once they’re up. You know, it’s very hard.”

At the same time that Trump won’t commit to a key promise of his campaign, he is gearing up to deliver on mass deportations, a policy position that many voters seem to treat as just blather.

When you take all of this together with policies — such as large tariffs on goods from Canada, Mexico and China — that are more likely to increase than lower the costs of most goods and services, you have a recipe for exactly the kind of backlash that eventually hobbles most occupants of the Oval Office.

The American public is exceptionally fickle and prone to sharp reactions against whoever occupies the White House. It wants change but continuity, for things to go in a new direction but to stay mostly the same. It does not always reward good policy, but it usually punishes broken promises and perceived radicalism from either party.

Ignore for a moment the high likelihood of chaos and dysfunction from a Trump administration staffed with dilettantes, ideologues and former TV personalities. It appears that what Trump intends to do, come January, is break his most popular promises and embrace the most radical parts of his agenda.

I can’t end this without conceding the real possibility that the basic feedback mechanisms of American politics are broken. It is possible that none of this matters and that voters will reward Trump — or at least not punish him — regardless of what he does. It’s a reasonable view, given the reality of the present situation.

And yet the 2024 presidential election was a close contest. The voting public is almost equally divided between the two parties, so Trump has little room for error if he hopes to impose his will on the federal government and make his plans reality.

If Americans are as fickle as they’ve been, then Trump’s second honeymoon might be over even before it really begins.

Rachel Maddow describes the six most important things to know about Tulsi Gabbard, nominated by Donald Trump to be Director of National Intelligence. The job requires a person with experience in national security. She has none but that’s the least troubling thing about her.

Ashton Pittman is the news editor of the Mississippi Free Press and a fine writer. I get my news about Mississippi by reading MFT, reported by people who live there. Pittman describes in this article why he debated whether to leave Twitter. When Musk bought Twitter, he knew it was going to be bad. He had spent years building up a following there and didn’t want to give it up. He investigated other social media platforms, but they weren’t right.

Then came the 2024 election, and Twitter turned into a political platform that favored Trump, where nasty trolls and bots created a toxic atmosphere.

Ashton joined BlueSky and very quickly gained a large number of followers close to what he (and the Mississippi Free Press) had had on Twitter.

He writes:

For a long time, it seemed like nothing was going to replace Twitter, even as it further devolved into a hellscape that seemed as if it were overrun by the trolls of 4chan, the neo-Nazis of Stormfront and the dullest AI bots Chat GPT ever powered. Twitter transformed into X, a place where racism, misogyny, homophobia and especially transphobia run rampant under the guise of “free speech,” but where using the word “cisgender” can get your account restrictedbecause Musk (who has described his very-much-alive transgender daughter as “dead”) considers it a slur.

I had really wanted one of the Twitter alternatives to take off, but one of the biggest impediments was the lack of buy-in from major journalists, publications, celebrities and other figures who could draw audiences away. A familiar pattern developed: People would leave X in hopes of joining another platform, then come back. 

Then came the election. Twitter turned into a Trump propaganda site. And Ashton was done.

But you know what I really enjoy about BlueSky? It doesn’t pigeonhole me. On other platforms, particularly X, you choose one facet of yourself and that’s the following you get, and the algorithm recommends you based on that. On BlueSky, I get to be a Mississippi journalist whose news stories draw engagement from people who care about news, but I also get to be a film photographer whose posts about my black-and-white film adventures spark conversations, too. None of us is just one thing, no matter what some lousy algorithm thinks, and it’s affirming to be able to build communities around shared interests beyond just news and politics. Social media should be social, not anti-social….

My experience as a journalist on BlueSky has reminded me that my job is to provide good information to those who want it, not to argue with trolls and validate attention-seeking behavior from the worst people on the internet. My desire to reach a diverse audience does not have to entail subjecting myself to constant abuse. I am not obligated to stay on a platform where Nazi trolls with 1488 in their usernames and cartoon frogs as their profile images regularly hurl the word “fagg-t” at me and issue veiled threats. I do not have to entertain the endless stream of incels who think “soy boy” is some sort of profound insult. I do not have to accept being under the thumb of an algorithm that prioritizes crypto scams, AI bots and conspiracy theorists over my voice.

And you know what? You don’t either.

Some of the smarter people among us have said that BlueSky is an echo chamber. Well, right now, it’s a place where I hear the echoes of artists, writers, cinephiles, scientists and neighbors caring about their neighbors. And that’s a hell of a lot better than being trapped in a chamber that’s increasingly filled with the echoes of Adolf Hitler.

So farewell, Twitter. I’m off to bluer skies.

Writing at Wonkette, Gary Legum describes what Elon Musk will get for the $250 million he invested in Trump’s campaign. He may seek waivers from regulations, he may seek contracts. Trump is very grateful. No one, to our knowledge, has ever given so much money to a Presidential campaign. What will he get in return?

Legum writes:

Compare and contrast if you will the two senators from the great state of Connecticut.

The first senator, Richard Blumenthal, spent time this week rallying support for his Kids Online Safety Act (KOSA) by verbally fellating sentient staph infection Elon Musk, calling him “the foremost champion of free speech in the tech industry.” This was a naked attempt to get Musk to try and influence the other tech bros infesting the incoming administration to support the bill even though any sort of regulation of the Internet goes against their core beliefs. Unless the regulations somehow bother liberals, in which case they get a thumbs-up.

Thus did Blumenthal violate yr Wonkette’s rule about lending any legitimacy to the right-wing billionaire who just spent a quarter of a billion dollars to buy the election for the other party and has been rewarded with the highest of high-level access to the incoming president. We don’t particularly care about the cause one is fellating in support of, although KOSA is a problematic bill that no one should want passed. But that’s a whole other post.

Now consider Connecticut’s other senator, Chris Murphy. Thursday night on MSNBC, Murphy told Alex Wagner in no uncertain terms that America is about to become the sort of oligarchy represented by Musk’s ascent to Trump’s inner circle that we used to be able to at least pretend was beneath us:

“What it means is a handful of really rich people run the government, and they steal from ordinary people using their access to government in order to make themselves and their families even richer.”

Whoa, that’s no way to get invited to the DOGE Christmas party, Senator.

Murphy’s description really applies to how our government has been for some decades, the difference being that now we have an incoming president and administration that are not bothering to pretend otherwise. But okay, we won’t split hairs with Murphy. We are where we are, so any tiny voices in opposition to the coming nightmare are appreciated.

Anyway, Murphy got us thinking that you really have to hand it to the sentient staph infection. Musk spent a quarter of a billion dollars buying himself a president who will roll over at the soft snap of the billionaire’s doughy fingers, and it has paid off again and again and again. And Sweet Potato Suharto’s coronation isn’t even for another five weeks.

A quarter of a billion dollars. Thanks a pantsload, Anthony Kennedy and the Supreme(ly Stupid) Court.

The latest atrocity to benefit Musk is a report on Friday that the incoming administration may drop the federal government’s car crash reporting rules. See, Tesla has a minor problem, in that it has had to report over 1,500 crashes to the National Highway Traffic Safety Administration, partly because the automated-driving systems that are supposed to set the cars apart from normie vehicles don’t work very well, turning them into fiery mobile deathtraps and causing untold misery and suffering to not just crash victims but their families as well.

Musk probably doesn’t believe this, but pain and suffering by humans is in fact bad. It’s true! Just ask us!

Please open the link to finish reading.

Maurice Cunningham, a retired professor of political science, reviewed the Boston Globe’s bad habit of treating billionaire-funded groups as authoritative on education issues.

He wrote recently, as posted on the blog of the Network for Public Education:

Maurice Cunningham finds that looking at the Boston Globe tells us too much about the folks who think education is just to prepare children to become useful tools for business. Reposted with permission. 

When I was a kid in the Sixties we’d occasionally hear stories about some poor Japanese soldier, abandoned on a Pacific island after WWII, finally being rescued while believing he was still fighting the war. That’s sort of where the Boston Globe’s post-MCAS coverage is. But as a lesson in the biased media approach to interest group coverage, it is a real education.

The latest is by reporter Mandy McLaren, With no more MCAS requirement, graduation standards vary widely among state’s largest districts. What interests me is the sources used in the story, which include a heavy presence of billionaire funded and tax deductible “non-profits” aka interest groups. That’s because non-profit, while it sounds eleemosynary ( I just wanted to use that word in a sentence) actually represents the policy preferences of the moneyed few; or as the media like to say the Massachusetts business community; or as I like to say: capital.

Let’s meet the Globe’s eleemosynary sources starting with “The risk moving forward, said Andrea Wolfe, president and CEO of MassInsight, a Boston-based education nonprofit.” Mass Insight’s donors include the Bill and Melinda Gates Foundation and the Boston Foundation (you will remember them from The Globe Puffs Up Another Dubious “Science of Reading” Program) and Fidelity Investments Charitable Gift Fund (also from Puffs Up).

Then there is “Erin Cooley, Massachusetts managing director for Democrats for Education Reform, a group that advocated against Question 2.” Don’t make me go through the Oligarch Party funding of Democrats for Education Reform again, but you can catch the gist at Democrats for Education Reform: Let’s Meet the Funders and How to Understand Democrats for Education Reform Using Two Quotes from Democrats for Education Reform.

Finally,

Erika Giampietro, executive director for the Massachusetts Alliance for Early College, said she hopes whatever path the state takes next focuses on the ‘competencies’ students graduate with, especially those that truly matter in the real world.”

“[Employers] are not saying, ‘I wish kids had taken two years of foreign language, four years of English and four years of math.’ They’re saying, ‘Yeah, kids aren’t coming with strong enough executive functioning and clear enough communication skills and showing up to work every day and realizing how important that is to be on time,‘” Giampietro said.

Funders include Gates, Boston Foundation, Fidelity Charitable Gift (also in Puffs Up).

Employers=business=capital. Ms. Giampietro offers the interest group frame: employers would like taxpayer paid employee training (while not increasing taxes). The focus is employers and not children. If you read enough of these stories, that comes through. Not that kids should be introduced to foreign cultures, discover a love of literature or art, or heaven forbid, question the prevailing structures of society. Such concerns are not the “the real world” issues of business.

The article did quote Max Page, president of Massachusetts Teachers Association. But when you also quote two superintendents who miss MCAS and three eleemosynary business group interests, well . . . does three from capital equal one from labor?

Money never sleeps. Follow the money.

“Imagine movie critics who either did not know, or did not care to know, that movies have producers, script writers, directors, financiers, or casting directors, and so based their reviews on the premise that it was the actors alone who created the storyline, dialogue and mise en scene, and that the most successful actors were those who best understood the audience. That is essentially how all politics is covered in 21st century America.”—Michael Podhorzer.

Network for Public Education

P.O. Box 227
New York, New York 10156
(646) 678-4477

President Biden announced today that the government will forgive student debt for another 54,900 borrowers, all of whom took jobs in public service to qualify.

The U.S. Department of Education released a statement:

The Biden-Harris Administration announced today the approval of $4.28 billion in additional student loan relief for 54,900 borrowers across the country who work in public service. This relief—which is the result of significant fixes that the Administration has made to the Public Service Loan Forgiveness (PSLF) Program—brings the total loan forgiveness by the Administration to approximately $180 billion for nearly five million Americans, including $78 billion for 1,062,870 borrowers through PSLF. 

 “Four years ago, the Biden-Harris Administration made a pledge to America’s teachers, service members, nurses, first responders, and other public servants that we would fix the broken Public Service Loan Forgiveness Program, and I’m proud to say that we delivered,” said U.S. Secretary of Education Miguel Cardona. “With the approval of another $4.28 billion in loan forgiveness for nearly 55,000 public servants, the Administration has secured nearly $180 billion in life-changing student debt relief for nearly five million borrowers. The U.S. Department of Education’s successful transformation of the PSLF Program is a testament to what’s possible when you have leaders, like President Biden and Vice President Harris, who are relentlessly and unapologetically focused on making government deliver for everyday working people.” 

The Trump Administration has promised to cease any student loan forgiveness. Project 2025 treats loan forgiveness as a racket and a political trick meant to buy votes. Since Biden has taken action after an election that his party lost, it’s hard to know whose votes he is “buying.” It seems more likely that he is keeping a promise made by the government to students who agreed to enter public service jobs after taking a loan. They kept their promise. Now Biden is keeping the government’s promise to them.

Chris McNaighton was an athlete in college and led an active life until tragedy struck: he was diagnosed with a painful, debilitating disease called ulcerative colitis. He was so disabled by its symptoms that he became housebound. After trying many treatments and doctors, he finally went to the Mayo Clinic, where a specialist prescribed a mix of drugs that were very expensive but saved his life.

Chris was covered by his parents’ insurance; they were both faculty members at Penn State. Chris enrolled at Penn State, so he was covered as a student as well.

UnitedHealth did not like paying the cost of Chris’s treatment. It was $2 million a year. It had Chris’s claims reviewed by doctors who denied them and said he could do with a lower dose, which would cost less. The doctor at Mayo responded that lower doses were ineffective.

Chris’s parents sued UnitedHealth.

Chris’s story was told by ProPublica.

It begins:

Christopher McNaughton suffered from a crippling case of ulcerative colitis — an ailment that caused him to develop severe arthritis, debilitating diarrhea, numbing fatigue and life-threatening blood clots. His medical bills were running nearly $2 million a year.

United had flagged McNaughton’s case as a “high dollar account,” and the company was reviewing whether it needed to keep paying for the expensive cocktail of drugs crafted by a Mayo Clinic specialist that had brought McNaughton’s disease under control after he’d been through years of misery.

In the wake of the brutal murder of United Healthcare’s CEO, there has been an outpouring of stories about UnitedHealthcare’s strategy of denying claims to increase profits.

ProPublica wrote about a mother in Louisiana who counted on UHC to pay the cost of behavioral therapy for her autistic son. The therapy offered promise of helping him learn necessary skills. But UHC, which made $16 billion in profits last year, denied the claim.

Thom Hartmann wrote an excellent description of our very expensive and often ineffective healthcare industry. Because we have swallowed the industry propaganda that “Medicare for All” would be “socialist,” that it would be hobbled by bureaucracy, we have allowed for-profit companies to dominate the marketplace.

As a result, we have a very expensive healthcare system, in which people’s claims for coverage are frequently denied. Many people pay through the nose and don’t get the medical care they need because of their insurance companies.

His article is titled: “When Profits Kill: The Deadly Costs of Treating Healthcare as a Business.”

Hartmann wrote:

The recent assassination of the CEO of UnitedHealthcare — the health insurance company with, reportedly, the highest rate of claims rejections (and thus dead, wounded, and furious customers and their relations) — gives us a perfect window to understand the stupidity and danger of the Musk/Trump/Ramaswamy strategy of “cutting government” to “make it more efficient, run it like a corporation.”

Consider health care, which in almost every other developed country in the world is legally part of the commons — the infrastructure of the nation, like our roads, public schools, parks, police, military, libraries, and fire departments — owned by the people collectively and run for the sole purpose of meeting a basic human need.

The entire idea of government — dating all the way back to Gilgamesh and before — is to fulfill that singular purpose of meeting citizens’ needs and keeping the nation strong and healthy. That’s a very different mandate from that of a corporation, which is solely directed (some argue by law) to generate profits.

The Veterans’ Administration healthcare system, for example, is essentially socialist rather than capitalist. The VA owns the land and buildings, pays the salaries of everybody from the surgeons to the janitors, and makes most all decisions about care. Its primary purpose — just like that of the healthcare systems of every other democracy in the world — is to keep and make veterans healthy. Its operation is nearly identical to that of Britain’s beloved socialist National Health Service.

UnitedHealthcare similarly owns its own land and buildings, and its officers and employees behave in a way that’s aligned with the company’s primary purpose, but that purpose is to make a profit. Sure, it writes checks for healthcare that’s then delivered to people, but that’s just the way UnitedHealthcare makes money; writing checks and, most importantly, refusing to write checks.

Think about it. If UnitedHealthcare’s main goal was to keep people healthy, they wouldn’t be rejecting 32 percent of claims presented to them. Like the VA, when people needed help they’d make sure they got it.

Instead, they make damn sure their executives get millions of dollars every year (and investors get billions) because making a massive profit ($23 billion last year, and nearly every penny arguably came from saying “no” to somebody’s healthcare needs) is their real business.

On the other hand, if the VA’s goal was to make or save money by “being run efficiently like a company,” they’d be refusing service to a lot more veterans (which it appears is on the horizon).

This is the essential difference between government and business, between meeting human needs (social) and reaching capitalism’s goal (profit).

It’s why its deeply idiotic to say, as Republicans have been doing since the Reagan Revolution, that “government should be run like a business.” That’s nearly as crackbrained a suggestion as saying that fire departments should make a profit (a doltish notion promoted by some Libertarians). Government should be run like a government, and companies should be run like companies.

Given how obvious this is with even a little bit of thought, where did this imbecilic idea that government should run like a business come from?

Turns out, it’s been driven for most of the past century by morbidly rich businessmen (almost entirely men) who don’t want to pay their taxes. As Jeff Tiedrich notes:

“The scariest sentence in the English language is: ‘I’m a billionaire, and I’m here to help.’”

Rightwing billionaires who don’t want to pay their fair share of the costs of society set up think tanks, policy centers, and built media operations to promote their idea that the commons are really there for them to plunder under the rubric of privatization and efficiency.

They’ve had considerable success. Slightly more than half of Medicare is now privatized, multiple Republican-controlled states are in the process of privatizing their public school systems, and the billionaire-funded Project 2025 and the incoming Trump administration have big plans for privatizing other essential government services.

The area where their success is most visible, though, is the American healthcare system. Because the desire of rightwing billionaires not to pay taxes have prevailed ever since Harry Truman first proposed single-payer healthcare like most of the rest of the world has, Americans spend significantly more on healthcare than other developed countries.

In 2022, citizens of the United States spent an estimated $12,742 per person on healthcare, the highest among wealthy nations. This is nearly twice the average of $6,850 per person for other wealthy OECD countries.

Over the next decade, it is estimated that America will spend between $55 and $60 trillion on healthcare if nothing changes and we continue to cut giant corporations in for a large slice of our healthcare money. 

On the other hand, Senator Bernie Sanders’ single-payer Medicare For All plan would only cost $32 billion over the next 10 years. And it would cover everybody in America, every man woman and child, in every medical aspect including vision, dental, psychological, and hearing. 

Currently 25 million Americans have no health insurance whatsoever.

If we keep our current system, the difference between it and the savings from a single-payer system will end up in the pockets, in large part, of massive insurance giants and their executives and investors. And as campaign contributions for bought off Republicans. This isn’t rocket science.

And you’d think that giving all those extra billions to companies like UnitedHealthcare would result in America having great health outcomes. But, no.

Despite insanely higher spending, the U.S. has a lower life expectancy at birth, higher rates of chronic diseases, higher rates of avoidable or treatable deaths, and higher maternal and infant mortality rates than any of our peer nations.

Compared to single-payer nations like Canada, the U.S. also has a higher incidence of chronic health conditions, Americans see doctors less often and have fewer hospital stays, and the U.S. has fewer hospital beds and physicians per person.

No other country in the world allows a predatory for-profit industry like this to exist as a primary way of providing healthcare. Every other advanced democracy considers healthcare a right of citizenship, rather than an opportunity for a handful of industry executives to hoard a fortune, buy Swiss chalets, and fly around on private jets.

This is one of the most widely shared graphics on social media over the past few days in posts having to do with Thompson’s murder…

Sure, there are lots of health insurance companies in other developed countries, but instead of offering basic healthcare (which is provided by the government) mostly wealthy people subscribe to them to pay for premium services like private hospital rooms, international air ambulance services, and cosmetic surgery. 

Essentially, UnitedHealthcare’s CEO Brian Thompson made decisions that killed Americans for a living, in exchange for $10 million a year. He and his peers in the industry are probably paid as much as they are because there is an actual shortage of people with business training who are willing to oversee decisions that cause or allow others to die in exchange for millions in annual compensation.

That Americans are well aware of this obscenity explains the gleeful response to his murder that’s spread across social media, including the refusal of online sleuths to participate in finding his killer.

It shouldn’t need be said that vigilantism is no way to respond to toxic individuals and companies that cause Americans to die unnecessarily. Hopefully, Thompson’s murder will spark a conversation about the role of government and the commons — and the very real need to end the corrupt privatization of our healthcare system (including the Medicare Advantage scam) that has harmed so many of us and killed or injured so many of the people we love.

For five days, the public was obsessed with the search for the man who murdered the CEO of United Healthcare. For a while, he seemed to be a mastermind, evading the surveillance state that so closely monitored his movements. But then he was caught while eating breakfast at a McDonald’s in Altoona, PA.

There is no excuse for murder. None, unless you are acting in self-defense, which Luigi Mangione was not. He has ended the life of Brian Thompson, the CEO of UHC, and simultaneously destroyed his own life. He is likely to spend the rest of his life in prison. Couldn’t he have thrown a bucket of red paint in protest? Or a cream pie?

The health insurance industry in this country is a mess. Most insurance companies operate for profit, and their actions seem to based on the prospect of profit, not the well-being of their customers. The industry makes obscene profits, based on its frequent denials of reimbursement.

This post was written by Qasid Rashid. When he learned that his child had a deadly disease, he sought help from his insurance company but was repeatedly denied any help. Read the story. It shows how repellent privatized for-profit insurance is. The insurance company was willing to let the child die rather than pay the cost of her desperately needed treatment.

He and his wife wrote:

This article is a deeply personal and vulnerable piece about our daughter Hannah Noor. It is primarily written by my wife Ayesha Noor. We are sharing this not because our daughter’s story is special, but sadly, because her story is all too common. Every year thousands of children and adults suffer incomprehensible pain, suffering, and even death. They suffer not because we lack the means to treat them, but because exploitative insurance companies, incompetent bureaucrats, and apathetic politicians deny them access to the life saving care they need. In light of recent events [See: America’s Violent Health System], we are sharing this story to bear witness to the preventable suffering of so many, the deadly violence imposed upon them, and to give hope that even in the darkest of times things can get better if we demand it. Let’s Address This.

Hannah Noor (Pictured Right) at 5 hours old.

A Scream in the Dark

It was just after her sixth birthday in 2021 when our daughter screamed from her bed in the middle of the night. We rushed to her room to find she had thrown up all over her bed. We cleaned her up, changed her sheets, and blamed the incident on the Oreos she’d eaten after dinner. The next day she complained of a stomach ache and rushed to the bathroom, experiencing diarrhea. Like most parents, we dismissed it as a passing bug—kids get diarrhea now and then. But something felt different this time, even though it was her first experience.

When it happened again just a short time later, the stomach pain was more severe. She screamed, cried, and rushed to the bathroom, but this time there was blood—so much blood. It terrified us. Before we could even make it to urgent care, she had another episode with even more bleeding. We hurried her in, only to be told by the nurse practitioner to “keep her hydrated” and that it was probably a stomach virus. But again, something in our gut told us otherwise.

This was just before Thanksgiving 2021, and I convinced myself she’d recover over the break and be able to return to school. She loved school, as most kindergarteners do. But the bleeding continued. The pain worsened. More urgent care and pediatrician visits followed, but answers did not. By now, our once energetic and chatty daughter was pale, frightened, and visibly losing weight.

Navigating Through the Dark

We reached out to a close friend who happened to be a pediatric gastroenterologist. His questions and careful listening indicated it was not a simple virus, but he didn’t say much directly. He urged us to connect with the GI team at Children’s National Hospital in Washington D.C. Unfortunately, we were met with insurance hurdles and skepticism from her pediatrician. Weeks passed, and her condition deteriorated until, thanks to our friend’s intervention, we finally secured an appointment with a pediatric GI doctor in December.

Hannah Noor, now frail and scared, was put on iron supplements, and an colonoscopy was scheduled for January. She now weighed just 30 pounds—skin and bones, and we feared the worst. Her fear of eating, going to the bathroom, or even moving too much consumed her days. Our winter break became a period of sleepless nights, endless tears, and prayers. We felt like prisoners trying to navigate through treacherous terrain while blindfolded and shackled.

The preparation for the scope was grueling—a 24-hour liquid diet. To make matters worse, a severe snowstorm in early January 2022 left us without power for three days. Despite the chaos, we made it to the hospital. As I held her tiny hand, she bravely went under anesthesia. Hours later, the doctors confirmed what we feared: Hannah had ulcers all over her colon.

Inflammatory Bowel Disease (IBD) was the diagnosis—a chronic, lifelong condition that would require extensive management. Even as the doctor explained, I couldn’t fully grasp the gravity of it. I naively asked, “How long will she need the medication?” The doctor replied—“Do you understand what it means to have IBD? This is for life.”

It shattered me. My world crumbled.

Steroids, with their array of side effects, initially helped stabilize her condition, and she was subsequently started on mesalamine. However, managing IBD is never straightforward. Moving homes and finding a new doctor compatible with our insurance became an uphill battle. Procuring mesalamine was a nightmare, as our insurance kept on requiring prior-authorization—a term we’d never even heard before. Evidently, even though our doctor had prescribed a specific medication to save our daughter’s life, the insurance company required their non-medically trained admins to agree that our board certified physician knew what she was doing in prescribing the medication she prescribed. Spoiler: They disagreed and repeatedly denied the critical medication our daughter needed.

Making matters worse, moving meant we were in between doctors. Desperate to try anything to improve Hannah’s quality of life, we spent hours consulting with a nutritionist to see if dietary changes could make a difference. We invested extensive time and resources into a gluten-free diet, but it did not help at all; in fact, it made her averse to eating. We also tried the FODMAP diet, which was recommended during a flare, but it added to the confusion of what she should or shouldn’t eat. Every day became a battle over something as simple as food—one filled with uncertainty and frustration. Despite our efforts, Hannah’s condition remained unpredictable, with debilitating flares continuing to disrupt her life. By late 2023, we had pursued every imaginable route to find a way to protect our daughter’s health and life, and yet felt exhausted and at a dead end. 

It was clear that only one option remained—she needed a quickly advancing form of therapy known as biological treatment. This would be a direct IV infusion of medication to stabilize the IBD, every six to eight weeks, forever. 

A Dark Dead End

We were at the end of the road. If we couldn’t access biologic treatment, there was nowhere left to go. But what we hoped would finally bring us closure and healing, resulted in yet another emotional roller coaster and painful circus—our insurance corporation blocked us. Turns out, insurance corporations block more than 51% of patients whose doctors prescribe them biologic treatment to save their lives.

The recommended biologic promised not a cure, but a chance at living a healthy life. Our insurance rejected us outright reasoning that we hadn’t tried other medications first—a policy called “step therapy.” Despite our daughter’s life threatening condition, they wanted us to try every other variation of every other possible medication—knowing full well they would likely fail just as much and make our daughter suffer, vomit, bleed, and lose weight. But that did not matter to them, because that was the preferable path to ensure they “maximized shareholder value.” 

Our doctor stepped in and conducted a peer-to-peer direct meeting with the insurance company to show all the data, blood tests, and medical reports to prove that our daughter needed biologics to live. To show without a shadow of a doubt that the yet untried medications they demanded we try were not substantively different than the plethora of medications we had tried and had not worked. Yet, that meeting also went in vain. The insurance company still refused to approve our claim. And Hannah Noor’s condition worsened. She was pale, swollen from steroids, in pain, losing weight, and back to missing school.

We finally contemplated paying for the biologic treatment out of pocket. We knew it would only require six doses a year. How much could one dose be, after all? We checked and our hearts sank once more. Each dosage cost and administration would run into the tens of thousands of dollars. A year’s supply to keep our daughter alive would run into the hundreds of thousands. We certainly did not have that kind of money. We were cornered and desperate.

We contemplated what any parents might. Do we sell the house and cars and move into a small apartment? Do we set up a GoFundMe? Do we borrow money from family and friends? Do we take out a second mortgage?

Do we file for medical bankruptcy, as 500,000 Americans do annually? 

But we soon learned another sinister result of hyper-privatization of health insurance—even if we had the excessive means to pay the hundreds of thousands of dollars out of pocket, the hospital would not accept the funds. Why? The industry is such that not only do insurance companies deny 51% of claims, they have enacted policies forbidding people from paying for the critical medication they need out of pocket, lest the insurance company lose control and revenue. “Either you pay us, or you pay no one,” is a line you’d expect out of a mafia handbook—not out of a health provider. This is not health insurance, this is health exploitation.

A Spark of Light in the Darkness

In that moment of confusion we happened to run into to a fellow parent who, now is a great friend, and learned her children shared a similar medical struggle. She suggested calling the biologic manufacturers directly and applying for their patient assistance program. An idea that seems so obvious now, but something we did not even know was a possibility then.

The application process was tedious, and even then, it was initially rejected. But after weeks of back-and-forth, countless phone calls, and sleepless nights, a miracle happened—we finally secured approval. We let out a cathartic sigh of relief after more than two years of suffocation. And to be sure, the approval was not through our insurance company, who never even bothered to offer such an option, likely because it would cost them money. Rather, the approval was from the drug manufacturer directly. To this day our health insurance company has refused to budge on their cruel and calloused “maximizing shareholder value” decision to deny our daughter the medicine she needs to live.

On March 6, 2024—more than two months after the doctor first prescribed it, a period in which our daughter suffered horrific and unimaginable pain, bleeding, and vomiting—Hannah Noor received her first infusion at Comer Children’s Hospital in Chicago. And since then, everything has changed. Her spark of light returned. Our daughter was back. 

The Light We Create

A process that should have only taken 30-60 days from the night we heard that scream in the dark, took us on a 28 month torturous journey to finally see light again. Hannah Noor’s journey since starting biologic treatment has been a blessing. She’s eating, playing, drawing, and even learning karate (currently a Yellow Belt). The last three years of her life had been a torture for her, but now she is finally thriving as any 9-year-old girl should. Though the fear of flares always looms, we refuse to let it dictate our lives. Herbal and homeopathic treatments complement her medical regimen, and her strength inspires us daily.

As for our insurance company? Those corporate leeches also denied covering the hospital costs as well. Fortunately, despite that high price tag still running into the thousands, we tightened our belts and found a way to pay for that out of pocket, and continue to pay for that out of pocket. (We were shocked there wasn’t some additional insurance rule preventing us from paying our hospital directly). Despite us paying our insurance premiums every single month without exception, our insurance company has not covered a single penny of our daughter’s critical healthcare needs. The care she needs to live. But at least they’re maximizing shareholder value.

This story isn’t just about one child’s struggle with IBD; it’s about the systemic barriers hundreds of millions of families face every single day. From insurance denials to inaccessible care, to step therapy nonsense, to prior authorization red tape, the system fails the most vulnerable. What if we didn’t speak English? What if we couldn’t afford out-of-pocket costs for tests and treatments? What if one of our close friends didn’t just happen to be a national expert on this particular rare disease, and couldn’t leverage his relationships to get us access to a world leading expert? What if we didn’t have a network of supportive friends to recommend new ways to acquire this life saving medicine? 

A Brighter Future Is Possible

We named our daughter Hannah Noor because Hannah was the mother of Mary Mother of Jesus, and Noor means light. We couldn’t think of a more beautiful name for our only daughter, and she has lived up to it every day of her life. 

In these darkest of times, she is the Light of our eyes.

Hannah Noor (now 9) at a recent family vacation in Lahore, Pakistan. Here she is giggling at a cat that wandered over to say meow, which Hannah Noor reminded us means “hello” in cat language.

Hannah Noor’s story highlights a flawed and cruel system that places profits over people. Yet it also underscores the power of advocacy, persistence, and community. To every parent navigating the complexities of chronic illness: stay strong, fight relentlessly for your child, and lean on the resources available, like the Crohn’s and Colitis Foundation, and do not underestimate support groups on Facebook. If I can be of any support, do not hesitate to reach out at ayesha [dot] noor @ gmail.com.

Hannah Noor is living proof that even in the darkest moments, there is hope. She teaches us daily to believe in miracles—and to fight for them when necessary. It is also a reminder that our for profit exploitative health insurance system will always only serve the wealthy elites, the stock market, and whatever private investor who decides to buy and sell these corporations. They will not serve the people. Not our beautiful baby girl, nor the nearly 70,000 Americans who die annually due to lack of care, nor the 500,000 Americans who are forced to file for medical bankruptcy every single year. It is by the sheer grace of the Almighty that we still have our wonderful Light with us today. But for so many parents and families, the end result is not so fortunate.

Perhaps the most frustrating part about all of this is that the medication to save our child’s life existed all along. But because some calloused business person decided her life wasn’t profitable enough and worth saving, it was an acceptable cost to reject her claim and let her die.

It is our responsibility to demand better, not just for our daughter, but for all the daughters, sons, and children out there. We do not suffer from a lack of resources, but from an excess of greed. We can ensure high quality, accessible, and affordable healthcare for all people in this country—but we cannot ensure the satiation of greed for the billionaire corporations, corrupt politicians, and elitists who care more about shareholder value than the survival of innocent children. We have to choose one side. And we choose the children of this great country—we hope you do too.