C (4:59)

Thanks, Isaac, and welcome everybody. Here are your quick hits for today. First up, Congress released a bipartisan government funding bill ahead of the Jan. 30 deadline to avoid a shutdown. Democrats in the House and Senate are expected to challenge provisions for the Department of Homeland Security seeking further reforms to immigrant and Customs Enforcement operations. Number two, President Donald Trump will speak at the World Economic Forum on Wednesday and is expected to address strained U.S. europe relations amid his push to acquire Greenland. On Tuesday, Canadian Prime Minister Mark Carney addressed the gathering, alluding to the Trump administration's actions as causing a rupture in the world. Order 3 the Justice Department subpoenaed five Minnesota government offices, including the governor's office, the attorney general's office and the Minneapolis mayor's office, amid its investigations into alleged efforts to obstruct federal immigration operations in the state. Number four Attorney General Pam Bondi announced that Lindsey Halligan is leaving her role as interim U.S. attorney for the Eastern District of Virginia. Halligan had brought charges against former Federal Bureau of Investigation Director James Comey and New York Attorney General Letitia James, but courts dismissed the cases after finding Halligan was illegally appointed at number five. Australia's parliament passed a series of gun control laws in response to the mass shooting that killed 15 people at a Hanukkah celebration at Bondi beach in Sydney in Dec. The new laws create a national gun buyback program, limit imports of firearms and enhance background checks. The White House just releasing a New document on Health care within the past.

B (6:38)

Few moments, the White House laying out.

C (6:40)

Some goals and objectives here for health care legislation on Capitol Hill this year, so some of these priorities will be familiar to people, particularly around drug pricing and insurance companies. What the White House is saying in a conference call that's going Right now, Dr. Mehmet Oz, the administrator of CMS, calls this a framework for legislation to be passed later this year. On Thursday, January 15, President Donald Trump announced several proposals to lower health insurance costs, which he called the Great Healthcare Plan. The health care reform framework focuses on four broad initiatives lowering drug prices, lowering insurance premiums, holding big insurance companies accountable, and maximizing price transparency. Although the White House does not announce specific legislative proposals to enact the policy Trump specified, he would seek to make more medications available over the counter, regulate pharmacy benefit managers and require insurance companies to explain their costs in simple and clear language. Separately, on Tuesday, congressional leaders reached a bipartisan deal in both chambers to advance a four bill minibus spending package that includes several healthcare stipulations. The spending bill set funding levels for the Departments of Defense, Transportation, Labor, Health and Human Services and Homeland Security. The HHS bill limits PBM benefits, extends telehealth coverage and extends funding for at home Medicare and Medicaid Services through 2030. The health care deal revives a 2024 bill scuttled by then President Elect Trump and Elon Musk over spending concerns. The new spending bill pursues many of the same goals as its predecessor. It also does not take up the Affordable Care act subsidies, which expired at the end of 2025 and and were central to last year's prolonged government shutdown. Democrats proposed extending the expanded benefits for three years in a bill that passed the house on January 8 but has since stalled in the Senate. We previously covered the government shutdown and the expiring ACA benefits. There are links to both of those articles in today's episode. Description the path to enacting the proposals in the President's Great Healthcare plan is unclear, and statements from Republicans indicate that changing the current bipartisan spending agreement would be difficult. You're going to need 218 votes, which means you're going to need to build consensus across the conference on what it is we're pursuing, representative Mike Lawler said. Senator Josh hawley called the GOP's health care options pretty limited. Democrats dismiss Trump's framework as ineffective Trump's great health care plan does nothing to substantively bring down health care costs, democratic National Committee Rapid Response Director Kendall Whitmer said. Today. We'll get into what the left and right are saying about the president's health care plan and Congress's spending bill, and then Senior editor Will Kabeck will give his take. We'll be right back after this quick break. It's a new year and the cold days are upon us. This is when you need your winter wardrobe to really deliver. You need pieces that are truly made to last season after season. And Quint's does just that by bringing together premium materials, thoughtful design and enduring quality so you stay warm, look sharp and feel your best all season long. Quint's has everything you need. They've got Mongolian cashmere sweaters, wool coats, leather and suede outerwear that actually holds up to daily wear and still looks good. I recently bought their shearling brown leather jacket and I gotta tell you, I've been getting compliments on it left and right. It looks really fresh. I'm not gonna lie, I look so fresh wearing it and I feel good wearing it because not only does it look fashionable, but it's kept me warm even in 29 degree weather out here in Colorado. Refresh your winter wardrobe with quince. Go to quince.com tangle for free shipping on your order and 365 day returns now available in Canada too. That's Q-U-I-N-C-E.com tangle free shipping and 365 day returns. Quince.comtangle.com.

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C (12:07)

Alright, first up, let's start with what the left is saying. Many on the left are critical of the health care plan, arguing that it has little substance. Some argue that the plan doesn't lay out a clear legislative strategy. Others say that Trump's proposals won't lower healthcare costs in public notice. Paul Waldman said Trump's long awaited health care plan is a joke. The plan does contain a few things that look like big ideas but are immediately baffling, waldman wrote. The biggest one is the government is going to pay the money directly to you. The plan quotes Trump saying. It goes to you and then you take the money and buy your own healthcare. How exactly is that going to work? We'll each get a check every month from the government. Is the entire insurance system going to be replaced by health savings accounts? Worry not. Trump insists that prices will come down because, he says, you'll go out and buy your own healthcare and you'll make a great deal. It's quite clear that if someone asked Trump to name two things his plan does, he would not be able to. This has been one of the defining features of healthcare policymaking in both Trump terms. He not only knows almost nothing about the issue, he has no evident beliefs about healthcare. In fact, he couldn't care less about it, waldman said. Trump does, however, have a simplistic but basic accurate understanding of what the public wants. So when speaking off the cuff, he'll say things to make him sound almost liberal. But when it comes time to produce something that vaguely resembles a policy blueprint, Trump steps aside and the right wing ideologues who surround him take over. In the bulwark, Jonathan Cohen wrote that Trump's great healthcare plan is not great. It's not even a plan. Trump's poll numbers are in the dumps, with voters identifying the high cost of living as a top concern. That includes the price of health care, which just went up for more than 20 million Americans who rely on the Affordable Care Act, Cohen said. Negotiations over enhanced ACA subsidies have since stalled, making Thursday's plan the latest in a series of chances for Trump to weigh in strongly on what he wants. And at first blush, it looked like Trump might do just that. Finally, because he endorsed two key ideas that Republicans have been discussing in the debate overextending the subsidies. One, which has gotten a fair amount of attention, would take at least some of the money from those extra subsidies and put them instead in tax favored spending accounts that people could use on health care. The other idea Trump endorsed is a call to provide funding for something called cost sharing reductions, cohen added. The endorsement of these ideas was conspicuously half hearted. It's possible Trump and his advisors were making a conscious, strategic choice not to slam the door on anything that might come out of the bipartisan talks on Capitol Hill. But staying out of the process isn't going to get a deal done either, because getting to 60 votes in the Senate would almost certainly require pressure on Republicans hesitant to support any extension of the subsidies. In Common Dreams, Egan Kemp argued that the plan is doomed to fail. We need Medicare for all. President Donald Trump's new great healthcare plan is anything but, kemp wrote. Unsurprisingly, Trump's concepts of a plan failed to even begin to reverse the damage he caused when he made massive cuts to Medicaid and the Affordable Care act in order to fund tax cuts for billionaires. Now, Trump and his Republican allies are trying to cover up the gaping wound they have created with a band aid. At the same time, Americans are desperate for relief from Trumpflation, including rapidly rising healthcare costs. Shutdown negotiations and subsequent scattershot health ideas from the White House and Republicans in Congress show that they have no real idea what to do when it comes to actually bringing down the cost of healthcare in America. The only alternate Republican plans for healthcare that currently exist strictly serve corporations and fail to provide relief to patients, kemp said. Fortunately, Medicare for All would address all of these issues and finally put the health of Americans ahead of corporate profits. Medicare for all would guarantee that everyone in the US can get great care that they need when they need it, without financial barriers or hoops to jump through, and would be cheaper than our current system while providing coverage that is better than any commercial health insurance plan.

B (16:02)

Foreign.

C (16:08)

That is it for what the left is saying. Which brings us to what the right is saying. The right sees Trump's health care plan as a mixed bag. Some say the document falls short of an alternative version to Obamacare. Others endorse direct payments to Americans over ACA subsidies. In the Federalist, Christopher Jacobs described the good, the bad and the ugly of the White House health care plan. In theory, sending money to patients rather than insurance companies will give the American people greater control over their health care choices while promoting competition, jacobs wrote. Likewise, proposals to allow more pharmaceuticals to be sold over the counter hold some appeal. Expanding the over the counter marketplace could increase competition while also lowering healthcare costs by eliminating additional trips to the doctor to obtain prescriptions. By contrast, Obamacare included language since repealed requiring people to obtain a prescription to have over the counter medicines reimbursed from a flexible spending arrangement or health savings account, which resulted in a rush of unnecessary appointments where patients asked for prescriptions. For things like NyQuil, proposals to increase transparency, requiring insurers to explain their plans in plain English, publish their rates of treatment denials and publicize their percentage of administrative overhead, and mandating providers to publish their prices should help at the margins. The proposal to fund the cost sharing reduction program falls into a similarly ambivalent category, Jacobs said. The worst of the White House proposals concerns policies to codify the president's most favored nation deals. American patients deserve lower health care costs, which several policies in the president's health care plan would achieve. They don't deserve arbitrary discrimination against the most vulnerable, which could result from codifying the White House's price control plan, the National Review editors wrote about Trump's not so great health care plan. President Trump deserves credit for thus far resisting Democrats demand to throw more money at the failed Obamacare program. But on Tuesday, he offered a one page policy response characteristically titled the Great American Healthcare Plan. That leaves much to be desired. The editor said the outline is mostly small bore ideas that range from inadvisable importing socialist price controls for pharmaceuticals to perfectly fine but inadequate allowing more drugs to be purchased over the counter and expanding price transparency. The plan misses because ultimately it doesn't offer a contrary vision for healthcare from Obamacare. It would be great if Americans had more control over health care dollars and had the ability to choose for more plans, but absent broader changes on the regulatory front, enrollees wouldn't have a real choice, as they would still be purchasing among Obamacare plans they added. To be clear, if the Trump health care outline serves the purpose of steering antsy Republicans away from a catastrophic decision to join Democrats in expanding Obamacare, that alone would be a net positive. But as an alternative vision for health care, it isn't big, beautiful or great in reason. JD Tucili said the plan has promise but should add more freedom for Americans. The great healthcare plan doesn't really undo the bad government interventions and restrictions that limit choice and raise costs. The plan might offer some improvement over what we have, but it should be a lot better. In fact, legislation that would greatly improve the plan has already been presented to Congress, tucili said. Critics of what we've seen of the great healthcare plan worry that it just builds a little more transparency and a few more options. Plus plus added subsidies into existing Obamacare Distortions of the medical marketplace A good place to start in terms of fleshing out the healthcare plan with details that would expand choice and patient freedom and lower costs is Senator Rand Paul's Health Marketplace and Savings Accounts for All act introduced last month, Tucheli wrote. The bill raises the annual contribution cap on tax advantaged health Savings accounts from $4,400 for individuals and $8,750 for families to $24,500 and extends HSA EL. It also expands what HSAs can cover. Basically, Paul's bill would dramatically increase Americans control over their health care money and make their coverage portable by delinking it from employment. Alright, let's head over to Will for his take.

B (20:23)

Thanks, John. All right, this is Senior Editor Will K. Back to read my take. President Trump's healthcare plan fell out of the headlines as quickly as it appeared, and that's understandable. Greenland anti ICE protests and the second phase of the Gaza ceasefire plan are just a few of the major stories that have supplanted it in the past few days. But the relatively quiet response from lawmakers and commentators to the plan is still surprising to me. After all, one of the most memorable moments of the 2024 presidential campaign was Trump saying that he had, quote, concepts of a plan for healthcare, an assurance that has remained about that vague for roughly a decade. Now Trump has finally introduced his proposal and the reaction seems almost muted. So what gives? Well, first off, the great healthcare plan, which I'll refer to as just the ghp. It's a misnomer. It's really more of a loose framework, the kind of document that works well as a page on a campaign website, but not as a baseline for actual legislative reform. While it puts forward some big ideas, Trump's proposal is short on details and shorter on a policy approach. Several of its prescribed reforms are intriguing to me, but the dearth of fleshed out policies makes it difficult to evaluate, a reaction that commentators on both sides have seemed to share. After diving into the responses to Trump's announcement, a few things are clear to me. One, the GHP is not the Affordable Care act replacement that Trump has long promised. It's also unlikely to be adopted wholesale by Republican lawmakers. And finally, it fails to address many core issues in our healthcare system. It's more of a gesture toward popular reforms without any action, an agreeable wish list without a commitment to the trade offs or political strategy required to enact anything substantial. Though the GHP is not a cohesive reform agenda, some of its ideas overlap with real legislative efforts that are worth examining. Most notably, Trump is pushing to codify his deals on prescription drug prices, some Senate Republicans are mobilizing on the call to replace Affordable Care act subsidies with direct individual payments, and Congress's recent bipartisan healthcare funding agreement includes a crackdown on pharmacy benefit managers, or PBMs. Now, I have mixed thoughts on each of these proposals, so let's take them one by one on drug prices. The GHP leads with a push for Most Favored Nation, also known as MFN deals, compelling pharmaceutical companies to sell their products at the lowest price that they're sold for in other countries. Trump signed an executive order last May directing the Department of Health and Human Services to facilitate these price targets for pharmaceutical companies. And at the end of 2025 he announced voluntary pricing agreements with nine major manufacturers to bring down drug prices. However, those same companies recently announced price increases for 872 different name brand medications, and the White House says that the negotiated price reductions are coming to state Medicaid programs and patients who pay in cash for some prescript, not these price increases that have happened in the past few weeks. But the episode underscores how only legislation, not executive action, can address drug prices. Relatedly, codifying MFN requirements isn't guaranteed to bring down prices either, whether through executive order or new legislation. Americans really do pay much higher drug prices than citizens of other countries, and this policy does have strong support from the left. But the plan relies on a few risky assumptions that drug companies wouldn't pull drugs from the market rather than lower prices or raise prices abroad rather than lowering them in the us Now I'm less concerned about the risk of stifling innovation, which is a core concern on the Republican and conservative side. As I've seen, recent studies estimate that similar proposals would have a small impact on the number of new drugs coming to market in the long run. So in sum, codifying MFN pricing, It sounds good in the abstract and I could support some proposal, But Trump's plan offers no details to account for these potential pitfalls in practice. Now, on the GHP's direct payments to individuals, these are effectively a replacement for the enhanced ACA subsidies that expired at the end of 2025 and that Democrats are now fighting to reinstate. Senator Bill Cassidy, a Republican from Louisiana, has offered one of the most detailed proposals for turning this idea into legislation, rerouting funds for the subsidies to individual health Savings accounts, or HSAs, that cover out of pocket health care costs. However, as some Democrats and health policy experts have noted, these savings accounts are only available through plans that carry higher CO pays and deductibles than others. In effect, this would reduce the savings provided by covering out of pocket costs by forcing people onto the plans that with the highest CO pays and deductibles, all without addressing the persistent problem of rising premiums, which HSAs can't be used to pay for. Perhaps these issues could be addressed with additional reforms, but again, we haven't seen them. Cassidy's plan hasn't been written up as a bill, and Trump's GHP offers no more guidance. Lastly, pharmacy benefit managers PBMs, the bipartisan health care package that legislators passed on Tuesday, includes, among other measures, an overhaul of PPBM practices. Today, PBMs decide which drugs are covered by insurance, meaning that they can earn more when they approve coverage for more expensive drugs because drug companies often give bigger discounts on higher priced medications and PBMs keep part of that money. So these new provisions would instead require PBMs be paid a flat fee for their services and pass along any discounts they get directly to health insurers instead of keeping those discounts for themselves. Of all the ideas raised by the ghp, with some legislative momentum, PBM reform seems like the best place to start removing warped incentives that lead to increased costs across the health care system. But does the GHP actually help with this effort? Without a clear legislative strategy from the White House, it's unclear whether Trump wants to save PBM reform for a comprehensive to be realized health care bill, or whether he's content with Congress passing different elements of the proposal in piecemeal fashion. Knowing the President, he probably prefers the former some kind of a bill that he can label the great healthcare plan. But that makes it surprising that the rollout of this plan has been so lackluster and really low energy. I can only speculate, but my impression is that the administration lacks the political will at this moment for a bruising health care fight while so much of its attention is focused abroad. And this half hearted plan signals to Congress that it should take up the reins instead. Now, that could still change, and I don't think that this story is written or the path it's on right now is predetermined. But think about it. The midterms are fast approaching and I think Trump's promise of comprehensive healthcare reform seems less and less likely to ever materialize. Another thought stuck in my head as I was reading commentary from writers on the right and left. All of the analysis I read from experts and editorial boards and legislators considering their options, all of them took healthcare reforms more seriously than Trump's proposal itself. And that's deeply disheartening to me. Just over a year ago, you'll remember that UnitedHealthcare CEO Brian Thompson's killing laid bare millions of Americans in deep rooted frustrations with our healthcare system. And just a few months ago, we had the longest government shutdown in US History, purportedly on account of needed health care reforms. Despite lots of talk about action, we still seem to be dancing around the actual decisions of which reforms to prioritize and how to make them law. Now, Congress at the moment at least, seems committed to some measure of reform. But seriously, where is the White House? Frankly, it's shocking that a president who has been so willing to flex executive power and impose his will on lawmakers when he wants to, has chosen to punt so visibly on such a key issue. After years of promises, Americans were told that the plan we have now would finally clarify the President's vision for healthcare reform. Instead, it underscores just how far we are from a serious, sustained effort to fix a system nearly everyone agrees is broken. All right, that is it for my take. I'm going to hand it over to Managing editor Ari Weitzman, who penned the response to today's reader question. Ari, over to you.

C (29:15)

We'll be right back after this quick break.

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This is Tango Managing Editor Ari Weitzman taking today's reader question, which comes from Jake in Grand Rapids, Michigan. Jake asks, I've seen several reports of DHS displaying supposed naughty and KKK slogans. One of ours, all of yours. And we'll have our home again. What do you make of this. I wanted to be the one to take this question, since I'm the member of Tango staff who most vocally claimed last year that Elon Musk did not make a Nazi salute at Trump's inauguration celebration. I still think it's reasonable to disagree over that instance. But a month later, Steve Bannon unambiguously made a sig hail at cpac, seemingly as a troll. And I said that at the time. Quote, this mainstreaming of Nazi salutes, even sarcastically, is an enormous problem for the right end quote. To risk egregious understatement, I'd say that problem has gotten worse. Over the past 10 days alone, official social media accounts for the United States government have posted messages with clear parallels to Nazi propaganda. On January 10, the Department of Labor posted a short video on X with the caption One Homeland, One People, One Heritage, an apparent reference to the Nazi slogan One People, One Empire, One Leader. On January 13, Department of Homeland Security Secretary Kristi Noem stood behind a lectern with the caption One of ours, all of yours. The slogan allegedly connected to the 1942 annihilation of Lidice in the Nazi protectorate of Bohemia and Moravia. On January 14, the White House posted a cartoon on X asking which Way Greenland man, referencing a book from 1978 that explicitly argued the inferiority of Africans and Jews. All of these apparent references on their own are explainable. Three short statements beginning with the word one are not uncommon. The slogan DHS used was actually never used by Nazis and only loosely connected to the Liti's massacre and which Way Western man had already become a flexible meme format long before the White House's Tweet. Then, on January 16, the Department of Labor posted on X will never stop fighting for the American way of life. America First, Americans First. The first line used the German noun capitalization and is notably 14 words long, an apparent reference to two prominent neo Nazi slogans known as the 14 words. Then, the whole post contains spacing that makes it 88 characters in total. Another apparent neo Nazi reference. Frankly, it strains credulity to dismiss this pattern, both including the labor tweet and within it as a string of innocuous coincidences. These are pretty clearly Nazi dog whistles, signals intended for normal people to miss or dismiss, but Nazi sympathizers to hear. So why are they doing this? Maybe employees who manage these accounts have coordinated these messages amongst themselves. It's a kind of edgy in group signaling, which Richard Henania has called the base ritual. Maybe their supervisors don't care. Or maybe they intend the strategy to both wink at this poisonous portion of their base while castigating the rest of us who pick up on these subtle yet troublingly consistent patterns as hyperventilating pearl clutchers. In my opinion, that's exactly what's happening. When I asked DHS for comment on these examples, assistant secretary Trisha McLachlan said, revolting. I already addressed this on CNN, and you're actually conspiracy theorists for giving this credibility. That's it for my answer to this reader question. Gonna send it back to John for the rest of the pod.

C (35:22)

Thanks, Ari. Here's your under the radar story for today folks. China is the world's second most populous nation, but in 2025 its population shrank for the fourth consecutive year. According to government statistics released Monday, China's total population decreased by 3 million people and the birth rate was 5.63 per 1,000 people, the lowest on record since 1949 and a 17% decrease from the previous year. People in China cite rising costs as a deterrent to having children, while experts also pointed to the lingering effects of the government's multi decade one child policy that rem in effect until 2015. Though China is viewed as an ascendant world power, economists say its population challenges could hamper its long term growth. The Associated Press has this story and there's a link in today's episode description and last but not least, our have a nice day story. The American Cancer Society projects that over 2 million people will be diagnosed with cancer in 2026, and the disease continues to be a leading cause of death in the US but new ACS data released on January 13 showed two promising trends. Survival rates for more fatal cancers have improved dramatically over the past few decades, and for the first time ever, 70% of people diagnosed with cancer live at least five years after their initial diagnosis. ACS Chief Scientific Officer Dr. William De Hutt identified available treatments, early screenings, and a drop in tobacco use usage as contributors to the rising survival rates. It's really an exciting point. If we went back to the 1970s, less than half the people would be cancer free or surviving at five years, the hut said. ABC News has this story and there's a link in today's episode description. All right everybody, that is it for today's episode. As always, if you'd like to support our work, Please go to retangle.com where you can sign up for a newsletter membership, podcast membership or a bundled member that gets you a discount on both. We'll be right back. Here tomorrow. For Isaac, Will and the rest of the crew, this is John Law signing off. Have a great day, y'.

B (37:22)

All.

C (37:24)

Peace. Our Executive editor and founder is me, Isaac Saul, and our Executive producer is John Lowell.

B (37:31)

Today's episode was edited and engineered by Dewey Thomas.

C (37:34)

Our editorial staff is led by Managing Editor Ari Weitzman with Senior Editor Will K. Back and Associate Editors Harji Moorhead, Lindsay Knuth and Bailey Saul.

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Music for the podcast was produced by Diet75. To learn more about Tangle and to.

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Sign up for a membership, please visit our website@retangle.com.

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