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DOGE and America’s last chance at greatness

In the annals of history, empires crumble not with a bang but with a whimper — a slow bleed of resources, a quiet surrender to the weight of their own excess. This is the grim prophecy of Ferguson’s Law, named for Scottish philosopher Adam Ferguson, who distilled a simple, brutal truth from the wreckage of great powers past: when a nation spends more servicing its debt than fortifying its defenses, it teeters on the edge of oblivion. Habsburg, Spain, the Ottoman Empire, and the British Empire all faltered when their ledgers tipped this way, their coffers drained by interest payments while their swords dulled. Today, the United States stands at that precipice. In 2024, the nation crossed Ferguson’s “limit,” with debt service eclipsing defense spending — $1.124 trillion to $1.107 trillion — a razor-thin margin that signals a deeper rot. If history is a guide, this is not merely a fiscal footnote; it is an existential warning.Enter Donald Trump and Elon Musk, an unlikely duo now wielding a chainsaw (sometimes literally) against the sprawling bureaucracy of the American state. Their weapon of choice is the Department of Government Efficiency, or DOGE — a name that nods to Musk’s penchant for cryptocurrency mischief but carries a far weightier mission. Launched by executive order on Trump’s first day back in the White House in January 2025, DOGE is no mere advisory panel; it is a battering ram aimed at the federal government’s bloated underbelly. Musk, the world’s richest man and a self-styled “Tech Support” for the republic, has taken to the task with the zeal of a man who once fired half of Twitter’s staff overnight. Already, the team has slashed contracts, shuttered leases, and offered buyouts to millions of federal workers, all while gaining access to the Treasury’s payment systems to root out what they call “fraud and waste.” Trump, meanwhile, has blessed this blitz, framing it as a crusade to save America from itself.The stakes could not be higher. Ferguson’s Law is not a theory to be debated in ivory towers; it is a mathematical certainty etched in the ruins of empires. When debt service outpaces defense, a nation’s ability to project power erodes. Resources that should fuel innovation, secure borders, or deter adversaries are instead funneled to bondholders — many of them foreign. The U.S. national debt, now a staggering $36 trillion, is a ticking clock. By 2049, the Congressional Budget Office projects net interest payments could hit 4.9 percent of GDP, dwarfing defense spending at an estimated 2.45 percent. This is not just a financial crisis; it is a death knell for a superpower. A country that cannot defend itself — or worse, cannot afford to — invites challengers to test its resolve. In a world of rising powers like China and emboldened autocrats, the United States cannot afford to be caught counting pennies while its rivals sharpen blades.DOGE’s early moves are a desperate bid to reverse this slide. The team has targeted agencies like the Department of Education and the U.S. Agency for International Development, slashing budgets and dismantling programs with a speed that has left Washington reeling. Critics howl about legality and chaos, but the urgency is undeniable. The federal budget, a $7 trillion behemoth, is riddled with inefficiencies — $208 billion in savings identified by the Government Accountability Office alone, from Medicare payment reforms to redundant contracts. Trump and Musk are betting that by hacking away at this excess, they can free up resources to shore up the nation’s defenses and stave off the Ferguson limit’s fatal embrace. It’s a gamble, but one rooted in necessity: a nation drowning in debt cannot long remain a nation.Yet there’s a delicate dance at play. Trump has vowed to protect Medicare and Social Security, the twin pillars of America’s social contract, from DOGE’s blade. It’s a promise that resonates with the millions who brought him back to power, a nod to the elderly and vulnerable who view these programs as non-negotiable. Together, they account for nearly $2.5 trillion of annual spending — more than a third of the budget — and their costs are rising as the population ages. The math is unforgiving: by 2035, the Social Security trust fund could be insolvent without reform, and Medicare’s hospital insurance fund may follow by 2036, according to the trustees’ reports. Still, Trump’s pledge buys time, serving as a political lifeline to avoid alienating his base while DOGE takes its first swings elsewhere.This strategy — beginning with discretionary spending and then revisiting entitlements — holds merit, both tactically and ethically. The federal government is a maze of waste beyond the traditional strongholds of Medicare and Social Security. For instance, the Pentagon wastes billions on outdated systems and unaccounted expenses — a 2024 audit discovered $850 million in discrepancies.Agencies like the IRS, which Musk’s team has already infiltrated, could streamline operations to increase revenue without raising taxes. The Department of Education, a longstanding Republican target, spends $80 billion annually, yet student outcomes remain behind; DOGE’s cuts there could redirect funds to more urgent needs. By addressing these areas first, Trump and Musk can build a case — dollars saved, efficiencies gained — before confronting the more challenging issue of entitlement reform.And that sale will come. Ferguson’s Law allows no room for sentimentality. Entitlements, however valued, are the elephant in the budget, projected to grow from 10.2 percent of GDP in 2024 to 14.2 percent by 2050, according to the CBO. Without reform — whether by raising the retirement age, means-testing benefits, or capping growth — the U.S. will plunge deeper into the debt trap, leaving less for defense, infrastructure, or the innovation that Musk advocates. The American public, long used to these programs as birthrights, will need convincing. DOGE’s early victories could provide the credibility to make that argument: If billions can be saved elsewhere, why not here? The alternative is unimaginable: a future in which the U.S. cannot fund its military, its commitments, or its very existence.Musk’s role in this drama is audacious and essential. He brings an outsider’s ruthlessness and a Silicon Valley ethos that views bureaucracy as a bug to be squashed. His clashes with civil servants and his gleeful X posts — labeling USAID a “criminal organization” — are indeed theater, but they highlight a deeper truth: the status quo is untenable. Trump, for his part, provides the political muscle, offering a mandate from voters who yearn for disruption. Together, they are racing against Ferguson’s clock, knowing that financial health encompasses not just balancing the books but also preserving the nation’s soul. If they fail, the United States risks becoming a cautionary tale of hubris and neglect, another name in the graveyard of great powers. If they succeed, they may just rewrite the ledger — and the future.

Roosevelt’s Arena: Today’s CEOs face dust, sweat, and torched Teslas

In the spring of 2021, the co-founders of Basecamp, a software company known for its project management tools, decided that political discussions had no place in their internal communications. The decree came down like a guillotine: no more debates about elections, no more arguments over social justice. The backlash was swift — employees quit in droves, and the press jumped in, with The New York Times documenting the exodus as a tale of corporate overreach.A few months earlier, Brian Armstrong, CEO of Coinbase, the cryptocurrency exchange, had taken a similar approach. He urged his staff to leave politics at the door and offered severance to those who couldn’t comply. About sixty employees — around five percent of the workforce — accepted the money and left, while critics condemned the move as a suppression of dissent. Both companies, in their pursuit of focus, stumbled into a firestorm.Elon Musk, the undisputed titan of technology, has entered a different kind of battle. Appointed by President-elect Donald Trump to co-lead a growing Department of Government Efficiency — DOGE, a reference to Musk’s cryptocurrency interests — his arrival in Washington has sparked not only debate but outright rebellion.Teslas are being vandalized in parking lots, dealerships are being picketed, and cars are being set ablaze in isolated bursts of anger. Threats against Musk’s life have emerged, serving as a grim reminder of the stakes when business and government collide. In recent days, left-wing favorite California Governor Gavin Newsom sent prepaid phones to a hundred tech CEOs, preloaded with his personal number, only to face a wave of skepticism from the media and many in his party: Why associate with the Silicon Valley elite?There are countless more examples, but the pattern is clear: when business leaders enter the public arena — or even flirt with it — the atmosphere fills with recrimination. Employees rebel, customers bristle, and the media sharpens its knives. This is enough to make any executive hesitate, questioning whether the reward is worth the effort.Let us present another perspective on this issue — one where a leader doesn’t shy away from chaos but embraces it. Theodore Roosevelt, in a speech that decorates many business leaders’ walls, articulated it best: “It is not the critic who counts, not the man who points out how the strong man stumbles.... The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood.” For business leaders peering over the parapet today, the question isn’t whether they’ll be liked — it’s whether they’ll have the courage to step in at all.The aversion to mixing business and governance is understandable. Business thrives on clarity — profit margins, market shares, quarterly reports. Politics, by contrast, is a swamp: murky, tribal, and unforgiving.Criticism in politics often only gains traction when there are elements of truth. Let’s look at the following:But to stop there is to miss the point. Life isn’t a popularity contest, though it’s tempting to live as if it were. The alternative — shying away from the arena because the crowd might jeer — is a recipe for stasis, a slow drift toward irrelevance.Roosevelt’s words carry a sting because they’re true: the arena isn’t kind. It’s a place of bruises and missteps, where every move invites scrutiny. Basecamp’s founders lost talent; Coinbase’s Armstrong lost goodwill. Musk’s Teslas are paying a literal price, scratched and scorched by those who see him as a usurper. Yet the arena is also where history gets made, where the timid don’t tread.Business leaders who engage with it — whether to streamline bureaucracy, resolve internal conflicts, or form a new alliance — aren’t guaranteed success, but they are guaranteed to face challenges. To do otherwise — retreating and polishing one’s image until it shines — is to squander the little time we have in life to make a difference.And that, Roosevelt would argue, is the only thing that counts.

Networking your way to loneliness

During lunch one day, Ron tried to convince Jacob to skip his child’s choir concert in favor of attending a “fireside chat,” a gathering that would surely draw the right people and connections needed to build a bank balance large enough to avoid attending such events in the future.The promise was enticing: networking, the quintessential American pastime of trading authentic family moments for uncertain, lucrative opportunities. This raises the question: Why do we make these types of choices so often?It’s a curious and stubborn belief that success requires personal sacrifice, especially sacrificing family time. Many professionals seem convinced that missing soccer games, choir concerts, or bedtime stories shows seriousness and ambition.In his influential book Excellent Sheep, former Yale professor William Deresiewicz argues that contemporary American society is defined by misguided worship of “busyness” and professional success at the expense of meaningful relationships. “We’ve become adept at impressing strangers,” Deresiewicz writes, “but hopelessly estranged from those who matter most.”Beneath the philosophical lament lies a deeper issue: a common cultural belief that attaining professional success inevitably requires sacrificing family milestones. But do these sacrifices produce the remarkable rewards we’re led to believe?Data suggests otherwise. A seminal study from the Harvard Business Review found that, ironically, those who prioritize family commitments by establishing clear boundaries around family time report higher job satisfaction, improved mental health, and, surprisingly, better long-term career performance. Conversely, professionals who frequently skip family events for work commitments consistently report higher stress, lower satisfaction, and a greater likelihood of professional burnout. It’s as if missing the choir concert leads not to the corner office, but to the corner couch in a psychiatrist’s office.Part of this disconnect may stem from what sociologist Arlie Hochschild termed “The Time Bind.” In her book, Hochschild notes that workplaces have subtly evolved into surrogate homes — spaces where validation, meaning, and identity are increasingly pursued at the expense of personal relationships. As Hochschild explains, “Workers often willingly accept longer hours, believing this sacrifice affirms their value in ways that home life does not.” This illustrates a fascinating paradox: networking events present themselves as opportunities for career advancement but primarily function as self-reassurance rituals.Such reassurances come at a cost. The family calendar, proudly pinned to the refrigerator, doesn’t lie. Missed events quietly accumulate, each one a small wound until one day, the choir concerts stop altogether.Psychology professor Daniel Kahneman, a Nobel laureate and author of Thinking, Fast and Slow, reminds us of our misguided intuition about happiness and success: “When thinking about how successful we’ll feel tomorrow, we rarely consider how we’ll feel looking back on missed opportunities ten years from now.”So why do we persist?Perhaps because networking is, at its core, performative theater. Who among us hasn’t come back from one of these events to say that everyone was just “pretending to like each other,” trying to transform superficial interactions into vague career benefits? The participants themselves are not oblivious to this fact. Yet, they persist, fearful of missing out on some enigmatic, game-changing opportunity — like a gambler continuously placing bets despite knowing the house usually wins.Wharton professor Adam Grant argues that the most successful professionals effectively blend authenticity and personal relationships with their professional aspirations. Grant emphasizes, “Success isn’t about what you sacrifice; it’s about what you refuse to sacrifice.”Ultimately, we must confront this uncomfortable truth: skipping your child’s (or family’s) event could indeed change your life — but perhaps not in the ways you hope. The sacrifices we make aren’t neutral exchanges; each choice shapes not just our careers but also who we become.Jacob’s child probably won’t appreciate his “sacrifice” but will only remember scanning the audience, hoping to see his father’s face. The irony is painfully clear: in a world where everyone worries about missing the right event, perhaps the most significant moments are the quietest ones — not those labeled “fireside” or “networking,” but simply and sincerely called “choir concert.”

Can Jony Ive and Sam Altman dethrone Apple’s empire?

Last week, a seismic ripple coursed through Silicon Valley, a place long accustomed to tectonic shifts but rarely surprised by them. OpenAI, the artificial intelligence juggernaut led by the audacious Sam Altman, announced it was acquiring io, a fledgling startup founded by Jony Ive, the legendary former Apple design chief whose aesthetic alchemy gave the world the iMac, iPod, and iPhone. The deal, valued at $6.5 billion in OpenAI equity, was not merely a business transaction; it was a gauntlet thrown at the feet of Apple, Google, and the entire tech establishment. The partnership between Ive and Altman, two titans of their respective domains, promises to forge a new kind of device — one that could, in their lofty rhetoric, “reimagine what it means to use a computer.” But beneath the gloss of their nine-minute promotional video, a peculiar blend of Silicon Valley hyperbole and earnest ambition, lies a question as old as innovation itself: Can lightning strike twice?Jony Ive’s departure from Apple in 2019 was a quiet cataclysm. For nearly three decades, he was the company’s design soul, the man Steve Jobs once called his “spiritual partner.” Ive’s work — sleek, minimalist, almost monastic in its devotion to form — defined not just Apple’s products but an entire era of consumer technology. The iPhone, with its elegant glass and aluminum design, has become a cultural artifact — a talisman of modernity that has reshaped how we communicate, work, and spend our time. Yet, Ive has admitted to a lingering unease about his creation’s unintended consequences: the screen addiction, the fractured attention spans, the way smartphones have colonized our lives. “Some of the products I designed have had some unintended consequences that were far from pleasant,” he told an interviewer recently, a rare moment of candor from a man known for his reticence.Enter Sam Altman, the 40-year-old wunderkind whose trajectory — from Y Combinator president to OpenAI’s CEO — has been defined by a relentless pursuit of the next big thing. Altman’s OpenAI, with its ChatGPT phenomenon, has already disrupted the tech landscape, amassing 100 million users in its first two months and challenging Google’s search dominance. However, Altman, like Ive, is haunted by a sense of unfinished business. He views the current interfaces for AI-keyboards, screens, and apps as outdated relics, hindering the seamless integration of artificial intelligence into daily life. “If I wanted to ask ChatGPT something right now about something we had talked about earlier, think about what would happen,” Altman mused in the announcement video, his voice tinged with impatience. The answer, he implied, is a tangle of swipes and prompts, a far cry from the intuitive magic he envisions.Their collaboration, formalized by OpenAI’s acquisition of io, represents a bet that hardware and software, designed together, can overcome these limitations. The details of their project remain tantalizingly vague, but leaks and whispers provide clues. At an OpenAI staff meeting, Altman described a device that would be “fully aware of a user’s surroundings and life,” unobtrusive enough to fit in a pocket or rest on a desk, a “third core device” alongside a MacBook and iPhone. Analyst Ming-Chi Kuo, a renowned expert in tech prognostication, suggests it might be a screenless pendant, equipped with cameras and microphones, worn around the neck and linked to smartphones or PCs. This is not a phone, not smart glasses, but something else entirely — an “AI companion” that could ship 100 million units on day one, if Altman’s ambitions hold.The audacity of this vision is matched only by its peril. The AI hardware graveyard is littered with cautionary tales. The Humane AI Pin, a $700 wearable backed by Altman himself, flopped spectacularly, criticized for its clunky execution and limited utility. Rabbit’s R1, another AI device, was roasted for its half-baked functionality. These failures underscore a brutal truth: consumers are loath to adopt new devices unless they offer something profoundly better than the smartphones already glued to their hands. Smartphones, as BGR noted, are now so advanced that replacing them is an “uphill battle from the outset.” Ive and Altman must not only surpass these flops but also convince a skeptical public that their device is indispensable, a feat akin to persuading people to abandon their cars for hoverboards.Yet, if anyone can pull it off, it might be Ive. His track record at Apple is a litany of disruption: the iMac revived a struggling company, the iPod transformed the music industry, and the iPhone redefined computing. Ben Wood, chief analyst at CCS Insight, told the BBC, “It would be foolish to bet against Jony Ive, given his remarkable track record of delivering products that disrupt a market.” Ive’s design philosophy — obsessive, reductive, almost spiritual — has always focused on stripping away the superfluous to reveal the essential. At Apple, he once described the iPhone’s creation as “turning our users’ previous experience and understanding upside down,” a sentiment echoed in his current mission to “elevate humanity” through AI.Altman, for his part, brings a different kind of alchemy. His vision is less about elegance and more about scale, less about form and more about function. OpenAI’s $300 billion valuation, bolstered by a SoftBank-led round, reflects its ability to sell not just products but paradigms. He speaks of AI as a civilizational shift, a force that could “change the course of humanity.” His rhetoric, often grandiose, finds a counterpoint in Ive’s measured restraint, creating a dynamic that recalls the Jobs-Ive partnership: one man dreaming in broad strokes and the other obsessing over details. Their promotional video, a nine-minute paean to their “meet-cute” and shared vision, is both cringeworthy and compelling, a testament to their belief that San Francisco’s foggy streets can birth a new technological epoch.But the specter of Apple looms large. The company’s stock dipped 2% after the announcement, a rare wobble for a $3 trillion behemoth. Apple has struggled to keep pace in the AI race, with its Siri assistant lagging behind ChatGPT and Google’s Gemini. The departure of key design talent, including Ive and his protégés Tang Tan and Evans Hankey, has left Apple’s innovation engine sputtering. Bloomberg reports that the Ive-Altman deal has sent “shockwaves” through Cupertino, where executives are scrambling to counter with Meta-like smart glasses and a major iOS redesign by 2026. For Altman, the rivalry is personal: a former Apple fan who showcased his startup Loopt at the 2008 Worldwide Developers Conference, he now aims to out-Apple Apple by crafting a device that could render the iPhone obsolete.The irony is thick. Ive, who helped make Apple the world’s most valuable company, is now its would-be disruptor. His regret over the iPhone’s social fallout—screen addiction, isolation — fuels his ambition to create a less invasive device, one that “weans users from screens,” as The Wall Street Journal reported. Yet, AI itself is not without its demons. As Gizmodo’s Kyle Barr notes, AI has “numerous well-documented problems,” from biases to energy consumption to existential risks overhyped by doomsayers. If Ives’ iPhone created a generation of screen addicts, what unintended consequences might an AI companion unleash? Will it be a benevolent oracle or a surveillance device masquerading as a friend?The tech world watches with bated breath. On X, speculation runs wild: renders of sleek pendants, memes of AI-powered nail clippers, and debates over whether Ive’s minimalist aesthetic will yield a “glorified paperweight.” One user quipped, “Sam is insane. He managed to seal a ChatGPT distribution deal with Apple while collaborating on an iPhone killer with Apple’s top designers.” The sentiment captures the high-stakes drama: Altman and Ive are not just building a device but challenging the very paradigm they helped create.In San Francisco’s North Beach, where Ive and Altman reportedly hashed out their vision over coffee at Cafe Zoetrope, the air hums with possibility and peril. Their device, still a prototype, is already being hailed as “the coolest piece of technology the world will have ever seen,” in Altman’s breathless words. But as The Atlantic’s Matteo Wong cautions, “when you promise the world a revolutionary new product, it helps to have actually built one.” For now, Ive and Altman are selling a dream, a vision of AI that’s less clunky, more human, and more magical. Whether they can deliver — whether they can outshine the iPhone’s long shadow — remains an open question, one that will define not just their legacy but the future of how we live with machines.

The case for slashing drug prices

Last week, President Donald Trump enacted an executive order named “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients," aiming to align U.S. drug prices with the lowest rates other developed countries charge. This policy builds upon previous, unsuccessful attempts from Trump’s first term and has ignited heated debate. Supporters view it as a long-overdue adjustment to a system that has made Americans bear the brunt of global pharmaceutical costs. Conversely, critics — primarily from the pharmaceutical industry and its supporters — consider it a dangerous threat to innovation that may hinder the development of life-saving medications. As always, the truth lies in the balance between these extremes, but the argument for reducing drug prices in the U.S. is not just persuasive — it’s imperative, rooted in both economic justice and moral duty.The United States, with less than five percent of the global population, accounts for roughly three-quarters of worldwide pharmaceutical profits, a staggering imbalance that has persisted for decades. Americans pay, on average, nearly three times more for the same medications produced in the same factories as their counterparts in other wealthy nations. A study by the Kaiser Family Foundation found that the U.S. price for a 30-day supply of the diabetes drug Januvia was $614, compared to $76 in Canada and $64 in the United Kingdom. This disparity isn’t an accident; it results from a global pricing system in which foreign governments negotiate aggressively with drugmakers, leveraging their single-payer systems to secure deep discounts, while the fragmented and profit-driven U.S. market bears the brunt of research and development costs. As G. Dirk Mateer argues in RealClearMarkets, this setup effectively subsidizes innovation for the world at the expense of American patients, who are left to choose between crippling medical bills and forgoing essential treatments.The human cost of this system is incalculable. A 2023 study revealed that 26 percent of Americans with prescription drug coverage still skipped doses or split pills due to cost, a figure that rises to 43 percent among those with chronic conditions like diabetes or heart disease. These are not abstract statistics; they are stories of real people — retirees rationing insulin, parents cutting corners on asthma inhalers for their children, cancer patients weighing survival against bankruptcy. The New York Times reported on a retired schoolteacher in Ohio who, unable to afford her $1,200 monthly rheumatoid arthritis medication, resorted to buying generics from a Canadian pharmacy, risking legal repercussions and inconsistent supply. Such desperation is a damning indictment of a system that prioritizes corporate profits over human lives.The economic argument for lowering drug prices is equally robust. Mateer likens the U.S. government’s role as a massive purchaser of pharmaceuticals to that of a savvy corporate buyer like Walmart, which uses its market power to negotiate steep discounts. Yet, for decades, the federal government has failed to wield this leverage, leaving taxpayers and patients to foot inflated bills. The Congressional Budget Office estimated in 2024 that Medicare alone could save $100 billion over a decade by negotiating prices for just 20 high-cost drugs. As Trump's order proposes, extending such negotiations across federal programs and into the commercial market could yield savings in the hundreds of billions of dollars that could be redirected to infrastructure, education, or expanding healthcare access. AARP, in a statement praising the executive order, noted that “big drug companies have been ripping off America’s seniors,” forcing them to “skip medications they can’t afford.” Lower prices would not only alleviate this burden but also stimulate broader economic activity by freeing up disposable income for millions of households.Critics of the most-favored-nation policy, led by the Pharmaceutical Research and Manufacturers of America (PhRMA), argue that slashing U.S. prices would choke off the revenue needed for research and development, stifling innovation. It’s a familiar refrain echoed by industry leaders like PhRMA CEO Stephen Ubl, who called the policy a “bad deal for American patients” that would “jeopardize treatments and cures.” But this argument rests on shaky ground. A 2021 study by the National Bureau of Economic Research found that only about 15 percent of pharmaceutical revenue is reinvested in R&D, with the lion’s share going to marketing, stock buybacks, and executive compensation. Moreover, the U.S. government already funds a significant portion of early-stage drug research through the National Institutes of Health, which spends over $40 billion annually on biomedical research. As The New York Times noted in its May 2025 coverage, drugmakers’ claims of innovation at risk often obscure the fact that “the U.S. alone is not going to pay for innovation” when other nations could contribute more equitably to global R&D costs.Skeptics also warn of unintended consequences, such as drugmakers withdrawing from lower-margin international markets or raising prices abroad to circumvent the most-favored-nation clause. Yet, this scenario assumes that pharmaceutical companies would willingly abandon profitable markets like Europe and Japan, a move that seems unlikely given their reliance on global revenue streams. Such withdrawals could increase domestic drug supply, a prospect that Trump reportedly welcomes. More critically, the threat of tariffs and import restrictions, as outlined in the executive order, gives the administration leverage to prevent such gaming of the system.The political optics of the policy are undeniable, particularly for a president whose populist rhetoric has long railed against elites fleecing ordinary Americans. Trump’s order, announced alongside Health and Human Services Secretary Robert F. Kennedy Jr., taps into a bipartisan well of frustration with Big Pharma’s unchecked power. Yet the policy’s success hinges on navigating a gauntlet of legal and practical challenges. Courts and industry lawsuits blocked Trump’s earlier attempts at most-favored-nation pricing in 2017 and 2020. Politico notes that the current order’s broad scope — extending beyond Medicare to include commercial markets potentially — may exceed executive authority without congressional backing. The Inflation Reduction Act of 2022, which empowered Medicare to negotiate prices for select drugs, offers a complementary tool, but its limited scope underscores the need for bolder action.For all its risks, the most-favored-nation policy represents a rare chance to rebalance a profoundly inequitable system. It’s not about punishing pharmaceutical companies; it’s about ensuring that Americans aren’t punished for their government’s failure to negotiate as fiercely as other nations do. The American Thinker framed it starkly: “If Germany pays $45 for a drug, we’re not paying $450.” This isn’t socialism, as critics claim; it’s basic fairness, the kind of hard-nosed dealmaking Trump has long championed. The alternative — preserving a status quo where Americans subsidize the world’s medicines while rationing their own — is not only unsustainable; it’s unconscionable.Lowering drug prices won’t solve every ill in America’s healthcare system, but it’s a critical step toward a future where no one has to choose between medicine and survival. The fight will be messy, with court battles and industry pushback inevitable. But the moral and economic case is clear: when the largest buyer in the world demands a better deal, it’s not just good business — it’s a lifeline for millions.

The emergency whisperer

In a city like New York, where the wail of sirens weaves into the urban hum alongside taxi horns and street chatter, the emergency response machinery feels both ever-present and unseen. We hear the ambulances and glimpse the flashing lights, but rarely pause to ponder the systems that drive them — or the minds behind those systems. Amir Elichai, founder and CEO of Carbyne, a company transforming emergency communications, is one such mind. In a recent interview with CEO.com, Elichai revealed the instincts and innovations fueling his mission: to ensure that a 911 call triggers not just a response, but one that’s swift, precise, and almost prescient. His story is one of grit, empathy, and an unshakable belief that technology can tame the chaos of crisis.Elichai began with a story that feels ripped from a screenplay. A decade ago, while strolling along a beach in Israel, he was robbed at knifepoint. Two men, a blade, the stark isolation of danger. He called for help, but the response was slow, fragmented. The police arrived too late, the robbers vanished. “I was frustrated,” he said, the memory still sharp. “There’s got to be a better way.” That frustration wasn’t fleeting; it birthed Carbyne, now a billion-dollar enterprise backed by giants like Founders Fund and Valor Equity Partners, serving emergency systems across 16 countries.Carbyne’s technology bridges the gap between a desperate call and the help it summons. The 911 system often relies on outdated infrastructure—analog lines and dispatchers taking notes by hand. Carbyne rewrites that narrative. Its cloud-native platform delivers GPS-accurate caller locations, streams live video from the scene, and gathers data like medical records or building schematics in real time. Imagine a dispatcher not just hearing a trembling voice but seeing the fire, the wound, or the threat through the caller’s phone. “It’s about giving the dispatcher superpowers,” Elichai said, a phrase that could sound hyperbolic but lands as urgent when you consider the alternative: a system blind to your whereabouts.What sets Elichai apart is not just his technical prowess but his near-philosophical grasp of an emergency’s weight. “When you call 911, it’s probably the worst day of your life,” he said. “You’re not calling because you’re having a great day.” This empathy drives Carbyne’s core. The platform doesn’t just chase faster response times; it seeks to ease the terror of those moments, making the system feel human, responsive, almost all-knowing. He shared a case where Carbyne’s video feed enabled a dispatcher to guide a caller through CPR, saving a life before paramedics arrived. It’s a story that could veer into boast, but Elichai delivers it with quiet conviction, as if it’s simply what the technology demands.His journey to this point has been circuitous. A former officer in Israel’s elite special forces and intelligence corps, Elichai carries the poise of someone who is well-versed in high-stakes choices. His military experience, he said, taught him to “run toward the fire,” a mindset that is as vital in entrepreneurship as it is in combat. After his service, he earned degrees in law and business, although he never practiced law. “Law is like the new BA,” he quipped, echoing a remark from an earlier interview with Alejandro Cremades. It’s a foundation for understanding the world’s rules before reshaping them. His first foray into investment banking shifted his path, but the robbery in Israel turned his gaze to public safety.Carbyne, initially named Reporty Homeland Security, sprang from that pivot in 2014. Its growth has been meteoric — 360% during the COVID-19 pandemic, Elichai noted, as governments raced to modernize emergency systems. With $128 million in funding, including a $56 million Series C round in 2022, the company’s trajectory reflects the urgency of its mission. Yet scaling at that pace brings its own challenges. Elichai described the slog of persuading governments to adopt new tech, a process he likened to pushing a boulder uphill. “Governments don’t move fast,” he said with a wry edge. “They need to trust you, and trust takes time.”Trust is a leitmotif in Elichai’s philosophy. He tackled head-on the privacy concerns that Carbyne’s capabilities — accessing locations, cameras, and data — can spark. “We’re not in the business of surveillance,” he said. “We’re in the business of saving lives.” Carbyne’s system is fortified with encryption, restricted access, and caller control, but Elichai doesn’t dodge the skepticism. In an era of eroded tech trust, Carbyne must be beyond reproach. “We have to be transparent,” he said. “People need to know we’re here to help, not to watch.”This dance between innovation and responsibility, speed and care, defines Elichai’s leadership. He shuns the spotlight, offering answers that are direct, unadorned, tethered to the problem at hand. Asked about his vision for the future, he didn’t paint a utopia free of emergencies. Instead, he spoke of “connected ecosystems,” where emergency services, hospitals, and even autonomous vehicles share data seamlessly. Imagine a crash where the ambulance knows your blood type en route, or a fire where drones map exits in real time. It’s bold yet grounded, already taking shape in Carbyne’s work.