Normal view

The lifesaving case for CPR dummies with breasts

26 August 2026 at 14:30

Every once in a while, I feel the urge to shout “women are not small men!” at inanimate objects. Today, that object is the flat-chested plastic torso typically used for CPR training. 

Breasts, it turns out, are really the bane of every woman’s existence — the back pain, the boob jail, the running. But here’s a new one: In a public cardiac arrest, they may be the reason nobody helps you.

Two years ago, an analysis of over 300,000 cardiac arrests showed that women are 14 percent less likely than men to receive CPR from a stranger if they have a cardiac arrest in public. Bystanders tend to be more hesitant and feel less comfortable providing CPR or using external defibrillator paddles, called AEDs, on people with breasts. Experts have time and again pointed, in part, to the fact that nearly everyone learns to perform CPR using the traditional, flat-chested dummies called “manikins,” which overwhelmingly represent the male anatomy. If the first time a stranger has to perform CPR on someone with breasts is in the middle of a high-stakes emergency — what else would you expect? 

For the last 20 years, not only has the survival rate for out-of-hospital cardiac arrests been around 10 percent, but also the chances of the victim surviving decrease by 10 percent every minute that interventions like CPR are not performed. It makes it all the more harrowing that women are not receiving the care they need when they experience cardiac arrests — especially in places where they are surrounded by people. 

Whether it is manikins used for CPR training, crash tests or medical care in combat, the default stand-in for what is “human” has long been male. 

But recently, researchers, advocates and governing bodies like the American Heart Association and European Resuscitation Council are pushing for better representation in CPR training and education. Increases in simulation-based research on the use of representative manikins, like ones that accurately represent female anatomy, are changing how people train to respond to cardiac arrest — and simultaneously exposing bigger gender gaps in design that systematically exclude women from experiencing the same level of safety and care as men. 

One size doesn’t fit all

The first CPR manikin was developed in 1960 by the Norwegian toy manufacturer Laerdal. The manikin, called Resusci Anne, which had the anatomy of a prepubescent teen, was ironically modeled off an unnamed girl who was thought to have drowned in the river Seine in Paris. Laerdal famously wanted a female face on the manikin since he thought men might hesitate to practice mouth-to-mouth resuscitation on a male manikin. It’s not surprising that women trainees didn’t factor into the equation at all back in the 1960s — they weren’t even included in clinical trials yet — but the norm of designing with the comfort of men at the forefront continues to this day. 

Since then, Resusci Anne has been reengineered many times over, and today’s manikins are surprisingly high-tech and interactive. However, as of 2022, about 95 percent of manikins on the market from mainstream manufacturers were still flat-chested and androgynous. 

Key takeaways

  • Women are less likely than men to receive CPR from a stranger in the event of a public cardiac arrest. 
  • Research indicates that this is because people feel uncomfortable and hesitant to touch or expose women in order to perform CPR, in case it is misconstrued as inappropriate. They also worry about injuring them in the process. 
  • Experts believe that such dangerous hesitation could be reduced by using resuscitation manikins that have female secondary sex characteristics, like breasts, during CPR training.
  • This is difficult to execute because anatomically accurate female manikins are not widely available for purchase or widely adopted; 95 percent of manikins on the market are flat-chested and androgynous.
  • The conversation surrounding the design disparity in CPR training is also exposing similar flaws in other fields like vehicular crash-testing or combat medicine, where female dummies are largely excluded from mainstream testing and training protocols.  

So why does this matter?

In the past, research has hinted at three main reasons why bystanders don’t immediately rush to the aid of a woman in cardiac arrest. One, they are hesitant to expose or touch her in any way that could be misconstrued as inappropriate and are worried about sexual assault allegations after the fact. Two, they don’t want to accidentally hurt them, perceiving them as generally more fragile than the average man. And three — perhaps saddest of all: bystanders often don’t recognize that a woman is in cardiac arrest if, say, she collapses in public, misattributing it as overreacting, simply fainting or faking it. 

CPR training with female manikins would go a long way in teaching people to be comfortable with the female form.  

In one study, people at MassCPR — the free CPR certification program offered by Massachusetts Institute of Technology for the MIT community — were trained using standard manikins,  as well as a few which were retrofitted with a mold resembling breasts. At the end of the certification, participants who practiced on the manikin with breasts reported greater comfort performing CPR on women. 

If there was widespread adoption of manikins that looked and felt different, this could ultimately become the norm. 

It’s really only in the past five years or so that research on this disparity has sped up, offering some evidence for the need for more representative manikins. Even then, widespread adoption of female manikins is hindered by commercial availability of anatomically correct models and the cost of switching existing CPR training programs over to using them.   

Closing the design (gender) gap

There are two main ways to go about increasing the availability of female manikins: Either you retrofit existing standard manikins with breasts or you design completely new ones. 

When Christoph Veigl and colleagues at the Medical University of Vienna surveyed 133 training organizations across 43 countries from six continents, they found that of more than 5,000 manikins in use, only a fifth of organizations owned a female one. While that number is still low, adoption is triple what it was four years ago. The researchers acknowledge that just the availability of female manikins is not necessarily an indication of how much they are used in training — about a quarter of the organizations were also employing makeshift adaptations, like placing a bra on standard manikins, to simulate training on women. 

Dr. Pooja Nawathe, a resuscitation science researcher and pediatric critical care clinician at Cedars-Sinai Hospital, chose to focus her research on gender disparity in resuscitation for a specific reason. 

“Skin color is about implicit biases, but female breast tissue, which is a normal physical characteristic, is about the actual science of this,” she said, speaking about variations in care during cardiac arrests. “Are we teaching how to place the pads on the breast tissue?”  

She also stresses the importance of gathering good, granular data on how CPR performance changes when people are exposed to diverse populations.     

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men.

CPR manikins are just one example of the gender gap in design: Across fields like crash testing, the “human” body has long been modeled on men. But that’s starting to change, too. Last year, the National Highway Traffic Safety Administration (NHTSA) released the design details for THOR-05F, the first detailed female crash-test dummy.

Before this, the standard female crash-test dummy was a model called the Hybrid III 5th percentile female dummy — literally just a scaled-down version of the Hybrid III 50th percentile male dummy that represents the average male body dimensions. But the THOR-05F — every woman’s dream name, I’m sure — is a much more anatomically accurate female dummy, and includes a female pelvis, breasts, and a flexible spine. 

THOR-05F has arrived just as new research by the NHTSA affirmed the need for better crash-testing on women. Although the gap in vehicular accident fatality rates between the sexes has narrowed significantly in newer car models, women continue to experience a higher injury rate compared to men in multiple different types of vehicular accidents. The hope is that testing with the THOR-05F will provide a better understanding of this trend and help engineer safer vehicles and regulations for women.

Women are not small men!

Women are often referred to as the “invisible sex,” and the lack of female manikins really brings that to the forefront. It’s not like the manufacturers or policymakers intentionally excluded women from this area — they simply ignored them, accepting an androgynous body as the standard with an unchallenged assumption that what applies to it will undoubtedly apply to women too. 

In 2019, Joan Creative, the New York-based ad agency, launched the Womanikin, a universal attachment for CPR manikins, in partnership with United State of Women, a now-shuttered organization focused on gender equity. Launched during National CPR Week, the Womanikin is a neoprene vest with silicone breasts that can be zipped onto any standard manikin. Built as an awareness campaign, they open-sourced the design for the breasted vest and helped spark a broader conversation about the CPR gender gap. But we don’t have any detailed information about its success or adoption. 

More recently, other manufacturers like Prestan have come out with newly designed female manikins that can be purchased as is. They also sell “replacement female skin” that retrofits any existing Prestan adult manikins. Notably, these are now available on the American Red Cross store, increasing visibility for female manikins.

The fact that women account for 50 percent of the world’s population and yet have to mold themselves to standards not designed for them in the first place is atrocious. Not only is it frustrating to live in a world not built for you, but in cases like CPR training, the gender gap can quite literally be fatal. This is true whether it is for motor vehicle crash-test dummies or those used to train battlefield medics — another field where women injured in battle have a higher fatality rate than their counterparts.

The basic idea is that repeated exposure to female bodily characteristics during training or testing can significantly alleviate discomfort that causes dangerous hesitation. If people had more practice administering CPR to models that looked more feminine, they wouldn’t be thrown off by breasts, would understand how to cut away clothing like bras if needed, and learn how to efficiently place the pads of the external defibrillator on a female body. 

CPR techniques remain largely the same irrespective of sex. Chest compressions are performed on the sternum, which is the flat bone running down the center of your chest. For women, it lies between the breasts, so there are some additional considerations. That is what representation in training manikins is meant to address — not new skills, but familiarity. 

Ultimately, it really comes down to not feeling awkward about putting your hand in between two breasts, if it means you save a life.

Iran faces strait of Hormuz paradox as strategic value of chokehold erodes

Internal calls to end war get louder as Gulf neighbours plan alternative pipelines to cut reliance on waterway

Is the strait of Hormuz, recently cited by the office of the Iranian supreme leader as “the pillar of Iran’s new security order”, and as transformative as possessing a nuclear weapon, in reality becoming a fast-diminishing asset, leaving Iran increasingly vulnerable to the new planned US wave of economic sanctions?

It is the key debate that is raging inside Iran, with many different conclusions being drawn for Tehran’s negotiating strategy. Those who warn the strait’s value as a chokehold on the world economy will erode, leaving the country without foreign exchange reserves, argue that Iran’s negotiators should seek a deal soon.

Continue reading...

© Photograph: Majid Asgaripour/Reuters

© Photograph: Majid Asgaripour/Reuters

© Photograph: Majid Asgaripour/Reuters

US battery startups have found a lifeline in defense

22 August 2026 at 18:20
U.S. battery startups pulled in $500 million in grants from the Department of Energy, throwing a lifeline to an industry that was on the ropes after EV incentives were slashed.

America’s murder rate hasn’t been this low in 70 years

22 August 2026 at 15:30
Baltimore’s Safe Streets office.

A few things are certain in life: death, taxes, LeBron James playing professional basketball — and Americans’ belief that crime is getting worse. Since Gallup began asking about national crime in 1989, a majority of respondents said they thought crime in the US was higher than the year before in every survey year except 2000, 2001, and 2025. Even in that last year, 49 percent still said more crime was happening. It’s perhaps the archetypal example of negativity bias, the mental habit of giving more weight to bad news than good.

Last week, the FBI put some numbers on just how big that bias is. The American murder rate — which peaked in 1980 at 10.2 per 100,000 — fell to an estimated 4.1 per 100,000 people in 2025, matching the rates recorded in 1955 and 1956 for the lowest ever measured in the country. The violent crime rate (murder, rape, robbery and aggravated assault) fell 9.7 percent, the largest single drop since J. Edgar Hoover was running the bureau in 1936

That much is known. But what’s not known for sure about the crime drop is almost everything else. Adam Gelb, who runs the Council on Criminal Justice, says that there is no single or easy explanation for the historic lows, while Jeff Asher, the analyst who spotted this decline before nearly everyone else, agrees. For every leading candidate — federal pandemic spending, some normalization after the 2020 social collapse, better violence prevention, even the decline of drinking — there is a corresponding hole. 

But there is one American city where researchers can point to a specific program, measure what it did, and put real numbers on it. And it just happens to be the city that spent 50 years — and five award-winning seasons on HBO — as America’s shorthand for murder.   

What Baltimore did

Baltimore recorded more than 300 homicides a year for most of the last decade, and more than 200 for most of the past half-century. In one month, July 2015, 45 people were killed — an astounding figure for a city of just around 600,000 people at the time. 

But Baltimore finished 2025 with 133 homicides, the fewest since 1977 and about 60 percent fewer than in 2020. Through the first eight months of this year, the city has seen 60 murders, and the police commissioner’s target is to stay under 100. 

What caused this? Three things at once.

Baltimore Mayor Brandon Scott’s Group Violence Reduction Strategy identifies the few people most likely to shoot or be shot — two groups that heavily overlap — and sends people to their doors with two messages: you are on our radar, and here is housing and job training. Separately, the longer-running Safe Streets program puts outreach workers with real street credibility between disputes, aiming to interrupt them before they become shootings.

That’s the harm reduction element. There’s also a tough-on-crime component. The state’s attorney office says it has secured 2,129 convictions since 2023 across several gun-related violent-crime categories, with over 1,700 of those defendants incarcerated. 

Meanwhile, Baltimore’s homicide clearance rate reached 60 percent by mid-2026. Its nonfatal-shooting clearance rate was 54 percent, up more than 12 percentage points from a year earlier. Criminologists have long held that the certainty of being caught deters criminals more than the severity of the sentence, and more successful shooting investigations are a common thread where violence is falling around the country. 

How do you tell whether a program worked, or whether a city just got lucky? Drug trials get a control group; cities don’t. Baltimore got one almost by accident: the strategy launched in the city’s Western District in 2022 and nowhere else, which left the rest of the city as a comparison.

That’s what a team of economists and criminologists used. They measured the Western District against Baltimore neighborhoods that hadn’t started the program yet, and over 18 months the number of people shot there, fatally or not, ran about 30 percent below that stand-in. Killings alone fell by a similar share, but deaths are rare enough that chance couldn’t be ruled out. Police made no more arrests than before. Arrests for serious violent crime rose 81 percent.

A second, looser test set the whole city against a composite of other big American cities and put Baltimore’s murder rate about 25 percent below it. The authors are careful with that one: too much changed in Baltimore at once to say how much it the strategy was responsible for.

Murder is contagious

Baltimore’s success is built on two ideas, and they came from two very different places. 

The first came from a doctor named Gary Slutkin, who spent the 1980s and early 1990s fighting tuberculosis in San Francisco, cholera in Somali refugee camps, and AIDS across Africa. He came home to Chicago in 1995, a year the city recorded over 800 homicides

Key takeaways

  • Americans have told Gallup crime is getting worse in nearly every year since 1989. In 2025 the US murder rate fell to 4.1 per 100,000, tying 1955 and 1956 for the lowest ever measured, and violent crime dropped 9.3 percent — the largest single-year fall since the FBI began national estimates in 1936.
  • Nobody can say why. Federal pandemic spending, the unwinding of the 2020 collapse, violence prevention programs, Americans drinking less: every leading explanation has a hole in it.
  • Baltimore is an exception. Because its Group Violence Reduction Strategy launched in one police district first, researchers could measure it against the rest of the city. Shootings there ran about 30 percent lower — and police made no more arrests than before.

When Slutkin examined the city’s shooting maps, they looked familiar. Clustered in space, clustered in time, and spreading case to case — murder resembled the outbreaks he used to fight. Slutkin reasoned that the way to treat violence was to treat it like cholera: find the people most likely to transmit. Interrupt the transmission. Change the conditions that let it spread. Slutkin built the model into a program called CeaseFire, now Cure Violence Global, and its Baltimore descendant is Safe Streets.  

The second idea came from a criminologist. David Kennedy, working in Boston in the 1990s, found that 61 gangs with about 1,300 members — under 1 percent of the city’s young people — were tied to at least 60 percent of its youth homicides. Get those people in a room with police, prosecutors, and community elders, tell them plainly what comes next, and the shooting slows down.

That approach is called focused deterrence. Baltimore’s Group Violence Reduction Strategy is a version of it. To see how it works over a longer period of time, take a trip across the Atlantic to Glasgow in Scotland, which in the early 2000s was considered the murder capital of Europe.

In 2005, in the midst of that wave of violence, Glasgow’s Strathclyde Police established a Violence Reduction Unit that operated with a basic thesis: evidence shows that violence can be prevented. Among other interventions, the unit sent trauma surgeons into schools to describe what a blade does to a face and stationed outreach workers at hospital bedsides to reach victims in the vital hours after an attack, the moment when retaliation can still be stopped. 

In 2024-25, Scotland recorded 45 homicide victims, the fewest since comparable records began in 1976 and down from 96 two decades earlier. Every case was solved.

Pull the handle

So we have clues to why crime has dropped so much, but not clear conclusions. As successful as Baltimore’s group violence strategy has proved, a 2023 study of a similar street-outreach effort in Boston found no effect whatsoever. And the latest evaluation of Baltimore’s own Safe Streets — 11 sites, each measured against a stand-in version of the same neighborhood without the program — produced numbers that sound terrific but settle very little: youth homicides down 42 percent and youth shootings down 21 percent, but neither is strong enough to rule out chance. And while some sites saw youth homicide fall by as much as 100 percent, two sites saw it rise by 42 and 89 percent. 

Some experts, like the UC Irvine criminologist Emily Owens, argue the crime decline has been so widespread and similar — big cities and small, red and blue governments — that the true cause is some larger social change rather than what any one city is doing. Nor can we be sure the fall will continue. Billions in federal pandemic relief money has supported many of the programs that have worked well in places like Baltimore, and that money is already running out. But we can identify one reason why it happened, and learn from that success. 

As it happens, Gary Slutkin was not the first doctor to look at a map of the dead and see a pattern in it. In September 1854, a cholera outbreak was killing hundreds of people in London’s Soho district. A doctor named John Snow had mapped the outbreak and saw the dead were clustered disproportionately close to the district’s Broad Street water pump. Snow had a theory that water was connected to the disease and convinced a Soho parish board to remove the handle of the pump. 

Nobody in Soho at that moment could have told you what caused cholera. It would only be 29 years later that someone would definitely identify the responsible pathogen, and in doing so, explain why Snow’s intervention worked. But the explanation could wait. The dying stopped that month in Soho, just as it is stopping in Baltimore and around the US today. And that’s what counts.

A version of this story originally appeared in the Good News newsletter. Sign up here!

TikTok reaches $400M settlement over children’s privacy lawsuit

21 August 2026 at 23:25
Two years after the U.S. Department of Justice alleged that TikTok violated the Children’s Online Privacy Protection Act, it has reached a $400 million settlement.

US government lab is probing Chinese lidar for security vulnerabilities

21 August 2026 at 19:01
The security review is being performed by the Idaho National Laboratory, and the research is being funded by a company -- or a group of companies -- in the electric and autonomous vehicle industries.

Why this year’s Medicare-for-all debate is different

21 August 2026 at 13:00
Supporters look on as Sen. Bernie Sanders (I-VT) speaks during a news conference to announce the re-introduction of the Medicare for All Act of 2023, outside the Capitol on May 17, 2023, in Washington, DC. | Drew Angerer/Getty Images

The affordability and availability of healthcare is emerging as a top concern for Americans, with some recent surveys ranking it easily as the top concern. Voters are upset with rising costs, and federal cuts to Medicaid and Obamacare subsidies threaten to leave millions more uninsured

Progressive candidates, who have won major primaries this cycle, have been eager to offer Medicare-for-all as a solution. Polling suggests there is broad support for the idea, even if most American voters aren’t sure what the phrase means in practice.

But Democrats have also been fighting about Medicare-for-all for the last decade, with battles reaching a fever pitch in the 2020 presidential primary. The popular slogan has been most closely associated with Vermont Senator and two-time presidential candidate Bernie Sanders, whose federal Medicare for All Act would enroll virtually every American into one national plan and largely eliminate private health insurance. Six years later, plenty of Democrats still remember bitter arguments over whether to replace private insurance or build on it, dividing the party over an issue they otherwise agreed was a top priority.

Key takeaways

  • The health care fight that defined 2020 may not happen again: Abdul El-Sayed, who wrote a book on Medicare-for-all, is running on a version that keeps private insurance — and Sanders and Ocasio-Cortez have endorsed him.
  • Voters still don’t agree on what Medicare-for-all means: A March 2026 survey found 60 percent think Medicare-for-all would create a single-payer system, while 61 percent also think they’d keep their private plan.
  • The stakes are rising fast: Health insurers want a median 15 percent premium hike on top of roughly 20 percent this year, and Medicaid work requirements start in January, just as the 2028 campaign begins.

Yet there are emerging signs that the party is not about to experience déjà vu when it comes to healthcare politics. In interviews over the last few weeks, activists, pollsters, and policy experts sound cautiously optimistic that the Democratic healthcare wars might finally be headed for a collaborative truce. And Abdul El-Sayed, the buzzy Michigan progressive who wrote a book on Medicare-for-all, is campaigning for US Senate on a version that would let people keep their private health insurance, a potentially major shift. In a recent interview, El-Sayed went as far as to say, “as long as it reduces the power of healthcare corporations, expands healthcare, and does so publicly, I’m for it.”

In the meantime, Democrats have been busy building a new stockpile of ideas. New and serious healthcare proposals are circulating among lawmakers and potential 2028 presidential contenders, ranging from breaking up healthcare monopolies and expanding public drug manufacturing, to regulating hospitals and establishing new public options, meaning government-run health insurance plans that people can choose to buy instead of private insurance.

Next year is shaping up to be particularly painful. Health insurers want to raise Obamacare premiums by a median of 15 percent, on top of a roughly 20 percent jump this year, and starting in January, millions on Medicaid will have to prove they’re working to keep their coverage. Higher premiums and new hurdles to staying on Medicaid will land right as the next presidential campaign gets going.

That’s part of why the drafting feels urgent. Major healthcare legislation is rare, and the groups crafting these proposals think the next window may be opening.

“People have moved on from messaging; people aren’t staking out extreme positions to move the Overton Window,” said Neale Mahoney, a Stanford healthcare economist who has been reviewing many of the new proposals and advises the Kitchen Table Project, one of the groups developing them. “I think people are very much in the ‘what is something that could actually work?’ phase.”

What Americans really think about Medicare-for-all

One reason healthcare experts are feeling hopeful that reform may play out more amicably this time is that the fight that consumed the last one — whether everyone would be forced off their private plans — may not happen. Medicare-for-all supporters themselves seem tentatively open to paths beyond the strict single-payer program outlined in Sanders’ bill.

This is also significant because to many Americans, “Medicare-for-all” means having the option to enroll in a public health insurance program, but to keep their employer health coverage if they want.

The ambiguity over private insurance became the single biggest source of confusion and infighting among Democrats the last time they debated Medicare-for-all. A 2019 Kaiser Family Foundation poll found over half of Americans thought Medicare-for-all meant you could keep your private insurance, a finding that led presidential primary candidates to finger-point and flip-flop on the question for months. Kamala Harris, for example, initially backed Sanders’ bill in her presidential run, but later renounced her support after facing questions about whether she’d back abolishing private plans. 

New polling suggests Americans’ ideas about Medicare-for-all remain largely the same today. A March 2026 survey led by the center-left Searchlight Institute and Impact Research, a progressive polling firm, found that while 60 percent of Americans agreed that Medicare-for-all would create a single-payer health system, 61 percent also said Medicare-for-all would allow people to keep their current private health insurance plan if they preferred to.

Another recent survey led by Searchlight, the Democratic polling firm Tavern Research, and the progressive media organization Zeteo found that support for government-run health insurance was least attractive to voters when it included mention of the elimination of private and employer-sponsored plans and that it would be funded through higher federal taxes. Asked directly, 70 percent said they’d rather keep their current coverage than enroll in a federal plan similar to Medicare.

Battleground state focus groups held this past spring by the Democratic research firm Navigator found that while nearly all wished the country’s healthcare system was “universal” and “affordable,” few could say what separates one healthcare reform label from the next.

Put differently, most voters, including most Medicare-for-all supporters, seem open to a range of approaches that improve access to affordable care. 

Mahoney, the Stanford health economist, thinks what’s new is that Democrats are realizing they don’t have to choose between improving the coverage people have now and building something better over time, like a strong public option. There’s a growing recognition among experts, he said, that people are being squeezed right now, while deeper structural problems keep mounting underneath, like an insurance system tied to employment that would only grow more precarious if AI drives waves of layoffs. 

Natasha Murphy, the director of health policy at the Center for American Progress,  a liberal think tank, said voter research has led them to recommend new “short-term solutions” that can bring healthcare costs down now. “Candidates and elected officials would serve themselves and their constituents by focusing on the more immediate benefits,” she told me, “while continuing to talk about universal coverage and broader-scale change” that could take a decade or more.

Adam Gaffney, a prominent single-payer advocate who previously served as president of Physicians for a National Health Program, believes Americans indicating support for “Medicare-for-all” in polls broadly support a national insurance health system, but it doesn’t mean that everyone therefore knows “everything in Bernie’s bill, or Jayapal’s bill, or [Physicians for a National Health Program] proposal” since “very few people do.” 

Gaffney says he’s not opposed to incremental reforms on the path to single-payer, though he does believe voters interpret “Medicare-for-all” as one insurance program that covers everyone, just as they generally know that Medicare covers all people above age 65.

The 2028 test

Whether Democrats can actually sustain a tentative peace on healthcare will likely depend on how the next presidential primary season shakes out.

Alexandra Ocasio-Cortez, who is considering a run, is a vocal Medicare-for-all supporter closely aligned with Sanders — yet both have enthusiastically endorsed El-Sayed and continue to stump for him. Would Ocasio-Cortez campaign on Sanders’s bill specifically, or on something like El-Sayed’s broader healthcare vision? How would she handle disagreements with rival plans, which at times became heated in 2020? And where will groups like the Democratic Socialists of America draw their lines for endorsements?

Weighing in on the topic recently on his political newsletter, journalist and Vox co-founder Matt Yglesias noted that El-Sayed’s recent remarks characterizing Medicare-for-all as more aspirational than any specific piece of legislation may help build a “permission structure” for all kinds of center-left Democrats to run on worthy healthcare reform ideas. 

“The single most important thing that El-Sayed can do to win moderate support is to leverage his credibility with the left into ending the destructive Medicare for All wars that have paralyzed the Democratic Party for the past 15 years,” Yglesias argued. 

The reverse might help too. Single-payer supporters have long suspected a public option is meant to defuse pressure for bigger change, and moderates could answer that by stating plainly they want a plan that grows to cover nearly everyone — not a patch for people falling through the cracks.

In Jacobin earlier this month, the socialist writer who publishes under the pseudonym Carl Beijer urged leftists to hold the line on single-payer healthcare. He noted that El-Sayed’s position is almost identical to the stance that Democrats like Pete Buttigieg and Elizabeth Warren got slammed for by the left for proposing back in 2020. The Sanders wing of the party, Beijer stressed, held back then that any plan that allows for private insurance has no right to associate itself with Medicare-for-all. The risk now, he argued, is that rather than serve as a stepping stone to single-payer, a private option would let the rich opt out, and voters who’ve opted out don’t tend to fight to fund what they’ve left behind. He mused that socialists may be more willing to let El-Sayed off the healthcare hook because of the uncompromising stance he’s taken on Israel, but that the underlying issues had not changed. 

Beijer’s warning is that agreement this easy is agreement about nothing. The next presidential primary is where we’ll find out where the real differences remain.

It doesn’t have to be this hard to get divorced

17 August 2026 at 13:45
an illustration of a man and a woman trapped inside of a small prison connecting two wedding rings together
“The system sets people up for conflict, sets people up for war.” | Eleni Kalorkoti for Vox

Rebecca Feinglos never expected to get divorced. She’d been with her partner for nine years, and married for six, but finally she had to admit to herself that her relationship had taken an abusive turn.

It was 2021 when she decided to end it. But Feinglos was surprised to discover then that the state she was living in, North Carolina, requires couples to reside in separate homes continuously for a full year before they can even file. 

“In amicable divorces you could lie, but I did not have an amicable divorce,” she told me. “It took 18 months for my divorce to be signed by a judge, and we did not have children.”

When she was finally out of her marriage she felt angry. She knew that many people could not afford to live in separate places, let alone pay for the attorneys needed to navigate all the fraught legal proceedings. Feinglos, a former state government employee with a master’s degree in public policy, started researching divorce laws nationwide. “It was so confusing even for me,” she said. “This was before ChatGPT, and all the Google search results were from family attorneys saying, ‘Oh this is really complicated, you definitely need to hire us to help you.’” She has spent the years since pushing to change those laws.

North Carolina is one of a handful of states, including South Carolina and Arkansas, that require couples to live separately for a set period before they can file for no-fault divorce. Most states make couples wait after they file, a “cooling-off” period meant to give spouses a chance to change their minds. In Wyoming, it’s 20 days. In Missouri, 30. In California, couples need to wait six months, and having children can stretch the timelines further. In some states the clock only starts when one’s spouse is formally served, which means a husband or wife who’s hard to track down can add weeks to the wait before it even begins.

“The system sets people up for conflict, sets people up for war,” said Erin Levine, a former divorce lawyer who founded a company that helps people navigate divorce outside the traditional law firm model. “In some states it’s called a ‘petition,’ in some states it’s called a ‘complaint,’ the forms say ‘spouse v. spouse’ — you are being sued.”

This issue runs, inevitably, into the culture wars. Today some conservatives are trying to make it even harder to get divorced, part of a broader push to strengthen the traditional nuclear family, built on the argument that children fare better when parents stay together. Over the last few years Republican lawmakers in states like Missouri, Tennessee, and Texas have considered new restrictions on no-fault divorce, which lets a person end a marriage without proving their spouse did something wrong. Others have proposed expanding so-called covenant marriages, which require counseling before the wedding and allow divorce only for specific reasons like adultery or abuse. House Speaker Mike Johnson has long endorsed making divorce harder, and Vice President JD Vance has complained that no-fault divorce allows people to “shift spouses like they change their underwear.” (Faced with criticism, a spokesperson later said that Vance does not support changes to divorce law.) 

But as more people come forward with stories of the financial cost, family stress, and even physical danger of extended divorce proceedings, there’s a growing push to address their complaints by making it easier to separate and divorce rather than harder. In 2023, Maryland lawmakers eliminated fault-based divorce entirely, cut Maryland’s separation mandate from a year to six months, and let couples count as separated even while living under the same roof. Washington, DC, has gone further. The same year, the DC Council unanimously scrapped its requirement that couples separate before divorce, and in Virginia, a law that took effect just last month lets people get in front of a judge on the first day they separate, instead of waiting six months or a year to sort out custody, support, and who stays in the house.

The issue has gotten more attention on social media over the last few weeks, as Jen Hamilton and Hadley (Vlahos) Fairley, two bestselling authors with more than 7 million followers across Instagram and TikTok, have started speaking out about how divorce laws in their respective states affect women like them. Hamilton, who is based in North Carolina and separated from her husband in June, has blasted the “asinine, outdated, and paternalistic laws” that keep people trapped in marriages, and has been fundraising on her platforms to help women afford to escape their unsafe relationships. 

Fairley, based in Mississippi, has been recounting the many court filings, legal fees, and emotional pain she endured for nearly three years trying to end her marriage. A no-fault divorce in Mississippi requires both spouses to agree to it, and when they don’t, the only way out is to prove in court that your spouse did something wrong, like adultery or desertion. In May, after eleven days in court, a judge finally granted Fairley a divorce, determining that her ex-husband’s conduct met the state’s legal standard for “habitual cruel and inhuman treatment,” citing a DUI he lied about under oath, more than $200,000 in secret trading losses that were mostly her earnings, a cancer diagnosis he faked to get her sympathy, and months of messages the judge called harassing and manipulative. Custody and the division of their assets are still unresolved, and more trial days are set for September.

“I understand burden of proof for a murder trial, but when it’s your personal life it’s very different,” Fairley told me. “I mean, you’re having our friends and our family go on the stand and testify to what they witnessed and it’s incredibly intrusive…even my therapy notes were subpoenaed.” 

Feinglos has been watching this all, and feeling cautiously hopeful that a reform bill pending in her state’s legislature might finally gain traction. “I do believe we’re at an inflection point,” she said.

The wait itself is the danger

Until the late 1960s, ending a marriage meant proving in court that your spouse had done something the state recognized as wrong, like cheating or abandonment. The burden fell on whoever wanted out, and meeting it often meant airing intimate details that judges weighed differently depending on whether a husband or a wife was asking. Starting in 1969, when California enacted the first no-fault law, states began letting couples divorce without assigning blame. Most followed within a decade, though holdouts like New York lingered. Divorce rates, already rising, peaked around 1980.

The laws mandating divorce waiting periods carry the logic of that earlier system. States tend to justify them by saying couples might reconcile if they’re given time. States also argue that decisions about custody and property shouldn’t be made quickly in the heat of the moment. Underneath both rationales is a theory that married households are valuable to the public, especially where children are involved, and so the state has a responsibility to slow couples down rather than treating marriages like contracts either side can simply cancel. 

Critics have long argued that the first rationale doesn’t hold up, since couples rarely reconcile during the waiting period and few people end a marriage on a whim. The second, they say, ignores what the wait actually does to someone leaving an unhappy or unsafe marriage, which is put them in danger. Separation is one of the most dangerous periods in an abusive relationship, and researchers have found that homicide risk climbs when an abuser senses they are losing control. Some research suggests a court’s intervention can make things worse rather than better if it provokes retaliation without actually getting the victim away from the abuser.

This danger has become a major issue in Virginia, where the push for divorce reform has been closely tied to a horrific murder-suicide by a prominent Democratic politician that made national headlines. 

Cerina Fairfax spent nearly two years in the same house as the husband she was trying to divorce, former Lt. Gov. Justin Fairfax. Up until last month, Virginia required couples with children to be separated a year before they could file, though permitted them to spend that year under one roof, so long as they could show a judge the marriage was genuinely over. When she finally filed for divorce in July 2025, her husband — a lawyer, representing himself — argued she hadn’t specified that she intended their separation to be permanent and in January a judge agreed with the technicality. Cerina Fairfax was told she could amend her complaint and try again. At some point during the proceedings she installed cameras throughout their house.

On March 30 a judge granted her sole physical custody and ordered Justin Fairfax to move out within a month. He was still there when he shot her in the house in the middle of April and then killed himself. Their two teenagers were home, and the cameras were recording.

Virginia’s new divorce law had just been signed days earlier. Tucked into it was an order for a work group to study whether the state should scrap fault-based divorce altogether. Activists pushing officials to take that next step point to the Fairfax episode, arguing it shows the dangers of prolonged divorce proceedings with a spouse who could become unstable or threatening. The report is due to the legislature in December.

Courtenay Schwartz, the legal and policy director for the Virginia Sexual and Domestic Violence Action Alliance, told me that while the change that just took effect in Virginia is a big one, her state’s laws still make it “very onerous” to get divorced, noting that the requirement to be separated still stands. 

“If you have someone interested in dragging out the process which Justin Fairfax was, it can really get drawn out and run in the hundreds of thousands of dollars,” she said. “It’s just prohibitively expensive, especially if you are experiencing domestic violence.” 

Schwartz says Virginia Democrats, who control both chambers of the legislature and the governor’s office, have grown increasingly interested in “access to justice” issues, meaning reforms that make the legal system navigable for people who can’t afford a lawyer. This has been driven partly by a 2022 Legal Services Corporation study that found 92 percent of the civil legal problems experienced by low-income Americans received inadequate or no legal help. 

North Carolina’s governor tells Vox he backs reform

Woodson Bradley, a Democratic state senator in North Carolina, won her first race in 2024 by just 209 votes, in a district the Republican-controlled legislature had redrawn the year before. She holds one of the most competitive seats in the state.

Now Bradley is the lead sponsor of SB 626, which would cut North Carolina’s separation requirement from a year to six months and let survivors of domestic violence file for divorce immediately, with no separation at all. It’s been stalled in committee for nearly a year and a half.

The issue is personal to Bradley, who experienced domestic violence in her 20s while living in another state. “When I left I was tracked down and beaten, and there were no real stalking laws back then in the 1990s,” she told me. She later moved to North Carolina, remarried someone “who I thought was wonderful, had two kids, and then things weren’t wonderful anymore.”

Bradley soon found herself in yet another abusive, coercive relationship, fleeing with her children, an experience she describes as “the most brutal thing I’ve ever been through.” It took her years to finally get a divorce, because her ex-husband continued to contest and extend the proceedings. 

Jen Hamilton, the famous labor and delivery nurse and author of the New York Times bestselling book Birth Vibes, has been raising the issue on her platforms and talking with Bradley about changing North Carolina’s laws.

“Jen speaking out is very much changing things,” Bradley told me, adding that although the issue is very partisan in North Carolina, five Republican lawmakers have reached out to her recently about her bill. Past efforts at reform in North Carolina have failed, including in 2015, 2019, and 2021.

North Carolina’s lame-duck Senate leader Phil Berger, who lost his Republican primary in March, did not return requests for comment but a spokesperson for North Carolina’s Democratic Gov. Josh Stein told me he supports reform. 

“North Carolinians don’t need government making their life harder, especially during some of their darkest times,” they said. “The Governor is willing to work with anyone to ensure our laws are more appropriate for the world we live in today.” Last year Stein signed a bill that made habitual domestic violence a felony.

For Rebecca Feinglos, the proposals moving through Raleigh are still catching up to what she already lived through.

“I remember the line in my divorce decree allowing me to change my last name back to my maiden name, my now late father’s last name,” she said. “Every moment I had to use my married name throughout the proceedings felt like a reminder that I was still stuck in a life I didn’t want.”

Ozempic is not just a weight-loss story anymore

15 August 2026 at 15:30

Just last month, I marked my 25th year as a professional journalist, which I guess means my journalistic career is old enough to rent a car, no questions asked. Work in the news for that long, and you’ll occasionally find yourself surprised by things you published in the past. Like, I had all but forgotten that I had written this Time magazine cover story in 2008:

A couple things here. One, as the cover demonstrates, journalistic sensitivity was…less than ideal then, to say the least. And two, over a quarter-century occasionally covering obesity (both childhood and adult), that story only seemed to go in one direction: worse.

It wasn’t for lack of trying. We put calorie counts on menus, taxed soda (well, in some places), built workplace wellness programs, and funded a small library of diet research. We deplored food deserts and promoted farmers’ markets. We told people — again and again — to eat less and move more. But the lines just kept going up.

By the CDC’s measured survey, the share of US adults with obesity did not change meaningfully between 2013 and 2023. The age-adjusted obesity rate sat at 40.3 percent, while the age-adjusted severe obesity climbed from 7.7 percent to 9.7 percent over the same stretch.

While the question of weight in America is inextricably tied to body image and moralizing, those numbers had a deadly effect. One demographic model estimated that obesity was associated with roughly 18 percent of deaths among Black and white Americans ages 40 to 85 between 1986 and 2006. From diabetes to kidney failure, heart disease to sleep apnea, obesity is the delivery system for other diseases.

Which is what makes a Gallup report published in July so surprising. In Gallup’s self-reported height-and-weight series, the US adult obesity rate fell to 36.4 percent, down from a peak of 39.9 percent in 2022. Over roughly the same period, the share of adults who said they were currently taking a GLP-1 drug for weight loss rose from 3 percent in 2024 to 11 percent in 2026 — approximately 29 million people. While this only shows correlation, not causation, and Gallup’s self-reported measure should not be compared directly with the CDC’s measured rate, the timing is suggestive to say the least. 

And the weight might be the least interesting thing about these drugs. 

Semaglutide — the molecule sold as Ozempic and Wegovy — was first developed and approved as a treatment for type 2 diabetes, not obesity. It was only after earlier GLP-1 drugs and diabetes trials showed substantial effects on appetite and weight that researchers deliberately tested a higher dose for obesity, resulting in Wegovy in 2021

But as it turns out, the list of things that have been noticed happening on the side with GLP-1s has gotten so long it’s begun to eclipse the main event. The coverage of GLP-1s has barely kept up with this news, because weight loss is what made these drugs famous and what we continually obsess over. But it turns out, weight loss may not be what they’re best at.

Side effects may include…

Let’s start with sleep apnea, which, untreated, drives up blood pressure, strains the heart, and raises the risk of stroke. These are people whose breathing stops dozens of times an hour, all night, every night. Two year-long trials put 469 of them on tirzepatide — the drug sold as Mounjaro and Zepbound — and cut those interruptions by more than half. Roughly half the group finished the year with no apnea at all, or with so little left that they stopped being tired all day.

Then there are the kidneys. A major trial followed 3,533 people with type 2 diabetes and chronic kidney disease for a median of 3.4 years. Semaglutide reduced the relative risk of a composite of kidney failure, a sustained loss of at least half of kidney function, or death from kidney-related or cardiovascular causes by 24 percent; all-cause mortality was 20 percent lower.

And the liver: A trial, still underway, biopsied the livers of 800 people whose organs had grown fatty, inflamed and scarred and randomly assigned them to semaglutide or a placebo. After 72 weeks the inflammation had cleared in nearly 63 percent of those on the drug, with no worsening of the scarring, against 34 percent on placebo. 

And the knees: In 407 adults with obesity and moderate knee osteoarthritis, pain scores on the 0-100 WOMAC metric fell 41.7 points against 27.5 on placebo. 

And to top it off, a 17,604-person trial of participants who were overweight or obese but did not have diabetes found a 20 percent drop in major cardiovascular events.

These results may not be as grabby as cultural debates over “Ozempic face,” but they deserve far more attention.

Medicine’s happy accidents  

As GLP-1s — which in part came out of a hormone in Gila monster venom — demonstrate, medicine has long found some of its biggest wins in the margins of drugs ostensibly built to do something else entirely. 

Sildenafil, better known as Viagra, began life at Pfizer as a candidate treatment for the heart disease angina. It failed at that, and its now-famous use turned up in data as a side effect in what must have been a very interesting trial for its subjects. Minoxidil (Rogaine) was a blood pressure pill that turned out to help patients grow hair. Finasteride (Propecia) was approved for enlarged prostates before anyone thought to sell it for baldness — and then a trial of more than 18,000 men found it cut prostate cancer diagnoses by about 25 percent, a benefit that took 20 years of follow-up to fully vindicate

Perhaps the most famous example is aspirin, which spent most of a century as a painkiller before a doctor in California named Lawrence Craven noticed that the patients he’d given aspirin gum to after tonsillectomies bled more than they should. He guessed the aspirin thinned the blood, and started handing it out to middle-aged men, who were at higher risk of heart attacks. Craven died in 1957; the trial that ultimately proved that he was onto something — showing that aspirin in heart attack victims cut vascular deaths by a fifth — didn’t run until 1988. 

The strange morality of Ozempic

Viewed this way, GLP-1s can seem like miracle drugs — but even miracle drugs can’t cure everything.

There had been great hope that GLP-1 might reduce dementia rates, but when Ozempic maker Novo Nordisk ran a proper trial, it didn’t show evidence of slowing clinical progression of Alzheimer’s. Much the same happened with cancer. Observational data had hinted that GLP-1 users developed tumors less often, but when a Harvard team pooled 48 placebo-controlled trials covering 94,245 people, they found the drugs have little to no effect on the risk of thyroid, breast or kidney cancer, though evidence for other cancers was less certain, leading to FDA boxed warnings. One plus: In some early animal studies, high doses of GLP-1 drugs caused thyroid tumors in rodents, but further research largely hasn’t validated the fears that it could be more widespread, though uncertainty about some rare thyroid cancers remains.  

For many people, weight loss isn’t the end of what these drugs seem able to do. It’s where the benefits begin.

The bigger concerns largely remain the known ones, starting with muscle loss. Across 22 randomized trials, about 25 percent of the weight lost on these drugs turns out to be lean muscle mass. Some of that is simply unavoidable in any weight loss, but too much can mean a great deal, especially if you’re 75. 

And cost remains a barrier: In a 2025 KFF poll, 56 percent of adults who had ever used a GLP-1 said the drugs were difficult to afford; 27 percent said they had insurance but paid the full cost themselves. In a separate Cleveland Clinic chart review of 288 adults without diabetes who stopped injectable semaglutide or tirzepatide within a year, 47.6 percent stopped because of cost or insurance problems, compared with 14.6 percent because of side effects. (The money, at least, is improving. An oral GLP-1 drug was approved in April, and it starts at $149 a month for people paying cash, while Medicare trial pricing of $50 a month for some GLP-1s went live in July.)

A stickier obstacle is the one that can’t seem to be divorced from questions about weight: judgment. As my colleague Dylan Scott wrote recently, researchers at Rice University found that people rate a GLP-1 user more harshly than someone who never lost weight at all. That makes perfect sense when you consider how contentious weight is in America — and none at all when you think about just how many people have benefited from these drugs in so many different ways.

I sometimes wonder how we would view GLP-1s if they could do everything they’ve been shown to do, but somehow not change a person’s appearance. 

So much of the discourse around these drugs has been shaped by the fact that many of the earliest and most public and apparent users were already thin people, often celebrities, using them to get even thinner. But that framing has become increasingly difficult to square with reality. 

Two things can be true at once: American culture has a toxic relationship to weight, and millions of Americans can and are benefiting from these drugs. For many people, weight loss isn’t the end of what these drugs seem able to do. It’s where the benefits begin.

A version of this story originally appeared in the Good News newsletter. Sign up here!

AOC’s insurance won’t pay to freeze her eggs. Yours probably won’t either.

12 August 2026 at 23:00
Alexandria Ocasio-Cortez on the steps of Capitol Hill
Alexandria Ocasio-Cortez says she’s freezing her eggs. But barriers remain for many Americans. | Bill Clark/CQ Roll Call/Getty Images

Over the weekend, Rep. Alexandria Ocasio-Cortez (D-NY) announced on Instagram that she had joined the thousands of American women who freeze their eggs every year, a number that has been steadily growing for the past decade.

“This is a choice that I am making to feel more in control of my life,” Ocasio-Cortez said in her Instagram story sharing her decision. 

As politicians in the public eye often do, Ocasio-Cortez turned her personal choice into a statement:

Usually I keep my private life quite private, but I have made the decision to start freezing my eggs, and I want to share this because I was weighing it for a very long time. I was saving for it for a very long time, and there just isn’t a ton out there, I feel, and sometimes it can feel very daunting. As women in general, we are not taught about our own bodies. We are not prepared for our own lives. … We need to show more depictions of women having full lives.

At the same time, she acknowledged being “in a very privileged position” to be able to take advantage of egg freezing. The process still typically costs $10,000 or more — and most insurance still doesn’t cover it. Not even AOC’s federal health plan. Egg freezing is a luxury afforded only to the people who can pay for it and take on the significant burden of the treatment and all of the uncertainty that comes with it.

Ocasio-Cortez’s announcement underscores the awkward place that egg freezing still occupies in the landscape of fertility access — at a moment when Republicans in power are lamenting falling birth rates and searching for ways to encourage more people to start families. In theory, egg freezing gives women the flexibility to take more control of their decisions about having kids and preserve that possibility for themselves in the future. But in reality, the promises of this important procedure have often been unfulfilled

Beyond the intimidating price tag, as AOC alluded to, many young women don’t know some of the basics about age-related fertility decline and how to maximize their chances that egg freezing will lead to an actual pregnancy. There are some “significant gaps in fertility knowledge amongst Gen Z women in particular,” said Danielle Melfi, CEO of Resolve, a fertility treatment advocacy group. 

“That points to why someone like AOC who has such broad awareness and broad reach across her channels,” Melfi told me, “specifically younger people who aren’t tuned into any politician but would be tuned into her. Her sharing her story and journey matters.”

Egg freezing is not a panacea, and it never will be. But it can give individuals options and a sense of empowerment. And right now, as AOC acknowledged in her video, those are privileges reserved for the people who are in the know and have the means to take advantage of it. For everyone else, significant barriers still remain.

Freezing time doesn’t come cheap — or easily

On average, the cost of egg freezing averages between $10,000 and $20,000. And, for most people, including AOC, who makes $174,000 a year on her congressional salary alone, health insurance coverage is not an option. According to a 2024 KFF employer survey, just 12 percent of large employers who offer health insurance provide egg or sperm freezing.

That’s not for lack of trying.

As of now, 21 states have mandates requiring health insurers to provide some level of coverage for “fertility preservation” when it is deemed medically necessary — for a younger cancer patient who is about to undergo chemotherapy, for example, a more and more common scenario these days. But coverage for what is viewed as elective freezing, as AOC is doing, is still generally not included in those requirements.

Sign up for the Good Medicine newsletter

Our political wellness landscape has shifted: new leaders, shady science, contradictory advice, broken trust, and overwhelming systems. How is anyone supposed to make sense of it all? Vox’s senior correspondent Dylan Scott has been on the health beat for a long time, and every week, he’ll wade into sticky debates, answer fair questions, and contextualize what’s happening in American healthcare policy. Sign up here.

But even the state-level mandates come with a huge carveout. Under America’s Frankenstein healthcare system, there is a very important type of health insurance plan that is exempt from such state laws: self-funded employer plans, meaning those that fully cover their workers’ medical expenses without relying on an outside insurance company. They are governed only by a federal law known as the Employee Retirement Income Security Act, and that law provides no guarantees for egg freezing or other reproductive care. 

About half of Americans get their insurance through their work, and of those employer plans, more than 60 percent are self-funded. That is a lot of people who have no guarantees for this kind of service, even when a serious medical reason is motivating them to freeze their eggs. The select few who can get egg freezing covered are typically higher-income, too, adding to the disparity between the US healthcare system’s haves and have-nots.

Support for IVF among the American public has been rising, with 70 percent saying in 2024 that access to IVF was a good thing. And fertility coverage is having a political moment, too: the HOPE With Fertility Services Act, which would require insurers to cover some basic fertility treatment when it is deemed medically necessary, was introduced this year with a bipartisan slate of more than 20 sponsors, though it remains stuck at the committee level for now. The Trump administration has fixated on dropping fertility rates, but, beyond a limited IVF executive order, they have not seriously pursued plans to expand access to egg freezing. A national mandate to cover egg freezing, even only when medically necessary, could end up being opposed by both health insurers (which have fought all kinds of benefit requirements in the past) and the religious right (which has specifically challenged mandates for reproductive healthcare, like the Affordable Care Act’s contraceptive mandate).

It will likely take a variety of policy changes to give people more financial support for this important but expensive service. So what now? Unfortunately, I think we are stuck with patchy coverage and can expect only incremental improvements for the foreseeable future. On the plus side, Melfi said, more employers may increasingly offer these benefits as a competitive advantage.

But access isn’t the only problem.

Egg freezing works best when people actually know how to take advantage of it

Even if a person is able to access egg freezing, it doesn’t always pay off. 

A study published in the American Journal of Obstetrics and Gynecology in February found that fewer than 6 percent of people who froze their eggs electively had come back to thaw them within five to seven years. Of those people, 79 percent had a usable embryo after warming and 29 percent had a pregnancy that resulted in a live birth.

How to improve your chances with egg freezing

  • Talk with your doctor about your reproductive health.
  • Consider asking your doctor for a blood test to measure your ovarian reserves.
  • If you decide to move ahead, check the SART database to find a high-quality fertility clinic. You can explore that here.

Of course, just because some people haven’t warmed their eggs within seven years doesn’t mean they won’t come back in nine: The point of this service is you could freeze your eggs at 30 even if you’re not ready for kids until you are 40. Those numbers will likely grow with time. And some of those people might end up successfully getting pregnant on their own the old-fashioned way, which means they won’t need their frozen eggs at all. 

“Typically, people who are coming in to freeze their eggs haven’t actually tried to conceive yet. When they are ready to start conceiving, a lot of people may not have any issues conceiving,” said Dr. Mabel Lee, a reproductive endocrinologist and infertility specialist at HRC Fertility in Pasadena, California who led the published study. 

What is true is that getting pregnant is difficult no matter how you go about it — even conceiving through intercourse only results in a 20 to 25 percent success rate on a given try, Lee said — and success with frozen eggs depends on how young the person was when their eggs were preserved: The younger they are, the higher the chances of success. That makes it all the more important that people — particularly younger people — know about the realities of egg freezing and how to make the most of it, whether they are spending thousands of dollars of their own money or whether they are using insurance to pay for it. Awareness among young people of the basic relationship between age and fertility remains discouragingly low. Lee said she has patients come in all the time who say they wish they had known more about egg freezing sooner.

The likelihood of a live birth may go up if the eggs were younger, but is that enough to convince someone in their mid-20s to pay out of pocket to freeze their eggs? In the midst of an affordability crisis, is that even an option? It might not be; in the meantime, Lee said women could get a blood test to measure their ovarian reserves, which estimates a person’s egg count, and use that to make an informed decision about egg freezing in consultation with their doctor.

Once you have decided to freeze your eggs, using a high-quality clinic is a must: That’s the other major variable in success, Lee told me. The Society for Assisted Reproductive Technology maintains a national database covering clinics across the country and tracking birth success rates and other metrics. It’s like a report card of sorts, so you can hopefully choose the best provider for you.

There are still no guarantees. Fertility is too fickle. But by improving access and raising awareness, there are clear steps we can take to try to maximize egg freezing’s potential.

Trump is searching for the Supreme Court’s breaking point on birthright citizenship

11 August 2026 at 14:07
Close-up of Donald Trump’s head next to the top of Joh Roberts’ head
President Donald Trump walks by Chief Justice John Roberts. | ANDREW CABALLERO-REYNOLDS / AFP via Getty Images

Last week, President Donald Trump issued a new executive order that purports to strip citizenship from some Americans. 

This isn’t our first time here: Last year, Trump issued an executive order that attempted to strip citizenship from many Americans born in this country. Months later, in response to a lawsuit brought over Trump’s order, the Supreme Court reaffirmed that everyone born in the United States who is subject to US law is a citizen. The Court’s decision in Trump v. Barbara (2026) was hardly a surprise, as the Court first ruled that everyone born in the US and subject to its laws are citizens in United States v. Wong Kim Ark (1898).

Still, the Barbara decision did invalidate an executive order from Trump. And that made him very angry. The new order appears to be a response to that 2025 Supreme Court decision, though it is much narrower than his original one.

In this sense, Trump appears to be experimenting with where the line is for the justices when it comes to birthright citizenship. When Trump’s first order came before the Court in Barbara, there was more than a century of precedent establishing that the order was unconstitutional. Nevertheless, four justices voted to overrule at least some of that precedent. 

Now, with the new order, Trump is testing whether a smaller bite at the apple is enough to win over one of the justices who voted with the majority in Barbara — two of whom are Republicans. If he manages to hold onto the four dissenters in Barbara and pick up just one more justice’s vote, his new order will stand. It’s a plausible outcome, and one that could potentially foreshadow future efforts to chip away at birthright citizenship.

What does the order actually do?

Trump’s first citizenship order, the one struck down in Barbara, attempted to strip citizenship from many Americans whose mothers were either undocumented or legally-but-temporarily present in the United States when they were born. Had this order been in effect at their birth, it would have stripped citizenship from many prominent Americans, including former Vice President Kamala Harris.

The new order, entitled “Continuing to Protect the Meaning and Value of American Citizenship” is much narrower; indeed, it’s unclear some of the categories of people it hopes to denaturalize actually exist. The new order, for example, purports to strip citizenship from children of two non-citizen parents when either parent belongs to a “designated Foreign Terrorist Organization.”

So, in the unlikely event that, say, a member of Al-Qaeda impregnated a non-US citizen woman who later gave birth on US soil, Trump’s order would mandate that the child’s US citizenship would be taken away. 

Another provision purports to strip citizenship from the children of foreign nationals who work in their nation’s embassies or in similar diplomatic capacities but who do not enjoy diplomatic immunity from US law. Again, it’s unlikely that all that many children fall into this category, given the relatively small number of these jobs.

The largest group of people that Trump targets in his new order is children whose parents “engage in a commercial transaction to ensure that the person’s mother is present in the United States” for their birth, such as by buying a plane ticket to enter the United States while pregnant. But this category is also fairly small. 

In 2024, the Centers for Disease Control and Prevention reported that 9,576 people were born in the United States to residents of foreign countries — out of about 3.6 million annual births — though it is unclear how many of these babies would be affected by Trump’s new executive order, because we don’t know if their mothers entered the United States “to ensure” that their child we be on US soil when born.

So, what does the Constitution actually say about birthright citizenship?

The question of whether people born in the United States are citizens was, until fairly recently, one of the most uncontroversial questions in US law. When Judge John Coughenour, a Reagan appointee, handed down the first court decision blocking Trump’s original attack on birthright citizenship, he commented that he’d “been on the bench for over four decades [and]…can’t remember another case where the question presented is as clear as this one is.”

The relevant provision of the Constitution’s 14th Amendment provides that “all persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States.” So, everyone born in the US, regardless of their parent’s immigration status, past behavior, or membership in a particular organization are citizens — unless they are not “subject to the jurisdiction” of the United States.

As the Court recently reaffirmed in Barbara, moreover, a child is within US jurisdiction if they are “subject to American law.” So, if undocumented immigrants and their children were not subject to US jurisdiction, that would mean that it was illegal to arrest and deport them. And, if members of foreign terrorist organizations were not subject to US law, that would mean that it is illegal for the US government to prosecute them for committing terrorist acts.

That said, Wong Kim Ark did recognize a few narrow categories of individuals who are present in the US but not subject to its laws — two of which are still relevant today. Children of invading foreign armies do not receive birthright citizenship, nor do children of foreign ambassadors and other diplomats who are immune from US law.

As the Court clarified in Barbara, both of these exemptions are derived from an old English rule that provided that the King could not convey citizenship to “those born in lands that he did not control.” Thus, when a foreign military occupied English soil and stripped the King of his ability to rule over those lands, children born to members of that military were not citizens.

The exemption for ambassadors and some other foreign diplomats, meanwhile, flows from what Barbara described as a “fiction of extraterritoriality.” While senior diplomats are present in the United States, they are nonetheless deemed to “remain on foreign soil” and thus are not subject to US law.

But not all employees of foreign governments qualify for this diplomatic immunity. Consider, for example, the tragic facts of Moncada v. Rubio (2025), a recent federal appeals court decision holding that a man who lived as a US citizen for nearly seven decades was not, in fact, a citizen. 

Roberto Moncada is the son of a Nicaraguan diplomat who worked in the United Nations when Moncada was born in 1950. The US government previously concluded that Moncada’s father served as a “consul” when his son was born, and, thus, Moncada was a US citizen, because consuls and their families do not enjoy diplomatic immunity. But, in 2018, the US government discovered that Moncada’s father was actually an “attaché,” a more senior diplomat who does enjoy immunity. And then, the father’s diplomatic immunity cut the son off from US citizenship.

Under these principles, several provisions of Trump’s new executive order are unconstitutional, at least in part. The provisions stripping citizenship from the children of employees of foreign governments are lawful to the extent that they apply to children of people with diplomatic immunity but unconstitutional to the extent they apply to lower-ranking individuals with no immunity. 

The provision dealing with members of foreign terrorist organizations is also unconstitutional, since people who engage in terrorism on US soil are very much subject to US law — as are babies born on US soil to parents connected to terrorism. Although, in the unlikely event that a foreign terrorist group actually seized control of some portions of US soil, then the exemption for children of invading armies would likely apply. 

The provision dealing with so-called “birth tourists” is also unconstitutional, because a pregnant woman who enters the United States to ensure that their child is a US citizen is subject to US law, as is her child.

Indeed, Trump appears to concede this later point in a separate executive order handed down at the same time as his “Continuing to Protect” order. The second order, entitled “Ending Birth Tourism,” instructs two federal cabinet departments to update their rules to discourage alleged birth tourists from entering the country, including by taking “appropriate action to prevent the entry into the United States of, or the granting of any visa or other travel authorization” to such individuals. But, again, if the United States has the power to deny visas or otherwise bar these individuals from entering the country, that means that they are subject to US jurisdiction.

Why Trump keeps trying to restrict birthright citizenship

So, the Constitution’s text, the Court’s venerable decision in Wong Kim Ark, and its brand new decision in Barbara are all clear about who qualifies for birthright citizenship. All of these authorities establish that much of Trump’s new executive order is unconstitutional, because it purports to strip citizenship from people who are subject to US jurisdiction.

But that doesn’t necessarily mean that the order will be struck down. While Barbara did little more than reaffirm the same rule the Court announced nearly 130 years ago in Wong Kim Ark, four justices dissented in Barbara — although, these justices also released four separate opinions with four separate definitions of who does and does not qualify for birthright citizenship. So, on this Supreme Court, the mere fact that a legal question has been settled for more than a century does not prevent many of the justices from voting to unsettle it.

Indeed, this Court does not even reliably follow its own recent precedents. The Court’s decision in Louisiana v. Callais (2026), which repealed a 1982 amendment to the Voting Rights Act and limited Congress’s power to prevent race discrimination in elections, was wholly at odds with the Court’s three-year-old decision in Allen v. Milligan (2023). The Court’s decision in Medina v. Planned Parenthood (2025), which repealed a federal law permitting Medicaid patients to choose their own doctors, cannot be squared with its decision two years earlier in Health and Hospital Corporation v. Talevski (2023). 

So, while two of the Court’s Republicans joined all three of its Democrats in Barbara, it is possible that at least one of those Republicans will vote with the dissenters on a narrower question, like whether Trump can strip citizenship from the children of so-called birth tourists. And even if all of the justices in the Barbara majority hold the line, if one of them leaves the Court while Trump is still in office, he will almost certainly replace them with someone who opposes birthright citizenship.

So, while Trump’s executive orders often defy the Constitution’s explicit text, Trump also understands something important about US law: It doesn’t actually matter what the Constitution says if you have five votes on the Supreme Court who are willing to do what you want them to do.

A new housing politics is taking shape on the left

10 August 2026 at 14:15
A smiling woman in a black dress and floral jacket gestures with both hands in front of a bright yellow-and-blue “Nithya for Mayor” campaign sign.
Nithya Raman at a campaign event in May 2026. | Myung J. Chun/Los Angeles Times via Getty Images

Los Angeles offers one of the most vivid examples of our nation’s broken housing system: a quintessentially American expanse of traffic-clogged roads and single-family homes, coupled with the highest home-price-to-household-income ratio of any major city in the country.

To moderate prices, LA urgently needs to build more homes by allowing more density in its neighborhoods — but much of the city’s leadership has vigorously opposed it. Nowhere has that been more evident than in the fight over SB 79, a landmark California law that overrides local zoning to permit taller, denser housing near major transit stops. LA’s city council and its incumbent mayor, Karen Bass, have opposed it and sought ways to avoid complying with it. 

Now, as Bass seeks reelection, mayoral candidate Nithya Raman — one of the city’s, and perhaps the country’s, strongest advocates for building more housing — wants to oust her.

Raman has gained unusual traction in a city long resistant to growth and has become a nationally prominent YIMBY. How to accommodate LA’s need for more housing, Raman told Vox in a recent interview, is “a question that the city has actually turned away from.” She believes she can do better.  

Earlier this summer, Raman advanced in LA’s mayoral primary, setting up a November runoff against Bass. The race has resonated far beyond Los Angeles, because Raman is making one of the defining problems in American life — the punishing non-affordability of our most productive cities — the centerpiece of her campaign. Its outcome could shape the future of housing in America’s most populous state and help determine whether LA can become the engine of California’s pro-housing turn, or its most potent obstacle. If she succeeds, she might cut a path forward for better housing policy in high-cost blue cities elsewhere.

Just as core to Raman’s appeal is a commitment that’s often seen as at odds with housing abundance. She is a member of the Democratic Socialists of America (DSA) and a forceful champion of tenant protections, including rent control. (Her relationship with the DSA is complicated, however.) She helped shape a stricter rent stabilization formula that was adopted in LA late last year, though it was strongly opposed by rental property owners. 

Many housing policy experts, as I recently wrote, believe rent control can worsen the housing affordability crisis it aims to solve, because it tends to reduce the supply of rental housing. But in high-cost cities and states, interest in it has been surging nonetheless. A rising cohort of progressive politicians, including Raman and Zohran Mamdani in New York City, believes cities must protect current renters from price shocks and displacement while adding housing supply. In doing so, they hope to mount the kind of political support that has long eluded YIMBYs.   

I spoke with Raman about how she thinks about these competing interests, and how she intends to combine them to make a meaningful dent where her predecessors have failed. I was struck by how cautiously she discussed one of the city’s most politically explosive housing policy questions — densifying single-family neighborhoods. Though she has previously pushed for legislation allowing midsize apartment buildings in some wealthier single-family neighborhoods, she emphasized gentler, more gradual change in our conversation. It reflected the core paradox facing housing reformers in LA and nationwide: the need for sweeping change, and the political pressure to make it feel gradual.

Our conversation, condensed and edited for clarity, is below.

You’ve gotten an enormous amount of traction on housing issues in LA. If you win the election, then what? 

When I’m asking for-profit developers and affordable housing developers alike, “What is your biggest barrier to building in LA?” they say that the city of LA is their biggest barrier to building in LA. Whether it is extraordinarily long permit approval timelines, whether it is the failure of the Department of Water and Power [DWP] to be a good partner and to provide real predictability in the building process, both in timelines and in costs. The city of Los Angeles stands in the way of new housing. 

As mayor, I want to do everything in my power to change that. I want to set deadlines by which departments have to respond to applications. I want to bring DWP to the table early and to ensure that they’re a predictable partner for new development. I want to make sure that departments that need to talk to each other are talking to each other quickly and early on in the process, as opposed to providing conflicting answers and taking months and even years to respond. These are all within the power of the mayor to influence and things that this mayor has ignored.

Sometimes rent control and renters’ rights on one hand and new housing production on the other are treated as rival agendas, yet you have made them both central to your politics. What connects them for you?

I don’t think that you can have lower rental costs in a city like Los Angeles without having more housing being built. This is a city that has resisted the construction of new housing for decades, explicitly restricted new apartments from being built in many, many parts of the city for a very long time. We have among the fewest homes per adult of any major city in America and the highest rent-burdened population of any city in America, and to me those two facts are very deeply connected. We can’t really lower rents unless we have more housing here, and lower rents are a big part of how you protect renters.

LA has a rent control system, and you were a champion of a change that tightened that system last year. Do you worry at all that tighter rent control could do damage to housing supply through some of the well-documented mechanisms, like causing landlords to convert apartments to condos? Is that in tension with the goal of increasing housing supply?

Housing built after 1978 cannot be subject to rent stabilization [in LA]. So, making sure that renters in older buildings are protected and trying to incentivize new housing from being constructed to me are not in conflict with one another.

You talked about landlords potentially exiting the market. We’ve also heard concerns from apartment associations and from neighborhoods that there’s been increasing corporatization of housing, that smaller landlords are selling to larger corporate landlords, that being a mom-and-pop landlord is becoming increasingly unfeasible. What we’d love to see is more data on that. And, if that is actually happening, if we are driving landlords out of the market through these changes, if smaller landlords are selling to large corporate landlords, I want to know, and we should be looking at the impacts of this policy accordingly.

I’m very open to learning more. But, so far, what I see is that we have an extremely unaffordable city where all the data has shown us that rents have risen higher than incomes for a very long time. The regulations that we put in place are really trying to ensure that struggling renters are still able to stay in LA.

Is there one specific, concrete housing policy mistake made by Mayor Bass that you would point to? How would you have handled it differently?

There has been an overall lack of urgency in addressing housing supply in [Bass’s] administration, exemplified by the fact that we have not had a deputy mayor of housing for years.

The city has actually opposed and written letters to state officials pushing back against new mandates to build more housing. Instead of telling Sacramento, “How do you want to build that housing?” and trying to shape state laws to suit us — the largest housing market in the entire state — those laws should be written with our input, not written with our opposition. 

I think the most stark example [of Bass’s failures on housing] is this: We’ve had 100 percent affordable housing projects like Venice Dell that are fully funded, that the city has sued and opposed and stalled for years.

“I think there is a growing consensus that supply is part of the problem and is driving the cost of housing.”

To what degree do you think that LA voters see the housing affordability crisis as a problem caused by a lack of supply — a housing shortage? 

I think there is a growing consensus that supply is part of the problem and is driving the cost of housing. It’s not universally necessarily agreed upon, but I think if you were to ask people, “Is there a housing shortage? Is there a shortage of housing you can afford?” everybody would say yes.

Why should renters trust private developers?

I think that renters should trust the city to regulate private development such that we actually are building what we need here in LA and such that new building is actually enhancing what people love about their neighborhoods. I don’t think it’s the job of renters to trust developers. They need to trust that their city is going to make sure that we’re working hard to build neighborhoods that are beautiful, and welcoming, and beneficial, and can help families thrive. 

That’s part of why I talk about production and protection always in the same breath. If you see that new construction is going to displace you, I think you’re less inclined to support it or to accept it. But if you feel secure in your current housing, and you know that you’ll be able to stay there, then new housing is less of a threat and can actually be a boon for a neighborhood.

That relates to an argument I’ve heard a lot: that tenants who feel protected from displacement by rent control and eviction protections will be less afraid of new development and more willing to support it. Have you seen evidence of that happening in LA?

There is a very broad coalition of people who are fighting for more housing now, a much broader coalition than I’ve seen in many other places. And it includes renters’ rights organizations that have historically been some of the strongest advocates for tenant protections. They’re actually in council chambers testifying around the need for more density across the entire city, particularly around transit hubs. 

Do you see rent control as a temporary bandaid on a broken housing market, or is it something that should have a permanent place in housing policy?

I think protections against rent gouging are really important, and I think regulation in the housing market is really important. As a city, we have to be very careful about how we regulate these markets so that we are eliciting the best results and outcomes for our residents. I’m going to follow the research, and I’ll always engage with these issues closely. 

The Democratic Socialists of America, of which you are a part, has talked about wanting to “de-commodify” housing and take it out of the private market. The DSA’s Housing Justice Commission says, “the housing market is not necessary.” Do you think that’s a good idea? 

My approach to these issues is driven by how I can help Angelenos who are dealing with spiraling costs that’s driving working families out of the city. The city saw, I believe, a 16 percent drop in people under 18 over the past few years, because families cannot afford to live here anymore. That is a travesty for the city of Los Angeles. 

My question as I approach this is about what I can do to ensure that we can keep people here. We can build new housing through publicly funded housing. I want to be able to make sure that people who will never be served by the private real estate market have support from the city to rely on that can help them stay, whether that’s in the form of housing vouchers, whether that’s in the form of social housing, whether that’s in the form of permanent supportive housing or new public housing.

I’m supportive of measures that are bringing public dollars to the table to build. However, the money that we have available to us will never be able to satisfy the extraordinary demand that there is for new housing in Los Angeles. So now, we have to rely on the private real estate market to make housing available and affordable to a much larger number of Angelenos. 

Rent control primarily protects tenants who already occupy apartments that are covered by rent control. But building more housing is partly about people who don’t yet have a foothold in LA and who would move there if they could afford it. Is it possible to build a housing politics that gives those future residents real weight, even though they don’t vote in city elections?

I think that’s the question of this election in many ways. That’s been the question of my politics. But it’s not just about the future; it is also about our present. It’s also about parents whose children can’t live near them anymore, because it’s too unaffordable here. It’s about rising homelessness, which is inextricably connected to the cost of housing. All the impacts of not having housing are already felt by Angelenos. 

So much of LA is single-family homes, and there’s been research finding that the city’s housing shortage can’t be filled without densifying single-family neighborhoods. Is that politically possible?

Some of the largest numbers of new units being built are actually ADUs, which are densifying single-family neighborhoods. And duplexes and triplexes and other kinds of interventions are in many places already legal to build. That’s been happening and, largely, been non-controversial in neighborhoods. 

Around certain transit hubs, I think potentially greater density will be allowed in single-family neighborhoods through SB 79. So I think some single-family neighborhoods will have to change. But what I’m seeing in LA is a gradual process of adding more density that I think, in many ways, can be even beneficial for homeowners, because they’re able to make additional income or accommodate more people on their lots.

Is it wrong to send your kid to private school?

9 August 2026 at 17:08
Illustration of children boarding a school bus

Editor’s note, August 9, 8 am ET: We’re bringing you some of our best-loved Your Mileage May Vary columns while Sigal Samuel is on parental leave. The one below was originally published in April.

This unconventional advice column offers you a unique framework for thinking through moral dilemmas. It’s based on value pluralism: the idea that each of us has multiple values that are equally valid but that often conflict with each other. Submit your own question here.


I’m trying to decide whether to keep my elementary school-age kid in the neighborhood public school or move him to a more exclusive private school. Our public school is okay, but my partner and I feel that he might be more challenged and ultimately better off moving to a private school.

But I’m very aware of the increasing flow of students around the US out of public schools, and the effect that is having on the children who remain there. For one thing, since public schools get more funding the more students they have, every family that leaves effectively takes money with them. I worry that by taking my child out of public school, I’m contributing to that problem, but I also don’t want my child to bear the personal burden of my politics.

Dear Public School Parent,

The way you’ve framed the question makes it sound like keeping your kid in public school means imposing a burden on him. And if that were the case — if we really were talking about sacrificing your child’s well-being — I know exactly what I’d tell you.

I’d tell you not to be bullied by utilitarian philosophers. They argue we have to consider everyone’s well-being equally, with no special treatment for our own kids, so they’d probably say it’s wrong to give your child a fancy education while consigning other children to a school with fewer resources. But the 20th-century British philosopher and critic of utilitarianism Bernard Williams argues that this sort of total impartiality is an absurd demand — and I agree.

Williams points out that moral agency — the capacity to act on values and commitments — always comes from a specific person. And as specific people, we have our own specific, individual, core commitments. These “ground projects,” as Williams calls them, are the commitments that give a life its meaning and continuity. A parent has a commitment to ensuring their kid’s well-being, over and above their general wish for all kids everywhere to be well. Williams would say any moral theory that requires you to ignore such personal commitments severs you from the very things that make your life recognizably yours.

So if keeping your kid in public school really meant hurting him, I wouldn’t say you have to do it.

But you said your neighborhood school is okay. It sounds like it’s not bad and not unsafe. So I don’t have reason to think that it is actually hurting him. In fact, it might be helping him in ways you’re not fully accounting for. 

Have a question you want to have answered in the next Your Mileage May Vary column?

Just fill out this anonymous form! Newsletter subscribers will get my column before anyone else does, and their questions will be prioritized for future editions. Sign up here.

Education is complicated. If I were to get into all the details about school choice and vouchers and charter schools and magnet schools, I’d have to write a whole book. So let me just stick to the main points relevant to your dilemma, starting with this: There’s a popular narrative that says private schools are better than public schools, but the evidence does not support that — especially if we take a broad look at what we mean by “better.”

Although studies do show private school students outperforming their public school counterparts on tests, the studies also show that private school advantages disappear mostly or entirely once you control for family background. 

Longitudinal research led by Robert Pianta and Arya Ansari at the University of Virginia tracked more than 1,000 children from birth to age 15 in 10 locations nationwide. After controlling for family income, parental education, neighborhood socioeconomic makeup, and other background variables, the private school advantage…vanished.

“If you want to predict children’s outcomes — achievement test scores, the things we care about socially — in high school, the best thing you can use to predict that is going to be family income — regardless of what high school you go to,” Pianta said.

Pianta’s was a modest-sized study with some methodological limitations. But another analysis of two large, nationally representative datasets also found that public school kids did just as well in math as private school kids — or even outpaced them — after accounting for demographic differences. (Math is considered a particularly robust indicator of school quality writ large because, unlike reading, it’s a subject learned mostly at school and not at home.) The researchers suggested that might be because public school teachers have to do stricter certification and can be required to do more frequent professional development, so they may be more reliably up-to-date on the latest pedagogical approaches, like those developed by the National Council of Teachers of Mathematics.  

Admittedly, the very fanciest of private schools do offer some special advantages. Network effects are real. Maybe you want your kid rubbing elbows with a future senator. And maybe if you send your kid to ultra-elite Andover or Exeter, he’ll have a leg up if he applies to a fancy private college. 

But that is not the same as ensuring your child actually thrives. I’m sure you also care about your child’s psychological well-being. And here, some of the evidence about exclusive, high-achieving schools is worrying. 

The most important educational institution in your kid’s life is you.

The unrelenting pressure to compete and achieve can be brutal in those schools. When students constantly compare themselves to others and peg their self-worth to achievement, the results are alarming. Studies conducted over decades by psychologist Suniya Luthar and colleagues found that students attending high-achieving schools are at significantly higher risk for anxiety, depression, and substance use. (These are often private schools, though hyper-competitive public schools can also fall into this trap.) In fact, the National Academies of Sciences now names these students an “at-risk” group for mental health problems, alongside kids who live in poverty or in foster care or who have incarcerated parents.

In addition to potentially providing a less stressful environment, public schools can confer other important advantages. For one thing, your local public school can help you and your child be part of the neighborhood community, which is incredibly valuable for social development and countering loneliness. And being in an environment that’s more diverse in terms of race, ethnicity, or class can teach your kid to empathize and get along with a wide variety of people. 

As the American philosopher John Dewey pointed out, these are essential skills and capacities for a flourishing adult life and for a flourishing democracy. Democracy is a way of being in community with people unlike yourself; that’s a mode of life that has to be cultivated, and public schools are great grounds for learning to navigate a shared world.

Plus, public education is free! (Well, “free” — you’ve already paid for it with your taxes, whether or not your kid uses it.) So you could save all the money you’d spend on private school and instead use it on enriching opportunities to expand your child’s horizons. Personally, I’d take my kid to Italy and teach them about Ancient Roman gladiators and Renaissance art and the many flavors of gelato! Or you could collaborate with your child to decide where to donate some of that money to fund education resources for kids elsewhere. 

On balance, since the evidence suggests that a child at a decent public school, with involved parents, probably won’t gain meaningful advantages from switching to an exclusive private school — and may face real psychological risks in a hyper-competitive environment — I don’t see a compelling reason to make the move. If you’ve got the resources to even consider private school, then your home life will probably play the biggest role in your kid’s academic trajectory, regardless of which building he sits in during the day. The most important educational institution in your kid’s life is you.

That said, I’m not arguing that parents should never pick private school. To some extent, this depends on the unique needs of your kid and your family. Maybe your kid is absolutely in love with music and the private school nearby has an amazing music program. Maybe your kid is being bullied at his current school but has a couple great friends who attend the private school. Or maybe a religious education is very important to you, so a private parochial school makes sense. 

If you do make the choice to send your kid to private school, you’ll have to grapple with the collective action problem you hinted at: Any single family’s departure from a public school barely registers, but when every family with options reasons the same way, the cumulative effect on the school’s funding — and on the kids who remain — can be devastating.

Here, the American political philosopher Iris Marion Young can help you. She points out that our usual model of responsibility — the “liability model,” which says that when something bad happens we should assign blame to a particular individual — is inadequate when we’re dealing with situations of structural injustice. In these situations, it’s a whole system that’s producing predictable patterns of disadvantage. 

Just look at the complex web that breeds educational inequality: Historical housing segregation has concentrated poverty in certain neighborhoods. Poorer neighborhoods generate less property tax revenue, which means less money for local schools. States can try to offset that, but schools in poorer areas still tend to end up with fewer resources. Families with options leave for better-resourced schools, enrollment drops at the local public school, and the school loses even more funding. The kids who remain get less of the materials — from textbooks to counselors — that would have set them on the path to success. There’s a clear downward spiral, but no one person or decision is the villain.

So instead of blaming any one individual for their personal lifestyle choices, Young says that in cases of structural injustice, we should adopt the “social connection model” of responsibility. Under this model, you don’t bear blame if you send your kid to private school, because systemic problems shouldn’t rest on one family’s shoulders. Young doesn’t think you need to discharge your obligations through personal lifestyle choices. 

But that doesn’t mean you owe nothing. 

You do still have a political obligation: to work toward changing the structure that produces injustice. As a participant in the political system that shapes education in this country, you have some power to act on it. You can vote and organize and advocate. You can pressure decision-makers and support reform movements. The more power you’ve got, and the more privileged you are by the current system, the greater your obligation to take action.  

Make the effort to act on that obligation. Let your child watch as you do. Better yet, involve them in the process. Kids learn from seeing what their parents do: Show them that you’re bent on enacting your values, and you’ll be giving them an education for life.

Bonus: What I’m reading

  • This is a fun piece in Asterisk about how high-school science fairs have become so ridiculously competitive that they no longer give students a chance to do real independent research.
  • This week’s question prompted me to listen to the podcast series “Nice White Parents.” It’s a fascinating look at what happens when parents think that choosing public school would mean sacrificing their child’s prospects on the altar of their own political ideals. Spoiler: Practically no parent is willing to sacrifice their own child. But they often don’t realize they’ve constructed a false trade-off.
  • Living life requires making choices. It’s unavoidable that we’ll feel regret about some of the paths not traveled. But this Aeon essay explains how “living in closer alignment with our values and authentic preferences may help us avoid the worst pain of regret.”

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get access to member-exclusive stories every month, become a Vox Member today.

The truth about rent control

5 August 2026 at 13:00
an illustration of a person within a small house silhouette, reinforcing the roof with their hand. A man is peering down at her from above. Several other house shapes are floating in the abstract space surrounding.

As homeownership slips further out of reach in America, more people are spending more of their lives as renters. Millennials and Gen Zs are less likely to own homes than older generations did at the same age, and the median age of a first-time homebuyer recently reached an all-time high of 40, up from 28 in 1991

That need not be a bad thing. Renting offers many benefits — flexibility, far lower upfront costs, never having to figure out what a “sacrificial anode rod” is — and homeownership is overrated as a savings vehicle. 

But being a renter in America (as roughly one in three people here are) can also be a very undignified experience. In most states, your landlord can kick you out when your lease ends for no reason at all, even if you haven’t done anything wrong. Many tenants live in fear of receiving their next lease renewal, not knowing if they’ll be displaced by the next rent hike. 

Some progressive policymakers, buoyed by the growing influence of democratic socialism and a resurgent tenant movement, are reviving an old, highly controversial answer to renters’ lack of security: simply ban steep rent increases through rent control. 

A crowd of rent-control supporters gathers on the steps of the Massachusetts State House, holding colorful signs that read “Rent Control Now,” “Keep Mass Home,” and “Support Rent Control,” as a speaker addresses the rally.

In June, New York City, under Mayor Zohran Mamdani, froze rents on rent-stabilized apartments, which make up about 40 percent of the city’s rental housing stock. Rent control laws have been passed or tightened in recent years in places from Washington state to Los Angeles to Montgomery County, Maryland, and tenant advocates this year have pushed similar measures in Massachusetts, Washington, DC, Providence, Rhode Island, and Redwood City, California. 

Decoding rent control jargon

Rent control: The broad umbrella term for laws limiting how much landlords can charge or raise rents on covered homes. It can refer to anything from a total freeze to a relatively loose cap on the size of annual increases.

Rent stabilization: A form of rent control that permits rents to rise but limits the size of annual increases, often according to inflation or a percentage set by a government board. It usually implies a less rigid system than a permanent price freeze.

Rent freeze: A temporary prohibition on rent increases for apartments covered by rent control, like the policy adopted in NYC this summer.

Vacancy decontrol: A rule allowing landlords to increase an apartment’s rent to its market rate after a tenant moves out. Limits on annual increases then resume once a new tenant moves in.

Rent control’s advocates argue that the policy not only moderates prices, but also offers tenants stability and a firmer claim to their homes. It helps put “the landlord-tenant dynamic on different and more equal footing,” as Siraj Sindhu, executive director of Reclaim Rhode Island, which backed a Providence rent-stabilization ordinance that passed the city council before being vetoed by the mayor, told me. 

Those are really important goals. I’m a lifelong renter, having literally never lived in an owner-occupied home, and I hate that I can’t predict what my housing costs will be less than a year from now. But is rent control the best way to achieve stability? 

Housing economists have long hated rent control; the Swedish economist Assar Lindbeck famously called it “the most efficient technique presently known to destroy a city — except for bombing.” Decades of research have found that it can have many unintended negative consequences, including depressing housing construction by making it financially impractical to build new rentals. And as we know from today’s crippling housing shortage, nothing is worse for long-term affordability than a scarcity of homes. More recent research, however, suggests that better-designed rent control laws can protect some tenants without having catastrophic consequences for housing supply. 

That rent control keeps coming back as a centerpiece of our housing politics reflects just how impoverished our policy ideas are for providing renters what they lack most: predictable costs and secure tenure. The US has an elaborate policy infrastructure to privilege and subsidize homeownership, while treating renting as an afterthought, like a condition of poverty or at best a waystation on the path to buying a house. That makes ever less sense in a country where millions of people will rent for life, whether by choice or necessity.  

The truth about rent control is somewhere between both extremes. It can, in some cases, certainly be worthwhile. But it remains a highly limited tool, and others can furnish some of the same benefits without fueling the very affordability crisis that they’re meant to address.   

Why economists (mostly) oppose rent control

Rent control polls favorably, and it’s not hard to imagine why — voters despise high prices. Capping rents might intuitively seem fair and costless: The tenant is protected from ridiculously high prices, the landlord profits a bit less, and society as a whole is no worse off. Who could object to that? 

In fact, though, many economists vehemently oppose rent control precisely because it isn’t cost-free — it merely moves costs onto others and makes them less visible.

In uber-expensive cities like New York and Boston, rents are so high because demand to live there far outstrips the supply of homes. In a healthy housing market, high prices signal to developers to build more homes, which then brings prices down and, just as importantly, grows the city’s population and economy by providing homes to people who want to move there. We’ve recently seen this happen in Austin, Texas: The city experienced a rapid run-up in rents during Covid, and builders responded (after the city eased some of its building restrictions) with a flood of new apartments. Rents have since fallen well below pre-Covid levels in real dollars. By contrast, policies that cap rents would diminish the incentive to build rental homes at a time when the US needs many more of them. 

Construction workers on lifts install windows on a new mid-rise apartment building, with other recently built apartment complexes visible nearby.

Meanwhile, if rent caps fail to keep pace with landlords’ rising costs, owners may neglect maintenance or even pull apartments from the rental market if they no longer pencil out. One widely cited economics paper documented this dynamic in San Francisco, where the majority of rental housing is rent-controlled and annual rent increases are capped well below inflation. The city’s 1994 expansion of its rent control law, the researchers found, shrank the supply of rental housing among newly covered properties by 15 percent, largely because landlords converted rentals into owner-occupied units. The expansion made tenants 10 to 20 percent more likely to remain in their homes, but at the cost of making San Francisco’s rental housing scarcer and raising the rents of non-rent-controlled apartments. 

Rent control programs are generally not means-tested, meaning that tenants in eligible apartments receive it regardless of their incomes. So a higher-income tenant who happened to secure a regulated apartment can remain indefinitely at a steep discount, while a lower-income newcomer is left to compete for market-rate units, which are exorbitantly priced in part because of rent control.

As a result, rent control laws bear part of the blame for why San Francisco and New York City are so unaffordable, Arpit Gupta, a housing economist at New York University, told me. Trying to suppress rents in cities like these is like trying to hold the lid down on a boiling pot — the pressure inevitably spills over somewhere else. Gupta, who sits on the New York City Rent Guidelines Board, which sets maximum increases for the city’s rent-stabilized apartments, cast the lone “no” vote on the rent-freeze measure this summer. 

The freeze creates “a severe risk of financial distress” for many buildings, he told me. It could prompt landlords to leave apartments vacant after a tenant moves out if the cost to rehabilitate it cannot be recouped through the legally permitted rent. The number of vacant rent-stabilized apartments in the city has already been rising, and Gupta has argued that New York state’s 2019 overhaul of its rent-regulation laws, which further constrained landlords’ revenues, may be partly to blame.

Many leftists don’t like arguments like these because they’re uncomfortable with the idea that housing must be kept financially worthwhile for private owners. I sympathize with that instinct — housing is a human need, and it feels wrong for its availability to depend on profitability. But it doesn’t do us much good to ignore the structure of the economy we actually live in, where housing is overwhelmingly provided by the private market. 

Housing markets can be very good at providing for people’s needs, if we allow them to work better by legalizing more housing construction and pair it with targeted rental subsidies to people with low incomes. 

How rent control got smarter 

One of the clearest ways to understand rent control comes from Shane Phillips, a housing researcher at UCLA. It should be viewed not as a long-term affordability strategy, he has argued, but as a targeted stability tactic. For affordability, there’s no substitute for building enough homes. But in already broken, unaffordable markets, like many of America’s superstar cities, rent control can be a stopgap that lets some residents remain in their homes. It’s reasonable to expect that people’s homes shouldn’t be treated as crude commodities that they can be priced out of at any moment. The question is how to balance security for existing residents against the structural harms rent control can cause to the overall market.

Not all rent control policies are created equal. Old forms of it appeared in places from ancient Rome to imperial China to the Jewish ghettoes of Early Modern Europe. When describing modern rent control, however, researchers distinguish among a few different types. “First-generation” rent controls arose largely as emergency measures across Europe during World War I, becoming very widespread in the US during World War II. These typically froze each unit’s rent at a fixed dollar amount, with few avenues for adjustment as costs rose; over time, they tended to push homes out of the rental market and discourage maintenance, reducing both the quantity and quality of rental housing.

By the 1970s-80s, a “second generation” of rent control laws, often called “rent stabilization,” was adopted in New York, Boston, Washington, DC, municipalities across New Jersey, and numerous California cities. These introduced some important innovations: They allow modest annual rent increases, set by a formula or regulatory board and often pegged to the rate of inflation. They exempt new-construction buildings from price controls, which reduces the disincentive for developers to build new apartments. 

Cars pass a cream-colored historic apartment building with Art Deco details.

They also often include “vacancy decontrol,” which allows landlords to reset an apartment’s rent to its current market rate after a tenant moves out (after that, the unit remains subject to the annual rent increase caps). Vacancy decontrol is especially important for preserving rental housing supply, experts told me. But it also creates an incentive for owners to try to push tenants out so they can raise the rent. To combat this, most rent-control programs include “just-cause” eviction protections, meaning that landlords cannot arbitrarily evict tenants or refuse to renew their leases; they must cite a serious lease violation (or another legally recognized reason, such as removing the unit from the rental market). 

Second-generation systems remain in place in major US cities, including New York, San Francisco, and Los Angeles. They tend not to distort housing markets as severely as first-generation laws, but they can still, as seen in the evidence from San Francisco, meaningfully damage housing supply. And Gupta has warned that New York City’s system has been regressing back toward first-generation rent control, with the recent rent freeze and the removal of vacancy decontrol under New York state’s 2019 Housing Stability and Tenant Protection Act.

Meanwhile, the recent revival of interest in rent control has produced some laws whose design may magnify the policy’s worst impacts. Montgomery County, Maryland, which includes some of Washington, DC’s most expensive suburbs, implemented a rent-control law in 2024 that lacks vacancy decontrol, while St. Paul, Minnesota, voters approved a 2021 ballot measure that initially lacked both vacancy decontrol and an exemption for new construction. Both places subsequently saw sharp declines in apartment construction, though the timing alone does not prove rent control was the sole cause. (St. Paul has since added partial vacancy decontrol and a permanent new-construction exemption.)

In a recent working paper, a pair of UCLA economists identified a “third generation” of rent control that is less restrictive than second-generation laws. California passed a statewide rent stabilization law in 2019, for example, that set a high ceiling on allowable annual rent increases: 5 percent plus inflation, or 10 percent, whichever is lower. It exempts new buildings for their first 15 years, and includes vacancy decontrol and just-cause eviction. Oregon passed a similar law the same year, as did Washington state in 2025. Using data from San Diego, the new paper found no discernible loss in housing supply there under California’s law. The implication is pretty intuitive: “The laxer the policy, the fewer the negative consequences,” as Phillips put it. 

The flipside, of course, is that the least restrictive laws also do the least to protect tenants — a 10 percent cap mostly just amounts to an anti-gouging measure, and landlords rarely raise rents by that much anyway. Still, double-digit rent increases do happen. And even a loose cap can offer renters peace of mind and insurance against a life-upending rent hike. 

We need a broader renter stability agenda 

Some current proposals may soon play out the tradeoffs of rent control. This November, residents of Redwood City, located between San Francisco and San Jose, will vote on a ballot measure that would cap rent increases at 60 percent of inflation, with a maximum increase of 5 percent.

Clara Jaeckel, a renter in the city and an organizer with the campaign, told me that the proposed law would allow landlords to petition for higher increases if it’s necessary to cover operating costs. It’s “designed to strike a fair balance between letting landlords have a fair return on their investment and keeping things affordable for renters,” she said. Under California law, the city would still be required to include vacancy decontrol and exempt housing built after 1995. “We believe building new housing goes hand-in-hand with rent control — so we want both of those things,” Jaeckel said.

Limiting rent increases so far below inflation, which is similar to San Francisco’s rent cap, has the potential to meaningfully reduce the quantity and quality of rental housing. But it’s also possible that its negative impacts remain muted. Gupta and Phillips both told me that vacancy decontrol substantially limits the harms of rent control, regardless of the exact percentage rent increase permitted, and the proposed Redwood City rent cap would apply to a smaller share of its rental housing than San Francisco’s law does. 

Voters and policymakers might decide that this tradeoff with housing supply is worth it if it can allow longtime residents to stay in their homes. The Bay Area has become so unaffordable that such laws right now represent one of the few ways that communities in the region can maintain some measure of class diversity. 

Single-family homes and a mid-rise apartment building fill a residential neighborhood in Redwood City, California, with hills in the distance.

But it’s worth considering how to deliver the same stability and affordability without rent control, which for too long has been the fallback that expensive cities and towns reach for after allowing their housing markets to become dysfunctional. It can ultimately only offer tenants a cramped kind of security, trapping them in homes that may no longer suit their needs because leaving would mean surrendering their only affordable option. 

A better stability agenda for renters would give them genuine choices in where to live, and how long to stay. In places with broken housing markets, that means, first and most importantly, repealing exclusionary zoning laws and other barriers to building enough homes. That’s the foundation of affordability for everyone, but especially for renters, whose housing costs rise unpredictably with the market rather than remaining relatively fixed by a long-term mortgage. Renters with low incomes, meanwhile, need help affording housing even in a balanced market, and that ought to be provided far more consistently (Section 8 vouchers and other federal rental-assistance programs currently only reach a fraction of people who qualify).

Other policies can offer the long-term stability that rent control provides, too. “The ultimate issue that a lot of [rent control] interventions are trying to target is the challenge of being a renter and being faced with these cost shocks year after year,” Gupta said. Most American residential leases are one year long, but policy could encourage longer terms, which are common in some peer countries like Germany and Japan, and, Gupta noted, widespread in US commercial leases. 

Another step is to give tenants a presumptive right to remain in their homes — in the vast majority of states, landlords can refuse to renew a lease without any cause because the law simply defers to their private property rights. That is a bigger deal than it might sound like: If you’re a renter in one of the 40-odd states that don’t have a right to renewal, and you have, say, loud young children who irritate one of your neighbors, you can be forced out when your lease ends without any recourse. I’ve seen this happen firsthand as a renter in Wisconsin, and it’s one of many ways that cities can be hostile to families. Protection from arbitrary eviction would benefit renters regardless of whether their units are rent-controlled.

These sorts of policies also need to be balanced with reliable processes for removing tenants who seriously damage property, endanger their neighbors, or repeatedly violate their leases. “Sometimes landlords are taken advantage of. Sometimes they are lied to,” Phillips said. It’s rare to find a jurisdiction in the US that’s both “very concerned about tenants and very concerned about landlords,” he said. Instead, US housing policy tends to oscillate between either extreme, but protecting the rights and interests of both need not be mutually exclusive. 

America will remain stuck with a housing shortage for the foreseeable future, which not only makes housing unaffordable in our highest-demand cities and suburbs, but also gives landlords a structural advantage over renters because they’re shielded from competition. Until that changes, a limited form of rent control can redistribute some of that power back to renters. That may be a bargain worth making, but, Phillips said, cities should make it knowingly: with a clear idea of which renters they intend to protect, and who will bear the cost.

❌