| I’m Lara Williams and this is Bloomberg Opinion Today, a mycelia of Bloomberg Opinion’s opinions. Sign up here. Something strange appears to be happening in the land of appendixes. In the last five months, I’ve heard of at least three people have all had their appendix fail them. One was my friendly colleague Howard Chua-Eoan, who was struck with appendicitis about 14 days ago and had to have that pesky organ removed. Loyal readers will notice that he usually writes this Friday newsletter. Fear not, though Harry Houdini perished a week or so after his appendectomy, Howard has recovered; he’s simply escaped the office for a well-earned vacation. Interestingly, a 2024 article published in the Lancet found that, globally, the rate of disease has stayed relatively stable, but there are huge regional variations. Rapidly developing areas such as east Asia and central sub-Saharan Africa saw incidence rates increase by about 25% and 28% respectively. The UK saw a very slight increase to 200 cases of appendix woe per 100,000 people in 2021 from 191 cases in 1990. Scientists aren’t really sure why case rates might be changing in some places and not others — it could be genetics, adoption of western dietary habits (high sugar, low fiber) or environmental factors like air pollution or temperatures. Either way, it looks like the high rate of appendectomies in my social circle is just a coincidence. With a healthy dose of paranoia and some web-based research, Howard made the very sensible step of taking himself to the closest A&E around midnight after his symptoms started. Somewhere between donning some bright red non-slip socks and arriving home with a fortnight’s worth of painkillers, he found himself grateful to be in the UK, rather than the US. That’s because even with Medicare, the 2025 deductible for inpatient hospital care is $1,676. Even for those with a comprehensive private medical insurance policy, emergencies tend to strike at unexpected moments — you could be out of network and out of pocket by tens of thousands of dollars thanks to some infuriating technicalities. An uninsured appendectomy in the US could set you back $7,000, and that’s before all the other medical essentials like diagnostic tests, drugs and room and board. Some people have reported being charged upwards of $40,000. Simply reading about the vast array of insurance varieties, potential unexpected costs and paperwork is enough to make this particular Brit spit out her cuppa in horror. After all, for Howard and my other freshly appendix-less friends, the cost to them for tests, surgery, an overnight stay and follow-up care, thanks to the NHS, is simply £0 ($0). But health insurance isn’t the only confusing part of America’s medical landscape. On Tuesday, the Food and Drug Administration announced a new strategy for Covid vaccine approvals. Despite a lengthy explanation published in the New England Journal of Medicine, Lisa Jarvis calls the plan “clear as mud.” What we do know is that the agency is adopting a “risk-based” approach to approving new Covid vaccines, developed every fall alongside seasonal influenza shots, which limits their use to people aged 65 and older or anyone with a health condition that puts them at risk for severe disease. What it all ultimately boils down to, Lisa says, is a policy that seems “designed to put the vaccines out of reach.” With fewer people opting for Covid boosters these days, companies might decide that the investment in newly required clinical trials is simply not worth it. That’d be a huge loss – vaccines, as Lisa points out, are a public good. The more healthy people get vaccinated, the better protected those at risk of more serious disease are. In fact, the likes of the FDA ought to be incentivizing the production of new immunizations. For example, we have precisely zero vaccines for fungal diseases, but we’re in desperate need of them. If you’re thinking, woah, isn’t this all a bit The Last of Us? Do we really need a vaccine for athlete’s foot? Well, here’s some news for you, courtesy of moi: Deadly fungal disease exists firmly in reality. In fact, they kill six times more people every year than malaria does. But medical mycology has long been an underfunded field, so we’re severely hampered in the armoury department. And it’s getting worse: Not only are the few fungi capable of infecting humans becoming resistant to the handful of drugs we do have, but climate change is altering their distribution and potentially helping species adapt to the sorts of conditions they’d experience within our bodies. Some mycologists believe that we’ve already seen a new fungal pathogen emergence thanks, at least in part, to global warming: Candida auris. First discovered in one unlucky lady’s ear in 2009, the fungi has since appeared on three continents, wreaking havoc in hospitals where it likes to cling to the likes of blood pressure cuffs and catheters. A Candida auris infection can be very serious and often resistant to drugs. I can only imagine the deductibles for an appendectomy and then a hospital-acquired C. auris infection would be eye-watering. For a while there, it seemed like Big Tech had really schmoozed its way into the White House. There was a gaggle of high-profile tech bros at President Donald Trump’s inauguration. Elon Musk seemed glued to Trump’s side, an unelected right-hand man. Given the massive influence of the US tech industry on the economy – a third of the value of the S&P 500 is accounted for by just seven tech companies – it wouldn’t have been surprising to see its political influence match up. But, Adrian Wooldridge says, the opposite is true. What’s really striking is the American tech industry’s relative lack of political influence. Not only has Musk’s time in the sun been brief (if expensive, for him), but the failure over tariffs is a clear sign that Silicon Valley has been unable to set the economic agenda. As Adrian says: “The most important thing to grasp about Trump is that he doesn’t represent anybody’s interests but his own.” Indeed, the broader American business community is discovering this, too. Not only is Trump actively bullying firms who point out the hardship that his trade regime is causing them, but Republicans can no longer be counted on as the business allies they once were. New populist Republicans have replaced the traditional conservatives. And new voters attracted to the GOP by Trump aren’t free-marketeers, explains David M. Drucker. Could it be that the reason we’re not seeing congressional Republicans standing up to Trump on behalf of business more often is because they’re scared of losing these new voters? Whatever the reason, it’s a brutal and uncertain time to be a business leader right now. Not only are trade tariffs going to hammer your margins, but the president is making impossible demands. For example, Trump has insisted that Apple stop expanding iPhone production in India and move it to the US. But would you buy an iPhone for $3,500? One solution to avoid feeling the full brunt of the White House’s power is to take advice from Kermit the Frog and act as a group. In an inspiring commencement address at the University of Maryland on Thursday, Kermit said “Life is better when we leap together.” Gautam Mukunda agrees, writing that “Business leaders acting together are perhaps the most powerful force in American politics.” After all, their financial resources are critical to the president’s party allies. A credible threat to withhold them, or even to donate to the opposition, could have an enormous impact. The UK and US are gearing up for a long holiday weekend. For many of you, that’ll mean sitting in gridlock traffic tonight as everyone and their dog tries to escape the city for nicer places. As you crawl along the M4 or I-87, think about all the roads in India, which now possesses the world’s second-largest road network after the US. Andy Mukherjee notes that perhaps India should be copying 21st-century China, with its efficient high-speed rail, rather than 20th-century America. The small group of car-owning Indians are feeling squeezed by a debt-laden National Highway Authority and heavily-taxed fuel and cars. Being too highway-minded is a cost for their wallets, and for the planet. Here’s another thing you can do on a long weekend in a long line of automobiles: reassess your fear of long bonds. Allison Schrager makes the case for them being just about the best hedge in a whacky world of uncertainty. After all, you’re probably saving for a long term retirement goal, for instance. Schrager explains: “Say you finance your retirement with a 20-year-coupon bond or an annuity when you retire. The price of your future retirement is just as volatile as a long-term bond, because it’s also based on long-term interest rates. If you invest in a short-term bond, you are not ensuring you can still spend a stable amount several years from now.” The conclusion: Go long! Trump seems to be picking flight over fight when it comes to the tricky business of brokering peace in Ukraine. It’s not that simple. — Hal Brands Washington needs to stop publishing cringey memes and targeting international students if it wants soft power in Asia. — Karishma Vaswani There’s been a spate of companies rapped for secretly using humans in place of AI. Is this the end of AI washing? — Parmy Olson Billionaire Patrick Drahi is on a roll. — Chris Hughes An explosive Oval Office meeting underlines that, for African leaders and beyond, the Trump administration is all about the deal. — Justice Malala The “Golden Dome” that’s some day supposed to make North America safer could have the opposite effect. — Andreas Kluth The resignation of a Kohl’s board member shows why quiet quitting isn’t always best for shareholders. — Beth Kowitt A gas pipeline deal between New York’s governor and the president simply moves a fight to Boston. — Liam Denning A city in China is on the frontline of the battery trade war. Here’s how Ukraine rebuilt its energy grid in the middle of a war. Netanyahu accuses leaders of “emboldening” Hamas. Silicon Valley’s most powerful people are obesessed with hobbits. Imagine waking up to a huge container ship in your garden. Gulls aren’t drunk, they’re just concentrating. (h/t to Andrea Felsted) Notes: Please send hobbits and feedback to Lara Williams at lwilliams218@bloomberg.net. Sign up here and find us on Bluesky, TikTok, Instagram, LinkedIn and Threads. | 
