7 February 2025
Dear Interested Readers,
As The Chaos Continues, I Want to Reflect On Primary Care, But Can’t.
In a New York Times opinion piece entitled “This Isn’t Reform. It’s Sabotage.” written by David Wallace-Wells and published on Wednesday we read:
It is, so far, worse than I feared. Last Friday, at the end of a week in which a vaccine skeptic and sometime conspiracy theorist auditioned to lead the country’s nearly $2 trillion, 80,000-person public health apparatus, much of the Centers for Disease Control and Prevention’s website went dark — its weekly mortality reports, its data sets, certain guidance for clinicians and patients, all taken offline. C.D.C. researchers were ordered to retract a huge raft of their own, already-submitted research. Next to go dark was the website of U.S.A.I.D., which Elon Musk announced that he would be working to shut down entirely, after several staffers resisting agency takeover by the billionaire were abruptly put on leave. (When the agency website later popped back online, it featured an announcement that all overseas personnel would be placed on leave and ordered to return.).
It seems to me that Elon Musk is in the news on an almost hourly basis. It appears that he is the president’s “muscle” and the final pathway for many of the most disturbing aspirations of Project 2025. We would be challenged if Musk represented the sum total of all of our worries about the next four years. I fear the Department of Government Efficancy (DOGE) is just an opening act of what is to come.
Mr. Wallace-Wells has a lot more to say about the intent, the strategy, and the damage that we are going to need to find a way to resist or live with over the next four years. It is disturbing to consider that we will not have a chance for a reprieve until the 2026 elections or worse, until after the election in 2028. I hope that House Minority Leader Hakeem Jefferies can find a few brave centrist Republican members from “purple” districts who would be willing to help create a small “speed bump” using the approval of the debt limit and budget in March as a way of resisting the radical restructuring of our Democracy. I fear that Jeffries’ dream is a hope and not a likely reality.
In his opinion piece, Wallace-Wells offers perspective on our current confusion and lack of effective strategies to resist the damage of the barrage of previously unthinkable presidential actions that we have experienced in the first two weeks of Trump’s second term. It occurs to me that we should add the image of a wildfire to our description of the concepts of “blitzkrieg, whack-a-mole, and flood-the-zone” as we try to describe Trump’s strategies and his flurry of well-planned and choreographed activities. Long-standing norms and structures seem doomed to be consumed by Trump’s desire for radical change that is in part fueled by his need for revenge.
Sometime between Jan. 6, 2021 and Nov. 5, 2024, many American liberals came to feel that “the resistance” — the reflexive moobilization against President Trump, after his first victory, on behalf of American institutions — had been embarrassing, pointless or even counterproductive, and that it might have been a touch hysterical to worry in grandiose terms about the threat posed by Trump rule. At the moment, it is hard to see it but hysterically: a blitzkrieg against core functions of the state, operating largely outside the boundaries set by history, precedent, and constitutional law, and designed to reduce the shape and purpose of government power to the whims, and spite, of a single man.
I have been shaking my head in disbelief. Mr. Wallace-Wells’s description of what we have endured since January 20th is an understatement of what we have experienced. He was writing before the president suggested that we take over the Gaza Strip and send 2 million people who are eager to rebuild their homes from the rubble of war to some fictitious places where they will be forever happy while we turn their 25 miles of Mediterranean beaches into a fabulous resort.
Yesterday, Dana Milbank of the Washington Post gave us an effective presentation of this most amazing proposal that would be absurd at any other time, but this is not any other time. He begins by saying: “Genocide Joe” never looked so good. It was an indirect way of asking all the American Palestinians who either voted for Trump or just didn’t vote as a response to their anger about Biden’s policies that were affirmed by Kamala Harris. It is somewhat similar to the question I would love to ask all those red-state Americans who voted for Trump because they did not like the cost of eggs. I wonder how paying ten dollars a dozen for eggs feels to them now? Soon they will feel more pain as all the items from China that they love to buy at Walmart will have at least a ten percent increase from the new Trump tariffs. It is also easy to predict that many of them will lose their SNAP benefits and discover that their access to healthcare has been a victim to reductions in Medicaid funding. Perhaps another pain they will suffer to fund tax cuts for Musk and other oligarchs will be that their children will no longer get food at school or a better chance at life through education as the Department of Education is crippled or closed as promised by the man “God saved” to save America.
Milbank gives a great replay of the nonsense that Trump spouted on Wednesday after he met with Benjamin Netanyahu, a business partner who is sharpening his authoritarian skills. After asking American voters with Palestinian ties who voted for Trump or stayed home on November 5th, “How’s that working out now? He gives us a good review of the president’s laughable presentation:
Trump, hosting Israeli Prime Minister Benjamin Netanyahu at the White House on Tuesday, made the stunning declaration that he wants all Palestinians removed from Gaza — permanently.
“All of them,” Trump said. “I mean, we’re talking about probably a million-seven people, a million-seven, maybe a million-eight. But I think all of them. I think they’ll be resettled in areas where they can live a beautiful life and not be worried about dying every day.”
And what would become of Gaza after all Palestinians were evicted? At a formal news conference with Netanyahu in the East Room a couple of hours later, Trump unveiled his next proposal: “The U.S. will take over the Gaza Strip. … We’ll own it.”
The members of the press core who heard the announcement were incredulous as Milbank’s reproduction of the continued exchange suggests:
Huh?
“You are talking tonight about the U.S. taking over a sovereign territory. What authority would allow you to do that?” an incredulous Kelly O’Donnell of NBC News asked. “Are you talking about a permanent occupation?”
“I do see a long-term ownership position,” Trump answered, as though the Palestinian enclave were a hotel property on the market. “Everybody I’ve spoken to loves the idea of the United States owning that piece of land, developing and creating thousands of jobs with something that will be magnificent.”
Greenland, Panama, Canada and now Gaza: The sun will never set on Trump’s colonial empire.
Was owning Gaza all that interested the president? No, Milbank continues:
A moment later, the president said he was also considering evicting the Palestinians from the West Bank and awarding that territory to Israel. “We’re discussing that,” Trump said when asked about giving Israel control over biblical “Judea and Samaria,” which includes the West Bank. “And people do like the idea.” He promised an announcement “on that very specific topic over the next four weeks.”
From the river to the sea, Palestine will cease to exist. As those uncommitted voters [pro-Palestenian] now know: Elections have consequences.
As I have said in recent letters to you, I am trying hard to ignore what is happening in Washington, the heading of this section of the letter represents my failed aspiration. For weeks now, I have been trying to focus on a subject other than Trump and write about the current challenges to primary care. I envisioned beginning with my own sense of the critical concerns related to the subject and the fact that I approached my role as a cardiologist from the perspective of primary care. I was going to spice my report up by relating a personal story of an interchange with a medical leader who would eventually become a “former CEO of Partners Healthcare” now MassGeneral-Brigham. This very influential clinician of the time announced to me and other local healthcare leaders who were meeting to discuss strategies for healthcare improvement in the months during the run-up to the passage of the ACA that he saw no need for primary care. He reasoned that the patients who came to him at the Mass General were intelligent enough to select the specialists they needed like diners ordering from a Chinese menu. In a way, I was thankful for his comment because I thought it was an honest sentiment that was shared by many who were more judicious and reluctant to express their opinions about a subject for which they had little interest. I was pretty sure that he was saying what some of them were thinking. Most of the CEOs were hospital-oriented and valued primary care only as a feeder to their high-tech-oriented institutions but feared revealing their biases. My bias led me to suspect that they would do little to measurably help reverse the erosion of what I considered to be the keystone of our delivery system. Maybe there will soon be a lull in the storm of startling announcements from the president, and I will be able to collect my thoughts about the core nature of an endangered species of practice, Primary Care.
Returning to the article by Wallace-Wells, his article focused on the public health implications of the president’s actions and the connection to the recent trend toward libertarian thought plus the confused responses of the left resulting in the president’s emphasis on “wokeism” that underlies much of the actions he has been taking to the delight of the MAGA crowd:
The war on public health is just one facet of this ugly diamond, but through it you can see both the breadth and the cruelty of the whole assault — and how it often hides behind an alibi of “reform.”
All of a sudden, last Friday, you could not view C.D.C. data about H.I.V., or its guidelines for PrEP, the prophylactic treatment to prevent H.I.V. transmission, or guidelines for other sexually-transmitted diseases. You couldn’t find surveillance data on hepatitis or tuberculosis, either, or the youth-risk behavior survey, or any of the agency’s domestic violence data. If you were a doctor hoping to consult federal guidance about postpartum birth control, that was down too. As was the page devoted to “Safer Food Choices for Pregnant People,” presumably because that last word wasn’t “Women.” Throughout the pandemic, conservative critics of these institutions complained that their messaging was unequivocal and heavy-handed. The new message seems to be: You are on your own.
Near the end of the article, his analysis of the confusion over public health is extended to become both an explanation and a warning for those of us who loathe this moment and feel confused about how to respond:
In the name of reform and government overhaul, the new administration is approving and ushering in something much more like destruction, with the president imploring his new health secretary to “go wild” in the role. The admonition does not apply just to Kennedy and public health, or even just to Musk and his initiative. A new generation of libertarians is not letting the country’s crisis of confidence go to waste.
Last week I wrote about the apparent strategy of “flooding the zone.” So much is happening that those of us who might want to resist are overwhelmed and confused. It now appears likely that the three most marginal nominees awaiting Senate confirmation—Kennedy, Gabbard, and Patel—will probably be confirmed. The Department of Education is probably doomed. USAID is getting the last rights, and we won’t hear any more discussions about the rights of transgendered athletes.
Legal challenges are the logical defense against many of the president’s executive order initiatives, but the ultimate “legal deciders” on the Supreme Court have already demonstrated a tendency to support and expand the powers and expansionist projects of the presidency. It feels like the president is “carpet bombing” progressive ideas and offering a satanic response to the reassurance that “the arc of the moral universe is long, but it bends toward justice.”
During 2024, my wife and I were frequent donors to Democratic candidates at the local, state, and national levels. Every day during the election season, we received emails and texts requesting contributions from the candidates who shared our worldview. We responded to many of those requests out of a sense of responsibility to future generations. We do have four grandchildren. I assumed that the barrage would end after November 5th, but it did not. We now get at least as many requests, if not more, every day to donate money to “save” Medicare, “protect” Social Security, or “block” a confirmation. Those efforts seem futile at the moment as the few Republican senators like Senator Dr. Bill Cassidy who did seem possibly open to reason fold and vote for unqualified and absurd nominees for candidates for Cabinet seats.
Dr. Cassidy is not alone in his fear of retribution from MAGA enthusiasts at the next election. I like the headline “Republicans Fold Like Little Origami Cranes To Back Trump’s Contentious Nominees.” Senator Susan Collins has again demonstrated that she is unreliable as a source of resistance to the president’s most controversial nominees. She announced that she would vote to confirm Tulsi Gabbard to a position for which she has no qualifying professional experience.
Trump’s “flood-the-zone,” whack-a-mole,” blitzkrieg” strategy plus his threats to Republican solons to get in line or he will “primary them” seems to be a strategy that is on a winning streak. It is indeed, a very dark hour. I feel like sooner or later many of his MAGA supporters will awaken to the reality that the vendetta against “wokeism” will be more personally costly than they ever imagined. The impulsive response of many voters that got us to this moment reminds me of a few words from an old Jim Croce ballad, “Five Short Minutes,” about impulsive behavior with long-term consequences. Croce sings:
…the rest is just a tragic tale
Because five short minutes of lovin’
Done brought me twenty long years in jail
…Then I said “Ooh, ooee! Sure was a tragic tale’
(Wasn’t worth it, wasn’t worth it!)
I hope that impulsive voters haven’t started a sequence of changes that will be the end of what we collectively still value. I hope as the story continues enthusiastic MAGA faithful won’t be left moaning: “Wasn’t worth it, wasn’t worth it!”
It is always reassuring to know that in your distress you are not alone. A few weeks ago I introduced Willem Lange to you. If you didn’t read that letter and don’t have time to click on the link, here is my description of him. I wrote:
Why are progressive ideas such a challenge to present and sell? I recently read an interesting column in my hometown paper, the Valley News, entitled “Why do we cling to our healthcare system?” The article was written by an older journalist [90 years old], Willem Lange, who has a recurrent byline, “A Yankee Notebook.” Lange is a fixture in New England journalism. He is a naturalist who for eighteen years has had an outdoor recreation television program called Windows to the Wild, aired on New Hampshire Public Television, that features hikes in the White Mountains and other environmental subjects and adventures. It was a big surprise to me to see that he was expanding his sphere of interest to include healthcare. The column is short, but as usual, I will annotate his interesting thoughts. It’s too bad that the article did not come out in “blue wall states” last October.
Willem is ten years my senior, but we share the same introspective thought which I would summarize as “ Why, since I am about to ‘shuffle off this mortal coil’ do I even care about the current craziness?” This week Willem added again to my sense that we share some feelings with a piece entitled “Common sense drowns under a tide of events.” Read the whole article or read on for what I consider Lange’s major thoughts. The similarities in our lives that he describes in his first paragraph give me a sense that there may be a brotherhood of old codgers to which we both belong:
What’s an old fellow to do? My sources of information are letting me down. The news of the day comes into my house mainly via the internet, a New York Times subscription, a couple of local newspapers and brief sessions with commercial-haunted CNN (insurance of all kinds, mesothelioma lawyers, and Medicare Advantage) while I’m cooking and eating meals in my kitchen. Not very elegant, but generally reliable, as nearly as I can tell by crosschecking.
Lately, however — since the presidential inauguration, to be specific — my news sources seem to have gone haywire.
It’s hard to believe that this isn’t intentional, but so many things are happening simultaneously that none of them is getting proper attention.
Neither of us is afraid of mainline journalism as a source of misinformation. My concern is that Trump is using lawsuits and the potential for retribution associated with control of the FBI and Department of Justice to create fear within the resources that Willem and I depend upon for connection to the larger world. After he describes the recent activities of Elon Musk and alludes to the president’s inappropriate reaction to the tragedy of the airliner-helicopter collision in Washington, he refers to the “flood-the-zone” strategy.
There’s a pattern here, one far too clever to have been devised by the president. The idea seems to be to flood the various news media with so many irresistible news items that listeners, readers and viewers will be so confused by the proliferation that they’ll give up trying to keep pace. It’s sort of the civilian version of the Blitzkrieg that the German armies used in the opening days of the Second World War.
It’s caught us flatfooted. Has anyone heard even a peep from Congress? It’s likely the sudden and blatantly illegal rush has sent it into its usual discussive [ I think that Willem poetically invented “discussive”] mode (what I call faculty meetings) to determine a course of action that will appear brave, but will ensure that no one will be personally exposed to the vengeance of the president’s men.
I smiled in amazement at his ability to express in a very few words what it takes me hundreds of words to say with less effectiveness. I marvel at his writing capabilities.
Thousands of people watch soap operas daily. But it’s a lot less entertaining to be living in one. It seems that our fates — especially those of us elderly folks — are to be directed by distant and unaccountable people devoid of even sympathy. It appears that our foreign policy, which has for decades been softened and sweetened by aid to nations and people in need, is about to eschew the soft speech and rather emphasize the big stick. Other potential suitors eagerly await such a development.
He finishes with a precious wisdom developed over his ninety years. I hope that we both live long enough to know that once again the strength of our Constitution has provided us with an effective shield against those who would throw it all away and follow a madman. His words suggest to me that we can’t passively believe that “the arc of the moral universe is long, but it bends toward justice.” At some point, we must remember that the Constitution and our democracy are fragile. Benjamin Franklin famously said. “We have a democracy if we can keep it.” It is hard to imagine better health for everyone in a country that descends into the self-serving policies that we are presented by our new administration.
All of this leaves us common folk wondering where to turn for the truth. It used to be that we could use our high school training to distinguish news from commentary, bias from propaganda, and fact from speculation. That’s not so easy anymore. Where are the commentators getting their facts? What corporations hold majority ownership in our sources of news? It would be easy to ask myself, at my age, why I care? At that point, the political philosopher Hannah Arendt writes, “The ideal subject of totalitarian rule…is the [person] for whom the distinction between fact and fiction … and the distinction between true and false … no longer exist.” Never think that it can’t happen again.
Willem warns us that a better future for everyone is not guaranteed. He is not exaggerating the peril of the moment. If our president can imagine stealing Palestine and turning the rubble of Gaza into a Mediterranean playground for those who can afford it while the West Bank is turned into comfortable housing for right-wing Israelis, what is in store for those here who suffer while waiting for improvements in the social determinants of health as inequities increase to fund more tax cuts and entrepreneurial opportunities for the wealthy?
Sooner or later, I promise to move on and write about the challenges and opportunities of a return to the primacy of excellent Primary Care for everyone.
When It’s This Cold, One Looks to the Beauty and Joy of Ice.
The very creative couple who are my neighbors, Peter Bloch and his wife, Kathy Lowe, have this last week once again contributed to my wintertime delight. My wife and I enjoyed a show of Kathy’s creative photography last week in the beautiful environment of the new art building at Colby-Sawyer College here in New London. Click on the link above to learn more about Kathy’s range of artistic interests.
Almost simultaneously, Peter published yet another video that is a study of the unseen, unnoticed, world of ice. The video is entitled LIMINAL SPACE ~ Between Water & Ice. I lifted today’s header from Peter’s video. I recommend that you click on the link and enjoy a five-minute reprieve from Trump World. The introduction to the video contains “bolding” by Peter and not me! He writes:
I love exploring and filming the natural world, especially when I get to share with you about places that we don’t normally get to see. This video explores that mysterious and almost impossible-to-access zone between the water and ice formations. These are like ice caves…. some are just little pockets of air, others are expansive “rooms” with crystalline ceilings and textured floors. Gaudi-esque icicles of all shapes and combinations line the walls or dangle from the roof of ice. Bubbles of air race along below the undulating sheet of clear ice. Join me in this exploration of a world that [is] too small and too low for us to enter without a camera on a long selfie stick – a world of beauty and wonder, tranquility and exhilaration, fragility, and permanence.
I plan to make good use of the ice during the President’s Day Holiday week that is fast approaching when my California grandsons will visit. I have just ordered and received a new “ice house shelter.” I have an auger to drill the holes in the ice so that we can try our luck ice fishing while being sheltered from the cold breezes that are certain to be a challenge.
For those of you who may be concerned about my recently revealed amyloidosis, I am glad to report that I am now consuming a daily dose of Vyndamax which costs Blue Cross over $260,000 per year, and for which I pay about $2.00 a day through the Blue Cross relationship with the CVS Caremark Specialty medical program. It’s probably just a placebo effect, but I feel better already!
I am grateful for the support of my cardiologist, Dr, Hannah Bensimohn at Dartmouth Health who wrote all the appeals and finally got my medication approved by Blue Cross. I feel blessed to have access to her skill and compassion. I am also delighted that so far I have no side effects as I await evidence of the benefits of what our system of care should make available to everyone who might need it. Perhaps, someday.
I hope that you have plans this weekend to be out in the world and far from the cares emanating from the White House. It is going to be a long four years and survival will require strategies that give us memorable moments with those we love. I hope planning many positive moments will sustain us all through four years of political cold and darkness. Oh, I almost forgot, enjoy the Super Bowl.
Be well,
Gene
