August 29, 2025
Dear Interested Readers,
Recently, I have spent a considerable amount of time and words writing about the illiberal tendencies of our president, and how he appears to be the tool of what I would label as the Project 2025 cabal. Among his many threats to our democracy, my justification for writing so much about him in a healthcare letter is that Project 2025 and other policies of the president pose a threat to your health, the public health of the world, your protection from natural disasters exacerbated by global warming, and health equity, and that is not all.
There is virtually no chance that the Triple Aim, universal access to quality care, or health equity will become realities as long as Donald J. Trump is president. Dreams of curing cancer or at least reducing its impact are delayed by decades. Make America Healthy Again (MAHA) is a bigger joke than Make America Great Again (MAGA). David Brooks points out that many of the young men who voted for the president are so distressed that they can rightly be considered nihilists who want to blow up logical efforts at improving our world rather than support an agenda for improvement through democratic processes, science, and thoughtful policies on a platform of diversity, equity, and inclusion.
You can click here to see the pictures and names of the cabal, the individuals who were the major organizers and contributors to the Project 2025. I doubt that you will be surprised to see that many of them now hold significant responsibilities in the administration. As you may recall, during the 2024 presidential campaign, the president denied knowledge of or intent to follow the illiberal prescription for change outlined in the more than 900 pages of the Project 2025 document. That was just another Trump lie. As I have reported before, it is now estimated that in the first six months of his second term, the president has already implemented about fifty percent of the actions advocated in Project 2025.
I feel like it is time to review the damage done and the damage expected to evolve for lower-income Americans and immigrant populations from the 50% of Project 2025 that has already been implemented. What lies ahead is hard to know, but it is unlikely to be anything that will lift the prospects of our most challenged families and individuals. I would emphasize that we have not yet experienced in healthcare most of the impact of items like the undermining of the Department of Health and Human Services, the CDC, the FDA, vaccine research, and the NIH, in the pursuit of RFK Jr.’s MAHA agenda. There may be much more to come than the dangerous reductions at FEMA, and the damage already done to the Bureau of Statistics, the Department of Education, our museums, and the attacks on Jerome Powell and the Federal Reserve.
And then there are daily fears of deportation experienced by the millions of productive, law-abiding, tax-paying, and hard-working immigrant families who perform much of the difficult and onerous work of feeding us, cleaning up after us, caring for our elderly parents and children, and building the homes we need. We have not yet experienced much of what is destined to happen as a result of Trump’s constantly changing tariffs or his inept management of foreign policy. What national defect in character has made this disastrous moment possible? It feels to me like we’re watching an Atlantic hurricane approach Florida. You know that bad things are going to happen, but the full impact of the destructive force has not hit yet.
It has been a few weeks since I consulted ChatGPT, so I decided to ask:
It is estimated that in the first six months of the second Trump presidency, about 50% of Project 2025 has been implemented. What has been the impact on lower-income Americans and immigrants?
I was delighted to see that the Bot is now including references in the body of its response, and it “bolds” important points for clarity.
ChatGPT said:
Here’s how the partial implementation (roughly 50%) of Project 2025 in the first six months of the Trump administration is affecting both lower-income Americans and immigrant communities—with wide-ranging consequences across healthcare, social services, legal protections, and economic stability.
Impact on Lower-Income Americans
1. Deep Cuts to Safety-Net Programs
- The One Big Beautiful Bill, aligned with Project 2025 principles, slashes over $1.2 trillion in federal spending from programs like Medicaid and SNAP.
- Stricter work requirements, higher premiums, increased verification, and service fees have already been introduced, significantly reducing access to care for millions.
Wikipedia+1
- Experts warn these changes could leave millions uninsured and worsen disparities in healthcare access.
SELFdefeatproject2025.org
2. Housing Instability Intensifies
- Project 2025 proposes eliminating benefits like Section 8 proration for mixed-status immigrant families, adding work requirements, and setting time caps—threatening access for single parents, women of color, and other vulnerable renters.
ShelterforceMississippi Free Press
- These policies risk increasing child poverty and homelessness, disrupting conditions essential for healthy development.
First Focus on Children
3. Dismantling Key Education Supports
- Plans under Project 2025 include dismantling the Department of Education and eliminating Title I funding, jeopardizing 180,000 teaching positions and reducing support for low-income and disabled students.
socialworkers.org
Impact on Immigrant Communities
4. Erosion of Legal Protections
- Programs such as TPS, DACA, and asylum protections are being curtailed under Project 2025, exposing affected individuals—many living in the U.S. for decades—to looming deportation.
DocketWiseLULAC
- The Vera Institute warns these policies pave a path to mass deportations and family separation—eroding due process and destabilizing communities.
Vera Institute of Justice
5. Heightened Immigration Fees and Barriers
- Legislation now proposes high application fees—up to $1,000 for asylum, $8,500 for sponsoring minors—without waivers, effectively pricing out many vulnerable immigrants.
The Guardian
6. Cuts to Essential Services
- Federal rules now exclude undocumented immigrants from programs like Head Start, adult education, and mental health services—removing lifelines for families and affecting U.S. citizen children too.
AP News
7. Disruptions to Childcare Industry
- Increased ICE enforcement in childcare centers threatens the largely immigrant workforce, risking closures, higher costs, and reduced access for families in need.
Vox
8. Economic and Emotional Strain
- A new 1% remittance tax, combined with federal aid cuts, would drain billions from immigrant families and their communities abroad, increasing financial strain and risk of forced migration.
Vox
- Expansion of work requirements in programs like TANF impedes economic mobility, particularly hurting working-class mothers and their children.
First Focus on Children
9. Reduced Medicaid Access for Undocumented Individuals
- The “Big Beautiful Bill” penalizes state-funded coverage for undocumented adults, lowering federal support and prompting rollback of such programs even in progressive states.
Wikipedia
Summary: A Colliding Crisis
| Group | Key Impacts |
| Lower-Income Americans | Lost access to health, food, housing, and educational support; increased financial and health stress |
| Immigrants & Mixed-Status Families | Stronger barriers to legal status, benefits, education, and healthcare; elevated risk of detention and deportation |
These policy shifts—spanning healthcare, housing, education, and immigration enforcement—risk dismantling the social safety nets that have long supported the most vulnerable populations and undermining the foundations of equitable well-being.
What remains as a perplexing reality is that a significant number of individuals and families who will be adversely affected by what has already been enacted stand to lose even more as the rest of Project 2025 is enacted. Going back to Trump’s first term, a nagging question for me has been why so many of those who are now attacked by Trump’s policies voted for him and remain loyal to him in the face of their increasing losses.
If you are a regular reader of these notes, you know that I have frequently searched for the answer to this question by citing the books of Professor Arlie Russell Hochschild, Stolen Pride: Loss, Shame, and the Rise of the Right, and Strangers in Their Own Land: Anger and Mourning on the American Right. It has been hard for me to fathom why so many people vote against their own physical and fiscal health. I decided to ask the Bot to comment on and summarize her work.
Please comment on and summarize the two books by Professor Arlie Russell Hochschild, Stolen Pride and Strangers in Their Own Land, that attempt to explain why disadvantaged Americans often vote against their own physical and fiscal best interests.
ChatGPT said:
Great question. Professor Arlie Russell Hochschild, a sociologist at UC Berkeley, has written two important works that together explore the paradox of why many Americans—particularly those struggling economically—support politicians and policies that appear to undermine their physical well-being (health, environment, safety) and fiscal interests (wages, social programs, benefits).
Here’s a summary and commentary on both:
1. Strangers in Their Own Land: Anger and Mourning on the American Right (2016)
Summary
- Hochschild spent years in Louisiana, embedding herself in Tea Party communities and trying to understand the deep emotional and cultural logic behind their political choices.
- She introduces the concept of a “deep story”—an emotional narrative that helps explain why people see the world the way they do.
- For many of her interviewees, the story is this: “I’ve been standing patiently in line, waiting for my share of the American Dream. But people are cutting ahead—immigrants, minorities, women—while government and liberals cheer them on. I feel invisible and disrespected.”
- This resentment, she argues, helps explain why many support deregulation, smaller government, and politicians hostile to federal programs—even when those programs might materially improve their lives (e.g., EPA protections in polluted Louisiana, or Medicaid expansion).
Key Themes
- Cultural displacement: A sense that their values, religion, and traditions are being eroded.
- Resentment of federal government: Seen as helping “others” instead of “deserving people like me.”
- Identity over material gain: Voting is not just about economics; it’s also about belonging, dignity, and cultural affirmation.
Commentary
- Hochschild’s work shows how emotions, identity, and perceived fairness can outweigh concrete economic benefits when people make political choices.
- Her empathy-driven ethnography highlights the need for dialogue across political divides—but also reveals how deeply entrenched mistrust of government can prevent public programs from gaining support, even among those who need them most.
2. Stolen Pride: Loss, Shame, and the Rise of the Right (2024)
Summary
- This later book builds on Strangers but expands the analysis to the Trump years and beyond.
- Hochschild focuses on the erosion of pride and dignity among many working-class Americans—white, rural, and evangelical populations in particular.
- She argues that “stolen pride” is a key emotional driver: people feel their identities, histories, and ways of life are being delegitimized or dismissed by elites, progressives, or the global economy.
- Policies that might materially help (e.g., universal healthcare, student loan relief, stronger unions) are rejected if they appear to come at the expense of their sense of self-worth, cultural identity, or moral worldview.
Key Themes
- Loss of respect: Economic insecurity is compounded by the perception of being ridiculed or shamed by media, academia, or urban elites.
- The politics of grievance: Leaders on the right (like Trump) tap into this sense of stolen dignity, reframing cultural issues (immigration, race, gender, DEI) as existential threats to identity.
- Fear of replacement: Echoing “Great Replacement” rhetoric, some feel that their contributions and traditions are no longer valued in America.
Commentary
- Hochschild here shifts from resentment of unfairness (in Strangers) to the pain of humiliation and disrespect.
- This framework helps explain why even when conservative policies worsen inequality, health access, or environmental safety, many still embrace them if they restore pride, dignity, or a sense of cultural survival.
- It underscores how politics is emotional first, rational second—and why appeals to economic interest alone rarely persuade.
Taken Together: Why People Vote Against Their Best Interests
- Both books illustrate that political behavior cannot be explained only through material self-interest.
- For many disadvantaged Americans:
- Identity > Economics: Feeling respected, recognized, and valued can matter more than tangible benefits.
- Distrust of Government: Programs are often seen as benefiting “others,” not “us.”
- Pride and Belonging: When cultural identity is at stake, policies that erode dignity are rejected—even if they improve health, jobs, or safety.
- Hochschild suggests that bridging divides will require acknowledging and addressing these emotional truths, not just offering better policies.
✅ In sum:
- Strangers in Their Own Land = explores resentment and unfairness (why others seem to be getting ahead).
- Stolen Pride = explores loss of dignity and respect (why people feel left behind and humiliated).
Together, they provide one of the clearest sociological explanations for why disadvantaged Americans often support leaders and policies that undermine their material well-being—but affirm their identity, belonging, and pride.
I was not really surprised when, at the end of a great review of Professor Hochschild’s work, the Bot asked me:
Would you like me to connect Hochschild’s ideas specifically to the Social Determinants of Health (e.g., how cultural mistrust and identity politics affect healthcare access, food security, housing, and education)?
My answer to the Bot’s question was an enthusiastic, “Yes, please do.”
ChatGPT said:
Excellent — let’s connect Arlie Russell Hochschild’s ideas from Strangers in Their Own Land and Stolen Pride directly to the Social Determinants of Health (SDOH):
1. Healthcare Access & Trust
- Hochschild’s insight: Many people in Louisiana and beyond distrust federal programs, believing they benefit “others” or undermine personal responsibility.
- SDOH impact: This distrust translates into resistance to Medicaid expansion, Affordable Care Act exchanges, or public health guidance (e.g., vaccinations, COVID measures).
- Result: Populations who could benefit most (low-income, rural communities) often have higher rates of being uninsured, worse preventive care, and delayed treatment.
2. Environmental Health & Safety
- Strangers in Their Own Land was rooted in Louisiana’s petrochemical corridor (“Cancer Alley”), where toxic exposure is severe. Many residents opposed environmental regulation even as they were harmed.
- SDOH impact:
- Weak enforcement of environmental protections increases asthma, cancer, and developmental disorders.
- When people vote for deregulation because it aligns with their identity or “anti-government” values, they accept higher exposure to environmental risks that directly undermine their health.
3. Education, Academic Freedom & Workforce Readiness
- In Stolen Pride, Hochschild describes how feelings of humiliation and exclusion shape resentment toward elite universities, DEI, and foreign students.
- SDOH impact:
- Undermining public education and academic freedom restricts upward mobility.
- If research funding and higher education access shrink, communities lose pathways to better jobs, reinforcing cycles of poverty.
- Hostility to immigrant students and educators reduces the intellectual capital that drives innovation, science, and medical progress.
4. Food Security (SNAP & Food Banks)
- Many low-income families rely on SNAP, WIC, and food pantries. But Hochschild notes that in conservative strongholds, government assistance is often seen as handouts that go to the “undeserving.”
- SDOH impact:
- Pushes toward restricting SNAP eligibility or cutting funding.
- Local families, already food insecure, must rely more on underfunded food banks.
- Poor nutrition → higher rates of obesity, diabetes, heart disease.
5. Housing & Energy Assistance
- Programs like LIHEAP (Low-Income Home Energy Assistance) provide winter heating and summer cooling, critical in rural and northern states.
- Yet, under the “deep story” Hochschild outlines, many reject these programs if they’re framed as giveaways to “undeserving” groups.
- SDOH impact:
- More families face housing instability or unsafe living conditions (cold homes, eviction risk).
- Housing instability is a core determinant of mental and physical health, worsening stress-related illnesses.
6. Mental Health & Community Well-being
- Hochschild’s theme of stolen pride highlights how humiliation, loss of dignity, and cultural invisibility create chronic stress.
- SDOH impact:
- Stress and hopelessness worsen mental health outcomes, leading to depression, suicide, and substance abuse (opioids, alcohol).
- This aligns with the “Deaths of Despair” phenomenon (Case & Deaton) that disproportionately affects white working-class Americans.
7. Health Equity & Social Cohesion
- When large groups of people feel left behind and humiliated, they resist collective solutions (universal healthcare, climate action, social safety nets).
- SDOH impact:
- Fragmented policy → persistent inequities in health outcomes across race, geography, and class.
- Communities that most need public health investment vote against it, perpetuating poor outcomes.
Bringing It Together
- Hochschild’s Core Insight: Emotional narratives (resentment, pride, dignity) drive choices more than material self-interest.
- SDOH Consequence: Even when health, food, housing, and education programs could materially improve lives, mistrust of government and defense of cultural identity lead to rejection of these supports.
- End Result:
- Higher mortality rates.
- More chronic disease.
- Widening inequality between regions (urban vs. rural, coastal vs. interior).
- A politics of grievance that undermines public health investment for everyone.
✅ In short: Hochschild helps us see that to improve Social Determinants of Health, policymakers must also address the emotional determinants of politics — feelings of fairness, pride, respect, and belonging. Without restoring dignity and trust, even the best-designed health interventions may fail.
I was flabbergasted to realize that, as much as I have focused on the Political Determinants of Health, the Structural Determinants of Health, and the Social Determinants of Health, I had never thought of the Emotional Determinants of Health. I had also never seen the subject discussed in the articles that I read. It makes sense even as a connection to diseases of despair, substance abuse, domestic violence, and even our epidemic of gun-related deaths. Perhaps there is another term we should consider: The Cultural Determinants of Health. My eyes are opened to the reality that what explains the moment we are experiencing is much more complex than the narcissistic sociopathy of Donald Trump and his attempts to become an authoritarian force at the center of a kleptocracy. To do that, he recognized that he must acknowledge the emotional and cultural pain of those who allow their anger and frustration to be used as a force against them.
As I considered the Emotional Determinants of Health and the cultural issues that cause pain for many Americans, I wondered if this was creative thinking from the Bot. As I pondered that question, I noticed that the Bot was asking me another follow-up question.
Would you like me to take this one step further and outline a policy framework for addressing SDOH in a politically divided America, informed by Hochschild’s findings? That could help imagine what practical strategies might work despite the mistrust.
I said yes and got extensive verbiage under the heading of “A Bridge-Building SDOH Playbook (Rooted in Hochschild).” After that 12-point presentation, the Bot then wanted to know if I would like a plan for my specific state or county that would bring together existing programs and institute new ones that would quickly improve the Social Determinants of Health where I lived. Of course, I said yes. What was produced was logical, lengthy, and challenging. Perhaps in a future letter, I will reveal the suggestions it made.
Some of the Bot’s suggestions are already underway in my community through existing non-profits where I spend several hours a week. One of the advantages that the Kearsarge Region has is the presence of Dartmouth Health, which is an excellent academic center that is trying hard to focus on small-town and rural challenges to the Social Determinants of Health. I was pleased to see that in a recent survey by the Commonwealth Fund, New Hampshire’s healthcare ranks third in the nation behind Massachusetts and Hawaii. That was at first a source of interest and pride, but then, on further reflection, when I thought about the deficits in care that are so easy to appreciate in New Hampshire and how at risk the efforts toward the Triple Aim are here, I immediately became a little gloomy. When our best is not good enough in the states that are trying, heaven help the “red states.”
In a recent editorial cartoon, I saw a drawing of Trump with a flying pig. As great as the locally based suggestions of the Bot were for attempting to improve the Social Determinants of Health by developing and implementing policies based on Professor Hochschild’s work, I was discouraged as I thought of how easy it is for decades of progress to be halted and how hard it is to implement positive change.
You might ask some of the same questions of ChatGPT that I asked. It’s free. All it will cost you is a little time. I am sure that your efforts will produce an interesting and detailed answer, complete with a presentation that you can show to friends and associates who may share your worries and concerns. There is no question that the Bot’s core idea is that we need to change directions from the usual progressive reflex to have the government be the leader in efforts to improve the Social Determinants of Health to a realization that progressive legislators can’t get elected if there is not an acknowledgement of the Emotional Determinants of Health and an effort to enlist community-based groups and institutions as the leaders, with the federal government being a concerned supporter with grants and policies that are managed locally. When will pigs fly?
I will conclude with a story that is both an expression of frustration and a plea for help from a father who is trying hard to provide for his family, but feels that the One Big Beautiful Bill will undercut his progress.
Recently, through some vagaries of how Facebook works, I had two surprising experiences. The first was that when I clicked on a post from my brother-in-law, who lives in Georgia, but is a compassionate progressive thinker whose Congressperson is Marjorie Taylor Greene, I was surprised to see comments from some of my former classmates in Texas from more than sixty years ago. I guess my connection to him and to them produced his exposure to their ideas. My former classmates were expressing their love and loyalty to the president. They were celebrating their belief that God had blessed the president and their confidence that he is an instrument of the almighty—a modern-day messiah. My brother-in-law responded negatively to their absurd hero worship. I gave my brother-in-law a silent “attaboy,” but kept my thoughts to myself.
A day or so later, a friend from my years in Massachusetts posted on her Facebook page an amazing short essay from a struggling young father who lives in the rural Shenandoah Valley of Virginia, which is the Eastern side of Appalachia, not far from the communities that Professor Hochschild wrote about in her most recent book, Stolen Pride. I know the area well because another brother-in-law grew up there on a struggling, rocky, hillside farm with great scenic views where his family had lived for more than two hundred years.
What was remarkable to me about the essay was the combination of pride and intelligence articulated in the piece. I was impressed with the prose coming from a hard-working guy who, based on his self-description, may not have had the benefit of a college education. The author knows that there should be a better way for everyone in a country that is as wealthy as ours. There is no question in my mind that if we want to build a resistance to Trump’s illiberal agenda, we must form a coalition with families like those of the author. There is little more that I can add to the resilience expressed in his essay other than that it gives me some hope that if we can speak effectively to the concerns described, we might look forward to a better collective future beyond our current nightmare.
Commentary: Living in the Shadow of the American Dream: A father’s reflections on the quiet, unseen struggles of working families today. Written by Andrew Tait.
I live in Shenandoah County, Virginia. I’m a factory worker. A farmer. A father of two girls, one still in diapers. I get up before the sun, and most days I don’t sit down until after it’s gone.
My partner Hannah and I raise our girls on a small farm in the Valley. She works full-time too-though nobody calls it that. She’s a caregiver, a homemaker, a livestock handler, and a mother. She doesn’t get a paycheck. She doesn’t get a break. She doesn’t get counted.
We’ve relied on a cistern for water for over three years. I’m trying to save up to dig a well before it runs dry. We heat with firewood I cut myself. We raise animals for milk, eggs, and meat because the grocery bill outpaces my paycheck.
We’ve stayed unmarried—not because we don’t love each other, but because getting married would kick my partner and our daughters off the Medicaid that keeps them healthy.
My employer offers insurance, sure—but only if I pay nearly as much as our mortgage. I can’t, so we stay as we are; in love but locked out.
I’m not ashamed of our life. It’s honest work, and it’s full of love. However, I am ashamed that in a country as wealthy as ours, people like us are left out in the cold.
When the so-called “Big Beautiful Bill” passed, it was marketed as a win for working Americans. From where I stand, it looks like the opposite. Cuts to Medicaid, reduced support for struggling families, and a ballooning deficit that somehow still leaves us more exposed than before.
You can dress it up however you want, but if it leaves working families behind, it’s not serving the people.
This bill, like so many before it, rewards the already powerful while punishing the people who hold up the economy in invisible ways. It gives to those who lobby and takes from those who labor. It reinforces a message I’ve felt in my bones for years: You’re on your own.
I’m not writing this as a Democrat or a Republican. I’m writing this as a man watching families like mine wear themselves thin; working hard, doing the right things, and still falling behind.
This isn’t about Red or Blue. It’s about the fact that we’re being divided against each other while both sides forget that real Americans bleed the same when the cost of insulin triples or the cost of groceries goes up again.
You shouldn’t be able to carry a hundred dollars’ worth of groceries in two hands. But these days, you can-and that’s not just wrong, it’s dangerous.
I’m writing to ask one simple thing: Who is this country really for?
Because if it’s not for parents doing their best to raise good kids in a broken system…
If it’s not for factory workers and farmers who show up every day, no matter how little is left in the tank…
If it’s not for families trying to make a life from the land and a paycheck…
Then maybe the flag doesn’t wave for all of us after all.
I don’t want handouts. I want fairness. I don’t want politics. I want policy that works.
I don’t want a revolution of violence. I want a revolution of responsibility-one where we take care of each other, where people can raise a family without choosing between groceries and medicine, and where love doesn’t have to take a back seat to red tape.
So, if you’re in power, hear me: We are not okay. We are drowning quietly.
And if you’re not in power, but you’re reading this and nodding along, then know this: you’re not alone either.
We’re not enemies. We’re neighbors. We’re parents, workers, and caretakers. And it’s time we start acting like it.
With respect,
A father holding faith
If a majority of Americans could take Mr. Tate’s plea to heart, if we could act on his idea that in a country as wealthy as ours, no one should be left out in the cold, we could make America truly great for everyone as the culmination of centuries of struggle toward worthy ideals.
Looking Forward To A Cool Labor Day Holiday.
Over the years, I have said that summer ends at 6 PM on Labor Day. That was when we had young boys, and school started the day after Labor Day. Most schools seem to start earlier than Labor Day now, and it seems that for this year, the summer is following the school schedule for the end of summer and the beginning of fall weather.
We are definitely having an early fall. Overnight temps are approaching the thirties, and even though the skies have been mostly clear, some of the recent daytime temps haven’t crested 70. I love walking in the fall. During the dog days of summer, which now seem to be behind us, I try to take my walks where there is lots of shade and not so many little hills. Now that the conditions for exertion have improved, I have taken a walk up Burpee Hill Road. From my house to the highest point where there are spectacular views of Lake Sunapee and Mount Sunapee, it is a steady uphill climb of three-quarters of a mile.
There are several rewards for the effort. On a clear day, you can see all the way to Killington Peak, which is an hour’s drive across the Connecticut River and into the middle of Vermont. Near the crest of the road, there is an interesting combination of high-end homes and beautiful open spaces, including a working farm. On the left, going up, I often see a herd of Hereford cattle milling around the field, which is behind an old farmhouse and its attached barn. Often on the right, there is a herd of 25-30 white cows. I think the two herds belong to the same farmer, and perhaps he doesn’t want them to mix their genes. Today’s header shows the white cows and a bit of the view toward the West.
Enjoy the holiday weekend. I’ll be taking walks with my oldest son from Florida and his family. We will also don wetsuits for some swimming and boating. I won’t wake surf, but I am sure my visitors will despite the chilly fall water. I hope that you are anticipating a fond farewell to summer and a pleasant hello to fall wherever you might be.
Be well,
Gene

Great, insightful blog Gene.
Steve