February 13, 2026
Dear Interested Readers,
The Benefits of Four Pillars
For the past couple of years, on many of my walks, I have been listening to a theological podcast, BEMA Discipleship, offered by a very entertaining and knowledgeable minister who grew up in an evangelical environment in Idaho. As an added twist, the minister, Marty Solomon, emphasizes his Jewish heritage as he seeks to expand our understanding of the original intent of the authors of the stories and wisdom in the Hebrew and Christian writings of the Bible, which seek to explain the relationship between humankind and the creator, and between empire and shalom. After establishing some basic information about how he approaches scripture, Solomon begins with Genesis 1:1 and, along with his conversational podcast partner, Brent Billings, works his way through all 39 books of the standard Bible over about 200 presentations. The podcast began in 2016, and there are now about 500 presentations. So I still have a lot of future listening to do. Since 2025, they have been doing an update to the original trip through the scriptures.
For many books of the Bible, the presentation goes verse by verse. At times, as with some Old Testament prophets or some of the shorter New Testament books, a podcast will simply be an overview of the underlying themes and history. The methodology always focuses on “the story” and “the context” of the time in which they were written. Solomon brings a rabbinic approach to hermeneutics. [In case hermeneutics is not in your vocabulary, hermeneutics is the branch of knowledge that deals with interpretation, especially of the Bible or literary texts.] Solomon’s approach to hermeneutics emphasises understanding the historical context as well as a focus on the “Eastern mind”, after which application can lead to a complete reversal of meaning from how those of us with a “fact-loving Western mind” have distorted much of the meaning since Constantine made Christianity the state religion of the Roman Empire.
Solomon emphasizes that, since the scriptures were written from an “Eastern perspective,” we should understand that not all “truth” is factual, and, for that matter, that not all facts add to the truth. Much of the writing is like a poem, and it should not be read like a textbook, newspaper, or government report. He repeatedly focuses on understanding the “story” from the point of view of the authors in the time and environment when the writing occurred. For example, when read from the perspective of the times and its original readership when it was written, Revelation, the last and most misunderstood book of the New Testament, is not a prediction of “end times” but is rather an encouraging allegory describing the oppression of the Roman Empire for the churches in what is now Turkey. At the time, most of those congregations were Jewish-majority, with a growing gentile population. Those early Jewish followers of Christ were well educated in the Hebrew scriptures and understood some of what many now refer to as “predictions,” as references to apocalyptic Hebrew texts like the books of Daniel and Ezekiel. It was a look back for encouragement, not a prediction of how time ends.
You may wonder what the interpretation of scripture has to do with healthcare. Healthcare is now more vulnerable than ever to the misinterpretation of scripture. As John Fugelsang humorously and accurately describes in his recent non-fiction best-selling book, The Separation of Church and Hate, Christian Nationalism is based on a distortion of the message of Christ and a misinterpretation of scripture. [Click on the link to hear the author discuss and position his book.] Proponents of Fundamentalist Christianity constitute a significant voting bloc that supports the oppressive policies of the president, his attacks on diversity, equity, and inclusion, our immigrant population, our LGBTQ+ community, and the environment. Ultimately, the president’s policies endorsed by those favoring a closer relationship between the coopted right-wing of Christianity and the state, through the rise of Christian Nationalism, are a significant threat to the nation’s health.
The tension between the true principles of Christianity and the perversions of the Trump administration is the theme of an opinion piece in the New York Times this week that I recommend you read. The article written by Leighton Woodhouse and entitled, “Donald Trump, Pagan King,” begins by referencing the defiant speech delivered at Davos by Canada’s Prime Minister Mark Carney, which included a quote by Thucydides that: “The strong do what they can, and the weak suffer what they must.” The article’s author notes the similarity between the quote and what Stephen Miller recently said in an interview with Jake Tapper.
“We live in a world in which you can talk all you want about international niceties and everything else, but we live in a world, in the real world, Jake, that is governed by strength, that is governed by force, that is governed by power.”
Woodhouse goes on to demonstrate how Trump, Miller, Vance and the partners in the dismanteling of our democracy have directed us away from the lessons of Judeo-Christain teachings:
…it wasn’t until Christianity came along that Western civilization derived the popular conception that the weak and the vanquished had any inherent moral value at all. Telling an ancient Greek or a pre-Christian Roman that their treatment of slaves was morally wrong would have inspired not argument but bewilderment, as if you had told them they were evil for the way they treated their kitchen utensils. These pagans generally believed that their gods favored the strong and were indifferent to the weak.
Christianity upended these assumptions. Christianity took the Jewish God, who cared for the weak and knew the difference between good and evil, and made his message universal. It taught that all humans are God’s creation. To oppress any person, even a slave, is an offense before him. Even more than that: the weak are closer to God than the rich and the powerful.
That shift toward including the weak and the foreigner in our concerns has been the foundation for many of the rights which we enjoy, and which many don’t realize are connected to the wisdom that began in the Talmud and was expanded in the Gospels. Woodhouse continues:
This moral instinct is so ubiquitous today that we barely recognize it as Judeo-Christian, or even as religious. Adherents of the world’s other great religions have largely integrated it into their ethical frameworks even if this tenet is not central to their faith. It is the basis for the American Declaration of Independence and the United Nations’ Universal Declaration of Human Rights.
I encourage you to read the piece because it supports much of my thesis, but back to Marty Solomon. Along the way in his podcasts, usually when the presentation of a significant group of books is complete, Solomon will review his hermeneutic principles and offer a quick 50,000-foot look back at the whole journey. I listened to one of those reviews this week (episode 203) after finishing the comments on the book of “Revelation,” which was followed by a few podcasts covering the history of Christianity, which coincides with much of the history Western culture and progress as emphasized in the Woodhouse opinion piece. During the review, Solomon returned to a concept that he presents in “Episode -1,” The Four Pillars of BEMA. Click here to hear the presentation of the pillars I heard, which are explained below.
- Text (Biblical Literacy): Prioritizing a deep understanding of the scriptures, specifically reading them within their original, primarily Jewish, historical and cultural context.
- Community (Radical Fellowship): Emphasizing that discipleship is not done alone, but in a supportive, communal, and relational environment that mirrors the early church.
- Discipleship (Following Jesus): Focusing on the authentic, sacrificial, and “down-to-earth” way of life that Jesus commanded, rather than merely adopting Western, intellectualized theological frameworks.
- Wrestling (Healthy Engagement): Encouraging a, thoughtful, and, at times, difficult, engagement with scripture, embracing questions, doubt, and complex, nuanced, or sometimes, “unanswered” questions as a necessary, and healthy part of faith development.
As I reflected on what Solomon was saying, I was captivated by the concept of “four pillars,” which seems to be a good way to organize information and explain complex subjects. If you ask your browser what the four pillars of LEAN management are, you will get an answer. If you ask the Internet what the four pillars of ethical medical practice are, you will discover multiple presentations of the same four pillars that are widely accepted in many places here and abroad. They are:
- Autonomy: Respecting the patient’s right to make their own informed decisions about their healthcare.
- Beneficence: Acting in the best interest of the patient; doing good.
- Non-maleficence: The obligation to “do no harm” and minimize risks to the patient.
- Justice: Ensuring fairness, equality, and appropriate distribution of healthcare resources.
As I was listening to the banter between Solomon and his co-host, Brent Billings, I asked myself whether I could identify four pillars of healthcare recovery from the damage Trump, his MAGA movement, and his misinformed admirers and sycophants in politics and business have inflicted on the nation’s health. I am sure you can do better, and as time goes on, I may adjust my four pillars. Perhaps there are more than four pillars that deserve our attention, but here is my list as it currently exists:
- Emphasize “right practice.” That means attending to the four pillars of medical ethics, which speak to how we honor and serve patients with a patient-centric approach to care that fully supports those providing care and seeks to overcome the factors that create burnout and professional moral injury.
- Rebuild an adequate infrastructure for medical education for all medical providers, robust and large enough to meet the nation’s access needs in perpetuity.
- Rebuild our support for the advancements of scientific knowledge of disease and health, and with a focus on the development of new medications and medical devices. This would include the rejuvenation and extension of our concerns into international public health in partnership with other nations. Our departure from the WHO makes us as vulnerable to medical disasters as our departure from NATO makes us vulnerable to the military ambitions of Russia and China.
- Develop a more effective healthcare finance system that lowers the cost of care, expands access, and fosters innovation in care delivery to improve the nation’s health. The structure of our healthcare financial system drives the operations and flexibility of our delivery system. The two can’t be separated if you want to achieve the Triple Aim.
I don’t expect any of my “four pillars” to be constructed during the next three years. Much of the Hebrew scriptures is about the cycle of losing the way, going into captivity, and then rediscovering “the story.” If what we are experiencing is a form of metaphorical captivity, it is a good time for us to reflect deeply on how we have lost our way on the journey toward the Triple Aim. Effective actions usually follow deep reflection.
One of Solomon’s four pillars is “community.” Perhaps it should be a fifth pillar in my concept of what is necessary to restore and improve our healthcare. Maybe community is reflected in each of my four pillars. As I ponder the damage that Trump is doing to us, it feels like he is establishing a dualistic society, or enhancing the dualism that already exists. Dualism in our community divides what should be a unity of acceptance into those who are “in” and those who are “out.” ICE’s efforts in Minnesota are an active exercise in promoting dualism.
At the core of efforts to incorporate the principle of diversity, equity, and inclusion into our society is the idea that DEI efforts are antithetical to dualism. It is impossible to provide humane healthcare that meets the needs of every person when we are struggling against a political force that wants to advance dualism by undermining years of increasingly beneficial DEI efforts and labeling so many among us as undesirable or “out.” The pronouncements of our president and his supporters are manifestly dualistic and are a dangerous threat to all of us. Recovery begins by trying to visualize the way out of our captivity. It is time to consider how we will begin moving toward renewed unity and the community we want to build when our recovery begins.
It’s Still Winter, Wait Till Next Year, and Give Someone Your Love On Valentine’s Day
As you can see from the picture that is today’s header for this letter, winter is still here. The scene is from Interstate 89 near exit 12, which leads to New London and my home on Little Lake Sunapee. This massive granite wall has fascinated me in all seasons, but especially in winter, when it is usually covered in ice. As with many pictures, the majesty of this massive granite wall is not really conveyed by my poor photography.
When highways are built, they try to make them as level as possible. The route from Concord to the Lebanon/Hanover area and across the Connecticut River into Vermont would have been a very hilly road without some blasting. This wall is what was once part of the downhill slope toward Lake Sunapee from the peak of Burpee Hill. Burpee Hill Road is one of my favorite places to walk. If you are a regular reader of these missives, you have seen many headers showing the view of Lake Sunapee and Mount Sunapee from the peak of Burpee Hill Road; the foreground usually reveals picturesque pastures with stone walls populated by cows, but I have never given you this view of the downslope of Burpee Hill. I imagine that if I could do drone photography, we might see that Burpee Hill looks like a miniature replication of Yosemite’s Half Dome.
The picture is a lesson in geology and history for me. A close inspection reveals that there is virtually no topsoil over this massive hunk of granite. Up close, you can see the long linear scars of the drilling shafts that enabled explosives to rip the face from what I imagine prior to 1965 was once a beautiful little hill. The image also reveals to me why our colonial and 19th-century ancestors found it difficult to farm this area and turned to raising sheep, working in woolen mills powered by falling water, or, as many did after the Civil War, fleeing to the Midwest in search of better farmland.
Switching subjects, I am happy to accept that the Seahawks are a better team than the Patriots. It is time for the Patriots to figure out how to better protect their quarterback. For those who understand the finer points of the game, it was yet another example of why Michael Lewis wrote a book about the importance of the blind side tackle. I think the Patriots will effectively address their issues. So, hope is eternal; just wait till next year. I wish that I could be equally positive about the near-term future of healthcare and our democracy.
I hope that you and those you love have a very happy Valentine’s Day!
Be well,
Gene
Postscript: I have learned from reader feedback that as email servers change, this letter may end up in your “Junk” folder rather than your inbox. It is also preferable to use your personal email rather than your work account. In reality, if you remember to look, you can always access the letter by visiting strategyhealthcare.com shortly after 3 PM every Friday. This has been true every Friday since late February 2008, except for the first three weeks of November in 2013. If you want to get the email reminder each Friday that connects you quickly and easily to the post, you should put strategyhealthcare.com into your “contacts.”
