March 13, 2026
Dear Interested Readers,
How Wisely Is The President Spending Our Resources?
About an hour and a half after last week’s letter was published, Michael, a retired physician, good friend, and regular reader, posted the comment:
Funny, you never once mentioned the Epstein files!
He was right. It is quite possible that one of the president’s motivations for launching the war on Iran, or if you prefer, following Netanyahu’s move into war with Iran, was to distract our attention from new revelations emerging in the Epstein saga. We have recently seen that there is a woman who alleges inappropriate contact with the president in the 80s when she was in her early teens.
The explanation offered for why the more than fifty pages of Epstein files that told her story were originally withheld was that the Justice Department believed the reports were duplicates of previously released documents. To me, that seems somewhat like the spurious explanation for the critical “accidental” 18 ½ -minute deletion in Nixon’s secret office tapes during the Watergate investigations of the 70s. But, what do I know?
What I do know is that many times since his inauguration last January, we have been outraged by a Trump action or proposal that moves our attention from one infuriating moment to the next. He is a master at moving our attention away from some recent mistake. The list of his temporarily outrageous and attention-diverting ploys is long and includes his desire to rename the Gulf of Mexico, destroy the East Wing of the White House for a casino-like ballroom, tack his name onto the Kennedy Center, do away with birthright citizenship for the children of immigrants, annex Canada, take over Greenland, unleash ICE goons on immigrants in “blue” cities, and apply 140% tariffs to everything coming from China.
My list of Trump’s outrageous actions and proposals is not exhaustive, and I am sure that you can add other confounding ideas and actions that were temporary distractions from his incompetence, or well-orchestrated small steps toward the intention of an imperial presidency. The president has developed the fine art of keeping his opponents off balance while ensuring that loyal Republicans in Congress, his staff, his Cabinet, and the sycophants in the “billionaire class” continue to say that he is a genius as they outperform one another in praising him to gain favorable attention. Their fawning behavior and celebration of his despicable performance are as disgusting as he is.
For me, the best explanation for why he ordered an attack on Iran now has more to do with his effort to regain some sympathetic patriotic momentum leading up to the fall midterm elections than the acute need to rectify or end forty-seven years of theocratic oppression of the Iranian people or any immediate risk to world peace posed by Iran’s repressive government and nuclear ambitions. Is Iran more of a risk to us than North Korea, China, or Russia? Unfortunately for us all, he has totally miscalculated his move, and we are in a terrifying mess from which he probably can’t walk away. “TACO,” Trump Always Chickens Out,” has become a new political term applied to the way he creates outrage over some unrealistic policy, and then shuts it down when things go south. I fear that this time there is no “TACO” off-ramp. The Strait of Hormuz may be Trump’s Waterloo and the Ayatollah’s ace up the sleeve.
The attacks on presumed drug smugglers in the Caribbean and Pacific and the bold action in Venezuela that doesn’t seem to have deposed the regime seem like other temporary distractions. Is Cuba next? It’s still a long time until November, and he still needs to distract us while costs rise, ICE terrorizes our cities, and he is engineering the undermining of the ACA marketplaces, the destruction of the infrastructure of our medical research community, and ignoring the dangers imposed by the radical vaccination conspiracies of Robert Kennedy, Jr. In his speeches, he denies the ongoing economic issues facing most Americans and the failure of his other controversial policies. I have got to believe that, despite his denials, he knows his presidency is in trouble, and it is possible that after the midterm elections the Democrats will control the House and perhaps even the Senate unless he does something dramatic to regain momentum. Could he fear that a third impeachment is on the horizon? What is a better foil to that possibility of embarrassment than a war and an appeal to patriotism? Trump’s fears make us vulnerable to Netanyahu’s continuing need to “mow the grass.”
Two political columnists I pay attention to when they write about foreign affairs are Thomas Friedman and Nicholas Kristof. Both men have spent considerable time in the Middle East and China, and both have written opinions this week that seek to answer some of the questions raised by the war. Both writers agree that the clerics of the ruling elite in Iran are despicable and that many of the Iranian people want them gone. The question is how change should occur in a nation of 90 million people, one-sixth the size of the United States, with a powerful military force to suppress opposition, and the ability to make one of the world’s most critical waterways functionally impassable.
Victory over such an adversary is highly unlikely to be accomplished by bombing alone. Regime change didn’t work smoothly in Iraq, Afghanistan, Syria, or Libya, which were much smaller, poorer, and less well defended. In Egypt, one oppressive regime was replaced by another. Let’s not forget Vietnam. What makes Iran vulnerable to collapse when demonstrations of the disaffected have not succeeded so far? In an article this week by Friedman in the Opinion pages of the New York Times entitled “Trump Has No Idea How to End the War With Iran,” we read:
…we’re more than a week into the war with Iran launched by President Trump and Prime Minister Benjamin Netanyahu of Israel, and the biggest question I have is this: What if the necessary is impossible? What if the transformation of Iran is so much more important than the war’s critics admit, but so much more difficult than the war’s designers understand?
Yes, nothing would improve the prospects of the people of Iran, Lebanon, Iraq, Syria, Gaza, Yemen and Israel more than removing the Islamic regime in Tehran.
But what if that regime is also so embedded — in mayoralties, schools, police stations, government jobs, the banking system, the military, neighborhood paramilitaries — that, despite its unpopularity with a majority of Iranians, it can’t be removed without plunging the entire Iranian landmass, about a sixth the size of the United States and home to 90 million people, into chaos? What if the only quick alternative to Iran’s Islamic autocracy is not democracy but disorder on an epic scale?
Many pundits question whether Trump has a plausible strategy to achieve his objectives, which change each time he speaks. Freidman continues:
…Trump has been all over the map when talking about the morning after in Iran — and saying truly ridiculous and often contradictory things that reveal a commander in chief who is just making it up as he goes along. One day it’s regime change, one day not; one day he doesn’t care about Iran’s future, the next day he will have a say in choosing the country’s next leader; one day he’s open to negotiations, the next day he is demanding “unconditional surrender.”
Friedman is making the case that the “emperor has no clothes.” Trump is supported in his delusions by the intense loyalty of a party that has a lot to lose if he is ever held to account for the damage he has done to so many for the temporary benefit of a relative few. Kristof’s piece is entitled “The ‘Arrogance of Power’ Drives War in Iran.” He begins by writing that he sympathizes with those Iranians who have longed for relief from the Ayatollahs. He has personally felt their oppressive strength.
I sympathize with those Iranians, because I’ve seen the oppression firsthand in my own reporting in Iran over the years: police officers swooping in on my interviews; security thugs shouting at women to cover up; and intelligence agents who once detained me in Tehran, accused me of being a spy and told me I could be imprisoned indefinitely until I confessed. It is terrifying to feel the breath of Iran’s dictatorship on your neck.
The facts are that the regime is oppressive. They are a bad actor on the international scene, and we can destroy much of their military infrastructure with bombing, but that still does not add up to the end of oppression. Even though many of its citizens want to live in a democracy and much of the world loathes the regime, the regime’s power is woven into the country’s structure. Considering all of the above, Kristof makes an interesting comment:
…while Americans saw the killing of Ayatollah Ali Khamenei as a way to weaken his regime, there’s some reason to think that Khamenei welcomed his own martyrdom as a way to strengthen it.
Kristof concludes by noting something other pundits have also noted: the war’s cost is measured in billions of dollars a day. He writes:
In Iraq, our arrogance of power led us to start a war that ended up costing hundreds of thousands of lives (mostly those of Iraqis) and perhaps $3 trillion — and ultimately benefited Iran. In Afghanistan, we wasted lives and some $3.4 trillion over two decades to replace the Taliban with the Taliban.
Indeed, it seems that we are on our way to astronomical expenses for this ill-advised adventure.
A little further on, Kristof questions whether we will run out of missiles for attack, but, more importantly, for defense against their incoming missiles. We had shortages of optimal numbers for ourselves and our allies going into this conflict. What happens when our supply of missiles to block their missiles is depleted? The missiles cost millions of dollars apiece, which explains much of why we spent more than a billion dollars a day in the first week of the war. That doesn’t include the added costs at home as prices rise. Reuters News Service has reported that the first two days of the conflict cost 5.6 billion.
I have seen estimates that the cost of the first week probably exceeds 10 billion dollars, plus the loss of life and the impact on the nation’s and the world’s economies. Wasting this amount of money just to allow the administration to impress swing voters that the president and his lackeys deserve their support, when we are told that we can’t afford the expense of continuing the financial support to the ACA marketplace, is a huge example of the twisted policies of this regime. The annual cost of the ACA extension is about $30 billion dollars, the same as two to three weeks of this senseless destruction.
Heather Cox Richardson published a much more complete accounting of the critical waste of this war and other excesses of the Department of “War” in the March 10 edition of her “Letters From An American.” She also comes to the conclusion that the mismanagement of our collective resources is even more egregious when Trump is simultaneously saying that we can’t afford many programs to improve the health of the nation. She writes:
A key reason the Framers of the Constitution put the power to declare war in the hands of Congress, rather than the executive, was that they were all too familiar with the history of European kings who had launched wars of choice that had reduced their subjects to poverty under crushing war taxes. They feared that the same thing could happen in their new country: that supporting an army would cost tax dollars, impoverishing the citizens of the new nation.
If the debate over war went to Congress, voters could hear the reasoning for the war hashed out and decide for themselves if the cost in lives and treasure was worth it to them. And, after they voted for a war, members of Congress would have to answer to their constituents for the money they spent and the lives lost.
It’s a terrific letter that begins with Senator Richard Blumenthal’s outrage following the “classified” briefing to the Senate Armed Services Committee, which attempted to justify Trump’s bypass of Congress before going to war. She then quotes James Talarico and President Eisenhower. I found Eisenhower’s quote about the importance of Congress, not the president, initiating a war, to be very appropriate to this moment in our national turmoil. Richardson writes:
In early March 1953, soon after he took office, Soviet leader Josef Stalin died, and Eisenhower jumped at the chance to reset the militarization of the Cold War.
All people hunger for “peace and fellowship and justice,” he said in a speech to newspaper editors, and he deplored the growing arms race with the USSR. Even if the two superpowers managed to avoid an atomic war, pouring wealth and energy into armaments would limit their ability to raise up the rest of the world.
“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed.” The sweat of workers, the genius of scientists, and the hopes of children would be better spent on schools, hospitals, roads, and homes than on armaments. World peace could be achieved, Eisenhower said, “not by weapons of war but by wheat and by cotton, by milk and by wool, by meat and by timber and by rice.”
As I think about the policy choices and the manipulation that we have all endured over the last year, while we have been told that what we are enduring will make America great again, I am once again reminded of the quote from Hubert Humphrey that is carved into the wall of the lobby of the building named for him and that houses our Department of Health and Human Services. I have referenced the quote before, but it deserves a regular repetition, along with how it came to my attention.
After the ACA passed in March 2010, I visited Don Berwick in his office at HHS. President Obama had tried to appoint Don as the Administrator of CMS, but Republicans blocked his confirmation by the Senate. Obama countered with a “recess appointment” of Don in July 2010. I was eager to have a conversation with my friend and former colleague to explore the opportunities for clinical innovation offered to our organization with programs like the Pioneer ACO. In time, Atrius Health became one of the best-performing Pioneer ACOs. As I was waiting for the security process to run its course and then the arrival of the escort who would take me to Don’s office, I had plenty of time to look around the vast lobby of the building. My eye fell on the quote from Hubert Humphrey that is carved into the wall near the elevators. Humphrey had said:
“The moral test of government is how that government treats those who are in the dawn of life—the children; the twilight of life—the elderly; and the shadows of life—the sick, the needy, and the handicapped.”
I think the quote describes a moral stance that is foreign to the thinking of Trump, Pete Hegseth, Stephen Miller, and the other architects of our current domestic and foreign policies. Our healthcare failures, persistent concerns about our Social Determinants of Health, and our inability to provide universal care to all of our citizens and neighbors stem from poor moral choices. We have the resources to give everyone access to care and to repair our system of care so that the care provided is high-quality, but we don’t choose to do so. Humphrey’s quote implies that a nation can’t be great without attention to the moral implications of its actions, and I firmly believe that our actions in Iran squander resources that could improve the nation’s health. Trump’s administration fails both a moral and practical test, and he is a greater threat to damage the physical and economic health of most Americans and the future of America than all the Ayatollahs of Iran could ever cause.
We Are In Transition
On Tuesday, my wife and I drove to Providence, Rhode Island, to visit her 86-year-old sister, who has been hospitalized for the last month with a slow recovery from a presentation with acute heart failure that has required a TAVR, trancatheter aortic valve replacement. Despite her month-long ordeal, she was alert and wanted to talk about the choices she had regarding the suggestions she was getting from her doctor. The visit reassured us that she was getting good care and was quite capable of deciding what made sense based on her values and life experience.
We didn’t know what to expect from her or the weather before we drove south. We had delayed going because Rhode Island recently got a dump of 36 inches of snow in what I am sure will eventually be referred to as “The Blizzard of ‘26.” To our delight, the further we went, the warmer it got, and the less snow we saw. By the time we reached the hospital, it was 76 degrees, and the only snow visible was in dirty little piles pushed by plows. Here in New London, the temp reached 68. It had been in the high forties and low fifties for the previous few days, and we are also beginning to see some of our snow melt, although we still have plenty. It has been a tease because the forecast going forward is that we will see temps in the teens again before spring establishes a firm foothold. More snow is predicted for this evening. Nevertheless, it has been a joy to walk for a few days without the extra layers and my “electrified” gloves. I am on the lookout for the first crocus of the year.
The header for today’s post was taken by my youngest son of his two-year-old son, my youngest grandson, who is enjoying a walk on the recently plowed road where they live in rural Maine, about a half hour above Portland. One of my grandson’s first words was “Outside!” Depending on his inflection, “Outside!’ could be a forceful demand, a gentle request, or a plaintive question. Once outside, he usually skips along, as you can see.
I must admit that when I am outdoors, especially with him, I wish that I could skip along. I can’t skip anymore, but when outdoors, I can just focus on the scene and forget for a moment how difficult life is becoming for so many others who suffer under the oppressive policies of our president. Our dysfunctional president can seem like a fictional character from some dystopian novel. Iran is on the other side of the world and almost a fantasy, or rather a nightmare. The difficulties of life that others experience and that I see on the nightly news and read about in the journalism I consume can feel like overly dramatic exaggerations, but despite the temporary euphoria of my walks, I believe that what we see and hear in the media is mostly true, and the reason for great concern.
The weather is a reality that is certain in the moment, and always in transition. I don’t know what will happen in Iran, or how the midterm elections will play out between now and November, but I can be certain that there will be some sunny days that will be great for my walks alone or with friends and family. The trees will grow new leaves. Birds will sing. The ice on my lake will thaw, and it will be good to be alive and enjoy the reprieve that is available to us all once again in the cycle of the seasons.
Be well,
Gene
