January 3, 2025
Dear Interested Readers,
My Jimmy Carter Musings
In the very early spring of 1976, I decided to take a short trip to Bermuda. After the stress of my first year in practice, which followed all the stresses of my medical school years, internship, residency, fellowship, and my wife’s demanding graduate school studies, it seemed time for a short getaway. We booked a long weekend at The Reefs, a boutique hotel in Bermuda that was highly recommended for its cuisine and the beauty of its location in South Hampton, far from the tourist congestion of busy Hamilton. The off-season prices were an additional attraction. If you click on the link you will discover that The Reefs offers spectacular views from every room and that the hotel is larger now than it was in 1976.
At the last minute, my wife decided that she could not go even though we had arranged for my parents to stay with our children. She was very busy with her coursework in the business program for women at Simmons College. I decided that a few days apart might be therapeutic for both of us, and to my surprise found myself experiencing for me, the rare event of being a solo traveler on an airplane headed to Bermuda. The hotel was even lovelier than I expected and was a world unto itself several miles down the eastern shore from Hamilton. I was just beginning to get into running in a dedicated way, and I discovered that the far end of Bermuda was a great place to run.
In the evenings, the hotel guests gathered in the bar for conversation before dinner was served. I am usually quite shy in new social environments, but on cruises and in resorts it is usually true that nobody knows anyone, and they are great places to try to develop social skills. Without my usual social apprehensions, I joined a conversation of a half dozen or so people who were talking about the election and this very atypical candidate, Jimmy Carter.
To my further surprise, one of the members of the group was a very articulate woman who revealed that she was a journalist who had been following the candidates around on the campaign trail. She explained that it was exhausting work, and she was just taking a short break to “recharge her batteries.” She explained her enthusiasm for Carter by contrasting him with the other “usual suspects” who were better known Democratic faces—Governor Jerry Brown of California, Governor George Wallace of Alabama, Congressman Mo Udall of Arizona, Senator Henry (Scoop) Jackson of Washington, and Senator Frank Church of Idaho. Former Vice President Hubert Humphrey who lost the presidential election to Nixon in 1968 and the Democratic nomination to Senator George McGovern of South Dakota in 1972, had decided not to try a third time for the presidency in 1976. By the time I went to Bermuda, Carter had gone from being “Jimmy Who” before his wins in Iowa and New Hampshire and was well on his way to being on the cover of Time Magazine on May 10, 1976.
There was no doubt in the journalist’s mind that Carter would be the right man to restore trust in the Federal government after the disappointments and deceptions of the Nixon years, and the outrage following Gerald Ford’s pardon of Nixon. In case you weren’t alive in 1976 and never got to the 70s in your high school or college American history courses, Nixon was not the only distrustful politician elected to national office in 1972. By the time Nixon resigned in August of 1974, Vice President Agnew had beaten him to the door and had already resigned from office. Gerald Ford had been named to fill out Agnew’s term. The Nixon years with Agnew, plus the debacle of Vietnam, plus Watergate, plus Ford’s pardon of Nixon, had undermined the average person’s trust in the government. Carter promised never to tell a lie to the country.
As the conversation continued, the journalist lost her journalistic perspective and went into full campaign mode. She encouraged us all to read his autobiography that had been published the year before, Why Not The Best? One of the first things I did on my return home was to find the book and read it. The book was a clencher for me. I was already favoring Carter, but after reading the book, I could point to his many qualities beyond the fact that he regularly attended church.
The book was originally published in 1975 by Broadman Press which is owned by the Southern Baptist Convention. At the time, Carter was the relatively obscure one-term governor of Georgia and the book generated little national interest. By the summer of ‘76 with Carter as the front-runner for the Democratic nomination, his book merited a review in The New York Times written by William Shannon. Reading the review now for the first time, I find that Shannon was pretty balanced but not overly enthusiastic. He was not yet drunk from the punch that had intoxicated my new friend, the journalist. It is interesting that Shannon eventually became ambassador to Ireland during the Carter administration. Shannon’s review reflected some of the skepticism that many people had at the time of a peanut farmer from Georgia becoming our next president. Shannon begins by quoting Carter:
“I have always looked on the Presidency of the United States with reverence and awe, and I still do. But recently I have begun to realize that the President is just a human being. I can almost remember when I began to change my mind and form this opinion.
“… During ‘1971 and 1972 I met Richard Nixon, Spiro Agnew, George McGovern, Henry Jackson, Hubert Humphrey, Ed Muskie, George Wallace, Ronald Reagan, Nelson Rockefeller, and other Presidential hopefuls, and I lost my feeling of awe about Presidents. This is not meant as a criticism of them, but it is merely a simple statement of fact.”
In this characteristically blunt language, Jimmy Carter tells how meeting Presidents and Presidential candidates prompted him to ask: Why not me? With the help of a useful anecdote about Adm. Hyman Rickover, the question is transposed into the title of this book, “why not the best?”
A little further along Shannon makes his next observation about the uniqueness of Carter’s approach to the presidency:
Although Carter naturally wrote it to advance his own candidacy—he has been planning his Presidential campaign since the fall of 1972 when he was halfway through his single term as Governor of Georgia and relatively unknown—the book serves the reader as well by providing some significantly revealing information.
Perhaps least revealing are the three quotations from Reinhold Niebuhr, Bob Dylan and Dylan Thomas that form the book’s epigraph they reveal is that Jimmy Carter, as a keenly intelligent man, knows that in autobiography as in war, the best defense is a fast‐moving offense. A Southern fundamentalist, he counters cultural suspicion by quoting Dr. Niebuhr, the unillusioned neo ‐ realist theologian (Paul Tillich also gets a nod in the body of the book). As a candidate preaching a socially conservative message of piety, patriotism, community service, hard work, self‐reliance and devotion to family, he offsets an impression of stuffiness by quoting Dylan, the radical troubadour. As an Intensely practical man whose biggest campaign issues ate government reorganization and zero‐based budgeting, he lightens the bookkeeper’s gloom with quicksilver lines from Thomas the Welsh romantic.
This is not to suggest that Carter may not have Niebuhrian, radical and romantic strands in his thought and personality. Only a complex man would have the wit to choose those opening quotations. Instead, it is to suggest that those strands are hardly dominant in him.
Shannon sticks with his bias that Carter may be little more than a repackaged conservative Southerner through several paragraphs, but then either by accident or insight ticks off the attitudes that Carter had in 1976 that were well ahead of his time, and are still active concerns in our current moment. As usual, I have bolded what struck me as remarkable:
…Critics, friendly as well as unfriendly, worry whether Jimmy Carter believes in anything larger than his own success. This book does not provide conclusive answers. As in his campaign speeches, what comes across most clearly is his sensitive feeling for black people and for the South, the commonality of his and their hard, church‐centered, rural life. His concern for the mentally retarded and for other handicapped persons, as well as his commitment to the environmental values of unspoiled land and clean air and water also come through as genuine.
Carter was well ahead of his time with his desire to transform healthcare, an objective that was blocked by Ted Kennedy when it was ripe for passage. He understood the potential of global warming and our need to move to alternative sources of energy. He even put solar panels on the roof of the White House which Ronald Reagan later gleefully removed in deference to his backers from the oil and coal industries.
Even as Shannon was skeptical about who the real Jimmy Carter was, at the end of the article he compares Carter’s attitudes and agenda to Teddy Roosevelt and JFK. He then finishes the article by accurately predicting the resistance Carter will encounter if he gets elected and comes to Washington as an outsider.
…Carter reminds one of two earlier Presidents, Theodore Roosevelt and John F. Kennedy. Although both were of a progressive bent, they were really neither liberal nor conservative by conviction. Rather, they believed in governing. They were strenuous doers who wanted to take the world by the scruff of the neck and make it shape‐up.
Carter describes his tenure ‐ as Governor as “a highly controversial, aggressive and combative administration.” If there is a Carter Administration in Washington beginning next January, that would seem to be a safe prophecy of its character.
The journalist’s enthusiasm for Carter had great credibility with me. I already wanted to like him, but I was concerned about the possibility that his overt wholesomeness and deeply held religious beliefs would eventually wear thin with the majority of voters, and we would be subjected to continued mistrust in government with the reelection of Gerald Ford who was a pretty clean politician despite his pardon of Nixon which he justified by saying that it would end the national trauma of Watergate.
Carter did get elected. He accomplished much more in office than he was immediately given credit for achieving. He was not a Washington insider like Johnson or Biden. He faced and managed overwhelming challenges like the Iran hostage crisis and economically crippling “stagflation.” His values and personality were not always aligned with the culture and predilections of the moment. He was accused of being a micromanager. He was never accused of untruthfulness, and as time has given us more perspective on the moment, his development and execution of beneficial policies that still have benefit today are better understood. With the Camp David Accords, he was more successful than any president before or after him in advancing the cause of peace in the Middle East. Can you imagine what it would be like now with conflicts between Israel and Hamas and Hezbollah if Carter had not been the broker of better relations between Israel and Egypt?
Over the days since Carter’s death, we have heard as much or more about Carter’s contributions to the social determinants of health like housing through Habitat For Humanity, his support of democracy and fair elections around the world, and his initiatives to fight disease in Africa. Arguably, he has used his position as a former president more effectively than any president before or after him. Based on who he has always been, I am not surprised by what he has done. Few people have ever lived as close to the wisdom presented in the Sermon on the Mount as Jimmy Carter. For a great expression of how his faith impacted his presidency, I would suggest that you read the transcript of his interviews with Terri Gross on NPR which were rebroadcasted this week.
Carter was believable as a man so founded in scripture and so devout that he came close to losing the election when at the end of a Playboy interview he famously equated the occasional moments as a younger man when he had thought “lustfully” about women to the act of adultery. In the interviews with Terri Gross, he describes that remarkable moment. An article from the Smithsonian Magazine reviews the significance of Carter’s faith in the election and the near disaster of an interview with Playboy magazine in the summer of ‘76. In the Smithsonian analysis of the near episode of political suicide associated with Carter’s total honesty, Rick Pearlstein, the author, writes:
…One of the things that made Carter such a remarkable politician in 1976 was his ability to attract the loyalty of so many different classes of voters—some of them from constituencies traditionally opposed to one another. …Thousands of little dots began to cluster around Jimmy Carter. Blue-collar workers started clinging to the Carter circle. Intellectuals gathered around him. Catholics and Jews…Blacks and Chicanos smothered him with their dots. People who care about busing dropped at his feet. People who were for gun control sided with him as well. Conservative women kissed his feet. Liberal women hugged his head. Environmentalists swarmed around him. The Rich touched him. The poor clung to him.
The Ford people emerged terrified; terrified, too, about a new political constituency that Carter, a devout Southern Baptist, was bringing to the table. Evangelical Christians, traditionally chary of getting involved in partisan politics. “It could be the most powerful force ever harvested,” Teeter said at that meeting. “They’ve got an underground communications network. And Jimmy Carter is plugged right into it.”
Then history, as it likes to do, threw a spanner into the works.
That summer, for a magazine article, Carter had sat for a series of wide-ranging interviews that formed perhaps the richest document of a presidential nominee’s thinking in the history of American electioneering. The candidate was strikingly self-reflective, unusually open in taking on sacred cows, frank in acknowledging America’s faults. He aired his self-doubts, his fears—but also, bracingly, his lack of fear regarding one subject in particular: the possibility of his own death by assassination. The reason, he said, was his Christian faith—which led to a long and searching theological discussion that culminated in an observation, in explaining the Christian concept of sin and redemption, that God had forgiven him even though he had committed “lust in his heart.” And because it appeared in the November issue of the soft-core pornography publication Playboy, Carter’s reference to sex became all anyone could talk about.
The interview shifted the entire dynamic of the election—and helped get the Republican Southern Strategy back on track for all the time to come, only now with religion, not racial integration, as its most conspicuous vector. “Four months ago most of the people I knew were pro-Carter,” one of Carter’s fellow Southern Baptists, the television preacher Jerry Falwell, told the Washington Post several weeks later. “Today, that has totally reversed.”
I think Carter understood the power of using what you say and do to reinforce complex ideas. What could have said more about wanting to be closer to the American people than the amazing moment when Carter and his wife got out of the limo on the ride from the Capital to the parade viewing stands in front of the White House after his inauguration? If you didn’t see it or don’t remember it, I have captured a screenshot of the moment to use as today’s header. If you click on the link you can hear Walter Cronkite gives the play-by-play of the unexpected event.
I must admit that as positively biased as I am toward Jimmy Carter, there is a downside symmetry in my feelings about Ronald Reagan. I will point to just two of several issues beyond their differences on global warming and the environment.
First, I was in practice throughout Carter’s term. During that time, I had no problem getting Social Security Disability for my patients who were severely disabled. Almost simultaneously with the beginning of Reagan’s administration, I noticed that severely disabled people in my practice were getting denial letters when they followed my advice and applied for disability. It took a little while for me to develop a hypothesis to explain the observation. In the end, I realized that many eligible people for disability would just give up when rejected. I learned that after three rejections, a disabled person could ask for a hearing in front of an administrative law judge. I changed tactics. When I had a patient who was disabled, I would describe the process so they would not be surprised or depressed. I told my patients to expect three rejections, and then I would go with them to the hearing as their advocate. It worked as a process, but the strategy to avoid payment of delay, deny, and defend is not new. I believe it did not occur de novo with Brian Thompson and UnitedHealthcare. I first saw it in the Reagan years.
Second, First Lady Rosalynn Carter and the president were vocal advocates for better mental healthcare. As powerful antipsychotics were developed it became clear that many mental illnesses could be successfully treated as chronic diseases. It was hoped that the need for state hospitals for chronic hospitalization of the mentally ill could be replaced by a dense network of community mental health resources. The benefit to patients was the hope that they would be able to integrate back into society as productive citizens. The benefit to the public would be a significant lowering of the cost of mental health care compared with the expense of continuing the use of mental hospitals.
Improving mental health had been a priority of the Carters dating back to before his time as governor of Georgia. Work on revamping mental health services began with the creation of a presidential commission in 1977. By 1979, there was a huge process in Congress to put forward a bill. After much compromise, the Mental Health Systems Act was passed and signed in 1980. The long gestation and sudden demise of the act are well-described in an article created by the Millbank Foundation.
The Mental Health Systems Act had hardly become law when its provisions were rendered moot. The inauguration of Ronald Reagan in January 1981 led to an immediate reversal of policy. In the summer of 1981 the Omnibus Budget Reconciliation Act became law. Under its provisions, the federal government provided block grants to the states for mental health services and substance abuse, although at levels of about 75 to 80 percent of what they would have received under the Mental Health Systems Act. The states had considerable leeway in expending their allocations. With a few exceptions—notably, the patients’ bill of rights—the Mental Health Systems and CMHC Acts were repealed, thus diminishing the direct role of the federal government in mental health (Public Law 1981). The transfer and decentralization of authority merely exacerbated the existing tensions, as federal support was reduced at precisely the same time that the states were faced with social and economic problems that increased their fiscal burdens.
By 1981 it had become clear that the effort to create a more coherent and integrated mental health system for persons with serious and persistent mental illnesses had fallen short of its goals.
Would we have had fewer chronically mentally ill homeless living under bridges and fewer deaths from drugs and diseases of despair if Carter had been reelected? It has always been my bias that Reagan’s famous overly optimistic “Morning in America” was actually a lie, and ushered in a dark and stormy midnight in America that was the origin of many horrors for disadvantaged Americans. Its legacy is MAGA.
Perhaps my greatest connection and source of admiration for Carter was the power of his faith. In the late 70s, the South was moving toward new strategies to maintain “separate but equal.” As public schools were integrated, we saw the emergence of “Christian” schools. Before the seventies, Southern Baptists were strong advocates of the separation of church and state, and a key tenant of the denomination was the idea that faith was an individual journey which was described as the priesthood of the believer. The idea of a religious hierarchy or a dominant orthodoxy was opposed.
In the seventies, as Carter became president there was a huge shift in political concepts within the Southern Baptist Church toward fundamentalist thought and an embrace of political power and orthodoxy as a way of making civil issues conform to a very conservative theology. The ideas drove me from the church of my childhood and were a source of huge disappointment for my parents who were deeply disturbed but never left the fold.
Jimmy Carter tried to broker a resolution of these issues, just as he tried to broker peace in the Middle East. In the end, Carter left the Southern Baptist Convention. I have long been concerned that several hundred years of religious thought can be reversed by right-leaning radical political positions over a relatively short time. What does that lived reality tell us about the risk we now face not only to the advancements in universal coverage and equity in healthcare over the last three decades but also the durability of the Constitution?
Reagan wanted to comfort us with the retention of the status quo and blamed others, like “welfare queens” and government employees for our problems. Carter advocated for a more progressive view of the future tinged with a sense that our problems were in part created by us and should be solved by us. He gave a speech that was hard for many Americans to hear entitled “The Crisis of Confidence.” Although he never used the word “malaise” it became known as his “malaise speech.” He tried to get us to accept responsibility for our future. We weren’t receptive to his message. Will we ever be willing to accept the challenge of moving from our individual concerns toward real solutions that can only be achieved through our collective efforts? Carter did his best after leaving office to model the behaviors that we should try to model.
After JFK died, a book was published entitled Johnny, We Hardly Knew You. Perhaps, someone should write a book entitled Jimmy, We Hardly Understood You. I think there are lessons to be learned from Carter’s life. I would like to believe that someday we will have a greater appreciation and acceptance for the example Jimmy Carter set and the messages that he tried to demonstrate both in office and after leaving office.
Back In The Deep Freeze, and Wondering What Will Be Next
It’s a new year and time to articulate a few resolutions. My first resolution is to spend more time with family. My second resolution is to read more good fiction and non-fiction and spend less time reading newspapers, listening to political podcasts, and watching British crime dramas on Britbox. My third resolution is to spend more time trying to overcome my multi-decade inadequacies with the piano and guitar. If I can do those things, I will be pleased, but I would also like to add the hope that I can find a little time to “journal” about my feelings as I get closer to my final event. Do you have a list?
The week between Christmas and the New Year was warm and wet. We lost a lot of snow cover, but then overnight after the ball fell in Times Square, we got a couple of fresh inches of snow cover. Now, we are predicted to stay in the 20s or lower for at least the next week.
I hope that your holidays were memorable and that 2025 will offer unexpected opportunities for all of us to make progress toward the Triple Aim, and our collective happiness and security. Stay warm, and…
Be Well,
Gene
