March 6, 2026

Dear Interested Readers,

 

I’m Trying To Look Beyond A Tough Week for the World

 

I am sure that I was not the only person who was dismayed on awakening Saturday morning. As I strapped on my iWatch, which is usually one of the first things I do when I arise, I was flabbergasted to see a message from the New York Times saying we had begun a war with Iran. My first thought was that I was not sure that we would survive the president’s bizarre behavior and misguided strategies. Was this foolish action a response to his fear that Republicans would lose their congressional majorities in the coming mid-term elections? Was the invasion a manifestation that he realized that he had lost support for the continuation of his inane policies by delivering a boorish and pathetic State of the Union Address that went on for almost two hours?

 

Who knows? What was immediately obvious is that on his own, he is quite dangerous, and when playing the role of lackey to Benjamin Netanyahu, all we can do is pray that somehow the world has the strength to survive their collective psychopathology and their self-serving concept that Iran was an immediate threat to the world order and their foolish action was necessary for the protection of the free world from the imminent dangers of Iran. 

 

In the moment, I reminded myself of the foundational principle of medical practice, primum non necere, translated “First, do no harm” or, as I prefer to think of it, “If you can’t make it better, don’t make it worse.” With no clearly or consistently expressed objectives, no defined endpoint, and no concept of what should follow, it is possible that we are in for a conflict that will end only when one side runs out of missiles or the whole thing expands to the Armageddon that Pete Hegseth seems to incorrectly believe was prophesied in the Bible in the Book of Revelation. Hegseth is no better Biblical scholar than he is Secretary of Defense (or War?). I won’t refer you to dense theological literature, but you can read in Wikipedia:

 

Modern biblical scholarship views Revelation as a first-century apocalyptic message warning early Christian communities not to assimilate into Roman imperial culture, interpreting its vivid symbolism through historical, literary, and cultural lenses.

 

It may disappoint Mr. Hegseth, but the world will probably not end with Operation “Epic Fury,” but there is little doubt that the foolish action will be costly, if not eventually tragic, for the likely waste of more young American lives and untold thousands of additional civilian losses in Iran. Our president’s lack of insight and judgment, plus his strategy of creating messes to obscure his true failures and inability, will surely cause a mess that will not be justified as an action worthy of our national resources. Is it really true that the only path toward our national security is the loss of more lives, the physical destruction of a nation’s infrastructure, and the worldwide economic grief that is sure to follow? Was this the only option the president and his sycophants in Congress and his administration had to maintain our safety? I think not. 

 

I am not a military strategist. Like Will Rogers, all I know is what I read in the papers. My reading of the papers suggests to me that more Americans are at risk from the failures of the domestic policies and the kleptocracy of Mr. Trump and his sycophants and coconspirators than from any evil ever conjured up by any Ayatollah on the other side of the world. Trump has been a genius at selling himself by a combination of empty promises, mining the social dissatisfaction and economic worries of many, and exercising great skill at fooling or frustrating most of us by jumping from one manufactured crisis to another. Ironically, he frequently causes a problem, as he did when he canceled the nuclear treaty with Iran that Obama negotiated, and then uses the problem he created, like the threat of Iran having a nuclear weapon, to launch us into a spiral of ill-advised events. This current international dilemma poses a greater immediate risk than ever existed before the president pulled the trigger.

 

I worry about the dangers that lie ahead with such a flawed individual guiding us into the future, and I am also very upset by all the opportunities for good that are being squandered under his guise of protecting us. Many Americans, myself included, have the economic resources to put up with the price increases that will surely be among the outcomes of this latest Trump adventure, but I fear that what has already been a difficult economy for many will become much more painful for an increasing number of our neighbors. The Social Determinants of Health (SDOH) are largely shaped by how we manage our national economy. According to the Office of Health and Human Services report “Healthy People 2030,” 

 

The five key domains of SDOH, as defined by Healthy People 2030, are:

• Economic Stability: Employment, income, expenses, debt, medical bills, and support.

• Education Access and Quality: Early childhood development, enrollment in higher education, high school graduation, and language/literacy skills.

• Health Care Access and Quality: Access to healthcare, access to primary care, and health literacy.

• Neighborhood and Built Environment: Housing quality, transportation, safety, parks, playgrounds, walkability, and zip code.

• Social and Community Context: Social integration, support systems, community engagement, discrimination, and stress.

 

To that list, I would add Trump’s mismanagement of our environmental policy, with pollution and global warming as threats to all of us. Even before Trump began to bomb Iran, our Social Determinants of Health were under direct frontal attack by the president and his administration through attacks on American cities with the masked marauders of ICE and the military, Project 2025, the Elon Musk-led DOGE effort, and the One Big Beautiful Bill. The misery of his abuse is not evenly distributed; it immediately affects the “least of us,” but it will eventually touch us all.  While Trump and Hegseth bring about Armageddon, the last battle between the forces of good and evil before “judgment day,”  do they remember Matthew 25:40 (NIV), where Jesus says: “Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.” Christian Nationalist, please note that Christ’s message implores us to avoid conflicts, treat the poor with mercy and generosity, and welcome the foreigner in our midst. 

 

As more Americans who could be described as the least of these brothers and sisters of mine descend into greater poverty, there will possibly be increases in crime and social unrest that eventually touch all of us.  As our educational system continues to deteriorate, the skills of our workforce will decline. As more Americans can’t afford housing, our communities will deteriorate. As the temperature of our planet rises, the quality of our air and water deteriorates. Eventually, even wealth will not protect the health of our most privileged citizens from the adverse effects of deteriorating Social Determinants of Health. The Social Determinants of Health are not just a challenge for the poor; they are a greater challenge to current and future Americans than any Ayatollah. 

 

The issues raised by Trump’s ignorance of and disregard for the Social Determinants of Health were effectively discussed in an article from The Atlantic this week, which ironically (to me) was published last Saturday, February 28, the day we attacked and killed the Ayatollah. The article was written by Dr. Aaron Richterman and Dr. Harsha Thirumurthy, both of the University of Pennsylvania School of Medicine, and was entitled “Four Conditions Make Cash Transfers Save Lives: The success of other countries shows these programs can work in the United States.” The article addresses the potential benefits of adopting policies that create an income floor through a Universal Basic Income program, or expanding the fragments of such a program that we now have with SNAP, the Earned Income Benefit, and WIC. 

 

Regular readers of these letters know that I have long been a proponent of Universal Basic Income, and see it as an option that would move us much closer to the Triple Aim while having social benefits that lower expenses in many areas of the federal budget, while it moves all of us toward a more just society. I am not a communist and wouldn’t call myself a socialist. UBI appeals to my pragmatic instincts and would help improve the world my grandchildren inherit. For about five years now, I have been on the board of Family Health Project, a charitable experiment in UBI that offers $400 a month for three years to first-time mothers at two Federally Qualified Health Centers in Eastern Massachusetts. I also work extensively with two organizations in New Hampshire, Kearsarge Neighborhood Partners (KNP) and Kearsarge Regional Ecumenical Ministries (KREM), both of which assist financially stressed members of our community. The work of all three is, in essence, an attempt to improve the Social Determinants of Health through nonprofit charitable activity. 

 

The Atlantic article begins:

 

Of all the ways that governments can try to help people, cash transfers can seem like one of the most straightforward. Their popularity has been growing: Over the past decade, dozens of American cities have launched cash-transfer pilots. During the coronavirus pandemic, governments worldwide dramatically expanded their own programs’ reach. And as AI reshapes work, the idea of guaranteed income—a specific kind of recurring, no-strings-attached cash payment—is moving into the mainstream.

 

You may remember that during COVID, under Joe Biden’s leadership, we passed the American Rescue Plan the included the Child Tax Credit, a bill that substantially increased federal support for families with children. Unfortunately, to gain passage, the benefits were time-limited and have now expired when the Republican controlled Congress voted not to extend the benefit. While payments were in place, millions of children were temporarily lifted out of poverty. A reasonable person might wonder why such a program was not renewed, or why there has not been greater enthusiasm for other UBI programs, given their success elsewhere. The authors continue: 

 

Yet while the provision of cash has saved many lives in dozens of low- and middle-income countries, it has seemingly produced only modest health gains in the United States. Guaranteed-income pilots also haven’t delivered the dramatic health improvements associated with cash-transfer programs elsewhere. Why does cash save lives in Tanzania but barely move the needle in Texas?

 

That is obviously a question that deserves an answer. Maybe there are complex reasons that obscure the benefits, just like the benefits of spending billions to kill the Ayatollah and friends seem obscure to me. The authors think their research has uncovered what obscures the success of UBI, the way we try to do it. Going forward in this letter, I will bold things I want you to ponder. 

 

From our work studying cash-transfer programs across 37 countries, we’ve come to see a consistent logic behind why cash succeeds in some places and falls short in others. Cash transforms health when four particular conditions are met. Most U.S. cash-transfer pilots have lacked them. But one major American policy does come close: the federal food-assistance program SNAP. Its success offers a road map for what effective cash assistance can look like in this country, if we choose to build on it.

 

Wouldn’t you know that Trump’s “One Big Beautiful Bill” undermined SNAP? Google’s AI responded to my question, “How did the ‘One Big Beautiful Bill’ impact SNAP?”

 

The One Big Beautiful Bill Act (OBBBA) of 2025 significantly alters the Supplemental Nutrition Assistance Program (SNAP) by shifting costs to states, tightening eligibility, and reducing benefit growth. It requires states to fund part of benefit costs based on error rates and increases their share of administrative costs. It also expands work requirements for older adults (55-64) and parents, limits the Thrifty Food Plan adjustments to inflation, and eliminates some eligibility, expected to reduce overall, long-term benefits. 

 

Those programmatic changes impacted several of the people that I assist through volunteer work in my community. Some of the SNAP recipients are unable to successfully complete the more complex and more frequent requirements to maintain their benefit. One of my needier clients for whom I do the application was getting over $250 dollars a month during the Biden administration. He now gets $81. Programs like the ones I am connected to and our local food banks try to fill the gap in access to food in our community, but I fear that the measurable impact of charitable organizations across the country will only be a band-aid, and not enough to establish a permanent, measurable nutritional benefit that replaces the SNAP reductions in a complex American population. We proceed to understand the authors’ analysis.

 

First among the necessary conditions, cash infusions must be large enough to change one’s daily reality… In many low-income countries, a modest amount, on the order of $20 a month or less, can represent a major share of household income. For families living in extreme scarcity, a small influx of funds can expand their food budget, allow children to get vaccinated, or help a mother reach a hospital to deliver safely. These changes are big enough to save lives.

In the U.S., by contrast, a few hundred dollars a month for a relatively short period of time, typical of guaranteed-income pilots, rarely matches the steep costs of housing, child care, and health care. The support modestly eases financial instability but doesn’t fundamentally alter the constraints that low-income families face.

 

That observation makes a lot of sense. There are four possibilities when we try to apply cash assistance, particularly from a charitable source, as the government backs off from a long-established program. First, we could fail to replace what was lost.  Second, we can find a way to match what the government has denied, but the economy is also changing, and the effect of the simple replacement is muted. Third, we could succeed in adequately replacing the lost government program with one that keeps pace with inflation, but that would not mean improvement. Finally, dreams could come true as they did with the child tax benefits under Biden, and measurable progress is seen.

 

Given the generational impacts of poverty, it is often true that when we provide help, we focus on the needs of the moment rather than the long run. We are not exercising the fantasy that we are doing something that could have a huge long-term benefit. Our ability to help is usually a metaphorical “drink of water” in the moment. Even the amazing short-term benefits of the child tax credit quickly dissipated when the cash stopped coming. 

 

Second, cash must be able to remove specific barriers that block good health. In the countries we studied, many of the leading causes of death—HIV, tuberculosis, malaria, malnutrition—are tightly linked to poverty. Families face life-threatening obstacles that a small amount of money can help them overcome, by creating access to transportation, better nutrition, a skilled birth attendant. When families have a little more income, the health effects can be immediate and profound.

 

As challenging as poverty is for many in America, it is better to be poor here than in many places in the world. We don’t currently have as many infectious diseases that respond to public health efforts or that can be mitigated with a small amount of money. Improving the Social Determinants of Health requires long-term changes in public policy and community culture that are beyond the scope of even generous UBI programs. As a result, to make a difference at the margin, to help the 10% in extreme need, or even the 50-60% living paycheck to paycheck and at risk of greater distress with any unexpected expense, we would need larger programs with long-term commitments that survive from one administration to the next, like the commitments most of us think we have made to Social Securtity or Medicare. 

 

In the U.S., the dominant health problems are chronic diseases shaped by neighborhood environments, structural inequities in housing and health care, and years of accumulated risk from unhealthy diets and other long-term exposures. These problems are far less responsive to short-term financial boosts. Cash can reduce stress and improve stability, but it cannot, on its own, undo the deep roots of these conditions. Yet in certain periods of life—such as during and after pregnancy—cash can have an immediate impact because health outcomes hinge on whether people can meet their basic needs and show up for health care when it matters most.

 

My comments here may seem redundant, but one of the programs I am affiliated with recognizes that a little bit of cash can help during the first three years of a baby’s life. The experience of the Family Health Project confirms that the modest sum of $400 a month for the first three years of a baby’s life can offer significant opportunities for a few steps along the pathway out of extreme poverty and toward better support for both the mother and the child. 

 

The chronic complex problems that plague the clients of the other organizations where I volunteer cause misery and often major inconveniences, but they are not life-threatening in the short run. For any of these efforts to show a significant long-term impact on the chronic problems that affect health over decades, given the short time frame we can provide assistance, would be surprising. That does not negate the short-term benefits of providing heat, food, transportation, and a variety of other supports to meet our clients’ immediate needs.  We undertake none of these activities with the expectation of improving health. At best, they might slow the decline of health or provide emotional or physical relief for a current problem. 

 

Third, scale matters. Successful cash-transfer programs reach large portions of the population. When millions of people receive support, the benefits spread beyond individual households, which helps explain why such programs have reduced mortality across entire countries. U.S. pilots have been small, reaching only hundreds or thousands of families—too limited to change the broader conditions that shape health outcomes.

 

Scale matters when measuring beneficial change across a large population. But I still see value in small-scale efforts like the Family Health Project that are not seeking to measure a benefit but rather to gain experience with a process. Family Health Project has seen time and again that $400 a month for a first-time mother who may also be undocumented can make a big difference. We know this from what the recipients tell us and what we can observe, although we have made no attempt to set up a “control group” or to structure our charity as an experiment with measurable objectives. If we have an overarching short-term objective, it is to learn how to distribute benefits to women and infants in need as efficiently and effectively as possible.

 

Primarily, we are responding to one mother’s need, hoping that, in some small way, we might improve her life and her newborn’s life in the moment. We hope that in a way we can’t currently measure, our efforts could give both the child and its mother a little long-term benefit. Our scale is at the individual level. We know that helping a population is far beyond our resources. Helping a whole population of mothers and infants in need would be a choice the government could make as an alternative to firing expensive weapons at enemies who are not an immediate threat. 

 

Finally, cash works best when it is woven into social infrastructure that families already rely on. In many low- and middle-income countries, payments are linked with health visits and other essential services…In the U.S., cash-transfer studies and guaranteed-income pilots are typically disconnected from other programs that translate cash into health gains.

 

Intuitively, the Family Health Project has partnered with two FQHCs: Lynn Community Health on the North Shore above Boston and The Whittier Street Health Center in the Roxbury area of Boston. We are in the process of expanding our efforts at both sites, and, as resources allow, possibly moving into new communities. Having a connection between the providers of care and the system that seeks to provide income makes strategic sense. My two New Hampshire charities, Kearsarge Neighborhood Partners and Kearsarge Regional Ecumenical Ministries, have close relationships and partnerships with our local hospital, VNA, the social services in our school district, with other local non-profits, and each town’s welfare officer. (New Hampshire’s social services safety net is tattered, and in a fashion that might have worked in the 19th century, focused at the level of the town budget.) We really are the “live free or die state.”

 

I am hopeful that someday, what researchers like the authors have learned, along with small experiences that nonprofits and communities across the country have gained, will be incorporated into public policies that not only mitigate current pain but also show long-term benefits for the nation’s health. One thing that galls me about some of our conservative neighbors and politicians is their continuing insistence that the recipients of public benefits are “free loaders,” substance abusers, or criminals. No one is ever accused of being a free loader if they make a tax-free investment or benefit by tens of thousands of dollars from a mortgage deduction. Despite the cultural legacy of Ronald Reagan’s comments about “welfare queens,” there has never been evidence of significant abuse of public programs. The authors state:

 

…Fears that cash discourages work or fuels spending on alcohol or drugs have not held up in the research. Across rich and poor countries, cash transfers have minimal or positive effects on work and do not increase drinking, smoking, and other substance use.

 

Later in the article, the authors try to educate readers that we have several programs besides SNAP that provide benefits to low-income Americans. Collectively, you might say that they provide some mitigation to the worst possible misery of a third-world country, but they are often plagued by wasteful regulations and rarely funded adequately to create real benefit. They write:

 

SNAP is not the only instructive example. The U.S.’s earned-income tax credit can also deliver a sizable cash benefit, typically as a lump sum, that low- and moderate-income workers can use to catch up on bills, pay down debt, or cover necessities. Because it is built into the tax-filing process, it avoids eligibility churn and can be readily expanded by states. It’s not a health program, but past expansions have been linked to improved child health. The Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC, is much smaller than SNAP in scope and generosity, but it’s integrated with local clinics and pairs food support with nutrition counseling and care referrals for pregnant and postpartum women, as well as infants and young children. By increasing access to healthy foods during a crucial period, and freeing up money that would otherwise go to groceries, WIC has been linked to improved birth outcomes and infant health.

 

Near the end of the article, the authors showcase a UBI program that has been successful in Flint, Michigan. They conclude by saying:

 

 Although these programs require public investment, the returns can be high. For young children, SNAP delivers roughly $60 in benefits for every dollar spent. The question is not whether cash is misused, but whether we choose to structure programs at the size and under the conditions where cash does the most good. Cash is not a cure-all. But when designed with the right basic ingredients, cash transfers are one of the most powerful levers that governments have to alleviate poverty and improve health.

 

Or we could take the same money and give Jeff Bezos and Elon Musk more tax relief while giving 85 billion to ICE and probably spending hundreds of billions trying to bomb Iran back into the stone ages. I have only one vote. I can hardly wait till November, when I plan to use it with the hope that my vote, plus the votes of you and others, might end the folly of this moment.

 

We Are Moving Toward Spring In Fits and Starts

 

I try to get in at least 2 miles of walking every day, no matter the weather. I have walked when the temp was 10 degrees, and I have walked in pelting rain. Nothing gives me more pleasure than walking in gently falling snow. I can head out with a head and heart full of animosity toward selfish, short-sighted politicians and soon become lost in the beauty of the gently falling flakes. Such was the case earlier this week when I took the picture that is this week’s header. If you look closely, you might see the tracks of my boots coming out of the end of the drive as it enters our property. Below my drive, the road ends at a washed-out culvert through which a little stream sometimes flows into our lake at the edge of our property. Now the town plow just pushes the snow a few yards past our drive and then turns around. That mountain of snow at the turnaround of the plow may last until sometime in late April. Last year, the ice on the lake lasted until late April. This year, who knows? Maybe there will be ice in May. 

 

After the snow earlier this week, the temp shot up into the 40s, almost to 50. Last night we got a few more inches, but the forecast suggests that we may hit 60 next week. As the temperature rises, there will be people skiing in shorts at nearby Mount Sunapee. Spring is on the way. Who knows what lies ahead in March? It can be madness. The snow we got last night may be the last we will see this season. They are playing baseball in Florida. Maybe Spring is just around the corner. 

 

Clocks leap forward early Sunday morning. Your weekend will be short by one hour. Let the loss of an hour be a reminder to make the best of the time you have. 

Be well,

Gene