September 19, 2025
Dear Interested Readers,
The Confusion In Make America Healthy Again
I have read a few pundits who have pointed out that President Trump understands our problems, but he is offering the wrong solutions. I doubt that turning our backs on science, efforts to achieve greater social equity, and returning our nation to the industrial mindset and cultural realities of the 1950s, replete with “traditional” roles of men and women that had men working in factories and women in the home raising large families, and 90% of Americans saying that they attended a Christian church, would Make America Great Again.
There is little doubt that, in many ways, America has had its share of turmoil over the last eighty years, which has led many to wonder if we have lost our “greatness.” Imposing an authoritarian mindset built on hatred and fear, which cruelly captures and deports immigrants, sends armed forces to occupy our cities, intimidates businesses, holds other countries hostage to destructive approaches to trade and foreign policy, while attacking free speech, academic freedom, and science at home, does not seem to me to be a strategy for a return to “greatness.” It is my opinion that a close and objective examination of history, if such is ever possible, would reveal that any greatness we ever had was because we were intermittently welcoming of the “huddled masses,” as described by Emma Lazarus:
…“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!”
My honest appraisal of any greatness we had in the past or might ever enjoy in the future lies in considering our aspirations and struggles toward a more just society as much as in the permanent accomplishments of those objectives. The message offered by the hope that “The Arc of the Moral Universe is Long, But it Bends Toward Justice” suggests that the process is long and associated with setbacks and detours away from the objective, however you might poetically describe it.
Yesterday, in what I consider to be one of his finest columns ever, David Brooks explained our current state of affairs as an expression of “dark passions.” You should read his discussion of the dark passions that include anger, hatred, resentment, fear, and the urge to dominate. He comments on how easily political leaders can exploit dark passions and describes their ascendancy in our society over the last twenty-five years. It is a balanced description that demonstrates how both the left and the right have used dark passions to promote their objectives.
Brooks continues his analysis by pointing out that “humiliation” makes people susceptible to those who use the destructive forces of dark passions. The impact of shame and humiliation is the major theme of Professor Arlie Russell Hochschild’s brilliant book STOLEN PRIDE: Loss, Shame, and the Rise of the Right, which I have so frequently quoted.
In his usual balanced way, after he has described the problem, Brooks presents a potential solution. He writes:
History provides clear examples of how to halt the dark passion doom loop. It starts when a leader, or a group of people, who have every right to feel humiliated, who have every right to resort to the dark motivations, decide to interrupt the process. They simply refuse to be swallowed by the bitterness, and they work — laboriously over years or decades — to cultivate the bright passions in themselves — to be motivated by hope, care and some brighter vision of the good, and to show those passions to others, especially their enemies.
The examples of leaders who opposed the dark forces include Václav Havel, Abraham Lincoln, Martin Luther King, Jr., Nelson Mandela, Alfred Dreyfus, Viktor Frankl, and Jesus. He finishes his long piece by offering advice to Democrats and those who seek to oppose Trump:
I’d add only that in order to repress dark passions and arouse the good ones, leaders need to create conditions in which people can experience social mobility. As philosophers have long understood, the antidote to fear is not courage; it’s hope. If people feel their lives and their society are stagnant, they will fight like scorpions in a jar. But if they feel that they personally are progressing toward something better, that their society is progressing toward something better, they will have an expanded sense of agency, their motivations will be oriented toward seizing some wonderful opportunity, and those are nice motivations to have.
The dark passions look backward toward some wrong committed in the past and render people hardhearted. The bright passions look forward toward some better life and render people tough-minded but tenderhearted.
I was in tune with the ideas Brooks expresses before I read his column. Most of what follows is what I had written before I read his elegant analysis. After reading a great book about the Dutch colony of New Amsterdam, which is part of our origin story that has been mostly forgotten, I was reminded of one of the most powerful transitions in world history, the emergence of the “Enlightenment.” There is no doubt that our founding fathers were profoundly influenced by the opportunities for all that the embrace of the Enlightenment promised. In our time, Stephen Pinker has met resistance when he has tried to swim against our prevailing dark moods by arguing for a resurgence of a sense of the Enlightenment in his 2018 book Enlightenment Now: The Case for Reason, Science, Humanism, and Progress.
As I began to write this week, I was focused on all that we are suffering now in our deeply divided nation, and all that we are at risk of losing to Trump’s MAGA and MAHA movements and the dark moments the political tone of our times generates like the assassination of Charlie Kirk, and the loss of free speech as demonstrated by the “cancellation” of Jimmy Kimmel. Always on my mind are the almost daily losses we are experiencing in our efforts to improve healthcare. So I wrote: If you type into the Google browser the question, “What are the fundamental concepts of the Enlightenment?”, the answer that I was quickly provided was:
The fundamental concepts of the Enlightenment revolved around reason as the primary source of authority, emphasizing individual liberty, natural rights, and the pursuit of progress through skepticism of traditional authority and religious dogma. Key ideals included the advocacy for representative government, the separation of church and state, the importance of the scientific method, and the belief in universal equality and tolerance.
If you continue your “research” by asking Google when the Enlightenment began and who its proponents were, it gives a lengthy answer. I bolded a few portions of the answer that resonate with me.
The Enlightenment began in the late 17th century and peaked in the 18th century, drawing upon the earlier Scientific Revolution. Notable proponents of the movement included Voltaire, John Locke, and Immanuel Kant.
When the Enlightenment began:
Historians identify several key events that marked the beginning of this philosophical movement.
- 1637: René Descartes published his Discourse on the Method, which emphasized systematic doubt and individual reasoning.
- 1680s: This decade in England saw the publication of John Locke’s Essay Concerning Human Understanding (1689) and Isaac Newton’s Principia Mathematica (1686), two foundational texts for the movement.
- Late 17th Century: The Enlightenment is often considered to have started in the late 1600s and extended through the 18th century, sometimes ending with the French Revolution in 1789 or the conclusion of the Napoleonic Wars in 1815.
Key proponents of the Enlightenment
The Enlightenment featured a diverse group of thinkers across Europe and America. Some of the most prominent proponents include:
- John Locke (1632–1704): English philosopher known for his concept of natural rights (life, liberty, and property) and the idea of the social contract, where a government’s authority comes from the consent of the governed.
- Voltaire (1694–1778): French writer and philosopher celebrated for his wit and advocacy for freedom of speech, freedom of religion, and the separation of church and state.
- Baron de Montesquieu (1689–1755): French political philosopher who proposed the theory of the separation of powers—dividing government into legislative, executive, and judicial branches—to prevent any one branch from becoming too powerful.
- Jean-Jacques Rousseau (1712–1778): Genevan philosopher whose social contract theory argued that a government’s legitimacy depends on the will of the people, heavily influencing the French Revolution.
- Immanuel Kant (1724–1804): German philosopher who defined the era’s motto as “Sapere aude!,” or “Dare to know!” and emphasized the importance of individual reason.
- Adam Smith (1723–1790): Scottish economist and philosopher, considered the father of modern economics for his work The Wealth of Nations, which advocated for free markets and limited government intervention.
- Denis Diderot (1713–1784): French philosopher and editor of the Encyclopédie, a massive project that aimed to compile all human knowledge and disseminate Enlightenment ideas.
- Mary Wollstonecraft (1759–1797): English feminist writer who argued for the equal education and rights of women in her book A Vindication of the Rights of Woman.
- Benjamin Franklin (1706–1790): American polymath, inventor, and diplomat who played a major role in bringing Enlightenment ideals to America and influencing European thinkers.
- Thomas Jefferson (1743–1826): American statesman and primary author of the Declaration of Independence, which drew heavily from Enlightenment principles regarding individual rights and the consent of the governed.
Core ideas of the Enlightenment
The work of these thinkers contributed to the spread of several key concepts that reshaped Western civilization.
- Reason and Empiricism: Emphasized that knowledge could be gained through observation and rational thought rather than blind faith or superstition.
- Individual Liberty and Rights: Promoted the idea that individuals possess inherent rights to life, liberty, and property, challenging the notion of absolute monarchy.
- Separation of Church and State: Argued for limiting the political power of organized religion and protecting religious tolerance.
- Progress and Human Improvement: Fostered a belief that humanity could improve society and itself through rational change.
A friend recently recommended a book to me that has further expanded my understanding of how the ideas of the Enlightenment played a key role in the underlying principles and norms that have accounted for any greatness we have achieved, and which the MAGA movement seems unaware.
The book is The Island at the Center of the World: The Epic Story of Dutch Manhattan and the Forgotten Colony That Shaped America (2004). It was written by Russell Shorto. In the New York Times review of the book, written in 2004 by Kevin Baker, we read:
…Henry Hudson’s entrance into New York Harbor has never gained full iconic status in the American experience…
…Russell Shorto, in his masterly new history, ”The Island at the Center of the World,” begs to differ… Shorto has taken up [an]…intrepid… pursuit here. ”If what made America great was its ingenious openness to different cultures,” he writes, ”the small triangle of land at the southern tip of Manhattan Island is the birthplace of that idea: This island city would become the first multiethnic, upwardly mobile society on America’s shores, a prototype of the kind of society that would be duplicated throughout the country and around the world.”
Just how the fresh new ideas of the Enlightenment were adopted and expressed in the evolution of self-government, individual opportunity, and religious tolerance took hold against resistance in a multiethnic colonial society makes for a deeper understanding of how our society evolved, and how tenuous its persistence is. Inclusive ideas and institutions are fragile, as Benjamin Franklin implied when he famously said, when asked what the Constitutional Convention had accomplished, over a hundred years after the Dutch lost New Amsterdam to the English, “A republic, if we can keep it.”
The story emphasizes that from the beginning, the great potential wealth of our continent has been obvious to those who were brave enough to venture here unencumbered by old-world ideas. The old ideas of aristocracy and a society built on serfdom were not compatible with New World success, but were hard to give up by those who were advantaged. Race has always been an issue, and the horrible and shameful tolerance of slavery, despite Trump’s recent efforts to sanitize the story, was present in New Amsterdam, but there was also a multiracial citizenry that included many of African heritage who were free.
…somehow, as Shorto puts it: ”New Netherland refused to remain a trading post. It was unique among the way stations of the Dutch empire in that it insisted on becoming a place” — and one that seemed almost magnetically drawn to the center of world events. From its very inception, New Amsterdam was a remarkably restless, ambitious, polyglot little seaport. ”It was Manhattan, in other words,” he says, ”right from the start.”
The importance of the themes of the book is enhanced for me by the realization that when Shorto wrote the book, and when the review I am quoting was written by the historian, Kevin Baker, no one realized that in twenty years the founding principles of our democracy, which were derived from the Enlightenment, would be challenged as they are now under the misleading banner of MAGA. The review continues:
What Shorto has hit upon is nothing less than the true dichotomy at the heart of the American story, the fact that most of our ancestors came to this land for material as well as idealistic reasons…Both motivations were complex. While Shorto concedes the innate ”messiness” of colonial Manhattan, a place where at one point a quarter of all buildings were devoted to the production or consumption of alcohol, religious dissenters flocked to the Dutch colony to escape persecution up on Massachusetts Bay. Meanwhile, the Puritans’ ”shining ‘city on a hill’ became Manifest Destiny, and morphs easily into a cheap battle cry.”
It should be obvious that much of the thinking and verbiage in our founding documents has its origin in the Enlightenment thinking of the seventeenth and early eighteenth centuries, and that our founders were active proponents of these ideas and realized that they were embarking on a challenge to the status quo of state religion, and a strict social structure that with rare exception slotted an individual into a place in society from which there was little chance of escaping.
One could argue that any greatness we ever enjoyed was achieved through the exercise of what MAGA would have us destroy. In the same vein, Make America Healthy Again is a great slogan and an effort in which we should all participate. The problem is that just as MAGA has the possibility of turning us into a third-world autocracy, MAHA, as it evolves under Trump and Kennedy, has the potential of destroying the accomplishments that have made us and the rest of the world healthier.
Robert Kennedy, Jr. has justified his destructive actions at HHS, the CDC, the FDA, and the NIH by pointing to the statistics suggesting that our children, especially, but really all of us, are unhealthy because of the medicalization of many issues that need no treatment, the toxic effects of processed foods and environmental toxins, and industires that exploit us for their profits.
He takes the reality that we are on the journey toward better health and are not there yet, which may contain some truth, and expands it into conspiracies that suggest that our medical institutions and research communities need to be blown up in a nihilistic way that will sacrifice much progress in medicine and science because perfection has not yet been achieved. He does not use any of the “Enlightenment” tools, nor does he understand that the “scientific methods” that have achieved so much are rooted in the principles of the Enlightenment and are the reason for our progress over time. He doesn’t seem to understand that what he wants to destroy is the methodology behind the progress we have made toward better health since we gave up using leeches and worrying about the conspiracies of witchcraft. We can always make improvements, but continuous improvement processes always respect and understand how progress was made in the past. Disruptive innovation is not destructive innovation.
The logical and strategic methods of science have moved us forward. Abandoning what has given us progress and a healthier world just because our full success has not been achieved is not an approach that will bring forth better health in America. Drinking raw milk and doing pushups may be healthy habits in the mind of RFK, Jr., but they do not protect most of us from the next pandemic.
I made the first of my few visits to the offices of HHS during Barack Obama’s presidency in 2009 or early 2010. In our era of heightened security, one must go through metal detectors. Once your lack of a weapon is verified, you advance to a desk where they determine whether and with whom you have an appointment. After that task is completed, you are given a temporary badge with your picture and destination, and then you move to a waiting area where an escort will eventually show up and take you to your meeting or the person with whom you have an appointment.
While waiting to be gathered up for delivery, you have plenty of time to look around. The scenery is one of “brutal architecture,” which makes sense given that the building was built in the late seventies. Google describes “Modern Brutalism” as the continued use and adaptation of the Brutalist architectural style, characterized by raw, exposed concrete (“béton brut”), geometric forms, with a focus on functionality and materiality, into contemporary designs. If you have ever seen City Hall in Boston, you have seen Modern Brutalism, you can easily have a feel for the Hubert Humphrey Office Building, which is the Home of HHS.
On that first visit, looking around the vast, mostly empty, space of the lobby of this architectural eyesore, I spotted a quote from Hubert Humphrey, for whom the building is named, carved in the wall near the elevators I was hoping to ride soon. It read:
“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped”.
I suspect that on the days Mr. Kennedy goes to his office, he has the opportunity to read that quote. I would be interested in hearing him expound on how what he is doing as he deconstructs our medical research programs, vaccine initiatives, and supports legislation that will deny millions of children, the elderly, and the poor the care they need, aligns with those sentiments.
I have one final word on the concept of Making America Healthy Again. It speaks to the role of individual physicians and other healthcare professionals who interface directly with patients. I know from being a provider of care that we all approach our tasks from the perspectives of our own experiences, biases, needs, personal interests, and concerns, as well as from an awareness of how we are perceived by our patients and colleagues. I believe that most of us have a strong sense of altruism that enables us to withstand monumental demands and stresses.
When I first began to practice outside the supportive confines of internship, residency, and fellowship, I was most concerned with doing the best job I could do in the exam room and at the bedside. I loved the intimate connection to my patient in the moment. I wanted my colleagues to think I was skilled and knowledgeable, even though internally I doubted both my skills and the adequacy of my fund of knowledge. I found the work to be both exhilarating and exhausting.
As time went on, and I saw many of the same patients over and over again, I began to look beyond my worries and concerns about doing a good job in the moment in the office and at the bedside, and realized that my patients would benefit if I sought to improve their care by becoming involved in our internal efforts to improve our patient services and quality. I was surprised to learn that many of my colleagues did not consider participating in practice improvement to be part of their professional experience. As time went further along, and coming in contact with many gifted colleagues and mentors, I realized that improving the health of my patients was facilitated by being concerned about the deficiencies and challenges in the care experience of all patients.
I understand the stresses of practice and patient care, and the reluctance of many to get involved with the social and policy issues that impact patient care. I have heard colleagues say, “I am not a social worker!” It is also becoming manifestly clear that for at least the near future political and social issues will become more and more important in the office and at the bedside, and we need everyone who cares about the principles of healthcare quality, equity, access, cost, public health, and the future of medical practice and health in America to ask, whether they are doing as much as their patients need them to do to make America healthier.
We must be active advocates for better health for everyone, and medical practice and policy built on the productive principles of the scientific method. We also must advocate for the extension of the benefits we are capable of producing to everyone. There is a lot yet to lose if we forget or deny some wisdom and truths that go back to the seventeenth century and earlier. Improvement does not depend on the destruction of what exists now. Again, disruption as a method of improvement is not the destruction of established principles, but rather it is the thoughtful application of what has been learned toward great efficiency and universal benefit, as the status quo is replaced with the next step in the evolution of knowledge. Improvements in America’s health will only occur if we can continue to utilize the principles of the Enlightenment, which create hope and opportunity for all.
Wishing For Rain
It is hard to believe that earlier this year, I was complaining about thirteen consecutive weekends that were washed out by rain. We are in the midst of a drought, and the weatherman does not see much hope for enough rain soon to end the drought. The water level in our lake has gotten so low that my neighbor took his wake boat out of the water weeks earlier than usual for fear of damaging his prop on the rocks that are hazards now that they are closer to the surface. The well of a man for whom I make food deliveries has gone dry. Many people in the area have dry wells. Bottled water is ok for drinking, but how do you shower, wash dishes, or flush a commode when your well is dry?
I have needed to modify my daily swims to get into deeper water where I don’t bounce off rocks with my strokes. The water temperature is falling, and I am back in a wetsuit. I alternate my strokes between the crawl, the breast stroke, and two kinds of backstrokes. I relax the most with my two backstrokes. What I mostly see these days while doing my backstrokes is what you see in today’s header. If the sky isn’t perfectly clear, it contains a beautiful collage of interesting clouds. Unfortunately, these beautiful, high-flying, fluffy white puffs don’t carry any rain.
Some of the trees around the lake are developing color, but fall doesn’t officially begin until Monday at 2:19 EDT. I hope that you will enjoy your last official weekend of summer. I am not worrying about a washed-out weekend. I satisfy any need for worry with my concerns about our future under the banners of MAGA and MAHA.
Be well,
Gene
P.S. Last week’s letter came late to you because of technical issues with the program that sends out the email notice that the letter is up on the Internet. In the future, if the notice isn’t in your mailbox by a few minutes after 3 PM on Friday, you can access the letter directly by typing strategyhealthcare.com into your browser.
As is usually the case when problems arise with this letter, things are fixed fast by my friend and technical guru, Russ Morgan, who supports the publication of these notes at no cost to me by utilizing the Internet connections he has created for his wife’s online jewelry business. His day job is to manage the IT needs of our state’s largest provider of mental health services.
As I was preparing this note for publication, another technical hurdle emerged. In desperation, I texted Russ asking for help. In just a few minutes, order had been restored. I thanked him, saying, “Thanks, Russ! Once again, you have fixed it!” His simple reply was: “It’s what I do. Fix things. Lol.”
We need more happy fixers like Russ in our communities if we are going to move forward and away from the “Era of Dark Passions.”
