November 15, 202
Dear Interested Readers,
What Happens Next?
I would like to move on from writing about politics, but I can’t deny the impact of politics on the future of our healthcare. The shock, awe, and pain for me of the reelection of Donald Trump have continued this week. I hoped against hope that the Democrats would gain control of the House, but it became clear by Wednesday evening that Republicans would narrowly maintain their majority which gives them a resistance-free pathway for President-Elect Trump’s legislative agenda and attempts to consolidate the supremacy of the presidency.
Trump’s cabinet picks and non-cabinet appointments have been even more startling. They are so controversial that they represent a challenge to the Senate which theoretically must confirm most of his announcements. Some journalists see the bizarre appointments as a “test” of his continuing dominance of his party and especially his control over the Senate. You might remember that it was three Senate Republicans, John McCain, Susan Collins, and Lisa Murkowski who blocked Trump’s 2017 attempt to repeal the ACA and replace it with a law that favored “junk” or grossly inadequate commercial products. Resistance from within his own party seems to be our only defense and it is less likely now than it was in 2017.
Trump’s nomination of Congressman Matt Gaetz as Attorney General has even some Republicans shaking their heads. But, will they refuse to confirm him? Gaetz was being investigated by his Republican colleagues in the House for possible ethics violations. Many believe that he lacks the credentials and experience to assume the role of the highest legal officer in the land. He briefly practiced law, but he was never a prosecutor or a judge. He has no experience in law enforcement, and he has managed such a large and important entity as the Department of Justice which includes the FBI, DEA, ATF, the Federal Courts, and many other activities and divisions. His only qualification is that he has been a very loud defender of the president-elect and one can imagine that he would quickly sign on to the task of using the DOJ as a weapon of revenge against Trump’s political opponents.
For Secretary of Defense, Trump has nominated Pete Hegseth, Fox News personality and critic of women in the armed services and the efforts to increase diversity in our armed services. Hegseth did serve with the National Guard at Guantanamo and in Iraq and Afghanistan, but he did not have a significant leadership responsibility in the service. He did write a book describing his concerns about trends in our military and defending several high-profile soldiers accused of crimes in uniform, and he has been active in non-profits that advocate for veterans. It is hard to imagine him resisting Trump’s worst ideas like using the military to attack Americans demonstrating in our cities as Trump wanted to do after the death of George Floyd, or Trump’s idea of using our missiles to attack drug cartels in Mexico.
Two of Trump’s five secretaries of defense in his first administration, Jim Mattis and Mark Esper resisted Trump and his inappropriate ideas while they led Defense. They continued to criticize him in books they wrote after leaving office. That won’t happen with Hegseth.
It would be a stretch to think that Hegseth has the experience or managerial expertise necessary to lead an organization as large as our military, but then Trump more likely wants someone who will obey him and not someone who would try to provide him sound advice that might prevent an international disaster. Trump is famous for calling our fallen or captured servicemen “losers.” I see his appointment of Hegseth as an even greater gesture of disrespect toward the men and women who serve in our armed forces.
Throughout his campaign, Trump would not acknowledge “Project 2025” but the flavor of his early appointments suggests that he is adopting many of the concepts in the plan. Elon Musk and Vivek Ramaswamy will be reorganizing the administration of government agencies in ways that will likely eliminate many career civil servants who Trump has described as the “deep state.” Others would describe the long-time civil servants who will be the victims of this effort as defenders of sane policies that attempt to protect the environment, improve the health of the nation, reduce the power of monopolies, look for criminals in high places, and hold big business in check. It’s a cliché, but in the coming Trump world, we will have several foxes watching the hen house.
Trump is moving toward the use of “Czars” in certain areas. Elon Musk’s responsibility will be to create “large scale structural reform” of government agencies from a position that doesn’t require Senate confirmation and won’t require him to give up his role as CEO of Tesla, Space X, or what was once Twitter. One thing Trump’s appointments indicate is that the primary requirement for a position is not deep experience. The primary requirement for an appointment is unquestioned loyalty to Donald Trump and not the Constitution.
To balance my complaints, I don’t share many points of view with Marc Rubio, but on paper, he is qualified to be Secretary of State. Tulsi Gabbard on the other hand is not qualified to lead our national security and Intelligence assets. Her nomination to manage all of our national security efforts is another head-scratcher. To add to my evolving concerns, Trump has begun to joke about a third term. Putin had the Russian constitution modified to allow him to remain in office for what will probably be the rest of his life, and Donald Trump has often expressed admiration for Putin’s strategic accomplishments. After this election, one would be a fool to question whether Trump wants more than four years, and other “far-fetched” moves toward drastic changes in the norms of our government.
When I wrote the first draft of this letter, I was waiting to see how the president-elect would employ Robert F. Kennedy, Jr. who had said that Trump had promised him that he would be our new healthcare czar. l had speculated that maybe Trump would craft some new title for Kennedy to avoid the need for Senate confirmation. I envisioned something like the titles of Musk and Ramaswamy. That theory was blown late yesterday afternoon when it was announced that Kennedy was Trump’s choice to be the Secretary of Health and Human Services where he will oversee CMS, the CDC, the FDA, the NIH. and other health and social service agencies.
Given that I wasn’t sure that I was including all of the responsibilities of the Secretary of Health and Human Services in my description of Kennedy’s new job, I thought that I would check the Internet to augment the deficiencies in my fund of knowledge which I assumed some of my readers might share, When I went to Google, the new AI function that keeps popping every time I try to use Google popped up again. I decided to try it. So I asked, “What agencies and services report to the Secretary of Health and Human Services?” I was surprised by the extent of the answer:
Agencies that report directly to the Secretary of Health and Human Services include: the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Centers for Medicare & Medicaid Services (CMS), the Administration for Community Living (ACL), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Indian Health Service, among others.
Key points about these agencies:
- NIH: Focuses on biomedical research to improve health and reduce disease.
- CDC: Monitors and responds to public health threats, including infectious diseases.
- FDA: Regulates food, drugs, and medical devices to ensure safety and efficacy.
- CMS: Oversees Medicare and Medicaid programs.
- ACL: Provides services for older adults, people with disabilities, and individuals with intellectual and developmental disabilities.
- SAMHSA: Addresses substance abuse and mental health issues.
- Indian Health Service: Provides healthcare services to Native Americans.
One wonders what will happen if the next pandemic occurs during Mr. Kennedy’s tenure. In pursuit of that idea, I decided to ask the bot at ChatGPT to review Mr. Kennedy’s controversial healthcare ideas including vaccines, food additives, fluoride, raw milk, and things that make children autistic or transgendered. My exact question was:
Please review Robert Kennedy’s controversial healthcare ideas including vaccines, food additives, fluoride, raw milk, and things that make children autistic or transgendered.
ChatGPT said:
ChatGPT
Searched 3 sites
Robert F. Kennedy Jr.’s healthcare views have stirred considerable controversy, especially given his outspoken stance on several public health topics. His ideas cover a wide range of subjects, from vaccines to food additives, and his rhetoric has placed him at odds with mainstream scientific consensus.
1. Vaccines and Public Health:
Kennedy is perhaps most famously known for his anti-vaccine stance. He has long argued that vaccines are linked to various health issues, particularly autism—a claim that has been extensively debunked by scientific research. Kennedy’s criticisms focus on vaccine ingredients like thimerosal (a mercury-based preservative), despite evidence showing that vaccines are safe and crucial for preventing infectious diseases. His position on vaccines has been described as promoting conspiracy theories, and he has been a vocal critic of COVID-19 vaccination efforts, arguing that vaccine mandates infringe on personal freedoms and that vaccine safety data is not thoroughly vetted by government agencies.
2. Food Additives and Pesticides:
Kennedy has also raised concerns about the impact of food additives and pesticides on public health. He argues that many common additives and agricultural chemicals contribute to chronic health conditions. For instance, Kennedy has criticized the widespread use of seed oils and glyphosate (a popular herbicide), claiming they are linked to various diseases, although these claims are not fully supported by the scientific community. His advocacy for cleaner food production aligns with his broader critique of corporate influence in the agriculture and food industries, where he suggests that regulatory bodies like the FDA and USDA are too lenient on harmful chemicals used in food production.
3. Fluoride in Drinking Water:
Kennedy opposes the fluoridation of drinking water, a public health measure that has been in place in many parts of the world for decades to prevent tooth decay. He argues that fluoride is a neurotoxin and should not be added to the water supply, a position that is at odds with the majority of dental and medical experts who assert that water fluoridation is safe and effective for reducing cavities in the population.
4. Raw Milk:
Kennedy has also advocated for the consumption of raw, unpasteurized milk, claiming that it has health benefits over pasteurized milk. However, public health authorities warn that raw milk can carry dangerous bacteria and pathogens, posing serious health risks.
5. Controversial Claims on Autism and Gender:
Kennedy has been linked to theories that environmental factors, including chemicals in food and vaccines, might contribute to rising rates of autism and other conditions. More recently, some reports indicate he has alluded to links between environmental toxins and gender identity issues, though these views have not been widely substantiated by scientific evidence and are highly controversial.
Potential Role in Trump’s Administration:
Amidst his controversial viewpoints, Kennedy has gained traction with some political figures, including former President Donald Trump, who reportedly plans to include him in his administration if re-elected. Trump has expressed interest in Kennedy’s ideas, particularly around healthcare reform and challenging the influence of pharmaceutical companies. Kennedy might be positioned in a role where he could influence public health policies, especially those related to chronic disease prevention and food safety regulations, which could lead to significant changes in federal health policy frameworks.
Kennedy’s stances have sparked concern among public health experts and industry groups, particularly regarding the possible rollback of established health safety measures if his influence grows within a new Trump administration. As of now, it remains to be seen how these controversial views would translate into policy should he be given a formal role in government.
These ideas have both ardent supporters who believe in reducing corporate influence on health and detractors who view his positions as pseudoscience that could undermine decades of public health progress.
To my surprise, the ChatBot did not seem to know that Trump had won the election and had nominated Kennedy to the position of HHS Secretary. So I asked another question. I asked:
Now that President-Elect Trump has nominated Kennedy to be the Secretary of Health and Human Services can you review the speculations about what he might do in this pivotal healthcare position?
In its response, the ChatBot reported that it had sourced the KFF News Service.
With President-elect Donald Trump nominating Robert F. Kennedy Jr. as Secretary of Health and Human Services (HHS), there is significant speculation about the future direction of U.S. healthcare policies under his leadership. Kennedy, known for his controversial views on vaccines and public health, may push for sweeping reforms in areas like vaccine mandates, food safety, and environmental health.
Kennedy’s previous stances include skepticism of vaccine safety, advocating for the removal of fluoride from water, and opposing certain food additives. His appointment could lead to attempts to overhaul public health policies, especially targeting chronic diseases in children, which he has likened to a new “Operation Warp Speed” focused on these issues. This aligns with his interest in reducing what he sees as harmful exposures in food, medicine, and the environment.
Observers expect that if Kennedy takes on this role, there could be significant shifts, particularly in the regulation of pharmaceuticals, public health initiatives, and possibly even agriculture, given his criticism of pesticides and food additives. His stance could place him in conflict with established public health agencies and scientific consensus on key issues.
While his exact plans remain unclear, there is anticipation of regulatory reforms that could impact vaccine policies, environmental health standards, and food industry practices, with a potential emphasis on natural and alternative health approaches. This could lead to contentious debates in the public health sector, especially if Kennedy’s past positions influence his policy direction at HHS
I apologize for the redundancies in my discussion of Kennedy, especially in the overlap of the AI responses, but I have not tried to reduce the verbiage because I think it emphasizes just how upset this appointment is to me. I speculate that the president-elect has deep animosities toward science and established healthcare perhaps based on the justified criticism he received for his handling of the COVID pandemic. It is ironic that the one thing he did best which was to facilitate the remarkably rapid development of the RNA vaccines that probably saved millions of lives is one of the things that his appointee most vigorously disputes. Then again, what does make much sense in Trump World?
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Considering the AG prize given to Matt Gaetz, Trump’s nomination of Kennedy to HHS, and Hegseth to lead Defense, one wonders what roles are in the cards for Representatives Marjorie Taylor Greene and Lauren Boebert. There are still several Cabinet positions to fill. I could see Greene as the Secretary of the Department of Education and Boebert leading Commerce.
I know that the next four years, I hope not more, of listening to Donald Trump and observing the chaos in his wake will be hard for many. Ironically, I may be a member of the community whose economic status will improve as Trump lowers taxes. To my dismay, the response of the stock market to his election has already increased my theoretical net worth. That is a shame when balanced with the likelihood that his majority was dependent upon many who are likely to be economic losers as government benefits in healthcare, social services, and education are slashed, and illeagal immigrants who provide cheap labor are deported. If Trump attempts to balance his tax cuts with tariffs as a source of revenue, the inflated prices that many of his voters were complaining about will begin to climb again.
All of this was too complex to explain in thirty-second political ads to people who were asked the simple question of whether their life is easier than it was four years ago. If you were born in 1998, you don’t have much life experience with inflation and its many causes. An advantage to being 79 is that I can remember paying $55 per month for a two-bedroom garden apartment, $0.25 a gallon for gas, $0.45 for a gallon of milk, and when newspapers and ice cream cones were a dime. Prices do rise, as do wages. My first job sacking groceries and stocking shelves at the local A&P paid $0.52/ hour. The pity that we all share is that all of our telecommunication assets haven’t led to a greater understanding of how the world works while creating a widespread desire for an authoritarian leader.
An electorate that is gullible to misinformation and impervious to responsible analysis based on confirmable data is unlikely to elect leaders who can solve problems. Such an electorate is very likely to elect someone who tells them they are being ripped off by the government and subjected to violence from immigrants. My wife tells me that Facebook tells her that one of the most “Googled” questions in the aftermath of the election is “What is a tariff?” The next four years may be a sad educational experience for many, but when it ends, we may have a much younger and more conservative Supreme Court that will be handing down decisions for the next thirty years that will continue to favor and protect the whims of an autocrat.
Two high points for me in this otherwise disturbing week were a letter from Joseph Betancourt M.D., the current President of the Commonwealth Fund, and a New England Journal of Medicine “Perspective” article from David Blumenthal and others. David Blumenthal is the former president of the Commonwealth Fund.
Betancourt’s letter entitled “Our Pledge to Continue Working Toward a Healthier Future For Everyone” begins with a brief history and statement of purpose of The Commonwealth Fund. As usual, the bolding is my addition for emphasis. He writes:
The Commonwealth Fund was established in 1918 by Anna Harkness — one of the first women to start a private foundation — with the broad charge of enhancing the common good.
Throughout our history, the Fund’s impact has been felt across the U.S. health care system. From support that led to the creation of the first public health departments, to funding for rural hospitals that led to the Hill-Burton Act and construction of hospitals across the country, to grants to urban medical schools, and to research that led to unprecedented health care coverage for Americans nationwide through the Affordable Care Act, the Fund has been steadfast in its mission to drive toward high-quality, affordable, equitable health care for everyone.
I should add that the Commonwealth Fund gave a significant grant to Dr, Robert Ebert, Dean of Harvard Medical School, in the mid-sixties to help launch the Harvard Community Health Plan as a pilot to find better finance mechanisms and clinical operations to lower costs and improve the delivery of care.
After Dr, Betancourt’s reminder of the origin and purpose of the Commonwealth Fund, he continues to stress its principles, and he affirms that the direction and objective of The Commonwealth Fund will not change. He is writing on November 7, but he does not directly reference the election held two days earlier.
The pillars upon which the Commonwealth Fund stand include the importance of respect, dignity, and the welfare of humankind. Today, our values compel us to be bold and impactful, to center community and common humanity, and to anchor equity and integrity in everything we do.
We remain steadfast and undeterred in our commitment to our mission and our values. With a dedicated and committed team, and like-minded grantees and partners, we are determined to continue to do the work every day to achieve meaningful change and improvements in the health care system for all Americans.
His next paragraph is a very succinct condensation of Dr. Blumenthal’s New England Journal of Medicine article which was first published online on October 9 and then in the October 31 hard copy edition of the NEJM.
Today this is more important than ever, as we continue to see the United States lag far behind its peers on health outcomes, despite spending more on health care than any other developed nation in the world. We are experiencing worsening access to care, affordability challenges that put care out of the reach of many, and significant disparities that leave populations of all backgrounds behind. As a physician, this is painful, and personal to me.
The letter ends with three paragraphs that are a “rededication” to their work and the hope for a better healthcare future. Again, there is no direct reference to the election or the evolving Trump administration:
At this time of great reflection about the direction of our country, and in the midst of hurtful and divisive rhetoric that dehumanizes so many, we lift up our history, our values, and everything that we stand for as fuel for the continued fight ahead.
As a nonpartisan, nonprofit, private institution, we take our role — and our privilege in society — seriously. While we will always strive to compromise with any who share our goals, we will be uncompromising as it relates to the values upon which we were established, and by which we aim to live every day.
Our work will continue, buoyed by a renewed sense of passion, energy, and purpose. We hope all those who share our values and this passion will come along on this journey with us to create a healthier tomorrow for everyone.
Sign me up for that positive vision for the future, especially for the next four years.
The utility of the Blumenthal article in the NEJM is that it is a snapshot of our current deficiencies. There is nothing in Project 2025 or in whatever Trump’s “concept of a plan” will propose that should give us any confidence that the state of our system of care will improve over the next four years because of anything done at the level of the federal government. Just as Matt Gaetz and Pete Hedseth were chosen for their tenacious loyalty to Trump rather than their expertise, It isn’t hard to imagine that Donald Trump is convinced that Robert Kennedy, Jr. will be more tenacious and loyal to him and his objectives than to the health of the nation.
Blumnethal’s article draws significantly on the data previously published by the Commonwealth Fund in an article entitled “Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System.” The reality presented in both articles is that in most health metrics we rank last when compared with other nations that have advanced economies. We spend more on healthcare, give it to a lower percentage of the population, and die much sooner than other advanced economies. One would hope that someone in the new administration would be concerned about this data. (My thought. Not in the article.) After repainting the picture of our miserable performance the article asks the key question:
What could the United States do to move from health care laggard to leader?
The remainder of the article is an attempt to answer that question. The authors begin their assessment with access to care:
…Possible solutions would involve actions well beyond the health care sector and would require significant reforms in a polarized society where making even incremental changes is extremely challenging.
Many of the U.S. health system’s shortfalls result from persistent economic barriers to obtaining essential care. The Affordable Care Act and related policies reduced the proportion of uninsured people to its current level of 7 to 8%. But 26 million Americans still lack insurance. Providing everyone in the United States with high-quality coverage that includes reasonable limits on out-of-pocket expenditures would ensure that Americans at all income levels have access to services that could help reduce preventable suffering and death. Substantial progress toward this goal could be made by building on existing programs, such as the Affordable Care Act, Medicare, and Medicaid.
Fixing access alone won’t solve the problem. We have crippling workforce problems:
The U.S. health care delivery system has profound problems that result in huge inefficiencies and excessive costs that would limit the benefits of expanded coverage. One such problem is the country’s worsening shortage of primary care clinicians, who are essential to assuring timely access to services and to managing increasingly prevalent chronic illnesses in an aging population. Improved compensation and reductions in administrative burdens for primary care clinicians would help the health system recruit and retain such clinicians and build desperately needed capacity.
It will be a long road to fix our shortage of healthcare professionals. We have expanded the scope of practice for many non-physician-advanced practice clinicians and we have drained many other countries of vital physicians for their populations even as we have blocked the migration of other workers, but those moves are not enough. When I was a healthcare executive we piloted other practice modalities like “shared medical appointments” and expansions of telehealth, but those processes are slow to develop and often meet resistance. AI offers potential benefits that would allow better leverage of our existing resources, but that hope is probably decades away because practice modifications are resisted long after they are technically feasible. They will also be expensive which means that they will require investments that may or may not yield greater profits, and much of our system of care is now rigged to yield a better bottom line and not better health. In the end, more healthcare professionals could improve access, but we missed the opportunity to expand our development of more professionals at least forty years ago when we began to retire more doctors than we graduated as our population was growing and getting older. Our healthcare is expensive in part because of workforce shortages, and in part because of resistance to the changes to better leverage what we have.
A second delivery-system failure is the high prices charged by U.S. health care facilities and professionals, which far exceed prices in other health systems. These high prices largely account for the extraordinary costs of care in the United States, which would make expanded coverage less affordable and which drive employers, who purchase insurance for more than half of Americans younger than 65 years of age, to impose high deductibles and copayments. One of the reasons health care organizations are able to charge such high prices is that they have obtained increasing economic power in local markets as a result of consolidation — both horizontal consolidation among hospitals and vertical consolidation, which involves large organizations acquiring physician practices. The arrival of private equity investors who “roll up” physician practices in local markets and then raise prices has also contributed to the escalation of U.S. health care costs. Increased scrutiny by antitrust agencies at every level of government is essential to mitigate the effects of consolidation on the cost of care in the United States.
I would expect that Trump will make it even easier and more potentially lucrative for private equity adventures in healthcare. If I had to bet, I would say that “private equity” could be a major portion of his “concepts of a plan.” More corporate opportunities to make large amounts of money in healthcare would “rhyme” with what I see in the healthcare comments in Project 2025. I would advise that you not hold your breath while waiting for the DOJ under Attorney General Matt Gaetz to address the antitrust issues that drive up the cost of care.
The collection of issues that drive much of the difference in the cost of care with associated bad outcomes in our system compared with the better outcomes of other advanced economies are in the folder of the Social Determinants of Health. Public spending on education, transportation, housing, and other social services plus attempts to address global warming, gun violence, and the deleterious effects of the environment on our collective health are not that compatible with Trump’s tax cuts and revamping of public agencies. The article says:
Improvements in coverage and the delivery system will need to be complemented by policies targeting critical influences on health outside the health sector. The United States lags behind comparator countries when it comes to addressing the social determinants of health, such as poverty, homelessness, inequality, and hunger. As its poor performance during the Covid-19 pandemic made clear, the United States needs a far more robust public health system to address the threat of pandemic illness. The toll of gun violence in the United States also demands policy attention.
Not everything that the Commonwealth Fund measured and compared was awful. We do a good job with health education. The authors speculate that may be the upside of pay for performance.
One notable finding from the report is the strong performance of the United States on measures of care process. These measures draw heavily on responses to survey questions concerning, for example, whether people received counseling from physicians about smoking cessation, alcohol use, diet, and weight control; whether they received preventive care, such as vaccinations and mammograms; whether their clinicians were respectful and engaged in their care; and whether physicians reviewed their medications with them. The United States ranked second overall in this domain.
The article was published just before the election. Perhaps it should have been condensed on Facebook or cited on Trump’s “Truth Social” because the people who needed to factor its message into their voting decisions along with their disgust with the border and inflation don’t usually read the New England Journal. In retrospect, now more than a week into the unknown of a return to a more vigorous Trumpism, the last paragraph is indirectly a sad request to consider the needs of our healthcare system as we cast our votes.
What is the future of a country that allows an untold number of its people to suffer and die unnecessarily because of a lack of access to basic health services, inadequate public health measures, and a tattered social safety net? Can it survive and thrive? Wittingly or unwittingly, Americans will be addressing these questions when they cast their votes on November 5.
Well, that didn’t work. The next chance for a major change of direction will be November 7, 2028. We could make a partial turnaround with the midterm elections in 2026. It is hard to be sure what the state of American healthcare will be four years from now. A lot depends on what healthcare professionals do, what happens locally within committed healthcare organizations, and at the state level in progressive states. I don’t expect much leadership in the effort to achieve the Triple Aim coming from Washington before 2028.
The Late Afternoon Fall Sky Can Be Beautiful
…, and it offers some relief from what we can’t change and must endure for a while.
If you have read this far, I appreciate your tolerance of my incredulity and verbosity. I fear you may compare my rant to Trump’s “weave.”
“I do the weave. You know what the weave is? I’ll talk about like, nine different things and they all come back brilliantly together, and it’s like, and friends of mine that are, like English professors, they say, ‘It’s the most brilliant thing I’ve ever seen.’”
—Donald Trump speaking at a rally in Johnstown, Pennsylvania, August 30
Writing all these words was cathartic for me. If I had been asked for a worst-case scenario for the election a month ago, I would have never imagined what we have witnessed this last week. Trump’s election looks like it will be the first act in a four-year tragedy for me, perhaps for you, and certainly for many of his enthusiastic fans who have yet to realize how with their votes they have disadvantaged themselves economically and have compromised the health of themselves, their families, and their communities.
I fear that our collective jaw will drop in disbelief many times over the next four years. My heart goes out to those earnest supporters of the Palestinian cause, especially in Michigan, who either didn’t vote, voted for a third-party candidate, or voted for Trump because of their anger over how the Biden administration has performed since the October 7, 2023, Hamas attacks. What did they gain? Now Trump has announced that he will appoint Mike Huckabee, the former Governor of Arkansas and a Baptist minister, as our ambassador to Isreal. Huckabee is on record as a supporter of the annexation of the Palestinian West Bank and some believe this applies also to Gaza. The New York Times reports that some Arab American leaders were misled into believing that Trump would appoint a Secretary of State who was responsive to their concerns. Instead, Trump has named Marco Rubio as his Secretary of State, and Rubio is highly aligned with the Israeli Right and Netanyahu.
We live in a complex world where deciding whom to trust or what to do can be complicated. I am sorry for those who believe in their hearts that Palestinians should have their own state. I have a similar sense of sorrow for all those in our country who felt disrespected by “intellectual elites” with college educations and blamed Biden for the inflation that resulted from the pandemic even as he was leading us to a remarkable recovery. Those who voted for Trump “just to shake things up” may soon discover that the federal programs of income assistance, educational support, and access to healthcare that they assumed were their permanent right have no more permanence or guarantee under Trump than a woman has to control her own reproductive decisions. We will see.
These days I am trying to get in a few more bike rides before it is too cold or wet to be on the road and before my knee surgery in early December. My rides tend to be in the late afternoon. The sun is low, and the light it casts can create an ethereal beauty that can take your breath away. My wife captured this beauty earlier this week in a photograph that she took a few minutes before sunset. She has let me use the picture for the header of this letter. The photo has not been enhanced using any of the options that the iPhone offers. What you see is what we see from our deck as we look to the east. The sun is going down behind the camera and sunlight is being reflected off the pine trees that populate the glacial eschar/drumlin that is the slender peninsula that divides our lake into almost two perfect halves with an east side and west side.
If you are worried or distressed, or if you just need to escape the next few announcements about Trump’s Cabinet that are likely to be delivered over the weekend and into next week, try a walk in the late afternoon sun to see what kind of a show it will put on for you.
Be well,
Gene
