October 23, 2026
Dear Interested Readers,
Millions Lose Healthcare Coverage; Millions More Are Underinsured: Do we suffer from a national decline in empathy as a partial explanation for the deterioration of the Social Determinants of Health?
It is eleven days until the midterm elections. Currently, early voting has reached record levels in the states where it is allowed. Speculations abound about what will happen in the few days left before the election, as do concerns about how the president might respond to what will likely be a Democratic majority in the House and the growing possibility that Democrats will also gain control of the Senate. This week, New York Times columnist David Wallace-Wells covered much of the current situation and reviewed the possible short-term and long-term consequences of the election in a piece entitled “Billionaire Republicans Are Vastly Outspending Democrats. Guess Who’s Winning.”
Wallace-Wells points out that even without a pre-election surprise or a post-election attack on the results, this election has become one of the most consequential, and unfortunately most expensive, in history. More importantly, it may represent yet another realignment among American voters while underscoring that money spent doesn’t always determine the outcome. Perhaps more important than the amount of money spent is its origin.
Much of the money that Republicans are spending comes from a small set of ultrawealthy megadonors who do a lot of business with the government. As they seek to enrich themselves, Republican megadonors are aligned with the president whose corruption has turned the Oval Office into a cash machine that benefits both the president and his generous donors. The reality of the corruption connected to the president has been so obvious that some polls identifying the top issues that concern voters have moved political corruption to the top of the list alongside “affordability” and healthcare costs and access. “Kleptocracy” is now a new vocabulary word that seems to more and more observant voters to be equally repugnant to its cousins–autocracy and fascism.
Wallace-Wells looks beyond the sum total of the Republican war chest and considers its effectiveness. He implies that the impact of the amount spent reaches a limit. I would go so far as to guess that at some point each additional dollar spent on annoying and frequently factitious ads by Republicans may benefit their Democratic opponents more than their Trump-anointed, MAGA-endorsed candidate. In summation, it is possible that hundreds of millions of dollars from a small number of megadonors may be offset by smaller amounts from tens of millions of small donors to Democrats. In fairness, I should acknowledge that there are a few Democratic megadonors like Michael Bloomberg and George Soros, but they appear to be donating more to preserve America’s dedication to democracy than to benefit their businesses.
Wallace-Wells ends his analysis writing:
…In many ways, it’s foolish to put too much narrative stock into polls: We’ll have real results soon enough. But the likeliest outcome — a blowout for Democrats — is also likely to leave plenty of Republican megadonors wondering what they spent all their millions on. And why they ever felt so sure they could buy themselves a permanent MAGA majority.
Recently, I have noticed that several pundits comment on their own pieces. The first comment after the article is a coda from Wallace-Wells himself. His afterthought was:
To me, the midterms are looking increasingly like a political earthquake. But even before it hits, you can see some huge shifts in the way the two parties appear to the public. Particularly the Republicans: when Trump first won election in 2016, he had a reasonable claim to representing the country’s left-behind.
But as the end of the Trump era comes into view, it looks like he’s remade the party in the opposite direction — as the most conspicuously plutocratic version of the GOP in … who knows how long.
Speaking for myself, I eagerly anticipate the end of the negative ads that interrupt the evening news coming in batches of four or five, one after another. They are not good for my health because, as I stew, I am sure bad things are happening inside. Also annoying, but understandable in an attempt to counter the Republican megadonors, is the annoying tsunami of requests coming from the Democrats in their effort to compete with the Republican megadonors. Yesterday, I received 84 emails and 21 text messages requesting money for Democratic candidates from Alaska to Florida, and almost every state in between. It is probably my fault. My wife and I have made small contributions to 14 Democrats running in Senate races, as well as to a few local and national congressional and gubernatorial races and to Democratic candidates for our state legislature. It makes sense that the candidates return to fertile ground. I understand their necessity, but it will be a great relief when it is over. I am all for publicly funded elections with spending caps, but I doubt that dream will materialize in my lifetime. The waste in our election process should be a campaign issue. On the positive side, I can imagine thousands and thousands of concerned Americans, some of whom in the past have drunk the MAGA Kool-Aid, filling up their home heating tanks with oil selling for $6.40 a gallon, and then, out of anger, making a donation to a candidate like James Talarico out of what little is left in their family coffers.
I have seen multiple articles that try to name the top five issues in this election. I think an individual’s list depends on who they are, what they do, where they live, how they view their economic status, how they relate ethnically, their sense of values if they are a follower of some religion, or how they define morality if they are not religious. I am sure there are other determinants, and most of us have a complex mix of these descriptors. What is clear is that there is an emerging consensus around a few key issues. My list of those issues is:
- The economy, or if you prefer affordability, which also includes tariffs and the cost of healthcare
- Healthcare access and the expense to everyone, whether they are covered or not
- Government corruption, particularly the corruption of the president and his key enablers.
- The unprovoked and poorly conceptualized war against Iran
- The abandonment of Ukraine in its struggle against Putin
- Our geopolitical role in the world vis-à-vis China, Russia, the Middle East, Venezuela, and the West
- Immigration, especially the thuggery of ICE
- The unknowns associated with AI and its polluting data centers
- Abortion and issues of women’s health
Perhaps I have left out your favorite issues, such as quality public education, law enforcement, or the Second Amendment. Clearly, there is overlap between many of the concerns. For instance, the economy or affordability can include the impact of the war in Iran on gas and diesel prices, as well as concerns about healthcare costs and the dismal plight of farmers in red states, which is driving up grocery prices. Besides government corruption, there is plenty of fraud in the vendors and recipients of government programs. Some of my concerns include what appears to be a general decline in empathy and the deterioration of our political norms. The sum of all these issues creates a sense in me that the economy, our collective cultural distress, our compromised collective sense of security, our declining access to affordable healthcare, and Trump’s dismantling of many of the programs to improve the Social Determinants of health will all be running against the president on November 3rd.
My concerns aren’t expressed with as much skill as some of the writers I read each week. Again this week, Paul Krugman lambasted the president for the damage he has done to our healthcare. He titled one of his letters this week, “Trump is Destroying Americans’ Healthcare: Twelve million have lost coverage — and it’s getting worse.” I suggest clicking on the link to see some of the charts he presents. I will bold a few of his points. He begins:
On the eve of the midterm election, American families are feeling financially stressed. As the chart above shows, the percentage of families who say that their financial situation is good has plunged. For the first time since the post-Covid inflation of 2022, it has fallen below the percentage who say that their financial situation is bad.
Rising prices are the obvious explanation for this stress. And while presidents usually have much less influence on the economy than is generally recognized, the current outbreak of high inflation is all on Donald Trump. He began this with two wars of choice: one, a trade war with his destructive tariffs, and then an unwinnable military war in the most important energy transit point in the world.
There is, however, a third factor behind Americans’ anger, and it isn’t getting nearly as much attention as it should. There has been a catastrophic decline in health insurance coverage combined with sharply rising premiums for many of those who have managed to hang on to their coverage. And this, too, is all on Trump.
That is a bold statement that deserves some evidence, which he immediately presents:
Here’s what happened: Trump and his congressional minions refused to renew the expanded subsidies that had made health insurance affordable for millions of Americans during the Biden years. At the same time the One Big Beautiful Bill imposed punitive work requirements that made it far more difficult for families to obtain Medicaid coverage.
And we haven’t felt the full effect of these changes yet — Republicans tried to backload the effects of the OBBB so that much of the pain will come after the midterms. But the consequences of this attack on healthcare have already been dire.
Krugman goes on to point out that many of those losing coverage will be children. Krugman quotes experts who estimate that so far Trump’s policies have caused 12 million Americans to lose their healthcare, and that reality suggests that there is more to come. Earlier this week, the Concord Monitor reported that by 2028, an additional 29,000 low-income New Hampshire residents will lose access to Medicaid. That may not seem so bad to you, but this state has a population of only 1.4 million, and in 2025 13% of our citizens were on Medicaid. 13% of 1.4 million is 182,000, which means that 16% of our Medicaid population will lose their coverage to support the tax breaks called for in the One Big Beautiful Bill. Downstream from that will be a critical loss of revenue for our hospitals and practices. Krugman’s obvious conclusion is that things will get much worse after the election.
After commenting on the future impact of not providing care for children, Krugman reports that, in recent speeches, Trump still says he has a “truly great” healthcare plan that we will hear about soon. I suppose that will be at the same time or just after petroleum prices go down, when we win in Iran, and after peace comes to Ukraine.
Krugman’s conclusion is that we are:
…now in the midst of an enormous healthcare disaster — a disaster that is receiving surprisingly little media coverage with, as far as I can tell, no recent articles on massive coverage losses in any of the major newspapers. I know that there’s a lot going on, but this seems odd.
He then says that recent polls show voters have noticed the impending healthcare collapse, and that, according to a recent KFF tracking poll, healthcare ranks second only to the economy as the top voter concern. He continues:
This ongoing healthcare disaster is all on Trump and his party. And again, voters appear to have noticed, giving Democrats a large and growing edge on the issue…
…So if there is a blue wave … it won’t just be the result of inflation and Trump’s vainglorious wars. It will also in part be the result of a quiet but massive healthcare disaster.
It would be great if, on the day after the “blue wave,” healthcare recovered miraculously, but you know that won’t happen, and there are moral implications. Krugman sums it up:
And ultimately, of course, the political implications are a secondary concern. What really matters is that Trump and his party have done all they can to deny healthcare to millions of Americans. They have done this partly to save money — not to reduce the budget deficit, but to make room for tax cuts for the wealthy. They have also done it out of sheer cruelty.
There are many terrible things happening in America right now, from the debacle in Iran to the depredations of ICE. But the healthcare disaster, which will ruin many people financially and in some cases kill Americans who can no longer afford essential care, deserves much more attention than it is getting.
In the end, it’s a steal that fattens the wallets of the beneficiaries of our new American Kleptocracy at the expense of the health and welfare of many vulnerable Americans, which is hard to repair quickly if we really have lost our ability to be a nation whose founding principles rest on a collective acceptance of the worth of every life. In the fifties and sixties, Pete Seeger asked in song where all the flowers had gone; a new verse now might ask where our empathy has gone.
A few weeks ago, in a post that featured getting to know Dr. Abdul El-Sayed and reviewing the chances for Democrats to take the Senate, I reported on Dr. El Sayed’s view of our need for public policies grounded in empathy. Shortly after reading Paul Krugman’s comments about healthcare as an important issue the press was failing to emphasize, I saw that another favorite writer of mine, Jennifer Rubin, was writing about the necessity of empathy. Her piece was entitled America Is a Decent Country, With a Warped Cult Eroding Our Democracy
She begins:
It’s become conventional wisdom for legacy media and their punditocracy to declare that America is “divided” or “polarized,” suggesting that we are evenly split between red and blue; between two political parties and sensibilities. However, as the recently-released 17th American Values survey (a mammoth sampling of 5200 adults) reveals, we have a pro-democracy, reality-based 65 percent (or so) majority, and a discrete radical minority — mostly white Christian nationalists — that holds views the rest of the country find abhorrent. Unfortunately, the latter group dominates one major party and holds disproportionate political power..
…PRRI’s survey underscores just how radical the MAGA outlook is. As it explains:
Two-thirds of Americans (68%) say empathy is a foundational moral value that helps build a healthy society, while 27% say it can become dangerous when it leads people away from building a society guided by God’s truth. The vast majority of Democrats (84%) and independents (70%) agree that empathy helps build a healthy society, compared with 54% of Republicans.
Ironically, if one reads the words attributed to Jesus in the Gospels, you learn that he espoused concern for both those who were your kith and kin and, radically, for everyone, including your enemies. One would imagine that the most conservative Bible-thumping Christians would make this norm-shattering philosophy central to their beliefs, but surveys suggest otherwise. Ms. Rubin continues:
- White evangelical Protestants are the only religious group in which a majority does not agree that empathy is a foundational moral value (42%). Instead, a majority (54%) say empathy can be dangerous.
- Views on empathy track closely with Christian nationalism.
That bizarre demonization of a core religious/ethical value may well be the product of a concerted effort to demonize and dehumanize other Americans, rendering acts of violence and cruelty commonplace.
She has more, and this is important because it may explain a lot of the public policy articulated by the MAGA movement, the president, and some of his religiously conservative supporters and cabinet members like Russell Vought, one of the principal authors of “Project 2025,” which foreshadowed much of the president’s agenda during the first two years of this “do-over” term.
The more intensely people identify with white Christian nationalism, the more empathy-averse they seem to be. “The survey also finds that skepticism about the social value of empathy is strong among Christian nationalism Adherents. Six in ten Adherents (60%) believe empathy can become dangerous when it leads people away from building a society guided on God’s truth, with half (50%) strongly agreeing with the statement. By contrast, nearly all Christian nationalism Rejecters (94%) say empathy is a foundational moral value for a healthy society, compared with 76% of Skeptics, 52% of Sympathizers, and 38% of Adherents.”
Those statistics, if true, are perhaps among the most defining realities in the policy divide between our political parties over healthcare and foundational concerns about the Social Determinants of health. I have heard it said that if you are focused on the “hereafter,” the problems of this world are not your concern. She points out that those who are Christians and who disagree with the objectives of Christian Nationalism are horrified by this interpretation of the religion. I would point out that similar divides exist within Judaism and among Muslims. She continues:
While this has serious political ramifications, for many Christians this is theologically horrifying. “As Christian nationalist leaders attack the sentiment of empathy, a disturbing ‘empathy gap’ has opened, separating Republicans and white evangelicals from most other Americans,” PRRI President and Founder Robert P. Jones, Ph.D. observed in a press release accompanying the survey. “Such orchestrated attacks are typical of violent authoritarian movements and should be disturbing to all who care about the moral foundations of our pluralistic democracy.”
It follows that if you think you are a member of the only true faith, then you may become a problem for the rest of us. Ms. Rubin explains her point in bringing up the issue.
That twisted mindset has led MAGA followers to cheerlead for treatment of immigrants that smacks of fascism. The survey found that “most Republicans and at least half of white evangelical Protestants support detaining undocumented immigrants in internment camps (62% and 53%) and stripping U.S. citizens of their citizenship and deporting them if they are determined to be a threat to the country (57% and 50%).” The numbers are stark and shocking:
White evangelical Protestants (53%) are the only religious group where the majority agree with placing undocumented immigrants into internment camps until they can be deported. …
If the core of your mindset is a form of duality, the chosen v. the outsiders, that recognizes the validity of only those who like you and pray like you, then it is hard not to be paranoid. Paranoid people who can’t see value in the natural diversity of humankind can be a problem for themselves and others, as we witness daily. What is more paranoid than a fear of being replaced? She explains:
The MAGA cohort has been indoctrinated by the great replacement theory. “White evangelical Protestants (61%) are the only religious group where the majority agree that immigrants are invading the country,” the survey found. “Less than half of white Catholics (47%) and white mainline/non-evangelical Protestants (44%) agree with the great replacement theory, as well as less than four in ten Latter-day Saints (39%), around three in ten Jewish Americans (34%), Hispanic Protestants (29%), and members of other non-Christian religions (28%), less than one-quarter of Black Protestants (23%) and religiously unaffiliated Americans (23%), and only 16% of Hispanic Catholics.”
After those disturbing facts, she begins to give us some reason to hope that the storm of MAGA with Christian Nationalism as its moral guide may be running its course, and the majority of us do see the benefit of living in a pluralistic nation where citizenship is a function of allegiance to inclusive thinking and our Constitution, and not race or religion. She continues:
The good news is that most Americans have recoiled against a cruel, xenophobic movement. “Nearly half of Americans (48%) say the MAGA movement poses a serious threat to the country, compared with 36% who say the same of Democratic Socialists of America,” the survey found. “Favorable views of the MAGA movement have slipped from 35% in March 2024 to 31% today, driven by declines among independents and Democrats. Republican views (72% favorable) have held steady.” Interestingly, “Half of Americans ages 18-29 and 30-49 (50% each) say the MAGA movement’s policies pose a serious threat to the country, as do 48% ages 65 and older — compared with fewer, 42%, ages 50-64.”
The long-term implication for these realities is that MAGA control of the Republican Party may be in its last phase. But before we throw a party to celebrate, history shows us that a focused 33% of the population can still get its way with an aligned autocrat in power. After quoting many more statistics, she ends with a warning, followed by a little reason for hope.
While they may not be a majority and may be alienating the rest of the country, a paranoid, xenophobic, religious nationalist cult at odds with fundamental values like empathy and antagonistic toward mainstream positions on a host of issues represents a deep challenge for democracy, especially in a system in which gerrymandering and undemocratic institutions (e.g., the Senate, a MAGA-dominated Supreme Court) hold disproportionate power.
However, cracks in the cult are appearing (e.g., massive decline in Trump’s and Republican Party support, substantial disaffection among Hispanic voters who say they are twice as likely to regret their vote as other Trump supporters, plummeting support for ICE, even among white Christian groups)…Ultimately, however, any religious or spiritual reformation of that segment of Americans will need to come from within — from those who reconsider whether they can abide by its twisted outlook. Regardless, the rest of the country must find common ground among shared values (e.g., empathy, inclusion) if our democracy is to survive.
Empathy is a political issue and essential to any improvement in the Social Determinants of Health.
The Peak Has Passed Here
I knew it was coming. We have passed the peak. The yellow and red leaves are beginning to merge into brown, and with each passing day, more of them are on the ground. The good part of this last week has been the clear, crisp days. Each evening I watch the national news, and one of the biggest stories every evening is how violent the weather has been somewhere else, but not here.
I took the picture in the header for this week on Monday, when it was warm enough to take what will likely be my last top-down ride of the season in my 1973 TR6. The picture was taken from the northern end of Pleasant Lake, on the other side of town, looking down the length of the lake toward Mount Kearsarge. The lawn and beach belong to the Inn at Pleasant Lake. (Click on the link for more pretty pictures.) The view here is one of my favorite local scenes.
I am taking my afternoon walks earlier and earlier because it’s dark by six, and soon it will be dark by five, since we will be turning back our clocks next weekend, right after Halloween. I don’t think we will have an Indian Summer this year, a day or days over 70 after the first night below 32, because the long-range prediction from now until the election never gets us out of the low 60s and on some days won’t make 50. We have already had several nights in the 20s. The concept of good weather is subjective. It will not be long before I am calling it “balmy” if the temp makes it to the high 30s or low 40s. The good news is that it will be clear and dry most of the time between now and election day. It should be great weather for both walking and voting. I hope that wherever you are, there is still color and that the days will be clear and inviting you to take a walk as you contemplate how you will cast your vote. A walk in crisp fall weather is a good way to manage your pre-election anxieties.
Be well,
Gene
