April 11, 2025
Dear Interested Readers.
Warning!
This has been such a turbulent week for the president, the country, economies of every country in the world, and healthcare here in America that I have needed to do three rewrites. There may be a few redundancies that have occurred as I have tried to weave in the latest events and changes of course that have left billionaires, small investors, owners of small businesses, and farmers shaking their heads and terrified of future uncertainties. Consumers are bewildered about what might happen to prices and interest rates for both the short-term and long-term. What is in this final version of this week’s letter may seem like an inappropriate and disrespectful exercise to some, but it was cathartic for me. Please forgive me if I have offended you with my rant. It got darker and longer with each rewrite. And now the letter:
The World’s Economy and American Healthcare Are Held Hostage By One Ill-Informed Narcissist
The president and his handlers have spent the last week trying to pass off his inconsistencies and field reversals, i.e., doing what he said he wasn’t going to do as evidence of his brilliant “strategy.” Few objective observers of his erratic behavior are accepting this baloney. The quote of the week for me came from Hanna Rosin’s “Radio Atlantic” podcast entitled “Tariff Are Paused, Uncertainty Isn’t.” The podcast, which was recorded late Wednesday afternoon, begins with Ms. Rosin and a guest economist, Justin Wolfers of the University of Michigan, in dialog.Â
Hanna: Was today real? Honestly, like today just seemed like an unreal day, truly.
Justin: Was this week real?
Hanna: Was this week real, exactly.
Justin: What day is today, Hanna? It’s Wednesday?
Hanna: It’s only Wednesday.
Justin: Okay, so in eleven minutes, we will have been at this for seven days in a row. [Trump’s Rose Garden Liberation Day announcement of tariffs was on Wednesday, April 2, at 4 PM]
Hanna: Yeah, Yeah. What’s this?
Justin: The confused mumblings of an old man who didn’t do very well in his college economics course.
Hanna: Are you talking about the president?
Justin: I might be.
If you are not a regular listener to Hanna Rosin, just click on the link to the show title, and enjoy the 23-minute conversation, which is a good review of the economics of tariffs, the bond market, and the chaos the president has created which is likely to put us into a recession that we don’t need and would not have occurred without the president’s need to be a powerful figure when in fact he doesn’t even score as a minor intellect, but he has been a world class con man. If you don’t like my use of con man, try grifter, con artist, scammer, swindler, cheat, deceiver, fraudster, chiseler, or gouger. He is not the genius that he thinks he is, but as president, he is the king of chaos. Â
Professor Wolfer’s description of Trump as a confused, mumbling old man who didn’t do well in his college economics course is a charitable description of who he is and is effective in helping us understand his performance.. I am an old man who is a year older than the president. My wife relates that sometimes I am “off,” but I did make an “A” in my economics course that I took as an elective 60 years ago. Of all the “electives” that I took as a premed chemistry major, my courses in modern English literature and economics were the most rewarding and have had a lasting impact on my view of our time. I have always paid attention to comments about economic issues like the cost of living, GDP, money markets, regressive taxes, and even tariffs and international trade. Perhaps the president just wasn’t listening carefully in class or paid someone to write his papers because I don’t think his current thinking would have led to a very good grade in 1965, and he is flunking the course for sure in 2025.
Since I have drifted into history, it occurs to me that on May 8 we will celebrate the 80th anniversary of the victory of the Allies of World War II over the forces of Nazi Germany. What has been remarkable in the years since that day, beginning with the Marshall Plan, has been our efforts with nations in Europe and around the world to promote progress, peace, and personal freedoms. President Trump believes that our leadership of the free world has come at a cost that is a “rip off.” It is not an exaggeration to say that we may have given a lot, but in so doing, we have taken the greatest share of the wealth derived from an “expensive peace,” and we had the strongest and most admired economy in the world until about 10-11 weeks ago. It is a fact that inflation from COVID was much worse everywhere else than here, even though inflation here upset many Americans and contributed to the re-election of President Trump despite his falsehoods, felonies, clearly stated penchant for retaliation against his domestic critics, and his pledge to wage a war of tariffs against the rest of the world.Â
In the first two and a half months of his presidency, he has thrown away all of the gains that we have made since defeating Hitler 80 years ago. We made our mistakes in the cold war, in the Middle East, and certainly in Vietnam, but we still were mostly trusted, mostly admired, and could usually use statesmanship and our resources to rally our allies in other democracies to join our efforts to build a more peaceful, safe, and equitable world.Â
Many economists believed that the ties of international business created a safer world where we were learning the non-zero reality that there was more to gain for everyone working together than working against each other. The benefits of cooperation were obvious in international public health efforts and the growing efforts to confront global warming from burning fossil fuels. What we knew and could teach brought more than a million international students to our colleges and universities in 2023-24, and we attracted some of the brightest minds to make America their permanent home. How could all that be blown in less than 100 days? The answer is that a government that is ill-informed, chaotic, unschooled in diplomacy, and oriented around the president’s narcissistic sociopathic personality can throw away 80 years of progress in a very short time.
I keep pinching myself with the hope that I will wake up from the nightmare that began on November 5, 2024. When I can’t fantasize my way out of our downward spiral, I ask if we have already endured the worst. The next jaw-dropping tweet from Truth Social immediately answers the question, proclaiming more absurdities. Yesterday, the stock market crashed again as it became obvious that the storm with China was worse by the day, even after Trump paused his tariffs on most countries for 90 days and substituted 10% across-the-board tariffs, which are still an insult to many of our allies. Who would have thought that one man in a so-called democracy would be such a threat to the economic and physical health of the world?Â
I wrote much of what follows before Trump blinked in the game he was playing with every country in the world until a combination of the collapsing stock market, caving bond prices, falling oil prices, nervous Republican legislators, and terrified CEOs somehow convinced him to halt some of the madness for ninety days. If you listened to the “Radio Atlantic” podcast, you know that the potential disaster in the bond market, which will make our national debt much more expensive, was probably what accounted for Trump’s partial reversal. The pause that he said would not occur did occur. The stock market jumped for joy for one day, but then savvy people realized that nothing had changed. Life and economics will remain uncertain with a talentless and emotionally immature old man in charge. China has thrown down the gauntlet, and our trade with China was the closest thing to a legitimate problem. Offending Europe, Mexico, and Canada has offered a diplomatic advantage to China, and our future remains clouded by the significant possibility of further decline.Â
At the end of the story of Noah’s voyage in his arc to avoid the extinction of humankind and all the earth’s animals, which is presented early in Genesis, God promises that he will never use a flood again to destroy most of the world as the beginning of another “do-over.” As evidence of his promise, we were given the rainbow. If you are unfamiliar with the promise, here is the King James translation of the Hebrew text of Genesis 9: 13-16:
13 I do set my bow in the cloud, and it shall be for a token of a covenant between me and the earth.
14 And it shall come to pass, when I bring a cloud over the earth, that the bow shall be seen in the cloud:
15 And I will remember my covenant, which is between me and you and every living creature of all flesh; and the waters shall no more become a flood to destroy all flesh.
16 And the bow shall be in the cloud; and I will look upon it, that I may remember the everlasting covenant between God and every living creature of all flesh that is upon the earth.
As a child, when I heard the story of the promise, I was terrified and traumatized because in my mind, I imagined that the next time the earth would be destroyed by fire, which seemed totally consistent with all the fearmongering around a nuclear holocaust and the evils of communism, which I could hear regularly on the news programs that I watched with wonder on our newly acquired 17 inch black and white RCA television. Getting blown up or burned to death seemed worse to my seven-year-old mind than drowning. Who could have ever imagined that after we had avoided extinction by the fires of nuclear war for eighty years, we would risk entering a second “dark ages” if not potential extinction of life as we have known it as the outcome of the misconceptions of one con man? Â
Perhaps my fantasy that Trump’s trade war will end the world as we have known it is a bit farfetched. We may not be incinerated, but around the world and here at home, most people are uncertain, and the fear grows that at some juncture, this madman will do something that will cause us all to suffer. Perhaps Trump will fulfill the prophecy of T.S. Elliot in his poem, “The Hollow Men.” Try substituting “with a tariff” for ” a whimper,”
This is the way the world ends
Not with a bang but a whimper.
Our intellectually deficient and ego-inflated leader seems delighted to have many of our friends and allies grovel for his attention and mercy. In public statements he gleefully declairs that other nations are “kissing my ass.” (If you can stomach listening to “dear leader,” click on the link to see and hear the president say this before a crowd of his sycophants.) Feeling that the nations of the world and our allies are groveling at your feet and lavishing you with inappropriate kisses must be a supreme delight for a narcissist. Even when he temporarily backs off from the brink of disaster, he is arrogant because he has caused fear in others. He is an international bully who has made up his reasons for his actions. He shows no evidence of any sympathy, let alone empathy for those of us who see our economic security melting with the report of each day’s hateful executive orders and increase in the tariff that he is leveling against China.
The outcome of Trump’s economic policies will be even worse for the more than a hundred million people who have little or no market share and can’t easily pay an unexpected bill of $400. I only “feel” nervous and uncertain when I look at my retirement account or try to imagine what will happen in the wake of our trade war with China. I am probably secure financially, short of a total economic meltdown worse than the Great Depression. I just shrug my shoulders when $75 doesn’t fill a grocery bag, but there are neighbors for whom unexpected expenses or the prices at the grocery store precipitate situations with health or life-threatening consequences. Estimates of the extra annual costs to the average American family generated by Trump’s tariffs are now over $4000. If you are living paycheck to paycheck as many Trump voters do, this will be a cruel reward for your ill-advised vote. Trump shows no discernible evidence that he cares about the lives of populations that are vulnerable to his pathology. His language explaining that he changed course because people were getting “yippy” indicates that he has little regard for the misery he is causing now or that future generations will endure because of his lack of concern about anything or anyone but himself. He is a complex case; I have heard that he fears being another Herbert Hoover. If it is true that he doesn’t want to be another Herbert Hoover, his strategy to avoid that place in history is also failing.
It would be one thing if only wealthy individuals and large businesses were temporarily dealing with the uncertainty of his ill-advised economic war with China or the tariffs that might be on the table again in 90 days. Most economists trace the greatest future damage to small businesses and those who have already been struggling. Perhaps the current uncertainties would be more defensible if they led to some future state when there would be long-term certainty upon which businesses could build, but that seems unlikely, especially since China is very unlikely to bend to his threats. Economists agree that the uncertainty for the future that is the result of his policies will likely preclude the outcome that he claims he is seeking, which is the return to America of the manufacturing that has gone offshore. It takes a long time to build factories, and investors would rather “wait and see” than begin to build and see him change his mind once again at their expense. There is virtually zero likelihood that what is happening now will ever benefit the most vulnerable Americans, who will be the biggest losers to the idiocy of his fantasy.
In his column yesterday, in a piece entitled “Producing Something This Stupid Is the Achievement of a Lifetime,” a once-upon-a-time conservative, David Brooks, said, referring to both Trump and the many who put him in office and bend a knee to his ignorance:
Producing something this stupid is not the work of a day; it is the achievement of a lifetime — relying on decades of incuriosity, decades of not cracking a book, decades of being impervious to evidence.
As Trump disgracefully told Vladimir Zalenskyy that he didn’t hold the cards he needed to win against Russia, Trump doesn’t seem to recognize that in the end, he also doesn’t hold all the cards he needs to execute his aggresive policies in a way that will have a lasting economic benefit for most Americans. He can destroy a lot by acting on his ill-conceived economic biases, but he is unlikely to succeed in a trade war with China. If he does win anything, it will be a pyrrhic victory. It’s one thing to bankrupt six casinos, but a far greater error to wreck an economy in service to your ego.
Our growing understanding of the interplay between our economy and the health of the nation, as mediated by the social determinants of health, underlines the importance of trying to develop effective ways of resisting most of the initiatives of Trump’s second term. Last week, there were at least two encouraging signs of growing resistance. First was the demonstration of courage and will by Senator Cory Booker’s record-breaking 25-plus-hour Senate speech. Second was the huge turnout in cities and towns across the nation in the “Hands Off” public protests of Trump’s policy agenda and the work of Elon Musk’s DOGE processes. I took the picture in today’s header of part of the crowd of 500 hundred (that number comes from our weekly paper) committed people who showed up in the rain and cold on the town green in my little town of 4,500 to register their displeasure. This week, there is a small but growing bipartisan movement developing in Congress that is trying to take back the voice of Congress on tariffs.Â
Even with Trump’s ninety-day delay on drastic tariffs while he enjoys receiving the leaders of other nations who will grovel for his mercy or if there is a miracle in Congress and the stampede toward international economic disaster is averted, much long-term damage has already occurred in the early days of his reign. The damage to scientific research, academic freedom, the workings of our system of laws, and the future of healthcare that he has already done and that is likely to persist until he leaves office will take decades to reverse.Â
There is currently no obvious path to the protection of science, healthcare, human rights, and academic and intellectual freedom. We are already living under an autocracy when one man can take away the intellectual freedom of private individuals and entities to discuss or develop programs to promote diversity, equity, and inclusion. Robbing people in this country of some form of “due process” or the intimidation of businesses, law firms, and universities suggests to me that we have sailed past the worry that we might lose our democracy to an authoritarian regime and now must accept that we have already arrived at the dreaded destination. We should wake up to the fact that our authoritarian leader is already demonstrating that his tight grip gets tighter every day as he extends his intimidating practices from the control of what was once the Republican Party to the control of the whole nation while threatening everyone’s freedoms.Â
This week, I got an email from the Commonwealth Fund that contained links to several of its recent publications and the most recent blog post of its president, Dr. Joseph R. Betancourt, which was entitled “Making America Healthy.”
In his post, which is dated April 4, 2025, Dr. Betancourt begins by reiterating the history, philosophy, and mission of the Commonwealth Fund since its founding in 1918. Their positions have always been nonpartisan since better health for everyone should not be a politically divisive issue. That is the way the Commonwealth Fund and most healthcare professionals wish the moment was. The post points out how the recent personnel cuts at Health and Human Services compromise everyone’s health without producing significant savings since they yield only about a 1% savings to the overall budget of the agency. The description of the Fund’s current stance describes the thoughtful restraint one would expect from an organization with a long history of contributing to real progress, but times are changing.
Over time, national leaders have had different perspectives and approaches to addressing our health care challenges, and so we have patiently watched — and taken stock of — how the new administration is shaping the health care landscape. While we have tried to be hopeful in the face of unprecedented disruption, we fear that many of the decisions and actions would do everything but make America healthy — and in fact may cause great harm.
Dr. Betancourt next reviews what the Fund and most everyone in healthcare has observed over the last ten weeks and the potential reversal of recent progress in extending healthcare coverage to almost all Americans. He expresses deep concerns about reductions in the support of medical research, which will damage the machinery of our scientific progress in identifying, understanding, and successfully treating disease.Â
I am a beneficiary of basic research that was probably significantly funded by HHS and the NIH at the Scripps Clinic going back over thirty years that led to the invention of tafamadis which treats the abnormal folding of transthyretin, which results in the production of amyloid fibrils that impair my heart and peripheral nerves. Click here to see a great three-minute video explaining amyloidosis and hopes for future treatment.
In the past, amyloidosis was considered to be a rare and quickly fatal disease. Now, other medicines are being developed and marketed through continuing research, and more people are being diagnosed through research into early diagnosis and increased clinician awareness. One form of amyloidosis has a prevalence in African Americans. I have “wild type” or “senille” amyloid. I was diagnosed through a cooperative research project involving the Mayo Clinic and Dartmouth Health. During my preop visit for carpal tunnel surgery, my surgeon asked if he could take a biopsy looking for amyloid since research has shown that carpal tunnel syndrome in older people can be an early symptom of amyloidosis. Three days after my surgery, I learned that I had amyloidosis. Subsequent isotope scans of my heart showed that I had a “grade 3” infiltration of my myocardium. An echo showed diastolic dysfunction and other abnormalities. I am now taking tafamadis, which costs over $250,000 a year but is covered by my insurance for a copay of $65/ month. I am considering joining other research studies that are directed at the production of transthyretin in the liver. Will the support of these studies and the advancement of research into other diseases with poor treatment options be damaged by the recent decisions about the funding of HHS and the NIH of the Trump administration? Damage to our research infrastructure for amyloidosis and a host of other diseases is a certainty. Progress will be delayed, and people, even rich people, will die. Betancourt makes a similar prediction:
… We’ve seen dramatic cuts to research funding — potentially mortal wounds to the crown jewel that is American science and innovation. And we’ve seen important public data sources withdrawn from view, despite their critical importance in tracking and improving health care access and affordability and ensuring everyone — no matter who they are or where they live — receives high-quality care and lives a healthy life.
… the administration conducted the largest “reduction in force” ever at the U.S. Department of Health and Human Services (HHS), which provides Americans with critical public health, health care services, information, and protections. This historic, sweeping removal of thousands of the department’s employees puts everything at risk, including childhood vaccinations, maternal health, and community health centers. While the full measure of these cuts is still coming into focus, we can already say with certainty that every state, county, and community will be affected.
Betancourt then describes how the work of the Commonwealth Fund will now be compromised because much of their analytic work depends on data coming from HHS that will no longer be available. Betancourt describes the situation:
Without these and so many other data sources that are at risk following the HHS reductions, we will be less able to understand trends, make needed changes to our health system, and determine if our nation’s resources — roughly 18 percent of U.S. gross domestic product (GDP) goes to health care — are being invested wisely. Simply put, without a workforce, and without data, we are flying with no GPS, and people’s lives hang in the balance.
Like the economy, with healthcare, I fear that Trump suffers from the problem of not knowing what he doesn’t know–the Dunning-Kreuger effect or syndrome. This should instill as much concern about the future state of healthcare in America as we have about our economy. His choice of Robert Kennedy as Secretary of HHS reveals a doubling down on ignorance. Dr. Betancourt offers no solutions, only a sense of shared misery mingled with a little hope but no certainty about why that hope should exist.
While the U.S. health care ecosystem is large and complex, the historical role of the federal government, including HHS, to guide health policy has been integral to providing health care to people in every corner of the country. We are not alone in this assessment.
It is our sincerest hope that a clearer, more strategic, and more thoughtful approach to making America healthy will emerge quickly. With recent actions, that hope grows a bit dimmer each day.
The Commonwealth Fund remains committed to engaging with all policymakers and stakeholders who want to have a constructive dialogue on ways to improve the health of our nation. More than ever, it’s incumbent on all of us to work together to make that happen.
I hope to be a little more positive next week by describing what concerned people in my community are doing to protect our vulnerable neighbors. We are beginning to do some strategic thinking about what we might do to blunt the economic and healthcare damage that we fear is coming.
Passover and Palm Sunday
My family is like many others in that we are a blend of religious and cultural backgrounds. Perhaps we can find hope and a sense of renewal associated with these religious observances and just the fact that sooner or later, spring will burst forth and will give us an emotional lift. I will continue to search the papers every day for evidence that a few Republican members of Congress will wake up to the damage that is occurring while they are “asleep at the wheel.” My prayers are that as a nation, we will become greater than before by developing a greater sense of community while we dial down our self-interests.Â
Our weather remains a challenge. We had an inch of snow earlier in the week, and we woke up this morning to another “dusting” of snow. It’s been cold with heavy wind most days, and we are expecting more of the same for a miserable weekend. I hope that wherever you are, you might enjoy a few spring buds.
Be well,
Gene
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