July 31, 2026
Dear Interested Readers,
The Importance of DEI To The Future of Our Nation’s Health
Of all the things the president has done that have damaged healthcare, none seems worse to me over the long term than the damage to efforts to improve diversity, equity, and inclusion. It seems to me that, whether your idea of the proper goal for optimizing healthcare is the Triple Aim or the Quintuple Aim, without the foundational efforts to improve DEI, success is unlikely.
At our nation’s founding 250 years ago, ideals were expounded that were more aspirational than descriptive of the existing reality. My sense of history suggests that the principles of liberty and equality that Jefferson described should be considered somewhat like a superego ideal for himself and the nation rather than a statement of reality at the time. If we begin with that premise, then we can see the last 250 years as a difficult journey toward that goal. At times we make progress. At other times, we lose momentum, and our progress is temporarily reversed, but the goal of our collective efforts remains the equality and universal freedom that Jefferson described as the intent of our creator.
In 1776, even though we did not yet have the moral strength to live up to our ideals, we were far ahead of other nations. Perhaps what we should celebrate was that, in a way that enfranchised only a minority of the population, we saw the benefits of giving up allegiance to a monarchy and testing the very new idea of democracy, even though those fundamental freedoms and participation in democracy were limited to white landowning males. The exclusion of indigenous people, women, and the enslaved was a conscious choice of the founders. In retrospect, it is easy to see that the power of a status quo where slavery provided tremendous economic benefits to those cruel enough to inflict it upon a fellow human, where millennia of cultural and religious practice had subjugated the freedoms of women to men, and where the ideas were not yet powerful enough to create a reality that matched the moment.
There is ample evidence that many in the late eighteenth century had already embraced the ideas expressed in the Declaration of Independence in 1776, but compromises prevented these ideas from being codified in the Constitution, which was written in 1787, ratified in 1788, and went into effect on March 4, 1789. Abigail Adams famously wrote to her husband asking that the “ladies be remembered.” The writings of many of the signers demonstrate that they considered enslavement of others to be wrong even though they owned slaves that they never freed. Despite the fact that he had many slaves, Jefferson wrote a condemnation of slavery in a draft of the Declaration of Independence that was deleted in the final version. These realities support the assertion that the declaration that “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” was more an aspirational concept than a statement of sentiment that could be embraced by those who controlled events at the time.
The economic advantage of the cheap labor offered through slavery, and the advantage of men of subjecting women to their control, and the control desired by those of wealth trumped any consideration of the morality of full equality. Nevertheless, the idea of universal equality was born, and I, for one, celebrate its launch and the difficult progress it has made over the last 250 years, despite the fact that the work remains far from complete. No truer statement was ever made than the assertion in an 1853 sermon by the Boston abolitionist minister Theodore Parker, and famously quoted by Dr. Martin Luther King. Jr. that “The arc of the moral universe is long, but it bends toward justice.” Dr. King used the quote so often that many believe it was his creation. King not only believed the statement to be true, but his writing and speeches reveal that he knew the bending would require considerable effort from people dedicated to the objective of true equality.
To control the future, our president understands that his forces need to control the interpretation of the past. He has launched a forceful effort to revise the accepted interpretation of our history, which means he has a big job of erasing the presentation of our history as it is revealed in museums and in print. In 2020, he condemned the Pulitzer Prize-winning “1619 Project” by The New York Times and threatened to withdraw federal funding from schools that use it in their curricula. He has advocated for a “1776 Commission ” for “patriotic education” that will present a very sanitized version of our history that downplays the suffering experienced by slaves and those who suffered under “Jim Crow” laws that replaced slavery between 1865 and 1964.
Heather Cox Richardson, who has the largest Substack readership with 2.6 million subscribers, pointed out in her July 27 post that Trump is now undermining the presentation of our history in public museums like the Smithsonian’s Museum of American History. If you are unfamiliar with Professor Cox’s work, click here. She begins her daily letter for July 27, 2026 with:
The Trump administration is trying to rewrite the history of the United States. Trump officials reject our traditional understanding that the country was based on the ideas the Founders wrote in the Declaration of Independence and that Americans from all walks of life have struggled ever since to make those principles come to life.
In place of that historic understanding, the administration argues that the United States was founded as a white nation whose citizens are defined by their European heritage and the land they inhabited, an echo of the “blood and soil” ideology of Germany in the 1930s.
She continues with some more specific and ominous news:
Making that shift requires erasing not just our multicultural past but also our history. On July 4 the White House Domestic Policy Council released a report titled “Saving America’s Story: How Ideological Capture at the Smithsonian Institution’s National Museum of American History Erases Our Heritage.” The report says that the National Museum of American History (NMAH) “fails in the basic task of illuminating our heritage.”
It continued: “Our central finding is not that the Museum has simply added overlooked stories, corrected perceived errors, or broadened its historical scope. Rather, it is that Museum leadership has explicitly adopted an ideological framework that no longer treats the American story as a shared national inheritance to be taught or celebrated, but as a political instrument to divide, dispirit, and discourage our citizens.”
Winners get to write history, and now our president wants to rewrite it and show us only what might make us feel good, even if what it takes is a gross distortion of the pain and suffering of dozens of generations of Black and native Americans for over four centuries that persists in a most obvious way in today’s healthcare. Facts are rejected as fake news because they can create cringeworthy discomfort. Might it be an uncomfortable surprise for our MAGA brothers and sisters, given the history supported by the president, that a lack of equality is even seen in our life expectancies? According to data from the Robert Wood Johnson Foundation reported in January 2025, using pre-COVID data from before 2018, the gap in life expectancy had been closing, but over the years it had been 5 years or more when comparing white men to black men, and it varies by state. Amazingly, in West Virginia, the gaps exceeded a decade compared to Rhode Island:
The analysis shows substantial variation across states. Life expectancy for Black women ranged from 67.5 years in West Virginia to 82.8 years in Rhode Island. Life expectancy for Black men ranged from 61.3 years in West Virginia to 76 years in Rhode Island.
It is hard to argue that we don’t need efforts to establish equity in healthcare with data like that. I find it even more disturbing when we look at mortality rates during pregnancy, comparing black women with a college education to white women who have not graduated from high school. Google’s Gemini AI reports:
Black women with a college education face a higher CDC Pregnancy-Related Mortality Report than white women who did not finish high school. Specifically, data from the Centers for Disease Control and Prevention show that college-educated Black mothers experience a pregnancy-related mortality rate that is about 1.6 times higher than that of white mothers with less than a high school diploma.
The documentation of a lack of medical equity between races is fact, not “fake news.” Race is not the only determining factor in life expectancy. Location is also a determinant. You experience healthcare inequity no matter your race or gender if you live in a “red state” that did not accept the ACA’s Medicaid extension. Data published this week demonstrates that inequity in healthcare access is an increasing burden even for for-profit hospitals. The damage to access to the ACA marketplace created by Trump’s healthcare policies has resulted in a marked increase in visits to emergency rooms by the uninsured ill. The problem will only get worse since most of the cuts to Medicaid in the One Big Beautiful Bill (OBBB) have been diabolically delayed until after the election. If you or your employer buys commercial insurance, you can expect that, like the rise in the price of gasoline following the failing unnecessary war with Iran, the price of your health insurance will increase substantially to cover the bad debt that hospitals are experiencing because of our failure to offer equitable coverage to everyone.
In 1966, Dr. King said that inequality in healthcare is immoral. Were he alive today, he could also add that we have data to show that inequality is unnecessarily expensive. Dr.King’s exact quote is:
“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”
Further along in her report, Professor Richardson writes:
The White House report is a nakedly political document, seeking to prove that “the museum profession has catechized and codified the ideological dogma of DEI to…an astonishing degree.” It builds on Trump’s belief that the Smithsonian has an “improper ideology” that Trump says is too focused on “how bad slavery was.”
Since the Smithsonian still has some legislated freedom created by Congress, at this moment the president can’t destroy it as quickly and efficiently as he did the East Wing of the White House, but he has a temporary solution. Believe it or not, Professor Richardson reports that:
On July 24 the president issued Executive Order 14415, titled “Restoring Trust in the Smithsonian Institution.” It ordered the National Park Service to place temporary signage outside the Smithsonian “that corrects inaccurate information presented inside the Museum.”
Richardson is a very clear thinker and a persuasive writer. For me, her most important comment was her summary of the meaning of this offense by the president and what his efforts attempt to block. She writes at the end of the post:
History is not just a set of facts and events. It is the study of how and why societies change. Why do people act in certain ways? Are there patterns in human behavior? What makes a society successful? What makes one fail?
Accuracy is imperative. Without it, we will learn the wrong answers—not just about the way Jim and Juan Crow worked, but also about whether our country’s foundation is about race and land or, as the Founders said, about principles and the rule of law.
Before I received Professor Richardson’s post, I was well on my way to writing about our nation’s history of slavery and the aftermath of the persistence today of the inequality that is still present now 62 years after the passage of the Civil Rights Act of 1964 and the Voters Rights Act of 1965. Again, it is important to note Dr. King’s position. In his last book, Where Do We Go From Here: Chaos or Community?, Dr. King implied that those two landmark pieces of legislation were a beginning, and not an end. He advocated extending the fight against inequality to all people suffering from inequality, and warned that the support from liberal white Americans that had helped the Civil Rights movement gain success was already showing signs of fatigue. It was as if the wisdom was, “job done.” I think that the same decline in focus on healthcare access and equity for disadvantaged populations of all races has occurred after the passage of Medicare and Medicaid, and then again after the passage of the ACA. The job of eliminating inequality will be metaphorically like maintaining a lawn; the work goes on because the weeds return.
On his July 3rd podcast, Ezra Klein had a very long conversation about the horrors of slavery and continuing inequality with Bryan Stevenson, the founder of the “Equal Justice Movement.” Klein began the podcast, entitled The America That’s Still Possible, with comments about our history and the 250th Birthday Celebration. He stated that he was in Montgomery, Alabama, and sitting in conversation with Bryan Stevenson at the Legacy Museum and the National Memorial for Peace and Justice, which Stevenson has created through his organization, the Equal Justice Initiative.
So it’s the 250th birthday of America, and Donald Trump is president.
The celebration you’re getting from the Trump administration is very specific…
There has been a severing of American history into two visions: one that can only see glory and one that can only see suffering and sin.
But one of my beliefs about politics is that until we can reintegrate that history, until we have leaders again able to tell a more holistic story of the country — one that is able to hold its triumphs and its tragedies together — it’s going to be very hard to move forward.
I’m in Montgomery, Ala. I think of Montgomery in some ways as the birthplace of American democracy. Not where it was conceived — that’s the founding — but where the actual thing promised at the founding really began to be born.
Klein is saying that the 1955 Montgomery Bus Boycott was the moment when the Civil Rights movement gained national attention. It was also the moment that Martin Luther King, Jr. became the inspirational leader of the movement. After Montgomery, we began in earnest to try to make the principle of equality articulated as an aspiration in the Declaration of Independence a reality. Montgomery was a beginning. Stevenson has made it a place of remembrance and one that can provide inspiration to continue the work.
I related strongly to the discussion of history about the horrors of slavery, the Civil War, the Jim Crow era, and our ongoing struggle to live up to our founding concepts. You must remember that the end of slavery in territories controlled by the Union Army that followed Lincoln’s “Emancipation Declaration in 1863, which was just an executive order, or by the ratification of the 13th Amendment to the Constitution on December 31, 1865, did not create equality, nor did the passage of the Civil Rights Act in 1964–99 long years after the end of the Civil War. Growing up in Kentucky, Oklahoma, Texas, and South Carolina from the mid-forties to the mid-sixties, I was living in an apartheid environment where it would have been a wrong answer on a history exam if asked why the Civil War was fought to say that the Civil War was fought “To abolish slavery.” The answer my professor would have wanted would have been, “To defend States’ Rights.” I have personal experience that underlines the importance of getting history right.
Klein reminds us of the remarkable accomplishments of Stevenson defending people on death row before starting the museum:
He is also the author of the book “Just Mercy,” which was turned into a movie, where he was played by Michael B. Jordan. How many of us can say that?
But over time, Stevenson began to expand that work into questions of remembrance, of our history and how we think about it, and whose humanity we are able to see inside of it.
Talking to Stevenson, I was interested in the question: How do you create a history of this country that loves it in its totality? How do you work with America’s past and its present in a way that doesn’t trap you in pain, but also doesn’t force you to inhabit only an imagined glory? How do you have a story that pushes a country forward, that enhances rather than reduces the bonds of brotherhood and solidarity between people within it?
I will leave it there and invite you to enjoy the conversation, which is almost two hours long. I think it is a very moving argument for loving America even as we honor through recognition the pain and suffering that our less than fully realized vision of equality has created for those who have been denied equality. I liked it so much that I listened twice and read the transcript. I promise you that reading it or hearing it will move you.
The future does hold the possibility for even greater accomplishments in commerce, improved living conditions, and health. We can do more together than just “pursue life, liberty, and happiness.” We could make those goals a reality for everyone. Failing to do so puts us all in a position of continuing risk. Dr. King had the right question, “Where do we go from here, chaos or community?” It feels like everything our current leadership advocates, beginning with the destruction of the DEI movement, moves us toward chaos. History suggests that societies don’t survive without offering equity to everyone.
Moving Into August
Much of our country and Europe is suffering from unusual heat, floods, and forest fires; it feels like I should steal a phrase from the president and describe the moment as “Like we’ve never seen before!” Despite the prediction of monsoon-like weather this week, my wife and I drove down to the beach in Narragansett along the south coast of Rhode Island. Our objective was to spend a few days enjoying a long-scheduled visit with two of her classmates from the Rhode Island Hospital School of Nursing, class of 1967, and their current husbands. One couple flew in from California. The other couple drove down from Maine. The central event at any of these reunions of these nurses over the past sixty-plus years has always been the consumption of lobster, corn on the cob, and champagne. I did not grow up in New England, so eating a freshly boiled whole lobster has always felt for me like a messy science project rather than an epicurean delight.
We cut our stay short when, as predicted, the weather began to turn from gorgeous to dangerous, but before we left we had another meal at a beachside bistro down near Point Judith, where I enjoyed a great lobster bisque followed by nicely battered and fried “coconut shrimp.” While there, I took the picture of the overcast sky and the Point Judith Lighthouse at the “end of land” that you can see in today’s header.
I do believe that a great summer must have as many episodes of getting together with friends and sharing good food as you can cram into a very short season. Labor Day is only six weekends away! Don’t waste a minute of time getting as much summer as you can.
Be well,
Gene
