October 2, 2026
Dear Interested Readers,
Can Democrats Win the Senate? And Getting To Know Dr. El-Sayed
As healthcare is sort of on the ballot for the 2026 midterm election, and will certainly be a big issue in the Democratic presidential primaries in 2028, it is interesting to note that the Republican majority in the Senate includes four physicians, and that there has not been a Democratic physician Senator since Dr. Ernest Gruennig of Alaska served from 1959 to 1969. Dr. Gruennig graduated from Harvard College in 1908 and from Harvard Medical School in 1912. After earning his MD, Dr. Gruennig never practiced medicine; he was a journalist before becoming a government servant and politician.
The last practicing physician to serve as a Democrat in the Senate was Dr. Royal Copeland, a Senator from New York who served from 1923 until 1938, when he died. He was an interesting academic physician who was born and educated in Michigan, where he practiced and was on the faculty of the University of Michigan until he accepted the position as Dean of the New York Flower Hospital and Medical School (now New York Medical College) in 1908. His Congressional bio says that he was “nationally known for his writings and radio broadcasts on health problems.”
Of the four current Republican Senators who are physicians, one is Senator Doctor Bill Cassidy of Louisiana. He was “primaried” by President Trump because he voted for his impeachment. Dr. Cassidy unsuccessfully tried to make amends by voting to confirm Robert F. Kennedy, Jr. as Secretary of Health and Human Services when Kennedy’s nomination needed Cassidy’s vote to clear the Senate Finance Committee. Senator Cassidy’s plight was shared by Senator John Cornyn this year, who also crossed the president and lost his political life. Sucking up to the president must be a full-time endeavor. It seems that one strike and you are out.
There is a second Republican physician/Senator who may not survive this year: Senator Doctor Roger Wayne Marshall, an obstetrician/gynecologist who has gotten some bad press lately for suing 700 of his patients for non-payment of their medical bills after charging them 18% interest. Dr. Marshall is running for reelection at a bad time since Trump’s tariffs and the rising cost of diesel fuel are a killing blow for many farmers in Kansas. His opponent is the Reverend Adam Hamilton, the popular pastor of a Methodist “megachurch” with 24,000 members. Due to Trump’s policies and declining approval, Senator Marshall is not the slam-dunk for reelection that sitting senators in Kansas have historically been. Since the president has asked voters to “vote like I am on the ballot,” the race is a toss-up. Kansas has not elected a Democratic Senator since 1932! The times, they are “a changing.” Unfortunately, Rand Paul, an ophthalmologist and Senator from Kentucky, and John Barrasso, an orthopedic surgeon and Senator from Wyoming, aren’t up for reelection this year.
Since my wife and I want the country saved for democracy for our grandchildren, we have been making small donations to Democratic Senate candidates in critical races across the country. The few bucks we give won’t offset the hundreds of millions flowing to Republican opponents from political PACs legitimized by the Supreme Court in its Citizens United decision of 2010, but the act of giving does mollify some of our darkest fears about the future, even as we anxiously await the outcome of November 3rd.
Number one on our list is Chris Pappas, the Democratic candidate for the Senate seat in our state being vacated by Senator Jean Shaheen. We have a special antipathy for Republican Senator Susan Collins of Maine, and support opponent Troy Jackson, the last-minute replacement for the flashier Graham Platner, who failed a test of morality that doesn’t seem to apply to Republicans. We can simultaneously thank Senator Collins for her vote back in 2017 that helped save the ACA and hold her accountable for helping to put Bret Kavanaugh on the Supreme Court and approving Pete Hegseth and RFK Jr. for the Cabinet. She needs to be held accountable.
Moving down the coast to my old home state of South Carolina, Dr. Annie Andrews, an academic pediatrician/hospitalist in Charleston, is closing the gap with the much less qualified Darline Graham, sister of Lindsey Graham. Almost as remarkable as the possibility of flipping the Senate seat in South Carolina is the resurgence of former Senator Sherrod Brown in the previously deep red state of Ohio.
One of the most exciting and potentially successful efforts is James Tallarico’s candidacy in Texas, where I spent much of my childhood. Texas has not elected a Democrat to the Senate since 1988, when Lloyd Bentsen was elected to his last term. Thanks to many of the immigration cruelties experienced by the Hispanic population of Texas, the obvious character flaws of Republican Ken Paxton, as well as the disastrous impact of the president’s social policies in the state with the highest percentage of citizens without access to healthcare, which is amazing given its resources, and Mr. Tallarico’s obvious political skills, this may be the year when Texas moves from deep red to purple.
We have also added our contribution to the efforts of the aforementioned Reverend Adam Hamilton of Kansas, and the amazing Mary Peltola in Alaska. I will say more below about the exciting candidacy of Abdul El-Sayed in Michigan, and I am taking for granted that former Governor Roy Cooper will win in North Carolina. In Nebraska, the sitting Republican Senator Pete Ricketts is vulnerable to independent Dan Osborn. In Iowa, things are looking hopeful for Josh Turek, who is seeking the open seat against Republican Representative Ashley Henson. South Dakota, independent (formerly Democratic) Brian Bengs has an improving chance against sitting two-term senator and former governor, Republican Mike Rounds.
I expect that Roy Cooper, a Democrat and former governor of North Carolina, will win the seat vacated by Republican Tom Tillis, and that Jon Ossoff will retain his seat in Georgia. Most pundits expect a “blue wave” in the House. I am hoping that the Senate swings to Democratic control. Miracles do happen. We live in an age of uncertainty, and I am encouraged by the often true reality that in the end narcissistic sociopaths do disappoint those foolish enough to follow them.
I have asked Google’s Gemini a question it can’t definitively answer. I asked if El-Sayed, Jackson, Pappas, Cooper, Andrews, Ossoff, Brown, Hamilton, Turek, Bengs, Osborn, Tallarico, and Peltola all won their Senate races, what would the Senate majority look like? The little wheel that spins as the AI agent(s) think turned and turned without much of an answer; finally, it said:
According to campaign strategies outlined by progressive groups like Forward Blue, this specific slate of candidates represents a mix of defensive holds and offensive pickups designed to retake the upper chamber from the Republicans. [1, 2, 3]
Majority Dynamics
- A Democratic-Led Senate: To determine the precise Senate majority and see if sweeping these highly competitive seats would secure enough total seats to surpass the 50-seat threshold needed for control, consult official election results and party seat distributions.
[1, 2, 3]
- Flipping Key Seats: A clean sweep means successfully flipping deep-red or highly competitive states—such as Texas (James Talarico), Alaska (Mary Peltola), and North Carolina (Roy Cooper)—while holding onto vital battlegrounds in states like Ohio (Sherrod Brown) and Georgia (Jon Ossoff). [1]
Since AI didn’t really do the job, I will try.
Currently, the Senate makeup is 53 Republicans, 45 Democrats, and 2 Independents who caucus with the Democrats, giving Republicans a 53 -47 majority. Tom Tillis’ seat should go to Democrat Cooper. Jon Ossoff should be reelected. I hope that Jean Shaheen’s seat is retained by Democrats’ Chris Pappas. I hope that Dr. Abdul El-Sayed will retain the seat currently held by retiring Michigan Senator Gary Peters. If that is all that happens the tally changes to 52 Republicans, 46 Democrats, and 2 independents.
As much as I hope that Andrews and Bengs come from behind, I expect South Dakota and South Carolina to be retained by the Republicans, but I see great possibilities for Jackson in Maine, Brown in Ohio, Tallarico in Texas, Peltola in Alaska, and Osborn in Nebraska. If those races were won, the tally would be 50 Democrats, 47 Republicans, and 3 Independents, with at least 2, and probably 3, caucusing with the Democrats, which would effectively give Democrats plus Independents a 53-to-47 majority. It just gets better: 51 Democrats to 46 Republicans and 3 Independents, if Hamilton takes Kansas, for which there is a possibility. It gets seriously amazing at 52-45, plus the 3 Independents if Turek wins in Iowa, which is beginning to look possible given Trump’s undermining of the farm vote amid rising diesel and fertilizer prices resulting from his adventures with Iran. The absolute best possibility occurs if Andrews wins in South Carolina and Bengs is elected as an Independent in South Dakota. That would make it 53 Democrats, 43 Republicans, and 4 Independents. Assuming that all Independents caucus with the Democrats, we have a very strong majority going into the 2028 elections that is just 3 votes shy of an ability to end a filibuster. The Hill, an online political publication, gives credence to part of my fantasy. They begin their analysis by writing:
Recent polling showing Democrats performing strongly in Senate battlegrounds and more reliably red states is fueling optimism that the party could clinch both chambers in November.
Were the Democrats to take the Senate, would our president revert to his former election-denial behavior and try, in some way, to nullify the results? Are the ads popping up on TV that tout the greatness of America and feature the president in heroic poses before “Paid for by the US Government” appears on the screen an ominous harbinger of things to come? November may be an interesting month.
Unless you have a total abhorrence of the current news cycle and have sworn an oath not to follow the progress toward the 2026 midterms, now just a month away, you probably know that this year the Democratic Senate candidate from Michigan is Dr. Abdul El-Sayed. He is an extremely accomplished epidemiologist with an MD from Columbia, a PhD from Oxford as a Rhodes Scholar, and a former faculty member at Columbia before returning to his home state to revitalize the Detroit Health Department as the public health commissioner. At the age of 33, he ran unsuccessfully for governor of Michigan in 2018. He finished second to Gretchen Whitmer in the Democratic Primary, despite the fact that, for much of the campaign, there was a question about his eligibility because he had at one time been registered to vote in both New York and Michigan, which is legal as long as you vote in only one of the states. He had voted in New York in 2012. By the time the question was settled in the courts, just weeks before the election, his campaign had been severely hindered and had lost much of its momentum because of the uncertainty.
Dr. El-Sayed is a talented communicator and author. He was the student commencement speaker for his undergraduate degree from the University of Michigan. His speech before an audience of many thousands was so good that Bill Clinton, the featured speaker, went off script to advise El-Sayed that he should become a politician rather than go to medical school, as was planned. If you follow the political news, you know that Dr. El-Sayed narrowly won the Senate primary in Michigan, where his name, religion, and progressive politics were issues in a purple state where Trump beat Harris by only 80,000 votes.
Of all the Senate candidates, Dr. El-Sayed has been the most interesting to me. He has made Medicare For All an explicit goal, but, more importantly, he addresses the social determinants of health from the perspectives of epidemiology and his experience in public health. His diagnosis is that America suffers from an epidemic of “insecurity.” I have enjoyed his 2020 book, Healing Politics: A Doctor’s Journey into the Heart of Our Political Epidemic. I asked Google Gemini to give an overview of Dr. El-Sayed’s writing. The response was:
Dr. Abdul El-Sayed has written two major books that blend his background as an epidemiologist, public health official, and progressive politician: [1]
- Healing Politics: A Doctor’s Journey into the Heart of Our Political Epidemic
- When it was written: Published on March 31, 2020 (following his 2018 run for Governor of Michigan).
- Summary: Part memoir and part policy framework, the book treats political polarization and social fragmentation as a public health crisis. Marrying his unique clinical perspective with epidemiology, El-Sayed diagnoses an “epidemic of insecurity” afflicting the country—driven by economic inequality, corporate influence, and systemic disinvestment. He argues that fixing our broken system requires a “politics of empathy” and comprehensive structural changes that treat basic necessities, like healthcare, as fundamental human rights. [1, 2, 3, 4]
- Medicare for All: A Citizen’s Guide
- When it was written: Published on January 3, 2021 (co-authored with Dr. Micah Johnson).
- Summary: This book serves as a straightforward, comprehensive manual designed to cut through partisan talking points and demystify single-payer healthcare reform in America. It analyzes the systemic flaws and costs of the current U.S. healthcare model and provides a detailed roadmap of how a Medicare for All system would actually function, look, and be paid for in practice. [1, 2, 3]
(Note: He also co-edited an academic textbook, Systems Science and Population Health, published in late 2016.) [1, 2]
Last week, I was excited to hear Dr. El-Sayed explain his personal history, values, and political ideas in an interview with Ezra Klein. Click here to learn more by listening: What Does Abdul El-Sayed Believe? The Senate nominee talks about his view for the future of the Democratic Party. Since the interview is over 90 minutes long and the transcript is a messy 18,000 words, I will just lift out a few of Dr. El-Sayed’s remarks, in the hope that, as you appreciate the logic behind his comments, you will become as excited about the prospect of having him in the Senate as I am. Klein introduced the conversation by saying:
The Michigan Senate race has emerged as perhaps the most important proving ground for some of the key fights in the Democratic Party right now. How will left populism perform in a Rust Belt state? What should the next Democratic idea for health care reform be? Is it time to rebuild Obamacare, or is it time finally for Medicare for All or Medicare for More or Many? And what should the Democratic Party’s relationship to Israel and to the Palestinians be? What should America’s role in that conflict be? Dr. Abdul El-Sayed is the Democratic nominee in Michigan. He’s running against Republican Mike Rogers up by a few points in most polls. Very few candidates this cycle have been argued over as much or clipped around the internet as often as him. But I wanted to talk to him myself, to hear who he is and what he would actually do in the U.S. Senate.
In the conversation, we learn that Dr. Sayed’s father was a good student from a poor Egyptian family who earned a Ph.D. in engineering at Wayne State University, and then became a lifelong employee of GM. His mother was also Egyptian. She is a physician. Their marriage was “arranged” and did not work out. They divorced not long after Dr. El-Sayed was born in Michigan. His father then married a woman who is also a Ph.D. with deep family roots in America; she is a descendant of Abigail Adams, converted to Islam, and raised him and two half-siblings. Her parents are typical small-town Michiganders, and have been very influential in Dr. El-Sayed’s life.
Dr. El-Sayed visited his illiterate but very wise Egyptian grandmother and impoverished cousins when he was a teenager. The contrast between what his life would have been like had he been born in Egypt versus the privilege he experienced in America has had a profound impact on his values and has been a great motivation for his desire to improve the lives of Americans who are inequitably excluded by race or economics from the benefits he has been by chance allowed to enjoy. In his 2020 book, he gives several examples of how before and after 9/11 he was bullied by classmates or mistreated by teachers and officials because of implicit biases related to his skin color and religion. As I listened to him and later enjoyed his 2020 book, I was reminded of Jimmy Carter’s 1975 book, Why Not the Best? and Barack Obama’s 1995 Dreams from My Father: A Story of Race and Inheritance.
After a long and very interesting review of his life and the factors in the formation of his sense of moral purpose, the conversation edges into current politics and healthcare policy, when Klein asks what led El-Sayed to forgo the practice of medicine in favor of epidemiology and public health. His answer was:
I really loved the clinical care part of things I really did. I loved people, I love hearing their stories. There’s something, a gift that people give when you talk to them in a clinical encounter where they bring you their worst problem on their worst day, and they’re willing to share that vulnerability with the belief that you can help them. And so often, you’d be in those clinical encounters and realize that I actually am not being given the tools to help you fully. And this institution gives those tools to some people and not others. And if you’re concerned with the idea that not everybody gets to live a long, healthy life and you start wondering why. And you spend a whole lot of your life learning how to be a solution to that, in part, and then realize that you’re in this institution, you’ve got these skills, but the institution itself hamstrings you from actually doing the thing that needs to be done…
From that platform El-sayed launches into the story of one woman that he cared for while working as a fourth-year extern in a New York hospital in a disadvantaged neighborhood. He realized that the current structure of care, its financial incentives, and the overwhelmingly negative issues of the social determinants of health made adequate care for this patient impossible. She would never find the care she needs without attention to the inequality in our society. He didn’t use the words “moral injury,” but what he personally experienced was the inability to make a difference in this woman’s life. Through this experience, he realized that the work he was called to do was to understand the epidemiology of our national distress, which is most problematic for our underserved populations. He stopped applying for an internship and residency in IM and turned all his energy toward epidemiology and public health. I should add that his 2020 book tells the same story, while providing a great overview of both the history and the practice of epidemiology and public health.
The conversation between Klein and El-Sayed about this patient, who was beyond help in our society, is the launching pad for a succinct analysis of all the issues I write about each week. I felt in total agreement with Dr. El-Sayed’s analysis of our current state. He sees a nation without a system of care capable of addressing the issues driving so much of our expense and failure. Approaching it as an epidemic, he postulates that the infectious agent that is at the root of our national malaise is “insecurity.” He generously extends insecurity to everyone, including the wealthiest members of our society who are even insecure about whether politics and factors beyond their control might rob them of all that they enjoy. Along the way, he presents the transition to Medicare For All as a much better way to get everyone into a system of care, although the complete portfolio of the changes he advocates extends to housing, education, food security, transportation, and attention to our nation’s failing infrastructure, plus our suicidal disregard for the environment and the climate.
Returning to access, he admits that an immediate jump to “Medicare For All” may be politically impossible, even if, in 2029, Democrats control Congress and the presidency. He sees an incremental path forward, beginning with a Medicare-like offering for more people, including children, and earlier than age 65. His ideas have been echoed by Paul Krugman, which I discussed in an August post.
Dr. El-Sayed is both strategic and tactical. He has studied and learned from past failures. He contends that he is more worried about resistance from those who profit from our current system than about Republican pushback. I have bolded his salient points:
It’s not the Republican opposition I’m worried about. It’s the industry. Opposition industry spends huge amounts of money to push back on all of this suspended in electioneering. They spend it in lobbying and they spend it on ads. Mis and disinformation via ads. So I think there are three things that we really need to be learning from those wars, with all due respect to the people who fought them before. Number one, the war doesn’t start the day you decide to do health reform. The war starts the day you start thinking about doing health care reform. And you have to have a broad national conversation early. Number two, understand how they gin up public discourse, understand what you’re actually dealing with in the ways that they work to try to manufacture public dissent. Politicians who’ve championed a lot of these reforms have not actually gotten a running start on them, have not pushed in the way that we need to build the public momentum and discussion around what exactly we’re trying to do. [Number three] When we talked about health reform, it usually was a conversation about how you provide health care for lower-income people. Today, it’s not that. It’s how do you provide health care for the median? And I think what’s happened is that the industry has gotten so greedy that the floor underneath which we are having this conversation has so far shifted that we need to have the courage to be able to say, actually, this moment requires that kind of change. Also, the tactics on which we are going to have this debate have changed entirely to the power of the industry to drop in with second ads. That’s just not as powerful as it used to be anymore. And so I think they are losing power quickly, and we really could actually get this done in 2029. That’s what I’d like to do. But part of the reason I’m excited about this, I know I’m going to be one US Senator if I get elected. Part of my job, though, is to be the first Democratic doctor in the US Senate since 1969 who wrote the book on doing this.
The conversation goes on to cover other topics like the Palestinian question and our relationship to the state of Israel. He denies being a socialist, and describes himself as a capitalist who understands the need for effective business regulations. He does not propose adopting Sharia Law as many opponents falsely claim. His forty-thousand-foot perspective on how to approach our national epidemic of insecurity is to pursue empathetic, well-considered government policy and the repair of our woefully neglected infrastructure.
I hope he gets elected. We could use such an articulate and studied student of the social determinants of health in the Senate. His election won’t turn the world around, but I think it would be a step in the right direction.
The Colors Are Coming On Fast
This last week, we had a “nor’easter” that gave us more than three days of intermittent, and sometimes quite heavy, wind and rain. The storm has passed, and the temperature has crept up from the 50s to the mid- to high 60s, and today it will peak in the mid-70s before we get more rain. On Wednesday, we enjoyed a mix of clouds and sunshine in the late afternoon, and on my walk I enjoyed snapping pictures of the emerging fall colors. For just a few late-afternoon hours during an otherwise drab week, I could enjoy the colors emerging from the gloom, as you can see in today’s header. I think we are about a week away from peak color, which generally occurs around Columbus Day or, if you prefer, Indigenous Peoples Day.
I am told that all the prerequisites for a gorgeous fall display of color are in place for 2026. I confirmed this hearsay with Google Gemini. It responded:
Yes, the natural checklist for an exceptional autumn color palette has aligned beautifully across several major regions for 2026. Forestry experts and meteorologists note that after previous seasons plagued by severe droughts, the environmental factors required to trigger intense red, deep orange, and vibrant gold pigments are highly favorable, especially across the Northeast, the Great Lakes, and the Central Appalachians. [1, 2, 3, 4, 5]
2026 has been a mixed year of ups and downs. I would love to think that the color this fall will be one of its high points, along with a very successful midterm election on November 3rd that delivers both the House and the Senate into Democratic control. It occurs to me that by the election on November 3, all the color will be “brown and down.” Enjoy it while you can! Simultaneously, I will be enjoying my fantasies about a very large “blue wave.”
Be well,
Gene
