September 12, 2025
Dear Interested Readers,
Much of this letter, which begins in remembrance of 9/11, including comments about previous assassinations in our nation’s history, was written before the tragic assassination of Charlie Kirk, the very effective and influential young conservative campus organizer, debater, presidential ally, and spokesman who was fatally shot while addressing a large crowd of students at Utah Valley University. I am completely in agreement with the sentiment expressed by many politicians and pundits that violence has no place in the politics of our nation. The theme of what I had written before the chilling event in Utah, which took Mr. Kirk’s life, was that the natural course of our history has been frequently diverted by violent events.
Considering the counterfactuals following one of these events of what might have happened had violence not redirected the flow of our history, has always extended the regret that I have felt for the victim, or victims, to all of us. Because of these events, what might have been often never is. We must share the huge sense of loss that Mr. Kirk’s family must feel. We must also accept that political violence harms us all and is a threat to our collective future. People naturally have different opinions, fears, and hopes. In a democracy, debate and not violence are how we blend those differences into a future that we hope will benefit everyone.
Twenty-Four Years With Too Many Loses
The anniversary of one of the most significant events of our collective lifetimes has come around again. I think it is likely that a hundred and sixty years ago, the moment that one learned that Lincoln had been shot was unforgettable to those who heard of the event with horror and disbelief. When I hear of such an event, I always ponder how it changed history. If Lincoln had not been assassinated, would the difficulties of the Reconstruction and the era of Jim Crow have been avoided?
As much as I might ponder the counterfactuals of Lincoln’s assassination, I am a little more certain in my opinion about what might have happened had Lee Harvey Oswald failed to make his difficult shot in Dallas. Those of us who are at least seventy probably remember exactly where we were when we got the news. I was sitting in an advanced placement freshman English classroom, waiting for my professor to arrive, as a murmuring spread through the room that maybe the president had been shot in Dallas. Some fools in the back of the room were yucking it up about perhaps he had gotten what he deserved. My professor arrived, with tears in his eyes, and a scowl for the jokesters, and told us all to leave, saying that there was no way that we could have class. Back in my dorm, it was not long before I heard Walter Cronkite announce the president’s death at 2 PM.
The image of Cronkite speaking will never leave my mind’s eye. So it is with the events of September 11, 2001. I am sure that almost every reader of these notes remembers the horror of that day and can see in their mind’s eye the people jumping from enormous heights to avoid the flames that trapped them without hope of survival. Each year, when 9/11 comes around, I always ponder the counterfactuals of that horrific day. What if we had learned of the plan and it had been blocked, and never occurred? Would we have had a war of almost twenty years in Iraq and Afghanistan if 9/11 had not happened? How would our Middle East policy have been different? Would all the miseries endured by our soldiers and their families, including the suicides of those suffering from various forms of PTSD, that occurred during twenty years of military action, have been avoided? The questions pile up and can never be answered.
The events of 9/11 felt particularly close to home for my family since four Wellesley residents were on the two planes from Boston that hit the World Trade Center Towers. One of those people lived just a couple of blocks from our home, and some of the children of the four attended school with our children. My most ingrained memory of the day followed a knock on the door of the exam room in the Medical Specialties Department at our West Roxbury offices of Harvard Vanguard Medical Associates, where I was seeing a patient. When I opened the door, my medical assistant made the strange suggestion that the patient and I should come down the hall to the staff breakroom, where there was a television. The room was quiet as those gathered around a television watched again and again the replays of a jet plane flying into a building. The scene was beyond belief. The staff soon began to send waiting patients home, and to call those who had not yet arrived for their appointments to tell them that the office was closed.
What followed is a less distinct blur. I am sure that there are similarities between my experience and yours, and of millions of others across our country, who will never forget the day. Fortunately, I did not need to worry about family members being in immediate danger. We did connect with our son, who was away across the continent in Portland, Oregon, for his freshman year at Reed College. Our irrational fear after talking to him was that he would impulsively leave college and volunteer for military service. We called close friends in Portland and asked them to watch over him. In retrospect, our call was probably unnecessary, but it was the manifestation of the irrational fear that is triggered by the uncertainties that can grip otherwise rational people when totally unexpected events occur.
Unfortunately, our history has many moments of uncertainty that were triggered by the violence of one individual or a group. In my lifetime, President Kennedy’s assassination was not the first in a series of similar events that surely changed history. In retrospect, the list is chilling and includes Malcolm X, Medgar Evers, Dr. Martin Luther King, Jr., and Bobby Kennedy. The sense of loss at the time was expressed in the song “Abraham, Martin, and John.” To hear Dion’s original version, click here. My favorite part of the song, the bridge to the part of the song about Bobby Kennedy, comes toward the end.
Didn’t you love the things that they stood for?
Didn’t they try to find some good for you and me?
And we’ll be free
Some day soon, it’s gonna be one day
What if Sirhan Sirhan had not shot Bobby Kennedy late in the evening of June 5, 1968? I learned of his death early the next morning from a classmate as I arrived to take an exam in neurophysiology, the last event of my first year of medical school. Would he have defeated Nixon? Would the war in Vietnam have ended sooner? Would we have returned from the war in Vietnam to resume a more effective war on poverty at home? For sure, we would not have had the Watergate fiasco.
As I contemplate the counterfactuals that come to mind in our history, I also realize that the natural processes when tragedies don’t occur include what I call “unforced errors.” As an observer of sports, I know that the winning team usually has a good strategy and has fewer turnovers or “unforced errors.” One could argue that a prominent factor in the reelection of our president following the riot on January 6, 2021, multiple court losses, a felony conviction, and manifest evidence of habitual lying and sexual predation resulted from a series of unforced errors made by those who sought to defeat him plus his strategy of “norm busting” and denying that he lost the 2020 election. He definitely had a strategy based on an insightful read of public anger and self-interest.
What would have happened if Mitch McConnell had voted for impeachment rather than deciding to make a speech in the Senate against Trump’s act of insurrection, suggesting that Trump’s punishment should be left to the courts? What would have happened if Merrick Garland had promptly named a special prosecutor? What would have happened if Fani T. Willis, the DA for Fulton County, Georgia, had not hired her lover as a prosecutor in the legal action in Georgia against Trump’s attempt to reverse the election results in Georgia? What would have happened if Joe Biden’s closest advisors had admitted that he was probably not going to be able to campaign effectively because of his health issues? Kamala Harris is releasing a new book, where it is reported that she thinks that perhaps she made an error by not defining herself as significantly different from Biden. Was that an unforced error?
I hope that all was well with you yesterday as you relived your own 9/11 experiences. If you found yourself pondering counterfactuals like I did, perhaps your thoughts expanded to include the counterfactuals of the 2024 presidential election. The aspirations for healthcare equity, improvement in the Social Determinants of Health, universal access to healthcare, improvements in healthcare finance, and the environment of practice and the experience of patients have all been affected by events in the political and cultural environments of the country. I decided to ask AI to help me explore the healthcare implications through the counterfactuals of the 2024 presidential election. I asked both the AI attached to Google and ChatGPT to consider the issues. The two answers were quite similar, but I thought the structure of ChatGPT’s response was better. My exact question was :
How might the future of healthcare, medical research, and public health been different if President Trump had lost the 2024 presidential election to Kamala Harris?
ChatGPT said:
Here’s a grounded and well-documented exploration of how American healthcare, medical research, and public health might have fared differently if Kamala Harris had defeated Donald Trump in the 2024 election:
Health Insurance & Access to Care
1. Affordable Care Act & Subsidies
- Kamala Harris campaigned on protecting and expanding the ACA, including making temporary premium subsidies permanent, thereby preventing a projected loss of coverage for millions—possibly 4 million at risk if subsidies lapsed after 2025. Commonwealth FundSTATThe Lund Report.
- Conversely, under Trump, policymakers moved to reduce or eliminate expanded ACA subsidies—likely resulting in higher premiums, fewer people insured, and reduced access to care. T. Rowe PriceAP News.
2. Medicaid Expansion and Funding
- A Harris administration likely would have preserved Medicaid expansion and encouraged additional states to opt in, ensuring continued federal financial support. JHU Bloomberg School of Public Healthqa.publichealth.jhu.edu.
- In contrast, a Trump presidency might have rolled back Medicaid expansion incentives or introduced work requirements, weakening coverage in rural and underserved areas. JHU Bloomberg School of Public HealthAP News.
Medical Research and Public Health Infrastructure
1. NIH and Research Funding
- Under Harris, NIH and broader biomedical research were expected to enjoy sustained or increased investment—continuing existing trends in innovation and pandemic preparedness.
- For Trump’s second term, clear evidence indicates real funding cuts: For example, the University of Texas Medical Branch lost over $19 million in NIH grants, severely disrupting antiviral research and warning-preparedness capacities. Houston Chronicle.
- NIH employees protested with the Bethesda Declaration, calling for the restoration of life-saving research funding halted under Trump’s early 2025 reorganization. Wikipedia.
Environmental and Public Health Protections
- Harris was expected to continue—and perhaps expand—federal regulation of toxic substances such as PFAS (“forever chemicals”), aligning with action already underway under the Biden administration. The Guardian.
- In contrast, Trump’s policy trajectory indicated potential rollbacks on environmental health regulations, posing threats to clean water, pollution control, and long-term health equity.
Healthcare System Stability & Workforce
- A Harris administration likely would have propped up the healthcare sector through continued ACA and Medicaid support; as scholars note, healthcare spending has been a major driver of job growth since the pandemic. Financial TimesCommonwealth Fund.
- Conversely, Trump’s rollback of healthcare financing could have led to cutbacks in hiring and reduced economic stability in healthcare-dependent regions. Financial Times.
Summary — What Might Have Been Different
| Policy Domain | Under Harris | Under Trump (Continued) |
| Insurance Coverage | Preserved coverage, extended ACA subsidies | Coverage loss, higher premiums, fewer health benefits |
| Medicaid Expansion | Continued expansion and support | Rollback risk, narrowed access |
| Research Funding (NIH) | Sustained or increased investments | Program cancellations, grant terminations |
| Environmental Health | Stronger regulation (e.g., PFAS) | Regulatory weakening |
| Healthcare Workforce | Continued job and system stability | Potential hiring pullback and hospital strain |
Bottom Line:
A Harris presidency would likely have strengthened healthcare access, protected public health systems, and sustained critical research funding and environmental protections. On the other hand, a second Trump term saw measurable negative impacts—especially on coverage, research, and public trust.
Let me know if you’d like a deeper dive into one of these areas—such as drug pricing, reproductive rights, or pandemic preparedness.
I didn’t accept the offer to extend the analysis, and I don’t think that the Bot told me anything that was either news to me or to you. The benefit of the analysis is to concentrate our attention on what has been lost, what will be lost, and how difficult it will be to turn the process around in an environment of deep political division. We know who will be injured first. What we don’t know and can only guess is when we will all be losers. Charlie Kirk was an effective spokesman for very conservative ideas. One of his themes that was particularly disturbing to me was his embrace of “replacement theory.” He was entitled to his opinions, and his beliefs did not justify his assassination. Other well-documented themes that he pushed as he sought to gain credibility with young people who had become disillusioned with their personal prospects in a homeland where they felt forgotten or neglected were, according to Google’s AI:
Key arguments Charlie Kirk used to gain influence with young voters:
- The “MAGA Doctrine” and “American Renewal.” Kirk positioned himself as a champion of the “Make America Great Again” philosophy, arguing that America needed revival rather than a preservation of the status quo. This argument resonated with young people who felt that the American Dream was becoming increasingly unreachable.
- Economic anxiety and the cost of living. He addressed economic concerns directly, claiming that young Americans have to “pinch pennies” while Democrats spend billions on undocumented immigrants and foreign nations. This argument connected young voters’ financial frustrations with his political agenda.
- Campus activism and free speech. As the founder of Turning Point USA, Kirk gained prominence by organizing events on college campuses, including the controversial “Professor Watchlist”. He championed free speech and encouraged students to confront what he characterized as liberal bias and “orthodoxy” in academia.
- A “new conservatism” based on religion. Particularly in later years, Kirk blended his politics with evangelical Christian beliefs, promoting the Seven Mountain Mandate, a concept suggesting that Christians should lead in seven key areas of cultural influence. He argued that separating church and state was a false premise and that conservative Christians were facing “dangers and threats” in modern America.
- Culture-war provocations. Kirk was an avid participant in “culture-war” debates, using his podcast and social media to attack liberal policies and figures. His controversial and provocative stances on topics like race, immigration, and gender identity generated significant engagement and media attention.
- Amplifying Donald Trump’s message. A close ally of Donald Trump, Kirk used his platforms to promote Trump’s rhetoric and amplify his claims, including the unfounded claims of voter fraud in the 2020 election. This strategy helped mobilize a new generation of grassroots support for the Trump movement.
His strategy was effective, and the young voters that he convinced to overlook the policies and lack of integrity that defined Trump may determine the outcome of many future elections. The Democratic loss in 2024, in my opinion, damaged the future of healthcare for decades to come. Kirk’s successes and not his death should remind us that convincing voters that policies that will improve healthcare at home and benefit others around the world will depend on the preservation of democracy, but those ideals will be defeated without the peaceful execution of strategies that convince skeptical people of the benefits of thoughtful and just policies.
It is much harder to argue for hope than to warn of catastrophe. Consideration of the counterfactuals following violence, avoidance of unforced errors, and the development of solid strategies to sell progressive ideas devoid of disrespect and projecting hope for everyone seems to me to be the right way to get back on track toward better and more equitable healthcare for all of our neighbors. There are lessons to be learned from the remembrance of our shared tragedies and consideration of the “what ifs” of the counterfactual possibilities.
Further Adventures With Walter or Wanda, Our Resident Groundhog
If you are a regular reader of these weekly notes, you will remember that not long ago, the “header” for the weekly letter was a picture of the groundhog that had taken up residency under our deck. The deck is close to the ground and surrounded by dense vegetation, so that we could not see what he was doing. We knew that the entrance to his abode was next to the granite steps going from the deck to the lakeside patio.
He was very cute, and we saw him so frequently that he was almost like a pet. We named him Walter, assuming that he was an unattached male, but our friend could have been properly named Wanda for all we knew. What worried us was the damage our uninvited new resident might be doing in pursuit of its natural way in the world.
Good fortune seemed to intervene one day when, on my walk that goes by the public boat landing on our lake, I spotted an interesting name on a truck that was sitting there attached to a boat trailer. The sign on the truck door said, “Live Free Wildlife Solutions.”
The business phone and email were there for me to capture with a picture. I later learned that the proprietor of “Live Free” enjoyed fishing on our lake. He is a “catch and release” kind of guy that fits philosophically with “Humane” solutions, which was also advertised in a second sign on the truck. As you can see in the picture, free estimates were available.
After procrastinating for a few days, I contacted Live Free Wildlife and made an appointment for a visit about a week later. To my surprise, there must be a backlog of requests. Scheduling, between the proprietor’s work and his fishing, was sort of like trying to get an appointment with a new primary care provider. When he did show up, I observed a real New Hampshire beard that would be the envy of “ZZ Top” band members or the picture of one of the Smith Brothers on the right side of one of their boxes of cough drops. I quickly learned that he had attended high school with the daughters of our neighbors across the road. My inquiries confirmed that he was a “catch and release fisherman.” He came across as a very responsible young man. My neighbor later suggested that in high school, one of his daughters had dated him.
His deal was that he would bait a humane trap on a Monday and then check it every day for a week for $450. Once captured, the animal would be taken far away to a wooded area about twenty miles away, where he had permission to release what he caught. There are vast tracks of “wilderness” near Croyden Peak between I-89 and the Connecticut River going north from my home. He attested that he had a high percentage of success.
Two traps were set. He returned faithfully every day to check and reset the traps with fresh bait. At the end of the week, Walter or Wanda had not taken the bait. We negotiated a discount. I paid him $250 for his efforts, and we talked about a second attempt at a later date.
A week or two later, we began to see Walter/Wanda in the front yard as well as around the backyard patio near the lake. After seeing him in the front yard on several successive days, I decided to get a closer look. I never got closer than about 30 yards, because the minute I was seen coming out the front door, he quickly waddled off to a stone wall that adjoins our second garage and guest apartment near the entrance to our property. I was able to take a picture of him and where he was hiding a new burrow under the stonewall.
I again called Burke, our Live Free consultant, and we agreed that he would “rent me” a trap so that I could try to catch Walter/Wanda. If I were successful, then he would transport the captive to a new home in the wild.
I was intimidated by the trap. He had dropped it off when I was not at home, and it took me a while to figure out how to load the device. Secondly, it was Friday. What if I were immediately successful? Burke did not indicate that he was available for removal over the weekend. I decided to place the trap on Sunday evening under the cover of darkness. After relearning what I had figured out on Friday about how to load the trap, I made my way in the darkness to the base of the wall. I chose a circuitous route, which enabled me to come up from behind because my wife had done an Internet search that produced an article about the importance of not being seen and not making the trap obvious. Fortunately, there are tall daylilies along the stone wall, which is on a steep slope, and it was easy to locate the trap without it being too obvious.
Monday morning, I was eager to see if I had succeeded where Burke had failed. To my chagrin, Walter/Wanda had not taken the bait. The same was true on Tuesday morning. I began to consider alternatives. I contacted Burke to describe my lack of success, and he said that if our humane efforts failed, there were other “lethal” alternatives. Those words gave me chills. As I returned from my Tuesday afternoon walk, I decided to check the trap, and to my delight, I discovered an unhappy but relatively relaxed Walter or Wanda. He/She had enjoyed all my bait.
Burke immediately answered my call and was present in less than twenty minutes since he was in the area, being humane with another customer. Per our agreement, I wrote out a check for $125. Burke made some repairs to the base of my wall and expeditiously transferred our friend to a new home. In the end, I saved $75 and had the sort of success that every 80-year-old would cherish as evidence that “I am not done yet!” I shudder to consider the counterfactuals that might have been associated with an alternative outcome.
I hope that you have a great fall weekend, embellished with some unexpected success.
Be well,
Gene
P.S.: The beautiful scene of mist rising from the lake at sunrise, which is today’s header, was posted on the Little Lake Sunapee Facebook page this week by my friend and neighbor, Peter Bloch, who gets up very early to see things that those of us who are slothful and arise after 9 in retirement can only enjoy in photographs.
