Category: Health Policy

Father Christmas Reminds Us We Can Do Better Than This

Dec 23, 2025

By MIKE MAGEE

The Ghost of Christmas Past, in the form of Surgeon General C. Everett Koop, has returned this season to torture one RFK Jr who refuses to fully share life saving vaccines with children. In the encounter, the ghostly Koop reviews a time 37 years ago when citizens came together to celebrate separating scientific fact from fiction with life-saving effects.

Beginning in 1988, the United States, along with the rest of the world, had formally acknowledged and celebrated World AIDS Day on December 1st each year – that is until 2025. At President’s Trump’s direction the State Department, and with HHS support, turned their back on an inconvenient truth – the Republican early record on HIV/AIDS. Let’s channel the truth-telling Surgeon General from Christmas past and remember this telling story.

On June 5, 1981, the CDC reported 6 cases of Pneumocystis carinii associated with a strange immune deficiency disorder in California men. Drs. Michael Gottlieb and Joel Weismann, infectious disease experts who delivered care routinely for members of the gay population in Los Angeles, had alerted the CDC. Inside the organization, there was a debate on how best to report this new illness in gay men.

The vehicle that the CDC chose was a weekly report called the Morbidity and Mortality Weekly Report or MMWR. So as not to offend, the decision was made to post the new finding, not on page 1, but on page 2, with no mention of homosexuality in the title. Almost no one noticed.

On April 13, 1982, nine months after the initial alert, Senator Henry Waxman held the first Congressional hearings on the growing epidemic. The CDC testified that tens of thousands were likely already infected. On September 24, 1982, the condition would for the first time carry the label, AIDS – acquired immune deficiency syndrome.

The new Surgeon General, C. Everett Koop’s focus at the time, along with the vast majority of public health leaders across the nation, was not on a new emerging infectious disease, but rather on the nation’s chronic disease burden, especially cardiovascular disease and cancer being fed by the post-war explosion of tobacco use. He had already surmised that the power of his position lie in communications and advocacy.

One month after his swearing in, he appeared on a panel to release a typically boring Surgeon General update report on tobacco. He was not intended to have a big role. When Koop rose to deliver what all thought would be brief, inconsequential remarks, he wasted no time disintegrating the lobbyist organization, the Tobacco Institute. For print journalists in the audience, he was clear, concise and quotable. For broadcast journalists, he was a dream come true – tall, erect with his Mennonite beard, in a dark suit with bow tie, exuding a combination of extreme confidence and legitimacy mixed with “don’t mess with me” swagger.

As Koop would later say, after that, “I began to be quoted as an authority. And the press from that time on was all on my side… I made snowballs and they threw ‘em.” The other thing that Koop noticed early was that the Reagan Administration didn’t shut him down. That was surprising since Koop’s major supporter in a year long confirmation battle (the AMA opposed his appointment) was NC arch-conservative Senator Jesse Helms.

Add to Jesse’s wrath, R.J. Reynold’s CEO, Edward Horrigan, complained directly to Reagan about Koop’s “increasingly shrill preachments. Cigarette consumption in the US was in free fall. By 1987, 40 states would have laws banning smoking in public places; 33 states had bans in public transportation; and 17 already had eliminated workplace smoking.

Still Reagan didn’t shut him down. Now everyone from public schools to medical groups to women’s associations to civic enterprises wanted him. And beginning in late 1982, he arrived in full regalia, in a magnificent Public Health Service, Vice-Admiral’s uniform with ribbons and epaulettes. And his aide, also in uniform, always carried with him a bag of buttons for distribution which read, “The Surgeon General personally asked me to quit smoking.”

But in the most pressing public health challenge of the day, HIV/AIDS, the department was AWOL. Koop was actively sidelined by top Administration officials. Not surprisingly, the situation deteriorated rapidly. Everyone was feeling the heat, including the CDC, who removed funding for AIDS education after being accused of promoting sodomy by conservatives.

To Improve Health, Design for Agency

Dec 19, 2025

By DAVID SHAYWITZ

Agency — the conviction I can shape my future — is a vital driver of human health and human potential.

It is also the factor overlooked by most digital health platforms.

University of Pennsylvania psychologist Martin Seligman, who has spent decades studying this, says agency boils down to the belief “I can make a positive difference in the world.” People with high agency believe there is something they can do next that might help – and then they actually try.

As Seligman emphasizes, the moments when we “try hard…persist against the odds…[and] make new, creative departures” are precisely when agency is at work. That extra effort and sustained determination — not just the mindset — shows up as improved performance, greater achievement, and enhanced health. It also manifests as resilience, enabling us not only to recover from adversity but (ideally) to bounce back as an even better version of ourselves.

GLP-1s highlight the power and promise of newfound agency. For many living with obesity, past attempts at weight loss reinforced a “cycle of despair” – trying harder mostly meant failing again. With the advent of GLP-1 medicines, many found that their weight would come down — and stay down. Oprah Winfrey called the feeling “a relief, like redemption, like a gift.”

The deeper change is psychological: for the first time in years, effort feels rewarded. GLP-1s unlock an agentic dividend: the motivational boost that comes from finally being able to take control of your health. That surplus sense of possibility can be channeled into the familiar health basics — moving more and sleeping better — but also, often more importantly, into how we show up in our relationships and communities, in the enthusiasm we bring to our hobbies and pursuits, into the totality of experiences that make life so meaningful.

Agency is the motivational currency of health, the ATP of behavior change – it lets success in one domain drive progress in others.

Connected fitness platforms have a similar opportunity. Each discrete achievement — finishing a class, riding three times in a week, noticing that the stairs feel easier or the back hurts less — is a small proof of “I can do this.”

Brown and Toland weighs in on the $34.94 Labcorp test. (Part 6)

Dec 18, 2025

By MATTHEW HOLT

I know you all care, so I am giving a 6th update on the telenovela about my Labcorp bill for $34.95.

The very TL:DR summary of where we are so far is that in May 2025 I had a lab test to go with the free preventative visit that the ACA guarantees, but I was charged for the lab tests and I was trying to find out why, because according to CMS I should not have been.

For those of you who have missed it so far the entire 5 part series is on The Health Care Blog (1, 2, 3, 4 & 5). Feel free to back and read up.

When we left the scene on Sept 9, Blue Shield of California had finished their 30 day investigation and their rep read me the letter they sent me (that I couldn’t open due to their secure email not working). The letter told me that Brown & Toland Physicians, the IPA that manages my HMO, was going to investigate. Today I got a text from Blue Shield alerting me to a secure email and I got all excited, but it was nothing to do with this. And of course I should have heard from Brown and Toland in October or November.

So I decide to pick it all up again, and I called Brown & Toland Physicians or actually Altais which is the holding company that owns them and Blue Shield. I got through the phone tree and eventually got, “leave your number and get a call back” which actually happened not too long later.

The very nice rep tried to figure out my case and told me this:

On 8/14/2025 Mike at Blue Shield called Brown and Toland and asked for the original claim to be reviewed (1430201). I am pretty sure Mike is the nice man from the Executive Admin office at Blue Shield we met in part 2 (or was it part 3?).

On 8/29/2025 the benefits department at Brown and Toland finished their review and reported that the original lab test wasn’t coded as preventative lab services by One Medical, so that the co-pay of $34.95 was correct. ($34.95 was the total agreed payment for all the tests, charged at a total of $322.28. And as it was less than my $50 copay, LabCorp only charges the patient for the total, not the $50!)

Meanwhile, that 30 day Blue Shield investigation was still going on. It ended up with them asking Brown and Toland to investigate. Presumably as a direct result of that, on 9/9/2025 Kelly from Blue Shield called Brown and Toland and sent them the $34.94 claim asking them to review it. (Again, as it turns out, as they just had reviewed it on 8/29/2025).

“So what happened?” I asked today.

My rep told me that whomever at Brown and Toland spoke to Kelly on 9/9/2025 didn’t get or didn’t put in correctly the claim reference number, and so when they passed it on to the adjuster in the benefits department it couldn’t be worked on, and so nothing happened since then. So much for their 30 day investigation!

However my nice rep today told me the results of the 8/29/2025 benefits analysis which as previously mentioned was that when Labcorp got this claim submitted it was NOT coded as preventative. So the solution is that One Medical needs to change the diagnosis or CPT codes and resubmit the corrected order at Labcorp so that Labcorp can bill Brown and Toland for these as preventative services, and presumably get its $34.95 directly from them. As of now, that’s it.

I am of course girding my loins and preparing to ask One Medical to re-submit that lab claim with the preventative codes.

Meanwhile, I mentioned to my nice rep that I had two subsequent tests that I was not billed for. One was a Fit test in which One Medical sent me home with a kit to scoop my poop. That seems definitely to be preventative as it was to test for colon cancer. The other was a set of tests for low iron ordered during my preventative care visit because my iron levels looked a little low. My guess is that doesn’t fit the preventative category and I should have paid for that.

You may recall that iron test was billed at $0 and neither me nor the Labcorp rep who was working the case with me quite understood why.

Turns out Brown and Toland think that I should have paid a co-pay for both of those tests. The Fit test billed on 5/18/25 was $15.60 (1537124). By the way, Brown and Toland is getting a good deal as the cash price Labcorp charges consumers for that is about $90! The iron test was billed at $60.79.

You’ll recall my lab copay is $50, so Labcorp should have been charged me the lower of the copay or the actual total. Which is $15.60 for the Fit test and $50 for the iron test.

I got no charge for either.

By the way, I would like to show you the EOB from Blue Shield, but as they cancelled and reinstated my insurance last month, their online site has wiped all my EOBs!

So I agreed with the Brown and Toland rep when she suggested that they investigate the $15.60 bill for the Fit test to see if there should be a co pay, and I may hear from them in 30-45 business days.

And just to square the circle I will (probably) ask One Medical to resubmit the claim!

And yes this is all totally ridiculous and it all indicates why health care is so overly complex and why no consumer can figure out what is going on.

CODA: Meanwhile I was contacted by a journalist asking about ChatGPT being used to to sort out and protest medical bills. So I went down that rabbit hole a little too.

Matthew Holt is the founder and publisher of THCB

Let’s get moving on AI-discovered treatments

Dec 11, 2025

By STEVEN ZECOLA

Recursion Pharmaceuticals announced results today for one its AI-discovered treatments. I was pleased to see the large, sustained reduction in polyps attributable to its treatment for Familial Adenomatous Polyposis. Recursions’ oral medication will be viewed by the traditional scientific and regulatory community as “promising”.

On the other hand, I was disappointed not to see/hear any reference to the savings of the cost to society from this treatment and a vague reference to working with the FDA in 1H2026. Quite frankly, the urgency seemed to be lacking.

Currently, treating FAP is an expensive, lifelong endeavor for the 50,000+ survivors. Early detection strategies cost $10k+ and late detection $37k+. The cost to treating metastatic colorectal cancer (for which FAP predisposes) can be extremely high, up to $300,000. Overall, the cost to society from FAP easily exceeds $1 billion per year, or more than $15 billion on a present value basis.

This medication should not be subject to any further regulatory delay. There is enough information now on efficacy and safety to have Recursion more forward with a broad application of this treatment, while continuing test dosage levels and stratifying the patient population. The alternative is more needless cost and suffering.

Steve Zecola sold his web application and hosting business when he was diagnosed with Parkinson’s disease twenty three years ago. Since then, he has run a consulting practice, taught in graduate business school, and exercised extensively

Health Insurance Cancel Culture

Dec 8, 2025

By MATTHEW HOLT

Strap in for a dramatic tale in which our hero battles bureaucracy and logic to try to get his health insurance back.

About 20 years ago lots of Americans, especially Californians who bought health insurance from Blue Shield of California, found that their coverage was cancelled without them knowing about it. That practice called “recission” got lots of attention during the run up to the ACA, and was banned by it. Now if you want to buy insurance and you pay for it, the insurance company has to sell it to you and can’t cancel it after the fact.

Or so I thought.

Post ACA most people who don’t get their insurance through an employer, or Medicare or Medicaid, now buy it via a very regulated “individual market” on a state-based or Federal exchange. Generally, the insurance they buy is heavily standardized (with bronze, silver or gold levels) and what they pay for insurance is heavily subsidized based on income. It’s those subsidies that were increased in the pandemic and extended in the Inflation Reduction Act (IRA) during the Biden administration. The subsidies were the topic–still unresolved–of the latest government shutdown. (Yes, yes, I know the shutdown is over—for now).

It’s pretty much impossible to buy individual insurance outside the exchange, although if you have Scott Galloway levels of wealth you can avoid buying insurance altogether and pay cash and you might be better off, or you can join some quasi-religious health share organization and take your chance. But for most people you are way better off buying on the exchange because that’s the only way you can get those subsidies.

I live in California and remain an under-employed blogger, and a few times in my recent life I have not been married to someone with health insurance provided by their employer. It happened in 2016-17 and again two years ago. No, not what you’re thinking. I didn’t get kicked to the curb by my wife, but in 2022 she got laid off by her employer and decided not to get another job. For the first year of that period (2023) we did not buy via the exchange, but used COBRA. That means we bought into her previous company’s insurance using our own money because it was cheaper than buying on the exchange. Two reasons for this. First, she got a severance package that made our combined incomes too high to get a subsidy and secondly, the ACA plans charge by age, whereas employers pay a flat fee for all employees. That made the exchange plan more expensive than the employer plan. (No prizes for guessing who in our family is old and expensive!)

But COBRA only lasts a year, and then it was time to head back to Covered California.

This starts a process where you try to figure out which plan offered is the cheapest, yet includes your and your family’s doctors, and which one has the lowest associated fees for the stuff you use the most (usually pediatric visits in our case). Turns out that in our case is the Blue Shield Trio 73 HMO. My inability to understand why it’s called Trio 73 reveals why no one calls me a marketing genius.

The other thing you have to figure out is what level of subsidy you get. As mentioned, the IRA passed in 2022 extended the pandemic emergency increase in subsidies for people with higher incomes. But then again, you have to figure out what your income will be when you sign up. Like the audience laughing at an obvious punch line a comedian hasn’t gotten to yet, those of you running ahead of me will have worked out a slight problem here.

I was signing up for a 2024 health plan in 2023. But I had to guess what my 2024 taxable income would be. Like many self-employed people with extremely variable income I had no idea what that final income would be until I filed my 2024 taxes in October 2025 (given I take the IRS extension). In other words, almost two years after I chose the plan. It turns out that in California, the people who track your income are not your health plan, nor the exchange but instead your local county health department. So in November 2023 I guessed my 2024 income and had to tell the local county what that guess is via some affidavit. The county health department actually called me to check that my estimate was correct. Or at least was what I told them it was. Remember this for later.

Meanwhile I sign up on what I regard to be a very complex web site run by Covered California, and select the aforementioned Blue Shield HMO. It covers One Medical and UCSF theoretically via the Brown & Toland IPA, and leads to lots of fun and games in terms generating much content for me on this blog and Linkedin.

As it turns out, I was sent for an echocardiogram by my primary care doctor this past summer to check if I had a heart. While many of you were surprised at the answer (yes, I do), apparently it’s got a congenital disorder that needs a little help.

This gets us to November 2025 (last month!) with your brave hero going back onto the Covered California exchange trying to figure out whether the cardiologist recommended by my primary care doc is covered by the 2026 version of the Blue Shield plan I am on, or whether I need to switch. I could now digress and tell you the late Ian Morrison’s formula for choosing a health plan but I will hold that for the next telenovela article as of course that process is a fricking mess too!

In order to try to do that I login to the Covered California site and see I have a notice that I am not eligible for health insurance. I am confused.

Slaying The Dragon

Dec 5, 2025

By MIKE MAGEE

The date was June 9, 1954. This was over a year after Wisconsin Republican Senator Joseph R. McCarthy had assumed the chairmanship of the Senate Permanent Subcommittee on Investigations. The history shows that he had “rocketed to public attention in 1950 with his allegations that hundreds of Communists had infiltrated the State Department and other federal agencies.” Clearly a psychopath, he escaped control of moderating voices, biting off ever larger targets, including now the U.S. Army.

“Judge, jury, prosecutor, castigator, and press agent, all in one”, was how Harvard law dean Ervin Griswold described him. In 1954, McCarthy accused the army of “lax security at its top-secret army facilities” which he claimed were infiltrated by communists. The army responded by hiring veteran Boston lawyer Joseph Welch to defend itself.

As documentarians reported, “Mothers who never watched TV during the day were glued to watching the Army-McCarthy hearings.” McCarthy’s right-hand chief council that day was lawyer Roy Marcus Cohn. Pragmatic, ruthless, and evil to the core, Cohn’s career was launched by McCarthy, and his tainted touch destroyed lives and weakened the U.S. government for three more decades, straight up to the moment of his death from HIV/AIDS in 1986.

His style and tactics are widely felt today to be the strategic scaffolding of our Executive Branch’s attempted takeover of the US government. Not surprisingly, a direct assault on the control functions, values, and traditions of the US Military are a leading wedge in these attacks. They have literally exploded in the past week with revelations that Defense Secretary Pete Hegseth himself gave the go-ahead on a “kill them all” order that ultimately engulfed two survivors of a rocket attack on an alleged drug-transporting speed boat.

In a 5-minute summation of the televised events of June 9, 1954, you (along with our leaders) are able to witness the historic takedown of McCarthy by Welch (with Cohn as witness) – the “slaying of the dragon” that finally destroyed McCarthy once and for all.

Cohn had reached an agreement with Welch that McCarthy would avoid attacking one particular Army service man as a communist if Welch remained civil. But Welch had laid a trap, and purposefully needled McCarthy into loosing his temper, and on camera, violating the agreement and “attacking the good lad,” who an outraged Welch tearfully defended in his historic and well-prepared retort.

As historian Thomas Doherty recalls, “It was as if the entire country had been waiting for somebody to finally say this line, ‘Have you no sense of decency.’” As Welch pounced on his victim, Cohn winces as his dragon is slain. To which Jelani Cobb adds, “At the end of it, all the illusions, the comfortable illusions that McCarthy had cultivated about himself, had effectively been dispelled.”

As Congress grapples with a situation that has veered dangerously out of control, we can only hope that this time “history will repeat.” Courage must be resourced from within. As Martin Luther King famously reminded: “In the end, we will remember not the words of our enemies, but the silence of our friends.”

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

Let’s Check the Math on Health Subsidies

Dec 3, 2025

By KIM BELLARD

It’s December 3, and, to no one’s surprise, Congress still has not acted on extending the expanded health care premium tax credits for ACA. To Congress, the subsidies don’t expire until the end of the year, so they figure they have until at least then to act, or maybe sometime after that, given the way they handled the recent government shutdown.

On the other hand, consumers who are renewing or shopping for ACA plans face a more immediate deadline; they have until December 15 to enroll for January 1^st. They’re already seeing huge increases that result from a normal renewal increase plus the loss of the generous subsidies; Kaiser Family Foundation estimates that their premiums will more than double without them. They can’t wait while Congress plays politics.

There seems to be agreement that something will be done about the subsidies, but less clarity about what that something is. Some centrists argue to extend the enhanced subsidies but with some tweaks, such as lowering the upper income levels and/or requiring everyone to pay at least some minimum premium. To me, that’d be a reasonable compromise. But some Republicans, including President Trump, are calling for a more radical change: instead of giving the expanded premium tax subsidies to those “fat cat” insurers, give them directly to consumers through health savings accounts (HSAs). Put individuals over insurers, they argue.

I’m here to tell you: the math does not work.

I am not an actuary, but long ago I was a group underwriter, setting rates for employer groups’ health insurance, and, also long ago, I was involved in the early days of so-called consumer directed health plans (CDHPs), including HSAs and high-deductible health plans. I don’t disagree that HSAs and high-deductible plans can play a role, but one has to understand the math that drives health care spending.

The central fact of health care spending is that it isn’t evenly distributed. It is a perfect example of the Pareto principle: 80% of spending comes from 20% of people. The flip of that is that about 15% of people have no healthcare spending in any given year. What insurance does is take money from everyone and use it to fund the spending of the high cost people. That’s what all insurance does.

OK, I’ve avoided doing the math as long as I could, but here goes. One proposal has called for $2,000 to be deposited in each enrollee’s new HSA. Let’s keep it simple and say there are 1,000 such people, and that their average annual health care spending is $2,000 (which, of course, is way low). So we have 1,000 x $2,000 = $2 million in both subsidies and spending. It works out perfectly, right?

Not so fast.

Farewell to Medicare Advantage

Dec 2, 2025

By JEFF GOLDSMITH

This morning, after twelve years, I dumped my Medicare Advantage plan and enrolled in a Medicare Supplement policy. My smoldering discontent finally boiled over and . . . I’m gone. It was a large network style national plan with zero premium.

My decision to enroll in MA was, in part, ideological. I liked the idea of a program design that rewarded healthy behavior. But I discovered that none of the alleged MA perks were actually reachable-my health club was out of network as was my dentist. When I got cancer in 2015, the plan did not give me attitude about my decision to fly 600 miles to the University of Chicago for my care. They merely paid the U of C about a third of what it cost them to rid me of my cancer.

There was not a single denial of care during the entire twelve years. But they pestered my primary care doc mercilessly by insisting that he sign off on every single care decision made in my cancer fight or anywhere else I went- hours of needless “paperwork”. And I fended off sixteen offers of a “wellness visit”- a nurse coming to my house to upcode me. My relationship with the carrier was basically to be on the receiving end of hundreds of robo-calls.

I got little signs that their networks were withering. The University of Pennsylvania did not accept them, nor Cedars Sinai, nor the Hospital for Special Surgery. But when Mayo announced they were not accepting them, that was for me the last straw. Mayo is my “safety net” provider if my local Charlottesville folks are not able to meet my needs.

From a policy standpoint, I think MA made sense when it was redesigned and rebranded in the early 2000’s. And if we had SCAN or even Kaiser here in my market, I would probably still be a member. Particularly for the multi-functionally impaired older folks or the dually eligible, thoughtful protocol driven care by a tightly linked multi-specialty medical group makes a great deal of sense. In this, my old friend George Halvorson and I agree.

But the idea that capitation or the newer version-micro-managed care run by a warm and fuzzy AI- is somehow a cure-all for what ails our society is increasingly questionable on its face. It isn’t about the incentives, folks. I ate the MA dog food for twelve years. It’s about the care system you rely on when things get scary. In twelve years, except for the frozen dinners they sent me after my cancer surgery, the carrier added no value whatsoever to my life. MA just wasn’t worth it, even if was free.

Jeff Goldsmith is a veteran health care futurist, President of Health Futures Inc and regular THCB Contributor. This comes from his personal substack

Why Patients – And Many Innovative Doctors – Are Pursuing Health Outside the System

Dec 1, 2025

By DAVID SHAYWITZ

Our current system of delivering care is awful from the perspective of seemingly every stakeholder. It frustrates, enrages, saddens, and depletes patients and physicians alike. No one designed it this way. It evolved through a series of choices and contingencies that perhaps made sense at the time but now seem to have led us down an evolutionary dead end.

While there’s no shortage of examples, I was especially struck by an anecdote I heard in Dr. Lisa Rosenbaum’s brilliant “Not Otherwise Specified” podcast series for the NEJM. Her focus this season is primary care, and in one episode she speaks with a Denver family physician named Larry Green.

“I practiced in the oldest family practice in Denver, for years,” Green explains. “I was the chair of that department, I directed that residency, and I’m now a patient in that practice. I cannot call it. It’s impossible. Because when I call the practice, I get diverted to a call center…”

From the perspective of what he calls the “medical-industrial complex,” he says, longitudinal relationships are “totally unimportant in healthcare.”

Yet these relationships – developed with care over time – tend to be what many patients crave and what effective doctoring typically requires.

Green’s experience won’t surprise anyone who has tried to get care lately. In November 2023, Mass General Brigham announced it would not be accepting new primary care patients. At hospitals everywhere, it’s not unusual for patients to spend hours on gurneys in emergency-department hallways, waiting for an inpatient bed.

I don’t know many physicians who haven’t struggled to get care for themselves or a loved one – often at the very institutions where they trained and to which they’ve devoted years of their lives. If even insiders can’t reliably access timely, compassionate care, what chance does anyone else have?

The miserableness of the system has been well documented, and physician burnout has sadly become a dog-bites-man story.

Applicants Are Still Flocking to Medical Schools

What’s perhaps more surprising is how many people are still desperate to enter the system and become physicians, fueling an application process that, as Drs. Rochelle and Loren Walensky have documented in The New England Journal of Medicine (NEJM), has become increasingly competitive, expensive, and time-consuming. Premed students routinely take an extra year (or more) to tick all the expected boxes and jump through the hoops that are perceived as mandatory.

This highlights something that’s easy to forget: the ideal of medicine remains deeply attractive. I wrote about this almost thirty years ago in a New York Times op-ed, and it’s still true today.

The notion of doctoring – of being trusted at the intersection of science and human stories – retains a powerful hold on young people. If only the actual experience could live up to the hope of these applicants, the well-worn quotes from Osler and Peabody, the promise of the profession, and the expectations of patients.

Searching For A Better Alternative

The idea that there must be a better alternative is at once familiar and evergreen.

Giving Thanks – Ken Burns “THE AMERICAN REVOLUTION”

Nov 26, 2025

By MIKE MAGEE

Give thanks for our America, blemishes and all. Ken Burns says as much, making it clear, we are a mess of contradictions, and that is (in part) what makes us a uniquely American.

Consider that in a single week, we have had to endure Trump’s “Things happen” as he defended the Saudi crown prince ordering the Khashoggi killing, while also rejoice in his smack-down THE HILL headlined, “The Epstein files are a turning point in the Trump presidency, but it’s not over yet.” Perhaps Marjorie Taylor Greene said it best for all of us, “I refuse to be a ‘battered wife’ hoping it all goes away and gets better.”

In the shadow of an autocratic assault unparalleled in our modern history, Americans are searching for a silver lining. Is it helpful to our Democracy to be stress tested and our Constitutional weaknesses revealed so that we might take corrective actions in the future? Should we accept some blame for supporting a culture rich in celebrity idolatry, and one tolerant of unsustainable levels of inequity? Hasn’t unbridled capitalism diminished solidarity and good government in equal measure?

It is heartening to see many of our public servants, several of whom are first generation immigrants, display their competence, professionalism and courage in support of these United States. Our citizens want to believe that they, rather than their DOJ inquisitors, represent us.

It’s encouraging that compassion, understanding, and partnership remain embedded in the caring citizens who say NO to kings, challenged mass ICE invaders, and (with the Catholic Church) lent a powerful voice to immigrants across our land.

In times like these, I rely heavily on a book my son, Mike, published with the University of Alabama Press in 2004, titled, “Emancipating Pragmatism: Emerson, Jazz, and Experimental Writing”. The book derived from his PhD dissertation at the University of Pennsylvania, and extensively delved into the writings of both Ralph Waldo Ellison, author of “The Invisible Man”, and his namesake, Ralph Waldo Emerson.

So what did he say in his book that was so compelling that I turn to it today, on the eve of another Thanksgiving Celebration?