Posted on | October 14, 2025 | 7 Comments
Mike Magee
In this morning’s New York Times, David Leonhardt, editorial director of New York Times Opinion, interviews former Transportation Secretary, Pete Buttigieg on the subject of Rebuilding America.
Buttigieg and his husband, Chasten, and their two children recently moved from South Bend, Indiana to Chasten’s home town in Traverse, Michigan. Extended family presence played a role in the decision, and Pete’s mom moved there too. But the adjustment hasn’t been major. As Buttigieg said, “It’s definitely more rural than where I grew up, but also very Midwestern in ways that make me feel right at home.”
Politically, the new home is in a rural, 50-50 county, but not unlike where Pete grew up. As he explained it, “Where I grew up, people might have Trump yard signs. Here, they have Trump flags on flagpoles.” As for his new neighbors, he notes that its nothing like his online critics. He recalls a neighbor approaching him at the local Target to say “I don’t share your politics, but it’s nice running into you.”
These days, Pete spends a fair amount of time reflecting on how to accomplish a “shared national future.” Looking in the rear view mirror, as a gay man who came of age when HIV/AIDS was raging, he is now 43 and takes the long view. He was born 6 months after the first mention of HIV in a weekly CDC Morbidity & Mortality Report on June 5, 1981.
It shaped his view of America, and the possibilities our our common futures. As he shared, “There’s a trajectory here that shows enormous change can happen when you’re willing to play out that strategy over the long term. What is inspiring about the gay equality movement — not just to somebody who benefits from it, but that it didn’t just take something from being unpopular to being popular. It took ideas that were preposterous for one generation and made them consensus for the next generation. That’s the level of ambition we ought to have.”
Leonhardt’s final question is “How would you encourage people to find some sense of hope that actually, some of our very deep problems are solvable…”
And Pete’s reply, “I’ve heard it said that hope is the consequence of action more than its cause, and that’s something I try to think about a lot in this moment. Instead of waiting around for hope, we actually have an obligation — a responsibility — to build hope, and that hope is the result of what we do in this moment. That’s how I think about the present.”
His positioning the challenge as a strategic choice (action creating hope, or hope for corrective action) caught my eye. In 2002. I published “The Book of Choices”. The premise of this book is that our lives are simply an accumulation of the thousands of decisions, large and small, that we make every day. The Book of Choices consists of 77 short chapters, each on a fundamental life choice. The chapter consists of a meditation illuminating the nature of that choice, followed by carefully selected quotations from history’s greatest thinkers, teachers, and doers. The digital book is now available free of charge on HealthCommentary.org under the banner, Caring Culture.
Earlier today, in preparation for a Zoom lecture to Dr. David Myers class on Health Policy and Ethics at Johns Hopkins, I was looking though this content, triggered by an inquiry from one of Dr. Myers’ students who had accessed the Book of Choices online.
Two of the 77 categories are “Action vs. Inaction,” and “Hope vs. Despair.” Most of the commentators (past and present) are allied with Pete Buttigieg. Here they are for your reflection:
ACTION vs. INACTION
There are risks and costs to a program of action. But they are far less than the long-range risks and costs of comfortable inaction.
John F. Kennedy
I am not built for academic writings. Action is my domain.
Gandhi
If a friend is in trouble, don’t annoy him by asking if there is anything you can do. Think up something appropriate and do it
Edgar Watson Howe
It is common sense to take a method and try it. If it fails, admit it frankly and try another, but above all, try something
Franklin D. Roosevelt
There comes a time when you’ve got to say, “Let’s get off our asses and go…” I have always found that if I move with 75 percent or more of the facts I usually never regret it. It’s the guys who wait to have everything perfect that drive you crazy.
Lee Iacocca
Even if you’re on the right track, you’ll get run over if you just sit there.
Will Rogers
He who is outside the door has already a good part of his journey behind him.
Dutch Proverb
If deeds are wanting, all words appear mere vanity and emptiness.
Greek Proverb
After all is said and done, more is said than done.
Anon.
If you want a thing done, go – if not, send.
Benjamin Franklin
I’d rather be strongly wrong than weakly right.
Tallulah Bankhead
‘Mean to’ don’t pick no cotton.
Anon.
Deliberate often – decide once.
Latin proverb
It is the characteristic excellence of a strong man that he can bring momentous issues to the fore and make a decision about them. The weak are always forced to decide between alternatives they have not chosen themselves.
Dietrich Bonhoeffer
HOPE vs. DESPAIR
Hope springs eternal in the human breast;
Man never is, but always to be blest.
Alexander Pope
Even in the deepest sinking there is the hidden purpose of an ultimate rising. Thus it is for all men, from none is the source of light withheld unless he himself withdraws from it. Therefore the most important thing is not to despair.
Hasidic Saying
When it is dark enough, you can see the stars.
Charles A. Beard
Hope is like a road in the country; there was never a road, but when many people walk on it, the road comes into existence.
Lin Yutang
It has never been, and never will be, easy work! But the road that is built in hope is more pleasant to the traveler than the road built in despair, even though they lead to the same destination.
Marion Zimmer Bradley
Even the cry from the depths is an affirmation: why cry if there is no hint of hope of hearing?
Martin Marty
Although the world is full of suffering, it is full also of the overcoming of it
Helen Keller
In the face of uncertainty, there is nothing wrong with hope.
Bernie S. Siegel, M.D.
Still round the corner there may wait,
A new road, or a secret gate
J. R. R. Tolkein
Deep in their roots,
All flowers keep the light
Theodore Roethke
When fear is excessive it can make many a man despair.
Saint Thomas Aquinas
Posted on | October 8, 2025 | 1 Comment
Mike Magee
With the announcement of the 2025 Nobel Prize in Physiology or Medicine last week, the American Association of Immunologists (AAI) took an understandable victory lap, stating: “This Nobel Prize demonstrates how immunology is central to medicine and human health. The ability to harness, modulate, or restrain immune responses holds promise across a vast range of diseases — from autoimmune conditions to cancer, allergies, infectious disease, and beyond.”
This year’s award went to Mary E. Brunkow, Fred Ramsdell and Dr. Shimon Sakaguchi, and it couldn’t have come at a better time as our nation’s scientific community and their governmental, academic and corporate science leaders push back against vaccine skeptic RFK Jr.
As the AAI proudly exclaims, “Since 1901, Nobel Prizes have been awarded to 27 AAI members for their innovation and achievements in immunology and related disciplines.” Make that 28 with the addition of Dr. Sakaguchi, a Distinguished Fellow of AAI.
The field of Immunology and the Nobel Prize in Physiology or Medicine have grown side by side over the past century.
Immunity has Latin roots from the word immunitas which in Roman times was offered to denote exemption from the burden of taxation to worthy citizens by their Emperor. Protection from disease is a bit more complicated than that and offers our White Blood Cells (WBCs) a starring role. These cells are produced in the bone marrow, then bivouacked to the fetal thymus for instruction on how to attack only invaders, but spare our own healthy cells.
WBC’s are organized in specialized divisions. WBC neutrophils engulf bacterial, fungi, and fungi as immediate first responders. Monocyte macrophages are an additional first line of defense, literally gobbling and digesting bacteria and damaged cells through a process called “phagocytosis.” B-cells produce specific proteins called antibodies, designed to learn and remember specific invaders chemical make-up or “antigen.” They can ID offenders quickly and neutralize target bacteria, toxins, and viruses. And T-cells are specially designed to go after viruses hidden within the human cells themselves.
The first ever Nobel Prize in Physiology or Medicine went to German scientist, Emil von Behring, eleven years after he demonstrated “passive immunity.” He was able to isolate poisons or toxins derived from tetanus and diphtheria microorganisms, inject them into lab animals, and subsequently prove that the animals were now “protected” from tetanus and diphtheria infection. These antitoxins, liberally employed in New York City, where diphtheria was the major killer of infants, quickly ended that sad epidemic.
The body’s inner defense system began to reveal its mysteries in the early 1900s. Brussel scientist Jules Bordet, while studying the bacteria Anthrax, was able to not only identified protein antibodies in response to anthrax infection, but also a series of companion proteins. This cascade of proteins linked to the antibodies enhanced their bacterial killing power. In 1919 Bordet received his Nobel Prize for the discovery of a series of “complement” proteins, which when activated help antibodies “drill holes” through bacterial cell walls and destroy them.
Victories against certain pathogens were hard fought. In the case of poliovirus, which had a predilection to invade motor neurons, especially in children, and cause paralysis, it required a remarkable collaboration between government, academic medical researchers and local community based doctors and nurses to ultimately succeed. The effort involved simultaneous testing in children of two very different vaccines.
Current vaccine skeptics like RFK Jr. argue against historic facts. One need only to examine graphs of annual case loads for diseases like diphtheria and polio, before and after the introduction of vaccines, to appreciate the dramatic preservation of life that resulted from intentional but safe exposure to killed or attenuated vaccines.
In this same era, scientific theorists like UK scientist Nils Jerne. were proven right. But it took three decades for the scientific community to agree. His 1984 Nobel Prize read, “He asserted that all kinds of antibodies already have developed during the fetus stage and that the immune system functions through selection. In 1971, he proved that lymphocytes teach themselves to recognize the body’s own substances in the thymus gland… An immunological reaction arises when an antigen disturbs the system’s equilibrium.”
By then, those Jerne’s WBCs had been termed “B lymphocytes” by an Australian scientist named Macfarlane Burnet, a 1960 Nobel laureate, who also saw antibodies already established in the fetus. These individuals were part of a long tradition of medical science imagineers. For example, Robert Koch’s main assistant was Paul Ehrlich, who imagined the inner workings of the cell this way, “In his eyes, cells were surrounded by tiny spike-like molecular structures, or ‘side-chains’, as he called them, and that these were responsible for trapping nutrients and other chemicals, and for drawing them inside the cell.”
The “side chains” were in fact antibodies, large protein molecules made up of two long and two short chains. It was later proven that roughly 80% of the four chains are identical in all antibodies. The remaining 20% varies, forming unique antigen bonding sites for each and every antigen. Almost immediately scientists began to wonder whether they could reconfigure these large proteins to create “monoclonal antibodies” to fight cancers like melanoma.
Imagination has occasionally carried the day. But more often direct problem solving uncovers answers. That was the case when French scientist, Jean Dausset described an “HLA (human leucocyte antigen) fingerprint.” One question always leads to another. In this case, “Why do HLAs exist?” What was eventually uncovered was that certain microorganisms (viruses) take up residence inside human cells gaining protected status.
To deal with the problem, humans possess a specialized WBC – termed “T-cell.” But for the T-cell to destroy an intracellular virus, it must “recognize and respond” to two messaging signals. First, the virus’s antigen. Second, a permissive signal that informs that the virus is housed in a host cell that deserves preservation. The fingerprint HLA is that signal.
Which brings us back to the most recent Nobel award last week for discoveries that the committee labeled as “fundamental.” How so? In the 1980’s Dr. Shimon Sakaguchi proved that humans have a backup system to prevent errant self-attacks – specialized “regulatory T cells” that develop in the thymus after birth in the first few weeks of life. It then took two more decades (in 2001) for Dr. Brunkow and Dr. Ramsdell to identify the gene (FOXP3) responsible for creating “regulatory T-cells.” No gene – no regulatory T-cells.
Why is this important? Two reasons:
- Turns out, cancers have a nasty habit of surrounding themselves with regulatory T-cells that protect them from an immune system that would otherwise eliminate them. New drugs may be able to selectively turn off the FOXP3 gene and allow appropriate destruction of these cancer cells by the bodies regular T-cells.
- On the flip side, autoimmune diseases (where the body turns on itself) appear to be fueled by the absence of effective FOXP3 gene enabled “regulatory T-cells. New drugs geared to turn on the gene and its critical cells may shut down the self-destructive process.
Immunology is a mysterious, complex, and constantly evolving field of study. Host and predators (including everything from a microorganism invader to a roque cancer cell, to a wooden splinter left unaddressed) could be fatal. But to respond the host must first identify the threat, and activate a specific and effective response, without inadvertently injuring the host itself. As our understanding has grown, harnessing the immune system to chase down metastatic cancer cells, or suppress a deadly rejection of a transplanted organ, or self-modify to avoid auto-immune destruction are clearly within our grasp in the not too distant future.
So to sum it all up, science is a process and RFK Jr. is ill-equipped to referee it.
Posted on | October 5, 2025 | 1 Comment
On “the problem of liberty and order in constitutional government.”
The Federalist – 51st Paper (1788):
“But what is government itself but the greatest of all reflections on human nature? If men were angels, no government would be necessary. If angels were to govern men, neither internal or external controls on government would be necessary. In framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed, and in the next place oblige it to control itself. A dependence on the people is, no doubt, the primary control on the government; but experience has taught mankind the necessity of auxiliary precautions [a well constructed constitution].”
– James Madison
Posted on | October 2, 2025 | 1 Comment
Mike Magee
For those prepared to take a deep breath and relax in the aftermath of the MAGA induced assault on the First Amendment that whipsawed Disney leadership last week as they abandoned and then rescued Jimmy Kimmel, be advised reproductive health access is at the top of the list when it comes to MAGA campaigns to “restrict liberties.”
Consider the ongoing campaign to federally restrict telemedicine enabled medication abortion.
A few facts:
- Medication abortion is a process that involves taking two medications (mifepristone and misoprostol) at specific intervals over one to three days. It is approved for use up to the first 70 days of a pregnancy and costs on average about $500.
- As defined by Yale Medicine, “Mifepristone is a medication that blocks progesterone activity in a female’s body. Progesterone is a critical hormone for supporting an early pregnancy. The second medication, misoprostol, causes contractions and expels the pregnancy tissue. It typically takes 12 to 24 hours to pass the tissue.”
- The overall number of abortions have risen since the Dobbs decision overturned Roe v. Wade. There were 1.1 million US abortions in 2023, that is 88,000 per month compared to 80,000 the year before.
- Medication abortions account for 2/3 of all abortions in the US. At least 1 in 4 of these last year involved telemedicine provision by mail order including to citizens from states with highly restrictive abortion laws.
- Success rate in terminating pregnancy is 99.6%. Major complications occur in .4% of cases and mortality is nearly non-existent.
- Anti-abortion advocates are currently focused on obstructing legal access to abortion pills.
Immediately following the Dobbs decision, 12 states banned abortion and 4 states imposed a 6-week gestational limit on access to abortion. Nine of these states now explicitly ban telehealth enabled medication abortion. Countering these measures, eight states where abortion remains legal have passed “shield laws” that protect health professionals from prosecution by other states for engaging in telehealth support of patients seeking self-care within states where abortion is illegal. By latest count, 1 in 7 telehealth assisted medication abortions involved practitioners from shield states.
President Trump’s campaign pledge to reinstate the dormant 1873 Comstock Act to cripple telehealth efforts in support of medication abortion has gone nowhere. In a similar vein, flawed science studies engineered by anti-abortion advocates attempting to challenge FDA clearances for safety and self management of the drugs involved have been exposed as unscientific, deceptive and biased. Multiple state suits, for and against imposing additional FDA hurdles to access in the absence of demonstrable medical benefit or risk mitigation are piling up in the courts. And Louisiana recently took a different tact, reclassifying misoprostol a “controlled substance” and inviting provider countersuits.
As Cornell legal experts remind us, the freedom of expression and the right to freedom of speech may be exercised “in direct (words) or a symbolic (actions) way.” When first written, and adopted as the first of the original 10 entries in the Bill of Rights in 1791, the First Amendment said: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.”
Nowadays, the provision applies to the entire federal government and is reinforced by the Due Process Claus of the 14th Amendment which protects citizens from state government interference as well.
For better or worse, the actions leading up to the Dobbs decision were led, funded, organized and executed primarily by religious groups, primarily Roman Catholics and Evangelical Christians, joining ranks on the issue five decades ago. Those very religions legitimacy and independence has long been protected by the First Amendment.
A simple listing of the opening salvo of our Bill of Rights reveals a complex tangle of protections that define not only our primary rights as citizens, but also our power and legitimacy as a healthy representative democracy.
What’s included? According to legal experts, our 1st Amendment “protects the right to freedom of religion and freedom of expression from government interference. It prohibits any laws that establish a national religion, impede the free exercise of religion, abridge the freedom of speech, infringe upon the freedom of the press, interfere with the right to peaceably assemble, or prohibit people from petitioning for a governmental redress of grievances.”
Religious leaders remain deeply divided. Opposing reproductive choice while protecting the religious freedom assured by the very same 1st Amendment is a difficult needle to thread. Consider the comment of Baltimore Archbishop William Lori, Chairman of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Activities, on June 24, 2022, the day of the Dobbs decision: “I recognize there are people on both sides of the question in the Catholic Church. What we are finding though is that when people become more aware of what the church is doing to assist women in difficult pregnancies … hearts and minds begin to change.”
Well, not exactly. A March, 2025 Pew Survey of Catholics nationwide revealed that 6 in 10 Catholics believe that abortion should be legal in all or most cases.
It is ironic that, in attempting to usurp women’s rights to their own reproductive freedoms, that some religious leaders continue to attack the country’s foundational 1st Amendment that has assured the continued existence of their sponsoring organizations.
Posted on | September 29, 2025 | 1 Comment
God Bless Walgreens for “Leaning-in” to Vaccines.
(Does this get them a spot on Trump/RFK Jr. Enemy List?”
Campaign Video
Schedule Your Shot Online – HERE.
Posted on | September 19, 2025 | 1 Comment
Mike Magee
Jimmy Kimmel and Donald Trump don’t get along. Their feud is long standing. But their argument now has Constitutional standing of the 1st Amendment kind. A back and forth on Trump’s Truth Social site has been the stuff of legends. But on March 10, 2025, at the 96th Academy of Awards, Kimmel did what many thought was impossible. He displaced President Barack Obama as enemy #1 in the Trump “insult-him-in-public” orbit.
Not that Obama has ever been forgiven. On April 30, 2011, after months of constant needling from Trump demanding that the President release his long form birth certificate, the President chose the White House Correspondent’s Dinner to settle the score with Trump and Melania in attendance. The President’s sarcasm laced put-down lives on in YouTube infamy.
Multiple experts later claimed that April 30th was the night that Trump decided to go all in on Presidential politics. A subsequent FRONTLINE documentary said simply that he acted on a basic instinct that “redemption and revenge are intertwined.” In the documentary, Trump biographer, Michael D’Antonio, elaborated: “Donald dreads humiliation and he dreads shame, and this is why he often attempts to humiliate and shame other people. This is a burning, personal need that he has to redeem himself from being humiliated by the first black president.”
But you don’t have to be a Democrat to get under his skin. Consider conservative New York Times political columnists, Ross Douthat. Three months into Trump’s first term in March, 2017, he penned a New York Times editorial titled,“The 25th Amendment Solution for Removing Trump.” Speaking of the presidency, he wrote, “One does not need to be a Marvel superhero or Nietzschean Übermensch to rise to this responsibility. But one needs some basic attributes: a reasonable level of intellectual curiosity, a certain seriousness of purpose, a basic level of managerial competence, a decent attention span, a functional moral compass, a measure of restraint and self-control. And if a president is deficient in one or more of them, you can be sure it will be exposed. Trump is seemingly deficient in them all.”
Eight years later, Kimmel delivered this killer line to a worldwide audience: “Donald Trump is mentally ill. Say it out loud!” Then, as the Awards extravaganza was reaching its final “Best Picture” climax, Kimmel reappeared from stage left at the Dolby Theatre in Los Angeles, California, and said he had an extra minute to burn.
As the spotlight shone, Kimmel said , “This show is not about me, and I appreciate you having me. It’s really about you, and Emma, and all these great actors and actresses and filmmakers, but I was told we had like an extra minute, and I’m really proud of something, and I was wondering if I could share it with you. I just got a review.
“Has there ever been a worse host than Jimmy Kimmel at The Oscars. His opening was that of a less than average person trying too hard to be something which he is not, and never can be. Get rid of Kimmel and perhaps replace him with another washed up, but cheap, ABC ‘talent,’ George Slopanopoulos. He would make everybody on stage look bigger, stronger, and more glamorous. Blah. Blah. Blah. Make America Great Again.”
With the structured timing of a comedic pro, Kimmel waited as the laughter began to fade , and then said, “See if you can guess which former president just posted that on Truth Social. Anyone? No? Well thank you President Trump. Thank you for watching. I’m surprised you’re still up. Isn’t it past your jail time?”
The 2nd term President’s 34 felony count conviction on May 10, 2024, remained fresh in his mind.
A tragic and malignant Donald Trump remains our inheritance. Douthat and Kimmel are not alone in their conviction that he is unsuitable for the Presidency. In The Dangerous Case of Donald Trump, a book published in October 2017, 27 psychiatrists said as much. Based on a Yale Psychiatry conference in April, 2017, titled “A Duty to Warn,” the psychiatrists reviewed in depth “the Trump dilemma” and his effect on American society. In short, we were amply warned, not only about him, but his autocratic friends providing the Project 2025 policy game plan fully funded by the likes of Peter Thiel and Elon Musk.
Those who continue to support his candidacy now do so despite the risk to all of us, and for their own personal gain. There remain a few on the religious right who honestly believe that “God put Trump here for a purpose” (to support patriarchy, outlaw abortion, advance Christian nationalism etc.)
Academics, Jurists, Priests, and Corporate CEO’s have been careful not to label Trump as mentally ill.
Sadly, his words in 2024 remind of another influential essayist, Kenneth Burke, whose 1939 masterpiece, The Rhetoric of Hitler’s Battle, is required reading for graduate students from English to Philosophy, and from Political Science to History and Religious Studies. The piece’s main focus involves a critical analysis of Hitler’s Mein Kampf (“my struggle”) which includes this stark warning.
Leaders of the free world need “to discover what kind of ‘medicine’ this medicine-man…concocted, that we may know, with greater accuracy, exactly what to guard against, if we are to forestall the concocting of similar medicine in America.”
Trump too has written his own fictional story; a despotic force with his own signature language. University of Massachusetts sociolinquist, Jennifer Sclafani, wrote a book about Trump-speak in 2018 titled, “Talking Donald Trump.” In it she explores “how Trump’s language has produced such polarized reactions among the electorate.”
Lara Trump, proudly announced, she too was now multi-lingual. “As my father-in-law says, ‘bigly’ … We’re going to win!”
Like zombies, Trump followers and the former Republican Party have now followed him into the basement, and are heading down a tunnel which has no end. It has been “a virtuoso performance without a grand finale.”
Does President Obama regret treating Trump like an Apprentice in front of a bunch of FOX-filled personalities? Probably no more than Trump may live to regret picking a fight with a super-tight band of the world’s greatest humorists and satirists.
Within 24 hours of Kimmel’s cancellation, Jon Stewart opened a dialogue with Trump in a UK Royal clad strategic retreat. His words: “Father has been gracing England with his legendary warmth and radiance. Gaze upon him, with a gait even more majestic than that of the royal horses that pranced before him!”
Ouch! And there’s more to come.
Posted on | September 15, 2025 | 1 Comment
Mike Magee
The massive extension of tax cuts to the super-wealthy and financing of ICE-laced terrorism of immigrants doesn’t come cheap. The Kaiser Family Foundation predicts it will expand the nation’s debt ceiling by $5 trillion and add 17 million to the ranks of the uninsured by 2034. And a big part of the funding baked into the Republican “One Big Beautiful Bill” for the wealthy will come from a familiar political football with a half century plus history – Medicaid.
President Kennedy’s efforting on behalf of health coverage expansion met stiff resistance from the American Medical Association and Southern states in 1960. Part of their strategic pushback was a faint hearted endorsement of a state-run and voluntary offering for the poor and disadvantaged called Kerr-Mills. Southern states feigned support, but enrollment was largely non-existent. Only 3.3% of participants nationwide came from the 10-state Deep South at the time.
Based on this experience, when President Johnson resurrected health care as a “martyr’s cause” after the Kennedy assassination, he carefully built into Medicaid “comprehensive care and services for substantially all individuals who meet the plan’s eligibility standards.” But by 1972, after seven years of skirmishes, the provision disappeared.
Riding a wave of early popularity, President Obama folded in federal subsidization of an expanded Medicaid with broader eligibility for all Americans living at or below 133% of the Federal Poverty Level. Generous federal subsidies of up to 90% of state costs, with acute need being reinforced later by a raging opioid epidemic that targeted disadvantaged and needy Americans disproportionately, led even red-state governors to consider offers for voluntary enrollment.
As the final year of Obama’s second term drew to a close, autonomous state leaders had chosen expanded Medicaid to manage the health care needs of 77 million Americans with high patient satisfaction scores. 34 million of these citizens were children. 2 million mothers that year ushered the newborns in as part of the full-bodied Medicaid prenatal and obstetric coverage. 9 million blind and disabled citizens slept easier each night thanks to the participating governors.
A decade later, 41 states (including DC) are now voluntary participants with primarily federal financing. The ten hold outs illustrated by the KFF graph above are Texas, Mississippi, Alabama, Georgia, South Carolina, Florida, Tennessee, Kansas, Wyoming, and Wisconsin.
One of the last conservative states to join the program was Missouri. The “Show Me State” held tight until their state budget bled bright red in response to mismanagement of the Covid-19 pandemic. The final reversal came in earshot of the new president’s musings about a “health-care plan within two weeks, a full and complete health-care plan” and laughable pledges to “repeal Obamacare” just as 45 million additional Americans became unemployed and uninsured simultaneously.
By a margin of 6% Missourians voted in 2020 to extend health coverage to an additional 200,000 state dwellers. Those votes came dramatically from former conservative leaning suburbans. By then even the state’s rural voters were beginning to get the message, having seen 10 rural hospitals shut their doors in the prior few years.
Now the state’s historic ambivalence when it comes to Medicaid is once again on full display. Their senator, Josh Hawley (R-Mo), suddenly turned camera shy on July 5, 2025, the day after the passage of the “One Big Beautiful Bill” that had earned his support. His irate and powerful state hospital industry was full-throated in their displeasure.
Within a few days, Sen. Hawley vowed that he would introduce legislation to remove measures in the bill that cut Medicaid payments to his Missouri hospitals from the legislation that he had loudly supported.
CEO’s at St. Louis Children’s Hospital, Children’s Mercy Adele Hall Hospital in Kansas City, Shriners Children’s St. Louis, among others were all ears since roughly half of all their revenue comes from Medicaid. Hawley and his colleagues had just green-lighted the elimination of supplemental payments, known as state directed payments, that account for 1/3 of these hospitals Medicaid revenue and 14% of their total revenue.
This is not the first time the famous 45 year old Missouri senator has been called out for an abrupt change in direction. On Jan. 6, 2021, he was caught on tape with “fist raised in solidarity with protesters already amassing at the security gates” – a gesture that according to Capitol police “riled up the crowd.” A few hours later, he reappeared on video, running to the closest exit from the Capitol to avoid the crowd of his supporters now in full insurrection mode.
Contrast this record with 94 year old former Indiana Congressman Lee Hamilton (D-IN), who serves as an honorary co-chair for the World Justice Project, an organization that works to strengthen the rule of law worldwide.
Lee Hamilton is beloved in Indiana where he was elected in 1982 to the Indiana Basketball Hall of Fame, (joining the likes of John Wooden, Oscar Robertson, and Larry Bird) after taking the Evansville Central Bears to the state finals in 1948, and setting scoring and rebound records at De Pauw University in 1951 and 1952.
Hamilton was a member of the large Democratic freshman class that entered Congress with the LBJ landslide in 1964, and served in that role for 34 years. He was asked in 2020 to comment on the factors that make for a great politician. He started by noting that the qualities that get you elected are not necessarily the same as those that mark a successful legislator. Then the former vice-chair of the 9/11 Commission (appointed by George W. Bush) added : “I think the most successful politicians have integrity. When you’re interacting with many others to deal with complex and difficult public policy issues, it’s hugely important that you can trust someone’s word. Most of the politicians I’ve met stay true to what they tell you. They recognize the need to work with others and know that trust matters.”
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