Cliff’s Note:
Eric Lullove is our contributing medical editor. He is a board-certified surgeon who runs a wound-healing center in Florida, and in August he wrote the only piece anywhere in progressive media about a line buried in a Medicare rule that is about to punish the sickest patients in the country. He reads the regulations. That is why he is here.
What he sent me this week is not a health policy article. It is a physician saying that the last year and a half is showing up in his exam room — in blood pressure, in sleep, in A1c numbers on people who are doing everything right — and that he has stopped being able to treat it as background noise.
There is a paragraph in the middle of it I have not stopped thinking about. He says he now checks federal health data against state health departments before he believes it. A doctor said that. About the CDC.
Read it and then go check your registration.
—Cliff
Why Elections Matter
Some version of the same conversation happens in my exam room every week. A patient’s blood pressure is up. Their sleep is broken. Their A1c has crept up despite doing everything right. When I ask what changed, the answer increasingly has nothing to do with diet or medication. It’s the rent. It’s the grocery bill. It’s the twice-a-week filling up the car with gas. It’s the benefit letter they don’t understand. It’s the feeling that the people running this country are lying to them, profiting off them, and that there’s nothing they can do about it.
This isn’t an article about health care policy. It’s about something more basic: the choices made in Washington right now are medical and psychological events. They enter our bloodstream. And the decisions of this administration and the people it has placed atop our federal agencies are producing a chronic, population-wide stress response that I, as a physician, can no longer treat as background noise.
The Body Keeps the Ballot
The late neuroendocrinologist Bruce McEwen called it allostatic load: the cumulative wear and tear of chronic stress. Acute stress is survivable. The body spikes cortisol, adapts, and recovers. Chronic stress never lets the system reset. The result is hypertension, insulin resistance, inflammation, suppressed immunity, cognitive decline, and depression.
What I’m about to describe is allostatic load administered by policy, at national scale.
Corruption and Grift: A Tax on Hope
Public health research, including Ichiro Kawachi’s work on social capital, has long linked social trust to lower mortality. When people believe the system is fair, they plan, invest in the future, and seek help. When they believe it’s rigged, they stop.
Now consider what Americans have watched in the past year and a half. According to a 927-page financial disclosure report filed with the Office of Government Ethics, President Trump and his family earned more than $1 billion last year through cryptocurrency ventures and other businesses. A Reuters investigation published in June found the family made $2.3 billion from four cryptocurrency ventures through the end of April 2026 while putting up little to no capital of their own, and outside investors lost an equivalent $2.3 billion in the same projects. More than $250 million of the new crypto firm’s revenue came from an investor tied to United Arab Emirates royalty. Days after a UAE sovereign fund’s $2 billion investment in the family’s stablecoin, the administration granted the UAE broader access to U.S. AI chips.
The material harm is money flowing to the connected. The psychological harm is worse: a nation watching the presidency function as a business opportunity learns that effort is for suckers and the rules are for other people. Anne Case and Angus Deaton named where that road ends: deaths of despair, from overdose, suicide, and alcohol. Grift doesn’t just steal money. It steals the belief that playing fair pays.
Lies: When the Truth Becomes a Political Variable
Here is a lie with a body count.
Pennsylvania is in the grip of the worst measles outbreak in decades. As of September 15, the Pennsylvania Department of Health had confirmed 693 cases in 38 counties, with 133 hospitalizations and four measles-associated deaths. HHS Secretary Robert F. Kennedy Jr. has said that only one of the earlier deaths was directly linked to the infection. The CDC has not counted any measles deaths in 2026, and the decision to exclude Pennsylvania’s reported deaths from its weekly update came from the agency’s new director, Dr. Erica Schwartz. And on the very day I’m writing this, Kennedy delivered the keynote at a Washington conference hosted by Children’s Health Defense, a vaccine-skeptic group, telling them they have “a friend in the White House” in President Trump.
The downstream effect is measurable. A Reuters/Ipsos poll in September 2026 found 76 percent of Americans considered the MMR vaccine safe for children, down from 84 percent in a comparable May 2020 survey, while national kindergarten vaccination rates have fallen below the 95 percent threshold needed to maintain herd immunity.
I want to be honest with you about something. I have spent my career practicing evidence-based medicine. For decades, the CDC, FDA, and CMS were the bedrock that evidence stood on. I didn’t always agree with them, but I trusted that their data was real and their guidance was made in good faith. I can’t say that anymore. As a scientist, I now check federal health data against state health departments, independent researchers, and investigative reporting before I believe it. That is what moral injury looks like from inside the profession. And if a physician feels it, imagine what it’s doing to the parent in Lancaster County trying to decide whether measles is a real threat to her child.
Psychologists define moral injury as the wound that forms when the institutions you depend on betray their own mission. When the nation’s health secretary and its disease-control agency become the source of confusion rather than clarity, every parent in America absorbs that injury. And a Finnish cohort study in Neurology found that people with high levels of cynical distrust had higher rates of dementia and death. Lies don’t just degrade the discourse. Over time, the distrust they breed degrades us.
Safety-Net Cuts and the Reduction of Services
The safety net is a budget line in Washington. In the body, it’s a stress buffer. The Oregon Health Insurance Experiment found that giving low-income adults coverage cut depression rates by roughly 30 percent, driven largely by removing the fear of financial catastrophe. Food insecurity tracks with depression and anxiety. Eviction tracks with maternal depression that lasts for years.
This administration and its congressional allies are pulling that buffer away. The One Big Beautiful Bill Act set in motion the largest cuts to Medicaid in the program’s history, roughly $1 trillion over ten years.18,19 The Congressional Budget Office estimates the law will increase the number of uninsured Americans by 10 million in 2034, 7.5 million of them because of its Medicaid provisions.
Medicaid eligibility redeterminations shift from annual to every six months beginning October 1, 2026, and work and reporting requirements for Medicaid expansion adults take effect January 1, 2027.19 The Congressional Budget Office also estimates the law cuts SNAP by nearly $187 billion through 2034, the largest cut in the program’s history, removing more than 2.4 million people from the program in a typical month.
Read that renewal schedule again with a clinician’s eye. Every six months, millions of the poorest and sickest Americans will face a paperwork test where failure means losing care. That is a recurring, state-scheduled stressor, designed into law.
Judicial Decisions: The Longest Half-Life in Politics
Presidents serve four years. The judges they appoint serve for decades, and their rulings shape the conditions of life long after the campaign ends.
This year showed both faces of that power. In a sharp rebuke to President Trump, the Supreme Court ruled 6–3 that the Constitution guarantees automatic birthright citizenship, firmly rejecting the executive order he issued on the first day of his second term. That’s what a working check looks like. But the Court also allowed Alabama to keep its 2026 elections using a map with districts a lower court had found to be racially discriminatory, the first test of Louisiana v. Callais, which substantially raised the bar for proving Voting Rights Act violations. That map eliminates a majority-Black voting district, scattering its residents over three districts.
Think about what that does to a voter’s psyche: being told your vote was diluted, a court agreed, and it’s happening anyway. That is learned helplessness delivered by judicial order.
Bad Policy: The Slow Poison
Some harm isn’t ideological. It’s institutional demolition. Last September, senators questioned Kennedy over his termination of CDC Director Susan Monarez, who had been confirmed by the Senate. In his own budget testimony, Kennedy projected saving an estimated $1.8 billion per year beginning in fiscal 2026 through a reduction in the HHS workforce. Fewer epidemiologists, fewer inspectors, fewer people answering the phone. Bad policy rarely announces itself. It shows up years later, in someone’s bloodwork, or in a county coroner’s report.
Now I Want to Ask You Something
Stop reading for a moment and take your own history.
How are you sleeping? When you open the news in the morning, what happens in your chest? Do you feel anger? Dread? A numbness you didn’t have five years ago? Have you caught yourself thinking that nothing you do matters, that they’ll do what they want regardless, so why bother?
I want you to name it, because naming a symptom is the first step to treating it. And I want you to notice something about that last feeling, the why bother. It isn’t a personal failing. It’s a textbook clinical response, and it has a name.
