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Gov. Bullock is running for health, healthcare and the presidency

The big, blue sky of Montana appeared to go on forever. Dozens of rocky, pointed peaks jutting from scores of densely wooded mountains rimmed Helena, Montana. Just outside of town, I saw a pronghorn antelope with its white, tan, brown and black colored fur grazing comfortably within a stone’s throw from the highway. Mule-deer were bountiful, and a bald-eagle flew overhead like something out of a National Geographic scene. Helena is bordered by the Missouri River, Helena National Forest, Helena-Lewis and Clark National Forest and Beaverhead-Deerlodge National Forest, all within an easy drive for the rugged outdoor enthusiast, or the casual observer of some of the best views in all of America.

This majestic beauty greeted our Morning Joe medical journalism team not long after we landed at Helena Regional Airport. The song, Time Waits for No Man written by singer-songwriter Marc Berger, aptly spilled out of the vehicle’s speakers as we drove to meet with trail-runner, father, husband, former Attorney General, present-day Governor and potential future President of the United States of America, Steve Bullock. He had a big day ahead of him with the many responsibilities as Governor, so we were grateful he was able to spend time with us.

In broad-ranging discussions with me, he outlined a practical and realistic approach to improve access to affordable healthcare for Americans. He has been doing that in Montana with the expansion of Medicaid and other healthcare initiatives. As governor, Bullock has not been willing to sit back and wait for others to do his work for him. It is apparent that this same drive is behind his decision to run for the presidency now.

Governor Bullock started by telling me how a year and a half ago, he had been part of a coalition of five Democrat governors and five Republican governor members. From being a member of this bipartisan group, and his work day in and day out as governor, he has seen how the Affordable Care Act works from the perspective of average folks. With the Trump administration’s ongoing attempts to dismantle the Affordable Care Act, Governor Bullock is keenly aware what losing that health plan will mean for many people in his state, and across the country.  The prospect of millions of people losing the many protections built into the Affordable Care Act is unacceptable to him.

This soft-spoken presidential candidate had quietly slipped into the presidential race without lots of fuss or fanfare. He explained his late-entry due to work that needed his attention as Chairman of the National Governor’s Association (NGA). The NGA was founded in 1908 to serve as the collective voice of the nation’s governors and one of Washington D.C.’s most respected public policy organizations. Its members are the governors of the 55 states, territories and commonwealths. Through the NGA, governors identify priority issues and deal collectively with matters of public policy and governance at the state and national levels.

We first met on the front-porch of the Montana Governor’s Residence where he lives with his wife and three kids. His home is close the public high school he graduated from before heading off to college, law school and going to work as an attorney. By tagging along with him on his morning run I can attest to his physical endurance and overall fitness. We stopped and spoke with him at his favorite running trail, the Deford Trailhead. Barely sweaty after the nearly one-mile run from his home to the trail, he was breathing like he was out for a Sunday stroll.  Born April 11, 1966, Governor Bullock is more fit than many only half his age.

His commitment to improving health and healthcare in Montana, and then in the United States if he is elected was abundantly clear. “We still have at least many days before any voters state a preference,” Governor Bullock said. “During my time in Iowa and other places, I hear folks saying, “I’m living paycheck to paycheck.” We need someone that can represent everyone’s needs.”

Governor Bullock spoke of the challenge of maintaining health and fitness through nutritious diet, exercise and sleep while away from home on the campaign trail. “It is more difficult. I try to get a run in every day,” he said.  “Running both at home and on the campaign-trail is what keeps me healthy and grounded.” He strives to get in a five-mile run nearly every day. “I should do more, but with a compressed time schedule, I can only get about an hour a day to work out,” he said.  “It’s not just to keep me physically fit, it’s almost meditative. For me, it’s so much better for me than being in a class with other folks.”

A calm outward demeanor belies an intensity behind the hectic pace he keeps as a leader and a family man. After a long series of connecting flights to get from the east coast to the capital city of Helena, we were all pleased at how patient and kind Governor Bullock was to our team from Morning Joe. He’s the kind of person that’s a pleasure to be around with a casual style of communication. His warmth was genuine. During my conversations with the governor, I learned how he negotiates so effectively with other members of his state government to advance the cause of health and healthcare in Montana.

Governor Bullock leads Montana as a Democrat, elected to office in a state that had a sixty percent majority popular vote in favor of Donald Trump for president. Even with such a heavily-weighted Republican electorate, he overcame that political hurdle to successfully expand Medicaid in his state. His ability as a Democrat to work with Republican colleagues to achieve such an important public health benefit speaks to his potential as president in our divided country.

Under his direction, Montana initiated a study and found that fifty-seven percent of every business in Montana had one or more employees on Medicaid. “This is about businesses,” he said. He continued, “when we expanded Medicaid in 2015,” we helped thirty thousand people in our state get access to mental health care. We helped ten thousand get treatment for substance use disorder.”

He continues to help those in his state understand that Medicaid is a health safety-net that benefits not just the recipient, but business and communities as well.

We then shifted to mental health. “How do you keep your mind fit,” I asked?  “I think that running helps with not just my mental health but also taking a hike with my family, just getting away,” he said. “Just having time away from work, taking time away from the pressures of the daily issues that come up on the campaign trail helps.”

Then we chatted sleep. “Can you tell me about your sleep habits,” I asked? “It is so critical to keep your brain sharp,” he said. “For me it takes a little bit of unwinding. I try to get six or seven hours a night. It is so critical to keep your brain sharp.”

We spoke about the importance of the American public knowing about the health of not just the president, but also the candidates running for the presidency. The governor said, “It’s probably important. Voters are exercising their choice in the hope that someone will stay in office the whole time. You are not necessarily electing the vice president.” He spoke a few times about the rigors of running a presidential campaign with the travel, food, sleep, stress and a myriad of other physical and mental demands.  “The balance between physical and mental health may be reflected in the marathon that is a campaign,” Governor Bullock said. He laughed as he said, “It is something no sane person would subject themselves to. The flip side is that both my family and I believe I need to contribute to this country in a meaningful way.”

A young Steve Bullock grew up trout fishing, elk and deer hunting and hiking in Montana. He was a budding conservationist long before he really knew what that meant. He was an outdoorsman long before becoming academically accomplished at Claremont McKenna College and gaining admission to one of the most competitive and respected law schools in the country, Columbia Law School in New York City. Now as a father, he makes the effort to spend time with his family outdoors. “I still fly fish quite a bit when I can,” he said. “And I still deer and elk hunt but admittedly am more successful with the mule deer here in Montana. My son and I will hunt together and we joke that hunting for us is like hiking with a gun, but it’s the best quality time.”

On a family vacation with his wife, two teenage daughters and his twelve-year-old son last year, they spent five nights camping and fishing on the South Fork of the Flathead River. With the enjoyment of being disconnected from cell phone coverage, they enjoyed each-others company. “We were catching twenty-five to thirty fish a day. There were more stars than you can imagine,” he said. “That one week grounded all of us in so many ways. I love that Montana is surrounded by mountains. And while the folks here are often a bit distrustful of the government, they would do anything for a neighbor. The people of Montana are very caring people.”

Governor Bullock made sure that we recognized Montana is not all woods, mountains, streams, hiking, fishing and camping. It also has vibrant cities, small towns and rural homesteads. The people of Montana care, not just about the abundant outdoor life, as the governor said, “also about our communities.”

“We share more in common in this country than we are divided,” he said. “And when you look at what we need to do to make healthcare more accessible, for all the challenges of the Affordable Care Act, we have come a long way.” He believes that if leaders in the United States make the case for improved access to affordable healthcare not just in Washington DC, but out in America where people live their lives, everyone will be better served.

I eventually asked him, “what would you say to the 160 to 180 million American workers that are getting their health insurance through their employer” He passionately explained, “I’d say to each of them that at times you might have some frustration,” he said. “Because your deductibles are too high, your out-of-pocket is too high, but let’s figure out what can make insurance more accessible and more affordable. Let’s improve what we have and let’s not completely tear apart the whole system.”

Diseases of despair, from suicide, depression and anxiety to addiction and unintentional overdose are ripping apart the fabric of American society. Teenage and young adult suicide is increasing in frequency. Montana, and especially the Native American youth in Montana are some of the hardest hit by this physical and mental health crisis. I asked Governor Bullock how as president he could rein in this crisis?

“As Commander in Chief of the National Guard, I’ve had nine of my soldiers die by suicide in the last six years,” he said. “On our Native American Reservations and all-across the state, teen and young adults are dying. You think you are so powerful, or people think you are so powerful as governor. At times I have felt so helpless seeing the epidemic of suicide. But I think there are many things we can do.” He is a proponent of starting programs and initiatives when kids are young.

He went on to say, “we have evidence-based programs targeted to our reservations and our schools,” he said. “We are not waiting now until they are in high school. We are starting when they are in grade school with resiliency programs.”

As a physician still treating patients now for over thirty years, I have seen plenty of Americans harmed by lack of access to quality, safe and affordable healthcare. Under Governor Bullock’s leadership, Montanans are now less likely to denied access to the healthcare. He promotes accessibility and affordability in a healthcare system with challenges known to all of us.

I find Governor Bullock’s experience, intellect, character and temperament to be a good indicator of how he will deal with American healthcare needs of the country should he become President. He is well-positioned to heal the wounds of political and partisan rancor now endemic in the United States of America. Washington, D.C. would learn a lot from Montana!

Unmasking mental illness and addiction in a post-pandemic world

As the COVID-19 positivity rates are again surging, so too are the under-acknowledged rates of mental illness, thoughts of suicide, and drug and alcohol misuse across the United States. Prior to the coronavirus outbreak, an estimated 1 in 5 Americans struggled with mental health issues, which have only been exacerbated by the pandemic. COVID-19 and its aftermath continue to disproportionately affect vulnerable segments of the population, from Native Americans, Blacks, and Hispanics to the elderly and those with underlying health conditions. While mental illness, substance misuse, addiction, and overdose are particularly tough on teens and young adults, no segments of the population are spared.

New York City struggled and then regained its footing after becoming the epicenter of the COVID-19 pandemic last spring. Like the rest of the United States, it is again experiencing a spike in the number of new cases, increased hospitalizations, and deaths. The first vaccines have now gone into the arms of American essential care workers, but the pandemic will continue to inflict disease and death on thousands more citizens over the next few months. New York City is a bellwether for the United States as social isolation and economic despair threatens lives and livelihoods amidst the already half a million unemployed in New York City and millions across the United States. Nearly a year of physical restrictions between friends and family have increased anxiety and depression, as fallout of this public and mental health crisis.

The Mayor of New York City, Bill de Blasio, and his wife, First Lady Chirlane McCray recently welcomed the Morning Joe Field Team onto the porch of their home at the historic Gracie Mansion. Our discussion focused on the devastation the past year has wrought on those with mental illnesses and addiction issues. Just over five years before the first COVID-19 case was identified in New York City, Chirlane McCray spearheaded the launch of ThriveNYC. It was an unprecedented commitment by the City of New York to work towards a mental health system for all, regardless of means. At the foundation of the initiative is the acceptance and understanding that mental illness is pervasive, but treatable. “I think during the coronavirus, people have come to understand mental health challenges reach into every American family,” Mayor de Blasio said. “It is astounding, figures are that one in five Americans deal with some kind of mental health challenge. And when you think about something that pervasive, how is it that it is not front and center in our healthcare approach? People need a place to turn to. We need a hotline with trained counselors, 24-7, in multiple languages, where people get immediate help…The sad reality we have seen in the opioid crisis is people without any kind of guide in the wilderness, Thrive seeks to change, to give people a connection point.”

As Chirlane explains it, ThriveNYC is a diverse coalition of programs poised to remove roadblocks to mental health and substance misuse and addiction services, as well as reverse the stigma around seeking such services. “There has been total agreement between our public health leadership and our police leadership, that you cannot arrest yourself out of the substance challenges,” Mayor de Blasio said. Chirlane also cited the family’s own awakening to mental health struggles as a pivotal moment when a close family member confided in them that she was suffering from addiction, depression, and anxiety. “I felt everything you’d expect a mother to feel,” she wrote back then. “Love, sadness, fear, and a whole lot of uncertainty. But I didn’t know where to turn. There was not an established series of steps for us to refer to. Bill and I had to trust the recommendations of people we didn’t really know and make some major decisions on faith alone.” The de Blasio’s were not alone with their frustration and desperation while dealing with a loved one’s mental illness and substance use disorder.

The coronavirus pandemic has put a spotlight on the quiet crisis of mental illness and substance use disorders, like no public health crisis in the past. It has exposed a fragile, uncoordinated, poorly accessible, inequitable and fragmented system of care for some of the most vulnerable people in the United States. The diseases of despair are spiking across the country as the pandemic surges. Increased alcohol consumption, drug use and thoughts of suicide continue to threaten large swathes of the United States. Public trust in the government to mount a safe and effective response to the pandemic and its mental health fallout has been eroded. The de Blasio’s are emissaries of hope lighting the way for those smothered by the fog of addiction and despair.

The Morning Joe team also spoke with directors of the Covenant House New York, New York City’s largest provider serving youth experiencing homelessness, the director of Hazelden Betty Ford New York, a center providing mental health and substance use disorder treatment and Dr. Emmanuel Fombu, a brilliant physician, scientist, and gifted communicator in the battle against mental illness and addiction.

Covenant House had been supporting New York’s endangered youth long before the pandemic covered the homeless youth in the City with a blanket of gloom and danger. At least one in five of the over 33,000 homeless youth in the City have been victims of human trafficking. The stigma of homelessness, like that of mental illness and addiction, has disenfranchised them from mainstream consciousness. The staff of Covenant House New York raises up this fragile and hidden segment of society with empathy and compassion. Sister Nancy Downing is an attorney by profession and a nun by the calling of faith. After a career in corporate America, she followed her faith to become a religious sister and brings that commitment, resilience and resolve to the homeless youth served by Covenant House New York as the Executive Director.

“It has been a long nine months for everyone around the world,” Sister Nancy said. “For our staff, since they are essential workers, they come in every day to take care of our young people. For many of them, that has meant they need to quarantine when they get back home…They are not sure what they may been exposed to. But these staff have been amazing. We can count on them to be here for our young people. Being able to come in here every day, to see the resilience of our young people, to see the spirit of our staff, that raises my spirit.” Speaking with Sister Nancy illustrated the reality of life as a front-line worker during the pandemic. “I have not been able to live in my religious community for these last nine months,” she said. “So, I have been living in an apartment and coming to work. But it has been my faith in God certainly that has helped me in this time.” She has several fellow sisters living in that community that are older and have underlying health conditions making their risk of severe COVID-19 too high to take any avoidable risks.

Sacrifices in her own life have allowed Sister Nancy to continue her daily care of the hundreds of at-risk young people that she calls her children. Many at Covenant House have seen the pandemic take away their first jobs, or the security of a college that provides a dorm and meal plan. She emphasized her mission to not only provide the youth in need with support, safety, and counseling, but also a renewed sense of self and agency in their lives. “It is really important for people in the United States to realize that youth homelessness is real here,” she said. “One in ten young people in any given year in the United States will become homeless, on their own, not with a parent or family member. The other thing is that once on the streets, they are subject to being exploited. Approximately twenty-five percent that come to Covenant House will have experienced sexual or labor exploitation. It is important to know that young people cannot be left on the streets. We cannot do that to our young people.”

Eliana Leve is Director of Hazelden Betty Ford New York. The mission of this respected institution is to provide outpatient addiction treatment and mental health services in New York. The needs of their clients, especially those most disenfranchised and stigmatized, have never been greater. If there is one thing the pandemic has taught her, it is to encourage those suffering from mental illness or substance misuse and addiction to reach out for help early—before crisis strikes. As with many diseases, treatment is more effective before mental health problems and substance misuse escalate. She also learned that the clinic’s necessary rollout of new virtual mental health care services was met with a surprising but encouraging adoption rate by the adult clients of the clinic.

This stands in sharp contrast to the request for face-to-face interactions by the 16 to 24, year-old demographic of homeless youth at Covenant House. While one might expect Zoom meetings to fit the needs of the digital-native generation, the Director of Mental Health at the Covenant House, Samantha Alvarez Benowitz, told us that they have seen an overwhelming demand for not only in-person counseling therapy, but group therapy. This has necessitated additional safety logistics, but the peer-to-peer counseling sessions have proven to provide immense support to the residents. Even under the care of Covenant House, COVID testing and unexpected episodes of mental distress underscore the challenges facing the youth every day.

Prevention and treatment of mental illness and substance use disorders is close to the heart and mind of the renowned, Dr. Emmanuel Fombu, who has been branded as “The Medical Futurist.” He is a brilliant physician and gifted communicator with a vision of digital and precision medicine. What many call artificial intelligence and machine-learning, he calls augmented intelligence, to emphasize the importance of combining data-driven science with the compassion and humanity of healthcare providers. He extends his expertise from the halls of the hospital and the laboratories of science by serving on the board of directors of Half The Story, a non-profit organization committed to promoting the healthy use of social media and technology in the next generation by way of advocacy, education, and providing access to resources for youth. Dr. Fombu’s work creates a bright future for mental healthcare and addiction prevention and treatment.

While Bill De Blasio approaches the end of his second term as Mayor of New York City, his and his wife’s mental health initiative has the potential to create lasting legacy. Chirlane still remembers when people were afraid to say “breast” and “cancer” out loud, a disease that was “only discussed between sisters and girlfriends in stolen whispers.” She is thankful that women are now proud to tell their stories, in and outside of the large, tight-knit community of breast cancer survivors. With high-visibility efforts in New York around mental health paving the way, a similar hope is on the horizon for those suffering from diseases of the brain. People in the United States can seize upon opportunities for mental health and addiction treatment programs, not just in New York City, but across the country.

With compassionate programs like ThriveNYC, Covenant House, and Hazeldon Betty Ford leading the charge, the United States is well-positioned to finally work towards eradicating the shame and treating the pervasive mental health issues and addiction in our post-pandemic country. Mayor de Blasio stated, “I think there will be a silver-lining for this pandemic. I think it will wake us up to things that we have to do differently starting with our kids. We have to reach every child in school with mental health support.” Dr. Fombu’s visions of augmented intelligence and personalized medicine brings even more hope that through modern science and enhanced healthcare, a skeptical public can be enlightened that diseases of the mind are treatable. They are not character flaws. Mental illness or addiction can strike anyone at any age, at any time.

If there is, indeed, a silver lining to be found in the cloud of this coronavirus pandemic, it will be our ability as a nation to learn from the experiences and compassion of our front-line workers, scientists, and clinicians. Even when Dr. Anthony Fauci finally tells the American people it is safe to return to a mask-free life and rebuild a sense of normalcy, the lessons of the pandemic must not be forgotten. It is time for the quiet crises of mental illness and addiction to be spoken of at the kitchen table without remorse, stigma, or shame. As we approach a new day of empathy and honesty in the United States, the nation can get down to the business of rebuilding trust. Hope can spring from the ground broken in New York City and flow throughout the United States.

The ThriveNYC hotline can be reached at 1-888-NYCWELL.

Senator Kamala Harris on Health, Healthcare and Family

MSNBC, Morning Joe

 “I’m Kamala Harris. I’m running for President of the United States. I fully intend to win this election, I really do. We believe in an America where women will always have access to reproductive health.” These words and many more from Kamala Harris, the United States Senator from California, greeted the medical journalism team from MSNBC, Morning Joe on this past Independence Day. By the time I left Iowa a day later, I was convinced Kamala Harris has all the traits of a superb leader as well as a kind and caring person. I knew that if she had chosen medical school rather than law school she would have been a safe, quality and compassionate physician.

Everyone was riding the wave of giddy excitement about her prospects for the 2020 presidential election. She was fresh from the first Democratic Debate in Miami in which where she thumped Vice-President Biden regarding his actions in the past with school busing and his relationships with politicians favoring segregation. Her own experience with school desegregation caught the media by storm and put Biden on his heels. She spoke of a young student that was bused to school. “And that little girl was me,” she said to Biden. And Senator Harris wasn’t selective or shy in taking on her competitors in that first debate. She schooled the entire presidential candidate panel by engaging the rancor as she said, “America does not want to witness a food fight.”

Time has a way of healing wounds, even between seasoned politicians. Two professional colleagues such as Biden and Harris know this well. Those with a child, friend or spouse know that time has a way of leveling out the peaks and valleys of relationships. All Americans can be pleased with the strength of character on full display by Vice-President Biden and Senator Harris after their kerfuffle. Maintaining respect for decorum is a hallmark of professionalism and ethics.

And it’s not just in the halls of Congress, or the hundreds of campaign trail events that prove Senator Harris’s character. Like many in America, she has a close-knit group of friends and family that live life through food. And it’s all about the kitchen. Prepping, cooking and eating creates the ambience of thriving family life in the kitchen, the center of activity of most American homes. Her husband Doug Emhoff, her sister and brother-in-law and a group of close friends pitched in to help prepare the first-ever Kamala Harris Cooking Show. And our team from Morning Joe was in Iowa to capture the moment forever on film. Everyone chimed in with heart-warming stories about Kamala as a youngster and even more stories about the senator once she was ‘all grown-up’. Once our time with the friends and family ended, we all felt a bond of friendship that will last far beyond the presidential election. It is these human bonds that make life such a joy.

“You are a hard worker and hard workers run the risk of burnout,” I said to Senator Harris as we got started in our sit-down interview. She nodded in affirmation. We were surrounded by the warmth of her family as well as the soothing view of a cool and clear stream meandering through the forest behind the house. The densely-wooded acreage was a beautiful mixture of green and brown hues, made even more lush by recent rain. I went on to ask, “How important to you is the balance between hard work and success with burnout and fatigue?”

“Very,” she replied. “My entire childhood was pretty much spent in the kitchen with these incredible cooks.” She was speaking of her mother and all the friends and family that lived to prepare meals for others.  “I would just sit there and smell everything. I would watch and then became an apprentice without knowing what the word apprentice meant. And I love to cook”.

 We spoke of the references to work in her memoir in which she wrote:

Our mother loved to talk with her hands, and she was always using her hands-to cook, to clean, to comfort. She was always busy. Work itself was something of value-hard work especially; and she made sure that we, her daughters, internalized that message and the importance of working with purpose…She also showed us, in so many ways, how much she valued all work, not just her own…She saw the dignity in the work that society requires to function. She believed that everyone deserves respect for the work they do, and that hard effort should be rewarded and honored.

I asked Senator Harris with her close friends and husband Doug listening in to tell me the importance of family to her?  “Family means everything to me,” she said.  “Truly. It is about the people you love”. She looked across the room at her loved ones gathered for the Fourth of July festivities and the entire room lit up. Doug was smiling, and her friends were grinning ear-to-ear. Senator Harris’s entire face brightened into a smile that left no doubt about the depth of feelings she had for all of them. Even our team from Morning Joe, me included, caught the infectious warmth of this close-knit group of friends and family and broke out with broad smiles of our own. It was a truly heart-warming scene. I knew at that moment the capacity Kamala had for genuine love. We could see it and feel it in that room, so far from home. Without even saying it, we knew she was also speaking about the children and family members that were not in Iowa, off doing their own thing, enjoying the company of others in other states on the Fourth of July holiday, but close to the heart of Kamala and Doug. While Iowa is a long way from California, matters of the heart feel no distance.

As if with a nod to her mother Shyamala, who had passed away from cancer some years ago, she said, “It is about the people you take care of. It’s about the people with whom you laugh, and you cry.” She finished the sentence while fixing her gaze on the family members sitting close by, “It’s the people who are on the journey with you.”

After a moment of somber reflection for all those loved ones that have passed away during my sixty years on earth, I got back on track with the issue of burnout again, remembering I was in Iowa to learn about Senator Harris, not to reminisce about my own family and friends and asked, “How do you find the balance while working a lot, between burnout and good mental fitness?”

“For me, working out in the morning is about physical health and mental health,” Senator Harris said.  “It’s that time to just kind of wake up. But also, to just get the adrenaline going, (as she pumped her arms in mock exercise). And sleep is important… Adults should get the appropriate amount of sleep, so we can perform and make good decisions.” She finished, “There has to be that balance struck.”

We all wanted to keep learning more about Senator Harris’s health and that of her family. It was a magical moment in that quaint sitting room and well-appointed kitchen in the heartland of America.  As a physician, I wanted to know how personal health will influence and shape her decisions for all Americans. I was seeing with my own eyes what her family and friends already knew. Kamala Harris has a heart of gold.

“Let’s talk about your vision of healthcare for America,” I said.

“Let’s not talk about the fiction that we are not supplying healthcare to everyone,” she responded. “Because we are, in the emergency room. The not uncommon story about any parent whose child has a temperature that is out of control in the middle of the night and they call 911 or they call their pediatrician. What am I going to do? (The pediatrician says) go to the emergency room.”

“Which is the right thing to say,” I chimed in.

“Which is the right thing to say,” Senator Harris reiterated. “But here’s the thing. They are going knowing that if they walk through those sliding glass doors, they will be out of pocket five thousand dollars. They have insurance, but the deductible is such that it could bankrupt that family. That is not an adequate health care system in America. That’s why I propose that we have as our goal Medicare-for-All.”

In our many conversations that Fourth of July, both on and off camera, Senator Harris proved to be well-informed on issues relevant to the United States. As a father with a large family of my own, I was comforted to learn that her experience as a public servant, working to ensure safety in American society, would serve all of us well from the White House. I sensed her kindness, good-spirited nature, warmth and compassion. Senator Kamala Harris is genuine and authentic.  She brought a freshness to the room, just as she does to the field of competitors for the office of the presidency. I knew I was in the presence of someone who would have been a wonderful physician or nurse, if she had only chosen that career path.

She spoke of an enlightened approach to improving access to healthcare for those struggling with addiction, depression, anxiety, risk of suicide and other manifestations of mental illness. Her plans for healthcare are ever more relevant with suicide increasingly becoming a major cause of death for teens and young adults.  She told me of solutions she would bring to the presidency, to help right the wrongs of social inequities which increase risk of premature death, physical disabilities and mental health disorders. I had to pinch myself a few times during the interview to remind myself that even though Kamala Harris was speaking and acting like a medical colleague of mine, I was in fact having a conversation with a United States Senator in the running to become President of the United States of America.

But alas, medical school was not in the cards for Kamala as a young, vibrant, hard-working student. She told me her motivations as a child, besides the most important of which being her mother’s influences, were many of the champions of the United States legal community such as Thurgood Marshall, the Associate Justice of the Supreme Court and its first African-American justice. In her memoir, The Truths We Hold, Harris wrote:

On July 4, 1992, one of my heroes and inspirations, Thurgood Marshall, gave a speech that deeply resonates today. “We cannot play ostrich,” he said. “Democracy just cannot flourish amid fear. Liberty cannot bloom amid hate. Justice cannot take root amid rage. America must get to work…We must dissent from the indifference. We must dissent from the apathy. We must dissent from the fear, the hatred, and the mistrust.

Kamala Harris was drawn to public service by way of law school, then San Francisco District Attorney, Attorney General of California, and now United States Senator from California. She and her younger sister Maya were raised by their mother, a scientific-researcher dedicated to finding treatments to ease the burden of those afflicted by cancer. Of all those who motivated Senator Harris in her life’s-journey to seeking the presidency, it was far-and-away her mother who developed Kamala’s passion for supporting those disenfranchised from society and those afflicted by diseases and social inequities. I have interacted with thousands of fellow physicians since my first day of medical school in 1981. During the last thirty-eight years I have learned a thing or two about the character traits that make for a good doctor. If a young Kamala had made only a slight turn in her life’s pathway, she would have been a fine physician today.

Senator Harris is a champion for erasing social inequities which can lead to poor health, shortened life-span and lessened quality of life. She is on a mission to bring healthcare to all Americans. She is especially sensitive to those suffering from mental health problems and to the rights of women to make reproductive health decisions for themselves. I learned of her passion for righting the wrongs of those underserved by healthcare in our society. She spoke of giving a fair chance for healthcare to the LGBTQ community, non-whites, women, children, those struggling with obesity and many more. She recognized the need to help those overweight with better nutritional choices and professional weight-management guidance. She has plans to improve access to primary care and mental health services for all people. Senator Harris is passionate about raising the bar for the education of children to reverse the cycle of trauma, poverty and truancy that degrades public health and public safety. She recognizes and will continue to take efforts to keep kids in school, feed them nutritiously, and graduate them to be more prosperous and fulfilled as adults.

Senator Harris brings compassion to her support for those living in the United States without affordable, accessible healthcare. She has gathered a lifetime of experience which will enable her efforts to improve the lives of those most disadvantaged. She is an advocate for a system of healthcare that is readily available to all in the United States. She stands by her belief that Medicare-for-All will work in the United States. She has an inclusive vision for healthcare in this country. The compassion etched into her soul while caring for a sick and dying mother resonates in her universal healthcare beliefs.

She spoke of the colon cancer that took her mother’s life even with Medicare-enabled, affordable and advanced healthcare. Colo-rectal cancer alone affects almost five percent of the population of the United States. Without the support of Medicare and the many close friends who pitched in, Kamala and her sister Maya would have struggled to maintain quality care for their mother, Shyamala.

Kamala describes how she felt the pain of “anticipated grief” even before her mother’s death. She felt the emotion of being powerless, an emotion foreign to her professional life. The grief experienced before and after her mother’s death continues to have a lasting effect on Kamala’s approach to healthcare for the millions of Americans shut out of the system. Her health and healthcare experiences reflect a strong desire to help not just the uninsured but those with health insurance that cannot afford the premiums, co-pays, deductibles and hidden or surprise charges. She is committed to helping those who must choose between necessary medications, doctor visits or surgery and paying the weekly living expenses such as food and rent.

I left Iowa with what I came for, an understanding of Kamala Harris as a person. I came to understand how she will use her experiences in life to help others improve their own quality-of-life. As to her health, she is fit as a fiddle, exercises regularly, doesn’t smoke, barely drinks, eats nutritiously, knows the value of a good night’s sleep and how to prevent burnout. The lessons learned in Senator Harris’s rich life have prepared her for the responsibilities that will come with being the President of the United States. I am convinced she will be a good shepherd of health and healthcare for all those fortunate to be living in this country.  I came away with a growing optimism for our country. As I travel the United States learning about each candidate, my sense of American leadership in the future is bright.

Sen. Booker leads by example for health in U.S.

Imagine a future in the United States in which the opportunity to receive health care exists for all people. Then think of that same country in which social justice exists for each person and each community. We hopped the river to Newark, New Jersey and learned that Senator Cory Booker already has those aspirations.

Watch: How Cory Booker stays healthy on the trail

The year 2019 has brought plenty of health challenges to the United States. The largest number of people in twenty-five years have been infected by the measles virus. Gun violence continues unabated. Obesity with its associated risks for heart disease, stroke, diabetes and dementia is an epidemic. Opioid overdose, tobacco deaths, alcohol-related car crashes, e-cigarette, or vaping, product use associated lung injury (EVALI), it can be asked where is it all going to stop? And what are the solutions to advance health and healthcare opportunities for millions in the United States who struggle to pay rent and buy food while purchasing necessary medicines for chronic diseases like diabetes and high blood pressure?  What measures will rein-in the high cost of health insurance premiums, co-pays, deductibles, prescription medications, medically-necessary tests, surgery and hospitalizations? How can surprise, eye-popping medical bills, even for those with health insurance be a relic of the past? What are pathways to universal healthcare in the United States that will have bipartisan support and the support of most Americans?

As a practicing physician interested in answers to these questions, I spoke with Senator Booker at his home in Newark which enjoys a commanding view of New York City back across the river. His years of experience as the Mayor of Newark and now a United States Senator for New Jersey, combined with an abundance of intelligence, character and compassion for all Americans, has created a leader with character traits worthy of respect.

Senator Booker leads Americans by example and raises awareness of the importance of diet, exercise and lifestyle to health. As a vegan he has already lowered his cholesterol, his risk of cardiovascular disease and cancer, and keeps his weight under control more easily. He exercises regularly and doesn’t smoke. The busy senator recognizes the value of sleep and commits to meditation every day. He does all this to maintain optimal physical and mental health. If this health-conscious, physically-fit former college athlete has his way, millions of Americans will shift to better health-related behaviors.

The United States could use a seismic shift to lower rates of obesity, diabetes, high blood pressure, heart attack and stroke. Senator Booker represents a beacon of hope to shine through the clouds of largely preventable chronic disease and disability.

Senator Booker explained how most days start with a session of meditation followed by a variety of exercises. His Newark basement is outfitted with free weights, a weight-machine, exercise bike and a floor mat, everything he needs to stay in shape. The big flat-screen TV helps keep him up-to-date on breaking news while maintaining his muscular and cardiovascular conditioning.

Being a United States Senator doesn’t just keep him busy, it’s tremendously stressful. He defuses that stress by practicing mindfulness throughout the day. He’s also a voracious reader and when not studying or reading for pleasure, Senator Booker keeps grounded by enjoying time with friends and family.

Cory Booker’s accomplishments as mayor and senator are legion. It is his commitment to improving the health of fellow Americans that has been a life-long ambition. Among his many goals as a leader, there are more than a few that will help improve health and health care for those most in need. He will enable a country where those living in rural American can stay home to work, rather than being displaced far from home. He will launch the City 2030 Project to bring small and medium-sized cities to the forefront of economic and cultural growth and dynamism. He will direct federal resources to communities desperately in need, those impoverished and those in deep and persistent poverty. He will invest in evidence-based interventions for the low-income and rural communities typically left behind, so they can realize their visions for economic growth.

Physicians in the United States are accustomed to patients arriving for their physical examination armed with the latest, greatest research culled from the internet. Senator Booker intends to make high-speed broadband a reality for all rural and non-rural communities. He recognizes what physicians and nurse practitioners need to practice quality medicine, and that for patients to thrive in the arena of health and healthcare, medical literacy through internet access is crucial.

Senator Booker will improve the plight of local, independent businesses faced with mounting healthcare costs by addressing higher prescription drug prices. This mounting problem especially affects those most in need of their medications. He will rein-in the worsening access to hospitals and pharmacies as more and more of the smaller or more rural facilities shutter their doors. He intends to help reverse the suppression of wage growth for hospital workers caused by the growing trend for mergers in the United States hospital sector. Senator Booker speaks of his aspirations to protect the public from so-called vertical mergers in the health care space. He points out the concerns raised by the FDA commissioner when two large health care insurers merged with pharmacy benefit managers.

High-level corporate activities are not well-understood most of my patients in the United States. They aren’t following the news in the health care business section. Rather, they are watching their insurance premiums go up, deductibles sky-rocket and cost of prescription medicines at times priced beyond their reach.

While he hasn’t had his break-out moment yet in the polls, Senator Booker told me he can still win and has the message to make that happen. While he certainly has the charisma, message and experience to win the nomination, I reminded him how close he came in the past to be chosen as a vice-presidential running mate. It was only two days before our Morning Joe team visit to Newark that the website- New Politics, reported Cory Booker to be the odds-on favorite to become the 2020 Democratic vice-presidential nominee. Senator Booker has the character, temperament and heart to lead Americans to better health, no matter the office he holds.

The day before my visit to the former mayor’s home in Newark, Mika chatted with him on Morning Joe. She asked him about his candidacy. “This election hasn’t settled,” Senator Booker said. “It is won on the ground in Iowa. You have to start talking about universal health care.”

“The majority of Americans do not know what things cost in health care,” Mike Barnacle said to the senator. “They do know what their drugs, prescription drugs cost them. What can you do immediately to change prescription drug prices?”

“The president can use Medicare to negotiate down costs,” Senator Booker responded. “The president has a lot of actions…We cannot afford the system we have right now…Healthcare is a right for everyone.”

The very next day, I was enjoying a vegan fruit smoothie with the senator in his home in Newark. He affirmed his aspirations for the health of fellow Americans includes universal health care. It is my observation that charges and payments for health care in United States are linked to a flawed, complex and fragmented system. Senator Booker brings a pragmatic approach to transforming that system into one that is more accessible and understandable while maintaining quality and safety. And it’s not just physical ailments, injuries and diseases, Senator Booker recognizes the stigma of mental illness and the need to address it head-on.  If given the chance, his words and deeds will bring the United States into a period of enlightenment regarding mental health.

His life’s mission, as I see it, is to right the wrong of social and health inequities that devast the most impoverished in the United States. He recognizes one way to achieve this goal. He will reduce the vast differences in health care costs between the United States and the rest of the industrialized world. Senator Booker is committed to lowering costs while raising quality in health care.

During a walk though the heart of Newark, Senator Booker and I came across a few of his neighbors. Every one of them waved and smiled while many thanked him for all he does for their community. His response was always open, warm and supportive.

Our conversation turned to my own family as he asked me about my children and grandchildren. When he learned of my six children and four grandchildren, he started to grin from ear to ear. There was no mistaking his interest in me as a person. It was also evident that his parents and siblings helped shaped Cory Booker into the compassionate, thoughtful person he is today.

In his memoir, United-Thoughts on Finding Common Ground and Advancing the Common Good, Senator Booker wrote the words of respected author, playwright and activist, the late James Baldwin, whose words are reflective of Booker’s own upbringing. “Children are never good at listening to their elders, but they never fail to imitate them…Know from whence you came. If you know whence you came, there are absolutely no limitations to where you can go.”

I came to learn that Senator Booker loves not just adults, but children as well. He opened-up with me about his desire to have children. Apparently, he’s been thinking a lot about this recently and feels the time is right. I will not be surprised to see a little Cory Booker Jr. sporting a New Jersey Devils onesie before too long.

A Morning Joe Presidential Candidate Medical Check-up like this is all about identifying health issues voters should know of. After spending a few hours with Senator Booker, he certainly seems to be in excellent physical and mental shape.

“How important is presidential candidate’s health,” I asked. “And even the president’s? How much should the American public know?” The senator believes transparency and openness is important for the American people. He advocates for the electorate knowing the health of those they are placing in office.

I wanted to know how a busy vegan senator balances nutrition with comfort foods. He likes to keep it simple. He proved the point by offering me a homemade smoothie, right then, right there, in his kitchen. Never one to turn down food, I took the senator up on his offer. Frozen bananas, organic blueberries and a few other assorted vegan ingredients went into the blender. In a jiffy, I was downing a delicious and healthy concoction. He proved that with nutrition, simplicity wins the day.

We spoke a lot of the importance of preventing disease through diet, exercise and lifestyle choices. I was pleased we shared common ground. He advocates achieving optimal health by avoiding refined sugar and tobacco, eating fresh fruit, lots of vegetables, nuts and berries, exercising regularly and avoiding tobacco.  His personal choice is to avoid consuming animal products.

 We wrapped up the morning when Senator Booker told me that what he went through as mayor, right there in Newark, allowed him to learn a lot about the stresses and strains of American life. “We have got to shift our whole system,” he said. I knew he meant it from the bottom of his heart.

The Mayor Pete I know on health and healthcare

I first met Mayor Pete on a recent evening in Manchester, New Hampshire. The thirty-seven-year old Mayor of South Bend, Indiana is a Harvard-educated Rhodes Scholar. He is the first major openly gay candidate for president, as well as the first millennial with a real chance to win. A deeply religious person, we talked life, family, service, policy, his health and the future of health care in America.

Watch: Dr. Dave Campbell talks with Mayor Pete in Manchester, NH

     It is more important than ever that a presidential candidate’s mental and physical health be known to the American people. Each person’s vote for president can be made with more passion and more practical knowledge by investigating the candidate’s health and the health of their family. All of us make decisions based on our experience, education, principles and integrity. In this voting cycle many of the Democratic candidates have already released years of income tax returns. My goal for the American people is to have the candidates be equally transparent in their disclosure of personal health information. The full-release of comprehensive medical records on all candidates, and interpretation by physicians, is vital before voters cast their ballots. It doesn’t need to be like pulling teeth.

     Both the age and medical health history of candidates varies widely, spanning three generations and a wide variability in underlying health conditions. Pete Buttigieg is the youngest at thirty-seven and it would be impossible to be healthier, since he has no health problems. Senator Bernie Sanders is oldest at seventy-nine and based on what we know right now is in good health. On the Republican side, incumbent President Donald J. Trump at seventy-two has no major health issues either, according to government doctors.


    By all standards, Pete Buttigieg, the mayor of his hometown of South Bend, Indiana, is young to be running for the presidency, or is he?

     If age is measured by years, then sure. He is two generations behind Senator Bernie Sanders and former Vice-President Joe Biden. However, a President Pete Buttigieg will be middle-aged in office if he wins two terms. When I mentioned this to Mayor Pete during our interview on health and healthcare in early April 2019 he was pleasantly caught by surprise.

     He said, “Cool. Wow. What counts as middle-aged? That’s interesting.”

     “Forty-five,” I responded.

     “Alright, alright, there you go,” he quipped.

     “So, you’re not as young as everybody says you are,” I said.

     Mayor Pete let out a sigh of relief and said, “Good…Good…I guess…No, it’s been interesting, the age thing especially because many of the voters.” He paused as I interrupted.

     I saw the puzzled and pained look on his face and felt concern that I had hit a raw nerve, which was not my intent. I said, “That hurt, didn’t it, when I said…”

     “A little bit, yeah, thought I was supposed to live forever. But our kind of generational appeal is, seems to be, resonating with young people for sure. But especially with older people. With people my parents age. They seem enthusiastic about the idea of a new generation stepping up and leading. And I think about that a lot in terms of how we build an alliance,” Mayor Pete said.

     “Because, of course, politics, at least good politics is a practice of addition and multiplication, and you’re building a coalition, and I’m really excited about the sort of innate support that a lot of older people feel for younger leaders,” he finished.

     Just as the last words rolled off his tongue, a huge American flag came into our view from inside the large, black SUV that was transporting us from the classic New England college town of Durham, situated along the Great Bay at the mouth of the Oyster River, back to Manchester, New Hampshire. “Look at the size of that flag. Is it a gas station? Something else? Crazy. Seems out of proportion to me,” he noted.

     As we talked about the giant flag, I asked Mayor Pete how somebody’s experiences and frames of reference inform their decision-making, to gain a deeper understanding of his basis for healthcare policy. We discussed the recent death from cancer of his father and how personal things that he has experienced speak to how he will be thinking of other American’s in his decision-making for their health.

     Mayor Pete said, “Well one of the things I’ve reflected on and talked about on the trail is, you know, you want your decision-making to be as free as possible from things that shouldn’t matter. And so, as example of that, that I reflect on a lot in the context of healthcare coverage, is that while we were making decisions about supporting dad in his final weeks, as he was losing his struggle with cancer, we were just thinking about the medical side, not the financial side, except for one period where we were looking at long-term care. And you don’t want a family to have to think about that when you’re experiencing, however difficult they are, … moments that can be really-important. You know, some of the best conversations I had with my dad were in some of those struggles. Taking him to the hospital and bouncing around from one experience to another also meant we spent the day together. And there’s a lot to do. There’s a lot of hurry up and wait, just like in the military.”

     As Pete Buttigieg, twenty-three years my junior, only two years older than my oldest daughter, I thought about the “hurry up and wait” that is endemic to military service in the United States. I thought of my experience as a surgeon in the United States Army Reserve Medical Corps years ago, in the time of the Gulf War, code-named Operation Desert Shield. My grey hair, Florida sun baked skin, and middle-aged paunch, compared to Pete’s dark hair, Indiana sun-protected smooth skin and weight in the normal range was a sobering reminder of how quickly time passes for all of us. I thought of my own mother, father and younger brother who all died within the last few years and how important Mayor Pete’s time spent with his father before he died was in the further development of Pete Buttigieg’s humanity and his role as the potential leader of the free world.

     “And so, you know, some of the conversations I’m really thankful for happened in that context. But it’s because there’s one thing we’re really having to deal with and that was his health, not his finances,” said Mayor Pete. “I’ve seen that over, and over again. I remember a case I was actually, bizarrely found myself on the scene of an overdose situation. I was coming out of an event and there was a kid lying on a lawn, kind of frothing at the mouth and somebody was trying to call 911. And first I assumed the kid was having a seizure, then I was two other kids there too. It was teenagers and that was when I realized this was not a seizure. This was a drug experience. They were probably, it was probably due to the synthetic, so-called synthetic marijuana which is highly toxic. Stuff that a lot of kids get from convenience stores because it’s hard to regulate.”

     “I thought he was kind of rolled over on his side and I was propping him against me,” Pete said. He indicated lifting the kid’s chin, “because I thought he was going to choke, and I wasn’t sure if these kids were going to make it. They did. But the one who was in the worst shape, by the time the EMT’s got there he was starting to come out of it, and they brought him back. He was saying, and this was…maybe like a fifteen-year-old, ‘Don’t take me to the hospital. I don’t have any money’. I’m thinking, like how does this kid think, that’s his problem.”

     “How did he even think of that as he’s coming out of being nearly comatose?” I asked.

     “I guess my point is,” Mayor Pete explained. “You know when our decisions are affected by our range of opportunities and our freedom to make a good decision depends on the constraints we’re under, and part of government’s job, I think, sometimes is to get out of the way. Sometimes it is to get there and tear down obstacles that get in the way of living a good life. Living a life of your choosing and choosing well. Or with being able to do that, so you know every American, every family, every day is making decisions. And we can’t make somebody thrive. That’s up to you. But, we can definitely empower people to thrive, through the services we provide. The kind of framework we create for everybody to live in, the rules we’ve laid down, left and right, boundaries for our life choices.”

     He went on, “And the great thing about democracy is we all get to decide together on what those rules ought to be.”

     If age is measured in physiological terms, something we physicians often speak of, Mayor Pete is a spring chicken. Throughout the several interviews spread over two days with me, the picture of youthful health. My first impression of the clean-shaven, handsome young man with a tightly cropped and full head of dark hair was that he is physically fit and mentally sound. After just a little conversation, it was obvious he was well-spoken, thoughtful and compassionate. He was kind enough to look past my chattering teeth as we walked through a street and then park in Manchester, where the ambient temperature was balmy for northerners, and those from the mid-west like Mayor Pete, but downright bone-chilling for someone freshly arrived from warm South Florida. They say your blood is thin (whatever that means) if you’re from the Sunshine State. Well, mine was downright as thin as water.

     Despite on tour in Afghanistan as an officer in the United States Navy Reserve, deployed while still the Mayor of South Bend, he came back without injury. He fitness was put on display when we shared a workout in the gym of the Holiday Inn Express in Manchester, New Hampshire. As a retired Major in the Army Reserve Medical Corps, I can attest retired Lieutenant Peter Buttigieg’s ability to still pass the Navy Reserve Physical Fitness Requirements. He knocked out a brisk thirty-minute run on the treadmill with a smooth stride. His strong legs were on full display. His effortless running technique spoke to his regular habit of running both on the campaign train and back home in South Bend with his running mates. If I had been his commanding officer, or supervising physician for a military fitness test, I would have had him pound out 54 curl-ups, 44 push-ups, and a 500-yard swim, and that would have been for a male 25-29 years old in the Navy Reserve. But the water in the swimming pool was way too cold to touch, let alone dive into, and there was no curl-up bar, and I didn’t want to try to go push-up for push-up with him, so I let it pass. My judgment as a team doctor for 18 years was that Pete would have completed the requirements with time and energy to spare.

     In the carpool karaoke interview from Durham to Manchester (following in the footsteps of trail-blazing work of The Late, Late Show with James Corden), freshly showered and dressed for the day after our work-out, I asked Mayor Pete about his thoughts on how the concept of the buddy system, like used in the military with Battle Buddies, scuba diving, and with friends and family that benefit by mutual support, may benefits health and healthcare in our American society.

     “We have seemingly gone away from the buddy system in the United States to the detriment of our health,” I asked. Mayor Pete picked up the conversation.

      “I think that’s right, you know, I hadn’t really thought about it in terms of the buddy-system, but I did read a really interesting book, came out recently, called “Palaces for the People.” And it’s partly about cities,” Mayor Pete said. “But it’s really about a subject called ‘social infrastructure’, what the author called it. He started out by looking into this question. There was a horrible heatwave in Chicago in the ‘90’s and as you might expect, lower income neighborhoods tended to have more fatalities. But he dug into the data and what he actually found was that there were two neighborhoods next to each other. Both minority low income neighborhoods. One of them had a lot of fatalities during this heatwave. The other one in terms of its fatality rate was safer than wealthy neighborhoods like Lincoln Park on the Northside. And he went in to say ‘why’ and as he explored what was going on, he found for a number of reasons, many of them accidental, one of the neighborhoods was set up in a way that people knew their neighbors. They checked on each other and there was a really strong social fabric and the other the reverse was the case. And so, people were more isolated. And the larger point is that, when people are checking on each other and looking out for each other, you’re safer. Everything from your survival rate in a tornado to your likelihood to develop different diseases is enhanced if you have people around. We know the social isolation of seniors is a major public health risk.”

     Sitting from my vantage in the backseat of the comfortable SUV, camera’s rolling, I felt that I was listening to a future of America that would be appealing to many voters. With just a simple concept of the buddy system under discussion, I had uncorked the flow of knowledge that has become the harbinger of good things to come for the health, healthcare and well-being of those living in the United States.

     “There’s a lot of these things we could do something about, some of it’s cultural, some of it I think requires some regard and support for things like family, things that conservatives talk about more, faith communities can do this,” said Mayor Pete. “But it’s also our responsibility, I think just as a, as a country, as a set of communities, there’s some public responsibility to try and create the spaces where these kinds of interactions can happen and foster a culture were that happen.”

     If age is measured by wisdom, accomplishment, use of God-given talents, genetics, environmental factors like quality education, and preparation, then Pete Buttigieg is anything but young. He was the president of his high school class in South Bend, the recipient of the JFK Profiles in Courage award in high school for an essay about the Independent Senator from Vermont, Bernie Sanders. After a college degree from Harvard, he went on to receive the highly-competitive and prestigious Rhodes Scholarship. Pete Buttigieg completed post-graduate studies as a Rhodes Scholar at the University of Oxford. He was in good company following in the footsteps of former President of the United States Bill Clinton, and former United States National Security Advisor and United States Ambassador to the United Nations, Susan Rice. Elected mayor at twenty-nine and then commissioned as an officer in the United States Navy Reserve, Pete is anything but young in experience.

     The road from historic Durham to Manchester, weaved through the historic heartland of the America I had only read about, as a Floridian. There were many answers to questions in my mind filling the pages of Pete Buttigieg’s book, “Shortest Way Home,” published earlier this year. Thank goodness I had already made the time to read it. It was well worth the time and was effortless, an easy, enjoyable, entertaining read, and contains a wealth of information that brings Pete Buttigieg and his friends and family to life. He describes being in Kabul, Afghanistan, deployed on active duty as a naval officer, encountering a local Afghan proverb which says, “A river is made drop by drop.” This local wisdom made Lieutenant Buttigieg picture the St. Joseph River coursing through his home town of South Bend some seven thousand miles away.

     Mayor Pete envisions the United States as a country where the health of the American people can be improved step by step, or drop by drop, incrementally, by harnessing institutions that already exist, improving them, expanding them, to bring safe, quality and compassionate health care to all. Much as he enables optimal health and fitness in himself through attention to nutrition and exercise.

     Mayor Pete arrived in the gym to join me at 0700. Sharp. Military precision. While some would still be groggy or grumpy after hundreds and hundreds of handshakes with Manchester citizens, dozens of questions from the gaggle of reporters, after a rousing stump speech to overflow capacity in the Currier Museum of Art, where people were left in the parking lot because of the rush of interested Manchester residents vying for a spot to see and hear Mayor Pete. Not him.  He was ‘bright-eyed and bushy-tailed’ as my grandmother Helen used to say. He smiled warmly and greeted me, his staff and the Morning Joe crew with a pleasant demeanor. In the hours I spent with him in New Hampshire, I never saw him lose his temper or get fazed. When addressing the crowd, first outside in a light-drizzle with the temperature just above freezing, and then inside for the lucky three-hundred, with another hundred left outside as the museum couldn’t hold everyone for his stump-speech, while in the car, in the gym, to our walk outside in the street and in the park, Mayor Pete was always engaging and pleasant. At sixty myself, it was tempting to ascribe his vigor and brightness to youth, but it is so much more than that. He has a love for people that comes across in all the interactions I witnessed in those two days.

     Mayor Pete says he makes healthy lifestyle choices. I asked him about alcohol and smoking.

     “Smoking? You don’t smoke? Alcohol?” I asked.

     “Nope,” he said. “Once in a while I’m guilty of a cigar but that’s about it.”

     Satisfied, I moved on, knowing that I was barking up the wrong tree if I thought there was some health problem yet to be uncovered in Mayor Pete. There is not, he says.

     Quite frankly, at thirty-seven, there weren’t any physical or mental health issues. He father recently died of cancer and his mother survived open-heart surgery. He reports stable vital signs. He seems to be in the sweet-spot of life as relates to health. Not so old to have acquired the inevitable clinical baggage of aging from sagging skin, grey hair, widening gut and a prostate growing like a grapefruit. He hasn’t `reached the day where chronic disease manifests in many. Illnesses that become more common with each passing decade face all of us in some form or fashion. Not yet for the mayor.

     I probed for some weakness in his nutritional habits. It was like searching for a needle in a haystack without any needles. He wasn’t sneaking Skittles, scarfing ice cream sandwiches, or secreting M & M’s. Too bad, I could have used a few. I sensed the grueling nutritional pressure for a presidential candidate moving incessantly from event to event, city to town to rural gathering, always with food spread temptingly for the candidate. Pete Buttigieg rarely eats at the campaign events. He relies on Kind bars to keep him going. We laughed about the lessons learned by watching candidates in the past shoveling in food while the cameras were rolling and how unflattering that footage can be. Open mouths, scrambled eggs and cameras are a bad combination for a presidential candidate. However, good fortune was shining on Mayor Pete the morning of our carpool interview. He was able to score an egg-white omelet and brisk cup of coffee at a local diner, absent the TV cameras.

     Even with all my best physician-journalist sleuthing, some on camera, and some off, probing Mayor Pete’s current and past medical history was like shaking an apple tree after all the fruit has been picked. Nothing was there. He will rank not just as the youngest presidential candidate for the 2020 presidency, but he will be the standard by which others’ health is measured.

     I asked Mayor Pete about his experience with injuries while deployed to a combat zone. I mentioned that my oldest son, Staff Sergeant, Gregory Campbell, United States Marine Corps, has been deployed three times, and seems to have, at least that which he has admitted to me, of the singular injury of developing his first and only cavity in a tooth, which he ascribes to dip and chewing gum to stay alert while on watch.

     I told him my son’s story and asked Mayor Pete, “No cavities while overseas?”

     “No, no cavities,” Mayor Pete said as he smiled ear to ear with his pearly whites on full display. “I had to see the doc once about something that happened to my eyes. I think because of some sand in the air when I was in Herat, on the Iranian border. But, no thankfully, on my way out I got some excellent dental care that made sure I was ready to be deployed. It was my civilian dentist that was going to do the whole crown thing and I mentioned it during a pre-deployment workup and the doc said, ‘well, you know I could probably take care of that. And the conservative thing would jut be to do blah, blah, blah…’ I didn’t really understand what he was saying and said, ‘well, do you think we could arrange that?’ and he said, ‘yeah, lean back’.

     “An hour later, I’m holding on to my jaw and it was fixed,” Mayor Pete said with a grin.

     Sand is the enemy for service-members deployed to the Middle East. It not only gets into the eyes, but also weapons, food, and sensitive parts of the body not designed to accommodate grit.

     “We were talking about Lasik surgery, Afghanistan and the sand?” I asked.

     “I remember that was a thing,” Mayor Pete said. “I just stick with contacts.”

     “How about mental health? How do you stay healthy on the trail? You’ve got a tough schedule,” I asked Mayor Pete while we were just getting to know each other, walking through a wide-open park in Manchester.

     “Obviously, campaign life puts a lot of pressure on somebody’s mental health,” said Mayor Pete. “And I think a lot about how to stay rooted. Part of its time management. Making sure you have a decent amount of sleep. Maybe not as much as I’d like but enough that I can function. Making sure I’m in touch with the things that are really important in my life, especially my marriage, my family, my parents-my mother,” he said. He had a slight hesitancy in that statement that probably reflects the difficulty we all face in coping with grief and sorrow caused by the death of a parent.

     “And also, my faith, I think is part of that, at least it is for me,” he continued. “Physical exercise, of course, is part of how you can take care of mental health. But when you’re sprinting a marathon which is what a presidential campaign is, you’ve got to stop and be intentional about that. And, luckily, I have a team that I think is aware of the importance of making sure that I’m taking care of (that). We make sure that every now and then there’s a down day where I can just gather my energies and take care of things around the house and just be human before going back into this crazy process,” he said.

     “How about general mental fitness?” I asked.

     “You know, I think there’s this relationship between mental and physical fitness,” said Mayor Pete. “You’ve got to keep it all in balance. And it’s about balance. You will inevitably have times when you’re under a great deal of stress and times when you’re down and times when you’re not. But that’s where relationships matter so much. It’s where quality time with people you love matters so much. It’s something I think we’ve learned gradually to be more intentional about. But it’s still a little bit unfashionable, especially in hard-working professions to admit, for example, that you do in fact need a certain amount of sleep. That there’s nothing wrong with taking a nap every now and then. And I think we’re still learning as a culture to really embrace those things that we know are such an important part of mental health and health in general,” he said.

         We know from information already in the public domain that other candidates are attuned to staying healthy, or at least managing their illness with medical attention. It will be important for the American people to learn as much as possible in the coming months about the health of all the candidates. Their health history, and that of their family, may play a role in their policy decision-making. It may also play a role in their fitness if elected. Ultimately, it will be the voters in America that decide what health and health care information is important.


Health and healthcare policies are top of the mind for the mayor of South Bend, running for the presidency of the United States. He sees lessons learned in positions of leadership as pivotal in his learning process. And his experience and preparation for the presidency goes beyond his time as mayor. When Lieutenant Peter Buttigieg was serving as a junior officer, a specialist in intelligence services, he also served in a supervisory role in monitoring the health and fitness of his fellow sailors. Maybe, the lessons learned started when he was class president of his high school senior class?


     Pete Buttigieg’s role as mayor places him squarely in charge of public works and municipal policies. In that role, he oversees existing projects, and develops new projects that positively impact social determinants of health for the people living in South Bend, Indiana. According to, The Centers for Disease Control and Prevention (CDC) reports “social determinants of health are the conditions in which people live, learn, work, and play that can affect a wide range of health risks and outcomes. Everything from access to healthy food and housing to safe neighborhoods and education are considered social determinants and, in theory, can serve as predictors of-and factor into-population health.”

     Mayor Pete is an advocate for addressing the root cause of disease in his constituents, and by extension the American people, if elected president. He and his husband, Chasten, use the same philosophy in their own family life.

     I explored this side of Mayor Pete’s personality. I spoke of social connectedness as a recognized metric of well-being. I asked how he would make social connectedness work for communities beyond those faith-based, or in communities with ethnic diversity? I asked him about the responsibility for local, state or federal government to bring disparate groups of people together, to enhance social connectedness?

     “Sometimes you can just create something, and my mind goes to local opportunities,” he said. “Right?” he asked. I nodded my assent.

     “Public art is a good example,” Mayor Pete said. “We have a great piece of public art called, ‘River Lights’ that kind of paint, uses LED’s to paint colors on the cascades of the river in South Bend. And it’s a place people come to because everybody likes seeing something beautiful. People with radically different backgrounds. So families cohere because they go there together, but also strangers get to know each other because they run into each other there, and enjoy this little feature together. And so, a lot of it is literally just the spaces that we can open-up through often local government work. And, you know, there can be a national environment that supports that. It’s one of the reasons things like ‘Support for the Arts’ are like there is a public health outcome. Just for good support of the arts.”

     South Bend, under Mayor Pete’s watchful eye, is working to improve safety while simultaneously making the city attractive as a place to stop, shop, go to diner, and enjoy the arts. Lowering the risk of accidents caused by, and the nuisance of having your vehicle smack into a pothole- a jolt to those with low back and neck pain– is just one of Mayor Pete’s public works projects. His early motivations for public works, leadership, literature and history is found tucked inside “Shortest Way Home”.  He writes:

Academically, it didn’t take long to decide that I should major in Harvard’s program in History and Literature. Plenty of subjects had been interesting in school, but it was literature that had captured not just my mind but also my emotions. I had wanted to explore it deeply ever since reading Robert Frost’s “The Road Not Taken” in Mr. Wylie’s sixth-grade English class at Stanley Clark School. At twelve years old, it felt like sudden enlightenment when we learned that this poem wasn’t just about two roads in a forest but about the choices we make in life. Once I figured out what a metaphor was, I saw them on every page of text. I wanted to read every great author, maybe become a novelist. And doing History and Literature together meant that I could study pretty much anything that had a past-ideas, politics, foreign countries, and global affairs.

     Besides road improvements and the never-ending chore of filling potholes caused by melting snow, then freezing ice, Mayor Pete’s projects include streetlights to improve safety and a sense of comfort in the dark of night, outdoor activities to augment social connectedness, enjoyable places to gather for community engagement, for people of South Bend to unwind and enjoy the arts and create a sense of community. He places community engagement high on his list of importance as mayor. I came to understand from my discussions with him he will do the same for all of America, if elected president. Mayor Pete is using these projects and concepts to improve the physical and mental health of his constituents, friends, neighbors and family. He is promoting social connectedness to improve well-being. He is learning on a smaller scale how to do the same for the American people on a larger scale. These concepts, if embraced by whichever candidate, left, right or center, wins the presidential election, for a seat in the White House after 2020, will guide all Americans to optimal health through the value of human-to-human interaction.


     The opioid crisis continues to plague the United States. The synthetic opioid fentanyl is rapidly increasing as a cause of unintentional overdose and death. Oftentimes, victims have more than one substance in their system at the time of death. Heroin, cocaine, alcohol, methamphetamine, and a myriad of novel synthetic substances continue to place Americans at risk of overdose and death. I asked Mayor Pete about his thoughts on the opioid crisis.

     “I’m cautiously hopeful that we’ve seen the worst of it,” he said. “but it’s going to take sustained action to really make good on that and bring things back to a better level. And some of that has to do with medication-assisted therapy. Some of it has to do making sure that we’re supporting people who are dealing with addiction, understanding that it’s a medical and not just a moral problem. Some of it has to do with accountability for drug companies and prescribers but in a way that doesn’t prevent prescribers from using prescription drugs as needed. I mean fentanyl, frankly was a blessing in the ICU when my father was near the end. But, of course we know it finds its way into the wrong places and can be lethal.”


     On the big healthcare policy debates currently within the Democratic party, Mayor Pete supports a gradual move to Medicare-For-All. His views on the best way to proceed in changing the system derive from his experiences as a mayor.

      “You haven’t had a tremendous opportunity yet to talk about health and healthcare policy,” I said.

     “One of the things I figured out very quickly as mayor was that knowing how many different things determine our health, every decision could be a healthcare decision,” he said.

     Mayor Pete had a chance to speak with the Surgeon General and put a question to him. “You know in our community  I don’t have formally a public health function. But I have a responsibility to make sure we have a healthy community. So how would you think about that if you didn’t have the resources or even the powers that you needed? But you want to be making a difference?” The Surgeon General pointed out that anything could be a health care decision. Safety concerns that limit walking in neighborhoods because of lack of functioning streetlights or sidewalks can impact health and are public health decisions.

     “Well, I’ve tired to have that mentality thinking about federal policy too,” Mayor Pete said. “So, in addition to my belief that we need to extend  coverage to everybody, through a pathway to a Medicare-For-All environment, it’s also clear that things like environmental health matter. Making sure that other than carbon and climate which I think is top priority, that the EPA has a public health mentality when it’s prioritizing what kind of pollutants to be dealing with. But also when you’re thinking about housing policy and the place where you spend the most time, for most of us, is your house.”

     “In a community like ours the water may be perfectly healthy,” he said. “ But you’re still seeing elevated blood lead levels in the kids because its coming from the house paint. I think the federal government could help with using federal dollars locally to remediate homes. But, it’s expensive. We also need to research ways to have much of the impact for less of the cost. There’s no safe level of lead. So, I think about how the federal policy as a whole is supporting not just healthcare, and health coverage, but healthy homes, healthy communities and healthy living.


     Pete Buttigieg was introduced by State Representative Matt Wilhelm, only an hour after I had first met the mayor. He touched on many issues important to voters across the country, as he has again done in his speech in South Bend April 14, 2019, announcing his decision to run for the presidency. To do justice to his speech and make it available for the rest of the country, it is included herein:

What do you think Manchester? Thank you, Matt for that great introduction. Thanks for the work that you’re doing and thank you for reminding us all, of the importance of the elections at hand. I know that I am here by way of the 2020 process. But, I think we all know that it is not time to be treating the Presidency like it’s the only office that matters. So much good work happens, and so much important work happens, and frankly our friends on the right figured this out, about twenty or thirty years ago, patiently and cleverly, they worked to build majorities in those local and state offices. So, its time for those with our values to be just as disciplined in doing that and I’m going to do my part to back (the roar of the crowd made the rest is this sentence unintelligible). Well, I’m having a pretty good two weeks.

Mayor Pete had been standing down on a low platform on the ground level of the museum. Someone in the crowd yelled, ‘stand on your tippy toes, stand on top where everybody can see you’. I thought he would steady the course and keep on giving his speech. But no, he stopped, looked around, looked behind him at the raised platform he was standing in front of, and said, “Well, that’s not a bad idea.” He stopped everything, grabbed his microphone, and headed up to his new perch as the crowd roared. I couldn’t help but think of the situational awareness drilled into those of us who have served in the military. Mayor Pete put that useful learned behavior on full display then and there.

There you go. It’s all good. It’s just a convention in campaigning, you’re supposed to be standing on an object of some kind. So, I think it’s what we expect to do. Look, thanks so much for being part of this and like I said, I’m mindful that this is a marathon. But we’re certainly thrilled with the way that our message has been resonating these last few weeks. And yet as I have these really good few weeks that we’ve been in the middle of one of the things I can’t stop thinking of is the worst few weeks of my life. Because those weren’t that long ago. And those were the weeks that were when my mother was ill and the weeks when, that wound up being, the last weeks of my father’s life. And I think about it a lot because I’m thinking about why politics matters. And in the toughest moment of my life or one of them, which is the moment that I was driving to where my father was getting his chemotherapy, because we had learned at that hospital with my mother that she was going to need open-heart surgery. And it’s not the kind of thing you tell somebody by text message, right? So, I had to go out and find him and sit down and tell him this, by the way mom’s fine, so just want you to know that. But I had these few things going for me even at that incredibly difficult and vulnerable moment in my life. And one of them was my husband. Maybe you’ve heard of him. I can’t wait to bring him back up here and introduce him to you. But he would be there staying with my mother while I was going out to find my father because he was a member of our family, in the eyes of the law, as well as in the eyes of my…(the crowd roared so loudly that I missed the following word or word).

The only thing I had going for me that day and the days and weeks to follow as things got worse for dad, and better for mom, was that we were making some incredibly difficult as a family. And I say this as somebody who makes decisions for a living, but never could have been prepared for what we faced in those weeks. Another thing I had going for me was that people in Washington who had power over our lives made decisions, mostly before I was even born, to bring us something called Medicare. And because they made those choices, that when you reach a certain age America would take care of certain medical issues. The only things we had to think about as we made those wrenching difficult decisions was what was right for the family. What was right medically for mom and dad. We did not have to think about whether we would be made bankrupt by those medical issues our family was facing because someone made a choice. And I want every American to have that same…( crowd was roaring).

Those moments propelled me just like the moment when I had to write a letter and put it in an envelope and mark ‘just in case’, and put it where my folks could find it, and in the moment just in case I didn’t come back safely from Afghanistan. And then the moment, thank God that I did come back safely, greeted by friends and family and supporters in South Bend. Thank you!

Because what all of those moments teach all of us is the impact on our everyday lives of the decisions that are made in Washington. The thing about something that’s grotesque is you can’t take your eyes off it. And what’s going on right now in Washington is grotesque. So, we can’t take our eyes off it. It’s mesmerizing. We can’t stop watching cable and who will look better in this committee? And what’s the President doing this time? Who’s going to jail today? It’s mesmerizing. And yet it takes our eye off the most consequential things that are happening in that city because what goes on in Washington is everyday life for somebody, every time they make a decision. And what I’m about is making sure that we hold our politics and our policies and above all, all our politicians accountable to the standard of whether they make our everyday life better or not. That’s what this is about. That’s why we have politics. That’s why we bother with any of this, is because everyday life depends on the decisions that are made in that city, and at every capitol city in every state, in every hall of power, all the way down from a waste water board to the presidency of the United States. And every one of those decisions need to be guided by values.

     My interactions with Mayor Pete have given me the sense that he believes he can help shape our nation’s healthcare system into one that decreases health inequity, while expanding access, affordability, safety, quality and compassionate care. I believe the 2020 field of presidential candidates, and the incumbent, can grow and learn from each other regarding health and healthcare issues. People living in United States deserve to have their leaders never stop growing in their concern for the health of fellow Americans. I, for one, chose to be optimistic for my country, the country of my family, and the country of my patients.

     My inquiries into the health and healthcare policies of Mayor Pete Buttigieg and the other candidates for the presidency will continue.

Once-A-Year Winter Treks Take Preparation

SkiingMany Floridians will trek to snow country during the winter months to participate in active winter sports. Whether you charge down a mountain while strapped to a pair of skis or sled down a slope, you should be cautious of the risks to your spine. To enjoy a successful trip and reduce the risk of injury, preparation is key.

The easiest way to prepare for many winter activities or even a change in the climate weather is to incorporate exercises that promote core strength for flexibility and agility.

Yoga poses provide plenty of strength, balance and focus while toning the entire leg, quadriceps, inner thighs, feet and core. To help protect your spine, develop body awareness and deliberate movement patterns to strengthen your core and tone your skills.

Have fun this winter season and stay safe with a healthy spine!

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