In part two of our video discussion, Debilyn Molineaux, CEO/president of the Bridge Alliance and co-publisher of The Fulcrum, continues a conversation about the desire for electoral reforms and cross-partisan support for legislation, which are seemingly in conflict during debate over the For The People Act.
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The Cost of Fear: What Immigration Enforcement Is Doing to Our Clinics
Mar 17, 2026
He was supposed to come in three months ago. When he finally returned to the clinic, it was not for routine follow-up. Instead, it was because he could no longer feel his feet, and his vision had begun to blur. He told us he had missed his appointments out of fear. Immigration enforcement activity in his neighborhood and rumors of Immigration and Customs Enforcement (ICE) near clinics made him afraid to be seen entering a healthcare space. So he stayed home. He rationed his insulin until it ran out. Now he sat before us with uncontrolled diabetes, worsening nerve damage, and worsening vision concerning diabetic retinopathy.
Stories like this are becoming increasingly common. In Minneapolis, recent ICE raids have sent shockwaves through immigrant communities, with reports of enforcement agents present in or near healthcare settings, including exam rooms. Families describe being too afraid to leave their homes, even to see a doctor, or choosing the most ill child to bring to urgent care because bringing multiple children would be too risky. Clinics meant to serve as places of healing are being transformed into sites of fear.
What is unfolding in Minneapolis mirrors what we are witnessing in Chicago, one of the largest academic medical center hubs in the nation. As medical students training here and volunteering in free clinics such as the Community Health Clinic, we see the consequences firsthand. Patients delay care not because they do not value their health, but because the perceived legal and personal risks of seeking care feel too high. People arrive later and sicker, carrying advanced disease alongside the psychological trauma of living under constant threat.
It is proven that fear and perceived risk not only suppress health-care utilization but also worsen health outcomes. Studies have identified that the threat of immigration enforcement is associated with reduced access to health services among immigrant populations, regardless of health insurance status3 . Clinicians who work with immigrant communities have reported significant disruptions in the care and management of their patient population, which has been directly attributable to fear of deportation. Decades of health services research clearly demonstrate that any avoidance or delay in care, due to barriers related to fear, is directly associated with worsened disease presentation. At the end, the avoidance of care due to fear leads to more costly and emergency treatments with worsened clinical outcomes. Fear from immigration enforcement is no different than fear from other barriers, as poor outcomes are always inevitable.
National immigration enforcement policies have reshaped healthcare spaces, driving delayed care, worse outcomes, and increased emergency department utilization5,6. At our clinics, patients present with complications that could have been prevented or better managed. These are not failures of individual responsibility. They are predictable consequences of policies that push patients away from care.
As future physicians, we are already inheriting the clinical fallout of today’s immigration policies: diseases diagnosed too late, trust eroded before a patient ever enters the exam room, and preventable harm shaped by fear rather than biology. Our responsibility is not only to treat illness, but to recognize how policy becomes pathology. Ethical commitments to justice and nonmaleficence demand that immigration status never determine access to medically necessary care7.
A healthcare system cannot function if patients are afraid to walk through the door. When immigration enforcement creates conditions under which patients avoid preventive services, delay urgent care, or forgo treatment altogether, the result is preventable harm. No amount of clinical excellence can compensate for a system in which trust has eroded so profoundly that seeking care feels dangerous.
Physicians and future physicians must also speak up. We must practice trauma-informed, culturally responsive care, advocate within our institutions, and name what we are witnessing in our clinics. However, the responsibility cannot rest solely on individual clinicians. Chicago is home to some of the most influential health systems, not just in the Midwest but in the entire country, and dozens of national medical organizations whose voices shape health outcomes. When these institutions remain silent or issue vague, noncommittal statements, they allow fear to flourish. Hospitals are not just sites of care; they are consequential actors with the power to affirm that healthcare spaces are safe for everyone. Institutional silence, like individual silence, carries consequences and undermines the very mission of medicine. Silence is not neutrality; it is complicity.
Change is still possible. The 2026 midterm elections offer an important opportunity for the public to treat immigration policy as a referendum. The people must decide whether we tolerate a system in which fear-driven enforcement undermines public health or we, the people, demand policies that allow people to seek care without risk. The election might seem far away at the end of the year, but both physicians and future physicians must begin advocating for healthier communities now.
If we want healthier communities, we must begin with a simple truth: patients cannot heal in systems where they do not feel safe. Healthcare must remain a place of refuge, not fear – for the patient who rationed his insulin, for the parent afraid to bring their child to an appointment, and for the communities watching clinics become extensions of enforcement rather than care.
The Cost of Fear: What Immigration Enforcement Is Doing to Our Clinics was first published by the Latino News Network and was republished with permission.
Jessica Toledo is the daughter of Mexican American immigrants and a rising third year medical student in Chicago. She grew up witnessing health disparities in her family and community, which fueled her passion for health equity and advocacy; she now volunteers at one of Chicago’s largest free clinics serving underserved populations.
Joshua Samaniego is a second-year medical student in Chicago who grew up in Southern California in a household of Ecuadorian immigrants. He is interested in pursuing a career in orthopedic surgery while also working to address health disparities.
Dr. Susan Lopez is a first-generation, Mexican American hospital medicine physician at an academic medical center in Chicago. She also works with medical students at one of the largest student-run free clinics in Chicago.
Dr. Octavio Vega is a Mexican American primary care physician practicing at an academic medical center in Chicago.
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A new Pew Research survey shows most Americans question each other’s morality. Can civic friendship—championed by Washington, Jefferson, and Lincoln—restore trust in U.S. democracy?
Getty Images, Boris Zhitkov
Can Democracy Survive When Americans See Each Other as “Bad People”?
Mar 16, 2026
Last week brought more bad news for American democracy when the Pew Research Center released survey results showing that “Americans are more likely than people in other countries surveyed in 2025 to question the morality of their fellow countrymen.” As Pew reports, “The United States is the only place we surveyed where more adults (ages 18 and older) describe the morality and ethics of others living in the country as bad (53%) than as good (47%).”
It is one thing for people in a democracy to disagree about policies or who should lead the country. It is quite another for them to think of their fellow countrymen as immoral. Without a presumption of goodwill, even among those with whom we disagree, democratic politics runs aground.
Right from the start, political leaders in this country have recognized the importance of a kind of civic affection in democratic life. Without it, they feared our political system would always be on the verge of civil strife.
In 1790, President George Washington sent a remarkable letter to the Hebrew Congregation of Newport, Rhode Island. In it, he laid out a kind of democratic creed.
“May the children of the stock of Abraham who dwell in this land,” he wrote, “continue to merit and enjoy the good will of the other inhabitants—while everyone shall sit in safety under his own vine and fig tree and there shall be none to make him afraid.” By stressing “good will,” Washington highlighted a civic disposition without which democracy cannot flourish.
Six years later, Washington returned to that theme in his Farewell address. It was addressed to “Friends and Citizens” and expressed Washington’s hope “that your union and brotherly affection may be perpetual.”
Washington famously called attention to “the baneful effects of the spirit of party,” which, he warned, “agitates the community with ill-founded jealousies and false alarms, kindles the animosity of one part against another, foments occasionally riot and insurrection.”
Poor George must be rolling over in his grave.
On March 4, 1801, Thomas Jefferson, echoing Washington, began his inaugural address with the salutation “Friends and fellow-citizens.” He urged his listeners to “unite with one heart and one mind [and] restore to social intercourse that harmony and affection without which liberty, and even life itself, are but dreary things.”
“Every difference of opinion,” Jefferson added, “is not a difference of principle. We have called by different names brethren of the same principle. We are all Republicans, we are all Federalists.’”
“Brethren of the same principle,” you wouldn’t know it from reading the results of the Pew survey.
And then there is Abraham Lincoln, who, on the cusp of the Civil War, also thought of citizenship through the lens of friendship. “We are not enemies, but friends,” he said.
“Though passion may have strained,” Lincoln observed, “it must not break our bonds of affection. The mystic chords of memory… will yet swell the chorus of the Union, when again touched, as surely they will be, by the better angels of our nature.”
Seems almost quaint to read the words of Washington, Jefferson, and Lincoln at a time when the current president takes every opportunity to demonize his opponents. But that is why it is particularly important for Americans to recall them and work to rekindle the spirit of civic friendship that those leaders praised.
Political philosophers have taken Washington, Jefferson, and Lincoln’s admonitions as inspirations to explore what civic friendship entails. For example, Hannah Arendt argues that “friendship among citizens …(is) a readiness to share the world with other men.” It is not “sentimental” or “intimately personal.”
For Arendt, the kind of friendship that democracy demands is expressed in “the constant interchange of talk…(among) citizens.” Civic friendship, Professor Roger Berkowitz explains, “is Arendt’s wager that a common world can be built not through domination but through the ongoing work of speaking, listening, and staying in relation. It is an austere hope: that among people who disagree, the world can still appear, and appear in common.”
Civic friendship requires, Berkowitz points out, “that we see each other as more than our opinions, to stay in relation even when arguments fail, and to preserve the trust without which no common world can survive. Without friendship, even courts, newspapers, and universities become instruments of suspicion and struggle. With friendship, the world regains its coherence.”
As the Pew survey shows, regaining such coherence in the United States will not be easy. But the poll results suggest that political division, in itself, does not necessarily lead to seeing others as bad people.
India, Israel, and Nigeria are marked by political conflict every bit as intense as it is in the United States. But in India, only 9% of the population says that others' morality and ethics are bad. In Israel, that figure is 27%, and in Nigeria, it is 29%.
Political scientists argue that Americans have come to demonize others and see them as immoral because, over the last half-century, our identities and sense of self have become wrapped up with our party affiliations. We think that if the other side wins, our very way of life will be destroyed.
In this way, policy differences become matters of life and death, and policies that we don’t like, and the people who support them, are seen not just as wrong but as evil.
But our tendency to view each other as immoral or unethical is also a product of ignorance and misinformation. As Johns Hopkins University Professor Lilliana Mason notes, “We all overestimate the extent to which people in the other party are extreme in terms of the policies. We also overestimate the degree to which the party is made up of groups that we kind of think of as like the stereotypical groups associated with the party.”
”Republicans,” she explains, “think that the Democratic Party is majority Black. It’s not. Democrats think that the Republican Party is majority wealthy people who make over $250,000 a year. It’s actually like 2 percent.”
When “political scientists and sociologists,” Mason adds, “have done experiments where we correct people’s misperceptions… it actually makes them hate the other party less because they hadn’t realized that the party wasn’t made up of maybe people they didn’t like or wasn’t made up of people who are really extreme in their policy preferences. We are overestimating the extent to which the other party is made up of people that we assume we would really dislike.”
Correcting such misimpressions is a good place to start in addressing America’s civic friendship crisis. Another place to start is supporting places like schools and libraries that bring people together while honoring their differences.
The words of Washington, Jefferson, and Lincoln remind us that repairing the breach documented by Pew does not require us to wait for direction from Washington, DC. We can begin the repair work needed where we live, study, and work.
The future of our democracy depends on doing so.
Austin Sarat is the William Nelson Cromwell professor of jurisprudence and political science at Amherst College.
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President Donald Trump speaks to members of the media traveling on Air Force One while heading to Miami on March 7, 2026.
(Photo by Roberto Schmidt/Getty Images)
A President in Sheep’s Clothing and a Democracy in Decline
Mar 16, 2026
Like a wolf in sheep’s clothing, America’s president is undermining the Republic by evading checks, consolidating power, and attacking democratic norms. He disguises his malicious intentions as innocence while dismantling policies and programs that would help citizens.
In earlier opinions, I wrote about three forces that corrode democracy: hypocrisy, corruption, and confusion. Hypocrisy creates a false image of leadership; corruption erodes public trust and suppresses voter participation; confusion keeps the public from seeing the truth. Together, they weaken the Republic.
A president who once declared, “I alone can fix it" now demands concentrated power while the country crumbles. He presents himself as a stabilizing force yet governs through intimidation. He speaks of restoring order while undermining the institutions that make order possible.
This fable of The Wolf in Sheep’s Clothing applies to public life. In the story, the wolf disguises himself as a sheep to confuse the flock and move freely among them. The disguise is not a costume — it is a strategy. It allows the wolf to deceive. The president uses a similar disguise. He wraps himself in patriotic language while weakening systems that safeguard the nation. He claims to defend the country while demanding loyalty to himself. He presents himself as a protector while pursuing power and money.
Confusion is not accidental. It is engineered to dull public judgment. When leaders flood public life with contradictions and manufactured crises, citizens lose the ability to distinguish governance from performance. A leader who creates chaos then presents himself as the one strong enough to control it. This strategy is not hidden. Project 2025 — a blueprint for consolidating executive power — is a public declaration of intent. Yet Congress, the branch designed to check presidential overreach, remains silent. Silence is not neutrality. Silence is permission — and it leaves citizens relying on their own judgment to see what leaders refuse to confront.
On January 20, 2025, he raised his right hand, repeated the oath, and immediately began performing duties that bore no resemblance to service to the people. Beneath the disguise, consequences were immediate: Families were separated and jailed. A violent immigration crackdown spread across the country. Innocent Americans were killed by ICE agents. DEI programs were dismantled. Journalists were humiliated and imprisoned. Personal voting data was collected. He pretended to protect the people but governed to protect himself. He pretended to be a reformer but dismantled systems that safeguard fairness.
The pattern extended beyond domestic policy. He invaded Venezuela in January 2026 and ordered strikes on Iran in February 2026, bypassing congressional authorization — a sweeping assertion of executive power. He pretends to be strong but relies on confusion, cover‑ups, and spectacle. His actions reveal a pattern of power without accountability. It is a performance — a fraudulent one — yet his loyalists ignore and excuse his overreach and abuse of power.
Americans watched as he built a cabinet designed for obedience. Nominees were individuals whose wealth insulated them from accountability and prevented them from challenging him. Those appointed to key positions were chosen not for experience, but for their role in crafting Project 2025 — a plan designed to concentrate presidential power by weakening the institutions meant to check him. These were not ordinary appointments; they were strategic placements. The very people who helped write the plan were positioned to carry it out. The intent was unmistakable: reshape the federal system so that loyalty to the president would outweigh loyalty to the Constitution.
Those strategic placements had consequences. Cabinet members and leaders in Congress have a responsibility not to the president, but to the Constitution and Americans. Yet many chose to reinforce the president’s falsehoods, applaud his distortions, and shield him from accountability. Rather than offering honest counsel and transparency, they echoed his claims. Rather than checking his excesses and overreach, they enabled them. Their silence — and their applause — do not protect us. They protect him.
On February 24, 2026, he delivered the longest presidential address in modern history — a marathon of exaggerations, self‑congratulation, and false claims. He boasted that he had taken prescription drug prices from the highest in the world to the lowest. He bragged about accomplishments that never materialized. He never mentioned unkept promises: relief on housing, food, or healthcare. And yet, despite the spectacle, his approval rating remained low — a sign the public no longer buys his lies. His loyalists applauded anyway, not because they believed him, but because loyalty has replaced judgment. That loyalty came at a cost.
He ignored the Epstein victims’ search for truth and closure, offering no acknowledgment of their suffering, while praising the hockey players he suggested had “fought on his behalf”. This is not leadership. It is favoritism disguised as strength.
Democratic decline rarely begins with a dramatic collapse. It begins with smaller fractures: norms stretched before they are broken, oversight criticized before it is weakened, elections questioned before they are undermined, institutions attacked before they are ignored. When a president claims the power to decide which laws apply to him, the public loses the ability to hold him accountable — unless citizens exercise independent judgment.
When he undermines the legitimacy of elections, the people lose their voice. When he attacks independent institutions, the nation loses its safeguards. Concentrated power does not return what it takes. It must be stopped — to prevent deepening inequality, to protect democratic processes, to guard against tyranny, and to preserve liberty itself. That is why constitutional clarity matters.
But the Constitution does not give the final word to any president. It gives it to the people. Democracy is not the property of any party or state — red, blue, or purple. For the Republic to endure, citizens must exercise their constitutional rights, demand that Congress use its power of checks and balances, and engage in civic responsibility.
Americans must see leaders as they are and refuse to surrender their judgment to noise, division, fear, or personality. Political judgment is about choosing sides. Citizen judgment is about choosing the Republic. Political judgment asks, “Which team am I on?” Citizen judgment asks, “What protects the Constitution and the common good?” One is driven by loyalty, personality, or party identity; the other by responsibility, research, and reflection.
Political judgment rewards performance, outrage, and allegiance. Citizen judgment evaluates whether leaders tell the truth, respect limits on power, and uphold their oath. Political judgment applauds a leader’s claims because he is “ours.” Citizen judgment checks whether those claims are real — and whether they strengthen or weaken democratic institutions.
Political judgment narrows the lens to winning. Citizen judgment widens it to safeguarding the Republic.
Judgment matters most when public life is clouded by confusion and spectacle. It requires research, self‑awareness, and reflection on how past choices shape the present. Voters must examine how their decisions affect the Republic, resist tactics meant to distract or divide, and demand accountability and transparency from every public official. Congress must prevent the concentration of power, exercise oversight, and uphold its constitutional responsibilities.
Citizens must vote, hold peaceful protests, challenge federal overreach, support a free press, and insist on separation of powers and judicial independence.
We must not allow the wolf to destroy our democracy. We strengthen the Republic when we let him know that we see who he is — and refuse to be misled. Democracy is not self‑correcting. It is citizen‑correcting. Judgment is not just a civic duty; it is the last line of protection between a free people and the concentrated power that seeks to weaken them.
_____________________________________________________________________
Carolyn Goode is a retired educational leader and national advocate for ethical leadership, civic responsibility, and institutional accountability. She writes about democratic norms, public trust, and the moral responsibilities of citizenship.
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Senator Harold Kipchumba, a polio survivor, gives the polio vaccine to a child and reflects on his experience. “Just two drops. This is what I didn’t have. “ Kenya Polio Vaccination Launch.
Photo credits: UNICEF ESARO 2013 via Wikimedia Commons.
Ordinary People Just Helped Save Millions of Lives.
Mar 16, 2026
With growing civic agony, an avalanche of questions demand our attention: Where is Congress’s backbone? What can I do? And will it even matter?
On Tuesday, Feb. 3, we saw glimmers of congressional backbone, in victories that should be shouted out. That day, President Trump signed into law a package of appropriations bills that included foreign assistance funding for the remainder of fiscal 2026.
Buried in the legislation was a story that few Americans know about: Congress rejected Trump’s drastic cuts to global health. Ordinary citizens played a key role in making that happen.
They didn’t do it by protesting, though protests matter, or by funding lawsuits, though lawsuits matter, or even through elections work, though elections matter. They did it through transformational advocacy – by building relationships with elected officials who make decisions in their names and, in the process, building a little bit of backbone in Congress.
Some highlights of what they accomplished:
- In fiscal 2025, total funding for global health programs was $10 billion. For 2026, the Trump administration asked for just $3.8 billion. The figure enacted into law was $9.4 billion.
- The 2025 allocation for the Global Fund to Fight AIDS, Tuberculosis and Malaria was $1.65 billion. The Trump administration wanted to reduce that to $800 million. The amount enacted was $1.25 billion.
- In 2025, Maternal and Child Health programs received $915 million. Trump’s request for 2026 was to slash funding to $85 million. The enacted amount was $915 million – fully restored.
This is literally a matter of life and death for millions of people. The Global Fund to Fight AIDS, Tuberculosis and Malaria partnership has saved 70 million lives since 2002. (Let that sentence sink in.) And U.S. Maternal and Child Health programs have helped drive a 66 percent drop in global child deaths since the early 1980s, saving some 10 million young lives a year. (That’s not a typo.)
The restoration of this money did not happen by chance. Behind these numbers – both the funds appropriated and the lives saved – are decades of tireless grassroots advocacy, including work last year to get 160 House members to sign a letter urging top appropriators to strongly fund the Global Fund and PEPFAR (the President’s Emergency Plan for AIDS Relief) and 128 members to sign a separate letter calling for robust funding for maternal and child health, GAVI (the Vaccine Alliance), and nutrition programs.
The Global Fund letter was led by two House Republicans and three House Democrats: Reps. Brian Fitzpatrick (R-Pa.), Maria Elvira Salazar (R-Fla.), Chrissy Houlahan (D-Pa.), Ami Bera (D-Calif.), and Mike Kelly (D-N.Y.). The Maternal and Child Health letter was led by the same two Republicans and Reps. Sara Jacobs (D-Calif.) and James P. McGovern (D-Mass.).
Why did the members of Congress who signed these letters – and the House and Senate appropriators who took the initial action – push back against Trump and his budget in this way? It’s foreign aid, for goodness’ sake. Some realized that what Trump, Elon Musk, and Marco Rubio had done to life-saving programs was wrong. Moreover, they were finally willing to say so, after conversations with citizen lobbyists, volunteers who received training and support from their local chapters of RESULTS.
RESULTS launched in 1980 to teach the skills of transformational advocacy. This is not transactional advocacy (e.g., sign the petition, transaction complete), but a set of strategies and skills empowering ordinary Americans to meet and build relationships with their members of Congress, to write letters to the editor and op-eds on any number of issues they care about, and to build backbone along the way. RESULTS chapters meet monthly to learn, practice, and support each other in effective advocacy.
For example, Nancy Taylor, who volunteered with the anti-poverty lobby RESULTS, had her first op-ed on global health published in the Chicago Tribune in 1986. “I can’t remember what pushed me past my fear and helped me dial the telephone,” Nancy told me decades ago, “but I found myself talking to an editorial writer at the Tribune, who encouraged me to submit an op-ed.”
Taylor took the challenge, but nothing appeared for two weeks. “My calm was shattered early one morning, when my husband thrust the editorial page in my face,” she said. “There it was — my words and my name. As I read what seemed like foreign phrases, I felt a head rush equivalent to an unfiltered cigarette and a stiff martini being ingested simultaneously. I had my first adult experience with getting ‘high on life.’”
That’s a key part of the transformation in transformational advocacy.
This work of grassroots advocates building congressional spine goes beyond global health. Initially, Trump proposed a 55 percent cut to the Environmental Protection Agency for fiscal 2026, House Appropriators proposed a 23 percent cut, and Senate Appropriators a 5 percent cut. In late January, however, the president signed into law an appropriations bill that provided a much smaller 3.5 percent cut to the EPA – 16 times smaller than his original proposal. Some pressure came from the United Church of Christ Climate Hope Affiliates, who used RESULTS’ methods of transformational advocacy to build relationships – and some backbone – with their members of Congress, and got dozens of letters to the editor published supporting the Environmental Protection Agency.
What will you be doing over the next few months? You could doomscroll your blood pressure ever higher as elected officials pursue policies and take actions that contravene your values and priorities.
Or you could try transformational advocacy. You could go here to get help connecting with a group like RESULTS or the Climate Hope Affiliates that continue to advocate for issues that matter and train their advocacy muscle.
It’s your move.
Sam Daley-Harris is the author of “Reclaiming Our Democracy: Every Citizen’s Guide to Transformational Advocacy” and the founder of RESULTS and Civic Courage."
Ordinary People Just Helped Save Millions of Lives" was originally published in The Renovator Substack and is republished with permission.
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