As He Concludes His Second Tenure, 21st U.S. Surgeon General Issues Parting Prescription for America

Dr.  Murthy has hit upon a profound and deeply meaningful, but somewhat unappreciated aspect of our culture and "modern" life.

The citizens of the United States have been insensitive to their loss of community because, like the air we breathe, "community" is invisible until it is disturbed. The long collective history of the United States is infused with the vaunted values of freedom, liberty, individual autonomy, equality, and democracy, etc. This is the story we tell ourselves, but it is not quite true! In fact, this is the story chauvinistic historians have spun to de-emphasize and hide the dynamics of our national ideology - "Naked Commercial Capitalism." In fact, while destroying community, this world view has promoted, for example, geographic mobility (Go where the jobs are.), consumption (You should work hard to get these things.), family instability (Promoting two working parents and, previously, slavery and child labor.) and individualism (You are responsible for your family's circumstances.) All of which contributed to the loss of community, freeing up labor for corporate production.

Dr. Murthy's observations, concerns, and prescriptions were all preceded a generation  ago by [It must be read] Robert Putnam's BOWLING ALONE: THE COLLAPSE AND REVIVAL OF AMERICAN COMMUNITY (2000). Professor Putnam documents, with extensive hard data, the history and causes of the withering away of "social capital," i.e. community, collective trust and cooperation in contemporary USA. Alas the "revival" never came to be. The main reasons for that are laid out in Elizabeth Warren's (written before she became a politician with her daughter) insightful THE TWO-INCOME TRAP; WHY MIDDLE-CLASS PARENTS ARE GOING BROKE (2003). A sense of belonging, cooperation, mutual respect and assistance, trust, that is, belonging to a community is the foundation of a fulfilled life and a healthy society.

The passionate, emotional response of Americans to the withering away of social capital, civic cohesion, trust,  and community provide the fuel and momentum for the MAGA movement which will only make matters worse. Understanding this dynamic explains why compassionate, empathetic therapy and meager concrete and economic supports for those in need or suffering are beneficial and valuable, but they are only fingers in the dike holding back despair. Collective action in the political sphere to take our country back is obligatory.

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From the inception of the country, enterprising individuals with the support of government appropriated the means of production from indigenous peoples. From our nation's birth the dehumanization of people into indentured means of production (slavery and the consequent racism) have been incorporated in our DNA. Forty-one of the fifty-six original signers of the Declaration of Independence were slave owners. The Civil War can easily be cast as a fight for capitalist power between Northeastern manufacturing (based on “sweatshop” labor) and Southern agriculture (based on indentured chattel slaves). Reconstruction failed because the government of the capitalist oligarchs of the time united around reconstituting and preserving capitalist enterprise, rather than embodying universal human and democratic values promoting community.

At the start of the 20th century capitalism ran wild in the First Gilded Age. While the 20s "roared," Senators were ‘owned’ by corporations. In 1895 and 1907 J.P Morgan twice personally bailed out the country after banking panics which were recurring and frequent due to unfettered capitalism (tearing apart family and community stability). The Supreme Court twice ruled that restricting child labor was unconstitutional. Andrew Mellon as Secretary of the Treasury in the 1920s lowered the top personal marginal income tax rate from 73% to 24%. At this time, the loss of community was actually felt by some elite capitalist businessmen. They used their wealth to support civic infrastructure and development. Leland Stanford started a university on his family farm. Andrew Carnegie’s donations built 1,679 libraries around the US. Julius Rosenwald, President of Sears Roebuck built over 5,000 schools and teachers homes for Blacks across the South.

The horrors, stress and challenges of the Great Depression and World War II created local and national community as people needed to work together and cooperate to support each other, their families and the nation during this period of great deprivation, challenge and distress. FDR and his New Deal, of necessity, invented a modern, citizen oriented and supportive, innovative and creative government through the institution of regulations, a more equitable rule of law, and a national government funded employment and manufacturing policy (all against great opposition) that saved the day. In his famous 1941 State of the Union address FDR enumerated “four freedoms”(freedom of speech, freedom of worship, freedom from want, and freedom from fear- all the basic prerequisites for community. He thus conceptualized and institutionalized American values and aspirations for the modern era and articulated a vision of the United States as a community.

Rebounding from the deprivation and devastation of the War, the United States entered an unprecedented period of growth, prosperity, economic equality and community cohesion. Uniquely in all our history during this period, capitalism was not a sum zero game. Few people realize that this prosperous period - from 1945 - 1970 - was historically unique in allowing the blossoming of the best democratic, civic and community ideals. But by 1980, the capitalists felt threatened enough by broad government policies supporting broad civic participation to re-exert their power. Capitalism as the national ideology was hidden as both major political parties promoted its policies and programs. The Republicans explicitly became the embodied modern party of capitalism with President Reagan (1981-1989) who during his acting days spoke out for the American Medical Association against Medicare, as a “socialist” program that would steal our freedom. In his 1981 inaugural speech he declared, “Government is not the solution to our problem; government is the problem… It is no coincidence that our present troubles parallel and are proportionate to the intervention and intrusion in our lives that result from unnecessary and excessive growth of government.” Thus began the long, usually quiet, process of unwinding and destabilizing the sense and function of community in the modernized United States. The Republican Party was dedicated to building a federal government supportive of Naked Capitalism while leaving the majority of Americans, in a civic sense, naked and isolated from community support.

The sunny face of President Reagan hid the devastating effects of neoliberal, free market fundamentalism ( “trickle down economics"),  vituperative denigration of "welfare queens" (allowing cut backs of federal social and family support programs), active antagonism toward community creating unions (leading the way by firing 13,000 air traffic controllers), and supportive government functions were out sourced to corporations to be exploited for profit rather than service (student loans, Medicaid, Medicare Advantage). This perspective also became the implicit norm of the Democratic Party  as President Clinton  passed the North American Free Trade Agreement (NAFTA) allowing cheaper consumption at the price of devastating the manufacturing sector, blue collar workers, the midwest and destroying our civic community by facilitating off-shoring of factories. Obama with capitalist neoliberal advisors responded to the Great Recession of 2008 by famously bailing out Wall Street (with essentially free money with no criminal punishment for any capitalists) while leaving the communities of Main Street to suffer with wholly inadequate stimulus program (5 million homes [the foundation of community] -1 in 54 - lost to foreclosure, 13 million jobs lost, and 7 years for the economy to recover).

Fast forward, there has been a harsh destruction of civic cohesion and community in a Second Guilded Age by an explosion in the maldistribution of income and wealth (and its attendant political power, with the hollowing out of federal agencies and policies). This explains the widespread economic insecurity, loss of trust and community cohesion, anger and restlessness of the Americans drawn to the MAGA message. In 2021 the top 10% of wealthy US families held 70% of the nation’s personal wealth, while the bottom 50% of all households together had less than 02.5% of the nation’s wealth. The few top 1% of households owned 30% of the country's net worth in 2023. Since 2007 wealth has actually declined among all US families except for the top 20% of households. About 7% of families had negative net worth in 1989, increasing to 10.4% of households by 2019. It is estimated that between 1981 and 2021 so-called supply-side economics moved $50 trillion from the bottom 90% to the top 1%. American households have become more food insecure—without enough to eat and not knowing where their next meals would come from—increasing from 10.5% in 2019 to 13.5% in 2024; that’s about 4.8 million more households, or around 10.2 million American adults and children without enough to eat. More than a quarter of US families spend more than 95% of their income on necessities and about 50% have less than $500 in cash savings for an emergency. The most stark evidence of the loss of community is the acceptance of unhoused people among us. In 2024, the known number of people experiencing homelessness in the United States reached a record high of 771,480, which is an 18% increase from 2023.

This history and these stark figures demonstrate that we are far advanced into the destruction of healthy communities and victory of Naked Capitalism. The ascension of President Trump now promises total victory of this ideology by removing the guardrails of the neutral rule of law and federal agencies that restrain the exploitations of corporate entrepreneurial behavior. This allows the creation of powerful othering fundamentalist passionate religious communities and of, often violent, feral MAGA communities. Meanwhile, the sick, the disabled, the poor, minorities, the uneducated are rejected and left to suffer. Suffering , alienation, exploitation, distress and loss of community will continue to spread throughout society. Worse is yet to come.