Let me tell you about a patient I saw not long ago. Diabetic. No insurance—kicked off the ACA when his restaurant job disappeared. Walked into my office in Coconut Creek with a 3 cm ulcer eating through the plantar surface of his right forefoot. Six other clinics had turned him away. Some wanted $250 to $400 per visit. One didn’t call him back. I put him in a treatment room, debrided the wound, did a full vascular workup, fitted him with a walking boot, and wrote scripts for generic meds he could actually afford.
When he asked how much he owed, my office manager said: zero. He cried. I walked him to the door and told him what I tell everyone: you pay it forward. That’s the medicine I practice. That’s the oath I took.
Now I’m watching a group of men—some in federal office, some on Sand Hill Road, some in both places simultaneously—dismantle the infrastructure that allows any of this to work, all while wrapping themselves in the language of health and wellness. And what they’re building in its place has a name. It’s not a new name. It’s a very old one. I want to talk about it plainly, as a physician and as someone who has spent a career watching what happens when systems decide certain bodies aren’t worth the investment.
I’m going to use the word. I know it makes people uncomfortable. Good. It should. Eugenics.
