The Grumpy Doc

Grumpy opinions about everything.

America’s Healthcare Paradox: Why We Pay Double and Get Less

By

On January 5, 2026

In Commentary, Medicine

The healthcare debate in America often circles back to a fundamental question: should we move toward a single-payer system, or is our current mixed public-private model the better path forward? It’s a conversation that gets heated quickly, but when you strip away the politics and look at how different systems actually function around the world, some interesting patterns emerge.

What We Mean by Single-Payer

A single-payer healthcare system means that one entity—usually the government or a government-related organization—pays for all covered healthcare services. Doctors and hospitals can still be private (and usually are), but instead of dealing with dozens of different insurance companies, they bill one source. It’s a lot like Medicare, which is why proponents often call it “Medicare-for-all”.

The key thing to understand is that single-payer isn’t necessarily the same as socialized medicine. In Canada’s system, for instance, the government pays the bills, but doctors are largely in the private sector and hospitals are controlled by private boards or regional health authorities rather than being part of the national government. Compare that to the UK’s National Health Service, where many hospitals and clinics are government-owned and many doctors are government employees.

America’s Current Patchwork

The United States operates what might charitably be called a “creative” approach to healthcare—a complex mix of employer-sponsored private insurance, government programs like Medicare, Medicaid and the VA system, individual marketplace plans, and direct out-of-pocket payments. Government already pays roughly half of total US health spending, but benefits, cost-sharing, and networks vary widely between plans, with little overall coordination.​ In 2023, private health insurance spending accounted for 30 percent of total national health expenditures, Medicare covered 21 percent, and Medicaid covered 18 percent.  Most of the remainder was either paid out of pocket by private citizens or was written off by providers as uncollectible.

Here’s where it gets expensive. U.S. health care spending grew 7.5 percent in 2023, reaching $4.9 trillion or $14,570 per person, accounting for 17.6 percent of the nation’s GDP, and national health spending for 2024 is expected to have exceeded $5.3 trillion or 18% of GDP, and health spending is expected to grow to 20.3 percent of GDP by 2033.

For a typical American family, the costs are real and rising. In 2024, the estimated cost of healthcare for a family of four in an employer-sponsored health plan was $32,066.

The European Landscape

Europe doesn’t have one healthcare model—it has several, and they’re all quite different from what we have in the States. Most of the 35 countries in the European Union have single-payer healthcare systems, but the details vary considerably.

Countries like the UK, Sweden, and Norway operate what are essentially single-payer systems where it is solely the government who pays for and provides healthcare services and directly owns most facilities and employs most clinical and related staff with funds from tax contributions. Then you have countries like Germany, and Belgium that use “sickness funds”—these are non-profit funds that don’t market, cherry pick patients, set premiums or rates paid to providers, determine benefits, earn profits or have investors. They’re quasi-public institutions, not private insurance companies like we know them in America.  Some systems, such as the Netherlands or Switzerland, rely on mandatory individually purchased private insurance with tight regulation and subsidies, achieving universal coverage with a structured, competitive market.

The French System

France is particularly noted for a successful universal, government-run health insurance system usually described as a single-payer with supplements. All legal residents are automatically covered through the national health insurance program, which is funded by payroll taxes and general taxation.

Most physicians and hospitals are private or nonprofit, not government employees or facilities. Patients generally have free choice of doctors and specialists, though coordinating through a primary care physician improves access and reimbursement. The national insurer pays a large portion of medical costs (often 70–80%), while voluntary private supplemental insurance covers most remaining out-of-pocket expenses such as copays and deductibles.

France is known for spending significantly less per capita than the United States. Cost controls come from nationally negotiated fee schedules and drug pricing rather than limits on access.

What’s striking is that in 2019, US healthcare spending reached $11,072 per person—over double the average of $5,505 across wealthy European nations. Yet despite spending roughly twice as much per person, American health outcomes often lag behind.

The Outcomes Question

This is where the comparison gets uncomfortable for American exceptionalism. The U.S. has the lowest life expectancy at birth among comparable wealthy nations, the highest death rates for avoidable or treatable conditions, and the highest maternal and infant mortality.

In 2023, life expectancy in comparable countries was 82.5 years, which is 4.1 years longer than in the U.S. Japan manages this with healthcare spending at just $5,300 per capita, while Americans spend more than double that amount.

Now, it’s important to note that healthcare systems don’t operate in a vacuum. Life expectancy is influenced by many factors beyond medical care—diet, exercise, smoking, gun violence, drug overdoses, and social determinants of health all play roles. But when you’re spending twice as much and getting worse results, it suggests the system itself might be part of the problem.

Advantages of Single-Payer Systems

The case for single-payer rests on several compelling points. First, administrative simplicity translates to real cost savings. A study found that the administrative burden of health care in the United States was 27 percent of all national health expenditures, with the excess administrative cost of the private insurer system estimated at about $471 billion in 2012 compared to a single-payer system like Canada’s. That’s over $1 out of every $5 of total healthcare spending just going to paperwork, billing disputes, and insurance company profit and overhead before any patient receives care.

Universal coverage is another major advantage. In a properly functioning single-payer system, nobody goes bankrupt from medical bills, nobody delays care because they can’t afford it, and nobody loses coverage when they lose their job. The peace of mind that comes with knowing you’re covered regardless of employment status or pre-existing conditions is difficult to quantify but enormously valuable.

Single-payer systems also have significant negotiating power. When one entity is buying drugs and services for an entire nation, pharmaceutical companies and medical device manufacturers have much less leverage to charge whatever they want. This helps explain why prescription drug prices in other countries are often a fraction of prices in the U.S.

Disadvantages and Trade-offs

The critics of single-payer systems aren’t wrong about everything. Wait times are a genuine concern in some systems. When prices and overall budgets are tightly controlled, some countries experience longer waits for selected elective surgeries, imaging, or specialty visits, especially if investment lags demand.

In 2024, Canadian patients experienced a median wait time of 30 weeks between specialty referral and first treatment, up from 27.2 weeks in 2023, with rural areas facing even longer delays. For procedures like elective orthopedic surgery, patients wait an average of 39 weeks in Canada.

However, it’s crucial to understand that wait times are not a result of the single-payer system itself but of system management, as wait times vary significantly across different single-payer and social insurance systems. Many European countries with universal coverage don’t experience the same wait time issues that plague Canada.

The transition costs are also substantial. Moving from our current system to single-payer would disrupt a massive industry. Over fifteen percent of our economy is related to health care, with half spent by the private sector. Around 160 million Americans currently have insurance through their employers, and transitioning all of them to a government-run plan would be an enormous administrative and political challenge.

A large national payer can be slower to change benefit designs or adopt new payment models; shifting political majorities can affect funding levels and benefit generosity.

Taxes would need to increase significantly to fund such a system, though proponents argue this would be offset by the elimination of insurance premiums, deductibles, and co-pays. It’s essentially a question of whether you’d rather pay through taxes or through premiums—the money has to come from somewhere.

Advantages of America’s Mixed System

Our current system does have some genuine strengths. Innovation thrives in the American healthcare market. The profit motive, for all its flaws, does drive pharmaceutical research and medical device development. American medical schools and research institutions lead the world in many areas of medicine.   Academic medical centers and specialty hospitals deliver advanced procedures and complex care that attract patients internationally.​

The system also offers more choice for those who can afford it. If you have good insurance, you typically face shorter wait times for elective procedures and can often see specialists without lengthy delays. Americans with high-quality employer-sponsored coverage give their plans relatively high ratings.

Competition between providers can theoretically drive quality improvements, though this effect is often undermined by the complexity of the market and the difficulty consumers face in shopping for healthcare.

Disadvantages of the Current U.S. System

The most glaring problem is simple: The United States remains the only developed country without universal healthcare, and 30 million Americans remain uninsured despite gains under the Affordable Care Act, and many of these gains will soon be lost. Being uninsured in America isn’t just an inconvenience—it can be deadly. People delay care, skip medications, and avoid preventive screenings because of cost concerns. 

The administrative complexity is staggering. Doctors spend enormous amounts of time dealing with insurance companies, prior authorizations, and billing disputes. Hospitals employ armies of billing specialists just to navigate the maze of different insurance plans, each with its own rules, formularies, and coverage determinations.  U.S. administrative costs account for ~25% of all healthcare spending, among the highest in the world.

Medical bankruptcy is uniquely American. Even people with insurance can find themselves financially devastated by serious illness. High deductibles, surprise bills, and out-of-network charges create a minefield of potential financial catastrophe.  Studies of U.S. bankruptcy filings over the past two decades have consistently found that medical bills and medical problems are a major factor in a large share of consumer bankruptcies. Recent summaries suggest that roughly two‑thirds of US personal bankruptcies involve medical expenses or illness-related income loss, and around 17% of adults with health care debt report declaring bankruptcy or losing a home because of that debt.

The system is also profoundly inequitable. Quality of care often depends more on your job, your income, and your zip code than on your medical needs. Out-of-pocket costs per capita have increased as compared to previous decades and the burden falls disproportionately on those least able to afford it.

What Europe Shows Us

The European experience demonstrates that there isn’t one “right” way to achieve universal coverage. The UK’s NHS, Germany’s sickness funds, and France’s hybrid system all manage to cover everyone at roughly half the per-capita cost of American healthcare. Universal Health Coverage exists in all European countries, with healthcare financing almost universally government managed, either directly through taxation or semi-directly through mandated and government-subsidized social health insurance.

They’ve accomplished this through various combinations of centralized negotiation of drug prices, global budgets for hospitals, strong primary care systems that serve as gatekeepers to more expensive specialist care, emphasis on preventive services, and regulation that prevents insurance companies from cherry-picking healthy patients.

Are these systems perfect? No. One of the major disadvantages of centralized healthcare systems is long wait lists to access non-urgent care, though Americans often wait as long or longer for routine primary care appointments as do patients in most universal-coverage countries. Many European countries are wrestling with funding challenges as populations age and expensive new treatments become available. But they’ve solved the fundamental problem that America hasn’t: they ensure everyone has access to healthcare without the risk of financial ruin.

The Path Forward?

The debate over healthcare in America often presents false choices. We don’t have to choose between Canadian-style single-payer and our current system—there are multiple models we could adapt. We could move toward a German-style system with heavily regulated non-profit insurers. We could create a robust public option that competes with private insurance. We could expand Medicare gradually by lowering the eligibility age over time.

What’s clear from international comparisons is that the status quo is unusually expensive and produces mediocre results. We’re paying premium prices for economy outcomes. Whether single-payer is the answer depends partly on your priorities. Do you value universal coverage and cost control more than unlimited choice? Are you willing to accept potentially longer wait times for non-urgent care in exchange for lower costs and universal access? How much do you trust government to manage a program this large?

These aren’t easy questions, and reasonable people disagree. But the evidence from Europe suggests that universal coverage at reasonable cost is achievable—it just requires us to make some choices about what we value most in a healthcare system.

Sources:

Life Below Deck: Enlisted Sailors in America’s Continental Navy

By

On January 4, 2026

In History

When the Continental Congress established America’s first navy in October 1775, they faced a daunting challenge: how do you build a fleet from scratch when you’re fighting the world’s most powerful naval force? The Continental Navy peaked at around 3,000 men serving on approximately 30 ships, a tiny force compared to Britain’s massive Royal Navy. But who were these sailors who were willing to risk their lives for a fledgling republic?

Where They Came From

The colonial maritime community had extensive seafaring experience, as much of British trade was carried in American vessels, and North Americans made up a significant portion of the Royal Navy’s seamen. Continental Navy sailors came primarily from port cities along the Atlantic coast, particularly New England communities where maritime trades were a way of life. Many had worked as merchant sailors, fishermen, or privateers before joining.

The naval service was notably diverse for its time, including native-born Americans, British deserters, free and enslaved Black sailors, and European immigrants. Unlike the Continental Army, which had periods of banning Black soldiers or sometimes placing them in segregated regiments, the Continental Navy was mostly integrated. At sea, there was less distinction between free and enslaved sailors, and those held in bondage had opportunities to work toward freedom. This maritime tradition of relative equality distinguished naval service from other Revolutionary War experiences.

Getting Into the Service

Recruiting sailors proved to be one of the Continental Navy’s biggest headaches. Navy boards supervised appointing petty officers and enlisting seamen, though these duties were chiefly performed by ship commanders or recruiting agents. The first Marine recruiting station was located at Tun’s Tavern, a bar in Philadelphia.

Enlistment was generally voluntary, though the line between volunteering and impressment—forced service—was sometimes blurred. Recruiting parties would scour port towns seeking able-bodied men, advertising not only pay but also the possibility of capturing British prizes for sale, with proceeds shared among the crew—a powerful incentive.

The problem was competition. Privateering—private ships licensed by congress to seize enemy vessels—was far more attractive to sailors because cruises were shorter and pay could be better. With over 2,000 privateers operating during the war, the Continental Navy struggled constantly to maintain adequate crew sizes. Continental captains often found themselves unable to man their ships due to privateers’ superior inducements.

Landsmen, Seamen, and Petty Officers

At the bottom rung of a Navy crew stood the landsman—a recruit with little or no sea experience. Many were farm boys or tradesmen who had never set foot on a ship. Their days were filled with the hardest labor: hauling ropes, scrubbing decks, and learning basic seamanship.

Above them were ordinary seamen, who had some experience afloat, and the more skilled able seamen who knew their way around sails, rigging, and naval gunnery. These sailors formed the backbone of the Continental Navy. Sailors skilled in managing the ship’s rigging were said to “know the ropes.” Without their knowledge of wind, tide, and timber, ships would have been little more than floating platforms.

The most experienced enlisted men were promoted to petty officers. These weren’t commissioned officers but rather specialists and leaders—boatswain’s mates directing rigging crews, gunner’s mates overseeing cannon fire, and carpenters’ mates keeping the wooden hulls afloat. They were the Navy’s “non-commissioned officers,” long before the U.S. Navy had a formal NCO corps.

Most Continental Navy ships also carried detachments of Continental Marines. These enlisted men were soldiers at sea, tasked with keeping order on deck, manning small arms in combat, and leading boarding parties.

What They Wore

Unlike officers who had prescribed uniforms, enlisted sailors received no standard clothing from the Continental Navy. Due to meager funds and lack of manufacturing capacity, sailors generally provided their own clothing, usually consisting of pantaloons often tied at the knee or knee breeches, a jumper or shirt, neckerchief, short waisted jacket, and low crowned hats. Most sailors went barefoot, and a kerchief was worn either as a sweat band or as a simple collar closure. The short trousers served a practical purpose—they didn’t interfere with climbing the ship’s rigging. This lack of uniforms reflected the Continental Navy’s financial struggles, where everything from ships to ammunition took priority over standardized clothing.

Daily Life at Sea

Shipboard duties for enlisted sailors were grueling and dangerous. Landsmen cleaned the deck, helped raise or lower the anchor, worked in the galley, and assisted other crew members. More experienced sailors handled the complex work of managing sails, operating guns during combat, standing watch, and maintaining the vessel. Specialized roles were filled by experienced hands, and most sailors worked long shifts in harsh conditions, often enduring crowded, wet, and unsanitary quarters below deck.

Living conditions were cramped. Sailors lived in close quarters with limited privacy, shared hammocks on the lower decks, and endured monotonous food rations. Meals were simple, based on salted meat, ship’s biscuit, and whatever could be supplemented from local ports or captured prizes. Leisure was rare, and recreation was often limited to singing, storytelling, or gambling. The work was physically demanding and accidents were common—falling from rigging, being crushed by shifting cargo, or drowning were constant risks.

Discipline and Relations with Officers

Discipline in the Continental Navy was deeply influenced by the British Royal Navy and the “ancient common law of the sea.” The Continental Congress issued articles governing naval discipline, empowering officers to maintain strict order and punish infractions including drunkenness, blasphemy, theft, or disobedience. Punishments included wearing a wooden collar, spending time in irons, receiving pay deductions, confinement on bread and water, or, for serious offenses, flogging.

Flogging was often done with a multi-thonged whip known as the cat o’ nine tails. The most common flogging consisted of between 12 and 24 lashes, though mutineers might receive sentences in the hundreds of lashes—often becoming a death sentence.

Even though officers held absolute authority aboard their vessels, the Continental Navy sometimes suffered from severe discipline problems. Some commanders found it impossible to maintain control over squadrons made up of crews recruited from one area and commanded by officers from another. The relationship between officers and enlisted men reflected the social hierarchies of the time, with a clear divide between the educated officer class and working-class sailors. However, the shared dangers of combat and the sea could create bonds that transcended these divisions.

A Brief but Important Legacy

Enlisted sailors of the Continental Navy came from diverse and often hardscrabble backgrounds, shaped by the hard labor and hazards of maritime life. These men, whose names are mostly lost to history, formed the foundation of America’s first navy and contributed profoundly—through sacrifice and service—to the establishment of American independence.

Of approximately 65 vessels that served in the Continental Navy, only 11 survived the war, and by 1785 Congress had disbanded the Navy and sold the remaining ships. Despite its short existence and limited impact on the war’s outcome, the sailors of the Continental Navy created a foundation for American naval tradition and provided trained seamen who would serve in future conflicts.

Sources:

Personal note: The Grumpy Doc proudly served as an enlisted sailor in the U.S. Navy from 1967 to 1974.

Thomas Jefferson: The Philosopher Who Played Hardball

By

On January 2, 2026

In History, Politics

Here’s the thing about Thomas Jefferson that doesn’t always make it into the history textbooks: the guy who wrote those soaring words about liberty and limited government? He was also one of early America’s most skilled—and sometimes underhanded—political operators.

It’s surprising when you think about it. Jefferson genuinely believed in transparency, virtue in public life, and keeping government small. He wrote beautifully about these ideals. But when it came to actual politics? He played the game as hard as anyone, often using tactics that directly contradicted what he preached.

Jefferson’s public philosophy was straightforward. He thought America should be a nation of independent farmers—regular people who owned their own land and weren’t dependent on anyone else. He worried constantly about concentrated power, whether in government or in the hands of wealthy financiers or merchants. He believed people should be informed and engaged, and that government worked best when it stayed out of people’s lives.

His Declaration of Independence wasn’t just pretty rhetoric—it laid out a genuinely revolutionary idea: governments only have power because people agree to give it to them, and when governments stop serving the people, those people have the right to change things.

The Reality: How Jefferson Actually Operated

Here’s where it gets interesting. While Jefferson was writing about virtue and transparency, he was simultaneously running what today we’d recognize as opposition research, planting stories in the press, and organizing political operations—sometimes against people he was supposed to be working with.

The Freneau Setup: Paying for Attacks

The most blatant example happened in 1791. Jefferson was serving as Secretary of State under George Washington, which meant he was part of the administration. At the same time, he arranged for a guy named Philip Freneau to get a government job—technically as a translator. The real purpose? To give Freneau money to run a newspaper that would relentlessly attack Alexander Hamilton and other Federalists.

Think about that for a second. Jefferson was using his government position to fund media attacks on his own colleagues. When people called him out on it, he basically said, “Who, me? I have nothing to do with what Freneau publishes.” But the evidence shows Jefferson was actively encouraging and directing these attacks.

John Beckley: The Original Campaign Fixer

Jefferson also worked closely with John Beckley, who was essentially America’s first professional political operative. Beckley coordinated messaging, spread information (and sometimes misinformation) about opponents, and helped build the grassroots organization that would eventually become the Democratic-Republican Party.

This wasn’t a gentlemanly debate about ideas. This was organized political warfare—pamphlets, coordinated newspaper campaigns, and opposition research. Jefferson and Jame Madison quietly funded much of this work while maintaining public images as above-the-fray philosophers. We can’t know exactly what Jefferson said in every private conversation with Beckley, but the circumstantial evidence of coordination is convincing.

The Hamilton Rivalry: Ideological War

Jefferson’s conflict with Hamilton was both philosophical and deeply personal. Hamilton wanted a strong federal government, a national bank, and close ties with Britain. Jefferson saw all of this as a betrayal of the Revolution—a step toward creating the same kind of corrupt, elite-dominated system they’d just fought to escape.

But rather than just making his arguments publicly, Jefferson worked behind the scenes to undermine Hamilton’s policies. He encouraged Madison to lead opposition in Congress. He fed stories to friendly newspapers. He coordinated with Republican representatives to block Federalist initiatives.

The philosophical disagreement was real, but Jefferson’s methods were pure political calculation.

Turning on Washington: The Ultimate Betrayal?

Maybe the most damaging thing Jefferson did was secretly working against George Washington while still serving in his cabinet. By Washington’s second term, Jefferson had convinced himself that Washington was being manipulated by Hamilton and moving the country toward monarchy.

 Jefferson stayed in the cabinet, maintaining cordial relations with Washington in person, while privately organizing resistance to administration policies. He encouraged attacks on Washington in the press. He coordinated with opposition leaders. And he did all of this while Washington trusted him as a loyal advisor.

When Washington found out, he was devastated. The betrayal broke their relationship permanently.

The Burr Situation: Using People

Jefferson’s handling of Aaron Burr shows just how pragmatic he could be. Jefferson never really trusted Burr—thought he was too ambitious and unprincipled. But in 1800, when Jefferson needed to win the presidency, Burr was useful for delivering New York’s votes.

After winning, Jefferson kept Burr as vice president but froze him out of any real power. Once Burr’s usefulness ended (especially after he killed Hamilton in that duel), Jefferson completely abandoned him, eventually supporting an unsuccessful prosecution for treason.

Deceiving Congress

Another example of Jefferson’s political manipulation was the Louisiana Purchase. This was a massive land acquisition that doubled the size of the United States. Jefferson knew that under the constitution he had no clear authority to acquire territory for the United States.  He was able to secure the purchase by keeping it secret from both congress and his political opponents until after it was finalized. This allowed him to avoid a debate that could have derailed the deal.  Does this sound familiar?

So, What Do We Make of This?

Here’s the uncomfortable question: Was Jefferson a hypocrite, or was he just being realistic about how politics actually works?  Jefferson’s political manipulation was not always ethical, but it was effective. He was able to use his skills to achieve many of his political goals.

You could argue he was doing what he thought necessary to prevent Hamilton’s vision from taking over—that the ends justified the means. You could also argue that by using underhanded tactics, he corrupted the very democratic processes he claimed to be protecting.

My speculation: I think Jefferson was aware of the contradiction and wrestled with it. His private letters show moments of self-justification and lingering doubt. But ultimately, he kept doing it because he believed his vision for America was too important to lose by playing nice.

The Bottom Line

Thomas Jefferson remains one of our most brilliant political thinkers. But he was also willing to play dirty when he thought the stakes were high enough. That duality—beautiful ideals combined with hardball tactics—might actually make him more relevant today than ever. Because let’s be honest, that tension between principles and pragmatism hasn’t gone away in American politics.

Understanding both sides of Jefferson helps us see that even the founders we most revere weren’t simple heroes. They were complicated people operating in a messy political reality, trying to build something new while fighting over what that something should be.

The evidence for Jefferson’s political maneuvering is extensive and well-established by historians. Some interpretations of his motivations involve educated speculation, but the actions themselves are documented in letters, newspaper archives, and contemporary accounts.​​​​​​​​​​​​​​​​

Reference List

Primary Sources

Founders Online – National Archives https://founders.archives.gov/

  • Digital collection of correspondence and papers from George Washington, Thomas Jefferson, Alexander Hamilton, Benjamin Franklin, John Adams, and James Madison. Essential for Jefferson’s own words and contemporaneous accounts of his political activities.

Library of Congress – Thomas Jefferson Exhibition https://www.loc.gov/exhibits/jefferson/

  • Comprehensive digital exhibition covering Jefferson’s life, philosophy, and political career with original documents and interpretive essays.

Thomas Jefferson Encyclopedia – Monticello https://www.monticello.org/site/research-and-collections/

  • Scholarly resource maintained by the Thomas Jefferson Foundation, covering specific topics including Jefferson’s relationships with Aaron Burr and other political figures.

Secondary Sources – Books

Chernow, Ron. Alexander Hamilton. New York: Penguin Press, 2004.

  • Pulitzer Prize-winning biography that extensively covers the Jefferson-Hamilton rivalry and Jefferson’s behind-the-scenes political maneuvering, including the Freneau affair. Particularly strong on the 1790s conflicts within Washington’s cabinet.

Chernow, Ron. Washington: A Life. New York: Penguin Press, 2010.

  • Provides Washington’s perspective on Jefferson’s activities within his administration and the betrayal Washington felt when learning of Jefferson’s covert opposition.

Ellis, Joseph J. American Sphinx: The Character of Thomas Jefferson. New York: Alfred A. Knopf, 1996.

  • National Book Award winner that explores Jefferson’s contradictions and complexities, particularly the gap between his philosophical writings and political practices.

Ferling, John. Jefferson and Hamilton: The Rivalry That Forged a Nation. New York: Bloomsbury Press, 2013.

  • Detailed examination of the ideological and personal conflict between Jefferson and Hamilton, showing how their struggle shaped early American politics and party formation.

Isenberg, Nancy. Fallen Founder: The Life of Aaron Burr. New York: Penguin Books, 2007.

  • Comprehensive biography of Burr that includes extensive coverage of his complex relationship with Jefferson, from their 1800 alliance through Jefferson’s eventual abandonment of his vice president.

Pasley, Jeffrey L. The Tyranny of Printers: Newspaper Politics in the Early American Republic. Charlottesville: University of Virginia Press, 2001.

  • Scholarly examination of how newspapers and partisan press became political weapons in the 1790s, with detailed coverage of Jefferson’s relationship with Philip Freneau and the National Gazette.

Secondary Sources – Journal Articles and Academic Papers

Sharp, James Roger. “The Journalist as Partisan: The National Gazette and the Origins of the First Party System.” The Virginia Magazine of History and Biography 97, no. 4 (1989): 391-420.

  • Academic analysis of Freneau’s National Gazette and its role in forming political opposition, including Jefferson’s involvement in funding and directing the publication.

Cunningham, Noble E., Jr. “John Beckley: An Early American Party Manager.” The William and Mary Quarterly 13, no. 1 (1956): 40-52.

  • Scholarly examination of Beckley’s role as America’s first professional political operative and his work organizing Jefferson’s political machine.

Historiographical Note

The interpretation of Jefferson’s political behavior has evolved over time. Earlier biographies (pre-1960s) tended to minimize or excuse his behind-the-scenes maneuvering, while more recent scholarship has been willing to examine the contradictions between his philosophy and practice more critically. The works cited above represent current historical consensus based on documentary evidence, though historians continue to debate Jefferson’s motivations and whether his tactics were justified given the political stakes he perceived.

Happy New Year

By

On December 31, 2025

In Commentary

From Reagan Conservative to Social Democrat: A Political Evolution

By

On December 30, 2025

In Commentary, Politics, Uncategorized

Political beliefs rarely change overnight. Mine certainly didn’t. My journey from Reagan-era conservatism to social democracy unfolded slowly, shaped less by ideology than by lived experience and an accumulating body of evidence about what actually works.

Morning in America

Like many Americans of my generation, my political awakening came during the Reagan years. The message was optimistic and reassuring: limited government, free markets, individual responsibility, and a strong national defense would restore American greatness. Reagan’s charisma made complex economic ideas feel like common sense. Lower taxes would spur growth. Deregulation would unleash innovation. Markets would reward effort and discipline.

That worldview was personally affirming. Success was earned. Failure reflected poor choices. Government’s role should be narrow—defense, public order, and little else. Social programs, we were told, fostered dependency rather than opportunity. It was a coherent framework, and for a time, it seemed to fit the facts.

Cracks in the Foundation

By the 1990s, inconsistencies began to surface. Economic growth continued, but inequality widened. Entire industrial communities collapsed despite residents working hard and playing by the rules. The benefits of “trickle-down” economics were not trickling very far.

Personal experiences made the abstractions impossible to ignore. Families lost health insurance because of pre-existing conditions. Medical bills pushed insured households into bankruptcy. These outcomes weren’t failures of character; they were failures of systems.

The 2008 financial crisis shattered whatever illusions remained. Financial institutions that preached personal responsibility engaged in reckless speculation, then received massive government bailouts, while homeowners were left to face foreclosure. Like millions of others, I lost nearly half of my retirement savings. The contradiction was glaring: socialism for the wealthy, harsh market discipline for everyone else. Individual responsibility meant little when systemic risk brought down the entire economy.

A Turning Point

Job loss during the Great Recession completed the lesson. Despite qualifications and work history, employment opportunities vanished. Unemployment benefits—once easy to dismiss in theory as handouts—became essential in practice. The bootstrap mythology doesn’t hold up when the floor is pulled away.

This period also exposed the fragility of employer-based healthcare and retirement systems. COBRA coverage was unaffordable. 401(k)s evaporated. The safety net that once seemed excessive suddenly looked inadequate. Meanwhile, countries with stronger social protections weathered the recession better than the United States.

Seeing Other Models

Travel and research broadened my perspective further. Nations like Germany, Denmark, France, and Sweden paired market economies with robust social programs—and consistently outperformed the U.S. on measures of health, social mobility, and life satisfaction.

These were not stagnant, overregulated societies. They were thriving capitalist democracies that simply made different choices about public investment and risk-sharing.

Writers like Joseph Stiglitz and Thomas Piketty documented how concentrated wealth undermines both democracy and long-term growth. Historical evidence showed that America’s most prosperous era—the post-World War II boom—coincided with high marginal tax rates, strong unions, and major public investment.

Healthcare Changed Everything

Healthcare ultimately crystallized my shift. The U.S. spends far more per capita than any other nation yet produces worse outcomes on many basic measures.

As a physician, I watched patients struggle with insurance denials, opaque pricing, and medical debt. Healthcare markets don’t function like normal markets. You can’t comparison shop during a heart attack. When insurers profit by denying care, the system aligns against patients. Medical bankruptcy is virtually unknown in countries with universal coverage—for a reason. We have a system where the major goal of health insurance companies is making a profit for their investors—not providing affordable healthcare to their subscribers. 

Climate and Collective Action

Climate change further exposed the limits of market fundamentalism. Individualism and laissez-faire policies have failed to account for shared environmental costs and long-term consequences. Markets alone cannot price long-term environmental harm or coordinate collective action at the necessary scale. Addressing climate risk requires regulation, public investment, and democratic planning.

What Social Democracy Is—and Isn’t

Social democracy is not the rejection of capitalism. It is regulated capitalism with guardrails—markets where they work well, public systems where markets fail. Healthcare, education, infrastructure, and basic income security perform better with strong public involvement.

This differs from democratic socialism, a distinction I’ve explored elsewhere. Social democracy embraces entrepreneurship and competition while preventing monopoly power, protecting workers, and taxing fairly to fund shared prosperity.

As sociologist Lane Kenworthy notes, the U.S. already has elements of social democracy—Social Security, Medicare, public education—we simply underfund them compared to European nations.

A Pragmatic Conclusion

My evolution wasn’t ideological betrayal; it was pragmatic learning. I adjusted my beliefs based on outcomes, not slogans. Countries with strong social democracies routinely outperform the U.S. on health, mobility, education, and even business competitiveness.

True prosperity requires both entrepreneurial freedom and collective investment. The choice isn’t markets or government—it’s how to balance them intelligently. This lesson took me decades to learn, but the evidence now feels hard to ignore.

References

  1. Federal Reserve History – The Great Recession
    Overview of causes, systemic failures, and economic consequences of the 2007–2009 financial crisis.
    https://www.federalreservehistory.org/essays/great-recession
  2. OECD – Social Protection and Economic Resilience
    Comparative data on how countries with stronger social safety nets performed during economic downturns.
    https://www.oecd.org/economy
  3. World Happiness Report (United Nations / Oxford)
    Cross-national comparisons of well-being, social trust, and economic security.
    https://worldhappiness.report
  4. Joseph Stiglitz – Inequality and Economic Growth (IMF Finance & Development)
    Analysis of how income concentration undermines long-term economic performance and democracy.
    https://www.imf.org/en/Publications/fandd/issues/2019/09/inequality-and-economic-growth-stiglitz
  5. Thomas Piketty – Capital in the Twenty-First Century (Data Companion & Summaries)
    Historical evidence on wealth concentration and taxation in advanced economies.
    https://wid.world
  6. Tax Policy Center – Historical Top Marginal Income Tax Rates
    U.S. tax rate history showing high marginal rates during the post-war economic boom.
    https://www.taxpolicycenter.org/statistics/historical-highest-marginal-income-tax-rates
  7. The Commonwealth Fund – U.S. Health Care from a Global Perspective
    Comparative analysis of health spending, outcomes, and access across developed nations.
    https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022
  8. OECD Health Statistics
    International comparisons of healthcare costs, outcomes, and system performance.
    https://www.oecd.org/health/health-data.htm
  9. IPCC Sixth Assessment Report – Synthesis Report
    Scientific consensus on climate change risks and the need for coordinated public action.
    https://www.ipcc.ch/report/ar6/syr
  10. Lane Kenworthy – Social Democratic Capitalism
    Comparative research on social democracy, public investment, and economic performance.
    https://lanekenworthy.net

Why We Make Promises to Ourselves Every January: The History of New Year’s Resolutions

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On December 29, 2025

In Commentary, History

New Year’s resolutions—a practice where individuals set goals or make promises to improve their lives in the upcoming year—have a rich and varied history spanning thousands of years. While the concept of self-improvement at the start of a new year feels distinctly modern, its origins are deeply rooted in ancient civilizations and religious traditions that understood the psychological power of fresh starts.

Origins of New Year’s Resolutions

The tradition of making promises at the start of a new year can be traced back over 4,000 years to ancient Babylon. During their 12-day festival called Akitu, held in mid-March to coincide with the spring harvest and planting season, Babylonians made solemn vows to their gods. These promises typically involved practical matters like repaying debts and returning borrowed items, reflecting the agricultural society’s emphasis on community obligations and divine favor. The Babylonians believed that success in fulfilling these promises would curry favor with their deities, ensuring good harvests and prosperity in the year ahead.

The practice evolved significantly when Julius Caesar reformed the Roman calendar in 46 BCE and established January 1 as the official start of the new year. This wasn’t an arbitrary choice—January was named after Janus, the two-faced Roman god of beginnings, endings, doorways, and transitions. The symbolism was perfect: one face looking back at the year past, the other gazing forward to the future. Romans offered sacrifices to Janus and made promises of good conduct for the coming year, combining reflection on past mistakes with optimism about future improvements.

By the Middle Ages, the focus shifted dramatically toward religious observance. In early Christianity, the first day of the year became a time of prayer, spiritual reflection, and making pious resolutions aimed at becoming better Christians. One of the most colorful New Year’s traditions from this era was the “Peacock Vow,” practiced by Christian knights. At the end of the Christmas season, these knights would reaffirm their commitment to knightly virtue while feasting on roast peacock at elaborate New Year’s celebrations. The peacock, a symbol of pride and nobility, served as the centerpiece for vows promising good behavior and chivalric deeds during the coming year.

In the 17th century, Puritans brought particular intensity to the practice of New Year’s resolutions, focusing them squarely on spiritual and moral improvement. Rather than the broad promises of earlier eras, Puritan resolutions were detailed and specific. They committed to avoiding pride and vanity, practicing charity and liberality toward others, refraining from revenge even when wronged, controlling anger in daily interactions, speaking no evil of their neighbors, and living every aspect of their lives aligned with strict religious principles. Beyond these behavioral commitments, they also resolved to study scriptures diligently throughout the year, improve their religious devotion on a weekly basis, and continually renew their dedication to God. These resolutions were taken with utmost seriousness, often recorded in personal journals and reviewed regularly.

In 1740, John Wesley, the founder of Methodism, formalized this spiritual approach by creating the Covenant Renewal Service, traditionally held on New Year’s Eve or New Year’s Day. These powerful gatherings encouraged participants to reflect deeply on the past year’s failings and successes while making resolutions for spiritual growth in the year ahead. This tradition continues in many Methodist churches today.

Interestingly, the first known use of the specific phrase “New Year’s Resolution” appeared in a Boston newspaper called Walker’s Hibernian Magazine in 1813. The article took a humorous tone, discussing how people broke their New Year’s vows almost as soon as they made them—a wry observation that suggests nothing much has changed over the last 212 years.

The Modern Evolution of New Year’s Resolutions

The secularization of New Year’s resolutions accelerated during the 19th and 20th centuries as Western societies became increasingly diverse and less uniformly religious. Self-improvement and personal growth gradually took precedence over religious vows, though the underlying psychology remained similar. The rise of print media played a crucial role in popularizing the practice beyond religious communities. Newspapers and magazines began publishing advice columns on how to set and achieve goals, turning what had been a primarily spiritual practice into a secular ritual of self-betterment.

The industrial revolution and urbanization also influenced the nature of resolutions. As more people moved to cities and took on wage labor, resolutions began to reflect modern concerns like career advancement, financial stability, and managing the stress of urban life. The self-help movement of the 20th century, spurred by books like Dale Carnegie’s “How to Win Friends and Influence People” and Norman Vincent Peale’s “The Power of Positive Thinking,” further embedded the idea that individuals could transform themselves through conscious effort and goal-setting.

By the 21st century, resolutions were firmly established in Western culture as a beloved tradition of hope and renewal, no longer tied to any particular religious framework. The internet age brought new dimensions to the practice, with social media allowing people to publicly declare their resolutions, fitness tracking apps enabling data-driven self-improvement, and online communities providing support and accountability.

Common New Year’s Resolutions

Resolutions tend to reflect both cultural priorities and universal human aspirations. When researchers survey what people resolve to change, recurring themes emerge that tell us something about areas of discontent in contemporary life. Health and fitness consistently dominate the list, with millions of people vowing to lose weight, exercise more regularly, and eat healthier foods. The popularity of these goals reflects our sedentary modern lifestyles, abundant processed foods, and the cultural premium placed on physical appearance and wellness.

Personal development goals are another major category. People promise themselves they will finally learn that new skill they’ve been putting off, read more books instead of scrolling through social media, and manage their time better to reduce stress and increase productivity. These resolutions speak to a desire for intellectual growth and a nagging sense that we’re not living up to our full potential.

Financial goals also rank high on most people’s resolution lists. Many resolve to save more money for the future, pay off debts that have been accumulating, or stick to a budget instead of impulse spending. These financial resolutions often stem from anxiety about economic security and a recognition that small daily choices compound into major financial consequences over time.

Relationship and community-focused resolutions reflect our social nature and the loneliness epidemic affecting many developed nations. People vow to spend more quality time with family and friends rather than staying busy with work and distractions. They plan to volunteer and to give back to their communities in meaningful ways. They hope to strengthen the social bonds that are crucial to happiness and longevity.

Finally, breaking bad habits remains a perennial favorite. Traditional vices like smoking and excessive alcohol consumption still top many lists, but modern resolutions also target newer concerns like limiting screen time and reducing smartphone addiction. These goals acknowledge how difficult it is to maintain healthy habits in an environment designed to encourage overconsumption and instant gratification.

The Success Rate of Resolutions

Despite their enduring popularity, New Year’s resolutions are notoriously difficult to keep. Multiple studies estimate that approximately 80% of resolutions fail by February, often crashing and burning within just a few days of January 1st. The reasons for this high failure rate are both psychological and practical. Many people set overly ambitious goals without considering the realistic constraints of their lives or the sustained effort needed for meaningful change. Others make vague resolutions like “get healthier” without specific action steps or measurable milestones.

Research in behavioral psychology suggests that setting realistic, measurable, and time-bound goals—often called SMART goals (Specific, Measurable, Achievable, Relevant, and Time-bound)—can significantly improve success rates. Rather than resolving to “exercise more,” for example, a SMART goal would be “go to the gym for 30 minutes every Monday, Wednesday, and Friday morning.” The specificity provides clear direction, and the measurability allows for tracking progress and celebrating small victories along the way.

However, it’s worth noting that most people approach their New Year’s resolutions more as a fun tradition than with serious anticipation that they will actually keep them. There’s a ritualistic, almost playful quality to the practice—we know the odds are against us, but we participate anyway, embracing the hopeful symbolism of a fresh start even if we suspect we’ll be back to our old habits before Valentine’s Day.

The Significance of Resolutions Today

New Year’s resolutions persist across centuries and cultures because they align with a fundamental human desire for self-improvement and the psychological comfort of fresh starts. The appeal of marking time with calendars and treating January 1st as somehow special—despite being astronomically arbitrary—speaks to our need for narrative structure in our lives. Whether rooted in ancient Babylonian pledges to repay debts, Roman sacrifices to Janus, Christian vows of spiritual renewal, or modern goals to lose ten pounds, resolutions represent an enduring belief in the potential for change.

The tradition reminds us that humans have always struggled with the gap between who we are and who we aspire to be, and that we’ve always believed, however naively, that marking a new beginning on the calendar might help us bridge that gap. Even if our resolutions fail more often than they succeed, the very act of making them reaffirms our agency and our hope that we can become better versions of ourselves with just a bit of conscious effort.

Sources:

History.com provides comprehensive coverage of New Year’s resolution traditions: https://www.history.com/news/the-history-of-new-years-resolutions

Britannica offers detailed information on Janus and Roman New Year traditions: https://www.britannica.com/topic/Janus-Roman-god

The Smithsonian Magazine explores New Year’s countdown traditions and their historical context: https://www.smithsonianmag.com/science-nature/why-do-we-count-down-to-the-new-year-180961433/

Anthony Aveni’s “The Book of the Year: A Brief History of Our Seasonal Holidays” provides scholarly analysis of New Year’s traditions across cultures.

Kaila Curry’s article “The Ancient History of New Year’s Resolutions” traces the practice from Babylonian times through modern era.

Joshua O’Driscoll’s research on “The Peacock Vows” documents medieval chivalric New Year’s traditions, excerpted in various historical compilations.​​​​​​​​​​​​​​​​

Study The Past If You Would Define The Future—Confucius

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On December 26, 2025

In Commentary, History

I particularly like this quotation. It is similar to the more modern version: Those who don’t learn from the past are doomed to repeat it. However, I much prefer the former because it seems to be more in the form of advice or instruction. The latter seems to be more of a dire warning. Though I suspect, given the current state of the world, a dire warning is in order.

But regardless of whether it comes in the form of advice or warning, people today do not seem to heed the importance of studying the past.  The knowledge of history in our country is woeful. The lack of emphasis on the teaching of history in general and specifically American history, is shameful. While it is tempting to blame it on the lack of interest on the part of the younger generation, I find people my own age also have little appreciation of the events that shaped our nation, the world and their lives. Without this understanding, how can we evaluate what is currently happening and understand what we must do to come together as a nation and as a world.

I have always found history to be a fascinating subject. Biographies and nonfiction historical books remain among my favorite reading. In college I always added one or two history courses every semester to raise my grade point average. Even in college I found it strange that many of my friends hated history courses and took only the minimum. At the time, I didn’t realize just how serious this lack of historical perspective was to become.

Several years ago I became aware of just how little historical knowledge most people had. At the time Jay Leno was still doing his late-night show and he had a segment called Jaywalking. During the segment he would ask people in the street questions that were somewhat esoteric and to which he could expect to get unusual and generally humorous answers. On one show, on the 4th of July, he asked people “From what country did the United States declare independence on the 4th of July?” and of course no one knew the answer.

My first thought was that he must have gone through dozens of people to find the four or five people who did not know the answer to his question. The next day at work, the 5th of July, I decided to ask several people, all of whom were college graduates, the same question. I got not one single correct answer. Although, one person at least realized “I think I should know this”. When I told my wife, a retired teacher, she wasn’t surprised.  For a long time, she had been concerned about the lack of emphasis on social studies and the arts in school curriculums.  I was becoming seriously concerned about the direction of education in our country.

A lot of people are probably thinking “So what, who really cares what a bunch of dead people did 200 years ago?” If we don’t know what they did and why they did it how can we understand its relevance today?  We have no way to judge what actions may support the best interests of society and what might ultimately be detrimental.

Failure to learn from and understand the past results in a me-centric view of everything. If you fail to understand how things have developed, then you certainly cannot understand what the best course is to go forward. Attempting to judge all people and events of the past through your own personal prejudices leads only to continued and worsening conflict.

If you study the past you will see that there has never general agreement on anything. There were many disagreements, debates and even a civil war over differences of opinion.  It helps us to understand that there are no perfect people who always do everything the right way and at the right time. It helps us to appreciate the good that people do while understanding the human weaknesses that led to the things that we consider faults today. In other words, we cannot expect anyone to be a 100% perfect person. They may have accomplished many good and meaningful things and those good and meaningful things should not be discarded because the person was also a human being with human flaws.

Understanding the past does not mean approving of everything that occurred but it also means not condemning everything that does not fit into twenty-first century mores.  Only by recognizing this and seeing what led to the disasters of the past can we hope to avoid repetition of the worst aspects of our history. History teaches lessons in compromise, involvement and understanding. Failure to recognize that leads to strident argument and an unwillingness to cooperate with those who may differ in even the slightest way. Rather than creating the hoped-for perfect society, it simply leads to a new set of problems and a new group of grievances.

In sum, failure to study history is a failure to prepare for the future. We owe it to ourselves and future generations to understand where we came from and how we can best prepare our country and the world for them. They deserve nothing less than a full understanding of the past and a rational way forward. 

This was my first post after I started my blog in 2021.  I believe it is even more relevant now.

Merry Christmas from The Grumpy Doc

By

On December 24, 2025

In Commentary

The Multitasking Myth

By

On December 20, 2025

In Commentary, Medicine

What’s Really Happening in Your Brain

You’re probably multitasking right now. Maybe you’re reading this with a podcast playing in the background, or you’ve got three browser tabs open and you’re checking your phone every few minutes. We all do it. We even brag about it on resumes: “Excellent multitasker!” But here’s the uncomfortable truth that neuroscience has been trying to tell us for years—what we call multitasking is mostly an illusion.

What People Actually Mean

When most people say they’re multitasking, they’re describing one of two scenarios. The first is doing multiple automatic activities simultaneously—like walking while talking, or listening to music while folding laundry. The second, and the one that gets more interesting, is rapidly switching attention between different demanding tasks—like answering emails while on a conference call, or texting while watching TV.

The distinction matters because our brains handle these situations very differently. Activities that have become automatic through practice don’t require much conscious attention. You can absolutely walk and chew gum at the same time because neither activity demands your prefrontal cortex’s full attention. But when both tasks require active thinking and decision-making? That’s where things get complicated.

The Brain’s Bottleneck

Here’s what neuroscience tells us: true multitasking—simultaneously processing multiple streams of complex information—is essentially impossible for the human brain. What feels like multitasking is actually rapid task-switching, and your brain pays a price every time it makes that switch.

The limitation comes from something researchers call the “response selection bottleneck.” When you’re performing tasks that require conscious thought, they all funnel through the same neural pathways in your prefrontal cortex. This region can only process one demanding task at a time, so when you think you’re doing two things at once, you’re really just toggling between them very quickly.

Studies using functional MRI brain imaging have shown what happens during this switching process. When people attempt to multitask, researchers observe reduced activity in the regions responsible for each individual task compared to when those tasks are done separately. Your brain literally can’t devote full processing power to both activities simultaneously.

The Switching Cost

Every time you switch from one task to another, there’s a cognitive cost. Your brain needs to disengage from the first task, shift attention, and then reorient to the new task. This happens so quickly—sometimes in tenths of a second—that we don’t consciously notice it. But those microseconds add up.

Sorry, but get ready for some doctor talk.  When people switch tasks, imaging studies show increased activation in frontoparietal control and dorsal attention networks, especially in prefrontal regions (like the inferior frontal junction) and parietal cortex (such as intraparietal sulcus). This boosted activity reflects the brain dropping one task set, loading another into working memory, and re‑orienting attention—processes that consume time and neural resources.

Over time, practice can make specific tasks more automatic, reducing average activity in these control networks and allowing smoother coordination of tasks. However, even in trained multitaskers, studies still find evidence for serial queuing of operations in the multiple‑demand frontoparietal network, reinforcing the idea that consciously doing multiple demanding things “at once” is extremely limited.

Research from Stanford University found that people who regularly engage in heavy media multitasking actually perform worse at filtering out irrelevant information and switching between tasks than people who focus on one thing at a time. Essentially, chronic multitaskers become worse at the very thing they practice most.

Even when people train extensively, studies indicate they mainly become faster at switching and coordinating, not truly doing two demanding tasks at once. Experimental work using reaction‑time paradigms shows a reliable “switch cost”: when people change tasks, responses get slower and more error‑prone compared to staying with one task.  This cost is one of the strongest signs that most human “multitasking” is serial switching under time pressure rather than genuine simultaneous processing.

The American Psychological Association reports that these mental blocks created by switching between tasks can cost up to 40% of productive time. Think about that for a minute—nearly half your work time potentially lost to the mechanics of jumping between activities.

The Attention Residue Problem

There’s another wrinkle that makes multitasking even less efficient. When you switch away from a task before completing it, part of your attention remains stuck on the unfinished work. Researchers call this “attention residue,” and it reduces your cognitive performance on the next task.

Sophie Leroy, a business professor at the University of Washington, demonstrated this effect in a series of studies. People who switched tasks performed significantly worse on the second task than people who finished the first task before moving on. The unfinished task keeps running in your mental background, using up cognitive resources you need for the new activity.

When “Multitasking” Actually Works

There are legitimate exceptions to the no-multitasking rule, but they’re more limited than most people think. You can successfully combine activities when at least one of them is so well-practiced that it’s become automatic—essentially requiring no conscious thought. You can listen to an audiobook while jogging because your body handles the running on autopilot.

Some research also suggests that certain types of background music or ambient noise can enhance performance on creative tasks, though this seems to work best when the music is familiar and lacks lyrics that compete with language-processing tasks.

Why We Keep Trying

If multitasking is so inefficient, why do we persist? Part of the answer lies in how it feels. Task-switching triggers the release of dopamine, the brain’s reward chemical. Every time you check your phone or switch to a new browser tab, you get a little neurochemical hit. It feels productive, even when it isn’t.

There’s also a cultural element. We live in an attention economy where being constantly connected and responsive feels mandatory. Focusing on one thing can feel like you’re missing out or falling behind, even though the research consistently shows that single-tasking produces better results faster.

It’s worth noting that research consistently shows this gap between perception and performance.  People who think they are excellent multitaskers tend to be the worst at it.

The Bottom Line

The evidence is pretty clear: what we call multitasking is really task-switching, and it makes us slower and more error-prone at both activities. Your brain has a fundamental processing limitation that hasn’t changed despite our increasingly multi-screen world. The prefrontal cortex can only fully engage with one complex task at a time, and switching between tasks creates cognitive costs that add up to significant lost productivity and increased mistakes.

This doesn’t mean you should never listen to music while working or that walking while talking will melt your brain. But when you’re doing something that really matters—writing an important email, having a meaningful conversation, learning something new—giving it your full attention will always produce better results than splitting your focus.

A1c Without Diabetes: Context Matters As Much As The Number

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On December 17, 2025

In Medicine

If you’ve had routine bloodwork lately, you might have noticed something called hemoglobin A1c (or HbA1c) on your results. For years, this test has been the gold standard for monitoring diabetes, but it’s increasingly also  being used to assess metabolic health in people who don’t have diabetes. Let’s dig into what this number actually tells us and if lower is always better.

What A1c Actually Measures

Hemoglobin A1c reflects your average blood sugar levels over the past two to three months. When glucose circulates in your bloodstream, some of it sticks to hemoglobin—the oxygen-carrying protein in your red blood cells. The more glucose floating around, the more hemoglobin gets “glycated” (coated with sugar). Since red blood cells live about three months, your A1c percentage gives a rolling average of your blood sugar control. It does not capture individual spikes and dips in glucose, but it correlates reasonably well with overall glycemic exposure and is widely used to monitor diabetes control.

For non-diabetics, a normal A1c is generally considered below 5.7%. The prediabetes range sits between 5.7% and 6.4%, while 6.5% or higher on two separate tests typically indicates diabetes.  Nondiabetic adults with A1c above about 6% are more likely to have impaired fasting glucose and other cardiometabolic risk factors than those with A1c around 5.2–5.3%.​

These cutoffs represent points where research has shown increased risk for complications, but like most biological measurements, they exist on a spectrum rather than as hard dividing lines. 

Even in non-diabetics, A1c can vary by genetics, age, ethnicity, iron levels, sleep quality, and stress—not just diet or exercise. That’s why one person may live at 5.2% with no effort, while another naturally runs 5.6%.

The Prediabetes Gray Zone

Here’s where things get interesting—and a bit complicated. Prediabetes affects roughly 98 million American adults, though most don’t know they have it. An A1c between 5.7% and 6.4% signals that your body’s relationship with glucose isn’t quite right. Maybe your cells are becoming resistant to insulin, or your pancreas isn’t producing insulin as efficiently as it once did.  Prediabetes isn’t a disease so much as a metabolic warning sign. It means your body is starting to struggle with glucose regulation—often due to reduced insulin sensitivity, higher visceral fat, chronic stress, poor sleep, or genetics.

The crucial thing about prediabetes is that it’s not a benign waiting room before diabetes. Research shows that even in this intermediate range, you face elevated risks for cardiovascular disease, kidney problems, and nerve damage—though not to the same degree as someone with full-blown diabetes. It often coexists with other metabolic risk factors such as excess weight, dyslipidemia, and elevated blood pressure.​ A large study published in The Lancet found that people with A1c levels in the prediabetic range had a 15-20% increased risk of cardiovascular events compared to those with normal levels.

The good news? Prediabetes is often reversible. Lifestyle changes—particularly losing 5-7% of body weight through diet and exercise—can bring A1c levels back down. The Diabetes Prevention Program, a landmark study, showed that such interventions reduced the risk of developing diabetes by 58% over three years.

Should Non-Diabetics Aim Lower?

Now we arrive at the million-dollar question: if your A1c is already in the normal range (say, 5.3%), would driving it even lower—to 5.0% or 4.8%—provide additional health benefits?

The honest answer is: we don’t really know, but the evidence suggests probably not much.

Here’s what the research tells us. Population studies have found a continuous relationship between A1c levels and cardiovascular risk even within the normal range, meaning that someone with an A1c of 5.5% might have slightly higher risk than someone at 5.0%. However—and this is critical—this doesn’t necessarily mean that artificially lowering your A1c will reduce that risk. Correlation isn’t causation.

Your A1c reflects your overall metabolic health, dietary patterns, genetics, and lifestyle. Someone who naturally maintains an A1c of 5.0% because they exercise regularly, eat a balanced diet, and have favorable genetics probably has lower risk than someone at 5.5%. But that doesn’t mean the person at 5.5% should obsess over shaving off half a percentage point.  Large cohort data suggest that the lowest risk band for nondiabetic adults is roughly an A1c around 5.0–5.6%; below about 5.0% the relationship between A1c and outcomes becomes more complex.

There’s a principle in medicine that “lower is better”  but it often has limits. In diabetes treatment, pushing A1c too low can actually increase risks—particularly hypoglycemia (dangerously low blood sugar), which carries its own serious complications. The ACCORD trial, which studied intensive glucose lowering in people with Type 2 diabetes, had to be stopped early because the group targeting very low A1c levels had increased mortality. While this study involved diabetics using medications, it illustrates that extremely low glucose isn’t necessarily optimal.

If someone tries to force their A1c unusually low through extreme dieting, fasting, or intensive exercise, they can run into unintended effects such as fatigue and irritability, hormonal disruption, disordered eating patterns, and nutrient deficiencies.  Importantly, extremely low A1c values can sometimes reflect anemia or other medical conditions, not superior health.

For non-diabetics with normal A1c levels, there’s no evidence that trying to push numbers lower through extreme dietary restriction or other interventions provides meaningful benefit. Your body is already handling glucose appropriately. The focus should be on maintaining that healthy state through sustainable lifestyle habits rather than chasing incremental improvements in a single biomarker. In practical terms, the benefit is less about the exact number (say 5.1 versus 4.8) and more about maintaining a metabolic profile that keeps A1c comfortably below the prediabetes threshold over the long term

What Actually Matters

Rather than fixating on squeezing every tenth of a point out of your A1c, the evidence supports a broader approach to metabolic health. Regular physical activity, maintaining a healthy weight, eating a diet rich in whole foods with plenty of fiber, getting adequate sleep, and managing stress all contribute to healthy glucose metabolism—and they bring countless other benefits beyond A1c.

It’s also worth noting that A1c isn’t perfect. Certain conditions—like anemia, chronic kidney disease, or hemoglobin variants—can make A1c readings inaccurate. Some people have A1c levels that don’t match what their continuous glucose monitors show, a phenomenon called “glycation gap.” A1c is a useful tool, but it’s one piece of a larger metabolic picture.

The bottom line? If your A1c is in the normal range, you’re doing well. Maintain the healthy habits that got you there rather than micromanaging the number itself. If you’re in the prediabetic range, you have a genuine opportunity to prevent diabetes through lifestyle changes, and bringing that number down has clear benefits. But for those already in the healthy zone, obsessing over fractional improvements likely won’t move the needle much on your actual health outcomes.

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