TIRED of hearing about American government? Take a vacation and hear about Nepal’s! Dive deep into the ocean of health policy with me.​

I have been eager to learn more about health policy in Nepal. But tracking down good information about Nepal’s government has been surprisingly tough. In part, because I don’t speak Nepali. But also because little such information exists.

Nepal is currently transitioning to a federalist system from one dominated by a central government. Powers will be shared with local levels, like in the United States. But as far I — or anyone else here — can tell, the final product is a big question mark. It’s under wraps. The “transition” period is set to end when the new fiscal year starts in July. So whatever they’ve been planning, they’ll have to share it soon.

However it looks, though, the fledgling government has big ambitions. Sudim, a research intern at G.T.A., showed me the outlines of its plan for universal health insurance. The government intends to create a national single-payer, in a form blending those of Britain and Canada. The federal government will raise taxes on its citizens, more on the rich (it seems), fund a national insurance, and reimburse care in the existing system of public and private hospitals and clinics.

The current system is out-of-pocket. Health insurance does not exist, so people pay whatever the price is for services. As a result, many people cannot afford them. Some “essential” medicines and services are provided by the government for free, but insurance would make for more equitable care and better outcomes.

The insurance looks like it will have “packages” for different services. But many details are fuzzy, like the tax scheme. (The government website for it has mostly empty pages.) But the plan is a decade in the making, and the government has apparently already tested it in 25 districts. The big rollout is next. This means that Nepal could well beat the United States to a single-payer system. Yes.

This is inspiring. Single-payer care is our best bet for lower prices and equitable care, and many developed countries already have it. But if the prospect of a developing country’s tackling single-payer makes you suspicious, you’re not alone.

The two concerns that came to my mind were cost and political feasibility, which go hand-in-hand. If the plan costs too much, will people willingly pay for it?

Take America. We spend an insane amount of money on health care: about $9,500 per person in 2015. That’s well over 16 percent of our G.D.P., or one-sixth of the American economy.

Now, switching to single-payer care wouldn’t cost more. You already pay for insurance. It would just come from the government instead. There’s even good reason to expect a single-payer to lower medical costs.

But the harder part is politics. To fund the insurance, a national single-payer would mean raising taxes, and Americans hate nothing more than taxes. Our unwillingness to reform our ragged health care system suggests that we hate taxes even more than death itself. (And the possibility of more money in our pockets!)

In Nepal, however, these worries don’t seem as relevant. We might worry that the cost of a single-payer would overwhelm the government, but spending on health here is very low. How low? Only $44 per person in 2015, if you can believe that. (If we adjust for purchasing power parity in the United States, it’s about $130.) I estimate that that’s only around 6 percent of G.D.P. Remember: We’re at 16.

To be sure, when people get access to more services, we should expect them to spend more, at least in the short term. And Nepal’s health spending has, indeed, spiked in the last two decades. It was only $9 per person in 2000. But even if it doubled again, it would be just above the relative spending of most developed nations.

(Cost concerns could be further minimized if the government decides to cover only certain health problems or procedures with its “packages.”)

Alright, but how about political capital? Surely, people will riot from the tax hike! Well, maybe not. Nepal’s government has ballooned in spending in recent years, from somewhere in the neighborhood of 20 percent of G.D.P. in 2014 to about 40 percent last year. The United States spends about one-third.

In other words, Nepal’s government has doubled in size! This fiscal year, it spent $9 billion, or about $300 per person ($1000 adjusted for purchasing power). Covering all health care would mean raising government revenue by just 15 percent. Since Nepalis seem quite comfortable with increased government spending, after a 100 percent increase in just two years, what’s 15 percent more?

So this looks like smooth sailing, right? Welcome, single-payer!

Well, there’s one more thing.

A few weeks ago, I went to a dinner with Deepak, the president of G.T.A., and two businessman friends of his. Over spicy Newari food, named for an ethnic group in the Kathmandu Valley, we discussed government and politics. One businessman raised a concern that hadn’t occurred to me: that Nepal’s government has the reputation of being, er, less effective than it could be.

He expressed extreme cynicism about it, actually. The people don’t trust it, he said; they don’t expect it to advance the country. There are two major parties, Communist and Congress, but unlike the polarization that Americans have come to expect from our parties, these two are apparently quite similar — above all, in their reputation for misusing funds. Their positions on policy don’t matter, the businessman insisted, because their predilection for corruption overrides all else.

Due in part to this mistrust, at least two people have told me that many Nepalis don’t pay their income taxes regularly or fully.

Now, hold on, these descriptions may be overblown. That they’ve come even from the well-educated is concerning. But remember that the American government is, in the minds of many, a “deep state” of corruption and ineptitude. It’s not. And, of course, many Americans believe that tax fraud is rampant. It’s not.

But there’s one crucial difference: infrastructure. You can’t hide most money from the American government. The I.R.S. can and often does find it, and much revenue comes from alternate taxes. Such infrastructure is weaker in Nepal.

How do I know? At least one Nepali told me, explicitly, that he does not pay his income taxes. And yet, here he is, unconcerned about the consequences.

When someone tells you, point blank, that he doesn’t pay income taxes, it’s hard to be optimistic about everyone else’s paying their taxes. As a result, it’s much harder to trust that the government can collect the funds it needs for a national health insurance.

Can it do so? It’s certainly possible. Can it find alternate sources? Also possible. It could borrow. When the government doubled in size, its deficit jumped from 1 or 2 percent of G.D.P. to 6.4 percent. But that’s larger than the relative size of America’s. And while our government has a great credit rating, Nepal’s is unrated. What happens if its wells of foreign and domestic lending start running dry?
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And let’s say that the government does pull off the political backflip of establishing single-payer care. If Nepal is anything like the United States, where tax fraud happens almost exclusively among the very rich, the system may find itself struggling to provide the equitable care that it promised.

Also, if you’re hoping that the partial rollout could shed some light, I haven’t found any documents in English on it. Maybe it’s going swimmingly. Maybe it’s not.

So will Nepal beat the U.S. to single-payer health care? Only time will tell. I’m rooting for them. Whatever the outcome, it is so refreshing to see a government working to implement ambitious, meaningful health policy.

Which brings me to my last question: Why can’t we? One of our parties is actively trying to dismantle our program for increasing access to health insurance and medical services. We’re moving backward. Imagine what it would be like to have a government that wanted to guarantee health care for all its citizens.

Nepal can. It does. And it’s inspiring.

I’m sorry. I promised a break from the American government. But I’m sorrier that a government with resources like ours isn’t as ambitious as Nepal’s.

THIS summer, I will be in Kathmandu, Nepal, for a “Reverse Innovation Fellowship.” I will work with the Group for Technical Assistance, a public health nonprofit, to develop strategies for encouraging responsible antibiotic use. The goal is to combat antibiotic resistance, which is a growing, long-term threat in health care. The internship will satisfy a requirement for my Master of Public Health.​

I arrived on May 31 and will stay through August 5. When I return, I will translate the solutions and insights that I find in Nepal for the context of Detroit. This will complete the “reverse innovation” piece. The term refers to the adaptation of innovations from low- and middle-income countries to high-income ones.

Although I haven’t been here long, this country already enchants me. At a staff meeting on June 1, each member of the team offered his or her sincere welcome to me in front of the group — after welcoming me the day before, too. And they had the great courtesy to speak English so that I could participate. As someone who has been on that more difficult side of the language barrier, I was so thankful.

On Saturday, June 2, Ganesh, a program coordinator at G.T.A., eagerly took me to Kathmandu Durbar Square. It is a famous site in the city. We rode a motorcycle through winding streets of chaotic traffic and freely roaming cows, between which the World Heritage Site emerged. It is home to centuries-old palaces and temples. The wood facades are hand-carved with stunning intricacy. Its statues of Hindu gods are beautifully painted. It is the sum of centuries of handiwork.

In 2015, however, a 7.8 magnitude earthquake killed thousands of Nepalis and destroyed many of the buildings in the Square. One fell upon a blood drive — the cruelty of misfortune. In addition to the immeasurable loss of human life and history, the physical damage across Nepal ranged in the billions of dollars.

But this is a country of resilience. A restoration of Durbar Square is currently underway (largely funded by Nepal’s neighbor, China — such is its ambitious reach), as for other buildings across the city. And, yet, the country looks forward. Many buildings stand upon fallen ones with new styles. The government and companies push economic development, the disaster notwithstanding.

And as for human life, the Nepalis look forward on that front as well. When I visited, a curious event was happening on the steps of one building in Durbar Square: a blood drive. A regular occurrence in the aftermath of the earthquake, Ganesh told me, it commemorates the lives that were lost. By saving the living.

Such is the Nepali spirit.

Over the next two months, I hope to learn more about this spirit. About this beautiful, ancient nation. Its culture and government. And some public health along the way. May I come away with a fuller understanding of the Nepalis’ world. And may they benefit from my being here even a fraction as much as I will.​

I will continue to update this blog on my adventure, discussing the people, curiosities, and more that I meet. Stay tuned. And namaste.

PRESIDENT Trump pledged to withdraw the United States from the Paris Climate Accord. His arguments were mostly economic, bemoaning lost jobs and international uncompetitiveness. They’re phony. And he can’t officially withdraw us until 2020 anyway. But the chatter had me thinking: What about health?​

An argument for remaining in the Accord is that reducing emissions will improve health. According to the World Health Organization, pollutive emissions increase “the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma.” And rising global temperatures will worsen tropical diseases, heat strokes, and possibly insomnia.

Apparently, health isn’t a good enough reason to stay. But let’s make this Trump-friendly: Health is an economic argument in its own right.

Here’s the logic, which applies to many “economic” policies of the Republican Party. If pollution, climate change, deregulation, reduced access to health care, etc., make people unhealthier (or dead), and if these people are less productive or more economically burdensome than healthier people beyond some breakeven point, then deregulation is costlier than the regulation itself.

It’s counterintuitive. But pulling out of the Accord and other “conservative” wishes may hurt — not help — the economy. While making us all unhealthier.

Let’s start with climate change. In his announcement, Trump cited a study that concluded up to 2.7 million American jobs would be lost under the Accord. That’s a lot. If the average American makes about $55,000, it’s about $149 billion each year. But the study does not account for any benefits of a planet-healthy economy, like new jobs in renewable energy and technological development. Already, we’ve underestimated the economic burden.

Nor does it account for the health benefits of a greener economy. The United States spends more money on health per capita than any other postindustrial nation. Improving or worsening health, even by a small amount, is economically impactful. We also lead the world in pollution per capita.

How do health, pollution, and cost interplay? As you guessed, negatively.

An analysis last year estimated that pollution from dirty energy production cost the United States $131 billion in 2011, mainly in health care costs. Most diseases that pollution causes are chronic and expensive. A few years earlier, the O.E.C.D. issued a broader report, “The Cost of Air Pollution,” estimating that death from all types of pollution costs the U.S. about $500 billion yearly. They factored in health care costs plus the lost consumption and productivity of dead Americans. Notably, the O.E.C.D. report included automobile emissions, while the other did not.

Although the numbers for death and “social costs” are fuzzy, we see that reducing pollution doesn’t have exclusively negative economic impacts. It recuperates much in health savings — and may even “profit.” If we could save half of that $500 billion, we’d more than cover the cost of lost jobs. Any more and we’re ahead.

Does rejecting the Paris Accord still make sense?

(Another consideration of pulling out is damage to foreign relations. Leaders in China, France, Australia, Britain, Germany, and more have expressed dismay at Trump’s decision. This strains military and economic alliances, possibly impacting trade. And as the U.S. retracts on the international stage, many countries are looking to China for leadership. This does not benefit American interests.)

Let’s try another policy: health care. Congressional Republicans justified their (many) plans on “economic” grounds, since they’d shave a small fraction off the federal deficit. But the plans would do so by cutting Medicaid and subsidies, which millions of Americans rely on for health insurance. And the plans do nothing to reign in health care costs, perpetuating an inefficient, unequal system.

By every estimation, they’d throw millions of people off their insurance, eventually making us unhealthier and costlier as a system. Because of this, I remain unconvinced that the plans would save the country any money whatsoever.

Is that economically justified?

Or consider deregulation, like the decision of E.P.A. director Scott Pruitt to allow continued use of the pesticide chlorpyrifos. E.P.A. scientists recommended banning it on farms nationwide because it was leeching into the water supply and causing cognitive defects in farm workers and children exposed to it. (The chemical was banned for household use a decade and a half ago.)

Pruitt overrode the recommendation because — that’s right — the ban would economically “burden” farmers that rely on the pesticide. But is it not conceivable that cognitive defects might decrease their productivity and increase their health care costs beyond whatever more they’d make in crop yields?

You see how this goes.

Any policy that attempts to save money while hurting health will have this trade-off. Health is economically consequential — Americans spend $3 trillion on it every year. Even small inflations in its costs can drown a policy’s other savings. But for whatever reason, these policies ignore it. It’s almost as if — dare I say it — Republicans are being more fiscally irresponsible than Democrats! Gasp!

As we dig deeper, this discussion only becomes sourer. The subtext of it all is morality: the value of a human life. In cutting Medicaid, polluting the air, or letting pesticides in water, all of which have paltry economic gains (or none), these policies place a higher premium on penny-pinching than on human lives. Illness and death by pollution are apparently worth it, so long as some coal jobs stay around.

This evaluation of human life is immorally low.

Of course, policy decisions necessarily balance positive and negative impacts, and we want to save money. But from a fuller economic perspective, these policies barely or don’t save money — all while bearing rampant unhealthiness and death, often for those they are meant to “help.” How does any of this make sense?

It doesn’t.

THE Republican American Health Care Act (A.H.C.A.) is the zombie of bills. Just when you think it’s been beaten down for good, it pops back up again.​

Oh, and with its older zombie friend, voodoo economics. To “save money,” the bill cuts nearly $1 trillion in taxes over the next decade — much of it for the rich — while cutting back Medicaid, the program that provides health coverage to low-income Americans. And it redistributes subsidies away from people that need them to afford insurance, like old and low-income Americans, to people that don’t.

I’ve already criticized the cruelty of repealing the Affordable Care Act, our current system, without a better option. Each incarnation of the A.H.C.A. has been worse than the last. Zombies can’t help it. It’s in their nature.

But the odd selling point of the A.H.C.A. has been that it “saves money.” This is technically true for the federal government. The last version would have reduced the deficit by $150 billion over a decade. The latest, $119 billion. (We just received the official report for this version — 20 days after passing the House. Republicans rushed it through anyway, because they smelled death aloft.)

Never mind that it does so by revoking people’s health insurance — an estimated 23 million over the next decade — but hey, if it saves a quick buck!

Besides cruel, this line of thinking is short-sighted. Yes, taking away insurance is short-sighted for obvious reasons, like people dying. But on the whole, I’m not convinced that it would save the country money either.

When people lack insurance, their health care still costs money. But it burdens the system more. For example, they rely more on emergency services that often go unpaid. Hospitals then foot the bill. The first incarnation of the A.H.C.A. was estimated to cost hospitals an extra $88 billion in unpaid care in 2019 alone.

Reliance on emergency services also means that people are waiting until the absolute latest to get care. Without insurance, they aren’t seeing their primary care physician for regular checkups or engaging in preventative care. In the long run, this adds unnecessary strain to the health care system. Treating advanced cardiovascular or periodontal disease, for example, is costlier than catching it early. And it’s much costlier than simply teaching people good nutritional habits.

So the costs snowball and snowball… And they land on Medicaid or, under the A.H.C.A, high-risk insurance pools, for which taxpayers pay. Or on hospitals and insurance companies, for which the insured pay. Either way, that’s you. And you — yes, you! — get to pay more! Call your Senator now for this unbeatable deal!

So while the A.H.C.A. might make the federal government’s deficit look a tad healthier on paper, it does nothing to improve health or health care costs.

In the end, the system still bloats, and you pay more for your care.

Because of problems like these, America pays more for health care than any other postindustrial nation. The average O.E.C.D. nation spends about 9 percent of its G.D.P. on health care each year. The United States, however, spends nearly 17. Almost double. Yet we have some of the worst health outcomes of this group, with gross inefficiency, unequal access to care, and high preventable mortality.

If we spent the same percentage on health care as the next highest nations, Japan and Switzerland, at 11.4 percent, we would save nearly $900 billion every year. That is greater than the G.D.P. of Switzerland itself.​

If we seriously want to reduce costs, there’s one obvious solution: single-payer health care. Yes, I know, Republicans would never go for it. But humor me.

In such a system, health insurance is administered by the government, although some countries have supplemental private insurance. It works for Britain, France, Spain, Canada, Australia, and others. And it has two key advantages over the A.H.C.A. for reducing costs. First, its guarantee of universal coverage would allow more Americans to engage in regular primary and preventative care. As people became healthier over time, the system would become less expensive.

This was one of the goals of the Affordable Care Act. Its increase in coverage has, indeed, begun to improve health. But a multi-payer system will never insure everyone. Single-payer could. (By the way, most of the Affordable Care Act’s health improvements are due to Medicaid expansion, our government health insurance.)

Second, single-payer has collective bargaining. Consider medications. In the United States, the F.D.A. does not evaluate cost effectiveness when approving a drug, unlike, say, the National Health Services in Britain. Instead, individual insurance companies must negotiate costs with the pharmaceutical. Whereas one insurance company represents only a few million people, only a small fraction of whom will ever require a drug in question, the N.H.S. represents all of Britain.

All of Britain can negotiate down costs much better than a single insurance company ever could — the N.H.S. can just threaten not to approve the drug.

The power of collective bargaining shows: On average, drugs cost three times more in the United States than in Britain. And overall, Britain spends just under 10 percent of its G.D.P. on health care, compared to our 17.

Relatedly, single-payer systems can better cap prices for procedures, encourage fee-for-value reimbursement, which reduces unnecessary tests, and incentivize efficiency. These all reduce costs. This is another area that the Affordable Care Act aimed to improve; it provided grants to states to develop more efficient systems. A national single payer, with its collective power, could do it even better.

On one final note, a single-payer system would increase taxes, yes. However, you or your employer wouldn’t pay for insurance anymore. We’d just swap the costs. And since the system is more efficient, the per capita cost would be lower. So your effective income would be higher. It’s a no-brainer.

Single-payer is the greatest health care “deal” that we could get — better health outcomes at a fraction of the cost. Maybe that’s how we sell it. Someone tell Trump, who’s desperately floundering about, hungering for a “win” wherever he can find it, that we have a huge, terrific, beautiful, tremendously big league deal.

On second thought, we don’t even have to tell him. He’s said it himself about the Australian single-payer system: “We have a failing health care — I shouldn’t say this to our great gentleman and my friend from Australia [Prime Minister Malcolm Turnbull], because you have better health care than we do.”

Alright, Trump. Let’s make a deal.

​THIS year, I spent spring break on a service trip in Guatemala. I’m a member of Sá Nimá, a student organization that brings engineering and educational solutions to rural communities there. I’ve worked on its educational curricula for three years, and my opportunity to visit our partner community finally arose.

Unfortunately, we ended up with only one day in the community. Due to volcanic activity near the capital city, our arrival was delayed by two days. An entire day of bus travel is necessary to reach the community, and another day, we had a planned excursion with our partner nonprofit organization to learn more about their model.

But that one day was intensely productive: We met with eight community leaders, opened new lines of communication with them, facilitated a tower-building activity with the elementary school students to develop their problem-solving skills, and attended Ash Wednesday mass. (I am a baptized Catholic.)

But when we left the community, gritty and greasy, I felt unfulfilled. Maybe I just wanted more time, but something felt incomplete. Why?

Spring break service trips are common among college students, and I get the impression that most students return from them with a brimming sense of self-congratulation — pride in having taught English for three days or having brought bottles of ibuprofen to a remote nation, humility for having briefly sacrificed their high standard of living to see how “others” have it.

There’s a buzzword that circulates throughout many organizations to describe what many of these trips amount to: “unsustainable.” After all, they say, while you might have removed a tapeworm from some child’s stomach, you’ve done nothing to change the conditions that caused it. That child still has no access to clean water, still bathes in unsanitary facilities, and will surely get another tapeworm.

They even call it “tourism.” It often benefits the giver more than the receiver. One can return to his comfy life with self-congratulation. The other cannot.

I understand this attitude, but I’m not fond of it. It’s defeatist. It suggests that unless someone can implement an elaborate, “sustainable” solution, then helping anyone is worthless. Why give a homeless man five dollars if it cannot resolve his current state? This attitude is also misleading because any improvement, however temporary, is still improvement. Affording a meal, even one, is meaningful.

But then there’s the matter of cultural colonization. Spring break travelers can unintentionally carry along their own culture’s conceptions of health, beauty, or happiness and export them to communities that were content. If these exports adversely remodel their social or economic structures, for example, by creating demand for products that the communities cannot access or afford, you’ve actually just worsened their lot. Not helped. Hurt. In countries with histories of actual colonization (which is most of the world outside Western Europe), cultural exports can be especially sensitive. This is another facet of sustainability.

In the face of apparent impossibility, then, how can one individual or student organization with limited resources change the world?

​The question has dogged me for years. It has haunted my academic pursuits and my pursuit to be a good man. In my best moments, I have a clear purpose and moral compass, and I believe that my actions positively impact others. In my worst, I become myopic and self-interested, uncertain, unhelpful, or at least I fear that my pursuits are so. I aspire to improve my world but am unsure how.

The search for purpose and satisfaction is much like a treasure hunt without a map — and without evidence that any treasure exists. As it relates to my profession, my zigzag path of clues has crossed more fields than I can remember. In the past year alone, I’ve considered biological research, policy-making, medicine, and public health as careers, sampling each and finding the same vague evidence that purpose and satisfaction are buried there, wanting to dedicate myself fully to one but fearing that I have greater opportunities and talents elsewhere.

And fearing that my impact will be inconsequential there.

Humans are naturally fearful of this, of meaninglessness, of being forgotten by a world that will, inevitably, continue without us. Without me. And without you. Great leaders have built monuments of themselves. Sure, when authoritarian leaders do it, they’re leveraging them as political tools to hedge their rule. But I bet, deep down, they do it out of that existential fear of inconsequentiality, too.

How did we get to empathizing with authoritarians?

Right, changing the world.

Due to our flight delay, we got two days in Miami, and we spent one evening at South Beach. Service trip? The vast ocean, over which hung heavy gray clouds, reminded me of Kate Chopin’s The Awakening. The protagonist Edna spends the greater portion of the book attempting to free herself from the shackles of gender norms. She flagrantly violates them, fights them to the detriment of her marriage and relationships. By the book’s end, though, the norms have decidedly won.

Finding herself unable to free herself that way, and unwilling to remain their slave, Edna decides to free herself by another: Suicide. By drowning.

“She [swam] on and on. She remembered the night she swam far out, and recalled the terror that seized her at the fear of being unable to regain the shore. She did not look back now, but went on and on, thinking of the blue-grass meadow that she had traversed when a little child, believing that it had no beginning and no end.”

I am Edna. We all are. The world is full of undesirable circumstances, unhealthiness, sorrow, plight. When we find ourselves in these, be they social, political, or personal, and many of us have the misfortune of remaining perpetually trapped in them, we have a choice: confront them or remove ourselves from them. In many cases, the latter option is unavailable to us, except by the route Edna took.

As humans, born fighters, we confront the circumstances. We beat back against undesirable conditions or norms. But change is stubborn. It’s like beating against the ocean. We spend a day in rural Guatemala, teaching engineering skills to children that will almost surely become farmers. We remove spoonfuls of water from the ocean at a time, tossing them behind us and occasionally admiring our progress but constantly aware of the apparent endlessness of the task before us.

We wonder whether or not the task even merits the effort.

​​The youngest students didn’t fully understand the tower-building task. They don’t speak Spanish yet, so they got the instructions via translation. And they were timid. They looked around in confusion. After trying, and failing, to re-explain the task to a table of students, I handed each a notecard. I motioned, silently, how to fold the card. Some followed. I then stood it upright and nodded to them. Some repeated it. I then placed a paper plate atop three cards, completing one floor of a tower.

They still didn’t understand. But then one boy shifted. He folded a card and added it atop to start the next level. We made eye contact. And he smiled.

LET’S hope I don’t have cancer. Or at least that I find out soon. The Republican Congress has laid the groundwork to roll back the Affordable Care Act, under which I receive health insurance on my parents’ plan until age 26. Before the A.C.A., I’d have been on my own at 21. I turn 21 in about 8 months.

Even if Republicans delay rollback until 2020, after the next presidential election, I will still be without health insurance in medical school. Without any income to afford a new plan. And without the law’s subsidies to help me.

Few policies of the Obama administration have been as controversial as the A.C.A., or Obamacare. It remodeled American health care and, like any remodeling, was imperfect. But despite its upgrades, Republicans have disparaged it nonstop.

Nobody likes Obamacare! Insurance premiums are skyrocketing! More people are uninsured than ever! It’s a “failed disaster”! It will implode under its own weight!

The hysteria is smoke and mirrors.

Far from a “failure,” President Obama’s law expanded health insurance coverage to 20 million people. More Americans have insurance than ever. The uninsured rate is down almost everywhere in America, the lowest as long as we’ve tracked it.

The law is wide-reaching. It prevents insurance companies from denying coverage for pre-existing conditions, allows young adults to stay on their parents’ plans until age 26 (that’s me), provides subsidies for low- and middle-income families to afford insurance, and allows states to expand Medicaid.

It’s true that, for 2017, insurance premiums on the A.C.A. exchanges will go up, including in Michigan. And it’s true that those markets will have fewer options. This is a significant structural challenge for American health insurance.

But premiums aren’t “skyrocketing.” There is no fire ravaging American health care. Just Republicans holding a match to the smoke detectors.

Rate hikes will impact only 3 percent of Americans. If your insurance comes from an employer, Medicare, or Medicaid (as for 8 in 10 Americans), you don’t even use the exchanges. And of those that do, most receive subsidies to help pay their premiums.

Frankly, the hysteria defies common sense — and most people’s best interests.

When you ask people about Obamacare, half support it. As you might imagine, it’s split along party lines. Eighty-two percent of Democrats like it, versus 8 percent of Republicans, largely because Republican politicians have campaigned against it.

But when you ask about the details of the law, suddenly people like it. The expansion of Medicaid, subsidies, no denial for pre-existing conditions, keeping young adults on their parents’ plans — all receive support from 7 or 8 in 10 Americans. Yes, most Republicans, too. The hysteria is entirely politics.

The A.C.A. revolutionized health care. It does need work, with its backward incentive structures, lack of a public Medicare option, and host of other issues. But right now, Republicans are poised repeal it without any replacement ready. This would destabilize health insurance markets and eliminate all the law’s benefits.

And revoke the insurance of 20 million Americans.
And threaten public health.
And increase the burden of unpaid care on hospitals by an estimated $88 billion.
And kill people (or passively let them die).
And cost an estimated 2.6 million jobs.
Oh, and revoke my health insurance in about 8 months, depending on rollback.

When we drop the politics, and drop the statistics, here’s what’s left: insurance for more people. Better access to care. That’s not hard to appreciate.

I have 8 months to draft a backup plan. Where should I start? I am a chemistry major. Maybe I can Walter White my way through this one…

Addendum: July 31, 2017
This post misstated the age that children could stay on their parents’ plans before the A.C.A. That age was 19, or 22 for full-time students, not 21. (And plans could extend it.) So good news! I have some extra time to learn to make meth.

Er, I mean, to become a salaried chemistry teacher with health benefits.

DONALD Trump’s proposed ban on Muslim immigration represents an age-old political trick: religious nationalism. It goes like this: In nations with a majority religion, most people share certain values and symbols. By triggering them, leaders can incite fear or anger, delineate in- and out-groups, and mobilize voters. It bends church-state separation and infuses religion into policy.

“F*** Islam! God bless Donald Trump!”

We’re being swindled.

Trumpism raises a fundamental question: What is American identity? Are we a Protestant Christian nation, as Trump supporters imagine? Or are we, in the words of President Obama, an all-inclusive “we” that “belongs to everyone”?

These questions are challenging since everyone conceives of America differently. But here’s an easier one: Why does America separate church and state?

After all, that is the reality. Church-state separation is a celebrated American tradition — free expression for all those in the melting pot, be they Christians, Muslims, or not. Yet when Trump peddles religious nationalism in the public arena, he and his supporters effectively promote Christianity-state integration via laws against abortion or L.G.B.T. rights and religiously motivated foreign policy.

Which America are we?

THE American narrative, as we know it today, begins with tolerant forefathers who escaped religious persecution to guarantee free practice here. We represent a land of freedom, which extends to religious expression and congregation.

Historically speaking, that was not actually so.

Rather than freedom of religion, our forefathers designed freedom of Protestant Christianity. The First Amendment intended less to protect all religions and more to prevent one Protestant sect from dominating the government at the expense of the others. And this “freedom” only applied federally (until 1947). On the state level, Protestants exclusively ran the show. North Carolina’s constitution of 1776, for example, required that no office holders could “deny the being of a God, or truth of the Protestant religion.” Such tests for office were common.

The political science research agrees: Protestant Christianity infiltrated the American political system. We incorporated Puritanical beliefs into institutional structures, imbued our political culture with Judeo-Christian values, and expanded the concept of citizenship as evangelicalism spread. In the words of two scholars, our church-state relationship was a “tangled web” that favored integration.

When societies produce hegemonies like this, or the dominance of one set of values, those values affect everyone. Such has been the case with Protestantism. For example, our Calvinist forefathers believed that God “predestines” certain souls for salvation, which manifested, they believed, as hard work and prosperity — the Protestant work ethic. Its permeance in our nation produced the American Dream: that any individual, by tugging at his bootstraps, can succeed.

Religiously inspired values have translated into action, driving social and political movements. The most notable is civil rights. That “prophetic movement” grew from the organization of black churches and drew on shared, Christian values to radically re-orient American thought on equality within the Protestant framework, positively progressing the nation in the process.

But while some Protestant influences have improved America, some have not, like the “prosperity gospel.”

This twentieth-century evangelical theology equated economic success with religion. If you work hard, the logic went, God will “bless” you. Although seemingly tame, it snowballed into its modern effect that many Americans believe that even the most underprivileged, unfortunate, or discriminated simply aren’t working hard enough. That the poor deserve to be poor. The homeless deserve to be homeless. And they therefore do not deserve welfare, higher wages, or charity.

Americans have violently discriminated against non-Protestants, too. During the nineteenth century, new waves of immigration came from Catholic, Southern and Eastern Europe, not the Protestant North. Religious cleavages plus economic fears incited discrimination and violence against Catholics, like “no Irish need apply” hiring policies or the 1831 anti-Catholic riots in Philadelphia.

Anti-Catholic nativism means that, as an Irish Catholic, myself, I would have been considered “un-American” at the time.

This discrimination continued into the modern era. Internment camps for Japanese Americans during World War II prohibited the practice of the Shinto religion. Restricted abortion rights eliminate a woman’s agency over her own body and health care. Shootings of abortion clinics make it violent. And the unequal provision of marriage, which has legal and tax implications and, therefore, constitutes a government right, discriminated against L.G.B.T. Americans.

Here’s the crux: Religion spreads values that can be healthy for adherents and societies. But these values can also provide kindling for religious nationalism. Rabid leaders can then ignite them. And when they do, it gets ugly.

IN THE 1980s and 1990s, the Bharatiya Janata Party of India adopted a Trumpian campaign strategy of sponsoring religious processions alongside political rallies. It co-opted Hindu symbols and drew on shared values. And once associated with the majority religion, the party incited religious nationalism. It attacked a coalition government that “pampered” minorities like Muslims, and it mobilized voters around a mosque constructed on supposedly sacred Hindu land.

While the party leaped in votes and parliamentary seats, its strategy was not without consequences. In the end, Hindus physically dismantled that mosque in mob fashion during a government-sponsored “religious ceremony.” And the party’s processions were trailed by anti-Muslim pogroms, committed by vigilante Hindus disgusted by “intolerant” Muslims. It was violent. It was undemocratic.

India learned better.

We’ve learned better, too. Our history bears the violent realities of church-state integration in waves of nativist anti-otherisms. We have realized that integration does not produce a pleasant peace, no “great” America of glory and prosperity. Instead, it produces a divided nation, a discriminatory and bloody one.

Americans pride themselves on religious freedom, and increasing diversity has required a constantly expanding national identity to calibrate our actions to values. We have become more conscious of minority religions and the areligious, who grow in number. As such, in 1947 with Emerson v. Board of Education, the Supreme Court extended protections for religious freedom to state law.

And we’ve become conscious of Christianity-inspired discriminations against abortion and L.G.B.T. rights, which, a majority believe, deserve legal protection.

The implications of separation extend beyond historical circumstance. Thanks to L.B.J., we mandate that churches not influence politics, not just the reverse. Legally, a priest cannot openly endorse a political candidate, lest his church lose tax exemption. That said, religious leaders can preach about political generalities, which nearly two-thirds of them do. The most common topic? Ironically, religious liberty.

Economically speaking, it is more advantageous for religious groups to support separation (and disavow religious nationalism). If another religion or sect rose to power, which is far likelier than yours’ rising, the result would assuredly be disadvantageous. In that fight, most would lose.

The political science research chimes in, too. Worldwide, tight church-state integration negatively correlates with civil liberties (like freedoms of education, expression, and economy) and political rights (like free and fair elections). In other words, integration negatively correlates with democratic principles themselves. (After all, look to the Islamic “democracies” of the Middle East or anti-religious Communist states as examples.) And, the research says, government involvement in religion increases persecutions against minority groups.

Yet increasing American separation has been accompanied by increasing political polarization. While many Christians embrace immigration, diversity, and religious liberties for all (not just themselves), many do not. They claim to be “under attack” and vote for Tea Partiers that promote Protestantism as policy. Republicans like Ted Cruz chastise President Obama for refusing to say “radical Islam,” as if the battle against ISIS represented the divine battle of Christianity against Islam itself. And, of course, Donald Trump proposes a ban on Muslim immigration.

Regarding ISIS, we have research on that, too. The Islamic State represents a “religious club,” an economic model for group behavior. These “clubs,” like Hamas, Hezbollah, and ISIS, don’t just provide religion to their members — they provide social services, stability, and protection. They tightly integrate religion, state, and welfare, giving members a choice: radicalize or lose stability. In war-torn areas like Syria, this choice is life or death, superseding any ideological misgivings.

In other words, Islamic “ideology” isn’t exactly the problem. Members join ISIS for the same motivations that drive all human beings: partly values, and partly the desire for safety, food, shelter, and the best life possible.

In reality, ISIS represents a mosaic of religious, geopolitical, economic, and social concerns. But by “carpet-bombing” it into oblivion, which destroys resources and stability, or by framing international teams as Christian versus Muslim, we do not stop it. We strengthen it. We necessitate its stabilizing presence, mobilize its members and other anti-American governments to radicalize, bolster its recruitment, and spread violent extremism.

Such is the power of church-state integration.

And such is the weight of America’s choice. We have two camps, two distinct visions of church-state relations. And, by extension, two visions of American identity.

But only one is dangerous. Trumpism, as it relates to religion, risks repeating our darkest moments in history. Today, Muslim Americans face the same violence and discrimination as nineteenth-century Catholics. Supreme Court nominees that would overturn Roe v. Wade or Obergefell v. Hodges jeopardize the rights of women and L.G.B.T. Americans. In fact, Republicans have already attempted to legally restrict abortions and anti-discrimination protections. No democracy is immune to the threat of religious nationalism, and India gives a modern example.

Not one of those groups? Trumpism threatens you, too. A foreign policy of religious wars that ignores the complex reality of ISIS endangers all Americans. It makes us less safe. And Trumpism endangers American democracy as we know it, imperiling fair and open representation and celebrated civil liberties. We are the land of the free, not the land of one authoritarian group that ejects the rest, that may include you today, or tomorrow not, just as well.

The reality is undeniable. We are a nation of Protestants, whose twisted history of Christian influence is unchangeable, withstanding revisionism. But our laws, foreign policy, and identity are not. We consciously choose them. Anti-Catholic nativism was a choice. Trumpism is, too. We self-define. We fashion our values, goals, and visions, and we democratically realize whatever nation best aligns with them.

Although we do not choose to be a nation of Christians, we choose to be a Christian nation. And this choice matters. For everyone in it and everyone not.

​In a presidential campaign that feels endless, the primaries have finally ended. So passes another milestone in the contest to choose the next leader of the free world — but don’t ungird your loins yet, because the last part is nastiest. And with the end of the primaries, folks, it’s time again to clean our Facebook feeds.

As our political culture has become increasingly polarized, so too has social media. Over the past six months, whenever we’ve opened Facebook or Twitter, we’ve unavoidably scrolled past anti-whomever posts of whatever kind.

However, many posts go beyond criticizing policy. Beyond signaling support. Many are neither inviting nor measured. They are angry. Hateful. They delegitimize other candidates as having won by conspiracy or foul play and therefore deserving overthrow or worse because they must, by having won, be evil itself.

They’ve displaced cat videos. Which, frankly, upsets me.

In the digital age, we commonly express our frustrations, political and otherwise, on social media. Facebook, Twitter, and other apparatuses leverage the pseudo-anonymity of posting online against our captive, ready-made audience: friends, family, colleagues, and whomever else we’ve befriended over the years.

But unlike typical posts, these ones alienate friends, especially with different views. The meme-oriented nature of social media promotes dubious, mud-slinging character attacks. And rarely, in my experience, do Facebook “debates” remain civil, nor does the character limit of Twitter foster nuanced discussion.

I’m sure you’ve seen it, too.

The culprits are young and old alike, across ideological and demographic divides. Among my college-aged friends, as Bernie Sanders’ chances dwindled, the anti-Hillary Clinton posts sky-rocketed, as did the anti-establishment and anti-rich ones. Among more conservative friends, the posts have been eerily similar: anti-Clinton, anti-Donald Trump, or anti-establishment, depending. And the dismissiveness of Clinton supporters stems from the same trend.

The end of the primaries might have, in another era, marked the joyous reuniting of embattled political parties (or the dog-tailed return of rogue members after populist forays). In the modern age, this might mean the deletion of now-embarrassing posts on Facebook, the scathing ones in which we attacked and delegitimized the candidates and voters that, in the end, represent our friends.

But not this time. Our political culture has, apparently, become so polarized that Sanders supporters continue publishing conspiratorial posts and chastisements of Clinton’s FBI investigators well after she’s clinched the nomination — it’s been months — and after their own candidate has transitioned from revolutionary ambition to stubborn temper tantrum to, ultimately, unity with her.

The conspiracy of last month, for example, was systematic voter fraud in California, which claimed to “prove” that Sanders actually won the state’s primary — despite trailing in state polls in the preceding weeks, despite Clinton’s strength in California’s early voting, which comprises a large portion of the state’s vote, and, of course, despite his fourteen-point deficit in the popular vote throughout the primaries as a whole. Not even alleged “collusion” by the D.N.C. against Sanders could manufacture a margin that large.

Is this who we are?

Of course, the nature of Facebook only feeds the frenzy: a steaming, unfiltered pot in which low-quality information can circulate without barriers of entry, and where group-think self-selects for desired information that enflames whatever pre-existing biases we have about the American political landscape, the opposing party, or the standard-bearers that we love to hate.

This election is unlike any other. As a college student whose Facebook feed is saturated by Sanders crusaders, I unfairly pick on them — Clinton supporters dismissed his candidacy. And after Donald Trump clinched his party’s nomination, many Republicans responded as Sanders supporters did. These frustrations, ironically, suggest that our system isn’t corrupt enough: that party leaders cannot (or will not) override the majority for one’s candidate.

In any case, the defining mood of the American electorate is polarized mistrust. And, as consequent, so too is the mood of our Facebook feeds.

But as we close the primary season, we must come to grips with the present state of things: Trump is the Republican nominee, and Clinton the Democratic. As distasteful many of us may find it, as “unfair” the process has seemed, we cannot delegitimize the wide voting margins by which both candidates won. Their winning does not signal a corrupt system. It signals American democracy, in which we exercise voting rights and concede to the majority.

In accepting their winning, we must drop the baggage of the primary battles. The Bern hereon must be survived by updated Democratic Party ideals and its nominee, not by the overstayed “welcome” of a challenger whose chances evaporated long ago. Ted Cruz and Marco Rubio must be survived by whatever remains of the Republican Party after November.

Our democracy is beautiful. We have the greatest privilege: to freely choose candidates that best represent us (or to run ourselves), to express our dreams and frustrations without fear of discrimination or repression, and to vote. Our polarization — and our Facebook posts — reflects this freedom. But, in order for democracy to function, we must also cooperate. We must compromise.

If we lose, we must embrace it. And move forward, too.

Let’s enter a post-polarization era without conspiratorial rejections. Let’s scrub our Facebook feeds clean of hateful and hate-mongering posts that alienate friends. (Really, have they ever convinced you?) Let’s unite around common goals. And, once November comes and goes, let’s again clean our social media of political frenzy and, having accepted the election results without polarized protest, work with our new president to further our most important interests.

Because that is American democracy. And because I miss my cat videos.

​An Open Letter to College Students:

Last January, after twenty hours of restlessly kneading airplane armrests and turbulent snowstorms, I landed in Madrid, Spain. I staggered off the plane and cowered before a city that stretched outward many miles, yet whose bulk was obscured by a haze. I swallowed hard. Then loaded into a taxi.

That was day one of study abroad.

I had never ventured off campus before, save for home and sheltered vacations. But when I left Madrid five months later, the world had become my campus. I had done it all: leapt closer to Spanish fluency, learned about diverse topics, taught grade schoolers English, tasted fearlessly, and immersed myself in independent adventure.

My confidence had heightened, as well as my awareness of the world. The experience had honed my passions and redirected my academic and career aspirations.

I had redefined myself.

College is for exploration. It’s for expanding horizons and violating comfort zones. While you will take a unique path, pursuing diverse passions and activities, study abroad can benefit you. There is a mind-opening quality about it. You see the world. You establish a second home. You sharpen communicative skills and may radically change your outlook on life.

Every path witnesses new views, perspectives, and ideas. If we are to challenge ourselves emotionally and intellectually, to grow as individuals, why not take that path abroad? Why not wander off the beaten Diag and onto the cobblestone streets of Lisbon or the thousands-year-old steps of Rome? Why not climb the Andes Mountains or double kiss Spaniards or share airplane conversations with South Africans?

Our footprints are our legacy. They tell our story — the long, triumphant strides when we sprinted to new heights, the stumbles when we grappled with unforeseen challenges. They trace the places we have ventured, the choices we have made. And although the rain and wind naturally smooth them away when we’ve long disappeared from the path, the routes we forge inspire others. They chart the unknown. They open new worlds to those that follow.

When I stepped off the airplane into the cool Madrid night, I hadn’t a clue where my path would lead. The miles ahead were hazy, dark, shrouded from sight by the big-city smog. But however threatening the path appeared then, however uncertain I felt, the miles I conquered thereafter were far more rewarding than whatever miles I would’ve repeated at home.

And so I continue forging. I continue chasing profound experiences. Because that’s the impact of study abroad. It instills within you a hunger to uncover new and unseen paths. To chart them for future reference. And to carry those experiences with you as a reminder that you can conquer anything because, after all, you’ve already conquered the world.

Chart your path. Chase adventures. Study abroad.

Sincerely,

Nolan M. Kavanagh
University of Michigan
nolankavanagh.com