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With confirmation hearings soon to begin for Kennedy and other healthcare department heads with similar views about to begin, the threat of future pandemics in an administration with a disastrous track record is another reason to urge their defeat.
One barely noticed pledge by President-elect Donald Trump during the 2024 campaign appeared in a May Time magazine interview that offers an especially ominous warning about Trump 2.0. If he won a new term, Trump said, he would “probably” disband the Office of Pandemic Preparedness and Response policy established by Congress in 2022.
Fast forward to his new nominees, especially Secretary of Health and Human Services anti-vax conspiracy theorist Robert F. Kennedy Jr., who has said he would pause National Institute of Health infectious disease and drug development research for eight years. As the saying goes, we might have a problem.
With confirmation hearings soon to begin for Kennedy and other healthcare department heads with similar views about to begin, the threat of future pandemics in an administration with a disastrous track record is another reason to urge their defeat.
If the U.S. had the same death rate as Australia, The New York Times later reported, about 900,000 American lives would have been saved.
The 2022 law was prompted by the worst pandemic in a century, that has killed over 1.2 million Americans. The law’s roots were in a pandemic global health security office former President Barack Obama set in the National Security Council. It followed Obama’s experiences with the H1N1 swine flu pandemic in 2009 that killed up to 575,000 people globally, including more than 12,000 in the U.S., and the 2014 Ebola outbreak that claimed thousands of lives in West Africa and provoked a major scare in the U.S.
Trump eliminated the office in 2018, suggesting, The Associated Press reported, “that he did not see the threat of pandemics in the same way that many experts in the field did.” In March, 2020, former pandemic office director Beth Cameron wrote she was “mystified” by the unit’s shutdown “leaving the country less prepared for pandemics… all with the goal of avoiding a six-alarm blaze.” Trump officials insisted they were fully prepared. Facts on the ground tell a different story.
In December 2019 the first reports emerged of patients in China suffering symptoms of an unknown pneumonia-like illness, drawing reminders of the Severe Acute Respiratory Syndrome Coronavirus, SARS Cov-1. By early January 2020, the World Health Organization (WHO) began referring to the outbreak as a 2019 Novel Coronavirus, soon to be renamed Covid-19.
With infections spreading in Asia, the U.S. Centers for Disease Control and Prevention (CDC) in late January reported the first U.S. cases. The first U.S. deaths occurred in January 2020. By mid-March, when Cameron’s op-ed appeared, the WHO confirmed more than 118,000 Covid cases and 4,291 deaths.
Australia, which had a similar profile of libertarian individualism and a right-wing prime minister in 2020, created a bipartisan response with opposition Labor Party and state leaders, and medical officers out front. They quickly subsidized production and distribution of masks, prioritized testing and contact tracing, and understood some shutdowns were necessary. If the U.S. had the same death rate as Australia, TheNew York Times later reported, about 900,000 American lives would have been saved.
The first year of Covid-19 was critical to establishing the protocols and public health protections to confront the crisis and reduce the deaths and suffering. But, due to widespread government failures, infections spread like wildfires. Yet the Trump administration was glacially slow to react. In his first public statement January 22, 2020, Trump declared, “We have it totally under control. It’s one person coming in from China. It’s going to be just fine.”
In multiple comments tracked by Rep. Lloyd Doggett (D-Texas), Trump downplayed the danger. February 2020: “Looks like by April… when it gets a little warmer, it miraculously goes away,” “CDC and my Administration are doing a GREAT job of handling Coronavirus,” “We’re going very substantially down, not up,” and, “One day, it’s like a miracle, it will disappear.”
Due to Trump’s malfeasance; promotion of misinformation, including false miracle cures; and actively discouraging government and community safety steps to slow the spread, Covid-19 exploded.
As Trump’s term ended on January 20, 2021, the U.S. recorded 25 million cases, and over 400,000 deaths.
Embracing the sluggish signals from Washington, hospitals stalled on adopting critical safety protocols and were ill-prepared for the flood of desperately ill patients that led to cascading deaths, with bodies piling up in makeshift morgues or refrigerated trucks outside hospital doors. It was made worse by inadequate isolation of infected patients and shortages of ventilators and proper protective equipment for overwhelmed nurses and other healthcare workers who paid a horrific price with thousands of deaths and many leaving due to unwillingness to work in unsafe conditions.
Trump’s failures continued for months. At a White House press conference on April 3, Trump eroded a new tepid CDC guidance people consider wearing masks, as other countries were now requiring to reduce transmission of the virus, by adding he would not do so.
Trump’s position, New York University sociologist Eric Klinenberg recalled, “undermined it,” suggesting “to anyone in his world that wears a mask, it’s cowardly, weak, feminine, so no one’s going to wear masks. [It] becomes clear to everyone in the Republican establishment that bearing your face is the way to show solidarity and support to the president,” reinforcing a partisan political divide on not just masks but soon all public health measures.
In late April 2020, as the U.S. death toll passed 60,000, Trump said, “This is going away.” In May, amid 80,000 deaths, Trump said, “We have met the moment, and we have prevailed.” In June, with 110,000 dead Americans, Trump said, “It is dying out, it’s going to fade away.”
On August 31, with the death count passing 180,000, Trump said, “We’ve done a great job in Covid, but we don’t get the credit” blaming a “fake news media conspiracy.” For months, Trump demanded an end to steps some states were implementing to limit infections. As Trump’s term ended on January 20, 2021, the U.S. recorded 25 million cases, and over 400,000 deaths.
National Nurses United (NNU), one of the first to respond to prior pandemics during H1N1 in 2009 and Ebola in 2014, had gained valuable experience. By early January, 2020, “before most people in the U.S. had even heard of Covid-19,” as The New York Times noted, NNU began mobilizing and aggressively pushing employers, government elected officials, and health and regulatory agencies to implement decisive safety actions. In contrast to public agencies, NNU launched multiple public endeavors from rallies to marches, vigils, pickets, and other collective action, including strikes, to demand optimal protections for nurses, other healthcare workers, patients, and the broader public.
Employers took their lead from Trump and the federal agencies he influenced, including the CDC and Occupational Safety and Health Administration (OSHA) that continually eroded safety guidelines and workplace regulations. Hospitals, observed NNU executive director Bonnie Castillo, RN, “took a gamble relative to how much to have and how much to be prepared. And the CDC came out with guidelines shifting, commensurate to what the hospitals are complaining of. The lower standard is cheaper. So they just kept lowering and lowering, all the way down to bandannas. They’re looking at us like fodder.”
Trump’s mismanagement and indifference to who was most harmed proved catastrophic for communities of color, including a large percentage who were essential workers in transit, food processing, service industries, and healthcare.
Early in the pandemic, Trump sought to shift blame from his administration to China, repeatedly referring to Covid-19 as “the China virus,” though by April the U.S., with 4% of the world’s population, accounted for 17% of global Covid-19 deaths. Trump’s racist scapegoating ignited a sharp rise in anti-Asian hate speech and physical assaults.
His future HHS nominee Kennedy was among those adding fuel to the fire. At a 2023 New York press event Kennedy claimed “there is an argument that it is ethnically targeted. COVID-19 attacks certain races disproportionately… The people who are most immune are Ashkenazi Jews and Chinese.”
“We’re being treated like we don’t matter and we’re dispensable.”
Asian American and Pacific Islander (AAPI) healthcare workers subsequently reported a rise in racist incidents, both in hospital settings and in their daily lives. Twice as many verbal and physical assaults were directed at women. “We must unite to challenge anti-Asian violence, harassment, and racism,” said University of California San Diego RN Dahlia Tayag at a statewide California Nurses Association protest against ongoing anti-Asian hate crimes.
The disproportionate racial impact was evident in Covid=19’s devastating toll on Filipino healthcare workers. Kansas City RN Celia Yap Banago, one of many RNs who had pressed her hospital to fix inadequate protections, was one of the first RNs to die in April 2020. “We were being told we’re not allowed to wear masks because it’s going to scare our patients,” said Jenn Caldwell, RN.
By August 2023 when the government stopped reporting healthcare-worker Covid-19 data, 5,753 healthcare workers, including 501 RNs, had died of Covid-19. In a June interview, Zenei Triunfo-Cortez, RN, CNA/NNOC’s first Filipina president, noted that nurses call for help from Trump and Congress “fell on deaf ears… Our employers are banking on (CDC) guidelines, which have been watered down… We’re being treated like we don’t matter and we’re dispensable.”
Centuries of structural racism accelerate the disproportionate impact of any crisis, including pandemics. As Trump was continuing to downplay the tsunami of infections and deaths, and discouraging safety procedures, the racial impact escalated. Black Chicagoans, 30% of city residents, comprised 72% of the Covid-19 deaths. Black Michigan residents, under 15% of the population, accounted for 40% of the deaths. Milwaukee African Americans, 26% of the population, totaled 70% of Covid-19 deaths. Similar rates were evident across the country, from states with large Black populations like North and South Carolina, to those with smaller percentages, such as Nevada and Connecticut.
Latinos were 80% of the first people admitted for care at San Francisco’s large public hospital and in Latino San Jose neighborhoods. Native Hawaiians and Pacific Islander infection and death rates were also higher in California. In March 2020, New Mexico Gov. Michelle Lujan Grisham cited “incredible spikes” in Navajo Nation. Two months later, Navajo Nation still had higher Covid-19 infection cases per capita than much more publicized, hard-hit New York City.
Columnist Jamelle Bouie linked the disparities to “longstanding structural inequities.” Systemic racism in healthcare had a long history, evident in less access to medical institutions and caregivers, provider treatment biases, lower rates of costly health coverage, housing segregation, and higher concentration in polluted neighborhoods. Hospitals in Black neighborhoods were far more likely to close than in mostly white areas, a National Institutes of Health study found.
“What it meant to be an essential worker was to be deemed expendable.”
Black and Latino workers were also far more likely to hold “essential” jobs. Many were concentrated in lower paid jobs often forced to keep working due to economic need or employer pressure, including in food services, grocery and drug stores, and poultry and other meat processing plants. The Guardianreported alarmingly high transit worker death rates among bus and subway drivers, mechanics, and maintenance workers in New York, Boston, Chicago, St. Louis, Detroit, Washington D.C., and other major cities.
In September 2020, the CDC drew condemnation for reportedly soft-pedaling safety precautions due to political interference at a South Dakota meatpacking plant. All these factors resulted in workers of color having less economic ability or opportunity to shelter or work from home, and less access to safety measures, from masks to social distancing on the job where they risked constant exposure.
It also reinforced a class chasm with “a lot of professional and more affluent people who could afford to make the kind of sacrifices this public emergency called for who were able to protect themselves, able to sustain a level of comfort that other people in America were not,” says sociologist Klinenberg.
“It wasn’t like when we called them essential, we said, because you’re essential we’re going to honor you, we’re giving you masks, you get the best access to healthcare in the world, and here’s a bonus from all of us and our forever gratitude. What it meant to be an essential worker was to be deemed expendable. And it wasn’t just you, you got exposed to the virus, then you were more likely to go back home to your family who also got exposed to the virus. So you’ve got these neighborhoods throughout the country where there’s a lot of working class people who are getting exposed and they have higher mortality,” he added.
“Covid was kind of a search light that showed us everyone, everywhere we had studiously looked away from,” writer and activist Naomi Klein observed. “Suddenly we’re forced to think about the way in which our culture produces disposable people, whether they are working in elder care facilities when there’s suddenly Covid outbreaks, or the poultry plants [that] were Covid hotspots. Places where you never see a camera because we’re not supposed to think about, [like] what’s going on in prisons.” Klein cited “the myth of neoliberalism, like we are just individual people and families, and we don’t owe anything to each other. Covid said that wasn’t the case because you can’t just treat individuals, you have to treat a body of enmeshed individuals.”
Workers and unions had to fight their employers and public agencies under Trump to protect their members and the public. Union pressure, Castillo told The New York Times, moved some hospitals to act. In the first six months alone, NNU “staged more than 350 socially distanced protests, including two vigils in front of the White House for the nurses who died from the virus.”
Though Trump’s first term ended with the rollout of a Covid-19 vaccine, lasting damage had been done with his encouragement of opposition to critical community protections from masking to social isolation to needed closures to reduce the spread of the virus, and his sympathy for an escalating anti-vax movement. NNU early in 2021 characterized the Trump administration’s response as “one of denial and abandonment.”
Going forward, with Trump nominating people with similar views opposing the importance of a robust approach to public health, including full preparedness and action on sure-to-come future epidemics, there is ample cause for concern. A new avian flu’s first U.S. death has already occurred. Measles, polio, and other illnesses could mushroom, especially with health officials hostile to vaccines in charge of health agencies with vaccination rates already declining.
With confirmation hearings approaching, The New York Times this week reported the alarming vaccination drop “creating new pockets of students no longer protected by herd immunity [with]… now an estimated 280,000 kindergartners without documented vaccination against measles, an increase of some 100,000 children from before the pandemic.” Resurgence of polio, once virtually eradicated, is also a threat.
Rising temperatures from climate change mean that bacteria not only grow faster but are also associated with increased antibiotic resistance, facilitating the rise of new deadly pandemics. Factor in expected cuts in federal agencies and reduced enforcement of workplace and community protections by an administration more friendly to corporate demands for cuts in regulations.
Over the coming days and years, our vigilance and mass action will be critical to protecting public health.
"The most efficiently run healthcare systems in the world," said National Nurses United, "have been proven time and time again to be single-payer systems."
Two of the United States' most outspoken critics of the for-profit health system welcomed billionaire entrepreneur Elon Musk's criticism of the country's sky-high healthcare spending—and suggested that Musk, a potential Cabinet member in the incoming Trump administration, join the call for Medicare for All.
A social media post by Musk drew the attention of Sen. Bernie Sanders (I-Vt.) and Rep. Pramila Jayapal (D-Wash.), who reintroduced legislation to expand Medicare coverage to every American last year and have long called for the for-profit healthcare system to be replaced by a government-run program, or single-payer system, like those in every other wealthy country in the world.
"Shouldn't the American people be getting getting their money's worth?" asked Musk, posting a graph from the nonpartisan Peter G. Peterson Foundation that showed how per capita administrative healthcare costs in the U.S. reached $1,055 in 2020—hundreds of dollars more than countries including Germany, Canada, and the United Kingdom.
"Yes," said Sanders, repeating statistics he has frequently shared while condemning the country's $4.5 trillion health system in which private, for-profit health insurance companies increasingly refuse to pay for healthcare services and Americans pay an average of $1,142 in out-of-pocket expenses each year.
"We waste hundreds of billions a year on healthcare administrative expenses that make insurance CEOs and wealthy stockholders incredibly rich while 85 million Americans go uninsured or underinsured," the senator added. "Healthcare is a human right. We need Medicare for All."
Jayapal added that she has "a solution" to exorbitant healthcare costs in the U.S.: "It's called Medicare for All."
Musk has been nominated by President-elect Donald Trump to lead a new federal agency that he wants to create called the Department of Government Efficiency (DOGE). Sanders has expressed support for some of the agency's mission, saying its plan to "cut wasteful expenditures" could be put to use at the Department of Defense, which has repeatedly failed audits of its annual spending.
But Sanders has sharply criticized the economic system and business practices that have helped make Musk the richest person in the world, with a net worth of $343.8 billion.
Another progressive, David Sirota of The Lever, suggested last month that DOGE could be used to eliminate the nation's vast health insurance bureaucracy and replace it with Medicare for All, pointing to a 2020 report from the Republican-controlled Congressional Budget Office that showed that a government-run healthcare program would save the country an estimated $650 billion each year.
"Such a system could achieve this in part because Medicare's 2% administrative costs are so much lower than the 17% administrative costs of the bureaucratic, profit-extracting private health insurance industry," wrote Sirota.
Musk drew the attention of Medicare for All advocates amid online discussion about the greed of for-profit insurance giants.
The killing of UnitedHealthcare CEO Brian Thompson on Wednesday prompted discussion about widespread anger over the U.S. healthcare system, and following public outcry, Anthem Blue Cross Blue Shield on Thursday backtracked on a decision to stop paying for surgical anesthesia if a procedure goes beyond a certain time limit. The American Society of Anesthesiologists said that if Anthem stopped fully paying doctors who provide pain management for complicated surgeries, patients would be left paying hundreds or thousands of dollars in out-of-pocket costs.
National Nurses United, which advocates for a government-run healthcare system, urged Musk and others who support the broadly popular proposal to "join the movement to win Medicare for All."
"The most efficiently run healthcare systems in the world," said the group, "have been proven time and time again to be single-payer systems."
The devastating storm was bad enough, but we can never forget the damage Donald Trump did to the island and its people.
One day after a warm up speaker at Republican presidential nominee Donald Trump’s closing campaign rally in New York City on Sunday night called Puerto Rico a “floating island of garbage,” the island’s largest circulation newspaper El Nuevo Día October 28 endorsed Vice President Kamala Harris for President.
The first paragraph of the editorial observed, “This is what Donald Trump and the Republican Party thinks of Puerto Ricans?” Signed by the signed by the editor M. Ferre Rangel, the editorial concluded, “We ask that every Puerto Rican that can vote please represent those of us who cannot vote. Vote for Kamala Harris.”
The racist slur by comedian Tony Hinchcliffe quickly reverberated across the U.S., especially in Puerto Rico and to states with large Puerto Rican populations, including critical Pennsylvania where an estimated 470,000 out of 600,000 registered Latino voters are of Puerto Rican descent. That fear prompted a feeble effort of damage control by the Trump campaign, which claimed the hateful comment did not “reflect the views of Trump or the campaign.” But notably there was no apology by Trump, or from the campaign about the multiple other racist jibes by various speakers targeting Latinos in general, African Americans, Jews, and, of course, Harris.
Ironically, the hate rally also came the same day Harris, campaigning in Philadelphia, presented a new policy platform for Puerto Rico, premised on economic development and improved disaster relief. She also reminded everyone of Trump of having "abandoned and insulted" the island during Hurricane Maria in 2017.
Indeed, as the New York Times reported Tuesday, the memories of Trump’s long, and ineffectual delay of aid to the island from a super storm that caused thousands of deaths and massive devastation, were quickly noted by those on the island, including his insulting image of tossing paper towels to a crowd at his one stop in San Juan two weeks after Maria made landfall.
“Well, this isn’t the first time. Three thousand Puerto Ricans died because he weaponized the aid. Because he didn’t think our lives were worth saving, and because of his inability to do his job,” said former San Juan, Puerto Rico Mayor Carmen Yulín Cruz.
“You have to understand the context of how hurtful this is by understanding the botched and deadly response to Hurricane Maria,” said U.S. Rep. Darren Soto, a Florida Democrat of Puerto Rican descent. Even the chairman of Puerto Rico’s Republican Party said that he would withhold his support from Mr. Trump unless he apologized.
Hurricane Maria slammed into Puerto Rico as a Category 4 storm on September 20, 2017, with a huge storm surge, very heavy rains, and wind gusts over 100 miles per hour. The hurricane's power was magnified nearly five times by climate change, a preview of what the nation would see again this year with Hurricane’s Helene and Milton.
As the federal response by the Trump administration was glacially slow, hospitals were rapidly overwhelmed, struggled to meet medical needs, clinics and doctor’s offices failed to re-open, patients with chronic illnesses did not have access to needed medications, and concerns emerged about the potential of cholera and other epidemics.
Where Trump failed, nurses and labor responded. Within days, National Nurses United’s Registered Nurse Response Network played a leading role in a 300-member AFL-CIO sponsored humanitarian mission, working with the Puerto Rican Federation of Labor and the San Juan mayor’s office. It launched on October 3, 2017, with NNU dispatching 50 volunteer RNs, the first of several delegations to provide medical aid in local hospitals, nursing homes, and other sites based on the immediate need for island residents.
Two weeks in, RNs reported that many people had yet to receive any food, water, and other supplies from FEMA or any other agency. Others stood in line for hours in blistering heat waiting for desperately needed water and food. They cited houses with roofs blown off and soaked interiors with dangerous black mold growing that creates respiratory distress and illness, and a breakout of leptospirosis, a dangerous bacterial disease that had already claimed lives.
“Our nurses have seen firsthand, on the ground, even in the past few days, that FEMA aid, which was far too slow and inadequate to begin with, is still necessary to save lives,” stated Cathy Kennedy, RN, lead volunteer for RNRN’s deployment in 2017, which dispatched nurses across the island.
“What nurses witness daily,” said NNU executive director Bonnie Castillo at the time “is the harsh reality of a woefully inadequate government response and the brutal, inhumane impact on the Puerto Rican people. People are still without food and water. That poses an enormous humanitarian threat in terms of disease, life, and death and who succumbs first.”
“When we arrived we were really the first responders there,” recalled Kennedy, now a co-president of NNU. “Puerto Rico is part of the United States. We never saw such a lack of basic necessities. The power grid was down. There was no access to get the medications people needed for their blood pressure, their diabetes medication, they couldn’t even keep vials of insulin because there was no refrigeration. Everybody felt like they were thrown away and treated like second class citizens.
“They were really happy to see all of the nurses and doctors, and said we were the first ones to come to their homes. A lot of our work was getting water, food, and some meds to them. We were not only the first responders, we also worked to show people how to navigate FEMA. It was unconscionable,” remembered Kennedy, contrasting Trump’s response to how quickly the Biden/Harris administration was responding to provide assistance following Hurricanes Helene and Milton.
NNU volunteers documented their experiences. In Rio Grande, outside San Juan, “we set up a clinic at a FEMA (Federal Emergency Management Agency) site. People lined up for blocks. But FEMA was only handing out papers which need to be filled out in order that they might receive some reimbursement eventually,” reported Erin Carerra, RN.
RN volunteers in 2017, recently back from Puerto Rico hurricane relief efforts, briefed members of Congress and Senator Bernie Sanders on the public health crisis that was taking place on the island due to an inadequate response by the Trump administration.(Photo: National Nurses United)
“We did home visits with public health liaisons who identify those in need and help them do basic blood pressure checks, blood sugar checks, refill their meds, etc. They have already had chronic diseases going on and now their environment is full of hazardous materials and sanitation is so poor. They could not get a hold of their doctors due to closure of many clinics in the area,” said RN Hau Cheng.
With another RNRN team, RN Kent Savary described how “they went to a man’s home. He had no roof, all his belonging were soaking wet due to the rain and no tarp. He is living in a garage beneath where he's in a 3x3 area. It’s an impoverished area with no access to clean water. There’s black mold built up in most of the houses on the second floor, which can cause upper respiratory infections, renal failure, and scarring of the lungs. There is a lack of relief communication and no FEMA in sight. Nebulizers are needed for asthma patients, but there is nowhere to plug in. FEMA is demanding folks apply online or via their cellphone app and provide bank account info by November 30 or they get no aid. Most people don't have cell phones, cell service, power or laptops.”
By late October 2017, NNU was alerting the press to the disastrous conditions. "Our people are being left to suffer, and the nurses hope that our elected officials work to change this before people die," said Kennedy, who had recently returned from the island.
“People were so desperate for water they started drinking it from the river, where rodents had died during the storms," Kennedy reported, citing concern about the spread of water born leptospirosis. "People are going to get sicker. What the nurses have uncovered, is that there’s still standing water. There’s black mold. There are homes that have no roofs. These are people’s homes, and they want to stay in their homes. And their health is at risk."
On October 26, 2017, RNRN volunteers back from Puerto Rico joined a Capitol Hill press conference with House Minority Leader Nancy Pelosi, Rep. Nydia Velázquez and other members of Congress to call for increased aid to confront the ongoing humanitarian and health care crisis in Puerto Rico.
“It pains us to know that for many Puerto Ricans, the volunteers on this deployment provided the only aid they received—and were a temporary buffer between life and death. If our volunteer nurses can provide this aid, how has our government, with all of its resources, been unable to do the same?” asked Kennedy. “While we are so proud of our nurses for stepping up to help, even sourcing food and water for desperate Puerto Ricans, using the nurses’ own resources. Their service begs a question: Where is our government?” asked Castillo.
A NNU report in later October of 2017 noted that one million people lacked access to running water in those weeks following the storm. The report also cataloged a daily shortfall of 1.8 million meals, devastated healthcare infrastructure and disease outbreaks, and concluded that “the response to the crisis in Puerto Rico from the U.S. federal government has been unacceptable for the wealthiest country in the world.”
Four years later, in another press conference citing the still disastrous recovery, Rep. Velazquez reported that “Puerto Ricans are experiencing blackouts almost daily” and “thousands of homes (still covered) with blue tarps. This is happening in America.”
“And it was painful,” said Cruz this week following the insults against Puerto Ricans once again from Trump, “because you think, ‘My God, it’s not like this person hasn’t showed who he is to the world.”
“Racism has always been present, but they feel emboldened (under Trump) about them and us,” says Kennedy today. “It’s very divisive, disrespectful language that shows hate. I went into nursing to provide care and compassion. When you have someone running for President who has such disregard for people other than himself, we can’t have that. I struggle to understand why anyone would vote for him.”