america is ending the world order It created

And it may be the most rational thing we’ve done in decades

The memo landed on a Thursday morning in the spring of 1993. I don’t remember the exact date, but I remember the feeling — that peculiar combination of dread and forced calm that descends when something enormous is happening and there is absolutely nothing you can do about it.

Christian Health Services, where I had built my career in communications and marketing, was merging with Barnes-Jewish Inc. to form BJC HealthCare, what would become one of the largest nonprofit hospital systems in the country. The hallways buzzed with the kind of anxious small talk that fills a vacuum when the real questions are too frightening to ask out loud: Will my department be redundant? Will my job survive? Will I?

The executive who pulled a small group of us aside that first week said something I have never forgotten. He didn’t offer reassurance. He didn’t reach for platitudes about opportunity or shared vision. Instead, he leaned forward and said, with the measured gravity of a man who had made a genuinely hard decision: “You don’t understand. If we don’t do this, we won’t survive.”

I’ve been thinking about that sentence a great deal lately. Not because of hospital mergers, but because of a different kind of restructuring — one that is upending not a regional healthcare system but the entire architecture of the post-1945 world order. And the rationale, stripped of diplomatic language, sounds remarkably similar.

The Merger Nobody Voted For

The rules-based international order is one of those phrases that means everything and nothing simultaneously. It conjures images of the United Nations, the World Trade Organization, the International Monetary Fund — a web of institutions and agreements designed after World War II to manage great-power competition short of catastrophic conflict. For roughly eight decades, it was the framework within which American foreign policy operated. The United States was, to use the metaphor that the NSS itself now explicitly rejects, Atlas holding up the world.

The Trump administration’s November 2025 National Security Strategy doesn’t tiptoe around what it’s doing. It says plainly that “American strategies since the end of the Cold War have fallen short,” that elites “placed hugely misguided and destructive bets on globalism” that “hollowed out the very middle class and industrial base on which American economic and military preeminence depend.”

The document doesn’t mourn the rules-based order. It autopsies it.

The 2026 National Defense Strategy, issued by what is now officially called the Department of War, is even more direct. It declares that prior administrations squandered America’s post-Cold War advantages on “grandiose nation-building projects and self-congratulatory pledges to uphold cloud-castle abstractions like the rules-based international order.”

The language is deliberately provocative. These documents are not reform proposals. They are termination notices.

To understand why — and whether they are right to be — we need to understand a political scientist named Robert Gilpin, a theory called hegemonic stability, and, strangely enough, what it felt like to walk into Barnes-Jewish Hospital for the first time as an outsider.

What Gilpin Knew

Robert Gilpin spent much of his career at Princeton developing what became known as hegemonic stability theory. The core insight is elegant and, once we grasp it, is difficult to unsee: open, rule-governed international systems don’t arise spontaneously. They require a dominant power — a hegemon — willing and able to bear the disproportionate costs of creating and maintaining them.

The British did it in the 19th century. The Americans did it after 1945.

Gilpin’s darker corollary is equally important: hegemonic orders are inherently temporary. The very openness of the system the hegemon creates accelerates the relative rise of other powers. Challengers grow wealthy and capable operating within the hegemon’s system, even as the hegemon’s own costs mount.

Eventually, a reckoning comes. Either the challenger surpasses the hegemon and imposes a new order — often through conflict — or the hegemon adapts, strategically contracts, and renegotiates the terms of the system before it’s too late.

Gilpin called this “hegemonic war.” He didn’t mean it was inevitable. He meant it was the recurring pattern of history when declining hegemons failed to manage their transitions wisely.

The question hanging over American foreign policy right now — the question the NSS and NDS are trying, in their aggressive way, to answer — is whether the United States is managing its transition wisely or simply managing it loudly.

Life Inside the Merger

I spent eleven years at BJC HealthCare after the merger. Eleven years, seven different titles, five different offices, and more moments of genuine professional terror than I care to count. I was not a natural survivor of institutional upheaval. I liked the predictable rhythms of the place I had come from — the suburban culture, the collegial pace, the sense that I understood the rules.

None of that survived contact with Barnes-Jewish.

Barnes-Jewish was part of a nationally ranked academic medical center affiliated with Washington University School of Medicine. Its emergency room was known locally, with grim affection, as the “gun and knife club” — a Level 1 Trauma Center that drew cases from across the Midwest, staffed by physicians who had little patience for anyone they considered a lesser institution’s cast-off. Walking into that environment as a representative of Christian Health Services felt, in those early weeks, like presenting credentials that everyone had already decided weren’t good enough.

The uncertainty was pervasive and unrelenting. Every hallway conversation carried an undertow. People who had spent decades in the old institution found themselves suddenly legible in a new way — not as they understood themselves, but as they appeared on an organizational chart that someone else had drawn. HR and purchasing had already been consolidated. Who was next?

What I came to understand, only later, was that the executives who ordered the merger weren’t being cruel. They were being realistic.

The healthcare landscape was changing in ways that made independent mid-sized systems increasingly unviable. Scale mattered. Negotiating power mattered. Research infrastructure mattered. The calculus was brutal and, viewed from a sufficient distance, entirely correct. Two organizations that might have slowly declined separately had a genuine chance, merged, of becoming something exceptional.

You don’t understand. If we don’t do this, we won’t survive.

The Hegemon’s Dilemma

Here is what the architects of the current American reorientation believe, and what the NSS lays out in unusual candor: the United States has been playing the role of hegemon long after the conditions that made that role sustainable have eroded.

The post-Cold War bet was that by welcoming China into the rules-based order — the WTO, global supply chains, technology transfer — the United States could facilitate China’s liberalization while maintaining its own dominant position. The NSS is unsparing in its assessment: “This did not happen. China got rich and powerful, and used its wealth and power to its considerable advantage.”

Meanwhile, the costs accumulated. Allies — wealthy, sophisticated allies — allowed America to subsidize their defense for decades while investing their own resources in domestic priorities. Trade relationships that once reflected asymmetries of development calcified into structural disadvantages for American workers. The industrial base that undergirds military power hollowed out. And the national debt grew.

Gilpin would have recognized this pattern immediately. The hegemon had been running a deficit — not just fiscal, but strategic — for a generation. The question was no longer whether adjustment was necessary but whether it could be managed deliberately or would happen chaotically.

The NSS frames this explicitly: not every country, region, or cause can be the focus of American strategy. The purpose of foreign policy is the protection of core national interests. It lists them: hemisphere stability, Indo-Pacific access, European security, Middle East energy chokepoints, and technological leadership — particularly in AI, biotech, and quantum computing.

Everything else is subordinate.

This is strategic triage, and it is long overdue.

The Advice That Stayed With Me

My father-in-law served in Germany during World War II. He was not a man given to sentiment, but he passed along one piece of counsel before I married his daughter. It’s advice I have returned to many times in the decades since. When his sergeant asked the platoon if anyone could drive a large truck, nobody raised a hand. My father-in-law eventually did. He had never driven such a vehicle in his life. He raised his hand anyway, said “I can,” and then figured it out.

His philosophy was uncomplicated: say yes first. Do whatever is asked of you to the best of your ability. If you have to fake confidence until real competence arrives, that is an acceptable price for staying relevant.

I lived by that advice at BJC. When my boss created a new role for me — Manager of Special Projects — my first assignment was to produce a comprehensive “Fact Book” for the board of directors and executive team. Nobody truly knew this new organization from the inside. I was a team of one, with a graphic designer and a mandate to gather information and interview dozens of people across both organizations.

Four months later, the finished product landed on the desk of every executive. Within weeks, people across BJC were calling and emailing to request copies. It became, informally, the organizational Bible.

I mention this not to brag — I am semi-retired now, and the statute of limitations on bragging has long since passed — but because the experience illuminated something I didn’t fully appreciate at the time: in moments of institutional upheaval, the person who does the unglamorous work of actually understanding the new landscape has an outsized advantage.

Chaos rewards the curious.

I think about this when I read the NSS’s assessment of American foreign policy since the Cold War. The document is, in some respects, its own kind of Fact Book — a cold-eyed inventory of what the organization actually has, what it actually owes, and what it can realistically defend. The accounting is not flattering. But accurate accounting, however uncomfortable, is the prerequisite for rational strategy.

What the Documents Actually Say

It would be a mistake to read the NSS and NDS as simply bellicose. The bellicosity is real, but it exists alongside something more intellectually serious: a coherent theory of what went wrong and what a sustainable American position in the world actually requires.

The NSS articulates several principles worth taking seriously on their merits. “Flexible Realism” — the acknowledgment that the United States cannot impose democratic transformation on cultures with different histories and traditions — is not a retreat from values; it is a recognition that the attempt to do so has repeatedly produced expensive failures. “Balance of Power,” as the document frames it, explicitly rejects American global domination as a goal while committing to prevent any other power from achieving it. This is, in essence, the classical realist position that many foreign policy scholars have advocated for years.

The emphasis on economic security as national security is perhaps the most consequential shift. The NSS treats reindustrialization, supply chain sovereignty, and energy dominance not as economic preferences but as strategic imperatives.

COVID demonstrated, with genuine brutality, how dependent American critical sectors had become on Chinese manufacturing. A country that cannot produce its own pharmaceuticals, semiconductors, or military components is not sovereign in any meaningful sense. The NDS makes this connection explicit: a strong military cannot exist without a strong defense industrial base, and that base had been systematically exported.

On China, both documents thread a careful needle. The goal is not conflict. The NDS explicitly states that it does not seek to “dominate, humiliate, or strangle” China — the objective is simply to ensure that China cannot dominate or strangle the United States and its allies. This is deterrence by denial, the logic of the First Island Chain, the strategic language of people who have studied how great-power competitions end and who are trying, with imperfect tools, to prevent the worst outcome.

The Costs of the Merger

I want to be honest here, because I think intellectual honesty is the only thing that distinguishes this argument from tribalism.

The transformation underway carries real costs, and some of them are severe. Allies who have relied on American security guarantees for generations are genuinely frightened — not paranoid, but frightened — and fear is not a stable foundation for partnerships the NSS claims to value. The disruption of multilateral institutions, whatever their flaws, eliminates dispute-resolution mechanisms that have prevented a great deal of low-level conflict from escalating. The speed and style of the current approach creates its own risks: allies who feel humiliated tend not to stay allies.

I felt something similar in those early months at BJC. Decision makers were right that the merger made strategic sense. But they were not always right about how to manage the humans inside it. For instance, the colleague who literally lied to superiors and took credit for my work was not a strategic visionary — she was a person whose anxiety expressed itself as aggression and made the environment measurably worse without making the institution measurably better. Institutional transformation does not excuse every behavior undertaken in its name.

There is also the question of what replaces the old order. Hegemonic stability theory tells us that open systems require a guarantor. If the United States is strategically contracting — and the NSS is essentially a document about strategic contraction, however it dresses itself — then who or what fills the space? The NSS gestures toward burden-sharing, toward allies assuming primary responsibility for their regions. This is reasonable in principle. The Hague Commitment, which pledged NATO countries to spend 5 percent of GDP on defense, is, if honored, a genuine rebalancing. But “if honored” is doing significant work in that sentence.

And then there is China. The NSS is correct that the Chinese Communist Party has used the openness of the international system to accumulate power without accepting its obligations. It is also correct that the relationship between the United States and China is the defining strategic competition of this century. What the documents cannot tell us — what no document can tell us — is whether the approach being taken will produce the deterrence it seeks or the conflict it hopes to avoid.

Surviving the Merger

I did survive BJC. Eleven years, seven roles, five offices. I wrote speeches for the CEO. I created what may have been the first physician-to-physician digital magazine for international referring doctors. I built the competitive intelligence function from scratch, presenting well-reasoned reports on what our rivals were doing and what we should consider in response. I marketed double lung transplants and brain surgery to physicians in places like Saudi Arabia and Egypt. None of that would have been possible at the institution I came from. The merger, for all its chaos and cruelty, expanded what was achievable.

Looking back, I can see that my father-in-law’s advice — say yes, then figure it out — was wisdom suited precisely to moments of institutional upheaval. The people who left BJC in those early years were, for the most part, people who could not tolerate the uncertainty. Some of them were talented. Uncertainty, not incompetence, was their undoing. The people who stayed learned to be resilient, flexible, and genuinely curious about what the new organization could become.

I eventually left BJC, though not because the uncertainty broke me. I left because I believed — and still believe — I was called in a different direction, toward full-time ministry. God had carried me through eleven years that required more reinvention than I had imagined I was capable of, and when the season ended, I recognized it. I walked out having accomplished things I would never have imagined possible from where I started.

I tell you this because it matters to the metaphor. The merger was not only disruptive. It was, in retrospect, generative. The best of times and the worst of times, as Dickens wrote — and he meant both simultaneously, not sequentially.

The Open Question

Whether America’s current geopolitical merger with hard reality will prove similarly generative is the question none of us can answer yet.

What I believe — and I want to be careful to present this as belief, not certainty — is that the diagnosis in the NSS is substantially correct even if the treatment is sometimes reckless in its delivery. The post-1945 order was not broken because bad people wanted to break it. It was broken by the ordinary operation of the forces Gilpin described: a system so successful it produced its own challengers, and a hegemon so committed to the system’s preservation that it failed to notice the system was no longer serving its own self interests.

The rules-based international order was not sustainable in its late form. China’s rise within it was real. The industrial hollowing-out of the American heartland was real. The free-rider problem among wealthy allies was real. COVID’s supply-chain exposure was real.

These are not talking points; they are documented phenomena with bipartisan acknowledgment in academic and policy literature going back at least two decades.

What is genuinely uncertain is whether the current approach — muscular, transactional, deliberately norm-disrupting — is the right instrument for the necessary correction. Strategic triage is correct in principle. Triage performed with a chainsaw is not the same as triage performed with a scalpel.

I am old enough to remember when disruption was what happened to you, not what you proudly announced you were doing to others. I am pragmatic enough to understand that sometimes the only available instrument is a blunt one. I am honest enough to admit I don’t know which of those is true right now, or in what proportion.

A New Golden Age?

The National Defense Strategy closes with a vision of President Trump “leading our nation into a new golden age.” The NSS uses the same phrase. It was in the inauguration speech. The repetition suggests both intention and aspiration — a promised destination that justifies the turbulence of the journey.

I emerged from the BJC merger a more capable, more resilient, and more experienced professional than I entered it. The chaos that seemed purely threatening turned out to be, in part, opportunity I hadn’t yet learned to recognize. I reinvented myself seven times in eleven years and discovered, somewhere in the process, that reinvention itself was a skill I hadn’t known I possessed.

What I know about institutional transformation — what those years at BJC taught me at a cellular level — is that people and organizations that survive are not the ones that avoid the disruption. They are the ones that stay oriented toward what they are actually trying to build on the other side.

The refrain I heard in those early merger days — you don’t understand, if we don’t do this, we won’t survive — was right. The merger was necessary. The disruption was real. The outcome was not guaranteed. And the people carrying the institution through that transition had to hold two things simultaneously: clear-eyed acknowledgment of how hard it was, and a genuine commitment to what it could become.

That is exactly the quality of mind that the current American moment demands of its citizens. Not cheerful denial of the costs. Not paralysis before the risks. But the capacity to look honestly at a broken system, acknowledge that the disruption required to fix it is real and painful, and commit — with eyes open — to the possibility that something better waits on the other side.

Whether it does is a question history will answer, not us.

But I have learned, in the years since I left BJC for a different calling, that refusing to engage with an honest question because the answer is uncertain is its own kind of failure. The world is being renegotiated. The rules-based international order that the United States built — and that served American interests for eight decades — is being dismantled and rebuilt on different terms.

The disruption is real. The stakes are historic. And somewhere in that upheaval, if the people navigating it are wise enough and honest enough and resilient enough, there may be something genuinely worth building.

You don’t understand. If we don’t do this, we won’t survive.

Maybe. But survival was never the only thing that mattered. It was always what we built after.

About the Author

Christopher Little spent the first half of his career in corporate communications — writing speeches for the CEO, marketing an academic medical center internationally, and navigating the institutional upheaval of one of the largest nonprofit healthcare mergers in American history. He spent the second half in pastoral ministry and now serves as a hospital chaplain. He is semi-retired and writes narrative essays and fiction from the Greater St. Louis area.