Author: mkbhhw

Mike Koetting’s career has been in health care policy and administration. But it has always been on the fringes of politics. His first job out of graduate school was conducting an evaluation of the Illinois Medicaid program for the Illinois Legislative Budget Office. In the following 40 years, he has been a health care provider, a researcher, a teacher, a regulator, a consultant and a payor. The biggest part of his career was 24 years as Vice President of Planning for the University of Chicago Medical Center. He retired from there in 2008, but in 2010 was asked to implement the ACA Medicaid expansion in Illinois, which kept him busy for another 5 years.

Attacking Medical Science

By Mike Koetting September 15, 2025

Every once and a while, you’ll run across an article about a bunch of teens absolutely trashing a local school. You’ll shake your head and wonder, “What the hell is this about? Okay, they don’t like school. But this doesn’t make any sense.”

What Trump and his Republican enablers are doing to the American scientific enterprise is remarkably similar, except with results that are going to be a lot worse. It’s a bit hard to tell exactly how great the damage will be given the uncertainty of what actions will withstand court challenges, what administrative actions will be taken to circumvent courts or where the juvenile in charge will change his mind. But working on this essay made it clear to me it is even worse than you probably imagined. Media covers it one event at a time, without stepping back to see the whole catalogue of damage. Likewise, the more you look at it, not only do you realize it’s more dangerous, but you also realize it is even more senseless than appears.

Old Political Order Fading; Future Is Scary

By Mike Koetting September 3, 2025

David Brooks, taking anguished stock of the depredations of Trump and the Republicans, on PBS NewsHour, wondered why there aren’t more people in the streets. This is a question I have often asked myself. And am not the only one. What Trump and the Republicans are doing is so destructive of the spirit of democracy as to demand vigorous response.

But if the attack on the ideals of America is so fundamental, why aren’t there more people in the streets?

AI’s Practical Concerns-Part Two

By Mike Koetting August 19, 2025

Today’s blog is the second of two posts about AI. It’s not about whether AI is good or bad for society. That’s a worthwhile discussion and I expect it to remain a hot topic for the foreseeable future. These posts, however, are based on the observable reality that, like it or not, it’s coming.

These posts focus on some practical questions about its arrival. Part One looked at some of the economic impacts; today’s post considers environmental issues and questions of security and reliability.

The Practical Implications of AI – Part One

By Mike Koetting August 5, 2025

Today’s blog is the first of two posts about AI. It’s not about whether AI is good or bad for society. That’s a worthwhile discussion and the answers likely to be endlessly debated. But these posts assume that, like it or not, it’s coming. (Whether it lasts or not is a different matter, but we’ll get to that later.)

The point of these posts is to ask some practical questions about its arrival.

Risk #1: Blowing up the Economy

Why Do We Tolerate the Crypto Scam?

By Mike Koetting

Republicans in Congress declared the week of July 14 as “Crypto Week” with the intent of passing three bills on crypto currencies as part of a push to boost and legitimize the U.S. cryptocurrency industry by giving it a regulatory framework that’s lighter than what traditional financial assets and institutions face but at the same time creates an aurora of legitimacy. All three of these bills passed. One, the so-called GENIUS Act, had already been passed by the Senate—with 18 Democratic votes– and Trump has signed it into law. The other two also passed, but face an uncertain future in the Senate. Not surprisingly, the value of existing cryptocurrency soared with the attention. Bitcoin, the best known cryptocurrency, hit an all-time high.

The details of these bills aren’t anywhere near as important as the fact that crypto is being treated seriously. There is no compelling reason for cryptocurrencies and profound reasons why they should simply be ignored. Or banned if ignoring them turns out to leave too many risky possibilities in play.

Being an American Right Now

By Mike Koetting July 8, 2025

Another Fourth of July rolled around and there was new grist for the perennial question of how I feel about being an American.

Being an American is, foremost, a legal definition laying out certain rights and responsibilities. Becoming an American was easy for me: I was born here. And since, at least so far, I haven’t wanted to leave, I am still an American. Of course, the legal fact doesn’t shed light on how I feel about this.

At one level, how I feel about being an American is kind of an unconscious, automatic response to being part of a group, a community larger than me. I always cheer for American teams to win in the Olympics. There are also certain patriotic tropes and evocations that never fail to move me. Lincoln’s Second Inaugural address, for example. Or Woody Guthrie’s “This Land Is Your Land.” I suspect this deep-seated sense of “home” will stay with me no matter what.

But these group instincts are nowhere near as important as the more analytical view of what I believe America stands for and how that is being realized, or not, at the moment.

Are Our Responses Matching the Risks?

By Mike Koetting June 24, 2025

Our country is drifting toward an authoritarian state. This is a fact, not a matter of opinion. One might argue about the speed of the drift or, in theory, even whether that’s a good thing or a bad thing. But one can’t really argue in good faith about the direction.

I am guessing most of the readers of this blog are troubled by this. The question that I can’t get out of my head is how should I feelabout it. And, then, what should I do about it. Asking these questions raises a lot of philosophical questions about what does the abstraction of democracy or, even, of country, mean, none of which have simple answers.

But it seems to me that there are fundamental reasons to believe that democracy is superior to authoritarianism, so much so, I would submit that standing up for it is a moral imperative.

Republican Organization Is (Mostly) an Illusion

By Mike Koetting June 10, 2025

How many times have you heard someone say: “Democrats need to get organized like Republicans.” I don’t have any problem with the idea of getting organized. What I find problematic is the idea that the Republicans have some magic template. For the most part, they are as disorganized as Democrats. They have simply hitched their wagons to one of the world’s most accomplished grifters and let him drag them wherever he wants to go. This simplifies organization enormously. To be sure, Trump has accommodated them by making various nods in the directions of long-time Republican goals. But it is erratic, inconsistent, and can be seen as part of an organized plan only through a peculiar lens. See below about Project 2025.

Democrats Real Problem Is a Lack of Options

By Mike Koetting May 27, 2025

I am increasingly skeptical that characterizations of the Democrats as chronically disorganized are useful. Democrats probably are disorganized. But all political parties are…and the more democratic they are, the more that is the case.

No doubt, mistakes were made in the last election. The biggest one was when Biden insisted on running. Maybe you could blame that on the Party. But just ask the (former) Republican establishment how easy is it is control someone who had structural momentum. And, although a year or so later one can spin all kinds of counter-historical scenarios, at the time there were compelling reasons not to pursue various alternatives.

Post-election, options are even more limited. The other party controls the national government and Democrats have no leverage. Republicans would prefer to toss over all reason (not to mention the Constitution) rather than strike any kind of compromise.

How Many Deaths for Congressional Republicans?

By Mike Koetting May 13, 2025

In Julius Caesar, Shakespeare writes: “Cowards die many times before their deaths; The valiant never taste of death but once.”

Republicans in Congress are today playing out their own version. By failing to take on any of the winnable small battles, they are slipping toward a situation where the entire foundation of the country could be up for grabs. Most Congressional Republicans understand that Donald Trump is playing fast and loose with the separation of powers—and in the process taking away Congressional power.