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.

The Unnecessary Scarcity We Tolerate Is Tearing Up the Country

By Mike Koetting October 28, 2025

I’ve been thinking that Abundance, the Ezra Klein-Derek Thompson book, has the right idea but the focus is too narrow.

The Klein-Thompson book starts with the observation that scarcity is a choice. It then proceeds to assume that the way out of the scarcity trap is to make it easier to create more stuff so that all may experience the abundance of what our technology can produce. This clearly has an element of truth. They correctly identify bottlenecks in our current production of social goods and they are right that there is no political appetite for “degrowth.” So power to their suggestions.

That said, however, they miss the urgency of the situation. A large chunk of the population is furious. Trying to remove obstacles to creating greater supply of desired goods, while laudable, is simply not a solution commensurate with the degree of anger in the body politic. I think Michael Hirschorn, in a recent New York Times op-ed piece, has a better handle on where we are: “Trumpism is more than politics. It’s an emotional gas-main explosion, from people who felt unheard, patronized, left behind.”

The Moment of Truth

By Mike Koetting October 14, 2025

I believe we are approaching a “make-or-break” point for Trump’s authoritarian impulses.

It’s not a question of what he wants to do. That’s clear. In the last several weeks, he has replaced Federal Attorneys until he found one who would pursue an embarrassingly flimsy indictment against one of his enemies, he signed an executive order that raised the possibility almost any kind of dissent could be treated as “treason,” he posted on Truth Social that Democrats are “THE PARTY OF HATE, EVIL, AND SATAN,” and he lectured the leaders of the Armed Services that their mission included fighting the “enemies within”.

His approach to controlling immigration is increasingly inhumane. His masked marauders have grabbed people off the streets with little regard for their situations or actual legal status. Here in Chicago, along with the wanton cruelty and indifference to legality, there has been a major performance element designed to intimidate: armed border guards patrolling the Chicago River, military marches down Michigan Avenue on a Sunday afternoon and ICE agents rappelling from Blackhawk helicopters into apartments filled with sleeping families—separating children from parents and causing total pandemonium. Now Trump is calling for Governor Pritzker and Mayor Johnson to be jailed.

Government Statistics for Policy

Curated by Mike Koetting September 30, 2025

I’ve been on vacation the last two weeks, so I don’t have a new post. But to fill the vacuum that would otherwise be created in the universe, I am posting this collection of relevant quotes on the above topic.

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.