Opposing “Obamacare” Is Political Suicide For Downstream Republicans.

Posted on | January 30, 2024 | 1 Comment

Mike Magee

Despite Trump’s recent renewed pledge to once again take on Obamacare, most Republican leaders understand that opposing the increasingly popular program is political suicide. Experts have repeatedly advised the opposite, as we move slowly and incrementally toward “universalism in conjunction with simple source funding,”

A brief summary of the past history helps refresh our collective memories on the road we’ve traveled.

Medicare (a federal health insurance program covering all citizens over age 65) and Medicaid (a state and federal health insurance for poor and disabled citizens) date back to the original LBJ legislation in 1965. President Johnson had intended that the programs would be standard fare in all states. But to achieve passage, Democrats agreed to make the federal/state Medicaid program voluntary, and allow states to determine the details, such as income eligibility limits and work requirements. Medicare became the law of the land immediately, and Medicaid in some form was active in all states by 1982.

In 2010, as part of the Affordable Care Act (popularly termed “Obamacare”), President Obama included an expansion of Medicaid with conditions – that all citizens up to 138% of the federal poverty limit be eligible. In return, the added cost to the states would be paid for with federal subsidies of 100% until 2020 when they would become 90%. Under the original proposed legislation, states with diminished benefits and restrictions would be forced to comply with the new rules or lose their existing federal funding under Medicaid.

In 2012, 26 Attorney Generals from Republican led states filed a lawsuit to challenge Obamacare on two counts in an attempt to collapse the entire program. First, the “individual mandate” (an annual charge or tax on those who did not have health insurance) was targeted. Second, they attacked the constitutionality of the Medicaid extension.

The Affordable Care Act’s (ACA) mandate was an original component of Governor Mitt Romney’s Massachusetts law designed to insure that all citizens and organizations would participate and contribute to even risk-sharing. In the federal bill the mandate was the “stick” to counterbalance the various “carrots” of premium subsidies.

The petition against the ACA mandate became part of the landmark case – National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012). The argument for repeal of the mandate was based on the fact that the administration had justified the mandate as constitutional based on the Article 1 Section 8 – the Commerce Clause or Necessary and Proper Clause.

On June 28, 2012, Chief Justice Roberts disappointed fellow Republicans with a complex decision that split the difference.

As he stated in his closing: “The Affordable Care Act is constitutional in part and unconstitutional in part. The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress’s power to tax.”

Roberts did, however, support Republicans on a their second issue. The Affordable Care Act had mandated that all states expand eligibility to Medicaid in return for a federal subsidy of 100% of the added expense until 2020, or risk loss of all existing federal Medicaid government funding.

The Court’s ruling : “As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding. Congress has no authority to order the States to regulate according to its instructions. Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer.”

As a result, states would have to voluntarily select Medicaid expansion under the ACA. Over the next decade, 40 states have signed up (the last being North Carolina in 2023), while 10 have not. The impact on uninsured numbers was almost immediate. States participating saw their uninsured rates drop and preventive health measures rise. States who chose not to participate and stayed with financial eligibility that was on average at 40% of poverty levels (rather than at 138%) lagged far behind on all measures.

For states opposing Medicaid expansion with federal subsidies, the decision proved costly. They were shown to spend more out of state coffers to support uncompensated ER care for their uninsured than the 10% contribution required after 2020. Yet they stubbornly held out in the hope of denying Democrats further victory as they celebrated states rights at a huge financial and wellness cost (higher mortality rates) to their citizens. The cost in dollars alone is increasingly difficult to justify. For example, Florida’s stubborn resistance left 1 million Floridians out in the cold, and cost the state $5.6 billion in immediate federal aid, and an additional $4.4 billion annually.

Over the past two decades, the numbers of citizens covered by Medicaid have grown substantially, from 40 million to over 90 million. The pandemic reinforced the critical role that Medicaid played in assuring Americans health coverage. On April 1, 2020, Biden signed the Families First Coronavirus Response Act which bumped up federal Medicaid subsidies for two years by 6.2% in return for a mandated freeze of Medicaid enrollee status in all states.

Medicaid numbers increased from 71 to 94 million during this period. That Act sunsetted on March 31, 2023, allowing states to disenroll citizens deemed ineligible. This “unwinding “ is viewed as potentially destabilizing, and states from Missouri to Texas, and Tennessee to Idaho, have been accused of shady practices in trimming their Medicaid rolls.

The ACA of course was not restricted to Medicaid enrollees. As part of the legislation, the Act also created subsidized “insurance marketplaces” nationwide, serviced by federally funded “navigators,” and made children eligible for parent’s insurance up to age 26, and prohibited insurers from disallowing coverage based on prexisting conditions. The popularity of these provisions contributed to Trump’s failure in 2017 to eliminate the ACA, with Senator McCann’s dramatic “thumb down.” Had Trump been successful, it is estimated that the number of uninsured would have increased by 32 million.

The pandemic and inflationary pressures allowed President Biden to expand the effectiveness of these markets. Increased federal subsides have lowered the cost to eligible consumers, as well as access, with eligibility now extended up to four times the federal poverty limit, or $120,000 a year for a family of four.

During the Trump years, from 2016 to 2020, enrollment in the health exchanges dropped 10% to 11.4 million as marketing and the use of navigators were all but eliminated. But in the following four years under Biden, enrollment skyrocketed by 87% to 21.3 million participants.That included 3 1/2 million Texans, and over 4 million Floridians.

Thirty-two states allowed the national HealthCare.gov to be their agent in the transactions, while 18 states chose to field their own websites.

If Obamacare was successful and popular, Bidencare is even more so. The original plan was plagued by an “ACA gap.” Medicaid for poor and disabled was hampered by deliberate state restrictions on access and work requirements, and Health Exchanges were underfunded with insufficient subsides to benefit middle income Americans. As a result, the poor were often underserved. And those with marginal incomes still made too much to qualify for ACA subsidies. By expanding Medicaid access and funding, while increasing eligibility to health exchange subsidies to 150% of poverty, President Biden has all but eliminated that gap, and enrollment has exploded.

So as Trump adds “eliminating Obamacare” to his campaign wish list, down stream Republicans best hope he’s just pulling their legs, and will soon go silent on the issue.

“Silence Is So Accurate” In A Hyperkinetic AI World.

Posted on | January 23, 2024 | 2 Comments

Mike Magee

“I mean, people keep saying in these troubled moments, in these troubled moments. It seems like we’re always in a troubled moment, perhaps this one even more so than usual…But the artwork is a great conduit to feeling that renewed hope for what the human being is capable of.”

Those were the words of Christopher Rothko, son of world renowned artist, Mark Rothko. They were spoken last month, at the National Gallery of Art (NGA), on Constitution Avenue in Washington, D.C. before a live audience of 1000, and countless others via live stream video.

Chris was joined that day by his sister, Kate Rothko Prizel, gallerist Arne Glimcher, and NGA curator, Adam Greenhalgh, who moderated the hour long panel discussion celebrating the opening of the exhibition, “Mark Rothko: Paintings on Paper.” My viewership owed to the fact that I believe in the transcendent power of art, and like many of you, am searching for answers, for solutions, during “these troubled moments.”

Mark Rothko’s official bio has, on the surface, a certain currency today – (Russia, Zionist, immigrant, Ivy League, NYC elite, educator of children). The first paragraph reads, “Mark Rothko was born Marcus Rothkowitz in Dvinsk, Russia, on September 25, 1903. His parents were Jacob and Anna Goldin Rothkowitz, and Rothko was raised in a well-educated family with Zionist leanings. At the age of ten, Rothko and his mother and sister immigrated to America to join his father and brothers… From 1921 to 1923 Rothko attended Yale University on a full scholarship and then moved to New York City. In 1924 he enrolled in the Art Students League…In 1929 Rothko began teaching children at the Center Academy of the Brooklyn Jewish Center, a position he retained for more than twenty years.”

NGA correctly labels him a ”world-renowned painter” who most admire for his “monumental soft-edged rectangular field” paintings that radiate with color. But experts like Michael Andor Brodeur, classical music critic at the Washington Post, emphasize his deep connection to Mozart, and Rothko’s much quoted statement, “I became a painter because I wanted to raise painting to the level of poignancy of music and poetry.”

Most agree that Mark Rothko was deeply contemplative. Or in Brodeur’s words, created “diffusely defined panels of abutting colors — their most subdued hues ignited into a strange glow, their uncanny depth achieved through layers of paint and pigment, their silence overtaking every room they occupied… though they’re heavy with silence, it’s undeniable that his paintings also contain music.”

Rothko put it more simple: “Silence is so accurate.” Perhaps his most famous quote.

Viewers of Rothko are not passive. Many accounts document visitors “bursting into tears.” NGA curator and Rothko expert, Adam Greenhalgh, explained the painter’s intent to “smile through tears” this way: “Rothko hoped his paintings conveyed basic human emotions — tragedy, ecstasy, doom — and that comes from tragedy…”

During his early years, the years Rothko was teaching art to children in New York City, he was working on a manuscript focused on what was the role of the artist in society. In a book about his father, written with his sister, Kate, Chris recounts that his father “sees the artist as someone who is almost like a soothsayer, someone whose responsibility is to some degree our conscience, but certainly to awaken us to all the ideas.” But his father never finished the book, according to his son, because “he realizes that he can actually paint that better than he’s writing it.”

Once his painting was “written,” Rothko worked hard to ensure that the viewer would be able to “read it” correctly. He insisted his monumental paintings be hung only 30 centimeters above the floor, so that you would experience a face-to-face immersion. Galleries were repainted in a light gray with brownish tones which the artist believed best completed his creations. And spot lighting the works was prohibited, as were stanchions that separated the visitors from the works. The works were grouped together in large space galleries, with benches if possible, to encourage long contemplation.

One could easily argue that our hyper-kinetic world, so distracted and anxious and fearful, a world where common ground escapes us, and health – in mind, body, and spirit – is elusive, needs other ways to reach out and touch, other ways to communicate.

On his father’s purpose, son Chris reflects, “he sets up the artist as sort of historically someone who’s not understood or discounted, but in fact, might have some things to say to us in a language that maybe isn’t the one that we speak all the time, but maybe goes a little deeper.”

If you happen to be in Washington in the next two months, and you have a few hours to burn, may I suggest a visit to the National Gallery of Art. The Rothko exhibit runs to March 31st. If not, buy or loan a copy of Chris and Kate’s book about their father (Mark Rothko), and set aside an hour to listen to “Mark Rothko: Insights from Arne Glimcher and the Rothko Family”, a remarkable conversation that highlights America’s complexity, strength, majesty, beauty and promise as we negotiate carefully the year – 2024.

Category: Uncategorized
Tags: Adam Greenhalgh > Arne Glimcher > Christopher Rothko > Kate Rothko Prizel > Mark Rothko > michael Andor Brodeur > National Gallery of Art > NGA

Don’t Panic. This Is Democracy.

Posted on | January 18, 2024 | 2 Comments

Mike Magee

Shock and dismay were once again in the air this week as Donald Trump did his best to be thrown out of the courtroom in New York City during his unrequested attendance at his second Jean Carroll libel trial.

But as an engaged citizen, I thank the former President for crash testing our form of government. Despite driving a majority of Americans to despair, he has driven the crazies, and their minority followers, out into the open, where they can be examined and confronted.

He has also meticulously probed the nooks and crannies of the checks and balances of our constitutional government for weaknesses to exploit. And his “What a’ ya gonna du about it?” gangster style has helped foster a certain alertness among true democracy’s defenders

Join me for a moment in Court with Trump this week:

E. Jean Carroll (on the stand): “I’m here because Donald Trump assaulted me, and when I wrote about it, he said it never happened. He lied, and it shattered my reputation.”

Donald Trump (slumped over), slams hands on desk, and loudly whispers to his attorney.

Shawn Crowley (Carroll’s attorney) to the Judge: “Mr Trump has been sitting at the back table and has been loudly saying things throughout Ms Carroll’s testimony. It’s loud enough for us to hear it. So I imagine it’s loud enough for the jury to hear it.”

Judge Lewis Kaplan to Trump’s attorney: “I’m just going to ask Mr Trump to take special care to keep his voice down when conferring with counsel, so that the jury does not overhear.”

Trump keeps at it.

Attorney Crowley approaches the bench: “The defendant has been making statements again [that] we can hear at counsel table. He said it is a ‘witch-hunt’, it really is a con-job.”

Judge Kaplan replies: “Mr Trump has the right to be present here. That right can be forfeited, and it can be forfeited if he is disruptive, which is what has been reported to me, and if he disregards court orders. Mr Trump, I hope I don’t have to consider excluding you from the trial … I understand you are probably very eager for me to do that.”

Donald Trump: “I would love it, I would love it.”

Judge Kaplan: “I know you would, you just can’t control yourself in this circumstance, apparently.”

Last word Donald: “You can’t either.”

Now let’s just say it out loud. Trump’s a jerk, and a pain in democracy’s ass. As my mother frequently said to me, “You’re testing my patience.” But he know’s what he’s doing – playing to the court of public opinion, and making a few bucks along the way – while feeding his malignant and insatiable narcissism.

A century ago, there were only 15 democracies worldwide. There are now over 100 representing 2/3 of the global population. The ascendant nature of the basic model suggests progress not perfection.

Indiana University history professor John J. Patrick, in a brilliant little book, Understanding Democracy, dipped into democracy’s messiness, writing that “Differences in opinions and interests are tolerated and even encouraged in the public and private lives of citizens…Democracy in our world implies both collective and personal liberty.”

“Democracies are anchored by Constitutions which define the responsibilities of the various counter-balancing branches of government, and jury a system of laws or rules that apply to all citizens. The Constitution defines the limits on the power of government. It is a tricky balance. The democratic government must be powerful enough to maintain law and order. Yet it must be sufficiently restrained to avoid oppressing individual liberty.”

But maintaining an authentic democracy means keeping it real. Federalist #51, dealt with this delicate balance, stating: “If angels were to govern men, neither external nor internal controls on government would be necessary. In framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed, and in the next place oblige it to control itself.”

Now say what you want about Trump, but he has inadvertently exposed a bunch of bad guys hiding in the cracks. I’m not just talking about the thousand or so January 6 militia insurrectionists sitting in jail cells now instead of instigating brawls in their local bars

I’m also talking about you, Leonard Leo, and your friends at the Federalist Society, who schemed for twenty years before successfully packing a Supreme Court willing to topple Roe v. Wade.

And you, Evangelical hypocrites, about who Marv Knox, who directs the Baptist Fellowship Southwest says: “Their theology runs the gamut, from neo-Calvinism to historic fundamentalism, with plenty of iterations in-between. Their attitude spans from aggressive preachers, politicians and internet posers to benign/benighted pew-sitters. But what they have in common is a dumbed down view of salvation, as well as a sold-out idolatry of political power.”

Point being, in the Donald Trump world of “me-me-me,” these characters can no longer hide. They have been forced out into the open by Trump’s constant need for public adulation, exposed, where their ideas and currency can be openly challenged.

We are already seeing the results of transparency. A very healthy democracy is throwing off the shackles of the Dobbs decision. By August, 2023, seven states had conducted abortion related ballot issues that protected abortion access. All seven ballots won easily. During this same period, poll after poll show large majorities of women see the Dobbs decision and regressive subsequent actions in Red States to be repugnant.

Most women now believe the issue is reproductive freedom, medical autonomy, and much overdue casting aside the chains of patriarchy. In short, once the screen was down, Dobbs supporters faced an extremely rude awakening, which will likely undermine Trump’s hopes for a second term.

Does that mean we can take the eye off the Trump ball. Just the opposite. Why? Because as Professor Patrick reminds, “In an authentic democracy, the citizens or people choose representatives in government by means of free, fair, contested, and regularly scheduled elections in which all adults have the right to vote and otherwise participate in the electoral process.” And as we all know, Trump will cheat you out of a fair election victory if you give him half a chance.

This is exactly not the time to give up on democracy. Open the windows even if the air is frigid. Let freedom ring. And don’t let the door hit you on the way out of court, Mr. Trump.

Category: Uncategorized
Tags: Baptist fellowship Southwest > Democracy > Donald Trump > E.Jean Caroll > Federalist 51 > federalist society > John J. Patrick > Judge Lewis Kaplan > Leonard Leo > Marv Knox > Shawn Crowley

Does AI Spell The Demise of Relationship Based Health Care?

Posted on | January 15, 2024 | Comments Off on Does AI Spell The Demise of Relationship Based Health Care?

Mike Magee

“What exactly does it mean to augment clinical judgement…?”

That’s the question that Stanford Law professor, Michelle Mello, asked in the second paragraph of a May, 2023 article in JAMA exploring the medical legal boundaries of large language model (LLM) generative AI.

This cogent question triggered unease among the nation’s academic and clinical medical leaders who live in constant fear of being financially (and more important, psychically) assaulted for harming patients who have entrusted themselves to their care.

That prescient article came out just one month before news leaked about a revolutionary new generative AI offering from Google called Genesis. And that lit a fire.

Mark Minevich, a “highly regarded and trusted Digital Cognitive Strategist,” writing in a December issue of Forbes, was knee deep in the issue writing, “Hailed as a potential game-changer across industries, Gemini combines data types like never before to unlock new possibilities in machine learning… Its multimodal nature builds on, yet goes far beyond, predecessors like GPT-3.5 and GPT-4 in its ability to understand our complex world dynamically.”

Health professionals have been negotiating this space (information exchange with their patients) for roughly a half century now. Health consumerism emerged as a force in the late seventies. Within a decade, the patient-physician relationship was rapidly evolving, not just in the United States, but across most democratic societies.

That previous “doctor says – patient does” relationship moved rapidly toward a mutual partnership fueled by health information empowerment. The best patient was now an educated patient. Paternalism must give way to partnership. Teams over individuals, and mutual decision making. Emancipation led to empowerment, which meant information engagement.

In the early days of information exchange, patients literally would appear with clippings from magazines and newspapers (and occasionally the National Inquirer) and present them to their doctors with the open ended question, “What do you think of this?”

But by 2006, when I presented a mega trend analysis to the AMA President’s Forum, the transformative power of the Internet, a globally distributed information system with extraordinary reach and penetration armed now with the capacity to encourage and facilitate personalized research, was fully evident.

Coincident with these new emerging technologies, long hospital length of stays (and with them in-house specialty consults with chart summary reports) were now infrequently used methods of medical staff continuous education. Instead, “reputable clinical practice guidelines represented evidence-based practice” and these were incorporated into a vast array of “physician-assist” products making smart phones indispensable to the day-to-day provision of care.

At the same time, a several decade long struggle to define policy around patient privacy and fund the development of medical records ensued, eventually spawning bureaucratic HIPPA regulations in its’ wake.

The emergence of generative AI, and new products like Genesis, whose endpoints are remarkably unclear and disputed even among the specialized coding engineers who are unleashing these forces, have created a reality where (at best) health professionals are struggling just to keep up with their most motivated (and often most complexly ill) patients. Needless to say, the Covid based health crisis and human isolation it provoked have only made matters worse.

Like clinical practice guidelines, ChatGPT is already finding its “day in court.” Lawyers for both the prosecution and defense will ask, “whether a reasonable physician would have followed (or departed from the guideline in the circumstances, and about the reliability of the guideline” – whether it exist on paper or smart phone, and whether generated by ChatGPT or Genesis.

Large language models (LLMs), like humans, do make mistakes. These factually incorrect offerings have charmingly been labeled “hallucinations.” But in reality, for health professionals, they can feel like an “LSD trip gone bad.” This is because the information is derived from a range of opaque sources, currently non-transparent, with high variability in accuracy.

This is quite different from a physician directed standard Google search where the professional is opening only trusted sources. Instead, Genesis might be equally weighing a NEJM source with the modern day version of the National Inquirer. Generative AI outputs also have been shown to vary depending on day and syntax of the language inquiry.

Supporters of these new technologic applications admit that these tools are currently problematic but expect machine driven improvement in generative AI to be rapid. They also have the ability to be tailored for individual patients in decision-support and diagnostic settings, and offer real time treatment advice. Finally, they self-update information in real time, eliminating the troubling lags that accompanied “new releases” of original treatment guidelines.

One thing that is certain is that the field is attracting outsized funding. Experts like Mello predict that specialized applications will flourish. As she writes, “The problem of nontransparent and indiscriminate information sourcing is tractable, and market innovations are already emerging as companies develop LLM products specifically for clinical settings. These models focus on narrower tasks than systems like ChatGPT, making validation easier to perform. Specialized systems can vet LLM outputs against source articles for hallucination, train on electronic health records, or integrate traditional elements of clinical decision support software.”

One serious question remains. In the six-country study I conducted in 2002 (which has yet to be repeated), patients and physicians agreed that the patient-physician relationship was three things – compassion, understanding, and partnership. LLM generative AI products would clearly appear to have a role in informing the last two components. What their impact will be on compassion, which has generally been associated with face to face, and flesh to flesh contact, remains to be seen.

Category: Uncategorized
Tags: AI > ama > ChatGPT > Generative AI > Genesis > Health Consumerism > LLM > Mark Minevich > Michele Mello

Trump is Mentally Ill. Say It Out Loud.

Posted on | January 6, 2024 | 5 Comments

Sunday Op-Ed:

Mike Magee

With the January 23rd New Hampshire primary in the rear view mirror, and the SC Republican primary February 24th primary fast approaching, a tragic Donald Trump continues to dig himself into a hole that will eventually lead to some personal hell.

I think we are at a point where Trump’s mental illness is undeniable to most. Those who continue to support his candidacy now do so despite the risk to all of us, and for their own personal gain. There remain a few on the religious right who honestly believe that “God put Trump here for a purpose” (to support patriarchy, outlaw abortion, advance Christian nationalism etc.) A Divine hand at work was part of the immoral justification in both Germany and Japan during WW II as well. That did not end well for the citizens of either nation.

But before Donald Trump, there was William Frederick Kohler. Kohler, like Trump, was not mentally well. Those who have analyzed this fictional creation of philosopher and novelist William H. Gass, describe him this way: “Preoccupied with evil, the nature of truth, and the effects of an individual’s relationship with others, he recalls his bookish childhood with a mother who drank to remember the ‘good old days’ and a bigoted father; graduate work in prewar Germany, where he hurled a brick on Kristallnacht; his unhappy marriage … Kohler, the personal memoirist … is as unreliable as Kohler, the eminent historian. A virtuoso performance without a grand finale.”

The real-life Gass who created Kohler was the author of the award winning novel, “The Tunnel.” He died in 2017. He received his PhD from Cornell in 1954, in return for his dissertation “A Philosophical Investigation of Metaphor.”

A metaphor, as we know, is “a figure of speech in which a word or phrase literally denoting one kind of object or idea is used in place of another to suggest a likeness or analogy between them (as in drowning in money).”

Gass’s love of metaphor is on full display in “The Tunnel”. You can almost hear the beloved high school advanced placement English teacher pleadingly asking her sleepy students “What do you think Kohler’s obsession with digging a tunnel in his basement represents?”

Of the novel, one critic wrote, “As the novel progresses we see the lies, half-truths, violent emotions, and relative chaos of Kohler’s life laid bare, and while he continues to dig away at the memories of his past he also begins digging a tunnel out from the basement where he works, a reflection of his tunneling through himself.”

Beyond Gass’s own story line, and that of William Frederick Kohler, one can easily catch glimpses of Donald Trump. As he entered the strange world of politics, he embraced the use of metaphor with memorable 3 and 4 word phrases like “drain the swamp”, “the system is rigged,” and “take our country back.” Secretive and opaque, Kohler and Trump focus on a very special audience, one the fictional Kohler labels the “Party of the Disappointed People”, a group with whom he shared the affinity “that the loss has been caused in great part by others.”

Trump mixes old, worn out “dead” metaphors like “take our country back” with occasional “live” ones. When he hits the mark, he makes news. For example, in a 2016 foreign policy speech, he used the metaphor, “shake the rust off American foreign policy” only to have it within days appropriated as a headline in the Financial Times.

Academics, Jurists, Priests, and Corporate CEO’s have been careful not to label Trump as mentally ill. But mentally ill he is.

Sadly, his words in 2024 remind of another influential essayist, Kenneth Burke, whose 1939 masterpiece, The Rhetoric of Hitler’s Battle, is required reading for graduate students from English to Philosophy, and from Political Science to History and Religious Studies. The piece’s main focus involves a critical analysis of Hitler’s Mein Kampf (“my struggle”) which includes this stark warning.

Leaders of the free world need “to discover what kind of ‘medicine’ this medicine-man…concocted, that we may know, with greater accuracy, exactly what to guard against, if we are to forestall the concocting of similar medicine in America.”

Trump too has written his own fictional story; a despotic force with his own signature “idiolect”; as admiring of Nazism as was William Frederick Kohler, and as taken with sticky metaphors as William Gass in search of his own “Party of the Disappointed People.”

Loyal indeed, like zombies, his followers and the Republican Party have followed him into the basement, and are heading down a tunnel which has no end. It has been “a virtuoso performance without a grand finale”, unless, that is, it be the destruction of our democratic form of government.

On this Epiphany Sunday, the voices of Americans need to rise as one, and declare out loud – “Trump is mentally ill, and unfit to serve as President.”

Category: Uncategorized
Tags: 2024 election > Epiphany Sunday > Iowa Caucus > Kenneth Burke > mentally ill > the rhetoric of hitler's battle > The Tunnel > trump > william frederick kohler > william Gass

Another Turn of the 25th Amendment – And Still Not The Answer For Trump’s Mental Illness.

Posted on | January 3, 2024 | 4 Comments

Mike Magee

On May 16, 2017 New York Times conservative columnist, Russ Douthat, wrote “The 25th Amendment Solution for Removing Trump.” That column was the starting point for a Spring course I taught on the 25th Amendment at the President’s College in Hartford, CT. I will not summarize the entire course here, but would like to emphasize four points:

The American public was adequately warned (now 7 years ago) of the risk that Trump represented to our nation and our democracy.
Douthat’s piece triggered a journalistic debate which I summarize below with four slides drawn from my lectures.
Had Pence and the cabinet chosen to activate the 25th Amendment, as it is written, Trump would have had the right to appeal “his inability”, forcing the Congress to decide whether there was cause to remove the President.
Judging from the later impeachment of Trump in the House, but failure to convict in the Senate, it is unlikely a courageous Pence and Cabinet would have been backed by their own party.

Let’s look at four archived slides from the 2017 lecture, and then discuss our current options in the case of 2024 Trump against Democracy.

Slide 1. Russ Douthat

In 2017, Scott Bomboy, chief of the National Constitution Center, wrote:

“Section 4 is the most controversial part of the 25th Amendment: It allows the Vice President and either the Cabinet, or a body approved ‘by law’ formed by Congress, to jointly agree that ‘the President is unable to discharge the powers and duties of his office.’ This clause was designed to deal with a situation where an incapacitated President couldn’t tell Congress that the Vice President needed to act as President.”

“It also allows the President to protest such a decision, and for two-thirds of Congress to decide in the end if the President is unable to serve due to a condition perceived by the Vice President, and either the Cabinet or a body approved by Congress. So the Cabinet, on its own, can’t block a President from using his or her powers if the President objects in writing. Congress would settle that dispute and the Vice President is the key actor in the process.” What might have been (but was not) would have played out this way according to Constitutional scholars:

“… scholars Brian C. Kalt and David Pozen explain the problematic process if the Vice President and the Cabinet agree the President can’t serve.”

“If this group declares a President ‘unable to discharge the powers and duties of his office,’ the Vice President immediately becomes Acting President.
If and when the President pronounces himself able, the deciding group has four days to disagree.
If it does not, the President retakes his powers.
But if it does, the Vice President keeps control while Congress quickly meets and makes a decision…
The Vice President continues acting as President only if two-thirds majorities of both chambers agree that the President is unable to serve.”

Had our leaders followed Russ Douthat’s advice seven years ago, it is highly unlikely that a 2/3rds majority of both chambers of Congress would have had their back. Instead, they went for Impeachment and failed, as Republicans chose rather to let voters decide. And they did, in 2020. Few likely envisioned that mentally deranged (now former President) would launch a January 6th insurrection, embolden white nationalists militia across the nation, and follow thru on threats to run and win a 2nd term in 2024, and then free his followers from jail cells, only to be filled with those who attempted to hold him accountable for his historic misdeeds. The 25th Amendment is no more a solution today than it was in 2017. Instead citizens loyal to our form of government, rely in 2024 on two protective backstops:

Our third pillar of government – The Courts (most especially the Supreme Court.
The voter, whose second day of reckoning fast approaches.

Some believe we are once again engaged in a great Civil War. In its’ summary of the Gettysburg Address, National Geographic states that “Despite (or perhaps because of) its brevity, since (Abraham Lincoln’s) speech was delivered, it has come to be recognized as one of the most powerful statements in the English language and, in fact, one of the most important expressions of freedom and liberty in any language.”

The last paragraph of that two minute speech, delivered now 180 years and two months ago, reminds us that Americans died on “the battlefield” on January 6, 2021 defending our democratic government, and Lincoln’s words are today, more relevant than ever.

As described by historians, Lincoln made it clear that the stakes could not have been higher, well before the Dobbs decision and the appropriation of Hitler’s words by Trump. “Lincoln tied the current struggle to the days of the signing of the Declaration of Independence, speaking of the principles that the nation was conceived in: liberty and the proposition that all men are created equal. Moreover, he tied both to the abolition of slavery—a new birth of freedom—and the maintenance of representative government.

As they were spoken, November 19, 1863, here are Lincoln’s final words, ones that deserve a most careful reading: “It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us—that from these honored dead we take increased devotion to that cause for which they here gave the last full measure of devotion—that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom, and that government of the people, by the people, for the people, shall not perish from the earth.”

Category: Abraham Lincoln, Brian C. Kalt, Dahlia Lithwick, David Pozen, Gettysburg Address, Jamal Greene, National Constitution Center, Russ Douthat, Scott Bombay
Tags: Democracy > Dobbs decision > Trump and Hitler > Womens Rights

2024 Prediction – Society Will Arrive At An Inflection Point in AI Advancement.

Posted on | December 21, 2023 | 4 Comments

Mike Magee

For my parents, March, 1965 was a banner month. First, that was the month that NASA launched the Gemini program, unleashing “transformative capabilities and cutting-edge technologies that paved the way for not only Apollo, but the achievements of the space shuttle, building the International Space Station and setting the stage for human exploration of Mars.” It also was the last month that either of them took a puff of their favored cigarette brand – L&M’s.

They are long gone, but the words “Gemini” and the L’s and the M’s have taken on new meaning and relevance now six decades later.

The name Gemini reemerged with great fanfare on December 6, 2023, when Google chair, Sundar Pichai, introduced “Gemini: our largest and most capable AI model.” Embedded in the announcement were the L’s and the M’s as we see here: “From natural image, audio and video understanding to mathematical reasoning, Gemini’s performance exceeds current state-of-the-art results on 30 of the 32 widely-used academic benchmarks used in large language model (LLM) research and development.

Google’s announcement also offered a head to head comparison with GPT-4 (Generative Pretrained Transformer-4.) It is the product of a non-profit initiative, OpenAI, and was released on March 14, 2023. Microsoft’s AI search engine, Bing, helpfully informs that, “OpenAI is a research organization that aims to create artificial general intelligence (AGI) that can benefit all of humanity…They have created models such as Generative Pretrained Transformers (GPT) which can understand and generate text or code, and DALL-E, which can generate and edit images given a text description.”

While “Bing” goes all the way back to a Steve Ballmer announcement on May 28, 2009, it was 14 years into the future, on February 7, 2023, that the company announced a major overhaul that, 1 month later, would allow Microsoft to broadcast that Bing (by leveraging an agreement with OpenAI) now had more than 100 million users.

Which brings us back to the other LLM (large language model) – GPT-4, which the Gemini announcement explores in a head-to-head comparison with its’ new offering. Google embraces text, image, video, and audio comparisons, and declares Gemini superior to the OpenAI/Microsoft GPT-4.

Mark Minevich, a “highly regarded and trusted Digital Cognitive Strategist,” writing this month in Forbes, seems to agree with this, writing, “Google rocked the technology world with the unveiling of Gemini – an artificial intelligence system representing their most significant leap in AI capabilities. Hailed as a potential game-changer across industries, Gemini combines data types like never before to unlock new possibilities in machine learning… Its multimodal nature builds on yet goes far beyond predecessors like GPT-3.5 and GPT-4 in its ability to understand our complex world dynamically.”

Expect to hear the word “multimodality” repeatedly in 2024 and with emphasis. But academics will be quick to remind that the origins can be traced all the way back to 1952 scholarly debates about “discourse analysis”, at a time when my Mom and Dad were still puffing on their L&M’s. Language and communication experts at the time recognized “a major shift from analyzing language, or mono-mode, to dealing with multi-mode meaning making practices such as: music, body language, facial expressions, images, architecture, and a great variety of communicative modes.”

Minevich believes that “With Gemini’s launch, society has arrived at an inflection point with AI advancement.” Powerhouse consulting group, BCG (Boston Consulting Group), definitely agrees. They’ve upgraded their L&M’s, with a new acronym, LMM, standing for “large multimodal model.” Leonid Zhukov, Ph.D, director of the BCG Global AI Institute, believes “LMMs have the potential to become the brains of autonomous agents—which don’t just sense but also act on their environment—in the next 3 to 5 years. This could pave the way for fully automated workflows.”

BCG predicts an explosion of activity among its corporate clients focused on labor productivity, personalized customer experiences, and accelerated (especially) scientific R&D. But they also see high volume consumer engagement generating content, new ideas, efficiency gains, and tailored personal experiences.

This seems to be BCG talk for “You ain’t seen nothing yet.” In 2024, they say all eyes are on “autonomous agents.” As they describe what’s coming next: “Autonomous agents are, in effect, dynamic systems that can both sense and act on their environment. In other words, with stand-alone LLMs, you have access to a powerful brain; autonomous agents add arms and legs.”

This kind of talk is making a whole bunch of people nervous. Most have already heard Elon Musk’s famous 2023 quote, “Mark my words, AI is far more dangerous than nukes. I am really quite close to the cutting edge in AI, and it scares the hell out of me.” BCG acknowledges as much, saying, “Using AI, which generates as much hope as it does horror, therefore poses a conundrum for business… Maintaining human control is central to responsible AI; the risks of AI failures are greatest when timely human intervention isn’t possible. It also demands tempering business performance with safety, security, and fairness… scientists usually focus on the technical challenge of building goodness and fairness into AI, which, logically, is impossible to accomplish unless all humans are good and fair.”

Expect in 2024 to see once again the worn out phrase “Three Pillars”. This time it will be attached to LMM AI, and it will advocate for three forms of “license” to operate:

Legal license – “regulatory permits and statutory obligations.”
Economic license – ROI to shareholders and executives.
Social license – a social contract delivering transparency, equity and justice to society.

BCG suggests that trust will be the core challenge, and that technology is tricky. We’ve been there before. The 1964 Surgeon General’s report knocked the socks off of tobacco company execs who thought high-tech filters would shield them from liability. But the government report burst that bubble by stating “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.” Then came the Gemini 6A’s 1st attempt to launch on n December 12,1965. It was cancelled when its’ fuel igniter failed.

Generative AI driven LMM’s will “likely be transformative,” but clearly will also have its up’s and down’s as well. As BCG cautions, “Trust is critical for social acceptance, especially in cases where AI can act independent of human supervision and have an impact on human lives.”