When Is a Deferral “Withholding”?

Under Title XIX of the Social Security Act the executive branch of the federal government is empowered to withhold Medicaid funds from a state following prior notice and a public hearing. At the Minnesota Star-Tribune Sydney Kashiwagi and Jessie Van Berkel report that the White House has “paused” Medicaid reimbursements to Minnesota:

The Trump administration announced Wednesday it plans to halt $259 million in Medicaid payments to Minnesota over concerns about fraud in the state’s social services programs, the latest chapter in the federal government’s crackdown on the state.

The announcement comes one day after President Donald Trump’s State of the Union address, where he zoomed in on fraud in Minnesota and announced Vice President JD Vance would be leading efforts to combat the issue. It also follows the wind-down of Operation Metro Surge, an immigration crackdown in the state initially prompted by allegations of fraud.

“A quarter billion dollars is not going to be paid this month to Minnesota for its Medicaid claims,” Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said alongside Vance in a Washington, D.C., news conference.

The administration said it would withhold the funds until the Walz administration puts together a “comprehensive corrective action plan to stop the problem.”

I think that distinguishing between “pausing” and “withholding” is splitting hairs. Is this action substantively a withholding, regardless of the label? If the executive branch can avoid statutory procedural safeguards simply by relabeling a withholding as a “pause,” then the statutory protections are illusory. I have no objection to the administration’s investigation of Medicaid fraud in Minnesota but I do think it should follow the letter of the law, that is it should issue a warning and conduct a public hearing.

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A Commentary on the Commentary

It was the best of speeches, it was the worst of speeches, it was a wise speech, it was a foolish speech, it evoked faith, it demanded incredulity, it was the beginning of a new day, it heralded the coming of darkness, it was the spring of hope, it was the winter of despair.

And so we listened, not to a speech, but to ourselves.

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Jack at Westminster


I’m ready for my close-up!

This picture was taken by Jack’s breeder at Westminster a couple of weeks ago. His handler does a great job in grooming him.

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State of the Union 2026

I tried my level best to listen to last night’s State of the Union address. A transcript is here. I gave up at 9:40pm and went to bed. It unfolded much as I had predicted to my wife: a catalogue of superlatives, some true, some arguably false, many exaggerated.

I counted sixteen of them. Too many to make a good drinking game, even when the speech clocked in at 108 minutes. They included:

  • “strongest and most secure border in American history”
  • “single largest decline in recorded history” (in homicides)
  • “lowest level in more than five years” (referring to the rate of inflation)
  • “lowest in four years” (mortgage interest rates)
  • “all-time record highs” (stock market)
  • “More Americans are working today than at any time in the history of our country”
  • “cut a record number of job-killing regulations”
  • “largest tax cuts in American history”

I’m sure the president’s fans were delighted. Some have claimed it’s an effective way of communicating with ordinary people. I’m not so sure. To my ear when superlatives are overused they are “tuned out”, i.e. they lose impact. I consider understatement a better rhetorical device because it leaves the speaker with somewhere to go—hearers will notice the rare superlative more in that context. Carthago delenda est (Carthage must be destroyed) was rhetorically effective because Cato the Elder wasn’t saying everything should be destroyed in every speech. De gustibus… Is this persuasion, performance, or simply the language modern voters expect?

To his credit President Trump’s State of the Union message this year was not as much of a presidential “wish list” as prior SOTU’s have been. In some cases matters in that wish list are never heard of again. I counted three calls for Congressional action:

  • ban sanctuary cities
  • require voter ID
  • prohibit medical “transition” treatment for minors without parental consent

Please construe neither support nor opposition from that list—they are merely the wish list actions I identified.

Did you listen to the speech? What were your reactions?

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Proof Positive (Updated)

I read this list of the “most famous local sandwiches in each state” at Yahoo and my immediate thought was that a steady diet of most of these would be enough to kill you.

IMO it’s proof positive that if American culture dies it will be of a heart attack.

In fairness I’ve tried about half of the sandwiches listed in the article at one time or another, for example the Horseshoe, Illinois’s entry, when I was in Springfield. The only one I’ve eaten lately is the banh mi, Washington State’s entry, and that was ten years ago. I have never had the courage to try a Fluffernutter in Tennessee Massachusetts. As my wife put it, “It’s just wrong”.

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And Then There Were None

WGN Television has laid off eight veteran members of its news staff. Crain’s Chicago Business reports:

Eight reporters and anchors were laid off Monday at WGN-Ch. 9, the latest round of cuts at the Chicago television station owned by Dallas-based Nexstar Media Group, according to the Chicago Tribune.

Among those let go was weekend morning anchor Sean Lewis, a nearly 20-year veteran of the station. Lewis said he was informed of his dismissal Monday afternoon after filing what became his final report for the noon broadcast.

The layoffs follow additional reductions in recent months, including six newswriters and three technical directors last month and four floor directors in October, according to newsroom sources cited by the Tribune.

Nexstar declined to comment on specific personnel matters but said in a statement it is “taking steps necessary to compete effectively in this period of unprecedented change.”

I’m sad to see this move. It’s another step in the decline of local news coverage.

As I’ve mentioned before my wife and I frequently watch WGN’s evening news coverage. That was particularly true during the nightly “Dolton follies” which I posted on. WGN’s regular reporting on the political and governmental problems in Dolton was instrumental in mobilizing that town to reform itself. That’s something that only local news coverage will do.

Some of our favorite WGN personalities have been laid off. I’d like to know more about this story but we’re even less likely to learn more about it now than we were a week ago.

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Only the Dead

As of today, February 24, 2026, the war between Russia and Ukraine enters its fifth year. Whatever the actual casualties their numbers have been horrific on both sides with tremendous harm to civilians and infrastructure.

As of this writing neither side has achieved its stated objectives in the war as gauged by President Putin’s and President Zelensky’s public statements and show little likelihood of doing so. In particular I see little material way of Ukraine accomplishing its goals.

All of that notwithstanding I believe that the United States should continue to provide military and humanitarian aid to Ukraine. Russia should not have invaded Ukraine—it is a violation of treaties to which Russia is a signatory. I also support continuing and tightening economic sanctions against Russia. Our policies with respect to Eastern Europe have often been misguided, even perverse but that is a digression. The matter at hand is the ongoing war. The objective is not total Ukrainian victory but the preservation of Ukrainian sovereignty under conditions that do not risk global catastrophe.

War is not a zero-sum game. Everyone loses. The “winner” just loses less than the “loser”. We will continue to lose as long as this war continues.

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A Single Step

In an op-ed in the Washington Post Mexican journalist León Krauze exhorts Mexico’s president to continue the fight in which she has engaged against criminal cartels in Mexico:

On Sunday, Claudia Sheinbaum’s government recorded a significant success in its fight against organized crime. In an operation led by its armed forces, Mexican authorities killed Nemesio Rubén Oseguera Cervantes — “El Mencho” — the leader of the Jalisco New Generation Cartel (CJNG), the most powerful criminal organization to emerge in Mexico in decades.

and

Oseguera’s death also marks a definitive break with years of permissiveness under the previous administration led by Andrés Manuel López Obrador. López Obrador’s “hugs, not bullets” strategy allowed criminal organizations such as the CJNG to expand their dominance. Oseguera’s killing suggests that the constant pressure exerted by the Trump administration has pushed the Mexican government to change course. Indeed, early reporting suggests U.S. intelligence helped make the operation a success.

warning that what she has already accomplished is just the first step in what is likely to be a long and bloody campaign:

Sheinbaum may have embarked on this more aggressive path only reluctantly, but she must now stay the course. It will probably be a complicated and bloody ride.

Although the U. S.’s provision of intelligence was prudent and the U. S. will benefit materially from a reduction in cartel activity in Mexico (and the U. S.!), we should take care to maintain a low profile in this “ride”. Not everything is about us and making it about us runs the risk of adding political risk to the material risks already involved, potentially derailing the campaign. Mexicans have a historically well-founded wariness of U. S. intervention in Mexican affairs.

Potentially, participation can have various escalating levels: quiet intelligence aid, taking credit, and actual operational participation. We should limit kinetic participation to activities on our side of the border. Doing otherwise invites nationalist backlash.

Mexico is a large, proud country, prosperous by world standards despite having many poor people in it. They don’t need us to fight their wars for them or want us to take credit for doing it. Take the win graciously.

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Do Professionals Have an Ethical Obligation to Use AI?

I recognized that I was likely to concur with Dr. Ashish K. Jha’s assessment of physicians’ use of LLM AI before I read his Washington Post op-ed:

The public is rightly wary about this new technology in health care. Its misuse can have serious consequences for patients, for example, by inappropriately denying care, hallucinating incorrect information or overlooking pertinent patient information. Clear guardrails and direct patient contact with medical professionals is crucial.

Still, for time-pressed doctors, a tool that both confirms judgments and broadens diagnostic thinking can be invaluable. When used properly, it can help combat the tunnel vision that often takes hold in busy clinics and hospitals.

The balance of his op-ed is devoted to his realization that AI makes him a better doctor as a consequence of his “experiment” with it. He goes on to describe three clinical cases in which he used AI and the benefits derived from it as well as its use in pedagogy. He concludes by recommending that future physicians be trained in using AI tools efficiently and effectively.

Not only do I concur with Dr. Jha’s conclusion, I would go one step farther. I think that professionals have an ethical obligation to use AI tools prudently, judiciously, and effectively for precisely the reasons Dr. Jha outlines: they make them better.

By definition a professional is a service provider who works for the public good and adheres to a code of ethics. Modern professional codes of ethics should require professionals to use AI. The AMA has published guidance for the ethical use of AI by physicians. It allows physicians to use AI and discusses issues like oversight, transparency, disclosure, and privacy and security but it does not quite go far enough—it treats AI as an option.

Given the choice, a professional should actively seek to be better than he or she already is. AI is a tool that can do just that. For physicians these tools can reduce error, broaden differential diagnosis, and mitigate cognitive bias. For those professionals it’s in the same class as evidence-based medicine, imaging, and sterile technique.

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Economic Power Is Hard Power, Too

There is something about financial columnist Matthew Lynn’s op-ed in the Washington Post that really struck me the wrong way. I think he’s missing something fundamental. Here’s the kernel of his piece, “China tried to buy the world. It failed.”:

China’s geopolitical ambitions have suffered a whole series of setbacks. The courts in Panama have ruled against Hong Kong’s CK Hutchison owning the ports at either side of the crucial canal through which at least 40 percent of U.S. shipping flows. Following the arrest of the Venezuelan dictator Nicolás Maduro its investment in the Latin American state looks far less valuable. Iran? You wouldn’t describe any investment in the country as rock-solid right now. Italy scaled down its agreements with China in 2023. The more than $23 billion it has pumped into Argentina probably won’t secure any special favors from President Javier Milei: He hates Marxists almost as much as he loves chainsaws. The list goes on and on. China has spent an estimated $1.5 trillion on its Belt and Road strategy, a huge sum of money for what is still basically a developing economy.

Let me try to investigate the problems I had with it.

I think Mr. Lynn misunderstands China. Labelling it “basically a developing economy” is misleading. It is the country with the 2nd largest GDP and an enormously large middle-income developing economy within the same geographic borders. That economic power enables China to do things no other developing country can.

Selective examples don’t prove a strategy failed. The Chinese Communist Party does not operate like a corporation with a board demanding return on equity. It allocates capital as a political instrument. Judging Belt and Road solely by commercial profitability misses the point.

The sheer size of that developed economy allows it to make mistakes impossible to other countries. The analogy is to wasteful infrastructure or other building projects. They do it because they can. Because the CCP’s objective function is political rather than strictly financial, it can absorb losses that would bankrupt a private actor. That does not mean every investment succeeds. It does mean that “unprofitable” is not the same thing as “failed.”

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