There’s an interesting piece from the Mayo Clinic Press editors on artificial intelligence in a healthcare setting. Here’s a snippet:

A report from the National Academy of Medicine identified three potential benefits of AI in healthcare: improving outcomes for both patients and clinical teams, lowering healthcare costs, and benefitting population health.

From preventive screenings to diagnosis and treatment, AI is being used throughout the continuum of care today.

I think they’re just scratching the surface. I saw artificial intelligence (mostly pattern recognition rather than generative AI) being used in remarkable ways in radiology several years back. One of the factors I don’t believe they’ve come to terms with yet is that GAI has implications for how good physicians will be selected and trained.

Carl Thayer’s assessment at The Diplomat of the situation in the South China Sea is somewhat disquieting. After detailing the situation with respect to China and the Philippines and China and Vietnam, he concludes:

Major developments in the South China Sea in 2024 do not augur well for 2025. China will remain committed to asserting its sovereignty over land features and adjacent waters that lie within the Philippines’ Exclusive Economic Zone, and the PLAN and CCG continue to expand in numbers. China will continue to pressure the Philippines to convince it that resistance is futile because the Trump administration will be a fickle ally and the Philippines lacks the capacity to stand alone against China.

The Philippines will have to weather the uncertainty of the U.S. commitment to the Mutual Defense Treaty now that President Donald Trump has taken office. Pete Hegseth, Trump’s secretary of defense, admitted he didn’t know which countries were members of ASEAN when questioned at his confirmation hearing. When Hegseth tried to make up for this lapse by noting he knew the U.S. had alliances with Japan, South Korea and Australia, he failed to mention the Philippines. Also, Marcos was not invited to Trump’s inauguration (while Xi Jinping was, although he sent China’s vice president in his stead).

Vietnam will continue to build infrastructure on its land features in the Spratly islands. It is unclear, however, if Vietnam will construct more air strips and militarize these features. This could provoke China into ending its “softly, softly” approach.

Malaysia has replaced Laos as ASEAN chair and this has given rise to guarded optimism that progress can be made on the South China Sea Code of Conduct in 2025. China can be expected to press for a quick conclusion to negotiations on the Code of Conduct with ASEAN members as one means of undermining a U.S. security role in maritime affairs.

I think this is a situation to which the United States needs to accustom itself. It is not a hegemon. It does not possess overwhelming force. Other countries including China do, in fact, have interests and will pursue them.

In the kerfuffle over Donald Trump’s executive order on birthright citizenship there have been quite some number of opinion pieces and articles forthcoming. One of those I found worthwhile was this this one by Michael Anton at The American Mind. What I found particularly interesting were his citations of the discussion around the 14th Amendment. Here’s one I found particularly interesting sine it illustrates that its authors understood the risks they were introducing:

There is nothing whatsoever in the debate that explicitly states, implies, or contextually suggests that the framers of the 14th Amendment meant to grant birthright citizenship to the children of illegal immigrants. They don’t talk about illegal immigration much because on that question, there was no need for debate. The children of persons “subject to any foreign power,” “owing allegiance to anybody else” were—all agreed and the law already declared—not citizens.

When they do talk about immigration—particularly Senator Cowan—they express concern that the amendment be carefully drafted so as not to allow or provoke unchecked immigration by offering too broad a definition of citizenship. (As an aside, I note that Senator Cowen’s long speech is quite triggering to our ears in 2018. It’s amusing to be called “racist” by people whose arguments rest on the views of men whose words I blush to read.)

One of the aspects of our situation today which most commentators miss is that we are facing unprecedented circumstances today. With 15% immigrant population and rising we have the highest immigrant population in the nation’s history. Furthermore, that so large a proportion of our immigrant population comes from a single country, that country shares a land border with the United States, people from that country think of large areas of the U. S. to rightfully belong to their country of origin, a high percentage of those who come here never seek citizenship, and they continue to participate in their country of origin’s politics provides challenges that are unique to our present situation.

At the Civitas Institute Richard Epstein argues that the case for birthright citizenship is not quite as opened and shut as some are claiming. Basically, his argument is that the case law is scant, United States v. Wong Kim Ark only addresses the citizenship of permanent legal residents not temporary or illegal residents, and that the 14th Amendment’s history does not support the interpretation that those claiming unambiguous birthright citizenship for all born in the U. S. regardless of status or permanence make.

I presume this case will ultimately make it to the Supreme Court and I have no idea what the Court will find. My intuition is that the case for the children for temporary residents is different than that for permanent residents.

A counterpoint to Mr. Goldman’s piece on China is Karl Zinsmeister’s op-ed in the Wall Street Journal, “American Society Was Built for Populism, Not Elitism”. I agree with much but not all of what he has to say:

Political, economic and cultural power have become concentrated in recent decades. Public-health officials, activists, tech executives and others press everyday Americans to let “experts” and “authorities” control decisions that affect all of society. Technology allows unprecedented monitoring and steering of civilians’ actions.

Throughout U.S. history there have been periodic backlashes against potentates attempting to hoard influence. In 1968 presidential candidate George Wallace said Americans were fed up with “pseudointellectuals lording over them . . . telling them they have not got sense enough to know what is best for their children.” This won Wallace nearly 10 million votes and shocked grandees of the Boston-Washington corridor who thought they had foreclosed arguments over who should run America.

Ronald Reagan recognized that Americans were chafing against intellectual authoritarianism. His administration collected mounds of evidence that bureaucratic central planning was having disastrous results. He pumped the brakes on impositions from Washington and discredited its manipulations of economy and culture.

Reaganism proved most effective as an economic force. Its cultural victories were rarer and didn’t last. A monolith of liberal activists, judges, educators, entertainers and media continued to overshadow our public square. The range of “acceptable” worldviews narrowed dramatically from 1988 to 2024.

Read the whole thing.

Where I disagree with Mr. Zinsmeister is that I think that the United States since its very inception has been a paradoxical combination of plutocracy and populist state. They are in tension, uncomfortable equilibrium with one another. And in every country whether China or the United States, every government at every level once it has reached a size above that of a neighborhood association is necessarily a bureaucracy and the behavior of bureaucracies is well-known. Bureaucracies don’t accomplish things; they grow.

Our system, too, has certain strengths and weaknesses. We should ignore those who long for the United States to be China or France or Germany or Denmark and deal with the United States as it is.

David Goldman has an introduction to China “as it is” at Law & Liberty I found interesting. I agree with his observations materially. The TL;DR version is that by virtue of the Chinese language family, the orthography developed to express it, and history China is a natural technocracy. Those are my words not Mr. Goldman’s.

Since the introduction of the imperial examination 2,500 years ago and its modern successor, the Gaokao, the university entrance examination, China has been selecting the experts who will run the country. Here’s a snippet from Mr. Goldman’s piece:

Ambition is the glue that holds the polyglot, ethnically mixed Chinese empire. Napoleon invented the modern mass citizen army, saying that each of his soldiers kept a field marshal’s baton in his rucksack. That is, he awoke the ambition of the downtrodden peasants of France and made them into a force that crushed the professional armies of the European monarchs. The Chinese are more practical than the French. Every Chinese person carries flash cards for the Gaokao, China’s formidable university entrance examination taken by 13.4 million Chinese in 2024. The United States has just 3.8 million graduating high school seniors; I doubt that 5 percent of them could pass the Gaokao. China is a ruthless meritocracy. Top officials and billionaires can buy admission to Harvard for their children, but not to Peking University. For well over two thousand years, academic achievement has been the path to success for the Chinese. It should be no surprise that China now graduates more engineers than the rest of the world combined.

Chinese people are not as too many an American is struggling to get out imagine, “Americana is struggling to get out”. China’s emergent system has strengths and weaknesses. We must deal with China as it is not as we might imagine it to be.

The fires continue to burn in Los Angeles. At this point the number of acres that have burned is 55,000 and nearly 16,000 structures have been destroyed. The editors of the Wall Street Journal, less delicate in their sensibilities than I, urge that some “sensible strings” be attached to the aid given by the federal government to California:

President Trump visits California on Friday to survey the wildfire damage, and no doubt he’ll hear requests for federal aid. A relevant question is whether this aid should be conditioned on policies that will reduce future damage.

Democrats want a blank check, and they’re comparing the fires to hurricanes. The fires are horrific and the damage in property and lives enormous. But the fire damage is worse than it would have been if not for the policy mistakes in Los Angeles and Sacramento on water and forest management.

Washington has in the past tied aid to financially troubled cities and Puerto Rico. New York state established a financial control board to impose fiscal reforms on a city that couldn’t muster the political nerve to make changes without outside pressure. The California fires are both a natural and man-made disaster, but California’s political leaders seem incapable of reform. What then should Congress and the Trump Administration ask for?

I continue to think it is ghoulish to dwell on this while the fires are still raging, as they are. I want to limit my remarks to one point.

Wildfires are part of Southern California’s natural ecology. So are mudslides. They cannot be prevented only mitigated and coped with. It may be that global climate change has exacerbated that problem. I don’t know. Certainly local climate change is a contributing factor. But so are poor land management and inadequate infrastructure.

I certainly hope that the federal government can, in a way consistent with sympathy for the suffering of the poor people in Southern California who’ve lost everything, gently nudge California in the direction of practices better than those that prevailed on January 1, 2025.

When St. Louis experience the fire of 1849, it caused the city to ban wood frame houses, required buildings to be built of brick or stone, and motivated them to improve the sewer and water systems. After Chicago went through the fire of 1871 Chicagoans received aid from St. Louis, New York, Cincinnati, Cleveland, Buffalo, and as far away as London and Scotland rather than the federal government. The experts who advised Chicago on new building codes were insurance companies rather than federal bureaucrats. It, too, updated its building codes. I expect something of the sort will happen in Los Angeles and I hope that the city is encouraged in that direction by state and federal governments.

As my wife says, “You can lead a horse to water but that won’t make him into a duck.” There’s a tragicomic quality to Joseph Sternberg’s advice to European leaders in the Wall Street Journal:

Not to jinx it, but Donald Trump’s second term is off to a good start—for Europe. Mr. Trump already has created enormous political and economic opportunities for the Continent if, and this is a huge if, any European politicians have the wit to seize their chance.

Amid the blizzard of executive orders and other actions that began on Monday, four matters are of particular relevance across the Atlantic. The Trump administration is withdrawing from the 2015 Paris Agreement on climate, scrapping Biden-era electric-vehicle mandates, ramping up American fossil-fuel production, and killing off a global corporate-tax agreement.

The first instinct of establishment European politicians and their media enablers is to interpret these steps as affronts to Europe. Which they are. Mr. Trump’s abandonment of the decade-old global climate agreement is as strong a signal as Washington can send that the new administration doesn’t care about an issue that Europeans have come to understand in quasireligious terms. All the promised drilling, and new internal-combustion cars, adds insult to this injury. Withdrawal from the major tax deal negotiated at the Organization for Economic Cooperation and Development demonstrates that the new administration is indifferent to European governments’ desperate search for new revenue sources.

Note, however, that Mr. Trump at least isn’t perpetuating the far bigger affront President Biden committed against our European friends: lying to them.

and concludes:

Europe can’t afford its climate commitments, whether the cost is measured in subsidies disbursed by cash-strapped governments or economic growth forgone. Yet European voters remain stubbornly committed to the policy goal for which they no longer want to pay. Mr. Trump is offering an off-ramp for politicians struggling to manage this cognitive dissonance. Expect Europe’s reversals on climate policy to be presented—more in sorrow than in anger, mind you—as unavoidable results of the economic pressures arising from America’s own climate-policy shift.

Likewise with the tax pact, which was intended to forestall precisely the sorts of tax reforms European countries need to help revive their flailing economies. By pulling the U.S. out of this attempt at global tax harmonization, Mr. Trump restores tax policy—and, specifically, tax competition—as a lever available to European politicians grasping for new economic-growth strategies.

Those are the sticks, and there are carrots too. An effect of the end of electric-vehicle mandates in America is that the world’s largest economy has again become an enormous market for the internal-combustion autos European companies can manufacture profitably. This is a lifeline to German automakers in particular, even after accounting for the threat of Trump tariffs on Mexico, where many European firms now manufacture cars. Meanwhile, the single most beneficial thing anyone could do for Europe right now would be to revive American energy production, which would boost U.S. economic growth and offer knock-on benefits in global energy markets. And behold, it’s happening.

Europeans may never learn to love Mr. Trump, but if they’re smart, they’ll learn to take “yes” for an answer when he offers it.

I need to remind Mr. Sternberg of German Foreign Minister Joschka Fischer’s observation to the effect that European politicians know what needs to be done, they just don’t know how they’ll keep their jobs if they do it. They can’t reverse course without confessing they’ve been pushing the continent in the wrong direction for twenty years and they can’t do that without acknowledging they’ve been wrong. So they won’t.

It will be up to some other group of European leaders which is why there’s so much ferment in Europe right now.

In a piece at The Next American Century Richard Vigilante makes the counterintuitive to me argument that the new Department of Government Efficiency (DOGE) can, indeed, cut $2 trillion from the federal budget:

DOGE should function not by cutting spending to save money, but by cutting spending to improve performance.

It’s not hard. Eliminate any agency that does not, on net, make more of the thing for which it is named.

That is followed by a list of departments that, per Mr. Vigilante, fail to make the grade: Energy, Education, Agriculture, HUD, Commerce, Homeland Security, HHS, etc. The small problem with Mr. Vigilante’s rubric is that each of these departments has its own empowering legislation which would need to be repealed and/or modified and constituency which would oppose eliminating their favored programs.

I hasten to point out that Ronald Reagan who actually won a landslide victory and ran on eliminating specific departments did not eliminate a single department.