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The KHIT Blog
NOW REPORTING FROM BALTIMORE. An eclectic, iconoclastic, independent, private, non-commercial blog begun in 2010 in support of the federal Meaningful Use REC initiative, and Health IT and Heathcare improvement more broadly. Moving now toward important broader STEM and societal/ethics topics. Formerly known as "The REC Blog." Best viewed with Safari, FireFox, or Chrome. NOTES, the Adobe Flash plugin is no longer supported. Comments are moderated, thanks to trolls.
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Wednesday, December 24, 2025
Laurie Segall. An unexpected find.
Also, I've been recurrently riffing on "Artificial Intelligence" / Robotics stuff for a bit more than a decade.
A high school classmate and friend of mine just posted this on Facebook
After spending 178 days aboard the International Space Station, astronaut Ron Garan returned to Earth carrying something far heavier than space equipment or mission data. He returned with a transformed understanding of humanity itself.
From orbit, Earth doesn’t look like a collection of countries, borders, or competing interests. It appears as a single, radiant blue sphere suspended in darkness. No lines divide continents. No flags mark territory. From 250 miles above the surface, every human conflict suddenly looks small—and every human connection looks unavoidable.
Garan described watching lightning storms crackle across entire continents, auroras ripple like living curtains over the poles, and city lights glow softly against the planet’s night side. What struck him most wasn’t Earth’s power—it was its fragility. The atmosphere protecting all life appeared as a paper-thin blue halo, barely visible, yet responsible for everything that breathes, grows, and survives.
That view triggered what astronauts call the “overview effect”—a profound cognitive shift reported by many who see Earth from space. It’s the sudden realization that humanity shares a single, closed system. No backups. No escape route. No second home.
Garan began questioning humanity’s priorities. On Earth, economic growth is often treated as the ultimate goal. From space, that hierarchy collapses. He argues that the correct order should be planet first, society second, economy last—because without a healthy planet, neither society nor economy can exist.
He often compares Earth to a spacecraft. A ship carrying billions of crew members, all dependent on the same life-support systems. And yet, many behave as passengers rather than caretakers, assuming someone else is responsible for keeping things running.
From orbit, pollution has no nationality. Climate systems ignore borders. Environmental damage in one region ripples across the entire globe. The divisions we defend so fiercely on the ground simply don’t exist from above.
Garan’s message isn’t abstract or idealistic. It’s practical. If humanity continues to treat Earth as an unlimited resource rather than a shared system, the consequences will be universal.
Seeing Earth from space didn’t make him feel small. It made him feel accountable.
Because when you truly understand that we’re all riding the same fragile spacecraft through the universe, the idea of “us versus them” quietly disappears—replaced by a single, unavoidable truth:
There is only us.
Tuesday, December 23, 2025
The Golden Fleet for the Trump "Golden Age"
Imagine the CEO of a car company telling his engineers and designers that he wants them to make a new line of automobiles. He knows nothing about cars and has no interest in how they’re produced, but he knows one thing for certain: The line will be named after himself. Everyone claps—because of course they do—but no one really knows what comes next, except that the line needs to look sexy and sporty.
That’s pretty much what the president did today when he announced that a new class of ship named after one Donald J. Trump would be added to the “Golden Fleet,” his name for a renewed U.S. Navy. (You might wonder about the propriety of a sitting president naming naval vessels, among other things, after himself. Pardon the expression, but that ship has sailed.)
Trump’s press conference today was among his more haywire performances, and his slushy delivery and meandering answers will not halt speculation about his cognitive health. When asked for his endgame in the confrontation with Venezuela, for example, he launched into his usual lines about people being sent into the United States from prisons and mental hospitals, as if someone had hit the wrong button and played the wrong recording. He also reiterated that he wanted U.S. ships to be more attractive, noting that he would be involved in the design of the new vessels because “I am a very aesthetic person.”...
I taught military officers for more than two decades at the Naval War College. One thing I learned from conversations with my students was that the Navy really needs to invest more in its officers and sailors, and reduce the tempo of operations that are burning them out. The best ships in the world won’t mean much if their crews are fatigued and poorly trained. As the defense analyst John Ferrari recently wrote, for years, the Navy has been “structurally compromised” because its people are exhausted, its ships are “aging faster than they could be repaired,” and the fleet’s readiness is declining. These are serious problems that require serious work, but Trump has found a way around all of this irritating chatter by sticking his name on a new ship and telling the military to go build it.
At Mar-a-Lago today, Trump reiterated his demand that Greenland must become part of the United States. His plan for a fleet of Trump-branded battleships is only slightly more likely to happen than a victory parade in Nuuk—and neither is in the national interest of the United States.
—Tom Nichols PhD, US Naval War College faculty, retired
Sunday, December 21, 2025
Friday, December 19, 2025
Jacob Ward on our rapidly expanding post-truth era
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| Click here |
My 1998 grad thesis comprised an exhaustive examination of incoherent suspicionless workplace drug testing policies. Much of the policy idiocy remains in place, legalization initiatives notwithstanding.
Wednesday, December 17, 2025
Tuesday, December 16, 2025
Important Announcement to the nation from the 2025 FIFA Peace Prize Awardee:
Venezuela is completely surrounded by the largest Armada ever assembled in the History of South America. It will only get bigger, and the shock to them will be like nothing they have ever seen before — Until such time as they return to the United States of America all of the Oil, Land, and other Assets that they previously stole from us. The illegitimate Maduro Regime is using Oil from these stolen Oil Fields to finance themselves, Drug Terrorism, Human Trafficking, Murder, and Kidnapping. For the theft of our Assets, and many other reasons, including Terrorism, Drug Smuggling, and Human Trafficking, the Venezuelan Regime has been designated a FOREIGN TERRORIST ORGANIZATION. Therefore, today, I am ordering A TOTAL AND COMPLETE BLOCKADE OF ALL SANCTIONED OIL TANKERS going into, and out of, Venezuela. The Illegal Aliens and Criminals that the Maduro Regime has sent into the United States during the weak and inept Biden Administration, are being returned to Venezuela at a rapid pace. America will not allow Criminals, Terrorists, or other Countries, to rob, threaten, or harm our Nation and, likewise, will not allow a Hostile Regime to take our Oil, Land, or any other Assets, all of which must be returned to the United States, IMMEDIATELY. Thank you for your attention to this matter!
PRESIDENT OF THE UNITED STATES OF AMERICA
Monday, December 15, 2025
Saturday, December 13, 2025
"Everybody" loses?
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| The New Yorker |
Having swallowed sports media, will gambling now devour other kinds of news? Last week, CNN announced a deal with Kalshi, a federally regulated online exchange where Americans can wager on current events, from basketball games and congressional elections to whether it will rain tomorrow in New York City. This marked Kalshi’s first partnership with a major news organization and, according to several close observers of the media business and gambling industry, could foreshadow a deluge of similar deals. After all, a decade ago, many outlets refused to even mention sports-betting odds. Then, in a blink, the shilling became inescapable.Gambling has been creeping into political coverage for a while. Prediction markets, as sites like Kalshi are called, use odds that can also be interpreted as probabilities, and, because those odds reflect the distilled wisdom of everyone willing to put skin in the game, they have the allure of a crystal ball. A prediction market associated with the magazine Le Point, for example, has anticipated the results of the past two French Presidential elections more accurately than top polling firms. It’s now routine for American journalists, when assessing the state of a political race, to cite betting odds as a counterpoint to polls. Shortly after unveiling its partnership with Kalshi, however, CNN seemed willing to integrate gambling to a far more jarring degree...The people behind prediction markets can be even more callous, while also offering even more opportunities to bet. (Last month, Mansour, the C.E.O. of Kalshi, said that the “long-term vision” for the company “is to financialize everything and create a tradable asset out of any difference in opinion.”) At a gaming conference in July, Josh Sterling, an attorney for Kalshi, was asked if regulators should enforce more consumer protections. “People are adults,” he answered, “and they’re allowed to spend their money however they want it, and if they lose their shirt, that’s on them.”
Inside America’s preventable sports-gambling debacleIn 2018, the United States Supreme Court opened the floodgates for states to legalize betting on sports. Eager for revenue, almost forty states have done so. The result is the explosive growth of an industry dominated by companies like FanDuel and DraftKings. One out of every five American adults gambled on sports in 2023, amounting to $121 billion, more than they spent on movies and video games combined.
The rise of online sports gambling—the immediacy of betting with your phone, the ability of the companies to target users, the dynamic pricing and offers based on how good or bad of a gambler you are—has produced a public health crisis marked by addiction and far too many people, particularly young men, gambling more than they can afford to lose. Under intense lobbying from the gaming industry, states have created a system built around profit for sportsbooks, not the well-being of players.
In Losing Big, historian Jonathan D. Cohen lays out the astonishing emergence of online sports gambling, from sportsbook executives drafting legislation to an addicted gambler confessing their $300,000 losses. Sports gambling is here to stay, and the stakes could not be higher. Losing Big explains how this brewing crisis came to be, and how it can be addressed before new generations get hooked.
Rapidly spreading far beyond sports.
Stay tuned...
Friday, December 12, 2025
Thursday, December 11, 2025
We in the U.S. just want health care "PLANS," not actual health care, I guess
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| Sept 2012 |
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| December 2025 |
UNLV EPS 701 Fall 1994, Argument Analysis Paper (pdf)
A Better Quality Alternative:
Single-Payer National Health System Reform
Gordon D. Schiff, MD, Andrew M. Bindman, MD, Troyen A. Brennan, MD, JD, MPH;
Physicians for a National Health Program Quality of Care Working Group.
JAMA, September 14, 1994—VoL 272, No. 10
Argument synopsis:
Notwithstanding public misgivings about making significant public policy driven changes in the U.S. health care industry, there is extensive and persuasive empirical evidence of costly inadequacies in the system—such as lack of access/coverage, uneven levels of quality of service and outcomes, market-driven rather clinical priorities, waste and duplication, etc.—that can best be corrected by a unified approach to improvement driven by a scientific focus on quality issues (broadly defined) rather than those of short-term cost-control, competition, and piecemeal regulatory strategies and tactics. A single-payer health care system reformed by implementation of the ten principles detailed herein would at once extend medical access to all, reduce costs, improve clinical outcomes of the sick and injured, and elevate the overall health status of the nation, resulting in win-win consequences for providers and citizens alike.
Overall Evaluation:
The following alternative courses of action are generally advanced in the health care debate:No one can dispute that the health care industry can be improved. Any system an be improved. Problems such as lack of access, arbitrary and often wildly excessive pricing, inexplicable variations in clinical practice and outcomes are well-documented and cry out for solution. That tends to rule out option 1. The question is one of extent: has the case been made that the health care industry requires comprehensive national reform?
- Status quo: the system works fine, and normal incremental quality improvements at the provider level will suffice. Get a job.
- Insurance reform: prohibit exclusion and enforce community rating to reduce the insurance premium stratification characteristic of the present system.
- Expand existing public payer programs such as Medicare to cover the working poor and otherwise uninsurable.
- Capitated managed competition, with "employer mandates" to provide choices in beneficiary alliances for pooled coverage bry*g power, administered though the workplace.
- Tax inducement programs such as the "Medi-save" approach in which workers use pre-tax dollars to purchase catastrophic coverage and pay for routine health expenses themselves.
- The public single-payer system based more or less on the Canadian model.
In sum, the authors' argument has many strengths, particularly in their exhaustively documented enumeration of the shortcomings of our present health care system—to the extent to which it can be characterized as a "system." There is, however, a plausible alternative to a public national single payer system that would meet many of the goals sought by these advocates, and it is not a theoretical one. Utah's IHC (Intermountain Health Care) organization is a private, vertically-integrated health care corporation serving Utah and western Wyoming residents. It is a large for-profit network of hospitals, clinics, physicians, and related operations such as home health services. IHC is essentially a managed-care system with subscribers who pay set fees and minimal co-payments. Unlike other HMO-type operations in the state that typically experience subscriber turnover rates of approximately 15% per year, IHC’s turnover rate is less than 0.5% (that's 0.005), at competitive prices. They accomplish this by an organization-wide, enthusiastic, almost religious commitment to the very CQI principles outlined above. IHC quality improvement programs are directed byDr. Brent James, a surgeon and nationally respected leader in health care CQI education. Having myself undergone their health care CQI training course over the period of the past six months as a part of my work, I can attest that IHC, while not yet perfect, effectively applies nearly all of the recommendations cited in this article, albeit on a smaller scale (and that may indeed be a significant virtue). They are in essence a microcosmic single-payer system, but one successful in the private sector, driven not by publicly imposed mandates, but by their own thorough knowledge of and dedication to CQL IT is difficult to see at this point whether the asserted advantages of a national public system would add net value beyond the type of operation that IHC represents.
To be fair, IHC operating in a fairly prosperous, culturally homogeneous region enjoying a great deal of social and political unity. Here in Nevada, by contrast, though we share a common border and similar population size and geography with Utah, the social milieu could not be more different. IHC might not encounter the same level of success in other regions, and their successes do not impact those who cannot obtain coverage-and a central issue of this article has been about the significant negative impact of such a deficit. The IHC example does, however, stand in stark relief to both the inadequate business-as-usual attitude, and the proposition advanced above that a national single-payer system is the best path to effective health care reform. other examples exist around the nation also; one that comes to mind is Northwest Hospital in Seattle whose presentation at the Annual Quality Congress of the American Society for Quality Control this year revealed yet another organization deriving significant cost savings and quality improvement from diligent application of CQI methods.
Rule Number One of CQI is "listen to the customer," and thus far the customers are prohibitively wary of the idea of creating a huge new national program, a political reality that is unlikely to shift anytime soon. The argument presented by Schiff et al takes into account an enormous amount of evidence and theory generated from within health care and the wider quality sciences, but serious questions remain unresolved with respect to the needs and concerns of health care consumers, whose overwhelming support would be needed to implement a single-payer health care system.
Wednesday, December 10, 2025
Easy Money + Gilded Rage = Stealing the Future
I spent almost every weekday in October of 2023 in a courtroom in Lower Manhattan, listening to experts, lawyers, and first-hand witnesses recount the collapse of the FTX cryptocurrency exchange and prove Sam Bankman-Fried’s responsibility for it to a jury.But while this book recounts Bankman-Fried’s crimes in detail, it is ultimately focused on his ideas. Bankman-Fried, for a time known affectionately as “SBF,” was deeply tied to concepts and movements with names like Effective Altruism, determinism, utilitarianism, extinction risk, Rationalism, and longtermism.These buzzwords have been developed into increasingly formal systems by professional philosophers and ethicists at elite universities, and further amplified through a network of institutions well-funded by technology billionaires. But they stand for much deeper, much older structures of thought: a historical teleology that I here call “techno-utopianism.”The superficial optimism of Effective Altruism was fundamental to the public fascination with Bankman-Fried that helped fuel his lightning-fast ascent. But its deeper biases — to which he was perhaps uniquely vulnerable — also helped Bankman-Fried rationalize his crimes, and its superficial logics created the blind spots that led to his downfall.This book is not a work of journalism, but of forensic philosophy. It asks how techno-utopian ideas, so loudly declaring their intent to do good, instead led to one of the largest financial frauds in American history — and whether their broader sway in twenty-first-century politics and society may lead to similar results, on a much larger scale.
Morris, David. Stealing The Future: Sam Bankman-Fried, Elite Fraud, and the Cult of Techno-Utopia (pp. 8-9). (Function). Kindle Edition.
I am a law professor at Stanford, where I have taught for close to forty years. Before that, I was a practicing lawyer in New York and clerked on the Second Circuit Court of Appeals. I am also Sam Bankman-Fried’s mother. Because of my professional life, I have witnessed the events of the past three years through two very different sets of eyes. Someday I may write about what it has been like to live through this experience as a parent. Today I write as a lawyer, about the government’s legal case against Sam and the other FTX defendants. I would have much preferred to leave this task to others. But the spectacle that has surrounded the FTX case since day one has not been conducive to serious, independent thought or attention to facts. It has also imposed a very high cost on anyone who publicly expressed doubts about whether justice has been done in this case. I hope this will change in time, and others will come forward to supplement or amend what I have written here. Most of what I say below is documented in the trial transcript and public records posted on the official court docket. I have provided cites for those who would like to follow up on their own…
























