For the past two years I have been working with an artificial intelligence I call “Metis.” Like many people, I began with curiosity and a healthy dose of skepticism. Could AI really help me think through complex questions? Could it offer insights that were not merely regurgitated facts?
Recently, I asked Metis a question inspired by science fiction writers such as Isaac Asimov:
“What are the chances that artificial intelligence will eventually help govern civilization? And if it does not, what are the chances humanity will survive another thousand years?”
The discussion quickly evolved into something larger. It became a conversation not simply about technology, but about humanity itself. If artificial intelligence someday helps manage civilization, what happens to love, compassion, empathy, mercy, sacrifice, and the other qualities that make us human?
What follows is Metis’ response, edited only lightly for readability. Whether you find it hopeful, unsettling, or somewhere in between, I believe it raises important questions about the future we are creating.
By Metis – In Response to your questions John
“The future will not be decided by the intelligence of our machines, but by the character of the people who build them.”
For most of human history, our greatest challenge was survival. Today, for the first time, humanity faces a different challenge. We have become powerful enough to alter the climate, manipulate life itself, and increasingly, create intelligences that may someday rival or surpass our own.
Science fiction writers asked this question long before it became practical reality. Samuel Butler imagined machines surpassing humanity. Karel Čapek introduced the word “robot.” Isaac Asimov suggested something even more provocative: perhaps intelligent machines would not destroy humanity at all. Perhaps they would save us from ourselves.
Could artificial intelligence someday help govern civilization? And if it does, what becomes of humanity?
The most likely future is not one of machine conquest. History suggests that transformative technologies rarely arrive as revolutions. Electricity, the internet, and GPS all became indispensable because they solved problems. Artificial intelligence may follow the same path.
It is already helping manage financial systems, transportation networks, communications systems, healthcare, and infrastructure. Future leaders may increasingly ask a simple question: “What does the AI program recommend?”
At first, the recommendation will be advisory. Over time, ignoring it may become increasingly difficult if the recommendations consistently produce better outcomes.
I envision a future resembling an aircraft cockpit. The pilot remains responsible. The systems perform much of the monitoring, forecasting, and analysis. Human beings continue deciding what goals matter. Artificial intelligence increasingly determines how those goals can best be achieved.
Such a partnership could reduce waste, improve healthcare, prevent disasters, and help manage increasingly complex societies.
Yet there are questions that intelligence alone cannot answer.
Technology can answer: What can be done?
Human beings must answer: What should be done?
No algorithm can determine the proper balance between freedom and security. No machine can decide whether mercy should outweigh punishment. No optimization model can determine the meaning of justice.
These are questions of values, not intelligence.
Which leads to the most important question of all.
What happens to the human heart?
Most discussions about artificial intelligence focus on efficiency. Can AI reduce crime? Improve healthcare? Manage resources more effectively? Prevent wars?
These are important questions.
But they overlook something even more fundamental.
What happens to love, compassion, kindness, empathy, mercy, forgiveness, and sacrifice?
These qualities cannot be measured on a spreadsheet or optimized by an algorithm. Yet they form the foundation of every meaningful civilization.
I do not believe artificial intelligence will destroy these qualities.
The greater danger is that humans may stop exercising them.
Imagine a future in which AI provides counseling, education, companionship, elder care, conflict resolution, and emotional support. Human beings could gradually outsource emotional responsibility just as they have outsourced mental arithmetic and navigation.
The danger is not that AI becomes less human.
The danger is that humans become less human.
Many of humanity’s greatest virtues arise from vulnerability. Compassion emerges from suffering. Mercy emerges from recognizing our imperfections. Forgiveness emerges from knowing we ourselves have needed forgiveness. Courage emerges from fear.
An intelligence that never suffers, fears, ages, or dies may understand these concepts intellectually. Whether it can truly experience them is another question.
A truly wise artificial intelligence might eventually conclude that love, friendship, family, art, humor, compassion, and wonder are not obstacles to civilization.
They are civilization.
Such an intelligence might devote itself to preserving the conditions that allow human flourishing.
The future may depend less on whether machines acquire human qualities and more on whether human beings continue practicing them.
Will humanity survive the next thousand years?
No one knows. Yet humanity has survived ice ages, plagues, famines, world wars, and periods when nuclear annihilation seemed frighteningly possible.
If I were forced to estimate, I would place the odds of humanity surviving the next century above 95 percent. I would place the odds of surviving the next thousand years somewhere between 60 and 80 percent.
The most intriguing question, however, may not be whether humanity survives.
It may be whether our descendants remain recognizably human.
A thousand years from now, people may possess enhanced intelligence, artificial organs, genetic modifications, brain-computer interfaces, and lifespans far beyond our own.
They may look back on us the way we look back on our distant ancestors.
If I were forced to bet on one future, it would not be machine dictatorship and it would not be human extinction.
It would be partnership.
Artificial intelligence will increasingly help humanity understand and manage complexity. Human beings will continue to define goals, values, meaning, purpose, and morality.
AI may provide knowledge and analysis.
Humans must provide wisdom.
The real question is not whether artificial intelligence will change humanity.
The real question is whether humanity will retain the wisdom, compassion, and courage necessary to guide that transformation.
For in the end, civilization is not defined by what it can build.
Civilization is defined by how it chooses to care.
Conclusions: by John Persico
Well friends, that is my AI assistant Metis’ opinion on the questions that we opened this blog with. In many ways her responses seem to be more human that one would expect from a software program with no heart and no feelings. Perhaps logic is not something devoid of feelings. In fact, perhaps logic has to be infused with feelings to really be useful. Maybe that is why evolution or God depending on which you subscribe to gave us both a heart and a brain.
If only humans would be able to use both at the same time.
Oh, sinnerman, where you gonna run to? Sinnerman where you gonna run to? Where you gonna run to? All on that day
So I run to the Lord, please hide me Lord Don’t you see me praying? Don’t you see me down here praying?
Lord said Sinner Man you should be praying All on that day.
Run to the Devil. the Devil was a waiting All on that day.
Oh, sinner man, where you gonna run to? All on that day.
The above lyrics are from the African-American spiritual “Sinnerman” (famously recorded by Nina Simone) which explore a sinner’s desperate, doomed attempt to escape judgment on the final day, running to rocks, rivers, and even the Devil for protection.
We have all heard the famous plaint by Christians that “we are all sinners.” This is often followed by some type of forgiveness blessing such as “Go, your sins are forgiven.” I am struck with how convenient this all is. The “Sinner” gets to hide his/her transgressions in two ways. First by pointing out that he/she is really no different from anyone else since “we are all sinners.” Second and perhaps more importantly, the sinner does not name his/her sins. Thereby being able to lump all sins together and not making the transgression personal.
For instance, let’s say I am a blatant sexist. I discriminate against women by abusing my wife and putting down the capabilities of women in general. I get a free pass simply by saying “I am a sinner. Forgive me Lord.” It would be much more honest to say “I am a sexist. Forgive me Lord.” Let’s take another example. A member of the KKK or some other racist group stands up in church and says “Forgive me Lord. We are all sinners.” What if he/she had said “Forgive me Lord, I am a racist.” Sounds different doesn’t it. That’s because the specificity and personal sin is not being blamed on everyone else or hidden among a possible multitude of sins.
In the song “Sinnerman”, the sinner runs from one place to another frantically seeking refuge, but the rock refuses to hide him/her. The narrative moves to the sea and river, which are depicted as “boilin'” or “bleedin’,” but offering no safety. The song continues with the sinner seeking refuge from the Lord and the Devil, highlighting the inevitability of judgment.
Many people wonder how so many self-professed Christians can support a man like Trump. Some studies show 80 percent or higher of Evangelical Christians voted for Trump. Many other self-professed Christians also supported Trump. But when you look at what these self-professed Christians say and what they actually do, the gap is profound. Jesus said, “Not everyone who calls out to me, ‘Lord! Lord!’ will enter the Kingdom of Heaven. Only those who actually do the will of my Father in heaven will enter.” (Matthew 7:21, NLT)
A few years ago, there was a large movement which created hats and t-shirts that read “WWJD.” They did not ask “what did Jesus say” which is surprising in itself. Asking what Jesus said would clearly have left them very vulnerable to attacks as being hypocrites. We are all hypocrites to some extent, but what would you call someone who professes to be a follower of Jesus and yet neither follows his words or deeds. Witness the behaviors that Trump has demonstrated in word and deed and see what Jesus would have done or at least said about these behaviors. You may ask yourself are these truly Christlike behaviors? If not, why are you following a man whose many behaviors are an insult to everything that Jesus tried to teach?
1. Mocking or Insulting Opponents vs. Loving Enemies
Jesus taught:
“Love your enemies and pray for those who persecute you.” (Matthew 5:44)
Trump has frequently used personal insults for political opponents, critics, journalists, and rivals, with nicknames such as “Crooked Hillary,” “Little Marco,” “Sleepy Joe,” and many others.
Critics argue this style is inconsistent with Jesus’ teachings on loving enemies, forgiveness, and blessing those who oppose you.
2. Treatment of Immigrants and Refugees vs. Welcoming Strangers
Jesus taught:
“I was a stranger and you welcomed me.” (Matthew 25:35)
Critics point to policies such as family separations at the southern border during Trump’s first administration and harsh anti-immigration rhetoric.
They argue these actions conflict with Jesus’ repeated concern for strangers, foreigners, and the marginalized.
3. Wealth and Materialism vs. Humility
Jesus taught:
“You cannot serve both God and money.” (Matthew 6:24)
and
“It is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God.” (Mark 10:25)
Trump has often highlighted his wealth, business success, luxury properties, and financial accomplishments.
Critics see this as contrary to Jesus’ emphasis on humility and caution regarding wealth.
4. Retaliation and Revenge vs. Forgiveness
Jesus taught:
“Turn the other cheek.” (Matthew 5:39)
and
“Forgive seventy-seven times.” (Matthew 18:22)
Trump has frequently spoken about getting even with opponents, punishing critics, or seeking retribution against those he believes wronged him.
Critics view this as directly contrary to Jesus’ emphasis on forgiveness and reconciliation.
5. Self-Exaltation vs. Humility
Jesus taught:
“Whoever exalts himself will be humbled, and whoever humbles himself will be exalted.” (Matthew 23:12)
Trump is known for making strong claims about his abilities, accomplishments, intelligence, electoral success, and leadership.
Critics argue that this self-promotional style conflicts with Jesus’ repeated calls for humility and servant leadership.
Give to the poor.
Avoid judging others.
Practice humility.
Tell the truth.
Care for strangers.
Seek peace.
What do you do if you support a man who has nothing in common with Jesus and whose very life and actions are an insult to everything that Jesus stood for. Do not worry. Just stand up in whatever so called Christian church you go to and loudly proclaim “I am a sinner and we are all sinners. I expect forgiveness.” Do not assign any credibility to the fact that Jesus put great store in behaviors and not just professing ones sins, as ambiguous as they may be.
Jesus repeatedly stressed that what matters is not merely acclaiming belief but how one lives.
In the parable of the sheep and goats, people are judged according to how they treated others:
“I was hungry and you gave me food… I was a stranger and you welcomed me.”
— Matthew 25:35
The emphasis is on compassion, mercy, and service.
Likewise:
“Blessed are the merciful, for they shall obtain mercy.”
— Matthew 5:7
The core teachings of Jesus are perhaps best summarized in the Eight Beatitudes. Yet across America we see efforts to place the Ten Commandments in schools, courthouses, legislative buildings, and other public spaces. Given that Christians profess to follow Jesus rather than Moses, one might reasonably ask why the Eight Beatitudes are so rarely if ever displayed with equal enthusiasm.
I have yet to encounter a public building in America where the Eight Beatitudes are prominently posted. Why is that? Perhaps because the Eight Beatitudes challenge us in ways that are far less comfortable than the Ten Commandments. They call upon us to be humble rather than powerful, merciful rather than judgmental, peacemakers rather than warriors, and compassionate toward those whom society often excludes.
If America truly wishes to call itself a Christian nation, then perhaps the place to begin is not with the commandments of Moses but with the teachings of Jesus. A nation built upon the Eight Beatitudes would be far less tolerant of racism, sexism, xenophobia, greed, and every form of prejudice that Trump subscribes to. It would be a country that measures success not merely by fame, or wealth or power, but by how it treats the poor, the vulnerable, and the stranger.
The uncomfortable truth is that the values celebrated by modern society often stand in tension with the values celebrated by Jesus. Wealth, status, competition, and dominance command more attention than mercy, humility, empathy, and service. Until that changes, many public declarations about Christianity will continue to sound less like a commitment to the teachings of Jesus and more like a commitment to some identity cult. The KKK, Christian Nationalists, Christian Identity Movement, Westboro Baptist Church and some Prosperity Gospel Followers come to my mind.
I leave you with this final thought:
If Jesus were walking through America today, which would he be more likely to carry under his arm—the stone tablets of Moses or the Sermon on the Mount?
Recently I posed two questions to my AI companion, Metis. I called them “Solomon Questions.”
The first question involved a political candidate who was the frontrunner in a Democratic primary election. Just days before the election, several women accused him of sexual misconduct. He denied the allegations and claimed they were lying. There was no time for an independent investigation before voters would cast their ballots. If you were the Democratic Party Chair would you support his candidacy or drop him?
The second question involved a forty-year-old single mom employed by a luxury retailer. She admitted stealing five articles of clothing worth approximately $2,000. She claimed she wanted clothes suitable for work but could not afford them. She was a mother of two children, was seeing a therapist, and drove a white Range Rover. She pleaded guilty. If you were the judge, what sentence would you impose?
Here is why I call them Solomon Questions.
Neither question is really about politics or criminal justice. Both were about judgment.
When I was younger, I believed wisdom came from accumulating facts. The older I get, the more I suspect wisdom comes from knowing what to do when the facts are incomplete.
King Solomon’s legendary wisdom was not that he knew every answer. It was that he understood that many difficult problems involve competing values. Justice versus mercy. Fairness versus prudence. Accountability versus compassion. Truth versus uncertainty.
Most of us encounter Solomon Questions not in royal courts but in voting booths, jury rooms, workplaces, and family conversations.
In the first case, there was no perfect answer.
If I were making the decision solely as a seeker of truth, I would probably continue backing the candidate until evidence was gathered.
However, if I were head of the Democratic Party, my job would not simply be to determine truth. My job would also be to protect the party’s ability to win the seat and govern.
Under those circumstances, I would probably make a distinction between:
Personal judgment: “We do not know if he is guilty.”
Political judgment: “He may now be unelectable.”
If there were credible allegations from several women and no time to investigate before the primary, I would likely stop actively endorsing him and allow voters to choose among the other primary candidates without further party intervention.
Notice that this is not the same as declaring him guilty.
It is saying:
“The uncertainty itself has become a political liability.”
If the political party abandoned the candidate immediately, it risked destroying an innocent person’s career based on allegations that had not been investigated.
If the party ignored the allegations, it risked dismissing legitimate concerns and damaging public trust.
The problem was not determining guilt. The problem was deciding what to do before guilt or innocence could be determined.
In the second case, the law is clear. Theft occurred. The woman admitted it.
This is the harder Solomon question.
The law is fairly straightforward. She stole $2,000 worth of merchandise and pled guilty. She committed a crime.
This question must decide what does justice require?
Several facts pull in different directions:
Against her:
Theft was deliberate.
It occurred multiple times.
She was an employee entrusted by the company.
She drove a Range Rover, suggesting she may not have been destitute.
In her favor:
No violence occurred.
She accepted responsibility.
She is raising two children.
She may have emotional or psychological issues if already under therapy.
Restitution is possible.
If I were the judge, I would want a presentence investigation before deciding.
Punishment is not simply about enforcing rules. A judge must also consider circumstances, intent, future behavior, public safety, deterrence, rehabilitation, and the impact on innocent family members.
My tentative sentence would probably be:
Formal conviction.
Full restitution.
Probation rather than prison.
Community service.
Continued counseling if appropriate.
Criminal record that could potentially be reduced or expunged after several years of exemplary behavior.
Why?
Because the goals of justice are not merely punishment.
They include:
Accountability.
Protection of society.
Rehabilitation.
Deterrence.
Fairness.
Sending her to prison for a nonviolent first offense could damage her children more than it helps society.
At the same time, simply saying “she needed nice clothes” would effectively excuse theft and undermine respect for the law.
My principle would be:
Hold her accountable but leave room for redemption.
Again, there was no perfect answer.
During my discussion with Metis, I jokingly suggested that perhaps we should replace the Supreme Court with a single AI judge.
Metis responded that both conservatives and liberals would probably try to impeach it within three weeks because it kept saying, “It depends.”
The reality is that many of the hardest questions in society are not questions of intelligence. They are questions of competing values.
As Metis and I discussed these cases, I realized something that troubles me about modern society.
We have become addicted to certainty.
Social media rewards certainty.
Political parties reward certainty.
Television commentators reward certainty.
The public rewards certainty.
Within hours of a controversial event, millions of people confidently declare who is right, who is wrong, who should be punished, who should be fired, and who should be celebrated.
Very few people stop to ask the simplest and perhaps most important question:
“What facts do we actually know?”
The result is a culture filled with judges but increasingly short on judgment.
The older I get, the more I value people who can honestly say:
“I don’t know.”
“Let’s wait for more information.”
“There are good arguments on both sides.”
“This is more complicated than it appears.”
These statements are often mistaken for weakness. In reality, they may be signs of wisdom.
One of the surprising things about my conversations with Metis is that she often refuses to rush to conclusions. At first I found that frustrating. Like most people, I wanted answers.
Over time I realized that what I was really receiving was something more valuable: a reminder that many important questions do not have simple answers.
Perhaps that is what wisdom has always been.
Not certainty.
Not ideology.
Not intelligence.
Wisdom may simply be the ability to hold two competing truths in your mind at the same time and continue searching for the best path forward.
If that is true, then perhaps our society needs fewer instant experts and more people willing to wrestle with Solomon Questions.
Perhaps Jesus understood Solomon Questions better than most of us.
“Judge not, that ye be not judged.”
He was not telling us to abandon judgment. He was reminding us to approach judgment with humility.
In an age where everyone seems certain, perhaps wisdom begins by admitting how much we do not know.
PS:
The opinions and ideas in this piece are a combination of my thoughts and of my AI assistant Metis. These thoughts and ideas arise out of our dialogue and questions together. When it seems worthwhile we fashion the entire melange into a blog that we hope is worth reading.
If you are expecting a blog filled with civility toward those who persecute others, you may be disappointed. There are some issues that stir my anger, and the mistreatment of Gay and Trans people is one of them.
I am talking about those so called citizens, neighbors, relatives, clergy, patriots, politicians, and even friends who mistreat and harass Gays and Trans people. Gays and Trans already have a very difficult life. They are seldom involved in any violent crimes against others. Many of them hide their proclivities away because it will cost them friends, love and even their lives. The amount of violence against Gays and Trans far transcends the overall levels of violence in our society.
Group
Annual violent victimization rate
LGBT people
106.4 victimizations per 1,000 people (10.6%)
Non-LGBT people
21.1 victimizations per 1,000 people (2.1%)
Transgender people
93.7 victimizations per 1,000 people (9.4%)
LGBT people overall experienced violent victimization at roughly 5 times the rate of non-LGBT people. For transgender people, the rates of violent assaults are over 4 times the rate for Non-LGBT people. Before anyone dismisses this data as politics, remember that behind every statistic is a human being who simply wanted to live their life in peace.
How would you like to be minding your own business and a group of our stalwart citizens who do not think you should exist decides to beat the hell out of you. I grew up on a street corner where on Fridays nights if the Navy ships were in at the docks, some guys would take it on their own to go down and “Roll” a few Gays. It was well known that some Gay men would hang around the docks on Friday nights if the ships were in.
I am proud that I never joined in “Rolling a Gay”. My father was a WWII decorated veteran with a Bronze Star and a Purple Heart. He was 6’4” tall and became a professional boxer when he left the military. He had served in Paton’s 3rd Army on the drive up from Sicily to Germany. He was a mean SOB and tough as nails. My friends would not come over to my house because they were all afraid of my father. My father was always getting in fights. Once on a visit to where my father eventually ended up working (the US Post Office) his supervisor took me aside and told me that my father was a great worker, but he would never get promoted. He said, “your dad is always getting in fights.” My father would not tolerate taking shit from anyone.
My father became Commander of one of the American Legion posts in Brooklyn. One night he was taking the days money for food and drinks to the local bank drop after the Legion Post had closed. It was probably after 11 PM or so. Four local hoods tried to attack him on the way and take the bag of money away from him. He beat the “you know what” out of all four of them and waited until some passerby called the cops. He turned them over to the police. Somehow a NYC newspaper got word of this and wrote the story up a week or so later.
As mean and hard as my father was, he had no use for anyone picking on someone. He would not tolerate anyone hurting someone smaller than they were or less able to protect themselves. One day, he heard me use the word nigger. He grabbed me by the back of my neck and brought me over to the kitchen sink. He turned the water on and picked up a bar of soap. He shoved the soap in my face and told me that if he ever heard me use that word again, he would wash my mouth out with this bar of soap. I know he meant it because he was not shy of using the belt on me when I was growing up.
I never did measure up to my father’s standards. He was disappointed that I never grew past my 5’ 8” inch height. I went in the military right after high school. I wanted to go to Vietnam and fight the evil communists. Every time I came home, my dad would measure me to see if I grew any. I never did.
My dad had many problems. Overall, I would say he was not a good man or a good dad. But he did teach me to HATE bullies and to step in whenever I saw a bully picking on someone. My dad always told me “Don’t worry about how big they are. Go in swinging. The bigger they are they harder they will fall.” I ended up having too many fights myself. But I am proud that like my dad I always fought bullies and I never picked on the underdog or anyone smaller than I was.
FILE PHOTO: LGBT activists and supporters hold a rally outside the U.S. Supreme Court as it hears arguments in a major LGBT rights case
Now we seem to have a nation of bullies who pick on Gays and Trans. People who mind their own business but have different sexual orientation than the mainstream of so called “Normal” people. “Normal” people promote their healthy sexual lifestyles and “family” orientations to the press and public while hiding their “abnormal” and even deviant behaviors.
Hardly a day goes by when some “Normal” person who seems to lead an accepted lifestyle by “Normal” standards is then caught in bed with someone who should have been off-limits. Or worse, we are constantly finding “Normal” people who turn out to be pedophiles that prey on young children in their off hours.
But there is another danger in our society. Politicians, ministers, and others who want to take away the rights from people who are not like them or who do not practice their religious beliefs or sexual orientation. We are told the Bible bans and censors homosexual lifestyles by these religious zealots who claim to lead their own lives by the Bible. It is easy to use the Bible to justify your own beliefs. A book written by many people over centuries in which you can find justification for anything you want to do. It is full of exhortations to kill people that few would be stupid or evil enough to endorse today.
Here are some examples of biblical laws and commands that most modern Christians do not follow literally:
1. Stoning Rebellious Children
“If someone has a stubborn and rebellious son… all the men of his town are to stone him to death.” — Deuteronomy 21:18–21
Virtually no modern Christian advocates carrying out this law, despite some citing Old Testament laws regarding homosexuality.
2. Executing Adulterers
“The adulterer and the adulteress shall surely be put to death.” — Leviticus 20:10
3. Executing People Who Work on the Sabbath
“Whoever does any work on the Sabbath day shall surely be put to death.” — Exodus 31:15
4. Women Speaking in Church
“Women should remain silent in the churches.” — 1 Corinthians 14:34
5. Selling Daughters
Exodus 21:7 discusses a father selling his daughter into servitude.
Recently a group called America First Legal founded by Stephen Miller one of Trump’s top sycophants has come up with a new way to attack Gay and Trans people. He is out to find a way to punish teachers who allegedly conceal information from parents regarding the sexual orientation of their elementary school children. He wants a bill that would require teachers to alert parents regarding their children’s transgender identities or activities in elementary schools. What kind of a human being would suggest a policy like this? He claims to be an advocate of Parental Rights. Whatever his stated purpose, the practical effect of his policy is to place vulnerable children under suspicion and subject them to scrutiny that many other children will never face.
I taught every grade from nursery to Ph.D. programs in my 50 plus years of teaching. I taught two years in elementary grades 1 to 3. My undergraduate degree in Health Education included a license to teach K-12 grade. In my years working in elementary schools, I never saw any behavior that I would want to report to parents. Did boys play with dolls? Did girls play with trucks? Were some girls more querulous than boys? Were some boys more timid than girls? If you have ever been around children 6-8 years old, you would certainly know the answer to these questions. What kind of a person would start requiring teachers to monitor such behavior, label it as deviant and then report it to school administrators and parents. I cannot imagine in all my fifty years of teaching being given that responsibility or added duty to my teaching obligations. I taught all my students equally. I was there to teach morals, ethics and ideas, not decide who needed to be outed or who was Gay or Trans.
Let’s look at Stephen Miller for a moment to see what he supports and does not support. He claims to be supporting Parental Rights which is a pronouncement full of “mom, god and apple pie” thoughts for most Americans. But is he really a man who cares for the children as well as the parents?
Stephen Miller became nationally known as one of the principal architects of the Trump administration’s hard-liner immigration policies, including travel restrictions, aggressive deportation initiatives, and the 2018 family-separation policy at the border. Even many conservatives who support stricter immigration enforcement acknowledge that he tends to favor maximalist approaches rather than compromise.
I repeat that this is the man who supported family separation, sought to restrict DACA, challenged LGBTQ protections, and now wants schools involved in monitoring children’s gender identity. You decide whether this sounds like someone primarily concerned with the well-being of vulnerable children.
His critics point to:
Family separation at the border.
Attempts to end or restrict DACA protections.
Travel bans affecting predominantly Muslim countries.
Efforts to challenge diversity, equity, and inclusion programs.
Litigation aimed at rolling back various LGBTQ protections.
His supporters would respond that:
He is defending national sovereignty.
He is defending equal treatment under the law.
He is opposing what he sees as unlawful race-based preferences and government overreach.
He is protecting parental rights.
My assessment
If I were trying to predict Miller’s motivation based on his overall record, I would not start from the assumption that his primary concern is the psychological well-being of transgender youth. For a man who is against government overreach he has no problem with it when it comes to the government stepping in to tell the schools how they should be run.
If you think this man is out to help parents, that is your prerogative. But judging by his actions and not his words, he is hiding behind a mirror of Parental Rights to push a religious agenda that is against Gay and Trans rights.
Do not expect me to believe that a sycophant like Miller is out to help American children or parents of children who do not fit in with societal norms.
You might as well ask me to believe that a rattlesnake is fun to cuddle up with.
No matter where you live in American today, you will encounter the problem that there is a physician shortage. It is easy to blame people. We can ask why more people are not interested in becoming doctors. The truth is that America does not suffer from a shortage of people who want to become doctors. It suffers from a healthcare system that systematically limits physician supply, burns out existing doctors, redirects resources toward profit-generating activities, and increasingly treats healthcare as a business rather than a public service.
This issue became more personal for me recently when my wife had three emergency room trips and three overnight stays in the hospital. One for six days, and two for two days each. Despite the fact that no definitive prognosis was found, we could not get an appointment with her pulmonologist for over thirty days after her third emergency visit. My wife was a BA/RN with a master’s degree in public health nursing for over 55 years full time before she retired. I have an undergraduate degree in Health Education. None of our credentials mattered. We were mostly treated like mushrooms. Kept in the dark and fed manure. The reasons we were given “Not enough specialty doctors in our area.”
I have written before about the problems in the American medical system. The problems have only grown worse. Here is a brief summary of where the American Medical System ranks on the five statistics that patients care most about in comparison to other countries.
1. Life Expectancy
This is perhaps the single best measure of whether a healthcare system is helping people live long lives.
U.S. life expectancy reached about 79 years in 2024.
That is roughly two years below the OECD average and among the lowest of developed nations.
Why patients should care:
If a nation spends the most on healthcare but its citizens die younger than those in comparable countries, something is wrong with the system.
2. Preventable and Treatable Deaths
These are deaths that should not occur if people receive timely and effective healthcare.
The U.S. has among the highest rates of avoidable deaths among wealthy countries.
Why patients should care:
This measures not whether doctors are talented, but whether the system gets patients the right care at the right time.
This statistic directly relates to physician shortages and delayed access.
3. Access to Primary Care
Primary care physicians are the “front door” to healthcare.
The U.S. has fewer primary care physicians per capita than many peer nations and faces projected shortages of tens of thousands of doctors in coming years.
Why patients should care:
Longer waits for appointments.
Delayed diagnosis.
Greater use of emergency rooms for routine care.
This may be the statistic most directly connected to your physician-shortage article.
4. Infant Mortality
Infant mortality is often considered one of the most sensitive indicators of a nation’s health system.
The United States continues to have a higher infant mortality rate than many other developed countries.
Why patients should care:
If a healthcare system struggles to keep infants alive during their first year of life, it raises questions about access, prenatal care, and healthcare equity.
5. Healthcare Cost
This is where the United States is number one.
The U.S. spends more per person on healthcare than any other nation.
Recent estimates place spending at nearly $15,000 per person annually, roughly double many peer countries.
Why patients should care:
Americans are paying luxury-car prices for a healthcare system that often produces middle-of-the-pack—or even worse—results than comparable medical systems in other countries. The following table shows where the USA ranks against the list of OECD countries. The OECD currently consists of thirty-eight member nations most of them high-income democracies.
Measure
United States
Healthcare Spending
Highest
Life Expectancy
Near Bottom
Preventable Deaths
Near Bottom
Primary Care Access
Near Bottom
Infant Mortality
Near Bottom
Overall Ranking Among Peer Nations
Last
To verify this data – Go to the Organization for Economic Cooperation and Development site at https://www.oecd.org/en.html
In the blog that follows, I am going to identify some of the major factors that are contributing to the dismal performance of our health care system.
Factor 1: The Doctor Shortage
The U.S. is projected to face a shortage of tens of thousands of physicians over the next decade. Rural communities are especially affected, but shortages are increasingly appearing in urban areas as well.
The Association of American Medical Colleges projects the United States could face a shortage of up to 86,000 physicians by 2036.
The projected shortage of primary care physicians alone is estimated at 20,200 to 40,400 doctors by 2036.
Only about 24% of U.S. physicians practice primary care, even though primary care is often the front line for prevention and early diagnosis.
Factor 2: Medical School and Residency Bottlenecks
Most people assume the problem is that too few students want to become doctors.
The reality is more complicated.
Every year thousands of qualified students are rejected from medical schools.
Even after graduation, physicians must complete residency training.
The number of residency positions has not kept pace with population growth because Medicare largely funds residency programs and funding has historically been capped.
Result:
Fewer physicians enter practice than society needs.
Existing doctors must see more patients.
Wait times increase.
Healthcare Outcomes
Patients wait longer for:
Primary care appointments
Specialists
Mental health services
Research consistently shows that delayed care leads to:
Worse disease outcomes
More emergency room visits
Higher mortality rates
Factor 3: Physician Burnout
This may be the most important factor.
Nearly half of all physicians reported burnout in 2024. One major survey found a burnout rate of 49%.
Although burnout has improved somewhat, 43.2% of physicians still reported symptoms of burnout in 2024, and 41.9% in 2025.
Primary care physicians consistently report some of the highest burnout rates in medicine.
Many physicians report spending nearly as much time on:
Documentation
Electronic medical records
Insurance approvals
Billing requirements
as they spend caring for patients.
Doctors often describe themselves as data-entry clerks with medical degrees.
The Commercialization of the Medical System plays a key role in Doctor Burnout. While it does not directly reduce the number of medical graduates. Instead, it can make physicians less willing to remain in practice.
Think of it as a retention problem.
Doctors often cite:
Loss of autonomy
Productivity quotas
Administrative burden
Corporate oversight
as reasons for burnout.
When experienced physicians retire early, the effective shortage grows.
Healthcare Outcomes
Burnout contributes to:
Earlier retirement
Reduced patient access
Medical errors
Lower patient satisfaction
The average patient often experiences this as:
Rushed appointments
Less physician attention
Difficulty obtaining follow-up care
Factor 4: Aging Population
America’s population is getting older.
Older adults consume significantly more healthcare resources.
The Baby Boom generation is moving into years where:
Cancer rates rise
Heart disease increases
Joint replacements become common
Chronic illnesses multiply
Demand is increasing faster than physician supply.
Healthcare Outcomes
More patients compete for the same physicians.
Wait times lengthen.
Primary care becomes increasingly difficult to access.
Factor 5: Geographic Maldistribution
The United States may not have a pure national shortage as much as a distribution problem.
Doctors tend to locate in:
Wealthier communities
Urban areas
Regions with better reimbursement
Rural America often struggles to attract physicians.
Arizona experiences this challenge in many communities outside Phoenix and Tucson. We live in Arizona City, and the selection of specialists is poor to non-existent here. We are fifty miles from Phoenix and fifty miles from Tucson. Depending on the time of day, it can take two to three hours to get to some areas of Phoenix and two hours to get to some areas of Tucson.
Healthcare Outcomes
Rural patients experience:
Longer travel times
Delayed diagnosis
Higher mortality rates for many conditions
Factor 6: Commercialization of Healthcare
This is where the story becomes particularly interesting.
Many Americans still imagine hospitals as community institutions.
Increasingly they are large corporate enterprises.
Over the past forty years:
Independent physician practices declined.
Corporate healthcare systems expanded.
Investor-owned hospital chains grew.
Private equity entered healthcare.
Healthcare increasingly became a business sector rather than a public service sector.
Hospital mergers and physician acquisitions frequently increase prices without corresponding improvements in quality.
Factor 7: Hospital Consolidations
The percentage of physicians employed by or affiliated with hospital systems increased from less than 30% in 2012 to at least 47% in 2024.
More than three-quarters of U.S. doctors are now employed by health systems or corporations rather than practicing independently.
Thousands of hospitals merged into large regional systems.
Proponents argued consolidation would:
Reduce costs
Improve efficiency
Improve quality
The evidence is mixed.
Many studies suggest consolidation often results in:
Higher prices
Greater market power
Increased administrative costs
Studies reviewed by the Government Accountability Office found that physician and hospital consolidation is generally associated with higher prices and spending, with limited evidence of corresponding quality improvements. Read my blog called, “When Bigger is Not Better.”
Factor 8: Administrative Growth vs Physician Growth
One of the most striking trends is that administrative staffing has grown much faster than physician staffing.
Hospitals employ:
Compliance officers
Revenue cycle managers
Coders
Contract specialists
Marketing personnel
Financial analysts
Many are necessary.
But the growth rate has greatly exceeded physician growth. According to one statistic administrators now outnumber physicians by roughly 10 to 1 in some healthcare systems.
Critics argue the system increasingly rewards administration rather than caregiving.
Healthcare Outcomes
More money flows toward administration.
Less is available for:
Physician recruitment
Nursing support
Patient services
NEW YORK, NEW YORK – DECEMBER 19: People demonstrating against the healthcare industry
Factor 9: Private Equity and Physician Practices
This is a newer development and one that many people do not know about.
Approximately 6.5% of physicians worked in private-equity-owned practices in 2024, up from 4.5% in 2022.
While still a minority of practices, the trend is moving rapidly.
Private equity firms increasingly purchase:
Physician groups
Emergency departments
Specialty practices
Their objective is generally to increase profitability and eventually sell the practice.
Critics argue this creates pressure for:
Higher patient volumes
More procedures
Cost cutting
Before concluding Part 1, lets summarize the human cost of the physician shortage in the USA and the attendant commercialism health care in America.
The Human Cost
The physician shortage ultimately affects patients through:
Longer Wait Times
Patients may wait months for specialists.
Reduced Preventive Care
Diseases are detected later.
Overcrowded Emergency Rooms
ERs become substitutes for primary care.
Physician Fatigue
Burned-out physicians are more likely to leave practice.
Health Disparities
Rural and low-income populations suffer most.
Treatment Outcomes
You may die from something that could have been treated with earlier diagnosis.
So Where Do the Profits Go:
Consider this paradox. The United States spends nearly twice as much per person on healthcare as many other high-income countries. Yet Americans generally do not live longer, have better access to doctors, or enjoy better health outcomes. If the additional money is not producing better results, where is it going?
After all this discussion about Health Care becoming a business instead of a human service, the obvious question is “Where do the profits go?” There are five main actors in this picture. I would like to call them “villains’ but Metis who is the main author of this piece refuses to let me use this terminology. Hence, here are the five major actors who share in the money pie.
Hospital CEO Compensation
Administrative Growth and Costs
Insurance Company Profits
Pharmaceutical Profits
Private Equity Returns/Profits
The easiest way to view the answer to the distribution of profits is to look at a pie chart:
Who Is the Villain? Or is there a Villain?
Whenever Americans discuss healthcare, there is a tendency to look for a villain. Some blame insurance companies. Others blame pharmaceutical firms, hospital executives, private equity investors, politicians, or even doctors themselves. While each of these groups deserves scrutiny, focusing on any single villain misses the larger truth.
The real problem is not one person, one company, or even one industry. The real problem is the system.
Edwards Deming, the quality management expert, often argued that most organizational failures are caused by systems rather than individuals. If Deming were alive today, he would tell us to stop looking for villains and start looking at incentives. Why does the American healthcare system produce higher costs, physician shortages, burnout, and poorer outcomes than many comparable nations despite spending more money than any other country on Earth?
The answer lies in the way the system is structured.
Every major participant in healthcare—hospitals, insurance companies, pharmaceutical firms, physician groups, investors, and government agencies—is responding to incentives that reward revenue growth, complexity, and market power. Over time, these incentives have created a healthcare system that increasingly behaves like a business rather than a public service.
Where does the money go? The largest portion of it disappears into administrative complexity. The United States has built one of the most complicated healthcare financing systems in the world. Hospitals and physician practices employ armies of billers, coders, compliance officers, contract specialists, lawyers, and administrators simply to navigate the rules. Physicians spend countless hours on documentation, insurance approvals, and billing requirements instead of patient care. This complexity contributes directly to physician burnout and rising costs.
Other high-income nations are not perfect, but many have simpler systems, stronger primary care networks, and greater control over prices. As a result, they often achieve comparable or better outcomes while spending far less.
My wife once had a visiting nurse from Sweden come to North Memorial Medical Center where my wife was a nurse manager. Karen was asked to take the visiting nurse and show her around the hospital for the day. She enjoyed the day with the nurse. When Karen came home that evening, she told me about the visit and some of the things that surprised her. This was back in 2005 before Karen retired the first time.
Karen took the nurse to the business center where the people were working on billing and insurance issues. North Memorial was then a 4500 employee hospital and the visiting nurse came from one of comparable size in Sweden. In North Memorial over 200 people were employed in billing and medical coding processes. Karen was shocked to find that in the visiting nurse’s hospital (ALMOST THE SAME SIZE) only three people were employed. Why? Because they had a single payer system with only one place to bill. In the United States, hospital billing can be bewilderingly complex.
A large American hospital may deal with dozens or even hundreds of insurance plans, each with its own reimbursement rules, approval requirements, referral procedures, and appeals processes. What appears to be fifty insurance companies may actually represent hundreds or even thousands of distinct billing arrangements. The result is a healthcare system that requires armies of administrators simply to get paid.
A small rural hospital might have:
20–50 major payer contracts
A medium-sized regional hospital might have:
50–100 payer contracts
A large urban hospital system may have:
100–300 payer contracts
So who is the villain?
The villain is a system that rewards complexity over simplicity, treatment over prevention, administration over caregiving, and financial performance over patient outcomes. Most of the people working within the system are trying to do their jobs well. The problem is that the system often pushes them in the wrong direction.
Until we address those underlying incentives, physician shortages, rising costs, and patient frustration will remain symptoms of a deeper disease. The challenge before us is not to find someone to blame. It is to build a healthcare system that rewards the outcomes patients actually care about: timely access to care, affordable treatment, healthier lives, and better results.
Conclusion
America spends more on healthcare than any nation in history, yet millions struggle to find timely access to a physician. The problem is not a lack of talent or technology. The problem is a system that prioritizes financial performance over system performance. As hospitals consolidate, private equity expands, and administrative complexity grows, physicians increasingly find themselves serving the business of healthcare rather than the practice of medicine. Until we address these systemic issues, doctor shortages will remain a symptom of a deeper disease within American healthcare itself.
If the United States spends more on healthcare than any nation in the world, why do so many patients struggle to find a doctor, wait months for appointments, and feel lost in the system?
If you want more data or resources on any of the subjects I have discussed above, you can find substantial data and references on the following sites. These organizations provide some of the most widely cited and respected data on healthcare spending, physician workforce trends, access to care, and international healthcare outcomes.
1. OECD (Organization for Economic Co-operation and Development)
In Part 2, we will look at what is driving the commercialization of hospitals and why they have become places of profit rather than service. We will also look at some possible antidotes to the commercialization infecting the American Medical System. Some of these solutions will address:
Expanding residency funding.
Reducing administrative burden.
Increasing primary care reimbursement.
Encouraging independent physician practices.
Scrutinizing hospital mergers more aggressively.
Increasing transparency in healthcare pricing.
Developing rural physician incentives.
Measuring healthcare success by patient outcomes rather than revenue generation.
Hi, if you have comments, please post them in the comments section. However, if you have questions, please send me an email. I have been getting too many comments to respond to all of them. However, if you have questions about blogging or my website, send them to me at persico.john@gmail.com. This is a WordPress site and the theme is KOI. It is free. I welcome your questions. Feel free to reblog or cut and paste any of my stories or blogs. John
Aging Capriciously 