The redrawing of legislative district boundaries. A 1967 federal law requires House members be elected from single-member districts that (within each state) have nearly identical populations. House maps must be redrawn after reapportionment but before the first congressional election of each decade, based on population changes in each state revealed by the census.
The warnings about artificial intelligence keep getting louder.
The companies building the world’s most powerful AI systems are reporting troubling behavior from their own creations. And some of the researchers closest to frontier AI development warn that powerful new systems could “cause human extinction.”
Scientists fear losing control. Government leaders in the United States and abroad are debating how to keep increasingly capable models from causing harm.
These concerns must be taken seriously. But as a physician, I worry that fear of AI will cause our nation to overlook an extraordinary opportunity: harnessing narrower applications to improve patient care and save lives.
Consider a question I often pose to medical professionals. If you had time to check on patients every day, could you detect complications earlier and improve outcomes?
Almost always, the answer is yes.
For postoperative patients, that could mean identifying a surgical wound infection early enough to begin antibiotics without delay. For patients with chronic heart failure, it could mean treating at the earliest signs of acute decompensation. And for people with diabetes or hypertension, it could mean monitoring closely enough to maintain effective blood glucose and blood pressure control.
I saw the value of more frequent outreach and evaluation as CEO of The Permanente Medical Group. From 2000 to 2015, heart-disease and stroke mortality among Kaiser Permanente members declined roughly twice as fast as it did nationally. TPMG also controlled hypertension in 85% of patients, compared with 54% nationally.
However, that kind of care requires substantial clinician time and organizational resources. Most medical groups cannot afford to provide that level of attention consistently. There are not enough doctors, hours or dollars to do so nationwide.
Generative AI agents could change that calculus. These are software tools designed for specific tasks. They could monitor data, respond to health changes, and take predefined steps without direct clinician oversight.
Consider, for example, how AI might help one of the 6.7 million Americans living with chronic heart failure. A cardiologist monitoring a patient at home would look for increases in weight, ankle swelling, and fluid in the lungs. Combining those signs with reduced endurance and difficulty lying flat comfortably would indicate worsening heart failure.
These assessments are neither especially complex nor beyond what AI could do today. Bluetooth can connect agents to electronic scales and stethoscopes. Video monitoring would allow other agents to evaluate ankle swelling, measure stair-climbing ability, and assess whether the patient can lie flat comfortably.
In each case, these agents would augment what the doctor already does, not replace it. The potential benefit is significant. Across dozens of randomized trials, remote monitoring of patients with heart failure has reduced hospitalizations by roughly 20%. AI agents could make that kind of continuous monitoring easier and more affordable nationwide.
The same logic applies to chronic diseases such as hypertension and diabetes. Nearly 120 million American adults have high blood pressure, and 38 million live with diabetes. Both illnesses can damage the heart, kidneys, and blood vessels when poorly controlled.
Yet treatment still depends primarily on information collected during office visits, several months apart. Millions of patients already own home blood pressure cuffs or glucose monitors, but doctors rarely have the time to evaluate those readings. AI agents could track them, recognize when control is failing and notify physicians based on the same clinical parameters they would use if they could review the information frequently.
Consider the upside for patients with hypertension. The CDC estimates that better “team-based control” of high blood pressure could prevent roughly 92,000 heart attacks, 139,000 strokes and 115,000 cardiovascular deaths over five years. AI agents could support that care by making monitoring and evaluation easier.
A third opportunity comes after surgery. Once home, patients are instructed to watch for signs of infection at the incision site: redness, drainage, and pain. But because some of those changes are normal after surgery, patients may struggle to recognize when they signal a complication.
If surgeons could see patients daily, they would compare the wound’s appearance with how it looked the day before. AI agents could do the same by collecting photos or video from the patient’s phone, analyzing progression for signs of improvement or deterioration, and asking about pain or drainage.
If the application identified a likely problem, it could send the images and findings to a clinician, who could quickly determine whether the patient needed to be seen. Patients with concerns could still contact the surgeon directly.
Surgical-site infections add about $3.3 billion to U.S. health care costs each year. Earlier recognition would bring patients to medical attention sooner, when treatment — including antibiotics — would be more effective.
These opportunities to improve quality and save lives raise an important question. If Bluetooth, video, and conversational AI already exist, why haven’t they been assembled into tools that augment what physicians do today?
The biggest barrier is the complexity and expense of obtaining regulatory approval for medical tools used by patients. But Medicare offers a starting point. Its new ACCESS model supports technology-enabled chronic care and rewards providers for improving outcomes rather than simply delivering more services. Working with the FDA and NIH, ACCESS could provide a structured setting to test these agents, determine whether they improve medical outcomes, and create a path toward approval.
A second barrier is collaboration. Safely developing these agents for patient use at minimal cost will require clinicians, medical societies, and health systems to work with AI companies such as OpenAI, Anthropic, and Google. In parallel, independent researchers will need to test reliability and ensure that false alarms do not overwhelm clinicians.
The existential risks posed by increasingly powerful AI systems demand serious safeguards. But our nation should not treat every use of AI as equally dangerous. Yes, the risk of moving too fast is real. So is the danger of standing still.
Robert Pearl, the author of “ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
Man holding American flag
Americans are exhausted — living through noise, chaos, corruption, and manipulation. But exhaustion creates another danger: surrender. When citizens become overwhelmed by government, they can believe they have no power to change it. That is when they need to remember the power of self-governance itself.
The Constitution was not written to make Americans spectators to their government. It was written to make them participants in it. The power of self-governance belongs to the people. It does not disappear when a president overreaches, Congress fails to act, or institutions are pressured. It becomes more important.
Self-governance is more than voting. It is informed judgment, civic participation, accountability, and constitutional responsibility. It means knowing our history, understanding our rights, questioning power, evaluating information, speaking when something is wrong, and participating rather than surrendering our voice. That power is difficult for a president to take because it begins with the citizen.
Self-governance is not only political — it is internal. It means governing one’s thoughts, emotions, and actions with discipline, awareness, and integrity. People who self-govern are composed, ethical, accountable, and purpose-driven. They recognize manipulation, resist pressure, and refuse to surrender independent judgment. A president can attempt to control institutions, pressure agencies, attack the press, manipulate information, and test constitutional boundaries. But a president cannot control a citizen who governs themselves. That is the power of self-governance.
The framers understood the danger of concentrated power. They created separation of powers, checks and balances, federalism, elections, and a free press because government was never supposed to depend on one person’s restraint. Constitutional government depends on citizens who recognize when these protections are being weakened — and are willing to act.
When executive power expands beyond constitutional limits, citizens must understand what is happening and what they can do. Executive overreach is not only a political problem; it is a constitutional warning signal. When Congress refuses to investigate, legislate, oversee, or use its constitutional powers, citizens cannot conclude that nothing can be done. When independent journalism is attacked, citizens must defend the information needed to make informed decisions. When elections are questioned or threatened, citizens must understand that elections belong to the people, not to any president or political party. Self-governance is how citizens respond.
Consider what happens when information becomes contested. A president who attacks reporters, restricts access, retaliates against dissent, or tries to replace independent reporting with a preferred narrative is not merely fighting with the press. He is affecting the information citizens need to govern themselves. Without reliable information, self-governance becomes harder. Propaganda is not just an attack on truth — it is an attack on the citizen’s ability to govern.
Citizens who know their rights and understand the constitutional system can distinguish fact from fiction. They can question claims, verify information, read beyond headlines, recognize manipulation, and reject conspiracies designed to make them distrust every institution. They can ask what was promised, what was done, who benefited, who was harmed, and what constitutional authority was used.
Self-governance is remembering. A nation that forgets becomes vulnerable to having its history rewritten. National memory belongs to the people. When history is altered to flatter power, citizens lose knowledge they need to recognize manipulation. Self-governance requires Americans to remember what leaders did, what institutions allowed, what rights were challenged, and what consequences followed. That memory shapes how citizens understand the present.
Reports indicate that Trump’s approval rating has reached historical lows, even as he urges voters to support candidates “as if his name were on the ballot.” After the administration revoked press passes for CNN, MS NOW, and Politico, a federal judge ordered their access restored, according to court filings. Continued restrictions on entry to certain events, however, have raised further concerns about the independent reporting citizens rely on. Additional reporting has also raised concerns about possible federal interference in elections, including ballot seizures, and altered election rules. These developments and warnings raise constitutional questions citizens must understand rather than dismiss or accept without scrutiny.
Elections are not personal loyalty tests. The press is not an enemy of the government. Constitutional rights do not belong to presidents. Public institutions do not belong to officeholders. They belong to the people.
Congress also matters because citizens cannot exercise self-governance fully if they do not hold their representatives accountable. Congress has constitutional powers designed to restrain executive overreach. When it fails to use them, accountability does not end — it shifts to the people. Citizens cannot perform Congress’s constitutional duties, but they can demand that their representatives fulfill them. That means more than complaining. It means contacting representatives, writing letters, making calls, attending town halls, supporting independent journalism, asking for roll-call votes, and remembering how elected officials responded when constitutional limits were tested. It means voting — not waiting for Election Day. Self-governance happens between elections.
And it happens close to home. City councils, school boards, county commissions, and other local bodies make decisions affecting education, safety, zoning, budgets, public resources, and community life. Citizens who attend meetings, speak at meetings, question officials, examine budgets, and serve on boards are not merely participating in government. They are governing.
Self-governance is not simply having a government that represents you. It is accepting responsibility for decisions that shape your community and country. This responsibility belongs to everyone — conservatives, moderates, independents, and progressives. It does not require agreement on every political issue. It requires agreement on something fundamental: government must remain accountable to the people, and constitutional limits must apply to those who hold power.
The people cannot protect what they do not understand. But civic understanding is not reserved for experts or elected officials; it can be learned, strengthened, and shared. Americans need to know what the Constitution protects, what each branch of government is empowered to do, where those powers end, and what citizens can do when leaders cross those boundaries. The Constitution is not simply a document government officials swear to uphold. It is also a framework that gives citizens authority to hold those officials accountable.
Self-governance is both a right and a responsibility. It means refusing to surrender judgment because politics is exhausting, refusing to accept propaganda because truth is inconvenient, and refusing to remain silent because speaking up feels powerless. It means remembering that government derives its legitimacy from the people and that elected officials serve the public — not the other way around.
The Republic drifts when citizens disengage and recovers when they use self-governance deliberately. Institutions can fail, and executive power can go unchecked, but neither makes the people powerless. Americans must use the power they possess: informed judgment, voting, civic participation, public pressure, independent journalism, constitutional knowledge, and accountability. They must question power rather than fear it, defend truth rather than surrender to narrative, and demand that Congress use its constitutional authority with courage and persistence. They must participate where government is closest to them — in their communities, schools, councils, commissions, and elections.
The people are not powerless. They are the sovereign. Self-governance is how they exercise that power. It is how they defend their rights when institutions fail, protect truth when history is manipulated, and demand accountability when leaders abuse authority. It is how the Republic survives, how the nation remains accountable to its people, and how Americans remain free.
Self-governance is America’s last defense against executive overreach — and the one defense no president can ever take unless the people surrender it.
Carolyn Goode is a retired school principal and an adjunct university instructor who writes about civic literacy, constitutional accountability, and the responsibilities citizens share in sustaining democratic governance.
Civics is a practice, not a quiz. See how immigrant and Indigenous communities are teaching schools to build, not blend in, as America turns 250.
Recently, I gathered with a group of dads outside Philadelphia to clear out a neighborhood park through Dads for All, the organization I co-founded. Some of us grew up in that neighborhood, some had never set foot in it, and plenty of us had no idea what we were doing. Our kids, ages three to seventeen, hauled branches and swung tools nearly as long as they were tall — and they were delighted.
Here's what I watched them figure out: A park is where a kid gets to be free. It's where you run, where you pretend to be a superhero, where the ground belongs to you. And you assume it just shows up. That morning, our children learned that it doesn't. Somebody has to see what it could be. Somebody has to partner with the people who own it and the people who use it. And then somebody has to pick up the loppers. That was the most honest civics lesson my son has ever had, and unfortunately, that is where the problem is.
I don't think we know what civics is anymore. We teach it like a vocabulary quiz — three branches of government, how a bill becomes a law, remember to vote. Those are the mechanics. They are not the practice. Civics is a mindset: the belief that you're responsible for people you didn't choose and will never meet, including the families who'll use that park thirty years from now. It's the reflex to see abundance where the room sees scarcity, and the belief that a closed door is just the first one you knock on. Nobody on that lot needed a class on the legislative process. We needed to believe the place was ours to change.
Ironically, the people who carry that conviction the most are the ones this country is currently teaching to be quiet.
My parents came here from Sri Lanka chasing a dream nobody handed them a map for. They worked multiple jobs and barely slept between shifts — not because they loved the grind, but because they refused the ceiling they'd been given. You don't leave everything you know for a country that has promised you nothing unless you are, at your core, a builder. That is the immigrant mindset, and it is the raw material of civic life.
Yet in the year America marks 250 years of exactly that story, the administration has made "patriotic education" a national priority — patriotism redefined as one racial, religious, and cultural story told louder than everyone else's. Books are pulled from shelves, curriculum is rewritten around a single narrative, arts and humanities programs are cut, and families live with the fear that a neighbor or a classmate could be taken by ICE. Together, those add up to a lesson written into no standard: some of you should take up less room here.
But we already know what the alternative looks like, because immigrant and Indigenous communities are already teaching it to schools, and it’s working.
None of that is easy. Students stand before panels and defend their thinking to adults under no obligation to be impressed. It's the same architecture as that Saturday in the park: nobody waiting for permission, everybody bringing something the others don't have.
In 2022, researchers at NYU’s Metropolitan Center brought together students, parents, and educators to evaluate three of the country’s most widely used elementary English and language arts curricula. They found that the same flattening starts young: superficial diversity and characters of color who appeared almost exclusively through struggle. One of the student researchers, Bolu Adelugba, told Education Week that in the curriculum she grew up with, Black history began in slavery and ended in segregation.
Bolu was a student leader at Our Turn, the youth organization I formerly led. She didn't stop at naming the erasure — she helped launch a Youth Consultancy that trained superintendents, school board members, and philanthropists on student voice and school culture. Adults with decades of experience were paying to learn from a teenager. Now imagine she'd been coached to blend in instead. We'd have lost every bit of it.
That's the choice in front of us, and it isn't abstract. School boards are adopting curricula this year. Districts are deciding whether a student's first language is a problem to be fixed or a tool to be used. Politicians are choosing whether to preserve an exclusionary version of the American story or invest in schools where every student can help build the country’s future. And fathers are deciding what their kids do on a Saturday.
Our children don't need us to narrate the American story to them for a year. They need us to hand them the loppers — and then follow the families who already know what the work takes.
Mohan Sivaloganathan is the founder and CEO of Harmonious Leadership, an ecosystem designed to break down false choices that stand in the way of innovation and impact. He is also the co-founder of Dads for All, a national network of fathers working to drive civic change in their communities.
Domestic violence survivors often struggle to find housing, and California’s “Unseen and Unheard Housing Act” will help make more housing available to meet their specific needs.
California Gov. Gavin Newsom signed the bill Sunday requiring cities and counties to factor in domestic violence survivors when planning for future housing.
The state’s 540 local governments are required to submit a plan for land use every five to eight years, depending on population size. The plan analyzes and proposes ways to meet community needs around climate change, health, economics and equitable opportunities. Within that is an assessment of housing supply and demand, which is required by law to include overviews of housing for seniors, people with disabilities, farmworkers, women-led households, households with five or more members and the unhoused.
Now cities and counties will have to account for the needs of domestic violence survivors, too.
“Our hope is that this bill will significantly increase the supply of permanent housing for survivors, and will bring funding, attention, and action to address the invisible crisis of domestic violence survivors falling into homelessness when they leave their domestic violence situations,” said Jennifer Willover, housing policy analyst at the California Partnership to End Domestic Violence, which coordinates domestic violence advocacy and response across the state.
Domestic violence and housing go hand in hand. Some victims choose to stay in a home with abuse in order to keep them — or their kids — housed, while others find there is no place to go when they need to escape violence.
Domestic violence is often a precursor to homelessness: 17 percent of unhoused cisgender women experienced intimate partner violence — most often physical — in the six months prior to homelessness, according to a 2024 report.
Among unhoused survivors of recent domestic violence, 40 percent said the abuse was a factor in leaving their prior housing. Twenty percent said it was the main reason.
According to DomesticShelters.org, at least 70 percent of California’s 165 domestic violence services organizations provide emergency housing. But those stays are typically only one to three months; longer-term support is much more difficult for survivors to find — and funding for it is drying up.
Stable housing in the months and years after fleeing abuse is hard to come by. Cost is an enormous barrier, and survivors don’t always have income or money of their own. According to the National Network to End Domestic Violence, many abusive partners exert financial control over victims, such as by forbidding them from working, refusing to put assets in their name or not allowing access to bank accounts.
The Bureau of Economic Analysis ranks California as one of the highest cost-of-living states, and rent in the most populous cities can be thousands of dollars a month. Credit checks can also make it harder to find a place to stay if an abusive partner coerced a victim into taking out loans or opened credit cards in their name.
This new law doesn’t provide any solutions, but it elevates the needs of domestic violence survivors who make up a large share of the population. Recent research from Tulane University showed 61 percent of women, 45 percent of men and 84 percent of gender-nonconforming people reported experiencing intimate partner violence across their lifetimes.
California’s New Law Aims To Close a Housing Gap for Domestic Violence Survivors was originally published by The 19th and is republished with permission.
The President Invited Iran to Bomb My Home