Healthcare comprises almost 20% of the United States gross national product. In our effort to keep our readers informed about the topics that most impact on their lives we presented a writing last week by Dr. Robert Pearl entitled, “ In healthcare’s game of Monopoly, one player will control the board, ” in which Dr. Robert Pearl presented a private solutions to inefficiencies and problems that exist in America’s health care industry. Today we present a video from IssueOne examining the healthcare industry. Right now, healthcare lobbyists are legally allowed to buy our elected officials’ votes. As long as that’s the case, our representatives will continue to choose campaign donations over Americans’ lives. The healthcare industry spends more than anyone else lobbying politicians to rig the system on their behalf. That should be illegal, but it’s not.
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Asociația de Reprezentare și Proiecte Diplomatice: What 127 Email Taught Me about Civic Engagement
Oct 14, 2026
It was 2:30 a.m., and while everyone else slept, my inbox failed me again.
For weeks, I spent many late nights drafting partnership proposals and reaching out to organizations I admired. Each email sent represented a different opportunity, a new connection, a compelling initiative, and a chance to help connect young people to civic engagement opportunities worldwide. But more often than not, my inbox responded the same way: silence. In total, I had sent around 127 proposals. Yet, I received virtually no replies.
At first, it was easy to see every unanswered email as direct evidence that the initiative was failing. How could a student in Washington even believe they could reach someone oceans away?
Looking back, I realize that those emails taught me one of the most important lessons about civic engagement: participation often begins before anyone else answers.
Too often, people celebrate civic involvement only when it produces tangible results: a successful campaign, the adoption of a new policy, or a community-proposed initiative that quickly gains traction. Far less recognition goes to the quiet, early steps taken long before these results: reaching out, building connections, and choosing to participate despite layers of uncertainty.
Nevertheless, the distinction is significant. Although many people understand the importance of public service, far fewer feel ready to participate actively. In Romania, a 2024 study by the Friedrich-Ebert-Stiftung found that more than 43% of the country’s youth reported no active participation in civic or municipal activity. Interestingly, although Romania often discusses this challenge, a parallel 2024 study by America’s Promise Alliance revealed similar signs of civic disengagement among youth in the United States. Although 9 out of 10 participants agreed that civic education is valuable among youth audiences, only 4 out of 10 reported feeling prepared to engage in and lead such activities. These statistics raise an important question: if so many individuals recognize the significance of civic participation, why do so few choose to engage?
At first, the results may appear to be indifferent. However, the reality itself is often more complex.
Through my work with Asociația de Reprezentare și Proiecte Diplomatice (ARPD), I learned that youth disengagement isn’t inevitable. Rather, it is a challenge that arises when young people lack access to the opportunities they believe they can contribute to.
When I first became involved with ARPD, it wasn’t years of experience in international relations or foreign affairs that pushed me to reach out. It was simply the decision that followed the desire to contribute to something larger than myself. As a Romanian-American student, I was searching for ways to stay connected to the place that shaped so much of my identity. I quickly discovered that ARPD fostered an environment where participation mattered more than prior experience. There, students worked together to coordinate committees, negotiate competing priorities, and develop programs that encouraged further discussion.
Through ARPD, one of the most valuable lessons that I learned is that civic engagement isn’t a solitary practice, and that complex challenges rarely offer simple solutions. Whether working on a partnership proposal, developing an outreach strategy, or organizing an educational conference, progress came through collaboration. Often, success came when individuals moved beyond advocating for their own perspectives and embraced diverse voices, inclusive priorities, and relationships with people from different backgrounds.
That said, regardless of current initiatives, not every individual has opportunities to engage civically in their community, something no single program can solve. Recognizing this gap can help contribute to the larger effort to narrow the divide between civic involvement and intentional youth participation.
While organizing one of Romania’s youth-led Model United Nations conferences, TimisoaraMUN, I found that when young people are given the opportunity to participate-many do. When they are given the responsibility to lead-many lead with ardor. And when they can meaningfully contribute to their community and explore the world around them, they develop skills that extend far beyond any single individual or organization.
Experiences like these suggest civic disengagement among youth isn't inevitable.
Perhaps the most important lesson I learned through ARPD about civic engagement is that meaningful participation doesn’t always begin with a vote, a campaign, or a policy. In fact, it rarely ever does. Instead, it begins with a question, an observation, or many emails that might never receive a reply.
The organizations I contacted were never obligated to reply. In fact, many never did. But looking back, I no longer see those unanswered emails as failures. Instead, they remind me that civic participation isn’t solely discovered through outcomes. But rather, they remind me of the desire to participate despite the uncertainty.
That drive and willingness to reach out, collaborate, and try is the root of meaningful civic engagement. Long before the change becomes visible, civic participation begins with the desire to try.
Catarina Pirvu is a high school student from Washington State serving as Director of ARPD Washington and Presidential Advisor for ARPD, a youth-led organization dedicated to diplomacy, international affairs, and civic engagement.
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Veterans of Iraq and Afghanistan Wars Sue New York After Being Denied the Right to Vote
Oct 14, 2026
NEW YORK CITY — Outside the Southern District of New York courthouse in Foley Square, Independent Veterans of America Founder Paul Rieckhoff and Army veteran Kristen Rouse, along with their attorneys, announced a lawsuit Wednesday challenging New York's continued use of closed partisan primaries.
The suit was officially filed Thursday. Independent Veterans of America and the Independent Voter Project joined the suit as organizational plaintiffs. The case is Rieckhoff v. Berger, No. 26-cv-08655.
It is part of a movement started by Rieckhoff and the Independent Voter Project called Let Vets Vote, which demands equal voting rights for the more than 3.1 million New York voters registered without a party, including an estimated 140,000 military veterans.
- YouTube youtu.be
At its core, the suit asks the court a basic question: Does the right to vote derive from citizenship or from joining a private political party? The goal is to set a constitutional precedent that every voter has a right to meaningful participation in publicly funded and administered elections.
"We are suing the state that we love because we want it to be better," Rieckhoff said. "The way our elections are working right now is unfair, un-American, unpopular, and we would argue unlawful and unconstitutional."
Independent Voter Project legal strategist Chad Peace, who is lead counsel for the plaintiffs, noted in the press conference that the question before the court is being litigated in different ways across the country.
There are lawsuits challenging the use of closed primaries in Maryland, Wyoming, and Oregon. Rieckhoff's case was also filed not long after a retired Florida attorney, Michael J. Polelle, brought the matter all the way to the steps of the US Supreme Court.
The Court considered the petition at conference but ultimately declined to grant the writ of certiorari.
The foundation for all of these cases was laid out by the Independent Voter Project, which previously led similar legal efforts in New Jersey and California.
Rieckhoff is an Iraq War vet, a 9/11 first responder, and yet he has had to explain to his kids why he can't vote for mayor in NYC in the primaries or the next governor of the state. It's because he chooses to hold on to his political independence.
- YouTube youtu.be
Rouse took a different path and ended up in the same place. She served 32 years in the Army, Army Reserve, and Army National Guard, including three tours in Afghanistan. She founded the NYC Veterans Alliance and served as a Deputy Director of the New York State Division of Veterans' Services, now the Department of Veterans' Services.
According to the complaint, Rouse never wanted to join a party. She enrolled as a Democrat in 2007 for one reason: it was the only way to vote in the primaries that decided who represented her in Brooklyn.
In 2021, she switched to the Working Families Party, believing she could still vote in primaries. She couldn't. The party held no primaries in her districts, and her enrollment shut her out of the Democratic primaries that did.
Last month, she withdrew from party enrollment entirely, and she will now be denied a ballot in every future primary.
"I spent 32 years in uniform serving my country, not a political party. I shouldn't have to sign up with a party to vote in a public election," Rouse said.
The primaries in New York are conducted in public schools and buildings. They are administered and overseen by public election workers. They use public voting machines. Yet, Rieckhoff and Rouse are denied the right to vote in them.
"My 11-year-old looked at me and said, 'Dad, that's messed up,'" Rieckhoff said.
"Independents should have the same right to vote as people who join a party." - Paul Rieckhoff, Founder and CEO of Independent Veterans of America
As previously analyzed on IVN, the impact closed primaries have on the democratic process can be most egregiously seen in New York. Only 7% of voters turn out, most districts are safe for one party, and about a third of elections go uncontested entirely.
While those who defend the use of closed primaries (and call them the "domain of private political parties") assert that they are not "formal elections," history and hard data show they are often the only elections that matter.
Rieckhoff says he isn't just suing New York on behalf of himself. He is suing on behalf of veterans like him and Rouse, who are more likely than any other segment of the population to be registered independent.
Yet, despite their service, they are treated like second-class voters.
"Veterans, 9/11 first responders, so many of us who have served our country and bled for this country and this state and this city should not be denied an equal right to vote," he remarked.
But he also explained that this case goes beyond veterans. Beyond independent voters. He said this is about all Americans and making the democratic process in the US "better and fair."
He promised that while this may start in New York, it's not going to end there.
Veterans of Iraq and Afghanistan Wars Sue New York After Being Denied the Right to Vote is republished as part of The Fulcrum’s partnership with IVN and the Latino News Network to expand voter‑first journalism and strengthen public‑centered coverage of democracy.
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AI Agents Could Save Lives—If We Let Them
Oct 13, 2026
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.
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Self-Governance: America’s Last Defense Against Executive Overreach
Oct 13, 2026
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.
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