Start by ensuring everyone is operating with the same context.

     

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My subjective feelings aside, I noticed my “why me” reaction and sat with it for a moment.

Three years ago, I accidentally drove past a stop sign on a similarly quiet road. The officer was kind, understood it was a genuine mistake, and sent me on my way without a ticket*.

I’m pretty sure I didn’t dwell on that stroke of luck anywhere near as long as I dwelt on this one.

It’s easy to ask “why me” when misfortune strikes. If we find ourselves stuck in that loop, it’s worth reflecting on the many times good fortune came our way — and we never thought to ask the question at all.

*I was clearly due a ticket from a karmic perspective. :-)

     

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It was hard not to see the parallel in this year’s NBA Finals between the Spurs and the Knicks.

The Spurs led in the first quarter of every game. Across the series, they outscored the Knicks by nearly sixty points in first quarters. And yet the Knicks won four out of five — because when it came to the second half, and especially the fourth quarter, they were a different team. By Game 5, down ten in the fourth, they went on a ten-nothing run and it felt inevitable. You just knew they were going to come through.

The Chicago Bulls had the same journey. Years of being unable to get past the Detroit Pistons before they finally summoned the ability to rise to the occasion.

There are really only two things that build clutch. Practice hard enough that it becomes second nature. And learn to embrace the big moment rather than shrink from it.

We don’t face NBA Finals. But we face big meetings, big weeks, big decisions. And in the long run, the ability to show up in those clutch moments that add up.

     

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The wider we expand that circle of assumed good intent, the more likely we are to find community wherever we choose to spend time.

And it’s why love is a verb. Especially in relationships that have lasted a long time, it’s easy to forget to choose it. To fall into patterns where all we see are the quirks, all we feel is the friction. Reminding ourselves of the intent takes real commitment.

It is why it takes commitment and character to consistently choose to love.

     

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Input is a perspective worth considering. An allergic reaction is something stronger — a signal that something is fundamentally wrong for that person.

Focus your group time on the allergic reactions. Deal with input async.

     

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Across the last few posts, one institution kept appearing as the immovable object in American healthcare — the American Medical Association. They killed Truman’s universal coverage plan with a fabricated Lenin quote. They tried to shut down Kaiser’s shipyard health plan by barring his doctors from existing hospitals. They called both “socialized medicine.”

To understand how a professional association accumulated that kind of power, we need to go back to 1910. To a report written by a man who had never treated a single patient in his life.

In the early 1900s, American medicine was chaotic. Medical schools resembled today’s for-profit colleges. There were no common standards for curriculum or matriculation. Many didn’t require students to have a high school diploma, and only the most elite programs took more than a year to complete. In 1904, there were 160 medical schools. The word “quack” was in common use.

The AMA had been pushing for standardization for years — but their conclusions carried the smell of self-interest. They needed an outside voice.

They found him in Abraham Flexner. He was not a doctor. He held a Bachelor of Arts degree and ran a for-profit school in Louisville, Kentucky. The Carnegie Foundation hired him to survey every medical school in North America. He visited all 155.

What he found was damning — students with no clinical training, schools admitting anyone who could pay fees, facilities barely functional. His 1910 report called for a complete restructuring: all schools connected to universities, two years of basic science followed by two years of clinical training, rigorous admissions standards. The model he described is still the foundation of American medical education today.

The results were swift. By 1920 there were 85 medical schools — down from 160. By 1935, more than half had merged or closed. The survivors were stronger, better funded, university-affiliated.

But something else happened alongside the quality improvement.

Fewer schools meant fewer doctors. Fewer doctors meant less competition and higher fees. Standardized licensing, controlled by state boards the AMA influenced, gave the profession a gatekeeper it had never had before. The reform that cleaned up American medicine simultaneously handed the AMA extraordinary control over who could enter it.

The report had other unintended consequences. For example, the cost of the report fell disproportionately on Black Americans as well. In 1910, there were seven historically Black medical colleges. They existed because mainstream schools almost universally refused to admit Black students. These institutions trained the doctors who served Black communities — communities that had no other access to care.

Flexner recommended closing five of them, saying only Howard University in Washington DC and Meharry Medical College in Nashville were worth developing. Five schools closed. Estimates suggest those institutions might have trained between 30,000 and 35,000 Black physicians over the following century. No new Black medical school opened between 1920 and 1987, when Morehouse School of Medicine opened in Atlanta. The AMA’s own local chapters prohibited Black doctors from membership well into the late 1960s.

This is what makes the story of American Healthcare fascinating. The Flexner Report genuinely improved American medical education. It built the scientific foundation that made the US a world leader in research and innovation — the breakthroughs in cancer treatment, vaccines, and medical technology that appear later in this series all rest on the infrastructure it helped create.

And it concentrated power, reduced access, and closed the schools serving communities the mainstream profession had no interest in serving.

The AMA that killed Truman’s plan, that attacked Kaiser, that shaped American healthcare policy for most of the twentieth century — that institution’s authority runs directly through 1910. Through a report written by a schoolteacher from Louisville, funded by Carnegie, embraced by an establishment that understood that controlling the supply of doctors was the foundation of everything else.

Paul Starr’s quote “The dream of reason did not take power into account” is an apt place to end today’s story.

     

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But the most intriguing thing about these majestic giants isn’t their height. A four-hundred-foot tall redwood has roots only eight to twelve feet deep. What keeps them standing is that those roots spread up to two hundred feet outward — intertwining with the roots of neighboring trees, connected through mycelium, sharing nutrients, holding each other steady, supporting the younger ones still growing.

Their survival isn’t a solo act. It takes a village.

For a species so rare and so majestic, it’s a beautiful reminder of what it actually takes to survive on this planet.

     

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The hard kind is creating an environment where they can actually thrive — where they have the tools and resources to get important things done without being hampered by bureaucracy and red tape.

     

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One word explains most of it: momentum.

I think about it every time something disrupts my routine. A good run of exercising, eating well, staying on track — and then travel, or something else, gets in the way.

Momentum is so easy to lose. And yet so powerful when you have it, because every move builds on the previous one.

It’s an ally when you can use it. An archenemy when you lose it.

The helpful reframe for me is that when the odds feel difficult, you don’t have to worry about the end. You just have to shift the momentum. Focus on the next thing that builds it, then the next. Keep going.

Just like the Knicks did.

     

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Smith recently shared a study that puts hard numbers behind that idea.

Researchers at NBER used a clever natural experiment: the iPhone launched in 2007 exclusively on AT&T through early 2011. That carrier exclusivity created geographic variation — some areas had coverage, others didn’t — allowing them to isolate the smartphone’s effect on birth rates.

The results are striking. iPhone access reduced births by 4.5–8% among 15–19 year olds and 3.2–6.6% among 20–24 year olds. Overall, the diffusion of the iPhone explains 33–52% of the entire decline in the U.S. fertility rate since 2007 among women aged 15–44.

The mechanism the researchers point to: less in-person interaction, more pornography use, less sexual frequency.

Sadly, it all makes intuitive sense. And birth control is likely just the tip of the iceberg.

And while it is easy to point to everyone else, the first place to examine at is our own phone habits.

     

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