Cyberterrorism: Will Russia, China and/or ISIS turn off our electrical power?

We just got this press release about an important conference on Newport. 

Two of the best-known publishers of energy newsletters, Sam Spencer, who publishes Smart Grid Today and Power Markets Today and Llewellyn King, who founded The Energy Daily and produces and hosts White House Chronicle, on PBS, are teaming up with the Pell Center at Salve Regina University on a comprehensive conference on cybersecurity in the utility industry. 

“Grid cybersecurity is one of the critical frontiers in the security of the U.S. infrastructure system,” King said.

The conference will be held Sept. 26-29, 2016 at Salve Regina University in Newport.  “In this scholarly setting the industry can learn best practices; cybersecurity vendors and others can get down to granular issues that aren’t easily discussed in the office setting,” Spencer said.

The “Newport Conference” will bring together utility IT officers, managers, first responder teams as well as vendors of firewalls, alarms and other security systems for utilities.

“The utility industry is undergoing great changes in its structure. It is being reshaped by disruptive technologies, environmental pressures and social expectations.

“More and more, the old grid is giving way to the new grid in a sophisticated, computer-dominated world where the enemy could be in any line of code, any weak link in the industry,” Spencer said.

King added: “The first goal of modern warfare is to take out the electrical supply, and the rest follows from there. As a result, those who wish to do harm to a country — and to the United States, in particular — are aware that without electricity, a great nation is paralyzed.”

He said that he saw the precursor to this kind of havoc back in 1965, when most of the Northeast went dark. That was incredible but today, with more reliance on electricity throughout the life of the nation, things would be even worse.

King and Spencer said enemies, both state and non-state (like ISIS), are hard at work probing our cyber-defenses, seeking weakness and waiting to strike.

“We want to advance the understanding of the threat as well as to ensure that the best practices in cybersecurity are being followed as the grid itself changes into something new and even more electronically interconnected than in the past,” they said.

For sponsorship and registration information, please contact Llewellyn King at 1-202-662-9731 or 1-202-441-2702, or e-mail him at llewellynking1@gmail.com.

Robert Whitcomb: FBI right about terrorist's iPhone

The U.S. government has the stronger argument in its battle with Apple over obtaining access to possible information about terrorism in the iPhone of Syed Rozwab Farook. That Islamic fanatic and his wife, Tashfeen Malik, murdered 14 people in San Bernardino, Calif., last Dec. 2 before police killed them.

The fact is, as Microsoft founder Bill Gates told the Financial Times, “This is a specific (emphasis is mine} case where the government is asking for access to information.’’

 “They are not asking for some general thing; they are asking for a particular case.”

“It is no different than [the question of] should anybody ever have been able to tell the phone company to get information, should anybody be able to get at bank records” to investigate a crime, Mr. Gates added. 

The government's case, backed by a federal judge, rests on  long-established law holding that "no item -- not a home, not a file cabinet and not a smartphone -- lies beyond the reach of a judicial search warrant"  in investigating crimes, Manhattan District Atty. Cyrus Vance has noted.

There exists no "right of privacy" to withhold evidence of a crime. The idea that the cellphone is a privileged device off-limits to law enforcement is absurd.

U.S. Magistrate Judge Sheri Pym is not telling Apple to create a “backdoor’’ that puts all users in new danger of being electronically violated. She has told Apple to help the FBI get into a single iPhone to obtain information that might save people from being murdered by ISIS-related terrorists.

We don’t want to break anyone’s encryption or set a master key loose on the land,” FBI Director James Comey has said.

Judge Pym has ordered Apple to create temporary software to let the FBI try many passwords on the phone without its data disappearing, which it normally would after 10 tries because of the company’s security walls.

Apple chief executive Tim Cook complains that such a “backdoor” could be used on other phones. But it stands to reason that Apple could control its software to unlock specific  devices, after the government obtained warrants detailing compelling circumstances.

Apple’s hypocrisy in this is impressive.

Consider its close cooperation with China, a police state. There, Apple has moved its local user data onto servers run by state-owned China Telecom, which mines such information with abandon. And Apple submits to security audits by Chinese officials. But then, Apple hopes to continue enjoying 40 percent profit margins by expanding further in China -- the company’s second-largest market.

Apple – at least for public consumption -- worries that if the U.S. government forces it to let authorities into Farook’s phone that China will demand the same right, which might scare away some potential iPhone buyers there. But there’s little indication that Apple will not continue giving the dictatorship whatever it wants.

James Lewis, a senior fellow at the Center for Strategic and International Studies, noted in the Los Angeles Times:

"What's driving this is Apple's desire to persuade the global market, and particularly the China market, that the FBI can't just stroll in and ask for data.  {But} I can't imagine the Chinese would tolerate end-to-end encryption or a refusal to cooperate with their police, particularly in a terrorism case."

Law enforcement must have the tools to keep up with criminals, who increasingly use such tools as encryption, Bitcoin currency and disappearing messages. In this case, Apple, rather than worrying that the publicity connected with letting the U.S. government get into a criminal’s cellphone might hurt profits, should focus on saving lives. (Do tech execs, shielded by wealth and gated communities, not feelquite as threatened by terrorists as the poorer people (e.g., in San Bernardino) who are usually the victims?)

Meanwhile, let’s worry more about how private-sector organizations such as Apple, Microsoft,  Google and Yahoo, invade our privacy and follow us wherever we go. As Fortune magazine columnist Stanley Bing wrote: “It's just the beginning, guys. Every breath you take. Every move you make. Every bond you break, every step you take, Apple will be watching you.’’

Robert Whitcomb, a fellow of the Pell Center for International Relations and Public Policy, in Newport, R.I., is overseer of New England Diary and a former editor at the International Herald Tribune and The Wall Street Journal.

Robert Whitcomb: In the Amazon jungle

 

Amazon is an impressive if rather creepy company, with its style set by its cold, “data-driven’’ founder/CEO, Jeff Bezos. An Aug. 15 New York Times piece, “Inside Amazon,’’ laid out the travails of the monopolistic and Darwinian enterprise’s white-collar workforce. Their issues have gotten more attention than the much worse Dickensian conditions of the blue-collar employees in its warehouses and the company’s relentless accumulation, like the also Orwellian Google’s, of our personal information. Amazonianism’s causes?

One is in the mirror. Americans have grown addicted to buying stuff online -- of course, the cheaper the better. They seem to want to avoid face-to-face interactions in stores -- and community engagement in general -- and Amazon’s power ensures that they’ll get low prices, at least for now (see below), even as their local stores close because of such online competition.

The preference for communicating via screens rather than person-to-person is especially common among the young, who grew up in the Internet Age. Human-resource managers have told me that young job applicants often don’t look them in the eye because in-person encounters make them anxious.

The disappearance of many well-paying jobs, and static (or worse) compensation except for top executives and investors, have encouraged consumers to seek out cheaper stuff than a few decades ago. But – irony of ironies! – Amazon and other high-tech automators have helped destroy good U.S. jobs in their “data-driven’’ mania to take full advantage of the international low-wage, cheap-goods machine.

Physical-store chains such as CVS and Home Depot are doing their bit to kill jobs --- by, for instance, installing automatic checkouts. I try to boycott stores with these machines because I know that each means the loss of another entry-level or second job for someone who needs it. This makes me feel better for a few minutes.

If Amazon’s workplace brutalities offend some consumers, they could resume shopping in their own communities and thus help employ some of their neighbors. Most won’t.

And look to Washington, where ideology and campaign contributions ensure that the Justice Department’s Antitrust Division doesn’t go after such monopolies as Amazon and Google. Until about 1980, Republican and Democratic administrations actually enforced laws against monopoly. The long disinclination to do so will hit consumers hard when Amazon, which has been undercutting other retailers to gain maximum market share, killing many brick-and-mortar competitors, suddenly jacks up prices big time.

Also consider the collapse of the private-sector union movement. If there were unions at Amazon, the Third World work environment would quickly go away. Gilded Age working conditions helped spawn the union movement in the first place. Now, management’s utter dominance has employees ready to put up with anything to keep their jobs.

Meanwhile, the “Big Data’’ revolution is turning workers into organic robots, soon to be replaced by real, inorganic robots. When every move of workers is measured for maximum productivity and profit potential, as at Amazon, kindly treatment of employees pretty much disappears. Employees are mere data points.

This process started with assembly-line and other blue-collar workers. The generally affluent types who read, say, The New York Times didn’t care that much. But turning employees into metrics is now heading rapidly up the food chain. Physicians, lawyers, tech engineers, middle managers and journalists (monitored for the number of Internet clicks their work gets) are being measured daily by senior executives who see their employees as entirely fungible and disposable.

And don’t expect the executive suite to share the riches from this speed-up with lower-level employees. The tendency for more and more of the wealth of companies to be shared by fewer and fewer people continues apace. We’re on a selfishness wave.

Amazon has created a fascinating machine for distributing goods. (Its delivery drones are next -- maybe equipped with surveillance gear?) Mike Daisey, writing in The Guardian (“Amazon’s brutal work culture will stay: bottom lines matter more than people,’’ Aug. 22), quoted comedian Louis C.K. as saying about such enterprises that “everything’s amazing and nobody’s happy’’ . Well, some are.

Anyway, most Americans seem to adore Amazon, which will repay them good and hard.

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Lovely dim late-summer light today, and  leaves are falling off the plane trees from sheer exhaustion.

Robert Whitcomb (rwhitcomb51@gmail.com) is a  Providence-based editor and writer, a partner at Cambridge Management Group (cmg625.com) and a Fellow of the Pell Center, in Newport, He used to be the editorial-page editor of The Providence Journal, the finance editor of the International Herald Tribune and an editor at The Wall Street Journal, among other jobs.

Robert Whitcomb: Drawbacks of deregulation and DIY

  For years, deregulation and the Internet have been pulling us into a more decentralized and freelance economy, in which there’s wider consumer choice, albeit with stagnant pay and a decline in person-to-person service that forces us to do more tasks ourselves that were previously done by those dinosaurs called “employees’’.

Consider Uber. As I discovered when one of my daughters pulled out her iPhone a couple of years ago on a busy Manhattan street to summon an Uber driver, it’s sometimes faster to find one of these mobile freelancers than it is to find a regulated Yellow Cab in a big city.

But the cabs, being regulated, function as a public utility. They have to meet certain basic minimums of availability, cleanliness and safety that can’t be imposed on the likes of Uber, whose drivers are, of course, not obligated to provide services in the same way as cabbies. I don’t think that we want unregulated drivers to totally replace generally reliable and regulated cabbies.

Long before Uber, of course, there was the partial deregulation of the airlines. While this led initially to lower prices for many travelers, it has also made travel more chaotic and unpredictable. And deregulation, the “Hub-and-Spoke’’ system and relentless airline mergers mean that mid-size cities get shorted on flights.

While better electronics systems make planes less likely to crash these days than three decades ago, air travel itself is increasingly miserable.

In the old, tightly regulated days, figuring out airline schedules and fares was comparatively easy. Now it’s an ordeal, and conditions within airplanes are increasingly crowded and unhealthy. And as the airlines, like other businesses, seek to outsource service to computers so that they can lay off more people, addressing problems by communicating with customer-service humans gets tougher.

Then there’s the new do-it-yourself, deregulated and decentralized energy world. Consider that many affluent folks are saving money and reducing their carbon footprints by having solar panels installed on their roofs. Good in itself! But this takes business away from the utility companies, which could jeopardize the viability of the huge electric grids that utilities maintain. We’ll continue to need that grid to support modern society, with its ever-increasing supply of electronic devices.

Might not it be better if we put more focus on producing green electricity with huge solar-panel arrays and wind-turbine farms maintained by utilities that serve everyone – rich and poor?

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The Obama administration has worked very hard to craft a deal with Iran to try to get it to at least postpone continued work on nuclear weapons.

But the administration’s effort will probably turn out to have been in vain. For one thing, the corrupt theocratic dictatorship that runs Iran will cheat and cheat as it evades inspections. It may receive technical help in this cheating from the likes of fellow police states Russia and China, two of the signatories to the nuclear deal, which will happily sell them militarily useful stuff.

Iran will almost certainly use the billions of dollars freed up by the ending of economic sanctions to increase its troublemaking. Iran’s regime seeks to dominate the Mideast – partly to protect and promote its fellow Shiites and partly because domination is fun and profitable for its leaders. And Tehran hasn’t really toned down its “Death to America and Israel’’ rhetoric.

Now we have made the mullahs more macho. No wonder Iran’s neighborhood is scared.

Some complain that America, as the first nuclear power, is hypocritical in trying to keep nuclear weapons out of the hands of other nations. That seeks to make an equivalence between a democratic nation like America and a dictatorship like Iran. And remember why we started our nuclear-weapons program in the first place – to defend ourselves from Germany’s mass-murdering Nazi regime, which was working hard to create an atomic bomb.

Some say that expanding trade with Iran will somehow make it kindlier. They said that about Germany before World War I and China now. Nations have other reasons besides economics to be nasty – for instance, paranoia, power for the sake of power and religion.

Robert Whitcomb (rwhitcomb51@gmail.com) oversees New England Diary. He's also a Fellow at the Pell Center, in Newport, and a partner at Cambridge Management Group (cmg625.com), a healthcare-sector consultancy. He used to be the editorial-page editor of The Providence Journal, the finance editor of the International Herald Tribune and an editor at The Wall Street Journal, among other jobs.

Robert Whitcomb: Health-care beacons, Snowden, our big river

The Connecticut River at Orford, N.H. (See item at bottom.)

Much of American health care’s future can be seen in two synergistic kinds of institutions in Rhode Island.

One is Federally Qualified Health Centers (FQHCs). These facilities, set up around America, provide a wide range of free and insurance-subsidized clinical help for millions of patients, most of them low-income. The other is Johnson & Wales University’s spanking new Center for Physician Assistant Studies.

Consider the state’s biggest FQHC organization -- Providence Community Health Centers (PCHC). Its teams of physicians and other clinicians, such as nurses and nurse practitioners, work for what is the biggest single provider of primary-care services in Providence, with more than 35,000 patients. (I toured PCHC’s immaculate Prairie Avenue campus the other week, led by Merrill Thomas, its CEO, and Jane Hayward, the Rhode Island Health Center Association’s president.)

PCHC ‘s mission, it says, is to “provide neighborhood-based high quality and accessible primary medical care to improve the health status of the residents of Providence and surrounding communities regardless of their ability to pay.’’ FQHCs play especially important roles in inner cities and impoverished rural areas, such as Appalachia, where many physicians don’t want to practice, especially because of low reimbursement and so many difficult cases involving seemingly intractable behavioral-health issues.

Expanding primary care -- especially preventive care -- is essential if America is to improve overall health outcomes that are near the bottom of the Developed World while better controlling medical costs, which are the highest.

Whatever happens with the Affordable Care Act, the U.S. population’s aging (older means sicker); the daunting complexity of our health-insurance system; the permanent exit of many well-paying jobs; emigration to the United States of low-income people, and the decline of the stable, two-resident-parent family suggest that Federally Qualified Health Centers ought to play even bigger roles.

Of course, increasing the numbers of primary-care clinicians is essential for the long-term success of these clinics. Doing just that is the Johnson & Wales Center for Physician Assistant Studies, which has a beautiful building in Providence’s Jewelry District.  George Bottomley, its director, gave  me a tour the other week.

Its 24-month master’s program addresses the need to train many more non-physician clinicians who can perform highly professionally and cost-effectively some of the tasks now performed by over-worked (if highly paid) doctors. PAs are especially useful in getting patients to make the behavioral changes needed to prevent serious illness, in part because they can generally spend more time with patients than can physicians; many of the latter are more harried than ever because of onerous electronic-health-record duties and administrative pressures to boost patient volume.

J&W notes that PAs work in integrated medical teams to “provide diagnostic, therapeutic and preventive health-care services.’’ (By the way, the differences between physician assistants and nurse practitioners mostly involve some education details. They’re very similar professions.)

With physicians as supervisors, physician assistants take patients’ histories and perform exams; order lab tests; prescribe medications; diagnose illnesses; develop treatment plans, and counsel and educate patients.

No wonder that demand for PAs is surging. Forbes.com has listed Physician Assistant Studies as the “No. 1 Best Master’s Degree for Jobs.’’ The American Academy of Physician Assistants (AAPA.org) says that “demand for physician assistants and nurse practitioners rose by more than 300 percent in the last three years.’’

We’ll need Johnson & Wales PAs in droves in coming years as, technology, demographics and new cost controls continue to transform U.S. health care for all patients, especially in primary care, in which physician assistants will be at the forefront.

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Edward Snowden – as a Russian spy and/or as an arrogant but naïve narcissist-- has provided vast amounts of U.S. security information to Vladimir Putin’s police state, perhaps resulting in the death of agents working for us. And he has aided the Chinese dictatorship’s relentless cyber-warfare against America. Some hero!

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Last week we cruised the gorgeous Upper Connecticut River on a pontoon boat. Because it’s by far New England’s biggest river, on it you get a sense of what Mark Twain might have felt on the Mississippi. We yakked desultorily in the soft breeze about big projects we’d do – as if we were 30 years younger than we are.

Robert Whitcomb (rwhitcomb51@gmail.com), overseer of New England  Diary, is a partner in  Cambridge Management Group (cmg625.com), a healthcare-sector consultancy, and a fellow of the Pell Center for International Relations and Public Policy.

Robert Whitcomb: Oregon points to better Medicaid

  Unsurprisingly, Rhode Island Gov. Gina Raimondo is getting pushback from interest groups against her goal of “reinventing Medicaid’’ – the federal-state program for the poor. The Ocean State’s Medicaid costs are America’s second-highest per enrollee (Alaska is first) and 60 percent higher than the national average.

Many in the nursing-home and hospital industries will fight the governor’s effort to cut costs even if it can be shown that her plan can simultaneously improve care. After all, the current version of Medicaid has been very lucrative for many in those businesses. The Affordable Care Act has brought them even more money.

As we watch her plan unfold, let’s be very skeptical when we hear lobbyists for the healthcare industry and unions asserting that reform would hurt patients. Lobbyists are adept at getting the public to conflate the economic welfare of a sector’s executives, other employees and owners with its customers’. Ambrose Bierce called politics “a strife of interests masquerading as a contest of principles.’’ Often true!

So “nonprofit’’ Lifespan, the state’s largest hospital system, has just hired eight lobbyists to work the General Assembly to defend its interests. (And beware healthcare executives’ citing their businesses’ “nonprofit’’ status. Many of these enterprises take their profit in huge executive compensation.) Some unions are also on the warpath. They worry that reform to reduce the overcharging, waste and duplication pervasive in U.S. health care might reduce the number of jobs.

But economic and demographic reality (including an aging population, widening income inequality and employers’ eliminating their workers’ group insurance) make Medicaid “reinvention’’ mandatory as more patients flood in.

Oregon provides a model of how to do it.

There, in an initiative led by former Gov. John Kitzhaber,  M.D., an emergency-room physician, the state has both improved care and controlled costs. It did so by creating 16 regional coordinated-care organizations (CCO’s). The state doesn’t pay for each service performed but gives each CCO a “global budget’’ of Medicaid funds to spend. The emphasis is on having a range of providers work with each other to create holistic treatment plans for patients that include the social determinants of health (such as access to transportation and housing quality) as well as patients’ presenting symptoms.

Oregon’s “fee for value’’ approach rewards providers for meeting performance metrics for quality and efficiency and punishes them for poor outcomes and increased costs.

Oregon CCO’s have great flexibility in spending Medicaid money. For example, they could use it to buy patients air conditioners, which may make it less likely that they’ll show up in the E.R. And Oregon CCO’s pay much attention to how behavioral and mental problems can lead to the more obviously physical manifestations of illness. After all, many in our health-care “system’’ “self-medicate’’ through smoking, drinking, drugs, eating unhealthy food and lack of exercise. You see many of these people again and again in the E.R. –wheezing from smoking and obese.

In Rhode Island, 7 percent of Medicaid beneficiaries account for two-thirds of the spending; many of these “frequent fliers’’ have mental and behavioral health problems best addressed through Oregon-style coordinated care.

Unlike the Oregon approach, the “fee for service’’ system that’s still dominant in U.S. health care encourages hospitals and clinicians to order as many expensive procedures as possible, prescribe the most expensive pills and do other things to maximize profit – and send the bills to the taxpayers, the private insurers and the patients.

But “evidence-based medicine’’ -- as opposed to “reputation-based medicine’’’ -- has helped to show that doing more procedures does not necessarily translate into better outcomes; indeed overtreatment can be lethal. I recommend Dr. H. Gilbert Welch’s book “Less Medicine/More Health’’.

Meanwhile, Oregon points the way:

Among the Oregon Medicaid reform’s achievements: a 5.7 percent drop in inpatient costs; a 21 percent drop in E.R. use (which is always very expensive), and an 11.1 percent drop in maternity costs, largely because of hospitals not performing elective early deliveries before 39 weeks of pregnancy. Thus Oregon officials assert that the state can reach its goal of saving $11 billion in Medicaid costs over 10 years.

Rhode Island can achieve similar successes.

Robert Whitcomb (rwhitcomb51@gmail.com), overseer of New England Diary, is a Providence-based editor and writer and a partner  in Cambridge Management Group (cmg625.com), a national healthcare-sector consultancy. He's also a Fellow of the Pell Center for International Relations and Public Policy.

Robert Whitcomb: Still Golden State; Medicaid reform

  While driving around Los Angeles’s vastness last week, I kept getting a déjà vu feeling, and not just because I’d been in L.A. before.

My trip reminded me of motoring in the ‘60s, even in the Northeast, with the new and still mostly uncrowded Interstates, cheap gasoline and capacious sense of freedom so that you’d think nothing of jumping into your car, be it a beat-up Chevy or a death-trap VW bug (with the gas tank over your lap), and happily drive for hours to vague destinations.

There’s lots of color in my memories, but also black and white, as in those old Perry Mason and Dragnet shows set in  ‘50’s  L.A. They and the many films noirs shot in California (e.g., The Big Sleep) recall Somerset Maugham’s calling the French Riviera a “sunny place for shady people.’’

Southern California is preposterous:  mountains covered with highly flammable brush and an earthquake-vulnerable desert made to bloom with water diverted/stolen from the Sierra.

And yet, as I GPS’ed from Pasadena and the hip neighborhoods of Silver Lake and Mount Washington across Beverly Hills and out to the farthest points in Malibu, I saw few signs that people were worried.

Lots of water is still being wasted to evaporation via sprinklers and always-uncovered swimming pools – which seem to play more of an aesthetic than an exercise or cooling-off role. A few cars have stickers with which owners laud themselves for saving water by not washing their vehicles, but most seemed recently washed. You view only a few more cactus gardens and a tad fewer fantastically green lawns than two decades ago.

The state is starting to crack down on water waste with big fines, but it can only be the beginning, assuming that the statewide drought continues.

And yet, young people, many fleeing New York’s frigid winters, sweltering summers  and astronomical rents are pouring into Los Angeles these days, drawn by the  Mediterranean climate, cheaper  and more spacious housing and a very contemporary  species of decentralized creativity. (Few have read Nathanael West’s dystopian L.A. novel, Day of the Locusts.)

They love Californians’ ingenuity, most famously in recent decades in Silicon Valley but all over the state, as well as its style, much more relaxed than the Northeast’s.

The innovative spirit seems to overcome pessimism and anxiety about drought, general environmental destruction, earthquakes and illegal aliens crossing the border from Mexico.

So California remains the Golden State, the quintessence of the American Dream.

Whether even worse drought, a big quake or a surge in gasoline prices would end car-dependent Los Angeles’s latest boom is unknowable. In any event, mass transit is being expanded. Yes, you can take light rail in the City of Angeles.

This reinvention ethos also characterizes New England, with its ‘er, vigorous climate and rocky soil. Especially in Greater Boston, the capacity to churn out inventions keeps saving our region’s economy, albeit with the occasional recession.

Of course, Southern California has a sunny climate. But we have lots of fresh water, which in the long run is even better. Still, I now think that the Golden State has enough Hollywood and Silicon Valley risk-taking inventiveness to assure its long-term prosperity.  Giant solar-powered desalinization plants on the Paramount lot?

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Kudos to Rhode Island Gov. Gina Raimondo for tackling waste in the state Medicaid program. Oregon provides a model of how to do this. Medicare is a much bigger national cost problem for America but harder to control: The old have better lobbyists than the poor.

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Rachel Held Evans’s  Washington Post piece, “Want Millennials back in the pews? Stop trying to make church ‘cool’’’ was spot-on.  Trying to maintain religion through trendy marketing is doomed.  We seek ritual that resists the gyrations of modern commercial culture.  We want the permanent and the transcendent to help maintain our sanity.

Even if we don’t believe the theology, we’ll take, say, The Book of Common Prayer over a Facebook “spirituality’’. The faster that technology and the consumer economy go, the more we need the quietly “traditional.’’

Robert Whitcomb (rwhitcomb51@gmail.com), overseer of newenglanddiary.com, is a Providence-based editor and writer, a partner in a health-care-sector consultancy, Cambridge Management Group (cmg625.com) and a Fellow of the Pell Center for International Relations and Public Policy.

Robert Whitcomb: Where we can win; childlessness; water wars

  The metastasizing Mideast chaos and violence have shown yet again the limitations of American power there. We’re backing and opposing groups in a fluctuating toxic religious, ethnic, tribal and national stew and frequently contradicting ourselves as we do.

Some neo-cons want us to go in with massive military intervention. We tried that. Now consider that the Sunni fanatics called ISIS use American weaponry captured from the Iraqi “army’’ to attack “Iraq’’ -- whatever that is -- an ally of longtime U.S. enemy Iran, which has joined in the melee against ISIS, even as Sunni Saudi Arabia fights its long-time foe and fellow dictatorship Shiite Iran in Yemen. And in Libya and Syria, the civil wars go on and on in permutations and combinations.

The U.S. must occasionally act quickly in the Mideast to rescue its compatriots and to protect the region’s only real democracy – Israel. But after all this time, we should know that the Mideast has so much confusion, fanaticism and corruption that a heavier U.S. role won’t make things better. The best we can do is to marginalize the region as much as possible, such as by reducing the importance of Mideast fossil fuel by turning more to renewable energy in America and Europe, while, yes, fracking for more gas and oil.

We must focus more on Europe, where a scary situation is much clearer. Our Mideast projects have dangerously diverted resources from countering the far greater threat to our interests posed by Vladimir Putin’s mobster Russian regime.

Now that it has seized Crimea from Ukraine and occupied a big slice of the eastern part of that large democracy, Putin’s fascist police state is firing off yet more threats to “protect’’ ethnic Russians in what he calls “The Russian World’’ (i.e., the old Soviet Empire) from bogus “persecution’’ by the majority population in the Baltic States and Poland -- NATO members and democracies. Latvia is coming under particularly hard Russian pressure now. Hitler used the same strategy against Czechoslovakia with the Sudeten Germans. It’s past time to re-energize NATO to thwart Russian aggressio

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Regarding an April 4 New York Times story headlined “No Kids for Me, Thanks’’:

My mysterious father used to say ruefully that “your friends you can pick, your family you’re stuck with.’’ He had five children.

From observing my childless friends, I’d say that contrary to an old social cliché, they are generally happier than those who have children – so far. A simple reason: They have more money, time and freedom to do what they want.

Arthur Stone, a professor of psychiatry at Stony Brook University who’s co-authored a study comparing childless adults’ happiness and those with kids told CNN: “They {parents} have higher highs. They have more joy in their lives, but also they have more stress and negative emotions as well.’’

CNN said he found “little difference" between “the life satisfaction of parents and people without kids, once other factors -- such as income, education, religion and health -- were factored out.’’ Yes, but how do you ‘’factor out’’ income? Paying for children causes a lot of anxiety.

People tend to be more self-absorbed these days, and so less enthusiastic about sacrificing so much for, say, children. But this presents a problem that some childless Baby Boomers are already experiencing: Who will take care of them when they get really old? If they think that younger friends will feel as compelled to squire them through old age as their children, they’re in Fantasyland.

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The California dream of always-green lawns in McMansion developments in the desert is being revised as drought deepens. (Probably global warming.) The land of Silicon Valley, Cal Tech and Hollywood has more than enough intellectual firepower to address the conservation challenge. (“Dehydrated water – just add water’’?) However, don’t expect many new L.A. Basin golf courses. Californians will see more cactus and less lawn. Meanwhile, places with lots of fresh water -- e.g., New England and the Pacific Northwest – may now be in a better competitive position.

Regarding Golden State water-wars, see the movie “Chinatown’’.

Robert Whitcomb  (rwhitcomb51@gmail.com) oversees New England Diary. He's a partner at Cambridge Management Group (cmg625.com), a healthcare-sector consultancy, a  Fellow at the Pell Center for International Relations and Public Policy, a former finance editor of the International Herald Tribune, a former editorial-page editor and a vice president at The Providence Journal and a former editor at The Wall Street Journal. 

Robert Whitcomb: Hospitals should be insurers, too

  This piece first ran in the Huffington Post.

Steven Brill's latest book, America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, has gotten a lot of attention in large part because of Mr. Brill's vivid anecdotes about the "jalopy'' of American health care. They're memorable stories, gathered with his famous work ethic and intense curiosity, though there's a bit too much about his own deluxe heart-surgery adventures at Manhattan's very expensive New York-Presbyterian Hospital, which comprises some of the narrative glue of this book.

(I found my own open-heart surgery a couple of years ago to be tedium interspersed by fantastical hospital "chargemaster'' billing. A doctor friend told me that the bills had little connection to the reality of the final  total bill.)

Since we're all healthcare consumers, it would be nice, even in this post-literate society, if most adults read this book, to see how their money is being spent. Mr. Brill brings a lot of transparency to this all-too-opaque sector.

Mr. Brill is a rich entrepreneur and journalist and very much a member of the elite, luminaries of which he has easy access to. But he also displays strong compassion for the low- and middle-income people with whom he talks. Many of these folks have a brutal time paying for essential care (especially the unexpected kind) and navigating the obscenely complicated and contradictory U.S. healthcare "system''. His richly reported book provides a colorful, disturbing and occasionally encouraging look at our medical maze.

It's also a sort of thriller about the near-death saga of getting the Affordable Care Act enacted amidst relentless lobbying and political conflicts of interest. Then comes the Obama administration's efforts to recover from the disastrous launch of the HealthCare.gov website. Mr. Brill provides a heartening counter-example by telling us about the triumph of healthcare reform in -- perhaps surprisingly -- the Red State of Kentucky.

Most readers are at least vaguely aware of the institutionalized squalor of much Washington lobbying by some healthcare constituencies, and Steven Brill doesn't stint on telling us more about that. One recalls the famous line by Otto von Bismarck to the effect: "Like sausage-making, you don't want to see how laws are made.''

But there aren't many big surprises, except perhaps that you may find from reading this book that the profiteering by the pharmaceutical and medical-device industries -- for which the public pays much -- is even more extreme than you thought.

Meanwhile, there hasn't been nearly enough comment on his very good ideas to improve the ''system's'' egregious lack of coordination, reduce its gigantic costs and even improve medical outcomes, of all things.

In my view, his most interesting proposals are to encourage more hospital systems to get bigger (and hence to offer broader population-health care and better, most cost-efficient care of individual patients, especially the chronically ill) and to be insurance companies as well as care providers.

And in fact more and more systems have been getting into the insurance business in recent years. It may be the best way to incentivize both care coordination and cost control. Most of hospitals' and their clinicians' financial incentives to over-treat and over-test would disappear if the hospitals were also stuck with the claims costs!

Mr. Brill emphasizes what most people in the public don't seem to get: That hospitals with cost-plus "chargemaster'' billing, big operating profits and hugely compensated senior execs have driven much of the health-cost surge. That very much includes the "nonprofit'' hospitals, many of which are hugely profitable. "Nonprofit'' usually just means that things are arranged so that these enterprises don't pay most taxes.

It is the insurance companies, with relatively small profit margins, they get unfairly blamed for just about everything in U.S. health care. (Mr. Brill would also have done well to note that U.S. physicians are by far the highest paid in the world.) Hospital-insurer mergers don't mean that all independent insurers would go away. They'd still be needed (barring extension of Medicare to everybody) to cover bills from small, independent hospitals, independent physicians and some other clinicians.

Hospital system-insurer combined entities are well-positioned to collect and analyze data about patients to improve care and better allocate resources. Indeed, Mr. Brill says, the bigger the hospital system in a region, the better opportunity a system has to coordinate a patient's care in various inpatient and outpatient venues and cut costs through efficient, expense-saving "bundling'' in treating individual patients' injuries and illnesses over time. This includes treatment at the outpatient clinics that systems are increasingly establishing as the number of inpatient beds steadily declines.

Mr. Brill quotes Jeffrey Romoff, the chief executive of the big-foot University of Pittsburgh Medical Center system, which has an insurance company, on provider-payer marriages:

"All the incentives are aligned the right way. It's the beauty of being the payer and the provider at the same time. When the interests are not aligned, it's why seniors dying of cancer get chemo when they should just get hospice care.''

Obviously the hospital systems becoming insurers take on new processing costs, but think of how much money could be saved by cutting out the third-party middleman. For one big thing, the hospital-insurance combo doesn't worry about paying dividends to insurance-company shareholders or insurance execs' multimillion-dollar salaries. And the new combos might become a little more disciplined about the hospital execs' compensation.

Mr. Brill also suggests capping operating profits of hospitals (including "nonprofit'' ones) to, say, 8 percent. While he doesn't use the term "public utility'' I was reminded of the old-fashioned model of state regulators allowing about that percentage for electricity and natural-gas utilities. Maybe it's time to look at hospitals as public utilities, which they sort of are.

This doesn't address pharmaceutical and medical-device companies' astronomical profit margins, protected by Washington lobbyists who are even more effective than the insurers' and hospitals'. They drive up healthcare costs a lot. But the increased transparency and rigor in looking at the unimpressive medical outcomes associated with some heavily marketed medicines and devices will help constrain their pricing.

Mr. Brill also wants to cap salaries of hospital executives. I'm always  leery of government micro-managing internal decision-making in nongovernmental organizations -- too clunky -- but the idea should be studied.

So let's hope that state and federal regulators don't put too many roadblocks in the way of many more hospital systems becoming insurers.

Extending Medicare to everyone might be the most cost-effective reform but economic constituencies, and ideology often divorced from macro-economic realities, in Washington will prevent that, at least for the foreseeable future.

But Mr. Brill's prescriptions could help a lot. Meanwhile, let us hope that the shrinking number of paid healthcare journalists, such as Steven Brill, do what they can to disinfect a  system with all-too-often mediocre care and exorbitant costs that threaten to bankrupt America. More sunlight equals more reform.

Robert Whitcomb (rwhitcomb51@gmail.com) is a partner and senior adviser at Cambridge Management Group (cmg625.com), a healthcare-sector consultancy, a Fellow of the Pell Center for International Relations and Public Policy and overseer of newenglanddiary.com. He's a former finance editor of the International Herald Tribune, a former editor at The Wall Street Journal and former editorial-page editor at The Providence Journal.

Robert Whitcomb: The delights of density

  Crowded American cities are generally healthier than less crowded ones -- usually safer, more interesting, more energetic, more convenient, more fun and more creative. Density is associated with higher rates of innovation and entrepreneurialism. Crowded urban cores spawn clusters of people who increase each other’s productivity via cross-fertilization of ideas.

As the late, great sociologist and city watcher William H. Whyte  told NBC News in 1987: “What makes a city great? A lot of people pretty close together. Buying, selling, talking, looking, eating.’’ Daily excitement. Reveling in a shared civic experience. “The trouble with most smaller cities is that they don’t have enough people out on the sidewalk. What they should be doing is concentrating, concentrating to get that critical mass,’’  Mr. Whyte said. (On this topic, I  particularly recommend his book “City: Rediscovering the Center’’.)

So I was happy to read a June 11 Providence Journal story headlined “Providence looks to rewrite zoning to build on a strength: Density’’.  About time! As other cities have recognized, the suburban paradigm of prioritizing parking lots and rigid zoning rules that severely separate commercial and residential areas doesn’t work well for real cities.  It doesn’t seem to work all that well in the suburbs either, as the increasing number of empty big-box stores there might suggest. Indeed, many suburban towns are trying to recreate their “village centers’’ of yore. (In the hometown of my boyhood, we’d walk or bike the three-quarters of a mile to such a center for just about everything, from candy to clothes to copies of Mad magazine. Then, big stores were built at a new shopping center near a divided highway on the edge of town with a windswept parking lot and soon there wasn’t much you could buy in the village center except overpriced lighthouse paperweights. About the same time (1959) commuter train service to the town was halted, a land-use disaster.  Now train service is back and residents lobby for more stores that they can walk to.)

Providence’s current zoning laws, like those of many cities, were written in the automobile’s glory years, the ‘50s, when cheap gasoline and the new Interstate Highway System helped fuel the idea that all of life could be connected by a car. Of course, since then, gasoline has become much more expensive and the environmental, sociological and economic costs of car-based sprawl much clearer.  That’s not to say that the door-to-door convenience of driving in those days with less-crowded roads (and better, nontexting drivers) was not often delightful. The lure of the open road was and is powerful. Kerouac was on to something. But with 310 million Americans now, that road is clogged in much of America.

Proposed new zoning for Providence and some other cities would reduce the parking-space requirements for businesses, which would be encouraged to share required parking spaces among themselves, and smaller businesses wouldn’t have to provide any parking spaces.  Space would be allocated for bikes. (I realize that the new rules would formalize what has already been happening to some extent.) In a denser city, having fewer parking spaces works because fewer people have cars.  They walk more, take the bus, bike and use such services as Zipcars when they need a car to, say, go out of town or to haul stuff. A city that encourages density almost by definition encourages mass transit.

And get rid of most setback rules that in some places bar store and restaurant owners from having their establishments right up against the sidewalk. The closer to the sidewalk a business is, the more it contributes to sidewalk life. Why encourage developers to put parking lots, forlorn at night, in front of sterile office buildings  or chain restaurants in downtowns?

As much as possible, make places where residents can live, work and shop by foot, with lots of “third places’’ that aren’t home and aren’t workplaces, such as coffee shops, restaurants, bookstores and pubs where loyal customers regularly do business and socialize in familiar and friendly settings. Those amenities are especially popular among young adults (who tend to marry late, if at all, and have fewer kids than their parents) and retirees, who seek proximity to the cultural amenities, doctors and hospitals concentrated in cities.  Current and future demographics favor the direction that Providence’s planners are heading in.  Public policy, however, should be more focused than it is on accelerating these urban-planning changes. The days when most people were content to drive 25 minutes to go grocery shopping are ending.

Providence, a medium-size city (with a metro area of about 1.3 million), has not destroyed so much of its dense urban built environment fabric that it cannot again achieve a thicker, healthier density. It’s the sort of density whose attractions draw so many people to put up with the high costs of living in New York or Boston.

Robert Whitcomb, a former newspaper editor, is currently a management consultant in the health-care sector,  a Fellow at the Pell Center for Public Policy and International Relations and a columnist.

Let them take responsibility

By ROBERT WHITCOMB

In the appendix of Philip K. Howard's mordantly entertaining new book, The Rule of Nobody: Saving America From Dead Laws and Broken Government, is a well-named collection of proposed new amendments to the U.S. Constitution that he calls the “Bill of Responsibilities.”I over-summarize them here; read the book. Mr. Howard is an engaging writer, using stories (some grimly funny) to get across his strong prescriptions.

Mr. Howard proposes amendments to: “sunset” old laws and regulations; give the president power to far more effectively manage the executive branch — including line-item vetoes and expanded discretion to hire and fire and reorganize operations, all subject to being overridden by a majority of each house of Congress — and widen judges’ power to dismiss unreasonable lawsuits.

Finally, he recommends an amendment to create a “Council of Citizens” as an advisory body to make recommendations on how to make government more responsive to the public’s needs. This reminds me of the Hoover commissions on government reorganization of the late 1940s and the ’50s, named after Herbert Hoover, who chaired them. The composition of this council would be very federalist, with members chosen “by and from a Nominating Council composed of two nominees by each governor of a state.” The idea is to push along the ideas represented by the other new amendments. This is intriguing but the nomination process could get caught in political sludge.

The phrase “Bill of Responsibilities” gets to the heart of what Mr. Howard is saying throughout his book: that we have become so tangled up in laws and regulations that it’s often impossible to exercise authority and take responsibility — the avoidance of which, I would add, is attractive to many people, just as long as they continue to have the perks of their positions. As a result, it’s tougher and tougher to get things done, at the local, state and federal levels, whether it is fixing a bridge, creating a health-care system whose benefits are commensurate with its vast cost, or firing an incompetent bureaucrat.

Admiral Chester Nimitz said during World War II, “When in command, command.” President Truman said of the prospect of Dwight Eisenhower as president: “He’ll sit here, and he’ll say ‘Do this! Do that!’ And nothing will happen. Poor Ike. It won’t be a bit like the Army. He’ll find it very frustrating.” Well, Eisenhower turned out to be a pretty effective president but Truman was fairly accurate: It has always been hard to make government work, and in many ways it’s harder now than 60 years ago because of the accretion of laws and regulations, many of which should have been eliminated or streamlined long ago. A law or a regulation cannot cover every eventuality, Mr. Howard writes: You need judgment and common sense. Fewer laws and more decisions, please!

The problems that Philip Howard tackles remind me of the growing dominance of process over content (or maybe call it substance). You see this in daily life with the increasing time demanded to keep up with endlessly updated computer programs (planned obsolescence!), and the hours needed to fill out tax returns and insurance forms.

Meanwhile, the European Court of Justice has issued an advisory judgment that European Union residents have the right in certain circumstances to make search engines remove links to personal information that people think damages them. It’s “the right to be forgotten,” a cousin of Americans’ famous, if informal, “right to be left alone.”

This will be very difficult to enforce, given the vast complexity of the Web. But I like the idea of taking down the arrogance of Google, et al., a few notches. You don’t have to be much of a “public figure” to be the object of scurrilous inaccurate attacks on the Internet for which the likes of Google wrongly take no responsibility. In the Digital Age your good name can be instantly destroyed on the screen.

The court supported exceptions for “public figures,” especially politicians. But that’s very tricky: Almost anyone can become a “public figure” on the Internet. And is it fair to exclude politicians, etc., from such protection from attacks? Whatever, the European case at least raises the issue of responsibility for content, which the search-engine companies, most notably Google, have tended to avoid while raking in billions of dollars.

***

A college “commencement” is a strange term because it seems much more of an ending, as emphasized by the dirge-like “Pomp and Circumstance.” Sadder is that so many colleges, supposedly refuges of the free exchange of ideas, surrender to demands for censorship by “activists” to block commencement speeches by people (usually with comparatively “conservative” views) whose opinions they don’t like. Cowardly college chiefs fail to take responsibility for protecting one of their central missions -- free and open discussion.

Robert Whitcomb (rwhitcomb51@gmail.com)  is an editor, writer,  fellow of the Pell Center for International Relations and Public Policy and a member of a management-consulting firm in the health-care sector.