The Difficulties of Defining and Discussing Security: A Perspective from the IGF 2009

posted by Audrey L. Plonk on November 19, 2009

The 4th annual Internet Governance Forum is ended yesterday in Sharm el Sheikh Egypt. Over 1500 delegates from around the world representing various industry sectors, governments, NGOs, and civil society are gathered to discuss important issues that affect the Internet. This might seem broad and irrelevant to a technology company like Intel, but if you think about the breadth of Intel’s technology around the world, you soon realize that our technology enables the functioning of the Internet globally and thus these global conversations are of relevance to our policies and technologies.

The IGF has five main tracks, one of which is entitled Security, Privacy and Openness. In addition to a main session on this topic, a wealth of other discussions, in the form of

Workshops, Open Forums and Best Practices Forums, occur throughout the four day meeting of the IGF. That has indeed been the case at this IGF however despite the fact that “security” is in the title of most of many of these sessions, the discussions tend to actually center around privacy and the protection of data. It seems as though we are confused, or at least struggling to understand what security means and what – in the context of this global forum – can be discussed. Are we talking about crime? Data protection? Laws? Policies? Technology?

I tend to think that most people understand intuitively what the word “privacy” means to them as individuals or their society as a whole. When applied to the online environment, I suspect most computer users understand that information about them – information they might consider private – may be exposed to a variety of actors, some malicious, some not. Some people care, some don’t, or at least don’t seem to. For those that care, we spend a lot of time discussing how to address that problem – who is responsible and what legal mechanisms are needed to protect that data.

So, what does this have to do with security? It seems to me that cybersecurity can best be described as processes, technologies and people that protect the online environment from the threats to that very environment (our data or technology assets). The difference with privacy is that privacy issues come into play when data has failed to be secured (here we’re back to security) – regardless of where it is held. And, security is about more than just cybercrime. Sure, a lot of the activities might end up being illegal in various jurisdictions but not in others. Nonetheless, not all security issues are criminal issues. Much of security is about prevention which is about solving the problem before it becomes a problem – this requires foresight and creative thinking about the future.

Given all this, it seems that because “security, or cybersecurity” as a problem is so broad and processes, technology and people as solutions are equally or more broad, we struggle to bound and define security – and therefore have productive conversations – about security. This conversation is further muddied by terms like cyberterrorism and cyberwar which are wholly undefined and are largely the responsibility of governments.

One approach for the future would be to define a few problem sets and then take some very specific case studies of solutions or approaches for addressing that issue. For example, often the solution to a vulnerability in one technology product affects another – or series of other – products. How do we address this so as not to make those affected more vulnerable? One solution is the Internet Consortium for Advanced Security (ICASI) on the Internet which works on multi vendor responses to product security issues. Another problem set could be how to determine interdependencies between infrastructures like energy and transport that rely on ICTs for their functioning.

Whatever is determined for next year’s IGF in Lithuania, I hope we can break down the topic of security into consumable parts that all participants can discuss and address. And I hope this can be related to the issues of privacy but not consumed by privacy as security implies more than just privacy. This is an important topic that is about much more than where data is stored and who has access to it (that would be privacy); it is about policies and technologies that help ensure we don’t get to the point that data or assets are compromised or that when they are, effective response and recovery are possible.

Government and Industry Innovate to Grow U.S. Economy

posted by Lisa Malloy on November 16, 2009

Today, Newsweek and Intel released the findings from a survey on innovation and the economy. The current economic environment makes for a unique opportunity to find out what’s really important to people. The survey indicates that despite one of the deepest recessions in history, Americans have undiminished faith in technology and innovation as the primary engines of economic growth.

The survey also tells us that 3 out of 4 Americans say that technological innovation is “more important than ever.” Intel believes that innovation requires complementary contributions by business and government. And we advocate for policies to drive education, U.S. competitiveness and economic growth.

According to the survey, nearly half of Americans want government to offer incentives to spur innovation and a third think a national innovation initiative would be very effective. We are encouraged by the energy and ideas around innovation coming out of the administration.

Not too long ago, the President outlined his innovation agenda -- a “strategy to foster new jobs, new businesses and new industries by laying the groundwork and the ground rules to best tap our innovative potential.”

These ground rules are so important not only to us in Washington, but to businesses throughout the U.S. Decisions made now by congress and the administration will have a long-term impact on how companies are able to innovate in the U.S.

Ground rules could be in the form of patent reform, market based H1B visa allocation, a permanent R&D tax credit. Right now, health care is clearly top of mind. Provisions should be included in legislation to spur innovation in health care through information technology.

Once the ground rules are established, it’s up to us -- U.S. business -- to make strategic investments to further the process of innovation.

This complementary role of government and business is a guiding factor in an upcoming conference in Washington, DC to explore what we can do to cultivate the innovation that will drive economic recovery and ensure long-term, sustainable growth.

Finally, the survey tells us most Americans say that the economic downturn has hurt the U.S.’s ability to innovate and they have significant doubts about our ability to maintain leadership. It’s our commitment at Intel to continue strategic R&D investment and our mission foster a culture of innovation.

The Infinite Loop of Finger Pointing: Chemotherapy, Congress, CMS, & the CBO

posted by Eric Dishman on November 13, 2009

“Janice” is dreading her 65^th birthday next month, and not for the reasons you might imagine. She is actually proud to be turning 65, especially because doctors told her ten years ago that she only had a year to live. I met her in 1999 when she was first diagnosed with a rare disorder that’s not really considered cancer but gets treated similarly with chemotherapy for the rest of her life. Little did they know that Janice would deny the manifest destiny of their numbers game, well outliving their most optimistic expectations. I have been helping her navigate a complex chemotherapy regimen for many years. But now we face a much more difficult dilemma: navigating her insurance situation as she fast approaches and financially needs Medicare.

But let me back up a bit. After tormenting over the decision, Janice finally took early retirement three years ago from the retail company where she had worked for two decades. She could no longer muster the energy to manage her career, her disease, and the bureaucracy of coordinating her disease. Like most people, she took COBRA insurance for the first 18 months, hemorrhaging money from her savings account, until she was forced to take money from her 401k prematurely with penalties because the “hardship paperwork” was just too complicated and time-consuming for her to figure out. (Her COBRA ran out and she had to pay exorbitant dollars for a private plan because of her pre-existing condition…which was another battle…but I don’t have the energy to cover that one here today.)

We spent eight months during that COBRA period faxing, phoning, and fighting a Dilbertesque battle with her insurance company and the hospital where she was being treated. Janice, on the advice from her doctor, wanted to receive two chemotherapy treatments per week through infusion in her home (costing $213 per episode) instead of having to find rides for the fifty minute pilgrimage to the hospital (costing over $2000 per episode for the same bag of IV fluids). Even though the hospital had a home health and infusion division… even though Janice’s condition could safely and effectively be treated in her own home…even though it was 1/10^th the cost to get that treatment at home compared to the hospital…and even though an open IV port for Janice puts her at even more risk of picking up a dangerous and expensive-to-treat infection (or now H1N1) every time she visits the hospital…the company refused to let her have treatment at home because “home care is only available to frail seniors over the age of 65.” Simply put, she wasn’t sick enough or old enough yet for the safer, cheaper course of treatment.

Those months were an exercise in finger-pointing futility and frustration, as each department blamed the ridiculousness of the situation (no one could argue with the fact that it was safer, cheaper, and better for Janice to receive treatment at home) on every other department, on Medicare, on state regulations, on patient privacy rules, on liability insurance, even on some obscure fire code (we never understood that one). Everyone defaulted to “no” from the start. Everyone claimed “I don’t have the power to fix this problem.” Everyone blamed “the system” that they were somehow absolving themselves from being a part of. Eventually, a lawyer friend of one of my co-workers got involved, we bugged the CEO of the hospital endlessly, and we convinced a doctor to convince a panel of administrators that Janice was not likely to live much longer anyway. We got approval for Janice to get chemotherapy infusion at home.

. . . . . . . . . . . . . . .

Now it is November 2009 and healthcare reform is in the (hot) air. Janice is weeks away from the miracle of her 65^th birthday, which she has been eager to celebrate for years because she can finally stop the steady flow of her 401k dollars to her private insurance plan. But a few months ago, her eagerness transformed into hopelessness. We began delving into the impenetrable maze of Medicare plans and terms, while Janice also started preparing for a big birthday bash for herself with friends and family in her Idaho home town. After much investigation and department-to-department shuffling all over again, Janice found out that Medicare was not willing to let her continue her chemotherapy at home. She would have to get treatment at a hospital or a nursing home—again, at far greater cost, risk, and hassle. One of the Medicare folks actually told her: “You’re too sick but also too young and capable to get home care.” Simply put, she was now too sick but still not old and frail enough for the safer, cheaper course of treatment.

In all the moments of bad news these 10 long years—her diagnosis, the death of her husband, the advancement of her disease, the bouts of painful side effects, the battle with her private insurance company, the fight over her preexisting condition—I have never seen Janice face such despair. I think she was almost serious when she asked me to take a hammer to her knees to cripple her enough to be eligible for home based care. And she said to me only days ago something I’ve heard from so many seriously, chronically ill patients before: “It’s not the disease I can’t handle; it’s the healthcare system I can’t survive.”

And then she sent me the following words to put verbatim into this blog: “I’m not asking for help or a hand out from anyone. I’ve got a good support network, and I’ll figure this problem out, too, like all the others. But wake up out there! Medicare may not be the Holy Grail you are hoping for. Do your homework early and often—and well before you turn 65! Because common sense in healthcare is quite uncommon.”

. . . . . . . . . . . . . . .

So wouldn’t you think Janice’s predicament would be something that healthcare reform is trying to fix? Well, think again. While the ink isn’t final or dry on the healthcare reform bills, so far Congress is mostly going the wrong way on home-based care for things like infusion of chemotherapy, home dialysis, getting medical durable equipment to the home, or providing home care for seniors and seriously ill chronic patients. While I’ve been out trying to make the case for even more home-based care using technologies for remote patient monitoring and independent living, the traditional home care industries have been under attack. Medicare is reducing reimbursement rates to the point that many small and medium-sized home care organizations will be forced out of business. The last thing I want to do is to inadvertently wipe out traditional home care as we make way for new kinds of care technologies and services in the home. We ought to be building upon that foundation and tradition instead of chipping away at it!

When home care is often cheaper, more effective, safer, and much preferred by patients, why is it under threat? I don’t entirely know. In part, because of rare instances of fraud and abuse by a few bad apple home care companies, some in Congress, CMS, and the Congressional Budget Office are over-reacting…are throwing the baby out with the bathwater. In part, it is due to a false impression that quality cannot be proven and measured in home care encounters as well as it can be in clinical encounters. Other detractors use a chicken-and-egg argument that there is not enough “evidence” that home-based care works, but, when you try to get funding to create that evidence, they use the very lack of evidence as a means of not funding the studies because home care is such a small niche. And I suspect, in part, the pushback on home care is due to perversities in the system that may make it easier for plans to get reimbursed for hospital visits than home visits.

But as I, and many of my colleagues from dozens of organizations, work these issues on the Hill, there is another more troubling reason why home based care is under threat. The infinite loop of finger pointing by different government agencies means most everyone is reticent to take up the charge, even if they believe in the power and effectiveness of home care. Each Congressional committee we go to says, “Sorry, not our area of focus” and points us to another committee. While there a few exceptions, this fragmentation of responsibility and accountability occurs as you literally traverse office by office with each of them pointing you to the next door down the hallway with an implied or explicit “not my problem.” And now those hallways are filled with whispers and finger-pointing to another culprit: the Congressional Budget Office, or the “CBO,” for short. As one staffer put it to me, “Home care can’t pass the score-ability sniff test.” I’ve heard this refrain dozens of times—and more and more recently as the reform bills near fruition. Somehow score-ability has become more important than care-ability of patients.

I’m not an expert in federal budgets, the CBO, or CMS…but I am an expert in human behavior. And it doesn’t take a social science degree to see that people—even powerful policy makers—are living in fear of the power of the CBO—as they work on healthcare reform legislation. And it doesn’t take powerful observational skills to see that people—even powerful policy makers—are now scapegoating the CBO as the catch-all excuse for refusing to move forward on legislation that their constituents are advocating for. And it doesn’t take an advanced degree in economics to know there is something strange afoot when an accounting organization isn’t willing to comprehend the risk/reward ratio and ROI of treating someone for $200 per day at home instead of $2000 per day at a hospital. It is the infinite loop of finger-pointing by an un-interoperable government….agency by agency….department by department…committee by committee…looping from Congress to CMS to the CBO and back again…that often keeps us going nowhere.

. . . . . . . . . . . . . . .

I may not understand all of the reasons, nuances, and history of these issues deeply enough. I probably don’t. But I do understand, very deeply, that day after day people like Janice are needlessly suffering—and that we are wasting billions of healthcare dollars—because of the unquestioned bureaucracies that we all tolerate, and thus, perpetuate. There is no doubt that the majority of people in Congress, in CMS, in the CBO, and in any other government acronym you can list here, are good people doing the best they can within the positions and policies they have inherited. But there is also no doubt that good people end up doing bad things to patients when administrators or policy makers hide behind finger-pointing, that’s-just-the-way-it-is, and not-my-departmentalism.

I hear lots of talk from Congressional members lately who lament that these healthcare reform bills will put bureaucrats in charge of care decisions instead of the patient making common sense decisions in consultation with his or her providers. Ask Janice and the doctor who prescribed her chemotherapy at home—and the millions of patients and doctors like them who are caught up in the infinite loops of these bureaucracies—who is really making the care decisions today. From my many perspectives—patient, patient advocate, policy advocate, researcher, innovator—we could all use a healthy dose of common sense, creative compassion, and a commitment to truly putting patients—not bureaucratic processes and procedures—first.

Meanwhile…Happy Birthday, Janice! And thanks for letting me share your story. I’ll call you tomorrow to work with you some more on your insurance plan. Hang on—they’re promising healthcare reform is on the way!

Comments are welcome.  please post to: http://blogs.intel.com/healthcare/ 

Intel and AMD Announce Settlement of All Antitrust and IP Disputes

posted by Brian Huseman on November 12, 2009

Today, Intel and AMD announced that they have settled all legal disputes between the companies, including all antitrust litigation.  Intel strongly believes that our business practices are both fair and lawful. We also note that microprocessor prices have declined significantly year after year, while innovation has thrived at a rapid pace.

Below is the text of Intel's press release on the settlement:

Intel Corporation and Advanced Micro Devices (NYSE: AMD) today announced a comprehensive agreement to end all outstanding legal disputes between the companies, including antitrust litigation and patent cross license disputes.  

In a joint statement the two companies commented, “While the relationship between the two companies has been difficult in the past, this agreement ends the legal disputes and enables the companies to focus all of our efforts on product innovation and development.”

Under terms of the agreement, AMD and Intel obtain patent rights from a new 5-year cross license agreement, Intel and AMD will give up any claims of breach from the previous license agreement, and Intel will pay AMD $1.25 billion.  Intel has also agreed to abide by a set of business practice provisions.  As a result, AMD will drop all pending litigation including the case in U.S. District Court in Delaware and two cases pending in Japan.  AMD will also withdraw all of its regulatory complaints worldwide.  The agreement will be made public in filings with the Securities and Exchange Commission.

Winning the War for Independence: The Independence at Home Act

posted by Eric Dishman on November 03, 2009

TED MED conclusion: Juxtaposition & Systemic Thinking at the Dinner Party

posted by Eric Dishman on October 30, 2009

Okay, TED MED 2009, after a 5-year hiatus for this conference series, is now over….and I, for one, am glad the conference is back. I’m mentally exhausted as I force myself to pound out these thoughts on the flight back to Portland. The Thursday and Friday sessions brought forth different messages and perspectives about healthcare, and I realize that part of the magic of the event is the juxtaposition of so many aspects of healthcare next to one another. One minute, it is tissue engineering, the next minute is robotics, next is prosthetics, then behavior change, then medical visualization, then consumer health technologies like the cell phone and telehealth, then stem cells, then personalized genomics. It’s part of the reason that it’s so important for participants to stay for the whole event (and thankfully, most of them…even the “stars”…do). You need to experience the systemic view that TED MED ultimately gives you by journeying to so many different healthcare places over four jam-packed days.

One of the things I really like about TED MED is that the “e”  in TED stands for “entertainment,” and the theme of this particular conference was around “story.” The juxtaposition of amazing breakthroughs in cancer research (with deeply technical talks that I could only admire from a surface level understanding) next to great song, poetry, and passionate story-telling challenged both mind and heart. Performer Sekou Andrews opened the conference on Tuesday with a vibrant performance piece that somehow synthesized and foreshadowed the titles and concepts for almost all of the talks we would see over the course of the week. Eric Mead and David Blaine doing magic tricks on stage and around the event was not only fun but evinced an undercurrent of mystery and questioning-of-your-beliefs that helped undercut the seriousness and surety of the science. Dave Stewart came up on stage yesterday with a fabulous singer and violinist who played the song they wrote for  the “Stand Up for Cancer” campaign, as well as his classic “Here Comes the Rain Again.” And there were great songs throughout all the days from singer, song-writer Jill Sobule.

Here were some of my other highlights and impressions from the rest of the meeting:

· Dean Ornish and Deepak Chopra had an interesting dialogue about prevention, behavior change, mindfulness, and other “low tech” ways to better manage health, which was a refreshing counterpoint to all the “high tech” interventions the day before. Dean’s comments that healthcare reform is too focused on payment and too little on chronic disease prevention, even reversal, was music to my ears. He showed data about how lifestyle changes—more than just diet—can actually reverse heart disease, even contribute to slowing the progression of prostate cancer and the reduction of PSA numbers.

· Deepak, whose comic timing and wit on stage must rival any of the major comedians on late night television, talked about having to change our “memes” (ideas that replicate) beyond traditional models of medical care. He talked a lot about how we have to use “cyberspace” like Twitter and social media to reach critical mass on messaging about very different notions of healthcare. Both of them gave evidence that “genes are our predisposition but not our fate,” and that lifestyle, attitude, and meditation can directly affect how long we live and our disease states. Deepak gave compelling evidence that the real epidemics on our hands are depression, loneliness, and isolation (he said we are 3 to 7 times more likely to die if socially isolated)…that isolation is at the root of our suffering and illness. Really made me feel like so much of the work we’ve focused on at Intel around building Social Health and community through new technologies will be a game-changer some day.

· Peter Diamandis, head of the X-Prize foundation, announced the five 10,000 patient cohorts they will fund with Wellpoint with the goal of having three-year innovations/interventions that can measurably improve community health. I love this. Rapid innovation. Measurable. Results oriented. On a large scale. We need more of this.

· Andrew Weil gave a talk on Integrative Medicine, with two opening points that really resonated with me: 1) that we only give lip service to health promotion and prevention because all of our industry is focused on disease treatment; and 2) that our interventions have come to depend on increasingly expensive technologies. Hey, I work for a “high tech” company, but so many of the pilots of personal health technologies Intel has done are simple, inexpensive, “low hanging fruit” opportunities to do disease prevention, early detection, or behavior change with the broadband, PCs, cell phones, and home sensor nets we’ve already got. It does seem that we, as a culture, are addicted to the expensive and complex, and dismissive of the simple and affordable. It’s almost as if we don’t believe we are getting good care unless it is expensive, complex, and high tech.

· Dean Kamen gave what was probably my favorite talk of the week. He stood simply, almost uncomfortably, on the side edge of the stage. And, in a calm, almost imperceptible voice, told amazing stories about building robotic prosthetics for veterans who were returning from Iraq and Afghanistan with leg and arm amputations. The stories, the videos of these amazing machines that they engineered in record time, and the results of seeing these amazing veterans wearing these things to feed themselves a grape or spoon full of cereal…were, simply, astounding. Dean’s entire presentation made me question the way we fund and do science in the United States. If every researcher was presented with real-world needs, deadlines, and high expectations to drive useful, usable results, we would advance the basic science and the impact so much faster.

· Rick Satava gave a whirlwind prediction of “what’s next?” for the frontiers of medicine. But first, he began with something I think was even more important, though not as sexy as cool videos, demos, and images of high tech gadgets of the future. He began with a compelling critique of the scientific method. He reminded us that the scientific method needs to be kept in its place—that it is a human creation at a moment in time in history—and that we need to innovate our methods of doing science as we progress. He suggested that we’re overdoing the use of “randomized clinical trials” as the means to answer a lot of our questions. I really agree with this. Much of the work on home health solutions Intel is working on are being treated, scientifically and financially, as if they are drugs being tested in drug trials. There’s an unquestioned assumption that the proof required for the viability and efficacy of these new kinds of technologies should be driven by the same old scientific methods and randomized controlled trials we’ve been doing for decades now.  We need to innovate the scientific methods and measurables, as much as the technologies themselves.

· Sanjay Gupta shared powerful images and stories from his time on the front lines reporting in Iraq and Afghanistan, as well as more recently around H1N1. The most memorable moment was his description of having the army team come running to ask him to step out of his reporter role to do brain surgery on a wounded solider, and all he could find was a Black & Decker drill used to put their sand tents together to do the surgery. Wow! (The solder lived and is doing quite well now.)

· Dave Gallo & Billy Lange on the closing day showed first ever videos from robot submarines sent down to the depths of the ocean where they discovered hundreds of new life forms in places that scientists were convinced no life could survive. The camera would pan to these underwater “lakes” of toxic chemicals a couple of miles beneath sea level—with pressures unimaginable—and as the biologists would say “nothing could possibly live here,” you’d see strange fish, sponges, crabs, sea spiders, and many un-namable creatures frolicking and swimming around down there. Which is to say: we don’t know nearly as much as we think we know…even when all the “experts” claim that we do. Message to me: keep on questioning, keep on challenging, keep on searching. And remember that at one point the experts were absolutely convinced that the world is flat!

So why have I spent two blogs on TED MED when most people have probably never heard of it? No, I’m not getting kickbacks from the conference organizers or anything like that, but in full disclosure, Intel was a sponsor. It’s because the conference challenged me, made me think, made me question what I know and what I assume about healthcare, medicine, the mind, and the body. Some of that questioning would be a good thing for all of us to take with us into our debates about healthcare reform. And some of the systemic thinking in this conference—from breakthrough ways to do diagnostics, grow organs, or personalize treatment to important reminders to drive behavior change, heal holistically, and look at the body and mind as an ecosystem that needs to be in balance—needs to become woven into the public debate about healthcare reform. After this week, even more than before, I am convinced that healthcare reform is doomed if we persist only in reforming the insurance system. There is so much more to be done…so much more to be talked about…than the public option. And many of the minds and stories in that conference room this week should be brought onto the national stage to help us transform how we treat our policies, ourselves, our minds, and our diseases. If only the whole country had the luxury and time for such a provocative and important dinner party.

Questioning the Public and the Options: Balancing Big Government & Big Business

posted by Eric Dishman on October 27, 2009

I am sitting on a plane on the way to the TEDMED conference (which I plan to blog about here later in the week), scanning the USA Today, trying not to catch the flu from the woman who is clearly very ill just a row behind me. Two above-the-fold headlines caught my eye: “Pushing Hospitals to Their Limit” and “Reid to Advance Opt-Out ‘Public Option.’” I saw the cable channels on the airport TVs looping feverishly on the same topic…abuzz with Senator Reid’s promise that the Senate version of the healthcare reform bill will contain a “public option” but with an “opt out” mechanism for states. Whatever that means. And then there is the elusive “trigger” option that is getting air time again. Somehow that is supposed to comfort me.

You can almost see relief in the faces of the TV reporters that the public option controversy is back (or that they managed to bring it back) for a few more polarizing news cycles. Polls are apparently showing that the majority of Americans favor a public option. I’ve certainly seen most of my circle of friends and family on Facebook celebrating the idea. But I am confused how everyone can be so confident about a public option. I’m worried that we’re being fed oversimplified, emotional bullet points in lieu of detailed proposals for how exactly this program would work. I’ve been working on these issues for two years now—have read all five of the Congressional bills and dozens of amendments in full—and still feel like I barely comprehend. 

I have avoided talking about insurance reform in this blog for three reasons. First and foremost, I am an not an expert on this complex topic. Second, the healthcare debate has become so bogged down in the public option controversy that I didn’t want to give even more time, energy, and attention to it. Third, this issue is so emotional and extreme for many people that I don’t want anyone to mistakenly assume that my opinions represent any kind of official Intel position. Because they don’t. What I am about to say—as with all things in this blog—are my own opinions. But since I can’t seem to get the world to focus on other important reform issues, I will try to address this big elephant in my little blogosphere.

Don’t get me wrong. I am in favor of everyone having access to quality healthcare—morally, economically, and from the standpoint of American competitiveness—and the idea of a public option is appealing to me. The reason I remain skeptical is because too little has been said about the implementation of a public option. The fact that the term “public option” is almost always in quotes when I read it—or modified with the words ‘so-called’ in front of it—is a red flag suggesting that there is no common or clear definition. Everyone seems to be quoting someone else’s definition. In fact, I’ve been trying to understand well over half a dozen different versions of a “so-called public option” from Congressional members, and there are significant differences among them. So if no one can define the term consistently, how can so many people be “for” it or “against” it, and how can we be in such vehement debate over what is kind of, sort of, notionally, a new and important concept?

We may all be simply investing our best hopes or worst fears into the ambiguity of the “public option” concept—which is fast becoming the new litmus test for belonging or not belonging to a so-called “political party.” People are also using the terms “government paid” and “government run” ambiguously and interchangeably, but those are very different phrases. Would the government both pay for and run some huge new insurance program? Or simply pay for it while some other entity—perhaps even the private market—runs it?  Would we have to create an entire new government department from scratch to run the public option? Or would this be housed in the Department of Health & Human Services, already the largest part of the federal budget? Some lawmakers are now calling the public option “Medicare Part E” for “Medicare for Everyone”—so does this mean Medicare, one of the largest, most painfully slow, un-innovative government bureaucracies in existence, would become much bigger and slower or the prototype for solving all of our healthcare problems? Really?

I know there are lots of plausible answers to the kinds of questions I asked above…but what is the proposed answer actually being voted upon in the end? That’s the version of the public option that I want to evaluate before making up my mind. But getting that level of detail has been difficult because so much of the negotiation in Congress about the public option has been anything but public. Oh, I’ve already complained about too much media attention on the topic, but that’s only been surface level analysis. Our elected leaders have been holding their cards so close to their chests in closed-door committee meetings that many Senators and House members themselves have expressed public frustration that they aren’t being given access to the details of these plans. We need more information on the “so-called public option” to be informed citizens.

It comes down to this for me: we need a hybrid insurance system that maintains fair competition and checks & balances between Big Government and Big Business to pay for—and run—our health plans. I believe that a government-only or a business-only system would hurt us all…that the tension between the two is what can produce a system that can be both universally accessible and continuously innovative.

We already have a Big Government system called Medicare—the largest insurer in the nation—that has its strengths and weaknesses but it is hardly a utopian cure-all for covering the uninsured or bringing down healthcare costs. It’s as easy to drum up anger and horror stories about Medicare as it is about those “big, evil insurance corporations.” Ask a lot of folks who are nearing the magic 65-year-old mark if Medicare is everything they want it to be. You will get an ear full about how complicated and confusing the system is, how it doesn’t cover a lot of the things their private plan did when they were working full time, how they had to give up their doctor of twenty years because he or she didn’t accept Medicare any longer, and how they have been denied services and free choice. As Medicare sets the (slow) pace of innovation and many of the (under) reimbursement policies/amounts for the private insurance marketplace, it needs much reform and rethinking itself before we use it either to run—or as a template for—the public option. But Medicare is also a literal life saver for millions and millions of people—and there are great programs and people in the system who do amazing things in spite of problems and abuses that inevitably occur.

So, too, we already have a Big Business system with the private and employer-driven insurance markets that consist of big and small, for-profit and not-for-profit, organizations that, in their collective, form another huge, confusing, and frustrating bureaucracy for everyone from clinicians to consumers to navigate. There is no doubt the time has come for reform of this system as well. The profit motive—especially with short sighted quarter by quarter thinking instead of long term ROI analysis—means abuses can and do happen. I don’t like big bonuses for insurance company executives, either, and the games that some of them play to deny coverage for pre-existing or emergent conditions are unforgivably horrible. But the private insurance system is also a literal life saver for millions and millions of people—and there are great programs and people in the system who do amazing things in spite of problems and abuses that inevitably occur.

So whatever form an additional “public option” takes, if it ends up happening at all, it should strive to maintain a healthy tension between the stabilizing force of the social safety net that a government run system provides with the innovating force of the services competition that a market-run system provides. I’m looking for a hybrid insurance system that does four things:

1) Covers everyone and every condition

2) Deals with costs by reinventing how care is delivered, delegated, and paid for

3) Drives checks and balances between market power and government power

4) And promotes fair competition and innovation within and between the two

Both systems need adequate oversight/regulation and more focus on prevention. And they both must radically transform where care is delivered (the home whenever possible), who takes responsibility for health (patients themselves in partnership with professional and informal caregivers), how clinicians practice medicine (via coordinated care teams, with a medical home champion overseeing all care with common sense scrutiny), and how clinicians are paid and incentivized (based upon quality outcomes instead of quantity of visits, procedures, or tests given).

So there. I’ve done it. I’ve uttered the “PO” words in this blog. And I’ve come to the conclusion that I can’t come to a conclusion yet. We need more details. We need to be more questioning. We need to strive for balance in all things. And we need to be able to move on beyond the “public option” controversy to start to deal with that other headline making my newspaper today: finding ways to stop pushing hospitals to their limits. Now that’s something I can really hold forth about.  I want to give the public another option: the option of getting health care at home.

NOTE:  ERIC DISHMAN'S 'HOME BLOG' PAGE HAS MOVED TO:  blogs.intel.com/healthcare. 

FEDERAL CLIMATE LEGISLATION SHOULD PROTECT AMERICAN COMPETITIVENESS AND REWARD PAST CLIMATE LEADERSHIP

posted by Stephen Harper on October 26, 2009

Earlier this summer, the House of Representatives passed the American Clean Energy and Security (ACES) Act, HR 2454, a massive bill addressing energy efficiency, green energy, and climate change, the latter through a cap-and-trade proposal. The Senate currently is considering S 1733, the American Clean Energy Jobs and American Power Act (ACEJAPA), which is mostly focused on cap-and-trade. Earlier the Senate Energy and Natural Resources Committee marked up a separate energy bill.

Intel views climate change as an important environmental and social challenge and we support development of a Federal program to respond to that challenge. As part of that response, however, we believe Congress should bear in mind two important principles: First, in deciding how cap-and-trade allowances are to be allocated among industries and programs, attention should be paid to using a significant quantity of “free” allowances to help protect US industries that are subject to significant international competition and therefore might suffer a competitive disadvantage as their US costs increase under a cap and trade program while their foreign competitors face no similar climate programs or increased costs. The bills focus mostly on industries that are energy-intensive or greenhouse gas-intensive, even if they are not very trade-intensive. By contrast, industries like semiconductors that are less energy- or greenhouse gas-intensive but very trade exposed are not eligible for allowance allocations. As the second-leading export sector in the US, the semiconductor industry is very trade-exposed. Our competitors in Asia and Europe do not face the type of climate regulations and increased costs that a Federal cap-and-trade program will impose on the US semiconductor sector. That competitive disadvantage needs to be addressed by the Senate by establishing trade exposure as a standalone criterion for allowance allocations.

Both the House and Senate bills sensibly include provisions for crediting with allowances companies that have shown prior leadership by reducing their climate emissions in advance of any regulatory requirement. Intel has spent approximately $100 million over the last decade reducing our climate emissions as part of a program between the semiconductor industry and the USEPA. Other US semiconductor companies have made significant reductions as well. The current credit for early action proposals fail in two respects. They both provide only a very small amount of allowances for crediting early action and both have very narrow criteria for qualifying for allowances. The final legislation needs to provide a bigger “pot” of allowances for this purposes and the eligibility criteria need to be broadened to encompass programs like our industry has with USEPA.

The need for a US – European Union Innovation Dialogue

posted by Christoph Luykx on October 26, 2009

The leaders of the European Union and the U.S. agreed in April 2007 to establish a Transatlantic Framework for Advancing Transatlantic Integration (the Framework) between the U.S. and the European Union. At the same time they established the Transatlantic Economic Council (TEC) to oversee these efforts and to accelerate progress and guiding work between the annual U.S. – EU summits.

The fourth meeting of the TEC will take place tomorrow, October 27th in Washington D.C. against the backdrop of a year which has seen tremendous change for both the United States and Europe. The U.S. experienced a change in political party, with a new President with an ambitious domestic agenda. Likewise, The European Union saw the election of a new European Parliament, the Irish approval of the Lisbon Treaty, and soon a new team of Commissioners under its re-elected President Barroso.

This parallel change occurring on both sides of the Atlantic presents tremendous opportunities as well as challenges for Transatlantic cooperation. And with the increasing importance of the BRIC countries, the need for such cooperation becomes even more urgent. Innovation is one area that is crucial for both the U.S. and Europe and our combined dealings with emerging economies. The Obama administration has repeatedly emphasized the importance of science, technology and innovation for the U.S. economy. It also looks likely that the new European Commission will have a specific European Commissioner dedicated to Innovation.

Given the fact that we are at an important inflection point, Intel has been very supportive of a renewed Transatlantic Innovation agenda. This would mean a restructuring of the different innovation topics under the TEC’s Framework. Such an Innovation agenda, based on a clear ownership structure, should focus on horizontal and vertical - technology specific – innovation issues, giving renewed impetus to the Transatlantic Innovation partnership.

To provide a forum for such a discussion, Intel also advocated for the creation of a Transatlantic Innovation Dialogue (TID). This would be based on the understanding that innovation is increasingly global and the challenges to promote and protect it need to be addressed holistically and globally. It looks likely that such an Innovation Dialogue will be discussed during the next TEC meeting. If approved, a cooperative effort between government and private sector stakeholders should address questions on the Dialogue’s concrete goals and governance structure.

On the goals, we think such a dialogue could focus on the exchange of experiences and best practices on science, technology, and innovation. The discussion could;

(i) identify potential synergies between different private-government innovation initiatives; (ii) examine how government policies can most effectively support (or impair) the private sector in creating innovation; and (iii) evaluate how other factors -- such as availability of venture capital, university curricula, and open markets -- contribute to an innovative climate.

Concerning the governance structure, it is of fundamental importance to the success of such a Dialogue for it to be founded on Public and Private sector cooperation. Intel therefore endorses both parties to engage in an open dialogue with all stakeholders to advance our common goals.

Intel is convinced that this dialogue could make great strides in promoting continued U.S. and EU joint leadership in science and technology and we look forward in participating in this debate and advancing our shared objectives.

Intel Whitepaper: Investing in Sustainable Broadband Adoption

posted by Margie Dickman on October 20, 2009

Intel just published a brief whitepaper titled "Investing in Sustainable Broadband Adoption": Investing in Sustainable Broadband Adoption_FINAL.pdf The paper discusses the significant broadband adoption gap in America: 96% of U.S. households have a broadband network available to them, but only 63% of those households have opted to subscribe to broadband service. Clearly, a big adoption gap.

A disproportionate number of non-adopters are low-income households and those living in rural areas. The main reasons that these Americans cite for non-adoption are the perceived lack of relevance and awareness of broadband, and the cost of acquiring broadband equipment (PCs) and broadband service. The paper explores a proposed public-private solution to close this vast adoption gap by utilizing stimulus funds for a PC-broadband bundle program targeted to low-income and other unconnected households.

The proposed program focuses on first-time residential broadband users by reducing the cost of both elements of a connected PC: the upfront equipment cost (of a full featured notebook or desktop) and the initial subscription cost for broadband service -- supported by community-based digital literacy training. Intel believes that this type of strategic public-private partnership, supported by local community involvement, will help bridge the digital divide in the U.S. and, consequently, help boost our nation's economy and competitiveness over the long-term.