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January 28, 2009


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In #4 you mention computerization of medical records may "create jobs in Bangalore." Though it is a minor point in your article, I beg to differ.

I am something of an expert on HIPAA and I can say that one of the first lawsuits under that statue involved a chain of sub-contracts that led to workers offshore where HIPAA is un-enforceable. The EU's Safe Harbor standards even require closer control of medical records than the US does.

In order to meet the regulatory requirements most companies will need to hold this information close to their own vests and they are responsible for anything that subcontractors do AND KNOWING WHAT THOSE PRACTICES ARE.

Those HIPAA 'covered entities' that don't know this may still use such off-shore resources but I don't think it will be a booming industry unless or until we have shared secure repositories for health records. So far, the industry can't even decide what these will look like or who will fund them so they are currently limited to local efforts like Washington's OneHealthPort.

Obama's problem is that he needs the stimulus to prop up an economy in freefall. While it's debatable how long the time horizon should be, most "believe" that it should be limited to the next two or three years. Longer than that, and the deficit spending begins to crowd out private sector borrowing necessary for sustained recovery.

I suspect that this problem is so much deeper than we know that even the trillions we do use cannot alter the fundamental crisis. We have too much debt to service while the prospects for long-term growth are being dimmed by Peak Oil and ongoing environmental issues. Obama's bad bargain is inescapable. Try to levitate the old economy or risk being a one-term president.

Of course, it's not just our problem. The whole world is now so tightly intertwined that American prosperity depends on salient factors outside our direct control. Thomas Friedman's "flat world", however, has no workable mechanisms for regulating macroeconomic breakdowns.

We got into this crisis by denying fairly obvious things. Like limited and declining resources, an overutilized planet, asset bubbles, and long-term debt accumulation. This may be a hole you don't dig yourself out of. If we're lucky, we may engineer new frameworks for dealing with a global civilization. I'm not hopeful about that but the coming storm may dramatically alter the way we see things.

It's as if someone were trying to float a boat off a sandbar by artificially flooding the area with water, without blocking off the holes, river channels, and spongy sand pits that will drain off or absorb the water instead of lifting the boat.

The federal government has a chance to do something historic here; but instead of requiring, by enforceable mechanisms, that the money be used as intended, it has fudged with half measures, providing the money but not the binding requirements and oversight.

It enacts bailout and stimulus legislation, but refuses to follow-through by specifying and controlling the use of funds, rejecting this as heavy-handed "interference" beyond the pale of democracy. Instead, it says "pretty-please" to the financial corporations and other recipients, shrugging its shoulders and hoping for the best.

There is also the problem of timing. Obama says that there is "not a moment to spare" on the stimulus plan, but many of the projects likely to receive funding will not be in a position to make use of it for many months or years.

This, of course, is a recipe for waste, diversion, corruption, and ineffectiveness. Budget conservatives on both sides of the aisle will then step forward, claiming that big government is incompetent to solve the nation's problems.

Meanwhile, such enormous amounts of debt-fueled spending will have taken place, that it will be all but fiscally impossible to attend to important and pressing problems (such as national health-care reform), even if the public appetite for interventionist government hadn't been ruined by the small returns on the nation's massive outlays.

You really expect change? With the same old special interests, faces, and political parties at the helm of State? Real change would involve nationalizing the banks, putting on trial the Bushies and investment bankers, throwing the lobbyists out, throwing the Republicans out and the Demos too, shooting the executives of Goldman Sachs... well I could go on and on, but the stimulas is obviously going to be about status quo.

I was at least hoping they would get a CCC thing going and rip all of the salt cedars out of the Southwest (a small dream I know).



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