"We Are Eating The Seed Corn"

Coffee Brown, University of New Mexico, Talk Radio News

“We are eating the seed-corn of the investments we made in the 1960’s” in roads and other components of distribution infrastructure, says Sen. Mark Warner, (D-Va.).

Funding is the big issue, and it doesn’t help that congress traditionally divides the distribution into sector into pieces: rail, road, waterways, air, etc, as well as geographic divisions. What’s needed, he said, is greater “multimodal integration.”

All of the speakers at The Council on Competitiveness Seminar on "Is America's Transportation Infrastructure Ready for Global Trade?" echoed that point over the course of their talks.

Four of America’s five major economic sectors depend on the fifth, transportation and distribution, which provides 11 million jobs. Domestic, internal, transport accounts for 85 percent of all commercial transport in the U.S. This “logistic structure” is valued at 10 percent of GDP, according to Commerce Secretary Gary Locke, and that’s the lowest in the world, meaning one of the most efficient.

Transportation Secretary Ray LaHood said the U.S. moves 50 million tons of goods per day, and our supply lines have helped America to remain competitive for 250 years, but now urban congestion and neglected infrastructure are compromising supply line efficiency.

“It’s about more than asphalt,” Warner said. “Supply is about moving goods, but it’s also about moving ideas.” Warner, whose business is telecommunication, advocates including broadband conduits into all new roads in order to extend the broadband infrastructure as inclusively and proactively as possible. “We’re still 15th in the world in terms of broadband environment,” he finished.

Council on Competitiveness President Deborah Wince-Smith extended the topic back to a global scale. “Sales from foreign affiliates of U.S. companies are three times total domestic sales,” she said, and therefore supply line efficiency is important to international competitiveness.

Douglas Oberhelman, Group President, Caterpillar, Said he sometimes can get shipments from Hong Kong faster than he can get them from an American port to their final destination within the U.S.

Overall the diverse group of speakers highlighted that global competitiveness requires:
1. Renovation and expansion of the infrastructure of roads and highways.
2. Smart distribution systems, in the form of information technology and associated technologies like RFID and sensors.
3. A return to education, science, and engineering as national values.
4. integrated, consistent, standardized, stable policies across modalities, regions, tax policy, energy policy and broadband information technology.

It Looked Like A Good Idea At The Time

Coffee Brown, University of New Mexico, Talk Radio News


As an investment, it could have paid off. As a bailout, it’s likely to be the expensive consequence of a hasty yet necessary response, according to Sen. Bob Corker (R-Tenn.), who helped frame the $700 billion TARP bill and spoke about it today at the Brookings Institution.

Corker pointed that the $85 billion AIG funds were from the Federal Reserve, not the Treasury. He said that TARP, as designed, would have turned presently toxic investments into longer term equity, and taxpayers could have gotten their money back.

But since not enough requirements were included, and financial capital was used to shore up failing institutions, rather than buying assets, he thinks much of that money is never going to be recovered. If General Motors, for example, were to go Chapter Seven Bankruptcy, taxpayers would get nothing.

Corker said that financial principles are being made up on the fly, partly because the situation doesn’t lend itself to precedent. For example, the GM pensioners gave up about $12 billion in equity for a 2.5 percent stockholder share, while the UAW gave up about $10 billion in equity for a 39 percent share, and declined to accept a requirement to become competitive within 2009, he said.

Rather than regulate the past, “let’s move past this and figure out the right regulatory regime” which, he said, needs to work here and now, for the rest of the world and in unforeseen circumstances. “We have to come up with cause neutral regulations.”

Looking to the future, he said that the parties are just beginning to work together on Social Security and Medicaid which, if not addressed are heading into $86 trillion in obligations.

Congress Protects Pork

Coffee Brown, MD, University of New Mexico, Talk Radio News

Please don’t call it “swine flu” anymore.

That was the main message at the Senate Appropriations Committee Agriculture, Rural Development, Food and Drug Administration and Related Agencies Subcommittee hearing on the 2009 H1N1 virus.

Witnesses, Agriculture Secretary Tom Vilsack and Dr. Joshua Sharfstein, acting Commissioner of the Food and Drug Administration, answered
questions from Sens. Herb Kohl (D-Wis.), Sam Brownback (R-Kan.), Robert Bennett (R-Utah) and Mark Pryor (D-Ariz.) about the commercially regrettable naming of the 2009 H1N1 virus and about vaccines.


Vilsack said the USDA has been aggressively campaigning with trading partners to protect pork’s image as a safe food, but China and Russia
have suspended purchases of American pork. Prices have fallen about 20 percent, he said, versus about 45 percent during the 1976 swine flu
scare.

Brownback asked whether there should be more surveillance of animals, since several recent infections have been zoonotic, or transmitted from
animals to humans. Vilsack said that such surveillance is ongoing but that funding has been flat. He stressed that while the last round of bird flu was from birds to humans, this flu has so far only gone from humans to animals. “We should really be calling this the human flu,” he said.

Kohl wanted to know if vaccines would be ready for a possible reoccurrence of the current atypical flu in the fall, and mentioned previous estimates at similar hearings of four to six months to prepare such a vaccine. Sharfstein responded by emphasizing the uncertainties: time to develop the vaccine, time to test it, and the final decision whether full production was merited. He said that full production would not significantly reduce production of the usual seasonal vaccine, as that version will have almost finished the year’s order by the time a decision has to be made.

Kohl asked Sharfstein whether this strain would prove to be dangerous, and Sharfstein replied that it doesn’t look bad now, but viruses mutate, so he couldn’t make predictions about future behavior.

OK Everybody, Back In The Pool.

Coffee Brown, MD, University of New Mexico, Talk Radio News


Atypical Flu Update 05/06/09
Today’s numbers: 642 cases in 41 states. There are now 2 deaths
reported with one being wholly American. Whereas the first was a
Mexican child who contracted the disease in Mexico, the second, per
WebMD, had no reported connection with Mexico other than living near
the border in Texas. She was young, but had other conditions’
“co-morbidities,” including recent childbirth, obesity, and recent
pneumonia. Counting her as the as the only native fatality so far, the
mortality rate in the U.S. is 0.1 percent.
Worldwide, there 1516 confirmed cases in 22 countries, with 29 deaths
in Mexico out of 822 confirmed cases (3.5 percent mortality), and no
deaths so far reported outside of Mexico and the U.S.
The World Health Organization is still not recommending travel
restrictions, except to advise people who feel ill to stay home.
WHO alert status remains at stage 5. Clusters of cases do not seem to
be occurring yet, which may mean that the virus weakens with time.
Nevertheless, the Centers for Disease Control and Prevention remind us
that we have weeks of this contagion to go yet.
The overall severity of this flu outside of Mexico is “mild to
moderate” per the CDC.
Per Secretary of Health and Human Services Kathleen Sebelius, “School
closing has gotten a lot of attention. There's a balance with the
importance of making sure our children go to school every day. The
virus transmits very quickly child to child, the end result has been a
more mild version of the disease than was originally feared and the
lethality seems at a much less significant level”
The current guidelines are to keep schools open, even if some students
get the flu, as would be done during any normal flu season, she says,
though that makes it even more important to keep symptomatic children
home.
“So we're urging parents to take steps if your child is sick, please
do not send your child to school. If a teacher is sick, please don't
come to school,” sebelius said.
And home means home. “And parents, don't turn around and keep your
child home from school and send him or her to the mall. This is really
about staying home,” Sebelius added.
The recommended period of “grounding” is seven days, even if symptoms
resolve, because that is how long sufferers may remain contagious.
So, did the CDC, WHO and media over-react? This flu is looking less
scary by the day, but it started with a significant number of
fatalities, and it was clearly a very different strain than had been
seen before. While we may start to feel some relief at this point,
these things can change quickly. Washing our hands, avoiding others
when we have symptoms, and insisting on common courtesy (Hey, cover
your mouth when you cough), may help reduce the 35,000 deaths per
year, and billions of dollars in lost productivity we have come to
think of as “normal.”

First Things First

Coffee Brown, MD, University of New Mexico, Talk Radio News

There are many blocks in the arch of medical reform, but Health Information Technology is the keystone, according to a panel of policy makers who spoke and answered questions at the Brookings Institution. Everything from electronic medical records, to electronic ordering, to integrated billing, to error reduction and decision support, won’t fix medicine by itself, the experts concluded.

Presenters at the event included: U.S. Sen. Sheldon Whitehouse (D-RI); former Rep. Nancy Johnson (R-Conn.) and Chairman of Health IT Now! Coalition; and Charles P. Friedman, Ph.D., Deputy National Coordinator for HIT Department of Health and Human Services. to discuss the current administration’s plans to upgrade the use of information technology in medicine.

“We are at a preposterous level of health information primitiveness,” White said.

According to moderator Darrell M. West, Vice President and Director, Governance Studies, Brookings Institution,, only one major business in the U.S. is less computerized than medicine; mining.


West co-wrote Digital Medicine: Healthcare in the Internet Era, published by Briikings. He said only one major business in the U.S. is less computerized than medicine; mining.

"Amazon can tell me what I’ve bought before, what I looked at today, and what I might like to buy tomorrow,” he said, adding that the majority of U.S. hospitals still keep manually-written, and, potentially life-saving, patient records in paper form.

According to the Institute of Medicine, only one in five clinicians in the U.S. are using electronic medical records.

West said the most optimistic projections are for savings of about $120 billion per year, but he believes the figure will be less.

Whitehouse quoted estimated healthcare savings as high as $320 billion per year , and he thinks that number could be a trillion.

The panelists agreed that interoperability is the first hurdle for the technology. Many, or most, of the computerized systems that exist now in hospitals can not share data with other computers.

This is intentional, Johnson said, because the competitive private business model favors a proprietary approach to information.

West said his doctor was using EMR now, but would never integrate the last 26 years of notes, “because that would cost too much.”

"Having HIT on a doctor’s desk is like having a car in the garage. you can enjoy the radio, air-conditioning and cigarette lighter but without a good road, you’re not going anywhere,” Whitehouse said.

The infrastructure, lines, connectivity and hardware all have to support the data flow, he said.

He pointed out that just moving data is not enough, “We need information aggregation, cross-checking, error reduction, decision support” and portability. The patient must be able to take data from system to system when traveling.

“Medicaid alone is approaching a $37 trillion obligation, not counting Medicare, VA benefits, S-CHIP, and similar entitlements. HIT is a necessary first step toward avoiding a healthcare cost tsunami,” he said.

Johnson discussed the tension between making the new healthcare more individuated and patient centered and avoiding the sort of consumerism that lets patients cow doctors into ordering expensive but unneeded tests and procedures.

She also pointed out the enormous proportion of healthcare costs that go to hopeless or marginal care, such as end-of-life care, or the prolongation of the lives of non-viable newborns. “No other country counts one breath as ‘live birth,’” she said. Many require hours, days, up to one year of life before being considered “live births”, she finished.

Friedman said the outlines of healthcare reform are clear and unlikely to change, but many details are still being worked out, not least a carrot and stick program to encourage and/or coerce stakeholders to adopt and “meaningfully use” HIT. “Meaningfully” is still being defined, but refers to applying this technology to actually improve clinical outcomes.

Whitehouse said that Republican opposition to Clinical Effectiveness Research surprised him. “No company would attempt a transformation one one-hundredth this complex” without Quality Assurance and accountability. “Someone has to be in charge."