Hospital pricing, a long overdue change

Hospital pricing, from MSNBC

Going to a hospital is stressful. People generally go that are sick and want to get better. But even if you do, getting the bill in the mail a few days later can often send a shock to your system. After Rebecca died, I did get the final bill (that my insurance gratefully paid for), and the total was almost $100,000. Paying that out of pocket would have been pretty tough.

A little while back, I was visiting friends and one of them told me she had finally paid off the hospital fees associated with her little girl. It was shocking to me, since I’m blessed to have insurance and because her girl was two years old. But her insurance didn’t do a great job of detailing out-of-pocket expenses, so she and her husband got a bill that they just couldn’t pay in one chunk.

Thus, I was really happy to hear the news that President Trump pushed for price transparency rules that require hospitals to post prices. Initiatives like this have been moving forward before with varying degrees of success. Not surprisingly, hospitals and insurance companies are pushing back, but that’s no surprise. Every time an organization can hide their cost model it doesn’t benefit the consumer. Banks were like this years ago, and I’d argue social media sites are in this category now.

The more we learn about how hospitals charge people, the more people will shop around for routine procedures and force larger hospitals to embrace change. The only place this works now is in elective surgery. You can in fact shop around for LASIK eye surgery, and that has kept the surgery within grasp of most Americans, even ones without health insurance. As that same level of transparency gets applied to other areas of health care, we’re going to get better pricing, and stop saddling people with huge hospital debt.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.

Ask a Vet about their story

I will be forever amazed how well our country treats veterans. Anytime I’ve traveled in uniform, it becomes hard to pay for a meal. This is especially true if I’m driving in the middle of the country where there aren’t a lot of military bases. This Veterans Day will doubtlessly be no different, and I’ll get reminded again that this is a country full of great people that care.

Over this past week I had a chance to interact with some of the older veterans from WW2 and Korea. Those veterans are disappearing at an alarming rate, and it won’t be long until they are gone. After that, we’ll eventually have nobody that lived through the Cold War. That time is coming faster than we think.

These veterans have stories that bring these conflicts to life. One WW2 veteran told me about the large number of plane accidents near his hometown. It reminded me that while we increased production of everything from ships to planes, it doesn’t mean it was the greatest quality. We cranked out Liberty ships in less than a month, but more than a few brittle fractured in half due to cold weather and poor welding. Planes and other weapon systems had similar issues. There are a lot of training aircraft on the bottom of Lake Michigan due to equipment failures.

The Liberty ship S.S. Schenectady, which, in 1943, failed before leaving the shipyard. (Reprinted with permission of Earl R. Parker, Brittle Behavior of Engineering Structures, National Academy of Sciences, National Research Council, John Wiley & Sons, New York, 1957.) From: https://metallurgyandmaterials.wordpress.com/2015/12/25/liberty-ship-failures/

I would encourage every non-veteran reading this to not just thank a veteran this weekend for their service, but ask them if they have 5 minutes to share a story. Our veterans can become increasingly isolated in their own little groups, and after a while your sea stories get old in the same groups of people. Having even a brief chance to hear about something they did will help bring the conflicts alive. You won’t read these stories in a book. History books capture facts and numbers well, but history is made by real people who are far too complex to capture on paper. This Veterans Day gives us a golden opportunity to remember that and carry on these stories in our minds before they are lost.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.

Open Skies and Comcast Cable: Both things that need to be cut

One of the Russian Open Skies Aircraft
By Oleg Belyakov – http://www.airliners.net/photo/Russia—Air/Tupolev-Tu-214ON/2007280/L/, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17241781

Anytime President Trump goes to cancel a treaty, it sure causes a ruckus. Open Skies, a treaty we’ve had with Russia and 32 other countries since 2002 (although the idea traces back to 1955) that allows flights by very specific aircraft with very specific imaging equipment to fly anywhere over the countries of the signatories. It was designed as a mutual-trust building measure to help the then-Soviet Union and Warsaw Pact countries build trust with their NATO counterparts.

Now President Trump doesn’t see any point to it. Similar to the INF Treaty, Open Skies has outlived its usefulness, for a lot of reasons:

China is a bigger threat. Yup, China. China is absolutely loving the world created for it by the post-World War Two winners, and has benefited tremendously. Not being constrained by Open Skies, INF, START, or a host of other treaties, it remains openly belligerent to its neighbors. Dropping out of US-Russia agreements allows us to restart negotiations and add in China.

We have other surveillance. Open Skies flights are announced in advance, and both sides take steps to limit what can be observed. The actual usefulness of the flights is pretty limited. Plus, with advances in satellite technology, the flights don’t add much value unless you don’t have access to any satellite imagery. Given that you can purchase public imagery, the Open Skies treaty is increasingly becoming irrelevant.

It’s a swipe at Russia. Russia continues to behave aggressively. Ukraine? Georgia? Still missing pieces of territory. If you’re in Estonia, Latvia, Lithuania and Poland, you’re not exactly comfortable with this trend. This, on top of Russia’s push to legitimize tactical nuclear weapon use, makes them increasingly dangerous. Why reward that behavior?

Open Skies is like Comcast Cable. The subscription gives you so little, yet benefits the other side an awful lot. You know you can do better, but that inertia to keep it remains.

We need to cut the cord on Open Skies and all other deals until Russia stops invading its neighbors.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.

Breaking the SCIF phones

What all phones should look like after a SCIF visit.

If you’ve never heard of a SCIF before this past week, you probably don’t work in government. SCIFs are Sensitive Compartmented Information Facilities. If you want to read or work on a document that is classified Top Secret, you work in a SCIF. As you can see from a released set of specifications, SCIFs are fairly intensively constructed. Floors and ceilings are solid, wires are in buried conduits checked by the NSA’s TEMPEST program, and access is tightly controlled.

It’s not surprising that when Republican lawmakers go into the SCIF with cell phones, it causes alarm. And it should. Photography equipment isn’t allowed, nor is anything that can conduct two-way communication. Already you have people calling for removal of clearances. But is that appropriate?

In short, no. Congressional Representatives and Senators get access to classified information based on their position. While they are required to take an oath of secrecy, they don’t have to go through the SF86 process. By electing them to their office, the people of the United States (whether they realize it or not) have declared their comfort with that individual having access to classified access.

While some very sensitive information is only released to certain individuals, its pretty small. A Congressman visited a site I worked at before and had access to everything. Now, his staff members did not, and I had to keep them out of certain briefings, but the Congressman himself was good.

In short though, you can’t take away access, unless you kick them out of office.

However, there should be consequences for violating rules. All the Armed Services have harsh and effective ways of dealing with this. Cell phones brought into a SCIF are normally sent to NCIS to be scanned. With people having most of their lives on a phone, losing it for a week while NCIS painstakingly goes through every image and file tends to be good persuasion. The Marines in Iraq, in response to people plugging their personal devices into classified computers, simply confiscated the devices and nailed them to a wooden board outside the SCIF. After walking by a board with iPhones and tablets nailed and screwed to the wall, you get the message quickly.

Confiscate and scan some phones, and put a policy in place that repeat offenders lose their devices. After a few of those, you won’t have idiots bringing phones into a SCIF.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency. The author kindly reminds you to keep your damn phone out of the SCIF!

Things that get worse

We like to think everything is going to get better over time. Mainly due to technological advances, this turns out to be true in most cases. Our phones tend to get better over time, or at least they get faster and have more memory (and get more expensive). We’ve gone from about two types of crap beer to so many microbrews that its becoming uncool to drink light beer. Our cars are safer, our water is better quality, and our appliances are more energy efficient.

Not everything is getting better. There are plenty of things that get worse, mainly due to human beings.

Home Building and the trades. I recently had a home built, and it was an ugly process. One of the most surprising parts was just how hard it was to find people that were willing to work, because most trades are solidly booked.

Locksmith? A week to get one in.
Electrician? Solidly booked, literally bounced from my house to another plus multiple emergency calls every week.
Brick and foundation guy? When I met him, he had five other jobs on the books.

Because of the shortage, we’re going to continue to get homes mostly built to lower, quicker to obtain standards. It’s not going to change until we get more people in the trades to help increase competition.

Wifi and Internet. Most people get internet in a cable modem, and then to an all-in-one wifi access point and router combo unit. The unit acts as a router, switch and wireless access point all in one, doing all three of these things poorly. Especially for bigger homes, the all-in-one sucks.

This is made worse by throughput. I have a small script that checks my internet throughput every hour, and its shocking how poor the connection can be from Cox. You might have a great WiFi device, but its like hooking up a new car to an old set of tires…you just don’t get the right performance.

Free Speech. We have access to tons of information via the Internet, and the exchange of ideas should be relatively free. But its not going to be, and social media is largely to blame. Social media is allowing people to remain in an echo chamber, and despite the increased connectivity, this is going to result in more restrictions on free speech.

Don’t believe me? I shared a Babylon Bee story and had a liberal friend of mine tell me he had never heard of the Babylon Bee. Now, Babylon Bee (a satire news agency) tends to be more conservative, but it’s very well known…unless your Facebook feed is being manipulated to never share conservative viewpoints.

Echo chambers lead to turning people into “others,” which make it far easier to legislate against and even commit violence against. At some point, we’ll have enough free speech restrictions that it will reach a tipping and we’ll snap back, but in the near future, social media is going to make it worse.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.

How’s that Africa plan working out for us?

Map of Nigeria, from Nigeria.ru

With the focus on the Middle East, its easy to forget there are other parts of the world. Africa in particular tends to not make our news feeds. It always makes mine though, and yesterday was more bad news:

Nigeria looks to sign military cooperation deal with Russia this month

with this gem:

““We’re sure that with Russian help we’ll manage to crush Boko Haram, given Russia’s experience combating Islamic State in Syria,” Nigerian envoy Steve Ugbah said in an interview with Russia’s RIA news agency.”

Steve Ugbah, Nigerian Envoy

Ugh.

As a nation we suck at African relationships. Nigeria in particular is a key nation, with not only a relatively functioning democracy, but also a large population and large economy. Nigeria will be a leading force in Africa over the next 20 years. And that is about where our relationship ends.

Our State Department is not pushing relationships forward enough, unlike China and Russia, who are more than happy to offer economic and military incentives to advance their influence in the region. On the military side, we should be pushing for a military collective with African Nations that would help build military standards (similar to NATO), allow collective exercises, provide personnel exchanges and open markets to military sales. On the economic side, Africa presents a unique opportunity break China’s grasp on low-cost manufature and invest in a region that is unlikely to build a military super-giant devoted to destroying the United States. While we’re at it, let’s reevaluate how we do sanctions, since we seem happy to put sanctions on African countries for human rights violations while willfully ignoring those of Arab countries.

Africa could be our answer to China if we let it be. Let’s make that choice vice letting China and Russia turn Africa into their next backyard.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.

Somalia and a coming Africa boom

US Embassy in Somalia in 1992, from Wikipedia

While everyone was busy talking about impeachment, the re-establishment of the US Embassy in Somalia popped into my Facebook feed. It will probably garner no real headlines or much fanfare. It is really important, because it might mark a culmination of investment into Africa, and perhaps a turning point in how we view that continent.

Africa has been left behind by most of the industrialized world. Although it was critical for trading, it just never industrialized like North America, Europe or Asia has. It’s been left in the dark and had its share of crime, dictators and poor rule. This despite its critical location, abundance of resources and a people that have proven they can accomplish a lot when not held back by corruption and crime.

Africa, if done right, is important. China figured this out and is trying to buy up Africa through debt-diplomacy, hoping to secure a future for itself. The US has mainly viewed Africa as a place to practice killing terrorists. That isn’t a long term strategy though.

Since we’re already in Somalia, let’s have a long term plan. Somalia has a ton of advantages. It’s right near the Bab-el-Mandeb Straits, a critical choke point for maritime trade. Somalia reaches to the equator and has a large expanse of ocean, which is preferable for launching satellites. Somalia has some pretty significant untapped oil reserves. It also has good beaches, game reserves and plenty of archaeological ruins that would attract tourism.

The United States should be taking our focus out of Syria, where we will only ever pour more money and get nothing, and into Somalia. Encouraging companies to invest in Somalia and using some of the revenue to rebuild the security a government needs to survive is a start. Building a Somali Navy that is dedicated to stopping piracy would prevent us from wasting US Navy ships on a relatively low-combat mission. Pushing academic institutions to invest in Somali education and archaeology will begin the process of building an educated society that won’t tolerate high levels of crime in the future.

Somalia, given a better start, should be a thriving long-term partner with the United States. Let’s hope we can treat them as such and walk down that path before China beats us to the punch.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.

Play the long game on Iran

Everything is focused on Iran. Everyone seems worried we’re going to war in Iran. And every time someone says President Trump is a warmonger (unlike President Obama, who was just quiet about killing people overseas), he goes off and does something non-warmongerish, like attacking the firms that ship oil to Iran.

He’s doing this because it really isn’t about Iran. The Iranian economy and government is on the brink of collapse. It’s propping itself up, but there are increasing protests against corrupt regime officials. There are similar protests in Hong Kong against corrupt Chinese regime overreach, and in Russia against election rigging.

War has a funny way of uniting an entire population against another population. Iran is itching for a war, not because it would win, but because it would distract its population from the poor economic situation they live in every day. Going to war with Iran, right now, is that last thing that we should be doing.

Instead, we need to apply pressure to what is propping up the Iranian regime, in this case Russia and China. Clamping down on illegal oil shipments is a start. But let’s take it one step further. The Russian oligarchs and Chinese officials that control most of the wealth in these countries are extremely unpopular. If their roles were emphasized, and sanctions imposed on their foreign investments, it would stoke the sympathy of Chinese and Russian populations.

The other point is looking at emerging countries and tamping down on their future oil requirements. Part of the reason oil continues to exert influence is that every time one country begins to ween off of oil, another emerging economy requires it. If the population of India suddenly started joining the middle class lifestyle, it would place a huge demand on oil that gives Russia and Iran significant influence. If the U.S. began exporting cheap, safe nuclear energy, that would make public transit viable in these countries, and keep oil from coming back in vogue. That’s playing the long game, but its our best bet for a long term win against Iran.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.

It was always about burden sharing

It’s easy to pick on President Trump for his treatment of allies, given his willingness to call out countries like Germany for not spending their fair share on defense. It’s also easy to gloss over the fact that Europe has taken for granted a strong US presence that guarantees security. Relying on the US to be the muscle in any fight is one thing, but purposely passing the buck and not defending your own nation is another.

Not anymore. An op-ed in the Norwegian news site DN.no written by Professor Janne Matlary outlined a new policy spelled out by the new Secretary of Defense Mark Esper:

“Secretary Esper’s message to NATO countries were that “if you receive infrastructure that we [USA] are building, it’s just fair that you are paying for it”, and Matlary states that the same policy will be valid for Norway and the building of new shelters at Rygge Airport. Matlary states that European countries (including Norway) have avoided the self-imposed 2 percent goal while at the same time believing that burden sharing is limited by that number, now challenged by Secretary Esper’s new policy. Professor Matlary also referred to Ambassador Braithwaite’s NATO op-ed in VG on August 12, asking if Norway’s security should be more important to American tax payers than for Norwegians. She is puzzled the Ambassador has not received any response, asking if Norwegian media and politicians are taking United States for granted, or if it’s too unpleasant to respond to.”

We need allies in any future fight. That is a given. But allies are worthless if they can’t do the basics of providing for some sort of defense of their own country. It would take the US some time to muster forces to defend or possibly liberate any European country, and the fact that Norway, like many other countries, has taken a constant US presence for granted is sad. Our alliances should not be an excuse to stand quietly by while other countries avoid burden sharing.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.

Biased media has gone from annoying to dangerous

Hurricane Dorian predictions, from ABC News, https://s.abcnews.com/images/US/FloridaSpaghetti_hpEmbed_16x9_992.jpg

It’s like some people just want to watch the world burn. And by watch, I mean set it on fire themselves and then sit back and smugly gaze at their destruction.

The latest sad example of this is the controversy over Hurricane Dorian’s track. Dorian was a particularly nasty storm. It was big, had strong winds, and was driving into a variety of high and low pressure regions that altered its path, in some cases by hundreds of miles. So when President Trump tweets out that the hurricane is bearing down on Alabama, he’s attempting to ensure that every state is prepared.

He’s not wrong for being concerned. Here’s NOAA’s prediction at 5 pm from 29 August:

“The guidance envelope has nudged southward this cycle, with the ECMWF and HMON along the southern side, and the GFS bracketing the northern side. There has also been an increase in
along-track spread or speed differences with day 5 positions among the dynamical models ranging from near the northwestern Bahamas to the northeastern Gulf of Mexico. This appears to be the result of differences in the models’ depiction of the strength or lack thereof of the western portion of the ridge by day 5.”

NOAA Website, https://www.nhc.noaa.gov/archive/2019/DORIAN.shtml?

Read the rest of historical data here: https://www.nhc.noaa.gov/archive/2019/DORIAN.shtml?

You’ll find lots of times the models “diverge” a lot. Would you want to be caught flat-footed if the storm diverges?

If Trump used old data and put out bad gouge to the state of Alabama, then ask yourself: does it matter? Was it a bad thing to be prepared for the worst? Is it worth tearing him down over? And if he hadn’t done it and the hurricane had turned that way, would he be criticized for not preparing?

The last part that gets me is this sort of non-controversy spreads around the world. News sources in Norway are jumping on this and calling it a fake weather forecast:

“In VG’s editorial, Per Olav Ødegård stated that “good economic times are Donald Trump’s best card in the election campaign. But the economy can also be his Achilles heel”. Ødegård commented that Donald Trump depends on good economic growth in the United States for his re-election campaign. Kenneth Lund and Terje Erikstad shared the same opinion in two pieces in Dagens Næringsliv published on the same day. Erikstad further speculated that “when Donald Trump is willing to fake a weather forecast, will he also fake economic statistics?”

Yup, this model looks fake:

Or the one at the top of the page.

President Trump does plenty of controversial things, but let’s stop pretending that being concerned for the welfare of a state in the path of a hurricane is somehow contentious.

This post represents the views of the author and not those of the Department of Defense, Department of the Navy, or any other government agency.