This may cause a little discomfort

Obama is right to propose federal spending on electronic medical records.

I don’t suppose a single vote on March 4 or November 4 will depend on the issue of electronic medical records. But I’ll write about them anyway:

  • It’s an important issue for health care;
  • There’s a clear difference between HRC and Obama on the matter;

    and Yanks have the bonus of

  • A costly British fiasco to jeer at.

The idea of a comprehensive national system of electronic medical records (EMR) is that clinical notes, and the associated data files from scans and tests, would be kept by all medical providers in the country in electronic form, in standard formats, and exchanged securely by standard protocols. This article by Robert Charette has more.

If you can get EMR right, as the Veterans Administration, the Mayo Clinic, the Regenstrief Institute in Indianapolis, and Finland seem to have done, there are great benefits in continuity and quality of care. Suppose you need treatment from unfamiliar doctors or nurses, for example in ER, if you have a medical problem while travelling, or when shifts change in a hospital. In these unsettling environments an accessible digital health record can improve and speed up diagnosis, avoid duplicate tests, and reduce medical errors. But what the USA has today is a vast patchwork of incompatible systems. There is a nice little federal initiative called the NHIN puttering away to develop standards for a national system, but obviously you don’t get implementation for a trivial $61m a year.

The three main Democratic candidates based their health care proposals on Jacob Hacker’s plan but Hacker was silent on EMR. HRC and Obama do mention it in their programmes, so briefly that I’ll just quote them:

Continue reading “This may cause a little discomfort”

Muddling through II – a Frenchie alternative

My scenario for British electrical generation: 25 GW of nuclear and 75 GW of wind

In my first post on the British energy policy muddle, I argued that what’s missing is a coherent target scenario, and promised my own back-of-an-envelope effort. Here it is – limited to electricity generation (don’t complain).

The current generation mix is summarised in this chart. (Spreadsheet here with sources.) Notice that nuclear provides only 13% of the capacity but 19% of the output, because it has low marginal costs. The winter peak demand is 62 GW, the summer one about 45 GW. I’ve converted total power output, usually expressed in terawatt-hours, into the equivalent mean continuous output in GW, so you can compare it with capacity. Pretty charts over the fold.

Continue reading “Muddling through II – a Frenchie alternative”

Muddling through I

British energy policy: a well-intentioned muddle without a coherent target scenario

This side of the water, British energy policy offers a nice reminder that while incompetence, corruption and fanaticism are bound to deliver bad policy, the converse does not hold: rational and well-intentioned policymakers can get into a mess if they lack method, vision and courage.

Gordon Brown made a major speech on climate change in November. It had more than its share of Big Statements:

The climate change crisis is the product of many generations, but overcoming it must be the great project of this generation.

– and characteristically Gordonian microdetails on standby consumption of consumer appliances. (The average daily summer temperature in Edinburgh does not exceed 18°C so Scottish TVs left on overnight are just providing needed space heating. Standby consumption is the sort of issue a genuine leader leaves to underlings.) The good point was that he rejected a ploy by mandarins aligned with the nuclear energy lobby to sabotage the EU’s ambitious targets for renewables. But it fell pretty flat. The media and Parliament soon had more exciting trivia to deal with.

There was besides nothing really surprising in the speech.

Continue reading “Muddling through I”

Walking the plank

universal jurisdiction on crimes of torture.

I agree absolutely with Mark’s response to Sam below (except that I think Bollinger’s introduction was spoilt by pointless discourtesy and the hysterical and flattering error of describing Ahmedinejad as a “dictator”).

Sam may not like universal jurisdiction on war crimes, but it’s a growing legal fact in most of the civilised world. Pirates early achieved status in international law as common “enemies of humanity” and from Cicero onwards the general idea was that anybody had the right and duty to string them up (Cicero isn’t strong on due process, but Grotius thought promises to pirates should be kept as made before God). Applying the doctrine to war crimes and crimes against humanity is just a revival. The British House of Lords judgements allowing the extradition to Spain of Augusto Pinochet were based on it: though the majority reasoning differs between round 1 and round 2. Either way, even Bush could not rely in Britain on immunity as a former head of state.

Regardless of formal jurisdiction, prosecutors are less likely to investigate and courts to extradite in cases where there’s no national connection. Garzón’s arrest warrant for Pinochet was based partly on torture committed against many Chileans, but also against a smaller number of Spanish citizens. The global reach of the American GWOT has caught up the citizens of many countries in unlawful detention and abuse; most from doubtfully democratic states, but some from say Britain and Germany. Even restricting jurisdiction to cases involving or including nationals (on the Garzón model), the global legal web would still be extensive.

Universal jurisdiction is contentious, complicated and therefore uncertain in operation. The US opposes it along with (according to Wikipedia) such bastions of human rights as China and Russia. Even in its current inchoate state, universal jurisdiction can still serve as a serious warning to perpetrators and an incitement to countries to clean their own houses.

There is as it happens an excellent solution to these uncertainties: ratifying the statute of the International Criminal Court. Or the pirate can always cry “state sovereignty!” as he walks the plank.

Brits leave Basra to its fate

Britain leaving Basra under a smokescreen.

The British Army has withdrawn its last troops from central Basra to the relative safety of the airport.

A Pentagon emissary, General Keane, and the International Crisis Group agree, from opposite perspectives, that Basra is in anarchy. Whitehall claims of course that it’s all part of a phased handover to the Iraqi army and government; though without troops in the streets the handover has already happened. Basra is now a real-life pilot for American withdrawal, a slice of Iraq without foreign troops. It will be a bloody mess until one faction comes out on top and imposes a modicum of order.

Gordon Brown has refused, in a letter to the Liberal Democrat leader Menzies Campbell, to set a withdrawal timetable. This was spun as pro-American. But the money quote is this:

Decisions on the ground will be made on the basis of advice from our military and other experts, taking fully into consideration the safety of our armed forces.

Translated:

I will decide when we go, not tell anybody till it happens, and pretend the decision is based on local progress.

Is there any atrocity in the Basra streets that could reverse the British exit? Perhaps someone blowing up the oil terminal – but the Shia factions and gangsters fighting for control are very unlikely to kill this golden goose, with its conveniently broken meters.

Way back I predicted that British troops would be gone from Basra 6 months into Brown’s Premiership. It may be sooner.

Gordon Brown, P.M

Gordon has at last taken over from his political sibling rival Tony Blair as Prime Minister. I wish him luck, a benefit which I expect he would despise as unmerited.

I see no reason to change my prediction here of last September that in six months British troops will be gone from Basra.