Mad Dog 21/21: Biting The Handout
February 16, 2009 Hesh Wiener
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At 7:20 a.m. on February 2, New York Mayor Michael Bloomberg visited the Staten Island Zoo to meet Chuck the groundhog. Chuck, formally known as Charles E. Schumer Hogg, according to Bloomberg News, didn’t appreciate Hizonner’s “teasing him with corn-on-the-cob.” The critter bit the mayor’s gloved left index finger hard enough to draw blood. Mr. Bloomberg remained affable, as is his wont, setting an example of good manners for the Federal government, which is going to spend the next few years feeding potential nippers, among them IBM, Google, and Microsoft. Now, it could well turn out that Chuck was not in the least upset by the mayor’s fooling with his food, but instead was simply showing his inner rodent when he chomped on the mayor’s digit. If so, it would be a classic. The persistence of a creature’s character, even in the face of death, is the stuff of which fables are made, and history, too. The relevant folk tale involves a frog and a scorpion. A scorpion persuades a frog to ferry him across a river. The frog refuses at first out of fear, but the scorpion argues that a fatal sting would kill the scorpion as well as the frog, making the sting a very illogical act. The frog relents and with the scorpion riding on his back starts to ford the water. Midway, the scorpion fatally stings the frog and as they are both drowning explains himself by saying, “What did you expect? I am, after all, a scorpion.” Scholars would like to attribute this tale to Aesop but they don’t all agree. A version of this story crops up in South Asian folklore, and that might be where it was born.
These days, quite a few people are worried that banks riding on the backs of investors and now governments might not be able to resist dangerous urges. But banks are not unique, even if they are exceptional, because they are in the money business and produce only funds. Enterprises that offer goods and services on which they make a profit don’t live on a higher moral plane. The ethical position an enterprise exhibits through its behavior and in its avowed aspirations is the result of a complicated stew. The ingredients include the character of its owners and managers, its customers’ attitudes, social pressures, laws, regulations, constraints imposed by business conditions as well as environmental factors and other circumstances. Right now, American companies are about to be offered unprecedented opportunities and temptations by the U.S. government’s fiscal stimulus plan. The new law (and those that may follow amending or extrapolating the current act) will put hundreds of billions of dollars in play. A substantial amount of money will be used to create medical records libraries. Here are a few specifics and the page number in the act where the details appear in the new economic stimulus bill, which should be signed by President Obama on Tuesday, February 17:
IBM has already said it wants to take part with technology that can be used to connect health devices such as physiology monitors directly to online databases such as the ones in the free (for individuals) cloud service called Google Health. (IBM has no similar service at this time and Google’s records system apparently adheres to publicly available interconnection standards). Just how much of IBM’s technology is open and how much will stay open remains to be seen; a lot depends on whether IBM can refrain from adding a proprietary sting to the tail of any open software it uses to get things started. Google is another technology giant that appears to want a big role in the refloating of America’s sinking economy. Its big enchilada, Eric Schmidt, was pretty active in the Obama presidential campaign. Google got into the personal health records game after Microsoft, but some observers think it has a better chance of finding a way to profitably monetize its Google Health service and to either shape or possibly provide significant medical record keeping services to federal, state and local government agencies. Google seems to be more image-conscious than IBM. Its corporate motto, “I am not a crook” is as enduring as Richard Nixon’s admonition to his top aides, “Do no evil.” (Yes, that is backward.) Google says its service for storing personal medical records is secure, but Google creates its own definition for privacy. Its revenue is based on scanning Web documents, emails, and other materials so it can sell targeted advertising. Google is brilliant at what it does. It is not only better at the Internet monetization game than its direct rivals such as Yahoo and Microsoft Live, it might have more sophisticated content analysis systems than the National Security Agency. It is probably difficult to overestimate Google’s capabilities.
It is also clear that Google adapts its practices to meet the requirements of markets that are quite different from those in its home country. In China, Google’s search service includes censorship technology that satisfies the requirements of its host country. This practice makes good business sense for a company that is in the search business and derives its income from commercial advertising. It’s not quite so clear that Google’s policies are the right ones for a company entrusted with personal medical records. Microsoft is also a serious candidate. It was the first information technology giant to offer personal medical record retention services to the public with its HealthVault cloud technology. There is no doubt that Microsoft’s founder, Bill Gates, is very serious about playing a constructive role in the world, particularly where health is concerned. But what he does with his foundation is not the same as what is done by Microsoft. Sadly, despite its success and the enormous contributions it has made to the popularization of computing, Microsoft has a reputation for publishing flawed software. The second Tuesday of every month is Microsoft Fixes Some Bugs Day. Microsoft is also the target of choice for hackers. So many script kiddies have Windows and its applications in their sights that to a large extent the entire computer security business is based on the never-ending battle between Microsoft and the vandals that attack the company, its products, and its customers. There may be only one way for Microsoft to play a large role in health records systems and that is to put all the software it uses for its services into the open source world . . . and to do this with one of the more generous licensing schemes, such as the GNU General Public License. Microsoft might have to rework its code to run atop Linux or BSD Unix rather than Windows because it is not going to open Windows to the public. If it keeps its technology proprietary, it can succeed with products sold to hospitals and it might get an adequate user base from the general public, but without putting the relevant source code technology into the public domain Microsoft would end up in a permanent state of siege, a situation that would sap its energy and corrode its good intentions. For IBM, Google, and Microsoft, which at this time seem to be the top three information technology companies racing to feed on the health related infrastructure provisions of the U.S. economic stimulus law and its successors, there is one more test they ought to be made to pass before they are awarded nine-digit contracts: Will they take their own medicine?
By this we mean that for the key contractors and subcontractors involved in government medical records systems, and for the U.S. government, too, there is one relatively simple way to make future systems as secure as possible: Compel the vendors and the government to be the first participants. Everyone on the payroll of the U.S. legislative, executive, and judicial branches should be the first people whose medical records are kept in any national health information system. The same should go for state and local government. Every employee and all the directors of the prime contractors and all their subcontractors should similarly be required to keep their personal medical histories in any national system. The requirements should be backed by significant penalties for a failure to fully comply with the most stringent requirements of any participant. If a Medicare beneficiary has to provide complete medical records and see that no data are old, let alone omitted, the very same rules should apply to President Obama and his family, to the House and Senate, to the Supreme Court, and down to very coder and clerk working on the software. This is a war where it is not only possible but absolutely necessary to send the generals to the front lines. Either that or, as the groundhog says, chuck the whole idea.
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