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Category: Public Policy

The New Normal

The New Normal

The New Normal.” That phrase, already becoming hackneyed through use, pretty much tells it like it is.

Whether in New York or Nice or London or Barcelona, terrorists’ use of vehicles to mow down innocent people has become part of that “new normal.” Why bother with hijacking or blowing up an airliner when one can rent a truck, penetrate low-security areas, and make one’s twisted point with the blood and broken bones and murder of innocent people? With this approach, every low-level fanatic or miscreant worldwide becomes a tool for ISIS or other such groups to spread their message of terror.

Sad, but I believe accurate, to say, what happened in New York on Hallowe’en afternoon when Uzbeki émigré Sayfullo Saipov used a rented truck to career down a bike and pedestrian lane to take the lives of eight innocent people and injure at least another 15 embodies this “new normal.” And while it isn’t the first, by no means will it be the last time we see such an attack. What’s more, the ease and economy of mounting attacks of this nature makes everyone who ventures outside or who takes part in enjoying group activities or just taking a walk on a nice day a potential target.

It has been reported that ISIS put out the word through its social-media channels encouraging its adherents worldwide to mark Hallowe’en by doing exactly what Saipov did. Probably the only remarkable thing is that there weren’t other such attacks to mark the day and provide ISIS with more of the impact it seeks. But that should not offer any solace or encouragement. There is every reason to believe that there will be more vehicular and other low-level attacks and they will, in fact, figure into this “new normal.”

Other than personal vigilance and being acutely aware of one’s surroundings, there isn’t a huge amount anyone really can do to protect against attacks of this nature. It’s hard to tread a path somewhere between being blithely unaware and persistent paranoia. Somewhat akin to awareness of the potential for criminal activity in any public place or on any public conveyance, staying on what I would term “Condition Yellow” – being attuned to what’s going on around oneself and being prepared to react quickly to a perceived threat – should probably become the base condition for any of us when out and about.

In terms of public safety, a better response demands keen and focused policing. It’s now known that the authorities were aware of Saipov, who figured into various security investigations that were under way. Why Saipov’s plans were not uncovered and why he was not picked-up before he could carry out his heinous attack remains to be seen. Whether we’ll ever know the answer to this question also remains to be seen. We see shades of the Boston Marathon bombers, Tamarlan and Dzhokhar Tsarnaev, who also were in the FBI’s radar. The FBI even had been warned about the Chechen brothers by the dreaded Russians, but the FBI failed to take the pair into custody in advance of their murderous 2013 attack that killed three people and injured hundreds of others.

Failures in intelligence gathering and failures to act on intelligence leads are serious and have real-world consequences. Boston and New York and many of the other terrorist attacks that have taken place here and abroad where it later came out that the terrorists were on officials’ radar demonstrate the truth of this.

One thing that has come under scrutiny as a result of the Hallowe’en bombing is what is known as the Diversity Visa Program (DVP), better known as the Visa Lottery Program. Saipov had been admitted to the U.S. in 2010 under this program. While it might be a stretch to say that were it not for the DVP the New York attack – or at least others like it – would not have happened, it is a program that demands scrutiny.

As a consular officer in 1990 when DVP was first introduced, the “brain child” – to speak euphemistically – of the U.S. Congress, I and other consular officers with whom I worked were appalled by the program. Not only did it offer one more way for foreign nationals to skirt the normal strictures of our immigration law, it took the value of immigration to the U.S. and debased it, making it a matter of simple luck. Neither skills nor specific qualifications nor even family relations played any role in being selected for a DVP visa. All it took was being a citizen of what was deemed to be an “under-represented” country and having a post card with one’s name on it picked at random. Winning a visa under the DVP was the same as winning any other lottery.

Now, 27 years later, the only substantive change to the DVP is that the numbers of visas allowed have increased from 20,000 to close to 50,000. While the initial rationalization for DVP was to benefit Irish would-be immigrants, 48,000 of whom were legalized in the first three years of the program, the mix of DVP immigrants today is strongly tilted toward Asia, Africa, the Middle East, and Eastern Europe. I can’t help but ask why the most diverse country on earth needs to resort to a lottery to further that diversity?

While admission of would-be terrorists can’t be any more directly attributed to DVP than to any other U.S. immigration category, it’s pretty clear it was the source for Saipov being in the country in the first place. It’s also pretty clear that Saipov, described by people who knew and worked with him as a disgruntled truck driver with a poor driving record, lacks any of the higher-level skills that the country needs and which DPV fails to address. If, as a matter of policy, the country wants to open up immigration to other than simply family members of those already here and to encourage merit-based immigration, the answer is not a visa lottery but rather a points-based immigration system, much like Canada, Australia, New Zealand, and other countries have. To see why, be sure to read my posting on Pointing Immigration in the Right Direction.

Regardless what happens with the DVP, it’s clear that we’ve moved into the era of a “new normal” where terrorism is concerned. So be alert, stay on Condition Yellow when in public, and let’s hope those whose responsibility it is to track and apprehend those who would do us harm do a better job than they have in cases like Saipov and the Tsarnaev brothers.

Physician, Heal Thyself!

Physician, Heal Thyself!

No, this isn’t about drugs or addiction or ODing, or any of those things. It is about frustration, though. Frustration with the medical profession. Frustration in trying to create sense where sense seems not to exist. Frustration that can lead to scenes such as in the image. Fall down on the floor, tear out your hair, rend your garments sort of frustration.

To be perfectly clear, this posting is based on a personal incident – drama is more like it – playing out now with certain elements of the medical profession. To protect both the innocent and the guilty, I’m not going to name any names. Now. But if I continue to be stymied, that decision might change. Watch this space.

If you’ve read my piece on The Biggest Shell Game in the World, which you should before reading on here, you know how I feel about the so-called “healthcare system” we have in this country. You’ll also see I elaborated on some specific actions that might help ease the growth in the cost of healthcare. That posting focuses on the macro dynamic of the system. This posting focuses on the micro dynamic, the one on the doctor level.

It’s no longer a laughing matter – it never was a joke – to say that much of the medical profession is still anchored, not just in the last century, but maybe even the one before it.

When I lived in Montana some dozen years ago, my physician – an author of the reputed Helena Heart Study, so no slouch – presented himself as advanced because he took his notes on a laptop. Why that should have been considered advanced when small computers had been in fairly wide business use for a quarter century already is a good question to ask, if you’re inclined to ask questions. Now, all the doctors I go to use laptops for their notetaking and recordkeeping. Of course, it is, at last count, 2017.

The one thing my Montana doctor did that really stood out was to communicate by email. Quick, easy, asynchronous. Email. One would think this also would be pretty standard now. That’s what I thought. I mean, I run a global business and communicate with clients all over the world at close to 100% by email. So picture my surprise to be out of Montana and in a southeastern state that also shall remain nameless (besides, I often reverse the “d” and the “i” in the name, which is embarrassing) and to find that email does not play a role in typical doctor-patient communication.

Does one even have to wonder why calling a doctor’s office often leads to more frustration, lengthy stays on hold listening to dreadful “hold” music and self-serving promotions, being asked, finally when you get past the official hold, “Can you hold, please?” (Okay, at that I’m tempted to fire back, what are my options here?)

Again, how can almost any organization in 2017 function without email? It’s not only a fast and easy means of communication, but it also can be used as a system of sending health information to patients and even, if one is allowed a bit of crassness, as a marketing device. But, no, this seems to be beyond the understanding of most doctors.

Then there are those doctors’ portals. Potentially great idea, completely mutilated, misused, and just plain not used, in execution and practice. First, they’re all clunky in that clunky way that special-purpose software (like used in lawyer and, yes, doctor offices) always is. I don’t know, maybe it’s me, but I’ve had a litany of problems with the portals of several doctors and healthcare groups. Sometimes I’d have to enter a new password each time I signed in. Sometimes things I’d want to see, like reports, are there. Sometimes not. One portal doesn’t even tell me my next appointment, which would seem pretty basic. I’ve yet to be able to get a prescription refill put through based on a request posted on a portal site. And, perhaps the biggest issue I’ve encountered, often doctors’ front offices don’t mind the sites, so sending a message to the office through the portal is like throwing a quarter down a deep well. “Pathetic” is too kind a word.

Okay, despite all that, that’s not my biggest problem nor the most immediate. Oh, no. I have a far bigger gripe, which we’ll get to now. The one that concerns the Health Insurance Portabliity and Accountabillity Act – HIPAA – and how doctors not only seem not to know much about its requirements but, worse, seem to think it exists to protect them and not the patient. Which is wrong.

I had one doctor earnestly tell me that there is a $50,000 fine attached to a single HIPAA violation. Well, he was part right. Fines can range from $100 to $50,000, or $1.5 million maximum per year for ongoing violations. What puzzled me then, and which irks me now, is that the implication was that the doctor had to protect himself against violations and resultant hefty fines. The point that was completely missed, even inverted, is that denying a patient access to his or her records in whatever way the patient deems suitable seems like a more sure route to a violation than just providing what it is the patient requests, in the form or via the means requested by the patient.

Now that doctor’s office will fax me things like test results. Some will even (horror!) email them. And then there are others, like another one of my doctors, who refuses to provide records or results in any form other than by mail, or picking it up in person. Never mind the inconvenience of the latter choice, I would defy anyone to show me how snail mail is any less prone to pilferage or misdelivery than a fax or email. I even maintain an encrypted email account for highly sensitive information. But all that is irrelevant. The Department of Health and Human Services (HHS), which oversees application of HIPAA, is clear on the subject: A provider should email, fax, or accommodate alternative delivery means as requested by the patient. Look it up. It’s right there, explicitly spelled out by HHS, in the department’s HIPAA FAQs.

That’s really the key issue: Patients have a right to see and receive their own records and results, and HIPAA exists to protect them, not the doctor or other provider. So if a patient wants his or her bloody records emailed or faxed to them, HHS says the provider should accommodate that request. But you’d never know that from the patchwork of restrictions, most of which make little to no sense anyway, that one encounters when requesting one’s records.

Of course, all this assumes that a patient has signed a statement authorizing release of information to the patient and whatever third-party designees, if any, that the patient might include in the release. Now here is a suggestion – a strong one: Why not include a check-off box with a line where the patient authorizes positively (by checking the box) transmittal of records via email or fax? Easy-peasy, and takes care of any misunderstanding. And while you’re at it, how about another line with a check-off box authorizing the same thing for any third-party designees? Two lines, and you can sleep better at night knowing the patient has asked for this and HHS says you should give it to them. And it’s in writing, no less.

All this leads to the source of my current distemperous mood toward doctors and things medical. It’s been four weeks – not hours, not days, not business days, but weeks – that I have been requesting the results of an MRI from a certain specialist. I requested that the doctor or his nurse-practitioner call me before I left on an extended trip so I could at least have a sense of what the MRI revealed. I was told, well, he probably won’t call you. He likes to do things in person.

Well, I like to do things in person, too, when that works. But in this case, it wasn’t even possible to get an appointment in less than a month or more. And I was clear that I was leaving the state and needed the information before I went.

Ha. Fat chance. Four weeks have gone by, I’ve lost count of the number of times I’ve called this doctor’s office, had my primary care physician’s office call him, even the insurance company called the office when I filed a grievance with them over this. And still I can’t get either the doctor or the nurse-practitioner (which would be fine) to speak with me and discuss the test results, much less actually get those results. Now if ever there is a HIPAA violation, it would seem this is it. It will take a formal complaint to HHS, but that is imminent. I now even have my attorney on the case.

The doctor might have his procedures, but there are two parties to the transaction, the other being the patient, and in this case this patient has different procedures. And HIPAA is on his side.

It’s bad enough having to deal with doctors and tests and health issues without having to be put under further stress and duress by providers and offices that just throw more roadblocks and obstacles in the patient’s path.

All this seems very 19th Century to me. Doctors hold themselves up as miniature deities and patients are just supposed to accept whatever inconveniences, incompetence, or affronts that the doctor and doctor’s minions subject them to. And there are others besides those discussed here. Let’s just save my rant on the prescription system for some other time, ‘kay?

If you’ve encountered any of these issues in dealing with doctors, I invite you to tell everyone about it in the comments. And if you have a different and more positive story to tell, by all means post that, too, in the comments. And if you question the premises on which this piece is based, well, fire away with that, too.

Meanwhile, I’m going to fax this piece off to a few doctors I know (I have to fax them since I don’t have their email addresses) and maybe shake a few trees. Or else things will just go on as they always do. And watch this space if I decide it’s necessary to start naming names.

Physician, heal thyself!

From Water to Water

From Water to Water

. . . for water thou art, and unto water shalt thou return.”

Taking a little poetic license here with the wording of Genesis 3:19 to illustrate the intrinsic nature of hydrogen technology.

We’ll get to how that works, but first a little background, about me, and about hydrogen and its use in electricity-producing devices known as fuel cells.

I covered the space program as a science writer back in the 1980s, including daily interaction with NASA’s Space Shuttle program. That’s when I first started getting really interested in hydrogen as a potential fuel source for the future, including replacing fossil fuels for use in our cars, trucks, buses, and possibly even aircraft. At the time, I considered various possible fuel sources, and the one that made the greatest sense to me was hydrogen, the most abundant element in the Universe. Not to burn hydrogen as we burn gasoline or diesel, or as the Space Shuttle burned it for lift-off, but rather as a source to produce electrical energy through a fuel cell that would then drive electric motors.

NASA has been putting fuel cells aboard spacecraft since the early 1960s, and they are what generate electricity aboard many spacecraft, including the Space Shuttle when it was operational. Fuel cell technology is actually a very old one, the principle first demonstrated in 1801 – yes, 1801, that’s not a typo – by Humphry Davy. Sir William Grove, who came to be known as the “Father of the Fuel Cell,” then invented the first fuel cell, which he called an “electric battery,” in 1839. Two researchers, Charles Langer and Ludwig Mond, were the ones, in 1889, to coin the term “fuel cell,” as they attempted to produce a device that would convert coal or carbon to electricity. What is considered the first successful fuel cell, using hydrogen and oxygen with alkaline electrolytes and nickel electrodes, was developed by Francis Bacon in 1932.

It wasn’t until 1959 that Bacon was able to produce the first practical fuel cell, one that could be put to use driving equipment. Also during the 1950s, General Electric invented the proton-exchange membrane fuel cell, and in the subsequent decade NASA started putting fuel cells aboard spacecraft. The technology since then has continued to develop, evolve, and gain in efficiency, which puts us where we are today.

My conclusion 30 years ago that hydrogen, used to generate electricity through fuel cells, would be the wave of future automotive technology was not the first bit of technical or scientific prognostication I had come up with. Ever since I was a kid I saw concept after concept that I first postulated subsequently adopted by manufacturers and appear on cars as well as on ships. It’s taken nearly three decades, and it probably will take another decade to be fully realized, but I finally am seeing my conclusion about hydrogen and fuel cells coming into reality. I don’t suppose I am the only one who saw this development, but I feel increasingly vindicated that it was an accurate prediction.

Now, getting back to the water-to-water thing. If you remember anything about your early schooling, beyond perhaps your first teacher’s name or the name of your best friend, it is the formula for water: H2O. The “O,” of course, stands for oxygen, the third most abundant element in the Universe. And the “H” stands for hydrogen. Two atoms of hydrogen, combined with one atom of oxygen, give us that liquid, water, essential to life as we know it.

Now here’s the really neat thing about hydrogen. It can be produced by separating it from oxygen in water, yielding both key elements to produce energy in a fuel cell – hydrogen and oxygen – and then when they are rejoined at the end of the process, voila, you get back water, and only water. It starts as water and ends as water. Water-to-water. Neat, huh?

Compared with a standard internal combustion engine burning gasoline or diesel, which produces poisonous carbon monoxide, nitrogen oxide, sulfur dioxide, particulate matter, and other nasty stuff, it’s kind of a no-brainer. But what about pure electric car with motors powered by batteries, you ask? Aren’t they even cleaner, producing no pollution? Well, that’s only if you look at the motors themselves. But where does the electricity needed to charge the batteries to drive the motors come from? Right. Power plants which, depending on the plant, might burn fuel oil, coal, nuclear fuel, or natural gas (the latter perhaps being the cleanest source of mass power production, save for hydroelectric plants which have their own issues associated with them).

Former Fox News commentator Bill O’Reilly once waxed eloquent about how all the nation’s cars should be electric and how much cleaner that would make the environment. I pointed out to him something called the Law of Conservation of Energy, which means it would take the same amount of energy to move all those cars regardless the source of the energy, and if the source of the electricity was central power plants, as it would be, there still would be a significant amount of pollution associated with all those electric cars. Alas, O’Reilly, clearly not a physicist, chose to ignore my message.

There are other problems with electric vehicles, too, including significant environmental issues with both the manufacture of the big batteries used in cars – building an electric car produces more greenhouse gases than does building a conventional car – and their disposal when they’ve reached the end of their useful life. And while the best pure-electric vehicle today might go over 300 miles on a charge, most still are limited to a range of 100 – 200 miles. Not very far, especially when it can then take anywhere from 30 minutes for a quick charge up to around 80 percent of battery capacity to as long as 12 hours to re-charge the batteries. If you’re not in much of a hurry or not going very far, an electric car might meet your need. Otherwise, not so much.

There is another huge problem with electric cars that was highlighted in recent months by the three major hurricanes to hit U.S. shores this year: Harvey, Irma, and Maria. When power is knocked out for large swaths of territory for hours, days, weeks, and, in some cases, months, an electric vehicle becomes a very large paper weight. Lacking a source of power to recharge its batteries, an electric vehicle isn’t going anywhere once its batteries are depleted. While there usually are conventional fuel shortages around big storms, people can fill their tanks ahead of time and often there are limited sources for gasoline and diesel available before, during, and after big storms. A conventionally powered vehicle might keep going while an electric one might not.

Looking now at hydrogen cars, the cars being produced and sold that are called “hydrogen-powered” actually employ fuel cells to drive the electric motors that drive the cars. While lagging far behind electric and hybrid-electric cars in terms of sheer numbers on the roads, the biggest problem retarding their more widespread use is a chicken-and-egg conundrum centered around the availability of hydrogen fuel stations. With low numbers of hydrogen vehicles there is low incentive to provide hydrogen fuel stations, and the low number of hydrogen fuel stations deters more widespread marketing and purchasing of hydrogen vehicles. But there might be changes on the way as, I would argue, there should be.

It’s estimated that by the end of this year there will be just 50 hydrogen filling stations in the U.S., most of them in California. There also are fleet stations and those used for research vehicles, but there is a huge gap in the number of places where one can fill up a hydrogen vehicle. Consider, however, that it only takes 3 – 5 minutes to refuel a hydrogen car, comparable to filling up a gasoline or diesel car, versus the hours needed to charge an electric vehicle, and the fact that hydrogen cars have ranges in excess of 300 miles and acceleration often equivalent to a conventional car.

Besides the paucity of places to fill up, the other problem with hydrogen is how to generate it in clean and economical ways. While it’s the most abundant element, it loves to join with oxygen to make water and other atoms to form other substances, and breaking it free to run it through a fuel cell is both a technical and an economic challenge. While there is enough oxygen in the air to use in a fuel cell, it’s a more difficult proposition with hydrogen.

There are all sorts of ways used to generate hydrogen, ranging from throwing iron filings into vats of sulfuric acid, to cracking hydrocarbon molecules in natural gas to, a more recent proposal, using geothermal heat at great ocean depths to generate large quantities of hydrogen. While the first method produces toxic waste, the second produces carbon dioxide, a greenhouse gas, and the third is still under development, there is a simple, tried-and-true method, alluded to at the outset of this piece, that starts and ends with water.

That method uses electrolysis to separate water into its constituent atoms, and then after passing them through a fuel cell, reunites them as water at the end of the process. In fact, it’s relatively simple to construct a hydrogen generator of this sort – I’ve done it myself with readily available materials costing somewhere around $100 – and there are commercially available hydrogen generators for prices equivalent, or less, than making one’s own, and there even is a portable hydrogen reactor and fuel cell available for $105.99.

The basic problem with generating hydrogen through electrolysis is that it uses electricity to produce the hydrogen to be used in a fuel cell to, you guessed it, make electricity. But it’s not hard to envisage using solar or wind energy to provide the electricity used in the electrolysis. In fact, I think it doesn’t take a huge amount of imagination to picture each household with a hydrogen vehicle generating its own hydrogen. And maybe it’s a bit of a stretch today, but why can’t we see each hydrogen vehicle with its own on-board hydrogen generator, powered with rooftop solar panels, producing its own fuel from water that then returns to water and is recycled back through the hydrogen generator and, employing a little hyperbole, becomes its own perpetual motion machine?

We’ve heard of the supposed possibility of running cars on water, but with hydrogen cars this is a possibility, and it’s all based on science, not science fiction or a scam, if the technical issues can be worked out.

Elon Musk, who has put all his eggs in the electric car basket with Tesla Motors and the Tesla Gigafactory battery-production facilities, calls hydrogen technology “incredibly dumb.” He thinks it’s inefficient. But the major automobile manufacturers against which Musk and Tesla are pitted might disagree, and there are no fewer than eight hydrogen cars either currently available or under development for the marketplace in the next few years. These include the Toyota Mirai and Honda Clarity, two hydrogen cars already on the market, and hydrogen cars planned for release in the next few years by Lexus, Mercedes-Benz, Audi, BMW, Ford, General Motors, and Nissan. A small Welsh startup, Riversimple, is making its subcompact hydrogen car available in the UK this year, Ford expects to have its hydrogen car out this year, and startup truck maker Nikola Moto Company unveiled a prototype hydrogen truck late last year that it expects to offer by 2020, with a range of between 800 and 1,200 miles. Nikola also plans to open 364 hydrogen filling stations by 2019.

Meanwhile, the French firm Alstom ran its first hydrogen fuel cell train, the Coradia iLint, in Germany in March, reaching 80 kph, and 140 kph in tests run in the Czech Republic, and orders for the train are already pouring in. Its sole emissions are steam and water.

“It’s so clean you can breathe it in,” says Stefan Schrank, Alstom’s project manager of the train’s emissions. And it is 60 percent less noisy than a diesel-powered train.

Whether the various plans for hydrogen cars and other vehicles reach fruition remains to be seen. It’s still not clear whether hydrogen is the fuel of the future and always will be – as Charles de Gaulle once said of Brazil – or if it becomes the primary fuel to replace fossil fuels. The question may be decided in the next 10 – 15 years, or even sooner. It was my pick 30 years ago, and so far I’m still betting on it.

Water-to-water, baby. I think that’s a winning formula.

The Hurricane Next Time

The Hurricane Next Time

Another week, another hurricane. There was Harvey. And then Irma. Jose is heading north. Maria has worked its devastation. Hurricane Season being what it is, the storms line up across the Atlantic and the Pacific. Whatever the next time is, there will be a next time. And another hurricane.

I’m back aboard my boat after evacuating to Destin in the Florida Panhandle to get out of the way of Irma. Part of my excuse for the delay in posting to this blog. Irma, it turned out, was accommodating and jogged northeast just before it hit the Tampa Bay area. Good news for me and my neighbors. Bad news, very bad news, for people in the interior of the state and further to the northeast. Storms create winners, and losers. Mostly losers.

Ask the people of Houston and elsewhere in Southeast Texas. Ask the people of the Florida Keys, or Southwest Florida, and lots of other places in the state. Ask the people of Barbuda and St. Thomas, of Sint Maarten and Saint-Martin and Puerto Rico. And before them, ask the people of the Philippines, of Mississippi and Louisiana, of Mexico and Honduras and South Carolina and New Jersey and even New Hampshire and numerous other places.

Hurricanes aren’t picky and they don’t discriminate. They’re equal opportunity destroyers and, given enough time, they spread their devastation around. Of course, the planet would have worse problems were it not for the big storms that redistribute the earth’s heat energy, but try telling that to someone who can’t get out of their house without a boat, or no longer has a house at all, or who has no water, food, or electricity. Or lost a loved one. It’s a tough sell.

I’ve been around hurricanes almost my whole life, in their projected path several times but, if you ignore passing through two of them during one sea transit of the North Atlantic as a kid, I’ve never been in the middle of one. I guess that’s my hurricane karma. But I’ve seen the aftermath of them, spent weeks that turned into months that turned into years living with the after effects of Katrina, and I’ve had a chance to observe both close-up and at a distance the preparations for their arrival and dealing with what they leave behind.

It’s those two elements – advance preparations and dealing with hurricane aftermaths – that I want to focus on here. Some of what I have to say is based on observation of those two things in several storms, and some is based on a plan I developed while living with the protracted recovery from Katrina.

Based on the events of recent weeks, at least in the U.S., I think some lessons have been learned. Some are partly learned. But we still have a continuing learning curve to go up and more work to be done.

The debacle that was the overland evacuation in Texas from the approach of Hurricane Rita in 2005 taught us some things about evacuations. Rita, the Atlantic’s fourth most intense hurricane ever recorded, the most intense storm ever seen in the Gulf of Mexico, and coming just three week’s after Hurricane Katrina’s onslaught, prompted fears the storm would devastate the Texas Coast. This led to an uncoordinated series of evacuations that poured between 2.5 million and 3.7 million people onto the state’s highways, leading to total gridlock. While the concept of contraflow, to reverse all inbound lanes on the Interstates to outbound, was already known, the order to implement it came too late and it took more than eight hours to make the change-over. Of the seven people in the U.S. who died directly as a result of Rita, only one was in Texas. But an estimated 113 people died in the botched Texas evacuation, including 23 nursing home residents who were killed when the charter bus they were on caught fire on the Interstate.

In advance of Hurricane Harvey this year, Houston Mayor Sylvester Turner decided not to issue any evacuation order for the city. Not mandatory, not voluntary. Turner, looking back at Rita, reasoned that you can’t put 6.5 million people on the highways without creating mayhem. But virtually the entire city wound up inundated, with many left homeless, or stranded in flood-damaged houses from record rainfall. Some were electrocuted when, for reasons that are not apparent, the power was not cut off as a precaution as is normally done. It seemed the city was far from prepared for the storm to come.

As for evacuations, the answer, of course, is not to evacuate an entire city the size of Houston, the nation’s fourth largest, but to evacuate the most vulnerable areas. To provide local shelters. To move some people in buses and not everyone in private vehicles. And to do the necessary to avoid ancillary deaths, to the extent possible. It wasn’t a mystery that Houston was going to be pummeled with massive rainfall. The path and potential of the storm was known, as was Houston’s topography and propensity to flood. And yet, there was no evacuation order.

Contrast that response with the response of Florida Gov. Rick Scott and state, county, and local officials in Florida. With Irma on its way and a high likelihood it would hit the state in some place or other, Scott went on what was almost a personal campaign to get people to evacuate the most vulnerable areas, and made it as easy as possible for them to do so. Tolls were removed from the state’s toll roads – they are about to be reinstated at this writing – hotels were ordered to accept pets, the Florida National Guard was partially mobilized, and state troopers were used to escort fuel trucks.

The first priority was evacuating the Florida Keys, which are tethered at the bottom of the state by 90 miles of the Overseas Highway, the sole land access to the Keys. Other areas deemed most vulnerable, the low areas of Southeast and Southwest Florida, were the next priority. And then other vulnerable areas came after that. Scott’s campaign launched a week before Irma’s arrival, and kept up throughout the storm and in its aftermath, and continues even well after the storm. Florida’s evacuation was not perfect – there were serious fuel outages, long delays at times on the state’s Interstates and other highways, and Irma’s vagaries wound up unexpectedly sparing some areas while hitting others, hard – but overall it went pretty well, given the enormous number of people affected.

Not everyone followed the evac. orders, and authorities said they would not arrest anyone for not complying. While a major reason for an evacuation is so first responders don’t have to risk their lives searching for stragglers in trouble, authorities also said that after a certain point no one should count on a rescue. Whatever the factors involved – in part, at least, the euphoria and excessive confidence that pervades many Keys residents – those who stayed behind in the islands came to find out the devastation a Category 4 hurricane can bring. It’s not yet known what the death toll is in the state as teams go through the destroyed housing of the Keys looking for survivors and casualties.

Of the points where preparations for the storm failed, perhaps the most telling and disturbing was the lack of back-up plans, power, and action by some nursing homes, both in Texas and Florida. The incident that has gotten the most attention was a nursing home in Hollywood, Fla., where so far 12 elderly residents have died. With a hospital just across the street, it’s hard not to assign negligence to the managers and owners of this facility. The state has opened an investigation and alleged criminal negligence, but meanwhile the horse – 12 of them so far – has left the proverbial barn and can’t be brought back.

A spokesperson for the nursing home association said that nursing homes are not required to have generators, only a back-up power supply. Whatever the hell that means. From my perspective, based on what happened in these and other storms and the personal experience of my own mother when she was alive, there is entirely too little oversight of nursing homes and assisted-living facilities. This paucity of oversight applies in other times, too, not just when there are storms. But certainly things need to be beefed-up to deal with natural disasters. Every nursing home and assisted-living facility should be required to have an emergency action plan (EAP), which should be reviewed by regulators, and also to conduct drills practicing the EAP, to the extent practical. There also has to be more attention paid to those “back-up power supplies” and sufficient generation capability should be required to not just keep the lights on, but also run the air conditioning in hot areas and heat in cold ones.

As I mentioned, I lived on the Mississippi Gulf Coast through most of the recovery from Katrina. The very slow pace of recovery in both Mississippi and Louisiana was a source of frequent frustration to me, but it was a true bane to those who had to suffer through it. In some cases, people have never recovered. Burdened with too much bureaucracy and red tape and some truly bone-headed decisions, FEMA proved to be largely inefficient and, for many, ineffective in its response. In the end, someone calculated that for all the money spent on FEMA and other agency responses, the government could have built a new house and put two new cars in the driveway for each affected family. That is a scandal of the first order.

What I have seen, and experience has borne out, is that a multi-pronged approach is needed to respond to any natural disaster of this magnitude. In the plan I previously developed, this approach would be more forward looking than backward looking. At the head of the effort would be a disaster council combining federal government agencies, non-profit relief organizations, faith-based groups (which often provide a major portion of recovery efforts), and the profit sector. All these groups have a stake, and a contribution to make, both in preparing for natural disasters and in recovery. And this applies not just to hurricanes, but to other natural disasters, such as tornadoes, earthquakes, and major fires.

Similar councils should be established at the state level in the most affected states, with coordination between the state and national councils. And under my plan, Congress and state governments should consider establishing a disaster fund into which both public and private funds would be deposited in advance of disasters, not leaving things to allocations after the fact, which often come too late to deal with the worst immediate effects of a major storm or other disaster. This approach makes the response both prospective – looking ahead to future disasters – and retrospective – looking back in the aftermath of those that have already occurred. The cost will be there in any event, but by having funds already allocated they can be assigned quicker and will offer the most and most efficient benefit to those affected.

We tend to avoid thinking about what might happen tomorrow, even less about paying for it. But just as our learning curve in preparation and recovery has continued to go up with each major storm, I see this as a logical next step in our approach to dealing with hurricanes and other natural disasters, which are not just going to go away.

Getting Out of Stalemate With North Korea

Getting Out of Stalemate With North Korea

Anyone can be excused for thinking the stalemate we find ourselves in with North Korea is a bloody mess without any really good outcomes, and they might well be right. It isn’t the first time we’ve been stalemated with North Korea, though the stakes and potential consequences are rising with a nuclear DPRK. So here I come to wade into this situation, which has proven intractable since the Korean War drew to a close on July 27, 1953, not with a victory for either side, but with an armistice that stopped the fighting and left both North and South in a state of war that has continued until today.

I don’t claim to be a Korea expert, and neither am I a proficient war gamer or military planner, so I want to make that clear up-front. But I do know a bit about international relations and can see what often works, and doesn’t work, in dealing with rogue states like North Korea, and also have peripherally followed U.S. dealings with Pyongyang over the past couple of decades. So those are my bases for offering the analysis that follows.

Unfortunately, in the current situation it’s easier to engage in Monday Morning Quarterbacking, to look at all the things done wrong by previous administrations rather than offering any reasonable alternatives looking forward. But those past bad decisions can offer some guidance about what doesn’t work with North Korea, if not what might.

I’d like to start by debunking some of the myths that people hold about North Korea and its leadership. Perhaps the most common one is that Kim Jong-un, the chubby 33-year-old with the funny haircut who serves as current Supreme Leader of the DPRK, is a madman, deranged, or some sort of a nut case. While no one can argue that he’s not idiosyncratic or a tad bizarre, that is a long way from being mentally deranged. Was Hitler, or Saddam, or Stalin, or Mao, or any of the other mass murderer-leaders of the past century, mad? On some level, perhaps, but that does not mean they did not run their respective states according to a plan and set of objectives that they had set out, and drove toward them with a singular purpose of mind and relentless brutality. It is no different with Kim Jong-un, really, and a huge mistake to simply write him off as a nut job.

The other thing I think it’s important to understand, and which even I have only recently come to better appreciate, is that the common goal of all of North Korea’s leaders, including its current one, is reunification of the Korean peninsula and people under one government – theirs. While Kim Jong-un threatens and goads the U.S., it is more because he sees the U.S. as a threat to his regime and his goal of Korean unification. The flip side of that, of course, is that the U.S. stands as the major defender of South Korea’s existence and freedom, and relinquishing that role is really not an option. So we are pitted in an intractable face-off with the North Korean regime.

One would think that the prosperity and progress South Korea has made in recent decades would serve to bolster the South’s position and eventually lead to the demise of the North from within. Still, it’s estimated that something like 30 percent of South Koreans would like to see unification with the North, and a large proportion of the North’s population, brainwashed as they might be, are staunchly loyal to their country, as well as to its regime and ideology. The thought that we might see a popular uprising that leads to the overthrow of Communism in the North, such as what we saw in Eastern Europe, is at best wildly optimistic and, at worst, delusional. What we see in North Korea is not just imposition of a social, economic, and political system, but a cult of personality, built around the Supreme Leaders, and the pervasive feeling of persecution and misunderstanding by the outside world.

Which leads us to the current stalemate and how to approach it. Arguably, previous administrations never should have allowed North Korea to become a nuclear state. The time to take firm action to prevent this really goes back to the Clinton administration, but instead of direct action that administration resorted to wishful thinking, offering concession after concession to North Korea, instead of standing firm and not allowing itself to be duped. Things weren’t much better under the Bush administration, and of course the Obama administration preferred to ignore the whole thing rather than stand up to Pyongyang. So now it falls to the Trump administration to try to clean up the mess it has inherited from previous administrations.

There has been much drivel issued in the media about how Pres. Trump’s threats to Kim Jong-un are inflammatory and risk destabilizing things. It’s hard to imagine how things can be any more destabilized than they were anyway, and that destabilization lies with North Korea. Trump was just trying to term things in the same kind of rhetoric as Kim Jong-un uses. I don’t know if the President actually expected that to get through to the Supreme Leader any more effectively than the usual diplomatic garble does, but it’s more humorous than anything, since what Kim Jong-un and the North Koreans do and say goes beyond rhetoric. Like any bully, they can use any kind inflammatory language they like, but speaking back to them in their own language doesn’t deter they from being any more of a bully than they are. So like North Korean rhetoric, I have to assign Trump’s rhetoric as being issued for public consumption rather than anything operational.

My big concern about the President’s threats is that they verge into the category of Obama’s useless “red line” threats to Bashar al-Assad in Syria. It’s not a good strategy to make threats one can’t or won’t enforce, just like it’s not usually a good idea to pretend you have a gun when dealing face-to-face with an armed gunman. The temptation is there to call the question, and Kim Jong-un showed himself as perfectly willing to call that question, just as Assad did with Obama, when he threatened to send missiles near – though notably not at – Guam. Not the threat of a madman, but the carefully calculated response of a clever actor on the world stage.

The administration did score an enormous victory this past week in getting an unanimous vote of the UN Security Council – including China and Russia in support – approving massive new economic sanctions against North Korea. This was a real accomplishment on the part of our UN Ambassador, Nikki Haley. Now one might wish that more than the third of the DPRK’s exports would be subject to the sanctions, but I would think that the limitation was important to gaining the support of China and Russia. Additionally, I think China’s oil exports to North Korea were not subject to the sanctions for the same reason.

The problem with any sanctions is that, with a regime such as North Korea’s, most of the impact falls on the general population rather than on the regime itself. North Korea has shown repeatedly that it’s willing to let its people starve to death rather than give in to demands of the outside world. This time will probably be no exception to that. So I wouldn’t put a huge expectation on the sanctions making any difference.

From anyone’s perspective – including even that of China and Russia – the real danger that North Korea poses is its nuclear capability. It certainly is a real and immediate danger to South Korea and the other countries of the region, and once it develops a means of delivering a nuclear warhead, a real danger to the U.S. and much of the rest of the world. And that delivery capability might not be that far off.

Much has been said that the North Koreans don’t have an ICBM that would enable a nuclear warhead to survive re-entry, and also that their ability to aim their missiles is less than competent. But they are making strides, and resolving these issues is clearly on their agenda and possibly within their grasp. But given these shortcomings, the North Koreans may still be able to inflict severe damage on the U.S. with only one, or a few, nuclear warheads that they send into orbit and detonate while over the U.S. This would lead to the dreaded electromagnetic pulse (EMP), which would effectively cripple our entire electronic and electric infrastructure, putting us into something close to the Stone Age. And we are completely unprepared for such an attack. A North Korean satellite already passes over the U.S. every 12 hours, so that capability is not simply notional.

There also is the threat of cyber warfare, for which we’re also not particularly well prepared, and in fact North Korea could already be engaging in that kind of attack against us.

Again, arguably, it fell to the Clinton administration to have eliminated North Korea’s developing nuclear capability at that time, when it was far less evolved, dispersed, and dug-in than it is now. But that didn’t happen, and the carrots offered then were ineffectual, so now we have to deal with it. The question for the Trump administration – or any administration, really – is whether we can live with a nuclear North Korea or not. Given the risks as I’ve outlined them, I think we might have a real and, if not present, future danger in allowing North Korea to further develop its nuclear capability. In saying that, I know similar things were said about Soviet, and then Chinese, and even Pakistani and Indian nuclear capabilities, and of course now Iranian nuclear capability, too. The one thing that differentiates the DPRK and Iran from the other cases is that we’re dealing with what have proven themselves to be rogue states. Whether that makes them any more prone to using nuclear weapons than the world’s other nuclear bad actors is a key question, but one I’m reluctant to delve into at this point given its scope.

If we are to attack North Korea militarily and not inevitably cause a blood bath in the South – the 10-plus million people living in Seoul, South Korea’s capital, are just 30 miles from the DPRK border, across which lie enormous artillery batteries that would rain death on Seoul – it would have to be a kind of blitzkrieg (lightning war) to simultaneously take out North Korea’s conventional military capability along with its nuclear and launch infrastructure. I think initially it is more critical to take out the conventional capability and then go back and finish rooting out and wiping out the nuclear infrastructure.

One problem is that North Korea today is not Poland in 1939, when Hitler conducted his blitzkrieg against it, and then against France and the Benelux Countries in 1940. How we could mass sufficient air, sea, and land power to make such a coordinated attack against North Korea before the North figured out what was going on and mount a preemptive strike against the South is, at best, an open question. One hopes that our intelligence about North Korea is better than it appears, but the North almost assuredly has its own intel capability, augmented by whatever support it would and does receive from China and Russia. While if we ever felt the need to launch a military attack against the North this – in my assessment – almost certainly would be how it would need to be done, it admittedly still isn’t a great answer.

Anyone who reads my essays knows that I like to offer solutions to the problems considered. I wish I could do that in this case. Alas, I don’t feel I can, other than in general prescriptive terms. I think we do need to keep North Korea from further developing its nuclear capabilities, for the reasons presented, but how we achieve that remains elusive. I think it will take action – diplomatic, economic, political, or other – by China to influence its maverick neighbor to curb its activities, but while that possibility might be growing closer, it’s still not something we can count on any time in the immediate future. Perhaps in the trade off of favors, threats, benefits, and costs the President is engaged in with the Chinese, something could be on the table to achieve this.

So there we are, in stalemate, with neither side about to resign, as they might were this simply a game of chess. Comments, thoughts, countervailing or other arguments welcomed.

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