Later On

A blog written for those whose interests more or less match mine.

Archive for the ‘Trump administration’ Category

” The Clinton campaign warned you about Russia. But nobody listened to us.”

leave a comment »

Jennifer Palmieri, communications director for Hillary Clinton’s campaign, writes in the Washington Post:

At the Democratic convention in Philadelphia last summer, Jake Sullivan and I took to our golf carts one afternoon to make the rounds of the television networks’ tents in the parking lot of the Wells Fargo Center. It is standard for presidential campaign staffers to brief networks on what to expect during that night’s session. But on this day, we were on a mission to get the press to focus on something even we found difficult to process: the prospect that Russia had not only hacked and stolen emails from the Democratic National Committee, but that it had done so to help Donald Trump and hurt Hillary Clinton.

Sullivan was Clinton’s policy adviser. He had been Vice President Joe Biden’s national security adviser, a deputy to then-Secretary Clinton at the State Department and a lead negotiator of the Obama administration’s nuclear deal with Iran. He is a widely respected national security expert and, as he does every day, he spoke carefully, without hyperbole. All we had to go on then was what had been reported by the press. We weren’t sure if Russia was doing this to undermine Americans’ faith in our political process or if it was trying to make Trump the next president. But we wanted to raise the alarm.

We did not succeed. Reporters were focused on the many daily distractions, the horse race, the stories they were doing based on the stolen DNC emails and the many other Trump scandals that were easier to explain. Voters didn’t seem worried. Earlier that week, our campaign manager, Robby Mook, was mocked for telling CNN that the leak of stolen emails before our convention was an indication that Russia was trying to help Trump. We did not know, as FBI Director James B. Comey told Congress this past week, that the bureau had already opened an investigation into Russian interference — and into possible links between Trump’s associates and the Russian government, including whether they worked together on his behalf. At the time, it seemed far-fetched that Russia would meddle so openly, and reporters and voters alike seemed convinced that it didn’t matter anyway, because Clinton was going to win.

Now that Trump is president, though, the stakes are higher, because the Russian plot succeeded. The lessons we campaign officials learned in trying to turn the Russia story against Trump can help other Democrats  (and all Americans) figure out how to treat this interference no longer as a matter of electoral politics but as the threat to the republic that it really is.

* * *

For me, Comey’s disclosure on Monday brought nearly unfathomable frustration. I will never understand why he would send a letter to Congress 11 days before the election to let lawmakers know that the FBI had happened upon more emails — which they didn’t yet know the contents of — that may or may not have been relevant to Clinton, but he did not think the public should know that federal agents were also investigating Trump’s campaign.

Without anyone knowing about the FBI’s interest, it was difficult to bring appropriate attention to the Russia issue and Trump’s curious pro-Putin bent. The week after the convention, we sought out credible national security voices to sound alarms. I was surprised by the enthusiasm with which some, such as former acting CIA director Michael Morell, jumped into the fray. When I worked in the Obama White House, people in national security positions had been uneasy making broad public arguments, particularly about political matters. Not this time. They were so concerned about the situation that, to me, the language they used to describe the threat they believed Russia and Trump posed was shocking. I remember my jaw dropping as I sat in our Brooklyn campaign headquarters and read the op-ed Morell submitted to the New York Times in early August, in which he shared his view that Russia had probably undertaken an effort to “recruit” Trump and that the Republican nominee had become an “unwitting agent of the Russian Federation.”

But the sheer spectacle of Trump kept the Russia allegations from getting the attention they would have had with any previous candidate. His unconventional campaign had so disrupted the press-political ecosystem that no one could fathom or absorb that — in addition to all the drama they saw on stage — Russia may have been conspiring with Trump or his allies behind the scenes to win the election for him. Compared with the lawsuits women were filing against Trump for alleged assault or his 3 a.m. tweets attacking a former Miss Universe, the details of who hacked whom seemed less interesting and more complicated. And because nearly everyone was sure that Clinton would win, and that she therefore needed more watchdogging, reporters and analysts were faster to jump on the latest batch of stolen emails or announcement from Comey.

We sought moments for Clinton and Tim Kaine, her running mate, to talk about Russia when we knew they would be on live television and couldn’t be edited. The debates offered the best opportunity, and Clinton took advantage, culminating with her famous line calling Trump Putin’s “puppet ” in the third one. It was tough deciding how much of her time to devote to the issue. We were in a Catch-22: We didn’t want her to talk too much about Russia because it wasn’t what voters were telling us they cared about — and, frankly, it sounded kind of wacky. At the same time, we understood the issue would never rise to the front of voters’ minds if we weren’t driving attention to it. It was already pretty clear they weren’t going to hear much about it in the press.

On Oct. 7, I thought the Russia story would finally break through. We were at a debate prep session in Westchester County, N.Y., when the director of national intelligence and the secretary of homeland security put out a joint statementsaying that the U.S. intelligence community was “confident” that not only had the Russian government hacked Democrats’ emails, but “Russia’s senior-most officials” were probably directing their release to influence the election. Incredible. Finally, here was the break we had been waiting for. I was on a conference call with my colleagues to discuss our response when someone said: “Hey, Palmieri. There’s an ‘Access Hollywood’ video that just got released.” Literally minutes later, WikiLeaks put out the first batch of John Podesta’s stolen Gmail. And that was that. The rest is history.

* * *

All of us — the press, Congress, the public, the administration — are still guilty of the soft complicity of low expectations. As president, Trump does and says outrageous and false things every week, from ordering arbitrary travel bans to accusing President Obama of illegal wiretapping with no evidence. The Russia charges blend in, making it all too easy to treat them as just the latest thing the president has blustered his way through. I understand how difficult it is to put the threat in the right context. We trod lightly at times during the campaign because it sounded too fantastic to be credible, too complicated to absorb.

In another era, Americans would have been able to count on both Democrats and Republicans in Congress to stand up to this kind of threat. A lot of Democrats like to play the “If we were Republicans” game. I usually hate it; I don’t want to behave like the Republicans do. But it’s useful here. If Clinton had won with the help of the Russians, the Republicans would have impeachment proceedings underway for treason. No doubt. Instead, dealing with Russia falls nearly solely on Democrats’ shoulders.

But Democrats can break out of the Catch-22 of the campaign: If we . . .

Continue reading.

Later in the article:

The worst part about our lackluster collective response to Russia’s interference is that it represents exactly what the Russians were hoping to produce: apathy. Their goal, in addition to installing a president sympathetic to their views, was to undermine Americans’ belief in our democracy. For Americans to think that none of this really matters, that it’s all a game. That’s how they truly erode U.S. moral authority and strength over the long term. It’s what they have sought to do to European adversaries for many years, and now they have brought this seed of destruction here.

Written by LeisureGuy

26 March 2017 at 7:16 am

It seems revealing that Trump has no pets

leave a comment »

I imagine that he doesn’t want any competition for attention. Plus loving a pet requires a kind of empathy, not a Trump strength. So: no pets.

Written by LeisureGuy

25 March 2017 at 4:26 pm

Trump will kill Obamacare by making sure it doesn’t work

leave a comment »

Nothing easier: reassign people, underfund, and delay. Kevin Drum has an interesting post on how the Republican “No” votes were all over the map, and he includes this in the post:

. . . here’s how the Journal’s article begins:

With the collapse of Republicans’ health plan in the House on Friday, the Trump administration is set to ramp up its efforts to weaken the Affordable Care Act in one of the few ways it has left—by making changes to the law through waivers and rule changes.

Obamacare won’t implode on its own, but it might after Trump does everything he can to sabotage it.

Written by LeisureGuy

25 March 2017 at 3:49 pm

The Department of Veterans Affairs built perhaps the most important medical computer system in history. Now it’s about to spend billions to throw it away.

leave a comment »

Note: Links currently do not work in my Chrome browser. (They work fine in Firefox.)

Arthur Allen writes in Politico:

Four decades ago, in 1977, a conspiracy began bubbling up from the basements of the vast network of hospitals belonging to the Veterans Administration. Across the country, software geeks and doctors were puzzling out how they could make medical care better with these new devices called personal computers. Working sometimes at night or in their spare time, they started to cobble together a system that helped doctors organize their prescriptions, their CAT scans and patient notes, and to share their experiences electronically to help improve care for veterans.

Within a few years, this band of altruistic docs and nerds—they called themselves “The Hardhats,” and sometimes “the conspiracy”—had built something totally new, a system that would transform medicine. Today, the medical-data revolution is taken for granted, and electronic health records are a multibillion-dollar industry. Back then, the whole idea was a novelty, even a threat. The VA pioneers were years ahead of their time. Their project was innovative, entrepreneurial and public-spirited—all those things the government wasn’t supposed to be.

Of course, the government tried to kill it.

Though the system has survived for decades, even topping the lists of the most effective and popular medical records systems, it’s now on the verge of being eliminated: The secretary of what is now the Department of Veterans Affairs has already said he wants the agency to switch over to a commercial system. An official decision is scheduled for July 1. Throwing it out and starting over will cost $16 billion, according to one estimate.

What happened? The story of the VA’s unique computer system—how the government actually managed to build a pioneering and effective medical data network, and then managed to neglect it to the point of irreparability—is emblematic of how politics can lead to the bungling of a vital, complex technology. As recently as last August, a Medscape survey of 15,000 physicians found that the VA system, called VistA, ranked as the most usable and useful medical records system, above hundreds of other commercial versions marketed by hotshot tech companies with powerful Washington lobbyists. Back in 2009, some of the architects of the Affordable Care Act saw VistA as a model for the transformation of American medical records and even floated giving it away to every doctor in America.

Today, VistA is a whipping boy for Congress; the VA’s senior IT leadership and its overseers in the House and Senate are all sharpening their knives for the system, which they caricature as a scruffy old nag that fails the veterans riding on it. Big commercial companies are circling, each one putting forward its own proprietary technology as the answer to the VA’s woes. The VA leadership seems to agree with them. “We need to move towards commercially tested products,” VA Secretary David Shulkin told a congressional committee on March 7. “If somebody could explain to me why veterans benefit from VA being a good software developer, then maybe I’d change my mind.”

You’d have to be a very brave VA administrator, and perhaps a foolhardy one, to keep VistA in 2017: The system’s homegrown structure creates security and maintenance challenges; a huge amount of talent has fled the agency, and many Congress members are leery of it. Because it serves nearly 9 million veterans at 167 hospitals and 1,700 sites of care, however, the wrangling over VistA concerns much more than just another computer software system. The men and women who created and shaped VistA over the decades were pathfinders in efforts to use data to reshape the multi-trillion-dollar U.S. health care system. Much of what they’ve done continues to serve veterans well; it’s an open question whether the Beltway solution to replacing VistA, and the billions that will be spent pursuing it, will result in a system that serves the VA—and the nation—as well in the long run.

What’s clear, though, is that the whole story of how VistA was born, grew and slid into disrepair illustrates just how difficult it can be for the government to handle innovation in its midst.

YOU COULD SAY that VistA—which stands for the Veterans Information Systems and Technology Architecture—began as a giant hack.

Its birth occurred in 1977, far back in the era of paper medical records, with a pair of computer nerds from the National Bureau of Standards. Ted O’Neill and Marty Johnson had helped standardize a computer language, originally developed at Massachusetts General Hospital, called MUMPS, and the two men were hired by the VA to see whether MUMPS could be the basis of a new computer system connecting the VA’s hospitals. Computerizing the one-on-one art of medical care seemed like a sacrilege at the time, but the VA, struggling with casualties of the Vietnam War, was underfunded, disorganized and needed all the help it could get.

O’Neill and Johnson began recruiting other techies to the effort, some of whom were already working in VA hospitals in places such as St. Petersburg, Florida; Lexington, Kentucky; and San Francisco. Though they were on an official mission, their approach—highly decentralized, with different teams trying things in various hospitals—ran against the grain of a big bureaucracy and aroused the suspicions of the central office. The project soon had the feeling of a conspiracy, something that nonconformists did in secret. They gave themselves an internal nickname—the Hardhats. People who followed the project recall being struck by just how idealistic it was. “This will sound a bit hokey, but they saw a way to improve health care at less cost than was being proposed in the central office,” says Nancy Tomich, a writer who was covering VA health care at the time. As bureaucratic battles mounted, she says, “I remember how impressed I was by these dedicated people who put their personal welfare on the line.”

In 1978, with personal computers just starting to appear in the homes of nerdy hobbyists, the Hardhats bought thousands of personal data processors and distributed them throughout the VA. Software geeks and physicians were soon exploring how patient care could be improved with these new devices. A scheduling system was built in Oklahoma City, while technicians in Columbia, Missouri, built a radiology program, and the Washington, D.C., VA’s Hardhats worked on a cardiology program. In Silicon Valley, Steve Wozniak was building a computer in his garage that would overturn an industry; at the VA, these unsung rebels were doing something that was equally disruptive in its own way—and threatening to the VA’s central computer office, which had a staff and budget hundreds of times greater and planned to service the data-processing needs of the VA hospitals and clinics by means of leased lines to regional mainframe centers. While the bureaucrats in the central office had their own empire, Tomich recalled, the Hardhats—some of them straight-looking guys with burr haircuts and pocket pen protectors, some scruffy, bearded dudes in T-shirts—were “in the field planting seeds, raising crops and things were blossoming,’’ she says.

The Hardhats’ key insight—and the reason VistA still has such dedicated fans today—was that the system would work well only if they brought doctors into the loop as they built their new tools. In fact, it would be best if doctors actually helped build them. Pre-specified computer design might work for an airplane or a ship, but a hospital had hundreds of thousands of variable processes. You needed a “co-evolutionary loop between those using the system and the system you provide them,” says one of the early converts, mathematician Tom Munnecke, a polymathic entrepreneur and philanthropist who joined the VA hospital in Loma Linda, California, in 1978.

So rather than sitting in an office writing code and having the bureaucracy implement it, the computer scientists fanned out to doctors’ offices to figure out what they needed. Doctors with a feel for technology jumped into the fray. “I got involved because it solved my problems,” says Ross Fletcher, a cardiologist at the Washington, D.C., VA—where he is now chief of staff—since 1972. Working in close consultation with their clinical partners, sometimes coding at home at night or in their spare time, the computer experts built software that enabled doctors to legibly organize their prescriptions, CAT scans and patient notes, and to share their experiences electronically. Fletcher, who had studied a little computer science in college, worked with a software developer to help create an electronic EKG record. “The technical staff was embedded with clinical staff. I had lunch with the doctors, and in the parking lot in the morning we’d report what we’d done the night before,” says Munnecke.

Munnecke, a leading Hardhat, remembers it as an exhilarating time. He used a PDP11/34 computer with 32 kilobytes of memory, and stored his programs, development work and his hospital’s database on a 5-megabyte disk the size of a personal pizza. One day, Munnecke and a colleague, George Timson, sat in a restaurant and sketched out a circular diagram on a paper place mat, a design for what initially would be called the Decentralized Hospital Computer Program, and later VistA. MUMPs computer language was at the center of the diagram, surrounded by a kernel of programs used by everyone at the VA, with applications floating around the fringes like electrons in an atom. MUMPS was a ludicrously simple coding language that could run with limited memory and great speed on a low-powered computer. The architecture of VistA was open, modular and decentralized. All around the edges, the apps flourished through the cooperation of computer scientists and doctors.

“We didn’t call it ‘agile development,’ but it was agile,” says Howard Hayes, another VA IT veteran who served as CIO for the Indian Health Service, which adopted VistA. “Tight relationships between user and programmer, and sometimes they were one and the same.” Instead of top-down goals and project sign-offs, teams of techies and doctors kept working to improve the system. “The developer did something, the user tried it, called him up or walked down the hall and says ‘It really needs to do this.’ The next day they had another build,” says Hayes.

The VA’s centralized computer department, which relied on contractors, was not amused. Its leadership wanted control, and they believed, with a position remarkably similar to current-day criticisms of the VA’s IT work, that it made more sense to let the outside experts move the ball than have “garages” full of unconventional nerds and upstart doctors. The Hardhats were sharing records among doctors and hospitals. They were digitizing X-ray images. They were doing everything much less expensively and more successfully than the central office. They had to be stopped. In 1979, Ted O’Neill was fired (he drove a cab for a while, and later became a real estate agent). The main Hardhats office was shut down, and “pretty much everybody in the Washington part of the organization headed for the hills,” says Munnecke.

But, remarkably, the project didn’t die. . .

Continue reading.

Written by LeisureGuy

25 March 2017 at 10:00 am

What If I Told You That Republicans Spent Only 36 Days on Trumpcare?

leave a comment »

Kevin Drum is on a roll. His new post includes a chart:

Written by LeisureGuy

24 March 2017 at 9:16 pm

Excellent Kevin Drum column: Obamacare Repeal Is Dead

leave a comment »

Excellent column. Read it now. Good take.

UPDATE: And read this one too, which begins:

It’s laughable watching President Trump whine endlessly this afternoon about how his health care bill didn’t get any Democratic votes. Not one! The Democrats just wouldn’t work with him to craft a bill! Boy, that sure makes things tough.

Needless to say, neither Trump nor Paul Ryan ever tried to bring Democrats into this bill. It was purely a Republican plan from the start, and neither of them wanted any Democratic input. That’s just the opposite of Obamacare, where Democrats tried mightily to get Republican buy-in, and still ended up getting no Republican votes in the end. Not one!

Anyway, Trump’s plan now is to wait for Obamacare to implode and then Democrats will have to do a deal. I guess it hasn’t occurred to him that he could do a deal with Democrats right now if he were really serious about fixing health care. But no. Trump says he intends to move on to tax reform, because that’s something he actually cares about.

In the meantime, it’s very unclear what will happen to Obamacare. With so much uncertainty surrounding it, it’s hard to say how insurance companies will respond. They might give up and pull out. Or they might stick it out and wait. It’s pretty close to a profitable business now, so there’s probably no urgency one way or the other for most of them. . .

Read the whole thing.

Written by LeisureGuy

24 March 2017 at 4:39 pm

The in-your-face hypocrisy of the Republican party: Leaks and anonymous sources

leave a comment »

Apparently leaks and anonymous sources are absolutely terrible… unless the leak and the anonymous sources are advantageous to Republicans, in which case they are perfectly okay. Matthew Balin reports at Mediaite:

NBC’s Peter Alexander confronted White House Press Secretary Sean Spicer on Thursday over an apparent double standard that President Donald Trump and his administration has regarding anonymous sources.

Alexander highlighted that “at CPAC, President Trump said people — quote, ‘shouldn’t be allowed to use sources unless they use someone’s name.’  You said it does — quote, ‘a tremendous disservice.’”

The NBC correspondent continued that Rep. Devin Nunesnoted sources that he couldn’t create and provide publicly. So why when it’s politically advantageous is that use of sourcing okay; but when it’s politically damaging, it’s not okay?”

Spicer retorted by pointing out that Rep. Nunes “came out and briefed people on what he knew at the time, and said he was literally going to give further briefs and and would have further updates.”

The press secretary also emphasized that House Intelligence chairman was “vindicating the president, in saying there is something you need to know about the substance of the allegations that are being made against you.”

Alexander followed up by wondering, “If it had not had vindicated him, wouldn’t it have been just as important for the president to learn?”

Spicer shot back, “Sure, and I think maybe he would have. And then, you probably wouldn’t have had any concern with that, would you?”

Watch the entire exchange, … here]..

Written by LeisureGuy

24 March 2017 at 9:32 am

%d bloggers like this: