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Health

All Your Medical Data In The Cloud? Not So Fast, Says HHS Privacy Official

Joy Pritts, Chief Privacy Officer at HHS's Office of the National Coordinator for Health IT

When it comes to electronic health records, “the switch to cloud is inevitable.” That’s according to Joy Pritts, Chief Privacy Officer at the Office of the National Coordinator for Health IT in the Obama administration, who spoke at a “Health Care, the Cloud, and Privacy” panel hosted by the Washington, D.C.-based advocacy group, Patient Privacy Rights.

Electronic health records are exactly what they sound like: A collection of health information in digital format that can include a wide range of data, from intimate details of your medical history and test results to demographic data to your billing information. Digital records are superior to physical ones because they can be transferred quickly when patients switch providers, help doctors get a complete picture of patient health, eliminate the need for redundant testing, and provide new opportunities for analyzing treatments for efficiency and effectiveness.

They are also supposed to be a cost saver. Some estimates have put the potential cost savings for switching over to electronic records as high as $81 billion annually, although the real world implementation hasn’t come close to hitting that target. Cloud storage and computing are part of this equation due to their potential to help make the transition to electronic health records more cost effective and unleash the analytics power of big data on health care information.

But while storing medical records digitally on the cloud may offer great promise for increasing the efficiency of the health care system, it is not without its challenges. Data security and privacy of health information are major obstacles where policy has not yet caught up with practice.

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Justice

After Failing Last Year, Kansas Legislature Is Expected To Consider Harmful Immigration Bills

Kansas Secretary of State Kris Kobach backs harmful immigration measures in the state.

Even though several strict immigration bills stalled in the Kansas legislature last year, legislators are expected to consider harmful immigration measures again this year. And after more conservative GOPers replaced several moderate Republican senators in the 2012 election, Kansas Secretary of State Kris Kobach, the anti-immigrant official who wrote Arizona’s and Alabama’s extreme immigration laws, said he thinks state lawmakers will pass at least one of the anti-immigrant bills, according to the Wichita Eagle.

The Kansas legislature likely will consider four bills:

  • One requires “state and local governments, and possibly private businesses, to vet employees through an electronic database;”
  • another would mandate that “local law enforcement officers to check the immigration status of people they come in contact with,” if the they suspect the person is undocumented;
  • another bill “would prohibit any public benefits from going to anyone here illegally;”
  • the final bill tries to undo a 2004 Kansas law that allows undocumented immigrants to qualify for in-state tuition at state colleges.

Kobach said Kansas’ in-state tuition bill turned Kansas into “the sanctuary state of the Midwest” and that extreme immigration measures would force undocumented immigrants to self-deport, leaving jobs for unemployed Kansans. But Janeth Vazquez, communications coordinator for Wichita-based Sunflower Community Action, a pro-immigration reform group, said undocumented immigrants contribute more in taxes. And without immigrant workers, farmers in Western Kansas could suffer if they do not have enough workers — just like farmers in Alabama and Georgia after those states passed extreme self-deportation measures.

Even some Republicans are unsure of the harmful bills being floated ahead of the state legislative session that begins in two weeks. Michael O’Neal, the outgoing Republican speaker of the House and now president of the Kansas Chamber of Commerce, said the chamber opposes forcing employers to get rid of hard-working employees because of their immigration status. “It turns good people into ones who will commit fraud to get a job and keep a job,” he said.

Last year, Kansas Agriculture Secretary Dale Rodman sought a waiver from the federal government so that companies could hire undocumented workers, but Kobach dismissed any type of what he called state-level amnesty as illegal. “You might as well pass a law saying all Kansans should sprout wings and fly,” he said.

But while state officials and anti-immigrant conservatives may want to push for more extreme state laws, it’s clear that a comprehensive immigration reform plan that offers a path to citizenship would benefit all states by increasing the nation’s GDP and tax revenue. Congress needs to pass a law in order to address the issue nationally instead of continuing to have states pass their own immigration laws.

Economy

Congressional Budget Office Finds GOP Corporate Tax Proposal Would Push Jobs Overseas

Under current U.S. tax law, corporations are allowed to defer paying taxes on their overseas profits, resulting in lost revenue for the federal government of up to $10 billion per year. President Obama has proposed doing away with this policy, somewhat, by restricting the use of tax credits until corporations bring those overseas profits back to the U.S. and pay taxes on them.

However, a slew of corporations have, for years, been pushing for the U.S. to adopt what’s known as a “territorial” system for corporate taxation instead. Under such a system, U.S. corporations would never have to pay taxes on profits earned overseas. House Republicans have embraced the idea, as did Mitt Romney during his unsuccessful presidential campaign.

But the Congressional Budget Office is out with a new warning about adopting such a system:

Alternatively, the United States could move toward a territorial system—for example, by exempting some income earned abroad from U.S. taxation or by taxing domestic income only but using a formula that considered the location of a company’s activities to determine the sources of its income. Such policies could result in a less efficient allocation of resources among countries by increasing incentives to shift business operations and reported income to countries with lower tax rates.

While it, too, has its problems, “eliminating deferral entirely would boost U.S. tax revenues by more than $100 billion over a 10-year period.”

As the Center for American Progress’ Seth Hanlon noted, “Deferral provides tax incentives for overseas investments. In fact, it encourages U.S. companies to make job-creating investments off shore even if similar investments in the United States (absent tax considerations) would be more profitable.” Economist Martin Sullivan wrote that “U.S. tax law provides a large tax advantage for building and moving factories to low-tax countries.” And adopting the GOP’s desired shift to a territorial system would make the problem worse.

Health

Americans Die Earlier Than People In Other Wealthy Nations

Regardless of race, class, education level, and even healthy eating and exercise habits, Americans have a shorter life expectancy than their peers in other affluent nations. According to a new government-sponsored survey released Wednesday, part of the gap in life expectancy can be attributed to the fact that people living in the U.S. are much more likely to die from traffic accidents and homicides than the people in other well-off countries like Japan, Australia, Canada, and Germany.

That health gap has worsened over the past three decades, even as medical advances have improved modern health services. And Americans are falling behind in several categories, whether or not they’re afforded privileges that would suggest they might be healthier than their less advantaged peers:

The study listed nine health areas in which Americans came in below average: infant mortality and low birth weight, injuries and homicides, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease and disability. [...]

“Even Americans who are white, insured, have college educations and seem to have healthy behaviors are in worse health than similar people in other nations,” said [Dr. Steven H. Woolf], a researcher who directs the Center for Human Needs at Virginia Commonwealth University in Richmond, Va.

The disparities were pervasive across all age groups up to 75, Woolf told the reporters, and seemed to stem from a variety of wide-ranging causes, including U.S. car culture, the number of uninsured people in the country, and weaknesses in our outpatient healthcare system.

“The pervasiveness of the problem was really staggering,” Woolf told Bloomberg News. “I don’t think American parents know their children will live a shorter life with greater disease rates than other countries.”

The United States spends more money on its health care system than any other developed nation, but other studies have confirmed that simply spending more money doesn’t guarantee better care. And many Americans may not even be able to access that care in the first place. Although Obamacare intends to extend health coverage to 30 million previously uninsured Americans by 2014, some Americans still struggle to be able to afford the care they need, particularly since the economic downturn during the Great Recession forced all Americans to cut back on medical services.

LGBT

White House Has No Comment On Anti-Gay Inaugural Pastor

At this afternoon’s White House press briefing, the Washington Blade’s Chris Johnson asked Press Secretary Jay Carney about the anti-gay sermon once given by Pastor Louie Giglio, who has been tapped to give the benediction at President Obama’s Second Inauguration. Carney had not yet seen the ThinkProgress report and directed questions to the inaugural committee. He would not address whether or not the administration was familiar with Giglio’s anti-gay views before selecting him to speak.

Justice

Federal Court Halts Illegal NYPD Stop-And-Frisks

A federal judge on Tuesday struck down a key component of the New York Police Department’s aggressive stop-and-frisk program, under which police stopped more young black men in 2011 than the city’s total population of young black men.

In the first federal court decision to find that some elements of the program violate the Fourth Amendment, U.S. District Judge Shira A. Scheindlin held that police officers in the Bronx are routinely stopping individuals outside private residential buildings without reasonable suspicion that they are trespassing, and with great consequence:

For those of us who do not fear being stopped as we approach or leave our own homes or those of our friends and families, it is difficult to believe that residents of one of our boroughs live under such a threat.

The stops are part of the Trespass Affidavit Program, also known as “Clean Halls,” in which property managers in the Bronx can ask the police to patrol their buildings and arrest trespassers. Scheindlin found that officers have misconstrued the program as allowing stops for anyone outside these properties, without regard for whether there is evidence that they are actually trespassing. Scheindlin describes the story of one of the name plaintiffs in the case:

[A]fter finishing his work for the day as a security guard, Charles Bradley, a black fifty-one year old resident of the Bronx, took the subway to visit his fiancée, Lisa Michelle Rappa, as they had arranged the evening before.

When Bradley arrived at Rappa’s apartment building, a young man who lived on the first floor and knew of Bradley’s and Rappa’s relationship let Bradley into the building. Bradley then walked up the stairs to Rappa’s apartment on the fifth floor and knocked. Because Rappa is deaf in one ear, Bradley waited a minute or two. When there was still no response, he returned downstairs and left the building. Outside, he looked up toward Rappa’s window.

While Bradley was standing on the sidewalk, an unmarked green police van approached and an officer in the passenger seat … gestured for Bradley to come over. After Bradley approached the van, the officer got out and asked, “What are you doing here?”

Bradley explained he was there to see Rappa, and that he worked as a security guard. Bradley testified that the officer responded to his attempts to explain his presence by suggesting Bradley was acting “like a fucking animal,” searched Bradley’s pockets, then told Bradley to place his hands behind his back. Once Bradley was handcuffed, the officer placed him in the van, where there were two other officers. While the van drove away, the officers began to question Bradley: “When was the last time you saw a gun? When was the last time you got high? When was the last time you bought some drugs?”

After twenty or thirty minutes in the van, the officers stopped at the station house. Bradley was taken into a room, stripped, and told to wait. He was searched in “inappropriate areas.” For the next two hours, he waited in a cell with other people who had been arrested. He was then fingerprinted and given a desk appearance ticket and a date to appear in court to answer the criminal charge of trespassing. Later, Bradley’s defense attorney provided the Bronx DA’s office with a notarized letter from Rappa stating that Bradley had been visiting her. “[A]t that point in time,” Bradley testified, “paperwork was submitted to me stating that the People of New York declined to prosecute.”

This encounter in and of itself is a disturbing example of how these police stops play out – resulting not just in an unreasonable stop and interrogation, but in subsequent harassing treatment such as strip-searching, detention, and verbal intimidation that far exceeds the scope of any perceived threat.

But perhaps the most significant aspect of the 157-page opinion is Judge Scheindlin’s explanation of the even greater potential cost for people not fortunate enough to have a public defender like Bradley’s:

The stakes of “field interrogation” by the police have dramatically risen since Terry [v. Ohio, which established the legal standard for stop and frisks,] was decided in 1968. The use of incarceration has increased, sentences have grown, the threat of lengthy incarceration has created new incentives to plead guilty, and the collateral consequences of a conviction — on employment, housing, access to government programs, and even the right to vote or serve on a jury — have become more common and more severe. If an unjustified stop happens to lead to an unjustified arrest for trespassing, as it did in Charles Bradley’s case, not every overburdened public defender will have the wherewithal to obtain a notarized letter from the defendant’s host explaining that the defendant was invited, as Bronx Defender Cara Suvall did on behalf of Bradley. When considering the relative hardships faced by the parties, it is important to consider the potentially dire and long-lasting consequences that can follow from unconstitutional stops.

This ruling is only a preliminary injunction, meaning the judge found the plaintiffs are likely to succeed in their case, with an order that police cease performing trespass stops without reasonable suspicion, and a forthcoming hearing on other potential remedies. The lawsuit filed by a class of blacks and Latinos is one of three to challenge the city’s stop-and-frisk program. Since initial outrage over stark evidence that police racially profile in their stops and interrogations without any improvement in public safety outcomes, NYPD somewhat decreased the number of stop-and-frisks. But in the first nine months of 2012, the overwhelming majority —  87 percent — of the some 1,400 individuals stopped every day were black and Latino.

Health

Second Republican Governor Agrees To Expand Medicaid Under Obamacare

New Mexico Gov. Susana Martinez (R)

New Mexico Gov. Susana Martinez (R) today announced that she will agree to expand Medicaid to extend coverage to additional low-income residents of her state, following a provision set forth in Obamacare.

Martinez is only the second Republican governor to join Nevada Gov. Brian Sandoval (R) and agree to the Medicaid expansion. Other Republican governors have refused to expand the program, essentially acknowledging that they would rather allow low-income people in their state to go uninsured than to follow the law of their Democratic president.

The AP estimates that the expansion will help cover roughly 170,000 people in New Mexico:

Republican Gov. Susana Martinez says New Mexico will follow provisions of a federal health care law to expand the state’s Medicaid program to potentially provide medical services to 170,000 low-income adults.[...]

Martinez made the announcement Wednesday during a speech in Albuquerque.

About a fourth of New Mexico’s population currently receives health care through Medicaid, but the program mostly covers uninsured children in low-income families along with the disabled and some extremely low-income adults.

The expansion in 2014 will make adults eligible with incomes of about $26,000 for a family of three or $15,400 for an individual.

New Mexico has among the highest rates of uninsured in the country. The Medicaid expansion seeks to remedy this problem by permitting those within 133 percent of the federal poverty line to join the program, helping aide those who earn too much to qualify, but not enough to afford coverage.

The state also moved to set up its health insurance exchange earlier this month.

Security

How Iranian Hackers Used The Cloud To Attack Major Banks And Why It Matters

U.S. officials believe a series of cyberattacks striking major banks including Bank of America, Citigroup, Wells Fargo, U.S. Bancorp, PNC, Capital One, Fifth Third Bank, BB&T and HSBC were the work of the Iranian government, potentially escalating the already tense cybersecurity standoff between the two nations. The type of attack used, a distributed denial of service attacks (DDoS) is relatively harmless — it disrupts access to services rather than stealing money or personal info — but the tactics used by the hackers raise concerns about the security challenges caused by our reliance on the so-called “cloud” storage and security of the data centers it relies on, the New York Times reports:

“Researchers at Radware who investigated the attacks for several banks found that the traffic was coming from data centers around the world. They discovered that various cloud services and public Web hosting services had been infected with a particularly sophisticated form of malware, called Itsoknoproblembro, that was designed to evade detection by antivirus programs. The malware has existed for years, but the banking attacks were the first time it used data centers to attack external victims

By infecting data centers instead of computers, the hackers obtained the computing power to mount enormous denial of service attacks. One of the banks had 40 gigabits of Internet capacity, Mr. Herberger said, a huge amount when you consider that a midsize business may only have one gigabit. But some banks were hit with a sustained flood of traffic that peaked at 70 gigabits.”

The way your typical DDoS attack has worked in the recent year is pretty straightforward: A hacker leverages a botnet, a collection of computers connected over the internet whose control has been ceded to a third party by security breaches, to take down a site by overwhelming it with too many requests to handle at once. The botnets can be a few hundred computers, or a few million, but are almost exclusively used for nefarious means. In this case the hackers applied that same botnet structure to a network of compromised data centers, dramatically increasing the force.

And as we increase our use of cloud storage and data centers the potential force available from this source is on the rise: Global data center IP traffic is expected to nearly quadruple over the next five years to 6.6 zettabytes annually. For reference, a zettabyte is equal to one billion terabytes.

Ultimately, this should be a wake up call to the security professionals whose data centers were used to perpetrate these cyberattacks: While we often think of security in the cloud as about safeguarding corporate secrets or your personal digital life, if you’re not properly securing your networks it’s not just the safety of your network at risk, it’s the safety of everyone your network could be used against.

Economy

Labor Secretary Hilda Solis Resigns

Secretary of Labor Hilda Solis, the first Latina to lead a federal agency, is resigning. In a statement announcing her resignation, Solis touted her agency’s work overseeing the federal stimulus plan, worker training programs, and other employment initiatives during her four years in office. “Over the last four years, Secretary Solis has been a critical member of my economic team as we have worked to recover from the worst economic downturn since the Great Depression and strengthen the economy for the middle class,” President Obama said in a statement.

AFL-CIO president Richard Trumka also praised Solis. “[Solis] brought urgently needed change to the Department of Labor, putting the U.S. government firmly on the side of working families,” Trumka said in a statement. “We hope that her successor will continue to be a powerful voice both within the Obama administration and across the country for all of America’s workers.”

Climate Progress

NPR: Remember That Whole Global Warming Problem People Once Worried About?

You may recall that classic Onion story from November 2010, “Report: Global Warming Issue From 2 Or 3 Years Ago May Still Be Problem.”  It included the image at the right captioned, “This 2007 chart predicting rising temperatures worldwide could still possibly be worth looking at today.”

Well, apparently NPR missed it. In a story last Friday, “Budget Deal Provides Tax Breaks For Green Energy,” NPR reports:

The tax benefits for green energy that Congress extended were originally created over the past decade. At the time, it seemed that energy sources, especially homegrown ones, were scarce. The country also seemed to be on the verge of setting limits on emissions of greenhouse gases like carbon dioxide.

“There was a sensible reason to want to subsidize a transformation,” says energy analyst Kevin Book. It’s harder to make a case for renewable energy now, given the booms in natural gas and oil, he says.

“All of these things are different now: Demand is declining, supply is increasing, the decarbonization mandate has weakened if not disappeared, and energy security isn’t the risk that it used to be,” he says.

Book predicts that the New Year’s tax package may be the last big payday for green energy.

Yeah, might as well have an extended quote from someone arguing there’s no need to ever decarbonize or incentivize green energy again, ’cause that whole global warming thing is so last year.

Or rather, so one week ago. Because on December 30, NPR filed an interview with Bill McKibben with this headline:

2013: A Tipping Year For Climate Change?

The story’s introduction spells out precisely why the decarbonization mandate has strengthened in the past year:

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