Below, a guest essay by David Rothman, of the Teleread site and the DC roman-a-clef The Solomon Scandals. David was one of the journalism world's earliest adopters of computers and related technology. Since 1992, when many people (including me) could barely imagine what a Kindle/Nook/iPad-style "e-reader" might be, he has been analyzing these devices and their social, economic, and political implications on his site. Previously on this site about such implications here and here. By the way, he is running a nice Fake Tony Hayward diary on his site.
In this essay, he proposes ways that radically speeded-up adoption of the iPad-style devices could serve economic-stimulus and social-equality needs at the same time. Although he doesn't put it this way, it's his counterpart to a post-Sputnik technology-promotion plan. I'll leave the rest of the argument to him. You can follow up directly with him at davidrothman@pobox.com or via his sites.
A national information stimulus plan: How iPad-style tablets could help educate millions and trim bureaucracy--not just be techno toys for the D.C. elite
By David Rothman
The Washington elite is discovering the Apple iPad.
Vice President Joe Biden, White House aides, and gadget-loving members of Congress are starting to tote the same evil tablet that the President denounced as an info-overload threat to young minds.
Might iPad-style technology in fact be a godsend for millions of schoolchildren with obsolete textbooks? And could e-books benefit the elderly, the disabled, and other library users, too, including U.S. workers eager to upgrade job skills?
If nothing else, the iPad and similar machines could drive down library costs per book. That could help keep reading alive in places like Hood River County, Oregon, where the 98-year-old library system plans to close for financial reasons --just one of many cash-strapped U.S. libraries.
Along the way, as the technology's price declined, the mass automation potential of the tablets could justify the cost of a national digital library system. Such potential might count even more than the library initiative itself. Call it a national information stimulus plan or NISP. The stimulus would be in the form of more and better information, as well as greater efficiencies in both the public and private sectors.
Politico's Erika Lovely recently told how the iPad "may be the ultimate paper saver for an institution that prints millions of pages a year and still piles huge stacks of bills outside the House chamber every day." She quoted Rep. Jason Chaffetz, a Utah Republican on an information-policy-related subcommittee: "The thing is the bomb." The new BlackBerry for some on the Hill? Meanwhile The Washington Post says White House Chief of Staff Rahm Emanuel and some other Obama staffers use iPads, and that Apple tablets will soon be standard for the power people of the West Wing.
Newspapers and magazines are among the "apps" in use on iPads in the West Wing; and economic adviser Larry Summers has even started to download e-books, including The Federalist Papers.
* * *
So what's the school-and-library angle? Well, think of the iPad and similar devices as one way to help spark a greater interest in books and other long texts that encourage sustained thought. Let's work harder to bring books, not just videos and games, to The Screen.
Barack Obama is more comfortable with bits and bytes than were earlier presidents, but in knocking iPad-style machines as wicked distractions adding to young people's information overload, he failed to allow for the positives. We can't stop Americans students from watching YouTubes or playing video games online. But technology can make it much easier for them to read books that reflect their needs and interests and help them sort out the facts.
Though iPaddish machines can display text crisply, just a fraction of modern books are online now. Along with private bookstores and commercial lending services, the public library model for e-books and other content could at least help change that and maybe grow the number of bookstore customers since reading would be a part of the routines of more Americans. Storage and handling costs are minuscule compared to those for paper books, which, along with other content, are just a fraction of a typical library's operating budget (yes, librarians add value, through such services as reference work, especially for the machine-adverse). Price per book would be lower, potentially allowing a much larger selection. E-books also would be easier on young backs and could reach Butte just as easily as Bethesda, or at least provide one more justification for decent cellular and broadband infrastructures. DVDs and satellite-linked WiFi at public libraries, meanwhile, would be alternatives for neglected rural areas.
Neighborhood libraries serve as community gathering places and for many other reasons are preferable to digital collections alone. But a national digital library system able to serve library-bereft neighborhoods--and places like Hood River County, where recession-racked voters voted down a referendum to finance brick-and-mortar libraries--would be better than no library service at all. Local librarians could still help choose books to be offered.
Other potential benefits would accrue from a well-stocked national digital library system. Better-read voters will make wiser choices at the polls. And some experts say, correctly or not, that novels in particular can build empathy, a trait said to be increasingly rare in schools, politics and the rest of American life. What's more, the same tablet hardware could make it easier to read newspapers at length online, because of superior interfaces, either through improved browsers or publication specific apps. Furthermore, multimedia e-books and related tech could provide special benefits for the people with disabilities and help Americans learn new skills in fields ranging from wind power to auto mechanics and culinary arts.
Imagine, too, the upside for older people who cannot drive or take the bus to the library. And how about e-books as the new large print? Definitely. This could be AARP catnip, then--not merely the K-12 variety; if nothing else, keep in mind that iPad-style machines can be simpler for older people to use than the usual desktops.
Like far less versatile Kindles, iPads can even read e-books aloud to the elderly and others. And on a large scale, the library model of compensation could make it easier to address the tricky issues of copyright and audio performance rights that have been bedeviling private companies such as Amazon. The expanded market would harder for recalcitrant content-providers to ignore.
* * *
Let's look, close up, at the paper dragon. When a Northern Virginia man suffered a heart attack in September 2008, this AARP member felt as if the healthcare industry had bullied him into becoming an accountant--caught as he was between the hospital, the doctors and the insurance company. Costs reached an outrageous $85,000. His wife's plan from her job, far better than the typical one, covered all but a fraction of that amount. But the paperwork ate up hours and hours that he could better have devoted to his work and cardio exercises.
The right hardware and software would make the health system more transparent to our friend the cardiac patient so hospitals and service providers were less likely to try to squeeze him unfairly--no small consideration if we remember that healthcare costs are among the leading causes of personal bankruptcy and steal away so much of our national wealth and income. Even as far back as 1999, the year studied by Harvard and the Canadian researchers, U.S. healthcare paperwork amounted to an estimated $1,059 per American http://harvardscience.harvard.edu/medicine-health/articles/study-shows-us-health-care-paperwork-cost-2943-billion-1999 or $294.3 billion. A single-payer system would be wonderful, but meanwhile the nightmare won't stop, wasting both money and time.
I know first-hand of the horrors here. You see, I'm the cardiac patient from Northern Virginia, and remember mine is a best-case scenario or at least somewhat close to it. The hospital itself was theoretically within the insurance company's network for almost full coverage. But oh, the loopholes! I still had to bargain with the surgeon's office and pay his people thousands. Dozens and dozens of mailings beset me from the insurance company and the other medical providers. I could have made a career of the paperwork. Alas, the current default for some doctor's offices and hospitals seems to be, "Let's see what we can get past the insurance company, and if that won't work, then we'll lean on the patient for the money--whether or not we're definitely right." I'd have paid out hundreds and perhaps even thousands more if my wife and I had not hung tough. While the Obama health-care legislation was a milestone, it hardly ended the possibility of a similar auditing nightmares should I suffer Heart Attack II.
So why not use iPad-type machines and easy-to-use software closely tied in with the devices? Then, for example, I could instantly show why an insurance company rejected problematic items that the doctors' offices or hospitals were now trying to get me to pay for.
Forget about just paper-based information or facts from separate corporate Web sites with password hassles and other joys. Give me instead a simple iPad-style application or a centralized Web-based "dashboard" or maybe a choice, so I can more easily try to reconcile information from different sources--and quote the source material in my boilerplate e-mails to hospitals and insurers. Here's to the magic of Web links and of facts consolidated via XML-based technology! Case by case, let patients themselves play more of a role in policing our health system, thereby lowering costs while actually taking up less of their time, thanks to the right automation. On top of that, with more automation at the patients' end, Americans would be more likely to benefit from shingles vaccines and other medical offerings that millions are foregoing now because of the paperwork often required (insurance companies may force you to buy the drugs and jump through the hoops for reimbursement for the $165+ often charged).
The same dashboard could also help me retrieve drug information--I gulp down five pills a day, a small number compared to some patients'--and alert me to relevant medical news. Likewise it could display my health records with plain English explanations from my physicians or others in text and audio (perhaps recorded during doctors' visits). No longer would patients have to depend so much on memory, their own notes, or doctors' scrawls.
Federal Chief Information Officer Vivek Kundra admirably wants to open up more government data to the citizenry, but we need to go further and use the federal government as an enabler for individual Americans to get a better grip on information about them in healthcare and other key areas so we can all save money and perhaps on occasion our lives.
Do you really think that the healthcare and tech companies on their own will give me everything I want and need, no matter which hospital or doctor I visit for for treatment? No, corporate executives prefer to balkanize markets or at least waste time duking it out to be the standard even if this may deny the sick an easy, comprehensive solution. I love Google on the whole and even own a tiny speck of stock in it as a long-range retirement investment, but does Google or Oracle care about my health and my pile of envelopes from doctors, hospitals and insurance companies? Hardly. Beyond that, under the current system, digital records can be grossly inaccurate, as a cancer-stricken user of Google Health discovered when Google startled him with a list of medical conditions he did not have.
The good news is that the Obama Administration wants to turn NHIN-Direct (NHIN stands for National Health Information Network) into full-fledged reality. The government is to oversee this platform for doctors, hospitals and other health-services providers and deal with such issues as interconnectivity and technical compatibilities and even patient access to records. But hopes are a long way from a working system and your ability to download to your iPad your cardiologist's precise diagnosis and advice.
Can such miracles actually happen? Actually at least one health cooperative is already emailing some actionable health tips to patients based on their doctors' findings --no small help when the patients may not immediately grasp all the nuances of orally delivered advise, and when 70 percent of Medicare spending involves 10 percent of patients in the program. This a shocking percentage even if you consider the expenses related to patients near the ends of their lives. If nothing else, imagine how much more effective drugs will be if taken correctly. Easier to master than conventional desktops, touch-screen tablets with the right software could make a major difference for the elderly and perhaps shave a percentage or two off that 70 percent.
* * *
ONE: FAIR TREATMENT OF CONTENT PROVIDERS
Allow for proper compensation for writers, America's besieged publishers, and other providers of content for the national digital library system, so that the quality of books and other offerings does not decline. Of course, readers could still read and download newspapers and magazines and non-library books without any tax money directly involved. They would already have the right hardware--iPads and other devices--in their hands.
TWO: PROPER PREPARATION OF TEACHERS AND LIBRARIANS
Prepare teachers adequately so that e-books and other online material truly became part of courses. Librarians, too, could receive proper training. No more reflexive, "Don't trust the Internet." Get good material online in a systematic way and tell the teachers and librarians where to look and how to use it and teach students to do the same.
President Obama, the threat isn't from information overload; rather it's from out-of-touch librarians and teachers, many of them still technophobic. Students could learn how to identify credible information and tune out distractions like Twitter. What's more, iPad-style software could come with a user-operated toggle to block Twitter notifications and other interruptions of the moment when students were reading books.
THREE: MAKE THE DIGITAL LIBRARY SYSTEM EASY TO USE
Simplify the fiendishly difficult steps that most library users must now endure to be able to read e-books. One way would simplify digital rights management or even come up with business models to do away with it entirely. A truly librarian-run system could address these issues better than the proprietary approaches now in use at the local and state levels.
Librarians are far, far from the ultimate interface designers, sometimes evincing more of an eagerness to teach their online systems to users than to simplify the technology for them. But a well-run national system could use focus groups and other techniques to deal with issues like DRM and interfaces in a standard way rather than forcing taxpayer-users to cope with all of the current complexities.
FOUR: TAX CREDITS TO PROMOTE PURCHASE OF THE RIGHT TABLETS FOR READING BOOKS AND OTHER LONG TEXTS
Give away book-friendly multiuse machines only to the poorest of the poor, but for now promote their use among others via tax credits and otherwise, even outside the business world. Besides, sooner or later, iPad-type machines will go for $50 at Walmart, which in fact may start selling iPads by the end of the year --the ultimate proof that this technology isn't just for the wealthy and the D.C. and corporate elites despite the current prices. Already the iPad is a hit among opinion leaders in Springfield, Missouri, and considering that Apple has moved some two million $499+ Pads since the machines hit the store shelves in early April, I'm not surprised.
Future iPad-style machines will inevitably be cheaper, lighter, smaller and more powerful and rugged than the current tablets, which, however, are still a good start regardless of their prices and fragility (stay tuned for more rugged machines using different screen technology).
The proposed program could help drive down prices somewhat from the iPad's current ones by spurring demand, since producers could gear up for a bigger market. Econo-tablets with WiFi are and will be appearing at lower prices, but let's shrink the costs still more, while maintaining iPad-level capabilities.
FIVE: OPEN TECHNOLOGY AND TECHNICAL STANDARDS TO DRIVE DOWN COSTS
I've focused here on the iPad simply because it has caught on so quickly and is a media darling. Don't expect iPad love to last forever. Better machines will inevitably appear in the future.
Let's reduce expenses for everyone via open technology and tech standards--to the maximum extent practical--and avoidance of a one-vendor approach. Scads of companies should be able to compete against Apple. Too, Americans need to be able to call up books and other content with many different kinds of machines, including the Kindle-style E Ink variety, as well as laptops and desktops of all kinds. No one-gizmo-for-all madness, please, not when individual preferences vary so widely. Furthermore, a variety of hardware and software options could be available for blind people and others with disabilities such as dyslexia.
To address one issue, yes, you can prop up an iPad on a stand and use it with an auxiliary wireless keyboard. But the proposed program could encourage the use of built-in stands to simplify matters. Compatibility with a mouse would also be nice; the iPad's touch interface is lousy for long writing sessions, which can be torture if you're on a deadline but must constantly reach for just the right part of the touch screen.
SIX: INTELLIGENT COST-JUSTIFICATION
Use cost-justification inside and outside government, as I've emphasized above. Imagine all the forms, both government and private, that the average American fills out. In effect, iPad-style technology could help redirect wealth from paperwork to knowledge.
Granted, taxes might go up slightly to pay for the plan, but with our Gross Domestic Product of some $14 trillion, the investment would be trivial in context.
Say, we waited until costs per machine were down to $200-$250--almost surely possible in the near future if suppliers minimize use of proprietary technology. And let's say the tax credit on 100 million devices amounted to $50 each for those made with X percentage of domestic parts (a way to slightly reduce the impact on the trade deficit). Or perhaps instead we would have income limits and increase the break from $50 to $100. Either way, the total direct costs to the U.S. Treasury would be $5 billion, plus maybe $1 billion to buy tablets for the very poorest of the poor. Just one machine per household would be eligible for the credit. The idea isn't to give everyone a free ride--rather to encourage widespread participation. What's more, the figures here are not iron-clad. Perhaps we could expand outright purchases for the poor in cases where it was obvious they could benefit, maybe after they passed a simple test, not that big a challenge for a device as easy as an iPad. Must so many Americans continue to go to the library to perform even simple paperwork?
The national digital library system and related costs such as preparation for teachers and librarians might come in at another $5 billion per year, after the start-up, and shrink or grow from there in accordance with the public's interests in various kinds of books and other content. Lowering communications expenses, most Americans could reach the library through their existing Net connections, and if need be, reasonable surcharges could be imposed for use of videos and other bandwidth-gobblers. Subsidies could go to the poor, especially those in vocational training programs for which relevant books and other media existed in the library. Needless to say, the library's communication costs would be one more reason to turn over more of the spectrum to WiFi or turbocharged variants.
Now let's say we spent an additional $10 billion in information-related goods and services for government and kept up the pace The current amount probably exceeds $70 billion a year, and I'd like to allow for programming costs at both the government and user ends. The $10 billion estimate may actually be too high. In many and perhaps most cases, the software for the public's individual machines could be developed privately and certified by the federal government or by independent contractors--or simply malware-checked if no security, health or safety reasons existed for further precautions.
The grand total in the federal budget would be $21 billion a year following a preparatory stage--a very imprecise, arbitrary, and hardly scientific guestimate offered as a discussion starter, but still just a faction of the several trillion that the wars in Iraq and Afghanistan are costing. Even though much of the $21-billion sum would be recurring, it would be tiny compared to the burden of the wars or the $700-billion + expenses of the American Recovery and Reinvestment Act, which already includes some tech-related components. In the end we'd be spending many billions less on bureaucracy in the public and private sectors. Remember, healthcare paperwork alone costs hundreds of billions a year, so even a tiny reduction would make a difference.
As the cost of the iPad-type machines declined, we could reduce the $5 billion cost of the tax breaks and divert more money to the library system itself or else cut back on the tax burden if we chose not to expand the library. Similarly, the related government automation costs might go down with the right infrastructure in place and further technological improvements.
Avoid creating a vast government infocracy to implement the technical side of the plan. On both the library and cost-justification sides, farm out much of the heavy lifting to companies like Google, Amazon and Oracle--hiring them as contractors.
Private library companies such as the e-book-oriented OverDrive and NetLibrary and specialized software suppliers like SirsiDynix could also participate this way. But librarians, not individual companies, should control the library system. If this approach could miraculously preempt the proposed Google Books Settlement or at least help augment it, I, for one, would be thrilled.
EIGHT: MAJOR ATTENTION PAID TO PRIVACY AND OTHER CYBERSECURITY MATTERS
Respect privacy--maybe by way of an independent agency with long-term funding that would administer databases with sensitive information. Carefully overseen private companies could supply the actual storage infrastructure.
Include robust cyber-security precautions, not just for the library but also for e-commerce and protection of individual information, such as the sensitive health-related variety, to reduce the privacy threat. The recent leaking of a database with 114,000 iPad owners' email adressesses and other sensitive information is one more indication that the private sector alone can't deal with the threat. The Chinese hacks of Google and other major U.S. companies are yet another. Security breaches make this proposal more timely, not less.
For iPads or other devices to qualify for tax breaks, should Americans have to use security-certified versions? That's a tricky issue, but one worthy of discussion, although in my opinion it would be a bad idea to make government-approved machines compulsory in all situations. But if you were entrusting your bank information to technology, wouldn't you want a secure system? Granted, the government itself can be a privacy threat, but isn't this true even without the plan I'm proposing?
* * *
What's more, for reasons of economy and freedom of expression and further privacy protections, I am not suggesting that the initiative replace all bookstores and paper libraries or even that Washington pay for all e-books and other content. But remember, we could start out focused on educational and training materials and free public domain books and grow gradually from there (with collection development assistance and other participation from many local, state, and academic librarians and educators, not just the Library of Congress).
Schools and libraries could still buy their own e-books and other items rather than merely point people to those in the national collection. But considering all the variations in educational spending between, say, Beverly Hills and Watts, this program could help ease the "savage inequalities" even if it it didn't include all content.
* * *
TeleRead is the name I've used in the past to describe this evolving proposal and I've been refining it and beating the drums for it in various forms since 1992, having even suggested the use of iPad-style tablets in my original article in Computerworld that year. The late William F. Buckley, Jr., my political opposite, championed TeleRead in his syndicated column. Maybe the time for the TeleRead/NISP approach has finally come for the United States and many other countries. The resultant improvements in our lives could be profound. Let books and better jobs and leaner bureaucracies in the public and private sectors, especially in healthcare--not just paperwork reduction among members of the Washington elite--be "the bomb."
=====
David H. Rothman is reachable at davidrothman@pobox.com, and another copy of this plan is or will be online at davidrothman.com/nisp.html http://davidrothman.com/nisp.html . An editor-writer in Alexandria, VA, Rothman founded TeleRead, the oldest English-language website devoted to general-interest news and views on e-books. TeleRead helped prod the e-book industry into developing the ePub format standard now used on the iPad, Sony Reader, the Barnes & Noble nook, and many other machines. Rothman is also the author of Copyright and K-12: Who Pays in the Network Era? (published by the U.S. Department of Education during the Clinton Administration). He has written The Silicon Jungle (Ballantine), The Complete Laptop Computer Guide (St. Martin's) and four other books on tech-related topics and contributed a TeleRead chapter to Scholarly Publishing: The Electronic Frontier (MIT Press/ASIS). He is the author of a recent novel, The Solomon Scandals.
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Joe Biden - Apple - Washington Post - United States - Barack Obama
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In this essay, he proposes ways that radically speeded-up adoption of the iPad-style devices could serve economic-stimulus and social-equality needs at the same time. Although he doesn't put it this way, it's his counterpart to a post-Sputnik technology-promotion plan. I'll leave the rest of the argument to him. You can follow up directly with him at davidrothman@pobox.com or via his sites.
A national information stimulus plan: How iPad-style tablets could help educate millions and trim bureaucracy--not just be techno toys for the D.C. elite
By David Rothman
The Washington elite is discovering the Apple iPad.
Vice President Joe Biden, White House aides, and gadget-loving members of Congress are starting to tote the same evil tablet that the President denounced as an info-overload threat to young minds.
Might iPad-style technology in fact be a godsend for millions of schoolchildren with obsolete textbooks? And could e-books benefit the elderly, the disabled, and other library users, too, including U.S. workers eager to upgrade job skills?
If nothing else, the iPad and similar machines could drive down library costs per book. That could help keep reading alive in places like Hood River County, Oregon, where the 98-year-old library system plans to close for financial reasons --just one of many cash-strapped U.S. libraries.
Along the way, as the technology's price declined, the mass automation potential of the tablets could justify the cost of a national digital library system. Such potential might count even more than the library initiative itself. Call it a national information stimulus plan or NISP. The stimulus would be in the form of more and better information, as well as greater efficiencies in both the public and private sectors.
Politico's Erika Lovely recently told how the iPad "may be the ultimate paper saver for an institution that prints millions of pages a year and still piles huge stacks of bills outside the House chamber every day." She quoted Rep. Jason Chaffetz, a Utah Republican on an information-policy-related subcommittee: "The thing is the bomb." The new BlackBerry for some on the Hill? Meanwhile The Washington Post says White House Chief of Staff Rahm Emanuel and some other Obama staffers use iPads, and that Apple tablets will soon be standard for the power people of the West Wing.
Newspapers and magazines are among the "apps" in use on iPads in the West Wing; and economic adviser Larry Summers has even started to download e-books, including The Federalist Papers.
* * *
So what's the school-and-library angle? Well, think of the iPad and similar devices as one way to help spark a greater interest in books and other long texts that encourage sustained thought. Let's work harder to bring books, not just videos and games, to The Screen.
Barack Obama is more comfortable with bits and bytes than were earlier presidents, but in knocking iPad-style machines as wicked distractions adding to young people's information overload, he failed to allow for the positives. We can't stop Americans students from watching YouTubes or playing video games online. But technology can make it much easier for them to read books that reflect their needs and interests and help them sort out the facts.
Though iPaddish machines can display text crisply, just a fraction of modern books are online now. Along with private bookstores and commercial lending services, the public library model for e-books and other content could at least help change that and maybe grow the number of bookstore customers since reading would be a part of the routines of more Americans. Storage and handling costs are minuscule compared to those for paper books, which, along with other content, are just a fraction of a typical library's operating budget (yes, librarians add value, through such services as reference work, especially for the machine-adverse). Price per book would be lower, potentially allowing a much larger selection. E-books also would be easier on young backs and could reach Butte just as easily as Bethesda, or at least provide one more justification for decent cellular and broadband infrastructures. DVDs and satellite-linked WiFi at public libraries, meanwhile, would be alternatives for neglected rural areas.
Neighborhood libraries serve as community gathering places and for many other reasons are preferable to digital collections alone. But a national digital library system able to serve library-bereft neighborhoods--and places like Hood River County, where recession-racked voters voted down a referendum to finance brick-and-mortar libraries--would be better than no library service at all. Local librarians could still help choose books to be offered.
Other potential benefits would accrue from a well-stocked national digital library system. Better-read voters will make wiser choices at the polls. And some experts say, correctly or not, that novels in particular can build empathy, a trait said to be increasingly rare in schools, politics and the rest of American life. What's more, the same tablet hardware could make it easier to read newspapers at length online, because of superior interfaces, either through improved browsers or publication specific apps. Furthermore, multimedia e-books and related tech could provide special benefits for the people with disabilities and help Americans learn new skills in fields ranging from wind power to auto mechanics and culinary arts.
Imagine, too, the upside for older people who cannot drive or take the bus to the library. And how about e-books as the new large print? Definitely. This could be AARP catnip, then--not merely the K-12 variety; if nothing else, keep in mind that iPad-style machines can be simpler for older people to use than the usual desktops.
Like far less versatile Kindles, iPads can even read e-books aloud to the elderly and others. And on a large scale, the library model of compensation could make it easier to address the tricky issues of copyright and audio performance rights that have been bedeviling private companies such as Amazon. The expanded market would harder for recalcitrant content-providers to ignore.
* * *
Let's look, close up, at the paper dragon. When a Northern Virginia man suffered a heart attack in September 2008, this AARP member felt as if the healthcare industry had bullied him into becoming an accountant--caught as he was between the hospital, the doctors and the insurance company. Costs reached an outrageous $85,000. His wife's plan from her job, far better than the typical one, covered all but a fraction of that amount. But the paperwork ate up hours and hours that he could better have devoted to his work and cardio exercises.
The right hardware and software would make the health system more transparent to our friend the cardiac patient so hospitals and service providers were less likely to try to squeeze him unfairly--no small consideration if we remember that healthcare costs are among the leading causes of personal bankruptcy and steal away so much of our national wealth and income. Even as far back as 1999, the year studied by Harvard and the Canadian researchers, U.S. healthcare paperwork amounted to an estimated $1,059 per American http://harvardscience.harvard.edu/medicine-health/articles/study-shows-us-health-care-paperwork-cost-2943-billion-1999 or $294.3 billion. A single-payer system would be wonderful, but meanwhile the nightmare won't stop, wasting both money and time.
I know first-hand of the horrors here. You see, I'm the cardiac patient from Northern Virginia, and remember mine is a best-case scenario or at least somewhat close to it. The hospital itself was theoretically within the insurance company's network for almost full coverage. But oh, the loopholes! I still had to bargain with the surgeon's office and pay his people thousands. Dozens and dozens of mailings beset me from the insurance company and the other medical providers. I could have made a career of the paperwork. Alas, the current default for some doctor's offices and hospitals seems to be, "Let's see what we can get past the insurance company, and if that won't work, then we'll lean on the patient for the money--whether or not we're definitely right." I'd have paid out hundreds and perhaps even thousands more if my wife and I had not hung tough. While the Obama health-care legislation was a milestone, it hardly ended the possibility of a similar auditing nightmares should I suffer Heart Attack II.
So why not use iPad-type machines and easy-to-use software closely tied in with the devices? Then, for example, I could instantly show why an insurance company rejected problematic items that the doctors' offices or hospitals were now trying to get me to pay for.
Forget about just paper-based information or facts from separate corporate Web sites with password hassles and other joys. Give me instead a simple iPad-style application or a centralized Web-based "dashboard" or maybe a choice, so I can more easily try to reconcile information from different sources--and quote the source material in my boilerplate e-mails to hospitals and insurers. Here's to the magic of Web links and of facts consolidated via XML-based technology! Case by case, let patients themselves play more of a role in policing our health system, thereby lowering costs while actually taking up less of their time, thanks to the right automation. On top of that, with more automation at the patients' end, Americans would be more likely to benefit from shingles vaccines and other medical offerings that millions are foregoing now because of the paperwork often required (insurance companies may force you to buy the drugs and jump through the hoops for reimbursement for the $165+ often charged).
The same dashboard could also help me retrieve drug information--I gulp down five pills a day, a small number compared to some patients'--and alert me to relevant medical news. Likewise it could display my health records with plain English explanations from my physicians or others in text and audio (perhaps recorded during doctors' visits). No longer would patients have to depend so much on memory, their own notes, or doctors' scrawls.
Federal Chief Information Officer Vivek Kundra admirably wants to open up more government data to the citizenry, but we need to go further and use the federal government as an enabler for individual Americans to get a better grip on information about them in healthcare and other key areas so we can all save money and perhaps on occasion our lives.
Do you really think that the healthcare and tech companies on their own will give me everything I want and need, no matter which hospital or doctor I visit for for treatment? No, corporate executives prefer to balkanize markets or at least waste time duking it out to be the standard even if this may deny the sick an easy, comprehensive solution. I love Google on the whole and even own a tiny speck of stock in it as a long-range retirement investment, but does Google or Oracle care about my health and my pile of envelopes from doctors, hospitals and insurance companies? Hardly. Beyond that, under the current system, digital records can be grossly inaccurate, as a cancer-stricken user of Google Health discovered when Google startled him with a list of medical conditions he did not have.
The good news is that the Obama Administration wants to turn NHIN-Direct (NHIN stands for National Health Information Network) into full-fledged reality. The government is to oversee this platform for doctors, hospitals and other health-services providers and deal with such issues as interconnectivity and technical compatibilities and even patient access to records. But hopes are a long way from a working system and your ability to download to your iPad your cardiologist's precise diagnosis and advice.
Can such miracles actually happen? Actually at least one health cooperative is already emailing some actionable health tips to patients based on their doctors' findings --no small help when the patients may not immediately grasp all the nuances of orally delivered advise, and when 70 percent of Medicare spending involves 10 percent of patients in the program. This a shocking percentage even if you consider the expenses related to patients near the ends of their lives. If nothing else, imagine how much more effective drugs will be if taken correctly. Easier to master than conventional desktops, touch-screen tablets with the right software could make a major difference for the elderly and perhaps shave a percentage or two off that 70 percent.
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ONE: FAIR TREATMENT OF CONTENT PROVIDERS
Allow for proper compensation for writers, America's besieged publishers, and other providers of content for the national digital library system, so that the quality of books and other offerings does not decline. Of course, readers could still read and download newspapers and magazines and non-library books without any tax money directly involved. They would already have the right hardware--iPads and other devices--in their hands.
TWO: PROPER PREPARATION OF TEACHERS AND LIBRARIANS
Prepare teachers adequately so that e-books and other online material truly became part of courses. Librarians, too, could receive proper training. No more reflexive, "Don't trust the Internet." Get good material online in a systematic way and tell the teachers and librarians where to look and how to use it and teach students to do the same.
President Obama, the threat isn't from information overload; rather it's from out-of-touch librarians and teachers, many of them still technophobic. Students could learn how to identify credible information and tune out distractions like Twitter. What's more, iPad-style software could come with a user-operated toggle to block Twitter notifications and other interruptions of the moment when students were reading books.
THREE: MAKE THE DIGITAL LIBRARY SYSTEM EASY TO USE
Simplify the fiendishly difficult steps that most library users must now endure to be able to read e-books. One way would simplify digital rights management or even come up with business models to do away with it entirely. A truly librarian-run system could address these issues better than the proprietary approaches now in use at the local and state levels.
Librarians are far, far from the ultimate interface designers, sometimes evincing more of an eagerness to teach their online systems to users than to simplify the technology for them. But a well-run national system could use focus groups and other techniques to deal with issues like DRM and interfaces in a standard way rather than forcing taxpayer-users to cope with all of the current complexities.
FOUR: TAX CREDITS TO PROMOTE PURCHASE OF THE RIGHT TABLETS FOR READING BOOKS AND OTHER LONG TEXTS
Give away book-friendly multiuse machines only to the poorest of the poor, but for now promote their use among others via tax credits and otherwise, even outside the business world. Besides, sooner or later, iPad-type machines will go for $50 at Walmart, which in fact may start selling iPads by the end of the year --the ultimate proof that this technology isn't just for the wealthy and the D.C. and corporate elites despite the current prices. Already the iPad is a hit among opinion leaders in Springfield, Missouri, and considering that Apple has moved some two million $499+ Pads since the machines hit the store shelves in early April, I'm not surprised.
Future iPad-style machines will inevitably be cheaper, lighter, smaller and more powerful and rugged than the current tablets, which, however, are still a good start regardless of their prices and fragility (stay tuned for more rugged machines using different screen technology).
The proposed program could help drive down prices somewhat from the iPad's current ones by spurring demand, since producers could gear up for a bigger market. Econo-tablets with WiFi are and will be appearing at lower prices, but let's shrink the costs still more, while maintaining iPad-level capabilities.
FIVE: OPEN TECHNOLOGY AND TECHNICAL STANDARDS TO DRIVE DOWN COSTS
I've focused here on the iPad simply because it has caught on so quickly and is a media darling. Don't expect iPad love to last forever. Better machines will inevitably appear in the future.
Let's reduce expenses for everyone via open technology and tech standards--to the maximum extent practical--and avoidance of a one-vendor approach. Scads of companies should be able to compete against Apple. Too, Americans need to be able to call up books and other content with many different kinds of machines, including the Kindle-style E Ink variety, as well as laptops and desktops of all kinds. No one-gizmo-for-all madness, please, not when individual preferences vary so widely. Furthermore, a variety of hardware and software options could be available for blind people and others with disabilities such as dyslexia.
To address one issue, yes, you can prop up an iPad on a stand and use it with an auxiliary wireless keyboard. But the proposed program could encourage the use of built-in stands to simplify matters. Compatibility with a mouse would also be nice; the iPad's touch interface is lousy for long writing sessions, which can be torture if you're on a deadline but must constantly reach for just the right part of the touch screen.
SIX: INTELLIGENT COST-JUSTIFICATION
Use cost-justification inside and outside government, as I've emphasized above. Imagine all the forms, both government and private, that the average American fills out. In effect, iPad-style technology could help redirect wealth from paperwork to knowledge.
Granted, taxes might go up slightly to pay for the plan, but with our Gross Domestic Product of some $14 trillion, the investment would be trivial in context.
Say, we waited until costs per machine were down to $200-$250--almost surely possible in the near future if suppliers minimize use of proprietary technology. And let's say the tax credit on 100 million devices amounted to $50 each for those made with X percentage of domestic parts (a way to slightly reduce the impact on the trade deficit). Or perhaps instead we would have income limits and increase the break from $50 to $100. Either way, the total direct costs to the U.S. Treasury would be $5 billion, plus maybe $1 billion to buy tablets for the very poorest of the poor. Just one machine per household would be eligible for the credit. The idea isn't to give everyone a free ride--rather to encourage widespread participation. What's more, the figures here are not iron-clad. Perhaps we could expand outright purchases for the poor in cases where it was obvious they could benefit, maybe after they passed a simple test, not that big a challenge for a device as easy as an iPad. Must so many Americans continue to go to the library to perform even simple paperwork?
The national digital library system and related costs such as preparation for teachers and librarians might come in at another $5 billion per year, after the start-up, and shrink or grow from there in accordance with the public's interests in various kinds of books and other content. Lowering communications expenses, most Americans could reach the library through their existing Net connections, and if need be, reasonable surcharges could be imposed for use of videos and other bandwidth-gobblers. Subsidies could go to the poor, especially those in vocational training programs for which relevant books and other media existed in the library. Needless to say, the library's communication costs would be one more reason to turn over more of the spectrum to WiFi or turbocharged variants.
Now let's say we spent an additional $10 billion in information-related goods and services for government and kept up the pace The current amount probably exceeds $70 billion a year, and I'd like to allow for programming costs at both the government and user ends. The $10 billion estimate may actually be too high. In many and perhaps most cases, the software for the public's individual machines could be developed privately and certified by the federal government or by independent contractors--or simply malware-checked if no security, health or safety reasons existed for further precautions.
The grand total in the federal budget would be $21 billion a year following a preparatory stage--a very imprecise, arbitrary, and hardly scientific guestimate offered as a discussion starter, but still just a faction of the several trillion that the wars in Iraq and Afghanistan are costing. Even though much of the $21-billion sum would be recurring, it would be tiny compared to the burden of the wars or the $700-billion + expenses of the American Recovery and Reinvestment Act, which already includes some tech-related components. In the end we'd be spending many billions less on bureaucracy in the public and private sectors. Remember, healthcare paperwork alone costs hundreds of billions a year, so even a tiny reduction would make a difference.
As the cost of the iPad-type machines declined, we could reduce the $5 billion cost of the tax breaks and divert more money to the library system itself or else cut back on the tax burden if we chose not to expand the library. Similarly, the related government automation costs might go down with the right infrastructure in place and further technological improvements.
Avoid creating a vast government infocracy to implement the technical side of the plan. On both the library and cost-justification sides, farm out much of the heavy lifting to companies like Google, Amazon and Oracle--hiring them as contractors.
Private library companies such as the e-book-oriented OverDrive and NetLibrary and specialized software suppliers like SirsiDynix could also participate this way. But librarians, not individual companies, should control the library system. If this approach could miraculously preempt the proposed Google Books Settlement or at least help augment it, I, for one, would be thrilled.
EIGHT: MAJOR ATTENTION PAID TO PRIVACY AND OTHER CYBERSECURITY MATTERS
Respect privacy--maybe by way of an independent agency with long-term funding that would administer databases with sensitive information. Carefully overseen private companies could supply the actual storage infrastructure.
Include robust cyber-security precautions, not just for the library but also for e-commerce and protection of individual information, such as the sensitive health-related variety, to reduce the privacy threat. The recent leaking of a database with 114,000 iPad owners' email adressesses and other sensitive information is one more indication that the private sector alone can't deal with the threat. The Chinese hacks of Google and other major U.S. companies are yet another. Security breaches make this proposal more timely, not less.
For iPads or other devices to qualify for tax breaks, should Americans have to use security-certified versions? That's a tricky issue, but one worthy of discussion, although in my opinion it would be a bad idea to make government-approved machines compulsory in all situations. But if you were entrusting your bank information to technology, wouldn't you want a secure system? Granted, the government itself can be a privacy threat, but isn't this true even without the plan I'm proposing?
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What's more, for reasons of economy and freedom of expression and further privacy protections, I am not suggesting that the initiative replace all bookstores and paper libraries or even that Washington pay for all e-books and other content. But remember, we could start out focused on educational and training materials and free public domain books and grow gradually from there (with collection development assistance and other participation from many local, state, and academic librarians and educators, not just the Library of Congress).
Schools and libraries could still buy their own e-books and other items rather than merely point people to those in the national collection. But considering all the variations in educational spending between, say, Beverly Hills and Watts, this program could help ease the "savage inequalities" even if it it didn't include all content.
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TeleRead is the name I've used in the past to describe this evolving proposal and I've been refining it and beating the drums for it in various forms since 1992, having even suggested the use of iPad-style tablets in my original article in Computerworld that year. The late William F. Buckley, Jr., my political opposite, championed TeleRead in his syndicated column. Maybe the time for the TeleRead/NISP approach has finally come for the United States and many other countries. The resultant improvements in our lives could be profound. Let books and better jobs and leaner bureaucracies in the public and private sectors, especially in healthcare--not just paperwork reduction among members of the Washington elite--be "the bomb."
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David H. Rothman is reachable at davidrothman@pobox.com, and another copy of this plan is or will be online at davidrothman.com/nisp.html http://davidrothman.com/nisp.html . An editor-writer in Alexandria, VA, Rothman founded TeleRead, the oldest English-language website devoted to general-interest news and views on e-books. TeleRead helped prod the e-book industry into developing the ePub format standard now used on the iPad, Sony Reader, the Barnes & Noble nook, and many other machines. Rothman is also the author of Copyright and K-12: Who Pays in the Network Era? (published by the U.S. Department of Education during the Clinton Administration). He has written The Silicon Jungle (Ballantine), The Complete Laptop Computer Guide (St. Martin's) and four other books on tech-related topics and contributed a TeleRead chapter to Scholarly Publishing: The Electronic Frontier (MIT Press/ASIS). He is the author of a recent novel, The Solomon Scandals.
