Robert Whitcomb: Hospitals should be insurers, too

  This piece first ran in the Huffington Post.

Steven Brill's latest book, America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, has gotten a lot of attention in large part because of Mr. Brill's vivid anecdotes about the "jalopy'' of American health care. They're memorable stories, gathered with his famous work ethic and intense curiosity, though there's a bit too much about his own deluxe heart-surgery adventures at Manhattan's very expensive New York-Presbyterian Hospital, which comprises some of the narrative glue of this book.

(I found my own open-heart surgery a couple of years ago to be tedium interspersed by fantastical hospital "chargemaster'' billing. A doctor friend told me that the bills had little connection to the reality of the final  total bill.)

Since we're all healthcare consumers, it would be nice, even in this post-literate society, if most adults read this book, to see how their money is being spent. Mr. Brill brings a lot of transparency to this all-too-opaque sector.

Mr. Brill is a rich entrepreneur and journalist and very much a member of the elite, luminaries of which he has easy access to. But he also displays strong compassion for the low- and middle-income people with whom he talks. Many of these folks have a brutal time paying for essential care (especially the unexpected kind) and navigating the obscenely complicated and contradictory U.S. healthcare "system''. His richly reported book provides a colorful, disturbing and occasionally encouraging look at our medical maze.

It's also a sort of thriller about the near-death saga of getting the Affordable Care Act enacted amidst relentless lobbying and political conflicts of interest. Then comes the Obama administration's efforts to recover from the disastrous launch of the HealthCare.gov website. Mr. Brill provides a heartening counter-example by telling us about the triumph of healthcare reform in -- perhaps surprisingly -- the Red State of Kentucky.

Most readers are at least vaguely aware of the institutionalized squalor of much Washington lobbying by some healthcare constituencies, and Steven Brill doesn't stint on telling us more about that. One recalls the famous line by Otto von Bismarck to the effect: "Like sausage-making, you don't want to see how laws are made.''

But there aren't many big surprises, except perhaps that you may find from reading this book that the profiteering by the pharmaceutical and medical-device industries -- for which the public pays much -- is even more extreme than you thought.

Meanwhile, there hasn't been nearly enough comment on his very good ideas to improve the ''system's'' egregious lack of coordination, reduce its gigantic costs and even improve medical outcomes, of all things.

In my view, his most interesting proposals are to encourage more hospital systems to get bigger (and hence to offer broader population-health care and better, most cost-efficient care of individual patients, especially the chronically ill) and to be insurance companies as well as care providers.

And in fact more and more systems have been getting into the insurance business in recent years. It may be the best way to incentivize both care coordination and cost control. Most of hospitals' and their clinicians' financial incentives to over-treat and over-test would disappear if the hospitals were also stuck with the claims costs!

Mr. Brill emphasizes what most people in the public don't seem to get: That hospitals with cost-plus "chargemaster'' billing, big operating profits and hugely compensated senior execs have driven much of the health-cost surge. That very much includes the "nonprofit'' hospitals, many of which are hugely profitable. "Nonprofit'' usually just means that things are arranged so that these enterprises don't pay most taxes.

It is the insurance companies, with relatively small profit margins, they get unfairly blamed for just about everything in U.S. health care. (Mr. Brill would also have done well to note that U.S. physicians are by far the highest paid in the world.) Hospital-insurer mergers don't mean that all independent insurers would go away. They'd still be needed (barring extension of Medicare to everybody) to cover bills from small, independent hospitals, independent physicians and some other clinicians.

Hospital system-insurer combined entities are well-positioned to collect and analyze data about patients to improve care and better allocate resources. Indeed, Mr. Brill says, the bigger the hospital system in a region, the better opportunity a system has to coordinate a patient's care in various inpatient and outpatient venues and cut costs through efficient, expense-saving "bundling'' in treating individual patients' injuries and illnesses over time. This includes treatment at the outpatient clinics that systems are increasingly establishing as the number of inpatient beds steadily declines.

Mr. Brill quotes Jeffrey Romoff, the chief executive of the big-foot University of Pittsburgh Medical Center system, which has an insurance company, on provider-payer marriages:

"All the incentives are aligned the right way. It's the beauty of being the payer and the provider at the same time. When the interests are not aligned, it's why seniors dying of cancer get chemo when they should just get hospice care.''

Obviously the hospital systems becoming insurers take on new processing costs, but think of how much money could be saved by cutting out the third-party middleman. For one big thing, the hospital-insurance combo doesn't worry about paying dividends to insurance-company shareholders or insurance execs' multimillion-dollar salaries. And the new combos might become a little more disciplined about the hospital execs' compensation.

Mr. Brill also suggests capping operating profits of hospitals (including "nonprofit'' ones) to, say, 8 percent. While he doesn't use the term "public utility'' I was reminded of the old-fashioned model of state regulators allowing about that percentage for electricity and natural-gas utilities. Maybe it's time to look at hospitals as public utilities, which they sort of are.

This doesn't address pharmaceutical and medical-device companies' astronomical profit margins, protected by Washington lobbyists who are even more effective than the insurers' and hospitals'. They drive up healthcare costs a lot. But the increased transparency and rigor in looking at the unimpressive medical outcomes associated with some heavily marketed medicines and devices will help constrain their pricing.

Mr. Brill also wants to cap salaries of hospital executives. I'm always  leery of government micro-managing internal decision-making in nongovernmental organizations -- too clunky -- but the idea should be studied.

So let's hope that state and federal regulators don't put too many roadblocks in the way of many more hospital systems becoming insurers.

Extending Medicare to everyone might be the most cost-effective reform but economic constituencies, and ideology often divorced from macro-economic realities, in Washington will prevent that, at least for the foreseeable future.

But Mr. Brill's prescriptions could help a lot. Meanwhile, let us hope that the shrinking number of paid healthcare journalists, such as Steven Brill, do what they can to disinfect a  system with all-too-often mediocre care and exorbitant costs that threaten to bankrupt America. More sunlight equals more reform.

Robert Whitcomb (rwhitcomb51@gmail.com) is a partner and senior adviser at Cambridge Management Group (cmg625.com), a healthcare-sector consultancy, a Fellow of the Pell Center for International Relations and Public Policy and overseer of newenglanddiary.com. He's a former finance editor of the International Herald Tribune, a former editor at The Wall Street Journal and former editorial-page editor at The Providence Journal.

Suppose you were Gordon Fox...

"Suppose you were an idiot, and suppose you were a member of Congress; but I repeat myself.'' This line from Mark Twain came to my mind when I read about former Rhode Island House Speaker Gordon Fox so brazenly taking $52,500 in bribes  from a Providence restaurant  so that it could get a liquor license and using $108,000 in campaign money for personal use. How brazen and how banal.

The name of the restaurant? The Shark Sushi Bar  & Grille!

Agricultural architecture

 

"Obstacle in a  Vermont Landscape,'' by WILLIAM HALL, who is  prudently working in Florida this winter.

James P. Freeman: Boston dies at 394

  JULY 4, 2024

With an air of inconsolable sadness, the Boston City Council announced today, on the anniversary of the republic’s birth, that the City of Boston passed away after a long illness. It was 394 years old, six years short of what would have been its 400th birthday.

While the cause of death was not immediately disclosed, it is widely believed that one of America’s oldest municipalities expired after complications arising from morbid obesity (collapsing from the weight of massive unfunded liabilities) and asphyxiation (suffocating on uncontrollable borrowing). Boston was to play host to the 2024 Summer Olympic Games, which were largely financed with debt and taxes. The opening ceremonies and the official competition, now cancelled, were due to commence later this month.

Whimsically referred to as “The Hub,” it also suffered from congestive heart failure and coronary artery disease. A complicated and expensive procedure was undertaken in 1991 to unclog its central artery. Known as “The Big Dig,” and thought to create a future unfettered, it provided only temporary relief by creating a double by-pass (the Tip O’Neill Tunnel and Ted Williams Tunnel).

It was finally completed in 2007, after 16 years and costing over $14 billion, well over the original $2.6 billion estimate. Plagued by administrative incompetence, mitigation payments and political corruption, that project, with a cruel irony, was to be finally paid off 14 years from now. Like many patients arrogant with self-indulgence, bad behavior contributed to its ruination.

Boston is predeceased by Detroit, MI, Jefferson County, AL, Orange County, CA, Stockton, CA, San Bernardino, CA, Bridgeport, CT and Central Fall, RI. Those cities suffered similar symptoms, ultimately succumbing to overextended obligations.

Founded by Puritan settlers, in 1630, on egalitarian political idealism and a revolutionary character, its members’ lives were structured by limited resources and stark morality. An early observer of America’s burgeoning democracy, Alexis de Tocqueville, wrote that the  Puritans were governed by “austere principles.” Such a peculiar genius seems remarkably quaint by today’s evolving standards of propriety. And those once-vaunted values guided that pioneering fervor to The Boston Tea Party and early support for Abolition, a sampling of its importance to American history as a beacon of liberty. But that libertarian spirit waned as a progressive wave dominated much of the 20^th Century.

In the years preceding its failure Boston was the 24^th largest city in the United States. Public communication often took place in the Brutalist-styled City Hall, before the bannered backdrop of a sign that read: “Thriving, Healthy, Innovative.” And so fiscal pathologists and actuarial planners were lamenting over the demise of a city thought to be a postcard of urban health.

In 2015, the last year for which records are available, the city’s budget was $2.7 billion. Despite its sterling bond ratings, it was reported to have over $6 billion in unfunded pensions and retiree healthcare liabilities, according to the Boston Business Journal.

Additionally, it also had over $1 billion in outstanding debt. Over 14,000 active city employees were supporting 10,000 retirees, who, on average, were receiving $36,000 annually.

A closer inspection of the books indicated an ever increasing portion of its budget was dedicated to pension and debt service, stripping the city of its ability to cover more discretionary spending. Demographic changes also showed an increasingly aging workforce.

Given this backdrop, it was surprising Boston submitted a bid for this summer’s games in 2014 (it was awarded them in 2017). Organizers originally proposed a $4.7 billion operating budget with total a cost projected well above $10 billion. Despite assurances by then-Mayor Martin Walsh that no public funds would be used to finance the games, and despite a significant infusion of private money, the city in fact was forced to pay a substantial part of the cost. With this additional burden -- and absence of adequate accountability and transparency -- the city was unable to continue as a going concern.

Expressions of sympathy began arriving from around the country, including Los Angeles, San Francisco, and Washington, D.C., cities not chosen by the U.S.  Olympic Committee. Heartfelt condolences were received also from Denver, originally selected to host the 1976 XII Olympic Winter Games, but relinquished holding that Olympiad when voters rejected its financing. Boston voters were never given that opportunity.

Mourners discerned a sort of political synesthesia over the last decade of its life. A mayor elected by popular vote in 2013 was against allowing a public referendum on the games in 2015. A clause in the agreement signed by the mayor and Olympic organizations forbid city employees to oppose the proposal. Of greater consequence, an elite group of private citizens usurped power properly held by public officials. The tension in Boston’s ancestral sinews became evident, stretching between its old Yankee parochialism and new modern internationalism.

In lieu of flowers, forensic experts and financial advisers have requested that donations be made to a financial collection committee, established in bankruptcy proceedings. It was determined that Boston’s insolvency would be better managed by liquidation instead of another restructuring. Among the creditors are 40 public unions that were once ardent supporters of the games.

Boston is survived by the collective memory of its glorious founding.

Visiting hours have been cancelled since widespread street closures and parking bans in Boston proper and surrounding neighborhoods were implemented as Olympic protocols. Infrastructure investments never materialized because the MBTA, the public transportation agency, for decades severely mismanaged, went into receivership in early 2018.

Advance copies of the Order of Service reveal that the recessional hymn will be “M.T.A.,” popularized by The Kingston Trio and originally recorded as a campaign theme song in 1949 for Progressive Party Boston mayoral candidate Walter A. O’Brien. It speaks of a sorry passenger who was trapped in the city’s subway system, with a pause in its choral phrasing allowing audience call out… “Poor Old Charlie” and “What a Pity.” A fitting coda for the organizers of Boston 2024.

James P. Freeman is a Cape Cod-based writer

Chris Powell: The Conn. higher-education racket

MANCHESTER, Conn. Hearing complaints the other week about the supposed affront to higher education in  Connecticut Gov. Dannel Malloy's budget proposal, the General Assembly's Appropriations Committee may have set a record for obliviousness.

University of Connecticut President Susan Herbst -- benefactor of a $251,000 honorarium to Hillary Clinton and fresh from a $300,000 raise on top of her $500,000 salary, which accompanies use of two mansions, one in Storrs and one in Hartford -- pleaded the university's poverty and warned that everything the university does might be impaired by the budget. No one on the committee asked Herbst about those grotesque expenses.

Coming along in tow were dozens of UConn students, including a women's varsity basketball player, who all knew that they didn't want to sacrifice anything, who apparently thought that somebody else somewhere does want to sacrifice, and who made no more helpful suggestions than Herbst did.

No one on the committee asked Herbst or the students if they could provide information about instructor course loads and staff salary and benefit increases at UConn or whether the university's refusal to accept oversight by the state Contracting Standards Board might get in the way of saving money.

The whole racket of public higher education in Connecticut was inadvertently exposed at the hearing by Gregory W. Gray, president of the Board of Regents for Higher Education, which purports to run Connecticut's four lesser universities, whose chief executives are paid only in the $350,000-$400,000 range, just 2½ times what the governor is paid for running the whole state. (Herbst soon will be making more than five times as much as the governor.)

Gray seemed most upset that the governor's budget neglected to appropriate for remedial education for university students -- that is, students admitted to college without ever mastering high school work, though they have been given high school diplomas anyway, academic standards in high school having been abolished.

Five years ago a state survey found that two-thirds of the university system's freshmen had to take remedial math or English courses or both. While the General Assembly and governor were horrified by this, they enacted legislation not to fix the problem but to hide it -- to outlaw remedial math and English courses and require university instructors to provide remedial help to students individually, so that there might never again be such a revealing survey.

No one on the committee questioned the premise and policy that everyone in Connecticut should be given a college education at public expense even if he has failed high school.

Nor was Gray questioned about his board's recent promotion to full professor of a Central Connecticut State University teacher while he was in jail and the university's persistence in that promotion despite his subsequent arrests and general irresponsibility.

Of course nothing better could be expected of Herbst and Gray, self-serving bureaucrats reflexively defending their burgeoning empires. It's their job, at least as they see it.

But a few critical questions from legislators on the committee might have made an impression on some of the students and encouraged them to aspire to become more than they were that day, mere props and tools for the government class.

Indeed, a few critical questions from legislators also might have made an impression on the news reporters who attended the hearing, prompting them to convey to the public more than the bureaucrats' predictable whining, to convey some of the choices that are made in state government all the time without ever being articulated --  such as salaries vs. services, actual learning vs. mere self-esteem, and efficiency in government vs. the educational inflation caused by the collapse of standards, whereby Connecticut now pays for 16 years of education but doesn't receive what it once got from 12.

Chris Powell is managing editor of the Journal Inquirer, based in Manchester, Conn.

Better than Kindle?

 

"The New Novel'' (watercolor), by WINSLOW HOMER, being shown along with early wood engravings by Homer  in the show "American Master: Winslow Homer,'' at the Michele and Donald D'Amour Museum of Fine Arts, in Springfield, Mass., through Sept. 27.

The thighs have it

 

Photo by AJEJANDRA CARLES-TOLRA, in the just completed show "The Bears'' at the Chazan Family Gallery, Providence. She investigated what it means to be "rugby girl'' -- or are there just girls who play rugby? She's interested in the relationship between individual and group identity.

Detailing Russian military forces in/around Ukraine

  Here's a breakdown of Russia's military assets in and around Ukraine as Russian dictat0r Putin steps up efforts to reestablish Soviet/Russian empire through force.

Ousted Ukrainian president deposited billions with China

  A Putin ally,  the former Ukrainian President Yanukovich, deposited billions of dollars with China.

Chris Powell: At least we plow well; sick vets and discretionary wars

MANCHESTER, Conn. Government in Connecticut does one thing well: snowplowing. While 2 inches of snow can send Washington, D.C., into comic panic and paralysis, Connecticut plays through even a foot or more of snow and can push it out of the way and be back in business in 24 hours.

Still, even in normal winters the snow is a drag here, and now, with heavy snow seeming to come nearly every week, it is more than a drag. It may be reducing economic output by 10 or 20 percent. Many people feel as if they are going to work mainly so they can earn money to pay someone to plow their driveway so they can go to work again.

Of course Connecticut long has managed despite having three terrible months each year. But that is because the state offered advantages offsetting that disadvantage.

On the whole for the last 25 years, since its enactment of an income tax, Connecticut has been losing population relative to the rest of the country, and the other day the Census Bureau reported that the state's population is back in absolute numerical decline as well.

Reflecting recently on state government's continuing budget deficits despite a record tax increase, budget director Ben Barnes said Connecticut has entered "a period of permanent fiscal crisis." His candor could be appreciated but Barnes also was confessing failure -- confessing that state government's policies have not been making Connecticut more prosperous but rather have been impoverishing it.

The excessive snow will make many state residents reconsider their premises for living here. To encourage them to stay put, state government better start reconsidering some of its premises as well.

* * *

Connecticut U.S. Sen. Richard Blumenthal is making much of his sponsorship of legislation aimed at reducing suicides among returned military veterans. The legislation is mainly a matter of requiring the U.S. Department of Veterans Affairs to increase mental-health services and hire more psychiatrists, and since the legislation passed the House and the Senate unanimously, its enactment may not have required as much political courage as the press releases about it imply.

Of course war always has been traumatic, and many returning soldiers always have suffered from a self-destructive depression even when they bore no debilitating physical wounds. Today there is a fancy name for it: post-traumatic stress disorder.

But at least with the country's biggest wars -- the Civil War, World War I and World War II -- veterans had the consolation that their work absolutely had to be done, whether it was preserving the nation and ending slavery or defeating totalitarian aggression that threatened the whole world, as well as the consolation that their fellow citizens profoundly appreciated their sacrifice.

It has been much different with the country's discretionary wars of recent decades, from Vietnam to Iraq to Afghanistan, where U.S. soldiers fought for dubious premises, where the national interest was not at risk enough to seem to require drafting the whole population into the war effort, and where the service of the soldiers was not really appreciated when they got home, because by then the wars they fought -- intervening in other countries' civil wars or trying to civilize barbarian cultures -- were not considered to have been worthwhile, the civil wars having burned themselves out on their own and the barbarians having not been civilized.

Yes, there are so many suicides of recently returned veterans, estimated at an appalling 22 every day, that the Veterans Affairs Department should have the resources to help more. But what the Armed Forces deserve most is not to be squandered on stupid and unnecessary wars -- like the ones in Iraq and Afghanistan that Senator Blumenthal has supported despite their failure to reach their objectives and despite the impossibility that they ever  could reach their objectives, at least not without the all-consuming effort  that elected officials like the senator did not dare to demand from their constituents.

Chris Powell is managing edit0r of the Journal Inquirer, in Manchester, Conn.

Robert Whitcomb: The light gets brighter and cars warmer

  A New England winter’s compensations? I’m so fed up with it now that making this list took strenuous self-hypnosis.

First, of course, there’s the beauty and quiet. For brief stretches, all seems sinless, albeit with intimations of a monochromatic death. Of course, you might also hear cursing as people fight over a parking lot’s sole remaining space amidst six-foot-high piles of dirty snow.

To me, the two best winter pleasures are 1) walking at night, with a soft snow falling straight down in big fat flakes and 2) on a bright still morning right after a snowstorm, with almost blinding sunlight. My fondest memories of this season, which too many persist in calling “character-building,’’ are from living in New Hampshire in the mid and late ‘60s. The sun on the snow was an anti-depressant, especially after drab November.

A crucial aspect to enjoying a snowscape is lack of wind. That’s why you should stay away from our coastal cities, damp and exposed to the gales of offshore storms. Head inland.

Walking down a street in Boston or Providence on a winter’s day with a northwest gale is advanced masochism. I’d rather stroll on the same day in, say, Windsor, Vt. (where J.D. Salinger used to regularly eat in a diner), in the Connecticut Valley. Clean, dry and open, but with the worst of the wind blocked by the hills to the west. Very different from the narrow, clogged and frozen-slush streets of Providence and Boston, which weren’t designed for thousands of cars.

Then there’s late-winter “spring skiing’’. In the sun the air finally seems warm, the corn snow bouncy and soft and the air fragrant with wood smoke from the chimney of the base lodge. After a day on the slopes, a rich languor falls over you.

Another New England winter asset is liquid. The snowpack helps ensure that our region will have plenty of water to get through the year. New Englanders underestimate just what a valuable resource this, and how lacking it is in most of the Sunbelt. Of course, we could do much more with it, especially with hydro-electric power.

Winter also forces innovation. That may be why the Northeast continues to be America’s richest region. Consider the subway systems of Boston and New York. The Great Blizzard of 1888, which paralyzed the Northeast for weeks, helped lead Boston to create America’s first subway system, followed soon by New York. The MBTA mess from the recent blizzards should not obscure that having such a public-transit system has been a huge boon to the New England economy.

Cold winters also reduce the incidence of many diseases. Microbes prefer warmer climates. The healthier states are the colder ones, although we associate cold winters with the flu and colds.

Anyway, about now you notice that car interiors are warming up faster in the stronger sun, you hear the morning music of birds you haven’t heard for months and see that the buds on the trees are swelling as the light lengthens.

Signs of future life and warmth just as you’re getting violent. Still, all in all, this year I’d rather be in Florida about now. Actually, North Carolina would do.

Late winter reminds me of what we used to say on my cross-country running team in high school: “It feels so good when you stop.’’

xxx

In other weather news, we have Wei-Hock Soon, of the Harvard-Smithsonian Center for Astrophysics, another poster boy for the economics of “expert opinion.’’ See http://www.nytimes.com/2015/02/22/us/ties-to-corporate-cash-for-climate-change-researcher-Wei-Hock-Soon.html?hp&action=click&pgtype=Homepage&module=first-column-region&region=top-news&WT.nav=top-news

Mr. Soon preaches that our burning ever-increasing amounts of fossil fuel isn’t the main culprit in global warming. Most scientists disagree with him. But then most scientists haven’t received, as he has, $1.2 million in fossil-fuel industry funds in the last decade without disclosing it in most of his scientific papers. In the same way certain “public-policy think tanks’’ are well compensated to promote positions that support certain industries.

The Times reported that, in correspondence with his corporate funders, he called many of his papers and testimony to Congress “deliverables.’’ A deal is a deal!

Robert Whitcomb (rwhitcomb51@gmail.com), is overseer of this site and a bi-weekly contributor to The Providence Journal, where for more than two decades he had been editorial-page editor,. He's also a former financial editor of the International Herald Tribune, a former Wall Street Journal editor, a Fellow of the Pell Center for International Relations and Public Policy,  and a partner at  Cambridge Management Group (cmg625.com), a national healthcare-sector consultancy. 

Hospital systems should be insurers, too

  Why hospital systems should be insurers too:

http://www.huffingtonpost.com/robert-whitcomb/hospital-systems-should-be-insurers_b_6762824.html

Webcast on Russian and Chinese imperialism

What to do about Russia and Chinese imperialism: https://mail.google.com/mail/u/0/?tab=wm#inbox/14bc8b7552045cd8

Isn't it pretty to think so?

 

"Love in the Universe" (0il/gold leaf on canvas), by the late SELINA TRIEFF,  via Berta Walker Gallery, Provincetown.

West still in Fantasyland over Putin?

  Has the West really comes to grips with the implications of the Russian police state's invasion and dismemberment of a major democracy -- Ukraine?

And would the Western press apply a little skepticism, please, to "polls'' showing an alleged 84 percent approval rating for Vladimir Putin? His regime controls ever more of  the media in his country, and uses propaganda  for domestic consumption with the skill of a  Stalin and a Hitler.

The fact is that we don't really know how popular Putin is. We do know, however, that he is feared. People who oppose him can  end up dead in "accidents.''

38 Studios Memorial Stadium

"Down the Drain (sublimated metal with float backing), copyright BOBBY BAKER PHOTOGRAPHY

The plan to put up a stadium for the Red Sox farm team now known as the Pawtucket Red Sox on redevelopment land in the middle of Providence makes n0 economic sense, except perhaps  for a few insiders.

For a few mostly minimum-wage jobs  from April to October, land that could be used for enterprises that could employ hundreds of well paid people in such fields as bio-tech and even light assembly would be taken out of use. This project is a plaything and ego trip for a  few rich politically connected operators who want to wrap themselves tighter in the macho world of baseball and send much of the bill to taxpayers with much less money than them.

Readers can research just how macro-economically over-rated are stadium projects for rich professional sports teams, even for the Major League teams, let alone Minor League teams such as the soon-to-be-late-lamented PawSox.

Another thing to remember is the remarkable ability 0f businesses to abandon their followers without warning. The entity that would like to call itself the "Rhode Island Red Sox'' could decide to close up shop and move to greener pastures, or just close up shop, period. That would then leave an empty stadium taking up space that could have been taken up by offices, labs or even a small factory where at least some people could continue to work. What would we do with an empty stadium in such a place?

After the strategic use of tax credits, the local (or Floridians six months a year plus a day) could have this stadium built at no cost to themselves, and then rake in some moolah until they bail out.

-- Robert Whitcomb

David Warsh: 'The Putin Show' is scarier than you think

The confrontation with Russia is becoming more alarming. Kathrin Hille, reporting from Moscow for the Financial Times, describes how cellphone operators are offering free ringtones of patriotic war songs, intended to evoke the defense of Moscow in 1941.

"The government-led drive, named Hurray for Victory!, comes as Moscow enters the homestretch in an impassioned and increasingly shrill campaign to commemorate the end of the Second World War.''

Meanwhile, The New York Times, as part of the rollout of its redesigned magazine, commissioned Soviet-born Russian novelist Gary Shteyngart to hole up for seven days at the Four Seasons Hotel on 57^th Street in Manhattan with the main Russian television networks on three screens. In “‘Out of My Mouth Comes Unimpeachable Manly Truth:’ What I learned from watching a week of Russian TV ‘” Shteyngart concludes,

''When you watch the Putin Show, you live in a superpower. You are a rebel in Ukraine bravely leveling the once-state-of-the-art Donetsk airport with Russian-supplied weaponry. You are a Russian-speaking grandmother standing by her destroyed home in Lugansk shouting at the fascist Nazis, much as her mother probably did when the Germans invaded more than 70 years ago. You are a priest sprinkling blessings on a photogenic convoy of Russian humanitarian aid headed for the front line. To suffer and to survive: This must be the meaning of being Russian. It was in the past and will be forever. This is the fantasy being served up each night on Channel 1, on Rossiya 1, on NTV.''

And The Wall Street Journal has an essay by Andrew S. Weiss, vice president for studies at the Carnegie Endowment, an aide in various capacities in the administrations of Presidents George H.W. Bush and Bill Clinton. Weiss writes,

''[T]he Ukraine showdown is even scarier than you think: Mr. Putin is making it up as he goes along….  Almost single-handedly, [he] seems to be dragging much of the West into a New Cold War.  He’s winging it, and when things get difficult, he tends to double down.''

Weiss describes an “extreme personalization of power” following Putin’s return as president, in 2012. As the Ukraine crisis intensified in late 2013 and 2014, Putin narrowed his circle of advisers and placed them on a war-footing, valuing loyalty over worldliness.

Blindsided when events in Kiev spun out of control last February and Ukrainian President Viktor Yanukovych fled to Moscow, Weiss says, Putin had only himself to blame for having backed a leader who simply panicked when the going got tough.”  So, on the “spur-of-the-moment,” Putin annexed Crimea.

''Why on earth would Moscow want to take over a money pit like Crimea at a time of slowing economic growth and plunging oil prices?  On the fly, Kremlin propagandists came up with a mantra that they invoke to this day: the new authorities who replaced Mr. Yanukovych in Kiev were illegitimate because they had staged a coup d’état with Western backing,''

Putin followed his invasion – “the most audacious land-grab since World War II” – with a “sham popular referendum” and formal annexation. Then came more “damn-the-consequences, trial-and-error improvisation” to sow unrest in  southeastern Ukraine: seizures of government buildings by Russian-speaking separatists, led by Russian “facilitators.” And after the situation escalated to outright war, Putin sought a ceasefire, obtained it on advantageous terms, and then violated it with an unexpected surge of fighting around Donetsk and Lugansk.

''Mr. Putin’s highly personalized, profoundly erratic approach to government tmay be even more dangerous than most Western governments are comfortable admitting.  How can the Ukrainians or dogged western leaders such as {German Chancellor Angela} Merkel possibly search for a diplomatic solution if they are dealing with a leader who is making it all up on the fly?  … Kiev doesn’t know what Mr. Putin wants; even Mr. Putin doesn’t know what he wants.''

Notice anything funny about this narrative? Putin is always the impulsive actor, never the one who is acted upon.  He is never reacting to anything that NATO or the Americans do.

There is nothing here about NATO expansion. Nothing about the brief 2008 war with Georgia. Nothing about the continuing controversy about who fired the shots on Kiev’s  Maidan Square, nothing about the phone call by U.S.  Assistant Secretary of State Victoria Nuland, taped by the Russians at the height of the crisis; nothing about the Russian naval base at Sevastopol on the Black Sea.  Nothing about the sanctions imposed on the Russians since the crisis began. Nothing about the Ukrainian army offensives in the southeast. Nothing about the Ukrainian vote to join NATO that may have triggered the January offensive. Nothing to note that all this is happening on Russia’s doorstep.  Is it any wonder Putin is “doubling down”?

The scariest thing of all is that it may be Putin who has been telling the fundamental truth all along:  NATO expansion in Georgia Ukraine is unacceptable to him and Russia is willing to go to war to rule it out. He’s been improvising, all right, but often in response to probes – Ukrainian, European, U.S.  For a fuller argument along these lines, see Gordon Hahn’s illuminating commentary on ''The American Education of Vladimir Putin, ''by Clifford Gaddy and Fiona Hill, which appears in The Atlantic for February.

Meanwhile, a friend, who knows the territory well, writes,

''I think it was Napoleon who said your adversary gets a vote in all battles. Putin is a complex, dangerous, possibly paranoid man. We in the West act in ways consciously or unconsciously that can affect his actions. Could he still be winging it? At times, he could.  I agree with Weiss that Yanukovich surprised, possibly astounded, Putin when he caved. I also think the oil price collapse and ruble meltdown caught him completely unaware. His finance people were not prepared and he fired them. Same for many of his agricultural  folks. Was that winging it or just having to react to tough times? We in the US did not have to fire Bernanke to right the ship in 2009.  There seems to be a purge mentality in Putin that comes from “Soviet man.”

Whoever started it, Putin is now thoroughly buttoned-up in a defensive posture. What’s more dangerous than a Russian bear?  A wounded Russian bear.

.

David Warsh, a long-time economic historian and business columnist, is proprietor of economicprincipals.com.

King of Boston

"Snow White,'' by FEDERICO URIBE, at Adelson Galleries, Boston.

Jim Hightower: Vt. Janitor leaves millions for hospital, library

When you get fed up with all the greed and narcissism that seems to rule our country, a good way to restore your faith in humankind is to reflect on the generosity of people like Ron Read — a philanthropist from Dummerston, Vt.

Read was no splashy, self-celebrating, David Koch-Michael Dell-Richard DeVos type. He’s not the kind of guy whose “altruism” depends on how prominently his name gets displayed on the facilities he endows.

In fact, no one in Dummerston had a clue that Ronald James Read was a man of wealth, much less a benefactor, until he died at age 92.

Known around town as Ron, he was a quiet, hard-working, and well-liked fellow who spent 25 years as a gas- station employee, then 17 more as a janitor at the local JCPenney store.

He drove a second-hand cars,  gathered downed limbs for firewood, held his well-worn coat together with safety pins, and hated seeing anything go to waste.

Some knew that Read enjoyed collecting stamps, and that he often checked out books from the local library. It was only after his death, however, that the town learned about another little hobby he enjoyed: picking stocks and making small investments.

Turns out, he was very, very good at it.

This February, local folks were astonished and delighted to learn that their modest neighbor had bequeathed $1.2 million to their library — the largest gift in its 129 years, doubling its endowment. He also gave $4.8 million to Brattleboro Memorial Hospital, the  region's major hospital, the largest bequest it ever received.

He didn’t even wait around for a public thank you, much less demand that he get tax writeoffs and have his name engraved on the library façade. Ron Read was an exemplary philanthropist — a genuine altruist who invested in the future of the common good.

Jim Hightower is a radio commentator, writer and public speaker. He wrote this for otherwords.org.

Get ready for oil/gas drilling off the Northeast?

By JOYCE ROWLEY/ecoRI News contributor

From EcoRi News

When the Bureau of Ocean Energy Management (BOEM) released its notice of intent to scope an environmental review for Atlantic Ocean oil and gas leases in January, it left little room for public comment at meetings. Using an open house-style meeting, BOEM’s Web site states the meetings “will not include a designated session for formal oral testimony.”

But by the third meeting, held Feb. 17 in Wilmington, N.C., 400 people had signed up to speak and 150 protesters convened at the meeting site, opposed to opening up any part of the Atlantic Ocean to the potential impacts of a BP Deepwater Horizon disaster.

The scoping sessions stem from BOEM’s 2017-2022 Outer Continental Shelf Oil and Gas Leasing Draft Proposed Program (DPP), released last month. Five-year plans are prepared under the 1953 Outer Continental Shelf (OCS) Lands Act.

However, this DPP calls for opening up sectors off the Mid-Atlantic  states and off the Southeast  to oil and gas drilling for the first time since 1983, triggering a programmatic environmental impact statement (PEIS) under the National Environmental Policy Act.

Atlantic Ocean OCS leases expired in the mid-1990s, after exploratory wells came up empty. Forty-three exploratory wells were sunk off the Northeast, one off the Mid-Atlantic  states and seven off the Southeast.

BOEM contends those studies are outdated, and against strenuous objections from environmentalists, commercial and recreational fishing industries, state and federal legislators, and tens of thousands of individuals, BOEM approved a PEIS for geotechnical and geophysical (G&G) studies in the Atlantic last summer. BOEM is now working with coastal states and the National Oceanic and Atmospheric Administration (NOAA) to secure permits, including incidental “takes” of marine mammals and endangered species of turtles. Eight G&G contractors haveapplications pending for the work.

Back in the mix Two years after congressional restrictions expired in 2008, the Atlantic OCS planning areas were put into the 2012-2017 plan. A PEIS published in early April 2010 included only the Mid-Atlantic and South Atlantic planning areas. But just as Northeast coastal communities breathed a sigh of relief, BP’s Deepwater Horizon exploratory oil rig exploded, creating the nation’s worst environmental disaster in its history.

In December 2010, the Atlantic planning areas were excluded from the final program plan. Six months later, governors in several Southern states formed the Outer Continental Shelf Governors Coalition, to expand areas for offshore energy development and regional revenue sharing. Virginia Gov. Terry McAuliffe, the former chairman of the Democratic National Party, also joined the coalition in asking for oil and gas drilling in the Mid-Atlantic.

Environmental groups, such as the North Carolina Chapter of the Sierra Club and the South Carolina Conservation League, had been protesting against use of the Atlantic OCS for three years. But U.S. Department of Interior Secretary Sally Jewell has said that it was Governors Coalition’s lobbying for opening the Mid-Atlantic and South Atlantic that convinced her to include these areas in the 2017-2022 DPP.

At the Feb. 20 Governors Association Conference in Washington, D.C., the Outer Continental Shelf Governors Coalition discussed putting legislation through Congress for federal-state sharing of royalties, bonus bids and rents from Atlantic offshore oil and gas development.

In opposition Virginia Congressmen Gerald Connolly, Bobby Scott and Donald Beyer have written Jewell asking her to exclude the Mid-Atlantic from consideration.

“Drilling on the Atlantic Outer Continental Shelf (AOCS) is a source of considerable debate in the Commonwealth. It threatens local economies, ecosystems, natural resources, and poses significant national security concerns,” the congressmen wrote.

The letter went on to say that the action puts at risk 91,000 tourism, recreation and fisheries jobs that represent $5 billion of Virginia’s GDP for “a few days’ worth of national oil and gas supply.”

This month’s public protests are a small segment of a much larger public outcry. Federal and state leaders, environmental NGOs and some 285,000 individuals have written in opposition. Senators Jack Reed, D-R.I., and Sheldon Whitehouse, D-R.I., Elizabeth Warren, D-Mass., and Ed Markey, D-Mass., co-signed a letter in opposition with five other senators.

Rep. David Price, D-N.C.,  wrote a letter co-signed by 36 other members of Congress, which read in part:

“We believe that the circumstances that informed the exclusion of Atlantic planning areas under the existing Five-Year Program remain unchanged. Additionally, significant federal, state, and local resources have been expended in an effort to improve the health of Atlantic fisheries, protect endangered and threatened species that rely on the Atlantic Ocean and coast, and ensure the continued economic vitality of coastal areas through recreation and tourism. We believe that allowing oil and gas development in the Atlantic would be inconsistent with and contrary to these ongoing efforts.”

Upon release of the 2017-2022 DPP last month, Markey, with senators Cory Booker, D-N.J., Robert Menendez, D-N.J., and Ben Cardin, D-Md., held a press conference seeking administrative withdrawal of the Atlantic planning areas.

Areas can be excluded one of three ways: by presidential administrative withdrawal, as has happened with the North Aleutian planning area in Alaska; by a congressional moratoria, which protected the East Coast from consideration until 2008 and now protects the Eastern Gulf of Mexico; or by the secretary of the interior.

Markey has noted that the existing 2012-2017 DPP utilizes 75 percent of all U.S. oil and gas reserves currently available, yet less than a quarter of all leases are actively developed. Addition of the Atlantic Ocean planning areas proposed would only increase accessible reserves by 5 percent, according to Markey.

Citing a recent Oceana economic analysis comparing offshore drilling and wind energy, Markey said:

“Offshore oil spills don’t respect state boundaries. A spill off the coast of North Carolina could affect Massachusetts. We saw what happened after the BP spill. My state’s fishing and tourism industry can’t afford that kind of tragedy.”

Noting there has never been a tragic wind-energy spill, Markey went on to say that Congress has yet to enact key drilling safety reforms, such as raising the liability cap for an offshore spill and increasing the civil penalties that can be levied against oil companies that violate the law.

Currently, the liability limit is set at $73 million for damages caused by an offshore oil spill.

The latest cost estimate for the BP spill is $46 billion in clean-up efforts and damages. In 2012, BP pled guilty to 11 felony charges in the deaths of 11 workers killed in the explosion and paid $4 billion. Last September, BP appealed a federal court ruling that 4.2 million barrels were spilled, claiming a much lower 2.5 million barrels flowed from its damaged well. The court may award damages of up to $4,300 per barrel under the federal Clean Water Act.

The most recent incident data available for the Gulf of Mexico indicates there have been 22 loss-of-well-control incidents, 461 fires/explosions, 989 injuries and 11 fatalities between 2011-2014. There were three major spills in 2011 and eight in 2012.

Public comment The last two Atlantic region meetings on the environmental scoping document are scheduled to be held March 9 in Annapolis, Md., and March 11 in Charleston, S.C.

There are two separate documents in progress — the 2017-2022 DPP and the scoping for the PEIS. Comments submitted to one will not be automatically included with the other. Comments will be accepted until March 30.

For the 2017-2022 DPP, submit online or in writing to Ms. Kelly Hammerle, Five-Year Program Manager, BOEM (HM–3120), 381 Elden St., Herndon, VA 20170.

To comment on the scope of the PEIS, submit online or mail in an envelope labeled ‘‘Scoping Comments for the 2017–2022 Proposed Oil and Gas Leasing Program Programmatic EIS’’ to Mr. Geoffrey L. Wikel, Acting Chief, Division of Environmental Assessment, Office of Environmental Program (HM 3107), Bureau of Ocean Energy Management, 381 Elden St., Herndon, VA 20170–4817.

Portions of this article used reporting by the Wilmington (N.C.) Star and The Myrtle Beach (S.C.) Sun News.