There has been a great amount of debate about Net Neutrality Vint. Do you think it is important to ongoing Innovation?
Yes, in the sense that it is intended to assure that the limited number of providers of broadband access to the Internet, do not use their control of this pipe to interfere with competing applications that rely on this transport. It is the anti-competitive aspect that is the most critical problem. A lot of smoke and misleading argument has obscured this basic fact.
The issue here is a business issue more than anything else. It is distorted and twisted around and treated as if its a technical problem or ‘just a bunch of geeks who don’t know what they’re doing’, but this is a real, honest business problem; especially in places where there is not much competition to provide broadband service.
When you don’t have a market that’s disciplined by competition, you have the potential for real monopoly or market power abuse. If you’re the only party supplying broadband access to the internet, and if you supply vertical services like video, then you may be persuaded to interfere with someone else’s service in order to take advantage of your control over the underlying pipe.
The situation in Australia largely eliminates that problem because of the way in which you’re investing in the NBN. Here in the United States we have a serious problem because Broadband is not very competitive. We have Telcos, CableCos and maybe you could consider satellite services to be a third possible competitor, but the synchronous satellite delay makes it a lot less attractive.
Increasingly, “e-patients” are using the internet to supplement the care they receive from professionals by connecting with information, and with each other, in ways that were never possible before. Some have found life-saving information online, but others warn that there’s garbage amid the gold. And some doctors don’t like it when patients present information they haven’t seen. Are there lessons from other fields that have similarly faced the democratization of information?
There are several facets to this question. First of all, there’s a lot of misinformation on the internet about healthcare. There are a lot of quacks and people who tried things and think there are correlations. Things like, “I jumped around on my left foot and sacrificed a chicken over my computer, and I got better.” So they conclude that you have to jump around on your left foot and sacrifice a chicken over your computer to get better.
Of course that’s all nonsense. Anyone who goes out on the net looking for healthcare information should be very careful to look for bona-fides and some evidence that the information is valid.
On the other hand doctors are saying that they have more informed patients than they have ever had before because information is more readily available. I sense that people are paying more attention to their health conditions and they’ve learned a lot.
Doctors don’t have a great deal of time to tutor their patients about their problems. So one thing the healthcare system would benefit from is a deliberate provision of good quality information about either a condition, or its treatment, its potential outcomes and possible side effects. Then the population can learn more without chewing up a lot of the doctor’s time.
As far as making a comparison with other vertical segments, none immediately come to mind, except perhaps Climate Change, which as you know is a hugely controversial thing. Perhaps one other would be in the financial services area where people go out on the net looking for advice about investments, specific stocks, or choices about home mortgages and things of that sort. All of that is subject to misinformation and deliberate fraud.
I think the honest answer is, people do get defrauded on the net. People do get involved in things that turn out to be unrealistic – ponzi schemes and whatnot. The only thing I can say is, if you don’t teach people, or at least encourage them to ask questions, or at least do some validation… if they don’t spend some time evaluating the information they’re getting, then they are going to be at risk.
The one thing that I would want to teach kids today about the net is: think critically about what you’re seeing and hearing – don’t accept everything that you see without doing some more homework.
As I’m sure you know, July 1, 2011 marked the 45th anniversary of the implementation of Medicare following President Lyndon Johnson signing the healthcare program on July 30, 1965.
How do you envisage eHealth developing with the advancement of the internet and broadband capabilities?
I have to confess that I had not been driven specifically by the eHealth vector in my work on the internet. But as it became increasingly apparent that the healthcare problem was going to get worse and worse here in the US, in terms of dollars spent per patient/capita I got more and more interested – for the same reasons that you mentioned.
As you probably know, Google has announced that its going to terminate its current efforts in the electronic health record effort. I’m disappointed at that. I think that we had hoped that it would have more traction that it did. Part of the problem is getting people to adopt and use those records – and interoperability and so on.
There is however, a small piece of light. The US CTO, Aneesh Chopra, at least succeeded in getting some agreements on a format for data that could be exchanged by email. As you know the concerns about privacy and health information have been quite intense here in the US. There’s a big, complex system here called HIPAA, (the Health Insurance Portability and Accountability Act), apparently he was able to cope with that and still get an interoperable agreement done.
From my point of view, there is no doubt that having records which are sharable, at least among physicians, would be a huge help. When people go in to be examined, they often have to repeat their medical histories. They don’t get it right every time, they forget stuff. Yet the doctors are not in a great position to service a patient without having good background information. I am very much in favour of getting those kinds of records online.
The second thing I would say is that for chronic conditions, which are generally the worst problems we have in healthcare – whether its heart disease, diabetes, cancer, [obesity] – those chronic conditions cost us more per capita than anything else in the healthcare system. If we were able to harness the electronic healthcare system to provide incentives for people to respond to those problems, to take better care of themselves, then we would reduce a lot of the system costs, simply because we had a more healthy population.
On this point about a healthy population, if you are not collecting data, you can’t know what the state of health of your population is. We have to get better data.
There is a concern about Telcos on the whole, and in the US in particular, having asked for and received huge subsidies along with the removal of regulations and obligations for common carriage. In return, they have promised to provide improved services for everyone, and yet they have consistently failed to do so.
With that in mind, could you comment on Brent Hall’s question: What is the greatest threat to the future of a free and open internet?
I worry about the: “Our business models don’t work anymore. We can’t expect the general public to pay for access to this expensive resource, so we have to find other sources of revenue to pay for the build out, which might mean government handouts,” argument. Or the, “Hey, look at those guys over there at Google and Facebook and Amazon. They’re sending streaming video over our pipes, and they’re not paying for it!”
Of course we are paying for it! We pay commercial services a lot of money to put our servers up on the net. Now they’re saying, “Customers can’t pay!” My reaction to that is: technology should be cheap enough that you can make this available to customers at a reasonable price.
Now, what are we going to do about it? Well, Google is doing something about it. We’re going to fibreize Kansas City. It’s not as big as Australia but it’s our attempt to do the work. We will expose what the problems were, what was easy, what was technically hard and what was fiscally expensive.
And by the way, I haven’t said this to [Senator] Stephen Conroy, but I would find it extraordinary if the Australian Government would be willing to share what the costs turned out to be. The reason for that is, it might encourage others, or at least give us a real datapoint so that if we want to do what you’re doing, we will all – the US and elsewhere – know what we’re getting into.
This could be a dangerous thing. If it turns out that its all a cock-up of some sort, if it costs more than was expected and it doesn’t get done, then nobody is going to want to talk about it. I understand that. But I am increasingly confident that you’re going to pull this off successfully. I sincerely hope you do.
The world over, citizens in their millions are calling for more openness from their respective governments. As part of the Board of advisors of Scientists and Engineers for America, what is your view of the effectiveness and potential of President Obama’s Open Government Initiative and its mandate to create an unprecedented level of openness in Government?
As you probably know, Vivek Kundra who is the CIO at OMB (the Office of Management and Budget) was vigorous in his pursuit of that objective. He got an enormous collection of government databases up and running and made them easily accessible – including budgetary information – which of course is what the OMB is all about.
What he did was to create a tool online, which enabled you to drill-down into the budget. It allowed you to find the actual person who was responsible for spending that ‘piece’ of money in the US budget, which is unprecedented. Nobody had ever done that before.
Coupling that with tools to visualize some of this ‘dry as dust’ information was really eye opening. You began to see historical trends and things you would never see by just leafing through pages and pages of table and figures.
I’m sorry to say that in the crunch of the national debt limits and concerns over entitlements such as healthcare, social security and so on – non-discretionary expenses… in the course of trying to negotiate reductions in spending, they reduced the budget Vivek had for some of his projects.
Whether it was causative or not, I don’t know, but recently Vivek announced that he is going to Harvard to the Berkman Centre. I don’t know who his replacement will be, but whoever it is will have less budget than Vivek originally had for the pursuit of this stuff.
I don’t think the President or any of his senior people are any less enthusiastic about openness and making information transparently available. I think they’re facing a reality of a budget problem that’s going to be hard to fix.
Looking to your past, who most influenced you in high school? I ask this, as I find it amazing that you, Jon Postel (editor of the RFC document series) and Steve Crocker (co-creator of the ARPANET) all went to the same school – was there a particular teacher, or club who inspired you there?
I actually did not meet Jon until we met at UCLA as graduate students. Steve and I were, and are, best friends -we were best men at each other’s weddings and have collaborated in many ways over the course of 5 decades.
I was a direct beneficiary of the emphasis placed on science, mathematics and technology in American high schools in the 1960s. I had teachers who encouraged me in all academic subjects including history, creative writing and literature, not only math, science, physics, chemistry, etc. Steve and I were members of the math club and he was president. The club won city-wide awards in contests and that was very satisfying.
And today, why is Google a good place for an Internet Evangelist and Futurist?
Google is vibrant and alive with ideas, energy and a youthfulness that leads to innovation and Innovation. The leadership is willing to aim at big targets and is willing to allow for failure as long as the targets are ambitious enough. The company has a highly successful business model and a culture of invention and collaboration.
Vint, thank you so much for your time, which I know you extended for me. If there’s ever anything I can do for you, don’t hesitate to let me know!
If you could figure out how to fix the exchange rate between the US dollar and the Australian dollar so I can could buy more Australian wine, I’d really appreciate that!
This interview is reprinted with the permission of Kim Chandler McDonald (all rights reserved).
image credit: dementesx.com
Kim Chandler McDonald is the Co Founder and Executive Vice President of KimmiC. As a Capital I Innovation specialist and futurist, Kim is a thought leader in disruptive approaches and transformational trends such as Flat World Navigation, meHealth and the Semantic Web.