The ER is for emergencies — or at least it should be. Nearly everyone agrees on that point. But when it comes to implementing policies to reduce non-urgent use of ERs, opinions quickly diverge.

For the past few years, Washington State has been ground zero for this fight. In 2011, the state's health care authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries “when those visits are not necessary for that place of service.” Because the plan was based on a retrospective determination of what was — or was not — an emergency, the proposal faced strong opposition from a range of health care stakeholders. Ultimately, a compromise was worked out.

This commentary appeared in The Wall Street Journal on May 22, 2013.

The U.S. and EU made opposing choices. Both failed because the private economy wasn't taken into account.

Why is it that in the United States the “stimulus” solution to the economy's ills has performed badly while in Europe the opposite approach, “austerity,” has performed even worse?

The answer is that austerity (defined as substantial reductions in debt-financed government spending) or stimulus (defined as high-levels of debt-financed government spending) will promote growth only in some countries and in some circumstances.

Whether either policy will work depends critically on the responses of the private sector. What is missing from consideration today is whether the private sector's reactions will enhance, retard or reverse either a policy of austerity or of stimulus. In both the European Union and the U.S., policies would have been more effective if efforts had been made to anticipate and mitigate the reasons for adverse responses of private businesses.

This commentary appeared on GlobalSecurity.org on May 21, 2013.

As Daddy Warbucks once observed, “You always have to skin your own skunks.” Perhaps this insight is particularly appropriate if the United States adopts the elimination of chemical weapons as a goal for involvement in Syria.

First of all, neither side of the Syrian conflict has committed to elimination of chemical weapons. If the United States chooses to intervene militarily to stop chemical weapon use, it should recognize from the start that it has limited ability to destroy chemical munitions through strikes even if it has the ability to destroy Syrian forces. Large chemical weapon stocks will survive even a sustained bombing campaign.

This commentary appeared on CNN on May 21, 2013.

The announcement by prosecutors that charges had been filed against suspected cyber thieves believed responsible for stealing $45 million in a matter of hours from ATM's in two dozen countries should send a stark message to governments around the world — banks could be the most vulnerable front in cyber space.

Plenty of people have been warning us these days to worry about cyber attacks, but generally we have been worrying about the wrong things. Most “cyber Armageddon” scenarios focus on gaps in our physical infrastructure and even far-fetched scenarios such as infant incubators in hospitals being turned off. But major swathes of the United States have routinely gone without electricity and water for days following natural disasters. Soon enough, life gradually gets back to normal. Want real chaos? Destroy confidence in the banking system (or even a part of it), and just stand back and watch....

The remainder of this commentary is available at cnn.com.

Contaminated drinking water contributes to the deaths of some 750,000 children under the age of five every year due to diarrheal disease. As a result, there is a pressing need in the developing world for ways to make water safe to drink that are affordable and widely used.

A RAND project, with USAID funding, is using mobile phones to increase the sales and use of safe-water filters in Kenya. The ceramic filters are microbiologically effective and often preferred by users over chemical disinfection (e.g., adding chlorine to water).

This commentary appeared in Financier Worldwide on May 1, 2013.

The corporate boardroom in 2013 is under pressure to change. That pressure is coming from multiple different directions. Basic questions have been raised about the evolving role of boards, at a time when scandal and perceptions of corporate opportunism have resulted in a loss of public trust in the business community. In a related vein, traditional notions of fiduciary duty are increasingly being questioned, both in regard to how effective boards really are in safeguarding equity shareholders, and in regard to whether boards really ought to try to balance a broader set of stakeholder interests. Meanwhile, many of the more specific facets of board responsibility are shifting as well. Compliance, reputation risk, ethical tone, and organisational culture are becoming more salient as concerns for corporate directors, even as they wrestle with how to deal effectively with any of these things. In a related vein, one question that comes up often, in conversations with directors, is what are boards actually supposed to do, in order to better address compliance and reputational risk?

On compliance in particular, there are two interesting trends in play. On one hand, there has been significant legal and regulatory movement over the past few decades, in the direction of placing more responsibility on boards to oversee the compliance function. In part, this has occurred through major appellate court cases like Stone v. Ritter, which have affirmed that board fiduciary duties encompass some responsibility for compliance oversight, and for making sure that the corporation has a meaningful compliance program. It has also occurred through revisions to the Federal Sentencing Guidelines on organisational crime, which provide for more lenient treatment to corporate offenders when related standards for effective compliance programs have been met (e.g., ensuring a direct channel of reporting access between compliance officer and board). Collectively, these policy developments have put pressure on boards to be more engaged in compliance oversight, while also providing a pathway for them to follow in carrying out that oversight.

The western United States will be facing fire season in a few months and the Forest Service is preparing to respond within the budget constraints of sequestration.

The summer fire season is the most taxing time for the Forest Service's fleet of aircraft because of the sheer number of fires that start across the western half of the U.S. There have already been large fires even before the start of this year's wildfire season, such as the Camarillo wildfire near Malibu, CA, that has burned at least 28,000 acres. As part of ongoing efforts to recapitalize their fire-fighting aircraft fleet, the Forest Service recently announced that it would be using six large air tankers and a DC-10. Large air tankers drop between 1,000 and 4,000 gallons of water or fire retardant, but the DC-10 is much larger and is in a class of aircraft known as very large air tankers (or VLATs in Forest Service parlance). VLATs can drop 10,000 gallons or more of water or fire retardant to put out or contain fires.

This commentary appeared in Christian Science Monitor on May 16, 2013.

Fairly or not, Bangladesh seems to make international news only at moments of tragedy.

Much of the misery that afflicts this teeming South Asian nation has been beyond human control. Since 1980, nearly 200,000 people have been killed in natural disasters, and more than 10 million Bangladeshis are affected by such events on average each year. Tropical Storm Mahasen hit coastal areas earlier today, killing 12 people, destroying thousands of homes, and forcing as many as a million people to flee the area....

The remainder of this commentary is available at csmonitor.com.

It's National Transportation Week—do you know why your gas taxes don't go as far as they used to?

Most Americans don't know how much they pay at the pump in taxes. It's not very obvious, since the price per gallon already includes federal, state, and in a few cases local gas taxes. Depending where you live, you pay anywhere from about 26 cents to 50 cents. That's not very much, considering most of us pay $4 per gallon, and in most places it hasn't changed since gas cost half that much.

Gas taxes are a type of user fee—you pay for the amount you use. It's analogous to other utilities—if you use more electricity, or gas, or water, you pay more. So far, so good. The gas tax has been a great system: reasonably inexpensive to implement, easy to understand, and for almost a century it's been a good way to ensure that people who drive more pay their fair share.

This commentary appeared on The Hill's Congress Blog on May 14, 2013.

The use of drones to attack the Taliban in Afghanistan and Pakistan, and al Qaeda there and in Yemen, draws criticism for exacerbating anti-American sentiment. But drone use needs to be seen in broader contexts as the U.S. withdraws from combat in Afghanistan, deals with unrest in the Middle East and Persian Gulf, and grapples with al Qaeda threats to our homeland.

Debate has focused on using drones to assassinate — that is the proper word — those identified as major al Qaeda operatives, their allies or others in Afghanistan, Pakistan, and Yemen. Al Qaeda continues to seek a 9/11-sized attack on the U.S., making it appropriate to target complicit individuals outside the United States for killing or capture. We need to re-examine how to do it, along with the costs and risks.