via The Baltimore Sun


Baltimore Inner Harbor from Federal Hill – photo by ktylerconk on Flickr

Frustrated by Maryland’s high rate of health disparities, state leaders are proposing a new attack — one more commonly associated with economic development. Gov. Martin O’Malley’s 2012-2013 budget will include funding to create Health Enterprise Zones, where doctors and community groups in areas with large health disparities, such as Baltimore, could add medical and support services for minorities. Tax credits and other financial incentives would be available to spur interest.

The plan is designed to save lives and healthcare dollars, according to Lt. Gov. Anthony G. Brown, who last summer formed a work group on disparities led by Dr. E. Albert Reece, dean of the University of Maryland School of Medicine.

“Maryland has world-class hospitals, top medical schools and one of the highest rates of primary-care physicians per capita, and yet we continue to see disparities in health care and outcomes among Maryland’s racial and ethnic communities. It’s clear that a lack of access to primary care in many communities is a significant factor driving these disparities,” Brown said, adding that funding is in the governor’s budget proposal, which has yet to be released.

According to state and national data, the disparities are many: In Maryland, the infant mortality rate among blacks is almost three times that for whites, the incidence of new HIV infections among blacks is almost 12 times that of whites, and Hispanics are more than four times as likely not to have health insurance as whites. Moreover, nearly twice as many African-Americans suffer from diabetes as whites, and hospital admission rates were three times higher for blacks with asthma and 41/2 times as high for blacks with hypertension. Treating such illnesses is costly, according to the work group, which cited data showing nearly $230 billion in direct medical costs could have been saved from 2003 to 2006 if there were no racial and ethnic health disparities.

The proposed program would work something like economic enterprise zones, where businesses receive subsidies to create jobs and activity in certain areas. The health zones program would be a pilot, available in two or three geographic areas. New and existing primary-care practitioners could receive loan assistance repayment; income, property or hiring tax credits; and assistance in installing health information and other technology. Subsidies would be capped, likely in the tens of thousands of dollars. Local health departments might get involved in recruiting participants.

Brown said he would push to expand the program statewide if it proves successful in a couple of years — not a given, considering the logistical and cultural complexity of the problems. For example, residents of some neighborhoods don’t have easy access to grocery stores that sell fresh fruit and vegetables, or don’t visit the doctor until there is an emergency. Reece said many groups have tackled disparities, but the work group wanted to focus its attention on chronic diseases responsible for 80 percent of health costs. They drilled down to a few key maladies that often have “ripple” effects. They include diabetes, hypertension and asthma.

“We decided to identify … areas where we thought we could make an effective impact within a reasonable time frame,” he said. The health enterprise zones approach is unique, he believes. Work group members got the idea from a similar program built around children’s needs in the community of Harlem in New York City. Program applicants are likely to come predominantly from rural and urban area where disparities are most pronounced.

In Baltimore, studies show a 20-year gap in life expectancy between upper-income, predominantly white neighborhoods and poorer, predominantly minority neighborhoods. Recently, city health department officials began working with community leaders in 55 neighborhoods to identify the most pressing health needs and develop plans to tackle them. The state’s zones would complement these efforts, Reece said. His work group also proposed other elements to promote health and track outcomes.

The group suggested Health Innovation Prizes with small financial rewards and public recognition for individuals and groups that improve health and well-being in their community. The group also recommended tracking disparity data for programs that already exist for primary care physicians and hospitals. Incentives and penalties assessed through these programs could eventually be linked to disparities.

Reece said the prize and the enterprise zones are two things Maryland can do now to help reduce disparities in a few key geographic and health areas. If legislation to create the zones is passed during the current legislative session, the details will be worked out by the state Department of Health and Mental Hygiene.
Already, Dr. Joshua M. Sharfstein, department secretary, supports the move: “The creation of Health Enterprise Zones will help communities target resources to have the most powerful impact.”

meredith.cohn@baltsun.com

By Motoko Rich
via nytimes.com

Private Sector Gets Job Skills; Public Gets Bill



When companies are deciding where to build new facilities or whether to expand in places where they already have factories or offices, states compete to shower them with incentives like tax breaks and help buying land. Increasingly, companies have come to expect that state and local governments will pay for job training, too.

For Sunday’s paper, I wrote about a $1 million customized training program that North Carolina designed for the benefit of Caterpillar, Inc., the global industrial equipment maker. The company opened a new plant in Winston-Salem in November, and the state is paying to train nearly 400 workers who will make axles for mining trucks.

North Carolina is also spending about $1.5 million to train workers for a new Honda Aircraft plant in Greensboro. About 163 workers went through training at Guilford Technical Community College in various areas including jet assembly and electrical system installation in the hopes of securing a job. Because Honda delayed the opening of its production lines, some of those workers, like Kent McDaniel, featured in this report from the video journalists at Purple States, decided to seek work elsewhere. Others, like Linda Merritt, stuck it out and are now working at Honda.

Coinciding with Veteran’s Day, a number of new initiatives were announced to help put veterans back to work. Here are a few resources for communities with large military operations, as well as veterans returning home.

President Obama has announced a new initiative to support veterans looking to return to the workforce. The Returning Heroes Tax Credit provides firms that hired unemployed veterans with a maximum tax credit of $5,600 per veteran. The Wounded Warriors Tax Credit offers firms that hire veterans with service-connected disabilities a maximum credit of $9,600.

Indeed.com and Google also launched products aimed at supporting the veteran community this month. At military.indeed.com, veterans can now enter their Military Occupational Code (MOC) to search for civilian jobs on Indeed that match their skills and experience. In a similar spirit, Google launched a Veterans Job Bank in partnership with the Department of Veterans Affairs.



These initiatives are timely in light of the Bureau of Labor Statistics report that put the unemployment rate for veterans who served in the military at any time since September 2001 (known as Gulf War-era II veterans) at 11.5% in 2010 (as compared to 8.7% for all veterans and 9.4% for nonveterans). Additionally, about 25% of Gulf War-era II veterans reported having a service-connected disability, compared with 13 percent for all veterans.

In a recent National Public Radio (NPR) report veterans describe a job market that presents some unique challenges. These challenges include a generation of managers who are less likely to have direct military experience (and therefore less likely to fully comprehend the range of skills veterans bring to the job) and the fact that some military qualifications do not automatically transfer to the private sector. However, David Loughran, senior economist at the Rand Corporation, goes on to describe how veterans actually have an employment advantage over the long run, including lower unemployment levels than civilians (8.7% vs 9.4%).

via The Heritage Foundation
China’s investment overseas is increasingly important to the United States and the international community. The China Global Investment Tracker created by The Heritage Foundation is the only publicly available, comprehensive dataset of large Chinese investments and contracts worldwide beyond Treasury bonds. Details are available on well over 400 attempted transactions — failed and successful — over $100 million in all industries, including energy, mining, transportation and banking.

Download the data set here.



Chinese investment and business contracts now span the globe. There is a clear effort to diversify across countries and regions but the Western Hemisphere has become especially prominent.

China’s investment total could be higher. Over $160 billion in proposed spending has been rejected by foreign or Chinese regulators or has failed due to mistakes by Chinese firms. However, there are also clear signs that Chinese firms are learning to be better investors.

Chinese Outward Investment: More Opportunity Than Danger

Chinese investment is not taking the world by storm financially, nor will it do so in the near future. It does not pose a major threat to the U.S., either in terms of the purchase of American assets or the expansion of Chinese influence around the globe. At home, American policy concerning Chinese investment should be more transparent. Overseas, the best reply to expanding Chinese commercial influence is to expand American commercial influence—for instance, through free trade agreements. These steps will help create more economic opportunities in the U.S., enhance America’s global position, and pose no threat to national security.

Where China Invests, And Why It Matters

The PRC has hundreds of billions of dollars available for investment and a desire to lock up resources; the U.S. has several trillion already invested and a bigger, more multi-dimensional economy. Concerns about increased Chinese investment and business activity should be addressed by expanding American activity, from investment in Ivory Coast to trade with Taiwan.

China’s Investment Overseas in 2010

The dominant feature of Chinese outward investment in 2010 was a rush to South America, particularly Brazil. Overall investment grew only modestly. The energy and power sectors continued to be the most attractive for Chinese enterprises. Troubled or failed investments – a huge problem in 2009 – were much less prominent in 2010. An obvious implication for American policy is to expand trade and investment ties to South America and around the world.

SHELBY CLARK, the founder of a start-up called RelayRides, was honored last week as a rising star in clean technology. But as he took the stage alongside companies creating new kinds of energy, he felt out of place.

RelayRides is a car-sharing start-up. Since when did encouraging people to drive carbon-spewing cars qualify as clean tech?

In Silicon Valley, where venture capital dollars nurture fledgling technology companies, clean tech is getting a makeover. Many investors are shying away from the high risks and costs of creating new forms of energy. Instead, they are doing what they do best — using software to cope with problems, in this case caused by climate change.

RelayRides, which lets car owners rent their vehicles to others, takes cars off the road because people can avoid owning them and the service’s users drive less than other people, Mr. Clark said.

“You can have a major impact on an individual’s carbon footprint by re-creating business models or behaviors without inventing a new energy,” he said.

This strategy has been percolating among some in Silicon Valley for a couple of years. But for many investors, doubts about alternative energy were confirmed last month when Solyndra, which made solar panel arrays and had raised more than $1 billion in venture capital and $528 million in government loans, filed for bankruptcy protection.

“A lot of people see it as a symbol of what they do not like in green investments or government involvement in tech,” said Nathan E. Hultman, director of the environmental policy program at the University of Maryland and a fellow at the Brookings Institution. “If the V.C.’s pull back, then a lot of these companies are going to have to fold, or at least put their plans on hold.

“This is a very familiar stage in the energy industry called the valley of death,” he said.

Green tech investing had been declining even before Solyndra. Venture capitalists invested $891 million in 80 such start-ups in the third quarter, an 11 percent decline from $1 billion in 88 companies in the second quarter, according to the National Venture Capital Association.

Investors, accustomed to financing low-cost Web start-ups, had grown wary of spending the money needed to pay for basic research and build factories to produce energy. Adding to their caution is uncertainty over whether Congress will exact a carbon tax, an increase in natural gas production in the United States and the difficulty of competing with the established energy industry.

But the Solyndra bankruptcy further spooked venture capitalists and particularly the pension funds, endowments and foundations that invest in venture capital, said Mark Heesen, president of the National Venture Capital Association.

Investors, he said, would continue to shift from investing in alternative energy to investing in companies that cope with climate change by, for example, using software to make buildings and cars more efficient.

Venture capitalists are on track to invest $275 million this year in start-ups that make software and other technologies that conserve energy or manage its use, up from $234 million last year and $104 million in 2009.

“Capital-intensive companies that take long cycles to create things, whether they’re solar voltaic cells or giant wind turbines, are not very scalable, so those are really tough businesses to imagine as venture-funded opportunities,” said Bill Maris, managing partner at Google Ventures.

His firm has invested in RelayRides and other start-ups that stretch the definition of clean tech investing. They include the Climate Corporation, for extreme weather insurance; Clean Power Finance, which runs an online marketplace for financing residential solar panels; and Transphorm, which makes tools that reduce power loss when electricity is converted in data centers or industrial motors.

“It’s tech companies that are applying their technology to this industry,” Mr. Maris said. “Those are the kinds of companies we tend to really understand and like.”

At first glance, companies like the Climate Corporation, which insures rural farmers, seem to have nothing to do with either technology or climate change. But David Friedberg, a Google veteran who is the company’s co-founder and chief executive, said its goal was “to help all the world’s business adapt to and understand climate change.”

For farmers, that means analyzing “crazy big data,” Mr. Friedberg said, from weather stations, government data feeds, soil moisture models and Doppler radar images. The Climate Corporation simulates the weather for the next two years and runs a Web site where farmers can enter their location and crop, buy insurance coverage and automatically receive payments for bad weather.

Soybean farmers in the Dakotas were recently paid for delayed planting because of an unusually rainy spring, and wheat farmers in Oklahoma and Texas were covered for a intense drought.

The Climate Corporation this month changed its name from WeatherBill, and Mr. Friedberg said he worried that the connection between his software and climate change was too vague for the new name to make sense.

“We were a little concerned about changing the name for fear of farmers thinking we’re a bunch of hippie Californians,” he said. “But the farmers said, ‘Yeah, it’s the climate that’s totally messing with us. The weather today is not the weather of my pappy or grandpappy.’ ”

FirstFuel Software is another company using computers to cope with climate change. It analyzes a building’s electric use based on data, without visiting the building, and produces an energy-saving plan. It raised $2.4 million from Battery Ventures and Nth Power in September.

Opower, which has raised $66 million from venture firms like Accel and Kleiner Perkins Caufield & Byers, gives electric and gas companies tools to communicate with customers, like text-messaging them midmonth if their electric bill is running particularly high.

Despite the interest in these types of companies, some venture capitalists are still betting on big alternative energy experiments.

Khosla Ventures announced this month that it had raised a $1.05 billion fund, one of the biggest this year. About 60 percent will go into clean tech and the rest into Internet and mobile start-ups.

“We’re not changing strategy,” said Vinod Khosla, the firm’s founder. “We’re sticking to our guns.”

The firm has invested in companies that make engines and biofuels and one that is trying to turn carbon emissions and seawater into cement. Mr. Khosla said he believed that start-ups that built efficiency software did not do enough to address climate change.

“They do the 5 to 10 percent improvements here and there,” Mr. Khosla said. “What we need is the 100 percent or 400 percent improvements.”

The problems brought on by climate change will not be solved without venture capital, he said. But what if Silicon Valley continues to recoil from tackling experiments like creating alternative energies?

“It’s the survival-of-the-species question,” said Eric Wesoff, a senior analyst on energy and venture capital at Greentech Media, a research firm. “If the V.C.’s are not willing to take that risk and the innovation slows, who’s going to fill that gap? Is it going to be China?”

Already, the bulk of the innovation is coming from India, China and Europe, Mr. Heesen said.

“We have been behind,” he said, “and we’re just going to get further and further behind in an area that is one of the few that can actually create jobs in the next 10 years.”

via NYTimes

via NYTimes, By BARRY MEIER and JANET ROBERTS

One afternoon last spring, a little-known congressman from Minnesota made an impassioned plea before a House oversight committee.

Rein in the Food and Drug Administration’s uncertain approval process for new medical devices, urged the Minnesota congressman, Erik Paulsen, or Minnesota and other states stand to lose up to 400,000 jobs because of lost investment in the device industry.

Over the following month, Mr. Paulsen’s campaign committee took in $74,000 from people with a stake in device regulation, much of it from executives affiliated with venture capital funds and their spouses. Now Mr. Paulsen, a two-term Republican, is a sponsor of a bill that would make it easier to bring new medical products to market.

As Congress considers reauthorizing a law that sets the fees for medical device makers, venture capitalists are emerging as a rich and influential ally of device companies eager to remove what they say are regulatory roadblocks in the approval process. The push has alarmed patient advocates and some doctors, who have been calling on the F.D.A. to intensify its oversight of devices, particularly in light of some all-metal artificial hips that are failing prematurely at an unusually high rate.

“They have this unwritten assumption that every new device is innovative,” Dr. Rita Redberg, who is the editor of the Archives of Internal Medicine, said, referring to the venture capital funds. But some devices, she said, “are killing people or causing significant harm.”



People associated with funds that underwrite companies developing new devices and other health products have made more than $3.3 million in political donations to Republicans, Democrats and political action committees over the past five years, according to an analysis of federal contributions by The New York Times.

Though such people donate for many reasons, about 20 percent of the money from the 182 donors identified by The Times went directly to candidates and political action committees supporting a streamlining of F.D.A. policy or other issues of importance to medical products producers. The total contributions from such donors could be much higher; The Times limited its analysis to individuals affiliated with venture capital funds that have joined two lobbying associations.

Investment funds and business groups have also increased their lobbying in Washington and have generated a stream of reports arguing that regulations are crippling innovation and driving away investment.

Simply put, the industry’s champions argue that the F.D.A. suffers from high personnel turnover, an unwieldy bureaucracy and a regimen that forces start-up device companies to run new and costly tests constantly, often duplicating past efforts.

“This is about survival,” said Michael Carusi, a general manager at an investment fund in Palo Alto, Calif., Advanced Technology Ventures, who contributed $1,000 to Mr. Paulsen. “We are deeply concerned about the future.”

Medical devices encompass a wide array of products, such as heart defibrillators, artificial joints and diagnostic equipment.

Lobbying to smooth the approval process has intensified over the last year as Congress prepares to reauthorize the law that requires device producers to pay fees to the F.D.A., fees that are used to pay the agency’s operating costs. Lawmakers have an opportunity to alter the agency’s regulatory procedures for the first time since the law last came up for renewal in 2007.

An industry lobbying group, the National Venture Capital Association, has intensified its focus on device regulation. In 2010, the association, which lobbies on many issues, spent more than $2.5 million, according to data from the nonpartisan Center for Responsive Politics. About $350,000 of that was related to devices, drugs and health care, a figure that is expected to increase to $450,000 this year, said an association spokeswoman, Emily Mendell.

While it is not unusual for businesses to point to regulation as a barrier to economic and job growth, medical device investors have found a particularly receptive audience on Capitol Hill in recent months. In October alone, 10 bills have been introduced by Republicans in the House to speed up the F.D.A. device approval process; in the Senate, similar legislation has been introduced by Amy Klobuchar, a Democrat of Minnesota.

Since February, four House panels have held hearings on the impact of F.D.A. procedures on device approval. At those sessions, 19 of the 26 listed witnesses were investors, entrepreneurs, industry consultants, trade group officials or patients who said that agency delays in approving a device had harmed them or a loved one. The list included no patients injured by a flawed device; one hearing in the Senate had a more varied witness list. Two weeks ago, four Democratic congressmen wrote to their Republican counterparts about the imbalance in the House testimony and suggested the hearings had failed to address potential dangers “if medical devices are not appropriately regulated.”

The letter, signed by Henry A. Waxman of California, Diana DeGette of Colorado, John Dingell of Michigan and Frank Pallone of New Jersey, also urged that hearings be held on the metal hip problem and similar issues.

Venture fund executives like Mr. Carusi and lawmakers like Mr. Paulsen insist that they are equally concerned about safety. However, in their view, a big part of the problem at the F.D.A. is philosophical; top officials, these critics say, have overreacted to recent episodes involving flawed products and become risk-averse. As a result, devices are available first in Europe, they say.

“The key is to strike the right balance,” said Dr. Josh Makower, a device developer and a consultant to New Enterprise Associates, a venture fund in Palo Alto.

F.D.A. officials said they have recently tried to address investors’ concerns by announcing programs to encourage innovation and reduce regulatory burdens. Still, the head of the agency’s device division, Dr. Jeffrey E. Shuren, said that executives like Dr. Makower seemed more interested in politicizing the issue than resolving it through discussion.

“The dialogue has become more political and adversarial,” Dr. Shuren said.

Some medical experts have also questioned recent studies about the negative impact of regulations, calling the reviews flawed in methodology.

William Vodra, a lawyer in Washington who has worked closely with medical device producers, said that investors had legitimate concerns about regulatory speed. That is because the approval of a new device can begin a process in which a start-up company is acquired by a larger manufacturer and early investors profit by cashing out.

But such investors may be less interested in what happens to that device after it reaches the market because they have already moved on, said Mr. Vodra, who served on an Institute of Medicine panel that recently concluded the F.D.A. failed to properly assess the safety and effectiveness of many new devices.

Mr. Paulsen, the Minnesota congressman, did not respond to requests for an interview. But a spokesman, Tom Erickson, said that the lawmaker’s testimony this spring was unrelated to any campaign donations and reflected his long-held view that the F.D.A. was undermining an industry crucial to Minnesota.

“He gave his testimony because he feels these jobs are being threatened by an inconsistent and unpredictable F.D.A.,” Mr. Erickson said. Mr. Paulsen, along with Democrats and Republicans from states that are home to device makers, has also sought to repeal a tax on sales imposed on the industry under the health care overhaul law.

Dr. Makower, the venture fund consultant, has donated $5,000 to Mr. Paulsen, records show.

“I think that he understands this issue,” said Dr. Makower.