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The U.S. government spends billions of dollars each year on computer hardware, software and file servers that may no longer be necessary. Currently, the public sector makes relatively little use of cloud computing, even though studies suggest substantial government savings from a migration to more Internet-based computing with shared resources.

On July 21, the Center for Technology Innovation at Brookings hosted a policy forum on steps to enhance public sector adoption of cloud computing innovations. Brookings Vice President Darrell West moderated a panel of experts, including David McClure of the General Services Administration, Dawn Leaf of the National Institute for Standards and Technology, and Katie Ratte of the Federal Trade Commission. West released a paper detailing the policy changes required to improve the efficiency and effectiveness of federal computing.

Audio

• Moving to the Cloud: How the Public Sector Can Leverage the Power of Cloud Computing

Transcript

• Uncorrected Transcript (.pdf)
• Download Dawn Leaf's PowerPoint Presentation (.pdf)
• Download David McClure's PowerPoint Presentation (.pdf)

Event Materials

• 20100721_cloud_computing
• 0721_cloud_computing_leaf
• 0721_cloud_computing_mcclure

As the nation still struggles with high healthcare costs that consume larger and larger portions of patient budgets as well as government coffers, the search for ways to get costs under control continues. Total healthcare spending in the U.S. now represents almost 18 percent of our entire economy. One promising cost-savings approach is called “reference pricing,” where the insurer establishes a price ceiling on selected services (joint replacement, colonoscopy, lab tests, etc.). Often, this price cap is based on the average of the negotiated prices for providers in its network, and anything above the reference price has to be covered by the insured consumer.

A study published in JAMA Internal Medicine by James Robinson and colleagues analyzed grocery store Safeway’s experience with reference pricing for laboratory services such as such as a lipid panel, comprehensive metabolic panel or prostate-specific antigen test. Safeway’s non-union employees were given information on prices at all laboratories through a mobile digital platform and told what Safeway would cover. Patients who chose a lab charging above the payment limit were required to pay the full difference themselves.

Employers see this type of program as a way to incentivize employees to think through the price of services when making healthcare decisions. Employees enjoy savings when they switch to a provider whose negotiated price is below the reference price, whereas if they choose services above it, they are responsible for the additional cost.

Robinson’s results show substantial savings to both Safeway and to its covered employees from reference pricing. Compared to trends in prices paid by insurance enrollees not subject to the caps of reference pricing, costs paid per test went down almost 32 percent, with a total savings over three years of $2.57 million – patients saved $1.05 million in out-of-pocket costs and Safeway saved $1.7 million.

I wrote an accompanying editorial in JAMA Internal Medicine focusing on different types of consumer-driven approaches to obtain lower prices; I argue that approaches that make the job simpler for consumers are likely to be even more successful. There is some work involved for patients to make reference pricing work, and many may have little awareness of price differences across laboratories, especially differences between those in some physicians’ offices, which tend to be more expensive but also more convenient, and in large commercial laboratories. Safeway helped steer their employees with accessible information: they provided employees with a smartphone app to compare lab prices.

But high-deductible plans like Safeway’s that provide extensive price information to consumers often have only limited impact because of the complexity of shopping for each service involved in a course of treatment -- something close to impossible for inpatient care. In addition, high deductibles are typically met for most hospitalizations (which tend to be the very expensive), so those consumers are less incentivized to comparison shop.

Plans that have limited provider networks relieve the consumer of much complexity and steer them towards providers with lower costs. Rather than review extensive price information, the consumer can focus on whether the provider is in the network. Reference pricing is another approach that simplifies—is the price less than the reference price? What was striking about Robinson’s results is that reference pricing for laboratories was employed in a high-deductible plan, showing that the savings achieved—in excess of 30 percent compared to a control—were beyond what the high deductible had accomplished.

While promising, reference pricing cannot be applied to all medical services: it works best for standardized services and where variation in quality is less of a concern. It also can be applied only to services that are “shoppable,” which is only about one-third of privately-insured spending. Even if reference pricing expanded to a number of other medical services, other cost containment approaches, including other network strategies, are needed to successfully contain health spending and lower costs for non-shoppable medical services.

Editor's note: This piece originally appeared in JAMA.

President Obama’s speech at West Point, outlining the way forward on Afghanistan and Pakistan, was followed three days later by two important events underscoring the president’s view that “our security and leadership does not come solely from the strength of our arms.” He conveyed a new smart power view of security that “derives from our people [including] … Peace Corps volunteers who spread hope abroad, and from the men and women in uniform who are part of an unbroken line of sacrifice …”

On December 4, General Anthony Zinni, USMC (Ret.), former commander-in-chief of U.S. Central Command (CENTCOM), addressed an audience celebrating the tenth anniversary of the International Center for Religion and Diplomacy (ICRD). He pointedly noted that hard power alone cannot fight terrorism; economic and social factors of terrorist populations should be addressed. He further noted that empowering faith-based approaches “is a tremendous asset to inform the ways we mediate and find common ground … to figure out what the other side of smart power means.”

Recognizing that educational reform is critical, ICRD to date has empowered about 2,300 Pakistani madrassas administrators and teachers with enhanced pedagogical skills promoting critical thinking among students, along with conflict resolution through interfaith understanding. Evidence of success is mounting as the program fosters local ownership reasserting Islam’s fundamental teachings of peace and historical contributions to the sciences and institutions of higher learning—a rich history that was misappropriated by extremists who took over a significant number of madrassas using rote learning laced with messages of hate.

Earlier the same day, President Obama’s newly minted Peace Corps Director Aaron Williams, himself a former Dominican Republic Peace Corps volunteer, received high marks from former Senator Harris Wofford—a JFK-era architect of the Peace Corps—and hundreds of NGOs and volunteer leaders at the “International Volunteer Day Symposium.”

Director Williams has embraced a new “global service 2.0” style leadership committed to championing Peace Corps volunteers alongside a growing corps of NGO, faith-based, new social media and corporate service initiatives. Wofford, who co-chairs the Building Bridges Coalition team with former White House Freedom Corps Director John Bridgeland, spoke about the present moment as a time to “crack the atom of citizen people power through service.”

The notion of a “smart power surge” through accelerated deployment of people power through international service, interfaith engagement, and citizen diplomacy should be quickly marshaled at a heightened level to augment the commander-in-chief’s hard power projection strategies outlined at West Point. 

According to successive Terror Free Tomorrow polling, such strategies of service and humanitarian engagement by the United States have been achieving sustainable results in reducing support for terrorism following the tsunami and other disasters from Indonesia to Pakistan and Bangladesh. Lawmakers should take note of these findings, along with the evidence-based success of Johnston’s ICRD Madrassas project (which, inexplicably, has not received federal support to date, in spite of its evidence of marked success in giving Pakistani children and religious figures critical tools that are urgently need to be scaled up across the country to wage peace through enlightened madrassas education and interfaith tolerance).

A growing coalition of now over 400 national organizations is amassing a “Service World” platform for 2010. They have taken a page out of the incredibly successful Service Nation platform, which Barack Obama and John McCain both endorsed, creating a “quantum leap” in domestic service through fast track passage of the Kennedy Serve America Act signed into law by the president last spring. Organizers hope to repeat this quantum leap on the international level through a “Sargent Shriver Serve the World Act,” and through private-sector partnerships and administration initiatives adapting social innovation to empower service corps tackling issues like malaria, clean water, education and peace.  

With the ICRD Pakistan success, a rebounding Peace Corps and the Building Bridges Coalition’s rapid growth of cross-cultural solutions being evaluated by Washington University, the pathway to “the other side of smart power” through service, understanding and acceptance, is being vividly opened.

A Brookings Global Views paper further outlines how multilateral collaboration can be leveraged with other nations in this emerging “global force for good.” It is a good time to reflect on all this as we approach the upcoming 50th anniversary of the Peace Corps next year in Ann Arbor, where on October 14, 1960 President John F. Kennedy inspired students to mount a new global service.  

President Obama’s call to global engagement in Cairo in June, which ignited the announcement of Service World later that same morning, now demands a response from every citizen who dares to live up to JFK’s exhortation to “ask not what your country can do for you—ask what you can do for your country,” along with our young men and women preparing for engagement at West Point.  

Volunteerism remains a powerful tool for good around the world. Young people, in particular, are motivated by the prospect of creating real and lasting change, as well as gaining valuable learning experiences that come with volunteering. This energy and optimism among youth can be harnessed and mobilized to help meet challenges facing our world today and accomplish such targets as the United Nations 2030 Sustainable Development Goals (SDGs).

On June 14, young leaders and development agents from leading non-governmental organizations (NGOs), faith-based organizations, corporations, universities, the Peace Corps, and United Nations Volunteers came together at the Brookings Institution to answer the question on how to achieve impacts on the SDGs through international service.

This was also the 10th anniversary gathering of the Building Bridges Coalition—a multi-stakeholder consortium of development volunteers— and included the announcement of a new Service Year Alliance partnership with the coalition to step up international volunteers and village-based volunteering capacity around the world.

Brookings Senior Fellow Homi Kharas, who served as the lead author supporting the high-level panel advising the U.N. secretary-general on the post-2015 development agenda, noted the imperative of engaging community volunteers to scale up effective initiatives, build political awareness, and generate “partnerships with citizens at every level” to achieve the 2030 goals.  

Kharas’ call was echoed in reports on effective grassroots initiatives, including Omnimed’s mobilization of 1,200 village health workers in Uganda’s Mukono district, a dramatic reduction of malaria through Peace Corps efforts with Senegal village volunteers, and Seed Global Health’s partnership to scale up medical doctors and nurses to address critical health professional shortages in the developing world. 

U.N. Youth Envoy Ahmad Alhendawi of Jordan energized young leaders from Atlas Corps, Global Citizen Year, America Solidaria, International Young Leaders Academy, and universities, citing U.N. Security Council Resolution 2250 on youth, peace, and security as “a turning point when it comes to the way we engage with young people globally… to recognize their role for who they are, as peacebuilders, not troublemakers… and equal partners on the ground.”

Service Year Alliance Chair General Stanley McChrystal, former Joint Special Operations commander, acclaimed, “The big idea… of a culture where the expectation [and] habit of service has provided young people an opportunity to do a year of funded, full-time service.” 

Civic Enterprises President John Bridgeland and Brookings Senior Fellow E.J. Dionne, Jr. led a panel with Seed Global Health’s Vanessa Kerry and Atlas Corps’ Scott Beale on policy ideas for the next administration, including offering Global Service Fellowships in United States Agency for International Development (USAID) programs to grow health service corps, student service year loan forgiveness, and technical support through State Department volunteer exchanges. Former Senator Harris Wofford, Building Bridge Coalition’s senior advisor and a founding Peace Corps architect, shared how the coalition’s new “service quantum leap” furthers the original idea announced by President John F. Kennedy, which called for the Peace Corps and the mobilization of one million global volunteers through NGOs, faith-based groups, and universities.

The multi-stakeholder volunteering model was showcased by Richard Dictus, executive coordinator of U.N. Volunteers; Peace Corps Director Carrie Hessler-Radelet; USAID Counselor Susan Reischle; and Diane Melley, IBM vice president for Global Citizenship. Melley highlighted IBM’s 280,000 skills-based employee volunteers who are building community capacity in 130 countries along with Impact 2030—a consortium of 60 companies collaborating with the U.N.—that is “integrating service into overall citizenship activities” while furthering the SDGs.

The faith and millennial leaders who contributed to the coalition’s action plan included Jim Lindsay of Catholic Volunteer Network; Service Year’s Yasmeen Shaheen-McConnell; C. Eduardo Vargas of USAID’s Center for Faith-Based and Community Initiatives; and moderator David Eisner of Repair the World, a former CEO of the Corporation for National and Community Service. Jesuit Volunteer Corps President Tim Shriver, grandson of the Peace Corps’ founding director, addressed working sessions on engaging faith-based volunteers, which, according to research, account for an estimated 44 percent of nearly one million U.S. global volunteers

The key role of colleges and universities in the coalition’s action plan—including  linking service year with student learning, impact research, and gap year service—was  outlined by Dean Alan Solomont of Tisch College at Tufts University; Marlboro College President Kevin Quigley; and U.N. Volunteers researcher Ben Lough of University of Illinois Urbana-Champaign.

These panel discussion directed us towards the final goal of the event, which was a multi-stakeholder action campaign calling for ongoing collaboration and policy support to enhance the collective impact of international service in achieving the 2030 goals.

This resolution, which remains a working document, highlighted five major priorities:

1. Engage service abroad programs to more effectively address the 2030 SDGs by mobilizing 10,000 additional service year and short-term volunteers annually and partnerships that leverage local capacity and volunteers in host communities.
2. Promote a new generation of global leaders through global service fellowships promoting service and study abroad.
3. Expand cross-sectorial participation and partnerships.
4. Engage more volunteers of all ages in service abroad.
5. Study and foster best practices across international service programs, measure community impact, and ensure the highest quality of volunteer safety, well-being, and confidence.

Participants agreed that it’s through these types of efforts that volunteer service could become a common strategy throughout the world for meeting pressing challenges. Moreover, the cooperation of individuals and organizations will be vital in laying a foundation on which governments and civil society can build a more prosperous, healthy, and peaceful world.

Volunteerism remains a powerful tool for good around the world. Young people, in particular, are motivated by the prospect of creating real and lasting change, as well as gaining valuable learning experiences that come with volunteering. This energy and optimism among youth can be harnessed and mobilized to help meet challenges facing our world today and accomplish such targets as the United Nations 2030 Sustainable Development Goals (SDGs).

On June 14, young leaders and development agents from leading non-governmental organizations (NGOs), faith-based organizations, corporations, universities, the Peace Corps, and United Nations Volunteers came together at the Brookings Institution to answer the question on how to achieve impacts on the SDGs through international service.

This was also the 10th anniversary gathering of the Building Bridges Coalition—a multi-stakeholder consortium of development volunteers— and included the announcement of a new Service Year Alliance partnership with the coalition to step up international volunteers and village-based volunteering capacity around the world.

Brookings Senior Fellow Homi Kharas, who served as the lead author supporting the high-level panel advising the U.N. secretary-general on the post-2015 development agenda, noted the imperative of engaging community volunteers to scale up effective initiatives, build political awareness, and generate “partnerships with citizens at every level” to achieve the 2030 goals.  

Kharas’ call was echoed in reports on effective grassroots initiatives, including Omnimed’s mobilization of 1,200 village health workers in Uganda’s Mukono district, a dramatic reduction of malaria through Peace Corps efforts with Senegal village volunteers, and Seed Global Health’s partnership to scale up medical doctors and nurses to address critical health professional shortages in the developing world. 

U.N. Youth Envoy Ahmad Alhendawi of Jordan energized young leaders from Atlas Corps, Global Citizen Year, America Solidaria, International Young Leaders Academy, and universities, citing U.N. Security Council Resolution 2250 on youth, peace, and security as “a turning point when it comes to the way we engage with young people globally… to recognize their role for who they are, as peacebuilders, not troublemakers… and equal partners on the ground.”

Service Year Alliance Chair General Stanley McChrystal, former Joint Special Operations commander, acclaimed, “The big idea… of a culture where the expectation [and] habit of service has provided young people an opportunity to do a year of funded, full-time service.” 

Civic Enterprises President John Bridgeland and Brookings Senior Fellow E.J. Dionne, Jr. led a panel with Seed Global Health’s Vanessa Kerry and Atlas Corps’ Scott Beale on policy ideas for the next administration, including offering Global Service Fellowships in United States Agency for International Development (USAID) programs to grow health service corps, student service year loan forgiveness, and technical support through State Department volunteer exchanges. Former Senator Harris Wofford, Building Bridge Coalition’s senior advisor and a founding Peace Corps architect, shared how the coalition’s new “service quantum leap” furthers the original idea announced by President John F. Kennedy, which called for the Peace Corps and the mobilization of one million global volunteers through NGOs, faith-based groups, and universities.

The multi-stakeholder volunteering model was showcased by Richard Dictus, executive coordinator of U.N. Volunteers; Peace Corps Director Carrie Hessler-Radelet; USAID Counselor Susan Reischle; and Diane Melley, IBM vice president for Global Citizenship. Melley highlighted IBM’s 280,000 skills-based employee volunteers who are building community capacity in 130 countries along with Impact 2030—a consortium of 60 companies collaborating with the U.N.—that is “integrating service into overall citizenship activities” while furthering the SDGs.

The faith and millennial leaders who contributed to the coalition’s action plan included Jim Lindsay of Catholic Volunteer Network; Service Year’s Yasmeen Shaheen-McConnell; C. Eduardo Vargas of USAID’s Center for Faith-Based and Community Initiatives; and moderator David Eisner of Repair the World, a former CEO of the Corporation for National and Community Service. Jesuit Volunteer Corps President Tim Shriver, grandson of the Peace Corps’ founding director, addressed working sessions on engaging faith-based volunteers, which, according to research, account for an estimated 44 percent of nearly one million U.S. global volunteers

The key role of colleges and universities in the coalition’s action plan—including  linking service year with student learning, impact research, and gap year service—was  outlined by Dean Alan Solomont of Tisch College at Tufts University; Marlboro College President Kevin Quigley; and U.N. Volunteers researcher Ben Lough of University of Illinois Urbana-Champaign.

These panel discussion directed us towards the final goal of the event, which was a multi-stakeholder action campaign calling for ongoing collaboration and policy support to enhance the collective impact of international service in achieving the 2030 goals.

This resolution, which remains a working document, highlighted five major priorities:

1. Engage service abroad programs to more effectively address the 2030 SDGs by mobilizing 10,000 additional service year and short-term volunteers annually and partnerships that leverage local capacity and volunteers in host communities.
2. Promote a new generation of global leaders through global service fellowships promoting service and study abroad.
3. Expand cross-sectorial participation and partnerships.
4. Engage more volunteers of all ages in service abroad.
5. Study and foster best practices across international service programs, measure community impact, and ensure the highest quality of volunteer safety, well-being, and confidence.

Participants agreed that it’s through these types of efforts that volunteer service could become a common strategy throughout the world for meeting pressing challenges. Moreover, the cooperation of individuals and organizations will be vital in laying a foundation on which governments and civil society can build a more prosperous, healthy, and peaceful world.

Dark clouds have gathered over Malaysia as a crisis deepens. Two weeks ago, the country witnessed a massive street protest - dubbed Bersih (lit: “clean”) - organized by a network of civil society groups agitating for electoral reform. This was in fact the fourth iteration of the Bersih protests (Bersih also mobilized in 2007, 2011, and 2012), and managed to draw tens of thousands of participants (the exact number varies depending on who you ask). On this occasion, the protest was a culmination of widespread popular indignation at a scandal involving 1MDB, a government-owned strategic investment firm that accrued losses amounting to approximately USD10 billion over a short period of time, and the controversial "donation" of USD700 million funneled to the ruling party through the personal bank accounts of Prime Minister Najib Tun Razak.

All this is taking place against an inauspicious backdrop of sluggish economic growth, the depreciation of the Malaysian currency, and several exposes on the extravagant lifestyle of Najib’s wife, Rosmah Mansor.

How consequential was Bersih?

When Bersih first mobilized in 2007, it managed to harness a flood of dissatisfaction in opposition to the government of Abdullah Badawi, and contributed to major opposition political gains at the general election of 2008. The second and third protests have also been credited as contributing factors to further opposition inroads at the 2013 polls. Assessments of the latest iteration of Bersih however, have been more equivocal. On the one hand, Bersih 4.0 indicated that the movement can still draw huge crowds and give voice to popular discontent, which continues to grow. On the other hand, analysts have called attention in particular to the comparatively weak turnout of ethnic Malays at Bersih 4.0 compared to the previous protests. This is a crucial consideration that merits elaboration if Bersih is to be assessed as an instrument for change.

Given how Malaysian politics continues to set great store by ethnic identity, the support of the Malay majority demographic is integral for any social and political change to take place. By virtue of affirmative action, ethnic Malays are privileged recipients of scholarships and public sector jobs. Therein lies the problem for any social movement agitating for change. Years of conditioning through policy and propaganda have created a heavy reliance on the state, which in essence means UMNO (United Malays National Organisation), the dominant party in the ruling coalition which Prime Minister Najib helms as party president. While it is difficult to say conclusively that this explains the tepid reaction of ethnic Malays during the Bersih protests, it is not far-fetched to hypothesize that at least a contributing factor was the fear among recipients of scholarships and public sector employees that their benefits might be jeopardized (For example, I know that scholarship holders were sent letters "dissuading" them from participating in "political activities.").

Ultimately though, the most telling feature of the event may not have been the dearth of ethnic Malays but the presence of one particular Malay leader – Mahathir Mohamad, Malaysia’s nonagenarian former prime minister and unlikely Bersih participant.

Hitherto a supporter of Prime Minister Najib, Mahathir has grown increasingly unhappy with the prime minister’s policies. According to Mahathir himself, attempts had been made to share his reservations with Najib in private, but they were rebuffed. Goes by this account, it is not surprising that Najib’s alleged snub prompted private reservations to crescendo into harsh public criticism. By the middle of 2014, Mahathir had assumed the role of Malaysia’s conscience to become one of the loudest critics of Najib. Asked to explain his criticisms, Mahathir reportedly responded: “I have no choice but to withdraw my support. This (referring to the act of privately reaching out to Najib) has not been effective so I have to criticize. Many policies, approaches, and actions taken by the government under Najib have destroyed interracial ties, the economy, and the country’s finances.”[1]

Today, it is Mahathir, Malaysia’s longest serving prime minister who was in office from 1981 to 2003, who is leading the charge to discredit Najib and have him removed from office for malfeasance. What explains Mahathir’s singleness of purpose to have Najib removed from power? Part of the answer may lie in Mahathir’s own record of political quarrels.

What lies beneath Mahathir’s attacks?

Mahathir is no stranger to bitter and bloody personal political battles. His interventions in Malaysian politics throughout his career in office are legion (and many Malaysians might also say, legendary). Longtime Malaysia watchers and critics have assailed Mahathir for his autocratic streak evident, for example, in how he emaciated the judiciary by contriving to have supreme court judges (and on one occasion, the Lord President himself) removed from office, incapacitated the institution of the monarchy by pushing legislation that further curtailed the already-limited powers of the constitutional monarch, and suppressed opposition parties and civil society by using internal security legislation against them.

Mahathir was no less ruthless within UMNO, where he brooked no opposition. The history of political contests in UMNO has his fingerprints all over it. In 1969, it was his provocations as a contumacious backbencher that precipitated the resignation of the respected founding prime minister of Malaysia, Tunku Abdul Rahman. In 1987, Mahathir weathered a challenge to his leadership of UMNO mounted by political rivals (the then deputy prime minister, Musa Hitam, and minister for international trade, Razaleigh Hamzah), turned the tables on them, and had them exiled into political wilderness. In 1998, Mahathir successfully fended off the ambitious Anwar Ibrahim by sacking him, and later having him arrested, charged, and eventually convicted for corruption and sodomy. Even when not directly involved, he was never content to be a bystander, choosing instead to either instigate or leverage power plays. In 1978, he played no small part in nudging Sulaiman Palestin to challenge then incumbent Hussein Onn for party presidency (a move that many Malaysian analysts agree signaled the beginning of the end for Hussein’s political career even though he managed to fend off Sulaiman’s challenge). In 1993, Mahathir did little to prop his then deputy, Ghafar Baba, who was crumbling under the challenge of a charismatic Malay nationalist and rising star by the name of Anwar Ibrahim. It was Mahathir's machinations in 2008 that forced Abdullah Badawi, his handpicked successor no less, to resign a year later.

All said, Mahathir had accomplished the signal feat of being involved in some way or other in almost every political crisis that has beset UMNO since 1969. Several observations can be drawn from this record to explain Mahathir’s present behavior. First, Mahathir has long been possessed of a drive to be at the center of power in UMNO and Malaysian politics. Second, he is also in possession of an acute survival instinct that has enabled the über-politician to see off a string of challengers and ensured his political survival at the helm for 22 years. Finally, one can also plausibly surmise that at the core of his recent interventions is the desire – not unlike others who have held any high office for 22 years - to protect his legacy. Therein lie the rub, for it is not difficult to imagine that Mahathir might have deemed his legacy challenged by Anwar in 1998, ignored by Abdullah Badawi in 2008, and now, disregarded by Najib.

Will Najib survive?

A crucial factor that plays in this unfolding drama between two of Malaysia’s political heaveyweights – and which cannot be over-emphasized – is the fact that power in Malaysia ultimately lies in UMNO itself, sclerotic though the party may have become. It is on this score that Najib remains formidable, even for the likes of Mahathir.

Unlike Anwar, who was only a deputy president when he launched his abortive attempt to challenge Mahathir in 1998 (for which he paid a heavy political and personal price), Najib enjoys the advantage of incumbency. Unlike Abdullah Badawi, who chose to remain quiescent when stridently attacked latterly by Mahathir, Najib has used the powers of incumbency adroitly to head off any potential challenge and tighten his grip on the party. He has done so by out-maneuvering pretenders (he removed his deputy prime minister), sidelining opponents, and co-opting potential dissenters into his Cabinet. These divide-and-rule measures closely approximate what Mahathir himself had used to devastating effect when he was in power. For good measure, Najib has lifted a few additional moves from Mahathir’s own playbook: he has neutralized legal institutions, hunted down whistle blowers, brought security agencies to heel, and shut down newspapers and periodicals that have criticized him. Najib’s consolidation of power has been aided by the fact that there is at present no alternative leader within UMNO around whom a sufficiently extensive patronage network has been created. It bears repeating that the arid reality of Malaysian politics is that power still lies within UMNO, so he who controls the party controls Malaysia. On that score, even if Najib’s credibility is eroding in the eyes of the Malaysian populace, within UMNO his position does not appear to have weakened, nor does he seem to be buckling under pressure.

There are no signs that the enmity between the current and former prime ministers of Malaysia will abate anytime soon. Given the stakes, the depths to which ill-will between both parties now run, and how far the boundaries have already been pushed, the rancor is likely to intensify. Mahathir still commands a following especially online where his studied blog musings on www.chedet.cc, a key vehicle for his unrelenting assaults on Najib’s credibility, remain popular grist for the ever-churning Malaysian rumor mill. In response, Najib has defiantly circled the wagons and tightened his grip on levers of power. While Mahathir is unlikely to relent, the reality is that the avenues available to him to ramp up pressure on Najib are disappearing fast. A recent UMNO Supreme Council meeting that was expected to witness a further culling of Najib’s detractors and Mahathir’s sympathizers turned out to be a non-event and an endorsement of the status quo. In the final analysis then, it is difficult to see Mahathir ultimately prevailing over Najib, let alone bend the sitting prime minister and party president to his will.

In July 2013, the World Bank decided to phase-out lending for new coal-fired power plants in middle-income countries, except in rare circumstances where no financially feasible alternatives to coal exist. This decision was made for a combination of reasons including concerns about local air pollution and global climate change, as well as evidence that these projects have little trouble attracting private capital without World Bank involvement. Now, policymakers are considering whether the World Bank’s policy should also cover projects designed to retrofit existing coal-fired power plants in middle-income countries by adding scrubbers and other technologies that increase efficiency and reduce air pollution. 

There are several fundamental questions underlying this debate: Is financing coal power plant retrofits a good use of World Bank resources? If so, should the World Bank insist on the use of best available technologies when it finances these retrofits? These questions are vitally important, as retrofit technologies are designed to minimize toxic air pollutants, including soot and smog, which are both dangerous for human health and the world’s climate. Older coal plants without retrofit technologies are less efficient, and emit more pollutants per unit of coal burned than those with retrofits applied. Evidence shows that soot and smog can cause respiratory illness and asthma, especially in children and elderly people, and can diminish local agricultural production by reducing sunlight. Furthermore, in many countries coal plants are the single largest source of carbon dioxide emissions driving climate change. 

To help inform the policy debate, this analysis surveys the technologies in use in more than 2,000 coal-fired power plants currently in operation, under construction, or planned in middle-income countries. The findings reveal that roughly 70 percent of these power plants rely on old, inefficient technologies. Retrofitting these plants would reduce pollution, increase efficiency and save lives. In middle-income countries that do not mandate coal retrofits, the World Bank could play a helpful role in financing those improvements, particularly as part of broader policy reforms designed to reduce climate pollution and increase efficiency across the power sector.

Importantly, however, the data also show that important qualifications should be made. First, because coal is a major source of greenhouse gas emissions and retrofits are likely to keep coal plants operating longer, the World Bank should insist that retrofit projects occur within a context of national and local policy reforms designed to abate greenhouse gas pollution. Toward this end, the World Bank should continue to help countries build capacity to adopt and enforce climate pollution controls and other offsetting actions and policies. Second, the World Bank should insist that projects it finances use best available pollution control technologies. Already, the substantial majority of coal retrofits completed to date in middle-income countries have used best available technologies. These retrofits were almost universally financed exclusively by private capital. The World Bank should not use its capital to support inferior retrofit technologies that are below the standards already adopted by the private sector in middle-income countries.

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On December 1, the Center on the United States and Europe (CUSE) at Brookings hosted a discussion exploring Russian power throughout history and how two of its most pivotal rulers—Josef Stalin and Vladimir Putin—defined Russian leadership and its role in the world in the 20^th and 21^st centuries. The discussion featured remarks by Stephen Kotkin, professor at Princeton University and author of the authoritative new biography, Stalin Volume I: Paradoxes of Power, 1878-1928 (Penguin Press, 2014).

In his book, Kotkin reveals Stalin as a ruler who is both astute and blinkered, diligent and paranoid, cynical and true-believing, charming and vicious. However, Stalin is more than just an eminent biography; it is a book about Russian power in the world as well as Stalin’s power in Russia, recast as the Soviet Union. Ultimately, Stalin offers an analysis of power—where it comes from, how it is utilized or squandered, and what its human consequences are.

Brookings President Strobe Talbott offered introductory remarks and moderated the discussion.  Prior to assuming the leadership of Brookings, Talbott served in the U.S. State Department as ambassador-at-large for the former Soviet Union and then as deputy secretary.

Audio

• Putin and Russian Power in the World: The Stalin Legacy

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• Uncorrected Transcript (.pdf)

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• 20141201_putin_russia_stalin_transcript

The flight of humans from Syria has been rapid, massive and dynamic. The number of refugees has grown from 26,000 in the first year of the war to almost 4.2 million now, four years later. It is time for bold action from the world to support Turkey and the other countries of the region hosting the vast majority of refugees.

None of Syria’s neighbors – the primary hosts of refugees – expected the displacement to reach such a scale, nor for the crisis to last this long. Many believed in the early days of the Arab Spring that the oppressive regime of Bashar al-Assad would be replaced by a reformist-minded, popularly-elected government - mirroring the transition that had just taken place in Tunisia and Egypt. Instead, Syria became mired in a civil war between an ever-growing number of opposition groups and the regime, whose repression of civilians, regardless of any involvement in the crisis, has forced millions to flee in terror on either side of the country’s borders.

Until recently, the overwhelming majority of the refugees were fleeing the indiscriminate attacks of the Syrian government. More recently, ISIS has been a significant source of terror, while even more recently Russia’s entry into the conflict has triggered another wave of flight.

Today, the refugee populations registered in Lebanon, Jordan and Turkey total more than 4 million souls. Managing the presence of such large numbers of refugees has been costly on host countries economically, socially and politically. What was expected to be a temporary refugee influx has become a protracted crisis. With no signs of a resolution of the conflict in the foreseeable future, the refugees’ hope to return is diminishing.

The massive influx of refugees into Europe, often via extremely costly and life-threatening channels, reflects the despair and harsh living conditions that many refugees feel. Syrians constitute the majority of the 800,000 migrants that have crossed into Europe this year. As the crisis spills beyond Syria’s immediate neighbors, the EU is experiencing major challenges in managing a response. It is clear that attending to refugees is not only a concern of the immediate neighborhood – but that of a much wider region.

In looking at the challenges to Europe, it is important to underscore that neighboring countries have shouldered most of the burden of caring for the refugees, with inadequate assistance from the international community. Resettlement has been extremely limited, and roughly only a third of the pledges to U.N. response plans have been met.

Now is the time to adopt a comprehensive approach that will offer a better future for refugees and their hosts. Attention must be paid to two areas in particular: Education and access to employment. In this regard, it will be critical to move beyond a strategy focused on humanitarian relief to one explicitly structured around sustainable development and empowerment of refugees.

We need a globally-funded Recovery Program for the Middle East that brings about immediate action to mitigate the impact of the crisis on the economies and services of Syria’s neighbors. As part of that, we need to recognize the skills and income that refugees could contribute to the Turkish economy, if they were only allowed to do so. This program could not be carried out by the Turks alone, but would need the engagement of a range of actors – from the U.N. to the World Bank to the private sector and other donors.

Turkey and its neighbors have generously cared for more than 4 million refugees: But as the displacement crisis enters its fifth year, this burden needs to be shared out much more fairly and effectively.

Sadly, despite the desperate need for peace in Syria, we need to respond to the reality that Syrian refugees will not be able to return home for a while yet. As simultaneously the host of the world’s largest Syrian refugee population as well as host to the G-20 Summit, Turkey is in an ideal position to bring this reality to the attention of G-20 member-states – and leverage more resources to assist it and its neighbors to cope with the crisis.

G-20 leaders must commit to sharing Turkey’s burden and place increased emphasis on empowering refugees to shape their own destinies and become productive members of their host societies.

And it must be remembered: The majority of Syrians want to go home. Eventually they want to be able to contribute to rebuilding a stable and democratic nation for themselves and their families. But peace cannot be served while al-Assad drops barrel bombs on his people and ISIS beheads journalists on the steps of Palmyra. Our leaders must focus on a sustainable political solution to this conflict as the end goal of any plan for the region.

This piece was originally published by Hurriyet Daily News.

Choosing a health plan on one of the new public or private exchanges is no easy task. That’s especially true for those with medical conditions who want to be very sure the plan they enroll in will provide the services they need.

This challenge is not unique to buying health plans, however. It’s always hard for consumers to buy complex and technical services or products when they have little or no expertise in the field. Health insurance can be especially daunting, with so many factors to consider, and even the terminology can be confusing.

Standardizing choices and terms can be helpful to a point. Grouping health plans according to premiums and out-of-pocket costs – bronze, silver, gold and platinum plans – has worked well in the public exchanges. But standardization will always be in tension with innovation, and the reality is that most exchanges will carry a larger inventory of plans than what the typical consumer wants to scroll through. So the question of “choice architecture” – how the plans are filtered or screened – will come to the fore. 

Consumers will have many questions.  What is the price? How do I assess the trade-off between lower premiums and higher cost sharing? Is my doctor in the plan’s network? Are the drugs I take in the formulary (whatever that is)? Things can get real complicated real fast, and it can feel like there are too many, not too few, choices. No wonder some call that “choice anxiety”.

But that view overlooks how technology is likely to reduce choice anxiety in health care, just as it has for other complicated searches.  It used to take a librarian to find an obscure article or a travel agent to plan a vacation. Today a few keystrokes on Google locates the article, and Travelocity makes vacation planning a cakewalk, with everything from on-time flight arrival data to pictures of hotel rooms and customer reviews arranged by star ratings.

Expect technology to have the same dramatic impact on buying health coverage in the near future. There are several reasons for this:

The presentation of consumer information will get better. When large new markets for products and services are created and the demand for buyers’ information rises sharply, the incentive for entrepreneurs – both for-profit and nonprofit – to provide customer-friendly information also rises. We’ve already seen this in parts of the health care market where there has been plenty of choice. Millions of federal employees have for many years been able choose among a wide range of plans with differing benefits.  Many have turned to the highly regarded Consumers’ Checkbook to help them understand and readily compare plans in the federal program.

Checkbook has launched a similar comparison tool for the  Illinois exchange and recently won the Robert Wood Johnson Foundation’s (RWJF) first "Plan Choice Challenge," a nationwide competition to design a technology application that helps people choose their best health plan options.

Navigation technology will make searches simple and quick.  Most consumers don’t want to spend a lot of time comparing plans; they want to find the best buy for their situation as quickly as possible.  That’s why brokers have traditionally encouraged employers to offer their employees a carefully limited set of shopping choices, but we expect plan navigation technology to constantly improve the shopping experience in ways that will help customers search a larger inventory and still make choices more easily.   Stride Health, a San Francisco startup and finalist in the RWJF Challenge, has developed a recommendation technology that searches massive data sets on networks and formularies in seconds to help consumers find a “match” that fits their budget and health care needs.  (Full disclosure – author Joel Ario is an investor).  

Stride is one of more than 40 “web brokers” that has met federal consumer protection and privacy standards enabling it to work with the federal exchange to enroll subsidy-eligible individuals in coverage.  Expect increasing collaboration between public exchanges and private vendors, with a surge of apps and gadgets to make navigation easier and easier in health exchanges.

Technology will allow choices to be tailored to medical history.  Advances in technology won’t just make it technically easier to pick and choose by price and reputation. These advances will also empower Americans to base their choices on their likely medical needs. Today, tailoring your coverage to your medical condition usually means trying to get a doctor– or several doctors– to help you figure out what you should look for in a plan. Even with that help, for the average person it’s still a hit-or-miss proposition. But new forms of choice technology are beginning to utilize questions about medical history to guide buyers towards the plans that are most suited to their condition.  

Checkbook and Stride already allow consumers to enter more detailed health histories and get more sophisticated assistance, and this will only improve as exchanges publish more data in machine readable formats.   Expect more and increasingly sophisticated customized navigators, especially as patients get more access to their electronic medical records.  Also expect sellers to respond with products than bundle services to meet the new demand.

Does this mean that an iPhone app will be all that’s needed to ensure that every consumer can find his or her perfect plan? Not quite.  Health insurance marketplaces will continue to present thorny regulatory challenges.  Insurance regulators will need to guard against unfair practices, such as insurers’ designing benefit plans to drive away applicants with certain health conditions; privacy concerns will be raised whenever apps ask for medical history; and new forms of provider integration will test antitrust doctrine.

But one thing is clear. Improving technology will soon make picking the right health plan a far more precise and simple process – easy enough for many of our children to do on their smart phones or whatever gadget comes next.