wallstreetjournaleurope_20170111_The_Wall_Street_Journal___Europe

(Steven Felgate) #1

THE WALL STREET JOURNAL. Wednesday, January 11, 2017 |A


OPINION


Keep America’s Word Again—and Protect Ukraine


D


oes “making America great
again” include living up to
the country’s commitments
to other nations? Senators should
put that question to Secretary of
State-designate Rex Tillerson at
his confirmation hearing Wednes-
day—especially with regard to
Ukraine, which gave up its nuclear
weapons in the 1990s in exchange
for assurances that the U.S. has
failed to meet.
More than 90% of Ukrainians
voted for independence in a Decem-
ber 1991 referendum; it was the only
former Soviet republic to condition
its independence on a vote of its cit-
izens. Independence would have left
Ukraine with the world’s third-larg-
est nuclear arsenal, but leaders in
Kiev did not wish to be a nuclear-
armed state. The parliamentary dec-
laration of independence, which the
voters approved, included a provi-
sion that Ukraine would be “nuclear
free.” Thus the people of Ukraine
voted for a nuclear-free state.
In several little-known 1992
meetings in Washington, Ukraine
expressed its desire to turn over
its nuclear arsenal to the U.S. But


the State Department took the po-
sition that Ukraine must ship its
weapons to Russia, the last country
Ukraine wanted to arm. Given no
alternative, Ukraine sought secu-
rity guarantees.
Presidents Bill Clinton, Boris
Yeltsin and Leonid Kravchuk signed
the January 1994 U.S.-Russia-
Ukraine Trilateral Statement and
Annex, which set the framework for
protecting Ukraine’s security in ex-
change for its surrendering its arse-
nal. Negotiations continued
throughout that year. Ukraine did
not easily deliver its nuclear weap-
ons to a state it feared would turn
aggressive against it.
In December 1994, Ukraine ac-
ceded to the Nuclear Non-Prolifera-
tion Treaty as a non-nuclear-weapon
state, and the U.S., Russia, Ukraine
and the U.K. signed the Budapest
Memorandum on Security Assur-
ances. The three other signatories
promised to respect the indepen-
dence, sovereignty and existing bor-
ders of Ukraine and to refrain from
threatening or using force or eco-
nomic coercion against Ukraine’s ter-
ritory or political independence.
The assurances were tested in


  1. Yuriy Meshkov, a Russian-


backed official in Crimea, took over
the regional government and
sought to establish independent
Crimean representation in Wash-
ington. Mr. Clinton called Yeltsin
and—citing the Helsinki Final Act,
the United Nations Charter, the

Trilateral Agreement of January
1994 and the Budapest Memoran-
dum—said the takeover in Crimea
could not stand.
Mr. Clinton also sent the U.S. am-
bassador to Kiev, William Miller, to
the Crimean capital of Simferopol
to tell Mr. Meshkov the U.S. would
not recognize his actions, and to
the port city of Sevastopol with the
same message for Adm. Eduard Bal-
tin, commander of Russia’s Black
Sea Fleet. Yeltsin withdrew support
and Mr. Meshkov’s “government”
collapsed. In 1995 Washington kept
its word to Ukraine.

But in 2014 Russia invaded Cri-
mea, which it continues to occupy.
Moscow instigated and has supported
military aggression against Ukraine’s
Donbas region. More than 10,
Ukrainians have been killed and many
more thousands wounded; more than
a million have been displaced. Curi-
ously, Mr. Clinton has not spoken
about the promises of the Budapest
Memorandum. Russia fosters subver-
sive efforts throughout Ukraine and
its propaganda machine misrepre-
sents reality undermining Ukraine’s
sovereignty—the sovereignty the U.S.
promised to protect.
America eventually imposed
sanctions and has provided sup-
plies—nonlethal support—and loan
guarantees, among other assistance.
But the help has been far from suf-
ficient to turn back Russian aggres-
sion. The U.S. has urged but not
participated directly in the Minsk
agreements, an attempt to end Rus-
sia’s war against Ukraine.
But there is no need for Minsk.
The U.S. government should ac-
knowledge Russia’s clear violations
of international law, the Trilateral
Agreement and the Budapest Mem-
orandum and honor its assurance of
Ukraine’s sovereignty.

It has been said the Budapest
Memorandum’s “assurances” are
not “guarantees.” That argument
should be beneath a great nation.
If “assurances” are not “guaran-
tees,” what are they? What was
President Clinton committing to on
behalf of the United States? Was
Ukraine misled? During negotia-
tions the Ukrainian translator,
Walter Sulzysnky, made clear to
the other parties that in Ukrainian
there is no translatable distinction
between “assurance” and “guaran-
tee.” Everyone knew the Ukraini-
ans understood “assurances” as
“guarantees.”
Congress has repeatedly passed
legislation giving the president
authority to be far more support-
ive of Ukraine than the Obama ad-
ministration has been willing to
be. President-elect Trump and
Secretary-designate Tillerson have
an opportunity, and an obligation,
to live up to the U.S. commitments
to Ukraine—to keep America’s
word again.

Mr. McConnell, co-founder of the
U.S.-Ukraine Foundation, served as
assistant attorney general during
the Reagan administration.

By Robert McConnell


Clinton made assurances
when Kiev gave up nukes.
Then Obama broke faith.
Trump can restore it.

PUBLISHED SINCE 1889 BY DOW JONES & COMPANY
Rupert Murdoch
Executive Chairman, News Corp
Gerard Baker
Editor in Chief

Robert Thomson
Chief Executive Officer, News Corp
William Lewis
Chief Executive Officer and Publisher

EDITORIAL AND CORPORATE HEADQUARTERS:
1211 Avenue of the Americas, New York, N.Y., 10036
Telephone 1-800-DOWJONES


DOW JONES MANAGEMENT:
Ashley Huston, Chief Communications Officer;
Paul Meller, Chief Technology Officer;
Mark Musgrave, Chief People Officer;
Edward Roussel, Chief Innovation Officer;
Anna Sedgley, Chief Financial Officer;
Katie Vanneck-Smith, Chief Customer Officer
OPERATING EXECUTIVES:
Jason P. Conti, General Counsel;
Nancy McNeill, Corporate Sales;
Steve Grycuk, Customer Service;
Jonathan Wright, International;
DJ Media Group:
Almar Latour, Publisher; Kenneth Breen,
Commercial; Edwin A. Finn, Jr., Barron’s;
Professional Information Business:
Christopher Lloyd, Head;
Ingrid Verschuren, Deputy Head

Rebecca Blumenstein, Matthew J. Murray
Deputy Editors in Chief
DEPUTY MANAGING EDITORS:
Michael W. Miller, Senior Deputy;
Thorold Barker, Europe; Andrew Dowell, Asia;
Christine Glancey, Operations; Jennifer J. Hicks,
Digital; Neal Lipschutz, Standards;
Alex Martin, News; Ann Podd, Initiatives;
Andrew Regal, Video; Matthew Rose, Enterprise;
Stephen Wisnefski, Professional News;
Jessica Yu, Visuals
Paul A. Gigot, Editor of the Editorial Page;
Daniel Henninger, Deputy Editor, Editorial Page
WALL STREET JOURNAL MANAGEMENT:
Trevor Fellows, Head of Global Sales;
Suzi Watford, Marketing and Circulation;
Joseph B. Vincent, Operations;
Larry L. Hoffman, Production


Siri, Am I About to Have a Heart Attack?


nology for Economic and Clinical
Health, or Hitech, Act. Part of the
2009 stimulus largess, it set aside
some $20 billion worth of incentives
for hospitals and doctors to show
“meaningful use” of electronic
health records, or EHRs.
Tons of data come with medical
records. Then there are digital scales,
Fitbit steps, WellnessFX blood tests,
Apple Watch data and 23andMe ge-
netic test results. Eventually there
will be daily commode sensors mea-
suring blood sugar and prostate-spe-
cific antigen levels, among other
things. Now imagine all that data be-
ing crunched, in real time, by ma-
chines looking for patterns—which
then put out a simple text message.
“Your Hemoglobin A1c has spiked
again. I thought we agreed to cut
back on the linguine.”
Describe this to anyone in health
care and you’ll get two words back:
Dream on. Instead of advancing
electronic health record “interopera-
bility”—a fancy word for being able
to share and access electronic health
records—the Hitech Act ended up as
a funding mechanism for electronic
health-record firms like Epic Sys-
tems, Cerner and Allscripts. By 2016,
the government scheduled $23.8 bil-
lion in payments for firms that
could achieve full electronic access
and true interoperability for the full
calendar year. It was later changed
to a much easier 90-day reporting
period for a subset of patients. Call
it meaningless use, but the money
kept flowing.
If you try to transfer your records
from one hospital to another or to a
doctor, you’ll probably end up “walk-
ing with paper,” as they say in the
industry. The average doctor still
deals with reams of faxes every day.
A friend tried to send records from
a Boston hospital to Miami; both

places use Epic Systems’ electronic
files. The records were faxed.
Epic Systems, a private company
based in Verona, Wis., is the indus-
try leader, controlling close to half
of all American medical records.
Still led by 73-year-old founder
Judy Faulkner, Epic also appears to
be the leading obfuscator when it
comes to transferring records and
interoperability.
In 2015, competitors Cerner,
Allscripts, Athenahealth and others
have set up a group known as Com-
monWell Health Alliance to ensure
health IT interoperability. Epic, with
annual revenues easily north of $
billion, refused to join, citing the
$1.4 million upfront fee and
$900,000 annual payments. Oh, and
Epic didn’t want to sign the nondis-
closure agreement.
My industry sources tell me Epic
won’t sign nondisclosure agreements

with anyone but makes outsiders
agree to them. The company doesn’t
co-develop applications with outside
companies. Third parties don’t have
access to application programming
interfaces, or APIs, which are the
gateway for record data. Hospitals
and doctors can have access, if they
beg hard enough, but then they must
hire inside developers to customize
their system.
The company avoids titles, but
good luck contacting any of its 9,
employees, who are forbidden to
give out their cellphone numbers.
Epic has one phone number to the
main switchboard. It’s still the 1970s
in many ways.
I called it. Eric Helsher, vice pres-
ident of client success at Epic, re-
sponded: “Today 100% of health sys-
tems using Epic are sharing patient
information to better care for pa-
tients. They exchange over 1.3 mil-

lion patient records a day and inter-
operate with all major EHR vendors
and government agencies.”
Epic is talking up something it
calls the App Orchard, a portal for
vendors to sell apps that dig into
Epic’s electronic records. Except
the proposed pricing comes to four
cents per message sent. Machine
learning would drive millions or
billions of messages. The company
might cap fees at 30% of the ven-
dor’s revenue: Even Apple isn’t
that greedy.
I’m trying to get my medical re-
cords from a hospital with Epic sys-
tems. The best I have been able to
do is a PDF file, a modern way of
walking with paper.
How do we fix this? Dr. Eric Topol
at Scripps in San Diego proposes
health records be patient-owned and
controlled, perhaps on a flash drive
or iPhone or in the cloud. Maybe
next to health savings account info.
It’s a start.
But forget government mandates.
The real incentive is insurers paying
for this data, and they are figuring
out that early detection is worth it.
It’s a lot cheaper to find a disease be-
fore it turns into expensive chronic
care for heart disease or cancer. The
machine learning output might be:
“You may have pre-Stage 1 cancer in
your pancreas, but no worries—we
can zap it out for you.”
That’s how you bend the cost
curve in medicine. Make firms like
Epic look at interoperability as an
incremental profit center rather than
an opening for competitors. The
dream of smart machines crunching
health info is real. Don’t let the
dream walk with paper.

Mr. Kessler, a former hedge-fund
manager, is the author of “Eat Peo-
ple” (Portfolio, 2011).

By Andy Kessler


GETTY IMAGES/ISTOCKPHOTO

O


bamaCare was always
about paying for health
care—costs have outpaced
inflation for decades—but
seldom about keeping peo-
ple healthy. As Republicans repeal
and replace, they need a vision for
the path to better care. Technology
now exists to provide cheaper and
higher-quality health care, but giant
roadblocks stand in the way.
That technology is artificial intel-
ligence and machine learning. The
algorithms behind AI are painfully
complex, but the final product is
simple—think Google Translate or


Amazon’s Alexa. Saying a phrase and
immediately having it translated is
cool. Being told that your week of
bad sleep and slight stomach pains
could be cancer is life-altering.
Machine learning is already in-
vading health care. Experts at Kag-
gle, an artificial-intelligence research
firm, shared a few real-world appli-
cations of the technology with me:
Predicting heart failure by looking at
massive amounts of MRI scans, diag-
nosing diabetic retinopathy from eye
imaging, and successfully predicting
seizures with a machine analyzing
electroencephalogram data.
The key is data. With more of it,
accuracy gets better over time. At
least on the surface, the Obama
administration did something
right—the Health Information Tech-


Big data could provide


early warning of disease—


if medical records can


learn to talk to one other.


Meryl Streep Upstages Obama


Back when her hus-
band was president,
Laura Bush found
herself in the thick
of a fashion faux
pas when she ap-
peared at a White
House reception
wearing the same
red Oscar de la
Renta dress three
other women were
wearing. Mrs. Bush handled the situ-
ation the way you would expect her
to handle it: Quietly and without
drama, the first lady went upstairs
and changed into a navy blue dress,
in an effort to spare the other
women embarrassment.
On Tuesday Barack Obama found
himself in the same pickle Mrs.


Bush did back at that 2006 gala.
Only this time the awkwardness
isn’t sartorial but rhetorical: some-
one who’s just delivered the speech
you were planning to give.
Tuesday night in Chicago, Presi-
dent Obama was scheduled to give
his farewell address. But what was
left for him to say after the Trump-
thump Meryl Streep handed down
Sunday night at the Golden Globes?
Ms. Streep was on stage to ac-
cept Hollywood’s Cecil B. DeMille
award for her “outstanding contri-
butions to the world of entertain-
ment.” Say this about her contribu-
tion that night: Would anyone even
be talking about the Golden Globes
today if she hadn’t used the occa-
sion to go after Donald Trump?
The problem for Mr. Obama is

that Ms. Streep managed to step on
many of the themes the president
was expected to hit in his last big
presidential speech, right down to a
snarky reference to foreign birth
certificates. Here are some of the
lines Ms. Streep delivered, followed
by a short interpretation of what
she really means:


  • “All of us in this room really
    belong to the most vilified seg-
    ments in American society right
    now.” Translation: You may think of
    us as rich and powerful and good
    looking, but we are really just vic-
    tims who live in fear.

  • “When the powerful use their
    position to bully others, we all
    lose.” Translation: In case you ha-
    ven’t heard, Donald Trump is a
    lout.

  • “We need the principled press
    to hold power to account, to call
    him on the carpet for every out-
    rage.” Translation: The big problem
    today is that journalists aren’t will-
    ing to criticize Mr. Trump.

  • “You’ll have nothing to watch
    but football and mixed martial arts,
    which are not the arts.” Transla-


tion: This is a warning for all you
deplorable people clinging to guns
and “Monday Night Football.”


  • “Ryan Gosling, like all of the
    nicest people, is Canadian.” Trans-
    lation: Under President Trump, the
    actor who just won a Golden Globe
    for “La La Land” lives in fear his
    home will be raided by the INS and
    he will be deported back to Ontario.


OK, this last one might not
make it into an Obama speech. But
the rest—the preening, the ritual
invocation of victimhood, the belit-
tling of working-class tastes, the
idea that no right-thinking person
might have a different view of this
election—these are all Obama
chestnuts. In Ms. Streep’s case,
Sunday night’s address was natu-
rally followed by a flood of celeb-
rity tweets attesting to how brave

she was to speak this way before
an audience made up almost exclu-
sively of people who think exactly
the same way she does.
Mr. Trump responded to Ms.
Streep as you would expect. He
tweeted, and had three points.
First, that as an actress the three-
time Oscar winner is “over-rated”;
second, that she is a “Hillary
flunky”; and third, that he didn’t
mock a disabled reporter the way
she said he did.
There are arguments for No. 1,
though they are beyond the scope
of this column. With regard to No.
3, the reader can judge the conten-
tion by Team Trump that he’s used
the same arm gestures with others
that he did when he berated a re-
porter with a congenital joint con-
dition for equivocating about a
story he’d written years before.
But it’s hard to argue with Mr.
Trump’s No. 2, much as Ms. Streep
might dispute the word “flunky.”
In July she spoke at the Demo-
cratic convention on behalf of Hil-
lary Clinton. As she would later
tell Variety, “when I went out, I
just felt what I felt. I did my How-
ard Dean scream.”
Now she’s done it again. And it’s
a tough act for President Obama to
follow.
It used to be said of Ginger Rog-
ers that she did everything dance
partner Fred Astaire did—only
backward and in heels. In much the
same way, Ms. Streep has now de-
livered a speech on what the Trump
succession means to all those in-
vested in the Obama legacy—in
barely six minutes, without the aid
of presidential speechwriters and
just two nights before President
Obama delivered his.

Peniel Joseph writing in the
Guardian, Jan. 7:

The Obamas leave the White
House, if not the world stage, hav-
ing accomplished, through sheer
force of will, something entirely un-
precedented in American history:
humanizing the black experience by
simply being themselves.
In the process they normalized
black excellence, codified graceful

resistance to white supremacy and
illustrated the profundity of black
romantic and familial love. And
they looked great doing it. The
Obamas will be missed by mil-
lions—but no one will miss them
more than black Americans. We
found in Obama a president who
justified the faith of generations
who persisted in loving America—
even when the nation refused to
love us back.

Notable & Quotable:TheObamas


Her Trump-thumping
wasahardactforthe
president to follow.

MAIN
STREET

By William
McGurn


To reprint or license content, please contact our reprints and licensing department at +1 800-843-0008 or http://www.djreprints.com

Free download pdf