March 23, 2022

A Post-War Economic Framework for Ukraine- and for Russia

Prior to a mission, the best military planners carefully consider how to eliminate the enemy’s operational capabilities, and ultimately will, without completely devastating the supporting infrastructure. Actions are designed to “incapacitate”; denying critical supply lines and limiting operational mobility, but not “devastate”. Astute planners recognize that that same infrastructure you attack during an early operation today could be needed in the counterattack phases tomorrow. And it will likely be needed in the post-combat stability/rebuilding phases.

This planning process of “incapacitation not devastation” is iterative, dynamic, and at times, gut-wrenching. It requires intensive inter-command and even inter-agency coordination. The operations themselves require surgicalprecision.

The on-going war Russia is conducting in Ukraine, contains no such strategy, demonstrating another not-so-subtle failure by this once-vaunted force. Each day, we witness the blunt-force, indiscriminate destruction of infrastructure and human capital at the hands of brutal and short-sighted Russian forces. But this war is one of not just bombs and bullets, but also of economic strangulation. As a result, the economic infrastructure of Ukraine, like so much of its physical infrastructure, is in shambles. At the personal level, we hear the horror stories of lack of food, heating oil, electricity, transport, and life’s other essentials. At the more aggregate level, Ukraine’s exports of wheat, oil, nickel and neon, (critical to high-tech manufacturing and technology) have ceased. That stoppage is not only a matter of supply-chain failures created by blocked highways and lost seaports; it’s the seizing of the country’s “engine of production”. Soldiers on the fields of battle and families in flight mean that crops are not being grown and oil and other essential raw materials, are not being extracted from Ukraine’s mineral-rich earth: And the whole world is feeling the impact.

One must also consider the protagonist, Russia. The current suite of economic sanctions imposed by the US, the European Union, and the dozens of otherwise non-affiliated nation-states is crippling the Russian economy. Corporate withdrawals have exacerbated their plight. The closure of the Russian stock market and the collapse of the ruble are reaching far beyond the yacht- owning oligarchs. Banks are shuttered: The life-blood of its national economy has been staunched.

While not predicting how this invasion phase will play out, one can be confident that any cessation of kinetic (combat) operations will not bring with it the rapid restoration of either economy. While the damage to Ukraine’s economic infrastructure is obvious, the wounds borne by the Russian state will also be slow to heal. Sanctions are not easily or quickly removed or reversed.

Mr. Putin’s brutal, unwarranted action will likely result in his government experiencing long-term economic isolation and ostracism should he somehow manage to remain in power.

Unfortunately, the economic weapons used in this war, like those used on the field of battle, have produced collateral damage. In our evermore global society, it is the entire modern world that suffers.

If we are to have any hope of mitigating and resolving this multi-faceted catastrophe, world leaders must work now to design a post-conflict framework of commerce for eastern Europe; one that will 1) ease the human suffering, and 2)
deliver the commodities: That plan must be overlaid upon governmental structures, each in their own way struggling to get off their knees.

The scale and complexity of such a plan will rival the famous “Marshall Plan” used to re-establish post-World War II Europe; but it cannot simply be Marshall Version 2.0. Rather, world leaders should be studying and consider crafting something more akin to the multi-national, multi-billion-dollar “Oil for Food (OfF) Programme” installed by the United Nations in the 1990’s as sanctions and export limitations gripped Saddam Hussain’s post-Desert Storm Iraq.

In a nutshell, OfF allowed Iraq to sell its oil under the oversight of the United Nations. Profits from those sales were used to procure the food and other essentials needed by the Iraqi people through a complex contracting process. Those contracts were catalogued and monitored by the United Nations with the actual payments funneled through the Bank of Paris. The process allowed the oil to once again flow onto the world’s markets and the people of Iraq in turn received life’s basics without everything flowing through a corrupt and brutal tyrant.

But while the concept briefed well, reality didn’t always match. What started out as “Oil for Food” quickly became “Oil for Stuff”, with each of the Iraqi Ministries procuring sometimes goods and services of questionable value on the
international market. More importantly, Saddam Hussain and his croniesmanipulated the program into “Oil for Kickbacks” and “Oil for Political Influence” with those countries (many on the UN Security Council) who stood to reap the greatest profits often failing to condemn the brutal actions of that criminal Iraqi regime. The process was somewhat cumbersome, and fraught with manipulation, religious discrimination, influence peddling, and multi-tiered
corruption.

Despite it’s numerous flaws, the “Oil for Food (OfF) Programme” of the 1990’s and early 2000’s does offer an instructive template. Iraqi oil did again flow on the international market and shiploads of food and other essential relief didreach Iraq businesses and its suffering citizens.

I urge those on today’s world stage to conduct a military-style “After Action Review”, assessing what went right and what went wrong in the OfF of that era. Work to plug loopholes, streamline processes, and install incentives and penalties as safe-guards.

Volumes have been written on OfF; perhaps the most comprehensive assessment was written by the award-winning international affairs journalist Claudia Rosett. Listen to the many who experienced the OfF program first-hand at the enterprise, day-to-day operational, and tactical levels.

I stand in awe of my many of heroic multi-national teammates, such as Ambassador Steven Mann, Coordination Center Director, Timothy Wilson, and contract overseer (then Major, now Colonel) Robert von Tersch, who worked tirelessly, and at great personal risk to deliver human essentials while rooting out the cancerous corruption implanted by profiteers at all levels. (I would be remiss if I didn’t also cite, with great pride, the dozens of young Iraqis who put their lives on the line to work the OfF Coordination Center phones and computers.)

As the world considers the devastated post-conflict economies of both Ukraine and Russia, may we learn from our past experiences, and may we tailor and rapidly institute programs that will lead to human relief, economic stabilization, and re-birth.

March 8, 2022

In my recent travels around Central New York and the Southern Tier, many of my friends and neighbors have asked if I am still considering a run for Congress in 2022.   While I appreciate the outpouring of support and encouragement since the word of the exploratory phase and potential campaign became public, I do not believe now is the right time to advance a formal campaign effort. I have made this decision after thoughtful (and prayerful) consultation with my wife Elaine and careful assessment of the political climate with my closest advisors and teammates.

The recent redistricting process has resulted in a dramatically new 19th Congressional District for this region. This new district does not include many of the traditional areas that I have historically called my neighborhood nor does it include many of my current cadre of core supporters. The result is the loss of organizational depth and a reduction in name and policy familiarity among many I would hope to represent. 

Although I will not be running this cycle, I am committed to continuing to advocate for and advance those programs and initiatives that I believe are so fundamental to our HOME region unlocking its full potential.  In addition to the many workforce and economic development initiatives and social wellness programs that are foundational to the “PeteforUPstate” movement, I am fully committed to serving as the mayor of the Village of New Berlin for the duration of my elected term which runs through March of 2023.

I believe we must all focus on Security (both national and local) and the Liberty of unencumbered Opportunities tomorrow.  As I often tell my long-time friends who now reside in neighboring communities, “Yesterday, we rode the bus together to school: Today we must work together to drive this region to the promise of tomorrow.”

February 24, 2022

Our prayers are with the people of Ukraine, but I ask that you include on your “prayer list” the leaders of our country and those of the free (and dare I say, humane and rational) world.  May they demonstrate a clear, common and steely-eyed commitment to peace: May they demonstrate a preparedness and the “will” to share the burden caused by Putin’s totally unwarranted and delusional invasion.  Finally, may they recognize the need for prudent, but forceful application of the four  inter-related instruments of foreign policy: Diplomacy, Intelligence, Military Deterrence and Force, and Economic Actions.

   My prayers are also with the media: That those, no matter where they land on the political spectrum, refrain from simply offering their standard roster of “talking heads” yet another platform from which to score points.  Rather, that they take this opportunity to inform and educate audiences with factual coverage of the gut-wrenching humanitarian and geopolitical crisis that is unfolding as we watch. 

   We are all better informed when we understand the significance of this invasion on the stability of the southern and eastern reaches of Europe radiating out from the Black Sea.  When we recognize Putin’s rationale for what it dis-distorted and delusional; When we can better imagine his desired “end-state” across the region, globally, and domestically.  And ultimately, when we understand the “so-what?” factor; how this unprovoked and brazen invasion impacts those of us thousands of miles away.  Freedom of the press was prominently guaranteed by the First Amendment of our Constitution: Let us all celebrate that freedom, but also demand that our media help us gain such an understanding. 

   Historians are already adding chapters to their books about the 30 year post-Soviet history of Ukraine. They will undoubtedly capture in great depth, the foreign policy mistakes and the regional and global (both political and economic) environment in which those mis-steps and miscalculations were made.

    But now is not the time for our leaders and our media to become mired in a finger-pointing or some second-guessing analysis of the actions of the past; We don’t have the time.

   While we can’t simply press the infamous “RESET” button, we can and we must learn from those missteps and learn them quickly.  And we must act with resolve and in all deliberate haste- While the primary audience for our immediate actions lies within the Kremlin, the rest of the world is also watching and assessing.

January 5, 2022

 Emergency Medical Services (EMS) Challenges in Rural Upstate New York and Rural America

Just before Christmas, Governor Hochul signed legislation creating a 12-person task force to address the challenges of providing responsive, professional life-saving ambulance services to our Upstate residents. 

Three red-flags:  As mayor of the Village of New Berlin,I was alerted to the extent of these challenge by three glaring symptoms. 

   1) Many local communities no longer have their own ambulance service and many of the traditional “mutual aid” agreements between communities have been replaced by contractual agreements.  The disheartening “business decision” to shut down a local service obviously threatens the responsiveness to a medical crisis.  It is also another loss of that “neighbors-helping-neighbors” environment we Upstaters consider part of our Quality of Life.

   2) The few “for profit” organizations that have been able to remain financially viable focus primarily on medical transport (where the reimbursements are guaranteed) to and between health care facilities, and 

    3) County officials have made the issue a priority. Experienced first-responders are aggressively working to develop process and equipment solutions to address a problem that grows more serious every budget year.  In New Berlin, whose EMS squad provides either primary service or mutual aid-type to communities in both Chenango and Otsego Counties, these County-wide plans should be harmonized into a multi-county, regional strategy for equipment sharing, response reduction, and reimbursement. 

Where we are today: The majority of our issues can be linked to two main challenges: Reimbursement for services and staffing.  The reimbursement challenge can be subdivided into two subcomponents; Refused Medical Assistance, known as RMA’s, and reduced Medicare and Medicaid reimbursement rates.

Refused Medical Assistance (RMA): If, after receiving preliminary attention (whether it be lifesaving services, basic medical assistance, or simply a medical stability check), a client is not transported to a medical treatment facility, there is no reimbursement.  EMS billing is based on transport: Hence- No transport; no pay.  Looking at New Berlin’s “call” numbers so far this year, nearly three of every ten calls have been RMA’s.   While thankfully not every client requires follow-on, facility-based medical attention, an RMA call means that personnel, equipment, and perhaps drugs were committed with no reimbursement to the service. 

  It should also be noted that Upstate New York’s RMA numbers have grown dramatically over the last few years due to 1) clients’ reluctance to go to a treatment facility due to increased risk of COVID exposure, and 2) an increase in opioid-related incidents that are treated on-site through the administration of a drug called NARCAN. (It should be noted that NARCAN, while free to trained members of the public, is often not free to municipal EMS services.) 

Expenses and Reimbursement:  Like any other business, EMS managers must consider “overhead”.   “Capital overhead” includes not only the ambulance and on-board gear, but the physical facility and utilities needed to house that equipment.  (For example, New York State regulations require that ambulances be stored in a heated facility.)  Capital overhead also includes temporary housing for on-duty squad members, security lockers, and a communication-intensive call center.

  There’s also “operational overhead” which includes, vehicle maintenance, fuel, specialty training and licensing for the drivers and medical professionals, management of specialty drugs/controlled substances, insurance for squad members, and clerical expenses associated with the many state and federally mandated reporting and billing protocols.  Even without personnel costs, these overhead costs can mean the average rural EMS call costs well in excess of $700.00 

  Obtaining appropriate reimbursement for these costs is not always easy.  New York is one of a number of states that doesn’t consider EMS an “essential service: ”Fire yes; EMS no. Therefore, no funding flows from the federal or state government to local municipalities to help in the operation of their service.

  Further, for those clients who are covered by Medicare or Medicaid, reimbursement rates can be as little as pennies on the dollar.  Planning figures show that reimbursement to the municipality starts at about 80-percent of the original charge and is negotiated down from there. This means that community EMS services are likely to lose money on nearly all Medicare or Medicaid-reimbursed calls:  And with the changing income and age demographics of our rural Upstate population, this group represents a growing percentage of all calls.

Staffing: The second set of challenges is staffing-related. Whether the service has a paid staff or depends on its amazing volunteers, the staffing numbers are dwindling and the demographic profile of those squads is changing. The training mandated to maintain certification continues to climb and the demands on these part-time employees (paid or unpaid) can be very taxing.  The changing rural environment has made it harder for our local volunteers to respond.  Squad members often must leave their primary job-site miles from the EMS facility to mount their “rig” and respond.

   A single call may run for several hours, making it a real challenge for those volunteers with traditional job commitments.  And ,as we all know accidents, fire-related medical emergencies, heart attacks, and drug overdoses don’t just happen during “normal business hours”.  Even many communities with paid services such as New Berlin run only from 7:00 AM to 11:00 PM so the late-night calls, which are often the most complex and time-consuming, fall on the shoulders of local volunteers. If the local municipality or its mutual aid partner can’t “crew a rig”, the response time for the nearest 24-hour service, often from 20-30 miles away, can climb dramatically. 

   And now for a bit of harsh Upstate New York reality- with an aging demographic, many of our most experienced and savvy responders find it harder to handle the physical rigors of service. Simply put, rural Upstate New York is in dire need of more, and frankly, somewhat younger trained EMS members.

Potential Steps Forward:  While New York’s creation of a task force is a significant step forward, these are problems are not limited merely to the Empire State.  We must work together and learn from other regions as we define the root challenges and work to develop a menu of  procedural tools and funding solutions that can be applied at the state and local levels. A few thoughts to get the conversation started:

     1. Consider a hybrid billing structure that includes a flat, per-mile, or per-hour charge for those calls that do not involve transport. 

     2. Establish guidelines that would aid in the designation of EMS as an essential service. Importantly, this designation should not be an open door for federal or state mandates.  Again, one size does not fit all:  Limit the centralized planning and regulation, decentralize the execution down to local municipalities or regions.

     3.  Conduct a thorough review of Medicare and Medicaid EMS reimbursement formulas and practices 

     4.  Incentivize more young people to join the local programs. Explore intern-type programs for high-school aged students.  Explore parental waivers to age mandates- it works in the military.  Collaborate with insurance carriers to develop plans that support incorporating more junior members.  Re-energize “Explorer Scout” type programs and consider a model like the Civil Air Patrol where young teens gain exposure to an exciting field and experience the reward of giving back to their community.

 Today’s challenges are serious, but they are not insurmountable. They require coherent planning, persistence, and most of all, collaboration and harmonization at the federal, state and local/regional levels.   Quality Emergency Medical Service is one of the cornerstones to a quality health care- and for rural Upstate and for rural America, the siren is sounding.