Endless Knots

Medicare explained: Your monthly premium will be $0

Want to drive yourself completely mad? Help someone subscribe to the confusing insurance that supplements Medicare.

I don't mean supplements unless we're talking about Medicare Supplements which is different from Medicare Advantage plans, which may or may not be the official name of them, no, sorry, it is the name of some of them, which probably are Medigap plans that address the Medicare doughnut, which is not something you eat because if you're paying for it you don't have any money to buy food unless you never go to the doctor which you most likely would not be able to do because any doctor you've ever gone to or possibly heard of doesn't take whatever plan you're on, which is OK because you wouldn't be going for your annual physical anyway since Medicare doesn't pay for that, a nod, I would venture, to its illogic that prevention is not that profitable so why bother with that so having learned all of this through approximately three weeks on the phone during which time you contracted, suffered from, and recovered from at least the seasonal flu and perhaps swine, which you can't be vaccinated against due to the fact that you're not in a high risk group even though you got it, you call everyone else you know who had to sign up for insurance that lives in the neighborhood of Medicare whereupon you learn that, to a person, they impulsively signed up for something rather than jump out the window which would be unfortunate since your daily co-pays are so high that you'll lose your house if you even drive near the hospital, at which point you call your relative's primary care provider's office for the thirty-fourth time to discover that the doctor whom the insurance company just told you was covered by the plan is not covered by that plan ("it's a mistake on their site and we can't get them to fix it"), whereupon you scream ohmygodcanyoupleasejusttellmewhattosignhimupfor and the primary care's insurance expert, having run into this a time or two before, pulls the standard answer out of the pile, which is that there is only one plan that the office has a contract with and even though you've never heard of the plan and are slightly suspicious because when you look it up on their site you see that the monthly premium is $0 and think naturally it must be a total typo, leading to seven more hours on the phone wherein you make the insurance company representative swear in court that the premium is $0 (don't ask, Medicare just pays them a lump sum so they don't need to charge you, the consumer), which seems completely like a total lie and certainly has been designed to catch you out on your first claim, well, you're so exhausted by this point, not to mention your poor relative who's very good at abstract systems thinking and, shall we say, less inclined to tolerate this kind of thing, but who because he unlike you can read manuals actually reads the whole 3000-page document the government sends out, which means he knows a gap from a doughnut and you just say, ok, sign him up and if you never hear from me again it's because I have, as you can see, gone completely bonkers.

It's not covered.

The senior senator from Massachusetts

Once, at a memorial service for Irving, a shirt-tail relative whom I was quite fond of but in all honesty wasn't terribly close to nor had great contact with over the years, I became unreasonably upset.

Embarrassed, I said something to my cousin, who had been quite close to Irving (he was actually her uncle, not mine). "When someone dies, everyone you've ever known who's died dies again," she said, which immediately made me feel better.

Perhaps this helps explain how many are experiencing Senator Kennedy's death and why so many have made the trek to the Kennedy Library in the past 24 hours to honor him. Reliving other deaths aside, he was our senator (yes, I'm from Massachusetts), has been my senator for as long as I've lived here, and present enough that I can remember going to a meeting with him at the local junior high school about, guess what, healthcare as many as 17 years ago. Occasionally, I thought I saw him driving past my house on the way to the private school up the street that one of his sons attended (and which he did as well).

I've already told my favorite story about him here. Please see "Oh, hi, Ted" for a small peak at who the man really was in a unguarded moment.

And with his passing, may the search for the cure for brain cancer be amped up. It took the life of my best friend's husband in the same time that it did "Ted's."

Congratulations, Mr. Ambassador

Perhaps your world is different but for me it's not all that often someone I've known for nearly all my adult life is named U.S. Ambassador to Italy. Such is the case with David Thorne, to us, half of "Rose and David," whose confirmation is titled this way in Glen Johnson's piece in today's Boston Globe: "Newly named ambassador to Italy has longtime ties to Kerry."

Much deserved. David's been a backroom force in Democratic politics for a very long time. Speaks fluent Italian; lived there; very smart; acquired and edited New Age Journal back in the day; and, yes, very close to Senator John Kerry, as per all the details in the article. But when I read a piece like this one, I see a different person from the David we've known. Not that everything isn't true; it is. When I think of David, I see someone with a very warm smile, who always asks a question about how you are, who always gives a kiss and a hug, and who's always on his way somewhere.

Through Rose and David, we met the friends who've been among our very closest for 30 years, the parents of our godson...and for that alone we'll always love them. Congrats, for sure, David. And, as I said to Rose when we first heard the news, I'm thrilled that her calm and contemplative energy will now be settled on the European continent. Have a blast, you guys. And, David, we're, of course, expecting you to now truly bring about world peace.

"Voluntary Simplicity" and "The Living Universe"

By Jeff Stamps, guest blogger for Endless Knots

This is Sunday morning, a time when people in my culture are used to receiving or giving sermons on the greater meaning of life and the practical applicability of the Golden Rule ("do unto others.."). Today's modest effort has been stimulated by a recent book, The Living Universe, by an old friend, Duane Elgin, whose 1981 book, Voluntary Simplicity, still resonates almost 30 years after its publication.

Our first book came out at about the same time as Duane's. In Networking: The First Report and Directory (see our books), Jessica and I recognized networks as a new form of organization in the grassroots movements of the 1970s. In the "report" part of the book, we chronicled the emergence of groups that were to become the centers for today's nonprofit world. So we often crossed paths with Duane and soon became friends.

Duane is a big thinker and a simple liver, and has devoted a lifetime to the notion of human transformation and inspiring positive change. He was a futurist researcher with SRI International in the 1970s, and worked on a number of cutting edge projects including Changing Images of Man, a stunning report with Joseph Campbell, Willis Harmon, and O.W. Markley.

His latest book hinges on a simple question, one you can take a moment to answer yourself before you go on:

Is the universe dead or alive?

Deadness is the prevailing scientific view, a container of inert matter that is the physical layer upon which the miracle of life grows. However, most people answer quickly, intuitively--in a "blink"--that of course the thing-as-a-whole is more alive than dead.

For me, it crystallized another question to pose about human beings, which you might also answer:

Are our organizations dead or alive?

Deadness is the prevailing view. The deadness of inert matter is found in our conventional "machine model" of organizations, particularly Big Ones, and most especially government ones. Many of our friends who promote networks dismiss the physical hierarchy as an antiquated machine relic rather than an evolving human organization that is becoming more networked. Our organizations are our greatest unexploited resource for addressing the confluence of disaster, change, and opportunity that defines our transitional time, so the answer "dead or alive" really matters.

While organizations cannot live without people, they are also different from people, yet still distinctly human--and alive. Two great networks--one social, the other organizational--intersect in the interrelated configuration of jobs, positions, and roles. Together, we get stuff done that as individuals we cannot do alone (see our Working Papers for some deep diving on this theme).

GM was the epitome of the industrial model, the archetype of the impersonal machine organization. 'Nuf said with Chrysler already in bankruptcy and GM headed there shortly.

Our organizations never were machines, but regarding them as such ensures a failure to adapt and learn and grow.

So this is where The Living Universe took me. If you enjoy a mix of religious and scientific views on the how the universe lives and why it matters, you should read Duane's newest book.

Kamensky: "Using czars and commissions to govern"

Encouraging everyone to click right on over to John Kamensky's post, "Using czars and commissions to govern." John, who's a Senior Fellow at the IBM Center for the Business of Government, has been keeping tabs on new thinking in government for a long time.

We first met in 1993 when we were advising Vice President Gore's National Partnership for Reinventing Government, where John served as deputy director.

In the post I'm referencing here, John talks about the use of alternative appointments, such as czars, and organizations, like commissions, to cut through some of the government morass - and shines a little light on (disclosing self-interest) OrgScope and its use to track recovery funds, as per a couple of posts here over the past few days. Thanks, John!

Mapping the recovery - "follow the money" - part 2

Lost in the firestorm over AIG bonuses yesterday was a quiet announcement by Attorney General Eric Holder that laid another solid plank in the government's structure of transparency and accountability. Michael J. Sniffen's AP story, "AG overturns strict Bush-era information disclosure rules," has a cutline summarizing the change underway in Washington: "Agencies urged to release records unless law forbids," i.e. there's an a priori bent toward openness. The AG was way ahead of schedule with this, acting earlier even than the May 21st deadline for policy directives implementing President Obama's Open Government initiative, established by the very first acts of his administration (see "Obama's Midnight Memos).

With the presumption of release of government information, transparency and trust take a big step forward. Which brings us to the second part of "Mapping the Recovery" (see part 1) in our NetAge Reports series. Here, we address the specifics of the data that will be used to provide transparency and accountability for the chunks (block grants) of spending, particularly of the $787 billion passed by Congress in February.

It is especially important that tracking the expenditures be done correctly and that it truly makes responsibility and accountability clear. Renewed public trust rides so heavily on how this money is spent. While AIG's shenanigans show how difficult it can be to engender trust at the recipient end of spending, particularly in the private sector, the government has an opportunity to increase trust in itself, in how it is handling this money, and making sure responsibilities are clear. Done properly, this builds social capital, quite literally, that will make other parts of the multiple critical agendas possible.

Geek (or wonk) warning: this part of the story, below the break, is more than a little geeky (and plenty wonky--a bit of each). We discuss the data that is required for reporting the recovery funds, then what's missing. Specifically, what's missing is the organizational chart of responsibilities--which is not so hard to fix.

We've created a prototype map of the network of relationships called for in OMB's recovery reporting requirements. We illustrate our example with a dummy grant at the end of a real recovery program, which we show in four views: the government agency responsible for the grant, the grant recipient (whom we're inventing in this example) who will be held accountable, the physical location of the grantee, and and the overall purpose of the grant program. You can see the recovery network model live in your browser (wait a moment for the Java to load), and trace the grant along four axis as described below.

-- Jeff Stamps

What’s in the Recovery Picture?

Accountability starts with transparency of details. What, exactly, will we know about each block of money? How will we find it, track it, and understand it?

In network lingo, the recovery data model laid out in the OMB memo specifies six nodes, including the grant node. Each node has a unique ID situated in a defined classification system, and it has a line of text that describes it, a memo field, if you will, providing a name or title. The six nodes are:

• Grant block, a chunk of money with its record ID;

• Responsible agency, with a Treasury Account Symbol (TAS) code;
• Program vehicle, identified by a code in the Catalog of Federal Domestic Assistance (CFDA) which provides a wealth of purpose-related categories to sort grants by;
• Agency account, the extension of Treasury’s TAS code;
• Recipient of the funds, identified by a Dun & Bradstreet number (DUNS), which, like the program’s CFDA code, provides entry to an array of associated details and purpose-related classification systems (e.g., sector, industry); and
• Place, the physical location of the recipient, completely defined in the data model by an address with a zip code and a city, county, and state Federal Information Processing Standard (FIPS) code, which enable easy association with political districts benefiting from the funds.

The grant block record laid out in the initial guidance (see Figure 2) means, for example, we can follow a grant to a zip code, which puts this chunk of money in the context of a nested set of legal and political jurisdictions capped by states. Simultaneously, the same record can be represented in a variety of other classification systems, such as one organized by purpose (CFDA, the Catalog of Federal Domestic Assistance) or by a chart of accounts (TAS).

Links between nodes are either contained in the data record for each grant block (e.g., all the levels of address are specified) or are implied by an external classification system (e.g., the program code is part of the CFDA and nestled in tree structures there).

The grant block record laid out in the initial guidance (see Figure 2) means, for example, we can follow a grant to a zip code, which puts this chunk of money in the context of a nested set of legal and political jurisdictions capped by states. Simultaneously, the same record can be represented in a variety of other classification systems, such as one organized by purpose (CFDA, the Catalog of Federal Domestic Assistance) or by a chart of accounts (TAS).

Links between nodes are either contained in the data record for each grant block (e.g., all the levels of address are specified) or are implied by an external classification system (e.g., the program code is part of the CFDA and nestled in tree structures there).

What’s Missing? Responsibility

The OMB model for “following the money” is missing the organization itself, the codes that place the grant within a chart of responsibilities.

There are two pieces of data missing.

• First is the position responsible for each grant; and

• Second, where appropriate, the name of the person serving in the authorizing position.

Thus, for completeness and transparency on the input side—not just the output side–two more fields (with both a unique ID and a name/title) need adding to the recovery data model (see Figure 3).

Making the Recovery Map

The network logic of responsibility-accountability—a directed link between two nodes—provides a simple way to connect the key elements associated with each chunk of money. To illustrate, we connected four trees into a prototype network map of the recovery spending, including the missing organizational hierarchy. Each chunk, each block grant, shows up in four ways: by granting organization, recipient of the grant, the program and purpose for which it is used, and the recipient location.

As recovery dollars flow, so will the data stream start, and the mapping will be easiest. We have created an OrgScope model to demonstrate what a cross-linked network model might look like using an actual grant program by the NIH for external research facilities and an illustrative grant to a hospital in our city of Newton, MA (see org chart strip in Figure 1 in part 1).

• For the organizational side, we used our network map of the top levels of the US Government (click to see this map live). To the existing org chart, which included NIH, we added the string of positions ending in a specific (dummy) grant block to Newton-Wellesley Hospital;

• Program category and type is modeled with a simplified outline of the Catalog of Federal Domestic Assistance (see CFDA.gov);
• Recipient type is illustrated through general categories of sector and industry; and
• Place is represented by a location map of Massachusetts organized by county (Middlesex), city (Newton), and zip code (02462, Newton Lower Falls).

Relationship chains relating a grant to the four major spokes of the recovery-spending wheel can be seen in the Figure 4 overview and the strings of connection shown in Figure 5 (see the live OrgScope map of these relationships). Of these, three have well-established classification systems (zips, DUNS numbers, CFDA). For the fourth, the government chart of responsibility for the funds, our digital org chart is a start to locating the program within the government structure. However, the government’s map of itself could and should extend to reach at least the program, if not the program officer levels.

It would not be too difficult to create an open government network map. At the top of departments and agencies, a few thousand positions in total are detailed in org charts that can be easily connected together, as we have shown in our publicly available USGov OrgScope map of many of these positions. For the two million or so civil service jobs, much of the information needed to assemble them almost automatically into org charts is just sitting there in federal financial systems. OMB may have much of it. The rest is in the many government human resource and information technology systems. Hooking the whole thing together is mostly a one-time expense of time and IT resources, and a process can easily be set up to refresh the basic data.

Transparency of organizational structure enables people both inside and outside the government to understand better the bureaucratic whole. By connecting the many bits of information into a coherent, shareable picture of our common government, we develop trust, hold one another accountable, and think through solutions with many minds.

Figure 5: Illustrative Grant in Four Interrelated Contexts

 

Mapping the recovery - "follow the money" - part 1

AIG. Again. Let us add our voices to the outcry over the bonus scam. Outrageous. Worse than outrageous is the damage it does to the Obama agenda, particularly the still critical moves to come on the economic rescue plan, as Tom Friedman pointed out in a March 18 opinion column in the New York Times.

What to do? On the recipient side of bailout funds, it will always be difficult to get real transparency and build trust. However, on the input side, the government itself, there is a lot that can be done.

But there's something even more disturbing than the AIG bonuses themselves.

It has to do with an aspect of transparency that is getting a bit of short shrift, in our opinion. There's a lack of visibility into the clear responsibility within government for overseeing the use of so many billions, this oversight, so to speak, from no less an authority than President Obama. Jennifer Loven and Martin Crutsinger's AP story reported in today's Boston Globe quotes the president: "Nobody here was responsible for supervising AIG and allowing themselves to put the economy at risk by some of the outrageous behavior that they were engaged in. We are responsible, though. The buck stops with me. And my goal is to make sure that we never put ourselves in this kind of position again."

Responsibility is the flip side of accountability, two roles in one relationship. While AIG is accountable, the government is responsible. Clarifying--making transparent--the structure of responsibility, aka the org chart (see our dynamic map of the top levels of the US Government in your browser, which takes a moment to load), is one way the government can directly increase the public's trust and govern more effectively. This is a much more direct route to developing trust, and will apply much more broadly across the multiple complex agendas of this administration.

To this point, we've written "Mapping the Recovery," another NetAge Report, this one on transparency, accountability, and responsibility particularly as they apply to tracking the recovery spending as laid out by the Office of Management and Budget (OMB). We are posting Part 1 today (after the break below). In this first part, we describe the network of accountability and responsibility, and how the accounting system IS NOT the organizational system, although it sort of looks like it. In the second part, which we'll post tomorrow, we  look specifically at how OMB has set up the data to track the recovery funds, how its multiple elements can be mapped, and, most important, what's missing (hint--responsibility).

-- Jeff Stamps

"No texting at the taaaa-ble" or at Selectmen meetings

Keen readers may recall my post, "What Mom Says," wherein I uploaded Anita Renfroe's hilarious rendition of the William Tell Overture, whereby she compresses into just under three minutes what a mother is prone to say in 24 hours. It provoked one of my biggest days ever on ye ole blogge as friends far and wide laughed themselves silly watching her video.

I'm reminded of Ms Renfroe - thanks to our Twitter followers/followees over at The Boston Channel, who just reported on the newest rule passed by the Billerica, Mass, Board of Selectmen. For those of you from away, selectmen are the peculiar version of town council members unique to New England.

"Town Bans 'Texting' at Selectman Meetings," (don't-cha love the special quotes around texting?), says The Boston Channel report, from which I now quote:

BILLERICA, Mass. -- Members of a Massachusetts town's governing body can cry, shout and speak for long periods during meetings. But they can't send text messages and e-mails.

Billerica's board of selectmen voted 3-2 Monday night to ban its members from sending text messages and e-mails during its public meetings.

Selectman Bob Correnti said he proposed the ban after a resident complained to him that it was "annoying" to see fellow Selectman Marc Lombardo texting while others were speaking. Correnti also said he was concerned that text messages could become public records...

("Annoying?" It's a good thing people can't see what the selectmen are thinking, which might be even more disturbing than watching them text.)

Why the title for the post and how does it relate? One of the unforgettable lines in "What Mom Says" comes in a string of don't-you-dares and is precisely: "No texting at the table." Got that, Mr. Lombardo?

How IT can track accountability from the get-go

This post is for IT departments. It offers some tips for tracking accountability through corporate data systems, a huge concern for the large number of organizations at both the federal, state, and local levels that will receive funds as part of the US rescue programs.

For months, we've been writing about how to reorganize for greater effectiveness with the smaller footprints. Over the past few days we've been writing about the opposite problem: reorganizing for expansion. The stimulus and other rescue funding is causing some organizations to grow, i.e. those responsible for managing the torrential funding stream (see "Transparency for accountability as the funds roll out" and "Accounting for trillions through OMB").

"Responsible," or accountable, are the operative words here. With a large number of new hires and even larger number of contractors flooding selected departments and agencies at the federal and state levels, the possibility of losing our "whose responsible" handle on the funds and their effectiveness is very high indeed.

There's something IT departments can do something right at the beginning, right now, to help. IT can do its part to ensure that org charts (what we're calling accountability maps) are naturally built into the system as people come on board. To do this, IT needs to collect two simple bits of data for each new "hire," whether employee or contractor:

1. A position title keyed to a unique ID representing its place in the organization's structure (separate from the person's name and unique personnel ID); and
2. A link to the supervisor position directly responsible for this job-holder (its "parent," in logical terms).

Large-scale enterprise data systems held by finance, HR, and IT departments usually house this information already. Finance tracks jobs for accounting purposes and HR tracks people's employment records, enabling them to automatically generate their own internal accountability charts. While most organizations, and certainly government, has this information, it is rarely rendered as a whole (see our USGov map of executive branch accountability.)

While IT often has this information (typically, in its LDAP directory), it sometimes has something more, the logins of all the contracted positions whose work is important enough to require access to internal information systems. If a contractor has access to the organization's network, there's usually a record of who authorized this access, i.e. the contractor's "parent."

Contractors are the "dark matter" of organizations, the great bulk of personnel who are not recognized by most finance and HR systems, except as line items and lump sums. If contractors are hired as a group, perhaps from an outsourcing firm, their from-to, parent-child links should connect to a lead contractor who in turn plugs into a particular supervisor, manager, or point of contact in the host organization.

If this information is collected at the beginning of the expansion wave, then you can automatically generate maps of the growing organization as it grows, attaching budgets, funds, deals, and other information as responsibilities are assigned. Thus, transparency for accountability is in place at the start, not after the fact. It enables complexity to be mapped and understanding to develop in real-time so changes and improvements can be made that are vital to success.

This simple recommendation--to gather and store job titles and parent links for all employees and contractors--is how any organization--public, semi-public, or private--develops its own charts of accountability. These connections serve  as the foundation for the much greater participation and collaboration required to make the new organizations work in a time of tumult and uncertainty.

-- Jeff Stamps

Accounting for trillions through OMB

When President Obama receives his first report on "open government" this coming May, we're wondering what it will include. As we reported a couple of days ago, the president's first five actions at the moment of taking office included ordering the Open Government Directive, due by May 21, four months from its issue.

This directive "...instructs executive departments and agencies to take specific actions implementing the principles set forth in this memorandum." What principles? Transparency, participation, and collaboration.

Three senior government folks have this deliverable on their to-do lists: Office of Management and Budget (OMB) Director Peter Orszag, the General Services Administration head (Paul Prouty is acting administrator), and the still-to-be appointed Chief Technology Officer, whose reporting structure remains unclear. (We're speculating, based on OMB's organization chart, that the CTO will be in that agency and likely report to Orszag and the president through the "Deputy Director for Management." But we can't really tell, especially since the president said during the campaign that the CTO would report directly to him. The deputy position, by the way, which is to include the new title of Chief Performance Officer, is vacant due to the original nominee's tax problems.)

We've added these OMB positions and other top spots in the newest edition of our OrgScope chart of the accountability structure, as portrayed in our US Gov Map (click, patiently wait a moment for Java to load, click on the Executive Office of the President at about 1 o'clock on the map, then follow the chain down through OMB).

"Transparency for accountability" is the starting point, the critical role for organizational transparency as the precondition for "open government through participation and collaboration." Transparency, accountability, and open government are really OMB's core responsibilities. In essence, OMB is the working hub of the new "open government."

By law, OMB is the place where the executive branch of the US Government comes to "get a whole of itself" (sorry, we couldn't pass up the pun). Its mission is to assist the president with budgeting and  administration of executive branch agencies. Responsible for management and budget, this agency also collects data, measures effectiveness, and helps set priorities. It is a major information pipeline between the administration and Congress. Itself a small agency, OMB's job performance contributes to the effectiveness and efficiency of all the rest of government.

So how OMB does its job is particularly critical at this critical time. Kind of "critical-squared."

Why is mapping the hierarchy, in the way that we've been doing with our US Gov Maps, so important? The maps reveal the clear structure of accountability, the interdependent set of "end-of-the-day" responsibilities that includes every person-in-a-job in the organization. An org chart is the foundation for transparency, and provides context for all the specifics around both organizations that disburse funds and organizations where those funds are headed.

In our FDIC post earlier this week on ballooning rescue organizations, we reported that the budget for just one division was going from $75 million to $1 billion--not in funds to distribute or guarantee (those will likely be many billions, if not trillions) but funds allocated directly for the organization and management.

Three-quarters of that $1 billion will go to contractors. In our view, all organizations--government and otherwise--should map their accountability structures. Those maps should include the jobs of everyone working in the organization, whether full-time employees or contractors, i.e., the only org charts that make sense are the ones that account for everyone. Again, "account for," as in accountability.

The next step for the government agencies involved in the rescue/economic turnaround is to hang the specific details of dollars and deals off the boxes of the agencies and teams responsible for making decisions and awarding funds for rescue spending, investments, loans, and guarantees.

Tracking the transparency trail is already part of at least the stimulus package. While the president graciously took the suggestion of a Republican congressman to include a web site to track the stimulus funds, he has been laying the foundation for real transparency in spending since he entered the Senate--and laying it at the feet of OMB even when it was run by the Bush administration. Obama's early and deep interest is indicated by his co-authorship of the “Google for Government” law.

This bipartisan Coburn-Obama Bill, officially the “Federal Funding Accountability and Transparency Act of 2006,” directed OMB to create a searchable database of almost $3 trillion (in 2007 dollars) in federal grants. It was the first law the new senator introduced when he came to Washington.

The legislation called for tracking contracts, earmarks, direct payments, and loans by January 1, 2008. What happened? OMB made its deadline (see www.USAspending.gov for the result of this useful piece of 21st-century legislation). This is doubtless the platform that will be used to track the stimulus spending (see some of the back story here). For the moment, Recovery.gov is a nascent site in the whitehouse.gov style that shows great promise, offering both tabular views and visual displays of the information, although now only in a few gross chunks adding up to $789 billion.

We believe real transparency connects the details of spending to the the configuration of accountability, aka the org charts. Make both context (the map) and detail (the dollars) visible.

-- Jeff Stamps