found vast potential for the introduction of new home care medical technologies but identified the reluctance of health insurers to pay for home care and the absence of infrastructure standards as formidable barriers to progress.

The federal government took the first step in this direction with the passage of the Health Insurance Portability and Accountability Act of 1996, which directed the Department of Health and Human Services (HHS) to standardize the way that health information is recorded and to develop rules to protect individual privacy. HHS has proposed standardized reporting practices that will simplify the sharing of data and rules for privacy protection that will inevitably make medical record keeping more complex. Computers and printers used for medical records will have to be physically secured, all software password protected, all transmissions encrypted, and electronic audit trails enabled that will identify everyone who has accessed the data. Health-care providers worry that the new requirements will be very expensive to implement and will undermine the information-sharing advantages of computerized patient records. Yet the public is very clear that it takes medical privacy very seriously. Reconciling the goals of enhancing the communication of medical information and preserving its privacy will be a contentious challenge.


The 2001 Council on Competitiveness report U.S. Competitiveness 2001 (summarized in Michael McGeary’s paper for the committee, Appendix E) places particular emphasis on human resources for R&D and for production. It worries that the United States could find itself without the brainpower to develop and produce the technology it can envision. For example, the report notes that the number of undergraduate degrees awarded for engineering, math and computer sciences, and the physical sciences was stagnant or declining from 1985 into the late 1990s. Only in the life sciences did the number of degrees grow during this period. The picture was similar for graduate programs. Enrollment grew at a healthy pace in the life sciences but grew only slightly in engineering, math and computer sciences, and the physical sciences. This decline is linked to the decline in federal support for research in these fields. The reduction in research funding has been accompanied by a drop in the support available to graduate students in those fields.

One reason graduate programs did not actually shrink is the large number of foreign-born students who come to the United States for graduate study. The percentage of doctoral degrees in science and engineering awarded to foreign-born students grew from 35 percent in 1987 to 41 percent in 1997. Many of these graduates remain in the United States, but a significant number return home to their native countries.

At the same time as student interest in science and engineering careers seems to be waning, demand by employers for scientists and engineers is growing

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