Timothy C. May wrote:
<good arguments for using cash deleted>
- temporal extent implies record-keeping, such as insurance records, hospital visits, etc. This is automatically a potential privacy concern.
Yes, but... An insurance company would hardly accept a totally anonymous agent as a customer, for obvious reasons (how would they know that the agent was paid for by the body needing repair and not used for an unfortunate uninsured friend?). Now, if there was only
I wasn't arguing that insurance companies would take anonymous customers, per se, though I suspect a privacy-preserving system could in fact be designed. In systems where a customer and insurance provider work out a mutually-beneficia contract, and where there is no requirement to forward records to the government, then privacy is mostly maintained. The concern many of us have is with systems in which governments demand to be "silent partners" in all contractual relationships.
(When a patient pays cash, no problem. When a central service is used, opportunities for fraud increase. Doctors with ghost patients, kickbacks, etc. Any central-payment system must then have records and investigations at that central point. Hence, a central bureaucracy. Hence, a loss of privacy at that level.)
One problem with cash here is of course the high costs of helth care, making it necessary for almost everybody to be insured if they are not suicidal or willing to gamble their lifes. Another problem is the unconsious-patient situation - or half-consious, might be hard to remember the password to the e$ anonymous account.
I'm not insured. Most health-care costs are payable directly...unless and until the U.S. gets a socialist health care system, in which case I'll still be uninsured (I'm not employed, I'm not indigent, so I won't be covered by any of the current proposals, as I understand it). I'm not going to digress further into insurance issues, except to say that insurance has had the bad effect of decoupling payments and services, a la the well-known "tragedy of the commons." People pay for insurance, or their companies do, and then they try to demand the largest number of services...it's game-theoretically advantageous for them to do so. Hence the $2000 almost-obligatory CAT scan upon entering a hospital in the U.S. (fed also by the malpractice racket--doctors order these $2000 CAT scans to cover their asses against lawsuits and because they get legal kickbacks for these services). Life expectancy, in the U.S. at least, has remained at roughly 72-74 years for the past couple of decades, so this huge health care industry has had little real effect on our chances of living longer. For the rare person who is in fact saved by this expensive system, it is "worth it," of course. But the aggregate benefits tell a different story. The relevance to Cypherpunks? I don't know, but it's partly connected to issues of whether centralized systems and record-keeping are a good idea. I actually see no reason why we as potential patients should not carry around our medical records ourselves. Perhaps in a smart card...the technology has existed for years. Or in a "medical bracelet" which either directly contains local storage (flash memory, for example) or contains a pointer to a file on the Net--and access information, if encrypted, as it should be--which contains relevant medical information and perhaps even financial payment instructions. Selective disclosure of credentials, a la Chaum, should apply quite naturally to medical care. A dossier society is not needed. (I don't demand that others use such a system, only that I and my medical contractor not be required to use someone else's idea of a system. Seems fair to me.) --Tim May -- .......................................................................... Timothy C. May | Crypto Anarchy: encryption, digital money, tcmay@netcom.com | anonymous networks, digital pseudonyms, zero 408-688-5409 | knowledge, reputations, information markets, W.A.S.T.E.: Aptos, CA | black markets, collapse of governments. Higher Power: 2^859433 | Public Key: PGP and MailSafe available. "National borders are just speed bumps on the information superhighway."