Mats Bergstrom writes:
Duncan Frissell wrote:
There's no way you can have a government-directed, third-party-paid, health care "system" without throwing privacy out the window. Bureaucracies *keep* records, they don't destroy them.
Yes, this is a lesson history tells us. But maybe, theoretically, strong crypto could make a change. Nested information with keys known only to parties with legitimate interest in a specific info layer and the master key only known to the patient and programs for self destruction (including backups) of data no longer needed. I repeat, theoretically that is.
The simplest solution is *cash*. It's worth taking a minute to see why cash is so important in this context, and why accounting-based systems that compile records are inherently insecure. The beauty of a cash transaction, throughout history, is *immediate settelement*. Parties have to examine a deal, look for flaws, and then make a judgement about whether to complete the deal. Once completed, it's hard to change one's mind, go back on the deal, complain, etc. This enforces a kind of due diligence. Cash on the barrelhead, as they say. Non-cash systems are of course sometimes desirable: credit cards, insurance schemes, contractual relationships, leases, etc. All kinds of variants. However, these contractual relationships involved *time extent*, that is, they are not settled immediately, on the spot. This has many potentially negative effects: - confusion of time...people evolve different expectations of a contract, causing disputes - people often fail to do the due diligence of a cash transaction (for example, the very same people who are good at haggling at a flea market, and understand "caveat emptor" implicitly, will bitch and moan and complain about contracts...seeking more, changes, adjustments, etc.--an interesting contrast). - temporal extent implies record-keeping, such as insurance records, hospital visits, etc. This is automatically a potential privacy concern. (And when the contract is more than just patient-doctor, but involves other payers, the records-keeping mushrooms. When the government is the ultimate payer, through mandatory plans, they'll have the records. No amount of crypto can possibly change that.) - efficiency. Parties in cash transactions get what they paid for, else they wouldn't have made the transaction. - fraud. While cash transactions can have fraud (con jobs, fake merchandise, etc.), the opportunities for fraud increase dramatically with non-cash systems. When others are paying, such as for health care, the temptation to participate in frauds is higher. (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.) And so on. My point is mostly that cash has certain elegant properties which are lost when replaced with a central accounting scheme. "Locality of reference" is the computer-related equivalent. Why should this matter to Cypherpunks, if you've read this far? (By the way, yes, Hal, I *did* read to your "Has anyone read this far?" question a few days ago.) Systems which preserve this cash/locality of reference feature, such as digital cash, digital postage, and the "Digital Silk Road" proposal of Hardy and Tribble, have likely advantages over centralized, record-oriented systems. You all know that digital cash is important. This is why the National Health Care Plan is a bad idea, will destroy privacy, and basically can't be fixed by band-aids that allegedly protect patient records. --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."