Private Health Care [On topic, please read.]
-----BEGIN PGP SIGNED MESSAGE----- Michael Sims wrote: [Ed. note: Declan wrote?:]
The free market approach won't keep medical records private.
In other words, the reason a "free market" approach may not work right now is because the market isn't free.
Declan, every part of the "health-care market" that people are complaining about, the parts of it that routinely and for fiscal reasons violate people's privacy, are completely and utterly dollar-driven and do not result from big nasty government making any laws.
This greatly underestimates the influence and involvement of the government. The medical profession uses the government to keep out competitors and keep their prices high. In many areas, the majority of the money spent on legislative campaigns is provided by various professional medical organizations. The flip side is that the medical profession will have a powerful incentive to remain in the good graces of the established political powers, whatever they may be. That means no weird experiments in protecting people's privacy. Doctors are also terribly vulnerable to liability suits. As patients, we are unable to agree to waive most liability. This makes it harder to walk into a doctor's office with a sheaf of bills and ask for service. The doctor has a strong incentive to have everything documented and ship shape because to do otherwise would make him or her look poorly in court. This may also endanger the doctor's liability insurance policy. And, because the medical market is tightly controlled, it is not possible to legally enter the market as an outsider. IMNSHO, I should be able to consult my drug dealer about ailments and their proper medication. The fact is, many people have much greater rapport with their drug dealers than with their doctors and there is often greater concern by the drug dealer for his client's welfare, at least in terms of obvious problems such as pain. Similar things can be said for health insurance companies. They are very greatly constrained in the types of policies they can offer and the sorts of agreements they can make with their customers. You could imagine an anonymous policy which opens with a medical exam which is repeated every so often for couple of years before taking effect. After, say, two years of good health, full coverage on the policy kicks in. Ironically, some states have rules very much like this, minus the anonymity. After a certain number of years all illnesses are covered regardless of whether the customer had the illness previously and lied about it on their application. (Some states even forbid life insurance issuers from excluding suicide for coverage for long term customers! Not only does this raise the price of life insurance, but in certain instances it compels people to kill themselves "for the good of their family". ) Given this legal environment, you would expect some company some where to try to corner the market on anonymous health insurance. There are a few reasons why this does not happen. One is the extreme discretionary power of insurance commissioners. This power is probably even greater than in most industries because the insurance industry is, absurdly, widely hated. No insurance company is going to rock the boat. Insurance regulation also creates a barrier to entry. Many states limit the amount of profit an insurance company can make. These limits are often very low and do not justify new entrants or new and interesting product offerings. Finally, in practice very few people choose their own insurance. The purchase decision is made indirectly by the company they work for. The feedback between what the user of insurance wants and what he or she gets is attenuated by this structure. This structure is required by law in many places because employers are required to provide "free" health insurance to their employees. The federal tax code strongly encourages companies to provide health insurance as it is a benefit which is not taxed as income. There is more to be said on this topic, I am sure. Monty Cantsin Editor in Chief Smile Magazine http://www.neoism.org/squares/smile_index.html http://www.neoism.org/squares/cantsin_10.htm -----BEGIN PGP SIGNATURE----- Version: 2.6.2 iQEVAwUBNFbSfZaWtjSmRH/5AQHP0Af/SiXKivk8zzUlvKgcYw3AFaHx2nad1ezl E/i7mYi887mx5bMhaHKQfcD2l7oXKM/tkU3ym9PXOdngMxdVvZj96XxazDpQMW8o MIhEIwMPlwQsoNylyD0+UraWCX9X/SsyFchTJqlodmn9QH7OrtLtOcnX+ibMB/Wl 3WkvHAIZeEQaSjMYhbEqEZA/N7ojz6WFsY3jQWRmsFbAKmwn0tr+3ncbuzxZP0h+ 6Bq97xnS+17wRPX1hVp04qq+gtgmnDzEmCI1wDqUrGGJXmDHiTYNurOy1mcNUU+L RaguGy69kSBNqOzLen4sV0xL+w2nw8iMVWTQ0Xg1Zo6QgLnAIv+k8w== =DdvV -----END PGP SIGNATURE-----
At 7:12 AM -0700 10/29/97, Monty Cantsin wrote:
And, because the medical market is tightly controlled, it is not possible to legally enter the market as an outsider. IMNSHO, I should be able to consult my drug dealer about ailments and their proper medication. The fact is, many people have much greater rapport with their drug dealers than with their doctors and there is often greater concern by the drug dealer for his client's welfare, at least in terms of obvious problems such as pain.
Ditto for pharmacists. In the U.S. one can only buy "prescription drugs" by, well, getting a "prescription." This is a nice side-racket the doctors have, of course, as the prescription generates a tidy little fee for the prescribing doctor. A $75 office visit for less than a minute of actual doctor involvement. Nice work if you can get it. And of course in Mexico and other "backward" places, where such reimbursement f office visits is considerably different, so-called prescription drugs are available at nearly all corner pharmacies. Lots of Americans make the drive from San Diego to Tijuana to buy prescription drugs either too expensive (those doctors visits) or unavailable in the U.S. And the Customs department at the border has pretty much given up on stopping people from carrying personal-use quantities. (The gay lobby exerted a lot of influence on this, as gays travel to Tijuana to pick up medicines they think are effective, whether approved in the U.S. for gay cancers or not.) The FDA has probably killed more people in the last 30 years than all the wars the U.S. has been in during the same time. Mostly because of the game-theoretic nature of the system: all that matters to FDA officials is covering their ass so that promotion is ensured. No points for approving a controversial drug, but lots of demerits for approving a drug which hurts even one person (if the media reports it as "another FDA oversight"). Avoiding flipper children is the raison d'etre for these people.
Similar things can be said for health insurance companies. They are very greatly constrained in the types of policies they can offer and the sorts of agreements they can make with their customers. You could imagine an anonymous policy which opens with a medical exam which is repeated every so often for couple of years before taking effect. After, say, two years of good health, full coverage on the policy kicks in.
There are interesting protocols which can be used to skirt statist laws about insurance. A la carte insurance, for specific illnesses, is one of the best examples. Thus, a heterosexual male who doesn't use IV needles can "opt out" of coverage for AIDS-related treatments, thus transferring the effective cost to those most worthy. (Probably why many legislators want such opt-outs banned.) This has similarities to crypto protocols. And anonymity. To wit, it is possible to arrange anonymous blood tests for various conditions. So, Alice arranges a distributed set of such tests, perhaps at multiple labs. When she finds she has no preconditions or precursors for Diseases A, B, C, and D, she opts out of being covered for these diseases. This is dramatically different from the way things are now supposed to be done: where Alice is given a suite of tests *by her insurer* to determine risks, premiums, etc. This approach, the tests by her insurer, almost immediately lead to potential privacy problems, as insurers (naturally enough) record such results in their records and may even "share" (or trade, or sell) results with other insurers, companies, etc. The "a la carte" approach allows Alice to "selectively disclose her preferences," by the coverage she buys. The insurer may still demand tests, of course, as is his right. But Alice may choose to pay higher rates for the limited things she wants covered, and so an overall privacy-maintaining balance should be possible. --Tim May The Feds have shown their hand: they want a ban on domestic cryptography ---------:---------:---------:---------:---------:---------:---------:---- Timothy C. May | Crypto Anarchy: encryption, digital money, ComSec 3DES: 408-728-0152 | anonymous networks, digital pseudonyms, zero W.A.S.T.E.: Corralitos, CA | knowledge, reputations, information markets, Higher Power: 2^2,976,221 | black markets, collapse of governments. "National borders aren't even speed bumps on the information superhighway."
-----BEGIN PGP SIGNED MESSAGE----- At 09:24 AM 10/29/97 -0700, Tim May wrote:
And of course in Mexico and other "backward" places, where such reimbursement f office visits is considerably different, so-called prescription drugs are available at nearly all corner pharmacies. Lots of Americans make the drive from San Diego to Tijuana to buy prescription drugs either too expensive (those doctors visits) or unavailable in the U.S. And the Customs department at the border has pretty much given up on stopping people from carrying personal-use quantities. (The gay lobby exerted a lot of influence on this, as gays travel to Tijuana to pick up medicines they think are effective, whether approved in the U.S. for gay cancers or not.)
This can be done by mail as well. See: "How to Buy Almost Any Drug Legally Without a Prescription" by James Johnson. DCF -----BEGIN PGP SIGNATURE----- Version: PGP for Personal Privacy 5.0 Charset: noconv iQCVAwUBNFnAE4VO4r4sgSPhAQEhHQP8C3WjwU4QIpRbAqvGBCNpPjALD2ux4FJS bC2Mt0FHy8XMyAlkpCPOwk5u9oXM5R83dc3y+wsmwW47oH5COEXZDQ6GFmgbe/49 Kp4GpLNF+DdcoSymN3gRSYXQhWMsnXNu10mUtYY4lg+mG/6D0xWRIeEFx4PrlAwC 1txzmME5qSs= =ZfZQ -----END PGP SIGNATURE-----
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Tim May