Re: Protocols for Insurance to Maintain Privacy
-----BEGIN PGP SIGNED MESSAGE----- Tim May wrote:
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.
Tim no doubt already knows this, but I'm going to mention it anyway. The FDA has other reasons for existing such as protecting the major drug cartels from competition and providing wonderful employment opportunities for former FDA employees in said drug cartels. The choice of medical products and services as a choke point to exploit is a particularly evil one as the link between government imposed oligopoly profits and people's lives is very clear. And, of course, this is worst of all for poor people because they are least able to manage their situation. I have my doubts as to whether it is possible to set up a really good anonymous insurance scheme. At some point the customer must physically be matched up with the policy. The damage may be minimized by putting a hash of the customer's DNA markers in the policy instead of the markers themselves. But, when the customer wishes to draw on the policy, his or her markers will have to be taken. If there were a way for the representative of the insurance company to absolutely verify the DNA markers such that the customer could be absolutely certain the information didn't leave the room, a really good anonymous policy would be feasible. But, I can't think of a way to do this. The really good way to protect your medical privacy is to self insure. Most people are happy with policies that tap out at $1 million. If you would be happy with such a policy, then all you need is $1 million to protect your privacy. It is likely that this $1 million will not ever be consumed by health care costs. (Probably much less likely than that a policy holder will hit that limit. People tend to spend their own money more responsibly than somebody else's.) One of the most important criteria for issuing insurance must be age. Is there anyway to unambiguously determine somebody's age? I know how to do it with trees, but it doesn't work with people. 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 iQEVAwUBNFgp6ZaWtjSmRH/5AQES/wf+Ijrvktr6VxOxFRKZsad19G6fLuotWLTx /kGEncb+3cAHg26Pxn2FRjt8FO4fdqNp/adaEtCmaVDJeJavhhiqW+XyXuLb1Iy4 5YrvG/xIbbPIIYdVeZ5coATNAIaKZvQu0UWrbDQzbmyxi0bIHmaixxx53isc14w1 qn+4PrlV7jVyKCPf/BMw7Mv7L33v8ZR3r3iS15L/OjIxBtvpVDvnBv8BdKwMA7C+ S5HBSYhiYjSGi1CnisnKI0POD9BqXXr5LwNA+407hPWDTkSGZ4iRqY3koiO0e/Je eEvfbcSBEazaXcqlMtuI5xkFhLOY3L9oF+BtRjAfc9TRocFTTzZwHA== =VcKo -----END PGP SIGNATURE-----
I have so far elected to self-insure, i.e., to just pay any medical bills I might have out of pocket. However, given this "sucker rate" and the increasing unwillingness of hospitals to take patients not in health care or insurance programs, I may have little choice but to sign up.
Why not establish an offshore insurance company (e.g., in the Caribbean so the area code doesn't make it appear outside our boarders) which knows you true ID, but let's you use a pre-agreed upon pseudo-ID. They could even have URLs on their pages to services which could help you out obtaining realistic hardcopy. Doctors don't much care as long as they are getting paid and all will accept out-of-state, many even knowingly out-of-the-country, insurers. They really don't care about the IDs as long as they match something insurance company says they'll pay. --Steve
At 8:50 AM -0700 10/30/97, Secret Squirrel wrote:
The really good way to protect your medical privacy is to self insure. Most people are happy with policies that tap out at $1 million. If you would be happy with such a policy, then all you need is $1 million to protect your privacy. It is likely that this $1 million will not ever be consumed by health care costs. (Probably much less likely than that a policy holder will hit that limit. People tend to spend their own money more responsibly than somebody else's.)
I used to think this was so, too. But there's a certain kind of market failure at work. (Actually, it's not a market failure at all....it's a manifestation of the market. Read on.) It turns out that if I have to go to the local hospital, the daily rate for a hotel room will be something like $2000 a day. Exclusive of whatever treatments I'm receiving, of course. Turns out that Blue Cross and Blue Shield have negotiated, through enormous buying power, daily rates of about $700 a day. (These numbers come from my memory of a "60 Minutes" report a few years ago. Details and current figures may vary.) Listed prices are the "sucker rates," kind of like the posted prices for out-of-towners, with locals getting a discount. And these pricing differences apply to the whole range of procedures. For example, an insurance company might have negotiated--over many years of intense negotiations--a fee of $100,000 for a liver transplant, but a "cash-paying customer" (a victim, a mark, a sucker) would pay the list price, e.g., $300,000. Could I negotiate a lower room rate, and lower fees for a spectrum of possibly needed treatments? Probably. I haven't had to try, fortunately. (Nor am I knowledgeable about procedures. Nor am I patient negotiator, no pun intended.) I'm not calling for market intervention, price regulation, government intervention, etc. Just noting that cash is not always king. Especially to any medium-sized or larger hospital, where filling out the forms correctly is more important than getting paid in cash. (My dentist's receptionist is befuddled by my paying in cash. She clearly prefers to just enter the number of an insurance company.) Walking in off the street, or arriving in an ambulance, without an insurance policy number is becoming a guarantee that one will pay the absolute maximum rate, the "sucker rate." If one is admitted at all, as many hospitals turn away anyone without a means of proving they can pay....and promises are not enough. And if one proves to the hospital that one has large resources, I fear for the consequences ("wallet extractions" being one risk). I have so far elected to self-insure, i.e., to just pay any medical bills I might have out of pocket. However, given this "sucker rate" and the increasing unwillingness of hospitals to take patients not in health care or insurance programs, I may have little choice but to sign up. --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."
On Thu, 30 Oct 1997, Tim May wrote:
At 8:50 AM -0700 10/30/97, Secret Squirrel wrote:
The really good way to protect your medical privacy is to self insure. Most people are happy with policies that tap out at $1 million. If you would be happy with such a policy, then all you need is $1 million to protect your privacy. It is likely that this $1 million will not ever be consumed by health care costs. (Probably much less likely than that a policy holder will hit that limit. People tend to spend their own money more responsibly than somebody else's.)
I used to think this was so, too. But there's a certain kind of market failure at work. (Actually, it's not a market failure at all....it's a manifestation of the market. Read on.)
It turns out that if I have to go to the local hospital, the daily rate for a hotel room will be something like $2000 a day. Exclusive of whatever treatments I'm receiving, of course.
Turns out that Blue Cross and Blue Shield have negotiated, through enormous buying power, daily rates of about $700 a day. (These numbers come from my memory of a "60 Minutes" report a few years ago. Details and current figures may vary.)
Listed prices are the "sucker rates," kind of like the posted prices for out-of-towners, with locals getting a discount. And these pricing differences apply to the whole range of procedures. For example, an insurance company might have negotiated--over many years of intense negotiations--a fee of $100,000 for a liver transplant, but a "cash-paying customer" (a victim, a mark, a sucker) would pay the list price, e.g., $300,000.
Actually, the real "sucker rates" are the amounts small businesses pay for insurance. The big businesses (who can buy in bulk) get a pretty reasonable deal for what they get. The smaller companies who cannot bargain the price down get screwed. (The rate my wife's employer was paying was close to double what my insurance costs and it covered ALOT less.) I seriously doubt that most people could afford to self-insure at the going rate. (Not unless they have some serious income they want to get rid of.) alan@ctrl-alt-del.com | Note to AOL users: for a quick shortcut to reply Alan Olsen | to my mail, just hit the ctrl, alt and del keys.
-----BEGIN PGP SIGNED MESSAGE----- At 08:11 PM 10/30/97 -0500, Dave Emery wrote:
On Thu, Oct 30, 1997 at 09:33:52AM -0700, Tim May wrote:
Turns out that Blue Cross and Blue Shield have negotiated, through enormous buying power, daily rates of about $700 a day. (These numbers come from my memory of a "60 Minutes" report a few years ago. Details and current figures may vary.)
My wife is a pathologist, and she tells me that some of the more aggressive HMOs get away with paying 15-20% of the posted "official" prices for procedures and tests. The difference between what insurance organizations pay and the nominal price is usually 2 to 3 to 1 for most things these days. And for many years Medicare has set defined prices for medical reimbursement that less than the gold plated bill amount as well.
The WSJ had an article about a guy who found out that his HMO had negotiated a payment rate which was less than his *copay* on the procedure so the insurance company paid nothing for his hospitalization at all. DCF -----BEGIN PGP SIGNATURE----- Version: PGP for Personal Privacy 5.0 Charset: noconv iQCVAwUBNFnGrYVO4r4sgSPhAQEBHQQAuHnkSWEtcwJbmOZqiPImpB7pHy0nTcI4 N0XPTiir5XYYS12f8hmbA9EuN266R/8nKbE2LR5hm5VqQ2Tagimo7gKwrWpfKYtK OxNVLHuEOF0AiB8H15+J2JNUnLECR5N7rhcMDsDNkZfxYK8wxHAMrFBVeVNfhdqA UaW7pG8IQFA= =qFrU -----END PGP SIGNATURE-----
On Thu, Oct 30, 1997 at 09:33:52AM -0700, Tim May wrote:
Turns out that Blue Cross and Blue Shield have negotiated, through enormous buying power, daily rates of about $700 a day. (These numbers come from my memory of a "60 Minutes" report a few years ago. Details and current figures may vary.)
My wife is a pathologist, and she tells me that some of the more aggressive HMOs get away with paying 15-20% of the posted "official" prices for procedures and tests. The difference between what insurance organizations pay and the nominal price is usually 2 to 3 to 1 for most things these days. And for many years Medicare has set defined prices for medical reimbursement that less than the gold plated bill amount as well. -- Dave Emery N1PRE, die@die.com DIE Consulting, Weston, Mass. PGP fingerprint = 2047/4D7B08D1 DE 6E E1 CC 1F 1D 96 E2 5D 27 BD B0 24 88 C3 18
-----BEGIN PGP SIGNED MESSAGE----- At 09:33 AM 10/30/97 -0700, Tim May wrote:
Listed prices are the "sucker rates," kind of like the posted prices for out-of-towners, with locals getting a discount. And these pricing differences apply to the whole range of procedures. For example, an insurance company might have negotiated--over many years of intense negotiations--a fee of $100,000 for a liver transplant, but a "cash-paying customer" (a victim, a mark, a sucker) would pay the list price, e.g., $300,000.
Could I negotiate a lower room rate, and lower fees for a spectrum of possibly needed treatments? Probably. I haven't had to try, fortunately. (Nor am I knowledgeable about procedures. Nor am I patient negotiator, no pun intended.)
You can negotiate in advance. Many doctors will cut their rates for surgery if you tell them you are uninsured. We actually called around to a number of hospitals recently to see if they would discount a birth for cash up front and we were able to find hospitals willing to cut their rates. A 50% cut seems the standard range.
Just noting that cash is not always king. Especially to any medium-sized or larger hospital, where filling out the forms correctly is more important than getting paid in cash. (My dentist's receptionist is befuddled by my paying in cash. She clearly prefers to just enter the number of an insurance company.)
The magic words are "Hill-Burton Act." Most hospitals have accepted Hill- Burton Act funding and are required to admit people with or without insurance. Some resist of course.
I have so far elected to self-insure, i.e., to just pay any medical bills I might have out of pocket. However, given this "sucker rate" and the increasing unwillingness of hospitals to take patients not in health care or insurance programs, I may have little choice but to sign up.
Me too. In 20 years, however, you and I will be drafted into Medicare (against our wills) unless the system is substantially modified by then (the most likely outcome). DCF -----BEGIN PGP SIGNATURE----- Version: PGP for Personal Privacy 5.0 Charset: noconv iQCVAwUBNFnFfIVO4r4sgSPhAQHRUgP/b9QZr/Z0UtKWCdEiOkfRaIQEnRMEWYKF FWEdiIjYmHldqsxTjtrICGsI4AQm/fyKEhGq5ED+vLt9rOeElz1j6IlmLCj+Hb1m QSFAUxyLpODYpPGs5+sofTnwHABHHW3fMk3aBSwqqHuh8BK7fSCIBOmAU3kLrJbp QkeAHQb6h3g= =KE8a -----END PGP SIGNATURE-----
participants (6)
-
Alan -
Dave Emery -
frissell＠panix.com -
Secret Squirrel -
Steve Schear -
Tim May