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-----

-----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-----

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."