1. Centralized health data storage – and privacy concerns: Centralized data storage creates the concern that the data can be stolen or misused. It is a legitimate concern. Since the data would only be available based on personal card with a fingerprint scan, it would actually be much safer than it is today. While this might cause problems should the person have an injury to all of the body parts (hands, eyes) that can be used for identification, it would protect privacy for 99.999% of us and that’s more than what can be said about our current system.
Of course, somebody could hack in to the system, but since medical records would be stored under a fingerprint ID, they would not be able to know whose records they are accessing.
2. Who determines what is junk food? In other words, who determines what to tax and what to subsidize?
Great question. Most things are actually OK in moderation, but clearly some things are much healthier than others. While a board on nutrition specialists can fine tune the system, it would seem to me that some things are so obviously unhealthy in large quantities that making them more expensive (and thus making us less likely to want to eat them) is fairly straight forward. Simple sugars – read corn syrup and saturated fat while commonly available should pay for the fair portion of the health bills they create. Obesity in US causes more deaths than just about any other cause of health problems, so while one should have the freedom to eat anything, twinkies should not be as cheap as a banana for example.
By having nutritional specialists assign a tax premium on goods as we learn about their health effects, would actually reduce or eliminate the need for strike lawsuits. Obviously, fraud will still be a problem. The special interests can obviously try to lobby this system, but they would have to convince the entire scientific community that something is healthy, to reduce taxes. It would be much simplier for most businesses just to reformulate their products, or target people who want to eat junk no matter what the price is.
3. Insurance credit card: My proposal is to have a card that has predifined coverage ammounts for predefined procedures. In this way you get instant approval and know how much of the charges are covered instantly. The insurance has predefined coverage ammounts for each procedure, so if you find a doctor who is willing to do the procedure for that ammount you owe nothing, but if want to go to a more expensive doctor, you still know how much you will owe up front. Should the insurance that the procedure is unnecesary, they can go after the doctor who prescribed an unnecessary procedure. (Just as in car insurance they have a fraud department that verifies unnecesary repairs).
4. Consumer’s freedom of choice in a world where all doctors are publically rated: Lets say I have an ear infection and need antibiotics. I have the choice of going to any doctor I want. Let’s say that the baseline for a visit is $60. With doctors commonly charging between $90 to $240 per visit. Let’say that the doctor I really like is $120 a visit. I have couple choices: a) I could buy 200% baseline coverage insurance which would cover all of my expenses; b) I could buy 100% baseline coverage and pay $60 myself; or c) I can go without insurance and pay $120. But at least I would know what I am paying before the visit. The cost of my insurance would vary by coverage level 100% or 200%, so if I wanted to see more expansive doctors my insurance would be more. On the other hand, if I was OK with seeing a local nurse practitioner for $60, I would be able to buy baseline coverage inexpensively. The doctors would know that the only way they can charge more is by having better stats, since most people would not go to a first year doctor with 50% satisfaction rate who charges $400 a visit. I would not need to have a medical background beyond knowing that on average this procedure has 70% success rate and the cost is $,1000 and the doctor that I am going to has 90% success rate and the cost is $1,200. I can decide if the extra price is worth the extra benefit.
5. Caring for the “terminally” ill: The care need not be (and likely should not be) institutional. I am not arguing for a place where people go to die. I am arguing against spending lots of money on mostly useless procedures to try and extend the person’s life by a few months. The Instead, I am arguing that a person in this situation is better off living their life to the fullest for the remaining time. One option might be hospice: http://www.hospicenet.org/html/concept.html.
Keep the questions coming. Let’s think together until we have it completely polished up.
10 responses so far ↓
1 TurboBorland // Nov 5, 2008 at 8:40 am
This centralized server could store the information under a fingerprint ID and this is a good idea. The problem is that you will somehow have to verify that fingerprint ID to a person through this system or a system just as similiar. We aren’t just going to be issuing biometric fingerprint scanners to every hospital so they can scan their fingerprints in and THEN they have access to the medical records over a 512+bit AES encrypted secure tunnel. Also, authoritative (police is most dangerous) people would probably have access to this information when they look you up in whatever people database they have access to.
Security, as well, isn’t just about taking data, it’s also about trickery (take a look at phishing). If you have to scan your fingerprint in order to access data, people are going to be modifying the fingerprint scanners to send the information somewhere other than where it should go or the people who make them are going to make some mistake (like send the information from the scanner to a server in the hospital via RFID or some other frequency that can be caught and monitored).
Even if all the above examples aren’t the case, you’ve managed to create a system in which people are classified by certain information. This information will be what is harvested and used against you. You know the amount of information and damage someone can do with your SS number, what about credit card number? People don’t even have to know who you are to use this information for themselves.
Also, imagine the amount of attackers when the world is told that a centralized server holds information on millions of people! Especially in cases of cyberwars between countries.
The fact is, having all of this information in one place is scary. It’s bad enough there’s a huge database on people that law enforcement and particular government agencies have access to. I don’t want a more easily accessible goldmine of user information somewhere else.
2 TurboBorland // Nov 5, 2008 at 8:57 am
“The special interests can obviously try to lobby this system, but they would have to convince the entire scientific community that something is healthy, to reduce taxes.”
I was actually thinking of something on the reverse. Sure, it would be hard to convince the “entire scientific community” that something is healthy, however it wouldn’t be as hard to convince them that something is unhealthy (look at all the “experts” saying x is unhealthy and several others saying it isn’t). I remember them telling me that milk was unhealthy a couple of years ago.
This would be a competitive strategy for certain corporations (who could afford it). Convince, whoever you must convince, that a certain product is unhealthy, so they raise the taxes on this item, and (in a most likely scenario) sales will drop due to higher prices.
I see this more in the restaurant/fast food area. Subway feels threatened by a new sub making place. However, their subs (or just certain ingredients on the subs) are much more unhealthy, so subway pays some lobbyists to bring it up at the next meeting dealing with the subject. If it goes through, they will tax whatever ingredient(s) that is required to make those subs and thus, in the most likely scenario, raise prices for the sub, unless the place is able to re-invent itself. Subway would easily have the money to throw away at such a tactic if it felt so threatened.
I understand that you are proposing a general outline for such things, but the process must be explained as much as possible or loopholes and strategies, like mentioned above, will take your idea that was meant for the good of people, and twist it.
3 TurboBorland // Nov 5, 2008 at 9:26 am
5.) This just seems overdone to me. A place where people go when they are terminally ill. It seems to me like it’d be a depressing place. EVERYONE there is about to die, how are you going to create an upbeat atmosphere, let alone help them get to sleep at night. Also, every time I imagine such a place, I think of it being like a nursing home. It sounds just like it too.
http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=NonPub&Title=Nursing+Home+Checklist&Size=26%2E49kb&Description=&RevDate=4%2F10%2F2007+10%3A17%3A20+PM&Filepath=%2FNursing%2FChecklist%2Epdf
Now, how many people do you know who say they want to live in a nursing home? I know you want to improve quality of life over unecessary surgeries, but you really can only suggest it and provide help to those who WANT it.
What I really want to know is what are you going to do different than the current system? The current system offers government aid to those who need to stay in such nursing homes (even that hospice has insurance policies to help you pay for it, like medicaid).
4 admin // Nov 5, 2008 at 12:40 pm
If the database is fully voluntery for the patients, only 90% of us who have nothing to hide from the police and who are willing to risk the data would join. That alone would hugely reduce the costs of health care. As far as the cost of biometric scanners, not having to conduct one unnecesary procedure would save enough money to pay for it. Security of your information right now is only a perception anyways. Criminals can easily obtain the social security numbers already. I am not recommending storing credit card numbers in the database. This is the basic question of progress, any new information can be abused. There are ways of building plenty of redundancy in to the database. To be sure there are technincal problems that would have to be overcome, but that’s still superior to having everyone keeping a separate file.
You make a very valid point regarding calling certain foods unhealthy (and in large enough quantities, everything, including milk, is). Maybe the solution is to have a public forum, where all sides can present their viewpoints (in a format that anybody who cares can observe) and the commission would vote and make recomendations for congressional approval once a year. Abuse would still be possible, but short of us eating less sugar or walking more, it might not matter in the near future, when the whole country is so obese that we can no longer take care of ourselves.
5 admin // Nov 5, 2008 at 12:49 pm
There is a huge difference between hospice and a nurcing home in that hospice does not have to be a place. Hospice is a non-medical approach to dealing with death. Nursing home’s goal is to keep you alive. Hospice, in theory, has the goal of improving your quality of life. I am not an expert on hospice, but my friends who work in the industry tell me that it is the exact opposite of a nursing home.
6 TurboBorland // Nov 5, 2008 at 1:52 pm
1.) I’m not saying that you should be worried about hiding information from the police, I’m saying they probably would have access to this kind of information. Police frequencies have been tapped for a long time now, even external wireless cards can now be modified to operate on and monitor/sniff the information being passed through legibly.
Who all is going to have legal access to this information? Is it just going to be the doctors?
As for the credit card and social security numbers, I think I did not get across my point clearly enough. These numbers are just numbers, as fingerprint data would just be fingerprints. But, given this sole information (meaning they only know the SS or CC data and nothing else about you) damage can be done and the information can be used. So if I were to grab the information on a person’s fingerprint, I would be able to supply this information somewhere and reap that data for my own benefit.
As to the biometrics part, I’m saying you would have to give them the biometrics. Most hospitals aren’t going to run out and buy a multi-hundred dollar biometric fingerprint scanner, hire someone to set it up/fix it if there is a problem, teach staff how to use it, buy the software that will probably be sold seperately if this were to take effect, configure this software to every machine in the building, and then change their entire operation to this new method. Sure, some may, but I doubt most would. If you force this without somehow supplying the funds for this venture (or any other business that may need this information) with it, several of them are going to feel a large loss. Which is rather opposite of what I would like the medical field to do.
I have worked in the information technology field and currently am a researcher for the security field, this is why I have such a worry about such an idea coming into existence (and even being standardized!).
2.) I like the idea of having a public forum. It would probably have to be like a jury system. Where the information is kept private from the people involved in the case. Such a thing would also greatly cut back on any possible corruption of this new system.
3.) I’m just saying that it sounds good in theory (nursing homes won’t really state that they are just there to “keep you alive”, instead they make it sound like they have incredibly caring staff to provide you assistance and expert medical help) but implementation, especially if you include it in multiple areas, would be lacking. The nursing home checklist sounds very good, but very few places actually place well when judged under this checklist. Nursing homes popped into my mind immediately because in your initial proposal this was under “elderly care”.
If hospice is not a place, than what would we be giving to these terminally ill people?
The whole idea started off sounding like a place where terminally ill people would go to supply a better quality of life instead of having to stay in the hospital getting things done that just aren’t going to help. As you’ve stated, this was not your attention. Unfortunately, now it sounds like you want to throw money at these people just because they are dying. A “non-medical” approach could be anything over the rainbow and back. Religious study could be a way to build better quality of life for several people deemed terminally ill and it would hardly cost anything. Each person is definitely not going to have the same outlook on what a better “quality of life” would be. Which is why this idea is just not making any sense to me. I completely agree that we should not force them to stay in a hospital or let them undergo some surgeries that may have a .1% chance of working, but just idly throwing money so they can increase their quality of life as they seem fit, also doesn’t work for me.
Help me get a better understanding of what exactly it is you are funding here.
7 admin // Nov 5, 2008 at 2:42 pm
Turbo: 1a) The information would be only accessible to medical staff. Obviously any widely used system can be easily hacked, but the information itself would not be very useful to anyone, since they don’t know whose it is. You make a good point about identity theft, but since the system is in no way tied to the insurance system, it would seem not all that useful. I agree that there are concerns but personally I would happily risk it, just so that every time I switch doctors (or dentists) I do not have to pay just to have the x-rays redone.
1b) If a doctor wants to use the data they buy the hardware (it has been coming down in price and becoming way more user friendly), if not he can justify to me as a patient why rather than spending $1000 (it’s less, but for the sake of argument) once to buy a finger scanner, the I must complete the same survey 4 times per visit, why I have to do an x-ray, even though I had one done last month across the street and why the doctor does not know what prescriptions I am taking, what sicknesses I had and what I am alergic to. We make medical professionals pay $1000s for certifications, $100,000s for education and yet we cannot expect them to buy one piece of hardware that would put my entire record at their disposal? That seems odd to me.
3) I am just now learning about hospice, so don’t take anything I say as gospel. But, in my understanding, hospice concept centers around a professional that gets together with a terminally ill person and their family and helps form a team and put together a plan that will help all the involved parties cope with the process of death. The nursing home is run by medical professionals who want to treat the sickness; hospice is centered around the concept of treating the person as a person. Hospice can be in a hotel, nursing home or home setting, but its focus is on helping the family cope through this time in their lives, rather than trying to avert it.
Look at it this way. You just found out that short of a miricle you have three months to live. You would want to make the most of these last three months. You would have a person whose job it is to help you cope with your feelings figure out what to do, give you advice regarding breaking the news to your family and work with them to help them cope with these news. The cost of a hospice arrangement is a small fraction of the hospital costs. It also relieves the shortage of doctors that we are going to be experiencing more and more over the next 10 years.
8 TurboBorland // Nov 5, 2008 at 6:53 pm
Sounds good, on all three points there.
Thanks for the deeper clarifications on all subjects and different aspects I presented.
Except one thing, it’s not really cost that these hospitals would be worried about. It’s time and technology. New technology is quit scary to a lot of people, turning your hospital from paper and pen into electronic form would probably seem like a scary venture for these owners. Imagine if something goes wrong, your biometric fingerprint scanners won’t work and no one can access customer records (I know it would be smart to have backup paper for this kind of event, but I’m trying to put myself in the shoes of searching out any and all possible problems as if I owned a hospital).
Now this would pay out in the end providing doctors with a plethura of information (and correct information from other doctors) and make less hassle for assistants, but they aren’t the ones who own the business.
9 admin // Nov 6, 2008 at 2:50 pm
Any new system has glitches and technical dificulties, but once a crytical mass of organizations has adopted it, there would be a tremendous pressure to adopt it for the rest of them. Since large chunk of payments comes from medicare/medicaid, the government is in a great position to “encaurage” the adoption of the new technology.
Thank you for a stimulating discussion. There are lots of new topics on which I hope to write shortly, would love to get your insight on those.
10 TurboBorland // Nov 11, 2008 at 2:10 pm
An interesting new technology that I am eagerly following is finger vein patterns. Take a look as several problems with fingerprint identifications are addressed and fixed with this new form of authentication.
http://technology.timesonline.co.uk/tol/news/tech_and_web/article5129384.ece
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