From: tcmay@netcom.com (Timothy C. May)
Date: Sat, 13 Aug 94 13:32:20 PDT
To: matsb@sos.sll.se (Mats Bergstrom)
Subject: Re: Why Cash is So Important
In-Reply-To: <Pine.3.85.9408131440.A23299-0100000@cor.sos.sll.se>
Message-ID: <199408132032.NAA14779@netcom13.netcom.com>
MIME-Version: 1.0
Content-Type: text/plain


> Timothy C. May wrote:
> 
> <good arguments for using cash deleted>
> 
> > - temporal extent implies record-keeping, such as insurance records,
> > hospital visits, etc. This is automatically a potential privacy
> > concern.
> 
> Yes, but...  An insurance company would hardly accept a totally
> anonymous agent as a customer, for obvious reasons (how would they
> know that the agent was paid for by the body needing repair and not
> used for an unfortunate uninsured friend?). Now, if there was only

I wasn't arguing that insurance companies would take anonymous
customers, per se, though I suspect a privacy-preserving system could
in fact be designed. In systems where a customer and insurance
provider work out a mutually-beneficia contract, and where there is no
requirement to forward records to the government, then privacy is
mostly maintained.

The concern many of us have is with systems in which governments
demand to be "silent partners" in all contractual relationships.

> > (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.)
> 
> One problem with cash here is of course the high costs of helth care,
> making it necessary for almost everybody to be insured if they are
> not suicidal or willing to gamble their lifes. Another problem is the
> unconsious-patient situation - or half-consious, might be hard to
> remember the password to the e$ anonymous account. 

I'm not insured. Most health-care costs are payable directly...unless
and until the U.S. gets a socialist health care system, in which case
I'll still be uninsured (I'm not employed, I'm not indigent, so I
won't be covered by any of the current proposals, as I understand it).

I'm not going to digress further into insurance issues, except to say
that insurance has had the bad effect of decoupling payments and
services, a la the well-known "tragedy of the commons." People pay for
insurance, or their companies do, and then they try to demand the
largest number of services...it's game-theoretically advantageous for
them to do so. Hence the $2000 almost-obligatory CAT scan upon
entering a hospital in the U.S. (fed also by the malpractice
racket--doctors order these $2000 CAT scans to cover their asses
against lawsuits and because they get legal kickbacks for these
services).

Life expectancy, in the U.S. at least, has remained at roughly 72-74
years for the past couple of decades, so this huge health care
industry has had little real effect on our chances of living longer.
For the rare person who is in fact saved by this expensive system, it
is "worth it," of course. But the aggregate benefits tell a different
story.

The relevance to Cypherpunks? I don't know, but it's partly connected
to issues of whether centralized systems and record-keeping are a good
idea.

I actually see no reason why we as potential patients should not carry
around our medical records ourselves. Perhaps in a smart card...the
technology has existed for years. Or in a "medical bracelet" which
either directly contains local storage (flash memory, for example) or
contains a pointer to a file on the Net--and access information, if
encrypted, as it should be--which contains relevant medical
information and perhaps even financial payment instructions.


Selective disclosure of credentials, a la Chaum, should apply quite
naturally to medical care. A dossier society is not needed.

(I don't demand that others use such a system, only that I and my
medical contractor not be required to use someone else's idea of a
system. Seems fair to me.)

--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.
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"National borders are just speed bumps on the information superhighway."