From: frantz@netcom.com (Bill Frantz)
Date: Tue, 20 Aug 1996 16:33:31 +0800
To: Rich Graves <cypherpunks@toad.com
Subject: Re: "Utilization Review"
Message-ID: <199608200618.XAA18824@netcom8.netcom.com>
MIME-Version: 1.0
Content-Type: text/plain


At  5:58 PM 8/19/96 -0700, Rich Graves wrote:
>On Mon, 19 Aug 1996, Bill Frantz wrote:
>> Perhaps, within our current social order, medical savings plans
>> are the best option on the table.
>
>What alternative social orders can you envision that would handle this
>problem elegantly? I can't think of any off the top of my head.

Well, under Cryptoanarchy the whole problem disappears.  Your medical
records are handled as per your contract with your doctor.  There are no
3rd party payers who have a stake.  With no taxes, the deduction for
medical savings plans disappears and with it the principle reason for them.
 (People would still need to save for medical costs.)
 

>Medical savings plans do not work for anyone but the extremely rich and
>healthy, because few normal people can self-insure to cover the risk.

The risk of catastrophic illness is indeed significant, but statistically
rare.  If we assume people will insure for it, and insurance companies
still have access to the records of the care they pay for, then we are
still better off than we are today with all care being paid by insurance
companies.  In this scenario, routine medical care is being paid by the
patient, and the records can be private between the patient and the doctor.
 This kind of system would prevent the general availability of information
such as whether a patient had a vasectomy.

Note that in the general case, people are healthy in their youth, and can
build up savings for when health problems develop with age.  TANSTAAFL.  On
the average, everyone has to pay the cost of their medical care.


>There's also the little matter of letting your doctor know your medical
>history.

I have no problem letting my doctor know my medical history protected by
doctor-patient confidentiality.  It's the insurance company/human resources
department/government access I worry about.


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