From: Tim May <tcmay@got.net>
Date: Thu, 30 Oct 1997 02:35:14 +0800
To: cypherpunks@cyberpass.net
Subject: Protocols for Insurance to Maintain Privacy
In-Reply-To: <199710291412.GAA29666@sirius.infonex.com>
Message-ID: <v03102802b07d0f3d4e21@[207.167.93.63]>
MIME-Version: 1.0
Content-Type: text/plain



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."