From: "Michael Sims" <jellicle@inch.com>
Date: Wed, 29 Oct 1997 09:02:33 +0800
To: Declan McCullagh <declan@well.com>
Subject: (off-topic--delete now) Re: Search warrants and Senate hearing o
In-Reply-To: <l03110700b07aea1a56ee@[207.33.180.233]>
Message-ID: <199710290004.TAA12015@arutam.inch.com>
MIME-Version: 1.0
Content-Type: text/plain



> If you're going to respond to Tim's post, you should copy him or
> cypherpunks... I've attached your whole message below...
> 
> I will respond to one point, though:
> 
> >The free market approach won't keep medical records private.
> 
> We haven't tried that approach yet, at least in the late 20th
> century. The wealth of federal regulation and involvement in health
> care is breathtaking. Ever since after WWII when for tax reasons
> businesses began bundling insurance and the rise of
> medicare/medicaid, well, the "free market" in healthcare has become
> much less robust. (Fortunately Clinton's socialistic health care
> plan was derailed.)
> 
> 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.  That HMO shlepping your medical record around to a dozen
adminstrators to decide whether or not to pay for your care?  Those
huge insecure insurance databases with information about what
diseses you're genetically susceptible to?  Those intrusive
questions and psychological screening tests at job interviews? 
Those urinalysis tests which screen for the presence of illegal
drugs, undisclosed prescription drugs and nicotine, with the
intention of firing you if *any* of the above test positive?  All are 
examples of a free market in health care information.

Oh, there are a few examples of government-caused privacy violations 
of health-care information.  I'm thinking of mandatory HIV/AIDS 
disclosure laws, Medicare information, and the fact that the 
government still hasn't figured out that putting all the health-care 
information they can get ahold of into a big database is a bad idea.  
These can certainly represent gross threats to individuals' privacy.  
(Haven't CDT and EPIC discussed this from time to time?  Though not 
extensively on either of the lists this is sent to, where it's 
assuredly off-topic.)  Yet, these aren't the abuses that people 
complain about /today/.

You're confusing services and information.

The US has the closest to a free-market in health-care information of 
any of the industrialized nations.  And people suffer for it every 
day.  You can say it's cool, it's Libertarianism in action, or you 
can think it stinks.

But don't try to blame those abuses on the government.

I found it astonishing that Tim May wrote:

"All we need to ensure medical privacy is a return to the right of
contract. I pay Dr. Jones for his services and for his agreement to
not pass my medical file around to his buddies, or to sell it to
advertisers, or to let "counter-terrorism" agents snoop around in his
files. Sounds fair to me."

Tim, you've got that right today, with a few minor exceptions like
gunshot wounds.  You have it!  You can insist on only going to a
doctor, or only belonging to an HMO, that won't share your
information around town!  The government has nothing to do with it! 
This "problem" you're talking about is solely a market failure
resulting from a nearly-pure, barely-adulterated free-market --- 
completely confidential health services are hard to obtain because 
they cost more and there isn't a sufficient market!  Those privacy 
violations occur because it helps companies make a profit, which 
outweighs your measly privacy concerns!

Gawd, libertarians complaining about a market failure.  I may cry.  


-- Michael Sims