Tuesday, June 30, 2009

Resistance is meaninglessness

The most useful things I know of are all actually just tokens for metaphysical entities. Like words, formulas, money, contracts, and yeah, I suppose, even people. And although every bit of their utility never leaves the metaphysical realm, they don't become very usable until they have a functioning physical form.

A meme isn't even knowable by it's holder until we have a word or phrase that can adequately contain it. A fact about the structure of our world isn't all that much more tangible even after we've outfitted it with a perfectly tailored formula. It can take a great deal of training just to see a blurred image of it. And cash seems more real to us that the real things we trade it for that seem mostly fake! This should amaze us.

Contracts can actually be too real. And people aren't just real, their physical manifestation can even be nice, naughty, or if you're really lucky, both. My only point in all of this is to illustrate what wonderful things can happen when something metaphysical somehow gets inside a body that suits it. Because I think that trick might just lead us to a great deal more than cheaper health care.

So I've long wondered what metaphysical concept, property, or idea could be embodied into a tangible entity whose presence in our environment would just naturally lead to our becoming deeply enfranchised. (Whenever I ask my wife something like this she looks at me or responds like I've been caught preparing to torture her. It's not easy to discuss this stuff.)

I stumbled onto what I think might be a solution when I was looking at what a mess my room had become and wishing I had a copy of me to do all the things I didn't feel like doing but knew I should do. I know I could tell the clone what it ought to be doing and that it would agree because it could see I had much more important things to do. But by that point I didn't want my clone to do any work because I wanted his complete attention while I explained what seemed like a clever way to solve the problem I mentioned above. Besides, if my room wasn't such a mess I wouldn't have stumbled in the first place.

Competing with your virtual clone

I realized that if we are all better at telling ourselves what to do than we are at doing it ourselves, then maybe, if we could make a virtual copy of ourselves more tangible, we could use it to improve ourselves. It could be a very natural, private, and compelling process--if the only way to endow my avatar with a property was to achieve it in real life then I might be onto something. And I started to look for ways that might work.

Then I noticed that my soul is already in cyberspace (well, bits of it), why not just make it official as a tangible presence for ourselves by pulling those bits together? We can do that to some extent already at sites like facebook and youtube, but I'm picturing a node, or URI, that's connected in various ways to a great deal more. The safest node in cyberspace is the one that represents us in the universal health care transactor I described earlier.

You can't secure liberties without robustly engineering them into the fabric of society. You already have lots of nodes that represent you in cyberspace. I'm not too happy about that. In fact, you might say I'm sort of ticked off that our government is so careless about defending our privacy and the integrity of our identity. Just because it's more intangible than I am doesn't mean it's not rather important to me. And just because the bits of your soul are presently scattered about cyberspace doesn't mean that a clever piece of software can't box them together faster than you can say 'unholy packet.'

Giving our souls an address in cyberspace is the best way to ensure our government puts protecting them above even us. We just have to ensure that if they fail there is no longer a way for them to collect our taxes. It's the ultimate identity protector because it need never share anything the identifier doesn't have a need to know. If the software running the database is open source, and can be proven by anyone to be correct, and the mechanisms is uses to protect us from even the most sophisticated attempts of our own government to get at it are verifiably robust, I believe we will be a lot better off than if we leave things to our leadership to work out. This is a technology that needs to emerge from academia fully tested and ready for governments to deploy or be left out of a new economic reality.

I guess I never got to what I promised in the prior post--a mechanism whereby we encourage ourselves to make wiser health care choices. Whoops. Maybe I'll make it there with the next one. Right now I'd like to bite something resembling food.

Monday, June 29, 2009

Consequences of a single health care transactor

In my first post I talked about creating a selective pressure that could direct progress by narrowing economic opportunities to be mostly in the direction we want our economy to evolve. This is the sort of thing I was talking about. Finding ways that don't so much change things as they are now, but undermine their ability to grow in any direction besides improving. Here's how I think the single transactor system I describe in my previous post would affect our nation:

Fewer Health Care Lawyers.

The impact on of a single transactor system on everyone in the health care industry that doesn't actually provide health care is not good. The lawyers will most likely have less work because patients wont be suing insurers for coverage that can no longer be denied or delayed. (Obviously proving fraud on the part of the insured is important if it took place and the system must be designed to allow that to happen without simultaneously giving insurers access to enough information to cherry pick who they cover.) Less malpractice suits are likely too, because the transactor will have a lot more data and better tools to discover subpar providers quickly. Less contracts will be needed since the transactor will have standardized ones.

Less marketing and administrating. No sales force.

Marketing departments and advertisers will have less work since health insurance will be as generic as we can make it. A lot less clerks, accountants, and secretaries are likely to be needed since the transactor is handling all health care payments electronically. The sales forces aren't needed at all since health insurance could only be purchased via the transactor.

(This process of creative destruction is a rough but necessary part of capitalism. These jobs are artifacts of the system we have now and would no longer add value to a single transactor system. I do believe there is some injustice in destroying these jobs because they only exist as a consequence of our governments willingness to ignore the payroll tax fraud implicit in employer provided jobs perks.)

Wiser more competitive HMOs and Insurers.

Not having a brand-able product to market will leave insurers with only three ways to compete; lowering overhead, earning a higher yield with premiums, or improving their ability to deploy preventative medicine effectively (so that it genuinely does save money by reducing a patients need for more expensive treatment later.) Of those, it is the last one that promises the most profit. This tightly aligns the fortunes of both insurer and insured--they profit most by helping us stay as healthy as possible and via no other way.

Perhaps our government should encourage this practice even more by offering some fraction of the savings generated by a breakthrough in preventative medicine as a reward to the discoverers. I would prefer this to the patent mechanism we use now, for health care technologies, because it promises the most rapid deployment, avoids a great many costs, and can generate the same or even better financial rewards for the discoverer genuinely commensurate with the utility of their invention.

A national health care database.

A universal health care transactor will create more jobs than it will destroy. Jobs for people to build and maintain the databases needed, design the most efficient and error-proof input and output equipment for providers, and create tools for allowing users to find the information they're looking for in the database.

It offers more opportunities for entrepreneurs to create insurance, medical products, drugs, and information processing technologies for the heath care marketplace formed by a common transactor. This is because a very accurate idea of how much of a market exists can be purchased enabling a more competent and believable business plan to be developed.

It might fund itself. The transactor would have a lot of information of great value to insurers, researchers, and entrepreneurs and can be carefully regulated to protect the public and the intellectual property of its clients. If we are clever enough, we might make health care solutions as easy to discover, deploy, and profit from, as iPhone applications are today. But every one of these jobs will share the property that they are directly involved in improving the quality, access, or affordability of health care. Contrast that with the system we have now, where most of the profit comes from passing on costs to the insured if at all possible, or by marketing coverage more effectively.

Trading your lifestyle data for health care coverage.

Suppose you were able to collect a great deal of data about what you consume, when and how long you sleep, where you go, and what sort of exercise you get. A transactor is in the unique position of making that safe to do (best protecting the information from government and industry) while allowing you to profit from anonymized access to it. This kind of data will enable the most comprehensive understanding of any relationships that exist between lifestyle choices, health care needs, and effective preventative measures. It will help patients by giving their health care providers a better window into a patients health than even the patient themselves could deliver. And regardless of whether they are conscious at the time.

I think the best way to protect our privacy is to create a single regulated mechanism for collecting information about us and make it illegal for anyone else to maintain certain kinds of information about people. (They must use the regulated mechanism to both store and retrieve that sort of information when they have a legitimate use for it. This would apply to all government agencies as well.) This may seem backwards to many people--actually creating a formal way to store everything about us in order to protect us from exploitation by entities with exactly that information. I think this belief is naive. The information exists and is collectible today by pretty much anyone with the desire to do so. We're constantly reading about this or that database of credit card customers, patients, or credit union members being stolen and exposing those people to identity theft or other fraud. By requiring those companies to use a common, heavily regulated and protected store for that kind of information we can better protect it and improve the accuracy too. This is a threat I think we had better face head on and very seriously.

Right now companies that collect data about us are free to sell it. That's the source of a lot of the unsolicited invitations you get. That can't happen if we switch to a common store. Instead you'll browse a web site that shows you the list of outstanding offers to buy anonymized access to your data and can pick which, if any, you'd like to indulge. There will even be studies you can be paid to participate in that ask you to change something about your lifestyle for a test period because researchers have the ability to verify that you did. This should dramatically reduce the cost and improve the accuracy of a great many kinds of clinical trials.

All of these things work together to lower health care costs and protect our privacy. I believe they would improve our health care system a lot all by themselves. But there is one more minor change I'll propose in the next post that should do a lot more. And it consists of how we might better connect what we pay for the choices we make in life to the true cost those choices have on us and others.

A single transactor system

The Observation: A single transactor system is better.

If a provider must collect from the patient their expenses will be higher than if they collect from a single payer. This seems like the easiest way to save some money relatively quickly.

The Proposal:

Suppose that all money paid to health care providers for any professional service had to go through a single agency charged with the task of maintaining the records, protecting the identities of those involved, and ensuring that each provider's prices are consistent and independent of the source of the payment. (Not trying to set prices, but ensuring that the same service isn't billed at multiple prices.)

My Reasoning:

Most importantly it promises to lower costs by removing the burden of collecting fees from providers. It gives them the ability to discover the prices and ratings of their competitors which might also encourage them to be more competitive. And it assures us that all issues or complaints with any medical procedure will be funneled through a single agency allowing the highest degree of quality control.

It forces all providers, insurers, and other payers to register with the paying agency allowing them to establish the computer connections necessary to ensure the process takes place automatically, that the patients records are maintained in a standardized and secured place, and that those records are complete with respect to each transaction that takes place. It ensures that an accurate record of what each taxpayer spent on health care is available for tax preparation.

By establishing a single database of all medical procedures researchers can find trends and correlations that enable more preventative medicine to take place.
  • It allows for control over how much information insurers can know about those they insure making it harder for them to illegally cherry pick clients by canceling the riskier or more expensive ones. Once a company has registered their coverage it's up to the regulators to decide whether they should even get to know which of their clients needed it. It prevents the insurers from bullying individuals entirely, since everything must go through the transactor they'll have to treat all of their customers the same way.
  • It allows entrepreneurs access to the information they need to to find out where the greatest need for innovation exists and where their efforts are likely to pay off most.
  • It gives ordinary people access to a great deal of completely unbiased information in choosing between providers and insurers and gives them a reasonable idea of what it would cost them to self insure. Combined with a mechanism that allowed people to borrow some multiple of their prior years tax return for payments made through the transactor it could help people avoid finance charges for unexpected health expenses that break their budgets.

Related Video Clips

(I am not affiliated with any other these organizations in any way. The links are provided here as supporting testimony.)

Patient Privacy Rights is a 501(c)3 non-profit organization located in Austin, TX. Founded in 2004 by Dr. Deborah Peel, Patient Privacy Rights is dedicated to ensuring Americans control all access to their health records.

Glenn McGee on Health Data Chips on Prime Time with Erica Hill

Device connectivity should enable a single source of truth for patient data.

Sunday, June 28, 2009

The Heart of the Machine

Hi there. Let's get something straight right away--you're nothing but a dendrite to me and I want to keep it that way. If the internet can become a universal neural transmitter I think we should encourage it by participating. At least if we think we have something to say. It's a responsibility thing. And I believe responsibility is the mother of freedom. (Who the father is I have no idea--mother dated so many flamboyant memes.)

I think a beautiful thought is a lot like a beautiful body--the more naked the better. Take off your nationality, your religion, your prejudices, and even your species. I realize only humans can read this, but I want to connect to that part of you that is still just an earthling--a crew member on a space ship that is our solar system.

Because we can. Because we should. Because together we might find a way to best harvest the wisdom and insight of all humanity. I speak of a meta-government that is forming as we speak and will grow to focus the intrinsic political capital of billions so effectively that it rolls like a giant mass towards those solutions that promise our world the best future. Peacefully herding all governments to adopt a compatible policy. I don't think it matters now what happens ultimately in Iran--the damage to dictatorships has been done. I can think of no more fitting memorial to Neda Agha-Soltan than for her slaughter to be the spark that breathes life into a tool for focusing the collective voice of humanity.
(I sure wonder why someone always has to die senselessly before the rest of us are willing to finally fix something that's been broken forever. I sure hope this wasn't the reasoning behind murderous ancient rites, but then maybe they were onto something and we should give it a try. We could test out our fancy new global voting machine with a write-in election. That might do more to improve leadership than anything yet devised, and we're better off offing some schmuck instead of a random person ... Don't worry folks I already have handlers.)
I think a lot about how to encourage this process (not human sacrifice, making our political capital more tangible) but also know that anything that can go right eventually will if the bits necessary can stick around long enough. It's a corollary to the infamous Murphy's Law. Evolution is smarter than we are because it is so dumb it doesn't have the sense not to try that which shouldn't work but actually does. We're just too smart to be any good at designing anything. Brains evolved for observing and deducing so we could reason out ways to outwit pretty much everything we could name. Not for designing things that are arguably forms of life in and of themselves--like governments, products, and services.

And I reckon that explains why pretty much everything we try to engineer sucks when compared in any way to those things engineered by the process of natural selection. In fact, the best things we do make got that way by a very similar, almost natural, process--gradual refinement at the rate of marketplace success.

I'm trying to justify a different approach to engineering things like government, enterprises, and even products and services. Lets use our brains for what they're good at and look for ways to create a gentle selective pressure that will drive the evolution of better products, services, and lifestyles. Let nature do the heavy lifting while we pick which direction we want to go. I vote that we head towards long term steadily improving rather than just sustainable.

Man is the measurer of all things, not the measure. Our capacity to measure stuff dwarfs even our capacity to dream up crazy shit we'd like to measure. But there's a lot of stuff we don't even try to measure. Really important stuff, like the impact a given behavior has on others. Or the fairness of the laws and rules we force everyone to live by. We know so much about particles too small to see and so little about problems too big to miss. What could explain this? How is it that were willing to build a machine larger than most counties to look for something smaller than George Bush's brain when we won't spend one hundredth of that amount to look carefully at the economy that paid for that overgrown microscope in the first place?

I think it comes from a prejudice hidden in our ideology. We are predisposed to judge rather than discover. We have to work carefully and cooperatively just to accomplish the latter--we call it science. It's nothing bad or substandard about us, it's just a consequence of being an individual--how could any organism possibly handle the problem any other way? And excellent judges we are too. But not perfect, or even that close to it. Just really good which isn't enough for design. If your body was only really good you'd be dead. You have to be nothing less than utterly remarkable just to be able to have any kind of life as an organism today. (Note to religious people: predators don't always get what they prey for.)

And that's why I believe we should rethink the world we've made from the ground up with a fresh perspective that begins with measuring the unmeasured, which in this context is more about revealing the messages in the many measurements we already make to create a detailed map of our economy. In this way, when ordinary people can get a good appreciation of the workings of our world we'll be many times better at finding a constructive and pleasurable way to participate in it. We'll be better at whittling away the fat and waste that clogs and undermines our infrastructure, and we'll direct perhaps several times as much human power to the enormous potential our species has to make the biosphere we inhabit ever more robust, secure, and empowered.

Saturday, June 27, 2009

Our Response to the Iranian Election Crisis

Wouldn't it be nice if there was no way to cheat the citizens of any nation out of their vote?

I want Obama to immediately call for the formation of an independent international agency to conduct the elections of every participating nation.

He should invite every nation that holds elections to come together to craft a treaty that defines and empowers such an agency. It shouldn't just conduct elections, but prove to each voter and the electorate as a whole that the results are genuine. It should prevent governments from ever knowing how any given citizen voted and undermine their ability to gerrymander. And it should incorporate many safeguards that can actually detect when anomalies indicate coercion, or other kinds of fraud to have occurred upwind of the election.

I think this leverages the situation in Iran to encourage the most nations possible to endorse such a convention if only as a significant statement to Iran about their recent election fraud. It opens up the possibility of exploring alternative strategies for voting itself (and mathematics suggests there are many better ways, like ranking the candidates for a position rather than just indicating your first choice.) It gives us the option of eventually voting globally about global issues as a fringe benefit.

No nation wants to give up control of anything if it doesn't have to. But in this one case there really is a conflict of interest in allowing any government to have anything to do with conducting its own elections. Certainly a nation that actually wants a genuine electorate will acknowledge this and endorse the approach.

I like this as a response to the Iranian crisis because it brings the most legitimate pressure possible to bear on the Iranian government, allows the entire world to focus behind a single response, and focuses the issue squarely where it belongs without even mentioning a side in the conflict. It would be nice if they named it after Neda. I think this is the most effective blow we could deliver to the Iranian leadership.