Tuesday, January 31, 2012

Technology Follows the Money

Information technology tends to follow the flow of the money.

In the insurance paradigm, money flows from big insurance pools to big hospitals and big pharmacy.

The result is that our health care information is in tightly controlled centralized networks.

The Medical Savings and Loan breaks apart the big pools into massively decentralized accounts. This money will be under direct control of the end user who will pay for medical care in cash directly to the doctor.

This change will transform the medical information system into a robust decentralized network.

Technology is morally neutral. Technology accomplishes what the programmers of the technology want to accomplish. Since our current technology was built to maintain insurance pools, the technology of our health care infrastructure was built for the primary purpose of advancing insurance companies.

In the medical savings and loan, people own their own health care resources. The technology in this new system will be built around helping the people.

Changing the focus of health care from pools to people would benefit society at large.

Monday, January 30, 2012

Information Driven Health Care

The goal of the Medical Savings and Loan is to restore the principle of self funded health care.

It is impossible to self-fund health care without good information about health care costs.

In a day when health care is dominated by big insurance companies. People hoping to self fund their care need to have a professional negotiator on their side to negotiate prices.

So, the first step to creating the Medical Savings and Loan is to start creating an infrastructure that allowed people to share and distribute health information.

To run the network, I created a position called the Health Care Advocate whose primary job is to record information on people's health experience, then to use this information to help people set up a structured savings plan.

If I found a group of people interested in pursuing the Medical Savings and Loan as an alternative to insurance, the people involved in the effort would find out that more work needs to go into creating this massively distributed network than in setting up the savings accounts.

The primary difference between the Medical Savings and Loan and Insurance is one of focus.

Insurance attempts to fund individual consumption with group resources. In this system, people pay into a group pool. The insurance industry then built a vast centralized information network around the pool.

The MS&L seeks to fund individual consumption through a widely distributed network of individual accounts.

To make the system work, you need a massively distributed network to share health care information.

Changing from a system of centralized group pools to individual accounts changes the focus of the information from the internal bureaucracy to the needs of the patient.

Anyway, the Medical Savings and Loan would be a really fun information project. That could be started the second that someone asks me to come and speak with their group.

Sunday, January 29, 2012

Life in an Information Society

When I try to engage in the health care debate, I am deluged with questions like:

"Do you know how much a bone marrow transplant costs?"

"Do you even know how much open heart surgery costs?"

"Do you even know how much chronic disease x costs?"

The answer, of course, is: "No!"

The amounts actually being paid for these procedures are closely guarded secrets of the health care industry.

We get anecdotal information from people's experience, but there is so much fudging going on in the billing system, that I find all the data I come across in the public domain suspect.

First of all, medicine is not a commodity. In a free market, the prices should vary according to conditions. Since health care is not a commodity, there will not be a commodity price for the care.

If you look at the real cost of heart surgeries, you should see some sort of bell curve depending on the conditions of the surgery.

To make matters even more confusing, major medical procedures often lead to chronic conditions (or occur as part of a chronic condition). A heart surgery followed by a chronic condition is more expense than one followed by full recovery.

Contrary to our fantasies, there is not a fixed commodity price for any medical condition. For every medical condition from acne to broken arms, there should be a wide selection of ever evolving treatment options with differing price tags.

In every case, the actions of the patients affect the cost of a condition. A person who exercises will respond better to most ailments than couch potatoes.

The amount of money people spend on health care also affected by the amount of money people have to spend on health care.

If you have a good record system in place, you can start asking intelligent questions about health care. If you had a big database on health expenses, you can do things like enter demographic information about a person and see how others in the same demographic group fared.

This is the direction that I want to take the Medical Savings and Loan. This program challenges people to self-fund their care with a system of savings accounts and loans.

The beating heart of the program is a distributed record keeping network run by a group of people called Health Care Advocates.

Your experience in the Medical Savings and Loan is that that you will periodically sit down with an advocate who maintains records regarding your health experience. The advocate will query the network for information about people in similar conditions to help you set up a structured savings plan to pay for your care.

When you need care, the advocate will query the network to see what others paying for a given service and help you negotiate pricing and service with local care providers.

The advocate will record info on the care you receive. NOTE: The system will periodically publish an abstraction of your expenses (with personal information removed).

In this network, you will control over both your health care resources and health records.

You will have an advocate who is directly in your employ who maintains your records. The advocate will have access to a rich database which shows how your experience compares to others.

The advocate will have both access to what people actually paid for expensive medical procedures and the likelihood that you will need such a procedure in your lifetime.

The current insurance paradigm actually gathers the same information. The difference is that it holds most of the information as a closely guarded proprietary secret.

The Medical Savings and Loan is more than just a financial gimmick. My hope is to transform health care from a system where pricing information is held internally as a closely guarded secret to one where pricing information is published externally in coordinated effort to help individuals self-fund their care.

Friday, January 27, 2012

Know Thyself

A driving principle of Health Care from ancient times to the era modern was "Know Thyself."

I read this aphorism to mean that the individual mind is the driving force behind the care of the individual body.

My goal in designing the Medical Savings and Loan was to create a structure in which the individual mind had greater control over the care of the body.

For several years I worked as a computer programmer for an insurance company. My job was to take information from paper medical records and to translate it into computer records.

To accomplish this goal, I was granted access to cabinets filled with informative and valuable health care records.

In the insurance paradigm, the health care records are the property of insurance companies, hospitals and other bureaucracies. The bureaucracy does not want people to have access to their health records as they would lose control.

For example, if you knew that your individual expected liability was $5000 a year, you probably wouldn't want to pay the $10,000 a year premium the insurance company charges.

The whole insurance industry is in direct opposition to the classical liberal tradition that sought to empower the individual to live full, happy and healthy lives.

I work in the computer industry. My primary concerns in life usually revolve around system architecture, processing records and writing code.

I know that this sounds as boring as all get-out, but my primary interest in designing the Medical Savings and Loan was the Health Care Records ... not the money.

The foundational premise of the Medical Savings and Loan is that the individual should own his own health care records. People lack the skills to maintain records; so they would hire a professional health care advocate to maintain the records.

Application Service Providers would create the technology used by the advocates to record the records. The service providers would essentially create a distributed network for sharing information about patients.

In this paradigm, you would own your health care records. The records would exist within a distributed network that is maintained by the Health Care Advocates.

Your experience in the Medical Savings and Loan we be a fun game where you would periodically sit down with an advocate in your employ to see how your individual health experiences contrast with the experiences of others.

The key to my vision isn't simply the money. The key to the vision is the ownership of the health records. I assert that the individual has a fundamental property right to their body and this right extends to thelr health records.

In contrast, insurance is built on the concept that they have property rights to your health care information. They use this information to build a massive centralized bureaucracy.

There is a fundamental dichotomy between the Medical Savings and Loan and insurance.  In the former, people own their resources in a distributed network. In the latter, insurance companies own the records and resources in a centralized monolith.

The primary health care debate has been about which big entity should own the monolith: big business or big government.

I don't want either group to own my health. I want to see a system in which individuals own their own resources in a massively distributed network.

Interestingly, this is the exact same issue as the conflict between main frame computers and a network of Personal Computers.

The internet is a distributed network of computers. So, my dream is not just pie in the sky. It has been realized in many areas of computing.

Thursday, January 26, 2012

Starting at the Beginning

The debate about health care usually begins with the small percentage of people who cannot self fund their care. The debate usually ends with cries to regulate if not nationalize care to handle the problem.

This is absurd.

A debate about health care should start with the vast majority of people who could, with a little guidance, self-fund their care.

If we built our health care system around the needs of the people who can self-fund their care, then we would find that the problem of those who cannot to be smaller and more manageable than it currently is.

The Medical Savings and Loan starts with a conversation about ways to help people self fund their care. Creating a model that helps people self fund their care helps identify those who cannot.

I've been blogging and tweeting about the Medical Savings and Loan on my primay blog for the last several years. The goal of my blogging was to build interest in the concept. In the last couple of week I've been fortunate to receive some responses.

So, I decided to take a second step to start a new blog, this blog, that would be exclusively about the challenges of self-funding medical care.

So, in this first post, I wish to scream from the hilltops that the health care debate should start in the positive space by looking at the needs of those who can self fund their care.

A well defined effort to help people self fund their care will create a knowledge base to help us identify those who are unable to fund their care. The tab at the top of this page titled Medical Savings and Loan introduces the plan I've put together.