healthcare nonsense

I see via the reliably interesting Jon Udell that yet another 'health-care database' is being trumpeted abroad in the land. Apparently neither Google nor Microsoft has noticed (or perhaps they prefer not to acknowledge) that the technical problem has been comprehensively solved already, by the Veterans Affairs medical system. The remaining problems are not technical but political. As Jim Gray benevolently wished for us, "may all your problems be technical". The world is full of smart people who can solve technical problems: all the smart in the world can't solve politics.

We can talk about 'shoulds' and 'translucency' all we like, in the end the insurance business will find a way to use such a database punitively.

The real question is how to arrive at a health-care system that doesn't punish the sick. The answer is technically simple but politically difficult. It starts with acknowledging that health care isn't a market. More accurately, it is a market, but the good being traded is healthy individuals, not health care itself. Senator Edward's health-care proposal (or Sen. Clinton's, as it's much the same thing) is a good first step. Once we have a system where we need not fear the database, we can proceed to establish evidence-based medicine.

Until that time, I will fervently oppose all attempts to establish a database of medical records. The incentives in our current system are so perverse, that the database will be very dangerous to our health.

A secondary issue is one of simple data gathering. According to the optimistic hurrahs of Microsoft,
"People want to be able to collect, and securely store, and share their private health care information which is today scattered all over the place, with doctor A and doctor B and hospital C, and wherever they were born."
Lovely. How do they propose to extract that information from doctors and hospitals ? For them, that data is part of their competitive advantage. Whenever I get tests or procedures done (and I've had a lot recently) the results are kept secret from me: sent only to my doctor and doubtless a variety of financially interested parties, insurance companies, and so on. On a few occasions kindly nurses or technicians have actually shared the information with me, but that's the exception. For the most part an inquiry as to obtaining the technical details is treated with a kind of amazed wondering contempt by the administrative staff.

Another notable database effort is the Personal Genome Project. In the different world where this information wouldn't be used by insurance companies to deny care, I'd enthusiastically volunteer. Well, maybe not, given the involvement of the egregious Ms. Dyson.

Update October 2007: turns out these databases aren't subject to the HIPAA privacy regulations. Microsoft's response ? "Trust us". Well, no, I believe I won't.

Update March 2008: ars technica has a decent overview of the situation. The takeaway: "many of the reasons for poor US health outcomes have much deeper structural roots related to a lack of preventative care versus emergency care, issues that are tied in to the lack of a universal healthcare system and the nature of insurance companies, that are outside the scope of medical records databases".

On a related note, the faery realm of consumer-directed health care: how is it that society spends six to ten years training doctors to provide health care, then rewards them handsomely for their expertise: yet, once the market fairy appears, consumers (who may not have completed high school) are supposed to be able to 'direct' their own health care ?
For what value of 'direct' can this policy actually work ?
Airily assuming that the policy works, the next question arises - What is the market failure that makes doctors so expensive, when untrained consumers are able to effectively make the same decisions and determinations as said doctors, about their health care ?