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Doug K explains:

... 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....

I could not agree more. But we are still stuck with a political dilemma. We are not getting single-payer health care in the United States (which means, of course, that about a fifth of all Americans are not getting health care any time soon and the rest of us get crappy health care at the highest possible prices). That's the sad truth.

Additionally, we are unlikely to get a Clinton/Edwards version of expensive universality any time soon.

And, we are unlikely to stifle Microsoft's, Google's, and the Cleveland Clinic's efforts to create digital health databases.

So what are our political option? Do we refuse to intervene to push for necessary regulations on what Google and Microsoft are doing in hopes that further disasters generate the widespread political will for single-payer health care? Do we sacrifice the health and security of millions for the possibility of a better system someday?

This is one of the classic conundrums of incremental liberalism. There is no easy answer.


Comments (1)

"Do we refuse to intervene to push for necessary regulations on what Google and Microsoft are doing in hopes that further disasters generate the widespread political will for single-payer health care?"
in a word, yes: at least for the healthcare records. I am not so pessimistic about the political situation - the current state of health insurance is so appalling, I think there is a constituency to drive changes.

Google/MS won't get the healthcare records unless we give them the data: that is, it will take actual effort from individuals to submit their records to these hoards. The insurance industry already has its own databases, and won't be keen to give away the family jewels. Given the difficulties noted in my earlier post, I can't see that these new databases will be able to get sufficient data to be a concern. This is quite unlike the data harvesting that Google can do online with the greatest of ease.

A decent incrementalist plan for healthcare:

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Siva Vaidhyanathan

This blog, the result of a collaboration between myself and the Institute for the Future of the Book, is dedicated to exploring the process of writing a critical interpretation of the actions and intentions behind the cultural behemoth that is Google, Inc. The book will answer three key questions: What does the world look like through the lens of Google?; How is Google's ubiquity affecting the production and dissemination of knowledge?; and how has the corporation altered the rules and practices that govern other companies, institutions, and states? [more]

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Like the Mind of God (22 posts)

All the World's Information (26 posts)

What If Big Ads Don't Work (10 posts)

Don't Be Evil (9 posts)

Is Google a Library? (43 posts)

Challenging Big Media (18 posts)

The Dossier (19 posts)

Global Google (3 posts)

Google Earth (3 posts)

A Public Utility? (19 posts)

About this Book (16 posts)

Other books by Siva:


Rewiring the Nation: The Place of Technology in American Studies (Johns Hopkins University Press, 2007)

The Anarchist in the Library (Basic Books, 2004)

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Copyrights and Copywrongs: The Rise of Intellectual Property and How it Threatens Creativity (New York University Press, 2001)


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