17 ms·

Medical Anarchy

45 points by prot 13y ago

kevingadd 13y ago
I'm bothered that this article seems to believe that the rise in homeschooling (in large part by unqualified parents using low-quality textbooks and ill-considered strategies) is another example of people 'opting out' of some particular brand of oppression by the State, and that doing so will increase supply, or something? As far as I'm concerned, students have a right to a high quality education because without one their future will be a trainwreck. Just because they're largely minors doesn't, to me, mean that their parents have the right to deny them a future in favor of whatever their personal reasons may be. Yes, this is an infringement on the 'rights' of parents, but I don't think parents have the right to treat children like property in the first place. And yes, there are some parents who do a great job homeschooling; I'm sure of it. I've just never met them, and I was extensively involved in local homeschooling programs back in my home town, so I interacted with dozens of homeschooling families, hundreds of homeschooled kids, and visited some of the organized conventions and programs that involved thousands more. Too many of these people simply aren't qualified to teach a child from the beginning up to college age, even if they may have the legal freedom to do it. As it relates to the article's premise: I also think individuals have a right to reasonable health because it is integral to their future. A nation full of sick people is going to be a nation with low productivity and a high tax burden from running things like emergency rooms. It is in our best interest to offer everyone affordable access to some basic minimum level of health care, and to do so in the cheapest possible manner. The author seems to believe that a comparison shopping website for doctors will deliver affordable health care to everyone, but I think he ignores a few essential issues that could make it impossible for such a website to deliver good results: a) Even now, many people who need health care do not have regular access to the internet. This is in part due to the huge stretches of rural America, but it is also due to the fact that we have a huge homeless population and a huge low-income population, both of whom may not even be able to afford the equipment necessary to get on the internet. You certainly aren't going to propose giving them free equipment and internet access so they can go buy health care on a website. b) It is arguably impossible to comparison shop for essential health care. You don't have the time to waste on it and you are emotionally/mentally compromised by the stress of your impending doom. To a degree, this is correct - you should be prioritizing your own well-being. It should be the responsibility of everyone else in the system to try and keep costs for this essential care to a minimum; instead, a profit-driven health system tries to maximize profit off this essential care, and deny claims to as many dying people as possible. Introducing more profit motive into this system does not seem like it will fix anything. c) Medical practice over the internet without licenses is simply a recipe for disaster. I am willing to accept that a licensed doctor could perhaps perform a subset of their duties over the internet; I occasionally email my doctor instead of visiting them in person when I need minor adjustments to medicine doses, and that is fine - both sides are fully informed and no corners are being cut. However, if you're not even going to license them to verify that they meet the basest standards of medical competence, you'd be mad to also let them practice without ever seeing a patient in person. It's just a bad idea. We have enough issues with malpractice and patients being sold treatments they don't need as things are; removing licensing and medical standards will make this worse as both of those problems can be increased by a profit motive. d) Comparison shopping for long-term health care seems nearly impossible since in many cases, if you discover the care you are getting is suboptimal, it is too late to switch - whether because of pre-existing conditions, or because the care is ongoing and transferring to another provider would put you at risk. You can't trivially ask to have your dying father moved to an intensive care unit across town just to save a couple thousand dollars, even if you CAN do it.
- eurleif 13y ago
  >Just because they're largely minors doesn't, to me, mean that their parents have the right to deny them a future in favor of whatever their personal reasons may be. Yes, this is an infringement on the 'rights' of parents, but I don't think parents have the right to treat children like property in the first place. So the issue is that the parents are forcing a decision on the child, in violation of the child's rights? What if the child wants to be homeschooled?
  - kevingadd 13y ago
    That would be fine with me, but we have precedents establishing that minors are not well-equipped to make important decisions for themselves (at least until they're older). So I don't know if they can actually make that choice. I know a couple kids who preferred homeschooling, but mostly because it was easier than going to school. That was to their detriment later on when they started college. I don't know if that makes it wrong, though. Education is definitely not one-size-fits-all. You could make the libertarian/capitalist argument that if a child is really lazy and wants to do highly relaxed homeschooling that won't prepare them for college, that's fine, and they can just accept never having a good job or lifestyle, I guess? I don't really like that. If the parent prefers homeschooling but doesn't have the time/energy to do it right, is that similarly fine? Or do they have an obligation to deliver their children an adequate education, just like they have an obligation to feed and care for them (otherwise the kids will be taken away)?
    - eurleif 13y ago
      Anecdote time: I was not just homeschooled, but unschooled. Unschooling basically means that instead of my parents teaching me, I was expected to learn on my own. They provided some direction and assistance, but they weren't especially well-equipped to teach, and I was always free to choose not to learn something, which I absolutely did do out of laziness sometimes. I got very into programming, and when I was 18, I launched a Web site which succeeded wildly, and has been paying my bills ever since. I did fine on the SAT, and I had a 4.0 GPA during the year I spent in college. (I left after that to run my company.) My feelings on unschooling are complicated. Knowing how it turned out, there is no way I would go back in time and make my parents send me to school. But I can easily imagine alternative outcomes where I end up dying in a ditch instead of starting a company. I don't think I would ever unschool a child myself. But since I'm happy with how unschooling turned out for me, how can I support a law denying those potential benefits to everyone else? That's essentially a law against what caused me to be who I am. I'm fairly certain that if I'd been sent to school, I wouldn't have started my company. It was the result of endless hours of tinkering -- time I wouldn't have had if I'd been busy with homework. It's a bit like doing a startup versus working a normal job. If you do the startup, you might lose all your cash and fail; but you also have a small chance of winning big. High risk, high reward. The job will give you consistent pay, with no chance of losing your hat; but also with no chance of a big win. Low risk, low reward. High risk certainly isn't for everyone, but imagine a world where no one ever took risks.
pak 13y ago
Disclosure: I'm currently attending medical school in New York. It seems incredibly irresponsible for a doctor to prescribe things based on an internet conversation without a physical exam. You can't auscultate (listen to with a stethoscope), visually inspect, run labs, do basic imaging, etc. over an anonymous internet forum, which are basic facilities that anybody should expect a doctor in the US to utilize. It is plainly evident, once you become involved in clinical encounters, that you discover things on exam that the patient didn't know about, forgot to tell you, or wouldn't be able to find themselves. These findings are often critical for diagnosis. Telling the patient to take a certain drug without that data is dangerous and irresponsible. You could certainly offer general "advice", but this will never be a substitute for seeing a doctor. Perhaps interfaces with video and sound are able to up the bandwidth of internet medicine but currently there is still too wide of a gap between that and actually laying hands on the patient. I was not surprised to find that this is exactly what the linked document of related policies by state medical boards states for New York (http://www.fsmb.org/pdf/InternetPrescribing-law&policylanguage.pdf http://www.fsmb.org/pdf/InternetPrescribing-law&policylangua...): Section 80.63 of the controlled substance regulations requires a practitioner to physically examine a patient prior to initially prescribing a controlled substance. Issuing a prescription for a controlled substance solely on the basis of a questionnaire or other medical history submitted to a practitioner over the Internet does not meet the requirement of a physical examination or establish a legitimate practitioner-patient relationship and is not a valid prescription. I cannot find anything controversial about that. I am all for forums linking doctors to talk to more patients, even for payment, but keep the "MD" out of the name because this is not a true substitute for seeing a doctor.
- lotsofmangos 13y ago
  I think attempts like this are symptoms of something really badly broken. It obviously isn't a good solution, but for anyone to even be thinking of seriously implementing it speaks volumes.
  - joe_the_user 13y ago
    Yes, but it is a symptom of the medical system being badly broken or a symptom of how we think about these kinds of problems being badly broken...? Come to think of it, it's both!
mwnz 13y ago
I stopped reading when the author implied that the U.S healthcare systems woes were due to supply and demand. This is a shallow view of a completely broken system. The supply and demand ratio is comparable to that of other wealthy nations, yet almost every other wealthy nation has kept their health care industry in check.
- thomas_eh 13y ago
  this
steveklabnik 13y ago
I'm quite torn about this. In some ways, it seems massively irresponsible, but framed another way, it makes some sense. I think it's important to distinguish here between "screw experts they don't know anything" and "I've taken your professional opinion into account, and will be making my decision." The second has a long, long history in anarchist thought: > Does it follow that I reject all authority? Far from me such a thought. In > the matter of boots, I refer to the authority of the bootmaker; concerning > houses, canals, or railroads, I consult that of the architect or the > engineer. For such or such special knowledge I apply to such or such a > savant. But I allow neither the bootmaker nor the architect nor the savant to > impose his authority upon me. I listen to them freely and with all the > respect merited by their intelligence, their character, their knowledge, > reserving always my incontestable right of criticism and censure. I do not > content myself with consulting a single authority in any special branch; I > consult several; I compare their opinions, and choose that which seems to me > the soundest. But I recognise no infallible authority, even in special > questions; consequently, whatever respect I may have for the honesty and the > sincerity of such or such an individual, I have no absolute faith in any > person. Such a faith would be fatal to my reason, to my liberty, and even to > the success of my undertakings; it would immediately transform me into a > stupid slave, an instrument of the will and interests of others. > > - Bakunin, "What is Authority" http://www.panarchy.org/bakunin/authority.1871.html
chimeracoder 13y ago
> The AMA, which is little more than a union for doctors, doesn’t allow any policy changes that threaten to increase competition and reduce their monopoly profits That's like saying that Comcast/Time Warner are a "union for Internet users". If the AMA were "little more than a union for doctors", doctors would have a lot more respect for it, instead of the great contempt that they currently do. If anything, you could argue that, because power follows the money, the AMA is an advocate for the insurance companies that the doctors are beholden to (essentially every doctor in the country must pay their fees to the AMA in order to process billing, because the AMA has a monpoly on that[0]). One of the big disadvantages of dissociating with the AMA (yes, a provider can do this) is losing the ability to use these insurance codes. I don't think that that characterization is quite fair either, but it's a lot more correct than saying that the AMA is a union for doctors. If you want to know more about CPT codes and billing, my startup[1] works with hospitals and outpatient providers to handle the billing process - I am happy to tell you far more about CPT codes than you ever wanted to know. :) [0] The AMA owns and controls the CPT codes - the billing codes that payers use. The providers don't always pay them directly (especially if they're not independent practitioners), but they do end up paying them in the end. [1] https://www.boardrounds.com/ https://www.boardrounds.com/ (plugging shamelessly because it's relevant).
- ary 13y ago
  As someone who had to license CPT codes for my own (now dead) medical billing app I can say unequivocally that the AMA is laser focused on getting their money. We had to pay a fee per user just so clerks could more easily process Medicare claims. Without a doubt the U.S. Federal government created a state-sanctioned monopoly in the AMA. That a private organization gets to profit from a public program (and much more) by having control of what amounts to an index table is nuts.
- nickff 13y ago
  >"That's like saying that Comcast/Time Warner are a "union for Internet users"." Comcast and Time Warner are most comparable to hospital chains in the medical context (or perhaps insurers, depending on what parameters you choose for the comparison). >"If the AMA were "little more than a union for doctors", doctors would have a lot more respect for it, instead of the great contempt that they currently do." Many rank-and-file union members hold their organizations in contempt. >"If anything, the AMA is an advocate for the insurance companies that the doctors are beholden to" The AMA's members are physicians, and other medical personnel; you may look at the AMA as a union, lobbying group, or a professional association, but it is certainly not advocating for the interests of the insurers.[1] [1] http://www.ama-assn.org/ama/pub/membership/faqs.page http://www.ama-assn.org/ama/pub/membership/faqs.page?
01Michael10 13y ago
This article is for real? Am I missing something? Sure, people want a diagnosis and other services from an unregulated, anonymous doctor with a reputation built by what? Amazon-like reviews? Come on!
- wyager 13y ago
  It worked fine with drugs while the Silk Road was running. No reason it couldn't work with medicine as well.
- eli5 13y ago
  That's not like that at all. As far as I understand all answers doctors give are open to the public on the site, so everyone else on the internet, including other doctors, can read them and say if it's a good answer or a bad answer. I imagine if this sites starts issuing bad advice, no one would want to go there. However, as of right now, it appears you are wrong and answers are getting paid for by willing customers. Now, this idea may be far from perfect. But comparing it to the existing system while having a blind faith in it is wrong. In our existing system patients don't have many options of checking what their doctor tells them; they are referred to doctors by other doctors and very often have no way of checking on the reputation (% of successful operations this doctor conducted, for instance). The current system is very inflexible and not consumer oriented at all. Consumer interests are sacrificed in the name of their supposed safety, without first giving said consumers options to decide what they actually want and consider safe.
  - 01Michael10 13y ago
    I am not referring to CoinMD so much but this paragraph... "Imagine a future where renegade doctors shun licensing laws and practice medicine over the internet. They build up a reputation around an anonymous identity. Use public key cryptography to sign their diagnosis, reassuring the patient that it really came from them. It’s not hard to imagine this would create a demand for anonymous accreditation agencies. These agencies could issue exams and then use their digital signature to sign the credentials of doctors who pass the exam. Patients pay for these services in anonymous currency ― Bitcoin ― and pay fraction of the price they would pay to the government enforced monopoly."
vezzy-fnord 13y ago
Time for a reality check. Okay, so I like the idea of CoinMD. It's a nice way for people with medical knowledge to get paid for their tips, but so far that's really about it. It's just yet another forum for medical advice, but with a gimmick. It's not even an original gimmick. The whole "integrate Bitcoin into everything" appears to be motivated by more of a cargo cult to appear modern and countercultural than anything rational. However, it does offer an alternative payment system and in this case it works, so I won't complain about that. But can we please let go of these childish fantasies that Bitcoin will overthrow all government and usher us into an anarchist utopia of voluntaryism and global human liberation? Those kinds of libertarian/anarchist pipe dreams were excusable during the very beginning of Bitcoin, when the protocol was still being sharpened and everyone was enthusiastic about this new idea. I don't know what kind of world the author lives in where he thinks people posting textual descriptions of their conditions on the Internet, backed by a digital currency, will revamp the healthcare system into an anarcho-capitalist institution and turn government irrelevant? What bullshit. Do I seriously need to explain that writing about your condition isn't enough to get diagnosed with anything beyond the most rudimentary of advice ("This might be that, but I'm not sure. Go see a doctor and try this herb in the meantime to see if it stops.")? Bitcoin will not render government irrelevant. You see, the thing is that even if the concept of Bitcoin theoretically can allow financial independence from the state, it's completely meaningless when your ecosystem is a mess. The Bitcoin ecosystem, as we have witnessed so many times, is absolute chaotic mayhem that can ironically only be controlled through state regulation, which many hardcore Bitcoiners are advocating for. Homeschooling is opting out of the state? Uh, last I checked, homeschooling requires one to be registered with the state, as well as offer vigorous and regular checks with it to ensure you're in line. The Silk Road isn't any different from your standard drug dealing market, only it's online and just as volatile and unreliable as the physical thing. Look, Bitcoin is certainly capable of great things, but these here are just naive pipe dreams.
- eli5 13y ago
  So, do you think that if enough people want to peacefully live without government interference at all (e.g. without a government) they don't deserve to do so and they don't deserve, for example, to be sold a piece of land to completely secede from state?
chiph 13y ago
You'd want that your physician has more training than just having read some WebMD articles. How can you be sure? What about liability in case they're wrong? A coworker lost a relative last year because the doctor missed an obvious case of septic infection. How do you take an anonymous physician to court for a mistake like this? Hard to pay restitution when the injured party dies.
- final_approach 13y ago
  Punishment is just one way of ensuring doctors pay attention. And as many people find out, it doesn't actually work simply because doctors make mistakes anyway. Now, for a price $10 I don't think anyone should expect any kind of liability. It's advice. If someone gives you a $10 take it as such and go see another doctor for $100 if you're unsure. To my understanding CoinMD simply provides what market needs: cheap accessible advice of reasonable quality. If you could sue doctors there, prices wouldn't be as low.
etanazir 13y ago
MD = Monopoly on Drugs
baddox 13y ago
I think an even better example of potential crypto-anarchist success is legal advice. It could work largely the same as the medical service this article describes, but legal advice fits better than medical advice.
psaintla 13y ago
So they are hoping people will make medical decisions based on advice from an anonymous doctor whose credentials you cannot verify and who does not have prescribing ability? Is this serious?
hershel 13y ago
Another interesting thing to do is having a high quality medical expert system(Watson), running outside the u.s.(say africa[1]) with people who we're taught how to use it(even doctors), with access to video communication with the patient, with access to his test results - administer advice to him. Assuming good , mostly automated process and a good expert system - this could be a way to offer highly accurate second opinion. And it would be a perfectly legal service from the provider side. [1]This could be used locally in the country, which is a nice way to augment/start a country medical system

45 points by prot 13y ago

I'm bothered that this article seems to believe that the rise in homeschooling (in large part by unqualified parents using low-quality textbooks and ill-considered strategies) is another example of people 'opting out' of some particular brand of oppression by the State, and that doing so will increase supply, or something? As far as I'm concerned, students have a right to a high quality education because without one their future will be a trainwreck. Just because they're largely minors doesn't, to me, mean that their parents have the right to deny them a future in favor of whatever their personal reasons may be. Yes, this is an infringement on the 'rights' of parents, but I don't think parents have the right to treat children like property in the first place. And yes, there are some parents who do a great job homeschooling; I'm sure of it. I've just never met them, and I was extensively involved in local homeschooling programs back in my home town, so I interacted with dozens of homeschooling families, hundreds of homeschooled kids, and visited some of the organized conventions and programs that involved thousands more. Too many of these people simply aren't qualified to teach a child from the beginning up to college age, even if they may have the legal freedom to do it. As it relates to the article's premise: I also think individuals have a right to reasonable health because it is integral to their future. A nation full of sick people is going to be a nation with low productivity and a high tax burden from running things like emergency rooms. It is in our best interest to offer everyone affordable access to some basic minimum level of health care, and to do so in the cheapest possible manner. The author seems to believe that a comparison shopping website for doctors will deliver affordable health care to everyone, but I think he ignores a few essential issues that could make it impossible for such a website to deliver good results: a) Even now, many people who need health care do not have regular access to the internet. This is in part due to the huge stretches of rural America, but it is also due to the fact that we have a huge homeless population and a huge low-income population, both of whom may not even be able to afford the equipment necessary to get on the internet. You certainly aren't going to propose giving them free equipment and internet access so they can go buy health care on a website. b) It is arguably impossible to comparison shop for essential health care. You don't have the time to waste on it and you are emotionally/mentally compromised by the stress of your impending doom. To a degree, this is correct - you should be prioritizing your own well-being. It should be the responsibility of everyone else in the system to try and keep costs for this essential care to a minimum; instead, a profit-driven health system tries to maximize profit off this essential care, and deny claims to as many dying people as possible. Introducing more profit motive into this system does not seem like it will fix anything. c) Medical practice over the internet without licenses is simply a recipe for disaster. I am willing to accept that a licensed doctor could perhaps perform a subset of their duties over the internet; I occasionally email my doctor instead of visiting them in person when I need minor adjustments to medicine doses, and that is fine - both sides are fully informed and no corners are being cut. However, if you're not even going to license them to verify that they meet the basest standards of medical competence, you'd be mad to also let them practice without ever seeing a patient in person. It's just a bad idea. We have enough issues with malpractice and patients being sold treatments they don't need as things are; removing licensing and medical standards will make this worse as both of those problems can be increased by a profit motive. d) Comparison shopping for long-term health care seems nearly impossible since in many cases, if you discover the care you are getting is suboptimal, it is too late to switch - whether because of pre-existing conditions, or because the care is ongoing and transferring to another provider would put you at risk. You can't trivially ask to have your dying father moved to an intensive care unit across town just to save a couple thousand dollars, even if you CAN do it.

eurleif 13y ago
>Just because they're largely minors doesn't, to me, mean that their parents have the right to deny them a future in favor of whatever their personal reasons may be. Yes, this is an infringement on the 'rights' of parents, but I don't think parents have the right to treat children like property in the first place. So the issue is that the parents are forcing a decision on the child, in violation of the child's rights? What if the child wants to be homeschooled?
- kevingadd 13y ago
  That would be fine with me, but we have precedents establishing that minors are not well-equipped to make important decisions for themselves (at least until they're older). So I don't know if they can actually make that choice. I know a couple kids who preferred homeschooling, but mostly because it was easier than going to school. That was to their detriment later on when they started college. I don't know if that makes it wrong, though. Education is definitely not one-size-fits-all. You could make the libertarian/capitalist argument that if a child is really lazy and wants to do highly relaxed homeschooling that won't prepare them for college, that's fine, and they can just accept never having a good job or lifestyle, I guess? I don't really like that. If the parent prefers homeschooling but doesn't have the time/energy to do it right, is that similarly fine? Or do they have an obligation to deliver their children an adequate education, just like they have an obligation to feed and care for them (otherwise the kids will be taken away)?
  - eurleif 13y ago
    Anecdote time: I was not just homeschooled, but unschooled. Unschooling basically means that instead of my parents teaching me, I was expected to learn on my own. They provided some direction and assistance, but they weren't especially well-equipped to teach, and I was always free to choose not to learn something, which I absolutely did do out of laziness sometimes. I got very into programming, and when I was 18, I launched a Web site which succeeded wildly, and has been paying my bills ever since. I did fine on the SAT, and I had a 4.0 GPA during the year I spent in college. (I left after that to run my company.) My feelings on unschooling are complicated. Knowing how it turned out, there is no way I would go back in time and make my parents send me to school. But I can easily imagine alternative outcomes where I end up dying in a ditch instead of starting a company. I don't think I would ever unschool a child myself. But since I'm happy with how unschooling turned out for me, how can I support a law denying those potential benefits to everyone else? That's essentially a law against what caused me to be who I am. I'm fairly certain that if I'd been sent to school, I wouldn't have started my company. It was the result of endless hours of tinkering -- time I wouldn't have had if I'd been busy with homework. It's a bit like doing a startup versus working a normal job. If you do the startup, you might lose all your cash and fail; but you also have a small chance of winning big. High risk, high reward. The job will give you consistent pay, with no chance of losing your hat; but also with no chance of a big win. Low risk, low reward. High risk certainly isn't for everyone, but imagine a world where no one ever took risks.

pak 13y ago

Disclosure: I'm currently attending medical school in New York. It seems incredibly irresponsible for a doctor to prescribe things based on an internet conversation without a physical exam. You can't auscultate (listen to with a stethoscope), visually inspect, run labs, do basic imaging, etc. over an anonymous internet forum, which are basic facilities that anybody should expect a doctor in the US to utilize. It is plainly evident, once you become involved in clinical encounters, that you discover things on exam that the patient didn't know about, forgot to tell you, or wouldn't be able to find themselves. These findings are often critical for diagnosis. Telling the patient to take a certain drug without that data is dangerous and irresponsible. You could certainly offer general "advice", but this will never be a substitute for seeing a doctor. Perhaps interfaces with video and sound are able to up the bandwidth of internet medicine but currently there is still too wide of a gap between that and actually laying hands on the patient. I was not surprised to find that this is exactly what the linked document of related policies by state medical boards states for New York (http://www.fsmb.org/pdf/InternetPrescribing-law&policylanguage.pdf http://www.fsmb.org/pdf/InternetPrescribing-law&policylangua...): Section 80.63 of the controlled substance regulations requires a practitioner to physically examine a patient prior to initially prescribing a controlled substance. Issuing a prescription for a controlled substance solely on the basis of a questionnaire or other medical history submitted to a practitioner over the Internet does not meet the requirement of a physical examination or establish a legitimate practitioner-patient relationship and is not a valid prescription. I cannot find anything controversial about that. I am all for forums linking doctors to talk to more patients, even for payment, but keep the "MD" out of the name because this is not a true substitute for seeing a doctor.

lotsofmangos 13y ago
I think attempts like this are symptoms of something really badly broken. It obviously isn't a good solution, but for anyone to even be thinking of seriously implementing it speaks volumes.
- joe_the_user 13y ago
  Yes, but it is a symptom of the medical system being badly broken or a symptom of how we think about these kinds of problems being badly broken...? Come to think of it, it's both!

mwnz 13y ago

I stopped reading when the author implied that the U.S healthcare systems woes were due to supply and demand. This is a shallow view of a completely broken system. The supply and demand ratio is comparable to that of other wealthy nations, yet almost every other wealthy nation has kept their health care industry in check.

thomas_eh 13y ago
this

steveklabnik 13y ago

I'm quite torn about this. In some ways, it seems massively irresponsible, but framed another way, it makes some sense. I think it's important to distinguish here between "screw experts they don't know anything" and "I've taken your professional opinion into account, and will be making my decision." The second has a long, long history in anarchist thought: > Does it follow that I reject all authority? Far from me such a thought. In > the matter of boots, I refer to the authority of the bootmaker; concerning > houses, canals, or railroads, I consult that of the architect or the > engineer. For such or such special knowledge I apply to such or such a > savant. But I allow neither the bootmaker nor the architect nor the savant to > impose his authority upon me. I listen to them freely and with all the > respect merited by their intelligence, their character, their knowledge, > reserving always my incontestable right of criticism and censure. I do not > content myself with consulting a single authority in any special branch; I > consult several; I compare their opinions, and choose that which seems to me > the soundest. But I recognise no infallible authority, even in special > questions; consequently, whatever respect I may have for the honesty and the > sincerity of such or such an individual, I have no absolute faith in any > person. Such a faith would be fatal to my reason, to my liberty, and even to > the success of my undertakings; it would immediately transform me into a > stupid slave, an instrument of the will and interests of others. > > - Bakunin, "What is Authority" http://www.panarchy.org/bakunin/authority.1871.html

chimeracoder 13y ago

> The AMA, which is little more than a union for doctors, doesn’t allow any policy changes that threaten to increase competition and reduce their monopoly profits That's like saying that Comcast/Time Warner are a "union for Internet users". If the AMA were "little more than a union for doctors", doctors would have a lot more respect for it, instead of the great contempt that they currently do. If anything, you could argue that, because power follows the money, the AMA is an advocate for the insurance companies that the doctors are beholden to (essentially every doctor in the country must pay their fees to the AMA in order to process billing, because the AMA has a monpoly on that[0]). One of the big disadvantages of dissociating with the AMA (yes, a provider can do this) is losing the ability to use these insurance codes. I don't think that that characterization is quite fair either, but it's a lot more correct than saying that the AMA is a union for doctors. If you want to know more about CPT codes and billing, my startup[1] works with hospitals and outpatient providers to handle the billing process - I am happy to tell you far more about CPT codes than you ever wanted to know. :) [0] The AMA owns and controls the CPT codes - the billing codes that payers use. The providers don't always pay them directly (especially if they're not independent practitioners), but they do end up paying them in the end. [1] https://www.boardrounds.com/ https://www.boardrounds.com/ (plugging shamelessly because it's relevant).

ary 13y ago
As someone who had to license CPT codes for my own (now dead) medical billing app I can say unequivocally that the AMA is laser focused on getting their money. We had to pay a fee per user just so clerks could more easily process Medicare claims. Without a doubt the U.S. Federal government created a state-sanctioned monopoly in the AMA. That a private organization gets to profit from a public program (and much more) by having control of what amounts to an index table is nuts.
nickff 13y ago
>"That's like saying that Comcast/Time Warner are a "union for Internet users"." Comcast and Time Warner are most comparable to hospital chains in the medical context (or perhaps insurers, depending on what parameters you choose for the comparison). >"If the AMA were "little more than a union for doctors", doctors would have a lot more respect for it, instead of the great contempt that they currently do." Many rank-and-file union members hold their organizations in contempt. >"If anything, the AMA is an advocate for the insurance companies that the doctors are beholden to" The AMA's members are physicians, and other medical personnel; you may look at the AMA as a union, lobbying group, or a professional association, but it is certainly not advocating for the interests of the insurers.[1] [1] http://www.ama-assn.org/ama/pub/membership/faqs.page http://www.ama-assn.org/ama/pub/membership/faqs.page?

01Michael10 13y ago

This article is for real? Am I missing something? Sure, people want a diagnosis and other services from an unregulated, anonymous doctor with a reputation built by what? Amazon-like reviews? Come on!

wyager 13y ago
It worked fine with drugs while the Silk Road was running. No reason it couldn't work with medicine as well.
eli5 13y ago
That's not like that at all. As far as I understand all answers doctors give are open to the public on the site, so everyone else on the internet, including other doctors, can read them and say if it's a good answer or a bad answer. I imagine if this sites starts issuing bad advice, no one would want to go there. However, as of right now, it appears you are wrong and answers are getting paid for by willing customers. Now, this idea may be far from perfect. But comparing it to the existing system while having a blind faith in it is wrong. In our existing system patients don't have many options of checking what their doctor tells them; they are referred to doctors by other doctors and very often have no way of checking on the reputation (% of successful operations this doctor conducted, for instance). The current system is very inflexible and not consumer oriented at all. Consumer interests are sacrificed in the name of their supposed safety, without first giving said consumers options to decide what they actually want and consider safe.
- 01Michael10 13y ago
  I am not referring to CoinMD so much but this paragraph... "Imagine a future where renegade doctors shun licensing laws and practice medicine over the internet. They build up a reputation around an anonymous identity. Use public key cryptography to sign their diagnosis, reassuring the patient that it really came from them. It’s not hard to imagine this would create a demand for anonymous accreditation agencies. These agencies could issue exams and then use their digital signature to sign the credentials of doctors who pass the exam. Patients pay for these services in anonymous currency ― Bitcoin ― and pay fraction of the price they would pay to the government enforced monopoly."

vezzy-fnord 13y ago

Time for a reality check. Okay, so I like the idea of CoinMD. It's a nice way for people with medical knowledge to get paid for their tips, but so far that's really about it. It's just yet another forum for medical advice, but with a gimmick. It's not even an original gimmick. The whole "integrate Bitcoin into everything" appears to be motivated by more of a cargo cult to appear modern and countercultural than anything rational. However, it does offer an alternative payment system and in this case it works, so I won't complain about that. But can we please let go of these childish fantasies that Bitcoin will overthrow all government and usher us into an anarchist utopia of voluntaryism and global human liberation? Those kinds of libertarian/anarchist pipe dreams were excusable during the very beginning of Bitcoin, when the protocol was still being sharpened and everyone was enthusiastic about this new idea. I don't know what kind of world the author lives in where he thinks people posting textual descriptions of their conditions on the Internet, backed by a digital currency, will revamp the healthcare system into an anarcho-capitalist institution and turn government irrelevant? What bullshit. Do I seriously need to explain that writing about your condition isn't enough to get diagnosed with anything beyond the most rudimentary of advice ("This might be that, but I'm not sure. Go see a doctor and try this herb in the meantime to see if it stops.")? Bitcoin will not render government irrelevant. You see, the thing is that even if the concept of Bitcoin theoretically can allow financial independence from the state, it's completely meaningless when your ecosystem is a mess. The Bitcoin ecosystem, as we have witnessed so many times, is absolute chaotic mayhem that can ironically only be controlled through state regulation, which many hardcore Bitcoiners are advocating for. Homeschooling is opting out of the state? Uh, last I checked, homeschooling requires one to be registered with the state, as well as offer vigorous and regular checks with it to ensure you're in line. The Silk Road isn't any different from your standard drug dealing market, only it's online and just as volatile and unreliable as the physical thing. Look, Bitcoin is certainly capable of great things, but these here are just naive pipe dreams.

eli5 13y ago
So, do you think that if enough people want to peacefully live without government interference at all (e.g. without a government) they don't deserve to do so and they don't deserve, for example, to be sold a piece of land to completely secede from state?

chiph 13y ago

You'd want that your physician has more training than just having read some WebMD articles. How can you be sure? What about liability in case they're wrong? A coworker lost a relative last year because the doctor missed an obvious case of septic infection. How do you take an anonymous physician to court for a mistake like this? Hard to pay restitution when the injured party dies.

final_approach 13y ago
Punishment is just one way of ensuring doctors pay attention. And as many people find out, it doesn't actually work simply because doctors make mistakes anyway. Now, for a price $10 I don't think anyone should expect any kind of liability. It's advice. If someone gives you a $10 take it as such and go see another doctor for $100 if you're unsure. To my understanding CoinMD simply provides what market needs: cheap accessible advice of reasonable quality. If you could sue doctors there, prices wouldn't be as low.

etanazir 13y ago

MD = Monopoly on Drugs

baddox 13y ago

I think an even better example of potential crypto-anarchist success is legal advice. It could work largely the same as the medical service this article describes, but legal advice fits better than medical advice.

psaintla 13y ago

So they are hoping people will make medical decisions based on advice from an anonymous doctor whose credentials you cannot verify and who does not have prescribing ability? Is this serious?

hershel 13y ago

Another interesting thing to do is having a high quality medical expert system(Watson), running outside the u.s.(say africa[1]) with people who we're taught how to use it(even doctors), with access to video communication with the patient, with access to his test results - administer advice to him. Assuming good , mostly automated process and a good expert system - this could be a way to offer highly accurate second opinion. And it would be a perfectly legal service from the provider side. [1]This could be used locally in the country, which is a nice way to augment/start a country medical system