In Singapore the health insurance companies have programs to get people to wear health trackers for a discount and people are oblivious as to why this may not be the best idea/ alignment of interests.
This trend towards manditory quantified health risks discrimination aginst chronically unwell people. Your data, even from healthy employees, is being weilded by unaccountable corporate goons to disenfranchise people, like digital star of David.
> risks discrimination aginst chronically unwell people
Technically it's not discrimination, they actually cost more, and their insurance would therefore be more expensive, in a free market. To the extent that the society values "fairness" and wants to help those people, government / non-free-market solutions are needed, with the society paying for them collectively.
There’s a gray area where insurance goes from protecting against unpredictable losses to becoming a subsidy from those experiencing fewer losses to those experiencing more losses. In a true insurance market, people’s entire health is not insurable, since it’s guaranteed to have losses therefore it’s simply a subsidy from those who are not currently experiencing losses to those who are.
What would be more akin to actual insurance is insuring specific events within a specific timeframe, such as broken bones from year x to year y, and then the insurance can charge more to people who play sports versus people who don’t, since obviously they would experience more losses, just like people who drive more pay more for auto insurance.
However, this all gets murky with our requirement to force everyone to be provided with healthcare and people being in control of some things about their health (via diet and lifestyle) and not others (genetics, environment) and the inability to tease out causal factors.
The primary purpose of health “insurance” in today’s world is to serve as an agent for the buyer since the buyer typically has no idea about what they’re buying from healthcare providers and at what cost, so theoretically, the doctors, pharmacists, and statisticians employed by insurance companies can do proper vetting of treatments for the patient.
Huge proponent of socialized medicine here. Lived under it for 18 years. It works. You are utterly correct when you say the "buyer" has no idea.
American "healthcare" is a sham in many ways. It's the only "transaction" a person enters into whereby you have zero idea of the final costs. I buy a car, I can negotiate and know before I sign. Ditto a house. Medical care in the US is designed to make money. Full stop. Not long ago, maybe even here on HN, an article was posted about American hospitals trawling the Internet for every bit of info they could glean about patients to both see if they would be monetary donors, as well as to ascertain if they were hiding their "wealth". This is what results from a for-profit system.
I have always believed that healthcare is a basic human right. I will never change my beliefs on this point. Profit and healthcare are mutually exclusive. When a cancer patient is literally refused treatment because a) their "health insurance" runs out or b) they cannot afford to pay, the system is morally bankrupt.
A friend of mine has a family member who needed a helicopter ambulance to save his life, as his accident was rural and he would have died. The 15-minute flight was almost $60k and they were billed for the full amount almost overnight. Insurance did not cover this. Another friend had a seizure and an ambulance was called, and the ensuing ride took about 10 minutes. Cost for the ambulance ride? $1200. This was in addition to the medical care, which in this case only paid 80%, even after deductions, etc.
Anyone who defends for-profit healthcare for reasons of "I'm not paying for others' mistakes, etc." is being short sighted. There is no way a cancer doctor should be making millions off the back of dying patients, many of whom have cancer through no fault of their own. Even smokers deserve compassion, because addiction is a beast that many play hell getting out from under. So many factors at play here. It's easy to sit back and play moral general, but unless and until it's you or yours, it's an entirely different animal.
We could easily afford single-payer in the US. The numbers being tossed out by various mouthpieces are intentionally misquoting to support the lobbyists and their ilk.
Many of you may know that almost all hospitals lease their equipment. The leases are not that expensive for most stuff, even MRI and like equipment. For the prices charged, they have paid their leases in full after less than a week, yet they charge for all manner of false bullshit, and I quote from personal experience:
"Mucous recovery system: $120" WTF is that, you may ask? After deciphering the code by obtaining a medical billing handbook, it turns out this is a box of Kleenex.
I'm 50 and I refuse to go to the doctor unless I have either an infection or I have to go because life demands it. Eat right, brush your teeth, exercise, and call it good. I cannot afford the insurance, deductibles, co-pays, additional money always being asked for, plus RX costs. Not everyone has the money for the sham that is American healthcare. When I do go, I go the low-income clinic, pay cash and get as good or better care than the expensive places. Remember, massive debt in America is largely brought on by medical crises.
> I'm 50 and I refuse to go to the doctor unless I have either an infection or I have to go because life demands it. Eat right, brush your teeth, exercise, and call it good.
Pushing back against this part but in support of your larger point: many of us don't really have that option due to chronic conditions. Society incentivizes us in various ways to hide them when we can, so people mostly don't realize how prevalent these conditions really are. By some criteria, American adults with no chronic conditions are in the minority. Much of that is due to hypertension and hyperlipidemia being their own diagnoses, but to pick one example, overall asthma prevalence may be as high as 8.3%. [1] [2]
The biggest issue with the US health insurance is very simple: it is underwritten for one year. Want to fix it? Pass a law where the minimum coverage period is 10 years and force the companies price it out in advance. Hell, make it 20-30 years. Suddenly the insurance companies will start buying hospitals and optimizing for health care costs rather than information and funnel arbitrage.
I agree with your overarching point, but why not just kill insurance?
My family in England go into hospital, checkups, RXs, never a cost to them directly. Everything is paid for by dint of taxation, and the taxes are not as high as Americans are lead to believe. My UK family are not wealthy by any standard, yet the do far better than me in America. They get 6 weeks paid holiday, too, something almost unheard of here. Time off leads to less health issues. Everyone needs a good holiday release a few times a year to get away. No email, no calls, nothing work related. This is actually good for people, but Americans in general don't even use up their allotted time off. Sad.
For the same reason that the insurance exists in the UK - when my family lived there, my sister had an issue. The choices were crappy slow "meh, but it will get better" NHS service in 6 months or deal with it within a week in a private hospital covered ( mostly ) by the insurance. We picked the private hospital and everything was resolved within 3 weeks.
Did you live in Switzerland? Doctors make a nice salary, many hospitals are private, yet the system seems to work well (from what my friends who live there are telling me).
> When a cancer patient is literally refused treatment because a) their "health insurance" runs out or b) they cannot afford to pay, the system is morally bankrupt.
Then every system is morally bankrupt.
We have to face the facts: resources aren't infinite, tradeoffs are necessary, and we can't help everyone. That's why even most "socialized medicine" has limitations and restrictions about what kinds of treatments they offer and to whom (e.g. you can't get a free breast scan every year).
I grew up in England. My father is British and my mother American.
We owe it to people to give them human dignity up to, and including, their last breath. Anything short of this is crass, careless, and evil. The West has always tended to value human life more so than other cultures, but in the last couple of decades, we have devolved horribly on this point.
When my first wife died of cancer, I did ridiculous amounts of research into costs. Pharmaceutical companies are utterly shams. They may make life-saving drugs, but at what cost? I learned that they intentionally manufacture as cheaply as possible and charge as much as possible. Look at the recent shamelessness with the Epi pens. Those cost very little to make. They would still see a profit at $20.
When my wife died, the chemo she was getting was $12k for a 500ml bag. Cost to manufacture? Less than $100. That is not a profit, that is outright effing theft.
Discrimination doesn't stop being discrimination even if it causes lower costs and/or might be rational from the perspective of the business.
It may be possible, for instance, due to a combination of structural and cycle of poverty factors that a black person in the part of town your store is would be more likely to commit a crime - that doesn't mean the store is non-discriminatory if they choose to ban all black people. The point is that you can't make decisions about people based on a protected trait, like race or disability.
(To be clear, the black crime example was used because I think that we can all see the most blatant forms of discrimination in race-based discrimination and the "black crime" trope is one of the drivers of that discrimination)
Technically that is discrimination. Discrimination applies any time two different groups get two different outcomes. It's a term that is used in economics without the negative connotation of things like racial discrimination.
Senior discount at the diner? That is literally called price discrimination, look it up.
I find this interesting for several reasons. I've lived in 5 countries. America is the only country where I've seen the senior/veteran/police/whatever discounts trotted out.
Isn't it funny, however, that "we" claim to value seniors, but almost to a man, elderly mom and dad are tossed into care homes as soon as it's inconvenient for their adult kids. Sadly, this is done for many reasons, many of which are to bilk people for their money. Most countries bring mom and dad or surviving parent into the home for the remainder of their natural life. In other cultures, not doing so is tantamount to an anathema. Welcome to America, land of the free to be bilked, and home of the brave should you step foot into hospital.
It is technically discrimination though, as the company would be treating unfit people differently than fit people on the average. I think that the word discrimination is unjustly given a sort of taboo meaning in that any actual discrimination is horrible. And yet nearly everything that we do relies on discriminating.
Indeed, it has a strong connotation, I guess I should have used unfair discrimination or bigoted discrimination or something... Although to avoid confusion, I prefer to use a different word for "legitimate differences", such as distinguish or differentiate.
I agree with your point, and there is likely a business case, society wide, to average health care costs across the population. People are less productive when they have major, long-term worries, and even folks who are young and healthy today think about the possibility of being very sick.
And in a society where sickness implies economic misery, people plan by building their own, ad-hoc mini-safety nets which are often less valuable and more expensive than a standardized solution. So most people would support averaging health costs if they perceive it as mostly efficient. That is, they would not mind a sick person next door getting treatment while paying the same cost as themselves. But if they think a bunch of doctors and crooks milking the system by making up and billing for fake services they will strongly push back. My 2c.
What scares me is that people who are, say, addicted to sugary soda, will be treated punitively by the system for making poor choices, rather than as someone who is afflicted with an expensive pre-existing condition (sugar addiction).
You don't have the same problem with, e.g. car insurance. Either you're speeding or you're not.
If you drive in a "bad neighborhood" they could penalize you there, which has very real potential to be racially discriminative. And this data could be given to police, who could use it to make a case against you just for appearing to drive in a similar pattern as a criminal. Giving companies this data is dangerous.
Well, I have general sympathy for the privacy topics discussed here just as any other average Joe, but painting sugar addicts as some helpless victims is a bit of a stretch to be polite.
At least we can agree it is something negative. But I fail to have much sympathy for people who simply have to buy ice cream, chocolate, soda etc. You put the products in the shopping cart yourself knowing well it harms you, you use your cash/card to pay for it.
Sugar addiction is real, but it doesn't make you a zombie without any free will. If you want to paint yourself as pathetic weakling without your own will, that's your own personal choice and be clear about this with everybody, especially yourself. But you are not describing sugar issues, but your own underlying mental issues that can and should be tackled by professional.
Man up (or woman up), own your shit and have some respect for yourself.
On one hand, people at a healthy weight throughout their adolescence who start a slow and gradual weight gain with their 'Freshman 15' that ends with being moderately chubby in middle age - yes, you're correct, that's not only the result of poor life choices, but it can probably be corrected with better ones.
On the other hand, some people have negligent or ignorant parents and are (as a result) overweight or obese from a young age. This dramatically cripples their ability to make healthy food choices at an adult because it bakes in their psychological weight set point at an unhealthily high level very early on, and so normal attempts at intervention make their body think it is being starved. These folks need more than just life advice, they need medical intervention, or they stand a low chance of digging themselves out of their holes. And if they can't do that, it's a detriment not just to them but to society as a whole, which will eventually have to foot the bill for their medical costs later in life.
> I fail to have much sympathy for people who simply have to buy ice cream, chocolate, soda etc. You put the products in the shopping cart yourself knowing well it harms you, you use your cash/card to pay for it.
What about alcohol addiction? Heroin? What about depression?
Most of the top health insurers in the US are publicly traded. The only thing you can expect from them is for them to return as much money as possible to investors.
They do the same in France for car insurance, they give you a box you put in your car, which has at the very least a GPS module (but most probably have tons of other sensors)
I think they are mostly targeting young drivers for which insurance can be pretty expensive, and knowing well that most young adults these days don't care much about privacy
The unfortunate part is that, if we could trust that the data would be handled correctly (not wide-open to hackers, not used for other purposes like advertising/marketing) this would be an improvement in the efficiency of the insurance industry.
I assume everyone who uses mobile networks has their location data being stored, shared, and sold by the mobile network companies. I assume government agencies and other people in positions of power can easily get identifiable information, and advertisers or other businesses can purchase "anonymized" information. At this point, I'm not sure what else is left to protect.
Are you sure? If the data in question also covers WiFi signals, which include the signals emitted by every phone near you, then I'm not sure the data really is that coarse.
I'm presuming here the location data is gathered outside of the phone (eg. by cell towers), not the phone itself. If you have access to the phone itself (eg. malicious app), then you can easily get GPS data as well.
Did this but with an app in Germany. As I "scored" 95 out of 100 points and was apparently at the top 1% of the drivers, I got a pretty good discount on my insurance.
About 500€ per year less than without this app. So yeah, for that price they can track me anytime I drive, I don't have an issue with that.
The accelerometer data is what they claim to be the most after. They're looking at intensity of acceleration/deceleration to determine if you're a defensive driver.
Worse: liberty mutual has a black box that uses your phone. Then you give up your driving/location data, your mobile data, your phone battery, and your OBD-2 port.
This, of course, brings in the devices that shake the trackers just right[0], to scam the companies(I remember reading about it being a thing in the USA).
I would guess that if this gets mainstream, insurance companies may purchase user data from other apps to cross-check users lifestyle and deny claims where the user appears to be jogging on the insurance app but sleeping according to the totally free and fun sleep tracking app.
Tbh, the insurance representatives even tell you which fitness trackers are best for gaming the system. Mine said to buy an Xiaomi as it adds an extra 20% and costs a lot less.
I also cannot help but see the dystopian outcome here, especially in a profit-driven system.
"Sir, we see your REM sleep is not being fully entered into most nights. Our system has indicated that you buy caffeine and pizzas multiple days a week. This will be reported."
"Sir, we are denying your life insurance application because our insurance "partners" have determined you are a risk we cannot afford."
Etc., etc.
I will never willingly wear a tracker that reports health data. I will never willingly be chipped. Nothing of that sort. I always tell people to pay cash for their peccadilloes. Never use "loyalty" cards, as the info is sold to all manner of companies, including insurance companies. Banks sell "anonymized" data about your buying habits as well. And no one seems to be anything other than completely and utterly apathetic...
We have this in the UK, Vitality offer rewards based on your Fitbit (or whatever) step tracking, and also offer to "give" you an Apple Watch and negate the repayments if you achieve your health goals.
I don't think it's actually that terrible as long as privacy is respected.
I wouldn't have took Vitality up on this offer for anything but an Apple Watch, but I trust Apple not to give them access to anything behind my back. They also use the workouts feature as input to their point rewards stuff, so it's a pretty good deal.
Yeah... Apple won't, but the health tracking apps that you'll be asked to install certainly will - many already share with Facebook, without your consent[1].
The company where I work recently changed health insurance providers. Reps from the new company pushed this stuff HARD, along with their program for using an app to get basic health care from some random remote doctor.
To the best of my knowledge, exactly nobody was interested in these programs.
> Clinicians should be conscious about the choices they make in relation to their app use and, when recommending apps to consumers, explain the potential for loss of personal privacy as part of informed consent.
That's for me the most important point of that study. It's no good if you avoid data kraken where you can, and meanwhile your physician unwittingly distributes your sensitive data via the latest health app.
My only critique of this is that clinicians in the US may be under large organizational umbrellas and may be strongly encouraged (forced?) to go through apps chosen by the org, and so they aren't really making any conscious choices.
(TBF the paper authors are affiliated with Sydney, Toronto, and California Universities so those healthcare systems are likely different)
"Journalists recently revealed that Australia’s most popular medical appointment booking app, HealthEngine, routinely shared 100s of users’ private medical information to personal injury law firms as part of a referral partnership contract.1 Although the company claimed this was only done with users’ consent, these practices were not included in the privacy policy but in a separate “collection notice,” and there was no opportunity for users to opt-out if they wished to use the application (app)."
Too bad most of the worst offenders are in the US or other countries with non-existing privacy laws.
> The US has HIPAA which while not perfect would cover any medical data sharing and does have decently sized fines behind it.
Because HealthEngine looks like it has business relationships with providers, it would probably be covered by HIPAA through provider BAAs in the US.
But if it only had a business relationship with the consumer, ala Google Duplex, and handled medical bookings on the consumer's behalf that would not be the case. So even though the specific case would enjoy covered by HIPAA in the US, it is illustrative of a problem HIPAA may not be adequate to address.
HIPAA may actually be dangerous here, because what lay awareness of it exists seems to see it as protecting health data generally, when it only protects health data held by certain entities, and consumer-facing entities that don't have a business relationship with your health provider or insurer aren't covered, and there are plenty of them trying to vacuum up health data.
I also wonder how drugstores manage all the patients' data. For my part, I pay in cash, and never give personally identifiable information unless strictly necessary.
In the US a drugstore's information falls under HIPAA which isn't perfect but does force some compliance at risk of large fines. HIPAA basically doesn't allow identified information to be shared except specifically related to treating or paying for your illness. Unlike a fly by night app a drugstore has a physical presence which means that tracking them down to fine is easier.
Look up prescription surveillance, prescription drug monitoring programs, and the companies that sell prescription data to see how “private” your private prescription info is.
