Health Care vs. Risk Snare

So I’m a guest on the latest TWiL (This Week in Law) podcast. Lots of VRM links at that link, below the topic, “How modernization of health data management is changing the health system.”

Here’s what I tried to say, or would like to have said better than I did.

Health care now lives in the networked world. That world is comprised of data. And the network is, as Kevin Kelly perfectly puts it, a copy machine. The result is, as Bob Frankston perfectly puts it, a sea of bits. Health care needs to adapt to this world, embrace it, take full advantage of it.

This imperative is at odds with the calculation of risk that is at the heart of our health care system here in the U.S. It would not be unfair, or even wrong, to call our health care system a risk management system. To see what I mean, imagine removing the insurance business from the middle of it.

Of course risk is always involved where odds must be calculated, and much of health care is legitimately about calculating the odds involved in a given condition, procedure or whatever. But huge hunks of our health care system, in addition to the culture surrounding it, is built around managing risk that has little to do with what our bodies and minds might require. Here are where we have fears of exposure, of disclosure, of mistakes, of all kinds of stuff that wouldn’t be a worry if we didn’t have to weigh the costs of knowning too much or too little in one circumstance or another, because something (a procedure, a doctor or a patient’s ass) might not be covered.

The nature of the networked world — of the big copy machine that constantly enlarges the sea of bits — is to reduce the risk of knowing too little, of having insufficient information, of reconciling data conflicts, or even conflicting judgment calls.

In the long run we must abandon a system that values risk more than care. I believe we have the former, to a dangerous degree, today. We will eventually require the latter. And that requires a health care system that essentially insures everybody.


  1. PXLated

    Good post. Two relatives are Docs and they’ve expressed similar sentiments.

  2. Britt Blaser

    “Single payer” is a red herring. The correct solution is a single risk pool, as the mlitary defines it. The odds of any American having a problem are well known. Let the Insurers bid to cover that known ri sk and compete on competence – the furthest tthing from their mInds.

  3. Bob Calder

    Britt Blaster is correct about single payor. Remember the article in Science about the Japanese system? Small number of payors, but still not one. Choice of many providers. Longer lives than in the U.S. Lower expenditure per person.

    Certainty of pricing is high with the numbers involved. Insurors have played with competing at risk selection, not pricing.

    The need now is for homogenious risk pools so that high cost is not disproportionately borne by the public. (BB says above, “…single pool”) Keeping the ability to move risk will allow the insurance companies to continue to play the game they play against each other. They are agile players and can dump risk even when it is manageable in order to take advantage of another offer. It pulls the rug out from under vulnerable people.

    Taking the health insurance risk away from the private sector will be just like taking flood insurance into federal hands (flood risk was radioactive.) Just don’t ever let Ross Perot convince anybody that he can manage it like he did the NFIP. 😉 Let me tell you. That sucked.

    Flood is WYO (write your own) that is written and serviced (claims paid) by anybody that wants to do it according to federal rules. It emerged after the great Perot fiasco and has functioned well.

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