Politicians, Big Business, and Medical Records

Lately I’ve been hearing a lot about storing our medical records in some electronic cloud, to be accessed by anyone who needs them, whenever they need to.  I’ve also heard a great hue and cry that it can’t be done or it can’t be done economically.  Personally, I think it’s eminently doable and doable at a reasonable cost.


Think Facebook.

What Facebook allows you and me to do is set up a personalized website that contains all manner of data, pictures, stories, links, etc, that we can access from virtually anywhere.  It also allows us to dictate who can see all that stuff.  And it does it for free.  So far.

Now, if I were to upload x-ray images, EKG readouts, CT scan data, doctor’s reports, test results, etc, etc, instead of just pictures and stories, I could have my entire medical history available from anyplace I can logon to a computer.  And with a few minor tweaks Facebook could be trained to accept a pin number or retinal scan, allowing me to authorize access to that data by any new ‘Friend’, i.e. my doctor or hospital or EMS team.  Think about it.

For example: I could go into my doctor’s office, have my insurance card scanned, enter my PIN, and voila, the doc could have permanent or temporary access to my entire medical history, or only to specific portions of it.  (Your dentist may not need access to your OBGYN data.)  When my visit is over, I could disallow or allow continued access to my data until access is no longer required, just like logging off a Facebook session.  Simple, what?

Technologically, Facebook does a masterful job collecting, organizing, and storing all the data we can throw at it.  From millions of folks around the world.  So why not a similar system for medical data.  Of course it would have to run on a VPN (Virtual Private Network) instead of the hackable Internet, but that’s no biggie, brokerage houses and banks do that all the time.

Why aren’t we doing it, you ask?

I think the real pushback is from people and organizations who want the data organized their way and who may also want unobstructed access so they can refuse to hire you, raise your insurance premiums, or own your data.  Therefore, our politicians would have to buy into the notion and then actually go to bat for us, to protect our privacy.  That’s the part I don’t see happening.  Too many politicians are just shills for big business; we must first learn how to elect politicians that represent us.  Full stop.

So, how would it work?

Your doctor, for example, would only need a workstation and a subscription to the VPN.  No fancy software, no tons of storage, and probably no training.  (Who trained you to use Facebook?)  A scanner could be used initially to capture existing paper documents and, as networkable devices become available, things like EKG units could be logically connected to the workstation so your doc could view the data and/or include it in your file.  A file that would reside on some secure server farm.  This approach actually fits, to a Tee, the KISS requirement for good technology solutions.  (KISS: Keep It Simple Stupid.)  And Mr. Zuckerberg could probably set up a demo over a weekend.

If ads germane to your doctor or hospital appeared at the edge of your ‘Page’, the system might actually pay for itself.  But, I would draw the line at the system parsing your data and recommending new ‘Friends’ (Specialists, undertakers, etc.).  That would be too creepy and an invasion of privacy.  It would also make the system ripe for take over by drug companies.

How do we start?  By electing ethical, non business-shill representatives.  If any exist.

Communism vs Capitalism

Remember when the world was divided among communistic and capitalistic countries?  When the Chinese were communists?  Well, the Chinese still call themselves communists, but today they are also capitalists.  In fact, if you visit China today you will find the most dynamic capitalistic nation in the world.

Beyond that, China also wants to be a power to be reckoned with and the Chinese have made that goal a national priority.

However, it wasn’t too many years ago when the West was having its way with China.

Consider the two periods in Chinese history now referred to as the Opium Wars.  The first was between 1839 and 1842, and the second was between 1856 and 1860.

Opium was smuggled by merchants from British India into China, in defiance of Chinese laws, resulting in open warfare between Britain and China in 1839, and further disputes over the treatment of British merchants in Chinese ports resulted in the Second Opium War.

China was defeated in both these wars, requiring it to tolerate the opium trade.

Britain then forced the Chinese government into signing the Treaty of Nanking and the Treaty of Tianjin, known as the Unequal Treaties.  These treaties included provisions for opening additional ports to unrestricted foreign trade; for fixed tariffs; for the recognition of both countries as equal in correspondence; and for the cession of Hong Kong to Britain.

Several countries followed Britain’s lead seeking similar agreements with China, and many Chinese found these agreements humiliating which lead to the Taiping Rebellion (1850–1864), the Boxer Rebellion (1899–1901), and the downfall of the Qing Dynasty in 1912 which put an end to dynastic China.

Next came the Cultural Revolution: A violent mass movement in the People’s Republic of China that started in 1966 and officially ended with Mao Zedong's death in 1976.  It resulted in social, political, and economic upheaval; widespread persecution; and the destruction of antiques, historical sites, and culture.

It was launched by Chairman Mao on May 16, 1966 when he alleged that liberal bourgeois elements were permeating the Party and society-at-large and that they wanted to restore capitalism.  Mao insisted, in accordance with his Theory of Permanent Revolution, that these elements be removed by a violent revolutionary class struggle manifested by mobilizing China's youth to form Red Guard groups throughout the country.

Chairman Mao did change China, but his Theory of Permanent Revolution died with him and capitalism has since re-entered the Communist Party and Chinese society.

Today, Chinese cities are booming and more building cranes are being used in them than in the entire United States.  China’s super-highways are filled with modern cars. Its deep-water ports and airports are world class.  Its research and development centers are state of the art.  And, at its current rate of growth China will soon be the largest economy in the world.  And a power to be reckoned with.

As a side note, China’s navy is already larger than that of the US.

Recently, Robert Reich wrote:

“China’s innovators, investors, and captains of industry are being richly rewarded. They live in luxury housing developments whose streets are lined with McMansions.  They feed in fancy restaurants, and relax in five-star hotels and resorts.  [China’s poor live in an entirely different world, but a tax-free world due to China’s tax structure and implementation of capitalism.]

China shows that when it comes to economics, the dividing line among the world’s nations is no longer between communism and capitalism.  Capitalism has won hands down.  The real dividing line is no longer economic.  It’s political.  And that divide is between democracy and authoritarianism.  China is a capitalist economy with an authoritarian government.

For years, we’ve assumed that capitalism and democracy fit hand in glove. We took it as an article of faith that you can’t have one without the other.  That’s why a key element of American policy toward China has been to encourage free trade, direct investment, and open markets.  As China becomes more prosperous and integrated into the global market -- so American policy makers have thought -- China will also become more democratic.

Well, maybe we’ve been a bit naive.  It’s true that democracy needs capitalism.  Try to come up with the name of a single democracy in the world that doesn’t have a capitalist economy.  For democracy to function there must be centers of power outside of government.  Capitalism decentralizes economic power, and thereby provides the private ground in which democracy can take root.

But China shows that the reverse may not be true, that capitalism doesn’t need democracy.  Capitalism’s wide diffusion of economic power offers enough incentive for investors to take risks with their money.  But, as China shows, capitalism doesn’t necessarily provide enough protection for individuals to take risks with their opinions.”

Robert Reich is Professor of Public Policy at the Goldman School of Public Policy at the University of California at Berkeley.

The Rise of the Giant Panda may in fact teach us new rules for economic engagement as well as new rules for governance.  Rules we may never agree with, but rules we must compete with if we don’t want to be relegated to history’s dustbin full of  “The Rise and Fall of xxx “ countries.

Giant Panda Rising

I have just returned from an eye-opening trip to China.

China, today, is a modern, vibrant country that is bound and determined to be the number one economy on the planet.  To that end they are purposefully building a middle class that will propel them to their goal by 2015, leaving the US vying with Japan and/or India for the number two or number three spot.

For our part, we are fighting back by tackling such heady issues as Gay bashing, becoming a Theocracy, defending our right to carry concealed weapons in Starbucks, and not offending any Mama-Grizzlies.

Current estimates of the size of the middle class in China range from 100 million to 247 million, depending on how much income it takes to make one “middle class.”  Assuming an income of about $9000 is necessary, China could have over 600 million middle class citizens by 2015; in other words they will have twice as many people in their middle class as we have in our entire country.

Also, roughly half of China's projected urban population will be middle class by 2025. And, unlike the US where income levels typically peak between the ages of 45 and 54, it is projected that the wealthiest consumers in China will be between 25 and 44 years old; a result of their younger generation being more highly educated than ours.

The Chinese government is promoting and subsidizing education as a major component of its economic war.  We, however, are experiencing the highest High School drop out rates since the signing of the Declaration of Independence.

So, who cares, you ask?

Well, consider this: if China’s middle class becomes large enough to consume all the output from its manufacturing facilities we could be forced to bid up the prices of their goods just to incentivize them to ship some our way.  And, if the US is successful in getting China to allow the value of its Yuan to float, the cost of cheap Chinese goods could skyrocket.

But, I’m betting that the next election in the US will be about other, far more pressing issues.

The meteoric rise in China’s middle class is tied to dramatic increases in its per capita income:

• The first industrial revolution created a 250% increase in per capita income over a 100-year period.

• The second industrial revolution triggered a 350% per capita income growth over a 60-year period.

By comparison, China is on track to create a 700% growth in per capita income in just 20 years.

The Chinese are also quite aware of how challenging meshing Communism and Capitalism can be: Russia failed miserably and even Japan, a democracy, overheated its economy in its bid to be top dog.

The primary difference in China’s tactic is what I call “Pay to Play”.  If you are Chinese and want to become rich you agree to pay high taxes, period.  If you are Chinese and poor you benefit by paying no taxes, period.  In other words the rich are required to lift the entire country up by its bootstraps, not just whine and whinge about having to pay taxes while figuring out how to move their money off-shore.  Pay to Play makes it desirable for the rich to move as many people as possible into the middle class as fast as possible.  What we deride as spreading the wealth is viewed in China as growing the country.  A very sound business strategy anywhere.  Well, almost anywhere.

Consider too that the Chinese are perfectly happy to let us send our youth to fight other's wars, but if we become too trigger happy, economically or militarily, they could easily apply sanctions forcing us to take our finger off the button and de-nuke ourselves, or else.  But, for the US, Gay bashing is much more important, especially if you can brandish a weapon while doing it.  All in the name of God of course.

So, in closing, think before you vote, demand politicians who understand the bigger picture.  Our country literally depends on it.