By SAURABH JHA, MD

Intrigued by many things in my first few days in the U.S., what perplexed me the most was that there seemed to be a DaVita Dialysis wherever I went; in malls, in the mainstreet of West Philadelphia, near high rises and near lower rises. I felt that I was being ominously followed by nephrologists. How on earth could providers of renal replacement therapy have a similar spatial distribution as McDonalds?

After reading Friedrich Hayek’s essay, Use of Knowledge in Society, I realized why. In stead of building a multiplex for dialysis, which has shops selling pulmonary edema-inducing fried chicken, DaVita set shop where people lived or hung out. It wasn’t a terribly clever business plan but its genius was its simplicity, its humility. If the mountain will not come to Muhammed, Muhammed must go to the mountain. DaVita went to the masses.

The link between Hayek’s wisdom and DaVita’s business plan may seem tenuous. But Hayek has been misunderstood, particularly in healthcare. Many a times and oft in the policy world Hayek has been rated about money and usances. This is because of a misperception that Hayek was all about profit and loss, which are anathema to healthcare. Hayek’s message was simple: local knowledge can’t be aggregated. From this premise sprouts others – dispersed agents in certain times and places possess fragments of knowledge which don’t come easily to central planners.

For Hayek, socialism and capitalism weren’t moral but epistemic issues. Socialism would fail because of a coordination problem – markets would succeed because they could use price signals to coordinate. Healthcare doesn’t use price signals to coordinate, not explicitly, at least. Nor does it capitalize on dispersed agents – on local knowledge. Hayek, a supporter of universal healthcare, didn’t specifically discuss healthcare in his essays. Nonetheless, it would be a useful intellectual exercise to speculate how Hayek might have applied his wisdom to modern healthcare.

What does local knowledge in healthcare even mean? Stated in a rather unlettered way, it is the provision of healthcare locally. AEDs are no good if they aren’t located where people congregate. The value of local presence of medical facilities, particularly in poor neighborhoods, is hardly rocket science. Just as great cities grew near rivers, great hospitals germinated in poor neighborhoods. But, with growing centralization of healthcare, with hospitals becoming multiplexes, futuristic cities with a distinct architectural phenotype, different from the neighborhoods they serve, the value of decentralization can be missed.

Continue reading…

By MINDY NUNEZ DUFFOURC

A New Era of Amazon Healthcare Should Take a Cue From Germany to Provide Support for Medical Malpractice Victims

Amazon, JP Morgan Chase, and Berkshire Hathaway recently announced plans to form a joint non-profit enterprise aimed at providing affordable, high-quality, transparent healthcare to hundreds of thousands of their U.S. employees. Although a healthcare venture departs from their prior expertise, the companies’ combined wealth, resources, and history of market innovation provide hope that this new alliance can reshape the delivery and cost of healthcare in the U.S. As Amazon and company attempt to tackle America’s healthcare problems with a new delivery model, there is also potential for them to support patients who encounter another critical problem in America’s healthcare system – the problem of medical errors.

Johns Hopkins estimates that 250,000 deaths in the United States are caused each year by preventable medical errors. Eliminating medical errors is admittedly difficult. It requires interdisciplinary collaboration, unlikely political alliances, and changing the longstanding “culture of silence” in healthcare. In contrast, supporting patients who are damaged by medical errors, which can have a larger positive effect on the healthcare system, can be easily achieved. And it doesn’t even require innovation. Germany has implemented a model for patient support that can be adopted in the United States.

In Germany, patients who suspect medical errors have a legal right to assistance from their healthcare insurers. This support can include assistance obtaining medical records, the examination and evaluation of documents submitted by patients, helping patients find an attorney or support groups, and providing patients with a free expert medical assessment. In addition, German public healthcare insurers, which insure 90% of the country’s population, are required to fund the Unabhängige Patientenberatung Deutschland (Independent Patient Counseling Germany – UPD). UPD is established pursuant to German federal law and provides patients with free expert medical and legal consultations. At UPD, patients who suspect that they were injured by a treatment error can receive a free online, telephone, or personal consultation from experts to help them understand their legal rights.

Continue reading…

By JASON CHUNG

This week MyFitnessPal announced that it had suffered a massive security breach which exposed or compromised 150 million MyFitnessPal accounts. Data that is affected included usernames, email addresses and hashed passwords. Luckily for those affected, the company claims that the affected data did not include government-issued identifiers or payment card data.

In some good news for MyFitnessPal users, the stolen passwords were encrypted. However, Under Armour continues to be vague about which percentage of the stolen data was protected by bcrypt, a secure algorithm employing key stretching, and what used SHA-1, a legacy hashing algorithm no longer considered to be “any good”.

That such data breaches occur should no longer be a surprise to anyone particularly given other high-profiles breaches involving companies such as Equifax, Yahoo and Target. However, what is surprising in this case is that cybersecurity experts are beginning to commend Under Amour for their “prompt response to the data breach after its discovery and their public announcement alerting users to the danger”.

Such praise for simply engaging in what most consumers would consider obvious moral behavior may shock many Americans. After all, isn’t it intuitive and legally responsible of companies that suffer data breaches to engage in proactive disclosure?

Continue reading…

By DAVID INTROCASO PhD

In late January the Trump administration proposed a Department of Health and Human Services’ (DHHS) regulation that would legally protect any health care worker who refuses to provide care directly or indirectly to any individual by claiming a religious, moral or conscientious objection. While the federal government has for decades protected freedoms of conscience and religious exercise, the proposed would vastly expand these protections. No longer would these protections be applied to a very limited number of medical procedures. Think: abortion. Now, for example, a pediatrician could to provide care for a lesbian couple’s newborn or an emergency room nurse could refuse to provide a terminally ill patient palliative sedation.

Criticism of the proposed rule was immediate. Opponents contend if finalized the proposed would allow providers to ignore a patient’s medical needs including emergency needs that in some instances cause the patient further harm. It would undermine a healthcare entity’s effectiveness and patient safety responsibilities and would legally allow a provider to violate both their professional code of ethics and the patient’s civil and human rights. Critics argue the rule constitutes, in sum, an insidious form of bigotry. It would weaponize discrimination particularly against LGBTQs. It would, for example, roll back the Obama administration’s interpretation of the Affordable Care Act’s (ACA) anti-sex discrimination provision that protected gender identity. These, not insubstantial, criticisms aside there appears to have been little discussion of the proposed’s underlying rationale. What is the Christian theological basis, if any, for legally protecting religious exercise in denying health care?

Continue reading…