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Comment by gph | Hacker News Reader

Healthcare is heavily regulated, and I understand why some companies would be reluctant to branch out into it.

But that doesn't mean the privacy and legal concerns surrounding HIPAA regulations are unwarranted. Yea, it would be nice if we lived in an ethical utopia where we wouldn't have to feel worried about people looking through our health records. But we don't. I would not feel comfortable with my health records being easily accessible, even if that would lead to better data-mining opportunities.

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It isn't just regulation, it is healthcare practically can't be entered in because of the established players and systems.

Please read this

http://www.washingtonmonthly.com/features/2010/1007.blake.ht...

Guy made a company Retractable Technologies and made medical devices that prevented infections and saved lives. Hospitals won't buy it because of the system.

Which happened partly due to regulation.

This might also be of interest

http://www.nytimes.com/2013/08/27/health/exploring-salines-s...

> Hospitals won't buy it because of the system. Which happened partly due to regulation.

If you actually read the article, it happened due to the absence of regulation. Hospitals formed an entity (the GPO) to bargain collectively for lower prices from suppliers. This is a classic example of collusion. The GPO started negotiating with the suppliers for a cut of the contracts that they entered into on behalf of the hospitals. This is a classic example of the principal-agent problem. As a result, Retractable Technologies' couldn't break into the market.

Collusion and principal-agent problems arise naturally in free markets. Indeed, the usual response to them is regulation. Antitrust enforcement would've prevented the hospitals from colluding with respect to purchasing supplies, and as the article points out, Medicare's anti-kickback provision, had it been applied to the GPO, would have reduced the principal-agent problem.

The problem with HIPAA is that it's supposed to look after my interests as a patient, but if I feel that it isn't, there's no way for me to opt out of it.

> The problem with HIPAA is that it's supposed to look after my interests as a patient, but if I feel that it isn't, there's no way for me to opt out of it.

To the extent that the first part is true [1], the second part is not true in any substantive way -- the privacy protections restrict what can be disclosed without your consent. So, yes, you can effectively "opt out" of any of the restrictions by consenting to disclosures.

[1] HIPAA -- the Health Insurance Portability and Accountability Act -- exists, in terms of direct goals, mainly to look after your interests as a potential purchaser of health insurance, the as-a-patient privacy protections are secondary to that, and were put in place in HIPAA, and subsequent revisions, to mitigate political opposition to the incentives for automation and related standardization of electronic transactions provisions designed to make the health insurance system -- both in terms of enrollment and claims processing -- more efficient.

Are you sure? I've seen waivers and "individual consent" forms that can supposedly release your health records.

I should have been more clear- What I mean is, I can't sign a form saying "I hereby waive all my HIPAA protections". All I can do is sign a form saying "I allow entity X to get access to my records", but there is no provision for a global, generalized waiver. (Of course if I signed a document waiving all protections I'd also want that document to contain reference to an alternative set of protections.)

"Heavy regulation" doesn't just include HIPAA.

True, but that was the one specifically mentioned in the article so I figured I'd address it.

I think the most illuminating thing about HIPAA is the fact that it lays bare just how poorly doctors and lawyers and healthcare administrators actually understand logical security in the computer science sense. I will point to the use of fax machines as a superb example. The law essentially considers PGP and a fax machine to be security equivalents.

And I say that as a doctor.

I think that ignores a lot of the technology involved. A fax van be intercepted, but an email is guaranteed to be recorded by intermediate servers. In most cases, e-mail will be data mined in a webmail system. So while PGP is clearly better, I think its reasonable to say fax is, in practice, better than email. Unless you want patients suddenly getting Valtrex ads because someone sent their health records over webmail.

Why don't they just buy an island make their own country with their own rules?? ;)

Not sure who downvoted you, but this is indeed the essence of one of the counterpoints against regulation-- that if we regulate an industry, the innovation in that industry will simply occur elsewhere in the world, outside of US regulation.

That is generally true for things like minimum wage laws or regulations on manufacturing. If it is expensive to manufacture in the US then companies can easily manufacture in China.

It doesn't really work for healthcare because you can't remove it from the jurisdiction. It isn't practical to fly to another country to receive emergency medical services or if all you need is to fill a prescription. Meanwhile the customers with the wealth to sustain research into novel health products are in the countries that impose heavy regulatory burdens on anyone who wants to service them.

Actually a lot of people do ... I know people who get their eyes lasered in Turkey for example (in this case it's because the treatment is cheap). Larry Page suggested the Island idea in last year's google IO.

I also don't really understand ... especially Larry Page suggested this. I also don't get the other comment why it would not work. Imagine Google buys couple of Islands and founds it's own state, they could do whatever they wanted in the boarders. It's a bit scary yet not so far fetched.

There's a whole lot of complicated issues of international law around gaining sovereignty, which is highly biased against the creation of new states. And beyond that there is the issue of gaining recognition from other states. Getting the recognition of even a number of the "micro states" that likes to recognise other small states because it helps validate their own existence would be hard enough. Getting the recognition of larger countries, which with corporate involvement would instantly be suspicious this was a tax avoidance scheme or otherwise something that would not be beneficial to them would be much harder. (E.g. many countries would start looking at their maps and worrying about what companies that is important to them could be coaxed by a poorer neighbouring country to buy territory)

To answer your question seriously, what makes you think your new country will be able to trade freely with every other country (e.g. USA & EU)? There's no point having an island with your own rules, if the only people you can get as customers are the inhabitants of your island.

Also, all land (more or less) is already in one country. Turning to split off a piece of one country into a new country is often quite deadly. Literally.

They are just waiting for a spot on the map to open up. Something between Spain and Greece would be nice, it's much warmer there.

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