Medical Anarchy

Crypto-anarchy is agorism without patience. Crypto-anarchists are anarchists with the tools to get the job done. ― Luke P

With rise of Bitcoin we’ve been given glimpse of what is possible with cryptography and anonymity tools like Tor. Individuals now have the power to control the flow and distribution of information and money. The ability of governments to control their citizens wanes every day and it’s only a matter of time before they lose control altogether.

Whether it be 3D printing, homeschooling, Bitcoin, or Silk Road people are channeling their creative energies to finding ways to “opt out” without the State’s consent. Yesterday I stumbled across yet another promising concept ― CoinMD. The idea is to provide an anonymous forum for doctors to diagnose patients and receive payment in Bitcoin. The service appears to be very primitive at the moment, but the potential is enormous.

You might ask, “Why would anyone want to get diagnosed by some anonymous doctor on the internet?” The answer to this question strikes at the very root of the problem with the healthcare system ― restricted supply.

All of the focus on insurance companies is nothing more than a distraction from the real problem. Basic supply and demand analysis should tell you that when you have rising demand (for various reasons including increased subsidies) coupled with restricted supply, it will translate into increased prices. Restrict supply for decades and you end up with astronomical prices.

The fix is relatively easy ― more doctors, more hospitals, more medical schools, more medical devices, more pharmaceuticals. Increase supply and prices will plummet. The problem is… doing so is illegal! And it’s illegal for the worst of all reasons. Specials interest groups have more or less co-opted government regulation and use it as their own personal piggy bank. The AMA, which is little more than a union for doctors, doesn’t allow any policy changes that threaten to increase competition and reduce their monopoly profits. Of course, this is all done for “public safety reasons” and the gullible public buys right into it.

Even the type of service that CoinMD offers ― internet diagnosis ― is more or less illegal. Why is that? In the 1990’s studies were published suggesting that internet diagnosis would increase physician productivity by 5 times. This would have the same effect of a massive increase in the supply of doctors and would have reduced the cost of an office visit by 80%. The prospect of falling prices sent the medical monopoly into hysterical apoplexy. They immediately took to their journals to lampoon the “dangers” of internet diagnosis despite no evidence of this. Ultimately the medical boards were pushed to declare internet diagnosis a “threat to public safety”. You can view the official position of the state medical boards here. Most deem it to be “unprofessional conduct” punishable by fines and sanctions.

So to answer the question of why anonymous internet diagnosis? It has the potential to do what the free market would normally do on it’s own ― increase supply and massively reduce healthcare costs.

Imagine a future where renegade doctors shun licensing laws and practice medicine over the internet. They build up a reputation around an anonymous identity. Use public key cryptography to sign their diagnosis, reassuring the patient that it really came from them. It’s not hard to imagine this would create a demand for anonymous accreditation agencies. These agencies could issue exams and then use their digital signature to sign the credentials of doctors who pass the exam. Patients pay for these services in anonymous currency ― Bitcoin ― and pay fraction of the price they would pay to the government enforced monopoly.

Our generation is lucky to witness the birth a whole new frontier. One where regulations do not exist, capital controls are non-existent, information is abundant, and where governments are irrelevant.

And as Balaji Srinivasan recently put it, “The best part is this, the people who think this is weird, the people who sneer at the frontier, who hate technology, won’t follow you there.”

Whether CoinMd gains traction remains to be seen. One thing is clear, however, wherever there is prohibition, there will be the black market. Wherever there is a government enforced monopoly, people will circumvent it. The burning desire for freedom will not go away and technology will only hasten this process.

3 thoughts on “Medical Anarchy

  1. “Imagine a future where renegade doctors shun licensing laws and practice medicine over the internet. They build up a reputation ”

    And those who don’t just kill a lot of people. I’m pretty amazed that a presumably functional adult cannot see the problem with allowing any old yokel to perform whatever surgery they convince a patient they need, all while being motivated entirely by the profit motive.

    • Hi Lola,

      Accreditation will work just fine in place of licensing. Licensing is largely a crony capitalist invention to restrict the supply qualified doctors to jack up prices. And of course it’s working like a charm.

      Consumers don’t need criminal penalties for unqualified doctors, they need information. Which doctors are qualified which ones aren’t?

      Would I patron “just any old yokel”? Of course not. I would only patron those who are accredited by a reputable agency, have demonstrated proficiency, and have positive patient reviews.

      Licensing isn’t needed for that. All it does is force us to pay 10x more for healthcare than we need to. I’m pretty amazed functional adults *don’t see that.

  2. @Lola

    ” I’m pretty amazed that a presumably functional adult…”

    I suggest you and Chris look at Milton Friedman’s series Free To Chose because there is an epsiode that takes a detailed analysis of private and public A&E services such as ambulances and first responders which is thought provoking on a number of levels.

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