[dnomad]

Yeah, it's like Americans have this massive blindspot when it comes to government. The "problem" of standardized medical record storage and distribution has been thoroughly solved in France. There you have a nationwide system of healthcare and there are largely no issues with medical record access. (Which is not to say it's perfect but what you're dealing with are largely internal organizational issues not the massive coordination issues that make American healthcare so unpredictable and expensive.)

There's this very naieve view that blockchains are somehow going to replace governments. I think a lot of people are in for a very rude awakening. The government, as they say, are the guys with the guns. It highly unlikely that they will surrender enormous power and privilege to decentralized networks. When it comes to currency, capital formation, medicine, energy, defense and transportation the governments will step in to ensure they remain firmly in control. These are political "core competencies" that no government in their right mind will abrogate.

This is what makes all these blockchain delusions about a blockchain of medical records so stupid and pointless. If there were such a blockchain it would be controlled by the government in which case you wouldn't need a blockchain at all as everything could be done much faster, cheaper and more securely using a centralized, government-controlled database. I mean, really? Do people not see this?

And the idea of "forking" Google or Amazon is so hilariously dumb all I can do cringe that somebody seriously wrote that and put their name behind it.

It's clear now that many of these blockchain advocates don't really understand where the blockchain is actually useful. There actually is a class of problems that require global, decentralized, democratic consensus and are not susceptible to economies of scale but are susceptible to network effects. (I say democratic consensus here because this idea that blockchains are "trustless" is nonsense. Every blockchain is a democracy and democracy requires enormous trust. As we've seen again and again if the majority of nodes vote one way you have no choice but to follow or lose all your assets. Blockchains do not fulfill this libertarian fantasy of freedom from democracy.) This class of problems does not overlap with what governments at all. But it does overlap almost 100% with those problems that the internet has already solved so successfully. Particularly investors like USV should be looking at their previous tech investments -- Twitter, blogging, open source companies, digital collaboration, content generation, messaging -- and thinking about how blockchains could help these problems. TLDR: the blockchains aren't anything new. They're global, decentralized networks that let millions of people communicate and coordinate in real-time. Just like the internet itself.

[icebraining]

The "problem" of standardized medical record storage and distribution has been thoroughly solved in France. There you have a nationwide system of healthcare and there are largely no issues with medical record access.

What happens when a French citizens moves to another country? Some people even live a few months every year on different countries, what happens then?

[PeterisP]

Whatever solution you'd propose for ensuring global adoption and interoperability of hypothetical blockchain-based medical records would also work just as well (or better) for any other type digital healthcare records. That's mostly a political problem, and not one where blockchain provides any advantage.

[icebraining]

I don't disagree, I don't think the blockchain makes any sense here (or mostly anywhere). I just disagree that France has "solved" the problem.

[PeterisP]

One could argue that France is one of multiple examples that demonstrate that the technical parts of the problem are already solved. If we actually wanted to (IMHO we don't), had the political decision to implement global interchange of health data, and had solved the political problems required to get the resources and will to implement it, then we could just copy and deploy the solution of France or Estonia or whatever, knowing that the technical and organizational structures are reasonably appropriate, and there's no need to suppose that something fundamentally technically different is needed, there are no obvious technical problems that need solving.

[icebraining]

I don't know who "we" are. But the solution proposed with the blockchains and stuff - misguided as I may think it is - had the goal of allowing general interoperability / portability of data among any providers, potentially across the world.

That France has some software that works well for their small corner of the world with their specific centralized model of healthcare is great for them, but doesn't solve the same problem. And it certainly doesn't mean you could necessarily apply it to the US, even if there was political will to do so.

[dboreham]

Except almost nobody does that.

[icebraining]

Perhaps. I know at least three retirees doing that (spending winters with their family abroad), and apparently there's a term for it in the UK ("mouseholing"), but I can't find any statistics.

[dboreham]

That's seasonal living between two places (e.g. Snow Birds). Presumably there is already a workable solution for those folks. Parent was talking about people who randomly move country to country.

[icebraining]

I am Parent, and I wasn't, even if I didn't explain myself clearly :)

Is there a workable solution? I don't have any experience with the French system, but between the two EU countries I know, there's no good solution, or at least none was offered by doctors on either side.

[dboreham]

I believe that in the US/Canada the solution is for the patient to carry a backpack full of medical records. Honestly though based on my experience with the medical system in several countries, and talking to medical provider friends, I'm not sure records, apart from very recent ones, achieve much anyway. e.g. Dr B won't trust that Dr A made the right diagnosis or that an old test result is to be trusted, and so on.

Personal example : I migrated (legally) from the UK to the USA 20 years ago. USA wants you to prove that you have vaccinations. However they don't actually take UK medical records as proof. Easier to just make everyone have the vaccinations again!

[snarf21]

Okay, but the US doesn't have a nationwide health system and probably never will. So how do we fix the medical record access issue?

Saying "solve it with regulation" is no more helpful than saying "solve it with blockchain". A working solution is better than something "better" that is theoretical.