Blockchain: Is it the bridge or barrier to universal healthcare?
Universal healthcare, as an idea, is really difficult to argue against. In essence, the current iteration of universal healthcare suggests that all people in the country should be covered by a single-payer, that would afford them access to all necessary healthcare.
This is not a new debate by any stretch of the imagination. In fact, some of the earliest discussions of the idea date back to as early as 1798, when President John Adams signed the first Federal public health law, “An act for the relief of sick and disabled Seamen.” This law issued a charge of $.20 per month to every seaman at American ports. The money would be used to care for the sick seaman and for building hospitals in these ports.
A little later in history, we see the Bill for the Benefit of the Indigent Insane, which would help establish institutions for individuals with mental health issues. Additionally, shortly after the Civil War, the federal government was responsible for building the first system of medical care in the south that would be called the Freedman’s Bureau. There were approximately 40 hospitals built, that employed over 120 physicians that would treat over 1 million sick and dying former slaves. So, let’s move past the notion that this is a novel concept in our country.
Okay. Now might be the appropriate time to provide a disclaimer that this article is not written to superficially discuss the pros and cons of universal healthcare. There have been, and always will be, PROS and CONS. Your political leanings, personal access to health coverage, or how richly colored the necrotic foot tissue potentially resulting from your untreated diabetes, determines which direction your scales are tipped. But, let’s be clear, however you feel about universal healthcare is fine — that’s not a prerequisite to finish reading.
Level set: Imagine that we have figured out how to pay for this coverage, which would now include nearly 27 million previously uninsured individuals. Imagine that we have developed the most full-proof curriculum to appropriately educate the population and providers about the importance of timely preventive care. Let’s also imagine that we have carefully constructed an elite team of actuaries that have developed a flawless algorithm to determine how and when elective procedures would be performed. Now that we are on the same page and have addressed the elephants (and donkeys) in the room, let’s get down to the real reason universal healthcare won’t see the light of day for a while — data.
Who will own the patient’s data? Yes YOUR data…who will OWN it?
Right now, there are quite literally, hundreds of companies that have some sort of rights to your health information. Your primary care provider has some of your health information. Your insurance company has some of your health information. The pharmacy you use also has some of your health information. There is a good chance that each one of these entities has a different system to maintain this information. So…which system is the most accurate? Well that all depends on the perspective. But for this concept of universal healthcare to exist in our country, there must first be a sole repository that houses all of the health information.
You’re probably wondering how something like “data” could be getting in the way of “Healthcare for All”. Think about your health information like currency (yes, your bloodwork is akin to bitcoin). The different countries of the world have different currencies. The country that you’re in dictates how your currency is handled. One key reason there is no universal currency, is because that would essentially render all other currencies useless.
So, how does this relate to your health information?
Well, like mentioned earlier, there will need to be one entity that is responsible for maintaining all of the patient data. But, if this happens…who selects that entity? Will it be a government entity? Or a publicly traded company? There are so many variables at play. Additionally, let’s imagine that we have figured out (in the most fair fashion of course) which entity will be responsible for all of this patient data. What will happen to all of the other companies that have been housing your data for decades? They will become obsolete.
What we will have is a war of billion dollar companies essentially fighting for the right to be the sole owner of your patient data! (Don’t you find it interesting how some of the largest companies in the world, which own most of your data, have recently planted their flag in the sands of healthcare — Amazon, Apple, and Google?)
Your data has become the new currency!
As the patient data migrates to one repository, there will also exist a need for a universal patient identifier (much like your social security number) that is consistently recognized across all healthcare providers. Not to mention, ALL of the data will need to be consistent and updated simultaneously regardless of the location of the service delivery.
Cue the entrance of blockchain!
Blockchain has been one of those “buzzwords” that has been thrown around quite a bit over the last several years. You may be most familiar with it as it relates to bitcoin. Yoon (2019) describes blockchain as:
a distributed, public ledger, recording transaction and tracking assets, and of which immutability is guaranteed by a peer-to-peer network of computers, not by any centralized authority. Assets can be tangible, such as homes or cash, or they can be intangible, such as patents or copyrights. A blockchain consists of ordered records arranged in a block structure. Each data block contains a hash (digital fingerprint or unique identifier), timestamped batches of recent transactions, and a hash of the previous block. With this design, each block is connected in chronological order and the connected blocks are called a blockchain. It is practically impossible to modify one of the blocks in the middle of the chain because all of the blocks after the modified block must be modified at the same time. With this mechanism, the data on the blockchain network are immutable.
So, what does this all mean? Blockchain will encourage improved data accuracy and consistency as it requires that all data is “approved” before it is amended in the record. The implications for this are incredible. Not only will it provide the foundation for universal healthcare, but also work to combat things like polypharmacy and incomplete medical records. Lastly, using blockchain technology in healthcare, also returns some of the “power” to the patient — they will have constant access to their information as well as transparency to see what changes are being made to their data.
Unfortunately, healthcare is one of the most stubborn industries! (Believe it or not, there are still some healthcare providers that have not yet made the full transition to electronic health records.) So then what are the takeaways?
- Your health information/data is currency that companies are fighting for control over.
- Utilizing blockchain technology is the most viable option for facilitating the move to universal healthcare.
As this discussion about universal healthcare continues to be shrouded in politics, we know that this is really a battle of the billion-dollar companies over shares of the new universal currency — your data — and the industry’s resistance to the adoption of the technology to facilitate the new transactions — blockchain.
(Yoon, Hyung-Jin. “Blockchain Technology and Healthcare.” Healthcare informatics research vol. 25,2 (2019): 59–60. doi:10.4258/hir.2019.25.2.59)