[HN Gopher] Every major pharmacy chain giving government warrant...
___________________________________________________________________
Every major pharmacy chain giving government warrantless medical
record access
Author : rntn
Score : 277 points
Date : 2023-12-29 15:13 UTC (7 hours ago)
(HTM) web link (www.techdirt.com)
(TXT) w3m dump (www.techdirt.com)
| local_crmdgeon wrote:
| Capsule doesn't do this, fwiw
| ceejayoz wrote:
| Do you have an official statement from them on this?
| deelowe wrote:
| The consolidation of the medical industry has been one of the
| most terrible things I've witnessed during my lifetime. What is
| the end state for all this?
| delfinom wrote:
| One company owning everything?
|
| To be fair, some of the consolidation is purely because the
| costs of business have been raised so far that both doctors and
| pharmacists can't operate independently. From mountains of
| school debt, to requirements for IT services and compliances,
| to the insane cost of real estate everywhere.
|
| This country is heading towards one of those cyberpunk endings
| where corporations own people.
| jimbob45 wrote:
| HIPAA was a stupid mistake by the Clinton administration. I
| really don't care who has my medical history and the field of
| medical study would be infinitely better off if it was
| public.
| jhloa2 wrote:
| Now that's a take I've never heard before. It'd be
| interesting to have an opt-in for sharing your medical
| history with entities, but there is no way in hell I'd be
| sharing information that is so easily weaponized against
| me.
| late2part wrote:
| But do you use pharmacies?
| ceejayoz wrote:
| "Yet you participate in society. Curious!"
| https://knowyourmeme.com/memes/we-should-improve-society-
| som...
| chimeracoder wrote:
| > It'd be interesting to have an opt-in for sharing your
| medical history with entities
|
| That already exists. It's baked into HIPAA (if you're
| talking about medical history collected by Covered
| Entities).
|
| All "medical" data collected by direct-to-consumer
| products that aren't providing clinical care (think
| 23AndMe, or third-party services that allow you to book
| appointments with doctors in a Yelp-style interface) are
| not subject to HIPAA, so they already can legally collect
| (and sell) that data without additional consent.
| tenebrisalietum wrote:
| Would you like employers to be able to pull medical history
| (using "background check" type firms) and able to deny
| employment based on your medical condition? Some employers
| may prefer not to hire anyone who has ever been on
| antidepressants, for example.
| tiahura wrote:
| Don't I have a right to avoid crazy or lepers?
|
| Freedom of association shouldn't end just because I want
| to hire an assistant.
| tenebrisalietum wrote:
| Individual rights vs. societal responsibilities.
|
| Jobs are touted as necessary as being part of modern
| society. Judges, legislators, and commmunity leaders
| expect you to have a job and consider whether or not you
| have one as judgement of your character. The health of
| society and a community are measured by the percentage of
| adults that have jobs. As long as this is true, then
| strict freedom of association should have lower priority
| than making sure everyone is employed.
|
| An alternative is UBI.
| jimbob45 wrote:
| No, but health is already a protected class in employment
| laws. Any employer pulling or seeking that information in
| any way would open themselves up to a class action
| lawsuit by everyone who had ever been rejected from that
| company.
| kevin_thibedeau wrote:
| The US government does that for security clearances.
| claytongulick wrote:
| So, treatment for an STD, for example, should be public
| information?
|
| What if that treatment occurred while the spouse was on a
| six month military deployment?
|
| Mental health records should be freely available?
|
| Would you enjoy having potential employers review all of
| your conversations with a counselor before deciding whether
| to hire you?
|
| There's a very good reason why society has placed a high
| value on the privacy of health care information above
| almost all else, including financial.
| thwarted wrote:
| _So, treatment for an STD, for example, should be public
| information? What if that treatment occurred while the
| spouse was on a six month military deployment?_
|
| There _has_ to be a better example of why privacy is
| important than keeping infidelity and having an STD
| secret from your military deployed spouse.
| claytongulick wrote:
| Marital infidelity rate is about 50% - and that's just
| for self-admitted [1]. Actual rates are likely much
| higher. A large majority of people of both sexes admit
| that they would have an extra-marital affair if they
| believed they wouldn't get caught.
|
| Anecdotally, when I was I the military I saw much, much
| higher than 50% when spouses were deployed. This seems to
| be a pervasive issue [2].
|
| Seems like a culturally relevant health issue to use as
| an example.
|
| [1] https://worldpopulationreview.com/country-
| rankings/infidelit...
|
| [2] https://pubmed.ncbi.nlm.nih.gov/28054799/
| gosub100 wrote:
| I sort of agree with you on the surface (who cares if some
| rando knows I take thyroid meds?), but the ways medical
| data can be used against you are very insidious. Even now
| that preexisting conditions are history (AFAIK), if your
| data were public, people could target you (or the elderly)
| for snake oil cure scams, financial scams (especially if
| they knew you were dying of cancer), identity theft scams
| (send you fake bills and steal your money). Anything sexual
| or psychiatric could be used to blackmail you, all sorts of
| cruel things could be done, it just takes some imagination.
| renewedrebecca wrote:
| Imagine being a woman with a miscarriage or a trans kid in
| Texas.
|
| Healthcare info being public invites all sorts of abuse by
| people going for political or "culture war" gains.
| conductr wrote:
| One of the catalyst for that were that insurance companies
| were kicking people off coverage as they knew about
| increased risk.
|
| I have a female family member who never got a genetic
| cancer lab test because a positive result came with risks
| of her getting kicked off private insurance. Even though
| her sister had cancer at 30 and her paternal line had tons
| of history of women dying young for "woman issues" as it
| was called back then.
|
| Anyway she assumed she had the genetic mutation but never
| could get the preventative surgery she should have because
| insurance wouldn't approve it without the positive lab
| results confirming she was at high risk for cancer.
|
| It's dystopian.
| FireBeyond wrote:
| And beyond the most obvious stuff too. I worked for a
| company that ran claims benefits management systems. We
| had regular inquiries from our customers (insurers)
| saying that they had genealogy databases and wanted to be
| able to mine not just their own systems for "increased
| familial risk" based on claims history, but wanted to be
| able to get this information from "partner" (not actual
| partners, just "our other customers") databases
| similarly.
|
| We would not, thankfully. But many of them asked. Some,
| repeatedly.
| HumblyTossed wrote:
| A rather naive take. That information will be taken and
| used against you in some way. But, hey, you do you...
| sowbug wrote:
| Lots of downvotes for this comment. Yet it represents the
| prevailing public opinion on privacy (even if the
| polarizing point about a particular US president is
| removed).* How will the privacy landscape change if the
| vast majority of people don't care?
|
| *Apologies for the excessive alliteration. Didn't see until
| I submitted.
| gruez wrote:
| >costs of business have been raised so far that both doctors
| and pharmacists can't operate independently. From mountains
| of school debt, to requirements for IT services and
| compliances, to the insane cost of real estate everywhere.
|
| It's worth noting that the costs you listed, only
| "requirements for IT services and compliances" seems to favor
| large corporations. Everything else you listed don't offer
| economies of scale (eg. 100 pharmacists = 100 "mountains of
| school debt"), so unclear how they're contributing towards
| consolidation.
|
| >This country is heading towards one of those cyberpunk
| endings where corporations own people.
|
| I don't get it. Does a future where you have to work for
| corporations mean "corporations own people"?
| jsbisviewtiful wrote:
| > I don't get it. Does a future where you have to work for
| corporations mean "corporations own people"?
|
| These kinds of responses are always so frustrating to see.
| The average person clearly is not paying attention to how
| much of a stranglehold corporations now have over the
| populous and how often they just buy themselves power - or
| even worse, the average populous just doesn't care or is
| willfully ignorant. In the US especially - folks always
| screaming about gov power but not caring about corporations
| and billionaires owning governments.
| llbeansandrice wrote:
| It's not a problem unless they do something I don't like
| like Apple /s
| gruez wrote:
| >The average person clearly is not paying attention to
| how much of a stranglehold corporations now have over the
| populous and how often they just buy themselves power
|
| Sounds like the actual issue is "corporation control over
| government". Why not say that directly instead of making
| a tenuous point about how "corporations own people"?
|
| >the average populous just doesn't care or is willfully
| ignorant
|
| Have you been living under a rock? "big corporations bad"
| is a bipartisan issue. The only difference between the
| parties is the reasoning for why they're bad. eg. "big
| tech is bad because they're hoarding wealth" vs "big tech
| is bad because they're pushing woke agenda".
| parineum wrote:
| Comments full of doomsaying with no examples are always
| so frustrating to see.
| fsflover wrote:
| For example, 99.9% of the smartphone market belongs to
| two huge corporations, which are not very different from
| one another (except marketing of course):
| https://news.ycombinator.com/item?id=34299433
| chaxor wrote:
| "screaming about government power but not caring about
| corporations and billionaires" - that's by design. Anyone
| falls for this (worries about government power over
| corporations) is simply not intelligent enough to see
| past the corporate media's shaping of the narrative. The
| US needs a massive shift of power towards the government
| as well as a decrease in the democratic deficit. While
| there are plenty of problems with unions and the
| government, overall the state of the US needs a change,
| and smashing unions was one of the worst contributors
| towards increasing the democratic deficit, and it would
| greatly help to increase the functioning of local
| democratic organizations to improve the national
| democratic deficit.
| giantg2 wrote:
| "so unclear how they're contributing towards
| consolidation."
|
| Easier to work for another entity than start up your own if
| you are already on debt, especially if overhead costs
| related to regulation require more capital.
| geodel wrote:
| > only "requirements for IT services and compliances" seems
| to favor large corporations.
|
| Of course other two matter. Large corp will have its own
| property management department and can get better deals for
| good locations to open new pharmacy or other medical
| location. Further large corp can offer more reliable income
| and better insurance to Doctors and pharmacists than small
| single store pharmacy or doctors with individual practice.
|
| See cost of group medical insurance for employees in big
| corp vs insurance for self-employed individuals. Simply it
| favors big corp.
| Geisterde wrote:
| >This country is heading towards one of those cyberpunk
| endings where corporations own people.
|
| That was settled in 1971, when money itself ceased to exist
| as humans have generally known it for thousands of years, and
| was instead replaced with fuduciary credit. So long as this
| stands, anything, you can only buy something if you or
| someone else has gone into debt to aquire the money for it,
| and those dollars will eventually be removed from circulation
| when they make their way back to a private banking cartel,
| the federal reserve.
| gruez wrote:
| For all intents and purposes, working for federal reserve
| notes and working for yellow lumps of metal (via federal
| reserve notes) is the same. Yellow lumps of metal can't
| provide you with food or shelter, so you'd have to exchange
| it with someone else that has those things. There's no
| difference between the two aside from the fact that federal
| reserve notes can be printed at will in response to
| economic conditions, and yellow lumps of metal are
| extracted from the ground at haphazard rates.
| claytongulick wrote:
| > aside from the fact that federal reserve notes can be
| printed at will in response to economic conditions, and
| yellow lumps of metal are extracted from the ground at
| haphazard rates.
|
| That's a pretty key difference.
|
| The value is based on scarcity.
|
| When there's no scarcity constraint, we can all just
| collectively vote ourselves to be billionaires.
|
| What could go wrong?
| renewedrebecca wrote:
| And yet, after all this time, we _haven 't_ voted
| ourselves to be billionaires.
| gruez wrote:
| >What could go wrong?
|
| I could say the same for basing your money supply on the
| production of a yellow metal. What happens when there's a
| massive discovery of gold? Or there's a (trade) war
| between the top producers (eg. china, australia, and
| russia)? Or when there's a worldwide pandemic and you
| need to provide stimulus so the economy doesn't collapse?
| logicchains wrote:
| >What happens when there's a massive discovery of gold?
| Or there's a (trade) war between the top producers (eg.
| china, australia, and russia)?
|
| Never in history has this situation caused a collapse
| like the hyperinflation seen in Weimar Germany or
| recently Zimbabwe. Because even a huge change in supply
| is only going to affect price by a double digit percent
| (check a chart of historical gold price volatility),
| while hyperinflation can reduce the value of currency by
| orders of magnitude.
|
| >Or when there's a worldwide pandemic and you need to
| provide stimulus so the economy doesn't collapse?
|
| The stimulus was only necessary because of the lockdowns,
| which in hindsight proved completely counter-productive,
| empirically producing no overall reduction in deaths (htt
| ps://onlinelibrary.wiley.com/doi/full/10.1002/hec.4737 ).
| Without the ability to print money governments wouldn't
| have been able to get away with locking down their
| citizens so long, and the damage they inflicted on mental
| health and children's educational outcomes could have
| been reduced.
| gruez wrote:
| >The stimulus was only necessary because of the lockdowns
|
| The question of whether lockdowns were justified aside,
| pandemics aren't the only form of economic calamity that
| might occur. Financial crisis occur. Other supply shocks
| (eg. war in ukranie) exist as well.
| logicchains wrote:
| And printing money isn't the only way to deal with supply
| shocks; a government could also use its reserves, as e.g.
| Singapore did during covid.
| gruez wrote:
| 1. Singapore is a city state that has a GDP around twice
| of other developed economies. What works for it does not
| necessarily work for every other country.
|
| 2. There's opportunity costs with keeping such high
| reserves around, rather than doing something productive
| like investing in infrastructure.
|
| 3. It's unclear how introducing massive amounts of gold
| (previously held in reserve) into the economy won't cause
| inflationary effects. Like I said earlier, you can't eat
| gold. Dumping a bunch of gold into the economy doesn't
| magically increase the amount of goods in existence,
| which would also lead to inflation that money printing
| would cause.
| logicchains wrote:
| > 1. Singapore is a city state that has a GDP around
| twice of other developed economies. What works for it
| does not necessarily work for every other country.
|
| China as a country with relatively low GDP per capita
| also manages to maintain high foreign exchange reserves.
|
| >2. There's opportunity costs with keeping such high
| reserves around, rather than doing something productive
| like investing in infrastructure.
|
| Infrastructure spending is only a small fraction of the
| US budget compared to warfare; if the US hadn't gone to
| war in Iraq and Afghanistan it could have a few trillion
| dollars of reserves with no drop in productive spending.
|
| > It's unclear how introducing massive amounts of gold
| (previously held in reserve) into the economy won't cause
| inflationary effects. Like I said earlier, you can't eat
| gold. Dumping a bunch of gold into the economy doesn't
| magically increase the amount of goods in existence,
| which would also lead to inflation that money printing
| would cause.
|
| It would cause inflationary effects initially, but this
| would be a one-off thing, as the mining rate of gold is
| relatively steady.
| gruez wrote:
| >China as a country with relatively low GDP per capita
| also manages to maintain high foreign exchange reserves.
|
| And they're only able to pull it off by having a high
| trade surplus. Needless to say, not everyone can have a
| high trade surplus, so it's unclear how this is a policy
| that can generalize.
|
| >if the US hadn't gone to war in Iraq and Afghanistan it
| could have a few trillion dollars of reserves with no
| drop in productive spending.
|
| If the pandemic is anything to go by, if there's a
| surplus the money would get plowed into tax cuts, not
| reserves.
|
| https://www.economist.com/united-
| states/2022/08/25/states-ha...
| logicchains wrote:
| >And they're only able to pull it off by having a high
| trade surplus. Needless to say, not everyone can have a
| high trade surplus, so it's unclear how this is a policy
| that can generalize.
|
| Governments with a gold-backed currency could maintain
| high (government) reserves even with a high trade
| deficit. Imagine a king with literal gold currency, a
| huge pile of gold in his throne-room. No matter how large
| the private economy's trade deficit, he's still going to
| have the same amount of gold in his pile.
|
| >If the pandemic is anything to go by, if there's a
| surplus the money would get plowed into tax cuts, not
| reserves.
|
| If governments couldn't print money they'd be forced to
| be more economically cautious, because they couldn't just
| print themselves out of trouble, instead they'd need a
| tax, which would face more resistance.
| gruez wrote:
| >Imagine a king with literal gold currency, a huge pile
| of gold in his throne-room. No matter how large the
| private economy's trade deficit, he's still going to have
| the same amount of gold in his pile.
|
| Isn't that just quantitative easing/tightening by another
| name? During good times you're taking gold out of
| circulation to build reserves, and during bad times
| you're releasing gold out of reserves to stimulate the
| economy.
|
| >because they couldn't just print themselves out of
| trouble, instead they'd need a tax, which would face more
| resistance.
|
| The above example involves US states, which can't print
| their own money.
| logicchains wrote:
| >Isn't that just quantitative easing/tightening by
| another name? During good times you're taking gold out of
| circulation to build reserves, and during bad times
| you're releasing gold out of reserves to stimulate the
| economy.
|
| Yes, exactly. But in this scenario the gold's being taken
| out of circulation by taxation rather than by inflation,
| which makes it more visible and constrained. Similarly
| the release is constrained by the amount of physical gold
| reserves, so you couldn't realistically have e.g. a few
| years of 100%+ inflation rates. And the process of
| transferring the wealth is less lossy; 100% goes to the
| government, none to intermediaries in the financial
| system.
|
| >The above example involves US states, which can't print
| their own money.
|
| They can't, but they can try to get the federal
| government, which can, to bail them out.
| gruez wrote:
| >which makes it more visible and constrained
|
| It comes at a heavy cost though: you need to keep tons of
| the yellow stuff around, rely on the past administrations
| being prudent to actually keep a sufficient reserve. In
| the end you're still relying on people to act prudently.
|
| >They can't, but they can try to get the federal
| government, which can, to bail them out.
|
| I mean if you're going to invoke extraordinary measures
| like this, then I can also invoke up extraordinary
| measures like the government debasing the currency, which
| was still done even when countries were on the gold
| standard.
| logicchains wrote:
| >It comes at a heavy cost though: you need to keep tons
| of the yellow stuff around
|
| A cost to the government, but much less of a cost to the
| lower classes, who pay low taxes thanks to progressive
| taxation so inflation represents the biggest drain on
| their wealth (especially since most don't have access to
| financial instruments or the education to use them).
|
| >I mean if you're going to invoke extraordinary measures
| like this
|
| It's not necessarily extraordinary; we haven't seen the
| Federal government bail out a state yet but we also
| haven't yet seen a state undergo a complete financial
| collapse, so it's quite possible there'd be a bailout if
| things got bad enough. The WSJ predicts a bailout of the
| states is upcoming: https://www.wsj.com/articles/the-
| coming-biden-bailout-of-blu...
|
| >like the government debasing the currency, which was
| still done even when countries were on the gold standard
|
| They did that by essentially turning their currency into
| a fiat currency: saying it was worth X, when the actual
| precious metal it consisted of was only worth e.g. half
| of X. But yes you're right that in theory nothing
| prevents a government with 100% gold standard from
| debasing it like that, however doing so would be more
| visible to citizens than inflation since it'd require
| centralising how the currency was priced.
| Geisterde wrote:
| I dont know whether being able to call it quantitative
| easing matters at that point. If the government has a
| pile of gold it deploys during an economic downturn, say
| they get it right and actually help, people will be less
| dissatisfied with the subsequent taxation. If they get it
| wrong though, and cause problems or fail to help the
| situation, people will be more resistant to that
| taxation; in the next cycle the government will be more
| careful about their allocations, pressured both by
| resource constraints and political pressure.
|
| Wouldnt that be a healthier cycle than one where we just
| paper over everything?
| Geisterde wrote:
| Right, its just how the power was used in real life,
| rather than the utopia that you were promised.
| logicchains wrote:
| >For all intents and purposes, working for federal
| reserve notes and working for yellow lumps of metal (via
| federal reserve notes) is the same
|
| It's absolutely not because with federal reserve notes
| 2-3% of your purchasing power (more recently) is
| transferred every year to the elites in the financial
| system. Because the Federal Reserve doesn't just deposit
| money evenly into everybody's bank accounts, it loans it
| out to banks, and banks as the first recipients of the
| newly created money benefit from a wealth transfer from
| the last recipients of the newly created money (termed
| the Cantillon effect).
| gruez wrote:
| It's a leap to go from "Cantillon effect" to "2-3% of
| your purchasing power (more recently) is transferred
| every year to the elites in the financial system". I
| agree there's some benefit from getting the money sooner,
| but it's nowhere close to 100% of inflation.
| logicchains wrote:
| Yes you are right, a lot of that 2-3% goes to the
| government, and only the remaining part goes to elites in
| the financial system. It's still higher though than the
| 0% it'd be with gold-based money (or a Fed that
| helicopter-dropped money directly into people's bank
| accounts).
| gruez wrote:
| >Yes you are right, a lot of that 2-3% goes to the
| government
|
| I'm not really sure how that's the case when inflation
| expectations are baked into any sort of fixed income
| products.
| logicchains wrote:
| >I'm not really sure how that's the case when inflation
| expectations are baked into any sort of fixed income
| products.
|
| The poorest people in the US, lower and lower-middle
| class, aren't holding many fixed-income products, and
| they're the ones hit hardest by inflation. But that
| aside, even if your fixed-income product covers
| inflation, you're still taxed on the capital gains as if
| it was real profit, because capital gains taxes (at least
| in the US) don't account for inflation. I.e. they tax the
| nominal gain, not the real gain.
| gruez wrote:
| This presumes that inflation wouldn't happen with gold,
| which isn't straightforwardly true. Technological
| advances could make gold easier to extract which would
| increase their supply, which in effect is printing money.
| Also, going back to your point about how benefit accrues
| to "elites in the financial system" because of the
| Cantillon effect, it's unclear why that wouldn't occur
| with gold backed currency. After all, gold would still be
| mined. The only difference is that it would go to miners
| rather than "elites in the financial system".
| logicchains wrote:
| >This presumes that inflation wouldn't happen with gold,
| which isn't straightforwardly true. Technological
| advances could make gold easier to extract which would
| increase their supply, which in effect is printing money.
|
| Yes, but it's unlikely there'd be such advances made
| consistently year after year, given that's not what we've
| seen historically. The US had a gold-backed currency for
| the entire 1800s and there wasn't any significant
| inflation: https://www.minneapolisfed.org/about-
| us/monetary-policy/infl... .
|
| >The only difference is that it would go to miners rather
| than "elites in the financial system".
|
| Yes you're right. Based on historical data though I'd
| expect them to receive overall much less than the
| financial industry currently does, given how much less
| inflation there was in the period prior to Bretton Woods
| ending. As per that link I shared earlier, the CPI was 51
| in 1800, 25 in 1900, 116.7 in 1970, and 900 in 2023.
| gruez wrote:
| >The US had a gold-backed currency for the entire 1800s
| and there wasn't any significant inflation:
| https://www.minneapolisfed.org/about-us/monetary-
| policy/infl... .
|
| The same source also shows that between 1800 and 1850
| prices halved. I guess that's technically not inflation,
| but 50% deflation isn't great either and causes other
| economic problems.
| logicchains wrote:
| >I guess that's technically not inflation, but 50%
| deflation isn't great either and causes other economic
| problems
|
| Yes, there was a lot of deflation in the 1800s, and
| although it caused hardship, GDP per capita continued to
| grow at around 4% throughout the century, without huge
| dips like we saw in the Great Depression or the GFC.
| Geisterde wrote:
| Historically the profit from gold mining was the least
| common denominator of society. The cost of gold mining
| closely tracks the revenue, meaning almost any other
| profitable investment would be preferable.
| airbreather wrote:
| Gold mining is effectively a black box that takes diesel
| in and produces gold out
| Geisterde wrote:
| The bailouts of 2008 led to a k shaped recovery just like
| the bailouts and stimulus of covid.
|
| People save money when times are hard, interest rates
| rise and unproductive ventures collapse, that is the
| homeostatic response of the economy and it is a healthy
| one; when productive ventures prove themselves, they are
| able to attract the investment of savers and use it to
| aquire capital goods etc.
|
| When you print money in an attempt to stimulate the
| economy, you are sending mixed signals to investors who
| now have to worry about inflation eating their savings,
| ecouraging them to spend or invest in often unproductive
| ventures. This response drives up the cost of consumer
| goods and allows those unproductive ventures to suck up
| the capital goods that would be better used elsewhere.
| gruez wrote:
| The alternative of "economy goes bad -> people try to
| save money -> supply dries up -> economy goes even
| worse", as we saw in the great depression isn't great
| either.
| logicchains wrote:
| The great depression wasn't caused by just people saving
| money. The US imposed massive trade tariffs prior to it,
| which as predicted by basic macroeconomics had a big
| negative impact. It also added price controls, even on
| labour, which again as predicted by basic econ prevented
| the market from clearing and led to mass unemployment (as
| deflation was happening, price floors prevented wages
| from following it, so in real terms wages were too high
| for employers to afford, causing mass unemployment).
| Those price controls BTW are why health insurance is tied
| to employers in the US: because companies at the time
| couldn't offer higher wages above the price ceiling, so
| instead compensated by offering benefits like insurance
| instead.
| Geisterde wrote:
| The federal reserve admitted that their policies
| prolonged the great depression.
|
| People will buy the things that they need, resources will
| follow those needs because thats what people are actually
| buying. Some things might die, that is a reflection of
| society not actually caring very much about it, otherwise
| they would be buying it. This is in fact an attempt to
| re-organize the economy around specific things that
| wouldnt otherwise be supported by the market, with some
| crumbs left to curate votes.
|
| When people save, interest rates go up, freeing the
| capital goods needed for ventures that the market
| actually has a revealed preference for.
| gruez wrote:
| > The federal reserve admitted that their policies
| prolonged the great depression.
|
| their policies of what? Not engaging in stimulus?
|
| >People will buy the things that they need
|
| People buying the bare minimum also means there's little
| investment going on, which needless to say is bad for
| economic growth.
|
| >When people save, interest rates go up
|
| Why would that be the case? Interest rates are a
| reflection of the cost of money. When there's more money
| floating around, the cost of borrowing becomes cheaper,
| not more expensive. Or to put it another way: for every
| saver, there has to be a borrower. If there's more savers
| than borrowers, then the savers will have to compete with
| each other on price (ie. the interest rate they charge),
| driving them down.
| logicchains wrote:
| >People buying the bare minimum also means there's little
| investment going on, which needless to say is bad for
| economic growth.
|
| Not spending money indirectly contributes to investment.
| If you imagine 50% of the population suddenly decided to
| not spend any money for 10 years, and they hold 50% of
| all the money in circulation, in the short term this is
| essentially equivalent to burning 50% of the money
| supply, in that the reduction of the supply of money in
| the market leads to an increase in the value of money,
| which allows the people spending money at that time
| (including people making investments) to obtain more
| goods and services for their money.
| gruez wrote:
| But if the economy is going to shit, who are the people
| that are sticking their necks out by borrowing money to
| invest, rather than accumulating savings to weather the
| downturn?
| logicchains wrote:
| >who are the people that are sticking their necks out by
| borrowing money to invest, rather than accumulating
| savings to weather the downturn
|
| Normal people aren't, but rich people (who don't face any
| real risk to their standard of living from a crash) are
| incentivised to "buy the low" while everything is cheap.
| And they can buy more thanks to the purchasing power that
| other currency holders temporarily forfeited by pulling
| their money out of circulation.
| gruez wrote:
| You claimed a few comments up that printing money would
| cause people "to spend or invest in often unproductive
| ventures", but based on what you're saying now, it would
| have the same effect? ie. more savings = more investments
| are needed to balance them out = more questionable
| ventures being funded as savers chase ever more
| questionable ventures for yields.
| logicchains wrote:
| >more questionable ventures being funded as savers chase
| ever more questionable ventures for yields
|
| The difference is that for private investment there's a
| process of natural selection: bad investors lose money to
| good investors, and over time the people with a record of
| better investment end up with more money, and overall
| better investments are made. Whereas the US government
| can keep spending money on economically unproductive
| things like the war in Afghanistan indefinitely without
| any feedback loop to stop it.
| gruez wrote:
| I agree that if government was somehow involved in the
| lending (ie. choosing which companies to bail out), there
| would be a risk of picking winners/losers and creating
| zombie firms, but it's unclear how it's an issue
| exclusive to fiat currency. After all, governments can
| still take on debt even while on the gold standard, and
| can still engage in bailouts.
| logicchains wrote:
| Yes, the lending during bailouts could still pick
| winners/losers, but overall during normal times the
| government would be spending relatively less compared to
| the private market (as it'd be constrained to what level
| of taxation voters were willing to tolerate), and there'd
| also be potentially more oversight over its spending (as
| it'd have to justify spending increases in order to
| receive public support for increasing taxes to pay for
| it).
| Geisterde wrote:
| People wkll invest in the ventures that have a profit,
| because those can weather the storm. Eventually the
| growth of those companies creates the economic surplus
| that allows greater specialization to return, only built
| on a foundation of profitable companies.
|
| When you bail companies out, you create zombies that dont
| need to compete for the business, they will weather the
| storm and come out the other side monopolizing the
| market. The specialization that flows from that is the
| spread of a cancer, doubling down on a failed foundation.
| Geisterde wrote:
| >their policies of what?
|
| This was answered by the other poster
|
| >People buying the bare minimum also means there's little
| investment going on, which needless to say is bad for
| economic growth.
|
| Growth for who? There is little investment going on, that
| is the point, ventures that cant profit die, freeing
| their resources up for more productive ventures.
|
| >Why would that be the case?
|
| In this paragraph you moreso identify the market forces
| that eventually cause rates to come down. Eventually
| there is enough savings, and when companies come forward
| demonstrating their ability to create value, competition
| between savers pushes rates back down. This comes _after_
| the period of everyone stuffing their money under the
| mattresses.
|
| You are confusing saving and lending, there is a creditor
| (buyer) for every lender, not every saver.
|
| --------------
|
| Lets summarize. I hope you find the following to at least
| engage you and make you question your prior understanding
| of the issue at hand.
|
| You are concerned that companies will own everything, but
| are not concerned with the 7% YOY (its not 2-3%) growth
| in the money supply, and how all interest on money that
| was printed into existence. The principle of that money
| will eventually be taken back out of circulation, leaving
| interest that remains to be paid. If you bought a house,
| but only paid back the principle, the bank is still going
| to repo your house, they own it afterall; there isnt
| enough money in the economy to repay the principle,
| meaning either mega-default across basically all
| industries, or we have to take on _more_ debt to repay
| the interest on the last debt; since we are dealing with
| precentages and compounding interest, a greater and
| greater sum of resources go explicity to repaying debt.
|
| If you wanted your repo-men world where everyone is
| enslaved to debt and private companies, thats all you
| need, just let it play itself out. If you really wanted
| to take it up a notch though, theres more we could do to
| confuse and repress the poor. Print lots of money, it
| doesnt matter how you justify it, forever wars, bank
| bailouts, socialized healthcare and welfare, it doesnt
| matter! When this money is printed, it will accelerate
| the process by rapidly growing the total amount of
| interest owed, and you will of course have your pockets
| open to receiving these streams of cash.
|
| Why do you think politicians have been getting so rich
| off the stock market? Do you think its because these
| people are world class investors? All of them? They are
| invested in the same companies that they regulate, and by
| that I mean they protect those companys against
| competition, and provide stimulus when possible.
|
| For the average person? The time-price of everything this
| money touches goes up, thats how many hours the median
| american has to work to aquire a good. Housing,
| healthcare, education, defense, everything that is paid
| for with money being printed into existence, is going up
| in price dramatically. Things like, tvs, computers, they
| become more accessible every year.
| deelowe wrote:
| These "costs" you speak of are purely fabricated through a
| complex system of insurance, pharmacy consolidation, medical
| practice consolidation, and intermediaries who structure the
| pricing.
| ClumsyPilot wrote:
| Consolidation drives consolidation. It's a closed loop.
|
| We've gotten to the point where 'communist' China has more
| competition than most of the west does.
| teeray wrote:
| > mountains of school debt
|
| Is this, plus the liability insurance aspect, the root of the
| problem? I wonder if prospective doctors could "enlist" where
| the government pays for all this training and shields them on
| the condition that they follow orders for some period of time
| like "be a primary care doctor in this underserved community
| and treat everyone." You can't go be a Malibu plastic surgeon
| until after your mandatory service period.
| MattGaiser wrote:
| Isn't this just the military? Canadian military is
| perpetually short of medical staff even with this.
| teeray wrote:
| Not exactly my thoughts, but similar. The military trains
| doctors for troops and veterans. This would be for the
| benefit of civilians. One provides for the common
| defense, this would promote the general welfare.
| giantg2 wrote:
| "Is this, plus the liability insurance aspect, the root of
| the problem?"
|
| Maybe for some, but not all. I know of more than a few
| older doctors that decided to retire because they didn't
| want to deal with increased regulation. So it's not always
| a money issue.
|
| "I wonder if prospective doctors could "enlist" where the
| government pays for all this training and shields them"
|
| They have these programs for military doctors. Doctors
| working for the VA (and maybe other federal things like
| prisons) can usually avoid a lot of state related costs,
| which I believe includes malpractice insurance (or maybe
| the federal version of malpractice is cheaper).
| logicchains wrote:
| Medical school is so expensive because it's a cartel; the
| government limits new entrants, so the schools can charge
| whatever they want because they know they're not going to
| get any competition. And it doesn't allow people to
| practice medicine unless they attended one of those
| privileged schools.
| FireBeyond wrote:
| > the government limits new entrants
|
| ... based on lobbying from the AMA, which is only in the
| last couple of years reluctantly acknowledging that
| maybe, perhaps, possibly, it shot itself in the foot with
| the increasing amount of physician burnout.
| lotsofpulp wrote:
| Source? I don't think the federal US government has any
| say about how many medical school students there can be.
|
| The federal government does provide funding for residency
| positions, and all doctors are required to complete
| residency. This residency funding has been effectively
| flat for many, many years, effectively capping the number
| of residency positions, which then caps the number of new
| doctors per year.
|
| But I am not sure what exactly limits anyone other than
| the government from funding residency positions.
| NegativeK wrote:
| Teach for America (a non-profit) works with some colleges
| to offset some of the tuition. There are states in the US
| that will cover the difference of out of state tuition at
| an out of state veterinary medical school in exchange for
| years of work in state.
|
| Unsurprisingly, those programs still exist because there
| are still shortages despite the help they're bringing. But
| there's precedent.
| Centigonal wrote:
| Perhaps we'll get single-payer... but the single payer will
| have a profit motive.
| droopyEyelids wrote:
| A move towards "Value Based Pricing" for medical services,
| where pricing corresponds to the value of our lives.
| hollerith wrote:
| Does anyone know of an actual case of a person who was impacted
| by this? The OP does not describe such a one. Is the only impact
| on people suspected of using prescription drugs to kill, rape or
| otherwise harm? I am having trouble imagining other kinds of
| impacts.
| alemanek wrote:
| If the police have a reasonable suspicion then they should have
| no problem getting a warrant. If they cant clear that bar then
| maybe they shouldn't get that information.
|
| Rules aren't just for people you like or approve of.
| hollerith wrote:
| So you're not curious at all about how this "information
| leak" you probably did not know about before today could bite
| you personally? For you, this conversation is only about
| public policy and how you and I might change it -- and not at
| all about how you personally (or someone you care about)
| could modify your purchasing behavior to reduce your
| vulnerability to adverse governmental action?
|
| I agree with the legal principle you describe, but to me that
| is the less interesting angle because public policy is hard
| to change whereas my own behavior is much easier to change.
| It is amusing that I cannot have a conversation here about
| any other angle without getting downvoted by people opposed
| to any writings that could possibly be useful to the opposing
| side in the public debate over the one angle they want to
| talk (write) about.
| xxpor wrote:
| The standard for a warrant is probable cause, not reasonable
| suspicion.
| ClumsyPilot wrote:
| I think OP's point is that, without privacy, there is no
| standard at all.
| mindcrime wrote:
| _Does anyone know of an actual case of a person who was
| impacted by this?_
|
| What difference does that make? It's wrong, regardless of
| whether or not one can cite a specific case where it affected
| someone. This is no different than the b.s. "you don't need
| privacy if you don't have anything to hide" crap that people
| spout sometimes.
|
| If the govt. needs this information, the can get a warrant. If
| they can't get a warrant, they don't need the information. This
| isn't that hard to figure out.
| edrxty wrote:
| Oh boy...
|
| Here's a good one: the FAA categorically prevents any pilots
| from taking any psychiatric medication (minor caveats but the
| point holds in practice), in particular for depression,
| anxiety, and ADHD, all of which are _extremely_ common in the
| airlines. As such, everyone just hides their diagnosis and
| waits until they snap because the alternative is permanently
| losing a job they took out hundreds of thousands in loans to
| get. Others pay out of pocket for treatment under false names
| so the FAA is currently trying to hunt them down.
|
| Before anyone says the usual stuff about not wanting their
| pilots on meds, the medications are safe to fly on and much
| safer than the alternative, the FAA just hasn't updated their
| psych guidelines since Freud was the standard because any
| change would open whichever bureaucrat up to being hauled in
| front of Congress for the next accident regardless of
| culpability. Additionally the medication standards are also
| inherited from ICAO so even if we wanted to change, we'd need
| to convince the likes of China and the Saudis (both major
| stakeholders) that they can come out from the rock they live
| under and accept modern psychological science.
| hollerith wrote:
| Thank you!
| raverbashing wrote:
| Ugh, this is absurd
|
| And I agree, it is safer to just get the drugs. Maybe some
| very specific drugs should be excluded, but that's it
|
| Same with leaded fuel and some very old mechanical gizmos in
| planes.
| logicchains wrote:
| >we'd need to convince the likes of China and the Saudis
| (both major stakeholders) that they can come out from the
| rock they live under and accept modern psychological science.
|
| Giving how overwhelmingly worse the mental health is of
| people, especially young people, in America, I can see why
| the Chinese and Saudis are so reluctant to accept western
| psychological "science".
| parineum wrote:
| What's it like to do a young woman in Saudi Arabia or a
| young Muslim in China?
| SpaghettiCthulu wrote:
| That's completely irrelevant to what OP was saying.
| ceejayoz wrote:
| No, it isn't. Mental health is a lot easier if you don't
| care about large portions of the population.
| wyre wrote:
| I would hope that the Chinese and Saudi's realize the youth
| in America's mental health is largely due to America's
| unique flavor of corporatacracy and the climate crisis. If
| you think this is wrong you either don't know or understand
| American youth or you're being willfully ignorant.
| edrxty wrote:
| We're talking about two different things: the cause of
| mental health issues and the treatment of mental health
| issues. The US is pretty modern at treating them and pretty
| outstanding at causing them.
| hamhock666 wrote:
| Yes but it seems like the treatment is addressing the
| symptoms and not the outstanding source of them as you
| say. We are slapping band-aids on an open wound
| 1920musicman wrote:
| Ha, it's like saying there are no gay people in Saudi
| Arabia. If having psychological issues is extremely
| stigmatized by the society don't expect the stats to
| reflect reality in any trustworthy sense.
| ijhuygft776 wrote:
| > FAA categorically prevents any pilots from taking any
| psychiatric medication
|
| Some of those medications can alter you in a big way... at
| least many of those medications should be on the list...
| ceejayoz wrote:
| > I am having trouble imagining other kinds of impacts.
|
| You don't even have to imagine; there are plenty of concrete
| examples.
|
| https://www.nbcnews.com/nbc-out/out-politics-and-policy/seat...
|
| "Texas Attorney General Ken Paxton asked a Seattle hospital to
| hand over records regarding gender-affirming treatment
| potentially given to children from Texas, according to court
| filings that appear to show the Republican going beyond state
| borders to investigate transgender health care."
|
| https://montanafreepress.org/2023/07/19/knudsen-other-republ...
|
| "Montana's attorney general and Republican officials from 18
| other states are opposing a federal effort to strengthen
| medical privacy regulations, arguing that states with abortion
| bans should be able to obtain reproductive health care records
| for criminal investigations, including when a patient travels
| to another state."
| hollerith wrote:
| Thank you!
| ClumsyPilot wrote:
| > Republican officials from 18 other states are opposing a
| federal effort to strengthen medical privacy regulations
|
| Against big government when it suits, I see. Hypocrisy is the
| worst disease in politics.
| claytongulick wrote:
| Succumbing to the temptation of expediency to achieve one's
| ideology is indeed a plague that affects all of politics.
|
| Dismissing critical thought, first order reasoning, and
| "the ends justify the means" short-term focus has brought
| our country once again to the brink of civil unrest.
|
| Unfortunately, it's a phenomenon that's not limited to any
| particular political party.
| FireBeyond wrote:
| Yup, and Texas, who also tried to sue Pennsylvania (and
| Georgia, Michigan and Wisconsin) over how they ran their
| elections in 2020.
|
| > Within one day of Texas's filing, Trump, over 100
| Republican Representatives, and 18 Republican state
| attorneys general filed motions to support the case.
|
| I expect that the 18 states opposing strengthening medical
| privacy are the same 18 states whose AGs filed these
| motions.
| gosub100 wrote:
| they could use it selectively to take away someone's guns.
| let's say someone gets on the wrong side of a politician who
| wants to wreck them. politician starts an "investigation" of
| the enemy, finds some very loose diagnosis of, say, depression,
| then has armed thugs raid the house and "remove all weapons",
| right after notifying the media. then the media leaks "our
| sources confirm $badguy was treated for an unknown psyciatric
| condition 2 years ago and tonight was found in possession of a
| high-powered rifle and out of concern for the safety of his
| family, his weapons have been confiscated". His reputation
| (whoever he is) is now shat on.
| fritzo wrote:
| Thanks, I was wondering the same.
|
| For those downvoting this question, I think askers are trying
| to weigh the benefits of better data-based decision making
| versus privacy. Amidst an opioid crisis we're wondering if more
| patient-level data may have helped form an earlier picture of
| abuse. Having done some data science, I immediately see the
| benefits of clearer pictures to inform policy; and having
| lucked out of being targeted for medical violence I'm honestly
| looking for examples.
| BobaFloutist wrote:
| >Is the only impact on people suspected of using prescription
| drugs to kill, rape or otherwise harm?
|
| The point of a warrant is that you need to have this suspicion
| to pull the info. If it doesn't take a warrant, they can go on
| fishing expeditions.
| calibas wrote:
| The government can violate your rights so long as they go through
| a 3rd party...
| pvg wrote:
| Big thread last week
|
| https://news.ycombinator.com/item?id=38719918
|
| and last last week
|
| https://news.ycombinator.com/item?id=38615841
| dang wrote:
| Thanks! Macroexpanded:
|
| _Police get medical records without a warrant_ -
| https://news.ycombinator.com/item?id=38719918 - Dec 2023 (258
| comments)
|
| _Pharmacies share medical data with police without a warrant,
| inquiry finds_ - https://news.ycombinator.com/item?id=38615841
| - Dec 2023 (46 comments)
| CodeAndCuffs wrote:
| I used to work in Drug Diversion investigations, which is
| basically any time a prescription medication gets used from
| something other than intended bona fide medical use. Sometimes
| its doctors selling prescription drugs for non-medical use,
| sometimes its medical staff stealing.
|
| The biggest thing we covered was prescription fraud. People
| stealing or forging doctor's prescriptions. Some were more subtle
| about it. Sometimes you'd see a patient filling a 30mg Oxycodone,
| 90 count.
|
| Leads would come from either the Doctor, or the pharmacy. 30mg
| Oxycodone/90 is generally a "You are in massive pain and probably
| dying" prescription. So when a health 20 something year old walks
| in and has it filled for themself, it raises some eyebrows.
| They'd either call the Doctor to verify, who'd call us to
| investigate, or theyd call us and then we'd call the doctor.
|
| But the state already has access to this information. All
| prescriptions are logged in the Prescription Monitoring Program,
| which I believe all states how now. Any Doctor can get a
| spreadsheet of all prescriptions filled in their name over the
| last N days, who it was prescribed to, what for, and when. It was
| an invaluable tool. Doctor Adams tells us he never wrote this
| prescription for Bill. We lookup Bill and see he has filled
| similar suspicious prescriptions from Doctor Charles and Doctor
| Daniels. We talk to Charles and Daniels and they tell us that
| Bill isnt their patient either. We encourage Charles and Daniels
| to check their PMP report, and they uncover 4 or 5 more
| suspicious prescriptions, and we just keep pulling at this thread
| uncovering more and more.
|
| Of course there is potential for abuse and neglect, but we werent
| (and couldnt, legally) just go into a pharmacy and ask for random
| documents, or lookup random names on the PMP. We had to have an
| initial lead, usually a doctor, or a pharmacist, who saw
| something suspicious. From there, its just checking state
| records, verifying what we saw with doctors, and getting paper
| evidence of the stuff we already knew was false. I had maybe 3
| cases where we had a red flag, called the doc, and they doc said
| "Yeah thats legit" and that was the end of the conversation. I
| don't need to know why this patient is on this narcotic, I just
| needed to know if it was a fraudulent. If its not, then thats
| between the doc and the patient.
|
| State law gave us authority to request pharmacy records, i.e.
| prescriptions and pickup logs, without a warrant. Most
| pharmacists did it with no hesitation. A few would want to make
| sure it wasn't a HIPPA violation (it wasnt) and that it was legal
| (it was).
|
| Concerningly, I did have a_couple instances where I asked for
| documents and the employee started to provide them before I had a
| chance to identify myself.
|
| In summary, if we were to blindly look at someones medical
| history or records without a bona fide articulable suspicion of a
| crime, it'd be massively illegal. If we did have a reason to look
| at the records, its because someone in the medical field saw
| something suspicious and reported it. From there we were mainly
| looking at records the government already had, and then finally
| getting medical records from the pharmacy that was just paper
| evidence of records we already had.
| jvanderbot wrote:
| I definitely appreciate the context here. It adds some color to
| breathless headlines.
|
| I'm curious what other precedents there are for this. Can a
| state policing agency of some kind go and pull purchase records
| for a credit card by name? Could they extract search history,
| drive destinations, music lists, or something else without
| warrant? It's not clear to me where the distinction between
| "warrant-less search/seizure/wiretap" crosses into "Get all
| data about a person who is outside their home for free".
| chimeracoder wrote:
| > Can a state policing agency of some kind go and pull
| purchase records for a credit card by name? Could they
| extract search history, drive destinations, music lists, or
| something else without warrant? It's not clear to me where
| the distinction between "warrant-less search/seizure/wiretap"
| crosses into "Get all data about a person who is outside
| their home for free".
|
| Yes, law enforcement routinely goes to private companies to
| get data without a warrant, oftentimes in cases where a
| warrant would otherwise be required.
|
| For example, Google only _just_ changed their internal policy
| of handing location data to LEO without a warrant - and while
| this sounds like great news, it's not as big as it seems,
| because other players (e.g. cell carriers) also have that
| data and are much more likely to hand it over than Google is.
| https://time.com/6539416/google-location-history-data-
| police...
| chimeracoder wrote:
| > In summary, if we were to blindly look at someones medical
| history or records without a bona fide articulable suspicion of
| a crime, it'd be massively illegal.
|
| It's extensively documented that law enforcement breaks laws
| _all the time_. Your comment isn 't reassuring at all - in
| fact, you're just describing how normalized the process for
| violating the 4th Amendment and patients' privacy is.
| CodeAndCuffs wrote:
| > how normalized the process for violating the 4th Amendment
| and patients' privacy is.
|
| Well thats the rub, isn't it? Right now the courts don't see
| this as a violating of the 4th amendment. I can see the
| argument for requiring a warrant. Im not necessarily against
| the requirement, but this isn't normalizing a 4th amendment
| violation any more than license checkpoint (which the courts
| have also ruled isn't a violation)
|
| [Edited to add the rest of the quote]
| chimeracoder wrote:
| > Well thats the rub, isn't it? Right now the courts don't
| see this as a violating of the 4th amendment.
|
| You omitted the end of my sentence in your quote, which is
| operative in this case. As explained in the article, the
| Third Party Doctrine establishes a loophole in 4th
| Amendment case law. The system you're describing is one
| which was created specifically to exploit this loophole: to
| violate patients' privacy while still complying with the
| 4th Amendment on technical grounds, all the while grossly
| violating it in spirit.
| CodeAndCuffs wrote:
| > You omitted the end of my sentence in your quote, which
| is operative in this case.
|
| My apologies. I've re-added it with an edit note.
|
| I think its a reach to say 'the system' was created to
| exploit 4th amendment loopholes, especially in this case.
| Again, the patients privacy isn't compromised by the
| pharmacies at all here. The state has its claim of a
| vested interest in prescription activity, much like with
| drivers licenses and vehicle registration, and has a
| database of said data, much like with licenses and
| vehicle registration.
|
| If I start running tags to see where someone lives to
| stalk them, thats bad, and illegal. If I start running
| prescription data for someone to see what they're on and
| stalk them, thats bad and illegal.
|
| If a car dealer says "These VINs on the car dont match,
| we think something was stolen" we can investigate it by
| accessing the state database. We will likely see some
| personal information of someone who isnt guilty of
| anything in the process of this investigation. If a
| doctor says "This person filled a prescription under my
| name that I didnt write" we can investigate it by
| accessing the state database. We will likely see some
| personal information of someone who isnt guilty of
| anything in the process of this investigation.
|
| My assertion here isnt "Everything is fine, change
| nothing". Its "If you're concerned about privacy here,
| you are looking at the wrong target". Warrant
| requirements could be reasonable. Whether we get them or
| not, I think a good start would be auto-redacting
| Prescription Monitoring Program reports. If Doctor Adams
| says Bill filled a fraudulent script, because Adams
| doesnt write for percocet, I shouldnt see every name for
| every prescription on Adams' report. That should be
| redacted. Then if I see a script for percocet, which
| we've established is fraudulent, we then un-redact the
| "patient" name.
|
| Again, CVS handing me a copy of a prescription that I
| already know is fake is the least significant issue at
| hand.
| refulgentis wrote:
| I've been here, aka worked at Google and became confused
| why people didn't trust it, since I now trusted it.
|
| Succinctly:
|
| - you described an _excellent_ process
|
| - the key part is "concerningly sometimes ppl handed me
| stuff before I identified myself"
|
| - there's nothing you can say or do to alleviate that
|
| Furthering the Google analogy, with intent to clarify:
|
| The Google version of this is "you can have all the data
| behind 20 locks and and 32 keys and 5 biometric measures
| and never let human eyes actually see it. Now let's
| turnover all Google employees. You sure they'll do the
| same thing?"
|
| (the answer is no, after The Great McKinsey-ification and
| the corner-cutting and self-justification of lies
| demonstrated since ChatGPT)
| Zak wrote:
| > _any more than license checkpoint (which the courts have
| also ruled isn 't a violation)_
|
| Personally, I think that was a terrible ruling. Any
| suspicionless stop and check/investigation/search in a
| place everyone has a right to be should be treated as an
| unreasonable search.
|
| The pharmacy records checks you're describing here are
| based on evidence that would likely hold up as probable
| cause in court.
| 1920musicman wrote:
| To play devil's advocate: sounds like a "bona fide articulable
| suspicion of a crime" doesn't necessarily mean there is a
| documented reason for the release of records that has been
| authorized by a judge. Wouldn't that leave too much space for
| abuse?
| CodeAndCuffs wrote:
| Yeah, it could. People can also lie on affidavits for
| warrants, but it does leave more of a paper trail to catch
| the guy. Honestly I don't think I'd be against a warrant
| requirement, but I also think we need a way to speed up the
| warrant process a _lot_. Right now it often involves a 1 hour
| + drive to a magistrates office, 30-45 minutes of filling out
| paperwork by hand, plus the hearing, getting the actual
| warrant printed+signed+logged, then 1 hour + drive back to
| where you need to be. I think you'd see less pushback of
| warrants in general if it leveraged the technology we have.
| We should absolutely be able to file an affidavit
| electronically, facetime a magistrate, and get a warrant
| approved/denied that way.
|
| But again, getting records from the pharmacy isn't really the
| issue. The government already has the records of the doctor
| that "wrote" the prescription. All the pharmacy is giving you
| is the physical copy of the record + data of who picked it
| up.
| dvngnt_ wrote:
| 3hrs seems like a small price to pay for patient privacy
| dwattttt wrote:
| Everything is cheap when you aren't the one paying for
| it.
| WarOnPrivacy wrote:
| > State law gave us authority to request pharmacy records, i.e.
| prescriptions and pickup logs, without a warrant.
|
| This is good to know.
|
| It is proposed that this arrangement be modified to require a
| warrant.
|
| Although I am comfortable accepting that your agency
| demonstrates the integrity you indicate, there are ~18k other
| law enforcement agencies in the US. A _not insignificant
| number_ have long and well-documented histories of excessive
| and inappropriate record access. (And many, many other LEA have
| similar histories, even if they don 't overreach as often.)
|
| A warrant provides some judicial oversight. When accessing our
| private and confidential information, this is the reasonable
| default.
| chimeracoder wrote:
| > It is proposed that this arrangement be modified to include
| a warrant requirement.
|
| That defeats the entire point of this arrangement, which
| allows them to investigate in situations where the legal
| requirements for obtaining a warrant are not met. (Which is
| the elephant in the room: the _entire premise_ of this system
| is to bypass established legal thresholds).
|
| > Although I am comfortable accepting that your agency
| demonstrates the integrity you indicate
|
| I'm not sure that's a safe assumption. As you mention, system
| abuse by law enforcement is incredibly common at agencies
| across the country. If you talk to any person at one of those
| agencies, they will almost invariably tell you that their
| coworkers take their job seriously, that they never abuse
| their own power, and that they can't imagine their coworkers
| doing the same.
| CodeAndCuffs wrote:
| > That defeats the entire point of this arrangement, which
| allows them to investigate in situations where the legal
| requirements for obtaining a warrant are not met. (Which is
| the elephant in the room: the entire premise of this system
| is to bypass established legal thresholds).
|
| This is just 100% false. If im pulling a prescription from
| a pharmacy its because Doctor Adams told me "I never wrote
| a prescription for Bill Barnes for percocet, but this state
| maintained record says that he filled a prescription for
| percocet at CVS #12345 on main street". That statement
| alone is enough to get a warrant for said pharmacy records.
| chimeracoder wrote:
| > That statement alone is enough to get a warrant for
| said pharmacy records.
|
| Great, then get a warrant.
|
| The entire reason this story exists is because people are
| surprised and - rightfully - upset that law enforcement
| is able to access this information without one.
| WarOnPrivacy wrote:
| >> That statement alone is enough to get a warrant for
| said pharmacy records.
|
| > Great, then get a warrant.
|
| I agree with my whole heart. This is the meat and bone of
| the discussion.
|
| And an important side note: The assertions "can't access
| without a warrant" and "can't access at all" need to be
| clearly distinct at all times. Once the 1st gets
| translated as the 2nd, the good faith portion of this
| discussion is lost.
| WarOnPrivacy wrote:
| >> Although I am comfortable accepting that your agency
| demonstrates the integrity you indicate
|
| > I'm not sure that's a safe assumption. As you mention,
| system abuse by law enforcement is incredibly common at
| agencies across the country.
|
| I feel a benefit of the doubt costs us little in this
| instance and I feel we need a familiarity with what
| responsible policing looks like. To me, the OPs recounting
| provides that.
|
| Past that, I believe that the widespread bad behavior of
| other agencies is insufficient reason for mistrust here.
| And casually using others' bad behavior to justify mistrust
| - this is something we reasonably criticize police for.
| chimeracoder wrote:
| > I feel we need a familiarity with what responsible
| policing looks like. To me, the OPs recounting provides
| that.
|
| The point is that nearly every cop you talk to will sound
| like OP. That doesn't mean anything about the integrity
| of them or their coworkers; it just means that they're
| capable of articulating their own behavior in a way that
| makes them sound reasonable with no context. That's an
| incredibly low bar, one that nearly every abusive cop
| will clear.
|
| To repeat what I said in a separate comment: Having
| worked extensively in this area, I'll be blunt and say
| that anytime someone who works in law enforcement says
| that there are no abuses of power in their workplace,
| that means either they were so oblivious that they never
| saw abuses that are occurring around them, or they were
| so mired in the system that they are incapable of
| recognizing the abuses of power that they themselves are
| participating in.
|
| > Past that, I believe that the widespread bad behavior
| of other agencies is insufficient reason for mistrust
| here.
|
| On the contrary, that's exactly what "systemic abuse of
| power" means. It means that the bad behavior is so
| ingrained in the operations of the system that
| individuals' actions contribute to its operations,
| _whether or not they recognize or even understand it_.
| zoklet-enjoyer wrote:
| You should mind your own business and let people put whatever
| they want into their bodies
| caskstrength wrote:
| Yeah, don't know why are you being downvoted. According to
| OP's description it is just big waste of money and erosion of
| privacy to catch some people who don't really hurt anyone.
| levinb wrote:
| Hi, I'm a former Federal LEO that has gotten warrentless access
| to medical records - a long time ago.
|
| I can't speak for every agency (there are more than 100 Federal
| agencies with sworn officers and arrest authority, and thousands
| of state and local agencies), but the few times I did this in the
| early 2000s, even most of the HN crowd would have thought it
| reasonable.
|
| I was an officer in the Coast Guard and had LE powers under two
| different branches of law - one public safety and one criminal.
| When Bad Things happened on federal waterways, my job was to
| first investigate threats to public safety. This comes with the
| power to issue a subpoena. This means we can 'compel speech' and
| then if you lie to us, you are in trouble.
|
| This has more to do with what you might think the NTSB or FAA
| might do following an accident. The government has the right
| under current law to understand threats to the public. If a
| shipping company is currently doing something that could dump a
| barge full of Xylene into the bayou next to an elementary school
| (this is not a made up scenario, and you should look up Xylene)
| then there is a public interest compelling enough that we can
| tell people they have to sit down and tell us the truth, and the
| 4th amendment is not a barrier.
|
| However, if a public safety investigation moves past
| 'understanding if something is a risk to the public', and
| individual criminal culpability appears possible, we are then
| required to disclose to the individuals involved that we have
| moved to a criminal investigation. In this case, the 4th comes
| back in play and warrants are required.
|
| For me, this really only came up a couple times with individuals
| involved in an accident that were either using medical
| prescriptions ("I missed my medications, I'm not drunk") to delay
| us investigating a scene. Or, for a couple of injured mariners
| who were in the hospital at the time we showed up. We needed to
| go to the hospital get their version of the story and to confirm
| an injury; grave injuries would increase the 'level' and thus
| mandatory resources involved in an investigation. Also, we would
| need to get a witness testimony from a deckhand or something that
| was on a boat or facility and saw what happened (did the boat
| really slam into the terminal coupling or did the guy just mess
| up attaching it because he wasn't an officially trained Tankerman
| who shouldn't have been operating the equipment).
|
| Being in the hospital or at the doctors was an excuse used more
| than once my companies trying to slow down inquiry into their
| mistakes. And yes, I think for our use case, it was completely
| reasonable for us to be able to call the hospital and ask "was so
| and so admitted last night?", just for us to find out that they
| were not, and went back home to mom's house to hide under orders
| from their captain.
|
| Anyway, with all that said, it seems unlikely these powers are
| not frequently abused, even if most of the LEO community is just
| trying to do their job. So, tin-hat away, friends.
| chimeracoder wrote:
| As someone who _also_ has a lot of experience in this area, I
| 'll say that your comment is a classic example of the tactics
| that that LEOs use to minimize or defend abuses of power. It's
| actually a great case study, because it exemplifies the way
| that abuses of power are adopted structurally at an
| institutional level, while also drawing the line to how that is
| internalized and effected in practice by individuals. (This
| process is a key component of any stable system for abuse; that
| said, it's rare to see it illustrated so plainly).
|
| > Being in the hospital or at the doctors was an excuse used
| more than once my companies trying to slow down inquiry into
| their mistakes. And yes, I think for our use case, it was
| completely reasonable for us to be able to call the hospital
| and ask "was so and so admitted last night?", just for us to
| find out that they were not, and went back home to mom's house
| to hide under orders from their captain.
|
| Just because it made _your_ job easier doesn 't mean that it
| was legitimate. Constitutional rights, privacy laws, and case
| law have been created specifically to _limit_ police power.
| Yes, it would be easier if cops didn 't need warrants at all.
| No, that is not a valid argument for bypassing them.
|
| Similarly - yes, it's common for LEOs to talk to witnesses to
| try and get them to incriminate themselves, either by engaging
| them in interactions that don't legally require a Miranda
| warning or by ignoring Miranda requirements altogether (which
| happens frequently). That doesn't justify it, either legally or
| ethically.
|
| > Anyway, with all that said, it seems unlikely these powers
| are not frequently abused, even if most of the LEO community is
| just trying to do their job.
|
| The assumption that "most LEOs are just trying to do their job"
| is itself questionable, given how much documentation there is
| of systemic abuse of police power. Even if it weren't, that
| isn't a valid defense when the government has explicitly placed
| restraints on the ways LEO can do their job (to say nothing of
| the broader question of the legitimacy of that job in the first
| place).
| levinb wrote:
| > Just because it made your job easier doesn't mean that it
| was legitimate.
|
| So, I suppose that the main point. In these cases, we weren't
| investigating the individual as a suspect, we were trying to
| understand the nature of an incident that could affect the
| safety of others in a relatively linear fashion.
|
| Imagine it's 20 years ago, there's no cameras everywhere, GPS
| is limited to multi-meter precision - did the 50-barge tow
| coming down the Mississipi river with millions of tons of
| cargo hit the interstate bridge broadside or did it just
| scrape it? There's a big pylon-shaped dent in the side of a
| naptha barge with cement dust on it, but the captain swears
| he just glanced it with the grain barge at the head of the
| tow. It's ancient and looks like it's battered 100 docks in
| the past year.
|
| So, Mr. Deckhand, what hit the bridge?
|
| In this scenario, he is not responsible for navigating the
| vessel, so we assume that it's unlikley that this would
| evolve into an investigation that would jeopardize him. And
| thus are free to issue a subpoenea if needed to find out if
| we need to shut down the only passage over the Mississippi
| for 100 miles.
|
| I think it's fair that the public has the right to his
| honesty in this scenario.
|
| Of course, these powers present the potential for abuse, and
| I'm sure it happens. Just not in the world I ever operated
| in; our powers and obligations were taken very seriously
| internally.
| chimeracoder wrote:
| > So, I suppose that the main point. In these cases, we
| weren't investigating the individual as a suspect, we were
| trying to understand the nature of an incident that could
| affect the safety of others in a relatively linear fashion.
|
| That doesn't matter. You're still talking about accessing
| private, sensitive data about an individual.
|
| > I think it's fair that the public has the right to his
| honesty in this scenario.
|
| Yes, and that's exactly why warrants exist. The courts are
| specifically responsible for determining the outcome of
| cases in which private rights potentially conflict with
| public ones (or with private rights of other parties).
|
| > Of course, these powers present the potential for abuse,
| and I'm sure it happens. Just not in the world I ever
| operating in; our powers and obligations were taken very
| seriously internally.
|
| Having worked extensively in this area, I'll be blunt and
| say: anytime someone who works in law enforcement says that
| there are no abuses of power in their workplace, that means
| either they were so oblivious that they never saw abuses
| that are occurring around them, or they were so mired in
| the system that they are incapable of recognizing the
| abuses of power that they themselves are participating in.
|
| Out of charity, I'll assume the former. But to be honest,
| every time I've spoken at length about this with LEOs, it's
| inevitably turned out to be the latter.
| levinb wrote:
| > Out of charity, I'll assume the former. But to be
| honest, every time I've spoken at length about this with
| LEOs, it's inevitably turned out to be the latter.
|
| I am sure this is often true at the local LE level. But
| remember, they deal almost entirely with criminal
| investigations about individuals for things that do not
| present a broader risk to the public (beyond their
| continued individual behavior).
|
| In our case, we are not reifying 'the drug menace' to a
| public level; we are trying to find out if a barge is
| full of vegetable oil or an explosive polymerization
| agent. And in those cases, no, I don't think your rights
| to privacy supersede our obligation to understand if
| there's a major threat to other people.
|
| > That doesn't matter. You're still talking about
| accessing private, sensitive data about an individual.
|
| This is true and I can assure you I know quite a bit
| about what can be in people medical records (I am a MD
| who has worked extensively in medical records exchange
| and machine learning). I don't think accessing this kind
| of data should be possible without genuine need.
|
| > Yes, and that's exactly why warrants exist.
|
| In our case at least, warrants wouldn't even make sense.
| We were not conducting criminal investigations and asking
| for access to pursue a person against their will, in
| response to a crime. We were trying to find out about
| near-term threats to other people.
|
| I think you and I probably agree on the spirit here -
| it's just that in our case (and cases like the NTSB or
| FAA) there are compelling public interests that supersede
| someones right to privacy. Finding out if you were
| prescribed benzos so I can charge you for some garbage
| possession misdemeanor is not one; finding out if there's
| 30,000 barrels of explosive leaking under a highway is.
|
| No?
| stackskipton wrote:
| Yes, No. there are compelling public
| interests that supersede someones right to privacy.
|
| This is road to hell path paved with good intentions. All
| crime has compelling public interests to be prevented.
| Using that logic, cops should be able to search
| everywhere. It's compelling public interest to stop
| people who do bad things.
| chimeracoder wrote:
| > In our case at least, warrants wouldn't even make
| sense. We were not conducting criminal investigations and
| asking for access to pursue a person against their will,
| in response to a crime. We were trying to find out about
| near-term threats to other people....Finding out if you
| were prescribed benzos so I can charge you for some
| garbage possession misdemeanor is not one; finding out if
| there's 30,000 barrels of explosive leaking under a
| highway is.
|
| Nothing you have said, in this comment or in the rest of
| the thread, refutes the point that warrants are the
| mechanism by which the legal system intermediates this
| power. It's quite telling that _even in a completely
| constructed example chosen for the discussion at hand_ ,
| you're not actually making a case that cops need access
| to people's medical information without a warrant.
|
| > I think you and I probably agree on the spirit here -
| it's just that in our case (and cases like the NTSB or
| FAA) there are compelling public interests that supersede
| someones right to privacy.
|
| No, I'm saying that it is literally not your job as a
| member of law enforcement to decide when the public
| interest "supersedes" someone's right to privacy. That's
| what a judge is for. That's why warrants exist.
| caskstrength wrote:
| > And in those cases, no, I don't think your rights to
| privacy supersede our obligation to understand if there's
| a major threat to other people.
|
| > No?
|
| No.
| yieldcrv wrote:
| Just because you couldn't think of a tool to "understand
| the nature of an incident that could affect the safety of
| others" doesn't mean it legitimizes your department policy
| or personal tactics
|
| I would be 100% fine with stripping that group of this
| discretion, sanctioning them, and sending them back to the
| drawing board on how to "understand the nature of incidents
| that could affect the safety of others", aka investigate.
| ralph84 wrote:
| Checks and balances are essential to the American way of
| government. Law enforcement should have to follow the
| Constitution, which means dealing with the check of obtaining a
| warrant. If the reason is really that compelling you'll have no
| problem convincing a judge or magistrate.
| levinb wrote:
| I guess that's the point I was trying to make - in our case
| we were not conducting a criminal investigation. And if we
| were headed that way (which only happened every once in a
| while) then yes, we'd have to go in to Criminal Mode rather
| than Public Safety mode, and 4th and 5th Amendment
| obligations where back on.
| pavon wrote:
| While all those are cases where LEO had legitimate reason to
| have access the information, none of them provide a compelling
| reason why a warrant couldn't be required.
|
| The third-party doctrine has become far too broad. There are so
| many situations where people share information with a third
| party, but also expect and deserve a right to privacy regarding
| that information. The fact that HIPAA doesn't provide a
| reasonable expectation of privacy in information shared with
| your doctor/pharmacist is just absurd. The law does explicitly
| carve out these LEO exemptions, but reasonable expectation of
| privacy is a constitutional right, and those carve-outs should
| be deemed unconstitutional. And we should extend those lines
| with good privacy laws all around - any information that a
| company is required to protect under civil privacy laws should
| also be exempt from the third-party doctrine and require a
| warrant.
| levinb wrote:
| I won't belabor points I've made below, but I do want to
| agree with you about 3rd party doctrine in general; the
| modern world makes it almost impossible to live a normal life
| without non-consensually making your self available for full
| time monitoring by everyone within eyesight of you.
|
| I think the point of this article is actually being elided
| over some by the conversation here though; it appears that
| these agencies are largely following the law. The question
| is, how broad should the reach of LE go given their
| legitimate authority?
|
| In the current scenario, should a LEO from Idaho be allowed
| to see prescription records from a pharmacy in California?
| Should they have the right to get data from CVS about things
| that didn't happen in Idaho? Every prescription ever? Every
| doctors note?
|
| The law as it stands allows states to determine the
| reproductive rights of their citizens and investigate
| violations thereof (note that I don't agree with the law, or
| the Supreme Court here). I think the question being raised by
| this letter is, what breadth of access should some Sheriff
| have over your medical records, and really, what the heck is
| even going on with this now?
|
| The Dobbs case has opened up a new frontier of potential
| abuse, and I think the letter and article are appropriately
| exploring that frontier.
| jodacola wrote:
| It's not just with LEOs where patient privacy gets dodgy.
|
| I've helped get a number of tech companies HIPAA compliant,
| so I've become very familiar with the workings and
| requirements of the act. My wife, a nurse, works in medical
| claim management. Lots of healthcare knowledge between us.
|
| I've had some very interesting conversations with her because
| of a tool she's described being used by insurance companies:
| medical canvassing. It's an "interesting" tool used by
| investigators that doesn't technically request PHI, but can
| paint a picture of one's past medical care.
|
| Basically, an investigator can ask a health care provider a
| bunch of yes/no questions - "did the patient receive care
| between $DATE1 and $DATE2?" "yes" "was the patient treated
| for $THING_RELEVANT_BUT_UNRELATED_TO_CLAIM?" "yes" "okay,
| thank you, that's all we needed." No "PHI" requested, none
| provided, but a picture still painted... and HIPAA allows for
| it.
|
| I'm very curious to know what other interesting methods exist
| that allow for the circumvention of patient privacy.
| stevenicr wrote:
| I am aiming to help get companies HIPPA compliant and aware
| this next year, both changing tech stacks and educating.
| Would like to connect with any resources / checklists /
| firms / anything that could help me help others understand.
|
| Contact in profile if willing to chat.
| stackskipton wrote:
| >Basically, an investigator can ask a health care provider
| a bunch of yes/no questions - "did the patient receive care
| between $DATE1 and $DATE2?" "yes" "was the patient treated
| for $THING_RELEVANT_BUT_UNRELATED_TO_CLAIM?" "yes" "okay,
| thank you, that's all we needed." No "PHI" requested, none
| provided, but a picture still painted... and HIPAA allows
| for it.
|
| How is that not PHI? You asked for treatment information
| and it was provided. Asking it roundabout way doesn't
| sidestep HIPAA.
| x86x87 wrote:
| Now consider states make it illegal to get birth control pills
| and retroactively go after anyone who has them prescribed. It's
| according to the law, ain't it?
|
| The states should keep their noses out of this and in effect all
| drugs should be made legal. If you do have a problem (ie an
| addiction) we should make it trivially easy to get help instead
| of burning resources to investigate these. As far as abuse goes:
| it should be trivially easy for a pharmacy to check if a doctor
| did indeed prescribe something without raping the privacy of
| everyone involved. As a matter of fact, why the hell does it take
| 30 minutes to fill a prescription in 2023?
| ljm wrote:
| I don't agree with your proposed solution (make all drugs
| legal), but I do think that the pharma industry in the US
| basically gets to socialise their losses while privatising the
| gains.
|
| The Sackler family's opioids, for example, have caused untold
| damage, and they made billions from it. They were able to
| offset the cost of all of that onto the society.
| x86x87 wrote:
| The "make all drugs legal" was meant as a way of saying that
| we should not punish people that have an addiction. I was not
| advocating giving highly addictive hard drugs out without
| prescription.
| lazide wrote:
| Aren't these two stances mutually exclusive?
|
| How do you propose not punishing people with addictions
| while somehow never giving out hard drugs without a
| prescription - since addictions are by their definition
| destructive and Dr's shouldn't be giving prescriptions for
| things that are known to cause problems for someone?
| x86x87 wrote:
| Are they? You don't prosecute anyone. You get them help.
| efnx wrote:
| I think the term you're looking for is
| "decriminalisation", which is different than
| "legalisation".
| lazide wrote:
| So then it's not actually illegal to do any of these
| things?
| reactordev wrote:
| Prescriptions exist to allow a non-doctor access to drug
| classified by the FDA/FHA as being "dangerous". I agree
| that we should make all drugs legal in the sense that it's
| a mental health problem but I'm not for allowing everyone
| access to fentanyl.
| YawningAngel wrote:
| Ex post facto laws are not possible in the United States
| vlovich123 wrote:
| Nominally. But if you're relying on a drug for medical care
| and it becomes illegal, the distinction seems superficial to
| me, no?
| x86x87 wrote:
| Lol. There are a lot of things that should not be possible in
| the majority of the civilized works.
|
| If this is your defense you're in trouble. Take for example
| the mythical "checks and balances" that are supposed to keep
| elected representatives under control. How is that working
| out?
|
| US == freedom and democracy! Until you see the fucking army
| mobilized to protect the capitol like we are some banana
| republic where the dictator in charge decided they would like
| to remain in power. This also is not possible in the US,
| right?
| lazide wrote:
| By convention, but in practice rules get 'reinterpreted' to
| punish previously at least nominally legal behavior all the
| time - especially when it comes to finance, business, guns,
| sex/porn, etc.
| newZWhoDis wrote:
| In theory, however California eliminated their statute of
| limitation's for rape (was previously 10 years) and now
| people are being charged (and convicted) for 20+ year old
| crimes with only verbal evidence.
|
| You might argue it's not the same thing, but the effect is
| definitely the same: the law changed and people went from
| unchargeable to chargeable
| local_crmdgeon wrote:
| Decrim has been an unmitigated disaster in Portland and
| Seattle. I once agreed with you, but seeing what's happened on
| the ground changed my position
| x86x87 wrote:
| Nobody talks about part 2 of the decriminalization which
| cannot happen in the US - which should be providing support
| for the addicts to recover.
| fnimick wrote:
| There's two massive hurdles to clear in public perception:
| 1) that addiction is a personal vice that people
| _shouldn't_ get help from others for, if they die on the
| street, it's their own fault, and 2) that helping people
| who are homeless is somehow offensive and unfair to people
| who are "productive" and don't get help for free.
|
| It baffles me, if someone homeless in my community gets
| housing, that doesn't make me feel aggrieved for having to
| pay for mine. Yet we spend more money per person on
| homeless services that fail to get them housing than we
| would spend just... paying for apartments for them, because
| it would be unfair to do so.
| Spooky23 wrote:
| The problem is that the welfare system failed to get
| implemented during the new deal and was introduced by the
| "Great Society" amendments to the Social Security Act in
| the 1960s.
|
| The core compromises essential to getting it done were
| the usual "states rights" revenue split and later
| limiting state liability by abusing social security
| disability. There's alot of overhead dollars that fund
| state operations so it is difficult to effectuate change
| - by design.
|
| Things like addiction support are aligned with mental
| hygiene and Medicaid, so you really need to destroy your
| life until the safety net kicks in. If you live in a
| place like Mississippi, they'll try to ship you north or
| push you towards SSDI (ie the Federal budget). In states
| that are less bleak, the community standard for
| disability is lower, and usually rehab is covered in some
| way by Medicaid.
|
| The other thing that's different about addiction vs
| regular healthcare is that the person needs to be ready.
| I worked for years with a gentleman who beat alcoholism
| and became a counselor. He was only able to get by it
| after harming one of his children accidentally.
| ForkMeOnTinder wrote:
| Indeed. It's a multistep process, like changing the oil in
| your car.
|
| Step 1. drain the old oil
|
| Step 2. pour in the new oil
|
| If you skip step 2 and damage your car, it doesn't mean oil
| changes are an unmitigated disaster. It means you didn't
| fucking do it right!
| stevenicr wrote:
| Just because the powers that be in Portland and Seattle
| failed to it properly does not mean that the opposite is
| better.
|
| There are dozens on things that should of been done better -
| but they disenfranchised those who could of helped the most.
|
| I don't have the data that I would like to have on funding
| for treatment and education there, but I'd like to see real
| case studies that could inform other places to get ahead of
| the issues rather than give up.
| chimeracoder wrote:
| > Now consider states make it illegal to get birth control
| pills and retroactively go after anyone who has them
| prescribed. It's according to the law, ain't it?
|
| Your example is _ex post facto_ , but it doesn't even have to
| be that egregious. State A makes it illegal to leave the state
| with the intention of having or facilitating an abortion.
| Because CVS operates nationally, cops in State A can go to a
| CVS locally and pull records of a CVS in State B filling a
| prescription for a medication that is sometimes, but not
| always, used for abortion. They can then use that to build a
| case for prosecuting the person in State A.
| anonuser123456 wrote:
| > State A makes it illegal to leave the state with the
| intention of having or facilitating an abortion.
|
| States do not have the authority to regulate travel across
| borders. The supreme court would strike this down 9-0, as the
| implications would be enormous.
| lazide wrote:
| You might be meaning to refer to interstate commerce? Which
| appears to be the more applicable situation?
| anonuser123456 wrote:
| Medical procedures are commerce.
| u32480932048 wrote:
| There are already numerous "leave the state with the
| intention of" laws, which I assume to be just some extra
| charge to throw at someone, like wearing body armor while
| committing a felony.
| anonuser123456 wrote:
| Can you show a 'leave state with the intent' law that has
| been successfully prosecuted?
| alistairSH wrote:
| Tell that to Idaho
|
| https://www.nbcnews.com/health/womens-health/idaho-most-
| extr...
| anonuser123456 wrote:
| That statute applies to people facilitating the travel of
| minors without parental consent.
|
| This bill establishes parents as having full legal
| authority over their minor children and no one else.
|
| As such, it does not really apply in the same way as a
| blanket travel ban. Parents have always been given
| preferential dominion over their children.
| CodeAndCuffs wrote:
| > Now consider states make it illegal to get birth control
| pills and retroactively go after anyone who has them
| prescribed. It's according to the law, ain't it?
|
| Are we discussing legality, morality, what should be legal, or
| what should be moral? I agree that would be bad morally, and
| shouldn't be legal, and currently isn't. My original comment
| was regarding how the process currently works, and why. It was
| also to explain that any concern of privacy regarding
| prescriptions comes more from the department of health/board of
| pharmacies than it does from 3rd partys providing documents, as
| the documents arent invading privacy anymore than what already
| happens.
|
| > The states should keep their noses out of this and in effect
| all drugs should be made legal.
|
| The whole "your right to swing your fist ends where someones
| face begins" thing applies here. The problem with some heavier
| drugs, and their addictive nature, comes in how it effects
| others. When something is so addictive that a person would sell
| their own child to acquire more of it, maybe we should limit
| access to that thing. Ive known a lot of addicts professionally
| and personally. They come in various degrees of wanting help.
| Some are in denial, some would do anything to kick the
| addiction. Some don't care at all and would fight to refuse any
| help under any circumstance. Its a super complicated issue,
| "Just legalize all of it", and "Just criminalize and punish all
| of it" are both equally shortsighted solutions.
|
| > we should make it trivially easy to get help I agree 100%
|
| > it should be trivially easy for a pharmacy to check if a
| doctor did indeed prescribe something without raping the
| privacy of everyone involved
|
| It is, and they do. They call the doctor, he says "I didnt
| write this". Then he gives me a list of people who filled
| prescriptions he didnt write. The biggest invasion of privacy
| of unaffected people is when we have a confirmed suspect, we
| see what other doctors he filled a prescription for, and then
| go through that list with the new doctor to see what is and
| isnt legit.
|
| So yeah, at some point in a table of a few hundred people I
| probably saw some names of people who were a doctors patient,
| and that they have a prescription from him. I've been inside
| their privacy just as much as the receptionist at the doctor's
| office and the pharmacy tech at the CVS
| x86x87 wrote:
| > as the documents arent invading privacy anymore than what
| already happens.
|
| Nope. Invading privacy is invading privacy. Just because
| something is happening today does not make it okay and
| acceptable
|
| > call the doctor
|
| Is this the 70s? Call the doctor? Do you call the doctor for
| every prescription?
|
| Here is a wild idea: we have tjis thing called the internet
| and this other wild thing called PKI. Give the doctor a
| certificate pair and they digitally sign every prescription.
| You don't ever need to talk to the doctor, you just need to
| pull their public certs.
|
| Since we're doing privacy, give the chumps that need the
| prescription a cert pair and encrypt their shit + make it a
| crime to store any of their PII at pharmacy level.
| lazide wrote:
| Ho man. Do you think the Dr's illegible scribble on the
| prescription pad as it is, is because Dr's are so great at
| attention to detail and learning new things that they'll be
| able to do that effectively?
|
| Without it being an even worse situation where they get a
| Trojan from opening random emails or surfing for porn, and
| then all the sudden 100k valid appearing prescriptions for
| controlled medications all the sudden show up in pharmacies
| across the country?
| Spooky23 wrote:
| This stuff is mostly fixed with EMRs. For most
| applications, paper scripts are rare.
| CodeAndCuffs wrote:
| > Nope. Invading privacy is invading privacy. Just because
| something is happening today does not make it okay and
| acceptable
|
| Thats not what I was trying to say. My point was that the
| state already has this data, and I've already seen it
| before I get a copy of the data from the pharmacy. If
| you're concerned about the privacy of the data, you should
| consider the root issue of warrantless access to the PMP by
| investigators. Anything I get from the pharmacy is just a
| piece of paper that says the same thing that I already had
| from that
|
| > Here is a wild idea: we have tjis thing called the
| internet and this other wild thing called PKI. Give the
| doctor a certificate pair and they digitally sign every
| prescription. You don't ever need to talk to the doctor,
| you just need to pull their public certs.
|
| This is a great idea in theory, but currently has some
| problems. Some of them probably could and should be
| addressed, some not.
|
| - Old people who dont want to learn. The PMP lets doctors
| get a list of every prescription filled in their name in a
| spreadsheet. You can sort and filter by where it was
| filled, patient name, type of medication, etc. Of the
| doctors Ive dealt with, maybe 10% knew about this and used
| it. A few learned about it from me, got excited, figured it
| out, and used it to its fullest extent. Most just went
| "yeah okay" and ignored it because spreadsheets are too
| complicated.
|
| - Where are we storing this? Can only the doctor do it?
| From only one computer? Can his receptionist call in the
| prescription? Can anyone else access that computer?
| Basically is there any way at all for fraud to happen? What
| if its the doctor whos the one doing it? Ive seen
| pharmacists say "Were getting a lot of suspicious
| prescriptons from this one doctor" who was just flat out
| selling them to people who had no problems. E-scripts are a
| thing, and ive seen cases where nurses and receptionists
| hop onto the system to write illegal scripts.
|
| > Since we're doing privacy, give the chumps that need the
| prescription a cert pair and encrypt their shit
|
| My mom thinks opening chrome dev tools is going to get her
| arrested for hacking a website. Please dont put the onus of
| key pair encryption on her in any way
|
| > + make it a crime to store any of their PII at pharmacy
| level Im not sure if its a legal/regulatory requirement, or
| just a moral thing, but Pharmacists are highly trained,
| with a Doctorate in what they do, and they catch things.
| Whether its a Doctor wrote the wrong script, or a
| potentially lethal contraindication between meds. Them
| having records of what else a person is on is a legitimate
| medical use case. There may be ways to keep this sort of
| data without PII, but it would be another concern to
| address.
| x86x87 wrote:
| Bake the cert pair into the id you are giving out to
| people. Look at the system in Estonia
| dang wrote:
| " _Eschew flamebait. Avoid generic tangents._ "
|
| " _Please don 't fulminate._"
|
| https://news.ycombinator.com/newsguidelines.html
|
| We detached this subthread from
| https://news.ycombinator.com/item?id=38807378.
| apapapa wrote:
| They probably van get that information 3 other ways also...
___________________________________________________________________
(page generated 2023-12-29 23:01 UTC)