Fwd: Self Employed Health Insurance Redux: Donation-Based P2P Health Cost Sharing Networks
Samuel Rose
thinking about the logistics and practicality of this. Coworking is a
network that has some inherent trust, and could probably pull off a
donation-based health care system, if they are interested in it enough
to pursue. And, they have people involved who can likely tackle some
of the programming/trust metrics issues, too.
But, I think they could also use some basic analysis of and advice
onthe underlying cooperation/trust/reputation dynamics. There is an
existing example with religious based donation healthcare networks
that apparently operate quite sustainably.
First off, a little background on Coworking. Coworking is "cafe-like
community/collaboration space for developers, writers and
independents."
People start these Coworking spaces as either for-profit, or non-
profit entities that rent out space, and also invite floating people
to come in and use certain parts of the spaces as well. It's like a
collaboration office for independents. One of the issues that had come
up was how to best leverage the numbers for coworking network
participants, to get affordable health care coverage see the email
below for the rest. Any feedback greatly appreciated
One key question that surfaces for me right now is:
How would a nationally or globally dispersed group of people co-
coordinate the routing of donated money to people who need it, in an
equitable, transparent way?
---------- Forwarded message ----------
From: "Samuel Rose" <samuel.r...@gmail.com>
Date: Aug 21, 1:58 pm
Subject: Self Employed Health Insurance Redux: Donation-Based P2P
Health Cost Sharing Networks
To: Coworking
I've been doing some thinking lately about this, and about the
inherent
dilemmas, legalities, social/cultural issues and barriers.
I think previously, we tentatively figured out (http://tinyurl.com/
328dk8)
(summarized athttp://wiki.coworking.info/Healthcare) that creating a
formalized health care entity might push Coworking into territory that
could
be detrimental to the core values/principles of this decentralized
movement.
I think we also tentatively figured out that local laws make creating
one
network-wide solution very problematic.
I think Chris, and maybe others were thinking about the idea of
group-buying, to help coworkers leverage their numbers. This is a good
idea,
yet, if I recall correctly, we also seemed to find geography is still
an
issue, because one provider cannot cover many different states, in
many
cases.
Earlier today, I was thinking back on a phenomenon that I research for
thehttp://cooperationcommons.comproject, and thehttp://p2pfoundation.netproject.
I came across the "Faith Based Health
Insurance" phenomenon:
http://www.medicalnewstoday.com/articles/32630.php
The way this works is that "members send a monthly check, or "share,"
that
ranges from $200 to $400 to the plan or to members the plan designates
with
"needs," or medical bills. The plans subtract overhead and
administrative
expenses from the total collected and use the remainder to pay claims"
Members are "vetted" or qualified to join the "plan" based on a letter
from
their clergy person verifying they are an active church member, and
trustworthy person.
So, what does this have to do with Coworking?
Well, this "church plan" shows a plausible legal international route
to
sharing health care costs among a network of people, religious or
otherwise.
These "church plan" participants are really just donating money to one
another, facilitated by their churches, and by "plan" coordinators.
Might a
non-religious network of people also think about a way to pool money,
and
route it to people who need it in this way? I think so.
The system that I envision here is:
1. Participation is based upon the trust metrics of others who are
already in the network (others "vouch" for you).
2. Money is pooled on the scale of coworking spaces. Pariticpants
pay
a trusted volunteer in their local homebase coworking space
3. Verification of medical need happens on the scale of coworking
spaces, with the ability to appeal to the greater network shuld the
local
coworking network fail to assist or address for some reason.
Participants
may opt to bypass the network and send donations directly to people
who are
appealing this way
4. Coordination of local spaces is done through a group of elected,
term-serving network orchestrators, who are dispersed around the
network,
and who split up the labor in a diverse way, so that one local
person does
not become the "lord and master" of their own local region. Other
people are
elected to act as voluntary impartial mediators and conflict
resolvers
5. P2P open identity based trust metrics help keep trust issues
transparent
6. All donated monies are totally transparent and accounted for,
100%
The idea here is that it is legal for us to give money to each other
for
pretty much anything we want to, so it becomes a matter of figuring
out how
we can give each other money in an equitable, not-for-profit way, that
can
systematize some aspects, and can buil on inherent trust.
--
Sam Rose
Social Synergy
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J Margolin
The point is actually how risk sharing works in lieu of insurance. For example, in a community if everyone gets sick because people can't afford antibiotics, then obviously it's in everyone's best interest to ensure that that level of healthcare is managed. Similarly, prenatal care: if everyone in a community is going to feel obligated to somehow care for all children no matter how neglected the mother was while pregnant, then the community springs for prenatal care.
However, if the risk isn't actually going to be shared in a similar way if there is inadequate insurance, then the community might not be the appropriate one for dispersing the risk. In that case you're better off looking at health insurance as a shared cost/overhead: we want people to join our coworking group, and we offer a beautiful environment and health insurance premium offsets (and free healthy catered lunches/dinners and discount gym memberships).
>How would a nationally or globally dispersed group of people co-
coordinate the routing of donated money to people who need it, in an
equitable, transparent way?
Another interesting model is DonorsChoose (though they have two major things I wish were different: (1) they require purchasing through their vetted suppliers, who are sometimes insanely expensive (2) they don't enable in-kind donations). DonorsChoose allows people to give money to specific projects selected by schoolteacher (anonymously). This might be a good model for people who need microcap / microgrants.
Jessica Margolin
Margolin Consulting
www.margolin-consulting.com
510 709 8267
Sam Rose
On Aug 21, 3:34 pm, "J Margolin" <jmargo...@gmail.com> wrote:
> There's actually a fascinating essay about how insurance groups formed
> historically - just read it. Will see if I can't find time this afternoon
> to get the reference.
>
If you do happen to recall or find, I would be interested to read it.
> The point is actually how risk sharing works in lieu of insurance. For
> example, in a community if everyone gets sick because people can't afford
> antibiotics, then obviously it's in everyone's best interest to ensure that
> that level of healthcare is managed. Similarly, prenatal care: if everyone
> in a community is going to feel obligated to somehow care for all children
> no matter how neglected the mother was while pregnant, then the community
> springs for prenatal care.
>
So, there possibly is a "willingness to pay" factor that could be
studied in a community (which does make sense). Plus, the community's
awareness of how certain issues could affect each one of them as
individuals might influence the willingness to pay (risk sharing).
> However, if the risk isn't actually going to be shared in a similar way if
> there is inadequate insurance, then the community might not be the
> appropriate one for dispersing the risk. In that case you're better off
> looking at health insurance as a shared cost/overhead: we want people to
> join our coworking group, and we offer a beautiful environment and health
> insurance premium offsets (and free healthy catered lunches/dinners and
> discount gym memberships).
>
Judging on reactions so far: http://groups.google.com/group/coworking/browse_thread/thread/668715b7b3114588
I think there are some people in the coworking movement who
understandably see health insurance as a messy issue that is much
better squared away by paying a relatively reasonable company to do
the work of insuring themselves and other members on their behalf.
People are quite busy these days, and the health care realm is
incredibly messy and labyrinthine.
Meanwhile, there are quite a others (like myself) who are more
interested in really radically changing the options available. We feel
like Coworking is pretty much about creating sustainable options for
independent workers that exist outside of the "machine". When it comes
to health care costs, this means finding other alternatives, because
most (probably all) of the current health insurance providers really
do not cover much of anything. Direct donation seems to be a way to
maximize money pooling, while also taking advantage of the right we
all reserve to freely give money to one another for legal purposes.
> >How would a nationally or globally dispersed group of people co-
>
> coordinate the routing of donated money to people who need it, in an
> equitable, transparent way?
>
> I'd suggest looking at community micro-debt groups like Prosper.com This is
> what they originally intended to do.
>
Yes, I think the local-scale group model is the best way to think
about building trust in this type of system, and the best way to sort
out the detailed logistics of who is in the plan, and if people have
legitimate needs, etc. It seems like a group could vote on itself, if
it thinks that it's own local effort is letting people in who are also
contributing money to the pool, and who have legitimate need, and that
orchestrators are not abusing power, etc. There could be a group index
of many factors. This could allow new groups to join, and to know
which other groups to trust within the system. Although, it could also
cause problems, because everyone starts out with very little trust/
reputation. These are issues we are exploring here: http://www.trustlet.org/wiki
and here http://socialsynergyweb.net/cgi-bin/wiki/AggregatedTrust and
http://trustmojo.com/ is also a good source of info (anyone else have
any good links to people studying trust issues?)
> Another interesting model is DonorsChoose (though they have two major things
> I wish were different: (1) they require purchasing through their vetted
> suppliers, who are sometimes insanely expensive (2) they don't enable
> in-kind donations). DonorsChoose allows people to give money to specific
> projects selected by schoolteacher (anonymously). This might be a good
> model for people who need microcap / microgrants.
>
That's interesting. Also found http://blog.socialsynergyweb.com/2007/06/13/216/
(iCare http://icare.ieor.berkeley.edu/) a while back. They are using
a system that is kind of like WalMart or UPS inventory tracking, to
route surplus goods/in-kind donations to disaster victims.
> >http://p2pfoundation.nethttp://blog.p2pfoundation.nethttp://www.coope...
>
> --
> Jessica Margolin
> Margolin Consultingwww.margolin-consulting.com
> 510 709 8267