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 at http://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.
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.
> 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
I should add to this that "coordination" and "orchestration" is really not much more than message amplifying. Making sure that the whole network is aware of where money is needed on any given month, or week. So, there really is not much "power" in this role.
> 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.
What about people like me who are atheists and eminently trustworthy and moral people?
Sorry, I don't mean to bash on your proposal, as health care in the US needs all of the innovative thought and energy it can get, but I'm also pretty darn tired of being assumed to be amoral/immoral just because I've never needed the help of a bunch of old white men to figure out what's right and what's wrong. I'm an atheist, and that does not mean I'm a bad person. You may be a Christian, but that doesn't mean you're a bad person either.
...getting back on topic...
FWIW, I don't think the current regulatory environment in the USA makes health insurance coverage a good fit for a coworking group in the USA. Real estate issues are different from health insurance issues, and they take fairly different solutions, resources, and skillsets. The only way I could see this kind of thing working is if each coworking space took on its regulars as paid staff and insured them that way. For most groups, that's much more commitment than makes sense for other important aspects of the business model.
>> 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.
> What about people like me who are atheists and eminently trustworthy > and moral people?
> Sorry, I don't mean to bash on your proposal, as health care in the > US needs all of the innovative thought and energy it can get, but I'm > also pretty darn tired of being assumed to be amoral/immoral just > because I've never needed the help of a bunch of old white men to > figure out what's right and what's wrong. I'm an atheist, and that > does not mean I'm a bad person. You may be a Christian, but that > doesn't mean you're a bad person either.
> ...getting back on topic...
> FWIW, I don't think the current regulatory environment in the USA > makes health insurance coverage a good fit for a coworking group in > the USA. Real estate issues are different from health insurance > issues, and they take fairly different solutions, resources, and > skillsets. The only way I could see this kind of thing working is if > each coworking space took on its regulars as paid staff and insured > them that way. For most groups, that's much more commitment than > makes sense for other important aspects of the business model.
At IndyHall we're going to be working with a couple of brokers to not only provide individual and group plans, but to educate indies on how to optimize these plans as well as long term savings cash flows.
-Alex
On 8/21/07, Geoff DiMasi <ge...@punkave.com> wrote:
> On Aug 21, 2007, at 3:36 PM, Graham Freeman wrote:
> On 21 Aug 07, at 10:58, Samuel Rose wrote:
> 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.
> What about people like me who are atheists and eminently trustworthy > and moral people?
> Sorry, I don't mean to bash on your proposal, as health care in the > US needs all of the innovative thought and energy it can get, but I'm > also pretty darn tired of being assumed to be amoral/immoral just > because I've never needed the help of a bunch of old white men to > figure out what's right and what's wrong. I'm an atheist, and that > does not mean I'm a bad person. You may be a Christian, but that > doesn't mean you're a bad person either.
> ...getting back on topic...
> FWIW, I don't think the current regulatory environment in the USA > makes health insurance coverage a good fit for a coworking group in > the USA. Real estate issues are different from health insurance > issues, and they take fairly different solutions, resources, and > skillsets. The only way I could see this kind of thing working is if > each coworking space took on its regulars as paid staff and insured > them that way. For most groups, that's much more commitment than > makes sense for other important aspects of the business model.
To clarify, the idea I was proposing is that people could do a similar thing as a network of non-religious people. There would be no religion requirement of any kind in the idea I am talking about here. The only requirement would be that other people in the network can verify that you are real and trustworthy
On Aug 21, 3:36 pm, Graham Freeman <graham.free...@cernio.com> wrote:
> > 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.
> What about people like me who are atheists and eminently trustworthy > and moral people?
> Sorry, I don't mean to bash on your proposal, as health care in the > US needs all of the innovative thought and energy it can get, but I'm > also pretty darn tired of being assumed to be amoral/immoral just > because I've never needed the help of a bunch of old white men to > figure out what's right and what's wrong. I'm an atheist, and that > does not mean I'm a bad person. You may be a Christian, but that > doesn't mean you're a bad person either.
> ...getting back on topic...
> FWIW, I don't think the current regulatory environment in the USA > makes health insurance coverage a good fit for a coworking group in > the USA. Real estate issues are different from health insurance > issues, and they take fairly different solutions, resources, and > skillsets. The only way I could see this kind of thing working is if > each coworking space took on its regulars as paid staff and insured > them that way. For most groups, that's much more commitment than > makes sense for other important aspects of the business model.
I really love Sam's idea. Personally, and after many bad experiences with the health care insurance companies down here (I'd like to know what they DO cover, really...'cause it seems like nothing), I'd love to subvert their system and create a truly community based approach to this.
Like a co-operative.
Sounds radically Canadian, really. ;)
It will just take time. And lots of research. And I'll just bet the insurance companies have some sort of great lobby against this kind of thing that seems to smack of communal thinking (the reds!).
Maybe we need to have a HealthCamp. Get Michael Moore involved, even. :)
Tara
On 8/21/07, Samuel Rose <samuel.r...@gmail.com> wrote:
> To clarify, the idea I was proposing is that people could do a similar > thing as a network of non-religious people. There would be no religion > requirement of any kind in the idea I am talking about here. The only > requirement would be that other people in the network can verify that > you are real and trustworthy
> On Aug 21, 3:36 pm, Graham Freeman <graham.free...@cernio.com> wrote: > > On 21 Aug 07, at 10:58, Samuel Rose wrote:
> > > 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.
> > What about people like me who are atheists and eminently trustworthy > > and moral people?
> > Sorry, I don't mean to bash on your proposal, as health care in the > > US needs all of the innovative thought and energy it can get, but I'm > > also pretty darn tired of being assumed to be amoral/immoral just > > because I've never needed the help of a bunch of old white men to > > figure out what's right and what's wrong. I'm an atheist, and that > > does not mean I'm a bad person. You may be a Christian, but that > > doesn't mean you're a bad person either.
> > ...getting back on topic...
> > FWIW, I don't think the current regulatory environment in the USA > > makes health insurance coverage a good fit for a coworking group in > > the USA. Real estate issues are different from health insurance > > issues, and they take fairly different solutions, resources, and > > skillsets. The only way I could see this kind of thing working is if > > each coworking space took on its regulars as paid staff and insured > > them that way. For most groups, that's much more commitment than > > makes sense for other important aspects of the business model.
> I really love Sam's idea. Personally, and after many bad experiences with > the health care insurance companies down here (I'd like to know what they DO > cover, really...'cause it seems like nothing), I'd love to subvert their > system and create a truly community based approach to this.
> Like a co-operative.
> Sounds radically Canadian, really. ;)
> It will just take time. And lots of research. And I'll just bet the > insurance companies have some sort of great lobby against this kind of thing > that seems to smack of communal thinking (the reds!).
> Maybe we need to have a HealthCamp. Get Michael Moore involved, even. :)
> Tara
> On 8/21/07, Samuel Rose < samuel.r...@gmail.com> wrote:
> > To clarify, the idea I was proposing is that people could do a similar > > thing as a network of non-religious people. There would be no religion > > requirement of any kind in the idea I am talking about here. The only > > requirement would be that other people in the network can verify that > > you are real and trustworthy
> > On Aug 21, 3:36 pm, Graham Freeman <graham.free...@cernio.com> wrote: > > > On 21 Aug 07, at 10:58, Samuel Rose wrote:
> > > > 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.
> > > What about people like me who are atheists and eminently trustworthy > > > and moral people?
> > > Sorry, I don't mean to bash on your proposal, as health care in the > > > US needs all of the innovative thought and energy it can get, but I'm > > > also pretty darn tired of being assumed to be amoral/immoral just > > > because I've never needed the help of a bunch of old white men to > > > figure out what's right and what's wrong. I'm an atheist, and that > > > does not mean I'm a bad person. You may be a Christian, but that > > > doesn't mean you're a bad person either.
> > > ...getting back on topic...
> > > FWIW, I don't think the current regulatory environment in the USA > > > makes health insurance coverage a good fit for a coworking group in > > > the USA. Real estate issues are different from health insurance > > > issues, and they take fairly different solutions, resources, and > > > skillsets. The only way I could see this kind of thing working is if > > > each coworking space took on its regulars as paid staff and insured > > > them that way. For most groups, that's much more commitment than > > > makes sense for other important aspects of the business model.
> To clarify, the idea I was proposing is that people could do a similar > thing as a network of non-religious people. There would be no religion > requirement of any kind in the idea I am talking about here. The only > requirement would be that other people in the network can verify that > you are real and trustworthy
Sam, I apologize - I mis-read your message such that I thought you were encouraging a religious tie-in.
I think I was touchy after recently hearing an insipid puff piece masquerading as journalism on NPR about how parents' worst nightmares are of their kids marrying atheists. The "reporter" went so far as to devote an extended portion of her time to talking about an episode of some prime-time TV show, as if that had any bearing on the real world.
So, when I read something that I interpreted as meaning that only Christians who are in good standing with church officials should get health care, I got annoyed and only skimmed the rest of your post.
> Flip the system on a large scale from the inside out? Count me in :-)
> On 8/21/07, Tara Hunt <horsepig...@gmail.com > wrote: > I really love Sam's idea. Personally, and after many bad > experiences with the health care insurance companies down here (I'd > like to know what they DO cover, really...'cause it seems like > nothing), I'd love to subvert their system and create a truly > community based approach to this.
> Like a co-operative.
> Sounds radically Canadian, really. ;)
> It will just take time. And lots of research. And I'll just bet the > insurance companies have some sort of great lobby against this kind > of thing that seems to smack of communal thinking (the reds!).
> Maybe we need to have a HealthCamp. Get Michael Moore involved, > even. :)
> Tara
> On 8/21/07, Samuel Rose < samuel.r...@gmail.com> wrote:
> To clarify, the idea I was proposing is that people could do a similar > thing as a network of non-religious people. There would be no religion > requirement of any kind in the idea I am talking about here. The only > requirement would be that other people in the network can verify that > you are real and trustworthy
> On Aug 21, 3:36 pm, Graham Freeman <graham.free...@cernio.com> wrote: > > On 21 Aug 07, at 10:58, Samuel Rose wrote:
> > > 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.
> > What about people like me who are atheists and eminently trustworthy > > and moral people?
> > Sorry, I don't mean to bash on your proposal, as health care in the > > US needs all of the innovative thought and energy it can get, but > I'm > > also pretty darn tired of being assumed to be amoral/immoral just > > because I've never needed the help of a bunch of old white men to > > figure out what's right and what's wrong. I'm an atheist, and that > > does not mean I'm a bad person. You may be a Christian, but that > > doesn't mean you're a bad person either.
> > ...getting back on topic...
> > FWIW, I don't think the current regulatory environment in the USA > > makes health insurance coverage a good fit for a coworking group in > > the USA. Real estate issues are different from health insurance > > issues, and they take fairly different solutions, resources, and > > skillsets. The only way I could see this kind of thing working > is if > > each coworking space took on its regulars as paid staff and insured > > them that way. For most groups, that's much more commitment than > > makes sense for other important aspects of the business model.
Cool! I'm really glad people are interested in this idea. One of the first things that I am doing right now is getting feedback from the Cooperation Commons project (homepage here: http://cooperationcommons.com/) Cooperation commons includes some of the best minds in the areas of human cooperation/trust/socio-politics/human complexity and cooperation as it relates to Anthropology, Biology, Poltical Science, Law, Economics, Cultural evolution, Business, Education, History, Information science, and more
We are exploring similar ideas in BarCampBank (see: http://www.wikiservice.at/fractal/wikidev.cgi?EN/BarCampBank) and at http://communitywiki.org, at least in terms of trust and exchanging currency. It's a brave new world to tread into, for sure, but so far, many educated and knowledgeable people agree that exchanging donations in the way that I describe is internationally legal, and almost universally unregulated (depending on what you say the gift is for, in some areas).
One bit of feedback I've received from Cooperation Commons folk is that it is more likely that gift exchanges will succeed among people who are connected through a common interest (in this case, co- working). I think our http://communitywiki.org/en/communityWikiBank experiment is one real world example that shows how a trust exchange like this can work on a small scale. And, on the flip side this shows how things can quickly fall apart when a system designed with good intentions begins focusing more on money and short term profits (especially when p2p money systems are run by traditional corporations): http://blog.socialsynergyweb.com/2007/08/16/the-prosper-lender-rebell...
Prosper is having problems because they lost their focus on trust among small groups of people. To get a loan on prosper, it is "recommended", though not required that a borrower join an affinity group, like a group of people who are borrowing to buy apple computers, etc. The prosper design was that these groups would help ensure payback of loans, by creating a reputation/trust group rating, which puts social pressure on individuals to help maintain the group rating, and also can optionally reward existing group members for helping sustain good group ratings. This all used to be right on the "about" page of Prosper. However, now if you look there, there is little if anythign mentioned about "groups": http://www.prosper.com/borrow/about_borrowing.aspx
And, not surprisingly, payback rates have plummeted on Prosper in recent months. Lenders are leaving, people are starting to game the system. Prosper is now more focused on getting new borrowers and new lenders in, then on maintaining and growing the community, in my opinion. Jessica Margolin pointed this out to me here: http://future.iftf.org/2007/08/finance-prosper.html
Now, if Propser had focused on the groups more, and on building and sustaining more quality groups under their original vision, and on creating and encouraging lots of communication, things could be different.
So, this suggests to me a possible direction for people interested in donation based P2P exchange networks: make as much of the nitty gritty dirty detail work happen on the small local scales as possible, then let communications about locally verified need happen on a group-to- group scale, but let actual money exchanges happen on an individual scale, with each person inputting their donation out to the network. And, let as much as possible be transparent. I suggest systematized trust based donation to solve this problem, because it is the least subject to stringent local regulation, and because there are existing examples of systems like this actual working on large scales.
Also, HealthCamp would be awesome, with or without Micheal Moore :)
On Aug 22, 8:33 am, "Alex Hillman" <dangerouslyawes...@gmail.com> wrote:
> Flip the system on a large scale from the inside out? Count me in :-)
> On 8/21/07, Tara Hunt <horsepig...@gmail.com> wrote:
> > I really love Sam's idea. Personally, and after many bad experiences with > > the health care insurance companies down here (I'd like to know what they DO > > cover, really...'cause it seems like nothing), I'd love to subvert their > > system and create a truly community based approach to this.
> > Like a co-operative.
> > Sounds radically Canadian, really. ;)
> > It will just take time. And lots of research. And I'll just bet the > > insurance companies have some sort of great lobby against this kind of thing > > that seems to smack of communal thinking (the reds!).
> > Maybe we need to have a HealthCamp. Get Michael Moore involved, even. :)
> > Tara
> > On 8/21/07, Samuel Rose < samuel.r...@gmail.com> wrote:
> > > To clarify, the idea I was proposing is that people could do a similar > > > thing as a network of non-religious people. There would be no religion > > > requirement of any kind in the idea I am talking about here. The only > > > requirement would be that other people in the network can verify that > > > you are real and trustworthy
> > > On Aug 21, 3:36 pm, Graham Freeman <graham.free...@cernio.com> wrote: > > > > On 21 Aug 07, at 10:58, Samuel Rose wrote:
> > > > > 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.
> > > > What about people like me who are atheists and eminently trustworthy > > > > and moral people?
> > > > Sorry, I don't mean to bash on your proposal, as health care in the > > > > US needs all of the innovative thought and energy it can get, but I'm > > > > also pretty darn tired of being assumed to be amoral/immoral just > > > > because I've never needed the help of a bunch of old white men to > > > > figure out what's right and what's wrong. I'm an atheist, and that > > > > does not mean I'm a bad person. You may be a Christian, but that > > > > doesn't mean you're a bad person either.
> > > > ...getting back on topic...
> > > > FWIW, I don't think the current regulatory environment in the USA > > > > makes health insurance coverage a good fit for a coworking group in > > > > the USA. Real estate issues are different from health insurance > > > > issues, and they take fairly different solutions, resources, and > > > > skillsets. The only way I could see this kind of thing working is if > > > > each coworking space took on its regulars as paid staff and insured > > > > them that way. For most groups, that's much more commitment than > > > > makes sense for other important aspects of the business model.
No problem Graham. I also caught the NPR piece the other day about Atheism, too, while driving.
It's culturally interesting to note that in the US, a lot of the support for quite a few people came from churches and religious groups for many years. Then, after WWII, although many people still were active in their churches, the new support system became the large companies and industries that people worked for. This new supportby these companies created a social and economic pathway in the 1960's and 1970's for many people to isolate themselves from all other communities besides their employer (including traditional religious communities). Now that industries have largely withdrawn this support (in the form of donating less to local civic development, scaling back on health insurance and retirement, removing pathways to lifelong employment), many people are cut adrift with out much of any community to attach to. So, Coworking communities offer one very promising emerging way for people to build new support communities, that can adapt and change to volitile conditions, and that can still focus on positive values like trust, sustainability, social equity, and to avoid some of the negative focuses and mistakes of past socio-cultural support systems.
On Aug 22, 8:52 am, Graham Freeman <graham.free...@cernio.com> wrote:
> > To clarify, the idea I was proposing is that people could do a similar > > thing as a network of non-religious people. There would be no religion > > requirement of any kind in the idea I am talking about here. The only > > requirement would be that other people in the network can verify that > > you are real and trustworthy
> Sam, I apologize - I mis-read your message such that I thought you > were encouraging a religious tie-in.
> I think I was touchy after recently hearing an insipid puff piece > masquerading as journalism on NPR about how parents' worst nightmares > are of their kids marrying atheists. The "reporter" went so far as > to devote an extended portion of her time to talking about an episode > of some prime-time TV show, as if that had any bearing on the real > world.
> So, when I read something that I interpreted as meaning that only > Christians who are in good standing with church officials should get > health care, I got annoyed and only skimmed the rest of your post.
If people are looking for health insurance options more immediately - before a new model is created for coworkers - I would also suggest checking with any organizations you may have any vague connection with. We've actually been surprised by the number of organizations we know that have plans available for individuals and small companies. It may provide you with what you need and provide negotiating leverage if needed. Our Chamber of Commerce has pre-negotiated health care packages and has shown an interest in making it work for the coworker members in our space (It might work. It might not.). The National Trust for Historic Preservation has rates for its members. The rates and/or benefits have been better than what we could get on our own.
Derek Young
(We'll be announcing our new coworking space in the next few days...)
Oh yes. All of the HMO's have plans for small business. They are very willing to insure us...
But it isn't getting the insurance that is an issue here. It's what happens when you get sick. I was paying $500/month for a full-blown kickass plan that covered, what I thought was, everything. Now I'm still wading under over a thousand dollars worth of bills for pretty routine stuff because they didn't think a woman my age should have tests of those types. They also didn't cover an emergency room visit (wrong hospital I guess) that resulted in being sent away (they didn't do anything, but I'm looking at a $500 bill for waiting for 2 hours).
The issue so far for me and for many others I know isn't getting health care (nor at a reasonable rate), it is getting our costs reimbursed. HMO's and PPO's are for profit entities who have a stake in getting your money, then not paying out.
Of course, I'm Canadian, so I'm perplexed at the entire system and why it is that every one of you aren't so angry about being treated like this that you aren't storming the whitehouse with pitchforks. I simply don't understand, but I suppose if I was treated like I should be thankful that I get something (anything!) covered after paying $6000 a year all of my life and wasn't raised believing that basic healthcare is a right, not a privilege, I wouldn't be angry, either.
Thank goodness you have angry people around. ;) Be prepared to be pampered someday and realize what your health is worth....
> If people are looking for health insurance options more immediately - > before a new model is created for coworkers - I would also suggest > checking with any organizations you may have any vague connection > with. We've actually been surprised by the number of organizations we > know that have plans available for individuals and small companies. > It may provide you with what you need and provide negotiating leverage > if needed. Our Chamber of Commerce has pre-negotiated health care > packages and has shown an interest in making it work for the coworker > members in our space (It might work. It might not.). The National > Trust for Historic Preservation has rates for its members. The rates > and/or benefits have been better than what we could get on our own.
> Derek Young
> (We'll be announcing our new coworking space in the next few days...)
On 8/22/07, Tara Hunt <horsepig...@gmail.com> wrote:
> don't understand, but I suppose if I was treated like I should be > thankful that I get something (anything!) covered after paying $6000 a > year all of my life and wasn't raised believing that basic healthcare > is a right, not a privilege, I wouldn't be angry, either.
Some background, followed by opinion:
The current situation is partly due to the fact that the AMA is the most powerful labor union in the US. With the supply of doctors strictly limited by admissions policy, the legislative clout to enforce licensing, the ruinous cost of medical school and the liability risk of practicing medicine independently, the current situation will only get worse.
I remember when the legislation passed to allow HMO's to operate. They were touted as providing "economies of scale" to "drive down the high cost of medical care." It all sounded great at the time. But anyone (not me at that time) with a basic sense of economics must have known that inserting a middleman into every health care transaction could only raise prices in the long run. Now, the middleman must be present, either by market force or by law, with the usual result: out of control pricing.
Probably the only long term solution is forming a formal non-profit collective, and growing it to be large enough to go mano-a-mano with the likes of Kaiser. Large as in UC size large.
FWIW, I am philosophically opposed to "positive rights" such as a "right" to health care. But I am also *very* much opposed to collusion by state- and federal-funded medical schools to limit admissions thus limit the number of doctors in the work force. My tax dollars should not be supporting such an educational system.
Given the "right" of state-funded schools to perpetuate a monopoly on the labor supply, we as consumers don't have any other recourse than to demand stricter regulation on health care pricing. On the other hand, if there were a lot more doctors looking for work, perhaps the current situation would resolve itself more equitably.
There is also the fact that a very large number of people are supported by the "health care industry." People that manage health care services rather than providing medical care. As the industry grows, so will the number of people receiving paychecks for performing "work" sans providing a service to the consumer. These people are dependent on your big monthly payment, and they vote too. Downsizing the health care industry will put many of these people out of work with the usual consequences of risk to the economy and an increased load on local government services. Hopefully temporary.
Right now, this is a Drupal based system, that incorporates the type of "vouching" or advocating for other people. (This tool could be used for many types of donation-based projects, not just for a p2p healthcare donation system)
I can see that this system would need some modification to do what we've talked about here, but it possesses most of the needed ingredients already.
Also, see response from Jessica Margolin at cooperationcommons group here:
> On 8/22/07, Tara Hunt <horsepig...@gmail.com> wrote:
> > don't understand, but I suppose if I was treated like I should be > > thankful that I get something (anything!) covered after paying $6000 a > > year all of my life and wasn't raised believing that basic healthcare > > is a right, not a privilege, I wouldn't be angry, either.
> Some background, followed by opinion:
> The current situation is partly due to the fact that the AMA > is the most powerful labor union in the US. With the supply > of doctors strictly limited by admissions policy, the legislative > clout to enforce licensing, the ruinous cost of medical school > and the liability risk of practicing medicine independently, the > current situation will only get worse.
> I remember when the legislation passed to allow HMO's > to operate. They were touted as providing "economies > of scale" to "drive down the high cost of medical care." > It all sounded great at the time. But anyone (not me at > that time) with a basic sense of economics must have > known that inserting a middleman into every health care > transaction could only raise prices in the long run. Now, > the middleman must be present, either by market > force or by law, with the usual result: out of control > pricing.
> Probably the only long term solution is forming a > formal non-profit collective, and growing it to be > large enough to go mano-a-mano with the likes > of Kaiser. Large as in UC size large.
> FWIW, I am philosophically opposed to "positive > rights" such as a "right" to health care. But I > am also *very* much opposed to collusion by > state- and federal-funded medical schools to > limit admissions thus limit the number of > doctors in the work force. My tax dollars should > not be supporting such an educational system.
> Given the "right" of state-funded schools to > perpetuate a monopoly on the labor supply, > we as consumers don't have any other recourse > than to demand stricter regulation on health > care pricing. On the other hand, if there were > a lot more doctors looking for work, perhaps > the current situation would resolve itself more > equitably.
> There is also the fact that a very large number > of people are supported by the "health care > industry." People that manage health care > services rather than providing medical care. > As the industry grows, so will the number of > people receiving paychecks for performing > "work" sans providing a service to the consumer. > These people are dependent on your big > monthly payment, and they vote too. Downsizing > the health care industry will put many of these > people out of work with the usual consequences > of risk to the economy and an increased load > on local government services. Hopefully > temporary.
On Aug 22, 9:05 pm, "Tara Hunt" <horsepig...@gmail.com> wrote:
> Oh yes. All of the HMO's have plans for small business. They are very > willing to insure us...
> But it isn't getting the insurance that is an issue here. It's what > happens when you get sick. I was paying $500/month for a full-blown > kickass plan that covered, what I thought was, everything. Now I'm > still wading under over a thousand dollars worth of bills for pretty > routine stuff because they didn't think a woman my age should have > tests of those types. They also didn't cover an emergency room visit > (wrong hospital I guess) that resulted in being sent away (they didn't > do anything, but I'm looking at a $500 bill for waiting for 2 hours).
Exactly.
The Greeks and Romans had an early donation-based funding system for health care , and funeral costs, that was tied to their guild system.
Modern "insurance", as a service in general was originally designed to be a hedge fund, which means that it is an market enterprise. Our modern insurance system was originally designed and formulated by Lloyd's of London to hedge financial losses in shipping disasters. Entrepreneurs would make a contract with the insurer to spread risk out among everyone in the fund, no different fundamentally, than any other hedge, or mutual fund. This is a equitable solution for people who launch into business ventures that contain a certain amount of risk. They are launching into these ventures for profit first and foremost, and they can employ the insurance hedge fund as an agent to collectively spread risk across all of the people in their market segment. They are at the whim of the greater market place, but both sides are making decent bets, usually, and the insurer is guaranteeing against to disaster up to a certain point, at a certain market rate.
To me, this does not sound like a good way to fund my health care costs. I don't want to buy a share in a hedge fund that it pitted directly against the market place, because what happens is that, as the cost of health care increases, it costs more money to hedge our bets against the health care markets. One problem is that health care providers, and drug providers inflate costs, of course. But the bigger problem is that volatile markets are no place for a vital need like heatlh care funding. When health care funding is market driven, then the fund managers are forced to start cutting out more and more coverage to balance their hedge fund against the health care market place. This is why they cover less and less, while you pay more and more. The same dynamics apply as someone calculating the current costs of replacing a ship and all of it's cargo, should it capsize and sink in the ocean. Under US and State Laws, this type of hedge fund commerce is understandably regulated like any other market. It is a market!
So, in my mind, the solution is simple, roll back to the ancient greek and roman system of group/trade/community-based donation. Take the money we putting towards health care costs off of the market, and give it directly to people who need it. The same could be said for certain types of disaster insurance. Look at how many people got screwed by the insurance companies down in the Gulf after Hurricane Katrina. The insurance companies scrambled to readjust to the markets, because they are pitted against the markets, and the contracts people made with them let the insurance companies loosely interpret what types of "damage" happened, and whether they should pay claims or not. Frankly, this is insane. What is the use of a group of people pooling money, if some of them will be discluded from the the help they need, when it is needed? This is the wrong way to leverage the power of groups for solving vital human needs. It's time to take our health and personal welfare off of the market place, and into our own hands.
> The issue so far for me and for many others I know isn't getting > health care (nor at a reasonable rate), it is getting our costs > reimbursed. HMO's and PPO's are for profit entities who have a stake > in getting your money, then not paying out.
> Of course, I'm Canadian, so I'm perplexed at the entire system and why > it is that every one of you aren't so angry about being treated like > this that you aren't storming the whitehouse with pitchforks. I simply > don't understand, but I suppose if I was treated like I should be > thankful that I get something (anything!) covered after paying $6000 a > year all of my life and wasn't raised believing that basic healthcare > is a right, not a privilege, I wouldn't be angry, either.
> Thank goodness you have angry people around. ;) Be prepared to be > pampered someday and realize what your health is worth....
> > If people are looking for health insurance options more immediately - > > before a new model is created for coworkers - I would also suggest > > checking with any organizations you may have any vague connection > > with. We've actually been surprised by the number of organizations we > > know that have plans available for individuals and small companies. > > It may provide you with what you need and provide negotiating leverage > > if needed. Our Chamber of Commerce has pre-negotiated health care > > packages and has shown an interest in making it work for the coworker > > members in our space (It might work. It might not.). The National > > Trust for Historic Preservation has rates for its members. The rates > > and/or benefits have been better than what we could get on our own.
> > Derek Young
> > (We'll be announcing our new coworking space in the next few days...)
Dave, I never realized what you discussed below about the state artificially limiting the "supply" of doctors, egged on by the AMA. I guess I am not surprised, but I wasn't aware of this.
On Aug 22, 9:48 pm, "David Doolin" <david.doo...@gmail.com> wrote:
> On 8/22/07, Tara Hunt <horsepig...@gmail.com> wrote:
> > don't understand, but I suppose if I was treated like I should be > > thankful that I get something (anything!) covered after paying $6000 a > > year all of my life and wasn't raised believing that basic healthcare > > is a right, not a privilege, I wouldn't be angry, either.
> Some background, followed by opinion:
> The current situation is partly due to the fact that the AMA > is the most powerful labor union in the US. With the supply > of doctors strictly limited by admissions policy, the legislative > clout to enforce licensing, the ruinous cost of medical school > and the liability risk of practicing medicine independently, the > current situation will only get worse.
> I remember when the legislation passed to allow HMO's > to operate. They were touted as providing "economies > of scale" to "drive down the high cost of medical care." > It all sounded great at the time. But anyone (not me at > that time) with a basic sense of economics must have > known that inserting a middleman into every health care > transaction could only raise prices in the long run. Now, > the middleman must be present, either by market > force or by law, with the usual result: out of control > pricing.
> Probably the only long term solution is forming a > formal non-profit collective, and growing it to be > large enough to go mano-a-mano with the likes > of Kaiser. Large as in UC size large.
> FWIW, I am philosophically opposed to "positive > rights" such as a "right" to health care. But I > am also *very* much opposed to collusion by > state- and federal-funded medical schools to > limit admissions thus limit the number of > doctors in the work force. My tax dollars should > not be supporting such an educational system.
> Given the "right" of state-funded schools to > perpetuate a monopoly on the labor supply, > we as consumers don't have any other recourse > than to demand stricter regulation on health > care pricing. On the other hand, if there were > a lot more doctors looking for work, perhaps > the current situation would resolve itself more > equitably.
> There is also the fact that a very large number > of people are supported by the "health care > industry." People that manage health care > services rather than providing medical care. > As the industry grows, so will the number of > people receiving paychecks for performing > "work" sans providing a service to the consumer. > These people are dependent on your big > monthly payment, and they vote too. Downsizing > the health care industry will put many of these > people out of work with the usual consequences > of risk to the economy and an increased load > on local government services. Hopefully > temporary.
On Aug 22, 9:48 pm, "David Doolin" <david.doo...@gmail.com> wrote:
> Probably the only long term solution is forming a > formal non-profit collective, and growing it to be > large enough to go mano-a-mano with the likes > of Kaiser. Large as in UC size large.
I don't know, I think people do not realize what the current legal system allows them to do, in terms of giving money to one another for legal purposes. And, i think people don't realize that increase knowledge about cooperation, and improving tools to facilitate decentralized voluntary cooperation, offer alternatives other than centrally controlled, monolithic organizations for solving problems like this.
> On Aug 22, 9:48 pm, "David Doolin" <david.doo...@gmail.com> wrote:
> > Probably the only long term solution is forming a > > formal non-profit collective, and growing it to be > > large enough to go mano-a-mano with the likes > > of Kaiser. Large as in UC size large.
> I don't know, I think people do not realize what the current legal > system allows them to do, in terms of giving money to one another for > legal purposes. And, i think people don't realize that increase > knowledge about cooperation, and improving tools to facilitate > decentralized voluntary cooperation, offer alternatives other than > centrally controlled, monolithic organizations for solving problems > like this.
Well, so far as I know, there is not a lot of regulation/restriction on simply giving money to one another. Other than donating to soemthing like a terrorist organization, or something bad and illegal.
It is legal for me to send you $100 towards the cost of your health care. It is also legal for everyone at Citizenspace, or another coworking group to pool $100 each every month, and then give it to other people in other coworkign groups, to fund their health care costs. If you create an insurance hedge fund, or even a not-for-profit cooperative-group managed insurance hedge fund, you are subject to state laws. But, if yo simply give the money directly to people who need it, then you are not subject to this regulation. This is how the "church fund" example that I discussed earlier works. They funnel millions of dollars around, basically from donors directly to people who have medical bills to pay, mediated pretty much mostly by a group who publish a newsletter directing people where to send money to next. The system works amazingly well, and costs each participant very little in comparison to insurance available from commerical or other providers. And, everyone gets all of their costs paid.
I am not suggesting that we would actually mirror-emulate the "church plan" system, but I think a good amount of the fundamental mechanics can be used. Although, instead of a "newsletter", people might be signaled as to where to send there donations based on a website, for instance. Donation requests get listed on the site by being vetted locally, by local coworking groups, for instance. The http://donorge.org system actually is a good model for what I am thinking of.
On Aug 25, 11:54 am, "Tara Hunt" <horsepig...@gmail.com> wrote:
> RE: I think people do not realize what the current legal system allows them > to do, in terms of giving money to one another for legal purposes.
> What does the current legal system allow me to do in terms of giving money > to one another...? (You may have explained it, but I think I missed it).
> T
> On 8/25/07, Samuel Rose <samuel.r...@gmail.com> wrote:
> > On Aug 22, 9:48 pm, "David Doolin" <david.doo...@gmail.com> wrote:
> > > Probably the only long term solution is forming a > > > formal non-profit collective, and growing it to be > > > large enough to go mano-a-mano with the likes > > > of Kaiser. Large as in UC size large.
> > I don't know, I think people do not realize what the current legal > > system allows them to do, in terms of giving money to one another for > > legal purposes. And, i think people don't realize that increase > > knowledge about cooperation, and improving tools to facilitate > > decentralized voluntary cooperation, offer alternatives other than > > centrally controlled, monolithic organizations for solving problems > > like this.
On 8/25/07, Samuel Rose <samuel.r...@gmail.com> wrote:
[]
> Entrepreneurs would make a contract with the insurer to spread risk > out among everyone in the fund, no different fundamentally, than any > other hedge, or mutual fund. This is a equitable solution for people > who launch into business ventures that contain a certain amount of > risk. They are launching into these ventures for profit first and > foremost, and they can employ the insurance hedge fund as an agent to > collectively spread risk across all of the people in their market
Indeed.
> segment. They are at the whim of the greater market place, but both > sides are making decent bets, usually, and the insurer is guaranteeing > against to disaster up to a certain point, at a certain market rate.
> To me, this does not sound like a good way to fund my health care > costs. I don't want to buy a share in a hedge fund that it pitted > directly against the market place, because what happens is that, as
This system works pretty well provided the risks are unknown, and the cost of care relatively low.
Now, with modern medicine and actuarial science, the amount of risk for the insurer is much, much lower, while the costs for care much, much higher.
The market is very efficient, and is an excellent way for economic activity to self-organize. Unfortunately, there really isn't any such thing as a free market; there is always a tendency to monopoly control in an unregulated system (ATT anyone?).
Excellent discussion.
My interest is high as Kaiser just denied me corporate group care: my company is too small.
On 8/25/07, Samuel Rose <samuel.r...@gmail.com> wrote:
> Well, so far as I know, there is not a lot of regulation/restriction > on simply giving money to one another. Other than donating to > soemthing like a terrorist organization, or something bad and illegal.
> It is legal for me to send you $100 towards the cost of your health > care. It is also legal for everyone at Citizenspace, or another > coworking group to pool $100 each every month, and then give it to > other people in other coworkign groups, to fund their health care > costs. If you create an insurance hedge fund, or even a not-for-profit > cooperative-group managed insurance hedge fund, you are subject to > state laws. But, if yo simply give the money directly to people who
You are subject to state laws in any case. These donations are gifts, and there is a large body tax code regulating gifts, including the size of gifts, what the gifts result from, what they apply to, etc.
> need it, then you are not subject to this regulation. This is how the > "church fund" example that I discussed earlier works. They funnel > millions of dollars around, basically from donors directly to people > who have medical bills to pay, mediated pretty much mostly by a group > who publish a newsletter directing people where to send money to next. > The system works amazingly well, and costs each participant very > little in comparison to insurance available from commerical or other > providers. And, everyone gets all of their costs paid.
No, not everyone. The state *will* insist on their "fair" share.
Coworking and related social experiments do not draw regulatory attention, yet: you can't get blood from a turnip. That is, there isn't enough money changing hands among people with enough assets to justify applying current tax code, develop new tax code, or audit. If coworking "takes off," the tax man will be at the door PDQ. This is sure as the sun rises in the east.
Any "solution" that doesn't make sure the state gets paid is doomed.
Barter is taxable, on both federal and state level.
Buying from out-of-state is taxable (use tax).
Health care is solveable at the current coworking scale of operations, but not without meeting all the state and federal regulations. The system can be hacked, but hacking requires intimate knowledge of the system.
I am not trying to be discouraging here, but I won't commit any money to anything until I know there won't be any trouble from federal or state tax bodies. I can write health care off the top of my income, if I can't write off donations into a p2p system, I can't afford to use it.
Any time any money is exchanged for any reason whatsoever, the federal and state governments reserve their right to regulate and tax the transaction. They can do this because because they have all guns. It's that simple.
Health care is solvable, no doubt, but not without meeting all appropriate state and federal regulations.
Whoever takes this on, and cracks it, will be able to make a very respectable living providing consulting services to like-minded organizations. I believe that time donated to this enterprise could be deducted for AGI, provided the necessary paperwork was handled up front.
Here is an offer: $150 donation to get a CA or DE non-profit incorporated to formally explore health care options for the coworking model. CA does not charge 1st year franchise fee ($800), so this can be done reasonably inexpensively. As a bonus, I need to make a trip to Sac this fall for other state-related business, and would be delighted to have someone ride. In my experience, doing business in Sacramento is faster than doing state business in San Francisco, even with the drive involved.
-d
On 8/25/07, Tara Hunt <horsepig...@gmail.com> wrote:
> RE: I think people do not realize what the current legal system allows them > to do, in terms of giving money to one another for legal purposes.
> What does the current legal system allow me to do in terms of giving money > to one another...? (You may have explained it, but I think I missed it).
> T
> On 8/25/07, Samuel Rose <samuel.r...@gmail.com> wrote:
> > On Aug 22, 9:48 pm, "David Doolin" <david.doo...@gmail.com> wrote:
> > > Probably the only long term solution is forming a > > > formal non-profit collective, and growing it to be > > > large enough to go mano-a-mano with the likes > > > of Kaiser. Large as in UC size large.
> > I don't know, I think people do not realize what the current legal > > system allows them to do, in terms of giving money to one another for > > legal purposes. And, i think people don't realize that increase > > knowledge about cooperation, and improving tools to facilitate > > decentralized voluntary cooperation, offer alternatives other than > > centrally controlled, monolithic organizations for solving problems > > like this.
When I received my insurance license I specifically remember that large employers fraternal organizations were allowed to offer health insurance to their employees as a group and the insure could spread the risk out over the entire group. In fact, the National Association of Realtors just started doing this. I also remember that is not allowed for any group to join together for the specific purpose of lowering their insurance cost. There must be some other compelling or logical reason for you to be banded together. I think that this health insurance fund idea runs afoul of this regulation.
> Any time any money is exchanged for any reason whatsoever, > the federal and state governments reserve their right to regulate > and tax the transaction. They can do this because because > they have all guns. It's that simple.
> Health care is solvable, no doubt, but not without meeting > all appropriate state and federal regulations.
> Whoever takes this on, and cracks it, will be able to > make a very respectable living providing consulting > services to like-minded organizations. I believe that > time donated to this enterprise could be deducted > for AGI, provided the necessary paperwork was > handled up front.
> Here is an offer: $150 donation to get a CA or > DE non-profit incorporated to formally explore > health care options for the coworking model. > CA does not charge 1st year franchise fee > ($800), so this can be done reasonably > inexpensively. As a bonus, I need to make > a trip to Sac this fall for other state-related > business, and would be delighted to have > someone ride. In my experience, doing > business in Sacramento is faster than > doing state business in San Francisco, > even with the drive involved.
> -d
> On 8/25/07, Tara Hunt <horsepig...@gmail.com> wrote: > > RE: I think people do not realize what the current legal system allows > them > > to do, in terms of giving money to one another for legal purposes.
> > What does the current legal system allow me to do in terms of giving > money > > to one another...? (You may have explained it, but I think I missed it).
> > T
> > On 8/25/07, Samuel Rose <samuel.r...@gmail.com> wrote:
> > > On Aug 22, 9:48 pm, "David Doolin" <david.doo...@gmail.com> wrote:
> > > > Probably the only long term solution is forming a > > > > formal non-profit collective, and growing it to be > > > > large enough to go mano-a-mano with the likes > > > > of Kaiser. Large as in UC size large.
> > > I don't know, I think people do not realize what the current legal > > > system allows them to do, in terms of giving money to one another for > > > legal purposes. And, i think people don't realize that increase > > > knowledge about cooperation, and improving tools to facilitate > > > decentralized voluntary cooperation, offer alternatives other than > > > centrally controlled, monolithic organizations for solving problems > > > like this.
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