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Bob Higgs, the Man with a Smart Card

In Creativity, Economics, Law, Politics, Science on October 11, 2017 at 6:45 am

A different version of this article appeared here in the Library of Law and Liberty.

The U.S. healthcare industry is notoriously inefficient and troublesomely massive. It’s also wealthy and getting wealthier and more powerful as medical costs have exceeded, by some estimates, $10,000 per person.

What’s to be done?

Back in 2005, a group of healthcare experts asked, in a RAND Corporation study, whether electronic medical-record systems could transform healthcare by reducing costs and increasing efficiency. The answer, in short, was: it depends.

Although systematizing electronic medical records could save over $81 billion per year, these potential savings would be realized, the study concluded, only if healthcare in the United States integrated new technologies to allow for the flow of medical data between the patient and relevant parties such as doctors, hospitals, or insurers. Non-standardized record systems would result, by contrast, in inconsistent, inefficient, and incomplete data exchanges that could increase rather than decrease costs.

RAND Corporation revisited the issue in 2013, finding that healthcare expenditures had grown by $800 million since 2005 in part because systems of electronic medical records remained non-standardized. “We believe that the original promise of health IT can be met,” wrote Arthur L. Kellermann and Spencer S. Jones, the authors of the study, “if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data.”

Healthcare in the United States is constitutionally fragmented: Not only does the industry consist of various entities, from doctors and hospitals and insurance providers to commercial suppliers of devices, goods, and services, but also the pricing of medical services is unreliable and unpredictable in part because the country is so large and the industry subject to different regulations from state to state.

Information integration could go a long way towards cutting medical costs and increasing medical savings. For example, it could reduce waste resulting from misdiagnoses, repetitive procedures, erroneous prescriptions, and duplicate testing and imaging.

What if there were a simple solution for this waste?

One entrepreneur believes he’s found the technology to revolutionize the way healthcare records are shared and maintained through Health Information Exchange (HIE).

Robert E. Higgs is the founder of ICUcare, a company that aims to improve technologies in the fields of telemedicine and electronic health records. He has invented a “smart” health card that can contain a patient’s complete medical history, which is stored in a cloud. His vision is that patients own their personalized smart cards, which they can voluntarily submit to healthcare providers and institutions for cheaper and more efficient services. Data on the card are easily stored and updated and exchanged only with the patient’s consent; thus, in the case of emergency, the patient’s medical records can be readily accessed and quickly reviewed.

There remains, sadly, a felt need to transition the healthcare industry from paper to electronic records. The smart card meets this need, but it does much more. It tracks your billing history, reconciles erroneous payment information, protects against fraud and identity-theft, and serves as a conveniently portable device.

One would expect such a card to have been in circulation by now, given the extensive government investment in HIEs. President George W. Bush, for example, issued an executive order in 2004 to create the Office of the National Coordinator for Health Information Technology (ONC), a division of the Department of Health and Human Services (DHS) designed to advance technology and innovation pertaining to the exchange of healthcare information. This office created eHealth Exchange, a coalition of states, federal agencies, hospitals, medical groups, pharmacies, and other such entities that’s now run by the Sequoia Project.

But the federal government and the public-private partnerships it has fostered have been unable to produce a smart card that matches Higgs’s in capability and functionality. And even if they had, government retention of sensitive medical data would, among other things, raise privacy concerns that voluntary private transactions and coordination would alleviate.

Moreover, the many spinoff organizations emanating from the ONC and DHS have only crowded the field with swollen, inefficient government and quasi-government structures and programs. Rather than helping the situation, these putative “solutions” have slowed down innovators like Higgs, forcing them to deal with politicians and bureaucrats rather than patients and hospitals.

Having heard about Higgs’s curious smart card through a friend, I decided to reach out to him to find out more. I asked him, first, about privacy implications, namely whether the smart card could increase incidents of non-consensual data transfers and disclosures.

The smart card, he said, “never sends data to the care provider—it brings the care provider to the data.” He explained that data on the smart card are encrypted using the same standards as those used by the Department of Defense for common-access cards.

“We used Advanced Encryption Standard 265, or AES-256,” he said, “the highest standardized encryption specification that’s used worldwide by entities as diverse as corporations and the U.S. government. The key size of 256 bits means that the key, which turns encrypted data into unencrypted data, is a string of 256 ones or zeros.”

I admitted that I didn’t fully understand.

“Put it this way,” he said. “The research I’ve read indicates that each character has two possibilities—one or zero—for which there are 2,256 possible combinations. If 50% of the possibilities must be exhausted to determine the correct key, then you need to guess 2,255 of them [to hack the encryption].”

Pressed about how long it would take to test all possible keys to break the encryption, Higgs, parroting a claim I’ve heard used to describe bitcoin, said, “The universe itself has existed for 14 billion years. It would take something like 1.5770813e18 longer than our universe’s full age to exhaust just half of the key-space of our encryption.”

An attempt to verify Higgs’s figures turned up a plethora of studies and blog posts about encryption and decryption, bitcoin, hacking, and computer engineering (the calculation appearing on many blogs and tech sites is ~6.7e40, which equals 235,385,265,247,008,100, which is multiplied by 6.7 to yield the 1.5770813e18 number that Higgs supplied).

These calculations can be confusing, but the point Higgs wanted to drive home is that the smart card reverses the current power imbalance: today corporations and governments store medical records that patients often can’t access or don’t know about; the smart card, however, empowers patients to store their own records that they may voluntarily release to corporations and governments. The smart card, in other words, returns agency to the consumer whose data is at stake.

It would also, Higgs alleges, reduce rates of healthcare fraud. According to estimates by the National Health Care Anti-Fraud Association, the United States loses tens of billions of dollars every year due to healthcare fraud. Canada, Germany, and France have each instituted some form of a smart card to successfully cut back on fraud.

A company called Cerner has just landed a deal with the Department of Veterans Affairs (the VA) to implement an electronic health records system. The move away from the VA’s Vista system to Cerner’s electronic system suggests that at least some government officials are aware of the need to adopt interoperable and integrated measures of retaining and sharing medical records. The VA will implement the same electronic health record system used by the DOD.

So far as I can tell, however, Cerner has not created a smart card like Higgs’s. I reached out to Adam Lee, a senior communications partner at Cerner, to ask about smart cards and Cerner’s hopes and plans with the VA. Lee referred me to this press release about Cerner’s work with the VA but did not discuss smart cards.

Talking to Higgs is like talking to a computer: more engineer than salesman, he’s strikingly intelligent but has difficulty getting through to politicians. He’s monotone and meticulous, frank and unexcitable. He’s fast with facts and figures and savvy with technology, but the average politician wants to know primarily whether the smart card appeals to constituents and only secondarily whether it’s operable and efficient.

Higgs grew emotional during our phone call, however, as he told me the story of his wife, who underwent a routine procedure that went wrong. He claimed that, during this standard operation, errors were made that could have been avoided had her doctors possessed his wife’s proper medical records. She’s been subjected to numerous tests throughout her illness, he said, only to have them redone when visiting a new facility or specialist because of an inability to simply retrieve her medical history. She remains in bad shape, living at home with hired assistance.

This unfortunate situation has motivated Higgs to seek answers to save others from similar mistakes in similar circumstances.

If Higgs’s smart card is so great, you might ask, why hasn’t it been adopted? Why haven’t I heard of it? Why doesn’t it circulate widely? Why aren’t hospitals jumping at the opportunity to use it?

The answer, according to Higgs, is simple: the healthcare industry doesn’t want you to know about his smart card because it doesn’t want to reduce costs. It’s full of people getting rich off inefficiency and artificially high prices. Lobbyists for the healthcare industry have taken advantage of the fear and apathy of politicians to ensure that technological progress is delayed or stymied.

Thus, Higgs describes his job in terms of David versus Goliath.

There are numerous ideas about how to trim healthcare spending; Higgs’s smart card is not the exclusive remedy or sole fix. But it’s an encouraging development. Healthcare spending makes up about 17.8% of the nation’s economy, according to an actuary report by the Centers for Medicare and Medicaid Services. And it shows no signs of decreasing. This trend is unsustainable; something must be done—and undone.

We could use more men like Higgs and less government to push us in the right direction before it’s too late.

 

 

 

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The Unmeaning of Uneaning

In Arts & Letters, Bioethics, Books, Humanities, Science, Western Civilization, Western Philosophy on October 19, 2016 at 6:45 am

Allen 2

This review originally appeared here in Chronicles. 

A computer was the victor on a popular television game show, easily defeating its human competitors; an arms race is under way involving militarized robots that can take the battlefield in the place of inferior humans; in Japan, artificial-intelligence software has outperformed college applicants on a standardized college-entrance examination.

Our machines are becoming a part of us, one of us.  Manufactured retinas have restored sight to the blind; the maimed and the crippled have regained their limbs and appendages in the form of robotic prosthetics; brain implants have alleviated problems associated with Parkinson’s disease; a company called EmoShape manufactures robots that display human emotions, including anger and fear and sadness.

But where there is human flesh, even a simulacrum of human flesh, there is the potential for eros.  The 2013 film Her explored the possibility that humans will attempt romantic congress with computer operating systems, reducing love to an algorithm and human sex acts to masturbatory exchanges with disembodied, computerized voices.

We have created our own reproductive anatomy—lab-engineered penises and vaginas—that soon will be tested on men and women with congenital defects.  Men may now visit virtual-reality brothels.  A baby recently was born out of a transplanted womb.

We are building more robots and killing more human fetuses than ever before.  Luminaries like Stephen Hawking warn of the dangers of artificial intelligence; futurists, on the other hand, celebrate the rise of cyborgs and the arrival of transhumanism and even posthumanism.  Synthetic biologists are learning, they claim, to direct natural selection through gene therapy and cell manipulation.  Silicon Valley’s brightest have announced that they are seeking “cures” for human aging.

In light of all this, the question of the meaning of human existence seems more urgent than ever before.

Edward O. Wilson purports to answer this question in The Meaning of Human Existence, his 30th book.  Wilson is one of the world’s most renowned scientists.  He is by all accounts a gentleman who enunciates his words in a soft, Southern drawl.  Raised in Alabama, blind in one eye, he developed a boyhood fascination with insects that eventually led him to Harvard, where he took his Ph.D. in biology.  He earned his reputation by studying ants and by writing popular books that are accessible to laymen.  On Human Nature, his fourth book, won the Pulitzer Prize for general nonfiction in 1979.  He has, despite his atheism, drawn praise from conservative intellectuals.  In 1989, for instance, The Rockford Institute, which publishes this magazine, gave him the Richard M. Weaver Award for Scholarly Letters.

As titles go, Wilson’s The Meaning of Human Existence is bold if not presumptuous.  Works that set out to establish definitively the “meaning” of human life promise more than they can deliver.  First, there is the problem of meaning itself.  Thus, Wilson begins with a short chapter titled “The Meaning of Meaning,” which, not surprisingly, raises more questions than it answers.  The meaning of meaning, according to Wilson, resides in the blurry overlap between two worldviews: the theological and religious worldview that locates meaning in the design and intention of an omnipotent creator, and the scientific worldview that locates meaning in the random accidents of history and in the nondesigned, adaptive, spontaneously ordered laws of nature.  These worldviews are tenuously linked, Wilson suggests, in their treatment of human free will and intentionality.

Wilson claims, for example, that intelligent organisms evolve associatively to combine their intents and purposes for their mutual benefit; their behavior grows more alike over time as together they respond to environmental imperatives and learn to commiserate and to cooperate as a social unit.  What was once merely the mechanical firing of brain activity in individual persons has become a behavioral trait among groups of humans.  Wilson provides an arthropodic example:

A spider spinning its web intends, whether conscious of the outcome or not, to catch a fly.  That is the meaning of the web.  The human brain evolved under the same regimen as the spider’s web.  Every decision made by a human being has meaning in the first, intentional sense.  But the capacity to decide, and how and why the capacity came into being, and the consequences that followed, are the broader, science-based meaning of human existence.

Meaning itself is not identified in this illustration: Wilson does not tell us what it is, only where we might find it.  It’s up to us to do the searching.

Despite his prefatory lip service to theology and religion, Wilson adopts a materialist worldview, which seems, the more he describes it, less and less compatible with the theological and religious worldview, until at last there is no overlap at all.  Wilson tells us that there “is no predestination, no unfathomed mystery of life.  Demons and gods do not vie for our allegiance.”  He assures us that the “eternal conflict” between groups of people “is not God’s test of humanity” or “a machination of Satan.”  “It is,” he says, “just the way things worked out.”

Wilson is convinced that humans are for the first time in their history (“not just the six millennia of civilization but very much further back, across hundreds of millennia”) leaving behind the process that, he claims, produced us—namely, natural selection—and entering into a new age of choice in which we have available to us a genetic “shopping list” to “direct our own evolution.”  He proposes that we understand our biological and evolutionary past in order wisely to shape our future.

One would think that a grounding in history or tradition would aid in satisfying this ambition, but Wilson makes clear that he is rejecting this kind of history and promoting a secular and scientific history that is not only stripped of providence, angelic intercession, heavenly statutes, and divine intervention but also antecedent to all written records.  “Humanity,” he avers to this end,

arose entirely on its own through an accumulated series of events during evolution.  We are not predestined to reach any goal, nor are we answerable to any power but our own.  Only wisdom based on self-understanding, not piety, will save us.

Tellingly, Wilson does not define what it means to “save” or what we need to be saved by or from if there is no God, Hell, sin, Satan, or transcendental moral order to the universe.  He is apparently content in his belief that “[t]here will be no redemption or second chance vouchsafed to us from above.”  “We have,” he adds, “only this one planet to inhabit and this one meaning to unfold.”

To seek answers to the meaning of human existence from this secular perspective in which man isn’t begotten by Adam but descended from Homo habilis and improved from organism to super organism, Wilson could have turned to the ideas of Emerson or Nietzsche or Bertrand Russell or Einstein or Ayn Rand, philosophers enthralled by the awesome powers of the human mind and dismissive of the doctrinal claims of religion in general and of traditional Christianity in particular—but he doesn’t.  Nor, thank goodness, does he turn to the close-minded, militant atheists such as Richard Dawkins (who is mentioned in the book) and Sam Harris.  He instead turns to “the biological evolution of a species and the circumstances that led to its prehistory,” professing that both our altruism and our instinctive, selfish urge to cooperate are explainable by science, which, therefore, is necessarily antecedent to, although participatory with, the humanities.  Wilson’s problem with the humanities seems to be that they retain the residue of theology, which was once the queen of the liberal arts.

Because in Wilson’s view human creativity and collaboration are the inevitable products of the impersonal forces of raw nature, he considers the “task of understanding humanity” to be “too important and too daunting to leave to the humanities.”  He maintains that “the humanities have not achieved nor will they ever achieve a full understanding of the meaning of our species’ existence” if they do not account for the “biological origins of human nature.”  He reasons that, since human nature has biological origins, and since creativity arises through competition and natural selection, we ought to embrace the ideals of the Enlightenment in which the humanities and the sciences were unified enterprises rather than distinct fields of operation.

Wilson blames Romanticism for the divorce of the humanities from science; rather than irreconcilable differences, he sees in this former marriage a powerful synergy that has since grown weak as experts in their respective fields have become hyperspecialized, the division of their labor increasingly alienated from the Big Picture.  The fact of the matter, he submits, is that the “explosive growth of scientific knowledge” has “everything” to do with the humanities, because “[s]cience and technology reveal with increasing precision the place of humanity, here on Earth and beyond in the cosmos as a whole.”

The meaning of human existence according to Wilson is found not in what we have created but in what has created us: a self-perpetuating, unthinking process of biological production shaped by genetic variety and the instinct for survival, not by a benevolent Creator.  The dust jacket informs us that this is Wilson’s “most philosophical work to date.”  But what we have here is a meandering series of essays that display with exceptional style an accretive learning arrayed from scientific theory.  And we also have a man, however gentle and unassuming, making grandiose claims based on mere supposition—not a call to arms but a triumphalist celebration that the war is already over.  Science has won; religion has lost.  Any seeming contradiction between religion and science must, he insists, be resolved in favor of the latter; any potential overlap between the two fields must, he reiterates, be dismissed.  He thinks that religion hinders knowledge, holds us back, and distracts us from real truths by enslaving us to fancy and superstition.  And he’s wrong.

His secular perspective isn’t unique, and it isn’t philosophical, either—at least not without some analytical backing or historical context.  Wilson supplies neither; he submits as fact what is open to interpretation.  When Wilson informs us that there is no God, as if that “reality” were as established as the laws of gravity, he undermines his credibility and throws philosophy out the window.  No need for proofs, second guesses, theological nuances, or even doubt.  His scientific faith in the unprovable—although politely conveyed—is on equal footing with religious faith in the unprovable.  Wilson doesn’t reject faith; he embraces it.  His faith is evident in his speculations that are unsupported by hard data—for example, that “[b]eyond the solar system there is life of some kind” (he admits that he lacks “[d]irect evidence” for this proposition but suggests that the evidence “may come soon, perhaps within a decade or two”), or that “life may have originated somewhere with molecular elements different from those in DNA and energy sources used by organisms on Earth.”  These claims aren’t provable, yet he believes them.  This is faith in the most rudimentary sense.

One would think Wilson would be more cautious after relying for so many years on “kin selection and its extensive inclusive fitness,” only to learn that “inclusive fitness was not just wrong, but fundamentally wrong.”  Wilson nevertheless evinces not even a modicum of doubt regarding the possibility of a Creator.  He seems blithely unconcerned that, having been wrong about one major premise, he might be wrong about another.  What standing should we assign to someone who faces Pascal’s wager and refuses even to hedge a bet in his own favor?  He is either heroically bold or foolishly proud.

His faith is more rudimentary than that he decries in theism, which recognizes an infinite, sovereign God, eternal and unchanging, Who permeates and controls everything and from Whom all material substance derives.  Wilson’s faith comes across as plain hope about what we’ll learn if the sciences can accomplish this or that.  His diversionary hypothetical speculations about extraterrestrial visitors and about how the humanities (to him, “the natural history of culture”) rather than the sciences would help us explain ourselves to these saucer-flying aliens might seem as radical or absurd to Christians as the doctrine of the Trinity or the nature of the Holy Spirit might seem to an atheist like him.  When Wilson states that the “interval between habitable and inhabited may seem like an eternity to the human mind, but it is scarcely a night and a day in the nearly 14-billion-year history of the Milky Way galaxy as a whole,” he doesn’t seem to realize there’s a scriptural equivalent to this dictum: that “one day is with the Lord as a thousand years, and a thousand years as one day.”

Wilson’s hope about the knowledge-creating possibilities enabled by science sometimes collapses into optimistic but unprovable conclusions about what is real or actual; the distinction between what might be known and what is known remains, too often in his book, fuzzy.  He asserts without qualification that,

[i]n time, likely no more than several decades, we will be able to explain the dark matter of the Universe, the origin of life on Earth, and the physical basis of human consciousness during changes of mood and thought.  The invisible is seen, the vanishingly small weighed.

This is pep-rally speak for scientists, and one has to admit, whether he is an atheist or a theist, that such talk is exhilarating.  Who doesn’t want more answers to these vexing elements of our phenomenal existence?  But when the stakes are so high, and the need for resolution and purpose so urgent, should we believe without hesitation a scientist who refuses to doubt his own suppositions, who goes far beyond rejecting the Genesis account of Creation to deny the possibility of any sort of creator altogether?

By the end of Wilson’s argument, readers are left wondering what, exactly, the title of his book refers to.  Wilson can teach us interesting facts—that some ant species enslave other ant species, for instance, or that the warrior ants are really a bunch of old ladies—but he can’t tell us the meaning of human existence because, in his paradigm, there can’t be any beyond the mechanical, chance desire to be altruistic in order to preserve and protect our “nests.”  Therefore, he reduces the meaning of human existence to this:

[I]t is the epic of the species, begun in biological evolution and prehistory, passed into recorded history, and urgently now, day by day, faster and faster into the indefinite future, it is also what we will choose to become.

Our meaning, then, is a sequence of biological accidents aided or offset by our own deliberate choices—and nothing else, nothing at all, according to Wilson.

The mark of a good scientist is curiosity and imagination; when those cease, so do reliable answers to tough questions.  Wilson foregoes any discussion of aseity and fails or refuses to account for how the cosmos could arise out of nothing.  Certainly, there’s the Big Bang, but what caused that?  And what caused the things that caused that?  And why couldn’t there be a God Who created us to evolve?  The fact that this is but a short book is no excuse: If you’re predicating the meaning of human existence on the nonexistence of God, you must at least address or acknowledge the weaknesses of your argument.

Wilson wants to explicate the complex niceties of biology and then, having gained our attention, demands that we take him at his word that God is irrelevant to the meaning of our astounding, sometimes joyous, sometimes agonizing, and always confusing presence on this one small planet in this apparently enormous cosmos.  Follow him at your own risk.

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