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Comment by big_chungus | Hacker News Reader

Are you sure the government is any more trustworthy? More importantly, are you sure that _everyone elected in the future_ will also be trustworthy? Remember, the "other side" can always gain power, so any system you conjure needs to work under the control of either party.

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Yep, I am confident the government is more trustworthy because you and your employer have a conflict of interest here. Their goal is to keep you working or reduce costs, your goal is to get healthy. Also, as a voter, you control the government. As an employee, you do not control your employer. Just look to literally every other country doing this.

They say you can vote with your pocket book but that doesn't apply to monoplies with hundred billion dollar war chests that can coast for a decade without making any profit what-so-ever.

Our vote applies immediately, not to mention there are term limits, so I trust the government much more also.

> Yep, I am confident the government is more trustworthy because you and your employer have a conflict of interest here.

It is such a relief to read this position on Hacker News, for once. I am continuously astonished by tech workers' refusal to recognize these conflicts between our interests as individuals, and our employers' interests in profitability. Work only gets done when these interests find an equilibrium.

I am especially concerned with how little my employer considers my long-term health. With tech job turnover rates universally understood to be a handful of years, I know my employer is unmotivated to maintain my long-term health, preferring to accrue "tech debt" in me, a jettisonable unit.

Well, it's the government that keeps health data sort of confidential now. If the government stops caring about that, I doubt private companies would step up.

If you have to trust the government on this anyway, cutting private insurers out seems to be minimizing risk, no?

> Well, it's the government that keeps health data sort of confidential now.

The government plays almost no role in keeping most health data confidential, since most PHI is held by private entities.

And it's not like the government has a great track record of what little PHI it is responsible for - there have been plenty of breaches against CMS and Medicare affecting large numbers of patients.

Without the US government playing it's current role, I am 100% confident that the US health data that is currently confidential would stop being confidential. Just as we see with companies adding spyware to software, selling out user's data is profitable.

Why would for-profit companies keep the data confidential when they can make more money selling it?

> Without the US government playing it's current role, I am 100% confident that the US health data that is currently confidential would stop being confidential.

The fact that the government has passed a law that requires private entities to keep PHI confidential says nothing about their competence in managing PHI of their own. The original claim is about the latter.

If my employer has the data - the government can subpoena it if it really wants to. It's effectively accessible to both entities. If only the government has it, at least my employer doesn't have it.

Edit: More damningly, if my employer has it multiple governments potentially have access to it. Companies generally aren't willing to stand up to requests from, for example, China.

> If my employer has the data - the government can subpoena it if it really wants to. It's effectively accessible to both entities.

"The government" isn't a single entity, and most of "the government" can't access your data via a subpoena any more easily than a private company can.

It’s a lesser of two evils thing. Personally I find it creepier for a private employer to have that data than a (non-authoritarian) gov’t.

The govmt hopefully has learned from the OPM breach [1]. Also, the USDS has a good track record and has already worked on multiple healthcare related projects [2]. They recently also revamped the VA claims system [3].

[1] https://en.wikipedia.org/wiki/Office_of_Personnel_Management... [2] https://www.usds.gov/projects [3] https://twitter.com/USDS/status/1192520880733208576

The VA seems to work approximately as well (or as badly) regardless of who's in charge.

Oddly enough, the VA works far better today than it did 3 years ago. YMMV.

Based on what?

It used to be 18+ months to get a VA claim of any kind completed. The norm now is less than 90 days. I've seen some faster than that. They are a whole different organization now than they were.

In your opinion, what changes made that happen? When did the changes start, and how did they affect care, scheduling, etc.?

the VA Mission Act Trump signed into law

Basically it gives them access to more private healthcare options. If they don't get timely access, they are covered under any network.

> "We are offering them choice in the medical marketplace, and we now have, thanks to the president and thanks to choice, the highest veterans satisfaction rate in our history. We're sitting at about 89.7 percent"

- Robert Wilkie, U.S. Veterans Affairs Secretary

Precisely these two items.

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