How can a hospital-like business operating outside of existing territorial jurisdictions avoid harrassment by governments whose medical lobbies want to spread FUD?
Given that these businesses will initially have no track record to point to and less protection than existing medical tourism providers from whatever government provides a flag of convenience to the business, merely providing comparable quality medical care won’t be enough for such businesses to thrive. So I’m proposing practices which could enable those businesses to argue that current U.S. hospitals are more dangerous. I’m not suggesting this just for marketing purposes – I want safe hospitals to be available, and regulatory costs in the U.S. make it easier to start an innovative hospital offshore than in the U.S. (especially for types of innovation that don’t respect doctors’ prestige).
It has been known since 1847 that doctors kill patients by failing to wash their hands often enough. Yet this threat is still common. An offshore hospital could offer patients documentation showing when medical personel who touch the patient washed their hands (e.g. by providing the patient with video recordings of the procedures sufficient for the patient to verify cleanliness), with a double your money back guarantee. There are many other less common errors that patients could use such videos to check for.
The book Counting Sheep argues that hospitals often impair patients’ health by disturbing their sleep. Paying patients if night-time noise or light levels exceed some pre-specified limits should reduce this problem.
Next, I want the hospital’s fee structure to give it increased incentives to avoid failure. For procedures with objectively measurable results, I want the hospital to charge the patient only if those results are achieved, and to pay the patient some pre-specified amount if results leave the patient measurably worse off. (For hard to measure results such as change in pain, this approach won’t work).
The article You Get What You Pay For: Result-Based Compensation for Health Care has more extensive discussion of incentives and of strategies that hospitals might use to reduce the rate at which they harm patients.
I once proposed using life expectancy as the primary indicator of what society should try to maximize.
Recently there have been reports that life expectancy is negatively correlated with standard measures of economic growth. I accept the conclusion that depressions and recessions are less harmful than is commonly believed, but I want to point out the dangers of looking at only the life expectancy in the same year as an event that influences life expectancy. Depressions may have harmful effects that take a decade to show up in life expectancy figures (e.g. long-term wealth effects, effects on willingness to wage war, etc). So I’d like to see how life expectancy averaged over the ensuing 10 or 15 years correlates with a year’s gdp change.
I attended about 2/3 of the recent Seasteading conference. There were plenty of interesting people there. But I became less optimistic that seasteading will be implemented within the next decade.
The most discouraging news was that floating breakwaters probably won’t work with using propulsion to control location. They might work if anchored (which needs shallow water that only provides a little usable area outside territorial waters), and should still work with seasteads that drift were the currents take them (only suitable for people comfortable with being isolated).
The medical tourism ship business idea had last year seemed the most promising stepping stone on the way to seasteading. This year’s talk by Na’ama Moran on that subject provided better talking points that might be used to interest investors, but had nothing resembling a business plan. A year ago there was some hope that moderate changes to SurgiCruise‘s business plan could turn it into something viable. The seasteaders who were involved in that gave up on working with SurgiCruise recently, and no progress appears to have been made yet on creating an alternative.
I was also disappointed that she described no plans for dealing with the U.S. medical establishment’s ability to smear competitors. A company with no track record and weak regulation by, say, Panama can be made to sound dangerous to patients even if it provides care as good as U.S. hospitals. Could a medical cruise company hope to get accreditation early enough? There are large uncertainties about how much that costs and how soon it would be needed. I want a medical tourism company to prepare to demonstrate ways in which it provides higher quality care than U.S. hospitals (more on this in a later post).
Kevin Overman presented a vaguely promising idea for using RepRap and products from algae to build (print) structures at a cost that he hopes will be an order of magnitude less than with the materials currently envisioned to build a seastead. If he’s right, he should be able to make a nice profit building things on land before anyone is ready to build a seastead. The one drawback that I noticed is that it requires thicker structures (2X?) to get the same strength.
I also stopped by Ephemerisle for Saturday afternoon. It shows some promise as a competitor to Burning Man, but it’s unclear whether anything people learned there is related to skills needed to hold a festival in international waters. Possibly the design of the main platform can be adapted to the ocean without radical changes, but virtually all the other activity was done without any apparent regard for whether it could be repeated in the ocean.