e-ID

Some modern organizations and institutions including governments now incorporate electronic identities into their normal functions, permitting new forms of digital engagement and interaction.

The technology and concepts are not new but the increasing use of this technology in society is impactful and has much potential. Long-understood cryptographic applications for electronic identity are finally becoming deployed by important institutions and used for social and legal purposes. While not the most effortless and user friendly systems yet, apparent progress is being made and new programs are being invented around them.

What Is Signing?

The main component to this system is your identity which can be linked to the real world or can be purely digital. Your identity is connected to your electronic key which you alone possess. Your key can exist unconnected to anything else as a purely anonymous identity, or it can be “signed” and verified by other identity keys which are in some way recognized as authoritative.

The holder of the “secret” half of their digital identity can electronically sign anything that can be digitally encoded in a computer. The meaning of the signature varies depending on the item they are signing but can have the same legal force as a handwritten signature in some jurisdictions. In addition to signing documents one can use their key to authenticate to online services and encrypt documents only readable by specific people.

Any computer system can verify that the user’s signature corresponds to their public identity, which has been signed by their trusted institution key in turn. The “public” half of the trusted “root” certificate is distributed ahead of time and widely available for any humans or software to verify the validity of a user and confirm their identity as defined by the institution.

Examples Of Uses

A citizen of a government implementing e-ID can use their secret key to sign an electronic document confirming they want to vote for a particular candidate for office over the internet. Or they can sign into their bank account, government websites, private forums, or any other service as their government-verified identity. Participants in an organization can collaborate online using identities that the organization previously has verified to their satisfaction. Such services can be assured of the real-world identity of the user communicating with them over the internet.

None of this necessarily has to take place over the internet; the mechanisms of signing and verification can work offline. The real potential of these systems comes with the ability to participate electronically yet with a verified identity.

The deployment of SSL made it possible for people to trust entering their credit cards on websites, resulting in a massive transformation of the economy. So too is the potential of cryptographically secure identities issued by trusted parties.

Institutions, governments, political parties, cooperatives, and any other type of organization can allow its members to participate remotely with the same assurance of their identity as in person. Voting, citizen input, taxes, banking, document signing, secured websites, smart cities and more applications not yet thought up can all be implemented with e-identity. The possibilities for digital self-organization enabled with this technology are extraordinary.

Traditional ballot-based voting can only be done very infrequently by governments and organizations because of the enormous expense and overhead involved. With e-IDs, polls could be taken as often as desired to maximize representation and participation from the local community level to national or even international levels.

New types of online communities could exist where people would choose between totally anonymous identities or decide to be linked to their real-world identity. A continuum of anonymity would be possible as people could choose how much to use or conceal their verified identity, with other participants taking this into account to weigh the credibility of the speaker. Imagine how polite a web forum comprised of only Canadian citizens speaking with their real identity would be.

The prerequisites to adoption of electronic identity of are the existence of willing governments and institutions and a widespread layperson understanding of how such a system works and can be used.

e-ID In Practice: Estonia

The Estonian government is not only a pioneer in the area of digital identity but also in extending verified identities to non-Estonian residents. The Estonian parliament created law in the year 2000 to give digital signatures the same legal status and handwritten ones and to implement a nationwide public key infrastructure and digital signature program. Their e-ID system is now available to non-Estonians via their e-Residency program.

Anyone at all can apply to get an identity key verified by the Estonian Police and Border Guard for €100. The main idea of the e-Residency program is to make it really easy for foreigners to open businesses and bank accounts in the country, while also building institutional knowledge and proficiency in using electronic identities. It also doesn’t hurt the much-touted tech innovator image of the tiny Baltic country, noted so for developing Skype and more recently Taxify and Transferwise.

In practice this means anyone can obtain a key signed by the Estonian certification centre. After applying and having been approved, you must visit an Estonian embassy in any country and verify your passport and give your fingerprints to get your key. The key comes on a chipped card (it comes with a miniature USB smartcard reader) protected by a PIN code which you can set. There is a sheet of paper with your PINs and another card with a backup reset PIN in case you forget. This is the ideal form of authentication; a combination of something you have (the chip card) and something you know (your PIN). On the card, protected by your PIN, is the secret half of your key. The government-signed public half of your key can be used to register yourself with electronic services and declare your official identity, and the secret half is used to prove that you are who you say you are.

The Friendly Welcome Kit
Using The Mini Card Reader

There is software for using your ID card with websites as well as signing and encrypting documents. There are browser extensions and standalone desktop software for macOS and Windows (and tools for Linux). The software is notable in that it is complete with extensive documentation online, is developer-friendly, has tools and services for testing, and is completely open source.

You can digitally sign legal documents as well as encrypt or decrypt files. If you have the personal, company, or registry number of a person or organization you can encrypt files that only they can decrypt without any pre-arranged encryption key. You can also use your card for authentication to websites and services that support it. Fraud is also made much harder compared to more traditional identity verification systems such as those in the US based on social security numbers and credit reports.

How Much Can e-IDs Be Trusted?

It’s up to every person and organization to decide how much trust to put in to the identity features of any given e-ID system. If you decide that you can trust the software you’re using and the root certification authority then you can decide to accept the asserted identity of people electronically.

Put another way, if you trust the verification process of the Estonian Police and Border Guard and you don’t find any issues in the software you’re using to verify identities, then you can be fairly confident that someone presenting an e-ID is exactly who they claim to be. Governments are in a fairly unique position to validate someone’s passport and fingerprints in a controlled environment (like an embassy) and can strongly attest to someone’s real world identity, to the extent that trust that government.

The danger of someone else using your identity card is roughly the same as someone stealing your bank card and withdrawing money from an ATM with it. Someone needs physical access to your card as well as a valid PIN code which can only be tried a few times. There is the possibility that an adversary could steal your backup piece of paper with the PIN reset code on it to defeat the PIN and then sign documents as you or log in to your bank account. However because of the physical access required, this is a vastly safer system than the standard email/password combination used for authentication these days.

The cryptography underlying the system is quite well-understood and has been employed for a long time in other domains. There is an extremely high degree of assurance that one can determine if another party owns the secret part of their identity, that only the recipient of a message encrypted for the recipient can decrypt it, and that the owner of the secret part of their key has signed something with their identity.

This security system like any other is not foolproof; you could get mugged for your ID card and PIN codes leaving the embassy, spyware on your computer or poorly-designed software can compromise the integrity of your ID. People will forget their PIN codes or write them on sticky notes stuck to their cards. People will lose their cards or sign something drunkenly late at night or under duress. Implementation problems can plague the system, as when a supplier of microchips left a theoretically exploitable fatal flaw in a vast quantity of identity documents:

An estimated minimum of 1 billion affected chips are used around the world in a variety of computing devices and on plastic cards.
The Infineon chips that led to the vulnerability in the
Estonian ID cards are used in driving licences, passports, access cards and elsewhere. The identity documents of at least 10 countries were
affected.

ROCA Vulnerability and eID: Lessons Learned

Such problems are not altogether unsurprising for rollouts of complex new technology and we can hope that these early issues can be learned from. Many precautions are in place for other anticipated difficulties such as a key revocation process, expiration dates on keys, the backup PIN reset codes, and an open source architecture with reference implementation software that can be reviewed by researchers and the public.

Future Possibilities

e-ID and the underlying technology is something that can be harnessed to enhance the identification measures needed for trustworthy communication and interaction online. It can vastly expand the scope for self-organization and self-government amongst people by enabling digital participation with trusted identities. Completely anonymous yet verifiable interactions are also possible as one can ensure the other person they are communicating with is exactly the same person they have interacted with previously even without knowing any other details about their identity.

Better collaboration is possible for collectives and cooperatives, online communities, local and national governments, businesses, trade groups, and any other sort of organization which can benefit from the fluidity and ease of online interaction with strong form of identity authentication. Types of institutions which had previously been limited by geography can become more virtualized.

Stronger authentication and identity systems, new possibilities for self-organization, and increased easy of civic participation are made possible by architecturally sound, open source, and trustworthy e-ID systems.


Technical notes on interacting with the Estonian e-ID hardware and verifying signatures and identities can be found here.

Ulex: an Open Source Legal Framework

Originally posted on the Institute for Innovative Governance’s blog

What Can Lawyers Learn from Programmers?

What kinds of professionals spend their days reading, writing, and editing rules?  Two kinds: lawyers and computer programmers. Despite this fundamental similarity, however, they seem to live in different worlds.  That’s probably because lawyers mistakenly think that programmers don’t have much to teach them (and, as a consequence, because programmers try to stay very, very far away from lawyers).  In fact, though, lawyers could learn a lot from coders.

Computer code and legal code are similar in more than a few respects. Both declare operations to be performed under specific sets of conditions, attempt to create definitions that correspond to human activity, incorporate and revise previously-written code, and (hopefully) account for exceptional circumstances. While there are a great many differences as well, there may yet be an opportunity for cross-pollinating knowledge and experience from one field to the other.

Legal systems resemble pre-1970’s software in terms of portability and reusability. Much like how programs and operating systems were bespoke designed unique for each architecture, governance and codes of laws are currently crafted for each environment or government and unable to build upon each other, despite performing very similar functions.

Modern software developers are aware of the recent explosion of new ideas, experimentation, forms of organization and impressive decentralized projects that came with the introduction of suitable layers of abstraction and portability in the form of C and UNIX and later combined with the open source movement and the internet. By freeing programmers from having to rewrite operating systems that did more or less the same thing but with different interfaces, they could focus on actually writing programs, and even port those programs to different computer architectures without having to rewrite the entire application. Instead of writing code in an assembly language that was incompatible with all other platforms, the introduction of a higher-level language allowed programs to be transferred from one environment to another.

While some members of the software profession may take this wonderful state of affairs for granted in the digital realm, in the offline world they live under systems of laws and governance that are still waiting for a common framework, a standardized legal operating system, a basic foundation that hobbyists and experts from different countries and disciplines can openly collaborate on. Many of us may have vague desires and ideas of how to share the lessons learned from portable computer systems with the legal profession, though such ideas are likely worth their weight in gold Dunning-Krugerrands. Now however, a few in the legal profession have attempted to apply these concepts to law.

But first, an explanation of the problem: many people are unsatisfied with aspects of the governments and legal systems they live under, and most people have little agency to come up with their own improvements. There is a high exit cost to changing countries, citizenship, and governments. Improvements and refinements from one jurisdiction cannot always be easily taken and applied to another because of incompatible legal systems, different definitions, unintelligible languages, and jurisprudence. The overhead of experimentation can be great; each new government writes its constitution from scratch, comes up with court systems, has its own legislatures and judges, and so on. This limits the scope for the sort of healthy robust competition and innovation that has been seen in the world of software since the introduction of portable programs and operating systems, open-source development, reusable libraries, and collaboration on a global scale.

Perhaps you would like to create a new set of codes for yourself and like-minded individuals to live by. Maybe you believe laws or punishments are unfair or unjust, or you certain immoral or unsavory behavior should be curtailed. Taxes should go to fund socially useful schemes or taxes are too damn high. Freedom of movement is a basic human right or we need to keep the bad guys out. Whatever your vision, there are practical and theoretical ways of implementing it today, be it via homeowner associations, Special Economic Zones, setting up your own seasteading colony in international waters, founding a religion, or incorporating a new town. There exists a vast number of overlapping codes and laws that govern all people already, but they often lack a shared foundation of well-understood, time-tested common principles. Enter Ulex.

What is Ulex?

In a nutshell, Ulex provides a set of sane legal defaults including a simple system for resolving disputes closely modeled on the system commonly used to arbitrate international trading disputes. There are recommended basic modules for civil procedure, torts, contracts, and property that incorporate best practices as codified by organizations including the American Law Institute/International Institute for the Unification of Law’s (ALI/UNIDROIT’s) Principles of Transnational Civil Procedure, and selected volumes from The ALI’s Restatements of the Law.

Ulex 1.1 can be viewed as a template for creating a legal distribution. It references the contents of the legal packages from quality upstream maintainers, along with some system utilities in the form of meta-rules, optional modules for criminal law, procedural rules and substantive rules. This distribution should not be considered final, complete, or the best legal system for any new self-governing group of people, but rather a starting point for experimentation. Since not everyone who wishes to create a new society is well versed in legal history and modern best practices, having a jumping-off point with quality material curated by a law professor should be useful. Not everyone wanting to build applications may know how to design a working operating system, and they shouldn’t have to.

Creating legal systems by means of references other documents is a common and systematic practice, much in the way that software is rarely written from scratch but instead makes use of libraries of already packaged code. So too can legal distributions be created with a few well-thought references to systems that already work well and some legal wording glue to create a coherent system. Implementation is accomplished via contract law in the context of the host state, a necessary bootstrapping mechanism for now. Ulex version 1.1 includes an optional host sovereign integration module (section 5) if better compatibility is desired.

All that is needed for implementation is for parties to formally agree:

Only Ulex 1.1 shall govern any claim or question arising under or related to this agreement, including the proper forum for resolving disputes, all rules applied therein, and the form and effect of any judgment.

Ulex is not the final answer in self-organizing legal systems but a potential first organizing principle and base layer of abstraction upon which more varied and ambitious legal projects can be based. If a common template and minimum functioning system can be designed, the process and results can be embraced and extended around the world as people increasingly experiment with new forms and options for self-governance. With competing designs and implementations may come, eventually, more inspired and community-driven legal systems all developed in the finest tradition of open source development.

For future reading, the description of Ulex 1.1 is recommended.


IoT Security Through Open Certification

(Cross-posted from SF ISOC blog)

IoT Security Through Open Certification

The more jaded nerds who’ve been around the block a few times here in San Francisco have an understandably dismissive attitude towards the use and abuse of technological buzzwords, of which “IoT” is a contemporary offender. In one sense they’re correct in that what we’re talking about are embedded systems connected to the internet, Big Deal. But remind them that it’s a bunch of embedded systems connected to the internet in the context of security, and the salient point is sharply made. They quickly turn from dismissive to despondent, knowing where this is all likely headed.

Obligatory Scary References and Predictions

Where is it headed? You don’t have to turn to prognostication to get a glimpse of the consequences of the Earth being flooded with sloppily-developed firmware. In case you missed it, in September and October of 2016 the Mirai botnet, thousands of embedded devices comprising 36 depressingly-poorly-secured IoT products shipping with default usernames and passwords were press-ganged into “multiple major DDoS attacks in DNS services of [the] DNS service provider Dyn […] using Mirai malware installed on a large number of IoT devices, resulting in the inaccessibility of several high profile websites such as GitHub, Twitter, Reddit, Netflix, Airbnb and many others” (https://en.wikipedia.org/wiki/Mirai_(malware)). At volumes of 620-1024 Gbps, these attacks were extremely consequential and disruptive, essentially breaking the internet for many users for the better part of a day.

This attack represented the most low-hanging fruit possible; default usernames and passwords, internet-addressable devices. The sophistication required was likely minimal.

Even more recently someone set up ZMap to find raspberry pis with SSH on and the default username and password, and created a worm capable of infecting millions of hosts that probably took the author an afternoon to make.

As the number of these sorts of devices proliferate and attacks increase in sophistication, we can expect a corresponding increase in bad days for network admins, not to mention the hapless end user. The FBI in 2015 felt the need to issue a PSA to this effect: “The FBI is warning companies and the general public to be aware of IoT vulnerabilities cybercriminals could exploit.”

The danger is well-known and publicized and not worth belaboring for too long. The real question is of course: what can we do about it?

Incentives and Obstacles

The reason that many IoT products have poor security is not due to a failure of morals, bad upbringing, or stupidity, but a reasonable economic calculation on the part of the manufacturer. They are concerned primarily with the time to market. Taking extra time to design and build properly and test their code only adds delay, for which they see no fungible benefit. These products are made by thousands of large and small manufacturers and pieced together from various developers and engineers around the world, a top-down regulatory approach is impractical. There are simply too many moving parts, countries, agencies, software libraries and stacks, for effective regulations to keep pace with this fast-moving target. So what’s to be done?

In the opinion of people smarter than me, what’s needed is an open certification for things connected to the internet asserting a minimum level of security. It doesn’t need to be ultra-rigorous to be of benefit, at least at the basic level. A simple “this device is not almost certainly going to get taken over and wreak havoc” stamp would be a great first step, one that many manufacturers are not passing muster on presently.

Why a certification?

A certification process can be designed collaboratively and openly, can be implemented by anyone, doesn’t require action from policymakers, can have different levels of rigor, and most importantly provides a market-based incentive to manufacturers to not make obvious, common blunders. The result can only be greater security and stability for pretty much the entire internet-connected planet. As a user of the internet I have a personal interest in not having everything susceptible to hacks and being used to take down internet infrastructure.

It’s the opinion of respected security professionals that this is a positive and necessary measure.

There would be incentive to manufacturers to conform to the certification; consumers and institutions should prefer to purchase conforming devices vs. similar devices that haven’t been vetted. Consider a government or corporation procurement policy that mandates that conforming devices be preferred or required.

This is not a novel idea, there are in fact a small number of company-sponsored certifications already but as far as I can tell they are proprietary and run by a single company. The most promising proposal comes from the Online Trust Alliance initiative from the Internet Society. They define a set of best practices for securing IoT devices and also take into consideration notifications and privacy. Their IoT Trust Framework provides a solid assurance that a device is trustworthy to deploy, at least more than any random off-the-shelf thing.

Other Options

Certification is not the only option for securing Things and embedded devices. Governmental policy is another possibility, though necessarily limited in its jurisdiction, scope, and ability to keep up with new developments in a rapidly-changing highly technical field. Also I don’t get to make policy, but I can help make a certification. As an example of useful legislation Dan Greer suggests making liability contingent on the openness of the firmware; if you use closed-source, proprietary systems then you are more legally liable for damage caused than if you used open-source software. This is both practical and reasonable, as open-source code can be audited and improved by the community, particularly if you go out of business but your devices remain. He has many more such intelligent suggestions that he lays out in his 2014 BlackHat keynote which I highly recommend watching. I also thought highly of his suggestion that devices should either be remotely-updateable (with signed updates of course) to patch flaws in the field, or they should “expire” and stop being connected to the internet after some period of time, say five years. Having insecure devices on the internet is one thing, having un-patchable systems that stay around forever is quite another. This could easily be a component of certification.

Another more extreme approach that as far as I’m aware was not predicted, is that some people such as the hacker “The Janit0r” have taken it upon themselves to release worms using similar vectors as the Mirai botnet to take over insecure IoT devices and then either brick them or firewall them so that they can’t be used maliciously. The Janit0r claims he has bricked over two million insecure devices so far, so that they can’t be press-ganged into evil servitude. The similar Hajime worm has no DDoS capability and instead blocks ports to lock down the device:

From https://www.symantec.com/connect/blogs/hajime-worm-battles-mirai-control-internet-things:

“There are some features that are noticeably missing from Hajime. It currently doesn’t have any distributed denial of service (DDoS) capabilities or any attacking code except for the propagation module. Instead, it fetches a statement from its controller and displays it on the terminal approximately every 10 minutes. The current message is:

Just a white hat, securing some systems.

Important messages will be signed like this!

Hajime Author.

Contact CLOSED

Stay sharp!

[…]

To the author’s credit, once the worm is installed it does improve the security of the device. It blocks access to ports 23, 7547, 5555, and 5358, which are all ports hosting services known to be exploitable on many IoT devices. Mirai is known to target some of these ports.”

Community and Governance

Another reason for optimism is the response from assorted institutions, individuals and corporations. AWS should be praised for absolutely requiring proper (mutual TLS) authentication for anyone using their IoT platform. On June 8th, 2017 the US NTIA put out a RFC specifically about hardening IoT devices and preventing botnets. The San Francisco Bay Area Internet Society has a new IoT Working Group to promote security and best practices for development, which I’m happy to be leading. If this is a topic of interest to you, there are plenty of communities of people willing to work together to make the coming flood of Things a positive transition instead of an internet minefield.

 

 

Drug War, Still Going For Some Reason

Attorney General Jeff Sessions believes we aren’t tough enough on drugs, and we need to lock people up longer to reduce crimes related to drugs. It’s an interesting theory, one that we’ve implemented at a policy level for quite a few decades. It seems that rarely do politicians or journalists ask the simple question: has it worked so far?

We’ve been issuing longer and longer jail and prison sentences for drug-related crimes, especially notably for the Schedule I “Devil’s Lettuce” scourge of violent hemp addicts inflicting untold misery on the population.

12898354_1077123692308467_5359530434043148041_o

One could point out some flaws in the logic behind the theory that locking people up is good for society, reduces violence and drug usage, and is a deterrent to would-be tokers and dealers. Putting people behind bars with often violent criminals for years probably doesn’t make them better people. Keeping them away from their children probably doesn’t improve society. Incarcerating them probably isn’t great from a fiscal standpoint. Proscribing personal usage of certain drugs on a demonstrably arbitrary and non-medical, non-biological, non-psychological basis really seems to violate the reasonable concept of not prosecuting victimless crimes. The fact that addiction has been shown to be a disease, greatly predicted by genes in fact, and not a moral failing. The logic behind the idea that drugs can ruin lives, therefore we should lock them up with criminals in a cage for years away from their families, give them felony charges, and make it incredibly difficult to find gainful employment afterwards doesn’t seem to be a great life-enhancer either. The fact that ethanol alcohol, an incredibly toxic, dangerous, addictive, inhibition-destroying, violence-inducting drug and poison to all living tissue is readily available on most blocks in the country for unlimited purchase while marjiuana is classified as Schedule I, unavailable for research purposes without an extremely cumbersome DEA license, legislated as having no conceivable medical usage, and worthy of felony charges. By the federal government of course, not in the many states which currently permit medical and recreational usage.

One could go on at length about the contradictions in logic of this drug enforcement policy theory. It doesn’t seem to convince some people. After all it’s a complex topic, there are many very different kinds of drugs, behaviours, societal normals, scare campaigns and wildly-differing personal experiences. I don’t expect this matter to be settled by pure reasoning alone. Nor is it necessary to discuss this in the abstract.

What are the goals of the drug war? Ostensibly it’s to reduce overdoses, addiction, usage, drive up drug prices, reduce availability and deter usage and related criminal activity. Reasonable goals, I think most would agree.

Or as one of the top aids to Nixon, who launched the drug prohibition campaign, describes the policy:

“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people,” former Nixon domestic policy chief John Ehrlichman told Harper’s writer Dan Baum …

“You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities,” Ehrlichman said. “We could arrest their leaders. raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

Did you fall for this campaign perhaps? Well you’re an idiot. But ignoring your simple gullibility, let’s forget about this interview and focus on the laudable goals mentioned previously. Reducing demand, access, affordability and overdoses.

cdcwonder2016_1

Opioids—prescription and illicit—are the main driver of drug overdose deaths. Opioids were involved in 33,091 deaths in 2015, and opioid overdoses have quadrupled since 1999.

 – US Center For Disease Control (CDC)

Okay, more people are dying from drugs, particularly opiates. So maybe we aren’t reducing overdoses. How about prices and purity?

Prices for hard drugs have fallen greatly since 1981, purity has risen. Source: Executive Office of the President, Office of National Drug Control Policy.

past-month-use-of-selected-drugs

Source: Substance Abuse and Mental Health Services Administration (SAMHSA), National Survey on Drug Use and Health

If you do any research you can easily see that overall demand for drugs has remained constant. People who want to do drugs will do them. All of the trillions of dollars spent on incarceration, interdiction, prosecution over fifty years have had little discernible impact on demand. Meanwhile fatal overdoses have greatly increased, hard narcotics prices have dropped dramatically. All kinds of drugs are trivially easy to obtain (according to my cool friends). Mexico is a failed state, run by narco-terrorists, and many cities are beset by gang violence for the simple reason that drugs are in great demand and quite illegal. Millions of lives have been ruined by the government in pursuit of getting people to not ruin their lives with drugs. So at what point does one look at the current policy and decide maybe it isn’t working out like the theory predicts? What’s the threshold for admitting maybe the last five decades of locking people up isn’t having the desired result?

Wikipedia: In October 2013, the incarceration rate of the United States of America was the highest in the world, at 716 per 100,000 of the national population. While the United States represents about 4.4 percent of the world’s population, it houses around 22 percent of the world’s prisoners.[1] Corrections (which includes prisons, jails, probation, and parole) cost around $74 billion in 2007 according to the U.S. Bureau of Justice Statistics.[2][3]

US incarceration timeline-clean

On what basis are we evaluating the effectiveness of this policy, if not based on medicine, price and availability, overdoses, demand, enriching of narco-terrorists and violent gangs, lives ruined, money wasted, or principles of justice?

What’s Wrong With the Affordable Care Act

The Affordable Care Act, also known by many as Obamacare really set this country’s healthcare system back in a major way. Let me try to explain why I have such an issue with it.

The biggest problem is that it is not a single-payer (“government-funded”) healthcare system like in every other first world country, not to mention very many third world countries too. This is the only correct system. If you believe our system of health insurance is more or less functioning properly and nicely and efficiently and providing the best bang for our personal and government-contributed bucks, you are utterly misinformed.

Working in healthcare IT for many years has given me a small glimpse into the madhouse of medical billing in America. The system is fucked. Ask anyone in healthcare and they’ll tell you the same thing. It’s all dumb. The thousands upon thousands of different insurance plans, the multitude of types (government, HMO, PPO, Discount Card, Indemnity, POS, EPO, Medicare, Medicare Advantage, Medi-Cal, Medicaid, Premier, Worker’s Compensation…) have different rules about reimbursement and fracture the American people’s ability to negotiate good deals on drugs and services. There is wild variation in prices due to an utter lack of transparency. The scheme of employers providing healthcare for their workers makes no logical sense, hurts competitiveness and massively screws over anyone who loses their job, unless they want to pay COBRA to keep their coverage (now around $1000/mo for some). Medical bills are submitted to third parties on all sorts of different paper forms, often faxed around. Oh yes, faxes are considered state of the art when it comes to medical billing and health insurance companies. In short, the current system would only be considered acceptable by anyone who has no idea how much better pretty much everyone in the developed world has it than us. This is reflected by popular opinion, as of 2016, showing a majority of Americans just want a normal federal-funded single-payer healthcare system. It’s the obvious solution, everybody knows it. So why don’t we have it?

Well, we have this health insurance scheme instead. Instead of the government providing basic healthcare to everyone it only provides healthcare to some people through a bewildering array of disparate systems. Poor people, people with kids, poor people in California, seniors, veterans, congresscritters, that sort of thing. If you don’t fit into one of those you can buy healthcare insurance instead of maybe get it provided by your employer if you’re lucky. A plan can cost several hundred dollars a month and may or may not include vision and dental insurance too. There is a provision of the ACA that says everyone must have health insurance or face a steep tax penalty (2.5% of your total household adjusted gross income). As a result, everyone must have health insurance.

Now I, just a lowly taxpayer, wonder if everyone has insurance, what exactly are the insurance companies doing? What benefit do we as a society gain from a universal system of insurance? Well, supposedly the health insurance companies price risk appropriately and disburse funds for claims.

Probably the main indicator of your likelihood of filing a lot of expensive claims are your pre-existing conditions. Like if you have cancer or some rare disease, you’re going to cost a lot of money. Before the ACA this would make it very hard to get normal health insurance because you would be a terrible policyholder from the insurance company’s point of view. One of the truly fantastic things, and at the same time one of the most subtly problematic things in the ACA is that it disallows pre-existing conditions from driving up your premiums or being denied coverage. This is actually really great news for seriously ill people, and it deserves being said that it has given (relatively) reasonably-priced healthcare to millions of people who need it the most. The end result appears to be a major net positive for society, and it really is. Taken in a vacuum this is a noble and wonderful thing. But it also undermines the entire argument for the extant system.

Now if everyone has insurance, and the insurance companies are not allowed to properly price risk, what function do they provide? If they cannot perform any real actuarial purpose then they are essentially clogging the arteries of our healthcare system, siphoning off vast quantities of money, wasting everyone’s time and collecting a massive payoff while decimating the quality of our healthcare.

Healthcare providers just want to care for people and, well, provide health care. That’s why they got into it and that’s what makes them put up with the years of school and massive debt and internships and all the rest. Once they actually try to practice medicine though they are faced with the intractable and thankless task of trying to deal with health insurance companies. Filing claims, getting denied, re-filing claims, telling patients you can’t see them because their employer went with the wrong insurance company or plan type, telling seniors they can’t get the medicine they need, buying ink for your fax machine, dealing with your medical billing intermediary company, upgrading to ICD-10, and on and on. This takes time and costs a great deal of money. It is not good for anyone except for the health insurance companies because it gives them a reason to exist.

The potential saving in efficiency, the massive gain in time of providers and nurses and office managers, the insanely powerful bargaining power, the standardization of billing forms and reimbursements would be some of the incredible benefits of having a coherent national health system. My problem with the ACA is that it cements this horrible mess of insurance providers. Its smaller improvement in expanding coverage means that we can pretend our system works for longer now instead of getting the sane and efficient system that we desperately need. That is why I have a problem with it. It powers the vacuum machine stuck in our pockets by health insurance companies. It entrenches the current corrupt system. It makes it that much harder for us to right it. The current shit abyss of healthcare probably resembles that of our legal system. It’s something most of us healthy people don’t have to get too acquainted with, so we don’t demand much change because it doesn’t affect us yet. But when you fall into this pit you’re going to wonder why our country is so fucked up. Even having health insurance won’t protect you from bankruptcy, of which health care is now the number one cause in America.

If a majority of Americans want a single-payer system, and we’re the only country that hasn’t gotten it yet, why do we still have this joke system of rent-seeking insurance companies taking their fat slice of the $2.9 trillion dollars a year we spend on health care (projected to shoot to $5.2 trillion in 2023)? Well, for one thing the opinions of the bottom 50-70% or so of Americans have no discernible impact on policy that gets made at the federal level. As in, the majority of Americans are literally disenfranchised because politicians do simply do not care what they think.

In 2007 health insurance companies were major donors to Obama’s and Hillary Clinton’s campaigns to become president. In the 2012 campaigns the insurance industry (with Blue Cross as the largest individual) contributed “a record $58.7 million to federal parties and candidates as well as outside spending groups” according to OpenSecrets. Draw your own conclusions.

MarketWatch has a bunch more fun facts about specific major problems with our health insurance system.