Esther Dyson

Should the government be involved in healthcare?

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How do we design a system that incentivizes good behavior?

Esther Dyson

Esther Dyson does business as EDventure Holdings, the reclaimed name of the company she owned for 20-odd years before selling it to CNET Networks in 2004. In the last few years, she has turned her sights towards IT and health care. She dedicated two issues of her newsletter, Release 1.0, to the topic (Health and Identity: No Patient Left Behind? in January 2005 and Personal Health Information: Data Comes Alive! in September 2005).  Also in September 2005, she ran the Personal Health Information workshop that laid out many of the challenges still perplexing the health-care community.

Currently, she is on the board of directors of 23andMe and is one of the initial ten subjects of George Church's Personal Genome Project. Her primary activity is investing in start-ups and guiding many of them as a board member. Her board seats include Boxbe, CVO Group (Hungary),, Evernote, IBS Group (Russia, advisory board), Meetup, Midentity (UK), NewspaperDirect, and WPP Group and Yandex (Russia).

Some of her past direct IT investments include Flickr,, BrightMail, Medstory and Orbitz. Dyson was the founding chairman of ICANN from 1998 to 2000, and was also chairman of the Electronic Frontier Foundation in the 90's. In 1997, she wrote Release 2.0: A Design for Living in the Digital Age, which appeared in paperback a year later as Release 2.1. In 1994, she wrote a seminal essay on intellectual property for Wired magazine.


Question: Should the government be involved in healthcare?

Esther Dyson: Personally it’s a very very complicated answer, I think they should definitely be there, as a last result and probably for Catastrophic Health Insurance but I think there is the question where should the government pay for healthcare and if you say yes to that and think you solve the problem you haven’t because the question will come for how much healthcare should they pay for should they pay for the 80 year old lady who is expected to stay alive in other six months should they pay for the liver transplant of the 40 year alcoholic should they pay for the operation on the guy who refused to wear a helmet in the motor cycle our resources are final and we need to do a much better job is figuring out where we spend them and where we done and right now, we make a lot of these decisions of people if you are black and poor chances are you are not going to get healthcare at if you are rich and white and even if you didn’t pay your insurance chances are you know somebody, who know somebody amount sign I sure you are going to get better cancer operation you live in Iowa and there is the certain operation that might cure you but they offered only in Seattle, you are probably not going to get that operation and we never going to have world of equality of outcome but we should at least have a world of the quality of opportunity and but we shouldn’t kid ourselves that every life is infinitely more valuable and anything else we make trait offs all the time and we don’t feed children right in school, and we destroy lives much earlier are they when they show of them a hospital and so at the problems is we don’t like confirm these decisions just is you might not like to conform decisions about that I mentioned early about your personal life we are the society feeling comfortable with explicit rules yet those things get adjudicated all the time, just quietly. And I didn’t really answer your question but I think at the day today care, people should pay their own costs, but the real issue is how to design a system then send of us healthy behavior because most of the healthcare costs in this country or due to either end of life or what is essentially the results of bad behavior, heart disease, lung cancer, diabetes, they are assigned that you being dead but they are aggravated by poor nutritional habits, lack of exercise all these things and if you could just get people to adopt much healthier lifestyles a medical cost with their down but I don’t particularly wanted the government monitoring what people lead either you said the challenge is had a change social noise without brain washing people. Let them understand their genetic information, educate them better at school and I mean it really the one that’s McDonald’s has a huge role the plan that’s just by what they offer people that if the food companies could start promoting genuinely healthy food rather than kind of what is it truthiness foodiness where you put chemicals into something and claim that its more healthy because its some kind of one piece of nutrition it like if you put please into something saying that is polite and this thing is still root, so its extremely complicated and more information is I start more information that the impact of that kind of food lead just as in the environment more information that the impact of that kinds of things we drive the stuff we use the cost of air-conditioning that kind of thing.

Recorded on: 03/21/2008