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Debate Over Digital Privacy Amid Coronavirus Pandemic Remains ‘Archaic’

Debate Over Digital Privacy Amid Coronavirus Pandemic Remains ‘Archaic’

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Cointelegraph interviewed Alogrand founder and Turing Award recipient Professor Silvio Micali to discuss blockchain-based solutions to contact-tracing amid the coronavirus crisis.

With some countries beginning to lift lockdown restrictions amid the coronavirus pandemic, many are focusing attention on the technological tools that can help public authorities to comply with the World Health Organization’s guidance for COVID-19 suppression —- “test, trace, isolate.” 

This mantra has become all the more resonant in light of the apparent failure of multiple states to implement contact-tracing measures successfully early on in the crisis. 

Amid the belated scramble to develop solutions that can safely enable the resumption of some aspects of social and economic life, the debate over tech-enabled contact tracing and movement-tracking has largely been framed as a trade-off between public health and privacy. 

Many have argued against the perceived deterioration of legal privacy rights and the intrusion of biosurveillance, in what is presented as a zero-sum game between medical advice and existing cultural norms. 

Yet there are others, including those in the blockchain community, who dispute the very framing of the debate itself. 

To unpack some of these issues, Cointelegraph interviewed MIT professor and cryptographer Silvio Micali, a recipient of the Turing Award in computer science and Gödel Prize in theoretical computer science. 

Professor Micali’s research interests in cryptography include zero knowledge proofs, pseudorandom generation, secure protocols, and blockchain technology. In 2017 he founded the open source, Proof-of-Stake-based public blockchain platform Algorand, where he continues to oversee research into security, theory and crypto finance.

In a recent article, Professor Micali stated that there are broadly two models that have been proposed for developing apps that could help the international community to trace contacts between symptomatic/diagnosed COVID-19 sufferers and healthy individuals — and thus to fall closer into line with the WHO’s guidance.

One type of app would follow a model whereby a government or public health agency would store data in some form of centralized database. The other — as proposed by the likes of Apple and Google — follows a decentralized model, where all the relevant contact information would be stored only on users’ phones.

Micali's proposal, based on blockchain technology, follows a third way — one that recognizes the need for a consolidated overview of all contact tracing data, but provides adequate privacy and data protection for individuals.

Cointelegraph: Can you outline the basic principles that underpin your approach? Why do you uphold that an overall view, which consolidates contact tracing data remains indispensable for policy development and public health measures? In what way would the purely individual-centric model proposed by Apple and Google be limiting?

Silvio Micali: It should be emphasized that the consolidated data we are speaking of is totally anonymized.  It is a database of how many qualified contacts are happening every day, nothing more.  

A qualified contact is defined as a physically close encounter (e.g., less than one yard) for a sufficiently long time (e.g., at least 10 minutes). Each report is provided by the phone of an individual who has voluntarily opted into the system. 

Reports do not disclose the identities of the people, nor those of the phones involved in any qualified encounters. They only report the number of qualified encounters.  For instance, the anonymized database consists of the following list of reports, each made by a different phone at the end of the day:

  • I (whoever I may be) had three qualified encounters today 
  • I (whoever I may be) had five qualified encounters today 
  • And so on…

Even though the information collected is quite minimal, it is very useful for the government to have this information. For instance, when opening or closing the beaches in a given state, the local authority can very easily see how much doing this has increased or decreased the number of qualified encounters. 

As a further example, with this consolidated and anonymized data, the government may have a better sense of when to transition from one phase to the next in opening up the economy.

Our view is that when individuals voluntarily help to create such an anonymized database, it is only fair that they can see it too. The goal is to help reduce information asymmetries while protecting the privacy of individuals. 

CT: Could you explain the concept of a “shared truth” in a blockchain ledger and how it can help to support COVID-19 contact tracing?

SM: A blockchain ledger is a “shared truth” in the sense that everyone sees the same information.  The information to be posted on the blockchain cannot be censored and, once posted, cannot be altered. In our case, the shared truth is a list of anonymized reports of qualified encounters. 

In situations such as the public health emergency we are currently facing, having public access to accurate data is critical. Truly decentralized blockchains can be of enormous value in this. Since they require no gatekeepers, everyone, the government and citizens alike, can be assured that the data they are seeing is the same data that everyone else is seeing.   

This use of the blockchain builds trust. No one can be accused of fabricating data, because anyone could match the reports in the governmental database with those posted by citizens directly on the blockchain. 

Note that even an honest government has an interest in guaranteeing to its citizens that no one can manipulate the reported data. In this case, more citizens are likely to volunteer their anonymized data. And the wider the adoption of the system, the more successful it will be.

CT: How far do you think that the provisions of a technology such as blockchain can help with the breakdown in public trust we’ve witnessed — during the pandemic, but also preceding this crisis?

SM: Trust between citizens and their governments is key for functioning societies. Allowing citizens access to anonymized datasets that they themselves help build is a crucial way of building such trust. 

It shows that there are no gatekeepers — the nature of truly decentralized blockchains is such that no gatekeepers are required — and that the government is confident that anyone checking the data will come up with the same numbers as the official ones.

CT: How do you view the limits and possibilities of technological solutions in this context? Some might argue that tech alone is not sufficient in the absence of an adequate debate about the limits of state authority, forms of individual and collective responsibility, and civil liberties.

SM: I am a technologist. I believe in technology. But I also believe that technology is only part of the solution. This said, why not take advantage of the best technology we have available?

CT: Can you give us some more insights into the technological design of your proposal? In layman's terms, can you explain the cryptography involved, different possible variations, and any potential challenges down the line, e.g. scalability?

SM: The Algorand proposal is very simple: use the blockchain to guarantee that (1) the anonymized data reported on governmental websites is indeed genuine and (2) the citizens are given access to the very anonymized data they helped the government to collect. 

Algorand uses state-of-the-art cryptography (in particular, verifiable random functions) in order to guarantee that our blockchain is truly decentralized, scalable and secure. 

Prior to the advent of Algorand, it was a widespread belief that any blockchain could satisfy at most two of the three mentioned properties: decentralization, scalability and security. It was hard to choose which of the three one should sacrifice: the so called blockchain trilemma! 

Solving the trilemma has been a major contribution of Algorand. Now that we can enjoy all these three properties, the blockchain has a much greater potential to help us solve societal problems such as the ones we are currently dealing with. 

CT: I'd be interested to hear your observations about the wider media's coverage so far of contact tracing, privacy and technology, as well as any comments on approaches that have been proposed within the blockchain development community.

Contact-tracing is crucial. But so is privacy. More generally, both correctness and privacy are crucial. Naively, one may think that they are necessarily at odds with each other and that one can at most hope to find some reasonable compromise. Yet one of the technological triumphs of modern cryptography is enabling the co-existence of perfect privacy and perfect correctness. But we technologists have not succeeded in explaining this to the public, and every time the debate starts from very archaic positions. 

I believe and hope that the media will be more successful in this educational mission than we technologists have been. To each her own trade!

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The most potent labor market indicator of all is still strongly positive

  – by New Deal democratOn Monday I examined some series from last Friday’s Household survey in the jobs report, highlighting that they more frequently…

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 - by New Deal democrat


On Monday I examined some series from last Friday’s Household survey in the jobs report, highlighting that they more frequently than not indicated a recession was near or underway. But I concluded by noting that this survey has historically been noisy, and I thought it would be resolved away this time. Specifically, there was strong contrary data from the Establishment survey, backed up by yesterday’s inflation report, to the contrary. Today I’ll examine that, looking at two other series.


Historically, as economic expansions progress and the unemployment rate goes down, average hourly wages for nonsupervisory workers improve at an increasing rate (blue in the graph below). But eventually, inflation (red) picks up and overtakes that wage growth, and a recession occurs shortly thereafter. Not always, as we’ll see in the graph below, but usually:



As you can see, there have been a number of exceptions to the rule, chiefly where inflation outstripped wage growth, but no recession happened anyway. Typically this has occurred because of the entry of so many more people (like women in the 1980s and early 1990s) into the labor force.

And we certainly see that inflation outstripped wages in 2022, not coincidentally when there were several negative quarters of real GDP. But with the decline in gas prices, in 2023 inflation subsided much more sharply than wage growth, and the economy improved more substantially. That has remained the case in the first two months of 2024.

But an even more potent indicator is one I have come to rely on even more: real aggregate payrolls for nonsupervisory workers. Here’s its historical record up until the pandemic:



There’s not a single false positive, nor a single false negative. If YoY aggregate payroll growth is stronger than YoY inflation, you’re in an expansion. If it’s weaker, you’re in a recession. Period.

And here is its record since the pandemic:



Real aggregate nonsurpervisory payrolls are positive, and they got more positive in 2023 compared with 2022. Currently they are 2.6% higher YoY than inflation.

In addition to the YoY comparison, real aggregate nonsupervisory payrolls have always declined, at least slightly, from their expansion peaks before every single recession in the past 50 years except for when the pandemic suddenly shut down the economy:



Not every slight decline means a recession is coming. But if real aggregate payrolls are at a new high, you’re not in a recession, and one isn’t likely to occur in the next 6 months, either.

And in case it isn’t clear from that long term graph, here’s the short term graph of the same thing:



Real aggregate nonsupervisory payrolls made a new all-time high in February. Despite the negative metrics in the Household survey, this is *very* potent evidence that not only are we not in a recession, but one isn’t likely in the immediate future either.


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Spread & Containment

KIMM finds solution to medical waste problem, which has become a major national issue

A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed…

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A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed for the first time in the country.

Credit: Korea Institute of Machinery and Materials (KIMM)

A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed for the first time in the country.

The Korea Institute of Machinery and Materials (President Seog-Hyeon Ryu, hereinafter referred to as KIMM), an institute under the jurisdiction of the Ministry of Science and ICT, has succeeded in developing an on-site-disposal type medical waste sterilization system that can help to resolve the problem caused by medical waste, which has become a national and social issue as the volume of medical waste continues to increase every year. This project was launched as a basic business support program of the KIMM and was expanded into a demonstration project of Daejeon Metropolitan City. Then, in collaboration with VITALS Co., Ltd., a technology transfer corporation, the medical waste treatment system was developed as a finished product capable of processing more than 100 kilograms of medical waste per hour, and was demonstrated at the Chungnam National University Hospital.

Moreover, the installation and use of this product have been approved by the Geumgang Basin Environmental Office of the Ministry of Environment. All certification-related work for the installation and operation of this product at the Chungnam National University Hospital has been completed, including the passage of an installation test for efficiency and stability conducted by the Korea Testing Laboratory.

Through collaboration with VITALS Co., Ltd., a corporation specializing in inhalation toxicity systems, the research team led by Principal Researcher Bangwoo Han of the Department of Urban Environment Research of the KIMM’s Eco-Friendly Energy Research Division developed a high-temperature, high-pressure steam sterilization-type medical waste treatment system by using a high-temperature antimicrobial technology capable of processing biologically hazardous substances such as virus and bacteria with high efficiency. After pulverizing medical waste into small pieces so that high-temperature steam can penetrate deep into the interior of the medical waste, steam was then compressed in order to raise the boiling point of the saturated steam to over 100 degrees Celsius, thereby further improving the sterilization effect of the steam.

Meanwhile, in the case of the high-pressure steam sterilization method, it is vitally important to allow the airtight, high-temperature and high-pressure steam to penetrate deep into the medical waste. Therefore, the research team aimed to improve the sterilization effect of medical waste by increasing the contact efficiency between the pulverized medical waste and the aerosolized steam.

By using this technology, the research team succeeded in processing medical waste at a temperature of 138 degrees Celsius for 10 minutes or at 145 degrees Celsius for more than five (5) minutes, which is the world’s highest level. By doing so, the research team achieved a sterilization performance of 99.9999 percent targeting biological indicator bacteria at five (5) different locations within the sterilization chamber. This technology received certification as an NET (New Excellent Technology) in 2023.

Until now, medical waste has been sterilized by heating the exposed moisture using microwaves. However, this method requires caution because workers are likely to be exposed to electromagnetic waves and the entrance of foreign substances such as metals may lead to accidents.

In Korea, medical waste is mostly processed at exclusive medical waste incinerators and must be discharged in strict isolation from general waste. Hence, professional efforts are required to prevent the risk of infection during the transportation and incineration of medical waste, which requires a loss of cost and manpower.

If medical waste is processed directly at hospitals and converted into general waste by applying the newly developed technology, this can help to eliminate the risk of infection during the loading and transportation processes and significantly reduce waste disposal costs. By processing 30 percent of medical waste generated annually, hospitals can save costs worth KRW 71.8 billion. Moreover, it can significantly contribute to the ESG (environmental, social, and governance) management of hospitals by reducing the amount of incinerated waste and shortening the transportation distance of medical waste.

[*Allbaro System (statistical data from 2021): Unit cost of treatment for each type of waste for the calculation of performance guarantee insurance money for abandoned wastes (Ministry of Environment Public Notification No. 2021-259, amended on December 3, 2021). Amount of medical waste generated on an annual basis: 217,915 tons; Medical waste: KRW 1,397 per ton; General waste from business sites subject to incineration: KRW 299 per ton]

As the size and structure of the installation space varies for each hospital, installing a standardized commercial equipment can be a challenge. However, during the demonstration process at the Chungnam National University Hospital, the new system was developed in a way that allows the size and arrangement thereof to be easily adjusted depending on the installation site. Therefore, it can be highly advantageous in terms of on-site applicability.

Principal Researcher Bangwoo Han of the KIMM was quoted as saying, “The high-temperature, high-pressure steam sterilization technology for medical waste involves the eradication of almost all infectious bacteria in a completely sealed environment. Therefore, close cooperation with participating companies that have the capacity to develop airtight chamber technology is very important in materializing this technology.” He added, “We will make all-out efforts to expand this technology to the sterilization treatment of infected animal carcasses in the future.”

 

President Seog-Hyeon Ryu of the KIMM was quoted as saying, “The latest research outcome is significantly meaningful in that it shows the important role played by government-contributed research institutes in resolving national challenges. The latest technology, which has been developed through the KIMM’s business support program, has been expanded to a demonstration project through cooperation among the industry, academia, research institutes, and the government of Daejeon Metropolitan City.” President Ryu added, “We will continue to proactively support these regional projects and strive to develop technologies that contribute to the health and safety of the public.”

 

Meanwhile, this research was conducted with the support of the project for the “development of ultra-high performance infectious waste treatment system capable of eliminating 99.9999 percent of viruses in response to the post-coronavirus era,” one of the basic business support programs of the KIMM, as well as the project for the “demonstration and development of a safety design convergence-type high-pressure steam sterilization system for on-site treatment of medical waste,” part of Daejeon Metropolitan City’s “Daejeon-type New Convergence Industry Creation Special Zone Technology Demonstration Project.”

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The Korea Institute of Machinery and Materials (KIMM) is a non-profit government-funded research institute under the Ministry of Science and ICT. Since its foundation in 1976, KIMM is contributing to economic growth of the nation by performing R&D on key technologies in machinery and materials, conducting reliability test evaluation, and commercializing the developed products and technologies.

 

This research was conducted with the support of the project for the “development of ultra-high performance infectious waste treatment system capable of eliminating 99.9999 percent of viruses in response to the post-coronavirus era,” one of the basic business support programs of the KIMM, as well as the project for the “demonstration and development of a safety design convergence-type high-pressure steam sterilization system for on-site treatment of medical waste,” part of Daejeon Metropolitan City’s “Daejeon-type New Convergence Industry Creation Special Zone Technology Demonstration Project.”


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Government

Buyouts can bring relief from medical debt, but they’re far from a cure

Local governments are increasingly buying – and forgiving – their residents’ medical debt.

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Medical debt can have devastating consequences. PhotoAlto/Odilon Dimier via Getty Images

One in 10 Americans carry medical debt, while 2 in 5 are underinsured and at risk of not being able to pay their medical bills.

This burden crushes millions of families under mounting bills and contributes to the widening gap between rich and poor.

Some relief has come with a wave of debt buyouts by county and city governments, charities and even fast-food restaurants that pay pennies on the dollar to clear enormous balances. But as a health policy and economics researcher who studies out-of-pocket medical expenses, I think these buyouts are only a partial solution.

A quick fix that works

Over the past 10 years, the nonprofit RIP Medical Debt has emerged as the leader in making buyouts happen, using crowdfunding campaigns, celebrity engagement, and partnerships in the private and public sectors. It connects charitable buyers with hospitals and debt collection companies to arrange the sale and erasure of large bundles of debt.

The buyouts focus on low-income households and those with extreme debt burdens. You can’t sign up to have debt wiped away; you just get notified if you’re one of the lucky ones included in a bundle that’s bought off. In 2020, the U.S. Department of Health and Human Services reviewed this strategy and determined it didn’t violate anti-kickback statutes, which reassured hospitals and collectors that they wouldn’t get in legal trouble partnering with RIP Medical Debt.

Buying a bundle of debt saddling low-income families can be a bargain. Hospitals and collection agencies are typically willing to sell the debt for steep discounts, even pennies on the dollar. That’s a great return on investment for philanthropists looking to make a big social impact.

And it’s not just charities pitching in. Local governments across the country, from Cook County, Illinois, to New Orleans, have been directing sizable public funds toward this cause. New York City recently announced plans to buy off the medical debt for half a million residents, at a cost of US$18 million. That would be the largest public buyout on record, although Los Angeles County may trump New York if it carries out its proposal to spend $24 million to help 810,000 residents erase their debt.

HBO’s John Oliver has collaborated with RIP Medical Debt.

Nationally, RIP Medical Debt has helped clear more than $10 billion in debt over the past decade. That’s a huge number, but a small fraction of the estimated $220 billion in medical debt out there. Ultimately, prevention would be better than cure.

Preventing medical debt is trickier

Medical debt has been a persistent problem over the past decade even after the reforms of the 2010 Affordable Care Act increased insurance coverage and made a dent in debt, especially in states that expanded Medicaid. A recent national survey by the Commonwealth Fund found that 43% of Americans lacked adequate insurance in 2022, which puts them at risk of taking on medical debt.

Unfortunately, it’s incredibly difficult to close coverage gaps in the patchwork American insurance system, which ties eligibility to employment, income, age, family size and location – all things that can change over time. But even in the absence of a total overhaul, there are several policy proposals that could keep the medical debt problem from getting worse.

Medicaid expansion has been shown to reduce uninsurance, underinsurance and medical debt. Unfortunately, insurance gaps are likely to get worse in the coming year, as states unwind their pandemic-era Medicaid rules, leaving millions without coverage. Bolstering Medicaid access in the 10 states that haven’t yet expanded the program could go a long way.

Once patients have a medical bill in hand that they can’t afford, it can be tricky to navigate financial aid and payment options. Some states, like Maryland and California, are ahead of the curve with policies that make it easier for patients to access aid and that rein in the use of liens, lawsuits and other aggressive collections tactics. More states could follow suit.

Another major factor driving underinsurance is rising out-of-pocket costs – like high deductibles – for those with private insurance. This is especially a concern for low-wage workers who live paycheck to paycheck. More than half of large employers believe their employees have concerns about their ability to afford medical care.

Lowering deductibles and out-of-pocket maximums could protect patients from accumulating debt, since it would lower the total amount they could incur in a given time period. But if the current system otherwise stayed the same, then premiums would have to rise to offset the reduction in out-of-pocket payments. Higher premiums would transfer costs across everyone in the insurance pool and make enrolling in insurance unreachable for some – which doesn’t solve the underinsurance problem.

Reducing out-of-pocket liability without inflating premiums would only be possible if the overall cost of health care drops. Fortunately, there’s room to reduce waste. Americans spend more on health care than people in other wealthy countries do, and arguably get less for their money. More than a quarter of health spending is on administrative costs, and the high prices Americans pay don’t necessarily translate into high-value care. That’s why some states like Massachusetts and California are experimenting with cost growth limits.

Momentum toward policy change

The growing number of city and county governments buying off medical debt signals that local leaders view medical debt as a problem worth solving. Congress has passed substantial price transparency laws and prohibited surprise medical billing in recent years. The Consumer Financial Protection Bureau is exploring rule changes for medical debt collections and reporting, and national credit bureaus have voluntarily removed some medical debt from credit reports to limit its impact on people’s approval for loans, leases and jobs.

These recent actions show that leaders at all levels of government want to end medical debt. I think that’s a good sign. After all, recognizing a problem is the first step toward meaningful change.

Erin Duffy receives funding from Arnold Ventures.

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