Sunday, December 27, 2015

Better Think Again

Usually this time of year people like to either look back at significant events of the year just ending, or to prognosticate about what might happen in the new year.  Well, neither my rear view mirror nor my crystal ball are quite that good, so I'll use my last post of the year to cite some examples of the kind of innovations that most fascinate me, ones that suggest the future may come sooner and/or be quite different than we expect.

Or maybe they'll prove to be red herrings.  It's hard to say.

I'll give three examples.  How and even whether any of them relate to health care, we'll get to later.  In no particular order:

Tell me your password:  If you go online with any regularity, chances are good that you've got a password.  Probably, in fact, a whole bunch of them.  With online security becoming ever-more important, more sites require passwords, and tougher/harder-to-remember ones at that.  The trouble is keeping track of them all.

People use different strategies to deal with this ever-growing plethora.  Some people have good enough memories to recall them all, although I don't know any such people.  Others create lists to keep all their passwords, or utilize apps to store and even create passwords for them.   Ironically, those apps themselves require a password, which creates kind of a cat-chasing-its-own-tail scenario.

But passwords are so 1990's.

Google and Yahoo, separately, are testing getting rid of passwords, replacing that step with a message sent to your smartphone, which you can use to authenticate the log-in attempt.  Of course, if you have failed to lock your phone, or have forgotten its password, you're out of luck.

Other new approaches include using fingerprints, which have the drawback that they, too, are now digital and thus can be stolen, or facial recognition, as Windows 10 now allows.  Hey, as if recognizing your face isn't enough, UK-based start-up AimBrain claims its software can recognize you by how you use your device, making passwords unnecessary.

I don't know what approach will win out, but, given how much people hate them, how poorly they use them, and how easy they are to hack, I'm willing to bet that in five or ten years we won't be using passwords.

Give me the cash:  We love our credit and debit cards.  Not all that long ago, it seems, we mostly used credit cards only for larger purchases, and debit cards not at all, but now you can pretty much use them about everywhere, for any amount.  Still, you probably go out with some cash on you, just in case.

Unless you live in Sweden, that is.

Sweden appears to be closer to a cash-free economy than just about anywhere.  According to The New York Times, cash is only used for twenty percent of consumer payments in Sweden, versus around seventy-five percent in the rest of the world (surely that is a typo, right?  75%?).   Some Swedish banks don't even keep cash on hand.  Seriously.  As one student said, "No one uses cash.  I think our generation can live without it."

In a cashless society, people use credit/debit cards, or smartphone-based approaches like Apple Pay or Google Wallet.  Those approaches still are primarily based on card networks, but don't require you to give your card info to a merchant.

Money is, after all, notational, even actual currency.  It only works because we all agree it has value, and whether it is cash or digital isn't fundamentally important.  As Bitcoin is slowing proving, "money" doesn't even need to be something issued by governments or central banks; just a bunch a people agreeing to accept it allows it to have value.

I don't know if the winner is going to be cards, electronic transfers, Bitcoins, or something else, but  in ten or twenty years you may have trouble getting a merchant to accept your cash.

Cutting the cords:  This is a hot topic.  I've written on it myself.  Instead of using a landline for telephone service, we figuratively cut that landline and rely on our mobile phone.  Instead of being forced to take whatever array of channels our cable company forces upon us, we choose our own shows or our own packages of shows, usually streaming via the Internet.

The cable companies prepared for the future by becoming ISPs, so they love broadband, which they can charge more for (despite our abysmal speeds).  The landline telephone companies are either out of business now or have become mobile carriers.  But neither may be really ready for the future.  Here's the fact that makes me think so: home broadband use is actually declining.

According to the Pew Research Center, broadband use declined from 70% in 2013 to 67% in 2015.  That doesn't sound like much, but it is statistically significant, and it is a shocking reversal of prior trends; remember, at the beginning of the century broadband use was essentially zero and was still below 50% as late as 2006.  Fifteen percent have dropped cable or satellite service; a third of younger Americans have dropped or never had pay TV.

The reversal is attributed to more people thinking that kind of connectivity is too expensive, especially when thy can get much of the content on, you guessed it, their smartphones.  

All this sounds bad for cable but surely good for the mobile telephone companies, yet they shouldn't get too cocky.  We may not need them either.  Google has launched Loon -- "balloon-powered Internet for all" -- while Facebook is using drones to accomplish the same.  Right now both giants are testing these approaches in rural or third-world areas, but to the extent they succeed they will certainly help change the paradigm.  

Cable and mobile phone companies should remember that consumers' using the Internet through them was, in some ways, a fortuitous happenstance, and that if they are too greedy -- how much are those packages and data plans? -- or too shortsighted, the future may no longer include them.

In 20 or 25 years, cables and mobile phone networks may be as outdated as analog broadcasting and television antenna are now.

OK, so these examples may not be about health care, or may only impact health care in the same way they impact other industries.  The importance of them, to me, is less in their direct applicability as in their reminding us that the world -- even for health care -- doesn't always evolve incrementally or even predictably.

And I love that.

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