We Have Seen the Future, and It Is...Estonia?

Kim BellardLike me, you may not have been paying close attention to what has been going on in Estonia.  That's probably something many of us should change, at least anyone interested in our digital future(s). OK, I have to admit: I had to look Estonia up on a map.  I knew it was in northern Europe, and that it had been involved in the whole U.S.S.R. debacle.  As it turns out, Estonia sits just across the Gulf of Finland from -- that's right -- Finland, and across the Baltic Sea from Sweden.  Skype was invented there, if you're keeping score. More to the point, over the last twenty years it has evolved into arguable the most advanced digital society in the world.

Nathan Heller has done a deep dive into Estonia in the most recent The New Yorker.  I recommend that you read it, or check out Estonia's e-Estonia site.  Basically, in Estonia:

  • everyone has a digital identity, safeguarded by a chip-encoded ID card and two-factor authentication;
  • virtually all other government transactions are done online, including voting;
  • most public and even private records are accessible online, so that, for example, in applying for a loan or a marriage license all needed data is pre-populated;
  • patient medical records are all online (owned by the patients), and are shareable only as patients specify;
  • most public records are stored in blockchain, and use the X-Road open source data platform for both public and private data.

If it sounds like a heavy government presence, that would be wrong.  One Estonian told Mr. Heller: "In Estonia, we don’t have Big Brother; we have Little Brother.  You can tell him what to do and maybe also beat him up."

They believe their efforts have saved two percent of G.D.P., by reducing salaries, expenses, and hassles for citizens.  Think about that: 2% of G.D.P.  As Everett Dirksen once said, pretty soon you're talking about real money.

And they're not done.  Just today, for example, Estonia announced it was launching its own form of cryptocurrency, which it refers to as a crypto token and calls "estcoin."  It can't actually be used as currency because Estonia, as part of the European Union, must use euros, but they're trying to figure out what it could be used for. 

They have some ideas about that, and many revolve around further support for their e-Residency program.  They claim that program created "a borderless digital society for global citizens:" 

E-Residency is a transnational digital identity that anyone in the world can apply for to obtain access to a platform built on inclusion, legitimacy, and transparency.  E-residents then have access to the EU business environment and can use public e-services through their digital identity.  

Some 28,000 people from around the world have already applied for e-Residency.

They admit that estcoins may be a solution in search of a problem, and they're OK with that.  Their attitude is, "OK, here's a cool new tool: what problems can we help you solve with it?" 

That is not your typical governmental attitude. 

Amazon has revolutionized retail by constantly trying to reduce "friction" for consumers.  Estonia has done that for government services and, increasingly, other commercial services.  No wonder they rank high in international competitiveness and ease-of-doing business rankings. 

The man behind the e-Residency concept, Taavi Kotka, told Mr. Heller:

If countries are competing not only on physical talent moving to their country but also on how to get the best virtual talent connected to their country, it becomes a disruption like the one we have seen in the music industry.  And it’s basically a zero-cost project, because we already have this infrastructure for our own people.

Kaspar Korjus, who announced the estcoin, put it bluntly: "Our focus will remain on our overall objective to grow our new digital nation and democratise access to entrepreneurship globally."

That is competing in the Internet age.

In the U.S., of course, we're talking about strengthening our borders, not becoming borderless.  Most of us still vote in local polling places, often using analog machines or even paper ballots.  We joke about standing in line at the DMV (although we're not very amused) and complain about how hard it is to file our taxes.  "Good enough for government work" typifies how we've dumbed down our expectations for government services.

In our health care system it's not much better.  We continue to plod towards electronic health records, although with much less progress on those EHRs actually being able to share data and virtually no progress in patients actually owning their own data or even in preventing it from being sold to third parties.  Waiting at the DMV has nothing on waiting in a doctor's office or ER.  We're talking about blockchain in healthcare, but there are heavily entrenched interests in the status quo. 

We don't have universal coverage (as Estonia does), and even some of our recent gains in covering people are starting to slip away, with Republicans happy to trade tax cuts for 13 million people potentially losing coverage.

We're still struggling to figure out how to deal with state lines in health care, as telehealth has illustrated.  Importation of prescription drugs has similarly shown how we have the same problem with national borders. 

Guess what: data increasingly drives our economy, even in health care, and data doesn't recognize borders.

We're not going to be a digital nation anytime soon.  We don't have an e-United States initiative.  We're not going to lead the world with creating a blockchain-based health care system.  We have huge sunk costs of infrastructure limiting not only what we do but what we think we can do.   We are a big battleship that turns oh-so-slowly.
But perhaps we're going to see state or local technological leaps forward.  Andrew Keen suggests that states may lead the charge in adopting new technology, specially pointing out how Rhode Island is looking at Estonia's example.  Meanwhile, Delaware -- long a locus for companies to incorporate in -- has passed a law allowing companies to use blockchain for corporate records, including stock trades.

Maybe next we'll see a local community fully jumping into the 21st century, not just for government services but for local private sector ones.  Wouldn't it be great, for example, if the near duopolies in the health care systems of, say, Cleveland or Pittsburgh came together to implement shared technologies for a frictionless patient experience? 

So what I'm wondering is: who/where in the U.S. is going to be our Estonia?

We Have Seen the Future, and It Is...Estonia? was authored by Kim Bellard and first published in his blog, From a Different Perspective.... It is reprinted by Open Health News with permission from the author. The original post can be found here.