Bush reduces privacy of medical records - a good thing?

Great Debates
21

MsRobyn, you clearly are far more knowledgeable than I in the area of insurance.

In my immediately prior post, the examples came just off the top of my head. I was somewhat hesitant as I typed them. I defer to your specific experience as to the specific examples I made up. It does not seem impossible to me that an individual could be disadvantaged by information sharing, and not realize that they were disadvantged or the specific cause of their disadvantage. But, since I cannot come up with a good example, I will abandon that.

You observe that no one is really arguing my basic premise. Agreed. Tho I view much of december’s posts as suggesting that any potential harms are relatively minimal. I also acknowledge that to some extent I was rephrasing my position. Given some of the intervening posts, I felt like doing that, absent a tremendous amount of clash in this “debate.”

You state that I can’t have it both ways. Well, I think I’m only having it one way when I express displeasure with the current state of American insurance. I find something offensive about profit as a (if not the) primary motivation for the provision of basic medical care. Speaking of my personal experience, I perceive myself as deriving no personal benefit from health insurance being as convoluted as it is. I resent having to try to predict what my family’s medical needs will be over the upcoming year when I decide which of several HMOs and PPOs I sign up for. I dislike having to make budgetary decisions about medical care, such as whether a certain ailment is worth a copay, or whether to seek routine dental and vision exams which are not covered. I resent having to become more familiar with my HMO’s prescription formulary than my doctor. And I hate the hours I must spend wading through my HMOs referral requirements that seem to change day-by-day, and then straightening out billing errors and denials after I made an honest effort to comply with their requirements. I consider it obscene that the richest country in the world cannot provide a better safety net of health provision for our poorest citizens. I dislike that in some cases maintenance or preventative measures are not covered, although more expensive care for a resulting and preventable condition is. It strikes me as inefficient that my doctor’s office has to expend so much effort on navigaing the insurance environment - effort they could instead expend on patient care.

Again, this is just a list off the top of my head, and is based upon my personal experiences instead of detailed knowledge of the industry.

But, since I am not a fan of the way the system is set up, I REALLY am not a fan of a policy change that seems to have the potential to harm me, while having no significant benefits for me.

Also, the initial linked article is not the initial one I read,and I had no itention for it to circumscribe the debate. The initial article I read was from Saturday’s Chicago Trib. It was much longer and, IMO, more informative than the one I linked, but the online version requires registration. I have also read additional articles since then. None of them suggest any advantage to the consumer, but several have repeated Tommy Thompson’s ridiculous comment of running all over town.

It seems telling to me that no one has stepped in to champion this policy change. To me, it seems but one of the more blatant elements of what seems to be a consistent undercurrent of the present administration towards curtailing individual rights and interests in favor of business interests or government efficiency. But, I should avoid extrapolating too much from this specific issue.

22

There may already be too much medical privacy when it comes to infectious or communicable diseases.

Take the syphilis rate of the US, which fell dramatically (in 1918 one in 18 people were infected) after a two pronged attack:

The introduction of penicillin that controlled (but didn’t cure) outbreaks
AND
Mandated partner notification and case-finding (testing).

The latter part of that equation is something the AIDS lobby in this country would never stand for.

23

Of course the AIDS lobby wouldn’t stand for it! How many people would be fired, completely ostracized by family, friends, and social institutions, and possibly beaten or killed if word got out that they were HIV+?

Maybe someone else can tell us when mandatory partner notification for other STD’s began; I don’t know myself, but I’d bet it was after syphillis became a curable disease. AIDS is not truly and reliably curable as things stand now, and nobody really knows how well even the current hideously expensive and complex drug cocktails will remain effective over the long run. How many small businesses would be willing to continue to employ a person with AIDS, or even cancer or MS or other noncommunicable and potentially disabling diseases, if it were driving their premiums through the roof and they could find a legal way to get rid of the person?

Right now, there are at least three people in my office who are not taking advantage of what could be a perfectly wonderful Medical Savings Account plan because there is no built-in buffer to protect their confidential medical information from management, and no practical recourse unless you are fired for having a disability (and even then, recourse would likely require a lawsuit and several years, with no guarantees of success, especially with the Supreme Court’s recent shrinking of what they believe constitutes a disability). I know, because I took it upon myself to discuss the issue at length both with our national HR director, who admitted their was essentially no formal privacy mechnism, and with my stepmother, a labor attorney with lupus who has researched the issue at length for herself.

If you were my co-worker with MS, would you want ANYBODY other than your doctor, and arguably the insurance company, to have access to that information? What if some direct-marketing moron got hold of your name and work address, and started sending you flyers at work on the latest MS treatment so management can see them at the front desk while the mail is being sorted? You don’t think that wouldn’t be somewhere in the boss’ mind when deciding who will survive the next round of layoffs?

Bosses can do wacky things; I once worked for a small home-based business when the secretary slipped on the rug and sprained her ankle, and the owners intimidated her into committing insurance fraud by having her claim that she was a houseguest and claiming it on their homeowner’s liability policy rather than the business’ employee medical insurance so their rates wouldn’t go up. And that’s just a sprained ankle: can you imagine how they would have handled a serious problem?

So in short, no, I don’t think Americans want or need more people to have access to their medical information than already do. The drug companies will just have to find some other way to sell more stuff.

24

That’s a good point. However…

Suppose that Patient A is diagnosed as HIV positive, and sex partner B is notified and chooses to be tested. If B also turns out to be HIV positive, then B now knows to take precautions when having sex with C, D or E. So, notification may still reduce the spread of AIDS, even without a cure.

Also, if Patient B is a pregnant woman, taking various medications can substantially reduce the probability that her baby will be born HIV+.

25

I deal with this situation every day. Getting a patient’s medical records from elsewhere is a grueling five minute process that involves calling the appropriate medical records department, getting a fax number, getting the patient to sign a form, and faxing said form to said number.

There are procedures, I believe, for obtaining medical records for a patient who is unable to sign (say, he’s unconscious).

I am among those who can’t see how the patient could possibly benefit from being cut out of the loop.

Dr. J

26

december, I agree that people with STD’s should notify their partners. However, how does your proposal relate to the OP? If Patient A has any morals at all, he will notify Patient B himself or allow someone else to do it (perhaps anonymously, as AFAIK that’s how it works now, at least in Illinois; a former acquaintance of mine actually did this for a living for the Dept. of Public Health, driving around to some nasty neighborhoods to track down people on the “contact lists” of people who had tested positive. Fun, huh?).

If Patient A has no morals, however, he can easily lie or omit people. So how do you propose to extract the information against Patient A’s will? And I don’t see anyway to keep Patient A out of the loop entirely.

Plus, there’s the very real danger that Patient A, knowing his privacy may be invaded and not relishing the results, will just decide not to get tested at all. How does that improve matters? Or Patient A tells Patient B, who is pregnant, and she decides not to get tested for the same reason, or maybe she’s also afraid that if she’s HIV+, DCFS will take the baby away. Again, how does that resolve anything?

There will always be stupid and irresponsible people in this world; I don’t see how the government can force people to be intelligent, and this kind of attempt will just make it worse. As for the “unsolicited gifts” idea: it blows my mind that a pharmaceutical company’s “right” to send unsolicited gifts or advertising materials should trump my right to be left the hell alone.