There’s an old saying that “fashion is never finished.” In principle, the idea is that cultural sensibilities for aesthetics (re the fashionable) are a continual evolution that will always find new and different ways to dazzle the eye.
In practice, what it really means is that you have to keep buying new pants to replace ones that still work perfectly well.
The same saying could probably be adapted for big government. On the one hand, people will always need police, National Parks, and roads (probably); but on the other hand, there will always be bureaucrats and elected officials who wants to replace a program that works perfectly well with one that has their name on it.
The one that’s currently most troubling is the Obamacare push to replace an existing patient database with an expensive new one that will exploit private healthcare data.
While Obamacare is currently making headlines for (much) higher than predicted costs, the Centers for Medicare & Medicaid Services (CMS) want to create a national database of highly sensitive personal health information for the 30 million Americans with individual and small group coverage. Under Section 153.610 of a new Health and Human Services (HHS) rule for Obamacare, this proposal would require health plans to send CMS data on enrollees on an unprecedented scale, including:
- Amount paid
- Diagnoses received
- Drugs prescribed
- Procedures received
- Health care providers seen
- Out-of-pocket liabilities assumed
- Individual demographics
- Social Security Number
So basically everything.
Furthermore, plans would be required to send private information about their contracted prices for their members’ hospitalizations, doctor visits, and prescription drugs in order to expand “HHS’s ability to use that enrollee-level data from risk adjustment covered plans to improve the risk adjustment model recalibration.”
Well. If it’s for risk adjustment model recalibration, you say, what harm is there in that?
That kind of information is essential in any insurance-based business model for actuarial-pricing reasons, but CMS demurely admits it may use these data for other purposes, and may even provide data to third parties for research.
Forgive my cynicism, but when the government says “may” that always means “will.”
It’s a continual astonishment that Sen. Barack Obama said, “we don’t like federal agents poking around our libraries” in 2004, but history will remember Pres. Obama as the one who let federal agents “poke around” everything. (Ask Edward Snowden what he thinks about the Obama Administration’s poking.)
Morally, CMS needs to reject this national database proposal. The government has no business creating an expensive new database for millions of individuals’ sensitive health information. There’s no scenario in which we’ll later say, “Ah. This is good that my private, sensitive health care information is being harvested like this.”
Because not only is centralizing this much consumer information costly, it’s also dangerous. When data is compartmentalized, it’s harder to find and it’s a less attractive target for cyber-attacks. In the age of foreign hackers and Wiki-leaks, millions of patients’ privacy are jeopardized in the event of a data breach, and CMS hasn’t even tried to justified this high-risk approach.
Even if this data never gets subverted by a third-party attacker, it’s already in the hands of an entity that shouldn’t have this kind of access: the government.
Particularly troubling, HHS’s plan lacks detail for how the database would be implemented, which is always scary when an agency is looking to get unlimited powers about their own data collection methods. The dark science-fiction series Black Mirror recently dropped an episode (SPOILER ALERT) in which the government uses artificial bees to spy on us: we’re not quite to that point, but we’re closer than we’ve ever been before.
Rolling over for the government to create this unprecedented data collection system could also be a back door to the single-payer system we were promised would never, ever happen.
Changing the current system is unnecessary as the aforementioned, existing server model for medical data offers an effective and less risky approach across the board: the External Data Gathering Environment, or “EDGE” system. (Honestly, how much money was spent just on coming up with that great acronym? And Obamacare wants to throw that away?)
A CMS white paper released in March defended the values of the EDGE system at the time, noting:
CMS is committed to protecting the individual health information of all enrollees whose data is collected via the new EDGE report in accordance with existing privacy laws and regulations to which CMS may be subject. (Section 4.6.4)
EDGE could be used to recalibrate the risk-adjustment model and perform essentially all the actuarial functions of a centralized database – but without any of the cost, risk, or troubling immorality.
Fashion may never be finished, but this new proposal needs to be. Government violations of privacy are never, ever in style.