Colorado’s all-payer database poses serious risk, little gain
by Amy Oliver, Linda Gorman
Colorado state government, and local foundations and health policy elites, have become so ideologically invested in failed health reform policies that they now see nothing wrong with forcing Colorado citizens to give their medical records to a centralized repository, free from scrutiny by state auditors, open records requests and open meeting requirements.
In 2010, state lawmakers passed HB 1330, which created the All-Payer Claim Database. It was an exceedingly vague piece of legislation. It created the usual sycophantic advisory committee to give an illusion of public control, but the real power was given to an “Administrator” empowered to collect whatever medical data it wished from every “payer” in the state. The Administrator may impose unspecified fines on payers who refuse to comply. The database was to be operational only if private funding could be found. With funding already in place from private sources intent on promoting government-controlled health care, the Center for Improving Value in Health Care (CIVHC) was appointed as the Administrator for the database. CIVHC promptly converted itself from an entity subject to public oversight to a private 501(c)3 nonprofit.
CIVHC supporters claim the database will be secure, that individual identities will be protected by encrypted Social Security numbers, and that individual privacy is protected by HIPAA.
These claims are disingenuous at best. Encrypted Social Security numbers do not protect individual identities in a database that also contains information on an individual’s gender, address, race, spouse, children, dependents, insurance group, insurance contract and member number, and the doctor, place of treatment, time of treatment, diagnosis, place of care, prescription drugs, and payments for all medical treatments for everyone covered under any insurance policy or making a cash payment.
Centralized electronic medical records have been maintained by Britain’s National Health Service for almost a decade with predictable and disastrous results. In April 2010, London’s Daily Telegraph reported that private detectives were selling top-secret patient information for up to #300 a pop. This means that if you or your spouse or children have ever seen someone for psychiatric care, an abortion, a sexually transmitted disease, or substance abuse, anyone with access to the database will be able to figure out who you are and use that information against you. Alternatively, you could be wrongly diagnosed as an alcoholic or a sexual abuser, have the diagnosis entered in your record, and be threatened by a blackmailer.
Good luck proving a negative.
CIVHC supporters say the All-Payer Database is essential because they cannot “manage what they cannot measure.” Never mind that people who pay for their own health care are perfectly competent to manage it themselves or hire others to do so, or that CIVHC’s form of centralized management has failed everywhere it has been tried. Claims that the database will improve medical care are nonsense because it does not collect the detailed physiographic information required by clinical studies that do. What it will do is add substantially to medical care costs.
All existing public information suggests that CIVHC plans to use the All-Payer Database to bring private medical care under the control of unelected and unaccountable bureaucrats. Its metrics emphasize imposing price controls on insurers, and physicians, targeting people who are obese, limiting physician freedom to recommend treatments, making sure that individuals have “advance directives” in place, monitoring the amount spent on the last six months of life, and limiting Colorado health spending to a fixed percentage of the state’s gross state product.
As it is cheaper to let people die than treat them, it is but a short step from this to copying the European tradition of letting underweight babies die, forcing the elderly to accept palliative care, and denying advanced care to the disabled and seriously ill.
This article originally appeared in the Summit Daily, December 22, 2011.
Improving Medicaid with block grants & consumer-directed health care
Linda Gorman, director of the Independence Institute‘s Health Policy Center has written an issue brief on the benefits of replacing federal matching funds with Medicaid block grants. An excerpt:
If Medicaid were turned into a block grant program in which the federal government gave each state a set amount of money, it could improve patient care, restrain the growth in costs, reduce complexity and improve outcomes. Furthermore, block grants could be used to implement consumer-directed reforms that allow Medicaid enrollees to control some of the spending on their care and give them incentives to avoid unnecessary care.
Read the whole brief: Medicaid Block Grants and Consumer-Directed Health Care, National Center for Policy Analysis.
Paul Krugman’s space aliens won’t create jobs, repealing health control law will
This article was printed in the Boulder Daily Camera on September 10, 2011 in response to this question:
What do you think will help decrease unemployment and underemployment? What role do you think the government can, or should, play in encouraging job growth?
Space aliens attack! Nobel laureate economist Paul Krugman says we need scientists to “fake an alien threat.” ”A massive buildup to counter” the threat, real or not, would end the economic slump “in eighteen months,” he said. Dr. Krugman unwittingly shows how loony Keynesian economic “stimulus” schemes are.
As an EconStories rap explains: “If every worker was staffed in the army and fleet, we’d have full employment and nothing to eat. Jobs are a means, not the ends in themselves. People work to live better, to put food on the shelves. Real growth means production of what people demand. That’s entrepreneurship not your central plan.”
[youtube GTQnarzmTOc]
Repealing parts or all of last year’s health control law [HR 3590] would encourage real growth. One-third of small business owners sited the law’s requirements as the greatest or second greatest “obstacle to hiring more employees,” reports a recent U.S. Chamber of Commerce survey. Three of four business owners “somewhat agreed” that the law “makes it harder … to hire more employees.”
For example, the law compels employers to buy insurance for full-time employees. In response, half of surveyed employers said they would “change their workforce strategy so that fewer employees work 30 hours or more a week,” reports Mercer consultants.
Is it merely coincidence that private-sector jobs growth stalled after health “reform” passed? Economist James Sherk shows that in the fifteen months before “reform,” average monthly job growth exceeded 67,000 jobs. Since then, it has plummeted to around 6,500 jobs per month. Don’t blame alien abductions.
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Thanks to Grace-Marie Turner for her article: Repealing Health Care Legislation Will Create Jobs, which led me to the health care bill references above.
Related, via FIRM, The Hill reports:
The medical device industry says it could lose 10 percent of its U.S. workforce because of a tax created by healthcare reform.
The Advanced Medical Technology Association (AdvaMed) released a report Wednesday that says device-makers might ship 43,000 jobs overseas once the tax takes effect in 2013.
Read more: Device-makers say tax will cost 43,000 US jobs.
What’s wrong with “evidence based medicine”?
John Goodman has a great critique of how the U.S. government is more-or-less compelling doctors to follow “evidence-based medicine.” Some excerpts:Washington telling the medical community how to practice medicine. Even though a recent study finds little relationship between the inputs Medicare wants to pay for and such outputs as patient survival, and even though the latest pilot programs show that paying doctors and hospitals for performance doesn’t improve the quality, we are about to usher in the era of big brother medical care. … What if there were a rule that says you can’t do anything during the week unless it is on the calendar by Sunday. Call this “calendar-based scheduling.” Instead of being an aide, the calendar would quickly become an oppressive barrier to your freedom of action. … So what’s not to like [about evidence based medicine]? A lot, it turns out. …Read Goodman’s whole post on what’s wrong with evidence based medicine.Finally, the whole idea behind guidelines and protocols is that it is appropriate to treat patients with similar conditions the same way. But individuals are individuals. They don’t always respond to treatments the same way.
- First, in most areas of medicine, there are no treatment guidelines; and where there are, they are often unreliable, conflicting and incomplete. …
- Second, even where there are well established guidelines, they are inevitably written for the average patient. But suppose you are not average. Is your doctor free to step outside the protocols and give you care based on her training, knowledge and experience? …
- Third, guidelines are often written by people who are not disinterested. One study found that 56% of the doctors who helped write guidelines for treatment of heart ailments had potential conflicts of interest. …
- Fourth, evidence-based guidelines are based on studies; and these studies often exclude entire segments of the population. …
