(Email newsletter published by the Institute
for Health Freedom)
March 2005
Contents:
Why the Right to Contract Privately
Must Be Upheld
The seriousness and tragedy of the Terri Schiavo case raises
the critically important question of who should determine one’s
health-care matters. Nearly everyone agrees that Terri’s wishes
should be honored. The problem is we don’t know what her wishes
truly are. This has led to much ambiguity and legal
wrestling, and enormous heartache amongst a family that cares
deeply for their loved one.
The case has heightened national awareness of the need for living
wills. It also highlights the critical need for citizens—especially
the elderly—to be free to pay privately for health-care services.
In Canada, it is illegal to pay privately for services covered
under the government health-care program. The United States’
Medicare Part B program (which covers outpatient doctor services)
also limits citizens’ freedom to pay privately, because it penalizes
doctors who accept private payment for Medicare-covered services.
The only way to ensure that the “collective good” won’t be making
seniors’ personal health-care decisions is to uphold their right
to contract privately for the services of their choice.
[Back to Contents]
Most Americans Are Uninformed about
Plans for a National Electronic Medical Records (EMRs) System
A recent Harris Interactive survey found that most Americans
are unaware of plans to establish a nationwide integrated system
of electronic medical records (EMRs). Only 29 percent of those
surveyed said they had read or heard about the effort to create
the national system over the next few years.
Even so, a solid majority are somewhat or very concerned about
privacy and security in an EMRs system. According to the national
survey:
- 70 percent are very or somewhat concerned that sensitive
medical information might be leaked because of weak data security.
- 69 percent are very or somewhat concerned that there could
be more sharing of medical information without patients’
knowledge.
- 65 percent are very or somewhat concerned that some people
will not disclose sensitive but necessary information
to doctors and other health-care providers because of worries
that it will go into computerized records.
When those surveyed were asked if they believe their medical
information had been disclosed improperly, some 14 percent (representing
30 million U.S. adults) said yes (down from 27 percent in 1993).
The survey also found that the public is evenly divided about
the assertion that the benefits of EMRs outweigh privacy risks:
48 percent accept that claim, while 47 percent reject it.
In considering these responses, it is important to consider
that the American public has been misled about the new federal
medical-privacy rule. Jim Pyles, the attorney who recently
challenged the rule in the U.S. Court of Appeals for the Third
Circuit (as discussed below) says, “The survey also shows that
most members of the public do not understand that the Privacy
Rule grants federal authority for the routine use and disclosure
of their health information against their will. Based on the
other concerns reflected in the survey, I think we have a good
idea of how they would feel about that if they understood it.”
Are the vast majority of Americans truly supportive of and ready
for a nationally linked EMRs system? Not according to the national
survey. The country is almost evenly split, even before being
thoroughly informed of how truly weak the existing federal medical-privacy
rule is.
Sources: National Committee on Vital and Health Statistics,
Subcommittee on Privacy and Confidentiality, website links:
[Back to Contents]
President’s Message: Why I’m Staying
Optimistic about Health Privacy
by Sue Blevins
It’s so tempting to become cynical when one considers the many
unjust and downright disgraceful games that are played in Washington.
If I hadn’t been carefully tracking the issue myself since
1999, I don’t think I’d believe that a so-called federal privacy
rule could actually legalize unconsented access to people’s
health information. It’s astonishing how things can be labeled
the opposite of what they are and then pushed on the American
public—against their will—by large lobbying groups. If a natural-supplements
company had provided such misleading information, it probably
would have been shut down and those responsible jailed!
But regardless of the injustices and misleading propaganda about
this medical-privacy rule, I’m staying optimistic and here is
why:
The American Public Wants Privacy
The good news is that the American public still wants medical
privacy. Poll after poll shows this. That is why the large
lobbying groups that want to gather and use people’s health
information, without first obtaining their consent, have had
to resort to the federal government to create a give-me-unfettered-access-to-health-data
rule they know would never fly in the free market. We can view
the cup as half-empty by focusing on the fact that we’ve had
forced on us a rule we don’t want. (Of course, most Americans
don’t know their privacy has been taken away, because they are
continually misled by government and special-interest groups.)
But the cup-is-half-full view is this: that government and
industry have to lie proves that the public doesn’t want to
give up its health privacy!
A Lie Can’t Last Forever
Another reason I’m optimistic is that I truly believe that a
lie can’t last forever. I am convinced that sooner or later
the public will become informed about how the rule actually
does the opposite of what it purports to do. When sensitive
health data gets leaked, people are going to wonder how it happened.
That’s when they’ll dig deeply and discover the truth about
the lack of medical privacy (defined as the ability to keep
one’s information confidential and determine for oneself if
others can have access to it). That is why true privacy advocates
must continue to tell the truth about how the federal rule fails
to assure confidentiality of health matters.
Lawsuit Challenges the Rule
A lawsuit challenging the misnamed federal medical-privacy rule
could help expose the truth about it. Attorney Jim Pyles recently
argued a case (Citizens for Health v. Tommy Thompson)
on behalf of several organizations and privacy advocates, in
the U.S. Court of Appeals for the Third Circuit in Philadelphia.
According to the Philadelphia Inquirer, during the appeal
the judges became informed about how "The amended rule…rescinded
the consent requirement, meaning that in ‘routine’ matters,
patient permission was no longer needed for private records
to be shared with doctors, dentists, hospitals, HMOs, insurance
companies, billing firms and others. Records include test results,
diagnoses, physicians’ notes and other information, some of
it embarrassing and all of it intensely personal." The Inquirer
reported that two of the judges "worried aloud that just about
anything could be construed as [related to] payment, treatment
and health-care operations—and thus could be shared." (See http://www.philly.com/mld/inquirer/news/nation/11094851.htm.
Note: This site requires readers to obtain a password.)
All the judges have to do is to read the rule in its entirety
and they’ll see that it doesn’t guarantee true medical privacy.
(The rule doesn’t even define the term.) The judges could declare
the rule unconstitutional. Additionally, the court record will
provide evidence that the government has been misleading Americans
about the federal medical-privacy rule.
Consider, for example, the U.S. Department of Health and Human
Services Office for Civil Rights "fact sheet" about health privacy.
Titled "Your Health Information Privacy Rights," the so-called
fact sheet states "You have privacy rights under a federal law
that protects your health information." (See http://www.hhs.gov/ocr/hipaa/consumer_rights.pdf.)
But how can a federal rule granting more than 600,000 insurers,
doctors, data-processing companies, and many others access to
patients’ records (without their consent) be considered protective
of privacy rights? In an honest and just world, it couldn’t.
And with judges exposing the truth about the rule, the deception
might end sooner rather than later. I’m staying optimistic.
[Back to Contents]
National Health Spending Trends for
2004-2014
Government Spending to Grow, Private Spending to Slow, and
More Seniors to Enroll in Managed Care
National health expenditures are expected to grow to more than
$3.5 trillion in 2014, up from $1.8 trillion in 2004, according
to a recent Health Affairs article and projections from
the Office of the Actuary, Centers for Medicare and Medicaid
Services (CMS). That amounts to approximately $11,045 per capita
(in an estimated population of 324.6 million), an increase from
$6,039 in 2004.
Increase in Public-Sector Spending Growth
The Health Affairs article, titled “U.S. Health Spending
Projections for 2004-2014,” projects faster growth in public-sector
spending on health care. The article reported these significant
findings (quoting):
- By 2014, total health spending is projected to constitute
18.7 percent of gross domestic product, from 15.3 percent in
2003.
- The faster public-sector spending growth is exemplified
by the introduction of the new Medicare drug benefit [which
takes effect in 2006]. While this benefit is anticipated to
have only a minor impact on overall health spending, it will
result in a significant shift in funding from private payers
and Medicaid to Medicare.
- In part because of this funding shift, our projection calls
for public funding of health care to exceed 49 percent by the
end of the projection period—a record share that could have
important implications for the budget as a whole.
Decrease in Private-Sector Spending Growth
Meanwhile, growth in private health care and insurance is expected
to slow from 9.9 percent in 2003 to 7.7 percent in 2004. The
article explains (again quoting):
- Two major factors contribute to this deceleration. First,
growth in the underlying costs of health benefits per enrollee
is projected to slow from 8.9 percent in 2003 to 7.7 percent
in 2004. Second, a modest downturn in the private health insurance
underwriting cycle appears to be under way.
- Private health insurance has historically exhibited a cyclical
pattern, known as the underwriting cycle, in which growth in
premiums first undershoots, and then overshoots, growth in the
underlying medical trend.
- Factors influencing this predicted turnabout are pressures
on Blue Cross/Blue Shield plans from state regulators in the
face of rising reserves…
- We assume that the take-up of health savings accounts (HSAs)
will be gradual and that further increases in all forms of cost
sharing will continue at a pace similar to that of the last
few years.
Increase in Medicare Managed-Care Enrollment
Finally, the Health Affairs article points out that the Medicare
Prescription Drug, Improvement, and Modernization Act (MMA)
of 2003 legislated payment increases to managed-care plans in
2004 and 2005. Quoting again:
- Our forecast assumes a shift in enrollment from traditional
fee-for-service (FFS) Medicare to MA plans [Medicare Advantage
plans, formerly Medicare+Choice].
- MA enrollees are expected to constitute about 30 percent
of total Medicare enrollees by 2014, compared with 12 percent
in 2003.
Sources:
[Back to Contents]
Health Freedom Watch is a monthly email newsletter published
by the Institute
for Health Freedom (IHF), a national nonprofit, educational
organization whose mission is to bring the issues of personal
health freedom to the forefront of the American health-policy
debate. IHF monitors and reports on national policies that affect
citizens' freedom to choose their health-care treatments and
providers, and to maintain their health privacy--including genetic
privacy. IHF is not affiliated with any other organization.
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