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Health Freedom Watch
July 2007


Should Congress or a Federal “Entity” Establish Your Privacy Rights?

The federal Agency for Healthcare Research and Quality (AHRQ) is proposing to establish a national “entity” to set rules and standards for collecting, sharing, using, and reporting health-care data. The AHRQ, a division of the Department of Health and Human Services, is requesting public comments on its proposal to create a National Health Data Stewardship Entity (NHDSE).   

If established, the NHDSE would be authorized to undertake “a wide range of activities [to] advance health data exchange and use, including the development of measures and setting data transmission/IT technical standards.”  AHRQ stresses, “While all of these activities are important, the entity's responsibilities would primarily focus on specific issues relating to data collection, aggregation, analysis, and sharing.” 

Regarding data collection, the agency wants to “set policies, rules and standards for collecting public and private sector data from relevant stakeholders, including providers, employers, health insurance plans and others…” It notes that based on current law, allowable data uses may include quality and efficiency improvement, consumer reporting, accountability, and pay-for-performance programs.

The agency also proposes setting policies, rules, and standards for data access and sharing.  For example, the new entity would determine “who should have access to data and applicable limitations, such as confidentiality and privacy rules; should consider policies which allow contributors, including both public and private sector entities, to have access to their own data as well as information which allows them to compare their data against benchmarks.”  It would also develop “guiding principles” for public reporting.

Twila Brase, president of Citizens’ Council on Health Care (CCHC), responded:  “We believe the proposed National Health Data Stewardship Entity (NHDSE) would open wide the vaults of private medical data, authorizing the exposure of more than 300 million Americans to unwanted disclosures…The proposed NHDSE would nationalize ownership and control of private patient data….”  The entire CCHC letter is online at:

An important question for all to consider is whether Congress or a federal health agency should be empowered to establish health-privacy rights for all Americans.  Brase stresses that under AHRQ’s proposal to establish a national data-collection and sharing entity, “A group of bureaucrats, corporate executives and political appointees would set the rules for how all private [health-care] data is disclosed and used.”

Public comments on AHQR’s proposal must be received by Friday, July 27:

  • Electronic responses are preferred and should be addressed to: (
  • Written responses should be addressed to:

P. Jon White, M.D.
Health IT Director
540 Gaither Road
Rockville, MD 20850

  • AHRQ notes: “Any information submitted will be made public. Do not send proprietary, commercial, financial, business confidential, trade secret, or personal information that should not be made public.”

Citizens should also share their own views about health-privacy rights with their elected officials, advising them as to who should establish privacy standards/rights: unelected government employees or members of Congress?

AHRQ’s Request for Information regarding the NHDSE: Federal Register, Volume 72, Number 106, June 4, 2007, Page 30803-30805.

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Private Health-Care Options Must Be Defended
By Richard E. Ralston

The U.S. government now pays for and controls half of the health care in America. That is up from less than 10 percent forty years ago. Government spending on health care has increased at a rapid rate as its share of health care has increased. Yet those who complain about the total amount of spending on health care in the United States to justify complete government control never discuss how much of the current spending is attributable to or mandated by government programs.

During a recent interview, a talk radio host told me that all private health insurance should be eliminated in order to give us all a reason to work together to make sure the government runs a good health care system.

My first reaction to that statement was to question how that approach has been working for public education. But I will come back to that. A better analogy would be that conditions in our prisons might be expected to improve if we were all required to live in them. Socialists and some Liberals would find this level of government-enforced uniformity to be a noble sacrifice to which all citizens must submit. Many Conservatives would reluctantly agree—but suggest a voucher system that would allow us each to select the prison cell of our choice.

The same reasoning would require the government to outlaw Federal Express, UPS and other private carriers, and force everyone to use the U.S. Postal Service exclusively. After all, Americans are now spending more than the citizens of any other country on package delivery. Even worse, poor people cannot afford to send anyone a FedEx package. Why allow rich people to have access to a better package delivery system? Would it not be simple social justice to require everyone to use the U.S. Postal Service? So what if it provides slower and less reliable service? Would not everyone be forced to band together to ensure that USPS does a better job?

Of course, we tried that for nearly 200 years when postmasters were politically appointed as a part of a federal spoils system. The Postal Reorganization Act of 1971 created the U.S. Postal Service as a semi-independent agency with less political interference. That plus only limited competition, in the likes of FedEx and UPS, was enough to cause the U.S. Postal Service to improve its efficiency and reliability considerably. What would be the consequences of eliminating that competition and restoring a total government monopoly? Would the U.S. Postal Service become better and cheaper?

Parents certainly have reason to band together to improve the near-monopoly of public education. They can exercise control only through politicians who often place their own interests—or those of public employee unions—ahead of those of students. Heads of unions, vying for political pull, use mandatory contributions deducted from teacher salaries to place their interests in the front of the line—ahead of students and parents. The leaders of those unions, who may spend hundreds of millions of dollars for contributions to politicians, maintain, of course, that their only concern is the welfare of the little children. Imagine for a moment what the power of a national physicians union or a national nurses union would do to health care, or imagine the prospect of a national health care strike. The only objective of these unions would be better health care for you, and for the children, right?

There are those who tell us that if we only place all of our trust in the government to control our health care, our problems will be solved. If only enlightened intellectuals ensure that each and every election puts their candidates for President and Congress in control, efficient and loving government will meet all of our medical needs. We all have surely learned that government always does a good job, and has a swell record at keeping down unnecessary expenses.

What would really happen if we had no options except government health care and no place else to go? What choice did wounded soldiers at Walter Reed Army Medical Center have? If this happened right under the nose of Congress—indeed in view of the windows of the VIP suites at the hospital reserved for Cabinet members and Congressmen—what kind of quality and oversight should the rest of us expect from a government system?

One of the things that helps curtail the inferior standards that exist in government health care is a comparison with services provided by private medical care. Such private care must be protected. Without it the 50 percent of care now paid for by the government would get much worse.

[Coerced] collectivism does not work. The immoral use of government force cannot compel better health care. Putting us all in a government health care prison will not ensure better health care. Only freedom can do that.

Richard E. Ralston is executive director of Americans for Free Choice in Medicine: Copyright © 2009 Americans for Free Choice in Medicine. Reprinted with permission.

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Massachusetts Mandatory Health-Insurance Watch

Exemptions: To avert a public backlash, nearly 20% of uninsured adults (some 60,000 persons) who don't qualify for subsidies but can't afford coverage will be exempted from the mandate to buy insurance (Boston Globe, 4/12/07).

Benefits Set: Massachusetts is the first state to set standards for "acceptable heath coverage" that apply to every resident and every insurer. Drug coverage, a maximum individual deductible of $2,000, and a $5,000 out-of-pocket maximum for in-network providers, are to be mandated (NY Times, 3/21/07). All plans for low-income persons have a host of non-preventive mandates below the deductible that make them ineligible to include an HSA [health savings account] (American Spectator,3/20/07).

"Universal Coverage Is a Tax," Citizens Say: One citizen complains that since his $300/month catastrophic plan isn't approved by the [Commonwealth] Connector, he'll be taxed $700/month to upgrade his plan. Another said that minimum credible coverage was designed such that any non-Massachusetts plan would be insufficient.

"More Mirage than Miracle": Massachusetts is already a very high-cost state "with a concentrated market of relatively inefficient providers already swimming in a sea of dysfunctional public subsidies and crippling overregulation." The plan "hopes to coerce enough relatively healthy uninsured residents into paying more for coverage than it is worth to them" (Health Affairs, 9/14/06).

Insurance Premiums Based on Income: Like in Canada, but for the first time in the U.S., people will have to pay more for equivalent coverage if they earn more. The Connector has determined the "Maximum Affordable Premium" to range from $0 for income up to $15,315 to $300/mon for income between $40,000 and $50,000. Those whose income increases from $40,000 to $40,001/y are expected to pay $100/mon more for their medical insurance (Consumer Power Report, 4/19/07)....

Source: Reprinted from AAPS News, June 2007:

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Health Freedom Watch is published by the Insitute for Health Freedom. Editor: Sue Blevins; Assistant Editor: Deborah Grady. Copyright 2007 Institute for Health Freedom.