Health Freedom Watch
Medical Freedom Initiative Launched in Arizona; Supported by 71 Percent of Voters
A ballot initiative in Arizona would preserve citizens’ rights to make their own choices about where, how, and from whom they receive their health care. “The Freedom of Choice in Health Care Act” is being proposed by “Medical Choice for Arizona,” a newly formed group of liberty-minded physicians and others who are concerned about the trend toward single-payer health care.
Dr. Eric Novack, the group’s chairman, says that approximately 71 percent of Arizona voters surveyed would vote for an amendment to ensure their right to choose whether or not to be included in a government-run or -mandated health-care system. Support increased to nearly 80 percent after arguments were presented for and against the initiative, according to a survey conducted in June 2007 among 500 likely Arizona voters.
Dr. Jeffrey Singer, a Phoenix surgeon, told the Arizona Republic that “[The Freedom of Choice in Health Care Act] would be a dose of preventive medicine to preserve patients' choice in health coverage.” The newspaper notes that two other groups in Arizona are exploring 2008 ballot initiatives that would take a very different approach, namely, universal coverage. “These ideas are floating around and they make me scared,” said Singer. “What if we get into some kind of program we can't get out of, where there’s no way out?"
Singer told the Arizona Republic that he has no prescription for the nation's health-care policy other than the ballot measure's stated intent to enshrine in the state Constitution the freedom to choose private health-care systems or private plans of any type. “Don't take our freedoms away,” Singer stressed. “We're neutral on everything else.”
The full text of the initiative reads:
“Because all people should have the right to make decisions about their health care, no law shall be passed that restricts a person's freedom of choice [of] private health care systems or private plans of any type. No law shall interfere with a person's or entity's right to pay directly for lawful medical services, nor shall any law impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan.”
Medical Choice for Arizona needs 230,047 voter signatures by July 3 to qualify the initiative for the November 2008 ballot.
- “State Health-Care Measure Touts Choice,” Arizona Republic, September 26, 2007.
- “Medical Choice for Arizona: Campaign Summary,” September 2007.
- “Full Text of the Freedom of Choice in Health Care Act,” Goldwater State blog, October 4, 2007.
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(Article modified/updated 10/31/2007.)
Microsoft Launches Free HealthVault for Storing and Sharing Medical Information Online
On October 4 Microsoft Corporation launched a free service called HealthVault that facilitates the gathering, storing, and sharing of health information online. According to Microsoft’s “Frequently Asked Questions” (FAQ), the service allows consumers to control who has access to their electronic medical records.
The following excerpts from the company’s FAQ about HealthVault may be of particular interest to Health Freedom Watch readers:
Q: How is HealthVault different from a personal health record?
A: HealthVault is not a personal health record (PHR). It’s a way for individuals to collect, store and share health information where partners can build applications [systems] that use health and wellness data to provide solutions for people. We expect there to be many different PHRs available in the future (for example, fitness, chronic condition). HealthVault offers a way to connect, store and share all this information in one place, without being tied to a siloed database. [Emphasis added.]
Q: What is Microsoft’s approach to privacy for the HealthVault platform?
A: People willing to try Microsoft’s HealthVault must trust that their data will not be lost or misused by us or anyone else. Microsoft designed and built HealthVault with a strong foundation of security and privacy while consulting with experts inside and outside the company to augment our significant expertise in these areas. HealthVault’s privacy principles show that we’re committed to putting people in control of their health information:
- The Microsoft HealthVault record you create is controlled by you.
- You decide what information goes into your HealthVault record.
- You decide who can see and use your information on a case-by-case basis.
- We do not use your health information for commercial purposes unless we ask and you clearly tell us we may.
Computer Privacy Expert Voices Concerns
In response to Microsoft’s announcement, Annie Antón, founder and director of ThePrivacyPlace.org (a research group of students and faculty at NC State University, Georgia Tech, Purdue University, and University of Lugano), questions whether that vault is really going to protect consumers’ privacy. Antón shared the following (excerpted) concerns and questions regarding HealthVault:
...Over the course of the past 7 years, researchers at ThePrivacyPlace.org have evaluated over 100 privacy statements for financial and healthcare web portals. In addition, we focus on evaluating the extent to which the privacy of sensitive information is protected in these systems as well as the extent to which system[s] comply with relevant regulations.
Even though physicians and the press are excited about the introduction of these new PHR systems, there are questions that I urge the public to ask before entrusting their sensitive health records to any PHR system. My concerns are based on a careful evaluation of the HealthVault privacy statements. Microsoft appears to have sought the counsel of physicians who believe that patient consent is the best indicator of privacy protections. Unfortunately, most physicians do not understand the subtleties buried within healthcare privacy statements within the context of the software that implements those statements. For this reason, I now list three primary questions that one should ask before entrusting their health records to HealthVault or any other PHR system: [Emphasis added.]
- Will your health information be stored in other countries without appropriate legal oversight, skirting many of the protections afforded by the HIPAA?
The HealthVault privacy statement explicitly states that your health records may be off-shored to countries that do not afford the same privacy protections for sensitive information that we do in the United States. In particular, if information is disclosed or altered, do you have any legal recourse or remedy?
- Will your health care records be merged with other personal information about you that was previously collected within the context of non-health related services?
Within the context of HealthVault, the answer to this question is yes. Microsoft explicitly states that they will merge the information they have previously collected from you via non-health related services with your HealthVault information. Moreover, it is unclear what information Microsoft already has about us other than our names and contact information and precisely what information third parties may access. Furthermore, we don’t know if that information is accurate or complete. Thus, use of the merged information may not be what we expect.
- Are the access controls to your health records based not only on your consent, but also on the principle of least privilege?
Although HealthVault requires patient consent for any accesses and sharing of your health records, access controls leave the door wide open for data breaches. HealthVault enables individuals to grant access to other people and programs that can further grant read/write access to your health record. The only safeguard is a history mechanism to provide an accounting of accesses if you suspect that your information has been breached after the fact. A better approach would be for Microsoft to proactively enforce contractual obligations via audits and monitoring mechanisms.
Antón also stressed, “The hype surrounding HealthVault’s privacy protections among those in the medical community must be balanced with the reality of the information security and privacy practice expressed in its public privacy statements.”
Patient Privacy Rights Supports HealthVault
The Austin, Texas-based Patient Privacy Rights, which worked with Microsoft to ensure patient privacy, announced its strong support for HealthVault. The group’s October 4 press release stated: “Earlier this year Microsoft sought advice from PatientPrivacyRights.Org about building privacy protections into their new consumer health platform, HealthVault. Today Microsoft’s HealthVault system goes ‘live’ and proves that technology can give consumers complete control over who can see or use the information in their health accounts….”
It goes on to note, “PatientPrivacyRights.Org applauds Microsoft’s implementation of the most stringent existing standards for privacy in HealthVault. Microsoft’s willingness to incorporate the Coalition’s strictest privacy standards is truly revolutionary and sets a new, very high bar for the entire industry…. No consumer should trust any digital health system or technology product that does not follow the same best practices for privacy and security that HealthVault has put into action. PatientPrivacyRights.Org looks forward to standing with other technology corporations as they step up and employ best practices for privacy and security.”
The offering by private companies of consumer-controlled privacy polices is certainly a great step in the right direction. However, Americans need to be assured that our state and federal laws will uphold contracts regarding private health data. In other words, a good business policy without law behind it is no assurance of privacy. Microsoft has the financial and political muscle to make sure laws do safeguard consumer-controlled privacy.
- Microsoft HealthVault Virtual Pressroom, October 4, 2007: www.microsoft.com/presspass/events/healthvault/default.mspx
- “Is That Vault Really Protecting Your Privacy?,” by Annie Antón, ThePrivacyPlace.org, October 9, 2007.
- “Microsoft Raises the Bar for Privacy in Electronic Health Record Solutions,” Patient Privacy Rights, October 4, 2007.
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Advice for Hillary; Bravo for Stossel
The following is a commentary from John Goodman’s blog:
Her plan was released [September 17]. There are lofty goals, but not many specifics.
[Nearly twenty] years ago Michael Dukakis campaigned for president with the boast, “I have insured everybody in Massachusetts.” Of course he hadn’t, and two decades later, everybody in Massachusetts is still not insured. Along the way there have been many other plans to create “universal coverage.” They haven’t worked either.
This is why candidates don’t get any points from me for “the thought was there.” Universal coverage at a minimum requires a credible plan. So far, no presidential candidate has come up with one, unless you count Dennis Kucinich’s plan to give health care away for free to everyone.
Here are a few principles politicians tend to overlook.
1. Employer mandates don’t work. Hawaii has had an employer mandate for more than 30 years; and the uninsurance rate in Hawaii is higher than in several states that have no mandate. A mandate is a tax on labor. Employers respond by economizing on labor as well as by turning to part time and contract workers. Pay-or-play mandates (insure your employees or pay a fine) have the same effect.
2. Individual mandates don’t work. All but three states mandate auto liability insurance. Yet the national uninsurance rate for drivers is only a point or two below the national uninsurance rate for health. Two Canadian provinces require a nominal premium to enroll in Canada’s Medicare. The uninsurance rate in those provinces is in the neighborhood of 4% to 5%.
Even if health insurance is absolutely free, mandates are unlikely to work. Up to 14 million people (almost one-third of the uninsured) are eligible for Medicaid or S-CHIP, but have not bothered to enroll.
3. A mandated benefit package only makes things worse. Health insurance mandates almost always specify a package of benefits that people must buy. The problem here is the cost of the package is going to grow at twice the rate of people’s incomes. So the mandate will absorb an increasing share of family income or require increasing tax subsidies. Things are made even worse as special interests lobby to include particular services and procedures in the package.
A much better alternative to a defined benefit, by the way, is a defined contribution requirement. The government could, for example, require people to spend $X on health insurance or pay $X in taxes, leaving cost control and the content of benefit packages to the market.
4. Insurance in name only is not universal care. The most important barrier to care for low-income patients is not lack of insurance or price rationing. It is rationing by waiting. Further, the uninsured and Medicaid and S-CHIP enrollees often get care from the same doctors and the same facilities. Indeed one reason why so many eligible people fail to enroll in government insurance plans is that enrollment often doesn’t expand access to care.
5. Pay or play for individuals is not enough. Making individuals pay more in taxes if they are uninsured is not unreasonable. In fact, we do that already under federal income and payroll tax laws. But as Massachusetts is currently finding out, many people will pay the fine and remain uninsured anyway.
6. The NCPA’s universal coverage plan is a reasonable solution. Fifteen years ago, Gerry Musgrave and I sorted through all this in Patient Power. Our idea combines all tax and spending subsidies into a single, simple policy. The government offers every person a subsidy of $X. If you buy health insurance, you get the $X as a refundable tax credit. If you are uninsured, the $X goes into a safety net institution in your neighborhood just in case you, and others like you, cannot pay your medical bills. A link to the latest exposition of the plan is below.
Bravo for Stossel
If you didn’t see John Stossel’s 20/20 program [September 14, 2007], you missed the best documentary on health care I have ever seen. (Best Scene: in Canada, a dog gets his MRI scan in one hour; people wait six months!) Get the DVD. View it. Share it with friends. Send a copy to our friends at The Commonwealth Fund. And note something about it that is unique.
For the past decade and a half, the orthodox conservative response to Hillary Care has been Hillary Lite. The left says, “The problem is that there is too little health insurance.” The right says, “You are right, that is the problem; we just don’t want as much insurance as you want.”
In Stossel’s program, insurance is neither the main problem, nor the main solution. Instead, the focus is on the market for medical care—on the value of empowering patients and letting providers compete for them.
John C. Goodman, Ph.D., is president of the National Center for Policy Analysis in Dallas, TX (www.ncpa.org).
Source: The John Goodman Health Blog, September 17, 2007.
- For Sen. Clinton’s summary of her plan, visit: (www.hillaryclinton.com/feature/healthcareplan/summary.aspx).
- For the NCPA’s universal coverage plan, see John Goodman’s article on “The ‘Do No Harm’ Principle to Health Policy” in: (http://cdhc.ncpa.org/commentaries/applying-the-do-no-harm-principle-to-health-policy).
- To get a DVD of Stossel’s 20/20 program go to: ( http://abcnews.go.com/2020/Stossel).
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(Article modified/updated 12/16/2007.)
Health Freedom Watch is published by the Insitute for Health Freedom. Editor: Sue Blevins; Assistant Editor: Deborah Grady. Copyright 2007 Institute for Health Freedom.