Opinion

Senate health care bill: the five paragraphs you must read

Buried in the Senate's 2,074-page health reform bill are provisions that undermine your health freedom and privacy.

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"There is no such thing as a little freedom," said Walter Cronkite. "Either you are all free, or you are not free."

Whether you're for or against federal efforts to help people buy health insurance, you should know that the reform bill before the Senate would mandate a healthcare system that is definitely "not free."

What most of us know about the Democratic bill is that it requires nearly all Americans to have health insurance. What most of us don't know is that it requires us to buy a minimum level of insurance approved by the federal government, and forces health plans and providers to share our personal health information with the federal government and other entities.

If this bill becomes law, we could each be assigned a national beneficiary ID number or card (possibly an electronic device). And our personal health information will flow electronically to the US secretary of Health and Human Services (HHS) – and many others – without our consent.

Sound farfetched? Buried in the Senate bill's 2,074 pages are provisions that actually permit and foster such things. Freedom and privacy are often lost in the fine print – which is why we've been studying the Senate bill since it was released Nov. 19 to help uncover the facts. Here are five highly invasive provisions Americans should know:

1. Mandatory insurance

Bill text: "Sec. 1501. Requirement to Maintain Minimum Essential Coverage.... An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month."

Translation: Uncle Sam will now serve as your national insurance agent and force you to buy "minimum essential coverage" – or else you'll have to pay an annual fine.

However, what Congress considers "minimum essential coverage" and "essential health benefits requirements" includes comprehensive coverage that many neither need nor want. Plus, those who prefer to carry catastrophic-only coverage won't have a free range of options for such coverage.

Bottom line: In a free society, the government should not force citizens to buy any product nor should the government mandate citizens' level of health-insurance coverage.

Rather than imposing penalties to coerce people into government-sanctioned health insurance, Congress should offer incentives to help those who wish to buy insurance but find it unaffordable.

Congress could allow everyone to deduct the full cost of health insurance (and provide tax credits for those with no tax liability), while offering assistance to those who can't afford insurance and subsidize high-risk pools for those with preexisting conditions.

Helping those in need is a much better way to reform our nation's healthcare system than overhauling the entire system and putting Big Brother in charge of deciding what is acceptable coverage for nearly every American.

2. Electronic data exchanges

Bill text: "Sec. 1104. Administrative Simplification…. (h) Compliance. – (1) Health Plan Certification. – (A) Eligibility for a Health Plan, Health Claim Status, Electronic Funds Transfers, Health Care Payment and Remittance Advice. – Not later than December 31, 2013, a health plan shall file a statement with the Secretary, in such form as the Secretary may require, certifying that the data and information systems for such plan are in compliance with any applicable standards (as described under paragraph (7) of section 1171) and associated operating rules (as described under paragraph (9) of such section) for electronic funds transfers, eligibility for a health plan, health claim status, and health care payment and remittance advice, respectively."

Translation: Requiring everyone to buy federally sanctioned health insurance, and then forcing qualified plans to comply with Administrative Simplification requirements, provides the government and health industry with power they would not be able to exercise in a free market.

Administrative Simplification rules are a product of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. They lay the foundation for a nationally linked database of personal health information. A federal "Nationwide Health Information Network" (NHIN) is well under way in the United States, without assurances that individuals will control their personal health data.

Bottom line: Americans should be able to contract privately with the insurance companies of their choice. Patients should be able to decide whether to have electronic or paper medical records, and not have the government require electronic records, which are then included in a nationally linked database.

3. Real-time health and financial data

Bill text: "Sec. 1104. Administrative Simplification…. (4) Requirements for Financial and Administrative Transactions. – (A) In General. – The standards and associated operating rules adopted by the Secretary shall – (i) to the extent feasible and appropriate, enable determination of an individual's eligibility and financial responsibility for specific services prior to or at the point of care.... (i) Eligibility for a Health Plan and Health Claims Status. – The set of operating rules for eligibility for a health plan and health claim status transactions shall be adopted not later than July 1, 2011, in a manner ensuring that such operating rules are effective not later than January 1, 2013, and may allow for the use of a machine readable identification card."

Translation: Administrative Simplification rules are being expanded to gather real-time financial and health data on individuals through a tracking ID, possibly a "machine readable" ID card (electronic device).

Bottom line: Moving forward with real-time data collection without an ethical patient consent provision means everyone loses their health-privacy rights. Congress needs to enact strong patient consent provisions for all health data, especially data collected "real-time."

4. Health data network

Bill text: "Sec. 6301. Patient-Centered Outcomes Research.… (f) Building Data for Research. – The Secretary shall provide for the coordination of relevant Federal health programs to build data capacity for comparative clinical effectiveness research, including the development and use of clinical registries and health outcomes research data networks, in order to develop and maintain a comprehensive, interoperable data network to collect, link, and analyze data on outcomes and effectiveness from multiple sources, including electronic health records."

Translation: Your personal health information may soon be studied by government scientists. Washington is creating a new research center that plans to use patients' electronic health records for conducting research and creating disease registries. The data network is comprehensive and includes use of electronic health records.

Bottom line: Federal funds should not be used to collect data electronically and conduct research on patients' personal health information without their consent.

5. Personal health information

Bill text: "Sec. 6301. Patient-Centered Outcomes Research…. (B) Use of Data. – The [Patient-Centered Outcomes Research] Institute shall only use data provided to the Institute under subparagraph (A) in accordance with laws and regulations governing the release and use of such data, including applicable confidentiality and privacy standards."

Translation: Think your health privacy is protected? It's not. This language refers to "applicable confidentiality and privacy standards," but HIPAA's so-called privacy law permits individuals' personal health information to be exchanged – for many broad purposes – without patients' consent (See 45 CFR Subtitle A, Subpart E – Privacy of Individually Identifiable Health Information; section 164.502(a)(1)(ii) "Permitted uses and disclosures").

Bottom line: Trust is a must for ensuring quality healthcare. Thus, as stated above, Congress needs to pass a strong, ethical patient consent law that ensures patients have control over the flow of their personal health information.

What about the consent of the governed?

All told, the national mandatory health-insurance bill puts the federal government in charge of individuals' insurance choices and data privacy. This philosophy of governing is the opposite of America's founding principle: consent of the governed.

Without health freedom and privacy rights, Congress is opening the door for many wrongs to be committed – all in the name of covering the uninsured.

Sue Blevins is president of the Institute for Health Freedom in Washington. Robin Kaigh is an attorney and medical-privacy advocate in New York.

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