From Professionals to Technicians

A hidden aspect of the president’s stimulus bill will make your doctor even less able to make individual judgement calls on your health care.

In this provision the federal government will- "'guide' your doctor’s decisions (442, 446)." (Page numbers refer to H.R. 1 EH, pdf version).

It also creates a new bureaucracy- "...the National Coordinator of Health Information Technology, (which) will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective."

According to the author of the Bloomberg piece in which these chilling details are revealed, Betsy McCaughey,-

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)
Anybody whose doctors must make difficult decisions in the inevitable atmosphere of fear this will generate will see the quality of their care suffer. So will anyone whose diseases or disorders are uncommon or especially difficult to address with standardized procedures of care. This is especially true for people suffering from chronic pain or mental health disorders, especially from things like fibromyalgia, Multiple Sclerosis, or any of dozens of debilitating, but highly individualized medical problems.

When government starts deciding how medical care must be done those who don't fit their standards of the good patient will be the ones chosen to die first.

Posted by Lee Emmerich Jamison at February 10, 2009 9:46 AM
Comments
Comment #275326

Lee,
Why Senator Spector commented on Fox News today that Congress would review how this part of the bill is written. To throw a red heron up and call for the whole American Recovery and Reinvestment Plan be trashed because it seeks to limit the options of treatment for certain medical problems fails totake into consideration that the current Health System of HMOs and Medicare already use such a program.

Yes, as a matter of Standard Treatment and to keep resreach out of doctoring I do believe that the family doctors should be limited on the treatment that they can recommend. For if 9 out of 10 clients can be helped by a certain treatment, but 1 out of 10 still suffers from the same problems. Should we pay for the family doctor to experiment on the client or force him to transfer the client to a Specialist who can offer different methods of treating the problem?

However, knowing that not even the Lawmakers who put this claus into the American Recovery and Reinvestment Plan did nothing more than give radio and media hosts like Hannity and Rush talking points. I would hope that My Democratic and Republican Pundits could see through the smoke that they are blowing. For seeing that the Bill is going to conference and that now Americas’ Elected Officials know that they can cut it or at least defang it. With the Drug companies and Health Services providing more than 17% of employment and the Etreme Left mad about the Senate cutting education spending. Hope that American Civil, Political, and Religious Leaders can find a fair compromise so that President Obama can sign a Comprehensive Economic, Energy, and Environment Plan that can keep the 20th Century on life support. Because why a First Step it is not the Bold Step that I believe My Peers and Their Children are looking for from Their Elected Democratic and Republican Civil, Political, and Religious Leaders.

Posted by: Henry Schlatman at February 10, 2009 11:10 AM
Comment #275328

The intent of the measure is to mandate electronic record keeping, first with incentives, then as time goes on with penalties for those doctors who don’t get with the program.

I don’t get the panic here. The VA does this, and it part of the reason their healthcare is considered better than private healthcare systems.

Electronic record keeping means you’re not drowning in paperwork, filling out new stuff everytime you show up at a doctor’s office for the first time. It means they can bring up a record of what medications have been prescribed to you, and your medical history without having to resort to swimming through a nightmarish bureacracy of hard copy records.

This stuff has saved lives. People have studied this stuff, and it’s worked for real. But of course, you’re going to take the word of somebody who is wrong now about what the policy goals are here, and was wrong before.

In 1994, McCaughey (as she was then known) vigorously criticized the health care reform package proposed by Bill Clinton in a widely read article in The New Republic. The piece, “No Exit”, won the National Magazine Award for excellence in the public interest. Supporters of the Clinton plan (including some of the editors of the New Republic) were vociferous in their criticism of McCaughey’s criticism. (Andrew Sullivan, The New Republic’s then-editor later acknowledged “I was aware of the piece’s flaws but nonetheless was comfortable running it as a provocation to debate.”)[1] While the article was seized by conservative commentators seeking to discredit the Clinton plan, much of McCaughey’s article later proved inaccurate; particularly, her claims that “the law will prevent you from going outside the system to buy basic health coverage you think is better,” and that “doctor[s] can be paid only by the plan, not by you” were flatly contradicted by the text of the legislation.[2] (Section 1003 of the Health Security Act provided that “[n]othing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services.”)[3]

I’m not a big fan of folks who run “provocations to debate” I want substance, not somebody who’s got what seems like a hair-trigger prejudice on the matter to begin with.

America needs to move out of the twentieth century in terms of medical record keeping. Obama’s measure will create incentives for a transition, and then when enough people should have picked it, then and only then will we see penalties applied. There’s no real point to not doing this. It’s not helping anybody to remain in the stone age.

Do yourself a favor, Lee: do some research for yourself before you let somebody like this stampede you into rash support for an ill-considered opinion.

Posted by: Stephen Daugherty at February 10, 2009 11:16 AM
Comment #275329

Henry,

All states already do have what are called “standards of care”, and these do limit how far out on a limb a doctor can go in treating patients. However, doctors are already highly skilled and will often educate themselves to deal with the specific problems of individual patients. As states have injected themselves into issues like medication and standards of care they more and more frequently are standing directly in the way, interdicting good-faith efforts of physicians to deal effectively with intractible problems.

My wife has lost three doctors in the last ten years because of the difficulties of treating fibromialgia pain under ever increasing burdens of government oversight. Others I know have had to deal with insurers who prevented doctors from trying different psychiatric drugs, though the ones they permitted were either ineffective or even counterproductive. What you’re saying is not that we arrange standard that make more sense for nine out of ten.

What you’re saying is that we sacrifice the tenth, and the other nine turn their backs and whistle, glad that it didn’t happen to them.

Posted by: Lee Jamison at February 10, 2009 11:26 AM
Comment #275330

Stephen,

If, indeed these are merely enticements to create electronic records systems they will be a strong enough program to survive on their own without being thrown into a vast washtub of disparate so-called “stimuli”.

Government repeatedly proves it is not worthy of trust with the intimate records of our lives. Look no further than Ohio’s violations of “Joe the Plumber’s” personal information. It damn sure is not worthy of trusting with things like genetic testing, psychiatric details, sexually transmitted disease histories, and cancer risks when those things would be germane to the probable efficacy of standardized care.

Should we let government compile such record? Perhaps.
Should we allow them to have ready access to those record at their discretion?

Hell NO.

Posted by: Lee Jamison at February 10, 2009 11:40 AM
Comment #275339

Lee Jamison-
Unless and until the system becomes government run, I would say we shouldn’t let the government have any of it without some heavy safeguards.

But if it just about pushing for the adoption of networked, standardized digital record-keeping, I think its long overdue. The average American rarely mails anybody an actual letter anymore. Memos are e-mailed nowadays- printing is optional. Our music has largely gone digital, and so will our TV and even many of our movies.

And why not? Such records have the virtue of being complete, compact to convey, and virtually flawless in their replication. You don’t need to wait weaks, write out records in triplicate, keep track of all those prescriptions… Digital record keeping is a labor saving device, and adopting it will save far more money for healthcare providers than tort-reform ever will.

Posted by: Stephen Daugherty at February 10, 2009 2:17 PM
Comment #275344

Lee, every advance in the human species development from hominid to the present carried with it an opportunity cost, something given up or foregone or to be paid in return for the advancement.

Electronic Records is no different. The benefits of improved health care and reductions in malpractice and accidental mistreatments warrant the opportunity costs of health care providers being pushed toward what they should have developed on their own and out of their own profits.

This is always the tension between government and the private sector when a better way of doing things is resisted by the private sector on the basis that their profits would be reduced by a fraction of a percent.

I am changing doctors, and the process of having my records from all my past doctors transferred to my new doctor is unbelievably time consuming, expensive, and fraught with holes of incomplete records. E-Records solves this problem, and my new doctor having my entire medical history from all previous doctors in a timely fashion will improve the health care I receive from my new doctor. I am 59 years with a decades long medical history, much of which I can’t even remember. E-records solves this problem and many others including all the injuries and deaths which result from on health care person relying upon the written script of another person, often barely discernable and subject to interpretation leading to misreading of prescriptions and procedures.

Let’s get on with it. It will reduce health care costs on some fronts, save lives, and facilitate vastly more accurate medical information available to our health care professionals to assist us in our health care issues.

You can try to turn this into a Big Brother “1984” issue, but infra red invasion of citizens in their homes and businesses is a vastly more dangerous capacity of government as are its covert auditory surveillance capacities.

Posted by: David R. Remer at February 10, 2009 3:54 PM
Comment #275346

From the link:
“The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.”

Interesting.
So, basically, its wrong for govt to listen to me discuss my health on the phone, but its ok for them to have access to and read my health records anytime they want? Its wrong for govt to know what my friends overseas are doing, but its ok for govt to know, and even determine, what my personal doctor is doing?

Well, I guess thats ok. As long as it was the Obama’s idea and saves a few bucks.
Freedom, privacy and all that other crap is over-rated anyways.

Posted by: kctim at February 10, 2009 4:06 PM
Comment #275348

David,

The key is that the records you are transferring now are your property under Texas law.

Texas law will have no sway over the federal system. To whom will the records belong. If someone wants to look at them will they have to have your permission? If they want to use them to investigate you will they need a warrant? If they want to use them to determine if your genetics make a cancer treatment worth the “governments” money (There was a story on the subject this week.) will they have that latitude?

Bet you don’t know.

Posted by: Lee Jamison at February 10, 2009 4:51 PM
Comment #275349

David-

Medical records are a State issue so check on your specifics. In SC transferring your records from one primary care to another is at no cost to you.

Posted by: George at February 10, 2009 4:52 PM
Comment #275354

I changed my primary caregiver two years ago. I signed a request and authorization form and that was it.

Posted by: Jim M at February 10, 2009 6:09 PM
Comment #275355

It must not have been hidden very well. After all, you found it.

Posted by: Dick Cheney at February 10, 2009 6:28 PM
Comment #275357

We all want doctors who can make their own decisions and recommendations. But maybe we’ve carried this want too far already?

> * 42% of people believed they had personally experienced a medical mistake (NPSF survey)
* 44,000 to 98,000 deaths annually from medical errors (Institute of Medicine)
* 225,000 deaths annually from medical errors including 106,000 deaths due to “nonerror adverse events of medications” (Starfield)
* 180,000 deaths annually from medication errors and adverse reactions (Holland)
* 20,000 annually to 88,000 deaths annually from nosocomial infections
* 2.9 to 3.7 percent of hospitalizations leading to adverse medication reactions
* 7,391 deaths resulted from medication errors (Institute of Medicine)

Maybe it’s time SOMEONE stepped in…

Posted by: Marysdude at February 10, 2009 7:32 PM
Comment #275358

Lee,
Why I feel your pain in finding 3 doctors; however, knowing that not all doctors have the training they need to address every issue thanks to 30 years of specialized education your wife expreince with medication that does not work is the exact reason why certain doctors should not be allowed to treat certain problems.

For were you given money back when the pills did not work? Did the doctor adjust your bill for the visits that did not cure or help the problem? Did your insurance company get a rebate from the doctors? Yes, you are among many everyday who pay the Medical Profession $100’s if not millions a year for advice and services that do not work.

So you may worry about your wife recieving proper treatment, but why should the rest of us pay higher health costs for Standard Health Care. In fact, one of my major arguments about today’s health care services is that we hold our auto mechanics to a higher standard than any doctor. Especially since we do not have to pay the shop if the cannot fix a car, but have to pay every penny to the Health Care Industry for tests and treatment that may or may not work.

Yes, advanement in standard health care cost should be based on what works for the vast majority. And why special consideration should be made for those who fall outside the box, those costs should be carried by and out the medical staff and clients offering themselves as living test subjects. For as you point out the difficulties of treating fibromialgia pain and other medical problems. So shouldn’t they be paid as other research subjects in trails or should we keep paying doctors for cod liver oil solutions?

Posted by: Henry Schlatman at February 10, 2009 7:41 PM
Comment #275362

Lee
I realize it must be difficult to accept a competant ,progressive adminisration but still,you could do better than this. This approach will save lives and money. There are some estimates that the amount of money wasted on the enormous amount of PRIVATE medical paperwork if simplified,would be enough to cover the uninsured, not to mention the death and damage from medical mistakes do to poor records. You and I both know that insurance companies use the paperwork to delay or deny payment of claims to maximize profit on the hope the claiment will die or give up. This program is a step forward to universal care. You must hate it that BHO is moving forward to keep campaign promises. Is that your real problem with this, I wonder? Your privacy concerns might have some merit I you had not spent 8 years defending an administration that wanted to monitor what library books Americans read. For profit HMOs already make medical decisions based on profit instead of patient benefit. Insurance companies already access medical records. Our privacy is MORE likely to be protected by this system than the current one with much less overhead.

Posted by: bills at February 10, 2009 10:06 PM
Comment #275364

To the Orwellians,

Does the Center for Disease Control have authority to review private medical records on demand made of health care providers?

The last transfer of Records I made in Texas I had to pay the reproduction costs for. It’s expensive reproducing X-rays, EKG graphs, and the like.

South Carolina may permit the patient to transfer their records at no cost to them, BUT, someone is paying the cost. It costs to reproduce medical records.

Yes, they are my property, Lee, just like my 5 acres is my property, but, just because they are mine, does not negate the Constitutional authority of the FEDs to view those records or enter my 5 acres with a warrant.

The E-Records legislation must require Constitutional due process to be employed BEFORE granting government access to private property. If it doesn’t, the legislation will in all likelihood be struck down by the Courts as unconstitutional. Unless it is a Republican appointed Court, then all bets are off. Bush’s appointees approved by a Republican majority Senate seem to mostly favor the power of the government over the individual citizen where the two are in contest. Ironic considering Republican’s smaller less intrusive government campaign mantra to get elected.

That Constitutional observance is vital to America, which is why the Justice Dep’t. of the Obama Administration has an obligation to investigate and prosecute the parties in the Bush Administration for violations of international treaties to which we were signatories, and violations of citizen Constitutional rights to privacy. The instant America entertains two sets of laws, one for those in power, and another for the rest of us, NO ONE’s privacy or property is safe from the power of Government.

Citizens also have the right of redress for infringement of Constitutional rights through the courts, something Conservatives and Republicans fight tooth and nail with their so called versions of tort reform, designed primarily to prevent individual citizens and the public from sueing the government or corporations when the individual’s rights have been compromised or violated.

You Republicans CANNOT have it both ways on this issue, claiming no one is safe from government, and defending Republican’s immunity from investigation and prosecution no matter the laws they broke or the citizen’s rights they violated.

If you want citizens to be secure against government overreach, you must STOP defending political immunity for government overreach.

Posted by: David R. Remer at February 10, 2009 10:45 PM
Comment #275375

Lee
Seems the special interest have once again thrown a baited hook out there and the right has again swallowed it hook, line and sinker.


From Krugman


The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing.

Because freedom is all about laying out vast sums on medical treatments without knowing whether they’re actually doing any good.

This is the same kind of crap responsible for blowing open federal vault after federal vault to allow special interest to plunder the country we have suffered for the last 8 years, NO MORE!

Posted by: bills at February 11, 2009 6:54 AM
Comment #275379

bills,
Ah, yes, I smell blind faith in the Church of God in Government.

There are some estimates that the amount of money wasted on the enormous amount of PRIVATE medical paperwork if simplified,would be enough to cover the uninsured, not to mention the death and damage from medical mistakes do to poor records. You and I both know that insurance companies use the paperwork to delay or deny payment of claims to maximize profit on the hope the claiment will die or give up.
Agreed, bills. This is in fact what insurers do. More to the point, that is what people who are driven to reduce costs by large corporate, agenda-driven entities do. Here is where blind faith in the Church of God in Government causes an intellectual breakdown.

People buried in the dogma’s of said church do not look hard at the forebears of their diety’s vision. Well, let’s do that for a moment.

Take this article from Reason Magazine. I’ll give you a couple of quotes.

“NICE considers treatments cost-effective if their cost-effectiveness ratio is £20,000 ($34,000) per QALY (quality adjusted life year).”
That comes from an article from the New England Journal of Medicine.
How does this work out in practice? Currently, NICE appears ready to rule out four new effective treatments for kidney cancer because they merely double patients’ life expectancies from six months to a year. As Cambridge University oncologist Tim Eisen explained, “If an intervention which doubles progression-free and overall survival in a disease where nothing else works is deemed to be cost-ineffective, the chances of introducing any new cancer medication must be deemed remote.”

That’s BRILLIANT! Save costs by preventing the use of incremental medical advances! It will only cost a few lives (comparitively speaking) in the first years, and none of the enemies of the Church of God in Government will be able to prove even years out that more could really have been saved!

So, Bills, what you described above is exactly what the Church of God in Government plans to do to you when you get cancer, or gow old, or have trouble adapting your mental problem to the available dogma of psychiatric medication.

But, of course, the Church of God in Government must be a home for innovation, a welcoming place for the “cutting edge”, right? Well…not so much. Just look at what government “innovation” looks like to the people who WANT to innovate at NASA.

Got Kool-Aid?

Posted by: Lee Jamison at February 11, 2009 9:58 AM
Comment #275380

I failed to mention that N.I.C.E. is Britain’s equivalent to the oversight program Tom Daschle had devised for the United States.

Posted by: Lee Jamison at February 11, 2009 10:03 AM
Comment #275384
Church of God in Government
Church of God in Government
Church of God in Government
Church of God in Government
Church of God in Government
Church of God in Government

Not much rhetoric here.

Posted by: womanmarine at February 11, 2009 10:43 AM
Comment #275389

Even sloganeering sometimes has a basis in fact.

Posted by: Lee Jamison at February 11, 2009 11:23 AM
Comment #275390

Read this.

I know, Liberal Blog, and everything, but here’s the nickel summary: The new position isn’t new. It’s five years old, created by Bush. Second, like I told you, the language in the bill only relates to putting records on computer.

More to the point, it relates to how your media figures, your sources are operating.

You folks have to program in some inhibition, or stop programming it out. If I can, with just a little browsing, show your argument to be based on a lie, how does that benefit you? Y’all need to be more discerning, if you want to build a solid foundation for political recovery.

Posted by: Stephen Daugherty at February 11, 2009 11:58 AM
Comment #275404

Stephen,

You are right that the office of health Information technology has been around for a while. I recalled reading of it but failed to connect it with this story. However, that being said, the guidelines by which the office operates and by which it’s use of records is guided say nothing about who owns the records. In fact the key guideline governing the gathering of information is chilling at best-

COLLECTION, USE, AND DISCLOSURE LIMITATION
Individually identifiable health information should be collected, used, and/or disclosed only to the extent necessary to accomplish a specified purpose(s) and never to discriminate inappropriately.
I see in that no sign of sensitivity to Fifth Amendment sensibilities, the very reason some states, like Texas, make a point of making health records the personal property of those whose records they are.

If the records are not pointedly personal property at what point does a search and seizure become “unreasonable”?

I am not against having properly collected, properly maintained, and Fifth Amendment protected medical records. as a mater of fact it would be making my life a whole lot easier even as we speak. But NOTHING in your assurances or in the guidelines gives me any reason to believe the warnings in conservative media are of events that can’t occur under current governance.

Oh, and Stephen, yes we sometimes get facts wrong. I’ll accept admission to the liberal club there. Interestingly enough over the years I’ve noted something it seems reasonable to point out here as well. When liberals express deep distrust of private corporations liberals blame conservatives.

When conservatives express deep distrust of public corporations (government, etc.) liberals blame conservatives.

Posted by: Lee Jamison at February 11, 2009 7:21 PM
Comment #275407

Thank you Mr. Daugherty for putting to rest this canard. Electronic compilation of medical records is way overdue. Indeed, it is astounding that, in this digital age, the medical industry is so far behind the curve. Virtually every significant financial transaction of every American is tracked, compiled and scored for credit worthiness. The fact that the government has to institute, fund and manage such a system for health data speaks volumns about the medical industry.

Clearly, a readily available medical history of a patient will lead not only to more effective care but also to a significant reduction of duplicative and expensive diagnostic and treatment procedures. It promises to reduce in some small measure the extraordinary upward trend in health care costs. Simply stated the proposal has both economic and health benefits.


Posted by: Rich at February 11, 2009 8:56 PM
Comment #275410

Rich,

Taken from the bill noted in my article there is this section-

`Subtitle A—Promotion of Health Information Technology

`SEC. 3001. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY.
`(a) Establishment- There is established within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology (referred to in this section as the `Office’). The Office shall be headed by a National Coordinator who shall be appointed by the Secretary and shall report directly to the Secretary.
`(b) Purpose- The National Coordinator shall perform the duties under subsection (c) in a manner consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that—
Now, it is obvious, but only to people who can read, that if one did not know this office already existed that this bill appears intended to create it. For all one can tell from the bill the people who wrote it didn’t know the office existed.

A canard is a lie. The people who followed up on McCaughey’s report saw a bill saying what she said it said. Not knowing all the minute intricacies of Washington’s labyrinth they, and I, reported what we saw.

It is also not difficult to misread portions of the bill downstream from this, given the legislative wonk-speak of which such things are manufactured. I did think it interesting that the bill would authorize nearly a third of a billion dollars (A billion use to be a big number, didn’t it?) in expenditures for this office.

It is impossible for even an informed layperson to read this with something approaching full understanding, but it would appear that privacy protection from federal breaches is still a serious issue.

I’ll have to look into HIPAA regulations.

Posted by: Lee Jamison at February 11, 2009 10:43 PM
Comment #275411

Lee
“Church of God in Government”? Pretty sillyIf faith is what you are talking about, I do put some stock in statistics,well gathered and wisely interpreted. If a treatment is shown to be less effective than another or even unnecessary why on earth should Medicare pay for it, even if the medical device industry lobbies for it. Its just common sense. The big bad government should no more pay for ineffective
treatment than cover breast implants etc.
“Because freedom is all about laying out vast sums on medical treatments without knowing whether they’re actually doing any good”-Krugman

Posted by: bills at February 11, 2009 10:51 PM
Comment #275414

From the website explaining the privacy rights granted under HIPAA I have found the following-

Examples of organizations that do not have to follow the Privacy Rule include:

life insurers,
employers,
workers compensation carriers,
many schools and school districts,
many state agencies like child protective service agencies,
many law enforcement agencies,
many municipal offices.
OK, now, just to keep score, in the bill noted in the article above I saw no limitations on access or use applied to the government. I was looking specifically that sort of thing because it is the sort of thing Daugherty is good at finding when we conservatives misspeak.

HIPAA does not state that your medical records are your property. It specifically denies you Fifth Amendment protections from search and seizure by several agencies. The bill, as written in the version cited above, largely defers to the rules of HIPAA, though some sections speak of privacy requirements from Social Security legislation.

In other words the issues remain as stated in the article. Though the records being collected are not specifically stated to be for the purposes McCaughey feared and others have reported they most certainly could LEGALLY be used for those purposes UNDER THE RULES OF HIPAA.

Posted by: Lee Jamison at February 12, 2009 12:07 AM
Comment #275415

BILLS,

The “Church of God in Government” is only “silly” to the extent that one thinks you have a handle on what government does.

You see, if I extend my trust to a company and the company sees fit to cheat me or crush me under their might I can turn to government with the help of others to set the company right (though the company often uses its influence to make that hard).

On the other hand, if I turn to government to do what the company used to do and government sees fit to cheat me or crush me under its might to whom do I turn? The faithful of the C.O.G.I.G. will chant t h e g o v e r n m e n t over and over.

People go bad. Corporations are run by people. The government is a corporation. Only a fool sets up a system where the organization of last resort is the first place to whom one turns.

Posted by: lEE jAMISON.COM at February 12, 2009 12:20 AM
Comment #275428

Lee Jamison-
What’s chilling about the guideline saying that companies should gather the bare minimum of identifiable information that’s possible? With all the lost laptops in the world, that’s probably for the best.

I don’t want to embarrass you, but unless you’re dealing with due process or immunity from self-incrimination, we’re not speaking of the fifth amendment here, but rather the fourth.

Here’s what’s lacking here, though: First, you do not quote any law as to what information the government may or may not gather. Presumably, patient records in private hands would be covered by ordinary restrictions against unwarranted search and seizure, and so it would be kind of redundant to emphasize that in guidelines. Additionally, there must be some guidelines and laws already in place governing the government’s gathering and/or use of that information, as it is. What is it in the law itself that would give the Government unrestricted access to medical records?

Unless and until you answer these questions, your suspicions are merely paranoia. I mean, consider this: much of our web infrastructure exists in private hands, yet there are obviously government resources devoted to its development and use. Government involvement does not require government ownership, much less intrusion into private information.

It is also not difficult to misread portions of the bill downstream from this, given the legislative wonk-speak of which such things are manufactured.

So, you don’t have any lawyers on the right who can explain these things to you? I know the Right enjoys trying to win every argument on rhetoric, but if you’re not merely playing the game for the good of the party, but for everybody’s good, there’s a moral imperative and a practical necessity to get your facts straight.

The question is whether you argue these kinds of things to move people with facts and logic built on facts, or whether your intent is to merely push people’s emotional buttons to get them to agree with you.

Worse yet, you might want to consider that the practical consequences are for a party that’s discourse is mostly based on what it feels is right, rather than what it can prove right.

Posted by: Stephen Daugherty at February 12, 2009 12:06 PM
Comment #275433

Stephen,
Thanks for the correction on the amendments. Yes, it was the Fourth, which I had combined with the Fifth in faulty memory.

As for the argument on the basis of emotion versus logic, it is not at all paranoid to want to see assurances at every hand that our employees know their place, especially when they are vastly enlarging the scope of the keeping of our most vital and intimate records. Do we not, at this privately maintained website, keep a set of rules posted to indicate the conditions under which someone is a participant in good standing?
Do we need to?

Not really. It is, however what we do as a matter of course in maintaining an orderly relationship with our guests.

The fact that privacy considerations are, in the bill, deferred to HIPAA “rules” (which the HIPAA site notes are a matter of law) and then makes no other detectable privacy considerations binding to the federal government on issues of search and seizure or ownership of information indicates they INTEND to keep that portion of their relationship with us as vague and fluid as possible.

Homeland Security considerations were poinedly one of the motivations for resident Bush’s establishment of the office we’re considering here. In his hands that latitude used to terrify people. What makes it good now?

Government is merely a tool. It is not inherently either good or bad. People can be either good or bad, though, and it is they who operate the increasingly powerful tool of government.

Stephen, here is the essential logic of giving power to government. Do not hand to the people of your side the powers you would not want the people of my side to exercise.

Someday they will control that tool.

Posted by: Lee Jamison at February 12, 2009 1:02 PM
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