Fix health care by keeping records private

The President’s new healthcare record digitization plan is fraught with good intentions.

Making healthcare records easier to exchange, analyze, cross-reference, maintain, and update. No one seriously doubts that particular issue. However, there are serious problems with the President’s plan that show the intrusion of big-government thinking over individual freedom.

There is no reason why the government needs to maintain the health records all by itself. What the industry needs, if anything, is for government to regulate, not by taking over the market, but by setting standards for data schema, interoperability, data ownership, data correction, privacy, security, and portability. By setting up these types of rules (and the federal government already handles similar issues via HIPAA, credit report rules, and cell phone numbers), government allows the market to expand through the efforts of non-governmental entities, such as nonprofits, healthcare companies, and separate private data warehouses. By solidifying the ground rules, government can create an immediate common platform for development and implementation.

Is that the only role for government? Of course not. Should the President want to “ensure” that everyone have access to this new system, the government could certainly provide such services to everyone for free. (The VA and medicare will certainly maintain their own databases in much the same way they do now.) An analogy can be made to the vehicle inspection regime in New Jersey: the motor vehicle department will inspect your car for free at specified location with (or sometimes without) an appointment. Or, you can have your car inspected at your convenience at a local garage for a modest fee. This dual approach helps people by allowing the market to segment itself rather than forcing everyone into the same box. Could we allow, but not require, everyone to use Medicare’s version of the health record information system? Why would a system that covers so many people *only* work if we force everyone else to use it too?

Avoiding the possible abuse of access by insurance companies, healthcare companies, or even hospitals is a worthwhile goal, but there is no reason that every citizen must then be required to trust the government. After all, many of these same politicians become incensed about government databases of other kinds, such as pictures of protesters at political rallies or even the cross-referencing of connections across pre-existing databases (remember “TIA?”).

Why should the citizens be forced to give up their most personal information to the government? Only fans of big government, who are confident in their own good intentions and certain of their wise decisions would tilt the scales in favor of the federal government, particularly when the other positions about government databases are considered. I expect we will hear assurances about the inviolate nature of the database, but a compelling case will certainly present itself quickly. What Democratic representative or senator will say that health data cannot be accessed to track a killer of doctors who provide abortions? A wifebeater? A child molester? A right-wing militia-style terrorist? An al-Qaeda sympathizer (sorry, that’s the other guys)? The basic point, the fundamental libertarian approach here, is that we can almost certainly trust people to make better decisions (for them) about how to disclose their medical information than government would; we ALREADY do that today. How does taking that power from the people increase freedom rather than extend government’s reach? How can we possibly prevent politicians from either party from deciding that their new bugaboo is a compelling-enough justification to eliminate the protections that will half-heartedly be added to this legislation?

Twist the issue around, and there’s no categorically worthy justification for preventing people from keeping their data safe from Uncle Sam virtually all the time. Hypotheticals about emergency access to data affect every system equally, and required disclosure scenarios (e.g., adoption, infection, genetic diseases, child support) will either affect the government system equally or have already been outlined by separate legislation in other areas, such as the rules that allow the IRS to share taxpayer information for the purposes of helping ensure payment of child support.

In short, government here can do what governments do best in these situations: set a standard and enforce compliance with the standard. There’s no need to overreach and take power from the people.


Why is this here? Because handling information is what America is all about these days. And handling it wisely, in ways that are respectful of the rights of the individual, is what prevents government officials, particularly well-meaning ones, from doing harm to us “for our own good.”

I’ve been working on and updating my proposal for a child-centered autism information system (maybe that’s the name, but I’m not sure yet). Thinking about ownership, control, and access to information is part and parcel of that project, and it reminded me of this. More to follow, of course.