Jewish World Review June 7, 2002 /27 Sivan, 5762

Drs. Michael A. Glueck & Robert J. Cihak

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Consumer Reports

Medical Privacy Lost: A hippo on the healthcare back! | O HIPAA! Wherefore art thou HIPAA?

No, this is not the love plaint of a wooing male hippopotamus calling out for female companions; it's a plaint about how the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (HR 3103) is impacting the medical system and how a new set of "clarifying regulations" and "administrative simplification" will impact your own medical care soon.

This hippo-sized set of new laws and regulations piles on the incomprehensibly complex herd of previously-issued elephant-sized laws and rules already in effect. We estimate that current Medicare laws and regulations alone contain 100 times as many words as the entire Bible.

What difference will it make to you?

For one thing, the cost of medical services will be pushed up to pay for all the consultants, new computer systems and people to manage the systems. That cost is sure to be more than the few billion dollars estimated by the government.

To add to this insult, patients will be asked to read, understand and sign new forms, at least 8 pages long, formally allowing your doctor, your insurance company and your government agencies to "use and disclose" your medical information. This is the information used for your medical treatment, for claims to insurance carriers and for government "health care operations". Even if you refuse to sign the forms, the rules would still require that your doctor and hospital give much of your medical information to your friendly government agencies.

You will find it harder to find a new doctor, or even to get in to see your current doctor. Various government clerks, prosecutors and judges will interpret these new rules differently, just as they've interpreted and reinterpreted previous rules in different ways. Because of the impossibility of doing everything just exactly right for all of these government officials, more doctors will face the possibility of having their reputations ruined and medical licenses revoked. Other doctors are already in jail because of $37.00 billing disputes with government officials. Because of these threats, many doctors are retiring from practice many years before the usual retirement age.

Because managed care organizations have larger legal and administrative staffs subspecialized in dealing with these regulations, more doctors are likely to take a salaried job in managed care and let the organization deal with these new rules. These doctors will be directly working for - and answering to - corporate managers instead of directly working for and answering to you and other patients.

If this happens, a declining numbers of independent doctors will have to learn more and more about the bureaucratic government rules, leaving them less time to keep up on advances in medical science and less time to actually treat patients.

The rules try to dictate that one doctor can tell only the "minimally necessary" data to another doctor in the course of your medical care, such as when you accept a referral from one doctor to a specialist. The rules are so complicated that even HIPAA officials we talked with recently don't understand them! We remain baffled as to why the government wants to know everything, even without your knowledge, but your doctors can't safely talk to each other for your benefit.

Perhaps worst of all is the loss of your personal medical privacy. The new regulations allow government employees claiming an undefined "national priority" purpose to look at your most private medical information without your consent or even your knowledge. A tiny, paperwork fig leaf in the earlier rules hid the government's desire to completely ignore your desire for privacy. The new rules rip off even that fig leaf.

We should interpret "privacy" in a traditional sense, to mean privacy for your control of your own records, not privacy against your control. We do not believe Congress intended "privacy" for government agents who secretly and unaccountably acquire your personal medical information, all without your consent.

So, faced with 2000 pages of HIPAA regulations, non-private privacy regulations, 137,000 pages of Medicare insurance rules enforced with an M-16 and malpractice insurance rates up 400 percent -- is it any wonder that your doctor will not be in? What other choice with a hippo on your back?

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Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.


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