PATIENT IDENTIFIERS: Health Care IDs Under Fire

      Plans to assign every American an electronic medical code are emerging in Washington amid the noisy debate over medical privacy and other patients' rights. The 1996 Kennedy-Kassebaum health insurance portability law mandated the development of a Department of Health and Human Services system that would create a "unique health identifier" for every American, but so far, federal officials have made little headway. The New York Times reports that officials were supposed to have a proposal ready by February, but ran into stumbling blocks as they attempted to hammer out a plan. Today, the Clinton administration will begin a series of public hearings to solicit comment on the proposed health care codes.

Pros And Cons
      So far, the issue has elicited a mixed reaction from parties that would be involved in the codes' implementation. The plan's backers say the system would mean simplified monitoring of patients' health, streamlined billing procedures and opportunities for further study of disease. But opponents "say the code smacks of Big Brother," and say they fear patient information would not be safe in a mammoth government database. "If this information ended up in some central repository, some giant clearinghouse, what protection do we have that some vandal would not break in?" asked Dr. Donald Palmisano, the American Medical Association's medical privacy expert. "What ID numbers do is centralize power, and in a time when knowledge is power, then centralized information is centralized power. I think people have a gut sense that this is not a good idea," said Dr. Richard Sobel, who studies the questions surrounding government databanks at Harvard Law School.

Fuzzy Details
      The 1996 Health Insurance Portability and Accountability Act also requires the government to assign codes to employers, health plans and providers, but only the patient ID proposal has stirred this kind of contention. So far, however, administration officials are still ironing out the specifics of the plan. They have not determined what kind of code the identifier will be; suggestions include Social Security numbers, other composite numbers or "biomedical markers" like thumb prints or electronic retina scans. Dr. Don Detmer, chair of the National Committee on Vital and Health Statistics, which is advising HHS head Donna Shalala on the issues, said, "My own feeling is that you do need to have a way to identify people uniquely. Now the challenge comes down to what is the best way of doing that." In a reversal of its usual ruling-making procedure, HHS will first seek public input on the proposal. The first hearing will be held today in Chicago. "It will be interesting," said Dr. Christopher Chute, a member of the HHS panel and an advocate of the system. "It could reduce to yet another forum for the disgruntled and the paranoid to vent." The Times reports that if "no consensus can be reached on how to develop the system, the administration could be forced to drop the plan and report to Congress that it was impossible to achieve."

On The Hill
      On Capitol Hill, patient privacy is already a hot topic; six bills on the issue are circulating in Congress. Lawmakers are debating provisions that would allow patients to exempt themselves from the system and are discussing whether "federal privacy legislation should override stricter state laws." And despite assertions by proponents of the medical ID that the plan would create a national repository of medical knowledge, opponents fear the consequences. "That information will be irrevocably integrated into a cradle-to-grave medical record to which insurers, employers, government and law enforcement will have access is, to me, exactly what privacy is not," said A.G. Breitenstein, director of the Boston-based Health Law Institute. "People are not going to feel comfortable going to the doctor, because now you are going to have a permanent record that will follow you around for the rest of your life that says you had syphilis, or depression, or an abortion or whatever else," he added. However, University of Pennsylvania bioethicist Dr. Arthur Caplan called the debate about a unique identifier a "red herring." He said, "It's illusory to give people the idea that they can protect privacy. Your managed care company knows what doctors you see, what pills you take, how often they are prescribed. What don't they know?" (Stolberg, 7/20).

Schlafly's Two Cents
      Columnist Phyllis Schlafly criticizes the federal proposal in Saturday's Washington Times, characterizing it as one of a series of incremental steps President Clinton has been working toward since his national health care plan failed in 1994. "Allowing the government to collect and store personal medical records, and to track us as we move about in our daily lives, puts awesome power in the hands of government bureaucrats," Schlafly writes. "It gives them the power to force us to conform to government health care policy, whether that means mandating that all children be immunized with an AIDS vaccine when it is put on the market, or mandating that expensive medical treatment must be withheld from seniors." She concludes: "Once all medical records are computerized with unique identifiers ... an instant check system will give all government agencies the power to deny basic services, including day care, school, college, access to hospital emergency rooms, health insurance, a driver's license, etc., to those who don't conform to government health policies" (Washington Times, 7/18).