The digitalization of health care records is snowballing in the media. Many of the problems not related to the budget for this activity center on privacy and data security.
Departing for a moment from the conventional arguments, I want to explore why this privacy is necessary, and if there is anything that could be done to reduce the need for privacy, and the gravity of the breaches that will certainly come.
Our current healthcare system is obviously on the over-the-hill side of an insurance system life-cycle. Given a lengthy time period, any open insurance system will end in failure, as the rising premiums price out more and more potential contributors. For a moment, accept that we have a market failure in the US for health insurance. What do we do? The free market answer is to let the system fail, take down the health insurers and the current health care pricing models with it, and then start over with another free market system. If we were talking about something that was not life saving, everyone would be screaming to let it go and rebuild already, as the population does about the bank and automaker woes. However, due to the incredibly emotional nature of health care, and the dire individual consequences of having a system in flux, prepackaged bankruptcy and reorganization does not seem to be an acceptable course of action.
Assuming that the free market approach will end soon in the health insurance companies going under, this gives us more freedom to explore other options. For health care, the obvious solution continually centers on nationalization. I say that understanding fully that my individual health care would probably get worse, at least for awhile. Many people with premium health insurance options feel the same way, and state that they are compromising by either simply saying no to another option, or accepting the thought of a nationalized healthcare system but insisting that there be supplemental paid insurance (a model that would compromise the baseline healthcare, and get us right back to the problem we are experiencing now). As a population, we treat healthcare in a much different way than cars or banks when we discuss its possible failure, so why are we so averse to treating it differently in “normal” operation?
Now armed with the assumption of health care nationalization, let’s move on to the privacy aspect, and why it is important right now. In our culture, being sick is often embarrassing, and many choose to hide their illnesses from friends, family, coworkers, and as we have seen lately, investors. This behavior is understandable, as there are currently all types of discrimination against the sick. Some of this discrimination comes from the fact that the sick might not be covered by health insurance, and if they are denied their claim, they are more or less out of luck because of the comical healthcare pricing in our current system. At the same time, the illnesses are often discovered at much more advanced stages because we have a medical care system that discourages preventative care.
The argument that our system discourages preventative care can be summed up by the “pre-existing condition”. If one switches providers or loses insurance for a period of time, as is common in the US since we have a system primarily dependent on employer-based health care, they may be ineligible for insured healthcare from a new provider for conditions diagnosed previously. This creates an incentive to remain ignorant of health problems so they will not have to be paid out of pocket in the event of an emergency. By creating a system where the insured have an incentive not to catch possible problems early, and to avoid things like genetic testing, we have defeated our insurance system from within. The current system forces out many of the sick, but does not give discounts to the healthiest users to make up for this. This provides a disincentive for the healthiest users to participate in insurance, and the system collapses from there.
Because of insurance exclusion in our current system, privacy is of the upmost importance, so much so that individuals often prefer to remain ignorant of their own impending health problems for fear of being excluded from insurance. A nationalized health care program would remove this disincentive for knowledge, and would likely make the need for privacy less important, as an acknowledgement of a medical problem would not lead to insurance exclusion. If there was not a possible penalty for learning about genetic conditions or future medical problems, many more individuals would likely prefer to know the medical histories and futures, and would not have the same fear of sharing their findings with the medical system. Obviously, medical records should not be made open to the public, but it seems misguided that this country is attempting to build the Fort Knox of data repositories to help continue such an obviously failed insurance and care system.