Bush to allow marketers to look at your medical information.

August 10, 2002 6:07 AM

Bush to allow marketers to look at your medical information. The bad news: Everyone is going to know your medical history without your approval. The good news: Free prozac. Reg: cpunks/cpunks
posted by skallas (28 comments total)

That Bush, always looking out for the little guy. Perhaps some nice compassionite conservative group will print flyers naming the HIV positive people in the neighborhood. I can't wait to have my medical history used against me for the rest of my days.

This administration's actions are becoming simply unexcusable. Can't wait for 2004.
posted by skallas at 6:13 AM on August 10, 2002

More at the NYTimes
posted by skallas at 6:25 AM on August 10, 2002

So, from what I understand from the article...HIPAA really doesn't matter anymore. This is after 5 years of getting ready for governmental actions. If you work in a hospital of some kind, you really know how much money has been wasted, only to have Bush change the rules at the last moment.

The HIPAA regulations pretty much made hospitals change anything from registration forms, information desks, how EMTs use the radio and even the wording on photo releases for Marketing. Damn....
posted by mkelley at 6:35 AM on August 10, 2002

This is B*LL$HIT! WTF do "marketing companies" have to do with treatment in emergency situations?

I haven't been this pissed in a while...
posted by drstrangelove at 7:06 AM on August 10, 2002

drstrangelove: Market research.

Marketing companies made aware of Condition X in a patient, including emercency room cases, may decide to offer a "poll" concerning the HMO coverage of Company Z. Or in other cases, they may persuade somebody to volunteer as a guinea pig for an alternate treatment with a unestablished outcome for success (thereby necessitating the requisite waivers & non-disclosure paperwork).

Some marketers also work closely with Human Resources deparements of various corporations, not to mention venture capitalists and mutual funds. Paint your own pictures here, particularly if you plan to re-enter the job market after your little sojurn in the hospital/hospice.

Hopefully enough pressure from the Hill or some curcuit court will administer the appropriate dopeslap to this proposal.
posted by Smart Dalek at 7:30 AM on August 10, 2002

And what great market research it is too! After all, medicine and the practice of making the sick healthy is, of course, a luxury commodity that only those who can afford it should ever rationally be able to believe they could actually have now, isn't it?

What skallas said. "Market research" doesn't seem to have a high security threshold. This sounds a lot like a way for future potential employers and government officials to find out everything about a person before letting them into their little groups. "Well, son, you'd be great here at Harvard, but according to this, you were administered to a hospital in New Orleans last March for a stomach pumping... care to explain that before we approve you?"

If this was a way to make the distribution of medicine more accessible and available to the American public, then it would be a rule making it easier for Americans to get health care. How much more depressing can this get: coupons in the mail for heart surgery?

On a side note, at least the login page for the Chicago Trubune doesn't ask for your medical information. Yet.
posted by XQUZYPHYR at 7:45 AM on August 10, 2002

Makes me glad I don't go to the doctor.
posted by eustacescrubb at 7:59 AM on August 10, 2002

This dovetails nicely into a general peeve of mine: marketing. It's an ugly word. We used to be a people who could build barns in an afternoon, grow foods, build high-quality products, etc. In other words, we used to do constructive, important things.

Now, our "best and brightest" drift towards things like: marketing, advertising, public relations. Aside from convincing us to buy things we don't need, or liking things we shouldn't, what the hell do these people do? Now they'll be thumbing through medical records...gee, this guy is (overweight, depressed, excited, has allergies, low sex drive) and he's not taking one of our drugs!

I'm pretty conservative, a health-care provider and I really am starting to not like our current administration.



posted by drstrangelove at 8:12 AM on August 10, 2002

my question, and one i can't seem to find the answer to, is what do the insurance companies have to gain by this? they say it will be easier for people to access health care, but since when have they been known to be altruistic? am i cynical to believe they have a secret motive? are they going to use your medical information to raise premiums or deny claims?

"uh oh. you are supposed to be dieting and exercising to treat "x disease" and you gained 10 lbs. since your last doctor's visit and he/she wrote in your file that you weren't exercising. no more "x medicine" for you!"

i mean, right now the insurance company pretty much takes the doctor's word that you need what you need. what if they start targeting individuals that are big drains financially and start second guessing the doctor?

i can understand marketers wanting to get a hold of the information, but i can't figure out the underlying motive for the insurance companies.
posted by centrs at 8:39 AM on August 10, 2002

I would post one seriously pissed-off message about this damn stupid law -- but who knows, it could be used against me any day now the way things are going. I wonder if there's anyone in the U.S. in favor of legislation like this.
posted by josh at 8:39 AM on August 10, 2002

If the new rules do not require a hospital or doctor's office to release patient information without a signature, but merely allow them to do so, I would personally seek out hospitals and physicians that promise in writing not to use my information in this way.

The complication: At first glance, I couldn't see how a doctor's office could be forced to share my information, that they would essentially be selling that information to marketers; however, it may be inevitable, given how medical research is funded. (Almost entirely by an industry of marketers--drug companies, surgical instrument companies, etc. They essentially own the medical journals, since any research arm, including a medical school, that decides to publish something out of favor will lose their research funding.)
posted by troybob at 8:47 AM on August 10, 2002

"In unveiling the final rules, Health and Human Services Secretary Tommy Thompson called them a "common-sense balance" between patients' desire for privacy and the need for doctors, insurance companies and other health-care professionals to share information necessary for treatment and payment."


I am confused. Are Market Research companies now treating, and pay for, my medical care? Because in that case, in the interest of saving time and money, I would rather just skip the middleman, in this case, those pesky doctors, nurses, and techs at the hospital, and just go right to the source - the marketeers.

Anyone here have a marketing/advertising degree? If so, do you want to look at something for me? Look at that toe - is that a fungus?
posted by kristin at 8:54 AM on August 10, 2002

no kristin, that fungus is, in fact, the person with a marketing degree. I'm very sorry, it was too easy not to say.

troybob: why should this even be an option? Hospitals? Are supposed to be competing? Does that sound utterly ridiculous to anyone else? No one should have to "seek out" a hospital.

Why is it that something like the Fire Department or the Highway System is something we immediately recognize as public and socialized, and yet the basic idea of making people healthy has to turn into a "who's better?" situation?

When there's a fire, you call the fire department and the closest fire truck around comes and puts out your fire. Are we really going to reach a level of society where your kid's having an asthama attack and you need to check the phone book for who's got the best prices that day? "Oh, well St. Phil's is 20 miles away, but according to their marketing, I can SUPERSIZE my next Colonoscopy!"
posted by XQUZYPHYR at 9:06 AM on August 10, 2002

what do the insurance companies have to gain by this?

As it is now, your information is shared with your insurance company for purposes of reimbursement; a doctor's office must provide detailed medical information to justify charges (although in the offices I work with, the doctor gets the patient's signature acknowledging that this is okay).

The big question is whether the sharing of information goes beyond this. If you are signing up for an HMO, can that HMO obtain your medical records before deciding whether to cover you? Can insurance companies share your information with each other?

right now the insurance company pretty much takes the doctor's word that you need what you need

Wrong. One of the most frustrating things about working in health care is that so few people outside of the field understand how health plans works. In the old days, a doctor performed a procedure and billed the insurance company and was paid; ostensibly, there was so much fraud by physicians that this had to be changed (although insurance companies were still making a fortune, and patients were getting appropriate care). Now, health plans second guess just about every decision a doctor makes. Ask your doctor's office, and see if they're allowed to answer you. (Many HMOs have contracts with doctors that prevent the doctor from discussing with you any disagreement they have with the insurance company.) Chances are your doctor's office is overwhelmed with the complicated process of preauthorization and proof of medical necessity, as well as with underpayment for services. Even if a procedure is preauthorized by the insurance company, they can decide later not to pay for it.
posted by troybob at 9:09 AM on August 10, 2002

XQUZYPHYR: I never said this should be an option, but the fact is that hospitals are competing, and doctors' offices are struggling to stay in business. Reimbursement for medical services is shrinking; the actual costs are not.

When health care has taken second priority to business, and the patient is merely a customer, we should take an active role and only deal with services that will respect our limits, at least as long as we can. If there is no emergency, and I have a choice between a doctor or hospital that will sign a statement agreeing not to sell my private information to a marketer and one that will not make such an agreement, I can make a choice. If more people do this, perhaps fewer doctors or hospitals will go that route.
posted by troybob at 9:27 AM on August 10, 2002

_{A 59-year-old Florida woman with a history of depression recently initiated a class-action lawsuit against drugmaker Eli Lilly and three doctors after she received in the mail a free one-month sample of the anti-depression medication Prozac and a note congratulating her on being on her way to "full recovery."}

So perhaps all is not lost. Hope she wins.

Here's the form you'll see as they wheel you from the ambulance into the emergency room:

<sub>YOUR PRIVACY RIGHTS AS A HEALTH CARE CONSUMER
Please select your preferred degree of privacy:

1. Only my doctor and necessary medical personnel my access my records. (NB: This option may result in denial of coverage.)
2. My doctor may share my records with whoever he damn well pleases because I'm prostrate on a gurney gurgling blood and I'll do anything it takes to get immediate medical attention.
3. I agree to waive all rights and claims to the privacy of my medical records and I also agree to allow my operation to be filmed and broadcast live during primetime on Fox. I agree to allow the doctors and nurses to perform this operation while wearing thongs. In compensation I will receive a free subscription to "Vitality, the Magazine for Healthy Living", a publication of Hoescht Pharmaceuticals.</sub>
posted by BitterOldPunk at 10:12 AM on August 10, 2002

Chances are your doctor's office is overwhelmed with the complicated process of preauthorization and proof of medical necessity, as well as with underpayment for services. Even if a procedure is preauthorized by the insurance company, they can decide later not to pay for it.

also something important to point out that people may not know/think about. the insurance companies have lists of acceptable tests based on what your disease is, so more and more, it's not even what the doctor wants. he/she doesn't have to ask the hmo what they will pay for, the doctor knows, because it's published by the hmo and soon-to-be very standardized. so if a doctor orders a test, they better make sure it's not just because they think you need that test, but also because they have diagnosed you with the disease in which that test is applicable according to the hmo. also, of course he/she can't just diagnose as they please, that needs to be proven too...
posted by rhyax at 11:23 AM on August 10, 2002

Marketing and Medicine...they just sound good together, don't they?

Actually XQUZYPHER, hospitals have been competing for years, especially in such densely populated areas like L.A. Drive around for any length of time and you will be inundated with billboards and radio commercials extolling this hospital's MRI and that hospital's obstetrical unit ("Mount Bethal-- where the doctors all wash their hands between patients!")

And the aggressive advertising by pharmaceutical companies frightens me ("Uberall-- you have no idea what this extremely expensive drug is supposed to do, but ask your doctor to prescribe it today!") My mother the nurse tells me that frequently older people come in and demand a prescription for the "latest" arthritis medication which is 10x as expensive and works half as well as the generic stuff they are already taking.

A free market economy is good for the country but bad for medicine.
posted by Secret Life of Gravy at 11:23 AM on August 10, 2002

What someone needs to do is find out the medical records of, say Health and Human Services Secretary Tommy Thompson and start reading them at a large gathering which he is attending. Or perhaps any politician who endorses this. I'd love to see their reaction to having their medical history known. I'm freaking pissed off right now.
posted by Hall at 12:11 PM on August 10, 2002

Many here are overreacting to this. Your medical information has to be given to your insurance company -- do you expect them to pay for a pig in a poke? This bill just allows your doctor or hospital to provide the information with less paperwork. It also allows for rapid exchange of information in time of medical emergency. I work in an ER. There are 50 hospitals in the Philadelphia area, and I frequently have to get information on an ER patient from another hospital where the patient was recently admitted. When the patient is unconscious, intoxicated, or otherwise unable to give written consent, it becomes problematic.

The one really inexplicable, bizarre item here is the release of individually identified information, without consent, to 'marketing' companies. That shouldn't ever happen, law or no law. It's contrary to the Hippocratic oath:

Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

Whatever doctor released that depressed woman's information to Eli Lily ought to be pistol-whipped by his state Medical Society.
posted by Slithy_Tove at 12:49 PM on August 10, 2002

Whatever doctor released that depressed woman's information to Eli Lily ought to be pistol-whipped by his state Medical Society.

As likely as not, it was the pharmacist. Pharmacists already provide HUGE amounts of detail to drug companies regarding physician prescibing habits. I see a detail rep, they ask me if I prescribe their product already knowing if I do and how much. It's totally bullshit, but they are watching me and most certainly already who is getting the drug. As a physician, I can do my damnedest to maintain confidentiality, but the deck is stacked against me.
posted by shagoth at 1:34 PM on August 10, 2002

From the article: "But in a reversal of regulations proposed by former President Bill Clinton, Bush would allow doctors and hospitals to share patients' medical information with insurance companies, health maintenance organizations and, in some circumstances, marketing companies, without patients' prior approval."

Ralph Nader: "There are no differences between the two major parties."
posted by owillis at 2:21 PM on August 10, 2002

owillis: Clinton signed the Defense of Marriage act, Lieberman is big on media censorship, Gore owns lots of Occidental Petroleum/supports war on drugs/death penalty, etc. Perhaps old Ralph had a point.

Regardless, that quote is being used out of context. Nader was illustrating how both parties are largely controlled by monied interests. He was more or less prophetic when you consider the government and industry collusion as revealed by the high profile Enron bankrupcy. Bush wants to see my medical records, yet we might never know much about those secret energy meetings. Sounds fair.
posted by skallas at 4:00 PM on August 10, 2002

If this becomes a Nader debate, I'm going to shoot myself in the face and then let all the hospitals compete over who gets to send a coroner.
posted by XQUZYPHYR at 4:28 PM on August 10, 2002

This is just so evil on so many levels. Time to yell at my congressional delegation again about my desire for some tiny shreds of privacy. Probably a lost cause, but what the heck.
posted by theora55 at 4:36 PM on August 10, 2002

The one bright side: a perfect smoking gun for the Democrats to wave up and down before voters in election ads, demonstrating how the Republicans are in the pocket of HMOs just as much as energy companies. Of course, they'll have to have the guts to use it, which it would be foolish to count on...
posted by ramakrishna at 7:28 PM on August 10, 2002

At one time in dentistry (I'm a general dentist), HMOs had you sign one-sided contracts that allowed them to review all of your patient records, including non-HMO subscribers. Their justification: to make certain you weren't treating their clients "differently." Nevermind the breach of patient privacy!

I wonder if GWB's plan will change this...

The bastards!!
posted by drstrangelove at 5:43 PM on August 11, 2002

owillis: if you're going to put quotation marks up, please make sure the quote is accurate.
posted by Ty Webb at 1:19 PM on August 12, 2002