Wednesday, February 11, 2009

EMENDATION: OBAMA'S MEDICAL RECORD PLAN

Yesterday we ran comments by Betsy McCaughey for Bloomberg about a provision in the bailout bill that set up a mandatory electronic medical records program in the health industry. As the following indicates, some of her comments were exaggerated, but, as we point out later, this does let get this bad provision off the hook. It never should have been in the stimulus package.

Progress Report - Late last month, the House passed an economic recovery package containing $20 billion for health information technology, which would require the Department of Health and Human Services to develop standards by 2010 for a nationwide system to exchange health data electronically. The version of the recovery package passed by the Senate contns slightly less funding for health information technology. But as Congress moves to reconcile the two stimulus packages, conservatives have begun attacking the health IT provisions, falsely claiming that they would lead to the government "telling the doctors what they can't and cannot treat, and on whom they can and cannot treat." The conservative misinformation campaign began on Monday with a Bloomberg "commentary" by Hudson Institute fellow Betsy McCaughey, which claimed that the legislation will have the government "monitor treatments" in order to "'guide' your doctor's decisions."

In her commentary, McCaughey writes, "One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective." But the fact is, this isn't a new bureaucracy. The National Coordinator of Health Information Technology already exists. Established by President Bush in 2004, the office "provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation" of "health information technology." Far from empowering the Office to "monitor doctors" or requiring private physicians to abide by treatment protocols, the new language tasks the National Coordinator with "providing appropriate information" so that doctors can make better informed decisions. As Media Matters noted, the language in the House bill, on which McCaughey based her column, does not establish authority to "monitor treatments" or restrict what "your doctor is doing" with regard to patient care. Instead, it addresses establishing an electronic records system so that doctors can have complete, accurate information about their patients. The Wonk Room's Igor Volsky pointed out that "this provision is intended to move the country towards adopting money-saving health technology (like electronic medical records), reduce costly duplicate services and medical errors, and create jobs."

Media Matters - In the commentary, McCaughey falsely claimed that under provisions in the economic recovery bill passed by House Democrats, "one new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and 'guide' your doctor's decisions." In fact, the language in the House bill that McCaughey, a former lieutenant governor of New York, referenced does not establish authority to "monitor treatments" or restrict what "your doctor is doing" with regard to patient care, but rather addresses establishing an electronic records system such that doctors would have complete, accurate information about their patients "to help guide medical decisions at the time and place of care."

Washington Monthly - The National Coordinator for Health Information Technology isn't "new"; it was created by George W. Bush five years ago. More importantly, the measure is about medical records, not limiting physicians' treatments.

Progressive Review - While much of the foregoing is true, a reading of the legislation suggests unprecedented interference in the business of doctors and hospitals, not unlike the feds ordering every small business to use a certain software and then make regular reports on just how they are using it.

The measure did not belong in the stimulus package. It should have been a stand alone bill with full hearings, especially with the deep questions it raised concerning patient privacy.

Further, some of the language is vague enough to suggest the possibility of greater future federal control. For example:

"The Secretary shall seek to improve the use of electronic health records and health care quality over time by requiring more stringent measures of meaningful use . . .

"The National Coordinator shall annually evaluate the activities conducted under this subtitle and shall, in awarding grants, implement the lessons learned from such evaluation in a manner so that awards made subsequent to each such evaluation are made in a manner that, in the determination of the National Coordinator, will result in the greatest improvement in the quality and efficiency of health care."

Frankly, we preferred that was left to our doctor.

The mere existence of this measure presumes, even though appearing to deal only with health records, an assumed right of the federal government to intervene in health care in a substantial way that could easily be expanded. The gestalt behind this measure is completely different than programs like single payer or expanded Medicare that are designed to deal with paying for medical care, not controlling it.

Add to this the major question of patient privacy - how long will it be before the NSA, FBI and Homeland Security have easy access to these records? - and there are more than enough reasons for this measure to have been dropped from the bailout bill.

Consider that every citizen who arrives at a hospital with an overdose or having drunk too much will be in a file easily accessible by law enforcement and others regardless of what nice promises are made to the contrary. It might even possible for the police to charge some one based on a doctor's report of drug use. And, of course, it’s a substantial gift to the spy agencies, the biggest data collection system since the NSA started recording phone calls.

Welcome to Obama's brave new world.

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