Saturday, March 12, 2005


My brush with the health care system, part III: Privacy Protection

This stuff didn't come up yesterday, but my HMO encounter brought to mind another of my pet peeves with managed care.

Rather than give us broad ranging health care reform, our Congress gave us a box of bandaids in the form of HIPPA, the Health Insurance Portability and Accountability Act of 1996. HIPPA's best provisions make it easier to carry your health insurance from job to job, without of course redressing the underlying ridiculousness of using the haphazard patchwork of employment benefits as a substitute for a universal health insurance system.

HIPPA also has a number of privacy provisions. The need for health care privacy certainly seems increasingly pressing in the "information age," when (a) all of our health records are now going onto computer systems which raises the specter of all of your ailments becoming available to former Attorney General Ashcroft at the push of a button*; and (b) there is a growing market for increasingly private information by insurance companies, credit reporting companies and god knows who else. My great fear, as I have said before, is that MBNA America Bank will find a way to put together my medical records, my credit card bills and my highly personalized answers to "security questions" (mother's maiden name, name of first dog) to clone me. Then they will sell me stuff and collect the bills by dealing directly with my clone.

Anyway, I digress. I don't know exactly how HIPPA's privacy provisions actually help me (I should really learn about that one of these days), unless you consider it a boon to your privacy that now every doctor's office and pharmacy has to give you a big honkin' "privacy form" explaining (rather opaquely) your rights and the various but limited ways they are allowed to use your health information, as well as a form that you have to sign saying that you received the privacy form.

Unfortunately, this impressive display of concern for privacy is somewhat offset by the fact that the HMO reception desk is actually run with all the privacy protection of a deli counter. A crowd of patients are standing alongside you being helped by other receptionists, or waiting behind you close enough to be within earshot. The "privacy screens" (if any! My current HMO has none) afford less privacy than the purely ceremonial ones sometimes placed between urinals. The receptionist then asks a series of questions eliciting highly confidential information and then finds a way to blurt out at least some of it out as if she were relaying a sandwich order to the guy at the cold cut slicer. For instance:
RECEPTIONIST: What is your current address?

PATIENT: [It's the same as it has been the last six years, and the same as it's been each and every one of the 14 times I've been here in that time frame.] 123 Main Street, Anywhere USA.

RECEPTIONIST: Social security number?

PATIENT: [Glancing around nervously at nearby patients.] Er... 123-45-6789.

RECEPTIONIST: Date of birth?

PATIENT: [Trying to lower voice a bit more] January 1, 1967.
Having completed the colloquy that enables at least half a dozen bystanders to commit identity theft on you, the receptionist gets to the heart of the matter.
RECEPTIONIST: What are you seeing the doctor about today?

PATIENT: Ummmm.... [inaudible mumble].

RECEPTIONIST: I'm sorry could you speak up?

PATIENT: [In as discreet a whisper as possible.] Genital warts.

RECEPTIONIST: [In full voice]: Genital warts? Okay. [Typing your answer into the computer] Gen – it – tal ... WARTS. Here is a form advising you of your privacy rights, and another form for you to sign saying that we've given you the privacy form. Please take a seat along the wall, and the nurse will be with you shortly.
Here's the funny thing. The receptionist already has all the identity theft information on her computer – for some bizarre reason, they always seem to have to re-enter it every time. And as to the "why are you here" information, the receptionist has no need to know. The couple of instances in which I've said, "I'd rather wait and discuss it with the doctor or nurse practitioner," they've said okay. That works on the phone too. Try it some time. Indeed, next time I'm asked why I'm there at the clinic, I'm going to say, "I'd rather not discuss it here at the deli counter."

*I know that Alberto Gonzalez is now the Attorney General, but somehow it's easier to imagine Ashcroft having the prurient interest to push that button -- Gonzalez being too busy finding loopholes in the Geneva Convention.

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