Culture & Society, Health Policy, Law, Medical Ethics, Medicine, Politics, What's New

America Out Loud PULSE: The Myth of Medical Privacy

June 18, 2023 No Comments

From my podcast with Twila Brase, RN, PHN – https://www.americaoutloud.com/the-myth-of-medical-privacy-with-twila-brase-rn/

Back in 2018, Amazon made a software application that can mine a patient’s medical data and convert it to a searchable database. Amazon could customize the database for pharmaceutical companies, insurers, hospitals, researchers, and clinicians. Amazon claims the application would comply with HIPAA, the Health Insurance Portability and Accountability Act of 1996. By the way, isn’t it interesting that the word “privacy” is not in the title of the law that everybody thinks is a law that protects privacy?

Worse, some electronic health records had an embedded app (developed by Xealth, Inc.) that prompted doctors to recommend health products to their patients that—surprise!—were sold on Amazon.

Amazon is being hailed as a “disruptor” in medical care with its online clinics. For a flat fee, you can get in touch with a clinician of some sort and describe your symptoms or needs. As one customer testimonial reads, “Amazon Clinic was incredibly easy and convenient to get my thyroid medical refilled. No hidden fees, no in person visit. Also for someone without health insurance the cost was the absolute best part.” But there is a giant “but.” Amazon’s health clinic requires patients to give Amazon the authority to redisclose their health information in the future.

Cost effective, yes; but Amazon clinic’s terms of use raise the question: How much is your medical privacy worth? I remember the attempt to discredit Daniel-Ellsberg who exposed damaging information regarding the Viet Nam War with the release of the “Pentagon Papers”. Operatives dispatched by the President broke into Ellsberg’s psychiatrist’s office looking for juicy tidbits. Imagine how easy that would be now. Hacking into electronic databases has become child’s play.

We’ll talk about this and so much more with my guest, a nationally recognized expert in the field of medical privacy.

Twila Brase, RN, PHN is President and Co-founder of Citizens’ Council for Health Freedom (CCHF), a national patient-centered, privacy-focused, free-market policy organization established 25 years ago in Minnesota to support health care choices, individualized patient care, and medical and genetic privacy. Her efforts led to a national law requiring parental consent for research using newborn DNA. Ms. Brase is author of the eight-time award-winning book Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records.

Ms. Brase’s “Health Freedom Minute” is heard weekdays by more than 5 million listeners across the United States. She provides testimony at state legislatures, meets with members of Congress and health care policymakers, and has been featured in major news outlets such as the Wall Street Journal and the Washington Post.

Doctors, Featured, Medicine, Politics, What's New

America Out Loud PULSE: The Truth About Medical Privacy

February 1, 2023 No Comments

From my America Out Loud Pulse podcast with Twila Brase – https://www.americaoutloud.com/the-truth-about-medical-privacy/

Do you remember those suspicions we had growing up after reading spy stories or George Orwell’s 1984? That feeling that someone was always watching? Those suspicions are fact in today’s medical environment.

Who would have thought that anyone but you and your doctor would have access to your private medical information? It is rare to find a doctor’s office that is not using electronic medical records. Your doctor has become a data clerk. Who would have thought that the American Recovery and Reinvestment Act of 2009 (the Stimulus Act) would have contained a section on electronic medical records? The Health Information Technology for Economic and Clinical Health (HITECH) Act “to promote the adoption of health information technology” tied physicians’ payments to the use of electronic medical records.

And yes, the federal government is the overseer of those records. In 2016 the director of Office of the National Coordinator for Health Information Technology (ONC) was encouraging a change in the “culture of data sharing.” Karen DeSalvo, MD remarked that “for too long, and today, we think about data as something that we have to hold tightly onto; it is built into our DNA of medicine that we want to hold data and we’re worried about exposing it.” Darn right we are worried about exposing it! Data breaches have now become commonplace, with an average of 56.75 per month reported to the Department of Health and Human Services. In May 2022alone there were 70 data breaches, exposing the records of 4,410,538 individuals.

It’s creepy enough when it comes to privacy but the over-emphasis on electronic records affects patient safety. Since these electronic records have been mandated, doctors spend more time navigating records than seeing their patients. Worse, to streamline the process a lot of “cut and pasting” of chunks of the records goes on. This is a recipe for mistakes.

Today’s episode features Twila Brase who sounded the clarion call about the lack of privacy of our medical information the failure of HIPAA to protect us. As she puts it, “our medical records are an open book.”

Culture & Society, Healthcare Reform, Medicare, Medicine, Op-eds, What's New

Obesity: America’s Self-inflicted Preexisting Condition

January 7, 2020 No Comments

Consuming too many potato latkes and Christmas cookies has left its mark on our waistlines. Unfortunately for Americans and their medical care, the seasonal overeating seems to last all year. Indeed, the American Medical Association has declared that obesity is a disease.

It may be more accurate to describe obesity as a contributor to certain diseases. Obesity raises the risk of premature death, heart disease, high blood pressure, stroke, type 2 diabetes, gallbladder disease, breathing problems, certain cancers, and osteoarthritis. Certainly, obesity can result from certain uncommon diseases and hereditary factors, but most people become obese simply because they eat too many unhealthy foods and do not exercise.

At its last count, the Centers for Disease Control and Prevention (CDC) estimated that 40 percent of U.S. adults age 20 and over, 21 percent of teens, and 14 percent of preschoolers are obese. A December 2019 study that analyzed 26 years of body mass index (BMI [the relation of weight to height]) data concluded that half of U.S. adults will be obese (BMI>25) by 2030. Some 25 percent will be severely obese (BMI>35). Moreover, less than 5 percent of adults get the recommended 30 minutes a day of physical activity. And even when people living in “food deserts” were presented with healthy options, only 10 percent changed their evil eating ways.

According to the CDC’s last comprehensive analysis, the annual medical cost of obesity in the United States to Medicare, Medicaid, and private insurers was $147 billion in 2008. And the medical costs for obese people were $1,429 higher than those of healthier weights.

The saddest development is the cultural normalization of obesity with lingerie models, singers, and television shows celebrating fatness. Do we high-five people with other lifestyle related conditions such as alcoholism, emphysema, or coronary artery disease? Of course not.

The obese are easy targets for drug company peddlers of quick fixes or “providers” who want to extract money from third-party payors. U.S. pharmaceutical companies spent $6.1 billion on direct-to-consumer prescription drug advertising in 2017. Many ads feature chunky type 2 diabetics happily frolicking about, thanks to the drug company’s magic pill. The ads might as well say, “pass the chocolate cupcakes with statin sprinkles drizzled with insulin.” We all know the prescription of eating less and exercising more is free of charge.

Alas, we are losing the battle of the bulge. A recent study found that participants failed to lose weight despite reporting that they were exercising and watching their diet. The authors concluded that “many of [the participants] might not have actually implemented weight loss strategies or applied a minimal level of effort, which yielded unsatisfactory results.”

While politicians debate the merits of spending trillions of dollars on government-sponsored medical care, a correctable source of high medical costs is hiding in plain sight. Irrespective of who pays for medical care, rational economic decisions must be made. The Affordable Care Act (ACA) waved a magic wand and removed preexisting conditions from the underwriting equation when calculating premiums. A sick person and a healthy person of the same age could purchase insurance at the same price. Consequently, the ACA doubled the costs for people who made the effort to take care of themselves.

The ACA did allow a “tobacco surcharge” of up to 50 percent more for premiums. Why not an obesity surcharge? This would provide an incentive for consumers to take obesity seriously. Additionally, health-conscious persons would not have to pay for the bad habits of others through taxes to fund government health insurance programs or through higher private insurance premiums.

Those who are stricken with illnesses through no fault of their own need a path to affordable medical care. A good start for lowering costs would be eliminating costly middlemen by encouraging consumers to pay directly for day-to-day medical expenses. Expanding contribution limits and eligible uses of Health Savings Accounts would help pay for the more reasonably priced direct-pay surgery and other alternatives to insurance like direct primary care.

With regard to insurance, we need a revival of competition in the insurance market with multiple products and carriers. Once again, single men could opt to decline pregnancy coverage. We need to restore the pre-ACA availability of low-cost catastrophic (major medical) insurance policies to all ages. Even before mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the large majority of insurers offered guaranteed renewable policies. Here, assuming timely payment of premiums, at the end of the policy period the insurer must renew coverage regardless of the health of the insured. Naturally, this valuable feature costs more but provides consumers with a strong incentive not let the insurance lapse.

Let’s confront the elephant in the room. Healthcare policy should promote personal responsibility, rather than encourage free riders. In America we are free to overeat and under-exercise but we have no right to make innocent bystanders pay for the consequences.

Culture & Society, Healthcare Reform, Medical Ethics, Medicare, Medicine, Op-eds

Data Mining, Artificial Intelligence, and Angels of Death

December 10, 2019 No Comments

By Marilyn M. Singleton, MD, JD

Google is universally well known as a search and advertising company. Now Google is tapping into the $3.5 trillion healthcare market. To compete with the Apple Watch, Google acquired FitBit, the wearable exercise, heart rate, and sleep tracking device. Data is king.

Voluntarily worn fitness tracking devices are one thing, but Google has entered the realm of the brave new world.A government inquiry has brought to light Google’s “Nightingale Project” that collected private medical data from Ascension Health’s 2,600 sites of care across 20 states and D.C., unbeknownst to the patients. Dozens of Google employees had access to the data which included lab results, physician diagnoses, hospitalization records, and health histories, complete with patient names and dates of birth. Google claims that the project complies with the Health Insurance Portability And Accountability Act (HIPAA) because it is a qualified business associate of Ascension Health. And unlike the ads for socks that appear on your computer a nanosecond after you purchased some tennis shoes, Google promises that the data won’t be combined with consumer data. Fat chance.

Amazon, which already knows our every thought, was not satisfied with merely creating software that can read medical records. Now they’ve created Transcribe Medical, a system that transcribes confidential patient-doctor conversations and uploads them directly into the electronic health record. Doctors would relinquish all control over “private” patient records. Google also has been working on its own automatic speech recognition “digital scribe” to upload multiple speaker conversations.

Not only is there a problem with inaccuracies that could lead to a patient receiving the wrong treatment, but we all know the ubiquitous problem of hacking—even in the Department of Defense and the federal Office of Personnel Management.

Disturbingly, certain circles oohed and aahed over the revelation that Google, using electronic health records (EHR), created an artificial intelligence program that could predict death better than doctors. Fortunately for humanity, many others found the thought of leaving doctors out of the equation horrifying. The cheerleaders crowed that it would decrease work for the doctors; they wouldn’t have to waste their time going through those pesky medical records to arrive at a conclusion. Using an artificial neural network to predict the death of a human being is a far cry from having a computer interpret an inanimate x-ray who is not a daughter, mother, sister, wife, or grandmother.

If you put it all together, it adds up to a death panel of one. Google’s software would decide that there is not a high likelihood of walking out of the hospital, no treatment would be given. We are becoming witness to the devolution of humanity.

Moreover, the government is incentivizing workforce development in palliative care through the Palliative Care and Hospice Education and Training Act. Perhaps this is why the hospice team seems to greet the patient at the hospital door. Of note, once a person has signed on to the Medicare hospice program, Medicare will not pay for any curative treatment or medications. Medicare will not pay for an emergency room visit unless the hospice team arranged it or someone decides it is not related to the hospice diagnosis.

The number of hospice agencies participating in the Medicare program nearly doubled between 2000 and 2016, for a total of some 4,382 providers. In 2000, about 30 percent of hospice agencies were for-profit, compared to about 67 percent in 2016. In that same period, Medicare payments grew from $3 billion to $16.8 billion.

Hospice care is lucrative. The minimum Medicare payment is $196 per day regardless of the quantity or quality of services provided on that day. A July 2019 report from the Office of Inspector General for the Department of Health and Human Services found that more than 80 percent of end-of-life facilities in the United States had at least one deficiency, and nearly 20 percent were poor performers with serious problems that jeopardized patient health and safety. It seems the compassionate medical service to care for suffering patients has turned into a heartless cash cow.

Is this what we want for our loved ones and eventually, ourselves? Medicare for All promises every type of medical care under the sun, including long-term care. Long-term care is expensive and if done properly, labor intensive. What better way to save money than to promote a computer program that convinces doctors that the patient is going to die no matter what they do. So the hospital tells the family that treatment or home care will drain their finances. For what? I’ll tell you for what. My parents died at home only after they were tired of doctors and ready to go. They strolled into heaven. They were not shoved in with a giant government backhoe.

Bio: Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

Culture & Society, Medicine, Op-eds, Politics

HIPAA, Hillary and Hype

February 17, 2016 No Comments

By Marilyn M. Singleton, M.D., J.D.

In watching Hillary Clinton campaign I’m reminded of a poem I learned in ninth grade: humorist Arthur Guiterman’s “On the Vanity of Earthly Greatness”:

The tusks that clashed in mighty brawls

Of mastodons, are billiard balls.

The sword of Charlemagne the Just

Is ferric oxide, known as rust.

The grizzly bear whose potent hug

Was feared by all, is now a rug.

Great Caesar’s bust is on my shelf,

And I don’t feel so well myself.

We came into this election cycle hearing that Hillary Clinton was going to be coronated the Democratic nominee for president. The queen is not to be defied. Worse yet, she actually believes the hype.

First, we have the Hillary is a trailblazer meme. Of course, the true trailblazer was Victoria Woodhull, the first female stockbroker on Wall Street, who ran for U.S. president in the Equal Rights Party in 1872 – well-before women could vote. And Senator Margaret Chase Smith ran in 1964, the first year in which any woman’s name was on the ballot as a candidate for President. (In the 19th century, voters cast tickets prepared by the parties rather than state-printed ballots). Smith was first woman to have her name be placed in nomination for the presidency at a major political party’s convention. There have been some 40 bold women who have launched presidential runs without the benefit of a political “machine” and a famous husband.

Then we have the demeaning battle cry that women should vote for Clinton merely because of her gender. Clinton grinned and vigorously applauded as Madeleine Albright said “there is a special place in hell for women who do not help other women.” Does this include Imelda Marcos or Isabel Perón? I suppose Hillary has assured her eternal damnation by not helping Michelle Bachman or Carly Fiorina.

Then there’s Clinton’s supporter, Georgia civil rights activist John Lewis’ rather convenient recollection from the 1960s. He said he never saw Bernie Sanders at freedom marches in the 1960s but he “met” the Clintons. Curious indeed, since according to Clinton herself, during high school (1963-65) she was a “Goldwater Girl,” and in college interned for Gerald Ford and worked for Nelson Rockefeller in his presidential nomination bid at the 1968 Republican convention. On the other hand, Bernie Sanders before his 1964 graduation from University of Chicago was the protest organizer for the Congress of Racial Equality (CORE) and the Student Nonviolent Coordinating Committee (SNCC). In 1963 Sanders was convicted of resisting arrest during a demonstration against segregation in Chicago’s public schools.

And of course we have the infamous emails on the private server that was wiped clean. Clearly Clinton’s emails with sensitive diplomatic activity would be a target – particularly as she traveled throughout a sometimes hostile world. The intelligence community believes that dozens of Clinton’s emails contained classified material, including “top secret/SAP (special access program)” materials. Government computer breaches are not merely theoretical. The Office of Personnel Management and Department of Homeland Security hacks exposed sensitive data on thousands of federal workers.

Personal email servers generally are not covered by enterprise-grade data backup, archiving, and network security. Moreover, a personal server is outside the reach of Freedom of Information Act (FOIA) disclosure requirements. The State Department Foreign Affairs Manual requires that custodians must keep “records that document the formulation and execution of basic policies and decisions and the taking of necessary actions; records that document important meetings; records that facilitate action by agency officials and their successors in office.”

As physicians, we value privacy and are held to high ethical and legal standards. The Health Insurance Portability and Accountability Act’s HIPAA Security Rule requires that all electronic personal health information (ePHI) must be properly secured from unauthorized access, whether the data is at rest or in transit. Custodians as well as their business associates must perform yearly risk analyses for vulnerabilities in the administrative, physical, and technical safeguards. Stiff penalties await violators of HIPAA rules. Penalties range from up to $50,000 per violation for “reasonable cause” to a maximum of $1,500,000 per year and criminal charges which could result in jail time for “willful neglect.” Criminal prosecutions have occurred (for example, here, here, and here).

At the very least Clinton violated the Federal Records Act that prohibits willful concealment, removal, or destruction of government records, punishable by up to three years imprisonment.

If Hillary Clinton were a physician she’d be in prison. I hear the facility in Allenwood, Pennsylvania is particularly pleasant in the Spring.

To blindly jump on the Hillary inevitability bandwagon would prove that “the world is grown so bad that wrens make prey where eagles dare not perch.” I’d rather heed Margaret Chase Smith’s caution: “Honor is to be earned, not bought.”

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School.

Dr. Marilyn Singleton then completed two years of surgery residency at UCSF, followed by an anesthesia residency at Harvard’s Beth Israel Hospital.

Dr. Marilyn Singleton was first an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before she returned to private practice in California.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Dr. Marilyn Singleton has conducted make-shift medical clinics in two rural villages in El Salvador.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012. (Audio version of the speech to AAPS doctors by Dr. Marilyn Singleton.)

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

Health Policy, Law, Medicare, Medicine, Op-eds, Politics

Government Regulations Leading to Medicare Overlords

March 10, 2014 No Comments

The Road to Serfdom is Paved with Good Intentions

by Marilyn M. Singleton, M.D., J.D.

What do TSA groping, NSA data-mining, and mercury-laced fluorescent light bulbs have to do with keeping your doctor? They are the products of seductively entitled but flawed laws. As Daniel Webster said, “good intentions will always be pleaded for every assumption of authority.”

The Transportation Security Administration and the National Security Agency restrain our liberty under the auspices of the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001 (PATRIOT Act). The Energy Independence and Security Act is phasing out incandescent bulbs.

The Patient Protection and Affordable Care Act (ACA/ “ObamaCare”) sounds as though our best interests were at the heart of the legislation. But so far, the 400,000-word law that nobody read has spawned some 12 million words in regulations. Now these regulations that even fewer people read are coming between you and that doctor you were promised you could keep.

The modern-day mission creep began with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). To “safeguard the privacy of protected health information,” HIPAA’s Administrative Simplification Standard mandated the use of the National Provider Identifier (NPI) for “covered entities,” i.e., those who electronically transmit health information.

The NPI extended its reach to “non-covered” physicians who neither sent nor intended to send claims for services they furnished to private insurers or government programs. Without an NPI on the paperwork to refer patients for diagnostic testing, a claim could be denied.

Obtaining an NPI was a small concession to Big Brother for physicians who were not enrolled in the Medicare program. After all, even if their patients chose to pay their personal doctor out of pocket, they had paid their Medicare premiums and deserved the benefit of that insurance for other services and supplies.

For the overlords at Medicare, an NPI was no longer sufficient. The ACA specifically requires physicians/practitioners to enroll in or officially opt out of the Medicare Program to order medical supplies and home health services and have these claims accepted. To “ensure program integrity,” a gem of a catchall ACA provision (section 6405(c)) gives the Secretary of Health and Human Services (HHS) unilateral authority to extend this mandate to “all other categories of items and services.”

Wasting no time, HHS added clinical laboratory and radiology tests to the mandate via regulations. Despite the longstanding policy of approving prescriptions dispensed under applicable state law, a new ACA-proposed rule adds medications covered by a Medicare Part D drug plan to the enroll/opt-out mandate.

Physicians are bullied into bowing at the altar of bureaucracy or having Medicare deny payment for their patients’ claims for pharmaceuticals and other providers’ services.

So to protect their patients financially, physicians acquiesce to more rigmarole. In short, opting out requires making payment contracts with each patient that must be available for inspection, and filing a 12-point affidavit with the government. The entire process must be repeated every two years.

And add this little buried nugget to the pile. Next year, health plans may only contract with providers who have “mechanisms to improve health care quality as the Secretary may by regulation require.” Only Heaven knows how this will work. The current “voluntary” Physician Quality Reporting System forms are so complex that despite the specter of financial penalties few physicians respond.

Studies have shown that the government with its mainly process-oriented quality measures differs with patients in their perceptions of quality care. Indeed, the government cautions that completing forms is no substitute for local quality-improvement efforts.

Physicians are regulated and disciplined by the medical boards of the states in which they practice. Nonetheless, the federal government wants to track physicians with their own Medicare GPS. Whether enrolled or opted out, the government’s mission is accomplished: controlling physicians through layer upon layer of paperwork.

The effort to control physicians and patients’ choices one rule at a time is backfiring. Patients are seeking out “high value” physicians who are willing to be innovative in providing individualized care and affordable payment options. They know that real “administrative simplification” is bypassing the middlemen with an open market that has transparent costs.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

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