Dr. Big Brother Is Watching You?

I am laughing. I mean, rolling on the floor, cackling hysterically, ready-for-the-jacket-with-the-sleeves-that-tie-in-the-back laughing. Read this article and then come back. Go on, I'll wait.

Done? Good. So Rep. Tim Huelskamp is afraid of the Federal Government getting its hands on everybody's private medical records because the Federal Government has a bad track record of securing the privacy of the information it collects. He fears it will lead to the loss of insurance company proprietary information that will undermine their competitiveness. Uh, guy, destroying the competitiveness of the insurance companies in order to drive them out of business and collapse the United States into a single-payer, government-run system that the majority of Americans don't want is the whole purpose of ObamaCare. Are you just now figuring this out?

And he spends the majority of his op-ed piece on these issues. But I can tell you know what the real problem is. Why didn't you make that the main emphasis of your article? Afraid of being singled out as the one who starts calling attention to the man behind the curtain? Not ready for the fires of holy hell to be place beneath your feet?
Let's look at some selected quotes from the piece:

It’s par for the course with the federal government, but abstract terms are used to distract from the real objectives of this idea: no matter which “option” is chosen, government bureaucrats would have access to the health records of every American - including you..... With its extensive rule-making decrees, ObamaCare has been an exercise in creating authority out of thin air at the expense of individuals’ rights, freedoms, and liberties. The ability of the federal government to spy on, review, and approve individuals’ private patient-doctor interactions is an excessive power-grab..... No matter what the explanation is, however, this type of data collection is an egregious violation of patient-doctor confidentiality and business privacy. It is like J. Edgar Hoover in a lab coat.

And then you weasel out at the end with the use of that one last wrong word:

....too many people already know what can result when their confidential information gets into the wrong hands, either intentionally or unintentionally.

The wrong word here is the word wrong. From the point of view of the people creating these rules, they think they are finally getting our private medical information into the right hands. But for those of us who love liberty and our God-given rights, we know that it is the Feds who are the most wrong people. And from all these quotes from the article, it is clear that Rep. Huelskamp is aware of this fact also. So why not just say it in so many words when you have such a bully pulpit to shout it from?

The biggest problem we face is not that the Federal Government might accidentlally release your medical records; it is that the Federal Government itself will do nefarious things with your medical records. Like decide that you don't get treated for your heart failure because you belong to the NRA. Or you're a TEA Party member. Or that you donated money to John McCain or Mitt Romney.

It is this kind of grab for power -- the power over individual life and death itself -- that I recognized instantly was the biggest threat from ObamaCare. And I recognized it before Dear Leader was even elected.
I laugh so hard now because I find it so amazing that it is taking so many people this long to understand this.

But I don't find it particularly funny. No, I don't find it very funny at all.

Repealing Just ObamaCare Is Not Enough

More Federal judges continue to properly find the insurance mandate unconstitutional, though most of them are ignoring the fact that the law being challenged has no severability clause, meaning that technically finding one piece of the legislation unconstitutional should actually negate all of it.  But since when has following the letter of the law mattered to a Federal judge?  Despite the not-unreasonable expectation that the Supreme Court will kill this nightmare once and for all, legislators on the right continue to call for the repeal of "ObamaCare", and the candidates for the Republican nomination for President are falling over each other (at least most of them) to try to make us think that he or she alone is the one who can best accomplish this task.

I must insist, however, that if we are to repeal "ObamaCare", repealing just ObamaCare is not enough.

In order to make myself clear, we must get technical.  When most people, and especially most politicians, refer to "ObamaCare", they are referring to the piece of legislation that is more accurately called the Patient Protection and Affordable Care Act of 2010, or PPACA for short.  This is the law that is undergoing all the legal challenges, and the law that public opinion is increasingly opposed to.  The PPACA is not the entirety of "ObamaCare", and if we are to get rid of "ObamaCare", the repeal bill needs to address all of it.  I have actually discussed this with my Congressman, but it appears that he didn't get the point, as the House has passed a repeal bill for only the PPACA.

There are two additional pieces of legislation that must be disposed of in order to repeal "ObamaCare".  Leaving either one in place provides a framework for the reinstitution of this monster.  What makes this interesting is that Dear Leader had absolutely nothing to do with the passage of one of these pieces of legislation.
Some explanation of how these laws are connected is required to fully understand why repealing the PPACA alone is insufficient.

PPACA is the final implementation of the Obama "healthcare" reform.  It is the law that has everyone so hot and bothered.  It is my considered opinion that the PPACA was never intended to function as it is designed, but is actually a veiled program to drive the insurance companies out of the medical insurance business, destabilize the current medical care system, and then force the imposition of a single-payer, government-run system.  But whether it works as written or as I suspect, it is built on the foundation of two previous pieces of legislation, without which PPACA makes no sense.  Since these two pieces of legislation are fundamental to the intended (or suspected) operation of PPACA, they must be considered to be parts of "ObamaCare".  The first of these is the so-called HITECH Act.

The HITECH (Health Information Technology for Economic and Clinical Health) Act is not a separate piece of legislation but rather a section of the American Recovery and Reinvestment Act of 2009, usually referred to as "the Stimulus Bill".  This section of the stimulus bill is generally considered to be simply an act to promote the use of electronic medical record systems by doctors' offices and hospitals.  Many parts of PPACA do not work without these electronic record systems.  PPACA calls for the creation of "Accountable Care Organizations" and calls for a substantial amount of reporting (to the Federal Government) of healthcare "quality measures", both of which are tremendously burdensome if not downright impossible to comply with without the use of electronic record systems.  Where the insurance mandate is the financial glue that holds PPACA together, these EMR systems are the operational glue that binds your personal health records to the Federal overseers, uh, holds the PPACA together.

While compliance with HITECH is technically voluntary, meaning doctors are not mandated to adopt these EMR systems, in reality there is nothing very voluntary about it.  By offering incentives to act now to install and "meaningfully" use an EMR, and by implementing penalties (in the form of Medicare and Medicaid payment reductions that can be increased without limit if not enough doctors adopt an EMR), few doctors will be able to refuse to comply and still stay in business.  But the catch is the "meaningful" use part; the criteria established at present to "meaningfully" use an EMR (required to receive the incentives) are designed around those things needed to funnel information to the Feds, as well as a few other "feel-good" liberal functionalities that do nothing but get in the way of actually caring for patients.  There is even talk that the informational needs of operating a PPACA-defined Accountable Care Organization may be substituted for the currently proscribed meaningful use criteria.  And if that isn't a way of tying PPACA to HITECH, I don't know what is.

HITECH also makes changes in another, older piece of legislation, making the older bill's penalties stronger.  This older legislation is the bedrock upon which all of "ObamaCare" is built.  This would be the Health Insurance Portability and Accountability Act of 1996.  Yes, good ol' HIPAA, those letters that strung together give us doctors heartburn.  And yes, you read that right -- 1996.

What does HIPAA, the so-called Federal Privacy law, have to do with "ObamaCare"?  Simply put, HIPAA created the Federal "right" to privacy of medical records while at the same time setting down regulations to secure that new "right".  Prior to 1996, the privacy of medical records was a state issue, and HIPAA added no new privacy protections than 50 state legislatures had not already provided; it merely wedged the Federal Government into what had previously been considered a function of the individual states.

So how does HIPAA have anything to do with "ObamaCare"?

HIPAA wedges the Federal Government into medical records privacy and thus into the provision of medical care at all levels, whereas prior to HIPAA the Feds' involvement had been limited to Medicare and Medicaid.  Part of HIPAA was to guarantee the standardization and security of the electronic transmission of medical information between providers and insurance companies.  (Actually this was all HIPAA was really supposed to do regarding medical records, but the enabling regulations written by the Clinton White House went waaaay beyond this.  Don't believe me?  Read the law; subsection F starting on page 87 deals with the security rule.)  With their feet in the door, the Federal Government creates HITECH as another way to standardize and secure such transmissions.  HITECH then serves as the operational conduit of the information that is necessary for PPACA to work as intended (interpret that as you may; you know where I stand on that).  A leads to B leads to C, and if you don't think this was planned, then you have not been paying attention for the last 20 years or so.

Repeal only PPACA, and HITECH and HIPAA remain to allow the creation of another monstrosity like PPACA at any time in the future.  Repeal PPACA and HITECH, but leave HIPAA, and the Federal Government remains inside the medical house, ready to grow like kudzu.
Only by repealing PPACA, HITECH, and HIPAA can we be truly free of what we refer to as "ObamaCare".  Of course, this means that "ObamaCare" really has nothing to do with Obama, as it has been in the works now for over 15 years.

Only after ALL of "ObamaCare" is repealed can we get down to the business of truly fixing what is wrong with our medical care system.

Remembering

Today, the 10 year anniversary of the 9-11 attacks upon our nation, is a good time for remembering.

I had just gotten out of the shower that morning 10 years ago.  As I was drying off, I turned on the TV in my bedroom.  This TV was old and the sound came on before the picture.  I heard the news anchor say that a plane had struck the World Trade Center in New York.  I looked at the screen and as the picture came on, I saw smoke and flames coming from both of the Twin Towers.  My mind did the arithmetic before the anchor could repeat the facts.  One plane could not have hit both towers.  Two planes could not be an accident.  Someone had deliberately attacked the United States.

As I continued to get dressed, the news reports came quickly.  When a preliminary report came that there were reports of an explosion inside the Beltway in Washington D.C., I said to someone in my home, "My God, how many of them are there going to be?"  This was before the news media had confirmed the plane crashing into the Pentagon. 

As I ate a quick breakfast, I continued to watch the unfolding events.  I observed and commented on the collapse of the first tower before Peter Jennings could stop pontificating long enough to tell us what was happening right before his eyes.  As I left to go to my office, I asked the person staying at my house to call me when the second tower collapsed.  Not if, but when.  The damage to both buildings was identical; to my mind, the collapse of the second tower was inevitable.  That phone call came while I was meeting with my bankers to go through the annual review of the office retirement plan.

When I arrived at my office, I told my office staff what was going on.  Most of them had left for work and arrived at the office before the first plane had struck, so they were completely unaware of what was happening.  It took me a bit of convincing.  They all thought that I was pulling some sick practical joke on them.  It was only when we got a radio on (the only station we could find covering the event was of all things NPR!) that they really believed me.  It was on the radio that we heard the first confusing reports of the explosion in southern Pennsylvania that turned out to be the crash of Flight 93 and its heroic passengers.

At noontime I managed to get a TV brought to the office and was able to watch the reactions of my employees as they saw those horrible images for the first time.  Throughout the day, my patients (and unbelievably, I had no cancellations or no-shows that day) could discuss almost nothing else.  That afternoon, as I left the office, I looked up at the clear blue sky and saw two parallel, curving jet contrails arcing across the southern sky.  By that time all the commercial traffic was on the ground.  Those jet trails could only have belonged to the sky cap being flown around Houston.  After completing my evening hospital rounds, I came home and watched many hours of the TV coverage that had been recorded for me, repetitive scene after scene of the aftermath of this vicious attack. 

That is my 9-11 story.  As such stories go, it is not much.  I am fortunate to have not personally known anyone who was killed on that day. A couple of the doctors from my community were in Washington and were on their way to go on a tour of the Pentagon that morning. But for the grace of God and timing, they might have been in the building when the plane crashed into it and my connection to the attacks could have been more personal.  These events remain ingrained into my psyche nonetheless, and I doubt that I will ever forget them. 

But even more than the events themselves, I remember how they made me feel.  I was angry -- royally pissed off -- that someone, anyone, had dared to do this to us.  Late that evening, when President Bush finally got the Secret Service to let him off Air Force One and make a statement to the nation, I was comforted by his statement that those who had done this to us would be brought to justice.  I was comforted because I then knew that we had a President that understood, who was just as angry, and would be resolute in his response, something that I felt his predecessor would not have been.  This has taken a lot longer than most of us wanted it to, and that task is still not finished.  But I suspect that President Bush and his advisers knew then that we had been forced onto a path the end of which would require decades to reach, but wisely kept this to themselves.

And now we have reached the end of the first and the beginning of the second decade of that journey, and many American are already weary of it.  I did not get to watch much of the coverage of the anniversary memorials today, though I expect that I will see parts of them over the coming days.  I don't need to have seen much of them to know that they were heavy with remembrance and memorialization of the innocent dead and the heroes who died trying to save them as well as the heroes who followed who have died or been permanently injured in defense of our country and all of her citizens.  And that is as it should be.  I am equally sure that they were not heavy at all in recalling how we all felt on that day and the days that followed, and that is not how it should be. 

Already the horrors of that day are being glossed over so that we can remember the dead but not the anger, and that is not right.  We should be reminded regularly of that anger, we should be shown regularly the horrors without editing of the most gruesome parts, so that we can never forget that anger.  Not until all of those who did this to us or would do something similar are either apprehended, killed, or so overwhelmed by our resolve that they abandon any further attempts.

For it is when we stop remembering this that it will happen again.  And 12-7-41 and 9-11-01 will have a new date of infamy join them.

Waking Up

This blog has been awake for far too long.  Time for it to wake up!