Medical ID Plan Ignites Privacy Debate


A proposed second national identification number, this one tracking the medical history of every American, was assailed Monday by critics on both the right and the left, who warned of government intrusion into personal privacy.

An unlikely combination of privacy experts, conservative groups and the American Medical Assn. said that they fear every medical detail of a patient's life potentially could be available to insurance companies, employers and anybody else who could get access to a patient's identification number.

"If a patient has a unique identification number, if somebody gets into a central database, it makes it very easy for them to get confidential patient information," said Donald Palmisano, a New Orleans surgeon who sits on the AMA's board. "The physician-patient relationship is based on trust and, if patients think that the information may not be confidential, they may not tell us things that could be important for treating them because they fear it could be found out and used against them."

Supporters of the proposal--the subject at a meeting in Chicago of a government advisory committee--included some insurers and health care providers, who said that it could help doctors in treating patients in emergency situations and help insurers track claims.

The proposal was mandated by a 1996 federal law and the National Committee on Vital Health Statistics, whose meeting Monday was the first of several hearings on the issue. The panel is responsible for advising the Health and Human Services Department on how to carry it out.

Despite the criticisms mounting against the identification number, the committee has little choice but to come up with a proposal because of the law, said John R. Lumpkin, a member of the panel and director of the Illinois Department of Public Health.

Lumpkin, who is also a physician, made the case for having a system. "Say you come into an emergency room with a pain in your stomach and a scar on your abdomen and the doctor asks you what the surgery was for and you say: 'It was 15 years ago, I can't remember.' If there was an identification system, the doctor could look up the history," Lumpkin said.

However, the core issue that is emerging is where the information would be stored and who else could have access to the data, according to privacy experts. Much of the committee's discussion is centering on how the identification number could be kept confidential.

Committee members have discussed simply linking the information via a person's Social Security number--the sole existing national identification system. But privacy groups argued strenuously that Social Security numbers are too widely available through many sources. Lumpkin said there now is discussion of ways to encrypt the proposed medical identification number to ensure that it remains confidential.

Such technological protections offer little comfort to privacy experts and anti-big-government groups, who view the very creation of such a complete record of a patient's life as potentially damaging to some individuals. Especially in an era when computer hackers can break into purportedly secure databases, those groups worry that there is little that can be kept private.

The issue dominated several conservative talk radio shows Monday, including a San Francisco program hosted by Jim Eason. After the prospect of the new identification number was mentioned, "there were full phones" right away, said Greg Chapin, Eason's producer, adding that it was "very unusual" to get such a strong reaction and that every caller "without exception spoke against it."

Concerns have also been raised from groups that generally find themselves on the opposite end of the political spectrum from Eason's listeners.

"If you have someone's lifetime medical record from cradle to grave, you have something much more valuable than a snapshot of [a period of time] when a person might have been covered by one insurer," said A.G. Breitenstein, director of the Boston-based Health Law Institute, which provides legal advice on health and human services to poor people.

"So if you had an abortion when you were 17 years old, and now you're 35, that information is probably pretty inaccessible . . . and it's under your control whether you tell someone that. But if you had a unique identifier, that information is going to follow you until you're dead," Breitenstein said.

The provision mandating the creation of the national patient identification system was buried in a law that allows workers to keep their health insurance when they change jobs.

The main intent of the identification system is twofold: to help ensure that patients get the right care by allowing their doctors access to their full medical histories and to help track administrative functions, such as billing and payment for insurance purposes.

Many of the proposal's critics say that some insurers already use medical screening to decide how much to charge patients for policies or whether to insure them at all, and that having additional medical information in a database would be an invitation to more discriminatory practices by insurers.

In the wake of the uproar, government officials said there is no chance that the new system would be in place before the middle of next year, at the earliest.

"We're trying to figure out what's the best way to go about this and whether it's even possible to get consensus," said Campbell Gardett, a spokesman for Health and Human Services.

"It's a very sensitive issue because it's a national number, which people are nervous about anyway, and it's [about] their medical records, which no one wants public, so it's going to take a lot of thought," Gardett said.

Researcher Tricia Ford contributed to this story.

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