For reasons too complicated to explain, I have more than a passing knowledge about medical informatics — or, in simple terms, the trend to put all patient records in computerized systems. That’s why, at a soccer game, a young woman who is clearly an Obama supporter asked me what I thought of the move to put all American medical records in a federal database. “What harm can it do?” she asked.
We both agreed that a comprehensive federal medical database probably couldn’t harm people financially, the way identity theft scams can. I suggested to her, though, that federal control over medical records — could harm people in much more significant ways. For example, I said, a 50 year old, vital man, might not want the feds responsible for keeping secret the fact that he has to use Viagra. Likewise, I said, no one wants information about their hemorrhoids to go much beyond their own doctor. Hackers, I pointed out, could easily blackmail or humiliate people with information such as that.
Further, I said, it’s not only, or even primarily, the big diseases like cancer or AIDS that are the problem. For most people, privacy means keeping around them a zone in which they forever function like a healthy young person, free of warts and erectile dysfunctions and fibroids and whatever other systemic failures people don’t want to admit to having.
She was much struck by this argument. She certainly agreed with me that the average citizen would be wise not to trust the government with his or her secrets. She understood, as I do, that government loses control of secrets, that a hostile administration may give away secrets, that individual government employees abuse secrets and that, by the nature of government, too many people know the secrets.
The gal pointed out, though, that we already give that same information to insurance companies, hospitals and doctors offices, and that they too have that information on their computer systems. That’s different, I explained. In those cases, there’s a one on one quid pro quo that precedes the entity’s taking on and computerizing that information. Thus, I, personally, agree to go to that doctor and I acknowledge that, as a necessary adjunct to my treatment, the doctor needs to create and maintain my medical records. Likewise, I choose to have insurance and, as part of that agreement, I also agree that it is reasonable for the insurance company, before it pays for my health care, to know what’s wrong with me.
With a federal database, though, I don’t get to make that agreement. The federal government, as it just did, dictates by legislative fiat that it is entitled to create and control these records — and, being the government, to lose, abuse, publicize, sell or, ultimately, use these records as a justification to deny me medical care entirely. There is no quid pro quo here. There is no contract. There is simply a federal government using its vast power to access and control, not only my big secrets (assuming I have any), but my little, humiliating secrets, the ones that knock down the sphere of physical inviolability all of us like to believe we have around ourselves.
I doubt I shook this gal’s faith in Obama, or the Democrats, or even the spendulus plan. But I like to believe I made her think. And maybe once she’s done thinking about this, she’ll start thinking about something else too.
UPDATE: A little off topic, but a good reminder that you should never, never, never trust the government with your secrets.