Keep Your Laws Off My Donuts

...or, "Big Government, Big Data, Healthcare, and You."

A news item from one of the many sources these days that provide really terrible journalism and writing, Bloomberg News, discusses how certain aspects of ObamaCare are resulting in hospital systems using consumer data to target individuals for proactive health management...to wit, the idea is that if your data shows you buy donuts every day, you'll end up getting a scolding call from your doctor.

Poor journalism notwithstanding, the article raises some interesting points that inspire contemplation of what the future may hold in this brave new world of big technology, big data, and big government.

The story of this story really starts before the story. That is, the foundation for where we are going was laid in 2009 under the American Recovery and Reinvestment Act (you know, one of those crazy huge "stimulus" spending bills). ARRA contained among its plethora of pages (in Title XIII) something called the Health Information Technology for Economic and Clinical Health Act (HITECH Act - oh, they are so clever, aren't they?). Part of that act (called "Meaningful Use") basically requires medical folks to switch over all their record keeping to what's called an EHR (electronic health record), and incentivizes that conversion with tax dollars (as well as penalizing non-compliance). Seems pretty innocuous, right? I mean, I'm all for going paperless in all businesses. Who isn't?

I work for a large and successful healthcare system comprising about two dozen hospitals, 180+ clinics, and a health insurance company - and this non-profit system is internationally known as a model for delivering the best care at the lowest cost. As part of "meaningful use" compliance, we have in place a program called "Shared Accountability," which basically means that people are encouraged to live in healthy ways as a preventative measure. Under ObamaCare, the fee-for-service model is changing such that it is better for hospitals and doctors to NOT have to see patients - which means trying to help them be healthy in preventative ways.

Again, that all sounds great - why not reduce costs and utilization by just keeping people healthy, rather than waiting until they are really sick to treat them?

But...as with pretty much everything in this world, there are always two forms of counterbalance to a decent idea: unintended consequences (that is, accidental bad results) and deliberate abuse (intentional bad results).

Possibly falling under the latter is this idea of doctors checking up on your lifestyle - a result of combining the data-juggernaut EHR of "meaningful use" and the busybody good intentions of "Shared Accountability." When it's in the best financial interest of your medical professional to butt into your personal life...there is suddenly a potential for conflicts of interest (that is, the interests of public health and doctors' livelihoods with the interests of personal freedom and privacy).

A couple of random thoughts on this whole idea:

First, let's remember that all of this - ALL OF IT - is the result of the government getting involved in things which it really has no Constitutional business being involved in (dubious SCOTUS rulings notwithstanding).

Second, it's easy to imagine a number of slippery-slopes resulting from this. With the government holding the purse strings of your healthcare, you can be coerced into behaviors "for the collective good," a situation that is antithetical to the philosophies of liberty on which this nation was founded. That's a fancy way of saying, "Dagnabbit, I got the God-given right as an Amurrican to eat as much bacon as I dang-well please!"

And whether that is a healthy idea or not, it is, fundamentally, true. And that truth is important, because you may not like bacon (weirdo!), but maybe you like something else that the government deems an unacceptable risk for the collective. The question eventually becomes, "where do we draw the line?" And the answer will inevitably be, "somewhere WAY back there...but it's too late now, because we relinquished the right to draw lines WAY back there."

Third, more slippery slope, in the form of "deliberate abuse" of a good idea: with all the data available on you, and all the power that knowledge gives to others who have access to that data, what's to stop someone with such power from controlling you in unrelated ways, such as for political or other ideological purposes? Well, nothing but their good intentions. (Heaven help us!)

Finally, the idea that a healthcare professional might call you up because you buy donuts every day is pretty ludicrous, given the fact that there's no way (yet) to know who is consuming what. If my wife buys me donuts each day, why should she get a call, when she's perfectly healthy? So, if they want this to work, they're really going to need to get more data. Not that that's out of the question...thank you NSA!