National Health Database: Benefit or Menace?
For chapter 15

Imagine moving to a new city after you graduate from college. You are ready to begin your new job, and during your orientation session you sign up for a particular health care package and select your doctor. Two weeks later you come down with a bad cold. You think it may be the flu and decide to make an appointment with your new doctor. When you show up for your appointment, the doctor informs you that she has already read your chart and is fully aware of your medical history, your allergies to certain medicines, and even when you broke your left arm.

At first you are amazed that she knows all of this and are happy that you do not have to fill out numerous forms and tell her your medical history. Immediately after that you are curious as to exactly how she knew what she knew. And then, you wonder who else might have access to this information that you didn't even know was available to your new doctor.

Although the above situation is not yet a reality, if the Clinton administrations plan for a national health database proceeds, it very well may be the reality in the near future. The plan, established as part of the 1996 Health Insurance Portability and Accountability Act, calls for the assignment of a unique tracking number to each American that will be used to identify that person in a national database. This database will keep track of each person's entire medical history from birth to death. The purpose of the database is to provide seamless health care coverage as people move around from job to job by eliminating much of the bureaucracy that people face at the doctor´s office. Currently, all of this information is kept in databases around the country, but not in one location, nor by one organization. The difficulty in obtaining complete information on one individual creates a sense of privacy.

Supporters of the database - insurance companies, and medical researchers - argue that the time consuming bureaucratic problems will be nearly eliminated. Very few people disagree with this point. The supporters also argue that the potential research opportunities of having a centralized, all-encompassing database will be incredible. As a result of these two benefits, supporters believe that medical care will improve in this country.

Opponents of the database - including the American Medical Association and numerous national privacy organizations - base their arguments on several issues such as information privacy and the unique identification of individuals. Currently, medical records are not protected by law, though credit records and video-rental records are. Until legislation is passed to protect medical records in the same manner, this medical database will not work. Second, unless Americans can trust the confidentiality of the database and the controlled access to it, the database will not contain complete records on individuals as they will not be forthcoming in fear of who might see their record. For example, employers may not wish to hire individuals with a family history of cancer, so if employers are somehow able to access the database, individuals will be reluctant to disclose such information. This, in turn, will decrease the effectiveness of healthcare. A third issue is that of how each individual will be identified. Social Security numbers are not an option because they can then be linked to credit reports. Any other method could create an administrative nightmare in itself that may defeat the purpose of the database in the first place.

Although the Health Insurance Portability and Accountability Act was passed in 1996, the database part of the act can be repealed before a 1999 deadline. More information on the 1996 Health Insurance Portability and Accountability Act can be found at http://hippo.findlaw.com/hipaa.html.

Points to Ponder:

1. How do you feel about such a national health database? Do you agree with the concept in general, assuming it could be implemented properly with assured security and privacy?
2. What method of unique identification do you propose for such a database, assuming that you cannot use Social Security numbers?