The sheer scale of our health care system and the complex flows of data among providers, networks, insurers, employers, and government agencies inevitably require a complex structure of legal rules and technical provisions to maintain the security and confidentiality of personal health information. But this complexity is itself a problem. It is impossible for individual patients or citizens to know whether these systems actually safeguard their data. But trust is scarce. Americans read countless stories about the abuses of managed care.
Talk radio is filled with tales of the evils of government bureaucracies.
I have some acquaintance with this current of populist distrust from my experience working on the Clinton health plan. There were legitimate privacy concerns in health care reform, but the atmosphere of distrust that pervaded the reform debate made rational public discussion of those problems nearly impossible. Today the problem is scarcely an imaginary one. Personal medical data are regularly used to set rates for health insurance in the individual and small-group markets that effectively exclude some people from coverage. Personal data are used to deny some people jobs.