Big Brother Is Watching Your Health Care

We all know that the big insurance companies are in the business solely to make a profit. They are not in the business to help people access and receive quality, affordable health care. At times it seems that the insurance companies don’t want to insure people who need it the most, but only those individuals that will use health care services the least.

We already know that if you have had a serious illness such as cancer or heart disease, even if successfully treated, you will find it nearly impossible to purchase health insurance if you are either self employed or are uninsured because you work for a small company which cannot afford the constantly rising health insurance premiums. This elimination of people with health risks from the pool of insured patients extends even to people with easily treatable chronic illnesses such as asthma, hypertension, diabetes, or mental illness. People have even been turned down for excess weight or prescription drug use. Eliminating these people from the ranks of the insured helps insurance companies make huge profits each year but unfortunately at the expense of the American consumer. There are now over 47 million people in the United States with no health insurance, and many others are underinsured.

I recently read an article, in the Washington Post by Ellen Nakashima entitled Prescription Data Used to Assess Consumers, which explained how in an effort to weed out people who may have had a serious illness or have a chronic health condition, health insurance companies collect and analyze personal health information on consumers through such companies as Ingenix, Milliman Intelliscript, and others. These companies maintain large prescription use databases and provide health insurance companies with consumer drug profiles. Traditionally the health insurance industry has gathered this information from doctors' offices, but with the advent of computer databases, health insurance companies are now gathering information from prescription drug records and clinical and pathological laboratories. You as a healthcare consumer are usually unaware that this is going on. It is certainly an invasion of your privacy. Consumers should find this very frightening.

As Joy Pritts, a research professor at Georgetown University’s Health Policy states: “As health care moves into the digital age, there are more and more companies holding vast amounts of patient’s health information. Most people don’t even know these organizations exist. Unfortunately the Federal health privacy rule does not cover many of them.”

These companies mine the huge prescription history databases kept by pharmacy benefit managers (PBMs). Every time that you have a prescription filled using your insurance card; this information goes into the PBMs database. Consumers are assigned a “pharmacy risk score” with the highest scores being assigned to AIDS and cancer medications.

While Congress did pass the Health Insurance Portability and Accountability Act (HIPAA) in 1996, whose purpose is to protect the confidentiality of patient health records, unfortunately, according to the article, companies like Ingenix and Milliman are not regulated by the HIPAA act. There is concern that this breach in the confidentiality of patient prescription data will be extended to other types of patient electronic medical data as well. Before long, people will not only be turned down for health and life insurance but for employment as well. This is surely a case of “big brother” overseeing your most intimate health records. There have been calls for further legislation on health privacy issues, so do let your local and Federal officials know where you stand on the issue.

If you find yourself uninsured or underinsured due to a pre-existing condition or a past serious illness, a

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