Over at Hot Air, Jazz Shaw makes the case that the Republicans in Congress are really barking up the wrong tree with their push to give employers easier access to people’s medical histories and DNA information.
It’s easy to agree that if there’s anything that ought to be private, it’s our DNA and medical info.
But if you participate in an employer-provided group health plan, and/or you expect to ever file a Medicare claim, your employer and the government have legitimate reason to want medical information about you. (If you’re on Medicaid, your medical information is of course the business of the government.)
Whoever is on the hook to buffer and/or manage the costs of your health care needs to know what kind of a burden you’re going to be. The cost of paying your health services claims has to be projected and planned for.
The employer absorbs the financial impact in the cost of group health plan premiums, for which he is on the hook to whatever degree is in your employment contract. You probably pay some of the premium amount, and the employer picks up the rest. He has to plan for that. If you’re a special cost burden on the plan, that may affect only you and the employer. But as more employees are added with a likelihood of costly claims, premiums for the group will go up.
Employers are fully justified in wanting to be able to predict this. The government, meanwhile, is supposed to manage Medicare so that it remains solvent and can pay out claims on the basis for which it is obligated, for the millions of people who have paid into the program for years.
As nice as it would be to think of ourselves as free and medically autonomous, entitled to unbreachable privacy, we lose that status the day we enroll in Medicare.
Now, if you are not participating in an employer-sponsored group health plan of any kind, then you don’t owe your employer intrusive medical information for that reason.
That said, part of the financial burden of employing you in most states is making payments into disability and/or public health assistance funds. Public health funds are rarer; disability in some form is universal. The state funds are intended to support you and give you access to health care if you lose your job due to incurring a disability (even if not work-related. Worker compensation and liability insurance, separate programs, are specifically designed to compensate you for work-related injuries).
Besides the contributions while you’re actively employed, it’s common for an employer to remain on the hook for contributions to these funds for some period after you’ve gone on disability. So even where you’re not participating in a group health plan, the employer still has a legitimate reason to predict how likely you are to incur a disability.
Regarding Medicare, meanwhile, if you are 100% certain that you will never, ever make a Medicare claim – and some people are (typically the very wealthy) – then you can legitimately assert that you don’t owe the government intrusive medical information. While you’re legally employed, you can’t get out of contributing to Medicare (except in very special circumstances; e.g., you’re Amish). But if you’re never going to make a claim, you’re justified in withholding medical information about yourself from the government.
Bottom line: if you participate as most people do in one of the prized 20th-century collective-health programs, you have no legitimate standing to demand privacy. Someone else is going to have to pick up at least part of the costs of your medical care. In most cases, they’ll pick up most of them. And government has mandated both itself and your employer into that picture, with part of the financial burden apportioned to each. These other parties have to project how much you’re going to cost them.
Note: insurance companies, for actual medical insurance, were always in the financial picture of your health care costs. That’s why the insurance companies for so many decades have wanted a doctor to check you out early on, and wanted to know things like whether you smoked or drank, and what your height and weight were and your and your parents’ medical histories.
If we want to have an insurance market, that part of the equation will never change. Tell any sane person that he can offer insurance, but only on the basis of not being able to predict his risk, and he just won’t offer insurance.
It would be a fine thing if the privacy calculus with government and your employer changed. But to legitimately insist on privacy, we’ll have to get rid of the mandates that require us all to participate in collective, cost-sharing health schemes. Those mandates have been there for decades now. Obamacare has just made them bite harder.
Getting rid of the mandates doesn’t mean, and it has never meant, that we can’t come together to take care of vulnerable, impaired, indigent, distressed people. We’ve actually done that for centuries, through things like state and county hospital systems and health ministries sponsored by religious groups.
Those methods could always use improvement in the execution. But the sham of pretending that an “insurance” scheme works better has not panned out. It’s just an added expense and a waste of time. It is utterly false to insist that everyone has to be mandated into the exact same health management scheme, if we’re to make sure there’s a safety net.
To the extent we gradually accept that all of us are supposed to live as if we need the safety net – as if that’s the baseline norm – we will never have medical privacy again. If we want medical privacy, we’ll have to agree that we don’t need a central “authority” exercising intrusive health-care supervision over us as a matter of course. It’s the way everything in life works: if you want privacy and autonomy to be the norm, then self-support has to be the norm, and dependency the special case. The other way around doesn’t work.