Amy Oliver Cooke and Linda Gorman
The Independence Institute

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December 21, 2011
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Colorado's all-payer database poses serious risk, little gain

Colorado state government, and local foundations and health policy elites, have become so ideologically invested in failed health reform policies that they now see nothing wrong with forcing Colorado citizens to give their medical records to a centralized repository, free from scrutiny by state auditors, open records requests and open meeting requirements.

In 2010, state lawmakers passed HB 1330, which created the All-Payer Claim Database. It was an exceedingly vague piece of legislation. It created the usual sycophantic advisory committee to give an illusion of public control, but the real power was given to an "Administrator" empowered to collect whatever medical data it wished from every "payer" in the state. The Administrator may impose unspecified fines on payers who refuse to comply. The database was to be operational only if private funding could be found. With funding already in place from private sources intent on promoting government-controlled health care, the Center for Improving Value in Health Care (CIVHC) was appointed as the Administrator for the database. CIVHC promptly converted itself from an entity subject to public oversight to a private 501(c)3 nonprofit.

CIVHC supporters claim the database will be secure, that individual identities will be protected by encrypted Social Security numbers, and that individual privacy is protected by HIPAA.

These claims are disingenuous at best. Encrypted Social Security numbers do not protect individual identities in a database that also contains information on an individual's gender, address, race, spouse, children, dependents, insurance group, insurance contract and member number, and the doctor, place of treatment, time of treatment, diagnosis, place of care, prescription drugs, and payments for all medical treatments for everyone covered under any insurance policy or making a cash payment.

Centralized electronic medical records have been maintained by Britain's National Health Service for almost a decade with predictable and disastrous results. In April 2010, London's Daily Telegraph reported that private detectives were selling top-secret patient information for up to £300 a pop. This means that if you or your spouse or children have ever seen someone for psychiatric care, an abortion, a sexually transmitted disease, or substance abuse, anyone with access to the database will be able to figure out who you are and use that information against you. Alternatively, you could be wrongly diagnosed as an alcoholic or a sexual abuser, have the diagnosis entered in your record, and be threatened by a blackmailer.

Good luck proving a negative.

CIVHC supporters say the All-Payer Database is essential because they cannot "manage what they cannot measure." Never mind that people who pay for their own health care are perfectly competent to manage it themselves or hire others to do so, or that CIVHC's form of centralized management has failed everywhere it has been tried. Claims that the database will improve medical care are nonsense because it does not collect the detailed physiographic information required by clinical studies that do. What it will do is add substantially to medical care costs.

All existing public information suggests that CIVHC plans to use the All-Payer Database to bring private medical care under the control of unelected and unaccountable bureaucrats. Its metrics emphasize imposing price controls on insurers, and physicians, targeting people who are obese, limiting physician freedom to recommend treatments, making sure that individuals have "advance directives" in place, monitoring the amount spent on the last six months of life, and limiting Colorado health spending to a fixed percentage of the state's gross state product.

As it is cheaper to let people die than treat them, it is but a short step from this to copying the European tradition of letting underweight babies die, forcing the elderly to accept palliative care, and denying advanced care to the disabled and seriously ill.

Amy Oliver Cooke directs the Colorado Transparency Project (COST) at the Independence Institute, a free-market think tank in Colorado. Linda Gorman is director of the Independence Institute's Health Care Policy Center.


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The Summit Daily Updated Dec 21, 2011 01:41PM Published Dec 21, 2011 01:41PM Copyright 2011 The Summit Daily. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.