In a June 26th, 2014 article entitled, “Your Doctor Knows You’re Killing Yourself. The Data Brokers Told Her,” by Shannon Pettypiece and Jordan Robertson, http://www.bloomberg.com/news/2014-06-26/hospitals-soon-see-donuts-to-cigarette-charges-for-health.html, reports that, “Carolinas HealthCare System…is placing its data, which include purchases a patient has made using a credit card or store loyalty card, into predictive models that give a risk score to patients.”
To use for what, supposedly? According to Michael Dulin, “chief clinical officer for analytics and outcomes…Within the next two years, Dulin plans for that score to be regularly passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.”
Because of the large number of comments listed (974, bigger than some survey results that are reported), I decided to go through the comments.
Probably no surprise to anyone in the US, the NAYS had it. Only a handful of people showed any support at all for the Carolinas HealthCare use of personal purchases to establish a RISK PROFILE of patients. I counted fewer than 10 supporting the practice, or who didn’t care about the practice, or who didn’t believe it was true.
What was interesting is that NONE seemed to believe Michael Dulin’s, of Carolinas HealthCare System, justification for the data mining, that the information would be “passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.” That’s NONE.
Most believed the data would be used “against” patients, explaining the most commonly offered solution to the situation by commenters: USE CASH.
There were a few who had some novel suggestions, such as Tanstagcopc who gives the White House address and phone number when asked for hers by a cashier and always claims to have lost her rewards card to get a new one which many cashiers will scan and remind you to finish your registration at home after your purchase.
There was another commenter, by Notademocrat that said that’s why the “worst thing anyone can do is use a smartphone.” To which another commenter Sourcecode-v3 who explained, “Why I still have my burner phone.”
Then there was Ivan Denisovitch who said, “What’s next is a back-door, underground black market medical service community.” To which Guest replied: “My physician’s exwife saw her friends as off-the-record patients…she was only interested in their cash.”
FelliniFan said, “Electronic medical records have destroyed patients’ privacy.”
Thinker warns: “…while some groups may appear to be ‘favored’ now, human history shows that they are always the first to go.’
Buck recommended: “Maybe consumers should band together and analyze data on American hospitals and why they charge $10,000 a day when hospitals in other western developed nations charge a small fractio nof that for the same service and provide better quality care.
And Common_sense 96 did indeed have some: If a doctor/hospital ever brings up things that I have/haven’t purchased I will not answer but immediately demand in writing on their letterhead what they are asking me and where they got the information from.”
When it came to blame, the answers reflected public diversity in who’s to blame that our world has come to this concoction of a RISK SCORE based on shopping. JimH said, “The use of informatics to improve patient care—especially driven by government res is called ‘care management,’ this is the reality healthcare providers face now.”
Some blamed HIPAA such as Polmom who said, “I refuse to sign HIPAA…but I don’t believe that stops anyone from accessing my records.” Or DaveB who said, “You can add mass shootings to the list of unintended consequences caused by HIPAA.” Or Jodie, who replied, “So true.”
So it was clear that the process of data mining was NOT supported primarily because of interests in privacy and that NOBODY believed Michael Pulin’s lame claim that the information would be used to help prevent illness because of any concern for patients (except as a means to save money for government and insurance companies).
But the bulk of the arguments divided down Republican-capitalist lines and Obamacare-social programs lines reflecting that we as consumers are aware of the hybrid nature of Obamacare that benefits both government and private industry off the backs of citizens, but we’re not sure what to do about fixing it. This is important because who our lawmakers, as we will choose them through voting, will influence changes to Obamacare.
There are those who forgive the Democrats because the Republicans do it too. Like Earl Turner who says: “Welcome to the Corporate States of Amurrica. All you neocons and Republicans would be screaming bloody murder if the government did this (and the government does) but it’s perfectly OK for business to do it.”
Not quite sure what that was about since the vast majority of ALL commenters were against Carolinas HealthCare System policy of gathering and distributing citizen purchasing habits via credit card and store discount cards.
Harry Taft responded to our confused friend Earl, “Earl, it may have escaped your notice but after the implementation of the ACA all of healthcare is simply a subsidiary activity of government.”
While hyperbolic in terms of “all,” Harry makes a good point, Obamacare simply created a new entitlement system where the government helps more people purchase health insurance from corporations and taxes them for a failure to do so.
Then there’s informatics Jim H who comments again, “Obamacare wasn’t the origin of quality measures.” Same argument. It’s not worse, it was happening before.
I respond to JimH, True, but rewarding these practices through government payouts in the form of dollars for outcome-based care and penalizing hospitals for re-admissions does make things worse than before by providing financial incentives to keep scores up by excluding the "RISKIEST" patients.
Finally it was GREAT to see that most people who commented recognized the arbitrariness and unfairness in singling out particular groups for uneven treatment. Those who supported singling people out usually did so by relying on untruths.
For instance, Ricecake202 commented: “When you make it law that everyone must buy healthcare insurance or else must pay fine you must also make it law that everyone must live healthily or else must pay fine for the risk and cost the tax society [actual words in comment]. It’s only fair.”
While the argument sounds almost reasonable, it is not relevant in terms of Obamacare which ONLY permits higher premiums be charged to tobacco smokers and older people.
As pointed out by Srh S: “Don’t forget gun owners, motorcycle drivers, and extreme sports participants.” We might also add those who use illegal drugs (not usually purchased with a credit card or store discount card), those who engage in promiscuous sex without protection (so condoms wouldn’t be showing up on their purposes), those who have gym memberships but never attend, or those that buy healthy in the grocery while paying cash at bars, restaurants and other places.
Srh S also says, “So what is wrong with trying to limit or eliminate the things that cause ER visits and cost taxpayers money? Sorry cons…time to stop living in the past.”
Unfortunately, experience so far does not support our snarky Srh S. For instance, on 7/8/2014, “USA Today” reported, “More patients flocking to ERs under Obamacare,” by Laura Ungar, http://www.usatoday.com/story/news/nation/2014/06/08/more-patients-flocking-to-ers-under-obamacare/10173015/.
Recovering Liberal wrote: “The situation is bullsh-t but Milton’s point is valid. If I’m forced to subsidize your healthcare then I should have the ability to mitigate the risks to my pocketbook by restricting your risky behavior. This is the dark…consequence of socialized medicine.”
This was what was going on before Obamacare (which by the way is not socialized medicine). It was being done by insurance companies who were paid premiums by citizens for the right to coverage in the event something happened and then were dropped when they became sick, denied insurance because they were sick, or were charged more in premiums based on that fact that they'd become sick. Obamacare, naturally, is not worse or better, it’s merely the SAME approach with a shift in who’s paying more.
Under Obamacare smokers and older citizens are to blame and charged more instead of women using expensive maternity services, drug users, those with pre-existing conditions from drug abuse or otherwise, or even the fat. Now we’re “paying” for all of that INSTEAD.
One of the biggest boosters of Obamacare who called himself Fartolio Fatso, confirmed my two conclusions so far: First, that the information mining is not believed by anyone to be the benefit to citizens so that healthcare workers can “reach out” to them but rather as an invasion of privacy that will be used against them and second that NOT understanding Obamacare is a barrier to reform.
Fartolio Fatso went on and on. Some of his comments were, “To decrease healthcare cost must go to the roots of problem…it’s bad behaviors.” And, “Now we’re talking about making smokers, alcoholics, fatsos have to chip in their fair shares of health care system’s costs burdens.” Finally, “I don’t like smokers, alcoholics and fatsos.” OK. Regarding the punishment aspect, obviously saying you don’t like someone is a great indicator. Regarding education, obviously this commenter doesn’t know that only smokers and NOT alcoholics or fatsos are affected by higher premiums under Obamacare.
One of the trends that COULD worsen is the trend in using emergency rooms if information from data mining is used by healthcare providers to deny care to patients who will bring down their good numbers for outcomes and efficiency in getting more federal dollars. Patients will and SHOULD go to the emergency rooms because they cannot turn you away in this case though emergency costs will be higher than seeing physicians elsewhere.
If physicians begin denying care Obamacare itself, I believe will also be in jeopardy since healthier older people and those with habits doctors don’t like who find they cannot obtain medical treatment will simply buy catastrophic policies which ultimately means that those individuals who eventually will get sick will have cheaper insurance up to and including the time when they get ill. Of course, older Americans in Medicare will begin to cost more money as people don’t get regular medical care which means that the Independent Payment Advisory Board will kick in and…
Still, thank you to the commenters regarding the June 26th, 2014 article entitled, “Your Doctor Knows You’re Killing Yourself. The Data Brokers Told Her,” by Shannon Pettypiece and Jordan Robertson, http://www.bloomberg.com/news/2014-06-26/hospitals-soon-see-donuts-to-cigarette-charges-for-health.html, discussing Carolinas HealthCare System and their practice of tracking your credit card purchases and discount card purchases to calculate your patient risk score for YOUR OWN GOOD.
