Fierce Necessity: Fort Hood, 11/10/09

Fierce Necessity: Tone Deaf, 11/07/09

"Click Pic"

Name that tune...



The Oregonian reports Thousands flood US capital to protest health care bill as Democrats predict passage.

The Financial Services Modernization Act of 1999 (Gramm-Leach-Bliley) allowed banking, securities and insurance companies to merge.

Until recently, most of the attention has been centered on the banking and securities sectors. Now we are seeing the insurance component of the power play.

Consider the following case study in privacy and conflict of interest:

Mr. Smith is 50-year-old systems analyst for a large financial services company. He is covered by his company's integrated health insurance benefits plan. The primary focus of this plan is to control health care costs. In order to do this, the employer itself coordinates all aspects of the patient's care and access to medical treatment.

After five years of employment, Mr. Smith independently discovers that he has contracted HIV. He does not want his employer and co-workers to know the details of his disease.

Under the Health Insurance Portability and Accountability Act (HIPAA), Privileged Health Information is supposed to be covered under the Privacy Rule of 2003 and the subsequent Security Rule should govern who has access to his confidential medical information. However, Mr. Smith works in Information Technology and is fully aware of information accessibility within his department and the greater corporate climate.

Mr. Smith is now in a double bind.

The Americans With Disability Act of 1990 is supposed to offer protection against discrimination in the workplace and ensure that reasonable accommodations are offered. However, in order to claim this protection, workers must prove the qualifying condition to the employer. Mr. Smith could then expect reasonable accommodation, which in his case would mean that he could work from home allowing him some privacy as his disease progresses, but at the expense of interaction with coworkers. Furthermore, this does nothing to address his health care needs.

Now, at this point you might argue that Mr. Smith would have no other choice but to divulge his HIV status to his employer and potentially, to his co-workers. However, I counter this argument from the position of a health care worker and testify that the stigma, prejudice and discrimination related to HIV/AIDS in the United States is far greater than any of us want to admit.

The U.S. Department of Health and Human Services - Health Resources and Services Administration - HIV/AIDS Bureau notes the following in its publication, PROVIDING HIV/AIDS CARE IN A CHANGING ENVIRONMENT :

• A 1999 telephone survey found that 1/5 of the general population feared people with AIDS and 1/4 felt uncomfortable around people with AIDS.
• Another survey found that 1/3 of the general population would not even shop at a grocery store owned by a person with AIDS.
• A survey on violence found that 20.5 percent of women, 10.5 percent of homosexual males and 7.5 percent of heterosexual males had been harmed physically since their diagnosis.
• Two of the most significant barriers to HIV testing itself are related to privacy and treatment concerns as a Kaiser 2000 health poll found that 1/3 of respondents were "very" to "somewhat" concerned that other people would find out if they were tested for HIV. Furthermore, eight percent of those not tested said that confidentiality played a part of their decision not be tested.

Please see the link to this report for discussion on stigma within the health care system itself.

Obviously, privacy and stigmatization are fundamental issues for Mr. Smith and not easily dismissed.

Thanks to the Gramm-Leach-Bliley Act, Mr. Smith's employer also provides for all of his banking, life insurance, mortgage, consumer loans and retirement services. It's a case of one-stop shopping for life.

Currently, the health care reform debate within the government rages on over anti-trust provisions. These types of efforts may or may not be a remedy for someone like Mr. Smith. So far, we have seen more unintended consequences from such pressured reform efforts than we have intended ones and I've yet to hear any administrative talk of challenging these monopolies.

According to the LA Times, Insurers are poised to reap benefits from the insurance overhaul.

It sounds like 16 tons to me.