Losing privacy to efficiency

September 16, 1998|By Max Frankel

While deploring the loss of his own privacy this summer, President Clinton set out boldly to invade mine. His administration promised me a healthier life if I would accept assignment of a computer code -- a number or thumbprint or retina marker or other electronic gizmo to be called a UHI, a unique health identifier.

It would instantly disclose my medical record to anyone needing to treat me anywhere, and also to those who labor to improve medical science with research.

Before I could even calculate the probable costs and benefits of UHIs, shouts of protest forced the president to retreat. Americans, it seems, fear snoops even more than they fear germs. Many, in fact, responded as if their privacy were an absolute right, guaranteed by the Constitution.

The Bill of Rights does indeed forbid "unreasonable searches and seizures" of my person, home, papers and effects. But society's increasing invasions of my privacy have taught me that "reasonable" is actually a term of taste, describing a shifting community standard.

Unlike freedom, which is inviolate, privacy has long been treated by Americans as a possession that they can trade in the marketplace. For example, we tolerate the intrusion of telephone sales calls at dinnertime in exchange for the convenience of phone service around the clock.

So I thought a UHI was worth considering. As reported in the New York Times, Congress ordered the creation of a health identifier in 1996 as part of the law that allows Americans to keep their medical insurance whenever they switch jobs.

The Clinton administration was to devise a UHI plan by February but did nothing until mid-July, when it scheduled public hearings instead. Just one week later -- and freshly sensitized by his president to issues of privacy -- Vice President Al Gore signaled a retreat and tossed the matter back to Congress.

The proponents' line

The proponents of UHIs foresaw vast benefits. With my identifier, I would always be given reliable diagnoses and be consistently treated no matter how often I changed doctors or hospitals. My medical bills would be streamlined, saving me money. And adding my records to a national database would facilitate scientific studies to improve the health of the whole society.

The opponents argued that the government would never properly guard my records. Once they were leaked, I would run the risk of higher insurance premiums and possibly job discrimination. Even if relatively healthy, I would be endlessly badgered by peddlers of insurance, pharmaceuticals and assorted snake oils.

Bernadine Healy, the former director of the National Institutes of Health, warned during the debate that government could not be trusted with such "sacred secrets" as sexual practices, suicide attempts, abuse of alcohol and drugs and a range of "potentially prejudicial" illnesses, procedures and medications.

And the vaunted national research, she said, would violate a fundamental ethical principle: It would lack the informed consent of its human subjects.

Those fears were grave enough to tempt me to join the opposition. But then I reflected on the privacies we have already traded or given away. I do not think of myself as a "human subject" just because the census regularly records my existence, types me by income and national origin and counts my children, toilets and TV sets.

It's an intrusion that mainly benefits commercial enterprises, but I have always accepted it in exchange for my fair representation in Congress, for the insight that social statistics give into American life and for my share of federal subsidies. And that is only one of the many ways in which I exchange privacy for some larger benefit.

I have long possessed a unique number to qualify eventually for Social Security payments. That number now doubles as my Medicare ID, and Medicare, of course, vigorously logs all my late-life illnesses and infirmities. The same number links all my income-tax returns and bank accounts, including one that compiles an electronic record as it pays my bills.

Several more numbers unique to me record my charge-card transactions, including meals eaten in and out, movies rented or attended and cash withdrawn, even in foreign lands.

Lifting the curtain

I value privacy. I once renounced the purchase of a desirable apartment because I would not let the co-op board members keep copies of my tax returns. But I have since claimed the right to inspect the tax returns of political candidates and think it only fair that my alma mater inspects the tax returns of families applying for student financial aid. Thus does privacy often yield to decency, or expediency.

For the safety of children, I no longer object to disclosure of a nanny's criminal record. To obtain sizable discounts, I no longer resent registering my medications in the computers of pharmacists and drug manufacturers.

For the convenience of a Visa card, I tolerate the disclosure of my buying habits to countless merchants who sell and resell my profile and clog my mailbox with catalogs.

When I can, I resist new computer-age incursions until the benefit outweighs the cost. But that makes my privacy less a fixed right than a fluid commodity, more a matter of taste, commerce and custom than of principle. Americans are obviously not ready to trade their health records for vague promises of better care, but as the medical advantages accrue, and insurers make it worth our while, we will, and should, cut a deal.

Max Frankel is former executive editor of the New York Times.

Pub Date: 9/16/98

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