With the new Congress nearly upon us (that’s a scary thought isn’t it?), there are rumblings that maybe the time is ripe to repeal or at least dramatically reshape the Affordable Care Act or Obamacare.
I have little optimism about repeal or substantive revision, no matter who pushes, largely because Republican Congressional leaders are neither conservatives nor problem solvers in any meaningful sense. They are luxuriating in the same river of crony capitalism as Democrats, and the endless stream of money and power washes away any good sense about actually helping the country work better. In fact, the strongest indicator that the non-repeal fix is already in was Mitch McConnell’s immediate post-election statement that he would not seek repeal.
This leaves gun owners and all Americans in a worrisome place about how Obamacare treats them. Some comments I’ve read online indicate gun owners may have a false sense of security about Obamacare because, on its face, the statutory language appears to prohibit using the health care industry as a vehicle to question people about gun ownership. Like nearly everything Congress does, the devil is in the details.
The specific section (2717 (b)) from the statute is at this link. To summarize, collection of information about firearms ownership is prohibited in only two circumstances. The first is organized health and wellness programs, such as workplace wellness programs promoted by Obamacare (which don’t work, by the way), and disease management programs. The second circumstance is the calculation of health insurance premiums by health plans. There is no prohibition on physician speech regarding asking patients about gun ownership and recording that information in their notes or in electronic health or medical records.
Wellness vendors are apparently abiding by the statutory restrictions on what they can ask in their intrusive and often absurd health risk appraisals (HRAs). My wife and I are in her employer’s workplace wellness program for the coming plan year, and we just completed our HRAs. There was no question about firearms ownership. Wellness vendors, however, are not the real issue here.
The federal government never intended to prohibit physician queries about firearms ownership. In January 2013 the President signed an executive order to clarify, specifically, that the ACA does not prohibit physician inquiries about gun ownership. This is the problem. While the statute expressly prohibits storing information about gun ownership in “databases,” it does not clearly define electronic medical records as databases subject to that prohibition. (The feds have created three different kinds of electronic medical records, all intended to serve a different purpose, and all accessible to different people.)
People opposed to the right of self-defense have spun this as no one is forcing physicians to ask, or requiring patients to answer, questions about gun ownership. This is, of course, not the same as telling physicians that asking about gun ownership is inappropriate and unnecessary, except when it is a medically valid inquiry that will help to protect the patient or others. That’s the approach taken in Florida, which I wrote about in an earlier essay.
A voluntary, consensual interaction between a health care provider and a health care consumer cannot and should not become a fishing expedition with the provider acting as an interloper or enforcer for the government. The major medical establishment, in the form of groups such as the American Academy of Pediatrics and the American Medical Association, is in lock step with the administration’s hollow and baseless meme that inanimate objects are the problem.
Even though the assault weapon ban has been deemed a failure, by the no less than The New York Times, it tops establishment medicine’s list of desires. Why does the medical establishment play footsie so willingly with government and its anti-gun provocateurs? Money, money, and more money. Government provides nearly $0.40 of every health care dollar we spend, and the amount is going up. It is a classic case of knowing who butters your bread, and Obamacare is a full employment act for the medical care industry and an open-ended invitation to control ever increasing elements of our lives, all under the banner of “we are going to do this to you for your own good…whether you like it or not.”
Physicians are increasingly employees of large health systems, whose motivations are quite distinct from days past. It is only a matter of time before physician independence wanes, and pressure increases to meet nebulous “quality” goals, which will of course impact their incomes, and fulfill government dictates, including poking and prying around the edges of information that is not germane to the clinical matter at hand, but could easily be noted in medical record. Is that the same as being stored in a database? Until the matter is adjudicated, no one will know for sure.
No one should take their health care interactions for granted any longer. Be careful what you say, who hears you say it, and what they write down. Not too far in the future, we will look back on the concept of medical trust and the sanctity of the exam room as a quaint anachronism. Your best long-term bet is to stay as healthy as you can and as far away from the medical care industry as you possibly can.
Vik Khanna is a health care consultant, writer, and gun owner in St. Louis, MO. His new e-book, Your Personal Affordable Care Act: How To Avoid Obamacare, is available now at Amazon.com and Smashwords.com.
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