H Berryman Edwards, MD, FAPA

ASK DR. DENIAL

June, 1996

Psychiatrist Patricia Lipscomb, MD writes from Seattle, Washington:

Dear Dr. Denial,

Is it not likely that privacy of medical information will be compromised even more under the highly touted "single payer" system?

Dear Dr. Lipscomb,

Are you sure this letter wasn't intended for the other Dr. Denial, AKA Dr. McDermott. He's the real expert on the single payer idea. I'm no expert on politics, but my fantasy is that what the system looks like will depend on whether it is designed by Democrats or Republicans or H Ross Perot. The Democrats would establish a Federal Department of Confidentiality funded by a psychotherapy tax. The Republicans would pay for only one session in which no information would be collected, but the psychiatrist would be reimbursed for telling the patient to get their act together. Mr. Perot would subcontract the whole thing to the Canadians so we wouldn't have to "reinvent the wheel."

The good news under a single payer system would be the uniformity of whatever policy would be established. The bad news would be that the information might be accessible to an enormous number of people: a great opportunity for "big bother". I believe the information would still be collected in order to "manage" the cases. The extent to which privacy is compromised would depend upon the amount and quality of information transmitted and stored, and the degree to which access is limited. I don't know how this is handled in Canada.

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