With today’s post, we conclude our discussion of Obamacare as it relates to the transgender community, especially to transsexuals.

The major concerns generally revolve around the creation and incentives under the new law to participate in a national electronic medical record database (aka EMR).  This is a serious concern of many privacy advocates and medical ethicists, and relates to Americans whether transgendered or not.  But there are some issues that are especially connected to the transgender individual.

1) Privacy issues within the medical community: there are admittedly benefits to medical care providers having access to all of your medical records.  An example is if you are a thousand miles from home and have a medical emergency that renders you unconscious.  Through the personal identification you normally carry, your medical records could be accessed from anywhere to inform the doctors of any medicines or forms of anesthesia that you are allergic to.

The downside is that medical personnel also have access to all your medical records, even in non-emergency situations.  Therefore, they may know more about you than needed for you to receive proper medical care.  It may also be more than you would care to disclose to this particular doctor and his staff.

Let’s say you need to see a foot doctor for a bunion or severe ingrown toenail.  You are able to tell the doctor anything he needs to know about a local anesthetic or any medication he needs to prescribe.  However, he still has access to your entire medical history.

First of all, transsexuals tend to have had greater usage of mental health services than the general public.  Have you or are you being treated by a psychiatrist for depression?  Perhaps the depression and gender conflict was so severe that it led to substance abuse, or suicidal thoughts or attempts?  Of course, your HRT and any transition related surgeries will all be part of your record.  This is all available to the foot doctor.

Some of the entries in your record could be quite embarrassing when seen by someone who has no reason to know about your transgender identity.  Let’s say there is an “F” on your record for your gender, but you were born with a male body. Does your foot doctor need to know your latest PSA score or the fact that sometime in the past, you were treated for erectile dysfunction?

There have been calls to change the EMR database functions so that the medical practitioners can only have access to that part of your record relevant to the case before them.  So far, the law has not been changed to do so.

2) Privacy issues with bureaucrats: entirely new bureaucracies are being created to oversee Obamacare.  In addition to the new auditors the IRS will be hiring (between one and two thousand), Health and Human Services will hire their own bureaucrats to make determinations that can affect the type of health care you can and cannot receive, even if you have insurance with a private company.

Section 1311 of the law empowers the Secretary of Health and Human Service to standardize what doctors do in their practice of medicine.  The Secretary will not be doing that work herself.  A reasonable assumption is that a multitude of bureaucratic minions will be gathering the data and writing up the recommendations that will eventually become the regulations that are published in the Federal Register and adopted (with some possible modifications after the comment period).

I had a discussion about this with my tech person who helped me set up my blog and is also a potential reader.  (Hi!)  Let’s just say that he is in a position to know that in the current environment, teams of professionals who provide technical support to the health care industry need to have access to this kind of data so they can do the job for which they were contracted.  He assured me that anyone violating patient privacy even in the slightest is subject to immediate dismissal.

There are some key differences, however.  I worked for HUD for 2½ years prior to working for a local housing authority.  And I deal with IRS agents on a regular basis.  Therefore, I am familiar with the government bureaucrat mentality.  They simply do not have the same level of professionalism as the type of person with private industry access to medical records currently.  Nor are they likely to have the kinds of salary and benefits packages that would make a person think long and hard about violating privacy and risking their jobs.

Perhaps most important, there are dozens of tech professionals with access to only a slice of patient medical data compared to thousands of bureaucrats who will have access to all of it.  In some ways, this is a numbers game.  And it only takes one person who decides that the right thing to do for his or her country is to out trans people.

One more potential risk was recently reported.  A very active hacker group called “Anonymous” has been breaking into various government websites and stealing privacy-compromising data.  In addition to the EMR database, it has been widely reported that security for HealthCare.gov has not been properly tested.  In one case, a hacker was given the name of a CBS News employee who had signed up on that website.  Within a minute, the hacker was able to come up with the employee’s answer to the security question.

3) Programming issues: this is related to the never-ending, oft-repeated disconnect between the programmer and the end user.  Transsexuals are a tiny percentage of the population.  Anti-discrimination notwithstanding, one concern brought up at the medical conference I attended was that our needs would slip through the cracks in the development of the data base.  Remember, multi-millions of dollars were spent to create the flaw-riddled HealthCare.gov website.  One would like to have faith that the database will be done right, but we have to consider the track record.

Potential problem number one is that our identification is limited to either an M or an F when it comes to gender.  (And while this is not a unanimous opinion in the transgender community, many of us would not want to be put in a third category.)  Therefore, it is reasonable to expect that the EMR database will conform to that: only two choices for the gender field.

I have usually been able to look over the shoulder of the nurse when she is entering any of my new information (weight, blood pressure, etc.) collected during my exam that day.  As she enters data, new screens automatically pop up based on what has been entered or is part of my basic information.  If an F is in the gender field, the screen for a prostate exam will never appear.  For a FTM, an M in the gender field will preclude the screen for a pap smear.

This is will probably prove to be a less serious concern than the privacy issues in the long run.  However, it is still something that will take time to surface and remedy.  And remember, the more obviously we are identifiable, the more likely the privacy issues can come back to haunt us.

For I will restore health unto thee, and I will heal thee of thy wounds, saith the LORD; because they called thee an Outcast … – portion of Jeremiah 30:17.

In my next post, I will begin to look at what the Bible says about how we are formed or made before we are born.

God bless,