Obamacare Is Not a Secret Sex Directory

Confidentiality remains protected by law. Doctors will not become covert government agents. But the Affordable Care Act may get more physicians talking with patients about preventing sexually transmitted infections.
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"'Are you sexually active? If so, with one partner, multiple partners, or  [sic] same-sex partners?' Be ready to answer those questions and more the next time you go to the doctor, whether it’s the dermatologist or the cardiologist and no matter if the questions are unrelated to why you’re seeking medical help. And you can thank the Obama health law."

So begins a screed in the New York Post, which also ran on FoxNews.com, earlier this week. This and more shocking things about Obamacare are brought to us by Betsy McCaughey—the one-time inventor of the "death panels" rumor.

I know, a person with an extreme agenda says an absurd thing, what's new. This sort of thing matters right now, though, because still only around a quarter of Americans say they understand the Affordable Care Act well, and it remains a point of contention. People want and need clear information for productive discussion. It is important to sift through some of the more volatile nonsense.

I also see it as an engaging way to learn something about the health law. McCaughey seems to be drawing an egregious conclusion from a clause that's worth being aware of.

So, McCaughey holds a Ph.D. from Columbia University and is a constitutional historian and self-described "patient advocate." She was lieutenant governor of New York from 1995 to 1998. She is the author of a book called Beating ObamaCare. Jon Stewart has called her dangerous, and James Fallows once gave her an award for "Most Destructive Effect On Public Discourse By A Single Person" with regard to Clinton-era health reform. This is one of those figurative, joke awards, though.

In this week's article, McCaughey tells us that Obamacare is not a plan to make healthcare more accessible to every American; the real “aim [is] to turn doctors into government agents.” How? By “pressuring them financially to ask questions they consider inappropriate and unnecessary, and to violate their Hippocratic Oath to keep patients’ records confidential.”

This stuff is not true, though, fortunately. Doctors are trained to take a sexual history, as part of a thorough evaluation, even when you're just complaining of foot pain. Few disease processes happen in isolation in the body. It's all part of the strange, late-stage Jenga tower that is human health, but when a doctor asks if you're sexually active, take it as a sign that you're being thoroughly cared for.

Obamacare does say that insurance must now pay physicians for preventive services, including things like STI counseling. This is meant to help patients not contract sexually-transmitted diseases, and save the whole system money down the line. It's cheaper and easier for everyone to just not get gonorrhea than to end up with a baby blinded by gonorrhea, or to require antibiotics and contribute to the advent of super gonorrhea.

Preventive services that physicians will be encouraged to offer go well beyond sexual counseling, too. Doctors will be encouraged to talk to you about depression, alcohol abuse, obesity, etc, before these things become a problem. These are practices based on evidence. Doctors aren't forced to offer these services, and they won't be penalized if they don't. Patients likewise don't have to answer questions they don't want to. But the financial incentives will encourage doctors to actually do the things that our best evidence says is the best approach for both the individual patient and the system.

Finally, nothing in the law mandates that the answers to your questions be sent anywhere public. Oppositely, it must remain in a confidential medical record, to be viewed only by healthcare professionals who care for you, under penalty of law, as always.

One true claim from McCaughey: "Thanks to the NRA, Section 2716 of the ObamaCare law bars the federal government from compelling doctors and hospitals to ask you if you own a firearm."

This subverts the plot by doctors and hospitals to systematically map the gun owners in a given community and ... I don't even know. As Dr. Aaron Carroll at Indiana University pointed out in response to McCaughey, "There are legitimate reasons to dislike Obamacare. It amazes me how opponents of the law keep needing to invent ones that aren’t accurate in order to rail against it."

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Ronald Reagan Speaks Out Against Socialized Medicine (1961)

If you hear a friend saying something about Obamacare sharing secret sexual information with covert government agencies, do your part and lay out the facts ("Also, why would they care about your sexual history, Steve?"). As Fallows said in 2009, "Seriously, every one of McCaughey's statements about public policy from this day forward should be subjected to the 'Oh yes, and how did it turn out last time?' test. We are in O.J. territory here. Stop this new claim before it gets real traction."

O.J. references in 2009 were hip, remember?

Jon Stewart once reminded McCaughey that in the 1960s, Ronald Reagan warned the nation that the implementation of Medicare would leave U.S. healthcare in ruins. Medicare is still today regarded as a success story. When McCaughey was seemingly seriously concerned about the death panel thing, Stewart asked, "Do you distrust doctors and healthcare professionals that much? Are they doing a Trojan Horse to try and keep old people from living longer?" She said yes.

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James Hamblin, MD, is a senior editor at The Atlantic.

 
 

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