Ellen Nakashima has a piece in today's WaPo biz section about the "lobbying war" over patient privacy and electronic medical records. While looking at the competing interests backing the different versions of the bill (nutshell: the House includes more consumer protections; the Senate bill is more business-friendly), the piece, more broadly, offers a primer on why it's so damn hard to pass even what seems like common sense legislation. Among the prime complications, so many people standing in the wings with grand ideas about how to turn a profit from the data in question. As Nakashima notes:

Resolving these competing visions will be the task of House and Senate negotiators. The outcome could determine, for example:

  • whether a hospital or doctor can make a profit by selling people's medical data, without their consent, to pharmaceutical companies for research;
  • whether a hospital or other provider must obtain patient consent before sending them fundraising letters.

One provision that has generated a great deal of lobbying on both sides would, for instance, bar a drug company from paying a pharmacy to send marketing letters to patients unless the patient consents.

OK. I wouldn't have thought to worry about the possibility of more junk mail, but I can't say that I object to having it barred. Except:

The National Association of Chain Drug Stores, which represents CVS Pharmacy and Walgreen's, among others, and which doubled its lobbying spending in 2008 to $1.4 million, opposed the provision. It sent a letter to lawmakers arguing that the restriction might block pharmacists from sending refill reminders.

Really? That could happen? Well, I'd certainly want that wrinkle addressed:

In the House, the pharmacists found a receptive ear in former House minority whip Roy Blount (R-Mo.), who sponsored an amendment last month in the Energy and Commerce Committee ensuring that "nothing" in the legislation would "prevent a pharmacist from collecting and sharing infomation with patients."

Problem solved? Not exactly:

But when Democrats on the House Ways and Means Commitee saw the language, they became concerned it would maintain a loophole that allows drug companies to pay pharmacists to send letters--at up to $4.50 per letter--pitching more expensive alternative drugs to their customers.

Ack. Just what I need: my Great Aunt Thelma getting sales pitches from her friendly pharmacists about the hottest new mood enhancer. What to do about this?:

[House Dems] revised the language to close the loophole. 

Then, of course, insisting that he was concerned about pharmacists' freedom to recommend generic drugs:

Blunt tried once more to amend the bill to the pharmacists' liking but failed.  

Meanwhile, on the other side of the Hill:

The Senate added an amendment to its bill by Sen. Tom Harkin (D-Iowa) that would allow pharmacists to send letters to patients as long as they are for a health-care item or service that has previously been prescribed.

And on and on it goes. By the end of this not very long piece, I was ready to bag the whole concept of digital record-keeping and just mandate that everyone to carry around their files in an old Trapper Keeper.

But not a Dawson's Creek Trapper Keeper Ultra Keeper Futura S 2000 like Cartman had. That would require more legislative debate than even the current proposal.

--Michelle Cottle