Health care and health insurance are in a sad state in America.

Consensus is building for reform, but it is important to see how we got here. One cause - and a symptom of the real problem - is the passing and subversion of the Health Insurance Portability and Accountability Act, known as HIPAA.

HIPAA was passed by Congress in 1996. It promised to protect us from unscrupulous insurance companies and employers. The concern was they might deny us insurance, or employment based on our medical history.

The act " ... limits restrictions that a Covered Entity (i.e. an insurance provider), can place on benefits for preexisting conditions." That sounds like good words, but that didn't happen. We know that insurance companies routinely deny insurance for pre-existing conditions. Providers of health insurance now require the waiver of HIPAA rights as a condition of service and by doing that they have gotten around the requirement.

The act also was supposed to prevent fraud and abuse. However, it mainly protects the insurer from fraud and abuse by the individual. Not surprisingly, that provision has not been bypassed, as far as I know.

Privacy is what this act is about. HIPAA limits the distribution of an individual's health information, including their payment history. An insurance provider can divulge such information only with the consent of the individual, and even then, must "... disclose only the minimum necessary information required to achieve its purpose."

An individual who believes that their privacy is being violated is encouraged to complain to the Department of Health and Human Services. Employers, for fear of being sued, must train employees to keep health information confidential.

Studies show that HIPAA has detrimental effects on medical research. The areas of research impeded by HIPAA include access to stored tissue and genetic datasets, data warehouses and medical records and community research.

HIPAA threatens the social good by seriously restricting biomedical research and unnecessarily slowing the path toward life-saving discoveries. A result of this lack of independent research is doctors now get all their information from salesmen, not from clinical studies.

Another problem is the public has no access to billing information. Doctors and individuals can't predict if a procedure will be covered by insurance, or how much it will cost. Studies can't link what a treatment costs with its effectiveness.

In this legal environment, insurance companies charge what they want. They can change the rules every month. They make it difficult to understand the rules. They can practice rescission, cancel policies and raise rates when people get sick. All this information is confidential, and cannot be studied.

How did a law get written this way, and how did it get subverted? There is a trail of money through lobbyists, campaign contributions and media manipulation. Sunlight is the best disinfectant. It is time to repeal HIPAA and also to cut off the money trail by supporting campaign finance reform.

Repealing HIPAA, combined with providing universal health care, will open the door to increases in efficiency and medical progress. People who analyze this information must have no financial stake in the outcome. Yes, bureaucrats.

Only bureaucrats will be impartial enough to have results that are audit-able, and public. Then once we have universal health care, the results then can be used to make better public policy.

Jim Sackinger is a Corvallis resident, who signed this essay: "Not a doctor, lawyer or health care professional."