Federal Ministry of Health

The BigBrotherAward 2015 in the “Consumer Protection” category goes to The Federal Ministry of Health represented by the current minister of Health, Hermann Gröhe, for its flagship project “electronic health card”, the upcoming “electronic health act” and for the redistribution of the multi-billion-Euro health system budget into the pockets of listed corporations.

The award we are presenting here is called the BigBrotherAward. As listeners, you are expecting to hear hard evidence of data abuse. And – judging by your applause – many here in the hall are delighted that the electronic health card finally got “caught in the act”.

Some ask themselves: “Why this award for the electronic health card only now, in 2015?” Others might ask: “What, again? The electronic health card won a BigBrotherAward back in 2004.” Yet both are somehow right: In 2004 we already warned that something sinister was going on in the public health sector. In 2004 the then Federal Health minister, Ulla Schmidt, received a BigBrotherAward from my co-juror Werner Hülsmann – for the health insurance reform bill. Already then (more than ten years ago) medical secrecy was being quietly laid to rest. We also warned that the impending introduction of the electronic health card in 2006 – ha ha – would create huge problems. Now, since the beginning of 2015, it really has arrived and has more than earned this award.

We took a long time deciding who should actually receive the BigBrotherAward for the electronic health card and the (proposed) electronic health law. We ultimately chose the Federal Health Ministry, which forced its flagship project into law, fulfilling the wishes of the financial world. Essentially this award goes to all the ministers since Ulla Schmidt. The true beneficiaries are, among others, the manufacturers of plastic cards, providers of digital signatures, the telematics industry (such as T-Systems, and Arvato of the Bertelsmann Group) and, of course, the companies producing card readers. I sat down with a sheet of paper and a black biro and tried to calculate what the project will cost once the 1.8 million health professional cards have been issued, all of the doctor's surgeries have card readers and all the 70 million insured persons have their cards. I came up with 15 billion Euros. A study by the company Booz Allen Hamilton came up with a similar figure.

In plain language: The government decides on the nationwide introduction of a technology and accordingly amends the social insurance code with articles that do not serve public health, but rather serve the financial markets and their henchmen in the IT industry (which for the most part is listed on the stock exchange). It is not diagnostics and treatment, training of medical personnel, time for consultation with doctors, or staffing levels that would be improved, instead the lobbyists who want to sell signatures, chip cards, and technical infrastructure have won. I call that supporting the finance sector at the expense of all the insured people.

The law forces health insurance funds to finance the expensive infrastructure and do so out of the pockets of the contributors. At the expense of us all.

This is not an Upton Sinclair Award¹ for social criticism, but rather a BigBrotherAward where it's about data security and dangerous developments. I think that due to the vivid criticism that accompanied the development of the electronic health card, great care was taken with the technical specifications. Gematik, the company that developed these specifications, paid great heed to “data security”. So much so that our friend and data protectionist Thilo Weichert referred to these specifications as “exemplary” and heavily criticised us civil liberties activists, who found fault with the electronic health card from the start. He believes it is better that these structures be implemented by the state rather than, as is often the case, by an uncontrolled proliferation of health apps.

And sure enough, electronic health is already installed in every iPhone. Google is expanding into this data market – or is already withdrawing – and at present we expect that each month 1000 new, mostly cloud-based health apps will appear. Thilo Weichert was certainly right about that. The apparently worthwhile applications, however, such as the electronic prescription, have either been put on ice or are simply not realisable.

I have occupied myself for quite some time with the electronic health card and with Germatik's papers. Yes, they are elaborate, ingeniously written, well specified. Privacy safeguards and data security were always considered. I gladly give these “papers” full marks for their high informational mandala factor. However: These specifications are highly complex. On paper, which can be very patient, it sounds just great. But it obscures the fact that people are involved, and they cannot be readily integrated into a data security concept. People forget their PINs. The medical health professional card remains in the terminal at the reception desk so that the surgery team does not have to log in anew every time. And: people find the system a bit eerie. Who is able to differentiate between the life-long patient record and the case record which is newly created for each event of illness? And yet it is alleged that both are stored on the card. That is simply not true. The card contains a key to access the data, which is stored, well, let’s just say “somewhere in the cloud”.

And I have a fundamental question about the electronic health bill: who came up with the idea that we need to develop a new secure infrastructure so that doctors can send each other e‑mail safely (in an e‑envelope with an e‑seal, e‑signature and e‑postage)? That has already been possible for a long time – with end-to-end encryption using PGP. Via the usual e‑mail structures. With mutually signed public keys, so that the prima facie evidence of a signature is assured. All this had to be newly devised from scratch (and paid for), because entities such as Deutsche Telekom, the state-owned “Federal Printer” (Bundesdruckerei) and Liz Mohn from Bertelsmann are behind it. They want to sell their concept of security (or simply what they consider to be profitable). And that, of course, could not be not PGP – which exists since 1991, is free of charge and whose further development as free software would be beneficial to everyone.Granted, PGP is certainly not 100% safe from human shortcomings. But the electronic health card project/electronic health law is not 100% safe either. The PGP solution, however, would have only devoured something like 0.001 percent of the expense already put into this bombastic technology project. And: We would be spared from the many gateways for for data theft that always turn up in such complex systems (or in data leech language: “additional applications that open up new markets”). Moreover: We would be spared from the despair resulting from the impression that the only innovative capacity we still have in Germany consists of “bureaucratic lunacy” and “inducing paranoia” in its citizens.

Whoever takes a look at this sick health project should not linger on minor deficiencies in data security. We are dealing with a project which has, bit by bit, over many years, crept into reality. We must talk about the transformation of hospitals into listed corporations, which should, above all, yield profits. We must talk about how the confidence in doctors has been severely undermined over the years. Yes, doctors who warned us about cutbacks in the public health sector were denounced in the media as those “who are afraid that their own deceitfulness might be uncovered more easily”. In reality, doctors are being stripped of their capacity to make decisions about their patients’ healing process. They are to prescribe treatments “in compliance with the guidelines”, specified by the health insurance providers, who decide according to a morbidity index whether it is worthwhile to provide someone with a hip replacement or an expensive medication above a certain age. It’s not quality of life but statistical life expectancy that counts.

We are speaking of a health budget in the region of 250 billion Euros per year for the whole of Germany. The shareholder value determines whether and how a patient is treated. There are huge financial syndicates, mostly overseas, which already own many hospital concerns and pharmaceutical companies. When the electronic health law takes effect, it will not be the doctors or aides in the town or countryside, the municipal or church-related clinics that heal and make a profit which will be spent locally, but rather a clinic concern with even less personnel will skim off even more purchasing power and divert the profits to the rich few.

That sounds like a critique of capitalism? Yes, it is a critique of capitalism. By means of networked computers, statistics and algorithms it is possible to redirect power and money. The faith in capitalism that has run rampant in Germany since the 1980s has burst open gaps in the public service structures initiated by Otto von Bismark, which were reasonably well balanced up until a few years ago.

Tomorrow, on Saturday the 18th of April 2015, protests opposing the TTIP trade agreement will be taking place all over Germany. That is fine and good, but the GATS successor TISA, which regulates the international services trade, deserves special attention. Among other things, it deals with the free flow of data among 23 nations. The negotiations are held in secret and will be made public only five years after the treaty is concluded. Consider that for a moment: a third party concludes contracts at your expense – and you are not allowed to know about the contents – much less do you have any say in the matter. Even though it concerns your money, your health, your most intimate data and our community.

If we only look at single components of the electronic health law, a little data protection here, a little money wasting there, we lose sight of the essential. All of the ministers of the ministry since Ulla Schmidt have stepped into line, even its former opponent Daniel Bahr. And today the ministry is headed by the current minister Hermann Gröhe, who probably does not begin to understand what kind of cold civil war² his departments are waging against the populace. When I think of Hermann Gröhe I always have this picture before my eyes of the scene just after the election victory, where Angela Merkel furiously grabs the German flag out of his hand. She was right. He should have been waving a pirate flag. With a skull on it. THAT would have portrayed the situation correctly: Our governments issue the financial world a letter of marque.

Even though all health ministers since Ulla Schmidt should have to accept this award: Congratulations, Health Minister Mr. Hermann Gröhe, on your BigBrotherAward in the category Consumer Protection.