When the Electronic Health Record (EHR) system replaced paper medical charts, critics worried about personal data privacy. A dozen years later, doctors and nurses are recording non-medical social codes as part of the EHR, and those extraordinarily subjective codes will likely have a decisive impact on how much of the $4 trillion the United States currently spends on health care will be diverted to social and environmental causes.

The Biden administration’s newly formed Office of Climate Change and Health Equity (OCCHE) has introduced plans to “redress the disparities” in health outcomes across populations. OCCHE was created under Executive Order 14008 and led by Admiral Rachel Levine. The bureau is tasked to “protect the health of people throughout the US in the face of climate change, especially those experiencing a higher share of exposures and impacts.”

In a recent interview, Acting Director Dr. John Balbus said OCCHE is going even further. The “equity lens says that we need to be incorporating climate resilience to our built environment to improve our built environment not just when the flood hits, but for the 99% of the time when people are working, playing and going to school in their environments to redress the disparities, and we are working on that, we are working on the indicators.”

Balbus went on to share the vision for exactly how to use health care money for infrastructure. “We are working on the data systems, we’re working on getting it into the EHR and ultimately we need to get it into the Z-codes and into reimbursement strategies.”

Balbus proposes using health care money to fix the environment to make it healthier for those “experiencing a higher share of exposure.” OCCHE Senior Advisor Joe McCannon promises to “explore Incentives and Standards” for businesses to “improve resilience in service of vulnerable populations.”

Z-codes were originally created as a medical chart catch-all for difficult to quantify health care procedures. However, providers now code “Social Determinants of Health” under Z-codes. For example, code Z-59 includes “inadequate housing, housing instability, lodgers and landlord problems.” Code Z-64 includes “unwanted pregnancy, multiparity and discord with counselors.” If the nurse notices “stress on family due to return of a family member from military deployment,” that falls under Code Z-62.

Biased health care workers could easily prejudge a patient of a particular line of work, neighborhood or political party and Z-code them into “help” from the government. If you homeschool your kids, live near a river and were the victim of a crime, you may get rung up for Z-65, Z-62, Z-57 and Z-55, even though you are all healthy and present no health complaints.

Political bureaucrats have no business asking doctors and nurses to assign a subjective social score in a medical chart. With $4 trillion in medical spending, there are four trillion great reasons to worry that the money for a pacemaker you thought you were getting might turn into a green roof in a targeted congressional district.

Matt Dean ([email protected]) is a senior fellow for health care policy outreach at The Heartland Institute.

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