Archive for the ‘health policy’ Category

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National ID Bashing with Cato’s

Jim Harper


Compromise is catnip in Washington, D.C. That’s my best guess at why Senator Lindsey Graham (R-SC) would endorse New York Senator Chuck Schumer’s (D) widely reviled plan to create a mandatory biometric national ID system.

Schumer’s national ID plans have no more definition today than when he wrote about them in his 2007 campaign manifesto Postitively American. Among the thin gruel of that book is a two-page lump displaying more ignorance than understanding of how identity systems work and fail. Schumer doesn’t know the difference between an identifier—a characteristic used to distinguish or group people—and an identification card or system, which does the entire task of proving a person’s previously fixed identity. (My thin gruel on the topic is the book Identity Crisis: How Identification is Overused and Misunderstood.)

“All the national employment ID card will do is make forgery harder,” says Schumer.

No, that’s not all it would do: It would also subject every employment decision to the federal government’s approval. It would make surveillance of law-abiding citizens easier. It would allow the government to control access to health care. It would facilitate gun control. It would cost $100 billion dollars or more. It would draw bribery and corruption into the Social Security Administration. It would promote the development of sophisticated biometric identity fraud. How long should I go on?

Senator Graham’s take is equally simple: “We’ve all got Social Security cards,” he said to the Wall Street Journal. “They’re just easily tampered with. Make them tamper-proof. That’s all I’m saying.”

No, Senator, that’s not all you’re saying. You’re saying that native-born American citizens should be herded into Social Security Administration offices by the millions so they can have their biometrics collected in federal government databases. You’re saying that you’d like a system where working, traveling, going to the doctor, and using a credit card all depend on whether you can show your national ID. You’re saying that bigger government is the solution, not smaller government.

The point for these senators, of course, is not the substance. It’s the thrill they experience as nominal ideological opponents finding that they can agree on something, securing a potential breakthrough on the difficult immigration issue.

They’re only ”nominal” ideological opponents, though. Chuck Schumer has always been a big government guy—and long a supporter of having a national ID, despite the lessons of history. Lindsey Graham is not really his ideological opponent. Typical of politicians with years in Washington D.C., Graham is steadily migrating toward the big-government ideology that unites federal politicians and bureaucrats against the people.

As I type this, the US House and Senate have both passed health care reform bills. While not an expert on the health care debate, I think there are good and bad parts in both versions, but I am disappointed with the outcome so far. Decisions seem to be made to favor the corporatism at the root of the problem rather than let consumers shop for insurance across state lines or import drugs at a lower cost, eg. I also fear a backdoor National ID lurking in the shadows.

One of the most troubling aspects of the bills is the individual mandate. Instead of merely reforming the system to make it easier to buy health insurance or even extend the government health care coverage to more people, Congress seems intent to initiate a National ID under the guise of health care reform.

Ad hoc broad left-right-libertarian coalitions have been successfully fighting a federal National ID for a while. I testified to the Senate against it when Bush was president, wrote commentaries, spoke against it at demonstrations at the Capitol, and sent letters to President Bush.

Later, I was part of similar coalitions against the “REAL ID” proposals. A broad group of us wrote to the Senate against the idea. Just when we thought we had finally killed it, the National ID is rising from the ashes like an ugly phoenix.

Many of us have been in this fight for a long time against both Democratic and Republican Administrations.

Now we need to ask our policy makers: How are they going to enforce a universal individual mandate without a National ID equivalent? Does health care reform need to mean creating an unconstitutional and unwarranted dossier on every American?

Michael Ostrolenk of the Liberty Coalition organized a group letter against an insurance mandate. The letter explained,

The “individual mandate” is a section of the bill that requires every single American to buy health insurance–whether or not they want it or feel they can afford it–or break the law and face penalties and fines. Consequently, the bill does not actually “cover” 30 million more Americans–instead it makes them criminals if they do not buy insurance from private companies. We hope you agree that it is unconscionable to force people to buy a product from a private insurer. This would effectively be a tax–and a huge one–paid directly to a private industry.

Mr. Ostrolenk explained to me, “to create and implement a clearly unconstitutional medical insurance mandate, the federal government will need to issue all Americans a medical identification number to ensure compliance with the law which would clearly be a national id system. It’s all about more tracking and control of a free people.”

The only way to enforce such a mandate is to implement a medical National ID. Massachusetts residents already have to file a medical form with their taxes to show compliance. Under the current Congressional proposals, such a scheme would constitute the worst aspects of a corporatist system using large corporate political donors to help monitor our personal medical information in cahoots with the Feds.

Follow J. Bradley Jansen on Twitter: http://www.twitter.com/bradleyjansen

ScienceDaily (Dec. 15, 2009) — Although physicians support the use of electronic health records, concerns about potential privacy breaches remain an issue, according to two research articles published in the January 2010 issue of the Journal of the American Informatics Association (JAMIA), in its premiere issue as one of 30 specialty titles published by the BMJ (British Medical Journal) Group, UK.

One published study is based on views of more than 1,000 family practice and specialist physicians in Massachusetts who were asked whether they thought electronic health information exchange (HIE) would drive down costs, improve patient care, free up their time and preserve patient confidentiality. They were also asked whether they would be willing to pay a monthly fee to use the system.

The electronic exchange of health information (HIE) among different long- distance providers has become the focus of intense national interest, following recent legislation and moves to offer cash incentives for those who switch to the system.
The responses showed widespread support for the use of HIE, even though only just over half were actually using electronic health records.

Most (86%) said that HIE would improve the quality of care and seven out of 10 thought it would cut costs. Three out of four (76%) felt that it also would save time.

But 16% said they were “very concerned” about potential breaches of privacy, while a further 55% were “somewhat concerned.”
The authors note that the responses indicate a lower level of concern than expressed by physicians in the UK, but suggest that this might change if breaches occur to a greater extent than currently recognized.

Despite their overall enthusiasm, physicians were not willing to support the suggested $150 monthly fee, and nearly half were unwilling to pay anything at all.

A second study reported in JAMIA, suggests that mental health professionals have significant concerns about the privacy and security of data on electronic health records.

Of 56 responding psychiatrists, psychologists, nurses, and therapists — out of 120 who were sent the survey–based at one academic medical center, most (81%) felt that the system permitted the preservation of “open therapeutic communications.” Most also felt that electronic records were clearer and more complete than paper versions, although not necessarily more factual.

When it came to privacy, almost two-thirds (63%) were less willing to record highly confidential information to an electronic record than they would to a paper record.

More than eight out of 10 (83%) said they if they were to become a patient, they would not want to include their own mental health records to be routinely accessed by other providers.

The authors point out that previously published surveys of patients/consumers have reflected a lack of confidence in tight security, and that people with mental health issues already face stigmatization.

While the narrative data of patients’ life histories and experiences inform clinical decision-making in psychiatric care, the threat of security breaches makes them vulnerable to potential misuse or misinterpretation, the authors say.
Adoption of electronic health records has been slower than anticipated, the authors add. And they conclude: “Designers of future systems will need to enhance electronic file security and simultaneously maintain legitimate accessibility in order to preserve confidence in psychiatric and other [electronic health record] systems.”

“The ramifications of data security cover more than the psychiatric domain, implying a need for considerable reflection,” they say.