2013-10-25

The Problem With Getting Your Way

The problem with getting your own way is that everyone else also gets your way. No big deal when you're arguing over a game of checkers. But, when you're running a government...

Law & Order
We've all seen that episode of Law & Order, or CSI, or Matlock in which a key witness to a horrible crime happens to be from Malaysia, and she refuses to cooperate with the investigators because she doesn't want to them to find out she's an illegal alien. Please come forward, they implore her. If you testify, then we promise not to follow up with the immigration authorities.

This sort of thing really happens. The US government even created a special class of visa for this, a sort of documents-for-cooperation barter scheme. Even so, many such witnesses refuse to participate because they are unaccustomed to governments that keep their word. They think that they'll be deported as soon as they're caught by authorities. So they bolt.

In the old days, before the Patriot Act, this was a lot easier to manage. Local law enforcement didn't ask too many questions, so when the USCIS officers came looking for information about a certain individual who may-or-may-not be an illegal immigrant, the local cops didn't have much to say. I dunno. She was a witness to a crime and helped us prosecute. She seemed legit to me.

But a major goal of the Patriot Act was to facilitate the sharing of records and information between local, state, and federal law enforcement agencies. What the beat cop has on you, the CIA has on you. Many people don't realize that this wasn't always the case.

The Health Of Illegal Immigrants
Last year, the Huffington Post published an interesting report on the fate of illegal immigrants in light of the ratification of Obamacare:
WASHINGTON, Aug 9 (Reuters) - As she was ushered into surgery eight years ago, Paula was confident that doctors at Washington's Howard University Hospital would find the cancer that had been growing in her right breast for months. She was less certain about where she would wake up the next day. 
...
She and other illegal immigrants worry that their ability to access healthcare at facilities like La Clinica will become even more risky once President Barack Obama's healthcare law takes effect. The reform requires all U.S. citizens and permanent residents to obtain health insurance, either through the government-run Medicaid program for the poor or by purchasing private insurance via state exchanges starting in 2014.
It also bars undocumented immigrants from participating. As more low-income citizens receive insurance, the fear is that many of the estimated 12 million undocumented immigrants will be easier to identify just because they lack coverage.
"It's my 3 a.m. nightmare," said Alicia Wilson, La Clinica's executive director. "While we do not collect information about the immigration status of our patients, the fact that they will be uninsured could be taken as 'code' for also being undocumented."
Immigration, of course, is a conservative issue, not a liberal one. Why would a good, upstanding, right-thinking liberal expect ObamaCare to result in the mass-deportation of immigrants to whom good, upstanding, right-thinking liberals would much rather grant amnesty?

But that's the trouble with getting your own way - everyone else also gets your way.

It's For Your Own Good
Here's a cute little anecdote from a 2009 Newsweek article:
During a routine visit, Hoffman's doctor asked her if she was still smoking. Hoffman said, "No, I quit." Her doctor then looked at her and said: "I guess that pack sticking out of your purse is for a friend." Still looking for an out, Hoffman replied: "How did that get there?" It would have been smarter for Hoffman to suffer the embarrassment and 'fess up. It may be painful, but telling your doctor about your questionable health habits like eating vats of junk food, or talking about socially risky behaviors like overindulging in alcohol, illegal drugs or unprotected sex, could save your life.
A little further down in the article, Newsweek gets to the point (emphasis mine):
These little lies can have consequences from not giving your physician the tools to work with you in preventing disease to sometimes unnecessary testing or changes in medications. If, for example, you tell you doctor you are taking your medications as prescribed, but you aren't, and your blood pressure is still off the charts, that can lead to increased dosing or changes in medications. Or if you continue to gain weight, despite swearing that you are dieting and exercising, doctors "are going to have to look for a cause," says Mount Sinai's Thomas. "That means increased costs and a lot of wasted time."
No one wants to pay increased costs! No one wants to waste their time! This is obvious enough because that's our money and our time. If we waste our own money and time, we suffer the consequences.

But what happens when it's no longer just your money and time? What happens when the bill is paid for by the government and the wasted time impacts everyone else's public health wait times? One clue can be found by taking a look at public attitudes of health care waste in countries that have socialized health care systems. You can do your own research on this topic, if you want to. But here's an interesting blurb to consider (emphases mine, again):
A few years ago surgeons in Melbourne, Australia, were refusing to provide heart and lung surgeries to smokers, even those who needed the operations to stay alive. “Why should taxpayers pay for it?” said one surgeon quoted in media reports at the time. “It is consuming resources for someone who is contributing to their own demise.
Already these attitudes have infiltrated discussions of health care reform here in the United States. For example, this New York Times article from 2010 (the one that provided the above tidbit about Australia) states:
In fact, the majority of Americans say it is fair to ask people with unhealthy lifestyles to pay more for health insurance. We believe in the concept of personal responsibility. You hear it in doctors’ lounges and in coffee shops, among the white collar and blue collar alike. Even President Obama has said, “We’ve got to have the American people doing something about their own care.”
Now The Scary Part
There is no question that unhealthy lifestyles increase costs in every health care system. The data for this is convincing, all the more so considering how intuitive the notion is. The more an individual's poor lifestyle choices end up being paid by "society," rather than the individual themselves, the more of a democratic or public health issue it is. If you want to kill yourself with cigarettes, and you expect to pay for it, what do I care? But if you want to kill yourself with cigarettes and make me foot the bill, then suddenly that's my business.

The result is a scenario in which any lifestyle choice can be re-framed as a public health issue. If the government foots your medical bills, the government can use its purse strings to manipulate your behavior.

Fans of "nudging" see no problem with this, and perhaps in the case of smoking - which we all know is unhealthy - the terrible consequences of this sort of thing aren't obvious. They become much more obvious when we consider more emotionally charged cases.

Here's a news story that popped up on my Facebook feed recently:
On July 2, Beltran, 28, met with a physician’s assistant at West Bend Clinic at Saint Joseph’s Hospital in West Bend, Wis., for her prenatal visit. When asked to detail her medical history, Beltran admitted a past struggle with the painkiller Percocet. But that was all behind her, Beltran said: She had been taking Suboxone, a drug used to treat Percocet dependency. Lacking health insurance and unable to afford the medication, Beltran had used an acquaintance’s prescription and self-administered the drug in decreasing doses. She had taken her last dose a few days before her prenatal visit.
...
Two weeks later, a social worker visited Beltran at home and told her that she needed to continue Suboxone treatment under the care of a physician, said Beltran, who again declined. Two days later, Beltran found police officers at her home, who arrested and handcuffed her. 
According to the police report, the officers took Beltran to a hospital, where she underwent a doctor’s exam. Her pregnancy was found to be healthy and normal, her lawyers say. Police then took her to Washington County Jail to await a hearing – hours later, she was led into a courtroom, handcuffed and shackled at the ankles, where a county judge ordered her to spend 90 days in a drug treatment center. 
Alicia had no idea she was giving information to the physician’s assistant that would ultimately be used against her in a court of law,” said Linda Vanden Heuvel of Germantown, Wis., one of Beltran’s attorneys. “She should not have to fear losing her liberty because she was pregnant and she was honest with her doctor.”
A couple of paragraphs later, we learn why the authorities were allowed to do this:
At the center of Beltran’s case is a 1997 Wisconsin law that grants courts authority over the fetus of any pregnant woman who “habitually lacks self-control” with drugs and alcohol “to a severe degree” such that there is “substantial risk” to the unborn child.
This, however, is not a particularly new problem. Here I found a briefing paper from the year 2000, published by an organization called The Center For Reproductive Rights, which argues that law enforcement officials and legislatures have been doing this sort of thing for "more than a decade." More than a decade in 2000 means more than 23 years in 2013 - over a generation, nearly a quarter-century.

Your Data, Your Life, Your Choices, Your Government
The final ingredient to this horror story is the Obama Administration's push to nationalize health care records. In 2010, President Obama "rolled out an ambitious five-year plan for moving doctors and hospitals to computerized medical records." The plan was part of the 2009 economic stimulus package and provided grant money to medical institutions that adopted electronic health records. The Administration said at the time that it would improve health outcomes and make the health care system more efficient.

After all, if records pertaining to the same individual can be easily shared between two or more offices, that's a good thing, right?

Wait a minute - where did we hear that before? I'll give you a hint.

I will spare you extensive links to the NSA's metadata analysis project, through which our government collects and analyzes data on all of us, innocent citizens with nothing to hide.

There is no crime against lacking health care coverage, so long as you pay the IRS's penalty - er, tax - er, whatever it is. But if the fact that you're uninsured is captured in a little info field within the electronic health records system, and you happen to be Honduran-American (or whatever), and maybe even your parents are illegal immigrants, but you're not, then we have ourselves a serious metadata problem on our hands. We have evidence that you are trying to collect health care benefits to which you may not be entitled. The Patriot Act says we can share your information with USCIS. Or the FBI. Who knows what's in your metadata.

As the government takes on a larger and more widespread role in our health care system, mandating coverage, incentivizing electronic records, sharing information among offices, and analyzing metadata, we can expect to see more stories like Beltran's.

The Left Shouldn't Fear The Left - They Should Fear The Right
The crux of the matter here is that conservatives never wanted ObamaCare. They were the ones derided for calling it a socialist takeover of the health care sector. They were the ones disparaged for filibustering the law. They were the ones mocked and ridiculed for saying "Keep your government hands off my Medicare!" The left couldn't figure out. They couldn't fathom it. What could be the problem? We're all on the government health care teat anyway. What's the big deal with a universal Medicare expansion? Why not single-payer?

If such leftists cannot see the link between Paula and Beltram, then there is no hope for American society. If Americans interested in civil liberties cannot draw logical chains between Patriot Act record-sharing and a giant federal initiative - funded entirely by public debt - to put the entire country on a unified system of electronic health record-keeping, then there is nothing left for me to say. If ordinary Americans cannot logically connect NSA metadata analysis "in the public interest" to government health care cost controls "in the public interest" then no one has a long enough attention span to fathom this problem even as a possibility, much less the frightening loss of personal liberty that it is.

When conservatives inevitably use electronic Medicare records - or, barring that, conduct a simple NSA metadata analysis of whatever records they can find - to wage their war on drugs, the left will have no one to blame but themselves. They wanted Obamacare despite what The Center For Reproductive Rights had to say. When conservatives inevitably use the provisions already contained in the ACA to hunt down and deport illegal immigrants, and possibly even their citizen children, the left will have no one to blame but themselves.

When the electronic health records begin to be assembled in such a way that the government can compile a list of patients who have, for example, had abortions, or had drug problems, or suffered gunshot wounds, or underwent circumcisions, that's when people will start to realize the scope of the problem.

The progressive liberals will blame the fascist conservatives for having done such a terrible thing. But who enabled what?

Conclusion
Please don't misunderstand me. A socialized health care system isn't sufficient to create a holocaust. For that, we would need the combination of a socialized health care system, a Patriot Act, and a modernized network of shared electronic medical records...

...Oh.

I am sensitive to the idea that people need treatment. But I am also sensitive to reality. The government - the US government - does not have a particularly good record when it comes to genocide. We waged it on the Native Americans. We put them in internment camps and sexually abused them. We tried to force them to assimilate. Then we did the same thing to the Japanese.

Listen: If it happened before, then it can happen again. It's not as if the lessons learned seven generations ago stick with society forever. Every new generation has to learn the previous generations' knowledge, and then a whole new set of lessons. That's what progress is. But we can also forget stuff.

In our push to provide for the poor, I worry that we've forgotten why immigrants from Honduras are scared to cooperate with law enforcement officers. I worry that we've forgotten why allowing our own government to keep electronic records on us is scary. I worry that we push too quickly to ratify one ideological policy, and forget that when the next election comes around, the people with the opposite ideology will take the reins.

Limiting the size and scope of government isn't about depriving the poor of resources, it's about making sure all those evil guys that disgust you don't take control of your institutions and purge you.

If you don't see it happening, then you're blind. Consider the size of this blog post. If what I've just said can't convince you, then nothing can, and there is no hope for you.

[UPDATE/EDIT]
In the comments, Phil accurately remarks that my last paragraph here isn't really arguing in good faith, and I concede that he's correct. However, if we acknowledge that fact, then we must also acknowledge the fact that there is such a thing as reading or listening in good faith. In other words, what we have in this blog post is sufficient evidence to inspire an incredibly hefty dose of skepticism against the kind of national health care surveillance state that has been created here in the United States. We have strong evidence from which to conclude that this surveillance state presents an eminent threat to innocent people. And we have sufficient evidence to understand that just because "the good guys" are in power today (or were in power yesterday) doesn't mean they'll be in power tomorrow (or today), thus every encroachment on our civil liberties - even if committed by the good guys - becomes a clear and present danger once the bad guys win an election and take control.

All that is to say that if this argument means nothing to you - if you cannot even acknowledge the threat that this kind of power presents - then it is probably also true that no additional evidence will change your mind, either.

So I am not really making a statement against readers who disagree, so much as I am making the claim that my evidence is so strong that someone who disagrees must either (a) refute my evidence, (b) present equal-and-opposite counter-evidence, or (c) clearly articulate to me what other evidence would be sufficient.