Tuesday, July 14, 2009

Why I'll Trust The Government With My Medical Information

Conor Friedersdorf asked:
It shouldn’t be too difficult to imagine another Dick Cheney or Richard Nixon in the White House. Are we really comfortable assuming that the state will never use its role in health care to pressure political opponents, or collect frightening kinds of data, or politicize medical decisions more than is now the case? Isn’t there any size and scope of government that progressives deem to be too big on prudential grounds? Why doesn’t this put us there?
Kevin Drum said:
Points for originality here: I don’t think I’ve ever heard this objection before. And around here we like new and different. Still, while I bow to no man in my contempt for either the Trickster or the Dickster, even I can’t really see either one of them scheming to deny Ralph Nader a liver transplant or something. But then again, maybe my imagination isn’t active enough.
The good Mr. Friedersdorf wants to continue the discussion, and several of his commenters have pointed out that the government has plenty of power to do all sorts of bad things to you (they control the IRS, after all) that don't usually happen, at least in terms of targeted attacks against political opponents. But it might be illuminating to go into some of the positive reasons why stuff like this is rare to nonexistent in most parts of the federal bureaucracy.

I'm assuming that the mechanism for bad people denying somebody a kidney, or say, revealing that a political rival has herpes, involves administration operatives calling up some midlevel civil service bureaucrat who has access to the info and getting him to make the right sort of mischief. In theory, you could do this just as easily in the private sector -- you'd just have to have the right sort of connections to the right insurance company bureaucrat. So I guess Friedsdorf's worry would be that our neo-Nixon would have greater clout over the Medicare guy than the guy at Aetna.

But whether we're talking about public or private insurance, there's a really strong reason not to play tricks like this. If the public finds out, they'll be really mad. Prying out political opponents' medical info and revealing it, or worse yet messing with their medical care, isn't the kind of thing that the voting public will stand for. And there's plenty of risk that your bureaucrat friend will expose you, either in a conscientious way before you do your shenanigans or afterwards if there's a big investigation and people are coming after him. The risks are too big to make the scheme worthwhile. It's one of the reasons that I shy away from conspiracy theories in general -- large conspiracies to do something important and dastardly are really hard to keep secret.

Now, there are parts of the federal bureaucracy that I'd worry about a lot more than Medicare or the IRS, in terms of their potential for these sorts of abuses. I'm thinking about the CIA. Since lots of stuff is kept secret there, it's probably much easier to get people to do shady stuff with the confidence that you won't be found out. I guess one way of putting the point is that if you're cool with having a CIA, you really shouldn't be sweating health care reform for presidential-corruption-related reasons.
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