Why the Government Shouldn't Run Anything Extra

Sometimes small examples point out huge issues.

Two local radio commentators were talking this morning on a Charleston, SC radio talk station about the issue of providing IPad2’s to children in a few local schools. One caller pointed out that it might be preferable to use the money for merit pay for better performing teachers. One of the hosts stated that “the money was allocated for capital improvement projects” and could not be used for pay. It seems like a small thing but it is not. It is typical of government at all levels and shows why citizens get so disgusted with the way government functions.

The money for the IPad2 computers is being distributed from a “pot of money” that was allocated for school improvement projects. Remember that this money was collected in taxes from citizens and the road to hell is paved with good intentions. The legislature or school board hung a piñata of many millions of dollars without any specific projects or uses in mind and people are now swinging sticks and fighting over where to spend the money which falls out. Politicians like to allocate spending this way because: 1) they can talk about how they support education, 2) they don’t have to actually make any decisions; and 3) they don’t have to do any work, and 4) when the money gets used in crony deals or for dumb projects, they can claim that it was someone else’s fault. The very fact that the money is not allocated for specific projects leads to back room deals, lobbyists influencing spending, and political payoffs.

The IPad2's might be a great idea but one would think that if buying IPad2s for students IS a great idea, there would be a public hearing where the people proposing the idea would explain: 1) how it will help the students, 2) the cost of the proposed project versus the cost of traditional textbooks; 3) how software updates, security, and content is managed, 4) how maintenance and repairs are handled, and 5) how they impact of the program will be measured and assessed. Then, if the legislature or school board is convinced that the idea has merit, the funds are allocated to cover the program, and not a penny more. As the judge in My Cousin Vinny stated, (paraphrasing) “That is a well thought out, cogent argument”. But that is not what happens. The money is distributed by lobbyist influence, political pay offs and to the "network of the connected".

Another result of allocating money in the government manner is that every September is Christmas for the government. Financial managers in the government know that any money allocated and not spent will be withheld the next year. Therefore, every September there is a buying spree for every government agency to ensure that the funding is spent, whether the purchases are needed or not. The money falls downhill. The big agency “dumps” money down to smaller organizations that have to spend the money or pass it down even further. If the government was surprised one year and was only allowed to spend in September at the average rate of the previous eleven months, billions of dollars would be saved and the waste exposed (which is why that will never happen).

One of the arguments for the recent health care bill was that funding could be obtained from waste recovery. Waste is built into the government spending and anyone who works in government knows that waste recovery is a false promise. Until the government leaders who spend the money are held responsible for the way that they allocate the money and do their business, waste will continue and cronyism will continue.

Anyone who thinks the government runs anything more efficiently than private industry is deluded, at best. There will always be someone who pipes up with, "What about the military?" Anyone who says that has obviously never been in the US military.

Liberals and Modern Education... or Lack Thereof

With education clearly on the decline in the nation’s public schools, one has to ask why it is happening. There is a movement afloat which began in the 1920s which theorized that there was too much information available to be taught and that new information was created at a rate that defied the ability to have it taught. The theory suggested that a better way to educate the young was to “teach them to think” rather than teach facts. Using that theory, mathematics, history, and science were placed on the back burner and “life skills” and “life adjustment” classes were prioritized. We have now had many years of those theories and to be honest, they suck. To paraphrase another writer, there is no use in being able to think if you have nothing to think about.

One could argue that the purveyors of those theories didn’t understand what was being taught in the first place. While it is true that most people not involved in science, engineering, finance, architecture, etc. don’t use higher mathematics on a regular basis, the theorists completely misunderstood mathematics education. While mathematics education does teach students how to manipulate and solve equations and problems, that is only one part of the class. More importantly, mathematics teaches students how to approach any problem rationally and to be careful in what assumptions you make. Problems need to be solved in a step-wise manner in which each step must be justified and not left to whim, chance, or assumption. Many times in mathematics, the real answer to a problem is not what the answer is intuitively. Additionally, when an answer is obtained using firm and true assumptions and steps based on correct technique, one can be confident that the solution is solid and reliable. This approach is valuable to almost everyone every day. Systematic problem solving is a valuable life skill and is arguably much more important than how you “feel” about the problem. As an aside, mathematics is important to the daily life of US citizens in that the current Congress certainly has demonstrated that they have no mathematics skills.

History classes tend to be criticized as rote memory of names and dates. If taught correctly, they are anything but that. The early history of the United States, for example, is a drama worthy of any novel or made for television movie. The founders of the United States were not homogenized in their views and goals. There was much consternation about splitting with Great Britain and even more dispute on the proper construction of the government once the revolution was won. The Constitution barely passed. The study of those people tells students not only who those people were but what this country was intended to become. It tells why these people were willing to die to create a way of life where individuals, not a monarch, held sway over their own lives. The founders were real people with differing thoughts and goals, not caricatures on different currency denominations. To be able to take a side in a political discussion, educated citizens should not only understand current issues but how the country got to be where it is and what it was in the past.

Science, at its core, is the search for the truth. Scientists are sometimes accused of being amoral because they do not subscribe to determined agendas. The true scientist takes the data presented and analyzes the data to determine where the real truth lies. Real science is reproducible and does not change with varying researchers. That is why true science is “open source”. Conclusions are only valid when someone else can do the same work and get the same result. When there is disagreement, it is because the data is conflicting when studied by many, not because a political or financial agenda is overshadowing the work. The ability to remain objective and unbiased is a very useful skill in everyday life and is difficult to achieve without education. If anyone watches opinion shows or reads the newspaper, they will realize objectivity is a resource surely lacking.

Political leaders who have nefarious objectives have always sought to “dumb down” the population because it is much easier to mislead and take advantage of an ignorant mob than an educated population. Educated populations ask tough questions and demand accountability from the leaders. In a representative form of government, the government functions best and is predicated on having an educated people. The founders realized that.

The conservative political philosophy encourages individual decision making and liberty. The liberal political philosophy encourages elite groups of leaders to make decisions for the population in their best interest. The assumption is denigrating in that the people are presumed to be unable to decide issues for themselves. It is therefore in the interest of liberals to have the population less informed and less educated and, conversely, in the interest of conservatives to have the population better educated so better individual decisions will be made. It is easier to guide the population to the liberal elites' interests if they are less informed and more dependent. The teachers unions are decidedly liberal, as evidenced by their devout support of liberal politicians. Perhaps that explains why the teachers unions oppose educational programs like the voucher program in Washington, DC which clearly produced better student results at half the taxpayer cost. Teachers colleges educate future teachers on the liberal 1920s theories of education and reinforce the “life skills” agenda. The old saying is “When you find yourself in a hole, you should stop digging”. The current educational philosophy in the United States public schools has consistently shown itself to be a failure. Why not go back to what worked and teach people how to think while they actually learn some factual information? Consider it a bonus.

Our Basic Freedoms: Exposing Hypocrisy, Lies and Arrogance

The founding fathers recognized early on that in order to have an effective government in which the people had a say in their governance, a number of things had to be present. I want to discuss several and the siege upon them. The basics are:

First, an educational system which allowed individuals to be cognizant of how the government worked and the history behind the system was necessary to have voters who had a sense of what the goals of the nation were and how it became what it was.

Second, individuals needed to be free to express opinions publicly so that all sides of a discourse were presented and debated.

Third, the press needed to be free to expose dishonesty, scandal, and the political process so that a ruling class could not operate in their own self-interest without being revealed.

The United States is not a democracy; it is a republic. Benjamin Franklin was quoted as saying something to the effect: “a democracy is two wolves and a lamb deciding what is for lunch; liberty is a well-armed lamb disputing the outcome”. In order for any representative form of government to be viable, an informed and knowledgeable electorate is required. Let’s look at some recent developments and see where we might be heading.

Education – the public education system in the United States has been declining over the last several decades by most measures, especially in urban areas. The basic skills required over the first several centuries of the countries existence (the three R’s: reading writing, and arithmetic), and the concerted study of our nation’s founding and history have been mostly replaced. Courses centered on “life skills” abound. Children are passed despite poor performance because we don’t want them to “feel bad”. There are no winners and losers. Everyone gets a trophy. The study of early American history and the moving parts of the government have less priority than contemporary study of the Civil Rights movement and homosexual rights. The Constitution is presented in essence as “someone wrote it and it passed”. There is no discussion of the effort and great contentiousness of the debate. Most cannot tell one Founding Father from another except to spout out sound bites. Samuel Adams is a beer. John Hancock is an insurance company. It seems the purpose of a public education is presently not to teach basic skills but rather to make people feel good about not knowing those skills. The teachers unions vote for Democrats because they are liberal. The Democrats pass legislation helping teachers unions. Teachers are then obligated to be liberal. It is incestuous. By dumbing down the population, politicians can operate without intellectual confrontation and debate. It is in the powerful player’s interest to stifle an educated population. It is easier to control the uneducated. Moslem countries and dictatorships have done this for all of history. Since test scores and measures of education keep getting worse, why expand the same policies which have contributed to the decline? If my walking was getting worse, I would stop hitting my foot with the hammer.

Individual Expression - Individuals who express opposing opinions can be dealt with in several ways. The most reputable way is to debate publicly on the issues and attempt to convince the populace that your side is correct. Politicians who are pursuing questionable policies or self-interest which will not hold up to public scrutiny use the second method which is to marginalize or demonize the critic. Using character assassination to dispute the reputability of your critic is common practice now. Recent episodes (i.e., Joseph Wurzelbacher, aka Joe the Plumber, an unknown prior to asking an opportune question) have shown that anyone critical of those in power can expect to be crucified by the supporters of the powerful. Politicians even set up media teams whose specific job is to destroy an opponent’s credibility. The third method, mostly used in dictatorships, is to have your opponents “disappear” to either a gulag or a grave. Fortunately, the United States doesn’t usually use that method. Using any of these methods to intimidate an individual citizen fly in the face of the founders expressed intentions.

Freedom of the Press – The way to fight corruption is to expose it. The central weapon in that regard is the press. Investigative journalism is the bedrock of acquiring information and shining the light of publicity on government practices. One of the first things a totalitarian regime does is to muzzle press freedom. There have always been and will always be people in the press and, more recently, broadcast media with agendas and political viewpoints. Anyone can watch CNN, NBC, CBS, etc. and easily see the liberal bias. Anyone watching Fox News knows that there is conservative bias. There is much more liberal television than conservative television. There are liberal newspapers and conservative newspapers. There is conservative talk radio and some, albeit a lot less, liberal talk radio. Those who constantly complain about the bias are unrealistic. It will always be present. The founders view was that the more media outlets there are, the more likely there was to be exposure of some semblance of the truth. One side can print biased stories or opinion pieces or even lies but the other side can confront those biases, opinions, and lies and publish or broadcast opposing views. There is now movement afoot to stifle public debate by controlling the media’s political viewpoint under government control under the guise of “diversity” and “fairness”. There has never been anything fair about the media. The Hearst papers essentially started the Spanish-American War. Grover Cleveland was called an illegitimate father. The papers of the colonial and post-colonial period, as well as the Civil War period were much harsher than anything seen today. For the government to attempt to control media is dangerous and is a first step toward totalitarianism. It should be avoided at all costs. Trying to control media output is tantamount to accusing the population of being too stupid to recognize nonsense when they see it and is disparaging. If you are going to have representative government, you can’t say the people are too stupid to participate.

Health Care Insurance Reform Fallacies

Most of the political posturing about health insurance reform has now gone back to the old political methods of presenting heart-wrenching cases as justification for sweeping reform. It is much akin to how the media produces a sad case to promote their agenda. During the middle of the Bush administration, when the financial outlook was really good, liberal news outlets would find some obscure person somewhere and do a story on how terrible her situation was as a way of blaming the administration. It is common procedure. But alas, you will never see a story now about how bad the economy is but how well a particular person is doing somewhere.

There are ways to improve health care access and reduce costs that are fairly simple and a lot less costly than what is being proposed. I have previously written about removing state monopolies and other strategies. However, let’s think about health insurance generically and what it is supposed to do.

Back in the day, someone thought it would be a good idea to go to someone with money and sell “If you pay me some money up front and regularly, I will pay for your expenses if you have a catastrophe of some sort.” The concept would work for fire damage, severe weather damage, your herd dying of disease, your crops not coming in, and other property losses. With the invention of the automobile and the large investment required to buy one and the potential for expenses if you ran yours into someone or something, it seemed a good idea to have insurance against those expenses. The government thought it was such a good idea that laws were passed requiring insurance. Of course, mortgage holders also required insurance for properties that they held liens upon in order to protect their loan pay back. Legislatures are always willing to require insurance as: a) they are made up of lawyers; b) lawyers always pass laws that help lawyers; and c) insurance companies are quite willing to pay legislatures to support passing those laws.

As insurance companies grew, they thought of more and more things to insure against. Of course, health care cost was one of them. Somehow, the concept changed over the years for health insurance. Using the original concept, you would have insurance for catastrophic expenses. If you were injured severely or had a very serious illness, insurance would cover your expenses (or most of them depending on how much you paid up front). Somehow, the health insurance morphed into policies that paid for everything. Routine office visits, visits to the emergency room (even if it wasn’t an emergency), home health visits, cosmetic procedures, and hundreds of other expenses became covered. Of course, there is no incentive to restrain your visits when it doesn’t cost you anything. In fact, there is a tendency to want to “get your money’s worth” out of a policy for which you pay premiums. It is also inevitable that a policy like that cannot ever be financially viable for the insurance provider because the costs have no constraint. As costs rose, it became cheaper to buy policies as a group in order to average risk across a group of people. Since people generally can’t get together and form a group to buy insurance, would form these groups? Company employees. Thus began the employer-provided insurance plans.

With an employer-provided plan, there is exactly zero incentive to restrain costs for the employee. The employee only fills out forms and the employer pays all the costs. The employer goes down the tubes. Another financial innovator went to the large employers with this idea, “If you give me a certain amount of money each year per person, I will take care of their health care needs and you will have fixed costs. If it costs more, I will take the loss, if it costs less, I will keep the extra money”. Thus, the Health Maintenance Organization (HMO) was invented. Of course, the way HMOs make money is by doing as little for patients as possible. It is built into the contract. The paradox is that the companies compete by purporting to offer more services but the way they make money is by not providing them.

The real question is how health insurance veered off the normal insurance track. If health insurance was still using the same model as other types of policies, people would primarily have catastrophic insurance and would set their co-pays and deductibles by their level of risk and how much they were willing to pay in premiums. To reduce costs, there has to be incentive for people to do it. The only real incentive is to have people pay for what they use which isn’t catastrophic. For example, if you pay for an office visit, you will decide whether you really need to go before you do. If it costs six to ten times more to go to the emergency room than it does to go to your regular doctor, you will likely go to your regular doctor rather than fill the emergency room with non-emergency patients.

I am not saying people who are destitute should not have access to care. The government should help the poor and people who are unable to work. People don’t have a problem with helping people who are incapable of working. People do have a problem with paying for people who choose not to work or providing free care to affluent people who don’t need it. To reduce health care costs, the exact wrong thing to do is to make it “free”. The real answer to the problem is to go back to basics and review what health care insurance is supposed to do and the best and most efficient way to provide that care. Trying to cover everyone with “free” care and reducing physician payments until there are few doctors left is clearly not the answer.

Now That They Get It, They Can’t Fix It

I have written a number of times previously about the source of the current economic crisis in the United States. To briefly review, the Congress and Clinton administration created policy which encouraged loans to low income individuals because they thought more home ownership would be good for the country. Freddie Mac and Fannie Mae bought a lot of the loans from primary lenders therefore leading the primary lenders to make more poor loans. The real problem came when Fannie Mae and Freddie Mac created securities based on the value of those bad mortgages and sold hundreds of billions of dollars of the securities to investment banks around the world. The current problem with fixing the problem is that there is no way to determine which mortgages are associated with which securities. Because there is no association, no one can determine how much each security is worth. Therefore, banks who own billions of dollars in those securities don’t have any idea whether they own securities of value or not. They are holding onto the solid money they have because they don’t really know how much they have in those securities. The US government is discussing how to get those “toxic assets”, as they are now known, out of the financial system to try to restore normality to the system. The administration and the Congress are still trying to figure out how to do it.

There are several possible ways to try to value those assets. The grindstone way is to look at every single mortgage which was bought by Fannie Mae and Freddie Mac to determine the value of the mortgage (solid, just getting by, or in default). Even if that monumental task was done (and it would take a long time), the question then becomes how to assign the individual mortgages to the securities. None of the owners of the securities want the worthless mortgages assigned to the securities that they own. In fact, the owners of the securities are looking for the government to get them their money back. That is patently ridiculous. The idea that taxpayers should make up money to speculators who greedily and hungrily bought those securities is insane. If I buy a stock and the value tanks, I don’t expect the government to refund my money. One way to assign mortgages which would seem fairer is to evaluate them all and to use the average value to calculate the value of the securities. That way, every institution that bought those securities will share proportionately in the pain of the downturn of the real estate market and none will be assigned entirely worthless mortgages. The problem with that approach is that a vague average is assigned and not the actual value of the individual mortgage. When assets are not based on a real value, there is a lot of uncertainty in the system. It is that very uncertainty which keeps financial institutions from freeing funds for lending.

The government solution currently seems to be to buy those “toxic assets” from the owners of the securities to resume normal operation of the financial system. There are several problems with this solution. The first is that by spending $750 billion on the first TARP (toxic asset relief program), a $760 billion “stimulus program” which had nothing to do with correcting the problem, a TARP II program, and then a $410 billion omnibus spending bill, the American public has caught on to the fact that the money has to come from somewhere. There is little, if any, patience left for another huge spending bill in addition to President Obama’s proposed 2009-2010 budget. The President is continuing to propose huge spending on social programs which are liberal politics and have nothing to do with fixing the problem. The cost of buying the “toxic assets” is staggering. I believe the current administration has misspent the political capital from the election on the huge liberal spending programs and now will have to deal with the resentment to their spending. The resentment and potential political backlash will likely prevent the spending which should have been the first priority, fixing the mortgage crisis. If the mortgage security problem had been originally addressed, the markets would have fixed themselves and several trillion dollars in government "stimulus" could have been saved. By taking political advantage of the crisis to put liberal social programs in place, there is nothing left with which to fix the crisis. The only option is to borrow from foreign countries and tax the people who actually earn money, therefore leaving them nothing to invest in the markets. It is self-defeating.

My guess is that they will inevitably screw the taxpayers by paying way too much for the assets in order to appear to be doing something and gain political points. The actual value of the assets will eventually declare themselves and the government (taxpayers) will be left holding the empty bag. The government will once again reward the speculators and failures at the expense of the prudent and safe investors. The same congressional representatives who screwed the pooch on oversight, regulation and then on spending will be the ones trying to fix the problem. When the government negotiates with people who are actually smart about financial matters and do it for a living, the government will always get hosed.

The Liberal versus Conservative Philosophies

I noticed that the Democratic Congress is talking about another bogus stimulus package. Everyone who paid attention knows that the first stimulus package was not intended for stimulus or, if it was, it was only a peripheral goal. The idea of that package was to use the crisis to advance liberal programs which would not have been passed through the normal appropriations process. By bundling them up in the package, the Democrats could get a lot of their long stalled programs into law. It was a total scam. President Obama used the Bill Clinton tactic of running as a moderate but has since shown his true colors as a far-left liberal. Let’s look at some of the fundamental differences in the philosophies between liberals and conservatives.

The overwhelming viewpoint of liberalism is arrogance. The view of liberals is that the population needs guidance and caring from the government. They are maternal in attitude. The liberals feel that the government has to be maternal because the liberal officials in government are so much smarter than the population. The fundamentals of conservatism include the concept that people can think and choose for themselves and that an individual or family will know better what they need for their own situation than program directors in the government. You will notice that states where there are large numbers of farmers, ranchers, and others who are used to living independently and making their own decisions are almost exclusively conservative and represented by conservative Republican or moderate Democrat officials. The states primarily in the north east and in the rust belt where people primarily live in large cities and depend more on government infrastructure tend to be Democratic. Much was made of the recent Democrat wins in 2008 but if you paid attention you would notice that a lot of the newly elected members of Congress were moderates, like Rep. Heath Shuler in North Carolina. I find the liberal attitude insulting and demeaning. The idea that someone who has never met me, knows nothing of my own or family situation, and has less education than I do, can tell me how to run my life because they are smarter than me is insulting and arrogant. The government is supposed to serve the people, not control their every day life. If you read the Federalist Papers, written by Alexander Hamilton, James Madison, and John Jay, it is clear that while there are clear reasons to have a strong central government (military, commerce, treaties, etc.) the Constitution is primarily there to define what government is NOT supposed to do. Liberalism thinks that the government should constantly guide your decisions because they know so much more than you do. It is offensive.

Both liberalism and conservatism attempt to improve the financial standing of the general population. There is a great difference in the ways that the two philosophies go about it. In general, conservatives feel that the road to economic success lies in opportunities and restricting the amount of personal or business income that the government takes from the population in the form of taxes. The idea is that people, when provided opportunity, will improve their own situations based on their merit and work ethic. By allowing individuals and businesses to achieve success based on their own ideas and effort, people have incentive to work harder and innovate. By allowing people to keep more of what they earn and by providing opportunities for people to succeed, those at the lower income levels can improve their situation with hard work. Liberals go about this differently. Liberals feel that people of lower incomes are “victims of the system”. The way that liberals will improve the plight of those at the lower end of the economic spectrum is to take income away from the upper income earners and give it to the lower income group. It is denigrating to those who would like to improve their situation on their own. It is tantamount to saying that those without success are incapable of achieving it on their own. It is a philosophy of victimhood and once again shows that the overarching liberal philosophy is that they are smarter than everyone else. Conservatives want to raise the lower end of the economic spectrum and liberals want to lower the upper end by giving their earnings to the lower end. They call it “fairness”. It is a disincentive to work and innovate. How many times have you heard someone say, “Why work? The government is going to take it, anyway.” Of course, the liberal philosophy leads to socialism and eventually communism. The only difference is how far you are willing to go.

Recent program proposals by the current administration are evidence of the differing philosophies. The proposal for government-run universal health care demonstrates the arrogance of the liberal elected officials. I have written a number of pieces about it. The idea is that in order to reduce costs, the government is now going to tell physicians how to practice and to take away the right of successful earners to individualize their coverage. It is demeaning. While everyone agrees that reduction of carbon emissions is a worth while goal, the last ten years have shown a cooling trend on the Earth. Despite data to the contrary, the current administration wants to put in place a “cap and trade” system which will substantially impact the American economy. Their justification is “global warming” despite all data to the contrary. It is because they are smarter than the scientists.

The real common thread of liberalism which differentiates the philosophy from conservatism is control. Everything about liberalism allows the government to obtain power over the population in their daily lives. Once again, the reason that they want that power is because they truly believe they are smarter than the population and therefore should tell the population how to live. If you look at the very populations that the liberals have identified as those they are "lifting up" in the last fifty years, there is little to no evidence that the liberal policies have done anything other than to further the dependence of those same people to government assistance. It is a Bernie Madoff scam of the highest order. Conservatism allows people to be left alone and gives more individual freedom to the population and therefore cedes control away from the government.

The idea that people are incapable of taking care of themselves, working hard and earning based on their own merits is arrogant and insulting. I am constantly amazed how liberal politicians can routinely insult people and still manage to acquire their vote by buying them off. It certainly is easier to just sit back, claim to be a victim, and have the government give you some free money that someone else earned, than it is to work hard for yourself. The problem with that is that if enough people do it, no one is left to earn. Then the economy collapses and you end up in the Soviet Union. Conservatism is the philosophy which drove people from Europe to the United States and drove the movement of people during the western expansion of the United States. It is a fundamental quality of the American people which will prove popular if elected officials who purport to be conservative would actually govern as conservatives once they are elected.

Centralized Medical Records, Behavioral Modification and Security

The currently debated “stimulus” bill has about $300 million in it for establishment of an electronic medical record system for the government. I mentioned this briefly in a previous post but think it should probably be explored in more depth.

The idea of a central repository for all medical records has great merit in an ideal world. Information would be available, no matter where a patient was located, about past medical history, allergies, current medications, and past surgical history. Since everyone is altruistic and no one would access information that was not required, the system would be wonderful in an ideal world. We don’t live in an ideal world.

A central repository of any information of value is a hackers dream. That information would be so valuable to obtain that it could be sold surreptitiously to potential employers, insurance providers, for personal motives, etc. by anyone with access and enough temptation. Miscreants could erase or modify the records for profit or for malicious reasons. The government would counter with a back up system of records. That just provides a broader target to access the information. Even without hacking through computer safeguards, the records could be compromised by individuals through bribes or other personal motives. This is a relatively common occurrence when it comes to national security issues in the United States. People with agendas or personal political philosophical differences with the government pass information to liberal publications like the Washington Post and New York Times which routinely publish classified information. Even more recently, out of one hundred forty anonymous screening tests for baseball players concerning steroids, only the name of Alex Rodriguez was leaked to the press. Someone clearly had an agenda against Alex Rodriguez. It is easy to see similar leaks for candidates for office, other sports figures, celebrities, and for personal vengeance. A history of a sexually transmitted disease, elective abortion, or potential debilitating disease could be used for extortion or political blackmail.

The breadth of the system is inherently a security and bandwidth problem. In order to be effective, the records will have to be available to any medical facility in order to care for patients wherever they present for care. That means that tens or even hundreds of thousands of facilities will have access to the system. A system that large will be similar to the AHLTA military system which is slow, unwieldy, and crashes regularly. A system with that kind of capability probably doesn’t exist outside of the military or National Security Agency anywhere in the world. An electronic health record system which is undependable would be a danger to patients as necessary patient information would not be available when required. Additionally, with the many thousands of access points to the system, there is no practical way to adequately maintain the security of the system. It is like a fence with thousands and thousands of gates, any one of which when breeched makes the entire system accessible.

As a physician, I am well aware of the tendency of health care administrators to now view patient care as a “product line”. In a group of physicians, I have once actually been instructed by a senior administrator to increase patient throughput even if it increases risk of inadequate diagnosis. The reason I bring this up is that there is a tendency for anyone under a time constraint to avoid “reinventing the wheel”. Errors in records in a central repository will propagate because the information will convey authority and go unchallenged. Errors will be like bad tattoos and go with patients everywhere.

To use the hackneyed Orwellian analogy, all health care information in the hands of the government is not a good idea. I will point out that while the government will be a problem, it may not be the biggest problem. With a records system that will inevitably leak like a sieve, it is only a matter of time before private insurance providers get their hands on the information. With that information in hand, insurance companies will begin to modify their actuarial tables depending on your private information. If they note a minor injury while surfing, skiing, sky diving, playing contact sports, riding, etc. you will have the option of stopping the activity, not being covered while doing it, or paying higher premiums. This type of focus will eventually lead to widespread financial behavioral modification. The analogous government scenario is to force behavior modification by denying benefits for activities, diet, etc. that are not approved by some group of “experts” who decide what they want you to do and not do. This is not a new argument. There was a suggestion years ago that in states with motorcycle helmet laws, if you didn’t wear a helmet, there would be no government funding for your health care should you be injured on a motorcycle. The idea was fairly popular. The same has been suggested for bicycle riding for children and cigarette smoking. The idea being that the government says out of one side of the mouth, “We aren’t forcing anyone to change their behavior” while making the behavior so financially untenable that no sane person would engage in it. It is a slippery slope that eventually leads to only government and insurance approved lifestyles being covered. Anything else leaves you on your own.

One advantage proponents will claim is the ability to gather data about treatment options and outcomes. Former Senator Daschle has already written in his book about using those data to determine which treatments will be available. In other words, the financial behavioral modification will not only be used on patients, it will be used to force physicians to become robotic in their prescribing and treatment patterns. Once again, it will be “Treat the patient in the way you see fit, but we will only pay you if you do it the way we want.” If patients cannot be treated individually, we might as well scrap the entire health care system and have everyone use a site like WebMD to treat everyone. There is no reason to talk to patients and examine them if it isn’t going to make any difference in what you can do for them.

My counter proposal, which I have actually sent to Senators Graham and DeMint, is to not have the government establish an actual computer system but rather to establish national standards for the electronic medical record. The format of the record, type of computer storage file, and transmission protocols could be specified and monitored by the Department of Health and Human Services. In the past, similar standards have been established for radio and television transmission, automobile safety, food safety, air traffic control systems, and other systems. My suggestion is that a commission or committee of overpaid top notch experts to establish standards has miniscule costs compared to establishing and building a huge overpriced ineffective system of computer networks. Additionally, in a free market economy, software developers will come out of the woodwork in droves to develop and market commercial versions of software to make new electronic records and convert existing records. To paraphrase Field of Dreams, “If there is money to be made, they will definitely come”. Having private companies supply the software will create many high-paying jobs and result in substantial tax revenue to the government, instead of costing huge amounts in government payroll. Additional jobs will be created all across the country when people are hired by health care facilities to convert existing records into the standardized electronic format. The government virtually never gets the appropriate value for its contracts, there is no reason to assume that it will on this one. Therefore, in the spirit of the American entrepreneur, to save hundreds of millions of dollars in taxpayer money and to avoid the Orwellian consequences, I believe the system I am proposing is superior to the current thinking.