What's there to fear in a national health card?

Robert Kuttner

September 07, 1993|By Robert Kuttner

WHEN White House officials disclosed a plan to create a national health insurance card last week, there was the usual squawking by some civil libertarians and immigrant-rights advocates.

Administration health planners say the card will allow more efficient processing of health claims, as well as the creation of a more comprehensive health database. The plan, however, prompted concerns by immigrant-rights groups, that the health card could be used as a device to screen out aliens. It elicited anxiety by the American Civil Liberties Union that the health card might become a backdoor national ID card.

As a journalist I am of course devoted to the First Amendment. But in this case the fears of the civil libertarians are misplaced.

The idea that any of us is sheltered from countless national databases or ID cards has long since been overtaken by technology. If anything, there is far more abuse of private databases than of government ones.

Just look in your wallet. Your Social Security card, which once (but no longer) pretended that it could not be used "for purposes of identification" is likely to be your driver's license number, as well as your IRS identifier. If you have a Visa or MasterCard, merchants can obtain profiles of your shopping habits. If you have health insurance, highly personal information is collected in private medical bureau databases, from which it can be bought and sold among insurance companies.

In 1991, a reporter for Business Week set out to expose the laxity of credit bureaus. He truthfully told a major credit bureau that he was an employee of McGraw-Hill (Business Week's parent company). This affiliation implied a legitimate business purpose and enabled him to obtain a password that gave him access to the confidential credit histories of millions of Americans,

including that of then vice president Dan Quayle.

So Americans are already vulnerable to massive invasions of their privacy, courtesy of computerized databases and ID cards. The real challenge is to regulate the abuse of ID cards and information banks, not to somehow ban them.

The paradox of our national phobia against ID cards is that we already have most of the liabilities, while denying ourselves potential benefits, of computerized record-keeping.

For example, a universal health card would not just simplify billing; it would allow research into epidemiology, the correlation of cancers with environmental risks, the tracking of whether all children are vaccinated, and a host of other social benefits.

By the same token, the fears of immigrant groups are misplaced. Whether you favor liberal immigration or strict quotas, some limits and criteria will always be imposed on who may legally enter the country.

Although an "internal passport" is associated with totalitarian societies, wouldn't it also be nice for law-abiding citizens if there were reliable records of who was eligible to vote (no more need for voter registration), whose medical license had been withdrawn by another state for malpractice, who was ineligible to drive, or to buy a gun?

We assume we are shielded from abuse because these records are haphazard. But in the checkered history of liberty in our country, there have been plenty of witch-hunts, enemy lists, red scares and the like, long before computerized databases or ID cards. Sen. Joe McCarthy, J. Edgar Hoover and the House Committee on Un-American Activities did their dirty work without national ID cards or databases.

The issue is not whether these information banks and ID cards can be eliminated -- they are unfortunately part of modern society -- but how best to regulate their abuse. If anything, we need much tighter controls on the ability of private business to buy and sell data collected for one purpose and then used for another. We need higher walls between government agencies, lest the IRS and CIA peek at individual census or health records, and lest off-duty cops illicitly sell data from the uniform crime reports to private eyes. We need stricter penalties for misuse.

The penchant of Americans to become fixated on the wrong grievance is nothing short of astonishing. Surely the greater national disgrace and greater denial of liberty is the fact that tens of millions of Americans risk financial ruin if they become sick.

Robert Kuttner writes a column on economic matters.

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