July 19, 2010
I'm from the Government, and I'm Here for Your BMI
Imagine that it is the year 2014. You have just gotten home from a long day of work when you get a knock at the front door. "Mr. Smith?" a youngish, neatly dressed man with a clipboard and plastic, government-issued identification badge asks. "I'm from the CDC. According to your official electronic health records, you haven't been to a health checkup for a while. In compliance with section 3001 of the 2009 Economic Stimulus Bill that was signed into law, you are required to submit your weight so that we can monitor your BMI (Body Mass Index). Please step onto the scale."
Does this seem a work of fiction to you? Certainly this Orwellian "Big Brother" scenario will never happen in our Republic, you say. Think again.
Last week, the effect of a little-noticed subsection of the 2009 Economic Stimulus Bill was revealed by Health and Human Services (HHS) secretary Kathleen Sebelius. Under section 3001 of the Stimulus Bill (on page 116 of 407), a new HHS Department was created called the Office of the National Coordinator for Health Information Technology (HIT). The Stimulus Bill specifically gives the recently appointed head of this department, Dr. David Blumenthal, the objective of "utilization of an electronic health record for each person in the United States by 2014."
While the Stimulus Bill requires that the government have access to your Electronic Health Record (EHR) by 2014, it only vaguely defines what the government will do with this information. Herein lies the danger. Vaguely defined power in new laws always leads to broad interpretation of power by the government. One such power that the Stimulus Bill delegates to the new HIT department is to derive "meaningful use" from the EHRs.
Meaningful use? The government would be hard-pressed to find more confused and indefinable verbiage, though they surely tried.
Seeing the opportunity to seize more power for her department, Secretary Sebelius, working with Dr. Blumenthal, released their "Standards and Certification final rule," an expansive 228-page declaration of authority where, on page 61, they expound on their power to monitor every American's body mass index, or BMI -- a measure to estimate healthy body weight.
Unfortunately, what might at first appear to be fiction is set to become political reality.
There are two grave concerns with the section 3001 of the Stimulus Bill and the government accessing our EHRs. First, the federal government has given itself access to the most private part or our lives. While they have assured us that the information will stay private, someone from the government is reading it, so by definition, the records are most certainly not private. In fact, if the Chinese can routinely hack into the computer systems of the White House, Pentagon, and CIA, then we should suspect that a hacker of lesser means can gain access to our electronic health records on a whim. Your health records should be for you and your physician only.
The second concern we should have is what the government agents reading our health care records will do with the information, such as our BMI, or our blood pressure, disease history, psychological profile, and everything else in our health records, once they have it. The only reason that the government measures anything is to exercise some level of control over the variable that is being measured, be it citizens registering guns, completing a census, filing taxes, or any other mandatory bureaucratic paperwork.
To predict what action the government might take after dissecting our most private information, we might look at what they have already said. Regarding BMI, we already know that the Center for Disease Control (CDC) believes that American society is "obesogenic" and that it is the government's role to regulate not only the food we eat, but also the society or environment that we live in:
Policy and environmental change initiatives that make healthy choices in nutrition and physical activity available, affordable, and easy will likely prove most effective in combating obesity.
This statement from their website should be extremely alarming to you. The verbiage "policy and environmental change initiatives" should send the chill of a big-brother government up your spine. This language indicates that a major government agency believes that only policy initiative and government action can manage the citizen's health and gives no power or mention to the rights of individuals over their own lives. Perhaps the predictive value of George Orwell's important political commentary 1984, written in 1949, was only a few decades off the mark.
In the novel, Orwell describes the miserable existence of Winston Smith, who lives in a totalitarian country where every aspect of his life, including exercise, is controlled by "Big Brother," a term coined by the book.
"Smith!" screamed the shrewish voice from the telescreen. "6079 Smith W! Yes, You! Bend lower, please! You can do better than that. You're not trying. Lower please! That's better, comrade..."
Do you have any reason to doubt that if the obesity figures continue to grow, the government will take further control of our lives? We must wonder if the government's insatiable appetite for the usurpation of power and control can ever be quenched. Only time will tell.