There's Manure on this Farm Bill

Democrat Tom Harkin Recently made the following statement regarding the 2008 Farm Bill:

“Farmers in Iowa and around the country are beginning to plant for the season. Here in Washington, Congress is fulfilling its promise to enact a farm bill that’s good for all America – farming families and rural communities, nutrition assistance for low-income Americans, fresh fruits and vegetables for school children, more sources of renewable energy and conservation of our natural resources and a disaster program.

“Like any compromise bill resulting from hard bargaining among regional and other interests, this farm bill is far from perfect. But no piece of legislation is. It includes significant reforms, as well as these major advances. It deserves the President’s signature.

“Inexplicably, the White House seems intent on destroying the harvest just as the seeds are being planted."

Pay particular interest to the second paragraph... the one in which Harkin lets us all know that included in this important piece of "compromise" legislation is a handful of givaways to "regional and other interests."

The entire committee passed version of the bill can be found here, if you're interested. But I'm going to talk about a few items in the bill which concern me.

Most agregious, in my mind, is a $126-million tax break for racehorse owners. That's no joke. Food prices are rising every day, fueled (literally) by continued subsidies for the production of ethenol from corn (known to most of the rest of the world as a food source) and the ever-rising cost of oil (which leads to higher transport costs), yet our congress thinks we need to give a tax break to millionaire playboys and girls who own racehorses.

But, that's not the end of the problems. According to TIME, "the top 10% of subsidized farmers collect nearly three-quarters of the subsidies, for an average of almost $35,000 per year. The bottom 80% average just $700. That's worth repeating: most farmers, especially the small farmers whose steadfast family values and precarious family finances are invoked to justify the programs, get little or nothing."

It goes on. The bill does nothing to fix the "commodity farm program." The policies in place under current rules are hurting local growers of fruits and vegetables AND consumers. But, that seems to be the goal, as the larger national-scale producers don't want the competition that comes from growers at a local-scale at a reduced price. Solution? -- Slap on heavy penalties to growers of fruit and vegatables who are using land previously used for the favored crops of the farm subsidies (corn, soybeans, rice, wheat and cotton). A farmer could decide to grow nothing at all on the land and be better off than if he or she decided to grow a fruit or vegetable.

These kinds of policies do nothing to actually HELP small farmers or consumers. Farmers should be allowed to grow whatever is in their best interest to grow.

The bill also calls for a reduction in the McGovern-Dole International Food for Education Program for overseas schoolchildren. This coincides with the current rise in food prices worldwide. This is also not acceptable.

But, in the end, as Harkin says, "compromise" is the rule of the day -- this IS congress, after all. The bill does provide for several important programs for some of America's neediest families by way of increasing the food stamp program and a sizable boost in dietary and nutrition programs.

Having grown up on one, I know that farms contain a fair share of manure. But, as bad as it smells it DOES make the soil more fertile. Are these "compromises" simply a necessity to move important gains forward, or can we do a better job of targetting the policies which really need changed without giving money away for racehorse owners?

I think you know where I stand. How about you?

Your Medical Records: Public Property?

Whenever we go to the doctor, we naturally assume that the doctor and their staff are going to safeguard our medical records, personal data, and financial information from exposure or theft. Granted, sometimes people cannot be counted on for that, but the general sanctity of our personal information at the doctor's is something that we expect- and that the medical establishment is in our corner on this one. However, like most assumptions depending on the Good Faith of Those in Government, it is false.

The first thing you need to know: you do not technically own your medical records. The copyright law on medical records is murky at best- your doctor actually owns your medical records and holds them in trust, but legally, they belong to him or her, as they did the work to fill them. Conversely, there are arguments that you own the paper they are printed on, but your doctor actually owns the content, which is where the real value lies. Murkier still, if these records are being kept electronically, the software firm that designed the database actually owns your records, with end-user licensing, proprietary software and Digital Millennium Copyright Act issues coming into play. There has been no strong precedent or finality in sorting through these issues.

Recently, the Institute of Medicine convened a workshop on what has been termed the "learning healthcare system," and how it promises to revolutionize clinical, lab research, and pharmaceutical data reporting in order to ensure greater outcomes for patients. Sounds great, I will admit, as most things do in theory. The question is, are you willing to allow a government agency or private firm harvest your full data, remove personally identifiable information, and make it part of a public database? This is exactly what dozens of agencies, research labs, hospitals and private firms are salivating over. You are the sum total of your data, and now that data would be public.

Consider the following scenario.

You go to the doctor, for that raspy throat and burning sensation that has plagued you on and off for the past few months. The medical transcriptionist enters your intake form into a database using your national patient identification number, assigned randomly by the overseeing agency. As your symptoms and personal information are entered, they are tacked onto the end of your patient file, sitting somewhere on a massive server, able to be instantly recalled anywhere, anytime, by anyone with proper access. Triplicate forms are replaced by three computing sites in California, North Carolina and Minnesota. After taking down your symptoms, they enter that data for a cross-reference against the region, your age group, your medical history and your gender, seeking patterns and explanations.

"Hmmm, interesting," the doctor taps his stylus on the screen. "Based on the aggregate data for your age and health cohort, we've had a 70% improvement rate on the reduction of coughing fits with this treatment program."

"I don't have many coughing fits," you say. "It's more of a sensation, a burning."

"It is probably just a different manifestation of the same symptoms," he replies coolly. "I'm prescribing a three week drug regimen for long-term relief, but short-term relief can be had by this spray. Please pick up the sheet from the front desk on your way out. Make another appointment in two weeks if you haven't improved."

As you drive home, you pop the first pill of your three-week treatment, choking it past a protesting throat. The spray, a peculiar-tasting concoction, is actually starting to work, to your and you are certainly pleased that it is reliable. Pulling into your house, you see a strange car in the driveway. Oh yes- the home appraiser is due today to give their final assessment. You have been optimistic, as home values have finally been rising after the collapse of the market years ago. As you enter, your husband looks sick to his stomach, and the appraiser seems to be actively trying to console him.

"Honey, this gentleman has some bad news." He looks at you with a mixture of anger, disbelief, and despair.

"I'm sorry, ma'am, but we simply had to take these other factors into account," he sputters. "While your property itself is highly valued, we cannot ignore the medical data for this neighborhood," Your stomach drops and twists up, all at once. "There are remarkably high respiratory disease rates in this county. It's all right here, if you want to review it- two standard deviations above the mean rate nationwide. Best as we can tell, it is due to coal-fired power plants a few hundred miles away. This is public information, after all, and our supervisors insist that we access these databases in our assessments. I'm sorry."

He hands you a bound report. There it is, in black and white: your county has been flagged as needing immediate attention to ambient air quality, with high levels of many types of pollutants, illustrated by colors wafting over multiple states, right over your home. Another page shows a map with your county glowing red, at the tail end of a trail of bright colors leading hundreds of miles southwest. 'Respiratory Illness Rates,' it reads. You take another spray, mind empty, heart racing, future plans fleeing before the pained truth in your hands.

Meanwhile, in a computing center in San Diego, or Durham, or St. Paul, an IT sub-contractor has just gone to get a smoke. He does not log off his workstation. An office supply courier enters the office. Updated files are compiling by the second on-screen, awaiting de-identification to add to the database. Opportunity knocks. Your record pops up just as he plugs in a flash drive, and begins entering commands.

Scary picture, yes? It is entirely possible with the technology in place. But the real questions is, when you weight out the pros and cons- Is it worth it?

You might not believe it after the above story, but there are demonstrable positives to this plan. For instance, with a national database, there can be instant follow-up on successful (and unsuccessful) treatments on any number of illnesses, from the flu to heart disease to cancer. Medical research could be conducted in real-time, effectively, with results updated to the minute. It could provide a sort of early-warning system for regional disease outbreaks, as alerts could be sent to area hospitals upon spikes of certain symptoms in a given population. A consolidation of medical records serves only to increase access, with the hope of giving you, the patient, better medical care.

There are a lot of "could's" in the paragraph above, because this is all strictly theoretical, and no one knows in practice how wieldy or useful this proposed database could be. For instance- doctors nationwide, and potentially worldwide, would have to perfectly align reporting, terminology, and symptomatic description conventions to fit the needs of this database, removing all subjectivity and likely removing a layer of the analysis of you, the patient. In forming an analysis, a doctor would rely on you as the sum total of your data, and may not have that supplemental relationship of knowing you personally, your attitudes and lifestyle, that could add color to a diagnosis. Deeply entrenched attitudes on what constitutes research and data would have to be reformed- as one speaker put it, "every patient walking through the doors is a research subject." All these things could cripple any potential system simply by making it useless for practical application. But the security issue stands out as paramount. Do you honestly want to sign over your medical records into a massive database, knowing what you know about the government's esteem for your personal data? For all the promises that are made, and all the complex and wonderful systems they propose, they are still designed and operated by flawed people. There is a limit to the security that can be put in place.

It is no surprise that some of the biggest HMOs, pharmaceutical companies and government agencies are all worked up about it. They have a lot to gain from this. Do you? There is really no guarantee that this system is going to produce measurable positive outcomes for the patient. Until such time as I can see what this will do for me, I will keep that medical history private, locked up tight, where it should be. Only the person in the white coat standing next to me should have access at that time. I am not your research subject. Until such time that I can have absolute faith in the inviolability of these records, consider them off-limits- that is my prerogative as a patient, and yours.

Quick Hit from Omaha, Nebraska...

From the Omaha World-Herald, the big news this week relates to the untold thousands of levees protecting the Mississippi and Missouri river watersheds. A significant number of these levees are not listed on any inventory by the Army Corps of Engineers- meaning no one has any kind of idea what shape they are in.

According to Robert Bea, a University of California at Berkeley levee expert, many of these levees have fallen into disrepair, and even at peak efficiency, were only able to protect against common floods- not floods on par with the Great Flood of 1993. Thousands more levees exist outside the control of the Corps, built and maintained by private citizens to protect land that has become much more valuable and populated since those levees were built. Many of these largely ad hoc levee are not maintained or even known to exist by anyone but their owners. Bea is not optimistic about our prospects.

"Once they do get an inventory," Bea said, "I think we're not going to like what we find." Read on below...

"Majority of levees are unmapped and uncertified." Elizabeth Ahlin, Omaha World-Herald, 5.11.08

"Army Corps says Condition of many levees a mystery." Jim Salter (AP), Omaha World-Herald, 5.12.08