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This is part of the background information by Sylvia Engdahl for her science fiction novel Stewards of the Flame. If you don't see a menu on the left, please click here and then on "Compulsory healthcare."

Government Control of Health Care Is a Serious Threat to Freedom

In 2006 New York began checking the blood sugar levels of residents with diabetes by requiring medical labs to report test results to the city -- the first time any American government has monitored individuals with a non-contagious disease. The program is justified by its supporters on grounds that money and lives could be saved through intervention in the care of those whose diabetes is poorly controlled. There have been surprisingly few opponents. On the other hand, that's not really surprising; it's strong evidence for the assumption in Stewards of the Flame that most people will voluntarily give up freedom and privacy, and willingly deprive others of it, if told that government action will "save lives" or even simply have "health benefits." I fear this premise of the story is not an exaggeration.

But surely Americans cannot be forced to submit to unwanted medical care; doesn't the law require informed consent? Yes, and the Supreme Court has ruled that competent adults cannot be treated against their will. But not everyone is aware of this fact. (It was, for instance, ignored in the Academy-Award winning movie Million Dollar Baby, the ending of which depended on the assumed inability of a conscious heroine to reject treatment.) Arrested criminals must be read their rights, but in medical situations people are often simply handed a consent form and told to sign it. Except for surgery, they generally must sign a blanket consent before even being permitted to see a doctor.

Moreover, the law is unclear when it comes to screening, as opposed to treatment; screening programs don't always provide for opting out. In any case, the vast amount of government indoctrination on health matters goes unchallenged and indeed, meets with widespread approval. One of the reasons I make a point of Stewards of the Flame not being suitable for the same readership as my YA novels is that I don't want parents and librarians to think I'm using my position as a well-lnown YA author to undermine this indoctrination among kids. To adults, however, I am quite open about the fact that I disapprove of most of it. What's best for the health of individuals is not a matter for the goverment to decide. It wouldn't be even if it weren't controversial -- and it is; medical experts don't always agree. Such decisions depend on personal factors, both physical and with regard people's differing priorities, and should not be made by anyone merely on the basis of statistics.

Although in America the government cannot force adults to be treated medically (unless they are deemed "mentally ill," a subject I discuss under "Harmful Psychiatric Treatment"), it can and does force the treatment of children against their parents' wishes. Sometimes, as with vaccination, most states allow exemptions, though parents are generally not informed of this. In other situations, where the life of the child is presumed to be endangered, courts often order treatments that the parents believe will be damaging, and the unfortunate parents must choose between betraying their child's trust and losing custody. This happens not only in cases of religious objection to treatment -- where, tragically, well-meaning parents have too often been convicted of neglect or even murder for avoiding government-approved care -- but in an increasing number of cases of disagreement based on medical controversy. And then there are the millions of children now being given dangerous psychoactive drugs with their parents' full cooperation, merely because schools and school-approved therapists say they should be.

It goes without saying that government control over prescription drugs is a serious restriction on freedom, not only in the sense of freedom from government interference with individual choice, but because it makes those who require medication continuously dependent on the officially-licensed medical establishment. Yet so accustomed are we to this control that most of us aren't even aware that it did not exist until 1938. Before that, Americans could buy whatever drugs they wished, except narcotics; doctors' prescriptions were mere advice, not legal authorization. There are a few people today (and I am one of them) who believe that the present law is wrong -- that the government has no right to dictate what citizens may or may not consume -- and that its power with regard to drugs should be limited to ensuring truth in labeling. But the vast majority are concerned only with whether or not presently-illegal drugs should be legalized, an issue that obscures the real problem. By declaring some drugs too dangerous for public consumption (which indeed they are) the current law promotes the idea that others are both safe and desirable. Yet no drug is "safe"; with few if any exceptions, all have "side" effects that are either risky or downright damaging -- though many are the lesser of evils compared to serious illness. The public is urged to take authorized drugs to relieve every conceivable condition, potential future condition, or discontent -- and then society wonders why some turn to unauthorized ones in pursuit of the same goal.

It should be noted that some opponents of government involvement in health care decisions are organized into what is known as the Health Freedom movement, which champions the freedom to choose one's own medical providers and treatments but is focused on -- and financed by -- promoters of nutritional supplements and other "natural" health remedies, along with practitioners of alternative medicine. I certainly support people's right to use these without restriction by the government, but the association of the term "health freedom" with lobbying for that specific agenda is unfortunate. By no means all advocates of freedom believe such products are beneficial, and the commercial and/or ideological arguments for them distract from the fundamental issue, which is that the pursuit of health is a person's own business, entirely apart from the question of whether or not a particular form of health care is efficacious.

As C. D. Herrera has written, "The state's close involvement with medical research, education and certification prevents it from being a disinterested spectator . . . [its] close involvement with medicine dictates a particular interpretation of what is in the child's best interests." I might add that political considerations, not to mention lobbying by the pharmaceutical industry, strongly influence its interpretation of what is in anybody's best interests. Furthermore, as Peter says in Stewards of the Flame, "Whenever health authorities succeed in overcoming some actual problem, such as contagion, they are left with a bureaucracy that must justify its existence by medicalizing more and more aspects of simply being human." Those of us who care about medical autonomy cannot afford to be complacent.

"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship."
--Dr. Benjamin Rush, signer of the Declaration of Independence.
I recently came across this quote and found that it appears at many websites. I was delighted and wanted to incorporate it in publicity for my novel, but unfortunately I soon discovered that its authenticity is at best questionable. Although Wikipedia includes it, Thomas Szasz, an eminent psychiatrist who himself opposed all forms of government compulsion, revealed that it is bogus -- no verifiable source for it has ever been supplied and it is inconsistent with Rush's view of medicine. Too bad, as I think the idea behind it is true.

"Of all tyrannies a tyranny sincerely exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."
--C.S. Lewis, God in the Dock, 1970
This is an even more apt quote. I got it from David Harsanyi's recent book Nanny State, which I urge everyone who objects to government interference in private lives to read. I've now found that the quote appears in many places on the Web.

Update, July 2012: This page was written in 2007, before the debate about the Affordable Care Act. It goes without saying that there is now vastly more commentary on the Web about government compulsion in health care. But the so-called compulsion to buy health insurance, which the Supreme Court has rightly called unconstitutional while upholding the right of the government to tax, is not the real issue. As the Court's opinion states, there is individual choice about buying insurance because it is cheaper to pay the tax than to do so. But there will be no choice about the nature of the health care available, and the allegedly "preventative" steps the goverment is likely to require of citizens, if this law is not repealed.

What government pays for, it controls. This is proper, which is one of the reasons why government should have no part in paying for health care beyond emergency care for seriously-ill people who cannot afford treatment. If promoters of tests, drugs, and even procedures -- both bureaucrats and companies with a financial interest in them -- convince the government that the use of these things will save money (which in fact it won't, but that's another story) then a law will require people to submit as a condition of receiving any care at all. It cannot make refusal illegal because the Supreme Court ruled long ago that there is a right to refuse medical treatment, but for all practical purposes compliance will be compelled. Doctors will be required to insist on compliance as a condition of receiving government payment, perhaps even of retaining their licenses to practice. Many opponents of the Affordable Care Act worry about "rationing" of health care, but the opposite is a greater danger to liberty. If you doubt this, read Stewards of the Flame.

Here is a small sampling of links to material dealing with government involvement in health care that either constitutes, or verges upon, compulsion:

New York City Starts To Monitor Diabetics, Washington Post, January 11, 2006. By Rob Stein. "Government concern often shifts to government coercion. . . . Today we're telling people what you should do voluntarily. Tomorrow it may be we're telling you what to do or you'll be penalized."

Is Diabetes a Plague? Eroding the Distinction Between Public and Private Health, Reason, March 17, 2006. By Ronald Bailey. "Given the trend toward ever more intrusive government intervention in health care, New York's proposed cure may well turn out to be worse than the disease."

Mayor Bloomberg, M.D., New York Sun, April 4, 2006. By Elizabeth M. Whelan. "Given the complete lack of protest in response to the new mandated diabetes reporting and tracking scheme ... it is highly likely that we will see proposals to mandate reporting of serum cholesterol levels, high blood pressure, and body mass indices, followed by city interventions to prod us into changing our behavior to reduce the risks of heart attack, stroke, and the spectrum of maladies associated with obesity. This new diabetes regulation is, in short, a harbinger of more intrusive legislation to come -- all in the name of 'public health.'"

The Model State Emergency Health Powers Act: An Assault on Civil Liberties in the Name of Homeland Security, Heritage Foundation, June 10, 2002. By Sue Blevins. "Although this model legislation was recommended as a means to help states protect citizens against bioterrorist attacks and deal with national defense issues, the draft bill goes much, much further. It calls for giving state public health officials broad, new police powers." (The draft bill aroused a storm of protest and was never passed anywhere in its original form -- but the mere fact that the government proposed it says a lot.)

Consent Not Needed to Test Patients in Emergency, Seattle Times, June 8, 2006 (AP: also appeared elsewhere) By Andrew Bridges. "In a public health emergency, suspected victims would no longer have to give permission before experimental tests could be run to determine why they're sick, under a federal rule published Wednesday. Privacy experts called the exception unnecessary, ripe for abuse and an override of state informed-consent laws."

State to Check on Residents' Health, Seattle Times, July 20. 2006. By Warren King. "Participants will be asked about their access to health care and whether they have dental problems, osteoporosis, emphysema or cancer. Other questions will center on diet, medications and other risks for disease such as tobacco and alcohol use. A nurse on each survey team will measure blood pressure, pulse, height, weight and waist size. A blood sample will be taken to measure cholesterol and blood sugar. . . . Officials are not seeking volunteers; participants are being chosen to represent the diverse population of the state."

Health Police Gone Crazy, The Lantern, Ohio State University, October 11, 2006. By Sandeep Rao. "In a manner not much different from their Nazi predecessors, the anti-smoking community has framed the smoking issue as one of a paternalistic state protecting its weak and downtrodden.... Firearms, fat and alcohol have all been the targets of medical analysis identifying possible health risks and accompanying recommended legislative action. This untamed tyranny of the medical community will continue as long as the lay public greets the health community's legislative pronouncements with tacit acceptance."

The Perils of "Health Care", Association of American Physicians and Surgeons, December 12, 2006. By Richard E, Ralston. "Increasingly, approved providers are backed up with the police powers of the state. The FDA and Codex may ban home remedies, while mental health screening, disease registries, and mandatory vaccines and psychoactive drugs proliferate."

Torture in Healthcare Settings, Washington College of Law Center for Human Rights & Humanitarian Law, 2013. "Medical treatments of an intrusive and irreversible nature, if they lack a therapeutic purpose, constitute torture or ill-treatment when enforced or administered without the free and informed consent of the person concerned. This is particularly the case when . . . performed on patients from marginalized groups, such as persons with disabilities, notwithstanding claims of good intentions or medical necessity."

Mandatory Health Insurance: Health Care by Force, American for Free Choice in Medicine, June 26, 2006. "'Mandatory insurance' is of course an exercise in euphemism. It means 'do what we say or become a criminal.' It does not even mean "go into the marketplace and buy 'insurance' -- which would be bad enough. No government is going to require you to buy health insurance without regulating in exquisite detail what it must cover and what you must do."

Kidcare: Socialized Medicine Through Government Schools, Institute for Health Freedom, January 20, 1998. "With more health care personnel in schools looking to justify their positions, parental control over children will continue to slip away. Worse still, parents and families could find themselves subject to Orwellian oversight."

Video: The Drugging of Our Children (trailer)

The Nanny State vs. the Family, Liberty Papers, July 12, 2006. By Doug Mataconis. "Abraham is 16 and technically a minor, but if it's clear that his decision is really his, then what right does the government have to stick a needle in his arm and pump toxic chemicals into his body?" [Later another judge ruled that this boy does have the right to refuse chemotherapy; however, he still must be monitored by a court-appointed doctor.]

Doctor's Orders: Parents Battle Medical Authorities for Control of Their Children, Reason, February 2001. By Brian Doherty. "Legal conflicts between child services agents who are convinced they know best and parents who insist on their rights to raise their children as they see fit run the gamut. Representatives of local and state governments have enforced unwanted treatment plans or taken children away from parents in cases involving conditions ranging from hyperactivity to obesity to hepatitis B to ulcerative colitis."

Health Visitors or Health Police? AIMS (Association for Improvements in the Maternity Services, a British organization), 2004. By Jean Robinson. "A young woman, expecting her first baby, hears a knock at the door. She opens it, and the woman standing there says she is a health visitor, and can she come in? The woman asks why, and the health visitor says, "Just to see how you are." The woman says she's fine and doesn't need a health visitor, thank you. The health visitor replies, 'If you don't let me in, I shall report you to Social Services.'"

Forced Vaccinations and the Death of Health Freedom, The Corbett Report, July 18, 2012. By James Corbett. "This fight is not about anyone’s personal beliefs over the efficacy or inefficacy of any particular vaccine. It is about the right to say no to enforced medical treatment."

Hands Off Our Kids, Association of American Physicians and Surgeons, March 2007. "The [Texas governor's] Order states: 'Rules. The Health and Human Services Executive Commissioner shall adopt rules that mandate the age appropriate vaccination of all female children for HPV [human papilloma virus] prior to admission to the sixth grade.'" Outraged parents protested that "Parents should not have to get permission from the state to make informed consent medical decisions for their own children.'"

Shots in the Dark, Reason, July 1999. By Sue Blevins. "Even when exemptions are available, parents are rarely told that they can turn down vaccinations for their children without repercussions. Some public health officials argue that parents who refuse to vaccinate their children should be held legally accountable for child neglect. The justification for mandatory vaccination, which used to be protecting the general public from disease carriers, has thus shifted to protecting children from parents who fail to take precautions recommended by the government's experts."

Mandated Influenza Vaccines and Health Care Workers’ Autonomy, Virtual Mentor, September 2010. By Andrew C. Miller and David W. Ross. "Respect for the rights of individuals—including health care workers—to exercise autonomy in health care decisions argues for allowing HCWs to refuse vaccination."

Should Mandatory HIV Testing Be the Norm?, CBS, August 16, 2009. By Priya David. "A few hospitals, like one in the Bronx borough of New York have found a way to work within the current rules. . . . A bill to eliminate written informed consent was recently introduced in the New York State legislature."

Well-Intentioned Food Police May Create Havoc With Children's Diets, New York Times, May 30, 2006. "The schools are overreacting to the so-called obesity epidemic, and in the process are doing our children more harm than good.... These food wars go beyond good sense and good science. They're misguided and red herrings, based more in conjecture and politics than on solid research-based solutions."

Control Freak Society: Government To Monitor School Lunches With Cameras, Infowars, May 12, 2011. By Steve Watson, Paul Joseph Watson and Alex Jones. "Where does this end? . . . Will the government move to ration your child’s calorie intake? Will the government issue fines to parents whose children’s eating habits do not match up to a predetermined definition of a “balanced diet”?

Health Care’s Brave New World of Compulsory Wellness, Bloomberg, October 12, 2011. By Ezra Klein. "Are we really ready to let employers -- much less the government -- tell us to quit smoking, skip the junk food and lose weight?"

The Issue Is Freedom, Not Soft Drinks, Commentary, May 31, 2013. By Jonathan S. Tobin. "The purpose of government is to protect freedom, not to heedlessly infringe upon it merely for the sake of what some people may believe is doing good. Like the city’s ban on the use of trans fats and draconian restrictions on smoking, the new soda regulations are an intolerable intrusion into the private sphere."

Government Control of Your Diet: Threats to “Freedom to Eat”, Heritage Foundation, September 3, 2013. By Daren Bakst. "If the government can control what the public eats, it is difficult to imagine what it could not do."

Death Is Inevitable, from a Canadian organization called Stop the Health Fanatics which appears to be inactive. This page sums up one of the main points of Stewards of the Flame very nicely. "What a tragic irony it would be, if nations where millions of citizens were willing to sacrifice their lives in the struggle to ensure liberty and freedom for all, ended up sacrificing that very liberty and freedom in cowardly and futile attempts to run away from the inevitablity of death, by forcing minimal-risk lifestyles on all of their citizens."

Last updated in 2014