When I was in High School the national debate topic was "Resolved: That The United States Should Adopt A National Health Service". My partner Les Cooper and I placed second in the State Tournament. My future brother-in-law placed first. Even then the arguments were so closely balanced that Les and I were able to win (until the finals, that is) debating either side of the issue. I personally could never decide which side had the most weighty arguments. It seems, however, that the time is approaching when public demand will dictate a national program, at least for those not otherwise covered by a private plan.

On November 6, 1991 President Bush's Secretary of Health and Human Services Dr. Louis Sullivan announced a plan to issue a health insurance card to Americans to permit direct billing by doctors and hospitals, hoping to simplify billing, thus reducing the administrative cost of private health insurance. The Secretary implied that this may prepare the way for eventually providing some sort of coverage for persons not currently insured.

The notion of a national insurance card, it seems to me, sets the stage for considering an idea which has been taking shape in my mind for several years -- ever since France developed the notion of "smart cards" while I lived there in the early eighties. I thought I'd put my thoughts on paper for circulation before public policy gets so set in concrete that sensible modifications of the Secretary of Health's notion can no longer we worked into planning.
The Effect of a National Identity Card on Curbing Illegal Immigration

In Mexico, before posting to China, I was in charge of setting up the H-2A visa (temporary agricultural worker) program under the new Immigration Act. Most of us at the Consulate in Hermosillo knew from experience that the provisions of the new law wouldn't work. Yet we were instructed by Washington to gear up for eight or ten thousand applicants per year. After spending a hundred thousand dollars renovating a building next to the consulate, constructing a spacious, shaded "holding pen", and installing a chain link "rodeo shoot" to channel the expected applicants single file in groups of fifty to the counter for interview, we ended up with a few hundred applicants. It was simply expecting too much of Mexican workers to pre-arrange their employment, obtain an approved petition, travel the length of Mexico to Hermosillo near the border, pay expenses while waiting in line for a couple of days, shell out a fee of US$50, and then proceed to the border in a group by bus (the only way the Immigration Service agreed to process H2A visa holders), when they'd become accustomed to simply walk across during harvest season to look up the nearest farmer needing help.

The real effect of the new law is that braceros must now invest in a fake Social Security card (which costs much less than the $50 visa fee) to get the employer off the hook when he gives them a job illegally. The employer is not even required by the law to ensure that the document offered even looks genuine. Clearly, we need not only a government issued medical insurance card, but a difficult-to- forge Social Security Card or other ID for employment purposes.
And If We Ever Do Adopt a National Health Insurance Scheme

Since all legal immigrants are required to carry their "green card" as an identity document to avoid deportation if picked up by the INS, why not go all the way and do what every other advanced nation in the world does, combining the new medical services card and the Social Security card into a single National Identity Card? At present Social Security cards do not establish if the bearer is a citizen or not, since this is immaterial to their purpose. If anything like a Kerry Plan is eventually adopted for medical care, it will be essential to distingush eligible citizens from non- eligible aliens and non-citizen legal residents. A combined Social Security/ National Identity document could make these distinctions electronically so the card could, with no essential additional alteration, serve as a medical eligibility document as well.

To be sure, many may still think this is un-American. But millions of us now travel abroad regularly and are accustomed to keeping our passport with us and handy while abroad. And with most males having served in the Armed Forces, and required to carry an ID at all times, the idea is probably not as alien as it may have been even a generation ago. Indeed, since Social Security cards are at present so easily counterfeited and some form of identification is needed for all kinds of services from check cashing to liquidating a U.S. Savings Bond or other security to registering to vote, driver's licenses have emerged as the most frequently requested form of identification. Many states have started to issue "ID only" driver's licenses for non-drivers requiring some form of identification document.
The New National Identity Card Could Double as a Passport

Carrying the usefulness of a National Identity Card a step further (and perhaps making the idea a bit more palatable), with most countries in Europe (the destination of most American tourists) no longer requiring visas, a foreward-looking National ID Card could be styled "U.S. Identity Card & Passport". Without the need for pages to be stamped with visas, why should we stick with unwieldy, multi-page, pocketbook-sized Nineteenth Century baggage just because of bureaucratic inertia? A National ID card serves Europeans for entry into almost all EC nations. Electronic visas, with all the latest computer protections, could be entered into the ID's electronic chip by countries still requiring visas. Those needing a Nineteenth Century passport with actual pages -- for the few primitive nations still requiring stamped visas -- could always make special application for an old fashioned book-style passport. Think of the work this would relieve the Passport Office of.
And Voter Registration Card?

There is much concern about low voter turnout as related to the difficulties of registration. It has been suggested that registration be made automatic as part of filing one's income tax return. Since everyone working in the United States, citizen or not, must pay income tax, this could present difficulties. The process of issuing National Identity Cards would require each individual to verify his status as either citizen or legal alien. This process could readily be extended to accomodate registration of citizens for voting purposes, thereafter serving as a voter qualification document, at least for national elections, speeding up lines at booths and, presumably, promoting voter turn out.
In the event of a military draft ever again being needed, it could be validated as a draft registration card.

Not least, like the process of periodically changing the currency, as is done in many countries, causing problems for drug dealers, and unlicensed/untaxed grey-market businessmen, a well-designed and difficult-to-counterfeit National ID Card might be instrumental in causing a flood of illegals to leave the country and/or put employers who've been turning a blind eye to illegal workers (just as long as they have a forged Social Security Card which can be xeroxed for the employment file to keep the INS off their back).

Now we've got a single card (with electronic differentiation among its several functions) which can, with the entry of an appropriate PIN by the owner, be read in any credit card-type machine, serving at one and the same time as a) as an ID for any number of purposes requiring legal identification (including employment for legal alien residents, and voter registration for citizens,), b) as a Social Security Card, c) as a medical insurance card, and d) why not? as IRS identification for purposes of filing electronic income tax returns.
The National ID Could be Adapted as a State Driver's License

Having gone so far, why not a step further, reserving space on the smart-card chip for states to use for drivers licensing purposes? The basic card will presumably carry a laminated photograph and other identifying data and protective elements and markings. All the states drivers licensing bureau will need to do is electronically add the license category, limitations, if any, and date of expiration. Think how this could expendite intra-state exchange of information regarding infractions. And eliminate illegally carrying multiple drivers licenses from several states.
The Card Could Carry One's Medical History for Emergency Treatment

With little extra thought, one can conceive of such a card being programmed with one's medical history in the event of an accident away from access to one's regular physician -- it could even contain names, addresses, and phone numbers of one's regular doctor in the event the emergency physician wished to consult with him, one's next-of-kin, attorney, financial advisor, and bank account details, as well as a "living will" so that organs could promptly be used in event of death.
It Could Even Serve as Government, Business, or Private ID -- Producing Some Welcome Revenue

Every U.S. government agency and many businesses now require employees to carry ID to gain entry to their premises. The State Department (and I suspect most others) requires one to pass one's card through a reading slot to activate the gate giving one access to the building (it also serves for check out at night to make sure the building is cleared for safety and security purposes).

With a little pre-planning and coordination, our universal ID could provide space for government agencies to electronically validate the card to serve as such Departmental ID. In the case of Commercial use, space could, without interfering with the basic anti-counter- feiting measures included in fabrication of the card, be reserved to print a logo or add a hologram. A supplementary charge could be made for such service (adding to the national revenue) as is done at present with most credit cards which carry the names and logos both of the credit company (e.g. Visa or Mastercard) as well of the sponsoring bank, association, club, or university.

By now, this may be getting to sound a little like Brave New World, though most countries, many of them, like France, as politically liberal (and perhaps even more open to immigrants and refugees than the U.S.) are already way ahead of us in this respect. Perhaps with rising concern over the effects of illegal immigration on the U.S. economy, language, and culture, Social Security abuse, and low voter registration and turnout, a National ID could contribute some of the positive elements of Huxley's vision of the future without generating such negative ones as Big Brother's TV monitoring screens in every room of the house and weekly meetings to assure "political correctness". (Though some of our great universities seem to be headed in this direction through questionable curriculum dilution to include sample writings from every obscure author on every obscure culture known to man -- or at least those included in the ethnic makeup of the contemporary United States.)
Selling Electronic Space so IDs Could Also Serve as Credit Cards

There appears to be no reason why a universal ID couldn't reserve electronic space for banks and credit card companies to activate for commercial purposes, saving significant costs in issuing and renewing their own cards: just bring (or send) your card to the bank for annual updating. There should be ample card space to be sold for imprinting business logos. Why not? Even with public assumption of responsibility for running busses and subways we continue to sell advertising space to help offset operating subsidies. The Post Office, at a charge, now even allows automatic stamping machines to imprint company slogans and logos on the envelopes it delivers.
The National ID Could Carry Portable Credit Ratings

There is much unease about dissemination of inaccurate credit information. Inclusion of the elements of one's credit history on one's smart-card would encourage people to verify this data as part of the process of having it encoded on their card -- with all indicated protections against fraudulent alteration and unauthorized access. I, for one, would welcome such a development. When we lived in Mexico we had a Laredo postal address. I was denied credit because the Laredo credit rating bureau had, quite naturally, never heard of us. We'd never lived in Laredo. This could not occur were one's tamper-proof national ID to include one's last annually updated credit rating from a national firm, encoded in a manner to be available only to authorized credit extenders.
And Would It Ever Save Space!!

Most importantly, my wallet is so crowded with the dozen pieces of plastic I must carry that I can hardly pocket it. I just pulled it out for examination: two Visa Cards, Master Card, Discover Card, American Express Gold Card, AT&T Universal Card, Merrill Lynch card, driver's license, professional license, car insurance card, medical insurance card, life insurance, and all-risk home insurance cards.
Space on the ID Chip Could Be Rented Out Or Made Freely Available for Other Private Uses to Promote Rapid Acceptance and Use

In addition to space for Government ID and driver's license purposes, space could also be reserved for validation by clubs and, other private associations -- and, unless someone were to make an unreasonable legal case about separation of church and state with respect to selling space on a federally issued card as a revenue- raising measure, I can't see why churches couldn't make use of the same universal card. There'd certainly be room on the chip. The Mormon Church, for example, issues special cards for use by credentialed members to enter its temples.

With proper validation by the private renter of services (in the case of the Mormon Church, by the Bishop after appropriate interview), and PIN (either the non-governmental user or the owner could choose to employ a unique RSA-type algorithm for all functions -- which, a recent Economist article reported, is particularly suitable for "smart cards" and would take even NSA code-breakers thousands of years to decipher. Or one could elect a separate PIN for each separate use, depending on preference or policy). With such a set-up one could gain access to most of the necessities and activities of life without being burdened by an attache case stuffed with plastic, or discovering you'd left a needed document at home.

The banking function of one's card could, as at present, be programmed to spit out any reasonable amount of needed cash from an ATM anywhere in the world (my wife and I were pleased to find our Merrill Lynch card got us all the Hong Kong dollars we needed when we found ourselves needing cash in downtown Kowloon during an extended visit from Beijing).

Best part of all for those concerned about privacy in an age of increasing intrusiveness, no one need sign up for any add-on services beyond basic verification of legal residence -- something anyone living near a border must put up with from time to time anyway as he encounters a Border Guard.