China’s Healthcare Revolution: A Three-Part Series – Data Collection, Management, and Control (Part Three)

The China Chronicle

China’s healthcare revolution lives and breathes on data. Part One of this series explored how China transformed its domestic healthcare system. Part Two looked outward at how China is growing and reshaping global healthcare norms. This Part Three examines governmental collection, management, and control of personal information in China’s healthcare model and why this unnerves America.

Data Banks in Guizhou Province, China (www.asiatimes.com)

Information = Power = Control.

Data legitimacy in China flows from the State. In Chinese healthcare this involves obtaining, storing, processing, and managing intimate and comprehensive information about each and every person. Insurance, medicine, preventative care, hospital stays, treatment, and follow-up are all linked. Such information amassed at scale is power. Effective management of this information is control.

In the view of the Chinese government, the principal duty of political leadership is exercising dominant control for the benefit of the people as a whole (in the healthcare sphere and beyond). Social harmony is the principal end goal. The community trumps the individual.

From this metric, the Chinese government has succeeded spectacularly over the past four decades. China is healthier. China is richer. China is advanced. China is powerful. Life in China is lightyears beyond what it was at the end of the Mao era.

It is this success and its broad acceptance domestically in China and increasingly in pockets abroad that crash onto American shores like a howling storm surge. In the face of so foreign a governing system, we feel intense political and social agita. We are confused and remain frozen on the wind-whipped shore, unsure of what and how to respond.

I propose three steps in response:

• The first step is recognition. A radically different governance model exists that is coherent and functional even though we neither endorse nor want to adopt it;

  
  

• The second step is acknowledgment. This alternative model is attractive to many hundreds of millions of people and should be studied, not simply dismissed or vilified out of hand; and

  
  

• The third step, if we get that far, is processing. Are there any aspects of the alternative model that we might want to incorporate here to improve American governance and society?

Authoritarian. National Security. Public Security. Surveillance.

The above drivers of the Chinese model represent social governance that is menacing to American concepts and definitions of privacy and freedom.

China. China is authoritarian. It is a society that is not afraid of and has long embraced and often thrived with absolute leaders wielding virtually unconstrained power. This is Chinese history with Confucian and Daoist communal cultural contexts. And now, the current Chinese government has accomplished what the West thought impossible. It has fused autocratic leadership with money and technological prowess to unleash incredible growth across Chinese society.

In discussing what she terms “smart authoritarianism,” Professor Jennifer Lind writes in her new book on autocracy in China that the adaptive, agile, innovative system created by the Chinese government depends on “good information—about what’s going on in the world, about technology, about strategies of control.”

China is an enormous place in terms of geography, population, and urban v. rural divides. Organizing, managing, and effectively operating an effective national healthcare system is a herculean enterprise. AI, HI, and a combination of both make it run.

As Dr. Ruby Wang notes, “China’s approach…recognises data as a national security asset,…and sees prioritisation of national control over health information as a core element of public security and governance.”

America. In America, we have been raised on the twin pillars of inviolable individual privacy and absolute individual freedom. The government always takes second place. This is fundamental. Any challenge is framed as existential. Unlike China, the individual trumps the community.

With this as backdrop, how then do we account for the fact that Alexa, Ring, Flock, our cars, and our cellphones enable corporations to listen, watch, and track almost everything we do? In America, data legitimacy is supposed to flow upward from the individual but is increasingly captured by private, if not also governmental, actors. Americans have accepted this silent surveillance voluntarily into our homes, on our bodies, and in our lives with few constraints and less accountability.

It often escapes notice that America appears to be morphing from a Rule of Law nation where every person is to be equal under the same laws no matter their station to a Rule by Law nation where law is used top down by the governing authority for greater control of citizenry. Constitutional provisions we take for granted, i.e., speech, assembly, religion, and privacy, are in substantive ways becoming more symbolic than real.

This article headline from the Indian think tank ORCA strikes me as particularly anathema to Americans’ notion of liberty: “Codifying Compliance: The Social Insurance Law and the Future of Health Citizenship in China.”

Nothing is more frightening to us than the idea of an all-encompassing digital presence dictated by a national government (or maybe tech giants). We see only negatives. Our digital footprints will determine whether we are denied or provided access to medicine and treatment, whether we receive rewards or are punished, and whether we are able to live lives of comfort or distress. The loss of control of self, whether as an ideal or an actuality, cannot be tolerated. And yet, it is happening.

Back to China. On the other hand, every Chinese person alive today in China has lived their entire life in this other system, with different history, different reality, and today a seemingly different trajectory.

In the prior, analog twentieth-century world, Chinese society was organized on ever smaller local communities, not the individual. Monitors watched their districts, information was collected, control was maintained (with glaring exceptions like the Cultural Revolution). In the hi-tech world, things have not really changed so much as they have been modernized and made hyper efficient.

What has been the outcome of the surveillance state in this new age?

Two, young Chinese who are allowed to be active on social media outside the Great Firewall argue that China has freedom that Americans cannot fathom. Specifically, Li Jingjing and Eric Nan Nie extol how ubiquitous surveillance and a well-controlled society enable Chinese people to live without fear. Lack of crime, no mass shootings, clean and peaceful streets, affordable basic healthcare, rising living standards, longer life expectancies. Freedom to them is safety and stability. Freedom to them is a bright future of confidence and potential.

Now, Jingjing and Eric are open to critique for soft-pedaling the harsh downsides of such a controlling society. The tradeoffs in China are that the needs of the many outweigh the needs of the few or the one, often with brutal-to-our-sensibilities results to minority groups and individuals. Nevertheless, the message that control leads to security, that security is protection not oppression, and that the Chinese government has delivered tangible benefits for its citizens resonates and is endorsed widely by the masses in China.

What of the future?

The United States is frightened that China is winning hearts and minds around the world, including (in thoughts and actions if not also by public statements) among powerful interests here at home. Our polity is fractured. American society is teetering on, if not already over, an abyss.

In these perilous times, we need to recognize, acknowledge, and process the positives and negatives of both the American and Chinese models. To survive and prosper, might we not be better served by considering a greater openness to promoting a sense of community in America?