The intersection of healthcare and immigration policy is found in the halls of hospitals and clinics across America, where increasing numbers of International Medical Graduates (IMGs) are filling in for doctors who won’t return, and state governments are doing their best to usher IMGs into practice where they’re sorely needed.
Help (Badly) Wanted: Foreign Doctors Apply Within
In 2023, Tennessee became the first U.S. state to drop residency requirements for some IMGs,1 giving them a new pathway to permanent licensure. Following Tennessee’s (somewhat surprising) lead, at least 15 states have introduced legislation to create streamlined pathways to medical practice for IMGs, with both Republican and Democrats contributing.2
During the 2025 state legislative sessions, over 20 bills have been introduced that would expand opportunities for IMGs to support America’s healthcare workforce needs. These range from allowing qualified DACA recipients to apply for licensure in New York to removing redundant training requirements in Montana.3
Some state legislation is more focused in scope. For example, in Illinois, IMGs must not only be legally able to work in the U.S., but are also mandated to work in medically underserved areas.
Perhaps most shockingly, in 2024 Governor Ron DeSantis of Florida signed the “Live Healthy” initiative to allow IMGs to bypass residency requirements if they have equivalent training experience. But then, the largest population of IMGs is in geriatric medicine, where they make up more than half of the physician population. And, well, it’s Florida.
Already at their shift
For that matter, according to the American Medical Association, a full 25% of licensed U.S. physicians are IMGs,4 with the largest number coming from India, followed by the Caribbean, Pakistan, the Philippines, and Mexico.
This is where the cognitive dissonance comes in– or at least, it should.
The new administration’s condemnation of everything related to equity and diversity, coupled with its rabid pursuit of an America free from immigrants, is simply incompatible with this reality. The reality is that massive numbers of the country’s doctors come from foreign countries, and are supported by legislation and advocacy work focusing on combatting racial and ethnic disparities.56
The AMA’s International Medical Graduate (IMG) Toolkit, in its section on “Academic opportunities and scope of practice,” acknowledges the fact that IMGs will face discrimination, but encourages them to press forward:
IMG physicians face several barriers in their goals and aspirations towards a career in academic medicine. . . Systematic exclusion is also a reason leading to discrepancies in leadership positions and promotions among IMG physicians. Despite challenges, IMG physicians are encouraged to choose an academic career as diversity is a strong determinant of innovation in medicine.”7
Those words “strong determinant” stick out to me, having written so much about social determinants of health.8910
A strong determinant doesn’t make a result inevitable, but rather highly likely. “You have something to contribute,” this guidance says, “So don’t give up in the face of discrimination. Keep trying, because we need you.”
I wonder if America is aware of how much we need IMGs, and how opponents of “DEI” and immigration reconcile their views with this reality.
Wait, actually I don’t. The reality itself is what matters– it’s where IMG physicians can, and do, make an enormous difference.
One of my first-year classes in college was History of Theater, in which I learned how the Greeks built amphitheaters into hillsides, carving out a semicircle of seating for the audience around the stage to maximize. The scenery for a play completes the circle, just as it does for any show in an amphitheater today. It’s the structure providing the necessary atmosphere for the experience.
Imagine sitting in such a theater, watching Euripides’ Helen, and seeing the demigods Castor and Polydeuces (Helen’s pissed off brothers) descend into the scene by a wooden crane—a mechane — whereupon they put an end to all of this murderous nonsense, and everybody lives happily ever after. It’s a literal top-down solution.
That’s where the expression deus ex machina, or “god from the machine,” comes from. And it became used, and mocked, throughout the world of fiction as a plot device providing a too-convenient, cheap ending to a story.
But my mind just keeps going back to that silly crane. It used to dangle a man dressed as a god before the audience, but these days he’d more likely be a techbro holding a smartphone, probably talking about the wonders of AI.
That’s on my mind today because in this post, I’m about to dangle a hypothetical mobile app in front of my audience– you. I illustrate our country’s mess of a healthcare system, and perhaps even reckon with it. This play isn’t ending any time soon, and we need to find a role in it (else one is chosen for us).
Healthcare data and analytics company Arcadia recently launched its own talk show, Spicy Takes, to discuss “hot perspectives in healthcare” while sampling—you guessed it—spicy food. The first episode placed President and CEO Michael Meucci in conversation with Chief Product and Technology Officer Nick Stepro and Chief Medical Officer Dr. Kate Behan.
I watched it while reading about their SDoH (social determinants of health) package, which promises to justify the time and expense required of providers to consistently record SDoH data by creating registries mapping that data with diagnostic codes, for use in proactively identifying patients at risk and connecting them to resources. While looking over the tear sheet, I heard Meucci say this:
I think that this is such a great platform for digital health as we start to think about how do you democratize access. Because if a patient is concerned that they’re not going to get the right treatment because of the color of their skin or the community they live in, the smartphone is a great equalizer. We talk about what’s changed for the last 10 years—that, to me is the biggest thing, the fact that you can pull out your phone and get connected with a doctor in 15 minutes.
“To your point, Stepro replied, “all of the technology and all of the access to healthcare in the world doesn’t change the fact that the single worst diagnosis you can have as a patient is being poor. You can’t address that with a healthcare institution. We can measure that poor people have lower outcomes but ultimately, we need to find and attack the problem of homelessness and poverty because you can’t just solve that in a clinic or with a smartphone.
I stopped reading and played that section of the show again. Meucci didn’t say that the healthcare industry can solve poverty with smartphones; he said we could democratize healthcare access. If that’s a spicy take then you can call me Spice Girl, because that’s my healthcare platform now. But I suppose coming from someone like him, that’s practically revolutionary.
And he’s right. As a country, America is primed for solutions like that: over 91% of Americans have smartphones. Even households without broadband hang on to their smartphones, because of course they would—it’s a tiny computer that can do more than any of us ever seem to realize, or ever will.
Democracy—another word with ancient Greek origins– literally means “power in the hands of the people.” What would it even look like to do that with a smartphone?
Let’s do a thought experiment to find out.
Time to design a smartphone app.
Imagine that in the beginning of The Legend of Navigating the American Healthcare System, our player character is given their first smartphone.
On that phone there’s an app installed (that I’ve just invented) called HACK: Health Agency, Care, and Knowledge.
Health – A full, patient-owned medical history
Agency – Control over your care, your records, your choices
Care – The power to find, compare, and advocate for treatment
Knowledge – Because to be informed is to be empowered
Does your vision of this app include it conferring access to all of an individual’s health records, stored securely but also accessible in their entirety at any time? If so, you’ve envisioned something better than what existing patient portal apps currently provide.
So yes, let’s absolutely start there, if we’re designing an app that democratizes healthcare in America.
And remember that democracy means that the power is in the hands of the people—not the “patients.”
Problem: we’re not in the driver’s seat.
Social Drivers of Health (SDoH) is the category of data on an EHR encompassing the non-medical factors affecting an individual’s health. In other words, your life, from the hospital where you were born (if you were born in a hospital) to the destination of your organs when you die.
They’ve been called the social determinants of health, but the word “determinant” suggests finality, immutability—that there’s nothing you (or anyone) can do about it. A driver, on the other hand, suggests that while the deck may be stacked against you, things could always change.
How easily could you could do that? *shrug* It depends, but we can safely say that “resident of the United States” is not an easy “driver” to change. We’re driving that road whether we want to or not.
And I hate to break it to you, but we live in a hostile health environment.
A 2024 study titled Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System was conducted by The Commonwealth Fund to understand why America is doing so poorly by comparison—that is, going beyond the factor that rhymes with “schmooniversal schmealthcare.” The categories they used are:
Access to Care
Administrative Efficiency
Equity
Care Process
Health Outcomes
In all but one of those categories, America comes in dead last or next to last.
To summarize the report, it found that Americans spend more on healthcare as a percentage of GDP to receive lower healthcare system performance than other countries. It faces the most barriers to accessing and affording healthcare. Its physicians and patients are most likely to face hurdles related to insurance rules, billing disputes, and reporting requirements. Equity in healthcare access and experience is low. And we live the shortest lives and have the most avoidable deaths. All by a longshot. USA! USA!
The one exception in these categories is Care Process, where we came in second. Their comments:
Care process looks at whether the care that is delivered includes features and attributes that most experts around the world consider to be essential to high-quality care. The elements of this domain are prevention, safety, coordination, patient engagement, and sensitivity to patient preferences.
I interpret this result as an indication that some version of enabling people to take charge of their own healthcare is key to accessing that care in spite of all other factors. It could even, possibly, raise America in those other categories where we’re currently ranking dead last!
Okay, probably not, but it could definitely help us face the hostile health environment in which we currently exist:
Misinformation is everywhere.
We live in an era where vaccine misinformation spreads faster than the viruses they prevent, leading to the resurgence of eradicated diseases, overwhelmed hospitals, and preventable deaths fueled by fear rather than science.
We live in an era where people google their symptoms and often reach the worst, scariest conclusions that inadvertently contribute to their paranoia, where “doing their research” on healthcare can lead to being convinced of conspiracy theories and pseudoscience.
We live in an era where the president of the United States once advocated for injecting disinfectant as a means of staving off Covid, and in his next term has appointed a raw-milk-drinking anti-vaxxer as Secretary of the Department of Health and Human Services.
We live in an era where social media influencers with no medical expertise gain massive followings by promoting unproven “natural cures,” convincing people to reject evidence-based treatments in favor of detox teas, essential oils, and dangerous fad diets
We can’t afford anything.
We live in an era where Cost-Related Nonadherence (CRN) is the primary reason for medical nonadherence (failure of patients to take their medication as prescribed due to cost) in some cases forced to choose between “treating and eating.”
We live in an era where the term “dual ineligibility” refers to the status of undocumented immigrants in the U.S. who qualify for both Medicaid and Medicare, but are unable to access either one.
We live in an era where medical debt is the leading cause of personal bankruptcy, where a single hospital visit can trap families in a cycle of financial ruin, and where crowdfunding platforms have become a substitute for a functioning healthcare system.
We live in an era where rural hospitals are closing at alarming rates, leaving entire communities without nearby emergency care, prenatal services, or even a local doctor, forcing low-income patients to travel hours for basic medical attention they still might not be able to afford.
Neighbors hate and fear their neighbors.
We live in an era where in transgender healthcare, patients frequently encounter providers who lack adequate knowledge of gender-affirming care or hold prejudiced views that hinder appropriate treatment.
We live in an era where in reproductive healthcare, political and ideological barriers, including misinformation and ignorance, stand in the way of basic, safe medical care.
We live in an area where Black patients are more likely to have their pain underestimated and undertreated, leading to worse health outcomes.
We live in an era where in disability healthcare, patients struggle to have their pain, symptoms, and autonomy taken seriously, with providers sometimes dismissing concerns as psychological or unavoidable aspects of their condition rather than treatable medical issues.
We live in an era where in chronic illness care, patients—especially women—are more likely to be dismissed as exaggerating their symptoms, leading to years-long delays in diagnosis for conditions such as endometriosis, fibromyalgia, and autoimmune diseases.
We live in an era where in elder care, aging patients often have their autonomy disregarded, with medical decisions made on their behalf without full consent, reinforcing the notion that age diminishes a person’s right to control their own body and treatment.
We live in an era where fat patients are often told to lose weight as the solution to every health issue, leading to delayed diagnoses and overlooked conditions that have nothing to do with body size.
We live in an era where for immigrants, language barriers, lack of documentation, and fear of discrimination or legal consequences discourage people from seeking medical care, exacerbating preventable conditions.
But remember: “they” are us, and we all deserve better.
If you’re still thinking about this in terms of how we can help them by this point, stop it. That’s “patient engagement” speak, and our identify is not “patient.”
Our identity is “person,” i.e. member of the human species, class Mammalia, spending every second of life alive, for 100% of the time (until we’re not), thus making our health, and healthcare a relevant part of our lives 100% of the time. Yes, even for doctors.
We all should get a remote control.
A note ondignity: Meucci mentioned not getting the “right” treatment based on the color of your skin or the community you come from, suggesting that a smartphone could be “a great equalizer.”
That’s a powerful thought, given the indignity that confronts many Americans when they try to interface with the healthcare system at any level, including when they see their providers—whether the providers intend that or not. The hypothetical HACK app, simply by virtue of being an app, confers a sense of dignity that we might not get in the doctor’s office, or indeed anywhere else.
As a survey on dignified care put it, “Dignity is at the heart of personalization. Dignity means treating people who need care as individuals and enabling them to maintain the maximum possible level of independence, choice and control over their own lives.”
We live in an era where America’s healthcare system does not prioritize dignity. Is it possible to claw some of that back?
If you’re going to design a healthcare app to democratize healthcare access for people, that includes you.
In another Spicy Takes exchange, Stepro observes, “Isn’t it better when the consumer is educated and activated—after all, it’s our own body on the line? I’m glad folks are turning to Google or GPT for answers, even if they aren’t perfect, because it shows a healthier dynamic.” Behan responds that unvalidated or wrong information is hard to overcome, and Stepro sarcastically asks if misinformation in medicine has been a persistent issue.
Well, yeah, those problems face all of us, don’t they? We all consult with Dr. Google occasionally, because it’s free, and you can consult it at any hour and ask it any stupid question you want. The downside is that the answers aren’t reliable and can’t substitute for what an actual doctor might advise. And Dr. Google has no idea what your full medical history is (not that you want it to).
Some third-party apps like Ada Health improve dramatically on Dr. Google by using symptom checkers based on verified medical information. Chatbots based on large language models can certainly look up your ailments and dispense advice, although you should be wary if they encourage you to eat rocks. If you’re fortunate enough to have access to the Wolters Kluwer’s UptoDate clinical decision support service, you can find loads of evidence-based data refuting social misinformation. You can even get mobile access to it, and at $60 a month that’s not too shabby.
It’s still pretty far from “free,” however, and UptoDate doesn’t know whether you have a medical condition that could make any recommendations it offers highly dangerous. But if that feature is integrated into the HACK app, you lose the danger of uninformed recommendations, and get to keep the endlessly useful medical library.
On that subject, what else can we pack into this thing?
What an app wants, what an app needs
So far, the HACK app has two big features:
A library of trustworthy medical information that you can consult for any reason, at any time, that’s informed by your medical history included in the app.
Your entire medical history, including all lab results, hospital stays, specialist care, etc. regardless of which healthcare provider you saw for any of these treatments.
Let’s continue stealing important features from other smartphone apps to integrate them into the HACK app, bearing in mind that they must be for the individual using the HACK app—not features designed for providers to gather data from, or to influence the behavior of, the patients they treat.
What else?
Let’s say the app has an UptoDate level of education materials in a database that connects to your specific data and diagnosis using MedlinePlus Connect. Give the app a chatbot that can pull from this database to answer all of your questions, regardless of how sensitive or embarrassing, and deliver that information in simplified terms without jargon. Now you’ve got a semi-omniscient doctor in your pocket who can tell your uncle (or RKF Jr.) to stuff it when he goes on about vaccines causing autism.
Let’s say the app prioritizes having control over your own data and lets you update and make corrections to your EHR data using a souped-up version of OpenNotes. It also includes a data permissions management dashboard, with the ability to see an audit trail of who has accessed that information—even if there’s nothing you can do about it.
Let’s say the app can also be a buddy who just happens to have a weird fixation on making sure you follow your treatment plan. It incorporates behavior modeling tools from Health Catalyst’s UpFront app to take over remembering stuff when your brain is full (i.e., cognitive offloading). “Hey, you were supposed to schedule that colonoscopy three weeks ago—want me to go ahead and set up the appointment, ya big baby?” Okay, to be fair, Upfront would be nicer than that.
Let’s say the app can create a localized map of all healthcare providers and resources in your area that you can filter by available services. It builds this using tools like Unite Us’s resource directory or ZocDoc’s appointment booking platform, but no referrals are required—you self-refer. “Hi, I have a weird rash and need to see somebody within a week. What do you have available and how much is it going to cost?”
Let’s say the app also has a filter that flags conditions you have, and procedures you might need in the future that might become, you know, illegal in your area at some point. The app could tell you the next closest location where it’s still legal, and point to ride-sharing and other assistance to help you get there/afford it. It could even alert you to events like Texas Attorney General Ken Paxton suing HHS to slide past HIPAA protects to access data indicating you had an abortion.
For that matter, the app could shield you from (some of) the effects of federal cuts to health services with built-in compliance to existing regulatory measures that protect and preserve your data.
Let’s say the app has access to population health data showing the health risks you face most imminently and what you can do about them, incorporating those insights from Arcadia’s population health platform and Health Catalyst’s Ignite platform. The risks matter whether they’re nature or nurture, and you need to know ASAP what you can do about those affecting you.
Finally, let’s say the app, while placing all of this individualized information and these resources in a little device in your individual hand, also puts you in touch with communities of other human beings affected by the same conditions you are, by offering a feature like HealthUnlocked. You were never alone in this, and here’s the proof.
Nice little fantasy app you’ve got there. Who’s going to make it, though?
Ah, the mask has fallen. The jig is up. The cat’s out of the bag, and the deus is off the machina. What now?
Just kidding. This is a thought experiment for a reason—I don’t expect anyone to make the app. America is ripe for such an app, we need such an app, and we have the tools to create such an app—but that doesn’t mean we’re going to.
But let’s continue to be optimistic– perhaps I’m wrong on that second point. So, okay, what would developing the HACK app require?
A governing body to make sure the app is trustworthy
A sustainable funding model (Stop laughing– we just got started!)
Interoperability across all EHR vendors (I said stop laughing!)
Assume that we have satisfied all three requirements. This is, once again, a thought experiment.
Now, can we seriously address the matter of who makes the HACK app– and why?
What are our options?
The ONC
This one is obvious, because they already oversee FHIR and TEFCA, and interoperability is their dream. They also have regulatory power without a profit motive. But they don’t make software—they just regulate it. Somebody else would have to make it, and put the ONC in charge.
A private tech company (e.g. Microsoft, Google, Apple)
Microsoft attempted something similar with HealthVault, a site where users could store and share their health information, which fizzled and died in 2019.
Google Health was born in 2008, died, and then came back again, finally dying off for good in 2023.
But Apple Health is alive and kicking, using Fast Healthcare Interoperability Resources (FHIR) to let users import and view their health data on their iPhones and iPads after retrieving it. FHIR standards, importantly, were developed and adopted after Microsoft and Google made their respective shots.
When Microsoft and Google started leveraging FHIR, they were no longer in the “patient records for patients” business. Azure Health Data Services and Google Cloud Healthcare API are data platforms used by healthcare systems, payors, research institutions, and so on.
But in none of those cases was the focus on providing services based on patient records—just the records themselves. Apple Health can only function as a sort of meta-patient portal, requiring users to log into their actual patient portals to access their records, and their providers have to agree to letting Apple share the records in the first place.
If a private company like this developed the HACK app, you could argue that it democratizes access far more than the patient-portal-like products these companies previously developed, but, again—it would be their product, for better or worse, and arguably so would we.
A public-private partnership
This means:
Private tech company builds the infrastructure.
Nonprofit coalition manages the project.
ONC (or other federal agency) sets the standards and governs the data.
I guess that’s an option. But if this combination of entities could accomplish something like the HACK app today, why haven’t they done so already?
Who’s going to own it?
Taking on the project of creating the HACK app through that kind of partnership would be a tacit admission that the current system has failed, and that it’s going to take an app to save it—or at least, to survive in the face of that failure.
That’s the paradox of designing a “subversive” app promising to democratize healthcare through the backdoor, while only requiring access to all of the health records that healthcare systems are refusing to share right now, even after the ONC has hounded them to do so for over 20 years.
Each of the app’s features “stolen” from an existing technology really would have to be stolen, and it’s hard to imagine healthcare tech companies welcoming someone pirating their platforms.
On the other hand, it’s also hard to imagine a better example of the healthcare industry doing what it can to make a difference. “I helped someone understand their own medical records and make plans for future treatment today, when otherwise they wouldn’t have” is not nearly as sexy a claim as “I helped someone out of poverty today,” but it’s a lot more realistic– and on a higher scale, both of those claims could easily be true.
But because healthcare tech platforms sell patient engagement tools to providers rather than to people, there’s no motivation to develop a HACK app per se.
And even if the motivation was there, America has a population of—what—over 340 million at this point? How’s the HACK app going to reach all of us, even a large fraction of us?
How do we get this kind of reach?
Let’s assume that the HHS is developing the app—it would have to, to approach anywhere near that reach.
I’ve actually done a lot of research and writing lately about another app, developed by another U.S. federal governmental department, that reached as many as 64 million—while also stringently adhering to high security and data protection standards and relying on nationwide interoperability and data integration. It’s installed on my phone now, actually, though I’ll admit that I haven’t used it recently.
Maybe the HACK app could take some lessons from it?
Federal development and oversight—If HHS takes direct ownership of the app, just as this other agency did, that would mean developing the app in-house rather than outsourcing it to private industry.
Security and data protection—The HACK app would need to encrypt personal data, require strict user authorization as well as access control and permissions management, and comply with federal security standards, just as the other app did.
AI and automation for user navigation—Both apps rely on automated data processing, proactive notifications and engagement, AI-driven risk assessment, and smart eligibility and routing systems that guide users through decision trees based on their data.
Large-scale user support and infrastructure—Both apps must be scalable to handle millions of simultaneous users, both use mobile-first design, and both require redundancy and real-time threat monitoring for resilience against system failures and cyberattacks.
That’s a very general list of requirements, but if another government-developed app can succeed on this level, couldn’t the HACK app do the same? Assuming that the HHS has access to all information and other resources required to do it, that is.
Now, if your answer is “Yes,” how shocked will you be to learn that the other app is CBP One? You know, the app developed by Customs and Border Patrol to scan the faces of migrants and use that as a basis to determine if they can enter the country? The one that Trump shut down on his first day in office, forcing me to defend it after bashing it for months? Yes, that one.
I know, different government agency altogether. Different goals, altogether.
But that’s my point– regardless of how you think about immigration or healthcare, it says a lot that even after such an app was (successfully) developed to regulate immigration, it’s impossible to imagine the government developing a similar app to get healthcare access to Americans.
CBP One has something else in common with regular patient portal apps—it wasn’t developed for its intended end users, but rather the organizations providing the app. And as with patient portal apps, that didn’t stop government officials from boasting about how the app provides migrant empowerment—”There’s a lot of people who would love to migrate to the United States. In essence, they see CBP One as sort of a self-petitioning mechanism that we’ve never had before.”
*cough* So, anyway…
After all of this, have we democratized access to healthcare yet?
No, but we’ve shown that it’s possible to make a tool for getting there.
The U.S. in 2025 is a country:
where the best way to reach the greatest number of the population, regardless of demographics, is via a smartphone
with a disaster of a healthcare system that we have no choice but to navigate
where, within in that system, our healthcare needs are socially driven out of our hands
where huge advancements in healthcare technology have been made, and continue to be made, every day
whose government has already built a large-scale, high-security, interoperable app for mass data processing, supporting daily access by millions of people. Granted, that was for a very different purpose– but still, they did it
All of the problems standing in the way have been solved—just in different directions, for different people, with different purposes.
And now, the goddess Panacea would like a word.
She’s been quietly waiting in the wings, refusing to step anywhere near that cursed crane, even though she’s arguably the most qualified to do so.
She wants us to remember that America is now an older country than it ever has been, and older folks are sicker folks. They’re also notoriously bad with tech—but they’ve come far since the days when everybody was posting screenshots of their parents failing spectacularly at texting. And we’re at the point where the first generation to grow up using computers is eligible for AARP, anyway. So while the HACK app won’t replace their knees later on, it would be the next best thing to having a personal nurse (or tireless family member) with them 24/7.
She also points out that administrative efficiency is one of the categories included in the Commonwealth study where the U.S. tanked, with wasteful administrative spending estimated as high as $570 billion in 2019. And the HACK app could streamline patient access to records, real-time cost transparency, and insurance verification outside of the doctor’s office. Just sayin’.
Lastly, she wants us to know that the deux ex machina isn’t always what we think it is.
If your job is making boots, and you make boots for soldiers to wear to go to war, then boots are not your deus ex machina for winning the war. They’re just the tiny but significant contribution you can make, using the power and skills you have, to make winning the war more possible.
Likewise, if you’re in the business of making healthcare apps, your apps are not your deus ex machina for democratizing access to healthcare—they’re the tiny but significant contribution you can make, using the power and skills you have, to make democratized access to healthcare more possible.
She departs stage left with a warning: Stop hanging gods from cranes, she says. Just build some damn ladders, and let people climb.
I would like to know why, in numerouspublishedstatements, Chairman Green has claimed that Anna Giaritelli published a “groundbreaking scoop showing that the criminal cartels had hijacked the CBP One app using virtual private networks (VPNs), and were exploiting the app to make even more money by scheduling appointments for migrants outside the geographical range.”
This is clearly and obviously false to anyone who reads the article. What Giaritelli wrote wasn’t a “groundbreaking scoop,” but rather a baseless claim. At no point in the article does Giaritelli cite a single source confirming that cartels are exploiting CBP One using VPNs.
She refers to “an extensive investigation” of DHS documents, but she doesn’t link to the documents, or quote them, or even say what they specifically address. That’s the closest she comes to providing any evidence whatsoever.
The one quote she provides from an actual DHS official (Erin Waters, Assistant Commissioner for Public Affairs) is refuting Giartitelli’s claim, stating that CBP One has actually been “bad for cartels and other criminal organizations seeking to exploit migrants.” Waters goes on to explain that CBP One rather relies on the location data supplied by devices used to access the app.
I would like to know if the Committee has ever spoken with Erin Waters on this issue– and if not, why not? Why rely on the bald assertions of a right-wing web site over a statement of fact from a DHS official?
At the very least, the obvious contradiction presented here should give the Committee pause, and encourage you to look into the claim further. But apparently the Committee had no time to even take a second look, in your rush to– again, repeatedly– make such a momentous claim, with such an extensive impact. You clearly think this matter is serious, so why are you relying on what amounts to rumors and gossip rather than statements of fact supported by evidence?
Could it possibly be that it’s because the rumors and gossip align with your pre-existing beliefs? That evidence be damned when it contradicts your desire to believe?
If so, that’s grossly irresponsible– not to mention dangerous– behavior on the part of a legislative committee. Misrepresenting the truth gets people killed, and yet you treat this reality with casual disregard.
I dearly hope that I’ve simply missed something here which exculpates Chairman Green’s statements about CBP One– and if I have, then assuredly I’m not the only one. So if you have actual evidence that doesn’t come from a vague and unsupported Washington Examiner article, please post it. I’d still be baffled to why you didn’t just provide that evidence in the first place rather than linking to the Examiner, but perhaps that’s a lesson that can be retained for future statements.
Thanks for your time and consideration on this matter.
For over a year now, the committee has been making hay about this so-called “bombshell report” that doesn’t show what they keep insisting that it shows. This line in particular is revealingly hilarious:
Since the Biden administration debuted the CBP One app in January, immigrants south of Mexico City had no reason to believe they would find a legal way to get into the U.S. if they crossed illegally.
The app debuted in October of 2020 (under Trump, btw), not January of 2023.
Using the app is, by definition, not crossing the border illegally.
CBP One is a legal way– unfortunately for most migrants, the only legal way– to enter the United States.
Republicans are tossing around a lot of terminology to obfuscate 2 and 3. The term “otherwise inadmissible” is a fun one, because it suggests that migrants would fall afoul of other immigration restrictions and be denied entry without using the app.
What’s the basis for this? There is none, and in fact the app’s facial recognition engine is designed to be a screen to prevent such individuals from entering the country before they can even reach the border. It does this by comparing the face captured within the app to templates from DHS’s HART database, which includes records of an individual’s entire history of encounters at the border, as well as any crimes committed.
Once again, as I pointed out in CBP One™: The Border in Your Pocket: the app isn’t designed to let as many people through as possible; it’s designed to make the lives of CBP officials and agents easier. Their lives are easier if they can gather as much information about the migrants as possible, as soon as possible, to minimize the seemingly endless paperwork and stress that comes from trying to process the entirety of someone’s information on the spot, all at once, at the border.
(Yes, I sound very sympathetic to CBP agents here. Am I? No, but I can empathize with their openly acknowledged wish to automate things to the extent that they can be).
Last September, Chairman Green and Subcommittee on Border Security and Enforcement Chairman Clay Higgins “demanded answers” from DHS Secretary Alejandro Mayorkas about cartels “abusing the Biden administration’s expanded use of the CBP One app to enhance their human smuggling operations.”
Yes, relying on this one article from the Washington Examiner. They “demanded” that the DHS Secretary address the baseless claims of a right-wing rag in which a CBP spokesperson was already quoted saying it’s all BS.
It’s staggering, and if I’m not misconstruing any of the details here, it’s staggeringly stupid.
“Dude, we don’t want to see that shit. Here, have a sip of Douche-Be-Gone so you’ll stop being so…you know.”
Concerning the topic of online sexual harassment against women, atheist and otherwise, and what to do about it, Stephanie Zvan defends the use of social disapproval:
I’ve even seen a couple of people say things like, “Social disapproval is a technique used against atheists by theists. We shouldn’t be doing that ourselves.” All told, the consensus among those feeling challenged for doing nothing is that doing something is dangerously repressive–when that doing something is registering that one simply does not approve. They’re even a tiny bit right. Social disapproval is indeed a potent force. It strongly shapes our societies and our interactions with each other. Being outcast presents a form of stress that is bad for us all on its own. However, where these folks are a tiny bit right, they’re also a whole heaping lot wrong. The problem with this sort of social pressure isn’t that it is inherently wrong. As I mentioned, this is a big part of how we add order and structure to our societies. The problem is when we use to enforce pointless conformity, when we shame or cast out those who are doing nothing wrong, nothing that will harm our society. For the record, sexism, misogyny, objectification, normalizing rape through nudge-nudge-wink-wink humor, threats to bodily autonomy–these are all doing something wrong. They all hurt a substantial portion of our society, and I don’t just mean women. This is not comparable to not believing in a god. Those behaviors are all also prevalent in our society, though less than they used to be before we started confronting them. They are being held in place by a narrative that, while it can no longer claim that nobody at all is concerned by this behavior, the only people who are concerned are “thin-skinned pussies” and “irrational cunts.” That means that if you–yes, you–don’t speak up when something like this happens right in front of you, you feed that narrative. This is what “If you’re not part of the solution, you’re part of the problem” means. The only thing that can really cut through that narrative is more voices that come from within the groups where this behavior happens. No bullying or questing for bad behavior required. You don’t have to be any more eloquent than “Dude, don’t go there” or “It’s only a joke if it’s funny” or “I’m with X on this” to back up someone else already taking the heat for standing up. Or you can just use the brilliant line that should become a meme as of yesterday: “I am also the internet and I don’t want to see that shit.”
Absolutely right. There is nothing intrinsic to social disapproval that makes it a bad thing. It can be a very good thing when it comes to dissuading people from treating each other terribly, even in an atmosphere like the internet where people are often allowed to be anonymous or anonymous-but-trackable (using screen names). The problem with social disapproval of atheists isn’t the what but the why— the shaming and alienation of people for something about them which has nothing to do with their actual worth or moral standing. When what you are is a troll and/or a jerk, however, your moral standing goes down and calling you on it is entirely appropriate. Social pressure can simply be what happens when a bunch of people call you on it, and it works.
Online communities can and usually do also have systems of moderation in place, automated or warm-blooded, whose job it is to regulate and prevent obnoxious and hateful speech. But the most likely message someone who is being arsey gets from being penalized from one of these is “The Man is keeping me down! Violation of freedom of speech!” Which is bollocks, of course– no private community has an obligation to protect the dissemination of odious speech if the owners/ruling powers do not desire it. Still, I think if possible it’s always better to rely on the community at large to make it highly uncomfortable to express nasty sentiments, so that the perpetrators know that the negative reaction isn’t just from one person or a few who happen to be on a power trip or have it out for them personally.
The corollary to the rule of using social pressure to combat internet douchiness is, of course, that those employing it should be able to explain what’s wrong with the speech to which they’re objecting so strenuously. A Picard facepalm might seem sufficient:
…but if not (and usually not), you should be able to articulate the problem, no matter how obvious it appears to you. For one thing, it makes the group disapproval amount to more than “There are a bunch of us who frown on that sort of thing” and create an opportunity for the jerk to comprehend the reason for the perception of his/her jerkiness.
This, in turn, creates an opportunity for him/her to correct the behavior. To maybe even apologize. It does happen! And when it does, that’s the cue to stop with the social disapproval. If the “Dude, that’s messed up”-ing doesn’t end even after the behavior has stopped and admitted fault, the message sent will instead be that he/she can’t do anything right, at least from now on, thereby negating any positive consequence of all of the disapproval. It will probably even counter-productively convey the impression that the disapproving crowd are irrational blowhards and there’s no point in listening to their exclamations. Our jerk in question may even nurse a messiah complex for him/herself as a result, thus becoming further bolstered against any future accusations of jerkiness. With great power comes great responsibility– so it is with the power of “not cool.”
One further thing to note is that online as well as in RL, the most effective social disapproval is likely to come from peers– the people most familiar and similar to the jerk. Yes, pro-active peer pressure! Don’t make the target of the jerkiness and his/her peers the only ones to speak up about it. It might not feel like the best thing, but the thoughts of people who are more like the jerk yet are willing to stick their necks out on the target’s behalf are probably going to carry more weight with the jerk, because they can’t be as easily dismissed as “whiners” or “killjoys” (or “thin-skinned pussies” or “irrational cunts”). Yeah, that’s not rational, but jerks often aren’t– that’s why they’re jerks. It’s also not rational to suddenly start listening to complaints about your behavior just because they start coming from someone you otherwise admire (even if they’re not exactly a peer), but damned if that doesn’t work pretty well too.
I do understand the complaint about misogyny being especially vexing to see in the atheist/skeptical community because they’re supposed to be so…well, skeptical. But though the same thing which makes a person mistrusting of stories about ghosts or Bigfoot should also make them doubt the premise that the most important thing about women is their appearance and general fuckability, justifying turning every internet discussion to that topic, all too often it doesn’t. As we have seen. So it’s high time to start calling out the people who pride themselves on rejecting the former but practice the latter as though it’s going out of style. And if you’ve been doing the calling out, the socially disapproving, all along…my hat’s off to you. Keep it up, please.
Let’s say you’re planning a big party. Unfortunately, when parties like the one you have in mind have been thrown in the past, they have tended to attract…well, some assholes. These assholes direct their ire to and about a certain specific group of people, and it can be really obnoxious, making others feel uncomfortable or even unsafe. You want to make sure that kind of thing isn’t going to happen at your party. So what do you do?
A) Announce in advance that assholery of any kind will not be tolerated, and enforce it by kicking out anyone at the party who insists on behaving that way. B) Take note of assholes who have attended such parties in the past, and make an effort not to invite them. C) Incentivise people of the group targeted by the assholes to attend, so as to create a disparity in numbers which encourages the assholes to keep their traps shut. D) Some combination of the above.
If you’re one of the organizers of an upcoming LAN party in Austin, Texas for Battlefield 3, your answer was…. E) None of the above! Announce that members of the group targeted by assholes are not invited to attend, for the sake of their own protection.
Yes, really. And as you can guess from this post’s title, the targeted group is women. From Owen Good at Kotaku:
Enthusiasts of military-style first-person shooters are not well known for their progressive thoughts on the matter of gender. The organizers of a large LAN party in Texas, scheduled to celebrate the launch of Battlefield 3, have decided the best way to deal with any slurs hurled at female gamers is to simply forbid them from attending. “Nothing ruins a good LAN party like uncomfortable guests or lots of tension, both of which can result from mixing immature, misogynistic male-gamers with female counterparts,” the organizers originally wrote in an event FAQ. “Though we’ve done our best to avoid these situations in years past, we’ve certainly had our share of problems. As a result, we no longer allow women to attend this event. This paragraph has since been removed, as the stink over the exclusion went viral, and replaced with: “This event is a ‘gentlemen’s retreat’; as such we do not allow women to attend.” Later, they clarified that with: “We actively discourage gamers from being the kind of mysogynistic jackwagons seen in the Reddit post, and such behavior should not be tolerated. Frankly, we don’t like that kind of player either. So far as this event goes, it is an special event designed specifically for male gamers. Further, it is meant as a getaway designed to help said male contingent become better men both for themselves and for those who love us.” This is a large, private event and its organizers certainly have the right to associate with whomever they please. But given what I usually hear over my headset in military shooters like Battlefield, I wonder if this party would so outwardly ban any black gamers from registering. Because it would be so, you know, uncomfortable to hear them being insulted. Or maybe the answer here is to forbid that kind of obnoxious behavior, and kick out anyone who breaks the rule, $49 registration be damned. Or maybe this event is more about the comfort of the organizers than the participants.
This is not the sort of event I would want to attend anyway, not being big on first person shooter (FPS) style games, let alone playing them with strangers who are known for their propensity to engage in aggressive smack talk throughout the game. That this is the general pattern of conversation for multiplayer FPS games is so well-known it is practically a truism. But as Good suggests above, insults to and about women are not the only kind of prejudice displayed in gamer put-downs. It’s not at all uncommon to hear racism and especially homophobia as well– would the LAN party organizers ban non-whites and/or gays as well, in the name of making those gamers who are allowed to attend “better”? Doesn’t it seem a little odd on its face to keep the assholes and exclude the victims, for the sake of decreasing the levels of general assholery?
The Battlefield 3 party is being organized by Powers Gaming, which is a private organization so of course they get to make their own rules. And I have no doubt that they are genuinely interested in keeping the level of aggressiveness during gameplay itself to a minimum. But their chosen means of doing so amounts to creating a heckler’s veto— an institutionalized means for those who are willing to be obnoxious to penalize those who are not, while escaping any penalty for themselves.
Lesley at Two Whole Cakes sums up what is going on:
Since it’s been picked up by some blogs, the text has been changed to describe the event simply as a “gentleman’s retreat”, with a link to this site, in an effort to either elicit hilarity (that said men are trying to be better people by playing Battlefield 3 together) or to earnestly reframe the male-exclusive space as a positive thing. There is also some weird drama in which possibly-imaginary female attendees describe harassment at prior LAN parties put on by this group that may have never happened. Ultimately, the question of whether women have been egregiously harassed at past events — although it would seem to be implied by the original wording — is irrelevant to this post. All I want to unpack here is the original language in the original pre-drama announcement quoted above, because I think it demonstrates a lot of what is wrong with games culture in an especially clear way. The encoded, indirect message behind that text is this: We don’t want this to be difficult. We just want to play our games and not have to worry about forcing people to behave. We don’t want to think critically about what kind of ground rules would need to be laid down, how we would make them clear, and how we would enforce them, because that seems like a lot of work without any worthwhile payoff. We don’t want to be distracted by having to police our participants. We just want to play some motherfucking Battlefield 3, and have fun doing it. Because dealing with misogyny, racism, homophobia, or any kind of hate speech? It’s just not fun. So in the interest of making this event fun for the men and safe for the women, we’re just going to require that the women stay home. The idea that it is somehow “safer” to make the event male-only is problematic in that it reinforces the assumption that men are feral fucking animals who are incapable of controlling their allegedly natural chromosomal need to be assholes. It presupposes that getting dudes to treat women and other non-dudebro people like human beings is, at best, a huge imposition, or at worst, an impossibility.
Exactly. Yet again, such a characterization is not doing menor women any favors.
I do very much believe that, in addition to simply being regularly exposed to friendly interaction with members of a targeted group, the next best way to eliminate prejudice against that group is peer pressure. As in, having friends who are not members of that group say to you “Hey, that’s not cool. Saying things like that makes you sound like a douche, actually. And I know you’re not one, so cut it out.” But I’m under no illusions that that is at all what this Battlefield 3 “gentleman’s retreat” will be about. It will be, quite naturally, about playing Battlefield 3. And that’s perfectly fine– that’s the reason the event is being held. But it could still be about Battlefield 3 without preemptively excluding the people who are likely to get picked on while the bullies walk right in the door…presumably to conduct all of the bullying they care to do, since the parties most likely to be offended have been eliminated.
Or have they? How cool would it be if a certain number of guy gamers went to the event to stand in for the excluded girl gamers? To apply a little peer pressure, while simultaneously not approving of the chosen format which makes it so much more important for them to fulfill that role?
Maybe I’m dreaming, in that regard. But it would be nice.
I really wish the term “mansplaining” would go away. I understand the problem it’s meant to convey– a man assuming he knows more about something than a woman and condescending to her about it– but it’s an awkward portmanteau and just strikes me as juvenile. Like there’s no way to effectively point out instances of this happening without coming up with a cute name for it. It also makes it sound as if this is something all men do, or that women never do, or that there aren’t other varieties of prejudice and/or privilege-based condescension. And if there are, do they all need clever names too? Richsplaining? Whitesplaining? “Gaysplaining” sounds marginally better aesthetically, but a person who uses it would probably be called homophobic even if using it correctly because gays are not a privileged group.
I like the words “prejudice” and “privilege,” because they’re generally applicable to errors in rationality (the former) and perspective (the latter), and don’t suggest that mistakes about the abilities and values of different groups are all fundamentally different in kind. Sexism already suffers from a good deal of confusion on that matter given that there are entirely legitimate statements that can be made about differences between sexes. The illegitimate ones, however, can come from the same kinds of thought processes that produce any other kind of in-group favoritism and aren’t inherently any better or worse. There are a million different ways to think sloppily, but I think it’s better that the commonality of these varieties of sloppiness be emphasized.
