Behind that supposedly secure lock is an electronic national data collection of Americans' personal medical records, resulting from a presidential order imposing a complex web of misnamed "privacy" regulations.
After wasting two or three years trying in vain to sell Congress and the American people on such a Unique Personal Identifier (UPI) key, proponents of socialized medicine came to the realization that a key with no lock to turn is a key of no value to them.
They reversed their strategy, going for the lock before the key.
And they found the pathway to that lock – a federally controlled national health system – in the unlikely format of a purported "privacy protection" rule originated by the outgoing president, Bill Clinton, and now embraced by his successor, George W. Bush.
Critics concerned with preventing the federal government from gaining greater access to, and thus control over, the private personal medical records of all Americans charge that the Clinton-Bush regulation is actually an "anti-privacy" rule in "privacy" clothing.
Civil libertarians have long focused their attention on the Big Brother attributes of a UPI – a federally assigned personal electronic identifier by which everyone would be tracked from even before birth and after death.
Growing acceptance of DNA coding, along with fingerprints, voice prints and retina images, to identify suspected criminals are natural corollaries to a universal electronic UPI.
Once every last American is dog-tagged with a unique alphanumerical code designed never to be replicated for anyone else, the permutations are endless for its use, and abuse, in revealing all manner of personal information.
Americans who have gone through the agonizing and expensive tribulations of discovering their Social Security number stolen and put to nefarious uses by identity thieves are particularly tender on that subject.
Privacy advocates raised such a ruckus about the dangers inherent in a UPI that they succeeded three years ago in killing it in Congress – but only for the moment.
Although technically laid to rest, the UPI is almost certain to be trotted out again – by virtue of Clinton's on-the-surface innocuous medical-records "privacy" rule that on April 14 was given, word for word, the status of law by President Bush.
Here's the background:
In enacting Title II, Subtitle F, Section 261-264 of Public Law 104-191, the Health Insurance Portability Act of 1996 (HIPAA), Congress called for steps to improve "the efficiency and effectiveness of the health-care system by encouraging the development of a health-information system through the establishment of standards and requirements for the electronic transmission of certain information."
On the eighth page of the lengthy Prelude to the Clinton-Bush rule, where its purposes are spelled out, it states:
"To achieve that end, Congress required the Department [of Health and Human Services] to promulgate a set of interlocking regulations establishing standards and protections for health-information systems."
As a result, HHS proposed in May and June of 1998 a "rule establishing a unique identifier for employers to use in electronic health-care transactions" and for "providers of such transactions."
But those proposed rules creating a UPI, offered by the Clinton-Gore administration midway in its second term, bit the dust in Congress in 1998.
The Prelude to the 2001 rule states flatly, "This regulation does not create an identifier."
However, some privacy advocates would argue it makes the creation of a UPI inescapable.
The Prelude goes on to say:
"Because of the public concerns about such an identifier, in the summer of 1998 Vice President Gore announced that the administration would not promulgate such a regulation until comprehensive medical-privacy protections were in place."
Such "comprehensive medical-privacy protections" have now been not only promulgated by the outgoing Clinton-Gore administration but also adopted by the Bush-Cheney administration.
Based on Gore's 1998 assurances, had he become president it would now be time for his administration to try to put a UPI into effect by regulation.
Two events got in the way of that.
One was that Bush, not Al Gore, was elected president in 2000.
The other is that, as the Prelude to the Clinton-Bush rule notes, in 1998 "Congress prohibited (HHS) from promulgating such an identifier, and that prohibition remains in place.
"The department has no plans to promulgate a unique health identifier."
But that was a reference to the department under the Clinton-Gore administration – and before "privacy protection" became law by Bush's executive order.
The question that haunts opponents of a UPI is whether the Bush-Cheney administration – after having adopted the Clinton-Gore medical-records "privacy" rule – will now do what Gore could well have been expected to do had he become president.
As Gore recognized back in 1998, once a complex set of medical-records "privacy" regulations is in place – as it is now – the inevitable pressures for a UPI will begin to mount.
The argument used then by UPI advocates will doubtless be used again by them now: What use is a national medical-records data base if it cannot be accessed by computer?
And the key to unlocking all that private data is a UPI.
Thus, the imposition of a medical-records "privacy" rule, which has the effect of generating nationwide interconnected computerized personal health files, becomes the locked data base that only a Unique Personal Identifier can open and sort through.
This latest rule gives a federal agency the authority to develop whatever electronic means are necessary to gain access to all that private information.
The Unique Personal Identifier has never died. It's just been in repose, waiting to be called into service of the architects of American socialized medicine.
For that, they can thank Bill Clinton's artful camouflage of "privacy protection" and George W. Bush's executive implementation order.
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