Date:       Wed, 06 Oct 93 16:59:27 EST
Errors-To:  Comp-privacy Error Handler <comp-privacy-request@PICA.ARMY.MIL>
From:       Computer Privacy Digest Moderator  <comp-privacy@PICA.ARMY.MIL>
To:         Comp-privacy@PICA.ARMY.MIL
Subject:    Computer Privacy Digest V3#053

Computer Privacy Digest Wed, 06 Oct 93              Volume 3 : Issue: 053

Today's Topics:				Moderator: Dennis G. Rears

                      Re: Clinton Health Care Plan

   The Computer Privacy Digest is a forum for discussion on the
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Date: Tue, 5 Oct 93 15:48:43 EDT
Organization: National Institute of Standards and Technology (NIST)
From: "Dennis D. Steinauer" <dds@csmes.ncsl.nist.gov>
Subject: Re: Clinton Health Care Plan

Bill Murray writes:
 >> 
 >> The bureaucrats response of choice in this situation will be a personal
 >> identity number and a massive data base.  This data base will contain
 >> our most intimate personal information.  It will be in the
 >> hands of government bureaucrats.  If bureaucrats simply do what
 >> bureaucrats do, these tools will result in huge loss of personal and
 >> family privacy.  While safeguards, may mitigate this to some small
 >> degree, and whether or not there is abuse, the impact will be major. 
 >> 
 >> This is a natural and unavoidable cost of this program.  Before we adopt
 >> this proposal, we should understand this cost which we cannot avoid.

I think it would be best not to be ratcheting up the sound level on the
debate until more facts and details are on the table.  I don't believe there
has been anyone familiar with the president's plan who has said anything
about a "massive database"  with "our most intimate personal information ...
in the hands of government bureaucrats"  -- nor do I believe that one has to
assume that such is implicit in any of the plan's elements.  In fact, the
president's reform plan retains a great deal of decentralization in order to
foster information technology innovation.

Nowhere does the president's plan dicate a monolithic approach to the use of
information technology.  Rather, it focuses on a rational and (much) less
fragemented approach that has been the case to date.  It focuses on data and
system interoperability standards and encouraging technical innovation.
It recognizes the need for information technology to address problems both in
administrative processes (read "claims processing") and ultimately in
clinical automation. The healthcare industry itself has recognized the
critical need for leadership in providing standards (including privacy and
security standards).

To the extent that personal information is maintained in "the system" -- and
it certainly will be -- the president's plan calls for clear, national
privacy rights and standards of protection.  It occurs to me that this is
certainly better than the current situation, which has resulted in a
patchwork of state legislation and, in effect, less assurance of medical
privacy than one has over ones video rentals.  (And, frankly, I think I
probably have a better chance of controlling my privacy rights with
"government bureaucrats" than I do private organizations such as "medical
information bureaus".)  Does anyone seriously think he as acceptible privacy
of his or her medical information now?

It seems to me that the president's reform proposal offers an outstanding
opportunity to IMPROVE the state of privacy and security -- not the opposite
as some people have suggested.  As with other aspects of the current
healthcare system, the worst thing we could do is nothing.

Dennis D. Steinauer
National Institute of Standards and Technology
A-216 Technology
Gaithersburg, MD 20899 USA
DSteinauer@nist.gov

BTW --  The "Card" isn't likely to be a smartcard, massive memory card, or
other such thing -- at least not for a long time.  Indeed, it probably won't
even be the SAME card in all ares.  The president's plan, in line with the
approach of encouraging technical innovation, initially calls for a minimal
machine readability capability (read "mag strip").  


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End of Computer Privacy Digest V3 #053
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