Coming Soon. . .
Every American Will Be Assigned
a"Unique Health Identifier"
Did you know that by law, the U.S. Department of Health
and Human Services (HHS) must assign each American a
"unique health identifier" (an electronic patient ID
number) to tag and track his or her electronic medical
Not many people are aware of this soon-to-be-enacted
plan. The media are busy reporting that the Clinton
administration is going to protect people's electronic
medical records. Yet the proposed protections are simply
a way to lull the American public into a false sense
How did this all come about? How will the unique health
identifier be assigned? What is being done to stop this
policy from moving forward?
Genesis of the "Unique Health Identifier"
The unique health identifier was part of the Clinton administration's
proposed Health Security Act in 1993. Clearly, you can't
create a centralized health care system without standardized
data in a central database. The Clinton health plan never
But three years later a similar provision was inserted
into the bipartisan Health Insurance Portability and
Accountability Act of 1996 (HIPAA), which was signed
into law in August 1996. HIPAA stipulates that "The Secretary [of Health and
Human Services] shall adopt standards providing for
a standard unique health identifier for each individual,
employer, health plan and health care provider for use
in the health care system." That provision is to take
effect by February 2000. But the rules for creating
the identifier have not been presented to the public.
Who Is Behind the Unique Health Identifier?
Both government and private groups have been pushing for
the standardization of medical care and patient records. According to a 1998 report titled "Nothing Sacred: The Politics of Privacy" (published by the Center
for Public Integrity),
the legislation to assign everyone a "unique personal
identifier" was written by a coalition of health care
groups, including insurers, hospitals, and providers.
Their purported goals are to simplify administrative
transactions, conduct medical research, monitor child
abuse, track contagious disease outbreaks, and improve
many other functions in the health care system. Who
could argue with those laudable goals?
How Will the Unique Health Identifier Work?
In a 2001 Cato Institute paper titled "Watching You: Systematic Federal
Surveillance of Ordinary Americans," Professor Charlotte Twight of Boise State University explains
that "On July 2, 1998, HHS released its lengthy White Paper entitled
`Unique Health Identifier for Individuals.' In this chilling document HHS calmly discussed exactly
what Orwellian form the `unique health identifier' would take and what degree of encroachment on individual privacy
would be compelled."
Twight notes that the federal government will assign
every newborn a birth certificate number, a Social Security
number, and a health identifier. Six alternatives for
the identifier are being considered:
- Social Security numbers,
- Biometric identifiers,
- Directory service,
- Personal immutable properties,
- Patient identification system based on existing
medical record number and practitioner prefix; and
- Public key/private key cryptography method. (To
view the White Paper, see the following Web site:
While all these systems would require centralization
of individually identifiable health information, the
most striking is the proposal to use biometric identifiers.
Twight reports that "The HHS White Paper describes biometric
identifiers as `based on unique physical attributes,
including fingerprints, retinal pattern analysis, iris
scan, voice pattern identification, and DNA analysis.'"
The public won't know which system will be used until
HHS publishes its proposed rule for unique identifiers.
Centralized Data is Centralized Power
"The issue is not just privacy; it is government power,"
writes Twight. She quotes Dr. Richard Sobel of Harvard
Law School, who notes that: "What ID numbers do is centralize
power, and in a time when knowledge is power, then centralized
information is centralized power. I think people have
a gut sense that this is not a good idea."
Who Can Stop the Unique Health Identifier?
Professor Twight points out that "absent congressional
reversal of the underlying statutory mandate the die is
largely cast." Congress has placed a temporary moratorium
on federal spending for unique health identifiers, but
that won't stop them from being created. To do that, Congress
would have to repeal the section of HIPAA that created
unique health identifiers. Representative Ron Paul (R-TX)
has introduced legislation (H.R. 220) that would do just
Those who care about their medical privacy should
voice their own opinions soon!
This article was originally published in the November/December
1999 issue of Health
This page/links were modified/updated May 21, 2009.