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Congress is quietly passing laws that may lead to the adoption Of a universal personal-ID system that would allow the Government to track almost every aspect of American lives.

A stealth poison was added to the 1996 Kennedy-Kassebaum health-care bill that allows workers to carry their health insurance with them when they leave a job. The amendment requires that a "unique health-identifier" number be assigned to every American, whether they have public or private health-care insurance, and that has created a fury among privacy advocates (see Symposium, p. 24). This code eventually is to be used in a data bank that tracks an individual's medical history from cradle to grave. But already there is concern that law-enforcement officials may be able to gain access to the database without so much as a court order.

"Patients have the fear that they will have the equivalent of a bar code stamped on their forehead," says Donald J. Palmisano, a Louisiana surgeon who is an expert on privacy issues for the American Medical Association, or AMA.

The amendment was tacked on to the Kennedy-Kassebaum bill by Ohio Republican Rep. David Hobson. He says he hoped to help simplify and modernize the way medical bills are paid. According to the Center for Public Integrity, or CPI, the measure was written by a coalition of private interests ranging from the American Health Information Management Association to IBM. During the time the amendment was being offered as a rider to the bill, two of Kassebaum's staffers were being considered for jobs in the health industry. And Hobson himself received $28,000 for his 1996 campaign from health, insurance and information interests that favored the legislation, with the American Hospital Association providing the most. Since 1987, according to CPI, Hobson has received more than $65,000 from the antiprivacy lobby.

"What is disturbing to me in this town is the deceit and denial that money doesn't affect policy," CPI Executive Director Charles Lewis said upon release of the CPI study Nothing Sacred: The Politics of Privacy.

The proponents of medical identifiers explain that there are other benefits besides simplifying billing procedures, such as eliminating the red tape associated with keeping and obtaining the old records. They say establishing a national-disease database would offer greater research opportunities and more efficiently identify oncoming epidemics. They say the number will not end up in a central database. But Palmisano points out that the law itself allows for health plans to send information to a central clearinghouse for processing. Other privacy watchers have likened the identifier to the Social Security number, which currently is linked to credit reports and financial records.

Palmisano says the AMA doesn't see why an identifier is necessary, and he argues it even may be detrimental to patient health. "The patient will be reluctant to tell me all the information I need to make a diagnosis. Sometimes the information is embarrassing. So the patient decides not to go to the doctor because he or she is afraid of a breach of confidentiality--an employer may discriminate or an insurance company with no right to the information will use" it to stop future coverage, he says.

Legislative efforts to provide medical privacy in the face of such threats nonetheless have languished on Capitol Hill. According to Lewis, the lawmakers' financial support from major medical interests has been very helpful in persuading Congress to ignore the issue. "Since 1987, hospitals, insurance companies and members of trade associations that oppose such protections have poured more than $45.6 million into congressional campaigns."

The inaction on the medical-privacy front is merely a snapshot of the larger picture of privacy loss, say critics. Lewis says Congress has killed legislation that would have protected workers from invasive work-site videos and wiretapping, insurance regulations that would have prevented companies from releasing information about policy-holder claims and a bill that would have restricted companies from developing information about children without parental consent. Meanwhile, a series of antiprivacy bills moving toward a single national ID and creating a number of national databases were passed in 1996.

"Congress seems to have the notion that any social problem can be solved by collecting a lot of data on people," Bob Smith of Privacy Journal tells Insight.

According to research conducted at Harvard Law School by research fellow Richard Sobel, five government data banks related to identification documents have been created in recent legislation or by executive action. Sobel says the converging databases "are all leading in the direction of a national identity document. Identity documents are not handed out simply. They depend upon the creation of large data banks and identification numbers, and this creates a very large apparatus that interferes with the idea that people have rights as citizens that should not depend upon documents or numbers."

Two years ago, Congress passed the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, which mandates that by the millennium all driver's licenses must bear personal Social Security numbers. The driver's license and birth certificate will be used to validate identity. The card will be proof of citizenship and right to employment. The Social Security Administration and the Immigration and Naturalization Service will have access to this data.

The Welfare Act and the Welfare Reform Act, both passed in 1996, push the envelope further. The first establishes data bank requirements for Social Security numbers for commercial driver's licenses, welfare benefits, professional and occupational licenses, marriage licenses, divorce proceedings and child-support determinations, according to the Privacy Journal. The other data bank sets up the National Directory of New Hires, a worker registry, and ties it to the Federal Parent Locator Service to hunt down deadbeat parents. All workers hired after October of last year will have their name, Social Security number and wages registered here. In some states, addresses, phone numbers, birth dates and driver's-license numbers may be included. According to the Harvard project the agencies with access to this data include welfare agencies, the Social Security Administration, the IRS and the Justice Department.

"There are a lot of practical problems with each of these data banks, but the health-care and ID number are clearest," Sobel says. "They are basically conduits for the most confidential and private information shared with your doctor in the goal of good health that potentially become data points for building big data bank systems doing health research without informed consent and potentially being used for law-enforcement purposes without any procedural safeguards." Whether law-enforcement and intelligence agencies will have access to this information still is under debate.

Finally, the Computer Assisted Passenger Screening System, or CAPS, which Insight described last year, is going full swing at local airports (see "Snooping on Passengers Under FAA's Watchful Eye," March 31, 1997). The FAA set up this database security system to protect against terrorism; however, in so doing, they have developed a profile of every passenger that includes their travel patterns. Smith says that CAPS may make people feel safer, but there is no way to ensure a terrorist will not use a counterfeit ID to put a suitcase bomb on a plane and leave the airport. "To secure an airplane you have to search luggage and the airlines don't want to do that" he adds. The American Civil Liberties Union, or ACLU, and other groups worried about discrimination have voiced concern to the government. Sobel says that it is a further infringement of citizen rights to have to show a government-issued photo ID before being allowed on the plane.

"Congress is very quietly, without the realization of the American people, creating an ID document that will be required to enter any federal building, drive an automobile, board an airplane and take a tax deduction for children, get a job, qualify for federal benefits and to get health care even if you pay for it yourself," Smith says. "Congress in 1996 really did put the nails in the coffin for those that think a national ID card is a bad idea."

Meanwhile, a practice called data mining potentially could rock national database systems, Smith says. Data mining allows users to search thousands of computers using names, addresses, Social Security numbers or characteristics of certain people, and then download the matching files. The threat of data mining coupled with the recent success of hackers breaking into the Pentagon computers conjures a grim vision of the future among privacy advocates.