September 19, 1997

Dr. Don Detmer
Chairman, National Committee
on Vital and Health Statistics
Department of Health and Human Services
Washington, DC

Dear Don:

The National Committee on Vital and Health Statistics recently approved a letter on the issue of a unique health identifier for individuals. We were unable to support the Committee's recommendations, and we wanted to state our objections clearly for the record.

First, the NCVHS letter supports the adoption and implementation of a unique health identifier for individuals. We believe that it is too early to reach that conclusion. Changes in the law or developments in technology could produce alternatives to an individual health identifier. We should only make a decision to have an identifier when we are ready to adopt one, and the Committee is clearly not ready to do so right now.

Second, we cannot support the adoption of the American Society for Testing and Materials criteria as a basis for selecting a health identifier. While the ASTM criteria were developed through an open process, there are many interest groups that did not participate in that process. Many of those outside the health industry -- including privacy and patient advocacy groups -- were not aware or were not able to be involved. While no criticism of ASTM is intended here, it is nevertheless true that if their work is to serve as the basis for making a major national decision that will affect every individual in the United States, a broader public debate about the criteria is essential.

In addition, the ASTM criteria are not complete or unambiguous. They include no clear method of evaluating identifier proposals under each of the criterion. Too much subjectivity is required. In addition, the criteria include no uniform way to weight the many different factors identified. As a result, the application of the criteria by different individuals could easily result in widely divergent assessment. In other words, the ASTM criteria in their present form will not provide a basis for objective judgments.

Third, adoption of a universal health identifier for individuals will have broad consequences for healthcare and privacy policy in the United States. Public and congressional concern about identification numbers and about privacy is at an all time high. Any decision about a new number should be made directly by the Congress. This is not a issue to be decided administratively on technical or economic grounds alone. It is a political choice that should be made only by elected representatives in a public fashion.

We do not disagree with everything in the NCVHS letter. We agree that the passage of comprehensive federal privacy legislation is an essential prerequisite to any decision on a universal health identifier for individuals. We would, however, defer all decisions about the identifier until that legislation is enacted. We also agree with the call for a cost-benefit evaluation and for more public hearings.

Sincerely,