How are we supposed to trust the government with medical records?

[Romulus Quirinus]

13. Because one's potential status as an enemy of the state isn't encoded in our entrails?

I had thought we had a fairly fruitful discussion about this.

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Say I was a gay man who had not revealed this to his conservative employers, and I have made myself known to President Santorum due to being a nuisance at a public event. He tells his spooks to look in my NHS record and find some dirt. Lo and behold, he finds I have a chronic HIV infection and have reported a homosexual relationship to my doctor. He could then hold this over my head as blackmail or release it to the regular suspects in the right-o-sphere and attempt to smear me (assuming this is still an effective tactic 10 years from now).

However, to do so, he would have to break the law (HIPAA, in this case).

Similarly, he would have to break the law to extract my closet-skeletons via the FBI/NSA route, as you and others have outlined previously. This, if I understand correctly, is the heart of your comparison.

However, there is a difference in the threat level.

1) Abuses of an NHS would be easier to audit and reveal, since there should be no security clearances attached to the operations of such a system, outside of HIPAA-style privacy protections.

2) FBI/NSA style intelligence gathering is much more opaque, concealed with several levels of security and having a very low audit rate. Also, it can gather much more than my medical history. It can potentially know my entire social network (if I'm not cautious or technology aware) as well as the contents of all my electronic communications. Breaching the NHS database is a violation, to be sure, but that data is a small subset of what can be found using intelligence systems, and I have no way to protect myself because I have no way of knowing how they got that information.

Moreover, the good yielded by an NHS would heavily outweigh the risk, based on examining the dozens of diverse implementations the world over, whereas we have no proof of efficacy with respect to intelligence gathering systems.

Thus, I think the argument can be made that supporting an NHS would not conflict with the goal of restraining in law our electronic eavesdropping capabilities.