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"But is the electronic linkage always unidirectional? Is it merely from the federal government to the state, and then to providers?"

More likely, it will increasingly move to drug manufacturers, and those who make durable medical equipment, magnifying a problem that has existed for quite some time now.

What else would explain the reason why I get mail and email from drug manufacturers, or pop up ads on internet pages touting their medication, which (amazingly enough) treat my medical conditions?

Bob, I don't doubt that the drug companies might be gaining access to these records. But it is clear that the political class and the donor class wants these records in their own possession, and also in the possession of insurers and managed care companies and Accountable Care Organizations and hospital systems and any other entities that stand to benefit from slicing and dicing data. Meanwhile, patient confidentiality and medical privacy are a thing of the past. And folks' medical histories will potentially be used against them in various ways-- by government, by employers and perhaps by others.

There is a major issue with this entire design from the standpoint of personal liberty.

And yes, this is also a major issue of medical privacy for veterans and those receiving medical care under the military system.

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