You can mandate whatever remote attestation you want, and they'll follow whatever security practices they damn well feel like and you can't do a damn thing about it. So, you've given up your ability to run software that doesn't spy on you, and they're operating business as usual because they don't have a single goddamn reason to care what you think remote attestation mean in the real world.
as defined by whom? Some government (which one) organization ?
This will end up making everything more ossified and less secure.
But also once that is in place, various organizations and goverments will be able to force you to use whatever spyware they want, in order for your attestation to go through.
but if I want, I can still create my own arbitrary security requirements and enforce them via software/audits
Try doing that to your bank or whatever other large company you interact with...
You almost certainly use software that calls their server at some point. Hope you will enjoy their vision of security. I'm moving into the woods if they can define how my _personal_ computer behaves.
As defined by the user.
RA doesn't care what software you run. In fact RA is better supported by Linux than any other OS! And, although the discussion in this thread is about RA of entire machines, that's actually pretty old school. Modern RA is all about attesting the tiniest slice of code possible, hence the "enclave" terminology. The surrounding OS and infrastructure doesn't get attested because it can be blinded with encryption. This is beneficial for both sides. I don't actually necessarily care how you configure your OS or even if it's up to date with security patches, if the security model treats the entire OS as an adversary, which is how Intel SGX works. You just attest the code inside the enclave and I send/receive encrypted messages with it.
There's nothing that keeps a medical provider from going old school.
Unless I'm completely overlooking something... It may have snuck in with ACA.
The basic guiding principle in force since HIPAA in 1996 is that patients, not providers, control access to their medical records regardless of whether those are stored on paper or in an EHR. If the patient authorizes sharing those records with another healthcare organization then the provider can charge a small fee for that service but they can't introduce additional spurious technical requirements on the receiving system.