MEDICARE IS BROKE -- LIKE ALL SOCIALIZED MEDICINE SYSTEMS

Because demand is unlimited once you remove from people the restraint of having to pay

The two independent trustees overseeing Social Security and Medicare broke with the Bush administration's trustees yesterday, saying Medicare's financial problems far exceed Social Security's and are in urgent need of attention. Republican Thomas R. Saving and Democrat John L. Palmer said Social Security's condition has changed little since they joined the Social Security and Medicare Boards of Trustees in 2000. But in the trustees' report released yesterday, they wrote that Medicare's prospects have "deteriorated dramatically" with rising medical costs and the addition in 2003 of a prescription drug benefit. "The financial outlook for Social Security has improved marginally since 2000," wrote Saving and Palmer. "In sharp contrast, Medicare's financial outlook has deteriorated dramatically over the past five years and is now much worse that Social Security's."

The three trustees from the Bush Cabinet -- Treasury Secretary John W. Snow, Health and Human Services Secretary Michael O. Leavitt and Labor Secretary Elaine L. Chao -- chose to emphasize Social Security's problems almost exclusively at the report's release. "The numbers leave nothing to doubt about the fundamental condition of the Social Security system," Snow said. "It's on an unsustainable course." "The report speaks for itself," Leavitt said.

Unlike past years, though, neither Saving nor Palmer attended yesterday's report release. Treasury spokesman Robert S. Nichols said any attendees of the trustees' meeting that preceded the release were free to attend the news conference. Saving did attend that meeting. But in an interview, Saving said the public trustees were purposely left out of the presentation. "They didn't particularly invite us," he said. "They're doing it differently, I guess. It's not our call."

The independent trustees are appointed by the president, subject to Senate confirmation, and must come from different parties. Both Saving, from Texas A&M University, and Palmer, from Syracuse University, were appointed by President Bill Clinton. Saving has emerged as a strong supporter of Bush's plan to add private investment accounts to Social Security.

In their closing message last year, Saving and Palmer also emphasized Medicare's problems, but Saving said that this year, he and Palmer wanted to use their final report as trustees to further flesh out the changes they have seen over their tenure on the board. In so doing, they joined a chorus of policymakers worried that the political attention being lavished on Social Security may have found the wrong target. "The question in my mind is why are we talking about saving Social Security?" said Bruce Bartlett, a conservative commentator with the National Center for Policy Analysis.

While Social Security benefits are scheduled to exceed tax revenue by 2017, Medicare's trust fund, which finances hospitalization of the elderly, reached that juncture last year. The trustees project the Social Security trust fund will be exhausted by 2041, one year sooner than projected last year. But Medicare's trust will be depleted more than two decades earlier, in 2020. Last year's report projected the Medicare trust fund exhaustion date to be 2019. By 2024, Medicare's cost will have roared past Social Security's, Saving and Palmer wrote.

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SURPRISE! SURPRISE!

Drug safety experts have long pushed for replacing old-fashioned prescription pads with high-tech drug order entry software. The technology is seen as a key step toward slashing the sky-high rates of drug-related adverse events, which are estimated to kill or harm more than 770,000 Americans every year. But a new study shows that drug-order software can have a surprising dark side, introducing potentially dangerous new sources of doctor error even while it eliminates others. It indicates that introducing computer order entry and other complex software to U.S. hospitals may be more difficult than anyone had imagined.

Researchers at the University of Pennsylvania surveyed 261 interns, residents and other hospital staff who had used an old computer order-entry system at the University of Pennsylvania Hospital between 2002 and 2004. They intended to study how various workplace stresses affected prescribing error rates. To their amazement, the researchers found 22 scenarios in which the computer system itself increased the odds of prescription drug snafus. Many of the doctors surveyed said the problems were common and occurred several times every week.

"The doctors kept on talking about the [order-entry software] itself being a source of errors and stress," recalls sociologist Ross Koppel, lead author of the study, which is published in the Journal of the American Medical Association. "I said, 'No, no, no, this can't possibly be the case, every study shows that it works." But eventually, he had to agree that the residents and interns were right.

One of the big problems with the system was a poor man-machine interface. "The system just didn't make sense in terms of the way doctors actually worked," says Koppel. It made doctors wade through as many as 20 screens to see the list of drugs for a single patient. By the time a doctor got to the right screen to order a drug, the patient's name was sometimes no longer on the screen, making it easy to confuse to whom the order was going.

At other times, the software displayed multiple patient names on a single screen, making it possible to give a drug to the wrong patient, if the doctor was distracted at the moment the order was being finalized. Koppel says he spoke to one doctor who ended up giving a potentially fatal dose of a drug to the wrong patient because of this multiple-name problem. While the patient survived unscathed, the doctor was still shaken by the near-miss two years later.

The University of Pennsylvania study looked only at the downside of the order-entry software: It did not assess whether the software reduced or increased the overall rate of drug adverse events at the hospital. Other studies at Harvard University and elsewhere have found that computer order-entry systems can reduce drug errors by 55% to 80%. The University of Pennsylvania has since replaced the old software in the study with a newer version that it expects will eliminate some of the old problems.

Paradoxically, the study results could actually be good news for makers of order-entry and medical record software. It may mean that hospitals will have to spend more money over a longer period of time than they ever imagined to optimize order-entry software so that it meshes well with hospitals' intricate and fast-paced workflow. Currently only about 6% to 10% of U.S. hospitals have computer order entry, but the Bush Administration is pushing hard to increase their numbers.

Numerous companies are racing to sell order-entry, electronic medical records programs or other software systems aimed at boosting patient safety. Among others, they include General Electric, Cerner, Eclipsys, McKesson and Siemens.

No one is saying that hospitals should abandon computer order-entry, but just that more care needs to be taken in how it is implemented. "The lesson is to realize software is just a tool" not an end in itself, says Dr. David Bates, a patient safety expert at Harvard's Brigham & Women's Hospital. "Any time you introduce a new process, you have to troubleshoot it. They didn't do as good a job of doing that here." Adds Oregon Health Sciences University's Joan Ash: "There are unintended consequences" for every new software system. She says hospitals need to spend more time researching workflow to reduce the error rate and make computer systems that work better.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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