Medicare's Big Database

By April, the federal government plans to put all "pertinent" information about Medicare users onto one central computer. This giant database would bring more efficiency and better service to the nation's largest healthcare program.

But it could also come with a loss of privacy and potential abuse of private health information.

Supporters of the plan say a one-stop computer for Medicare would be easier to secure than the present use of many smaller databases. That point may be true, but the public needs reassurance that the proposed massive, centralized accumulation of information won't be vulnerable to massive (or even minor) misuse.

Currently, health records are first entered on Medicare computers after an individual applies for Social Security benefits. (With few exceptions, applicants who reject enrollment in Medicare must forgo Social Security benefits.) Under federal privacy rules, such data can be sent across the Internet, and be open to untold numbers of government workers and others allowed access by law. Police officers, for example, can have access without a court subpoena. So can the Food and Drug Administration, and even independent researchers.

The new system needs a corresponding tightening of security. And Medicare users should have greater control over what's on the database. Equal emphasis on efficiency and privacy is needed.