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I See Dead People…

On June 11, the Washington Post's "Wonkblog" ran an online article about The Social Security Administration (SSA) mistakenly declaring about 12,000 U.S. citizens dead every year (cue photo of zombies). In it, the blogger Ana Swanson notes:

By entering one number into the system incorrectly, a Social Security employee can bring your whole world crashing down, as the blog Priceonomics writes in a new post on the subject. People who have been mistakenly declared dead may be unable to apply for jobs, access bank accounts or credit cards, or rent or buy new homes. Their disability, Medicare or Medicaid benefits may cease. Their pension plan and insurance may be terminated. They may be left without access to housing and the medications they need. They basically can end up like Tom Hanks in "The Terminal," wandering around in terrible liminal state of boredom and frustration, except without Catherine Zeta Jones for company. And they and their family members must jump through a series of bureaucratic hoops to prove that they are still alive.

Swanson in her concluding paragraph notes the important role of the 57 vital jurisdictions (50 states, five territories, District of Columbia, and New York City) as the legal stewards of vital records on births and deaths, as well as their responsibility in providing timely death information to the SSA (and other public and private sector users) to help prevent waste, fraud and abuse:

There are some simple bureaucratic things that might be able to be done to help fix these problems. As of March, 37 states and the District of Columbia reported deaths to the administration electronically, which greatly increases the speed and accuracy of death reports. By implementing electronic reporting across the U.S., the states could almost totally eliminate the twin catastrophes of declaring the dead living and the living dead.

As the legal stewards of vital records on births and deaths, jurisdictions are the only complete and accurate source of this information. Indeed, state data are the gold standard.

NAPHSIS members – the state vital records offices (VRO) - are making rapid progress in modernizing systems to transmit data to SSA even faster. To date, there are now 45 (not 37, as reported) jurisdictions registering deaths electronically, with four states currently in development and just three that have not yet started their planning.

But even in states with electronic systems, some reports from funeral directors and medical certifiers are still provided to VROs on paper. That means no automatic quality controls and cross-checks up front, and slower reporting of those deaths to SSA. The more fully electronic death reports that go to SSA, the less SSA will have to rely on unofficial and less reliable reports from family members and others. As Swanson's blog notes, it's through these unofficial reports that the living may be mistaken for the dead, and then spend too much time and money trying to prove themselves otherwise.

States can't do this alone. They need additional resources to build a 21st century vital statistics system. The president has requested that Congress provide $5 million to the National Center for Health Statistics (NCHS) to help the states implement Electronic Death Registration Systems (EDRS) - mere budget dust by federal standards considering the billions of dollars in savings we stand to gain. House appropriators have granted this funding request, while Senate counterparts have directed NCHS to make EDRS implementation a priority, while providing the agency $10 million less than current levels. More on the funding environment in my next blog…

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