Medicare and Social Security have long been considered “the third rail of politics.” Politicians who even suggest they might change these entitlement programs do so at their own peril. Everyone can still remember when the Democrats claimed Paul Ryan, the Republican Speaker of the House, was portrayed as “throwing Grandma off the cliff” in a widely seen ObamaCare political advertisement in 2012.

Even today, when Medicare and Social Security are badly in need of changes to remain fiscally viable for the future, both parties are reluctant to talk about any change. Yet President Biden is making changes he hopes no one will notice.

The editorial board of The Wall Street Journal, however, noticed. They say, “President Biden keeps accusing Republicans of trying to gut Medicare. No doubt he hopes seniors don’t notice that his Administration recently cut payments to Medicare Advantage plans, which will lead to higher patient costs and reduced benefits.”

They explain that about half of seniors are enrolled in Medicare Advantage plans, which are administered by private insurers with government funding. These plans have been increasing in popularity, especially among lower-income Americans, because they offer additional benefits such as dental and vision care. Out-of-pocket costs tend to be lower than in traditional fee-for-service Medicare.

Critics of Medicare Advantage say insurers sometimes put up bureaucratic hurdles to covering needed treatments and procedures, which is true. But they also prevent unnecessary care, which is rife in traditional Medicare. Insurers also do a better job of coordinating care and keeping patients out of the hospital. If seniors disliked the program, it wouldn’t be growing.

Enter the Biden Administration, which is trying to limit the program’s growth by squeezing insurers. Progressives oppose Medicare Advantage because they dislike private market competition and want the government to control all of healthcare. The Administration last year restricted plan marketing and cut payments to insurers on average by 1.1%.

Now the Centers for Medicare and Medicaid Services is clipping insurer base payments by another 0.16%, which will take effect next year. The cut comes as insurers report increasing utilization among seniors owing to delayed pandemic care. Providers are also seeking higher reimbursements from insurers to offset rising overhead and labor costs.

Berkeley Research Group projects Medicare Advantage medical costs will climb by 4% to 6% next year. In response to last year’s payment cut, many plans increased patient co-pays and premiums, reduced benefits like vision and dental care, and tightened provider networks. More will have to do so next year.

Medicare Advantage plans send notices of annual plan changes in the autumn—a few weeks before the November election. Seniors may be in for a rude cost and benefit shock when they try to renew. If seniors like their doctor, they might not be able to keep her.

Perhaps election considerations explain why a bipartisan group of 61 Senators, including Majority Leader Chuck Schumer, urged CMS in a January letter to “ensure payment and policy stability for the Medicare Advantage program,” adding that seniors must “have stable access to the extra benefits and out-of-pocket protections only available in Medicare Advantage.” But it seems the White House isn’t listening.

The WSJ editors ask, “Will Mr. Schumer now protest the Administration’s cut to drive more seniors out of private plans? By the way, CMS is also cutting physician payments in traditional Medicare to control its ballooning costs. The predictable result will be more provider consolidation, less healthcare competition, and a shift in costs to privately insured Americans.”

It’s time for politicians of both parties to come clean to the American people.

If you’re not comatose, you’ve probably noticed that most young people spend much of their time with their noses buried in their cell phones. Go to any restaurant in your area and spend a moment observing families not speaking to one another because the children, and sometimes the parents, are looking at their cell phones rather than having a conversation. We’ve become accustomed to this behavior, but in our hearts we know it’s wrong.

Now someone has finally come out and told us what we know is true. Peggy Noonan, writing for The Wall Street Journal, tells us about a new book by Jonathan Haidt called The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness. Noonan says Haidt’s book has broken through and is clearing the way for parents’ groups and individuals to move forward together on an established idea – doing something about this widespread problem. Mr. Haidt is a widely admired social psychologist who teaches at New York University’s Stern School of Business. He has spent his career studying emotion, culture and morality, turning along the way to child development and adolescent mental health.

Noonan says, “What we all know is that there’s a mental-health crisis among the young, that they seem to have become addicted to social media and gaming, and that these two facts seem obviously connected. Mr. Haidt says, and shows, that the latter is a cause of the former.”

He tells the story of what happened to Generation Z, which he defines as those born after 1995. (They followed the millennials, born 1981-95.) Older members of Gen Z entered puberty while four technological trends were converging. One was the arrival of the iPhone in 2007, another the continuing spread of broadband internet. The third, starting in 2009, was “the new age of hyper-viralized social media,” with likes, retweets and shares. In 2010 came the front-facing camera on smartphones, which “greatly expanded the number of adolescents posting carefully curated photos and videos of their lives for their peers and strangers not just to see, but to judge.” This became “the first generation in history to go through puberty with a portal in their pockets that called them away from the people nearby and into an alternative universe that was exciting, addictive, unstable and . . . unsuitable for children and adolescents.”

Pew Research reports that, in 2011, 23% of teens had a smartphone. That meant they had only limited access to social media—they had to use the family computer. By 2016 one survey showed 79% of teens owned a smartphone, as did 28% of children 8 to 12. Soon teens were reporting they spent an average of almost seven hours a day on screens. “One out of every four teens said that they were online ‘almost constantly,’” Mr. Haidt writes. Girls moved their social lives onto social media. Boys burrowed into immersive video games, Reddit, YouTube and pornography.

The tidal wave came to these children during puberty, when the human brain is experiencing its greatest reconfiguring since early childhood. In puberty, as brain researchers say, “neurons that fire together, wire together.” What you do at that time “will cause lasting structural changes in the brain,” Mr. Haidt writes. Suddenly children “spent far less time playing with, talking to, touching or even making eye contact with their friends and families.” They withdrew from “embodied social behaviors” essential for successful human development. It left them not noticing the world.

You don’t have to be a doctor to understand all this leads to mental illness. Rates of mental illness among the young went up dramatically in many Western countries between 2010 and 2015. Between 2010 and 2024 major depression among teens went up 145% among girls, 161% among boys. There was a rise in disorders related to anxiety as well. Haidt says “The rate of self-harm for. . . young adolescent girls nearly tripled from 2010 to 2020.”

Naturally, parents had to make choices about how to respond to this situation. Haidt says parents over the past few decades made two big choices about how to keep children safe, and both were wrong. “We decided the real world was so full of dangers that children should not be allowed to explore it without adult supervision, even though the risks to children from crime, violence, drunk drivers, and most other sources have dropped steeply since the 1990s. At the same time, it seemed like too much of a bother to design and require age-appropriate guardrails for kids online, so we left children free to wander through the Wild West of the virtual world, where threats to children abounded.”

Mr. Haidt suggests four reforms:

• No smartphones before high school, only basic phones with no internet capability.
• No social media before 16. Let their brains develop first.
• All schools from elementary through high school should be phone-free zones—students can store their devices in lockers.
• Bring back unsupervised play. Only in that way will kids naturally develop social skills and become self-governing.

Florida Governor Ron DeSantis is already taking action along these lines to address this problem. On March 25^th he signed new legislation which prohibits children under the age of 14 from becoming social media account holders and allows 14 and 15-year-olds to become account holders with parental consent. “Social media harms children in a variety of ways,” said the governor. “HB 3 gives parents a greater ability to protect their children.”

Who is to blame for this situation?

Near the end of the book, Haidt quotes Sean Parker, the first president of Facebook, on the inner thinking of the Silicon Valley pioneers who created this new world. In a 2017 interview Mr. Parker said they wished to “consume as much of your time and conscious attention as possible.” The “social validation feedback loop” they created exploits “a vulnerability in human psychology.” The apps need to “give you a little dopamine hit every once in a while, because someone liked or commented on a photo or a post or whatever. And that’s going to get you to contribute more content, and that’s going to get you . . . more likes and comments.” He said that he, Mark Zuckerberg and Kevin Systrom, a co-founder of Instagram, “understood this consciously. And we did it anyway.” He added: “God only knows what it’s doing to our children’s brains.” Now we all know.

“The chatbot will see you now.” When the nurse tells you that as you sit in the doctor’s waiting room, perhaps it’s time for you to run.

Artificial intelligence is getting lots of attention lately in many walks of life. It may be useful in writing term papers and preparing speeches. It may be helpful in designing new cars and other forms of mechanical equipment. But I’m not sure it’s ready to replace your doctor.

A recent study was reported at the American Academy of Orthopedic Surgeons meeting in San Francisco by Branden Rafael Sosa and colleagues at the Weill Cornell Medical School. They analyzed the validity and accuracy of the information for orthopedic procedures that large language model chatbots provided to patients. They also assess how the chatbots explained basic orthopedic concepts, integrated clinical information into decision-making and addressed patient queries.

They concluded that large language model chatbots may provide misinformation and inaccurate musculoskeletal health information to patients.

In the study, Sosa and colleagues prompted OpenAI ChatGPT 4.0, Google Bard and BingAI chatbots to each answer 45 orthopedic-related questions in the categories of “bone physiology,” “referring physician” and “patient query.” Two independent, masked reviewers scored responses on a scale of zero to four, assessing accuracy, completeness, and useability.

Researchers analyzed the responses for strengths and limitations within categories and among the chatbots. They found that when prompted with orthopedic questions, OpenAI ChatGPT, Google Bard and BingAI provided correct answers that covered the most critical points in 77%, 33% and 17% of queries, respectively. When providing clinical management suggestions, all chatbots displayed significant limitations by deviating from the standard of care and omitting critical steps in workup, such as ordering antibiotics before cultures or neglecting to include key studies in diagnostic workup.

“I think clinical context is one of the things that they struggled with most and particularly when coming up with an assessment or a plan for a patient who presents with infection. Oftentimes, they forgot to get cultures before initiating antibiotics, forgetting to order radiographs and the workup of a patient with hip osteoarthritis, or to the point of seminal papers that highlight changes in the way that treatment is delivered,” Sosa told Healio/Orthopedics Today.

“I would say that in certain applications, AI chatbots, in particular ChatGPT, performed pretty well. It was able to give clinically useful information in the majority of cases, broadly speaking. But that generally good performance carries with it some significant risks as well,” said Matthew B. Greenblatt, M.D., PhD, an associate professor of pathology and laboratory medicine, Weill Cornell Medicine, and co-author of the study.

Greenblatt said results of this study highlight the importance of oversight by subject matter experts in using large language model chatbots in clinical contexts. “It could potentially be a timesaver or helpful in summarizing information. When all of that is overseen and checked by someone who is truly an expert, one can be well aware of where the chatbot led astray,” Greenblatt said.

Personally, I don’t want to go to a doctor who at best is only correct 77% of the time. I believe there is still a place for good old human physicians and human intelligence in this world of increasing technology and artificial intelligence.