Service providers and their employees routinely access IT systems with "superuser" or "root" credentials ("Insider Threats," Dec. 11). This practice goes largely unchecked because of the critical nature of the work being done by the service provider to keep IT systems healthy.

Companies continue to invest heavily to ensure auditability in the financial and privacy arenas. With the increased importance and value placed on information assets, it's surprising that companies invite risk, settling for little auditability and visibility into the actions of administrators.

Companies must demand the same visibility into IT employee and contractor activities as they do from their accounting departments. Cost-effective access management systems that can provide the necessary level of control and audit exist today. IDS systems that at best can analyze for trends present a poor choice.

Bill Whitney
CTO, ION Networks
South Plainfield, N.J.

Its Own Set Of Rules

Health care is the most complex and poorly managed business on earth ("Attack The Root Of The Health Care Mess," Dec. 11). It violates some fundamental concepts of business, such as "the customer is always right" and the "law of supply and demand." Consider this:

1. There's no identifiable customer. Is the customer the patient, insurer, or employer? (Online personal medical record service Dossia is trying to solve this one, so maybe it's the employer and the employee working together.)

2. There's no one in charge. A hospital is a conglomerate of contractors and conflicting agendas at best. It's a car without a steering wheel. If no one is driving, no one can be held accountable.

3. It's the only business where the supplier calls the shots. The Baxters, Abbotts, and McKessons have long been telling the customer what and when to buy and how much to pay.

The problem isn't just one of cost but also of culture. Health care is schizophrenic in spades, and, until it's fundamentally changed, nothing much is going to happen. That said, Dossia is most encouraging.

David Hough
Director of Supply Chain Management
PSC Group
Schaumburg, Ill.

An Insider's View

You suggest that the health care system is dysfunctional and cite its growth and percentage of GDP as evidence. I suggest that both may be better evidence of an industry that has responded well to the economic incentives placed before it. Also, in a country that has generally met its most basic of needs, who is to say 20% of GDP is inappropriate?

The basic problem is a system that's considered a right but funded like a privilege. I'll leave it to minds better than mine as to how one might develop a funding system that makes individuals bear the appropriate percentage for health care costs associated with behavior and how to spread costs that are the result of noncontrollable variables--genetic illnesses, obesity not tied to eating habits, etc.

Another factor is inappropriate use. As an industry, hospitals have overrun emergency departments treating patients with nonurgent problems. In some cases, they have no access to primary care because they're unable to pay, in some cases we're a more convenient option, but in all cases the visits represent an expensive way to access primary care.

Prescription drugs are the fastest-growing component of health care costs. We as a society use prescriptions as a substitute for behavior modification.

There are a lot of issues with health care. But I can assure you that a look at Whole Foods' experience over one year isn't sufficient to declare victory. You don't know how many employees may be forgoing routine care that, if missed, will yield higher costs later.

James K. Pruitt
VP for Finance
East Tennessee Children's Hospital
Knoxville, Tenn.

Tech's Victims

Technology is driving a wedge between the "IT savvy" and the "rest" ("Personal Tech Is A Part Of Work--Get On With It,"). We need to have some way of redressing this imbalance.

The fact is, computers are cool. I like being able to do e-checkout at the supermarket. It saves standing in line. Of course, it also saves the market money, though the goods are no cheaper, and I have to fill the sack myself. So that's more money in the supermarket's pocket and more people out of work.

Is all this convenience really worth it? Is one man's convenience another man's sentence to poverty? If we don't address this issue as an industry, it will come back to haunt us.

Paul Nelson
Research Informatics Architect/Developer
Company name withheld by request
San Diego