Wednesday, October 20, 2010

A Conservative's Lament: The Specter of Public Health

With the midterm elections drawing near, conservatives should pause and reflect on missed opportunities. Despite Obama’s unprecedented unpopularity and strong opposition to his signature policy achievements: Obamacare and the Stimulus, it is almost a perfect certainty that the Democrats will hold onto the US Senate. The expert prognosticator Nate Silver, of FiveThirtyEight, has determined the Democrats will control the Senate barring a last-minute game-changer. At this point, all the game changers have cut against conservatives – as the liberal base rallies and Tea Party candidates flail. Democratic momentum is real, conservatives must assess the road not taken.

In my mind, one of the larger issues ignored by both parties is that of public health. "Obamacare" has been dragged through the mud by conservatives and their anti-government counterparts in the Tea Party and rightly so; it expands the government's presence into the realm of public health beyond any historical precedent (a central point of contention for conservatives). This message has been effectively used in garnering support amongst the Republican base; Thune, O'Donnell, Angle, Paul and others have made clear their intentions to repeal the bill should Republicans control either the Senate or House. Of course, without complete control in the Senate their efforts will be limited to defunding the bill and incentivizing the creation of a smaller incarnation but as far as conservatives are concerned, it's a start. Interestingly enough, the issue of public health has become a lightning rod for the Republican base; it is clear that the mere mention of the subject is sufficient to draw the ire of those most depended on by the Republican party to vote. The most pressing example currently available would be California's current battle to legalize and tax marijuana. It is important to note that while Republican/Tea Party voters seem to hold little animosity for the issue (it being a concession to the all-important issue of "state's rights") the nature of the debate changes when one suggests that drug offenders, for which the bar is set very high, are now to be wards of the state's various public health agencies and rehabilitation programs. At the mere mention of expanding government involvement in the state's administration of its programs the game changes; where conservative support for the bill once was high, explication of the program's intentions (true or not as is often the case in these elections) to rehabilitate offenders via federal programs has sent Republican voters away from the ballot box with Proposition 19's status now in question. So when conservatives ask themselves, "what could we have done to change the outcome of this midterm election" the answer, invariably, is finding ways to effectively tie the expansion of federal government's purview over the private lives of citizens into new policy frameworks. The public health issue is but one of many I intend to explore both before and after the results of the election are finalized and the dust has settled. On a side note, it is interesting that before Congress took their recess to fight the good fight nationwide in a series of contentious elections President Obama held off on delivering to the public a new series of government programs intended to better the lives, ironically, of the very people who would vote against them if he did.

Thursday, December 03, 2009

My Beautiful Father's Obituary

Rest in peace, my beloved father.

Sunday, September 20, 2009

Let's Get Along

Monday, September 14, 2009

Traficant Released

Hard to keep a good man down.

Thursday, September 10, 2009

So You Had a Bad 6 Hour Period of Time

People generally measure the quality of their experiences in days, rather than a more precise unit of time.

That is, they refer to having a good day, a bad day, the best day of their life, etc.

But almost no one says "Boy, that was a terrible span of 3 hours" or "Those were the best 75 minutes of my life." This is true even though the experiences they're referring to almost certainly didn't last a full 24 hours.

There are exceptions, of course. But I think the general tendency is interesting. Also it resulted in this great song.

Wednesday, September 09, 2009

Is this a Government Takeover?

The existing draft of HR 3200 would add 53 agencies [SEE UPDATE BELOW] in one form or another:

1. Health Benefits Advisory Committee (Section 123, p. 30)
2. Health Choices Administration (Section 141, p. 41)
3. Qualified Health Benefits Plan Ombudsman (Section 144, p. 47)
4. Program of administrative simplification (Section 163, p. 57)
5. Retiree Reserve Trust Fund (Section 164(d), p. 70)
6. Health Insurance Exchange (Section 201, p. 72)
7. Mechanism for insurance risk pooling to be established by Health Choices Administration Commissioner (Section 206(b), p. 106)
8. Special Inspector General for the Health Insurance Exchange (Section 206(c), p. 107)
9. Health Insurance Exchange Trust Fund (Section 207, p. 109)
10. State-based Health Insurance Exchanges (Section 208, p. 111)
11. "Public Health Insurance Option" (Section 221, p. 116)
12. Ombudsman for "Public Health Insurance Option" (Section 221(d), p. 117)
13. Account for receipts and disbursements for "Public Health Insurance Option" (Section 222(b), p. 119)
14. Telehealth Advisory Committee (Section 1191, p. 380)
15. Demonstration program providing reimbursement for "culturally and linguistically appropriate services" (Section 1222, p. 405)
16. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 438)
17. Accountable Care Organization pilot program (Section 1301, p. 443)
18. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 462)
19. Community-based medical home pilot program under Medicare (Section 1302(d), p. 468)
20. Center for Comparative Effectiveness Research (Section 1401(a), p. 502)
21. Comparative Effectiveness Research Commission (Section 1401(a), p. 505)
22. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 519)
23. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 546)
24. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 548)
25. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 559)
26. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 565)
27. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 607)
28. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 674)
29. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 716)
30. Medical home pilot program under Medicaid (Section 1722, p. 780)
31. Comparative Effectiveness Research Trust Fund (Section 1802, p. 824)
32. "Identifiable office or program" within CMS to "provide for improved coordination between Medicare and Medicaid in the case of dual eligibles" (Section 1905, p. 852)
33. Public Health Investment Fund (Section 2002, p. 859)
34. Scholarships for service in health professional needs areas (Section 2211, p. 870)
35. Loan repayment program for service in health professional needs areas (Section 2211, p. 873)
36. Program for training medical residents in community-based settings (Section 2214, p. 882)
37. Grant program for training in dentistry programs (Section 2215, p. 887)
38. Public Health Workforce Corps (Section 2231, p. 898)
39. Public health workforce scholarship program (Section 2231, p. 900)
40. Public health workforce loan forgiveness program (Section 2231, p. 904)
41. Grant program for innovations in interdisciplinary care (Section 2252, p. 917)
42. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 920)
43. Prevention and Wellness Trust (Section 2301, p. 932)
44. Clinical Prevention Stakeholders Board (Section 2301, p. 941)
45. Community Prevention Stakeholders Board (Section 2301, p. 947)
46. Grant program for community prevention and wellness research (Section 2301, p. 950)
47. Grant program for community prevention and wellness services (Section 2301, p. 951)
48. Grant program for public health infrastructure (Section 2301, p. 955)
49. Center for Quality Improvement (Section 2401, p. 965)
50. Assistant Secretary for Health Information (Section 2402, p. 972)
51. Grant program to support the operation of school-based health clinics (Section 2511, p. 993)
52. National Medical Device Registry (Section 2521, p. 1001)
53. Grants for labor-management programs for nursing training (Section 2531, p. 1008)

Is this a government-run healthcare system? I guess it depends on what you mean by government-run. But it sure seems like an incredble addition to the existing bureaucracy, and it merely begs the question to ask whether it's "government-run" or not. Whatever it is, does it lead to better services and lower costs?

UPDATE: JS rightly points out that this list isn't "agencies," but rather a mix of individuals, funds, and various programs. For more on our discussion, see the comments.

Friday, September 04, 2009

You're Not Going to Tell Me How to Run My Congressional Office

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