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.
posted by wt @ 9:13 PM
8 comments
8 Comments:
Seriously? I seriously don't know what gets into you sometimes, WT.
Five of these are individuals. Twenty-five of them are "programs." Which could be something complicated, or it could be something efficient and simplifying. Five of them are "funds."
But beyond that, why would the number of capitalizable titles that could be culled from a bill be a representative measure of the efficiency of the implemented system compared with the present one?
Consider the fact that corporations, very successful privately run ones that can be held up as models of operational efficiency, have enormous numbers of committees, boards, programs, funds, grants, reviews, and options. It's because collective action is costly and these things reduce transaction costs.
Beyond sloppy. Explain to me, very carefully, why this is not completely idiotic.
-js
What a weird comment. How careful do I need to be to reach the status of non-idiocy?
I think you're right that the original post mischaracterizes all 53 capitalized terms as agencies, when they are in fact a variety of individuals, boards, funds, and programs.
But my question as to whether this many new and varying types of bureacracy creates efficiency is useful to evaluate the core at what's behind competing arguments about whether HR 3200 would lead to "government-run" healthcare.
Sure, private corporations have committees, but these committees are ultimately accountable, hierarchical, and remain subject to the underlying motive of the corporation to cut costs and turn a profit (part of the alleged problem with private corporations in the healthcare industry).
There's no evidence that HR 3200 would include anything like, say, a mechanism to ensure that various programs and agencies are run at minimum cost and at maximum efficiency. Indeed, rumblings about unionizing the new employees necessary to staff these positions indicate that the future employees may earn substantial salaries and healthy job security. Even if a program ends up being unnecessary, or unhelpful, there's no guarantee that it's budget will ever be cut.
Moreover, far from being sloppy, the post is designed to overwhelm the audience with the fact that there is a lot happening in this bill. To say that the public option will never lead to a government takeover of healthcare seems to put a lot of faith in idea that these 53 agencies, funds, etc. have clearly defined roles and institutional limitations that many probably don't have.
In any event, let's agree that the question of whether the public option would lead to a government takeover of healthcare involves a judgment call on the definition of the term based on the bill's provisions, rather than conclusory assertions on either side.
Not careful enough. Let's get back to the original claim. The large number of things with proper names in H.R. 3200 indicates that the bill has faults.
How?
-js
Yes, indeed, this IS a government takeover.
Terrified in case we get the same ostrich attitude to social health care,try lifting yourmheads up,the world realy is a wonderful place.
-js, hOW ABOUT YOU BREAK DOWN FOR EVERYONE WHAT IS NOT AT FAULT IN THIS UNCONSTITUTIONAL LAW?
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