02 November 2009

PelosiCare Bureaucracy Break-out

Via a conversation in a comment thread on Facebook, I went through all 111 of the new bureaucratic agencies/programs/whatnot that would be created by the House health care bill, as laid out here. I did a quick topical sort on them, based on a variety of keywords that jumped out at me as seeming important. There are some items that would fall under multiple categories; I weakly cross-referenced these with a mention of the number from the original list.

Quoted here is my response comment, roughly tied to the list pasted below. It's lacking some context, regrettably, but I think still makes some useful points:

To the first: Criticism accepted, I trusted the source without double-checking that all 111 were independent. However, I just went through and loosely categorized each of them (will post this as a note here shortly & share it), and I see very few, if any, that are identical duplicates. There are a number that apply to the same general entity/concept/whatever but that are distinct.

To the second: what does it matter if these are independent or not? Independence has no obvious causal link to, and to my mind even an implication of, greater cost. Subordinate, dependent, or corollary, it matters little - they'll still suck down resources. Further, out of the 111 entities listed, only 26 or so contain the word 'grant', and I could find only one contains 'scholarship'. In context, that's hardly 'many'. And, these grant programs, too, will require funding. And, thus, oversight to determine where the funding will go; and, thus, a director or committee to handle this oversight. $$$.

To the third: Do you really expect these few 'transitional' committees for the establishment of whatnot will allow themselves to dissolve out of existence once their nominal function is achieved? Further, I see only two with names implying a transitory function, #10 and #111. The rest are boards, committees, programs, grants, funds, trustees, secretaries and the like.

In short, it's a forest's worth of paper, laden with bureaucratic-job-creating, special-interest-pandering, taxpayer-money-wasting, cost-bloating fail.

And, the list:

Simplification and Improvement
4. Program of administrative simplification (Section 115, p. 76)
58. Center for Quality Improvement (Section 2401, p. 1322)

Advisory committees
5. Health Benefits Advisory Committee (Section 223, p. 111)
17. Telehealth Advisory Committee (Section 1191 (b), p. 589)
50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
(#100, Indian matters)

Demonstration programs (incl. #55)
18. Demonstration program providing reimbursement for "culturally and linguistically appropriate services" (Section 1222, p. 617)
19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
23. Independence at home demonstration program (Section 1312, p. 718)
32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
64. "No Child Left Unimmunized Against Influenza" demonstration grant program (Section 2524, p. 1391)
79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)

Demonstration 'projects'
76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
102. Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809)
107. Indian youth telemental health demonstration project (Section 3101, p. 1909)
103. Urban youth treatment center demonstration project (Section 3101, p. 1873)

Wellness grants
2. Grant program for wellness programs to small employers (Section 112, p. 62)
54. Grant program for community prevention and wellness research (Section 2301, p. 1305)
55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
56. Grant program for community prevention and wellness services (Section 2301, p. 1308)

Women's Health
90. Health Resources and Services Administration Office of Women's Health (Section 2588, p. 1618)
91. Food and Drug Administration Office of Women's Health (Section 2588, p. 1621)
86. Health and Human Services Coordinating Committee on Women's Health (Section 2588, p. 1610)
87. National Women's Health Information Center (Section 2588, p. 1611)
88. Centers for Disease Control Office of Women's Health (Section 2588, p. 1614)
89. Agency for Healthcare Research and Quality Office of Women's Health and Gender-Based Research (Section 2588, p. 1617)

6. Health Choices Administration (Section 241, p. 131)
10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)

8. Health Insurance Exchange (Section 201, p. 155)
9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
11. Health Insurance Exchange Trust Fund (Section 307, p. 195)
12. State-based Health Insurance Exchanges (Section 308, p. 197)
34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)

'Public Health Insurance Option'
14. "Public Health Insurance Option" (Section 321, p. 211)
15. Ombudsman for "Public Health Insurance Option" (Section 321(d), p. 213)
16. Account for receipts and disbursements for "Public Health Insurance Option" (Section 322(b), p. 215)
42. Public Health Investment Fund (Section 2002, p. 1214)
46. Public Health Workforce Corps (Section 2231, p. 1253)
47. Public health workforce scholarship program (Section 2231, p. 1254)
48. Public health workforce loan forgiveness program (Section 2231, p. 1258)
57. Grant program for public health infrastructure (Section 2301, p. 1313)

'Accountable Care'
20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)

'Home pilot' programs
21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
35. Medical home pilot program under Medicaid (Section 1722, p. 1058)

'Comparative Effectiveness'
24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)

Nursing facilities (both 'skilled nursing' and 'nursing' - difference in jargon terms?)
27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
37. Nursing facility supplemental payment program (Section 1745, p. 1106)

Anti-fraud (note: *one* entity)
33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)

Tracking to prevent 'double-dipping' (*ONE* entity)
40. "Identifiable office or program" within CMS to "provide for improved coordination between Medicare and Medicaid in the case of dual eligibles" (Section 1905, p. 1191)

41. Center for Medicare and Medicaid Innovation (Section 1907, p. 1198)
49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)

'Grant programs'
3. Grant program for State health access programs (Section 114, p. 72)
13. Grant program for health insurance cooperatives (Section 310, p. 206)
45. Grant program for training in dentistry programs (Section 2215, p. 1240)
60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
61. Grant program for nurse-managed health centers (Section 2512, p. 1361)
62. Grants for labor-management programs for nursing training (Section 2521, p. 1372)
63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
68. Grant program to implement medication therapy management services (Section 2528, p. 1412)
69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
70. Grant program for State alternative medical liability laws (Section 2531, p. 1431)
71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
73. Grant program for community-based collaborative care (Section 2534, p. 1440)
74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
93. Grant program for national health workforce online training (Section 2591, p. 1629)
94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
(plus others?)

American Indian
97. Program of Indian community education on mental illness (Section 3101, p. 1722)
98. Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754)
99. Office of Indian Men's Health (Section 3101, p. 1765)
100. Indian Health facilities appropriation advisory board (Section 3101, p. 1774)
101. Indian Health facilities needs assessment workgroup (Section 3101, p. 1775)
104. Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874)
105. Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877
110. Native American Health and Wellness Foundation (Section 3103, p. 1966)
111. Committee for the Establishment of the Native American Health and Wellness Foundation (Section 3103, p. 1968)

1. Retiree Reserve Trust Fund (Section 111(d), p. 61)
51. Prevention and Wellness Trust (Section 2301, p. 1286)

43. Scholarships for service in health professional needs areas (Section 2211, p. 1224)

52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
53. Community Prevention Stakeholders Board (Section 2301, p. 1301)

Training programs
44. Program for training medical residents in community-based settings (Section 2214, p. 1236)
106. Mental health technician training program (Section 3101, p. 1898)

83. CLASS Independence Fund (Section 2581, p. 1597)
84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
85. CLASS Independence Advisory Council (Section 2581, p. 1602)

Emergency Care
77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
78. Council for Emergency Care (Section 2552, p 1479)

Treatment programs
108. Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925)
109. Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927)

7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
59. Assistant Secretary for Health Information (Section 2402, p. 1330)
67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
82. National Medical Device Registry (Section 2571, p. 1501)

Call your representatives and tell them they'll lose your vote next November if they vote for this monstrosity...

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