Health reform's bureaucratic spawn
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http://dyn.politico.com/printstory.cfm? ... 749F082B21
Health reform's bureaucratic spawn
By: Gloria Park and Fred Barbash
August 3, 2010 04:31 AM EDT
Don’t bother trying to count up the number of agencies, boards and commissions created under the new health care law. Estimating the number is “impossible,” a recent Congressional Research Service report says, and a true count “unknowable.”
The reasons for the uncertainty are many, according to CRS’s Curtis W. Copeland, the author of the report “New Entities Created Pursuant to the Patient Protection and Affordable Care Act.”
The provisions of the law that create the new entities vary dramatically in specificity.
The law says a lot about some of them and a little about many, and merely mentions a few. Some have been authorized without any instructions on who is to appoint whom, when that might happen and who will pay.
Those agencies created without specific appointment or appropriations procedures will have to wait indefinitely for staff and funding before they can function, according to Copeland’s report.
And others could be just the opposite: One entity might not be enough and could spawn others, resulting in an “indeterminate number of new organizations.”
The CRS report cites as an example a minority health provision that “requires the heads of six separate agencies within Health and Human Services to each establish their own offices of minority health.”
Another section, by contrast, says that the Patient-Centered Research Institute “‘may appoint permanent or ad hoc expert advisory panels as determined appropriate.’ How many such panels will be ‘determined appropriate’ by the institute is currently unclear.”
Implicit in the report is a message not to take too seriously the elaborate charts and seemingly precise numbers peddled by Republican critics that are designed to show the law’s many bureaucratic tentacles.
The Center for Health Transformation, founded by Newt Gingrich, recently estimated that the new law created as many as 159 new offices, agencies and programs. Republican staffers on the Joint Economic Committee determined that there were 47 bureaucratic entities.
“Although some observers have asserted that PPACA will result in a precise number of new boards and commissions,” the CRS document reads, “the exact number of new organizations and advisory bodies that will ultimately be created ... is currently unknowable.”
Even in the few cases in which the PPACA set explicit creation dates for organizations, the consequences of missing these deadlines remain unknown.
The legislation, for instance, mandated HHS to establish an Interagency Task Force to Assess and Improve Access to Health in Alaska by May 7, as well as an Advisory Committee on Breast Cancer in Young Women by May 22.
HHS has yet to appoint members to the breast cancer committee and is currently reviewing nominations, according to HHS spokeswoman Jessica Santillo. The Alaska task force didn’t hold its first meeting until July 16.
The CRS author based his conclusions on a search of the law for any of the following formulations: “there is established,” “there is created,” “there is hereby created,” “shall establish,” “shall create,” “shall convene,” “shall appoint,” “purpose of this section to establish,” “there is hereby established” and “there is authorized to be established.”
Beyond the problem of enumeration, the CRS paper expresses concern that the lack of specificity in the bill could complicate congressional oversight. Copeland also raises questions about the number of appointments to boards delegated to the comptroller general of the United States, who heads the Government Accountability Office.
“Under the new law, the Government Accountability Office must appoint at least 83 new members to six new boards,” he notes. “It is unclear how GAO will be able to independently audit these entities when the CG has appointed their members.”
Some of these new “entities” have been politically controversial.
For instance, prominent Senate Republicans introduced legislation last week to repeal the Independent Payment Advisory Board, which must submit Medicare cost-cutting proposals to Congress and will consist of 15 members, appointed by the president and confirmed by the Senate.
“America’s seniors deserve the ability to hold elected officials accountable for the decisions that affect their Medicare,” Sen. John Cornyn (R-Texas) said in a statement, “but IPAB and many of these other new boards would take that away from seniors and put power in the hands of politically appointed Washington bureaucrats.”
I thought there were'nt going to be any so called DEATH PANELS and all that was is fear mongering put out by people who opposed this bill :lolno:Maybe one day all you guys on the left will statr listening to us.
Cornyn, one of five senators calling for the IPAB repeal, further denounced the number of new boards created by the PPACA. “This avalanche of new boards is arrogantly premised on the idea that Washington has all the answers,” he wrote in an e-mail to POLITICO. “In true fashion of Obama-Reid-Pelosi hubris, this is an outrageous growth in government.”
The political battle over IPAB is especially consequential because its proposals will not be merely advisory. PPACA mandates the secretary of HHS to implement IPAB’s proposals unless Congress adopts alternative measures to cut at least as much Medicare spending as the original IPAB recommendations.
The fact of the matter is Obama lied about this bill and people bought it. What a shame :(
Health reform's bureaucratic spawn
By: Gloria Park and Fred Barbash
August 3, 2010 04:31 AM EDT
Don’t bother trying to count up the number of agencies, boards and commissions created under the new health care law. Estimating the number is “impossible,” a recent Congressional Research Service report says, and a true count “unknowable.”
The reasons for the uncertainty are many, according to CRS’s Curtis W. Copeland, the author of the report “New Entities Created Pursuant to the Patient Protection and Affordable Care Act.”
The provisions of the law that create the new entities vary dramatically in specificity.
The law says a lot about some of them and a little about many, and merely mentions a few. Some have been authorized without any instructions on who is to appoint whom, when that might happen and who will pay.
Those agencies created without specific appointment or appropriations procedures will have to wait indefinitely for staff and funding before they can function, according to Copeland’s report.
And others could be just the opposite: One entity might not be enough and could spawn others, resulting in an “indeterminate number of new organizations.”
The CRS report cites as an example a minority health provision that “requires the heads of six separate agencies within Health and Human Services to each establish their own offices of minority health.”
Another section, by contrast, says that the Patient-Centered Research Institute “‘may appoint permanent or ad hoc expert advisory panels as determined appropriate.’ How many such panels will be ‘determined appropriate’ by the institute is currently unclear.”
Implicit in the report is a message not to take too seriously the elaborate charts and seemingly precise numbers peddled by Republican critics that are designed to show the law’s many bureaucratic tentacles.
The Center for Health Transformation, founded by Newt Gingrich, recently estimated that the new law created as many as 159 new offices, agencies and programs. Republican staffers on the Joint Economic Committee determined that there were 47 bureaucratic entities.
“Although some observers have asserted that PPACA will result in a precise number of new boards and commissions,” the CRS document reads, “the exact number of new organizations and advisory bodies that will ultimately be created ... is currently unknowable.”
Even in the few cases in which the PPACA set explicit creation dates for organizations, the consequences of missing these deadlines remain unknown.
The legislation, for instance, mandated HHS to establish an Interagency Task Force to Assess and Improve Access to Health in Alaska by May 7, as well as an Advisory Committee on Breast Cancer in Young Women by May 22.
HHS has yet to appoint members to the breast cancer committee and is currently reviewing nominations, according to HHS spokeswoman Jessica Santillo. The Alaska task force didn’t hold its first meeting until July 16.
The CRS author based his conclusions on a search of the law for any of the following formulations: “there is established,” “there is created,” “there is hereby created,” “shall establish,” “shall create,” “shall convene,” “shall appoint,” “purpose of this section to establish,” “there is hereby established” and “there is authorized to be established.”
Beyond the problem of enumeration, the CRS paper expresses concern that the lack of specificity in the bill could complicate congressional oversight. Copeland also raises questions about the number of appointments to boards delegated to the comptroller general of the United States, who heads the Government Accountability Office.
“Under the new law, the Government Accountability Office must appoint at least 83 new members to six new boards,” he notes. “It is unclear how GAO will be able to independently audit these entities when the CG has appointed their members.”
Some of these new “entities” have been politically controversial.
For instance, prominent Senate Republicans introduced legislation last week to repeal the Independent Payment Advisory Board, which must submit Medicare cost-cutting proposals to Congress and will consist of 15 members, appointed by the president and confirmed by the Senate.
“America’s seniors deserve the ability to hold elected officials accountable for the decisions that affect their Medicare,” Sen. John Cornyn (R-Texas) said in a statement, “but IPAB and many of these other new boards would take that away from seniors and put power in the hands of politically appointed Washington bureaucrats.”
I thought there were'nt going to be any so called DEATH PANELS and all that was is fear mongering put out by people who opposed this bill :lolno:Maybe one day all you guys on the left will statr listening to us.
Cornyn, one of five senators calling for the IPAB repeal, further denounced the number of new boards created by the PPACA. “This avalanche of new boards is arrogantly premised on the idea that Washington has all the answers,” he wrote in an e-mail to POLITICO. “In true fashion of Obama-Reid-Pelosi hubris, this is an outrageous growth in government.”
The political battle over IPAB is especially consequential because its proposals will not be merely advisory. PPACA mandates the secretary of HHS to implement IPAB’s proposals unless Congress adopts alternative measures to cut at least as much Medicare spending as the original IPAB recommendations.
The fact of the matter is Obama lied about this bill and people bought it. What a shame :(
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So a few agencies, boards and commissions are being created....I guess the world is over...
don't you get it? having 500,100 government agencies/boards/commissions clearly make us a socialist country... But only having 500,050 apparently did not...
was like a picture
of a sunny day
“We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses.”
― Abraham Lincoln
http://www.house.gov/brady/pdf/Obamacare_Chart.pdf
SHOW COUNT: (164) 1990's=3, 2000's=53, 2010/20's=108, US=118, CAN=15, Europe=20 ,New Zealand=4, Australia=5
Mexico=1, Colombia=1
The funny thing is, the more you resist "increasing government" in this way, the more bureaucracy is added because of provisions, exceptions and compromise deals that are the outcome of the resistance. Politics is often highly ironic.
Peace
Dan
"Every judgment teeters on the brink of error. To claim absolute knowledge is to become monstrous. Knowledge is an unending adventure at the edge of uncertainty." - Frank Herbert, Dune, 1965
the bureaucracy that exists within major gov't programs is ridiculous beyond belief ... it's not necessarily the gov'ts fault but really the product of a nation that has lost it's way ...
i wonder if they would also be the same people who are unhappy about the illegal immigrants, who, with a limited understanding of english to start with, have not followed immigration procedures to become residents.
here's their flowchart of what they need to do to get their green card.
unbelievable.
http://immigrationroad.com/green-card/i ... n-card.pdf
Tell me about it... I've been paying taxes and lawyers for 6 years and I'm don't have a clue where am I in that chart :( I'm not illegal but i don't have a clear status... I'm submerge in the bureaucratic limbo, people don't have a clue how complicated and twisted is the immigration system in this country but it's easier to have the illegal immigrants as scape goats...
Ok let's get back to topic... sorry for the rant
Neil deGrasse Tyson
Why not (V) (°,,,,°) (V) ?
How is a single payer system going to reduce bureaucracies when in fact it's going to be the gov who runs it. :? Sorry i don't trust our gov to run our healthcare. Our gov destroys practically everything it touches. Social security is a prime example. They stole all the money.
http://www.heritage.org/Research/Report ... nd-Doctors
The federal government would amass greater power over the financing and delivery of medical services; it would also determine the benefits and medical procedures that Americans would get and the prices providers are paid for them. This concentration of government power over health care would have a profound impact on all Americans, especially members of the medical profession.
Such government control would:
Result in substantially lower payments to physicians and other health care providers compared to a multiple-payer system;
Reduce the quality of care by limiting the ability of physicians to invest in advanced medical equipment that takes advantage of new technology;
Limit access to care in the near term, as current physicians and other professionals retire earlier or otherwise leave the profession;
Limit access to care even more substantially in the long term, as the prospect of lower lifetime earnings reduces the incentive for talented people to choose careers in health care; and
Reduce the rate of medical progress, because fewer talented people receiving medical training decreases the supply of talented medical researchers.
Robert A. Book, Ph.D., is Senior Research Fellow in Health Economics in the Center for Data Analysis at The Heritage Foundation.
I think others might listen to you a little better when you can present articles or links that are a little more fact oriented and that are written with a little more journalistic integrity. I would also stop labeling people so much, epecially as "leftists". Let's just discuss the merits of the actual issues and not divide ourselves into teams so much.
"With our thoughts we make the world"
relax, my friend...Kat's been taking names lately...
anyway, here's the rub about this bureaucratic thing...the reason the Gov't has to have all these bureaus is to pacify people like you that whine and moan about gov't and spending...after all, if the gov't is spending money, it must be justified and checks & balances must be in place...thus, oversight must be created...
have a nice day...
Look there are people on here no matter what amount of evidence is put forth they still aren't going to believe it because they fail to do any research what so ever and they are too close minded. I don't know what you really consider journalistic integrity. Afterall most of the stuff I post isn't even talked about by the MSM because they lean to the left and they are in the tank For Obama and the Dems. Most of all the links I get my info from are from very reputable sources. Politico being one of them. There have been many articles that i have posted that I get made fun of ,but at the same time they are the ones who can't prove that what I post isn't true.
please take this piece of advice next time you post about climate change ... thanks and have a good day ...
But let's please not derail the thread....
I agree that many of us aren't researching the basis for our opinions or ideas fully and that there are media sources "in the tank" for Obama and the Dems. But, two wrongs don't make a right (no pun intended). I could take the the Politico article in question a bit more seriously if people from other sides of the issue were quoted and/or if the quotes utilized were a little more fact based and not just slanted conjecture such as "In true fashion of Obama-Reid-Pelosi hubris...". The article may raise many points worthy of discussion or investigation but the slanted language and presentation in your post and and in the article makes me feel like I am being propagandized to and that is just a turn-off for me.
"With our thoughts we make the world"
I guess this is where we differ...I happen to think this a wonderful country that can continue to survive and grow...I have faith that we will be just fine...can there be improvements? yes, of course...
I just don't buy into the fear propaganda spread by the hate-driven right wing...I don't blindly follow and spit out their words as if they were my own...
I guess you're the opposite...that's a shame...
to underscore that link..
One of the more illuminating remarks during the health-care debate in Congress came when House Speaker Nancy Pelosi told an audience that Democrats would “pass the bill so you can find out what’s in it, away from the fog of controversy.”
That remark captured the truth that, while many Americans have a vague sense that something bad is happening to their health care, few if any understand exactly what the law does.
To fill this vacuum, Representative Kevin Brady of Texas, the top House Republican on the Joint Economic Committee, asked his staff to prepare a study of the law, including a flow chart that illustrates how the major provisions will work.
The result, made public July 28, provides citizens with a preview of the impact the health-care overhaul will have on their lives. It’s a terrifying road map that shows Democrats have launched America on the most reckless policy experiment in its history, the economic equivalent of the Bay of Pigs invasion.
Before discussing what the law means for you, we have to look at what it does to government. That’s where the chart comes in handy. It includes the new fees, bureaucracies and programs and connects them into an organizational chart that accounts for the existing structure. It’s so carefully documented that a line connecting two structures cites the legislative language that created the link.
Ornate System
This clearly is a candidate for most disorganized organizational chart ever. It shows that the health system is complex, yes, but also ornate. The new law creates 68 grant programs, 47 bureaucratic entities, 29 demonstration or pilot programs, six regulatory systems, six compliance standards and two entitlements.
Getting that massive enterprise up and running will be next to impossible. So Democrats streamlined the process by granting Health and Human Services Secretary Kathleen Sebelius the authority to make judgments that can’t be challenged either administratively or through the courts.
This monarchical protection from challenges is extended as well to the development of new patient-care models under Obama’s controversial recess appointment, Donald Berwick, whom Republicans are calling the rationer-in-chief. Berwick will run the Centers for Medicare and Medicaid Services, where he can experiment with ways to use administrative fiat to move our system toward the socialized medicine of Europe, which he has at times embraced.
Closer to Home
A sprawling, complex bureaucracy has been set up that will have almost absolute power to dictate terms for participating in the health-care system. That’s what the law does to government. What it does to you is worse.
Based on the administration’s own numbers, as many as 117 million people might have to change their health plans by 2013 as their employer-provided coverage loses its grandfathered status and becomes subject to the new Obamacare mandates.
Those mandates also might make your health care more expensive. The Congressional Budget Office predicts that premiums for a small number of families who buy their insurance privately will rise by as much as $2,100.
The central Obamacare mechanism for increasing insurance coverage is an expansion of the Medicaid program. Of the 30 million new people covered, 16 million will be enrolled in Medicaid. And you could end up in the program whether you want it or not. The bill states that people who apply for coverage through the new exchanges or who apply for premium-subsidy credits will automatically be enrolled in Medicaid if they qualify.
Hurting the Elderly
To pay for this expansion, the bill takes $529 billion from Medicare, with roughly 39 percent of the cut coming from the Medicare Advantage program. This represents a large transfer of resources, sacrificing the care of the elderly in order to increase the Medicaid rolls.
For all this supposed reform, you, the American taxpayer, can expect a bill to the tune of $569 billion.
Front and center among the new taxes is the 40 percent excise tax on those lucky people with so-called Cadillac health plans. The higher insurance costs that are driven by the government mandates will push many more ordinary plans into Cadillac territory.
If the idea of taxing people with coverage deemed too good doesn’t bother you, maybe the new 3.8 percent tax on investment income will. That will apply even to a small number of home sales, those that generate $250,000 in profit for an individual or $500,000 for a married couple.
In vivid color and detail, Congressman Brady’s chart captures the huge expansion of government coming under Obamacare. Harder to show on paper is the pain it will cause.
(Kevin Hassett, director of economic-policy studies at the American Enterprise Institute, is a Bloomberg News columnist. He was an adviser to Republican Senator John McCain in the 2008 presidential election. The opinions expressed are his own.)
To contact the writer of this column: Kevin Hassett at <!-- e --><a href="mailto:khassett@bloomberg.net">khassett@bloomberg.net</a><!-- e -->
i would say people on the left would agree the world is going to shits
I guess I'm in the middle...
yup ... where most people are!
How can you say that we are going to be fine if we continue to stay on our current path. You know there is a saying that goes if you dont learn from history your bound to repeat it. and right now our so called leaders haven't learned a thing from history..
and its people like you that aren't paying attention
now that's a shame
Here's another way: We're fucked!
I disagree though. The fear-inducing propaganda being spewed about health care reform today is exactly the same as has been spewed for 100 years - and the world hasn't come to an end yet.
My friend, If we made through Bushy and Co., we can make through just about anything...
I'm sorry to hear you're so scared...I'm just saying I'm not...I adapt and move on...
If you ever come across an old newspaper, take the time to read it...all the same complaints you hear today were going on back then...
I think Folks want what they want right now and if they don't get it right now, they think world will end...
Do yourself a favor, tune out for awhile...it will do you some good... please know, I'm not being a smart-ass, I'm serious when I say that...
that's what you think!!! Bush destroyed the world 100 years ago and now we are plugged into the Matrix...
Neil deGrasse Tyson
Why not (V) (°,,,,°) (V) ?
FYI, if you think you're country is fucked... it was that way far before Obama took office. :shock:
You seem to be under the misapprehension that it's only bureaucracy if it's the government doing it. Bureaucracy is rampant also inn large businesses. What creates bureacracy is laws and rules that have exceptions and means-testing. Because when you do, someone must be paid to do the judgement or the testing. Americans are terrified to death of comprehensive public solutions, but at the same time think it's too bad that granny should die for lack of treatment. Enter subsidiary programs and means testing. Furthermore, when hospitals are privately owned and seperate entities, combined with a torrent of different providers, well you can do the math. You could have all hospitals organized together, with one place to send the bill every time, or you could have houndreds of seperate hospitals needing payments from houndreds of different providers. Which generates the most paper work do you think?
You can feel what yo want about single payer vs private, but it is pretty well documented that your system creates a lot more overhead because so many different parties must talk together and agree. (Or avoid responsibility) So administratively, there's no question at all that single payer will be cheaper, because that would mean less, yes less, bureaucracy than the mess you have now.
But let me just drive home 1 point thoroughly: Bureaucracy is not something of government, but something that accumulates in big, complex organizations no matter which sector or business. Health care is already big and complex, to which you add complexity with having many different providers that's gonna bill eachother.
So be free to resist a universal system, but don't tell me it would be more expensive because of bureaucracy. Universal would cover more and thus cost more on the national budget, but it would mean better health for more people and a more efficient use of health resources, ie you'd get more health from every buck spent than under the current. To compare costs, you have to include what americans today pay in premiums and add to what the government spends on health care.
Peace
Dan
"Every judgment teeters on the brink of error. To claim absolute knowledge is to become monstrous. Knowledge is an unending adventure at the edge of uncertainty." - Frank Herbert, Dune, 1965
From Physicians for a National Health Program:
"Won’t this just be another bureaucracy?
The United States has the most bureaucratic health care system in the world. Over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented.
The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial single-payer plans in Canada have an overhead of about 1%.
It is not necessary to have a huge bureaucracy to decide who gets care and who doesn’t when everyone is covered and has the same comprehensive benefits. With a universal health care system we would be able to cut our bureaucratic burden in half and save over $300 billion annually."