Wednesday, July 29, 2009

Reading the Health Care Bill: Part III

HR 3200: “America’s Affordable Health Choices Act of 2009”

Part III

Division C – “Public Health and Workforce Development”

In this my third, and final, report from my reading of the health care bill, I still haven’t found any provisions to address the root cause of rising health care. There is ample funding for new programs and a commensurately large outgrowth of government oversight, regulation, and private entity reporting requirements. I can find plenty to increase the costs of health care, increase the cost of government, and increase the cost and tax burden on all Americans. Not surprisingly, the CBO was dead on in its assessment.

There is no attempt at tort reform, no provisions for curtailing illegal immigration (and illegal immigrant use of our health care facilities and tax dollars), no funding or provisions for reducing the cost of technology (i.e. studies to reduce capitalization costs or manufacturing costs), no provision to reduce the burden of FDA approval for new drugs, and certainly nothing else that would impact rising health care costs. This bill amounts to nothing less than a government takeover of health care. America would be foolish to accept this plan.

As before, I have provided my commentary in italics preceding the copied text of the bill to which it pertains:

Division C starts off with Section 2002, “Public Health Investment Fund,” an expansion of spending (still looking for that cost savings). The total allocated out of the “general revenues” of the Treasury total $88.7Billion from 2010 to 2019 They are appropriated for “community health centers, the National Service Corps Program, the National Health Service Corps Scholarship and Loan Repayment Programs, primary care loan funds, primary care education programs, nursing workforce development, the National Center for Health Statistics, and the Agency for Healthcare Research and Quality. Hmm…more spending, where’s the savings? But don’t worry, the government won’t county these costs as part of that terrible Balanced Budget and Emergency Deficit Control Act:

(3) BUDGETARY IMPLICATIONS.—Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal year during which appropriations are made from the Fund.

Section 2213 describes who will benefit from the new government scholarship/loan repayment programs for medical professionals. Interestingly, it is only applicable to general practitioners. Is there no need for specialists? Of course, no government program would be complete without preferential treatment:

(d) PREFERENCE.—In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:

(2) Training individuals who are from under represented minority groups or disadvantaged backgrounds.

So what happens when there is a shortage of specialists and an over-abundance of generalists? This is a major problem with Federal programs – they are not designed or able to adapt to the market; in turn, they reinforce activity that may not be beneficial all while increasing tax burdens thereby decreasing economic prosperity.

The presumed purpose of this division in the bill is to encourage more people to enter the medical field. But if the effect of the bill is to limit the income potential of health care providers (which the President admits, the CBO confirms, and world-wide experience reveals) then helping a few minorities pay part of the costs of education and requiring them to work in underserved (read: low paying) markets will not resolve the problem. Having some of your college costs paid is no inducement to a low-paying, high-stress career. There will always be a few people in medicine because they feel called to serve in that way, but that is not enough to adequately fulfill the needs of our country.

Subtitle C – “Public Health Workforce,” describes the establishment (or massive expansion) of yet another government-run system. And who says the government is going to control your health care?! ßsarcasm

Part 1 of Subtitle D adds more charge to funding minorities’ education with a touchy-feely title, “Health Professions Training for Diversity.” I have nothing against minorities, but shouldn’t the address people with low income in general, regardless of race? Furthermore, shouldn’t we target individuals that need financial assistance who have academic merit, regardless of race? The longer our government enunciates the racial divide the longer it will take to overcome it.

Section 3121 puts to rest the “myth” that the government will attempt to control our lives through health care:

(a) IN GENERAL.—The Secretary shall submit to the Congress within one year after the date of the enactment of this section, and at least every 2 years thereafter, a national strategy that is designed to improve the Nation’s health through evidence-based clinical and community prevention and wellness activities (in this section referred to as ‘prevention and wellness activities’), including core public health infrastructure improvement activities.

Section 3131 establishes a “Task Force on Clinical Preventive Services,” which reviews the data from the findings of section 3121 and makes “recommendations” for preventive medicine. I include some excerpts below. Anyone care to guess what strings would be attached to their recommendations?

(1) IN GENERAL.—The Task Force shall convene a clinical prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in clinical preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services.

(3) RESPONSIBILITIES.—In accordance with subsection (b)(5), the clinical prevention stakeholders board shall—

(A) recommend clinical preventive services for review by the Task Force;

(B) suggest scientific evidence for consideration by the Task Force related to reviews undertaken by the Task Force;

(C) provide feedback regarding draft recommendations by the Task Force; and

(D) assist with efforts regarding dissemination of recommendations by the Director of the Agency for Healthcare Research and Quality.

Section 3132 answers the questions about what strings would be attached. You have to read it carefully, though. Fortunately for you, I’ve highlighted the part you need to pay attention to.

(c) ROLE OF AGENCY.—The Secretary shall provide ongoing administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force.

For those of you who have followed the patient dumping scandal at the University of Chicago Hospital, section 3151 might resonate a little longer with you:

(2) HEALTH EMPOWERMENT ZONE.—In this subsection, the term ‘Health Empowerment Zone’ means an area—

(A) in which multiple community preventive and wellness services are implemented in order to address one or more health disparities, including those identified by the Secretary in the national strategy under section 3121; and

(d) HEALTH DISPARITIES.—Of the funds awarded under this section for a fiscal year, the Secretary shall award not less than 50 percent for planning or implementing community preventive and wellness services whose primary purpose is to achieve a measurable reduction in one or more health disparities, including those identified by the Secretary in the national strategy under section 3121.

(e) EMPHASIS ON RECOMMENDED SERVICES.—For fiscal year 2013 and subsequent fiscal years, the Secretary shall award grants under this section only for planning or implementing services recommended by the Task Force on Community Preventive Services under section 3122 or deemed effective based on a review of comparable rigor (as determined by the Director of the Centers for Disease Control and Prevention).

When I read section 3162 the hair on the back of my neck stands up. “Uncle Sam says go get your shots.” “Uncle Sam says you can’t have any more children.” “Uncle Sam says hamburgers aren’t healthy and you can’t have them.” Over exaggerations? I’m not so sure.


(a) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall expand and improve the core public health infrastructure and activities of the Centers for Disease Control and Prevention to address unmet and emerging public health needs.

In case you think “core public health infrastructure” refers only to the government owner/run portions, section 3171 helps eradicate your delusion. Keep in mind what you just read from the above excerpts when you read this definition:

(1) The term ‘core public health infrastructure’ includes workforce capacity and competency; laboratory systems; health information, health information systems, and health information analysis; communications; financing; other relevant components of organizational capacity; and other related activities.

Another revelation into the way the government plans to use its “research.”

(c) PERIOD BEFORE COMPLETION OF NATIONALSTRATEGY.—Pending completion of the national strategy under section 3121 of the Public Health Service Act, as added by subsection (a), the Secretary of Health and Human Services, acting through the relevant agency head, may make a judgment about how the strategy will address an issue and rely on such judgment in carrying out any provision of subtitle C, D, E, or F of title XXXI of such Act, as added by subsection (a), that requires the Secretary—

(1) to take into consideration such strategy;

(2) to conduct or support research or provide services in priority areas identified in such strategy; or

(3) to take any other action in reliance on such strategy.

Section 2401 has an ominous, “Quality and Surveillance,” in it’s title heading. It describes a quality system by which “best practices” are to be reviewed and implemented. Supposedly, implementation by providers will be voluntary, but most of this section reads otherwise.

(g) EVALUATION OF BEST PRACTICES.—The Director shall evaluate best practices identified or developed under this section. Such evaluation—

(1) shall include determinations of which best practices—

(A) most reliably and effectively achieve significant progress in improving the quality of patient care; and

(B) are easily adapted for use by health care providers across a variety of health care settings;

Section 2511 provides for the establishment of “School-Based Health Clinics.” In addition to being another expansion of government (still looking for all that savings), it begs the question: what services will be provided? The following paragraph vaguely hints:

(C) OPTIONAL SERVICES.—Additional services, which may include oral health, social, and age-appropriate health education services, including nutritional counseling.

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