How Health Care Would Be Run
The Washington Examiner ran an interesting story late last week on how health care reform might impact the responsibilities of the Health and Human Services Secretary. I've been interested in this subject for a while, because though Congressional passage is a major step in the process, and endlessly reported on, it's really only a step, rather than full accomplishment of reform. Putting the apparatus in place, on the federal and state level, to actually implement health care reform is going to be a much longer and harder process. Especially since legislation would create new categories of responsibility for federal agencies:
"It's a huge amount of power being shifted to HHS, and much of it is highly discretionary," said Edmund Haislmaier, an expert in health care policy and insurance markets at the Heritage Foundation, a conservative think tank.Haislmaier said one the greatest powers HHS would gain from the bill is the authority to regulate insurance. States currently hold this power, and under the Senate bill, the federal government would usurp it from them. This could lead to the federal government putting restrictions and changes in place that destabilize the private insurance market by forcing companies to lower premiums and other charges, he said.
"Health and Human Services ... doesn't have any experience with this," Haislmaier said. "I'm looking at the potential for this whole thing to just blow up on people because they have no idea what they are doing. Who in the federal government regulates insurance today? Nobody."
Just because the federal government doesn't currently perform a task doesn't mean that it won't be able to. But it does mean there will be a learning curve for agencies to do so. And even before getting to that point, health care reform means reorganizing offices, hiring people to staff new roles, designating leadership, training them, etc. As the aggregation of existing functions under the Department of Homeland Security demonstrated, that's an enormous task, even with agencies already stood up and functional. This will happen on a smaller scale, and there won't be as many employees involved. The Transportation Security Administration isn't a perfect analogue either, since the jobs involved are very different, but the sheer number of problems with training, turnover, and even scheduling demonstrate how hard it is to stand up an agency. Health care watchers should take implementation and bureaucracy-building at least as seriously as they take Congressional passage of a reform bill.
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ABOUT THIS BLOG
Government Executive Staff Correspondent Alyssa Rosenberg takes a look at news affecting the management and operations of the massive federal bureaucracy.
Who in federal government knew how to send a rocket to the moon? They will learn, although the process is not likely to be pretty.
Ted Bean Posted Monday, November 30, 2009 3:23 PMThe Federal Government has never performed any task with efficiency in the realm of health care. The V.A. hospitals are places that provide substandard care to our veterans. Medicare uses private insurance carriers to manage health care claims denying payment for necessary services, Medicaid also shamefully denies payment for services and equipment that patients need for life support. Thus everything that is wrong with health care today is the result of how the federal government screws up everything that it touches. Therefore the only thing we can expect from Health Care Reform is more of the same in spades.
Thomas A. Sharon, RN, MPH Posted Monday, November 30, 2009 3:40 PMGerat post and almost total ignorance in Washington and Executive Branch about the 4th or 5th largest pool of capital completely unregulated by Uncle Sam due to the McCarran-Ferguson Act of 1947 which does not exempt insurance from federal regulations but exempts that business to the extent the states regulate it. Life, health, property, casualty. Essentially unregulated and subject to price fixing and monopoly. Even collection of statistics on the industry is fought by its lobbies which should tell you something. The insurance business in the US is Not about "Risk" but trying to avoid risk in order to claim as many pre-tax dollars in the GDP as possible. Some think that over 20% of total GDP is raked off by the insurance business. Hey why not continue to rake rather than perform the semi-public functions of risk management, risk spreading, and mitigation of risks. This business is laden with conflicts of business and financial interests and could collpase totally if any Executive Branch organization was allowed to document the scam known as the insurance business in the US. Ever ask why almost 40% of policy premiums in the National Flood Insurance Program go to the private companies when their actual costs are less than 3% of premium. Another not-so-hidden subsidy to the insurance business just like health care?
William R. Cumming Posted Tuesday, December 1, 2009 3:26 AMOur nation’s health care system certainly needs adjustment, but not these wholesale changes that dismantle a system that provides the best medical care in the world. The proposed bills create far-reaching negative impacts on our freedom of choice, and will negatively affect health care availability, quality, cost, and add to the ballooning deficits being rapidly created by the Obama administration and congressional Democrats. The public option is wrong, funding abortion is wrong, government meddling in health care is wrong – period.
The government should stick to “governing” and stay out of health care decisions and management. Passage of the proposed health care bill, even with compromise, sets a very dangerous precedent that wrongly leads to a socialist, government controlled/rationed system. Fining citizens or businesses for not choosing government mandated insurance is unconstitutional and runs counter to the foundation of our nation. This is far different than automobile insurance – mandating health insurance just because we exist eliminates freedoms guaranteed by the Constitution.
Reducing the cost of health care should be the focus of health care reform. Congress should pursue tort reform and the resulting high costs associated with unnecessary tests/procedures and malpractice insurance. Waste, fraud, and abuse of MEDICARE and MEDICAID should also be attacked. But we certainly do not need to add yet another government-run entitlement and health care sink hole to the mix.
Write your Senators to ask that they oppose the dangerous and socialistic health care proposals being hastily pushed by individuals that obviously have no desire to rationally address the real problems. We need to oppose these proposals to socialize our health care, wrongly place the government in a decisional role for medical care, and over-regulate a free market system. Americans have Constitutional rights - we should expect elected officials to support and defend those freedoms.
Elected officials inclined to support the current health reform bill need to know that the American public is NOT HAPPY about what is being foisted on them. We should actively and aggressively fight to defeat any elected official that votes for the proposed bill during their next election – not a threat, a promise.
American Posted Tuesday, December 1, 2009 9:39 AMDoes health care reform really have any chance now after the political defeat in MA?
Kyle Jackson Posted Saturday, January 23, 2010 10:09 AM