"This is just one sliver of it, one aspect of it," President Barack Obama quipped, upon word on August 16, 2009, that his administration is supposedly revisiting the Public Option of its proposed healthcare legislation. Indeed. For virtually missing from the nationwide dialogue on President Barack Obama's call to reform healthcare as we know it, is any detailed discussion as to how it would essentially operate and be structured; slivers and all.
Perhaps such details have wisely remained absent, as the proposed infrastructure, as laid out primarily in the House of Representatives' H.R. 3200, known as America's Affordable Health Choices Act of 2009, would not only change healthcare for every American, but would reconstitute its delivery system both for the private sector as well as federal agencies, some of which have yet to be formed.
Inducing Americans into believing that of which fairy tales are made is at worse deceitful and at best disingenuous:
"But what we'll do is, we'll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies. And so, that approach, I think is what is going to allow people to stay involved in this process."
- Presidential Candidate Barack Obama (Cluster, VA 8/21/08)
Unlike federal programs that may less directly impact taxpayers, an individual's healthcare encompasses very personal and vital information that will be embedded in a complex new system utilizing multiple federal and state agencies in new and unprecedented ways. Such cannot simply be mandated by way of politics-as-usual.
No matter how badly the president and the Democratic Party apply strong-arm tactics to dictate passage of their healthcare legislation, it is such recalcitrance that flies in the face of representative government or good government, and improperly denies the American people of full disclosure on matters so vital to their personal well-being.
This series of reports will attempt to highlight those issues pertinent to Americans that are not being covered clearly, if at all, by the mainstream media nor by elected officials or lawmakers; that which depicts the elemental infrastructure for the implementation of this immense and controvertible proposed body of law.
The proposed layout of agencies or its hierarchy by the Obama administration and presently encased in H.R. 3200 and its various renditions thereafter, is draconian in nature. It would encompass up to 31 new federal programs, commissions and agencies, to be touched upon in this report.
Also, keep in mind, that all involved agencies, commissions and appointees will either have some type of systemic control of or access to Electronic Health Records (EHR), which will be a requirement for all healthcare providers and patients; that which is our most personal healthcare information. It is a mandate of the American Recovery and Reinvestment Act of 2009, (ARRA) also referenced as the stimulus package, which became law in February 2009. Such will be more fully covered in the 2nd report of this series.
By now, in the early Obama administration, many Americans are well aware that a broad-based change in the way in which they will access medical care and its delivery system in the United States is coming and in an aggressive manner. But it also requires change in the way the federal government shall be retrofitted in order to deliver such medical care to all.
And it has been seemingly decided by lawmakers and from those on-high that key words such as expenditures, cost containment, choice and privacy rights are no longer allowed into any honest discussion. Unfortunately, the American people will witness unabated unilateral healthcare reform measures, many of which will only be realized by future dates-certain, which will be provided subsequent to such legislation becoming law.
Yet, the term reform falls far short of its intended consequence. For not only will there be an expanse of federal mandates over Americans' personal healthcare records and data, but necessary systems required to protect such data are still being discussed as we speak, for an initial rollout as early as 2011.
H.R. 3200, as well as its various renditions in both the U.S. Senate and the U.S. House of Representatives, all provide for the restructuring of certain agencies, new cabinet secretaries, committees, appointees and councils, as key contributors to the impending bureaucratic upheaval. To wit, reinventing Medicare and Medicaid with new conditions for each state to embody in their own statutes.
Key to the new infrastructure is the White House's heavy-handed dominance in the ultimate plan that waits for ratification by the Congress. The conglomerate for oversight and rule making will firstly stem from hand-picked White House czars, executive branch appointees, and White House and agency committees all chosen by President Obama. Essential to note, however, is that a majority of these appointments by the White House are out of the jurisdictional oversight of the U.S. Congress, nor require confirmation by the U.S. Senate.
Thus far, both the House and the Senate Democratic majority has backed such a re-engineering plan, also considered in the interest of reform. And it will impact multi-levels of both federal and state governments' current systems.
Wide discretion has been awarded the executive branch in the Obama administration thus far, and in this, for purposes of healthcare reform. But the White House itself is not set up to administer or oversee agencies and legislation. That is the reason the U.S. Congress exists and why cabinet level officers are picked and confirmed by the U.S. Senate.
And it is these types of legal complexities and knowing exactly which body of government will be looking out for constituents' concerns, only heightened by an issue as compelling as their own personal healthcare.
And let us not forget the admission by many lawmakers, however only recently, that they do not read proposed legislation, suffer its details nor consider the future impact it will have on the American people. And in this case, they will not even be consumers of such new healthcare legislation, as their own platinum healthcare plan remains intact.
Most notably, the legislation will give new and unprecedented power to the U.S. Surgeon General, which historically has been a position of advocacy, as an appointee by the president, rather than one that yields administrative power over other agencies or officials. There will also be a Health Choices Committee, appointed by the president, a Health Exchange agency, and formidable roles by both the Internal Revenue Service (IRS) and the Department of the U.S. Treasury, each with new directives and capacities specific to healthcare.
In addition, Senator Jay Rockefeller (D-WV) has recently introduced legislation to expand the role of the Medicare Payment Advisory Commission, (MedPAC) for determination and implementation of Medicare reimbursement policies. All the more remarkable, at such time in our history, that Senator Rockefeller believes that "It's time to move MedPAC into the executive branch .... Congress has proven itself to be inefficient and inconsistent in making decisions about provider reimbursement under Medicare."
Furthermore, Rockefeller believes, "Establishing MedPAC as an independent executive branch agency - which can only change through an act of Congress - is the cornerstone of improving our delivery system reform."
Therefore, MedPAC will solely be under the auspices of the White House through a five-member independent Medicare Advisory Council, which by mandate would produce two reports per year, establishing Medicare rates for physicians, hospitals, nursing homes and medical equipment.
MedPAC will be remodeled after the Federal Reserve Board. And the only jurisdiction the U.S. Congress would have is to block a recommendation by resolution, provided it is done within 30 days.
But the greater veto power would rest with the White House. Presently, MedPAC operates in an advisory capacity only. If that does not remain the case, then MedPAC would act unilaterally without any accountability to the U.S. Congress.
Additionally, under Rockefeller's legislation, Congress would have even less authority, requiring a 3/5 majority of both the House and the Senate prior to overturn any payment decisions recommended by MedPAC. The MedPAC Council's priority would be to reform payment rates healthcare providers receive for services for the elderly and the disabled. Secondarily, to date, private sector insurance rates generally follow the established rates approved for Medicare for their own customers.
A Health Choices Commissioner, also appointed by the president, would oversee a new independent agency noted as the Health Choices Administration.
It would be the regulatory agency of health insurance compliance. It does not provide for a collaborative effort with the various states and their set legislation concerning healthcare and would fundamentally require them to abdicate their authority to the federal government.
The new Health Choices Administration would also control the new Health Insurance Exchange, noted in H.R. 3200, Section 201, Title II, which calls for the Congress to establish such under the power of the Health Choices Commissioner. A Health Choices Committee, also appointees of the president, would advise the Health Choices Commissioner on crucial matters such as whether to recommend, for example, expenditures for medical procedures or funding for known cures for specific diseases.
The Health Choices Commissioner must establish "standards for and accept bids from qualified health benefit plans and negotiate and enter into contracts with these qualified health benefit plans, which must offer at least 3 different levels of benefits that are statutorily required with high degree of specificity."
The Public Option, one of the more controversial elements of the drafted legislation in both the House and the Senate at present, will be overseen by the Health and Human Services Secretary and will involve both the IRS and the Department of the Treasury taking on brand new roles.
And central to the distribution and flow of patients' confidential medical records will be how it will be accessed throughout the country and the federal government, as mandated in ARRA. Presently, two committees are rushing to suggest a working framework, initially, for how health information systems shall at least be certified.
The National Coordinator for Health Information Technology, David Blumenthal, also a presidential appointee, has wide and sweeping power to make such decisions on IT, along with input from Secretary of Health and Human Services (HHS) Kathleen Sebelius, concerning not only how information will be disseminated but how it will be protected when shared.
But key to centralizing the exchange of medical records is a set of criteria for myriad software applications to be used by healthcare providers. And Blumenthal expects to unveil a framework for such certification guidelines by September 30, 2009.
Importantly, certification of such applications has a direct bearing as to whether Medicare and Medicaid providers will be appropriately reimbursed, a maximum of $44,000.00, if at all, for their cash outlay costs for the required certified software, which can cost an average of $300,000.00 for a 3 physician practice. The software will also be used to receive payments from Medicare and Medicaid for services rendered.
What remains to be decided is if there will be numerous certifying agencies or an additional new oversight agency. Yet, protection of patients' rights in light of collection and dissemination of their medical information without systems already in place to protect such data has already spurred legal action by patients' rights advocates.
They wish to legally block allocation of the $22 billion provided in ARRA for EHR development. The concern is possible violations of the Health Insurance Portability and Accountability Act (HIPAA) as well as possible violation of Federal Common Law.
As the federal government continues to seize more power, as more and more oversight is designed to originate from the executive branch in the White House, it will but leave states left to succumb to federal authority.
To wit, the Health Choices Commissioner's authority will encumber the ability of states to rely upon their own reforms for health insurance in their local markets, as they see fit. It will not be a relationship of mutual interests but rather one of domination and control by federal statute. And if the word nationalize is offensive to some, then try on the word federalize; perhaps the more correct legal term, yet just as much of a threat to states' sovereignty.
And finally, this initial report has been an attempt to bring some clarity to an enormous change forthcoming, not only in how healthcare will be consumed by Americans, but the extreme and unprecedented governmental changes put forth in the process and in how the federal government and the White House will conduct the peoples' business going forward. And that sets the foundation for all aspects of the future of U.S. governance, its management, oversight, accountability and its relationship to the private sector.
Part 2 of this series shall venture into providing more detail of the proposed responsibilities or powers many these fore-mentioned agencies, commissions, appointees, councils and committees will have, or those that have at least been thus far disclosed in H.R. 3200.
And whatever you may hear or read over the next few weeks, keep in mind that you are only hearing but a very small aspect of the real facts; intentionally so.
Copyright: 2009 Diane M. Grassi