Obamacare's Bureaucracy Nightmare

There's no way to know where it will end.

We now see how the regulatory bureaucracy works—or probably can’t work-- and how it “may well push us into the single-payer health care system,” Grace-Marie Turner astutely pointed out Aug. 26 in the Detroit News. Turner is president of the Galen Institute, a research organization focusing on health policy. Under a single-payer system, the federal government would be the paymaster making the medical decisions.

Three influential House Democrats are now pushing for a public option (single-payer). ModernHealh.com reported July 22. Rep. Pete Stark (D-Calif), chairman of the House Ways and Means Health Subcommittee, is leading the movement. The “public option offers lower cost competition to private insurance companies,” added Rep. Lynn Woolsey (D-Calif ) co-chair of the Congressional Progressive Caucus. Rep. Jan Schakowsky (D-Il), is the third Member.

Even before a single-payer system could evolve, ObamaCare has the potential to topple from bureaucratic overload. Uncountable unelected and untested bureaucrats will be making life-affecting decisions. At this stage, not even experts who have pored over the 2,000-plus-word law know how many bureaucracies are hidden away in the ObamaCare statute. According to Politico no one can figure out exactly how many new agencies ObamaCare will spawn once it comes into full effect. Congress authorized a “self-perpetuating bureaucracy, one that can expand on its own and make determinations far outside of the boundaries Democrats promised during the ObamaCare debate.”

A Congressional Research Service Report, “New Entities Created Pursuant to the Patient Protection and Affordability Care Act (PPACA) is a dramatic eye-opener. Curtis W. Copeland earnestly attempted to compile and briefly explain the pieces and parts of the regulatory jungle in a 40-page report in July. In his summary section, author Copeland, described as a specialist in American National Government, writes:

Some of these new entities are offices within existing cabinet departments and agencies, and are assigned certain administrative or representational duties related to the legislation. Other entities are new boards and commissions with particular planning and reporting responsibilities. Still others are advisory bodies that were created to study particular issues, offer recommendations, or both. Although PPACA describes some of these new organizations and advisory bodies in detail, in many cases it is impossible to know how much influence they would ultimately have over the implementation of the legislation.

This report describes dozens of governmental organizations or advisory bodies that are mentioned in PPACA but does not include other types of entities...(e.g. various demonstration projects, grants, trust funds, programs, systems, formulas, guidelines, risk pools, websites, ratings areas, model agreements, or protocols)....The precise number of new entities that will ultimately be created...is unknowable....PPACA significantly increased the appointment responsibilities of the Controller General of the United States, and it is unclear how the Government Accountability Office (GAO) will be able to independently audit entities whose members are appointed by the head of GAO.

Seemingly always conscious of racial matters, an example of the minority health provision that the CRS analysis mentions “requires the heads of six separate agencies within Health and Human Services to each establish their own offices of minority health.”

This astonishingly frank description of the law’s provisions reminds one of Shakespeare’s Act 3, Scene 4 when Lady Macbeth says “You have displaced the mirth...with most admired disorder.” A law perhaps admired by some in Congress, but certainly in disorder.

The Center for Health Transformation (CHT), founded by former House Speaker Newt Gingrich, estimated 159 new offices, agencies, and programs created by the health law, Politico reported Aug. 3. “Even in the few cases in which the PPACA set explicit creation dates for organizations, the consequences for missing these deadlines remain unknown.” The law’s provisions “vary dramatically in specificity.” It states a lot about some provisions, but a little about many other provisions. “Some have been authorized without any instructions on who is to appoint whom, when that might happen and who will pay.”

Gingrich’s CHT lists the sections of the law and page numbers for the 159 programs it finds in the ObamaCare law as well as the department or agency which would seem to logically oversee the specific provisions and programs. Matters to be regulated range from grants for women with postpartum depression, to grants for long-term care ombudsmen, whose duties are vague. Five separate major programs deal with women’s health. Section 3509 (a), for instance, says PPACA "transfers all functions and authorities of the existing Office of Women’s Health of the Public Health Service. Located within the Office of he Secretary of HHS; no creation date specified...PPACA authorizes such sums as may be necessary for FY 2010 through FY 2014. Composition of the office not specified; headed by a director, who is appointed by and reports to the director of CDCP [Centers for Disease Control and Prevention]." No date specified for appointment of director.

For the Office of Minority Health, the CRS analysis says: "PPACA transfers existing office within the Office of Public Health and Science of the Office of Secretary. No transfer day specified. Composition of the office not specified. Office headed by Deputy Assistant Secretary for Minority Health, who shall report directly to the Secretary (of HHS). Office is to 'retain and strengthen authorities...for the purpose of improving minority health and the quality of health care minorities receive and eliminating racial and ethnic disparities.' Submit a report to 'appropriate committees of Congress by 03/23/11 (and biennially) summarizing agency activities.'"

Section 3012 (a), as described briefly by the CRS, is called “Entities to be established by the President. The President shall establish...Interagency Working Group on Health Care Quality. No location or creation date specified....Composed of senior level representatives from HHS, CMS, NIH, CDCP, FDA, HRSA, AHRQ, SAMHSA, and ACF, 13 other specified departments and agencies, and any other agencies selected by the President...” (This large assemblage of “worker bees” is to report to Congress by 12/31/10 and annually thereafter.)

Copeland notes that in a number of cases, no mention is stated regarding the management, when a provision will cease to exist and the amount and timing of appropriations. These “may have significant implications for...agency discretion in the implementation of PPACA.” Elsewhere, he says, in other cases, PPACA provides a general description of the new organization, but permits substantial discretion regarding where the new entities are to be positioned.....Much more commonly, however, PPCAC does not indicate in either specific or general terms where the newly created entities are to be established.....Where specific duties are not delineated...those responsible for leading these organizations (and those responsible for appointing those leaders) appear to have substantial latitude in determining how the organizations will operate, and for what purposes.” In other words, faceless bureaucratic rule will be the order of the day.

Single-payer health care is financing the delivery of universal health care to an entire population through a single insurance pool, typically government regulated, according to wikipedia.org. The disadvantages of a single payer health system are the loss of choice, and inevitably increased expenses that are typical with government programs. We already have a single-payer system with Medicare, which certainly doesn’t cover everything, including routine dental care, dentures, hearing aids and exams for fitting hearing aids, cosmetic surgery, and acupuncture, for example. But we will spend about $375 billion for it this year. In a National Bureau of Economic Research Study, authors comparing the U.S. and Canadian Health Systems said that “while it is commonly supposed that a single-payer, publicly-funded system (as Canada has) would deliver better health outcomes ...than a multi-payer system with a private component, their study does not support this view. Pap smears (for women) and PSA screenings (for men) were more frequent in the U. S.  And the rate of cancer detection was higher in the U.S., for example. As George Will wrote in his July 11 column, “The new health care legislation is a step toward elimination, by slow strangulation, of private health insurance and establishment of government as the ‘single payer.’”

A key bureaucrat in ObamaCare is Dr. Donald Berwick, who heads the federal Medicare and Medicaid Services (CMS) and says he loves the single-payer system, as reported July 27 by CNS News.com and others. Berwick was quoted as saying, like a single-minded bureaucrat, “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That’s for leaders (translation: know-it-all bureaucrats) to do.”

Before his election, Obama said. “I happen to be a proponent of a single-payer universal health care program. But as we all know, we might not get there immediately.” What makes us think he has changed his mind? And remember what Sen. Tom Harkin (D-Iowa), a fervent proponent of the public option, said in the health-care debate last December “What we are buying here” is a “starter home.” He said, “At some point in the near future we’re going to have some sort of public option.”