Diane M. Grassi
New Healthcare
Infrastructure Would Subjugate Americans
September 7, 2009
This is the first in a
series of articles by Ms. Grassi of the issue of healthcare
“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, 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 be
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.
