The sheer volume of pages of the House version of the National Healthcare Plan have sent many a concerned individual screaming in the other direction.  Pages upon pages explain the functionality of various agencies, commissions, programs and committees.  Wait a minute!  I thought we were aiming to reduce the size of the government!

What many liberals don't realize is that Republicans want the health care issue addressed.  Our concern lies in the way Congress and the Obama Administration is going about ramming a healthcare package down everyone's throats without proper thought, planning and procedure.  I can envision a 23-year old intern typing away at a computer, holding the entire house of cards in his idealistic mind as he creates a landmark piece of legislation affecting every citizen in the U.S.  It's a frightening thought.

I've read 90 percent of the document, except the indices of course.  It's pretty heavy.  It's labor intensive reading that strains the brain and the heart with the huge loopholes and unbelievable number of new entities that will be created within our government.

At last count, I reached 27 new entities.  I've had vast experience with the federal government so I'm well aware how federal agencies and Congress work.  The creation of one agency creates a blooming bureaucracy that just doesn't go away ever.  You think the creation of an agency is bad?  Try committees too.  They need staffers and space to operate to produce reports and respond to constituents.  Think about programs.  Programs need administrators, space to operate, an operating budget and people to run the show for quality control and assurance.  Commissions require official appointment by someone in the Executive Branch of the government.  Then they need staff, space to operate, etc...you get the picture.

Programs, committees and commissions are not agencies.  Agencies are an entire different bird.  Agencies require layers, creating a chain of command from the lowest peon to the secretary of agency.  It's a nightmare of government expansion.  

Please note.  Just because individuals aren't interested in a gross expansion of the federal government doesn't mean we aren't concerned about the state of healthcare in our country.  It means we don't want more government.

One other point.  Portions, as in major portions, of the health care bill refer to existing law.  One wonders if the required amount of research went into investigating the statute or if anyone will ever check this.  This is a loophole that needs to be appropriately addressed by Congress and the Senate before anything reaches committee.

And now for the list compiled directly from the House Bill itself.  Please note that items in bold and italics indicate agencies, programs, committees or commissions that were never formally set up as an entity in the bill.  These items appear in the bill without indication of which agency will administer the entity or any delineating mission statements.  I've attempted to list where each entity reports to and basic functionality.  In some cases, text was taken directly from the bill to show the true ambiguity of the language.
 

Health Choices Administration - executive Branch of the Government

Public Health Workforce Corps - very little information.

Health Benefits Advisory Committee
* panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.
*Chaired by Surgeon General
*Members appointed by President who aren't federal employees.

Agency for Healthcare Research and Quality
*No mention of this Agency and what it will be doing.  First shows up on page 971.

Center for Comparative Effectiveness Research
* established under Agency for Healthcare Research and Quality.
* to conduct, support, and synthesize research with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically. (from bill)

Comparative Effectiveness Research Commission
*oversees Center for Comparative Effectiveness Research.
*reports to Secretary.

Task Force on Clinical Preventive Services
*Part of  Agency for Healthcare Research and Quality
*evaluation of Clinical services
*reports to Secretary - 30 members appointed by the Secretary.
    
Task Force on Community Preventive Services
* to conduct, research in priority areas identified by the Secretary in the national strategy (from bill).
*Secretary appointed, acts through Director of CDC.

National Advisory Committee
*shall collaborate with the advisory bodies at the Health Resources and Services Administration, the National Advisory Council, the Advisory Committee on Training in Primary Care Medicine and Dentistry, the Advisory Committee on Interdisciplinary, Community-Based Link ages, the Advisory Council on Graduate Medical Education, and the National Advisory Council on Nurse Education and Practice. (text from Bill)

Advisory Committee on Health Workforce Evaluation and Assessment
*not mentioned anywhere except in an index on page 857.

Health Care Comparative Effectiveness Research Trust Fund
*not mentioned anywhere except in a clerical amendment on page 829

Office of the National Coordinator for Health Information Technology
*first mentioned under the section describing duties for the Assistant Secretary for Health Information
*no mention of what this position involves.

Office of the Ombudsman for the Public Health Insurance Option
*new position.  Not defined.  

Telehealth Advisory Committee
*make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services members appointed by the secretary.

Medical Home Pilot Program

*reimbursing qualified patient-centered medical homes for furnishing medical home services.

Community-based Medical Homes
*secretary establishes criteria for these community based medical homes, which means some kind of oversight for this program.
*Termed a "pilot program" later in the documentation on page 470.

Quality Assurance and Performance Improvement Program (QAPI)
*established by the secretary for nursing programs.

Pilot program to develop, test and implement use of an independent monitor to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities

Compliance Programs for Providers of Services and Suppliers
* the Secretary shall establish procedures under which screening is conducted with respect to providers of services and suppliers described in such 12 paragraph.

Providers and suppliers to adopt programs to reduce waste, fraud and abuse

Primary Care Training Program
*Primary care training and capacity building program consisting of awarding grants and contracts

Accredited Professional Training Program
*including an accredited residency or internship program, in the field of family medicine, general internal medicine, general pediatrics, or geriatrics for medical students, interns, residents, or practicing physicians

Training of Medical Residents in Community-based Settings
*The Secretary shall establish a program for the training of medical residents in community based settings consisting of awarding grants or contracts

Training for General, Pediatric and Public Health Dentists and Dental Hygenists
*The Secretary shall establish a dental medicine training program consisting of awarding grants and contracts under this section.

Cultural and Linguistic Competency Training Program
*The Secretary shall establish a cultural and linguistic competency training program for health care professionals, including nurse professionals, consisting of awarding grants and contracts

Innovations in Interdisciplinary Care Training Program
*The Secretary shall establish an innovations in interdisciplinary care training program consisting of awarding grants and contracts.

Community Preventive and Wellness Services Program
*shall establish a program for the delivery of community preventive and wellness services consisting of
awarding grants to eligible entities.

Core Public Health Infrastructure Program
*establish a core public health infrastructure program consisting of awarding grants.

School-based Health Clinic Program
*The Secretary shall establish a school-based health clinic program consisting of awarding grants to eligible entities to support the operation of school-based health clinics.

National Medical Device Registry
*The Secretary shall establish a national medical device registry (in this subsection referred to as the
‘registry’) to facilitate analysis of postmarket safety and outcomes data on each device (implantable, life supporting and life sustaining).

Education Programs for Nurses and Health Care Workers
*partnership grant program to award grants to eligible entities to carry out comprehensive programs to provide education to nurses and create a pipeline to nursing for incumbent ancillary health care workers who wish to advance their careers.

And finally, we have this generic entry that gives the Secretary the ability to establish commissions, comittees, programs, offices, divisions, departments and units as he/she sees fit:

Generic duties of secretary to:
*The Secretary shall make grants to or enter into contracts with eligible entities to establish, maintain, or improve—
‘‘(A) academic administrative units (including departments, divisions, or other appropriate units) in the specialties of family medicine, general internal medicine, general pediatrics, or geriatrics; or ‘‘(B) programs that improve clinical teaching in such specialties.