Wednesday, November 11, 2009

The House Health Care Bill and Bureaucratic Duplication

I don't mind health reform. In fact, I believe we need it. But when reform bills fund projects that already exist, or fund special projects for other non-health care professionals, like lawyers, I have to wonder what Congress is doing.

The recently passed House bill (H.R. 3962 pdf) contains a multitude of grants and "demonstration projects." I wasn't sure what some of these grants were meant to support, so I looked them up. I was surprised to find that many of the grants duplicate programs or departments already in place. While this list is by no means comprehensive, I thought I would provide a few comments on a few of these grants shown in italics):
  • Grant program for "community-based collaborative care"
    (Seems this is really a grant to fund telemedicine programs and HL-7 hospital coding standards so computers can talk together. While ultimately this should be a good thing, the grant actually has little to do with collaboration of health care in the community right now.)

  • Grant program to develop infant mortality programs
    (Why is more money needed when a department already exists for this?)

  • Grant program for reducing the student-to-school nurse ratio in primary and secondary schools
    (Forget teachers, stick with nurses for schools I guess)

  • Grant program so "No Child is Left Unimmunized Against Influenza"
    (And yet, I'm sure we'll soon have a Pay for Performance measure for that)

  • Grant program to implement medication therapy management services
    (Once again, never mind this has already been done)

  • Grant program for community-based overweight and obesity prevention
    (been there, done that, but it seems we can never get enough of this.)

  • Sec 2221 (pg 1246) Grant program for nurse-managed health centers
    (APN's doing "primary care." Can't help wonder why the AMA loves this bill. Where's there support of what we do?)

  • Grant program to support demonstration programs that design and implement regionalized emergency care systems
    (already being done in certain communities. The natural question is how much money is anticipated for the multitude of communities in need.)

  • Grant programs to prepare secondary school students for careers in health professions
    (What ever happened to "Career Day?")

  • Grant programs for community prevention and wellness research (What is "wellness" anyway?)

  • Grant program to promote positive health behaviors in underserved communities
    (Sounds like attitude adjustment training: "Don't worry, be happy," I guess. Interesting that Senate Bill 319 already addresses this for women and children. Men, it seems, don't matter.)

  • Grant program for state access programs (These grants already exist, too!)

  • Grant program for national independent monitor pilot program for skilled nursing facilities and nursing facilities
    (What is this? An independent monitor to "oversee" large chains of skilled nursing facilities for some defined period of time. What about Medicare's Nursing Home Compare program?

  • Grant program for training in dentistry programs
    Already exists

  • Grant programs for innovations in interdisciplinary care (Yep, got this in place already, too)

  • Grant program for health insurance cooperatives
    (Helpful cash for insurance interests

  • Grant program for wellness programs to small employers
    (I can hear it now: "Don't drink, eat or smoke too much..." and place some nice posters on your wall...)

  • Grant program to disseminate best practices on implementing health workforce investment programs
    (A bill already exists on the House floor: H.R. 2810)

  • Grant program for national health workforce online training
    (looks like medical schools might be in trouble!)

  • Grant program for state alternative medical liability laws
    (a grant to see if liability reform might work - fair enough - but will it change anything?)

  • Grant program for public health infrastructure
    (um, don't we already have an Office of Public Health and Science?)

But the "demonstation project" that was created specifically for lawyers: Section 2537 (pg 1464) - a demonstration project of "grants to medical-legal partnerships" was most concerning.

What's this you ask? Is it for health care?

Not really. It's actually a grant just for lawyers who practice poverty law so they can "assist patients and their families to navigate health care-related programs and activities" for the next five years. Never mind that's why we have doctors, nurses and social workers.

Bottom line, there are plenty of places this bill could (and should) be cut to save costs.

But hey, when it comes to health care reform, it seems there's something for everyone when the taxpayer's paying!



Michael Kirsch, M.D. said...

Wes, the grant to study liability reform has some intriguing provisions. The states are prohibited from enacting caps on non-economic damages and cannot address lawyers' fees. What's left? This is analagous to sutdying sepsis with all medical tools available except antibiotics.

Anonymous said...

Doctors and nurses are available to help the poor navigate the morass of health care programs and regulations? Really? You might want to rethink that claim.