Tuesday, August 11, 2009

Section 3131 of H.R. 3200 Health Care "Reform" Bill - Preventive Care

Looking at various sections of the health care "reform" bill H.R. 3200, you can't help noticing some militaristic terms. You have "National Health Service Corps" (Section 2201) and "Public Health Workforce Corps" (Section 340L). You also have lots of "force" - workforce, task force. And "community organizing" is not forgotten, and there are lots of sections to promote "community"-based health care (whatever it means). Section 2214 Training of medical residents in community-based settings, Section 3132 Task force on community preventive services, Section 3142 Community prevention and wellness research grants, etc., etc.

(By the way, do we, the general public, even know what the government mean by "Community"? The President may know very well personally, as he, as an attorney, represented one such "community organization" (ACORN), but do we know? I haven't find anywhere where the word "community" is defined.)

That aside, here's another "force" in Section 3131 TASK FORCE ON CLINICAL PREVENTIVE SERVICES. Ardent supporters of the bill have said the "reform" will provide easy and low/no cost access to preventive health care. Let's see if that's the case.

`(a) In General- The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall establish a permanent task force to be known as the Task Force on Clinical Preventive Services (in this section referred to as the `Task Force').

`(b) Responsibilities- The Task Force shall--
`(1) identify clinical preventive services for review;
`(2) review the scientific evidence related to the benefits, effectiveness, appropriateness, and costs of clinical preventive services identified under paragraph (1) for the purpose of developing, updating, publishing, and disseminating evidence-based recommendations on the use of such services;
`(3) as appropriate, take into account health disparities in developing, updating, publishing, and disseminating evidence-based recommendations on the use of such services;
`(4) identify gaps in clinical preventive services research and evaluation and recommend priority areas for such research and evaluation;
`(5) as appropriate, consult with the clinical prevention stakeholders board in accordance with subsection (f);
`(6) as appropriate, consult with the Task Force on Community Preventive Services established under section 3132; and
`(7) as appropriate, in carrying out this section, consider the national strategy under section 3121.

What an all-knowing Task Force it should be! And who will be the member of this Task Force?

`(d) Membership-
`(1) NUMBER; APPOINTMENT- The Task Force shall be composed of 30 members, appointed by the Secretary.

`(2) TERMS-
`(A) IN GENERAL- The Secretary shall appoint members of the Task Force for a term of 6 years and may reappoint such members, but the Secretary may not appoint any member to serve more than a total of 12 years.

`(B) STAGGERED TERMS- Notwithstanding subparagraph (A), of the members first appointed to serve on the Task Force after the enactment of this title--
`(i) 10 shall be appointed for a term of 2 years;
`(ii) 10 shall be appointed for a term of 4 years; and
`(iii) 10 shall be appointed for a term of 6 years.

`(3) QUALIFICATIONS- Members of the Task Force shall be appointed from among individuals who possess expertise in at least one of the following areas:
`(A) Health promotion and disease prevention.
`(B) Evaluation of research and systematic evidence reviews.
`(C) Application of systematic evidence reviews to clinical decisionmaking or health policy.
`(D) Clinical primary care in child and adolescent health.
`(E) Clinical primary care in adult health, including women's health.
`(F) Clinical primary care in geriatrics.
`(G) Clinical counseling and behavioral services for primary care patients.

`(4) REPRESENTATION- In appointing members of the Task Force, the Secretary shall ensure that--
`(A) all areas of expertise described in paragraph (3) are represented; and
`(B) the members of the Task Force include practitioners who, collectively, have significant experience treating racially and ethnically diverse populations.

In addition to these appointed 30-member Task Force, you get to have "Clinical Prevention Stakeholders Board", comprised of undetermined number of "stakeholders":

`(1) IN GENERAL- The Task Force shall convene a clinical prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in clinical preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services.

`(2) MEMBERSHIP- The members of the clinical prevention stakeholders board shall include representatives of the following:
`(A) Health care consumers and patient groups.
`(B) Providers of clinical preventive services, including community-based providers.
`(C) Federal departments and agencies, including--
`(i) appropriate health agencies and offices in the Department, including the Office of the Surgeon General of the Public Health Service, the Office of Minority Health, and the Office on Women's Health; and
`(ii) as appropriate, other Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary).
`(D) Private health care payors.

`(3) RESPONSIBILITIES- In accordance with subsection (b)(5), the clinical prevention stakeholders board shall--
`(A) recommend clinical preventive services for review by the Task Force;
`(B) suggest scientific evidence for consideration by the Task Force related to reviews undertaken by the Task Force;
`(C) provide feedback regarding draft recommendations by the Task Force; and
`(D) assist with efforts regarding dissemination of recommendations by the Director of the Agency for Healthcare Research and Quality.

Now, do you feel secure that you have a easy, timely access to preventive care? I don't. Appointed (=unaccountable) people deciding on the level of preventive care. All I see is bureaucracy heaped on top of bureaucracy. I don't see how this could be low-cost either, because we have to pay for these people. Members of theTask Force will be considered "special Government employees". Members of the Stakeholders Board won't be, but they (and Task Force members) will receive travel expenses and per diem. (Federal per diem rate in District of Columbia is between $229 and $297 max, depending on the time of the year.)

And remember, we don't have money. Just today alone, the U.S. Treasury Department auctioned $72 billion worth of Treasury debts. By the end of this week, the Treasury will have auctioned $210 billion Treasury debts. In one week. Why are we being goaded into this "reform" when we have no money? With government health care (Medicare, Medicaid) already broke, why should we trust the government with the rest of health care? So that the rest of health care can go broke as well? If the argument is that the private health care is broke, why should the government be trusted to fix it, given the sub-steller track record in Medicare and Medicaid?


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