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Health Care and Bureaucratic Influences

March 3, 2010

There have been a lot of studies, even comedic routines, where the evidence suggests many citizens are clueless about the operations of their government.

There’s little wonder why the health care debate is largely a simplistic point and counterpoint affair from both sides.

The real nitty-gritty of the 1,200 page health care document is far too complicated for lawmakers to decipher, especially since officials have but a scant grasp on how specific elements of the bill will be implemented, once passed.

The legislation itself is simply a framework of ideas, with the actual rules and regulations of the bill to be determined by federal employees at various agencies, not elected officials.

A few years ago, Ronald Reagan warned us about the power inherently invested, not in our elected representatives, but in civil servants and government bureaucrats.

Reagan was concerned about "a permanent structure of government insulated from the thinking and wishes of the people," and said giving a bureaucrat a new rule "is like handing a pyro-maniac a lighted match in a hay row."

Reagan was concerned about the expanding role of federal government employees, like those today, who may soon have the responsibility, and the power, to determine the implementation of the proposed health care legislation.

Reagan went on to say, "this is a structure which for all practical purposes is more powerful than our elected representatives."

People should be concerned that many elements in health care will likely be decided by faceless, nameless, government employees, and the decisions they make, will impact the access, and quality, of our care.

No doubt, as those rules are written, a nucleus of paid lobbyists will descend on federal agencies in an effort to influence the interpretation of the bill, and we can only assume that some of those lobbying efforts will be successful.

Interests from every industry affected by the legislation will be involved in the lobbying effort, including the insurance companies, doctors, health care providers/practitioners, hospitals, lawyers, dentists, outpatient care centers, diagnostic laboratories, and nursing care facilities.

One element of the bill that will be heavily lobbied is the "pre-existing medical condition" language, which will ensure that persons who have already been diagnosed with a medical problem cannot be denied health insurance.

This provision will require many rules, definitions, time frames, and other conditions to implement, and no doubt there will be several federal agencies involved in the decision making.

There are other areas (including medicare, doctor/hospital reimbursement, uninsured individuals, insurance costs) where it will be left to federal agencies to decide the requirements, rules, and regulations, and you can be sure, it won’t be a one-size fits all, either.

This process is often ignored by Congress, and receives scant attention from the media, yet the public will be forced to live with the decisions, often made by career civil servants.

There’s good reason for Congress to slow things down, and write each page individually, under a spotlight, visible, for all to see. This will ensure a health care bill that’s written by elected officials, not a cadre of government employees.

This could make for a good bipartisan start, too.