As much attention as the draft health care restructuring bills have received, so much has been missed in the thousands of pages of proposed legislation. It is not an exaggeration to say that these proposals create numerous and layered levels of new bureaucracies, on top of the expansion of existing layers of government.

The draft bill proposed by the Senate HELP Committee creates the following new bureaucracies. This is just a sample, and is not a complete list:

Sec. 174. Negotiated Rulemaking Committee and Facilitator
Sec. 187. Commission on Key National Indicators
Sec. 211. Patient Safety Research Center
Sec. 212. Community-based Multidisciplinary, Interprofessional teams
Sec. 219. Center for Health Outcomes Research and Evaluation
Sec. 229. Office of Women’s Health
Sec. 301. National Prevention, Health Promotion and Public Health Council
Sec. 411. National Health Care Workforce Commission
Sec. 430. Surgeon General Ready Reserve Corps
Sec. 511. Health Care Program Integrity Coordinating Council

Deep within the text there are innumerable new studies, rulemaking requirements, grants, programs, and other provisions which will expand existing bureaucracies. And this is just the Senate draft, which is barely half as long as the House version. Here are some examples (not a complete list) from the Senate draft of grants to fund private bureaucracies:

Sec. 212. Grants to establish community health teams to support a medical home model.
Sec. 213. Grants to implement medication management services in treatment of
chronic disease.
Sec. 321. Community transformation grants.
Sec. 412. State health care workforce development grants.
Sec. 426. Grants for State and local programs (to increase health care workers)
Sec. 436. Mental and behavioral health education and training grants.
Sec. 454. Workforce diversity grants.

And here are some new programs (again, just a sampling), which will require a combination of government and private staffing to administer:

Sec. 217. Program to facilitate shared decision-making.
Sec. 220. Demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals.
Sec. 311. Right choices program.
Sec. 334. CDC and employer-based wellness programs.
Sec. 422. Nursing student loan program.
Sec. 423. Health care workforce loan repayment programs.
Sec. 424. Public health workforce recruitment and retention programs.
Sec. 425. Allied health workforce recruitment and retention programs.
Sec. 426. Grants for State and local programs.
Sec. 444. Youth public health program.
Sec. 455. Primary care extension program.

The Senate draft is titled the ‘‘Affordable Health Choices Act’.’ It should be titled the “Bureaucracy Expansion Act of 2009.”

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