To read the Czar’s review of HR 3200, pages 801-900, please click here.

One of the sticking points the Democrats have had is the undeniable question: who the hell would want to be a doctor anymore? The solution is quite elegant: HR 3200 will build a Corps of medical professionals. Not like a Marine Corps. More like a Peace Corps. It shall be known as the Public Health Workforce Corps, or simply “the Corps.” I love the Corps, they’ll surely bellow.

There will be a regular corps and a reserve corps, supplemented with “civilian employees.” Oddly, no use of the word cadre. The Director of the CDC shall instruct the Secretary where to place or assign these Corpmen. Aha, that explains it: this is a paramilitarized medical group, obedient to the President, not to the patient. And we’ll learn, it includes doctors, nurses, veterinarians, dentists, lab technicians, and anyone who wears white coats.

No doubt these folks will be staffed anywhere and everywhere regular medical staff need government minders.

We then move on to how some of the outrageous sums of money will be spent: on grants and loans to medical personnel to learn additional languages, take diversity training programs, discover innovative interdisciplinary care such as mental health or oral health, and so on (pages 912-930).

Thereafter, we jump to Prevention and Wellness, which talks about Prevention and Wellness so thoroughly that every consideration of Prevention and Wellness is listed as it pertains to Prevention and Wellness…to the point that the Czar is reminded of that guy you know who tends to repeat incessantly whatever technical phrase he just learned so that he can sound smart.

We talk about taskforces to explore the subject, reviews of existing facilities to perform gap analyses, research on it, delivery of it, and review of it—just so you know that if anyone believes Prevention and Wellness is essential to good medicine, then ObamaCare has got it nailed, baby!

We then conclude with some disquieting information on Best Practices, curiously billed as “Quality and Surveillance.” As you expect, the goal is here is to watch everything going on in medicine and identify all the best practices—the best ways of doing common tasks—reporting them, and then enforcing them to all other areas. You know, on the one hand, it seems odds that you would need to enforce best practices: usually folks, when shown a better way to do something, either adopt it wholesale or adapt it to their unique environment. But a key element of Best Practices, at least from a business perspective, is to know what the goal is. Best practices for what? Speed? Cost? Simplicity? Documentation? Liability? Without knowing what the x is in “best practices to achieve x,” this becomes another minefield for abuse. Think this through, as its authors did not: a medical procedure can be done in different ways, based on the desired goal. A best practice for speed might be using expensive Coban-type wrapping around wounds. A best practice for cost might be using thin gauge gauze. A best practice for liability might be irrigating a wound with purified water regardless of bleeding, employing a clotting agent, adding a polysporin-type ointment, 2 x 2 squares, followed by a Coban wrap. Or a best practice for maintaining discipline to the government cause might be extensive documentation to justify everything the orderly did to ensure that High Quality Prevention and Wellness was achieved, followed by board review. Which is it?

See where the Czar is going with this? Someone heard the buzzword Best Practices and decided to jam it in here as a panacea for ensuring some uniformity of healthcare delivery. Of course, this is asinine if you don’t understand how Best Practices work. The bill author clearly does not.

The Czar cannot help but be suspicious that a Best Practices program will control or restrict the decisions made by doctors and nurses, someday, somehow, somewhere. This suspicion is especially fueled by the control factors that follow seemingly for no reason. These include outsourced federalization of school nurse’s offices in a school based healthcare settings (§2511), national registration of medical devices (§2521), and federalization of nursing programs to ensure nursing shortages are addressed (§2531). The last, especially, works with union labor to overpower decision-making by management.

The listing of programs to cover even more trivial aspects of healthcare go well past any consideration of healthcare reform. Is it essential that a school nurse be federalized? How much does Timmy co-pay for the nurse to give him a bandage during a recess wipe-out?

As we end the 10-part review, the last 117 pages are a little unnerving. A paramilitary medical corps? Prevention and wellness enforcement? Best practices billed as surveillance? Federalization of seemingly trivial aspects for purposes of control consolidation?

The Czar will wrap this up tomorrow with some conclusions.

The Czar of Muscovy

Божію Поспѣшествующею Милостію Мы, Дима Грозный Императоръ и Самодержецъ Всероссiйскiй, цѣсарь Московскiй. The Czar was born in the steppes of Russia in 1267, and was cheated out of total control of all Russia upon the death of Boris Mikhailovich, who replaced Alexander Yaroslav Nevsky in 1263. However, in 1283, our Czar was passed over due to a clerical error and the rule of all Russia went to his second cousin Daniil (Даниил Александрович), whom Czar still resents. As a half-hearted apology, the Czar was awarded control over Muscovy, inconveniently located 5,000 miles away just outside Chicago. He now spends his time seething about this and writing about other stuff that bothers him.