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Government Executive Editor in Chief Tom Shoop, along with other editors and staff correspondents, look at the federal bureaucracy from the outside in.

Questions After the Health Care Speech


So, I watched President Obama's speech last night, and while I'll leave the political prognostication to others, there was one substantial omission in the speech that I want to look at a little bit. Obama explained in detail what his proposal for health care reform would do, and provided a scenario for how he would pay for it. But he didn't talk about how it would be done. Are we going to have a new agency? Are existing federal employees going to be expected to do some of the tasks that would be required under the current plan? These aren't minor questions. They impinge on Obama's ability to do what he wants to do, and the cost at which he wants to do it. From the text of the speech, these are the tasks that seem like they'll have to be performed:

1. Make sure that insurance companies are complying with the new rules that bind them, including covering preexisting conditions.

2. Manage the health care exchanges that will offer insurance to those who don't currently have it.

3. Issuing tax credits to low-income purchasers of insurance.

4. Somehow "immediately offer[ing] low-cost coverage that will protect you against financial ruin if you become seriously ill." (This is the part of the plan that I think most needs to be explained administratively. Is there a deal with a company in the works? A program set up by HHS that could start functioning immediately?)

5. Enforcing the mandate to purchase insurance.

Those are all substantial tasks that will touch far more than the 40 or however-many million Americans are currently uninsured, and it's going to take a huge amount of work to make it happen. I'm genuinely unsure as to whether it would make sense to consolidate all of these functions in an independent agency, or one that would be overseen by the Department of Health and Human Services. At minimum, this is going to require a huge number of man-hours, and I can't see those work-hours coming out of existing federal employees' time. These tasks are too specialized and too large to just be slotted in somewhere. I think the question of not just what would happen, and not just what it would cost, but how it would happen is an important one, both politically and operationally.

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