Federal Government Can’t Be Audited – Part 3

….TakeThe Paranoid QuizWhat are you afraid of?

Premise: You probably thought that two bureaucracies (GAO and OMB) devoting resources to documenting the extent of all bureaucracies, and both failing in the attempt, seems pretty ridiculous. But let’s not forget the Congressional Budget Office (CBO). They too have been given a mandate to document all government bureaucracies. You’ll never guess the result. [/sarcasm] Predictably the CBO has also failed in its attempts to audit the whole of the federal government. But it doesn’t end with the CBO. In 1993 the Government Performance and Results Act (GPRA) was enacted to direct bureaucracies to prepare annual performance reports. Because of the shear volume of data that is produced, to expedite this process so that the data is actually useful, in 2011 the GPRA Modernization Act of 2010 was signed into law requiring that all bureaucracies make their reports machine-readable, (meaning that they be produced within data formats that actually make them useful). Not only has this been a failure in terms of the reports, but one would think that at least this might at least lead to a definitive list of all federal government bureaucracies. Nope – it too has utterly failed.

Question: So, after three bureaucracies plus updated legislation having failed to be able to document the size the big-mommy government, do you think that maybe – just maybe – big-mommy should go on a starvation diet and shed a few hundred bureaucracies?

[Scroll to bottom of page to read Conundrum, Explanation and Conclusion.]

The following list is of new Obamacare bureaucracies:

State basic health plan programs
State-based reinsurance program
Program of risk corridors for individual and small group markets
Program to determine eligibility for Exchange participation
Program for advance determination of tax credit eligibility
Grant program to implement health IT enrollment standards
Federal Coordinated Health Care Office for dual eligible beneficiaries
Medicaid quality measurement program
Medicaid health home program for people with chronic conditions, and grants for planning same
Medicaid demonstration project to evaluate bundled payments
Medicaid demonstration project for global payment system
Medicaid demonstration project for accountable care organizations
Medicaid demonstration project for emergency psychiatric care
Grant program for delivery of services to individuals with postpartum depression
State allotments for grants to promote personal responsibility education programs
Medicare value-based purchasing program
Medicare value-based purchasing demonstration program for critical access hospitals
Medicare value-based purchasing program for skilled nursing facilities
Medicare value-based purchasing program for home health agencies
Interagency Working Group on Health Care Quality
Grant program to develop health care quality measures
Center for Medicare and Medicaid Innovation
Medicare shared savings program
Medicare pilot program on payment bundling
Independence at home medical practice demonstration program
Program for use of patient safety organizations to reduce hospital readmission rates
Community-based care transitions program
Demonstration project for payment of complex diagnostic laboratory tests
Medicare hospice concurrent care demonstration project
Independent Payment Advisory Board
Consumer Advisory Council for Independent Payment Advisory Board
Grant program for technical assistance to providers implementing health quality practices
Grant program to establish interdisciplinary health teams
Grant program to implement medication therapy management
Grant program to support emergency care pilot programs
Grant program to promote universal access to trauma services
Grant program to develop and promote shared decision-making aids
Grant program to support implementation of shared decision-making
Grant program to integrate quality improvement in clinical education
Health and Human Services Coordinating Committee on Women’s Health
Centers for Disease Control Office of Women’s Health
Agency for Healthcare Research and Quality Office of Women’s Health
Health Resources and Services Administration Office of Women’s Health
Food and Drug Administration Office of Women’s Health
National Prevention, Health Promotion, and Public Health Council
Advisory Group on Prevention, Health Promotion, and Integrative and Public Health
Prevention and Public Health Fund
Community Preventive Services Task Force
Grant program to support school-based health centers
Grant program to promote research-based dental caries disease management
Grant program for States to prevent chronic disease in Medicaid beneficiaries
Community transformation grants
Grant program to provide public health interventions
Demonstration program of grants to improve child immunization rates
Pilot program for risk-factor assessments provided through community health centers
Grant program to increase epidemiology and laboratory capacity
Interagency Pain Research Coordinating Committee
National Health Care Workforce Commission
Grant program to plan health care workforce development activities
Grant program to implement health care workforce development activities
Pediatric specialty loan repayment program
Public Health Workforce Loan Repayment Program
Allied Health Loan Forgiveness Program
Grant program to provide mid-career training for health professionals
Grant program to fund nurse-managed health clinics
Grant program to support primary care training programs
Grant program to fund training for direct care workers
Grant program to develop dental training programs
Demonstration program to increase access to dental health care in underserved communities
Grant program to promote geriatric education centers
Grant program to promote health professionals entering geriatrics
Grant program to promote training in mental and behavioral health
Grant program to promote nurse retention programs
Student loan forgiveness for nursing school faculty
Grant program to promote positive health behaviors and outcomes
Public Health Sciences Track for medical students
Primary Care Extension Program to educate providers
Grant program for demonstration projects to address health workforce shortage needs
Grant program for demonstration projects to develop training programs for home health aides
Grant program to establish new primary care residency programs
Program of payments to teaching health centers that sponsor medical residency training
Graduate nurse education demonstration program
Grant program to establish demonstration projects for community- based mental health settings
Commission on Key National Indicators
Quality assurance and performance improvement program for skilled nursing facilities
Special focus facility program for skilled nursing facilities
Special focus facility program for nursing facilities
National independent monitor pilot program for skilled nursing facilities and nursing facilities
Demonstration projects for nursing facilities involved in the culture change movement
Patient-Centered Outcomes Research Institute
Standing methodology committee for Patient-Centered Outcomes Research Institute
Board of Governors for Patient-Centered Outcomes Research Institute
Patient-Centered Outcomes Research Trust Fund
Elder Justice Coordinating Council
Advisory Board on Elder Abuse, Neglect, and Exploitation
Grant program to create elder abuse forensic centers
Grant program to promote continuing education for long-term care staffers
Grant program to improve management practices and training
Grant program to subsidize costs of electronic health records
Grant program to promote adult protective services
Grant program to conduct elder abuse detection and prevention
Grant program to support long-term care ombudsmen
National Training Institute for long-term care surveyors
Grant program to fund State surveys of long-term care residences
CLASS Independence Fund
CLASS Independence Fund Board of Trustees
CLASS Independence Advisory Council
Personal Care Attendants Workforce Advisory Panel
Multi-state health plans offered by Office of Personnel Management
Advisory board for multi-state health plans
Pregnancy Assistance Fund
Value-based purchasing program for ambulatory surgical centers
Demonstration project for payment adjustments to home health services
Pilot program for care of individuals in environmental emergency declaration areas
Grant program to screen at-risk individuals for environmental health conditions
Pilot programs to implement value-based purchasing
Grant program to support community-based collaborative care networks
Centers for Disease Control Office of Minority Health
Health Resources and Services Administration Office of Minority Health
Substance Abuse and Mental Health Services Administration Office of Minority Health
Agency for Healthcare Research and Quality Office of Minority Health
Food and Drug Administration Office of Minority Health
Centers for Medicare and Medicaid Services Office of Minority Health
Grant program to promote small business wellness programs
Cures Acceleration Network
Cures Acceleration Network Review Board
Grant program for Cures Acceleration Network
Grant program to promote centers of excellence for depression
Advisory committee for young women’s breast health awareness education campaign
Grant program to provide assistance to provide information to young women with breast cancer
Interagency Access to Health Care in Alaska Task Force
Grant program to train nurse practitioners as primary care providers
Grant program for community-based diabetes prevention
Grant program for providers who treat a high percentage of medically underserved populations
Grant program to recruit students to practice in underserved communities
Community Health Center Fund
Demonstration project to provide access to health care for the uninsured at reduced fees
Demonstration program to explore alternatives to tort litigation
Indian Health demonstration program for chronic shortages of health professionals
Office of Indian Men’s Health
Indian Country modular component facilities demonstration program
Indian mobile health stations demonstration program
Office of Direct Service Tribes
Indian Health Service mental health technician training program
Indian Health Service program for treatment of child sexual abuse victims
Indian Health Service program for treatment of domestic violence and sexual abuse
Indian youth telemental health demonstration project
Indian youth life skills demonstration project
Indian Health Service Director of HIV/AIDS Prevention and Treatment
DC federal exchange
California state exchange
Colorado state exchange
Connecticut state exchange
District of Columbia state exchange
Hawaii state exchange
Idaho state exchange
Kentucky state exchange
Maryland state exchange
Massachusetts state exchange
Minnesota state exchange
Nevada state exchange
New Mexico state exchange
New York state exchange
Oregon state exchange
Rhode Island state exchange
Utah state exchange (small businesses only)
Vermont state exchange
Washington state exchange
Alabama federal exchange
Alaska federal exchange
Arizona federal exchange
Delaware federal exchange
Florida federal exchange
Georgia federal exchange
Illinois federal exchange
Indiana federal exchange
Iowa federal exchange
Kansas federal exchange
Louisiana federal exchange
Maine federal exchange
Michigan federal exchange
Mississippi federal exchange
Missouri federal exchange
Montana federal exchange
Nebraska federal exchange
New Hampshire federal exchange
New Jersey federal exchange
North Carolina federal exchange
North Dakota federal exchange
Ohio federal exchange
Oklahoma federal exchange
Pennsylvania federal exchange
South Carolina federal exchange
South Dakota federal exchange
Tennessee federal exchange
Texas federal exchange
Utah federal exchange (not including small businesses)
Virginia federal exchange
West Virginia federal exchange
Wisconsin federal exchange
Wyoming federal exchange

Conundrum: So what does Barack Obama do? He creates Obamacare, taking over another 1/6 of the national economy. [sheesh!!!]

[So, do you still agree with creeple that big-mommy government should just keep getting bigger and bigger?]

Explanation: The CBO has even given up attempting to assess the additional cost of Obamacare. They first estimated $1T, then $2T. The Senate Budget Committee, using the last CBO estimates calculated that Obamacare would actually cost an additional $2.6T over the first 10 years! However with all of the gerrymandering changes over the first year of the program Obamacare is now fiscally incomprehensible. President Obama claimed that Obamacare would save money [LOL!]. (Can you say, “liar”?) Yup, the CBO have thrown up their hands in the air and claimed that Obamacare is beyond their ability to calculate and already out of fiscal control, even though only a tiny fraction of it has been implemented at this time.

Conclusion: In regards to the immeasurable bureaucracies of big-mommy government one word describes a situation that should never need be applied to government – unfathomable.

Take The Paranoid Quiz – What are you afraid of?