Coleman Robert
Pepperdine University School of Law, USA.
Issues Law Med. 2011 Fall;27(2):121-77.
This comment explores whether health care reform legislation establishes an administrative body effectively charged with the rationing of health care resources; insofar as it establishes a presidentially appointed Independent Medicare Advisory Committee (IMAC). IMAC would be charged with "making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health, and durable medical equipment." IMAC's recommendations would be implemented nationally, subject to a Congressional vote. Congress would be granted a thirty-day window to achieve a simple majority for or against the IMAC recommendations. Part I is an introduction. Part II of this article covers the history of American health care. It lays out the federal government's evolving role in the arena of public health and health care, starting in the mid-nineteenth century and continues up to the present day. Part III examines the existing process by which Medicare spending is controlled. This part focuses on the administrative procedures that control Medicare reimbursements. Part IV examines IMAC. This part discusses IMAC's statutory provisions and the administrative transparency laws IMAC would be bound to follow. The close of this part, draws on three analogies as a gauge for how IMAC will operate: Senator Tom Daschle's Federal Health Board (FHB) proposal; the administrative oversight of the Federal Reserve; and the United Kingdom's National Institute for Health and Clinical Excellence (NICE). Part V creates a snapshot of the U.S. health care system as it operates today. This part emphasizes cost, quality, and accessibility of health care, with comparisons to international and state-run health care systems. Throughout this article there are a number of words, phrases, and agencies that have been given acronyms. For convenience, an index of these acronyms is provided in an appendix following the article.
本评论探讨了医疗保健改革立法是否设立了一个有效地负责医疗保健资源配给的行政机构；具体而言，它设立了一个由总统任命的独立医疗保险咨询委员会（IMAC）。IMAC将负责“每年发布两份报告，规定医疗保险供应商（包括医生、医院、专业护理机构、家庭医疗和耐用医疗设备）的更新费率”。IMAC的建议将在全国范围内实施，但需经国会投票表决。国会将有30天的时间窗口，以简单多数票赞成或反对IMAC的建议。第一部分为引言。本文第二部分涵盖了美国医疗保健的历史。它阐述了联邦政府在公共卫生和医疗保健领域不断演变的角色，始于19世纪中叶，一直持续到今天。第三部分审视了控制医疗保险支出的现有流程。这一部分着重于控制医疗保险报销的行政程序。第四部分审视了IMAC。这一部分讨论了IMAC的法定条款以及IMAC必须遵循的行政透明度法律。在这一部分结尾，借鉴了三个类比来衡量IMAC将如何运作：参议员汤姆·达施勒的联邦健康委员会（FHB）提案；对美联储的行政监督；以及英国国家卫生与临床优化研究所（NICE）。第五部分呈现了当今美国医疗保健系统的概况。这一部分强调了医疗保健的成本、质量和可及性，并与国际和国有医疗保健系统进行了比较。在本文中，有许多单词、短语和机构都被赋予了首字母缩略词。为方便起见，这些首字母缩略词的索引在文章后面的附录中提供。
