An article in the NY Times mag on CDC, critically assessing it and its role in the overall health care system. One thing which stood out to me was this:
Around half of the agency’s domestic budget is funneled to the states, but only after passing through a bureaucratic thicket. There are nearly 200 separate line items in the C.D.C.’s budget. Neither the agency’s director nor any state official has the power to consolidate those line items or shift funds among them. “It ends up being extremely fragmented and beholden to different centers and advocacy groups,” says Tom Frieden, who led the C.D.C. during the Obama administration. That lack of flexibility makes it extremely difficult to adapt to the needs of individual states.
It reminds me of USDA/FSA. Over the years the number of programs and crops covered has grown rapidly, The reason seems similar in both cases: there is a group/organization which feels strongly and has found a representative in Congress to push for coverage. In the case of a disease/illness, it's patients and their families; in the case of agricultural products it's the growers. In both cases, they're tapping the federal treasury and have no countervailing opponents; it's not like the old days when big business was counterbalanced by big labor.
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