Dr. David Gratzer: Slay the bureaucracy monster, Mr. President

President Obama will attempt tonight to rally support for health-care reform in his address to the joint session of Congress.

Here's the big question: will he take on the health-care bureaucracy monster that the House Democrats are proposing?

While Americans debate, sometimes bitterly, the big ideas in ObamaCare - like a Medicare-style public insurance - it's the small details that are most concerning. That's right, the small details.

Consider the various committees, task forces, commissioner posts all to be created by the bill passed by the House Education and Labor Committee:

The Health Benefits Advisory Committee (HBAC) will be chaired by the Surgeon-General, serving alongside up to 26 other appointees.

This committee will help set the standards for any plan available through the Health Exchange. In a nod to liberal social engineers, the bill notes that the committee should pay special attention to "health disparities."

The bill requires that the committee should include "consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities..." and "at least one practicing physician or other health professional." If your daughter wants to influence health policy when she grows up, make sure she becomes a union leader, not a doctor.

Under the House bill, a Health Choices Commissioner (HCC) will be the new health insurance czar, with powers and staff to manage the Health Insurance Exchange and regulate all "Qualifying Health Benefits Plans." In one of many studies legally required under the bill, the new commissioner must identify any existing incentives for smaller businesses to self-insure within 18 months.

The bill also creates a Center for Quality Improvement with a new director and staff, advising doctors on cheaper ways to practice medicine. With Senate Democratic support, this will likely be replaced by the more sweeping Independent Medicare Advisory Committee, or IMAC.

The bill also creates a Center for Quality Improvement with a new director and staff, advising doctors on cheaper ways to practice medicine. With Senate Democratic support, this will likely be replaced by the more sweeping Independent Medicare Advisory Committee, or IMAC.

IMAC will be authorized to deny coverage for expensive treatments, similar to a British committee called NICE. (Recently, NICE insisted anti-blindness drugs weren't needed just for one bad eye because patients could get by half-blind.)

What does TFCPS stand for? The Task Force on Clinical Preventative Services, or the Task Force on Community Preventative Services. Both, with 30 appointees each, are in the House Bill, replacing one Task Force that used to do the same work. Remember the old movie line: "the first rule of government contracting: Why build one when you can have two at twice the price?"

The Secretary of Health and Human Services is mentioned close to a thousand times. Alongside vast new rulemaking powers, the Secretary gets a new Assistant Secretary, a fund of $2 billion to startup the Public Insurance Option bureaucracy, and three months of float money for Public Insurance Option claims.

The Secretary has new powers to create grant-eligible "health empowerment zones" run by community activists, and new authority to give grants for alternative-language health services.

Plus there are more new committees to appoint - like the Telehealth Advisory Committee (TAC) and the Advisory Committee on Health Workforce Evaluation and Assessment (ACHWEA), each with support staff, of course.

In fact, this bill creates a sea of new government programs, offices, and bureaucracies (some 53 in all) that will determine what is an acceptable health plan for your family, what treatments your family doctor should prescribe, and how clinics and hospitals serve you and your family. Conservatives have spent the last 9 months arguing that a public option would undermine private health insurance; the bill threatens to do more: bureaucratize American medicine.

Obama says he wants meaningful reform. Tonight, he should tell Congress to get back to the drawing board.