We also worked on the rules governing our committee and how we would work together. This seemed laborious to me, but is important ground work.
General Thoughts from day 1:
- The committee is filled with passionate advocates for underserved persons and groups.
- Most committee members have a fairly clear sense of 'who they represent' on the group. For me, I do not have such a clear sense. I was involved in research in this general area for most of the 1990s, but honestly had given it up because past efforts (in 1998) to reconsider many of these issues had failed and it seemed intractable. So, I have a history with the topic and an interest (it was my dissertation research), but have been away from it for a decade. I don't feel as though I am representing any particular group, and most want to ensure that we allocate scarce resources to aid underserved groups in the best way possible.
- There will be a great deal of technical discussion around data and the like. A big challenge will be to remember the main point: looking at a means of allocating scarce resources to best aid the disadvantaged and underserved in our nation.
- We need to get it right. History shows a great deal of inertia in such efforts to designate aeas and groups. The MUA and HPSA methods are largely unchanged since I was in elementary school and middle school. No pressure guys, but we don't need to screw it up...
- We need to land the plane. The Clinton Administration sought to reconsider these designations in 1998; the Bush administration did so in 2008. In both cases the plans went on the rocks due to lots of negative comments from those who expected to be adversely affected by any changes. We will have to navigate this.
- In several instances, people said 'what does the law say?' meaning PPACA which specified creating this negotiated rulemaking committee, or the Public Health Service Act provisions in the 1970s that did things like create the National Health Service Corps which is why HPSAs were created....often the laws are fairly vague. So, the committee will (and HHS for the past 35 years has) had to exercise a great deal of discretion in working out the nuts and bolts of these designations and programs.