Below is a report from March of this year which shows graphically that Medicare Advantage is not an advantage to most of the country, YET, it is very expensive for the federal government to subsidize.
High resolution of the Daily Yonder Classification of Counties in the USA (click here)
...Nationally, 23.7 percent of Medicare beneficiaries belong to a Medicare Advantage plan.
Some Medicare Advantage plans do provide more benefits, just as Congress hoped. But most Medicare Advantage plans don’t save any money. In fact, they cost much more than traditional Medicare fee-for-service plans. Each dollar’s worth of enhanced benefits in the private plans costs the Medicare program over three dollars....
“Medicare Advantage” plans (click here) have been touted as a way for elderly rural residents to have a choice in health care plans paid for by Medicare dollars. But few rural Medicare recipients are enrolled in Medicare Advantage plans — and those who have joined are enrolled in Medicare Advantage plans with the highest costs and the fewest benefits....
The other issue with Medicare Advantage is fraud. There has been some wide spread issues in the country regarding fraud.
As noted in the financial sector in October or 2008, when the private sector of our society is provided with vast sizes of money, they can't handle it. The monies are poorly recorded and basically there is waste and greed. So, anytime the private sector of the country states they have a better idea that won't cost the public as much as government, be aware.
The problem and it is a profound problem is that when government monies make its way into the private sector there are problems and although the private provider looks good on paper, the waste and cost only shows up when the 'entire' dynamics of what it costs to monitor them and litigate them is realized. It is not worth it and people suffer due to the fraud and greed. Ultimately, people get better services and overall costs of any government program is less than private providers.
The American people need to find confidence in the decisions of their government and seek to be very skeptical of the arguments that want to demonize it, especially when people of integrity are at the top of its leadership. We have witnessed what eight years of the worst Republican administration in history has brought us. Yeah, even worse than Nixon. So, while it is true most years with Republicans 'demonstrating' poor quality government is real, it is 'loaded' to be that way. "W" was incompetent. "Right, Brownie?" I can't believe he was actually in office for eight years. His administration was such a joke. They were corrupt to the core.
The Washington Post has validated my most profound point through this entire debate. When the youngest of our citizens have health care, the 'cost' levels out and we as a nation are 'balanced' and 'healthy' both fiscally and through the deepest understanding of 'habeous corpus.'
Analysis: (click title to entry - thank you) There is a lively debate about whether the penalty would goad healthier people to get coverage. But the reports are probably too pessimistic. Massachusetts has gotten all but 3 percent of residents into coverage with a penalty of roughly the same size. The reports also do not take into account the draw of the low-cost "young invincibles" policy included in the bill. And the Congressional Budget Office estimates coverage levels would rise to 94 percent of Americans, from 83 percent.
A lot of this is common sense. Trust your instincts, they are usually right and OUR government is effective when the right people are in charge. The Obama Administration is just about the most sincere administration short of FDR.
You can put the Kennedy administration in that category as well. But, it was very short lived, wasn't it? JFK never wanted to go into Vietnam and he was doggedly pursuing corruption and organized crime in this country, civil rights was paramont to his 'idea' of just and fair. The country is better off in the hands of 'the working class' and that is primarily the Democratic Party. Sorry, it is just the way it is. The USA Constitution wasn't conceived for the rich and powerful to ignore the well being of citizens. It wasn't !!!! It also was written with the 'idea' that citizens could 'opt' to be greedy over reasonable.
I'm going to take a look at the rest of the House Bill. I don't think the Senate Bill is worth shit. Senator Chris Dodd is the only one that really cares about it, so I hope he is successful on the Senate floor. I'll read the Senate bill, too.Page 820, lines 1 through 18:
TITLE VIII—REVENUE-RELATED PROVISIONS
SEC. 1801. DISCLOSURES TO FACILITATE IDENTIFICATION OF INDIVIDUALS LIKELY TO BE INELIGIBLE FOR THE LOW-INCOME ASSISTANCE UNDER THE MEDICARE PRESCRIPTION DRUG PROGRAM TO ASSIST SOCIAL SECURITY ADMINIS8
TRATION’S OUTREACH TO ELIGIBLE INDIVIDUALS.
(a) IN GENERAL.—Paragraph (19) of section 6103(l) of the Internal Revenue Code of 1986 is amended to read as follows:
‘‘(19) DISCLOSURES TO FACILITATE IDENTIFICATION OF INDIVIDUALS LIKELY TO BE INELIGIBLE FOR LOW-INCOME SUBSIDIES UNDER MEDICARE PRESCRIPTION DRUG PROGRAM TO ASSIST SOCIAL SECURITY ADMINISTRATION’S OUTREACH TO ELIGIBLE INDIVIDUALS.—
Everything goes into figuring out eligibility for folks. Example: Page 821, lines 9 through 17:
‘‘(ii) unearned income information and income information of the taxpayer from partnerships, trusts, estates, and subchapter S corporations for the applicable year,
‘‘(iii) if the individual filed an income tax return for the applicable year, the filing status, number of dependents, income from farming, and income from self-employment, on such return,
And don't believe for one minute those folks making all the noise about Health Care Insurance Reform don't object to this as well. They won't be able to hide. When government works to benefit the people it is economically prudent, especially over a long period of time. It took Former President Clinton nearly eight years to turn a National Debt into a National Surplus. It took "W" less than a year to squander it. Republican administrations 'specialize' in 'immediate gratificiation' to reinforce their popularity. Democratic administrations believe in good government for ALL.
The flow of information between agencies of the government to administer a domestic program is widely criticized by Right Wing Bozos, but, it is necessary to provide a better venue of government control. And yes, it is control. Absolutely. I would think that would be reassuring to folks. That the government has control over information. This isn't a 'free flow' of information to the public or identity thieves, but, it is a way for one agency to speak to another to insure the best outcome for the 'PUBLIC TRUST.' There is nothing threatening about it unless one has gotten used to living outside the law and conducting themselves in a corrupt 'fashion' much of which is the venue of 'The South.' I shouldn't get started on this, but, the impoverishment of the Southern USA is based in lack of good government and the corruption of the public because average folks have to survive, so 'they play by the rules.' Things have to change and it will.
Page 821, lines 24 and 25 and Page 822, lines 1 thorugh 5:
‘‘(v) if the individual files a joint return for the applicable year, the social security number, unearned income information, and income information from partnerships, trusts, estates, and subchapter S corporations of the individual’s spouse on such return, and
S Corporations (click here)
S corporations are corporations that elect to pass corporate income, losses, deductions and credit through to their shareholders for federal tax purposes. Shareholders of S corporations report the flow-through of income and losses on their personal tax returns and are assessed tax at their individual income tax rates. This allows S corporations to avoid double taxation on the corporate income. S corporations are responsible for tax on certain built-in gains and passive income....
Page 823, lines 9 through 18:
‘‘(D) RESTRICTION ON USE OF DISCLOSED INFORMATION.—Return information disclosed under this paragraph may be used only by officers and employees of the Social Security Administration solely for purposes of identifying individuals likely to be ineligible for a low-income prescription drug subsidy under section 1860D–14 of the Social Security Act for use in outreach efforts under section 1144 of the Social Security Act.’’.
There is a lot 'going on' about the way this reform initiative is paid for. It closes down long lived programs in order to CONSOLIDATE efforts and streamline the system. That scares people. Folks become 'used to' thinking about 'their security' in a particular venue and particular dynamic and they are 'shaken up' when change occurs. Change is a nice word, but, the 'actuality' of carrying it out is another story. That is a good deal of what is occuring in the USA regarding this issue. Page 824 sets up a new Trust Fund. Lines 8 through 25 and Page 825, lines 20 through 25 and Page 826, lines 1 through 4:
SEC. 1802. COMPARATIVE EFFECTIVENESS RESEARCH TRUST FUND; FINANCING FOR TRUST FUND.
(a) ESTABLISHMENT OF TRUST FUND.—
(1) IN GENERAL.—Subchapter A of chapter 98 of the Internal Revenue Code of 1986 (relating to trust fund code) is amended by adding at the end the following new section:
‘‘SEC. 9511. HEALTH CARE COMPARATIVE EFFECTIVENESS RESEARCH TRUST FUND.
‘‘(a) CREATION OF TRUST FUND.—There is established in the Treasury of the United States a trust fund to be known as the ‘Health Care Comparative Effectiveness Research Trust Fund’ (hereinafter in this section referred to as the ‘CERTF’), consisting of such amounts as may be appropriated or credited to such Trust Fund as provided in this section and section 9602(b).
‘‘(b) TRANSFERS TO FUND.—There are hereby appropriated to the Trust Fund the following:...
...The amounts appropriated under paragraphs (1), (2), (3), and (4)(B) shall be transferred from the Federal Hospital Insurance Trust Fund and from the Federal Supplementary Medical Insurance Trust Fund (established under section 1841 of such Act), and from the Medicare Prescription Drug Account within such Trust Fund, in proportion (as estimated by the Secretary) to the total expenditures during such fiscal year that are made under title XVIII of such Act from the respective trust fund or account.
Don't underestimate the importance of the competency of The Secretary of Health and Human Services. She has to know how to do math. She has to have folks that work for her that understands how to do math and then they have to coordinate their figures and efforts with the US Treasury to insure all the monies are where they should be when they should be. There is a lot of responsibility on her shoulders when this bill passes and her department is responsible for the health of this nation. She is very important.
Page 827, lines 21 thorugh 24 and Page 828, lines 1 and 2:
"(1) IN GENERAL.—Subject to paragraph (2), amounts in the CERTF are available, without the need for further appropriations and without fiscal year limitation, to the Secretary of Health and Human Services for carrying out section 1181 of the Social Security Act.
Page 829, starts language about 'the insured' and 'self-insured health plans.' It is a change in direction of the relationship between government and insurance companies. In this case, there is a fee (it is an administration fee) placed on these plans to be sure they are registered with the government and to be sure their 'insured' are actually well cared for under the provisions of this bill. Here again, it is easier to prevent issues than litigate them afterwards and that is what this provision is about primarily.
Lines 9 through 18:
‘‘Subchapter B—Insured and Self-Insured Health Plans
‘‘Sec. 4375. Health insurance.
‘‘Sec. 4376. Self-insured health plans.
‘‘Sec. 4377. Definitions and special rules.
‘‘SEC. 4375. HEALTH INSURANCE.
‘‘(a) IMPOSITION OF FEE.—There is hereby imposed on each specified health insurance policy for each policy year a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the policy.
‘‘(b) LIABILITY FOR FEE.—The fee imposed by subsection (a) shall be paid by the issuer of the policy.
This provision goes on to define terms and words. There isn't anything 'tricky' about the language.
Just as a point of interest, there was a meeting recently where some of the best professionals in the health care industry met to 'talk about' the movement of change for the USA's health care. It was called, "The Aspen Institute/Time Aspen Health Forum." This forum is not new. It is mostly an annual event and has been looking at health care in the USA as well as globally, including disease trends and treatment such as the avian and swine flu. There are several video forums published on this website. They are all interesting, but, take some time to listen to their content. The last video features Former Senator Tom Daschle. He makes a concerted effort to put the debate into perspective:
President Obama’s Prospects for Health Reform, Insurance Reform (click here) featuring:
- The Honorable Tom Daschle, Former Senate Majority Leader
- David B. Snow Jr., Chairman and CEO, Medco
- Peter Long, Senior Vice President for Executive Operations, Kaiser Family Foundation (Moderator)
The former Senator eloquently addressed the enormity of the issues we face as a nation regarding health care. Not to alienate anyone interested in this debate, Former Senator Daschle refers to an acronym called CER. Another name for CER is 'being careful we are making the change the nation needs.' This forum took place only a few days ago so it is very relevant.
Comparative Effectiveness Research Funding (click here)
The Recovery Act (ARRA) contains $1.1 billion for comparative effectiveness research. Comparative effectiveness research (CER) compares treatments and strategies to improve health. This information is essential for clinicians and patients to decide on the best treatment. It also enables our nation to improve the health of communities and the performance of the health system.
Back to the House Bill.
The bill includes all forms of health delivery, including these small incidental policies we occassional subscribe to for travel, school activities, etc. Page 833, lines 14 through 18:‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The term ‘accident and health coverage’ means any coverage which, if provided by an insurance policy, would cause such policy to be a specified health insurance policy (as defined in section 4375(c)).
There are 'except entities' to any fee rendered, page 834, lines 22 through 24 and page 835, lines 1 though 10:
‘‘(C) any program established by Federal law for providing medical care (other than through insurance policies) to individuals (or the spouses and dependents thereof) by reason of such individuals being—
‘‘(i) members of the Armed Forces of the United States, or
‘‘(ii) veterans, and
‘‘(D) any program established by Federal law for providing medical care (other than through insurance policies) to members of Indian tribes (as defined in section 4(d) of the Indian Health Care Improvement Act).
Page 835, lines 22 and 23 and page 836, lines 1 though 9:
‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS
‘‘Subchapter A—Policies Issued By Foreign Insurers’’.
(B) The table of chapters for subtitle D of such Code is amended by striking the item relating to chapter 34 and inserting the following new item:
‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES’’.
(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply with respect to policies and plans for portions of policy or plan years beginning on or after October 1, 2012.
I don't approve of American funds for health care to go to foreign entities or any entity in countries that practice 'tax shelter' banking opportunities. Every USA dollar that leaves the country, leaves the economy. There are specific protests I have regarding government and the use of USA monies to foreign entities. It is WRONG to send American dollars anywhere outside the USA boundaries and its possessions in regard to the military and health care dollars. They are areas of national security and YES, the issue of the health of the people of this nation is one of security. It is my opinion all issues of national security should be 'housed' within the definition of the sovereignty of the USA kept within its borders.
There are going to be repeal of some existing laws. And here again, some people will be screaming, "I never bargained for this." Hogwash. The government needs to be fluid and efficient. There cannot be conflicting language or focus to laws if they are to be effective and efficient. Page 836, lines 11 though 24:
TITLE IX—MISCELLANEOUS PROVISIONS
SEC. 1901. REPEAL OF TRIGGER PROVISION.
Subtitle A of title VIII of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) is repealed and the provisions of law amended by such subtitle are restored as if such subtitle had never been enacted.
SEC. 1902. REPEAL OF COMPARATIVE COST ADJUSTMENT (CCA) PROGRAM.
Section 1860C–1 of the Social Security Act (42 U.S.C. 1395w–29), as added by section 241(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173), is repealed.
This is a new focus for 'delivering' health care in the USA. Page 838, lines 8 through 17:
‘‘Subpart 3—Support for Quality Home Visitation Programs
‘‘SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN.
‘‘(a) PURPOSE.—The purpose of this section is to improve the well-being, health, and development of children by enabling the establishment and expansion of high quality programs providing voluntary home visitation for families with young children and families expecting children.
This is very important. Every child being born in the USA will be addressed with a program that will start them on the best path. The reasons for such a program are more than can be discussed in a short paragraph, however, put it into context this way; "If every child and their parents are given information and guidance to prevent obesity in children we would be a healthier America." It is my opinion a program like this is not only necessary, but, vital. Why? Because it brings children closer to a relationship with health care professionals, including their pediatrician.
A personal story.
I raised two sons. I love them dearly and they are good sons. They love me and we have an open and honest relationship. I am a resource to them and they are a joy to me. When they needed a pediatrician, they had one from birth and had the same pediatrician for all their growing up years, to the age of 18 years old.
Regardless of where we lived on the East Coast of the USA, they were always returned at least once a year for their annual physicals. Dr. Wilson was well known to them, they knew they saw him at least once a year and as they became young adults they had their physical exams in complete privacy with their pediatrician while I was seated in the Waiting Room should there be an issue to discuss. It was our choice to allow that privacy and it worked to give them a sense of autonomy in a very important aspect of growing up.
The result? I rarely experienced illness with my children. The physician visits outside of their wellness visits were very limited over the entire 18 years of their lives. No lie. I did not have enormous costs to their wellness. They were cared for by a man well versed in his profession and I had complete faith in any and all of his recommendations. Today, at the ages of 30 and 28, my sons are healthy without complications. They are substance free and happy in relationships.
I might have been lucky, but, I could put all my worries to rest at the doorstep of Dr. Wilson and the result was incredible. My sons aren't afraid of health of their bodies and seek physicians when needed and have physical exams on a regular basis. My youngest son has two children and they receive regular check ups and those kids are healthy. They enjoy their healthy little lives to date.
Healthy bodies begin at tender ages with good habits. This provision is very important.
There is a mandate for spending on this program and while 5% is a healthy allowance it is also a limit on the spending of the program. Page 840, lines 6 through 9;‘‘(B) the State will reserve 5 percent of the grant funds for training and technical assistance to the home visitation programs using such funds;
To help contain costs, the bill spells out clearly the lack of waste in duplication. Page 840, lines 10 through 29:
‘‘(C) in supporting home visitation programs using funds provided under this section, the State will promote coordination and collaboration with other home visitation programs (including programs funded under title XIX) and with other child and family services, health services, income supports, and other related assistance;
‘‘(D) home visitation programs supported using such funds will, when appropriate, pro20
vide referrals to other programs serving children and families; and
I like the attention given to Indian tribes. They have been viewed as a nation within a nation with 'hands off' of spending federal monies to improve their quality of life. There aren't even police forces that deal with the crime found among American Indian tribal grounds, it is the FBI that responds to issues. Regardless, to extend the Health Care Reform initiative to our American Indian Tribes is right and best. These folks have suffered from a long time when it comes to quality health care and it time we realize how they struggle as a small nation to provide for their people and extend health care to them no different than a citizen of the USA born outside of a tribal area. And, yes, the USA has tribal areas !
Page 841, lines 3 through 14:
‘‘(1) INDIAN TRIBES.—From the amount reserved under subsection (l)(2) for a fiscal year, the Secretary shall allot to each Indian tribe that meets the requirement of subsection (d), if applicable, for the fiscal year the amount that bears the same ratio to the amount so reserved as the number of children in the Indian tribe whose families have income that does not exceed 200 percent of the poverty line bears to the total number of children in such Indian tribes whose families have income that does not exceed 200 percent of the poverty line.
Here again is the stipulation of the 200% poverty line (approximiately $35,000 annually), page 841, lines 15 through 25 and page 842, lines 1 and 2;
‘‘(2) STATES AND TERRITORIES.—From the amount appropriated under subsection (m) for a fiscal year that remains after making the reservations required by subsection (l), the Secretary shall allot to each State that is not an Indian tribe and that meets the requirement of subsection (d), if applicable, for the fiscal year the amount that bears the same ratio to the remainder of the amount so appropriated as the number of children in the State whose families have income that does not exceed 200 percent of the poverty line bears to the total number of children in such States whose families have income that does not exceed 200 percent of the poverty line.
One of the criticisms I ALWAYS hear about Democratic programs is that it is an attempt to 'control' parenting and tell a parent how to raise a child.
That isn't the case.
The word isn't 'control' it is 'empowerment.'
There are specific 'interventions and outcomes' expected of this provision of the bill and I want to list them here, although I think it is a little silly, simply because the critics will take issue of every aspect of the program. By defining the 'interventions and outcomes' there is an understanding that the bill will provide 'AT LEAST' this much and has a limit to 'THE MAXIMUM' it provides in 'authority' of government and licensed personnel that will provide the program.
Page 844, lines 17 through 25, page 845, lines 1 thourgh 25 and page 846, lines 1 and 2:
‘‘(iv) monitor fidelity of program implementation to ensure that services are delivered according to the specified model; and
‘‘(v) provide parents with—
‘‘(I) knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains (including knowledge of second language acquisition, in the case of English language learners);
‘‘(II) knowledge of realistic expectations of age-appropriate child be5
haviors;
‘‘(III) knowledge of health and wellness issues for children and parents;
‘‘(IV) modeling, consulting, and coaching on parenting practices;
‘‘(V) skills to interact with their child to enhance age-appropriate development;
‘‘(VI) skills to recognize and seek help for issues related to health, developmental delays, and social, emotional, and behavioral skills; and
‘‘(VII) activities designed to help parents become full partners in the education of their children;
‘‘(B) includes expenditures for training, technical assistance, and evaluations related to the programs; and
‘‘(C) does not include any expenditure with respect to which a State has submitted a claim for payment under any other provision of Federal law.
The bill goes on to describe quality assurance issues for the monies spent. Page 846, lines 5 through 15:
‘‘(A) IN GENERAL.—The expenditures, described in paragraph (1), of a State for a fiscal year that are attributable to the cost of programs that do not adhere to a model of home visitation with the strongest evidence of effectiveness shall not be considered eligible expendtures for the fiscal year to the extent that the total of the expenditures exceeds the applicable percentage for the fiscal year of the allotment of the State under subsection (c) for the fiscal 15 year.
The bill recognizes the Federal legisation cannot 'impose' this provision by the terms of the States. Page 847, lines 6 through 11:
‘‘(h) WAIVER AUTHORITY.—
‘‘(1) IN GENERAL.—The Secretary may waive or modify the application of any provision of this section, other than subsection (b) or (f), to an Indian tribe if the failure to do so would impose an undue burden on the Indian tribe.
It is important to recognize the special circumstances of American Indians. They do have very different dynamics within the authority of their tribes, but, they are also a part of the USA and we want them healthy and contributing productively to their own nation as well as the greater of the people of the USA.
The bill goes on to discuss issues of quality assurance and economy. The program will be monitored for effectiveness, cost and efficiency of delivery. The program will be modified to deliver 'over time' as the 'best' strategies emerge. The bill has the best interest of the 'USA budget' at heart while still delivering high quality of care to citizens.
Page 853, lines17 through 25:
‘‘IMPROVED COORDINATION AND PROTECTION FOR DUAL ELIGIBLES
‘‘SEC. 1150A. (a) IN GENERAL.—The Secretary shall provide, through an identifiable office or program within the Centers for Medicare & Medicaid Services, for a focused effort to provide for improved coordination between Medicare and Medicaid and protection in the case of dual eligibles (as defined in subsection (e)). The office or program shall—
Here again, it cannot be stated enough that we have duplicity in legislations over the years, which happens in a democracy of people numbering more than 300 million. The bill actively seeks to reduce 'dual status' of participants. It streamlines the administration of the government's responsibility and it controls cost.
There is provision in the bill to allow appeals to any of the decsions of the Secretary. Different from the legislation of the Republicans that block litigation. I was astounded to realize there was no recordkeeping demanded of the investment banks given the bailout funds. The Bush adminisration did that sort of thing on a regular basis. The monies sent to Iraq's government and Halliburton were literally 'give aways' without accountability. The bailout was the same way. I don't believe in that. If the American people provide money for anything there should be an accounting. I am still waiting to hear where Rumsfeld put his 'offshore account.' Its got to be somewhere.
And yes, I am stating the Republicans in the Bush years STOLE money from the government and it was just too bad for the taxpayers of the nation. Absolutely and if anyone doesn't believe Paulson and Goldman Sachs didn't loot the USA Treasury, then they need to think again.
The next section of the bill deals with 'work force' development. It is a quality assurance statute. It is lengthy from what the outline looks like, but, seems standard and straight forward. Health care needs a workforce and for the first time in history the government is going to be sure that workforce is important enough to monitor and facilitate.
Page 856, lines 1 through 4.
DIVISION C—PUBLIC HEALTH AND WORKFORCE DEVELOPMENT
4 SEC. 2001. TABLE OF CONTENTS; REFERENCES.
The table of contents alone comprises three pages. I am not going to go over every aspect of the outline. I didn't see the provision for unions, through.
I am going to take a break and I'll be back.
