Now where did I leave off...

Page 501, lines 17 through 22 and Page 502 entirely and Page 503, lines 1 through 4:

This supports 'quality assurance' and the provision speaks for itself. There is no secret agendas, this provision supports research in seeking better quality to consumers.

TITLE IV—QUALITY
Subtitle A—Comparative Effectiveness Research
SEC. 1401. COMPARATIVE EFFECTIVENESS RESEARCH
(a) IN GENERAL.—title XI of the Social Security Act is amended by adding at the end the following new part:

‘‘PART D—COMPARATIVE EFFECTIVENESS RESEARCH
‘‘COMPARATIVE EFFECTIVENESS RESEARCH
‘‘SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED.—
‘‘(1) IN GENERAL.—The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of
health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.
‘‘(2) DUTIES.—The Center shall—
‘‘(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;

This provision is to receive oversight with its own commission. It requires an independant commission because the topic is different requiring different qualification for its members.

Page 505, lines 5 through 14 and Page 506, lines 19 through 24, Page 508, lines 6 through 25 and Page 509 entirely. This is all self explanatory and placed here as reassurance of content.

‘‘(b) OVERSIGHT BY COMPARATIVE EFFECTIVENESS RESEARCH COMMISSION.—
‘‘(1) IN GENERAL.—The Secretary shall establish an independent Comparative Effectiveness Research Commission (in this section referred to as the ‘Commission’) to oversee and evaluate the activities carried out by the Center under subsection (a), subject to the authority of the Secretary, to ensure such activities result in highly credible research and infor14
mation resulting from such research....
...‘‘(G) make recommendations for policies that would allow for public access of data pro21
duced under this section, in accordance with appropriate privacy and proprietary practices,
while ensuring that the information produced through such data is timely and credible;...
‘‘(3) COMPOSITION OF COMMISSION.—
‘‘(A) IN GENERAL.—The members of the Commission shall consist of—
‘‘(i) the Director of the Agency for Healthcare Research and Quality;
‘‘(ii) the Chief Medical Officer of the Centers for Medicare & Medicaid Services;

and ‘‘(iii) 15 additional members who shall represent broad constituencies of stake16
holders including clinicians, patients, researchers, third-party payers, consumers of Federal and State beneficiary programs. Of such members, at least 9 shall be practicing physicians, health care practitioners, consumers, or patients.
‘‘(B) QUALIFICATIONS.—
‘‘(i) DIVERSE REPRESENTATION OF PERSPECTIVES.—The members of the Commission shall represent a broad range of perspectives and shall collectively have experience in the following areas: ‘‘(I) Epidemiology. ‘‘(II) Health services research. ‘‘(III) Bioethics. ‘‘(IV) Decision sciences. ‘‘(V) Health disparities. ‘‘(VI) Economics.
‘‘(ii) DIVERSE REPRESENTATION OF HEALTH CARE COMMUNITY.—At least one member shall represent each of the following health care communities: ‘‘(I) Patients. ‘‘(II) Health care consumers. ‘‘(III) Practicing Physicians, including surgeons. ‘‘(IV) Other health care practitioners engaged in clinical care. ‘‘(V) Employers. ‘‘(VI) Public payers. ‘‘(VII) Insurance plans. ‘‘(VIII) Clinical researchers who conduct research on behalf of pharmaceutical or device manufacturers.

I can hear the complaints now, "Is all this necessary?"

Ahhhh, yep.

The USA is embarking on providing health insurance for everyone while tightening up the industry with provisions that will serve the best interest of the citizens of this country. Those best interests are a streamlined health care delivery system that is state of the art in quality. Health care is a complex issue, but, it can be made simple if there are experts developing the quality at every turn to be sure no dollars are squandered. Efficient health care delivery not only holds down costs it provides for better quality care. It is my guess each one of the commissions affiliated with the 'start up' of the Bill will dissipate over time and not be necessary.

This provision continues in the 'usual' manner of the Bill in that there are definitions and organizational structure, but, I found this interesting:

Page 520, lines 1 through 8:

‘‘(A) be designed, as appropriate, to take into account the potential for differences in the effectiveness of health care items and services used with various subpopulations such as racial and ethnic minorities, women, different age groups (including children, adolescents, adults,
and seniors), and individuals with different comorbidities; and—

This was also important. There is no direct link to reimbursement for services through the research provision, it is strictly fact finding to bring better quality to the citizens of the country while the Commission reviews any necessary changes to treatment modalities currently in place that research might prove prudent to change.

Page 524, lines 14 through 17:

‘‘(h) CONSTRUCTION.—Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.’’.

Page 525 begins a provision to increase transparency with Nursing Homes:

Subtitle B—Nursing Home
Transparency
PART 1—IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING FACILITIES AND NURSING FACILITIES
SEC. 1411. REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.
(a) IN GENERAL.—Section 1124 of the Social Security Act (42 U.S.C. 1320a–3) is amended by adding at the end the following new subsection:
‘‘(c) REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.—

Page 527, lines 8 through 20:

‘‘(I) each member of the governing body of the facility, including the name, title, and period of service of each such member; ‘‘(II) each person or entity who is an officer, director, member, partner, trustee, or managing employee of the facility, including the name, title, and date of start of service of each such person or entity; and ‘‘(III) each person or entity who is an additional disclosable party of the facility.

It seems to me this would prevent double dipping by receiving payment through an establishment as an owner or physician while still billing in an individual capacity. Keeps everything honest. There is a provision to allow the Secretary to exempt such information where it is reported on IRS forms.

Just to example page 531, lines 21 through 25:

‘‘(i) a corporation, the officers, directors, and shareholders of the corporation who have an ownership interest in the corporation which is equal to or exceeds 25 percent;

There are directions to make such information available to the public. The transparency will make it easier to enforce the 'ethics' component to the Bill.

Page 536, lines 19 through 24 and Page 537, lines 1 through 7:

‘‘(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a skilled nursing facility, a program of the operating organization that—‘‘(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and

Imagine that. Ethical standards no less. Well. This should be interesting. CEOs of health care industry factilities like to circumvent ethics while replacing it with 'customer care' rituals to distract from any adverse opinion of their institution. Soothing the public with 'customer service' in place of ethical standards allows for greater profits. Oh, yeah. Customer Service and Ethics are totally different dynamics. I mean there isn't strong ethical standards for the guy that changes the oil in your car, but, there certainly are high expectations of Customer Service.

Health Care Industry CEOs learned some time ago, if one can make a nurse and unit secretary to perform like Disney personnel there will be more satisfaction with the facility even when the actual care given is poor. As a matter of fact, there are hospitals in the country that bring in Disney Trained Customer Service experts to train their staff, professional staff as well as housekeeping and dietary workers. It isn't just a matter of making health care palatable, providing 'comfort' allows distraction from the severity of the purpose to hospitalization. Absolutely. Higher degrees of creature comforts and distractions allow for lax standards that aren't under the control of the CEO, prevents lawsuits and brings higher approval ratings by patients and family.

Proven paradigm.

Absolutely.

Why would they do it?

TO BE NICE?

You've got to be joking.

Have a Latte on us for any inconvenience !

There is a hospital in Wilmington, North Carolina that actually stocks 'Customer Care' items in their supply rooms. Why? Because it allows the professional staff the 'ease' of finding a Gas Card or $5.00 voucher for the coffee shop or a $25 Gift Card to Target to present to any disgruntled 'customer' (not patient necessarily mind you) regardless of the reason. And I do mean regardless of the reason. Preceived malpractice? Having to wait in the hallway for an x-ray. They even have 'suggestions based on severity of unhappiness' as to what to give a patient or family. It is unbelieveable. Now I am not talking about the annual Teddy Bear drive for plush animals in the ER to assist with children and their fears. No, no. That isn't it. These are ADULTS in care on the floors and units and their families. Amazing. Along with the paraphernalia to be presented to adults including "Beanie Babies," there is a sheet any professional has to write on regarding the infraction, the item presented and the outcome. Talk about adding paperwork to any professional's work day. Not only that, but, those items are all part of the operating budget of the unit. Spare no expense. I have a feeling all that will change. The health care system run by Capitalists is an amazing institution.

Stop to realize the level of UNETHICAL standard that is. Stop and think about it. It borders on criminality. There are 'strategies' put in place in hospitals by CEOs and Directors of Nursing, etc. to distract anyone receiving services, from their complaints or grievances, regardless of the severity or legitmacy. It is designed to 'undermine' the 'will' of the patient and/or family to achieve a goal. All this is put in place to EFFECT 'certain' opinions. I guess patients and their families are mindless idiots that can be manipulated like marrionets on a string. Talk about insulting. That is American Health Care compliments of Capitalists.

Page 538, lines 5 through 13:

‘‘(III) The organization must have used due care not to delegate substantial discretionary authority to individuals whom the organization knew, or should have known through the exercise of due diligence, had a propensity to engage in criminal, civil, and administrative violations under this Act.

Page 543, lines 1 through 16:

‘‘(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS.—In this subparagraph, the term ‘compliance and ethics program’ means, with respect to a nursing facility, a program of the operating organization that—
‘‘(I) has been reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under this Act and in promoting quality of care; and ‘‘(II) includes at least the required components specified in clause (iv).

I'll end for today after this.

Page 551, lines 6 through 22:

(c) GAO STUDY ON NURSING FACILITY UNDER CAPITALIZATION.—
(1) IN GENERAL.—The Comptroller General of the United States shall conduct a study that examines the following:
(A) The extent to which corporations that own or operate large numbers of nursing facilities, taking into account ownership type (including private equity and control interests), are
undercapitalizing such facilities. (B) The effects of such undercapitalization on quality of care, including staffing and food costs, at such facilities. (C) Options to address such undercapitalization, such as requirements relating to surety bonds, liability insurance, or minimum capitalization.

...until later...

Senator Arlen Spector stared down snarling Right Wing Extremists and now he is looking forward to the President's speech.

I think he says all that needs to be said. The President is speaking tonight and welcoming new ideas while seeking a resolve on the issue.

Posted: Tuesday, 08 September 2009 6:13AM

Specter Ready For Obama's Health Care Speech (click title to entry - thank you)
by KYW's Kim Glovas President Obama is preparing his speech for Wednesday night on health care.
A local Senator believes the president will stand by the public option as part of the package.
Senator Arlen Specter is looking forward to the president's speech before the joint session of Congress. He says the president will use this opportunity to regain control of the debate over health care:
"President Obama is going to lay it on the line that we really need to do something about the rising cost of health care and covering all Americans."
Specter believes the president's plan will include a robust public option, despite opposition from right wing critics. The senator says he hopes President Obama gives Congress guidance in getting a health care package completed soon.
The president's remarks to Congress on Wednesday at 8pm can be heard on KYW Newsradio 1060AM and at KYW1060.com.

To some extent the debate on Health Care and Health Insurance is over. There has been considerable implosion of insurance over the years since 1993. More Americans are uninsured and more have health insurance plans that don't work for them with high deductibles and unrealistic premiums.

There is a hidden PROFIT to providing quality health insurance to all Americans and that was captured by Institute of Medicine at the National Academies of Science in a report they issued in 2003 entitled, "Hidden Costs, Value Lost: Uninsured in America (click here):

Hidden Costs, Value Lost: Uninsurance in America, the fifth of a series of six reports on the consequences of uninsurance in the United States, illustrates some of the economic and social losses to the country of maintaining so many people without health insurance. The report explores the potential economic and societal benefits that could be realized if everyone had health insurance on a continuous basis, as people over age 65 currently do with Medicare.

In the report, the Committee concludes that the estimated benefits across society in health years of life gained by providing the uninsured with the kind and amount of health services that the insured use are likely greater than the additional social costs of doing so. The potential economic value to be gained in better health outcomes from uninterrupted coverage for all Americans is estimated to be between $65 and $130 billion each year.

In the report of 2004, "Insuring America's Health: Principles and Recommendations,: it is stated, "Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." It is difficult to believe of the USA, but, it is a fact to realize it is the only industrialized country in the world that allows people to die UNNECESSARY deaths preventable through adequate health insurance.

The report goes on:

"In Insuring America's Health (click here): Principles and Recommendations, the committee offers a set of guiding principles, based on the evidence reviewed in the Committee's previous five reports and on new analyses of past and present federal, state, and local efforts to reduce uninsurance., for analyzing the pros and cons of different approaches to providing coverage. The principles for guiding the debate and evaluating various strategies are:
1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable for society.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.
Although all the principles are necessary, the first is the most basic and important....

Is it such a 'leap' for all to realize there is lost productivity in people chronically left ill or profoundly disabled due to lack of health insurance coverage? I don't care what numbers of uninsured you want to abide by it is a large number of people. People that don't maintain an optimal state of wellness because they have no access to health care that works for them. People choose on a regular basis between health care and maintaining a home.

That is the American Dream?

No.

That is the American Nightmare and it is time to end it.

Current Manned Space Program, Constellation, unachievable.

Panel: No moon or beyond for NASA without new funds (click here)
...After a summer of public meetings and deliberations, the committee, led by former Lockheed Martin chairman Norman Augustine, also endorsed the international space station but offered less support for NASA's Constellation program to develop its next generation of rockets....

...The panel's review found a serious gap between the goals outlined by President George W. Bush in 2004 — to return to the moon by 2020 and eventually send humans to Mars — and the amount of money provided for the task.

And far from finding a way to shorten the gap in America's ability to launch astronauts beyond orbit, the panel said a more realistic time frame is probably seven years, at least.

“The U.S. human spaceflight program appears to be on an unsustainable trajectory,” the panel wrote in its summary report, submitted to the White House and NASA on Tuesday. “It is perpetuating the perilous practice of pursuing goals that do not match allocated resources.”
The panel found that, without $3 billion more annually beginning in next year's budget, NASA would be able to do little more than fly the shuttle through early 2011, extend the nearly completed international space station's lifetime through 2020 and begin planning a heavy-lift rocket that could blast humans and the equipment they would need to the moon....

...Discovery and its crew undocked today (click here) (Tuesday) from the space station, in preparation for their return to Earth Thursday evening. In the meantime, they will be flying more or less in tandem with the station....

One of the first cases Judge Sotomayor will participate is regarding Campaign Financing. See video at bottom of entry.

Should businesses be able to give to politicians? (click title to entry - thank you)
Since Teddy Roosevelt was president, corporate money in federal politics has been restricted by U.S. law. That could change. The U.S. Supreme Court meets Wednesday over whether to overturn two prior rulings. Sparking it all -- "Hillary: The Movie."

Corporate speech is no impediment to democracy

This law has been on the books for years. Why change it now?

The storms are pretty puny after Labor Day. The water vapor will always be an issue. Not enough of it to really maximize any storm.

Michael Moore is getting rave reviews. He is definatively in his element. (click here)

"Capitalism is Evil"

AP: 'Warmly Received'

Variety: 'Returning to His Roots, One of His Best Films'Time: 'Moore's Magnum Opus' Bloomberg: 'Scathing, Effective and Hilarious'The Independent: 'Rousing and Entertaining' Guardian: 'Tumultuous Applause'

Dedicated to "good people who struggle, who work hard and who've had their lives ruined by decisions that are made by people who do not have their best interest at heart."

One of the reviews stated, "Capitalism" is stereophonic. Mike sort of brushed it off as a typical Italian observation of operatic content. But, I have to say in agreement that when I listened to the 'composite of sounds' incorporated in The Trailer to 'Capitalism, A Love Story' it shocked me to my toes. There were huge conflicts of sounds that tied together all kinds of emotions people were feeling. The 'composite of sounds' did it well. Very well. The melding of sounds eerily conveyed the violation of trust the American people had of their government.

I can't wait to see the movie on October 2nd. It should be more than interesting and I hope every American takes the time for insight as only Michael Moore can compose it.

I hope he enjoys his reviews. I wish him great success with an obvious work of passion.

September 5th, 2009 11:20 pm

Michael Moore Slams Bailout of Wall Street, Wants 'Money Back' (click here)
By Farah Nayeri
Sept. 5 (Bloomberg) -- Michael Moore launched his movie "Capitalism: A Love Story" at the Venice Film Festival today, staging an all-out attack on the free-market system and on the U.S. government bailout of financial institutions.
"Capitalism is an evil, and you cannot regulate evil," Moore, an American director and satirist, says in his two-hour documentary, one of 24 films vying for the top Venice prize. "You have to eliminate it and replace it with something that's good for all people, and that something is called democracy."...

September 5th, 2009 1:37 pm

AIG gets some tough love from Michael Moore (click here)

Ouch! – this could be painful. Beleaguered bosses at American insurer AIG (or Chartis as it now wants to be known) are bracing themselves for an uncomfortable few days.
Dashwood, edited by Jonathan Russell / Telegraph
Michael Moore's latest film Capitalism: A Love Story will have its first screening at the Venice Film Festival this week before opening early next month.
Although Moore is looking wider than just AIG's part in the global economic meltdown he saves some special treatment for the insurer.
"This is Michael Moore, I have come to make a citizen's arrest of the board of directors of AIG," he says as he turns up outside the US insurer's headquarters with the requisite loudhailer....

And, yes, I do remember Lehman Brothers and I remember the zealots that caused their collapse and rejoiced over it by offering fragments of pennies on the dollar for stocks. And look what we are left with today, Goldman Sachs, the losers of all losers if it weren't for their corruption in Hankie Paulson.

The Last Days of Lehman Brothers (click here)

Wednesday, BBC2, 9pm
By Paul Whitington
If there was one single event that made the world sit up and realise it was in the middle of an almost unprecedented financial meltdown, it was the collapse of blue-chip Wall Street giant Lehman Brothers almost exactly a year ago....

They're SLIMEBALLS. There isn't any other word to describe the 'beasts of wall street.' There just isn't. Not in the English Dictionary. Predatory, maybe. Bottom feeders on the ladder of Integrity. They 'clean up well' at your expense. Look at the heidousness of what GMC is pulling. They JUST left bankruptcy court and already they are violating the very trust of the agreement with TWO NATIONS of people and the 'spineless' let them get away with it. It's just amazing.

No, this isn't about Urban Sprawl. It is about the size of a small city losing health care coveraage.

10,000 working parents in Arizona to lose health insurance (click title to entry - thank you)
State is unable to provide matching funds for federal program
by Casey Newton
Sept. 8, 2009 12:00 AM
The Arizona Republic
Nearly 10,000 working parents will lose their health insurance this month in the wake of state budget cuts, leaving some families with nowhere to turn as they seek affordable coverage.
KidsCare Parents, a program that provides low-income families with inexpensive insurance, will end Sept. 30. The Arizona Health Care Cost Containment System, which administers the program, could not pay the $6 million annual cost following cuts by the Legislature. The state faces a $3 billion budget shortfall.
The move comes as demand for government assistance is skyrocketing. Arizona has lost an estimated 240,000 jobs since December 2007, and AHCCCS has added 150,000 people to its rolls since January....

September 8, 2009 4:14 PM
Sen. Reid: Health Reform 90 Percent Done (click here)

Posted by Stephanie Condon

After meeting with President Obama and House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid said today that health care reform is 90 percent done and that Republicans still have a seat at the negotiating table. President Obama has often said that Republicans and Democrats can agree on 80 percent of the health care reforms Congress should enact -- that it is the remaining 20 percent that has stalled legislation. "In our conversations today, we think we're up to 90 percent," Reid said from outside the White House. "We have 10 percent to work on, and we can do that."...

One of the purposes to USA health insurance reform is to promote efficient use of infrastructure while giving our citizens incentives to improve their longevity through good health practices. This section of the bill addresses ways to achieve better 'performing' health care keeping in mind the end result is to be a healthier and happier populous.

Page 443, Lines e through 21:

TITLE III—PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE
SEC. 1301. ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM.
Title XVIII of the Social Security Act is amended by inserting after section 1866C the following new section:
‘‘ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM
‘‘SEC. 1866D. (a) IN GENERAL.—The Secretary shall conduct a pilot program (in this section referred to as the ‘pilot program’) to test different payment incentive models, including (to the extent practicable) the specific payment incentive models described in subsection (c), designed to reduce the growth of expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries (as defined in subsection (d)) by qualifying accountable care organizations (as defined in subsection (b)(1)) in order to—

No one expects change to the American populous overnight. That is especially true for the people that already have health insurance. It is even more true for Americans that are lucky enough to belong to health insurance plans that provide incentives for better health through reductions in cost.

So, short of requiring every American to achieve The President's Physical Fitness Award, there can be models of new modalities of providing health care that will also provide 'feedback' regarding ways to incentivize a better more efficient health care delivery system that provides better outcomes to Americans.

This section addresses the opportunity to improve health care delivery and outcomes of patients. After all what good is health care insurance reform if does nothing about improving the outcome of patients?

Page 444, Lines 7 through 15:

‘‘(b) QUALIFYING ACCOUNTABLE CARE ORGANIZATIONS (ACOS).—
‘‘(1) QUALIFYING ACO DEFINED.—In this section:
‘‘(A) IN GENERAL.—The terms ‘qualifying accountable care organization’ and ‘qualifying
ACO’ mean a group of physicians or other physician organizational model (as defined in sub15
paragraph (D)) that—

It is interesting. This section of the Bill provides for monetary incentives to physicians and groups of physicians that provide documentable improvements in their patient conditions while reducing the cost of care delivery. If there is no remarkable improvement there will be no paid incentive. The section doesn't ask for payment to the Secretary if the circumstances prove to worsen though. Now, that would be a sincere disincentive.

Page 447, lines 1 through 14:

‘‘(E) The group provides notice to applicable beneficiaries regarding the pilot program (as determined appropriate by the Secretary).

‘‘(F) The group contributes to a best practices network or website, that shall be maintained by the Secretary for the purpose of sharing strategies on quality improvement, care coordination, and efficiency that the groups believe are effective.

‘‘(G) The group utilizes patient-centered processes of care, including those that emphasize patient and caregiver involvement in planning and monitoring of ongoing care management plan.

The 'idea' of posting outcomes of these pilot programs to a 'Best Practices Network or Website' reminds me of the 'short track' to medication approval by the FDA should it prove to be more a miracle medication than expected.

By posting statistics to the 'Best Practices Network' physicians from around the country can learn how to best streamline their practices to help improve patient outcomes while holding down costs.

It also is a 'transparent' method to monitor these programs so there can't be any abuse or short cuts that might actually compromise patient outcomes and safety. And there is nothing like Peer Review among providers regardless their specialty or credentials. I imagine one of the most frequent visitors might be administrators as well as Physician Peers.

Page 450, lines 1 through 12:

‘‘(i) IN GENERAL.—Subject to clause
(ii), a qualifying ACO that meet or exceeds annual quality and performance targets for a year shall receive an incentive payment for such year equal to a portion (as determined appropriate by the Secretary) of the amount by which payments under this title for such year relative are estimated to be below the performance target for such year, as determined by the Secretary. The Secretary may establish a cap on incentive payments for a year for a qualifying ACO.

There isn't anything about this House Bill that hasn't been well planned or considered.

Page 453, lines 22 through 25

‘‘(1) STARTING DATE.—The pilot program shall begin no later than January 1, 2012. An agreement with a qualifying ACO under the pilot program may cover a multi-year period of between 3 and 5 years.

Page 455, lines 18 through 25 and Page 456, lines 1 through 3:

‘‘(g) EXTENSION OF PILOT AGREEMENT WITH SUCCESSFUL ORGANIZATIONS.—
‘‘(1) REPORTS TO CONGRESS.—Not later than 2 years after the date the first agreement is entered into under this section, and biennially thereafter for six years, the Secretary shall submit to Congress and make publicly available a report on the use of authorities under the pilot program. Each report

shall address the impact of the use of those authorities on expenditures, access, and quality under this title.

Page 456, lines 16 through 21:

‘‘(3) TERMINATION.—The Secretary may terminate an agreement with a qualifying ACO under the pilot program if such ACO did not receive incentive payments or consistently failed to meet quality standards in any of the first 3 years under the program.

Page 457, lines 13 through 19:

‘‘(B) CERTIFICATION.—The Chief Actuary of the Centers for Medicare & Medicaid Services shall certify that 1 or more of such models described in subparagraph (A) would result in estimated spending that would be less than what spending would otherwise be estimated to be in the absence of such expansion.

Just in case anyone is wondering why this Bill is always discussing Medicare and Medicaid, it is obvious; the USA government has authority to change the structure of these institutions to accommodate better performance of care models to insure outcomes. But, there is also a provision to include private payers as well. So, I imagine some of the better known health systems will be first in line for the incentive.

Page 459, lines 4 through 8:

‘‘(3) INVOLVEMENT IN PRIVATE PAYER ARRANGEMENTS.—Nothing in this section shall be construed as preventing qualifying ACOs participating in the pilot program from negotiating similar contracts with private payers.

There is also a pilot program incentive for Home Health Care:

Page 460, lines 17 through 26 and Page 461, lines 1 through 3:

‘‘(1) ESTABLISHMENT OF PILOT PROGRAM.— The Secretary shall establish a medical home pilot program (in this section referred to as the ‘pilot program’) for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services (as defined under subsection (b)(1)) to high need beneficiaries (as defined in subsection (d)(1)(C)) and to targeted high need beneficiaries (as defined in subsection (c)(1)(C)).
‘‘(2) SCOPE.—Subject to subsection (g), the pilot program shall include urban, rural, and underserved areas.

Here again some of the finest health care delivery systems will be participating as they probably already have models in place that can set the trend early and successfully. The rules and regs go on for some pages, but, then it enters into increased payment reimbursement for Certified Nurse Midwives. I doubt that is much about Medicare, but, I am sure there are the exceptions.

Page 483, lines 10 through 20 provides for Preventive Care Services:

SEC. 1305. COVERAGE AND WAIVER OF COST-SHARING FOR PREVENTIVE SERVICES.
(a) MEDICARE COVERED PREVENTIVE SERVICES DEFINED.—Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 1235(a)(2), is amended by adding at the end the following new subsection:
‘‘Medicare Covered Preventive Services
‘‘(iii)(1) Subject to the succeeding provisions of this subsection, the term ‘Medicare covered preventive services’ means the following: prostate cancer screening, colorectal cancer screening, diabetes self management training services, glaucoma screening, medical nutrition services, preventive physical exam, cardiovascular screening blood tests (cholesterol is my guess), diabetes screening, ultrasound screening for AAA (abdominal aortic aneursym), pneumonia, influenza and hepatitis B vaccines, mammograms, pap smears, bone density screenings, kidney disease education and other not yet specified preventive services.

All these services, including sigmoidoscopes and colonoscopies including any removal of tissue for diagnostic purposes when necessary, are all 100% paid for by the insurance without any cost sharing.

There will no longer by Clinical Social Work Services provided at Skilled Nursing Facilities. There are plenty of other professionals at SNFs so excluding Social Work Services is more than appropriate when viewed as duplication of expertise. It will be considered included in the lump sum payment to the facility.

There will be Marriage and Family Counceling Services and Mental Health Councelor Services.

Page 489, lines 19 through 25 and Page 490, lines 1 and 2:

SEC. 1308. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES.
(a) COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES.—
(1) COVERAGE OF SERVICES.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 1235, is amended—

The coverage will be 75% of the cost. The Marriage and Family Councelor services are very limited in a Skilled Nursing Facility. Reimbursement is in conjuction with referral by a physician.

The next major section begins on Page 501, entitled "TITLE IV—QUALITY, Subtitle A - Comparative Effectiveness Research

...until tomorrow's read...

The violence in Iraq is due to increased tensions with Syria. Our soldiers need to come home. We are not part of a diplomatic deployment.

Blasts kill four U.S. troops in northern Iraq (click here)
Tue Sep 8, 2009 12:02pm EDT
"Blasts kill four U.S. troops in northern Iraq"
BAGHDAD, Sept 8 (Reuters) - Two roadside bomb attacks killed four U.S. soldiers in northern and central Iraq on Tuesday, the U.S. military said, an unusually bloody day for American soldiers as they curtail their military their military activities....

...Talabani, a Kurd, told Reuters (click title to entry - thank you) after meeting with the council that the escalation of tensions was 'unacceptable.''

"This is not in the interest of Syria, Iraq or (other) Arab nations. Such a stand from the Iraqi government, without consultation with the presidency council, is illegal," he said.

A diplomatic feud has cropped up between the neighbouring nations since Aug. 19, when militants blew up truck bombs at two ministries in downtown Baghdad, killing almost 100 people.

Iraqi officials have blamed the attacks on Sunni Islamist al Qaeda militants and members of Saddam Hussein's banned Baath party, believed to be in Syria....

As Iraq establishes its presence on the world stage it will engage in relations with neighboring countries. It is not up to the USA Troops to 'refight' the war in Iraq to secure the interests of the new government.

Iraq had over six years to work out the wrinkles with countries at their borders and they didn't. A primary reason they didn't is because of the presence of USA troops.

One of the early directives that failed under the Bush/Cheney White House was the demand on Bremer to secure the borders of Iraq from infiltration of foreign entities from causing problems. It never happened and perhaps now that the USA is leaving the government of Syria will finally take their responsibility seriously and stop migration of hostile elements over its border into Iraq.

General Motors Company is in violation of their Agreement with the USA and Canada (click here)

On several counts, GMC is in violation of the agreement signed with the USA and Canada.

1. Under its plan, GM will sell substantially all of its global assets to the New GM.

2. The New GM will:
- Focus on four core brands in the U.S. - Chevrolet, Cadillac, Buick and GMC - with fewer nameplates and a more competitive level of marketing support per brand

- More efficiently utilize U.S. capacity while increasing over time the percentage of U.S.sales manufactured domestically

Other than the $8 billion of debt owed to the U.S. Treasury and the Canadian and Ontario governments by the New GM, all amounts owed by GM or the New GM to the U.S. Treasury and Canadian and Ontario governments would be equitized in exchange for the New GM securities described above, and no other debt will be owed by GM to the U.S. Treasury and the Canadian and Ontario governments.

3. GM Europe Restructuring
GM announced separately today, GM Europe has an agreement for €1.5 billion of bridge financing from the German government and a Memorandum of Understanding to partner with Magna International Inc. Under the agreement, the Opel/Vauxhall assets have been pooled under Adam Opel GmbH, with the majority of the shares of Adam Opel GmbH being put into an independent trust (the balance to remain with General Motors), while final negotiations with Magna proceed. Negotiations to close the agreement should take several weeks.

The European Restructuring 'verbiage' is included as part of the agreement for the New GMC in the Agreement with the USA and Canada governments. There is a clear understanding such a sale would go forward with liquid assets returned to GMC for operations and payment of debts.

GMC is gambling on 'sparking' a new market place in Europe for technology perfected with the Volt. There is absolutely no guarantee there will be such a market available and they are in violation of the agreement with the people of the USA and Canada.

In seeking to continue to manufacture autos in Germany, it is moving jobs that rightfully belong in the USA with the sale of Opel to Europe.

GMC is in GROSS and FRANK violation of the agreement crafted to protect the company from a liquidation of its assets to help insure American Auto Workers still continued to be employed and retirees were provided for in the best interest of the USA economy.

The company should be seized and operated to the satisfaction of both governments under management supervised by a Board of Trustees that will serve the best interest of the American and Canadian people, to insure the integrity of the Agreement and compliance with the repayment of the GMC debt !

Geither needs to 'get the lead' out of his lethargy and indifference and insure the sale of Opel to Magna as the German government perfers and as insures the BEST interest of the people of both Canada and the USA. In case Mr. Geithner doesn't 'get it,' it is called living up to the letter of the law. It is enforceable in court. Anything short of it is negligence of the power of his office !

05.09.2009 18:41
Steinbrueck to Geithner: Germany wants Opel decision (click here)

LONDON, Sept 5 (Reuters) - German Finance Minister Peer Steinbrueck said he told U.S. Treasury Secretary Timothy Geithner on Saturday that Berlin wants a decision on the future ownership of Opel, which parent GM is considering selling.
Steinbrueck said he reiterated Germany's preference for a bid from Canadian auto parts maker Magna, which is competing with Belgian-listed financial investor RHJ for Opel.
'I told him (Geithner) our position -- that it's very important to us to fill this vacuum with a decision,' Steinbrueck said of the drawn-out process to decide the future ownership of Opel.
'My impression is that the U.S. government is leaving the decision to the GM board,' he told a news conference in London.
The U.S. Treasury owns a 60 percent stake in GM, acquired by providing some $50 billion in taxpayer loans and bankruptcy financing to the automaker.

And a word from our right wing bigots - "I don't want THOSE people talking to my children."

The message of hate spewed by the Right Wing regardless of 'rank' in its militia, is grossly Un-American.

The Obamas are parents of young children growing up in a world that is highly competitive and unforgiving. They know the pressures children face and are sympathetic to the reality such competition can have on someone that is a bit different, unimpressive or feels defeated before getting started.

Michelle and Barak are remarkable people in their 'own stories' of success and accomplishment. They weren't born to wealth or priviledge, didn't have movie star charisma and suffered loss of close family members long before anyone should. I don't know any other persons more qualified to speak to the school children of America than the President.

I recall the warm, open and endearing reception Michelle received while visiting in Great Britain. What more can be asked of a First Lady, but, the gracious compassion of caring.

It is reassuring to know our nation's children are not overlooked regardless of the obvious devotion by this administration to solve the problems of educating, which are compounded by a struggling economy adding complications at home. The timing to The President's speech is perfect, when everyone is back in school at the beginning of achievement and not the end of year test results.

Barak has dedicated himself to this end. He graduated from a prestigious law university to act in service to his community and ultimately to his nation. He is selfless in his achievements and that is a rare quality to find in anyone, yet alone the President of the USA. I applaud 'his moment' and hope he engages this opportunity at the beginning of every school year.




Obama's trip to the blackboard jungle (click title to entry - thank you)
By Yael T. Abouhalkah, Kansas City Star Editorial Page columnist
So what did America learn about itself -- and President Barack Obama --during the silly run-up to his speech Tuesday to the nation's schoolchildren?
-- First, that a lot of Americans on the far right go plainly bonkers when they think a president they didn't vote for is going to be allowed to speak to their kids.
That shows just how unruly and how uncivil these critics are. And, dare we say, how disrespectful they are to the office of the President of the United States.
-- Second, that judging the speech before it was given was a huge mistake, especially by the GOP wingnuts who simply want to tear Obama down.
My favorite quote so far: "It's a good speech. It encourages kids to stay in school and the importance of education, and I think that's what a president should do."
That's from a should-be-sheepish Jim Greer, the Florida GOP chairman who last week accused Obama of wanting to "indoctrinate America's children to his socialist agenda."
-- And third, that the Obama administration is tone-deaf when contemplating how the president's actions will be seen by its still-powerful opponents, led by the shock troops in radio and TV such as Glenn Beck and Rush Limbaugh.
Make no mistake: The speech Obama is giving today should be seen by students. It is inspiring.
Given the low expectations of so many kids today by so many teachers and administrators, Obama's speech might just help inspire someone like, well, like a younger version of the president to do something special with his or her life.
That would be a clear victory for Obama.

The cry first went out in 2007 - click here - Is the USA still a country of quality, small business and opportunity or simply big money?

New York will never be as charming if it is willing to give up all its legacy industries.

...It’s fair to ask why we still need a garment district. But even in the Internet era, proximity offers many advantages. Designers are able to work alongside manufacturers. We can stop by factories to inspect garments, change the fit or correct the sewing. Manufacturing locally, as opposed to overseas, allows us to quickly increase or decrease production, depending on what customers want, and is the only affordable option for young designers with limited resources working on a small scale.

More important, in close quarters a mutual respect develops across the chain of production. The people who make the clothes are as passionate as the designers. Both vision and execution benefit from this relationship, and that’s why we do 85 percent of our manufacturing within five blocks of our 35th Street office.

The city once recognized these benefits, and that’s why it passed a zoning law limiting the conversion of the area’s factory space to offices in 1987, in an effort to keep garment makers from being priced out (something that had been going on since the district’s mid-century heyday.)

But the city stopped enforcing the law in 1993, and although the Bloomberg administration devoted some new funds to enforcement in 2005, it simultaneously weakened the zoning restrictions. It’s easy to see that many landlords still get away with breaking the rules, and we’ve heard of only one landlord ever getting prosecuted. So floor by floor over the years, manufacturing space has been quietly diverted to other uses, and manufacturing jobs have moved overseas....

President Obama 'On the Job' on Labor Day in the USA, where Bush / Paulson unemployment is still significant.

Obama to make labor speech (click title to entry - thank you)
WASHINGTON (AP) — President Barack Obama can expect a friendly audience when he talks about health care Monday. He'll be in Ohio to make a Labor Day speech to an organized labor group. He'll also be announcing to union members that he's named a senior counselor for manufacturing policy.

As far as September 11, 2001. Well. We all know how attentive George Walker was to detail. Now don't we. (click here)

..and if this isn't enough we can talk about Zacarias Moussaoui currently residing in the United States Penitentiary Administrative Maximum Facility (ADX) in Florence, Colorado.



First ignore the August 6, 2001 PDB (President's Daily Brief) from the CIA. And then go about the daily political rant to insure a reelection in 2004.

So, tell me that George Walker Bush and Richard Cheney aren't guilty of compromising the security of the USA. Go ahead, tell me that. I love to hear those lies !!!

They needed an 'impetus' to invade Iraq. Originally it was Saudi Arabia, but, when that wasn't possible they settled for Iraq. Go ahead. Tell me that is just folk lore after we know there was no WMD and we now have nearly 5000 dead American soldiers. Go ahead, tell me that is just folk lore !




It was Dianne Feinstein that was sincerely terrified for this country following the attacks of September 111, 2001. She 'spilled the beans' that she engaged Richard Cheney TWICE on the PDB alerting the attacks would occur within three months. Richard Cheney told Dianne it would be probably six months before any of the Bush Administration could address the issue.

Tell me the Bush Administration cared about the security of this nation. Tell me Paulson did! Go ahead.

Feinstein Releases CRS Report: Congress Did Not Have Access to Full Scope of Prewar Intelligence (click here)

December 16, 2005
Congressional Desk
Washington, DC – The nonpartisan Congressional Research Service (CRS) has produced a report that clearly rejects White House assertions that Congress had access to the same intelligence as the President in the march to war with Iraq, U.S. Senator Dianne Feinstein (D-Calif.) announced today.

There have been a number of claims that Congress had access to all the same intelligence before going to war as did the Administration. The nonpartisan Congressional Research Service study released today indicates that these claims are patently false,” Senator Feinstein said. “The report demonstrates that Congress routinely is denied access to intelligence sources; intelligence collection and analysis ‘methods;’ ‘raw’ or ‘lightly evaluated’ intelligence; and the President’s Daily Brief (PDB). This report goes to show that members of Congress were not seeing the same picture as the Administration.

When the Senate voted to authorize the use of force in Iraq in 2002, it was based on a more limited scope of prewar intelligence than was available to the Administration. In light of claims of the possible use or misuse of intelligence by policymakers in the march to war with Iraq, the Senate Intelligence Committee voted unanimously on February 12, 2004 to investigate five key questions on pre-war intelligence.

I believe that Congress and the American people deserve to know what precisely was known by the President and the Administration before the use of force in Iraq. If the Senate Intelligence Committee is to produce a credible and useful report for its ongoing ‘Phase II’ investigation, it must have access to all the same intelligence as the Administration that it was previously denied, particularly the PDBs.”

Specifically, the CRS report (http://feinstein.senate.gov/crs-intel.htm) lays out the following points:

• The President has access to all national intelligence collected, analyzed and produced by the Intelligence community, and has the authority to restrict the flow of intelligence to Congress.
  
  By virtue of his constitutional role as commander-in-chief and head of the executive branch, the President has access to all national intelligence collected, analyzed and produced by the Intelligence Community,” the report states. “The President’s position also affords him the authority – which, at certain times, has been aggressively asserted – to restrict the flow of intelligence information to Congress and its two intelligence committees, which are charged with providing legislative oversight of the Intelligence Community.”
  
  
• Administration officials routinely have access to more, and to more sensitive, intelligence than do Members of Congress. And through their daily routines and staff, Administration officials are inherently more capable of assessing finished intelligence products.

• T]he President and a small number of presidentially designated Cabinet-level officials, including the Vice President – in contrast to Members of Congress – have access to a far greater overall volume of intelligence and to more sensitive intelligence information, including information regarding intelligence sources and methods,” the report states. “They, unlike Members of Congress, also have the authority to more extensively task the Intelligence Community, and its extensive cadre of analysts, for follow-up information. As a result the President and his most senior advisors arguably are better positioned to assess the quality of the Community’s intelligence more accurately than is Congress.”
  
  
• The President has a statutory responsibility to keep Congress “fully and currently informed of all intelligence activities.”
  
  The President’s otherwise exclusive control over national intelligence, however, is tempered by a statutory obligation to keep Congress, through its two congressional intelligence committees, ‘fully and currently informed of all intelligence activities …’” the report states. “Current law also prevents the executive branch from withholding intelligence information from the committees on the grounds that providing the information to the congressional intelligence committees would constitute the unauthorized disclosure of classified information or information relating to intelligence sources and methods.”
  
  
• There are four types of intelligence not routinely shared with Congress.
  
  
  
  
  • Tailored intelligence products such as the President’s Daily Brief (PDB);
    
    
  • Identities of intelligence sources;
    
    
  • Intelligence collection and analysis “methods”; and
    
    
  • “Raw” or “lightly evaluated” intelligence.
    
  
  
  
• There is precedent for sharing source information and PDBs with Congress (and other groups)
  
  Although Congress generally has not had access to information pertaining to intelligence sources and methods, raw intelligence or intelligence products tailored to high-level policymakers – including PDBs – it is noteworthy that Congress occasionally has sought and obtained such intelligence information from the executive branch,” the report states. “Intelligence committee staffers, occasionally, have successfully obtained access to PDBs, and PDB articles, during the course of conducting investigations and general oversight.
  
  While denying Congress access to certain PDB articles, the Bush Administration has provided such access – albeit limited – to two commissions: the 9/11 Commission and the Commission of the United States Regarding Weapons of Mass Destruction [or the WMD Commission].”
  

The full CRS report is available online at: http://feinstein.senate.gov/crs-intel.htm

What does Ann Coulter have in common with Van Jones?

About a week, maybe two weeks ago, she called for the defaming of President Obama's Czars on 'talk radio.'

Reporting from Washington (click title to entry - thank you) - Responding to a firestorm that raged on conservative talk shows and websites, the White House on Sunday announced the resignation of a top environmental advisor who had made fiery remarks about Republicans and signed a petition questioning whether the U.S. government had any role in planning the Sept. 11 attacks....

Basically, Coulter didn't see any chance of defaming the Obama Cabinet so the next best attack was on his 'appointed' Czars, of which number about thrity.

The Right Wing is attempting to create the 'image' of a 'corrupt' administration that talks out of both sides of their mouths by continuing the "Palinesque "attacks on then Candidate Obama by 'invoking' the 'idea' he affiliated with people such as Bill Ayers (his days in the Weather Underground) and therefore had a faux agenda that was hidden from public view.

To bring that 'concept' up to current speed: So long as the Right Wing Extremists of the country can continue to banter 'fear mongering' within that same 'fear dynamic' by rooting through all kinds of garbage from past history, they can find SOMETHING, ANYTHING that can be used against each and every Obama Czar. It is no different than the Health Care Insurance Reform Bills and the gross distortions as well at the Veteran's Website and the 'Information booklet regarding end of life decisions.'

This is a strategy that Murdock pledges to in order to maintain his audience and monetary base. You have to remember the 'source' of these attacks, distortions and lies. Without overpaid guests and endorsement of political distortions, there would be no extremist wing to exploit for fiscal gain for Murdock. Murdock's reality in the 'real world' is a political cartoon. Basically.

The Right Wing Extremeists of the USA are the Professional Oppressors of the populous. They bask in their power in 'constant commentary' be it truth or 'DARE.'

The African Americans that have made it through 'the ranks' earning every rung of the ladder as they go, including prominent figures such as Governor Patrick, will be hardest hit by these war/hate mongering idiots.

And yes I stated, idiots.

They wouldn't know what is good for them if it bit them in the arce. All they understand are their bank accounts and the comfort that brings them through whichever means it is obtained, even scouring the American Treasury for billions in bailouts. They are indeed the greatest offenders of 'WEALTH-FARE' in the world.

The Republicans don't care if their economic 'scheme' tanks. Tanking is frequently the desired end product. Do you actually think Paulson knew what he was doing at Goldman Sachs as CEO? Hell, no. He was screwing up left and right and it took him coming into the US Treasury to 'bailout' his screw ups. Now look at where Goldman Sachs is and how much they OWN (Oh, sorry, that was OWE) the USA Treasury. Idiots, I am telling you. Idiots !

The African American political figure has reached their goals frequently by being ACTIVISTS. As Activists there are sometimes compromises to make and affiliations that aren't necessary 'Apple Pie' as the struggle to defeat oppression and strive to gain equality and recognition. Not only that but successful African American political figures are usually 'socially aware' in ways that Capitalists are not. That 'reality' of what oppression and what it takes to move through the ranks of oppression to try to achieve in the USA is one of the most distant concepts in the American Psyche. It is why most Americans believe there is 'ethnic equality' in the face of daughting statistics otherwise. The more African Americans come to the 'center' of the political rhelm and put in place policies that bring equity while removing oppression, the more they will be ridiculed by scum bags like Coulter.

There is an insidious image underlying the American political fabric in that affiliation with the poor or oppressed in every real way is not the image to exhibit. That is for Mother Theresa. The Image any political figure has to emulate is one of wealth and a greater wealth than any corporate 'anybody' to maintain the aloofness of 'above any willingness to corruption' that wins elections. There could never be a 'middle class' President in this country. And even though the Obama's continue to speak to 'the story' of those they choose to be a part of their administration and appointments and nominations there could never be a 'true' Middle Class President elelcted from the ranks of the Democrats. Never.

The Republicans don't have that issue. They have more money than is rightfully theirs.