It would seem the House Rep from South Carolina has a need for addiction recovery. Typical, he is in self-denial. Pity.

Rob Miller for South Carolina House. Let's face it, South Carolina needs someone that cares about the people. They have a Governor that was legislated into receiving Stimulus dollars and now this humiliation. How much can the people of South Carolina stand?
Act Blue (click here)

Meet Rob Miller (click here) - One of Rob's Campaign focus is to stop outsourcing jobs.
Born and raised in South Carolina as the youngest son of a Navy Veteran, Rob learned the importance of hard work from a very early age. Facing staggering medical bills after his father passed away, 14-year old Rob went to work washing dishes to help support his family. Through hard work and lots of support from family and the community around them, Rob’s family weathered the financial storm....

12:42 September 11th, 2009
No lie! Poll shows Joe Wilson trailing in reelection bid (click here)
Posted by: Thomas Ferraro
Congressman Joe Wilson might be tempted to yell “You lie!” again – this time at a poll that shows the presidential heckler trailing in his reelection bid.
The survey by Public Policy Polling found Democratic challenger Rob Miller leading the five-term Republican lawmaker by 44 percent to 43 percent. The numbers had Democrats cheering, and at least one pollster offering a new view of the contest in the heavily Republican South Carolina district....

Evidently, the Obama Presidency is making history at every turn.

...Campaigns have always played fast and loose with the facts. (click title to entry - thank you) But as the partisan divide in Washington has grown, the rules have changed
“Now we’re in an era of the permanent campaign, and the line between campaigning and governing is virtually gone,” said Gary Jacobson, a political science teacher at the University of California-San Diego.
Enter Wilson. After his shout on Wednesday night heard ’round the political world, his Democratic challenger raised $400,000 by Thursday evening.
Proof enough for Kim Alfano Doyle, a Republican campaign strategist for two decades, who said that Wilson’s move was crass and that the take-no-prisoners approach is a mistake.
“It just looks ugly, it looks petty, it looks like no one’s getting anything done,” she said. “When you’re up there having a slap fight, you’re not taking it seriously. Everything’s a campaign, and that’s a shame.”
The Washington Post contributed to this report. To reach David Goldstein, call 202-383-6105 or send e-mail to dgoldstein@mcclatchydc.com.

Wilson took caffeine pills in 2007 (click here)
By Jordan Fabian - 09/10/09 06:21 PM ET
Rep. Joe Wilson (R-S.C.), who shouted "you lie!" at President Obama during his Wednesday night address to Congress, admitted to regularly consuming caffeine pills in 2007.
It is unclear if Wilson still takes NoDoz, a brand of pill that contains 200 milligrams of caffeine a pop. By comparison, a seven ounce cup of drip coffee contains 115 to 175 milligrams of caffeine.
A source told The Hill in 2007 that the congressman ingested the tablets “like candy," but Wilson insisted he was not addicted despite the fact that he had been taking them since high school.
"I love coffee, but I don’t have time to drink it and I don’t have access to it," Wilson said at the time.
The fifth-term Republican said he shared his NoDoz use with his doctor, who Wilson said assured him that the over-the-counter pills are not dangerous unless you get addicted.
Wilson interrupted the president yesterday night after he said that his health reform plan will not insure illegal immigrants. He quickly apologized for his outburst last night but maintained that Obama was lying in a radio interview today.

Page 151, 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.

Nursing Homes are a huge issue. It requires attention and it requires attention now. There are many reasons to 'get this right.' The next generation of elderly will be numerous and some will require Long Term Care. The Baby Boomers come from a generation that would rather 'opt' for longevity with activity and purpose, however, there will be the exceptions.

By every definition of 'Sandwich Generation' I should be one of those taking care of elderly parents while paying for a child's wedding. But. I am not. Why? Because my parents are in excellant health for their age and they live in their own home able to take care of themselves. That, by the way, is true for most of my extended family. Irish Americans. Evidently, we are a sturdy bunch.

I say this with anticipation of seeking the same autonomy for myself, until my death. And. I expect the same 'ideals' hold true for my generation. I believe that is an important 'directive' for any Health Care Insurance Reform. Why? Because if The Baby Boomers are able to care for themselves all their lives, the SNF (Skilled Nursing Facilities) just might be a thing of the past. And, that is another thing. Why aren't their 'earning' opportunities for Seniors that live in Nursing Homes, should they have the ability. Imagine a 'Mom and Pop Country Store' in every SNF that residents and visitors can frequent for the latest in DVDs, Music Downloads or Gourmet Frozen Dinners.

It will be vital for the next generation of 'elders' to remain active, in good health and quite possibly able to produce an income that will continue to contribute to the country's tax base. BUT. In realizing there is a chance that will be part of the American Landscape, please let it be in balance with 'respect for The Golden Years' and some entitlement of Seniors for 'down time' and relaxation as they seek to send it.

There is also this 'hazard' accompanying longevity. It is the 'longevity of job occupation.' And by occupation, I don't mean 'profession.' By occupation I mean staying in a position too long. While some of the most qualified employees a company has is their 'experienced' and older workers and executives, there is a moral issue with 'job protection' in the face of a younger generation 'stuck in the rut' of No-Advancement and no advancement opportunity. It is a concern for many reasons.

As Americans live longer, they will work longer. Even in retirement, the opportunities to earn and fight 'built in' inflation of retirement income, will be met with job seekers. There is a problem with that as it 'oppresses' younger workers and potential executives. There needs to be a 'longevity' component to those jobs frequently sought for their higher income or prestige or responsibility. There comes a time when 'the younger generations' need a chance at their goals. Now, this is somewhat of Age Discrimination, but, it doesn't have to be. If an individual comes into a managerial position with a healthy income in their forties, there needs to be some expectation on 'changing' such employment within twenty years of achieving it.

Why?

Not because the older worker can't do the work, they can probably accomplish it handily. But. There are several reasons that will enhance 'the futrue' of any enterprise, including, local economies.

An enterprise that has longevity has the right to remain vital. It is good for the economy. Often younger workers will become diminished in abilities if they are 'stuck' in lower paying and lower expectation employ. In that, there is a hazard. It is a dynamic that needs to be addressed from the standpoint of what is good for any company to remain viable and what enhances 'vitality' in the American economy. Why discourage younger workers from achieving if they feel their best years will be stalemated in lower or middle management or jobs of lower esteem than they hoped for when graduating from classes, be it High School or the University.

With anticipated increased longevity. Longevity with purpose and income. There needs to be an understanding to the extent longevity will play in any economic dynamics. That is not Age Discrimination, unless, it is viewed as being OPPRESSIVE against young workers. And by young, it includes those in their fourth and fifth and sixth decade of life that has yet 'the chance' to reach for the Gold Ring.

It may be that this unique dynamic might be exclusive to the Baby Boomers and Generation X will find a more 'traditional' meaning to retirement. But, to anticipate such an issue is to address it. That was off the path of reading the House Bill as it stood before Summer Recess.

There are problems with 'chain store' SNFs. Corporate structure removes 'compassion' from SNF. There are also opportunities for fiscal exploitation of the USA Treasury and SSI, especially considering there might be increased demand for such services. So, to understand the SNF and its fiscal 'habits' is more than prudent for any National Health Care Insurnace Reform Bill.

Page 551, lines 23 and 24 and Page 552, lines 1 and 2:

(2) REPORT.—Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1).

It sound not only correct to proceed, but, neglectful if we don't.

The bill goes on to list definitions, the website which sounds like a central clearinghouse for information and certifications. There is recommendations for 'staffing improvements' or at least 'consumer awareness' of what staffing should be available. Usually that type of information will bring about change for the better with consumer advocacy.

Page 555, lines 1 through 3:

‘‘(IV) an explanation that appropriate staffing levels vary based on patient case mix.

That is more than interesting. In today's SNF, staffing it arbitrary based on parameters set up by the Director/Vice President of Nursing. They are viewed as 'standards' by the profession, but, there is little to no application of 'staffing for acuity.' There is no reason why a SNF should not be viewed as a 'fluid' environment for changes in 'residents' acuity. There is also no reason why that dynamic should be 'ignored' as a part of any management practice within any facility. It may mean that two more Nursing Assistants are needed on The Alzheimer Unit as some of the residents are changing their wellness status, while The Rest Home Unit is enjoying many agile residents needing far less assistance.

Most hospital units today use some type of acuity scale to staff probably. There is no reason why that dynamic cannot be applied to SNFs as a way of maintaining clearer understandings of their 'client population' and their ever changing needs.

But, this is more or less about 'empowering' the consumer seeking a SNF, as a method to compliance of 'quality of care.' The new website, of which has a name, ‘Nursing Home Compare,’ will provide a place to download forms when a complaint needs to be filed.

Page 555, lines 13 through 19:

‘‘(v) The standardized complaint form developed under subsection (f)(8), including explanatory material on what complaint forms are, how they are used, and how to file a complaint with the State survey and certification program and the State long-term care ombudsman program.

The legislation goes on to define staff that acts in a criminal manner, enforcement, deadlines for provisions in the bill to be incompliance, there is stated the 'agencies' the Secretary will consult with, Page 557, line 21 and 25, Page 558, lines 1 through 5:

‘‘(B) CONSULTATION.—In conducting the review under subparagraph (A)(i), the Secretary shall consult with—
‘‘(i) State long-term care ombudsman programs; ‘‘(ii) consumer advocacy groups; ‘‘(iii) provider stakeholder groups; and ‘‘(iv) any other representatives of programs or groups the Secretary determines appropriate.’’.

Continued in entry below.

Continued from previous.

Young adults a key to health care reform (click title to entry - thank you)
Many are uninsured, with mixed opinions on need for change
By Childs Walker, Stephanie Desmon and Paul West Baltimore Sun reporters
September 11, 2009
...In the debate over health care reform, Stokes and his peers are known as "invincibles," strong and healthy young adults who have no experience with wallet-crippling illness and feel they have no need for coverage....

Yet, young males are at risk for serious diseases such as Testicular Cancer. Young women have incidence of Breast Cancer. We aren't speaking to our young people the way they need us to speak to them.

Testicular cancer is the most common form of cancer among males age 15 to 44 (click here). After motor vehicle accidents and suicide, cancer is the leading cause of death in this age group, followed by homicide, heart disease, and HIV. Testicular cancer is known as the young man's cancer.

This table is on Page 46 of article (click here). It was the only 'study' on the internet that was handy. Unfortunately, it only addresses White Males, but, I think the 'idea' of misinformed youth is validated.

TABLE 1. Age-specific and age-adjusted incidence rates of testicuiar cancer (per 100,000) for US White males from 1973 to 1995: Surveillance, Epidemiology and End Results Program
In 1995 - ages 15 thru 19 there were 3.9 cases per 100,000 Caucasian men.

In 1995 - ages 20 to 24 there were 7.9 cases per 100,000 Caucasian men.

In 1995 - ages 25 to 29 there were 15.9 cases per 100,000 Caucasian men.

To return to the legislation, Page 559, lines 11 through 17:

‘‘(8) SPECIAL FOCUS FACILITY PROGRAM.— ‘‘(A) IN GENERAL.—The Secretary shall conduct a special focus facility program for enforcement of requirements for skilled nursing facilities that the Secretary has identified as having substantially failed to meet applicable requirement of this Act.

This entire provision sets up Consumer Education and Advocacy as well as sets expectations for SNFs. The title of this initiative is "Special Focus Facility Program." It's a good title. Leaves open the inclusion of 'miscellaneous' facilities including Rehab facilities like the one that welcomes and specializes in returning, disabled veterans.

Proper staffing will ultimately be an initiative with this Secretary of Health and Human Services.

Page 560, lines 20 through 25 and Page 561, lines 1 through 6.

‘‘(i) Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C)(ii), including information on staffing turnover and tenure, in a format that is clearly understandable to con2
sumers of long-term care services and allows such consumers to compare differences in staffing between facilities and State and national averages for the facilities. Such format shall include—

Properly staffed and well run SNFs looks to be a priority of the Secretary.

Page 566, lines 7 though 10:

‘‘(B) PERIODIC SURVEYS.—Under such program the Secretary shall conduct surveys of each facility in the program not less often than once every 6 months.’’.

The provision provides for transparency in that the reports and surveys will be available at the website to the public and professionals. The States are going to have a role in quality assurance as well.

Page 568, lines 7 through 18:

(1) GUIDANCE.—The Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) shall provide guidance to States on how States can establish electronic links to Form 2567 State inspection reports (or a successor form), complaint investigation reports, and a facility’s plan of correction or other response to such Form 2567 State inspection reports (or a successor form) on the Internet website of the State that provides information on skilled nursing facilities and nursing facilities and the Secretary shall, if possible, include such information on Nursing Home Compare.

And I have to apologize here. I usually cover at least 50 pages per day, but, I have some personal business that is pressing and I won't be able to complete this review until Monday afternoon or evening.

In hoping everyone is well...

...until then...

I'll read some more of the House Health Care Insurance Reform Bill tomorrow.

...until then...

It is kind of a strange day. September 11, 2009. 8 years and the perpetrators are still a danger to us.

There is this report. It was published by Voice of America and I didn't see this content many other places. The 'map' to click on in the article is more than interesting. And when looking at this article and the map I think it is wrong to have an emotional reaction, but, one has to study the map a minute to realize its implications. In my opinion.

Taliban Control Spreads in Afghanistan (click here)
By Steve Herman New Delhi

11 September 2009

Eight years after the terror strike on the United States, which prompted an invasion of Afghanistan to oust the Taliban, there are indications that the insurgents are continuing to widen their reach inside the country. Meanwhile, some high-ranking British and American officials are expressing mounting concern about Afghanistan's fraud-tainted election process.

A respected international think tank has released a new map showing, for the first time, the Taliban have a "permanent presence" in 80 percent of Afghanistan. "Permanent presence" in a province is defined as one or more insurgent attacks - lethal and non-lethal - per week...

The years of a diverted war has literally left Afghanistan to the Taliban. They have been having a heck of time 'tearing up' the place. What I find interesting about the map at first glance is the location ONE, and only ONE, Taliban Base in the Tanji Valley. It is remarkably close to Kabul and the lousy encampment is still there. Tell me that makes sense? What the heck has been going on that an enemy's encampment is in such close proximity to Kabul.

It is also understandable for the Taliban to attempt to 'hold on' to every inch they took away from decency and democracy. They nearly own the blasted country when one looks at it from this perspective.

But, there are also portions of the country that aren't even touched by the Taliban. They are along the northern region where former Soviet nations share a border with Afghanistan.

..."We're now seeing Taliban control across the country. And one of the most significant things that we're seeing in this latest map is the increased level of Taliban presence in the north of the country. Provinces such as Kunduz and Balkh, which previously were relatively stable, are now seeing very high levels of Taliban activity," he said....

The movement into the northern region has to do with Pakistan's actions to eliminate the insurgency there and it is where the NATO and USA troops conduct their supply lines. Basically, I think the strongest reason for the Taliban to be migrating north to attempt to dominate the area is to cut off the supply lines to Western Troops.

Even to disrupt the supplies is a victory for them. The other day, the Taliban were taking a stolen fuel tankers to kill the German PEACEKEEPERS. As a result the tankers were exploded. Now, while there are supposed to have been innocent civilians involved there was also precious fuel destined for the troops. So even though the Taliban failed at executing their directive, the fuel was still gone.

What I find even more fascinating about the land in the northern region is the complete and absolute absence of Taliban attacks on the narrow strip of land bordered by Tajikistan and Pakistan. They must be doing something right otherwise the Taliban would be far more invasive.

I believe Tajikistan and Pakistan are doing so much right that it supplies a buffer to the rest of Afghanistan. If one notes, the TWO regions immediately west of this area, Badakhshan and Takhar is still seeing 'relief' from the Taliban than other areas. Not only that, but, there is also another small province, Panjshir, bordered by those TWO regions I mentioned in the previous sentence that is again completely absent of Taliban violence.

For this to be true, Pakistan and Takikistan must be exerting a good amount of force and that brings me to my next observation.

Considering Pakistan is having a great deal of success in combating the violent occupation of The Taliban. And it would appear Tajikistan is taking a hard line with any possibility of migration of the Taliban into their country. Also, this 'buffer zone' exists with the efforts of both these countries to secure their own borders, along with the reality of the Supply Line presence as allowed by Russia. It is obvious, at least to me, that the Taliban are under stress in most of the other areas of Afghanistan because it is the only place they have any 'elbow room.'

There are others in the military that can speak to this better than I, but, it appears to me the Taliban are contained. But. They are contained in Afghanistan where our troops are facing most of the violence the Taliban can muster. The reality the Taliban are contained, the escalation in the war in Afghanistan should have been expected.

The issue is this. And it is an issue that would require a 'regional' perspective, in that, while Afghanistan is absorbing all the Taliban and their violence as they try to reassert themselves, what does the rest of the region look like? The Taliban are virtually removed from any influence in Pakistan and the military in that country continues to be successful with the remnants of the Taliban militas.

Does the reality, at this point, reflect a successful war to secure the region with a 'hot spot' concentrated in Afghanistan. Because if they are 'contained' in Afghanistan, squeezing them will result in more chaos within their ranks and eventual collapse of any infrastructure that facilitates violence.

One of the great failures in fighting the Taliban or any of the international criminal networks in this region is their ability to 'liquidate' their presence and migrate back around any advancement of Western troops. These networks sort of disband and meld into the landscape of civilians while they reconstitute in areas where Western Troops have finished operations.

If the reality is that the region is MORE stable than in anytime in the last decade that cannot be ignored. The reality that these networks are actually impuned from some of the northern regions speaks to their decreasing ability to carry out chaos as a strategy. In other words their operating/staging area is limited and closing in on them.

If that is not the reality of the region then the advancement of the Taliban speaks to 'civilian loyalty' and whether they are accommodating the Taliban in favor or the Afghanistan government.

The corrupt election and no one should be denying at this point the Afghanistan election was corrupt. There appears significant evidence to that by most. The corrupt(ed) election is more evidence of the desperation of the Taliban and their influence among the electorate. I might add, that even though the elections were corrupted, they still are 'intact' enough to find 'majority' candidates. It is a concern IF the corruption was actually carried out by the leading candidates themselves and that is another issue.

If I could have my way, I would like to see a 'final election' with two candidates. It would give the nation one more time at conducting intact elections. It would give the 'observers' and I am assuming there are observers, a real chance at finding the corruption and those involved, because it will show up more when there are only two candidates running. If, however, President Karzai and the Afghanistan election board could prove his successful election with more than 50% of the vote, there should be a court to certify the win. But. If President Karzai has less than the required 50% then a court needs to certify that as well.

I realize there is conjecture regarding President Karzai's administration and a brother engaged in somewhat of a warlord status engaged in the Poppy Culture. But. I point to the fact, the Poppy yields are lower and the export is diminishing, therefore, in that reality there is less 'financial infrastructure' to lend support to the violence of the networks currently 'surviving' in Afghanistan.

I also won't speculate on WHY there is diminished capacity in the Poppy market place as it could be Climate Change and/or an inflitration of those that would like the culture to disappear. Just speculation.

Bottom line is, here we are eight years after the attacks of September 11, 2001 and the occupation of Afghanistan has reached critical mass. It is due to the negligence of the Bush/Cheney years to the 'real war' to secure our nation. But, is the 'critical mass' we are witnessing in Afghanistan 'the end' of the Taliban regime and violence OR growth of a strengthened network?

I hold a wish for peace for all the survivors and families of the victims of September 11, 2001.

The contracture of the economy is slowing.

This recovery is going to be different than any recovery in the past history of the USA with some exception of the FDR administration. The reason is the 'character' of the stimulus which is titled, "American Recovery and Reinvestment Act." This stimulus wasn't just dumping money into the economy through tax cuts or rebates as was practiced in the past eight years, this is a 'reinvestment' stimulus.

While jobs were definately saved with this stimulus there are also new jobs 'being' created. As the NEW American infrastructure takes place job growth results. Example: Constructing high speed rail in at least thirteen hubs around the country, there first has to be design/architects and all the technical folks doing their part. When plans are in place there is usually a significant government process that has to be mounted to begin any construction. Once all the permits and objections are answered and resolved, then the construction can actually begin. The most job creation will result far later than a 'quick infusion of money' result. The long term recovery is best because it is sustainable employment that creates jobs with longevity and can't be outsourced.

U.S. Initial Jobless Claims Fell to 550,000 Last Week (Update2) (click title to entry - thank you)
By Courtney Schlisserman

...Applications fell by 26,000 to 550,000 in the week ended Sept. 5, lower than economists forecast, from a revised 576,000 the week before, Labor Department data showed today in Washington. The total number of people collecting unemployment insurance declined to the lowest level since April....

Link to chart (click here)
Also known as insured unemployment. This is an actual of the number of individuals who are unemployed and are currently receiving unemployment benefits. These are the number of people who filed for unemployment benefits at least two weeks ago. Weekly initial jobless claims is the number of people who have filed for unemployment benefits for the first time. To file a claim you must be eligible and meet five (5) guidelines. 1. Meet the requirements of time worked during a 1 year period (full time or not). 2. Become unemployed through no fault of your own (cannot be fired). 3. Must be able to work; no physical or mental holdbacks. 4. Must be available for work. 5. Must be actively seeking work.

Calif. State Assemblyman Mike Duvall stepped down after being caught bragging about sex with two lobbyists on a live microphone. (AP)

Snake in the grass or perhaps in the garden. What does Ann Coulter and Joe Wilson have in common? They are both political operatives.

Joe Wilson lied. Illegal immigrants can get health care insurance, so long as they pay for it in full without government funds.

After Congress comes back in January, having passed the National Health Care Insurance Reform, the next topic on the agenda is Immigration Reform. Get the picture? Joe Wilson picked a 'quiet moment' to 'strategically' place the words 'out there' to idiots like the Murdock tribes.

If Wilson were successful, the entire distraction would incorporate anger over immigration and health care into one big storm of emotion that would carry them into November 2010.

Wilson is a snake, no different than the Right Extremists that 'lie like rugs.' The aggressive act mimiced the actions of activists at the town hall meetings. It was deliberate. It was a political maneuver and he should be severely sanctioned to 'make an example' of the jerk. If a legislator lowers their standard this much, he'll do anything.


Sept. 9: Rep. Joe Wilson of South Carolina is seen shouting "you lie!" at President Obama during his speech to Congress in Washington. (AFP)

Censure !!! If not censure, impeachment !

Joe Wilson, Van Jones, and the watermelon (click title to entry - thank you)
Rep. Joe Wilson (R-SC) showed a grave lack of respect for the president and congressional protocol when he shouted, "You lie!" at Mr. Obama as he insisted in his speech last night that health care reform would not mean insuring illegal immigrants. (The president was not lying.)...

Specter Calls for Censure of Wilson (click here)
By Garance Franke-RutaSen. Arlen Specter (D-Pa.) called Thursday for the censure of Rep. Joe Wilson (R-S.C.) for shouting "You lie!" at President Obama as the president addressed a joint session of Congress on Wednesday night.
"There ought to be a reprimand or censure of Rep. Joe Wilson to discourage that kind of conduct in the future," he Tweeted.
"Rep. Wilson apologized immediately afterward but I don't think that's adequate," he wrote just moments before.


Expulsion, Censure, Reprimand, and Fine: Legislative Discipline in the House of Representatives (click here)
Summary
The House of Representatives is expressly authorized within the United States Constitution (Article I, Section 5, clause 2) to discipline or “punish” its own Members. This authority of the institution of the House to discipline a Member for “disorderly Behaviour” is in addition to any criminal or civil liability that a Member of the House may incur for particular misconduct, and is a device or procedure designed not so much as merely a punishment of the individual Member, but rather ultimately as a measure to protect the institutional integrity of the House of Representatives, its proceedings and its reputation....

If GMC decides to continue with ownership of Opel, then they planned it from the beginning...

...lying all along the way. I do believe that is criminal in intent. After all, there is no proven performance of GMC's ambitions and absolutely NO REASON to believe there is 'sound judgement' in moving in any other direction EXCEPT the sale of Opel as dictated in 'The Agreement.'

...A decision not to sell the European business (click title to entry - thank you) would be bad news for Opel and German jobs.
Paul Newton, of IHS Global Insight, said: "GM has invested a lot of money in GM Europe, especially in research and development in Germany.
"To walk away from this for not a lot of cash (the deals offered by RHJ and Magna), obviously didn't make sense. But the big question is where will they get the money from?
"GM has to find around $6bn - that's a large amount of money."
German unions are threatening to launch mass strikes if the decision goes against them.

GM has not commented on the reports.

In Sight, but Not Yet within Reach - The Slimeballs from Wall Street See 'Sea Green' but they may not survive to claim it.

There has been very startling events occurring in the North Atlantic. There is significant release of Methane Gas.

Methane gas seeps from seabed outside Svalbard (click here)

2009-08-19

A scientific study shows that the powerful greenhouse gas methane is escaping from the Arctic seabed. This could be a response to climate change and higher ocean temperatures and accelerate climate changes even more....

The exact article is here:

Warming Ocean Contributes to Global Warming (click here)

14/08/09
The warming of an Arctic current over the last 30 years has triggered the release of methane, a potent greenhouse gas, from methane hydrate stored in the sediment beneath the seabed....

The Permian Extinction was caused by warming of Earth. Earth's oceans lost 99% of its phytoplanton following the release of Methane Gas from the oceans as the Earth warmed at an incredibly faster rate with atmospheric methane climbing. The only phytoplankton that survived the Permian Extinction was the Silicon based single celled plants.

As carbon dioxide enters the ocean and there is more and more of it in the ocean it produces carbonic acid. Acidic oceans do not allow for the 'shells' of marine species to form. Therefore the oxygen producing single celled plants that are necessary for the breathable oxygen on Earth can't survive as their use of calcium carbonate is vital. However, with acidic seas the calcium carbonate is dissolved and unavailable.

The silicon content of the oceans is far lower than the calcium carbonate, so even though there are some Silicon Based Shelled phytoplanton that survives such a warming event, there is very little to produce enough oxygen to support all life currently on Earth.

For those seeking wealth in the Arctic Ocean and believe the oceans becoming acidic is just a 'sign' that Earth's warming is to benefit to humans, reconsider; when the oceans are warm enough, the phytoplanton that produce your very breath will die.

Carbon dioxide sequestration would be an excellant idea long about now. And. Oh, yeah. The best place to prevent the CO2 from re-entering the troposphere is where it can be frozen all year long. Like. Antarctica. Or. The Arctic Ocean. Stored in seamless stainless steel tanks without VALVES, but, sealed and buried in a location very, very cold so even if a tank should develop a leak, the carbon would be too cold to escape.

Hate to tell you, I told you so. But. I told you so. In 2003 I gave it five years after the vortices showed up. I was a year off.

Currently, the weather at Glacier Bay National Park (crystal wind chime) is:

Local Time: 11:06 PM AKDT on September 09, 2009 (GMT -08)
Lat/Lon: 58.8° N 137.0° W
Elevation :: 33 feet
Temperature :: 57 F
Conditions :: Overcast
Humidity :: 77%
Dew Point :: 50 F
Wind :: 12 mph from the SE
Pressure :: 29.79 in (Rising)
Visibility :: 10.0 miles
UV :: 0 out of 16
Clouds :: Scattered Clouds 3500 ft
Mostly Cloudy 4700 ft
Overcast 6500 ft
(Above Ground Level)

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.