You can explain away the violence if you want to, but, extremists are sometimes viewed as 'favorable' by a people that want to change their government

This was a big kill for ANY of the revolutionaries in Iran. The Iranian government needs to be sure they have the right people and they don't know that. Why do they need to be careful? Because if they 'get it wrong' or 'scapegoat' anyone then they haven't solved the problem.

If the President of Iran DECIDES to assassinate people to simply lay blame and move on in hopes it will terrify the people to stop their revolution, it will only serve to enhance it. The more innocent people the President of Iran kills, the worse the streets will become !


Jundullah have been blamed for attacks aiming at destabilising Iran (click title to entry - thank you)
By Roger Hardy
BBC Middle East analyst
The Iranian authorities have accused a shadowy group called Jundullah - the Soldiers of God - of carrying out a suicide bombing in mid-October which killed six commanders of the Iranian Revolutionary Guards. But what is Jundullah, what does it want - and who is behind it?
It was founded in 2002 to defend the Baluchi minority in the poor, remote and lawless region of south-east Iran.
Its leader, Abdolmalek Rigi, denies the group has either foreign links or a separatist agenda.
In an interview in October 2008, he said the group - also known as the People's Resistance Movement - was not interested in trying to break away from Iran.
It simply wanted the state to respect the human rights, culture and faith of the Baluchis....

President Ahmadinejad must have a question to whom could carry out this violence. It may very well be al Qaeda or an al Qaeda backed rebel group. Iran has problems. Iran needs to stop escalating nuclear armament to threaten global stability and seek to solve their internal problems.

He is asking Pakistan to arrest terrorists and rebels. I do believe the Pakistanis are doing exactly that, so Mahmoud needs to 'rethink' whom is out to take over the government by coup. Iran will not 'back' the Taliban in Pakistan either. They need to focus on the 'unrest' and 'neglect' of the people of the country.

Ahmadinejad calls on Pakistan to help arrest terrorists, rebels (click here)
www.chinaview.cn

2009-10-19 19:27:25

TEHRAN, Oct. 19 (Xinhua) -- In a telephone conversation with Pakistani counterpart on Monday, Iran's President Mahmoud Ahmadinejad called on the Pakistani government to help arrest the terrorists and rebels and bring them to justice, the official IRNA news agency reported....

...Early on Sunday, a deadly bomb attack occurred in Iran's southeastern province of Sistan-Baluchestan near Iran's border with Pakistan, killing some 45 people, including a number of Islamic Revolution Guards Corps (IRGC) commanders, and wounded dozens others.
The Sunni rebel group Jundallah (God's soldiers) has claimed responsibility for the deadly suicide attack.

Oh, well, I've always wanted to live in a manmade cave, haven't you?

The grapes of Afghanistan. Where is the vino, babe? I love a man with a beard and a turban. Hubba-hubba. The Afghans need to 'sex up' their economy and put their children's future first!
These folks are not having fun and the reason for that is the Taliban. Barbers anyone?


It is called "status." What kind of goats to you raise? These are Angora Goats and their wool is used for Angora sweaters. Now, in my opinion, a goat is a goat is a goat and they all eat and drink about the same food and water. The question is do Afghan farmers want to continue subsistence farming or do they want to export 'high end' sweaters to Fifth Avenue?

Hello?


A United States Army soldier and a Marine searched the home and compound of an Afghan farmer in Khan Neshin. American officials are debating whether cracking down on the drug trade will anger farmers dependent on it for their livelihood.

This is more than a little silly and why there needs to be a REFORMER elected in Afghanistan in the Presidential Runoff Elections.

By allowing the current 'dysfunctional' drug economy to exist there are several things that are going to make this war difficult and hideous.

1. The USA should not be intimidated into being a drug warlord and throw in the society.

2. The Afghan people do not want to live under Taliban oppression.

3. The Afghan people are in the circumstances they are now because of the Taliban. They oppressed democracy and economic reform and the people of Afghanistan are only allowed to have an economy that services al Qaeda while causing problems in Advanced Societies.

4. The poppy fields have to go!

Only a very small share of Afghanistan's land (about 15 percent), (click here) mostly in scattered valleys, is suitable for farming; about 6 percent of the land is actually cultivated. At least two-thirds of this farmland requires irrigation. Water is drawn from springs and rivers and is distributed through surface ditches and through underground channels, or tunnels, which are excavated and maintained by a series of vertical shafts. Such a tunnel is known as a karez or qanat. In 1987 about 26,600 sq km (10,300 sq mi) of farmland were irrigated.
Wheat is the most important crop, followed by barley, corn, and rice. Cotton is another important and widely cultivated crop. Fruit and nuts are among Afghanistan's most important exports. Afghanistan is noted for its unusually sweet grapes and melons, grown mostly in the southwest, north of the Hindu Kush, and in the fertile regions around Herat. Raisins are also an important export. Other important fruits are apricots, cherries, figs, mulberries, and pomegranates....

Texas' soldier-farmers seek to remake Afghan farming (click here)

Monday, August 25, 2009

By Chris Vaughn

Fort Worth Star-Telegram
In uniform, they look like any other soldier.
But the heart of Lt. Col. Stan Poe’s unit of Texas National Guard troops is radically different than most combat outfits in Afghanistan, answering to the sounds of agriculture and the sight of crops.
Soldier-farmers, one might call them.
The Texas soldiers, agricultural experts who come from Aledo to Weslaco, are on the forefront of a new National Guard initiative to bring Afghan farming out of the 19th century, in a place where decades of war have destroyed infrastructure, wrecked government capabilities and provided a favorable environment for illicit poppy production....

Summary (click here)
Agriculture’s share of total economic activity – as measured by gross domestic
product (GDP) – is significant in seven countries located in Central and South Asia:
Afghanistan, Iran, Kyrgyzstan, Pakistan, Tajikistan, Turkmenistan, and Uzbekistan.
Its share ranges from about one fifth in Tajikistan to more than one half in
Afghanistan. Those employed in the agricultural sector account for a large portion
of the entire labor force in all seven countries. Agricultural workers account for
almost one-third of all employment in Iran; in Afghanistan, farmers and related
workers represent more than two-thirds of the labor force.
Large desert regions and extreme mountainous terrain limit the amount of arable
land in most of these countries. Irrigation systems are vital in most countries in
directing limited water supplies to agricultural producing areas.
All seven countries are net food importers, meaning they do not produce enough
to cover all their food needs....

The Afghan government needs to build 'strengths' when it comes to economics. They have to develop a service economy and a manufacturing economy. Sheep, goats can provide wool for weaving, leading to clothing, draperies, etc. Therefore, there is an industry for designers and marketing. The problem is that the food for the animals will inhibit the ability to propagate that economy.

From there they need to develop craftsmen and craftswomen, build REAL homes, hospitals and schools, educate teachers, doctors and nurses and provide public services. They need to have a fire department so their homes are made of something more than stone and plaster and they need to develop 'central plumbing' and find water sources along with sewage treatment.

A change in 'quality of life of these people' will develop an economy that is servicable through taxes from wages, no different than the USA economy. Police, trash removal and a transportation department that provides for tourism. Conservation and park quality viewing. Don't tell me it doesn't exist in Afghanistan because there are plenty of incredible vistas,

So.

The next President needs to set 'standards' for the people to live by and they need to organize themselves around a mayor and council and not the strength of warlords that can kill them if they are not obedient.

I mean honestly !

The President of the United States just signed a bill sending gobs of money to 'rehabilitate' Afghanistan. That includes drug treatment centers and monies to improve the infrastructure. THAT does not mean that the infrastructure is going to SEVICE al Qaeda. No. No. There is 'change' due the USA people in Afghanistan and we want it now!

The Senate Finance Committee is in the MINORITY of Senators that want to kill reform.

The best venue at this point, is for the House and Senate to be prepared for Reconciliation (click title of entry - thank you) of the Health Care Insurance Reform Bill. The reference to the title of this entry indicates the Insurance Industry is doing more than anticipating change, they are attempting to fight it.

From the "National Underwriter"...By packaging the bill as a budget bill, House leaders might be able to use a process called the “reconciliation” process to get a health reform bill through the Senate with just 51 votes, rather than 60 votes normally required....

Rep. Charles Rangle was under attack for ethics issues that failed. Why? Because he was leading the charge for Reconciliation. The ethics charges are baseless. I am not a fan of Rep. Rangel as he feels manditory military service should be a part of the citizenship of the USA, but, either charges are valid or not and in his case there was no wrong doing. He was attacked by the Republicans because of his power in Ways and Means and their cronies are getting nervous.

...Republican members of the House (click here) last week attempted to oust Rangel from his powerful chairmanship of the House Ways & Means Committee for the duration of a House Ethics Committee investigation into alleged ethical misconduct surrounding his real estate investments and dubious personal financial disclosure reports....

Considering the contentious measure has come from the Finance Committee and the House is sending their's to Budget, there is every indication we will have a Health Care Insurance Reform Bill within the next month or so. The American People can't wait any longer and the Republicans are 'set' on serving their cronies well and 'saving face' to their electorate. The Republicans are desperate for the lack of members since the 2006 elections and are spending all their political capital on the 2010 elections. It is an impossible environment in the Legislature. Reconciliation might be the only tool left to stop this hideous debate as there are other issues pressing, including, Climate Change and Immigration.

It goes like this. The Republicans in the House and Senate want to 'appear' to cooperate with the President, after all come November 2010 if they are sequestered in their own little GOP world it might cost them votes.

So, the Senate FINANCE Committee decided to 'set aside' all animosities and work for their cronies to pass a bill they can vote for; it would give everyone 'the face of success' including President Obama and the Democrats. Everyone that is, except, the American people in the majority.

Now that the Senate Finance Committee, acting against their colleagues and stabbing them in the back, has placed a stamp of approval on the Technologies Spending Bill (AKA The Health Care Reform Bill, or should I say Formerley Known As) the Republicans are attempting to place a 'wedge' issue into their strategy and turn the tables stating the Democrats don't know how to be bipartisan.

It's corruption through and through. What occurred in the Senate Finance Committee was the undermining of health care reform. It was during the media circus following the Committee's ? Work ? that the health care insurance INDUSTRY came out against the Democratic Majority and their bills. It is more obvious than ever and quite frankly the Senate Finance Bill is the last ditch effort for the Health Care Industry to stop a Public Option and provide for lining their coffers.

On CUE, case in point, still yet another version of a Republican lead charge, dissing the Baucus Bill, against the American people. What is the cry "Too much money." So what else is new from a Republican?

Health reform: Bipartisan plan will help all Americans (click here)

By Peter J. Pitts
October 18, 2009

Congressman Bill Cassidy, R-La., recently broke some news that could turn the health care debate on its head. During a radio interview, he revealed that Blue Dog Democrats have been quietly reaching out to Republicans to draft an alternative health reform bill.

This isn't surprising. After all, neither Republicans nor centrist Democrats nor the majority of Americans approve of the clumsy hodgepodge of big-government policies that make up Sen. Max Baucus' health care bill.

Fortunately, an alliance between Republicans and moderate Democrats could give Americans the reform package they're looking for — one aimed at lowering costs while promoting competition....

The next section of the House Bill which begins on page 931 with a title concerns itself with Health and Wellness, which is where billions are appropriated and that isn't because spending is a choice by Democrats, it is because it costs more than a dollar per person to be sure 300 million Americans are receiving COST SAVING Preventative Care.

Page 932 (the second page with the title to the section), lines 1 through 8:

‘‘TITLE XXXI—PREVENTION AND WELLNESS
‘‘Subtitle A—Prevention and Wellness Trust
‘‘SEC. 3111. PREVENTION AND WELLNESS TRUST.
‘‘(a) DEPOSITS INTO TRUST.—There is established a Prevention and Wellness Trust. There are authorized to be appropriated to the Trust—

This section of the bill is lengthy, sets up 'The Trust Fund' for the provision and is NOT outrageously expensive considering the 'per person' expenditure. The monies come from appropriated funds in the Health Investment Fund. All these monies by the way are 'housed' in the USA Treasury. So, when Paulson drained the Treasury to bail himself out of his incompetency as a CEO, he was acting with disregard to the priorities of the people of this nation. He didn't care if every other dollar in the Treasury appropriated for the well being of the nation went bankrupt.

One has to consider when making the observation that TODAY, Wall Street is zipping right along while there are still failing banks in the USA and high rates of unemployment in the face of stimulus. Paulson could not care less what was the outcome of his bailout. He didn't care if the American economy imploded and people were impoverished and living on the street or worse.

The reason that reality is not ours today, although there are people living on the street, is because we elected a moral man in the White House and a majority of Democrats to the House and Senate that passed a stimulus plan the began to turn things around. Otherwise, the 'domestic' condition of the nation would be very different than it is today.

Page 932, lines 12 through 14:

‘‘(2) in addition, out of any monies in the Public Health Investment Fund—
‘‘(A) for fiscal year 2010, $2,400,000,000;

Page 933, lines 11 through 13:

‘‘(2) for carrying out subtitle D (Prevention and Wellness Research)—
‘‘(A) for fiscal year 2010, $100,000,000;

Page 933, lines 24 and 25 and page 934, line 1:

‘‘(3) for carrying out subtitle E (Delivery of Community Preventive and Wellness Services)—
‘‘(A) for fiscal year 2010, $1,100,000,000;

Page 934, lines 12 through 15:

‘‘(4) for carrying out section 3161 (Core Public Health Infrastructure and Activities for State and Local Health Departments)— ‘‘(A) for fiscal year 2010, $800,000,000;

Page 935 begins the 'particulars' of the definition and focus of Preventive and Wellness provision:
Page 935, lines 7 through 18:

‘‘Subtitle B—National Prevention and Wellness Strategy
‘‘SEC. 3121. NATIONAL PREVENTION AND WELLNESS STRATEGY.
‘‘(a) IN GENERAL.—The Secretary shall submit to the Congress within one year after the date of the enactment of this section, and at least every 2 years thereafter, a national strategy that is designed to improve the Nation’s health through evidence-based clinical and community prevention and wellness activities (in this section referred to as ‘prevention and wellness activities’), including core public health infrastructure improvement activities.

The provision continues in mapping the National Strategy in Health Care. It tells the Secretary where to concentrate efforts. It does not give the Secretary of Health and Human Services open uncontrolled power to 'be the decider' on what path to take for the nation's health. That would be incompetency in the Legislature if that occurred. The powers of the Executive Branch are to come from the Legislation and it is why the bills have to pass through the House and Senate.

Page 935, lines 19 thorugh 23:

‘‘(b) CONTENTS.—The strategy under subsection (a) shall include each of the following:
‘‘(1) Identification of specific national goals and objectives in prevention and wellness activities that take into account appropriate public health measures...

Page 936, lines 1 though 13:

(the) ...standards (including Healthy People and National Public Health Performance Standards).
‘‘(2) Establishment of national priorities for prevention and wellness, taking into account unmet prevention and wellness needs.
‘‘(3) Establishment of national priorities for research on prevention and wellness, taking into account unanswered research questions on prevention and wellness.
‘‘(4) Identification of health disparities in prevention and wellness.
‘‘(5) A plan for addressing and implementing paragraphs (1) through (4).

Those specific priorities 'keep' the focus of the provision from being undermined anytime in the future. It directs emphasis on UNMET needs. It would be easy to undermine the Health Care Reform Bill's initiatives if there wasn't strong language directly its focus. In other words, let's say Bush's Brownie were in the Secretary's seat and figured the 'unmet' needs are simply not needed at all by a minority of the people that don't vote in his direction anyway, so why do it. Brownie would simply focus on the accomplishments 'to date' of the American Health Care System and cut budgets in some areas and reappropriate in the direction of cronies. The bill prevents it. The UNMET needs of the nation has to take a priority, too.

The bill goes further to direct the Secretary in seeking 'consult' from specific 'agencies:'

Page 936, lines 15 through 21:

...strategy under subsection (a), the Secretary shall consult with the following:
‘‘(1) The heads of appropriate health agencies and offices in the Department, including the Office
of the Surgeon General of the Public Health Service, the Office of Minority Health, and the Office on Women’s Health.

Page 937, lines 6 through 14:

‘‘Subtitle C—Prevention Task Forces
‘‘SEC. 3131. TASK FORCE ON CLINICAL PREVENTIVE SERVICES.
‘‘(a) IN GENERAL.—The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall establish a permanent task force to be known as the Task Force on Clinical Preventive Services (in this section referred to as the ‘Task Force’).

This provides for the 'expertise' of the Federal government to make all consults and recommendations focused on Prevention and Wellness. It is a dedicated Task Force because with Prevention and Wellness being a national priority the cost of any health care program, be it public or private will come down. This isn't just a 'Pie in the Sky' idea, it is a well accepted precept noted in the Private Health Care Insurance Industy that to bring down costs, offer Wellness programs.

The Secretary is responsible for appointing the 30 member Task Force. A little scary when considering this is probably the place where Republicans would seek to undermine 'the system.' So, the provision takes things a little further to insure 'quality control:'

Page 940, lines 11 through 19:

‘‘(4) REPRESENTATION.—In appointing members of the Task Force, the Secretary shall ensure that—
‘‘(A) all areas of expertise described in paragraph (3) are represented; and
‘‘(B) the members of the Task Force include practitioners who, collectively, have significant experience treating racially and ethnically diverse populations.

Page 941, lines 1 through 10:

‘‘(f) CLINICAL PREVENTION STAKEHOLDERS BOARD.—
‘‘(1) IN GENERAL.—The Task Force shall convene a clinical prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in clinical preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services.

The bill, being Constitutionally Correct, does not stop at the totality of government power and also includes a 'shareholders' group of public and private entities. This is somewhat standard for really good lawmaking. As example, "The Clean Air Act" provides for 'The New Source Review' every five years, I believe it is.

The New Source Review is exactly what the words imply, it is an opportunity for public and private sectors to report 'changes' in the 'nature' of air quality to the government. In these 'shareholder' groups ARE the interests of the public and private sector. It is our chance to tell the government about the issue as it relates to topic.

These are important aspects of any legislation and what 'empowers' the public to practice Democary.

The Treasury Department of the USA does not have these venues that I am aware of, it is sort of left up to the Federal Reserve.

Sorta.

If there were shareholders groups at the Federal level assisting the direction of policy we might be seeing a far different outcome to our society. The 'bailout' probably would not have happened, as citizens would have been screaming at the government at least by early 2007 and the warning signs would have been on record before 2008.

THEN, responsiblity could have been assigned for ignoring the reporting of the citizens of the USA to err on the side of negligence that served to bailout Goldman Sachs.

It really wasn't AIG's issue, except, the insurance to investment firms should never be trusted to a private entity, the only entity able to insure such ventures is a sovereign power and it is NOT in the best interest of the country to 'gamble.' The investment banks should have taken out policies with Lloyds of London. They probably tried. They were most likely rejected.

I believe some of the 'experimenting' that went on at AIG to try to build enough resources to cover such expensive policy holders was a direct result of a private insurer that was out on a limb. AIG was a dreamscape that should have never happened. It was never reasonable.

To return to health care policy, the bill requires 'health care consumers' to be members of the 'shareholder' group.

This bill also does not GROW the size of government, it ALLOWS for participation as a Democracy is required to do. Page 943, lines 5 through 11:

‘‘(h) NO PAY; RECEIPT OF TRAVEL EXPENSES.— Members of the Task Force or the clinical prevention stakeholders board shall not receive any pay for service on the Task Force, but may receive travel expenses, including a per diem, in accordance with applicable provisions of subchapter I of chapter 57 of title 5, United States Code.

A Personal Note: When it came to rasing my sons to be healthy and having a wonderful Pediatrician to count on, the operative word is 'Vitamins.' I took special vitamins when I was expecting and that continued after they were born. There was not a day that went by the boys forgot to take their vitamins. And it was fun, Flintstone vitamins and stuff like that. As a matter of fact one of the first 'adult health care decisions' my young men made was the choice of an appropriate adult vitamin. Where did they go? You guessed it, GNC.

The House bill is very fluid. It provides for 'thinkers' to be engaging the health care and health insurance issues of the American people. There is little 'control' in the path this legislation is taking, EXCEPT, to demand of all its government participants to improve the health of the American people. There is very little I object to within the language of this bill or its appropriations.

Page 947, lines 11 through 20:

‘‘(f) COMMUNITY PREVENTION STAKEHOLDERS BOARD.—
‘‘(1) IN GENERAL.—The Task Force shall convene a community prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in community preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of community preventive services.

Page 950, lines 5 through 18:

‘‘Subtitle D—Prevention and Wellness Research
‘‘SEC. 3141. PREVENTION AND WELLNESS RESEARCH ACTIVITY COORDINATION.
‘‘In conducting or supporting research on prevention and wellness, the Director of the Centers for Disease Control and Prevention, the Director of the National Institutes of Health, and the heads of other agencies within the Department of Health and Human Services conducting or supporting such research, shall take into consideration the national strategy under section 3121 and the recommendations of the Task Force on Clinical Preventive Services under section 3131 and the Task Force on Community Preventive Services under section 3132.

The House Bill provides for a lot of research. This is a quality control issue. The agencies mentioned in this provision are not small potatoes. The CDC is vital to any such Prevention and Wellness program as they are knowledgeable to the trends of disease in the nation. The NIH has to be a player/shareholder in this provision, it has a vested interest in the well being of the people of this nation. So, although some of this seems redundant, it isn't. The 'shareholders' change through many of the paragraphs and are empowered to act with 'equity' to any of the findings that impact the nation's health. It is important legislation. Truly.

Page 951, lines 14 through 22:

‘‘Subtitle E—Delivery of Community Prevention and Wellness Services
‘‘SEC. 3151. COMMUNITY PREVENTION AND WELLNESS SERVICES GRANTS.
‘‘(a) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a program for the delivery of community preventive and wellness services consisting of awarding grants to eligible entities—

All these measures aren't important without 'health care delivery.' These are necessary words. The House Bill is 'standard' good law. The bill goes on to define the delivery system across the spectrum of the USA including tribal heath departments. It uses the language "Core Public Health Infrastructure" and it is defined. It is huge. It is our health care delivery system and through this legislation it is now law as to the form that infrastructure. It cannot be dissolved at the whim of some maniac that wants to cut the federal government to the bone.

Page 960, lines 9 through 15:

‘‘(1) The term ‘core public health infrastructure’ includes workforce capacity and competency; laboratory systems; health information, health information systems, and health information analysis; communications; financing; other relevant components of organizational capacity; and other related activities.

The Republicans protestation of how Democrats GROW 'Big Government' is such a joke. The following provision CONSOLIDATES assets of the people of this nation to streamline decision making and facilitate the expediant care of the people.

Page 961, lines 9 through 22:

(1) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, AND ADMINISTRATIVE ACTIONS.—All functions, personnel, assets, and liabilities of, and administrative actions applicable to, the Preventive Services Task Force convened under section 915(a) of the Public Health Service Act and the Task Force on Community Preventive Services (as such section and Task Forces were in existence on the day before the date of the enactment of this Act) shall be transferred to the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, established under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a).

There are pages of 'Best Practice' statues, identifying existing, developing new, evaluation of, implementation and transparency to the public. How careful can the House be?

Page 972, lines 1 through 6:

(4) OBSTETRICS.—Improving the provision of obstetrical and neonatal care, including the identification of interventions that are effective in reducing the risk of preterm and premature labor and the implementation of best practices for labor and delivery care.

This particular statute addresses the Mother, Infant Death Rates in the USA. Those death rates, also may be considered 'survival' rates receive plenty of criticism by the Global Community. The USA does not have the best track record.

This is from the CIA World Factbook and the USA ranks 44th in Infant Mortality Rates. (click here) The chart is recorded from highest death rate to lowest and the USA is 44th from the 'least' infant morality rate. 6.26 infant deaths per 1000 births in current 2009 statistics with Singapore the lowest at 2.31.

Something I want to focus on is the GDP per capita. Singapore has the fourth largest GDP 'per capita' of any country on Earth. It is third on the list of the World Bank and fourth on the IMF (International Monetary Fund) and seventh on the CIA list. The USA is ranked below Singapore in its GDP per capita on all lists. The USA is ranked fourth by the World Bank, fifth by the IMF and eighth by the CIA list.

It is a way of looking at 'how' the USA is spending its money per person. How much the USA earns and how outsourcing and the lack of manufacturing effects the people of this nation.

Page 981, lines 12 through 19:

TITLE V—OTHER PROVISIONS
Subtitle A—Drug Discount for Rural and Other Hospitals
SEC. 2501. EXPANDED PARTICIPATION IN 340B PROGRAM.
(a) EXPANSION OF COVERED ENTITIES RECEIVING DISCOUNTED PRICES.—Section 340B(a)(4) (42 U.S.C. 256b(a)(4)) is amended by adding at the end the following:

This is not a subsidy provision, it lifts restrictions on hosptials to participate in group purchase, including generic substitution, of pharmaceuticals to bring down the cost of health care.

Page 993, lines 1 through 12 and Pages 21 through 25:

Subtitle B—School-Based Health Clinics
SEC. 2511. SCHOOL-BASED HEALTH CLINICS.
(a) IN GENERAL.—Part Q of title III (42 U.S.C. 280h et seq.) is amended by adding at the end the following:
‘‘SEC. 399Z–1. SCHOOL-BASED HEALTH CLINICS.
‘‘(a) PROGRAM.—The Secretary shall establish a school-based health clinic program consisting of awarding grants to eligible entities to support the operation of school-based health clinics (referred to in this section as ‘SBHCs’)....
...‘‘(A) evidence that the applicant meets all criteria necessary to be designated as an SBHC;
‘‘(B) evidence of local need for the services to be provided by the SBHC;...

I don't want to hear from Right Wing political extremists how the government is going to be handing out condoms to children. It is the most outrageous idea I have ever heard. The House bill provides for the establishment of School Based Health Clinics in areas of the country and in communities where they do not exist today. This is an opportunity to bring better health care to all the children of the USA. I don't want to hear it, because this provision does not effect everyone, as they have to 'qualify' for the clinics to fill a need that is unfulfilled today.

Page 999, lines 5 through 15:

‘‘(C) OPTIONAL SERVICES.—Additional services, which may include oral health, social, and age-appropriate health education services, including nutritional counseling.
‘‘(2) MEDICALLY UNDERSERVED CHILDREN AND ADOLESCENTS.—The term ‘medically underserved children and adolescents’ means a population of children and adolescents who are residents of an area designated by the Secretary as an area with a shortage of personal health services and health infrastructure for such children and adolescents.

Page 1001, lines 9 through 11 and lines 21 through 24 and Page 106, lines 15 through 23:

Subtitle C—National Medical Device Registry
SEC. 2521. NATIONAL MEDICAL DEVICE REGISTRY....

...‘‘(g)(1) The Secretary shall establish a national medical device registry (in this subsection referred to as the ‘registry’) to facilitate analysis of postmarket safety and outcomes data on each device that—...

...(2) EFFECTIVE DATE.—The Secretary of Health and Human Services shall establish and begin implementation of the registry under section 519(g) of the Federal Food, Drug, and Cosmetic Act, as added by paragraph (1), by not later than the date that is 36 months after the date of the enactment of this Act, without regard to whether or not final regulations to establish and operate the registry have been promulgated by such date.

This is self explanatory.

Page 1008, lines 4 through 16:

Subtitle D—Grants for Comprehensive Programs to Provide Education to Nurses and Create a
Pipeline to Nursing
SEC. 2531. ESTABLISHMENT OF GRANT PROGRAM.
(a) PURPOSES.—It is the purpose of this section to authorize grants to—
(1) address the projected shortage of nurses by funding comprehensive programs to create a career ladder to nursing (including Certified Nurse Assistants, Licensed Practical Nurses, Licensed Vocational Nurses, and Registered Nurses) for incumbent ancillary health care workers;

The word 'pipeline' is a bit odd unless one is discussing oil and gas, but, in this case the words 'Clinical Ladder' would have been far more important. It is a program to facilitate the movement of health care workers from vocational programs to higher education and RN jobs. It is a good idea and will provide for more 'career' oriented persons in the health care field of nursing.

That is basically 'it' for the HOuse health care bill. The provisions that add people receiving subsidies above the 200% level of poverty has to be an amendment because I didn't find any 'scale' of income attached to any of these provisions as is being discussed in the media. So, the House Bill is substantial in how it addresses the issues of Health for the people of the nation, how it relies on previous legislation to validate its precedent status, measures in addressing the issues of the nation in a continuous and 'responsive' mannner and how the provisions are implemented and enforced.

The 'body' of the bill is significant and cannot be altered in the future, however, the amendments can be modified and of course amendments can be added to it, but, that is the case of all USA legislation.

I like the House Bill. The country needs reform in this industry. The reform has been neglected for nearly two decades that Republicans held majorities in the USA and it is time to get on with it. I don't want to hear how after these bills are passed, people within the borders of the USA died because the legislation wasn't passed in time. No more delays.

Hi-Tech Healthcare. Will it give physicians more time with their patients?

President Obama speaks at a rally on health care reform at the University of Maryland Photo: AP

...Senior advisor at the White House Office of Management and Budget (click title to entry - thank you) on health policy Ezekiel Emanuel (brother to Rahm) gave a presentation on Sunday at the Medical Group Management Association's annual conference on the need to restructure how physicians deliver care.
In a speech he titled, "High-Touch Medicine, the Future of the Physician-Patient Relationship," Emanuel, who is also bioethics chair for the National Institutes of Health, said that while the use of information technology is essential for improving healthcare quality, increasing the amount of time physicians spend with patients should be an equally compelling goal....

I have some reservations about the 'character' some of the Senate bill rolls out in the way of touting health care savings based in technology. I don't really buy it. I see a lot of that as a 'spending' bill and not a health care insurance reform bill. The Republican Senate is good at that. Republicans will put together a bill that will spend a lot, but, will it actually reform and revolutionize health care delivery? Maybe.

I believe electronic records, if perfected, can save lives. Absolutely. It will provide immediate information to any physician anywhere in the country to expedite care, especially in emergency rooms.

But, I have reservations about the 'prompts' to physicians delivering care. According to some of the reviews of the Senate bill there will be all this 'data base' availability to physicians when diagnosing a patient. There will be 'prompts' regarding the tests needed and medications to order. There will be prompts to new ideas and new venues of care.

I don't believe physicians that care about their practice need all that and I think it will serve to cause 'excellant' physicians to 'pause' in administering care. It is usually the dedicated and compassionate doctors that seek the most information with a willingness to establish state of the art care for his or her patient.

I don't want my physician to be making decisions regarding my care based upon the latest trend. I want solid diagnosis with proven treatment. One has to wonder what effects this 'automated' format will look like and who has time for it. I would think physicians think new methods and medicine through before using them in their practice and it is why I don't see 'bedside prompts' as an improvement to care. I mean, where is the 'filter' to this information and whom exactly is approving it to be used in a treatment modality.

I believe some of the technologies the Senate has proposed shows short sightedness. There needs to 'trials' of the new high tech bedside doctoring before it is used in general practice. I hope that was part of the bill. Trials of any new idea in the House bill is strongly noted and the venues of change in health care delivery can come swiftly provided there is overwhelming results to the benefits to patients. I also don't see supplying such 'prompts' as a commercial enterprise and/or a 'perk' for the MD. Either it improves patient care or it doesn't.

The next section deals with the Public Helath Service Act (click here) OR here. The Public Health Service Act has been around for decades and has appropriation spending every year. This section simply states it will continue and in a perscribed manner.

The Public Health Service Act has several amendments including Health Insurance Portability, a few issues with Cancer, Muscular Dystrophy and Family Planning. The bill gives the funding a name and states where the monies are found for this provision.

Page 859, lines 1 through 5 and page 860, lines 3 through 5.

SEC. 2002. PUBLIC HEALTH INVESTMENT FUND.
(a) ESTABLISHMENT OF FUNDS.—
(1) IN GENERAL.—There is established a fund to be known as the ‘‘Public Health Investment
Fund’’ (referred to in this section as the ‘‘Fund’’)....

...(B) Amounts deposited into the Fund shall be derived from general revenues of the Treasury.

Below is a list of the 'services' the Public Health Service Act provides. There is no option in replacing it or eliminating it. It was well written decades ago and is fine the way it is:

-coordinating with the States to set (click here) and implement national health policy and pursue effective intergovernmental relations;
-generating and upholding cooperative international health-related agreements, policies, and programs;
-conducting medical and biomedical research;
-sponsoring and administering programs for the development of health resources, prevention and control of diseases, and alcohol and drug abuse;
-providing resources and expertise to the States and other public and private institutions in the planning, direction, and delivery of physical and mental health care services; and
-enforcing laws to assure the safety and efficacy of drugs and protection against impure and unsafe foods, cosmetics, medical devices, and radiation-producing projects.

and

-reducing health care costs, through studies on the interaction of cost, quality, and access; microsimulation modeling, to understand the effect of proposed health care reform; and analyzing health care costs effected by acute, ambulatory, and long-term care and AIDS;
-expanding clinical practice guideline activities by increasing production of important guidelines and evaluating their effect on the cost and quality of health care; and
-enhancing the scientific evidence base for cost-effective clinical practices, by expanding research to improve clinical decisionmaking and strengthening clinical information systems for effectiveness research.

The Public Health Service Act illustrates and sets precedent to the reform the government is working on now. It demands good quality care to Americans at a reasonable cost. One could say, it provides a 'demand' on elected officials to seek reform now that the industry is so out of control and negligent of the priorities of physicans for their patients and providing coverage to everyone. So, when opponents to health care insurance reform refuse to participate they are actually conducting themselves in an Anti-American modality and against 'established' law. Those that oppose this reform bill are sincerely incompetent to understand their role as an elected offical.

In all honesty, The Public Health Services Act is where American Health Care gets 'its tone' and 'impetus.' It wasn't as though one day a House Representative 'thunk it up' and thought it would be a good idea to reform health care. There is a reason why the House bill is so well written and very structured for its implementation. This reform has been on the agenda of the House for some time and it is the Public Health Services Act that is the basis of these reform bills. It is THE LAW, not an option.

This House bill actually is providing another amendment to the Public Health Services Act. Page 862, lines 15 through 23:

(I) appropriated under the heading ‘‘Prevention and Wellness Fund’’ in title VIII of division A of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5); and (II) allocated by the second proviso under such heading for evidence based clinical and community-based prevention and wellness strategies.

Of course, the ARRA (American Recovery and Reinvestment Act) is the stimulus package passed this year once President Obama was in office. This provision takes the monies of the stimulus and impliments it under established law.

Page 863, lines 16 through 24:

(3) BUDGETARY IMPLICATIONS.—Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Fund.

The funds allocated for this portion of the bill cannnot be reallocated. They are dedicated funds for the purpose of which they are stated.

Page 864, lines 1 through 5:

TITLE I—COMMUNITY HEALTH CENTERS
SEC. 2101. INCREASED FUNDING.
Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended—

This is funding for a new provision under the Public Health Service Act to include "Community Health Centers."

"National Association of Community Health Care Centers" (click here)

The Associated Press has a nice artilce about them.

Community clinics have key role in health reform (click here)
By JULIANA BARBASSA (AP) – 3 days ago
SAN JOAQUIN, Calif. — Francisco Lupercio has insurance for his house, his truck and the store he runs with his wife. But he can't afford health insurance, so he joined dozens of other people lining up for exams at a community clinic.
As the recession grinds on, more and more people are relying on taxpayer-supported health centers that offer care on a sliding fee scale. If Congress passes a law giving more Americans access to health insurance, the clinics will also be a critical element to ramping up capacity to care for millions of new patients.
"There is going to be a wave of chronically ill people," said Tanir Ami, executive director of the Community Clinic Consortium for Contra Costa and Solano counties, east of San Francisco. "We're well positioned to care for them."...

Page 865, lines 6 through 14:

TITLE II—WORKFORCE
Subtitle A—Primary Care Workforce
PART 1—NATIONAL HEALTH SERVICE CORPS
SEC. 2201. NATIONAL HEALTH SERVICE CORPS.
(a) FULFILLMENT OF OBLIGATED SERVICE REQUIREMENT THROUGH HALF-TIME SERVICE.—
(1) WAIVERS.—Subsection (i) of section 331
(42 U.S.C. 254d) is amended—

This is establishing the 'status quo' of allowing certain waivers for loan repayment to those that come to work in a 'corp' placement. It provides for scholarships that if accepted by the candidate agree to service in places in the country where they are most needed. It is an 'equity' issue to provide high quality health care workers to all areas of the country, regardless of what is normally preceived as a low earning capacity region.

This provision goes on for awhile about definitions and how a participant has some options to satisfy the service of the contract. The physicians that funded their education through these programs actually have the option of 'servicing the contract' 50% of the time while they spend the rest of their time establishing their own private practice or entering a group practice if they desire. It is a nice option.

These programs also include funding for Dentists and Dental hygienists.

If the 'Loan Repayment Corp Program' has unused monies there is methods to use the monies for recruitment of folks to serve the underserved.

Page 875, lines 4 through 15:

‘‘(d) INSUFFICIENT NUMBER OF APPLICANTS.—If there are an insufficient number of applicants for loan repayments under this section to obligate all appropriated funds, the Secretary shall transfer the unobligated funds to the National Health Service Corps for the purpose of—
‘‘(1) recruitment of sufficient applicants for the National Health Service Corps for the following year; or
‘‘(2) making additional loan repayments under section 338B if there is an excess number of qualified applicants for loan repayments under such section.

There is an emphasis in this section to promote the 'specialty' called "Primary Care." It is also clear in the legislation that these applicants have to demonstrate financial need. There is a lot of legislative support for establishing training in family medicine, general internal medicine, general pediatrics, or geriatrics, including physican assistants including in community-based settings. Other specialties mostly take care of themselves. There is a lot of incentive to practice in high paying specialties and there really is no need to promote those, especially with government monies. There are also aspects of this section to make the public aware of these existing opportunities to those people that need financial assistance. A program is no good if no one knows about it.

Page 892, lines 14 through 25 and page 893, lines 1 through 3:

Subtitle B—Nursing Workforce
SEC. 2221. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.
(a) DEFINITIONS.—Section 801 (42 U.S.C. 296 et seq.) is amended—
(1) in paragraph (1), by inserting ‘‘nurse-managed health centers’’ after ‘‘nursing centers,’’; and
(2) by adding at the end the following:
‘‘(16) NURSE-MANAGED HEALTH CENTER.— The term ‘nurse-managed health center’ means a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and is associated with an accredited school of nursing, Federally qualified health center, or indpendent nonprofit health or social services agency.’’.

"Institute of Nursing Centers" (click here)

The Institute for Nursing Centers is a network of organizations that focuses on the advancement of nurse managed health centers (NMHCs). The intent of the network is to enhance the work of all partners with an emphasis on developing a national data center for NMHCs. The founding members of the INC are the Michigan Academic Consortium (MAC), the American Association of Colleges of Nursing (AACN), the Nursing Centers Research Network (NCRN), the Michigan Primary Care Association (MPCA), the National Nursing Center Consortium (NNCC), and the National Organization of Nurse Practitioner Faculties (NONPF).

Nurse Health Centers can 'pick up the slack' when emergencies beset the nation. That is not all they do and many Advanced Practice Nurses have speciality areas such as anesthesia, midwives and pediatrics. Example of how a Nurse Health Center can participate:

Eugene schools offering H1N1 vaccine (click here)

Last Update: 10/15 8:07 pm

Eugene (KMTR) - Students in Eugene’s 4J school district started receiving the H1N1 flu vaccine Thursday.
The school health centers at Sheldon, North Eugene and South Eugene High Schools got a larger supply of H1N1 nasal spray vaccine than they expected, and made it available on a first-come, first-served basis.
The first doses were given to students who are in high-priority groups and who can take the nasal form of the vaccine. The live-virus vaccinations are being given to students whose parents bring them to the health centers, according to North Eugene school nurse Debbie Goodman.
“The live vaccine has very specific requirements in order to qualify for that,” Goodman said. “Number one, right now, we are targeting our most vulnerable population, so that's our priority. And with the live virus we can only give the vaccine to healthy individuals with no chronic health conditions, from the age of two years old to 24."...

There is no gender bias or discrimination as nursing is traditionally a woman's field. There are financing programs, loans and grant programs to promote Advanced Practice.

Page 907, lines 18 through 25 and page 908, lines 1 through 3:

SEC. 2232. ENHANCING THE PUBLIC HEALTH WORKFORCE.
Section 765 (42 U.S.C. 295) is amended to read as follows:
‘‘SEC. 765. ENHANCING THE PUBLIC HEALTH WORKFORCE.
‘(a) PROGRAM.—The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention, shall establish a public health workforce training and enhancement program consisting of awarding grants and contracts under subsection (b).

Page 909, lines 22 through 25 and page 909, lines 1 through 4:

‘‘(4) to provide financial assistance in the form of traineeships and fellowships to public health professionals who are participants in any program described in paragraph (1) and who plan to teach in the field of public health, including nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine.

And yes, veterinary medicine is as much a public health concern as human medicine. So, we need veterinarians, too. Examples:

15 Oct 2009: Report
The Spread of New Diseases:The Climate Connection (click here)

by Sonia Shah
As humans increasingly encroach on forested lands and as temperatures rise, the transmission of disease from animals and insects to people is growing. Now a new field, known as “conservation medicine,” is exploring how ecosystem disturbance and changing interactions between wildlife and humans can lead to the spread of new pathogens.

Look up into the tree canopy of the urban tropics in South Asia, Australia, or equatorial Africa and as often as not you will find masses of Pteropos fruit bats, hanging from the branches like so many furry stalactites. Their forests cut down by bulldozers, torched by slash-and-burn farmers, or desiccated from a disrupted climate, fruit bats increasingly intrude upon human communities, adapting to the orchards and cultivated fruit trees of the cities, farms, and suburbs that have subsumed their forests....

It's showdown time over pet licensing (click here)
Houston vows to get tough with vets who defy law for rabies data
By CINDY HORSWELL

HOUSTON CHRONICLE
Oct. 17, 2009, 1:34PM

For more than two decades, many Houston veterinarians have engaged in a quiet mutiny of sorts.
They have refused to follow a law requiring them to essentially name names — to turn over the identities and addresses of pet owners whose dogs and cats received rabies shots.
The city of Houston wants these names to identify some of the hundreds of thousands of pet owners who have failed to obtain the required city license for their dog or cat — and which could result in a citation. Only 4 percent of Houston's estimated 1 million pets are registered today, city officials said....

This section of the House bill goes on for many more pages. It allows for financial assistance to disadvantaged students and sets limits to the extent they can receive those monies. Although this is a large section of the bill, the monies being appropriated are in the millions and not the billions. So, the investment into the workforce is important, but, the bill still has its primary focus on getting good health insurance for the populous of the USA.

This section also gives permission for much more fluidity for change in the health care professions with allowances for 'inter-disciplinary' education and monitoring the need for different specialities for a changing population.

Page 931, lines 14 thorough 19:

TITLE III—PREVENTION AND WELLNESS
SEC. 2301. PREVENTION AND WELLNESS.
(a) IN GENERAL.—The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following:

It is the next section of the House bill and where I will stop for now. I am almost complete in reading the House bill as the pages number to 1018.

Regards.

Medicare Advantage goes down kicking and screaming. I thought this comparison of 'the truth' against the report from the Insurance Lobby was good.

The report at the title is from The Washington Post and I thought they made a real effort to understand the biased report of the Health Industry.

Below is a report from March of this year which shows graphically that Medicare Advantage is not an advantage to most of the country, YET, it is very expensive for the federal government to subsidize.

High resolution of the Daily Yonder Classification of Counties in the USA (click here)

...Nationally, 23.7 percent of Medicare beneficiaries belong to a Medicare Advantage plan.
Some Medicare Advantage plans do provide more benefits, just as Congress hoped. But most Medicare Advantage plans don’t save any money. In fact, they cost much more than traditional Medicare fee-for-service plans. Each dollar’s worth of enhanced benefits in the private plans costs the Medicare program over three dollars....



“Medicare Advantage” plans (click here) have been touted as a way for elderly rural residents to have a choice in health care plans paid for by Medicare dollars. But few rural Medicare recipients are enrolled in Medicare Advantage plans — and those who have joined are enrolled in Medicare Advantage plans with the highest costs and the fewest benefits....


The other issue with Medicare Advantage is fraud. There has been some wide spread issues in the country regarding fraud.

As noted in the financial sector in October or 2008, when the private sector of our society is provided with vast sizes of money, they can't handle it. The monies are poorly recorded and basically there is waste and greed. So, anytime the private sector of the country states they have a better idea that won't cost the public as much as government, be aware.

The problem and it is a profound problem is that when government monies make its way into the private sector there are problems and although the private provider looks good on paper, the waste and cost only shows up when the 'entire' dynamics of what it costs to monitor them and litigate them is realized. It is not worth it and people suffer due to the fraud and greed. Ultimately, people get better services and overall costs of any government program is less than private providers.

The American people need to find confidence in the decisions of their government and seek to be very skeptical of the arguments that want to demonize it, especially when people of integrity are at the top of its leadership. We have witnessed what eight years of the worst Republican administration in history has brought us. Yeah, even worse than Nixon. So, while it is true most years with Republicans 'demonstrating' poor quality government is real, it is 'loaded' to be that way. "W" was incompetent. "Right, Brownie?" I can't believe he was actually in office for eight years. His administration was such a joke. They were corrupt to the core.

The Washington Post has validated my most profound point through this entire debate. When the youngest of our citizens have health care, the 'cost' levels out and we as a nation are 'balanced' and 'healthy' both fiscally and through the deepest understanding of 'habeous corpus.'

Analysis: (click title to entry - thank you) There is a lively debate about whether the penalty would goad healthier people to get coverage. But the reports are probably too pessimistic. Massachusetts has gotten all but 3 percent of residents into coverage with a penalty of roughly the same size. The reports also do not take into account the draw of the low-cost "young invincibles" policy included in the bill. And the Congressional Budget Office estimates coverage levels would rise to 94 percent of Americans, from 83 percent.

A lot of this is common sense. Trust your instincts, they are usually right and OUR government is effective when the right people are in charge. The Obama Administration is just about the most sincere administration short of FDR.

You can put the Kennedy administration in that category as well. But, it was very short lived, wasn't it? JFK never wanted to go into Vietnam and he was doggedly pursuing corruption and organized crime in this country, civil rights was paramont to his 'idea' of just and fair. The country is better off in the hands of 'the working class' and that is primarily the Democratic Party. Sorry, it is just the way it is. The USA Constitution wasn't conceived for the rich and powerful to ignore the well being of citizens. It wasn't !!!! It also was written with the 'idea' that citizens could 'opt' to be greedy over reasonable.

I'm going to take a look at the rest of the House Bill. I don't think the Senate Bill is worth shit. Senator Chris Dodd is the only one that really cares about it, so I hope he is successful on the Senate floor. I'll read the Senate bill, too.

Page 820, lines 1 through 18:

TITLE VIII—REVENUE-RELATED PROVISIONS
SEC. 1801. DISCLOSURES TO FACILITATE IDENTIFICATION OF INDIVIDUALS LIKELY TO BE INELIGIBLE FOR THE LOW-INCOME ASSISTANCE UNDER THE MEDICARE PRESCRIPTION DRUG PROGRAM TO ASSIST SOCIAL SECURITY ADMINIS8
TRATION’S OUTREACH TO ELIGIBLE INDIVIDUALS.
(a) IN GENERAL.—Paragraph (19) of section 6103(l) of the Internal Revenue Code of 1986 is amended to read as follows:
‘‘(19) DISCLOSURES TO FACILITATE IDENTIFICATION OF INDIVIDUALS LIKELY TO BE INELIGIBLE FOR LOW-INCOME SUBSIDIES UNDER MEDICARE PRESCRIPTION DRUG PROGRAM TO ASSIST SOCIAL SECURITY ADMINISTRATION’S OUTREACH TO ELIGIBLE INDIVIDUALS.—

The States are 'qualifying' people into the areas of subsidy to the new 'Public Option.' But, it is the brevity of the Federal government that will allow this new commission to monitor that eligibility through examination of records. Those records are fairly invasive. The Federal government wants the truth and nothing short of it. It is the way it should be. It is easier and less costly to prevent fraud than to litigate it. It is easier to stop the flow of monies to the wrong hands than to attempt to recoup those monies.

Everything goes into figuring out eligibility for folks. Example: Page 821, lines 9 through 17:

‘‘(ii) unearned income information and income information of the taxpayer from partnerships, trusts, estates, and subchapter S corporations for the applicable year,
‘‘(iii) if the individual filed an income tax return for the applicable year, the filing status, number of dependents, income from farming, and income from self-employment, on such return,

And don't believe for one minute those folks making all the noise about Health Care Insurance Reform don't object to this as well. They won't be able to hide. When government works to benefit the people it is economically prudent, especially over a long period of time. It took Former President Clinton nearly eight years to turn a National Debt into a National Surplus. It took "W" less than a year to squander it. Republican administrations 'specialize' in 'immediate gratificiation' to reinforce their popularity. Democratic administrations believe in good government for ALL.

The flow of information between agencies of the government to administer a domestic program is widely criticized by Right Wing Bozos, but, it is necessary to provide a better venue of government control. And yes, it is control. Absolutely. I would think that would be reassuring to folks. That the government has control over information. This isn't a 'free flow' of information to the public or identity thieves, but, it is a way for one agency to speak to another to insure the best outcome for the 'PUBLIC TRUST.' There is nothing threatening about it unless one has gotten used to living outside the law and conducting themselves in a corrupt 'fashion' much of which is the venue of 'The South.' I shouldn't get started on this, but, the impoverishment of the Southern USA is based in lack of good government and the corruption of the public because average folks have to survive, so 'they play by the rules.' Things have to change and it will.

Page 821, lines 24 and 25 and Page 822, lines 1 thorugh 5:

‘‘(v) if the individual files a joint return for the applicable year, the social security number, unearned income information, and income information from partnerships, trusts, estates, and subchapter S corporations of the individual’s spouse on such return, and

S Corporations (click here)
S corporations are corporations that elect to pass corporate income, losses, deductions and credit through to their shareholders for federal tax purposes. Shareholders of S corporations report the flow-through of income and losses on their personal tax returns and are assessed tax at their individual income tax rates. This allows S corporations to avoid double taxation on the corporate income. S corporations are responsible for tax on certain built-in gains and passive income....

Page 823, lines 9 through 18:

‘‘(D) RESTRICTION ON USE OF DISCLOSED INFORMATION.—Return information disclosed under this paragraph may be used only by officers and employees of the Social Security Administration solely for purposes of identifying individuals likely to be ineligible for a low-income prescription drug subsidy under section 1860D–14 of the Social Security Act for use in outreach efforts under section 1144 of the Social Security Act.’’.

There is a lot 'going on' about the way this reform initiative is paid for. It closes down long lived programs in order to CONSOLIDATE efforts and streamline the system. That scares people. Folks become 'used to' thinking about 'their security' in a particular venue and particular dynamic and they are 'shaken up' when change occurs. Change is a nice word, but, the 'actuality' of carrying it out is another story. That is a good deal of what is occuring in the USA regarding this issue. Page 824 sets up a new Trust Fund. Lines 8 through 25 and Page 825, lines 20 through 25 and Page 826, lines 1 through 4:

SEC. 1802. COMPARATIVE EFFECTIVENESS RESEARCH TRUST FUND; FINANCING FOR TRUST FUND.
(a) ESTABLISHMENT OF TRUST FUND.—
(1) IN GENERAL.—Subchapter A of chapter 98 of the Internal Revenue Code of 1986 (relating to trust fund code) is amended by adding at the end the following new section:
‘‘SEC. 9511. HEALTH CARE COMPARATIVE EFFECTIVENESS RESEARCH TRUST FUND.
‘‘(a) CREATION OF TRUST FUND.—There is established in the Treasury of the United States a trust fund to be known as the ‘Health Care Comparative Effectiveness Research Trust Fund’ (hereinafter in this section referred to as the ‘CERTF’), consisting of such amounts as may be appropriated or credited to such Trust Fund as provided in this section and section 9602(b).
‘‘(b) TRANSFERS TO FUND.—There are hereby appropriated to the Trust Fund the following:...
...The amounts appropriated under paragraphs (1), (2), (3), and (4)(B) shall be transferred from the Federal Hospital Insurance Trust Fund and from the Federal Supplementary Medical Insurance Trust Fund (established under section 1841 of such Act), and from the Medicare Prescription Drug Account within such Trust Fund, in proportion (as estimated by the Secretary) to the total expenditures during such fiscal year that are made under title XVIII of such Act from the respective trust fund or account.

Don't underestimate the importance of the competency of The Secretary of Health and Human Services. She has to know how to do math. She has to have folks that work for her that understands how to do math and then they have to coordinate their figures and efforts with the US Treasury to insure all the monies are where they should be when they should be. There is a lot of responsibility on her shoulders when this bill passes and her department is responsible for the health of this nation. She is very important.

Page 827, lines 21 thorugh 24 and Page 828, lines 1 and 2:

"(1) IN GENERAL.—Subject to paragraph (2), amounts in the CERTF are available, without the need for further appropriations and without fiscal year limitation, to the Secretary of Health and Human Services for carrying out section 1181 of the Social Security Act.

Page 829, starts language about 'the insured' and 'self-insured health plans.' It is a change in direction of the relationship between government and insurance companies. In this case, there is a fee (it is an administration fee) placed on these plans to be sure they are registered with the government and to be sure their 'insured' are actually well cared for under the provisions of this bill. Here again, it is easier to prevent issues than litigate them afterwards and that is what this provision is about primarily.

Lines 9 through 18:

‘‘Subchapter B—Insured and Self-Insured Health Plans
‘‘Sec. 4375. Health insurance.
‘‘Sec. 4376. Self-insured health plans.
‘‘Sec. 4377. Definitions and special rules.
‘‘SEC. 4375. HEALTH INSURANCE.
‘‘(a) IMPOSITION OF FEE.—There is hereby imposed on each specified health insurance policy for each policy year a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the policy.
‘‘(b) LIABILITY FOR FEE.—The fee imposed by subsection (a) shall be paid by the issuer of the policy.

This provision goes on to define terms and words. There isn't anything 'tricky' about the language.

Just as a point of interest, there was a meeting recently where some of the best professionals in the health care industry met to 'talk about' the movement of change for the USA's health care. It was called, "The Aspen Institute/Time Aspen Health Forum." This forum is not new. It is mostly an annual event and has been looking at health care in the USA as well as globally, including disease trends and treatment such as the avian and swine flu. There are several video forums published on this website. They are all interesting, but, take some time to listen to their content. The last video features Former Senator Tom Daschle. He makes a concerted effort to put the debate into perspective:

President Obama’s Prospects for Health Reform, Insurance Reform (click here) featuring:
- The Honorable Tom Daschle, Former Senate Majority Leader
- David B. Snow Jr., Chairman and CEO, Medco
- Peter Long, Senior Vice President for Executive Operations, Kaiser Family Foundation (Moderator)

The former Senator eloquently addressed the enormity of the issues we face as a nation regarding health care. Not to alienate anyone interested in this debate, Former Senator Daschle refers to an acronym called CER. Another name for CER is 'being careful we are making the change the nation needs.' This forum took place only a few days ago so it is very relevant.

Comparative Effectiveness Research Funding (click here)
The Recovery Act (ARRA) contains $1.1 billion for comparative effectiveness research. Comparative effectiveness research (CER) compares treatments and strategies to improve health. This information is essential for clinicians and patients to decide on the best treatment. It also enables our nation to improve the health of communities and the performance of the health system.

Back to the House Bill.

The bill includes all forms of health delivery, including these small incidental policies we occassional subscribe to for travel, school activities, etc. Page 833, lines 14 through 18:

‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The term ‘accident and health coverage’ means any coverage which, if provided by an insurance policy, would cause such policy to be a specified health insurance policy (as defined in section 4375(c)).

There are 'except entities' to any fee rendered, page 834, lines 22 through 24 and page 835, lines 1 though 10:

‘‘(C) any program established by Federal law for providing medical care (other than through insurance policies) to individuals (or the spouses and dependents thereof) by reason of such individuals being—
‘‘(i) members of the Armed Forces of the United States, or
‘‘(ii) veterans, and
‘‘(D) any program established by Federal law for providing medical care (other than through insurance policies) to members of Indian tribes (as defined in section 4(d) of the Indian Health Care Improvement Act).

Page 835, lines 22 and 23 and page 836, lines 1 though 9:

‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS
‘‘Subchapter A—Policies Issued By Foreign Insurers’’.
(B) The table of chapters for subtitle D of such Code is amended by striking the item relating to chapter 34 and inserting the following new item:
‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES’’.
(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply with respect to policies and plans for portions of policy or plan years beginning on or after October 1, 2012.

I don't approve of American funds for health care to go to foreign entities or any entity in countries that practice 'tax shelter' banking opportunities. Every USA dollar that leaves the country, leaves the economy. There are specific protests I have regarding government and the use of USA monies to foreign entities. It is WRONG to send American dollars anywhere outside the USA boundaries and its possessions in regard to the military and health care dollars. They are areas of national security and YES, the issue of the health of the people of this nation is one of security. It is my opinion all issues of national security should be 'housed' within the definition of the sovereignty of the USA kept within its borders.

There are going to be repeal of some existing laws. And here again, some people will be screaming, "I never bargained for this." Hogwash. The government needs to be fluid and efficient. There cannot be conflicting language or focus to laws if they are to be effective and efficient. Page 836, lines 11 though 24:

TITLE IX—MISCELLANEOUS PROVISIONS
SEC. 1901. REPEAL OF TRIGGER PROVISION.
Subtitle A of title VIII of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) is repealed and the provisions of law amended by such subtitle are restored as if such subtitle had never been enacted.
SEC. 1902. REPEAL OF COMPARATIVE COST ADJUSTMENT (CCA) PROGRAM.
Section 1860C–1 of the Social Security Act (42 U.S.C. 1395w–29), as added by section 241(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173), is repealed.

This is a new focus for 'delivering' health care in the USA. Page 838, lines 8 through 17:

‘‘Subpart 3—Support for Quality Home Visitation Programs
‘‘SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN.
‘‘(a) PURPOSE.—The purpose of this section is to improve the well-being, health, and development of children by enabling the establishment and expansion of high quality programs providing voluntary home visitation for families with young children and families expecting children.

This is very important. Every child being born in the USA will be addressed with a program that will start them on the best path. The reasons for such a program are more than can be discussed in a short paragraph, however, put it into context this way; "If every child and their parents are given information and guidance to prevent obesity in children we would be a healthier America." It is my opinion a program like this is not only necessary, but, vital. Why? Because it brings children closer to a relationship with health care professionals, including their pediatrician.

A personal story.

I raised two sons. I love them dearly and they are good sons. They love me and we have an open and honest relationship. I am a resource to them and they are a joy to me. When they needed a pediatrician, they had one from birth and had the same pediatrician for all their growing up years, to the age of 18 years old.

Regardless of where we lived on the East Coast of the USA, they were always returned at least once a year for their annual physicals. Dr. Wilson was well known to them, they knew they saw him at least once a year and as they became young adults they had their physical exams in complete privacy with their pediatrician while I was seated in the Waiting Room should there be an issue to discuss. It was our choice to allow that privacy and it worked to give them a sense of autonomy in a very important aspect of growing up.

The result? I rarely experienced illness with my children. The physician visits outside of their wellness visits were very limited over the entire 18 years of their lives. No lie. I did not have enormous costs to their wellness. They were cared for by a man well versed in his profession and I had complete faith in any and all of his recommendations. Today, at the ages of 30 and 28, my sons are healthy without complications. They are substance free and happy in relationships.

I might have been lucky, but, I could put all my worries to rest at the doorstep of Dr. Wilson and the result was incredible. My sons aren't afraid of health of their bodies and seek physicians when needed and have physical exams on a regular basis. My youngest son has two children and they receive regular check ups and those kids are healthy. They enjoy their healthy little lives to date.

Healthy bodies begin at tender ages with good habits. This provision is very important.

There is a mandate for spending on this program and while 5% is a healthy allowance it is also a limit on the spending of the program. Page 840, lines 6 through 9;

‘‘(B) the State will reserve 5 percent of the grant funds for training and technical assistance to the home visitation programs using such funds;

To help contain costs, the bill spells out clearly the lack of waste in duplication. Page 840, lines 10 through 29:

‘‘(C) in supporting home visitation programs using funds provided under this section, the State will promote coordination and collaboration with other home visitation programs (including programs funded under title XIX) and with other child and family services, health services, income supports, and other related assistance;
‘‘(D) home visitation programs supported using such funds will, when appropriate, pro20
vide referrals to other programs serving children and families; and

I like the attention given to Indian tribes. They have been viewed as a nation within a nation with 'hands off' of spending federal monies to improve their quality of life. There aren't even police forces that deal with the crime found among American Indian tribal grounds, it is the FBI that responds to issues. Regardless, to extend the Health Care Reform initiative to our American Indian Tribes is right and best. These folks have suffered from a long time when it comes to quality health care and it time we realize how they struggle as a small nation to provide for their people and extend health care to them no different than a citizen of the USA born outside of a tribal area. And, yes, the USA has tribal areas !

Page 841, lines 3 through 14:

‘‘(1) INDIAN TRIBES.—From the amount reserved under subsection (l)(2) for a fiscal year, the Secretary shall allot to each Indian tribe that meets the requirement of subsection (d), if applicable, for the fiscal year the amount that bears the same ratio to the amount so reserved as the number of children in the Indian tribe whose families have income that does not exceed 200 percent of the poverty line bears to the total number of children in such Indian tribes whose families have income that does not exceed 200 percent of the poverty line.

Here again is the stipulation of the 200% poverty line (approximiately $35,000 annually), page 841, lines 15 through 25 and page 842, lines 1 and 2;

‘‘(2) STATES AND TERRITORIES.—From the amount appropriated under subsection (m) for a fiscal year that remains after making the reservations required by subsection (l), the Secretary shall allot to each State that is not an Indian tribe and that meets the requirement of subsection (d), if applicable, for the fiscal year the amount that bears the same ratio to the remainder of the amount so appropriated as the number of children in the State whose families have income that does not exceed 200 percent of the poverty line bears to the total number of children in such States whose families have income that does not exceed 200 percent of the poverty line.

One of the criticisms I ALWAYS hear about Democratic programs is that it is an attempt to 'control' parenting and tell a parent how to raise a child.

That isn't the case.

The word isn't 'control' it is 'empowerment.'

There are specific 'interventions and outcomes' expected of this provision of the bill and I want to list them here, although I think it is a little silly, simply because the critics will take issue of every aspect of the program. By defining the 'interventions and outcomes' there is an understanding that the bill will provide 'AT LEAST' this much and has a limit to 'THE MAXIMUM' it provides in 'authority' of government and licensed personnel that will provide the program.

Page 844, lines 17 through 25, page 845, lines 1 thourgh 25 and page 846, lines 1 and 2:

‘‘(iv) monitor fidelity of program implementation to ensure that services are delivered according to the specified model; and
‘‘(v) provide parents with—
‘‘(I) knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains (including knowledge of second language acquisition, in the case of English language learners);
‘‘(II) knowledge of realistic expectations of age-appropriate child be5
haviors;
‘‘(III) knowledge of health and wellness issues for children and parents;
‘‘(IV) modeling, consulting, and coaching on parenting practices;
‘‘(V) skills to interact with their child to enhance age-appropriate development;
‘‘(VI) skills to recognize and seek help for issues related to health, developmental delays, and social, emotional, and behavioral skills; and
‘‘(VII) activities designed to help parents become full partners in the education of their children;
‘‘(B) includes expenditures for training, technical assistance, and evaluations related to the programs; and
‘‘(C) does not include any expenditure with respect to which a State has submitted a claim for payment under any other provision of Federal law.

The bill goes on to describe quality assurance issues for the monies spent. Page 846, lines 5 through 15:

‘‘(A) IN GENERAL.—The expenditures, described in paragraph (1), of a State for a fiscal year that are attributable to the cost of programs that do not adhere to a model of home visitation with the strongest evidence of effectiveness shall not be considered eligible expendtures for the fiscal year to the extent that the total of the expenditures exceeds the applicable percentage for the fiscal year of the allotment of the State under subsection (c) for the fiscal 15 year.

The bill recognizes the Federal legisation cannot 'impose' this provision by the terms of the States. Page 847, lines 6 through 11:

‘‘(h) WAIVER AUTHORITY.—
‘‘(1) IN GENERAL.—The Secretary may waive or modify the application of any provision of this section, other than subsection (b) or (f), to an Indian tribe if the failure to do so would impose an undue burden on the Indian tribe.

It is important to recognize the special circumstances of American Indians. They do have very different dynamics within the authority of their tribes, but, they are also a part of the USA and we want them healthy and contributing productively to their own nation as well as the greater of the people of the USA.

The bill goes on to discuss issues of quality assurance and economy. The program will be monitored for effectiveness, cost and efficiency of delivery. The program will be modified to deliver 'over time' as the 'best' strategies emerge. The bill has the best interest of the 'USA budget' at heart while still delivering high quality of care to citizens.

Page 853, lines17 through 25:

‘‘IMPROVED COORDINATION AND PROTECTION FOR DUAL ELIGIBLES
‘‘SEC. 1150A. (a) IN GENERAL.—The Secretary shall provide, through an identifiable office or program within the Centers for Medicare & Medicaid Services, for a focused effort to provide for improved coordination between Medicare and Medicaid and protection in the case of dual eligibles (as defined in subsection (e)). The office or program shall—

Here again, it cannot be stated enough that we have duplicity in legislations over the years, which happens in a democracy of people numbering more than 300 million. The bill actively seeks to reduce 'dual status' of participants. It streamlines the administration of the government's responsibility and it controls cost.

There is provision in the bill to allow appeals to any of the decsions of the Secretary. Different from the legislation of the Republicans that block litigation. I was astounded to realize there was no recordkeeping demanded of the investment banks given the bailout funds. The Bush adminisration did that sort of thing on a regular basis. The monies sent to Iraq's government and Halliburton were literally 'give aways' without accountability. The bailout was the same way. I don't believe in that. If the American people provide money for anything there should be an accounting. I am still waiting to hear where Rumsfeld put his 'offshore account.' Its got to be somewhere.

And yes, I am stating the Republicans in the Bush years STOLE money from the government and it was just too bad for the taxpayers of the nation. Absolutely and if anyone doesn't believe Paulson and Goldman Sachs didn't loot the USA Treasury, then they need to think again.

The next section of the bill deals with 'work force' development. It is a quality assurance statute. It is lengthy from what the outline looks like, but, seems standard and straight forward. Health care needs a workforce and for the first time in history the government is going to be sure that workforce is important enough to monitor and facilitate.

Page 856, lines 1 through 4.

DIVISION C—PUBLIC HEALTH AND WORKFORCE DEVELOPMENT
4 SEC. 2001. TABLE OF CONTENTS; REFERENCES.

The table of contents alone comprises three pages. I am not going to go over every aspect of the outline. I didn't see the provision for unions, through.

I am going to take a break and I'll be back.