Senator Baucus exhibits NO leadership abilities.

In the Senate the blood is in the water and the Republicanesque environment will continue to hack away at as much of the House Bill as possible, ultimately, reducing it to nothing if possible.


Baucus buys and sells the American people as if they were his personal property to make deals with Wall Street.

46 million uninsured

25 million under-insured

And the USA Senate has sold out to Wall Street.

It is PROFOUNDLY time for a change !

The USA is supposed to be an example of democracy, not demagoguery.

They can’t stop us; we are going to get this done (click title to entry - thank you)
By Melissa DeRosa
September 30, 2009, 6:56 AM
Aflurry of new reports from the Treasury Department, the U. S. Census Bureau, Robert Wood Johnson and the Kaiser Family Foundations underscore something we’ve known in New York for a long time — we can’t wait another year for health insurance reform.
According to recent national data from the U. S. Census, the number of uninsured increased from 39.8 million in 2001 to 46.3 million in 2008. Most of these individuals are in the middle class. In New York, there are now 2.7 million people living without insurance, one accident or illness away from financial disaster. Nearly half of all Americans under 65 will lose their health coverage at some point in the next 10 years.
Over the past 10 years, health premiums increased by 131 percent and the average family policy now costs $13,375 a year. Premiums continue to rise three times faster than wages and eventually the United States will spend more on Medicare and Medicaid than every other government program combined.
President Obama’s health insurance reform plan takes the best from Democratic and Republican proposals to address three broad goals: provide more security and stability for people who have insurance; provide affordable, quality choices for those who don’t; and lower health care costs....

Within the next ten years every Middle Class American will face the choice of keeping their health care coverage or losing their home !

The stimulus is working. A change in USA infrastructure is going to contact before it expands. The USA is shedding jobs that are irrelevant to the future and the change in energy and transportation infrastructure.

The USA, under President Obama, is taking on a 'new face' to combat Climate Change while increasing the focus on education, health care, genetic medicine, natural/environmental aesthetics of life (If not sure what I am referring to, click here) and the arts.

The venues least focused on by the previous administration are actually where growth needs to take place and is the place where change is taking place. This is very good news that will definitively be the trend of the NEW American economy.

U.S. economy shrinks less than expected (click here)
...The world’s largest economy contracted at a 0.7 percent annual rate in the second quarter, its best performance in more than a year, according to a revised final estimate released Wednesday by the U.S. Commerce Department.
Economists had expected GDP to contract at a 1.2 percent annual rate, according to the median forecast in a Bloomberg survey of 78 economists....

Give President Obama a Senate he can work with in 2010 !

The country has a lot of work to do, including the continued recovery from the economic abuse of the Bush/Cheney years.

"...President Obama seems to be out there all alone..."

Washington Post Poll: (click here)

Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans? Do you feel that way strongly or somewhat?
September 12, 2009-09-29

Support
Net - 55
Strongly - 33
Somewhat - 22

Oppose

Net - 42
Strongly - 33
Somewhat - 22

No Opinion 3

The Public Option is not an OPTION. The Senate sold out today to Health Insurance Lobbyists. That sounds like a 'rhetorical' statement as well, but, it isn't. Let me portray the real issue that will result without the Public Option.

Within the Health Care Reform Bill, Americans will be required to have health insurance no different than they have car insurance. However, without a Public Option, the citizens of the USA are at the mercy of the Insurance Companies that will return to the federal legislature and demand higher rates over and over and over again as they can't make ends meet and they will declare the reform a failure and a 'I told you so.'

This was complete sabotage by the Senate. Mike is correct, the movement for reform needs to be heard loud and clear. The Pubic Option has to stand as a part of this legislation. It is vital and no joke. By demanding the American Public have health care by statue it overwhelmingly opens them to exploitation by Wall Street and the CEOs of the insurance companies that will complain about their profit loss because they can't throw '? risky ?' clients off their enrollments.

Today the Senate sold the people of the USA to Health Care Insurance Companies, it is up to the President and the House to stop this complete idiocy. Every Senator that voted against the Public Option needs to be scrutinized for re-election. Candidates should be elected in 2010 that have favored it regardless of the outcome of the Reform Bill.

The film loop below is a poor example and 'spinelessness' of Senate Democrats. They are a joke.

New York Times / CBS Poll (click here)
Would you favor or oppose the government offering everyone a government administered health insurance plan – something like the Medicare coverage, something like the people 65 and older get, that would compete with private health insurance plans?

September 19-23, 2009

Favor – 65%

Oppose – 26%

Don’t know/ NA – 9%

The Economist / YouGov Poll (click here)

9. Do you favor or oppose having a “public option” which would allow individuals to purchase health care insurance coverage”

Favor – 47%

Oppose – 32%

Not sure – 21%

Where's the bill?

David Lewis
Muncie
September 28, 2009
Why did the Senate vote to keep the health-care bill from being released to the Internet? (click title to entry - thank you) Do you think it is because we Hoosiers can't read? Or would there be some other motive such as protecting us from information we would not want to know?

Isn't this the Senate Bill? (click here)

I believe I left off with Page 700 of the House bill or something like that.

I am more than curious about this topic. Page 704, lines 17 through 20;

Subtitle C—Enhanced Program and Provider Protections
SEC. 1631. ENHANCED CMS PROGRAM PROTECTION AUTHORITY.

This is a quality assurance provision. Basically, after the law is in effect there will be a review of participating entities as decided by the Secretary. This is simply the House giving the Secretary of Health and Human Services the 'right' to conduct whatever review of providers that is needed. It is a way for the House of Representatives saying, they approve any action necessary to be sure providers are well intended and qualified. I don't see that it is a mandate and the Secretary has to institute reveiws. At least now yet. I need to read through a few pages to be sure.

‘‘(a) CERTAIN AUTHORIZED SCREENING, ENHANCED OVERSIGHT PERIODS, AND ENROLLMENT MORATORIA.—
‘‘(1) IN GENERAL.—For periods beginning after January 1, 2011, in the case that the Secretary determines there is a significant risk of fraudulent activity (as determined by the Secretary based on relevant complaints, reports, referrals by law enforcement or other sources, data analysis, trending information, or claims submissions by providers of services and suppliers) with respect to a category of provider of services or supplier of items or services, in15
cluding a category within a geographic area, under title XVIII, XIX, or XXI, the Secretary may impose any of the following requirements with respect to a provider of services or a supplier (whether such provider or supplier is initially enrolling in the program or is renewing such enrollment):

This provision empowers the Secretary to work with states for quality assurance of providers. They can do background checks and unannounced visits, etc. The paragraph here sums up the provision. Page 709, lines 8 through 18:

‘‘(d) PROGRAM INTEGRITY.—A State child health plan shall include a description of the procedures to be used by the State—

‘‘(1) to enforce any determination made by the Secretary under subsection (a) of section 1128G (relating to a significant risk of fraudulent activity with respect to a category of provider or supplier described in such subsection through use of the appropriate procedures described in such subsection); and ‘‘(2) to carry out any activities as required by the Secretary for purposes of such subsection.’’.

The ultimate outcome is on Page 711, lines 8 through 14;

‘‘(3) AUTHORITY TO DENY PARTICIPATION.—If the Secretary determines that there has been at least one such affiliation and that such affiliation or affiliations, as applicable, of such provider or supplier poses a serious risk of fraud, waste, or abuse, the Secretary may deny the application of such provider or supplier.’’.

This is law. This is legislating every detail in order to facilitate the benefits for the people. This is what DC, the State, county and local municipalities are all about. This is being sure the person that will carry out the law is equipped with tools outlined in the legislation. That is what most of this provision provides. It empowers the Secretary the ultimate right to deny participation if a provider is found to be unworthy and/or harmful.

A lot of people involved in the health care industry don't like this empowerment of the government. They like their money no matter what quality of services are provided. Once money changes hands it is too late. The quality has to be in place before payment, otherwise, that will be monies poorly spent. It doesn't have to be fraud either, just plain 'lousy' quality.

They aren't going to like this either. It is a modifer to alter payment amounts to providers if there is duplication of services. Page 713, lines 1 through 14:

‘‘(p) PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.—The Secretary shall establish a payment modifier under the fee schedule under this section for evaluation and management services (as specified in section 1842(b)(16)(B)(ii)) that result in the ordering of additional services (such as lab tests), the prescription of drugs, the furnishing or ordering of durable medical equipment in order to enable better monitoring of claims for payment for such additional services under this title, or the ordering, furnishing, or prescribing of other items and services determined by the Secretary to pose a high risk of waste, fraud, and abuse. The Secretary may require providers of services or suppliers to report such modifier in claims submitted for payment.’’.

The provision goes on in the usual manner, implementation, assignment of responsibilites, what standards will be applied, enforcement for non-compliance. This is new. There is a 'expiration' to filing for a claim.

SEC. 1636. MAXIMUM PERIOD FOR SUBMISSION OF MEDCARE CLAIMS REDUCED TO NOT MORE THAN 12 MONTHS.
(a) PURPOSE.—In general, the 36-month period currently allowed for claims filing under parts A, B, C, and, D of title XVIII of the Social Security Act presents opportunities for fraud schemes in which processing patterns of the Centers for Medicare & Medicaid Services can be observed and exploited. Narrowing the window for claims processing will not overburden providers and will reduce fraud and abuse.

I am a little concerned. There is a loophole that needs to be closed with this provision, unless, I simply haven't read it yet. I think the provision is good. Twelve months is more than enough time for providers to file a claim for payment, HOWEVER, what if that time period goes by and individuals lose their benefits because it. Can the provider then bill and insist payment from the client/individual without the benefit of any insurance payment?

There needs to be more incentive to be sure providers file for payment in a timely fashion. There has to be an understanding that if their claim period expires and this is a claim that would carry a payment with the insurance, then the provider loses all income from that lost opportunity to receive payment.

To ignore billing an insurance in a 'reasonable' time period should also become part of a review process with brevity. It is a form of negligence. It is equivalent to 'financial abuse.' As an example, the elderly can be protected from people that care for them when they are being exploited for money. There are criminal penalites for such abuse of the elderly. That same logic should apply to this provision. If a provider is negligent in sending in claims for payment and then in turn attempts to collect the debt portion of the cost that would normally be billed to the insurance it is fiscal abuse of the insured.

The provision goes on with the usual statements, effective date, enforcement and submitting documentation, including a copy of a written order, of claims upon request of the Secretary.

Section 1640 delegates investigation authority to the Inspector General of Health and Human Services. That is pretty much standard throughout these provisions. I just hadn't stated it before, so I wanted to be sure I mentioned it at least once. There is no sense in making this entry as boring as the reading of the law itself. So, there it is. The Inspector General will carry out investigations.

Ah, a provision that requires honesty. Overpayment. Gee, they have to give it back? Not like Christmas or anything? A birthday surprise maybe? No?

Page 726, lines 7 through 12;

‘‘(c) REPORTS ON AND REPAYMENT OF OVERPAYMENTS IDENTIFIED THROUGH INTERNAL AUDITS AND REVIEWS.—
‘‘(1) REPORTING AND RETURNING OVERPAYMENTS.—If a person knows of an overpayment, the person must—

Ya got sixty days to give the monies back to the Secretary. So, that should happen, take the money to Goldman Sachs and have them backroll it into some derivitive and make a few bucks. If you lose the money, however, it might not be insured, ya know? Sixty days to make it all happen for yourself.

Page 726, lines 21 through 26 and Page 727, lines 1 and 2.

"(2) TIMING.—An overpayment must be reported and returned under paragraph (1)(A) by not later than the date that is 60 days after the date the person knows of the overpayment. Any known overpayment retained later than the applicable date specified in this paragraph creates an obligation as defined in section 3729(b)(3) of title 31 of the United States Code.

A little bit of an enforcement issue here, page 727, lines 3 through 13;

‘‘(3) CLARIFICATION.—Repayment of any overpayments (or refunding by withholding of future payments) by a provider of services or supplier does not otherwise limit the provider or supplier’s potential liability for administrative obligations such as applicable interests, fines, and specialties or civil or criminal sanctions involving the same claim if it is determined later that the reason for the overpayment was related to fraud by the provider or supplier or the employees or agents of such provider or supplier.

There must be a significant amount of 'double dipping' with the ownerships of these free standing, speciality clinics. Page 728, lines 18 through 25 and 729, lines 1 through 6;

SEC. 1643. ACCESS TO CERTAIN INFORMATION ON RENAL DIALYSIS FACILITIES.
Section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)) is amended by adding at the end the following new paragraph:
‘‘(15) For purposes of evaluating or auditing payments made to renal dialysis facilities for items and services under this section under paragraph (1), each such renal dialysis facility, upon the request of the Secretary, shall provide to the Secretary access to information relating to any ownership or compensation arrangement between such facility and the medical director of such facility or between such facility and any physician.’’.

Let me see if I can explain this clearly, because it is very important. This isn't government being difficult, it is being vigilant of the USA Treasury and the cost of private health insurance.

Let's say my name is Dr. Zebra. I am making rounds in the hospital during the early morning hours and have ordered 'hemo' dialysis on a patient for the very first time in an outpatient facility, as they are being discharged and are to report to their dialysis facility after leaving the hospital for their first outpatient treatment.

I am paid for that service. I am paid for my evaluation of the necessity of the order and its brevity to the patient.

I have late evening office hours where I will see patients. I have late evening office hours once per week. So, I leave the hospital, after making rounds, at about 1:00 PM.

I stop at the Hemodialysis Clinic that I have a partnership in ownership with another physician. While there, the patient I discharged comes into the facility. I review the orders I wrote and might modify them a bit to change the amount of fluid that is being removed considering the blood pressure of the patient.

I am paid for that service. I am paid for my evaluation of the necessity of the order and its brevity to the patient.

I leave the facility, grab a bite to eat and head to the office. While the patient was receiving hemodialysis, she had an adverse reaction, but, not so severe that she needs to return to the hospital, so I tell the clinic, which I own in partnership with another physician, to have the patient come to the office for evaluation. The patient complies and stops into the office where I examine the patient and realize there was too much fluid removed and she needs replacement, so I order her to take three glasses of water while in my office.

I am paid for that service. I am paid for my evaluation of the necessity of the order and its brevity to the patient. I incurred expenses at the office with support personnel that are periodically checking the patient's blood pressure for a reasonable recovery.

The patient then goes home and she is to report for re-evaluation after her next dialysis treatment in two days.

Dr. Zebra received three payments from three different locations for his services regarding one patient. As a partner to the Dialysis Clinic he also was paid for the time the patient was receiving dialysis. Now, one can debate as to whether that is abuse of the system or not, but, it seems fairly clear to me there needs to be a better way of tracking the actual practice of a physican and the monies received to them, especially when there is a huge conflict of interest in their ownership of free standing clinics or nursing homes.

Are there ethical issues? Good question.'

The 'key' to the issue, in my opinoin, is 'the quality of a physician's practice' and 'the trend in the practice' in treatment of patients. In other words, is this a routine that frequently appears.

Page 729, lines 12 through 18;

‘‘(D) BILLING AGENTS AND CLEARING HOUSES REQUIRED TO BE REGISTER UNDER
MEDICARE.—Any agent, clearinghouse, or other alternate payee that submits claims on behalf of a health care provider must be registered with the Secretary in a form and manner specified by the Secretary.’’.

Okay. This is a provision to bring brevity to accuracy by billing agents. By having them register with the government, they can be tracked to their performance by a simple code or registration number. The volume of billing they do and how many times the same service is being billed will make finding and prosecuting fraud a lot easier.

Page 731, lines 3 through 9;

‘‘(13) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to a Federal health care program, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to a Federal health care program;’’; and

There a many definitions to this section, as well as improvements in the wording of the law. Page 735, lines 3 thorugh 6;

‘‘(9) The term ‘material’ means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.’’.

This is a compliance issue. It provides for access to records.

Page 735, lines 7 through 11;

Subtitle D—Access to Information Needed to Prevent Fraud, Waste, and Abuse
SEC. 1651. ACCESS TO INFORMATION NECESSARY TO IDENTIFY FRAUD, WASTE, AND ABUSE.

Page 740, lines 1 through 8 (of the same provision).

SEC. 1653. COMPLIANCE WITH HIPAA PRIVACY AND SECURITY STANDARDS.
The provisions of sections 262(a) and 264 of the Health Insurance Portability and Accountability Act of 1996 (and standards promulgated pursuant to such sections) and the Privacy Act of 1974 shall apply with respect to the provisions of this subtitle and amendments made by this subtitle.

I wish Congress would review the HIPPA laws. I don't believe they are good laws. I believe the old standards were far better. The enforcement of HIPPA laws requires more paperwork and more personnel time and in some instances can delay patient care. They aren't good laws. An understanding about privacy, enforcable through negligence of abiding by a patient's right to privacy is all the public needs. In my opinino, HIPPA adds to health care 'overhead' costs.

Page 740, lines 9 through 17;

TITLE VII—MEDICAID AND CHIP
Subtitle A—Medicaid and Health Reform
SEC. 1701. ELIGIBILITY FOR INDIVIDUALS WITH INCOME BELOW 133-1⁄3 PERCENT OF THE FEDERAL POVERTY LEVEL.

(a) ELIGIBILITY FOR NON-TRADITIONAL INDIVIDUALS WITH INCOME BELOW 133 PERCENT OF THE FEDERAL POVERTY LEVEL.—

This is the reference to The Public Option. These words appear several times to each of the defining paragraphs of the updates to existing laws. Page 743, lines 9 through 24 and Page 744, lines 1 abd 2:

(C) by adding at the end the following new subclause:

‘‘(IX) who are under 65 years of age, who would be eligible for medical assistance under the State plan under one of subclauses (I) through (VII) (based on the income standards, methodologies, and procedures in effect as of June 16, 2009) but for income and who are in families whose income does not exceed 1331⁄3 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the
size involved;’’.

One hundred and thirty-three and a third of the poverty level is in the ballpark of about $23,000 annually. Right? One hundred percent would be about $17 - $18,000 annually. Then add one third more as qualifying income brings it to somewhere around $23,000. That is a very low income for folks under 65 years of age and an exceptionally low income for any family. That is ridiculous. There should be access to free health care, without question, to these people. Absolutely.

This is basically adding the parents of SCHIP children. That's what it seems like to me.

I could tell you a story here, but, I don't know if I want to. Give me a minute.

Okay, what the heck. This is protecting the 'innocense' of the unborn. This goes back to mid-1990s in Newark, New Jersey at UMDNJ's obstetric HIV/AIDS clinic. Yes, it is about AIDS again, but, it is a stark example.

Oh, what about the news about a vaccine? Pretty good, ah?

Okay. I stated before the children in Lowell, Massachusetts were receiving gammaglobulin in transfusions to stop the effects of HIV/AIDS on their growth and development. Well, the MD that headed up the clinics at UMDNJ in regard to women and children took that one step further. When a woman was diagnosed with HIV and was pregnant, they would get gammaglobulin transfusions for the length of the pregnancy. The idea was to bring relief to the fetus while developing in utero.

The hope was that infants would be born without the disease. In fact, there were some infants born positive, but, converted to negative about a month after their birth. In other words, when they started producing their own blood through their own bone marrow outside the uterus of the mother. Truly. It didn't happen every time, but, there were occassions when it did. Now, whether they remained healthy is another question. They might have reinfected after a long time.

But, this isn't about them. It is about their parents.

It was almost ludicrous to walk into the OB Clinic at UMDNJ. There were healthy mothers waiting to be seen and there were HIV mothers waiting to be seen. There was no difference in their appearance, because the HIV mothers were relatively healthy during their pregnancy. Good body weight, 'secondary' diseases in check. In appearance they looked no different than the healthy mothers.

So, then what was so ludicrous, right?

What was so ludicrous was the appearance of the fathers. They were usually under weight and appearing rather ill. There were remarkable differences between the healthy fathers and the HIV fathers. Of course, there was also the sadness the HIV fathers might not live to see their children born if they became ill with a severe secondary infection. It was a stressor to the HIV mothers and difficult to live with knowing their transfusions would end with the birth of the child. They were discouraged at all costs not to breastfeed. The HIV parents had a very different reality than the healthy parents. It was a tough environment to be in somedays.

Oh, yes, the fathers would accompany the mothers. This was Newark. There were safety issues and bonding issues. The fathers were absolutely a part of this picture.

The point is, where there are children there is a need for parents. If we as a society state the children are important enough to provide health care for, then aren't we obligated, MORALLY, to provide every opportunity for the well being of their parents? Isn't a child allowed to be raised by parents that will be healthy and able to support them? Do they have to live in a parallel universe whereby their parents may not be healthy enough to participate in their lives all their lives?

There are many eligibility certification statements under this provision. Admitting 'non-traditional' patients to Medicaid/Medicare is a mutual relationship between the federal and state governments. Both the states and federal government provide benefits to some predetermined formula. The provision in this part of the bill tells the states about certification of people eligible for benefits. How they can certify, where the law changes and how often people certify.

There is a special set of statements regarding non-traditional newborns. In other words, a newborn can receive benefits immediately until certification processes are complete and they are either covered by the Public Option or another form of insurance.

The purpose of this section is obvious.

A child has to receive medical care immediately at the time of birth. There may not be any insurance in place when the child is born, so this provides coverage at the time of birth so any child will not be compromised. The eligibilty is waved at this point until all the certifications can be completed. I would think that would be accomplished 'in house' by the Social Service department in the facility in a day or so.

This is page 750 and I am going to end here for tonight. I do read other things than bills.

Until later...

As an endorsement to the Afghan people, none of the winning parties in the election to date were Taliban.

If I had to go through this to vote I doubt I would. The Afghan people want their democracy.

The third place winner in the elections state his vote is clean and only of the people, believing of course, he should then be granted his right place in the Afghan Presidency.

...The EU estimates focused on polling sites (click title to entry - thank you) where more than 90 percent of the vote went to a single candidate. Bashardost scoffs at the notion that he was pulling in fraudulent ballots, saying he lacked the bribe money or government officials willing to falsify his ballots.
"My vote is clean," Bashardost says. "It is absolutely a vote of the people."
During the election, Bashardost did have an advantage with one ethnic voting bloc. He's a Hazara, a central Afghanistan ethnic group whose people traditionally have been persecuted, and suffered several massacres during the Taliban era.
Bashardost's roots are in Kabul, where his father had a small automobile parts shop. After the Soviet invasion of Afghanistan in 1979, Bashardost made his way to Iran and finally to France. There, he lived for 22 years, earning a doctorate in political science and law as he published a book about Afghan constitutional law.
Returning to Afghanistan in 2003, Bashardost served briefly as Karzai's minister of planning in 2004.
There, he proudly claimed to have angered his ethnic Hazara constituency by rejecting their pressure to stack his bureaucratic appointments with their ethnic bloc. "I said 'I'm a minister of Afghanistan, not Hazarajat," Bashardost said...

Afghanistan is not another South Vietnam. The stakes are much higher.

U.S Gen. Stanley McChrystal

General McChrystal is honest, forthright, dedicated and the list goes on. I have not witnessed in any other commander or general in the eight years in Afghanistan with this level of pure dedication to country and purpose. I believe he walks the talk and I believe he has the troops in mind when he issues opinion to his staff. He is well credentialed in defeating the men that would see civilization destroyed. He has successfully confronted the 'terrible' and brought them to justice or death.

He's right. I remember an assessment of Afghanistan by Representative John Murtha whom stated it would require 600,000 troops to be successful in Afghanistan. That seemed like such an unrealistic number, but, in his interview on CBS, General McChrystal stated, Afghanistan needs to have a fighting force of 400,000 of their own troops.

A fighting force of 400,000 Afghanistan troops isn't assembled overnight. It takes many people to recruit and train them.

In an interview today, Secretary Gates stated that last time there was a 'strategy' for Afghanistan was 1980. That is a lot of neglect. There was no real strategy for Afghanistan following September 11, 2001. There was a 'holding' pattern to make the Karzai government seem intact.

When President Obama ordered a strategy for Afghanistan little did anyone realize how much the Taliban had reconstituted its opposition to an organized government. President Obama, Secretary Gates went forward with the idea of securing the democracy in Afghanistan by hoping to succeed with elections. Little did anyone realize, the only 'surviving democracy' in Afghanistan was a Constitution and a exoskeleton of an infrastructure. Basically, President Karzai was a figure head to the issues of the country and the sincere structure of this democracy was gutted by violence as the Taliban were allowed to plunder Afghanistan with the cooperation of a very weak President/General Musharraf.

The corruption that besets Afghanistan is a direct result of the violence. Anarchy in a warlord domain is perfect for developing power brokers of 'mini-nations' of ethnic groups within the borders of the country. In order to stop the corruption, the Afghanistan government has to stop the violence. The two entities contribute to each other and one cannot exist without the other.

Afghanistan cannot be abandoned, unfortunately. It is in a sensitive region of the world that allows the nurturing of international criminals among a populous of people that sincerely want a democracy that values many of the qualities of life civilization values. If Afghanistan had a glut of oil between the rocks of the mountains, it would be occupied until every ounce was extracted. That isn't the case and Afghanistan through decades of neglect has devolved from a once reasonably peaceful society into one dominated by a bizarre culture nurtured by al Qaeda and given legitimacy by the Taliban.

The region has to find stability. The last eight years hasn't resolved the violence or dominated the culture by values of civilized countries because the 'real war' was sidelined to Iraq where there is significant oil deposits extracted to the last drop by injecting water into the oil wells at a time when humanity is suffering from a warming Earth and CO2 toxication while experiencing the worst droughts in history. To say the values here is bizarre is an understatement. The 'idea' of using water to inject into oil wells when people at the surface can't find potable water to drink is an unbelievable reality in Iraq.

But, Iraq is not the topic, the stabilization of Afghanistan is the reason for this entry. I believe we are committed to this conflict, it does have a resolve and we have the best talent in the military heading the effort. If the Congress of the USA can't see the forest for the trees than they have failed AGAIN to resolve turbulence that will revisit the USA. If politics defeats General McChrystal and his assessment I will think less of those that act against his dedication and his remarkable abilities. He is one of the bravest men I have ever witnessed in regard to these last eight years, able to stare down international criminals, hunt them down and insure their demise. He is a rare talent at a time when it is needed most.

At the United Nations this week we witnessed incredible cooperation between countries. We had the exceptional pleasure of witnessing the one and a half hour speech by a Libyan leader that stands testament to the power of non-proliferation. No different than the abandonment of Afghanistan since 1980, the USA diplomatic corps have abandoned a denuclearized nation in efforts to further the outreach to the Libyan people and its economy.

The rhetoric of Colonel Muammar al-Gaddafi is a result of the in appreciation of the disarmament of his nation without conflict and the realization he did authorize a horrible crime of murder of over two hundred people. All that is taken for granted that The West had a right to accomplish such a feat without appreciation that it was actually accomplished without confrontation and with realization the Libyan people needed to be further included in the world of openness and peaceful resolve. The rhetoric of al-Gaddafi is due to the lack of forgiveness.
When efforts to secure the world away from violence and nuclear armament succeed there needs to be more than a flag of victory planted, there needs to be connectedness of the people of any nation willing to commit to peace and mutual economy. The war strategy for Afghanistan cannot end with simply stating 'we tried' or 'we won' it needs someone to change the face of the nation that is so willing to go where we lead. Libya was willing to go where The West lead it, but, abandoned appreciation of the effort by the people to cooperate.

If the USA had not abandoned Afghanistan in 1980 there wouldn't be the level of violence within that country and we would never have experienced the attacks of September 11, 2001. By abandoning Afghanistan now that we realize how powerful a violent and oppressive regime that is the Taliban can become, we are only setting up the USA to be endangered by those same elements again and the Afghan people to lives of servitude to international criminals again.

If the USA believes it can simply turn its back and walk away hoping Afghanistan will simply remain a containable haven for these criminals, realize that Colonel Muammar al-Gaddafi at the age of 67 is not finished with his focus. He headed up the African Union for a long time and saw it develop into an organization with economic realities and potential. He is not a stupid man that simply bends his knee to The West. He is now asking for a 'one state' solution to unite Africa and South America. I remind South America has its own 'world bank' now. Col. al-Gaddafi isn't settling back to rest his former priorities in an easy chair into retirement, quite the contrary. He sees a bigger picture and one that might manifest in the destruction of Western culture should the opportunity present itself and 'the need' arise. There is no good feeling when leaders are faced with 'illegal' invasions by a certain political party in the USA.

For the USA to abandon these accomplishments and allow fear to breed hatred is a foolish game. To commit to Afghanistan to make the reality of stability of the region a success will add to the legitimacy of the intentions of the USA on a scale that no one can ignore under the leadership of a Secretary of Defense and a general of exceptional ability. To turn our backs on the victory that is guaranteed by such exceptional men at this point will be to lose every potential of repeating the ability of securing the USA.

There is the chance there will not be another General McChrystal. If that is the case and the 'freshness' of his ability to 'know' the enemy and defeat them is lost to political concerns will be to lack the ability to insure the best outcome for the USA and its allies in the future.
If we consider the world burgeoning on a path to sustainable peace with non-proliferation a reality, it is all regions of the world that will have to be stable and not just those that suit the wealth merchants of Wall Street. I am confident strong alliances can be sustained with Pakistan and nurtured again with Russia bringing all pressure to bear to stabilize Afghanistan. Both of these countries are cooperating with all the requests of the USA and seek a region more secure and more democratic.

The Afghan people are wonderful people who are willing to accept our leadership, we can't betray them and allow them to be disposable lives falling again victims to oppression and violence. I stand with General McChrystal and his assessment. I believe in him. It isn't easy for me to make that commitment either. I believe there will be less causalities with a stronger military force under his leadership.

The ACORN issue will be dismissed in any legal action. There is nothing to the allogations.

Bertha Lewis, the CEO of ACORN.

The exploitive film of a fired ACORN worker is not admissible evidence in court. It was planned that way.

Steven Crowder and his associate Hannah Giles took it on themselves to mastermind a 'scenario' to provide something that looked like a system wide corruption of ACORN. One incident does not a systemic problem make.

The victimization was organized in Maryland to further embarass 'government' as an entity to trust. Maryland requires two party consent for taping. The entire mess is to create a Right Wing Circus for media exploitation that hopefully will tarnish the Democratic Party.

Any and all pursuits to this 'hideous' scenario should be dropped. If ACORN has suffered losses due to this 'Made for Republican Politics' movie it should pursue relief through the courts, including the media that facilitated it.

This is outrageous already. This is the Republican Right Wing media at its best. It was a completely fictious pursuit and someone at ACORN fell into the trap. The scenario should be investigated as should any potential corruption of ACORN, but, to allow this kind of 'game playing' to provide political volleys when nothing substanitive ever existed before is simply outrageous.

If the FBI has the time to investigate under age prostitution and finds instances where any organization has assisted same then they should do so. I mean are there kidnappings in the country by pips? But, in all honesty I would rather the FBI pursue justice to 'real life' realities such as angry men intent on killing others and destroying infrastructure to satisfy some strange ideological philosophy.

This is another one of those 'census' issues. Does ACORN report its successes to the federal government? If any entity is receiving federal or state monies, the results of their programs should be reported to the agencies receiving the services. I am assuming ACORN has reported on all its programs to someone. Are the ACORN projects successful?

Census should cut SEIU ties because of ACORN, Kirk says (click title to entry - thank you)

September 25, 2009

BY ABDON M. PALLASCH

Political Reporter/apallasch@suntimes.com
Since the U.S. Senate voted 83-7 earlier this month to cut off funding for ACORN, the activist/voter registration group has become so controversial that some are calling for sanctions against groups associated with it.
The debate is invading the race for U.S. Senate in Illinois.
Republican U.S. Rep. Mark Kirk announced Friday he will hold a news conference calling on the U.S. Census Bureau to sever its ties to Illinois’ largest union, the Service Employees International Union, because, Kirk says, the group is too close to ACORN.
The union endorsed Kirk’s front-running Democratic rival for the Senate seat, Democrat Alexi Giannoulias, the previous day.
Up until ACORN became controversial for alleged vote fraud during last year’s presidential election, even Republican administrations funded the group.
Kirk himself voted in 2005 to approve a $140,000 earmark for ACORN’s New York office to fight teen delinquency, SEIU's political director Jerry Morrison said....

The 'idea' behind the Republican Right Wing media is to 'revolutionize' government and prove its inability to function and therefore legitimize private enterprise over government run anything. Of course, like Medicare Advantage all the private enterprises receive tax dollars as their primary income.

The Right Wing assault against ACORN is no different than their other media events. They are contemplated and staged to appear legitimate. They aren't and this 'episode' with the Right Wing Media is simply another example of them creating 'an issue' where none existed before. I want to know how many prostitution houses ACORN has financed.

Iran's strategy is to strike Israel with its first test of its long range missiles. Nothing can be left to chance, stop Iranian aggression.

The Iranian government has proven it has never acted in good faith toward the International Community. It is covert and its aggression is obvious. While 'calm' surmounts reality in an understanding that sanctions will work, even tougher sanctions than has worked to date, there is an element of risk that has to be faced regarding the potential for a 'risky' first strike at the opportunity to test Iranian long range missiles.

In my opinion, the USA has no other choice but to maintain a nuclear submarine presence within striking distance of Iran. The Iranians under its current leadership are too unpredictable, which brings all to clear the uproar following the last elections. The Iranian leadership of the opposition would know of the aggressive strategy against Israel and knows all to well the response by The West and potentially Russia and China in retaliation.

The elections resulted in riots due to the impending doom the opposition realized is inevitable under the current regime.


Sept. 25: A view of what is believed to be a uranium-enrichment facility near Qom, Iran, is seen in this satellite photograph. Iranian President Mahmoud Ahmadinejad said Friday the United States, Britain and France would "regret" accusing Iran of hiding a nuclear fuel facility, saying it was not a secret site (Reuters).

Iran plans to test-fire missiles capable of hitting targets (click title to entry - thank you) across the Middle East tomorrow, in a show of defiance before Thursday's pivotal talks on the country's nuclear programme.
The test of the Shahab-3, following trials of short-range missiles today, is likely to raise tensions across the region. Iran claims the missile, based on a North Korean design, has a range of 1,500 miles – far enough to reach Israel and Iran's other Middle East rivals Egypt, Saudi Arabia and Turkey....

The only way the Iranians should be tolerated in allowing any missile testing is for complete and immediate inspection of all its nuclear facilites. The Iran regime in power is completely untrustworthy and all safeguards to prevent confrontation are necessary. Iran cannot be contained without the dismantling of their nuclear intentions. It doesn't need nuclear power for peaceful purposes. Its energy needs can be obtained through solar and wind projects.



If Iran was to be the saviors of the Shi'ite acting in peace they should have never covertly conducted expansion of their nuclear facilities. This is NOT the way to secure a 'Shi'ite' presence on Earth, it is sure to destroy any of its chances at survival.
continued...

"Morning Papers" - Its Origins

The Rooster

"Okeydoke"

The graph is independant from the article which appeared in the New York Times as an editorial.

...A survey by the Kaiser Family Foundation found that (click title to entry - thank you), once again, health insurance premiums rose faster last year than either wages or general inflation. A study by the Treasury Department found that almost half of all Americans below Medicare age have gone without insurance at some point over the last decade.
The Kaiser study, conducted jointly with the Health Research and Education Trust, an affiliate of the American Hospital Association, found that the average premium for a family policy offered at work rose above $13,300 in 2009 — up from $5,800 in 1999. The average employer paid more than $9,800 of that, while the workers contributed more than $3,500. The workers were also hit with larger co-payments and deductibles, while their policies often offered fewer benefits....


There is no way this can be allowed to go on.

The pages 650 through 653 of the House Bill are a completion of the previous provision and it is fairly routine. So the next topic is on page 654 entitled "Public Reporting on Health Care Associated Infections."

Page 655, lines 3 through 18:

‘‘(2) REPORTING PROTOCOLS.— Such information shall be reported in accordance with reporting protocols established by the Secretary through the Director of the Centers for Disease Control and Prevention (in this section referred to as the ‘CDC’) and to the National Healthcare Safety Network of the CDC or under such another reporting system of such Centers as determined appropriate by the Secretary in consultation with such Director.
‘‘(3) COORDINATION WITH HIT.—The Secretary, through the Director of the CDC and the Office of the National Coordinator for Health Information Technology, shall ensure that the transmission of information under this subsection is coordinated with systems established under the HITECH Act, where appropriate.

This is a change in the public reporting by the CDC. The infrastructure already exists through previous 'purpose' and legislation, it a matter of requiring public access to SPECIFICALLY "Nosocomial Infections."

Nosocomial infections are defined as "hospital acquired." See example below:


September 22, 2009
Tales from the C. difficile trenches (click here)
Admitted to hospital for pneumonia, the retired man was visited every day by his wife, who helped feed and care for him. Then he contracted Clostridium difficile from a roommate and had to be transferred to intensive care. His wife was later admitted to another part of the hospital – with C. difficile. She was too ill to visit him as he lay dying and too sick to attend his funeral.
A true story, one that Dr. Michael Gardam tells to bring home the human toll of an infection that is so often transmitted in hospital.
“Things like this happen in hospitals and telling them is how we recognize the impact that hospital-acquired infections can have on patients,” explains the director of infectious disease prevention and control at the Ontario Agency for Health Protection and Promotion....

The reason, of course, for reporting such events publically is to make all the services to patients better. Easy access to immediate information regarding trends in nosocomial infections will allow for better understanding of the pervasiveness in hospitals and how the hospitals that have low rates combat those problems. These efforts lead to lower health care costs and better patient outcomes.

C. difficile is a bacteria that CAN manifest when antibiotics are administered. The reason it occurs with some frequency in hospitals is due to IV antibiotics and the immediate effects on any bacterial infection. Sometimes it is due to the 'strength' of the medication as well and its overall 'spectrum' of infection fighting capacity. Broad spectrum antibiotics are good for 'immediate' care, but, should be substituted as soon as possible with antibiotics that 'specificially' treat the organism causing the infection. There is no need to treat all infections with broad spectrum antibiotics because that is what caused 'super bugs.'

The reason such measures haven't been conducted before is because it is also 'bad advertisement' for hospitals and health care facilities that have chronic issues with nosocomial infections. Where would you like to be treated? In facilities, including MD offices, where there are very low occurrences of these infections or a place with chronic 'sanitary' issues? You know. The 'persistent' dirt in the corners of public bathrooms, including patient rooms, carry all kinds of 'mess' with it. There are some 'dirty' health facilities in this country. So, those that would 'victimize' the public to promote sales of medications wouldn't want BETTER reporting, because, people might actually stay healthy and alive of all things.


You know the Republicans chronically complain about 'tort reform.' It isn't tort reform that is needed and this is a fine example. Why should any law regarding enforcement of high sanitary standards matter if there is no deterrent. Law suits for unnecessary deaths of patients, due to in this instance, hospital acquired infections are a means of deterrent. When the lives of people being treated mean nothing in the way of fiscal losses to practitioners and facilities because tort reform eliminates liabilty, what does that interpret into in 'the real world?' An ethics violation? So. No MD loses their license due to an occassional ethics complaint because a patient died due to a hospital acquired infection. No hospital is closed due to that reason either. BUT. They pay attention to malpractice costs and payments on lawsuits.


HENCE.


A person's life, no matter where they fall into the socioeconomic strata of the USA has definition. If anyone or any entity screws up and costs a person their life, they will lose millions with potential for billions depending on the extent of negligence or malpractice occurring. It is a 'safety' issue. Tort reform isn't about money. Not really. It is about providing a safety net to medical care.

National Briefing South: North Carolina: Settlement For Transplant Error (click here)
Published: Saturday, June 26, 2004
Duke University Hospital has reached an undisclosed settlement with the family of a Mexican teenager who died after being given a heart-lung transplant of the wrong blood type. The girl, Jésica Santillán , 17, died last year, 15 days after the botched transplant....

There are more words to this provision that insures high quality reporting, annual reporting to Congress, noncompliance and implementation.

So you know everyone is on the same page and this isn't 'just my take' on things, page 658, lines 1 through 12:

‘‘(e) HEALTH CARE-ASSOCIATED INFECTION.—For purposes of this section:
‘‘(1) IN GENERAL.—The term ‘health care-associated infection’ means an infection that develops in a patient who has received care in any institutional setting where health care is delivered and is related to receiving health care.
‘‘(2) RELATED TO RECEIVING HEALTH CARE.— The term ‘related to receiving health care’, with respect to an infection, means that the infection was not incubating or present at the time health care was provided.


Page 660. lines 1 through 4:


TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION
SEC. 1501. DISTRIBUTION OF UNUSED RESIDENCY POSITIONS.

Page 666, lines 3 through 13;

‘‘(iii) CONSIDERATIONS IN REDISTRIBUTION.—In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall take into account the demonstrated likelihood of the hospital filling the positions within the first 3 cost reporting periods beginning on or after July 1, 2011, made available under this subparagraph, as determined by the Secretary.

"The devil is in the details." This provision allows for redistribution of 'effective' residency programs to hospitals actively engaged in conducting them. There is reporting to the Secretary the number of successful engagement of residencies, including, the inability of any hospital to have a successful program. There is opportunity for hospitals to expand their programs as well. Basically, the Secretary wants to be sure, beside quality programs in the USA existing, that they are actually producing the physicians and surgeons needed in the country. It is a quality assurance issue.

Same page, lines 14 through 20:

‘‘(iv) PRIORITY FOR CERTAIN HOSPITALS.—In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall distribute the increase to qualifying hospitals based on the following criteria:

Page 667, lines 1 through 5:

‘‘(II) The Secretary shall give preference to hospitals with 3-year primary care residency training programs, such as family practice and general internal medicine.

The provision is very lengthy. There are many quality assurances to implementation of the provision including increasing exposure of residents to non-hospital settings. It all seemed very appropriate, long overdue and carefully thought out. This is page 686, lines 6 through 10:

TITLE VI—PROGRAM INTEGRITY
Subtitle A—Increased Funding to Fight Waste, Fraud, and Abuse
SEC. 1601. INCREASED FUNDING AND FLEXIBILITY TO FIGHT FRAUD AND ABUSE.

Page 687, lines 12 through 16:

Subtitle B—Enhanced Penalties for Fraud and Abuse
SEC. 1611. ENHANCED PENALTIES FOR FALSE STATEMENTS ON PROVIDER OR SUPPLIER ENROLLMENT APPLICATIONS.


Both these provisions provide for increased 'enforcement' to stop abuse of the new health insurance system. There has to be such enforcement and as time goes forward there will be less and less need for it as it is realized there is little 'profit' in fraud as well as high consequences. This will also expose wasteful spending and will provide a means to lower costs of health insurance. Page 688, lines 5 through 16 provides an over view of the provision:

‘‘(8) knowingly makes or causes to be made any false statement, omission, or misrepresentation of a material fact in any application, agreement, bid, or contract to participate or enroll as a provider of services or supplier under a Federal health care program, including managed care organizations under title XIX, Medicare Advantage organizations under part C of title XVIII, prescription drug plan sponsors under part D of title XVIII, and entities that apply to participate as providers of services or suppliers in such managed care organizations and such plans;’’;

Page 689, lines 11 through 13:

SEC. 1612. ENHANCED PENALTIES FOR SUBMISSION OF FALSE STATEMENTS MATERIAL TO A FALSE CLAIM.

Page 690, lines 15 and 16:

SEC. 1613. ENHANCED PENALTIES FOR DELAYING INSPECTIONS.

Page 691, lines 1 thorugh 7;

‘‘(10) fails to grant timely access, upon reasonable request (as defined by the Secretary in regulations), to the Inspector General of the Department of Health and Human Services, for the purpose of audits, investigations, evaluations, or other statutory functions of the Inspector General of the Department of Health and Human Services;’’; and

The following is a fascinating provision. It regards hospice as a place where quality of care should exist. I remember one of the first 'rantings' of the Republican Right Wing Media was about how the government is going to kill off the aged and dying. Well. It would seem the government, at least the House of Representatives, are more interested in the 'quality of care' provided to those in hospice care. For those in the Right Wing Media that doesn't understand what 'hospice' is? It is the specialized care of the dying. Anytime the Republican Right Wing Media wants to apologize I am sure the nation would be eager to hear it.

Page 692, lines 8 through 24 and page 693, lines 1 and 2:

‘‘SEC. 1819A. ASSURING QUALITY OF CARE IN HOSPICE CARE.
‘‘(a) IN GENERAL.—If the Secretary determines on the basis of a survey or otherwise, that a hospice program that is certified for participation under this title has demonstrated a substandard quality of care and failed to meet such other requirements as the Secretary may find necessary in the interest of the health and safety of the individuals who are provided care and services by the agency or organization involved and determines—
‘‘(1) that the deficiencies involved immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the Secretary shall take immediate action to remove the jeopardy and correct the deficiencies through the remedy specified in subsection (b)(2)(A)(iii) or terminate the certification of the program, and may provide, in addition, for 1 or more of the other remedies described in subsection (b)(2)(A); or

Now.

Whom exactly of the Right Wing Media provides QUALITY information? Whom is it that reads every line and understands every word? No one? That would seem to be the 'honest' answer. Whom is guilty AS SIN of lying and deception in the capacity of a licensed media outlet? Hm? Whom might that be? Murdock's tribe? Yeah.

The penalites for actions that jeopardize the care of a hospice patient might be what Murdock's tribe really objects to. Ready? It's interesting. Considering this is in ADDITIONAL to any and all payments a malpractice insurance company has to pay. These penalities aren't covered by insurance, now are they?

Page 693, lines 22 through 25 and page 694, lines 1 through 25 and page 695, lines 1 through 22:

‘‘(b) INTERMEDIATE SANCTIONS.—
‘‘(1) DEVELOPMENT AND IMPLEMENTATION.—
The Secretary shall develop and implement, by not later than July 1, 2012—

‘‘(A) a range of intermediate sanctions to apply to hospice programs under the conditions described in subsection (a), and‘‘(B) appropriate procedures for appealing determinations relating to the imposition of such sanctions.
‘‘(2) SPECIFIED SANCTIONS.—
‘‘(A) IN GENERAL.—The intermediate sanctions developed under paragraph (1) may
include—
‘‘(i) civil money penalties in an amount not to exceed $10,000 for each day of noncompliance or, in the case of a per instance penalty applied by the Secretary, not to exceed $25,000, (if it were me, I'd put no limit on it and put them out of business)
‘‘(ii) denial of all or part of the payments to which a hospice program would otherwise be entitled under this title with respect to items and services furnished by a hospice program on or after the date on which the Secretary determines that intermediate sanctions should be imposed pursuant to subsection (a)(2),
‘‘(iii) the appointment of temporary management to oversee the operation of the hospice program and to protect and assure the health and safety of the individuals under the care of the program while improvements are made,
‘‘(iv) corrective action plans, and
‘‘(v) in-service training for staff.
The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (i) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). The temporary management under clause (iii) shall not be terminated until the Secretary has determined that the program has the management capability to ensure continued compliance with all requirements referred to in that clause.
‘‘(B) CLARIFICATION.—The sanctions specified in subparagraph (A) are in addition to sanctions otherwise available under State or Federal law and shall not be construed as lim21
iting other remedies, including any remedy available to an individual at common law.

Page 698, lines 17 through 19;

SEC. 1616. ENHANCED PENALTIES FOR PROVISION OF FALSE INFORMATION BY MEDICARE ADVANTAGE AND PART D PLANS

Page 700, lines 21 and 22;

SEC. 1618. ENHANCED PENALTIES FOR OBSTRUCTION OF PROGRAM AUDITS.

Page 701, lines 15 through 17;

SEC. 1619. EXCLUSION OF CERTAIN INDIVIDUALS AND ENTITIES FROM PARTICIPATION IN MEDICARE AND STATE HEALTH CARE PROGRAMS.

Page 702, lines 1 through 25 and page 703, lines 1 through 22;

‘‘(4)(A) For purposes of this Act, subject to subparagraph (C), the effect of exclusion is that no payment may be made by any Federal health care program (as defined in section 1128B(f)) with respect to any item or service furnished—
‘‘(i) by an excluded individual or entity; or
‘‘(ii) at the medical direction or on the prescription of a physician or other authorized individual when the person submitting a claim for such item or service knew or had reason to know of the exclusion of such individual.
‘‘(B) For purposes of this section and sections 1128A and 1128B, subject to subparagraph (C), an item or service has been furnished by an individual or entity if the individual or entity directly or indirectly provided, ordered, manufactured, distributed, prescribed, or otherwise supplied the item or service regardless of how the item or service was paid for by a Federal health care program or to whom such payment was made.
‘‘(C)(i) Payment may be made under a Federal health care program for emergency items or services (not including items or services furnished in an emergency room of a hospital) furnished by an excluded individual or entity, or at the medical direction or on the prescription of an excluded physician or other authorized individual during the period of such individual’s exclusion.
‘‘(ii) In the case that an individual eligible for benefits under title XVIII or XIX submits a claim
for payment for items or services furnished by an excluded individual or entity, and such individual eligible for such benefits did not know or have reason to know that such excluded individual or entity was so excluded, then, notwithstanding such exclusion, payment shall be made for such items or services. In such case the Secretary shall notify such individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services.
Payment shall not be made for items or services furnished by an excluded individual or entity to an individual eligible for such benefits after a reasonable time (as determined by the Secretary in regulations) after the Secretary has notified the individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services.

Consumers have to be aware that if an individual or entiry becomes ineligible for payment, they could still be held liable for the costs that cannot be gained from a government program. The Secretary under this provision will notify the people receiving services, but, then they have to stop their patronage, or be personally liable for the cost. This will probably be a matter of a public reporting page on the website eventually. The tricky part is confidentiality and being sure there is accurate information in such an instance.

I am going to end it there. The next major section is on page 704, beginning with lines 17 through 18.

Subtitle C—Enhanced Program and Provider Protections

Regards.

It may have been more than one Right Wing Extremists that killed him. A set of milita members, possibly?

The Census is a huge issue for Republicans and the extremists believe in its control. The Extremists of the Right Wing will stop at nothing. "Fed" equates to McVeigh's understanding of the government. If one census worker dies a horrible death supposedly that will stop the census as a threat to all census workers.

How correct does Janet Napolitanio have to be for the nation to realize there is an organized and armed element within its borders that license themselves to be bigots and war mongers?

From archives:

Ex-Aide Says Republicans Killed Census Adjustment; Undercount of Blacks, Hispanics Expected
(click title to entry - thank you)
[FINAL Edition]
Spencer Rich
Jan 15, 1988
Barbara Bailar said yesterday that she quit her post as a high-ranking Census Bureau official last month because she believes Republicans in the Commerce Department had political motives in killing a plan to compensate for an expected severe undercount of blacks and Hispanics in the 1990 census.
Adjusting the official census to compensate for blacks and Hispanics missed by counters on April 1 would benefit Democrats in reapportionment and redistricting of the House and the state legislatures, according to many analysts. The reasoning is that most blacks and Hispanics live in areas that usually vote Democratic. An undercount adjustment would increase the official population of those areas.
[Robert Ortner] said senior officials of the Commerce Department decided against the undercount adjustment because there was no unanimity, even within the Census Bureau, on whether the proposed methodology was adequate, practical and would improve accuracy. "You can't say there was an absolute, airtight case in favor of adjustment," he said.

Expert on Undercount Quits Census Bureau (click here)
[FINAL Edition]
Spencer Rich
Dec 18, 1987

A top Census Bureau official who has supervised the government's effort to develop a way to adjust 1990 census figures to correct an anticipated undercount of blacks, Hispanics and others has abruptly resigned her post and will retire.
According to the methodology worked out under [Barbara Bailar]'s direction, the Census Bureau could adjust the undercount by taking a survey of 300,000 representative households nationwide shortly after the April 1 census, and then comparing the results to see how many people were missed the first time.
TerriAnn Lowenthal, staff director of [Mervyn M. Dymally]'s House subcommittee on the census, said, "We have an awful lot of respect for Barbara Bailar. If, in fact, her resignation was prompted by dissatisfaction with the decision not to adjust, it is a further indication that the decision was made at higher levels of the administration and not by professionals at the Census Bureau."

The decadonal USA Census has been a method of control for the Republican Party as a political strategy to winning elections. They gerrymander and play this idiotic game as if people were cattle to be herded. They have lauded over the Census for a long, long time.

Published on Thursday, May 19, 2005

by CommonDreams.org
The Texas Nexus: Where Racial and Partisan Gerrymandering Came Together (click here)
by Karyn Strickler

Naive American voters still believe that they select their Congressional representatives. Texans are under no such illusion after the bitter redistricting battle that took place there. Partisan and racial gerrymandering has created a situation in Texas and across the nation, where very few U.S. Congressional seats are competitive today -- in effect allowing Congressmen to choose their voters.
U.S. House Majority Leader, Tom DeLay (R-TX), led the way for Republican Congressmen in Texas to pick their voters. The untold story of DeLay’s belligerent power grab in Texas redistricting involves partisan political domination, intrigue, alleged corruption and perhaps most significantly -- minority disenfranchisement.
U.S. Congressional redistricting takes place in state legislatures once per decade, following the decennial census to reflect population shifts, as mandated by the U.S. Constitution. Tom DeLay led the effort to violate all historical precedent by drawing the Congressional district lines in Texas -- twice....

He states the people are behind the Pakistan Army, yet, he never did anything about the extremists.

He was insuffienct as a leader and allowed the Taliban to flourish.

...To bring stability and peace to Afghanistan, (click title to entry - thank you) "the political element is the most critical," he said.

Nation-builders in Afghanistan need to "look for a homegrown political covenant," he said.

Musharraf endorsed the U.S. Army General Stanley McChrystal's plan to put more troops into Afghanistan.

When asked by an audience member whether Pakistan has the "national will" to exercise control over tribal areas like the Swat Valley, Musharraf said the violence in the Swat Valley has turned most ordinary Pakistanis against the Taliban.

"The people of Pakistan are behind the army."

One audience member asked what can be done to purge Paskistan's intelligence services of rogue extremist elements.

The former general denied that those elements exist, saying that dissension in the ranks is merely a "perception created by certain Western interests and the media.

"If the army and intelligence services are not leading the fight against extremism in the tribal areas, Musharraf asked, "Who will?"

"We must trust them," he said. "There is a trust deficit. ... This trust deficit has to go."

Obama's General, I plan to watch CBS on Sunday evening.

US Terror Suspect to Face Charges in New York (click title to entry - thank you)
By VOA News 26 September 2009

Prosecutors say an Afghan-born terror suspect in U.S. federal custody spent more than a year plotting a massive attack on the United States with co-conspirators.Najibullah Zazi was transferred Friday from the western state of Colorado, where he was detained, to the northeastern city of New York, where he faces charges of conspiring to detonate bombs.A federal grand jury in New York indicted 24-year-old Zazi on Wednesday, but that was not made public until Thursday. The U.S. government says Zazi received bomb-making instructions in Pakistan in 2008. It also says he bought components to build improvised explosive devices and traveled to New York City on September 10, 2009, to move forward with his plans....

Some of questions they won't ask will probably be, "What are acceptable losses in the war in Afghanistan? Will there be less losses if there are more troops? What is the military advantage to increasing the troop level? When will the USA declare victory over the insurgency? What is a measure of that? Are you confident you are asking for all that it will take or are you wagering on the effort? If given everything you need, when will the war end?"

...There were two battalions to the north of Kandahar city. (click here) Another to the far south. Canadian forces were going to swing to the west. About 5,000 new U.S. troops in all.
"But there, there and there," the officer said, pointing to towns just outside a belt where the Americans and Canadians were stationed, "and there," putting his fist on the city, which with 800,000 residents is the country's second-largest population center, "we don't have anyone."
If more forces are not forthcoming to mount counterinsurgency operations in those parts of the province, he concluded, the overall U.S. effort to stabilize Kandahar -- and by extension, the rest of Afghanistan -- will fail....

Four U.S. troops killed in Afghanistan (click here)

Sat Sep 26, 2009 6:54am EDT

...The eight-year-old war in Afghanistan has been in its deadliest phase for foreign troops since July, when U.S. and British forces launched the biggest offensives of the war.
There are now more than 100,000 Western troops in Afghanistan, about two-thirds of them American.
Their commander, U.S. Army General Stanley McChrystal, is expected to ask for thousands more in a request he will deliver to Washington this week. He has said that without additional forces, his mission is likely to fail....

Polling records appear to back fraud allegations in Afghanistan presidential election (click here)
By HAL BERNTON
McClatchy Newspapers

...The records appear to bolster fraud allegations surrounding the Aug. 20 presidential election — which has become ever more critical to the U.S. and its allies in the face of Afghanistan’s increasingly powerful Taliban insurgency....

Officials To Audit Sampling Of Suspect Afghan Ballots (click here)
by Soraya Sarhaddi Nelson

September 25, 2009

Five weeks after Afghanistan's presidential elections, it's still unclear who will lead the country.
A preliminary tally suggests that incumbent Hamid Karzai is the winner, with 54 percent of the vote. But widespread allegations of fraud and official calls for a recount have stalled the final outcome.
Afghan and international officials are now hoping to break the logjam by agreeing to review ballots at about 10 percent of the nearly 3,100 polling stations flagged as suspicious by a U.N.-backed watchdog....

Doubts raised on Afghan mission ahead of German vote (click here)
SIMON STURDEE

September 23, 2009
Days before German elections, an influential former chancellor on Wednesday slammed the country's unpopular mission in Afghanistan, a foreign policy headache for whoever wins power.
As the race for Sunday's vote heated up, police raided the headquarters of the NPD, a neo-Nazi party with serious financial problems and next to no chance of winning any seats, after offensive letters were sent to ethnic minority MPs.
The election is expected to return Chancellor Angela Merkel to power, but two new opinion polls published on Wednesday confirmed that it is far from certain that she will be able to form her preferred centre-right coalition.
Helmut Schmidt, West German chancellor between 1974 and 1982 and still a respected figure in national politics at age 90, said meanwhile that the aims of Western forces in Afghanistan were "ever blurrier" and "not achievable"....

One question that always crosses my mine when I hear that bin Laden is still propagandizing his allegience to death is, "When will his iconography be too old to use?" Will it 'time out' when he reaches 100 years old or not? And what are the chances he is still alive considering the average longevity in the region?"

Bin Laden seeks to sway German election, Obama debate on Afghanistan (click here)
The new Al Qaeda tape, attributed to Osama bin Laden, coincides with a US policy debate on the Afghan war and a new poll showing the German race tightening.
By Dan Murphy Staff writer 09.25.09

In a new audio tape released Friday by Al Qaeda’s propaganda arm, a voice purported to be Osama bin Laden’s followed up on a series of threats made by more junior Al Qaeda members in recent months against America’s European allies in the Afghan war, warning that if they don’t pull out there will be retaliation against “the oppressor on behalf of the oppressed.”...

President Obama has accomplished nearly the impossible. A return to non-proliferation.

Click on the picture for a view of its 2005 context. Click here for the report.

I congratulate the member countries of the United Nations in bravely addressing, not just nuclear proliferation, but, a global fire storm of 'fear' in countries that are not armed with nuclear weaponry. It is a day that will go down in history as one of civlizations finest initiatives.