A sampling of editorial opinion around Texas:
Sept. 20
Austin American-Statesman on Congress and health care: (click title to entry - thank you)
You should probably think of U.S. Sen. Max Baucus' health care reform proposal as a sacrifice bunt. It's fairly obvious that Baucus, who heads the Senate Finance Committee, won't see the legislation he unveiled last week become law, but it advances the issue....
...One fair criticism of the plan is that it is more an attempt at insurance reform than health care reform. There is a difference, although the distinction gets lost in the superheated rhetoric generated since President Barack Obama proposed an ambitious overhaul of the health care system this spring.
In fact, the superheated rhetoric is driving the legislation, and that is no way to approach this most important topic. Senate Democrats and the White House are reacting to unfounded beliefs that the legislation will kill Grandma or lead to a government takeover of the health care industry and rationed health care. "Socialized medicine" was a refrain heard in 1964 when Medicare and Medicaid legislation initiated by the President Lyndon B. Johnson was making its way through Congress. Health care is rationed now -- by your insurance carrier, if you are lucky enough to have one.
If reform is to be meaningful, access to health insurance and access to primary health care have to be aggressively attacked....
...Mark-up on the bill begins this week, and all of us should hope that legislators focus on real issues and not cave into the hysteria that has dominated the debate.
The stakes are real. Health care costs are skyrocketing. Even those lucky enough to have a job find health insurance premiums taking bigger divots out their paychecks. According to a study released last week, family health care premiums in Texas rose about 4.6 times faster than their incomes between 2000 and 2009....
...Even if you are insured, access to care may be difficult if you live in a rural area or even in the wrong ZIP code of a metropolitan area....
...One solution would be granting nurses and nurse practitioners diagnostic and prescriptive authority. "Scope of practice" is what political pros call that type of legislation, and it is usually left to state legislatures to deal with. Those fights are usually brutal. It's time Washington weighed in....
Those issues are just a few that must be addressed in a serious discussion of health care reform.
We'll find out how serious Congress is this week.
URL: http://www.statesman.com
I left off with Page 625 of the House Bill.
I want to reflect on a trend in the bill incase I am the only one that picked it up. Not likely.
So far, through 625 pages of approximately 1100, there has been a new provision introduced approximately every 30 pages or so. The majority of the bill is redundant in that when a new provision is rendered, there needs to be whom will have authority to carry it out, whom will have oversight, when the bill will take effect and what laws it will replace or amend. So, if that trend continues for the entire '1100 some' pages (I am assuming the reports of 1100 pages are correct.) then there are approximately 33 provisions in the bill. Hardly what I would call earth shaking or radical.
Page 626, lines 19 through 24;
‘‘SEC. 1193. GAO EVALUATION OF DATA COLLECTION PROCESS FOR QUALITY MEASUREMENT.
‘‘(a) GAO EVALUATIONS.—The Comptroller General of the United States shall conduct periodic evaluations of the implementation of the data collection processes for quality measures used by the Secretary....
Very straight forward, the Government Accounting Office will track the quality measures in the bill and report on the completeness of the Secretary's work.
Page 628, lines 1 through 5:
SEC. 1443. MULTI-STAKEHOLDER PRE-RULEMAKING INPUT INTO SELECTION OF QUALITY MEASURES. Section 1808 of the Social Security Act (42 U.S.C. 1395b–9) is amended by adding at the end the following new subsection:...
This section is still about 'quality control.' It explicitely states the public is to have transparency in knowing what the 'quality measurements' consist of and if they are meaningful to the national health care need. This tone of transparency is true, so far, throughout the bill. It goes to extremes to 'de-paternalize' government and make the public an active 'quality control officer' themselves. It is the venue of the media and where needed editorials by qualified folks dedicated to inform the public of what is going on in their government.
Maybe a more unkind description is that it ENCOURAGES 'WATCH DOGS' of and/or by those in the public. It's a good thing. There are also official mechanisms to bring complaints and/or changes to the quality issue. There are also 'stakeholders' that will have active roles in carrying messages to government in regard to quality. Below is a list of 'shareholders' to the quality issues:
Page 630, lines 9 through 24 and Page 631, lines 1 through 9:
‘‘(6) MULTI-STAKEHOLDER GROUPS.—For purposes of this subsection, the term ‘multi-stakeholder groups’ means, with respect to a quality measure, a voluntary collaborative of organizations representing persons interested in or affected by the use of such quality measure, such as the following:
‘‘(A) Hospitals and other institutional providers.
‘‘(B) Physicians.
‘‘(C) Health care quality alliances.
‘‘(D) Nurses and other health care practitioners.
‘‘(E) Health plans.
‘‘(F) Patient advocates and consumer groups.
‘‘(G) Employers.
‘‘(H) Public and private purchasers of health care items and services.
‘‘(I) Labor organizations.
‘‘(J) Relevant departments or agencies of the United States.
‘‘(K) Biopharmaceutical companies and manufacturers of medical devices.
‘‘(L) Licensing, credentialing, and accrediting bodies.
There is an interesting use of the word, "Shareholder" that might be obsure. Shareholder is not the same, AT ALL, as Stockholder.
Example:
Every American is a Shareholder in their government.
The USA is run on a treasury of all the people as stipulated in the laws of this country. We are not 'Stockholders' although with the latest collapse it could be said that we are due to all the 'private industry' bailouts.
A shareholder is simply a person that has 'an interest' in a particular aspect of government or other issues. In the venue of conservation, there are shareholders that come together every time the TVA (Tennessee Valley Authority - click here) meets or monitor the rivers and streams that contribute to the dams of their electrical production. The waterways sometimes are effected by weather and dam levels and backwash and all sorts of 'physics' that occur with these huge power producers. As a result even the average citizen can have a say in what is occurring with the operation of the TVA. So, there are many 'shareholders' in its operation and there are ways of accessing the power structure to be sure all parties/shareholders are heard and taken into account.
...The quality of the water in the Tennessee River system (click here) affects not only the people who live in the Valley but also business and industry and the plant and animal life that are part of the river ecosystem....
That is a shareholder. Shareholders are more important than stockholders. Far more important because their 'contribution' to any issue is 'real' and brings about the reality we all live within.
This provision goes on to state more of the obvious and where current laws will be amended to allow these changes.
Page 635, lines 1 through 10:
Subtitle D—Physician Payments Sunshine Provision
SEC. 1451. REPORTS ON FINANCIAL RELATIONSHIPS BETWEEN MANUFACTURERS AND DISTRIBUTORS OF COVERED DRUGS, DEVICES,BIOLOGICALS, OR MEDICAL SUPPLIES UNDER MEDICARE, MEDICAID, OR CHIP AND PHYSICIANS AND OTHER HEALTH CARE ENTITIES AND BETWEEN PHYSICIANS AND OTHER HEALTH CARE ENTITIES.
Boy, oh boy, this is a good one. All those 'freebee' trips to the Bahamas that come along with writing 500 perscriptions of a new medication on the market will have to be 'transparently' reported. Wow !
Oh. Not everyone knew that went on, huh? Where ya been?
Page 635, lines 22 through 25 and Page 636, lines 1 through 25 and Page 637, lines 1 through 2:
‘‘(a) REPORTING OF PAYMENTS OR OTHER TRANSFERS OF VALUE.—
‘‘(1) IN GENERAL.—Except as provided in this subsection, not later than March 31, 2011 and annually thereafter, each applicable manufacturer or distributor that provides a payment or other transfer of value to a covered recipient, or to an entity or individual at the request of or designated on behalf of a covered recipient, shall submit to the Secretary, in such electronic form as the Secretary shall require, the following information with respect to the preceding calendar year:
‘‘(A) With respect to the covered recipient, the recipient’s name, business address, physician specialty, and national provider identifier.
‘‘(B) With respect to the payment or other transfer of value, other than a drug sample—
‘‘(i) its value and date;
‘‘(ii) the name of the related drug, device, or supply, if available; and
‘‘(iii) a description of its form, indicated (as appropriate for all that apply) as—
‘‘(I) cash or a cash equivalent;
‘‘(II) in-kind items or services;
‘‘(III) stock, a stock option, or any other ownership interest, dividend, profit, or other return on investment; or
‘‘(IV) any other form (as defined by the Secretary).
YEP.
Want to know why?
There is a good reason.
"Providers" will be 'causing' the cost of health care and health insurance to either increase or decrease. If manufacturers or suppliers are 'supplementing' the income and/or status of a provider (Physician, Nurse Practitioner, Hospital CEO, etc.) the 'behavior' of that provider will be affected. If a Provider decides to perscribe a new and 'brand name' medication for the patient because they get a 'bonus/otherwise known as a 'kickback' the cost to the government and/or insurance company will go up.
So.
If the Providers are required to report income outside that of the 'payment' for the service to the consumer, those 'incomes' can counter balance the 'payment' to the provider. In other words, we 'ain't' gonna pay for a medication or product or service because it favors the 'wealth' of a Provider. The Provider will have to accept a reduction in 'REAL MONEY' payment in lieu of his 'other reimbursement' from other sources.
It isn't right that the cost of medicines or treatment goes up while Providers bask in exploitation of the consumer to receive additional compensation.
This mess goes on all the time. It is a marketing strategy.
Page 638, lines 21 and 22:
‘‘(5) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO CLINICAL INVESTIGATIONS.—In...
I am a little concerned regarding any 'draconian' measure in regard to 'clinical trials.' While any trial should not provide a huge return for the cooperating Provider, there should be some leeway when 'clinical trials' are VALID and provide a 'graditude' for cooperation with a manufacturer or distributor. I don't know if distributors will be involved all that much in clinical trials, but, certainly when a Provider is cooperating with a clinical trial that will bring new and better products to the consumer there should be some understanding that an 'appreciation' for cooperation can be allowed in moderation.
Clinical trials need to be defined in this section as well, with clear indications as to what comprises a clinical trial and what does not. Perscribing an established but new medicaiton is NOT a clinical trial.
The provision provides for confidentiality in reporting.
There is a reassertion beginning on Page 639 regarding the reporting of ownership interests in hospitals and other entities including those of immediate family members. I am assuming immediate family members are spouses and children or siblings and parents.
More transparency on a website.
Accurancy in reporting, special rules for drug samples, special rules for national provider identifiers, penalties for noncompliance, blah, blah, blah...
On this is different. The Secretary is going to be able to ask State Attorney Generals to bring charges. Interesting. That is probably going to over like a 'fart in church.' I think that ? might ? be questionally constitutional.
Page 645, lines 23 through 25 and Page 646, lines 1 through 6:
‘‘(4) ENFORCEMENT THROUGH STATE ATTORNEYS GENERAL.—The attorney general of a State, after providing notice to the Secretary of an intent to proceed under this paragraph in a specific case and providing the Secretary with an opportunity to bring an action under this subsection and the Secretary declining such opportunity, may proceed under this subsection against a manufacturer or distributor in the State.
Although. ?????? In that context is seems pretty legal and correct, actually.
I am criticizing for no reason. Here it is.
Page 646, lines 20 through 24 and Page 647, lines 1 through 7;
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) APPLICABLE MANUFACTURER; APPLICABLE DISTRIBUTOR.—The term ‘applicable manufacturer’ means a manufacturer of a covered drug, device, biological, or medical supply, and the term ‘applicable distributor’ means a distributor of a covered drug, device, or medical supply.
‘‘(2) CLINICAL INVESTIGATION.—The term ‘clinical investigation’ means any experiment involving one or more human subjects, or materials derived from human subjects, in which a drug or device is administered, dispensed, or used.
That is typical of the Bill. It repeats that context throughout each provision.
Legal clarifications.
Page 648, lines 23 through 25;
‘‘(7) KNOWINGLY.—The term ‘knowingly’ has the meaning given such term in section 3729(b) of title 31, United States Code.
Page 649, lines 10 through 25 and Page 650, lines 1 through 21;
‘‘(9) PAYMENT OR OTHER TRANSFER OF VALUE.—
‘‘(A) IN GENERAL.—The term ‘payment or other transfer of value’ means a transfer of anything of value for or of any of the following:
‘‘(i) Gift, food, or entertainment.
‘‘(ii) Travel or trip.
‘‘(iii) Honoraria.
‘‘(iv) Research funding or grant.
‘‘(v) Education or conference funding.
‘‘(vi) Consulting fees.
‘‘(vii) Ownership or investment interest and royalties or license fee.
‘‘(B) INCLUSIONS.—Subject to subparagraph (C), the term ‘payment or other transfer of value’ includes any compensation, gift, honorarium, speaking fee, consulting fee, travel, services, dividend, profit distribution, stock or stock option grant, or any ownership or investment interest held by a physician in a manufacturer (excluding a dividend or other profit distribution from, or ownership or investment interest in, a publicly traded security or mutual fund (as described in section 1877(c))).
‘‘(C) EXCLUSIONS.—The term ‘payment or other transfer of value’ does not include the fol11
lowing:
‘‘(i) Any payment or other transfer of value provided by an applicable manufacturer or distributor to a covered recipient where the amount transferred to, requested by, or designated on behalf of the covered recipient does not exceed $5.
‘‘(ii) The loan of a covered device for a short-term trial period, not to exceed 90 days, to permit evaluation of the covered device by the covered recipient.
It goes on from there. The federal laws will supercede the state laws and the transparency of all the reporting is restated in this provision. This provision ends on page 653 and Page 654 begins with this topic:
Subtitle E—Public Reporting on Health Care-Associated Infections
And that is where I will end for tonight.
