.04:00 AM PT, Oct 15 2008
When President Clinton left office (click title to entry - thank you), the federal budget was showing a $127-billion surplus.
The books are closed on fiscal 2008. The surplus the current President Bush inherited has turned into a record deficit: $455 billion.
That is more than twice the 2007 deficit of $162 billion and beyond the previous record of $413 billion in 2004....
...from The Nation...
Paulson Bailout Plan a Historic Swindle (click here)
By William Greider
September 19, 2008
...If Wall Street gets away with this, it will represent an historic swindle of the American public--all sugar for the villains, lasting pain and damage for the victims. My advice to Washington politicians: Stop, take a deep breath and examine what you are being told to do by so-called "responsible opinion." If this deal succeeds, I predict it will become a transforming event in American politics--exposing the deep deformities in our democracy and launching a tidal wave of righteous anger and popular rebellion. As I have been saying for several months, this crisis has the potential to bring down one or both political parties, take your choice....
The pages I have been reading for at least the past 100 pages are primarily regarding Medicare and the changes that will provide for a streamlined and more efficient use of American Health Care which is anticipated to allow people a higher quality of life and less cost to the USA Treasury.
The House Health Care Recovery Bill seeks to set 'example' to the Health Care Industry with their improvements in Medicare delivery. Ultimately, all private physicians will be members of the new Health Delivery Infrastructure as a means of improving their own care delivery to their patients.
Page 299, starting with line 3 there is a solid commitment by the House Legislature to these goals:
SEC. 1152. POST ACUTE CARE SERVICES PAYMENT REFORM PLAN AND BUNDLING PILOT PROGRAM.
(a) PLAN.—
(1) IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the ‘‘Secretary’’) shall develop a detailed plan to reform payment for post acute care (PAC) services under the Medicare program under title XVIII of the Social Security Act (in this section referred to as the ‘‘Medicare program)’’. The goals of such payment reform are to—
(A) improve the coordination, quality, and efficiency of such services; and
(B) improve outcomes for individuals such as reducing the need for readmission to hospitals from providers of such services.
(2) BUNDLING POST ACUTE SERVICES.—The plan described in paragraph (1) shall include detailed specifications for a bundled payment for post acute services (in this section referred to as the ‘‘post acute care bundle’’), and may include other approaches determined appropriate by the Secretary.
(3) POST ACUTE SERVICES.—For purposes of this section, the term ‘‘post acute services’’ means services for which payment may be made under the Medicare program that are furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to an individual after discharge of such individual from a hospital, and such other services determined ap10
propriate by the Secretary.
(b) DETAILS.—The plan described in subsection
(a)(1) shall include consideration of the following issues:
The bill goes on to describe more details and definitions not necessary to list here. There is an important limitation to the 'Pilot Program' that is designed to promote the 'principles' of these provisions. It is important to realize the commitment of which the House Bill lends itself to a benevolent intent of the citizens of the USA.
Page 306, lines 11 through 23:
‘‘(c) LIMITATION.—The Secretary shall only expand the pilot program under subsection (a)(2) if the Secretary finds that—
‘‘(1) the demonstration program under section 1866C and pilot program under this section maintain or increase the quality of care received by individuals enrolled under this title; and
‘‘(2) such demonstration program and pilot program reduce program expenditures and, based on the certification under subsection (d), that the expansion of such pilot program would result in estimated spending that would be less than what spending would otherwise be in the absence of this section.
AND
Page 307, lines 5 through 7:
‘‘(e) VOLUNTARY PARTICIPATION.—Nothing in this paragraph shall be construed as requiring the participation of an entity in the pilot program under this section.’’.
Page 311, line 15 begins a discussion about home care and the new provisions for it under Medicare.
The provisions continue for many pages while it defines the requirements for physician participation and hospitals and physician owned hospitals, etc. It is all necessary terminology to protect, 'ultimately' the monies being paid for services. In other words, are there monies being paid twice to the same entity under different names and is there an exploitation by any entity for double dipping. The extent this bill goes to 'secure' proper payment to the entity providing services is rather extensive with every section. They are being careful with the people receiving care and the money that pays for the services. This bill was NOT drafted in a couple weeks. This bill has been 'in the works' for some time. There isn't this kind of detail without very careful processes to cover all the bases necessary. This isn't a 'rough draft' either.
Page 315, lines 16 through 20 provide for transparency. The following paragraphs details what happens where there isn't disclosure.
‘‘(3) PUBLICATION OF INFORMATION.—The Secretary shall publish, and periodically update, the information submitted by hospitals under paragraph (2)(A) on the public Internet website of the Centers for Medicare & Medicaid Services.’’;
This will allow 'watch dogs' such as AARP to monitor services, providers and payment of monies. There is fairly tight control over unsustainable growth of a health care system. There are formulas within the legislation that provides for assessment of hospitals, the number of their procedure rooms, operating rooms and bed in relation to the size of the community it serves and the growth of that community. In other words, the 'facilities' can't just dump monies into building a parking garage because their non-profit 'fund' has extra monies that would put them outside the definition of non-profit. Within this bill, facilities have to clearly justify the spending on infrastructure and where the justification lacks, the extra monies will be returned to the clients of that facility in the form of rebates. It is the the way it is supposed to be. Non-profits aren't supposed to continually increase what they charge simply to have surplus and build things. It is wasteful.
I am listing this here because it is a definition most people don't think about in terms of health care providers. Page 326, lines 4 through 9.
‘‘(3) PHYSICIAN OWNER OR INVESTOR DEFINED.—For purposes of this subsection and subsection (f)(2), the term ‘physician owner or investor’ means a physician (or an immediate family member of such physician) with a direct or an indirect ownership or investment interest in the hospital.
Some physician owned facilities can be non-profits. Some don't have emergency rooms and don't necessarily provide for emergencies that occur within them. Some are long term care facilities. At any rate, much of this section discusses all that and wants to have plans from these facilities as to what they do when emergencies result, etc. It is a lot of long winded '...but, what if ...' kind of stuff. There is a provision on Page 321, lines 7 through 13 that allows for community input in regard to local facilities.
continued...
