This Blog is created to stress the importance of Peace as an environmental directive. “I never give them hell. I just tell the truth and they think it’s hell.” – Harry Truman
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The 'vulnerable' Ted Kennedy and his relationship with his god.
City churchgoers said Sunday they were moved by Sen. Edward Kennedy's letter (click title to entry - thank you) confessing his failings to Pope Benedict - and that, sins and all, he set a good example for Catholics. "I know that I have been an imperfect human being, but with the help of my faith I have tried to right my path," he wrote in a missive President Obama delivered to the Pope. Theodore Cardinal McCarrick read part of it at Kennedy's burial Saturday night. "Not everyone is humble enough to ask for forgiveness before death," East Village resident Hans Kullberg, 24, said after Mass at St. Patrick's Old Cathedral in Little Italy. "Especially for someone in his powerful position, it is much more difficult."
A recent survey from Survey (click title to entry - thank you) USA reports three-quarters of Americans back a public option in health care. This is in line with what was found since 2003. NBC News and the The Wall Street Journal didn’t include the public option in their August polling, Jonathan Singer reports in My Direct Democracy. SurveyUSA decided to do so in order to determine how Americans continue to feel about the public option. What they found in asking the very question NBC and The Journal had used in June was when people are given the public health care option as a possibility, a significant majority consider it to be extremely important. These are the results found . Parentheses reflect June results from the NBC/Wall Street Journal survey:...
I urge you to make it absolutely clear to everyone you know, everyone who cares about universal health care and what it will mean to our country, that the bill must contain a real public option. Tell that to your representatives in Congress. Tell that to the White House. If you are receiving piles of emails from the Obama email system asking you to click in favor of health care, do not do so unless or until you know it has a clear public option. Do not send money unless or until the White House makes clear its support for a public option. This isn’t just Obama’s test. It’s our test. Robert Reich
This is in regard to physician owned facilities. The community has a right to be heard when a facility changes purpose, etc. The provision limits any increase in facility rooms to 200% of the 'baseline' of its original purpose.
‘‘(ii) OPPORTUNITY FOR COMMUNITY INPUT.—The process under clause (i) shall provide persons and entities in the community in which the hospital applying for an exception is located with the opportunity to provide input with respect to the application.
The new facility requires proof over a 5 year time frame there is a need. In other words, a hospital, regardless of the nature of the facility can't just build to be building. There has to be a demonstrated need. Page 324, lines 1 through 9.
‘‘(i) that is located in a county in which the percentage increase in the population during the most recent 5-year period for which data are available is estimated to be at least 150 percent of the percentage increase in the population growth of the State in which the hospital is located dur8 ing that period, as estimated by Bureau of the Census and available to the Secretary;
I like that provision. Sincerely. The bill goes on from there with more definitions as to what a procedure room is, etc.
There is a discussion regarding physician or investor owned facilities whereby there is not a physician on the premises 24 hours, 7 days a week; there has to be in place full disclosure to the Secretary.
Page 327, Lines 6 through 8 allows the Secretary to conduct unannounced visits on these facilities.
The Secretary may use unannounced site reviews of hospitals and audits to verify compliance with such requirements.
The bill continues with the jargon regarding implementation, funding, administration and quality assurance. The quality assurance is to maintain evaluation to the availability of health care work force and resources in relation to the population of the region they serve. There is 'consideration' in payments of Medicare and Medicaid where work markets are stressed and need incentive to bring in more opportunity for workers. Such changes occur after January 1, 2014. There is more jargon to replace language in the Medicare and Medicaid legislation to reflect these changes.
The House Bill provides for an increase in the monies Medicare Advantage is to receive. There is a 'bridge' of services when the bill is implimented.
I think this is going to be eliminated. Medicare Advantage is a 'private industry service.' President Obama has already stated, the Medicare Advantage program would be suspended as it is very costly and does not provide the same benefits as Medicare. The Medicare Advantage Program limits the doctors and hospitals citizens can obtain care. It is a HMO. It provides a small advantage to the out of pocket costs as the co-pays are slightly lower, but, basically there is no need for it. When a citizen enters into a contract with Medicare Advantage it removes any and all 'equity' one would receive through regular Medicare. The care citizens receive is not facilitated by the government. I believe this section of the Bill will be eliminated and/or modified. The cost to the government in administering this insurance is disproportionate to the cost of administering regular Medicare.
This is from an information page from Medicare Advantage:"When you join a Medicare Advantage Plan (click here), you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services."
Page 341, Lines 3 through 9:
‘‘(iv) AUTHORITY TO DISQUALIFY CERTAIN PLANS.—In applying clauses (ii) and (iii), the Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.
"...The group of academics outlined dozens of changes in their report, (click title to entry - thank you) from restructuring payments under the Medicare insurance program for the elderly and disabled to providing doctors incentive payments for helping avoid costly treatments or complications. All of the proposals, some of which are already included in various congressional plans, together will help provide better care for patients while lowering costs over time, said Dr. Mark McClellan, a former economic official under President Bill Clinton and health official under President George W. Bush...."
There is significant verbiage ad nauseam dedicated to the interface between the new law and Medicare Advantage. It appears the 'change' bqck to Medicare will be 1012.
Page 344,, Lines 7 through 19:
SEC. 1167. IMPROVING RISK ADJUSTMENT FOR PAYMENTS. (a) REPORT TO CONGRESS.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report that evaluates the adequacy of the risk adjustment system under section 1853(a)(1)(C) of the Social Se13 curity Act (42 U.S.C. 1395–23(a)(1)(C)) in predicting costs for beneficiaries with chronic or co-morbid conditions, beneficiaries dually-eligible for Medicare and Medicaid, and non-Medicaid eligible low-income beneficiaries; and the need and feasibility of including further gradations of diseases or conditions and multiple years of beneficiary data.
These are steps to make the transition from Medicare Advantage. Page 350, Lines 21 through 25 and Page 351, lines 1 through 9.
‘‘(A) the Secretary shall require the Medicare Advantage organization offering the plan to give enrollees a rebate (in the second succeeding contract year) of premiums under this part (or part B or part D, if applicable) by such amount as would provide for a benefits ratio of at least .85; ‘‘(B) for 3 consecutive contract years, the Secretary shall not permit the enrollment of new enrollees under the plan for coverage during the second succeeding contract year; and ‘‘(C) the Secretary shall terminate the plan contract if the plan fails to have such a medical loss ratio for 5 consecutive contract years.’’.
Dingell, Stupak Continue Investigation of Predatory Sales Practices of Medicare Advantage Plans (click here) Monday, 13 October 2008 17:00 Washington, D.C. - Reps. John D. Dingell (D-MI), Chairman of the Committee on Energy and Commerce, and Bart Stupak (D-MI), Chairman of its Subcommittee on Oversight and Investigations, today sent two letters as part of their continued investigation into predatory sales practices of Medicare Advantage (MA) plans.
I know the Acostas. They are great Florida attorneys that have worked in Medicare benefits and fraud for a long time. Nice people. Really nice people.
For Immediate ReleaseMay 11, 2009 United States Attorney's Office Southern District of Florida Contact: (305) 961-9000 Two Suspects Arrested in $21 Million Medicare Advantage Fraud Scheme Spanning Five States (click here) R. Alexander Acosta, United States Attorney for the Southern District of Florida, Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, Daniel W. Auer, Special Agent in Charge, Internal Revenue Service, Criminal Investigation Division, and Al Lamberti, Sheriff, Broward County Sheriff’s Office, announced that defendants Michel De Jesus Huarte and Ramon Fonseca, both of Miami, FL, were arrested today on a criminal complaint charging them with conspiracy to commit health care fraud, health care fraud, and conspiracy to commit money laundering. If convicted, each defendant faces a statutory maximum penalty of 10 years in prison on the health care fraud charges, and 20 years in prison on the money laundering charges.
The bill goes on to discuss Medicare Advantage provisions until page 353, line 12. I am going to end it here for tonight. Please give President Obama your support to pass effective health care reform. It is the right thing to do to insure our citizens are receiving the best of care.
...The White House has assembled a list of about 50 measurements (click title to entry - tahnk you) to gauge progress in Afghanistan and Pakistan as it tries to calm rising public and congressional anxiety about its war strategy. Administration officials are conducting what one called a "test run" of the metrics, comparing current numbers in a range of categories with baselines set earlier in the year. The categories being measured include newly trained Afghan army recruits, Pakistani counterinsurgency missions and on-time delivery of promised U.S. resources. The results will be used to fine-tune the list before it is presented to Congress by Sept. 24. Lawmakers set that deadline in the spring as a condition for approving additional war funding....
Freed Afghan prisoners leave the central prison of Jalalabad, the capital of Nangarhar province, east of Kabul, Afghanistan on Tuesday, Sept. 1, 2009. Around 130 Afghan prisoners released from captivity based on the decree of Afghan President Hamid Karzai, honoring the 90th Afghan independence day on Aug. 19, 2009. (AP Photo/Rahmat Gul)
Abuses by the Afghan government (click here) Justice system In June an international conference highlighted serious and systematic flaws in Afghanistan’s administration of justice, including the Ministry of Justice, courts, prisons, the police, the army and the Afghan intelligence service, the National Directorate of Security (NDS), despite several years of international support to reform these institutions....
Sardar Ahmed, Agence France-Presse Kabul, September 01, 2009
President Hamid Karzai’s lead over his main election rival narrowed slightly on Monday as US envoy Richard Holbrooke said Western troops had inflicted “vast damage” on the Taliban. Holbrooke’s comments struck a rare optimistic note at the same time as the US and NATO commander in Afghanistan submitted a review of the eight-year war, calling for a revised strategy to reverse the “serious” situation. Afghan officials have announced results from nearly half the polling stations used in the country’s second direct presidential vote, which has been tainted by an escalating Taliban insurgency and abysmal turnout. Out of 2.87 million valid votes released by the Independent Election Commission (IEC), which has been criticised for favouring the incumbent, Karzai won 1.3 million and former foreign minister Abdullah Abdullah 954,256....
...More than 30,000 extra U.S. troops arrived in Afghanistan this year, most part of a package of reinforcements ordered by Obama in May. There are now more than 100,000 Western troops in the country, 63,000 of them Americans. A NATO statement said the four U.S. service members were killed in the south, the Taliban's heartland, but gave no further details. That would bring the number of foreign troops who died in Afghanistan this year to 295, according to Web site icasualties.org, which compiles figures. Last year was the previous deadliest year when 294 were killed....
Years wasted in Afghan effort, UN official says KABUL — The international community has wasted years in Afghanistan by not coordinating its efforts, a top U.N. official said Tuesday on the eve of a meeting by U.S. and European envoys to discuss the country’s recent election and deteriorating security. Senior officials from 27 countries — including special U.S. envoy Richard Holbrooke — were to meet Wednesday in Paris, where officials were expected to urge Afghans to take more responsibility in the almost eight-year international effort to rebuild the country. Kai Eide, the top U.N. official in Afghanistan, said the international community needs to embrace well-coordinated, big-picture goals that will help Afghanistan in the long term. “The piecemeal approach is not going to get results,” Eide said. “Enough is enough with the piecemeal approach.” Eide did not elaborate, but he and other critics have complained that foreign governments tend to favor funding small, relatively easy projects without a national impact rather than major missions — such as overhauling the transport network — which would serve as an economic engine for the whole country. The Paris meeting comes as the country faces mounting security and political challenges. Fighting is increasing; August was the deadliest month of the war for U.S. forces with at least 49 deaths, followed closely by July with 44....
Turkey, Armenia move toward diplomatic ties, opening of border (click title to entry - thank you) Tue, Sep 01 2009 16:24 CET
Turkey and Armenia are to hold six weeks of intensive domestic consultations and will ask the approval of their respective parliaments in a move towards a deal, brokered by Switzerland, on establishing diplomatic relations and opening their mutual border.
The key dividing factor between the two neighbouring countries has been an episode in history that Armenia and its backers describe as a genocide of its people under Ottoman rule, a claim that Ankara rejects, saying that the mass deaths were a result of a breakdown of order as the then-empire crumbled.
The countries agreed on April on a process to take them in the direction of diplomatic relations....
There is no reason for 100 trucks in an organized convoy passing through Pakistan with supplies for NATO should be stopped for inspection at all. The governments of NATO, Pakistan and Afghanistan should have full manifests of the trucks, their cargo, their license plate numbers or other identifying marks and their credentialed drivers in their possession before the convoy even moves one mile to its destination. This is nothing but sloppiness in protecting NATO's supplies and the personnel that protect the convoy. This is nonsense !
...Sources say at least one person was wounded in the incident. (click here) Witnesses report hearing gunfire before the explosion, and police say emergency crews were fighting the fire into Sunday night. Hundreds of trucks, many loaded with NATO supplies, have been stuck on Pakistan's side of the border. The Chaman crossing had been closed for two days because of a dispute between Pakistani and Afghan customs officials relating to the inspection of goods. Pakistani police say they foiled an attack on supply trucks earlier Sunday when they found and defused a bomb. The Chaman crossing is one of two main crossing points for supplies destined for American and NATO troops in Afghanistan....
PESHAWAR: At least 41 bodies, mostly of Taliban militants, have been found in Pakistan's Swat valley over the past 24 hours, officials said Tuesday, describing them as revenge killings by residents. The corpses, six of them beheaded, were dumped on the roadside, riverside and fields in different areas. Pakistan's military claims to have cleared Swat of extremists in an offensive launched earlier this year after militants extended their grip into the northwest valley, terrorising residents with public beheadings and other violence. Officials said a total of 251 people had been found dead in similar circumstances since July, and believed that the militants were killed by residents who feared a Taliban comeback. ‘Among the 41 dead bodies, six were beheaded, almost all of them were militants,’ Atifur Rehman, the top administrative official of Swat district, told AFP, adding that the rest had bullet wounds. ‘According to my information they were militants and were killed by residents,’ Rehman said. Fourteen police cadets were killed Sunday in a suicide attack in the main town in Swat valley which police blamed on Taliban militants....
...Pakistan’s extremist Taliban movement is badly divided (click here) over who should be its new leader, and analysts and local tribesmen say the al Qaida-linked group may be in danger of crumbling. A wave of defections, surrenders, arrests and bloody infighting has severely weakened the movement since its founder, Baitullah Mehsud, was killed Aug. 5 in a U.S. missile strike. The announcement this weekend that Hakimullah Mehsud, a 28-year-old with a reputation as a hothead, would succeed him is likely to further widen the split. … Pakistan authorities arrested the Taliban’s high-profile spokesman, Maulvi Umer, in the tribal areas, while a key interlocutor between the Taliban and al Qaida, commander Saifullah, was also detained at a house in Islamabad where he was receiving medical treatment. Separately, 60 Taliban fighters gave themselves up in the Swat valley in Pakistan’s northwest. Many Taliban in Waziristan have defected since Baitullah Mehsud’s death. In a further sign of internal discord, Pakistani Interior Minister Rehman Malik claimed Sunday that militants had killed Baitullah Mehsud’s in-laws, including his father-in-law, on suspicion of giving away his location. The former Taliban leader had been staying at his father-in-law’s house in Waziristan when he was killed by a missile fired from a U.S. drone....
Perhaps it is time for Dr. Abdul Qadeer Khan to tell the COMPLETE story as to whom else was involved with his nuclear escapades?
...‘I saved the country for the first time when I made Pakistan a nuclear nation and saved it again when I confessed and took the whole blame on myself,’ Khan told AFP in an interview last year while under effective house arrest....
India is uneasy about the lethary Pakistan has shown in regard to prosecutions of the perpetrators of November 26th attacks on Mumbai. Realizing Pakistan has their hands full with the resolve in places like Swat, there might be a chance the security will increase if criminals are captured and brought to justice.
There should not be militias developing training camps in Pakistan. That only puts the military and police in danger. Perhaps what would be best is for NATO, the USA, Pakistan and India to work out a prioritized schedule that allows for a timeline to complete the disruptions to objectionable militants. With Pakistan's security in the balance there needs to be an understanding that criminals will be dealt with in a way that doesn't disrupt the progress the Pakistan military has made within the country. Surely, India can appreciate the steps the Pakistani government has made to secure its borders and stop the militants. I am confident Pakistan has an appreciation for India's worries.
NEW DELHI: With no concrete steps against the plotters of the Mumbai attack in view, Pakistan’s anti-terror claims were tantamount to a chimera, India’s National Security Adviser M.K. Narayanan has said. His comments coincided with similar views expressed by unnamed foreign ministry officials in New Delhi who were quoted on Monday as saying that no new dates had been set for the foreign secretary-level talks in view of Islamabad’s alleged reluctance to act against Hafiz Saeed, who has been named by New Delhi in the November 26 assault on Mumbai. The Hindu quoted Mr Narayanan as saying in his first ‘substantive comments on relations with Pakistan since the Sharm el-Sheikh summit’ that averting another major Mumbai-like incident was the government’s top priority and that unless Islamabad took ‘real action’ against those involved in terrorism, the progress it had reported so far in the Mumbai case would amount to ‘a chimera’. In an interview to The Hindu published on Monday, he painted a picture of official frustration at Pakistan’s unwillingness to act against the Lashkar-e-Taiba and the Jaish-e-Muhammad ‘despite the fact that there was concrete information about these groups re-establishing training camps’.
It would seem as though India and Kashmir have mutual issues. There has been less violence in Kashmir. Kashmir is still attempting to secure its independence from both India and Pakistan. At least all parties are talking, instead of military conflict and violence. The region is changing. There is less hostilites. Pakistan has to be given some credit.
Petition filed in IHK HC to seek number of Kashmiri detainees (click here) Srinagar, August 31 (KMS): Srinagar-based International Forum For Justice And Human Rights (IFJHR) has moved a petition in the High Court of occupied Kashmir to seek the exact number of Kashmiri detainees in jails and interrogation centres. The Chairman of the forum, Ahsan Untoo, in a statement issued in Srinagar, said that the number of detainees under the black law, Public Safety Act, stated by the puppet administration in the so-called assembly was incorrect. He maintained that hundreds of innocent Kashmiri youth were languishing in different interrogation centres in India. Revealing the details, Untoo said that in Tihar jail, 61 Kashmiris were illegally detained while at least 51 other Kashmiris were detained as under trials, many of them without any trial for the past 15 years. In Kanpur jail, he said, Gulzar Ahmad and Gulam Mohi-u-din Shah were under detention for the past 10 years. “Three Kashmiris were languishing in Varanasi, four in Bangalore, three in Gujarat, four in Kolkata, five in Uttranchal, four in Benaras and seven in Rajasthan jails,” he added. He appealed the court to direct concerned Indian authorities to provide the details of Kashmiri detainees in different jails and interrogation centres.
Giving Kashmir independence will resolve the quarrels between two nuclear countries and provide a DMZ between Afghanistan, Pakistan, India and China so long as there is no migration of criminals into the region.
By Zeeshan Haider ISLAMABAD (Reuters) - Kashmiri politicians opposed a Pakistani plan on Monday they say is aimed at integrating the strategic but disputed Northern Areas into Pakistan, arguing it will undermine their case for independence from India. The Northern Areas of Gilgit and Baltistan were bundled in with Kashmir and demarcated as disputed territory under U.N. resolutions passed after Pakistan and India fought the first of their three wars in 1948. Bordering China on one side and the mainly Buddhist Indian region of Ladakh on the other, Pakistan's sparsely populated Northern Areas are known to mountaineers as the home of many of the world's highest peaks. Nuclear-armed Pakistan and India fought a brief but intense border conflict in the Kargil sector of this region in 1999. Although Pakistan has held the northern territories since the first war with India, their status was hitherto undefined as Pakistan had not wanted to compromise its case in the broader dispute over Kashmir....
A defence ministry delegation (click title to entry - thank you) has gone to Belgrade to discuss bringing the MiG-21s and 23s back into service. A spokesman said the aircraft, whose existence had recently come to light, would be an important addition to Iraq's defence capability. Two of the MiGs were ready for immediate use, a statement said. The statement did not specify how the discovery was made or what condition the other 17 aircraft were in. At the moment Iraq's air force has no jet fighters, only helicopters, and it had been planning to buy 18 F-16 fighters from the US manufacturer Lockheed Martin. It is not known if the discovery of the MiGs will change that. Sanctions and flying restrictions were imposed on Iraq following its 1990 invasion of Kuwait, after which Saddam Hussein's government was unable to repatriate military equipment located abroad. After his government's overthrow in 2003, the Iraqi state collapsed and its army was disbanded by Iraq's US-led occupiers. Baghdad has struggled to rebuild its military capability since then. The Iraqi defence ministry spokesman said four Iraqi navy vessels had also been discovered in Egypt and Italy, as well as "aircraft and equipment in Russia and France". Saddam Hussein co-operated closely with the communist-ruled Yugoslav government and its Serbian successor, led by Slobodan Milosevic. Serbia's defence minister visited Iraq earlier in August and Belgrade has recently signed deals to export hundreds of millions of dollars worth of military equipment to Iraq.
Iraq is still an unknown commodity. It has not 'track record' in regard to aggression. It doesn't recognize Israel that I know of and it is becoming somewhat of a 'state' to Iraq. I don't believe Iraq should have an Air Force at all, except, what it needs to protect its borders. The less 'fire power' there is in Iraq the most stable the region will become.
Amnesty calls for halt to executions in Iraq (click here) Tue Sep 1, 2009 12:00pm EDT BAGHDAD, Sept 1 (Reuters) - Rights group Amnesty International called on Iraq on Tuesday to halt executions, saying the woeful state of the justice system was unable to guarantee fair trials in capital cases.
Amnesty said more than 1,000 people were on death row in Iraq, including 12 women.
"One of these, 27-year-old Samar Saad Abdullah, facing execution for murder, has alleged that she was tortured into making a false confession, including with electric shocks and beatings with a cable," the rights group said.
"She reportedly received a trial lasting less than two days, where one of her lawyers was ordered out of the court by the trial judge."
Amnesty International UK Campaigns Director Tim Hancock said the Iraqi justice system could barely cope with normal trials, let alone death penalty cases.
In the chaotic and lawless years following the U.S.-led invasion in 2003, judges have been targeted by insurgents, courts have been overwhelmed by caseloads, and the system has been seen as tainted by corruption and lacking transparency.
"Instead of sending hundreds of people to a grisly death at the end of a rope, the Iraqi authorities should halt all executions and impose an immediate moratorium," Hancock said in a statement.
Amnesty has expressed concern frequently about the use of the death penalty in Iraq....
As of Tuesday, day 2,348 of the war in Iraq… (click here) 4,337 American military service members — 2 more than last week — have died in the war since it began in 2003, according to the US Department of Defense. A total of 13,856 have suffered injuries serious enough to keep them from returning to duty.
$5 billion has been spent on improving Iraq’s oil industry since 2003, yet production is far less than the 3 million barrels a day Iraq produced before the invasion, The Wall Street Journal reported.
$444,100,000 from Pasadena taxpayers has gone toward wars in Afghanistan and Iraq, enough to fund 6,274 arts and music teachers for 1 year, according to the National Priorities Project.
51 percent of Americans in a Washington Post/ABC News poll said the war in Afghanistan is not worth the fight, according to the Associated Press. There are 62,000 troops in Afghanistan, and that number is scheduled to grow to 68,000 in the coming weeks, the Los Angeles Times reported.— Compiled by Jake Armstrong
This wasn't about love, it was about sex. His wife was subservient to his demands. The entire episode even hosted Phillips friends in evenings of frolic as well. The entire mess is completely disgusting.
I don't know how Phillip managed to maintain control, but, he sure did. You'll never convince me of anything else. I shouldn't say I don't know how he managed to maintain control. I have a good guess. His wife 'enabled' his desire, otherwise, he would have ended up like most pedophiles, in prison or worse and the girls would have ended up dead. Phillip maintained control through permission garnered from his wife.
September 1, 2009 0815 z UNISYS Water Vapor North and West Hemisphere Satellite
That is an incredible vortex over the Gulf of Alaska. There are two storms in the Eastern Pacific, "Hurricane Jimena" and "Tropical Storm Kevin." Kevin is further to the west of the Baja Peninsula. Kevin has a well defined 'eye' and is traveling parallel to Jimena. There is also a tropical system south of Hawaii.
The 'system' of Jimena is actually a heat transfer system that extends across Mexico, the Gulf of Mexico, along the Eastern seaboard of the USA and across the Atlantic. In the Atlantic there is a tropical system easily discerned maintaining a place east of the Lesser Antilles. There remains a turbulence the Bahamas and west of Africa. The African tropical system is further north today, just off Senegal.
...Mony Schlomo, owner of Dolphin Souvenir Shop at 2900 Seawall Blvd. was shocked that his building untouched by Hurricane Ike, was so extensively damaged, inside and out, by the twister. The windows of two police cars were smashed and in a five block area around the souvenir shop, there were fences, trees and power lines down. CenterPoint Energy reported 4,000 customers without electrical power for awhile during the night but was restored by daylight. Customers in an area bar said they were dodging flying picnic tables, glass and umbrellas. There were roofing shingles and siding ripped frome homes and a home behind Dolphin's had it's roof ripped almost completely off. At least three people were treated for minor injuries inflicted by flying debris....
Barack Obama with Iraqi war veteran Tammy Duckworth after the two placed a wreath at The Bronze Soldiers Memorial in Chicago on Veterans Day last year. Duckworth, now assistant secretary at the Department of Veterans Affairs, says a controversial VA guide on end-of-life decisions continues to undergo revisions.
It is another 'alarmist' attempt as defaming the Obama Administration. This is a Right Wing initiative and there really isn't anything to say, but, the document in question is 52 pages or so long, so I thought I'd read through it.
It is only correct to note the Department of Veteran's Affairs has made a disclaimer stating the document is being reviewed by professionals and clergy and will ungo changes as needed.
I have a feeling this is standard issue, "Living Will" stuff. I haven't read it before, so let's see exactly what is so offensives. I'll say this up front as an initial assessment, as this Bush Official, what's his name? Jim Towey. Mr. Twoey was grasping at straws in 2007 when he couldn't explain the heightened suicide rate and the negligence of those Veterans that were in 'waiting lines' for treatment. Mr. Towey, took the 'easy route' out of a difficult situation and decided to 'blame' a document he found offensive. Perhaps there are some words that are offensive and perhaps if a Veteran was suicidal and decided to read a book on "Living Wills" it might push him over the edge, but, the point is WHY were Veterans feeling suicidal? The book didn't cause the suicidal feelings or ideation. It questionably could have entertained throughts AFTER the fact, but, it didn't CAUSE those overwhelming feelings. A lot of these Veterans were attempting to receive treatment, but, were put on waiting lists. The waiting lists are the issue, NOT, the book.
That said.
The PDF opens up to 55 pages. The first page is the VA disclaimer I already stated. Page Two is the title page; "Your Life, Your Choices, Planning for Future Medical Decisions: How to Prepare a Personalized Living Will." The picture on the cover is of a COUPLE sitting together in COUNCIL with a man that seems to be interested in their outcome in the decision making. There is one cup of coffee on the round table they are all sitting at with an undetermined person as to whom is drinking the coffee.
Page 3 is another title page with the authors listed. Yep. The 'creators' are:
Authored by
Robert Pearlman, MD MPH Helene Starks, MPH Kevin Cain, PhD William Cole, PhD David Rosengren, PhD Donald Patrick, PhD MSPH
Design & Layout by
Brems Eastman & Partners
Information Design Seattle
There is one MD MPH, one MPH, three PhDs and one PhD MSPH. Now, if there is anything offensive in this official document by the USA Veterans Affairs I would think the highly qualified authors should be held responsible. What do they call it when a person kills themselves because of actions of someone else? Manslaughter? There ya go.
The book opens with an example. It is a good example. It is fictious, but, does place the reader in a set of circumstances that would dictate a 'moral/ethical' dilemma. Profoundly. The Example states:
Dad had been in declining health for months. Then he fell asleep at the wheel and was in a bad car accident. Three weeks later he was still in a coma. A breathing machine pumped air into his lungs because he could not breathe on his own. The doctors thought his chances of coming out of the coma were slim. They talked with Mom and me about turning off the breathing machine and allowing Dad to die naturally. I felt terrible. I didn't think Dad would want to be kept alive like this. But I knew Mom would feel guilty for the rest of her life if we told the doctors to "pull the plug" while there was still even the slightest hope. We weren’t sure what we should do because Dad never told us what he would have wanted. I really wish we'd talked about this before."
I want to take a look at the example. The 'content' is a person of unknown gender with a father. There is absolutely no reference to a 'military' anything in that example. It is a bland example, void of any 'invitation' to military demise. No names, no titles, no rank, no nothing.
The same page has an introduction to the 'concept' of taking responsibility for 'advanced directives/decision making.' It is standard issue regardless of it being a hospital brochure or otherwise:
...But studies have shown that spouses guess wrong over half the time about what kinds of treatment their husbands or wives would want. You can help assure that your wishes will direct
future health care decisions through the process of advance care planning.
Page 5 gets right down to business. Think about it, decide, write down your wishes, tell your significant other(s), etc.Most terminally ill cancer patients welcome this discussion.
Page 6 offers the reader two options. Either read through 'The Basics' and fill out the form at the back of the booklet OR there is a further 'insight' in a section called "Resources." This is the description of the "Resources."
Part II: Resources. Turn to these sections for additional help and further explanation of ideas and topics introduced in “The Basics.” Page 7 and 8 are the Table of Contents and the title to each section gives the reader a good preview to any of the topics. Certainly, someone not prepared to discuss the issue could be well warned off by any of the titles. Nowhere so far have I witnessed this booklet recommending to make this decision on one's own. There is 'collaboration' written all through this up to now. Ultimately, taking 'responsibility' is still up to the person making the Living Will.
The brochure goes on with examples. The topic is unpleasant and so are the examples. It discusses how family members are left to 'guess' about someone's final decision regarding life support. By page 11, the brochure is giving examples of the 'differences' in definition of words casually used in conversations regarding life support and the continuation of life. The concept is difficult to discuss and the words are difficult to read:
People have very different notions of what it means to be a “vegetable.” Here are some more examples:
• “You sit in a chair and don’t do anything all day.”
• “You can’t read anymore.”
• “You’re just a body with some life in it.”
The brochure goes on about how does a person make the decision whom to elect to speak for them. In other words, how does someone choose a "Health Care Power of Attorney." There are examples as to why it is important to select ONE person who understands one's wishes as they have conversed about it. The example cited in the book is one of a man with terminal cancer.
In the margins of the brochure there is mentioned a 'exercises' to help one decide beginning on 21. On page 20 there is help in guiding decision making to Health Care Power of Attorney (my words, not theirs). The brochure is worded very 'simply' at this point.
Page 13 is frequently asked questions. Page 14 are definitions to advanced directive, proxy directive, instructional directives and personalized statement. The brochure goes on to ask, "Which directive is best?"
I am up to Page 22 and I am finding NOTHING offensive about this brochure. It has a goal and that is to have the client write a Living Will. In the side margins there are little illustrations stating there is an blank document to fill out in the back and on Page 45 and 46 there are statements to help open up the discussion between yourself and the person you choose to be your spokesperson should you not be able to speak for yourself in a health care setting. All through these pages I have read nothing but collaboration between the person writing the Living Will and the person they are entrusting their life to. There is nothing, absolutely nothing offensive or inappropriate in these 22 pages. It is s difficult subject and the brochure acknowledges it all through its content.
The bottom of Page 22 it refers to Resource section. HOWEVER, it 'previews' the kinds of topics covered in the Resource section. In previewing the topics the reader is fully aware as to whether it is necessary to proceed. There are no statement of 'must read' the Resource section or no absolutes in any of the content.
Here’s a sample of the kinds of questions that are answered in the Resources section:
• What makes life worth living?
• What’s likely to happen if you have a serious stroke? What do you need to think about in
advance?
• What if someone you love needs a feeding tube? What are the pros and cons?
• What can you do to keep the courts out of these advance care planning decisions?
There is not a darn thing wrong with this brochure. NOTHING. It approaches a delicate subject with openness and as if the reader has no basis of understanding of the topic. The brochure states to seek spiritual advise. Now, a book that is THE DEATH BOOK wouldn't bother doing that, would it?
The pages of the PDF do not coincide with the pages of the brochure as it would appear in print.
Thought-provoking exercises.
Which exercises should I complete?
You can complete any or all of them. Each of the exercises addresses different issues, including:
1. What to consider when choosing a spokesperson (page 20),
2. Your wishes regarding what makes life worth living (page 21),
3. Your personal and spiritual beliefs that affect medical decision making, and your feelings about hope and risk taking (pages 22-23),
4. Your wishes regarding the way you might spend your last weeks or days if you were dying, and other related matters (pages 24-26).
We recommend that you complete at least the exercises on pages 21-24. These will be the most useful to others if they have to make decisions for you. You may want to ask your religious advisor to help you think through the questions about quality of life, medical interventions, and death and dying. Religions have different philosophies about what to do under the situations described in these exercises.
Everyone that has a Living Will, I hope has put some thought into it. We know as a society what is tolerable as a 'condition' of the body to one person, might be intolerable to others. I witnessed a runner who stated, "If I were ever in an accident and couldn't walk or run, I wouldn't want to live." That is somewhat questionably extreme to my way of thinking, but, none the less they are legitimate points of view. Hopefully, it is a point of view that was well thought out and 'decided' with the discussion of those that love them and perhaps with a 'spiritual' advisor.
So, on Page 24 of the PDF begins CHECK LISTS. Page 24 hosts the 'checklist' "Who should speak for me? " Page 25 of the PDF begins the CHECK LIST for "Your Beliefs and Values - What makes your life worth living?" Within this Check List are four selections for one to check off. They are: "difficult, but acceptable," "worth living, but just barely," "not worth living," and "can't answer now." The LIST to the Check List has some very tough statements. I believe these are some of the frequently mentioned as 'offensive.': a. I can no longer walk but get around in a wheelchair. b. I can no longer get outside—I spend all day at home. c. I can no longer contribute to my family's well being.... ...j. I can no longer control my bladder. k. I can no longer control my bowels.... ....m. I can no longer think clearly-I am confused all the time. n. I can no longer recognize family/friends o. I can no longer talk and be understood by others. p. My situation causes severe emotional burden for my family (such as feeling worried or stressed all the time).... ...r. I cannot seem to “shake the blues.”
They are definitively 'sensitive' statements. HOWEVER. Nowhere in this brochure is it advised to make these decisions alone. Nowhere in this brochure does it state there should not be a conversation with those that are significant to your life. On the contrary this brochure goes out of the way in the early pages of its content to be sure the one filling out these pages have engaged others in discussion and is supported through their participation, even with a suggestion to consult a 'spiritual' advisor. The brochure continues in 'facing' tough questions regarding 'end of life' issues. The brochure discusses organ donation, autopsy, funeral services, burial arrangements and it has many pages dedicated to discussing specific medical conditions such as coma, dementia, stroke, etc. I believe if there needs to be any 'update' to the brochure it might be in the area of medical conditions and what is being done in the year 2009, which is very different than nearly 40 years ago.
There is a discussion of feeding tubes, CPR, ventilators, palliative care and hospice. Beginning with page 42 of the PDF, there are more checklists that CUSTOMIZE the care one would receive if any, for all the specific medical conditions previously discussed. See, the person working through this brochure is allowed to receive different 'care' or 'lack of it' for a stroke or coma or whatever the case may be. I've need seen that approach before. I think it is a good one. There isn't necessarily a 'blanket' Living Will for all incidence of health insults one might encounter. As a matter of fact, in the year 2009, the outcome to many strokes these days is very hopeful with better understanding, yet, a vegetative coma is another subject entirely. There are mentioned words such as ethical standards, legal considerations. All sorts of complicated concepts such as that. The brochure does an incredibly good job of 'breaking it all down' into understandable and definitively challenging terms. On page 55 of the brochure even goes on to REFER anyone reading it and working through its Check Lists to contact other Resources.
Other Resources
Contact any of the following organizations for more information about topics covered in this workbook. Many of the national organizations have local chapters. Call the numbers listed for a referral to the chapter nearest you. Each organization also has a wealth of information on the World Wide Web, with links to other sites and organizations. Visit them at the internet addresses
listed below.
Resources on the List (and this section should be checked for accuracy of addresses and websites)
Disease-related groups
Alzheimer's Association
(800) 272-3900
Internet: www.alz.org
American Cancer Society
(800) 227-2345 (800-ACS-2345)
Internet: www.cancer.org
American Diabetes Association
(800) 342-2383 (800-DIABETES)
Internet: www.diabetes.org
American Heart Association
(800) 227-8721 (800-AHA-USA1)
Internet: www.americanheart.org
American Lung Association
(800) 586-4872 (800-LUNGUSA)
Internet: www.lungusa.org
National Kidney Foundation
(800) 622-9010
Internet: www.kidney.org
National Stroke Association
(303) 649-9299
Internet: www.stroke.org
There is dearly nothing wrong with this brochure. It is to the point and it is an excellant tool for those that want to confront this subject. I will say this, any Veteran that is suicidal belongs in treatment, surrounded by loving families and should not be handed a brochure on Advanced Directives UNLESS that Veteran is feeling despondant due to 'end of life issues.' Then a Living Will might actually seem like a mechanism of control. But, if the Veteran is suffering from PTSD, depression or other psychological issues; there is no way they should be confronting this issue. It could be that they never should confront this issue. Now, is having this brochure on a website wrong? No. There are plenty of other places a suicidal individual could go to decide about a Living Will if they wanted to, so having it on a Veterans' website is no different than having one anywhere else on the web.
What has occurred with this brochure is the same thing that is occurring with the House's Health Care Bill. It is taken out of context and exploited to raise fear in the American populous to turn the tide of 'popular opinion' away from President Obama and his administration. Lying and decieving the public is the only way the Right Wing can achieve their goals. Chris Wallace is guilty of removing the meaning of the 'content' of the words in this brochure. He is one of Murdock's. (I don't care if I do spell his name "W"rong. Actually, I kinda like it that way.) What do you expect from Murdock's 'tribe' ?
I am sure any 'updates' that can be brought to the brochure will be welcome. I also believe President Obama and his Press Secretary are handling this mess exactly right. They talk to the issue in logical terms without ignoring the topic. They have to confront the lies and deceptions. That is the best part about being decent people in an honorable administration; the lies can be directly dispelled and once they are, then dismiss them as lies and get on with the business of the country.
I'll start back with the House Health Care Bill this evening.
