Remember what Bush did when he got into office? With the currency. He wanted to melt down pennies and forget there was ever a denomination that small and he minted all these dollar bills with colors and gold leaf on them.
Pennies are important again. I like it. I like it a lot. It matches the color of the print I indicate are 'my words' to distinguish from newsprint. Yep. I have a small incomplete collection of 'Wheat Pennies.' Yep. Buffalo head nickels, too. I have nearly a complete set of them. Yep.
Honest Abe.
President Barak Obama is NOT a politician before he is this country's President. This speech took place in Texas where the Governor plays the electorate for fools in declaring he wants to secede from the nation.
This speech was in Texas where impoverishment of 'humanitarian values' is held near and dear to their hearts as a means to fight socialism.
Would Georgie Bush or Dickie Cheney ever take the chance of being booed at a rally of Democrats in Fint, Michigan? No. Their public appearances were insulated and orchestrated.
Hello? Our President is a real President. Hard to recognize I know since its been so long since we had one.
He went to Texas to initiate 'outreach.' He is a "Politician without Borders." I didn't see Governor 'what's his name,' oh, yeah, Perry there either.
From the New York Times (click here)
Cost of health insurance rising faster than pay (click here)
Associated Press
10:02 a.m. CDT, September 17, 2009
WASHINGTON - A national advocacy group says health insurance premiums rose five times faster than earnings in Illinois from 2000 to 2009.
The report released Thursday says, on average, the annual insurance premium for a family paid by employers and workers rose from $7,220 to $13,397. That's an increase of nearly 86 percent.
The workers' portion rose at an even steeper pace.
Meanwhile, the median earnings of Illinois workers rose just 17 percent, from $26,806 to $31,414.
The report comes from Families USA, a group working to expand health care coverage. The group based its findings on federal data.
Congress is considering several bills that aim to restrain costs. But benefits consultants have said if any reform is passed this year, it won't have a major effect for a few years.
Let's do some reading. I think I left off with Page 600 or something close to that. It was the penalities to institutions that dragged their feet and broke the rules. That went on for awhile. Let's see.
Here is the paragraph that speaks to the closing of facilities:
Page 601, a word at the end of 14 to line 24:
...and some portion of such funds may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community based settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities,...
The Secretary intends to collect the money, too. They ain't messin' around. Well, they can't. People's quality of life and well being are on the line. You know?
Page 603, lines 15 through 25:
‘‘(IV) COLLECTION OF CIVIL MONEY PENALTIES.—In the case of a civil money penalty imposed under this clause, the Secretary— ‘‘(aa) subject to item (bb), shall, not later than 30 days after the date of imposition of the penalty, provide the opportunity for the facility to participate in an independent informal dispute resolution process...
Page 607, lines 6 through 14:
(1) IN GENERAL.—The Secretary, in consultation with the Inspector General of the Department
of Health and Human Services, shall establish a pilot program (in this section referred to as the ‘‘pilot program’’) to develop, test, and implement use of an independent monitor to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities.
This is an important provision and I am going to tell you a true story as to why this is important. It might not seem like a true story, but, it is. Has nothing to do with HIV/AIDS either.
There is a chain of nursing homes in this country that specializes in 'ventilator dependant' patients. Patients on vents are sometimes quadraplegics and need continuous monitoring. If a family is unable to care for them at home, the patients are placed in one of these nursing homes. The nursing home itself is very different than an ordinary facility. They have operating rooms where 'procedures' are performed and an emergency room that doesn't really accept patients for treatment, except for an occassion drunk that wanders in. The reason this chain has these 'extra' facilities is because it ranks them as an acute care facility and they are able to charge more for their services. They really are 'faux' hospitals, but, are sincerely 'dumping grounds' for nursing home patients no one else wants to accept.
There was a 19 year old man involved in a car accident where he was a passenger. He suffered a spinal cord injury that made him a quadreplegic.
Nice guy.
When he made it to the hospital emergency room, Level 1 Trauma Center, his cognition was intact. His cognition remained intact during his stay in the Intensive Care Units. He was stabilized. There came a time when there wasn't anything else the hospital could do for him and he needed to go home. His parents, people like you and me that would be grateful to have him alive, were unable to care for him. So, it was decided he would have to be placed in a nursing facility that would provide care to vent dependent patients.
About three days after his discharge, he was readmitted to the same exact Intensive Care Unit that sent him to the nursing facility. This time, however, he was without the cognition he left with. He had suffered an anoxic event. The event was so prolonged that he had a heart attack as well. There was significant damage to his body systems and he died approximately two weeks later in kidney failure as well as myocardial damage.
The nursing home facility had 'on staff' nurses certified in ACLS. As a matter of fact, all their nurses are certified in ACLS. One would think a person on a vent would be in the best of care in such a facility. However. That is not the case. The reason the nurses needed to be Certified in Advanced Cardiac Life Support is because there were frequent events where patients, including quads (sometimes in halo traction) unable to help themselves, would come off their vent. They would cough and sometimes plug their trachea tubes. They would have their vent tubing come off their trachea tubes. So, the anoxic events were an issue in this facility and the administrators had to come up with a way to 'MAKE THEM ALIVE' in case they died while 'on a ward' or in a 'multi-bed' room.
You see, vent alarms go off so frequently and there is less staff then necessary to maximize profits, that the nurses can't keep up with the care and if they simply run around putting out vent alarms they never get any of their medications passed or documentation done.
So, every once in awhile, when a patient is left on an alarm a little to long, they have to 'MAKE THEM ALIVE' even though they died. Hence, many patients with cognitive issues. But, they are cared for, right? I mean someone has to do it. And it is a good business for the economy as it employs folks and all that mess. There are very few visitors after a time.So, this 'pilot' project is far, far overdue. Yep.
Page 208, lines 4 through 13:
(b) REQUIREMENTS.—The Secretary shall evaluate chains selected to participate in the pilot program based on criteria selected by the Secretary, including where evidence suggests that one or more facilities of the chain are experiencing serious safety and quality of care problems. Such criteria may include the evaluation of a chain that includes one or more facilities participating in the ‘‘Special Focus Facility’’ program (or a successor program) or one or more facilities with a record of repeated serious safety and quality of care deficiencies.
The House really has been working on this bill for some time now. I can tell.
Page 608, lines 14 through 17 and 23 through 25 and Page 609, lines 1 through 3:
(c) RESPONSIBILITIES OF THE INDEPENDENT MONITOR.—An independent monitor that enters into a contract with the Secretary to participate in the conduct of such program shall—...
...(2) undertake sustained oversight of the chain, whether publicly or privately held, to involve the owners of the chain and the principal business partners of such owners in facilitating compliance by facilities of the chain with State and Federal laws and regulations applicable to the facilities;
I guess they didn't want health care insurance reform, now did they?
Page 612, lines 14 through 23:
‘‘(7) NOTIFICATION OF FACILITY CLOSURE.— ‘‘(A) IN GENERAL.—Any individual who is the administrator of a skilled nursing facility must— ‘‘(i) submit to the Secretary, the State long-term care ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure—
Page 620, lines 1 through 13:
Subtitle C—Quality Measurements
SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR QUALITY IMPROVEMENT.
Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end the following new part:
‘‘PART E—QUALITY IMPROVEMENT
‘‘ESTABLISHMENT OF NATIONAL PRIORITIES FOR PERFORMANCE IMPROVEMENT
‘‘SEC. 1191. (a) ESTABLISHMENT OF NATIONAL PRIORITIES BY THE SECRETARY.—The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.
I think it sounds like a good idea.
Page 620, lines 19 through 24 and Page 621, lines 1 through 15:
‘‘(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES.—With respect to such priorities, the Secretary shall ensure that priority is given to areas in the delivery of health care services in the United States that—
‘‘(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic diseases;
‘‘(2) have the greatest potential to decrease morbidity and mortality in this country, including
those that are designed to eliminate harm to patients;
‘‘(3) have the greatest potential for improving the performance, affordability, and patient centeredness of health care, including those due to variations in care;
‘‘(4) address health disparities across groups and areas; and
‘‘(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons.
It looks self-explanatory. There isn't anything sinister about it.
Page 623, lines 23 through 25 and Page 624, lines 1 through 2 and Page 625, lines 1 through 3:
‘‘(c) DEVELOPMENT OF QUALITY MEASURES.—
‘‘(1) PATIENT-CENTERED AND POPULATION BASED MEASURES.—Quality measures developed under agreements under subsection (a) shall be designed—
‘‘(2) AVAILABILITY OF MEASURES.—The Secretary shall make quality measures developed under this section available to the public.
I'll end there for tonight.
Until later...
