I need to finish a thought before I go on with the health care bill.

This was 1968. The Mexican Games. Olympics.

Tommie Smith and John Carlos, gold and bronze medalists in the 200m, stood with their heads bowed and a black-gloved hand raised as the American National Anthem played during the victory ceremony.

These men bravely allowed their fame and stature to speak to the world regarding a profoundly important fact about the USA. They did it in protest. Their reputations will always have that 'stigma' attached to it. They stood for the reality of oppression of the minorities in the USA. They did the 'right thing.' They should never be ashamed of those stands and the willingness to express the 'unspeakable.'

I am so pleased we have a President in the Oval Office that sincerely loves this country and the people that live within its borders. I am more than pleased he is billiant and genuine. I am also elated that he seeks out ways of honoring the minorities in this country that have been forgotten. I am happy about his minority choices.

One thing we know for sure and why the nomination and confirmation of Sonya Sotomayor was so very, very important is that oppression is actually a window to the people that experience it. When a person is going through the 'rungs' of the American Dream to achieve its pinnacle, but, is impeded for reasons that do not make sense, there are realities that accompany that no one else can understand or explain except those going through it.

It is vitally important that this minority President seek the place of minorities to be influential in ways others do not have the insight. It is important for them to bring their wisdom to this government. Now, is the time. I hope the 'rantings' of the bigoted in this country do not AGAIN cause oppression so many have worked through the ranks to find their place among the people most needed to bring our country equity.

I think the words I remember as a child go like this, "Sticks and stones can brake my bones, but, words will never hurt me."

Those that seek oppression of the appointees of President Obama are bigots. They don't understand nor do they want to understand the sacrifice of those that brought about change through their own sacrifice. Please, don't succumb to people that hate.

From "The Dallas Morning News?" Really ! Did the editors do this willingly?

09/21/2009
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.

Quite a Sunday morning in the USA. President Obama appearing on five television stations at 9AM.

President Obama is attempting to answer the questions the people of the nation have if only the news media asked them.



September 21, 2009
Top 10 Reasons Obama Did Letterman (click here)
10. Heard the lady with the heart shaped potato was gonna be here. (a reference to a woman in the audience).
9. Thought it would be fun to watch someone else get heckled.
8. Something to do with that whole cash for clunkers deal.
7. Every president since Teddy Roosevelt has done it.
6. Someone offers you 600 bucks you take it ladies and gentlemen.
5. We told him Megan Fox would be here.
4. Needed some time to hang out before check in time at his hotel.
3. I have no idea.
2. Said yes, without thinking, like Bush did with Iraq.
1. Wanted to congratulate Dave on the big Emmy win....

President Obama spoke on five separate Sunday morning programs to achieve the nation's attention. He spoke of more than health care. He willingly fielded questions regarding all kinds of issues, including that of racism which he ducked quite eloquently on Letterman. However, he did state, he didn't feel the heckling was about racism, so much as opposing points of view. I believe we can trust his judgement.

Barak Obama has never been one to put himself in the spotlight for the sake of being in the spotlight. He has been there and continues to be there for the nation and a return of decency to government.

Obama Takes to Airwaves to Push Health Care (click here)
By Paula Wolfson

Washington

20 September 2009
U.S. President Barack Obama took his campaign for health care reform to the nation's airwaves Sunday. In a series of interviews with five television networks he made the case for reform and tried to ease the angry tone of the debate. He touched on foreign policy matters as well.
President Barack Obama It was a media blitz for the president - the latest step in his effort to sell his health care reform plan to a skeptical public. On all five programs, his message was the same....

I will say this, I do believe the Former President James Earl Carter is also a good judge of the Republican Party and if he strongly feels there are issues of racism with the party then is. There are definately elements of this society that clearly demonstrate their hatred of anything except Right Wing Extremism which includes the dynamic of viewing the country out of control because a black man sits in the White House. Former President Carter is correct about that.

The Former President also knows the Republican Party does not delineate between people that hate that side with their party in 'their base' and those that would be decent people that view the dynamics of economics wrongly. The Republicans completely cater to all those that would vote for them, including the extremists. That was completely evident during the Bush/Cheney years and those remnants in the House and Senate remain. So, the Former President Carter is correct on recognizing the ability of elected members of the Congress to be willing to 'appear' bigoted for the sake of their electorate.

The Former President is also correct in stating President Obama may try to solicit support for much needed reform in the health insurance debate from the Republicans, but, he should not expect it and settle his expectations to have the much needed reform carried completely by the Democratic Party.

Steven Dick wrote an interesting editorial in the Muskogee Pheonix. I found it to reflect what is a profound reflection of the 'State of Race' in the USA. I agree with Steven Dick in that the Republican Party cannot deny the use of race 'as a tool' in elections, ie: Willy Horton.

There has been a 'back sliding' of belief in President Obama and there is a reason why so many want to say he is 'over exposed.' I don't believe he is. I sincerely believe he is attempting to reach the people that were lied to and are afraid to 'trust' again.

During the 2008 presidential campaign (click title to entry - thank you), much ink and breath were spent talking about race. Most of it, after the nomination of Barack Obama, was positive, marking the historical significance of a black nominee and exploring the possibilities of a post-racial country.

There were still members of the right-wing fringe who said they would never vote for a black man. But most Republicans who, in the past, never hesitated to use race as an election edge held their tongues from overtly attacking Obama for his race.

But it didn’t take long for racial animosity to rear its ugly head.

To be sure, Bill Clinton faced lynch mobs on the right at every move. But he didn’t face crowds that said things like, “We want our country back.”

Conservatives would say this is a reaction to Obama’s perceived liberalism, but look at what the president is doing. He seeks to make nice with Republicans and still believes in bipartisan problem solving. There is no liberal revolution going on. The deadheads who populate the tea baggers want their country returned to white conservatives.

A woman called the office last week upset about a pro-Obama editorial. "I’m tired of all that black stuff," (over exposure, I suppose) she huffed.

Not just Obama, she added, but pictures of blacks, presumably of her fellow community members. She hastened to point out that she had nothing against black people, to which I responded that it sure seemed like she did.

Take the case of Van Jones, a black man who just lost his Obama administration job because he had some choice derogatory names aimed at Republicans and lent his name to a Web site that seeks an investigation of the Bush administration’s possible role in the Sept. 11 attacks.
I can remember when a repugnant representative from Indiana, Dan Burton, called Clinton a scumbag. Burton, who is white, keeps getting elected.

Now conservatives are going after Mark Lloyd, (It worked on Van Jones, so now there is blood in the water and the feeding frenzy is on.) a staffer at the Federal Communications Commission who is critical of corporate-owned media and right-wing dominance of talk radio. Rush Limbaugh thunders into his microphone that Lloyd will bring back the Fairness Doctrine (which would be a great idea since the public owns the airwaves), but Lloyd has no policy power. He is black, though....

I wouldn't say Mark Lloyd is another Michael Powell, but, I sure as hell wish he would be and draconianly revert the rights to the airwaves back to the spirit of HONESTY and TRUTH. I like the idea of a strong black man able to handle the worst of the Right Wing 'Mean Machine.'

While President Obama is saying what he needs to in delivering the agenda of the people of the USA; Steven Dick said what needed to be said and I thank him for it.

Seriously good news. A Russian leader that wants to speak to the free world. "Go Russia" (click here)

I believe as the years with President Obama progress we will not only make enormous strides in returning to a viable economy, affordable health insurance, a workable national immigration policy, but, also 'Peace between Russia, China and the USA.'

I guarantee that in only one year in office, The West will come to find out they share a great deal in common with The East and it will bring the relations between these powers into a solid understanding of peaceful progress to nuclear disarmament.

It is a very exciting time on the International Front for President Obama. We will be involved with new agreements and treaties that will expand the horizons of possibilities for economic opportunity between countries as the USA rehabilitates its manufacturing sector.

I sincerely believe as the gap of misunderstandings closes between these powers, there will realizations of how far civilization has come and how well we have accomplished peaceful co-existance between sovereign nations; finding no reason ever again to 'chance' danger to their populous, their allies or returning to rhetoric that casts suspicion on the good intentions of treaties.

Vice President Biden should extend a more welcoming word to Russia as he is underestimating the resolve of this allie. He is wrong, his criticism uncalled for and it is very dangerous. Every country on Earth has weaknesses and the USA has many. There are no words that can cast 'shadowy' images on Russia that could not be cast on the USA as well.

Russia, under President Dmitry Medvedev and Prime Minister Vladimir Putin, has made enormous strides in global leadership, including near border countries to the USA. I would never underestimate their resolve or ability nor especially the longed lived intention of Russia to see an Earth intact and people of all nations living viable lives.

Currently, the issue of alcoholism plagues Russia. It has for sometime. It is one of the resolves of President Medvedev to stop this egregious habit of the Russia people.

I have a suggestion.

Perhaps one of the best places President Medvedev can begin to change the 'social conscience' of Russia regarding the use of alcohol, is in relation to the very sad syndrome called "Fetal Alcohol Syndrome." Certainly, every Russia obstetrician that gives care to women, wants nothing but healthy babaies born without the threat of diminished mental capacity.

Bringing social conscience to the Russian people regarding the dangers to their unborn would be a way of raising concern for pre-natal care and the understanding drinking alcohol during pregnancy harms a fetus and ultimately an infant. It is vitally important to stop the abuse of alcohol within a society at a point where the most innocent of lives are effected due to adult over indulgence. I wish the Russian medical society great success in regard to their unborn and ultimately their population. The USA went through a similar awakening some time ago.

There is much Russia, China and the USA already share in the way of space exploration and the opportunities to 'bond for THE FUTURE'S benefit' are endless. All one has to do is recall the recent 'short fall' of funding to NASA to realize how much cooperation between nations can change the possibility of deep space travel. I mean, there is no reason for a 'space race' to Mars, is there? The dangers far exceed the reasons for lack of cooperation between these nations.

I believe when these leaders are finished we will know a peaceful and sustainable resolve in the Middle East, a reasonable reduction in nuclear armaments and a return to The Non-Proliferation Treaty; where there are only a few nuclear nations with plans for none.

The future of the people of Earth all line on the same path. A sustainable planet with nations of educated and employed peoples able to support their country. There is some work to be done, but, not as much as one might expect. I believe many 'leaps of faith' can begin as a reassurance to more and more cooperation as time goes on and the trust between nations grows. I would like to see a strong return to peaceful economic cooperation in the years of the Obama Presidency with most achieved in the first term.

Our planet is tired. It needs stewardship to renew its biotic ability to sustain and propagate life. It is achievable and I believe Russian leaders are more than ready to step into the light with renewed dignity and commitment. They have many, many 'Firsts' in Russia, including being a major power to sign the Kyoto Protocol. Perhaps it is time for Russia to act within its "Friendship Pact of 2000" with China to pursue cooperation with Kyoto?

I completely reject any septicism of Russia and welcome the people of Russia as friends.