"Morning Papers" - Its Origins

The Rooster

"Okeydoke"

The graph is independant from the article which appeared in the New York Times as an editorial.

...A survey by the Kaiser Family Foundation found that (click title to entry - thank you), once again, health insurance premiums rose faster last year than either wages or general inflation. A study by the Treasury Department found that almost half of all Americans below Medicare age have gone without insurance at some point over the last decade.
The Kaiser study, conducted jointly with the Health Research and Education Trust, an affiliate of the American Hospital Association, found that the average premium for a family policy offered at work rose above $13,300 in 2009 — up from $5,800 in 1999. The average employer paid more than $9,800 of that, while the workers contributed more than $3,500. The workers were also hit with larger co-payments and deductibles, while their policies often offered fewer benefits....


There is no way this can be allowed to go on.

The pages 650 through 653 of the House Bill are a completion of the previous provision and it is fairly routine. So the next topic is on page 654 entitled "Public Reporting on Health Care Associated Infections."

Page 655, lines 3 through 18:

‘‘(2) REPORTING PROTOCOLS.— Such information shall be reported in accordance with reporting protocols established by the Secretary through the Director of the Centers for Disease Control and Prevention (in this section referred to as the ‘CDC’) and to the National Healthcare Safety Network of the CDC or under such another reporting system of such Centers as determined appropriate by the Secretary in consultation with such Director.
‘‘(3) COORDINATION WITH HIT.—The Secretary, through the Director of the CDC and the Office of the National Coordinator for Health Information Technology, shall ensure that the transmission of information under this subsection is coordinated with systems established under the HITECH Act, where appropriate.

This is a change in the public reporting by the CDC. The infrastructure already exists through previous 'purpose' and legislation, it a matter of requiring public access to SPECIFICALLY "Nosocomial Infections."

Nosocomial infections are defined as "hospital acquired." See example below:


September 22, 2009
Tales from the C. difficile trenches (click here)
Admitted to hospital for pneumonia, the retired man was visited every day by his wife, who helped feed and care for him. Then he contracted Clostridium difficile from a roommate and had to be transferred to intensive care. His wife was later admitted to another part of the hospital – with C. difficile. She was too ill to visit him as he lay dying and too sick to attend his funeral.
A true story, one that Dr. Michael Gardam tells to bring home the human toll of an infection that is so often transmitted in hospital.
“Things like this happen in hospitals and telling them is how we recognize the impact that hospital-acquired infections can have on patients,” explains the director of infectious disease prevention and control at the Ontario Agency for Health Protection and Promotion....

The reason, of course, for reporting such events publically is to make all the services to patients better. Easy access to immediate information regarding trends in nosocomial infections will allow for better understanding of the pervasiveness in hospitals and how the hospitals that have low rates combat those problems. These efforts lead to lower health care costs and better patient outcomes.

C. difficile is a bacteria that CAN manifest when antibiotics are administered. The reason it occurs with some frequency in hospitals is due to IV antibiotics and the immediate effects on any bacterial infection. Sometimes it is due to the 'strength' of the medication as well and its overall 'spectrum' of infection fighting capacity. Broad spectrum antibiotics are good for 'immediate' care, but, should be substituted as soon as possible with antibiotics that 'specificially' treat the organism causing the infection. There is no need to treat all infections with broad spectrum antibiotics because that is what caused 'super bugs.'

The reason such measures haven't been conducted before is because it is also 'bad advertisement' for hospitals and health care facilities that have chronic issues with nosocomial infections. Where would you like to be treated? In facilities, including MD offices, where there are very low occurrences of these infections or a place with chronic 'sanitary' issues? You know. The 'persistent' dirt in the corners of public bathrooms, including patient rooms, carry all kinds of 'mess' with it. There are some 'dirty' health facilities in this country. So, those that would 'victimize' the public to promote sales of medications wouldn't want BETTER reporting, because, people might actually stay healthy and alive of all things.


You know the Republicans chronically complain about 'tort reform.' It isn't tort reform that is needed and this is a fine example. Why should any law regarding enforcement of high sanitary standards matter if there is no deterrent. Law suits for unnecessary deaths of patients, due to in this instance, hospital acquired infections are a means of deterrent. When the lives of people being treated mean nothing in the way of fiscal losses to practitioners and facilities because tort reform eliminates liabilty, what does that interpret into in 'the real world?' An ethics violation? So. No MD loses their license due to an occassional ethics complaint because a patient died due to a hospital acquired infection. No hospital is closed due to that reason either. BUT. They pay attention to malpractice costs and payments on lawsuits.


HENCE.


A person's life, no matter where they fall into the socioeconomic strata of the USA has definition. If anyone or any entity screws up and costs a person their life, they will lose millions with potential for billions depending on the extent of negligence or malpractice occurring. It is a 'safety' issue. Tort reform isn't about money. Not really. It is about providing a safety net to medical care.

National Briefing South: North Carolina: Settlement For Transplant Error (click here)
Published: Saturday, June 26, 2004
Duke University Hospital has reached an undisclosed settlement with the family of a Mexican teenager who died after being given a heart-lung transplant of the wrong blood type. The girl, Jésica Santillán , 17, died last year, 15 days after the botched transplant....

There are more words to this provision that insures high quality reporting, annual reporting to Congress, noncompliance and implementation.

So you know everyone is on the same page and this isn't 'just my take' on things, page 658, lines 1 through 12:

‘‘(e) HEALTH CARE-ASSOCIATED INFECTION.—For purposes of this section:
‘‘(1) IN GENERAL.—The term ‘health care-associated infection’ means an infection that develops in a patient who has received care in any institutional setting where health care is delivered and is related to receiving health care.
‘‘(2) RELATED TO RECEIVING HEALTH CARE.— The term ‘related to receiving health care’, with respect to an infection, means that the infection was not incubating or present at the time health care was provided.


Page 660. lines 1 through 4:


TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION
SEC. 1501. DISTRIBUTION OF UNUSED RESIDENCY POSITIONS.

Page 666, lines 3 through 13;

‘‘(iii) CONSIDERATIONS IN REDISTRIBUTION.—In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall take into account the demonstrated likelihood of the hospital filling the positions within the first 3 cost reporting periods beginning on or after July 1, 2011, made available under this subparagraph, as determined by the Secretary.

"The devil is in the details." This provision allows for redistribution of 'effective' residency programs to hospitals actively engaged in conducting them. There is reporting to the Secretary the number of successful engagement of residencies, including, the inability of any hospital to have a successful program. There is opportunity for hospitals to expand their programs as well. Basically, the Secretary wants to be sure, beside quality programs in the USA existing, that they are actually producing the physicians and surgeons needed in the country. It is a quality assurance issue.

Same page, lines 14 through 20:

‘‘(iv) PRIORITY FOR CERTAIN HOSPITALS.—In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall distribute the increase to qualifying hospitals based on the following criteria:

Page 667, lines 1 through 5:

‘‘(II) The Secretary shall give preference to hospitals with 3-year primary care residency training programs, such as family practice and general internal medicine.

The provision is very lengthy. There are many quality assurances to implementation of the provision including increasing exposure of residents to non-hospital settings. It all seemed very appropriate, long overdue and carefully thought out. This is page 686, lines 6 through 10:

TITLE VI—PROGRAM INTEGRITY
Subtitle A—Increased Funding to Fight Waste, Fraud, and Abuse
SEC. 1601. INCREASED FUNDING AND FLEXIBILITY TO FIGHT FRAUD AND ABUSE.

Page 687, lines 12 through 16:

Subtitle B—Enhanced Penalties for Fraud and Abuse
SEC. 1611. ENHANCED PENALTIES FOR FALSE STATEMENTS ON PROVIDER OR SUPPLIER ENROLLMENT APPLICATIONS.


Both these provisions provide for increased 'enforcement' to stop abuse of the new health insurance system. There has to be such enforcement and as time goes forward there will be less and less need for it as it is realized there is little 'profit' in fraud as well as high consequences. This will also expose wasteful spending and will provide a means to lower costs of health insurance. Page 688, lines 5 through 16 provides an over view of the provision:

‘‘(8) knowingly makes or causes to be made any false statement, omission, or misrepresentation of a material fact in any application, agreement, bid, or contract to participate or enroll as a provider of services or supplier under a Federal health care program, including managed care organizations under title XIX, Medicare Advantage organizations under part C of title XVIII, prescription drug plan sponsors under part D of title XVIII, and entities that apply to participate as providers of services or suppliers in such managed care organizations and such plans;’’;

Page 689, lines 11 through 13:

SEC. 1612. ENHANCED PENALTIES FOR SUBMISSION OF FALSE STATEMENTS MATERIAL TO A FALSE CLAIM.

Page 690, lines 15 and 16:

SEC. 1613. ENHANCED PENALTIES FOR DELAYING INSPECTIONS.

Page 691, lines 1 thorugh 7;

‘‘(10) fails to grant timely access, upon reasonable request (as defined by the Secretary in regulations), to the Inspector General of the Department of Health and Human Services, for the purpose of audits, investigations, evaluations, or other statutory functions of the Inspector General of the Department of Health and Human Services;’’; and

The following is a fascinating provision. It regards hospice as a place where quality of care should exist. I remember one of the first 'rantings' of the Republican Right Wing Media was about how the government is going to kill off the aged and dying. Well. It would seem the government, at least the House of Representatives, are more interested in the 'quality of care' provided to those in hospice care. For those in the Right Wing Media that doesn't understand what 'hospice' is? It is the specialized care of the dying. Anytime the Republican Right Wing Media wants to apologize I am sure the nation would be eager to hear it.

Page 692, lines 8 through 24 and page 693, lines 1 and 2:

‘‘SEC. 1819A. ASSURING QUALITY OF CARE IN HOSPICE CARE.
‘‘(a) IN GENERAL.—If the Secretary determines on the basis of a survey or otherwise, that a hospice program that is certified for participation under this title has demonstrated a substandard quality of care and failed to meet such other requirements as the Secretary may find necessary in the interest of the health and safety of the individuals who are provided care and services by the agency or organization involved and determines—
‘‘(1) that the deficiencies involved immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the Secretary shall take immediate action to remove the jeopardy and correct the deficiencies through the remedy specified in subsection (b)(2)(A)(iii) or terminate the certification of the program, and may provide, in addition, for 1 or more of the other remedies described in subsection (b)(2)(A); or

Now.

Whom exactly of the Right Wing Media provides QUALITY information? Whom is it that reads every line and understands every word? No one? That would seem to be the 'honest' answer. Whom is guilty AS SIN of lying and deception in the capacity of a licensed media outlet? Hm? Whom might that be? Murdock's tribe? Yeah.

The penalites for actions that jeopardize the care of a hospice patient might be what Murdock's tribe really objects to. Ready? It's interesting. Considering this is in ADDITIONAL to any and all payments a malpractice insurance company has to pay. These penalities aren't covered by insurance, now are they?

Page 693, lines 22 through 25 and page 694, lines 1 through 25 and page 695, lines 1 through 22:

‘‘(b) INTERMEDIATE SANCTIONS.—
‘‘(1) DEVELOPMENT AND IMPLEMENTATION.—
The Secretary shall develop and implement, by not later than July 1, 2012—

‘‘(A) a range of intermediate sanctions to apply to hospice programs under the conditions described in subsection (a), and‘‘(B) appropriate procedures for appealing determinations relating to the imposition of such sanctions.
‘‘(2) SPECIFIED SANCTIONS.—
‘‘(A) IN GENERAL.—The intermediate sanctions developed under paragraph (1) may
include—
‘‘(i) civil money penalties in an amount not to exceed $10,000 for each day of noncompliance or, in the case of a per instance penalty applied by the Secretary, not to exceed $25,000, (if it were me, I'd put no limit on it and put them out of business)
‘‘(ii) denial of all or part of the payments to which a hospice program would otherwise be entitled under this title with respect to items and services furnished by a hospice program on or after the date on which the Secretary determines that intermediate sanctions should be imposed pursuant to subsection (a)(2),
‘‘(iii) the appointment of temporary management to oversee the operation of the hospice program and to protect and assure the health and safety of the individuals under the care of the program while improvements are made,
‘‘(iv) corrective action plans, and
‘‘(v) in-service training for staff.
The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under clause (i) in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). The temporary management under clause (iii) shall not be terminated until the Secretary has determined that the program has the management capability to ensure continued compliance with all requirements referred to in that clause.
‘‘(B) CLARIFICATION.—The sanctions specified in subparagraph (A) are in addition to sanctions otherwise available under State or Federal law and shall not be construed as lim21
iting other remedies, including any remedy available to an individual at common law.

Page 698, lines 17 through 19;

SEC. 1616. ENHANCED PENALTIES FOR PROVISION OF FALSE INFORMATION BY MEDICARE ADVANTAGE AND PART D PLANS

Page 700, lines 21 and 22;

SEC. 1618. ENHANCED PENALTIES FOR OBSTRUCTION OF PROGRAM AUDITS.

Page 701, lines 15 through 17;

SEC. 1619. EXCLUSION OF CERTAIN INDIVIDUALS AND ENTITIES FROM PARTICIPATION IN MEDICARE AND STATE HEALTH CARE PROGRAMS.

Page 702, lines 1 through 25 and page 703, lines 1 through 22;

‘‘(4)(A) For purposes of this Act, subject to subparagraph (C), the effect of exclusion is that no payment may be made by any Federal health care program (as defined in section 1128B(f)) with respect to any item or service furnished—
‘‘(i) by an excluded individual or entity; or
‘‘(ii) at the medical direction or on the prescription of a physician or other authorized individual when the person submitting a claim for such item or service knew or had reason to know of the exclusion of such individual.
‘‘(B) For purposes of this section and sections 1128A and 1128B, subject to subparagraph (C), an item or service has been furnished by an individual or entity if the individual or entity directly or indirectly provided, ordered, manufactured, distributed, prescribed, or otherwise supplied the item or service regardless of how the item or service was paid for by a Federal health care program or to whom such payment was made.
‘‘(C)(i) Payment may be made under a Federal health care program for emergency items or services (not including items or services furnished in an emergency room of a hospital) furnished by an excluded individual or entity, or at the medical direction or on the prescription of an excluded physician or other authorized individual during the period of such individual’s exclusion.
‘‘(ii) In the case that an individual eligible for benefits under title XVIII or XIX submits a claim
for payment for items or services furnished by an excluded individual or entity, and such individual eligible for such benefits did not know or have reason to know that such excluded individual or entity was so excluded, then, notwithstanding such exclusion, payment shall be made for such items or services. In such case the Secretary shall notify such individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services.
Payment shall not be made for items or services furnished by an excluded individual or entity to an individual eligible for such benefits after a reasonable time (as determined by the Secretary in regulations) after the Secretary has notified the individual eligible for such benefits of the exclusion of the individual or entity furnishing the items or services.

Consumers have to be aware that if an individual or entiry becomes ineligible for payment, they could still be held liable for the costs that cannot be gained from a government program. The Secretary under this provision will notify the people receiving services, but, then they have to stop their patronage, or be personally liable for the cost. This will probably be a matter of a public reporting page on the website eventually. The tricky part is confidentiality and being sure there is accurate information in such an instance.

I am going to end it there. The next major section is on page 704, beginning with lines 17 through 18.

Subtitle C—Enhanced Program and Provider Protections

Regards.

It may have been more than one Right Wing Extremists that killed him. A set of milita members, possibly?

The Census is a huge issue for Republicans and the extremists believe in its control. The Extremists of the Right Wing will stop at nothing. "Fed" equates to McVeigh's understanding of the government. If one census worker dies a horrible death supposedly that will stop the census as a threat to all census workers.

How correct does Janet Napolitanio have to be for the nation to realize there is an organized and armed element within its borders that license themselves to be bigots and war mongers?

From archives:

Ex-Aide Says Republicans Killed Census Adjustment; Undercount of Blacks, Hispanics Expected
(click title to entry - thank you)
[FINAL Edition]
Spencer Rich
Jan 15, 1988
Barbara Bailar said yesterday that she quit her post as a high-ranking Census Bureau official last month because she believes Republicans in the Commerce Department had political motives in killing a plan to compensate for an expected severe undercount of blacks and Hispanics in the 1990 census.
Adjusting the official census to compensate for blacks and Hispanics missed by counters on April 1 would benefit Democrats in reapportionment and redistricting of the House and the state legislatures, according to many analysts. The reasoning is that most blacks and Hispanics live in areas that usually vote Democratic. An undercount adjustment would increase the official population of those areas.
[Robert Ortner] said senior officials of the Commerce Department decided against the undercount adjustment because there was no unanimity, even within the Census Bureau, on whether the proposed methodology was adequate, practical and would improve accuracy. "You can't say there was an absolute, airtight case in favor of adjustment," he said.

Expert on Undercount Quits Census Bureau (click here)
[FINAL Edition]
Spencer Rich
Dec 18, 1987

A top Census Bureau official who has supervised the government's effort to develop a way to adjust 1990 census figures to correct an anticipated undercount of blacks, Hispanics and others has abruptly resigned her post and will retire.
According to the methodology worked out under [Barbara Bailar]'s direction, the Census Bureau could adjust the undercount by taking a survey of 300,000 representative households nationwide shortly after the April 1 census, and then comparing the results to see how many people were missed the first time.
TerriAnn Lowenthal, staff director of [Mervyn M. Dymally]'s House subcommittee on the census, said, "We have an awful lot of respect for Barbara Bailar. If, in fact, her resignation was prompted by dissatisfaction with the decision not to adjust, it is a further indication that the decision was made at higher levels of the administration and not by professionals at the Census Bureau."

The decadonal USA Census has been a method of control for the Republican Party as a political strategy to winning elections. They gerrymander and play this idiotic game as if people were cattle to be herded. They have lauded over the Census for a long, long time.

Published on Thursday, May 19, 2005

by CommonDreams.org
The Texas Nexus: Where Racial and Partisan Gerrymandering Came Together (click here)
by Karyn Strickler

Naive American voters still believe that they select their Congressional representatives. Texans are under no such illusion after the bitter redistricting battle that took place there. Partisan and racial gerrymandering has created a situation in Texas and across the nation, where very few U.S. Congressional seats are competitive today -- in effect allowing Congressmen to choose their voters.
U.S. House Majority Leader, Tom DeLay (R-TX), led the way for Republican Congressmen in Texas to pick their voters. The untold story of DeLay’s belligerent power grab in Texas redistricting involves partisan political domination, intrigue, alleged corruption and perhaps most significantly -- minority disenfranchisement.
U.S. Congressional redistricting takes place in state legislatures once per decade, following the decennial census to reflect population shifts, as mandated by the U.S. Constitution. Tom DeLay led the effort to violate all historical precedent by drawing the Congressional district lines in Texas -- twice....

He states the people are behind the Pakistan Army, yet, he never did anything about the extremists.

He was insuffienct as a leader and allowed the Taliban to flourish.

...To bring stability and peace to Afghanistan, (click title to entry - thank you) "the political element is the most critical," he said.

Nation-builders in Afghanistan need to "look for a homegrown political covenant," he said.

Musharraf endorsed the U.S. Army General Stanley McChrystal's plan to put more troops into Afghanistan.

When asked by an audience member whether Pakistan has the "national will" to exercise control over tribal areas like the Swat Valley, Musharraf said the violence in the Swat Valley has turned most ordinary Pakistanis against the Taliban.

"The people of Pakistan are behind the army."

One audience member asked what can be done to purge Paskistan's intelligence services of rogue extremist elements.

The former general denied that those elements exist, saying that dissension in the ranks is merely a "perception created by certain Western interests and the media.

"If the army and intelligence services are not leading the fight against extremism in the tribal areas, Musharraf asked, "Who will?"

"We must trust them," he said. "There is a trust deficit. ... This trust deficit has to go."

Obama's General, I plan to watch CBS on Sunday evening.

US Terror Suspect to Face Charges in New York (click title to entry - thank you)
By VOA News 26 September 2009

Prosecutors say an Afghan-born terror suspect in U.S. federal custody spent more than a year plotting a massive attack on the United States with co-conspirators.Najibullah Zazi was transferred Friday from the western state of Colorado, where he was detained, to the northeastern city of New York, where he faces charges of conspiring to detonate bombs.A federal grand jury in New York indicted 24-year-old Zazi on Wednesday, but that was not made public until Thursday. The U.S. government says Zazi received bomb-making instructions in Pakistan in 2008. It also says he bought components to build improvised explosive devices and traveled to New York City on September 10, 2009, to move forward with his plans....

Some of questions they won't ask will probably be, "What are acceptable losses in the war in Afghanistan? Will there be less losses if there are more troops? What is the military advantage to increasing the troop level? When will the USA declare victory over the insurgency? What is a measure of that? Are you confident you are asking for all that it will take or are you wagering on the effort? If given everything you need, when will the war end?"

...There were two battalions to the north of Kandahar city. (click here) Another to the far south. Canadian forces were going to swing to the west. About 5,000 new U.S. troops in all.
"But there, there and there," the officer said, pointing to towns just outside a belt where the Americans and Canadians were stationed, "and there," putting his fist on the city, which with 800,000 residents is the country's second-largest population center, "we don't have anyone."
If more forces are not forthcoming to mount counterinsurgency operations in those parts of the province, he concluded, the overall U.S. effort to stabilize Kandahar -- and by extension, the rest of Afghanistan -- will fail....

Four U.S. troops killed in Afghanistan (click here)

Sat Sep 26, 2009 6:54am EDT

...The eight-year-old war in Afghanistan has been in its deadliest phase for foreign troops since July, when U.S. and British forces launched the biggest offensives of the war.
There are now more than 100,000 Western troops in Afghanistan, about two-thirds of them American.
Their commander, U.S. Army General Stanley McChrystal, is expected to ask for thousands more in a request he will deliver to Washington this week. He has said that without additional forces, his mission is likely to fail....

Polling records appear to back fraud allegations in Afghanistan presidential election (click here)
By HAL BERNTON
McClatchy Newspapers

...The records appear to bolster fraud allegations surrounding the Aug. 20 presidential election — which has become ever more critical to the U.S. and its allies in the face of Afghanistan’s increasingly powerful Taliban insurgency....

Officials To Audit Sampling Of Suspect Afghan Ballots (click here)
by Soraya Sarhaddi Nelson

September 25, 2009

Five weeks after Afghanistan's presidential elections, it's still unclear who will lead the country.
A preliminary tally suggests that incumbent Hamid Karzai is the winner, with 54 percent of the vote. But widespread allegations of fraud and official calls for a recount have stalled the final outcome.
Afghan and international officials are now hoping to break the logjam by agreeing to review ballots at about 10 percent of the nearly 3,100 polling stations flagged as suspicious by a U.N.-backed watchdog....

Doubts raised on Afghan mission ahead of German vote (click here)
SIMON STURDEE

September 23, 2009
Days before German elections, an influential former chancellor on Wednesday slammed the country's unpopular mission in Afghanistan, a foreign policy headache for whoever wins power.
As the race for Sunday's vote heated up, police raided the headquarters of the NPD, a neo-Nazi party with serious financial problems and next to no chance of winning any seats, after offensive letters were sent to ethnic minority MPs.
The election is expected to return Chancellor Angela Merkel to power, but two new opinion polls published on Wednesday confirmed that it is far from certain that she will be able to form her preferred centre-right coalition.
Helmut Schmidt, West German chancellor between 1974 and 1982 and still a respected figure in national politics at age 90, said meanwhile that the aims of Western forces in Afghanistan were "ever blurrier" and "not achievable"....

One question that always crosses my mine when I hear that bin Laden is still propagandizing his allegience to death is, "When will his iconography be too old to use?" Will it 'time out' when he reaches 100 years old or not? And what are the chances he is still alive considering the average longevity in the region?"

Bin Laden seeks to sway German election, Obama debate on Afghanistan (click here)
The new Al Qaeda tape, attributed to Osama bin Laden, coincides with a US policy debate on the Afghan war and a new poll showing the German race tightening.
By Dan Murphy Staff writer 09.25.09

In a new audio tape released Friday by Al Qaeda’s propaganda arm, a voice purported to be Osama bin Laden’s followed up on a series of threats made by more junior Al Qaeda members in recent months against America’s European allies in the Afghan war, warning that if they don’t pull out there will be retaliation against “the oppressor on behalf of the oppressed.”...