From the "National Underwriter"...By packaging the bill as a budget bill, House leaders might be able to use a process called the “reconciliation” process to get a health reform bill through the Senate with just 51 votes, rather than 60 votes normally required....
Rep. Charles Rangle was under attack for ethics issues that failed. Why? Because he was leading the charge for Reconciliation. The ethics charges are baseless. I am not a fan of Rep. Rangel as he feels manditory military service should be a part of the citizenship of the USA, but, either charges are valid or not and in his case there was no wrong doing. He was attacked by the Republicans because of his power in Ways and Means and their cronies are getting nervous.
...Republican members of the House (click here) last week attempted to oust Rangel from his powerful chairmanship of the House Ways & Means Committee for the duration of a House Ethics Committee investigation into alleged ethical misconduct surrounding his real estate investments and dubious personal financial disclosure reports....
Considering the contentious measure has come from the Finance Committee and the House is sending their's to Budget, there is every indication we will have a Health Care Insurance Reform Bill within the next month or so. The American People can't wait any longer and the Republicans are 'set' on serving their cronies well and 'saving face' to their electorate. The Republicans are desperate for the lack of members since the 2006 elections and are spending all their political capital on the 2010 elections. It is an impossible environment in the Legislature. Reconciliation might be the only tool left to stop this hideous debate as there are other issues pressing, including, Climate Change and Immigration.
It goes like this. The Republicans in the House and Senate want to 'appear' to cooperate with the President, after all come November 2010 if they are sequestered in their own little GOP world it might cost them votes.
So, the Senate FINANCE Committee decided to 'set aside' all animosities and work for their cronies to pass a bill they can vote for; it would give everyone 'the face of success' including President Obama and the Democrats. Everyone that is, except, the American people in the majority.
Now that the Senate Finance Committee, acting against their colleagues and stabbing them in the back, has placed a stamp of approval on the Technologies Spending Bill (AKA The Health Care Reform Bill, or should I say Formerley Known As) the Republicans are attempting to place a 'wedge' issue into their strategy and turn the tables stating the Democrats don't know how to be bipartisan.
It's corruption through and through. What occurred in the Senate Finance Committee was the undermining of health care reform. It was during the media circus following the Committee's ? Work ? that the health care insurance INDUSTRY came out against the Democratic Majority and their bills. It is more obvious than ever and quite frankly the Senate Finance Bill is the last ditch effort for the Health Care Industry to stop a Public Option and provide for lining their coffers.
On CUE, case in point, still yet another version of a Republican lead charge, dissing the Baucus Bill, against the American people. What is the cry "Too much money." So what else is new from a Republican?
Health reform: Bipartisan plan will help all Americans (click here)
By Peter J. Pitts
October 18, 2009
Congressman Bill Cassidy, R-La., recently broke some news that could turn the health care debate on its head. During a radio interview, he revealed that Blue Dog Democrats have been quietly reaching out to Republicans to draft an alternative health reform bill.
This isn't surprising. After all, neither Republicans nor centrist Democrats nor the majority of Americans approve of the clumsy hodgepodge of big-government policies that make up Sen. Max Baucus' health care bill.
Fortunately, an alliance between Republicans and moderate Democrats could give Americans the reform package they're looking for — one aimed at lowering costs while promoting competition....
The next section of the House Bill which begins on page 931 with a title concerns itself with Health and Wellness, which is where billions are appropriated and that isn't because spending is a choice by Democrats, it is because it costs more than a dollar per person to be sure 300 million Americans are receiving COST SAVING Preventative Care.Page 932 (the second page with the title to the section), lines 1 through 8:
‘‘TITLE XXXI—PREVENTION AND WELLNESS
‘‘Subtitle A—Prevention and Wellness Trust
‘‘SEC. 3111. PREVENTION AND WELLNESS TRUST.
‘‘(a) DEPOSITS INTO TRUST.—There is established a Prevention and Wellness Trust. There are authorized to be appropriated to the Trust—
This section of the bill is lengthy, sets up 'The Trust Fund' for the provision and is NOT outrageously expensive considering the 'per person' expenditure. The monies come from appropriated funds in the Health Investment Fund. All these monies by the way are 'housed' in the USA Treasury. So, when Paulson drained the Treasury to bail himself out of his incompetency as a CEO, he was acting with disregard to the priorities of the people of this nation. He didn't care if every other dollar in the Treasury appropriated for the well being of the nation went bankrupt.
One has to consider when making the observation that TODAY, Wall Street is zipping right along while there are still failing banks in the USA and high rates of unemployment in the face of stimulus. Paulson could not care less what was the outcome of his bailout. He didn't care if the American economy imploded and people were impoverished and living on the street or worse.
The reason that reality is not ours today, although there are people living on the street, is because we elected a moral man in the White House and a majority of Democrats to the House and Senate that passed a stimulus plan the began to turn things around. Otherwise, the 'domestic' condition of the nation would be very different than it is today.
Page 932, lines 12 through 14:
‘‘(2) in addition, out of any monies in the Public Health Investment Fund—
‘‘(A) for fiscal year 2010, $2,400,000,000;
Page 933, lines 11 through 13:
‘‘(2) for carrying out subtitle D (Prevention and Wellness Research)—
‘‘(A) for fiscal year 2010, $100,000,000;
Page 933, lines 24 and 25 and page 934, line 1:
‘‘(3) for carrying out subtitle E (Delivery of Community Preventive and Wellness Services)—
‘‘(A) for fiscal year 2010, $1,100,000,000;
Page 934, lines 12 through 15:
‘‘(4) for carrying out section 3161 (Core Public Health Infrastructure and Activities for State and Local Health Departments)— ‘‘(A) for fiscal year 2010, $800,000,000;
Page 935 begins the 'particulars' of the definition and focus of Preventive and Wellness provision:Page 935, lines 7 through 18:
‘‘Subtitle B—National Prevention and Wellness Strategy
‘‘SEC. 3121. NATIONAL PREVENTION AND WELLNESS STRATEGY.
‘‘(a) IN GENERAL.—The Secretary shall submit to the Congress within one year after the date of the enactment of this section, and at least every 2 years thereafter, a national strategy that is designed to improve the Nation’s health through evidence-based clinical and community prevention and wellness activities (in this section referred to as ‘prevention and wellness activities’), including core public health infrastructure improvement activities.
The provision continues in mapping the National Strategy in Health Care. It tells the Secretary where to concentrate efforts. It does not give the Secretary of Health and Human Services open uncontrolled power to 'be the decider' on what path to take for the nation's health. That would be incompetency in the Legislature if that occurred. The powers of the Executive Branch are to come from the Legislation and it is why the bills have to pass through the House and Senate.
Page 935, lines 19 thorugh 23:
‘‘(b) CONTENTS.—The strategy under subsection (a) shall include each of the following:
‘‘(1) Identification of specific national goals and objectives in prevention and wellness activities that take into account appropriate public health measures...
Page 936, lines 1 though 13:
(the) ...standards (including Healthy People and National Public Health Performance Standards).
‘‘(2) Establishment of national priorities for prevention and wellness, taking into account unmet prevention and wellness needs.
‘‘(3) Establishment of national priorities for research on prevention and wellness, taking into account unanswered research questions on prevention and wellness.
‘‘(4) Identification of health disparities in prevention and wellness.
‘‘(5) A plan for addressing and implementing paragraphs (1) through (4).
Those specific priorities 'keep' the focus of the provision from being undermined anytime in the future. It directs emphasis on UNMET needs. It would be easy to undermine the Health Care Reform Bill's initiatives if there wasn't strong language directly its focus. In other words, let's say Bush's Brownie were in the Secretary's seat and figured the 'unmet' needs are simply not needed at all by a minority of the people that don't vote in his direction anyway, so why do it. Brownie would simply focus on the accomplishments 'to date' of the American Health Care System and cut budgets in some areas and reappropriate in the direction of cronies. The bill prevents it. The UNMET needs of the nation has to take a priority, too.
The bill goes further to direct the Secretary in seeking 'consult' from specific 'agencies:'
Page 936, lines 15 through 21:
...strategy under subsection (a), the Secretary shall consult with the following:
‘‘(1) The heads of appropriate health agencies and offices in the Department, including the Office
of the Surgeon General of the Public Health Service, the Office of Minority Health, and the Office on Women’s Health.
Page 937, lines 6 through 14:
‘‘Subtitle C—Prevention Task Forces
‘‘SEC. 3131. TASK FORCE ON CLINICAL PREVENTIVE SERVICES.
‘‘(a) IN GENERAL.—The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall establish a permanent task force to be known as the Task Force on Clinical Preventive Services (in this section referred to as the ‘Task Force’).
This provides for the 'expertise' of the Federal government to make all consults and recommendations focused on Prevention and Wellness. It is a dedicated Task Force because with Prevention and Wellness being a national priority the cost of any health care program, be it public or private will come down. This isn't just a 'Pie in the Sky' idea, it is a well accepted precept noted in the Private Health Care Insurance Industy that to bring down costs, offer Wellness programs.
The Secretary is responsible for appointing the 30 member Task Force. A little scary when considering this is probably the place where Republicans would seek to undermine 'the system.' So, the provision takes things a little further to insure 'quality control:'
Page 940, lines 11 through 19:
‘‘(4) REPRESENTATION.—In appointing members of the Task Force, the Secretary shall ensure that—
‘‘(A) all areas of expertise described in paragraph (3) are represented; and
‘‘(B) the members of the Task Force include practitioners who, collectively, have significant experience treating racially and ethnically diverse populations.
Page 941, lines 1 through 10:
‘‘(f) CLINICAL PREVENTION STAKEHOLDERS BOARD.—
‘‘(1) IN GENERAL.—The Task Force shall convene a clinical prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in clinical preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services.
The bill, being Constitutionally Correct, does not stop at the totality of government power and also includes a 'shareholders' group of public and private entities. This is somewhat standard for really good lawmaking. As example, "The Clean Air Act" provides for 'The New Source Review' every five years, I believe it is.
The New Source Review is exactly what the words imply, it is an opportunity for public and private sectors to report 'changes' in the 'nature' of air quality to the government. In these 'shareholder' groups ARE the interests of the public and private sector. It is our chance to tell the government about the issue as it relates to topic.
These are important aspects of any legislation and what 'empowers' the public to practice Democary.
The Treasury Department of the USA does not have these venues that I am aware of, it is sort of left up to the Federal Reserve.
Sorta.
If there were shareholders groups at the Federal level assisting the direction of policy we might be seeing a far different outcome to our society. The 'bailout' probably would not have happened, as citizens would have been screaming at the government at least by early 2007 and the warning signs would have been on record before 2008.
THEN, responsiblity could have been assigned for ignoring the reporting of the citizens of the USA to err on the side of negligence that served to bailout Goldman Sachs.
It really wasn't AIG's issue, except, the insurance to investment firms should never be trusted to a private entity, the only entity able to insure such ventures is a sovereign power and it is NOT in the best interest of the country to 'gamble.' The investment banks should have taken out policies with Lloyds of London. They probably tried. They were most likely rejected.
I believe some of the 'experimenting' that went on at AIG to try to build enough resources to cover such expensive policy holders was a direct result of a private insurer that was out on a limb. AIG was a dreamscape that should have never happened. It was never reasonable.
To return to health care policy, the bill requires 'health care consumers' to be members of the 'shareholder' group.
This bill also does not GROW the size of government, it ALLOWS for participation as a Democracy is required to do. Page 943, lines 5 through 11:
‘‘(h) NO PAY; RECEIPT OF TRAVEL EXPENSES.— Members of the Task Force or the clinical prevention stakeholders board shall not receive any pay for service on the Task Force, but may receive travel expenses, including a per diem, in accordance with applicable provisions of subchapter I of chapter 57 of title 5, United States Code.
A Personal Note: When it came to rasing my sons to be healthy and having a wonderful Pediatrician to count on, the operative word is 'Vitamins.' I took special vitamins when I was expecting and that continued after they were born. There was not a day that went by the boys forgot to take their vitamins. And it was fun, Flintstone vitamins and stuff like that. As a matter of fact one of the first 'adult health care decisions' my young men made was the choice of an appropriate adult vitamin. Where did they go? You guessed it, GNC.
The House bill is very fluid. It provides for 'thinkers' to be engaging the health care and health insurance issues of the American people. There is little 'control' in the path this legislation is taking, EXCEPT, to demand of all its government participants to improve the health of the American people. There is very little I object to within the language of this bill or its appropriations.
Page 947, lines 11 through 20:
‘‘(f) COMMUNITY PREVENTION STAKEHOLDERS BOARD.—
‘‘(1) IN GENERAL.—The Task Force shall convene a community prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in community preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of community preventive services.
Page 950, lines 5 through 18:
‘‘Subtitle D—Prevention and Wellness Research
‘‘SEC. 3141. PREVENTION AND WELLNESS RESEARCH ACTIVITY COORDINATION.
‘‘In conducting or supporting research on prevention and wellness, the Director of the Centers for Disease Control and Prevention, the Director of the National Institutes of Health, and the heads of other agencies within the Department of Health and Human Services conducting or supporting such research, shall take into consideration the national strategy under section 3121 and the recommendations of the Task Force on Clinical Preventive Services under section 3131 and the Task Force on Community Preventive Services under section 3132.
The House Bill provides for a lot of research. This is a quality control issue. The agencies mentioned in this provision are not small potatoes. The CDC is vital to any such Prevention and Wellness program as they are knowledgeable to the trends of disease in the nation. The NIH has to be a player/shareholder in this provision, it has a vested interest in the well being of the people of this nation. So, although some of this seems redundant, it isn't. The 'shareholders' change through many of the paragraphs and are empowered to act with 'equity' to any of the findings that impact the nation's health. It is important legislation. Truly.
Page 951, lines 14 through 22:
‘‘Subtitle E—Delivery of Community Prevention and Wellness Services
‘‘SEC. 3151. COMMUNITY PREVENTION AND WELLNESS SERVICES GRANTS.
‘‘(a) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a program for the delivery of community preventive and wellness services consisting of awarding grants to eligible entities—
All these measures aren't important without 'health care delivery.' These are necessary words. The House Bill is 'standard' good law. The bill goes on to define the delivery system across the spectrum of the USA including tribal heath departments. It uses the language "Core Public Health Infrastructure" and it is defined. It is huge. It is our health care delivery system and through this legislation it is now law as to the form that infrastructure. It cannot be dissolved at the whim of some maniac that wants to cut the federal government to the bone.
Page 960, lines 9 through 15:
‘‘(1) The term ‘core public health infrastructure’ includes workforce capacity and competency; laboratory systems; health information, health information systems, and health information analysis; communications; financing; other relevant components of organizational capacity; and other related activities.
The Republicans protestation of how Democrats GROW 'Big Government' is such a joke. The following provision CONSOLIDATES assets of the people of this nation to streamline decision making and facilitate the expediant care of the people.
Page 961, lines 9 through 22:
(1) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, AND ADMINISTRATIVE ACTIONS.—All functions, personnel, assets, and liabilities of, and administrative actions applicable to, the Preventive Services Task Force convened under section 915(a) of the Public Health Service Act and the Task Force on Community Preventive Services (as such section and Task Forces were in existence on the day before the date of the enactment of this Act) shall be transferred to the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, established under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a).
There are pages of 'Best Practice' statues, identifying existing, developing new, evaluation of, implementation and transparency to the public. How careful can the House be?
Page 972, lines 1 through 6:
(4) OBSTETRICS.—Improving the provision of obstetrical and neonatal care, including the identification of interventions that are effective in reducing the risk of preterm and premature labor and the implementation of best practices for labor and delivery care.
This particular statute addresses the Mother, Infant Death Rates in the USA. Those death rates, also may be considered 'survival' rates receive plenty of criticism by the Global Community. The USA does not have the best track record.
This is from the CIA World Factbook and the USA ranks 44th in Infant Mortality Rates. (click here) The chart is recorded from highest death rate to lowest and the USA is 44th from the 'least' infant morality rate. 6.26 infant deaths per 1000 births in current 2009 statistics with Singapore the lowest at 2.31.
Something I want to focus on is the GDP per capita. Singapore has the fourth largest GDP 'per capita' of any country on Earth. It is third on the list of the World Bank and fourth on the IMF (International Monetary Fund) and seventh on the CIA list. The USA is ranked below Singapore in its GDP per capita on all lists. The USA is ranked fourth by the World Bank, fifth by the IMF and eighth by the CIA list.
It is a way of looking at 'how' the USA is spending its money per person. How much the USA earns and how outsourcing and the lack of manufacturing effects the people of this nation.
Page 981, lines 12 through 19:
TITLE V—OTHER PROVISIONS
Subtitle A—Drug Discount for Rural and Other Hospitals
SEC. 2501. EXPANDED PARTICIPATION IN 340B PROGRAM.
(a) EXPANSION OF COVERED ENTITIES RECEIVING DISCOUNTED PRICES.—Section 340B(a)(4) (42 U.S.C. 256b(a)(4)) is amended by adding at the end the following:
This is not a subsidy provision, it lifts restrictions on hosptials to participate in group purchase, including generic substitution, of pharmaceuticals to bring down the cost of health care.
Page 993, lines 1 through 12 and Pages 21 through 25:
Subtitle B—School-Based Health Clinics
SEC. 2511. SCHOOL-BASED HEALTH CLINICS.
(a) IN GENERAL.—Part Q of title III (42 U.S.C. 280h et seq.) is amended by adding at the end the following:
‘‘SEC. 399Z–1. SCHOOL-BASED HEALTH CLINICS.
‘‘(a) PROGRAM.—The Secretary shall establish a school-based health clinic program consisting of awarding grants to eligible entities to support the operation of school-based health clinics (referred to in this section as ‘SBHCs’)....
...‘‘(A) evidence that the applicant meets all criteria necessary to be designated as an SBHC;
‘‘(B) evidence of local need for the services to be provided by the SBHC;...
I don't want to hear from Right Wing political extremists how the government is going to be handing out condoms to children. It is the most outrageous idea I have ever heard. The House bill provides for the establishment of School Based Health Clinics in areas of the country and in communities where they do not exist today. This is an opportunity to bring better health care to all the children of the USA. I don't want to hear it, because this provision does not effect everyone, as they have to 'qualify' for the clinics to fill a need that is unfulfilled today.
Page 999, lines 5 through 15:
‘‘(C) OPTIONAL SERVICES.—Additional services, which may include oral health, social, and age-appropriate health education services, including nutritional counseling.
‘‘(2) MEDICALLY UNDERSERVED CHILDREN AND ADOLESCENTS.—The term ‘medically underserved children and adolescents’ means a population of children and adolescents who are residents of an area designated by the Secretary as an area with a shortage of personal health services and health infrastructure for such children and adolescents.
Page 1001, lines 9 through 11 and lines 21 through 24 and Page 106, lines 15 through 23:
Subtitle C—National Medical Device Registry
SEC. 2521. NATIONAL MEDICAL DEVICE REGISTRY....
...‘‘(g)(1) The Secretary shall establish a national medical device registry (in this subsection referred to as the ‘registry’) to facilitate analysis of postmarket safety and outcomes data on each device that—...
...(2) EFFECTIVE DATE.—The Secretary of Health and Human Services shall establish and begin implementation of the registry under section 519(g) of the Federal Food, Drug, and Cosmetic Act, as added by paragraph (1), by not later than the date that is 36 months after the date of the enactment of this Act, without regard to whether or not final regulations to establish and operate the registry have been promulgated by such date.
This is self explanatory.
Page 1008, lines 4 through 16:
Subtitle D—Grants for Comprehensive Programs to Provide Education to Nurses and Create a
Pipeline to Nursing
SEC. 2531. ESTABLISHMENT OF GRANT PROGRAM.
(a) PURPOSES.—It is the purpose of this section to authorize grants to—
(1) address the projected shortage of nurses by funding comprehensive programs to create a career ladder to nursing (including Certified Nurse Assistants, Licensed Practical Nurses, Licensed Vocational Nurses, and Registered Nurses) for incumbent ancillary health care workers;
The word 'pipeline' is a bit odd unless one is discussing oil and gas, but, in this case the words 'Clinical Ladder' would have been far more important. It is a program to facilitate the movement of health care workers from vocational programs to higher education and RN jobs. It is a good idea and will provide for more 'career' oriented persons in the health care field of nursing.
That is basically 'it' for the HOuse health care bill. The provisions that add people receiving subsidies above the 200% level of poverty has to be an amendment because I didn't find any 'scale' of income attached to any of these provisions as is being discussed in the media. So, the House Bill is substantial in how it addresses the issues of Health for the people of the nation, how it relies on previous legislation to validate its precedent status, measures in addressing the issues of the nation in a continuous and 'responsive' mannner and how the provisions are implemented and enforced.
The 'body' of the bill is significant and cannot be altered in the future, however, the amendments can be modified and of course amendments can be added to it, but, that is the case of all USA legislation.
I like the House Bill. The country needs reform in this industry. The reform has been neglected for nearly two decades that Republicans held majorities in the USA and it is time to get on with it. I don't want to hear how after these bills are passed, people within the borders of the USA died because the legislation wasn't passed in time. No more delays.
