I encourage everyone to write to their Representatives and Senators regarding support for The Public Option. The legislators need to hear from their constituencies. Someone needs to come up with a way of providing 'validation' in their mailings to allow those in the legislator's office know it is actually a constituent they are hearing from and not a Neocon Phone Bank or some Repbulican on a pilgramage to every legislator in the phone book.
The Democrats across the board are in support of The Public Option. The media attempting to derail this to benefit their 'wealth management' are relying on 'a significant minority' of Independants that don't know their own minds. Independants 'pull this kinda stuff' when they feel 'uncertain' about decision making. They figure they'll get a party in power they can manipulate when it suits them. The Party in Power at this point needs to find 'their backbone' and stand up for what Democrats believe in.
This waivering by Independants will happen again and again and again. Democrats need to 'get to get used to it.' The majority of Democrats that stayed united during the Bush Years are still united and what their agenda passed. It is time to get on with it.
White House Senior Adviser David Axelrod talks to reporters about Health Care reform outside the West Wing of the White House in Washington, Wednesday, Sept. 2, 2009. (AP Photo/Gerald Herbert)
I think one of the things I would want to know is, what is a health care disparty? Yes?
First, let's dispell another lie by the politics of 'wealth management.' I think it is important to 'keep my eye on the ball' including the difficult fight of maintaining 'the truth' within the struggle for equitable health care for all citizens.
In the article below, I am assuming the merchants are referring to legal immigrants that come to the USA seeking opportunity for themselves and their families. These immigrants are working class folks engaged in employment with the merchants.
Local small businesses come out in support of health care reform (click title to entry - thank you)
Sunday, September 6th 2009, 4:00 AM
Among the many lies and distortions spread by those intent on derailing health-care reform at any cost, one of the most persistent is that business owners don't want any part of it.
That's why a group of small-business owners gathered in Jackson Heights, Queens, on Friday to set the record straight. Their intention was to let everyone know that they - like the majority of the American people - support real health-care reform.
"We feel health care is a right, not a privilege," said Julie Newman, the owner of Espresso 77, a Jackson Heights espresso bar where the group met. "Yet, we are a small business and we cannot afford to provide insurance to our employees. Something has to be done."
The merchants urged their elected representatives to go back to Washington and fight for a reform that includes a public plan and includes immigrants...
So. Health Disparities.
When I think of health disparities I think of 'socio-economic' lines and 'ethnic divides' when it come to the USA. In other words, there is a known difference in the incidence of hypertension in the African American Race in the USA. It is a known fact the occurrence is much higher than any Caucasian ethnicity.
In the case of Japanese Americans, their health is better in the USA than in Japan. The incidence of most diseases are lower when they live in the USA than in Japan. Within the populous of the USA, however, there are some Japanese men that have far higher incidence of Type II Diabetes, as high as 20% and many go undiagnosed.
So, that is the kind of delineation I see as a Health Disparity. However, I make no assumptions as to what the legislation means by it and I have not read any further along since my last entry.
True to form the legislation is seeing 'communication' as a health disparity and seeks to address a vital link between being informed in decision making and being on the outside of information no matter the technology.
Page 401, lines 7 through 14;
Why this is necessary, I refer to the issue of HIV/AIDS (One of the all time favorite topics of Americans for sure.) . In the 1980s when HIV was first isolated as a concern by the CDC, there was little information getting out to people, hence, there was a lot of 'populous' belief that was going around. Eventually, as the CDC became more knowledgeable of this new 'phenomena' it began to release information regarding same. The medical community reacted in the only way it could and that was to 'change' medical aseptic protocols to 'universal' protocols to isolate doctors and nurses from any opportunity of contracting the virus.
I might add at this juncture that there definately were medical professionals that died of HIV before it was known to be what it is. It isn't discussed in this society, but, it did occur.
That is NOT the point here. The point is that when the American Society finally began to educate the public regarding HIV/AIDS it was completely done in English. It was more or less directed at information campaigns that weren't addressing 'life sytles' of some Black women. As a result the Hispanic community and Black women were showing very high incidence of the disease. They were excluded from 'the communication loop' of education within the society of the USA.
In Lowell, Massachusetts there were home health agencies making rounds on children known to have HIV and giving transfusions of gammaglobulin to fight the effects of HIV/AIDS in childhood. At the time a significant number of these children were of Hispanic families. The immigrants, mostly illegal, were involved in substance abuse. Substance abuse among un or under educated (primarily men) was a cultural issue that reflected 'manhood.' These men didn't know they were breaking the law or poisoning themselves and their former cultures predisposed them to the danger of blood borne diseases.
At any rate, when the home health nurses went to do transfusions they also brought information with them regarding HIV/AIDS and it was among the first efforts in the USA to stop the spread of the disease in a Spanish speaking populous.
That is the 'disparity' this aspect of the House Health Insurance Reform Bill is addressing. Any and all information regarding choices in Health Insurance and 'health care' as well (I am assuming.) will be conducted in every available language of American citizens with emphasis directed at the community level. It is correct to have this provision in this legislation. More importantly, it is vital to have communication disparities addressed for many reasons, including, the ability to save lives.
The legislation goes on from this point regarding the particulars of developing the programs in hospitals, the cost and cost sharing and how this might effect physician payment, etc.
By the way, I am sure everyone is reflecting on the NEW JOBS that will be created within this bill, right? Where there are new services, there is job creation. Where there is job creation there is a wider tax base and I am sure everyone knows the dynamics from there.Evidently, there is an entire 'consideration' regarding immunosuppressant medications (referred to here as drugs) in the Medicare laws. There is some understanding regarding payment thereof. This legislation extends the coverage of these vital medications to 'transplant' patients at least two years. I am assuming during that time it is important for such issues to be addressed UNTIL 'the donut hole' (as mentioned in earlier entries) closes. That is my understanding of this section.
Page 420, beginning with line 1;
Subtitle C—Miscellaneous Improvements
SEC. 1231. EXTENSION OF THERAPY CAPS EXCEPTIONS PROCESS.
Section 1833(g)(5) of the Social Security Act (42 U.S.C. 1395l(g)(5)), as amended by section 141 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275), is amended by striking ‘‘December 31, 2009’’ and inserting ‘‘December 31, 2011’’.
SEC. 1232. EXTENDED MONTHS OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT PATIENTS AND OTHER RENAL DIALYSIS PROVISIONS.
(a) PROVISION OF APPROPRIATE COVERAGE OF IMMUNOSUPPRESSIVE DRUGS UNDER THE MEDICARE PROGRAM FOR KIDNEY TRANSPLANT RECIPIENTS.—
(1) CONTINUED ENTITLEMENT TO IMMUNOSUPPRESSIVE DRUGS.—
(A) KIDNEY TRANSPLANT RECIPIENTS.— Section 226A(b)(2) of the Social Security Act (42 U.S.C. 426–1(b)(2)) is amended by inserting ‘‘(except for coverage of immunosuppressive drugs under section 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth month’’.
Now, for everyone seeing nothing but dollar signs, I might reflect on the reality the legislation pays for itself.
ALSO.
Up to this point, Medicare traditionally covers folks in 'Their Golden Years.'
I might add here, if the USA has technology that extends people's lives through transplants there isn't much sense to it if they have to do nothing with their lives except pay for immunosuppressant medications.
An economy is BEST served in the USA when people are enjoying their lives and spending 'disposable income' on items other than medications. In other words, there would be more hotel rooms filled, more movie theater seats filled and more people listening to the band and on the dance floor when the USA economy works toward the 'enjoyment' of life rather than 'the daily grind.'
I also want to correct 'the name' of this legislation. The House Bill is called, "America’s Affordable Health Choices Act of 2009."
Page 425, lines 5 through 12. One of the more 'controversial' provisions. Before I enter this provision to be read, I want to relay 'the reality' of "Grief Councilors" that already exist in the American Health Care System landscape.
During the years of 1990 through 1995, there were a lot of innovative improvements made at The University of Medicine and Dentistry of New Jersey. It had the second largest population of HIV/AIDS (there I go again) patients in the nation. The first place winner to that title was San Francisco.
In place at UMDNJ were a variety of services, including a dedicated MD that supervised clinics of patients with HIV. He was a wonderful man with a great deal of compassion and dedication to all the people that fell under his gaze. He began one of the nation's first OB clinics for parents that would provide gammaglobulin to pregnant women. He also ran a Pediatric AIDS clinic. Needless to say, the university hospital complex was well funded, with 40% coming from the State, and it was one of the most progressive hospitals in the nation regarding infectious disease. UMDNJ saw it all. Everything from the "Mouse Retrovirus" to parasites in the brains of illegal immigrants. Parasites by the way that would be transmitted into society if the opportunity presented itself.
One of the provisions UMDNJ required of the hospital staff was to have a 'Grief Councilor' available at least 40 hours per week. This person regularly came to the ER for intervention with families. Mind you, this was somewhat of a rough neighborhood. About 16% of the patients that came through the Trauma Room doors were young men that fell victim to gun shot wounds and/or stab wounds. I could tell you a few stories, but, that would take awhile.
So, with a mild imagination, the 'understanding' of intervention can be gleaned by nearly anyone from this REALITY at an esteemed State Trauma Center.
To take this one step further, the 'idea' of any kind of 'medical education' is required in many instances 'by law' and definitively within the professions of practice in this field. Those words are Medical Education. Not the kind one embarks on to become a physician or otherwise, but, the education that accompanies making the public knowledgeable regarding issues of health, including Mental Health.
So, to realize the 'idea' of "Advanced Care Life Planning" is a vital necessity to physicians in their practice is to realize their 'burden' of supplying that information personally is removed with the placement of councilors prepared to carry out that 'dogma' of the medical society of the USA. Much of this is already done in hospitals in a measure called, "Advanced Directives." This provision is doing nothing but making sure this service is in place and paid for to insure its continuation.
That's all this is.
‘‘Advance Care Planning Consultation‘‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph, the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
That is basically all I am going to comment about here. It is called Quality of Life and everyone regardless of ethnicity or gender or age has their own definition.
The legislation goes on 'as usual' with definitions, providing toll free hotlines, it makes reference to "The Older Americans Act of 1965," and legal parameters. I also believe a very interesting aspect of this bill is its RESPONSIBILITY to whom sets these understandings in writing. The legislation does not SET THE STANDARD, but, only provides for it. The standard of practice is set by others that have not written this legislation, which removes any 'CONCEPT' of the USA government having control over life and death issues.
Page 428, lines 5 though 13,
‘‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
One of the changes that will occur in the practice of life sustaining interventions will be the inclusion of the verbiage of the individual either in doctors notes and/or orders. At least that is what I am reading here:
Page 429, lines 13 through 16 and page 430, lines 1 through 4;
‘‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—
‘‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
In other words, the Advanced Directives of any person can openly state, "DO EVERYTHING" and that would be reflected in the physicians words during his interventions as well. So realizing an Advanced Directive can also state, '...keep me alive to every measure possible...' sort of disavows all the fear mongering that has been going on.
The legislation goes on to state the Advanced Directive can be as customized as the individual cares to make it, use antibiotics, don't use antibiotics, use oxygen, don't use oxygen, do CPR, don't do CPR, call my family, don't bother, etc., etc.
Anyone besides me getting the 'idea' this is definitively a patient - physician relationship?
I mean if the physician has to enter into his order for medical care 'the words' of the patient as well, there is something intimately understood between those two people, yes?
Definately.
This legislation is based upon the idea there is nothing to interfer in that relationship even at the level of 'pulling the plug.' There is nothing here that states to me there is intent in any remote interpretation that the government has power over one's life or the relationship one has with their physicians. Nothing. If anything, this legislation INSURES there is nothing standing in the way of it, including, ill willed family. There is such a thing in some instances.
The legislation goes on its usual format stating definitions, the necessity for a handbook for people to refer to in making these decisions and the frequency of 'updates' to the handbook.
Page 435, line 17 begins to discuss Tricare. For those that don't know what Tricare is, it is a military option for health insurance.
Link to Tricare: http://www.military.com/kwlp08?ESRC=ggl_mem_ben_tric_kw.kw&nipkw=tricare
It primarily discusses enrollment. This is the heart of the provision, Page 435, lines 21 through 25;
‘‘(4) The Secretary of Defense shall establish a method for identifying individuals described in paragraph (1) and providing notice to them of their eligibility for enrollment during the special enrollment period described in paragraph (2).’’.
The reason I state this is the heart of the provision is because it defers all necessary enrollment to a methodology developed by The Secretary of Defense. That removes any federal authority from making decisions regarding the military interest in the bill. It is a measure of 'inclusiveness' and that is all it is.
The delicate aspect to enrollment with Tricare is dependents. We all know we sometimes lose our military personnel even in old age. So the enrollment has to be sensitive to the needs of families left behind that find themselves dependent on this provision.
The legislation goes on to limit the number and qualifications of 'experts' so to speak available to the Secretary of Health, Education and Welfare regarding the implementing of any aspects of this bill. The Secretary can have up to 30 advisors and no more. The qualifications are to be of the highest available in regard to the dynamics of administration of health standards in regard to this reform. There is also a mention in about five lines of divorce and the proceeds of a sale to a house in regard to paying Medicare B.
I am going to stop here as there is a major section beginning on Page 443, line 3 stating: "TITLE III—PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE
Being tomorrow is a National Holiday, I may not write on this subject tomorrow, but, will return to it on Tuesday. I will more than likely make an entry of some variety tomorrow.
Until then.
