The most important words President Obama said were, "threat serious...urgent...swiftly...together...time is running out...we can reverse it...

China is becoming a major player in the reversal of Human Induced Global Warming. Now, the two greatest contributors to the Earth's warming problem, China and the USA are partners in the future of generations.

I want to thank the Chinese people and their government for taking their responsibility so seriously and I want to thank President Obama and the Democratic leadership for setting an example of urgency the global community is taking seriously.

...China's President Hu Jintao (click title to entry - thank you) announced plans to cut emissions significantly by 2020...

There are deaths in Georgia. I don't know why. The rain has lasted for eight days. I mean when do people see the creek rising?

Do NOT wade into waters !

Nothing else to understand. DO NOT allow waters that are overflowing their banks to come in contact with your skin and if you do, go to a shelter immediately and ask for access to clean and dry clothes following a shower with soap and water.

END OF DISCUSSION !

In Atlanta, Raw Sewage In Chattahoochee River Adds To Flooding Woes (click title to entry - thank you)
By Mark Memmott
Torrential rains that have already led to at least half a dozen deaths in the Southeast have now produced flooding that overwhelmed a water treatment plant in Atlanta this morning, "causing a massive dump of raw sewage" into the Chattahoochee River, The Atlanta Journal-Constitution reports.
According to the newspaper, "the R.M. Clayton plant is the largest in Georgia with capacity to treat 240 million gallons of sewage a day."
One bit of good news: Lake Lanier, which supplies most of Atlanta's water, has been partly replenished.

What the hell is going on in this country? Have people become complete baffons? When there is this amount of rainfall it didn't happen without warning?

What is everyone saying? "Gosh, Martha, we got a little of rain outside?" Is that the kind of idiocy that exists these days. Waiting for someone to tell you it is time to hit the highway and get out of Dodge? Think people, there are scalebacks in government and the Sherrif might not be coming to the neighborhood to rescue you when the OBVIOUS is all around.

The 'deluges' of water from the sky will result in huge accumulations of water very, very quickly actually. My insulting remarks is to get the point across, people HAVE TO think and react to such dire consequences as they happen. This is an extremely different climate and there is no time to waste when 'tropical rainfall' hits downtown Atlanta and the suburbs. YES, that is correct. The deluges are the equivalent of a tropical rain event.

Rainfall totals released by Weather Service (click here)
By Mike Morris
The Atlanta Journal-Constitution
The National Weather Service has released some rainfall totals measured at selected measuring sites for the 8-day period ending at 8 a.m. Tuesday:
Canton -- 17.14 inches
Doraville -- 13.88 inches
Chamblee -- 13.19 inches
Lafayette -- 12.73 inches
Sautee -- 11.47 inches
Hartsfield-Jackson International Airport -- 11.23 inches
Dallas -- 11.09 inches
Gainesville -- 10.27 inches
Cartersville -- 7.59
Macon -- 9.46 inches
Athens -- 8.72 inches

Septermber 22, 2009
15:30:14z
UNISYS North and West Hemisphere Water Vapor Satellite (click here for 12 hour loop)




In the satellite above, there is a profoundly simple identification of the mixture of hot tropical air from the Equator mixing with cold Arctic Air over the USA. I would not expect this weather pattern to change in the near future.

September 21, 2009
Suwanee, Georgia
Photographer states :: Suwanee Creek Greenway flooding

The weather at Glacier Bay National Park (Crystal Wind Chime) is warm and seasonal.

Local Time: 7:51 AM AKDT (GMT -08)

Lat/Lon: 58.8° N 137.0° W

Elevation :: 33 feet

Temperature :: 46 F

Conditions :: Overcast

Windchill :: 45 °F

Humidity :: 93%

Dew Point :: 45 F

Wind :: 4 mph from the NE

Pressure :: 29.83 in (Rising)

Visibility :: 10.0 miles

UV :: 0 out of 16

Clouds :: Overcast 1100 ft
(Above Ground Level)

Last updated September 18, 2009 6:43 p.m. PT
Pollock survey shows fewer fish than anticipated (click title to entry - thank you)
By MARY PEMBERTON

ANCHORAGE, Alaska -- Pollock numbers in the Bering Sea continue to remain depressed despite expectations from government scientists that large amounts of young fish were growing to harvestable size.
Two surveys provide a dim outlook for the bland, white fish that accounts for the largest commercial fishery by weight in the United States worth about $1 billion after processing. The meat is used mostly in fish sticks and fish-fillet sandwiches and to make imitation crab meat.
The 2009 survey data was presented Friday at the North Pacific Fishery Management Council meeting in Seattle. While preliminary, it confirmed the pollock population remains low.
Doug DeMaster, director of NOAA's Alaska Fisheries Science Center in Seattle, said the pollock spawning biomass has declined below target levels.
"Fewer young fish entered the population between 2001 and 2005," he said.
The surveys were 24 percent below what scientists expected, said Jon Warrenchuk, a fisheries biologist for conservation group Oceana who attended the meeting.

"This is the lowest survey biomass they have ever seen, which is kind of worrisome," he said.
Pollock population estimates were low even before Friday's news. The previous assessment indicated that the 2008 spawning biomass was at its lowest level in nearly 30 years....

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.

"Morning Papers" - Its Origins

The Rooster

"Okeydoke"

"It wasn't that I had a bad relationship with the president. It just didn't exist." stated Woolsey.

Nothing will ever change in Washington, DC, UNTIL the changes finally come. And the 'establishment' won't like it.

The other five CIA Directors dont' really matter, especially Goss and Hayden. They are all Republican appointees and who needs it anymore. The Cold War is over and I suppose they haven't gotten the word on that either.


John Deutch is the one in the middle.

IMPROPER HANDLING OF CLASSIFIED INFORMATION BY JOHN M. DEUTCH (click here)
(1998-0028-IG)
February 18, 2000

After Deutch left the CIA, it was learned he had personal laptops marked as classified. He was never prosecuted for it.

...The discovery of classified information on Deutch's unclassified computer on December 17,1996 was immediately brought to the attention of senior Agency managers. In January 1997, the Office of Personnel Security (OPS), Special Investigations Branch (SIB), was asked to conduct a security investigation of this matter.1 A technical exploitation team, consisting of personnel expert in data recovery, retrieved the data from Deutch's unclassified magnetic media and computers. The results of the inquiry were presented to CIA senior management in the spring and summer of 1997....

Neocons aren't running the White House or Executive Branch anymore. Maybe 'the word' hasn't gotten out yet ! Who put them all up to it, Cheney?


James Woolsey is a neocon and a advisor to the Libby Legal Defense Trust. You know the guy, Scooter Libby, the one that helped out a CIA agent in Valerie Plame. Yeah, that guy. Woolsey is an advisor to Scooters Defense Trust.

7 ex-CIA chiefs ask Obama to abort Holder's probe (click title to entry - thank you)


September 18, 2009


5:24 pm


Warning that the new Justice Dept. probe into past CIA activities will "create an atmosphere of continuous jeopardy," seven men who've run the intelligence agency under presidents of both parties over the past 35 years called today for President Obama to abort the investigation....

The Uninsured Working Age American has a 40% higher risk of dying in the USA.

Nearly 45,000 annual deaths (click here) are associated with lack of health insurance, according to a new study published online today by the American Journal of Public Health. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.
The study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.
“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”...

Health Insurance Reform, the USA needs to recapture the health of its citizens.

One other thing I found fascinating. I received a new Lincoln penny the other day in some change from a purchase. I didn't know there was a new penny minted. It is really very nice. I love it. Love the artwork, too. I put it aside until I at least get another one.

Remember what Bush did when he got into office? With the currency. He wanted to melt down pennies and forget there was ever a denomination that small and he minted all these dollar bills with colors and gold leaf on them.

Pennies are important again. I like it. I like it a lot. It matches the color of the print I indicate are 'my words' to distinguish from newsprint. Yep. I have a small incomplete collection of 'Wheat Pennies.' Yep. Buffalo head nickels, too. I have nearly a complete set of them. Yep.

Honest Abe.



President Barak Obama is NOT a politician before he is this country's President. This speech took place in Texas where the Governor plays the electorate for fools in declaring he wants to secede from the nation.

This speech was in Texas where impoverishment of 'humanitarian values' is held near and dear to their hearts as a means to fight socialism.

Would Georgie Bush or Dickie Cheney ever take the chance of being booed at a rally of Democrats in Fint, Michigan? No. Their public appearances were insulated and orchestrated.

Hello? Our President is a real President. Hard to recognize I know since its been so long since we had one.

He went to Texas to initiate 'outreach.' He is a "Politician without Borders." I didn't see Governor 'what's his name,' oh, yeah, Perry there either.

From the New York Times (click here)

Cost of health insurance rising faster than pay (click here)
Associated Press
10:02 a.m. CDT, September 17, 2009
WASHINGTON - A national advocacy group says health insurance premiums rose five times faster than earnings in Illinois from 2000 to 2009.
The report released Thursday says, on average, the annual insurance premium for a family paid by employers and workers rose from $7,220 to $13,397. That's an increase of nearly 86 percent.
The workers' portion rose at an even steeper pace.
Meanwhile, the median earnings of Illinois workers rose just 17 percent, from $26,806 to $31,414.
The report comes from Families USA, a group working to expand health care coverage. The group based its findings on federal data.
Congress is considering several bills that aim to restrain costs. But benefits consultants have said if any reform is passed this year, it won't have a major effect for a few years.

Let's do some reading. I think I left off with Page 600 or something close to that. It was the penalities to institutions that dragged their feet and broke the rules. That went on for awhile. Let's see.

Here is the paragraph that speaks to the closing of facilities:

Page 601, a word at the end of 14 to line 24:

...and some portion of such funds may be used to support activities that benefit residents, including assistance to support and protect residents of a facility that closes (voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to home and community based settings or another facility), projects that support resident and family councils and other consumer involvement in assuring quality care in facilities,...

The Secretary intends to collect the money, too. They ain't messin' around. Well, they can't. People's quality of life and well being are on the line. You know?

Page 603, lines 15 through 25:

‘‘(IV) COLLECTION OF CIVIL MONEY PENALTIES.—In the case of a civil money penalty imposed under this clause, the Secretary— ‘‘(aa) subject to item (bb), shall, not later than 30 days after the date of imposition of the penalty, provide the opportunity for the facility to participate in an independent informal dispute resolution process...

Page 607, lines 6 through 14:

(1) IN GENERAL.—The Secretary, in consultation with the Inspector General of the Department
of Health and Human Services, shall establish a pilot program (in this section referred to as the ‘‘pilot program’’) to develop, test, and implement use of an independent monitor to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities.

This is an important provision and I am going to tell you a true story as to why this is important. It might not seem like a true story, but, it is. Has nothing to do with HIV/AIDS either.

There is a chain of nursing homes in this country that specializes in 'ventilator dependant' patients. Patients on vents are sometimes quadraplegics and need continuous monitoring. If a family is unable to care for them at home, the patients are placed in one of these nursing homes. The nursing home itself is very different than an ordinary facility. They have operating rooms where 'procedures' are performed and an emergency room that doesn't really accept patients for treatment, except for an occassion drunk that wanders in. The reason this chain has these 'extra' facilities is because it ranks them as an acute care facility and they are able to charge more for their services. They really are 'faux' hospitals, but, are sincerely 'dumping grounds' for nursing home patients no one else wants to accept.

There was a 19 year old man involved in a car accident where he was a passenger. He suffered a spinal cord injury that made him a quadreplegic.

Nice guy.

When he made it to the hospital emergency room, Level 1 Trauma Center, his cognition was intact. His cognition remained intact during his stay in the Intensive Care Units. He was stabilized. There came a time when there wasn't anything else the hospital could do for him and he needed to go home. His parents, people like you and me that would be grateful to have him alive, were unable to care for him. So, it was decided he would have to be placed in a nursing facility that would provide care to vent dependent patients.

About three days after his discharge, he was readmitted to the same exact Intensive Care Unit that sent him to the nursing facility. This time, however, he was without the cognition he left with. He had suffered an anoxic event. The event was so prolonged that he had a heart attack as well. There was significant damage to his body systems and he died approximately two weeks later in kidney failure as well as myocardial damage.

The nursing home facility had 'on staff' nurses certified in ACLS. As a matter of fact, all their nurses are certified in ACLS. One would think a person on a vent would be in the best of care in such a facility. However. That is not the case. The reason the nurses needed to be Certified in Advanced Cardiac Life Support is because there were frequent events where patients, including quads (sometimes in halo traction) unable to help themselves, would come off their vent. They would cough and sometimes plug their trachea tubes. They would have their vent tubing come off their trachea tubes. So, the anoxic events were an issue in this facility and the administrators had to come up with a way to 'MAKE THEM ALIVE' in case they died while 'on a ward' or in a 'multi-bed' room.

You see, vent alarms go off so frequently and there is less staff then necessary to maximize profits, that the nurses can't keep up with the care and if they simply run around putting out vent alarms they never get any of their medications passed or documentation done.

So, every once in awhile, when a patient is left on an alarm a little to long, they have to 'MAKE THEM ALIVE' even though they died. Hence, many patients with cognitive issues. But, they are cared for, right? I mean someone has to do it. And it is a good business for the economy as it employs folks and all that mess. There are very few visitors after a time.

So, this 'pilot' project is far, far overdue. Yep.

Page 208, lines 4 through 13:

(b) REQUIREMENTS.—The Secretary shall evaluate chains selected to participate in the pilot program based on criteria selected by the Secretary, including where evidence suggests that one or more facilities of the chain are experiencing serious safety and quality of care problems. Such criteria may include the evaluation of a chain that includes one or more facilities participating in the ‘‘Special Focus Facility’’ program (or a successor program) or one or more facilities with a record of repeated serious safety and quality of care deficiencies.

The House really has been working on this bill for some time now. I can tell.

Page 608, lines 14 through 17 and 23 through 25 and Page 609, lines 1 through 3:

(c) RESPONSIBILITIES OF THE INDEPENDENT MONITOR.—An independent monitor that enters into a contract with the Secretary to participate in the conduct of such program shall—...
...(2) undertake sustained oversight of the chain, whether publicly or privately held, to involve the owners of the chain and the principal business partners of such owners in facilitating compliance by facilities of the chain with State and Federal laws and regulations applicable to the facilities;

I guess they didn't want health care insurance reform, now did they?

Page 612, lines 14 through 23:

‘‘(7) NOTIFICATION OF FACILITY CLOSURE.— ‘‘(A) IN GENERAL.—Any individual who is the administrator of a skilled nursing facility must— ‘‘(i) submit to the Secretary, the State long-term care ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties, written notification of an impending closure—

Page 620, lines 1 through 13:

Subtitle C—Quality Measurements
SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR QUALITY IMPROVEMENT.
Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end the following new part:
‘‘PART E—QUALITY IMPROVEMENT
‘‘ESTABLISHMENT OF NATIONAL PRIORITIES FOR PERFORMANCE IMPROVEMENT
‘‘SEC. 1191. (a) ESTABLISHMENT OF NATIONAL PRIORITIES BY THE SECRETARY.—The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.

I think it sounds like a good idea.

Page 620, lines 19 through 24 and Page 621, lines 1 through 15:

‘‘(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES.—With respect to such priorities, the Secretary shall ensure that priority is given to areas in the delivery of health care services in the United States that—
‘‘(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic diseases;
‘‘(2) have the greatest potential to decrease morbidity and mortality in this country, including
those that are designed to eliminate harm to patients;
‘‘(3) have the greatest potential for improving the performance, affordability, and patient centeredness of health care, including those due to variations in care;
‘‘(4) address health disparities across groups and areas; and
‘‘(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons.

It looks self-explanatory. There isn't anything sinister about it.

Page 623, lines 23 through 25 and Page 624, lines 1 through 2 and Page 625, lines 1 through 3:

‘‘(c) DEVELOPMENT OF QUALITY MEASURES.—
‘‘(1) PATIENT-CENTERED AND POPULATION BASED MEASURES.—Quality measures developed under agreements under subsection (a) shall be designed—
‘‘(2) AVAILABILITY OF MEASURES.—The Secretary shall make quality measures developed under this section available to the public.

I'll end there for tonight.

Until later...

The photos of GIs fighting in Vietnam were far more gruesome and bloody than this.

President Obama has promised transparency to his administration and there should not be censorship by the USA military. This isn't the Bush/Cheney years of paranoya anymore. The Associated Press had every right to publish what they felt was appropriate for the context of their news story.

We believe in democracy and have complained of lies in the media, it is hardly appropriate we propagate any lies or deceptions to the American people. Censorship is a form of deception. It is like putting blinders on the public. It is unethical. The American people have a right to know what their military is sacrificing.

I believe in the wars in Pakistan and Afghanistan. I hate the killing more than anyone. But, to allow international criminals access to two countries and one with nuclear potential is unrealistic. If soldiers are to be spared this fate, which they should be, that means there will be more civilian deaths due to more aggressive weapons. The entire war in Afghanistan doesn't make sense to me. Either there is a war to fight and we protect our military from harm or there isn't. This 'mess' of protecting civilians as if they are immune from the battlefield is hideous. If they choose up sides and decide it is more beneficial from a 'warlord' perspective to join the Taliban than they made their choice. The people of Afghanistan either move out of the way of 'shortening and capturing' the battlefield or they don't. But, that is just my opinion.

If the war in Afghanistan is proceeding so poorly, the military needs to weigh the stakes against the outcome. If the American people are going to be disgusted with the photos being published, there needs to be a strategy to success in Afghanistan that will deliver the same outcome.

I don't see a whole lot different between this photo and the flag drapped coffins coming into Dover. One leads to the other.

There were many more issues with Vietnam. The Nixon administration invoked a draft of 19 year olds with a lottery and demonstrators were being killed on college campuses. The dynamics of opposition were different. Today, there were significant deaths for Italy and in that the Prime Minister Silvio Berlusconi called for the withdrawal of their forces. He is also involved in a tough election in Italy as well and it serves his purpose to ask for withdrawal even though it may not occur.


The war in Afghanistan has been allowed to deteriorate by the past administration and deteriorate it has. It is my opinion, it is by far the most dangerous place in the world today and if left to the devices of the Taliban any abandonment by all military forces will result in the return of power to them and a return to neglect of the world only to repeat what has occurred before.

Afghanistan is a disaster area. It is where the Taliban and international terrorists have taken haven from the attacks by The West to end their capacity to strive to destroy civilization as it exists in any country and not just the USA and Europe. As far as I am concerned, there was such gross neglect by the Bush/Cheney administration Afghanistan is a global emergency.

It is not another Vietnam that if left alone will heal its ills. Vietnam had no designs on killing innocent people in far away countries, nor achieving domination of global culture. Afghanistan is different. The consequences are higher.

The Geneva Conventions exist. Yes, they do. But, nowhere in those accords does it state civilized nations have to sacrifice their military or accept defeat for the sake of civilians in a country that has been allowed to become the enemy to the world. Charlie Wilson's War didn't fail because the USA did not send money for infrastructure improvements. Charlie's war was a defeat because he facilitated 'the base' of al Qaeda, while Russia signed onto the Geneva Convention of War. Why do I believe diplomacy with Russia to achieve the same outcomes while limiting the spread of international terrorists would have been a far better idea?

USA militaries are not supposed to have decade long wars and sustained body counts. It is supposed to end the dangers to the country and civilization and pay reparations afterward. If the war is wearing on American's patience AND their treasury that is all part of the battlefield picture. I suggest Secretary Gates, the Joint Chiefs and their generals start assessing the battlefield as it is, not as a politician would want it to be.


In this photo taken Friday, Aug. 14, 2009, Lance Cpl. Joshua Bernard is tended to by fellow U.S. Marines after being hit by a rocket propelled grenade during a firefight against the Taliban in the village of Dahaneh in the Helmand Province of Afghanistan. Bernard was transported by helicopter to Camp Leatherneck where he later died of his wounds. (AP Photo/Julie Jacobson)

Elder organization states, "Senate Health Insurance Reform NOT Good Enough."

...B’nai B’rith has some major concerns about the Senate Finance bill, which would still allow charging older people significantly more for coverage," says its release. "The bill also lacks a workable mechanism – such as a public option – that would force insurance companies to compete for our business, even in traditionally monopolistic markets like rural areas. The weakness of incentives for employers to have and maintain coverage for their workers is also an issue. And we are also concerned about the failure to include the CLASS ACT (from the Senate HELP bill), which would encourage long-term coverage in a revenue-neutral way....

The equivalent of Duck and Cover. The Poles and Czechs will have to resort to diplomacy leading to peace rather than aggression.

...In one of the sharpest breaks yet with the policies of the Bush administration (click title to entry - thank you), Obama phoned the leaders of Poland and the Czech Republic last night to tell them that he had dropped plans to site missile interceptors and a radar station in their respective countries. Russia had furiously opposed the project, claiming it targeted Moscow's nuclear arsenal.
Obama is to announce the reversal officially at a news conference today. This morning the Czech prime minister, Jan Fischer, revealed that Obama phoned him about it last night....

Let's get started. Russia played a huge role in defeating Hitler's Nazi War Machine. Russia took and held an entire border of Germany by themselves, they were the first to discover the 'Nazi Death Camps' and they were the first to retake Berlin.

Russia and Poland continue to argue over the Second World War (click here)
This online supplement is produced and published by Rossiyskaya Gazeta (Russia), which takes sole responsibility for the content

On September 1, at the ceremony to mark the 70th anniversary of the Second World War in Poland, Russian Prime Minister Vladimir Putin and his Polish counterpart Donald Tusk exchanged barbs over the legacy of the war. But why has the controversy over historical memory erupted in recent years, and why can’t it be left to historians?...

Pope to be accompanied by 100 people on visit to Czech Republic (click here)

Benedict XVI, 82, and his team will fly to Prague aboard a plane of the Italian Airlines. He will return to Rome by a Czech special plane.
The Pope's team will also include a personal doctor, his assistant, two interpreters, an official photographer and three experts in liturgical ceremonies.
On the other hand, Benedict XVI never takes a personal cook to his trips abroad as he is not on a special diet, a clerk, from the Vatican administration, told CTK.
The Vatican also confirmed that Benedict XVI would spend two nights in the Czech Republic in the seat of the Vatican diplomatic mission in Prague, Federico Lombardi, spokesman for the Vatican state secretariat, told CTK.
Two bulletproof "papa-mobiles" (cars specially adjusted for the Pope) were sent to the Czech Republic two weeks ahead of the visit. A Czech policeman is to drive them.
Hundreds of Czech policemen will protect the Pope during his three-day visit to the Czech Republic on September 26-28.
The security measures are to be as tight as during the April visit by U.S. President Barack Obama to Prague....

Thank you, Senator Baucus. I am happy for everyone, the Senate, the people of the USA and President Obama. It's really going to happen.

The Compromise Bill will be very interesting. The House and Senate needs to pass their final bills and move it to committee to finalize the Bill the President will sign. I congratulate the Democrats for fighting and continuing to fight an incredibly uphill battle for so very long. This is a wonderful legacy to the memory of Senator Kennedy as well.

...The House version of the health legislation (click title to entry - thank you) would require some employers to pay as much as 8% of payroll as a fine if they don’t offer coverage to workers. Under the Senate Finance measure, employers who decline to provide coverage would face a smaller penalty, and in narrower circumstances.
The Senate Finance legislation — set to be unveiled on Wednesday — says employers with more than 50 full-time workers would pay a $400 fee for each employee if they don’t offer health insurance. The fee would be triggered if any employees apply for federal tax credits to buy coverage....

Health Care Insurance Reform. The nation wants it and physicans approve of it. Time to get it done !

...When polled, "nearly three-quarters of physicians supported some form of a public option (click here), either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September....

The majority in TWO physician opinion polls shows a consistency in favor of the Bill for Reform that includes BOTH private and public options. We need to get this done, the nation is waiting for it. Enough already.


...Overall, a majority of physicians (62.9%) supported public and private options (click title to entry - thank you) (see Panel A of graph). Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001),>

The squeakiest wheel gets the most attention. That would be the case with Health Care Insurance Reform in the USA. In more and more polls across the country there is considerable consent for reform. The poll above is from The New England Journal of Medicine's current issue of September 10, 2009. The country is reconciled to have reform, it is simply the noisest and least informed that are opposed to it.

...On health care reform Rasmussen reveals that a majority of people (51%) (click here) actually support reform as opposed to a minority (46%) that oppose. While Rasmussen still has a "large intensity gap" between the number strongly supporting reform and strongly opposing reform a ABC/Washington Post poll finds that gap closing. The Rasmussen numbers are nearly a new high for support and is tremendous jump from the lows of August when (53%) actually opposed reform...

I left off the review on Page 151, that is more than half way through the proposed legislation.

Page 151, lines 6 through 15 addresses the 'need to know' by the USA government of the nature of facilities that provide Long Term Care. This provision sets up the ability for the GAO (Government Accounting Office) to do so:

(c) GAO STUDY ON NURSING FACILITY UNDER CAPITALIZATION.—
(1) IN GENERAL.—The Comptroller General of the United States shall conduct a study that examines the following:
(A) The extent to which corporations that own or operate large numbers of nursing facilities, taking into account ownership type (including private equity and control interests), are
undercapitalizing such facilities.

This is a transparency measure so the people of the USA are aware of the structure of their health care system. One cannot sufficiently administer correct policy to reduce costs while still maintaining high quality health care without this information. There isn't anything sinister about it. The tone of the legislature is to empower facilities that provide care to do it well and efficiently.

There are people that need us to pass these bills and provide quality care to them, it's time to get this done and stop procrastinating.

Following these surveys by the GAO, the Comptroller will have 18 months to prepare a report to Congress.

The Bill goes on with its usual definitions, the particulars on the website that will carry information to the health care community as well as the public.

Page 555, lines 20 through 25 state there is going to be important information (of which this is a sample) on the website for consumers to consider when chosing a Long Term Care facility:

‘‘(vi) Summary information on the number, type, severity, and outcome of substantiated complaints. ‘‘(vii) The number of adjudicated instances of criminal violations by employees of a a nursing facility—

The States will be contributing information to the website as well. The surveys will be required to be updated every six months. That means every SNF (Skilled Nursing Facility / Long Term Care Facility) will be required to not only report their facts with the initial survey, but, every six months to maintain and improve on quality of care. There will be no 'flash in the pan' in improvement of care of people just to look good on a survey only to return to bad habits and poorer conditions.

Page 560, lines 20 through 25 and Page 561, lines 1 through 6 states:

‘‘(i) Staffing data for each facility (including resident census data and data on the hours of care provided per resident per day) based on data submitted under subsection (b)(8)(C)(ii), including information on staffing turnover and tenure, in a format that is clearly understandable to consumers of long-term care services and allows such consumers to compare differences in staffing between facilities and State and national averages for the facilties. Such format shall include—

The Bill seeks to be helpful to consumers while empowering them with Federal laws that will require good quality care PERFORMANCE.

Page 568, lines 7 through 18 is to be sure there are provisions that allow the States and Federal government to communicate and develop together web-based information to close the 'gap' to consumers for well informed decisions:

(1) GUIDANCE.—The Secretary of Health and Human Services (in this subtitle referred to as the ‘‘Secretary’’) shall provide guidance to States on how States can establish electronic links to Form 2567 State inspection reports (or a successor form), complaint investigation reports, and a facility’s plan of correction or other response to such Form 2567 State inspection reports (or a successor form) on the Internet website of the State that provides information on skilled nursing facilities and nursing facilities and the Secretary shall, if possible, include such information on Nursing Home Compare.

There is provisions for protections for Whistle Blowers. too.

Page 575, lines 1 through 11:

‘‘(C) WHISTLEBLOWER PROTECTION.— ‘‘(i) PROHIBITION AGAINST RETALIATION.—No person who works at a skilled nursing facility may be penalized, discriminated, or retaliated against with respect to any aspect of employment, including discharge, promotion, compensation, terms, conditions, or privileges of employment, or have a contract for services terminated, because the person (or anyone acting at the person’s request) complained,

The provision is a lot longer than those 11 lines.

Within the reporting the facilities have to perform is the status of the 'staff' of the facility. That status is to be derived from recorded payroll data. The 'measure' of stating the reporting is to be from payroll data is to insure accuracy in reporting. It demands accuracy so a 'source' of auditing can be conducted to be sure the 'patient : professional staff ratio' is best for the residents of that facility. In other words the Bill states clearly where reporting information on exact type of staff is coming from to insure there cannot be any misunderstanding or misreporting. That is the only reason any mention is made of 'payroll data.' It isn't about monitoring what people are paid, so much as whom is getting paid in relation to the capacity they serve the residents.

Page 588, lines 14 through 25 and Page 589, lines 1 through 4 addresses monetary penalites any non-compliance with the law will be rendered. The Bill delineates that there will be penalities and not a suspension of payment of Medicare or Medicaid benefits so there is no undo outcomes to residents depending on the facility. I am sure of the facility is a chronic offender, the facility will face possible sanctions on accepting patients for care with potential of closing their doors. The line has to be drawn somewhere otherwise the Bill becomes meaningless.

SEC. 1421. CIVIL MONEY PENALTIES.
(a) SKILLED NURSING FACILITIES.— (1) IN GENERAL.—Section 1819(h)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395i– 3(h)(2)(B)(ii)) is amended to read as follows: ‘‘(ii) AUTHORITY WITH RESPECT TO CIVIL MONEY PENALTIES.—
‘‘(I) AMOUNT.—The Secretary may impose a civil money penalty in the applicable per instance or per day amount (as defined in subclause (II) and (III)) for each day or instance, respectively, of noncompliance (as determined appropriate by the Secretary).

This provision of hte bill is quite extensive and spells out all the particulars of the penalities, how the monies will be collected, the participation of the States and so on and so forth. The provision goes past page 606 and it is here I will end for now. I'll return to it later.

Write your legislators and ask to have this Bill moved forward. Thank you.

Have a good day.

Lake Tiberias (Sea of Galilee), Northern

Posted September 14, 2009