HR3200 : Division B : Day Six

Division B, Title VII, Subtitle C covers payments to primary care practitioners, the medical home pilot program (as it will work under Medicaid), translation and interpretation services, option coverage for freestanding birth center services, and inclusion of public health clinics under the vaccines for children program.

Subtitle D begins by defining optional Medicaid coverage of low-income HIV-Infected individuals, extending transitional Medicaid assistance, and then defines the requirement for 12-month continuous coverage under certain CHIP programs. That’s it. I don’t know how or why those three topics relate to each other, but that’s all that is included in Subtitle D titled “Coverage”.

Subtitle E sets payments to pharmacists (Section 1741),

The Secretary shall calculate the Federal upper reimbursement limit established under paragraph (4) as 130 percent of the weighted average (determined on the basis of manufacturer utilization) of monthly average manufacturer prices.

Requires manufacturers to provide rebates for some drugs (Section 1742),

In the case of a drug that is a line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form, the rebate obligation with respect to such drug under this section shall be the amount computed under this section for such new drug or, if greater, the product of—

“(i) the average manufacturer price of the line extension of a single source drug or an innovator multiple source drug that is an oral solid dosage form;

“(ii) the highest additional rebate (calculated as a percentage of average manufacturer price) under this section for any strength of the original single source drug or innovator multiple source drug; and

“(iii) the total number of units of each dosage form and strength of the line extension product paid for under the State plan in the rebate period (as reported by the State).

In this subparagraph, the term ‘line extension’ means, with respect to a drug, an extended release formulation of the drug.”.

Extends the prescription drug discounts to enrollees (Section 1743), and affords payments for graduate medical education (Section 1744),

Subtitle F, another “waste, fraud, and abuse” section, allows the government to decide which “health care acquired conditions” will be be covered. In other words, the government will be allowed to ration what they pay for and what they don’t. Section 1751 states,

Medicaid non-Payment for certain health care-Acquired conditions.—Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended—

(1) by striking “or” at the end of paragraph (23);

(2) by striking the period at the end of paragraph (24) and inserting “; or”; and

(3) by inserting after paragraph (24) the following new paragraph:

“(25) with respect to amounts expended for services related to the presence of a condition that could be identified by a secondary diagnostic code described in section 1886(d)(4)(D)(iv) and for any health care acquired condition determined as a non-covered service under title XVIII.”.

In other words, if you are in the hospital and you contract a health care acquired condition, you will be rolling the dice as far as coverage is concerned. I’m sure that brings a lot of reassurance to those who will be staying in the hospital.

Section 1759 requires any billing agents, clearing houses, or alternative payees be registered under Medicaid. Every private payment system will be required to register with the government. How many regulatory hurdles will the Secretary impose on them before approving their registration?

Section 1902(a) of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended by sections 1631(b), 1703, 1753, and 1757, is further amended—

(1) in paragraph (76); by striking at the end “and”;

(2) in paragraph (77), by striking the period at the end and inserting “and”; and

(3) by inserting after paragraph (77) the following new paragraph:

“(78) provide that any agent, clearinghouse, or other alternate payee that submits claims on behalf of a health care provider must register with the State and the Secretary in a form and manner specified by the Secretary under section 1866(j)(1)(D).”.

Subtitle H covers technical corrections to the Social Security Act.

And with that, we finally come to the section where they draw the lines. Remember yesterday when I mentioned they had to draw the lines somewhere?

If they are mandating a minimum income to “qualify” for low-income Medicare, someone has to draw the line somewhere and I can guarantee you that the “we cover everyone” line is nowhere near the low-income line when they are drawn.

It took a few more pages, but we finally found it. Of course, this line only includes persons on Medicare, but heck, it’s a line. I knew they would be drawing lines. They always do.

Title VIII, Section 1801 defines the disclosures to facilitate identification of individuals likely to be ineligible for the low-income assistance under the Medicare Prescription Drug Program to assist the Social Security Administration’s outreach to eligible individuals.

Upon written request from the Commissioner of Social Security, the following return information (including such information disclosed to the Social Security Administration under paragraph (1) or (5)) shall be disclosed to officers and employees of the Social Security Administration, with respect to any taxpayer identified by the Commissioner of Social Security—

“(i) return information for the applicable year from returns with respect to wages (as defined in section 3121(a) or 3401(a)) and payments of retirement income (as described in paragraph (1) of this subsection),

“(ii) unearned income information and income information of the taxpayer from partnerships, trusts, estates, and subchapter S corporations for the applicable year,

“(iii) if the individual filed an income tax return for the applicable year, the filing status, number of dependents, income from farming, and income from self-employment, on such return,

“(iv) if the individual is a married individual filing a separate return for the applicable year, the social security number (if reasonably available) of the spouse on such return,

“(v) if the individual files a joint return for the applicable year, the social security number, unearned income information, and income information from partnerships, trusts, estates, and subchapter S corporations of the individual’s spouse on such return, and

“(vi) such other return information relating to the individual (or the individual’s spouse in the case of a joint return) as is prescribed by the Secretary by regulation as might indicate that the individual is likely to be ineligible for a low-income prescription drug subsidy under section 1860D–14 of the Social Security Act.

In an earlier post, I wondered how the government was going to cover the cost of insuring so many more people under the “public option”. Section 1802 answers the question for funding Medicare.

The government plans to impose a fee on every private health insurance policy (while they last) and every self-insured health plan to fund the

Chapter 34 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subchapter:

“subchapter B—Insured and Self-Insured Health Plans
“Sec. 4375. Health insurance.
“Sec. 4376. Self-insured health plans.
“Sec. 4377. Definitions and special rules.

“SEC. 4375. Health insurance.

“(a) Imposition of Fee.—There is hereby imposed on each specified health insurance policy for each policy year a fee equal to the fair share per capita amount determined under section 9511(c)(1) multiplied by the average number of lives covered under the policy.

“(b) Liability for Fee.—The fee imposed by subsection (a) shall be paid by the issuer of the policy.

The government already deducts a percentage of your paycheck for Medicare. Now they are going to take a piece from those who provide your health plan. What happens if you choose the public option? You know the government is not going to pay themselves, so I’m sure they will pass that fee on to you as well.

Unlike Section 441 which stated that “tax imposed under this section shall not be treated as tax“, this section states,

the fees imposed by this subchapter shall be treated as if they were taxes.

So remember, taxes are not treated as taxes but fees imposed are treated as taxes. Fees are the new taxes.

Title IX, Miscellaneous Provisions, is one of the most disturbing pieces of this legislation (as if the threat of socialism isn’t bad enough, this takes it a bit further) and the last section of Division B.

The section in question is Section 1904. “Grants to States for quality home visitation programs for families with young children and families expecting children.”

The government establishes the creation of “quality home visitation programs”,

The purpose of this section is to improve the well-being, health, and development of children by enabling the establishment and expansion of high quality programs providing voluntary home visitation for families with young children and families expecting children.

While the purpose states that these visits are “voluntary”, states will have a monetary incentive to increase the number of visitations, therefore pressuring more and more families in need to accept those services where government officials will be entering their homes, monitoring their children and teaching the parents the “government standard” for raising their children.

In order to qualify for the grants, each state will be required to submit a needs assessment.

The results of a statewide needs assessment that describes—

“(A) the number, quality, and capacity of home visitation programs for families with young children and families expecting children in the State;

“(B) the number and types of families who are receiving services under the programs;

“(C) the sources and amount of funding provided to the programs;

“(D) the gaps in home visitation in the State, including identification of communities that are in high need of the services; and

“(E) training and technical assistance activities designed to achieve or support the goals of the programs.

And the government must received certain assurances from the State.

Assurances from the State that—

“(A) in supporting home visitation programs using funds provided under this section, the State shall identify and prioritize serving communities that are in high need of such services, especially communities with a high proportion of low-income families or a high incidence of child maltreatment;

“(B) the State will reserve 5 percent of the grant funds for training and technical assistance to the home visitation programs using such funds;

“(C) in supporting home visitation programs using funds provided under this section, the State will promote coordination and collaboration with other home visitation programs (including programs funded under title XIX) and with other child and family services, health services, income supports, and other related assistance;

“(D) home visitation programs supported using such funds will, when appropriate, provide referrals to other programs serving children and families; and

“(E) the State will comply with subsection (i), and cooperate with any evaluation conducted under subsection (j).

They go on to define exactly what they will be looking for while performing these visitations.

“(I) knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains (including knowledge of second language acquisition, in the case of English language learners);

“(II) knowledge of realistic expectations of age-appropriate child behaviors;

“(III) knowledge of health and wellness issues for children and parents;

“(IV) modeling, consulting, and coaching on parenting practices;

“(V) skills to interact with their child to enhance age-appropriate development;

“(VI) skills to recognize and seek help for issues related to health, developmental delays, and social, emotional, and behavioral skills; and

“(VII) activities designed to help parents become full partners in the education of their children;

These requirements will make it difficult for any family to refuse the visitations as the government could very well imply that families are abusing their children or neglecting them by refusing the home inspections visitations.

This section completely opens your home to inspection by authorities in your state based on their assessment of your parenting skills, or possibility that you are abusing your children.

It gives the government the right to come into your home to check whether or not your kids are eating properly, whether or not they are going to sleep at an appropriate time, and basically, whether or not you are a good parent.

While this section does not directly impact homeschool freedoms, I think you can see the dangers that lurk if this section is allowed to become law. Many states and communities frown on homeschoolers as it is. How long will it take before States start pressuring homeschoolers to “volunteer” for this visitation program?

With that, we have completed Division B of “America’s Affordable Health Choices Act of 2009“. I’ll leave you with one final thought for the day.

“Don’t you see that the whole aim of Newspeak is to narrow the range of thought?… Has it ever occurred to your, Winston, that by the year 2050, at the very latest, not a single human being will be alive who could understand such a conversation as we are having now?… The whole climate of thought will be different. In fact, there will be no thought, as we understand it now. Orthodoxy means not thinking—not needing to think. Orthodoxy is unconsciousness.”

– George Orwell, 1984, Book 1, Chapter 5

Tomorrow we will begin to tackle Division C, “Public Health and Workforce Development” on page 856. That’s right people, there are only 162 pages remaining and we have covered the entire text of H.R. 3200.

HR3200 : Division B : Day Five : Part Two

This evening we begin with Division B, Title VII (Medicaid and CHIP), Subtitle A (Medicaid and Health Reform), Section 1701, “Eligibility for individuals with income below 133 1/3 percent of the federal poverty level”.

Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396b(a)(10)(A)(i) is amended—

(A) by striking “or” at the end of subclause (VI);

(B) by adding “or” at the end of subclause (VII); and

(C) by adding at the end the following new subclause:

“(VIII) who are under 65 years of age, who are not described in a previous subclause of this clause, and who are in families whose income (determined using methodologies and procedures specified by the Secretary in consultation with the Health Choices Commissioner) does not exceed 1331/3 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved;”.

According to the Department of Health and Human Services, the poverty rate for a family of five (like mine) is $25,790. Using the brilliant calculation above we know that I could make as much as (but not more than) $34,385.80 and still qualify for Medicaid. We all know what happens to those people who make $34,385.81 or more, don’t we? Yes, they fall through the cracks just like they do now!

Remember, this plan is about health care for everyone. Everyone who can be covered by existing plans (which will be phased out), everyone who can choose to be covered through the public plan through their employer, and everyone who can pay an additional 2.5% tax on their income to pay for the public plan on their own. But not everyone, really. Get real people.

If they are mandating a minimum income to “qualify” for low-income Medicare, someone has to draw the line somewhere and I can guarantee you that the “we cover everyone” line is nowhere near the low-income line when they are drawn.

Let’s read on to see what happens to those people who fall into the “gap”.

The first thing we learn is that States may not add someone to the managed care entity unless the entity has the capacity to meet all of the needs of that person being added.

A State may not require under paragraph (1) the enrollment in a managed care entity of an individual described in section 1902(a)(10)(A)(i)(VIII) unless the State demonstrates, to the satisfaction of the Secretary, that the entity, through its provider network and other arrangements, has the capacity to meet the health, mental health, and substance abuse needs of such individuals.”

How many health care plans do you know of, right now, that have the capacity to meet the health, mental health, and substance abuse needs of every person enrolled under that plan?

Sure. Uh-huh. What if everyone on that plan goes loopy tomorrow, do they still have that capacity? This provision simply provides a loophole for not covering people that cannot pay their fair share.

Section 1703 addresses CHIP and Medicaid maintenance. Where they allow states to impose limitations on coverage in order to limit expenditures under their child health plan.

Paragraph (1) shall not be construed as preventing a State from imposing a limitation described in section 2110(b)(5)(C)(i)(II) for a fiscal year in order to limit expenditures under its State child health plan under title XXI to those for which Federal financial participation is available under section 2105 for the fiscal year.

Subtitle B, Section 1711 defines the “Required Coverage of Preventive Services” where vaccines will now be required.

The preventive services described in this subsection are services not otherwise described in subsection (a) or (r) that the Secretary determines are—

“(1)(A) recommended with a grade of A or B by the Task Force for Clinical Preventive Services; or

“(B) vaccines recommended for use as appropriate by the Director of the Centers for Disease Control and Prevention; and

“(2) appropriate for individuals entitled to medical assistance under this title.”.

Nothing in this section indicates there will be a “religious exemptions” where administration of these vaccines is concerned. Will people no longer have the right to refuse vaccinating their children for religious reasons?

Section 1712 tells us that Medicaid will not cover tobacco cessation. I actually laughed when I read this section.

Section 1927(d)(2) of the Social Security Act (42 U.S.C. 1396r–8(d)(2)) is amended—

(1) by striking subparagraph (E);

(2) in subparagraph (G), by inserting before the period at the end the following: “, except agents approved by the Food and Drug Administration for purposes of promoting, and when used to promote, tobacco cessation”; and

(3) by redesignating subparagraphs (F) through (K) as subparagraphs (E) through (J), respectively.

(b) Effective date.—The amendments made by this section shall apply to drugs and services furnished on or after January 1, 2010.

It’s a given that the government is not going to pay for this. Of course they won’t. The government is not going to pay for something that helps you quit smoking. The taxes you pay for those cigarettes are going to help fund this program you moron.

The way they see it, every time someone lights up a cigarette another Medicaid recipient gets treatment (think bells and angel wings here people). They forget that a lot of those low-income people smoke too, defeating the purpose.

While the word “abortion” never appears in this version of the bill, Section 1713 does make reference to something you might find interesting.

The term ‘nurse home visitation services’ means home visits by trained nurses to families with a first-time pregnant woman, or a child (under 2 years of age), who is eligible for medical assistance under this title, but only, to the extent determined by the Secretary based upon evidence, that such services are effective in one or more of the following:

“(1) Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.

“(2) Reducing the incidence of child abuse, neglect, and injury, improving family stability (including reduction in the incidence of intimate partner violence), or reducing maternal and child involvement in the criminal justice system.

“(3) Increasing economic self-sufficiency, employment advancement, school-readiness, and educational achievement, or reducing dependence on public assistance.”.

Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies?

Notice they don’t say they will work to help “prevent pregnancies”, but they will work to “increase birth intervals”. How do you increase “birth” intervals, without preventing the pregnancies in the first place. Yeah. Enough said. The word “abortion” never appears in the bill, but it’s implied much more strongly (and subtly) than even I thought it would be.

If that wasn’t enough, Section 1714 covers the state eligibility option for family planning services. We all know what kind of services are offered and what advice is given at family planning clinics. They don’t have to use the word abortion if they don’t want too. We can all read, can’t we? Abortion will be covered by this bill. These last two sections leave no doubt about that.

I can’t take anymore of this tonight. I need sleep. Tomorrow we will begin with Division B, Title VII, Subtitle C, on page 778.

HR3200 : Division B : Day Five : Part One

Division B, Title IV, Subtitle E, “Reporting on Health Care Associated Infections” begins with a new requirement for public reporting by hospitals on health care associated infections. While the whole “reporting infections” thing is awesome, the intentions of the section may actually be a little deceptive.

The Secretary shall provide that a hospital (as defined in subsection (g)) or ambulatory surgical center meeting the requirements of titles XVIII or XIX may participate in the programs established under such titles (pursuant to the applicable provisions of law, including sections 1866(a)(1) and 1832(a)(1)(F)(i)) only if, in accordance with this section, the hospital or center reports such information on health care-associated infections that develop in the hospital or center (and such demographic information associated with such infections) as the Secretary specifies.

Hospitals and ambulatory surgical centers can only be part of the overall health plan if they agree to report “on health care-associated infections that develop in the hospital or center (and such demographic information associated with such infections) as the Secretary specifies.

While seemingly innocuous to most readers, I question the additional information that will be required simply on the Secretary of Health and Human Services’ decision. I understand that infections should be reported, and I agree that the information about which types of infections are important, but what other information would the Secretary require? Will they be collecting data on the race of patients? Maybe the age and overall health of patients? Some of that data may be legitimate and needed when analyzing infection data, but the section doesn’t stop there. It gives the Secretary the discretion to include any data he/she sees fit, which could be anything.

Section 1461 goes on to state that the CDC will be the collector of the above mentioned data, so it seems my brother-in-law may have some long term job security if the bill passes.

Such information shall be reported in accordance with reporting protocols established by the Secretary through the Director of the Centers for Disease Control and Prevention (in this section referred to as the ‘CDC’) and to the National Healthcare Safety Network of the CDC or under such another reporting system of such Centers as determined appropriate by the Secretary in consultation with such Director.

Another problem I have with this section is the fact that all of the information will be posted publicly. Remember, the Secretary will have the discretion to collect any information he/she sees fit, and we already know that privacy laws do not affect the government throughout most of this piece of legislation. Exactly what information will be collected and posted on the Internet?

The Secretary shall promptly post, on the official public Internet site of the Department of Health and Human Services, the information reported under subsection (a). Such information shall be set forth in a manner that allows for the comparison of information on health care-associated infections—

“(1) among hospitals and ambulatory surgical centers; and

“(2) by demographic information.

Think about it. If they collect data on staph infections and post that information, will they be including names of patients, age of patients, underlying medical conditions of patients, and prognosis following the infection? What about a patient’s right to privacy? Oh yeah, that’s right it doesn’t apply here. So, if you are someone with an illness that you would rather not be known to your friends, family, co-workers, priests, pastors, and everyone else, you better pray to God that you don’t pick up a health care associated infection while you are in the hospital.

Am I fearmongering? Some might say so, but this section (like many others in the bill) leaves the gate open for a lot of possibilities. Everyone knows that dog is going to run once you leave the gate open.

Starting with Title V, Section 1501 we learn that the government will now “redistribute unused residency positions” at hospitals.

If a hospital’s reference resident level (specified in clause (ii)) is less than the otherwise applicable resident limit (as defined in subparagraph (C)(ii)), effective for portions of cost reporting periods occurring on or after July 1, 2011, the otherwise applicable resident limit shall be reduced by 90 percent of the difference between such otherwise applicable resident limit and such reference resident level.

Does this mean there will be the same number of doctors at each hospital, no matter which hospital you choose? What happens if all the residency programs are filled up in your home state? Does this mean young doctors will be forced to move out of state to pursue their chosen profession? Who will decide which hospitals will be allowed more residency positions? Oh yes, the great and powerful Secretary, apparently.

In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall distribute the increase to qualifying hospitals based on the following criteria:

“(I) The Secretary shall give preference to hospitals that had a reduction in resident training positions under subparagraph (A).

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

“(III) The Secretary shall give preference to hospitals insofar as they have in effect formal arrangements (as determined by the Secretary) that place greater emphasis upon training in Federally qualified health centers, rural health clinics, and other nonprovider settings, and to hospitals that receive additional payments under subsection (d)(5)(F) and emphasize training in an outpatient department.

“(IV) The Secretary shall give preference to hospitals with a number of positions (as of July 1, 2009) in excess of the otherwise applicable resident limit for such period.

“(V) The Secretary shall give preference to hospitals that place greater emphasis upon training in a health professional shortage area (designated under section 332 of the Public Health Service Act) or a health professional needs area (designated under section 2211 of such Act).

“(VI) The Secretary shall give preference to hospitals in States that have low resident-to-population ratios (including a greater preference for those States with lower resident-to-population ratios).

Read that last one again. Residents will no longer have the option to choose which location they will practice medicine. In fact, someone from Georgia, who is educated at Emory, could end up doing their residency in some small town in northern Idaho, simply because the Secretary of Health and Human Services decided that the hospital there had a low resident-to-population ratio and they were a Federally qualified health center.

The government makes all the rules. The government enforces all the rules. The people have no say. The government decides it all. If it’s not good for the collective, it is not allowed. If it serves the collective, then it is required.

Socialism — a theory or system of social organization that advocates the vesting of the ownership and control of the means of production and distribution, of capital, land, etc., in the community as a whole.

Once again, we are left with no doubt as to the direction this bill will take our country.

The remainder of Title V covers all of the different aspects of the resident programs. Feel free to read it if you wish.

Title VI, Subtitle A is an oxymoron as far as government is concerned. “Increased Funding to Fight Waste, Fraud, and Abuse” and Subtitle B describes the “Enhanced Penalties for Fraud & Abuse”. Subtitle C provides for “Enhanced Program and Provider Protections”.

All three of these Subtitles give the Secretary of Health and Human Services the authority to impose penalties and ultimately to decide if a provider is a “serious risk of fraud, waste, or abuse”. If so, the Secretary has the discretion to deny their application as a Medicare/Medicaid provider.

Section 1632 requires a face-to-face encounter with the patient in order to certify eligibility for home health services or durable medical equipment under Medicare. Section 1632 will modify Section 1814(a)(2)(C) of the Social Security Act.

by inserting after “care of a physician” the following: “, and, in the case of a certification or recertification made by a physician after January 1, 2010, prior to making such certification the physician must document that the physician has had a face-to-face encounter (including through use of telehealth and other than with respect to encounters that are incident to services involved) with the individual during the 6-month period preceding such certification, or other reasonable timeframe as determined by the Secretary”.

On the surface this does not seem so bad, does it? The doctor must meet with the patient before they are eligible for home health services or medical equipment under Medicare. The key is that they have to have had a face to face encounter with the patient in the six month period leading up to that certification. How long will certification last? Will patients be required to see the physician every six months to continue certification?

In the case of my sister-in-law, who is mentally handicapped, the government sends her notices every year insisting that she can “work” to offset some of the costs of her care. She has the mentality of a three-year old and cannot talk. She suffers from seizures and has injured herself numerous times during those seizures. Where exactly would she be qualified to work, and what job would she perform? Yet, the government insists on her seeing a physician every year to “guarantee” that she has not recovered from her 50 plus year diagnosis of brain damage. Yes, they’ve been requiring this every year for the past twenty years or so.

Can you imagine what will happen if seniors and disabled people all across the country are required to meet with their physician every six months simply to prove that they still require the treatment or equipment to keep them healthy (and/or alive)? How does this ensure lower cost health care? Won’t more frequent visits drive up the costs?

If you’re not disabled, requiring home health care or durable medical equipment, don’t worry about feeling like you have been left out.

The Secretary may apply the face-to-face encounter requirement described in the amendments made by subsections (a) and (b) to other items and services for which payment is provided under title XVIII of the Social Security Act based upon a finding that such an decision would reduce the risk of waste, fraud, or abuse.

Every person on Medicare/Medicaid could be required to visit their physician every six months whether or not they have a reason to be doing so, simply to help reduce the risk of waste, fraud, and abuse in the system. If this isn’t an abuse of the system, I don’t know what is.

Subtitle D, Section 1651 takes health care into the realm of criminal justice by allowing access to information by the Attorney General.

For purposes of law enforcement activity, and to the extent consistent with applicable disclosure, privacy, and security laws, including the Health Insurance Portability and Accountability Act of 1996 and the Privacy Act of 1974, and subject to any information systems security requirements enacted by law or otherwise required by the Secretary, the Attorney General shall have access, facilitation by the Inspector General of the Department of Health and Human Services, to claims and payment data relating to titles XVIII and XIX, in consultation with the Centers for Medicare & Medicaid Services or the owner of such data.”.

Once again, on the surface this sounds like something that should already be done. If someone is committing a crime that information should be turned over to law enforcement. The thing is, it already is. I served on the Grand Jury just a couple months ago and one of the cases before us was someone trying to defraud the Medicaid system. Why would the government need to add this to the books?

Of course this just ties up all of our information into one central database.

Financial information, medical information, and now criminal history. All of our information provided to anyone in the government who needs it, all in one nice nifty central database.

Once central place where all of your information is located. One central place where your existence is recorded. Once central place where that mere existence could be wiped from the record books, forever.

“People simply disappeared, always during the night. Your name was removed from the registers, every record of everything you had ever done was wiped out, your one-time existence was denied and then forgotten. You were abolished, annihilated: vaporized was the usual word.”

– George Orwell, 1984, Book 1, Chapter 1

Could this happen? Sure it could. Will this happen? Let’s not find out.

HR3200 : Division B : Day Four

I’ve heard from several people since publishing yesterday’s second post who all had stories about Veteran’s Administration related health care. I am not going to go into each and every story, as there are enough of them to provide content for several weeks.

I get the feeling we’re all going to be in a lot of trouble if the new health care system is going to be as reliable as the VA and the Post Office.

“UPS and Fedex are doing just fine, it’s the Post Office that’s always having problems.”

I don’t know about you, but if it comes down to a choice of UPS or the USPS when it comes to delivering a new kidney or making sure my medical supplies arrive on time, I’ll take ol’ Brown everyday over the Post Office.

President Obama said it himself. So think about it. If the Post Office is having problems compared to UPS and Fedex, why on Earth would we want a government health care plan that is clearly going to be insufficient when compared to our current health system? I thought this bill was supposed to be about improving health care in America, not degrading it?

Anyway, I digress. Let’s move forward, shall we? Today we pick up with Division B, Title IV, Subtitle B, Nursing Home Transparency.

Upon passage of the bill, nursing facilities will be required to disclose all ownership and disclosable parties information. They will be required to retain such information on the effective date of the final regulations, and of course, they will be required to keep them forever.

Nothing in subparagraph (A) shall be construed as authorizing a facility to dispose of or delete information described in such subparagraph after the effective date of the final regulations promulgated under paragraph (4)(A).

Whether or not the facility is a publicly traded company, they will be required to make all of that information available to the public.

During the period described in paragraph (1)(A), a facility shall—

“(A) make the information described in paragraph (3) available to the public upon request and update such information as may be necessary to reflect changes in such information; and

“(B) post a notice of the availability of such information in the lobby of the facility in a prominent manner.

There is a lot more to this section, including more about the required components of the program, design of regulations, and evaluations. I am sure you get the gist though. Nursing facilities will be required to follow all of the new regulations and report all information and activity to Big Brother. Seriously, is this any different than any other section thus far?

Section 1421 shows us if a skilled nursing facility is found to be in noncompliance, the Secretary of Health and Human Services will once again have the authority to impose an arbitrary fine.

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).

Some of these penalties are defined in the bill.

In this clause, the term ‘applicable per instance amount’ means—

“(aa) in the case where the deficiency is found to be a direct proximate cause of death of a resident of the facility, an amount not to exceed $100,000;

“(bb) in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy, an amount not less than $3,050 and not more than $25,000; and

“(cc) in each case of any other deficiency, an amount not less than $250 and not to exceed $3050.

Wow. $100,000. That’s what your life is worth (in fines) to the government. If you’re wondering how the government will fund some of the items in this bill, look no further than the arbitrary fines and penalties that will be imposed by the Secretary of Health and Human Services.

Section 1422 will regulate the “large intrastate chains of skilled nursing facilities” and provide a pilot program to monitor them.

The Secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph (1) to participate in the pilot program from among those chains that submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

How much you want to bet they will add chains to their list, even if they don’t send in an application requesting it. Think about it. Who is going to request that the government monitor every move they make? Yeah, they’ll be beating down the doors, won’t they?

When has the government ever had a quality program that is efficient, disciplined, and well-run? Yeah. Well, it seems they are going to be defining exactly what quality is when it comes to health care. Section 1441 defines a quality measure.

The term ‘quality measure’ means a national consensus standard for measuring the performance and improvement of population health, or of institutional providers of services, physicians, and other health care practitioners in the delivery of health care services.

If they plan on enforcing the same quality measures imposed by the Veteran’s Administration, you may as well plan on hearing a lot of stories about people who died choking on sandwiches, falling out of their wheelchairs, being placed in a room and forgotten about, and maybe even released out the front door with no memory of anyplace else to go.

Sure, it sounds extreme. Sure, it sounds frightening. It’s happening now, with people under the care of the Veteran’s Administration. Don’t believe me? Just ask some of our elderly veterans about the care they receive. Just ask them what it’s like waiting months for a procedure that usually takes 10 minutes. Just ask them if they support a national health care plan modeled after the quality of care they currently receive. Don’t take my word for it.

The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States.

Oh Lord, here it comes.

Quality measures developed under agreements under subsection (a) shall be designed—

“(A) to assess outcomes and functional status of patients;

“(B) to assess the continuity and coordination of care and care transitions for patients across providers and health care settings, including end of life care;

“(C) to assess patient experience and patient engagement;

“(D) to assess the safety, effectiveness, and timeliness of care;

“(E) to assess health disparities including those associated with individual race, ethnicity, age, gender, place of residence or language;

“(F) to assess the efficiency and resource use in the provision of care;

“(G) to the extent feasible, to be collected as part of health information technologies supporting better delivery of health care services;

“(H) to be available free of charge to users for the use of such measures; and

“(I) to assess delivery of health care services to individuals regardless of age.

Wow. To assess the functional status of patients. Are you still able to perform as a productive member of society? If so, we’ll coordinate your care, assess the timeliness of that care, assess the efficiency of that care, and make sure your health care services are delivered no matter how old you are. Well, until you meet with the advanced care planning consultant anyway.

Section 1443 will allow multi-stakeholder input into the selection of quality measures. What does this mean? This means any multi-stakeholder in a facility will be allowed to help define what constitutes quality care at that facility.

A consensus-based entity that has entered into a contract under section 1890 shall, as part of such contract, convene multi-stakeholder groups to provide recommendations on the selection of individual or composite quality measures, for use in reporting performance information to the public or for use in public health care programs.

Let’s reflect on that section for a moment. Any multi-stakeholder will be invited to participate. Who might these multi-stakeholders be? Private investors, unions, community organizations, you get the idea. Remember though, physicians will not be allowed to increase their ownership in such facilities after the passage of this bill. (From Section 1156 of the Division B):

The percentage of the total value of the ownership or investment interests held in the hospital, or in an entity whose assets include the hospital, by physician owners or investors in the aggregate does not exceed such percentage as of the date of enactment of this subsection.

This means the “quality measures” decided upon will not be determined by anyone trained to know what quality health care is in the first place. That sure makes me feel confident about the level of care I would receive. (cough)

Never fear though. If the entity has not defined quality measures for a given procedure or area, the Secretary of Health and Human Services will determine what is appropriate. Section 1444 actually takes it a step further.

In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical quality measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.

If a measure has not been endorsed by the entity or if one has been decided and the Secretary has given consideration to those measures, the Secretary has the authority to decide on the quality measures therefore overriding the entity endorsements. I honestly don’t think Josef Stalin had the kind of authority that the Secretary of Health and Human Services will have if this bill passes.

Division B, Title IV, Subtitle D, Section 1451 exposes the financial relationships between manufacturers and physicians, but does nothing to expose the relationships between those same manufacturers and representatives of our government.

The section covers approximately 18 pages and covers everything from reporting such relationships, making that information public, the accuracy of that reporting, and the penalties for not reporting or knowingly failing to report. The section also defines the term payment when pertaining to these financial relationships.

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.

Check out the terms I highlighted. Don’t those sound like items a Senator or Representative may receive from specific corporations for their support on certain legislation?

Why is there no “sunshine” clause for our elected officials and representatives of our government? Why are they exempt from the ethical standards being imposed on everyone else? What exactly do they have to hide?

That’s it for tonight. Tomorrow we will pick up on page 654, Division B, Title IV, Subtitle E, “Reporting on Health Care Associated Infections”. That should be fun.

HR3200 : Division B : Day Three : Part Two

Now that we have established that cancer treatment will likely be rationed, special needs patients will be left waiting, doctors will be penalized for readmissions, and “death panels” really were in the original text of the bill, let’s more on.

Before we do, however, let me pass something on to you. I received a few messages from someone who read my earlier post today (part one), and told me that the entire “end of life” section I covered was eerily similar to existing VA policy.

It seems her grandfather, who was 78 years old at the time, was diagnosed with prostate cancer. The Veteran’s Administration told him that he was too close to the end of his life to validate the cost of treatment. He lived another eight years as cancer spread through his body before he passed away. But here’s the kicker.

He did not die from the cancer. He died choking on a tuna fish sandwich because the VA also considered the performance of the Heimlich Maneuver to be a violation of his DNR. I kid you not. If you think the government can handle health care on a nationwide scale, all you have to do is look at the VA to learn otherwise.

Let’s see what other gems H.R. 3200 has in store for us.

Division B, Title II, Subtitle C, Section 1234 begins with the waiver of limited enrollment penalty for TriCare beneficiaries. If you are not familiar with it, TriCare is the health care program which serves active duty service members, National Guard and Reserve members, retirees, their families, survivors, and certain former spouses.

Section 1234 will mandate that qualifying individuals will automatically be enrolled in TriCare.

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).”.

Now we have the Secretary of Defense deciding who gets medical care, along with the Secretary of Health and Human Services, and the Health Choices Administration “Commissioner”, all of whom are not required to be doctors. Section 1234 also states that rates for TriCare will rise.

Section 1236 will establish “patient decision aids”.

The Secretary of Health and Human Services shall establish a shared decision making demonstration program (in this subsection referred to as the “program”) under the Medicare program using patient decision aids to meet the objective of improving the understanding by Medicare beneficiaries of their medical treatment options, as compared to comparable Medicare beneficiaries who do not participate in a shared decision making process using patient decision aids.

It seems your doctor will not be allowed to discuss your treatment options with you unless he/she uses one of these “shared decision making demonstration programs” to help you learn the best treatment option for you at the time. Shouldn’t the best treatment option be the one that saves your life? I wonder what that flowchart would look like?

Do you have a serious illness? If yes, continue. If no, get out of here before we penalize your doctor for allowing you back in the door so soon.

Is your serious illness life threatening? If yes, continue. If no, then get the hell out of here before we penalize you for wasting our time.

Are you older than 65? If yes, continue. If no, receive the best treatment possible adjusted by the number of productive years you have remaining in your life. Have a nice day.

Hello senior. You have reached the end of the flowchart. Congratulations! Unfortunately, by reaching the end of the flowchart you have also reached the end of your usefulness to society, therefore we cannot justify spending a dime in additional care for your “serious illness”. Please return home where you will receive a nice visit from one of our “advanced care planning consultants”. Oh, and don’t forget to make your appointment to complete your health care proxy.

It may sound far fetched to you, but that’s basically how it’s going to work if this bill passes.

Title III, Section 1301 creates a new “accountable care organization pilot program”. Say that three time fast.

The Secretary shall conduct a pilot program (in this section referred to as the ‘pilot program’) to test different payment incentive models, including (to the extent practicable) the specific payment incentive models described in subsection (c), designed to reduce the growth of expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries (as defined in subsection (d)) by qualifying accountable care organizations (as defined in subsection (b)(1)) in order to—

“(1) promote accountability for a patient population and coordinate items and services under parts A and B;

“(2) encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery; and

“(3) reward physician practices and other physician organizational models for the provision of high quality and efficient health care services.

Physicians will be rewarded for high quality and efficient health care services, but only if they have not already been penalized for readmitting the patient or not following the government guidelines with the “decision aid” for that patients care.

Remember, everything the government is implementing in this bill will be on the reward/penalty system. If you comply, you will be duly rewarded, if you fail to comply you will be penalized in the form of lower payments and therefore forced to comply if you want to eat.

Section 1302 establishes the “medical home pilot program”. Yes, Medicare covered treatments delivered directly to your front door in the form of medical home services, if you live in a “medical home” anyway.

Subject to subsection (g), the pilot program shall include urban, rural, and underserved areas.

Don’t be surprised, however, if you don’t see a doctor when you answer the door.

Nothing in this section shall be construed as preventing a nurse practitioner from leading a patient centered medical home so long as—

“(i) all the requirements of this section are met; and

“(ii) the nurse practitioner is acting consistently with State law.

I can tell you how well this is going to work.

Our oldest son got sick a while ago. He had a fever, was nauseous, and was feeling just awful. Our pediatrician was out of town, but an “office assistant” (who we didn’t even know was not a nurse), told us how to treat his symptoms because a “bug was going around”. After he did not respond to those treatments and seemed to be getting worse we took him to the emergency room. We made it just in time. He had appendicitis and he would have died had we not arrived when we did. He was in the hospital for a week.

We almost lost our son because we had faith in our doctor’s office. We believed we were getting the proper advice from a properly trained individual. It turns out we were wrong, and our son almost died. The doctor was not penalized, the “office assistant” kept her job, and we found another pediatrician immediately.

I can just imagine how well this “medical home pilot program” is going to work. Puh-leaze! Oh, in case you were wondering,

Chapter 35 of title 44, United States Code shall not apply to this section.

That’s right. Those obtaining services under the “medical home pilot program” will not be afforded the right to privacy. Remember, Chapter 35 of Title 44 of the U.S. Code makes a few assurances, one of which is to,

ensure that the creation, collection, maintenance, use, dissemination, and disposition of information by or for the Federal Government is consistent with applicable laws, including laws relating to—
(A) privacy and confidentiality, including section 552a of title 5;
(B) security of information, including section 11332 of title 40 [1] ; and
(C) access to information, including section 552 of title 5;

Section 1308 amends the Social Security Act to allow for marriage and family therapist services.

Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 1235 and 1305, is amended by adding at the end the following new subsection:

“Marriage and Family Therapist Services

“(jjj) (1) The term ‘marriage and family therapist services’ means services performed by a marriage and family therapist (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses, which the marriage and family therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.

Because universal health care is all about diagnosing the problems within your marriage. Notice they pooled marriage and mental health into the same section? Is this so your health care practitioners who decide you are too close to the end of life can also claim your spouse is mentally impaired when they try to protest their decision? Just thinking out loud.

Section 1308 goes on to define mental health counselor services, by defining the services that will be covered, creating those services, setting the prices of those services, and then, ultimately, rationing those services.

Section 1310 will expand access to vaccines, which if I am not mistaken are available now at most health department locations for a low, nominal price, or even free in some cases.

Moving on to Division B, Title IV, Subtitle A, Section 1401 brings us to comparative effectiveness research.

The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.

Privately funded medical research has been at the forefront of most major discoveries, yet now, in the age of Obama, the government is going to create their own research facility to see if the “effectiveness, and appropriateness of health care services and procedures” are up to par and identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.

The government controlled post office can’t even deliver my mail reliably but I am supposed to think the same government can perform valid research on a topic they know nothing about? Unless this “Comparative Effectiveness Research Center” is comprised of the best clinical minds our country had to offer, it won’t be worth the paper it was created on.

The “Center” will have the authority to collect data from any government agency or department.

The Center may secure directly from any department or agency of the United States information necessary to enable it to carry out this section. Upon request of the Center, the head of that department or agency shall furnish that information to the Center on an agreed upon schedule.

They will also be authorized to utilize all existing information, both published and unpublished.

In order to carry out its functions, the Center shall—

“(i) utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section,

“(ii) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate, and

“(iii) adopt procedures allowing any interested party to submit information for the use by the Center and Commission under subsection (b) in making reports and recommendations.

So far, I have covered 524 pages of the original 1,018 page House bill. Have you noticed the repeating patterns and the total disregard for the freedoms we enjoy in this country?

This bill will allow the government to keep creating new entities, in the form of administrations, committees, and other administrative (bureaucratic) positions. This bill will allow the government to slowly dissolve our rights as citizens. This bill will allow the government to violate our right to privacy and even one of the amendments to the Constitution.

This bill will allow the government to ration health care where they see fit. This bill will allow the government to ignore current laws regarding paperwork and record keeping. This bill will allow the government to schedule the time frame in which you will die.

But most of all this bill will allow the government to destroy the very fabric of our country by destroying the republic for which we stand and replacing it with a socialist agenda that has proven to fail time and time again.

I’ll pick up tomorrow on page 525, Division B, Title IV, Subtitle B, Nursing Home Transparency.

HR3200 : Division B : Day Three : Part One

I hate to say I told you so, but I told you so.

It seems people are finally waking up and reading the health care bill. Some of those people include journalists like David S. Hilzenrath at the Washington Post. David has been reading the bill. He’s paying attention like everyone should be and the best part? He’s reporting what he reads. It’s about time.

David writes,

President Obama promises that, if health-care reform is enacted, people will be able to keep their current coverage.

“I keep on saying this but somehow folks aren’t listening: If you like your health-care plan, you keep your health-care plan. Nobody is going to force you to leave your health-care plan,” he said Saturday in a town hall meeting in Grand Junction, Colo., much as he said Friday in Belgrade, Mont., and earlier in the week in Portsmouth, N.H.

However, under legislation drafted by House and Senate Democrats, that would not necessarily be true.

Under the House legislation, many companies eventually would have to comply with new requirements for minimum benefits, meaning that if they did not already meet the standard they would have to upgrade their insurance.

Nonetheless, in his effort to allay fears about health reform, Obama has continued to make his promise.

Obama’s promise is not just at odds with legislative proposals — it is also at odds with reality. Under the current system, employers can drop coverage, alter benefit packages and switch insurers. In addition, as the president has noted, people who lose or leave their jobs can lose their health plans; that is one of the fundamental problems the legislative proposals address and one of the main arguments for reform.

But in the campaign to overhaul health care, Obama’s promise may serve to reassure people anxious about change. As he said at a news conference on July 22, people may favor the devil they know over the devil they don’t.

Now that people are waking up, and writers like David S. Hilzenrath are telling people what is really happening, maybe President Obama will get a “reality check” from the citizens of this great nation. (Hat tip to Vinny for the heads up on this article).

Section 1181 of Division B eliminates the coverage gap in Medicare Part D. It doesn’t close the gap completely, right away, but slowly closes the gap over a period of years. Section 1181 offers discounts for certain Part D drugs. The funding for closing these gaps will be provided with a “drug rebate agreement” from the drug companies. These rebates are basically taxes that will be imposed on the drug companies.

A rebate agreement under this subsection shall require the manufacturer to provide to the Secretary a rebate for each rebate period (as defined in paragraph (6)(B)) ending after December 31, 2010, in the amount specified in paragraph (3) for any covered part D drug of the manufacturer dispensed after December 31, 2010, to any full-benefit dual eligible individual (as defined in paragraph (6)(A)) for which payment was made by a PDP sponsor under part D or a MA organization under part C for such period. Such rebate shall be paid by the manufacturer to the Secretary not later than 30 days after the date of receipt of the information described in section 1860D–12(b)(7), including as such section is applied under section 1857(f)(3).

The next several pages discuss the varying amount of these rebates, exemptions, qualifications, and all that mess.

Subtitle F, Section 1191 creates yet another government entity. This time, it’s in the form of the “Telehealth Advisory Committee”.

The Secretary shall appoint a Telehealth Advisory Committee (in this subsection referred to as the ‘Advisory Committee’) to make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services as established under section 1834(m), including the appropriate addition or deletion of services (and HCPCS codes) to those specified in paragraphs (4)(F)(i) and (4)(F)(ii) of such section and for authorized payment under paragraph (1) of such section.

What exaclty does “telehealth” work anyway? What kind of services do you offer through “telehealth”? Will some people be diagnosed over the phone in an attempt to keep them from showing up at the emergency room or doctor’s offices?

Title II, Subtitle A, Section 1201 resets the “assets test” for the low-income subsidy program.

“(III) for 2012, $17,000 (or $34,000 in the case of the combined value of the individual’s assets or resources and the assets or resources of the individual’s spouse); and

“(IV) for a subsequent year, the dollar amounts specified in this subclause (or subclause (III)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.”

If your assets are valued more than the amounts shown above, then you will not be considered low-income even if you are not making any income. Interesting huh? You cannot be considered low-income if you own anything of value. Of course, once you sell it all to pay for your care, or you turn over your assets to Big Brother, then you’ll be considered low-income and qualified for additional help.

I thought this bill was all about picking people up and helping them? This bill may make people think they won’t lose everything, but the truth is, it looks like it’s just going to be spread over a longer amount of time. Don’t fret for grandma though, because the government is also going to put measures in place to guarantee that every Medicare eligible person has the same opportunity to be included in this wonderful program with “intelligent assignment in enrollment” written into Section 1205.

or through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible. In the case the Secretary enrolls such individuals through use of an intelligent assignment process, such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a PDP sponsor of a prescription drug plan that uses a formulary, the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor, and the overall quality of a prescription drug plan as measured by quality ratings established by the Secretary.

Section 1206 modifies Section 1860D of the Social Security Act for the “special enrollment period”, by adding,

In the case of an individual (as determined by the Secretary) who is determined under subparagraph (B) of section 1860D–14(a)(3) to be a subsidy eligible individual.

and the “automatic enrollment” section, to state,

The process established under subparagraph (A) shall include, in the case of an individual described in section 1860D–1(b)(3)(D) who fails to enroll in a prescription drug plan or an MA–PD plan during the special enrollment established under such section applicable to such individual, the application of the assignment process described in subparagraph (C) to such individual in the same manner as such assignment process applies to a part D eligible individual described in such subparagraph (C). Nothing in the previous sentence shall prevent an individual described in such sentence from declining enrollment in a plan determined appropriate by the Secretary (or in the program under this part) or from changing such enrollment.

Not only will the Secretary of Health and Human Services be allowed to automatically enroll people under Medicare Part D, but he/she will also have the authority to prevent you from changing that enrollment. Re-read that section again if you don’t believe me. Government forced health care at its finest.

In an effort to ensure effective communication in Medicare, Title II, Subtitle B, Section 1221 exempts the government from the Paperwork Reduction Act.

Chapter 35 of title 44, United States Code (commonly known as the “Paperwork Reduction Act”), shall not apply for purposes of carrying out this subsection.

Keep reading this section as well as the next several pages, because the government is also going to require language translation (at our expense) and those companies with “limited English proficiency” will not have to pay cost-sharing or co-pays for language services.

Limited English proficient Medicare beneficiaries shall not have to pay cost-sharing or co-pays for language services provided through this demonstration program.

That’s right. The only companies that will be required to “subsidize” (pay taxes to support) the “language services” will be those who do not need to utilize them. It wouldn’t be the first time that the government taxes one group of people to pay for the services provided to another group of people.

Now I come to the section that many politicians are claiming never existed in the bill. Under Title II, Subtitle C, Miscellaneous Improvements, Section 1233 provides for “advanced care planning consultations”. These consultations will include (please take the time to read this),

“(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

“(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

“(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

“(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

“(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

“(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—

“(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

“(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

“(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

“(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—

“(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

“(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

“(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—

“(I) ensures such orders are standardized and uniquely identifiable throughout the State;

“(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

“(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

“(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.

It sure sounds like an awful lot of “end of life” talk to me. If you are elderly, or close enough to death’s door that the government sees fit, you will be subject to one of these advanced care planning consultations and you will be subject to these “consultations” at the discretion of your health care practitioner (aka doctor, nurse, or physician’s assistant).

An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

In other words, your health care practitioner will be allowed to hound you and hound you to make the decision they want you to choose. How many people have time to focus on a fight over end of life care when they are literally fighting for their lives? Yeah, it’s a bit of an oxymoron isn’t it?

The level of treatment provided (covered) by the health care bill may vary slightly based on your condition.

The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions.

You may receive full treatment, or, if it looks like your days or numbered (aka it’s going to be a waste of money to treat you) you may receive none of the specified interventions. Remember, your family will not be making this decision for you. You will be “consulted” by your health care practitioner while you are fighting to stay alive, and that health care practitioner will be allowed to “sign off” on your decision, whether anyone knows if you were truly capable of making it.

The media has attacked Sarah Palin for her “death panel” statement, which you can read on her Facebook account.

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

She was right. The bill did address this issue, and it did state exactly what she said it did.

Take a few hours to digest this part of the bill which many politicians claim was never included in the bill. I don’t know how you remove something that was never there, but they claim it has now been removed. There is no guarantee, however, that it will not be added back into the bill by amendment or other last minute maneuvering by the House and/or Senate.