HR3200 : Division C : Day Two

In addition to the National Health Services Corp (NHS), the government will also establish a new “Public Health Workforce Corps” to ensure they have people to fill the positions they will be “providing” under this section of the bill.

There is established, within the Service, the Public Health Workforce Corps (in this subpart referred to as the ‘Corps’), for the purpose of ensuring an adequate supply of public health professionals throughout the Nation. The Corps shall consist of—

“(1) such officers of the Regular and Reserve Corps of the Service as the Secretary may designate; and

“(2) such civilian employees of the United States as the Secretary may appoint.

This section gives even more unbridled power to the Secretary of Health and Human Services. To appoint such civilian employees as he/she sees fit. Wow. Is that insane or what? Apparently he/she will be doing it under yet another “administration.

Except as provided in subsection (c), the Secretary shall carry out this subpart acting through the Administrator of the Health Resources and Services Administration.

Exactly how many administrations, commissioners, ombudsman, and other positions will it require to manage health care in our country? Does anyone know if the Tootsie-Roll Owl is available to figure this one out for us?

The Director of the Centers for Disease Control and Prevention will help develop the methodology for placing and assigning Corps participants as public health professionals.

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop a methodology for placing and assigning Corps participants as public health professionals. Such methodology may allow for placing and assigning such participants in State, local, and tribal health departments and Federally qualified health centers (as defined in section 1861(aa)(4) of the Social Security Act).

I feel kind of silly now. I thought “Public Health Care” meant, you know, providing health care for the people of the country, little did I know it mean employing everyone in the country in health care. I wonder though, what exactly will the responsibilities for the Reserve Proctologist be?

So, are you thinking of becoming a doctor, but this new bill seems like a lot of bull, so you have decided to treat bulls instead? Don’t worry, President Obama and Congress aren’t going to leave you out of the loop.

To be eligible to participate in the Program, an individual shall—

“(1)(A) be accepted for enrollment, or be enrolled, as a full-time or part-time student in a course of study or program (approved by the Secretary) at an accredited graduate school or program of public health; or

“(B) have demonstrated expertise in public health and be accepted for enrollment, or be enrolled, as a full-time or part-time student in a course of study or program (approved by the Secretary) at—

“(i) an accredited graduate school or program of nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine; or

“(ii) another accredited graduate school or program, as deemed appropriate by Secretary;

They were not kidding when they said this bill was going to cover health care “for all”. I wonder if it includes jackasses too?

As part of the National Health Service Corps, the Public Health Workforce Corps will help build and run the Public Health Training Centers. Let’s take a peak at what those training centers may look like.

When deciding whether or not you may like to participate in this training program you will be required to sign a contract.

Contract.—The written contract between the Secretary and an individual under subsection (b)(3) shall contain—

“(1) an agreement on the part of the Secretary that the Secretary will—

“(A) provide the individual with a scholarship for a period of years (not to exceed 4 academic years) during which the individual shall pursue an approved course of study or program to prepare the individual to serve in the public health workforce; and

“(B) accept (subject to the availability of appropriated funds) the individual into the Corps;

“(2) an agreement on the part of the individual that the individual will—

“(A) accept provision of such scholarship to the individual;

“(B) maintain full-time or part-time enrollment in the approved course of study or program described in subsection (b)(1) until the individual completes that course of study or program;

“(C) while enrolled in the approved course of study or program, maintain an acceptable level of academic standing (as determined by the educational institution offering such course of study or program);

“(D) if applicable, complete a residency or internship; and

“(E) serve full-time as a public health professional for a period of time equal to the greater of—

“(i) 1 year for each academic year for which the individual was provided a scholarship under the Program; or

“(ii) 2 years; and

“(3) an agreement by both parties as to the nature and extent of the scholarship assistance, which may include—

“(A) payment of reasonable educational expenses of the individual, including tuition, fees, books, equipment, and laboratory expenses; and

“(B) payment of a stipend of not more than $1,269 (plus, beginning with fiscal year 2011, an amount determined by the Secretary on an annual basis to reflect inflation) per month for each month of the academic year involved, with the dollar amount of such a stipend determined by the Secretary taking into consideration whether the individual is enrolled full-time or part-time.

“(d) Application of certain provisions.—The provisions of subpart III shall, except as inconsistent with this subpart, apply to the scholarship program under this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps Scholarship Program established under section 338A.

As far as I can tell, you are not forced to sign this contract with blood, but that could change once it hits the House floor for debate.

The funding for the Public Health Workforce will be allocated as follows.

For the purpose of carrying out subpart XII of part D of title III and sections 765, 766, and 768, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $51,000,000 for fiscal year 2010.

“(2) $54,000,000 for fiscal year 2011.

“(3) $57,000,000 for fiscal year 2012.

“(4) $59,000,000 for fiscal year 2013.

“(5) $62,000,000 for fiscal year 2014.

“(6) $65,000,000 for fiscal year 2015.

“(7) $68,000,000 for fiscal year 2016.

“(8) $72,000,000 for fiscal year 2017.

“(9) $75,000,000 for fiscal year 2018.

“(10) $79,000,000 for fiscal year 2019.”.

A total of $642 million. The government is going to allocate more that double the money for the training of nurses than it will for training and placement of doctors, dentists, and veterinarians under the Public Health Workforce initiative. This tells us who will be doing most of the work doesn’t it? Stop fussing. It costs a lot to supply you with that bedpan and wake you up in the middle of the night to take your meds. (Don’t be offended nurses, I know you do a heck of a lot more than any doctor will ever admit).

Section 2241 will provide scholarships for health professions training for diversity for “disadvantaged students”. Yes folks, it’s affirmative action in health care education. Al Sharpton will be very pleased with Section 2241.

The funds for “health professions training for diversity” will be allocated as follows.

For the purpose of carrying out sections 736, 737, 738, 739, and 739A, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $90,000,000 for fiscal year 2010.

“(2) $97,000,000 for fiscal year 2011.

“(3) $100,000,000 for fiscal year 2012.

“(4) $104,000,000 for fiscal year 2013.

“(5) $110,000,000 for fiscal year 2014.

“(6) $116,000,000 for fiscal year 2015.

“(7) $121,000,000 for fiscal year 2016.

“(8) $127,000,000 for fiscal year 2017.

“(9) $133,000,000 for fiscal year 2018.

“(10) $140,000,000 for fiscal year 2019.

Diversity will cost an additional $1,138,000,000, or $1.138 billion. Along with the Workforce funding of $642 million, and “interdisciplinary training programs” which will cost $1,149,000,000 or $1.149 billion, that brings our total to $49.373 billion of the $88.7 billion allocated from the general funds of the Treasury for this “division” of the Health Care bill

Title XXXI, “Prevention and Wellness” establishes a “Prevention and Wellness Trust” which will be allocated from, you guessed it, the “Public Health Investment Fund”. The money will be allocated as follows.

There is established a Prevention and Wellness Trust. There are authorized to be appropriated to the Trust—

“(1) amounts described in section 2002(b)(2)(ii) of the America’s Affordable Health Choices Act of 2009 for each fiscal year; and

“(2) in addition, out of any monies in the Public Health Investment Fund—

“(A) for fiscal year 2010, $2,400,000,000;

“(B) for fiscal year 2011, $2,800,000,000;

“(C) for fiscal year 2012, $3,100,000,000;

“(D) for fiscal year 2013, $3,400,000,000;

“(E) for fiscal year 2014, $3,500,000,000;

“(F) for fiscal year 2015, $3,600,000,000;

“(G) for fiscal year 2016, $3,700,000,000;

“(H) for fiscal year 2017, $3,900,000,000;

“(I) for fiscal year 2018, $4,300,000,000; and

“(J) for fiscal year 2019, $4,600,000,000.

For a total of $35,300,000,000 or $35.3 billion, bringing our total money spent from the $88.7 billion Public Health Investment Fund to $84.673 billion (95.5%).

The strategy of the Prevention and Wellness Trust will be to identify the specific goals and objectives in prevention and wellness activities for “Healthy People and National Public Health Performance Standards”.

Identification of specific national goals and objectives in prevention and wellness activities that take into account appropriate public health measures and standards, including departmental measures and standards (including Healthy People and National Public Health Performance Standards).

Subtitle D, “Prevention and Wellness Research” and Subtitle E, “Delivery of Community Prevention and Wellness Services” set the stage for all of the “big government” infrastructures you might expect in government forced health care that we have not already covered.

The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a program for the delivery of community preventive and wellness services consisting of awarding grants to eligible entities—

“(1) to provide evidence-based, community preventive and wellness services in priority areas identified by the Secretary in the national strategy under section 3121; or

“(2) to plan such services.

The Secretary, once again, will give preference to some entities over others.

In awarding grants under this section, the Secretary shall give preference to entities that—

“(1) will address one or more goals or objectives identified by the Secretary in the national strategy under section 3121;

“(2) will address significant health disparities, including those identified by the Secretary in the national strategy under section 3121;

“(3) will address unmet community prevention needs and avoids duplication of effort;

“(4) have been demonstrated to be effective in communities comparable to the proposed target community;

“(5) will contribute to the evidence base for community preventive and wellness services;

“(6) demonstrate that the community preventive services to be funded will be sustainable; and

“(7) demonstrate coordination or collaboration across governmental and nongovernmental partners.

Title V, Subtitle B, mandates the creation of a school-based health clinic program which basically nationalizes the school nurse programs. As we know most schools eliminated those positions years ago because of the lack of government funding, but now we’re bringing them back with a vengeance.

Not only will the school nurse be taking your temperature and calling your parents when you are sick but now they will be full-fledged clinics meeting requirements established in this bill and otherwise integrating every aspect of your child’s school records into the same database as your financial information, medical information, and criminal history.

Title V, Subtitle C provides for a new “National Medical Device Registry” because they apparently forgot (at least until page 1001) that they wanted to track that information in the database as well.

In developing the registry, the Secretary shall, in consultation with the Commissioner of Food and Drugs, the Administrator of the Centers for Medicare & Medicaid Services, the head of the Office of the National Coordinator for Health Information Technology, and the Secretary of Veterans Affairs, determine the best methods for—

“(A) including in the registry, in a manner consistent with subsection (f), appropriate information to identify each device described in paragraph (1) by type, model, and serial number or other unique identifier;

“(B) validating methods for analyzing patient safety and outcomes data from multiple sources and for linking such data with the information included in the registry as described in subparagraph (A), including, to the extent feasible, use of—

“(i) data provided to the Secretary under other provisions of this chapter; and

“(ii) information from public and private sources identified under paragraph (3);

“(C) integrating the activities described in this subsection with—

“(i) activities under paragraph (3) of section 505(k) (relating to active postmarket risk identification);

“(ii) activities under paragraph (4) of section 505(k) (relating to advanced analysis of drug safety data); and

“(iii) other postmarket device surveillance activities of the Secretary authorized by this chapter; and

“(D) providing public access to the data and analysis collected or developed through the registry in a manner and form that protects patient privacy and proprietary information and is comprehensive, useful, and not misleading to patients, physicians, and scientists.

That Secretary sure is going to be holding a lot of cards, isn’t he/she?

And finally, we come to the last page of the bill. 1017 pages down, one to go, and we learn that States will only receive funding under this provision (Division C) if they agree to fulfill each obligation under Division A and any amendments made by such division application to persons in their capacity as an employer and if they assure that all political subdivisions in the State will do the same.

States are only eligible for money to cover everything I discussed yesterday and today (Division C) if they, and every county and city government within them, agree to every condition in the first four days of posts (Division A).

In other words, the only way a State will qualify is if every city, town, parish, community, county within that State, along with the State itself, agrees to surrender some of the sovereign rights guaranteed to each State under the U.S. Constitution.

America’s Affordable Health Choices Act of 2009 starts by violating our rights as individuals as well as the Tenth Amendment to the U.S. Constitution, and it ends by demanding the voluntary surrender of States rights in order to “participate” in the soon to be required plan.

I don’t know about you, but this entire bill doesn’t sound to “affordable” nor does it seem to offer any choices.

So how many of you actually read the entire bill with me? It only took 12 days. If you read it, like I did, you can ask your Representative, “What did you do on your summer vacation?

I bet only a handful have read the bill, even now.

Make sure you tell your friends about the bill. Make sure they read the bill. Tell them not to listen to the hype and propaganda from either side of the aisle. Tell them to read the bill. The only way to dispel any “myths” in the bill is to read the bill yourself.

You cannot argue a position on the bill if you don’t even know what it says.

HR3200 : Division C : Day One

Tonight we cover Division C, the last “division” of the monstrosity known as “America’s Affordable Health Choices Act of 2009“.

Division C concentrates on Public Health and Workforce Development. The first thing we learn in this division is that each “amendment” mentioned in this division, unless otherwise specified makes reference to the Public Health Service Act.

Except as otherwise specified, whenever in this division an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.)

Section 2002 establishes a fund to be called the “Public Health Investment Fund”. The funding for this “fund” will be set by the following schedule.

There shall be deposited into the Fund—

(i) for fiscal year 2010, $4,600,000,000;

(ii) for fiscal year 2011, $5,600,000,000;

(iii) for fiscal year 2012, $6,900,000,000;

(iv) for fiscal year 2013, $7,800,000,000;

(v) for fiscal year 2014, $9,000,000,000;

(vi) for fiscal year 2015, $9,400,000,000;

(vii) for fiscal year 2016, $10,100,000,000;

(viii) for fiscal year 2017, $10,800,000,000;

(ix) for fiscal year 2018, $11,800,000,000; and

(x) for fiscal year 2019, $12,700,000,000.

That’s a total of $88,700,000,000. That’s $88.7 billion dollars over the next 10 years. Which amounts to just $16 billion more than the cost of covering 0.9% of the population (those treated for HIV, Cancer, and Parkinson’s Disease).

Where do you think the government is going to get an additional $88.7 billion over the course of the next 10 years?

Amounts deposited into the Fund shall be derived from general revenues of the Treasury.

Where do you think general revenues come from? That’s right. Taxes. There ain’t no mincing words about that.

The funds allocated for the “Public Health Investment Fund” will not be subject to the Balanced Budget and Emergency Deficit Control Act. That means the costs for operating this fund may rise and rise with no limit on appropriations at all. Yes, that means your taxes will rise and rise with no limit (until they hit 100%) on your income.

Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Fund.

Title I, section 2101 increases funding for community health centers. This actually makes sense since most of the bill up to this point deals with the Public Option, Medicare, and Medicaid. Everyone will be covered by the time the fund is funded to the levels they claim, so community health centers are going to need the money, aren’t they?

Community health centers will be appropriated money out of the Public Health Investment Fund, in the following amounts.

For the purpose of carrying out this section, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) For fiscal year 2010, $1,000,000,000.

“(2) For fiscal year 2011, $1,500,000,000.

“(3) For fiscal year 2012, $2,500,000,000.

“(4) For fiscal year 2013, $3,000,000,000.

“(5) For fiscal year 2014, $4,000,000,000.

“(6) For fiscal year 2015, $4,400,000,000.

“(7) For fiscal year 2016, $4,800,000,000.

“(8) For fiscal year 2017, $5,300,000,000.

“(9) For fiscal year 2018, $5,900,000,000.

“(10) For fiscal year 2019, $6,400,000,000.”.

The total for Community Health Center funding comes to $38,800,000,000, or $38.8 billion. That’s 43.7% of the money allocated for the Public Health Investment Fund.

Title II covers the “Workforce”. Section 2201 mandates the creation of a “National Health Service Corps.

Individuals who receive educational funding through a federal Scholarship Program or the Loan Repayment Program will be required to provide “half-time” clinical practice. No this does mean that the new up and coming doctors will be treating all their patients during the break in the local football game. It means they will be required to offer half-time service (yes, devoting half of their employment time) for two years to fulfill their obligation for the funding services they received from the government.

I wonder what the “government service” interns will be required to wear? With their coats be red in color?

Section 2202 sets the authorization of appropriations and provides for additional funding for the scholarship and loan repayment programs in the following amounts:

“For the purpose of carrying out this subpart, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $254,000,000 for fiscal year 2010.

“(2) $266,000,000 for fiscal year 2011.

“(3) $278,000,000 for fiscal year 2012.

“(4) $292,000,000 for fiscal year 2013.

“(5) $306,000,000 for fiscal year 2014.

“(6) $321,000,000 for fiscal year 2015.

“(7) $337,000,000 for fiscal year 2016.

“(8) $354,000,000 for fiscal year 2017.

“(9) $372,000,000 for fiscal year 2018.

“(10) $391,000,000 for fiscal year 2019.”.

A total of $3,171,000,000. Thats $3.171 billion or 3.6% of the Public Health Investment Fund. So far, we’ve spent $41.971 billion of the $88.7 billion dollar fund.

Section 2212 sets the loan provisions, rate of interest for those loans, and requires the student to practice in such care for 10 years or through the date on which the load is repaid in full, whichever occurs first.

If you take a government loan to become a doctor, you will be required to work “half-time” in clinical practice, as well as practice for at least 10 years or at least as long as you are repaying the loans you received.

to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first.”

The powerful and mighty Secretary of Health and Human Services will be pulling more strings behind that giant green curtain too. In addition to all of the other new responsibilities he/she will hold once this bill becomes law, the Secretary will also be responsible for something else.

The Secretary shall make grants to, or enter into contracts with, eligible entities—

“(A) to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program, in the field of family medicine, general internal medicine, general pediatrics, or geriatrics for medical students, interns, residents, or practicing physicians;

“(B) to provide financial assistance in the form of traineeships and fellowships to medical students, interns, residents, or practicing physicians, who are participants in any such program, and who plan to specialize or work in family medicine, general internal medicine, general pediatrics, or geriatrics;

“(C) to plan, develop, operate, or participate in an accredited program for the training of physicians who plan to teach in family medicine, general internal medicine, general pediatrics, or geriatrics training programs including in community-based settings;

“(D) to provide financial assistance in the form of traineeships and fellowships to practicing physicians who are participants in any such programs and who plan to teach in a family medicine, general internal medicine, general pediatrics, or geriatrics training program; and

“(E) to plan, develop, operate, or participate in an accredited program for physician assistant education, and for the training of individuals who plan to teach in programs to provide such training.

That’s right. The Secretary will be responsible for creating training programs for new doctors. The Secretary will decide (by entering into a contract with services or corporations of his/her choosing) what doctors will learn, how they will serve their communities, and how the inductees students, will repay their debt for the awesome opportunity to serve their country.

The Secretary will decide which hospitals qualify for these contracts, which programs will serve the best community good, and which students will be allowed to participate in these programs.

This bill isn’t just about the common good where health care is concerned, it’s not about lowering costs or making the system more efficient. It’s about the outright full control of health care, and ultimately our lives, in this country.

The allocation for funding for primary care and dentistry will amount to the following values.

For the purpose of carrying out subpart XI of part D of title III and sections 723, 747, 748, and 749, in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $240,000,000 for fiscal year 2010.

“(2) $253,000,000 for fiscal year 2011.

“(3) $265,000,000 for fiscal year 2012.

“(4) $278,000,000 for fiscal year 2013.

“(5) $292,000,000 for fiscal year 2014.

“(6) $307,000,000 for fiscal year 2015.

“(7) $322,000,000 for fiscal year 2016.

“(8) $338,000,000 for fiscal year 2017.

“(9) $355,000,000 for fiscal year 2018.

“(10) $373,000,000 for fiscal year 2019.”.

This amounts to another $3,023,000,000 or $3.023 billion. This brings our total “spent” to $44.994 billion.

In case you were wondering, Section 2221 adds nurses into the same “plan” as doctors where they will be allowed to serve their government as a “repayment” for two years. The funding for this additional program is allocated (like the rest) over the next ten years.

For the purpose of carrying out this title, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:

“(1) $115,000,000 for fiscal year 2010.

“(2) $122,000,000 for fiscal year 2011.

“(3) $127,000,000 for fiscal year 2012.

“(4) $134,000,000 for fiscal year 2013.

“(5) $140,000,000 for fiscal year 2014.

“(6) $147,000,000 for fiscal year 2015.

“(7) $154,000,000 for fiscal year 2016.

“(8) $162,000,000 for fiscal year 2017.

“(9) $170,000,000 for fiscal year 2018.

“(10) $179,000,000 for fiscal year 2019.”

A total of $1,450,000,000 or $1.45 billion. Our total is now $46.444 billion of the $88.7 billion total set in the fund. Yes, the government actually wants you to believe that they can fund the opening of community health centers (nationwide) and define plus fund the education of doctors as well as nurses for just $46.444 billion. Remember, it’s going to cost $72 billion to treat just 0.9% of the people in our country. When do we talk about covering the remaining 99.1 percent of the people? Is that included in the remaining 47.6% of the Public Health Investment Fund or are we talking about allocating money somewhere else?

Tomorrow we’ll begin with Subtitle C, “Public Health Workforce” on page 898.