| According to The Hill, Boehner filed a brief in support of he 20 State lawsuit against the healthcare bill, http://thehill.com/blogs/blog-briefing-room/news/128983-boehner-files-brief-in-favor-of-court-challenge-to-health-reform. And apparently Mitch McConnell is planning to do the same, http://www.politico.com/news/stories/1110/44923.html. I hope they both argue the facts of process that make the healthcare “law” an unconstitutional usurpation. If you look up HR 3200, which is not the healthcare bill that was “passed,” you'll find no individual mandate, instead you find a tax of 2.5% of the individual's income under the bill's Section 401 (acrobat pages 167-179), a tax that one can file for exemption from due to hardship--explain how this makes sure you and I aren't “paying a hidden tax of $1000 a year for the uninsured” that Obama used to tell us about over and over--as well as religious exemptions, and an subsection on where it's reported on the return. Lo and behold, in comparison, under section 1501 (acrobat page 125) and 1502 of “HR 3590,” which is the final compiled bill based on the idea of the House passing HR 3200, supposedly being “amended” by the Senate, you find a statement that doesn't exist in HR 3200, more than an amendment but an entirely new section with an entirely new idea and meaning: “(a) FINDINGS.—Congress makes the following findings: (1) IN GENERAL.—The individual responsibility requirement provided for in this section (in this subsection referred to as the ‘‘requirement’’) is commercial and economic in nature, and substantially affects interstate commerce, as a result of the effects described in paragraph (2).”-- Emphasis mine. Paragraph 2 is the laundry list of costs, followed by the Title 26, Amendment: ‘‘SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE. ‘‘(a) REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.— An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month." And this is, of course, followed again by the poverty exemption: ‘‘(e) EXEMPTIONS.—No penalty shall be imposed under subsection (a) with respect to— “(1) INDIVIDUALS WHO CANNOT AFFORD COVERAGE.—[with subsection definition of such individuals laundry list]...." ‘‘(2) TAXPAYERS WITH INCOME UNDER 100 PERCENT OF POVERTY LINE.—Any applicable individual for any month during a calendar year if the individual’s household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act is less than 100 percent of the poverty line for the size of the family involved (determined in the same manner as under subsection (b)(4)). ‘‘(3) MEMBERS OF INDIAN TRIBES.—Any applicable individual for any month during which the individual is a member of an Indian tribe (as defined in section 45A(c)(6))."[So the impoverished of Indian tribes with or without a casino get the care but don't have to pay even if they had a Casino, and have an income above the poverty line. Can you say, “up to $4,000 increase per person of new unhidden taxes for those who don't have health insurance shall now be paid by each one of us?” And this holds true for all Indians, even the casino owners. Sure is looking like healthcare is a form of reparations law.]... (Of course, those are Indians who belong to a tribe on a month-to-month basis – sorry, I couldn’t resist.) ‘‘(5) HARDSHIPS.—Any applicable individual who for any month is determined by the Secretary of Health and Human Services under section 1311(d)(4)(H) to have suffered a hardship with respect to the capability to obtain coverage under a qualified health plan. [Maybe it's me, but those in subcategories 1 and 2 above appear to also qualify under subsection 5 here. Luckily this isn't a bureaucratic nightmare or we, the hospital, and the States might be beholden to the national government for our unalienable right to “Life.”]”--Commentary mine, and made with a shameless sense of compulsion. Which brings me back to the question how this is to assure you and I aren't “paying a hidden tax of $1000 a year for the uninsured” that Obama used to tell us about over and over to justify the reason we need universal healthcare--government managing what was once our hidden tax, as an actual government imposed tax, collected and distributed with all the palm greasing patronage that goes with government running anything, which now inflates the amount that was once hidden, into a staggering amount in the light of day due to government's greed. But I digress. Some of the principles between these bills are the same, however their difference is striking. The House version is the only one applicable due to Article I, Section 7, Clause 1, where “all Bills for raising Revenue shall originate in the House” according to Our Written Constitution, and here is where this gets to the meat of things: Though the Senate has advise and consent authority, the substantiation of the tax in the Senate version of the bill requires the House Rules be applied via the House voting on the bill, as that is when the House is proposing by passage of a bill any change to the Internal Revenue code, to which these must go through the Ways and Means Committee, with prohibitions according to House Rule XIII, h1 and h2 (ADDENDUM: Original Link inaccurate, moved, etc. House Rules in effect at time of passing Obamacare: http://www.gpo.gov/fdsys/pkg/CDOC-111hdoc157/pdf/CDOC-111hdoc157.pdf page 646. The following link to be unused but left here as the original posted with this article http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_house_rules_manual&docid=110hruletx-70.pdf) Best read at page 646 of first link: “(h)(1) It shall not be in order to consider a bill or joint resolution reported by the Committee on Ways and Means that proposes to amend the Internal Revenue Code of 1986 unless— (A) the report includes a tax complexity analysis prepared by the Joint Committee on Internal Revenue Taxation in accordance with section 4022(b) of the Internal Revenue Service Restructuring and Reform Act of 1998; or (B) the chair of the Committee on Ways and Means causes such a tax complexity analysis to be printed in the Congressional Record before consideration of the bill or joint resolution. [This is a notation] “This provision was added by the Internal Revenue Service Restructuring and Reform Act of 1998 as a new clause 2(l)(8) of rule XI, effective January 1, 1999 (sec. 4022, P.L. 105–206). It was transferred to this paragraph when the House recodified its rules in the 106th Congress (H. Res. 5, Jan. 6, 1999, p. 47). A gender-based reference was eliminated in the 111th Congress (sec. 2(l), H. Res. 5, Jan. 6, 2009, p. l). “(2)(A) It shall not be in order to consider a bill or joint resolution reported by the Committee on Ways and Means that proposes to amend the Internal Revenue Code of 1986 unless— (i) the report includes a macroeconomic impact analysis; § 849. Tax complexity analysis. [633] Rule XIII, clause 4 § 850 RULES OF THE HOUSE OF REPRESENTATIVES (ii) the report includes a statement from the Joint Committee on Internal Revenue Taxation explaining why a macroeconomic impact analysis is not calculable; or (iii) the chair of the Committee on Ways and Means causes a macroeconomic impact analysis to be printed in the Congressional Record before consideration of the bill or joint resolution. (B) In subdivision (A), the term ‘macroeconomic impact analysis’ means— (i) an estimate prepared by the Joint Committee on Internal Revenue Taxation of the changes in economic output, employment, capital stock, and tax revenues expected to result from enactment of the proposal; and (ii) a statement from the Joint Committee on Internal Revenue Taxation identifying the critical assumptions and the source of data underlying that estimate. [This is a notation.]”This requirement of a macroeconomic analysis of any tax proposal replaced a provision that authorized the chair of the Committee on Ways and Means to request the Joint Committee on Internal Revenue Taxation to prepare a dynamic estimate of revenue changes proposed in a measure designated by the Majority Leader as major tax legislation (sec. 2(j), H. Res. 5, Jan. 7, 2003, p. 7). The former provision was added in the 105th Congress (H. Res. 5, Jan. 7, 1997, p. 121); but, before the House recodified its rules in the 106th Congress, it was found in former clause 7(e) of rule XIII (H. Res. 5, Jan. 6, 1999, p. 47). A gender-based reference was eliminated in the 111th Congress (sec. 2(l), H. Res. 5, Jan. 6, 2009, p. l).” As you can see there are particular safeguards by studies done when a Tax is suggested in legislation before the House, yet, there is also the ability of the Majority Leader to claim a bill isn't “major tax legislation,” and this is how we got here. Yet it remains true that, due to the defensive admission by pleading of the Justice Department that the individual mandate is a tax, the entire placement of the healthcare bill before the House was out of order without carrying out the procedures in XIII h1 and h2. This would be meaningless if not for Obama, speaking as President, During entire course of the healthcare discussion, and telling us over and over that the individual mandate “is not a tax.” We knew this was the quintessential stuff that sticks to your boots, even hip deep, in that the Title being amended is Title 26! That alone says the healthcare law is affecting taxation. The House HR 3200 tax made sure to have some gray area but was not out to make the 2.5% increase in taxation to cover healthcare costs into an individual mandate, instead it is collected as the rest of the income taxes are, whether legal or not, the mechanism is silent, hidden, and doesn't involve the individual in some compelled requirement of government to compel them to carry health insurance. If you search for the Senate term “minimum essential” in HR 3200 you'll find nothing. This takes us to Max Baucus Senate Committee, originating the tax structure in HR 3590 as the Individual Mandate, or, as to be titled in Title 26, ‘‘SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE,” which doesn't exist in HR 3200, and therefore, was never reviewed by the Ways And Means Committee in the House! I submit that this is why Obama kept saying it's not a tax! The goal was to make sure this healthcare bill could pass under the rules of reconciliation, which would not be applicable to a tax! One could say this was the Scott Brown Effect, to make the Progressives carry on even more illegally than before. The findings in Section 1500 of HR 3590 have no basis as a tax without complete demonstrable review by the House Ways And Means Committee, and thus, the defense argument of the Department of Justice requires, for us to prevail as quickly as possible, that the 21 compel the production of the documents that were reviewed by Ways And Means regarding this tax, that includes all the reports above listed under House Rule XIII h1 and h2. Without these reports the Justice Department's argument it is a tax falls flat, the Senate is revealed for usurping the House's Sole Constitutional authority, and the entire healthcare bill is revealed for the fraud and sham it actually is. Boehner and McConnell know the rules better than I do, and if anyone can get this to the lawyers of the 20 state lawsuit, and/or Boehner and McConnell, I believe we can unravel the entire government argument rather swiftly and show the absolute corruption of the Progressives in Congress by their clear unambiguous willingness to go along with usurpation of the Constitution by the House, Senate, and President of the United States of America. This will disqualify every single one of those who voted for it, and most importantly, the President who signed it, all through one judicial ruling and how the lawyers of the winning argument frame the public disclosure and discussion of it, as well as our Tea Party discussion and reporting of it. I have been yelling about this for a while but this is the first time I quoted every aspect of it, and am merely doing so to articulate my hope of what Boehner and McConnell discuss as well as the 20 States suing. Thank you for reading, Toddy Littman |
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| Your Vote For Conservatives Nov 2nd Protects The Individual “Unalienable Right To Life” Recently Glenn Beck mentioned that the scientists claim to have found “the liberal gene.” He wasn't joking. http://www.nbcsandiego.com/news/weird/Scientists-May-Have-IDd-Liberal-Gene-105917218.html and http://www.sciencedaily.com/releases/2010/10/101027161452.htm This prompts a need to ask the question why there was a study to find a gene responsible for ideology. What in Heaven's Name is there of any necessity for anyone to know of a gene responsible for ideology? Can you see the threat to mankind by this? Imagine millions of people injected, infected, and altered by having this gene introduced into their system through food, through water, and most importantly, through a visit to the doctor's office! Conspiracy “Theory,” really? I mean, it's entirely implausible in light of World War II and the leader of the National Socialist Party (NAZI) party, Adolf Hitler, wasn't attempting genetics in trying to build a “master race” either, right? Hitler was swept into power on a variety of promises. He sold the people on his ideas through economic policies that spread the wealth around, and, eventually, cultivated tolerance of his desire to build a master race, one bred by bringing blond-haired, blue-eyed people together. The test tube baby was a long way away, the genome certainly not known, but the idea of a recessive gene and the ability to better assure the outcome of the child was possible. Crude genetics yes, but available. Now keep this in mind with the Jews and the homosexuals who were forced publicly to wear symbols stitched to their clothing announcing and identifying their heritage and sexual preference. Also note these two groups were targeted and killed by the Nazi party as a blight upon the earth, the same party that had courted the German people with promises of “change” to gain power in the first place. We fought World War II to scourge the beasts who could, and did, inflict inhuman, ungodly medical experiments, torture, and ultimate death upon our fellows; to deny the possibility of these horrors happening again. Today we have mapping of the genome occurring at a fevered pace, and still we think it wise to hand health care to the government? And this is while we do know the government has carried out experiments on us in the past, particularly with nuclear power plant radiation release, the syphilis project on black men in the South and, in San Francisco on the homosexual population. Do we decide to question this when the government-run, funded, or otherwise organized, health care system's bureaucrat decides to rebut our rationing claims by explaining that “if you had received the government provided gene therapy you wouldn't have this disease” at some future date? Or is it when someone hires a capable attorney and sues after their spouse dies, getting the bureaucrat on the stand to admit, “Well, statistics showed poor response to other therapies and after reading an article in TIME magazine about genome advances, I took it upon myself to insist that the doctor have all their patients with that medical condition try this therapy or the doctor's payment would be held up indefinitely.” Pardon me. You can’t sue the government. It’s in the bill. No one has guaranteed this will not, cannot occur, or is an absolute impossibility according to any health care bill put forth. For a President who keeps invoking the 21st Century as a blazing horizon of hope (oh, let’s not forget “change”), he and his comrades in the other branches of government appear incapable of thinking this far ahead. Or have they? But there is more, and this will sound like science fiction, but it is real and coming to a brain near you: nanobot technology. Imagine for a moment appreciating some little thing, be it from a friend or loved one, maybe a fond memory that brings a tear to your eye. Now, imagine not feeling anything from it. So now let’s say it’s something big, say a child getting married or the birth of a grandchild. Just imagine feeling nothing from it, or even anger toward something about it. Imagine a variety of memories you once had, gone, just vanished because they do not make you more intelligent. But you don’t care since you no longer even remember them, the neurons that made them exist are no longer present in your mind. These can easily be the results of nanobot technology that the 18 intellectuals who can have the most influence on policies worldwide have suggested “to make people think more intelligently.” Anyone who knows someone with Alzheimer’s knows how heart-wrenching this is to consider. And, apparently, according to a group of experts, intelligence is a static set of values, ideas, knowledge, etc., there is no variance, no other activity but that which is identified by these people, or others like them, that is intelligence. “One size fits all” is apparently how intelligence is determined and the idea of sanctity of one’s own thoughts to themselves is no longer valid. Here are links to articles about nanobots as a real, tangible, design to be in our midst in less than 20 years. And you wonder why government wants to run healthcare. http://www.nanobot.info/ http://www.youtube.com/watch?v=R-2Xw-GNkUQ http://www.scienceahead.com/entry/artificially-intelligent-nanobots-in-human-brains-by-2029/ Gene therapies are good, but programmed bots that replace the neurons in your mind, now that puts an end to a variety of troubles for government and the minions of bureaucrats who want the public to “just comply,” to “just obey.” Imagine being hacked through wi-fi or voting for someone on the basis of what the program in a group of nanobot neurons tells you is right, and not due to your mind’s own knowledge, life, and experience. This is what is in store for us all, and a damn good reason so many in government voted for healthcare this time around, the price they pay for their vote will be temporary. Hell, there are people in Prince Edward Island who are sure there are nanobots in the H1N1 shots (Comments under article at http://www.theguardian.pe.ca/index.cfm?sid=303591&sc=98) So while we are sold the idea on the basis of the cost to us of the uninsured, let’s not kid ourselves into believing government isn’t doing what is in government’s best interest. If socialism, spawned, bred and brought to thrive the regime of Hitler, and we're in the midst of a Progressive ideologue who passes bills over our objection and hires 8,000 people who are immediately put into a military medical unit, there is absolutely nothing to say the Progressives, as a collective, aren't absolutely moving in this direction. Their honest belief is that with this nanobot technology you will “think more intelligently.” Once there is this government healthcare in place, irrespective of 60% of Americans not wanting this bill, it’s very obvious this law was illegally passed for purposes the government has in mind, nothing else, and we have history, the writing on the wall, to show this can happen, a history that we appear to be ignoring. Maybe Obama’s mention of “doing things no one knows about,” on Jon Stewart’s show, comes under this category. I just hope enough read this to understand our entire race of people and the sentience we've enjoyed for 500 years, is at stake here. Makes me wonder if we fought Hitler merely because those who wanted this here didn't want him to have it first. May sound crazy but every single Man, Woman, and Child on this planet should be fighting their governments until this activity is brought to an end. Individuality, “viva la difference,” is the basis of our evolution under God. Thank you for reading, Toddy Littman |
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| Now that we have the Justice Department's admission that the Healthcare purchase requirement is a tax, or incidental to a tax by operational treatment of it, I found it necessary to restate a Constitutional issue that was also true of the bank bailout bill regarding taxes and revenue. I brought this up about the Bank Bailout before there was a Tea Party, http://changingwind.org/index/comment.php?comment.news.2. The unconstitutionality relies on a simple clause of the Constitution, Article I, Section 7, Clause 1: “All Bills for Raising Revenue shall originate in the House of Representatives; but the Senate may propose or concur with Amendments as on other bills.” At least with the bailout bill the Senate used an interpretation of ... “but the Senate may propose or concur with Amendments as on other bills” to justify their taking the Bank Bailout Bill and making it the Dodd Amendment to a bill that had already passed the House. With Healthcare, there is absolutely no mistake. There was no “origination in the House,” which would be required if the Healthcare Purchase requirement is considered “raising revenue” as the Justice Department appears to be arguing. The House passed a bill, and then the Senate passed a bill, after which they were blended together so as not to lose any of the previous “yea” votes in either body, and then the blended bill, which ended up being almost entirely the Senate version of the bill, was passed by the House, and put before the Senate for a procedural appearance. You see, this Clause of the Constitution forbids the Senate from being the source for any and all laws to generate revenue for the United States Government. Title 26 changes made to the Bailout bill by the Senate are what triggered my looking into this particular clause. And I should note that in my review of the House passed healthcare bill, HR 3200, there appears to have been no requirement of purchase, and no IRS enforcement, that these ideas were devised entirely in the Senate. It appears President Obama, our Commander-in-Thief, was well aware of this Constitutional provision when arguing the dictionary definition of a tax, or, he just wanted to see how far he could mock our intelligence, after all he is a Progressive Elite, hand-picked for President by the Progressive cartel/cabal of George Soros, Warren Buffett, Oprah Winfrey, Bill Gates, and a host of millionaires and billionaires, banks, and institutional union wealth. Of course these people, who can afford any doctor day or night, and at any time, could care less about the rest of us being taxed. It’s just a good thing almost every American makes over $250,000 a year, or Obama’s Healthcare Law could be breaking his campaign pledge, and we all know he would never do anything like that. Thank you for reading, Toddy Littman P.S. Please if your state is one of the states suing the federal government in regard to the Healthcare bill get this to your Attorney General’s office, as it seems this little rule in the Constitution has been overlooked for far too long. |
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| This is Senator Byrd's letter to the Senate: Image: http://3.bp.blogspot.com/_2SW2_lbrxgY/S4dov3f2opI/AAAAAAAAA0w/XbWlVJFys2A/s1600/docpage-byrdhealth1.jpeg Their conscience for America, American Pride, freedom at as many levels of right of the individual, that is where the opportunity to reach them remains. Their sway toward this take over of a large part of our lives and our nation is based on the majority of them being lawyers, knowing that to move the jury one must "shock the conscience." As they act as jury in our stead we cannot shock them with the atrocities they can cite due to a lack of healthcare, affordability, or access due to pre-existing conditions, in the minuscule minority percentage of cases of medical care in the United States of America. We can shock their conscience of what bipartisanship, what getting something done according to the Will of the People means, and how anything less is oppression. We can appeal to their memories of father, mother, and the way freedom was taught by them, and ask these legislators if that same freedom can be taught to children today or is it less, and does this legislation move us any closer to the freedom our American ancestors had. We can bring them to terms with the fact that the imposed cost of mandated healthcare on those who can't afford it, when coupled with collection by the IRS, is healthcare in mockery, and an atrocity against the poor--Our best example citing one of the causes of the economic collapse, Oil, a necessity to modern day life, rose in price so dramatically that those who can barely make ends meet ended up defaulting on their home loans, and our economic house of cards collapsed with the magnitude the terrorists intended of the World Trade Center collapse on 911. We can make certain they know we understand that there is a clear and distinct abuse of power when a government is so certain and ready to impose such a heavy hand on a segment of society already barely able to survive. It is this dramatic reality of their actions that they do not comprehend but that must be brought to their attention in balance to the cancer patient who cannot get healthcare, the insurance companies failing to have a way to fund a situation that is likely to end in death and impossibility to fund the account enough to afford the coverage for the price charged. These denial of healthcare talking points are used as "shock the conscience points," and it is up to us to help them see an even more overwhelming dramatic effect if they pass this bill, the rugged independence of America is sacrificed for their President. These things it would seem are necessary to be brought up along with the myriad other well known and, that they are ready to debate, issues with the healthcare bills. We need to shock the conscience enough to vote no and hope to hear more from us as to what we truly want as opposed to what they've assumed we are asking for in desire to effect political upheaval irrespective of it only adding to the corruption and destructive character the United States Government is becoming known for throughout all of its people. Thank you for reading, Toddy Littman |
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| A Seat at the Emperor’s Table? You may all recall the fanfare and audience our imperious Progressive celebrity leader received by announcement after the Superbowl, via his “top gun” Katie Couric, of invitation to have a meeting with the GOP “to discuss healthcare” next week. Anyone scratch their head and ask, “Mr. President, why didn’t you do that in the first place?” That’s all that came to my mind. Of course I recognize this invitation admits the leadership of Congress has not had an open door to ideas outside of democrat party circles, to where they say the GOP, or anyone else for that matter, has no ideas--the democrats don’t know, their door is always closed. But finally the Grandmaster of our nation has admitted with this invitation that he and the democratic party carried out their acts in the shadows, as liars, cheats, and thieves, or, to be Midwestern honest “The Chicago Way.” Just ask anyone from Illinois, and specifically Chicago, how long it takes to get anything done unless you are already bought and sold by the political machine as a patronage junkee. Also ask them how often someone is shaking someone else down, even Churches! Yet this situation gets “progressively” worse as Chicago style partisan politics are asserted as the national means of policy making.... The White House, announced they are working on their own merging of House and Senate bills, a reconciliation healthcare bill to be presented for budget reconciliation--the 51 vote option. Fascinating that the President, who was so busy campaigning he was actually absent from the U.S. Senate more often than the number of votes of “not present” he made in the Illinois Legislature, is now LEGISLATING FROM THE OVAL OFFICE to pass a bill with 51 votes that around 70% of the American public is against, and to add further insult to injury in our representative system, before the meeting he scheduled with republicans (breathes very slowly to slow bleeding from the eyes). What is just beyond belief to me, is that every democrat spoken to about this brings up republican handling of revenue and expenditure legislation, that cut taxes or cut spending, things germane to the budgetary process, the democrats claiming this as their excuse to do the same with healthcare! This seems more like revenge and childish "they did it so we can too" partisan games, and is being done irrespective of the difference in the nature and effect of the healthcare bill. The democrats are going to caste, for the first time in American history, healthcare as a government revenue and/or expenditure bill to get it through, to bring healthcare into being a budgetary item of the government irrespective of the American people wanting healthcare to stay in private hands just with better regulation. And, since the White House is choosing this option, Obama is unequivocably breaking his promise of bipartisanship to get things done, not that I am all for them working “progressively” together, but that it is HIS promise he is going to additional lengths to break. It appears the Tea Party, and Scott Brown, have forced the Progressives to press the accelerator even harder, to try to do all the damage they could do to America in 4 years, in the next 10 months! Let us hope a some Tea Party nudging will effect a few democrats, as they still have the most seats, to come to recognize that passing healthcare like this is the most violent act of abuse of the American People that the democrat party could ever carry out. And, if they do pass healthcare this way, let us all make certain to tell the world, “Barack Hussein Obama and the Progressives exacted vengeance against the American People by passing healthcare like this. This is a vengeance that is equivalent to Saddam Hussein firing missiles of mustard gas on 400,000 Kurd and Iraqi men, women and children, his own citizens, in Northern Iraq!” It is our will, our conscience, our necessity, our known and accepted role, to be a beacon of hope to people of all nations who want a better life, one based on freedom. And this is a historic role, one that has assured mankind will be free. A role that no longer exists when under an oppressive regime of elite, class baiting, rhetorical Progressives, who appear bound and determined to break the individual American Spirit. In a dictatorship we expect the ruler to disregard, abuse, and exploit their people, but not in the American Republic, where the people are the sovereignty of the nation and not the national government. Thank you for reading, Toddy Littman |
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| Obama Agrees With GOP at Retreat Well actually President Obama is agreeing with the American People without knowing it. Just go to the following link and scroll the video to 40:19 and let it play. (if you can't view the video here is the link at YouTube http://www.youtube.com/watch?v=R5vOMIN673A) You’ll find President Obama arguing with Dr. Tom Price from Georgia, that HR 3400, the Republican Healthcare Proposal that does all that the President wanted but "without raising taxes one penny," is, according to President Obama,..... “just not true, you can’t structure a bill where suddenly 30 million people have coverage and it costs nothing.....It’s not enough, if you say, for example that we’ve offered a healthcare plan....Specifically it’s gotta work. There has to be a mechanism in these plans that I can go to an independent healthcare expert, and say, ‘is this something that will actually work?’ Or is it boilerplate?” Isn’t that what we’ve all been saying while Reid and Pelosi have pushed for as much nationalization of healthcare as they can in both of their bills and with the President saying the bills "save money" or are "deficit neutral?"= But to exacerbate the intellectual elitism of our Progressive President, Obama further argues against tort reform, citing a lack of significant savings, “....But the CBO, or other experts, say to me, at best this could reduce healthcare costs, relative to where they are growing, by a couple of percentage points, or save 5 billion dollars a year, that’s what we can score it at, and, it will not bend the cost curve long term, or reduce premiums significantly, then you can’t make the claim that’s the only thing that we have to do.” Intellectual elitism is established here because Mr. Obama demonstrates a perfect lack of understanding of tort reform in regard to the healthcare issue. Arizona, for example, has a lack of medical doctors available to take care of patients. The reason is that the cost of liability insurance has left it virtually impossible for doctors to carry on business with a profit. This shortage of doctors drives the price of healthcare up due to the basic laws of supply and demand and is why the doctors we have are able to be profitable. Thus the ratio of doctors to patients can’t be increased without sacrificing the success of the current doctors and, at the same time, the opportunity for new doctors. Of course in typical lawyer fashion, Obama knows nothing, and needs to have some expert of one kind or another tell him what will or won’t work, and, that verification is how he derives if what is proposed will work or not. To me this reliance on experts is one hell of an opportunity for lobbyists. Let’s imagine if we could get twice as many doctors as we have competing in the marketplace for residency and the market of people who need medical care, and prices would come down. Of course then government would have no reasonable basis to claim a need for government to control healthcare merely to assure 15-30 million people are covered by a medical policy (5-10% of the entire population of the United States). This is an inequity to suggest, let alone pass, a law to displace the comfortable consumer market of current healthcare that is enjoyed by 90% of Americans merely to assure 10% or less have a means to get healthcare. I believe the term “over reaching” is in order, but another more juvenile yet appropriate term could be used here “unnecessary drama.” Our economy is fragile enough as it is, and proposing this type of reckless legislation, legislation that does not even impute the impact of tort reform on the equation, is a very quick way to destabilize what little we can see with any sort of stability, as even a bad system has predictability, and thus is one less area of worry, one less thing to think about in the midst of worry about ones employment, eating, feeding their family etc. Lastly, of course the idea President Obama put forth, "that it costs nothing" is in telling counter-distinction to "doesn't raise taxes a penny" and reveals that Mr. Obama feels taxes are indicative of cost, the notion that government is the answer and must spend, must have a cost, for there to be any "meaningful change," and without such cost, it is just the status quo and what we've done for 8 years, irrespective of private enterprise being the engine of America for over 200 years in fact! Thank you for reading, Toddy Littman |
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| This article has proven to be hard for me to work on. Imagine for a moment appreciating some little thing, be it from a friend or loved one, maybe a fond memory that brings a tear to your eye. Now, imagine not feeling anything from it. So now let�s say it�s something big, say a child getting married or the birth of a grandchild. Just imagine feeling nothing from it, or even anger toward something about it. Imagine a variety of memories you once had, gone, just vanished because they do not make you more intelligent. But you don�t care since you no longer even remember them, the neurons that made them exist are no longer present in your mind. These can easily be the results of nanobot technology that the 18 intellectuals who can have the most influence on policies world wide have suggested �to make people think more intelligently.� Anyone who knows someone with Alzheimer�s knows how heart wrenching this is to consider. And, apparently, according to a group of experts, intelligence is a static set of value, ideas, knowledge, etc., there is no variance, no other activity but that which is identified by these people, or others like them, that is intelligence. �One size fits all� is apparently how intelligence is determined and the idea of sanctity of ones own thoughts to themselves is no longer valid. Here are links to articles about nanobots as a real, tangible, design to be in our midst in less than 20 years. And you wonder why government wants to run healthcare. http://www.nanobot.info [This link has been compromised. Direct link disabled. !!!!! WARNING DO NOT USE THIS URL !!!!! Apparently that link references to a "dating" site now. Note that: Changingwind.Org website has been hacked more than 20 times. As I no longer post to the site I do not administrate it but when there's a problem like this found. Again, !!!!!WARNING!!!!! DO NOT USE http://www.nanobot.info . If this link hadn't been in the article when originally published I'd take it out. Luckily there's an archive of the article, https://web.archive.org/web/20100622063217/http://www.nanobot.info/] http://www.youtube.com/watch?v=R-2Xw-GNkUQ http://www.scienceahead.com/entry/artificially-intelligent-nanobots-in-human-brains-by-2029/<< [Direct link no longer works, please use, https://web.archive.org/web/20120416044200/http://www.scienceahead.com/entry/artificially-intelligent-nanobots-in-human-brains-by-2029/. Thank you.] Gene therapies are good, but programmed bots that replace the neurons in your mind, now that puts an end to a variety of troubles for government and the minions of bureaucrats who want the public to �just comply,� to �just obey.� Imagine being hacked through wi-fi or voting for someone on the basis of what the program in a group of nanobot neurons tells you is right, and not due to your mind�s own knowledge, life, and experience. This is what is in store for us all, and a damn good reason so many in government voted for healthcare this time around, the price they pay for their vote will be temporary. Hell there are people in Prince Edward Island who are sure there are nanobots in the H1N1 shots (Comments under article at http://www.theguardian.pe.ca/index.cfm?sid=303591&sc=98 << [Direct link no longer works, please use, https://web.archive.org/web/20091118153827/http://www.theguardian.pe.ca/index.cfm?sid=303591&sc=98. Thank you.]) So while we are sold the idea on the basis of the cost to us of the uninsured, let�s not kid ourselves into believing government isn�t doing what is in THEIR best interest, and with this nanobot technology where you will �think more intelligently� according to government. Once there is this government healthcare in place, irrespective of 60% of Americans not wanting this bill, it�s very obvious this bill is being done for purposes the government has in mind, nothing else. Thank you for reading, Toddy Littman |
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| "That'll never happen!" you say, or "You right-wingers will stoop to anything!" Will we? Let's try an objective approach, one that uses the record. Hitler was swept into power on a variety of promises. He sold the people on his ideas through economic policies that spread the wealth around, and, eventually, cultivated tolerance of his desire to build a master race, one bred by bringing blond-haired, blue-eyed people together. The test tube baby was a long way away, the genome certainly not known, but the idea of a recessive gene and the ability to better assure the outcome of the child was possible. Crude genetics yes, but available. Now keep this in mind with the Jews and the homosexuals who were forced publicly to wear symbols stitched to their clothing announcing and identifying their heritage and sexual preference. Also note these were two groups targeted and killed by the Nazi party as a blight upon the earth, the same party that had courted the German people with promises of “change” to gain power in the first place. We fought World War II to scourge the beasts who could, and did, inflict inhuman, ungodly medical experiments, torture, and ultimate death upon our fellows; to deny the possibility of these horrors happening again. Today we have mapping of the genome occurring at a fevered pace, and still we think it wise to hand health care to the government? And this is while we do know the government has carried out experiments on us in the past, particularly with nuclear power plant radiation release, the syphilis project on black men in the South and, in San Francisco on the homosexual population. Do we decide to question this when the government-run, funded, or otherwise organized, health care system's bureaucrat decides to rebut our rationing claims by explaining that "if you had received the government provided gene therapy you wouldn't have this disease" at some future date? Or is it when someone hires a capable attorney and sues after their spouse dies, getting the bureaucrat on the stand to admit, "Well, statistics showed poor response to other therapies and after reading an article in TIME magazine about genome advances, I took it upon myself to insist that the doctor have all their patients with that medical condition try this therapy or the doctor's payment would be held up indefinitely." Pardon me. You can’t sue the government. It’s in the bill. No one has guaranteed this will not, cannot occur, or is an absolute impossibility according to any health care bill put forth. For a President who keeps invoking the 21st Century as a blazing horizon of hope (oh, let’s not forget “change”), he and his comrades in the other branches of government appear incapable of thinking this far ahead. Or have they? Let's face it folks, we are that endless money tree, the producers who cultivate this economy, and upon which growth government reaps in harvest to feed it's own agenda. There are 53 new agencies currently slated in HR 3200. Building a vast bureaucracy is not a means of saving money, particularly to the tune of 900 billion dollars of "waste and inefficiency." There is only one guarantee that health care will not result in our being subjected to the genetic model, the genetic notion, the Hitlerian potential of a perfect race, and this is by rejecting entire the notion of government-run health care. We the people of all backgrounds, experiences, ideologies, and attitudes must safeguard that chaotic but effective melting pot that has secured our freedom for over 200 years, and that means keeping government out of having ANY opportunity to affect our genetics. Let's learn from history this time. Thank you for reading, Toddy Littman and A. Dru Kristenev |
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| Taking Over Health Care by Government and Special Interestes A better formatted version of this, due to limitation of the e-107 engine, is available to be read at http://toddy.blogtownhall.com/2009/08/12/taking_over_health_care_by_government__special_interests.thtml. HR 3200 is available from http://energycommerce.house.gov/Press_111/20090714/aahca.pdf Here are the pertinent sections of the health care bill, HR 3200, found by merely searching the document for the term "end of life." The end is the agreement under Social Security Act Section 1890(a). I strongly advise you to not not wear your literalist hat when reading this so that gems of legislative interpretive flexibility can easily be found, such as: "‘‘(2) FORM OF AGREEMENTS.—The Secretary may carry out paragraph (1) by contract, grant, or otherwise." Every college, university, corporation or other individual who engages with the government for any "contract, grant, or otherwise" related to health care shall find themselves being stuck with the quality standards of those entities who apply to be a "consensus-based entity" who also are "mulit-stakeholder groups." Legally a stakeholder is the one who invests in a non-profit or not-for-profit organization, however who is the stakeholder in your health, them or you? Are they out to protect you or their investment and notariety? And as you read you'll learn the Secretary of Health and Human Services is entirely in control of this, they can even carry out their own reasons for rulemaking so long as it's been considered by the rest of the multi-stakeholder groups, even if not adopted by them, so long as "the Secretary shall include the rationale for continued use of such a measure in rulemaking.’’." "End of life" is the connection between Part I (pages 424-432) and Part II (Pages 619-633). Section 1890 is the connection between Part II and Part III. PART I-H.R. 3200 (Pages 424-432) SEC. 1233. ADVANCE CARE PLANNING CONSULTATION. (a) MEDICARE.— (1) IN GENERAL.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (A) in subsection (s)(2)— (i) by striking ‘‘and’’ at the end of subparagraph (DD); (ii) by adding ‘‘and’’ at the end of subparagraph (EE); and (iii) by adding at the end the following new subparagraph: ‘‘(FF) advance care planning consultation (as defined in subsection (hhh)(1));’’; and (B) by adding at the end the following new subsection: ‘‘Advance Care Planning Consultation ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following: ‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to. ‘‘(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 require ments 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 stake-holders 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. ‘‘(2) A practitioner described in this paragraph is— ‘‘(A) a physician (as defined in subsection (r)(1)); and ‘‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments. ‘‘(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1). ‘‘(B) 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. ‘‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order. ‘‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that— ‘‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care; ‘‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual; ‘‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and ‘‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual. ‘‘(B) 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. Such indicated levels of treatment may include indications respecting, among other items— ‘‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems; ‘‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting; ‘‘(iii) the use of antibiotics; and ‘‘(iv) the use of artificially administered nutrition and hydration.’’. (2) PAYMENT.—Section 1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’. (3) FREQUENCY LIMITATION.—Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended— (A) in paragraph (1)— (i) in subparagraph (N), by striking ‘‘and’’ at the end; (ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘‘, and’’; and (iii) by adding at the end the following new subparagraph: ‘‘(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;’’; and (B) in paragraph (7), by striking ‘‘or (K)’’ and inserting ‘‘(K), or (P)’’. (4) EFFECTIVE DATE.—The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011. (b) EXPANSION OF PHYSICIAN QUALITY REPORTING INITIATIVE FOR END OF LIFE CARE.— (1) PHYSICIAN’S QUALITY REPORTING INITIATIVE.—Section 1848(k)(2) of the Social Security Act(42 U.S.C. 1395w–4(k)(2)) is amended by adding at the end the following new paragraphs: ‘‘(3) PHYSICIAN’S QUALITY REPORTING INITIATIVE.— ‘‘(A) IN GENERAL.—For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment. ‘‘(B) PROPOSED SET OF MEASURES.—The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’’. (c) INCLUSION OF INFORMATION IN MEDICARE & YOU HANDBOOK.— (1) MEDICARE & YOU HANDBOOK.— (A) IN GENERAL.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following: (i) An explanation of advance care planning and advance directives, including— (I) living wills; (II) durable power of attorney; (III) orders of life-sustaining treatment; and (IV) health care proxies. (ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including— (I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.); (II) website links or addresses for State-specific advance directive forms; and (III) any additional information, as determined by the Secretary. (B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS.—The Secretary shall include the in formation described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act. PART II-H.R. 3200 (Pages 619-633) Subtitle C—Quality Measurements SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR QUALITY IMPROVEMENT. Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end Subsection (a) as referenced by subsection (c) below the following new part: ‘‘PART E—QUALITY IMPROVEMENT ‘‘ESTABLISHMENT OF NATIONAL PRIORITIES FOR PERFORMANCE IMPROVEMENT ‘‘SEC. 1191. (a) ESTABLISHMENT OF NATIONAL PRIORITIES BY THE SECRETARY.—The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement. ‘‘(b) RECOMMENDATIONS FOR NATIONAL PRIORITIES.—In establishing and updating national priorities under subsection (a), the Secretary shall solicit and consider recommendations from multiple outside stakeholders. ‘‘(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES.—With respect to such priorities, the Secretary shall ensure that priority is given to areas in the delivery of health care services in the United States that— ‘‘(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic diseases; ‘‘(2) have the greatest potential to decrease morbidity and mortality in this country, including those that are designed to eliminate harm to patients; ‘‘(3) have the greatest potential for improving the performance, affordability, and patient-centeredness of health care, including those due to variations in care; ‘‘(4) address health disparities across groups 14 and areas; and ‘‘(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons. ‘‘(d) DEFINITIONS.—In this part: ‘‘(1) CONSENSUS-BASED ENTITY.—The term ‘consensus-based entity’ means an entity with a contract with the Secretary under section 1890. ‘‘(2) 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. ‘‘(e) FUNDING.— ‘‘(1) IN GENERAL.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $2,000,000, for the activities under this section for each of the fiscal years 2010 through 2014. ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $2,000,000 for each of the fiscal years 2010 through 2014.’’. SEC. 1442. DEVELOPMENT OF NEW QUALITY MEASURES; GAO EVALUATION OF DATA COLLECTION PROCESS FOR QUALITY MEASUREMENT. Part E of title XI of the Social Security Act, as added by section 1441, is amended by adding at the end the following new sections: ‘‘SEC. 1192. DEVELOPMENT OF NEW QUALITY MEASURES. ‘‘(a) AGREEMENTS WITH QUALIFIED ENTITIES.— ‘‘(1) IN GENERAL.—The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States. ‘‘(2) FORM OF AGREEMENTS.—The Secretary may carry out paragraph (1) by contract, grant, or otherwise. ‘‘(3) RECOMMENDATIONS OF CONSENSUS-BASED ENTITY.—In carrying out this section, the Secretary shall— ‘‘(A) seek public input; and ‘‘(B) take into consideration recommendations of the consensus-based entity with a contract with the Secretary under section 1890(a). ‘‘(b) DETERMINATION OF AREAS WHERE QUALITY MEASURES ARE REQUIRED.—Consistent with the national priorities established under this part and with the programs administered by the Centers for Medicare & Medicaid Services and in consultation with other relevant Federal agencies, the Secretary shall determine areas in which quality measures for assessing health care in the United States are needed. ‘‘(c) DEVELOPMENT OF QUALITY MEASURES.— ‘‘(1) PATIENT-CENTERED AND POPULATION-BASED MEASURES.—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. ‘‘(2) AVAILABILITY OF MEASURES.—The Secretary shall make quality measures developed under this section available to the public. ‘‘(3) TESTING OF PROPOSED MEASURES.—The Secretary may use amounts made available under subsection (f) to fund the testing of proposed quality measures by qualified entities. Testing funded under this paragraph shall include testing of the feasibility and usability of proposed measures. ‘‘(4) UPDATING OF ENDORSED MEASURES.—The Secretary may use amounts made available under subsection (f) to fund the updating (and testing, if applicable) by consensus-based entities of quality measures that have been previously endorsed by such an entity as new evidence is developed, in a manner consistent with section 1890(b)(3). ‘‘(d) QUALIFIED ENTITIES.—Before entering into agreements with a qualified entity, the Secretary shall ensure that the entity is a public, nonprofit or academic institution with technical expertise in the area of health quality measurement. ‘‘(e) APPLICATION FOR GRANT.—A grant may be made under this section only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section. ‘‘(f) FUNDING.— ‘‘(1) IN GENERAL.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $25,000,000, to the Secretary for purposes of carrying out this section for each of the fiscal years 2010 through 2014. ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $25,000,000 for each of the fiscal years 2010 through 2014. SEC. 1443. MULTI-STAKEHOLDER PRE-RULEMAKING INPUT INTO SELECTION OF QUALITY MEASURES. Section 1808 of the Social Security Act (42 U.S.C. 1395b–9) is amended by adding at the end the following new subsection: ‘‘(d) MULTI-STAKEHOLDER PRE-RULEMAKING INPUT INTO SELECTION OF QUALITY MEASURES.— ‘‘(1) LIST OF MEASURES.—Not later than December 1 before each year (beginning with 2011), the Secretary shall make public a list of measures being considered for selection for quality measurement by the Secretary in rulemaking with respect to payment systems under this title beginning in the payment year beginning in such year and for pay ment systems beginning in the calendar year following such year, as the case may be. ‘‘(2) CONSULTATION ON SELECTION OF ENDORSED QUALITY MEASURES.—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. ‘‘(3) MULTI-STAKEHOLDER INPUT.—Not later than February 1 of each year (beginning with 2011), the consensus-based entity described in paragraph (2) shall transmit to the Secretary the recommendations of multi-stakeholder groups provided under paragraph (2). Such recommendations shall be included in the transmissions the consensus-based entity makes to the Secretary under the contract provided for under section 1890. ‘‘(4) REQUIREMENT FOR TRANSPARENCY IN PROCESS.— ‘‘(A) IN GENERAL.—In convening multi-stakeholder groups under paragraph (2) with respect to the selection of quality measures, the consensus-based entity described in such paragraph shall provide for an open and transparent process for the activities conducted pursuant to such convening. ‘‘(B) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS.—The process under paragraph (2) shall ensure that the selection of representatives of multi-stakeholder groups includes provision for public nominations for, and the opportunity for public comment on, such selection. ‘‘(5) USE OF INPUT.—The respective proposed rule shall contain a summary of the recommendations made by the multi-stakeholder groups under paragraph (2), as well as other comments received regarding the proposed measures, and the extent to which such proposed rule follows such recommendations and the rationale for not following such recommendations. ‘‘(6) MULTI-STAKEHOLDER GROUPS.—For purposes of this subsection, the term ‘multi-stakeholder groups’ means, with respect to a quality measure, a voluntary collaborative of organizations representing persons interested in or affected by the use of such quality measure, such as the following: ‘‘(A) Hospitals and other institutional providers. ‘‘(B) Physicians. ‘‘(C) Health care quality alliances. ‘‘(D) Nurses and other health care practitioners. ‘‘(E) Health plans. ‘‘(F) Patient advocates and consumer groups. ‘‘(G) Employers. ‘‘(H) Public and private purchasers of health care items and services. ‘‘(I) Labor organizations. ‘‘(J) Relevant departments or agencies of the United States. ‘‘(K) Biopharmaceutical companies and manufacturers of medical devices. ‘‘(L) Licensing, credentialing, and accrediting bodies. ‘‘(7) FUNDING.— ‘‘(A) IN GENERAL.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $1,000,000, to the Secretary for purposes of carrying out this subsection for each of the fiscal years 2010 through 2014. ‘‘(B) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out the provisions of this subsection, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $1,000,000 for each of the fiscal years 2010 through 2014.’’. SEC. 1444. APPLICATION OF QUALITY MEASURES. (a) INPATIENT HOSPITAL SERVICES.—Section 1886(b)(3)(B) of such Act (42 U.S.C. 1395ww(b)(3)(B)) is amended by adding at the end the following new clause: ‘‘(x)(I) Subject to subclause (II), for purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year 2012 and each subsequent fiscal year, the quality measures specified under clause (viii) shall be measures selected by the Secretary from measures that have been endorsed by the entity with a contract with the Secretary under section 1890(a). ‘‘(II) 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.’’. (b) OUTPATIENT HOSPITAL SERVICES.—Section 1833(t)(17) of such Act (42 U.S.C. 1395l(t)(17)) is amended by adding at the end the following new subparagraph: ‘‘(F) USE OF ENDORSED QUALITY MEASURES.—The provisions of clause (x) of section 1886(b)(3)(C) shall apply to quality measures for covered OPD services under this paragraph in the same manner as such provisions apply to quality measures for inpatient hospital services.’’. (c) PHYSICIANS’ SERVICES.—Section 1848(k)(2)(C)(ii) of such Act (42 U.S.C. 1395w–4(k)(2)(C)(ii)) is amended by adding at the end the following: ‘‘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.’’. (d) RENAL DIALYSIS SERVICES.—Section 1881(h)(2)(B)(ii) of such Act (42 U.S.C. 1395rr(h)(2)(B)(ii)) is amended by adding at the end the following: ‘‘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.’’. (e) ENDORSEMENT OF STANDARDS.—Section 1890(b)(2) of the Social Security Act (42 U.S.C. 1395aaa(b)(2)) is amended by adding after and below subparagraph (B) the following: ‘‘ ‘If the entity does not endorse a measure, such entity shall explain the reasons and provide suggestions about changes to such measure that might make it a potentially endorsable measure.’ ’’. (f) EFFECTIVE DATE.—Except as otherwise provided, the amendments made by this section shall apply to quality measures applied for payment years beginning with 2012 or fiscal year 2012, as the case may be. SEC. 1445. CONSENSUS-BASED ENTITY FUNDING. Section 1890(d) of the Social Security Act (42 U.S.C. 1395aaa(d)) is amended by striking ‘‘for each of fiscal years 2009 through 2012’’ and inserting ‘‘for fiscal year 2009, and $12,000,000 for each of the fiscal years 2010 through 2012.’’ PART III-SOCIAL SECURITY ACT SECTION 1890 Note, as referenced above, Social Security Act Section 1890 (42 U.S.C. 1395aaa) as copied from http://www.ssa.gov/OP_Home/ssact/title18/1890.htm "Sec. 1890. [42 U.S.C. 1395aaa] (a)Contract.— (1) In general.—For purposes of activities conducted under this Act, the Secretary shall identify and have in effect a contract with a consensus-based entity, such as the National Quality Forum, that meets the requirements described in subsection (c). Such contract shall provide that the entity will perform the duties described in subsection (b). (2) Timing for first contract.—As soon as practicable after the date of the enactment of this subsection, the Secretary shall enter into the first contract under paragraph (1). (3) Period of contract.—A contract under paragraph (1) shall be for a period of 4 years (except as may be renewed after a subsequent bidding process). (4) Competitive procedures.— Competitive procedures (as defined in section 4(5) of the Office of Federal Procurement Policy Act (41 U.S.C. 403(5))) shall be used to enter into a contract under paragraph (1). (b) Duties.— (1) Priority setting process.—The entity shall synthesize evidence and convene key stakeholders to make recommendations, with respect to activities conducted under this Act, on an integrated national strategy and priorities for health care performance measurement in all applicable settings. In making such recommendations, the entity shall— (A) ensure that priority is given to measures— (i) that address the health care provided to patients with prevalent, high-cost chronic diseases; (ii) with the greatest potential for improving the quality, efficiency, and patient-centeredness of health care; and (iii) that may be implemented rapidly due to existing evidence, standards of care, or other reasons; and (B) take into account measures that—. (i) may assist consumers and patients in making informed health care decisions; ‘‘(ii) address health disparities across groups and (ii) address health disparities across groups and areas; and (iii) address the continuum of care a patient receives, including services furnished by multiple health care providers or practitioners and across multiple settings. (2) Endorsement of measures.—The entity shall provide for the endorsement of standardized health care performance measures. The endorsement process under the preceding sentence shall consider whether a measure— ‘‘(A) is evidence-based, reliable, (A) is evidence-based, reliable, valid, verifiable, relevant to enhanced health outcomes, actionable at the caregiver level, feasible to collect and report, and responsive to variations in patient characteristics, such as health status, language capabilities, race or ethnicity, and income level; and (B) is consistent across types of health care providers, including hospitals and physicians. (3) Maintenance of measures.—The entity shall establish and implement a process to ensure that measures endorsed under paragraph (2) are updated (or retired if obsolete) as new evidence is developed. (4) Promotion of the development of electronic health records.—The entity shall promote the development and use of electronic health records that contain the functionality for automated collection, aggregation, and transmission of performance measurement information. (5)Annual report to congress and the secretary; secretarial publication and comment.— (A)Annual report.— (i) the implementation of quality measurement initiatives under this Act and the coordination of such initiatives with quality initiatives implemented by other payers; (ii) (ii) the recommendations made under paragraph (1); and (iii) the performance by the entity of the duties required under the contract entered into with the Secretary under subsection (a). (B) Secretarial review and publication of annual report.— Not later than 6 months after receiving a report under subparagraph (A) for a year, the Secretary shall— (i) review such report; and (ii) publish such report in the Federal Register, together with any comments of the Secretary on such report. (c) Requirements Described.— The requirements described in this subsection are the following: (1) Private nonprofit.— The entity is a private nonprofit entity governed by a board. (2)Board membership.— (A) representatives of health plans and health care providers and practitioners or representatives of groups representing such health plans and health care providers and practitioners; (B) health care consumers or representatives of groups representing health care consumers; and (C) representatives of purchasers and employers or representatives of groups representing purchasers or employers. (3) Entity membership.—The membership of the entity includes persons who have experience with— (A) urban health care issues; (B) safety net health care issues; (C) rural and frontier health care issues; and (D) health care quality and safety issues. (4) Open and transparent.— With respect to matters related to the contract with the Secretary under subsection (a), the entity conducts its business in an open and transparent manner and provides the opportunity for public comment on its activities. (5) Voluntary consensus standards setting organization.— The entity operates as a voluntary consensus standards setting organization as defined for purposes of section 12(d) of the National Technology Transfer and Advancement Act of 1995 (Public Law 104–113) and Office of Management and Budget Revised Circular A–119 (published in the Federal Register on February 10, 1998). (6) Experience.—. The entity has at least 4 years of experience in establishing national consensus standards (7) Membership fees.— If the entity requires a membership fee for participation in the functions of the entity, such fees shall be reasonable and adjusted based on the capacity of the potential member to pay the fee. In no case shall membership fees pose a barrier to the participation of individuals or groups with low or nominal resources to participate in the functions of the entity. (d) Funding.— For purposes of carrying out this section, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $10,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2009 through 2012. Thank you very much for taking the time to do this little bit of what most Congresspersons and Senators will not do at all, and have myriad excuses to not accomplish: read the bill. Towing the party-line, making up for decades of frustration for many a politician whose been in Washington for decades solely to bask in the glory of their new found power, but democrat and republican alike. Oddly they forget they serve at our pleasure. When we speak, they shall be quiet. When we yell, they shall take note of the import of what we have to say. We are not the subjects of a sovereign government but they are the subjects of a sovereign people! It is about time we remember they are the tail and we are the dog, that those limits placed on them, the ones further affirmed by the 10th Amendment, are there to protect us from government, while empowering government to take it's proper role and place in our lives. Our failure to recognize and remember this is something politicians and every other broker of power, of currency manipulations of all sorts, has been wanting and waiting for since our Birth as a Nation. Toddy Littman |
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