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Let's discuss what's in the Health Care Bill

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posted on Aug, 9 2009 @ 10:12 AM
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Originally posted by drock905
I have a question, could be a dumb one though....

In Section 246 where it says no "undocumented" alien will recieve federal care.

Can you be considered documented and still be in the country illegally? How does the government actually define this?



That is NOT a dumb questions at all.

You may have noticed the CDC spokesman assuring us that reports of this proposed health care law allowing for tax-payer dollars being used to treat and care for illegal aliens is false.

They go on to call such an assertion an example of purposefully disseminated misinformation by those who are generally to be characterized as either evil or stupid.

Yet when he cites the 'proof' that this is not so, he quotes the very line you refer to; "no "undocumented" alien will receive federal care." But he fails to explain that in and of itself that stipulation DOES NOT MEAN THAT UNDOCUMENTED is the same thing as ILLEGAL.

The lies and disinformation we are all exploring is carefully crafted vagueness and assumed or presumed definitions that they will 'clarify' AFTER the law is in place.

It's 1,000 pages of expertly compiled information presented in such a way as to almost definitively say something that might mean one thing or might mean another. As the eager argue of the vague possibilities, we are prompted to denigrate and vulgarize those who see things differently.




posted on Aug, 9 2009 @ 10:17 AM
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Claim:

Page 763 1-8 No DS/EA hospitals will be paid unless they provide services without regard to national origin


What the bill says:

14 (d) DISPROPORTIONATE SHARE HOSPITALS (DSH)
15 AND ESSENTIAL ACCESS HOSPITAL (EAH) NON-DIS
16 CRIMINATION.—
17 (1) IN GENERAL.—Section 1923(d) of the So
18 cial Security Act (42 U.S.C. 1396r-4) is amended by
19 adding at the end the following new paragraph:
20 ‘‘(4) No hospital may be defined or deemed as
21 a disproportionate share hospital, or as an essential
22 access hospital (for purposes of subsection
23 (f)(6)(A)(iv), under a State plan under this title or
24 subsection (b) of this section (including any waiver
25 under section 1115) unless the hospital—
1 ‘‘(A) provides services to beneficiaries
2 under this title without discrimination on the
3 ground of race, color, national origin, creed,
4 source of payment, status as a beneficiary
5 under this title, or any other ground unrelated
6 to such beneficiary’s need for the services or the
7 availability of the needed services in the hos
8 pital; and
9 ‘‘(B) makes arrangements for, and accepts,
10 reimbursement under this title for services pro
11 vided to eligible beneficiaries under this title.’’.


This claim is true.

If I am reading it right I think this also allows illegals to get coverage at hospitals that are deemed disproportionate or an essential access hospital, they also can't deny coverage for any reason.

So what I think this means is the those types of hospitals will not be those types of hospitals.

[edit on 9-8-2009 by Hastobemoretolife]



posted on Aug, 9 2009 @ 10:22 AM
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PG 303 Line 12-25 Post Acute Care Services Data – Government will collect data including personal information as they see fit.


Page 303 Line 12 - Page 304 Line 5:

(2) ANALYSIS AND DATA COLLECTION.—In developing such plan, the Secretary shall—
(A) analyze the issues described in subsection (b) and other issues that the Secretary determines appropriate;
(B) analyze the impacts (including geographic impacts) of post acute service reform approaches, including bundling of such services on individuals, hospitals, post acute care providers, and physicians;
(C) use existing data (such as data submitted on claims) and collect such data as the Secretary determines are appropriate to develop such plan required in this section; and
(D) if patient functional status measures are appropriate for the analysis, to the extent practical, build upon the CARE tool being developed pursuant to section 5008 of the Deficit Reduction Act of 2005.


The bolded section leads me to believe this claim is true.


PG 304 Line 17-19 BIG ONE HERE: Expedited Data Collection – More information here

PG 304 Line 17-19 Government does NOT have to protect your private, share with anyone, & is not resp (more on expedited data collection)


Page 304 Lines 17-19:

(2) EXPEDITED DATA COLLECTION.—Chapter 35 of title 44, United States Code shall not apply to this section.


I'm not sure what the claim is. The bill does say expedited data collection... I hunted down Title 44 Chapter 35, but there wasn't anything that jumped out at me as being the obvious reference from the bill.

EDIT: Found the second claim and added it here. The claim is clear to me now, and I have to call the second part false. There's nothing here that says your private data won't be protected.

US Code Title 44 Chapter 35:

§ 3501. Purposes
The purposes of this subchapter are to—
(1) minimize the paperwork burden for individuals, small businesses, educational and nonprofit institutions, Federal contractors, State, local and tribal governments, and other persons resulting from the collection of information by or for the Federal Government;
(2) ensure the greatest possible public benefit from and maximize the utility of information created, collected, maintained, used, shared and disseminated by or for the Federal Government;
(3) coordinate, integrate, and to the extent practicable and appropriate, make uniform Federal information resources management policies and practices as a means to improve the productivity, efficiency, and effectiveness of Government programs, including the reduction of information collection burdens on the public and the improvement of service delivery to the public;
(4) improve the quality and use of Federal information to strengthen decisionmaking, accountability, and openness in Government and society;
(5) minimize the cost to the Federal Government of the creation, collection, maintenance, use, dissemination, and disposition of information;
(6) strengthen the partnership between the Federal Government and State, local, and tribal governments by minimizing the burden and maximizing the utility of information created, collected, maintained, used, disseminated, and retained by or for the Federal Government;
(7) provide for the dissemination of public information on a timely basis, on equitable terms, and in a manner that promotes the utility of the information to the public and makes effective use of information technology;
(8) ensure that the creation, collection, maintenance, use, dissemination, and disposition of information by or for the Federal Government is consistent with applicable laws, including laws relating to—
(A) privacy and confidentiality, including section 552a of title 5;
(B) security of information, including section 11332 of title 40 [1] ; and
(C) access to information, including section 552 of title 5;
(9) ensure the integrity, quality, and utility of the Federal statistical system;
(10) ensure that information technology is acquired, used, and managed to improve performance of agency missions, including the reduction of information collection burdens on the public; and
(11) improve the responsibility and accountability of the Office of Management and Budget and all other Federal agencies to Congress and to the public for implementing the information collection review process, information resources management, and related policies and guidelines established under this subchapter.


EDIT: Fixed external tags
EDIT 2: Added second part of claim.

[edit on 9-8-2009 by Jenna]

[edit on 9-8-2009 by Jenna]



posted on Aug, 9 2009 @ 10:27 AM
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reply to post by Hastobemoretolife
 


That's how that reads to me as well. Yet another section where they're so intentionally vague that it could be argued either way.



posted on Aug, 9 2009 @ 10:28 AM
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Also if anybody else is having trouble finding the laws listed in other sections I would like to direct your attention to This website it is fairly easy to search.



posted on Aug, 9 2009 @ 10:48 AM
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Originally posted by mikerussellus
-personal note, I think it's still ok to trust your doctor. . . -


You should never, ever, trust a doctor.

Jon



posted on Aug, 9 2009 @ 10:57 AM
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Claim:

Pg 757-762 Fed Government will shift burden of payments to Disproportionate Share Hospitals (DSH) to States. (Taxes)


What it says:

(2) DSH HEALTH REFORM METHODOLOGY.—
16 The Secretary shall carry out paragraph (1) through
17 use of a DSH Health Reform methodology issued by
18 the Secretary that imposes the largest percentage re
19 ductions on the States that—
20 (A) have the lowest percentages of unin
21 sured individuals (determined on the basis of
22 audited hospital cost reports) during the most
23 recent year for which such data are available;
24 or
1 (B) do not target their DSH payments
2 on—
3 (i) hospitals with high volumes of
4 Medicaid inpatients (as defined in section
5 1923(b)(1)(A) of the Social Security Act
6 (42 U.S.C. 1396r–4(b)(1)(A)); and
7 (ii) hospitals that have high levels of
8 uncompensated care (excluding bad debt).


Maybe I'm having a hard time trying to read this section, but this is the relevant section in the claim, but what it seems to be telling me is that states will be paying higher taxes according to the people that are uninsured.



posted on Aug, 9 2009 @ 10:58 AM
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PG 306 Line 3-6 The Government can expand the scope & size of Post Acute Program Services anytime & as they see fit.


For the sake of clarity, I'm posting the beginning of the section as well as the section referenced in the claim:


SEC. 1866D. CONVERSION OF ACUTE CARE EPISODE DEMONSTRATION TO PILOT PROGRAM AND EXPANSION TO INCLUDE POST ACUTE SERVICES.
(a) IN GENERAL.—By not later than January 1, 2011, the Secretary shall, for the purpose of promoting the use of bundled payments to promote efficient and high quality delivery of care—
(1) convert the acute care episode demonstration program conducted under section 1866C to a pilot program; and
(2) subject to subsection (c), expand such program as so converted to include post acute services and such other services the Secretary determines to be appropriate, which may include transitional services.
(b) SCOPE.—The pilot program under subsection (a) may include additional geographic areas and additional conditions which account for significant program spending, as defined by the Secretary. Nothing in this subsection shall be construed as limiting the number of hospital and physician groups or the number of hospital and post-acute provider groups that may participate in the pilot program.


The section does say that the Secretary can expand the program, and contains even more vague language about the Secretary doing whatever they determine to be appropriate.


PG 313 Line 9-14 Government MANDATES Health Services providers will state ownership, invest, & compensation arrangements.


Page 313 Line 7 - Page 314 Line 7:

(f) REPORTING AND DISCLOSURE REQUIREMENTS.—
(1) IN GENERAL.—Each entity providing covered items or services for which payment may be made under this title shall provide the Secretary with the information concerning the entity’s ownership, investment, and compensation arrangements, including—
(A) the covered items and services provided by the entity, and
(B) the names and unique physician identification numbers of all physicians with an ownership or investment interest (as described in subsection (a)(2)(A)), or with a compensation arrangement (as described in subsection (a)(2)(B)), in the entity, or whose immediate relatives have such an ownership or investment interest or who have such a compensation relationship with the entity. Such information shall be provided in such form, manner, and at such times as the Secretary shall specify. The requirement of this subsection shall not apply to designated health services provided outside the United States or to entities which the Secretary determines provide services for which payment may be made under this title very infrequently.


This claim is true, but it does not apply to "designated health services provided outside the United States or to entities which the Secretary determines provide services for which payment may be made under this title very infrequently."



posted on Aug, 9 2009 @ 10:59 AM
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PG 317 Line 13-20 PROHIBITION on ownership/investment. Government tells Drs. what/how much they can own.

‘‘(B) PROHIBITION ON PHYSICIAN OWNER
14SHIP OR INVESTMENT.—The percentage of the
15 total value of the ownership or investment in
16terests held in the hospital, or in an entity
17 whose assets include the hospital, by physician
18 owners or investors in the aggregate does not
19 exceed such percentage as of the date of enact
20ment of this subsection.


Claim is true.



posted on Aug, 9 2009 @ 11:03 AM
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PG 317-318 Line 21-25,1-3 PROHIBITION on expansion- Government is mandating hospitals cannot expand.

‘‘(C) PROHIBITION ON EXPANSION OF FA
22CILITY CAPACITY.—Except as provided in para
23graph (2), the number of operating rooms, pro
24cedure rooms, or beds of the hospital at any
25 time on or after the date of the enactment of
1 this subsection are no greater than the number
2 of operating rooms, procedure rooms, or beds,
3 respectively, as of such date.‘‘

Why this was put in, I have no idea (anyone?) but it appears to be true.



posted on Aug, 9 2009 @ 11:05 AM
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Originally posted by Hastobemoretolife
Claim:

Pg 757-762 Fed Government will shift burden of payments to Disproportionate Share Hospitals (DSH) to States. (Taxes)


What it says:

(2) DSH HEALTH REFORM METHODOLOGY.—
16 The Secretary shall carry out paragraph (1) through
17 use of a DSH Health Reform methodology issued by
18 the Secretary that imposes the largest percentage re
19 ductions on the States that—
20 (A) have the lowest percentages of unin
21 sured individuals
(determined on the basis of
22 audited hospital cost reports) during the most
23 recent year for which such data are available;
24 or
1 (B) do not target their DSH payments
2 on—
3 (i) hospitals with high volumes of
4 Medicaid inpatients (as defined in section
5 1923(b)(1)(A) of the Social Security Act
6 (42 U.S.C. 1396r–4(b)(1)(A)); and
7 (ii) hospitals that have high levels of
8 uncompensated care (excluding bad debt).


Maybe I'm having a hard time trying to read this section, but this is the relevant section in the claim, but what it seems to be telling me is that states will be paying higher taxes according to the people that are uninsured.


I think the part I bolded means that the states with the lowest percentage of uninsured will have the largest rate reductions. I'm not 100% on that though.


EDIT: changed 'insured' to 'uninsured'

[edit on 9-8-2009 by Jenna]



posted on Aug, 9 2009 @ 11:11 AM
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PG 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!!



(2) EXCEPTION TO PROHIBITION ON EXPANSION OF FACILITY CAPACITY.—
(i) ESTABLISHMENT.—The Secretary shall establish and implement a process under which a hospital may apply for an exception from the requirement under paragraph (1)(C).
(ii) OPPORTUNITY FOR COMMUNITY INPUT.—The process under clause (i) shall provide persons and entities in the community in which the hospital applying for an exception is located with the opportunity to provide input with respect to the application.


What is it with this guy and ACORN?


The claim itself is true. Hospitals can apply for an exception, but the community will be able to provide their input.



posted on Aug, 9 2009 @ 11:12 AM
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PG 318-319 Government is mandating how hospitals & physicians conduct business & investments. We’re next!

‘‘(D) ENSURING BONA FIDE OWNERSHIP
5 AND INVESTMENT.—
6 ‘‘(i) Any ownership or investment in
7terests that the hospital offers to a physi
8cian are not offered on more favorable
9 terms than the terms offered to a person
10 who is not in a position to refer patients
11 or otherwise generate business for the hos
12pital.
13 ‘‘(ii) The hospital (or any investors in
14 the hospital) does not directly or indirectly
15 provide loans or financing for any physi
16cian owner or investor in the hospital.
17 ‘‘(iii) The hospital (or any investors in
18 the hospital) does not directly or indirectly
19 guarantee a loan, make a payment toward
20 a loan, or otherwise subsidize a loan, for
21 any physician owner or investor or group
22 of physician owners or investors that is re
23lated to acquiring any ownership or invest
24ment interest in the hospital.
1 ‘‘(iv) Ownership or investment returns
2 are distributed to each owner or investor in
3 the hospital in an amount that is directly
4 proportional to the ownership or invest
5ment interest of such owner or investor in
6 the hospital.
7 ‘‘(v) The investment interest of the
8 owner or investor is directly proportional
9 to the owner’s or investor’s capital con
10tributions made at the time the ownership
11 or investment interest is obtained.
12 ‘‘(vi) Physician owners and investors
13 do not receive, directly or indirectly, any
14 guaranteed receipt of or right to purchase
15 other business interests related to the hos
16pital, including the purchase or lease of
17 any property under the control of other
18 owners or investors in the hospital or lo
19cated near the premises of the hospital.
20 ‘‘(vii) The hospital does not offer a
21 physician owner or investor the oppor
22tunity to purchase or lease any property
23 under the control of the hospital or any
24 other owner or investor in the hospital on
25 more favorable terms than the terms of-
1 fered to a person that is not a physician
2 owner or investor.
3 ‘‘(viii) The hospital does not condition
4 any physician ownership or investment in
5terests either directly or indirectly on the
6 physician owner or investor making or in
7fluencing referrals to the hospital or other
8wise generating business for the hospital.


Claim is true. Unlike much of this bill, these statements are straight forward. If you are an investor, you get to keep what you invested, BUT you cannot obtain more. You cannot invest more, expand your hospital/medical business.



posted on Aug, 9 2009 @ 11:14 AM
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Claim:

Pg 770 SEC 1714 Federal Government mandates eligibility for State Family Planning Services. Say abortion & State Sovereign.


What it says:

1 ‘‘(A) whose income does not exceed an in
2 come eligibility level established by the State
3 that does not exceed the highest income eligi
4 bility level established under the State plan
5 under this title (or under its State child health
6 plan under title XXI) for pregnant women; and
7 ‘‘(B) who are not pregnant.
8 ‘‘(2) At the option of a State, individuals de
9 scribed in this subsection may include individuals
10 who, had individuals applied on or before January 1,
11 2007, would have been made eligible pursuant to the
12 standards and processes imposed by that State for
13 benefits described in clause (XV) of the matter fol
14 lowing subparagraph (G) of section subsection
15 (a)(10) pursuant to a waiver granted under section
16 1115.
17 ‘‘(3) At the option of a State, for purposes of
18 subsection (a)(17)(B), in determining eligibility for
19 services under this subsection, the State may con
20 sider only the income of the applicant or recipient.’’.


I'm going to have call this one false, I don't see anything relating to abortions or anything vaguely referring to abortions, and there is also nothing saying the federal gov is going to mandate eligibility for family planning.



posted on Aug, 9 2009 @ 11:17 AM
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PG 328 Line 1157 Government study disguised. Its a HealthCare workforce study mandated by law for unionization.



SEC. 1157. INSTITUTE OF MEDICINE STUDY OF GEOGRAPHIC ADJUSTMENT FACTORS UNDER MEDICARE.
(a) IN GENERAL.—The Secretary of Health and Human Services shall enter into a contract with the Institute of Medicine of the National Academy of Science to conduct a comprehensive empirical study, and provide recommendations as appropriate, on the accuracy of the geographic adjustment factors established under sections 1848(e) and 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395w–4(e), 11395ww(d)(3)).
(b) MATTERS INCLUDED.—Such study shall include an evaluation and assessment of the following with respect to such adjustment factors:
(1) Empirical validity of the adjustment factors.
(2) Methodology used to determine the adjustment factors.
(3) Measures used for the adjustment factors, taking into account—
(A) timeliness of data and frequency of revisions to such data;
(B) sources of data and the degree to which such data are representative of costs; and
(C) operational costs of providers who participate in Medicare.
(c) EVALUATION.—Such study shall, within the context of the United States health care marketplace, evaluate and consider the following:
(1) The effect of the adjustment factors on the level and distribution of the health care workforce and resources, including—
(A) recruitment and retention that takes into account workforce mobility between urban and rural areas;
(B) ability of hospitals and other facilities to maintain an adequate and skilled workforce; and
(C) patient access to providers and needed medical technologies.
(2) The effect of the adjustment factors on population health and quality of care.
(3) The effect of the adjustment factors on the ability of providers to furnish efficient, high value care.


The claim is half true. There will be a study, but I see nothing about unionization.



posted on Aug, 9 2009 @ 11:18 AM
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Originally posted by mikerussellus
PG 317-318 Line 21-25,1-3 PROHIBITION on expansion- Government is mandating hospitals cannot expand.

‘‘(C) PROHIBITION ON EXPANSION OF FA
22CILITY CAPACITY.—Except as provided in para
23graph (2), the number of operating rooms, pro
24cedure rooms, or beds of the hospital at any
25 time on or after the date of the enactment of
1 this subsection are no greater than the number
2 of operating rooms, procedure rooms, or beds,
3 respectively, as of such date.‘‘


Why this was put in, I have no idea (anyone?) but it appears to be true.


I'm sure they will argue that the reason for this is that any type of expansion would add to the overall cost of health care, so it is cost prohibitive.

In reality that will help them cut costs, but ultimately as population grows these facilities must expand in order to provide treatment to a larger number of people.... By prohibiting these types of expansions they are going to make it easier to delay care in the future, if they don't have a bed for you, and a long waiting list for treatment then they can delay your care, you will just have to wait. Here, take some pain pills and go home and wait. We will let you know when we have a bed for you, and when an operating room is available.




[edit on 9-8-2009 by Walkswithfish]



posted on Aug, 9 2009 @ 11:19 AM
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I have a couple of observations thus far, and a specific section to mull over.

First, this Bill is only an outline of the general nature of the Health Care Plan. The specifics will be worked out by Federal agencies.

Why does this matter?

The Bill, like all legislation, is subject to public scrutiny and open debate in Congress. We are seeing the initial stages of that here on ATS and in the 'town hall meetings' so much discussed in the MSM.

The actual implementation of the Bill will be from executive/administrative agencies (read: Barack Obama appointees) and NOT subject to public debate.

Typically, AAs publish proposed "Rules" and "Rule Making" in the CCH or administrative publications for "public comment." There are NO HEARINGS. There is no Aministrative review or even a requirement that 'comments' be acted upon. After a set period of time, usually 90 to 180 days, the "Rules" become law.

The real danger is what the non-publicly-accountable AAs do to "implement" these broad changes. Remember how the EPA, and DoE came up with the "5 Gases" regs that will embody Obama's "climate change" agenda?

Congress doesn't have to do ANYTHING else! The Administrative Agencies will do the heavy lifting for Obama once they have enabled them through this legislation!

B., if the Feds can't appropriately monitor and police the fraud-ridden Medicare and Medicaid programs (serving far fewer 'constituents'), what do you expect to come of a program that is exponentially larger and, in fact, ENCOMPASSES these two bankrupt licenses to steal?

III., what about States Rights and the 10th and 11th amendments? Welfare Reform was initiated under individually-tailored STATE programs, then "federalized" to adopt the best of the best plans.

State-run medical benefits programs (remember the previous question about 'Health Insurance Exchange' programs) are being swept out of the picture when they are best positioned to assess needs and deliver resources to their residents. A federal bureaucracy is no "solution" to a problem best addressed through co-ordinated State efforts and re-direction of State tax payments to the people who need the money the most.

Finally, what about the "end of life" mandates?

Section 1233 of the health-care bill would pay doctors to give Medicare patients end-of-life counseling every five years -- or sooner if the patient gets a terminal diagnosis.

Link: edlabor.house.gov...

Though not mandatory, the consultations envisioned in Section 1233 aren't quite voluntary. To most people "purely voluntary" means "not unless the patient requests one."

Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. In reality, that's an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill permits "formulation" of a plug-pulling order right then and there!
I question how Congress can authorize health care professionals to practice law in any State, don't you?

Section 1233 would place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign, or with 'programs' crafted by "professionals" they might not otherwise consult!

Even worse, Section 1233 dictates the content of the consultation. The doctor "shall" discuss "advanced care planning, including key questions and considerations, important steps, and suggested people to talk to"; "an explanation of . . . living wills and durable powers of attorney, and their uses" (even though these are legal, not medical, instruments); and "a list of national and State-specific resources to assist consumers and their families." The doctor "shall" explain that Medicare pays for hospice care (hint, hint).

The script is vague and subject to manipulation.
What are "key questions"?
Who belongs on "a list" of helpful "resources"? Jack Kevorkian?

Decisions about how to manage life's end should be made in a setting that is neutral.

Section 1233 goes beyond facilitating doctor input to preferring it.

On its own terms, the measure would have an interested party – the government -- recruit doctors to sell the elderly end of life measures and their associated providers, professions and organizations.

I question that approach.

I'd say he got this one right.

deny ignorance

jw


[edit on 9-8-2009 by jdub297]



posted on Aug, 9 2009 @ 11:20 AM
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reply to post by Jenna
 


I think you meant uninsured, so the states with the highest amount of uninsured will have a higher tax burden. Interesting.

Also there ever the bill says "community services organizations" you can pretty count on that meaning ACORN.



posted on Aug, 9 2009 @ 11:24 AM
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PG 341 Line 3-9 Government has authority to disqualify Medicare Adv Plans, HMOs, etc. Forcing peeps in to Government plan.



(iv) AUTHORITY TO DISQUALIFY CERTAIN PLANS.—In applying clauses (ii) and (iii), the Secretary may determine not to identify a Medicare Advantage plan if the Secretary has identified deficiencies in the plan’s compliance with rules for such plans under this part.


For clarity, here are clauses (ii) and (iii):

(ii) IDENTIFICATION OF HIGH QUALITY PLANS IN TOP QUINTILE BASED ON PROJECTED ENROLLMENT.—The Secretary shall, based on the scores for each plan under clause (i)(I) and the Secretary’s projected enrollment for each plan and subject to clause (iv), identify those Medicare Advantage plans with the highest score that, based upon projected enrollment, are projected to include in the aggregate 20 percent of the total projected enrollment for the year. For purposes of this subsection, a plan so identified shall be referred to in this subsection as a ‘high quality MA plan’.
(iii) IDENTIFICATION OF IMPROVED QUALITY PLANS IN TOP QUINTILE BASED ON PROJECTED ENROLLMENT.—The Secretary shall, based on the percentage improvement score for each plan under clause (i)(II) and the Secretary’s projected enrollment for each plan and subject to clause (iv), identify those Medicare Advantage plans with the greatest percentage improvement score that, based upon projected enrollment, are projected to include in the aggregate 20 percent of the total projected enrollment for the year. For purposes of this subsection, a plan so identified that is not a high quality plan for the year shall be referred to in this subsection as an ‘improved quality MA plan’.


The claim is true to an extent. The Secretary will have the ability to disqualify a plan if it doesn't comply with the rules that are set for such plans. Whether this will force anyone into the governmnet plan, I don't know.



posted on Aug, 9 2009 @ 11:30 AM
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Pg335 Line 16-25 PG 336-339 Government mandates estab. of outcome based measures. HealthCare the way they want. Rationing.

‘‘(i) FOR YEARS BEFORE 2014.—For
2 years before 2014, the quality performance
3 score for a Medicare Advantage plan shall
4 be computed based on a blend (as des
5ignated by the Secretary) of the plan’s per
6formance on—
7 ‘‘(I) HEDIS effectiveness of care
8 quality measures;
9 ‘‘(II) CAHPS quality measures;
10 and
14 Such measures shall be risk-adjusted as
15 the Secretary deems appropriate.

16 ‘‘(ii) ESTABLISHMENT OF OUTCOME
17BASED MEASURES.—By not later than for
18 2013 the Secretary shall implement report
19ing requirements for quality under this
20 section on measures selected under clause
21 (iii) that reflect the outcomes of care expe
22rienced by individuals enrolled in Medicare
23 Advantage plans (in addition to measures
24 described in clause (i)). Such measures
25 may include—
1 ‘‘(I) measures of rates of admis
2sion and readmission to a hospital;
3 ‘‘(II) measures of prevention
4 quality, such as those established by
5 the Agency for Healthcare Research
6 and Quality (that include hospital ad
7mission rates for specified conditions);
8 ‘‘(III) measures of patient mor
9tality and morbidity following surgery;
10 ‘‘(IV) measures of health func
11tioning (such as limitations on activi
12ties of daily living) and survival for
13 patients with chronic diseases;
14 ‘‘(V) measures of patient safety;
15 and
16 ‘‘(VI) other measure of outcomes
17 and patient quality of life as deter
18mined by the Secretary.
19 Such measures shall be risk-adjusted as
20 the Secretary deems appropriate. In deter
21mining the quality measures to be used
22 under this clause, the Secretary shall take
23 into consideration the recommendations of
24 the Medicare Payment Advisory Commis
25sion in its report to Congress under section
1 168 of the Medicare Improvements for Pa
2tients and Providers Act of 2008 (Public
3 Law 110–275) and shall provide pref
4erence to measures collected on and com
5parable to measures used in measuring
6 quality under parts A and B.
7 ‘‘(iii) RULES FOR SELECTION OF
8 MEASURES.—The Secretary shall select
9 measures for purposes of clause (ii) con
10sistent with the following:
11 ‘‘(I) The Secretary shall provide
12 preference to clinical quality measures
13 that have been endorsed by the entity
14 with a contract with the Secretary
15 under section 1890(a).
16 ‘‘(II) Prior to any measure being
17 selected under this clause, the Sec
18retary shall publish in the Federal
19 Register such measure and provide for
20 a period of public comment on such
21 measure.
22 ‘‘(iv) TRANSITIONAL USE OF
23 BLEND.—For payments for 2014 and
24 2015, the Secretary may compute the qual
25ity performance score for a Medicare Ad-
1 vantage plan based on a blend of the meas
2ures specified in clause (i) and the meas
3ures described in clause (ii) and selected
4 under clause (iii).
5 ‘‘(v) USE OF QUALITY OUTCOMES
6 MEASURES.—For payments beginning with
7 2016, the preponderance of measures used
8 under this paragraph shall be quality out
9comes measures described in clause (ii)
10 and selected under clause (iii).
11 ‘‘(C) DATA USED IN COMPUTING SCORE.—
12 Such score for application for—
13 ‘‘(i) payments in 2011 shall be based
14 on quality performance data for plans for
15 2009; and
16 ‘‘(ii) payments in 2012 and a subse
17quent year shall be based on quality per
18formance data for plans for the second
19 preceding year.

I only bolded one section. It was what the secretary deemed appropriate. So for all there standards, this is also based on what ever they ALSO deem appropriate. I don't see rationing, and I don't want to read between the lines.
What I do see, is an outcome based rating system.
But, in all honesty, isn't that what hospitals do now?
I'll rate this as true, but with a caviat on rationing.




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