The Smoke Break

You want some brie with that whine?

Post-Election Thoughts

By

As one of the scorned and quickly dwindling 53%, Tuesday’s election was like a nightmare from which awakening seemed almost impossible.  It was horrifying to realize that half of the people in America are really that stupid; primarily due to 70 years of progressive liberal subversion of our educational system, and deliberately because despite all evidence to the contrary that socialism has never worked, they are just too fearful or too greedy to take responsibility for their own lives.

There is a small glimmer of hope in one fact, however.  President Composite’s win was by only a slim popular vote margin; a far cry from being an actual mandate to roll the tanks of his nefarious redistribution agenda over the will of the American people.  It would be nice if Congress understood this but whether or not they do remains to be seen.  I’m not holding my breath, though; John Boehner’s conciliatory words this week sounded more like a Pelosi-chastised blue-dog Democrat than a conservative Republic Speaker of the House holding the power of the purse in a majority grip.

The agenda for the next 4 years is being examined by pundits and one of the nastiest items on the list is how to deal with the 11 million-plus criminals in residence here.  Apparently sidestepping the rule of law with the bastardized executive fiat version of the DREAM Act gave the communists an advantage (and more illegal votes than anyone has the balls to investigate) but if the truth be told it is a problem that needs to be properly addressed sooner than later.

It’s far too late to round them all up and send them back to their home countries so yet another attempt at amnesty is going to rear its head.  And I think Rush Limbaugh is onto something about how to handle the problem.  It’s actually quite brilliant.  Go ahead and grant these deliberate, premeditated criminals amnesty but, since they are going to have to plead guilty to their crime in order to gain citizenship, like convicted felons, simply do not allow them to vote.

Problem solved.  They will be able to openly pull up a chair at the table of opportunity of the United States as well as be wholly subject to her overciminalized rule of law.  They will be forced to contribute to and may collect Social Security and Medicare like the rest of us.  If you think that this might be too harsh, remember:  Reagan granted amnesty on the condition of border security but all we got was 11+ million more criminals, Fast and Furious, and 26 years of lies that the GOP hates Hispanics.  This is a way to force Democrats to uphold their end of the bargain on border security and at the same time keep this particuar pet demographic of theirs from mucking with the system by voting for those who only encourage criminal behavior.

 

Choom Daze

By

A new book is due out next month from one of the associate editors at the Washington Compost that, based on lavisciouly gushing advance reviews by people of whom we’ve never heard, apparently does a quite fine job romantically chronicling President Lame Duck’s strange, illusory, left-leaning life.  In particular and by its timing it is clearly intended to be a counter to the rightful claims that Romney’s high school years pale in comparison to BO’s history of adolescent and young adult drug abuse, not to mention an attempt to recapture the fascination of the American people pre-election 2008.  Because it so blatantly attempts to convince us that his high school “choom” daze (so severe that his yearbook entry includes a thanks to his drug dealer, not his mother or grandmother) really just makes him “cooler” than the rest of us, we thought it might be helpful to point out the realities of going through high school stoned.

From Science And Management of Addictions:

There are many ways that psychoactive substances can alter or damage the development of the adolescent brain. Firstly, psychoactive substances often target and alter function of neurotransmitters, the chemical messengers that allow nerves to communicate at their junctions. Interference with neurotransmitters can directly damage fragile developing neural connections. Secondly, use of these substances alters perception and may interfere with the developing perceptual skills. And finally, the habits and choices associated with the use of drugs and alcohol slowly become ingrained in the wiring of the brain. Repeated action becomes habit and the habits of thought, perception, and reasoning developed in childhood and adolescence can stay with a person throughout his or her lifetime.

 Perceptual changes caused by drugs can also have long-term complications for adolescent development, since adolescent perceptive abilities are not fully mature. For example, MRI studies show that adults tend to use the frontal lobes, or logical problem solving, to determine facial expressions while adolescents use the amygdala, an area which normally processes emotions such as fear and worry. It holds true in many studies that where adults use problem solving areas of the brain to perceive the world adolescents use the more primitive areas of the brain more associated with emotions, and self-preservation; it also holds true that adult perception is generally more accurate.

Marijuana, like all drugs, changes perception. And like most drugs, it engenders perception that is fearful, emotional, defensive, and often inaccurate. Though the short term addiction potential of marijuana may be less than other drugs, the long-term impact of chronic marijuana use can be profound. Determining the feelings and motives of other people is necessary to function as an adult in society. If marijuana use is chronic or constant enough to hinder perceptual maturation, an adolescent user may encounter misunderstood failures in school, work, and relationships, which in turn re-enforce the desire to retreat to drugs.

 Adolescents and young adults who are heavy users of marijuana are more likely than non-users to have disrupted brain development…..researchers found abnormalities in areas of the brain that interconnect brain regions involved in memory, attention, decision-making, language and executive functioning skills. (Ashtari, Manzar Ph.D., Director of Diffusion Image Analysis and Brain Morphometry Laboratory in the Radiology Department of the Children’s Hospital of Philadelphia. Journal reference Manzar Ashtari, Kelly Cervellione, John Cottone, Babk A. Ardekani, Sanjiv Kumra, Diffusion abnormalities in adolescents and young adults with a history of heavy cannabis use. Journal of Psychiatric Research, 2009; 43(3): 189-204 DOI: 10,1016/j.jpsychires.2008.12.002.)

This last little tidbit comes up in article after article; to be fair there appears to be a genetic component that is still being researched. 

 “We believe there is now enough evidence to inform people that using cannabis could increase their risk of developing a psychotic illness later in life.” (Moore et el. Lancet 370, 319-328, 2007; Nordentoft and Hjorthoj Lancet (307), 293 294, 2007)

The literature really isn’t any different for alcohol or the “blow” in which President Lame Duck also indulged.  Combining them simply makes the problems bigger.

Rather explains a lot, doesn’t it?  Not just about TOTUS’ behaviors and his mindset but that of all liberal progressives who spent too much time during their youth in drug-induced or drunken stupors.  The numbers that show the drug use and abuse of recently-graduated and current high schoolers helps to explain their propensity to avoid what common sense (and the Constitution) calls “personal responsibility”, with all its negative implications.

It sure doesn’t make us feel safe knowing someone like this is supposed to answer the red phone in the middle of the night.

Taking Stock, Lock and Barrel

By

Three years after President Lame Duck’s election, even his staunchest supporters are starting to see that something is very rotten in Denmark.  Failed policy after failed policy combined with a jet-setting lifestyle that even Marie Antoinette would envy have sent the children into the streets in protest and while the administration thought perhaps this would be their moment to tip the balance of derisive sentiment spreading across the land, the children’s exhibition of the fruits of modern progressive liberal public education have only backfired as it quickly became obvious they are as clueless, as greedy and as uncouth as their former messiah.

How do you spell failure?  Let us count the ways.  First and foremost and worst of all there is “Fast & Furious”; that covert little gun-running operation with no intention other than to somehow bassackwardly prove that the 2nd Amendement is a bad thing.  But like most guns in the hands of a complete moron, it wasn’t pointed in the right direction and Obama and Holder have American blood on their hands after Border Patrol agent Brian Terry was gunned down by a Mexican drug dealer hunting Border Patrol agents using a gun the administration forced a gun shop owner to sell illegally.

The Department of Justice’s attempts to stonewall the Congressional investigation into “Fast & Furious”, along with Holder’s inability to accept the responsibility that comes with the authority of his position during hearings into the matter have done nothing to endear them to anyone with even a shred of common sense.

It doesn’t help that the lamestream media continues to punt on anything that might raise an eyebrow among rank and file Americans.  To whit, the man who used his companies to back Obama’s first steps into politics in 1995 and then continued with major support that even includes a “helping” the Obamas buy property in Chicago (Rezko’s wife purchased and then resold a side yard to the Obama’s home they could not afford initially), Tony Rezko, was just this week sentenced to 10-1/2 years in prison for corruption and extortion.  Let us not forget that Rezko has spent the last 3 years sitting in prison after his 2008 conviction on 16 fraud and attempted bribery counts.  Exactly the kind of friend we all want, right?  NewsBusters has a nice rundown on the media sidestep. 

Then there is the “green jobs” waste of taxpayer money.  First it was Obama’s much-touted poster-child Solyndra with the administration’s first energy loan of $535 million.  It is now being revealed that the whole thing was nothing more than political payback, with the DOE going so far as to “…push very hard for us to hold our announcement of the consolidation to employees and vendors to Nov. 3rd [2010] – oddly they didn’t give a reason for that date.” 

I’ll give you three guesses why any announcement of Solyndra’s spectacular failure would be better made on November 3, 2010 and the first two don’t count.

But Solyndra is just the tip of that pesky little global-warming iceberg.  At the end of the last month word came out that yet another “green” company, Beacon, was also going under on the taxpayer’s dime.  They received a $43 million Energy Department loan guarantee issued in August 2010 and they also received $29 million in grants from the U.S. and Pennsylvania.

Now even Democrat Senator Claire McCaskill (MO) is getting into the act.  But while such an outright and overt defection of the woman once thought a possible VP running mate for President Lame Duck may raise some eyebrows, it’s no surprise that the administration’s recent $433-million contract with Democratic donor, Siga-controlling shareholder Ronald O. Perelman’s pharmaceutical company for an unapproved, experimental smallpox drug smells just as bad. 

[box] “Siga was offered the sole contract for the drug without the government seeking out any competition from fellow pharmaceutical companies. The United States currently has $1 billion worth of smallpox vaccines on the ready, which is more than enough to aid the entire country in case of an epidemic. While the experimental drug, ST-246, has yet to be proved effective, it has also yet to be evaluated or approved by the FDA and is being purchased at a whopping $255 per pill.”[/box]

Of course, McCaskill is up for reelection in 2012 so her motivation is less than noble.  But if the elected progressive liberal hacks have become willing to point out the stench with which they have surrounded themselves, it ought to bode nothing but well for the conservative cause.

Until you remember that there are still people like David Axelrod running around free.  And the “dirty politics” that make Chicago famous are already in full display with the recent Herman Cain sexual harrassment allegations.  Ann Coulter connected the dots recently in a piece for Townhall:

[box]”…both Axelrod and Daley have a history of smearing political opponents by digging up claims of sexual misconduct against them.

John Brooks, Chicago’s former fire commissioner, filed a lawsuit against Daley six months ago claiming Daley threatened to smear him with sexual harassment accusations if Brooks didn’t resign. He resigned — and the sexual harassment allegations were later found to be completely false.

Meanwhile, as extensively detailed in my book “Guilty: Liberal ‘Victims’ and Their Assault on America,” the only reason Obama became a U.S. senator — allowing him to run for president — is that David Axelrod pulled sealed divorce records out of a hat, first, against Obama’s Democratic primary opponent, and then against Obama’s Republican opponent.

One month before the 2004 Democratic primary for the U.S. Senate, Obama was way down in the polls, about to lose to Blair Hull, a multimillionaire securities trader.

But then The Chicago Tribune — where Axelrod used to work — began publishing claims that Hull’s second ex-wife, Brenda Sexton, had sought an order of protection against him during their 1998 divorce proceedings.

From then until Election Day, Hull was embroiled in fighting the allegation that he was a “wife beater.” He and his ex-wife eventually agreed to release their sealed divorce records. His first ex-wife, daughters and nanny defended him at a press conference, swearing he was never violent. During a Democratic debate, Hull was forced to explain that his wife kicked him and he had merely kicked her back.

Hull’s substantial lead just a month before the primary collapsed with the nonstop media attention to his divorce records. Obama sailed to the front of the pack and won the primary. Hull finished third with 10 percent of the vote.

Luckily for Axelrod, Obama’s opponent in the general election had also been divorced.

The Republican nominee was Jack Ryan, a graduate of Dartmouth and Harvard law and business schools, who had left his lucrative partnership at Goldman Sachs to teach at an inner-city school on the South Side of Chicago.

But in a child custody dispute some years earlier, Ryan’s ex-wife, Hollywood sex kitten Jeri Lynn Ryan, had alleged that, while the couple was married, Jack had taken her to swingers clubs in Paris and New York.

Jack Ryan adamantly denied the allegations. In the interest of protecting their son, he also requested that the records be put permanently under seal.

Axelrod’s courthouse moles obtained the “sealed” records and, in no time, they were in the hands of every political operative in Chicago. Knowing perfectly well what was in the records, Chicago Tribune attorneys flew to California and requested that the court officially “unseal” them — over the objections of both Jack and Jeri Ryan.

Your honor, who knows what could be in these records!

A California judge ordered them unsealed, which allowed newspapers to publish the salacious allegations, and four days later, Ryan dropped out of the race under pressure from idiot Republicans (who should be tracked down and shot).

With a last-minute replacement of Alan Keyes as Obama’s Republican opponent, Obama was able to set an all-time record in an Illinois Senate election, winning with a 43 percent margin.

And that’s how Obama became a senator four years after losing a congressional race to Bobby Rush. (In a disastrous turn of events, Rush was not divorced.)

Axelrod destroyed the only two men who stood between Obama and the Senate with illicitly obtained, lurid allegations from their pasts.

In 2007, long after Obama was safely ensconced in the U.S. Senate, The New York Times reported: “The Tribune reporter who wrote the original piece (on Hull’s sealed divorce records) later acknowledged in print that the Obama camp had ‘worked aggressively behind the scenes’ to push the story.”

Some had suggested, the Times article continued, that Axelrod had “an even more significant role — that he leaked the initial story.”

This time, Obama’s little helpers have not only thrown a bomb into the Republican primary, but are hoping to destroy the man who deprives the Democrats of their only argument in 2012: If you oppose Obama, you must be a racist.”[/box]

Frankly, I think things are going to get far worse before they begin to get better.  With the collapse of the euro now being seen as imminent, judging by reports coming out of the UK that their “Foreign Office is preparing contingency plans to help expats from the Costa del Sol and the Algarve who could be stranded without cash – or caught up in riots and civil unrest” the ripple effect combined with the propensity for violent rioting by those denied their self-perceived and government-encouraged entitlements will certainly reach across the pond (as evidenced by the Euro-copycat OWS).  As one pithy comment put it,

[box]”at least europe is warning its people. Here we just continue to give people handouts from tbe bottomless piggy bank of china. As beck would say, how many warnings do you need?  If you are not prepping at this point, talk to your family about the quickest route to the superdome. Let them know they will be safe there. Also tell them that youre an idiot and apologize for being their parents.”[/box]

There is hope, of course, since the majority of Americans are really conservative and rather moderate; it is the minority located in the progressive liberal bastions of the major cities, particularly on our coasts, who pose the greatest threat.  But that threat can be mitigated by a concerted effort to oust Democrats and those Republicans from any and every elected office from dog catcher to local sheriff to President if they are merely a hack and not willing to uphold the Constitution.

It is also extremely imperative to vote in the upcoming presidential primary.  If you really don’t want someone with questionable conservative values like Romney as the GOP 2012 candidate, get to the polls and vote for the candidate you want.  But then support the eventual choice with everything you’ve got because, OMG – Obama Must Go.

What Is The Value Of A Unit Over 70?

By

Today is the day Americans give thanks; thanks for the bounty of blessings made possible by freedom.  While out driving this evening I was listening to the Mark Levin show and sit here now giving thanks that in just less than one year we still have one more chance to get rid of the blight of progressive liberalism that threatens to destroy this beloved country.

One of Mark’s callers tonight was a brain surgeon.  A brain surgeon who recently attended a seminar in Washington, D.C.; a gathering of highly-trained medical colleagues who were apparently given a preview of coming Obamacare attractions by the Department of Health & Human Services.

What this doctor calmly laid out was chilling.  Should you or a loved one find yourself experiencing a stroke or other such serious, life-threatening neurological event and are rushed to the emergency room, unless you are less than 70 years old you can forget about receiving anything more than “comfort care” unless the “ethics panel” from whom your neurosurgeon must request permission to do anything else decides that your value as a “unit” is worth the expense.

Even if it’s 2 a.m.

Yes, Virginia; Sarah Palin was right.  “Death panels” are actively being developed even as you read these words; though from the sound of it we, the people, conveniently aren’t supposed to hear about it until after the election.

You don’t have to be a brain surgeon to know this is wrong.

Dead wrong.

The Tea Party vs. the Flea Party

By

As the great unwashed masses take to the streets to loudly lament the fact they are facing the consequences of their coddling and therefore bad choices and demanding that others fix it for them, we throught we’d compare their…errr…whatever with what the now-fawning, slavering lamestream media has barely covered and only then with great derision:  the Tea Party.

There are certainly more examples than this and, knowing the progressive liberal mindset, more to come.  But here is a start.

The Tea Party

The Flea Party
Is paid to work Is paid to protest
Has sex in the bedroom Has sex in the street
Uses a bathroom as intended Eliminates wherever; including on cars and in the street
Pays taxes Lives off taxes
Expects to earn a promotion by working hard Expects to start at the top
Gives to charity Lives off charity
Takes out only a mortgage they can repay Defaults on a mortgage above their ability to repay
Pays off credit debt Declares bankruptcy to avoid paying credit debt
Protects the unborn Protects convicted child rapists and murderers
Considers having a cell phone a nicety Considers having a cell phone a right
Respects government property Defaces government property
Obtains permits for public protests Demands taxpayer resources for protests
Protests on public property Trespasses to protest on private property
Proudly displays the American flag Burns the flag and/or demands it be removed from display
Heroes include Washington, Jefferson, Franklin Heroes include Mao, Guevara, and the Communist Party
Supports the 1st Amendment Exercises 1st Amendment right to make a fool out of themselves in public
Supports the 2nd Amendment Demands death for those with whom they disagree
Believes in small, limited government Believes government knows best
Knows history Repeats history

The Founding Fathers On Health Care

By

There is much rumbling about the constitutionality of what Congress is now doing to legislate health care “reform”.  Those who think the Constitution is a “living document”, subject to the whims of whoever manages to buy the most votes, and therefore argue that health care in this country is a “right” are, however, sadly off the mark.  In fact, my not-so-humble opinion is that they can be described as traitors for their subversion of the Constitution and the perpetuating of such a myth is itself treason, but that is a discussion for another day.

Right now, what concerns me is the intention of the Founding Fathers and nowhere are they stated more clearly than in the Declaration of Independence.  It is the single most critical document to be considered for it is the very reason that United States exists.

The Declaration states:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed.

There is great hypocrisy in liberal arguments that focus on the literal in the health care debate yet deliberately ignore the literal in these two simple statements.  It is quite clear that equality was considered crucial and key by the Founders.  By definition (all courtesy of Merriam-Webster), equality means of the same measure, quantity, amount, or number as another; it means identical in mathematical value or logical denotation.  It does not mean, by modern Democratic parlance translated into legislation, that some are more equal than others.  Yet Congress and the federal government consistently hold themselves apart from the people and earmarks, particularly those handed out by Senator Reid to get his 60 votes for the Senate bill, are a blatant disregard of the definition, for by giving more to some they then give less to others (in itself a violation of Article 1, Sections 8 and 9 of the Constitution but that will be addressed further down).

So if you can understand and accept the fact that by simple definition we all stand as equals, then what follows is that every equal one of us has certain “inalienable Rights”.  An “inalienable Right” is one that is incapable of being withdrawn or diverted, surrendered, or transferred.  Meaning, it’s yours; you own it without having to buy it, and no can force you to sell it.  It is something that no one may ever take away from you, now and forever, amen.

These inalienable Rights are Life, Liberty, and the Pursuit of Happiness.  We have discussed them here before but in terms of the health care debate, they translate thusly:

1.)  Life:  The inalienable Right to Life means that no one is allowed to take yours away from you.  Not now, and not even before you are born (except by specific and narrow definition that we will adress when we get to Happiness).  The bottom line is that you – the individual – by the very grace of God (or Buddha or the Great Pumpkin or whatever have you since all religious beliefs or the lack thereof are also equal) have the right to be alive.  Period.

2.)  Liberty:  The inalienable Right to Liberty means that when you exist, you are free.  But what exactly is “free”?  It means that you not subject to the control or domination of another, you are not determined by anything beyond your own nature or being; you are capable of choosing for yourself,  not hampered or restricted or confined.  You may decide how and what you think and say, how you wish to live, where you wish to live while you think and speak, how you care for yourself and/or for others.  The examples go on and on but this one small word is the centerpoint upon which everything in this country is balanced.  Liberty is, by definition, dependent upon freedom.  It is  the power to do as one pleases, the freedom from physical restraint, the freedom from arbitrary or despotic control, the positive enjoyment of various social, political, or economic rights and privileges; liberty is the power of choice.

Let’s look at that last definition a little more closely.  You have the power of choice.  You have the inalienable RIGHT TO CHOOSE.  It is your right to look at the options available to you and to choose what makes the most sense to you based on your own individual circumstances.  But in the matter of abortion, doesn’t this conflict with the Right to Life?  Glad you asked.  The inalienable Right to life and the inalienable Right to liberty are equal rights, neither one takes precedence over the other but they are also equal to the third inalienable right and it is there that the balance point for this and other matters may be found.

3.)  Pursuit of Happiness:  This is the inalienable right to follow your heart, to go after those things that for you, the individual, bring a state of well-being and contentment.  If it makes you happy to dye your hair blue or cover every inch of your body with swastika tattoos, if it makes you happy to invent the next best thing after sliced bread and thereby make a fortune, if it makes you happy to spend that fortune on stuff or to give it all away, you have the inalienable right to do these things.  In terms of health care, if drinking yourself into a stupor every night makes you happy or smoking or eating nothing but McDonald’s french fries or any other thing that medicine tells us may have a negative impact on health, it is still your inalienable right to do them.  I know it may be hard to believe this since the federal government has decided it is in your best interests to legislate your ability to pursue your choices of what science deems as “unhealthy” but the reality of the Republic of these United States of America is that such legislation was never and is not now really within their powers.  I would argue that to “provide for the general Welfare” means simply insuring that science is allowed to operate freely and its results then made available to everyone; it is the States, made up of the people in each of them who then decide what, if anything, should be done based on whether they choose to believe those results or not.

May it be noted for the record that the inalienable Right to pursue your own individual happiness does not mean that you are guaranteed to get it.  This Right is only about opportunity, it is the inalienable Right to life and liberty with a hefty sprinkle of fate that affects results.  In the health care debate over abortion, the balance between the inalienable Right to life, liberty, and happiness is found in the ruling in Roe v. Wade and in the Hyde amendment.  These two things allow the individual to make the decision and the freedom to pursue it yet prevent individual choice from negatively impacting any individual who would choose differently.

And that is exactly the sort of balance that is meant by the saying, “Your rights end where mine begin”.  You may have the inalienable Right to choose but because everyone is equal and therefore has exactly that same Right, you may not make a choice for which your consequences (intended or not) become the consequences of someone else who did not make your same choice.

Surely, all of this balancing ’tis a delicate act to accomplish, yet by granting limited powers to the federal government, the Founding Fathers were very clear that individual freedom is paramount.  James Madison addressed the “general welfare” argument long before the Democrats decided that it means they can force Americans to do whatever it is they think best by making regulations and laws and using the IRS as their means to enforce compliance.  In Federalist Paper 41, he explains the enumerated powers of the Constitution (highlights mine):

It has been urged and echoed, that the power “to lay and collect taxes, duties, imposts, and excises, to pay the debts, and provide for the common defense and general welfare of the United States,” amounts to an unlimited commission to exercise every power which may be alleged to be necessary for the common defense or general welfare. No stronger proof could be given of the distress under which these writers labor for objections, than their stooping to such a misconstruction.

Had no other enumeration or definition of the powers of the Congress been found in the Constitution, than the general expressions just cited, the authors of the objection might have had some color for it; though it would have been difficult to find a reason for so awkward a form of describing an authority to legislate in all possible cases. A power to destroy the freedom of the press, the trial by jury, or even to regulate the course of descents, or the forms of conveyances, must be very singularly expressed by the terms “to raise money for the general welfare.

“But what color can the objection have, when a specification of the objects alluded to by these general terms immediately follows, and is not even separated by a longer pause than a semicolon? If the different parts of the same instrument ought to be so expounded, as to give meaning to every part which will bear it, shall one part of the same sentence be excluded altogether from a share in the meaning; and shall the more doubtful and indefinite terms be retained in their full extent, and the clear and precise expressions be denied any signification whatsoever? For what purpose could the enumeration of particular powers be inserted, if these and all others were meant to be included in the preceding general power? Nothing is more natural nor common than first to use a general phrase, and then to explain and qualify it by a recital of particulars. But the idea of an enumeration of particulars which neither explain nor qualify the general meaning, and can have no other effect than to confound and mislead, is an absurdity, which, as we are reduced to the dilemma of charging either on the authors of the objection or on the authors of the Constitution, we must take the liberty of supposing, had not its origin with the latter.

Let me translate this into contemporary English.  Madison says that those who argue that the federal government can do anything, in this case health care, because it affects the “general welfare of the United States” are idiots.  He says they are making up their facts by deliberately misunderstanding what is in the Constitution and how it is written.

He explains that the first sentence in Article 1, Section 8 is not a stand-alone statement.  The sentence was not written as:  “The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States.”  It was written as:  The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;” and herein lies the meat of his explanation.  The difference in the two sentences I have just typed is that the first one ends in a period and the second one ends in a semicolon.  And, as in all proper writing, which should be well-understood by all those “best and brightest” Ivy League types scuttling around Washington, punctuation matters.  Madison then calls out those who deliberately ignore the meaning of the Article’s punctuation.  He explains that the opening sentence of Article 1, Section 8 is a general phrase that is explained in full – qualified – by what then follows after that all-important little semicolon.  To suppose that the Founders meant anything more or less than what they put down in writing in that section is “an absurdity”.  For the sake of those who may not have ever read them, according to the Constitution then, these and these alone are the powers that the Founding Fathers saw as belonging to the federal government:

To borrow money on the credit of the United States;

To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

To establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States;

To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;

To provide for the Punishment of counterfeiting the Securities and current Coin of the United States;

To establish Post Offices and Post Roads;

To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;

To constitute Tribunals inferior to the supreme Court;

To define and punish Piracies and Felonies committed on the high Seas, and Offenses against the Law of Nations;

To declare War, grant Letters of Marque and Reprisal, and make Rules concerning Captures on Land and Water;

To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;

To provide and maintain a Navy;

To make Rules for the Government and Regulation of the land and naval Forces;

To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;

To provide for organizing, arming, and disciplining the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;

To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dock-Yards, and other needful Buildings; And

To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

And just in case Madison had not fully and successfully won the argument that the laundry list contained in Article 1, Section 8  is the sum total of the power granted by the Constitution to the federal government, the Founding Fathers included Amendment 9 in the Bill of Rights:

Amendment 9 – Construction of Constitution. Ratified 12/15/1791.

The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

I don’t know about you, Sunshine, but I don’t see health care included in this list.  And it wasn’t because there wasn’t any medical care in the 18th century, either, because even though doctors actually killed more people than they saved, medicine was already a long-recognized profession. One of the signers of the Declaration of Independence, Dr. Benjamin Rush, put forth this argument at the Constitutional Convention: 

“The Constitution of this Republic should make special provision for medical freedom. To restrict the art of healing to one class will constitute the Bastille of medical science. All such laws are un-American and despotic.” 

“Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers.”

That is as close to a mention of health care as you’ll find, though the good doctor addresses only the individual freedom of his fellow doctors to practice their art.  That we find no such special interests included in the final version of the Constitution is because the Founding Fathers understood that things like health care are the sole purview of the individual and that our inalienable Rights already covered matters like choice of profession.  His words are prophetically ironic, though, and Dr. Rush is quite likely spinning in his grave over the contents of the House and Senate health care legislation since both create exactly the situation he feared would happen to the American people.  I can only imagine his angst, as one willing to die for our inalienable rights, that it comes directly from the hands of the federal government.

HR 3962: Frankenstein’s Monster

By

While this column has been quiet due to other priorities (like working so that the mortgage is paid, and volunteering so that others may improve their lot in life), it doesn’t mean we haven’t been watching the wankers in Washington as they continue their dangerous attempts to complete the progressive’s long-planned enslavement of the citizens of these United States.  Indeed, our silence is due, in part, to head-shaking amazement that writing fresh material for this column becomes harder and harder because every day has become Groundhog Day.  President “I Won” continues to use our hard-earned tax monies to hump his campaign stump; appearing on television almost every day in order to jolly Americans into thinking he’s just a normal guy via some talk show or to actively campaign for Democrat candidates in upcoming elections around the country.  Speaker of the Nuthouse, Nancy Pelosi, hasn’t stopped her deer-in-the-headlights, utterly non-sensical evasion of legitimate questions; like, for example, exactly where in the Constitution does it give Congress the power to, among other oversteps, mandate health care be purchased by every American? 

And true to their lying form, “the most transparent administration in history”, this legend-in-their-own-minds gang of thugs and thieves, scuttled off like the rats they are and locked themselves into an obviously airless room in order to poke and prod and breathe some semblance of life back into deadly, massive HR 3200, their first blatant, sweeping attempt at the usurpation of the private-sector, free market-driven business of American health care.  What came out of that headlong rush into madness is HR 3962.  A veritable Frankenstein’s monster at 1,990 pages and about 400,000 words, this latest incarnation of mandated submission to government welfare is designed to take over and, as is the case with anything run by the government, annihilate a full ONE-FIFTH of the nation’s economy.

It is a monster only progressives and idiots could love.  Like its predecessor, HR 3962 sets up a financial shell game by front-loading revenue and postponing serious spending to later years (years when those who would otherwise be called on the carpet for such reckless misuse of hard-earned taxpayer monies will be far away, enjoying their taxpayer-funded retirements).  It contains 13 tax hikes that will hit everyone one way or another:

Employer Mandate Excise Tax (Page 275): If an employer does not pay 72.5 percent of a single employee’s health premium (65 percent of a family employee), the employer must pay an excise tax equal to 8 percent of average wages. Small employers (measured by payroll size) have smaller payroll tax rates of 0 percent (<$500,000), 2 percent ($500,000-$585,000), 4 percent ($585,000-$670,000), and 6 percent ($670,000-$750,000).

Individual Mandate Surtax (Page 296): If an individual fails to obtain qualifying coverage, he must pay an income surtax equal to the lesser of 2.5 percent of modified adjusted gross income (MAGI) or the average premium. MAGI adds back in the foreign earned income exclusion and municipal bond interest.

Medicine Cabinet Tax (Page 324): Non-prescription medications would no longer be able to be purchased from health savings accounts (HSAs), flexible spending accounts (FSAs), or health reimbursement arrangements (HRAs). Insulin excepted.

Cap on FSAs (Page 325): FSAs would face an annual cap of $2500 (currently uncapped).

Increased Additional Tax on Non-Qualified HSA Distributions (Page 326): Non-qualified distributions from HSAs would face an additional tax of 20 percent (current law is 10 percent). This disadvantages HSAs relative to other tax-free accounts (e.g. IRAs, 401(k)s, 529 plans, etc.)

Denial of Tax Deduction for Employer Health Plans Coordinating with Medicare Part D (Page 327): This would further erode private sector participation in delivery of Medicare services.

Surtax on Individuals and Small Businesses (Page 336): Imposes an income surtax of 5.4 percent on MAGI over $500,000 ($1 million married filing jointly). MAGI adds back in the itemized deduction for margin loan interest. This would raise the top marginal tax rate in 2011 from 39.6 percent under current law to 45 percent—a new effective top rate.

Excise Tax on Medical Devices (Page 339): Imposes a new excise tax on medical device manufacturers equal to 2.5 percent of the wholesale price. It excludes retail sales and unspecified medical devices sold to the general public.

Corporate 1099-MISC Information Reporting (Page 344): Requires that 1099-MISC forms be issued to corporations as well as persons for trade or business payments. Current law limits to just persons for small business compliance complexity reasons. Also expands reporting to exchanges of property.

Delay in Worldwide Allocation of Interest (Page 345): Delays for nine years the worldwide allocation of interest, a corporate tax relief provision from the American Jobs Creation Act

Limitation on Tax Treaty Benefits for Certain Payments (Page 346): Increases taxes on U.S. employers with overseas operations looking to avoid double taxation of earnings.

Codification of the “Economic Substance Doctrine” (Page 349): Empowers the IRS to disallow a perfectly legal tax deduction or other tax relief merely because the IRS deems that the motive of the taxpayer was not primarily business-related.

Application of “More Likely Than Not” Rule (Page 357): Publicly-traded partnerships and corporations with annual gross receipts in excess of $100 million have raised standards on penalties. If there is a tax underpayment by these taxpayers, they must be able to prove that the estimated tax paid would have more likely than not been sufficient to cover final tax liability.

Note for the record that those individuals paying the “individual mandate” tax don’t get anything for their money.  It is a penalty, cleverly set up to be enforced (as a criminal liability) by the IRS.  Those folks still have to buy health insurance, and the government’s option contains higher premiums that low- and moderate-income individuals and families would have to pay for health coverage to avoid the tax.

Like its predecessor, HR 3962 includes yet another uncontrolled and unaccountable czar who will determine the requirements for health insurance policies.  For ALL health insurance policies; which means, as before, if your employer’s plan doesn’t meet the czar’s requirements, it will be determined to be illegal and you will be forced to make another “choice”.  Read:  take the government’s plan.

Of course, mandating requirements that are unsustainable, such as no exclusions for pre-existing conditions and specific items and services than must be covered as well as the minimum frequency or duration of a required covered service and the maximum allowable patient cost sharing, sets the stage for failure of the free market.  The government will simply regulate the free market for health insurance out of existence.  Leaving you with no choice but what the government wants to give you. 

And with that lack of choice must, by definition, come rationing.  The same rationing that exists in the free market and with welfare programs like Medicare and Medicaid today, though the former driven (and therefore avoidable) by consumer choice and the latter driven by its inherent purpose of pulling the unsuspecting under the control of the government for the gains of a few who consider themselves above those they see as the stupid, great unwashed masses (citizens of these United States whom they are, by oath, supposed to represent). 

There’s nothing new in this warmed-over, dung-filled bowl of swamp water soup.  Those who work hard and play by the rules are going to continue to pay for those who buy into the progressive mindset that they are entitled to something for nothing for the price of their freedom.

HR 3200 was wrong.  Its latest incarnation as HR 3962 does nothing to fix any problems and, indeed, only serves to make them worse.

Health Insurance Is Not Health Care

By

After spending the time necessary to digest the initial draft of H.R. 3200, that bastardizing socialization of American medicine the U.S. House is calling “health care reform”, not only do I find I have a severe case of heartburn, I am even more deeply angered at the state of this great nation under the current adminstration.  I am also flabbergasted at the depths of ignorance calculatingly displayed by those unrepresenting representatives in Washington and dismayed at the ignorance unintentionally displayed by Americans in general.

When you strip away all the rhetoric, a truth is that we are each responsible for our own lives.  You can’t spin the fundamental fact that, with the extreme exceptions of abortions and executions, no one makes our choices for us; all they do is offer us various options.  It remains up to us to take something or to leave it, or to take something else instead.  Speaking philosophically and literally, even choosing nothing is still having made a choice.

When it comes to our health, our choices in this country are nearly endless.  Every breath we take (or do not take), everything that enters our bodies through our mouths, our ears, our eyes, every movement or non-movement (as with tv-slothing or sleep) is a health-affecting choice on our part.  Sure, some things like breathing are, in the main, unconscious choices but remember the last time you caught yourself holding your breath in eagerness, anticipation, or fear and reminded yourself to breathe again?

Truly, all bodies are marvels in and of themselves.  They are an ultimate machine, capable of both creation and destruction even when simply existing, and such is mirrored every second through continuous regeneration at the cellular level.  But, like all machines, each one of our bodies was apparently designed for a limited period of service and as we age our regenerative abilities slow down until, in the end, it stops altogether and so we die.

There is nothing bad, nothing shameful in all of this.  It is, as in popular vernacular, the circle of life.  But Man sees himself in the mirror and believes that the recognition of Self somehow makes him superior to other species.  Yet the whispers of his instincts can never be suppressed for long, and it is those whispers – ever-reminding him that man, too, is ruled by natural law –  that cause him to vainly create a phantom, parallel world within his own species.  A world where his physical inferiority is replaced by some pseudo-intellectual or material superiority.

Life will never be anything more than a competition, a survival of the fittest.  Certainly, as a species man is more willing than some to assist others, to assist the collective but this latest Obamanation of forced equality, particularly this religious zealotry aimed at the idea of health care reform, will fail.  As it has forever failed.  For it goes against natural law and no matter how “smart”, or how much techology we can create, we are now and will be forever subject to our humanness.

Ask the antelope in the jaws of the jaguar if life is fair.  We would be better off to accept our place in this world and enjoy the fact we get a life at all.  Return to the foundations upon which this country was birthed and let its inherent support of natural law take care of things like the auto industry, the banks, people who bit off more mortgage than they can chew, and also take care of “health reform”.  Anything else will simply accelerate our inherent propensity for self-destruction.

If you take the time to read and to understand what is being proposed in H.R. 3200, it is clear that the Obama administration intends to wholly assume not the business of health insurance but to flat-out control every aspect of the practice of medicine in the United States.  The campaign rhetoric endlessly spewing forth vaccilates and confuses care with insurance and perhaps this is done on purpose, but without understanding the difference it is easy to get swept up in its destructive fervor.

It is well-known that health CARE in the United States is the best in the world.  As a result of our capitalistic, free-market economy, innovations in the field of medicine have resulted in understandings of human health and the manifestation of health CARE that allows us to live far more comfortably and far more productively than anywhere else in the world.  We have the best doctors, the best facilities, and the best equipment.  Period.

But everything comes with a price and medical technology is no different.  Whether it is a Viagra capsule that gives an old man past his reproductive prime the ability to pursue nothing more than simple carnal gratification or the MRI machine that gives doctors the ability to diagnose the presence and extent of a tumor in a young child, each and every thing we use or do has cost someone time and money to create.  They pursue these things out of a combination of altruistic and financial motivations and…you know what?  There is absolutely nothing wrong with that.

With the help of more and more technology, the collective mindset of the modern era has served to steer us further and further away from the basic understanding of nature’s cycles and somehow given rise to a belief that we, humans, have a fundamental right to, for lack of a better term, physical immortality.  Or at least the right to die in a body that looks like a plasticized 20-year old.  Fearing death, we cling to the notion we are immune from the processes of aging, that we may exist above the mandates of natural law. 

But, again, the truth is that we are not now, nor will we ever be.  And the sooner we let go of this dangerous belief, the better off we will find ourselves. 

Now, this does not mean that if we get sick, we shouldn’t bother going to see a doctor.  It doesn’t mean that medical CARE should never be provided.  What it means is that medical CARE can only do so much for us and the responsibility to choose that CARE is entirely our own.  And this is where the business of health INSURANCE enters the picture. 

Health INSURANCE is simply a financial risk agreement between two parties.  It’s a lot like a bet.  One person bets that they’ll need expensive medical care at some point and the other is betting they won’t.  If the payer stays healthy, the insurer keeps their money; otherwise the insurer shells out what is needed to get the payer back on their physical feet.  Frankly, it’s a rather nifty and interesting arrangement.  The problem is that over time the payer has come to believe that the sum they pay to the insurer is a replacement for the choices that they make for themselves in terms of what they put into and how they treat their body.  Like les enfants terrible, it’s come to be expected that everything needed will simply be provided, promptly and without question.

Nice thought, but dangerously naive.  Everything comes with a price, remember?  If, for example, you ask me to watch your house while you’re away and agree to pay me to do so, the cost for me to stop by every day and bring in the mail is going to be a lot lower than asking me to spend additional time to water your plants, feed your cat, scoop its litterbox, etc.  If you travel a lot and want to keep the costs down, well, you won’t keep either houseplants or a cat, will you?  Health insurance works very much the same way.  If you want me to pay your doctor(s) for every little thing you want done, you’re going to have to pay me more money.  Now, it makes sense for me to help you pay for preventative-type screenings, those early warnings that you, the individual, need to change your couch potato, greaseburger, fries, and beer gut ways.  But if you choose to do or continue to do things proven risky to you, with your unique historical combination of DNA, then you’re going to have to pay me more to cover your body’s sooner-than-later eventual breakdown.

What we need in America is, in my mind, not health CARE reform but to take another look at health INSURANCE.  Medical CARE is available and, for the most part, guaranteed.  Sure, there are situations like in Chicago, where Michelle Obama’s infamous “Urban Health Initiative” was found to be turning away the poorer, less-insured patients in favor of the well-heeled genteel folks, but that’s a business and a moral problem, not a medical CARE problem.

Bottom line:  it’s more than time for the federal government to just get out of the way.  It’s time to stop unsustainable federal medical programs, cut out all the pork-funding taxes, and let Americans look for different and better ways to take care of themselves.  Let Americans place their own bets on what kind of medical care they may need; one thing that comes to mind is having more walk-in clinics or small general practices for all the garden-variety cuts-scrapes-sore throats and even preventative-type care (there is one here in my area that even without any insurance is affordable).  These old-fashioned, less-expensive, priced to pay-as-you-go practices could be combined with health insurance to cover only catastrophic illness, the kinds of illnesses that most of us never experience but that hurt families the most.  And then have a menu of available coverage running the gamut between the two for the more cautious and the hypochondriacs.  I suspect that tort reform would have to accompany such an idea since our sue-happy society has yet to get a grip and stop blaming everyone but themselves for their individual stupidity, but I know from talking to them that there’d be far more general practioners/family doctors if it wasn’t for all the stinkin’ government-related paperwork and the price of insurance against the constant threats of lawsuits.  It would also be good to quit advertising drugs on television with the insistent, cheery message that people should “ask their doctor” about them.  Someone savvy could easily set up an information clearinghouse that provides a searchable list containing all the same caveats as the commercials.  (Am I the only one who’s noticed that for some of the advertised drugs, the list of side-effects takes longer to read than the actual “buy me” part of the commercial?!)

I look at it this way:  doctors (and lawyers) practice.  To expect guarantees from their efforts, then, is ridiculous.  But they do serve a purpose, for the probability of healing as a result of their efforts remains higher here than anywhere in the world.  We should be encouraging doctors by taking back ownership of our health and working with them as our counsel, our partners, not handing the responsibility for our medical care over to the federal government and its proven track record of program administration failures.

HR 3200: A Deadly Swamp Of Socialized Medicine

By

The actual text of health care reform legislation is starting to percolate up from the depths of the committees, and it contains a plethora of hard stops on the freedoms that Americans are guaranteed and have come to expect.  President Obama remains inordinately fond of continuing to campaign about all the “choice” he wants us to see in his vision of health care reform, but what’s in this House version of the bill contains anything but.

Since our unrepresenting representatives can’t be bothered to do so, let’s put on our waders and tiptoe through the alligator-infested swamp and take a gander at it, shall we?

The Biggest and Baddest provision turns President Obama into a bald-faced liar.  The party line is that if you currently have health insurance, sure, you can keep it.  They call this “grandfathering” in your plan.  But Section 102: PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE doesn’t protect anything except the government-run “gateways” and “exchanges” because the day you decide to give up your current plan, it’s all over but the shouting because unless you enroll in an employer-provided plan (that must provide no less than exactly the same benefits as the government’s plan), it’s straight into the machine for you.

These are the key excerpts:

(1) LIMITATION ON NEW ENROLLMENT-

(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(Notice that this is the sum total of verbiage in “this paragraph”.  There are NO exceptions.  Health insurers may no longer enroll new plan participants.)

(c) Limitation on Individual Health Insurance Coverage-

(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.

This means that if a health insurance company wants to stay in business, it must get in bed with the government.

(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.

How very kind of them.  Separate insurance policies will be “permitted” by the government.  If you didn’t ask “What are excepted benefits?” then you deserve the government we’ve got today and don’t come crying to us when Pater Obama tells you that your life isn’t worth the cost of saving it.  But because I’m feeling generous today, I’ll ask the question for you.  What are these “excepted benefits”?  Well, basically anything except what we all think of as common medical treatments, such as:

  • Coverage only for accident, or disability income insurance, or any combination thereof.
  • Coverage issued as a supplement to liability insurance.
  • Liability insurance, including general liability insurance and automobile liability insurance.
  • Workers’ compensation or similar insurance.
  • Automobile medical payment insurance.
  • Credit-only insurance.
  • Coverage for on-site medical clinics
  • Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

Not exactly the “choice” the President, Pelosi, Reid, and those other generous progressives (gag) are leading you to believe, is it?

So just what happens to your “health care” once the government gets their guaranteed hold of it?  Pull out your airsickness bag and read on.

What is covered:

From section 122 (Essential benefits)

(b) Minimum Services To Be Covered-

(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

(1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.

This is the 2008 list of those “preventative services” from the U.S. Preventive Services Task Force:

Grade A:

  • Cervical cancer screening for women
  • Colorectal cancer screening for men and women over 50
  • Discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease
  • Screening for high blood pressure in adults aged 18 and older
  • Screening for chlamydial infection for all sexually active non-pregnant young women aged 24 and younger and for older nonpregnant women who are at increased risk
  • Prophylactic ocular topical medication for all newborns against gonococcal ophthalmia neonatorum
  • Screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit
  • Screening for human immunodeficiency virus (HIV) all adolescents and adults at increased risk for HIV infection
  • Screening all pregnant women for HIV
  • Screening persons at increased risk for syphilis infection
  • Screening all pregnant women for syphilis infection
  • Screening all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco
  • Screening all pregnant women for tobacco use and provide augmented pregnancy-tailored counseling to those who smoke
  • Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care
  • Screening for sickle cell disease in newborns

Grade B:

  • One-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 who have ever smoked
  • Genetic counseling and evaluation for women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes (breast & ovarian cancer)
  • Chemoprevention for women at high risk for breast cancer and at low risk for adverse effects of chemoprevention
  • Screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older
  • Screening for chlamydial infection for all pregnant women aged 24 and younger and for older pregnant women who are at increased risk
  • Screening all sexually active women, including those who are pregnant, for gonorrhea infection if they are at increased risk for infection (that is, if they are young or have other individual or population risk factors)
  • Screening and behavioral counseling interventions to reduce alcohol misuse (go to Clinical Considerations) by adults, including pregnant women, in primary care settings
  • Screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and followup
  • Intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease.  Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians
  • Routine screening for iron deficiency anemia in asymptomatic pregnant women
  • Routine iron supplementation for asymptomatic children aged 6 to 12 months who are at increased risk for iron deficiency anemia
  • Screening all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults
  • Screening women aged 65 and older routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures
  • Structured breastfeeding education and behavioral counseling programs to promote breastfeeding
  • Primary care clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months of age whose primary water source is deficient in fluoride
  • Screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years

(2) ANNUAL LIMITATION-

Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.

Pay particular attention to this.  It’s your annual out-of-pocket expenses for for anything not included in the Grade A or Grade B list of “preventative items and services”.  So although a preventative test may be covered, you’ll still be liable for co-pay expenses to walk in the door to get it.  And just like with most plans today, you’ll still be liable to share the costs of fixing anything found wrong with you by those tests.

Of course we have to have a “Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.”  This will be chaired by the Surgeon General and will have “9 members who are not Federal employees or officers and who are appointed by the President”, “9 members who are not Federal employees or officers and who are appointed by the Comptroller General”, and an “even number of members (not to exceed 8 ) who are Federal employees and officers, as the President may appoint.”  A committe with up to 27 members, 18 of whom are picked by the President.  The bill says these people will “reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies, and at least one practicing physician or other health professional and an expert on children’s health”.  But with no checks and balances on the selection of this group, you can bet they will reflect the President’s personal opinions and/or especially those to whom he owes campaign favors.

And, of course we have to have a Health Choices Administration and a Health Choices Commissioner.  At least the commissioner will be appointed by the President “by and with the advice and consent of the Senate”.  This will be an independent agency that will audit and enforce compliance for all “qualified health benefit plans”, whether or not the plan participates in the government’s “exchange”.  They will be able to levy financial penalties and shut down plans that fail to make their grade.  The Commissioner will appoint a “Qualified Health Benefits Plan Ombudsman” to help people stuck in the maze of government’s plan find their way out, but must do so “in a linguistically appropriate manner” (read:  “press 1 for English”).

Section 1173a of the bill discusses “Standardizing Electronic Administrative Transactions”.  Everything from enrollment to payment for services will be automated.  A good thing?  The bill allows up to 5 years to implement it so in the meantime we may look forward to not only the lumbering pace of bureaucracy, but utter chaos and confusion.

Section 164 outlines a “Reinsurance Program For Retirees”.  The government intends to pick up some of the tab for “participating employment-based plans” in order to lower the costs to the plan’s participants.  It includes the word “temporary”, but in the interim it is your tax dollars that will go to cushion employers who perhaps bit off more than they could chew with regards to retiree health benefits.  (Why do unions immediately come to mind?)

The “Health Insurance Exchange” is such a behemoth that it gets its own title within the bill.  It’s essentially the “Obama Does Costco”, one-stop shopping center where you can go to choose from the various government-seal-of-approval plans, including the government’s “public health insurance option”.  Meaning you can choose between vanilla and vanilla via “culturally and linguistically appropriate communication”.

Section 205, “OUTREACH AND ENROLLMENT OF EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS IN EXCHANGE-PARTICIPATING HEALTH BENEFITS PLAN”, is interesting.  It defines “outreach” as informing and educating “individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.”  Nice.  But down in (d)(1) we reach “COVERAGE FOR CERTAIN NEWBORNS” and weasel words that are sure to have the hearts of La Raza going pitter-patter with excitement.  And I don’t mean just the closing, “In carrying out this section, the Commissioner shall establish effective methods for communicating in plain language and a culturally and linguistically appropriate manner.”

(A) IN GENERAL- In the case of a child born in the United States who at the time of birth is not otherwise covered under acceptable coverage, for the period of time beginning on the date of birth and ending on the date the child otherwise is covered under acceptable coverage (or, if earlier, the end of the month in which the 60-day period, beginning on the date of birth, ends), the child shall be deemed–

(i) to be a non-traditional Medicaid eligible individual (as defined in subsection (e)(5)) for purposes of this division and Medicaid; and
(ii) to have elected to enroll in Medicaid through the application of paragraph (3).

Since the bill makes is mandatory for every American to have health insurance, I’ll let you figure out how a child will be born here without being covered.

To pay for the “Health Insurance Exchange”, we’ll have a “Health Insurance Trust Fund”.  And where will we get the money for it?  Easy!

Section 207 (c)(1) DEDICATED PAYMENTS- There is hereby appropriated to the Trust Fund amounts equivalent to the following:

(A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE– The amounts received in the Treasury under section 59B of the Internal Revenue Code of 1986 (relating to requirement of health insurance coverage for individuals).

Yes, Harry & Louise, if you choose to not buy health insurance or want to pay for a plan that is structured differently than the government wants a health insurance plan to be structured, the IRS is going to make you pay for it anyway.

(B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE– The amounts received in the Treasury under section 3111(c) of the Internal Revenue Code of 1986 (relating to employers electing to not provide health benefits).

(C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS– The amounts received in the Treasury under section 4980H(b) (relating to excise tax with respect to failure to meet health coverage participation requirements).

(2) APPROPRIATIONS TO COVER GOVERNMENT CONTRIBUTIONS– There are hereby appropriated, out of any moneys in the Treasury not otherwise appropriated, to the Trust Fund, an amount equivalent to the amount of payments made from the Trust Fund under subsection (b) plus such amounts as are necessary reduced by the amounts deposited under paragraph (1).

Numerous other “trust funds” are also embedded in the bill  for enormous and far-flung entire government-run programs  to fund the education of doctors and nurses and all kinds of research, which is essentially a huge step smack into the middle of the private sector.

Sections 241-245 are essentially premium subsidies for those who fall “below 400 percent of the Federal poverty level for a family of the size involved” and individuals; this also includes subsidizing “unaffordable employer coverage”, which is defined as “full-time employees for which the cost of the employee premium for coverage under a group health plan would exceed 11 percent of current family income”.

In the “Employer Responsibility” part of the bill, a nice double-dip can be found in section 311:  “if an employee declines [their employer’s plan]but otherwise obtains coverage in an Exchange-participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee”.  What this is saying is that employers will be penalized 8% of the employee’s average salary if their employees don’t want what they offer.  The employer isn’t paying the employee’s premiums, either.  This money goes right into the Health Insurance Exchange Trust Fund.

Small businesses get hit with this double-dip penalty, too, though “only” up to 6% on a sliding scale up to an annual payroll of $400,000.

Employers will be held liable for “civil penalties” if they do not provide health insurance; to the tune of $100/day up to $500,000.  Interestingly, the money collected “shall be deposited as miscellaneous receipts in the Treasury of the United States” instead of funding the government’s snake-oiled medicine machine.  The IRS will also be involved, collecting employment taxes on employers who “fail” to participate – 10% of what should have been paid up to $500,000.

Section 2793 addresses what’s required if an employer wants to use the government’s plan.  “Such election shall be treated as the establishment and maintenance of a group health plan” and because, say, Joe’s Plumbing & Heating is now Joe’s Plumbing & Heating Health Insurance Plan, the now-infamous “Secretary shall regularly audit…and conduct investigations and other activities…so as to discover noncompliance with the health coverage participation requirements….”  Anything wrong will be sent to the “Secretary of the Treasury and the Health Choices Commissioner. The Secretary shall take such timely enforcement action as appropriate to achieve compliance.”  The same civil and IRS-driven penalties noted above will also apply if Joe’s Plumbing & Heating Health Insurance Plan fails to “satisfy the health coverage participation requirements with respect to any employee.”

Of course, complying is going to be as easy as filing with the IRS, because the “Secretary” is given the authority to make up “such regulations as may be necessary or appropriate to carry out the provisions of this section”.  Section 6050X spells out how information will be provided to about everyone that Joe’s Plumbing & Heating Health Insurance Plan covers; provided both to the IRS and Joe’s employees, of course.

Because the federal government intends to not just reform health care for Americans, but to control it from birth to (early) death, section 324 has to spell out that cooperation between “the Secretary of Labor, the Secretary of the Treasury, the Secretary of Health and Human Services, and the Health Choices Commissioner” will insure that everyone is singing from the same songbook when it comes to “enforcing” adherence to this sweeping new law of the land.

Title IV of the bill amends the already impossible tonnage of the Internal Revenue Code of 1986.  Here is where individuals without coverage will be forced to pay a 2.5% tax, except for non-resident aliens and anyone living outside the United States, or folks who have a “religious exemption” on file.  If Joe’s Plumbing & Heating decides not to provide any kind of health insurance for its employees, Joe will pay a tax equal to 8% of his employee’s salaries, though if his business is very small and his payroll is less than $400,000, he’ll pay on a sliding scale up to 6%.

And just in case you were wondering, go ahead and substitute “state” for “Joe’s Plumbing & Heating”.  In a behind-the-scenes look at the crafting of this bill, the House Energy & Commerce Republicans reported that:

An amendment offered by Rep. Nathan Deal, R-GA., would prohibit the Federal government from taxing or withholding benefits from States whose health plans don’t comply with the new arbitrary essential benefits mandates that the HHS Secretary is authorized to make under this legislation. These could include mandated coverage of abortion or Botox injections, and if States don’t comply they would face an 8% tax on their employee payroll or drastic cuts in Federal grants.

The issue was outlined starkly in questions posed by the ranking Republican, Joe Barton of Texas, to the committee’s chief Democratic staff counsel:

Barton: “Is it true that if we don’t strike this and the bill stays as is, the federal government could withhold grants from states if they didn’t comply with some of the mandated requirements for health coverage of their state employees?

Democratic counsel: “Yes.”

Barton: “Is it true under the provisions of the bill if not struck or amended that if the federal government required abortions to be covered, a state would have to do that or lose grants?

Democratic counsel: “If the secretary, acting on advice of the benefits advisory commission, had made abortion a minimum benefit for any acceptable insurance package, yes, sir. They could withhold that.”

“We can’t tell states what to do directly,” Waxman said later, explaining why withholding funding would be necessary. “We have to use whatever leverage we have over them.”

Deal pointed out that the requirement seemed at odds with the Democrats’ long-stated intention to enact health care reform in order to cover people without insurance. “If the thrust of this bill is to cover the uninsured, state employees are not uninsured,” Deal pointed out. “Local municipal employees are not uninsured.”

However, Health Subcommittee Chairman Frank Pallone, D-N.J., stuck with the story that states might require federal intervention, “All we’re doing here is saying the state has to act like other employers.”

Nice, eh?  Anything the “Secretary’s” black little hole-where-the-heart-should-be desires will be funded by your hard-earned tax dollars.  Including abortions.

In Section 45R, “Health Coverage Expenses”, the smallest “qualified” businesses will get a 50% tax credit on the cost of providing health insurance, and there’s a sliding scale that decreases the credit based on the number of employees and their pay.  Starting in 2012.

Gee whiz.  Such generosity, eh?

In “Subtitle C—Disclosures to Carry Out Health Insurance Exchange Subsidies“, it states that the “Secretary” can “disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit”.  Just what information about you will be made available?

  • Taxpayer identity information
  • Filing status
  • Modified adjusted gross income
  • Number of dependents
  • Such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and
  • The taxable year with respect to which the preceding information relates or,if applicable, the fact that such information is not available.

The government will spend $750 million to tell you just how you should raise your children.  Section 1904: GRANTS TO STATES FOR QUALITY HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN, subpart 3: Support for Quality Home Visitation Programs, Section 440: HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN intends to provide parents with a “one size fits all” —

  • knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains (including knowledge of second language acquisition, in the case of English language learners);
  • knowledge of realistic expectations of age-appropriate child behaviors;
  • knowledge of health and wellness issues for children and parents;
  • modeling, consulting, and coaching on parenting practices;
  • skills to interact with their child to enhance age-appropriate development;
  • skills to recognize and seek help for issues related to health, developmental delays, and social, emotional, and behavioral skills; and
  • activities designed to help parents become full partners in the education of their children

If you’re a woman pregnant with your first child or have a child under the age of 2 and use the government’s plan the government is going to monitor you.  And don’t be surprised to find someone knocking at your door to check on you, in part to increase “birth intervals between pregnancies”.  (Can’t have poor people reproducing too quickly, can we?)

Other invasions of privacy are found in Section 2521, NATIONAL MEDICAL DEVICE REGISTRY, where private sector health-related electronic data (such as pharmaceutical purchase data and health insurance claims data) will be gathered to “facilitate analyses of postmarket safety and patient outcomes for devices.”  It is intended to be viewable by the general public but, of course, “in a manner and form that protects patient privacy and proprietary information and is comprehensive, useful, and not misleading to patients, physicians, and scientists.”

The government intends to spend $88 billion for a “PUBLIC HEALTH INVESTMENT FUND” (Section 2002) to pay for

  • Community health centers
  • The National Health Service Corps Program
  • The National Health Service Corps Scholarship and Loan Repayment Programs
  • Primary care loan funds (including funds appropriated for schools of medicine or osteopathic medicine under the authority of section 735(f) of such Act (42 U.S.C. 292y(f))
  • Primary care education programs
  • Nursing workforce development
  • The National Center for Health Statistics
  • The Agency for Healthcare Research and Quality

So how do we pay for all this?  Subtitle D—Other Revenue 8 Provisions cuts out the heart of the American dream so that the federal government can River Dance on it until it resembles British comfort food.

  • SURCHARGE ON HIGH INCOME INDIVIDUALS
    1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000
  • 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000
  • 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000

In 2013, the amounts go up from 1% to 2%, and from 1.5% to 3% unless the “excess Federal health reform savings is more than $150,000,000,000 but not more than $175,000,000,000”.  If the “excess Federal health reform savings” is more than $175,000,000,000, then this tax won’t apply.

From what we’ve seen so far, I’m not going to hold my breath on those “savings” happening.  (And we’re only up to page 199.)  Not when section 4 of this Subtitle states, “The tax imposed under this section shall not be treated as tax….”

DIVISION B—MEDICARE AND MEDICAID IMPROVEMENTS has a 7-page table of contents.  Suffice it to say that is bodes ill for those who use the systems.  Skimming through it find that home infusion therapy will be reassessed, as will the effectiveness of “bone mass measurements”.  Hospitals with high readmission rates will see their Medicare payments reduced, and hospitals will be “monitored” to insure they aren’t turning people away.  The bill will control a hospital’s growth (number of beds, procedure or operating rooms, etc.)  but research will be conducted and a “demonstration program” deployed to find out “the extent to which Medicare service providers utilize, offer, or make available language services” so that “on-site interpreters, including interpreters who work as independent contractors and interpreters who work for agencies that provide on-site interpretation…could directly bill Medicare”.

And how about seeing if  “contracting directly with agencies that provide off-site interpretation including telephonic and video interpretation” so they, too, could directly bill Medicare?  Including “languages not frequently encountered in the United States”.  The participants providing language services in the “demonstration program” can use up to 10% of the “grant money” for their “administrative expenses”.

Maybe it’s just me, but it’s a little disconcerting to read that these “demonstration program” grantees “must ensure that their network providers receive at least 50 percent of the grant funds to pay for the provision of competent language services to Medicare beneficiaries who are limited English proficient, including physicians and pharmacies.”  Does anyone else wonder how a United States-licensed doctor or pharmacist functions without being proficient in English?  The bill itself defines “limited English proficient” as “an individual who speaks a primary language other than English and who cannot speak, read, write or understand the English language at a level that permits the individual to effectively communicate with clinical or nonclinical staff at an entity providing health care or health care related services.”

There are lots more outlays included as well (explaining in part why what doctors do is called “practice”?).

I’d say here’s the kicker in the Medicare portion of the bill, but that sounds almost cruel.  Section 1233 ADVANCE CARE PLANNING CONSULTATION actually spells out a 5-year doctor-patient talk that must include:

  • An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
  • An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
  • An explanation by the practitioner of the role and responsibilities of a health care proxy.
  • 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).
  • 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.

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

  • 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
  • the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
  • the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy)

An advance care planning consultation with respect to an individual may be conducted more frequently…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.

…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.

And to top it off, they’ll update the “MEDICARE & YOU HANDBOOK” so it contains information about:

  • Living wills
  • Durable power of attorney
  • Orders of life-sustaining treatment
  • Health care proxies
  • A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including—
    • Available State legal service
    • Organizations to assist individuals with advance care planning
    • Wbsite links or addresses for state-specific advance directive forms
    • Any additional information, as determined by the Secretary

I don’t know about you, but as insane as this whole bill reads, this is among the worst of it.  The government has no business mandating that my doctor to stick his or her nose into my personal life nor mandating how someone manages their personal affairs or how they want their life to end.

Now let’s run through some more of the laundry list of federal expenditures:

SEC. 1301. ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM

SEC. 1302. MEDICAL HOME PILOT PROGRAM

SEC. 1304. INCREASED REIMBURSEMENT RATE FOR CERTIFIED NURSE-MIDWIVES

SEC. 1305. COVERAGE AND WAIVER OF COST-SHARING FOR PREVENTIVE SERVICES

SEC. 1306. WAIVER OF DEDUCTIBLE FOR COLORECTAL CANCER SCREENING TESTS REGARDLESS OF CODING, SUBSEQUENT DIAGNOSIS, OR ANCILLARY TISSUE REMOVAL

SEC. 1308. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES (80% covered)

Under TITLE IV:

SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED
COMPARATIVE EFFECTIVENESS RESEARCH TRUST FUND; FINANCING FOR THE TRUST FUND.—For provision establishing a Comparative Effectiveness Research Trust Fund and financing such Trust Fund, see section 1802.

Subtitle B—Nursing Home Transparency
PART 1—IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING FACILITIES AND NURSING FACILITIES
SEC. 1411. REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.

In a nutshell, if you own, operate, serve on the board of, provide services to, or simply work in any kind of managerial position for a nursing home, the government wants your name made available to the general public.  (The better for ACORN to march outside your home, my dear.)

The government is also going to supervise nursing home operations with an even bigger magnifying glass than it does today, down to the level of requiring reporting of even the staff’s qualifications, the hours they work, and their tenure, and there are civil fines waiting for those who fail to comply.  The feds even mandate how states can impose fines.  All of which results in yet another “pilot program”:  SEC. 1422. NATIONAL INDEPENDENT MONITOR PILOT PROGRAM

Let’s not forget government training:  SECTION 1431. DEMENTIA AND ABUSE PREVENTION TRAINING.  But then we have to figure out just what should be required:  SEC. 1432. STUDY AND REPORT ON TRAINING REQUIRED FOR CERTIFIED NURSE AIDES AND SUPERVISORY STAFF.

And, of course, “The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.”  To the tune of $2 million each year.

We’ll spend $5 million a year for SECTION 1192. DEVELOPMENT OF NEW QUALITY MEASURES, which is intended to be done with a broad cross-section of “stakeholders” and includes the word “transparency” and states that public input will be allowed, too.  Kinda like recovery.gov and allowing 5 days for public viewing of bills, I suppose?

Subtitle D—Physician Payments Sunshine Provision makes into law similar ethical constraints under which the private sector normally operates and puts it all out for public viewing.  (SECTION 1451. REPORTS ON FINANCIAL RELATIONSHIPS BETWEEN MANUFACTURERS AND DISTRIBUTORS OF COVERED DRUGS, DEVICES, BIOLOGICALS, OR MEDICAL SUPPLIES UNDER MEDICARE, MEDICAID, OR CHIP AND PHYSICIANS AND OTHER HEALTH CARE ENTITIES AND BETWEEN PHYSICIANS AND OTHER HEALTH CARE ENTITIES.)

TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION, SEC. 1501. DISTRIBUTION OF UNUSED RESIDENCY POSITIONS is where the government will allocate how many residents a hospital may have.

The Secretary shall give preference to:

  • Hospitals with 3-year primary care residency training programs, such as family practice and general internal medicine
  • Hospitals insofar as they have in effect formal arrangements (as determined by the Secretary) that place greater emphasis upon training in Federally qualified health centers, rural health clinics, and other nonprovider settings
  • Hospitals that receive additional payments under subsection (d)(5)(F) and emphasize training in an outpatient department
  • Hospitals that place greater emphasis upon training in a health professional shortage area (designated under section 332 of the Public Health Service Act) or a health professional needs area (designated under section 2211 of such Act)

And, of course, we’ll pay for these “preferred” hospitals to have residents on staff, too.

“The Secretary of Health and Human Services shall conduct a demonstration project under which an approved teaching health center…would be eligible for payment …for its own direct costs of graduate medical education activities for primary care residents, as well as for the direct costs of graduate medical education activities of its contracting hospital for such residents, in a manner similar to the manner in which such payments would be made to a hospital if the hospital were to operate such a program.”

Oxymoron alert! “TITLE VI—PROGRAM INTEGRITY Subtitle A—Increased Funding to Fight Waste, Fraud, and Abuse”.  (There are also increased penalities, and even unannounced “surprise” on-site visits.)

Section 1636 reduces the maximum amount of time allowed to file Medicare claims from 36 down to 12 months.  “Narrowing the window for claims processing will not overburden providers and will reduce fraud and abuse.”  If you believe that, I have a bridge for sale….

Section 1639 says you can forget ordering that motorized scooter from the companies that advertise them on tv.  Your doctor must provide proof of a face-to-face visit with you first or else Medicare won’t pay for it.

Now if I’m reading it correctly, state’s rights to control how they administer Medicaid are eliminated.  SECTION 1702, REQUIREMENTS AND SPECIAL RULES FOR CERTAIN MEDICAID ELIGIBLE INDIVIDUALS removes the state’s ability to determine eligibility for Medicaid, and must accept anyone the government decides is to be covered.  And buried in SECTION 1703. CHIP AND MEDICAID MAINTENANCE OF EFFORT, “a State is not eligible for payment…for a calendar quarter …if eligibility standards, methodologies, or procedures under its plan…that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan…as in effect on June 16, 2009.”  And, “a State is not eligible for payment…for a calendar quarter…if the State applies any asset or resource test in determining (or redetermining) eligibility of any individual.”

Section 1704 outlines the elimination of Medicaid DSH.

Section 1712 allows coverage for tobacco cessation outpatient drugs.

Section 1741 PAYMENTS TO PHARMACISTS includes drug pricing that is determined, in part, by providing “opportunity for public comment”.  Not that some drugs do seem to be priced solely as a get-rich scheme, but I fail to understand how forcing a business to charge a certain price for something will do anything except stifle innovation in the private sector.  Which is, actually, a prime directive of the Obama administration.  But I digress.

Section 1744 describes how we’ll all pay for doctors to go to school; states will be reimbursed by the government for “graduate medical education”.

Section 1801 is where the bill describes how your federal tax return will be used to determine whether or not you’re eligible for a low-income prescription drug subsidy.

Section 4375 is where you’ll find the tax they are calling a “fee equal to the fair share per capita amount” that will be levied on all private sector health insurance plans (even auto insurance plans will be taxed if they contain any kind of medical coverage).  It takes great pains, however, to exempt government plans, of course.

If it isn’t clear to you already, the final sections of the bill are chock-full of spending on what is nothing short of a government takeover of the  field of human medicine in the United States, including a handover of states’ sovereignty:

DIVISION C—PUBLIC HEALTH AND WORKFORCE DEVELOPMENT
TITLE I—COMMUNITY HEALTH CENTERS
Sec. 2101. Increased funding
TITLE II—WORKFORCE
Subtitle A—Primary Care Workforce
PART 1—NATIONAL HEALTH SERVICE CORPS
Sec. 2201. National Health Service Corps
Sec. 2202. Authorizations of appropriations
PART 2—PROMOTION OF PRIMARY CARE AND DENTISTRY
Sec. 2211. Frontline health providers
SUBPART XI—HEALTH PROFESSIONAL NEEDS AREAS
Sec. 340H. In general
Sec. 340I. Loan repayments
Sec. 340J. Report
Sec. 340K. Allocation
Sec. 2212. Primary care student loan funds
Sec. 2213. Training in family medicine, general internal medicine, general pediatrics, geriatrics, and physician assistantship.   Preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds.
Sec. 2214. Training of medical residents in community-based settings.  Preference give to individuals who are from underrepresented minority groups or disadvantaged backgrounds; or individuals who practice in settings having the principal focus of serving underserved areas or populations experiencing health disparities.
Sec. 2215. Training for general, pediatric, and public health dentists and dental hygienists.  Preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds; practice settings having the principal focus of serving in underserved areas or populations experiencing health disparities; teaching programs that address the dental needs of vulnerable populations.
Sec. 2216. Authorization of appropriations
Subtitle B—Nursing Workforce
ADVANCED EDUCATION NURSING GRANTS…to train advanced education nurses who will practice in health professional shortage areas (and) to increase diversity among advanced education nurses.
Sec. 2221. Amendments to Public Health Service Act
Subtitle C—Public Health Workforce
Sec. 2231. Public Health Workforce Corps
SUBPART XII—PUBLIC HEALTH WORKFORCE
Sec. 340L. Public Health Workforce Corps
Ensures an adequate supply of public health professionals throughout the Nation. The Corps shall consist of such officers of the Regular and Reserve Corps of the Service as the Secretary may designate; and such civilian employees of the United States as the Secretary may appoint.
Sec. 340M. Public Health Workforce Scholarship Program
Sec. 340N. Public Health Workforce Loan Repayment Program
Sec. 2232. Enhancing the public health workforce
Sec. 2233. Public health training centers
Sec. 2234. Preventive medicine and public health training grant program
Sec. 2235. Authorization of appropriations
Subtitle D—Adapting Workforce to Evolving Health System Needs
PART 1—HEALTH PROFESSIONS TRAINING FOR DIVERSITY
Sec. 2241. Scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistance in the health professions regarding individuals from disadvantaged backgrounds.
Sec. 2242. Nursing workforce diversity grants.
Sec. 2243. Coordination of diversity and cultural competency programs.
PART 2—INTERDISCIPLINARY TRAINING PROGRAMS
Sec. 2251. Cultural and linguistic competency training for health care professionals, including nurse professionals, consisting of awarding grants and contracts to test, develop, evaluate and implement models of cultural and linguistic competency training (including continuing education) for health professionals.  Preference given (in part) to “entities” placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border.
Sec. 2252. Innovations in interdisciplinary care training.
Awards and grants to test, develop, evaluate, then implement health professional training programs (including continuing education) designed to promote the delivery of health services through interdisciplinary and team-based models, which may include patient-centered medical home models, medication therapy management models, and models integrating physical, mental, or oral health services; and coordination of the delivery of health care within and across settings, including health care institutions, community-based settings, and the patient’s home.

PART 3—ADVISORY COMMITTEE ON HEALTH WORKFORCE EVALUATION AND ASSESSMENT
This is a permanent advisory committee, 15 members appointed by the Secretary, to be known as the Advisory Committee on Health Workforce Evaluation and Assessment, providing recommendations on the supply, diversity, and geographic distribution of the health workforce; the retention of the health workforce to ensure quality and adequacy of such workforce; and policies to carry out the recommendations.  These are to include health professionals within the health workforce; health care patients and consumers; employers; labor unions; and third-party health payors.
Sec. 2261. Health workforce evaluation and assessment.
PART 4—HEALTH WORKFORCE ASSESSMENT
Sec. 2271. Health workforce assessment.
Collect data about the supply (including retention) of and demand for health professionals; the diversity of health professionals (including with respect to race, ethnic background, and gender); the geographic distribution of health professionals; and data on individuals participating in the programs authorized by subtitles A, B, 14 and C and part 1 of subtitle D of title II of division 15 C of the America’s Affordable Health Choices Act of 16 2009
PART 5—AUTHORIZATION OF APPROPRIATIONS
Sec. 2281. Authorization of appropriations.
TITLE III—PREVENTION AND WELLNESS
Sec. 2301. Prevention and wellness.
TITLE XXXI—PREVENTION AND WELLNESS
Subtitle A—Prevention and Wellness Trust
Sec. 3111. Prevention and Wellness Trust
Subtitle B—National Prevention and Wellness Strategy
Sec. 3121. National Prevention and Wellness Strategy
This is for our own good.  To improve our health “through evidence-based clinical and community prevention and wellness activities (in this section referred to as ‘prevention and wellness activities’), including core public health infrastructure improvement activities; identification of specific national goals and objectives in prevention and wellness activities that take into account appropriate public health measures and standards, including departmental measures and standards (including Healthy People and National Public Health Performance Standards).
Establishment of national priorities for prevention and wellness, taking into account unmet prevention and wellness needs.
Establishment of national priorities for research on prevention and wellness, taking into account unanswered research questions on prevention and wellness.
Identification of health disparities in prevention and wellness.
A plan for addressing and implementing them.
Subtitle C—Prevention Task Forces
Sec. 3131. Task Force on Clinical Preventive Services
This is a group of 30 members, all appointed by the Secretary to identify clinical preventive services for review;  review the scientific evidence related to the benefits, effectiveness, appropriateness, and costs of them for the purpose of developing, updating,publishing, and disseminating evidence-based recommendations on the use of such services; then as appropriate, take into account health disparities in developing, updating, publishing, and disseminating evidence-based recommendations on the use of such services;  identify gaps in clinical preventive services research and evaluation and recommend priority areas for such research and evaluation.
Sec. 3132. Task Force on Community Preventive Services.
Subtitle D—Prevention and Wellness Research
Sec. 3141. Prevention and wellness research activity coordination
Sec. 3142. Community prevention and wellness research grants
Subtitle E—Delivery of Community Prevention and Wellness Services
Sec. 3151. Community prevention and wellness services grants
Subtitle F—Core Public Health Infrastructure
Sec. 3161. Core public health infrastructure for State, local, and tribal health departments.
Sec. 3162. Core public health infrastructure and activities for CDC
Subtitle G—General Provisions
Sec. 3171. Definitions.
TITLE IV—QUALITY AND SURVEILLANCE
Sec. 2401. Implementation of best practices in the delivery of health care
Sec. 2402. Assistant Secretary for Health Information
Sec. 2403. Authorization of appropriations
TITLE V—OTHER PROVISIONS
Subtitle A—Drug Discount for Rural and Other Hospitals
Sec. 2501. Expanded participation in 340B program
Sec. 2502. Extension of discounts to inpatient drugs
Sec. 2503. Effective date
Subtitle B—School-Based Health Clinics
Sec. 2511. School-based health clinics
Subtitle C—National Medical Device Registry
Sec. 2521. National medical device registry
Subtitle D—Grants for Comprehensive Programs To Provide Education to Nurses and Create a Pipeline to Nursing
Enormous and far-flung; includes employer-match for tuition and paid leave time from a job to go to school
Sec. 2531. Establishment of grant program
Subtitle E—States Failing To Adhere to Certain Employment Obligations
Sec. 2541. Limitation on Federal funds
Federal funds are available “only if the State agrees to be subject in its capacity as an employer to each obligation under division A of this Act and the amendments made by such division applicable to persons in their capacity as an employer; and assures that all political subdivisions in the State will do the same.”

Welcome to the end of 1,017 pages.  Is your head spinning?  Does your head hurt?  Mine sure did.  But through the pain, one thing is crystal clear:   this is NOT what America needs to help make sure that those who need medical care can receive it in a way that is affordable.

Only the gods know how this version will end up, if it ever makes it out of all the committees.  But the cost estimates for this bill show a 10-year “net increase in the deficit of an estimated $65 billion.”  The Congressional Budget Office also caveats that “…the figures do not include certain costs that the government would incur to administer the proposed changes and the impact of the bill’s provisions on other federal programs, and they do not reflect any modifications or amendments made after the bill was introduced.”

The Republican Ways & Means Committee staff put together a spiffy graph that demonstrates this, and projects the numbers beyond the 10 years forecasted by the CBO:

deficitgraph_gop_healthcare

And so the Congressional Budget Office is shaking its head at it all.

“We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount,” Douglas Elmendorf, director of the Congressional Budget Office, told the Senate Budget Committee. “On the contrary, the legislation significantly expands the federal responsibility for health-care costs,” he added.

Of course, Pelosi and Reid were quick to poo-poo them, trotting out the empty old, sad (and unmeasurable) sack of “better health care decreases health care costs”.

In his appearance, Mr. Elmendorf suggested lawmakers could take steps to control costs. Among other things, he said Congress could reduce the tax subsidy that critics say encourages employers to offer large health-insurance policies. That idea was being considered by members of the Senate Finance Committee, but dropped after Senate Democratic leaders — including Mr. Reid — voiced concern. The proposal has been sharply opposed by labor unions, among other groups, that have big tax-advantaged plans.

On Thursday, Mr. Reid expressed disdain when asked by reporters about Mr. Elmendorf’s suggestion. “What he should do is maybe run for Congress,” the Nevada Democrat said.

That’s an excellent idea, Harry.  How about we start by replacing YOU?  And replacing every other wanker in Washington who thinks that this is a road down which America should be driven.