Get this great quote from that wonderful Dem lawmaker, John Boccieri of OH-16, in response to the barrage of contact he is having to deal with regarding the health care bill:

“We can’t even get to the business of the day, helping folks with their passports and weeding through some of the bureaucratic red tape. That’s frustrating,” Boccieri said. “I wish they would just let us focus on doing our job and listening to our constituents.”  (From http://www.politico.com/news/stories/0310/34600_Page3.html)

Hey, Ohio-16, don’t you have anyone you can run against this guy?  C’mon, it wouldn’t take much, if, when faced with what may turn out to be a constitutional crisis, constituent services is all that he thinks the job of the legislative branch is.

Fla Mom

Referring to the bill found at http://budget.house.gov/doc-library/FY2010/03.15.2010_reconciliation2010.PDF, it seems to:

1) Fund additional residents (doctor trainees) in primary care (the favored medical specialties) at certain hospitals

2) Specifies minimum services that must be covered, including all preventive services and mental health and substance abuse treatment (combined with #3 below, will pay in perpetuity for someone to recycle in and out of mental health and substance abuse facilities for their entire lives)

3) “[D]oes not impose any annual or lifetime limit on the coverage of covered health care items and services” (hand over your wallets, you won’t be needing them anymore)

4)  “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” (taxpayers foot the entire bill)

5) “The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services…benefit standards…and periodic updates to such standards.  (Death panel, here, get your death panel!  The Health Benefits Advisory Committee giveth and the HBAC taketh away.)

6) “In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.” (i.e., thumb-on-the-scale for favored groups, regardless of the true reasons that their average health status differs from that of other groups)

7) A ‘big picture’ focus, like studying how many hours of training on dementia nurses aides should have:  The Secretary shall conduct a study on the content of training for certified nurse aides and supervisory staff of skilled nursing facilities and nursing facilities. The study shall include an analysis of the following:
(A) Whether the number of initial training hours for certified nurse aides required under sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II) of the Social Security Act (42 U.S.C. 1395i–3(f)(2)(A)(i)(II); 1396r(f)(2)(A)(i)(II)) should be increased from 75 and, if so, what the required number of initial training hours should be, including any recommendations for the content of such training (including training related to dementia).
(B) Whether requirements for ongoing training under such sections 1819(f)(2)(A)(i)(II) and 1919(f)(2)(A)(i)(II)
should be increased from 12 hours per year, including any recommendations for the content of such training.

“COVERAGE OF FAMILY PLANNING SERVICES AND SUPPLIES.—Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless such coverage includes for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section.’’ (mandatory “family planning?”  Including what, abortion?)

9) “HEALTH PROFESSIONS TRAINING FOR DIVERSITY.”  (Not training for competency?)

10) “There is established a fund to be known as the ‘‘Public Health Investment Fund’’ – There shall be deposited into the Fund—
(i) for fiscal year 2010, $4,600,000,000;

(ii) for fiscal year 2011, $5,600,000,000;
(iii) for fiscal year 2012, $6,900,000,000;
(iv) for fiscal year 2013, $7,800,000,000;
(v) for fiscal year 2014, $9,000,000,000;
(vi) for fiscal year 2015, $9,400,000,000;
(vii) for fiscal year 2016, $10,100,000,000;
(viii) for fiscal year 2017, $10,800,000,000;
(ix) for fiscal year 2018, $11,800,000,000; and
(x) for fiscal year 2019, $12,700,000,000.
(B) Amounts deposited into the Fund shall be derived from general revenues of the Treasury.  (“Investment,” right.)

11) Central planning of the health workforce:  “The Secretary shall, based upon the classifications and standardized methodologies and procedures developed by the Advisory Committee on Health Workforce Evaluation and Assessment under section 764(b)—
(1) collect data on the health workforce (as defined in section 764(i)), disaggregated by field, discipline, and specialty, with respect to—
(A) the supply (including retention) of health professionals relative to the demand for such professionals;
(B) the diversity of health professionals (including with respect to race, ethnic background, and gender); and
(C) the geographic distribution of health professionals”

12) “There is established a Prevention and Wellness Trust. There are authorized to be appropriated to the Trust—
(1) amounts described in section 2002(b)(2)(ii) of the America’s Affordable Health Choices Act of 2009 for each fiscal year; and
(2) in addition, out of any monies in the Public Health Investment Fund—
(A) for fiscal year 2010, $2,400,000,000;
(B) for fiscal year 2011, $2,800,000,000;
(C) for fiscal year 2012, $3,100,000,000;
(D) for fiscal year 2013, $3,400,000,000;
(E) for fiscal year 2014, $3,500,000,000;
(F) for fiscal year 2015, $3,600,000,000;
(G) for fiscal year 2016, $3,700,000,000;
(H) for fiscal year 2017, $3,900,000,000;
(I) for fiscal year 2018, $4,300,000,000;
(J) for fiscal year 2019, $4,600,000,000.

There’s more, I know, but I’ve only made it to page 983, and I’m scanning and searching on certain terms.

Fla Mom

Here’s some information that is instructive about what life would be like under the proposed health care insurance public option and that tells us why, when people crow about Medicare being a government program that everyone loves, there should be an informed response that educates those who are and will be patients under it (i.e., virtually all of us):

From the August 28, 2009, report from the President of the Florida Medical Association, James B. Dolan, MD:

“…I want to share with you a disturbing development emanating from the Centers for Medicaid & Medicare Services (CMS) in Washington.  Hiding behind the zero-sum, budget neutrality idiocy of the SGR [Medicare Sustainable Growth Rate*], CMS has promulgated a change in the Medicare fee schedule. This change cuts reimbursement for certain cardiac diagnostic testing by up to 40 percent, and CMS is establishing similar cuts in reimbursement for certain end-stage oncology drugs and radiation oncology treatments.  In my conversations with cardiologists, their opinion is uniform that it will essentially put them out of business.  My sister is an oncologist and has shared with me that she will be made the villain, having to tell her patients that although she could prolong their life, Medicare will not pay for the drugs and, thus, has effectively hastened the time of their death.

“Application of the budget neutrality concept is flawed and must be changed.  The application of this regressive principle means that factors such as the nation’s aging population and new technologies cannot be included in the Medicare budget.  As new patient needs arise and advanced technologies become available, the Medicare budget should adjust to account for these changes.  …

“This is simply wrong.  Rather than encourage clinical protocols and guidelines, CMS, once again hiding behind the skirts of the SGR, uses the bludgeon of the Medicare fee schedule to effectively force rationing on our patients.  Make no mistake; my specialty of orthopaedic surgery may be next.  Consider this: If CMS doesn’t like an X-ray, MRI or bone density imaging in my office, it can just quit paying for the service.”

*from John Cogan’s ‘Regulating Health Insurance’ blog

Fla Mom

P.S.–How do you adjust fonts?  Thanks-

Rep. Allen Boyd, a Blue Dog Democrat whose district re-elected him while also favoring John McCain in 2008, came to Live Oak, FL, on Wednesday, August 12, 2009, for a town hall meeting on the pending health care legislation. The venue was changed the day before the meeting, reportedly in anticipation of a large crowd, but even so only about 150 of the approximate 500 people who turned out could fit in the City Hall meeting room. More stood in the lobby area, listening on loudspeakers, while even more stood outside, unable to hear at all. With the doors to the lobby open and so many people inside, the indoor temperature rose to what one police officer said must be over 100 degrees, but very few people left. This crowd, whose sentiment was decidedly against the pending legislation, constituted approximately 7% of Live Oak’s entire population, indicating the level of interest in the community. The meeting took place at 1:30 on a week-day afternoon, so most had to take time off from work to attend. About 20 or 25 minutes or so into the 80-minute event, I began counting the number of times Rep. Boyd shushed the crowd after it became very obvious that he felt forced to do a lot of shushing. I counted 41 times, even though I counted his “Sh-sh-sh-sh’s” as only one “Sh.”

I may have missed the first minute or two of Rep. Boyd’s remarks, as I worked my way into the lobby. He began with a sort of stump speech in which he said that Live Oak had gained $7.4 million from the stimulus bill through a $5.5 million loan and $1.8 million to stabilize funding in education. Moving on to health care, he said that problems with our current health care system include cost, access, loss of coverage, and inefficiency. Because people are forced to drop expensive insurance coverage, we all pay the cost when they utilize emergency rooms for primary care. He went on to say that denial of coverage for pre-existing conditions and rises in insurance premiums above inflation are also problems, contributing to the national debt and resulting in 46 million uninsured, threatening the long-term economic stability of the U.S.

He said that good, responsible health care reform would include the following four principles:

1) Wring out savings in the current system; stabilize or lower insurance premiums

2) Ensure patient choice; allow people to keep their current plans

3) Improve access to coverage for the uninsured

4) Be paid for, not adding to the deficit.

He said that there are five bills pending in Congress and that he could not vote for H.R. 3200, the bill he said most of the audience was likely concerned with, as it is currently written.

He then opened the floor to questions and answers. I likely missed some of the early discussion as a search was made for a microphone for the audience so that those in the lobby could hear the questioners and not just Rep. Boyd. In the opinions of those around me and of those I overheard in the grocery later that day and of others who were quoted in local news stories about the meeting, Rep. Boyd didn’t really answer any of the questions posed to him.

One questioner said that FEHBP, the health insurance program for government employees, including legislators, should simply be opened to everyone. Rep. Boyd responded by describing FEHBP (a ‘menu’ of private insurance options from which the employee can choose, based on desired coverage and expense).

One woman, who made a point of describing herself as a local Live Oak woman who was not paid or asked to be there by anyone else, read her comments and questions, likely in order to be sure not to stumble over her words or leave out part of what she wanted to say; they sounded like her own words to me. Her questions included whether he would support exclusion of abortion coverage and support forcing members of Congress to participate in any public option. In his somewhat snarky response, he thanked her for focusing on deficits, said that he will try to get a bill that will improve our lives, and thanked her for reading a statement.

In reply to another question from someone concerned with prevention of chronic illness, he expressed concern that health care as a proportion of GDP has risen from 8-9% 15-20 years ago to 17% today. A man standing near me commented that medicine has much more capability now than it did 15-20 years ago, so of course it will cost more. (As an aside, someone I know has been diagnosed with an illness that can be treated with transfusions of medicine that cost $2,000 per week. Some treatments are indeed costly in money, but the alternative is to be costly in lives.) My thought while listening to Rep. Boyd cite these statistics was about how adding millions of now-aging baby boomers to the patient rolls impacts health care spending. Neither of these situations, costly but effective new treatments and demographics, are amenable to legislative solutions. In his response, Rep. Boyd also said that there is a long way to go in the legislative process and that he’s trying to listen to us and get it right.

A person said that about 80% of the uninsured are eligible for existing programs, such as Medicaid, so there isn’t really a need for a restructuring of our health care system.

Another quoted from H.R. 3200 about the 27-member board that would be created that would control benefits and urged not re-wording the bill but killing it (cheers all around).

To a question that couldn’t be heard in the lobby, Rep. Boyd replied that illegal immigrants will not be covered in any legislation (jeers from the audience).

A woman said that no politician has yet told her who will pay for the cost of this bill and that she can’t pay any more in taxes. Rep. Boyd said that deficit spending is resulting in borrowing from the Chinese; that her generation will end up paying; and that “we’ll try to stop it.”

One person came from Tallahassee, part of the district but not close enough to make sense attending this particular town hall, to say that she supports a single-payer system. Rep. Boyd responded that there is no single-payer plan on the table; that there are advantages and disadvantages to single payer; and that we should take the good parts of the current system and current health plans to stop the rise in costs. He then paused to ask people to show respect and not shout or interrupt.

A woman said that welfare and Medicaid fraud should be fixed and that when she thinks of government she thinks of the aftermath of Hurricane Katrina, including the corruption that made the government-built levees; nothing but the privately-built and –run oil wells worked in the aftermath. She also advocated tort reform. His response was that we should wring out waste from the current system and work on tort reform.

A woman asked where the money is coming from for this legislation; he said our money is going to prosecute the war and mentioned that China is borrowing our money to fund spending, which he doesn’t support.

Asked why the financial and auto bailouts bills and now this one have to be rushed through while the President took 6 months to decide on what dog to get as a pet, Rep. Boyd said that we have to understand the facts and do better.

A man who worked in the health care industry on medical devices pointed out that development of pulse oximetry (a real-time way to test for oxygen in the blood) so decreased poor outcomes in surgery that malpractice rates for anesthesiologists dropped dramatically after its development. He also said that Britain employs 1.4 million health care workers for its National Health program even though it has a small population, and its death rates are higher. The U.S. population is aging and revenue dropped last year; how will we fund this legislation for even 10 years? Rep. Boyd responded that it should be deficit-neutral, a principle he has used throughout his career. He said the Blue Dogs asked CBO and others to draw up a list of items to cut costs in the current system, but he’s not sure if the country is willing to step up with additional revenue.

A couple of people suggested opening up state borders for health insurance; one said we could give money directly to the uninsured and it would cost a fraction of what the pending legislation is expected to cost.

A woman said we have the best health care in the world, why revamp it when the problem is with insurance costs and not health care providers? Rep. Boyd said she hit the nail on the head, that 46 million people can’t get health insurance and the cost of premiums is a problem; defensive medicine, tort reform.

Asked whether he believed health care is an entitlement, Rep. Boyd seemed to want to act as if he didn’t quite understand the question. He then went on to talk about how we can’t compete in the world with an unhealthy population and that if we don’t solve this problem young people won’t have the same place in the world as the questioner does. He went on to say that arbitrary timelines aren’t important, that we’ve got to get the legislation right. The Blue Dogs kept the bill from reaching the House floor before the recess. (Jeers).

Exeunt.

For other coverage of this event, see http://www.suwanneedemocrat.com/.

Fla Mom

See http://files.meetup.com/515268/kristi_bronson_letter.pdf

Fla Mom