READING HR 3200

I've been extremely busy in recent weeks and anything not business related has pretty much taken a back seat. But I have made the rounds through the bloggerhood enough to see there is a frothing frenzy of misinformation and demonization developing over the dastardly health care reform. There was enough alarming screed and liars claiming to have read this document to prompt me to start reading the WHOLE document - even though I must do it in small bits of time that I can scrape together these days. Here is what I have gleaned so far:

Section 102 – Protecting the choice to keep current coverage.
This section allows those with current employer coverage to keep it but does require that the coverage meet the minimum requirements set by this bill in 5 years. So there will be a set of standards by which health plans will be judged.

Section 111 - Prohibits pre-existing condtions clauses.

Section 112 – Prohibits the cancelling of health insurance or refusal to renew coverage based on anything but nonpayment of premiums or fraud.

Section 113 - Will limit increases in rates based on factors such as age or location. This section also mandates that a study be done to ensure that the coverage risk is evenly spread out so as not to penalize one group over another.

Section 114 – Prohibits discrimination in benefits for mental health or substance abuse issues.

Section 115 – Ensures that any PPO health plan have an adequate network so the consumer can get in network treatment.

Section 116 – Calls for a medical loss ratio to be met. Simply put, if an insurance company collects X number of dollars from enrollees but pays out for medical expenses less than a preset percentage, they will have to rebate back to the consumer. (It could be argued that this would cut the insurance company’s profits and I suppose that is true – but the other side is it would no longer be profitable for the insurance companies to give that bonus money to providers for NOT performing life saving tests).

Sections 121 & 122 – This outlines what will be expected of all qualified health plans: There will be non-exchange participating plans (mostly current employer plans) and exchange participating plans (the so-called “public” plans).
Limits cost sharing (aka co-pays), requires coverage of medically acceptable items and services.
The plan cannot impose an annual or lifetime limit on any treatment.
A qualified plan must cover: hospitalization, outpatient services, professional services of doctors and other health care professionals, equipment and supplies, prescription drugs, rehab services, mental health and substance abuse treatment, preventative services, maternity and well baby.
No cost sharing (ie co-pay) for preventative and well baby services.
Annual deductible in year 1 will be $5,000 individual and $10,000 for family.
Co-pays until deductible met would be 70%/30%.

Section 123 – Establishes a health benefits advisory committee. They will establish benefits standards.
This section also provides for establishing an Enhanced Plan and a Premium Plan for those who desire to have more coverage.

Section 131 thru 137 – Provides additional consumer protections such as fair marketing practices in regard to health care plans, fair grievance and appeals mechanisms, accurate and timely disclosure of plan details in plain language and includes a provision for advance notice of any plan changes. All plans will have to comply to the same set of standards.

Sections 141 thru 144 – These sections cover the duties of the Health Choices Commissioner in ensuring that all plans are compliant. There is also a provision for a Health Insurance Ombudsman who will provide assistance and handle grievances for individuals.

The 150’s sections cover things like Whistleblower protection and prohibiting discrimination of health care plans.

Then comes the STANDARDIZE ELECTRONIC ADMINISTRATIVE
TRANSACTIONS section that seems to cause great alarm. I’m not sure why exactly. I mean, I’m not too keen on all my personal information out there in cyberspace but we have had electronic records for years now and so our information has been floating around out there for a long time.
Particularly rankling to many is:

‘‘(D) enable the real-time (or near real
time) determination of an individual’s financial
responsibility at the point of service and, to the
extent possible, prior to service, including
whether the individual is eligible for a specific
service with a specific physician at a specific fa
cility, which may include utilization of a ma
chine-readable health plan beneficiary identi
fication card;
‘‘(E) enable, where feasible, near real-time
adjudication of claims;
‘‘(F) provide for timely acknowledgment,
response, and status reporting applicable to any
electronic transaction deemed appropriate by
the Secretary;

Looking at this one section at a time: D is pretty much what happens now in larger medical facilities. If I needed to go to a specialist (when I had insurance) at the large metropolitan complex, they would take down my information, check my insurance and tell me what was covered, if the doctor was in my network and what my co-pay would be. Nothing too exciting or radical there.

For some reason there are people who want to read E and F together and come to the conclusion that the Secretary or some other government entity (read; devil) is going to dun their bank account.

But they are actually labeled separately. E has to do with adjudication, which generally means to settle a dispute. So, if taken by itself like it was written, I go to the doctor’s and they tell me my co-pay for a procedure will be $X but this is a preventative visit and there should be no co-pay so I protest. E says the provider or their employees should do what they can to resolve the issue as quickly as possible, preferable before I leave the office.

That leaves F. No where does F talk of obtaining funds. It addresses timely acknowledgement, response and staus reporting – regarding any electronic transaction deemed appropriate by the Secretary (of Health). This makes perfect sense if you have started reading from the beginning of this document, especially the entries describing how the Health Secretary will be responsible for establishing universal electronic standards.

Now if you add G and H which follow D,E and F in the document, it becomes a little clearer.

'(G) describe all data elements (such as
reason and remark codes) in unambiguous
terms, not permit optional fields, require that
data elements be either required or conditioned
upon set values in other fields, and prohibit ad
ditional conditions; and

‘‘(H) harmonize all common data elements
across administrative and clinical transaction
standards.

This brings me to page 60 of HR 3200, just 957 pages left!

AN ADDENDUM:
AARP has an informative article with resource references HERE. Worth reading ~

Area Dinosaur Confronts LaRoucheNuts Displaying Barack-as-Hitler Poster Outside Trader Joe's

Startled eyewitnesses told of a highly unusual clash today between a snarling but more or less civil dinosaur and a pair of LaRouche supporters determined to vilify President Obama at a local Trader Joe's grocery store.

"It was amazing," said Joanie Contreras of _____, a systems analyst. "The two humans asked this big lizard if it 'had a minute' to talk about what Barack Obama is doing to America, and the toothsome, khaki-colored lizard cocked its head from side to side …" ("just like you see in Jurassic Park right before the T-Rex eats that lawyer!" chimed in Alyssa, Mrs. Contreras' still excited nine-year-old daughter) "and then it snarled something that sounded a lot like, 'I voted for Barack Obama. I like Barack Obama. Go to hell!' But it couldn't have said that because, as everybody knows, dinosaurs can't vote."

"So then it went inside and I'll be damned if it didn't buy some groceries," continued middle-school teacher Jim Bogle of _____, "and when it came back out a short while later at the same time I exited the store, there were those same two smartypants, ill-informed humans with the Barack-is-Hitler poster, asking again if the extinct lizard 'had a minute.' We thought that this time it would surely eat the pair and have done with it, but again it cocked its head and snarled what sounded like, 'Are you out of your minds? Get an education!' But of course that couldn't have been what we heard. Anyhow, the two humans tried to offer a comeback of sorts, but it made no impression and the cantankerous reptile was off to whatever godforsaken, time-forgotten swamp it calls home. The whole thing was just strange! And who knew that a predatory dinosaur would like garlic fries, bread, and avocados?!"

TJ's Manager Joe Stinson points out that the saw-toothed beast is a regular at his store, often buying such items as half-and-half, ricola cough drops, soy milk, and rennetless cheese. "We've never really been thrilled to have the creature ambling around the premises, to tell you the truth," said Stinson, "but at least it has a credit card and doesn't seem to bother anybody – unless, evidently, he or she is a seedy-looking, bandy-legged moron who compares the president to an evil dictator with a stupid-looking mustache. Which I kind of understand."

Feeding the birds.

We had only a jumble of disconnected phrases from which to discern Sarah Palin's plans for the future and a possible reason for her abandonment of the governorship of Alaska. We have a few more complete and coherent sentences from Florida Republican Senator Mel Martinez but probably no better idea of why he's walking away and where he's going. "Feeding the birds" is the clearest hint he's given us of his plans.

I wouldn't blame anyone for not being aware that a US senator from a large state spontaneously resigned yesterday. The press has been otherwise occupied with trying to make it less obvious that Big Pharma and the Republicans are trying to disrupt any rational discussion of health care reform using violence and intimidation and symbols and tactics of the Third Reich. Martinez tries hard to emphasize however that it is indeed spontaneous and of his "own free will" and nobody is pressuring him. That he brings up that strange notion, rather suggests that someone is.

It will be up to Governor Charlie Crist to replace Mr. Martinez, but Crist will be leaving the Governorship to run for Senator himself and so isn't going to be motivated to replace him with anyone unbeatable -- which is a nice, but unavoidable conflict of interest.

On a more local level my State Representative Ken Pruitt recently resigned "for family and financial reasons." As Pruitt wasn't shy about endorsing the fundamentalist agenda, I'm not sorry to see him go, even though I have to wonder what the family and financial problems were and what improprieties might be involved. Of course his replacement is no less fond of government support of Christian institutions and the first thing one notices about him is his striking lack of intelligence, but one has to expect that in Florida.

But something is happening here and neither I nor Mr. Jones knows what the hell it is.

Ben Stein's Money

I have to say I loathe Ben Stein, so I was pleased to hear the New York Times has fired him for conflict of interest. Dispensing financial advice from the Sunday Business Section while being a spokesman for Freescore.com which offers free monthly credit reports for only $359 seems reason enough, but of course there was the financial advice itself. Ben gets his prognostications from the same source on Neptune that Jim Cramer does.

"I’m writing this on Aug. 13, 2007… the stock market is cheap on a price-earnings basis, profits are fabulous… and in the long run, both here and abroad, stocks are a lovely place to be." [emphasis mine]

That's classic Ben Stein bad advice and bad enough to suggest seppuku to a more honorable man. In fact, it closely mirrors the bad advice of his close friend Cramer and to the point where Stein was willing to tell us all that Jon Stewart had "yelled and cursed" at him when in fact, it was not true. That's classic Ben Stein projection -- or outright lie, if you prefer. I did mention that I loathe him, didn't I?

For anyone who still thinks Ben has ever had much to offer beyond the faux elitism, the wildly dishonest defense of Creationism and enduring belief that Richard Nixon was not a crook, I will refer you to the Ben Stein Watch archives; about to close it's "doors" now that the mission has been accomplished. Let's hope it really has been.

MOB VIOLENCE AT TAMPA HEALTH CARE FORUM

Reports here and here.

It was only a matter of time before demonstrations staged by town hall hooligans turned violent. Hours ago, a group of angry protestors clashed with healthcare reform supporters at the Children’s Board of Hillsborough County near Tampa, Florida. There were accounts of fistfights, minor injuries, and at least one handicapped woman knocked to the ground. It is time to investigate and indict those responsible for inciting mob violence … starting with Rick Scott, Dick Armey, Steve Forbes, and the other thugs at FreedomWorks.

I HAVE SEEN THE ENEMY: AMERICA’S MEGA-CORPORATIONS AND THEIR MEDIA SHILLS

Before Octopus inks the aquarium, let me start this diatribe with a quote from Noam Chomsky:

“Personally I'm in favor of democracy, which means that the central institutions in the society have to be under popular control. Now, under capitalism we can't have democracy by definition. Capitalism is a system in which the central institutions of society are in principle under autocratic control. Thus, a corporation or an industry is, if we were to think of it in political terms, fascist; that is, it has tight control at the top and strict obedience has to be established at every level (…) Just as I'm opposed to political fascism, I'm opposed to economic fascism. I think that until major institutions of society are under the popular control of participants and communities, it's pointless to talk about democracy.”

Before the seas turn black from enraged cephalopod ink, let me quote myself from this comment thread under Captain Fogg’s recent post, Regulation is bad for business:

All too often we forget that cable news is a product of media conglomerates … in other words “corporatists” … that depend upon other corporations for their advertising revenues. Thus, our news services do not serve the interests of citizens and voters, merely the interests of corporate advertisers.

Here is what happened today - CNN Refusing To Run Health Care Ad Critical Of Insurance Industry:

Americans United for Change [UAC], a top White House ally in the health care wars, tried to book time on CNN and MSNBC for the ad, which hits the insurance industry for wanting to preserve the status quo and levels harsh criticism at insurance giant Cigna’s CEO, Ed Hanway.

“Why do insurance companies and Republicans want to kill health insurance reform? Because they like things the way they are now,” the ad says, and then slams Hanway’s annual salary of over $12 million and golden parachute retirement package of over $70 million.

Jeremy Funk, the spokesperson for AUC, points out that CNN would be more than willing to accept paid advertising from Cigna; yet CNN turns down paid advertising critical of the company for their role in trying to kill health insurance reform.

See where I am going? Last year, we worked hard to elect a new president who promised change, who promised healthcare reform, who promised investments in alternative energy to free us from dependence on OPEC.

This year, the Empire strikes back. Our health management insurers want to protect their greedy franchises. Our fossil fuel suppliers want to preserve their filthy energy infrastructure. Corporations don’t vote but citizens do. Yet, corporations have the means to manipulate public opinion, and there are always idiots ready and willing to oblige.

Manipulating public opinion is easy … when you are the CEO of a corporation with lots of money and lobbyists and crooked politicians in your pocket ... and you can always count on an ignorant rabble all too willing to sell themselves short, sell-out their own interests, and serve as sycophants on behalf of their corporate masters.

Corporations need not dirty themselves when they can hire proxies like Dick Armey to do their dirty work, when their proxies can recruit goons, malcontents, and nut jobs to stifle public debate. This is how corporations assert their interests, nullify the popular will, and derail democracy.

The hooligans have taken over; the corporations have won. The American experiment in democracy is dead. Does anyone reading this diatribe doubt what I say?

Dinosaurs don't pay taxes

In a way, we might look at the vast, seemingly endless and profoundly deep ignorance of Americans as a resource. Certainly many people make a good living from it. People who have less than an intelligent 4 year old's grasp of reality are willing to spend money to have their pathetic fantasies upheld in places like Dinosaur Adventure Land where you can view fake animals in a fake surroundings made to resemble fake history and pretend that the most certain things can be less certain than baseless conjecture.

Yes, I'm talking about Florida where for decades fake was like a second name for the state and sleazy roadside attractions and amusement parks made it a Mecca for kitsch enthusiasts and carloads full of rubes and hicks percolating down from Dixie. Much of it is still here, like the Weeki Wachee Mermaids and alligator wrestling and Lion Country Safari but as far as I know nobody is claiming that the mermaids are real or the lions were dropped off in Florida by Noah on his way to Turkey.

The fake history park in Florida flaunts things on their website like the idea that "the more is known about DNA the more difficult it is to escape the conclusion that all things have a personal creator." Of course there's no way around calling this a complete lie and if there is anything ineluctable about what's taught in Dinosaur Adventure Land is that nothing they say has any basis in fact whatever. Evolution as the origin of species and indeed as the origin of life from natural algorithms and natural law is not on its way out, isn't "just a theory" that Science is moving away from in the light of new data. Of course, the age of the Earth and of the universe is very accurately known and sorry, our planet is more than 4 billion years old and no man ever saw a trilobite or a Gorgonopsid or a Sauropod.

It's more than possible to escape the conclusion that existence of living organisms demands the existence of a deity and all their miracles and all the attempts to demonstrate otherwise have been shown to be fallacious and fraudulent. Yet, the Creationists persist in marketing their perverted epistemology demanding that unwillingness or inability to understand opens a window into understanding -- as though ignorance and stupidity were virtues. Wisdom through ignorance certainly winds through Christianity's bowels like a tapeworm but particularly through the kind of cartoonish fundamentalism sold like tawdry talismans at a flea market to tourists in T shirts.

It must be apparent that I view this kind of militant superstition as a cancer threatening any progress in learning and perhaps the safety of civilization itself and so you won't be surprised that I have to smile a bit to hear that an amusement park built on lies and the mockery of truth is in big trouble with the IRS for not paying employee withholding taxes and is due to be seized. Hardly surprising is it, that people who make a living telling lies and attacking the truth are dishonest?

Hardly surprising either that Kent Hovind, who founded the park and a ministry, Creation Science Evangelism, simply to profit by lying, would forget that Jesus told his followers to pay their taxes: “Ἀπόδοτε οὖν τὰ Καίσαρος Καίσαρι καὶ τὰ τοῦ Θεοῦ τῷ Θεῷ” or "Render unto Caesar. . ." Matthew 22:21

Hovind's position was that since he and his brothers in dishonesty worked for God, they didn't owe any taxes to the Government at all. I don't know what Jesus' position on obstruction of justice or last minute, back-dated, illegal transfers of property to avoid seizure was, but of course anything Jesus is supposed to have said is "just a theory" right? The argument was persuasive enough to get him 10 years in the slammer. For once Jesus and the Law -- and I -- seem to agree.

The quiet American

Normally, the rescue of captured Americans gets tremendous coverage; launching over-dramatized movies and mini-series and giving politicians a platform for unrestrained self adulation and patriotic buffoonery -- but not always. Sometimes we puff up a story until, like Jessica Lynch, the hero has enough of the lies and walks away. Sometimes we make the hero look like a traitor. Welcome to the ugliness of American tribalism.

When the rescue is facilitated by someone the Republicans need as a symbol of inaction and incompetence; when a political enemy walks into the lion's den and returns with two young women many had given up for lost, it becomes necessary to bring in the creeps. That starts with C and that rhymes with B and that stands for Bolton.

Perhaps it was the short notice that explains it. John Bolton went on the air almost instantly after Fox's report that Clinton along with Center for American Progress President and CEO John Podesta had pulled off a rather John Wayne gambit and had secured the immediate release of journalists Laura Ling and Euna Lee who had been arrested for espionage and sentenced to hard labor in a very nasty North Korean prison. Perhaps it was simply the desperation one feels when one's enemy leaves one on the sidelines throwing tantrums like Yosemite Sam while the damsels in distress are rescued from the dragon. Perhaps the Republicans are simply jealous of the international prestige of Clinton when compared to any president since Eisenhower. Perhaps Bolton just had no other tools with which to try to dismantle the story and rebuild it as a straw man, but that's just what he did.

It's "rewarding bad behavior" said he. It's "negotiating with terrorists" said he. It's "legitimizing the regime." It's going to make them kidnap more Americans so they can get visits from ex-presidents. It's pathetic and childish and disgusting and embarrassing to listen to him, but then, he's only repeating the line the GOP has used for decades -- even while Saint Ronald was selling arms to someone at war with us.

Whatever one might say about Clinton and his liberal commandos, we got our fellow Americans out of there without beating our chests like impotent apes, waving our dicks and threatening nuclear annihilation unless the country disbands and turns its assets over to Halliburton. What could be more emasculating and humiliating to Republicans?

ARMEY'S HOOLIGANS

Never in my life could I imagine this taking place in OUR country: hooligans disrupting town hall meetings, intimidating elected officials, shouting down citizens and driving them from the room … hands cupped over ears. What’s next? Fist fights? Violence in the streets?

We can blame these ugly brownshirt tactics on former GOP Majority Leader Dick Armey and Freedom Works for “astroturfing” these events. And we can blame corporate lobbyists for employing these thugs to protect their filthy franchises and ambush reform. If readers find this post uncharacteristically aggressive, lets just say I am feeling uncharacteristically livid. I have nothing more to say tonight, but I want to keep this topic on the front burner … and leave you with this reading list:

Inside The Tea Partiers Anti-Health Care Organizing Campaign

Coal Industry Behind Forged Letters to Congressman Asking Him Vote Against Climate Bill

Lobby Firm Sent Forged Climate Change Letter To Congressman

Behind The Forged Letters: Jack Bonner's "White-Collar Sweatshop"

Death, Dishonesty and the GOP

The 10 Dumbest Arguments Against Health-Care Reform

Orchestrated Hooliganism At Town Hall Meetings on Health Care Reform

Bill Clinton's mission accomplished

George W. Bush may have looked good in his tailored flight suit with the sock stuffed in his pants when he pretended to have just made a carrier landing all by himself, but in terms of courage, the guy who denied having got drunk and crashed his car and walked away from National Guard duty couldn't, as Charles Bukowski used to say, carry Bill Clinton's balls in a paper bag.

President Clinton is now returning home with the two young American reporters being held at hard labor in that stinkhole North Korea. Mission Accomplished.