Spanky's Place

1 - It's clearly a big change, politically and practically.

I'm too young to know how the National Health Service was implemented in the UK but I can tell I'm SO grateful for it. I'm grateful not just for myself and my family but for poorer families who would otherwise be denied essential healthcare.

I have medical insurance provided by my employer as a taxable benefit and I'm very happy to continue to pay taxes to support the NHS. It says a lot about what it is to be British I think.

How did Obhama present the proposal in his election campaign? It's clearly unreasonable to present the public with a 1000 page document but it should be possible to provide a summary. If the government doesn't, no doubt the media will.

Not sure that you have an old style bunch of Socialists in the White House more like a man and a government with an inclusive vision. I like him a whole lot more than the last guy. You might be tempted to say well you can afford to he's not running your country but it's a small world.....

2 - I'm going to tackle my ignorance about the NHS initially by going here:

{ Link }

3 - Devin, they don't CARE that it's not being read. Well, unless you look back to when Obama himself was criticizing the Bush administration for trying to push through legislation without everyone having read it. But he can't be held to his on standards I presume.

Thing is that we're seeing a lot of buyers' remorse already setting in. And when he DOES raise taxes on the middle class { Link } then he will definitely be out of hopes for a 2nd term. He continually ran on that "no new taxes" mantra, but many sane people clearly saw that there was NO WAY that his spending agenda could work without raising taxes.

4 - Regarding "Obamacare" (technically House Resolution 3200); I'm concerned about things like:

• Section 1233: This covers advance care planning, and essentially requires (by overriding section 1861 of the Social Security Act) that all persons covered by the plan who are age 65 or older be counseled on ending their life for the good of the country.


• Section 163: (Amends Part C of title XI of the Social Security Act)
  Grants without warrant, prior cause, or explicit approval the government or designated representative permission to access the financial records of any person covered by the plan. This access includes the ability to perform direct deposit or direct withdrawals. This access requires NO advance notification. This section essentially overrides the Right to Financial Privacy act of 1978.

Think I'm just being paranoid? Convinced that I'm a conspiracy theorist? Go read it for yourself: { Link }

5 - Devin, reality is calling. Answer the phone, OK? Neither of those sections does what you've claimed. It's a popular right-wing meme, but that doesn't make it true.

Section 163 is designed to reduce paperwork and increase efficiency. It doesn't give the government the right to take money out of my account, it requires hospitals to accept electronic transfers. It also includes explicit data protection and privacy requirements.

Section 1233 is aimed at preventing the cases where people wind up on life support against their will, or through ignorance of their options. You may be interested to note the explicit limitation that it only applies within states that allow for things like living wills to begin with. Living wills were created by people who objected to the way hospitals were deciding how their lives ended. Those decisions should be made by the individual, not Big Healthcare or Big Brother or Uncle Sam, and that's what this section accomplishes.

Since you may not have read these yourself (or you wouldn't have posted those errant conclusions), I've appended them here. They make for interesting reading:

SEC. 163. ADMINISTRATIVE SIMPLIFICATION.

(a) Standardizing Electronic Administrative Transactions.--
(1) In general.--Part C of title XI of the Social Security
Act (42 U.S.C. 1320d et seq.) is amended by inserting after
section 1173 the following new section:

``SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS.

``(a) Standards for Financial and Administrative Transactions.--
``(1) In general.--The Secretary shall adopt and regularly
update standards consistent with the goals described in
paragraph (2).
``(2) Goals for financial and administrative
transactions.--The goals for standards under paragraph (1) are
that such standards shall--
``(A) be unique with no conflicting or redundant
standards;
``(B) be authoritative, permitting no additions or
constraints for electronic transactions, including
companion guides;
``(C) be comprehensive, efficient and robust,
requiring minimal augmentation by paper transactions or
clarification by further communications;
``(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 facility, which may
include utilization of a machine-readable health plan
beneficiary identification 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;
``(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 additional conditions; and
``(H) harmonize all common data elements across
administrative and clinical transaction standards.
``(3) Time for adoption.--Not later than 2 years after the
date of implementation of the X12 Version 5010 transaction
standards implemented under this part, the Secretary shall
adopt standards under this section.
``(4) Requirements for specific standards.--The standards
under this section shall be developed, adopted and enforced so
as to--
``(A) clarify, refine, complete, and expand, as
needed, the standards required under section 1173;
``(B) require paper versions of standardized
transactions to comply with the same standards as to
data content such that a fully compliant, equivalent
electronic transaction can be populated from the data
from a paper version;
``(C) enable electronic funds transfers, in order
to allow automated reconciliation with the related
health care payment and remittance advice;
``(D) require timely and transparent claim and
denial management processes, including tracking,
adjudication, and appeal processing;
``(E) require the use of a standard electronic
transaction with which health care providers may
quickly and efficiently enroll with a health plan to
conduct the other electronic transactions provided for
in this part; and
``(F) provide for other requirements relating to
administrative simplification as identified by the
Secretary, in consultation with stakeholders.
``(5) Building on existing standards.--In developing the
standards under this section, the Secretary shall build upon
existing and planned standards.
``(6) Implementation and enforcement.--Not later than 6
months after the date of the enactment of this section, the
Secretary shall submit to the appropriate committees of
Congress a plan for the implementation and enforcement, by not
later than 5 years after such date of enactment, of the
standards under this section. Such plan shall include--
``(A) a process and timeframe with milestones for
developing the complete set of standards;
``(B) an expedited upgrade program for continually
developing and approving additions and modifications to
the standards as often as annually to improve their
quality and extend their functionality to meet evolving
requirements in health care;
``(C) programs to provide incentives for, and ease
the burden of, implementation for certain health care
providers, with special consideration given to such
providers serving rural or underserved areas and ensure
coordination with standards, implementation
specifications, and certification criteria being
adopted under the HITECH Act;
``(D) programs to provide incentives for, and ease
the burden of, health care providers who volunteer to
participate in the process of setting standards for
electronic transactions;
``(E) an estimate of total funds needed to ensure
timely completion of the implementation plan; and
``(F) an enforcement process that includes timely
investigation of complaints, random audits to ensure
compliance, civil monetary and programmatic penalties
for non-compliance consistent with existing laws and
regulations, and a fair and reasonable appeals process
building off of enforcement provisions under this part.
``(b) Limitations on Use of Data.--Nothing in this section shall be
construed to permit the use of information collected under this section
in a manner that would adversely affect any individual.
``(c) Protection of Data.--The Secretary shall ensure (through the
promulgation of regulations or otherwise) that all data collected
pursuant to subsection (a) are--
``(1) used and disclosed in a manner that meets the HIPAA
privacy and security law (as defined in section 3009(a)(2) of
the Public Health Service Act), including any privacy or
security standard adopted under section 3004 of such Act; and
``(2) protected from all inappropriate internal use by any
entity that collects, stores, or receives the data, including
use of such data in determinations of eligibility (or continued
eligibility) in health plans, and from other inappropriate
uses, as defined by the Secretary.''.
(2) Definitions.--Section 1171 of such Act (42 U.S.C.
1320d) is amended--
(A) in paragraph (7), by striking ``with reference
to'' and all that follows and inserting ``with
reference to a transaction or data element of health
information in section 1173 means implementation
specifications, certification criteria, operating
rules, messaging formats, codes, and code sets adopted
or established by the Secretary for the electronic
exchange and use of information''; and
(B) by adding at the end the following new
paragraph:
``(9) Operating rules.--The term `operating rules' means
business rules for using and processing transactions. Operating
rules should address the following:
``(A) Requirements for data content using available
and established national standards.
``(B) Infrastructure requirements that establish
best practices for streamlining data flow to yield
timely execution of transactions.
``(C) Policies defining the transaction related
rights and responsibilities for entities that are
transmitting or receiving data.''.
(3) Conforming amendment.--Section 1179(a) of such Act (42
U.S.C. 1320d-8(a)) is amended, in the matter before paragraph
(1)--
(A) by inserting ``on behalf of an individual''
after ``1978)''; and
(B) by inserting ``on behalf of an individual''
after ``for a financial institution.''
(b) Standards for Claims Attachments and Coordination of Benefits
.--
(1) Standard for health claims attachments.--Not later than
1 year after the date of the enactment of this Act, the
Secretary of Health and Human Services shall promulgate a final
rule to establish a standard for health claims attachment
transaction described in section 1173(a)(2)(B) of the Social
Security Act (42 U.S.C. 1320d-2(a)(2)(B)) and coordination of
benefits.
(2) Revision in processing payment transactions by
financial institutions.--
(A) In general.--Section 1179 of the Social
Security Act (42 U.S.C. 1320d-8) is amended, in the
matter before paragraph (1)--
(i) by striking ``or is engaged'' and
inserting ``and is engaged''; and
(ii) by inserting ``(other than as a
business associate for a covered entity)''
after ``for a financial institution''.
(B) Effective date.--The amendments made by
paragraph (1) shall apply to transactions occurring on
or after such date (not later than 6 months after the
date of the enactment of this Act) as the Secretary of
Health and Human Services shall specify.


SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

(a) Medicare.--
(1) In general.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended--
(A) in subsection (s)(2)--
(i) by striking ``and'' at the end of
subparagraph (DD);
(ii) by adding ``and'' at the end of
subparagraph (EE); and
(iii) by adding at the end the following
new subparagraph:
``(FF) advance care planning consultation (as defined in
subsection (hhh)(1));''; and
(B) by adding at the end the following new
subsection:

``Advance Care Planning Consultation

``(hhh)(1) Subject to paragraphs (3) and (4), the term `advance
care planning consultation' means a consultation between the individual
and a practitioner described in paragraph (2) regarding advance care
planning, if, subject to paragraph (3), the individual involved has not
had such a consultation within the last 5 years. Such consultation
shall include the following:
``(A) An explanation by the practitioner of advance care
planning, including key questions and considerations, important
steps, and suggested people to talk to.
``(B) An explanation by the practitioner of advance
directives, including living wills and durable powers of
attorney, and their uses.
``(C) An explanation by the practitioner of the role and
responsibilities of a health care proxy.
``(D) The provision by the practitioner of a list of
national and State-specific resources to assist consumers and
their families with advance care planning, including the
national toll-free hotline, the advance care planning
clearinghouses, and State legal service organizations
(including those funded through the Older Americans Act of
1965).
``(E) An explanation by the practitioner of the continuum
of end-of-life services and supports available, including
palliative care and hospice, and benefits for such services and
supports that are available under this title.
``(F)(i) Subject to clause (ii), an explanation of orders
regarding life sustaining treatment or similar orders, which
shall include--
``(I) the reasons why the development of such an
order is beneficial to the individual and the
individual's family and the reasons why such an order
should be updated periodically as the health of the
individual changes;
``(II) the information needed for an individual or
legal surrogate to make informed decisions regarding
the completion of such an order; and
``(III) the identification of resources that an
individual may use to determine the 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).
``(ii) The Secretary shall limit the requirement for
explanations under clause (i) to consultations furnished in a
State--
``(I) in which all legal barriers have been
addressed for enabling orders for life sustaining
treatment to constitute a set of medical orders
respected across all care settings; and
``(II) that has in effect a program for orders for
life sustaining treatment described in clause (iii).
``(iii) A program for orders for life sustaining treatment
for a States described in this clause is a program that--
``(I) ensures such orders are standardized and
uniquely identifiable throughout the State;
``(II) distributes or makes accessible such orders
to physicians and other health professionals that
(acting within the scope of the professional's
authority under State law) may sign orders for life
sustaining treatment;
``(III) provides training for health care
professionals across the continuum of care about the
goals and use of orders for life sustaining treatment;
and
``(IV) is guided by a coalition of stakeholders
includes representatives from emergency medical
services, emergency department physicians or nurses,
state long-term care association, state medical
association, state surveyors, agency responsible for
senior services, state department of health, state
hospital association, home health association, state
bar association, and state hospice association.
``(2) A practitioner described in this paragraph is--
``(A) a physician (as defined in subsection (r)(1)); and
``(B) a nurse practitioner or physician's assistant who has
the authority under State law to sign orders for life
sustaining treatments.
``(3)(A) An initial preventive physical examination under
subsection (WW), including any related discussion during such
examination, shall not be considered an advance care planning
consultation for purposes of applying the 5-year limitation under
paragraph (1).
``(B) An advance care planning consultation with respect to an
individual may be conducted more frequently than provided under
paragraph (1) if there is a significant change in the health condition
of the individual, including diagnosis of a chronic, progressive, life-
limiting disease, a life-threatening or terminal diagnosis or life-
threatening injury, or upon admission to a skilled nursing facility, a
long-term care facility (as defined by the Secretary), or a hospice
program.
``(4) A consultation under this subsection may include the
formulation of an order regarding life sustaining treatment or a
similar order.
``(5)(A) For purposes of this section, the term `order regarding
life sustaining treatment' means, with respect to an individual, an
actionable medical order relating to the treatment of that individual
that--
``(i) is signed and dated by a physician (as defined in
subsection (r)(1)) or another health care professional (as
specified by the Secretary and who is acting within the scope
of the professional's authority under State law in signing such
an order, including a nurse practitioner or physician
assistant) and is in a form that permits it to stay with the
individual and be followed by health care professionals and
providers across the continuum of care;
``(ii) effectively communicates the individual's
preferences regarding life sustaining treatment, including an
indication of the treatment and care desired by the individual;
``(iii) is uniquely identifiable and standardized within a
given locality, region, or State (as identified by the
Secretary); and
``(iv) may incorporate any advance directive (as defined in
section 1866(f)(3)) if executed by the individual.
``(B) The level of treatment indicated under subparagraph (A)(ii)
may range from an indication for full treatment to an indication to
limit some or all or specified interventions. Such indicated levels of
treatment may include indications respecting, among other items--
``(i) the intensity of medical intervention if the patient
is pulse less, apneic, or has serious cardiac or pulmonary
problems;
``(ii) the individual's desire regarding transfer to a
hospital or remaining at the current care setting;
``(iii) the use of antibiotics; and
``(iv) the use of artificially administered nutrition and
hydration.''.
(2) Payment.--Section 1848(j)(3) of such Act (42 U.S.C.
1395w-4(j)(3)) is amended by inserting ``(2)(FF),'' after
``(2)(EE),''.
(3) Frequency limitation.--Section 1862(a) of such Act (42
U.S.C. 1395y(a)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (N), by striking
``and'' at the end;
(ii) in subparagraph (O) by striking the
semicolon at the end and inserting ``, and'';
and
(iii) by adding at the end the following
new subparagraph:
``(P) in the case of advance care planning
consultations (as defined in section 1861(hhh)(1)),
which are performed more frequently than is covered
under such section;''; and
(B) in paragraph (7), by striking ``or (K)'' and
inserting ``(K), or (P)''.
(4) Effective date.--The amendments made by this subsection
shall apply to consultations furnished on or after January 1,
2011.
(b) Expansion of Physician Quality Reporting Initiative for End of
Life Care.--
(1) Physician's quality reporting initiative.--Section
1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2))
is amended by adding at the end the following new paragraphs:
``(3) Physician's quality reporting initiative.--
``(A) In general.--For purposes of reporting data
on quality measures for covered professional services
furnished during 2011 and any subsequent year, to the
extent that measures are available, the Secretary shall
include quality measures on end of life care and
advanced care planning that have been adopted or
endorsed by a consensus-based organization, if
appropriate. Such measures shall measure both the
creation of and adherence to orders for life-sustaining
treatment.
``(B) Proposed set of measures.--The Secretary
shall publish in the Federal Register proposed quality
measures on end of life care and advanced care planning
that the Secretary determines are described in
subparagraph (A) and would be appropriate for eligible
professionals to use to submit data to the Secretary.
The Secretary shall provide for a period of public
comment on such set of measures before finalizing such
proposed measures.''.
(c) Inclusion of Information in Medicare & You Handbook.--
(1) Medicare & you handbook.--
(A) In general.--Not later than 1 year after the
date of the enactment of this Act, the Secretary of
Health and Human Services shall update the online
version of the Medicare & You Handbook to include the
following:
(i) An explanation of advance care planning
and advance directives, including--
(I) living wills;
(II) durable power of attorney;
(III) orders of life-sustaining
treatment; and
(IV) health care proxies.
(ii) A description of Federal and State
resources available to assist individuals and
their families with advance care planning and
advance directives, including--
(I) available State legal service
organizations to assist individuals
with advance care planning, including
those organizations that receive
funding pursuant to the Older Americans
Act of 1965 (42 U.S.C. 93001 et seq.);
(II) website links or addresses for
State-specific advance directive forms;
and
(III) any additional information,
as determined by the Secretary.
(B) Update of paper and subsequent versions.--The
Secretary shall include the information described in
subparagraph (A) in all paper and electronic versions
of the Medicare & You Handbook that are published on or
after the date that is 1 year after the date of the
enactment of this Act.