More of Obama’s Promises

Last night was President Obama’s State of the Union address. There has been no shortage of people analyzing every word, every gesture, and every possible reaction. YAWN! I thought the State of the Union would be a perfect time for some real random fun. That’s right; it’s time for the triumphant comeback of “President Obama’s 500 Promises”!

You may remember the fun I had with these cards back in April 2009. It’s a box of 510 cards that compile promises Obama made in interviews, debates, speeches, and on his website while campaigning to become President. Then you go to www.PolitiFact.com (remember, the one with the Pulitzer bitches!) and find out how Obama is doing at fulfilling that promise. Instead of watching all the media spin I opted to open up my box of 500 Promises and draw 3 cards at random. I then went to www.PolitiFact.com to see how the President is doing on fulfilling them.

1. Promise 48: Close the “donut hole” in Medicare prescription drug plan. Eliminate the “donut hole” in the Medicare Part D Prescription Drug Program that limits benefits for seniors with more than $2,250 but less than $5,100 in annual drug costs, meaning they end up paying full price for drugs while also paying drug plan premiums.

PolitiFacts says: In the Works. After months of talking about health care reform, the U.S. House of Representatives introduced major legislation to overhaul the nation’s health care system. House Democrats unveiled the 1,000-plus-page bill, called America’s Affordable Health Choices Act of 2009, on July 14, and it includes most of President Barack Obama’s key proposals on health reform.

One of Obama’s campaign pledges was to close the “doughnut hole” in the Medicare Part D Prescription Drug Program, a coverage gap that affects some seniors who have to pay for drugs that might otherwise be covered. The health care bill aims to slowly eliminate the gap, beginning with a $500 reduction in 2011 and completing phase-out by 2023. Under the House bill, that move would be paid for by requiring drug manufacturers to pay new rebates involving the Medicaid program.

We should be clear that there’s a long way to go — maybe months — before this bill becomes law. It has to get through the Senate, where many an ambitious House bill has seen its hopes dashed.

Nevertheless, the bill marks significant, measurable progress on Obama’s promise, and we rate it In the Works.

Promise 111: Allow all veterans back into the Veterans Administration. Sign an executive order ending the unfair ban on healthcare enrollment of certain groups of veterans, including ‘Priority 8’ veterans who often earn modest incomes and have no service-connected disability.

PolitiFacts says: Compromise. This promise had its roots in a government decision in 2003 that, due to limited resources and a mandate to provide quality and timely health care, the VA would prioritize those veterans who would be eligible to receive health care benefits. Priority was given, for example, to veterans with service-connected conditions, people with low income or those with special health care needs. The VA decided, however, to stop enrolling nondisabled “Priority 8” vets whose income exceeded some set thresholds.

During the campaign, Obama promised he would do away with those income thresholds. All veterans, he vowed, would be allowed back in the VA.

In May, President Obama proposed a $113 billion Veterans Affairs budget for 2010 that would make significant progress toward restoring eligibility to VA health care benefits for many “Priority 8” veterans.

According to the budget plan, “For the first time since January 2003, VA expands eligibility for VA health care to nondisabled veterans earning modest incomes. This expansion will bring nearly 550,000 eligible veterans into the VA health care system by 2013. The 2010 budget request provides the resources to achieve this level while maintaining high quality and timely care for lower-income and service-disabled veterans who currently rely on VA medical care.”

While 2013 is the longer-term goal, the 2010 veterans budget approved in July by the House Veterans Affairs Appropriations Committee included $533 million to expand eligibility for health care services to non-service disabled veterans. That amount would allow the VA to increase the income limit by 10 percent (to about $30,000, depending on where you live). The VA estimates it will translate to an additional 266,000 veterans who will enroll in the VA health care system.

The White House plan calls for relaxing the income thresholds more and more over the next several years.

That’s a big commitment. And by and large, it appears veterans leaders are pleased.

“The president is taking care of veterans,” said Joe Davis, national spokesman for Veterans of Foreign Wars. “He is following through on this provision.”

Still, Davis said, it will be interesting to see if the VA system is equipped to handle the additional people made eligible this year.

“It’s going to be difficult because of capacity,” Davis said. “But you have to start somewhere. Only time will tell if you can open it further.”

Testifying before the House Committee on Veterans’ Affairs, Eric K. Shinseki, secretary of the Veterans Affairs Department, said the VA is up to the task.

“The president’s decision to relax income thresholds established in 2003, which froze Priority Group 8 enrollments, has enabled many more veterans to access the excellent health care available through our Veterans Health Administration (VHA),” Shinseki said. “It has increased VA’s workload, but we are prepared to accommodate up to 500,000 enrollees, who are being phased in over the next four years.”

Clearly, Obama has made strides toward keeping his commitment on this promise. But in the campaign, he didn’t say he was going to phase in the changes. Look again at what Obama’s position paper stated:

“When troops serve, they are not divided by income classes or priority groups. Yet, today the VA is picking and choosing which veterans to serve. Barack Obama is committed to ending the unfair ban on health care enrollment of certain groups of veterans, including ‘Priority 8’ veterans who often earn modest incomes. He has voted to end this unfair policy, which has resulted in the VA turning away nearly one million veterans since 2003. As president, one of Barack Obama’s first acts will be signing an executive order reversing this ban.”

But it was not one of his first acts. Indeed, Obama has not signed an executive order reversing this ban, as he said he would. Instead, he has outlined a budget plan to relax income thresholds to allow more and more Priority 8 veterans to be eligible for health care benefits over time. And Obama didn’t make the change in one fell swoop as promised.

Perhaps Obama concluded that it was more sensible to roll out the changes over time so as not to overwhelm the VA system. And some would certainly argue the president is making steady progress toward keeping the substance of this promise. Nonetheless, Obama didn’t do it on the timetable he promised. And so we rule this one a Compromise.

Promise 255: Expand teacher mentoring programs and provide incentives for more planning time. Expand mentoring programs that pair experienced teachers with new recruits. Also provide incentives to give teachers paid common planning time so they can collaborate to share best practices.

PolitiFacts says: In the Works. President Barack Obama has packed a number of his campaign promises related to education into his “Race to the Top” program, which seeks to encourage innovative approaches to teaching and learning by having states compete for $4.35 billion worth of grants from the Department of Education. The program was funded through the Obama-backed economic stimulus package approved by Congress in February.

In a speech in Madison, Wis., on Nov. 4, Obama announced the criteria for states to win the grants. One of the goals, Obama said, is to create “alternate pathways to teaching for talented young people,” and he specifically cited as an example a program in Boston “where aspiring teachers work side-by-side with effective mentors in a yearlong residency.”

A notice from the Department of Education inviting applications talks about priority being given to states that provide effective support to teachers, and specifically mentions as examples “professional development, time for common planning and collaboration.”

That sounds to us like what Obama promised he would encourage if elected president.

Competition for the grants will be conducted in two rounds — the first starting this month and the second in June next year — with winners announced in April and September next year.

But by establishing a competitive grant program that encourages teacher mentor programs and paid planning time for teachers so they can collaborate to share best practices, we think that moves this promise to In the Works.

Two “In the Works” and one compromise. Not too shabby. It’s not too late to get your own box of “President Obama’s 500 Promises” and play along at home! We still have a few years left to track how he’s doing.

A Letter: Part Four

When I relaunched The Magical Buffet website, I opened up with my letter to then President George W. Bush, Senator John McCain, then Senator Hillary Clinton, Senator Chuck Schumer and then Senator Barack Obama with regards to the situation in Zimbabwe. Despite great appreciation from friends of The Magical Buffet, I received no response, from any of them. A pox on all their houses!

Being the spunky, or some could say annoying, gal that I am, I decided the perfect welcome to the new job gift for now President Barack Obama and Secretary of State Hillary Clinton would be shiny new letters, about how they ignored me even while courting my vote. I went Kucinich, but there was no way they could have known that then. Based on the responses I received he’ll be getting my vote again next Democratic primary because he’s a man who at least knows how to send a form letter, thank you very much. And you know he’ll run, because that’s what he does. That, and have you SEEN his wife?! Holy hot potential first lady Batman! I mean Michelle Obama is beautiful, but Elizabeth Kucinich is beautiful, with a British accent, and a tongue piercing. A TONGUE PIERCING! Wow, where was I? Oh yeah, so I sent our shiny new change bringing President and our feisty new Secretary of State letters that were quite good, if I do say so myself.

To that I received nothing from Secretary Clinton’s office, and I got a wonderful form postcard from the Obama administration. I mean, not even a letter in an envelope, a post card, sent bulk mail I suspect. Seriously? I’ll admit it, I’ve been feeling daunted since then.

Of course since then the situation in Zimbabwe hasn’t necessarily gotten worse, but it sure as heck has gotten more confusing. A few weeks ago the MDC pulled out of the unity government, apparently they had some hang ups about political prisoners not getting released as promised and wide spread violence against MDC supporters. (I believe the personalities over at Fox News would calls those types hippies.) Now, like an abused spouse the MDC has returned giving their violent spouse President Mugabe 15 days to get with Prime Minister Tsvangirai and outline all the deal breaking issues and then that no good Mugabe has 30 days to clean up his act or else the MDC is out the door and presumably moving in with mother. Seriously, it is strange and dangerous days in Zimbabwe, our kinsmen are still in peril. So I’ve decided to find the un for my daunted, get my butt off the couch (despite there still being new episodes of “Castle” in my DVR) and do something.

Obviously, I’ve essentially tapped out the fun of poking my elected officials. I’m not saying I’m done with them, but I needed something suitably large and bizarre to bring a smile to my face.

I considered a letter of support to the Movement for Democratic Change, complete with my husband taking a picture of the postal employee as I asked for postage to Zimbabwe. I also considered a letter to the President of Botswana. Something to the effect of, you guys seem to be a reasonable sort, can’t you do anything? Again, that had the appeal of the confused postal employee when I went to get postage, but then I had a truly inspired idea.

United Nation’s Secretary-General Ban Ki-moon.

And when I discovered how hard it is to get an actually letter in the mail to him (just try and find me a mailing address on that U.N. website!) I loved it more. I smile thinking of his Communications Director going, someone, from someplace that isn’t New York City in the state of New York has written a letter to Secretary-General Ban about Zimbabwe?! This has some seriously fun potential. Obviously, I’ve been to this party before, so I’m not actually expecting a response. However I do feel confident that someone over in his office is going to certainly be perplexed. I can feel the Nobel Peace Prize in my grasp.

11/09/09

Dear Secretary-General Ban,

I’m not going to insult your intelligence, or waste your time needlessly. Let me get right to the point, Zimbabwe is in trouble. It’s been in trouble for a very long time now, but you know that, don’t you? I mean, everyone knows that, and you’re the Secretary-General of the United Nations, so you know better than me. Especially after Manfred Nowak, the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, was not allowed admittance into the country at the end of October. So, no long explanations as to why I’m concerned, no acting like we’re not on the same page. Of course we’re on the same page. Anyone that is even remotely paying attention to the situation in Zimbabwe is on this page with us.

In July 2008 I wrote a letter that I sent to President George W. Bush, Senator John McCain, then Senator Hillary Clinton, Senator Chuck Schumer and then Senator Barack Obama expressing my concerns and arguing that the United States of America, more than any other country, had an obligation to attempt to help facilitate change. Despite it being an election year, a time when more than ever American politicians endeavor to engage and interact with the American people, I did not receive any response. Not one.

When Senator Hillary Clinton became Secretary Clinton for the U.S. State Department. I wrote her a letter expressing my concerns and told her how I was looking forward to seeing how a fresh administration, one built on diplomacy, would approach the situation. Again, I received no response.

I also wrote what I felt was a compelling letter to now President Barack Obama immediately upon him taking office. Again, concerns were expressed and impassioned pleas were made. I received a response in the form of a post card that did not clearly indicate if anyone within the Obama administration had actually read my letter.

That journey is what brings this letter to your office. I had hoped that America would take note of the situation in Zimbabwe and at least acknowledge that someone in the country cared. I do not feel that has occurred. So now I turn to you, the Secretary-General of the United Nations, a leader of the international community. Do you think there is anything to be done to help Zimbabwe? Can you at least take note that there is someone in the United States who is concerned with what is happening in the country?

Thank you for your time. I look forward to hearing your thoughts on the situation.

Sincerely,
Rebecca Elson

Attachments: 2008 letter, 2009 letter to Secretary Clinton, 2009 letter to President Obama

Stay tuned for any responses or other zany ideas!

The Colbert Healthcare Challenge: The End

Here I am, at the end of an era. Yes my friends, I have completed reading the dreaded 1018 page House healthcare bill. In truth, I finished a little while back but I’ve been trying to figure what the heck to say about it all. The healthcare reform debate manages to remain full of fire and vigor, while I, as if stuck in a perverse version of Dorian Gray, get older and more tired by the day.

I accepted Mr. Colbert’s challenge and did a thing that many notable politicians and pundits did not bother doing, read the entire 1018 page House healthcare bill. What did I learn?

I was out of my depth on day one. The bill was long, it referenced other pieces of legislation that I didn’t have access to, and it required some understanding of how Medicare works. I learned that it was most definitely not a socialist plot to take over our federal government. In truth, I’ve seen stronger acts of socialism from gamer groups placing delivery orders. It also didn’t strike me as being overtly “bad”. To this totally untrained eye, it looked like a bunch of bureaucrats attempting to do the right thing while ruffling as few of feathers as possible. I’m sure buried within its depths are loopholes that would make my eyes bleed if I understood them, or things so awesome that I’d kick myself forever for failing to catch them and mention them here, but alas, if they’re there, they didn’t register.

However, the most important thing I learned is that there is no good excuse not to try. Yes, this was a foolhardy idea from the start. Read an outrageously long piece of legislation that wasn’t even a bill that was going to be voted on. Why bother? Because it’s my right as a United States citizen to hold my elected officials responsible for their actions. I can only do that by educating myself on issues that I care about. You think I know the inner workings of the Zimbabwean government for fun? No, it is so I can write informed and compelling letters to my elected officials about my concerns regarding the country….so they can be ignored. What was my point again?

Oh yes, that the important thing is to try.

Sign Watching With Rebecca

Astute readers will notice that I haven’t done an update on my progress through the House healthcare bill this week. You’re correct, I haven’t. Several factors well beyond my control have kept me from being as diligent in my reading as I would like. For instance, the holiday weekend, my husband’s new PS3, and Kathy Griffin’s new book “Official Book Club Selection”. See? Totally out of my control. However my friends, do not despair because I have something way more fun than that for you. I attended an event featuring my Congressman, Scott Murphy.

Due to my own laziness, the morning of the event I sat on our sofa zoning out watching my husband play a new game on his Playstation 3, so in the end we rushed out the door with me skipping breakfast. (A big deal for anyone who knows me.) But I was determined to be an active participant in my government. Feh, who am I kidding? I went hoping to see someone get hit with a chair.

Much to my displeasure, everyone behaved rather well, and there were no chairs. There was the occasional yell back and forth, but that was pretty much it. My husband wouldn’t let me work my way into the crowd and say inappropriate things to provoke a brawl, which is probably for the best since we don’t own a video camera. On the other hand, we do own a digital camera, and the signs there were worth coming out for.

Here’s Congressman Murphy. He maintained his cool throughout the event. It seemed to me that he, in fact, has read the 1018 page bill. With him was the whole thing printed out, dog-eared, with visible notes written on it. He occasionally discussed things I had read and we both seemed to have read it the same way. Of course, his job was made easier by him stating up front that he wouldn’t vote for that bill the way it was now. This pleased the people who hate it with a white hot passion for its public option and advanced care planning, and it also pleased the progressives who want to hear about single payer universal healthcare and hate the bill with a white hot passion for its wussy notion of a public option. People are neat, aren’t they?

Speaking of people, I think political sign watching is going to be my new hobby. Way more fun than bird watching! The awesome thing about it is that if you want a picture of a sign and can’t get a good shot, you can just ask to take a picture of it; they assume you agree with the message on the poster board. This was made more fun by me wearing my “I’d Rather Be Fighting the Man” t-shirt. A sentiment that works well for most political philosophies these days. I rock.

First up is, “Where’s Tort Reform”. For those of you unfamiliar with tort and the tort reform debate, I’ll direct your attention to Justinian Lane’s website. Although his post is obviously from one side of the debate, it does a good job of defining tort. A thing I heard several times at this event, but had not heard on television anywhere, were people feeling the need to reform how malpractice lawsuits work. They feel the huge expense doctors pay into malpractice insurance causes doctors to pass the expense onto their patients.


Many Americans are fearful of a government run healthcare program. Next are a couple of pretty common sentiments, on television and apparently on a local level. “U Think Healthcare is Expensive Now….Wait Till It’s Free” and “Vote No! Public Healthcare”. Nothing really new there. The media has done an excellent job of digging up dirt on every country that has a single payer system. In my opinion, there is no such thing as a perfect healthcare system. America certainly doesn’t have one, and as far as I can tell no other country does either. It really comes down to how do we make sure that every working American gets the healthcare that they need, without breaking the bank, or collectively hosing everyone?


This segues nicely into the next sign. The bottom is cut off, but it reads “Bombs or Bandaids? What Would Jesus Buy?” I’m a big fan of this sign. It was obviously quickly handwritten, which says to me, this is this woman’s immediate gut reaction to the healthcare debate. I also like it because it addresses the healthcare debate in a way that I rarely hear, which is as a moral issue. Some people, this woman for example, feel that as a fairly wealthy, moral nation, it’s our obligation to make sure that our citizens receive healthcare. I suspect this is how so many countries ended up with a single payer system of some type or another. They went; well, it’s impossible to have a perfect healthcare system. The least we can do is try to make sure that everyone has access to what we can offer. I could be wrong about that, for some reason the heads of state from Afghanistan, Argentina, Austria, Australia, Belgium, Brazil, Canada, Chile, China, Cuba, Costa Rica, Cyprus, Denmark, Finland, France, Germany, Greece, Iraq, Iceland, Ireland, Israel, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Oman, Portugal, Russia, Saudi Arabia, Spain, Sweden, South Korea, Sri Lanka, Ukraine and the United Kingdom don’t consult me on these matters. (And yes folks, all those countries listed have some sort of publicly sponsored universal healthcare system.)


This next sign just perplexed me. “Unlike ACORN We’re Not Paid Stooges”. I’m going to be honest here; I don’t get what she was going for with this one. You may remember that ACORN is the community activist organization that has had a few different scandals, primarily from their mass voter registration drives and penchant for giving tax advice to pimps. I don’t know what she was trying to say, but the bold red ink and big block letters tell me that she really means it. I found the mention of ACORN a fun addition to the muddled political atmosphere at the event. Thank you ACORN lady!


I have saved the best for last. This final sign was THE sign at the event for me. Its horrible fear mongering was only topped by the glaringly obvious lack of understanding of the healthcare bill. This kind of crazy is the stuff I LIVE for! “Government Healthcare. A Lethal Injection. Seniors First. Baby Boomers Next.” Sweet mother it was a beautiful sight. And I had to stalk her to get the photo. She was a nimble lady, weaving around the crowd. The payoff of this photo was worth the effort. Now if you read The Magical Buffet, then you read my last Colbert Healthcare Challenge article where I posted the exact text of the advanced healthcare planning section of the bill. No where in it does it imply any sort of death panel or the administering of lethal injections. In fact, thorough advanced care planning, gives you more control over your death, not less. The idea of death panels and lethal injections also alludes to the concerns over “rationing of care”. This is the idea that the government will determine how your doctors will treat your health issues, etc. I have no doubt that a single payer system will involve some of that, not to the extent of the government killing you when you become too expensive (Although that does sound like an awesome sci-fi book or movie. It’s probably already been done.). On the other hand, I’ve had my assorted health insurance companies throughout the years restrict me from taking certain medications and not cover types of treatment. Remember, no healthcare system is perfect.



So what did I learn? For starters, Congressman Murphy can be one savvy mother (hush your mouth!) when he needs to be. Good for him! More importantly, I learned that we’re all a bunch of irrational individuals, being pulled by the media, our personal sense of ethics, fear of the unknown, and more. That no one can bring themselves to admit the truth, which is there is no answer to the healthcare debate. That dazzling ignorance that we all possess, myself included, is what makes Americans such a heartwarming, frightening, and contrary bunch. I think that’s just fantastic.

The Colbert Healthcare Challenge: Part 4

Well, here I am, just about halfway through the dreaded 1018 page House healthcare bill. I’m at page 501! Victory is many, many weeks from being within my grasp. Although still an unwieldy bundle of reading, things have started to get a little interesting. (Don’t know why I’m reading this? Click here.)

I’m going to launch right into the “what I’ve learned” part of the article, however, do keep in mind that this whole thing gives me a big ole’ headache so what I think I’m reading may end up not being what it means at all! Hey, at least I’m being honest about it!

– I’ve definitely been having some fun with language in this part. A “power-driven wheelchair” is now a “complex rehabilitative power-driven wheel-chair”.
– This chunk of the bill mentions the development of “meaningful use of an electronic health record”. It looks like thus far they mention it with regards to “The collection of health data to identify deficiencies in the quality and coordination of care for individuals eligible for benefits under this part.”
– There is a whole lot about trying to “reduce potentially preventable hospital readmissions”. If I’m reading this right, it looks Medicare may reimburse hospitals less for excessive readmissions, bearing in mind that they will be doing a study to determine an average, and also to determine a list of acceptable conditions and reasons for readmissions so that hospitals are not penalized in any way for those.
– With regards to this it appears there will be a commitment (maybe providing funding to hospitals?) to having translators available to be certain that upon discharge patients understand what their follow up care should be.
– They want to establish a “medical home pilot program” for “high need beneficiaries”, which are people who ” require regular medical monitoring, advising, or treatment”. If I’m reading it right, they’ll also be examining home health care options for individuals in general. That may just be wishful reading on my part, but having a doctor come to your home does sound like some super pro-active preventive medicine.
– I don’t know how Medicare works now, so this may be new, or maintaining of the status quo, but preventive services with Medicare would be covered 100%. This includes all the usual suspects, mammograms, colonoscopies, physicals, so on and so forth, etc., etc.
– Now for the part you’ve all been waiting for….the death panels (cue ominous music). Since there has been so much attention paid to this one, allow me to liberally cut and paste (it’s long, but pretty easy to follow):

Advance Care Planning Consultation
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 decision maker (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.
I’ll let you decide if this is a “death panel” situation, in my opinion, it is not.

– I still don’t believe this is a socialist plot to take over our federal government.

517 pages left!

The Colbert Healthcare Challenge: Part 3

When we last left our intrepid heroine she was on page 143 of the 1018 page House healthcare bill. Let’s tune in…. (If you missed how this whole thing began, click here.)

I am now up to page 243. I wish I was further along, but it’s a long, slow, read. (And you know, the new season of “Psych” has started, I’m a busy woman.) I’ve got to be honest here, on more than one occasion, while desperately trying to make sense of what I’m reading, I’ve fallen asleep. I’m not proud to admit it, but yes, my head would droop and I would wake up from my chin hitting my lower neck. That said, I also came to another alarming realization. Remember how in Part 2 I said, “It’s constantly referencing other sections of the bill, and nine times out of ten it’s a section nowhere near the section you’re reading.”? Well, it’s not just referencing other sections of the healthcare bill; it’s often referencing other sections of ENTIRELY DIFFERENT BILLS! That’s right; in order to fully understand this bill I would need to access several other bills. Guess what? Not going to happen.

I think we’re all starting to get a clear picture on why no one, regardless of what side of the aisle they’re on, can coherently and intelligently discuss this bill. I’m beginning to think that the Democrats might be happy that they have all these people yelling and interrupting them, it keeps them from having to actually try to explain this beast. You want to throw a politician off at one of these town hall meetings, politely ask a very pointed, detail oriented question….and watch them sweat!

I have to admit, that not a whole lot of this bill is sinking in or making sense to me. I understand the words, but I have trouble seeing the whole picture. What I have noticed, and is cool, is that sometimes I’ll read a news story about the House bill and I’ll have this flash. It’s like I’m Bruce Willis at the end of “The Sixth Sense”; there is a montage of pages that flicker through my mind’s eye and I can go, oh crap, I do remember reading that. So I guess that means this is not an entirely pointless endeavor, just mostly pointless. Yay!

So what meager offerings do I have for you aside from my aforementioned revelations?

– Still no sign of death panels.
– Looks like they’re doing a whole lot that is affecting Medicare. If only I knew anything about Medicare, then I would be able to understand how good or bad that is.
– If the bill goes through as is, which is highly unlikely, everyone will be required to have health insurance, either through their employer or the government. It appears that you can get permission to opt out of any sort of health coverage on religious grounds.
– This is still, most definitely, not looking like a socialist plot to take control of our federal government.

And one final note to leave you with…..

Sen. Jim Inhofe (R-Okla.), you don’t need to read the bill? Congratulations, you’re now on my list of people whose opinions I do not need to care about.

The Colbert Healthcare Challenge: Part 2

I know you’ve all been eagerly waiting to hear about my adventures with the House healthcare reform bill. Well, I am currently on page 143 of the 1018 page document. As readers know, I am not afraid of a long and winding document. United States Constitution and Bill of Rights? A 19 page cake walk. Constitution of Iraq? A frustrating, but manageable 43 page read. The Malaysian Constitution? A very challenging 650 page quagmire, but I got the job done. I walked into this challenge cocky and confident. (Don’t remember the challenge? Click here.)

Here’s the thing, when everyone in the media reported on the bill, they said it was 1000 pages long. What they failed to mention is that it isn’t merely a 1000 page read. It is a 1000 page, soul crushing, life diminishing, tortured read. Mr. Gingrich, Newt, I apologize. You had every right to snort at the idea of reading this bill. Compared to you, I’m a young woman, with years ahead of me. You, on the other hand, have got to be in your 60’s. You don’t have the years to spare to have them sucked out of you by attempting to navigate this document. I now understand Newt, and I apologize.

So what I’m saying is, ouch, this is not an easy thing to digest. It’s constantly referencing other sections of the bill, and nine times out of ten it’s a section nowhere near the section you’re reading. The language is fairly clear, it has to be considering page 39 is sure to state:

PLAIN LANGUAGE.—In this subsection, the term “plain language” means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is clean, concise, well-organized, and follows other best practices of plain language writing.

“Concise and well-organized” is debatable, but I knew what all the words were, although occasionally despite reading statement out loud I still didn’t quite understand what it meant.

In defense of how outrageously long and complex the bill is, I have to say I hadn’t quite grasped the ripple effect of adding a government provided health option to our nation’s health care mix. You need to figure out who will manage it, how they will manage it, what it does to the tax code, how it may affect Medicare, and so much more. It’s this long because they’re attempting to be thorough.

That said, yes, I now understand why it’s so long and complex, that doesn’t actually make it any easier for me, Rebecca the Blogger, (Yes media outlets, contact me, I’m totally the next Joe the Plumber. If he can get a whole new career out of one question, I certainly deserve one for attempting this.) to read. Here’s the notables:

– I haven’t seen anything that looks like death panels.
– Looks like they want to lay the smack down on insurance companies: no dropping people suddenly, no denial due to pre-existing conditions, making sure all plans offer something with regards to hospitalization, outpatient hospital and clinic services, services of doctors and health care professionals, prescription drugs, Rehabilitative and habilitative services, Mental health and substance use disorder services, preventive services, maternity and infant care, no co-pays for preventive care.
– They are trying to make sure you can keep your current insurance if you like it.
– So far I’ve yet to see anything that looks like a socialist plot to take control of our federal government.

There you have it, the feeble sum up of the first 143 pages of the bill. Sweet mother, at this rate it will take me around two months to get through it all. I’ll keep working at it, but I suspect the bill will be passed, dumped, or radically altered by the time I get done reading this version.

There is one point I would like to make here, if you all will indulge me for a moment. I am not a politician nor am I a political analyst. I don’t even get paid to write for this website. I am not a professional anything. Yet here I am, struggling to wrangle this monster of a bill. I’m doing it out of a desire to try to be an educated citizen, and also to get some amusing blog content. Although I apologized to Newt, I’m outraged that a leader in the political arena would dare pretend to understand the bill without having ever read it. You make a LIVING with this stuff. You have a staff that could read it for you and give you a power point presentation. I got nothing. I’m a woman of average intellect with a PDF document that has nothing to gain by attempting to be versed in the nuances of this bill. Major news outlets aren’t asking me for an interview on the subject. I don’t have books to hustle. If you haven’t read the bill, I don’t want to hear your thoughts on it. Period.

Okay, I’ll get off my soap box now, because honestly, I can’t afford to lose any more time to writing this, I still have 875 pages to read.

Challenge Accepted Mr. Colbert

While catching up on my DVRed episodes of “The Daily Show” and “The Colbert Report” it was hard to miss that the big news, and comedy, of the day is the battle over healthcare reform. Obviously I have my opinions on the subject, and I understand and share many of the concerns of many Americans. Also, being the often mean-spirited person that I am, I’m greatly enjoying the comic stylings of Stewart and Colbert as they cover this issue. But then, on the August 10, 2009 episode of “The Colbert Report”, it happened.

The Colbert Report Mon – Thurs 11:30pm / 10:30c
Death Panels
www.colbertnation.com
Colbert Report Full Episodes Political Humor Meryl Streep

That sounds like a challenge to me! That’s right, I went to CNN’s special healthcare website and downloaded the infamous 1018 page current House healthcare reform bill. I will do the thing that seems increasingly obvious that most politicians and television personalities won’t do, I am going to read the bill.

Keep in mind that this bill isn’t even finalized yet. It’s not at the point where anyone will be voting on it, and most likely will change dramatically. But since this version, right now, is the one that is just too big to bother to read, I made sure to download it to my computer, just in case it disappears from the internet.

I will be sacrificing time that could be spent reading awesome stuff, like Colleen Deatsman’s new book “Seeing in the Dark” or the Llewellyn’s “2010 Witches’ Companion” and “Sabbats Almanac”, in order to man up and read this bill that everyone else seems unwilling to read, but more than willing to discuss as if they have.

Challenge accepted Mr. Colbert.

3 Steps Forward, 2 Steps Back: The Iraqi Two-Step

Like many Americans, I don’t know how we ended up in Iraq. Just one day I turned on the news, and there we were, toppling Hussein’s regime. I think that I, like many of us from countries who have committed troops to Iraq, feel that we ended up there undereducated and under confused circumstances, but that if at the end of the day Iraqis could experience the security and freedoms that we have, it would be worth it.

And things have changed. Despite continued violence Iraqis have started experiencing a new life. One where stores sell alcohol (Is there such a thing as Iraqi Rum, and if so, can someone get me some?), Turkish soap operas are on the television, and internet cafes have started allowing the youth of Iraq to experience the joys of Facebook refusing to upload their photos (Simple photo uploader my butt, is all I’m saying.) Any change that allows a whole new group of people access to my website, well that is change I can believe in.

But quietly, the Iraqi government has been taking steps to begin censoring, monitoring, and denying access to books and the internet to its citizens. According to The New York Time’s article on August 4, 2009 “this spring the government contacted the handful of Iraqi book publishers still in business and asked them to compile lists of their books, along with a description of the subject matter. The material is to be kept at the Ministry of Culture, which is also preparing a document to be signed by publishers in which they will pledge not to distribute books the government deems offensive.”

The Associated Press stated in their article that “the plan to strengthen government control of content and usage will require Internet cafes – and later the service providers as well – to obtain licenses that are subject to government review and cancellation if compliance requirements are not met.”

The Journalistic Freedom Observatory is quoted by the Associated Press explaining that “the plan violates the Iraqi constitution, which guarantees the freedom of mail, telegrams, phone and electronic communications. The constitution, enacted in 2005, says such communications cannot be monitored, tabbed, or revealed.” Then I read in the New York Time’s piece that “Iraq’s Constitution is not clear on the matter. It guarantees freedom of expression, but only if it ‘does not violate public order and morality’.” Now wait, the Associated Press is going with the plan violating the Constitution but the New York Times is saying that the Constitution isn’t clear on the matter? Who is right?

Well, long time readers know that I’m not afraid to dive into another country’s constitution. I still have fevered dreams of wading through all 165 pages of the Malaysian constitution. The good news is Iraq’s constitution comes in at a pitiful 43 pages, still more than ours, but considerably less than Malaysia. So after several glasses of wine and a whole lot of talking to my computer monitor I’ve come to the conclusion that everyone is right.

Article 40 does guarantee “The freedom of communication and correspondence, postal, telegraphic, electronic, and telephonic, shall be guaranteed and may not be monitored, wiretapped, or disclosed except for legal and security necessity and by a judicial decision.” And Article 38 does read much like America’s First Amendment, guaranteeing, “Freedom of expression using all means. Freedom of press, printing, advertisement, media and publication. Freedom of assembly and peaceful demonstration, and this shall be regulated by law.” But those are actually sections A, B, and C of the Article. The Article begins with “The State shall guarantee in a way that does not violate public order and morality:” And that to me seems like an awesome way to at any point decide that something “violates morality”. I mean, with a qualifier like that, why bother?

To put it into perspective, I can say right here on my publicly viewed website that I think Taher Naser al-Hmood (Iraq’s deputy cultural minister) is dooty head and that I would encourage someone to kick him in the shin. To say that here in the United States gets you nothing, even if I said I would encourage someone to kick President Obama in the shin, it still merits no attention. (You’ve got to make credible threats against the President’s life to get a visit from the nice men in suits with guns. Don’t ask me how I know.) However, to make that statement about Taher Naser al-Hmood in Iraq, let’s say by a frustrated teen on his Facebook page, could get an entire internet service provider shut down, assuming Taher takes offense, and that these laws are passed.

This brings me to something I discovered while wading through Iraq’s Constitution that got no mention by The New York Times or the Associated Press. That might mean it’s nothing, or that I’m reading it wrong. I’m not even an expert on America’s Constitution, let alone Iraq’s! However, here it is. The second section of Article 126 of Iraq’s Constitution states “The fundamental principles mentioned in Section One and the rights and liberties mentioned in Section Two (which is where the Articles mentioned are from) of the Constitution may not be amended except after two successive electoral terms, with the approval of two-thirds of the members of the Council of Representatives, the approval of the people in a general referendum, and the ratification by the President of the Republic within seven days.” This says to me there could potentially be a vote about the changes being proposed. Of course, the government can avoid it by arguing that they are not amending those Articles, they are merely putting things in place to ensure that things in the press, books, or on the internet do not “violate public order and morality”. See what I mean about why bothering?

Benjamin Franklin said “They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.” Iraq is a country struggling to secure itself. They want what every nation wants, to live in peace. To help the process along, their government feels that by censoring what its citizens can read will make a difference. And let’s say it works. By not being able to read things critical of Islam, or seeing violent images, or watching scantily clad women shake their badonkadonks on You Tube, the violence in Iraq decreases. Congratulations Iraqi government, you saved Iraq from violence, but in the process of saving it, you’ve taken it back to the policies that existed under Saddam Hussein. Congratulations.

Update: I’m pleased to say, the journalists, authors, and publishers of Iraq are fighting back! Click here!

Happy Independence Day!

IN CONGRESS, July 4, 1776.

The unanimous Declaration of the thirteen united States of America,

When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

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, –That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.–Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.

He has refused his Assent to Laws, the most wholesome and necessary for the public good.
He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.
He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.
He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public Records, for the sole purpose of fatiguing them into compliance with his measures.
He has dissolved Representative Houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.
He has refused for a long time, after such dissolutions, to cause others to be elected; whereby the Legislative powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.
He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.
He has obstructed the Administration of Justice, by refusing his Assent to Laws for establishing Judiciary powers.
He has made Judges dependent on his Will alone, for the tenure of their offices, and the amount and payment of their salaries.
He has erected a multitude of New Offices, and sent hither swarms of Officers to harrass our people, and eat out their substance.
He has kept among us, in times of peace, Standing Armies without the Consent of our legislatures.
He has affected to render the Military independent of and superior to the Civil power.
He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his Assent to their Acts of pretended Legislation:
For Quartering large bodies of armed troops among us:
For protecting them, by a mock Trial, from punishment for any Murders which they should commit on the Inhabitants of these States:
For cutting off our Trade with all parts of the world:
For imposing Taxes on us without our Consent:
For depriving us in many cases, of the benefits of Trial by Jury:
For transporting us beyond Seas to be tried for pretended offences
For abolishing the free System of English Laws in a neighbouring Province, establishing therein an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies:
For taking away our Charters, abolishing our most valuable Laws, and altering fundamentally the Forms of our Governments:
For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.
He has abdicated Government here, by declaring us out of his Protection and waging War against us.
He has plundered our seas, ravaged our Coasts, burnt our towns, and destroyed the lives of our people.
He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation and tyranny, already begun with circumstances of Cruelty & perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.
He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the executioners of their friends and Brethren, or to fall themselves by their Hands.
He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages, whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.

Nor have We been wanting in attentions to our Brittish brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these United Colonies are, and of Right ought to be Free and Independent States; that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.

To learn more, click here.