So much to be thankful for......

History lessons appear to be the missing element of a good education anymore, I mean our own nation's rich history, a history that includes those who founded the system that embodies the meaning of The Age of Enlightenment, a system America once affectionately called "capitalism." Yet none of us learned this in school.

More odd is what capitalism has accomplished for the entire race of mankind over these 200+ years. How the idea of one owning their own property, having elected to work hard to achieve and attain it, meant first the recognition of all people as being sentient, which was the great discovery of the artisans and philosophers of The Age of Enlightenment.

But some how, instead, a system that is the mirror image of feudal rule of The Dark Ages has seized the day. A system of privileged existence under an authoritarian rule based on the "parens patriae" doctrine, a Latin legal phrase that, according to my old Blacks Law Dictionary, Fifth Edition, means:

"'Parens Patriae,' literally 'parent of the country,' refers traditionally to role of state as sovereign and guardian of persons under legal disability."

Consider how many forms of medical condition exist to which one can be considered disabled, and placed on the public dole, even prisoners in prisons are considered afflicted with a particular legal disability.

Now let's take a look at Health Care again, and we'll note a grand opportunity stands before the authoritarian and rulemaking branches of the United States Government to once and for all, with the people's blessing if we support it, finally have the means to define every citizen with a legal disability according to medical records the government will have in their possession and control.

This may explain the final blows to destroy a system which the Pilgrims discovered (http://changingwind.org/index/news.php?item.32.11). A system where each is rewarded with the result, the fruit, of their own labor, a Christian tenet which is why it was one of the more begrudged issues of the actual slave ancestors of African Americans, no matter where they were worldwide, the issue that some could reap the reward of their labor, but they themselves could not. Taxes appear to be a legal mechanism of this same principle, where government acts as the master to reap a guaranteed income, even as a debt owed to government if you do not pay, based solely on government claiming this right in an individual's property.

The import of the civil war, the idea these men who were once slaves could now earn for themselves from their own labor was, and remains, the significant point of departure from slavery to civility. You see the Pilgrims, many of which came here as "indentured servants," some just to pay their passage from Europe to the United States, knew very well the state of upheaval ones mind endures when moving from the mind of being a captive peasant and slave subject to the mind of an owner and master of ones own-self, ones own-life. These men and women only knew the oppression of a structure which honored and operated according to the whim of a Sovereign government, a government that consistently asserted the denial of any rights in property to the peasantry. In fact all were subject to their very life being disposable as their right to live was entirely at pleasure of this Sovereign government, much like women will be with these new proposed rules on mammograms based on cost savings that pale in comparison to the value of peace of mind in a person's life, as well as the long term cost of those whose cancer isn't detected early and complicated by lack of such early detection. This further denies recognition of the cost upon a family when a loved one dies, both emotionally and financially, the survivors who never wanted to be, but instead wanted the best health care they could get for their mother, wife, sister, and occasionally their brother. But apparently this is the value of rationing and, according to liberal democrats, in no way, shape, or form, bares any resemblance to a "death panel," rationing, or the Canadian Health System.

And it is as though freedom in the manner that Our Founders laid out, has been lost. The strides made by capitalism have become regularly tempered since a new name for feudalism was made available by The Communist Manifesto, called Marxism, and again repackaged as "liberalism." This is a clear influence when we review the speeches of former "Green Jobs Czar" Van Jones vigorously espousing, "give them the wealth," or by then Candidate Obama, speaking to "Joe the Plumber" to explain "spread the wealth around." These speak volumes for the promotion of "government provided freedom," a subsidized life, similar to the subsidized inner city housing projects. It is this idea of government that we walked away from according to the Declaration of Independence. We have known throughout history that such a freedom, as the Pilgrims, African-American slaves, and now we, who pay half our paycheck to local, state, and nation government have found is only a freedom to produce for sake of the King, master, or other oppressive sovereign government's need to live beyond their means and further borrowed against. At current we've helped these people, enabled them to place our nation in jeopardy by paying the tax, by never questioning the government authority to do so in a vigorous manner that holds government accountable. Instead we trudge along, assuming we "can't beat City Hall." So far we've agreed to be obedient subjects of what has proven to be an oppressive political self interest structure where politicians think of themselves without any regard to the people, to the governed.

Oh a miniscule few who line these politicians pockets well gain favor of the neo-liberal political establishment. Those who give sweet heart bank loan deals to politicians and establish court case precedents finding in favor of enlarging national government power. What else, other than to regurgitate hatred for George Bush, can be at the heart of recognition that self proclaimed terrorists, who have acted upon their wish to destroy Americans in the name of Jihad, and, those enemy combatants found on the battlefield, who fired upon our blood and treasure, our soldiers, have the same Constitutional Rights as citizens of the United States of America, and deciding to hold trial of a group of them in New York? And the ultimate special interest group is of course those who bring suit regarding a carbon footprint or encroachment on "wilderness" on the grounds that these "could have a negative impact on global climate change and increase CO2 emissions while also threatening an endangered form of gnat that only grows in this area." Please note no mention of Lawyer Obama's former employer ACORN.

What these consistently ignore is the history of capitalism. Capitalism is the source of property rights due to the need for a means for protection of property by rights vested in the individual through ownership. Meaning, you paid for it, it's yours, and the responsibility of protection of that property is yours too, and by protecting your property you assert your sovereignty, your sentience.

This is why the facts of history bare out that it is from these property rights derived from capitalism there came a need for courts for individual people, courts to air out their grievances in regard to a transaction. Thus the Code of Civil Procedure and Civil Code, and the notions of a means to use a neutral forum to address disputes became the preferred means of resolving an issue, preferred versus duals, and other trials by ordeal, that usually ended with death of one of the parties, to settle disputes. This code and the procedure it implements are the very manifestation of sentience through capitalism, a recognition of the rights of the individual through their ability to generate their own money and purchase things with it to attain a level of wealth over time.

Of course from these property rights came individual rights, and eventually civil rights, though the latter remains more of misnomer and is factually a modern day event where government is conferring rights on people as their Sovereign from a Throne on High. The Emancipation Proclamation is not a recognition of rights in the people, where those who once were enslaved are included as a part of one family of free Citizens. Thus why the "freed" were not treated with the same respect by government as government is required to treat upon each and every individual Citizen. This limitation on the national government was established at the founding of the United States of America, when the first 10 Amendments to the U.S. Constitution were recognized and amended to it. Their very language indicates their tenor, intent, and purpose as limits placed upon the national government to assure no encroachment into a State or the life of a Citizen of any State. Civil rights are not such limitation, and instead are a mechanism for attaining monetary damages, often without any level of monetary interest through investment by the plaintiff, monetary interest that would of course include the rights and responsibilities that come with such investment. Today civil rights are a means for lawyers to attain settlement from successful capitalist businesses in America, a way to exploit and game the system due to liberal socialist design interpretation of the Emancipation Proclamation, something even Martin Luther King said "creates a second class citizenship in the United States" in a communication to John F. Kennedy by Western Union telegram.

It is just amazing that such a phenomenal figure in history, as Martin Luther King whose great wisdom and capability to discern the truth of things is rarely matched throughout history, has left his message in the hands of those whose entire success today is based on misrepresentation of his message by wrapping it around their own axle, an exploitation, and appeal to the worst of societal situations as an intended and caused norm of the wealthy on one group, irrespective of the government encroaching on the property of all citizens over time in such a manner that the freedoms sought by the original slaves do not even appear as phantoms, as ghosts on the edges of what we envision freedom to mean. Worse is the belief that this can only be changed by those who earned through their labor, or inheritance of others who labored, to give to the have-nots.

Who believes Martin Luther King wanted handouts? And who believes that Martin Luther King wanted those who are oppressed in slavery to, once free of bondage, be beholden to someone else for their crumbs from the Master's Table? And do you believe African American slaves, the ancestors to many American Citizens of African decent today, wanted freedom so they can ask for money from the wealthy? Utter hypocrisy to claim "our being free now gives us a right to ask you to provide for us."

And how kind of the variety of American leaders of African and slave descent to so easily throw a blanket of assumption that the negatives in society are caused by the wealth of others, irrespective of the fact that most poverty, of most people overall, is caused by those who will not take on the mantle of being an American Citizen no matter their heritage or what country they are from. For many the Christian idea of working for ones reward, of seeking personal wealth and freedom, along with the entire battery of rights and responsibility that comes with such American Citizenship, is entirely foreign as their fathers for thousands of years were taken care of by a Sovereign Ruler be it Samurai, a Crown Head of Europe, or Tribal Chieftain. So the remedy, the solution of having government encroach on the wealthy, as promoted, offered, and suggested by this variety of leaders of African and slave decent, as well as others, only continues to deny the very people who deserve to think freely the very opportunity to attain the mind of a free sovereign individual person with all the gifts of freedom they gain by individual action.

Sure some think "I own my home" ignoring that more often than not their very benefit is entirely derived from the will and whim of the state in the politicians self interest at political bidding for their vote. The end doesn't justify the means, which end in this case is the destruction of America by disempowering the people through the idea of "well it doesn't matter, I have the house." Knowing of these instances, and that this has been going on since Franklin Delano Roosevelt, hasn't the wealth, the taxpayers and producers of this nation, already paid their fair share? Sure it isn't by a court decree but the free ride many have had already on the basis of the abusive use of the Civil Rights Act and other benefits programs under FDR, appears to be a staggering amount of money, amount of exploitation, of the American People, the designated taxpayer to foot the bill. When are we the creditor here, or that the borrower is government subordinates our being the supply side of this equation? This taxing power of government is blind to the variety of ethnicities and cultures in this nation, yet does all it can to focus our attentions on differences amongst each other, apparently so we'll never have the epiphany, "it's not that poor person's who is taking from me, but the government who does, and aren't they actually giving less to these people and giving more to their pet projects, to their friends and other cronies? I've been a fool to blame anyone else!"

But I keep forgetting, this is a transformation from a nation built on the freedom of the individual to a nation built on the government issued privilege of the individual who has agreed to a life of subject dominion under the ruling class, an agreement purchased initially through the showering of benefits from a government that can't afford them except by oppression, seizure, and any other abuse of the structure of collective taxation. Health care, use of energy, and seeking to become successful by merit of production, are the casualties after the fact of borrowing from other nations-yea we are stronger now that we have foreign creditors who we must submit to, but we won't recognize the people who pay the bill, the governed, as the true creditor for our 3rd party liabilities we are foisting on they and their children. Of course our image is better around the world when we are seen weaker and actually our people agreeing to be similar to those who dislike us. Some may say they see us more akin to themselves, which very well may be true, since we have adapted the mindset of a subject people just like the people across Europe who've known thousands of years of feudal authoritarian rule.

I mean, isn't it clear that liberal America cares about only one class from the 235 legal millionaires in Congress since the last election? But to emphasize and see just how asleep we are, they are deciding to change the rule on mammograms to not cover them on women under 50 years old....Anyone upset yet? Anyone making the big ruckus and making sure the health care bill fails by 60 votes instead of 40 something?

Can you understand now why I titled the previous article as I did http://changingwind.org/index/news.php?item.62.12?

This is the same control over a people a fuhrer once had over a nation we helped destroy because it was promoting and identifying a master race to define all other races inferior, and, claiming those that are most inferior in their view are subject to extinction. Winning World War II is a testament to America that today we undermine at every turn, as though there are none in the world who would think of controlling the rest of us. They are in our midst, and, care of President Obama, they are ready and willing to carry out their duties to destroy a country that has done more for the freedom of mankind than all the other nations of the world combined. This is why we have so many enemies, so many who loathe and hate us, for our roots embody the meaning of freedom and, should our people ever wake up and seize their reign as the government of this nation that they actually were designed to have, we will again contribute to mankind in ways no other nation can resist or undermine. This is why they love our liberal president, for these enemies to the freedom of each individual of mankind, a freedom derived from self interested ownership of property that develops responsibility and sentient un-hindered and un-impinged free thinking, undermines the very weakness of individuals that those who promote, and are at the center of, collective control exploit, weaknesses necessary to gain government authoritarian dictatorial imposition of rule at their pleasure upon the governed, a power they seek merely due to their elitist belief, "I know better than you do what's good for you."


Happy Thanksgiving, it may be one of our last ones to be had as a somewhat free American People,


Toddy Littman

HR 3200 can be found at http://energycommerce.house.gov/Press_111/20090714/aahca.pdf

Here are the pertinent sections of the health care bill, HR 3200, found by merely searching the document for the term "end of life."
The end is the agreement under Social Security Act Section 1890(a).  I strongly advise you to not not wear your literalist hat when reading this so that gems of legislative interpretive flexibility can easily be found, such as:

"‘‘(2) FORM OF AGREEMENTS.—The Secretary may carry out paragraph (1) by contract, grant, or otherwise."

Every college, university, corporation or other individual who engages with the government for any "contract, grant, or otherwise" related to health care shall find themselves being stuck with the quality standards of those entities who apply to be a "consensus-based entity" who also are "mulit-stakeholder groups."  Legally a stakeholder is the one who invests in a non-profit or not-for-profit organization, however who is the stakeholder in your health, them or you?  Are they out to protect you or their investment and notariety?  And as you read you'll learn the Secretary of Health and Human Services is entirely in control of this, they can even carry out their own reasons for rulemaking so long as it's been considered by the rest of the multi-stakeholder groups, even if not adopted by them, so long as "the Secretary shall include the rationale for continued use of such a measure in rulemaking.’’."

"End of life" is the connection between Part I (pages 424-432) and Part II (Pages 619-633).  Section 1890 is the connection between Part II and Part III.


PART I-H.R. 3200 (Pages 424-432)

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 require ments 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 stake-holders 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 in formation 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.


PART II-H.R. 3200 (Pages 619-633)

Subtitle C—Quality Measurements
SEC. 1441. ESTABLISHMENT OF NATIONAL PRIORITIES FOR QUALITY IMPROVEMENT.

Title XI of the Social Security Act, as amended by section 1401(a), is further amended by adding at the end

Subsection (a) as referenced by subsection (c) below the following new part:
    ‘‘PART E—QUALITY IMPROVEMENT
    ‘‘ESTABLISHMENT OF NATIONAL PRIORITIES FOR
    PERFORMANCE IMPROVEMENT
   
    ‘‘SEC. 1191. (a) ESTABLISHMENT OF NATIONAL PRIORITIES BY THE SECRETARY.—The Secretary shall establish and periodically update, not less frequently than triennially, national priorities for performance improvement.
    ‘‘(b) RECOMMENDATIONS FOR NATIONAL PRIORITIES.—In establishing and updating national priorities under subsection (a), the Secretary shall solicit and consider recommendations from multiple outside stakeholders.
    ‘‘(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES.—With respect to such priorities, the Secretary shall ensure that priority is given to areas in the delivery of health care services in the United States that—
        ‘‘(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic diseases;
        ‘‘(2) have the greatest potential to decrease morbidity and mortality in this country, including those that are designed to eliminate harm to patients;
        ‘‘(3) have the greatest potential for improving the performance, affordability, and patient-centeredness of health care, including those due to variations in care;
        ‘‘(4) address health disparities across groups
14 and areas; and
        ‘‘(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons.

‘‘(d) DEFINITIONS.—In this part:
        ‘‘(1) CONSENSUS-BASED ENTITY.—The term ‘consensus-based entity’ means an entity with a contract with the Secretary under section 1890.
        ‘‘(2) QUALITY MEASURE.—The term ‘quality measure’ means a national consensus standard for measuring the performance and improvement of population health, or of institutional providers of services, physicians, and other health care practitioners in the delivery of health care services.
‘‘(e) FUNDING.—
        ‘‘(1) IN GENERAL.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $2,000,000, for the activities under this section for each of the fiscal years 2010 through 2014.
        ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $2,000,000 for each of the fiscal years 2010 through 2014.’’.

SEC. 1442. DEVELOPMENT OF NEW QUALITY MEASURES;
    GAO EVALUATION OF DATA COLLECTION
    PROCESS FOR QUALITY MEASUREMENT.

    Part E of title XI of the Social Security Act, as added by section 1441, is amended by adding at the end the following new sections:

‘‘SEC. 1192. DEVELOPMENT OF NEW QUALITY MEASURES.

‘‘(a) AGREEMENTS WITH QUALIFIED ENTITIES.—
    ‘‘(1) IN GENERAL.—The Secretary shall enter into agreements with qualified entities to develop quality measures for the delivery of health care services in the United States.
    ‘‘(2) FORM OF AGREEMENTS.—The Secretary may carry out paragraph (1) by contract, grant, or otherwise.
    ‘‘(3) RECOMMENDATIONS OF CONSENSUS-BASED ENTITY.—In carrying out this section, the Secretary shall—
        ‘‘(A) seek public input; and
        ‘‘(B) take into consideration recommendations of the consensus-based entity with a contract with the Secretary under section 1890(a).

‘‘(b) DETERMINATION OF AREAS WHERE QUALITY MEASURES ARE REQUIRED.—Consistent with the national priorities established under this part and with the programs administered by the Centers for Medicare & Medicaid Services and in consultation with other relevant Federal agencies, the Secretary shall determine areas in which quality measures for assessing health care in the United States are needed.

‘‘(c) DEVELOPMENT OF QUALITY MEASURES.—

    ‘‘(1) PATIENT-CENTERED AND POPULATION-BASED MEASURES.—Quality measures developed under agreements under subsection (a) shall be designed—

        ‘‘(A) to assess outcomes and functional status of patients;
        ‘‘(B) to assess the continuity and coordination of care and care transitions for patients across providers and health care settings, including end of life care;
        ‘‘(C) to assess patient experience and patient engagement;
        ‘‘(D) to assess the safety, effectiveness, and timeliness of care;
        ‘‘(E) to assess health disparities including those associated with individual race, ethnicity, age, gender, place of residence or language;
        ‘‘(F) to assess the efficiency and resource use in the provision of care;
        ‘‘(G) to the extent feasible, to be collected as part of health information technologies supporting better delivery of health care services;
        ‘‘(H) to be available free of charge to users for the use of such measures; and
        ‘‘(I) to assess delivery of health care services to individuals regardless of age.
       
    ‘‘(2) AVAILABILITY OF MEASURES.—The Secretary shall make quality measures developed under this section available to the public.
    ‘‘(3) TESTING OF PROPOSED MEASURES.—The Secretary may use amounts made available under subsection (f) to fund the testing of proposed quality measures by qualified entities. Testing funded under this paragraph shall include testing of the feasibility and usability of proposed measures.
        ‘‘(4) UPDATING OF ENDORSED MEASURES.—The Secretary may use amounts made available under subsection (f) to fund the updating (and testing, if applicable) by consensus-based entities of quality measures that have been previously endorsed by such an entity as new evidence is developed, in a manner consistent with section 1890(b)(3).
    ‘‘(d) QUALIFIED ENTITIES.—Before entering into agreements with a qualified entity, the Secretary shall ensure that the entity is a public, nonprofit or academic institution with technical expertise in the area of health quality measurement.
    ‘‘(e) APPLICATION FOR GRANT.—A grant may be made under this section only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
    ‘‘(f) FUNDING.—
        ‘‘(1) IN GENERAL.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $25,000,000, to the Secretary for purposes of carrying out this section for each of the fiscal years 2010 through 2014.
        ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out the provisions of this section, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $25,000,000 for each of the fiscal years 2010 through 2014.

SEC. 1443. MULTI-STAKEHOLDER PRE-RULEMAKING INPUT INTO SELECTION OF QUALITY MEASURES.

Section 1808 of the Social Security Act (42 U.S.C. 1395b–9) is amended by adding at the end the following new subsection:
        ‘‘(d) MULTI-STAKEHOLDER PRE-RULEMAKING INPUT INTO SELECTION OF QUALITY MEASURES.—
            ‘‘(1) LIST OF MEASURES.—Not later than December 1 before each year (beginning with 2011), the Secretary shall make public a list of measures being considered for selection for quality measurement by the Secretary in rulemaking with respect to payment systems under this title beginning in the payment year beginning in such year and for pay ment systems beginning in the calendar year following such year, as the case may be.
            ‘‘(2) CONSULTATION ON SELECTION OF ENDORSED QUALITY MEASURES.—A consensus-based entity that has entered into a contract under section 1890 shall, as part of such contract, convene multi-stakeholder groups to provide recommendations on the selection of individual or composite quality measures, for use in reporting performance information to the public or for use in public health care programs.
            ‘‘(3) MULTI-STAKEHOLDER INPUT.—Not later than February 1 of each year (beginning with 2011), the consensus-based entity described in paragraph (2) shall transmit to the Secretary the recommendations of multi-stakeholder groups provided under paragraph (2). Such recommendations shall be included in the transmissions the consensus-based entity makes to the Secretary under the contract provided for under section 1890.
            ‘‘(4) REQUIREMENT FOR TRANSPARENCY IN PROCESS.—
                ‘‘(A) IN GENERAL.—In convening multi-stakeholder groups under paragraph (2) with respect to the selection of quality measures, the consensus-based entity described in such paragraph shall provide for an open and transparent process for the activities conducted pursuant to such convening.
                ‘‘(B) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS.—The process under paragraph (2) shall ensure that the selection of representatives of multi-stakeholder groups includes provision for public nominations for, and the opportunity for public comment on, such selection.
            ‘‘(5) USE OF INPUT.—The respective proposed rule shall contain a summary of the recommendations made by the multi-stakeholder groups under paragraph (2), as well as other comments received regarding the proposed measures, and the extent to which such proposed rule follows such recommendations and the rationale for not following such recommendations.
            ‘‘(6) MULTI-STAKEHOLDER GROUPS.—For purposes of this subsection, the term ‘multi-stakeholder groups’ means, with respect to a quality measure, a voluntary collaborative of organizations representing persons interested in or affected by the use of such quality measure, such as the following:
                ‘‘(A) Hospitals and other institutional providers.
                ‘‘(B) Physicians.
                ‘‘(C) Health care quality alliances.
                ‘‘(D) Nurses and other health care practitioners.
                ‘‘(E) Health plans.
                ‘‘(F) Patient advocates and consumer groups.
                ‘‘(G) Employers.
                ‘‘(H) Public and private purchasers of health care items and services.
                ‘‘(I) Labor organizations.
                ‘‘(J) Relevant departments or agencies of the United States.
                ‘‘(K) Biopharmaceutical companies and manufacturers of medical devices.
                ‘‘(L) Licensing, credentialing, and accrediting bodies.


‘‘(7) FUNDING.—

    ‘‘(A) IN GENERAL.—The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $1,000,000, to the Secretary for purposes of carrying out this subsection for each of the fiscal years 2010 through 2014.
    ‘‘(B) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out the provisions of this subsection, in addition to funds otherwise available, out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services $1,000,000 for each of the fiscal years 2010 through 2014.’’.

SEC. 1444. APPLICATION OF QUALITY MEASURES.
    (a) INPATIENT HOSPITAL SERVICES.—Section 1886(b)(3)(B) of such Act (42 U.S.C. 1395ww(b)(3)(B)) is amended by adding at the end the following new clause:
        ‘‘(x)(I) Subject to subclause (II), for purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year 2012 and each subsequent fiscal year, the quality measures specified under clause (viii) shall be measures selected by the Secretary from measures that have been endorsed by the entity with a contract with the Secretary under section 1890(a).
        ‘‘(II) In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical quality measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.’’.
    (b) OUTPATIENT HOSPITAL SERVICES.—Section 1833(t)(17) of such Act (42 U.S.C. 1395l(t)(17)) is amended by adding at the end the following new subparagraph:
        ‘‘(F) USE OF ENDORSED QUALITY MEASURES.—The provisions of clause (x) of section 1886(b)(3)(C) shall apply to quality measures for covered OPD services under this paragraph in the same manner as such provisions apply to quality measures for inpatient hospital services.’’.
    (c) PHYSICIANS’ SERVICES.—Section 1848(k)(2)(C)(ii) of such Act (42 U.S.C. 1395w–4(k)(2)(C)(ii)) is amended by adding at the end the following: ‘‘The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.’’.
    (d) RENAL DIALYSIS SERVICES.—Section 1881(h)(2)(B)(ii) of such Act (42 U.S.C. 1395rr(h)(2)(B)(ii)) is amended by adding at the end the following: ‘‘The Secretary shall submit such a non-endorsed measure to the entity for consideration for endorsement. If the entity considers but does not endorse such a measure and if the Secretary does not phase-out use of such measure, the Secretary shall include the rationale for continued use of such a measure in rulemaking.’’.
    (e) ENDORSEMENT OF STANDARDS.—Section 1890(b)(2) of the Social Security Act (42 U.S.C. 1395aaa(b)(2)) is amended by adding after and below subparagraph (B) the following:
        ‘‘ ‘If the entity does not endorse a measure, such entity shall explain the reasons and provide suggestions about changes to such measure that might make it a potentially endorsable measure.’ ’’.
    (f) EFFECTIVE DATE.—Except as otherwise provided, the amendments made by this section shall apply to quality measures applied for payment years beginning with 2012 or fiscal year 2012, as the case may be.

SEC. 1445. CONSENSUS-BASED ENTITY FUNDING.
    Section 1890(d) of the Social Security Act (42 U.S.C. 1395aaa(d)) is amended by striking ‘‘for each of fiscal years 2009 through 2012’’ and inserting ‘‘for fiscal year 2009, and $12,000,000 for each of the fiscal years 2010 through 2012.’’


PART III-SOCIAL SECURITY ACT SECTION 1890

Note, as referenced above, Social Security Act Section 1890 (42 U.S.C. 1395aaa) as copied from http://www.ssa.gov/OP_Home/ssact/title18/1890.htm

"Sec. 1890. [42 U.S.C. 1395aaa] (a)Contract.—

(1) In general.—For purposes of activities conducted under this Act, the Secretary shall identify and have in effect a contract with a consensus-based entity, such as the National Quality Forum, that meets the requirements described in subsection (c). Such contract shall provide that the entity will perform the duties described in subsection (b).

(2) Timing for first contract.—As soon as practicable after the date of the enactment of this subsection, the Secretary shall enter into the first contract under paragraph (1).

(3) Period of contract.—A contract under paragraph (1) shall be for a period of 4 years (except as may be renewed after a subsequent bidding process).

(4) Competitive procedures.— Competitive procedures (as defined in section 4(5) of the Office of Federal Procurement Policy Act (41 U.S.C. 403(5))) shall be used to enter into a contract under paragraph (1).

    (b) Duties.—

        (1) Priority setting process.—The entity shall synthesize evidence and convene key stakeholders to make recommendations, with respect to activities conducted under this Act, on an integrated national strategy and priorities for health care performance measurement in all applicable settings. In making such recommendations, the entity shall—

            (A) ensure that priority is given to measures—

                (i) that address the health care provided to patients with prevalent, high-cost chronic diseases;

                (ii) with the greatest potential for improving the quality, efficiency, and patient-centeredness of health care; and

                (iii) that may be implemented rapidly due to existing evidence, standards of care, or other reasons; and

            (B) take into account measures that—.

                (i) may assist consumers and patients in making informed health care decisions; ‘‘(ii) address health disparities across groups and

                (ii) address health disparities across groups and areas; and

                (iii) address the continuum of care a patient receives, including services furnished by multiple health care providers or practitioners and across multiple settings.

        (2) Endorsement of measures.—The entity shall provide for the endorsement of standardized health care performance measures. The endorsement process under the preceding sentence shall consider whether a measure— ‘‘(A) is evidence-based, reliable,

            (A) is evidence-based, reliable, valid, verifiable, relevant to enhanced health outcomes, actionable at the caregiver level, feasible to collect and report, and responsive to variations in patient characteristics, such as health status, language capabilities, race or ethnicity, and income level; and

            (B) is consistent across types of health care providers, including hospitals and physicians.

        (3) Maintenance of measures.—The entity shall establish and implement a process to ensure that measures endorsed under paragraph (2) are updated (or retired if obsolete) as new evidence is developed.

        (4) Promotion of the development of electronic health records.—The entity shall promote the development and use of electronic health records that contain the functionality for automated collection, aggregation, and transmission of performance measurement information.

        (5)Annual report to congress and the secretary; secretarial publication and comment.—

            (A)Annual report.—

                (i) the implementation of quality measurement initiatives under this Act and the coordination of such initiatives with quality initiatives implemented by other payers;

                (ii) (ii) the recommendations made under paragraph (1); and

                (iii) the performance by the entity of the duties required under the contract entered into with the Secretary under subsection (a).

            (B) Secretarial review and publication of annual report.— Not later than 6 months after receiving a report under subparagraph (A) for a year, the Secretary shall—

                (i) review such report; and

                (ii) publish such report in the Federal Register, together with any comments of the Secretary on such report.

    (c) Requirements Described.— The requirements described in this subsection are the following:

            (1) Private nonprofit.— The entity is a private nonprofit entity governed by a board.

            (2)Board membership.—

                (A) representatives of health plans and health care providers and practitioners or representatives of groups representing such health plans and health care providers and practitioners;

                (B) health care consumers or representatives of groups representing health care consumers; and

                (C) representatives of purchasers and employers or representatives of groups representing purchasers or employers.

            (3) Entity membership.—The membership of the entity includes persons who have experience with—

                (A) urban health care issues;

                (B) safety net health care issues;

                (C) rural and frontier health care issues; and

                (D) health care quality and safety issues.

            (4) Open and transparent.— With respect to matters related to the contract with the Secretary under subsection (a), the entity conducts its business in an open and transparent manner and provides the opportunity for public comment on its activities.

            (5) Voluntary consensus standards setting organization.— The entity operates as a voluntary consensus standards setting organization as defined for purposes of section 12(d) of the National Technology Transfer and Advancement Act of 1995 (Public Law 104–113) and Office of Management and Budget Revised Circular A–119 (published in the Federal Register on February 10, 1998).

            (6) Experience.—. The entity has at least 4 years of experience in establishing national consensus standards

            (7) Membership fees.— If the entity requires a membership fee for participation in the functions of the entity, such fees shall be reasonable and adjusted based on the capacity of the potential member to pay the fee. In no case shall membership fees pose a barrier to the participation of individuals or groups with low or nominal resources to participate in the functions of the entity.

(d) Funding.— For purposes of carrying out this section, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of $10,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2009 through 2012.

Thank you very much for taking the time to do this little bit of what most Congresspersons and Senators will not do at all, and have myriad excuses to not accomplish:  read the bill.  Towing the party-line, making up for decades of frustration for many a politician whose been in Washington for decades solely to bask in the glory of their new found power, but democrat and republican alike.  Oddly they forget they serve at our pleasure.  When we speak, they shall be quiet.  When we yell, they shall take note of the import of what we have to say.  We are not the subjects of a sovereign government but they are the subjects of a soverieign people!  It is about time we remember they are the tail and we are the dog, that those limits placed on them, the ones further affirmed by the 10th Amendment, are there to protect us from government, while empowering government to take it's proper role and place in our lives.  Our failure to recognize and remember this is something politicians and every other broker of power, of currency manipulations of all sorts, has been wanting and waiting for since our Birth as a Nation.


Toddy Littman