Health Provisions Slipped into Stimulus Package

kmoonshine, RN · Feb 11, 2009

Just a thought: would these new "rules and regulations" be applied to our president, senators, congressmen/congresswomen etc? I doubt it.

We (the American people) should receive the same quality of health care as our elected officials. Afterall, we put them in office...

As far as futile treatment - yes, we need to rethink this and focus on future "prevention" rather than fixing problems as they arise (ie HTN, kidney failure, etc). In my opinion, non-compliant pts are not entitled to treatment and should pay out-of-pocket should they continue their health-destructive ways (ie non-compliant diabetic eating cake and drinking beer prior to drs appt with blood sugars running well over 300 and on dialysis and natrecor infusions for chf; etc).

We also need to re-examine the amount of money medicare pays out for ICU care at the end-of-life, and "futile" treatments. It would be better for the pt to receive hospice and to die with dignity rather than to undergo aggressive and painful treatments with no hope of recovery only to die in ICU on a vent with skin breakdown.

We do have amazing medical treatments, but they should be used under appropriate circumstances. Its difficult for a young person to receive quality preventitive care, and its even harder to receive specialized care for a young adult. However, as we get older there seems to be an army of specialists ready and willing to write prescriptions for pills and perform surgeries when there is little chance of full recovery. So, as our children lack basic health care and our young adults forgo basic physicals due to lack of finances, grandma who is 89 yrs old is getting prepped for a CABG and can barely consent due to her progressing dementia...

Jolie, BSN · Feb 11, 2009

Just a thought: would these new "rules and regulations" be applied to our president, senators, congressmen/congresswomen etc?

No. They have a plan unto themselves that differs from Medicare, Medicaid, the VA system and every other federal program designed for ordinary citizens.

mawa · Feb 11, 2009

This is very troubling to say the least....government control of our lifestyle choices, and as the result, control of what medical treatment we may/may not receive. Not a good idea....this is a slippery slope that not only takes away personal freedom but also can easily lead to euthanasia by deciding "who is worthy" of healthcare and life. I'm all for living a healthy lifestyle and educating the masses about the risks involved in poor diet, lack of exercise, rising incidence of chronic disease, at risk behaviors, etc. however, I thought this was the United States and that personal freedom meant just that....freedom to live the way you want to live without government interference. Freedom to choose the way you want to live or die, freedom to enjoy whatever it is that gives you happiness. I know some of these choices will and do result in negative consequences, however, we should be able to make those choices for ourselves and live or not with the consequences. We're constantly being told about risks, etc and will not be able to say we weren't warned, so we should be able to "make our own bed and sleep in it", right? Perhaps it's time for another tea party? Just my thoughts about this.....

allnurses Guide · Feb 11, 2009

i cannot find any rules and "regulations" limiting any care for anyone in the bill!

please don't just assume.

please provide a quote.

it seems people are debating a fantasy.

i already posted links to the bill twice.please read this section:

http://thomas.loc.gov/cgi-bin/query/...ecamre:e216072:

and/or the entire hr bill:

http://frwebgate.access.gpo.gov/cgi-...f:h1eh.txt.pdf

please read befor formulating an opinion.

for your convenience:

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 11, 2009

i cannot find any rules and "regulations" limiting any care for anyone in the bill!
please don't just assume.
please provide a quote.
it seems people are debating a fantasy.
i already posted links to the bill twice.please read this section:
http://thomas.loc.gov/cgi-bin/query/...ecamre:e216072:
and/or the entire hr bill:
http://frwebgate.access.gpo.gov/cgi-...f:h1eh.txt.pdf
please read befor formulating an opinion.
for your convenience:

your links did not work for me.

allnurses Guide · Feb 11, 2009

Thank you. I'm trying to attach the PDF

Jolie, BSN · Feb 11, 2009

Herring, the following article is a good place to start.

http://www.cnsnews.com/public/content/article.aspx?RsrcID=43358

Stimulus Bill Raises Concerns Over Government Rationing of Health Care

Wednesday, February 11, 2009

By Fred Lucas, Staff Writer

(CNSNews.com) - Two provisions in President Barack Obama’s economic stimulus plan could give the federal government the authority to oversee the medical decisions made between doctors and patients, critics warn, which could result in the rationing of health care. The plan to make all health records electronic and establish an effectiveness board to review health care costs was part of the $838 billion economic stimulus bill that passed the Senate Tuesday....

Further, the legislation also spends $1.1 billion to establish a Federal Coordinating Council for Comparative Effectiveness Research, which would serve as an umbrella group for all federal health programs, including Medicare, Medicaid, S-CHIP, and veterans’ care, with 15 members from various federal agencies making determinations about health care needs and cost-effective treatments....

The bill also indicates that a doctor who is not a “meaningful EHR user” in terms of using patients’ health records to provide the most cost-efficient coverage could face penalties.... One problem critics note is that the electronic medical records will be mandatory. “I am not against electronic records,” Betsy McCaughey, former lieutenant governor of New York, told CNSNews.com. “I am against coercing doctors to limit care. I certainly do not support vague guidelines. E-records are fine as long as they are not mandatory.”

McCaughey, an adjunct senior fellow at the conservative Hudson Institute, told CNSNews.com there is “no question” that the goal is to ration health care to control costs. That is achieved, she said, by first putting every individual in a medical treatment database, and secondly by putting the new effectiveness council in charge of providing doctors with guidelines for how to most effectively treat those patients based on the data.

“The powers of the secretary of Health and Human Services are so vague as to raise constitutional questions,” McCaughey said. “The guidelines of what is cost effective could penalize doctors for providing too much care. Treatment decisions guided by the information in the database could determine if a doctor is providing inappropriate care, or excessive care, which would be defined as giving more care to one patient than other patients. This is harmful to patients.”

“A better way to generate comparative-effectiveness information would be for Congress to eliminate government activities that suppress private production,” the Cato study said. “Congress should let workers and Medicare enrollees control the money that purchases their health insurance. Further, Congress should require states to recognize other states’ licenses for medical professionals and insurance products.”

Though the bill, still under final revision in Congress, states that privacy of electronic health records will be protected, Sue Blevin, president of the Institute for Health Freedom, is concerned that there is not an opt-out for people who choose not to have their records computerized and entered into the national network.

“Without those protections, Americans’ electronic health records could be shared – without their consent – with over 600,000 covered entities through the forthcoming nationally linked electronic health records network,” Blevin said in a statement.

“Unless people have the right to decide if and when their health information is shared or whether to participate in research studies, they don’t have a true right to privacy.”

The bill establishes 2 boards, one for the oversight of electronic medical records and one for the oversight of utilization of health care resources. It is the latter that raises the most concerns. The first was actually established by Bush, but never implemented to any degree. The board overseeing health care resources technically only applies to government health plans, but private plans that fail to follow its provisions will be taxed so heavily as to be put out of business. So in essence it is regulation of both the public and private sectors.

Most of the health care related provisions in the Stimulus Bill come from Tom Daschle's book, Critical. I highly recommend reading this. It is an eye-opening description of his future view of America's health care system, and apparently is endorsed by Obama. Frightening.

Jolie, BSN · Feb 11, 2009

An interesting and objective take on the Federal Coordinating Council for Comparative Effectiveness Research:

http://www.nationalhealthcouncil.org/forms/press-releases/1.29.09-PR.pdf

Jolie, BSN · Feb 12, 2009

Daschle's own words on the Federal Coordinating Council for Comparative Effectiveness Research:

By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed.

This statement from Daschle’s blue print for health reform, “Critical: What We Can Do About the Health Care Crisis”, shows that the intent of federally funded comparative effectiveness research is to enable the government to ration care. While the provision does not yet have teeth it is a place holder for the liberals’ universal health care plan. In the words of Daschle:

The Federal Health Board wouldn't be a regulatory agency, but its recommendations would have teeth because all federal health programs would have to abide by them…Congress could opt to go further with the Board's recommendations. It could, for example, link the tax exclusion for health insurance to insurance that complies with the Board's recommendation.

full file:http://rsc.tomprice.house.gov//UploadedFiles/AdvisoryHealthBd1_23_09.pdf

flightnurse2b, LPN · Feb 12, 2009

dont look at me, i didnt vote for him. infact i was saying that exactly this was going to happen! there is not one gov. run program in this country that runs well (wellfare, ss, unemployment etc etc etc) so why will gov run health care be any different?? i know that the current problems w the insurance companies was bad too, but not like this. how is it fair that someone with an education, a good job, and what used to be decient benefits (and had the ability to pay out of pocket if they so choose) is now going to have the exact same coverage as someone who has never worked a day in their life, lives off welfare and ss? im not saying that i am better than anyone but i have made smart choices so that i dont have to worry about alot of this stuff. it just doesnt make sence to me that i have to take what the gov gives me and can not pay for any more if i want to because i would be getting better treatment than someone else who never worked for anything?

i think it's funny you say "i've made smart choices so that i dont have to worry about alot of this stuff".

smart choices don't prevent you or your loved ones from getting sick. the education, a good job, and decent benefits are great to have--- but that doesn't dictate who needs medical care and who doesn't.

my mother is a registered nurse. my father was a stock broker, before he became disabled. both are well educated with great benefits. mom was healthier than anyone, worked out everyday, ate right, didn't smoke. my mom got diagnosed with ovarian CA with mets to the uterus and cervix and a sarcoma attached to the outside of her ovary and her omentum @ age 35. HER INSURANCE DENIED COVERAGE. the doctors "in network" told her to write her will and plan her funeral, and with four children, my mom told them to take a hike. my parents were fortunate enough to afford to pay for an expirimental 12 hour surgery, her rounds of chemo and her stay in the hospital by cashing in numerous investments. they paid out of pocket.

if i were to have the same diagnosis today, i'd be signing the will, or attempting to pay for treatment and lose everything i have and end up homeless. i don't have that kind of money. i have a good job, an education and decent benefits too. bad luck and disease don't spare people for making smart choices. don't be so silly to think it couldn't happen to you.

what i find funny is that most people who say "you liberals are closed minded" are the ones opposed to this system in partial because they have an education, a job and health insurance and wonder why in God's name should they share what they have with those who "didn't make smart choices". that's the mind-set i see.... as long as you got your seat, who cares about anyone else?

just because someone made bad choices or has bad luck, does that make them less worthy of getting good care? should they just be allowed to die because they aren't well educated, have a good job, good benefits-- or their insurance denies the claims and leaves them no choice but to run out of money and lose everything?

whatever.

Meredith09 · Feb 12, 2009

I posted links to the bill.
PLEASE quote the language you refer to.
I cannot find it.

"In addition, $400,000,000 shall be available for comparative effectiveness research to be allocated at the discretion of the Secretary of Health and Human Services (`Secretary'): Provided, That the funding appropriated in this paragraph shall be used to accelerate the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies, including through efforts that: (1) conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions; and (2) encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data: Provided further, That the Secretary shall enter into a contract with the Institute of Medicine, for which no more than $1,500,000 shall be made available from funds provided in this paragraph, to produce and submit a report to the Congress and the Secretary by not later than June 30, 2009, that includes recommendations on the national priorities for comparative effectiveness research to be conducted or supported with the funds provided in this paragraph and that considers input from stakeholders: Provided further, That the Secretary shall consider any recommendations of the Federal Coordinating Council for Comparative Effectiveness Research established by section 9201 of this Act and any recommendations included in the Institute of Medicine report pursuant to the preceding proviso in designating activities to receive funds provided in this paragraph and may make grants and contracts with appropriate entities, which may include agencies within the Department of Health and Human Services and other governmental agencies, as well as private sector entities, that have demonstrated experience and capacity to achieve the goals of comparative effectiveness research"

This $400 mil is one part of over $2 bil just for this part of the "stimulus" bill. Let me just say up front that the one part of this $2 bil that I don't have a beef with is the $600 mil that they want to throw at the National Health Service Corps (educates much-needed primary care physicians, NPs, other HCW in exchange for several years of service to communities in need of them), even though I'm still not sure it should be included in this stimulus bill that has been touted as absolutely critical at this time, as opposed to being included in some other separate legislation to be constructed at a later date. But that's beside the point.

Aside from that...this section of the bill is a hell of a lot more dangerous than its language might make it appear:

First, the results of this "research assessing the comparative effectiveness of health care treatments and strategies" that they refer to will ultimately determine who receives federal funding for their research and programs in the future, based on what named entities--"agencies within the Department of Health and Human Services and other governmental agencies, as well as private sector entities"--"have demonstrated experience and capacity to achieve the goals of comparative effectiveness research." HMM...Playing the naive card, I would imagine that I am supposed to believe that, seeing as how this is included in a so-called "stimulus package," the goals of this research include creating jobs, jump-starting the economy, etc. But alas, I *humbly* consider myself an intelligent human being, and as such, I took a closer look at the goal statement included at the beginning of this little gem of political rhetoric:

"the funding appropriated in this paragraph shall be used to accelerate the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies, including through efforts that: (1) conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions; and (2) encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data."

Translation: 1) The federal government wants to spend a massive amount of money to determine what constitutes effective and appropriate treatment of patients, so that they can--and here's the ironic part--save money in the future! How much money will be saved, I ask?? I see no such estimate in this bill that justifies this outlandish initial cost, which will, no doubt, come at the expense of true quality patient care. "Sorry, Grandma! You're just too old to be spending money on!"

2) They want to design, conduct, and interpret the results of their research by June 30, 2009, at which point they want to present a complete report to Congress. All of this in LESS THAN FOUR MONTHS?? I smell bad science in the works here; there is no way such a report can be an accurate and trustworthy measure of what "effective and appropriate" treatment is! This report will then be used, in part, to decide who receives future funding for further research. It also stipulates that preference (monetary and otherwise) be given to such agencies "that have demonstrated experience and capacity to achieve the goals of comparative effectiveness research." In other words, scratch our back, we'll scratch yours. Gentle reminder: this whole thing is being billed as a way to save money...yet this very piece of legislation promises future federal funding to the select few "good apples" who step up to play on Big Brother's team--and only the most valuable players in this game will ever be rewarded.

Whoever penned this should have their head examined...unless, of course, they are deemed an unjustifiable expense.

Just my :twocents:

Quark09 · Feb 12, 2009

I just wanted to say thank you to those of you who have taken the time to look up additional information pertaining to this discussion and post it here for the rest of us to read...when I have time I like to surf around and search for information, but when I don't it's a huge help to have it readily available on-site. :flowersfo