Obama - Healthcare 'Bait and Switch'?

[WhiskeyGirl]

From memory, in the first half of 2009, the Obama administration identified healthcare disparities as a priority.

The Obama administration used statistics to support a number of perceived disparities that affected minorities.  IIRC, some discussion involved the use of statistics instead of raw numbers.  Disparities were determined by statistics. 

Raw numbers often tell another story.  For example, there are more poor 'whites' than poor 'fill in the blank' group. 

Statistically, a non-white group may contain a higher percentage of poor people, but fewer in real numbers.

Interesting reading about disparities -

Health Disparity/Equity: Operationalizing Terms of Use
http://www.cdc.gov/about/pah/pages/pahbestPractices.htm

Abstract

This paper proposes the need for and the opportunities of operationalizing terms normally found when evaluating and reporting results of public health practices that deal with health disparity/equity. The purpose of this paper is to put forth a framework in an effort to garner consensus in the use of terms often seen in the evaluation of programs with a focus on health disparity/equity, especially within the area of health communications. The terms dealt with in this paper are: fairness, health equity, health disparity, underserved populations, health access, and health outcome.

Obama and Holder also suggested that the nation needed to have some discussions about race.  Was Obama 'baiting' Americans on the race issue?

Americans are cowards...

Beer summit at the White House...

H.R. 3200 introduced into the House.

[WhiskeyGirl]

On July 14, 2009, the House introduced -

H.R.3200 - America's Affordable Health Choices Act of 2009
http://www.opencongress.org/bill/111-h3200/text?version=ih


I would imagine, they had some inkling, that the bill would be pulled apart word by word, and people would be angry.

Why would anyone be angry?  Was the Obama administration (or Congress) baiting Americans on the issues surrounding race, ethnicity, and political favoritism?

SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE.

(5) PARTICIPATION- The membership of the Health Benefits Advisory Committee shall at least reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies. and at least one practicing physician or other health professional and an expert on children’s health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee.

Why didn't they focus on providing healthcare for everyone, regardless of the factors that make us different? 

SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN.

(e) Data Collection- The Secretary shall collect such data as may be required to establish premiums and payment rates for the public health insurance option and for other purposes under this subtitle, including to improve quality and to reduce racial, ethnic, and other disparities in health and health care.

Establishing premiums and payment rates to reduce "racial, ethnic, and other disparities" in healthcare?

Politicians deciding premiums and payments based on race, ethnic, favoritism, cronyism, and nepotism?

SEC. 224. MODERNIZED PAYMENT INITIATIVES AND DELIVERY SYSTEM REFORM.

(b) Requirements for Innovative Payments- The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that--

      (1) seeks to--

            (A) improve health outcomes;

            (B) reduce health disparities (including racial, ethnic, and other disparities);

An innovative payment system?  One designed to "reduce health disparities" based on "including racial, ethnic, and other disparities"?

Starts with 'shall'.

Why introduce a bill that provides for racial, ethnic, or political disparity preference?



H.R.3962 - Affordable Health Care for America Act - passed house 11/07/09
http://www.opencongress.org/bill/111-h3962/show

SEC. 324. MODERNIZED PAYMENT INITIATIVES AND DELIVERY SYSTEM REFORM.

      (a) In General- For plan years beginning with Y1, the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value-based purchasing, bundling of services, differential payment rates, performance or utilization based payments, partial capitation, and direct contracting with providers.

      (b) Requirements for Innovative Payments- The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that--

            (1) seeks to--

                  (A) improve health outcomes;

                  (B) reduce health disparities (including racial, ethnic, and other disparities);

Why vote for and/or support a bill that provides for racial, ethnic, or political disparity preference?


More bill numbers
S.1796 - America's Healthy Future Act of 2009
http://www.opencongress.org/bill/111-s1796/show


S.1679 - Affordable Health Choices Act
http://www.opencongress.org/bill/111-s1679/show

Why vote for and/or support a bill that provides for racial, ethnic, or political disparity preference?

Why would Obama go on the campaign trail for discrimination?

Creating an image for Obama's legacy?  Ignoring the facts?

[WhiskeyGirl]

Signed by Obama with some big changes.

H.R.3590 - Patient Protection and Affordable Care Act
http://www.opencongress.org/bill/111-h3590/text

SEC. 10334. MINORITY HEALTH.

      (a) Office of Minority Health-

            (1) IN GENERAL- Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) is amended--

                  (A) in subsection (a), by striking ‘within the Office of Public Health and Science’ and all that follows through the end and inserting ‘. The Office of Minority Health as existing on the date of enactment of the Patient Protection and Affordable Care Act shall be transferred to the Office of the Secretary in such manner that there is established in the Office of the Secretary, the Office of Minority Health, which shall be headed by the Deputy Assistant Secretary for Minority Health who shall report directly to the Secretary, and shall retain and strengthen authorities (as in existence on such date of enactment) for the purpose of improving minority health and the quality of health care minorities receive, and eliminating racial and ethnic disparities. In carrying out this subsection, the Secretary, acting through the Deputy Assistant Secretary, shall award grants, contracts, enter into memoranda of understanding, cooperative, interagency, intra-agency and other agreements with public and nonprofit private entities, agencies, as well as Departmental and Cabinet agencies and organizations, and with organizations that are indigenous human resource providers in communities of color to assure improved health status of racial and ethnic minorities, and shall develop measures to evaluate the effectiveness of activities aimed at reducing health disparities and supporting the local community. Such measures shall evaluate community outreach activities, language services, workforce cultural competence, and other areas as determined by the Secretary.’; and

An 'Office of Minority Health' charged with among other things, "improving minority health and the quality of health care minorities receive, and eliminating racial and ethnic disparities."

Why isn't everyone given the same opportunity for better health?

SEC. 1323. COMMUNITY HEALTH INSURANCE OPTION.

(6) REIMBURSEMENT RATES-

      (A) NEGOTIATED RATES- The Secretary shall negotiate rates for the reimbursement of health care providers for benefits covered under a community health insurance option.

      (B) LIMITATION- The rates described in subparagraph (A) shall not be higher, in aggregate, than the average reimbursement rates paid by health insurance issuers offering qualified health plans through the Exchange.

      (C) INNOVATION- Subject to the limits contained in subparagraph (A), a State Advisory Council established or designated under subsection (d) may develop or encourage the use of innovative payment policies that promote quality, efficiency and savings to consumers.

In the end, 'innovative payment' is no longer directly linked to racial, ethnic, or political disparities.


Another use of 'innovative payment'

PART III--ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
SEC. 3021. ESTABLISHMENT OF CENTER FOR MEDICARE AND MEDICAID INNOVATION WITHIN CMS.

      (a) In General- Title XI of the Social Security Act is amended by inserting after section 1115 the following new section:

    ‘CENTER FOR MEDICARE AND MEDICAID INNOVATION

          ‘Sec. 1115A. (a) Center for Medicare and Medicaid Innovation Established-

                ‘(1) IN GENERAL- There is created within the Centers for Medicare & Medicaid Services a Center for Medicare and Medicaid Innovation (in this section referred to as the ‘CMI’) to carry out the duties described in this section. The purpose of the CMI is to test innovative payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care furnished to individuals under such titles. In selecting such models, the Secretary shall give preference to models that also improve the coordination, quality, and efficiency of health care services furnished to applicable individuals defined in paragraph (4)(A).

(snip)

‘(2) SELECTION OF MODELS TO BE TESTED-

      ‘(A) IN GENERAL- The Secretary shall select models to be tested from models where the Secretary determines that there is evidence that the model addresses a defined population for which there are deficits in care leading to poor clinical outcomes or potentially avoidable expenditures. The models selected under the preceding sentence may include the models described in subparagraph (B).

      ‘(B) OPPORTUNITIES- The models described in this subparagraph are the following models:

            ‘(i) Promoting broad payment and practice reform in primary care, including patient-centered medical home models for high-need applicable individuals, medical homes that address women’s unique health care needs, and models that transition primary care practices away from fee-for-service based reimbursement and toward comprehensive payment or salary-based payment.

            ‘(ii) Contracting directly with groups of providers of services and suppliers to promote innovative care delivery models, such as through risk-based comprehensive payment or salary-based payment.

Is 'high-need applicable individuals' objective?  Who determines what a 'high-need' individual is?

Where did the innovative payment sections disappear to?  The payments based on racial, ethnic, and political disparity?

Was it massaged and hidden away in other parts of the bill?

Why wasn't the racial, ethnic, and political preference removed months earlier?

Why keep fueling the fire about something like this?

[WhiskeyGirl]

Somewhere along the way, there is the story of Obama and the little boy asking why everyone hates him (Obama).

Somewhere along the way, there are the stories about people lacking care, and their debunking.

Somewhere along the way, there are the stories about members of Congress and racial taunts, threats, violence...

Somewhere along the way, the finger is pointing at the Tea Party folks.  Anyone get that on tape?

Assumptions that some how, in some way the Republicans are responsible for the taunting, threats, and violence? 

Did anyone get that on tape?  Any media?

Check the phone records?  In the olden days before caller ID, police and phone companies were able to keep track of calls to a number, even when the number did not display.  Anyone track down those callers?

The 'right wing Christian militia' story.  Threaten a policeman.  Sedition.  Kill more folks at funeral.  Guns.

What about the black panthers that threatened folks at the polls in 2008?  Holder, ok you're free to go.  No harm done.

===

Did the Obama administration add to the racial tension by incorporating the race, ethnic, and political disparity into the various bills?  Letting it fester for almost a year?

Did they plan to get folks upset?  Keep them stirred up and angry?

Maybe say, ooh, the final bill isn't so bad after all...

Or, maybe for Obama's legacy, show the anger, the Tea Parties, and suggest these folks were racist all along?  Got upset about things not in the bill?

How many folks research the origins of the bill compared to the end result?

During the civil rights era, from memory and text books, Americans worked to rid the law of racial, ethnic, and other preferences.  Preference was a bad thing.

For some reason, the Obama administration (or Congress, including Teddy) wanted to add this back into our laws. 

For some reason, I recall Obama made a promise to put the bill on CSPAN and read/go over it line by line so everyone understood what was in the bill.  Did he ever do any of those things?

How a government ever justify racial, ethnic, political disparity, and favoritism, nepotism, and cronyism? 

So many fought for so long to end racism and preference.  What add it back?  What was the intention for leaving that in there for months?  Ignoring the racial, ethnic, and political preference?

Was it intentional?  Fanning the flames of distrust and anger on purpose?

An intentional Obama bait and switch?

Guns - in my family, people have always been responsible gun owners.  For many years, with regard to food, if they didn't grow it or kill it, they didn't eat it.   

Why the big to-do about some guns?  Overreaction to a comment by Sarah Palin and 'reloading'?

Is it so difficult to believe that in many families and communities, guns aren't the source of criminal activity?  Murder?  Crime?  Maybe it's a cultural disparity? 

Why isn't there an outrage about all the violence, drug and human trafficking along the Mexican border?  Why does the Obama administration and some media seem to ignore those problems?  Deaths?

Why focus on a portion of the population that does not have a history of gun violence?   

One group of fanatics v. Years of violence, drugs, and human trafficking along the uncontrolled border with Mexico?

What is the responsibility of the Obama administration for this unrest?  Dissatisfaction?

Did the Obama administration 'bait and switch' pieces of the healthcare legislation over a year to incite unrest?  Create some false impressions?

Obama - 'Bait and Switch'?

my opinions, questions, and theories