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Health Care Reform Bill (HR 3200) - My Reading Continues.... Now I'm Mad and Even More Motivated to Finish

I resumed my reading of HR 3200 over the past day or two, having been bogged down with actual money-making behaviors (imagine that!). If you would like to see all of my previous posts on this topic, you can visit my site at:

The notes below are for pages 368-434, out of a total 1,017. The next post should take us to the midway point of the bill. :)

Interestingly, my eight-year old daughter announced yesterday that she intends to read the entire unabridged dictionary, which is a mere 2662 (very large) pages with very small font. Frankly, I believe her, since she is the fastest reader in our house, and we are not slouches around here, believe me. This was unrelated to my own project - just thought it was supremely cool.

Incidentally, the video below is from Thomas R. Carper, an actual member of the Senate Finance Committee, who said that he has no intention of reading the bill, nor does he think that others can even understand it. Sorry to burst your bubble, Senator Carper, but some of us are actually reading it, and it's not "incomprehensible" (your word). Either you need to produce legislation in "plain English" (again, a quote from you), or read the bill before you vote on it. Anything less is criminal, especially on a topic that has the potential to affect everyone in the United States. I may need to run for Congress after all, when I see guys like this making a mockery of the process:


As I mentioned last time, from here on out, I will provide a glossary of terms that I am learning as I read:

TELEHEALTH: According to Wikipedia, this refers to the delivery of health-related services and information via telecommunications technologies. Telehealth delivery could be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using videoconferencing between providers at facilities in two countries, or even as complex as robotic technology.

LEP - Limited English Proficient - This is a nice/official way of referring to someone who cannot speak English very well.

ESRD - End-stage renal disease - My mother-in-law passed away from this in May, so we are relatively well-versed about kidney disease and dialysis in our house.



(a) In General- Not later than 6 months after the date of the completion of the study described in section 1221(a), the Secretary, acting through the Centers for Medicare & Medicaid Services, shall carry out a demonstration program under which the Secretary shall award not fewer than 24 3-year grants to eligible Medicare service providers (as described in subsection (b)(1)) to improve effective communication between such providers and Medicare beneficiaries who are living in communities where racial and ethnic minorities, including populations that face language barriers, are underserved with respect to such services. In designing and carrying out the demonstration the Secretary shall take into consideration the results of the study conducted under section 1221(a) and adjust, as appropriate, the distribution of grants so as to better target Medicare beneficiaries who are in the greatest need of language services. The Secretary shall not authorize a grant larger than $500,000 over three years for any grantee.

MY NOTE: I realize that the paragraph above is a big portion of the bill to include, but this is proposing to allocate up to $12 million in grant money to Medicare service providers so that they can hire interpreters (referenced slightly earlier in the bill) for places where there are language barriers. I don't think I want to help fund this, frankly. Prepare yourself mentally, because this is going to sound uber-conservative of me to say, but if you are living in the United States, and you want to take advantage of this particular government benefit, shouldn't you be able to speak the language or bring along a friend or family member who does?

Sorry if that seems harsh, but I guess I have a hard time imagining other countries making provisions for English translators if I were living there and didn't speak the language. Just an opinion. I don't think that emergency medical care should be denied to anyone, but I have a tough time supporting this portion, since it deals with Medicare specifically.

Sec. 1222 (i) Authorization of Appropriations- There are authorized to be appropriated to carry out this section $16,000,000 for each fiscal year of the demonstration program.

MY NOTE: This appears at the end of the same section. This appears to add $16 million more for translation-related services each year, along with the $12 million over three years allocated in part (a). Yikes!


MY NOTE: Generally speaking, this section seeks to extend coverage for patients with end stage renal disease, including immunosuppressive drugs, which help transplant patients (intended to keep their bodies from rejecting the new organs).

SEC. 1233. 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.

MY NOTE: Based on what I have seen/heard on the news, this is where the "death panels" comment came from. Unfortunately, like so much other stuff bandied about by politicians and pundits alike, this innocuous section has turned into something scary by those who haven't taken the time to read the bill. Basically, this entire section requires physicians (or nurse practitioners) to explain to their patients about the continuum of end-of-life services available, along with the meaning of a living will, durable power of attorney, and more. It doesn't encourage anyone to take advantage of any of these things, nor does it put the decision making in anyone's hands other than the patient himself/herself.

`(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.

MY NOTE: Clearly, this is an emotional topic, but this doesn't appear to encourage anything that isn't already in place. When my mother-in-law was very ill a couple of years ago, these topics were addressed, as they should have been. The same goes for my father, who passed away back in 2005. When our loved ones are facing the end of their lives, it's a good idea to understand their directives and treatment options, right? An advance care planning consultation does not imply that someone else is making the call.



In Section 1233, under hhh (5)(b)(i), it states, "if a patient is pulse less" - this should read "pulseless". Better yet, it should say, "if a patient has no pulse". Just my opinion.

Capitalization error: In Section 1233, (b)(1) and (b)(3), the word "physician" should be in all caps to match the remainder of the heading.

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