Until you have gone off the deep end on nutritional therapy as I have, a Western medicine aficionado has every reason to doubt its effectiveness. Thr only people who know how useful it is to tightly control the toxins, vitamins, and foods that go into their bodies are the people who MUST know: very sick people, usually with cancer or diseases that can’t be diagnosed and are chronically debilitating, people who sell supplements, and wackos like me who want to live long and prosper.

When I undertook my journey to better health, it was for many reasons. First, the US health care system is broken; it is costly and access is limited by a critical doctor shortage. Second, I have two young grandsons, for one of whom I will soon be the only surviving grandparent. Third, two former husbands, a former lover, and my daughter’s inlaws all suffered from cancer. Fourth, I was on anti-depressants since the death of my last husband almost fifteen years ago.

I wasn’t a bad eater to start with: no fast food, little processed food, organic fruits and vegetables, limited amounts of meat.

But then I went to the nutritionist/pharmacist in North Scottsdale, where wealthy people have access to treatments the ret of us lack. They pay out of pocket, as I did.

The nutritionist (http://www.time4health.com) administered an IGC panel for food sensitivities and then prescribed fish oil, immune support, digestive enzymes, probiotics, and a multi-vitamin high in B Complex.

He also told me to eat only grass fed beef if at all, only Wild fish, no gluten, and for me especially no dairy of any kind and no Lima,kidney, or navy beans. (the blood test showed I have intolerances to them).

He also told me to get off frappacinos and start the day with protein rather than a banana, get off the single Diet Coke I drank a day, and stick to a pretty much plant based diet.

I balked. So would you. After all, I am a healthy person. I didn’t feel bad to begin with, although I did have a little joint pain and some digestive bubbles, which I thought normal for my age.

But I am now six weeks into the program. I can stand at a cocktail party without feeling my back. I easily gave up Diet Coke and Frappacinos, without even missing them. I have ten times the energy I had before.

But the most important result so far: I am off Lexapro. Those SSRIs are supposedly very difficult to get off, with major withdrawal. I, However, cut my pills in half for a few weeks, then went to half a pill every day, and then to nothing. With no withdrawal that I noticed.

One of my best friends is an MD. He kept asking me for the “literature.” My family doctor called me “meshuga,” Yiddish for crazy. But he did agree to order another series of blood tests to find out even more about me. Trust me, there is literature being written about this every day at major medical centers as a result of new clinical trials– trials that were forced into existence by patients who demanded them, patients who offered their own experiences online, and patients simply desperate for remedies for chronic conditions. Oh, and by a health care system staggering under the costs of treating these conditions– conditions that could be halted or prevented by proper nutrition.

Don’t let the American food-industrial complex maim you. Do your own research.

Food, Inc. (Image via RottenTomatoes.com)

As the widow of a doctor, I have devoted a lot of energy to thinking how to live to a healthy old age. Life extension theory has changed radically over the course of my life.

When I was a kid, there was not much processed food, and we ate meat, vegetables, and potatoes, along with dreadful stuff like jello. Yes, we ate cookies and cake,but my mother went to a butcher and a bakery, and our foods were fresh. Calories were the main concern. You had to limit the number of calories.

Oh, and drugs were just being discovered. My doctor put me cheerfully on amphetamines to lose weight, barbiturates to sleep, and tranquilizers for anxiety. We thought they were all good for you. We now know they are as addictive as “street drugs.” Indeed, the current wave of addiction is to prescription drugs, not street drugs. Even then, I hated the side effects of those drugs and quit taking them as soon as I could.

Things changed in the 70s. When I met my mother-in-law, she had just turned 65, she was concerned with longevity, and she followed Adele Davis, who believed in high protein diets and B-12 shots. She took those. At the time, they were called “liver shots.” Those of us who didn’t take shots ate liver, because it was high in vitamin B, protein, and iron. Only later, when they began to put cows on hormones, did people become afraid to eat liver because that’s where the toxins accumulated in the cow.

When I got pregnant with my daughters, I stayed on a very high protein-and-vegetable diet because it was supposedly brain food. Pregnancy taught me about salt: cans of tuna made my ankles swell. Excessive salt, which is put into our depleted processed food to make it taste better, causes high blood pressure. So does smoking.

I had already given up smoking, because the very first inkling about the relationship of lifestyle to disease was the Surgeon General’s report in 1964 that linked smoking to heart disease.

In the 80′s, Diet for a Small Planet came out and we all became vegetarians. I grew vegetables in the 70s as well. Even then I stayed away from fast and processed food.

All the while, food processing has become more and more a chemical affair, and most food chemists and nutrition scientists trace heart disease, diabetes, and cancer to food processing: the addition of chemical preservatives, the leaching out of vital minerals and vitamins by pesticide depleted soil, and so on.

I’ve seen “Food, Inc“., in addition to “Forks Over Knives” and “Fat Sick and Nearly Dead.” The agricultural products that are subsidized (corn, dairy, beef) have ginormous PR campaigns that tell you what to eat. Then the government puts it in the school lunches and the food pyramid.

Bottom line: stay as pure as you can. I have read the medical studies. “It’s the toxins, stupid.”

You can eat beef and chicken as long as they are free range and grass-fed, and not injected with hormones, steroids, etc. Or fed wheat and corn, because those crops are now toxic because of the pesticides and the soils they are grown in. And as long as they make up less than 20% of the calories in your diet (and they have more calories than plant-based foods). My nutritionist says to prefer grass-fed beef (if eating out) to farmed fish, because farmed fish is fed toxic grains and hormones. Wild fish is best, but even it is polluted with mercury.

Stick to green leafy vegetables and fruits like berries and watermelon and citrus that don’t have much sugar. Sugar creates havoc in the blood, because it causes your energy to fluctuate wildly even if you aren’t diabetic. Protein evens out the blood sugar, which is why you need it. Nuts and seeds are also good, although you have to be careful what chemicals they are prepared with (barbecued or honey roasted nuts can be full of chemicals). Starch, by the way, becomes sugar during the digestive process, so forget potatoes and anything but whole grain bread.

Wheat free is desirable, but not necessary. I am now wheat free, and have more energy. I am also dairy free, which probably IS necessary because of the toxins in the feed our cows are given. And in my case, I’m intolerant of dairy.

Which brings me to my final step of how to fine tune: I went for a series of blood tests, including an IGC panel. That panel told me what foods I was sensitive to, which means which foods cause inflammation in my particular body. I eliminated them.

The current scientific thinking is that most disease is caused by inflammation. Cholesterol doesn’t necessarily cause heart attacks; inflammation does. It breaks the cholesterol loose and sends it through the blood. Cancer is also thought to be inflammation, which weakens the immune system so it doesn’t automatically just kill the cells that become aberrant.

And here’s where stress comes in: stress also weakens the immune system. Anything that causes the immune system, which weakens anyway with age, to weaken further could be a cause of disease. For example, stress causes the blood to pump harder against the walls of the heart, which causes high blood pressure,
which in turn causes thickening and enlarging, which in turn causes less efficient pumping, which can cause heart failure.

The health care system has known all this for a while, but has chosen to address it with technological fixes (surgery) rather than root causes (change the way you live). Now that we can’t afford ourselves as a sickly nation, you will see the preventive measures come into play. They are our “austerity program,” but they should have been our program all along, IMHO.

On balance, I feel great. My arthritis and high blood pressure, caused by excessive exercise and stress, are now controlled. What have I given up? Dairy, wheat, and processed food (which I never ate anyway). What haven’t I given up? Red wine and dark chocolate. I haven’t found any articles that tell me they aren’t good for me.

Here at Health 2.0 there is definitely an air of transformation. Several initiatives that I had been following have come to fruition, or at least to critical mass, among them implementation of EMRs and patient communities. MedHelp now has over 12 million visitors a month, while millions of women annually visit the women’s social health site EmpowHER.com

On the electronic medical records side,  physicians have finally begun to implement EMRs in large numbers, because they are now subsidized by ARRA, the stimulus bill (you remember, the one that didn’t work?) to do so. In order to receive $50,000 to deploy an EMR, a physician need only buy one and demonstrate its “meaningful use” in his practice. For this year, to qualify for the Medicaid meaningful use incentive, all you had to do was purchase the software and go live in your practice. In the future, there will be other, more important qualifiers, such as the health outcomes of your patients. But for this year, just buy the product and begin to use it.

As a result, companies like Practice Fusion, which always made its software free, and is a (private) cloud-based platform have begun to grow by leaps and bounds. Founded in 2005, Practice Fusion grew by 400% in 2009 with the passage of ARRA now has 100,000 users and 21,000,000 patient records online. Next year, it is projected to have  100,000,000 records. Its iPhone app will launch soon, and its iPad app is being designed by one of the country’s top designers, who will speak at Practice Fusion’s user conference in November.

As part of an “exclusive” interview  with Practice Fusion’s founder and CEO, Ryan Howard, in which we took a pedicab ride around downtown San Francisco, I found out that within the next few years, users of EMRs like Practice Fusion will be able to choose physicians based on whether they have EMRs and allow the patient to have access to his or her data. After five years of waiting for the market to catch up with his innovation, Ryan has found himself sitting pretty, with open data ready for the new wave.

[ Aside: I also found out that in the early days of the company, Ryan actually took an insurance settlement check for an automobile accident and used it to make payroll instead of having his torn rotator cuff fixed. Yes, he's a hard core entrepreneur]

However, if you are a patient of the VA, of Medicare, or of any other insurer that is part of the Blue Button initiative, you can get your data today, by logging into VA.gov or Medicare.gov and registering online. Once you prove your identity, you will be given an opportunity to use the Blue Button  to download your data as a text file, or view it as a .pdf . You can save the data to your hard drive or send it to a PHR, such as Health Vault.

Everyone in health IT is looking at the proliferation of mobile devices and wireless communications capacity and they are salivating. Now, they say, we are finally going to be able to monitor the vital signs, activity levels, food intake, lifestyle habits of patients and use all this information for prevention. Remote monitoring will bring about the Holy Grail in prevention. And prevention will lower costs.

Not so fast, Kimo Sabe.

For my birthday this year, I got an iPod Nano Watch. The new Nano has a pedometer built in and it uploads your data to Nike. I have been wearing it every day, even though that means I have to charge it every night (this is decidedly sub-optimal for a watch). Faithfully I count my steps and upload them. Rarely do I have get to 10,000 steps a day, except at BlogWorldExpoNY, where I went over the top twice. Most days a dog walk and a trip to the gym put me at 6,000 or so steps.

The Nano Watch replaced my Fitbit, which I wore faithfully all last year. The Fitbit was more complicated and gave me even more information. It tracked my activity, and if I wore it at night, it tracked my sleep patterns and told me how effectively I was sleeping. I also could log my food.

For months I found out that I have a banana and a frappacino for breakfast, some other kind of fruit in mid-morning, along with a diet Coke right before lunch. I then have a salad of some kind or a sandwich on one piece of bread for lunch, fish and a vegetable for most dinners, 2 glasses of wine, and about half a chocolate bar (dark) after dinner. Every once in a while it varies, but most days, that’s it. Oh, and I sleep at 97%.

I gave up the Fitbit because I had the knowledge. And what did I do with it?

Nothing.

The same thing I am doing with the data I am uploading to Nike. Nothing.

Why? Because now I have to make real changes, and the biggest thing I’ve learned from all these monitoring devices is that I AM NOT WILLING TO DO THAT!

There are certain things all the remote monitoring in the world won’t fix. I’ve read about the applications that will tell doctors whether I have taken my pills, too. But if I don’t want to take them, can’t I still refuse the reminder phone call? Or even thank the (probably robo-) caller, hang up and do nothing?

The technology, as usual, is far ahead of the user. And until it gets into our heads and convinces us that we MUST change, we probably won’t. This is the saddest part of all the talk about invoking “prevention” to lower healthcare costs. All of that requires participation by the patient. It’s not dictated by the provider, the payer, or least of all by the health IT product manager.

Anybody want a Wakemate? I have one of those, too.

My friend Robert Scoble just came back from Davos and spoke to Andrew Thompson of Proteus Biomedical, a company that keeps track of your medications and sends information about your health condition to your phone. If you are a provider, or an insurer, please adopt this as soon as it gets FDA-approved (going through the process now).

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Please listen. The medication’s effects are transmitted through the skin to the cell phone. The product tracks medication compliance and medical condition. It was working on an Android phone with Bluetooth. The information is stored on a bandaid.

The business model for this product should vastly decrease the cost of healthcare. Thompson: ” a drug to Proteus is like a song to Apple. The hardware, the data, and the content are all monetized separately like the iTune store.” does it.

Tech is loved, and health care is hated. That’s because tech is used by individuals to empower themselves. Healthcare is now used by governments and insurers. Thompson wants healthcare to be as empowering to the individual as technology.

The greatest opportunity for cost savings and increased quality in health care is mobile wireless technology.  Many engineers already know this;  Withings‘ scale that sends information to the computer, Nike and the iPod, and Fitbit come to mind, transmitting user fitness data to online databases. But why can’t this be done for medical patients — diabetics, heart failure patients, and others who would benefit from continuous monitoring?

It can, and it is already beginning. According to a blog post by Dr. Unplugged, (aka Dr. Joseph Smith), of the Western Wireless Institute:

The connected person of the future will carry a personal Communicator (PERC) whose function is to connect that person to the optimum network and to be aware of the user’s precise location. There will be at least a half dozen network choices depending upon the location, the user’s priorities and budget, etc. The device will be located on the body in a customized fashion as simple as belt-worn or as complex as an ankle worn unit that charges kinetically. Inputs to the PERC come from a selection of devices tailored to the needs of the user including some devices that could be embedded in the PERC.

Thus, one configuration might be a cell phone much like a modern smart phone. More likely, the “phone” itself would be optimized as a behind-the-ear or embedded device. The user’s running shoes might include sensors that derive calories expended as well as other performance measures, and a variety of health related sensors would be mounted on the body as determined by the user’s specific problems, age, interests, or genetic data.  Input would also come from external devices such as the bathroom scale, mattress, and automobile.

The PERC contains, in effect, the identity of the user and thus would become the focus of commercial transactions (obsolescing the credit card and even money), security systems, and the like. Depending upon the user’s desires and sensitivity to privacy issues (all of which will be creatively and effectively addressed) the user’s health, fitness, eating habits, and financial health could be continuously monitored in addition to enhance versions of the already implemented communications ability (phone calls, texting, and social networking of many kinds).

This is the vision of Martin Cooper, who invented the cell phone. Cooper says there’s no reason why people can’t be continuously monitored wirelessly, and their data fed to a central source like the physician’s office, where it can send out an alert if there’s a noteworthy or dangerous variation.

A recent study says consumers want mobile health, and will pay for it:

Worldwide about 70 percent of people are interested in having access to at least one mHealth application, according to …Pyramid Research. What’s more they are willing to pay for that access, the report found. Pyramid also estimates that about 200 million mHealth applications are in use today and that number will triple by 2012.

Think  how this might help patients with cardiac arrhythmias, who show up in the doctor’s office and then can’t duplicate the feeling they had when they called to make the appointment.  These patients, who now have to wear a Holter monitor and come back to the office to have it read, could now be diagnosed from home.

Yes, people will question the privacy or the security aspects of this new application of mobile technology at first, but they will acclimate to it, just as they now openly converse on cell phones in public places and post the intimate details of their love lives on social networks.

I’m optimistic about the impact this will have on health care costs as the Baby Boomer generation begins to age.

Rarely does a blogger reprint a press release. But I am SO proud of EmpowHer, on whose advisory board I serve, and SO happy for my friends Pat Elliott and Michelle Robson, whom I introduced to each other when Pat was diagnosed with CML, that I have to do this (and besides, yesterday was Pat’s birthday and one year since her diagnosis and she’s now cancer-free and advocating for patients on EmpowHer.

In my mind, EmpowHer represents the best of what the internet offers for health care.

Pat Elliott is a cancer patient whose quick online advice to others about cancer and other health issues onEmpowHER.com, a Top 10 women’s health and wellness resource and community, is also helping her manage her own medical condition. Elliott, who lives in Phoenix, is one of a growing network of national patient advocates who are helping others to improve their own health.

For Elliott and many other women who serve as Patient Guides at EmpowHER, it’s all in a 24-hour day’s work. They are the caring and compassionate voices at the other end of EmpowHER.com, responding to health questions from EmpowHER members within 24 hours. Guides respond to all questions submitted and the average response time from an EmpowHER Guide is 4 – 5 hours. However, women who sign up for a free membership with EmpowHER are guaranteed a response within 24 hours.

Through the ASK A Health Question form on the website, women who come to the site are able to reach out to a trained individual who may be able to help a member through a difficult situation when access to medical advice may be limited. EmpowHER Guides can often offer exceptional resources on EmpowHER and other sites that may be able to help women, as well some understanding in times of need.

As part of her own journey through the medical quagmire of cancer care, Elliott immersed herself in helping others. “I advocate for my own health every day to get the best care possible. Helping others is healing to me, providing an uplifting and positive experience,” says Elliott.

The 24-hour turnaround commitment is designed to help women with health issues who are worried and need information quickly. “When I was ill and kept asking questions on web sites and wasn’t receiving the answers I desperately needed, I knew that there were other women out there with similar experiences,” said Michelle King Robson, Founder, Chairperson and CEO of EmpowHER, who notes that EmpowHER’s goal is to give women information that will help them properly advocate for their own health when they need it — as soon as possible. “No one likes to wait if you have a health issue, whether if it’s for your doctor’s appointment or a post on a web site. Women want to know that someone is there to help them in their time of need. With our 24 Hour Promise, they know they will get that from us.”

“While our team is not a substitute for one’s own doctor or other health care professional, they do provide insight and can help them with further resources,” adds King Robson.

To date, the website has received nearly 6,000 ASKS and Guides have provided 24,000 responses to original questions and comments.

About EmpowHER
EmpowHER is an award-winning health media company for women. The Company’s website provides visitors access to one of the largest women’s health and wellness content libraries on the web, as well as the largest online community of women discussing their health and wellness issues. EmpowHER promotes a “24 Hour Promise” to its visitors, who can come to the site, ask any health question and receive a response within 24 hours. Health care marketers rely on EmpowHER for reaching the most influential health and wellness buying audience on the Internet — women. Millions of women visit EmpowHER.com every year, making it one of the largest and fastest-growing resources dedicated exclusively to women’s health and wellness. For more, visit www.empowher.com.

President Obama’s HiTech Act, enacted right after he took office, should produce a major transformation in American health care when it gets going. Along with the health care reform legislation that was dragged kicking and screaming through Congress last spring, the Act could put the planets in alignment for real change in the way care is delivered and paid for, and the way patient outcomes are achieved.

The HiTech Act specifies that every American should have an EHR (electronic health record) by 2014, and receive continuity of care through a regional Health Information Exchange. It even provides coverage for Geek Squads to help providers with the transition to EHRs: finding vendors, deployment, and identifying specific ways to advance care in their own practices. A first set of rules for what constitutes “meaningful use” of these information technology tools has just been released. So things are getting moving to give both patients and providers the information to make better health care choices. But…

These programs always sound good. For example, one new federal program, Beacon, looks at health system change at a community level in a group of demonstration communities, The communities that have been chosen as Beacons have already achieved a high level of EHR adoption and want to find out how they can use the information these records generate to improve health care. The stakeholders in these communities will come together, identify goals, and unleash a range of strategies in service of these goals.

But the programs requires the coming together of four largely separate tribes of crusaders for improvements in health care:

1) Quality improvement fanatics who want fewer accidents and bad outcomes in hospitals
2) Payment reformers who want to change reimbursement from volume to value
3) Consumer energizers who want consumers to be more involved in their own care, and to be given better information
4) Health IT evangelists who want to unleash futuristic tools and applications

For any of this to work, all these tribes have to work together, combining their perspectives and tools.

Fifteen demonstration communities with baseline high EHR adoption rates have already been chosen as Beacons. They’ve already been working through questions such as What do you want your community to look like in three years? Which patients do you want to achieve what outcomes (for example, care coordination for asthmatic children using range of Health IT tools to prevent hospitalizations)? And how do you measure whether you are getting anywhere?

Geisinger, one of the Beacons, is working through the process to get its outcomes identified first, then measures, then tools, then sustainability of its goals. It is trying to extend its best practices outside its boundaries.

It’s a laudable goal to deploy information technology in service of specific payment reforms and clinical reforms. What are the odds that this will succeed, however? Many people have broken their picks on the hard rock of true health care reform.

Here’s another post from Pat’s CaringBridge journal:

One of the things I truly enjoy in my professional life is helping people understand the power of the Internet. Today, I tapped into some of that power myself.

From the comfort of my home, I attended a presentation titled CML: What Every Newly Diagnosed Patient Needs to Know with Dr. Jorge Cortes, known internationally for his expertise. Dr. Cortes is Chief of the CML Section of the Department of Leukemia at the University of Texas and MD Anderson Cancer Center in Houston. (MD Anderson is one of the mothers of all cancer centers and Banner recently announced an affiliation with them.)

The presentation was sponsored and paid for by Novatris, the company that makes Gleevec, and offered through the Leukemia and Lymphoma Society. Gleevec is a chemotherapy drug that targets a specific protein within cancer cells and stops the cancer cells from growing.

As mentioned earlier, CML is rare. Getting information is a challenge. Last week, in my first visit to the oncology practice in Phoenix, I got less than 15 minutes total with my doctor.

Today I got one hour with Dr. Cortes. The content was mainly clinical, followed by a Q&A session in which participants could ask questions online or by phone. 1,100 people joined in – from the US, Canada, Australia, Barbados, South Africa, India, Kenya and other countries. They included patients, caregivers, parents of patients and clinicians who care for CML patients.

Boy, did I learn a lot. CML used to be fatal for 50% of those who were diagnosed. Today, 90% of those with CML are still alive and doing well.
Dr. Cortes said this is very rare and you don’t see this much in other diseases.

He provided a lot of information about CML treatment, including the options for patients who fail on Gleevec and new treatments that are in the pipeline and in clinical trials. He also touched on bone marrow transplants for treatment. He helped a father worried about the disease’s impact on his ability to have a child. He answered a clinician’s question about a move toward international standards for data reporting so clinicians could have common ground in studying the disease and developing treatments. He was great!

Personally, I appreciated getting some answers to questions about side effects from the chemotherapy. And, wow, I learned that some of the treatments for side effects, including such things as over the counter antacids, can negatively impact the absorption of the chemotherapy drug. He gave a cautious answer about whether or not a swine flu shot would be okay – it leaned more toward it being okay than not okay.

Bryan in Utah wanted to know if anything was being done to deal with the high cost of Gleevec. ($4K a month) Dr. Cortes said – “Wow, You just put me in the middle of the debate in Congress.” He then went into one of those nonresponsive responses that PR people like me are paid to craft for people who want to politely answer a question without giving a response.

Although she’s resting, she’s also blogging, and she gave me permission to reprint anything I wanted to that I thought would help others or shed light on the situation all Americans are in.

After spending my weekend tamping down fires around HR 3200 which were purely the result of a lack of understanding about how legislation is constructed, I thought it might be helpful to put together some pointers on how to read it, along with some key terms.

Format

The bill is written in outline form. Because many provisions touch existing law (sweeping reform bills in particular), they are separated into divisions, titles and subtitles.

Each title outlines a specific area of focus. Each subtitle outlines specific provisions.

Within subtitles, there are sections. Each section addresses a very specific area of focus. For example, Division A, Title I, Subtitle A, Section 102 is an area that has been the subject of controversy. However, when read in the context of its specific focus it is not controversial at all. It breaks down as follows:

Division A = Affordable Health Care Choices
Title I = Protections and Standards for Qualified Health Benefits Plans
Subtitle A = General Standards
Section 102 = Protecting the choice to keep current coverage

Therefore, when reading page 16 of the bill (one of the sections which has been lifted out of context and widely misinterpreted), it must be read within the context of the division, title, subtitle and section to which it relates. In this case, it is written in the context of protecting choice to keep current coverage, and begins with a grandfather clause.

Key terms

• Grandfather clause – (from Wikipedia) “an exception that allows an old rule to continue to apply to some existing situations, when a new rule will apply to all future situations.”

  This is a key term which must be understood to interpret the meaning of Section 102(a) on page 16. Clearly the intent is to allow contracts currently in existence to continue for the length of the contract. Simply put, no one has to kill it. It can die a natural death.

• Qualified versus Non-Qualified Plan –

  A “Qualified” plan is a plan that meets specific requirements in order to receive favored status under another section of the law. In terms of health care reform, Qualified Health Benefits Plans will meet certain standards with regard to benefit levels, copayments, availability and cost.

  A “Non-Qualified” plan is a plan that is perfectly legal, but does not meet the requirements for Qualified Plans and will not be eligible for preferred treatment.

  Here is an easy example: A Qualified Health Benefits plan must have a premium rate structure that does not vary by any factors other than a small age variation ratio, area, or family enrollment. A Non-Qualified Health Benefits plan could have a different rate structure and be available for sale, but it will not receive favorable tax treatment or be considered an eligible plan for the Health Benefits Exchange.

Prohibitions and Exceptions

For every sweeping provision of a law, there is some reason to make an exception. For example, HR3200 requires that Providers may not also own hospitals. However, in rural areas where hospitals are few and far between, that provision could mean that people have to travel hundreds of miles to get to a hospital. To accommodate the situation, an exception was written (page 316) allowing providers to refer to provider owned hospitals as long as they agree to certain terms.

Again, this is standard language. Like the grandfather clause, it’s intended to preserve the status quo in situations where people would be harmed by the prohibition.

Cross-references

Any section may contain a cross-reference to another section. It’s critical that when a cross-reference exists, the reader check the referenced section for context and understanding of what the intent is. Often, cross-references are definitions which are key to understanding the intent of that particular section.

Example: On page 17, Section 102(b)(1)(A)refers to “the essential benefit package requirement under section 121.”

Section 121 begins on page 25 and very specifically outlines coverage requrements for exchange-participating and non-exchange-participating plans.

Cross-references are critical. If they’re ignored, the entire context of the section can be misconstrued.

In General

1. Context, context, context – When reading, pay attention to the section description, and be careful not to extend the meaning of any particular paragraph beyond the context of that section focus.
2. Keep notes as you read. There are lots of great PDF note-keeping tools (including Acrobat, but there are others as well). I use the bookmarking tools to annotate specific sections that either define or outline broad provisions. The advantage to taking notes is twofold. First, notes help to remember key points. Second, in a bill this large, they are top-level search hits which make it easy to get back to a section you may have left behind.
3. Understand the lingo. Legislation has a language of its own. For example, much of the law is stated in the negative, like this:

   “A health plan shall NOT be a qualified health benefits plan UNLESS it contains the following provisions…”

   That’s paraphrased, but fairly typical and accurate for this type of legislation. Beware those negative statements. I try to rephrase them in the positive to test them, so in this case, I would read it as “A health plan must contain the following provisions to be a qualified health benefits plan…”

4. Don’t get bogged down in amendments to existing law. In this bill, there are amendments to the Internal Revenue Code, Medicare laws, and other laws that touch the sides of this one. Some are key and critical, like the taxation of income above a certain threshhold. Others are amendments to ERISA, for example, and are repeated so they can be inserted into the relevant portions of the Internal Revenue Code relating to ERISA. I don’t recommend getting too bogged down there, since it’s likely to change when the House and Senate bills are reconciled and the compromise bill is reported out.

   Read for key changes and additions, because those are the heart of the bill and the heart of Congressional intent.

And of course, your questions are welcome in our comment section. If you’re reading and something doesn’t make sense, leave your question and we’ll work on getting an answer.

Disclaimer: I am not a lawyer, nor do I pretend to play one on TV, or even want to be one. However, I’ve spent over 25 years working with these laws, reading similar legislation relating to pension and profit sharing plans, and have a clear understanding of how they’re structured and how to read them.

Now…go read it (pdf). Show your representatives that if you can read the bill, they can read the bill. Ask questions, but be informed and accurate. Tossing inaccurate interpretations into the stream just weakens whatever arguments are to be made, when there are plenty of strong ones waiting for you. ]]> http://ushealthcrisis.com/2009/07/read-the-bill-101/feed/ 4