"Home is where the heart is, so unless you're one of those zombies from
horror movies that have no heart, or the Tinman character from the Oz myth,
who claimed to have no heart, home is wherever you are right now"
- The Listener
"Well, actually, in this chair on the HMS Titanic right now"
- Jack, Titanic movie, paraphrased
(Got direct quote? E-mail me it please. From scene at dinner)
ll the words and/or opinions you see and read on these pages are the opinions of individual humans, who, just by the very fact that they are human beings, are only guesses, and, if they are growing even a little, are even subject to change in a millisecond.... so even as they're typed in here, they may have changed and/or expanded already.
Take what touches your heart, your soul, your deepest places, and leave
the rest. e-mail:
ListenerOne@hotmail.com
to voice your opinions, indicating in the body of the letter if you
want it posted here for all to see.
If anything pisses you off, it is probably touching some really really deep truth you have been resisting. If you have this kind of violent reaction to anything you read here, it is strongly suggested that you write out all your feelings and RE READ THEM before sending them. This will avoid the possibility of you sharing your processes and/or incompleteness instead of your deepest truth. Often, you will come to your deepest truth somewhere towards the end of a rant, and you can copy and paste THIS part into an e-mail, rather than typing the whole rant, pressing "send", and regretting it later.
Thank you for visiting "The Listener" home page. If you've come, you care, whether it's "veiled" in coming just to find something to attack, you would not spend the time to log in and come unless this has touched you deeply in some way, even, and maybe especially, if this movement and it's ideas have "pushed a button".
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She will go forth. She will listen. If you see her, flag her down, and tell your story..... are you forgotten?
Contents:
Quote by Leo
Buscalgia
How lucky are you?
(Quote for friendship week, pause
for thought friends!)
Universal declaration
of human rights
Patients bill of
rights and updates/additional comments on it
Journal of the journey of The Listener,
including added comments and reminisces: (please be patient, I'll get it
all typed in as soon as I can, it was hand-written, so this'll take some
time)
Stories of the forgotten: (as received by e-mail)
Other e-mails
Let us remember each other, our humanity,
LOVE...............
May we meet on the Path of the Heart,
The Listener
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"Our culture is constantly teaching us to be suspicious. Not to trust.
Not to believe. To be afraid of everything! What we're doing is we're building
higher and higher walls to protect us from each other! I don't ever want
to be protected from you. I want to just dive right in the middle
of you. I want to experience you. I don't want to be protected from you.
I'll trust. And if there are one or two of you who smack me along the way,
that's okay. But I don't want to miss you. Never. That scares me most.
But our culture keeps telling us these things: "The person next to you
cannot be trusted". We don't even know our neighbors. And that's a shame.
Because what are we doing? We're telling our children also that they must
not trust. And we're becoming more and more separated from each other.
It's time we start to build little bridges."
--- Leo Buscaglia
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READ THIS RIGHT TO THE END
If we could shrink the earth's population to a village of precisely
100 people, with all the existing human ratios remaining the same,
it
would look something like the following:
There would be:
57 Asians
21 Europeans
14 from the Western Hemisphere, both north and south
8 Africans
52 would be female
48 would be male
70 would be non-white
30 would be white
70 would be non-Christian
30 would be Christian
89 would be heterosexual
11 would be homosexual
6 people would possess 59% of the entire world's wealth and all 6
would be from the United States.
80 would live in substandard housing
70 would be unable to read
50 would suffer from malnutrition
1 would be near death; 1 would be near birth
1 (yes, only 1) would have a college education
1 would own a computer
When one considers our world from such a compressed perspective, the
need for acceptance, understanding and education becomes glaringly
apparent.
The following is also something to ponder...
If you woke up this morning with more health than illness...you are
more blessed than the million who will not survive this week.
If you have never experienced the danger of battle, the loneliness
of imprisonment, the agony of torture, or the pangs of starvation you
are ahead of 500 million people in the world.
If you can attend a church meeting without fear of harassment,
arrest, torture, or death...you are more blessed than three billion
people in
the world.
If you have food in the refrigerator, clothes on your back, a roof
overhead and a place to sleep...you are richer than 75% of this world.
If you have money in the bank, in your wallet, and spare change in a
dish someplace ... you are among the top 8% of the worlds wealthy.
If you can read this message, you just received a double blessing in
that someone was thinking of you, and furthermore, you are more blessed
than over two billion people in the world that cannot read at all.
Someone once said: What goes around comes around.
Work like you don't need the money.
Love like you've never been hurt.
Dance like nobody's watching.
Sing like nobody's listening.
Live like it's Heaven on Earth.
It's National Friendship Week.
Send this to everyone you consider a FRIEND.
Pass this on, and brighten someone's day. Nothing will happen if you
do not decide to pass it along. The only thing that will happen, if
you DO
pass it on, is that someone might smile because of you.
Happy friendship week!
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"United we stand. Divided we fall.
And if you back should ever be against the wall,
We'll be together,
Together,
You and I."
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"Authors" note:
The story of this Journey is in
three parts. Part one is the Kauai trip. Part two is the mainland portion.
Part three is the return to Maui and the continuation of The Listener's
journey. Any additions to the original
journal, "after comments", will be in this shade of maroon, and boldfaced,
for those with black and white monitors.
It may be that as long as The Listener remains alive, this journey will
not end. If so, this journal will be expanding over time. It may be that
even if/when she dies, those that are speaking, and those who have become
active listeners, will continue The Work. In either of these cases, if
you wish to be made aware every time the page is updated, and you have
an e-mail account, please take advantage of the option at the top of the
page to be automatically alerted of updates. If you do not have an e-mail
account, there are many free ones offered on the net which you may easily
access from any computer, even if you do not own one yourself. Use a search
engine, type in "free e-mail" and choose one, perhaps shopping around beforehand,
some only offer minimal storage space, so if you do not have a computer
of your own, you may want to get an account that will allow you to store
all your mail, which means at least 2 megs, preferably 5, since many people
are using colors, graphics, and sending photos and/or other attachments
that take up quite a bit of room.
Much of what is written here is highly personal, do not let it detract from the message. Often the clearest, deepest messages, are embedded or even directly stated in personal experience.
It is good to have spoken
-The Listener
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Universal
Declaration of Human Rights
Adopted and proclaimed by General Assembly resolution 217 A (III) of 10
December 1948
On December 10, 1948
the General Assembly of the United Nations adopted and proclaimed the
Universal Declaration
of Human Rights the full text of which appears in the following pages.
Following
this historic act the
Assembly called upon all Member countries to publicize the text of the
Declaration
and "to cause it to
be disseminated, displayed, read and expounded principally in schools and
other
educational institutions,
without distinction based on the political status of countries or territories."
PREAMBLE
Whereas recognition of
the inherent dignity and of the equal and inalienable rights of all members
of the human family is
the foundation of freedom,
justice and peace in the world,
Whereas disregard and
contempt for human rights have resulted in barbarous acts which have outraged
the conscience of
mankind, and the advent
of a world in which human beings shall enjoy freedom of speech and belief
and freedom from
fear and want has been
proclaimed as the highest aspiration of the common people,
Whereas it is essential,
if man is not to be compelled to have recourse, as a last resort, to rebellion
against tyranny and
oppression, that human
rights should be protected by the rule of law,
Whereas it is essential to promote the development of friendly relations between nations,
Whereas the peoples of
the United Nations have in the Charter reaffirmed their faith in fundamental
human rights, in the
dignity and worth of
the human person and in the equal rights of men and women and have determined
to promote social
progress and better
standards of life in larger freedom,
Whereas Member States
have pledged themselves to achieve, in co-operation with the United Nations,
the promotion of
universal respect for
and observance of human rights and fundamental freedoms,
Whereas a common understanding
of these rights and freedoms is of the greatest importance for the full
realization of this
pledge,
Now, Therefore THE GENERAL ASSEMBLY proclaims
THIS UNIVERSAL DECLARATION OF HUMAN
RIGHTS as a common standard of achievement for
all peoples and all nations, to the end that every individual and every
organ
of society, keeping this Declaration constantly
in mind, shall strive by teaching and education to promote respect for
these rights
and freedoms and by progressive measures, national
and international, to secure their universal and effective recognition
and
observance, both among the peoples of Member
States themselves and among the peoples of territories under their jurisdiction.
Article 1.
All human beings are
born free and equal in dignity and rights.They are endowed with reason
and conscience and should
act towards one another
in a spirit of brotherhood.
Article 2.
Everyone is entitled
to all the rights and freedoms set forth in this Declaration, without distinction
of any kind, such as
race, colour, sex, language,
religion, political or other opinion, national or social origin, property,
birth or other status.
Furthermore, no distinction
shall be made on the basis of the political, jurisdictional or international
status of the country
or territory to which
a person belongs, whether it be independent, trust, non-self-governing
or under any other limitation
of sovereignty.
Article 3.
Everyone has the right to life, liberty and security of person.
Article 4.
No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.
Article 5.
No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.
Article 6.
Everyone has the right to recognition everywhere as a person before the law.
Article 7.
All are equal before
the law and are entitled without any discrimination to equal protection
of the law. All are entitled to
equal protection against
any discrimination in violation of this Declaration and against any incitement
to such
discrimination.
Article 8.
Everyone has the right
to an effective remedy by the competent national tribunals for acts violating
the fundamental rights
granted him by the constitution
or by law.
Article 9.
No one shall be subjected to arbitrary arrest, detention or exile.
Article 10.
Everyone is entitled
in full equality to a fair and public hearing by an independent and impartial
tribunal, in the
determination of his
rights and obligations and of any criminal charge against him.
Article 11.
(1) Everyone charged
with a penal offence has the right to be presumed innocent until proved
guilty according to law in a
public trial at which
he has had all the guarantees necessary for his defence.
(2) No one shall be held
guilty of any penal offence on account of any act or omission which did
not constitute a penal
offence, under national
or international law, at the time when it was committed. Nor shall a heavier
penalty be imposed
than the one that was
applicable at the time the penal offence was committed.
Article 12.
No one shall be subjected
to arbitrary interference with his privacy, family, home or correspondence,
nor to attacks upon
his honour and reputation.
Everyone has the right to the protection of the law against such interference
or attacks.
Article 13.
(1) Everyone has the right to freedom of movement and residence within the borders of each state.
(2) Everyone has the right to leave any country, including his own, and to return to his country.
Article 14.
(1) Everyone has the right to seek and to enjoy in other countries asylum from persecution.
(2) This right may not
be invoked in the case of prosecutions genuinely arising from non-political
crimes or from acts
contrary to the purposes
and principles of the United Nations.
Article 15.
(1) Everyone has the right to a nationality.
(2) No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.
Article 16.
(1) Men and women of
full age, without any limitation due to race, nationality or religion,
have the right to marry and to
found a family. They
are entitled to equal rights as to marriage, during marriage and at its
dissolution.
(2) Marriage shall be entered into only with the free and full consent of the intending spouses.
(3) The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.
Article 17.
(1) Everyone has the right to own property alone as well as in association with others.
(2) No one shall be arbitrarily deprived of his property.
Article 18.
Everyone has the right
to freedom of thought, conscience and religion; this right includes freedom
to change his religion or
belief, and freedom,
either alone or in community with others and in public or private, to manifest
his religion or belief in
teaching, practice,
worship and observance.
Article 19.
Everyone has the right
to freedom of opinion and expression; this right includes freedom to hold
opinions without
interference and to
seek, receive and impart information and ideas through any media and regardless
of frontiers.
Article 20.
(1) Everyone has the right to freedom of peaceful assembly and association.
(2) No one may be compelled to belong to an association.
Article 21.
(1) Everyone has the right to take part in the government of his country, directly or through freely chosen representatives.
(2) Everyone has the right of equal access to public service in his country.
(3) The will of the people
shall be the basis of the authority of government; this will shall be expressed
in periodic and
genuine elections which
shall be by universal and equal suffrage and shall be held by secret vote
or by equivalent free
voting procedures.
Article 22.
Everyone, as a member
of society, has the right to social security and is entitled to realization,
through national effort and
international co-operation
and in accordance with the organization and resources of each State, of
the economic, social
and cultural rights
indispensable for his dignity and the free development of his personality.
Article 23.
(1) Everyone has the
right to work, to free choice of employment, to just and favourable conditions
of work and to
protection against unemployment.
(2) Everyone, without any discrimination, has the right to equal pay for equal work.
(3) Everyone who works
has the right to just and favourable remuneration ensuring for himself
and his family an existence
worthy of human dignity,
and supplemented, if necessary, by other means of social protection.
(4) Everyone has the right to form and to join trade unions for the protection of his interests.
Article 24.
Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.
Article 25.
(1) Everyone has the
right to a standard of living adequate for the health and well-being of
himself and of his family,
including food, clothing,
housing and medical care and necessary social services, and the right to
security in the event of
unemployment, sickness,
disability, widowhood, old age or other lack of livelihood in circumstances
beyond his control.
(2) Motherhood and childhood
are entitled to special care and assistance. All children, whether born
in or out of
wedlock, shall enjoy
the same social protection.
Article 26.
(1) Everyone has the
right to education. Education shall be free, at least in the elementary
and fundamental stages.
Elementary education
shall be compulsory. Technical and professional education shall be made
generally available and
higher education shall
be equally accessible to all on the basis of merit.
(2) Education shall be
directed to the full development of the human personality and to the strengthening
of respect for
human rights and fundamental
freedoms. It shall promote understanding, tolerance and friendship among
all nations, racial
or religious groups,
and shall further the activities of the United Nations for the maintenance
of peace.
(3) Parents have a prior right to choose the kind of education that shall be given to their children.
Article 27.
(1) Everyone has the
right freely to participate in the cultural life of the community, to enjoy
the arts and to share in
scientific advancement
and its benefits.
(2) Everyone has the
right to the protection of the moral and material interests resulting from
any scientific, literary or
artistic production
of which he is the author.
Article 28.
Everyone is entitled
to a social and international order in which the rights and freedoms set
forth in this Declaration can be
fully realized.
Article 29.
(1) Everyone has duties to the community in which alone the free and full development of his personality is possible.
(2) In the exercise of
his rights and freedoms, everyone shall be subject only to such limitations
as are determined by law
solely for the purpose
of securing due recognition and respect for the rights and freedoms of
others and of meeting the
just requirements of
morality, public order and the general welfare in a democratic society.
(3) These rights and
freedoms may in no case be exercised contrary to the purposes and principles
of the United
Nations.
Article 30.
Nothing in this Declaration
may be interpreted as implying for any State, group or person any right
to engage in any
activity or to perform
any act aimed at the destruction of any of the rights and freedoms set
forth herein.
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A Patient's Bill of Rights was first adopted by the American Hospital
Association in 1973.
This revision was approved by the AHA Board of Trustees on October 21, 1992.
Introduction
Effective health
care requires collaboration between patients and physicians and other health
care
professionals.
Open and honest communication, respect for personal and professional values,
and
sensitivity
to differences are integral to optimal patient care. As the setting for
the provision of health
services, hospitals
must provide a foundation for understanding and respecting the rights and
responsibilities
of patients, their families, physicians, and other caregivers. Hospitals
must ensure a health
care ethic that
respects the role of patients in decision making about treatment choices
and other aspects
of their care.
Hospitals must be sensitive to cultural, racial, linguistic, religious,
age, gender, and other
differences
as well as the needs of persons with disabilities.
The American
Hospital Association presents A Patient's Bill of Rights with the expectation
that it will
contribute to
more effective patient care and be supported by the hospital on behalf
of the institution, its
medical staff,
employees, and patients. The American Hospital Association encourages health
care
institutions
to tailor this bill of rights to their patient community by translating
and/or simplifying the
language of
this bill of rights as may be necessary to ensure that patients and their
families understand their
rights and responsibilities.
Bill of Rights
These rights
can be exercised on the patient’s behalf by a designated surrogate or proxy
decision maker if
the patient
lacks decision-making capacity, is legally incompetent, or is a minor.
1.The patient has the right to considerate and respectful care.
2.The
patient has the right to and is encouraged to obtain from physicians and
other direct caregivers
relevant, current, and understandable information concerning diagnosis,
treatment, and prognosis.
Except in emergencies when the patient lacks decision-making capacity and
the need for treatment
is urgent, the patient is entitled to the opportunity to discuss and request
information related to the
specific procedures and/or treatments, the risks involved, the possible
length of recuperation, and
the medically reasonable alternatives and their accompanying risks and
benefits.
Patients have the right to know the identity of physicians, nurses, and
others involved in their care,
as well as when those involved are students, residents, or other trainees.
The patient also has the
right to know the immediate and long-term financial implications of treatment
choices, insofar as
they are known.
3.The
patient has the right to make decisions about the plan of care prior to
and during the course of
treatment and to refuse a recommended treatment or plan of care to the
extent permitted by law
and hospital policy and to be informed of the medical consequences of this
action. In case of such
refusal, the patient is entitled to other appropriate care and services
that the hospital provides or
transfer to another hospital. The hospital should notify patients of any
policy that might affect patient
choice within the institution.
4.The
patient has the right to have an advance directive (such as a living will,
health care proxy, or
durable power of attorney for health care) concerning treatment or designating
a surrogate decision
maker with the expectation that the hospital will honor the intent of that
directive to the extent
permitted by law and hospital policy.
Health care institutions must advise patients of their rights under state
law and hospital policy to
make informed medical choices, ask if the patient has an advance directive,
and include that
information in patient records. The patient has the right to timely information
about hospital policy
that may limit its ability to implement fully a legally valid advance directive.
5.The
patient has the right to every consideration of privacy. Case discussion,
consultation,
examination, and treatment should be conducted so as to protect each patient's
privacy.
6.The
patient has the right to expect that all communications and records pertaining
to his/her care
will be treated as confidential by the hospital, except in cases such as
suspected abuse and public
health hazards when reporting is permitted or required by law. The patient
has the right to expect
that the hospital will emphasize the confidentiality of this information
when it releases it to any other
parties entitled to review information in these records.
7.The
patient has the right to review the records pertaining to his/her medical
care and to have the
information explained or interpreted as necessary, except when restricted
by law.
8.The
patient has the right to expect that, within its capacity and policies,
a hospital will make
reasonable response to the request of a patient for appropriate and medically
indicated care and
services. The hospital must provide evaluation, service, and/or referral
as indicated by the urgency
of the case. When medically appropriate and legally permissible, or when
a patient has so
requested, a patient may be transferred to another facility. The institution
to which the patient is to
be transferred must first have accepted the patient for transfer. The patient
must also have the
benefit of complete information and explanation concerning the need for,
risks, benefits, and
alternatives to such a transfer.
9.The
patient has the right to ask and be informed of the existence of business
relationships among
the hospital, educational institutions, other health care providers, or
payers that may influence the
patient's treatment and care.
10.The
patient has the right to consent to or decline to participate in proposed
research studies or
human experimentation affecting care and treatment or requiring direct
patient involvement, and to
have those studies fully explained prior to consent. A patient who declines
to participate in research
or experimentation is entitled to the most effective care that the hospital
can otherwise provide.
11.The
patient has the right to expect reasonable continuity of care when appropriate
and to be
informed by physicians and other caregivers of available and realistic
patient care options when
hospital care is no longer appropriate.
12.The
patient has the right to be informed of hospital policies and practices
that relate to patient care,
treatment, and responsibilities. The patient has the right to be informed
of available resources for
resolving disputes, grievances, and conflicts, such as ethics committees,
patient representatives, or
other mechanisms available in the institution. The patient has the right
to be informed of the
hospital's charges for services and available payment methods.
The collaborative
nature of health care requires that patients, or their families/surrogates,
participate in
their care.
The effectiveness of care and patient satisfaction with the course of treatment
depend, in part,
on the patient
fulfilling certain responsibilities. Patients are responsible for providing
information about past
illnesses, hospitalizations,
medications, and other matters related to health status. To participate
effectively
in decision
making, patients must be encouraged to take responsibility for requesting
additional information
or clarification
about their health status or treatment when they do not fully understand
information and
instructions.
Patients are also responsible for ensuring that the health care institution
has a copy of their
written advance
directive if they have one. Patients are responsible for informing their
physicians and other
caregivers if
they anticipate problems in following prescribed treatment.
Patients should
also be aware of the hospital's obligation to be reasonably efficient and
equitable in
providing care
to other patients and the community. The hospital's rules and regulations
are designed to
help the hospital
meet this obligation. Patients and their families are responsible for making
reasonable
accommodations
to the needs of the hospital, other patients, medical staff, and hospital
employees.
Patients are
responsible for providing necessary information for insurance claims and
for working with the
hospital to
make payment arrangements, when necessary.
A person's health
depends on much more than health care services. Patients are responsible
for
recognizing
the impact of their life-style on their personal health.
Conclusion
Hospitals have
many functions to perform, including the enhancement of health status,
health promotion,
and the prevention
and treatment of injury and disease; the immediate and ongoing care and
rehabilitation
of patients;
the education of health professionals, patients, and the community; and
research. All these
activities must
be conducted with an overriding concern for the values and dignity of patients.
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H.R. 3605
PATIENTS' BILL OF RIGHTS ACT OF 1998
SUMMARY
ACCESS TO CARE
Choice of Plans
Choice is one of the key components of consumer
satisfaction with the health system. The Democratic bill
would allow a limited point of service option
(POS) for employees who are offered only a closed panel
HMO. The health plan, not the employer, would
be required to make the POS available, and the employer
would not be required to contribute to the
point of service option.
Adequacy of Provider Network
Plans must have a sufficient number, distribution,
and variety of providers to ensure that all enrollees
receive covered services on a timely basis.
Specialty Care
Patients with special conditions must have
access to providers who have the requisite expertise to treat
their problem. The Democratic bill allows
for referrals for enrollees to go out of the plan's network for
specialty care (at no extra cost to the enrollee)
if there is no appropriate provider available in the network
for covered services.
Chronic Care Referrals
For individuals who are seriously ill or require
continued care by a specialist, plans must have a process
for selecting a specialist as a primary care
provider and for accessing necessary specialty care without
impediments.
Women's Protections
The Democratic bill extends important protections
for women in managed care, including direct access to
ob/gyn care and services and the ability to
designate their ob/gyn as a primary care provider. The
proposal also includes bills regarding mastectomy
length-of-stay and breast reconstruction.
Children's Protections
The Democratic bill ensures that the special
needs of children are met, including access to pediatric
specialists.
Continuity of Care
Patients should be protected against disruptions
in care because of a change in plan or a change in a
provider's network status. The Democratic
bill lays out guidelines for the limited continuation of treatment
in these instances. There are specific protections
for pregnancy, terminal illness, and institutionalization.
Emergency Services
Individuals should be assured that if they
have an emergency, those services will be covered by their plan.
The Democratic bill says that individuals
must have access to emergency care, without prior authorization
in any situation that a "prudent lay person"
would regard as an emergency.
Clinical Trials
Access to clinical trials can be the only hope
left for individuals with serious and life-threatening diseases,
especially when no standard treatment is effective.
Plans must have a process for allowing certain
enrollees to participate in a defined set
of approved clinical trials and for covering the routine patient costs
associated with these trials.
Drug Formularies
Prescription medications can not be one-size-fits
all. For plans that use a formulary, the plan must have a
process for beneficiaries to access medications
that are not on the formulary when medically indicated.
And, plan doctors and pharmacists must help
in the formulary development.
Non-discrimination
Patients should not be discriminated against
in their access to covered health care services. The
Democratic bill prohibits plans from discriminating
against their enrollees on a variety of factors including
genetic information, sexual orientation, and
disability. This provision does not affect issuance or pricing of
policies.
INFORMATION
Health Plan Information
Informed decisions about health care options
can only be made by consumers who have access to
uniform, comparable information about health
plans, plan policies, and providers. This bill requires
managed care plans to provide that information.
Confidentiality
Patients need to know that their medical records
are kept confidential. This bill says that health plans must
have appropriate safeguards to ensure confidentiality,
update records in a timely and accurate fashion,
and allow patients access to their records.
It does not address the broad issue of medical records
confidentiality, which will require separate
legislation.
Ombudsman
The health care marketplace can be confusing.
The Democratic bill authorizes an ombudsman program in
each state to assist consumers in understanding
health insurance options, filing appeals and grievances,
etc.
QUALITY ASSURANCE AND IMPROVEMENT
Quality Assurance
In order to constantly improve the quality
of health care provided, plans should be monitoring care given to
their enrollees, especially with regard to
at-risk or chronically ill populations. The Democratic bill requires
plans to have a quality assurance program
to monitor care and improve care.
Data Collection
The Democratic bill requires plans to collect
data in order to monitor the quality of care provided to
enrollees. Data must be in a standard format
so comparisons can be made across all plans.
Advisory Board
A private/public Advisory Board would be established
to advise the Secretary on the standardized
minimum data set and other activities to improve
health care quality.
Provider Selection
Plans should not discriminate against providers
when selecting them for the network. The Democratic bill
requires plans to have a written, objective
process for provider selection and forbids discrimination
against providers based on license, location
or patient base. Plans would, however, be able to limit the
number and mix of providers as needed to serve
enrollees for covered benefits.
Utilization Review
When a plan is reviewing the medical decisions
of its practitioners, it should do so in a fair and rational
manner. The Democratic bill lays out basic
criteria for a good utilization review program: physician
participation in development of review criteria,
administration by appropriately qualified professionals,
timely decisions, and ability to appeal.
GRIEVANCE AND APPEALS
Internal Grievances
Patients need to be able to appeal denials
of care and voice concerns about their plans. They also should
have their concerns addressed in a timely
manner. Plans must maintain an internal grievance process that
is expedient and conducted by appropriately
credentialed individuals. There also must be an expedited
process for special circumstances.
External Grievances
For cases of sufficient seriousness or beyond
a certain monetary threshold, individuals must have access
to an external, independent body with the
capability and authority to resolve these cases. In the
Democratic bill, States and the Department
of Labor must establish an independent external appeals
process for the plans under their respective
jurisdictions. The plan must pay the costs of the process, and
any decision is binding on the plan. Plans
may not retaliate against providers who advocate on behalf of
their patients nor against patients who choose
to access the appeals process.
PROTECTING THE PROVIDER-PATIENT RELATIONSHIP
Anti-Gag and Provider Incentive Plans
Consumers have the right to know all of their
treatment options. The Democratic bill prohibits plans from
gagging providers. It protects providers in
these situations from retribution, and protects providers who
report quality problems to appropriate authorities
from retribution. It also prohibits plans from providing
incentives to providers to limit medically
necessary services.
Provider Due Process
Providers should receive reasonable notice
of termination and should be allowed to review any
information behind the termination decision
and appeal such adverse determinations within the plan.
Medical Necessity
Health plans should not be allowed to place
arbitrary limits on covered services. Treatment decisions
should be made in accordance with generally
accepted principles and standards of professional medical
practice. The Democratic bill applies this
standard for medically necessary care.
Insurer Liability
Although health plans are increasingly involved
in health care decisions, the Employee Retirement Income
Security Act (ERISA) preempts individuals
in employer-sponsored plans from holding health plans legally
accountable for decisions to limit care that
ultimately cause harm. Presently, an injured person can only
recover the dollar value of the benefit that
was denied. The Democratic bill includes a provision that would
allow State law to determine whether or not
a health care beneficiary can bring a state cause of action
against health plan administrators who cause
harm through their actions. The provision also protects
employers from liability when they were not
involved in the decision.
Prepared by the Democratic staff of the Commerce Committee
2322 Rayburn House Office Building, Washington, DC 20515
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Part Two, Mainland Journey
12/10/00
It is 7:07 AM. After landing in San Francisco,
was sitting near an information booth, resting, had been there no more
than 5 minutes when a tall man with silver curly hair got up from his chair
many rows over, and sat across from me 3 chairs down. The chairs were black
vinyl with armrests, in rows. There were only 4 people in the large room.
It was a little past 9 PM. There was no sign on me, or my chair, (had
planned to hang sign saying "Are You Forgotten?" to attract folks ready
to spill their stories into my willing, listening, lap. Ended up never
having to do this for entire length of trip. It was as if some Divine Voice
spoke to and called people to me, one right after another, without end
at times.) yet........
Yet.............
I looked at him. He smiled, not broad- but it
qualified. I smiled back- polite but with the weary travelers dull patina.
Then, we started talking.