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CMS Proposes Funding In-Home Dialysis for Acute Kidney Injury Patients By Tom Ozimek, 7/4/2024

The federal government has announced a federal rulemaking proposal that would extend Medicare coverage to include in-home dialysis for patients with acute kidney injury.

The Centers for Medicare & Medicaid Services (CMS) said it had issued a proposed rule that would update payment rates and policies of the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for 2025.

Besides increasing overall expenditures in 2025 on the ESRD payment system by 2.2 percent, or around $170 million, the update includes a proposal to increase patient options for dialysis treatment for Medicare beneficiaries with acute kidney injury.

Contrary to popular misinformation and disinformation, Medicare is not funded by the Federal Insurance Contributions Act (aka “FICA” or payroll tax).

No federal taxes fund federal spending. All federal taxes are destroyed upon receipt by the federal government.

Taxes begin in the M2 money supply measure, but when they reach the Treasury, they are absorbed into the Treasury’s infinite money supply. Effectively, they are destroyed:

When “x” is any amount of federal taxes and ∞ is infinity,  ∞ + x = ∞.

“x” disappears.

Medicare “A” and “B” supposedly are funded differently — “A” by FICA and “B” by the government and by recipients. I say “supposedly” because here is how both are funded:

1. Each month, the federal government sends instructions (not dollars) to health providers’ banks, instructing the banks to increase the size of the providers’ checking accounts by a specific amount (i.e., “Pay to the order of . . .” ).

2. The instant the bank does as instructed new dollars are created and added to the M2 money supply measure. No dollars are subtracted from any corresponding money supply measure.

That is the primary way the government creates net dollars — by instructing banks to increase checking accounts.

3. The banks’  books are balanced,and new dollars created, by clearing the government’s instructions through another part of the government, the Federal Reserve.

Compare the above to the way monetarily non-sovereign state and local governments (and businesses, you and I) pay our bills:

Like the federal government, we send instructions (checks or wires) to creditors’ banks. The difference is that in clearing your instructions, the Fed sends instructions to our banks, telling them to subtract dollars from our accounts.

When monetarily non-sovereign entities pay creditors, no net dollars are created. M2 rises when the creditors’ bank increases balances, and M2 falls when our bank decreases our balances.

Thus, the overall money supply grows when the government pays for things, not when the private sector pays for things. The money supply shrinks when the private sector pays the government for things.

A growing money supply leads to a growing GDP, while a shrinking money supply leads to recessions and depressions.

For 2025, CMS is proposing to allow Medicare beneficiaries with acute kidney injury to receive dialysis at home.

The agency also proposes that dialysis facilities be allowed to bill Medicare for training patients with acute kidney injury to perform in-home dialysis.

The agency also plans to update the payment rate for acute kidney injury dialysis to $273.20, which is the same as the base rate for regular dialysis.

For in-center hemodialysis, which is typically done three times a week, the annual cost was reported to be approximately $72,000 to $88,000, which could translate to about $250 to $350 per session.

Peritoneal dialysis, often done at home, might be slightly less expensive, with annual costs around $53,000 to $65,000, equating to roughly $145 to $180 per day.

The proposal represents a significant shift in CMS policy as, under current Medicare rules, only in-center dialysisis covered for beneficiaries with acute kidney injury who are not hospitalized.

CMS said in the announcement that dialysis-dependent patients with acute kidney injury have the potential to recover kidney function and avoid long-term dialysis.

The agency added that providing such beneficiaries with more flexible treatment options like in-home dialysis would encourage more frequent dialysis at lower ultrafiltration rates, supporting recovery of kidney function in patients with acute kidney injury.

If the rule is ultimately adopted, Medicare coverage of home dialysis will be available to both patients with acute kidney injury as well as end-stage renal disease.

Given that federal spending costs you nothing, and stimulates economic growth, there is no reason why Medicare has been slow to cover in-home dialysis.

Specifically, CMS said that its proposal would increase the base rate to $273.20 in 2025 from $271.02 in 2024, incorporating a 1.8 percent market basket percentage increase adjusted for productivity.

The agency estimates that the updates would increase the total payments to all ESRD facilities next year by 2.2 percent compared to 2024. Hospital-based ESRD facilities are projected to see a 3.9 percent increase in total payments while freestanding facilities will see a total payment increase of 2.1 percent.

CMS is also proposing updates to the policy of handling unusually high costs, or outliers, in providing kidney dialysis services.

It wants to include more specialty drugs and biological products in the list of services considered for extra cost adjustments. These are items that were or would have been included in the composite rate prior to the establishment of the current ESRD payment system.

The agency is also proposing technical changes to how it calculates the extra cost amounts, which consist of the outlier services fixed-dollar loss (FDL) amounts and the Medicare allowable payment (MAP) amounts, in order to better match current data and costs.

The oft-quoted objection to federal spending is that it causes inflation. The arguments are shown in green:

1. When the government spends more, it can increase the overall demand for goods and services in the economy. If the production capacity doesn’t keep up with this increased demand, prices may rise.

However, federal spending amounts to only a small fraction of GDP. GDP = Personal Consumption (68%) + Private Investment (18%) + Government Expenditures (18%) – Net Imports (4%)

Further, in a capitalist economy, increased demand is met by increased capacity.

2. Increased government spending can also raise the cost of production by increasing demand for resources, which can lead to higher prices for consumers.

However, increased demand for resources is widely inflationary for only one resource: Oil.

Further, oil prices are less subjet to supply and demand than to prices determined by major oil suppliers OPEC, Russia, and the U.S.

3.  To finance spending, the government might borrow money, which can influence the interest rates. If the Federal Reserve purchases these securities, it increases the money supply, which can devalue the currency and lead to inflation.

However, the U.S. government, being Monetarily Sovereign, does not borrow dollars. While higher interest rates are inflationary, they are not caused by market forces. They are caused by the Fed’s strange belief that higher rates lower prices.

The government has the infinite ability to spend, which increases the money supply — while also increasing the ability to produce.

4. If businesses and consumers expect that government spending will lead to inflation, they may adjust their behavior accordingly, such as by raising prices or wages, which can create a self-fulfilling prophecy.

However, in a capitalist economy, excessive profits quickly are met with price cutting.

SUMMARY

It is far better for the economy and for individuals if the government funds things rather than the monetarily non-sovereign, private sector paying.

This not only applies to Medicare but also to Social Security and to everything currently tax-funded by city, county, and state governments. Consider the implications.

1. Free, comprehensive medical and health support for all age and income groups.
2. Generous Social Security benefits for all age and income groups. (Yes, the rich, too. This is to avoid needless paperwork and investigations.)
3. Free college for everyone who wants it.
4. Funding for all the sciences.
5. Funding for infrastructure, including infrastructure now funded by cities, counties, and states.

Rodger Malcolm Mitchell

Monetary Sovereignty Twitter: @rodgermitchell Search #monetarysovereignty Facebook: Rodger Malcolm Mitchell; MUCK RACK: https://muckrack.com/rodger-malcolm-mitchell ACADEMIA: https://www.academia.edu/

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The Sole Purpose of Government Is to Improve and Protect the Lives of the People.

MONETARY SOVEREIGNTY

Textbook authors told climate change references must be cut to get Florida’s OK

The directive appears similar to requirements the state imposed on math and social studies textbooks said to include “critical race theory” and “social justice” material

By LESLIE POSTAL | lpostal@orlandosentinel.com |July 5, 2024 at 5:36 p.m.

Textbook authors were told last month that some references to “climate change” must be removed from science books before they could be accepted for use in Florida’s public schools, according to two of those authors.

A high school biology book also had to add citations to back up statements that “human activity” caused climate change and cut a “political statement” urging governments to take action to stop climate change, said Ken Miller, the co-author of that textbook and a professor emeritus of biology at Brown University.

Both Miller and a second author who asked not to be identified told the Orlando Sentinel they learned of the state-directed changes from their publishers, who received phone calls in June from state officials.

Miller, also president of the board of the National Center for Science Education, said the phrase “climate change” was not removed from his high school biology text, which he assumed happened because climate change is mentioned in Florida’s academic standards for biology courses.

But according to his publisher, a 90-page section on climate change was removed from its high school chemistry textbook and the phrase was removed from middle school science books, he said.

The other author said he was told Florida wanted publishers to remove “extraneous information” not listed in state standards.

“They asked to take out phrases such as climate change,”he added.

The actions seemed to echo Florida’s previous rejection of math and social studies textbooks that state officials claimed include passages of “indoctrination” and “ideological rhetoric.”

And they fall in line with the views of many GOP leaders, who question both the existence of climate change and the contributions of human activities to the problem, despite a broad scientific consensus that human-caused climate change is transforming the earth’s environment.

In May, Gov. Ron DeSantis signed a bill that stripped the phrase “climate change” from much of Florida law, reversing 16 years of state policy and, critics said, undermining Florida’s support of renewable and clean energy.

The bill did not address public education nor the state’s science standards, which were adopted in 2008 and spell out what students should learn in science instruction from kindergarten through 12th grade.

But SB 1645 altered Florida’s energy policy, removing the goal of recognizing and addressing “the potential of global climate change,” Senate staff wrote in an analysis of the bill.

DeSantis has said the new legislation, passed by Florida’s Republican-dominated Legislature, was “restoring sanity in our approach to energy and rejecting the agenda of the radical green zealots.”

The Florida Department of Education did not respond this week to a request for comment about the science books nor to earlier questions in May and June about when its approved list of science textbooks for elementary, middle and high school science classes would be released.

Florida’s school districts use the list to purchase books for their schools and had been told the state would release the science list in April.

Late Tuesday, the department posted the list on its website. Miller’s and the other author’s books were among those approved. The texts have not yet been printed so the Sentinel was unable to review them.

But there are no textbooks for high school environmental science classes on the approved list, though three companies submitted bids to supply books for that class, according to documents on the department’s website. Course material for that subject typically includes significant discussion of climate change.

“How do you write an environmental science book to appease people who are opposed to climate change?” asked a school district science supervisor, who is involved in science textbook adoption for her district. She asked not to be identified for fear of job repercussions.

She and other educators, the textbook authors and science advocates said the state’s actions will rob students of a deeper understanding of global warming even as it impacts their state and communities through longer and hotter heat waves, more ferocious storms and sea level rise.

Florida had already earned a D —and was among the five lowest-ranked states in the country — in a 2020 study that graded the states on how their public school science standards addressed climate change, said Glenn Branch, deputy director of the center for science education, which was a partner in the study.

Excising the phrase from science textbooks will “make Florida climate education even worse than it is,” Branch said. “These ill-considered actions are going to cheat Florida students.”

Branch said it was especially troubling the decision seemed based on “ideological grounds” and ignored the “rock solid” science that has documented climate change and its impacts.

Brandon Haught teaches environmental science at a Volusia County high school and was active in efforts to include evolution — another controversial science topic — in the standards adopted 16 years ago.

His ninth graders know almost nothing about climate change because it is not taught in the lower grades, he said. He spends at least a week on the topic but is covering only “the basics,” he said.

Florida students need more information on the subject not less, he added. “Florida is one of the most impacted by the impacts of climate change, and oh my goodness Gov DeSantis, why?”

The state’s push to get publishers to remove “climate change” from some science books seems similar to its actions in 2022 and 2023 when it rejected some math and social studies textbooks publishers wanted to sell in Florida.

In those cases, the department announced it had rejected textbooks in press releases that claimed the books contained “critical race theory” and “social justice” topics, which were prohibited by state laws and rules. Some of those textbooks were later approved after the publishers made changes.

In contrast, the list of approved science books was posted to the department’s website without an accompanying press release.

Judging from past practice, science textbooks that were rejected, such as those for environmental science, could later be approved if they were altered to meet Florida’s requirements.

Some school districts, including those in Orange and Seminole counties, were poised to buy new science books as soon as the state list was released.

But districts can continue to use older books for a while, and some districts now may not purchase new science books immediately because the list was released months later than expected.

There were 146 textbooks submitted for consideration.

About 75 books from a total of about 10 publishers were approved for middle and high school classes, with four publishers also approved to provide science books for kindergarten-to-fifth-grade classes, according to documents on the department’s website.

Textbooks can be rejected for failing to match Florida’s standards or failing to provide content that is accurate, among many other issues.

Science textbook publishers were told in advance to keep “critical race theory,” “social emotional learning” and other “unsolicited strategies” out of their textbooks.

However, the “rubric” used to evaluate the books made no mention of “climate change.”

The Sentinel could not reach for comment the three publishers — Cengage Learning, McGraw Hill and Savvas Learning Company — that submitted environmental science books that did not make the approved list posted Tuesday.I publish this article for you, without comment.

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The History of Nazi Book Burning Julia Rittenberg

The rise in book censorship across the United States is reminiscent of the fascist tendencies throughout history.

While book banners and censorship supporters paint their concerns as specific to contemporary issues, it’s a common way to consolidate power.

The history of Nazi book burning is one of the most obvious antecedents to the censorship of books in the U.S.

Book burning began shortly after the Nazi Party took control over the government: “Beginning on May 10, 1933, Nazi-dominated student groups carried out public burnings of books they claimed were “un-German.”

The book burnings took place in 34 university towns and cities.

Works of prominent Jewish, liberal, and leftist writers ended up in the bonfires.”

With these ideas came the need to define what was German and what was not. Exclusion is necessary to create an enclosed nation.

Part of the rhetoric of German nationalism was that all true Germans were Christian.

Some German nationalists believed Jews could assimilate only if they converted. German Jewish people disagreed and fought for equal recognition under German law.

Gabriel Riesser, a prominent Jewish activist during the first half of the 19th century, argued that the Jewish people’s participation in the army validated their German identity, not their faith.

The German poet Heinrich Heine wrote with chilling clairvoyance, “where one burns books, one will soon burn people.”

Although Germany was officially unified in 1871, chaos and power-grabs in the form of nationalistic fervor were quick to dominate the country.

Taking the time to separate German and un-German texts (even if a number of them originated in Germany) also allowed the Party to define the enemy.

The un-German forces defined by the Party were texts from Jewish writers, socialist writing, anything democratic, or foreign authors.

On May 6, 1933, the first book-burning action took place. The Institute of Sexology was targeted by German students.

The library of the Institute collected over 20,000 texts about intersexuality, homosexuality, and transgender people.

Magnus Hirschfeld, the founder of the Institute, also performed the first gender confirmation surgery on Dora Richter, who died in 1933 and was most likely killed in the chaos of the book burning action.

This initial step was part of the Nazi Party’s mission to ban all “deviant” sexuality.

The fact that state governments are choosing schools to start the book bans is also deliberate. The Nazi Party exerted control over universities and children through the Hitler Youth program in order to raise compliantly racist Germans.

American schools filled with students with no knowledge of the Middle Passage, the Jim Crow era, or internment camps will pay no attention to the erosion of protections for marginalized people under federal or state law.

If they know nothing about discrimination, they can’t fight it.

They’re also fed a false narrative of American exceptionalism, similar to the narratives of German purity that drove the book burnings.

Th(is) could even preface a future in which students learn very little about the lead-up to the Holocaust and fail to recognize the signs of dictatorial cultural power.

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The Sole Purpose of Government Is to Improve and Protect the Lives of the People.

MONETARY SOVEREIGNTY