PIPECCAA

 The Permanently Increasing Provision of Ever Cheaper Care to Americans Act

(PIPECCAA)

Extent of Application of other laws to this law.

The medical information from malpractice cases must be available to doctors in public hospitals who are doing research, as shall the results of that research (made available to all doctors in the world once the information necessary to personally identify a patient is removed other than the literal A’s, T’s, C’s and G’s of each patient’s DNA if the machines for decoding it are available for the majority of the study’s subjects).

A triage policy of the Council on Health must recognize the fundamental limitations that exist for medical resources at any given point in time, and a policy that recognizes this cannot be considered arbitrary or capricious based on a particular person close to the front of the line not getting care (and potentially even dying), even when people farther back in line do get care.

In the absence of anyone with both a JD (Juris Doctor) and MD (medical doctor) degree being able to be found in the United States (who would thus be qualified to serve as a “private arbitration” federal judge on a panel of 3 to determine all cases regarding questions of malpractice or similar against doctors working in these public hospitals), the President may appoint one who has received the degrees in other countries that themselves recognize those degrees as valid, even if degrees from those institutions are not accredited in the United States.

When someone who seems to be a minor is rushed to a public hospital under this section by someone who seems to act like the parent of the minor, that person may sign the consent form for “private arbitration” (if the minor is conscious at the time, the minor must also sign for this to be valid; taking action by a doctor to render the minor unconscious to avoid needing the minor to sign is malpractice, the other person taking this action (if not a doctor or nurse) to render the patient unconscious to avoid needing the patient to sign the consent form is assault (malpractice otherwise)) to satisfy the requirement for “private arbitration” to be used in any case of malpractice in the public hospitals under this Act, even if that person is found out later to not be the parent of the presumed minor, and no attempt need be made prior to providing care to determine who the parent or guardian is, but the contact information and picture of the one bringing the presumed minor to the hospital seeming to be the parent must be registered into the permanent file for the patient.

Wherever possible, all patients of the public hospitals shall have digital records with all information (including pictures, fingerprints and DNA samples) necessary to identify the patient (and connect them to the same person elsewhere in the database by biological markers), and all patients who do not bring state or national government IDs when they get care must have pictures, fingerprints and DNA samples taken from them when they get care along with any information they can provide to those assigned by managers to verify the identities of patients, and the reports by those assigned by managers regarding the success of verifying a patient’s identity.

The Council on Health:

The Council on Health referred to in this Act shall consist of seven people with Medical Doctor degrees appointed to staggered terms of 14 years each. Each one must be confirmed by the Senate for that one to have any power at all. May only be removed prior to the end of the term by the President for the cause of neglect of duty under this Act and must provide the House of Representatives, Council on Health, and Senate 30 days notice or else such an order is void, it is also void if the Council on Health member concerned can have any federal judge state (does not even have to be an official order) that “the President has provided insufficient evidence for the Council on Health member’s supposed neglect of duty”.

The House of Representatives may make a resolution whenever a term of a member of the Council on Health’s term is within 30 days of ending due to the end of the term for that spot saying “Resolved. It is the policy of the House of Representatives that the member of the Council on Health’s term which is about to end should go on for the next 14 years.” After the House of Representatives makes that resolution, whether or not they later rescind it, the particular member whose term on the Council on Health was about to end is considered to serve for an additional 14 years. This resolution may be made in the same way in the case of the President ordering the removal of the member of the Council on Health to have the duration of the delay to the end of that Council on Health member’s term of service before the order comes into effect be delayed until 30 days after the start of the next Presidential term (during which time it could be rescinded by a different President or by any federal judge saying “the President has provided insufficient evidence for the Council on Health member’s supposed neglect of duty” in an unofficial capacity (even as a snide comment to reporters)).

May hire managers using the qualifications of standard members of the civil service to carry out their roles under this Act other than creating budgets for hospitals, generating a hierarchy of what doctor positions will be assigned to what manager positions, and which manager positions will be assigned under which manager positions (the hierarchy must form a directed acyclic graph where each manager is a vertex that must have either no managers assigned under that manager or at least 2 managers assigned under that manager (i.e. no chains of managers allowed), and the number of managers must be less than max(100, min(square_root(number of doctors employed (happens after a position opens up and is filled by one who has otherwise been on retainer under this Act to that point in time) under this Act)*ln((same) number of doctors employed)*ln(sqrt((same) number of doctors employed)), (same) number of doctors employed))), and determining the triage rules for maximizing lives saved by any hospital.

Funding:

All persons residing in the United States or profiting off transactions made in the United States must pay 5% of their income or profits to the Internal Revenue Service, which shall take 1% of those receipts in order to enforce this tax and send the rest to the Council on Health. All corporations making profits off transactions that happen in the United States must pay 5% of those profits made in the United States (even if that money would be used for paying dividends or stock buybacks) to the Internal Revenue Service, which shall take 1% of those taxes for paying for enforcing it.

Outside of the 1% of PIPECCAA’s 5% tax the IRS receives, the budget of the IRS shall not be less than its budget in 2016 with respect to the consumer price index and not less than its budget in the previous year with respect to the consumer price index. Any law that would reduce the budget of the Internal Revenue Service is exempt from the Congressional Budget Act and during debates on such a bill every Senator may speak twice and only be interrupted with that Senator’s consent with all such interruptions first directed to the chair. This plus the 1% of PIPECCAA’s tax revenue is otherwise considered a permanent appropriation of funds to the IRS.

Price to receive care: the Council on Health shall determine the value of x and y as some positive real numbers in the expression of cost: ( ( $1)*(position (indexed starting at 0, not 1) in line at a hospital relative to the longest waiting person who has not received care yet, and the number of people behind that person who have not received care at that hospital yet when first arriving (or signing up online))^x )*(100 - (probability of death in the absence of care (measured as a whole number “percentage” out of 100)))^y

The first term means that if no one is in line (either physically at the main entrance or ambulance entrance, or through a queue established through online surveys (for care to send out messages to come in as soon as it looks like a healthcare provider is available, at which point the patient who signed up that way has up to the amount of time stated on the survey it would take the patient to arrive when called to come in, and if the patient didn’t come to the hospital in that window of time, the appointment is canceled (no charge to patient) and the patient will have to sign up again to have a place in line for care, or wait in the physical line)) for the hospital when a patient comes in, the patient cannot be charged any price for the patient’s care.

The second term in cost means that if the patient needs any sort of resuscitation during a procedure, or has a condition that is historically (prior to modern medicine) been considered “fatal”, the cost of going to the public hospital is $0 because 100-100=0, and 0 times finite numbers is zero. The probability of death can otherwise be determined relative to the historical average chance of death (within some time frame chosen by the triaging doctor or algorithm that may be defined in the Council on Health’s triaging rules) due to some medical condition becoming apparent prior to operations to make it resolvable being invented.

The price to receive care must be paid before receiving care if it is not obvious to the secretary on hand at the time that the patient is unconscious, unable to think, or about to die, in which case those 3 situations will mean that any payment will be charged only after receiving the care.

All such fees shall be paid into the general budget of the Council on Health.

Money left over (after the Council on Health has done what it can to fund items under its authority as efficiently as possible and all retainers and doctor salaries and scholarships) may be retained in relatively liquid assets (such as dollars or gold) that will clearly increase (or at least decrease in value less as a function of marginal utility (i.e. they may purchase less liquid assets if they can get a good deal and have profits to reinvest in the meantime) relative to other options to put remaining money towards by the time that the assets need to be sold (if ever) to pay for increased healthcare services under this Act. Though asset purchases using these leftover funds must be done without the use of any sort of eminent domain and must follow all state and local laws (other than income tax laws) as if the Council on Health were an individual person living in the community (e.g. must get permission to build new houses, must pay property taxes and must satisfy construction codes, but those codes may not be specifically designed (de facto) to target deep pockets like the Council on Health, nor may they have residency requirements to do certain things with respect to profiting on assets, nor may the Council on Health be sued on account of a project used as a holding asset for more money than it invested into the project, and this limitation applies cumulatively over the course of all suits with respect to the project in question (i.e. they can pay twice the price for something in order to keep it forever (save for the property taxes that are defined generally for everyone else in the area (equitably)))).

 

 Authority of Council on Health

The salary of each of the seven members is $300,000 per year, adjusted for inflation (as per the consumer price index) from the time the Act passes, with up to $200,000 for the expenses of each in carrying out duties (such as in flights and hiring a personal Secretary), also adjusted for inflation. In the case of deflation, the amounts are kept flat (inflation pricing thereafter being based on having the ending salary be $(max(300000*CPI now/CPI in 2016, previous year’s salary)) (works the same way for everything else that is inflation-adjusted in PIPECCAA).

The Council on Health shall use Eminent Domain to purchase the cheapest non-flooding (in any stretch of the last 10 years nor predicted to flood in the next 10 years from purchase), non-burning (in any stretch of the last 10 years nor predicted to burn in the next 10 years) piece of land large enough to build a hospital and 200 feet around its hypothetical perimeter that would be closer to more people than the next closest public hospital built or under construction, without other considerations outside of this Act (as in, ignoring the restrictions due to construction codes, particularly with respect to providing everything within those locations necessary for doctors, managers, secretaries, computer scientists, and janitors to be efficiently able to carry out their duties under this Act (and thus shall include on-site housing (particularly in known high cost of living areas, and for the obvious reason that patients will also be effectively housed on-site whenever doctors see that as necessary for better healthcare outcomes) and internally defensive measures (a rule of thumb for the Council on Health should be that these be proportional to known opposition by local residents and known criminal activities in a 30 mile radius) as the Council on Health sees fit) (this is to specifically eliminate the possibility of a future replication of the 1858 burning of a hospital in New York based on it being a quarantine center that reduced home prices, or the activities of anarchists or others opposed to the existence of these government interventions for the common good), and potentially also include nuclear energy generation capacity if the local grid cannot otherwise provide sufficient electricity (and of course are still limited by virtue of the fact that it needs to both be solely owned by the Council on Health and that it needs to be contained enough to not directly affect the health of anyone (to satisfy the underlying obligation of the Council on Health)) for any of these purposes the Council on Health would have to pay the Department of Energy the whole cost of checking the containment to satisfy the minimum conditions of safety and making alterations necessary to satisfy this, as well as the price for the fuel to be refined originally and delivered (all of this must be done “in-house” by the Department of Energy, defaulting to automatic approval if they do not have the civil servants available to make the necessary checks and changes, and delaying the project of the Council on Health by no more than 3 months relative to the expected completion date of the hospital according to the original designs by the architects and engineers, though any design for a hospital that includes any nuclear energy generation must be sent to the Department of Energy prior to beginning the bidding process, with the main hospital itself being the first to start being built severable from the nuclear energy generation so as to provide the maximum leeway for the Department of Energy to make changes just to the design of the nuclear energy generation capability (The Department of Energy may not require the use of a light or heavy water reactor, and the Department of Energy may not prohibit the use of molten Thorium salt as fuel))). The Council on Health may otherwise accept donations and get good deals on the free market for property for aforementioned uses.

The Council on Health shall use the permanent fund provided under this Act to place on retainer all American citizens who have successfully completed a Medical Doctor degree from an accredited medical school and have not yet taken up a job outside of the following 3 possible volunteer positions:

1. Providing medical care to patients not paying for care or paying below the material costs of providing care (and who are not being covered in payments by insurance companies or personal friends).

2. Performing medical research (in which case it is illegal for the group performing the research to prevent the volunteer from revealing any information that would be useful for increasing quality or decreasing price for medical care for others; the fine for the group breaking this law shall be no higher than twice the de facto costs they impose on the volunteer for utilizing this information, and the amount paid out of this fine shall be given to the volunteer). Volunteers performing this research must provide a summary of what is done at the end of every month to a database set up by the Council on Health that is searchable by any doctor in these public hospitals. This database can be searched and the person making the summary can be summoned as an expert witness in cases done by “private arbitration” in this Act with the travel, meal and hotel costs of that person providing the summary concerned paid out of the budget in this Act while coming to (and during the course of, if the case lasts more than a day) and going from the place that “private arbitration” is done as speedily as possible.

3. Teaching Biology, Chemistry or some class of medical knowledge to people who do not yet know that material.

If the Council on Health determines that a retained doctor is doing one of the three above, then the retainer shall be increased by $25,000 per year while doing that service.

The Council on Health shall hire architects and engineers on a competitive basis for long-term contracts to design each hospital based on making sure that the foundation is deep enough to avoid the effects of sinkholes or other underground causes of destabilization, and otherwise survive a 500 year wind, 500 year flood, 500 year fire, and 500 year earthquake. There must be sufficient space, electrical connections, separate ventilation systems, and plumbing to provide for every activity that doctors could be expected to use as listed out to them by the Council on Health and other panels of independent doctors they will convene when coming up with these plans. The architects and engineers shall develop a set of construction checkpoints in the process of finishing the hospital with respect to time working on it and with respect to what order things need to be included in it.

The Council on Health shall then call for bidding by construction companies for building the design.

At each checkpoint in construction, the architects and engineers shall come in and check for any deviation from what needs to be included considering the amount of time the construction company has people on the site. If there is any deviation, then the construction company shall only be paid the value of what can be salvaged to build the final hospital by the next contractor, and all employees who worked on that site building it to that point are banned from the premises until the hospital is complete (presumably coming back in as patients for care). Other contractors shall bid on completing the remainder of the hospital under the same conditions otherwise.

The Council on Health shall, {when the following conditions are satisfied: (1) its budget is in surplus, (2) 435 hospitals have been built according to the equation for maximizing the number of people closer to each new hospital than to any other public hospital under this Act with at least 1 in each state and territory of the United States, (3) a large number of patients in line for care at a public hospital have conditions that cannot be resolved with the medical knowledge and skill of sufficiently many doctors in the same hospital, (4) the doctors in the hospital have time within their 8 hour per 24 hour and 40 hour per 168 hour maximum working time that they are not working on physically caring for patients (after managers hired by the Council on Health have hired enough secretaries, janitors and computer scientists to maximize the amount of time that doctors can work on patients) due to the number of people in line for care whose conditions can be treated by those doctors regularly falling to zero,} find doctors in the hospital who have been recommended by a manager to be of sufficient quality to hypothetically treat the patients in line who could not be treated, and negotiate with those doctors long-term contracts and scholarships that would allow them to learn everything necessary to specialize in solving those problems.

The Council on Health shall have the power to hire emissaries from among those qualified to be in the civil service for the purpose of purchasing pharmaceuticals and medical equipment from other countries to use solely within the public hospitals without requiring the permission of anyone, provided that the cost including the price of shipping and 10% on top of that is less than the cost of the equivalent thing in the United States. The FDA shall be given 10% of the cost of all such pharmaceuticals and equipment for the purpose of testing its quality (tests must be done in such a manner that the material purchased remains completely (or 99%+ if it is designed to be consumed inside of a patient (like the insulin in a bottle of insulin)) usable by the doctors under this Act on demand). Such pharmaceuticals and medical equipment must be segregated from those bought in the United States and patients, if they can be brought to consciousness safely or someone with power of attorney for them can be speedily found, must be able to choose to use a U.S. alternative unless no U.S. company provides it, and be given the latest test data on that pharmaceutical or piece of medical equipment if the FDA has completed it. For these emissaries, they may not be required to spend more time than they believe is necessary in setting up paperwork or getting approval for moving these medications and medical equipment to the public hospitals in this Act (this sentence is to give a hint to the civilians with very particular skills to help their country in a more direct manner with those kinds of skills not to be specified).

The Doctors

Doctors who are held on retainer shall be notified by the Council on Health whenever a position is opened by their distance from the hospital, starting with all within 100 miles and extending it by 50 miles every 14 days if the position isn't filled in a given 14 days. Applications shall be accepted according to the proximity of the doctor on retainer to the hospital (only doctors on retainer (as in, effectively just graduated from Medical School and before taking a job after Medical School) may be hired). Anyone with a greater than 1 hour 30 minute commute one way shall have $200,000 available to pay for moving expenses to get within that distance if possible. If not all positions are filled within 14 days at a given increment of miles from the hospital and there are doctors on retainer that have not applied who live within that increment of miles (and thus would have been notified), then those non-applying doctors in that distance are removed from the retainer.

Doctors shall be hired on the following terms:

A $100,000 to $300,000 yearly salary indexed to inflation as of 2016 and indexed according to the cost of living adjustment for the doctor’s area, paid weekly or monthly.

$3,000 available each year to match 401(k) contributions.

In any 24 hour period, the doctor may not work more than 8 hours.

 

 In any 168 hour period, the doctor may not work more than 40 hours.

14 days of paid vacation per year.

May receive a monthly bonus of up to $1000*(1+years worked to that point)*1.02^(years worked) indexed to the consumer price index as of 2016, determined by the manager assigned by the Council on Health over that doctor in any month.

6 months of paid maternity or paternity leave per child.

The manager assigned over the doctor shall maximize the 8 hours of working time each day for treating patients by hiring secretaries, janitors and computer scientists to deal with all situations that do not specifically require someone with a doctor’s qualifications (the paperwork issues).

Doctors (unless assigned to do research (and thus not directly providing the care that patients may pay for under this Act (since research often involves having paid test subjects)) that involves this kind of communication as part of a scholarship under this Act) are prohibited from meeting with pharmaceutical or medical device company representatives, with all such information about how to treat patients directed to secretaries, who shall only provide that information either to their managers or to a database; the managers receiving these advertisements may choose to ask computer scientists to put the information into a database that could be searched for by the doctors and look for any research paper that can be found regarding the thing in the advertisement to attach to any search on the database a doctor makes. The manager may choose to tell a doctor about this advertisement (if other research papers do not indicate the advice of company representatives to be wrong), and may choose to ask the Council on Health to request more information about these medications or medical devices from the volunteers doing research (on retainer under this Act) and/or from the National Institutes of Health (or from doctors doing research as scholarships under this Act), about whether more information exists on these pharmaceuticals and medical equipment that shall be attached to its record in the database.

Doctors requesting more information on pharmaceuticals or medical devices shall either search through the database set up by the computer scientists hired by the managers hired by the Council on Health or the database of the public hospitals patient results where some pharmaceutical or medical device was used, or ask their manager to ask the computer scientists and Council on Health to find out more about something, or have the manager ask the secretary to relay the question about the advertisement back to the company representative (and restart the cycle).

Doctors (other than those under the aforementioned scholarships) choosing to communicate with pharmaceutical or medical device company executives or representatives, unless one comes in as a patient with a legitimate health concern, shall first have the doctor’s salary reduced by $10,000 by the manager (ending after 1 year), and a second offense shall result in suspension without pay for a month, and a third offense shall have the doctor fired.

Pharmaceutical and medical device company representatives may not try to communicate with doctors hired for working on patients in public hospitals, doing so shall result in a fine no greater than $10,000 per offense. Advertisements (ads) that are published in media in a generic way to not specifically target a public hospital doctor do not fall afoul of this rule, but any radio or TV channel that runs inside the hospital must be changed away from those that show such ads to those working in the hospital, and ad blockers must be installed on all computers used by public hospitals, and it is vandalism to physically drop ads on hospital premises.

Doctors are required to get patients or someone with power of attorney over that patient to sign a waiver to use the “private arbitration” of 3 federal judges with both J.D. and M.D. degrees assigned specifically to resolve the penalties on doctors for malpractice or similar while using rules of procedure relaxed enough that most doctors shall not feel the need to hire a lawyer or prepare a defense before going in on a complaint from a patient with open questions of the Plaintiff and doctor where they have ample time to find the documents about a question and ask for expert witnesses, requests for whom shall be made by those judges if they see that the medical issue concerned is one that expert has done sufficient research in to be helpful here, and the decision of that panel shall be legally binding as long as an attempt was made to have the patient be conscious when signing the waiver or a parent (in the case of an obvious minor, this is required unless the secretary involved could assume that the person bringing in the minor and signing was the parent (the justification for such an assumption is irrelevant as long as a photo, fingerprint, DNA and any sort of copies of any extra identification information are maintained in the record for the patient, which shall have the patient’s fingerprints, pictures and DNA as well)) or someone with power of attorney over the patient.

Other than in cases of involvement with a pharmaceutical or medical device company representative or where the doctor makes a lawsuit to have particular data removed from a protected database under this Act (for some weird reason that this Act would not have an obvious reason for them to need to do so (especially if said information is wrong, in which case the way to deal with that information is to provide notices on it that it is wrong and have the notice include the link to the correct information, and not via lawsuits)), managers must first receive the consent of at least one member of that hospital’s panel of judges that otherwise serve as “private arbitration” before reducing the pay, suspending, or unemploying a doctor whose position is assigned under that manager’s position.

 

 Managers

Managers are officers of the United States hired by the Council on Health from among those qualified to be civil servants on a competitive basis.

Managers shall negotiate long-term contracts and benefits with the Council on Health and may be fired from their position in the hierarchy under the conditions of waste, fraud, abuse of those hired or contracted under this act, allowing the abuse of patients, neglect of duty, or failure to provide information to those assigned by the Inspector General’s (the Office of Inspector General for the Department of Health and Human Services also applies its responsibilities to the Department of Health and Human Services equally to the Council on Health) office in its investigations into such things.

Managers shall each be given budgets by the Council on Health for hiring secretaries (necessarily including the funding to purchase their supplies (like paper, ink and computers) as well as taking orders for medical equipment and pharmaceuticals from doctors and managers to service the needs of patients to those selling the needed items), janitors (including anyone hired to physically fix things, which necessarily includes the funding to purchase the items needed to fix things) and computer scientists (necessarily including the funding to purchase their supplies, like computers and other equipment for connections) and for potentially giving bonuses to doctors assigned under them as they see fit for maximizing the amount of time doctors use in their maximum of 8 hours of working time in physically working with patients. Money left over in these budgets is returned to the Council on Health.

Emissaries

Emissaries are officers of the United States hired competitively from among those qualified to be civil servants by the Council on Health or by managers hired by the Council on Health in positions in the hierarchy approved by the Council on Health to make these hires or by Emissaries (recursively downward within a hierarchy created by the Council on Health).

 

 Emissaries shall be given a budget for purchasing medical equipment and pharmaceuticals from other countries, travel expenses, and to potentially hire additional emissaries as needed in order to fulfill the orders by secretaries as efficiently as possible.

Their employment contracts made with those hiring each one shall determine pay and benefits (allocated from the budget of the position doing the hiring) with conditions for termination of contract by the Council on Health (or manager over the given hierarchy of emissaries, or the emissary over the given hierarchy of emissaries the given emissary is in) finding the particular emissary to have caused waste, fraud, abuse of another staffer provided under this act, or neglect of duty.

Emissaries shall not pay duties (nor other fees (besides a general sales tax) other than what can be attributed as the “purchase price” that normal people in that country could be expected to pay for normal purchases) nor otherwise allow any item purchased on the request of a secretary under a manager to be confiscated or otherwise removed from the emissary’s possession, and may call on the Council on Health (unless the emissary was given orders to leave no trace and hide any connection with the U.S. government as part of a strategy to enable continued purchases with plausible deniability by other emissaries in that country (and to allow them to act as an emissary to another country)) to call on another agency to enforce that the emissary is able to carry out the emissary’s duty to bring all purchased items to the public hospital who had a secretary request it, so that the emissary can do so without delay or other administrative harassment.

Once the requested medical equipment and pharmaceuticals from other countries are delivered to the public hospitals requesting them, the items shall be segregated from the items bought in the United States, and the emissary shall use the database used by the Council on Health for these purchases to state the purchase price and travel costs associated with the items, the sellers, and country of origin of each item, and to request 10% of the purchase price of the items to be paid to the FDA for testing items (like those just delivered) for quality.

 

 Patients

Patients have no right to their health data when they enter the public hospitals under this Act; the records are the property of the Federal Government. Their health records, upon entering, shall include their pictures (taken each time served), fingerprints (checked along with DNA to match a given person to the same person’s record, where some extra research can be done in the case of names not matching to also put in the file), and DNA, and copies of any identification they have with them and other identifying information they may give.

These records shall have all treatments they say they have had, patient records from private (or other) doctors or care facilities, and any treatments done in these public hospitals recorded separately in a full-text searchable format.

These records may only be used by doctors in these public hospitals while they are on the premises in their capacity as paid employees and medical researchers on salaries from the federal government, and the computer scientists hired by managers hired by the Council on Health to maintain the integrity of the data.

Technicalities

The Council on Health shall appropriate money for creating efficient systems to make full genome encodings (all ATCGs of one side of the helix from each chromosome) of each patient’s sample of DNA available in patient records. This can be done as part of the scholarship long-term contracts they make with the doctors recommended by managers in these public hospitals, who can use this money to hire their own staffs and get all possible research information to build the necessary systems, and potentially keep building them, with other doctors on the same kind of scholarship testing the validity of the transcriptions and potentially hiring their own people to make sure the other doctors are using the most efficient methods known.

For the purpose of the scholarships given to recommended doctors hired under this Act, these doctors cannot be held to Non-Disclosure Agreements, nor Non-competition agreements, and “stealing trade secrets” or other information is not a crime for them as long as they keep the information from being used to create products sold to groups (but may be used to sell products to the public hospitals under this Act), and as long as they put all the information derived from their scholarship (medical research) in with the database that has the well-protected patient records.

Non Severability

A court that finds that any of the provisions of this bill are unconstitutional must strike down the entire bill (i.e. deprive Americans of the biggest way to get cheaper healthcare).

“Private arbitration” federal judge panels.

“Private arbitration” in this Act refers to panels of 3 federal judges appointed by the President and confirmed by the Senate (only having power when actually confirmed by the Senate) for a term of good behavior with non-decreasing salaries with the precondition before being a member that each must have both a Juris Doctor (JD) degree and a Medical Doctor (MD) degree from accredited (within their own country) schools of law and medicine, respectively.

 

 In order to skirt the 7th amendment right to have civil suits tried by a jury, the doctors are required to find some way to get the patient and someone potentially legally eligible to vouch for the patient (especially if the patient cannot safely be brought to consciousness) to sign the waiver of this right in order to use this “private arbitration” in all medical malpractice or similar cases against the doctors in these public hospitals. In this case only is it acceptable, and required, for all other courts in the United States to accept the decision of the “private arbitration” judges and not reconsider the validity of the waiver provided only that the patient signing it was conscious while doing so (or, failing that, that the person vouching for the patient by signing the waiver (where the patient cannot safely be brought to consciousness without an operation) be assumable to have some power to vouch for the decisions of the patient in the absence of (while the patient is untreated) an investigation into the truth of such an assumption, deferring to the judgement of the secretary hired under this Act originally involved in receiving that waiver).

The number of these judges shall not exceed 3 times the number of public hospitals built under this Act, and, in the case of fewer than this number being around, the Council on Health shall assign these judges to panels of three to rule on the cases that happen in up to ceil((number of hospitals)/(number of panels)) hospitals based on making sure each panel will have as close to the same number of cases as the others. These panels may not have their jurisdiction in one hospital be removed except by the consent of those same judges.

The judges shall avoid using too strict of rules for accepting evidence, acting instead in a manner similar to a deposition until both the Plaintiff and Doctor have provided sufficient arguments to decide the case. The general framework that may be used by the judges must be consistent with the average doctor on trial not feeling like the doctor actually needs a lawyer, so that framework must include such things as asking questions to the doctor, informing the doctor of where the doctor could go to find extra information, and allowing doctors to, prior to a case against the doctor existing, getting a binding advisory opinion from the judges on what their liabilities for malpractice or similar would be in the eyes of those judges based on a certain set of hypothetical or imminent actions, including with respect to performing research.

The judgements granted by “private arbitration” are legally binding upon the doctor tried, with the maximum penalty on the Plaintiff being the legal fees of the doctor (or $20 per hour if the doctor did not hire a lawyer) (payable to the doctor only) in the case of a frivolous lawsuit. The judgement on the doctor cannot exceed the dollar value of the doctor’s after tax salary in the previous 12 months as a government employee plus the max(0, doctor’s assets’ values minus loans on those assets), and may otherwise include such things as listed in: {a restraining order to prevent the doctor from approaching the plaintiff for some time period, removing the Medical Doctor degree (and ordering the alma mater to never verify the completion of the degree) and associated evidence that it was completed, a future reduction in salary (payable either into the budget of the Council on Health (i.e. a paper reduction in salary) or to the Plaintiff or some combination of the two), disqualification from Council on Health scholarships or long-term contracts, some length of suspension either with or without or with reduced pay, or being no longer employed by the public hospitals (which would further disqualify the doctor from being able to be rehired by the public hospitals, because only those just graduated from medical school (and thus still having the retainer due to not having taken a job outside of the three allowed volunteer positions since graduating) become doctors at the public hospitals under this Act)}. Payments made to the Plaintiff are considered personal damages.

 

 In any other case concerning the conduct of a doctor working in these public hospitals in state or federal court, a lawyer chosen by the doctor shall be paid out of this Act and the jury must consist only of doctors from the same hospital. Any grand jury for criminal indictments against a doctor for actions while working in a public hospital must consist only of doctors from the same hospital. No doctor working at a public hospital may be held in contempt of court without the consent of 12 doctors at the same hospital. No doctor working at these hospitals may otherwise be arrested or otherwise have administrative measures used against them (outside of those under the authority of the Council on Health) (except with the direct approval by a grand jury of randomly chosen doctors from the same hospital) while on hospital premises. The specific purpose of this is to provide doctors hired under this Act with a backstop protection of jury nullification when the doctor takes controversial (but necessary in the eyes of the doctors at the hospital) actions on hospital premises (an example of how this would be used is in stopping a doctor from being considered to have committed murder when performing a heart transplant (there was a case in Japan where the first doctor to perform that operation was convicted of murder), and another case in the U.S. where a court ruled against doctors who chose to use machines to operate a brain-dead woman in order to allow her baby to become viable (this verdict would clearly have been stopped had the jury consisted of doctors from the same hospital); this jury nullification system is ripe for some level of abuse, but that abuse will be far less than what unbound courts can do given that, while patients can just choose to not go to these public hospitals, doctors in these hospitals should only be concerned about saving as many lives as possible, and their ability to do that is hampered when they second guess themselves in the moment relative to the possible decisions of an antagonistic court (an example of the effective maximum extent of this provision being used poorly would be the extreme situation of rioters coming in to Lynch the doctors wherein a doctor massacres them with firearms (in which case, it is still the best interests of the United States (in a Machiavellian sense (as opposed to a preferred legal norms sense)) to allow the doctors to decide to find themselves not guilty, given that allowing the rioters to win would have resulted in a reduced capacity to save lives, and thus this provision would follow the doctors' Machiavellian conclusion if they so chose (especially since, given their oaths to "do no harm", doctors are unlikely to choose the profession based on a desire to kill people (of which, doctors who show such tendencies are likely to be fired early on by managers with relative ease in getting the consent of one of the doctor-lawyer judges))))).

Rider to PIPECCAA (not related to healthcare)

Managers and directors and anyone who has the power to remove or redistribute scientists working at the Environmental Protection Agency who themselves work at the Environmental Protection Agency are required to, over the next 10 days after this bill is enacted into law, appoint replacements for themselves from among the scientists who have worked at the Environmental Protection Agency for the last 10 years, and those replacements must be scientists who have done their own experiments to show the danger of a new chemical brought forward by a chemical company in the last 5 years (with a preference for scientists whose determinations at the EPA have been opposed by chemical companies in a very vocal manner). After those replacements have been made over the next 10 days, all later replacements for management (or other positions with those kinds of responsibilities) at the EPA must be chosen from among the scientists who have worked at the EPA for 10 years and have exposed problems in private industry (with a preference for the scientists who have exposed more problems in industry (or the chemicals invented therein) that could expose people to carcinogenic or toxic chemicals). Anyone in a management-type position not satisfying the requirements stated in this section is removed at the end of the 10 days, with the first scientist who satisfies the requirements who applies for the position taking up the position 10 days from when their application is submitted, unless another scientist’s application for that position within those latter 10 days provides substantially more examples of problems in industry that that scientist has discovered (this is what is referred to later as “automated filling,” since it is a virtual person (could be an actual person) with no free choice that is making the “appointment”). 

In adjudicating disputes under this section, the jury for such cases must consist entirely of scientists who have worked at the EPA for 10 years and who have done at least one experiment that shows a health/environmental problem with a private company’s activity or chemical the company invented. Private companies may not sue to prevent the release of information relevant to the carrying out of this section, and that someone disputes the results of a science experiment (especially when the dispute comes from higher up in the chain of command) done pursuant to this section is not relevant to the discussion of whether someone qualifies for a management position at the EPA or on the juries for resolving these cases. 

The automated filling of management positions at the EPA includes positions that are considered political appointments (including Presidential appointments) when the current person in a given position does not satisfy the requirements of this section (or when the position is vacant). Personnel at the EPA who are at first part of automated filling who are replaced top-down with qualified people return to their previous non-management positions at the EPA. 

The Office of Inspector General of the EPA is excluded from being affect by this rider, as is anyone who does not have scientists who evaluate environmental or health risks (or positions that should be filled with scientists who evaluate environmental or health risks (includes positions vacated by scientists who were doing that or were supposed to be doing that)) working below them in a chain of command.