December 4th, 2008
04:16 PM ET

Extreme Challenges: How Obama should address health care

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

There is no doubt health care will be an extreme challenge, especially with the economy in the tank. A bigger challenge may be a perception one. To remind people the economy and health care reforms are truly linked. After all, we have the most expensive health system in the world, and Americans spend more on health care than housing or food. Here is a number to ponder. The United States spends nearly 500 billion more than peer nations on health care, and we don’t get nearly enough for it.

As a doctor and a parent, I can’t believe we have let ourselves get to this point. Too many people are uninsured, and even more have insurance that is simply inadequate. According to the American Cancer Society, 100,000 Americans will end up in bankruptcy because of a cancer diagnosis. Can you believe that? You are diagnosed with the most devastating medical illness of your lifetime only to be hit with the most devastating financial crisis you will suffer. Yes, the economy and health care are truly linked.

Last month, nearly half of all Americans surveyed reported skipping pills, postponing or canceling medical appointments and generally cutting back on medical care simply due to cost. The uninsured who are injured or who developed a chronic illness were less likely to receive follow up care, which worsened the severity of their condition. So, here is another number: Roughly 22,000 people die each year due to lack of coverage. For sake of reference, the number of people who die annually from homicide in the United States is around 17,000. It would seem being uninsured is a different sort of homicide.

The next administration will be faced with extreme challenges and health care reform has to be front and center. As you may infer, you can’t really fix the economy without addressing health care. Still, this reporter is optimistic we will see some changes over the next few years. Heck, the next administration might even deal with stem cells and obesity to boot.

Programming note: Tune in tonight at 11 pm ET for the program, “Extreme Challenges: President Obama”, to hear Anderson Cooper and the CNN team lay out the challenges facing America’s 44th President and offer some advice.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

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soundoff (18 Responses)
  1. grace

    I see two big problems with the cost of health care for regular people:

    1. A fairly large number of some groups of doctors and institutions seem to get away with charging fees which are ridiculously inflated beyond reason for the same services that others charge a fraction of their fees.

    For example, I once was referred to have a set of standard cardiology tests done at the local hospital outpatient clinic, for which the insurance company was billed and paid the full $5000. All the tests were performed by technicians in about 2 man-hours and I was never seen by a doctor. My father who happens to be a cardiologist in private practice was shocked and said he charges a few hundred dollars for the same. He also performs the tests himself. Why is one place charging about 10 times more, and more than $4000 more? After they pay the technicians $100 for their time, where does the rest of the $4900 go?

    Another example, I was once referred to have neuropsychiatric testing done. One test was administered during a 2 hour visit to a psychologist. The other test was a take-home fill-in-the-bubble scantron test scored by a machine. There was a 1 hour follow up visit. The total bill was $3000, paid mostly by the insurance company. Perhaps the psychologist spent a generous couple of hours scoring and writing up the results. But we are talking about, I'm guessing, about a maximum of six hours worth of work total. $500 per hour for a psychologist working solo with no assistants? My friends who see psychologists and psychiatrists mention that they usually charge $100 to $150 per hour.

    Both patients and doctors who charge reasonable fees are being jipped. Are 10% of health care practitioners making 90% of the money? Do insurance companies have any idea that they are reimbursing some practitioners and institutions 10 times more money than others for similar services?

    2. The uninsured who pay out of pocket are charged a ridiculous many times more than the insured for the same services.

    Here's one example from my insurance records:

    Laboratory services:
    Billed Amount: $116
    Network Discount: $110.68
    Paid by Plan: $5.32
    Patient Responsibility: $0

    The price one would have had to pay if one were uninsured (or if one had insurance but the claim was rejected) was more than 20 times the total cost with insurance network discounts.

    Health care would be a lot more affordable to the uninsured if they could pay the same prices the majority of people get to pay via their insurance carriers. Maybe that is how insurance companies make people have to buy insurance if they can.

    December 5, 2008 at 06:43 | Report abuse | Reply
  2. Craig at Balanced Immune Health

    Health care is the only industry I know where overcapacity exists (too many unused hospital rooms, too many underused MRI machines) yet prices continue skyrocketing. In any other industry, if factory capacity or inventory levels are too high over a period of time, prices drop and things get real competitive.

    I had a friend whose daughter stayed 6 nights in a hospital following back surgery. Her hospital bill: $104,000! That's for the room, not the surgeon. And this is Iowa, not Cedars Sinai.

    December 5, 2008 at 16:47 | Report abuse | Reply
  3. Marta

    I see one big problem with the health care industry. IT SHOULD NEVER BE AN INDUSTRY. The word "profit" should never come up. Compassionate capitalism..humane, affordable treatment for every American citizen. Hospitals should not conpete for "clients". One CT scanner can serve an entire smaller town. There are a million ways to cut costs, but first, insurance companies need to cease to exist. We, taxpayers, should pay for state mandated healthcare..after all, we're paying for everything else.

    December 6, 2008 at 08:07 | Report abuse | Reply
  4. Albert Juszczak

    Too much is made of the necessity for universal insurance coverage, too little is made of the poor quality of medical science. I think that more reform is needed of medical education than of access to health care. We need a real revolution in how the medical profession thinks about disease and health care delivery. Right now, doctors see the human being as a physical body and try to take care of ills by physical means alone: drugs and surgery. But most people are very much aware that the human being is much more than just a physical vehicle. We need a truly holistic approach to medical treatment: physical body and spiritual body. Nature Cure, psychic healing ought to be given much more serious consideration. And we don't need decades of healf-hearted studies of those treatment venues. Both have centuries of successful use behind them. But the experts in those fields are not in the USA – they are in India, and Europe and other parts of the world and ought to be consulted.

    December 6, 2008 at 20:56 | Report abuse | Reply
  5. Karin Clatterbuck

    Economy and Health Care connected? ABSOLUTELY!!! We adopted two special needs children in 2000. We had good paying jobs, a beautiful house, a great life. Only our beautiful daughter whom we were told had a mild disability, turned out to be severely disabled as well as her brother. We could not get any help at all with their medical needs and over the next 4.5 years went horrifically in debt with medical bills, and we HAD medical insurance. We lost everything we had ever worked for. Including the house, my career, our retirement, everything! And the government would not help us AT ALL!! Whats worse is these situations happen every day in our great country. Now we don't know what we will do, and we barely make it month to month which is horribly stressful with two special needs children. Where is our BAIL OUT? Why won't anyone help us? Instead, we will see our taxes go up again on someone else's account. We've lost everything because we adopted two special needs children. This is not fair! YOU BET WE NEED HEALTH CARE REFORM!! And we need to listen to people who have "Been There, Done That" on how we need to do it!

    December 6, 2008 at 21:53 | Report abuse | Reply
  6. Bob McLaurin

    I am one of the millions who have added to the Health Care problem that we all now face. Several decades of my lack of taking responsibility for my own health, resulted in several diseases that required, and still do, very expensive Health Care. Insurance had to pay most of the cost, which has contributed to the affordability of insurance costs nationwide I can only imagine how many millions of people who are now doing exactly what I have done. All of the diseases I eventually developed were avoidable, had I fully recognized my own responsibility. How do you actually reach all those people that currently don't give nutrition a thought? The only way most get any information or education is via TV. Are we serious enough to have the Govt go to the expense of using it? Are TV companies willing to air ads that may directly conflict with certain advertisers? Would the Govt. be willing to institute a program for example called "Good Choice" where when people shop for groceries, that get a credit to an account for making good food choices. Money for these accounts could come from producers of "Good Choice" foods, Companies that recognize the value of healthier employees, etc. These accounts could then be used to help cover co-pays on care or drugs. Something like this would be complicated, but in today's world, technically possible. Dr David Katz has some initiatives, that If they were ever to be widespread, the health care demand would be lowered, the cost of Insurance would be lowered, and the overall Health Care System, might eventually be able to cope with our health care needs. Just a thought.

    December 7, 2008 at 08:03 | Report abuse | Reply
  7. Barbara Bahat-Kenton

    Dear Dr. Gupta,

    Please take a moment to read the following letter sent to President-Elect Obama, regarding a person who does have health insurance but can no longer afford medication for a chronic neurological illness:

    September 11, 2008

    Dear Senator and Ms. Obama:

    In response to your challenge to believe in my own ability to “bring about real change to America," I submit the following.

    I have a designer disease. It is familiar to many Americans, including your own family. I have Multiple Sclerosis. It seems we all know someone touched by this disease, despite its relatively small number of casualties – approximately 500,000 nationwide. We, the afflicted, can only hope our voice will be heard and our needs addressed in the planning and execution of your health care agenda. My own story is an illustration of the inherent problems of the current system.

    I come from a middle class family. I have a middle class family of my own (a husband, a 16-year-old son and aging parents). We pride ourselves on our fierce work ethic and independence. I was employed by one company for twenty-three years, from my college graduation in 1976 until I accepted a severance package in 1999. I was diagnosed with MS in early 2000 but nevertheless returned to school, earned an ABA Paralegal certificate and re-entered the workforce. I remained employed until MS made it impossible for me to perform my work. I applied for Social Security Disability (SSDI). After 1 ½ years, one appeal and attorney involvement, I was finally approved. During this time I had continuous healthcare coverage – first by my employer, and then through my husband’s employer.

    In the last ten years we have seen the development of disease- modifying drugs for the treatment of MS. It would have been a blessing for Ms. Obama’s family if these drugs had been available for her father. Or, would it? Consider this:

    These drugs are prohibitively expensive, averaging between $1500 and $2000 monthly. On most prescription plans they are categorized as "Specialty Tier," with typical co-payments of 20-50% - a hefty sum especially when added to the monthly premiums of the prescription plan. They must be taken for life.

    My prescription plan caps at $6500 per year, and then, they are "very sorry," but I’m on my own. There are various programs available for subsidy, but I have yet to find one for which I am eligible because my income level is above near- poverty level. You can do the math any way you like, but, for most of the middle class the cost of any these disease-modifying drugs, even with the current assistance available, is simply prohibitive. As a result, the current dynamics meant to help in fact threaten the existence of an American middle class by excluding so many of us in real need - those of us who simply cannot fill in the gap between $6500 in coverage and the additional $17,500.00 that must come out-of-pocket to complete a full-year of prescription medicine for our illness. Sick more than half the year, every year, for the rest of our lives. That is the repercussion of this oversight. The shortfall between coverage and co-payment for the necessary preventive drugs for MS are a compelling example of the disconnect in government policy when it comes to recognizing the real needs of the middle class in America. Abandoning the middle class in this way - in the guise of regulation that appears to "pay" for the medicine when the true cost of the medicine remains out of reach for most - contributes to the ever-widening economic gap between rich and poor - and I might add the "hope" gap - between classes in the United States. We work. We save. We follow the rules. We contribute our fair share of the cost. And it is not enough. And we are left behind.

    The particulars of my case illustrate the point. For the past two years (2006-2007), my prescription was subsidized by N.O.R.D. (National Organization for Rare Diseases). In 2008, I became eligible for Medicare (after the exceedingly long and harsh requisite of the standard two-year waiting period from the date I officially became disabled). Once I was accepted by Medicare's Prescription D drug plan, N.O.R.D. discontinued my application for aid through them. The majority of Prescription D drug plans require a deductible and a monthly premium. In my case, as in most, the benefit cap of $2500 plus the $4050 out-of-pocket required before actual plan coverage takes effect made it impossible for me to afford the medicine. Only after $6,550 each year would 5% co-pays take effect. And the entire process repeats at the beginning of each year, for life.

    Currently, I am not on medication. My disease is under control. But one of the fundamental characteristics of Multiple Sclerosis is its unpredictability, and the key to treating the disease properly and avoiding high hospital costs and harm to my life and limb is prevention through the new medications. I am so very happy to report that my insurance will cover the cost of a hospital stay, should that become necessary. Obviously, this risk becomes very real and the odds increase enormously due to lack of proper coverage for prevention and early containment of symptoms. Equally obvious is the game being played between Department A (Hospitalization) and Department B (Prescription Drugs) of the same health-care company, a number-crunching corporate strategy exclusively courting the CEO’s of the healthcare industry and rendering me a pawn.

    I find it ironic that creative solutions cannot be found when I can offer a few myself. Perhaps, we could pool each family’s benefits – after all, we are already paying for this coverage. In my case this would pay for my yearly medication, and still have a reserve. Perhaps the cost could be spread among the entire plan’s members, as most of its costs are. I find it unconscionable that these companies are willing to put individuals at undue risk and, by their very short-sighted quick fixes, are also jeopardizing the integrity of the middle class and plunging us further toward bankruptcy. Can they themselves afford to do this? I am particularly intrigued by Senator Obama’s mention that every citizen should have access to the Congressional healthcare package. I would gladly pay what Congress does for their fine coverage – in fact, I would gladly pay more.

    My dilemma mirrors the plight of much of the middle class. Depleting my family’s resources to pay the annual $6500 gap for a single necessary medicine affects my retirement, my son’s opportunities for quality higher education (he is a straight A honor student, the future of this country), and our sense of inclusion and participation in a working healthcare system. Do I enroll in Medicare Prescription D and stand to lose any security I have worked so hard for my entire adult life? Or do I become a burden to my family who winds up subsidized by the Government once my options and health fail?
    Victims of MS are a slight number in terms of the general population. We have not fallen through the cracks - we have been pushed through. I am appealing to you for direction and placing my faith in your integrity when you say to America that you will be tenacious in following through on your promises to the middle-class. Time is not on our side.

    Barbara Bahat-Kenton
    Roswell, GA

    December 7, 2008 at 18:54 | Report abuse | Reply
  8. Ronald D'Angelo MD

    The US spends half of the world's health care dollars for 5% of the world's population. Still, we have poor grades for life expectancy and infant mortality. How do other countries do it better? We are the most wasteful healthcare system, but not the best. Every active healthcare provider can give numerous examples of how we're wasting money, but healthcare reform will be initiated by politicians and administrators, not active providers. CNN could help by beginning a dialog on waste in healthcare among providers.

    December 8, 2008 at 09:27 | Report abuse | Reply
  9. Alexander Verharen

    Combat fraud. Too many doctors add charges or inflate charges on their bills, costing insurance companies, and the public, a lot of money. Try to dispute a charge – the National Health Care Anti-Fraud Association tells you to contact your insurance company. Most insurance companies don't have an easy way to make a report (get ready to spend many hours of your own time). We should make it law to provide the insured with EASY ways to question any charges on their bills.

    March 5, 2009 at 14:32 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.