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March 10th, 2009
11:54 AM ET

Jumping in head first to health care policy

By Dr. Sanjay Gupta
Chief Medical Correspondent

 

All this week, we are going to jump into something that is hardly ever covered on television. There is no question that health policy, full of its obscure terms and wonkish numbers, may have a better home in newspapers or long-form magazine pieces. But over the last few months, I have been thinking about this non-stop.

Health policy has been debated over and over again since the days of Teddy Roosevelt, and most recently in the mid ’90s, under the leadership of then first lady, Hillary Clinton.

As you may know, I worked as a White House fellow during President Clinton’s second term and I most recently was considered for the post of surgeon general. While I chose to continue my neurosurgical practice at the local county hospital and help my wife prepare for the birth of our third child, I did have a unique chance to independently evaluate some of the Obama health care plan components.

As we sat down as a production team, we tried to focus on some of the key issues those plans seek to address. I emphasized a couple of points: First, let’s remember there are real people and stories behind all these numbers. All of our segments will reflect that. Second, do not bite off more than we can chew. We will pick a specific topic on any given day, and see to it that you can understand it fully, before moving on to the next topic. This week, we picked five areas of the health care discussion that will help inform your thinking. While there will be many more topics to come, we found these essential as starting points.

We start off with a discussion of universal health care. Turns out you don’t have to travel to Canada or France to get a glimpse of how it might work. We have a model right here in this country, in the state of Massachusetts. What are the lessons learned?

Next will be a look at “pre-existing condition.” If you hear that term from your insurance company, it feels like the kiss of death. But, aren’t those with pre-existing conditions the ones who need insurance most?

Countries like India can offer very good health care at 10 percent of the cost of the United States. How?  (Watch Video)

Preventive care is another term you will hear a lot. As a doctor, I can tell you, of course it makes sense to keep people from getting sick in the first place. Are more screenings the answer or will they cause more anxiety and higher costs in the long run? (Read More).

And, finally this week, we will give you a segment we’re calling the “Young Invincibles.” When you are young, you feel immortal and perhaps don’t feel you need to worry about such mundane things as health insurance. So, what if something catastrophic happens to you while you are uninsured? How will it shape the rest of your life?

Over the weeks and months to come, I will strive to be your independent and objective guide as we explain this complicated but important world. You will not find a more passionate and committed translator. Let’s start the conversation.

Programming Note: Tune in to hear more from Dr. Sanjay Gupta every night this week on AC360 at 10 PM eastern.
 
 
 

 

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.


soundoff (41 Responses)
  1. J.Marti

    It's amazing to hear all the suggestions to alleviate the health care burden and improve access to all. I saw Wolf Blitzer last night making a point that it was about time someone started addressing the problem when the topic involved doctors ordering to many tests. The gist was that the Doctors are the problems with the efficiency of our health care system. I continuousely hear that it is physicians that are the heart of the problem. It is astounding to me to see what our health care dollar is spent on. I've seen many reports that estimate the cost of Healthcare just in terms of management and processing from the insurance perspective is 30-40 %. When you see what these companies report in terms of profits and what they pay they CEO's is sickenning. My view may be somewhat limited because as a healthcare provider most of my time involves the care of acutely ill individuals, but I'm still perplexed as usual the solution involves those that are in the trenches and sacrifice but no or very little attention is again given to the businessmen making enormous amounts of money. As Wolf said it is about time we addresses the problem aggressively but I strongly feel it is irresponsible to look at the problem from one side that actually has a direct impact on how our families are cared for. As Wolf would have it, we should go after those inefficient doctors who order too many tests. There is probably an element of this but please remind Wolf about the underlying liability involved in healthcare and providing care. It would make sense that if as physicians we are told that we are limted as to what test we can order to establish diagnosis or plan of care then on the flip side there should be some limitation with liability. If we have a beaurecrat telling us what we can do then either that individual or entity should be implicated in any adverse outcomes. Nonetheless, the cost of healthcare will be obviosely affected be creating a more efficient system but it is crazy to ignore the overall effect of healthcare insurance on the overall cost of healthcare. Why is it we can limit salaries of bankers because of government supplements. It's obvious that a huge portion of healthcare is funded by our tax dollars which come out of our generated income. Why can't we limit the salaries of these insurers that obviousely draw a large part on their revenues from Medicare and Medicaid. Why isn't anyone talking about the enormous amount of money that is spent on Healthcare insurance companies rather than healthcare on our citizens. Again, 30-40 cents on the dollar are spent on insurance processing and profits alone. It seems that this should be a major focus of making healthcare more efficient.
    It's amazing to me that my premiums have increases this year by 16-18% and my benefits seem worse everyyear. I believe madicare has calculated approx a 3% increase in cost. It would be interesting to see what effect this has on executive compensation within specific insurance firms. I doubt their salaries are frozen as most of us have been told there are no cost of living raises. Please ask Mr Blitzer to be a little more responsible in expressing his views. I certainly respect Mr Blitzer and appreciate (usually) his reporting but please look at the overall picture rather than snapshots which likely would have other unintended results.

    March 10, 2009 at 13:58 | Report abuse | Reply
  2. John Messer

    I am a 45 year old resident of Massachusetts and I am appalled that the Massachusetts health care policy is being looked at as a model. $350 dollars a month for a $5000 deductible policy or you are penalized more than $1000 a year by the state. This is out-right theft. I don't get sick and use doctors. Over the last two years I have been only able to find work through Temp Agencies at an insulting wage with either no offer of health insurance or again $350 per month and a $5000 deductible. I am one of thousands that have noone that listens. We have to choose between eating or becoming criminals by the state chasing their penalty money. Where is the outrage for us? I live in Revere Massachusetts and cannot find a construction job. A vast majority of companies in my area employ illegals and pay them cash. They seem to get healthcare without penalties. The house next door to mine is a two family. There are six families in it with six new children over the last two years. They work landscaping and construction jobs for cash and are good people. They pool their money while I eat every three to four days. Where are my rights to and freedoms to have a legal job with a living wage as a U.S. citizen?

    March 10, 2009 at 14:33 | Report abuse | Reply
  3. Shounda Connell

    I haven't been able to keep up with all that has been going in the past three weeks concerning this topic. However, I have heard a lot of people saying that they do not want socialized medicine in this country. Well, guess what, we already have it in the form of Medicare/Medicaid. Personally, I don't feel that it is the government's responsibility to provide me with health care. However, I do believe that the government should make sure that everyone has the opportunity get affordable health care coverage. That last place that I worked which offered medical insurance did so at $125/wk. That was half of my pay check. Who can afford half of their pay check going to premiums and then still having to make co-payments at the doctors office and at the pharmacies?
    Secondly, if every individual is insured we should see the costs decrease.

    March 10, 2009 at 15:18 | Report abuse | Reply
  4. Al, Lawrence KS

    The last commenter makes an excellent point. Excessive profits and compensation for insurance companies and executives should be examined. The mood of the country at present is sharply against "excessive compensation" for executives. Exploring these issues would go a long way toward turning the tide toward universal care. It is important when reporting on this complicated issue, to report all of the facts, and that would include the money being made in for profit health care.

    March 10, 2009 at 15:21 | Report abuse | Reply
  5. TRUDY CROWE

    One thing I would like to see addressed, is the migriane sufferers that have to go to the ER and get a shot for pain. I am on daily meds plus I take so zomig. There are sometimes when nothing but a shot of demerol and phenergan will do the trick. About every 6 months, but when you go in you are treated like you are a drug seeker, and when you tell them what works best for you even though you have suffered for two to three days not to go to the ER. The Doctors think you just want the narcotic. basically, onw shot cost me 300.00. when I could probally get it on the street cheaper. Should'nt there be some kind of training for ER Docs on this? I know that when I see a Doc that suffers from migraines the treatment is quite different. would like your oppinion.

    March 10, 2009 at 15:52 | Report abuse | Reply
  6. A patient

    Dear Dr. Gupta,

    I was recently a patient in a hospital.

    Just before I was admitted, I went to a specialist who ordered a specific test.

    I wanted a second opinion, so I went to a second specialist who specialized the same kind of medicine as the previous doctor.

    He told me he wanted me to go for the same exact test I had just been given. I told him that and he refused to look at the previous test and made me and my insurer pay for a second test. To me this was a waste of time and money.

    The second doctor appeared to be all full of himself and I got the impression the second test was for his own vanity. So he could say he gave me the test.

    I went back to the original specialist.

    Also, doctors do not listen to what their patients are telling them. They walk into the examination room and act like they know all. They don't.

    Doctors also rely too much on Nurse Practioners. It has gotten so that when I called the surgeon's office and left a message for him with a question I needed answered (I was frantic), I got the Nurse Practioner instead. If I wanted a Nurse Practitioner I would have called one in the first place. I felt like somebody slapped me across my face.

    Also, I recently discovered why a particular test I have to keep getting every week was getting a low number, it was what I was eating. Not once did any of the physicians tell me not to eat certain things. Not once did they ask me what I was eating. After months post op I was the one who figured out what the problem was, not any of my physicians.

    Also, when I complained about the generic form of a medication I had been prescribed, because I was having an allergic reaction to it, they dismissed everything I told them. After much arguing, I asked my primary care physician for a script that said to dispense as written on it. I was given the non-generic form of the same medication and have been fine ever since.

    In short, healthcare providers need to put the care back in healthcare, because as it stands now, they don't care. Their patients are looked upon as nothing but a piece of meat!

    March 10, 2009 at 16:49 | Report abuse | Reply
  7. Changehealthcare1

    Dr. Gupta,

    I am glad to see that you will be talking about the so-called "Young Invincibles." The fact is that most young adults know that they are not invincible, and if health insurance were somehow made affordable, it is something most young adults would rather have, than not. I am part of the millions of Americans who want access to truly affordable health care that allows us to see a doctor, to be prescribed the right treatments, and to go to an ER without fear of financial ruin. We want all these things, yet we also must eat, pay rent, and put gas in our cars to go to work. That's why SHOUTAmerica has started a new campaign called "The Insurables." For more information go to: http://www.shoutamerica.com/blog/79/insurables-idea-millions-young-americans-without-access-affordable-health-care

    March 10, 2009 at 17:14 | Report abuse | Reply
  8. Renee S.

    Try catch words that insurance agencies use and get away with all the time...

    "pre-existing condition" (which has been covered) will be applied to your son for the rest of his life" and guess what, he is age nine.

    Any type of medical mental illness is a "mental illnesses, and are not covered in your insurance plan (which we can't change to any other plan because we then fall into pre-existing conditions)...

    ADHD is considered a medical illness (yes, used in the same sentence as the sentence before) but it is not covered."

    Bipolar is not a medical illness therefore it is not covered.

    Our insurance company is located in a parity state, therefore while your state passed the "parity law" we we do not honor "parity," because our state does not honor parity.

    We spend $7,500 on medical appts. and prescriptions per year and that covers our "medical mental illnesses" of our son and myself. This DOES NOT cover any other items of health, yearly physicals, health insurance monthly premium (which is basically paid in case there was an emergency – $340.00 a month), blood work, etc. We have had to stop going to the dentist several years ago, we simply can't afford it.

    The insurance companies as far as we are concerned, are worse than the bankers, worse than Wall Street. Something needs to be done to rein them in...hopefully you can help.

    Lakewood, CO

    March 10, 2009 at 17:28 | Report abuse | Reply
  9. Janice

    Emergency Departments are full of patients seeking a free high. If the patient with the history of migraines could just shadow in an emergency department for a day and see how many patients come in claiming nothing but demerol will ease their suffering, they might then understand the jaded approach to patients with migraines or low back pain. If they could evaluate patients from not only the need to offer care but to provide some sheild to legal realities IF this patient has that far from common cause of the back pain or headache, then maybe the tests would not seems as useless. The realities of end of life ethical choices for the demented or very old are subjects that no one will discuss but drains millions of dollars that could be used for others. Today, the quality of insurance rather than the quality of life seems to be the ethical standard for who gets what care. Let us start there.

    March 10, 2009 at 17:59 | Report abuse | Reply
  10. Katrina

    I studied “The History of Medicine” in college, and you are exactly right… we have been talking about health care reform for years! But isn’t that the problem – a whole lot of talking and not enough doing. For quite sometime, I have argued that there are five major players in this mess we call “Health Care,” one of which is the government. The other four: doctors (other health care providers), big pharma, individuals, and insurance companies. I have yet to appoint percentages of influence. I think it would be interesting to investigate health care policy and the need for reform from these five sides of the story.

    Truthfully, I think the majority of Americans know our system is failing, but are unwilling to make any sacrifices or changes. No one likes change, but we have had a third party paying for our health care for far too long. On top of that, the government cannot bail us out of our obesity (or sub other unhealthy behaviors) and sense of entitlement. Insurance companies sure aren’t going to help either.

    There are three things that are going to help fix this system: Individual accountability is the first one. We have to stop running to the doctor every time we have the sniffles. We must make health and wellness a priority – and start exercising.

    Second, is transparency… no one really knows the true cost of healthcare. With the “birth” of high deductible health plans, people are just now starting to realize that an office visit does not cost $20. Transparency is going to be necessary for consumers/patients to be accountable, and cost/quality information must be available for any reform to be successful long term.

    Last, is competition… by being accountable for our decisions, and knowing the true cost and quality of healthcare, providers can begin to compete for our care. Until doctors/hospitals have to be accountable for the quality of care they provide and the amount they charge in relation to other health care providers, nothing is going to change. Every other market has competition, why should healthcare be any different.

    Now I know there is no "silver bullet” that is going to fix health care, but I think that examining the major players – how they interact with one another, and what they are doing to promote accountability (often within their organizations), transparency and competition – is a great place to start.

    March 10, 2009 at 18:04 | Report abuse | Reply
  11. Clark

    Cheaper pharmacy policy ? Why should you pay for overrated costs ?

    March 10, 2009 at 18:38 | Report abuse | Reply
  12. E Curras

    It is great that finally health policy will be discussed. Yes, Health policy has been debated over and over again since the days of Teddy Roosevelt, and most recently in the mid ’90s, under the leadership of the first lady, Hillary Clinton. Although Dr. Gupta worked as a White House fellow during President Clinton’s second term and was considered for the post of surgeon general. Dr. Gupta continued his neurosurgical practice at the local county hospital and continued to help his wife prepare for the birth of his third child. I will also evaluate Dr. Gupta opinions on President Obama health care plan components. Your production team has focus on some key issues that in my opinion will affect doctors and no patients. As Dr. Gupta points out there are real people and stories behind all these numbers but we are about to find out his analysis of the segments to reflect the findings. Although we have a model in the state of Massachusetts; we also have one in the territory of the United States Puerto Rico. Have this subject has being considered? The term “pre-existing condition” is a kiss of death. But I hope that the present administration understand that there are the ones who need insurance most. The terms of free enterprise, monopoly, etc pushed behind the Health Care Reform in the United States and yes we need to look around for those who have provided health care at a 10% of the cost of health care on 2008. Preventive care should be for everybody and not exclusive to the elite. Certainly I do agree when we are young we feel immortal and perhaps we do not feel the worry about such mundane thing as health insurance but the equalizer came aboard and has equalize everybody. We need to make sensible our society. We need to mingle and break the barriers.

    March 10, 2009 at 19:39 | Report abuse | Reply
  13. Anonymous

    The segment on pre-existing conditions is the one I'm looking forward to the most, although I think they are all relevant issues. You are absolutely right that it is those with pre-existing conditions who require the most access to high quality and cost-effective healthcare. These are the people who can regularly look at their taxes at year-end and confirm that they have indeed met the 7.5% out-of-pocket medical expenses required by the IRS in order to claim a write-off. Oh, but wait! You only get to write off anything ABOVE AND BEYOND that amount; but, I digress.

    Your point about being young and careless about the status of your health care hits home as well. I was just barely 21 years old when I learned that I had chronic kidney failure. No prior signs of any problems and then suddenly, I'm going in for every test under the sun (biopsies, CT scans, MRIs, 24-hour urine studies, innumerable blood draws and on and on and on), taking medications that you can't pronounce, monthly shots that cost approximately $1,200/month and you're told that you will need a transplant somewhere down the road that is said to cost anywhere from $25,000 -$100,000 (depending on how you do). Of course, that doesn't include dialysis costs. Now imagine paying for that in your early 20s, before you're even done with college (and you thought student loans were bad!) and before you have a solid career path in front of you?

    Meanwhile, you try and take the high road and NOT live off the citizens of the United States – partly because you're in denial and try to pretend none of it is happening and partly because you want to reserve that for those who REALLY need it. You try and work for a living (which as it turns out, may be the ONLY way to get health insurance if you do in fact have a pre-existing condition) because under a group plan (in some cases) it doesn't matter that you have a pre-existing condition! Depending on the plan, so long as you haven't had a gap in coverage of more than 30-90 days, you are covered! Don't worry, your pocket book will still be hurting and you will never make it out of the renters world, even though you make decent money, but at least you've got health insurance coverage, right? And sometimes, just sometimes, they might even give you coverage under a group employer plan after you are a member for 18 months or longer. Isn't that sweet of them? But what if something happens during those 18 months you ask? Good question.

    From here you get to look forward to the annual "should we change health plans because it is costing us a fortune" discussion that your employer inevitably has (sometimes by choice and sometimes not). You get to hold your breath wondering if all of your specialists who you have JUST started to become comfortable with after last year's health plan switch-aroo will be covered under this NEW plan? What about my medications? And they wonder how so many medical mistakes happen?

    I could write a novel (even longer than this one), but instead I'll tune in to CNN and see what perspective they offer because it is one that deserves A LOT of attention.

    Thanks for covering this very important issue.

    Anonymous
    Now 31 and 2 years post-kidney transplant

    March 10, 2009 at 19:54 | Report abuse | Reply
  14. June

    What happens to the people who have no access to insurance? I have a 21 year old mildy retarded nephew, who is now taking abilify and ritalin, the cost is $1200 a month. He does work part time, without benefits, lives with his dad who lost his job after 30 years, they are now homeless. Without this medicine my nephew is a monster, with it, he is the nicest young man you will ever meet. Without he beats his dad and threatens to kill himself, won't shower and is a monster. I have been trying to find programs to assist him but nothing yet. He has only been on this medicine for a month and he is doing great, so what is someone is his situation suppose to do. It scares me to death because without it, he will harm someone, and himself. We have already been down that road. Is there any help out there for him?

    March 10, 2009 at 22:54 | Report abuse | Reply
  15. joseph

    I am 55 yrs. old disable I get social security disability and medicare Hospital Part A and Medical Part B with mandatory prescription drug plan through Advantage Freedom Rx America. the problem that I am having with program is that the paitent and their Doctor's are beening left out on what prescriptions the Doctor's prescribe and the prescriptions the drug plan will pay for. i.e. MY local Doctor prescribed Diovian to control my blood pressure in 2006, I took my prescription into my pharmacy to be refilled and was told that Advantage Freedom America no longer cover Diovian, I contacted Advantage Freedom Rx. Am. and spoke to a supervisor named Jennifer P., I explained to her that I couldnot contact my Doctor to, get a physcian waiver and that I am OUT OF my medication she told ME 'SORRY WE CAN'T HELP YOU' because gave you a waiver on 1/12/09 and we Mailed you a notice 3 days later. How can Our we be forced to pay for services that we donot get and that the only drug that they pay for and I have to Pay a $30.00 co pay. So now until I can contact My Doctor and get Him to request a waiver or go and pay another Doctor to write me a waiver request for a generict that we do not know what side effect might be.

    March 10, 2009 at 23:54 | Report abuse | Reply
  16. Gary Chute

    Comment: No more health "insurance". Insurance is a business, as any business, it is there to make money. Example: insure 100 people, pay claims on 5, make money. If everyone is forced to buy "insurance" and the claims eventually outweigh the money collected, will the government then agree to BAILOUT the health "insurance" companies? Stop "insurance". Outlaw "insurance". There is no way health "insurance" can be made "affordable", ever! Free healthcare for all Americans, no pre-existing condition limitations, no more need for Medicare or Medicaid. No cost for anyone on Social Security. Would a flat 10 or 20 dollars a week, in withholding taxes pay for it? Would a 1 cent national sales tax pay for it? I, for one, am so proud of our President, for having the nerve to say let's try something new, because it sure isn't working the way it is. My wife (62) and I (57) are the statistic: she worked and her employer didn't offer health "insurance", and at her 10 dollar an hour job, it would not have been "affordable" anyway; I was an unemployed construction worker; then my wife got cancer. Two surgeries later, both unemployed, we lost the new car we were making payments on, 215 thousand dollars in debt, we filed a chapter 7 bankruptcy last September (2008). She has a life insurance policy that costs 63 dollars a month, and could never get another policy if she lost the one she has...with AIG! My wife will stop working this year and have $800.00 a month in Social Security to live on. Can you provide us with the name, address, and phone number, of one single health "insurance" company, that she could pay 15% of her income and be covered for all health, dental, and vision services, including pre-existing? No, you can't, if you could, we wouldn't have a health care problem, would we? Health "insurance" has to be outlawed, including Medicare and Medicaid. We have to have free healthcare, including dental and vision, in the United States. Just start by opening all VA Hospitals to the public at no cost. Hire more doctors, nurses, janitors; create millions of jobs. There's alot of vacant commercial buildings in these economic times, buy them, open free clinics, or build new state of the art hospitals. Would anyone object to 20 dollars a week in withholding for free health care? And, if needed, a 2% national sales tax, corporate tax, and import tariff? And, if needed, a national lottery like powerball? AND, make Social Security the National Retirement Program and raise, no, double the benefits. More money for seniors who need it, more money spent in the economy, more sales taxes collected. Everybody wins. Please try something new Mr. President. Thanks, Gary Chute.

    March 11, 2009 at 08:06 | Report abuse | Reply
  17. Tom

    CNN's article this morning (March 11) was filled with innuendo and few facts about health insurance. That article implied that it is wrong to exclude those from private health insurance due to pre-existing conditions. So who will buy health insurance before it is needed, if it guarantees pre-existing conditions to be covered? When that happens, I also expect to be allowed to buy long term insurance while at the nursing home, and my survivors to be able to buy my life insurance when I am dead at the morgue. I also expect uniform auto insurance rates, even though I drive a Corvette, and recently got my second DUI.

    The solution to the pre-existing conditions is to be continuously insured, and to allow the certificate of credible coverage (CCC) of those leaving group coverage to apply to the individual insurance. For those not yet insured, that CCC should be earned with an 8 or 12 year duration of continuous insurance. Until then, pre-existing conditions need to be covered by medicare or medicaid. It is only fair.

    Meanwhile, group coverage is a wasteland of inefficiency caused by the careless patients transferring cost to those who are not. I am referring to the 30% obese, the 22% tobacco users, and the 3% unmanaged diabetics who, with impunity, transfer cost to their employers and fellow workers in the group plan via their high claim rates. That transfer is because these careless patients pay the same premium as those who take care of themselves. If they paid a premium appropriate for their actuarial risk, it would then be fair. In short, it is only fair that the drivers of claims pay a greater share of the premium.

    So CNN's article this morning was just incomplete. The real fact is that insurance without actuarial science is just a bill paying service, The National Association of Health Underwriters reports the average cost of health services for 2008 was $5200 per person below age 65. If we guaranteed health coverage, that would be the cost of the insurance, plus admin. Is the Taxpayer ready for this to be stacked on top of the already $1.8 trillion budget deficit?

    March 11, 2009 at 09:33 | Report abuse | Reply
  18. Tom

    John is just about right. Federally run healthcare is bound to look like the events of Massachusetts.

    One of my sources says that Senator Obama's health insurance, run by the government, cost over $17000 in 2008. Hmm. How many families can afford that, when the mean family income here in the US is just over 50k?

    March 11, 2009 at 09:38 | Report abuse | Reply
  19. Tami

    As an ICU RN I see an incredible amount of money millions spent on people who cannot be saved, but their families will not let them go so we trach and peg them and send them off to a long term care facility. In the end we will all pay for their medical costs and their families inability to accept that life is not forever. Doctors it seems can no longer do what we know is right, as far as end of life care, because they are afraid of lawsuits from families that again can not accept that it is time for their loved one to die. I am talking about end stage cancer, severe strokes, vegetative states, end stage MS, end stage dementia/alzheimers. Everyone talks about having a living will, which is great but make sure your family knows yours wishes, because if they want to keep you alive forever they can despite your living will, it happens everyday in ICUs accross the country. If people in this country could accept that quality of life is more important than quantity we could save a lot of money and not put people at the end of their lives thru torture just to get them to a long term ventilator home or nursing home so their family can visit them once a week. This is no quality of life for anyone. It is becoming clear that we do not have an endless supply of money for healthcare and therefore some form of rationing health care is going to have to happen and I would rather my money be spent on preventative and care of chronic diseases where people can be treated and have quality of life.

    March 11, 2009 at 12:36 | Report abuse | Reply
  20. Ron Howerton

    Anybody who fears government bureaucrats making medical decisions needs to seriously consider whether that is any worse than insurance company bureaucrats making medical decisions. As an SSA employee and former insurance company employee, I have seen both private industry and the government making essentially the same sorts of decisons.

    The one thing I can with certainty is that our public servants are not motivated by saving money to pay higher dividends to investors. Insurance company employees are trained to minimize payments and save money for the insurance company. Government employees, otoh, are stewards who simply safeguard against fraud. The difference is staggering, not only in how cases are handled, but in the quality of service provided. I'll trust the judgement of a government paid social worker any day, over that of some insurance company executive with a multi-million dollar bonus packages for keeping expenses down.

    March 11, 2009 at 14:28 | Report abuse | Reply
  21. Brent P.

    I take issue with the term "young invincibles," to my knowledge the term is widely used within the insurance industry to describe young Americans without health insurance. Judging from where the word originates, it leaves little doubt to the connotation it carries – that millions of young Americans are simply choosing to go without health insurance, irreverent of the risks and consequences.

    In the attempt to explain phenomena in society, there have always been attempts to boil it down to individuals making bad decisions and simply not taking responsibility for their own lives. Such is an especially common narrative when it comes to issues involving America's youth. In doing so, one can often disregard the systemic, often structural issues that accompany such problems. Such a problematic approach is evident in discussions over the "young invincibles" in our health care system.

    The "young invincibles" come from a demographic in which nearly a third of individuals have no health insurance, that is over 13 million Americans (and quickly rising) that are simply making bad choices? Sure it's possible, but a highly unlikely explanation. Rather, upon closer examination one can find answers as to why these individuals are uninsured and much of it has to do with how as is, the system is stacked against them.

    In our largely employer based system of insurance – which in many ways is a vestige of the post war economy – young workers simply don't have the same access to affordable health care coverage that older generations do. The combination of the rising cost of health care with changing economic realities, has put access to affordable coverage out of reach for millions of young Americans with only about half of 19-29 year olds eligible for employer sponsored coverage and with over a third of today's college graduates destined to spending some time being uninsured and as a result being unprotected and without access to affordable health care.

    Young Americans have been simply left behind by today's health care system and their interests must be attended to as we move towards reform, here are some things to consider:

    – Given current restrictions for young people to stay covered under their parents, they are highly susceptible to temporary as well as prolonged gaps in coverage. As a young person just starting out their career, finding a job is not an easy task anymore, much less is finding one that offers health coverage. Young people just starting out are also more likely to change jobs several times, meaning the current employer based structure is out of touch with the increased fluidity of the young labor force.

    – The insurance plans currently available for individual purchase (especially those marketed to young people) often come with tight restrictions and deductibles so sky high that they obscure the definition of affordable access. While being under these plans may prevent absolute financial disaster should something occur, it is easy to see why young people on a tight budget are tempted to take the risk.

    – The disregard for covering young people reveals deeper flaws in a healthcare system that is more concerned with intervening once illness occurs, rather than preventing it and promoting a culture of health that can help mitigate chronic diseases and improve overall public health.

    March 11, 2009 at 15:26 | Report abuse | Reply
  22. Rob, California

    To Tami: Yes, people in this country make life and death decisions, about their loved ones, every day. Have you ever been in the position to make a life or death decision about someone you love? Your words on this subject make me think you have not. I went through this with a parent. I had the advantage of knowing her condition was terminal, a full year in advance of her final hospitalization. We had time to learn about her illness, and prepare for the life or death decisions we would have to make. How many people have this happen to them without any warning? They have to make the life and death about a loved one with no preparation. Would you have them make all decisions base on cost effectiveness? You make valid points about money spent on end of life care. Remember what our founding fathers said in declaring independence, that all men are created equal and are endowed by there creator with certain unalienable rights, that among these are Life, Liberty, and the pursuit of happiness. Are decisions we make about a loved ones health excluded from this? Life is precious, and reducing it to a dollar amount is runs counter to the principles this country was founded upon. There are many health care reform proposals being considered. Let them all be measured against the Constitution and The Declaration of Independence. Our freedom depends on it.

    March 11, 2009 at 15:39 | Report abuse | Reply
  23. Ryan Q

    I agree with many people in this post. For one, I agree with Tami, that people must let their families know what their wishes are before it is too late. I don't think anyone would tell their family that they want to be in a nursing home for as long as machines can sustain their life for them. That just sounds silly. People need to accept that not everyone can be saved (easier said than done, but very necessary). Also, I agree with those who stress that there is not enough money in government health care to go around for people who either don't take care of themselves or take advantage of government help that could be used for someone who genuinely needs it. For example-and this may be a little off the topic-but I met someone who receives $100,000.00 in social security disability every year and works under the table, lives in an $800,000.00 house, has cars, motorcycles, etc. If a little money were used to investigate scam artists like this, that money could be used for people who really need it, instead of a 40 year old guy who fakes a limp and collects a hundred grand a year to live in luxury. The money that would be saved by paying a little closer attention to the people the government is just shelling $100,000 to a year, could be used to catch more scam artists like this and even save money on top of it to help people like June's nephew who only need $1,200.00 a month (a lot less than $100,000 a year) to live a good life that he deserves.

    Bottom line, sometimes it just seems like the people who benefit from our system are the ones who just take, take, take from the needy.

    March 11, 2009 at 16:08 | Report abuse | Reply
  24. John A Messer

    Thanks Tom,
    At least I know one person read my posting regarding the federal government looking at Massachsetts plan. I have no answers to healthcare but I really disagree with Mass' pay or penalty policy.

    March 11, 2009 at 21:39 | Report abuse | Reply
  25. Ron

    Former President Bill Clinton seemed to be using the term "embryo," in his response to Dr. Gupta this evening concerning stem cell research, to include the possibility of an "unfertilized" embryo when he stressed that researchers should not be permitted to fertilize an embryo capable of becoming a baby. The National Institutes of Health's (NIH) website states in pertinent part that "embryonic stem cells....are derived from embryos...that develop from eggs that have been fertilized in vitro.." In other words, by definition, an embryo results from "fertilized eggs." To produce an embryo using unfertilized eggs is not possible. This means that any human embryo destroyed through research processes raises the great "value" debate and issue of destroying a human however nascent. This is a core issue in health policy that requires national decision. To destroy or not to destroy humans in the interest of science research.

    March 11, 2009 at 23:19 | Report abuse | Reply
  26. Gail

    Dr. Gupta and CNN: It is very puzzling to me that the Medicare Means Test which took effect last year has had zero coverage in the health care reform debate. These draconian provisions add an onerous penalty onto the standard premium for those on Medicare who are deemed "wealthy:" – a ludicrously low threshhold is set, which like prior Social Security means tests, will gradually affect almost all, because there is no inflation protection. A pernicious feature is that the penalty is based on the prior year's income – as of this year, I have paid the penalty for my 2007 income in 2007, 2008, and 2009. This legislation, which has been kept very quiet, is well analyzed in an article by Richard L. Kaplan, a law professor at Univ of Illinois. The link to a press conference discussing this article is:
    http://news.illinois.edu/news/09/0309medicare.htm
    Medicare needs reform, not means testing, and should be included in the overall health care debate. This article is a good (the only) starting point. I hope to see this issue discussed on CNN news in an appropriate place. Thank you, Gail

    March 12, 2009 at 00:28 | Report abuse | Reply
  27. J B Coop

    Please consider the importance of funding home health care to keep aging citizens in their homes as long as possible to avoid the high cost of nursing homes. This funding would include care for caregivers. This is a long-term view of saving money on health care.

    March 12, 2009 at 00:32 | Report abuse | Reply
  28. theresa alexander

    I have just watched Sanjay Gupta's interview with President Clinton. They were just discussing the apparently cheaper drugs in Canada and Europe.

    I am a middle income pensioner and I pay as much, or more for my Lipitor as you Americans do. I looked it up online to be sure. Apparently if one buys three months' worth it is much lower in price. Up here it is just the same, merely 3 x 30. I pay about $2.00 for one 10 mg pill of Lipitor and I am not given the choice of a generic.

    Since we have heard for decades that our pharmaceuticals are lower in price than the US, I sure would like to know how to purchase those ones!

    March 12, 2009 at 00:43 | Report abuse | Reply
  29. Todd Herron, Edmonton, Alberta

    Health care reform cannot lose sight of the primacy of the prevention agenda.

    We know that better educated, better employed people who live in safe and clean communities are healthier, happier, live longer and are more productive.

    What are the determinants of good health? Good education. Clean environments. Effective policing and social services.

    These are the very things that seem to slip in priority and get crowded out when reform's myopic focus settles on reactive acute care. This broader context cannot be lost in health care reform discussions.

    An ounce of prevention really is worth a pound of cure.

    March 12, 2009 at 03:08 | Report abuse | Reply
  30. Rob, California

    To John and Tom: If the Massachussetts plan is going to be used as a model for national healthcare reform, there will be problems. I am not sure this plan will happen, as opponents view Massachussetts style reform as a bridge to single payer health care. The "obtain coverage or pay a fine" approach will have the same affect as the "raise taxes on those making $250,000 or more". Those who are right at the $250,000 will just work and earn less to avoid the new tax bracket. Most of the Mass style reform plans would have governent subsidies for those earning $25,000 to $40,000 annually. I wonder how may people will just work and earn less to avoid the tax penalty for not having health insurance? Ask John's neighbor that has six families in one home. These lower earners can then get a subsidized health insurance plan? How are we going to pay for all this subsidized healthcare? Oh, I forgot, we are going to do that by taxing those who make $250,000 or more. But, that is only if they still bother to earn that much, and stay in the higher tax bracket. Do not think this will not happen. The so-called "wealthy" in America are already planning for the new tax bracket.

    As for Todd in Alberta, you say education,clean environments an "effective policing and social services" are "determinants of good health". Please explain what you mean by "effective policing and social services" . I do agree with Todd in Alberta on one point: An ounce of prevention really is worth a pound of cure. I would advise all Americans to take "an ounce of prevention" and read our Constitution. Do it before "effective policing and social services" limit your liberty. That could be the "pound of cure" America desperately needs.

    P.S. to Todd. What will happen to Canada's economy if your American
    national trade partner has a weakened economy as result of all this?

    March 12, 2009 at 13:30 | Report abuse | Reply
  31. Janet Turvey

    Dear Dr. Gupta,

    I don't know why Americans are afraid of universal health care. I am from the United Kingdom and have lived in the USA for 24 years. My health care here has been no better than in the U.K. My mother who recently died with cancer has had the most unbelievable care in the U.K. She died at home peacefully with nurses visiting three times a day, the doctor visited almost daily and came when requested, the doctor returned my calls from the U.K. Patients' records are all electronic and can be retrieved immediately so that I was able to have a conversation with a specialist and he was able to relate every visit, every test that my mother had had, etc. The cost is cheaper per person in the U.K. than here and I have to say, I feel it is kinder and empathetic because healthcare is not a business there. Medication is free to people over 60. My mother even had a hospital bed with sides brought in to the house for her comfort.
    jturvey@hamilton.edu
    Janet Turvey

    March 13, 2009 at 11:42 | Report abuse | Reply
  32. Karl

    I am a retired physician living part time in Thailand where medical costs are a fraction of that in the US, and high quality care is available. A major reason for low cost that is often not mentioned in news reports is the low cost of health care workers compared to their U.S. counterparts. Just as factory workers are paid $150 per month to make DVD players, RN's are paid $500 per month. Personnel is the largest expense of any hospital or medical office in the U.S. Even health care has entered the global marketplace, and demonstrates just one more reason why the high cost of the American worker will continue to drain jobs and hurt our economy. There are many talented neurosurgeons in Asia, Dr. Gupta, who will remove that brain tumor for a lot less than you charge ... :>)

    March 14, 2009 at 02:52 | Report abuse | Reply
  33. Dan Miller

    Unversal health care is very much overdue but might it also be a good thing to have the federal government provide universal membership to a health/exercise club or spa. I am disturbed to find out that while medications, shoes, etc. are provided there remains no cost incentive for prevention. There are nutrition programs that have patented products to assist in prevention of illnesses and weight loss but no one receives assistance from our government to use or participate. Hopefully the feds will see fit to put some money into prevention. For this to be a cost effective program in the long run is a no brainer in my opinion.

    March 15, 2009 at 22:37 | Report abuse | Reply
  34. caroltaylor

    Dear Dr Guypta. I hope your are sharing with Mr. Obama the letter of interest from John Messer of Mass. concerning their health care in that State, I for one do not want the government to run my care or oppose to the care I receive. We as Americans need the care given to us and not what Pres. Obamas plans are! He nor anyone in Congress have to worry about their health care. They have a lifetime plan.

    March 16, 2009 at 14:17 | Report abuse | Reply
  35. caroltaylor

    Well I have forgotton quite a few things. Thanks John for your comments on Health Care. I am another person who does not want the government to take control over my life. The average person in America is not aware of all the drug trials that have to be completed before a durg can be approved in the United States. Knowing people who have taken part in these tests have make me more aware. I for one would not take a drug before a trial had been done on it. Many of our high skilled Drs and Nurses will leave this country if this passes as they don't want tne government to take control over their health. I must also tell the average american that the government receives most of the money from tobacco sales and they are going to be the people who have control over our health. What a laugh. Perhaps more attention should have been on our defense budget, America is failing fast and falling rapidly. But we have a President who needs all the extra money for helping other countries. Perhaps prayers will help because most Americans are in fear for this Country.

    March 16, 2009 at 16:39 | Report abuse | Reply
  36. caroltaylor

    Well: I see again that we have people trying to push for taking away Employee sponsored Health Care. I"m not for this. I wish to see the Dr. of my choice and share a one to one conversation with him. We don't need the Government involved with our own bodies. I don't want this to happen in our country. I'm sure someone is making suggestions to pour more money into our Government. Be-ware- Especially, since what happened with A.I.G. President Obama and his cabinet should all be held accountable for this! A major error which I'm sure alot of these people in Congress were aware of before this happened.

    March 16, 2009 at 21:42 | Report abuse | Reply
  37. concerned doc

    As a presently practicing physician who has worked in both British and American systems, please recognize that each system has strengths and weaknesses. The biggest difference is the legal monster here in the US. US "consumers" expect perfect outcomes and will seek court sanctioned revenge if the outcome is not perfect. So, I order "excessive" testing in the US that I would NEVER do in other countries. WHY? Because I "have done all that I could do" and that (almost) eliminates the personnal liability threat.

    Excess cost to patients-at least double the testing.
    Patient outcomes-the same.

    I agree with comments about insurance, prevention, end-of-life reforms. However, the legal burden is the number one issue for the US medical system. EVERYTHING else depends upon legal reform.

    March 20, 2009 at 04:05 | Report abuse | Reply
  38. Growthcreator

    These are very interesting comments on the case for universal care. One of the concerns that I have is the impact that U care will have on investment in medical technology for the pharmaceutical and medical device industry. The greatest concentration of pharma and med device companies and innovation is in the United States, a non-universal care country. I am concerned that we could place this innovative environment at risk if we are not careful.

    March 21, 2009 at 07:48 | Report abuse | Reply
  39. Rob, California

    Which is better, Massachusetts style health care reform or single payer health care? Both have pros and cons. American politicians and political talk radio try to scare Americans about single-payer health care systems. The biggest scare tactic is about waiting lists for medical procedures in single payer systems, e.g. waiting six months for hip replacement. And a six month wait is better than the other possible option, which is no chance at all for that procedure at all? Want to end a debate with single payer opponent real fast? Ask them which option they think is better. But, you have the government as your health care provider and decision maker.

    As for nations that have single payer, we can look to our biggest trade partner Canada as an example. Canada's #1 export to the US is oil. The #2 export to the US is passenger cars, and the #3 export to the US is auto parts. What companies manufacture cars in Canada? They are General Motors of Canada, Honda Canada, Chrysler Canada, Toyota Canada, and Ford of Canada. Why are American car companies building cars in Canada to be sold in the US? It costs less to build them there. Why does it cost less to build them there? It is because of lower employee healthcare costs due to single payer healthcare.

    Opponents of single payer health care will not tell you this. Most are proponent of Massachusetts style health care reform. These proposals (and there are more than one of them) go by names like the "Healthy Americans Act" sponsored by Sens. Ron Wyden (D) Oregon, and Bob Bennett (R) Utah. You might as well just change the name of proposals like this to "Guaranteed Profits for Private American Health Insurance Companies" because that is all they will accomplish. Ask the good citizens of Massachusetts about their escalating cost of health insurance premiums and lower coverage as a result of their "health care reform" Ask the good citizens of that state, what they think of the law that requires them to buy private health insurance.

    Is single payer better than the Massachusetts Law? If you don't want government run healthcare, the Massachusetts law is not the solution. All it does is criminalize you for not having health insurance. The government determines "minimum creditable coverage" and then requires you to buy it, or pay a penalty. It is government run, and means more government involvement in your personal health care decisions. They require you to buy into a private system that has been historically denying claims for policy holders for decades.

    Is single payer healthcare the answer? Single payer gets profit driven insurance companies out of the equation. But, you do get government involvement in personal healthcare decisions. Either way you go, you have government run healthcare and its involvement in your medical decisions. Single payer gives you government run health care, without corporate driven private insurance. It just does not criminalize you for not having health insurance. But, you get the government as the sole health care decision maker.

    So, to all who clamor for "health care reform", be careful and study the proposals carefully. Sadly, you may not get that opportunity if congress uses the "budget reconciliation" procedure, to ram a health care proposal, which ever one it is, into law. That will be a very sad day for America if that happens.

    April 23, 2009 at 17:09 | 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.