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July 21st, 2009
01:08 PM ET

soundoff (200 Responses)
  1. Frank

    Dr. Gupta:

    Health care reform can not be just to improve health care for the poor (as you stated mostly Blacks and Hispanics). It should include decrease cost for all Americans – rich or poor. The current proposal will increase spending by adding more people. It is a simple math.

    Health care reform also needs to put some responsibility of poor health on those who are over-weight, who are smoking, who are involved in risky behaviors, and more. Should we pay for those people's care? Ask Americans. The answer would be a NO.

    You should address the issue of doctor's pay. Most doctors are paid too much and are as greedy as those on wall street. That is the driving force for those unnecessary tests ordered by them and drives up the cost for all. Put all doctors on salary!

    July 21, 2009 at 13:22 | Report abuse | Reply
  2. Jim David Barnard

    Here is a modern way to consider the provision of health care. We can't continue the old model since it is cost based. We need to become outcome based with every person in the USA having a "designated physician" linked to every person in the USA.

    Please read the plan as written below.
    American Health Care Plan
    Jimmie David Barnard
    7/16/09

    The health care structure is too complicated. When you buy a car, you buy a car rather than a sum of parts which you then call a car. The present system is based on pricing the various components of services which its components together supposedly are to equal to a “health care plan” for a patient. It is maintained this is similar to a "trial and error" methodology. Volumes of services rendered are too low, care seems to be considered better if complicate and multiple health care modalities are employed, physicians don’t see enough patients, and only a few of the present patients pay for any services. Physicians are training to operate on a defensive basis……..test more to make sure of the diagnosis. Physicians struggle to operate their offices in the “black” and they are stressed. Not enough Nurses and patient care support personnel.
    Strategy:
    1) Structure health care where there is physician responsibility for the health of all patients. Physicians shall receive bonus compensation when they improve the health of the patients in their profile group.
    a) Every patient shall have a “designated physician” responsible to supervise and monitor the patient’s care. It can be a either a primary physician or a specialists, as the patient chooses. The physician will be responsible to monitor all medications given to the patient by any physician, dentist, etc.. The patient’s medical record and drug history will be kept by the “designated physician” via the patient Social Security number. All drugs and appliances given the patient will be identified with such number and the “designated physician” will be responsible to make sure they are suitable for the patient. If the patient fires the “designated physician”, then the patient will then have to select another “designated physician”. All patients will have a “designated physician”.
    b) Designated physician will be responsible to:
    i) monitor the patients health
    ii) to keep the patient in a fit and healthy condition
    iii) call and make sure the patient is following the health plan
    iv) Semi-annually monitor, test, and insure patient isn’t taking steroids or other illegal drugs and maintain documentation verifying an illegal drug free status.
    v) Provide follow-up to make sure there is progress.
    vi) Monitor the physician referrals and make sure they are effective and that the drugs and medical care they provide is suitable and meets the patient’s goals.
    c) The “designated physician” will report both patients and other health care providers who deviate and miss identify patients for the purpose of obtaining drugs or engaging in unsupervised experimental therapy and treatment outside of the legitimate scope of care and positive support of health of the patient.
    d) Physician will be encouraged to work in groups with support staff to help them. These medial groups can be extended. For example, a physician might be located in a rural area by himself with maybe one or two other physicians, but he is supported by his major group at the “home base” who handles the billings, and other administrative tasks. Every physician must be in a “home base” physician group, which will provide professional review of physician performance in his private practice.
    e) Every person in the USA will have a physician assigned who will be identified as the “designated physician”.
    f) Compensation for physicians shall be simplified to include categories for:
    i) surgical procedures
    ii) Medical supervision for general well being (weight control, smoking cessation, drug dependency intervention, exercise, etc.)
    iii) medial office visits (includes compensation for patient tests)
    iv) hospital visits
    v) Laboratory, x-ray, other tests are included in the compensation in the above categories and specific fees for such tests cannot be charged.
    g) Medical Malpractice insurance shall be provided by one USA agency that shall provide such insurance, monitor claims, and limit awards.
    h) Medical Malpractice is provided for each physician the medical group “home base”. If a medical malpractice issue comes up, a medical review board shall determine if there is a legitimate cause for action. The medical review board shall be made up of:
    i) 1/3 physicians (total of 5 physicians, 3 of which is in the specialty of the physician(s) accused
    ii) 1/3 by patients (total of 5) having been treated in the past having the diagnosis of the complaining patient
    iii) 1/3 by community leaders (total of 5) who live in the community of the complaining patient.
    The medial review board determines if there is a justified complaint. A simple majority opinion of the medical review board stands and they determine there is or is not justification for the patient complaint. If there is no justification, then the issue is dropped with no appeal. If they determine there is cause for damages, then they recommend to the judicial system that the case should be heard with a recommendation for damages as determined by the medical review board. Is there is a trial, the patient only stands to be rewarded a maximum as determined by the medical review board, no more. All members of the must be present and vote for a decision for action. The number of physicians shall always be in the minority.

    The medical record is for health care notes and cannot be used by anyone to prepare for legal action, document problems, and used in any trial.
    2) Provide enough nurses, nurse practice, and support staff to care for patients.
    A massive program needs to be undertaken to educate RNs and other Health Care professionals. 10 times the number of professionals needs to be trained.
    3) Make products, services, and pharmacies available to all hospitals at competitive prices. Reduce the number of complicated alternatives of products, services, and pharmacies which drive up costs.
    a) Private company product supply cooperatives shall be formed by State (only one per state and shall be designated as a State Medical Supply Cooperative) and Region (no more than 6 regions in the USA and shall be designated as a Regional Medical Supply Cooperative) for the purpose of offering medical products, pharmacy products, and supplies at the most competitive prices. Each State (Supervisor) shall license their State’s Medical Cooperative. The Department of Health and Human Services (Supervisor) for the USA shall License the Regional Medical Supply Cooperatives. Should any cooperative fail to offer products which support services of all types and forms, the Supervisor shall then select another Cooperative group to be the Licensed Cooperative. The Supervisor shall insure that the Cooperative maintains a full array of products and those they sell in reasonable volume. Further, each Supervisor shall insure there is a competitive environment in which the Cooperative functions.
    b) All health care buyers shall pay the same price for any product sold through any one cooperative. Cooperatives shall compete for price between other Cooperatives. Any hospital, clinic, or other health care provider is authorized to buy from any cooperative in any state or region. A Medical Cooperative shall sell its products to all providers at the same price per unit and item regardless of provider’s size, credit history, or purchasing profile for items purchase within any cooperative. A monthly products catalogue shall be produced by each cooperative with all products identified and their prices which shall be available online from which any provider may purchase products from the catalogue. This enables a small hospital to purchase products at the same price as a huge hospital group.
    4) All providers shall be not-for-profit companies including hospitals, nursing homes, skilled nursing homes, health care providing groups, physician, dental, and other professional party practices.
    5) Hospitals and other similar providers such as nursing homes, etc. shall be paid based on a per diem based on Diagnosis, Surgical Procedure, or other similar criteria. There shall be no compensation directly for laboratory, radiology, or other tests or services. These services are inclusive in the per diem. The Per Diem rates shall be established by State to account for variation in the cost in property, building costs, and other local costs, and based on the prevailing rates for medical personnel, and the cost of Medical supply costs as incurred by the cost of supplies obtained from Medical Cooperative purchases. The goal is to get the greatest level of diagnostic, surgical and treatment services possible while being wise and efficient in the expenditure in resources to achieve such medial outcome objectives for the patient. The medical record is solely for the purpose of medical care and cannot be used in any way for the purpose of legitgation.
    6) There shall be no services for medical care offered which is considerate outside these guidelines. Anyone who offers medical care shall offer such care with pricing and costs structured under these program guidelines. This stops a privileged and elite medical program from developing. Every medical and dental care program shall be of the highest quality and shall be described and supervised under the parameters of this program.
    7) Medical, Dental, and any other patient care health insurance programs shall be offered by a government agency (similar to FNM). Private companies will be encouraged to also offer such insurance programs. There shall be umbrella insurance against catastrophic illness. No one’s individual home valued $500,000 or under, bank account valued $500,000 or under, and a single automobile valued $50,000 or under shall be claimed to cover the costs of health care services per individual and double that for a husband and wife. If someone works their entire life to build their fortune, he shall not have that fortune reduced or eliminated because of an illness to the limits so described.
    8) Mental Health Care shall be dramatically improved and expanded including greatly improved provision of services for the drug and dependency programs. The Mentally Ill shall be taken out of the back streets and gutters and given proper care in the proper settings. Early educational programs in grade school and beyond shall provide increased human behavior education and discipline to counter any propensity to seek out relief from stress by drug use or tendency to withdraw from conflict and life. Proper manners, language (there are young people who do not speak English, but a coded language), courtesy, and human behavior life skills shall be emphasized to insure optimal survival skills for the 21st Century. Our people must be employable, have skills, and the ability to get along with other people. All these skills are important.
    9) Medicare services shall be based on the same medical outcome philosophy as previously described. See 11). Medicare patients shall not received reduced services or have their medical and dental care providers paid differently than any other patient.
    10) Medicaid services shall be based on the same medical outcome philosophy as previously described. See 11). Medicaid patients shall not received reduced services or have their medical and dental care providers paid differently than any other patient.
    11) All patient care shall be reimbursed at the same rate for each patient outcome category.
    12) Military Care continually shall be offered by government hospitals; however in addition, any veteran or active duty military personnel may select any licensed hospital in the USA for his medical care upon approval and upon admission order by his “designated physician”. Veterans and active military personnel may select either the military option or the private physician model via the “designated physician” route.
    Summary.
    These steps as identified here will dramatically change the landscape of medical and dental care in the USA. It will take medical care from a procedural based medical care and treatment focus to an outcome goal oriented medical care and treatment focus.

    July 21, 2009 at 13:59 | Report abuse | Reply
  3. Donna Rice-Bassett

    Has anyone run models on the impact of a major outbreak (flu, plague, whatever) on the US with healthcare reform versus the US without healthcare reform? Or to put this another way: Isn't it easier to nip an epidemic/pandemic in the bud before it has a firm grip on the nation via the millions that cannot afford proper health care versus waiting until it's too late? (And by models, I'm not just talking about the potential for horrific cost in human lives here, but also the losses in revenue as commerce shuts down, etc.?) Surely it's cheaper and safer in the long run to opt for reform (an more humane) than to maintain the status quo?

    July 21, 2009 at 14:14 | Report abuse | Reply
  4. Michael Allen

    Since I have been following the health care debate, I am confused somewhat about the 47 mil uninsured. I have heard other commentary state that this number is misleading when you take into account illegal immigrants, persons who can afford health care but refuse it, and persons who have lost their jobs but will find other jobs with health care. So to me this number appears to be a moving target. So when we talk this issue what is the real number?

    One additional question, and that is Why does all persons over 65 have to go on Medicare if they have insurance? I look forward to hearing from you on this important subject.

    Thank You!

    July 21, 2009 at 14:54 | Report abuse | Reply
  5. cathy christopher

    Dr. Gupta, it was a relief to finally hear someone talk about the fact that we are already paying for health care for the uninsured, through hidden costs. i work in health care and everyday i see the barriers to patients maintaining health and getting primary care due to lack of insurance, so inevitably they come to the ED for thinks like stomach aches and flu. this escalates the cost of health care for everyone. you are the only one so far to acknowledge this reality, and it needs to be reiterated over and over again so that the public understands that health care reform will reduce cost for everyone in the long run. please continue to address this issue

    July 21, 2009 at 15:10 | Report abuse | Reply
  6. Freddie

    I retired and moved down to FL two years ago. I had to cancel my health insurance, after carrying it for two years on my own at a cost of over $6,500 a year, because I could not afford it any more and since I never got sick, so it was like throwning money down the garbage disposal.

    I went to the emergency room twice because of pains in my back. Twice, because it was never addressed the first time. The hospital changed it from pains in my back to pains in my chest. I saw the doctors for less than two minutes each time I was there.The first time they kept me there a few hours and hooked me up to a machine (EKG??) and just left me there. After two hours, I disconnected myself from the machine. They did blood work, X-ray, and God knows what ever else.

    I actually saw the doctors both times for less than two minutes each. However on their records the pain in my back changed to pain in my chest. I had to insist that they release me. The bills I received in total from hospital and doctors total over $5,000. To make things worst, I believe I picked up an infection in the hospital.

    WE NEED MEDICAL REFORM. THE HOSPITALS ARE RIPPING PEOPLE OFF.

    July 21, 2009 at 15:34 | Report abuse | Reply
  7. jennifer clouston

    Hi Dr. Gupta,
    I am really angry with the ad on CNN. The Canadian woman
    says that she would have died waiting 6 months to have a cancerous brain tumour removed......This is not true......she had a benign cyst on the back of her head. She would not have waited if it was cancerous tumour.. My expericence is that sick people have excellent care and do not wait. YES WE HAVE TRIAGE!!!
    The ad is fear mongering against universal healthcare BY PEOPLE WHO WANT TO KEEP OVERCHARGING FOR THEIR SERVICES.
    We are short of doctors in Canada because the greedy ones move to the U.S to make the big bucks. If you guys had universal healthcare you wouldn't have our problem of not enough nurses and doctors.
    Your healthcare system is not humane, my U.S. sister had to sell her home to pay medical bills after her husband of 38 years old died of cancer. She had to start all over again as a very young widow with a 5 year old child. The cost of your health srevices make people sick.
    Please ask CNN not to run ads against our Canadian system.

    July 21, 2009 at 15:49 | Report abuse | Reply
  8. Ingeborg Hahn

    I am Canadian and 75 years old. I was so glad to hear ' finally ' a Canadian Health Minister speak to CNN today . I have 2 children and they have four children. All of them had numerous operations for which they never paid a cent. We can select our Doctor and he will
    make the decision what has to be done. I have ALWAYS received IMMEDIATE treatment when I needed it. My eyes were operated on and I did not even realize I needed it. My eye doctor decided it and after three months I had it done. I paid for 40 years into my health plan and I never have to ask an insurance company or submit a claim. I cannot believe the garbage we hear about the Canadian Plan from Republicans. It is sad to see the ' greed' in America. Listen to Canada

    July 21, 2009 at 16:05 | Report abuse | Reply
  9. Ahmed Alvi

    Everyone is talking about the deficiencies of Canadian healthcare system – the long waits on elective procedures.
    (And I know Dr Gupta is not a great admirer of French system).
    Fact: In 2008, Canada spent US $4700 per person on healthcare.
    In 2008, USA spent US $7900 per person on healthcare.
    Question: If Canada spent US$ 7900 per person, will it still have any significant waiting lines?
    You don't have to be a neurosurgeon to answer this question.

    July 21, 2009 at 16:06 | Report abuse | Reply
  10. Carol Johnson

    After I had been diagnosed with MS in 2004, my husband decided to retire in 2007. His only income is his Monthly Pension. He is now 59 and we are paying $850.00 a month for health insurance. Because of my illness we are unable to find a comparable health plan for less. HOW IS THE HEALTH REFORM GOING TO HELP PEOPLE LIKE US?

    July 21, 2009 at 16:26 | Report abuse | Reply
  11. Denise Foss

    No one seems to be listening. It's not that we need Health Care Reform. If the Doctors, Pharmasitcal Companies and Insurance
    Company's would just lower their cost's we would be in good shape.

    July 21, 2009 at 16:30 | Report abuse | Reply
  12. Denise Foss

    Look at the profits, it's about greed not health. Money!

    July 21, 2009 at 16:32 | Report abuse | Reply
  13. Ed Bercovitz

    In all of the discussions on health care reform why is the issue of the non-medical components of health care costs never highlighted ... the two major ones being profit and administration/bureaucratic overhead.

    All private insurance firms and private hospitals are businesses and like all other businesses they want to maximize their profits by maximizing income and minimizing expenses. In practical terms this means increasing premiums, keeping benefit payouts as low as possible and not providing services to high cost, unprofitable clients ... i.e. patients who need medical care. Competition will keep the worst excesses in check but from the current state of the economy it is evident that private sector firms will do pretty risky and ill conceived things in pursuit of profits.

    With the large number of private sector insurance firms and private medical care providers there is a highly complex mass of plans and services with different coverage, plans, rates etc. To process all these medical claims takes a large number of clerks, administrators and bureaucrats all of which cost significant amounts of over head dollars and time all of which are considered part of medical care costs even though they provide no medical benefits.

    If we could reduce the profit and overhead components in national health care costs the money saved could be put back in patients pockets or to provide more and better medical services at no additional costs.

    So where is this aspect being included in the health care debate?

    July 21, 2009 at 16:33 | Report abuse | Reply
  14. Denise Foss

    Green Backs. Dinero. $$$. Lets be honest (not that any house rep or congressmen or legislater would understand they are all rich. excuse me and f you

    July 21, 2009 at 16:36 | Report abuse | Reply
  15. liz

    what can you tell me about edometrial hyper plasia & will there ever be a cure ,TTC..im to young..

    July 21, 2009 at 16:37 | Report abuse | Reply
  16. Denise Foss

    I want to know why my honest truths have not yet been aired? We don't need re-form just lower the cost's.

    July 21, 2009 at 16:39 | Report abuse | Reply
  17. Anil Ahlowalia

    I recently have been converted into a vegetarian and I am truly loving it. I had a little bit of meat last week after not having any for months and the mood swings, constipation and low energy levels were extreme. Dont get me wrong I loved meat more than you can imagine, but turning 39 this year and having a wife that is 11 years younger than myself, I needed to make the change for our future and for my overall health.
    Question – I have heard alot about raw food diets, and I have seen and met people who are on them and they just seem to have unlimited energy, more than myself as a vegetarian and also they have a high natural glow to them. How good is a raw food diet for you and and recommendations if one was to go on a all raw food diet.

    Thanks and my family and I love you on CNN

    -Anil

    July 21, 2009 at 16:56 | Report abuse | Reply
  18. RN NC

    Just had to add my 2 cents worth on all the health care broo-ha-ha. I saw a report on CNN about the $1200 wheelchair and almost laughed – truly! This soaking has been going on for the past 20 years that I know of personally, having spent much of it home care. In the 90's, when MC decided to save some $$, it was on the backs of the home care nurses and therapists, cutting pay per visit by incremental, yet ridiculous amounts. Then they thought – we'll give them a certain amount per diagnosis, increasing our paperwork by reams – the ICD-9 code book borders on 3 inches thick, the paper is telephone book thin – wrong codes, less money for the home care agency... they don't like that. The suppliers seem unchecked in their greed, however – it is both frustrating and infuriating. doctors do not consider the cost of medications when they prescribe them, and since the average patient can't read them anyway, has no idea what the cost is until they get to their pharmacy. Price shopping here sounds like a good idea, but if you don't stick with the same pharmacist all the time, your safety net is gone on monitoring drug interactions goes out the window too. Hospitals routinely overcharge or stick a charge in on someone's bill if they don't know wherelse to put it – its got to go somewhere, and the insurance, or MC is footing the bill, right? So why should we care? We should care because it has been going on for decades unchecked by anyone – and it is time to stop. If we were to eliminate all this fraud and abuse, the health care package, whatever the cost, would be paid for. Period. Man, I wish I were on somebody's task force – I know where most all the skeletons are buried! My apologies for the length, but I had to get it to someone – perhaps you are the one who can make a difference.

    July 21, 2009 at 17:13 | Report abuse | Reply
  19. Briana in Canada

    I know that health care reform in the U.S. doesn't affect me, but I'm angry at how the Canadian system is being lied about to Americans in an effort to scare monger Amercan people against the President's plan to provide universal health care.

    I see ads that threaten to have government bureaucrats in charge of people's medical records and medical decisions and that's not what happens here. Even if our government did have access to people's health care records, we have strict confidentiality standards. We cannot be refused employment based on these records or refused care for pre-existing conditions. And I don't see how government officials having access to one's medical records could be worse than having greedy, self-centered, and profit-focussed insurance executives all over people's medical information and making life and death decisions about their treatment.

    To say that a patient and their doctor would no longer be making these decisions is a total fallacy–ultimately, it's not up to people and their doctors now–it's the insurance companies making all the decisions and they will allow anyone to die in order to line their pockets with the money of those they condemn for personal profit.

    The Canadian provincial governments decide what can be afforded and what cannot within their annual budget (health care is a provincial issue, not a federal one) based on the money transferred from the federal budget to each province every year, and it is extremely costly treatments (e.g. new medications for chemotherapy) that may not get the green light until they are proven elsewhere. None of these decisions are personal. No one is refused surgery on the basis of age usless there are other medical conditions that would make the outcome unlikely to be a positive one, and if such a decision is made, it is made by the doctor, not the government. The patient is free to seek a second opinion if they disagree.

    Surgical waitlists are on a priority basis–those who are likely to suffer life-threatening consequences without their surgeries are placed on urgent and even emergent lists and have procedures much quicker. My daughter came into the ER in May with an infected gall bladder and had it removed the same day. The same thing happened to me seven years ago when I had appendicitis. We wait for low-priority procedures due to a lack of doctors and to accommodate those who are sicker and need care sooner. This is only fair. People do complain, but I believe that it is those who do not follow up on their worsening condition with their physicians (and/or don't follow the advice given to maintain their condition in the meantime) who run the risk of dying while waiting for surgery.

    As you stated the other night, the uninsured in the U.S. are not free–they cost more because they don't get the care they need until their heath is in a crisis state, when it is much costlier to fix. If Americans don't think they paying for this already with their tax dollars, they have their heads in the sand. Regardless of what it may cost in the short run to implement health, in the long run, it will cost less as people get the care they need long before treatment to fix–rather than merely prevent–serious medical problems cost taxpayers tens, hundreds, and even thousands more to deal with.

    To leave things as they are doesn't make the U.S. the "greatest and most powerful nation in the free world," but the most selfish. If the "poor little guy" doesn't stay healthy enough to run your factories and do all the dirty work, eventually the wealth of all the rich people who don't want to pay more taxes (but already do, even if they don't yet realize it) will collapse completely. Even China provides health care for their poor, and look at how powerful that nation is becoming.

    Greed and selfishness always costs more in the end. The scare-mongerers don't care about their country, they only care about themselves, and just like those who selfishly ruined the economy, they will wreck even worse havoc on the U.S. with these lies if people keep being foolish enough to listen to them.

    July 21, 2009 at 17:18 | Report abuse | Reply
  20. Danny

    If we really want to lower healthcare costs, then why isn't EDTA chelation therapy done on more patients with with heart disease? The reason why is because the healthcare system is a political scam that politicians, doctors, and insurance lobbiest get rich off of. I hope everyone looks up EDTA chelation and gets pissed off when they see this therapy could be used to save lives at the fraction of the cost of open heart surgery.

    July 21, 2009 at 17:48 | Report abuse | Reply
  21. Dennis

    Why won't the Republican's and the conservative Democrats tell the truth? Is the issue on healthcare really just about selling out to the lobbyist who are afraid of losing money? I believe the oppsition fight is about liining their pockets. Why would a public official not want better and cost efficient healthcare? So many people are are hurting and dying. What could be more important than human life? Has it come to this? Do these people hate the President so much that they would allow people to suffer? What can we do to help the President get this bill passed? Help us please?

    July 21, 2009 at 18:44 | Report abuse | Reply
  22. Debbie Kelly

    I had to write to Americans why they should welcome Government health care reform, because it WORKS! All medical bills are paid for. You can go to an emergency room and pay nothing. You can have the most serious of conditions and you pay nothing. Having a baby through a difficult birth can costs Americans so much, but we pay nothing, even if the infant has to stay in the hospital for months with or without the mother. It is time Americans took the power from the the wealthy Insurances and put it in their own pocket. Health tax is a good tax, because it pays for all your medical regardless of the condition. The onlyl exception we have in Canada is the drug costs, which are too high and some are unaffordable, but we are working on solving this problem. But please Americans, welcome and help your President bring free medicare to you and yours and for the millions that don't have any at all. If you could only feel what it's like to not be afraid to be sick, you would know it is worth it. We have said here, that some cuts don't heal and that making a profit off the sick, ill and dying is deplorable. This is one battle you want to win.

    Thank you

    July 21, 2009 at 19:16 | Report abuse | Reply
  23. Lori

    Will medicare coverage remain the same for seniors. Now we have A and B parts coverage with a minium payment for A. That only covers 80 % of medical bills. we have a secondary policy to cover the 20 % at a very high payment. Will the government pick up the entire cost for seniors under the new healthh plan?

    July 21, 2009 at 19:53 | Report abuse | Reply
  24. Ann

    I recently heard that congress will opt out of using the government sponsored health plan. Why is that? Don't they feel the health plan they have developed for the rest of us is good enough coverage for them.

    July 21, 2009 at 19:57 | Report abuse | Reply
  25. Claire

    Is there any actual evidence that says that insuring people with pre-existing conditions is that difficult? The majority of insured people have employer-sponsored insurance. Many mid- to large-sized companies offer insurance programs that do not underwrite not only the employees but their entire families as well. Essentially, we already have working models of group insurance programs where people are not turned away for pre-existing conditions and it is profitable for the insurance companies otherwise they wouldn't be doing it.

    From looking at my insurance records, uninsured people are charged 2 to 10 times as much for the same tests and doctor visits as the insurance companies pay at their negotiated network discount rates. For example, my insurance company paid about $5 to the lab for some tests which if uninsured, or if my claim had been denied, I would have had to pay about $500. Then of course uninsured people have difficulty paying medical bills! If they were charged $5 for the lab test like the insurance companies actually pay, they could probably afford it. What is going to be done about this unfair pricing scheme?

    I often hear of charges for the same medical procedures ranging over a ten-plus-fold price range. Someone told me his procedure cost $15,000 to the insurance company while when I had the same procedure elsewhere, it cost less than $1000 to the insurance company. My insurance company also was charged and paid $5000 for some tests which another doctor told me that he charges about 1/10th of that and was at a loss for an explanation. I don't understand how there can be such a wide range in pricing and the insurance companies don't even question it and pay the inflated prices, and meanwhile I hear many doctors complaining that they're not paid enough. As a beneficiary of a doctor's income, who charges 1/10th of those inflated prices, I can say that that still allows us to be really quite wealthy. At the uninflated prices, medical care could actually be affordable. What is going to be done about the wild price ranges from the low of MediCare to the absurdly inflated?

    July 21, 2009 at 21:01 | Report abuse | Reply
  26. LEE METCALFE

    I would like to correct Liz Cheney,s comment on LLK,tonight that we in Canada can,t choose our doctor.I have lived for over 80 yrs.and have never been told what Dr.to choose,it was always my choice even when I moved. We also have a drug plan and I get the RX ,s that he orders and as a senior I do not pay more than $15. for each one.I live in the povince of Saskatchewan,I have had 3 major surgeries which were done promptly .I don,t mind someone criticizing our system but they should at least be well informed about it .I hope somebody will tell Liz Cheney how wrong she is.I am rather angry!!! Lee Metcalfe

    July 21, 2009 at 23:13 | Report abuse | Reply
  27. rukidding?

    I saw your show last night about two different health care programs in New York. Your show attempted to put a racial spin on what was happening there. My question is if Medicaid patients don't get the same care as the privately insured. Why in the heck are we blindly going down the road of National Health Care with the government taking more control. I may be mistaken but isn't Medicaid/Medicare/VA all Government plans? HOW'S THAT WORKING OUT?

    July 21, 2009 at 23:20 | Report abuse | Reply
  28. Barbara Strowd

    Hi – I just sent an email to the white house in support of health care reform. I want to march on DC when congress comes back in session to quietly stand 4 the uninsured that can't go. I am covered by a great plan so I think everyone who is should go and stand for our neigbors that aren't. I am willing to pay more taxes if need be to be able to say everyone in this country can go to a doctor and get the medicine they need. Do you think it would help?

    July 21, 2009 at 23:24 | Report abuse | Reply
  29. Patricia Monger

    As a dual American-Canadian citizen, I have had plenty of experience with both health-care systems (as well as the British one, having lived there for two years). And I live in the same area as the U.S. right-wing media's new darling, Shona Holmes of Waterdown, Ontario (who got her 15 minutes from this particular media outlet at http://www.cnn.com/2009/POLITICS/07/06/canadian.health.care.system/).

    So, I figured I should share my story to you as well. Of course, two isolated anecdotes are really no more valid than one. Pity CNN didn't make that clear when you turned Ms. Holmes into a right-wing media darling.

    In May 2007 my husband had a heart attack. It took him a few days to realize it was something serious. When he called his doctor and described some vague symptoms he got an appointment for the next day. The doctor sent him at once to the emergency room, and he was in the hospital for the next 15 days, under constant monitoring, for an angiogram and other tests, and then a quintuple bypass surgery and post-operative recovery. For that we paid a total of $900 – or would have done had we not had supplemental insurance through his work – because he preferred to be in a private room at the hospital.

    He was put on nine different drugs for the first weeks after the surgery, gradually winnowed to three. We pay about $5 for a 90-day supply of each of those, because of his supplemental work insurance. But once early on he made a mistake and didn't mention that he had prescription drug insurance when he filled one of the prescriptions, for a beta-blocker, Metoprolol. The uninsured price for 90 days worth of that, including delivery to our house, was $14.62.

    We each pay $750 per year for our health coverage. That is a sliding
    scale based on income and we are both at the top of the scale. And as
    budget manager for my department I also know how much our supplemental insurance costs our employer: $2500/year (we both work for the same employer). That $2500 covers our prescription drug benefit, supplemental coverage for things like a semi-private room and physiotherapy, and our health insurance coverage for when we travel to the US and other countries. Maybe if your employers only had to pay something like that you wouldn't worry so much about having it be considered a taxable benefit.

    And indeed, though I do have that insurance, I had to pay out of pocket for my visit to a California emergency room (Santa Barbara in my case). I was sent there from the drop-in clinic who refused to even let me in because though I have insurance, the card (Blue Cross) I gave them did not have a U.S. address for sending the bill printed on it, so the accounting people didn't want the bother of figuring out how to get reimbursed. So they told me to go to the emergency room because "they have to take everybody".

    Of course, at the emergency room I did get just as good a treatment as I have had in Canada. But I did have to stand, or sway because of my 102 fever, in front of an accounting window and give them a credit card as well as the insurance card so they could take $200 deposit before actually letting me see a doctor.

    Oh yeah, and then I needed an antibiotic. Six pills, $60. So that means my bacterial bronchitis in your system cost about 1/3 of the cost of a quintuple bypass in our system. And meanwhile I have watched how my sister in Colorado worried that the freak heart attack her son had at age 22 would ruin his future because no one would hire him due to the insurance costs. And another nephew in Missouri suffering not only the fear and despair at losing his job, but the added terror that it also meant loss of his health care. And a brother in Kansas with ocular myasthenia gravis who first has to wait for the one neurologist who can treat this condition to make a monthly visit to his city, and then needs to borrow money to pay for his treatment, though the neurologist has gone to a great deal of effort to secure him some of the treatments under some kind of poverty plan. His city is Wichita, the largest one in Kansas. My city is the same size, but I could find that treatment right here and not have to wait for the doctor's monthly visits.

    You REALLY don't want to have this argument about the relative merits of the U.S. and Canadian health care systems; the U.S will only embarrass itself – again. No doubt that is why CNN decided to only show one extremely limited and non-representational aspect of the full story.

    July 21, 2009 at 23:25 | Report abuse | Reply
  30. David Lovejoy

    Dr Gupta,
    I'm a second year medical student at the University of Kentucky and as I prepare another round of financial aid applications, I was curious to know what you've heard from Washington regarding debt reimbursement, if our Health Care system becomes socialized. Its my understanding that most countries that practice socialized medicine also pay for medical school. How will the government make this transition? Will my generation of physicians simply fall through the cracks and spend the rest of our lives paying off our debts?
    Sincerely,
    David A Lovejoy

    July 21, 2009 at 23:30 | Report abuse | Reply
  31. Maura Parte

    I just watched Liz Cheney on LKL saying that people in Canada don't get to choose their own doctors. This is plain wrong. I chose my family physician, in fact your first meeting with your physician is an interview for you to decide whether or not you want them to be your physician, they are prohibited by their professional college from rejecting patients, the patient makes the choice. I am currently 8 months pregnant with my second child. I was given a choice between an obstetrician or a midwife. I am having and have had a low risk pregnancy so I chose a midwife whom I got to chose from several practitioners. I saw the midwife once a month until 30 weeks, bi-weekly until 36 weeks, and once a week after that. At any point during my pregnancy I can see an obstetrician. We were concerned last week that the baby may be in a breech position so I was immediately given an ultrasound and a consult with an obstetrician within a couple of days, all was fine, no breech. The only thing I will pay for during all of this is a $100 per night hospital fee to have an optional private room instead of sharing a room with one other person. That fee is 100% covered by my public sector employer. After I give birth my midwife will attend to me at home as will a public health nurse. You always choose your healthcare practitioner, if I was having a surgery instead of a pregnancy my family doc would recommend a specialist and I would make my own choice about who to see based on their recommendation and availability. There is no question we choose our own healthcare practitioners every step of the way.

    July 22, 2009 at 03:33 | Report abuse | Reply
  32. Deb

    Please discuss the problems with getting rehab for stroke survivors. The current research shows that stroke survivors can recover speech and physical limitations with intense therapy. Medicare estimates show that physical, occupational, and speech therapy costs providers about $40/hour; yet they charge between $200-$700 per hour to patients. Insurance companies often limit coverage to 20 hours of therapy a year. But recent research findings show that patients need at least 9 hours per week for many months for lasting results.

    It seems that the health systems are greedy and the insurance companies and the insurance companies are cut ting corners, leaving stroke survivors needlessly paralyzed.

    July 22, 2009 at 05:34 | Report abuse | Reply
  33. Nancy Bittner

    I think President Obama should pick say 2 states and do a trial run with the program of his choice first long before he decides for the entire country.
    What is the BIG hurry.
    Are we looking for kudos I did it, or a serious resolution for the needed in healthcare.This way he can tweek the problem areas before we have an epidemic that would cause major kaios.
    It is insane to think one program will fit all. It should be proportionate to your needs and income level. Chrildren shoud be first in the program.

    July 22, 2009 at 07:15 | Report abuse | Reply
  34. Carol Carrier

    Dr. Gupta,

    What will be the affect of health care reform on medical transcriptionists? We are losing our jobs to off shoring Dr. Gupta. I am only one story but I know of many, many more. Our pay has gone down to a nonliving wage, yet we are expected to produce a quality medical record. The medical records from off shoring are filled with errors. I think many Americans would be amazed at the mistakes in their records, all to save a dollar. The professional medical transcriptionist who takes pride in his or her work and wants to be a part of the team to create quality healthcare is being pushed aside by big business.

    I believe there is a story here Dr. Gupta. Can you help us get the word out about what is happening to the quality of the records and the importance of the job we do?

    Thank you.

    Carol Carrier

    July 22, 2009 at 07:33 | Report abuse | Reply
  35. Scott Marion

    Everyone wants to know how taxing the health benefits of people who already have health care to support the health reform will benefit them. Most people have fears of our health costs rising without much benefit to us. From my personal observations, one thing is evident to me that I have not heard discussed to this point.

    Currently people who do not have any health care plan must go to the emergency room for any type of care. The result of this is that many people who go to the emergency centers in their local hospitals go there for treatment that really are not emergencies. This must be costly to all of us both in terms of the rates we pay for our health care and also by needlessly filling up our emergency centers with non-emergency cases. These non-emergy cases would be much more cost effective if these people could just go to their doctors and not to the emergency room for simple treatments.

    Can you please comment on how the health reform may help alleviate this problem and how health care reform may actually save money in this regard? Thanks for your time.

    Scott

    July 22, 2009 at 07:39 | Report abuse | Reply
  36. Kim

    There is a misleading ad aired featuring Shona Holmes and her claims of being denied care for a fatal brain tumour. It turns out that she did NOT have any such fatal tumour. But, a highly respected for-profit American health care institution was willing to step up – for a hefty fee – to help her jump the queue for treatment of her benign condition.

    Unfortunately, this is what for-profit care does best – respond to whomever plunks down the cash. There are, unfortunately, doctors who are keen to devote scarce resources to unnecessary tests and procedures, when a firm response re a less cash-intensive course of action is required.

    I'm very satisfied with Canadian healthcare. As most Americans know, all that is administered by the government is the payment, not the care. We pick our own doctors. However, the primary care physicians do make the call re access to specialists, and we do understand that we cannot spend infinite sums on every patient. Patients with non-life-threatening benign conditions some times do have to wait. End-of-life no-hope cases are not necessarily kept alive indefinitely – and certainly we don't interfere with nature's course terminal cases to score political points (remember poor Terry Schiavo?)

    You might want to investigate whether Ms. Holmes was paid for her 'testimonial'. No one here is trivializing Ms. Holmes' condition, but we have scant sympathy for someone who is deliberately misleading and hypocritical (Ms. Holmes is quite welcome to leave Canada if she doesn't like it here...)

    We wish our American friends well, and hope that the PACs will not prevail, but instead, hope that patients come out on top, as they should.

    July 22, 2009 at 08:16 | Report abuse | Reply
  37. used-to-be-a-democrat

    I am appalled at our President's arrogance and ignorance. He knows nothing about the heath care industry but yet is trying to ram his plan down the throats of US citizens for political gain. Healthcare needs to be fixed but it needs bi-partisan, careful and complete analysis. This plan will increase costs and lower quality. The claim that you can keep your current plan is complete fiction. You can keep your plan, only, if you do not change jobs. Taxing the high wage earner will stop any progress to an economic recovery and -Where are the jobs we were promised?? If this plan is such a great solution, why are the President and Congress not jumping on board. Oh no – they have their golden plan that is too good for the American people. Same goes for social security. All these programs will not be fixed, until Congress, the President and federal workers are on the same playing field..

    July 22, 2009 at 08:36 | Report abuse | Reply
  38. Stephen Gallagher

    Dr. Gupta,

    I'm an American who lived in Canada from 1996 to 2008. While living there I was covered under the Ontario's Health Insurance Plan. And I want to say that I survived Melanoma while living in Canada. The insurance system covered me timely, and I'm cancer free today.

    About three years ago, my doctor in Toronto sent me to a dermatologist to have a mole examined. The dermatologist removed a section of the mole and sent it for analysis. It turned out to be Melanoma which as you know is a deadly form of skin cancer.

    I was told by the dermatologist that I needed to have it removed and I was told to contact an oncological surgeon. I was given the names of several surgeons, but the ultimate decision on who to go to was mine.

    The surgeon I chose told me his first available appointment was in three weeks. After being examined by the surgeon, I waited three more weeks for the surgery to take place, which it did in a hospital operating room under general anesthesia. They removed the mole, plus one inch of skin around it, and three lymph nodes.

    So, it was a total of about eight weeks from when my physician told me to have it looked at, to when it was removed.

    Note that the only involvement that the government had was that the bills were set to them as the insurer and they paid 100%. The government didn't decide when it could take place, or whether I could have the surgery, or tell me that I had to wait before having it done.

    Everything was between me and my doctors. Doctors that I chose.

    I'm not saying that Canada's system is perfect, but the horror stories that some people are claiming are the exception, not the norm.

    Plus, Canada's system is single payer, and nobody is proposing to implement that system here.

    July 22, 2009 at 08:48 | Report abuse | Reply
  39. Dan

    Lately,Dr. Gupta has been quoted by many of his CNN hosts as saying,"I would'nt want to have a Canadian style health care system if I was having a heart attack."
    Why are so many talking heads demonizing the health care system in Canada.The latest poll shows that a large majority of Canadians like their health care coverage,and certainly would'nt trade it for the U.S system.
    My mom had a heart attack 2 weekends ago.She went to the E.R on Sunday afternoon,saw a Dr. immediately,was admitted to the CCU,worked up,and stabilized.Monday morning she had a heart cath,which showed a rt coranary artery blockage.they placed a stent,and continued to monitor her heart function.Her heart rate was slow enough that they thought she would need a pace maker,but on tues. evening her rate converted to normal sinus rhythm.She was transferred to Telemetry unit,monitored for 2 more days,then discharged home on fri. where she is recovering nicely.When I talked to her by phone,and enquired about her care,her response was "Everyone is taking such great care of me,they're treating me like a queen."
    Dr.Gupta,my mom was a very lucky lady,she was having her symptoms for several days before seeking care,but she received the best medical care available anywhere in the world.She was not neglected,ignored,or pushed to the back of some imaginary bread line,like the U.S tries to portray.And most importantly,she will never see a bill,or be harassed by an insurance company,and her new cardiac meds will not put an ungodly strain on her monthly bills.
    Canadians are totally unaffected by whatever healthcare system the States decide to adopt,but we're mentioned every day in a negative way in your debate.Our system won't work here!! your population is ten times larger,and the fast food mentality doesn't apply well to universal health coverage.So,if you're not going to give an honest portrayal of our system,please leave us out of your debate.
    Thanks, Dan

    July 22, 2009 at 08:59 | Report abuse | Reply
  40. Carolyn Young

    On your piece this am(7/22) re the disparity in health care between blacks and whites, you cited a black man who went to the ER with a paper cut. It was said that this person had health insurance. His diabetes, the cause of his infection, weight loss, etc. went undiagnosed for months. The allegation was that it went undiagnosed because he was black, and recieved poor care because of his race. My question is: Why, if he had health ins. did he go to the ER instead of his own primary care giver. ? Why, if he has health care, did he not have regular checkups, which would have picked up on his diabetes.? Why did he not take personal responsibility for his own well being?
    Maybe this is not so much an issue of black and white, but one of smart and not smart.

    July 22, 2009 at 09:17 | Report abuse | Reply
  41. heidi

    President Obama says we MUST spend money to save the health care system. I don't get it.. Why can't we just fix what's broken instead of throwing money at it? I would like to hear your opinion about tort reform.

    July 22, 2009 at 09:21 | Report abuse | Reply
  42. T. Sturgell

    Why do politicians consistently dismiss a "single payer" health care system? Isn't it time our healthcare system joined the best/most successful in the world?

    July 22, 2009 at 09:22 | Report abuse | Reply
  43. Dana Slaughter

    Why is Obama's health care reform always compared to and criticized as a clone of the Canadian system? There are other countries in the world that have universal health care, yet the media has not examined these systems for their effectiveness or comparisons to Obama's package. Surely this has been looked at, but I have yet to see any meaningful analysis in the news.

    July 22, 2009 at 09:22 | Report abuse | Reply
  44. heidi

    What can we do to help people become motivated to improve their own health? Access to health care isn't necessarily the problem, as ove 50% of health is determined by behavior and environment, and only 10% by access to the health care system. Any thoughts?

    July 22, 2009 at 09:22 | Report abuse | Reply
  45. Roberthe Antoine

    Dr Gupta

    I do not have a comment I was watching you this morning about the guy with diabetes. I have a story that I never share with anyone, but with my sons doctors. I had one of my sons who got sick in 2007 just out of the blue. He was arguering with his brother and passed out after that, I called 911. When we got to the hospital the EMT guys bypass the emergency room and made us seat at triage for two hours while my kid could not bread. I went to the nurse she said they will call us soon, but they had called everyone who were before us. Finally after I bothered her so much the nurse send us to convenient care (whitch is for minor cases). When the doctor check my son and do an EKG, she transfer him to the ER and he had to be air lifted to yale University, and there he had to have open heart surgerry. By the I am black, I am from Haiti, from this day I kept asking my self why they almost let my kid die, because he was hardly breading when we got to yale new haven. He is doing fine now Thanks to God. My son was born with a rare heart defect that no one knows until that day. The doctors said he could had collapse any day and die, because he play sport. My son was 15 when he got sick.

    July 22, 2009 at 09:31 | Report abuse | Reply
  46. Robert White

    Your credibility dropped significantly this morning!
    Everybody is different and much as we try we treat and get treated differently. Halth care is primarily an indiviual responsibility. This person obviously didn't get regular health appraisals or they would have found out they were diabetic. This doesn't happen in the emergency room!

    July 22, 2009 at 09:33 | Report abuse | Reply
  47. angell

    Come to Cailfornia you would be surprise how health care system works for A A with medical insurance. Last year what was did to my Brother was horrible. 44 yr old great shape single parent had a stroke. My brother was in so much pain he died 2 weeks later. DR who was assign to my brother case did not treat my brother condtion as she would have had he been (White). To re live this twice in six yrs my mother was miss DX for six months with unbearble pain died in 02. That is all I can my family wil never be the same. I work at a major hospital I see all the time.

    July 22, 2009 at 09:43 | Report abuse | Reply
  48. Dana Rayl West

    Do you think it's true that there may be over $700 billion dollars of waste in the health care system spent annually? See the Christian Science Monitor October 13, 2008.

    Many of us who were around for the White House Health Care Reform efforts in 1994 and who have worked for HMO's, PPO's, hospitals in Hawaii and Indiana can't get our information to anyone. Do you have any ideas for a place where serious issues can be raised....besides this blog?

    July 22, 2009 at 10:04 | Report abuse | Reply
  49. danaraylwest

    Please see this article:
    http://newsblogs.chicagotribune.com/triage/2008/10/700-billion-.html

    July 22, 2009 at 10:10 | Report abuse | Reply
  50. Gail

    All I hear is about poor health care for the black people, it isn't just them, it's everyone. My husband is on medicare, we only have social security income, and we can no longer afford health ins. for me. The ins. we had dropped him a month before he turned 65, for us to continue the same ins. for me it would cost the same as for both of us, $680.11. Since he no longer can work because of his health, we only have $1400 a month to live on. I have pre-existing problems and had cancer in 2003, any ins. for me is outragely high. How are the people going to be able to afford ins. if it is made mandatory, with the ins. co. having no regulations they charge whatever they want to and they also tell you when they will pay for something or if your doctor can prescribe what you need. My husband cannot get one of his prescriptions, even though he did take it for a while, the medicare system says now he is not allowed that product they give him a different product even though thru the doctor he has let them know this new product does not work as well. Our health is not what everyone wants us to believe it is. I can't get medicade unless we separate, which I have met older couples who have divorced just so they can survive. Why not make the insurance companies let the doctors take care of their patients without all the bull? Why not make the insurance companies make the payments for health ins. affordable? I, also, don't believe that congress should be making laws about healthcare unless they a degree in the medical field. What they need to do is regulate insurance companies, to keep they from robbing us like they do. I also don't like the mandatory car insurance, I paid full coverage thru Progressive , was in an accident that was not my fault but they did not fix my car, nor give me something to drive while my car was in the shop, but this is another issue.

    July 22, 2009 at 10:20 | 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.