 |
|
|
|
|
July 27th, 2009
04:19 PM ET
Ask Dr. Sanjay Gupta your health care reform questionsDo the health care reform headlines leave you with more questions than answers? Dr. Gupta is your health care reform insider – and he wants to hear from you! Post your questions for Dr. Gupta in the comments below or tweet him @SanjayGuptaCNN. |
  About this blog
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.
 |
|
|
|
Dr. Gupta,
I just graduated from medical school with over $280,000 in debt. How do you think the Health Care Reform policies will impact doctor's compensation? Do you think there will be anything included in the bill to reduce the burden on young and future physicians?
Thanks
Recently, I left the Republican Party after 25 years, because I realized they don't care for the little guy, they are just about the rich people. And I say this as a Cuban-American that understand the price of liberty.
Now, I see that the democrats are just the same way.
We need Health Care reform, everybody knows that, but here we are, no excuse for the democrats, the own everything, from the White House to Congress, and still it looks like once again we, the little people, are going to continue without medical care.
I am so dissapointed, I feel like I don't want to vote again in my life.
I am not sure when the politicians talk about patient's choice-patients have to choose from a panel of physicians and the care is determined by insurance companies-not by physicians-As a physician I have seen a patient die of colon cancer as insurance company refused it-I was on a phone today for 1 hr.to get approval for kyphoplasty for vertebral fx.of a patient who was on plavix and needs it but could not get prior authorization still and have to wait for one more day and then scheduling it will take longer exposing this patient with high risk of thrombosis to embolic phenomenon.I am not sure the present system is patient friendly.
The current is good for greedy insurance company executives and the supporting politicians. They are creating unnecessary fear to common people-We need to understand that money spent is limited and to be used wisely-and it is good for govt. to compete with other insurance companies. I wonder if any senator is willing to wait one to two weeks to get pre-certification for a vertebral fracture and willing to get treated by some physician he does not know and has to go to a hospital of his insurance choice. Every time a patient's employer changes the insurance company, they have to find a new physician and it is difficult to go to a new physician for a chronic condition. Why are the insurance companies scared of Obama's proposals.How come they increase premiums, reduce benefits but not bonuses to executives-( I am not talking of salaries) My feeling is cutting patient's benefits are inversely proportional to their bonuses.
I am sorry this is long but as patient advocate I am fed up with insurance companies.
Dr. Gupta,
On a monthly basis I need Advair 500/50. Under present conditions I can not afford this medication nor do I have adequate insurance. I make too much money to receive any type of help from the govornment at any level and just don't know what to do except maybe stop breathing. What can I expect if health care reform passes and is there anything I can do in the meantime?
Thank you,
Judy in Florida
Will the new health care options cover birth control? Costs are out of control right now...my birth control costs over $70 a month now, and I simply can't afford it. I take birth control for other medical reasons, not for protection from pregnancy, but it's not even covered by a lot of insurance providers. I recently purchased some from Canada, because as an unemployed, uninsured American, I couldn't afford it. I got a three months' supply from a Canadian pharmacy for $84 because I was desperate.
When I was laid off from my job over a year ago, I was offered COBRA. The plan covered nothing, and the premium was $350. COBRA is a slap in the face of someone who's lost their job. I couldn't afford it, and have been uninsured for over a year. My previous insurance covered only a few dollars of my birth control.
The last administration cut funding to Planned Parenthood, which used to be a source of low-cost birth control options. I have many friends in their late teens and early 20s who are having babies because it's a cheaper alternative than birth control pills! (These kids should be using condoms, but the last administration also preached abstinence-only education, and they frankly don't understand the dangers of unprotected sex!!
Also...here's another thought I had yesterday. All these conservatives keep saying that you'll have a bureaucrat between you and your doctor. However, we have INSURANCE COMPANIES already between us and our doctor. I recently started working again, and now have insurance. I want to go to an eye doctor that I know and trust. They won't take insurance at all, because of the hassles. And my insurance company will only pay a tiny amount if anything. Therefore, my insurance company is standing between me and my doctor, and my only choice is to go to a "drive thru" eye doctor to the masses. I had a problem with pitting on my cornea, and I really need to see someone who is more specialized. But it's not covered under my medical insurance, and they're trying to force me to go to someone else. We already have no "choice," and haven't for years. We need real reform.
Do you see any attempt to stop the direct advertising from the pharmecutical companies to the consumer? We are constantly told to ask our doctor about a drug. Shouldn't we be informed of possible problems and related symptoms and then go to the doctor? Let him address the issues and then treat us? It would seem that the advertising costs associated with these ads drive up the cost of treatment. Will our health care system have to pay for these additional costs? Should it? The tail is wagging the dog.
What provisions are in the bill to re-evaluate outcomes when new research becomes available? Time, etc.
Thanks
Kathy
When will the medical legal climate be address in the health care reform? The high cost of health care is due in part to the uncontrolled law suits that occur. This has forced many doctors to practice defensive medicine so they can prove they did everything that was possible just in case they should get sued. The general public are unaware of the high cost of medical malpractice insurance and unaware that many doctors do not collect 100% of what they bill. Health insurance companies decide how much they will bill for a procedure. Patients do not always makeup the difference or pay their co-pays. The doctor absorbs the cost. When Medicare lowers the amount they pay, the private insurance companies generally follow. So, what will happen? When current physicians can not longer make a living, pay their employees and their bills, they will retire. Individuals considering becoming a physician will think twice and chose a different profession. Consider at family practice. Fewer and fewer medical students are considering this area because they can not earn enough to pay their bills. We already have a shortage of physicians and when this happens the entire health care system will collapse. A final note. I wonder if the average citizen knows how long it takes for someone to become a physician, a specialist and how much money it costs.
With respect to H.R. 3200 section1233, pg 424 & following. I understand that the government will make the ultimate decision after end life consultation. In your opinion is this true?
Dr. Gupta;
I am 39 years old and disabled, will this reform change things, like How many medications are paid for, I am a rare hemophiliac, as well as suffer from Celiac disease. I have a special diet I have to eat, Yet I get no help from anyone for paying for those foods. and I have to take over the counter Vitamins that no one seems to think i need covered as well.
I live in Arkansas, and Trust me what I get from SSD and SSi isn't enough to live on . as it is only 625 per month. I am church mouse poor! and in diar need of HELP!!!!!!!! now!. Please do answer these questions for me.
Thank You For Your Time
Ms. Lisa Osburn
One blog says that if you have conditions like Macular degeneration or need of a heart stint -diagnosed after 56, ins will not cover these conditions. Is that accurate?
Dr. Gupta;
I am 39 years old and disabled, will this reform change things, like How many medications are paid for, I am a rare hemophiliac, as well as suffer from Celiac disease. I have a special diet I have to eat, Yet I get no help from anyone for paying for those foods. and I have to take over the counter Vitamins that no one seems to think i need covered as well.
I live in Arkansas, and Trust me what I get from SSD and SSI isn’t enough to live on , as it is only 625 dollars per month. I am church mouse poor! and in dire need of HELP!!!!!!!! now!. Please do answer these questions for me.
Thank You For Your Time
Ms. Lisa Osburn
This morning (7-28), I saw the brief clip about what Medicare does and does not cover, and what the proposed health plan will or won't cover. I think it could be misleading to say that Medicare does not cover "virtual colonoscopy". I am sure that most viewers will confuse that procedure with the more traditional "invasive" colonoscopy, and wonder about a plan that won't pay for this diagnostic procedure. Frankly, I looked up the term, just to be sure I understood what your intended meaning was in the news clip. But I would guess that most of your viewers won't bother to make sure of your meaning, and may jump to a conclusion that Medicare doesn't cover basic and helpful medical procedures. R. Morris
My daughter was recently diagnosed with TMJ, which is excluded from my insurance coverage. If the pain and discomfort she experiences every day is real, how can an insurance company deny coverage of this medical condition? I am currently in the process of appealing the decision, which is also delaying any further treatment for my daughter. I understand that it is a common practice among insurance companies to specifically exclude TMJ disorders.
Today on CNN, you stated and displayed on the screen, that at this time, Medicare does not pay for PAP smears annually for a patient that has had a previous hysterectomy for a benign condition. Not true!! Please respond.
Thank you.
From SoCal:
For the past couple of years. my wife has been campaigning for single payer health care. Twice the California Legislature has passes it but Arnold has vetoed it. There is a bill in the congress for single payer health care, will you support it? From what I understand is that it would get rid of the insurance companies, and the state or feds would run the pool. More people in pool less costs, no high insurance co. profits. Many doctor groups and health care groups in ca. have supported this plan. It seens that every politico has his own plan. This plan has been debated and approved by California legis.
Your comments
The main concern of mine and other srs is the cost of drugs – my 4 scrips retail at $1100/mo. I pay $160 a month, drug plan pays balance of the retail until the total of copay and card coverage reaches $2750 – this covers just a couple of months; I get my scrips from Canada for less than $500 a month – a huge difference. Why has the governent succumbed to the Pharma lobbies and refused to allow negotiation of prices? This is criminal – a difference of $600. For srs on limited income, this involves serious choices. My doctor approves my source, The drug industry needs to be controlled.
Dear Dr.. Gupta,
The Medicare cuts will leave seniors with NO quality of life surgery, like knee and hip replacement. NO life saving surgery like, dialysis, chemotherapy, lung or brain surgery, etc. We all know that Medicare was going bankrupt, yet our government will find ways to cover the country, when 80% of Americans say they are happy with their health care, yet Seniors will "Have to learn to live with their pain." I don't know of anyone who wants health care reform. Pages 15-17 clearly states private health insurance will be phazed out. REPORT THE TRUTH FOR A CHANGE!
WHY IS IT THAT I RARELY...........IF EVER HEAR ANYONE USE
THE WORD....GLUTTON........., AND TO ME THAT IS ONE OF THE TRUE CAUSES IN OBESITY....
ANYONE HAS A BUILT IN DIET, AND THAT IS THE LENGTH OF THEIR ARM AND THEIR MOUTH.....
WE ARE IN THE AGE OF "FIX ME"...AND LOOK OUTSIDE OURSELVES RATHER THAN TAKE PERSONAL RESPONSIBILTY FOR ALL ASPECTS OF OUR LIVES.
I guess my comment...is all the people working for the goverment including the president going to have this coverage also? Or is it going to be like social security....it was good enough for the people but not the goverment...they had a different "program".
It looks like the health reform is going against the seniors of the nation.
Thank you
Mary Sullivan
Why do you keep focusing on how thew government will "come between you and your doctro"? This is done every day in every state. Below is a partial list of bills in the Virginia General Assembly last year that dealt with what would be covered by health insurance. The government is already neck deep in your health care.
HB 1977 Health insurance; mandated coverage for prosthetic devices and components.
HB 2024 Health insurance, basic; increasing availability thereof in State.
HB 2191 Health insurance; mandated coverage for telehealth services.
HB 2521 Health insurance; coverage for length of hospital inpatient stay for mother and newborn.
Dear Dr. Gupta,
I was diagnosed with a liver tumor January, 2009. I was "laid off" December, 2009 (18.4 yrs). My 6-months of paid COBRA coverage ends 8/31/09.
I am single and over 55 years old. The likelihood of finding "affordable" insurance at my age with this pre-existing condition is pretty slim. I am living on a small severance and unemployment checks at present while job hunting. Questions:
1) Can I extend my COBRA coverage to ensure I have something to cover the tumor, should it become malignant?
2) If so, who should I contact to arrange extended coverage at the discounted rate (I believe the government's discount is 65%)
3) Is there any insurance company that would insure me for a reasonable monthly cost as a single individual with a pre-existing?
4) If I start a small business, can you explain (again) how to form a "corporation or company of one" (for insurance coverage reasons).
My tumor is in a bad spot and surgery is risky. The surgeon has advised it not be removed unless it becomes malignant. How should I handle this ticking time bomb?
Thank you for your help.
Kat – Chicago, IL
katmeloney@gmail.com
312-339-0776
Website: http://www.laidoffandlivid.com
I can respect what's going on in the "fray" of the health care debate but its essential that the public has to understand that what we're getting from the news and most reporters are opinions. Some to tarnish the Republicans, some against the Democrats and especially the President, but I'm tired of the M/M of Federal Health Care, I can remember my parents saying that a surge of people in this country were applying for Medicare (M) and Medicaid(M), while they had to sit through insurance denials of care which resulted , of course in the death of my father because the lack of treament caused his cancer to spread, creating the single parent household that ships most Americans today to living inthe tumultous waters of POVERTY. What my questions is "For over fifty years our health care system has been crippling American household and killing the American "dream" of many immigrants, whats so wrong with the changes being sought by President Obama???" I'm a professional in industry yet, a dental visit can cost me a co-pay of over $300.00 for a single visit and thankfully my medical co-pays are less stringent, and I'm considered in great health. I wait expectantly for a balancing of care in this country. What I'd like from Dr. Gupta is an explanation of what I hesrd on CNN this morning; something referencing that a committee will be formed to alert the President when a patient has a doctor refer procedures that may be costly, does this committee plan to do this for each and every case, this sounds preposterous, PLEASE clarify!!!!
One point nearly everyone in the media seems to fail to address:
The INSURANCE COMPANIES are in control NOW of our health care NOT US OR OUR DOCTORS, and these insurance companies are there to MAKE A PROFIT!!! True health care reform would take the profit makers out of the middle of the system, and save millions of dollars for Americans. We could pay higher taxes if both citizens & employers did not have to pay exorbitant insurance premiums, co-pays & deductibles.
Please address these issues in your discussions to truly inform the public.
Thanks!
When you comment on Pap smear coverage in the course of a story in which you discuss ongoing studies re appropriate screening intervals, you should note that with Pap smears there is definitely agreement that in women over 65 with no history of nl Paps at least q3 yrs is safe, with the possibility that no further Paps need be done. This does not mean that pelvic exams do not need to be done yearly; that is part of an annual physical.
For years there have been stories about health insurance companies getting between the doctor and the patient. Now that we're struggling nationally with ways to insurance the American people, the argument has shifted to cries of government interference between doctors and patients. Why isn't anyone talking about the two side by side? Is it okay for insurance companies to tell doctors what they will and will not pay for, but it's not okay for the government?
Dear Dr. Gupta:
Did I hear you correctly that 'Medicare does not cover colonoscopy'? I have Medicare and use Kaiser Permanente provider. I just had sigmoidoscopy 5 days ago. It was covered by Medicare and I only paid five dollar co-payment ($5.00). My wife is going to have colonoscopy soon and I assume it will be also covered. Please clarify.
Thanks
Ky Nguyen, California
Did you say that there isnt enough research on healthcare prevention and what the outcomes would be?? Please clarify yourself
Quote, American College of Sports Medicine "Physical activity and exercise clearly prevent the occurances of cardiac events; reduce the incidence of stroke, hypertension, type 2 diadetes mellitus, colon and breast cancers, osteoporotic fractures, gallbladder disease, obesity, and delay mortality"
SECOND, FYI, the top three causes of death in the U.S. are heart disease 28%, cancer 22.7% and stroke 6.5%, 61% of total deaths are related to diet and 68% are related to lifestyle and not to mention we are the most obese country in the world. Dont mention anything about prevention, that dosent work, haha. Look up US Health and Human Services, USDA, National Institute of Science, AHA, ACSM, take your pick, there are thousands and thousands of pages of research on prevention.
is the health care system in the ststes going to be like the canada health care system. I'm from canada and like our health care system.
Hello Dr. Gupta,
I would like to know if this can be true. See below. Thanks.
This man was warded in the hospital and was constantly warned by the nurses not to leave food stuff by his bedside because there were ants about. He did not heed their advice. Ants finally got to him. His family members said that the man constantly complained about headaches. He died and a postmortem or autopsy was done on him. Doctors found a group of live ants in his head. Apparently, the ants had been eating bits of his brain.
Dear Dr Gupta,
It seems that the health care crisis is being portrayed as an either/or situation. Either private or public, free enterprise or government run. The CNN story comparing private insurance coverages to Medicare used cholesterol testing as an example for comparison, scaring people by saying that Medicare only covers cholesterol screening every 5 years. Truth is, I can get my cholesterol checked through my local health department, which offers screening twice a week at locations around our county. Other low cost preventative testing such as mammograms are also available periodically. Seems to me we can take a sort of combination approach and get the job done. Thanks for all you do, Terri
The American Medical Association (AMA) knows firsthand the devastating effects of our broken health care system. As the nation's largest physician organization, we feel it is imperative to take this opportunity to formally reiterate to you our commitment to meaningful health system reform. Progress has been made and common ground exists, but there are still difficult issues that must be resolved. We believe it is time for results, not rhetoric. America's patients and physicians deserve better. More information can be found at our health system reform resources community at http://www.ama-assn.org/go/reform.
I am the Practice Administrator of a primary care practice consisting of eight physicians with 30,000 patients. Our senior physician has written a letter to Senator Kay Hagan addressing healthcare reform from the perspective of physicians "in the trenches". I would like to share this letter with you if I could be provided an email address.
No hospital should be put in a position to decide policy with regards to medical care for illegal immigrants and bear the burden of the expense.
What if, as a matter of law, visitors to this country, along with their passports, visas, and green cards, are required to show proof of medical insurance when entering the country. Employers who hire foreign nationals must provide health insurance for foreign nationals and be able to show proof of such coverage. If a foreign national shows up in a hospital for medical treatment without proof of insurance, emergency treatment should be given and then, it should be the hospital's right to have the patient reported and subsequently returned to their country of origin.
We're having enough trouble providing care to our own citizens.
I don't know how you can go on CNN and tell people that Medicare does not pay for Colonoscopy screening. I have had one that Medicare paid for and my friend just had one because he changed doctors, and his private health plan paid for it. Please research your statements before you make them. That one is untrue and misleading.
It is very easy to place all the blame (or a large majority of the blame) on physicians. Many so-called experts have come out of the wood-works to weight in on health care without any formal training or prolonged exposure to the field. While they are all entitled to their opinions and to share their opinions, it is very dangerous to accept their opinions as fact. This problem goes all the way to the top – right up to President Obama.
He places blame on everyone but patients because placing any blame/need for responsibility on patients would be a political disaster for him. In particular, he seems very ready to scape goat physicians. I am very frightened by numerous examples of his obvious lack of knowledge of how medicine works. At the last "town hall meeting" he said that reimbursement is done in such a way that if you bring your child to the doctor for a sore throat, rather than going ahead with conservative medical treatment or dealing with possible allergies, the physician (who in this case would be a pediatrician) would elect to take the child's tonsils because he/she is paid more for procedures. I ask you – when was the last time you heard of a pediatrician doing a tonsillectomy? Pediatricians are not surgeons and therefore they do not do surgeries. In fact, a referral to the ENT to have such a procedure done would not benefit the pediatrician financially whatsoever and would only be done in the patient's interest. This goes to show yet another example of the fact that Obama really has no idea how medicine works, yet he feels he knows enough to dictate how medical practice should work.
He cherry picks his data and says that we spend more, but have no better medical outcomes. I would ask Mr. Obama to look at some confounders that may contribute to some of his claims. For example, obesity is a major problem that our nation faces. While many people believe that hypothyroidism is the cause of their weight problem (a “gland problem”), many studies suggests that this is not the case. Even if this was the case, one could have a simple blood test done and if they were found to be hypothyroid, they could take thyroid replacement therapy (levothyroxine) with the direction and guidance of their physician. The real problem with obesity in our nation probably has more to do with our lifestyle than hormonal imbalances. In fact, within the hospital that I train at, the one restaurant present (not including our cafeteria) is McDonalds. If one made the claim that they intend to eat at McDonalds and be healthy, they will be surprised to see how much more they will have to pay in order to eat healthy. The financial incentive at McDonalds and many other restaurants is to eat high fat, high sugar, high salt, high cholesterol meals, perhaps because it may be more expensive for McDonalds to maintain supplies of vegetables and fruits than frozen meat, french fries, etc. Now, let us look from a scientific perspective just why obesity is a problem:
1. Among the leading killers of adults in the US include heart disease, stroke, colon cancer and breast cancer.
a. Atherosclerosis: the deposition of fatty plaques into blood vessels. This deposition takes place in places like the abdominal aorta (which can lead to an abdominal aortic aneurysm that can rupture and rapidly lead to death), the coronary arteries which supply oxygen and nutrients to the heart (which can lead to a heart attack and/or heart failure), the carotid arteries (which can lead to a stroke), the mesenteric arteries (which can lead your intestines dying), medium and smaller sized vessels which supply other organs and your limbs (which can lead to peripheral vascular disease, a disease state where not enough oxygen and nutrients are delivered to areas such as the legs and feet that can ultimately result in ulcers, infections and the need for amputation). Among other causes, atherosclerosis is accelerated by high low-density lipoprotein, LDL, levels (the “bad” cholesterol), low high density lipoprotein, HDL levels (the “good” cholesterol because it can help remove some of the fatty plaques in the arterial walls), smoking and diabetes.
b. Colon Cancer: this is the third most common cancer in males and females separately, but is the second most common cancer killer when both genders are combined. The risk of colon cancer is increased by low fiber, high fat and cholesterol diets.
c. Breast Cancer: this is the second most common cancer among women and the second most common cancer killer among women. In a women who no longer has periods (post- menopausal), the amount of estrogen she has present in her body decreases. This is good because estrogen stimulates many tissues to multiply. Many studies have shown that increased exposure time to estrogen increases the risk of breast and gynecological cancers. For example, late menopause and early menarche (starting of having periods in adolescence) are risk factors for the development of cancer later in life due to the prolonged estrogen exposure. This includes breast tissue and other gynecological tissue. Fat has an enzyme present known as aromatase. This is the same enzyme present in the ovary that converts compounds into estrogen in the pre-menopausal woman. Therefore, the more obese a woman is, the more estrogen she makes and the more she exposes her estrogen responsive breast tissue. Therefore, obesity is considered a risk factor for the development of breast cancer.
These are just samples of the health impact of obesity. They can lead to deadly disease and also can lead to disability. For example, obesity contributes to osteoarthritis. Additionally, obesity causes insulin resistance and can result in the development of Diabetes Mellitus type 2. The result of diabetes is widespread. It is a leading cause of blindness in the United States. Additionally, it is a leading cause of kidney failure necessitating long term dialysis (which is a tiring and terrible experience for the patient), a kidney transplant (which requires long term immune system suppression therapy that predisposes to life-threatening infections and cancer) or death. Additionally, diabetes will accelerate atherosclerosis leading to an increased risk of heart attacks and strokes. Another common problem with diabetes is a lack of sensation at the feet and poor function of the immune system. The combination of the two previously mentioned results in diabetics being unaware that they have injured their foot and an immune system that cannot fight the infection that sets in. This results in the need for amputation of the toe foot or leg if the infection cannot be controlled by antibiotics. The main point about obesity is that it is an epidemic in the U.S. and leads to significant health problems which plague the lives of our patients and run up massive costs in terms of health care dollars. The initiative should not to ostracize obese patients, but rather to find a more effective way to reduce this problem.
1. I have personally seen many patients with chronic, treatable disease such as diabetes, high cholesterol, high blood pressure, etc who will not make life style modifications (exercise, better diet) and are not compliant with (or outright refuse to take) medication. These same patients come back time and time again with diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic non-ketotic syndrome, congestive heart failure, heart attacks or strokes. Many of these patients are on Medicare or Medicaid and so tax payers pay for their hospitalizations. These hospitalizations are largely reducible or even preventable with adherence to lifestyle modifications and medical therapy. In particular, during one month, I saw the same patient come in 2-3 times for DKA because he/she “could not figure out how to work his/her insulin.” Each time he/she came in, he/she spent at least one day in the intensive care unit which costs a considerable amount of money. Before he/she left, he/she had a meeting with a diabetic educator to teach about diet, monitoring blood sugar and using his/her insulin.
2. I have seen patients who cannot fit into the MRI scanner (diameter too large) or they exceeded the weight limit. As I previously mentioned, this is not a laughing matter. This is a major health concern for the patients.
3. I have seen uninsured, unemployed patients in the labor and delivery units having their 4th or 5th child. While we do not place limits on how many children a person can have (and should not), people need to take responsibility for their health and the health of their family.
4. I have seen drug users come in for overdoses or drug related problems and get caught using drugs in the hospital. Often, they use the same IV lines the doctors are using to give medicine to give themselves drugs.
5. I have seen alcoholics come in multiple times for their treatment only to return time and time again for more drinking related problems.
6. Smoking. This is the leading cause of lung cancer which is the most common cancer in the U.S. and is the biggest cancer killer for both men and women. Additionally, smoking accelerates atherosclerosis and is a risk factor for many other forms of cancer. Also, it is a major risk factor for COPD, another major killer in the U.S. However, I have seen many patients, both young and old, who refuse to stop smoking – or even consider stopping of smoking. Some even stand outside, plugged into their IVs smoking right outside of the hospital.
7. End of life care – this is the big topic that Obama dances around but never answers. Massive spending occurs for this part of one’s life. Many patients want everything possible to be done when it is them or their loved ones (which is understandable). In a setting where cost cutting taking place like being described, one place that will be certainly cut will be this area. If your outcome will be no better, you will not have the option to undergo such treatment. An example close to the heart of Dr. Gupta would be patients who suffer from glioblastoma multiforme. From what I have learned, the outcome is almost universally dismal and the radiation therapy, chemotherapy and surgery offer very minimal in terms of prognosis. However, they offer the patient and their family hope. Should we take that away hope and maybe a few more months of life from patients and their family to cut costs?
What all this means is one of the ways we can reduce costs is by providing financial incentive to patients being compliant with medical recommendations and strategies. For example, the patient with diabetes who takes their medications and make lifestyle changes that brings their hemoglobin A1c down into the range shown to reduce morbidity and mortality should get more health care coverage than another diabetic who decided to not be compliant and would rather just wait for emergency care when the disease has progressed. Additionally, the patient who refused to even attempt to quit smoking probably should not be entitled to the workup, diagnostic imaging, surgery, chemotherapy and hospice for their lung cancer. If a smoker makes continuous and honest attempts to reduce smoking or stop smoking all together, they should receive financial incentive in the form of better health care coverage. This strategy can be employed for many other disease processes and translates to a financially sustainable health care system and an overall healthier population.
This is not to say that some basic coverage should not be extended to everyone. Personally, I believe that non-self induced catastrophic medical treatment should be priority number 1 for the government. For example, a child with leukemia should be entitled to health care dollars before the 40 year smoker with lung cancer.
Electronic medical record keeping: It would save money for sure, but by cutting the jobs of administrative people in the medical community. For example, the people who used to type up physician dictations are being largely replaced by software that types the records as the physician dictates. This is what the electronic medical record push will result in – a reduction of overall costs to the consumer by cutting the salaries of people who used to work as administrators in medicine. However, duplication and waste could still exist if there is not a single computer program for all providers to use. The patient would have to have a copy of their complete medical records (including test results, imaging and doctor notes) on a portable mass storage device (that could be backed up on a central server in the event of a lost mass storage device) which could be plugged in and updated at each provider encounter. This would be ultimate efficiency, but security and privacy would become the new issue.
Lastly, to cut costs by paying physicians less, taxes need to pay for the medical student education. It is unrealistic to think that people would train for minimally 11 years after high school (to become a primary care physician) or an additional 5-7 years to be a specialist to work to pay off the massive education debt. To provide an idea, the cost of undergrad and medical school could be 20-40,000 USD/year. Assuming a 30,000 USD tuition cost, that is 240,000 USD for education not including living expenses or interest for the resident that, like his/her patients, wants to have a support their family. Also, to keep the good access to care, it would be wise to change medical care in all fields to shift work. This would dispel the use of the call system and could reduce hours to a more reasonable load which could reduce costs in paying physicians.
In summary, the best way to cut costs:
1. Have a system that financially rewards (though increased healthcare coverage) compliant patients and penalizes non-compliant patients.
2. Offer universal catastrophic healthcare coverage for non-self imposed medical castastophies.
3. EMR with a central database and a mass storage device the patient carries from provider to provider to reduce duplication of care
4. Raise taxes to pay for medical education
5. Change medical care schedules to shift work for all fields
6. Cap malpractice suits and strong tort reform which penalize patients and attorneys for frivolous cases
7. Strong campaigns in school (must start early) about the importance of maintaining a healthy lifestyle. This includes ensuring that all students are provided with a mandatory exercise time each day in school (PE has been cut in many schools).
8. Pay for drug research and development with taxes so that generic drugs can be made for the patients. This way, drugs can be made and released to the public not for profit which allows for cheap, newer and better medicine for all patients
9. Mandate that everyone contributes to the healthcare system
My first choice is to have a health care system on a par with France or Canada; however, that is not going to happen. So, my second choice is to have a public option like Medicare for all but with dental, mental and vision included. Those are my wishes, but questions I've not heard addressed: 1. All the politicians speak of "no pre-existing condition exclusions. To my knowledge, that is already an option available, you just have to pay exorbitant fees for it. Has anyone addressed the issue of preventing all insurers from simply increasing their premiums to cover the costs of insuring pre-existing conditions? 2. It is a slippery slope to have one's employer involved in one's health care. HIPPA regulations are a nice thought, but then there is reality. Especially if there is this crossover of information from "wellness" programs with employer sponsored perks for participation in the "wellness" program as well as the pre-existing condition issue. What is to prevent employers from using those issues against existing or potential employees? By the by, I have great respect for your reporting – sensitive and informative. Thank you.
Are you familiar with the study by The Commonwealth Fund, that concludes health care reform with a public plan will NOT increase the budget and in fact yield a savings?
See: http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Jun/Fork-in-the-Road.aspx.
I just watched Dr. Gupta's report on differences between Medicare and private insurance benefits. I was very disappointed to see his failure to point out that the more limited Medicare benefits are consistent with evidence based guidelines. The United States Preventive Task Force recommends PAP smears every 1-3 years at the discretion of patient and physician and may stop screening at age 70. Evidence shows more frequent screening (yearly) in patients with regular normal PAP smears is of very unlikely benefit (about 1 in 250,000 PAP smears). Lipid screening in healthy patients is recommended every 5 years, not yearly. The Medicare guidelines do not appy to patients with abnormal conditions, only healthy patients. Patients need more information about the very questionable benefits of excessive screening and testing and not be scared that reform will prevent them from getting needed health care. Dr.Gupta shold have been much clearer about the rationale for the Medicare guidelines.
I've been a medical writer for over 20 years for the pharmaceutical industry. Perhaps people's questions about whether the new national health insurance plan would pay for off-label medications could be divided into 2 issues:
1. If a drug already on the market is prescribed for a patient who doesn't have the indication (what FDA allows pharm company to say the medication can do), but the doctor thinks it will help, would the national health insurance still pay for that drug. My own experience with migraines many years ago comes to mind. The neurologist prescribed Inderal, a drug for lowering blood pressure, to help prevent my headaches. I didn't have high blood pressure, but the drug's normaql activities helped prevent migraine headaches.
2. A second issue is whether the national health insurance program would pay for costs associated with clinical studies. Of course, the pharmaceutical company doing the research provides medicine at no cost, but there are blood tests, x-rays, perhaps MRIs and EKGs to pay for. Will national health insurance cover the costs of the costs related to new drug research?
I wonder if some of the resistence to nationl health care is actually from the fact that people already have to get authorization numbers, approval for certain prescriptions, call multiple times to make sure that they received the statement from the doctor and that the check is in the mail ... I have to do that all the time, and as a result, I now am not offered the best effective treatment for my painful physical condition.
The approved use for MyoBloc injections is cervical dysplasia–I have that. The insurance company requires that I get an authorization number for the treatment. I have to have these injections done at an ambulatory surgery center because I have a lot of hardware in my neck (from disc fusions) and the doctor requires fluoroscopy to perform these injections safely. That requires another approval number and a double-check that the ambulatory surgery center is "an approved facility."
Last year, the incompetent bookkeeper at the ambulatory surgery center was fired and the books redone. Whoops! All of the sudden, I was being harassed and inundated with mail demanding payment for almost $10,000. Even though I had made the calls, double-checked the approval numbers and made certain each time that the surgery center was an approved provider.
Now I'm the patient whose insurance doesn't pay its bills, and as a result, I am stumbling along with severe shoulder spasms and terrible tension headaches. I have to take benzodiazepines and narcotic pain medications, which take the edge off, but do not actually correct the cause of the spasms, which the MyoBloc injections did.
My husband and I are too terrified to report this insurance company to the state insurance regulatory agency because he might be fired.
I know MyoBloc injections are expensive, but what is in my best interest: to receive expensive but effective treatment that I only need every 3 months and function as a loving mom and wife, or to be forced to take narcotic and benzodiazepines, both of which are very addictive and just take the edge off because they do nothing to correct the problem.
P.S. I am very interested in finding out how national health insurance would support clinical research, which is vital to the development of scientific knowledge in our country. American medical schools and medical care in the United States are still the first options that s many students and people seek first.
To the medical student who just graduated with 280,000 dollars debt:
Too bad for you! Don't worry, you and your other greedy, procedure oriented, I dont care about the patient colleagues will pay that debt off during your residency and be driving a different Hummer each day of the week (when you are not sleeping on the golf course in the meantime).
OK, but really, I am a medical student as well and am very frustrated that people do not get this. There are many ignorant people out there who think that the above is true. Newflash to the people – in order to be a doctor:
1. 4 years undergrad, pricetag minimally 80,000 if not paid by family
2. 4 years medical school, pricetag minimally another 80,000 if not paid by family
3. In reality, most medical schools charge 30+ thousand annually for tuition alone
4. We work way more than any other profession; we take call overnight multiple times a week
5. We get paid 11 dollars an hour during residency while interest compounds on our loans
6. Medical school tuition is only increasing
7. The students in medical school had to be at the top of their class to get into medical school and must work harder than any other higher education student (law, business, english, etc)
8. Malpractice premiums can be tens of thousands of dollars annually for some specialties
9. If you change jobs, you have to purchase "tail coverage" which means you pay malpractice insurance for your old job (for a certain time in case someone from the previous job wants to sue you) and your current malpractice insurance
So lets use Obama's famous phase:
"Lets be clear..." It is incredibly difficult and time consuming and requires great sacrifice both personally and for your family to become and practice as a physician. It is not cheap to run a practice and with the politicians (who are mostly lawyers) looking out for their own self interest by refusing to seriously tackle tort reform, costs will keep rising. In other countries, medical education is paid for by taxes. Maybe we should increase taxes for all Americans so that we can pay for the education debt and then decrease the physician salaries?
Dr. sanjay gupta could you please tell me if breast cancer runs in your family can you eat and drink soy products. my sister was 80 years old when they found the lump.
Dr. Gupta, You should breakdown the proposed Obama health Care reform and present it as a CNN special to your viewers. (Similar to what Alley Velshi et al did for the economic melt down). We hear so many stories from the left and right that, we all are confused.
This question is in regards to the issue recently come to light in the wake of the arrest of New Jersey Government officials and religious members. It was reported that roughly 80,000 people in the U.S. are awaiting a KIDNEY FOR TRANSPLANT. Why such a large number, and how does that number compare to other developed and/or developing countries ??
Dr. Gupta,
I thought you mgiht be interested in seeing what General Electric has just announced to their employees regarding major changes to their health care benefits beginning January 2010. It appears that GE believes that health care reform is going to happen!
From: ~Corp US Employee Services
Sent: Tuesday, July 28, 2009 6:20 AM
To: Dudoff (GE, Research)
Subject: Important information about your health care benefits
Dear Colleagues:
In recent years the health care system has changed dramatically, health care costs have risen rapidly and we've entered a difficult economic environment.
As a result, in the fall we will introduce a new health care benefit plan for all US salaried employees that will replace GE Medical Benefits and GE Health Care Preferred beginning in January 2010.
This new plan will continue to provide you and your families with excellent medical care and coverage.
We know that keeping our employees healthy and detecting disease early is the best way to keep health care costs low. Because of this, the plan will offer expanded coverage of preventive care doctor's visits and screenings for you and your family at no cost. We will also provide you with state-of-the art tools and education to help you identify and address health risks, as well as new technology to help you manage your health expenditures.
Other new features of the plan include incentives and coaching to encourage you to adopt healthier behaviors. The plan will also offer increased benefits coverage for autism and infertility.
Under the new plan, how you pay for health care will be different. You will be offered three options, allowing you to select how much you pay out of your paycheck versus how much you will pay in a deductible when you seek care. (This is much like how car insurance works. You can pay less up front but have a higher deductible, or pay more up front to have a lower deductible).
Depending on the option you choose and the amount of medical care you need, some employees will pay more overall for their health care than they pay today and some will pay less. As with our plans today, in the case of a serious illness, GE will protect you financially from high medical bills.
More importantly, you and your family will need to take a greater role in managing your health and your health care spending. We will provide you with education, tools and transparency around cost and quality to help you become a more "active consumer" of health care services.
Many other companies have successfully implemented this type of plan and have had positive results in both employee health and health costs.
This will be a major change in how your health care benefits are provided. More information will be provided during September and October, and you will be able to make benefit selections during annual enrollment in November.
Please watch for and take advantage of the training and educational opportunities about this new plan that will be offered in the fall.
Thank you,
Robert S. Galvin, M.D.
Director- Corporate Health Care and Medical Programs
A copy of this information is included in the Focus newsletter which you should receive at home in the next few weeks.
I am soon to be 63 female. I have had fibromyalgia for over 15 years. Doctors gave me a antidepressant. When I took it, it made me useless, forgetful and still had pain. I asked for something else. Then my doctor of 30 years gave me xanax .25 mg 3x a day as needed. Then the insurance made me take generic brand. I kept a journal and everytime I had generic. Everytime I had generic. I had pain. I showed my doctor my journal and he made a copy and sent to insurance and now I can have brand name. But last 2 years I have been laid off and thru aarp I can get my medicince, (generic) $40.00 dollars. Brand name cost $200.00. I am in such pain. My arm is in a sling. my legs hurt and I can not even do yoga, which I have done for the last 10 years. I can not pick up my grandchildren or really do anything. They say their is no difference, BUT THEIR IS. So the pharmacy is making me sick because of cost. I really miss yoga. I did just finished going to school , thru unemployment for medical billing and coding, (I passed,) but now I can not really work. Please bring down the cost for brand name. Their is a difference. I even have permission from my doctor to wear Berkinstock shoes. (My sister brought them for me). They help my back. I was doing preventive care, but cost has put me down. Thanks for listening
It appears a lot of individuals do not understand insurance nor the current rush to a new government run health plan. Insurance should pay for the items you have paid to cover not everything you wish. If you don’t understand this basic concept you will never understand this government run health care plan. Ask your Rep. or Sen if they will be covered under this government run program and if they will give up their current plan? As sure as the sun will come up tomorrow NONE will give up their plan and take this new one.
As a new anesthesiology attending I find many parts of the president's plan disturbing. Of utmost importance is that he plans to extend Medicaid payments under the public option. Medicaid reimburses anesthesia only 33% from what private insurance does, whereas every other practice gets roughly 78% reimbursement. This has long been a problem, ignored by the AMA, but his plan not only will make it worse, it will cripple the field of anesthesia. The reimbursement simply won't pay for the cost of providing anesthesia. Also, anesthesia providers cannot "opt-out" as they are required by contract to provide care to the patient presented to them who requires anesthesia. To this end, the ASA has sent a strong letter to the AMA explaining that the ASA does not support the president's bill in its current form and that the AMA's continued neglect of the poor reimbursement for anesthesia services has strained the two organizations relationship more than ever.
Of course the effects will be obvious, the shortage of anesthesia providers will only grow, and on a practical level, with the massive cuts in reimbursement and salary, there will be no monetary incentive to be productive. I will always provide excellent care for my patients, but the days of fast-turnover OR's and scheduling cases into the night will quickly come to an end, as physician salaries become static, not based on workload, no one will opt to continue to work 60-80 hr weeks when they get paid the same as working a 40 hr week.
Will you please comment on how this plan will might cripple anesthesia, a service that no one elects to have, one they need, one that is as vital to operating rooms as any other. If nothing else, please let people know that this current plan would simply make providing anesthesia an economic impossiblity, create a dire shortage of providers, and let them know the ASA does not support the AMA on this issue! The ASA is not against health care reform, its likes many parts of the president's plan, it is against one that expands the pathetic 33% reimbursement for anesthesia services!
7.28.09
This morning you compared a couple of health coverages or lack of between a possible National Healthare Plan and Medicare. You indicated that a lipid test under Medicare is covered only every five years...that is incorrect. You also said that Medicare does not cover colonoscopy's. Again that is incorrect. I've had both recently and Medicare paid their normal 80% and I had to pay the balance along with co-pays.
I work in the healthcare industry and went without insurance for 9 years. I would venture to say that most people opposed to healthcare reform have never had to choose literally between groceries and taking a sick child to the doctor. Medicare and state Medicaid programs are government run programs. People who utilize these programs aren't complaining. Medicare sets the standard for commercial insurances. There are government agencies deciding ICD-9 coes, CPT codes, rates, HIPPA just to name a few. Any medical facility receiving government grants and funding of any kind are subject to government regulations. The government is already running healthcare. The bottom line is that it should available to everyone. Our tax dollars goes towards all that regulating whether we have insurance or not. At least I would get something out of the deal if I am allowed a universal plan. Other countries have made healthcare a priority. We make wars a priority and suddenly the funding is there. If healthcare is made a priority then the funding will be there too. It really is that simple.