 |
|
|
|
|
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.
 |
|
|
|
My first daughter was born on June 6, 2002 in Manhattan after a perfect pregnancy. However, day two of life she had 98% of her intestines surgically removed. The drs. told us she only had months to live – that the medications feeding her would result in end stage liver disease and death.
Some Dr’s suggested that we remove the lines that fed her and let her die of starvation – a fate far better than end stage liver disease – it was our choice to make.
Instead, my husband researched online and found that there were a few hospitals doing a new intestinal transplant. Knowing it offered hope for our daughter we chose this path and placed her on the organ waiting list in NY.
By the time she was 13 months old, we had been forced to move to Pittsburgh to receive care and as predicted, Acacia was dying of end stage liver disease and on life support.
At the time I was 8 months pregnant with my son, living out of state and helplessly watching my baby deteriorate – unfortunately these types of situations are not uncommon for families waiting for organs.
Then in September of 2003 after being given less than a week to live she received her transplant – a new liver, small bowel and pancreas – her second chance.
This gift was from total strangers – a family suffering from the loss of their own infant. Yet, in the midst of their grief they chose to donate organs.
My daughter calls those organs her “angel parts.”
Today she is in first grade in Chappaqua NY. She skis, surfs, plays T-ball and soccer. If you met her, you would never know what she had endured in those early years.
That donor family transformed my daughter’s life – my life.
Organ donation works – transplantation works – for solid proof you only need to look at my daughter Acacia
Everything was covered – which included the out of state birth of my son, almost a year and a half of ICU hospital stays and countless procedures in different hospitals and the mulitvisceral transplant – Would we have received the same level of care under the Obama plan?
Thank you.
Seems like those who are MOST interested in better health care and health insurance are either sick, destitute, or both, and aren’t as able to spend time and energy speaking out in favor of reform as the well-off are at speaking against it. The problem with health insurance is that by the time you find out you have a bad plan, you are already sick, you’re already getting billed a ton, and you can’t go and get a better plan because who will cover you now? Can’t we just try a different system for 10-20 years? If people really feel like there freedoms are reduced in the new system, they can vote an end to it.
Did you read proposed House Healtcare bill? Integrity is sacrosanct.
(1) Illegal Aliens Eligible for Public Plan. Section 246 applies only to “affordability credit” access, but does not
apply to anyone attempting to enroll in the public health insurance plan created by Section 221. Affordability
credits can be used to offset the cost of health care coverage for individuals who enroll in private insurance plans,
but there is currently no provision barring illegal aliens from enrolling in the taxpayer-funded public plan. An
amendment offered by Rep. Dean Heller (R-NV) at the Ways & Means Committee markup would have required
that enrollees in the public plan, or those seeking affordability credits, must verify eligibility with the Income
Eligibility Verification System (IEVS) and the Systematic Alien Verification for Entitlements (SAVE) system.
That amendment was rejected by the committee on a party-line vote. As currently written, the bill would allow
illegal aliens to freely enroll in the public plan.
(2) Section 246 Lacks Verification Requirements. Over the years, Congress has required various methods to
ensure that only eligible individuals receive federal public benefits. The most effective of these methods involves
the requirement that an agency or employer confirm eligibility with a verification database. Examples of effective
databases to verify eligibility include the SAVE system, which confirms an individual is a citizen or qualified
alien (as defined by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, more
commonly known as the “Welfare Reform Act of 1996”)2 and is therefore eligible for certain benefits; the IEVS,
which confirms income eligibility for purposes of certain means-tested benefits like Temporary Assistance to
Needy Families (TANF); or the E-Verify system, which confirms an individual is work-authorized in the United
States. A lesser method to screen for benefit eligibility would be to require applicants to self-attest eligibility,
subject to penalties of perjury, on a benefit enrollment form. This method is unreliable because it depends solely
on the honesty of applicants and also fails to actually determine an applicant’s eligibility. The health care reform
bill does not require the use of any verification database to determine eligibility for affordability credits.
Likewise, this bill does not require any screening or self-attestation by applicants to determine eligibility for
affordability credits. Instead, Section 246 bars illegal aliens from receiving affordability credits but contains no
enforcement method to ensure compliance so as to preclude ineligible individuals from receiving that benefit.
Where enforcement is lacking, we can expect compliance to be similarly lacking. Accordingly, Section 246 will
do nothing to actually preclude benefits from being improperly provided to illegal aliens.
(3) Government Studies Confirm: Bar on Benefits without Verification is Ineffective. Government research
confirms that a statute that limits the availability of government benefits is meaningless unless it is also coupled
with a vigorous method of ensuring eligibility in order to eliminate fraud and abuse. For example, the
Government Accountability Office (GAO) and other independent research have concluded that illegal aliens have
been a significant factor in the rise of Earned Income Tax Credit (EITC) disbursements despite the fact that illegal aliens are technically ineligible for the tax benefits.3 Likewise, the Congressional Research Service (CRS)
reported in May 2008 that illegal aliens receive significant federal benefits, notwithstanding numerous federal
laws designed to prevent this form of fraud.4 CRS cited studies from the U.S. Departments of Agriculture, Labor,
Health and Human Services, and a private organization to support the contention that a statutory bar alone will not
prevent illegal aliens from accessing government benefits.5 Accordingly, it is highly unlikely that Section 246
will operate to effectively prevent illegal aliens from receiving affordability credits provided for in the bill.
(4) Does Loophole Extend Health Coverage to Illegal Aliens Via Dependents? Section 246 may also be
rendered ineffective by virtue of Section 242(a)(2). 242(a)(2) states “members of the same family… shall be
treated as a single affordable credit individual eligible.”6 This raises the question of whether a family of illegal
aliens can qualify for the affordability credit because they have a single family member who is eligible. For
example, could an illegal alien woman receive the credit for herself simply by giving birth to a child in the United
States? If so, this exception would negate the general rule barring illegal aliens from receiving the credit and
would impose a significant cost burden on the American taxpayers.
(5) Recent Congressional Enactment to Limit Benefits for Illegal Aliens. In recent years, Congress has
enacted various provisions to effectively preclude illegal aliens from receiving taxpayer-funded benefits. For
example, the Welfare Reform Act of 1996 contained a number of reforms to ensure that only “qualified aliens”
(which excludes illegal aliens) would be eligible to receive “federal public benefits.” More recently, as part of the
Economic Stimulus Act of 2008, Congress precluded the issuance of stimulus rebate checks to illegal aliens by
limiting rebates only to persons with valid Social Security numbers (SSNs) while prohibiting checks for
individuals using individual tax identification numbers (ITINs) which can be used by illegal aliens.7 This
provision was effective in preventing the issuance of stimulus checks to illegal aliens. Likewise, the American
Recovery and Reinvestment Act of 2009 included language to preclude illegal aliens from receiving the bill’s
“Making Work Pay” tax credit.8
Conclusion. The health care reform bill lacks adequate safeguards to ensure that illegal aliens will not qualify for
the taxpayer-subsidized public health plan or affordability credits. The best way to protect the American taxpayers
is to require that each individual who enrolls in the public plan or who applies for an affordability credit to first
verify their eligibility using the IEVS and SAVE databases. Government studies confirm that statutory bars, like
Section 246, are ineffective by themselves to protect taxpayers. Congress has enacted effective language to
preclude illegal aliens from receiving benefits in recent years. The same willingness to adopt verification
requirements in the past is again necessary with respect to AAHCA in order to protect the interests of the
American taxpayers.
Dear Dr. Gupta,
I am living in Jamaica and would like to make a suggestion for health care reform in the U.S. Unfortunately, there is limited info on the proposed plan and as with many other bills I doubt if anyone has fully looked through the entire plan much less fully grasped it.
I would like to suggest that if the government makes it mandatory for all americans to be covered under the health care reform bill. It may be useful to set regulations such that the health insurance companies have to include the government plan in any package they offer. They will then pay the government the prescribed premium and the balance of the premium they would charge be used to cover the additional benefits they offer above the government. This, I believe would ensure that the majority will benefit and it will also most likely expand the client base of the health insurance companies which has been and will continue to decline giving the rising cost of living.
There are other issues to be addressed like regulation/accountability. I don't think the ability to chose a doctor/hospital should be an issue since both health insurance and government would use doctors based on similar guidelines as to cost and competence.
Sincerely,
Dr. Heron Edwards
In your broadcast this morning I was disappointed you did talk about the excessive profit that drives hospital costs up. Is there an barrier to charging $250,000 for a two day stay $300,000? It is unconscionable that we have let the system get this far out of hand. It reminds of the efforts now under way to look at excessive payouts for the financial industry. Does anyone bleived that there are no abuses in the medical industry, greed, excessive salaries, profits? We wouldn't be talking about national health care if the industry was not rife with greed and poor management. If we do not pass health care reform the system will collapse under its own weight.
What percentage of SALARIED physicians at the Cleveland Clinic have been subject to tort actions against them, as compared with the percentage for those doctors in private practice/hospitals under for-profit HMO arrangments?
Ways to reduce cost of healthcare:
1. Mandate catastrophic health insurance for everyone. There are uninsured who can afford healthcare but would rather spend the money on the new iphone or an expensive purse. YOU KNOW WHO YOU ARE. Expanding Medicaid is NOT the answer.
2. Have taxes in place for sin (s) smoking, alcohol, obesity. Obesity is taking this country by storm. Preexisting medical conditions is one thing but why should I have to pay for someone's health condition that is self inflicted.
3. PREVENTION! PREVENTION! PREVENTION.
4. End of life care and futile procedures and life support NEEDS to end. This should not be decided by family members or the patient. Let the dying process take place....we all DIE at some point.
5. TORT REFORM. Raise the bar in medical licensing...ie physicians that are dangerous or just plain stupid should not be practicing and should be judged by his or her peers.
6. Community or state resources for addicition and psyche issues or homelessness...the frequent flier who just wants Dialudid or a bed and breakfast.
7. Change the EMTALA law. Individuals should not abuse the ER because they can.
Tonight you stated that not everyone will be eligible for the public
health plan. This was the first time I've heard this. Who would be
excluded?
Why can't the reform on health care go more slowly until the government proves it can handle it? They have listed the main causes ($1.2 trilion ) in waste – obesity,smoking, too many tests, too many emergency room visits, high cost of paperwork, tort reform.Tackle these and see how well they do in solving these issues before tackling the entire mess.
Why can we not make sure only those who qualify get the care? Do other countries provide interpreters for patients as some want mandated here?
Secondly, why won't the administration try a program that has been tried and works, Lou Dobbs talks about one at 1/2 our cost, greater longeviity than Americans and has been working for years. Do we have to reinvent the wheel?
Thank you for your time.
Dear Dr. Gupta,
In listening to comments this morning, I noticed that we will be allowed to keep our current coverage if we so desire. However, I realize that not only will I be paying for my current coverage but I will also have to pay for those who either drop their coverage or have no coverage. It seems like we will be paying double and be penalized if we decide to keep what we currently have.
In the case of social security we all give but we know that we will be getting something in the end. I do not mean to sound selfish but money is tight nowadays.
It seems like this works one way only. Shouldn't those who are paying "double" be given at least some kind of a tax break?
Thank you
Dear Dr. Gupta,
I was against privatization of Social Security-I'm not much for a change over all I guess. Now I'm afraid about Medicare. If the health care bill passes without public option does it mean that Medicare has to be privatized? Maybe it is better to leave everything the way it is than risk having senior citizens like me without affordable coverage. I really cannot pay ant more.
Irene
Dr. Gupta,
I've seen much talk about "preventative medicine" in healthcare reform. But what concerns me is proper diagnosis when someone is sick. We seem to treat empirically, which was fine under blood culture the last 100 years. But why, especually with the advent of TEM-PCR, is there resistance for doctors to wait until the test results come back (next day) and then treat?
Also, my nephew took an H1N1 test on a Thursday and received definitive results on a Friday. The doctor said it was a new lab down in Huntsville, AL that was credited with helping to contain SARS in China. If we have this technology available, why would we not be hearing about it more often? My state (TN) doesn't even want to test for H1N1 because they can't determine results within the necessary time period.
Thanks.
I currently have my healthcare (PPO) through my employer. They pay about 50% of the premium. My fear/question is once the presidents bill passes, (he says that it will not effect my current coverage) but I can see my company coming out and saying, "good now since the government is paying the bill we are going to stop offering the coverage and let our employees go with the free benefits. (they've already took most of the benefits away already i.e... no 401K match, no more stock purchase discount, no more pay differential for working off shifts ect. ect. Is there any guarantees this won't happen?
Dear Dr. Gupta,
My husban has been diagnosed with a Grade IV Glioblastoma, he is 66 yrs old, diabetic and hypertensive. He was operated on the July29th, left temporal lobe. He is still in the hospital recuperating. He is off balance and his speech most often doesn't make any sense.
My question is that with all the info that I've read on the net, there doesn't seem to be a good prognosis for this disease. Should I put him through the suffering of radiation therapy and chemotherapy just to prolong his life for a year, maybe two? It is such a hard decision to make. Please help me make an informed decision. Thank you very much.
Dr. Gupta - I'm surprised that you have yet to touch on a topic that MUST be close to your heart when you've talked about health reform: TORT reform
as a neuro-surgeon, I can only assume that your malpractice insurance rates must be outrageous
is it a surprise that there's no tort reform when the President is a lawyer, his wife is a lawyer, most of Congress are lawyers, all their best friends are lawyers, and much of their election contributions are coming from the American Bar Association
but, one of the huge costs in our medical system is:
1) defensive medicine - doctors ordering tests and procedures that they KNOW aren't really called for - they KNOW that there's a one-in-a-million chance that the test/procedure might be necessary, but they fear that they are the one doctor who will be called to task when that test/procedure MIGHT have been called for
2) the LOTTERY attitude for crazy punitive awards in medical malpractice situations, even when no malpractice actually occurred - it's to a point that insurance companies pay "blackmail" from vulture lawyers rather than pay to defend the doctor/drug company - on your own CNN, every third commercial seems to be from some SHYSTER talking about "bad drugs" and how if you EVER took that drug, you could be the recipient of big $$
I can only assume that YOU have ordered tests/procedures that, in your heart of heart, you KNOW are unnecessary - but have done so to cover your butt against the miniscule chance that it might have been useful in a very small percentage of cases. I also assume that you have been victimized as being a "bad doctor", just because the outcome was not what the patient/family wanted. And that your insurance rates have unfairly increased because of it.
With that in mind, I find it incomprehensible that you have NEVER mentioned how the medical reform has not touched TORT reform. This will continue to add multi-billions to the cost of medical care.
I think that you should cover this topic in your continuing reports concerning the whole health reform issue.
Thanks in advance for your attention.
OK you guys! What is wrong with you people?
I am a Canadian who is scatching my head wondering why the American people would have a problem with a National Health Care System.
In Canada we can go to any Doctor of our choosing, get tests done as needed and recieve an adaquate diagnosis and treatment at NO cost to us!. That is right! We do not pay a monthly fee for heath care insurance, no fees for going to a Doctor, no fees for tests, no fees for hospital stays or sugery or anything. Also we dont wait for treatment as those trying to scare you away from a National Health Care System tell you we are.
I think you are all brainwashed by the big fat cats racking in all the dough from your current system. You know who they are. I guess you like paying $500.00 or more a month for an insurance plan that is still going to charge you a deductable when you go to a Doctor or have tests done or what ever. Having your HMO tell you what Doctor you can see, what tests and treatments are covered. Give me a break!
Be grateful for the gift that is being presented to you. Look at the facts and not the smoke and mirrors those making money from your insurance premiums and deductable charges are handing you.
Be informed, be smart, dont slap a gift horse in the mouth!
Well I guess you could continue to go broke paying for a health care system that is not working for you. You are working for it!
Louise
Good discussion on CNN Larry King tonight. Focus on behaviors that could affect health care costs. I can think of a couple of them that I haven't heard mentioned. 1. Alcohol consumption – how many deaths and illnesses are attributed to alcohol abuse/use? How does it compare to smoking? 2. Sexual behavior – with AIDS and other STDs on a rise, with millions of abortions every year - who is going to have the courage to say that we are obese, eat wrong, smoke, don't exercise AND we are permiscuous sexually AND we are drunk. Also ... I don't know what the solution is, but I sure would be interested in some facts about the profits that private insurance companies are making. As we watched our premium triple while our coverage declined, copay & deductible increase during the last 5 years - all to cover costs or just GREED? I don't know – it would be interesting. Thanks.
How much does health care contribute to the labor cost, and what does that do to force our jobs to other countries? We were taught that the US cannot compete in a world market because our industries have to pay health insurance in this country and other countries don't. Their health care is paid through their taxes or some other method. How much truth is there to that? Is it making us less competitive in a worldwide market? I wondered why other countries wouldn't want to be like us, but we seem to lose our insurance, and our jobs, when we get sick, so it doesn't really make sense to have our health care tied to our jobs.
Some jobs seem to go to other countries because they don't have as good of environmental laws as we do.
Cost is all about perspective. From whose perspective are you looking at the cost from? the insurance company? the employer? the physician? the hospital? the patient? They are all different. Have to be very clear about all of those different perspectives in the debate.
Very difficult to base individual health scenarios on population research that is highly specific and doesn't necessarily fit the individual in question. We need better quality research to make better decisions. Individualized medicine.
We are still going to need our doctors to make individual decisions...not based on populations studies so much, but more on real life situations. The mammogram missed my tumor. The first two biopsies missed it. The doctor said that it wasn't a guessing game, we need to know what that lump was. It was cancer. I caught it before it got into any lymph nodes. But, she said that from all of the information that she had, she had no reason to test further...and yet...we didn't have the answer. So, we did one more biopsy and it caught it. It seems unlikely to me that we can eliminate our doctors yet.
Dr. Gupta,
I was wondering about the healthcare for the Native Americans in our country and how that operates. I think that it is a form of government healthcare that we all pay for with taxes. How are their costs controlled and should that model of healthcare be looked into for the rest of us? I like it if you would address this question. Thanks.
I believe that Medicare seniors are being misled into believing that we will be able to keep seeing our current doctors when the reality is that with the proposed cuts in payments to doctors, only the least experienced and least successful doctors will be willing to treat Medicare patients. It is appalling that at a time when the aging baby boomers will greatly increase the number of seniors to be cared for, there is a proposal to cut $5,000,000,000.00 from Medicare funding. Surely there is a great deal of unnecessary expenditure in government which could be cut instead to fund care for the uninsured rather than taking good care from seniors at a time when it is most needed. Seniors have faithfully worked and paid into the system all of their lives and
should not be deprived of the care they have earned and deserve.
Also I am told that there is a limit to out-of-pocket expenses in the reform legislation. This should not be applied to voluntary spending by patients. Presently seniors have the ability to pay out-of-pocket for diagnostic tests and treatments not covered by Medicare. We can see doctors who do not take medicare at our own expense when we wish. This costs Medicare nothing and provides better care for many seniors. In our free American society we are able to spend our money on the best homes and cars we can afford, travel and even gambling. Why should seniors be prohibited from spending our own money on quality health care just because we have reached sixty-five?
Americans have always had the freedom to select the health coverage which fits their pocketbook and needs. Employer plans allow employees to select and contribute to paying for HMOs or more expensive PPOs. Private insurances offer us an array of plans. Like younger Americans, seniors have had the right to select a Medicare HMO plan or pay extra and take a supplement plan which provides better access to physicians and procedures. With my current Medicare and good supplement which I pay for I can go to the best specialists to treat specific medical problems. I don't have to wait to see a primary doctor who may not be qualified to diagnose and treat a problem in a specialized area and then wait until he is ready to refer the problem to a specialist and then wait again to see the specialist, often suffering a worsening of the prognosis due to the delay or incorrect initial treatment. The option to pay for and receive this quality of care which is available to younger Americans should not be taken away from us just because we have reached sixty-five. If medicare can no longer provide it under the current premiums we pay, seniors who can do so should have the option to pay more for their Medicare as we do for our supplement and continue our current quality of care. We should not be forced in our golden years into a lesser quality of care than we can afford?
Since allowing us to spend our own money for better medical care does not cost anything to the Medicare program, one wonders what is the real agenda behind stopping seniors from getting quality care to prolong our lives. Perhaps it is that shorter lives for seniors will reduce the number of beneficiaries of Social Security and Medicare. Maybe there is some political agenda in reducing everyone to the lowest level of care. Is it any wonder that seniors are fearful of this type of reform?
In search of true facts, please note the following:
CHICAGO–The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight.
Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.
Three weeks ago, the President suggested that a surgeon's decision to remove a child's tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what's right for the patient.
We agree with the President that the best thing for patients with diabetes is to manage the disease proactively to avoid the bad consequences that can occur, including blindness, stroke, and amputation. But as is the case for a person who has been treated for cancer and still needs to have a tumor removed, or a person who is in a terrible car crash and needs access to a trauma surgeon, there are times when even a perfectly managed diabetic patient needs a surgeon. The President's remarks are truly alarming and run the risk of damaging the all-important trust between surgeons and their patients.
We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.
I just found out that even though i have group coverage through my company's health insurance, I am being denied a claim for a routine checkup because the doctor wrote "deviated septum" in his report. Is this legal for them to do? I have not had a pre-existing condition, and I only mentioned to him that I had difficulty breathing out of my left nostril. Why has this been deemed a pre-existing condition and what can I do about it?
Ever since the start of managed health care (HMOs), the cost has INCREASED. HMOs were supposed to decrease costs by encouraging more preventive care. Today, too much of our routine medical care is covered by insurance, instead of just being paid out of pocket. The purpose of buying insurance is to protect against catastrophic costs. When insurance covers everything, it has to cost more. Now we have so many visits to the doctor charged to insurance that the premiums we pay keep increasing. Instead of pushing ahead with more insurance-covered care, why not DECREASE our insurance premiums by buying insurance with high dedustibles, and just pay for routine medical care out of pocket?
I asked my stepfather, who is a doctor, what percentage of people die in the emergency room as a result of stupid decisions that were totally preventable. He estimated 50%. I also asked his opinion on the percentage of people who sought treatment from the emergency room because they knew they could get away with not paying even though they could afford to pay. He estimated about 30%.
I asked a friend who is also a doctor, what percentage of patients would not need to see him for various health problems if they simply ate right and exercised. He said about 50%.
I eat very healthy and exercise every day. Because of my lifestyle, I'm in my mid-30's and have no chronic pains or illnesses. While I see other people's health deteriorate as they get older because of their poor lifestyle choices, I feel my body is better than when I was a teenager. I have medical insurance, but I never need to use it.
So when it comes to the idea of universal health care and health care reform, the question I have is why should I (or anyone else for that matter) be forced to pay for others who make poor decisions and live unhealthy lifestyles? Whatever happened to self-responsibility and dealing with the consequences of one's own actions?
My mother-in-law is extremely obese and is on high blood pressure medication. In the past, when she had me run her though exercise workouts. She lost a lot of weight and did not need high blood pressure medication anymore. However, she did not like the discomfort of strenuous exercise and eventually quit working out. Even though the doctor told her to continue exercising, she chose not to and chose medication to control her blood pressure rather than exercise. Why should anyone but her pay for her decision?
In regards to the Canadian who commented earlier....
Your system is great- as long as you are willing to pay sky high taxes. I have a friend who is Canadian and he mentions all the great benefits he has up there. He also mentions that he pays close to 60% when all the various taxes are added up.
Dr Gupta,
Hi, I am an undergraduate pre-med student enrolled in a seven year program, who is wondering about how the health care reform will affect those who want to become doctors. You may have answered this, I haven't seen a good explanation anywhere about this area of healthcare reform, but I estimate by the time I finish my medical program, I will be 200,000+ in debt from student loans. How will the health care reform bill affect how doctors will be paid? Don't get me wrong, I'm becoming a doctor to help people and irregardless I am still becoming a doctor whatever the outcome of reform will be, it's just I want to know if my desire will become a major financial burden.
Also concerning specialties, will the new bill cause all doctors to be paid equally? I'm only asking as it seems fair for a neurosurgeon or a cardio-thoracic surgeon to be paid more than say a general practitioner, as they have extra training and the work is more risky. I remember my primary physician mentioning how some specialties are declining and that concerned me. He said that it's becoming too costly in some areas such as OB/GYN that sky high malpractice and other fees are causing less and less to go into those fields.
Maybe I'm worrying a little too soon but does it really seem that unfair(to others) that a doctor whose has hundreds of thousands in debt, took 10+ years to train , works 60-80 hours and has sky high malpractice- should be paid a good wage?Or be paid more because they are in a harder and riskier specialty ? Thanks for reading and thank you for all that you do.
Hi dr Gupta!
i am a 40 year old working mother single mother without health insurance and applied for kids care for my children. How will health care reform affect my family?
Thank you
Dr Gupta,
85% of Americans presently have health care. Most of that 85% are presently opposed to a government take over of health care, but many, if not most, would change their position if the government take over could be shown to improve care AND lower their insurance cost.
The only way that health care can be improved AND the cost lowered at the present is to accelerate the research into the DNA Personalized Medicine where actual cures, not just treatments, become the majority.
Treatments (about 90% of present medicine) are nothing more than ineffective, expensive, stabbing around in the dark by Doctors.
Cures are exactly that, -CURES. Only the DNA based Personalized medicine can find true CURES for 4,000+ known ailments.
I reccomend that the government could be most effective by setting up methods to accelerate the DNA Personalized Medicine research.
The most likely and most effective method would be to offer monetary prizes for each disease so cured by the numerous organizations presently doing the research.
Otherwise, most persons think and see the government's frantic drive to seize control of healthcare as nothing more than a devious means of directing the $2.4 Trillion annual health care insurance money directly to the government, not for the purpose of improving health care, but for the government to use the income as an asset to increase the government's ability to borrow more money and increase its debt even further.
I appreciate this chance to ask you my questions about health care reform:
I am very concerned about the President’s statement that "you can keep your current plan and your current doctor". I think that this statement is as big of a myth as Palin’s comment about death panels. Please help me to understand how this statement is true.
If a public plan is instituted, I understand that the provider reimbursement structure will be similar to Medicare. If this is true or anything close to Medicare or Medicaid, that cuts payments to providers by at least 30%. This has the potential to be extremely disruptive to our current health care system and believe the following questions should be answered before anyone should support this plan:
How are private plans (including Michigan based plans like BCBS of Michigan, HAP, Priority Health, HealthPlus, Total Health Care and others) supposed to compete with a plan whose reimbursement structures are approximately 30% less? It has the potential to cut right through the private pay system at that level of differential in fees, even with the inefficiency of Washington run health care we see currently in Medicare.
And where does the tax revenue for our state associated with those plans as a business and employers, along with the premium taxes from their policy holders get replaced by? And how to the causes they fund to improve health in the state continue to be funded? We are talking about millions of dollars the drive the Michigan economy that have the potential to move elsewhere.
And why would an employer offer health coverage at a cost of $8,000 per employee per year when a likely cheaper public plan is available (see above) and they can opt out for roughly a $1000 penalty? What did employers do when Medicare D was offered? They eliminated retiree benefits because it no longer needed to be their burden. What facts does the Government have to support that employers won’t do the same and that I can really “keep my plan if I want to”?
And how are physicians and hospitals supposed to offset this loss in revenue? We need to spend less, but we need to find ways of using less health care not paying less for the same volume. Cutting funding without cutting services is not achievable for our health care providers. There is plenty of over treatment in our system, but it won’t go away with the reform on the floor: Tort reform is needed to prevent huge amounts of defensive medicine and changing the health of Americans so that we need less care for preventable conditions like heart disease, cancer, diabetes, hip/knee disorders etc. are the real drivers of health trend in the past decade. The system cannot withstand a drop in revenue of this magnitude and maintain its standards and keep hospitals open. It seems that we are at risk of lowering quality and increasing costs as a result. If not, help me understand how.
And how will we mandate that physicians and hospitals now accept a government fee schedule for services or can physicians chose to not accept that payment and only treat those that can afford more? If they are able to opt out and provide services to those who can afford to pay current fees, how do I know if I can keep my doctor if my employer no longer offers coverage and I can’t pay more?
Based on my understanding of the above, how can the President tell the American people that they can keep their plan and keep their doctor if they like them? It is only true if employers offer health coverage and if physicians accept the fee schedule that this plan will be structured on. Either my understanding of the above is wrong, or we have a right to be angry about this health reform.
I heard someone in Congress on the news over the weekend challenge whether we have the best health care system in the world, given our high costs and seemingly marginal outcomes when compared with other countries. I think this statement is misleading for the following reasons and want to know your opinion:
• Most of the world does not track outcomes like we do (example, infant mortality is grossly understated in most of the world).
• Most of the world does not treat disease like we do (for example in China most people would not receive Cancer treatment without cash to pay for it like ALL Americans do). People in most countries around the world simply die at home without the cost or poor outcome of any treatment, which changes the cost and reported statistics that we are comparing to.
• Most of the world is not as unhealthy as we are. We are less active, more overweight, and have more chronic disease than almost any other country. Until we prevent heart disease, diabetes, and cancer through LIFESTYLE changes, our health care costs will always cost more because we are using more services than the rest of the world.
• Lastly, many of the reasons that cause our mortality statistics to be off are significantly higher murder rates and vehicular crashes than the rest of the world which have nothing to do with our health care system.
I think the proposals on the floor of congress will take away the innovation in medicine that have continually benefited Americans, as well as everyone else in the world. It will increase costs without addressing quality. It is upsetting to have some of the media accepting statements that our health care system delivers low quality results and I'm just wondering what you think?
How is adding millions to the insurance roles and NOT DECREASING THE COSTS OF HEALTHCARE supposed to make this more affordable?
I can't comprehend the need to charge $10 for an aspirin, pay $3,000,000/yr for an administrator or $5000 for a 25 minute outpatient procedure.
Can you describe the political pusheback the Republicans gave to the original Medicare Bill when it was passed. IT sounds just like THIS debate and people would not give THAT up now...HISTORY help explain these things...Same for Soc Security we were told the world would end and the government would take over all kill us all etc...
Can you tell us how many people have to leave the US to get healthcare elsewhere? Because of Insurance denials or just excessive costs .And compare the outcomes better or worse for those people...ie better if they go to Germany or worse if they go to other poor countries...perspective would help.
Proponents of the "public option" say it is necessary to force insurance companies to compete with the lower costs. Opponents say it will force insurance companies out of the marketplace. Please comment.
Please comment on the following:
There is "Comparative Effectiveness Research" for our health written into the Feb. '09 Economic Stimulus Bill that President Obama wanted passed real quick!
Please explain this, and the reason why it was hidden in an Economic Stimulus Bill, instead of a Health Bill. This is not 'pork'.
I helped elect President Obama, but I won't help anymore! I thought he meant honest "CHANGE"...not this STRANGE CHANGE!
Why even think about a bigger health plan, when our govt. can't even work out govt. run medicare and govt. run medicaid?
Is Congress and this Adm. even willing to sell off their fleet of 24 luxury jets to help pay for better health care under those govt. run health plans...or are they just wanting to cut health care to our older population and those with severe health problems, raise taxes, and cut grants to those groups that help older Americans and those in need?
I don't see Congress and this Adm. sacrificing...like the rest of us!
I didn't even go on employment because my husband has a job...and I thought someone else would need that money more!
There is plenty of tax money for the U.S. citizens if our govt. would just spend it wisely! And this goes waaaaaaaay back...not just the Bush Adm.
By the way, did President Obama pay for his family and their staff to be with him on HIS BUSINESS TRIP to Europe, Africa, the Western USA...like former Gov. Palin had to? I thought that was a great idea!
And while I'm at it,
How dare the U.S. Senate pass a bill to use our Social Security for illegal aliens! If they want to help illegal aliens, they can use their OWN RETIREMENT MONEY!
Thank you for your time.
I have 2 questions for Dr Gupta,
This morning (8/16/09) you included an interview with a gentleman who used to work for Signa. You discussed terribly sad situations where insurance refused payment to people in life and death situations. My question is, would health care reform guarantee that all of these people would receive all of the treatment their doctors are requesting? And, if yes, would that include people of all ages?
Are there ANY guidelines from the government that would need to be followed by doctors when discussing end of life options with senior patients.
Thank you,
Mary, Florida
i am, 65 years old and i have diabetes that is under control. i
have been trying to get long term care but i have bad reports on
my kidnneys( protein in my blood). will the health care reform
bill cover any long care coverages .
please advise me it there is any hope for me so my family
doesnot have a chance to loss everything.
thank you
alan bart
I just read on MSN that the public option portion of the reform bill may be dropped due to public pressure. Is this true? if it is, then i am very disappointed and frustrated with President Obama. I feel he is backing down on one issue after another. I felt the 'dumbing of America' had occurred during the last 8 years and we were finally coming out of it. Now, i feel we are heading back into it. The Republicans had 8 years to improve things and failed miserably. Why is the President so conciliatory?
It is common knowledge that legal suits have added immense burden to US health care cost. This is a key difference from other developed countries. No one is perfect and there always will be few errant health care providers. However, ultimately it is the common population footing the bill. Life is priceless but our claims and legal costs have become senseless. Why are we not willing to cap these ridiculous compensations? Let me guess. Since majority of the politicians are lawyers by background, they lack the political will to go against their fraternity (??)
SOLUTION to Health Care Reform... one of many solutions...
I think we all are looking for reform, and I'm against government controlled health care.
Personally, I think there should be one health fund for the whole nation, and complete care for all, without the "ala carte" menu of services that most private insurance companies offer, etc. ...and be non-profit. The broader and bigger the fund, the more efficient it will be for paying out for services that are needed at any point in time, and premiums should shrink by more than half of what we are paying today. This fund would also cover all government sponsored health programs... OPM, TriCare, Veterans Admin, Medicare, Medical, and local government programs, etc.
Employers may be able to foot the whole bill, then. For the unemployed, they would pay their premiums on a "percentage" basis of what their pension, capital gains, or passive income is (approx.2%). Employers may be able to pay a percentage of an employee's individual wage, too. That would level the burden of the cost of health care... such as charge all revenues on the percentage basis.
Or, do something similar to what Mike Huckabee wanted to do with income tax... take a percentage out of the "sales tax"...like 1% or 2% and have the sales tax fund contribute to the health care fund account. This would take care of tourists and illegal aliens, too, who would receive only initial care for their illness in the United States under the health fund, and their government or their personal health insurance would pay for the rest, or have them deported to a medical facility in their country. They would be their government's responsibility.
Control should be done by the American people, because the fund would belong to the American people, since we would be paying the premiums into that fund. Sort of like a co-op, only on a giant scale. I think control should be done by committees representing the American people and audit agencies, with a government Inspector General to make sure that the American people have consumer protection. That would prevent,hopefully, what happened on Wall Street and AIG, etc., and bleeding of the health care funds account and fraud.
If a patient should want an especially talented doctor who charges more than what the plan would provide for, the additional difference in cost could be paid out of the patient's pocket, or through a private insured policy. The same would be for labs (if a particular lab charges more because of a better reputation) , meds (generic vs. brand name), medical facilities (like John Hopkins if they charge more), or comfort settings (like more luxurious quarters while being hospitalized), etc... Basic premiums should be low enough to enable patients to pay for additional private insurance policies if desired to cover the additional cost.
Everyone should be able to submit a claim for all medical care from the basic fund, and if necessary, have private insurance to pay for anything additional that the basic health fund will not cover.
Everyone should be able to choose from a "public facility" or their own private physician and still make a claim against the fund. Everyone should also be able to "mix and match" between services from the "public facility" or their own facility of choice.
There are many ways to make the system more efficient, such as purchasing power, etc., and the wage payment structure for health employees should be calculated by "cost of living allowance" for their area of employment, as well as all other financial payments (supplies, building structures, etc)
The above would be basic and too simple and too cost efficient, so it would never catch on... 🙂 ... but that is my 2-cents 🙂
I have not figured out if Obama wants to have 100% government control over health care such as dictating what procedures you are allowed to have, or, if he is just looking to oversea the health care system to protect the consumers when they are at their weakest.
--------------------------–
Please go to this website and download the “The Federal Coordinating Council for Comparative Effectiveness Research (FCCCER)” report from: http://www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf
or from:
http://phiinstitute.org/arena-our-public-comments-may-are-part-fcccer-report
Read the report. Learn how the health care dollars will be saved.
Learn how the health care dollars will be allocated.
Learn how payments to doctors will be determined.
Learn how the distribution of H1N1 was determined!
Please explain to me how this is not rationing!!!
OH, that's right; the government does not ration health care!!!
Dear Dr.Gupta
This is a question to those oppose Public Sector Health Care Insurance option proposed by President Obama. US health care insurance Giants ilike AIG, Prudential ,Allianz etc. are in India. There are also Public Health Care Insurance companies like Oriental Insurance, General Insurance, United India Insurance.etc. Both co-exisit.
Similarly many US bankers like American Express, City Group etc. do exisit with Indian Public Sector bankers like State Bank of India, Bank of India, Punjab National Bank etc.
India is not a communist country.
P.B.Menon
I have tried to read as much as I can about this badly needed Health Care Reform Bill, as I have been in a uninsurable mess since birth. I've been covered under parents' group plans thru work, or spouses plan for over 25 years. I had one year inbetween that transition where I paid over $150.00/mo. for basic medical with the provision I could not have any claim for pre-existing orthopedic issues during a probationary period. Once married, I was on a group plan that allowed pre-existing issues.
I have recently been in situation where the private insurance hospital rep has been in my hospital room weekly telling me 'unless I improve, my insurance company won't authorize another week." That lasted fivemonths. I was discharged only after an appeal and after a four day extension so medical staff could teach me all I needed to know to be safe to discharge. I remember when I was a child, and I stayed in a hospital from June to November, as it was medically necessary, and the insurance company never hasseled my parents. That was pre-80's healthcare.
So, I have pre-existing conditions, and under current health care system, I AM UNINSURABLE once COBRA runs out. ( We are currently Unemployed) What senior citizen in USA doesn't have pre-existing conditions that require insurance before eligible for Medicare? I'm scared and I still in my 40's! I pray morality and common sence prevail when these provisions are voted on this year, and that no politician is swayed by the all mightly dollar from some insurance company whose profits are more important than the wealfare of it's clients.
How will TRICARE be affected by the proposed healthcare bills? TRICARE is the government plan covering military families (active duty and retired) and has many similarities to MEDICARE. Thank you.
A future doctor just 1 ½ yrs away from being a licensed practicing physician:
From a future doctor’s point of view:
The road to becoming a physician is one of the longest, most difficult in terms of both academics and social, most competitive and longest investment payout in all industries! Every year hundreds of thousand students with a dream of becoming an excellent physician go to interview where every school gets thousands and thousands of applicant and interviews only about 1000 of those and only accepts about 200-250 at most. Every year standards keep going up and up creating more and more qualified physicians. The investment that we have put into our education is one that only someone a little insane would do.
From an economical standpoint:
4 years of undergraduate education
4 years of medical school
4 year of residency where we make next to nothing in the hopes that soon we will make enough to one day pay off the debt that we have incurred in our education meanwhile the interest keeps on ringing and tacking on more money we are in the hole!
Avg debt of a graduating doctor = $250,000
Not to mention the interest that keeps going up every year on these loans where 10 yrs ago it was no big deal around 1-2% NOW its more like 6-8%.
SO we invest at minimum 12 year of our lives (the prime years 20s and early 30s) not to mention now we are $250,000 in debt where if we decided to not go to medical school and make $60,000/yr doing something else….
So we could have made $720,000 but instead we are now in our mid 30s 250,000 in the hole so that’s 1-MILLION dollars lost!!!!!!! Now we are a doctor making (if your lucky) $250,000….so just in terms to $ that means it will take another min 5YRS to break even so now we are almost 40yr old!!! That’s not even including taxes and living expenses…. consequently as a physician we wont be able to own our own home and vehicle until we are well in our 40s and almost 50 when most ppl start thinking about retirement we are just barely getting started!!!!!!!!!!
From a social standpoint:
We waist “the best years of your life” – typically, the 20s and 30s and some the 40s in pursuit of helping ppl. We spend (at least I did) min 5 hrs per day studying not to mention the 8hrs/day in lectures. Our social lifes are non-existent, trying to start a family or relationship is very hard if your sig other is not in the same situation. Normal ppl outside of professional school do not understand the commitment it takes to go through our medical education and it is a life long process. Not to mention when we have to study for National Board Examinations where I spent min 12hrs stuck in a small room with a table, laptop, fellow students and stack of books preparing so we can move on and get closer to graduating.
In conclusion doctors not only take a financial risk/investment but also sacrifice our livelihoods in hopes of obtaining our doctorate in medicine.
The government sees us as the problem in healthcare and we are under attack. Historically as a whole we have not been smart businessmen and we have allowed insurance companies and regulations to choke hold us into submission and handcuff us in giving the best healthcare possible. As a future physician I am worried about my own earning potential and if the government takes control and puts more regulations and more restrictions how will I provide for a family let alone myself? The focus is on the wrong guy, we are not the scapegoat here and we are not the problem! Take a look at insurance companies and how the keep reimbursing less and less every year! As a professional if you told an attorney that you are only going to give him 30% of the bill and he will have to live with that…NO they are able to charge what they want because they have earned the right.
Over the years there has been a shift of the earnings, insurance companies take to money that doctors earned (the pp that do the work) and take it as create a “administration fee” and now create positions in the company that make as much if not more than the physicians that did the job! The government needs to stop paying attention to the lobbyists that make sure bills against insurance companies do not get through and start talking to the ppl that provide the healthcare and ask them how to make the system work more efficiently and effectively!
1. Create legislation that protects doctors from lawsuits! One reason health care cost so much…every pts gets the “kitchen sink” workup B/C they are concerned about protecting from getting sued by the families we work night and day for! If the system allows physicians the ability to make calls on what diagnostic test/blood test/imaging studies to give the patient…it would cost less the patient would get the treatment sooner and pay the doctors what they earned and stop this steady decline of withholding payments by insurance companies. For example 10 yrs ago a surgeon would make $3,000 for taking out a gallbladder and NOW the only make $300 while the cost of time and supplies and overhead (ie paying the surgical techs/nurses..ect) cost more than that in some cases the surgical nurses and techs make more on a case than the surgeon himself and with that $300 it is their patients meaning if something happens and the patient sues the surgeon and NOT the techs/nurses/PAs on the same case. Doctors need to be compensated and insurance companies need to be regulated on what the feel like reimbursing the physicians for their job! NO other profession has a system where we can charge a fee and you can only pay a percentage of that price and the professional has to accept that as payment! If you only give a mechanic 30% of his charge they will sue and screw your credit as well…BUT not in the medical field when it comes to paying physicians!!
2. With the Obama’s plan on healthcare our incentive and earning potential that makes all the sacrifices worthwhile will be eliminated and there is no plan to 1. lower the cost of tuition 2. lower the interest rates on the loans and make more government loans available so we do not have to go to private grad-plus loans with even higher interest rates and make more subsidized loans where the government doesn’t allow the interest to build while we are in schools! If you lower the cost of education along with the earning potential it will lower the difficulties we face once we are out, one of the main reasons ppl go into specialties is because we have this huge debt to repay and family medicine will not cut it anymore! I think it will eliminate all incentive of being a good doctor and putting the patients needs first and instead create a field of doctors who’s main concern is seeing enough pts in a day to keep our heads above water with overheads and insurance.
State of Medicine:
From what I can see from the past 2 ½ yrs in school no doctor has the time needed because there are protocols that need to be done so they can get paid for the visit, there is no incentive to listening to the patient they just get the chief complaint and start the process with diagnostics/labs/other studies without even taking the time to do a good history and physical where we are taught 90% of all diagnosis can be made with a good history and physical exam. If we are reimbursed what we should get paid and put the power back into the doctors hands that would give us the freedom to make the diagnosis and go forward on treatments instead of useless test and studies that tax healthcare! The government who knows nothing about medicine is and what it takes to care for someone’s health should not try to institute a program that will put more restrictions on a doctor. The plan may work in the presidents eyes but the practicality of his system will not work, talk to any doctor and they will tell you the plan will not work and just create a system that might allow more people to have healthcare available to them BUT the quality of healthcare will go way down and over work physicians. Not to mention with so many more ppl in an already overcrowded office will not allow proper training of students and further downgrade the quality of physicians practicing!
From a concerned 3rd year medical student!
Dr. Gupta, in this reform does it cover all health issues, such as dental and mental, eyes. This is all related to your health, and it can make you very sick, such as infected tooth. thank you
I just viewed Anderson Cooper 360 "Health Care Reform".
I have two questions for you:
What do you believe is the best choice for the majority of Americans: keep the "system" we have, universal healthcare as proposed by Obama, or a socialized system. I understand each has its pros and cons but I would like your take.
Everyone talks about the U.S. healthcare "system" yet in truth healthcare is an industry of competing companies (insurers, soft and durable medical supply vendors, hospitals, physician groups, etc) that ultimately operates not to improve health but to make money. If there is no profitably in healthcare the industry collapses. The healthcare system we Americans talk about is an illusion...it doesn't exist. Perhaps if we could as a nation understand this, we would understand attempts to reform are difficult since our healthcare is entrapped in a free market, capitalist industry in which profitability and answering to shareholders is the goal.
Dr. Gupta,
I don't understand the words "free healthcare." If someone gives my a twenty dollar bill "free", it means that I did not have to produce anything to get it. However, this somebody had to do something in order for me to recieve it from him. Are doctors going to work for free - doubtful in most circumstances. Is the U.S. government going to start selling goods and services to produce funds for our "free healthcare"? Where will the funds come from and who will have control over how these funds are used?
Canada has agovernment healthcare plan, and from what I hear, there are too many patients using this benefit for things that arent absolutely ncessary clogging the lines of more essential care.