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August 6th, 2009
06:00 AM ET

Setting mandatory prices for healthcare?

As a regular feature of CNNhealth.com, our team of expert doctors answers readers' questions. Here's a question for Dr. Gupta.

From Cindy in Covington, Georgia:

“Why doesn’t the government make mandatory prices for doctors and their services? That’s the problem. They all charge outrageous prices and vary from place to place. Will that change in the new plan?”

Answer:

Well, first of all, Cindy, you're absolutely right. It’s amazing, even within Medicare you have widely varied prices across the country. One operation in one state might cost $6,000, but in another state, the same operation might cost $17,000. So it does vary even for those covered under Medicare right now.

We are hearing some of the specifics of these health care bills. Nothing has been set in stone but we're hearing that there may be caps on out-of-pocket expenses and full coverage for preventive care.

What we are not hearing are specifics about is whether there will be a set price for various procedures and tests. We asked the White House specifically about that and we were told no, there is no plan in any of the bills so far to set prices across the board, across the country.

The idea is that the government would have a public option for some Americans. This option is for people who can't afford their health care right now. And it's based on a percentage of their premiums as compared with their income. If your current insurance premium is 11 or 12 percent of your salary or higher, you might qualify to buy into this public option. And in terms of overall costs, a public plan would in some ways compete with private insurance companies and may influence how prices are set overall.

The bill being considered now specifies two interesting points in terms of costs. One is that no payment rates would be lower than the Medicare rates right now. Also they would not be able to set prices higher than the average of all plans in the so-called insurance exchange. “Exchange” is the term used to describe the system of private insurance plans and the public option that would come with reform. So there is no direct setting of prices for doctors or hospitals, but a lot of potential influence over prices in the long run.

Critics of the House health reform bill argue that the government plan will always get the better deal. It will always be able to negotiate better prices than private insurers because there will be a larger pool of people. Therefore it would be able to negotiate prices that will not be as low as Medicare but will be low enough that private companies won't be able to compete.  The administration will say this assumption that Americans will flood the public plan is not necessarily true because not everyone will qualify.

One thing I can tell you is that the specifics of the bill are likely to change in the days and weeks to come. I'll continue to break down the details and give you both sides of the argument as Washington works to reform our health system.


Filed under: Expert Q&A • Health Care Costs

August 5th, 2009
12:05 PM ET

Swine flu vaccine for pregnant women

By Miriam Falco
CNN Medical News managing editor

Last October, I blogged about why health officials say pregnant women need to get a flu shot. (Full Story) Reporting on the need to get vaccinated against the influenza virus is something medical reporters do every year. Why in October? Because that's when the vaccine is usually available and when flu season is right around the corner. Why pregnant women? Well, as I learned last year, if a pregnant woman gets the flu, it could lead to serious complications including pneumonia, dehydration and hospitalization. Because pregnancy changes a woman's immune system, she can get a lot sicker than women who aren't pregnant. She can even die from it.

What was even more alarming was learning that the flu can also lead to preterm labor and fetal demise, according to one of the top flu experts at the Centers for Disease Control and Prevention, Dr. Carolyn Bridges. The CDC also found that less than 14 percent of pregnant women between the ages of 18 and 44 actually got a flu shot during the 2006-2007 flu season. I was pregnant last October. After speaking to health officials and several moms who had experienced the flu and told me they’d never been so sick before, I decided that for me, avoiding the risks to me and my unborn child was worth getting a flu shot. Apparently it worked because I didn't get sick.

But now it's August, not October. So why are we thinking about the flu already? Because of the new strain, H1N1. Health officials are now saying that pregnant women not only need to get a seasonal flu shot, but they also should be vaccinated against this new, 2009 H1N1 pandemic flu, better known as the "swine flu" (even though pigs have nothing to do with it) - once the vaccine has been tested and deemed safe.

Last week, the CDC's point person for this new strain of flu virus, Dr. Anne Schuchat, told reporters that pregnant women are “disproportionately” affected by this virus and that they have a fourfold increase of being hospitalized compared with the general population.

The H1N1 virus is causing worse complications and severe infections in pregnant women, Schuchat said.

A study published in the medical journal The Lancet found that pregnant women are more likely to die from this virus and that vaccinating them is one important step to prevent such serious complications.

Health officials told reporters this week that once the H1N1 vaccine is proven safe and becomes available, those in the high priority groups will have to get two H1N1 flu shots – three weeks apart, in order to get full immunity. Those high priority groups include not only pregnant women, but also household contacts of children under 6 months of age (because those children can't get the vaccine); children and young adults age 6 months to 24 years; health care workers and emergency medical personnel; and non-elderly adults with pre-existing medical conditions. It will take two weeks after the second flu shot to build up to full immunity, which means the whole process to protect yourself from H1N1 takes a total of five weeks. Since this new flu vaccine isn't expected to roll out until mid-October, health officials don't expect the population to be protected until the end of December.

Given the experience earlier this spring, where swine flu rapidly spread in some schools and colleges and other places with lots of people in close quarters, health officials are bracing for a big uptick in people getting sick as the regular flu and the new H1N1 flu viruses spread during the cold weather months.

So this year, I once again am pondering what to do. This time it's a lot more difficult because come October, my little son will be just old enough to fall into the priority "six months to 24 years-old" category. Should he get two brand new flu shots plus a seasonal flu shot? It's not an easy decision. Fortunately, I still have a little time to think this over.

How about you? Are you pregnant? Will you get seasonal and H1N1 flu shots when available? Are you a parent of a newborn or infant and are you planning vaccinations for yourself or your child?

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


August 3rd, 2009
06:15 PM ET

Fighting divorce: An endemic public health crisis

By Akash Goel
CNN Medical intern

New research contradicts the age-old adage, "'Tis better to have loved and lost, than never to have loved at all."

A study, “Marital Biography and Health at Mid-Life” appearing in the September issue of the Journal of Health and Social Behavior found that the middle-aged divorced or widowed have 20 percent more chronic health conditions such as heart disease and diabetes and 23 percent more mobility limitations such as difficulty climbing stairs.

While it may seem odd to think of it as such, divorce can be viewed as a public health crisis with national rates estimated by the Centers for Disease Control and Prevention to be nearly 50 percent nationally.

A large field of research suggests that people who are in close, social relationships are healthier. When marriages are functional, they are perhaps the ideal form of social and emotional support. When marriages fail, however, these mental health bedrocks crumble (among other parts of your life.)

Kristi Williams, a professor of sociology at Ohio State University, believes changes in societal perceptions of the idea of marriage are influencing rising divorce rates.

"We've come to view marriage as a source of individual satisfaction whereas in the past marriage was viewed largely as an institution that was necessary in order to raise a family," she says. "When that goes away, it is much easier to dissolve the marriage."

Tal Ben-Shahar, positive psychologist and former Harvard professor, argues instead that we're philosophically less committed to relationships.

"In the past, people stayed together even when they were not happy together — for religious reasons, because of convention, or because they had no real choice," he says, "Today, both men and women have more choice, and it’s more acceptable to divorce — hence easier. And when they face challenges in their relationships, instead of dealing with these challenges, they opt to leave."

Williams suggests that many studies have linked poor marriage quality to poor health outcomes, and thus improving marriage quality should be a worthy public health pursuit.

One example of this is the Department of Health and Human Services’ support of the “Healthy Marriage Initiative,” which provides $150 million each year towards relationship education to help strengthen families.

However on an individual level, one of the most important things we can do to ensure a successful marriage according to Ben Shahar, is learn how to handle gridlock: a term coined by sex therapist David Schnarch that refers to the point at which couples feel stuck in a conflict surrounding issues of children, in-laws, money, or sex and see no way out. While gridlock is often the tipping point leading to divorce, Schnarch believes we should embrace these "the drive wheels and grind stones of intimate relationships" as essential stepping stones towards realizing a successful marriage.

"Marriage operates at much greater intensity and pressure than we expect," Schnarch writes, "so great, in fact, couples mistakenly assume it’s time for divorce when it’s really time to get to work.”

Have you been through a divorce? Did you feel unhealthy as result?

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


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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.

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