December 21st, 2009
01:34 PM ET

Real-life effects of reform getting lost in the noise

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Last night I was up late covering the senate vote on health care for CNN. The number of e-mails I was receiving while discussing this on air was staggering. I realized that as much as we talked about cloture and reconciliation, most people who didn’t read the 2,000+ page bill (which is most everyone) really wanted to know what this bill means for them. They didn’t care as much about the compromise that was struck by Sen. Ben Nelson, which would obligate the federal government to pick up the Medicaid tab for his state of Nebraska into perpetuity. They are still not sure if a public option is a good thing or not, and they aren’t sure how the exchange would work for them. In short, there is a collision of politics and health care, and sometime the impact on individuals gets a little lost in the shuffle. (Read the Senate health care legislation)

I want to use this blog as a platform to try and address some of your specific questions and to also throw out some key information that may have flown under the radar. I will start with a number. 2014. This is the year most of the provisions of the bill would kick in under this version of reform. That’s right – four years away. Many people think health care reform in binary terms. One moment there is a vote, and the next moment you have it. Many wish it were that easy. It is true that children may benefit earlier in some areas, but for the vast majority of the more than 40 million uninsured, things aren’t going to change significantly for a few years. And, speaking of the more than 40 million uninsured, this bill won’t impact all of them, but instead roughly 31 million.

So, let’s start here: Based on what you know about this bill, do you think you will be impacted? Has this affected your current plan, if, for example, you are working for a large corporation? What information is still lacking for you?

Click here to see Dr. Gupta answering some of your health care reform questions.

soundoff (416 Responses)
  1. Julie

    I find it disgusting that there are elected officials who care so little about the american people that have twisted this bill to benefit insurance companies and themselves and not who it was intended to help. I find it sickening that they have allowed religion to dictate policy in this... so much for the first amendment against the state telling you what religion to follow! Changes are needed but these elected officials just don't care as long as they are getting their payments from insurance companies. Apparently they are somehow also making money off the american people who go into bankruptcy because of medical bills. There is no logical reason to NOT reign in insurance companies... except for the money the republicans and some democrats are making from these companies! In this case NOT passing a bill to reform health care is far more harmful, healthy wise and financially, then leaving the current "system" in place!

    December 21, 2009 at 16:44 | Report abuse | Reply
  2. CarrieAZ

    This bill will help no "Hard-working American". I am a small business owner, my taxes will go up – resulting in pay decreases for my employees and price increases for my consumers. I thought America was the land of opportunity, not the land of hand-outs...poor quality medical care w/ universal coverage sucks. If I wanted socialized medicine, I'd live in a socialist or communist country.

    December 21, 2009 at 16:50 | Report abuse | Reply
  3. Ken

    The email above from Mary Pagels shows why we need health care reform and NOW, not in 2014.

    Mary's story about being unable to afford the treatment she needs and also being unable to afford insurance is one htat is told too many times. I saw another story this morning on ABC about a Nevada couple, he is a local police officer, and their son was born with a heart problem that requires treatment the officer's health insurance won't cover. They were told that the best way to get the required treatment was for the Mother to divorce her husband and then she could get public assistance.

    Those who are opposed to this legislation seem to bristle at the thought that heatlh care is a "right". Fine, I won't argue that, but I will state that health care for all citizens should be a top national priority, and not dependent upon how much money someone makes, or which company you work for. There are many western civilized countries that recognize this as the top priority for their citizenry. The U.S. is wealthier than all of these other countries, but apparently we would rather spend our money providing security for the rest of the world, than security for our own!


    December 21, 2009 at 16:58 | Report abuse | Reply
  4. CBR

    We are impacted by health care costs every day. Seniors with the doughnut hole, hospitals paying for emergency room care for the uninsured, and the costs of medication in general since the government decides where medications may be purchased.

    I watch my friends and neighbors struggling to pay medical bills because they do not qualify for any health insurance. Those who are self-employed and those working in small businesses find health insurance cost prohibitive. As a result they are forced to decide which bills to pay. The end result, on this island neighborhood is a fund set up to help with fuel costs and property taxes. We also have increased donations to the food bank.

    Any way you look at it Dr. Gupta, those who can must help those who can't and this health bill may take some of the onus off of us.

    December 21, 2009 at 17:05 | Report abuse | Reply
  5. Ron

    I certainly hope this bill will affect me. My wife and I only have insurance on our 2 children because insurance premiums (and health care in general) are just too expensive.

    In order for my wife and I to also have insurance, it would cost an additional 20 percent of our annual income just for the premiums alone, not including the $5,000 deductible we would have to pay each year if we actually used it for anything other than twice a year checkups. That is simply not feasible or realistic.

    December 21, 2009 at 17:09 | Report abuse | Reply
  6. Mike

    Start with the premis 84% of americans currently have health insurance and 89% of them are generally happy with the coverage. Cobble that with the Census statistics that determined 45.7 million people who were in the census do not have insurance. Subtract 9.7M illegal immigrants (who under the plan would not be eligible for coverage), subtract those who can afford insurance and choose not to buy it and those who are eligible for medicaid but have not enrolled and you are left with approximately 9-10 million Americans who cannot afford insurance and/or who are permanently without insurance, approximately 3% of Americans.

    Now I ask the simple question is gutting the current system to help 3% of Americans who cannot afford insurance or who are permanently ineligible for coverage seem like the right thing to do?

    Before you accuse me of being a right wing nut, I believe changing the rules to ensure that those who have pre-existing conditions can purchase affordable insurance. I believe in making it against the law for insurers to drop the sick from coverage. I believe the government can and should help those who cannot afford insurance with some assistance. I do not believe in allowing those with no insurance or who did not have it because it was inconvenient should be allowed to buy it once they have become ill.

    However, it seems to me a complete takeover of insurance by the government will hurt all Americans in the long run. For the same reasons medicare is going bankrupt, and that social security is going bankrupt. Quite simply, the government cannot provide something for nothing and I believe this 'reform' will cost much more than the current estimate ($1.2 Trillion over 10 years). Look no further than Massachusetts universal coverage, in 2007 it cost $640 Million and in 2009 costs have doubled to $1.3 Billion.

    December 21, 2009 at 17:13 | Report abuse | Reply
  7. jedigal007

    I am wondering why people are so fearful about this bill. Who do they think is paying to cover the expenses of the uninsured and the underinsured right now? How much is it costing? How much will it cost in the future? How does that compare to this health bill's cost? And why are so many people happy with their current insurance plans? Is it because they have yet to be denied a needed coverage, or they have yet to lose their insurance due to illness? Do they think this just happens to someone else; that they are impervious? And let us not forget the ever memorable [and grossly misleading] Palin stirring of the pot....the death panels! As an RN of 35 years I must share my dismay with how our society refuses to accept death, and the adverse impact this has on the spiritual, emotional and physical needs of the dying patient. Palliative care is not a death panel; it is a specialized service of caring practitioners who help those who are dying just as a cardiologist is specialized to treat the heart. I am not saying this bill won't have it's pros anc cons, and I would like to learn more about it. But I can say the system we currently have is not meeting the needs of the patients, and it is long beyond time for change.

    December 21, 2009 at 17:19 | Report abuse | Reply
  8. Brad

    I see some of the typical partisanship and fear-mongering here. I don't think that's what was asked for. I would appreciate a coherent summary from Dr. Gupta as to his thoughts on what the bill got right and what it got wrong.

    As for me, I'm on COBRA right now because my small company doesn't have a plan. We want it but we have too small a group and the employees are too old to get good rates. I have a pre-existing condition that is totally under control but I can't qualify for a regular individual policy. I'm personally happy that pre-existing conditions will no longer be a reason to deny coverage. I just need it to happen sooner than 2014 since my COBRA runs out at the end of 2010.

    December 21, 2009 at 17:21 | Report abuse | Reply
  9. Ben

    No one has explained how exacly 500 bil. will be cut from Medicare?
    Who is going to get less: patients will get less treatment or providers will be paid less?
    Please someone explain the real meaninng of the Medicare cut.

    Also, is it fare to transfer 500 bil. from medicare to pay for people who are not entitled yet for medicare benefits?

    December 21, 2009 at 17:21 | Report abuse | Reply
  10. parker

    2014? A lot of good that does those of us without any coverage or benefits. I am a type one diabetic and can't get coverage at ANY price.

    So to me, any government option, coverage or benefit is far better than allowing the insurance industry total control over who does and does not get coverage. I can understand 'they' are in it for profit. But I just vomit everytime I see or read one of their feel good ads. Talk about lying and false advertising. I trust politicians and car salesmen more than the insurance industry.

    December 21, 2009 at 17:23 | Report abuse | Reply
  11. Terry

    With 1 in every 110 children diagnosed with autism (recent CDC study) my son will FINALLY get insurance coverage for his ABA therapy – we have spent $40K each year for the last 4 years out of own pocket to cover his therapy. My paycheck goes soley to his therapy – my husband pays for everything else and we live check to check. The therapy has changed our lives for the better but has NEVER been covered by insurance – now it will!

    December 21, 2009 at 17:31 | Report abuse | Reply
  12. Albert

    I'm in my late forties/early fifties. (I always keep that vague in public.) The reason I have no health coverage is simply because I do not have the cash flow to pay for it.

    It's not clear what the "Individual Mandate" will end up costing me. I live in NYC and believe me, earning about $34K is not a hell of a lot. As it is, I pretty much live paycheck to paycheck. To make matters worse, for tax purposes I am considered self-employed by the IRS even though I am by no means a business man or an entrepreneur. Just a guy trying to earn a living. As such, I have a much larger tax burden than W-2 wage earners.

    I can give up my Triple Play cable, Internet and phone and also my cell phone. (Giving up my cell phone could cause me to lose my job.) In total, that adds up to roughly $200 a month. Every other dollar is pretty much spoken for: Rent, Utilities, IRS, Credit Cards. So, unless the bill gives me a dollar for dollar tax break, this "Individual Mandate" has the potential to absolutely ruin me.

    December 21, 2009 at 17:34 | Report abuse | Reply
  13. Dee

    I have no assurance that the premium rates will be affordable, even if the insurance companies cannot deny you for a pre-existing condition. I cannot find anywhere that they are restricted from charging unreasonable premiums for pre-existing conditions. Does this exist anywhere in the bill?

    December 21, 2009 at 17:40 | Report abuse | Reply
  14. Philip J. Slama

    From what I have read in the entire House and Senate bills since they have not been reconciled at this point I understand that I will relatively unaffected at this point in time since my all of my medical insurance totals to about $2,200 a year for a single person (about 6% of my salary) I don't feel the same burden others do with a family.

    The one thing that intrigues me about the bills is the portion regarding illegal immigrants. Since I live in Miami we have quite a bit of experience with illegal immigrants who take advantage of emergency room services and leave taxpayers with the bill which means higher local taxes.

    What I have trouble understanding is how the enforcement of this provision of the bill will be undertaken? It is already hard enough to serve people in the emergency rooms but how does this affect the current situation?

    Of course it should be said that I am not against treating these people because the general health of the public is important here in Miami since we have major traffic from all parts of the world through our city and surrounding areas.

    I would just like to know how they plan to "enforce" this provision. From what I understand is that if they prevent the treatment of these people it seems to infer that our local taxes "may" decrease since the public hospitals would no longer be required to treat these individuals.

    December 21, 2009 at 17:45 | Report abuse | Reply
  15. Joy, AL

    I don't like this Bill. It's huge and messy and nobody is able to give a straight answer as far as the true cost and the actual benefit. Not only that, our President lied. He shut out the Republicans. He offered to go over the Bill line by line. One Senator took him up on that offer but, our President refused to do so. This Senator even went on several programs begging the President to go over this Bill, to express concerns.

    I am very concerned about how blatantly our government officials are abusing their power. This Bill was not passed for our benefit and most of us recognize that. This Bill was passed because certain elected officials wanted to meet some ridiculous deadline regardless of the consequences to its citizens. Now every citizen has to pay the price for their arrogance. Well, at least the middle and upper classes have to pay. Socialism, here we come!

    December 21, 2009 at 17:47 | Report abuse | Reply
  16. jacquie

    We are blessed with great health insurance because m husband works for a large company. I do worry about all the people without insurance, especially those with pre-existing conditions. What I don't really know is what this will do for the un-insured because I don't feel anyone has a clear understanding on what this bill will do. We need health reform but is there anyone that could possibly keep the politics out of the discussion and tell us what this bill means to us?

    December 21, 2009 at 17:50 | Report abuse | Reply
  17. Christine Finnigan

    Will this reform bill assist 20 somethings who have aged out of their parent's insurance policies and have no health coverage through their employer but do not earn enough to buy their own insurance?

    December 21, 2009 at 18:02 | Report abuse | Reply
  18. Shane

    Will my employers now drop their insurance, or drastically reduce their coverage due to this?

    I have concerns about the supposed money they're supposed to find to help fund it via efficiency changes in Medicare aren't going to be there, and it will effectively cost a lot more than they say. (ie. bait and switch).

    I'm concerned about mandated insurance. What does this mean? It sounds like a big tax to me. What if you can't afford it, are you fined?

    I have concerns about how many doctors we have to do this. Every time I take my kids to the doctor, or I go myself its a long wait. Ok, so you have insurance, can you get a doctor to pick you up now that they are basically going to be mandated an increase in patients?

    I have concerns about care, not so long ago we had stories of neglected care coming out of the VA hospitals for our troops.

    December 21, 2009 at 18:25 | Report abuse | Reply
  19. RJ

    All these comments "what about me, what about me" reeks of selfishness. I honestly have no idea what this bill means for my healtcare services. I have UnitedHealthcare through my company. But if the bill helps some people get access to insurance in 2010 then I applaud it!! Maybe in 2011 that number will grow until we're all insured. Do I like that? NO. Someone's life will be made better by this bill, even if it isn't yours. Stop worrying about what you may or may not lose. Concentrate on what might be gained!

    December 21, 2009 at 18:28 | Report abuse | Reply
  20. Obed Santos

    I don't think this will affect me at all. I'm on SSI, and I receive free health insurance. I call upon the Congress to raise taxes on everyone earning over $50K per year and use the monies to improve my benefits.

    December 21, 2009 at 18:33 | Report abuse | Reply
  21. Michelle

    While I believe each and every American is entitled to quality healthcare, I also believe this healthcare bill has become a monster and should be scrapped. I hate that we have politicians who live in ivory towers dictating what should and should not be for the poor in this country. The bill talks about government subsidies so that the poor can afford the premiums and then fines for those who don't pay. Based on this, I suppose all of the poor will eventually be behind bars for not paying their fines, but then again, healthcare in prisons is free.

    December 21, 2009 at 19:04 | Report abuse | Reply
  22. Patt Barrington

    I am hopeful that some part of reform bill will allow those of us in the construction industry to buy into a year round affordable insurance plan. Even when one job ends and another starts (with or without a noticeable break in employment) you are subject to a new contracting employment company for a new client. Depending on the lenght of the construction projects worked, you could have to change insurance companies (and make those new choices of coverage) often. Then, of course, when there is a break between employment you have no insurance. Affordable is the key. Not free, not too cheap; simply affordable.

    December 21, 2009 at 19:04 | Report abuse | Reply
  23. Jen

    I am relatively young and self-employed. I also have a pre-existing condition that is a lifetime rejection for all individual insurance carriers. This bill will affect me in that I may qualify for insurance for the first time – but I don't know whether the reform bill will prevent insurance companies from charging me a fortune because of my condition. Healthcare is one thing, AFFORDABLE health care is quite another.

    December 21, 2009 at 19:08 | Report abuse | Reply
  24. Robert

    It's bad enough that not A SINGLE SENATOR THAT VOTED FOR THIS BILL WAS ABLE TO READ IT BEFORE VOTING, but that TENS IF NOT HUNDREDS OF BILLIONS in pork was required to pass this bill before we even talk about all the extra taxes and fees. Is there ANYONE AT ALL who benefits from this bill? A single cancer case can take several MILLION a year to treat(and sometimes not even successfully!) At even 1 in a hundred thats 25K per person-how is conceivable that the general public can pay that?-Ohh, make it 50K as filtering it through the government makes us support the useless government paper pushers. In the 80's Reagan gave a speech where he said that if we gave cash to all those below the poverty level to bring them out of poverty, we would be spending HALF of what they were currently spending!

    I feel sympathy for those that have cancer or some extreme medical condition which they cannot afford to treat. But Canada and England have government healthcare and their YEARLY allotment for a cancer patient is 22K with 9 months for an appointment and then a YEAR to begin treatment! 22K might not even get a test and doctor's consultation! This "coverage" isn't going to help ANYONE who's posted here!

    December 21, 2009 at 19:21 | Report abuse | Reply
  25. dave

    health care reform to me is a bill to improve access without needed measures to improve capacity. The health care industry is expected to be short 150000 primary care physicians in 20 years. 65 million Americans live in areas that have serious shortages of health care providers. These trends will unfortunately continue. In addition quality of care will get worse as we stretch existing health care resources to meet the needs of much more people seeking health care.
    As I see it this bill largely serves the health care industry who spent $600 million lobbying Congress on this measure. The public will be shortchanged and the health care system will implode- probably within a decade-unless new measures are implemented that go beyond the short-sightedness of current health care reform.

    December 21, 2009 at 19:24 | Report abuse | Reply
  26. steve

    The devil is in the details so most of the information is still lacking for me since this has been changed in secrecy so many times but here's an idea of some-

    Why is beneficial to us about insuring 31 million when only 8 million are both eligible for tax-funded benefits and don't already have access to healthcare insurance?

    About half of primary care doctors won't take Medicare. Those who do limit the number of Medicare patients they will see. And many specialists won't accept it. Even more will drop it when the 22% reduction in payment to doctors takes effect in 2010. Very few accept Medicaid. What is in the legislation to make us believe that enough doctors with good reputations will take this insurance while providing the same good quality of care as for other patients?

    With the reductions in Medicare payments to doctors, how can we believe that doctors will spend adequate time caring for seniors? And what is in the legislation to prevent rationing of healthcare?

    Most, if not all competent doctors won't prescribe a course of diagnosis or treatment for patients they have never seen. So what makes government bureaucrats competent to determine what's appropriate?

    The number of doctors who won't accept Medicare and/or Medicaid is testimonial to the fact that the government isn't competent to run healthcare insurance or delivery. There have been many free-market alternatives to government-run healthcare that the Dems have rejected. What percentage of doctors support government-run healthcare over free-market solutions?

    December 21, 2009 at 19:25 | Report abuse | Reply
  27. Greg Paris

    If I said I could cut your private healthcare costs 40% tomorrow, would you be interested? Most peopel don't know that Medicare pays doctors and hospitals less than it actually costs (not less than charges, less than cost) to provide care, and you get to subsidize that through higher premiums on your private insurance. If we all paid the same price for care, your premiums would be 40% less.

    Anyone who thinks we are going to pass a bill that raises costs $850 billion and it will reduce your costs and reduce the federal deficit is a moron.

    December 21, 2009 at 19:29 | Report abuse | Reply
  28. Anonymous Science Nerd

    I've heard a lot about expanding coverage and preventing insurers from charging different rates based on health-status, and health-insurance exchanges. As laudable as these all may be, they bring up the cost of my premium and/or taxes. This bill is supposed to "bend the cost curve" so to speak. How does it do so?

    December 21, 2009 at 19:34 | Report abuse | Reply
  29. Jim

    Harry Reid said we need to pass this because people are dying out there. But he passes a bill that takes effect 5 years from now.

    Not only is this disingenuous, it is a stat that is based on an observed association, that is the death rate in those without insurance, and makes it a causation, which is unlikely to be true, and then extrapolates it to the entire population.

    To scare people with this type of dishonesty is outrageous. One can only hope this will be undone by future leaders. If government run care is so much more efficient than private health insurance, where are they going to locate 500 billion dollars in fraud and abuse in Medicare without cutting benefits? Is someone drinking too much of the talking point Kool-Aid?

    December 21, 2009 at 19:35 | Report abuse | Reply
  30. Ann Tate

    I am 61 year old woman who worked for 33 years and lost my job 18 months ago. After my cobra ran out I applied for insurance with the same company I have had it with for most of the time I worked and was turned down because of prexiting illnesses. I've applied for disability and live on a very limited income now. Hopefully I can get on medicare if I get on disability, if not I'm praying I stay well until I get 65.

    December 21, 2009 at 19:36 | Report abuse | Reply
  31. Mike Someone

    I spent the last 24 hours actually reading the bill. YOU MUST READ THIS GARBAGE. This so called health care reform bill has nothing to do with reform other than the name on the bill; it is packed with "sweetheart" deals. It is obvious that Nancy, Harry, and Obama realized that there plan was dead and "something" needed to be passed just to claim a victory. The only winners in this Insurance companies, illegal imigrants (yes if does cover them in emergency room cases), and the un-insured (this assumes all uninsured want insurance). Many of the uninsured may not want insurance. My 22 year old son does not want to HAVE to buy insurance. If the goal of "health care reform" was to cover the uninsured the congressional budget office has stated the coverage for these people could be provide for less than 10% of what this bill will cost.

    December 21, 2009 at 19:38 | Report abuse | Reply
  32. Lynne

    I am happy and proud of our legislators. Healthcare reform has been long overdue and many people will benefit from this much-needed change.

    December 21, 2009 at 19:39 | Report abuse | Reply
  33. Jon F

    No, health care won't – at least not perceptibly. My wife and I currently pay about $6,000 a month for horrible individual coverage. We will have to drop coverage long before this massive boated bill goes into effect in 2014.

    In 2018, I become eligible for Medicare, which is probably going to end up with very little left to it.

    So yes, I am annoyed, disappointed, and totally fed up with our government. They could have done this piecemeal and intelligently. Instead they chose a 2000 page monstrosity that will take years to decipher and implement. This is politics as usual in Washington – no change that I can see.

    December 21, 2009 at 19:48 | Report abuse | Reply
  34. Pam H

    Usually I do not write on these blogs, but in searching for info on the recent Senate Health care bill this afternoon I came across this blog and thought there might be some intelligent banter here on the issues. Instead, I see the same naysayers and for once I just could not resist responding. Seems to me like you people (Jeff, Pete, "Kathy Bates" - the list goes on unfortunately) should get on the Internet (or to your local library), download a copy of the actual bill, read some or all of it and stop watching all of the negative propaganda ads that we are all being inundated with on TV. Don't let other people tell you what is and isn't good for you, or will or won't effect you - READ, EDUCATE YOURSELF – believe me, it's powerful stuff. It saddens me to see this forum used as a springboard for more negative campaigning versus a place to find the real answers that some folks need relative to what this health care bill will do for them. I guarantee that the final bill will not meet everyone's needs - that's called COMPROMISE people – we all learned about it as early as kindergarten, but some of us chose not to pay attention and cling to entitlement instead. In this bill, some needs will be met and some will not, but this may be the closest we get to any kind of reform for many years to come. We are giving insurers way too much of our money and getting very little or nothing back in return. They've been telling us to drink the Koolade for years and we've just lined up to do so talking all the while about how refreshing it will be when we finally get to drink it up. Honestly - wake up people – the insurance industry is not your friend. Hopefully some of you will read this and get inspired to educate yourself on these issues and not just spew forth the misinformation you are being force fed.

    December 21, 2009 at 19:49 | Report abuse | Reply
  35. Pat

    In other countries when people pool their resources EVERYBODY gets to be treated by a physician of their choice, and all the medical care providers are paid well. Let's allow the parasitic insurance companies to go find some other way to make money. They are resourceful and would of course survive, but please NOT via the propagation of a controlling fear throughout the population with the illusion that they are in the business of "health care." If health care can be mandated & handled by the Insurance industry perhaps we should also let other financial institutions like banks handle health care coverage, too...whaddya think?
    Personally, I would prefer to have my doctor report to The People than to any financial institution. Most doctors initially go into medicine in order to serve and heal people, not insurance companies.
    What our politicians are grappling with is not health care reform – the issue is insurance reform.

    December 21, 2009 at 19:51 | Report abuse | Reply
  36. Dr Paul

    Why did they not raise the tax or as I call it the user fee on cigarettes by at least $2 per pack. That will not come close to the cost we all pay for the medical bills of those who enjoy this deadly choice but sends a message that those who partake PAY for it.

    December 21, 2009 at 19:55 | Report abuse | Reply
  37. Sandra Gander

    I am over 65 on regular Medicare and pay for private health insurance as a secondary carrier to cover what Medicare doesn't pickup. I am fortunate enough to have a retirement income that, at least at this time, is sufficient to cover the costs.

    The new Health Care bill will help me by helping those who can't afford health insurance at all get some coverage. Thus preventing the overall cost of health care from rising – my Medicare coverage included.

    I am very disappointed that our politicians did not have the guts to enact single payer Universal Health Care.

    December 21, 2009 at 19:58 | Report abuse | Reply
  38. steve

    CATO calculated that the first 10 years of healthcare coverage (2014-2023) will cost the government $2.5 trillion and will cost eligible citizens another $2.5 trillion in what citizens and companies pay to private entities in fees and/or fines. $5 trillion/10 years for 8 million fplks comes to $ 62,500/person/year. Simply buying private insurance for the 8 million would be cheaper so what's in the legislation that justifies the extra cost?

    Health insurance companies only make 2% profit on average so they can't afford to absorb the cost of government mandates like covering pre-existing conditions, etc. How much will they have to raise their rates to compensate for the extra cost of government mandates? Also, with a 2% profit margin, how can they afford to compete with the governemnt?

    December 21, 2009 at 20:03 | Report abuse | Reply
  39. Phil Sasich

    Dr. Gupta

    I sincerely hope you'll have the intellectual/journalistic integrity to call out some of the grotesque misperceptions and fears I see here.. E.g kathy bates suggestion that her current health care standard (large group coverage) will go down or that there will be a government list of allowed procedures.

    These are pure bunk. The bill has many flaws but the notion that it promotes rationing and incremental government control of allowed therapies and the Dr. Patient relationship is pure fiction..spun for political reasons...has nothing to do with the content of the bill.

    December 21, 2009 at 20:05 | Report abuse | Reply
  40. Sy

    This bill is a worthless because the Democrats and the Republics represent themselves and not the people they represent. They all want to get re-elected so that they have to bend to where the money is.

    If they were honest, they would vote to reduce the cost of drugs by letting them get imported. They would stop they insurance companies from walking away from a State when they have made their monies and then rape another State.

    Their is no competition where insurance Companies compete among each other to lower the cost of care. Preventive care should be free so that we will not have the poor die because of it.

    When the House and Senate vote to correct this mess, they must have the final product as their coverage, and not have the lifetime coverage with these high priced insurance policies which they have and 98 % of the public do not.

    December 21, 2009 at 20:06 | Report abuse | Reply
  41. Lewis G. Odom Jr.

    I noticed very few comments about what this bill will mean to the lives of millions of their fellow citizens. It is always about me, me, me. I have a very comfortable life as does my family. I am a member of the Federal Employees Health Plan and have been for over 50 years. I do not worry that one of my loved ones or I will be struch with a debilitating illness and expenses far beyond my capacity to deal with them. I just guess I am just a goody, goody two shoe who believes in the gospel of Jesus Christ and the wonderful charge he made to all his followers in the Sermon on the Mount.

    I worry about the future of Congress. I worked on and around the Hill for almost 40 years. While a Senate staffer we always thought in a representative democracy such as ours where small states are protected in the Senate, that a majority vote was sufficient to pass legislation. That has all changed now and our country is facing a parliament that can be eternally dead locked. It is not likely that any party will be able to maintain a 60 or more majority in the Senate. And unfortunately what goes around comes around.

    December 21, 2009 at 20:08 | Report abuse | Reply
  42. Betty Jones

    Although I do not agree with NO Public Option, I like other aspects of the insurance bill a lot. I am a working Registered Nurse on Medicare still putting kids through college. For the first time there will be health care benefits to over 30 million previously uninsured Americans. My taxes may be higher, but Republicans who say they are "family" people want to forget those 30 million. Why didn't they come up with a plan in the last 8 years to help those without health care? It is the "working poor" who are doing without so the rich can enjoy life. We need health care reform now!

    December 21, 2009 at 20:11 | Report abuse | Reply
  43. James Cusator

    Any bill passed will be compromised and influenced due to closed door arrangements with insurance companies, pharmaceutical companies and trial lawyers. They have the strongest special interest groups and lobbyists in this forum. Their profit margins will be protected. That is the reality of how politics and government is practiced. Although the system may offer increased coverage to the uninsured, it will likely be a restricted and limited coverage. The costs will be transferred to the physician in continued decreasing reimbursement and to the patients in higher premiums, increased out of pocket expenses and higher taxes.

    December 21, 2009 at 20:13 | Report abuse | Reply
  44. Mickey D

    I don't like the bill completely either, but one important thing was accomplished that being doing away with the Healthcare Insurance Industry being NO longer able to discriminate against folks with pre-existing conditions. This here Healthcare Insurance Reform will remain a work in progress over the next 10-20-years and I am quite certain along the way many more changes will be made. Kudo's to President Obama and those Democrats for finally at least getting the ball rolling on Healthcare Reform period! Double HEX on all those evil mean-spirited hateful Republicans who chose only to wage a war of fear on the American public instead of offering any positive maeningful counter-proposals to the overall debate!

    December 21, 2009 at 20:13 | Report abuse | Reply
  45. Ohio Doctor

    Dr. Gupta,
    I am very concerned about this bill. To be more specific, I am most concerned about the changes in Medicare in the Senate version. In our practice of over 50 physicians that represent the only physicians in our specialty for over 1 million people, we are considering dropping Medicare entirely because we will no longer be able to afford to see the elderly. We are also very concerned about the increased hurdles to jump through, the fines levied against doctors for resource usage without Tort coverage and the inability to review any decisions by the Secretary of Health and Human services in court or administration. This will be a terrible blow to our city, and I am afraid that the same thing is going to start happening at other cities across the country. My parents are on Medicare, and they are scared out of their minds, because many physicians in my hometown are planning the same move as our practice in Ohio.
    This will be even more probably if the SGR is not fixed and doctors are cut another 20%. The simple fact is that I believe that this bill may very well be spelling the end for Medicare. This is not being discussed in the media, and it needs to be.

    December 21, 2009 at 20:16 | Report abuse | Reply
  46. JB Sullivan MD MBA

    The senate version of health reform is an excellent platform to build on towards cost control, better quality of care, and universal coverage. The bill could have been much better but at this point this is a good start. the American people should profusely thank the democrats for their courage. The republicans have basically abandoned Americans. As a physician and health care executive I am pleased!

    December 21, 2009 at 20:24 | Report abuse | Reply
  47. Realist in Texas

    Since when was "living" a government granted right? Sorry people, but Darwin's survival of the fittest is the biological fact that no man-made rule can overcome in the long run. If you are able to compensate for infirmity by some other means, then you survive. If you don't, then, well, you don't. Face it, the concept of everything for everyone is less than 100 years old. You're a dreamer if you believe that any governing body on the planet can or would undo thousands of years of allowing the have-nots to die sooner than those with the means to prolong their OWN lives. Isn't the impetus to succeed in society to possess what one wants, to enjoy to the fullest and to live as long as one can afford? We either believe in capitalism or we don't. Redistributing our collective wealth for whatever reason, health care or standard of living, is socialistic or communistic. If you want this, go elsewhere.

    December 21, 2009 at 20:24 | Report abuse | Reply
  48. Kevin Munnelly MD

    As a physician and anesthesiologist, I think I have a better view of the american health care system than most. This is not a 'big win for Americans" as President Obama claims. Here are some of the reasons I think this health care bill is a disaster.
    Firstly, quality of care will go down drastically over the next 5 to 20 years as less qualified students go in to medicine. Why not work for a technology company such as Cisco, IBM or Google. Medicare already pays physicians apporoximately 20 cents on the dollar and now with a further 21% reduction looming it will be very difficult for young doctors already a few hundred thousand dollars in debt to make ends meet and get out of debt. I would hate to be a medical student now with this debt load and making cents on the dollar for each office visit or procedure.
    Secondly , of the 2.2 trillion dollars involved in the american health care system most studies say there is 20-25% wasted on excessive tests. Just think of the 23 year with a headache in the emergency room who must get a Cat Scan or MRI becuase of defenstive medicine and fear of being sued despite physical findings that indicate it is just a stress headache or migraine. There is absolutely no TORT reform in this bill. If the President really wanted to save money and make the health care system more efficent this should be one of the first goals. He could save 400-500 billion a year. However, he is a lawyer and his biggest contributors are trial lawyers. Enough said!!
    Thirdly, access to physicians will be a major problem in the next few years because of the loss of physicans and the30million more people in the health care system. It will be very hard to find a primary care physican for an office visit and the lines will be enormous. When Massachusetts initiiated their "great" reform the average wait to see a primary care physician increased to 6 months. I don't think Americans will be patient with all these delays as the system evolves more like the Canadian system.
    Fourthly , hospital reimbursement will be cut 155 billion over the next ten years. Many smaller hospitals will go out of business and the larger ones will have to merge to become "super" hospitals. Also , the hospitals will have to cut expenses to stay in business with less income. So there will be less nurses, radiology ,ekg techs on the floor. Good luck being a patient on the floor needing a bedpan or having another problem. Eventually it may become like China where family members have to stay in the room with a loved one to get things done in the hospital and watch over thier loved ones secondary to lack of personnel.
    Lastly , I know some of the politicians state the the AMA supports this bill. The rank and file of physicians and health care providers are against this bill by over 70%. The AMA trustees do not represent the
    majority of doctors and their misguided approval of this bad piece of legislation in the guise of improved coverage for all americans is truly pathetic.

    December 21, 2009 at 20:30 | Report abuse | Reply
  49. Harvey Karten

    Cuts in Medicare are scary. Since doctors are not required to accept patients, particularly if they don't like the kind of reimbursement they will get, more physicians will opt out of accepting Medicare at the very time that 31 million people, some of whom have built up an array of health problems, will enter the patient rosters.

    December 21, 2009 at 20:40 | Report abuse | Reply
  50. JR

    This bill will touch every American, their children and their children's children.

    MASSIVE debt and deficit. If we get to the point where we cannot pay the interest on the debt that we already have, as a nation we will be bankrupt. We were just warned by the Chinese that no one in the world wants more of our debt. We don't have much more wiggle room before inflation hits.

    Wake up. We go under financially and no one will have health insurance. We need reform but this crap bill is not it.

    December 21, 2009 at 20:42 | Report abuse | Reply
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