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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. Mark

    As a doc in an ER-we need a system. Docs won't do it on their own- this is the "business of healthcare" and profit or margin is a bottom line need that must be achieved to survive.
    Government does a great job with management in roads, military, and the social security of millions. Walk a mile in the shoe of the uncovered as they try to find a doc to care for their illness or their child's illness and you will know this bill was long overdue and very needed.

    December 22, 2009 at 01:12 | Report abuse | Reply
  2. observer

    maybe if you fat americans ate healthier and actually took care of your bodies you wouldn't require so much medical treatment. You are such a land of gluttons, economy based solely on consumption.

    December 22, 2009 at 01:14 | Report abuse | Reply
  3. bernie

    As a lifelong Democratic physician who is not a member of the AMA and staunchly supports Universal Care, I have been working with Republican California Gubernatorial Candidate Tom Campbell on a Health Care Reform Platform. Our collaboration produced a truly bipartisan, comprehensive plan which limits administrative waste, allows for choice, access and portability and controls utilization without rationing.

    I do not believe that the arguments and dilemma regarding the insurance industry and the single payor model need be so complicated. Polls and responses are only as good as the questions which are asked. Although there is a sudden rally by some individuals supporting their health insurance companies it primarily revolves around the simplistic question "Are you happy with your present insurance?" Questions which delve deeper or become more sophisticated should include "Are you happy with the double digit premium increase by your insurance company?", "Have you every had a hassle with your insurance company about who you could see or what the insurers would pay for?", "Does your insurance company work for you once they have your premium dollars by calling to see if you have received your screenings, taken your medications or are making other healthy lifestyle changes?", "Do you think that the insurance industry as a whole is competitive for your insurance premium dollar?", "What is it that your health insurance company actually does for you?" Were you to ask those questions, it would become quite evident that the rallying point FOR the insurance industry is really a rallying point AGAINST a government bureaucracy (the public option).

    The truly bipartisan solution lies between these positions in a non-governmental single payer system where High Deductible insurance is put out to bid and insurers are treated as a utility; where money is shifted from the insurers to the individuals to fund their individual HSA's so that they can be responsible for their own decisions; and developing a medical coach system independent form the doctor patient relationship to provide advice free of profit motives– "The Intelligent HSA "

    The issues of appropriate utilization to control cost versus rationing to control utilization also need not be so difficult. The issue revolves around the indemnity health insurance business model which dissociates the person receiving the service ("the patient") the person providing the service ("the physician") and the person paying for that transaction ("the third party insurer"). There is every incentive for the patient to want to get the most services (so long as they are being paid), the doctors to want to provide the most service (so long as they are being reimbursed on a fee for service basis) and for the insurers to provide nominal resistance to both parties such that premiums creep inexorably higher in a controlled fashion (so as not to attract too much attention!). There is tacit rationing by insurers already and stories aplenty to attest to that. If health care dollars are re-aligned with the patient rather than the insurance company you ultimately shift "power over decisions weighing financial cost versus health benefit to the only actor capable of making such choices: the patient."

    This discussion can be found at: http://www.theintelligentHSA.com

    December 22, 2009 at 01:19 | Report abuse | Reply
  4. Janece

    I heard today that adults with pre-existiing health conditions, in reference to health care reform, will not take place until 2014. This will not help those who need it now with pre-existing conditions or those who may become ill prior to 2014. In the next four years there will be a lot of deaths. We are in a recession and the job market has not come back. It will probably take three to four years before we see the light at the end of the tunnel as far a work force. Health reform should also include Physicians and Hospitals who charge astronomical fees. Example: Spent 10 minutes with a Doctor and he billed the insurance company $200.00. I asked why. The answer was "don't worry about it. Your insurance will take care of it". In the state I reside, Doctors are turning away Medicaid patients because the insurance doesn't pay enough. The Doctors who had prior patients with good insurance will not take them anymore because they have Medicaid, due to loss of employment. There is not enough Doctors here to cover Medicaid patients.These patients wonder around in stress trying to find some medical care. What happened to the oath Doctors took before they came into practice? What do we care about? Cost or Life? Politicians only want to humor us. They don't have anything to worry about. They are set for life. We have paid for their lifestyles. It would be a miracle if they took some cuts in their pay to help this economy and health reform. Again, Americans have taken the responsibility of what politicians have created. We are the ones hurting. They are making the calls to suit them, pretending to care about us.

    December 22, 2009 at 01:24 | Report abuse | Reply
  5. J. Le

    Dr Gupta,
    I wish you would do this for all of us before we can tell you how the health care reform will affect us: Summarize for us in bullet points what the reform will do or change.
    For example:
    * People who can't afford insurance (people who work, but job doesn't pay enough and doesn't offer insurance): how is the reform going to help them?
    * People who can't afford insurance (whether they work or not): are they going to be penalized? (where would they find money to pay the penalty if they can't even afford insurance?)
    * People who currently have insurance: is our premium going to increase and how much?
    * People who are on medicare: are their benefits being cut back?
    * People who are unemployed and lost their insurance: how is the reform going to help them?
    I just don't know enough to even tell you how this will affect me and my family!!!

    December 22, 2009 at 01:32 | Report abuse | Reply
  6. Geoff

    Dr. What are your thoughts? Be candid as a medical professional.
    Past three years I have been treated for cancer, lost Job, wife lost job, Cobra at $900 per month, money runs out, lost insurance, pay cash for tests, hope they stay good. Don't know what we will do if they go bad.
    Did you know you can not get private insurance if you have accepted Cobra and are still eligible?
    What are my options going to be in both the near future and five years down the road? Assuming I make it that long and that I get one of the jobs that the government will sooner or later get around to not destroying.

    Please excuse my sarcasm but I have had enough of us allowing this ludicrous group of "representatives" ignore the peoples demands.

    December 22, 2009 at 01:35 | Report abuse | Reply
  7. greg Miller

    It is easy to understand why a bill will show a deficit neutral reading when we are paying in 4 years ahead of time. This is hogwash! Personally, I believe if this bill is so great the first line should read "All members of the government ("ie. Legislative, Executive Branch") will receive these benefits from this day forward. I don't expect CNN will display this, since they also don't believe the corruption in the global warming fiasco is news worthy.

    December 22, 2009 at 01:38 | Report abuse | Reply
  8. greg Miller

    Also, of the ??? million who are not insured, how many have held a job in the last 5 years. This bill is ridiculous and must be stopped before it ruins the best medical system on the planet.

    December 22, 2009 at 01:43 | Report abuse | Reply
  9. webster

    Wwelcoome to our healthcare nightmare. Currently we have great healthcare. In the near future, we will all suffer from decreased quality helthcare. Just think about this one aspect. We will have to pay a federal tax on medical items like pacemakers, stents, hip replacements, etc. How immoral. Thank you Reid,Pelosi and Obama.

    December 22, 2009 at 01:49 | Report abuse | Reply
  10. Dad

    Mike, you sound like my son Mike. I'm retired and my health insurance has been going up astronomically the past five years. If something is'nt done to lower my insurance costs soon, I'll have to move in with you & your family and depend on you for my old age care.. Talk about scarey....!

    December 22, 2009 at 01:56 | Report abuse | Reply
  11. Charles MD

    I am currently in my 5th year of residency with one to go (6 total) to be a specialist (Oh, no not another physician-specialist sob story). I am 31, $175K in debt from medical school only. I had no debt from college. By the way, both were public, in-state schools for me. I drive a 9 year old car. I pay my bills every month to have a roof over my family and I pay my own disability insurance out of pocket, like most surgeons do. Fortunately I have health insurance and am healthy.

    I, like most of my colleagues, agree the system needs change but slow down and do it right. We all know what happens when we rush into things (Iraq war). The one thing that bothers me is the sense of entitlement people have. Every patient I see has a billing sheet on their chart. I see many patients with "Medicaid" listed and employer "none" who walk in with iPhones, Blackberrys, nice watches and are wearing high-end fashion clothes and shoes. Where do these people get their money? I especially hate it when they ask for prescriptions for Ibuprofen or tylenol so that Medicaid will pay for it and they don't have to.

    I work hard for my salary (ask any physician what residency is like, especially surgeons-me). I save if I want to buy something. Seeing this sense of entitlement disgusts me because I have essentially wasted 13 years of my life in school and residency only to be told that I will be paid 20 cents for every dollar I bill (and I won't see all 20 of those cents) and that I can't practice what is best for the patient. I will be 33 when I start on my own and will have to save for retirement, pay off debt and provide for me and my family.

    I foresee many physicians in all areas of medicine retiring early or changing careers. What good is universal healthcare if there aren't enough doctors to see everyone?

    Maybe I should just quit, default on my loans, declare bankruptcy, and collect public assistance so that I can have new clothes and an iPhone.

    December 22, 2009 at 02:01 | Report abuse | Reply
  12. George Swindell

    How can anyone reasonably expect that health care insurance premiums will no go up no matter what happens? ignoring the moral imparative, we need to eliminate, or at least reduce, the cost of uncompensated treatment, by requiring everyone to carry health insurance, (like we require drivers to carry liability onsurance). The devil is in the details and neither party has distinquished themselves in terms of educating the public and avoiding inflammatory sound bites. One strategy for the Republicans might be find a few moderates who will commit to voting for some version which would allow the Democrates to put Bill Nelson and other "pay to play" senators on the sidelines.

    December 22, 2009 at 02:05 | Report abuse | Reply
  13. Peter

    To MARY PAGELS

    Mary, your story is a sad one. If the system is not fixed soon, the health care costs are going to drive more and more people into your situation.

    You are (will be) spending over $600 a month on your insurance and not able to get the care you need. I think you should start looking into the option of outsourcing your medical issue. Look for highly reputed health institutions outside this country Mexico, Brazil, India. It might work out for you to dump your insurance companies and the brojen health system here and use the cheaper alternatives,. You may be surprised to find out that they are highly efficient, effective and costs only a fraction of what you have to pay here.

    Good luck!

    December 22, 2009 at 02:06 | Report abuse | Reply
  14. chris

    As a physician, I am very concerned about this impending bill. The time crunch is obviously the 2010 mid-term elections. This is the only chance the dems have to shove this bill through. I don't think the government should fund abortion (or even consider it). I don't think the government has done a good job managing Medicare/Medicaid. For those of us who have trained in medicine, we've seen the disasters in the VA healthcare system. I wouldn't take my dog to the VA, and I'm a medical officer in the Army Reserves. The government will destroy health care. They will "evolve" into a system where every procedure will be regulated, and possibly denied. The good physicians who can, will leave the States for a better life; devoid of higher taxes and red tape. The American people who spend their life working don't deserve a rushed attempt to carry those who feel entitled. It is a shame to see this path unfold. I hope that the senate loses most of its democratic seats in 2010.

    December 22, 2009 at 02:13 | Report abuse | Reply
  15. David Everest

    Everyone shold scroll up and read the post from Mary Pagels, if you haven't already. This is someone who the medical system has screwed over worse than anybody. What kind of people are we to allow this?

    I actually was moved to tears by this, Mary, if you are reading this, I wish I had a way to contact you and help you, but I don't know how to do that. But please know that somebody heard you tonight, and did shed a tear for you.

    Dr.Gupta (or your staff), if you are reading this, then you have Mary's e-mail address, and you should help her. Go public with how the medical system has violated her as it has. You will be doing a public service, and maybe she will be able to get the help she needs.

    David Everest, San Luis Obispo, CA

    December 22, 2009 at 02:13 | Report abuse | Reply
  16. J.V.Hodgson

    This is pure political ploys and acting to get cloture in the Senate so that reconciliation can begin.
    Thier will be changes designed to overcome Republican opposition based on thier basic demands, and the quid pro quo will be these crude pork requests will have to go and will because some good Republican ideas will buy the needed extra votes for passage being inter state competition for Insurance companies satisfactory abortion language, illegal immigration language and maybe even low cost medication imports and Limiting liability claims.
    Its all tactics to get a meaningful bill back to the Senate.
    Our congressmen and women and all presently insured americans have amoral obligation to pass the bill for the 31m uninsured
    Regards,
    Hodgson.

    December 22, 2009 at 02:15 | Report abuse | Reply
  17. Charley

    Almost any health care reform will have a major impact on my life and my family's life, but the House version is preferred over the Senate version.

    I am 56 years old and self employed. My wife is older than I am so when she retired and went on Medicare, I had to go out and obtain whatever coverage I could find and afford.

    I had one choice but it excludes a pre-existing condition (asthma). It also has very high deductibles and copays, as well as both annual and lifetime caps. I can easily afford this policy as long as my business keeps going, but even with this coverage routine medical care and medication will cost me 15-20% of my gross earnings!

    In the event I have any serious injury or illness, the odds are I'll end up bankrupt!

    I'm in fair health for my age (high blood pressure, cholesterol on the edge, never smoked, don't drink, diet is fair but exercise limited by asthma) , but there is almost nothing for preventative care, such as a colonoscopy or PSA tests, so I'm taking a lot of risks with my life and my finances.

    The Senate version will at least remove the pre-existing condition exclusion and the caps, but I expect it will also cost more – which is fine as long as the increase is realistic. The latter is less likely without a public option because I'm still locked out of joining a larger group that can negotiate better rates and share the risks.

    The House version with the public option is the best choice because then I would be able to buy coverage with preventative care. The costs are likely to be more manageable because I would be able to buy as one of a large group so the risks are shared and the costs are managed.

    The House version would also be better for mt ex-wife and one of my sons and my grandson. She has a job, but very limited health care coverage. My son also has a job with limited health care coverage. Both do not see a doctor on a regular basis and as a result have had health issues that could easily have been prevented and cost less, as well as reduced risks for more potentially serious complications.

    My grandson was born premature (3 pounds 11 ounces) and fortunately has had few health issues; however under the current paradigm, he is considered a high risk by the insurance companies and thus faces a lifetime of rate and coverage discrimination.

    We need a public option for everyone that is a square peg so the costs can be managed and the risks shared!

    December 22, 2009 at 02:20 | Report abuse | Reply
  18. Jan

    I am a three-year survivor of ovarian cancer. I am insured by the employer from which I retired. This month, my former employer informed me I would have to pay 100% of the premium - in my case, $1,161 a month for myself and my husband. That's a 240% increase. My husband already pays $480 a month for inferior coverage. He, too, has a pre-existing condition that makes it impossible to secure competitive coverage. I have no choice but to drop my husband from my coverage because we can't afford the $19,000 pricetag for insurance plus the $6,000-$8,000 we pay out of pocket. I have been praying that Congress would pass meaningful health care reform, but I am not sure the bills that are emerging from the two chambers will help my husband and I to secure affordable health coverage.

    December 22, 2009 at 02:40 | Report abuse | Reply
  19. anon

    what about the middle-class married couple?
    I appreciate the obsession with the poor but the middle-class is damn near poor, Washington doesn't realize that the world has drastically changed in the past 30 years and the cost of living has skyrocketed. Of course I have questions. Who trusts politicians anymore? why are they cramming this through ON CHRISTMAS EVE? if it's so great, take time and explain it to people. Republicans say one thing, Dems another, it's just nauseating.
    Republicans claim that under it there's a $12,000 PER YEAR MARRIAGE PENALTY.
    outrageous.

    December 22, 2009 at 03:22 | Report abuse | Reply
  20. don, Dayton OH

    My mind is blown by the amount of assumptions in the comments here. People have already decided that the sky is falling and they're losing this and losing 'that.'
    Kathy Bates (3rd comment) is already convinced she is doomed as a result of the new bill.
    Look here, everyone: NOBODY knows what this final piece of legislation will reveal or how it will affect you.
    But one of the problems with America (especially after claiming what a 'sad day' it is) is that Americans rarely take the time to sort the facts from the rumors.
    Remember all the 'death panel' talk? PEOPLE FELL FOR THAT stuff. It was AMAZING to me as an educated, rational, logical American that so many people openly and publicly embraced a lie like that.
    Not coincidentally, that was chose as POLITICAL LIE OF THE YEAR (from the mouth of Sarah Palin) by politifact.

    But you can't tell Americans anything anymore unless it's doom & gloom. They refuse to be optimistic even when the facts aren't in.
    This bill will reveal itself to us ONLY after it's been finalized. Until then, all these assumptions are a gigantic waste of time.

    I wanted a public option but I didn't get it. Guess what?
    I'm not crying and hemming and hawing over it because I want to read the important parts of the bill for myself. Anything less would be a waste...just keep watching Fox News and keep believing in 'death panels' and keep thinking the sky is falling.

    Me? I pay for private insurance and it's EXPENSIVE. I do it because I have to. And I'm going to stay optimistic about the potential this bill has. There is a lot of room for fixing it and making it better.
    Republicans shot themselves in the feet. They tried to spoil it and ruin it as best they can so that it wouldn't get the votes it needed.
    Well, surprise...it IS going to get the votes it needs so now they've inflicted this version of the bill on their supporters.

    So all republicans need to realize that this IS the result of republican input and debate as well. Don't just blame the democrats...they're voting to push it through but the republicans created what it ended up being as much as the democrats did.
    Keep that in mind.

    December 22, 2009 at 03:30 | Report abuse | Reply
  21. Bruce

    I am insured by Blue Cross and Blue Shield. What is in the health care plan to make it easier for people to understand the new billing system and to prevent double billing? Under the current system, it is very difficult for an educated person to understand charges that should or shouldn't be paid, let alone someone who has a little memor loss. Will the health care bill make it easier for us? Will rules have to be written before the bill has to become law?

    December 22, 2009 at 03:33 | Report abuse | Reply
  22. john susmaras

    Healthcare reform will have a positive impact on our family since we deal with the issue of pre-existing conditions. A family member has epilepsy and access to health insurance , particularly medications, is extreemly difficult . We currently use an expensive COBRA type plan to cover our family member.

    December 22, 2009 at 04:31 | Report abuse | Reply
  23. LJ

    The comments clearly show that our country needs reform. Yes, I have been impacted. My spouse & I were both forced out of work in our late 50's. Then the economy wrecked our 401ks. For seveal years we purchased into each other's job assisted insurance in case we were disposed of and when it happened we found ourselves paying close to $1,000 a month plus for ONE coverage-and the doctors in-network are a short list.. We did everything right, but our financial blood was sucked out of our veins and we face a very poor future.

    The question begs, if employers broker and facilitate medical plans how can the country ever expect to see a better economy with more available employment due to those costs? If contracts can be brokered then why can't a larger force like AARP or our government broker better costing?

    By the way I know of a stunch Republican who travels to Thailand to get dental & some health care. Amazing huh?

    I say YEAH for the public option!

    December 22, 2009 at 04:33 | Report abuse | Reply
  24. Bonnie

    I am not sure what to think as I have not seen all of the provisions, I wish there were an overview somewhere that hit all of the highlights of the bill for everyone to see..it seems as if noone wants the American folks to find out what is going on with the bill until the Congress passes it and we are all stuck with a mess that none of them will be subject to..the American people deserve the same sort of health care coverage that our elected officials get...after all we are paying for it out of our own pockets..how dare they think that they deserve better thatn the folks who elected them.

    December 22, 2009 at 05:41 | Report abuse | Reply
  25. Alex

    It is with interest I am following the course of health care reform in the US. I a medical doctor who used to practice medicine in Northern Europe (socialized medicine), and moved to the US to get the best medical training possible.
    In the socialized medicine each hospital department was allocated a budget by the goverment/politicians. The hospital department's administration then had to decide how to get the most bang for the buck. Their decision was generally not based on medical knowledge or medical ethics, but rather on finacial considerations.
    Let me give you an example. Patients who presented to our ER with stroke were treated based on their age. People 60 years and younger were admitted to the Department of Neurology and treated actively, whereas those older than 60 were admitted to the Department of Internal Medicine for observation only, to see if they made it. This was part of the "cost-containment" strategy.
    In surgical department the allocated money usually ran out around september or October, and for the rest the year the surgeons were not allowed to perform any elective operations, despite the fact that a lot of people were on the waiting lists for months to have their surgery done.

    In this system the medical directors (who were medical doctors) of the departments were the goverment bureaucrat's extended arm and had to play by the rules set by the goverment bureaucrats, otherwise the medical directors would be removed from their position. The individual patient's welfare took the backseat.

    The other aspect of socialized medicine that I despised was the fact that you had to put a pricetag on human life. Then it was the goverment bureaucrat's job to decide if that human life was worth spending X-amount of tax-payer money on. Inevitably this decision was based on how productive the person was for the society, or in other words how much tax revenue he could provide for the goverment if his broken hip was repaired in 2 months versus in 6 months, or her breast cancer was treated in 3 months versus in 6 months.
    In this culture the senior citizens were the biggest losers. In general the senior citizen were considered to be a burden on the society, as they were no longer prodcutive, but only consumer of the goverment entitlement programs (goverment pension option and goverment health care option for senior citizens). Spending any money on their health was considered waste, especially if they had a serious ailment.
    The sadest part was that the senior citizen considered themselves to be a burden on the society and did not expect any investment in their health. In general people did not have much expectations to the health care system.
    But that is not the case in America, yet. Currenlty the average american has high expectations to his medical care. That is why the the current health care reform, once passed, will set up the avearge american for an even bigger surprise.
    The good new is that the surprises are going to be trickling in slowly, one at a time, so people can mentally adjust to the changes. I imagine the following scenario taking place in the US:
    First the US Prevente Services Task Force will change their mammogram screening recommendations from every year to every other year based on financial considerations (cost-benefit analysis). Next the goverment bureaucrats will dictate who is eligible to be treated for various medical conditions (stroke etc.), and the private insurance companies will likely follow suit, if it is in their financial interest.

    Although currently I do not see my patients in the US accepting to be put on a waiting list for surgery for breast cancer (the average waiting list for breast cancer from the time of diagnosis till surgery was between 3-6 months in my hospital in Europe), I will expect, that once the current health care reform is passed, the people will gradually mentally adapt to the idea of waiting lists and denial of certain treatments based on some arbitary characteristics (age etc).

    As a supporter of the Democratic party and president Obama, I think it is unfortunate that the current health care reform is forced on people by a democratic Majority in the Congress/Senate/White house, and most likely will backlash and weaken the democratic party in the very near future. And what happened to the American originality? The whole world used to look up to the US as the intellectual pioneer, why are we now trying to copy a european health care model (socialized medicine), that is struggling in Europe?

    December 22, 2009 at 06:09 | Report abuse | Reply
  26. Dianne

    Obama stated that this bill will cut the deficit by 132 billion. He is lying and him and his cronies are working out deals to get this passed. Makes me sick. This bill comes in under 1T because they took out the Doc Fix of 270B and also they tax immediately but benefits don't kick in till 2014. Also they are counting on cutting 470B from Medicare which we all know won't happen. This is a gimmick of huge proportions. Also they are creating another entitlement program-CLASS for long term care.Again the takes your money right away for a later benefit that the CBO said is going to be broke. The bill was 2074 pages but with the latest amendment released and you know none of them read it is over 2500 pages. How can that be good. Government does not need to get involved in this and the true estimate of the cost is more like 2.5 T. We could have done things that didn't cost so much like take away regulations where you can't buy insurance across state lines, tort reform etc.. Obama just wants to say he passed Healthcare Reform no matter how bad of a bill it is.

    December 22, 2009 at 06:20 | Report abuse | Reply
  27. Sabrina

    I am FURIOUS with this bill. I am currently a Govt employee. I GAVE up additional salary to have good health insurance, etc. You can consider mine a cadillac plan. In my current job as a GS 12, I could be easily making 30-50k more in the private sector. I traded that salary for benefits. I am one of the ones that dumps 5k into FSA accounts for medical. I use it ALL up by August each year. Now they are only going to allow $2500? How does that help me? I am certainly going to be taxed to pay for others. We can barely pay for ourselves. 2 kids in daycare at $1200 a month is a LOT of money. All I see is insurance and senators getting rich off this plan. Why the heck does Nebraska get ALL of their medicaid costs paid in perpuit? I live in upstate NY. I pay around $5k in property taxes for a $100,000 house. NY already is busted at the 2 billion mark for medicaid and other free services. So we are going to get taxed more.

    How about reform medicaid. How about tort reform? Where is that? People who go to the ER for a pregnancy test that they can get from th DOLLAR store. People who abuse ambulance services because they need a ride across town. What about the mom with 6 kids who takes one to the ER to be seen for a cold and then decides they ALL need to be seen because it is free. What about going to the ER for a rx for motrin because it is FREE for medicaid there. Where is THAT reform. How about giving access to pcps?

    This bill makes me SICK.

    December 22, 2009 at 08:17 | Report abuse | Reply
  28. Ram Krisn

    Healthcare is a moral, etical and a human rights issue around the world. USA should in the forefront of this righteousness! How will tourists to USA be covered under the new legislation?

    December 22, 2009 at 08:27 | Report abuse | Reply
  29. Lee Irons

    What parts of the bill increases the number of licensed doctors, improves the quality of medical care, and decreases the cost of medical care (I'm not talking about the cost of insurance)?

    December 22, 2009 at 08:39 | Report abuse | Reply
  30. webster

    We were promised transparency by this administration. We are given a 2100 page bill, written in secrecy behind closed doors; rushed to a vote without being read to the people. HOAX and CHANGE! I am no longer a democrat.

    December 22, 2009 at 08:47 | Report abuse | Reply
  31. Marshall

    I am 62 years old, and took early Social Security, partially because my wife and I have saved enough for my retirement with her still working, and partially because of health reasons. Since age 11, I have had a chronic medical condition that resulted in heath insurance coverage being denied, unless I was willing to pay for unrated insurance – that is, poor coverage with a very high deductible, and a staggering monthly premium that is now more than $1200 a month for me as an individual. My wife has to have her own individual policy, but at least hers is not as expensive. As I understand the senate bill, there will be a tax on "Cadillac" health insurance based on the cost of the insurance, and not based on the coverage. Does this mean that my meager coverage and very expensive health insurance policy will cost even more?

    December 22, 2009 at 09:07 | Report abuse | Reply
  32. Bill Simerson

    One thing I know for sure, if companys did business like our government just did passing this health care bill, people would be going to jail. pay offs for a vote is like paying for business or a contract.

    Damn, I voted for change and I got a real crook in office. Isn't this called bait and switch???
    I thought Bush was bad... thing is, we all get it were the sun don't shine.

    December 22, 2009 at 09:16 | Report abuse | Reply
  33. Spencer

    So instead of paying for insurance for 20 years, now a person would just pay a $750 fine when they needed a $28,000 appendectomy? How is this suppose to add up?

    December 22, 2009 at 09:22 | Report abuse | Reply
  34. todd

    How can this be presented as a 'sincere' attempt at reform when the 10 year cost is skewed to give the appearance of fiscal responsibility yet does really show the annual cost of Obamacare? Taxed for ten and benefits for 5 or 6 years? Seems like nobody is really concerned about transparency, integrity or fiscal responsibility. And they wonder why we have problems with Politicians.

    December 22, 2009 at 09:27 | Report abuse | Reply
  35. Scott

    Will this bill or won't this lower or at least slow down the acceleration of health care costs? That's all I care about.

    December 22, 2009 at 09:41 | Report abuse | Reply
  36. Scott

    John has it right, "tax the rich". Never mind the fact that Americans are paying historically low, or close to it, tax rates, let's B and Moan about how we have to pay. Vote Republican the last 8 years with zero health reform and 2 wars? Tax the rich. Vote for a regime that allowed the world economy to crash? Tax the rich. Vote for the party that represents Bill Gates and Warren Buffet? Tax the rich. Yup sounds about right and also something about chickens coming home to roost.

    December 22, 2009 at 09:47 | Report abuse | Reply
  37. steve

    this health care bill will effect everyone by creating higher taxes and a bureaucratic nightmare. no one knows what is in this bill including eveyone on the hill

    December 22, 2009 at 09:48 | Report abuse | Reply
  38. Ken-Long Island

    Here is what you need to know. Ninety-four per cent of the people in this country will be covered. Not only will they be covered, but they will be entitled to any care they need, which in case you haven't noticed, even if you have insurance now, you are not always covered for what you need. Small businesses will be given subsidies for their employees, the donut hole for Medicare Part D will be closed, people with pre-existing conditions cannot be denied coverage, and there is no cap on care. It reduces the deficit, preserves Medicare and extends the availability of primary care. It is a clear victory for the common man over special interests. The bogus bromides put forth by Republicans would do none of these things. The supposed ability to buy across state lines would not bring down premiums. The reason they are less in rural areas is because rural people don't bother to read their policies. They are paying premiums for the barest of coverage. They only realize it when they get sick. What this plan does is value each and every individual by insuring their health, really insuring it.. The very people who argue against it are representing those who would fire in in a second as they have in this recession and leave you in the lurch.

    December 22, 2009 at 09:53 | Report abuse | Reply
  39. jodiRN

    I believe it will impact all of us dramatically.

    Due to the pending 2010 cuts in Medicare, many cardiology groups are being forced to close, as they will be taking a 30 to 40% reduction in revenue for their services. As such, many staff including myself will be out of work. Higher yet unemployment. Moreover, and worse yet, those outpatient facilities that provide vital cardiac care will mean many rural areas will have diminished access. People will no longer have the spread out outpatient clinics to turn to, and will be forced into one place (a hospital, where it's more expensive) for the same services now provided in a wider range of outpatient settings. The years it took to build-up these outlying facilities – closed – just like that.

    I think hospitals will fare well, as will the insurance companies, drug companies, and medical device companies. The drug companies and medical device companies will pass on their excise taxes to the consumers, causing an increase in consumer costs. The insurance companies will still be free to arbitrarily deny claims. Drug companies received even more leverage to gouge Americans who need non-Medicare drugs for decades to come.

    Physicians will be faced with an onslaught of 31 million more regular consumers, during an agreed upon physician shortage, leaving them more prone to error and at a greater risk for lawsuits. This, of course, will increase the lawsuits in this country, therefore increasing malpractice premiums – which will get passed along to the consumers.

    The government's new task force will make its decisions about which services they will score an "A", "B", "C", or "D" – effectively highjacking the patient-doctor relationship because the services THEY choose to score a "C" or "D" will no longer be covered by our insurance, and therefore not at our discretion to use – and we won't be able to shop around for an insurer who does cover it – because they'll all be regulated by the same government task force.

    If there is a public option, private insurers will ultimately be squeezed out leaving only the government and therefore even less choices, zero competition, and zero competition means less service incentives.

    Medicare will still go bankrupt, because a system that has 38 trillion dollars in unfunded liabilities, 60-90 billion dollars in waste and fraud, cannot be saved by cutting $470 billion in payments to providers. AND, even if they do cut Medicare reimbursements (even MORE than what is already pending that will sink cardiology, for example) access will diminish for everyone, not just those on Medicare (Medicare drives the reimbursement rates. When Medicare cuts, private insurers follow-suit. And Medicare/Medicaid often pay less than what it costs to provide care. CMS states the Medicare Economic Index – ie., inflation for cost to provide care, rose 54% between 1992 and 2010, while reimbursements rose only 11%). Access will diminish for everyone because of my example above, clinics will be forced out of business, and the affects everyone, not just those on Medicare. True Medicare reform and health insurance reform will fail to happen.

    December 22, 2009 at 09:55 | Report abuse | Reply
  40. Greg Smith

    I would like to know what insurance reform is next because this bill doesn't have anything to do with healthcare reform. Is the next target car insurance reform? Car insurance is expensive and most states require that you carry car insurance. Driving is a right as much as healthcare in that it is necessary to go to school or work or shopping. Why is it if I have poor driving habits do I get charged more for car insurance than someone else? Why does a DWI arrest or an accident drive up my car insurance costs? Shouldn't all people who are not covered by car insurance be provided it by the a tax on the rich? Shouldn't illegal immigrants have the ability to buy car insurance so that if they hit someone they are covered?

    Now how about homeowners insurance? Dental insurance? Vision insurance?

    I understand that actresses, musicians, atheletes etc have body parts insured. So why can't I get my legs insured and paid for by those rich people?

    Where does it end? And if it doesn't end who will need to be defined as rich to pay for it?

    December 22, 2009 at 09:57 | Report abuse | Reply
  41. AMG

    Why won't Congress and the House of Representatives listen to the American people? WE DO NOT WANT GOVERNMENT RUN HEALTH CARE SHOVED DOWN OUR THROATS!!! We need to reform the money-hungry lawyers who try to destroy doctors and hospitals by suing them for obscene amounts of money. Congress and the House of Representatives should be fired; all of them, and we should start over with a clean slate and no one should be allowed to serve more than six years. And if THAT does not work, make all of these so-called representatives have to sign up for the same healthcare mess they are shoving down our throats. What is good for the goose should be good for the gander.

    December 22, 2009 at 10:00 | Report abuse | Reply
  42. Dr. Rich

    As a physician running a 7 man practice, I hear everyday the concern and fear about what this reform will do to the patient-physician relationship. Making physicians "gatekeepers" that are on a capitation arrangement pushes true rationing right into our exam rooms. our administrator already is concerned how we can maintain staffing, purchase new equipment, ect and the reality is we probably will not be able to stay in business. Our physicians will never make patient care decisions ( especially with no tort reform in this "reform" bill) based on financial incentives so 2 of our doctors ( both in their mid 50's) will retire early. I have heard of about 15 doctors in our small community that also will retire early or "go work for the university" about 29 miles away. Rationing is coming folks, like it or not, and this bill is the reform you don't want or need. Nothing is in there that is true reform, it is just a way for the uninsured to be covered. The AMA sold out doctors which is one of the reasons that most practicing physicians won't join the AMA. They have no idea what it is like here in the real world. SO there will be less doctors to care for not just these newly insured patients but the millions of baby boomers that are reaching 60 and will demand more services. Be prepared to pay in cash for services folks like they do in Europe or just sit and wait in line. This will be a disaster but we won't know it for about 5 to 10 years.

    December 22, 2009 at 10:01 | Report abuse | Reply
  43. CI

    I just don't see it working. If the US population is roughly 310 million, and 40 million are uninsured, it just seems illogical to reshape healthcare for everyone instead of targeting that 1/8 population who is uninsured.

    Also, it bothers me that we are the WORLD'S leader in obesity, and that childhood obesity has trippled over the last 40 years. I read on cnn.com that obesity related health effects will be an estimated $380 billion by 2020 (currently obesity related issues are about 15% of all health care costs). In general, how about we quit making excuses for our poor lifestyle, drink more water, exercise more (really only takes maybe a solid 30 mins per day), and do our part to help ourselves (cancer, alzheimer's and the like are what we can't prevent but obesity we can).

    Dr. Gupta, can nothing be done to simply lower the affordability of health care to increase the likelihood that the uninsured will obtain sufficient care rather than reshaping a trillion dollar industy in the midst of one of the worst recessions in US history (such bad timing)?

    December 22, 2009 at 10:02 | Report abuse | Reply
  44. Billie

    We have coverage through my husband's employer. He works for a small company and they have already told the employees that if this goes through..they will cancel their contribution to any health care program and we would have to seek enrollment to the gov't program. He has already had his hours cut and they are expecting more cuts in 2010. NY State is in trouble financially and small businesses are struggling. We, like many other New Yorkers are looking at other states to live.
    My husband and I both believe that having the Government handle health care is the worst possible decision. There will be more waste...more people falling through the cracks and Medicare (with it's cuts to the program) will be even worse than it currently is now.
    We have turned at the fork in the road that has a sharp cliff at the end. I am extremely concerned for our children and their children. With government getting involved with so many areas of our lives...our freedoms are disappearing and that is very sad. Health care is NOT working properly but what has been put in place is NOT a good choice. And, interesting, our Congress is NOT listening to their constituents.
    To force people to purchase health care insurance is not what I expected from our government. Many people just can't afford it. The winners here...the Health Insurance Industry.

    December 22, 2009 at 10:11 | Report abuse | Reply
  45. Nancy Fraser

    They really have it wrong, don't fix medical care we have the best in the world. FIX INSURANCE companies. They control what in covered and not in this country.

    December 22, 2009 at 10:19 | Report abuse | Reply
  46. Zuella Wylie

    If this health plan is so good and all the government officials think they can rule on how we get our health care, why don't all of them give up the health plan they have and get on board with ours. It seems to me all they can do is treat us like little children who don't know anything and say just do it.

    December 22, 2009 at 10:21 | Report abuse | Reply
  47. Keith

    Should this monstrosity come to pass, I will almost certainly lose my current coverage, a cheap, high-deductible health insurance plan coupled with a Health Savings Account. The plan will not meet the minimum benefit level prescribed by either the House or Senate bills.

    So much for keeping my current coverage if I like it, right? Congress and Pres. Obama have essentially decided that health "insurance" should not be about risk mitigation but should instead function as pre-paid health care, and that the costs of health care for the entire population should be socialized.

    The end result? The young and healthy (me) pay more for health insurance coverage so that the older and sicker can enjoy artificially low premiums. As with Medicare, Social Security, housing bailouts, etc., the young are forced to forego opportunity so that the old (who, in most cases, also happen to be the relatively wealthy) can enjoy a lifestyle they never earned.

    My generation's only hope is that we can screw over the next generation of suckers as much as we've been screwed. Wait a tick, isn't that how a pyramid scheme works? ("Now just get four friends to join....")

    December 22, 2009 at 10:32 | Report abuse | Reply
  48. Mike

    I am a democrat, but this reform is shameful........

    why should I pay for the useless guy who donot want to work and want free health insurance from my money...

    days are numbered for this US 'super power'...Shame on Obama. he is the one motivated by special interest(black votes)

    December 22, 2009 at 10:33 | Report abuse | Reply
  49. Mary

    My issue is Medicare Advantage. This is not "free" to me, I pay into Medicare System like everyone else. The government then pays Kelsey Seybold to take care of me, a fixed amount and I think it's around $1200 a year. If they take this plan off the table, I become the government's responsibility for all my health care instead of kelsey Seybold's. Where are the savings in that?

    My second and major problem is the arrogance of the president and Congress who are quoted as saying they don't care what the polls say or the American people think, they've done this for our own good. As an educated adult I'd like to decide what's being done for my own good.

    Finally, how can anyone vote for something when they don't know what they are voting for? Incredible. Can't wait until Nov 2010.

    December 22, 2009 at 10:43 | Report abuse | Reply
  50. layla

    Both my husband and I have pre-existing conditions and our medical insurance runs out this June. The public option is for people like us. I have spoken to folks within my own family and friends that feel like the public option is charity that they are paying for. But these folks have never had a chronic disease and needed to use their plan significantly. We never thought we would either. And here we sit scared for health and lives. My husbands Cancer meds cost $3,000.00 every three weeks and that is not counting his infusions of Chemo and Doctor's visits. I have Rheumatoid Arthritis and need infusions every 8 weeks and these are expensive. But I cannot live without them. I ask those people that are against the public option "what would you do?"

    December 22, 2009 at 10:45 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.