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. Nebcal

    I strongly believe this bill will impact on middle class tax payers. Property tax, fed tax and other taxes will go up significantly to pay for this bill. Therefor we will see big reduction on take home income. It will increase foreclosures. I just don't understand why do we need to pass this bill now? We don't even have money to start this bill. We are in big debt!! This Obama and Harry Read Healthcare Bill is not fair to the hard working middle class people. This bill is disaster!!

    By the way, 40% of Americans are none tax payer and those one's are strongly for this bill.

    December 22, 2009 at 10:53 | Report abuse | Reply
  2. Lynn

    By the time any of the reforms go into effect, I'll probably be on Medicare. I have struggled for years trying to change insurance companies, but have been rejected by all as I'm a cancer survivor. Even before I had cancer, I had gyn surgery & the insurance companies that would accept me at that time would only due so if they excluded any gyn coverage for me. Yep, I'm damaged goods apparently. My premiums are prohibitively high & I have to pay for them out of savings. A number of things my doctors recommend are either excluded by my policy (I had to take a lesser policy as mine had gone up to $1315 per year – a $465 jump in only one year for their basic policy) JUST FOR ME!) or too expensive for me to pick up what they wouldn't pay.

    For any person in elected office thinking reform is a bad idea is either extremely beholden to the insurnace/pharmacudical industries or extremely selfish & self serving – not the kind of person we need representing the American people.

    December 22, 2009 at 10:53 | Report abuse | Reply
  3. Brian

    Of course I will be impacted. It is impossible not to be. When rules change and new nationwide mandates are put in place everyone is impacted. This bill is a joke. It DOES NOT increase competition. In 2014 it forms a not for profit national exchange but that does nothing to increase competition. It allows those in the exchange to get better rates but even supporters admit this will only include approx. 6 million Americans. That is less than 2% of the population. 16 million more people will be added to Medicaid. GREAT! Let's add another entitlement that states have no way of paying for. The Senate bill only provides for partial federal support of the increase for 3 yrs. Except in the case of Nebraska. This will enable people to become dependent on the government even more, when the govt can't afford it. The bill mandates that everyone must buy health insurance but only partially subsidizes it. Good luck to all you kids fresh out of college. You will have a hard enough time making rent let alone pay for your health insurance. Oh but if you can't afford it with the subsidy you can give the govt 2.5% of your income and they will let it slide. The bill does not lower premiums. In fact, as the White House and Congress members have said, it merely slows the increase in the cost of premiums. This bill needed to accomplish 3 things. 1.) Health care for all 2.) Increase competition 3.) Lower the cost of Health care.
    Unfortunately it only partially accomplishes the first one, by a mandate and an increase in govt entitlements. It would have been easier just to let us buy coverage accross state lines, don't you think?

    December 22, 2009 at 10:54 | Report abuse | Reply
  4. Concerned American

    OMG where to start on this disaster! I sell insurance (esp) to seniors. I also live in Nebraska with the idiot Sen Ben Nelson. He & others really need to get their religious views out of our government and out of my personal life!

    Im really hoping that we Americans wake up & VOTE THESE PEOPLE OUT OF OFFICE! they are NOT doing us any favors by passing this & forcing it upon us.

    why cant they fix what we have to make it better. we already have medicare & medicaid...they already have the federal exchange.
    all they need to do is open up the federal exchange and work on making medicare & medicaid BETTER.

    and then waiting 4 yrs for this to take effect??? This is not going to help anyone, they need the help now!.....

    my husband & i own our own business & we are the only employees...he also works part time so we have health insurance and has a good plan. someday we would like to get our own health insurance....but NOT with this insane mess

    December 22, 2009 at 11:03 | Report abuse | Reply
  5. ahmad rachidi

    I had lung transplant four years ago and since than my medical insurance keep going up about 60 percent every year i called my agent his reply was they do not want to insureme any way in couple more years I will not be able to afford it any mor in the new bill is there any mention of a limit how much the insurance company can increase your premium.

    December 22, 2009 at 11:04 | Report abuse | Reply
  6. Cordila

    Every time I move states, I have to get new health care coverage. As we are the 'united' states, I find this odd. Will this health care reform bill allow us to keep the same insurance coverage from state to state? If not, can you explain to me the reasoning behind why this is so?

    December 22, 2009 at 11:04 | Report abuse | Reply
  7. Cynthia Beasley

    Everything about the health care reform bill is confusing. So many changes have been made to accommodate (buy votes) from sly Democrats along with Harry Reed's hiding of the final bill from the Americans who pay their salary and from Republicans until the last minute, what will I actually be paying for? If one red cent of my money is used to pay for abortion, then I am affected. I am an educator in a public school system in Louisiana whose employer pays 100% of employee health care. Since my husband and I both work for the same school system and have for 24 years, our health care cost to our family is around $12 per month to insure our children. I believe that there is much collusion and lies in the package being forced upon Americans, therefore none of what is in the bill is honest enough to make any difference other than negative on each and every American citizen...including the freeloaders out there. Do not get me wrong, I am willing to help others, but not the drug users, gang members...hey, are they going to send Democrat leaders into the hood to collect the fine from those gang members and other thugs? Perhaps that's the solution to this attempted Congressional gang alliance. True reform should start with the entitlement programs that have been messed up by EVERY president since their inception. Stop, take a true assessment of the current programs and proceed from there...together....all parties...keep Chicago out of the White House.

    December 22, 2009 at 11:04 | Report abuse | Reply
  8. gabby

    Irrespective of what the naysayers are touting about INSURANCE and Pharmaceutical Companies, the truth is there has been no new Insurance company created in the last 50 or 100 years. If you tried to create an insurance company, you would be taken out worst than the Mafia. Insurance companies are synonymous with "RIP Off'" and the things that they get away with, you would think that if congress found out they would be made illegal. But fact is, your Congressmen and women are not only in bed wth these insurance companies, they are also in their pockets. So who care about the average American? Not your Insurance companies nor your Congressman. More Power to Obama for taking the boldest step in a century! The American people cannot ask for better!

    December 22, 2009 at 11:08 | Report abuse | Reply
  9. bmw

    I am on an insurance program and have been all my life. What I do not understand is why the public option is such an issue. Those of us that pay for all of our health care are currently covering the costs of those that do not have health care. We either pay in higher taxes or higher emergency room costs and of course all medical care in general. If someone is on medicaid why should't they be paying a premium for health care just like medicare. Those that cannot afford ins. usually get a full tax refund they could use for ins. A small premium from every individual would go a long way towards reducing health care costs and allowing the 31 million people to practice some preventative care.

    December 22, 2009 at 11:14 | Report abuse | Reply
  10. Robert

    I have worked since I was 16 years old, including 2 jobs while putting myself through 5 years of college. I am now 58 and trying to figure out retirement options. In all of my working years, nothing the Federal goverment has done has ever resulted in a net benefit to me or my family. It all costs more because of government inefficiency and the accompanying huge staffing costs.
    This health "reform" bill is stuck together by a bunch of out-of-touch politicians who will probably never have to worry about using it. Where is all of the additional medical capacity going to come from, if millions more people start seeing doctors more often? Throw in a couple more million illegal immigrants, and see what a mess results. Thanks a lot, Washington.

    December 22, 2009 at 11:14 | Report abuse | Reply
  11. ajay dave

    Requiring employers to pay for their employees' healthcare insurance will affect all small business owners like myself. This kind of bill, as well as other bail outs that leave out small businesses, is surely going to affect the overall economy.

    December 22, 2009 at 11:16 | Report abuse | Reply
  12. Karl

    Dr. Gupta,

    My best friend is HIV positive. He is currently on, what I call a cocktail of insurance plans, Ryan White, Medi-Pass, Medicaid etc... Sorting through the different is very confusing.

    Will this health care Bill simplify things for him?

    December 22, 2009 at 11:16 | Report abuse | Reply
  13. Elizabeth Stubbs

    Did I get this right? The insurance companies spent $39 million dollars this last year on lobbying–enough to treat every man, woman and child in this country for CANCER! This is truly sick! The insurance companies are no better than the fat cat bankers.

    December 22, 2009 at 11:17 | Report abuse | Reply
  14. Jon

    How is getting charged for not having government run healthcare and different from the "big brother" government of the Bush administration wiretapping?? So because it's supposed to be for the betterment of America's health it's ok but if it's for our security it infringes on basic rights??

    December 22, 2009 at 11:17 | Report abuse | Reply
  15. missblondi

    I'm hit on both sides of this debate. I am 43, wear two hearing aids, have two kidneys that are failing due to a 2ndary disease acquired by malpractice that was caught after Florida's statute of limitations, so every bit of medical care I need comes out of my pocket and whatever insurance company I happen to have at the moment. Hearing aids are considered "cosmetic" in nature for someone my age, irregardless of the fact that I need them to work... I take 7 pills a day just to get up and get going, even with insurance the total out of pocket is over 300 dollars. I have a 13 year old that is extremely smart with a bright future ahead of her, and a 20 year old that is getting ready to apply for medical school...and a husband that is killing himself working overtime so that I am able to stay at home and try to keep from going in the hospital. Ironically I used to do medical billing, so I do know that Dr's really don't make that much, it's the insurance companies that are the crooks in all of this.
    All in all, I think changes need to happen, a public healthcare? NO. I would die before I was able to receive the transplant that I will need...Regulations need to be made on the insurance companies and the hospitals. Not the physicians, and not the consumers. Nuff said? I hope. I pray.

    December 22, 2009 at 11:18 | Report abuse | Reply
  16. Larry-T

    This bill will help by starting to rein in the excesses of the criminal class known as for-profit health care insurance companies. The right wing blather about a "takeover of health care" is garbage. Health CARE has already been taken over by the Health insruance industry. What we have now are insurance company clerks under pressure to deny coverage for any reason in order to inflate the profits of their companies. A takeover of this industry by the Federal government would be a vast improvement.

    Everything the right wing accuses the Democrats and Progressives of wanting to do is what their fascistic allies in the insurance industry have ALREADY done. That's the "inconvenient truth" they don't want you to hear.

    December 22, 2009 at 11:22 | Report abuse | Reply
  17. Gary

    I have spent a lifetime keeping my body in excellent shape. Eating right, exercising regularly, keeping my weight down, fighting the genetics of my family (heart disease, obesity) Now I will be penalized for this. I will have to pay the insurance costs for all of the people who have done nothing.

    December 22, 2009 at 11:24 | Report abuse | Reply
  18. Perry

    I have no clue what this bill contains. All I hear is you will be forced to pay for health insurance whether you want it or not. And you will be fined and go to jail if you don't pay for it. Unless you are qualified as living at the poverty level.

    Is this true? I can't afford health care. I am above the poverty level but I need my meager salary to pay my bills. Will i be imprisoned for not participating?

    What happened to freedom of choice? The president should throw his Nobel Peace prize in the garbage if this is true.

    December 22, 2009 at 11:26 | Report abuse | Reply
  19. Bill Pierce

    If anyone thinks the present health care is bad just wait till Obama care comes into play! I see nothing in the new bill that would stop healthcare providers from jacking up the prices. Hospital, Doctors, Dentists and insurance companies will have a blank check book. The ones that are being controlled and deprived of excellent medical service are the ones paying the bill, the tax payer. Bill

    December 22, 2009 at 11:28 | Report abuse | Reply
  20. Steve K

    Dear Dr.

    Please make it clear to your readers that this legislation is NOT about taking from the have's and giving to the have-nots. Please please please.

    I know so many people who have good, affordable coverage through their employer who oppose reform because they think their coverage will be adversely affected. Opponents of reform have contributed to this fear pitting self-employed workers against everybody else. We who are self-employed need this reform.

    December 22, 2009 at 11:34 | Report abuse | Reply
  21. Voice of Reason

    There are major implications that many do not realize.

    What the current bill fails to do is to fix the ridiculous Medicare reimbursement cuts. Medicaid already often fails to cover even the basic costs of care provided but since revenue can be made up from other sources (Medicare and private insurance), most providers are still willing to care for these patients. However, if Medicare also becomes unprofitable, all bets are off. We could see many providers deciding it is not worth taking Medicare and turn away these patients. The bigger issue then becomes that these hospitals, if they no longer receive Medicare dollars, are no longer bound by EMTALA and therefore can turn away any patient that is not profitable. Then hospitals that get these dumped patients are unfairly burdened and could go under financially leading to a vicious cycle.

    In the short-term, seniors stand the most to lose but in the end we all will lose and ironically, health care coverage becomes more starkly stritfied between the haves and have nots. I'm not sure what the rush is. When making such drastic changes in people's lives and in the economy, we should be taking our time, not rushing a poorly-conceived, watered-down bill through the door.

    December 22, 2009 at 11:41 | Report abuse | Reply
  22. Donna

    Dear Dr. Gupta,

    We keep hearing about the drastic cuts to Medicare, yet I cannot find out what it is that is actually being cut. I have searched on the internet, listened to different news broadcasts and still have not heard the truth. Please post the actual changes on this website for those of us who are on Medicare to see. I am on Medicare, not one of the HMO's, etc. My Husband will be elgible for it in 2010. Are we going to be able to get the care we need?

    December 22, 2009 at 11:43 | Report abuse | Reply
  23. epworth

    What most people do not consider is the fact that they will not be able to retire before age 65 or 70 without health care.
    Health Care will cost our children 20,000 to 30,000 a year in the future if there is no government program.
    They would have to have a retirement income of 50 to 60 thousand a year just to survive.

    December 22, 2009 at 11:44 | Report abuse | Reply
  24. Michael Ronn

    Yes, reform will touch me. But, maybe "fondle" is a better word. This doesn't look like a perfect bill, but it's definitely a step in the right direction.

    December 22, 2009 at 11:45 | Report abuse | Reply
  25. RJ

    I am retired and have a Medicare Advantage Plan. I am extremely concerned about the government's proposed onslaught on these plans. They are basically a Medicare HMO and are fantastic - give you much greater access to services and physicians than straight Medicare - at the same cost.

    We seniors pay for our Medicare plans via deductions from our Social Security - and neither is an "entitlement" program, as so many uninformed "young" posters like to claim. We have paid for Social Security via FICA taxes all our working lives.

    Social Security is broke, they say - why? Because the government continually raids Social Security funds for other purposes.

    I am also concerned about health care rationing for the elderly - which exists in virtually EVERY nationalized health care program in the world. (I.e., after a certain - and NOT so old - age, you simply are not permitted a hip replacement - just one example).

    I agree totally with Mike and others who ask why should we completely gut a system that is pretty terrific - rather than fixing the small part that is not.

    I don't see how any sane person can look at this "reform" and see it as anything other than the deliberate attempt by this administration to take over the nation's health care system - and then another and another - and all behind the cloak of darkness.

    I think this is an abomination, and I am outraged.

    December 22, 2009 at 11:51 | Report abuse | Reply
  26. Bobby

    Reading these comments, what I don't understand is: Why are people saying that this bill will hurt doctors and nurses when the largest doctor and nurse associations in this country support this bill? Do these people think that doctors and nurses are masochists and will support something that hurts them? It makes absolutely no sense and goes to show just how easily and efficiently the Republican misinformation machine works.

    December 22, 2009 at 11:52 | Report abuse | Reply
  27. kaetcalloway

    YES, this will help me. I have been in perm/temp limbo for 19 years with no access to a real health insurance policy; currently only a discount program I dropped because it doesn't pay anything. I have asthma and am partially disabled, I can't get any form of insurance on my own. The ability to buy into a temporiay plan until the health care exchanges are in place will be a Godsend for me. The fact that pre-existing conditions won't matter is huge. I may be able to go to the doctor instead of having to try and treat myself in in way possible. I don't go to the emergency room, I can't afford it, I just suffer through and hope I make it. I have watched this process very carefully and I will NOT forget those who tried to derail the bill. I'm not asking for anyone to pay for me, just the ability to buy into an affordable plan that will actually pay back when needed.

    December 22, 2009 at 11:54 | Report abuse | Reply
  28. joyce

    I have very little faith that this will have a positive impact on the majority of our citizens. I think we will all be taxed more, wait more in doctor's offices and hospitals, and the quality of preventative care will decrease. The government is trying to do too much too fast without hitting the target. What happened to intrastate buying of insurance? What happened to targeting Pharma? What about tort reform? If we want to change health care in our country will have to tackle the larger problems. This is a wimpy band-aide.

    December 22, 2009 at 11:54 | Report abuse | Reply
  29. Marc

    Mike – that's the problem... your numbers. I have NO clue where those numbers come from.

    I currently work IN healthcare... and have worked in healthcare for the last 20 yrs. I have worked clinical, administrative and now technical. I have worked in MAJOR hospitals in MAJOR cities, 2 of the top 3 health ins companies, small physicians offices and clinics.

    80% of legal citizens of this country do NOT have health insurance. (Why do think there are SO many commercials.) I would venture to guess the numbers should be more like 45-50% are fully covered. With another 10-15% being UNDER-insured. (Aetna is one of the companies I have worked for.) ER's in America serve as healthcare. The homeless do not have healthcare.

    Kaiser has quite a few of the illeagals, as Kaiser insures 70-80% of unions in this country. The also provide individual coverages. (outside of an company plan.)

    Small companies often can NOT afford to provide adequate coverage for their employees.

    On any given day in the winter, stop through an ER. You will see for yourself. If you REALLY polled Americans (not on-line gallop polls that the average citizen can not access) you will see a SHARP contrast to what's erroneously reported. Come to Washington, DC..... Atlanta, GA..... Chicago, IL... LA, St Louis, MO, Dallas, TX; cities where they have are large populations. People are NOT covered. If they are they are often under-insured.

    Why did swine flu spread so rapidly? Flu seasons. HIV rates increasing. Asthma, hypertension, high cholesterol, diabetes obesity. All of these are on the rise. All would be lessened if we started practicing PREVENTATIVE medicine, and not reactionary medicine. (Look at the French. The eat breads, pastries, smoke, and love wines... granted they walk more. But, they practice preventative medicine.)

    I have worked in clinics. Part of the reason why HIV continues to rise in MAJOR cities is because people are afraid they can't afford the meds & treatments. (I have heard this 1st hand in clinics in Washington, DC and in Chicago and in LA.)

    Please stop 'fudging' (and/ or believing these bogus) numbers...

    When you talk to regular citizens, they are NOT happy.

    OH, I have been to France & Canada... we should be so lucky to match their healthcare systems. The wait times talked about are the same if not shorter than the standard ER wait times.... without the bill 2 wks later.

    Healthcare is the US is a JOKE.

    A conservative independent.

    December 22, 2009 at 11:55 | Report abuse | Reply
  30. AlanB

    Yes, this bill will affect me. I currently have private insurance, and consider myself lucky to have it. Why should I be penalized with a salary tax, lose the coverage I currently have, and settle for less coverage when it becomes available? I work in emergency healthcare, and I can tell you that I have never seen anyone turned away for lack of money. I do not live in a fantasy world BTW. I do think there should be some concessions with existing plans to cover more people, but this is not the bill.
    Also, Why The Rush? What else is going on in this bill that no-one has had time to figure out? Obviously Nebraska is not the only state benefitting from this RUSH to pass a FLAWED bill.

    December 22, 2009 at 11:55 | Report abuse | Reply
  31. Scott

    Why read this bill, it is not the final bill!

    Anyone telling you what this bill does or does not do is either lying or ignorant. Yes there is some basic framework, but the devil is in the details, details that you are not privy to, or worded in a way to to vague or convoluted to understand.

    If they are going to do this, the first step is write the bill in a way that there can be no misunderstanding.

    Think this is too much to ask? Really the government is planning on a bill that would require credit card companies to have a one page credit card terms and conditions. The government see the need for transparency, when it is someone else, wish they would take their own advice

    December 22, 2009 at 11:55 | Report abuse | Reply
  32. Ken

    I believe we could have a better bill, if the Republicans would not have indicated that they would use every method available to delay the bill. Therefore, we get a camel instead of a horse. However a camel can still provide transportation.
    I do believe that this bill benefit me indirectly. By covering costs – that come from uninsured that do/can not pay their bill – passed on to me my medical costs will go down. Based on the way the bill will be paid for, my taxes will not go up. Also, my level of care will not be improved or degraded.
    I wish the first set, as the Democrats are now saying, would be better, but a first set is a first step.

    December 22, 2009 at 11:58 | Report abuse | Reply
  33. bob

    The health care bill is a giant leap for communism. This is an attempt to make our country less free and more under the thumb of ruthless dictatorial rule. Wake up people this is just the first salvo for a government everybit as wonderful as Stalin or Hitler let us review:

    The government in power wants to:
    A) Take over private sector (GMC, Chrysler, Banks, Healthcare)
    B) Wants to takeaway your right to self defence (Hitler rid his streets of firearms as well)
    C) Has a persecuted group that is to be punished (unborn babies, and Christians) (I remember a government that persecuted a relgious group before)
    D) Cares more about foreign respectability than his own people (Nobel Peace Prize, Olympics Plea)

    Democrats are evil they want to destroy everything Christian America stands for next they will be trying to dispose of us. Beware of Demoncrats!

    December 22, 2009 at 11:59 | Report abuse | Reply
  34. bayjabbr

    Everyone will be affected without a doubt. Everyone will pay higher premiums. Another program that will go way beyond the stated goal of reducing health care costs and cover more people. It may cover more people but at what cost. If you believe it will reduce costs to the consumer or reduce deficits I have a bridge in Brooklyn I want to sell you.
    The republican plan addressed the pre-existing conditions covered additional people and reduced cost to everyone (except the lawyers) without payoffs.
    Just wait until illeagals are given amnesty and that effectively will give everyone health care coverage with sky rocketing costs and reduced quality and availability. This is the most corrupt bill passed via a most corrupt process by a corrupt democratic party.

    December 22, 2009 at 12:01 | Report abuse | Reply
  35. Kirsten

    I was born with a pre-existing condition, which my sister shares. When I was younger, I was covered under state insurance until my mom began to work more out of necessity, which brought us above the income cut off for the insurance. I haven't been able to visit a doctor or dentist since because of monetary issues. My illness is one that generally requires a huge amount of medicine and physical therapy as well as being one that destroys bone and joints.

    My family has a huge amount of medical problems. Financially, we are barely making it by making half-payments on bills every month. To have to add insurance – which with just my condition right now would be upwards of $1500 a month and wouldn't cover anything – and there's no way we'd be able to make it.

    Yes, the health care system needs to be overhauled. However, if the poverty line were raised to a more realistic level to account for inflation and the like, this would be less of a problem. Let's not just treat a symptom, but let's focus on the real problem.

    December 22, 2009 at 12:01 | Report abuse | Reply
  36. Sharon Ritchie

    Why will be fined if I can't afford health insurance? I've been unemployed for 9 months without insurance. Has this country become Communist where our goverment impose fines on it's people?

    This is an absolute discrace!

    Sharon in Yonkers

    December 22, 2009 at 12:04 | Report abuse | Reply
  37. KARED

    "Senator" Nelson is a self-interested, no-good, shameless excuse for a human being. This is health care reform which is supposed to be good for the country, not some opportunity to wield one's power. I don't think that Senator Kennedy who was the biggest proponent of health care reform would have used his MUCH greater power to benefit the people of Massachusetts.
    I am so disgusted with his behavior – it really makes my stomach turn. He should be ASHAMED of himself. His family and friends should be ashamed of him. President Obama should publicly chastise him and line-item veto that preposterous addendum.
    I am going to suggest to my Senators (whoever that may be) that residents of Massachusetts shouldn't have to pay income taxes any longer. After all, a family of 4 who lives in Nebraska and makes $33,000/year is a whole lot better off than a family of 4 making $33K/year and living in California, Massachusetts, New York, etc. where the COL is so much higher. There are already inequities built into the tax system, but favoring one state over another seems to be, dare I say UNCONSTITUTIONAL.

    December 22, 2009 at 12:04 | Report abuse | Reply
  38. Dan

    Given the grave condition of most state budgets, what cost impact will additional Medicaid coverage have on the individual states (except Nebraska)? I fear that the government is spending us into oblivion.

    December 22, 2009 at 12:06 | Report abuse | Reply
  39. John

    Heath care reform?! Europe and some third world countries have health care reform...it looks nothing like what these politician dogs have created. I am 58 self employed in a market that failed political oversite and wall street greed has plundred. My wife is 55 and an unemployed re-trained teacher that the college system told her that employment oportunities abounded but can't get work "because she's too old". We can't afford medical health insurance, reformed or not by the looks of it. Who knows where we will be in four years when this bill (sic) comes on line. I am totally dissolutioned by our political leaders, Dems or GOP. There's no difference.

    December 22, 2009 at 12:06 | Report abuse | Reply
  40. Jim W

    Health reform has already affected me. My Medicare supplemental insurance is going up by 18% on February 1. This has to be due to what is coming down the pipe for insurance carriers. Mandatory procedures such as yearly exams have to be paid by someone. Everyone will be affected in a negative way by this legislation. It is wonderful if more people can be covered by insurance, but it should not be at the expense of those of us who are on fixed incomes.

    December 22, 2009 at 12:09 | Report abuse | Reply
  41. Akshay

    My concern about this health care reform is about how the Democrats are voting for this. I do NOT like the way how the US Govt is bribing Senator Ben Nelson with money for Medicaid for Nebraska just to get his vote. Especially if this covers our taxpayers' dollars. First question is it is over 2000 pages. How in the world are you supposed to cover that? Second, if you are cutting Medicare, how are the Seniors able to get treatment? Third, what about the Death Panel (aka "Pull the plug on Grandma")?

    December 22, 2009 at 12:10 | Report abuse | Reply
  42. Deb

    Hi Doc,

    The government is blind. They've lost sight of the *REAL* issue and sold out to the medical insurance lobbyists. The REAL issue *was* affordable health care for Americans. The *REAL* issue was *not* medical insurance.

    Part of the *problem* is medical insurance. Health care used to be affordable, but then–physicians didn't drive BMWs either. With the advent of health insurance paying more & more for procedures, physicians, who ordinarily would not order 12 different tests for their patients, saw gold and wrapped their insured patients into a web of procedures and test that enriched the physicians and the hospitals who provided those tests.

    I've been on both sides: I've been covered by "Cadillac" insurances in the past. I currently have no insurance. You'd be amazed at the differences in attitudes in the medical industry. With insurance, the patient becomes the victim of procedure after procedure & test after test. Without insurance, the patient hears, "It's probably nothing. Take Tylenol."

    We've been slammed with statistic after statistic showing how many Americans die "due to lack of health insurance." Where are the stats showing how many Americans die "due to health insurance" that facilitated unnecessary procedures or medications that resulted in their deaths?

    The CEOs of hospitals make incredibly big bucks & some of these CEOs have degrees from diploma mills & are less-qualified than myself to run hospitals. Yet, medical insurance has facilitated the exorbitant wages these charlatans bank.

    Again–the issue *WAS* affordable health care yet our myopic, ADD representatives in the government lost track of the issue and became fascinated with the shiny object– "medical insurance for all."

    Here's what people don't get: This government fiasco is NOT free. The American people will not be getting FREE health care or FREE insurance. This is going to cost the American people a pile of money, medical costs will soar, people seeking treatment will overwhelm the already overburdened medical system, and then we'll start hearing the screams of deception as people realize they've been had once again by greedy politicians lining their pockets with special favors and kick-backs from the lobbyists.

    Top all this off with the threat of fining people who don't carry medical insurance because they don't have the money to purchase it. Some people will have to choose between food, roofs over their heads, or medical insurance. Which do you think they'll choose? But the government is going to fine these people for not having enough money? Ridiculous!

    And who is going to enforce this unconstitutional abomination of *requiring* people to buy medical insurance?

    This whole thing points up the fact that our government is out of control. The Senators and Congress People who voted for this did so out of personal gain–not out of concern for the American public. For example, Congressman Dodd's wife is the President of a pharmaceutical company, & Dodd himself sits on the Board of Directors for 5 different pharmaceutical companies. Can anyone say conflict of interest?

    If this madness continues, a look into the future reveals the potential government control of all aspect of personal health care–from all personal medical information stored online (& insecure) in government databases, to the government dictating when and where and to whom we shall report for medical exams, to what lifestyle changes we must make and by what date–or find ourselves fined, to all medical decisions being made by government-made actuary tables based on statistics which serve only the government coffers.

    I can understand why you took yourself out of the running for Surgeon General under this current "leadership." The United States is moving from a Capitalistic Society to a Socialist Society, just as the USSR predicted 50 years ago that we would.

    As for myself–if I cannot afford health insurance or choose not to carry it, come arrest me because I'm not paying any stinking fine for choosing my path to pursuit of happiness by keeping a roof over my head. I'm sure I'll get free health care in prison, which is more than any Americans outside of prison will be getting.

    December 22, 2009 at 12:11 | Report abuse | Reply
  43. Will

    It seems that nobody really knows the bill, but everyone has an opinion.

    The USA "haves" don't care about the "don't haves" and are afraid it will cost more to them directly. It will be interesting to see what happens once they find themselves on the other side of the fence (jobloss, or god forbid . . some terrible affliction grounds them, causing jobloss and high medical costs). It is SOO EASY to ignorently oppose change, when you are not in need of it.

    Many countries have a more social health care system than the USA, while they pay A LOT LESS per capita for that system, have zero "un-insurred" in that system, can go to see a GP any day of the week, then have access to specialists as the need arises. Very fair, very accessbile, very affordable.

    I really do not see where all the opposition come from, other than for very personal and most likely very selfish reasons, based on hearsay rather than knowledge.

    Get with it and be a better person, for caring for those who will be able to take there children to a doctor, ONLY once this bill comes into effect.
    (I am not at all affected by this bill, but am horrified by the political games played against this bill, the fearmongering by politicians etc. Could someone take a step back, and explain the costs calculations <>
    Nobody shouts that car insurrance should not be mandatory, since it is clearly necessary. So you all pay premium, but you hope you never have to claim anything. Basic Health insurrance should be the same; EVERYBODY pays, thus making the general premiums lower, and anyone having the right to insure additionally as they please and can afford.

    December 22, 2009 at 12:12 | Report abuse | Reply
  44. Bob Edmond

    How in the world we anyone of us know how this bill will effect us? Has anyone even seen what the actual bill will say? I don't think so.

    December 22, 2009 at 12:14 | Report abuse | Reply
  45. sebedell

    First, I have excellent health insurance and at 62 will have three health insurance plans covering me. This comment is about my daughter, who is 20 and is profoundly hearing impaired. She will need a cochlear imlplant soon. When she turns 22, our family plan will drop her. Getting health insurance after that will be expensive and very hard to find good coverage. We need reform.

    December 22, 2009 at 12:16 | Report abuse | Reply
  46. Roseann

    There are so many other countries offering Healthcare to their citizens, do we have to reinvent the wheel? Why can't we just review all the options that other countries offer to their people, and take the best out of each one, and offer it to our people. Why are we having this pushed down our throats- during a recession??

    December 22, 2009 at 12:20 | Report abuse | Reply
  47. Meegan

    I recieved Medicaid for several years when I was in college working on my degree. What I can say about what I do know is that if the Gov't turns Medical Insurance into what Medicaid is...We are going to be up the Creek w/o a paddle. Medicaid seems great for those that don't pay! You are always hear its free insurance. But what about those ppl that work hard and as taxpayers we pay for someone else to have free insurance. The sad part is as a taxpayer you; Yourself may not even have health insurance because you can't afford to but some how in the myriad of gov't policy you pay for someone else. I think that is absolutely absurd. Also, Medicaid isnt that great trust me. You have to wait for visits and god forbid if you don't have an HMO attached to it. You are going to the clinic where everyone else goes and you can only imagine what that is like!!!!

    December 22, 2009 at 12:20 | Report abuse | Reply
  48. Thanh B.

    Dear Dr. G.
    I read the comments above and they made me sad. Everyone is telling their own problem. If they think for others they may feel better. At least they have a computer to voice their thinking or opinion. I believed most of the people who writing to you were not planned a life that they should feel comfortable at their end of their lives.
    What is life? A span of 75 years? And we will all died. People spoke all the time that our time come, we will go. What about "our time will come" phrase? We forget the time that we live on earth is shorter than we think.
    How about other countries? They have nothing.
    We should be grateful that we live here and have a computer to research for our needs.
    Well! I am 60 and in a good health. Thank to not smoking and drinking and gambling. I also thank my parents to give me a clean bill of health. If a disease struck me then I am ready to go. I called it life.
    I thank God every day that I am able to eat sleep and do my things without help. If I have to be in a nursing home then I will accept that is life. I will go sooner or later. I saw workers in nursing home were not to parr, but the uncomfortableness is just physical, "We will all go" some day.
    Thank you for having a space for me to express the deep feeling from the bottom of my heart for people who is less fortunate than I am and our country.

    December 22, 2009 at 12:24 | Report abuse | Reply
  49. Diane Marie

    Whatever makes insurance companies dance with glee cannot possibly be good for the rest of us. During the past week, their stock prices have gone way up, which to me conjures images of bald executives wringing their hands with delight while plotting ways around any government mandates. No doubt their client base is about to expand as the uninsured wonder which is cheaper: to buy private health insurance or to pay the government fine. How will the government determine who is poor enough to qualify for subsidies? If someone can afford their insurance premiums only by telling their kids to drop out of college, will they qualify? Forcing people to buy health insurance by giving them a public option is one thing. Forcing people to buy health insurance from an already bloated, irresponsible, greedy, profit-driven company is just plain immoral.

    December 22, 2009 at 12:25 | Report abuse | Reply
  50. Victoria Else

    I am self-employed and I will therefore be eligible for the exchange, as I understand it. But I'm really worried that the plans in the exchange will be no better than the stripped-down coverage I'm getting now, or any cheaper. What does non-profit mean? My husband has supposedly non-profit BC-BS and they have been a nightmare, very expensive and denying coverage for a serious emergency visit. If you have to sue your carrier to get them to pay legitimate claims, that's not health care, that's harrassment.

    December 22, 2009 at 12:25 | Report abuse | Reply
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