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December 22nd, 2009
12:21 PM ET

Health care reform and personal responsibility

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

As we continue this discussion, there are a few emerging themes. (read the Senate health care legislation) So, to keep the direction focused, I will try and take on one at a time.

The topic I would like to explore today is “personal responsibility.”

In many different ways, it seems you have questions about this topic. So, let me attempt to summarize it this way.

Will increasing access to health insurance make people more responsible about their health? Should it? And, will it improve their health overall? It is an important question to me as a doctor, because the measure I care most about is a healthier society, and the corresponding health of individuals.

There is no question that people who have unlimited resources, in terms of money and insurance, are often the unhealthiest of all. So, it would seem that access to health insurance alone does not equate to good health. On the other hand of course, over 40 million people don’t currently get a chance to test that theory.

Personal Responsibility.

How would you define the current obligation of any individual for their own health? And, if you would believe in the power of personal responsibility, how do we get better at it as a nation?

Programming Note: Tune into Larry King Live tonight at 9pm ET for a discussion about life after death. Can we come back from the dead? People who say they've done it say "yes"! Dr. Sanjay Gupta and Deepak Chopra take on the mystery of life after death – only on CNN at 9pm ET.

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


soundoff (159 Responses)
  1. Dave

    I think overall people will be more responsible about preventative health care risk: such as smoking and diet. The access to health care will provide people with critical resources to live healthier lives.

    To have an impact on social changes I think it is important how these services are enforced. Will someone with dietary issues have access to a nutritionist? How far will the care go for people with mental illnesses. Are homeless people included in the healthcare envelope?

    December 22, 2009 at 14:56 | Report abuse | Reply
  2. Ted

    This will be the first time in US history that any government, federal or state, has attempted to REQUIRE citizens to purchase something. Under no other circumstances am I required to buy something on pain of fines. In the case of the House bill, even non-citizens would be required to buy insurance.

    I know, youre thinking "what about car insurance", well, you can choose to not drive a car. With health insurance, you can only choose not to live.

    If passed this will be a turning point in American history. What might come next? All inhabitants of our ostensibly free country are not required to rent or own a home and if unaffordable the Federal government will subsidize it?

    December 22, 2009 at 14:56 | Report abuse | Reply
  3. Harold

    If the wallstreet idiots were on the take and our system collasped, what do you think the health insurance companies are doing? I have seen my insurance rates at work go up 115% in 9 years. I have to wait weeks to get into to see a doctor, and when I do get in Im sent home with a perscription that cost more than I can afford and I wind up with side effects that make me feel worse. Im making less pay now since the down turn, because my company uses the excuse they have to cut back. Do you see the health insurance companies cutting back their cost so working class people can afford to keep insurance when they are laid off? And when you do have a serious illness, you become a high risk and are denied. Like Wallstreet, without some kind of government control the health insurance outlaws will bankrupt the nation. Im for reform NOW!

    December 22, 2009 at 14:57 | Report abuse | Reply
  4. Donna

    I;m 56 and some of the healthiest people I know are those who don't have health insurance. Why? Because they MUST take personal responsibility or risk losing their home or bankruptcy at worst or paying unnecessary medical costs at best. I'm fortunate enough to have health insurance but I still take very good care of myself and do not smoke, drink, eat red meat and I exercise and am not overweight. One never knows if insurance will be there tomorrow. Frankly, I think those who don't take care of themselves should pay higher premiums. Why should I and the rest of society share in the cost of someone else's bad lifestyle choices?

    December 22, 2009 at 14:57 | Report abuse | Reply
  5. Riyad Gandhy

    Hi Dr. Gupta,
    I do believe that the people who already really want to be responsible about their health, but currently cannot afford to, will be the ones that make use of greater access to health care the most. But I do not believe it does anything to change the attitudes of others who have no interest in taking care of themselves. I do believe the medical establishment has a lot of blame to share as well, because so much money is spent discrediting non-conventional treatments and therapies. While modern medicine has improved incredibly when it comes to treatments/surgeries etc, it is still in the stone age as far as letting people know how to avoid the sicknesses in the first place. It is not an emphasized area in training doctors. People get far better advice from naturopathic doctors about ways to stay healthy and prevent disease than any conventional doctor. For example, about 15 years ago, Chiropractors were widely criticized by doctors as being "voodoo bone crackers", and today, a growing amount of doctors themselves go to chiropractors, or work alongside them in practices. Back pain and postural deformities can really be prevented if more people were proactive. Very few doctors advise patients on methods of detoxification (something extremely important given that the toxins we are exposed to on a daily basis has grown exponentially in the last few decades). The majority of doctors still laugh at the notion of 'detoxification' or any other methods that are outside the mainstream of pharmaceutical industry dominated practice of medicine. And then they scratch their heads and wonder why more people are sicker now than before. Individuals will never really know all the information on how to stay healthy themselves, unless medical schools start training doctors with a different philosophy of preventative health. And boy, would the drug companies hate that!!

    December 22, 2009 at 14:58 | Report abuse | Reply
  6. Justen Watkins

    I am a current 1st year medical student I am looking at close to $300k in debt by the time I graduate and begin residency. I am sick and tired that people say that doctors are "rich." I will tell you that the sentiment among medical students right now is that this is going to make doctors pay go down even further and the only safe haven to be a doctor will be private practice that doesn't take medicare/medicaid. Also, more and more doctors will opt to serve only those who will pay an annual retainer to guarantee their patients access to them without lines. This is what is coming, a two tiered medical system based on income. Touche America. Touche.

    December 22, 2009 at 14:59 | Report abuse | Reply
  7. tom

    Jenny with the BMI of 22
    Yes, you do deserve a break.
    You should get to pay 1/2 off, let's say for your health insurance
    just please still send in a check for 2-3x what you're paying now so that we can pay for everyone else...thanks
    Obama

    December 22, 2009 at 15:04 | Report abuse | Reply
  8. Tanya

    Do you think in Germany, France, Canada, or any other country with universal health care people not drink, not smoke, or do not eat not healthy food? I do not think so, but no one of them will loose house, or loose all savings, or file bancrutcy because of getting ill. That is the point, all citizens have rights to have health coverage. It is a lot of other ways to get us tax: tobacco, alcogol, etc. It is all about power and money, that is why in USA health care is in such mess. Sorry for being so negative.

    December 22, 2009 at 15:07 | Report abuse | Reply
  9. Ray Collins

    Don't ever assume that wealthy people automatically take more responsibility for their health than lower income groups. I live in a highly educated, wealthy neighborhood in Silicon Valley where you'd think people who have access to some of the best health education in the nation would be able to take responsibility for their health. Most don't. They have multiple afflictions, I believe, caused by a lifestyle out of control: alchohol abuse, heart disease, depression, hypertension, obesity, ulcers, exhaustion, drug abuse, on and on.

    That fact is, true wealth is our good health. The nation should learn without that, you got nothin'.

    December 22, 2009 at 15:15 | Report abuse | Reply
  10. IEK

    Jim, I'm not sure about your source, but I think you may be confusing part of the Senate bill. Its not that they will triple the cost to older individuals, they'll be limited to only 3 times the price of the lowest premium for that plan.

    Insurance companies will only be allowed to vary premium prices based on Age, Geography and Family size. But there's a limit on the premium difference based on age, set at 3 times the price of a young person on the same plan. It seems like a lot, but take for example a plan from BCBS in my area (www.ehealthinsurance.com). The plan for a 20 year old costs $104 a month. The exact same plan for someone who is 60: $558 a month. So older people are already paying more than 5 times the cost that a young adult pays for the same plan. The bill will limit how much of a difference age makes.

    Maybe that's not at all it, but that's the only place I know of where you would have gotten a 3x increase in premiums for older Americans.

    December 22, 2009 at 15:27 | Report abuse | Reply
  11. Cheryl Lilienstein

    Good choices for what we put in our bodies, whether we smoke, and how we behave certainly influence our health. But, the framing that people must take responsibility for their own health causes me great discomfort. It reminds me of the time period in the 1980s when we were told that "you have to be more responsible for your own medical care," as if we had the tools to do that! Tell me: other than for problems resulting from poor nutrition, drinking, smoking, and lack of exercise, how is a person responsible for such health problems as cancer, downs syndrome, H1N1?

    I have always felt that the claim that people must be more responsible for their own health is too non-specific, and also that it dumbs down the complexity of health. Specific campaigns, to stop smoking, for example, are useful. But the "personal responsibility" message seems to be used to deflect attention away from the elephant in the room: expensive and ineffective care.

    Unlike other countries, most of our doctors and hospitals do not maintain transferable record-keeping, critical information gets lost, and there are unconscionable delays in getting care. Equally bad, we mostly don't use evidence-based decision making because we don't require health data accumulation, thus we don't have systems to analyze health care outcomes to improve quality of care.

    We are guilty of NOT building an evidence-based health care network capable of efficiently and effectively enhancing health. Healthcare is an extractive industry, a money machine for insurance companies, and the money they extract is NOT used to improve healthcare.

    So, while we encourage everyone to be as healthy as we can be by behaving well, let's not insinuate that ill health is a character flaw. The social responsibility problem beats in the financing arena of medicine. Use that bully pulpit to popularize a not for profit, publicly financed system that uses tax dollars focused on developing, improving, and propagating robust healthcare delivery systems. Because I think you'd agree, good health depends on good healthcare systems, not just personal behavior.

    December 22, 2009 at 15:32 | Report abuse | Reply
  12. Charles MD

    To Justen Watkins: go into academics. They pay you a salary and you see whoever comes in the door. Tuition and state funds will pay your salary. Unfortunately not everyone is geared for academics.

    This country will never have personal responsibility, NEVER. I do. I eat well, don't smoke, exercise regularly and live modestly within my means. And my 5 year old cathode ray TV works just as good as the plasmas.

    As for those who cannot afford a gym membership, walking is free. Also you don't have to shop at Whole Foods to eat healthy. Buy fresh produce, clip coupons and buy generic.

    In the meantime, I will still treat my patients by the current standards of my specialty, though they likely will not follow my recommendations. Again, no personal responsibility

    December 22, 2009 at 16:43 | Report abuse | Reply
  13. Allen N Wollscheidt

    Personal responsibility is, of course, the most important element of health care. However, it can only be imposed by social interaction, not law. Ridicule is an important tool in this respect.

    As for the rest of the health care debate, it has rolled off the lane into the gutter.

    The REAL issue is not how to PAY for the costs of healthcare, but rather how to CUT the costs of health care so that they assume their rightful and reasonable relative positions alongside food, shelter, clothing, etc. There really is no choice - all we are doing is to delay the inevitable.

    HOW to cut costs - just like in every other one of man's activities : Employ technology. Presently, a visit to the doctor is largely a waste of time - the records are scattered, incorrect, illegible or non-existent, the doctor has not read them yet, there is not enough time to tell the entire story, etc. With proper technology, the doctor serves only as a sanity check against what the machinery has already determined from the running record, recent tests and prior physical examination.

    No human can today be expected to efficiently keep track of it all for hundreds of patients. SEND IN THE MACHINES ! !
    .

    December 22, 2009 at 21:13 | Report abuse | Reply
  14. Fig

    Hi,

    I agree with the idea that personal responsibility is important. However, I don't see it as the answer to the main question of health insurance access.

    You can be the healthiest and most responsible person in the world, but you are still subject to chances that something bad happens to you – an accident or disease. What then? Insurance was designed specifically for such cases – where the person has no real control over his or her exact future.

    It is utterly misleading to try convince people that personal responsibility makes health insurance unnecessary. The fact that some people are unable to get it in USA is issue. It would be quite heartless to say to a person with a pre-existing condition "Sorry, you should have been more responsible and not get into that accident!"

    December 22, 2009 at 22:16 | Report abuse | Reply
  15. H.

    Personal responsibility in health care cannot be separated from collective responsibility and inetgrity in dealing with the issues. It takes courage to say the truth and it takes resolve to make it happen.

    The patient's responsibility is to deal with healthcare by living a healthy lifestyle, not abusing the system and thinking about the realities of the statistics that puts us as a fairly unhealthy nation. The patient needs to be incentivized with lower premiums for lifesyle diseases that have nothing to do with genetics. The mortality rate of the top diseases according to the CDC are heart heart disease , diabetes and cancer all seemingly preventable. Accidents and murder/suicide are about 2% of the mortality in the 2006 CDC survey.

    The Collective responsisbilty of the medical profession's starts by using judgement instead of expensive testsand making the profession more patient oreinted (customer oriented), less greedy and without even the appearance of conflict of interest with hospitals, insurance companies and the pharmacetiucal industry. the profession needs to be regulated by medical technocrats without an agenda. A larger pool of GPs incentivized to perform according to the Pareto principle will redirect money for research and relieve a rather unsustainable shortage. Other countries will fill the vacuum for those who will weigh the risk and cost of treatment overseas.

    The pharmaceutical companies' collective reponsibilty is to be at par witjh pricing in other coutries. it seems disingenuous that they negotate how much profit they are willin to make in teh next 10 years make and ask the administration to halt the flow of drugs from Canada. If price is equlaized there would be no issue of getting medicine form Canada . The FDA should have a more significant role in approving drugs instead of publishing lists of medications which are recalled or they missed in requiring companies to thoroughly check the side effects.

    The collective responsibily of insurance companies and businesses is to give the best care for the lowest price and they need to be establish larger pools of patients across the nation so that actuarial tables can create a profitable business models without denying coverage. Incentivising a healthy lifestyle should eneter into the equation. It is not clear what value agents bring to the process other than raising premiums by as much as 30-40%.

    The collective reposnsibility of The Senate and the House republicans and democrats is to deal with these issues openly and responsibly. The countries with which we have to compete in this century do not have such bloated budgetsor medical costs. This is a good calibrator instead of getting hung up about who pays for abortion. the issues unfortunately are framed by rote talking points on both sides of teh aile which makes a mockery of intentions.

    The Executive branch has a collective reponsibility to look at its past record as a bureaucracy in managing healtcare or any other program. Do they really believe that other than the oversight responsibility they can spend the taxpayer's money and manage such a bill successfully? The principles outlined by the administration while very noble do not stand the test of being competitive in a global economy, they do not stand the srutiny when examined in detail and abrogate the original intent through pork barrel politics illogical compromise.

    The collective reponsibility of all organized religion is work for the greater good rather than pushing an agenda. If the religious organizations and non-profits do not reduce their overhead and stop their medling with their agendas then every dollar collected for a purported altruism will be wasted .

    the collective reposnsibility of the media is to stop editorializing and soundbiting tghe issues but to have civil debates with factual and competent analysis.

    Our personal and collective repsonsibility is to deal with healthcare honestly, openly otherwise we will continue on the trend of putting our head in the sand, becoming more so an unghealthy nation that does not have its financilal house in order to compete globally.

    December 22, 2009 at 22:35 | Report abuse | Reply
  16. H.H. Yacoubian, PE, PMP

    Personal responsibility in health care cannot be separated from collective responsibility and integrity in dealing with the issues. It takes courage to say the truth and it takes resolve to make it happen.
    The patient's responsibility is to deal with healthcare by living a healthy lifestyle, not abusing the system and thinking about the realities of the statistics that puts us as a fairly unhealthy nation. The patient needs to be incentivized with lower premiums for lifestyle diseases that have nothing to do with genetics. The mortality rate of the top diseases according to the CDC are heart disease , diabetes and cancer all seemingly preventable. Accidents and murder/suicide are about 2% of the mortality in the 2006 CDC survey.
    The Collective responsibility of the medical profession's starts by using judgment instead of expensive tests and making the profession more patient oriented (customer oriented), less greedy and without even the appearance of conflict of interest with hospitals, insurance companies and the pharmaceutical industry. the profession needs to be regulated by medical technocrats without an agenda. A larger pool of GPs incentivized to perform according to the Pareto principle will redirect money for research and relieve a rather unsustainable shortage. Other countries will fill the vacuum for those who will weigh the risk and cost of treatment overseas.
    The pharmaceutical companies' collective responsibility is to be at par with pricing in other courtiers. it seems disingenuous that they negotiate how much profit they are willing to make in the next 10 years make and ask the administration to halt the flow of drugs from Canada. If price is equalized there would be no issue of getting medicine form Canada . The FDA should have a more significant role in approving drugs instead of publishing lists of medications which are recalled or they missed in requiring companies to thoroughly check the side effects.
    The collective responsibly of insurance companies and businesses is to give the best care for the lowest price and they need to be establish larger pools of patients across the nation so that actuarial tables can create a profitable business models without denying coverage. Incentivizing a healthy lifestyle should enter into the equation. It is not clear what value agents bring to the process other than raising premiums by as much as 30-40%.
    The collective responsibility of The Senate and the House republicans and democrats is to deal with these issues openly and responsibly. The countries with which we have to compete in this century do not have such bloated budgets or medical costs. This is a good calibrator instead of getting hung up about who pays for abortion. the issues unfortunately are framed by rote talking points on both sides of the ailed which makes a mockery of intentions.
    The Executive branch has a collective responsibility to look at its past record as a bureaucracy in managing healthcare or any other program. Do they really believe that other than the oversight responsibility they can spend the taxpayer's money and manage such a bill successfully? The principles outlined by the administration while very noble do not stand the test of being competitive in a global economy, they do not stand the scrutiny when examined in detail and abrogate the original intent through pork barrel politics illogical compromise.
    The collective responsibility of all organized religion is work for the greater good rather than pushing an agenda. If the religious organizations and non-profits do not reduce their overhead and stop their meddling with their agendas then every dollar collected for a purported altruism will be wasted .
    the collective responsibility of the media is to stop editorializing and sound biting the issues but to have civil debates with factual and competent analysis.
    Our personal and collective responsibility is to deal with healthcare honestly, openly otherwise we will continue on the trend of putting our head in the sand, becoming more so an unhealthy nation that does not have its financial house in order to compete globally.

    December 22, 2009 at 22:46 | Report abuse | Reply
  17. Joy Hogg

    We all need to improve our health through good choices, but some people just get some bad luck with health – allergies, cancers etc. They didn't necessarily bring it on themselves. And our environment, over which we may have little control, may also contribute to some people's illnesses. As a country, we do need to spread the cost of health over all of us and not just the ones fortunate enough to be accepted by an insurance company and have the money to buy it. We talk of a country "of the people, for the people ..." not just "of the fortunate, for the fortunate..." And I would love to see religious people take the lead in wanting to care for the less fortunate.
    I come from Canada where we pay 8% of our GNP on health coverage and all get coverage, although basic. A fortunate person can buy additional coverage for things like private hosptial rooms, home nursing care etc. But basic is for all, and we have a clear conscience about that.

    December 22, 2009 at 23:10 | Report abuse | Reply
  18. bernie

    This issue of personal responsibility in health care reform is undermined by the indemnity health insurance model. If MONIES are TAKEN from you PRIOR to medical services being rendered and NO DIVIDENDS are returned to you if you are healthy or a cost conscious consumer of medicine, there is little incentive to change.

    The solution to this paradox is to align the medical dollars with the individual rather than with the insurance companies. Establish universal HSA accounts for all and fund them fully from the difference between the premium savings between high and low deductible insurance. Then HSA's become a zero impact event for the consumers by merit of shifting the money from the insurer to the patients' control. If you exercise personal responsibility you are then immediately and directly rewarded by retaining your own money. Those with little personal responsibility burn through their own money sooner and get to their HDHP faster and are no worse off than with the current indemnity model. However, those people will quickly learn the virtues and rewards for personal responsibility!

    You can read about this and other innovative ideas at http://www.theintelligentHSA.com

    December 22, 2009 at 23:11 | Report abuse | Reply
  19. Kevin Warren

    Don,

    That's brilliant. Heavily punish people who aren't healthy and force them to live how the offices in DC want them to live.

    As to penalizing those who aren' healthy, Isn't that what the government health care advocates are saying the private insurers already do?

    December 22, 2009 at 23:19 | Report abuse | Reply
  20. CE MD

    The American entrepreneurial spirit mandates that a constant balance is maintained between quality of care and the number of "providers". As we add 40 million patients into the pool and cut MD pay by >20%, we will irrevocably dilute the quality of physicians caring for these patients (that includes you who read this). It's hard to find a caring, conscientious and well trained US born and english speaking MD. They are a dying breed, and the US Congress has no clue that you can drive them out of practice, and into early retirement, by politicking to protect their precious seats...does it bother you that my colleagues universally tell their college aged kids "do NOT go into medicine"...

    December 22, 2009 at 23:42 | Report abuse | Reply
  21. sick to my stomach

    Cheryl Lilienstein:
    Thank you... you have said eloquently what I would have said.

    People, really? You support our current healthcare system because you've made good lifestyle choices and so it works for you? Good for you. Guess everyone else can just suck it. Great thing you have good genes. Great that you can afford insurance.

    What about that 9-year old boy with leukemia that lives down the street... dad lost his job, couldn't afford COBRA anymore, and is looking for a job, but... individual insurance coverage will NOT cover his pre-existing condition. Mom and dad cannot afford his chemo treatments... what are his options? Parent's go deep in debt, bankrupt. And that's the better scenario.

    Maybe if that 9-year old took better care of himself...

    This is what the best country in the world accepts?

    December 23, 2009 at 00:49 | Report abuse | Reply
  22. Julie

    I am worried about what I hear this health care bill has turned into...Originally I was for health care REFORM, but not for all these additional rules and yet no public option, nor health care offered to all...WHat happened?! Looks like we are NOT adding improvements, at least not for a family like ours, a family supported by a small business. It looks like we are once getting the short end of the stick! Why is it that those of us who are hard-working and not making large amounts of money get stuck paying huge amounts for health care (with huge inflationary costs annually). And we will be required to have insurance?! If inusrance is going to be REQUIRED, then the government NEEDS to provide a public option. How rediculous for our government to put such importance on everyone needing health care coverage, and yet not provide it?! Infuriating! Stop bowing down to the insurance companies, hospitals, doctors, and drug companies. It's time to take care of the people – especially those who are hard-working members of society!

    December 23, 2009 at 09:08 | Report abuse | Reply
  23. Candace Hill

    What is going to happen to the homeless, jobless, illegal immigrants, poor with no means or assets to afford insurance when they arrive at the emergency room or need hospitailzation with a life-threatening condition? Will they be turned away? Fined? If they have nothing, what then? This country is on the wrong path.

    December 23, 2009 at 09:11 | Report abuse | Reply
  24. Vince Rivera

    My question about health reform has to do with the impact or benefit it will have on early retirees between 55 and 64 years of age. Is there anything that helps this group?
    Thanks,
    Vince

    December 23, 2009 at 10:13 | Report abuse | Reply
  25. dwight butler

    I pay $93 a month for medicare. If healthcare reform is passed will I have to pay medicare and the mandated pay to the government?

    I am not a math expert, but if the government gets 30 million people to pay money every month until 2014 with out benefits are they not getting over?

    December 23, 2009 at 10:33 | Report abuse | Reply
  26. gloria palestrini

    If people are collecting unemployment insurance how can they afford to pay for Healthcare Insurance? Both my children are out of work and can barely pay their expenses, they definitely can't buy Healthcare Insurance, what do they do?

    December 23, 2009 at 10:44 | Report abuse | Reply
  27. Carter

    First offer the carrot. Patients should have fiscal incentive to take preventative steps to reduce health risk factors (obesity, smoking, etc). These things can be tracked in a number of ways, and if you have improved your health with each checkup, there should be a mechanism by which the insurers reduce your premiums. I am sure that with the health plan exchange there will be companies with innovative plans that offer these types of incentives. Already many such incentives are available via existing employer plans. Money in your pocket is generally the best incentive for one to change behavior.

    That is the client side approach. The other actions which should be considered are more taxes on unhealthy food products. It's hardly fair to ask the public to shape up if our food supply is contaminated with nutrient poor food. Several states are starting with schools due to the child obesity epidemic, but the concept should be more generally applied, just as we have done with cigarettes.

    Finally, health care providers should have fiscal incentive to improve the health of their patient cohort. I know that this is the case in the UK, where doctors get a bonus for improving the health stats of their patients. It makes much more sense to put in place a requirement that caregivers are paid for doing what they are supposed to do: improve the health of their patients. Such a plan could either be government mandated or offered by forward-looking insurers.

    December 23, 2009 at 11:57 | Report abuse | Reply
  28. ET

    In all this dialog, there's too little focus on health.

    There's too much focus on paying for an industry that doesn't operate with an effective business model. There's too big a boon for insurance in all this conversation.

    Where's the financial support for nutrition? For self-management of one's health? That's the conversation that will deeply benefit all humans.

    How can we remove commerce from health care? Therein lies the rub.

    December 23, 2009 at 12:05 | Report abuse | Reply
  29. Tranquility

    How will the health bill affect veterans benefits? There are millions of us who use the veterans health system at zero or reduced fees due to service connected disabilities. Does this count as "health coverage" or will we be required to pay for totally unneeded insurance? No where in the lengthy dialogues have I seen this issue addressed. Your comments will be most appreciated.

    December 23, 2009 at 12:30 | Report abuse | Reply
  30. Marlaine F.

    One way each of us can take personal accountability is to take responsibility to understand the complexities our system generates. Do we insist on designer drugs when a generic will do just because we have insurance? All of this drives costs in a very complex system. For example, the drug companies want your doctor to prescribe the designer drug that costs $600 to treat your acne rather than the generic that costs $10. The health insurance companies want you and your doctor to select the $10 drug. So the games begin when the drug companies supply your doctor with a coupon to allow you to get the designer drug for only $10 out of pocket but your insurance company is paying $590. It makes no difference to your doctor or you but a big difference in the overall cost of your care. The doctor and patient become pawns in a big game.

    December 23, 2009 at 13:14 | Report abuse | Reply
  31. dave

    Health care reform is really more of the same and issues of quality have not been adequately addressed. So costs will continue to rise dramatically without concomittant improvement in care quality or effectiveness. In fact in seems likely there will be great rationing of health care in the near future and people with inadequate pai care in particular will suffer from less access to needed health care as the health care industry doesnt regard pain care as important in the first place.
    So health care reform is largely a boom for the health care industry and of dubious value to the public.

    December 23, 2009 at 13:18 | Report abuse | Reply
  32. bk

    The irony is that physicians have had no input into the Health Reform debate. The AMA is full of "Political" physicians and like our congressman don't listen to the majority of physicians. We like the general public have no voice.

    Question: Being close to $450,000 in medical school debt (I married a fellow medical student and doubled our debt), why are there are no plans for loan forgiveness or relief for those of us entering the "real world" and making much less money than originally thought? We will be taxed more, make less, and have a mountain of debt that we can never pay back.

    December 23, 2009 at 13:35 | Report abuse | Reply
  33. Eric - NJ

    Personal responsibility is dead and long buried. We live in an age of denial of responsibility. As Congress passes more social legislation, people no longer need to be responsible. Currently, people do not have to be responsible for their children. You can drop them off at a hospital in some states. Wall Street executives & bankers simply turn to the government to absolve them of any wrong doing and receive huge payments to compensate for their incompetency. Why would anyone believe that healthcare reform will lead to further personal responsibility. I see it the other way. We are enabling lack of responsibility across the board. Wake up America – the system is broken for anyone who pays taxes and tries to be self-sufficient.

    December 23, 2009 at 13:42 | Report abuse | Reply
  34. David Wills

    Health Care Reform = Insurance Companys that offer polices that we can afford based on our income that could offer some basic health care.

    December 24, 2009 at 12:04 | Report abuse | Reply
  35. Robyn

    Injuries and chronic illness often cause people to not be able to exercise, and metabolic disorders can cause people to live with very low energy and still gain weight no matter how much they exercise. Not having good health care available causes one thing to lead to another in a domino effect. For instance, any injury that causes a person not to be able to exercise leads to increased weight gain. Low income families often eat lots of carbs because they cannot afford the fresh vegetables. There is a direct correlation between poverty and overweight. AND, even those with health insurance often live with undiagnosed, untreated or under treated chronic illness because of these very prejudices toward "fat people," with not concern for the inheritance factors, the degenerative joints, the inflammation, etc. that caused the people to "slow down" in the first place. We get judged before we can open our mouths. AND, insurance companies discourage thorough testing or prescribing the best meds that REALLY work.

    If every American had access to honest, unprejudiced, effective health care, a lot of people would feel so much better they might be able to take better care of themselves and their families. They might gain enough health to go back to work instead of languishing at home with no clue how to move forward in their lives. They would be able to become productive, tax paying citizens.

    As it is, if you have a misfortune early in life and lose your health insurance and become ill, ,there is often no way to get back on track. You can't work because you're sick. You can't get well because you don't have proper care. So you just get sicker and sicker and sicker and people look and say ,'Look at that fat lazy bum. He should just die and decrease the surplus population." But, those who rant against a public health option won't even read this. They are too full of themselves to care about others people and what they might be able to contribute if they were healthy.

    December 27, 2009 at 08:44 | Report abuse | Reply
  36. Don S

    This is in relation to Gloria's comment on December 23:

    I wholeheartedly agree with you. I think that Universal Healthcare is good for healthcare companies mainly. How can they ask every American to buy coverage or pay a penalty? They can because it's supposed to benefit the overall good. WRONG. It does not benefit many people to be federally mandated to purchase healthcare coverage. That is part of the lie. It does increase the client base of healthcare providers thus ensuring more profit.

    We must contact our senators and representatives and tell them "NO."

    December 27, 2009 at 16:50 | Report abuse | Reply
  37. Betty

    Great article and very interesting comments. I think we are all responsible for our own health by the lifestyle we choose to live. I also think I would be more responsible for my health care insurance if I wasn't so insulated from the actual costs by my insurance company. There are plans out there such as CDHP (consumer driven health plans) that would allow me to get insurance for what I really want/need. I want to take a more active roll in fine-tuning my health plan strategy, maximize my wellness, and lowering health care costs.
    A book called "Bend the Health Care Trend" is all about CDHP and what can happen when people are empowered to make informed, responsible, and cost-conscious decisions about their lifestyle and health care spending...they become responsible!

    December 29, 2009 at 22:46 | Report abuse | Reply
  38. CAA

    I am fortunate enough to now have one of the CDHP insurance companies instead of the major insurers. I've spent the last 37 of my 45 years with preexisting conditions and have felt the "moral outrage" from others judging me as a failure or "bad" person because of my illnesses (even though none of the three preexsiting conditons I live with were caused by lifestyle or personal choices).

    Previously, I couldn't afford to pay for my basic medical needs, which cost me 28% of my net pay, and pay for preventative care, such as wellness education classes, fitness club membership or training, or dietician consults. Now, the wellness component of my newest insurance company provides me with incentives, such as going to the fitness center four times a week means I don't have to pay for it, and having a consultant to talk to about my food allergies means I've put together a food plan that actually allows me to meet my nutritional needs without ending up in the hospital. It is now five months later and I am 42 pounds lighter, am taking three fewer prescription meds each month, and only making two doctors' visits per month instead of four. That means saved money for medical treatment, more productive time for me to work, and better outcomes for the economy and myself.
    Coudn't we put together something like this on a national scale?

    December 31, 2009 at 15:17 | Report abuse | Reply
  39. Allen N Wollscheidt

    On and on it goes - but not a word about the necessity to CUT THE COST OF GOOD HEALTH CARE.

    ALL the rest is only secondary ! !
    .

    December 31, 2009 at 16:09 | Report abuse | Reply
  40. gloria palestrini

    The President should come forward and insist on a Public Option before the Healthcare Reform Bill reaches his desk and have it take effect immediately not in 4 years, we could be dead by then. If he is looking for a way to pay for the Plan, pull the troops out of Afghanistan and worry about our own safety, not theirs. Terrorists are all over the WORLD, we can't protect everyone!

    January 6, 2010 at 11:29 | Report abuse | Reply
  41. Valerie

    The US has a considerable population suffering from lifestyle diseases, and these individuals will continue to be a drain on financial resources. Get over it. Using phrases like "personal responsibility" opens the door for finger pointing and blaming. Useless.

    How about the phrase "care of health" and all that suggests? If care of health was half the fiscal priority that subsidizing high fructose corn syrup is, we'd be well on our way to getting a handle on health costs.

    I'm a lifelong Democrat, and the cost of providing health care for a nation of junk food eating, cigarette smoking, booze drinking, body wisdom ignoring, stress junkie, aging baby-boomers scares the crap out of me. Social security? HA! I've been paying into that for the last 35 years and worry that won't be around because our nation is broke!

    Care of health is the most productive, cost effective way to reduce health care costs looking into the future.

    Politicians, fight later. Your nation has work to do, and needs you. Your political parties can wait.

    January 25, 2010 at 23:25 | Report abuse | Reply
  42. Patti Kay

    I am a 31 year old female who has worked ever since the day I turned 16. I have a job now that offers me part-time employee insurance. However I can not afford to enroll in it because all the money I make goes to pay for rent, bills, groceries and the basics one needs to get by in everyday life. I have never applied for foodstamps to help pay for groceries even though I know I quailfy for them. I don't receive any assistance from the goverment at all. I did however apply for a medical card at one time. I was denied because I wasn't pregnant and I didn't have children already, I wasn't physicaly or mentaly handicaped and wasn't elderly or a veteran. This had me quite upset. I just wanted to be able to see a general physican to make sure I was healthy. I wanted to see an OBGYN to make sure I was healthy. I wanted to go to the dentist to make sure my teeth were healthy. I have worn glasses since I was little and wanted to go to the eye doctor to make sure my vision wasn't getting any worse. These are all common things that any individual would want to monitor for themselves. I don't make a lot of money so I can't afford insurance like most people can. So what is wrong with me being able to get a medical card? I can take control of my health by being personaly responsible but I can't diagnos or treat the things I can't see that a physician can. I work everyday I can. I don't sit on my butt and pop out a punch of kids that I cant take care of meanwhile mooching off the goverment. I just want to be able to see a physician just like everyone else. Why shouldn't healthcare be available to me like it is to the lazy irresponsible dummies who think sitting at home watching TV with their 5 kids that they don't work to take care of and that are just scamming the goverment into taking care of them and their kids. Can anyone explain this to me?

    March 21, 2010 at 00:53 | Report abuse | Reply
  43. Patti Kay

    I am a 31 year old female who has worked ever since the day I turned 16. I have a job now that offers me part-time employee insurance. However I can not afford to enroll in it because all the money I make goes to pay for rent, bills, groceries and the basics one needs to get by in everyday life. I have never applied for foodstamps to help pay for groceries even though I know I quailfy for them. I don't receive any assistance from the goverment at all. I did however apply for a medical card at one time. I was denied because I wasn't pregnant and I didn't have children already, I wasn't physicaly or mentaly handicaped and wasn't elderly or a veteran. This had me quite upset. I just wanted to be able to see a general physican to make sure I was healthy. I wanted to see an OBGYN to make sure I was healthy. I wanted to go to the dentist to make sure my teeth were healthy. I have worn glasses since I was little and wanted to go to the eye doctor to make sure my vision wasn't getting any worse. These are all common things that any individual would want to monitor for themselves. I don't make a lot of money so I can't afford insurance like most people can. So what is wrong with me being able to get a medical card? I can take control of my health by being personaly responsible but I can't diagnos or treat the things I can't see that a physician can. I work everyday I can. I don't sit on my butt and pop out a punch of kids that I cant take care of meanwhile mooching off the goverment. I just want to be able to see a physician just like everyone else. Why shouldn't healthcare be available to me like it is to the lazy irresponsible dummies who think sitting at home watching TV with their 5 kids that they don't work to take care of and that are just scamming the goverment into taking care of them and their kids. Can anyone explain this to me? Will this healthcare reform help me?

    March 21, 2010 at 00:54 | Report abuse | Reply
  44. Kirov

    Странно, искал совсем не это, но именно эта информация показалась мне наиболее актуальной.
    Давно Ваш сайт ведёте?

    June 30, 2010 at 07:36 | Report abuse | Reply
  45. WhiqueWogue

    Круто! Хотелось бы побольше таких же интересных постов

    July 28, 2010 at 16:53 | Report abuse | Reply
  46. WhiqueWogue

    Очень познавательно.

    August 8, 2010 at 11:54 | Report abuse | Reply
  47. WhiqueWogue

    Увлекательно! Спасибо за материал.

    September 5, 2010 at 14:35 | Report abuse | Reply
  48. PIRalph

    Блог в ридер однозначно

    November 1, 2010 at 13:39 | Report abuse | Reply
  49. ZTScott

    Нужно посмотреть,Спасибо

    December 6, 2010 at 10:59 | Report abuse | Reply
  50. WhiqueWogue

    В общем спасибо

    December 21, 2010 at 08:21 | 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.

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