Comments on: Seeing the cost of health care firsthand http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/ Mon, 21 Dec 2009 21:13:33 +0000 http://wordpress.com/ hourly 1 By: Rita http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-3697 Rita Fri, 03 Oct 2008 18:02:45 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-3697 Generic medications are a great way to keep your prescription drug costs down. I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new, when something old or generic would do the job for cheaper. Generic medications are a great way to keep your prescription drug costs down. I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new, when something old or generic would do the job for cheaper.

]]> By: Gregory Wlodarski, MD http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-830 Gregory Wlodarski, MD Tue, 06 May 2008 20:17:24 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-830 Continuation after I accidentally hit the enter button... As an example: insulin vials are the prefered (by insurance) and insulin pens often are not covered while in Europe, pens are the standard dispensing form. It would be nice if CNN could do a special on health care in the developed world outside the US, from the perspective of doctor, hospital, community clinic and patient. Continuation after I accidentally hit the enter button...

As an example: insulin vials are the prefered (by insurance) and insulin pens often are not covered while in Europe, pens are the standard dispensing form.

It would be nice if CNN could do a special on health care in the developed world outside the US, from the perspective of doctor, hospital, community clinic and patient.

]]> By: David Dunning http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-811 David Dunning Sun, 04 May 2008 13:27:00 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-811 Thank you Victoria. I read your comment on Medicare's Prescription Drug Plan, Part D. I am also stuck in the coverage gap, donut hole. The way my insurance company does it, is that they add their cost with mine to the first 2.500 dollars spent on medications. I am then placed in the coverage gap until my cost alone, not with theirs, adds up to another 1,500 dollars. At this point they stop paying for brand name medications. After I accumulate the 1,500 they will than pay for all of my medications. The only problem with this is that with a fixed income where do I find the 1,500 dollars. I am saving my money, but it's going to take months to collect it. This means that I will have to go without some of my medications, because my most important medications do not come as a generic. A months supply for one type cost close to 1,000 dollars. That's for one. Right now I am trying to find the money to pay for a type of insulin that I need. It is not generic. What I hope is that other people with this problem will write congress over and over to change this practice. I'm sure that there are other people traped in the hole and can not get some of their medications. Thank you Victoria. I read your comment on Medicare's Prescription Drug Plan, Part D. I am also stuck in the coverage gap, donut hole. The way my insurance company does it, is that they add their cost with mine to the first 2.500 dollars spent on medications. I am then placed in the coverage gap until my cost alone, not with theirs, adds up to another 1,500 dollars. At this point they stop paying for brand name medications. After I accumulate the 1,500 they will than pay for all of my medications. The only problem with this is that with a fixed income where do I find the 1,500 dollars. I am saving my money, but it's going to take months to collect it. This means that I will have to go without some of my medications, because my most important medications do not come as a generic. A months supply for one type cost close to 1,000 dollars. That's for one. Right now I am trying to find the money to pay for a type of insulin that I need. It is not generic.

What I hope is that other people with this problem will write congress over and over to change this practice. I'm sure that there are other people traped in the hole and can not get some of their medications.

]]> By: Ken Lonquest http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-758 Ken Lonquest Wed, 30 Apr 2008 16:46:47 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-758 I think this sort of discussion ought to address a fundamental structural conflict of interest between the system of medical care as such, physicians, hospitals, and patients, and the pharmaceutical and health-care-access business. The conflict is in the fact the revenues and profits of both health care access providers and pharmaceutical companies is proportional to the total cost of health care services. Consequently, these companies' business models achieve success by maximizing the overall cost of health care. The effects of this conflict of interest manifest in a variety of ways that do harm to the practice of health care. For example, two of the largest components of the overall cost of health care in the US are obesity and consequent chronic medical conditions, notably type 2 diabetes. Pro-active wellness maintenance programs are by far the most cost-effective means of addressing obesity and its complications, yet there are very few examples of health care access providers pursuing such programs. Instead, health care providers receive massive incentives to avoid addressing wellness, because chronic acute care is one of their biggest sources of revenue. A related example is the care of acid-reflux disease. A significant proportion of the GERD case load traces its root causes back to chronic stress and poor stress management. Health care access providers would best serve patients by empowering them to reduce and manage their daily stress, through pursuit of pro-active wellness programs and through education programs that would teach about the true cost of chronically excessive stress. Once again, there's a huge disincentive to pursue disease prevention programs because chronic care is such a huge cash cow for both health care access providers and pharmaceutical companies. This is the fundamental structural conflict of interest built into the business models of the health care access and pharmaceutical industries that seems obvious to me, but that I don't ever hear spoken of in public. Normal insurance business models are based on risk management, and profit by risk avoidance, but health care access providers and pharmaceutical companies profit most from risk realized and from growth in the cost of health care provided. This means that the business interests of health care access providers and pharmaceutical companies are in direct opposition to the interests of physicians and patients. Unless this issue is brought into public view and a way is found to counter the incentives built into current business models, the priorities of health care access providers and pharmaceutical makers will continue to create a direct conflict between these businesses' profit incentives and their stated mission to efficiently and effectively improve the health of patients. In the face of this conflict, I've never heard of a case in which patients won out over profits. I think this is the most fundamental reason the US health care system costs what it costs. Succinctly, the health care system is what it is because it gets paid for treating the sick, and not for keeping people well. I think this sort of discussion ought to address a fundamental structural conflict of interest between the system of medical care as such, physicians, hospitals, and patients, and the pharmaceutical and health-care-access business. The conflict is in the fact the revenues and profits of both health care access providers and pharmaceutical companies is proportional to the total cost of health care services. Consequently, these companies' business models achieve success by maximizing the overall cost of health care. The effects of this conflict of interest manifest in a variety of ways that do harm to the practice of health care.

For example, two of the largest components of the overall cost of health care in the US are obesity and consequent chronic medical conditions, notably type 2 diabetes. Pro-active wellness maintenance programs are by far the most cost-effective means of addressing obesity and its complications, yet there are very few examples of health care access providers pursuing such programs. Instead, health care providers receive massive incentives to avoid addressing wellness, because chronic acute care is one of their biggest sources of revenue.

A related example is the care of acid-reflux disease. A significant proportion of the GERD case load traces its root causes back to chronic stress and poor stress management. Health care access providers would best serve patients by empowering them to reduce and manage their daily stress, through pursuit of pro-active wellness programs and through education programs that would teach about the true cost of chronically excessive stress. Once again, there's a huge disincentive to pursue disease prevention programs because chronic care is such a huge cash cow for both health care access providers and pharmaceutical companies.

This is the fundamental structural conflict of interest built into the business models of the health care access and pharmaceutical industries that seems obvious to me, but that I don't ever hear spoken of in public.

Normal insurance business models are based on risk management, and profit by risk avoidance, but health care access providers and pharmaceutical companies profit most from risk realized and from growth in the cost of health care provided. This means that the business interests of health care access providers and pharmaceutical companies are in direct opposition to the interests of physicians and patients.

Unless this issue is brought into public view and a way is found to counter the incentives built into current business models, the priorities of health care access providers and pharmaceutical makers will continue to create a direct conflict between these businesses' profit incentives and their stated mission to efficiently and effectively improve the health of patients. In the face of this conflict, I've never heard of a case in which patients won out over profits.

I think this is the most fundamental reason the US health care system costs what it costs. Succinctly, the health care system is what it is because it gets paid for treating the sick, and not for keeping people well.

]]> By: David Barlow http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-751 David Barlow Wed, 30 Apr 2008 14:38:36 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-751 I watched a special april 26, 2008 titled "Broken Government, Crisis in Healthcare" on CNN. I would like to purchase a video. Please advise. Thank you, DBarlow I watched a special april 26, 2008 titled "Broken Government, Crisis in Healthcare" on CNN. I would like to purchase a video. Please advise. Thank you, DBarlow

]]> By: Joe Montour http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-743 Joe Montour Tue, 29 Apr 2008 23:24:03 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-743 Dr Gupta My wife and I watched your program on health cost, we found it very interesting a new born baby costing 40,000 dollars per day for its care. My wife and I are retired but still work part time jobs to make ends meet.We own are house mortage free ,live in a rural Northeast Town and pay plenty to survive like the rest of the country. My main purpose of contacting you is to inform you how much were paying for insurance monthly . Our deduction from our social security check for medicare part A and B we also have the supplement insurance Blue Cross and Blue Sheild to cover what Medicare does not pay for.A total of 640.00 dollars per month for both of us.Makes it tight for extras. Thank you Joe M Dr Gupta
My wife and I watched your program on health cost, we found it very interesting a new born baby costing 40,000 dollars per day for its care.
My wife and I are retired but still work part time jobs to make ends meet.We own are house mortage free ,live in a rural Northeast Town and pay plenty to survive like the rest of the country.
My main purpose of contacting you is to inform you how much were paying for insurance monthly .
Our deduction from our social security check for medicare part A and B
we also have the supplement insurance Blue Cross and Blue Sheild to cover what Medicare does not pay for.A total of 640.00 dollars per month for both of us.Makes it tight for extras. Thank you Joe M

]]> By: Leah Amir, MS, MHA http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-730 Leah Amir, MS, MHA Mon, 28 Apr 2008 15:42:10 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-730 I am a healthcare economist doing evidence based research for over 18 years. During this time I have helped bring to physicians and their patients significant advances in medicine that markedly improve patients lives, in a cost effective manner. I am watching a documentary on Healthcare in the US. Two couples were shown each having children needing extensive neonatal coronary surgery, advanced life support, etc to keep their babies alive. Unfortunatley the “Payment” system caused hospitals to charge an exorbant amount due to the negotiated contracts they have with the payers. We all know a bill of $700,000 may actually be paind at less than $250,000 from the insurance company. The hospial then charges the patient the balance, or if the procedure is considered not covered by the insurance company, then the patient’s family is liable for the entire bill. Two points mentioned by the patrents that are NOT correct. The parents said they would have received better care for their children in different countries. This is NOT correct. If the baby were born in Canada or the UK, the baby would likely have died earlier. The skills and technology may not have been available, and advanced surgical interventions are not availabe in many countries due to budgeting contraints. For example, in the UK, oncology drugs are not paid for by the NHS. Patients need to go to other countreis and pay a handsome out of pocket amount for these advanced forms of treatment. So, yes our system has many problems, but clincally we have excellent advances in medicine, we have excellent physicians and care givers. A system that would be entirely subsized by a government organization would have the authority to limit what a patient can receive in medical care. Clearly being denied an advanced medical service, or told to pay out of pocket for these advanced services, puts us right back to where we are today. After 18 years here are my suggestions: Each private insurance company, pharmaceutical company,, device company, and some of the most profitable hospitals. but take a sliding scale of their profits to fund the un and underinsured population, creating a “social insurance fund”.. Patients would have to pass a means test to verify they actually qualify for the newly created insurance fund. If a person were employed with an insurance plan of their own, then they would be eliminated. People that particiapte in high risk behaviors such as smoking, have chemical dependency,or participate in high risk behaviors would be required to go through programs to stop the risky behavior. Those that choose to continue to behavior would receive less of the “. These people by the way, currenlty are not considered insurable by many health insurance companies today. Certainly this is just one aspect of the solution, but what is not democratic is for the medical industries “selling” to the patients and physicians, making generally huge profits, and putting riska and costs on the patients. Thank you for reading this far. I realize this plan would never materialize. Any politician that wants to stay in office would not have the nerve to propose such a solution. By the way, do you really beleive employers, such as Wal Mart, or the bigger employers will take the money they paid in premums and pass that as added income to their employee is dreaming. I am a healthcare economist doing evidence based research for over 18 years. During this time I have helped bring to physicians and their patients significant advances in medicine that markedly improve patients lives, in a cost effective manner. I am watching a documentary on Healthcare in the US. Two couples were shown each having children needing extensive neonatal coronary surgery, advanced life support, etc to keep their babies alive. Unfortunatley the “Payment” system caused hospitals to charge an exorbant amount due to the negotiated contracts they have with the payers. We all know a bill of $700,000 may actually be paind at less than $250,000 from the insurance company. The hospial then charges the patient the balance, or if the procedure is considered not covered by the insurance company, then the patient’s family is liable for the entire bill. Two points mentioned by the patrents that are NOT correct. The parents said they would have received better care for their children in different countries. This is NOT correct. If the baby were born in Canada or the UK, the baby would likely have died earlier. The skills and technology may not have been available, and advanced surgical interventions are not availabe in many countries due to budgeting contraints. For example, in the UK, oncology drugs are not paid for by the NHS. Patients need to go to other countreis and pay a handsome out of pocket amount for these advanced forms of treatment. So, yes our system has many problems, but clincally we have excellent advances in medicine, we have excellent physicians and care givers. A system that would be entirely subsized by a government organization would have the authority to limit what a patient can receive in medical care. Clearly being denied an advanced medical service, or told to pay out of pocket for these advanced services, puts us right back to where we are today. After 18 years here are my suggestions: Each private insurance company, pharmaceutical company,, device company, and some of the most profitable hospitals. but take a sliding scale of their profits to fund the un and underinsured population, creating a “social insurance fund”.. Patients would have to pass a means test to verify they actually qualify for the newly created insurance fund. If a person were employed with an insurance plan of their own, then they would be eliminated. People that particiapte in high risk behaviors such as smoking, have chemical dependency,or participate in high risk behaviors would be required to go through programs to stop the risky behavior. Those that choose to continue to behavior would receive less of the “. These people by the way, currenlty are not considered insurable by many health insurance companies today.
Certainly this is just one aspect of the solution, but what is not democratic is for the medical industries “selling” to the patients and physicians, making generally huge profits, and putting riska and costs on the patients.
Thank you for reading this far. I realize this plan would never materialize. Any politician that wants to stay in office would not have the nerve to propose such a solution.
By the way, do you really beleive employers, such as Wal Mart, or the bigger employers will take the money they paid in premums and pass that as added income to their employee is dreaming.

]]> By: Melissa Barnes http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-728 Melissa Barnes Mon, 28 Apr 2008 13:57:54 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-728 I feel the true medical crisis is how the elderly are kept alive, way beyond their natural course of life, just to feed the insatiably money-hungry medical machine. Patients may have renal failure (natural for old age), heart failure (natural for old age), respiratory failure (natural for old age), inability to swallow (natural for old age). All of these medical conditions help an elderly person shut down and die a natural death. However, the medical community keeps these patients alive in the hospital or long-term acute care and puts them on a ventilator, passes a feeding tube into their stomach, makes them undergo dialysis several times a week, inserts a central line into their body so they can continuously draw blood, puts a Foley catheter into their bladder, and often places them on 20 medications or more. Theses are terminally ill patients, being kept alive in an unnatural state for years, but they bring in billions of dollars to the medical community. These patients finally die of massive sores all over their body, which the medical community attempts to treat aggressively with amputation and cutting away the sores. Please investigate the true cause of the medical crisis, and that is offering aggressive medical care to the eldery, while ignoring the children and families who truly need medical help. Thank you -------------------------------------------------------------------------------- I feel the true medical crisis is how the elderly are kept alive, way beyond their natural course of life, just to feed the insatiably money-hungry medical machine.

Patients may have renal failure (natural for old age), heart failure (natural for old age), respiratory failure (natural for old age), inability to swallow (natural for old age). All of these medical conditions help an elderly person shut down and die a natural death.

However, the medical community keeps these patients alive in the hospital or long-term acute care and puts them on a ventilator, passes a feeding tube into their stomach, makes them undergo dialysis several times a week, inserts a central line into their body so they can continuously draw blood, puts a Foley catheter into their bladder, and often places them on 20 medications or more. Theses are terminally ill patients, being kept alive in an unnatural state for years, but they bring in billions of dollars to the medical community. These patients finally die of massive sores all over their body, which the medical community attempts to treat aggressively with amputation and cutting away the sores.

Please investigate the true cause of the medical crisis, and that is offering aggressive medical care to the eldery, while ignoring the children and families who truly need medical help. Thank you

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]]> By: Carol http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-716 Carol Sun, 27 Apr 2008 04:50:05 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-716 Comment on the cost of Health Care: I am a unemployed MRI Tech. unable to obtain Health Ins. Unemployed because 2 years ago I suffered two sudden major verigo attackes at my place of work. Both attackes lasted over 6 hours and patients had be cancelled and my employor sent me home the first time and the hospital the second time. After all the medical work-ups were done, the Neurologist just to humor me ordered an MRI at which time I was informed I had , had a stroke and possible tumor on the pons/medullary junction or possible a AVM there. Two weeks ago I had another sever veritgo attach in public, ended up in an amblunence and 8 hours in an ER I have no Health Ins. and just PRN employed. Since I did not have Ins. the Doctor changed his MRI of the Brain order, to a CT scan just to see if there was leak bleed. Now this CT scan show possibly an aneurysm on the Tip of the Basilar Artery, but no doctor is willing to address this since I can not pay cash. I am 56 years old wondering now if I have verigo again or just a bad headach, if is a terrific stroke or growing tumor. Needless to say, I am looking for any form of a job, that offers Health Ins. In a very sick way this all is very ironic, for foreigners come to America for their medical needs, as Americans we send money to third world counties for medical needs...but do we do for Americans? If they can not pay, to, to bad, tough love. Comment on the cost of Health Care: I am a unemployed MRI Tech. unable to obtain Health Ins. Unemployed because 2 years ago I suffered two sudden major verigo attackes at my place of work. Both attackes lasted over 6 hours and patients had be cancelled and my employor sent me home the first time and the hospital the second time. After all the medical work-ups were done, the Neurologist just to humor me ordered an MRI at which time I was informed I had , had a stroke and possible tumor on the pons/medullary junction or possible a AVM there. Two weeks ago I had another sever veritgo attach in public, ended up in an amblunence and 8 hours in an ER I have no Health Ins. and just PRN employed. Since I did not have Ins. the Doctor changed his MRI of the Brain order, to a CT scan just to see if there was leak bleed. Now this CT scan show possibly an aneurysm on the Tip of the Basilar Artery, but no doctor is willing to address this since I can not pay cash. I am 56 years old wondering now if I have verigo again or just a bad headach, if is a terrific stroke or growing tumor. Needless to say, I am looking for any form of a job, that offers Health Ins.
In a very sick way this all is very ironic, for foreigners come to America for their medical needs, as Americans we send money to third world counties for medical needs...but do we do for Americans? If they can not pay, to, to bad, tough love.

]]> By: Katie Dickerson http://pagingdrgupta.blogs.cnn.com/2008/04/21/seeing-the-cost-of-health-care-first-hand/#comment-709 Katie Dickerson Sat, 26 Apr 2008 10:56:15 +0000 http://cnnpagingdrgupta.wordpress.com/?p=23#comment-709 Doctors prescribe antidepressant/anxiety medications --without warning patients that if they take this medication--they will no longer be able to purchase health insurance. I work full time to be able to have health insurance. I was refused health insurance because I took care of myself. What's wrong with this picture? I also had a mole removed in 2000 that was diagnosed as melanoma insitu. If I had never taken Paxil, they told me I would be able to buy insurance in 2010--but if I had had a breast removed (a major body part) I could have been insured two years following a mastectomy. Go figure! Doctors prescribe antidepressant/anxiety medications –without warning patients that if they take this medication–they will no longer be able to purchase health insurance. I work full time to be able to have health insurance. I was refused health insurance because I took care of myself. What's wrong with this picture?
I also had a mole removed in 2000 that was diagnosed as melanoma insitu. If I had never taken Paxil, they told me I would be able to buy insurance in 2010–but if I had had a breast removed (a major body part) I could have been insured two years following a mastectomy. Go figure!

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