Dr. Gupta wants to hear from you on health reform

Dr. Gupta:

Health care reform can not be just to improve health care for the poor (as you stated mostly Blacks and Hispanics). It should include decrease cost for all Americans – rich or poor. The current proposal will increase spending by adding more people. It is a simple math.

Health care reform also needs to put some responsibility of poor health on those who are over-weight, who are smoking, who are involved in risky behaviors, and more. Should we pay for those people's care? Ask Americans. The answer would be a NO.

You should address the issue of doctor's pay. Most doctors are paid too much and are as greedy as those on wall street. That is the driving force for those unnecessary tests ordered by them and drives up the cost for all. Put all doctors on salary!

Here is a modern way to consider the provision of health care. We can't continue the old model since it is cost based. We need to become outcome based with every person in the USA having a "designated physician" linked to every person in the USA.

Please read the plan as written below.
American Health Care Plan
Jimmie David Barnard
7/16/09

The health care structure is too complicated. When you buy a car, you buy a car rather than a sum of parts which you then call a car. The present system is based on pricing the various components of services which its components together supposedly are to equal to a “health care plan” for a patient. It is maintained this is similar to a "trial and error" methodology. Volumes of services rendered are too low, care seems to be considered better if complicate and multiple health care modalities are employed, physicians don’t see enough patients, and only a few of the present patients pay for any services. Physicians are training to operate on a defensive basis……..test more to make sure of the diagnosis. Physicians struggle to operate their offices in the “black” and they are stressed. Not enough Nurses and patient care support personnel.
Strategy:
1) Structure health care where there is physician responsibility for the health of all patients. Physicians shall receive bonus compensation when they improve the health of the patients in their profile group.
a) Every patient shall have a “designated physician” responsible to supervise and monitor the patient’s care. It can be a either a primary physician or a specialists, as the patient chooses. The physician will be responsible to monitor all medications given to the patient by any physician, dentist, etc.. The patient’s medical record and drug history will be kept by the “designated physician” via the patient Social Security number. All drugs and appliances given the patient will be identified with such number and the “designated physician” will be responsible to make sure they are suitable for the patient. If the patient fires the “designated physician”, then the patient will then have to select another “designated physician”. All patients will have a “designated physician”.
b) Designated physician will be responsible to:
i) monitor the patients health
ii) to keep the patient in a fit and healthy condition
iii) call and make sure the patient is following the health plan
iv) Semi-annually monitor, test, and insure patient isn’t taking steroids or other illegal drugs and maintain documentation verifying an illegal drug free status.
v) Provide follow-up to make sure there is progress.
vi) Monitor the physician referrals and make sure they are effective and that the drugs and medical care they provide is suitable and meets the patient’s goals.
c) The “designated physician” will report both patients and other health care providers who deviate and miss identify patients for the purpose of obtaining drugs or engaging in unsupervised experimental therapy and treatment outside of the legitimate scope of care and positive support of health of the patient.
d) Physician will be encouraged to work in groups with support staff to help them. These medial groups can be extended. For example, a physician might be located in a rural area by himself with maybe one or two other physicians, but he is supported by his major group at the “home base” who handles the billings, and other administrative tasks. Every physician must be in a “home base” physician group, which will provide professional review of physician performance in his private practice.
e) Every person in the USA will have a physician assigned who will be identified as the “designated physician”.
f) Compensation for physicians shall be simplified to include categories for:
i) surgical procedures
ii) Medical supervision for general well being (weight control, smoking cessation, drug dependency intervention, exercise, etc.)
iii) medial office visits (includes compensation for patient tests)
iv) hospital visits
v) Laboratory, x-ray, other tests are included in the compensation in the above categories and specific fees for such tests cannot be charged.
g) Medical Malpractice insurance shall be provided by one USA agency that shall provide such insurance, monitor claims, and limit awards.
h) Medical Malpractice is provided for each physician the medical group “home base”. If a medical malpractice issue comes up, a medical review board shall determine if there is a legitimate cause for action. The medical review board shall be made up of:
i) 1/3 physicians (total of 5 physicians, 3 of which is in the specialty of the physician(s) accused
ii) 1/3 by patients (total of 5) having been treated in the past having the diagnosis of the complaining patient
iii) 1/3 by community leaders (total of 5) who live in the community of the complaining patient.
The medial review board determines if there is a justified complaint. A simple majority opinion of the medical review board stands and they determine there is or is not justification for the patient complaint. If there is no justification, then the issue is dropped with no appeal. If they determine there is cause for damages, then they recommend to the judicial system that the case should be heard with a recommendation for damages as determined by the medical review board. Is there is a trial, the patient only stands to be rewarded a maximum as determined by the medical review board, no more. All members of the must be present and vote for a decision for action. The number of physicians shall always be in the minority.

The medical record is for health care notes and cannot be used by anyone to prepare for legal action, document problems, and used in any trial.
2) Provide enough nurses, nurse practice, and support staff to care for patients.
A massive program needs to be undertaken to educate RNs and other Health Care professionals. 10 times the number of professionals needs to be trained.
3) Make products, services, and pharmacies available to all hospitals at competitive prices. Reduce the number of complicated alternatives of products, services, and pharmacies which drive up costs.
a) Private company product supply cooperatives shall be formed by State (only one per state and shall be designated as a State Medical Supply Cooperative) and Region (no more than 6 regions in the USA and shall be designated as a Regional Medical Supply Cooperative) for the purpose of offering medical products, pharmacy products, and supplies at the most competitive prices. Each State (Supervisor) shall license their State’s Medical Cooperative. The Department of Health and Human Services (Supervisor) for the USA shall License the Regional Medical Supply Cooperatives. Should any cooperative fail to offer products which support services of all types and forms, the Supervisor shall then select another Cooperative group to be the Licensed Cooperative. The Supervisor shall insure that the Cooperative maintains a full array of products and those they sell in reasonable volume. Further, each Supervisor shall insure there is a competitive environment in which the Cooperative functions.
b) All health care buyers shall pay the same price for any product sold through any one cooperative. Cooperatives shall compete for price between other Cooperatives. Any hospital, clinic, or other health care provider is authorized to buy from any cooperative in any state or region. A Medical Cooperative shall sell its products to all providers at the same price per unit and item regardless of provider’s size, credit history, or purchasing profile for items purchase within any cooperative. A monthly products catalogue shall be produced by each cooperative with all products identified and their prices which shall be available online from which any provider may purchase products from the catalogue. This enables a small hospital to purchase products at the same price as a huge hospital group.
4) All providers shall be not-for-profit companies including hospitals, nursing homes, skilled nursing homes, health care providing groups, physician, dental, and other professional party practices.
5) Hospitals and other similar providers such as nursing homes, etc. shall be paid based on a per diem based on Diagnosis, Surgical Procedure, or other similar criteria. There shall be no compensation directly for laboratory, radiology, or other tests or services. These services are inclusive in the per diem. The Per Diem rates shall be established by State to account for variation in the cost in property, building costs, and other local costs, and based on the prevailing rates for medical personnel, and the cost of Medical supply costs as incurred by the cost of supplies obtained from Medical Cooperative purchases. The goal is to get the greatest level of diagnostic, surgical and treatment services possible while being wise and efficient in the expenditure in resources to achieve such medial outcome objectives for the patient. The medical record is solely for the purpose of medical care and cannot be used in any way for the purpose of legitgation.
6) There shall be no services for medical care offered which is considerate outside these guidelines. Anyone who offers medical care shall offer such care with pricing and costs structured under these program guidelines. This stops a privileged and elite medical program from developing. Every medical and dental care program shall be of the highest quality and shall be described and supervised under the parameters of this program.
7) Medical, Dental, and any other patient care health insurance programs shall be offered by a government agency (similar to FNM). Private companies will be encouraged to also offer such insurance programs. There shall be umbrella insurance against catastrophic illness. No one’s individual home valued $500,000 or under, bank account valued $500,000 or under, and a single automobile valued $50,000 or under shall be claimed to cover the costs of health care services per individual and double that for a husband and wife. If someone works their entire life to build their fortune, he shall not have that fortune reduced or eliminated because of an illness to the limits so described.
Mental Health Care shall be dramatically improved and expanded including greatly improved provision of services for the drug and dependency programs. The Mentally Ill shall be taken out of the back streets and gutters and given proper care in the proper settings. Early educational programs in grade school and beyond shall provide increased human behavior education and discipline to counter any propensity to seek out relief from stress by drug use or tendency to withdraw from conflict and life. Proper manners, language (there are young people who do not speak English, but a coded language), courtesy, and human behavior life skills shall be emphasized to insure optimal survival skills for the 21st Century. Our people must be employable, have skills, and the ability to get along with other people. All these skills are important.
9) Medicare services shall be based on the same medical outcome philosophy as previously described. See 11). Medicare patients shall not received reduced services or have their medical and dental care providers paid differently than any other patient.
10) Medicaid services shall be based on the same medical outcome philosophy as previously described. See 11). Medicaid patients shall not received reduced services or have their medical and dental care providers paid differently than any other patient.
11) All patient care shall be reimbursed at the same rate for each patient outcome category.
12) Military Care continually shall be offered by government hospitals; however in addition, any veteran or active duty military personnel may select any licensed hospital in the USA for his medical care upon approval and upon admission order by his “designated physician”. Veterans and active military personnel may select either the military option or the private physician model via the “designated physician” route.
Summary.
These steps as identified here will dramatically change the landscape of medical and dental care in the USA. It will take medical care from a procedural based medical care and treatment focus to an outcome goal oriented medical care and treatment focus.

Has anyone run models on the impact of a major outbreak (flu, plague, whatever) on the US with healthcare reform versus the US without healthcare reform? Or to put this another way: Isn't it easier to nip an epidemic/pandemic in the bud before it has a firm grip on the nation via the millions that cannot afford proper health care versus waiting until it's too late? (And by models, I'm not just talking about the potential for horrific cost in human lives here, but also the losses in revenue as commerce shuts down, etc.?) Surely it's cheaper and safer in the long run to opt for reform (an more humane) than to maintain the status quo?

Since I have been following the health care debate, I am confused somewhat about the 47 mil uninsured. I have heard other commentary state that this number is misleading when you take into account illegal immigrants, persons who can afford health care but refuse it, and persons who have lost their jobs but will find other jobs with health care. So to me this number appears to be a moving target. So when we talk this issue what is the real number?

One additional question, and that is Why does all persons over 65 have to go on Medicare if they have insurance? I look forward to hearing from you on this important subject.

Thank You!

Dr. Gupta, it was a relief to finally hear someone talk about the fact that we are already paying for health care for the uninsured, through hidden costs. i work in health care and everyday i see the barriers to patients maintaining health and getting primary care due to lack of insurance, so inevitably they come to the ED for thinks like stomach aches and flu. this escalates the cost of health care for everyone. you are the only one so far to acknowledge this reality, and it needs to be reiterated over and over again so that the public understands that health care reform will reduce cost for everyone in the long run. please continue to address this issue

I retired and moved down to FL two years ago. I had to cancel my health insurance, after carrying it for two years on my own at a cost of over $6,500 a year, because I could not afford it any more and since I never got sick, so it was like throwning money down the garbage disposal.

I went to the emergency room twice because of pains in my back. Twice, because it was never addressed the first time. The hospital changed it from pains in my back to pains in my chest. I saw the doctors for less than two minutes each time I was there.The first time they kept me there a few hours and hooked me up to a machine (EKG??) and just left me there. After two hours, I disconnected myself from the machine. They did blood work, X-ray, and God knows what ever else.

I actually saw the doctors both times for less than two minutes each. However on their records the pain in my back changed to pain in my chest. I had to insist that they release me. The bills I received in total from hospital and doctors total over $5,000. To make things worst, I believe I picked up an infection in the hospital.

WE NEED MEDICAL REFORM. THE HOSPITALS ARE RIPPING PEOPLE OFF.

Hi Dr. Gupta,
I am really angry with the ad on CNN. The Canadian woman
says that she would have died waiting 6 months to have a cancerous brain tumour removed......This is not true......she had a benign cyst on the back of her head. She would not have waited if it was cancerous tumour.. My expericence is that sick people have excellent care and do not wait. YES WE HAVE TRIAGE!!!
The ad is fear mongering against universal healthcare BY PEOPLE WHO WANT TO KEEP OVERCHARGING FOR THEIR SERVICES.
We are short of doctors in Canada because the greedy ones move to the U.S to make the big bucks. If you guys had universal healthcare you wouldn't have our problem of not enough nurses and doctors.
Your healthcare system is not humane, my U.S. sister had to sell her home to pay medical bills after her husband of 38 years old died of cancer. She had to start all over again as a very young widow with a 5 year old child. The cost of your health srevices make people sick.
Please ask CNN not to run ads against our Canadian system.

I am Canadian and 75 years old. I was so glad to hear ' finally ' a Canadian Health Minister speak to CNN today . I have 2 children and they have four children. All of them had numerous operations for which they never paid a cent. We can select our Doctor and he will
make the decision what has to be done. I have ALWAYS received IMMEDIATE treatment when I needed it. My eyes were operated on and I did not even realize I needed it. My eye doctor decided it and after three months I had it done. I paid for 40 years into my health plan and I never have to ask an insurance company or submit a claim. I cannot believe the garbage we hear about the Canadian Plan from Republicans. It is sad to see the ' greed' in America. Listen to Canada

Everyone is talking about the deficiencies of Canadian healthcare system – the long waits on elective procedures.
(And I know Dr Gupta is not a great admirer of French system).
Fact: In 2008, Canada spent US $4700 per person on healthcare.
In 2008, USA spent US $7900 per person on healthcare.
Question: If Canada spent US$ 7900 per person, will it still have any significant waiting lines?
You don't have to be a neurosurgeon to answer this question.

After I had been diagnosed with MS in 2004, my husband decided to retire in 2007. His only income is his Monthly Pension. He is now 59 and we are paying $850.00 a month for health insurance. Because of my illness we are unable to find a comparable health plan for less. HOW IS THE HEALTH REFORM GOING TO HELP PEOPLE LIKE US?

No one seems to be listening. It's not that we need Health Care Reform. If the Doctors, Pharmasitcal Companies and Insurance
Company's would just lower their cost's we would be in good shape.

Look at the profits, it's about greed not health. Money!

In all of the discussions on health care reform why is the issue of the non-medical components of health care costs never highlighted ... the two major ones being profit and administration/bureaucratic overhead.

All private insurance firms and private hospitals are businesses and like all other businesses they want to maximize their profits by maximizing income and minimizing expenses. In practical terms this means increasing premiums, keeping benefit payouts as low as possible and not providing services to high cost, unprofitable clients ... i.e. patients who need medical care. Competition will keep the worst excesses in check but from the current state of the economy it is evident that private sector firms will do pretty risky and ill conceived things in pursuit of profits.

With the large number of private sector insurance firms and private medical care providers there is a highly complex mass of plans and services with different coverage, plans, rates etc. To process all these medical claims takes a large number of clerks, administrators and bureaucrats all of which cost significant amounts of over head dollars and time all of which are considered part of medical care costs even though they provide no medical benefits.

If we could reduce the profit and overhead components in national health care costs the money saved could be put back in patients pockets or to provide more and better medical services at no additional costs.

So where is this aspect being included in the health care debate?

Green Backs. Dinero. $$$. Lets be honest (not that any house rep or congressmen or legislater would understand they are all rich. excuse me and f you

what can you tell me about edometrial hyper plasia & will there ever be a cure ,TTC..im to young..

I want to know why my honest truths have not yet been aired? We don't need re-form just lower the cost's.

I recently have been converted into a vegetarian and I am truly loving it. I had a little bit of meat last week after not having any for months and the mood swings, constipation and low energy levels were extreme. Dont get me wrong I loved meat more than you can imagine, but turning 39 this year and having a wife that is 11 years younger than myself, I needed to make the change for our future and for my overall health.
Question – I have heard alot about raw food diets, and I have seen and met people who are on them and they just seem to have unlimited energy, more than myself as a vegetarian and also they have a high natural glow to them. How good is a raw food diet for you and and recommendations if one was to go on a all raw food diet.

Thanks and my family and I love you on CNN

-Anil

Just had to add my 2 cents worth on all the health care broo-ha-ha. I saw a report on CNN about the $1200 wheelchair and almost laughed – truly! This soaking has been going on for the past 20 years that I know of personally, having spent much of it home care. In the 90's, when MC decided to save some $$, it was on the backs of the home care nurses and therapists, cutting pay per visit by incremental, yet ridiculous amounts. Then they thought – we'll give them a certain amount per diagnosis, increasing our paperwork by reams – the ICD-9 code book borders on 3 inches thick, the paper is telephone book thin – wrong codes, less money for the home care agency... they don't like that. The suppliers seem unchecked in their greed, however – it is both frustrating and infuriating. doctors do not consider the cost of medications when they prescribe them, and since the average patient can't read them anyway, has no idea what the cost is until they get to their pharmacy. Price shopping here sounds like a good idea, but if you don't stick with the same pharmacist all the time, your safety net is gone on monitoring drug interactions goes out the window too. Hospitals routinely overcharge or stick a charge in on someone's bill if they don't know wherelse to put it – its got to go somewhere, and the insurance, or MC is footing the bill, right? So why should we care? We should care because it has been going on for decades unchecked by anyone – and it is time to stop. If we were to eliminate all this fraud and abuse, the health care package, whatever the cost, would be paid for. Period. Man, I wish I were on somebody's task force – I know where most all the skeletons are buried! My apologies for the length, but I had to get it to someone – perhaps you are the one who can make a difference.

I know that health care reform in the U.S. doesn't affect me, but I'm angry at how the Canadian system is being lied about to Americans in an effort to scare monger Amercan people against the President's plan to provide universal health care.

I see ads that threaten to have government bureaucrats in charge of people's medical records and medical decisions and that's not what happens here. Even if our government did have access to people's health care records, we have strict confidentiality standards. We cannot be refused employment based on these records or refused care for pre-existing conditions. And I don't see how government officials having access to one's medical records could be worse than having greedy, self-centered, and profit-focussed insurance executives all over people's medical information and making life and death decisions about their treatment.

To say that a patient and their doctor would no longer be making these decisions is a total fallacy–ultimately, it's not up to people and their doctors now–it's the insurance companies making all the decisions and they will allow anyone to die in order to line their pockets with the money of those they condemn for personal profit.

The Canadian provincial governments decide what can be afforded and what cannot within their annual budget (health care is a provincial issue, not a federal one) based on the money transferred from the federal budget to each province every year, and it is extremely costly treatments (e.g. new medications for chemotherapy) that may not get the green light until they are proven elsewhere. None of these decisions are personal. No one is refused surgery on the basis of age usless there are other medical conditions that would make the outcome unlikely to be a positive one, and if such a decision is made, it is made by the doctor, not the government. The patient is free to seek a second opinion if they disagree.

Surgical waitlists are on a priority basis–those who are likely to suffer life-threatening consequences without their surgeries are placed on urgent and even emergent lists and have procedures much quicker. My daughter came into the ER in May with an infected gall bladder and had it removed the same day. The same thing happened to me seven years ago when I had appendicitis. We wait for low-priority procedures due to a lack of doctors and to accommodate those who are sicker and need care sooner. This is only fair. People do complain, but I believe that it is those who do not follow up on their worsening condition with their physicians (and/or don't follow the advice given to maintain their condition in the meantime) who run the risk of dying while waiting for surgery.

As you stated the other night, the uninsured in the U.S. are not free–they cost more because they don't get the care they need until their heath is in a crisis state, when it is much costlier to fix. If Americans don't think they paying for this already with their tax dollars, they have their heads in the sand. Regardless of what it may cost in the short run to implement health, in the long run, it will cost less as people get the care they need long before treatment to fix–rather than merely prevent–serious medical problems cost taxpayers tens, hundreds, and even thousands more to deal with.

To leave things as they are doesn't make the U.S. the "greatest and most powerful nation in the free world," but the most selfish. If the "poor little guy" doesn't stay healthy enough to run your factories and do all the dirty work, eventually the wealth of all the rich people who don't want to pay more taxes (but already do, even if they don't yet realize it) will collapse completely. Even China provides health care for their poor, and look at how powerful that nation is becoming.

Greed and selfishness always costs more in the end. The scare-mongerers don't care about their country, they only care about themselves, and just like those who selfishly ruined the economy, they will wreck even worse havoc on the U.S. with these lies if people keep being foolish enough to listen to them.

If we really want to lower healthcare costs, then why isn't EDTA chelation therapy done on more patients with with heart disease? The reason why is because the healthcare system is a political scam that politicians, doctors, and insurance lobbiest get rich off of. I hope everyone looks up EDTA chelation and gets pissed off when they see this therapy could be used to save lives at the fraction of the cost of open heart surgery.

Why won't the Republican's and the conservative Democrats tell the truth? Is the issue on healthcare really just about selling out to the lobbyist who are afraid of losing money? I believe the oppsition fight is about liining their pockets. Why would a public official not want better and cost efficient healthcare? So many people are are hurting and dying. What could be more important than human life? Has it come to this? Do these people hate the President so much that they would allow people to suffer? What can we do to help the President get this bill passed? Help us please?

I had to write to Americans why they should welcome Government health care reform, because it WORKS! All medical bills are paid for. You can go to an emergency room and pay nothing. You can have the most serious of conditions and you pay nothing. Having a baby through a difficult birth can costs Americans so much, but we pay nothing, even if the infant has to stay in the hospital for months with or without the mother. It is time Americans took the power from the the wealthy Insurances and put it in their own pocket. Health tax is a good tax, because it pays for all your medical regardless of the condition. The onlyl exception we have in Canada is the drug costs, which are too high and some are unaffordable, but we are working on solving this problem. But please Americans, welcome and help your President bring free medicare to you and yours and for the millions that don't have any at all. If you could only feel what it's like to not be afraid to be sick, you would know it is worth it. We have said here, that some cuts don't heal and that making a profit off the sick, ill and dying is deplorable. This is one battle you want to win.

Thank you

Will medicare coverage remain the same for seniors. Now we have A and B parts coverage with a minium payment for A. That only covers 80 % of medical bills. we have a secondary policy to cover the 20 % at a very high payment. Will the government pick up the entire cost for seniors under the new healthh plan?

I recently heard that congress will opt out of using the government sponsored health plan. Why is that? Don't they feel the health plan they have developed for the rest of us is good enough coverage for them.

Is there any actual evidence that says that insuring people with pre-existing conditions is that difficult? The majority of insured people have employer-sponsored insurance. Many mid- to large-sized companies offer insurance programs that do not underwrite not only the employees but their entire families as well. Essentially, we already have working models of group insurance programs where people are not turned away for pre-existing conditions and it is profitable for the insurance companies otherwise they wouldn't be doing it.

From looking at my insurance records, uninsured people are charged 2 to 10 times as much for the same tests and doctor visits as the insurance companies pay at their negotiated network discount rates. For example, my insurance company paid about $5 to the lab for some tests which if uninsured, or if my claim had been denied, I would have had to pay about $500. Then of course uninsured people have difficulty paying medical bills! If they were charged $5 for the lab test like the insurance companies actually pay, they could probably afford it. What is going to be done about this unfair pricing scheme?

I often hear of charges for the same medical procedures ranging over a ten-plus-fold price range. Someone told me his procedure cost $15,000 to the insurance company while when I had the same procedure elsewhere, it cost less than $1000 to the insurance company. My insurance company also was charged and paid $5000 for some tests which another doctor told me that he charges about 1/10th of that and was at a loss for an explanation. I don't understand how there can be such a wide range in pricing and the insurance companies don't even question it and pay the inflated prices, and meanwhile I hear many doctors complaining that they're not paid enough. As a beneficiary of a doctor's income, who charges 1/10th of those inflated prices, I can say that that still allows us to be really quite wealthy. At the uninflated prices, medical care could actually be affordable. What is going to be done about the wild price ranges from the low of MediCare to the absurdly inflated?

I would like to correct Liz Cheney,s comment on LLK,tonight that we in Canada can,t choose our doctor.I have lived for over 80 yrs.and have never been told what Dr.to choose,it was always my choice even when I moved. We also have a drug plan and I get the RX ,s that he orders and as a senior I do not pay more than $15. for each one.I live in the povince of Saskatchewan,I have had 3 major surgeries which were done promptly .I don,t mind someone criticizing our system but they should at least be well informed about it .I hope somebody will tell Liz Cheney how wrong she is.I am rather angry!!! Lee Metcalfe

I saw your show last night about two different health care programs in New York. Your show attempted to put a racial spin on what was happening there. My question is if Medicaid patients don't get the same care as the privately insured. Why in the heck are we blindly going down the road of National Health Care with the government taking more control. I may be mistaken but isn't Medicaid/Medicare/VA all Government plans? HOW'S THAT WORKING OUT?

Hi – I just sent an email to the white house in support of health care reform. I want to march on DC when congress comes back in session to quietly stand 4 the uninsured that can't go. I am covered by a great plan so I think everyone who is should go and stand for our neigbors that aren't. I am willing to pay more taxes if need be to be able to say everyone in this country can go to a doctor and get the medicine they need. Do you think it would help?

As a dual American-Canadian citizen, I have had plenty of experience with both health-care systems (as well as the British one, having lived there for two years). And I live in the same area as the U.S. right-wing media's new darling, Shona Holmes of Waterdown, Ontario (who got her 15 minutes from this particular media outlet at http://www.cnn.com/2009/POLITICS/07/06/canadian.health.care.system/).

So, I figured I should share my story to you as well. Of course, two isolated anecdotes are really no more valid than one. Pity CNN didn't make that clear when you turned Ms. Holmes into a right-wing media darling.

In May 2007 my husband had a heart attack. It took him a few days to realize it was something serious. When he called his doctor and described some vague symptoms he got an appointment for the next day. The doctor sent him at once to the emergency room, and he was in the hospital for the next 15 days, under constant monitoring, for an angiogram and other tests, and then a quintuple bypass surgery and post-operative recovery. For that we paid a total of $900 – or would have done had we not had supplemental insurance through his work – because he preferred to be in a private room at the hospital.

He was put on nine different drugs for the first weeks after the surgery, gradually winnowed to three. We pay about $5 for a 90-day supply of each of those, because of his supplemental work insurance. But once early on he made a mistake and didn't mention that he had prescription drug insurance when he filled one of the prescriptions, for a beta-blocker, Metoprolol. The uninsured price for 90 days worth of that, including delivery to our house, was $14.62.

We each pay $750 per year for our health coverage. That is a sliding
scale based on income and we are both at the top of the scale. And as
budget manager for my department I also know how much our supplemental insurance costs our employer: $2500/year (we both work for the same employer). That $2500 covers our prescription drug benefit, supplemental coverage for things like a semi-private room and physiotherapy, and our health insurance coverage for when we travel to the US and other countries. Maybe if your employers only had to pay something like that you wouldn't worry so much about having it be considered a taxable benefit.

And indeed, though I do have that insurance, I had to pay out of pocket for my visit to a California emergency room (Santa Barbara in my case). I was sent there from the drop-in clinic who refused to even let me in because though I have insurance, the card (Blue Cross) I gave them did not have a U.S. address for sending the bill printed on it, so the accounting people didn't want the bother of figuring out how to get reimbursed. So they told me to go to the emergency room because "they have to take everybody".

Of course, at the emergency room I did get just as good a treatment as I have had in Canada. But I did have to stand, or sway because of my 102 fever, in front of an accounting window and give them a credit card as well as the insurance card so they could take $200 deposit before actually letting me see a doctor.

Oh yeah, and then I needed an antibiotic. Six pills, $60. So that means my bacterial bronchitis in your system cost about 1/3 of the cost of a quintuple bypass in our system. And meanwhile I have watched how my sister in Colorado worried that the freak heart attack her son had at age 22 would ruin his future because no one would hire him due to the insurance costs. And another nephew in Missouri suffering not only the fear and despair at losing his job, but the added terror that it also meant loss of his health care. And a brother in Kansas with ocular myasthenia gravis who first has to wait for the one neurologist who can treat this condition to make a monthly visit to his city, and then needs to borrow money to pay for his treatment, though the neurologist has gone to a great deal of effort to secure him some of the treatments under some kind of poverty plan. His city is Wichita, the largest one in Kansas. My city is the same size, but I could find that treatment right here and not have to wait for the doctor's monthly visits.

You REALLY don't want to have this argument about the relative merits of the U.S. and Canadian health care systems; the U.S will only embarrass itself – again. No doubt that is why CNN decided to only show one extremely limited and non-representational aspect of the full story.

Dr Gupta,
I'm a second year medical student at the University of Kentucky and as I prepare another round of financial aid applications, I was curious to know what you've heard from Washington regarding debt reimbursement, if our Health Care system becomes socialized. Its my understanding that most countries that practice socialized medicine also pay for medical school. How will the government make this transition? Will my generation of physicians simply fall through the cracks and spend the rest of our lives paying off our debts?
Sincerely,
David A Lovejoy

I just watched Liz Cheney on LKL saying that people in Canada don't get to choose their own doctors. This is plain wrong. I chose my family physician, in fact your first meeting with your physician is an interview for you to decide whether or not you want them to be your physician, they are prohibited by their professional college from rejecting patients, the patient makes the choice. I am currently 8 months pregnant with my second child. I was given a choice between an obstetrician or a midwife. I am having and have had a low risk pregnancy so I chose a midwife whom I got to chose from several practitioners. I saw the midwife once a month until 30 weeks, bi-weekly until 36 weeks, and once a week after that. At any point during my pregnancy I can see an obstetrician. We were concerned last week that the baby may be in a breech position so I was immediately given an ultrasound and a consult with an obstetrician within a couple of days, all was fine, no breech. The only thing I will pay for during all of this is a $100 per night hospital fee to have an optional private room instead of sharing a room with one other person. That fee is 100% covered by my public sector employer. After I give birth my midwife will attend to me at home as will a public health nurse. You always choose your healthcare practitioner, if I was having a surgery instead of a pregnancy my family doc would recommend a specialist and I would make my own choice about who to see based on their recommendation and availability. There is no question we choose our own healthcare practitioners every step of the way.

Please discuss the problems with getting rehab for stroke survivors. The current research shows that stroke survivors can recover speech and physical limitations with intense therapy. Medicare estimates show that physical, occupational, and speech therapy costs providers about $40/hour; yet they charge between $200-$700 per hour to patients. Insurance companies often limit coverage to 20 hours of therapy a year. But recent research findings show that patients need at least 9 hours per week for many months for lasting results.

It seems that the health systems are greedy and the insurance companies and the insurance companies are cut ting corners, leaving stroke survivors needlessly paralyzed.

I think President Obama should pick say 2 states and do a trial run with the program of his choice first long before he decides for the entire country.
What is the BIG hurry.
Are we looking for kudos I did it, or a serious resolution for the needed in healthcare.This way he can tweek the problem areas before we have an epidemic that would cause major kaios.
It is insane to think one program will fit all. It should be proportionate to your needs and income level. Chrildren shoud be first in the program.

Dr. Gupta,

What will be the affect of health care reform on medical transcriptionists? We are losing our jobs to off shoring Dr. Gupta. I am only one story but I know of many, many more. Our pay has gone down to a nonliving wage, yet we are expected to produce a quality medical record. The medical records from off shoring are filled with errors. I think many Americans would be amazed at the mistakes in their records, all to save a dollar. The professional medical transcriptionist who takes pride in his or her work and wants to be a part of the team to create quality healthcare is being pushed aside by big business.

I believe there is a story here Dr. Gupta. Can you help us get the word out about what is happening to the quality of the records and the importance of the job we do?

Thank you.

Carol Carrier

Everyone wants to know how taxing the health benefits of people who already have health care to support the health reform will benefit them. Most people have fears of our health costs rising without much benefit to us. From my personal observations, one thing is evident to me that I have not heard discussed to this point.

Currently people who do not have any health care plan must go to the emergency room for any type of care. The result of this is that many people who go to the emergency centers in their local hospitals go there for treatment that really are not emergencies. This must be costly to all of us both in terms of the rates we pay for our health care and also by needlessly filling up our emergency centers with non-emergency cases. These non-emergy cases would be much more cost effective if these people could just go to their doctors and not to the emergency room for simple treatments.

Can you please comment on how the health reform may help alleviate this problem and how health care reform may actually save money in this regard? Thanks for your time.

Scott

There is a misleading ad aired featuring Shona Holmes and her claims of being denied care for a fatal brain tumour. It turns out that she did NOT have any such fatal tumour. But, a highly respected for-profit American health care institution was willing to step up – for a hefty fee – to help her jump the queue for treatment of her benign condition.

Unfortunately, this is what for-profit care does best – respond to whomever plunks down the cash. There are, unfortunately, doctors who are keen to devote scarce resources to unnecessary tests and procedures, when a firm response re a less cash-intensive course of action is required.

I'm very satisfied with Canadian healthcare. As most Americans know, all that is administered by the government is the payment, not the care. We pick our own doctors. However, the primary care physicians do make the call re access to specialists, and we do understand that we cannot spend infinite sums on every patient. Patients with non-life-threatening benign conditions some times do have to wait. End-of-life no-hope cases are not necessarily kept alive indefinitely – and certainly we don't interfere with nature's course terminal cases to score political points (remember poor Terry Schiavo?)

You might want to investigate whether Ms. Holmes was paid for her 'testimonial'. No one here is trivializing Ms. Holmes' condition, but we have scant sympathy for someone who is deliberately misleading and hypocritical (Ms. Holmes is quite welcome to leave Canada if she doesn't like it here...)

We wish our American friends well, and hope that the PACs will not prevail, but instead, hope that patients come out on top, as they should.

I am appalled at our President's arrogance and ignorance. He knows nothing about the heath care industry but yet is trying to ram his plan down the throats of US citizens for political gain. Healthcare needs to be fixed but it needs bi-partisan, careful and complete analysis. This plan will increase costs and lower quality. The claim that you can keep your current plan is complete fiction. You can keep your plan, only, if you do not change jobs. Taxing the high wage earner will stop any progress to an economic recovery and -Where are the jobs we were promised?? If this plan is such a great solution, why are the President and Congress not jumping on board. Oh no – they have their golden plan that is too good for the American people. Same goes for social security. All these programs will not be fixed, until Congress, the President and federal workers are on the same playing field..

Dr. Gupta,

I'm an American who lived in Canada from 1996 to 2008. While living there I was covered under the Ontario's Health Insurance Plan. And I want to say that I survived Melanoma while living in Canada. The insurance system covered me timely, and I'm cancer free today.

About three years ago, my doctor in Toronto sent me to a dermatologist to have a mole examined. The dermatologist removed a section of the mole and sent it for analysis. It turned out to be Melanoma which as you know is a deadly form of skin cancer.

I was told by the dermatologist that I needed to have it removed and I was told to contact an oncological surgeon. I was given the names of several surgeons, but the ultimate decision on who to go to was mine.

The surgeon I chose told me his first available appointment was in three weeks. After being examined by the surgeon, I waited three more weeks for the surgery to take place, which it did in a hospital operating room under general anesthesia. They removed the mole, plus one inch of skin around it, and three lymph nodes.

So, it was a total of about eight weeks from when my physician told me to have it looked at, to when it was removed.

Note that the only involvement that the government had was that the bills were set to them as the insurer and they paid 100%. The government didn't decide when it could take place, or whether I could have the surgery, or tell me that I had to wait before having it done.

Everything was between me and my doctors. Doctors that I chose.

I'm not saying that Canada's system is perfect, but the horror stories that some people are claiming are the exception, not the norm.

Plus, Canada's system is single payer, and nobody is proposing to implement that system here.

Lately,Dr. Gupta has been quoted by many of his CNN hosts as saying,"I would'nt want to have a Canadian style health care system if I was having a heart attack."
Why are so many talking heads demonizing the health care system in Canada.The latest poll shows that a large majority of Canadians like their health care coverage,and certainly would'nt trade it for the U.S system.
My mom had a heart attack 2 weekends ago.She went to the E.R on Sunday afternoon,saw a Dr. immediately,was admitted to the CCU,worked up,and stabilized.Monday morning she had a heart cath,which showed a rt coranary artery blockage.they placed a stent,and continued to monitor her heart function.Her heart rate was slow enough that they thought she would need a pace maker,but on tues. evening her rate converted to normal sinus rhythm.She was transferred to Telemetry unit,monitored for 2 more days,then discharged home on fri. where she is recovering nicely.When I talked to her by phone,and enquired about her care,her response was "Everyone is taking such great care of me,they're treating me like a queen."
Dr.Gupta,my mom was a very lucky lady,she was having her symptoms for several days before seeking care,but she received the best medical care available anywhere in the world.She was not neglected,ignored,or pushed to the back of some imaginary bread line,like the U.S tries to portray.And most importantly,she will never see a bill,or be harassed by an insurance company,and her new cardiac meds will not put an ungodly strain on her monthly bills.
Canadians are totally unaffected by whatever healthcare system the States decide to adopt,but we're mentioned every day in a negative way in your debate.Our system won't work here!! your population is ten times larger,and the fast food mentality doesn't apply well to universal health coverage.So,if you're not going to give an honest portrayal of our system,please leave us out of your debate.
Thanks, Dan

On your piece this am(7/22) re the disparity in health care between blacks and whites, you cited a black man who went to the ER with a paper cut. It was said that this person had health insurance. His diabetes, the cause of his infection, weight loss, etc. went undiagnosed for months. The allegation was that it went undiagnosed because he was black, and recieved poor care because of his race. My question is: Why, if he had health ins. did he go to the ER instead of his own primary care giver. ? Why, if he has health care, did he not have regular checkups, which would have picked up on his diabetes.? Why did he not take personal responsibility for his own well being?
Maybe this is not so much an issue of black and white, but one of smart and not smart.

President Obama says we MUST spend money to save the health care system. I don't get it.. Why can't we just fix what's broken instead of throwing money at it? I would like to hear your opinion about tort reform.

Why do politicians consistently dismiss a "single payer" health care system? Isn't it time our healthcare system joined the best/most successful in the world?

Why is Obama's health care reform always compared to and criticized as a clone of the Canadian system? There are other countries in the world that have universal health care, yet the media has not examined these systems for their effectiveness or comparisons to Obama's package. Surely this has been looked at, but I have yet to see any meaningful analysis in the news.

What can we do to help people become motivated to improve their own health? Access to health care isn't necessarily the problem, as ove 50% of health is determined by behavior and environment, and only 10% by access to the health care system. Any thoughts?

Dr Gupta

I do not have a comment I was watching you this morning about the guy with diabetes. I have a story that I never share with anyone, but with my sons doctors. I had one of my sons who got sick in 2007 just out of the blue. He was arguering with his brother and passed out after that, I called 911. When we got to the hospital the EMT guys bypass the emergency room and made us seat at triage for two hours while my kid could not bread. I went to the nurse she said they will call us soon, but they had called everyone who were before us. Finally after I bothered her so much the nurse send us to convenient care (whitch is for minor cases). When the doctor check my son and do an EKG, she transfer him to the ER and he had to be air lifted to yale University, and there he had to have open heart surgerry. By the I am black, I am from Haiti, from this day I kept asking my self why they almost let my kid die, because he was hardly breading when we got to yale new haven. He is doing fine now Thanks to God. My son was born with a rare heart defect that no one knows until that day. The doctors said he could had collapse any day and die, because he play sport. My son was 15 when he got sick.

Your credibility dropped significantly this morning!
Everybody is different and much as we try we treat and get treated differently. Halth care is primarily an indiviual responsibility. This person obviously didn't get regular health appraisals or they would have found out they were diabetic. This doesn't happen in the emergency room!

Come to Cailfornia you would be surprise how health care system works for A A with medical insurance. Last year what was did to my Brother was horrible. 44 yr old great shape single parent had a stroke. My brother was in so much pain he died 2 weeks later. DR who was assign to my brother case did not treat my brother condtion as she would have had he been (White). To re live this twice in six yrs my mother was miss DX for six months with unbearble pain died in 02. That is all I can my family wil never be the same. I work at a major hospital I see all the time.

Do you think it's true that there may be over $700 billion dollars of waste in the health care system spent annually? See the Christian Science Monitor October 13, 2008.

Many of us who were around for the White House Health Care Reform efforts in 1994 and who have worked for HMO's, PPO's, hospitals in Hawaii and Indiana can't get our information to anyone. Do you have any ideas for a place where serious issues can be raised....besides this blog?

Please see this article:
http://newsblogs.chicagotribune.com/triage/2008/10/700-billion-.html

All I hear is about poor health care for the black people, it isn't just them, it's everyone. My husband is on medicare, we only have social security income, and we can no longer afford health ins. for me. The ins. we had dropped him a month before he turned 65, for us to continue the same ins. for me it would cost the same as for both of us, $680.11. Since he no longer can work because of his health, we only have $1400 a month to live on. I have pre-existing problems and had cancer in 2003, any ins. for me is outragely high. How are the people going to be able to afford ins. if it is made mandatory, with the ins. co. having no regulations they charge whatever they want to and they also tell you when they will pay for something or if your doctor can prescribe what you need. My husband cannot get one of his prescriptions, even though he did take it for a while, the medicare system says now he is not allowed that product they give him a different product even though thru the doctor he has let them know this new product does not work as well. Our health is not what everyone wants us to believe it is. I can't get medicade unless we separate, which I have met older couples who have divorced just so they can survive. Why not make the insurance companies let the doctors take care of their patients without all the bull? Why not make the insurance companies make the payments for health ins. affordable? I, also, don't believe that congress should be making laws about healthcare unless they a degree in the medical field. What they need to do is regulate insurance companies, to keep they from robbing us like they do. I also don't like the mandatory car insurance, I paid full coverage thru Progressive , was in an accident that was not my fault but they did not fix my car, nor give me something to drive while my car was in the shop, but this is another issue.

I'm Canadian and do feel that we have a really good health care system. The commercial there are playing on CNN is fear based and NOT true. I've never waited very long to be tested. Yes, our taxes are higher than in the USA but it's worth it. EVERYONE have health care here no matter what. There is no such thing is you can't afford it.

Dr. Gupta, always enjoy and learn so much from your segments. But I beg to differ on todays segment. The man that claimed it was racism that caused him not to be diagnosed as a diabetic. Why didn't a grown man know that weight loss, frequent urination, trouble healing, are signs of diabetes? A very common disease in blacks. He was not a child. He goes to the emergency room with a PAPER CUT. No wonder they didn't jump to his emergency. That is what is wrong with our medical care. So called emergencies.

Dear Dr. Gupta:

As a former California resident, NOW living in Canada, it is appalling to hear Representatives in the U.S. Congress
trashing Canada's National Health Care System using the negative stories of a very few Canadians to support their case.

Please use your considerable knowledge and common sense to tell the World that Canadians are Proud of THEIR (OUR) SYSTEM- and Americans will be well advised to emulate it!

In November, 2008 my Gallbladder was removed within 24 hours of my 2nd attack. At NO COST to me!

Sincerely,
Walter Grant
Burlington, Ontario
CANADA

As a Social Worker healthcare has always been my soap box. Since my personal cancer diagnosis it has been even more important.

A. We already have a Universal Health Care Plan that doesn't work.
B. When I had insurance it helped underwrite the costs of ER care for the uninsured who can't or won't pay and need high cost acute care.
C. Since the era of Managed Care no one has had the luxury of selecting their own doctor, specialists, ancillary services or hospitals.
D. My cancer was over 10 years ago and still can't buy affordable, good insurance, limiting who I work for and jobs available.
E. Last company I worked for went bankrupt so I "can't" get COBRA. Haven't heard anyone mention this fact in discussions of healthcare and I also understand that there have been a few Bankruptcies lately.

I was just hearing that they are pushing for mandatory insurance or pay a penalty. I would not pay the penalty and let them put me in jail, that way I would finally get the medical attention I can't afford since our ins was so high after my husband turned 65. With pre-existing problems ins is unbelieveablly high. So jail me.

I've been watching your country's reaction to the possibility of healthcare reform with interest. There has been alot of critizing Canada's healthcare system without actually researching it. I am an average citizen with a husband and two kids. Our family pays $108.00 per month for our BC Medical. We also have extended health through my husband's employer. I know that if a medical issue arises we will not loose our home or be left with an unpayable debt. If President Obama can come up with a public/private partnership that would be ideal. Good luck President Obama!

people opposed to a national health care system point to the few people who have to wait for medical care as a reason for rejecting the plan . What about the many many pople under the current plan that have no medical care and die from health problems that could be easly ttreated if health care was available? Also it seem to me that if we want to control medical costs we need to keep the drug companys from over charging the people!

Do the citizens of America realize that the only people not willing to move to universal health care are the big pharms, big business, the wealthy, doctors and politicians? The other 90% or so of the populace would benefit greatly with health care that would encourage them to stay healthy because they could afford to visit a doctor or clinic when they needed to do so. The plans in operation in Canada, Britain and France work well for the citizenry, and their plans have been working for years. It is frustrating listening to the reports of any negative examples when the millions of people in other countries are well-served by their health plans. This has turned into a war of the rich and powerful to maintain their status, damn the middle class and poor.

Dr. Gupta... They keep asking on Tony Harris live programming today "what are you willing to give up?" Why are they not asking what doctors are willing to give up on the prices they charge???? When my local cardiologist said a heart test would be $1,500 and I got a bill for the $5,000 my insurance would not pay for the $8,000 test... where is the problem? Let's be fair...we all need to give up something, including these exorbitant prices!! Not a popular issue for you to address, and uncomfortable....but I cannot afford these prices. I am a 60 year old single teacher.... I am not rich...so do I give up health care? Thank you for listening. Katie Katz, Wichita Falls, TX

Sanjay,

THe claim that the difference in healthcare is rasicst is absolutely absurd. The majority of medicaid patients in New York are minorities and they are too poor to purchase private insurance. Medicaid does re-imburses on average $7-10 to a physician and around $100 or so the the hospital ofr a clinic visit. For this reason, most attendings do not accept medicaid and these patients are seen by resident physicians in clinics. Resident physicians are ALL supervised and generally the care is excellent. I trained as a neurologist and an ophthalmologist an NY Presbyterian Hospital and I can tell you the care these patients received was excellent and it is absolutely insulting when they say there is a rascist policy in place.

Dean Cestari, MD

Dear Dr. Gupta, (RETT SYNDROME)
Don't know if this
goes under healthcare reform or not but it's need to be address to the public and in the government and medical field ,lot's of Dr's and the public don't know much about this , that it just attacks young girls. I have a grand
daughter, it took 18 months to find it., she look normal ,happy but had no strength in her muscles. She is now five years can't walk, talk or make any motions with the use of her muscles.
She has seizures sometime two or three a week you can take her to the hospital get the seizure under control start home and have another this is a 24/7 job .
The government is very hard to get any finacial help and the government don't want to help with funds to research , this can be stopped with research. This is sad because these girls and parents don't have a life. And these girlscan die at any age.
BUT NO ONE WILL HELP !!!!!!!! PLEASE MAKE THIS KNOWN TO THE PUBLIC.
Thanks,
Travis Brown

There is no unified model of the history, situation, decision/control points, and decision impacts of the US Healthcare Reform situation. Everyone is presenting their "facts" and viewpoints from a limited and fragmented viewpoint (i.e., partial facts). It's like trying to diagnose and treat an illness by only considering a body-part and its local appearance.

A simple and repeatable public domain collaborative, concurrent, and cooperative method is available, using open-source technologies, to create such a unified model (from global to local to individual scales). This unified model would give everyone (e.g., nations, organizations, communities, groups, persons) the ability to contribute and see the most complete, integrated, unified view of all of the diverse factors and interests of an issue from their vantage point. (This could be called a "localized view of unified knowledge", like looking through a single facet of a multi-faceted crystal.) This unified model is built using modeling techniques common in the medical, legal, and a few other professions with an organized and shared body of knowledge.

I used this method under Federal contract to build a prototype knowledge-model repository for US Federal Executive Branch (FEB) business continuity in 2004-2005 to satisfy Executive Orders resulting from the events of 9/11. It was called the Continuity Communication Enterprise Architecture (CCEA) project, and was a combined effort of the Executive Office of the President (EOP), DHS, and DoD. Internal FEB politics, narrow-interests, and clouded vision kept the effort from moving into pilot and then production stages. The same prototype was offered up as a means to support emergency management and local/regional continuity, several months before Katrina hit New Orleans, but there was no interest from those with the authority and resources to achieve this emergency planning/response/management capability.

This unified modeling method can be used to take an "issue" like Healthcare Reform (or Economic Recovery, Financial and Automotive Bailout Performance Results, etc.) and create a single mechamism that everyone can use to submit their own viewpoints and provide their own analyses and "facts", which is then "merged, integrated, and unified" into that single model. Large numbers of diverse viewpoints can each contribute to building a shared viewpoint.

Note that many will resist such a unified view. A unified view puts diverse viewpoints into a broader context. It can thus weaken the diverse rationale when a broader shared viewpoint and solution is developed.

Experience tells me that government or industry will not pursue such a unified view for political or economic reasons, so I have come to accept that Non-Profit (e.g. watchdog), Academic, or News Organizations, or combinations of these in collaboration with government and industry, can be successful in building such a unified view of an of these issues.

The public-domain unified modeling method is published at http:gem-ema.one-world-is.org.

I was inspired by my late Dad to eat four raw cloves of garlic daily for the last thirty years of my life. I was wondering whether this amount is too much for a daily use; and if so, what are the side effects/phenomena that might develop, such as a tendency to develop bruising on the hand palm. My dermatologist could not provide any information on this issue. As a whole, I am very healthy and is considered skinny in American terms.

Physicians should received tax credits to treat their Patients who are without Health coverage.
As if that's gonna happen.
Best wishes always.

Cordially,

Joseph W Arabasz MD

I just went through major surgery in PANAMA to remove 3 tumors in my pelvic region (10, 5 & 4 cm). I was in the hospital for 10 days, including intensive care for 2 days. I am a U.S. citizen and have residency in PANAMA.

This is the same cancerous tumors I had 11 years ago and was removed vaginally in Chicago at a cost of $500k. I had insurance at the time and paid $500 deductible.

My costs this time was $400.00. This included 4 cancer specialists fees, hospital room, ICU room, surgery, medications, etc. My pre-surgery expenses included $750 for 2 CAT scans with dye, $300 for 2 ultrasounds, $75 for colonoscopy, $10 for EKG, $27 for chest x-ray, and $150 for numerous blood work over 3 week period of time.

I have NO insurance.

Now if I was still in the states instead of PANAMA I would be bankrupt and no place to live. My daughter came down from OMAHA, NE to check out my care and was here for my surgery. She was really impressed with my care and the hospital–she has her Bachelor's in Hospital Administration and is currently working on her LPN license.

Healthcare costs have gotten way out of HAND and needs to be reformed BIG time!

Mary Johnson

I am the owner of two businesses currently employing 20 people (down from 40 a year ago). Over the past five years I have struggled to continue to provide meaningful health benefits for all employees, and have been forced to increasingly shift the burden to these employees due to the exponential rise is coverage costs. The layoffs over the last year have been particularly painful to me, not only because of the devastating financial impact to those laid off and their families, but also because I know that after the subsidies for COBRA end many of these former employees will not be able to obtain insurance because of cost, and in some cases due to pre-existing conditions (I have in fact retained some individual employees due to this fear). Last year, we instituted a "wellness" aspect to our benefits, and increased our cost to establish this program for employees (fitness memberships, individual counseling and screening, susidized organic farmers market produce, etc.) in an effort to do something to solve the problem ourselves.

The question is being asked "what would I give up to provide health care reform". I will answer this on two levels. As an employer, I would be willing to pay a tax on the benefits we provide, for a defined period, if this helped provide coverage for all in America, and helped to turn the tide of rising costs. As an individual, I would be willing to do any of the proposals I have heard including a tax on my benefits, a tax on high-income earners (though this year I am certain not to hit the threshold in consideration), and I absolutely support the idea of a public option if that was a vehicle for coverage and competition.

As the only country in the developed world without universal coverage, I am embarrased for my country that we can't (aren't willing) to make the neccessary changes. The partisan politics need to end, or I will never vote Republican again due to the stance of the leadership in this debate.

On another note, I am a six year cancer survivor (lymphoma), so I understand the importance of access to good, affordable care, but at times I wonder how and why it was my good fortune to have access to this care when so many don't. In any event, in the current state of the health insurance world, I won't be able to get insurance. This is a vicious circle- the rising cost of health care is one of the factors that is putting my businesses at risk. If these go under, 20 employees won't have health care, I won't be able to get replacement insurance, and the problem keeps compounding.

I am hopeful that we all, as humans, realize the importance of this effort, and support reform even if imperfect and biased. Self-interest needs to be balanced with concern for the welfare of my neighbors- that is, in my mind, one of the prime definitions of what it is to be American. I am willing to make sacrifices, for my sake and that of my family, but also for my current and former employees, and all others in the same boat.

I am uninsurable because I have MS. No company will sell me a policy other than indeminity type insurance which will not help. I have not neard what health care reform will do for people like me.

The cost isn't really a big factor for me. I have repeatedly tried to get insurance, but always get turned down. How can I be forced to buy insurance when no one will insure me?

I am 60 years old, work part time, and the small office I work at offers no group medical insurance. Hopefully when I reach Medicare age, Medicare will still exist so that I can finally get the medical care I have been missing for so long.

Can you please tell me what the President's plan is for people like me who cannot buy insurance due to health problems?

Thank you!

The cost savings from PBMs.No body is talking about them.If congress makes their dealings with drug companies transperent then more savings can be obtained.
PBMs will always argue that transperency will increase drug cost.Nothing in health care refrom addresses this issue.Transperency can only increase savings.

I am a retired general surgeon who practiced in Canada for more than 30 years. I am outraged at the ad featuring Shona Holmes stating that she could have died if she had not been treated in the US. She had a Rathke Cleft Cyst which was inpinging on her optic nerves and apparently secreting ACTH. Her statement that she could have died was based on a statement by one physcian, who should have known better.
It is unfortunate that her primary care physician did not bother to pick up the phone and call one of his colleagues to expedite her treatmnet. I have never, nor do I know of any instance of a surgeon not seeing a patient immediately when requested by a colleague when indicated.
My wife was diagnosed with breast cancer in Oct 2008. Had I not intervened her surgery and treatment would have been delayed by several weeks. This was not in Canada this was in Massachusetts!
I would be happy to discuss with you our one of your colleagues about the intricacies of the system in Canada and the situatioin in the US.
I have practced fee for service before Canadian Medicare came in in the 1970s. I practiced in Medicare. My wife and I have been consumers of medical care in both Canada & the US and can provide a clear understanding of the differences.
I have been a consultant to hospitals for their surgical departments performing operational reviews and insurance companies since retiring from active clinical practice.
These inflammatory misleading adverts are of no help to the understanding of the issues and are destructive.

Every time I hear the President talk about health care, I hear him use the phrase "all Americans". Will this health coverage I am expected to pay for include coverage for the 11.6 million illegals in the U.S.?

I saw the report regarding the wheelchair yesterday. If a manual chairs cost surprised you, take a look at the cost of an electric. I am a C5-6 spinal cord injury and my electric wheelchair cost $17,000 and it doesn't have either a radio or refrigeration.

Thanks

Mary

I don't care if I have to pay taxes on juice and soda, Health care is an American issue and it has to be reformed NOW.Going to the ER room for care if you are uninsured is no Answer , you will be sent on your way with a referral for followup care which you can't afford, this happened to my 41 yr old son abt 3-4 yrs ago , the working poor with no ins. he broke his foot in 3 places, ran up a 1600 dollar- bill at the dr's and quit going, it never healed and now after work his ankle swells up and he walks like a cripple half the time, Now the ER room says he may have arthritis in both knees, he could not walk and had to be wheeled into the ER room. and they say he needs a MRI and followup care, RIGHT, He is back at work now still hobbling, THIS is what the uninsured goes thru, he will not get a MRI cause he has no money for it. My message to both the republicans and democrats is GET IT DONE. We don't want free care just affordable. THANKS. Jane Boucher.

What would I be willing to give up for health care reform? The health insurance companies. Their bite of the apple is more than half a trillion dollars a year–25 cents of every dollar spent every year on health care in the U.S. I'd also be willing to give up the health care we provide our senators and congressmen.

Hello out there,

Just another day in the office for me…..I live in this whole debate and have to hear about the discussions from all the politicians and “TV” people while us doctors and patients fates lie in the balance.

There are a lot things wrong with healthcare and the Obama administration’s approach that we should mention the uninsured first and foremost is wrong. They are the LEAST of the problem. Yet they make out this group as the poster child for the need for this government intervention. They (government) still have A LOT of work to fix Medicare???? Why would the public throw another trillion dollars into the Medicare abyss? These uninsured are not devoid of healthcare. They can go get a check up or visit a medical doctor for illness for a reasonable cash price. They have access. Let’s stop saying they are WITHOUT care. This is just not true. They are without payment help and serious health issues become difficult to pay for. However the uninsured can save money for that emergent need. I have personal knowledge of a self pay patient who had a mass in his abdomen and saved his money for six months and then had it removed. He negotiated a cash price for treatment. He sacrificed. He saved. He is better. He did not need the government. Americans pay for their healthcare. Stop pretending that the insured have some gift or hand out. Either they pay personally or their employer pays some or all of the cost. We need cost control for all Americans but not at the expense of all Americans.

Reform can occur from two areas and both can be initiated by the government and DO NOT require ANY NEW TAXES…….

1) Limit the misuse of the courts to pursue lawsuits against doctors and hospitals.

Putting a cap on medical malpractice lawsuits will stop the practice of “defensive” medicine and help doctors with lower malpractice premiums. More labs, medications, tests, and imaging is used then is usually necessary to make sure EVERY differential diagnosis is covered. Bad outcomes happen in medicine and this is not the doctors’ fault. Hindsight is always 20/20. Remember that doctors “practice” medicine. This is not an exact science.

2) Institute Citizen’s Rights and stop Medical Insurance Profiteering Practices

Protect tax paying citizens from being prayed upon by insurance companies with ambiguous rules, escalating fees and higher deductibles for less care. This is not fair and does not make sense. Create a uniform standard for all companies to follow if they provide health insurance. Fees and rules need to be fixed for a longer contract term like 10 year term life insurance for an example. Provide doctors the ability to manage the care of their patients instead of the insurance company bottom line. This type of change would require a battle with the way the insurance companies currently pull the strings to manipulate patients and doctors to protect their profits.

Please keep these thoughts in mind as you bring this debate to the public....Thank You

As I watched your comments today about possible racist medical practices and insurance bias', I am compelled to ask you a few questions. In the cases that were at issue, you never inquired where these people got their medical help, either from a clinic, or doctors office, and whether or not these individuals were treated by African American doctors. It would make sense that they were treated by African American doctors by the mere fact of ease and association. If this were the case, then it would appear that problem lies in who treats patients, not the insurance companies as you have indicated, and it might also be the case that these physicians were not qualified to be treating patients at all. So the question should be who treated whom and what were their qualifications, and the issue should not be a racist issue as you have indicated. I would appreciate a response. Thank you, Joseph madden

I am a proud Canadian with a free healthcare system. I have 2 brothers in the states. One brother in Florida before age 65 had cataracts, he had to go to the Lions Club to pay for it, and work off the debt. My other brother in Maryland, has to pay over and above his Medicare $300 monthly from AARP to receive the same care we get for FREE. The (Canadian) woman denouncing our healhcare system must have received a great deal of money from the HMO's to pay off the house she had to mortgage to get the U.S. treatment. A close friend received breast cancer surgery within two weeks here. Yes, there are horror stories, but your country has millions I will wager.

I am an RN working in Ontario Canada for 40 years in a hospital.The right to universal health care goes to the heart and psyche of the Canadian people. Our system is not perfect, but not all Canadians agree with Shona Holmes that our system will let you down.We try to look after our own here at home.Most costs are covered through federal and provincial taxes, based on one's income, but no one is turned away, even the unemployed.We will fly them to the states if we have to. It is unheard of that people lose their homes to cover health care costs.

Canada has roughly 1/10th population of the US, and one of the problems we have is the 'brain drain' of some of our brightest and best professionals being drawn to the US by the lure of the dollar, leaving us with a shortage. We are now also concerned about job losses and the economy, the same as you.
My advice to those seeking health care reform is take small steps to make these changes, in each state, getting feedback from the people along the way, while keeping a national coverage goal in mind.
Each state should have reciprocal agreements to cover at least some of the cost of it's citizen's care if service cannot be found within its own boundaries.This is a complex problem that cannot be fixed overnight, so one has to be careful not to throw out what is good about your system with what is not, but don't give up!

I am the medical director of a Canadian Trauma centre. I am sick and tired of US polticians 'slagging' the Canadian health care system. Most of these politicians are very ill informed as to how our system actually works. We know it is not perfect but we work hard to provide the best care possible. I am proud of the centre I work in and we treat many Americans who get injured and have to be treated by our dedicated group of nurses and doctors. We do not care if you have health insurance we look after you. Many of the Americans we treat say quite openly how pleased they are with their care and say it as good as anything they would have had in US. I have many close American firends and I do my best to help then understand the pros and cons of universal health care in Canada.<

I was wondering how the new reform act will help me.
1. I am Disabled
2. I live on Social Security and Insurance Income(UNTIL 65)
3. mY wife has HEP C and not qua;ified for Medicare as she never worked..She is 53 and I am 59
4. I pay 800.00 per month for her insurance with The State of Texas.

When the Prescription Insurance was reformed, I automatically lost my Prescription Insurance and was forced to use medicare. This was OK for the 1st year. The scond year the prescription insurance was changed. The donut hole was introduced and brand name meds were no longer paid for after 2400.00..However generic was still covered. Now if I want brand coverage after the deductible, I must pay for the next 4000.00 myself/. The insurance I had before was much better.
Is there anything in the new reform act that will help my situation. WHAT WOULD MY WIFE DO IF i CANNOT PAY HERE INSURANCE . This will be reality in 7 years. I will then live off SS only with no other income and my wife is 6 years younger.
Thank You
Steve Taylor

Dear Dr. Gupta:
Government controlled healthcare programs are certainly very frightening, especially for the American consumer, given all the negative propaganda we've seen on TV recently. It seems to me that a public health system similar to that of countries such as Germany or Sweden, which seemingly are very good in terms of actual delivery of services should be worth investigating and emulating. Why is it that all we hear about are the government sponsored programs that have such a bad reputation? Hasn't anyone done a piece on Germany or Sweden's healthcare systems?
Thanks.

Hello Dr.,

I am the mother of a 20 year old girls who recently has had major medical issues. This is a young lady that has over the past 14 years been playing soccer year round and has been in excellent health. On April 16, 2009 she was diagnosed with MS. On May 13th she began having siezures. She was transported to Kaiser Hospital and soon after was intubated to protect her airway. She spent 2 weeks in the hospital and a cause was not determined for the siezures. About 1 1/2 weeks later she began having difficulty breathing and I attributed the problem to the pnemonia she had. It soon became clear that it was not pnemonia. We spent 3 nights at our emergency room where they continued to tell us that she was having anxiety or it was asthma. Finally one of the doctors at Kaiser referred her to an ENT for further tests. They tried to put us off for 2 more weeks until I insisted with the threat of an attorney and they found an appointment for her. Several more tests were done and they realized that she had tracheal stenosis and would require surgery. After further review, it was clear that because of the extent of the damage, she would not be a candidate for the surgery, they had a stent put in. Since then she has been doing fairly well until recently when she began to cough alot and have a fever. She will be 21 in August and we will only be able to insure her for 2 more years. Since she has MS and now this problem with her trachea, what will the health care reform do for someone like her? Will it be much harder than it already is to get the necessary medical care? As it is now, unless you are very firm with your health care provider (only from my experience), they give you a pill and send you on your way.

HELP!

I am more in line with the 'blue dog' democrates. I believe in pro-choice. However, I do not think we should include the cost of abortions in the health bill reform. Take it out. Thankfully, I have private health insurance. However, I support providing needy citizens with coverage. I just think that an abortion or paying for someone to have plastic surgery and/or surgery to reduce weight should be included in the reform.

RE: GRAPHIC EXAMPLE HEALTH CARE NEEDS IN US

Dear Dr. Sanjay:

Recently saw your graphic show on Haiti and condition of children sold for domestic use.

Closer to home this weekend in Wise County, Va is Remote Area Medical whose volunteer medical staff will probably see 5,000 Americans.

This is the program that impacted Wendell Potter, who then left VP at Cigna and now speaks out about health care needs.

You probably saw him on Bill Moyers or recently on Amy Goodman.

Over a thousand of your fellow medical personnel will volunteer their time and expertise.

Isn't it about time that such programs and people get visibility nationally? Bill Moyers and Amy Goodman do a great job of bringing such issues before us. Think of the audience you have and this opportune time of highlighting graphically the issue.

Wendell Potter spoke of walking thru the crowds at such an event, like being in a third world country....people waiting in the rain, procedures being done in animal stalls, no privacy.

This is not in the jungle but right here in America.

Wise County, Va

This weekend.

Would love to see your coverage of it. (If not interested or not available, could you pass this on to Elizabeth Cohen?).

Sincerely,

Dean Olson

Hello Dr. Gupta,

We must reform the Health care system in our country. I appreciate the fact that I live in a Democracy but I wish that President Obama would simply mandate universal health care today. No one will get rich on a universal system. Could we just start by taking care of all kids under 18?
Dr. Gupta, please stay strong, speak out against the Insurance industry or the AMA if that is what it takes. I have written to my Congressmen from Pennsylvania. Encourage your viewers to do the same. Thank you very much for your time, Ann

Government Health Insurance Program is no bargain.

The health insurance program is said to cost over $1,000,000,000,000. I figured if there are 300,000,000 Americans and 10% is un-insured or about 30,000,000 Americans. It is said the congressional health program would include only 70% of the uninsured American. So the congressional program would only include 21,000,000 additional Americans. The math shows it would cost $47,616 per person to insure just another 21,000,000 Americans.

Sams Club has a health insurance policy they sell $350 a month with a $1,000 deductable and $30 co-pay. This would cost $4,200 in premiums and $1,000 in deductibles a year for a total cost of $5,200 per person. Insuring 21,000,000 Americans at $5200 a year would total $109,200,000,000 a year. The co-pays can be pay upon need.

A program costing $1 Trillion compared to $109 Billion performing the same thing is no bargain.

Actually the Sam Club insurance may be better than what the government is offering for about a 90% cheaper cost.

Dear Dr Gupta,
I have been a nurse for thirty years and i have seen many changes in the delivery of health care,some for the better and others not,in my professional opinion to allow the goverment to oversee health care is a diaster waiting to happen. I have never seen anyone refused health care because of there economic status,color or beliefs,most of the complaints are from the patients who want what they want and not what is right for them,if people truely believe they are not reciving health care wait until obamas plan it is a joke,a blunder and a diaster and the people who understand what he is trying to do know this and are against it .I would like to known how many children in our own country are ill because there parents cant afford to properly feed there children or how many elderly die in the winter because they cant afford their gas or electric,or their medication yes there are free programs but how many people are informed about them,i am against goverment controlled health reform,give health care back to the doctors and nurses who dedicate their lives to caring for the sick let them run the system not a bunch of buraccrates who dont know a urinal from a bedpan

Dr Gupta
I am following closeley all the issues of the HC reform.
In brief; To lower the cost of delivering health care without busting the bank the Drug comp. need to be regulated, they created and hold monopoly over the drugs we use and the cost of it,the cost is stagarring! Also medical supply is very costly! No wonder the cost of heatlh care is a problem.Natures medicine is much more human friendly than all these drugs,wile syntetic drugs do a quick job it's like using an expensive bandaid.Prevention ,education daily preventive pactice diet and excersise is a better way to go.These great drugs that are developed are coupled with many side effects, addictions and sometimes death.I feel that the natural way is the way to go.

Re: Healthcare cost debate or “heist of the millennium”

Dear Sir or Madam,
It troubles me when I hear endless discussions about little things that don’t really matter that much while avoiding the most fundamental problem.
Here is what I think it is:
It is a well known fact that At 16+% of GDP or 2.2 trillion dollars per year American healthcare costs twice as much as healthcare in any other developed country, while the outcomes (morbidity and mortality) are worse and 15% of the population (45 million) is not covered. Unfortunately the debate at this point focuses only on the 45 million people that are not covered and how to find even more money to cover them. In addition an argument is frequently made that American healthcare is the best in the world, without any evidence to prove it, and thus needs to be preserved. At the end of the discussion a passing reference is usually made to the need to do something about the rising costs.
What about the costs that are already there?
Unfortunately, not a single person said this – by doing simple arithmetic, based on the above facts, one can easily arrive at the following – If this extra 8% of GDP isn’t producing any improvement in the health of this nation, then it is a WASTE?
In other terms, more than 1 trillion dollars per year goes to the “Medical industrial complex” without producing any benefit for the country. Clearly this amounts to massive and systematic wealth transfer, comparable to the Wall Street deeds over the last few years. This astronomical amount of waste exceeds the GDP of the most countries in the world. And there is nothing to show for it.
So this trillion dollars is either stolen or wasted every year and it is rising at the rate of 12-15%per year.
Who pays for it? We, the taxpayers, through lower wages, higher taxes and insurance premiums.
Some of this extra $1trillion/yr cost is illegal (like overbilling, etc), some is borderline, although should be illegal (like price fixing by the providers in the particular part of the country), some has to do with plain mismanagement, but most of it is probably legal and done “by commission or by omission”. In other words, it had to be intentionally designed into the system.
This system is designed to “be best at being the most expensive”. One can only imagine the amount of influence the stakeholders on a receiving side can afford to buy with just 5 percent of this extra trillion dollars per year.
One can also imagine that if this waste were to be eliminated, assuming that the government had the courage to do it (and no one else can even try to handle this task), the savings to the economy would be sufficient not only to cover the 45 million people (this would cost less than 100 billion dollars per year), but also, enough to rebuild the whole American industrial and transport infrastructure within just a few years.
If so, then the whole different set of issues has to be discussed:
1. Why is this 1 trillion dollars continues to be wasted? Why is this allowed to go on? How do we as a nation get our 1 trillion dollars/year back?
2. Who are the main beneficiaries of this 1 trillion/yr of national wealth transfer and who allowed them to do this to us? Where specifically is all this money going, to whom?
3. Why do the lawmakers, the law enforcement, federal and state governments allows this to go on? Who and why allowed this to happen?
4. how do we get the healthcare cost down to 8% of GDP? How and when will this nation get its 1 trillion dollars/year back
5. Who will be responsible to stop this “heist of the millennium”?

Even Pres. Obama hinted in one of his earlier speeches that this problem is so bad that it might bring this country to bankruptcy (and as such is a matter of national security).

Unless we address these issues, rather than talk around them, we don’t stand a chance as a nation.

The Honest Doctor

WHY NO ONE TALKS ABOUT WHY THE HEALTH CARE COST IS HIGHER?
FREVIOUS LAW SUITES.
INSURANCE COMPANY PROFITS.

I am writing from Canada and am completely perplexed with all the rhetoric going on in the USA about healthcare reform. Our Canadian system has been up and running for going on 45 years now and is largely based on the European system in place for at least 100 years. Canadians have access to doctors usually within 30 minutes if attending the walk-in clinics or emergency rooms anywhere in Canada. FREE. THEY HAVE ACCESS TO THEIR OWN DOCTORS WITHIN ONE WEEK AT THE LATEST BY APPOINTEMENT. Again this is FREE. I am 72 years old and my wife is 71. We have both had major healthproblems and have been served over the years by the system here in Canada. FREE. 90% OF MOST DOCTOR VISITS ARE FOR REASONS THAT ARE MINOR. Usually it involves kids coughs ,flu symptomes, aches or pains in joints.etc. AGAIN THESE MINOR VISITS ARE FREE. Canadians can visit their clinics FREE OF CHARGE ANYTIME. They don't have to declare bankruptcy because they are NEVER CHARGED FOR A MEDICAL PROCEDURE.... .THIS MIGHT SOUND UNBELIEVABLE TO THE AMERICAN PUBLIC BUT HEALTHCARE TO THE CANADIANS AT ANY AGE IS FREE,FREE,FREE, AT ANY TIME.

Health Care Reform- just FYI
Just to make you aware of why I believe that the Health Care System needs to be reformed and why there is plenty $ been wasted. I am a healthy female so far. I used to be in the US Army. I used to be 20 lbs lighter and toned and I used to have better “bad cholesterol”. Now I am out of the Army. I have a great Insurance plan that I am very happy with, as happy as I was with TRICARE.

I go to see my Doctor 4 X a yr because my “bad cholesterol” has been inching up. I see my Doctor; he orders labs 4x yr to check my cholesterol and a full chemistry panel, sometimes he does my urinalysis to make sure that I am not breaking down. It costs my Insurance about $1000.00 total for the visit + labs. He also not too long ago sent me to a Specialist which I requested to check my heart because I am always tired. While at the Cardiologist, he ordered about $2000.00 worth of tests excluding his bill. My insurance this year has paid about $3500.00 for me. The verdict, I need to exercise more, that is why I’m tired and that is why my cholesterol is going up.

I knew that much and when I called my insurance earlier I asked for them to get me in a gym. They said no, that is not an option. I am used to working out with other people. I am not getting on my treadmill because it’s boring. I asked for them to hook me up with a couple of people with similar issues. It costs $30.00/month to get me in a gym. It will cost my insurance company $100.00/month to get me and my three friends who have the same insurance in the gym to lose the extra weight we gained when we got out of the Army. That is $1200/year for 3 people plus maybe a $600.00 for yearly labs.

My math tells me that if my friends are getting the same care as I do? My insurance company could save about $6000.00/yr for the three of us. Now, I live in a military town and there are a lot of ex-military here. We all are getting fatter for obvious reasons. If BCBS had a gym in my town, they would be saving tons. I don’t know why the Insurance Companies are not bankrupt yet; maybe my employer pays them well for my health care. By the way, my employer is the US Government.

1. Keep government out of insurance business and direct provision of health care (personal impact)

Neverever government bureaucrat can make better health care decisions for you (may be cost efficient not better). Have we forgotten all the past scandals of VA? If you think insurance companies are bad, imagine calling a government agency for your benefits.

2. Incentive alignment is important (talent impact)

We don't want to see doctors make less. You don't want to go to a doctor who will make 100K in the future since bright and talented won't go into medicine and old doctors may leave the profession. All you will get is mediocre and average. Also, it'll make rural and border towns pretty much scrounging for doctors (they already lack proper care). So pay them well and align their incentives (share) to cost savings.

3. Make people own their care (cost impact)

If we give care for free to every one with out any mechanism to reward good and healthy behaviour, where is the incentive to keep oneself healthy.

4. Make insurance affordable/provide subsidies to who can't afford (moral impact)

We need make sure every body has an insurance. Health care is a right as long as you follow healthy behaviour.

Our beloved politicians and endeared talking heads frame healthcare from a reactive perspective – why are we looking at fixing healthcare from a medicinal perspective? By the time we have a doctor involved the damage has been done. Eight of the top 10 illnesses that kill us are self inflicted.
We can absolutely reduce healthcare costs but it starts with the individual. We have known for a long time that eating properly (in moderation, vegetables, fruits, fish, whole grains, minimal processed foods, etc) and regular exercise provides for a healthy life. To be blunt, fat kills. 60% of Americans are obese. On a recent visit to a hospital, I was shocked at the preponderance of obese people that were there for treatment.
We need to change the behavior of Americans. They have not been able to do it on their own, even with all the evidence that has been provided that a sedentary lifestyle consuming fatty and sugary foods is a failed path.
It was not until we started taxing cigarettes at a considerably higher rate did we see a significant drop off in use. It is time to look at pricing food at the true cost. In other words, tax foods that we know are bad for us. Type II Diabetes is one of the fastest growing diseases in the US and primarily due to the foods we consume. To look at this from another perspective, why should people that take care of themselves subsidize the cost of healthcare for people that chose to be irresponsible with their own bodies?
If we want to fix healthcare, it starts at home. It’s time for personal accountability to be healthy. If we can’t do it on our own, it’s time to provide disincentives for poor choices and incentives to make the healthy choices necessary to be healthy and reduce America’s health care costs.
It’s not complicated but it does require effort.

I was a nurse anesthetist for 30 years. At the Cleveland Clinic, where I worked for many years, everyone was on salary and we were there to provide the best care we could to our patients...it was a wonderful system. When I moved to private practice in South Carolina, the only thing that was important to the physicians I worked with was money, money, and more money. I was so disgusted that I left medicine.

I now am a student at Clemson University and I purchse health care through their system. I have experienced first hand, to the detriment of my personal health, that the function of a health insurance company is to deny and delay all that they can. Making health insurance available to everyone will only create more mountains of paperwork and frustration for physicians and patients. I have a good friend that is a physician and in her office of 4 doctors, they need 10 people just to work on health insurance claims....! I am totally behind a national health care plan that can control costs and provide the care that people need. Bring it on!

Hi.

I just want to comment on all the weird stuff I've been hearing about the Canadian health care system.

I'm a 57 year old woman and I have never had the kinds of problems mentioned on certain American ads by certain Canadians. Nor do I know anyone who has.

My mom died in February of this year. She was 88. In the last 8 years or so, she lost a breast to cancer, both legs (in 3 different surgeries), broke a hip falling out of her wheelchair and was hospitalized more times than I can count.

Although she was elderly when all this started, she received top notch care throughout. The amount of time, effort and expertise put into trying to save her legs was remarkable. Each time she was sent to the emergency she got excellent treatment. A couple of times, she was at death's door and it would have been easy for the doctors to write her off due to her age. But they never did. All we had to pay during all of this is the extra amount for a semi private room.

For some bizarre reason, Americans and perhaps other countries, seem to think that our Government dictates what care we get and what doctors we see. Nothing is further from the truth.

We see the doctors we want and they decide what tests are required. We are constantly encouraged to have preventative tests such as colonoscopies, mammograms, all kinds of scans etc.

When people talk about wait times for certain tests, it's usually for non life threatening issues. If a doctor believes your life is at risk or if you're in a lot of pain, you won't wait an undue amount of time.

While no system can be perfect, I believe that the horror stories we hear about are the exception, not the rule and that the vast majority of Canadians support our health care system.

I can't remember a time when I was worried about the prospect of getting sick and not being able to afford the care needed.

Thanks for your attention.

Please do a piece on Switzerland's health care system. We see a lot on Canada and Europe's failed systems, but what about a system that is seeming to work. The public needs more detailed information on this. Not in a book, because that does not reach the masses. I think the piece should start here: http://www.hbs.edu/news/releases/090804_JAMA_herzlinger.html

My thoughts:

There are hurdles upon hurdles for health care reform. To craft the right plan you need both Republicans' fiscal conservatism and the Democrats' idealism among other things.

For example, a person is smartest when they master using their left brain for essential habitual acts (walking, talking, breathing) and their right brain for morality and spirituality. We are unbalanced when the left brain tries to create habits in religion or human interaction; it was not meant for such things. These tendencies can lead to depression in a person. And the analogy, of these mental loops we get in, demonstrates that everything has a purpose and that purpose must be fulfilled wholeheartedly to avoid failure. Therefore, I would like to see a valid attempt at consensus in Congress not compromise or failure. Failure is not acceptable for this and compromise gives too much up. Consensus on the republican and democrat strengths is the only way to optimize our results on a healthcare plan.

Without the correct "blade sharpening blade" approach, we may make some major costly mistakes. However, we have to start sharpening this plan with all the tools we have now, so that we do not lose this opportunity.

A great solution is to lock up all of the Republicans in congress until the work on health care reform is over. If the "party of no" have their way, it will be the status-quo forever.

I run a nonprofit where most of my staff are paid under $12/hr and we are forced to keep them on a part time schedule because we can not afford the cost of health insurance. Our company renewal this past June went up 48%, the cost to cover a family was over $1250/mo or $15,000/year when the employees annual wages are about $24,000/year that makes the cost of providing health insurance 62.5% or more of the cost of the labor and this doesn't include the cost of dental or vision. This just doesn't make any sense. We want to contribute to our employees health coverage but neither we nor they can afford this. So we are forced to limit who can get insurance and this is a gut wrenching decision and goes so far against our culture and mission. I'm not sure what the solution is but I can say that trying to force us to pay more than what we can pay today will just force us to close our doors since as a nonprofit we can barely cover our costs as they are today and often don't and rely on reserves to cover operating cost loses.

There are some innovative solutions for health coverage that can be substantially more cost effective. In Washington State they passed a bill allowing doctors to operate in a coopoerative fashion. One group that is based in Seattle is called QLiance (www.qliance.com). The offer preventitive care, unlimited office visits, lab work, cardio testing, etc with no office co pay for simple flat monthly rate; Adults $62/mo and Kids $38/mo, presriptions can be purchased at their pharmacy at just above cost. They do not accept insurance providers other than medicare/medicade in order to keep their costs low. This is an individual protection and therefor stays with they employee. An employer can contribute to the cost and can offer a high deductable coverage for the more catastrophic hospital stays. Generally if you have more than 25 employees the overal premium savings the company can self fund the employee deductable in a year and then bank the ongoing savings. The problem is that this is so new that there are only a few clinics open, it is still just expanding access.

Medical Reform by using medical royalties

I am not a medical professional but I was just thinking about how I thought a successful medical system could operate by keeping medical costs as low as possible, reward good doctors and give patients the best medical care.

Requirements:

• Massive data base for electronic records (meaningful tax incentive for implementing e-record system)
• Medical administration to evaluate patient care and release point-of-service (POS) reimbursement and eventually profit royalty
• Medical & Finance panels to review:
o Best treatment methods for all illness
o Universal identification of illness (patient based)
o Total cost determination for treatment of all illnesses
o Determine fair profit royalty for all illnesses and when
should it be paid, refunded if necessary, etc
o Ethical dilemmas
o How will the medical field try to circumvent the system?
Overview:

Basically, I think medical professionals need to be rewarded when they provide excellent and appropriate care, and keep the medical cost low. I think this is done by incenting them to provide the best medical treatment up front. Initial claims result in only getting reimbursed for costs up front (supplies, overhead, standard hourly rate * standard time, etc.) After they submit their claim (maybe 1 month)… their profit royalty comes later (maybe 6+ months later) after all medical care has been completed and patient is healthy and ALL costs from all sources (multiple doctors, multiple pharmacies, public health insurance used vs. any private insurance that patient might have) have been verified.

Medical panels (Medical Standards Board (MSB)) will discuss the best methods for treating specific illness. There probably needs to be a tiered system based on severity of illness, as well as a range of treatment options.

Based on this standard, a finance panel will determine and aggregate standard costs (# of visits required, supplies required, standard wages * standard time, prescription costs, etc.).

The profit royalty will be determined and added to the range of costs. The longer it takes for a patient to get well, the more costs that will be incurred and the more the profit royalty is reduced. However, perhaps the profit potential is higher for saving a patient with more severe illness. Perhaps if a patient’s live is saved there is a profit kicker, and conversely if patient dies reduced or no profit royalty. A tiered system may be needed based on the severity of the illness. Also profit royalty may be reduced on some ratio system… 200% if life is saved, 100% profit royalty if treatment works in specified standard time/cost range, 60% royalty for a second visit, 0% if patient dies etc.

Medical costs need to be primarily identified to the patient to capture all costs, not by doctor because multiple doctors could treat same patient for same illness. The universal identification system would work like this: if a patient went to two doctors for treatment of sore throat because doctor A did not remedy illness, but doctor B did, doctor A’s royalty should be decreased (to some degree) by the expenses of the treatment provided by doctor B… while doctor B gets full royalty.) The system would require doctor A and B indicating on patients electronic medical records that patient discomfort identified in zone (2.2.123 = neck.throat.sorethroat… or some similar system).

There should be a separate, unbiased board to discuss ethical issues of proposed system.

Finally, there should be a panel to discuss how this system will be circumvented, i.e. doctor’s intentionally diagnosing patient with illness that is not what they have, but has higher profit royalty, while the doctor treats the lesser, easier to treat illness. Maybe there will need to be peer audits or some other oversight.

I doubt that my suggestions are perfect or complete, but maybe there are some good ideas for others to pull out and develop further. We all have a vested interest in making this work!

John Hyde

You can never trust a plan in which, members of congress and the executive branch do not have to particpate. Until congress and the president will share "our" problem by receiving exactly what the rest of us get, they have no credibility. As a result, the public should demand all members of congress and the executive branch be a part of the health care plan they proposed for us.

I am a Canadian, I have a doctor that I have choosen, I can go to my doctor as many times as I wish. No one has ever asked me for a credit card. I have annual medical check-ups, mammograms when necessary, and blood work done as part of that annual check-up. I recently watched Dick Cheny's daughter on CNN's Larry King. She talked, as if she knew, about the Canadian medical system, her comments were filled with inaccuracies. Perhaps CNN should consider talking to the average Canadian about their health care (and perhaps anything else, so the average American is better informed about Canada and Canadians. Healthcar here is not perfect, we do have problems due to lack of focus on preventative health care and underfunding, but I think you do the average American a terrible disservice by not reporting accurate facts.

The recent commercial displaying a disgruntled "Canadian" is one person with an issue, we don't know her circumstances, or the facts about her medical condition, nor whether she is being compensated for her comments. I can tell from personal experience since I recently broke my leg, I was provided with emergency medical service in a hospital, had surgery and remained in the hospital for 4 days and it cost me nothing!

Don't let large corporations, and monopolies dictate what is best for the average American, and please report the facts about Canadian healthcare. I agree it is not perfect, but we are all covered, isn't that better than what you currently have?

regards

Hi Sanjay: I am a retired Special Ed. teacher in Toronto. It is astounding to many of us here to listen to the healthcare "struggle" taking place in your country. The "mythology" about the Canadian system is particularly upsetting. Here are some facts:

1. We ALL choose our own doctors.
2. There is NEVER a medical bill; the Ministry of Health pays doctors directly.
3. There is NEVER a cash register VISA MASTERCARD sign in a doctor's office or in the hospital.
4. Unemployed? Change jobs? Get fired? Get laid off? Retire? HEALTHCARE CONTINUES UNINTERRUPTED.
5. Treatment is provided based on medical need NOT INCOME.
6. We can drop our doctor anytime and "shop" for another if we are not satisfied with the care.
7. There are NO PREMIUMS. The service is comparable to public education or mail service or the military. What would Americans do it they had to begin paying premiums for their national defense?
8. Politicians, homeless, unemployed, seniors, conservatives. liberals, socialists–all have the same access to the same system.
9. Canadians NEVER need to budget healthcare costs...they don't exist. What could you do with this savings?
10. The system becomes active when you are born in Canada and continues throughout life uninterrupted.

Call it whatever you want–socialized medicine, public healthcare, government run healthcare-it works and it is universal, accessible and free. It is time for Americans to hear from "unpaid" Canadians like me.....not the compensated endorsers seen in recent TV commercials.

Don't let the propoganda affect you. Sheldon Pelly

Dr Gupta,

Most doctors are not the problem. Insurance companies and drug companies have had record profits in the past several years. Doctors fees have went down. My health insurance is $1000.00 a month and the reimbursement to my doctor is terrible. Insurance reform is what we need. When I recently had a chest x-ray my insurance paid my doctor $5.00. I agree that there are Doctors that own there own diagnostic equipment that should not be allowed do abuse the system,but my doctor is grossly underpaid and overworked.

Growing up in a universal health care country I know it is not the walhalla people in the US think it is. The things you do not hear about are: costs and how it gets funded (people pay a lot more in taxes..), long, long waiting lists for most common procedures, most of these countries are moving (some partially) away from this system and are moving toward a system where everybody pays for their own insurance (you choose your own level of co-pay, level of insurance etc) and on top of that have mandetory co-pays for a doctors visit or for medicine.

Before the US goes into any major overhaul it needs to curb costs and make sure there is less waste; which also means to look at doctors pay. I do agree everybody should have health insurance, but you cannot change a system that costs too much and have so-called "rich or wealthy" people make up for the shortfall if it happens to not work out the way you think or hope it will. The people they are talking about for additional taxes are mostly hardworking people that live a good live, not the super wealthy who wouldn't notice $10000 a year in extra taxes.
The new system will have to pay for itself with excisting moneys and cost cutting.

Has the concept of Non-Profit health insurance ever been raised? and is it feasable?

I am one of the many uninsured American citizens. I'm a 45 year old male who can't even get an annual physical or the dental care I so urgently require. There are cost savings to be found within the current system so that everyone can have coverage. How about we start by cutting out the overcharging to medicare and medicaid by suppliers and providers for things such as medical equipment and $12.00 Tylenols during hospital stays? Why do hospital Tylenols cost so much? Do we import them from Mars? The corruption on all levels is so blatant and disgraceful.

I am a recent retiree with an excellent health care package. However, I feel strongly that any and all legal residents should be entitled to an affordable health care program. I am willing to pay more to benefit the program. At the same time, if more people have access to the health care system, the overall cost will in fact go down and at the same time enable the medical community to benefit in the learning & teaching process due to the increased number of particular procedures. If the system was to use technology appropriately, a wealth of information for health treatment could be accessed from a collective data base.

I am tired of Insurance companies misleading the public. Check those EOB's(explanation of benifits) folks! The doctors aren't making the money insurace companies are. To see patients in a specific insurance plan a doctor has to accept there discounts which can be lower than Medicare many are based on medicare based fees. Wake up they are trying to save their golden parachutes. Check their salerys and bonuses.

Subject: Healthy, Self-Employed Denied Health Insurance

Dr. Gupta,

Thank you for providing this forum. I am writing to call your attention to an issue in our health care system that is less publicized. I am a 38 year-old, single, female HEALTHY entrepreneur. Two years ago, I left the corporate world to launch a business. With limited time remaining on California COBRA, I applied with Blue Shield of California and much to my surprise, received a denial letter.

I appealed the denial and subsequently received a request from Blue Shield for additional information on two prior routine tests- both of which produced negative results. I supplied the results along with a letter from my physician, reiterating my healthy status. Four months later, I just received notification my appeal was denied.

The two reasons cited:

1) I had a normal pap smear in September 2008. During this office visit, my health care provider informed me of a new, secondary test which indicates whether a FUTURE pap might return positive. This additional test came back positive, indicating in the future, I could possibly have an abnormal pap smear. Bottom line, as my doctor indicated, I am currently healthy with normal pap results.

2) During the same visit, while doing a routine breast exam, the provider recommended I have a lump checked out. The results came back negative, stating I have normal cysts. The recommendation was to return when I turn 40 for a routine mammogram.

My denial cites these two factors “exceed Blue Shield’s underwriting acceptance criteria” and as a result…“we must decline your request for health care coverage”. I do not have any pre-existing health conditions and the two routine tests in question rendered negative results. It appears our health care system may be so diseased that even HEALTHY INDIVIDUALS WHO CAN AFFORD COVERAGE, are being denied by insurance companies. Recently, I have learned of several other healthy, self-employed, thirty-something people who were also denied coverage.

I understand there are issues around “over-treating” patients, however, in my opinion both of my tests were perfectly reasonable and the right thing to do. I feel compelled to voice two strong concerns:

1) In the immediate term, with California COBRA expiring, I may be without reasonable insurance options, which is leaving me very concerned about the viability of my business.

2) While I believe a government-sponsored insurance option might make sense, I do not believe it should be the ONLY option for those who can afford insurance. I strongly believe THE UNDERWRITING PRACTICES OF INSURANCE PROVIDERS NEED TO BE REVIEWED as the idea of denying healthy individuals is beyond words. I can only imagine how difficult this must be on those who are dealing with pre-existing conditions.

I am happy to provide any documentation or serve as a voice for this segment of healthy, small-business owners who are being denied coverage.

Best,

Kim

I am an american indian from the oneida reservation.If i need medical care of any kind Ihave to go to the res in North Carolina.Ilive in al.Iam on ssi due to an MI. My res. is recieving fed aide in all directions but we who live off res do not whats up? I have tp pay for all my own dental work, my 20% on pre drugs ,which are very expensive, can not get food stamps because my ssi is twenty dollars to much. please let me hear from you. marion

My husband has had health insurance for 30 yrs from the company he works for, when he found out he had prostate cancer they would not let him use any of the urologists in a large practice in our city. They were fighting over how much the doctors charged, we could wait 6 months to get into a less expensive urologist that did not do the latest treatment. He ended up going to an oncologist that did not do the latest robotic surgery and had radiation instead. He is doing well but wouldn't it have been nice to have had a choice. Insurance companies are just out to make money. Bring on government health care.

I have yet to hear of anyone resisting healh care reform who doesn't have health care. I pay for it, but I don't really have it. And my situation is not unique. I'm talking about those criminal scam companies who advertise on TV for individual health insurance as low as $6 per day.

The discussion on health care should have started with some basic questions:
1. Are we a "caring" nation?
2. What kind of people are we?
3. What is our national character?

Generally speaking, if you have health care you don't care much about those who do not (leave Obama and others out–they have political agendas). And that is why those millions of uninsured will probably remain so.

Sound crazy? We all need to look at our core values. For more craziness, humorous and serious, you can read more at::
http://worsethanyouthink.weebly.com

Imagine what opponents of government healthcare would say if Congress decided that citizens would pay monthly premiums for police services, public education and military defense. These are all socialized government services.

"Socialized" means "operates for the betterment of society" as a whole. With 47ish million people uninsured in your country, is the American "privatized" system operating for your benefit or for private megaprofits? Why do so many Americans end up in bankruptcy when their neighbours to the north pay zero for excellent care and NEVER have to ask "How can I afford to be treated"?

I wish someone would do a documentary on Canada's healthcare system. It is terrifying to think the cancer rate could increase 15% due to rationing; we could wait 9 months for a test; and our average age of death could drop!!. THIS IS THE DARK DARK MEDIEVAL AGES. All I hear on TV is about the cost but not the quality of care. I have been fighting cancer preventively for 21 years and can't imagine any more difficulties obstacles to living a very long life. HELP and do a program on rationing, healthcare quality, etc.

Thank you.

IT IS MY UNDERSTANDING THAT INSULIN DELIVERY PUMPS ARE PROVIDED TO ALL DIEBETICS IN MANY OTHER COUNTRY'S THAT DO HAVE HEALTH CARE BECAUSE IT IS THE BEST SYSTEM TO DELIVER INSULIN AND IS COST EFFECTIVE BECAUSE IT BETTER PREVENTS THE COSTLY & DEBILITATING SIDE EFFECTS OF DIEBETIS.
INSURANCE CARRIERS PAY FOR THE PUMP FOR REASONS OF MEDICAL NECESSITY WHILE MEDICARE ONLY PROVIDES THE PUMP FOR TYPE 1 DIEBETICS.
THIS SIDE EFFECTS FROM THIS DESEASE FOR BOTH TYPE 1 & TYPE 2 ARE FAR MORE COSTLY THAN THE PUMP. WILL THIS COSTLY OVERSIGHT BE CORRECTED IN PRESIDENT OBAMA'S HEALTH PLAN & IF NOT WHY WHEN OTHER COUNTRIES HAVE ALREADY DONE THE MATH.
THANK YOU.

In a recent contest in Canada, the CBC asked: " Who is our greatest Canadian of all time?" Gordon Lightfoot? Joni MItchell? Pierre Trudeau? The winner was Tommy Douglas a prairie member of parliament and the " Father of Canadian Healthcare" Read about him.

Jim, you are a smart man. I like a lot of what you said. Frank, your commemt does not deserve even to be answered: you are either too young to even think or you are an unconscious old man!

It will be a great day when the military has to hold a bake sale to raise money and the healthcare system is fully funded in America.

And, it will be a great day when American doctors can treat their patients based on medical need without the "interference" from the health care insurance companies. You see, the truth is, the so-called "government interference" myth about the Canadian healthcare system plays on the American citizens' fear of "interference" when in reality, it is the American healthcare system that puts up roadblocks to a citizen's healthcare, NOT the Canadian system.

We in Canada NEVER hear from the government or anyone else about our healthcare. Can Americans say the same thing about their medical insurance providers?

How do Americans feel about the U.S. borrowing 12 billionish dollars from China etc per month for 2 foreign wars and, in the same breath, insist the government cannot provide healthcare. What about diverting a billion or so borrowed Asian dollars from the war efforts each month and get all Americans covered. "Ration" war funds: fully cover all citizens with quality healthcare and "tighten the belt" on waging wars. Imagine what 1 or 2 billion a month could do for the American healthcare system?

In Canada we have sent our military forces to Afghanistan and we maintain our healthcare system as is. If we can do it.....................

I think we need health care reform desperately. However, I do have a problem with one proposal that would require insurance companies to pay for abortions. An abortion is an ELECTIVE procedure and insurance currently does not and should not be required to pay for elective procedures. If the life of the mother is in danger, that is an emergency and insurance does pay for life-threatening emergencies.

H1N1 Virus

In 1976 I got the Swine Flu Vacanation, I have read that this would not protect aganist this new strain H1N1.

In June 2009 while visiting my Daughter and her family of six, they were all taken ill by a very bad virus. The entire family, ages 11 months to 34 years. One after the other, they came down, with fever,
vommiting, diarreah, body aches, compared to being hit by a truck.
The illness lasted about 48 hours each. I became care giver and waited my turn to be sick, but did not.. After a person is well, is there a test to see if it was actually the H1N1 virus? I am just curious, and wonder if the 76 Vacanation was the reason I did not become ill..

Thanks

If we were able to send a man to the moon forty years, than we should have the brain power in this nation to formulate a plan that makes health care available to ALL Americans. The commercial from the Canidian woman with the brain tumor, is only intended to create fear, and is not true. The Fox interview I saw today, claiming millions of working Americans have insurance available but chose not to take advantage of it, made me SO ANGRY. The employee that spoke, said he could not afford the $200 a month, he choose not to have insurance. This guy looked to be in his twenties. He probably has not thought too much about his retirement yet either. He was very young, and might prefer to spend the money to travel or have nice cars etc.

This interview insinuated that millionsof us have it available, but choose not to pay for it, and just want handouts This story had nothing to do with the reality of the health care problem.

Obama said last night its not about him or congress, they have great insurance. I am a Baby Boomer, many years in my career, I had great coverage thru my employers, and I was happy to pay the premiums.

October 2001, however, was the last time I had the luxury of company health plans. I was laid off, I could not afford Corbra or private health insurance policy.
.
As it turns out that was the last time I was able to have health insurance, until June 2009 when I became eligible for Medicare.

For those eight years, I did not fit, into any slot, that would allow me to see a Doctor. There were many times I needed to. I had been on antidepressants, and blood pressure meds for fifteen years. My elderly mother requested and was prescribed the medication I needed, and so I surrived. At one point 2005, I paid $170. to see a Doctor She did an EKG and said that I had had a stroke or heart attach, and wanted me to see a cardiologist ASAP, when I told her I had no insurance, she said well if anything happens go to the ER.

In this same time frame, a friend's mother had a quadruple bypass.
She was my age, and the proceedure was paid for by the US, you see
they were from Jordan and the surgery was preformed in Jordan. We paid because we deemed them refugees. I do not begrudge her medical treatment for any reason, but it felt wrong that I, a tax paying American Citizen could not see a Doctor.

I believe, that every American Citizen has, the right to medical care.

If they can get insurance from their employer, and decline, that is their right and they should not recieve assistance.

Life's circumstances change, and sometimes we need help.

We need all these well paid, well insured, politicians, insurance execs, talking heads etc., to stop the scare tactics the lining of pockets and take a step into reality and get it done.

Dr. Gupta:

I haven't heard this issue discussed before and think it needs to be. I am 62 years old. I have Medicaid health insurance. Because I will loose the medical coverage if my income is as much as $900, I am drawing early social security, which is less than that. Consequently, my meager retirement savings is quickly disappearing to cover living expenses. After going through 5 years with a very painful back injury and no health coverage at all, Medicaid seems to be my only option.

If affordable health coverage that would not exclude pre-existing conditions were available to me, I would be more than glad to leave the Medicaid rolls and pay for it. I can't work full-time but I might find a job that would pay enough to reduce my social security income. The money the government would save on me and others like me might do a lot to fill in the funding gap we are hearing so much about.

From experience, I can tell you that Medicaid is not good insurance. Most doctors in my area won't accept it and some who do seem to be trying to set a record for getting me out of the office the fastest. It is better than nothing at all but it does not do what it should to promote wellness. The long term cost of that will be paid eventually.

Please consider recommending the elimination of Medicare, Medicaid, Veterans Health Services, and all the other existing government programs. Everyone should have the same benefits and it only takes one government program to provide them. We don't need the administrative costs of all these separate programs, and doctors should not be paid more for treating some people than others.

From two different countries, many people whose incomes are under $100,000 have told me that their income taxes are 18 to 19%. That is their total tax and it includes health insurance as well as many other benefits that we don't have. Their infant mortality rates are lower and their longevity is longer. They assure me that all the Republican scare stories are completely untrue.

Please, Dr. Gupta, support President Obama fully. Optional goods and services are handled well by capitalism. But the welfare of our citizens should never be decided by people who can profit by denying them health care. We need the Public Option, and it needs to be a good one.

Just to put in my 2 cents: Health care reform is desperately needed. I'm extremely concerned that it finally gets accomplished after languishing for almost a century. A single payer system would seem the best for us citizens, but otherwise, the public option will have to do. We really need coverage to be tied to the individual, not the job. For many of us, even if we have medical coverage now, we're afraid that if we get seriously ill, we'll lose our jobs, not have the money to pay COBRA, and the uncovered expenses, and we'll end up losing our homes and all we've worked for. Health care should be more important than funding a war or anything else in this country. We need a health care system that's for the people, not for making profits for corporations.
Thanks for all that you do, we greatly appreciate it!

AMERICAN FRIENDS: Post your medical bills here for us Canadians to see. I would do the same from here, but medical bills don't exist here. I have NEVER been billed for any medical treatment....whether in my doctor's office or in a hospital setting. So last year i went to a Blood Pressure Clinic (Hypertension clinic) at Mt. Sinai hospital for diagnosis and treatment. I visited my family doctor three times. I had my eyes examined. My daughter saw her doctor several times last year. The cost in 2008 for both of us was...........you guessed it........$0.00. This is the same cost my mother paid for her lumpectomy........$0.00. This is the same cost my neighbour paid for surgery to repair his shattered leg bones after an accident..including titanium rods, 3 months in hospital, physiotherapy and weekly home nurse assistance during recovery. Again the cost........$0.00. It's always easy to budget for medical care here. What do my American friends get for $0.00? NADA ZILCH ZERO NOTHING and certainly no medical care. WAKE UP AMERICA!

Lynn Littau,

It breaks my heart to hear people with serious health concerns victimized by all this groundless fear mongering. People all over the world speak English. Please seek out those who live under Universal Health Care and ask them to tell you the real story of how it works. I did and I am now so ashamed that I ever allowed myself to be called a Republican. It won't happen again.

If President Obama's plan reflects the kind of care people in other countries are getting, you will not have to worry about the quality of care that you receive. In fact, your care may improve. Non-urgent cases can have a bit of a wait but cases that require immediate care are moved to the front of the line and get the treatment they need.

Don't be intimidated by the Republican lies. The internet makes this a small world. Please check it out for yourself.

I am 34 years old and disabled due to multiple sclerosis and many other heath problems and living on disability. I get medicare and medicaid I am grateful that I am able to get it even though I would give any thing to be healthy and not need it. I get very upset with Medicare on how some of the befefits thats are handled I am very prone to infection and I get spetic alot. When I do my doctor orders 6 weeks of IV antibiotics. I do get home health a nurse comes 3 times a day. But medicare will not cover IV therapy at home anymore for patients they used to. So when I need IV therapy I have to be admitted to a nursing home and stay for 6 weeks. Look at how much money is spent on a nursing home by medicare when I can get it at home handled by home health nurses. Not to mention it tears me up being 34 and having to stay at a nursing home. Medicare needs to reconsider how they are spending the money and keep the patient in mind.

As many Canadians and I (an American who has lived in Canada) have said many times in this blog, the statements currently being made by American politicians and in a few political ads about how bad Canada's health insurance system is are overwhelmingly inaccurate.

But, I'm afraid that the American people, as a whole, will never be told the truth.

Why? Because the insurance system in Canada follows the single payer model, and that's not what President Obama is trying to establish in the US.

If the proponents of health reform start showing ads stating that Canada's system isn't a bad , then the opposition will start shouting "See they do want to put everyone on a government plan!"

A great tactic. They claim that Canada has a bad system and that Obama wants to bring Canadian healthcare to the US, knowing that Obama can't directly counter the claim because it would imply that he really does want to copy the Canadian system.

I hope people reading this thread are taking in the realities of the medical system we have here, and not believing Republican hyperbole and the flat-out lies they perpetuate using scare tactics, misinformation, and monetary incentives from the insurance companies. The bottom line source of medical problems is not the doctors, or the hospitals, or the obese people sitting in the waiting room: these people are all just trying to work within a broken system that is designed FOR PROFIT. In other words, insurance companies , drug companies, and Wall Street investors looking to make money off American citizens are at the core of this issue. Putting non-profit health care at the core of any new universal system takes out the reason for the inflated prices: no insurance company looking for increased quarter profits for their shareholders, not to mention the investors getting rich off the deaths of the sick and ill.

If you think you won't be affected because you have insurance, YOU'RE WRONG! You are already affected because that's the source of your costs being so high. I happen to have insurance through my employer, but I STILL can't afford all my medications or the deductibles to have surgical procedures my doctor is insisting I need to survive.

Dr.Gupta,
I saw the segment on the discrimination of doctors. I wonder if that is what happen to my sister. She has been to 7 doctors and a specialist and they all say the same thing. She has heartburn, allergies,or its asthama and give her the same medicine repeatedly. She does not have insurance and is not able to work. She believe that what ills her can be help if giving the right care. She has been struggling with this for years.

I am a Canadian...I have health care, I go to a doctor of my choice, I receive regular checkups that include bloodwork, pap test, and a mammogram, I pay for this with through my taxes, and I believe in universal health care. I was disgusted the other evening watching Larry King and his guest Dick Cheny's daughter, who spoke about the Canadian health care system as if she was an authority. She did not provide accurate information.

Why not ask the average Canadian citizen about their health care, I am not saying that it is perfect, but no one asks me for a credit card when I go to a hospital, I am not faced with the high costs of monthly premiums, and I won't face bankruptcy due to a catastrophic illness.

The recent ad running on CNN depicts a "Canadian" who did not receive, what she deems to be adequate health care. We know nothing about her circumstances, her medical history, her prognosis/diagnosis. What I do know is that I had a friend struggle with cancer during the past year and he received all of the medical treatment that was required at no cost to him, and he received this medical attention in a timely fashion; he didn't have to wait for treatment.

I think most Canadians even though we have issues with certain aspects of our medical system, as I said it is not perfect, would not trade places with any American when it comes to what is provided in this country. Please educate yourselves before you condemn what you don't understand, or don't wish to know about. Healthcare shouldn't be about someone lining their pockets!

Thank goodness, I will not ever have to make a decision to either feed a member of my family or go for a medical procedure, or receive preventative healthcare.

regards

Dr. Gupta,

HOW can I help the 14 year old young lady in the Haiti "slavery" video??

Please tell me WHAT I can do to help her...the video was appalling.
I could clearly feel her pain and helplessness.

Thank you.

Ann Velazo
CT

I 'll ake any kind of health care reform as long as we have it on the table. Don't tell me it is going to take another 30 years again. From then I will be gone. I am a hard working person and I have health insurance but when I have to fill my prescription my insurance does not pay for brand name medication. Why am I paying insurance such a high cost then I still have to pay for my prescription. The democrats better do something otherwise I will not vote for those people. They forgot we the people send them to washington to do our work not for the status quo.

Government run insurance cuts costs. It cuts reimbursement as much as legislature determines, not the market. Many physicians currently do not accept medicare because it's the worst reimbursement in healthcare.

Medicare part D (national drug coverage for retirees), although great for folks with no previous coverage, has taken the place of retirement benefits for many of my patients. Why would an employer pay for coverage when the government gives it to you free? Many of these patients cannot afford their drugs or their house payment.

We are already short on doctors and pharmacists, but what about when reimbursement is cut? NOBODY WILL GO TO SCHOOL 16 YEARS TO BE A SURGEON MAKING $50,000 per year!! There is no question that medicare is failing... WHY WOULD WE DO THIS TO EVERYONE??

dr gupta,
lots of ways to help poor americans on food stamps- put restrictions on what they can buy- following someone using food stamps at the grocery store is sickening to see potato chips, salty snack foods, cakes, cookies and pops. just restricting these things would help on the obesity – b/p control, diabetes, – make food stamps for fresh fruits and vegs only and it would help the farmers out.
rate children as at risk and assign social workers to make sure the parents are feeding the right foods to the kids- and if they don't – if the kids don't get the weight under control – put them in foster care. its child abuse to raise greatly overweight children. start in all the schools.
if someone smokes and has lung cancer – they should be comfort care only- its their choice after all to smoke knowing the risk.
anyone overweight doesn't need back or knee surgery – they need wt control. refuse to do surgery such as this unless the weight is under control.
prisoners should pay for their meds-
alternative med should be available and paid by insurance if the person desires this type of medicine.
people over 80 shouldn't be on hemodialysis – esp if they have other system failure.
families shouldn't be allowed to direct medical care – continuing grandma on life support because they can't let go. we have kept pts for months in icu – because multi-system failure and families can't let go. shouldn't be up to them. lots of $ wasted – after 4 months of the best care the pt still dies. family ends up with lots of guilt – as a nurse of 25 years i have lots of ideas. one is people shouldn't be scared of death – the churches of the country need to start weekly -preparing people for what comes natural. we were not made to live forever.
sincerely
cathy sabolcik rn
ps my daughter is going to uom 2010

Dr. Gupta: Four years ago, I had quadruple bypass surgery. I had an excellent surgeon and a fine competent nursing staff and recovered quickly with one small complication. About one month post op. I had fluid build up in my peri-cardial sac requiring another hospital visit to drain the fluid. Since then I have been in excellent condition and feel great. I guess you can say that my insurance is also excellent, I never had to pay anybody a single dime for either of my hospital visits, never had to call anybody to resolve a problem, never got a full bill, indeed received very few bills or invoices. I did get a invoice from my surgeon for $6500 marked 'awaiting insurance resolution'. The insurance company finally paid the guy only $3600. I would have gladly paid the guy $10,000 out of my pocket, he saved my life and, he did an excellent job. I am pleased but, I would also like to know what my operations actually cost? I inquired as to how I could get a copy of my medical records and was told it would cost me over $350 to get copies of both hospital visits. I listen to all those bloviating republicans railing against health care reform and say to my self, why can't everyone get the kind of care that I got? I understand that a poor person could not afford my insurance bill but, that is not fair in my mind. They talk about the reforms putting a bureaucrat (sp?) between you and your doctor. I hate to tell them but there are already a bunch of folks between you and your doctor, they work for the insurance company. More in my next email.........

Continued from my previous post: I believe that most of the cost (excess cost) in our health care system comes from too many lawsuits. I live in Beaumont, Texas which, until recently, was one of three lawsuit capitals of the U.S (it seems that lately some rules were modified on 'change of venue' , making it more difficult to shop for a sympathetic jury. We are currently experiancing a 'lawyer depression' in town). It seems the juries in this area give out the most generous awards (they might not like me on the jury). I do not think that if you have a hangnail removed and then your finger gets infected and swells up you should be able to sue and receive enough money to live for the next fifteen years. Lots of people look at any medical complication as an oppurtunity to get an attourney and join in on the medical lottery, come and get your million dollar settlement. This constant threat of lawsuit drives extra costs into everything. It does not necessarily improve any service or product. It just forces the providers of the medical products and services to immunize themselves with lawyers on call and higher prices. Two examples, in the back of every databook on semiconductor devices is printed a disclaimer that 'if any of the circuits in this databook are to be used in any medical equipment', before the component can be sold for that purpose, an officer of the corporation must be notified. Presumably the device requested will be hand selected and run through extra testing for quality and, the price will be about 10 times more than the everday price (collecting up front to save the money for the possible legal fees). Does this really get a better safer device to your heart lung machine, probably not. Example number two, that little sealed plastic bag with the I.V. loop components that they use when they hang an I.V. bag and drip stuff into your veins, do you know what that costs? I think the average price is about $50-75. ?For a few feet of plastic tubing that you could buy at an aquarium store for just a couple of bucks? Oh but it is in a guaranteed sterile bag and made to stringint specs. Really, are they really sterile? Who exactly tests them routinely? The same folks who check our tomatoes and our peanut butter for salmonella and e-coli, I wonder. You guys should obtain several actual hospital bills and go line by line scrutinizing each item and what it costs. Compare that cost to a similar non-medical device and ask yourself why the items cost soo much. I would be happy to sign off for you to acess my medical bills if you wish, just send me an email.

Okay, I just had to leave a third comment. I just read the post by W Wallace Watson MD.,CM., FACS, FRCS That told the truth about the lady from Canada that had 'the brain tumor that would have killed her in a few weeks'. This is so wrong that her false trumped up story is out there to kill universal health care. Dr. Gupta, don't you feel obligated to investigate this story and put the truth out on the air to offset this erroneous story. Thank you for your attention...

Dr. Gupta,
I have been listening to the debates on healthcare reform and I am concerned about the arguement that overuse of services is driven by physicians and their greed. While there certainly may be a few bad apples out there, I do not believe that the vast majority of physicians would subject their patient to unnecessary procedures purely for financial benefit. It would simply be unethical. Most physicians are truly concerned about their patient's welfare and are not just in it "for the money."

One factor that is important to understand is that physicians are typically restricted from owning equipment or labs where tests would be done in order to protect the income of the community hospital. For example, if I order an MRI, I don't make anything on that... I don't own the MRI. In fact, in my state, I couldn't buy an MRI if I wanted to. Individual physicians are restricted from owning equipment that could take income away from hospitals. If a primary physician orders blood tests or a stress test, he doesn't make money on that. The patient is sent to another facility or specialist and therefore, automatically, treatment decisions and financial incentives are by-and-large separated. It is only in very limited cases that physicians have ownership stakes in treatment facilities or equipment.

That said, potentially excessive testing can occur just to protect the doctor from unfounded legal action. Although an exam might be completely adequate to diagnose a condition, an MRI might be ordered just to rule out something completely rare and unlikely. In the past, this would not have been necessary but now, because we have this technology and patients can sue on a whim without any cost to them or basis for their suit, doctors will order the extra, and expensive, test just to protect them legally. This is a waste of services and often an unnecessary cost to the patient and their insurance company. Until we also talk honestly about tort reform, there will always be this waste of services.

The postion of physicians is highly underrepresented in this healthcare debate. I would appreciate it if you would bring the input and opinions of currently active primary care and specialist physicians into this debate via your show on CNN. I feel that we are not being heard and ironically, we are the ones with the most first hand knowledge of how to help the system and our patients.

Thank you.
Stephen Whitfield, MD

It always raises my eyebrows when I hear U.S. Congress members talk with doom gloom and fear about the coming of socialized medicine to your country. Hey "Blue Dogs" and Republicans......you don't seem to complain about the socialized medicine you receive as part of your job....how's that going for you as 47 million of your constituents have no health insurance.....socialized or not? Any complaints?

AMERICAN FRIENDS: If you really want to know how Canadians feel about their healthcare system ask a Canadian citizen what would happen if the government here decided to get rid of our current system. Canadians are usually a compliant nation but I know there would be protests in the street if that happened. Don't be "bamboozled" as Barack Obama has said. Support healthcare reform for your own sake.

Dr. Stephen Whitfield,

You sound like an ethical person and a physician who genuinely tries to provide good patient care. I agree that you and other medical professionals like you should be involved in the debate.

Please consider the issue of tort reform from the position of the medical profession's ability to minimize lawsuits by monitoring and controlling the causes of those suits from within. Unfortunately, there are more than a few bad apples in the medical field these days. Most families have at least one horror story to tell even though only a small percentage of them have filed lawsuits.

People understand that physicians are human beings who can make mistakes just like the rest of us. Because the stakes are so high, we hope you try harder than most of us not to make mistakes, but it happens. That is a legitimate reason for insurance and the public would not oppose reasonable limits on such settlements. Those are not the cases that have caused your insurance premiums to skyrocket.

It is not so easy to understand harm caused by willful negligence or sadistic abuse. I believe the failure of the medical profession to rid itself of that kind of people is the primary cause of the high insurance premiums. Even after repeated lawsuits that leave no doubt about their character, unethical people continue to practice, apparently without opposition from their more responsible peers. Boards of Medical Examiners end up looking like good-ole-boys clubs.

If good medical practitioners had the courage to unite and oust those who do not measure up to the standards of the profession, I think the only serious problem you would be left with in the area of insurance would be the greed of the companies providing it. You do not perform an optional service. Your service is necessary to the welfare of our citizens and, by extension, our government. It seems to me that that makes regulation of the greed part of your premiums legitimately subject to government regulation.

Dr. Gupta,

Why isn't personal responsibility at the core of the health care debate? Americans choose to eat poorly, and don't exercise enough, and then complain about rising healthcare.

Without strong financial incentives to stop these lazy habits the costs will continue to soar.

As long as we have a pay-per-procedure medical system, we won't have any kind of meaningful reform.

these folks who talk abt lazy habits, do they not believe children get cancer and young adults, and skinny people who do eat healthy., OR Accidents and broken bones, as for folks losing their jobs and getting another with health ins. get real, companies are doing away with health coverages,THEY can't afford to pay their part, and sometimes these premiums are so high folks can't afford it anyway. I would like to ask one QUESTION.

How are we gonna pay for our current system 5 yrs from now. with 14,000 losing health ins. almost every day. We pay for all the uninsured as it is now. I bet few have the answer to this one, they'd better come up with one. Jane

I would like to hear more about work/life balance and health care reform. How can workers get a few more days off...more maternity leave? Why can't more workers telecommute more often? While work/life is out of balance we will have no "reform."

Why cannot all Americans receive excellant Healthcare of Congress members since only 1 premium would cut its expense?

Will the Public Inurance Option a realty or just an empty threat.

I have a queasy feeling that the President's commitment on the Public Option is wavering. Heard Whip Clyburn say that there is a sentiment among some Dems to let the Public Option PO be a Sword of Damocles. over the heads of Insurance Industry. That we give them a chance to comply. If they don't, it will trigger a Public Option. This is a nebulous and blatantly stupid idea to imagine that the market place will turn based on a threat. It will require a real Public Insurance operation – with reduced operating overhead and leverage like Medicare – in order to realize the relief the President has been promising. As it is, the Plan has to be operational ASAP and the project should begin rolling as soon as a bill is passed in House/Senate. Summarizing, the proponents of the trigger idea is either a fool or is on the take from Health Care Business Lobbies. Members of congress peddling such a canard, will be punished badly by the electorate. I hope I am wrong and somebody was just pulling Whip Clyburn's leg.

Mr President if any such move is afoot, you must put your foot down and nip in the bud, such a nefarious idea

Odd how we have no idea what the health care sytem is of our Congress!!! Why can't we have the health care system brought to light for those of the House and Senate so we can compare what they receive to what is anticipated for their consituents? Afterall...aren't they really supposed to be looking out for us in the very best way?

Dr. Gupta had a segment on healthcare this am (Saturday, July 25) where a black minister spoke of his wife not receiving treatment for ovarian cancer soon enough that could have saved her life. Dr. Gupta, ovarian cancer is missed in so many cases because women of all color and nationalities may complain of symptoms and they are over looked by their doctors or the wrong tests are given. As an ovarian cancer survivor of over 10 years, I have seen way too many women in that same circumstance. Even President Obama's mother passed away from this deadly disease. Could she have been detected earlier in her disease?Definitely a time for change. However, it is not the government that needs to control us. We need a check and balance system to help the AMA get rid of the bad doctors that travel from state to state, slapped on the hand and given more chances to make their medical mistakes over and over. Also, women and the men who love them need to know the facts and symptoms of ovarian cancer. Knowledge is power. It is up to we, the people to be informed and take action when and where needed. Silence gets us nowhere. Thank God we live in America!!

I would like to know what is being done about insurance companies who require spouses to maintain their own insurance if it's available through their employer, even if it cost (co-pay) the employee to maintain it when their spouse has full coverage for free.

Our country or no country can afford the type of medical care President Obama is promising. All countries that have universal coverage are about bankrupt and their care has gone way down. I have friends in Canada and they come to the US and pay for care. You can't get treatment for months in Canada. We have to stop this at all costs.

The piece about the black man who sought treatment for the paper cut that would not heal at an emregency room and a emergency center and was bot tested for diabetes. Why had he not made an appoitment with a primay care physician when he had lost 80 pounds and had frequency urination? Emermency rooms and centers are just that. They are set set up for tests and return visits. This not because he is black.. And as for the minister's wife who dies from ovarian cance. again, not a black issue. As I recall Gild Radner, of Saturday Noght Live fame died from the same thing. She was white and had oodles of money. The race card is played when it is the case and we start ignoring it. And as the Cambridge Police office and the Harvard professo: the racial prifiling was on the the professor.

I received an email from a relative that I find very hard to believe.
This is rumor going around. How do I respond to this?;

"This health care bill not only makes us want to shoot ourselves, but it even suggests we do – every 5 years.

Page 425 of Health Care Bill – Listen to this interview Fred Thompson's Radio Show interviewing Betsy McCaughey (pronounced Mc Coy). Or look it up on http://www.fredthompsonshow.com, under interviews.

On page 425 it says in black and white that EVERYONE on Social Security, (will include all Senior Citizens and SSI people) will go to MANDATORY counseling every 5 years to learn and to choose from ways to end your suffering (and your life). Health care will be denied based on age. 500 Billion will be cut from Seniors healthcare. The only way for that to happen is to drastically cut health care, the oldest and the sickest will be cut first. Paying for your own care will not be an option.

Now, CALL YOUR PEOPLE IN WASHINGTON!!!!!!!!!!!!!!!!!! Tell them to read page 425 if they don't read anything else. Surely some of them have parents.

"ON PAGE 425 OF OBAMA’S HEALTH CARE BILL, the Federal Government will require EVERYONE who is on Social Security to undergo a counseling session every 5 years with the objective being that they will explain to them just how to end their own life earlier. Yes...They are going to push SUICIDE to cut medicare spending!"

Fred Thompson: Interviews"

I support health care reform. When my daughter was a few months pregnant with her second child my son in law changed jobs and she was denied insurance for their second child becuase of a pre-existing condition...she was two months pregnant. My son in law was making $12 hour at his work. 90% of the biils they have in collections is due to medical bills. My son stepped on a nail the other day but because he does not have medical insurance did not go to the doctor and will only go in an emergency. Two days later his foot began to swell. I forced him to go to the ED and he had to have it lanced and then had to obtainmecication for the infection and pain pills. I work two jobs and just happened to get my check in the mail from one employer and paid for his medications which came to $70. He has had a tooth infection in the last three months but can not afford the dentist. He has had to go on antibiotics twice for the infection. He also missed two weeks of college last term because he was so ill he could not attend classes now he is on suspension. I was concerned with the swine flu but he would not go to the doctor. He will say, "I can't afford it." So much for the health care system. He is only 25. My family is only one example. These are only a few examples of many more I could give you just within my family.

My biggest concern for the U.S. is that the way you will "transform" the health care system WILL cost you more, for the simple reason that you're not eliminating the ridiculous doctor and insurance profits and other profiteering.
Sometimes, for the benefit of the majority, you just have to take the bull by the horns and do the right thing, even if it causes a firestorm. When Canada switched over from private to public health care, a ton of detailed planning went into it, because the results otherwise would have been a chaotic disaster.
It is astonishing how the 'right' to make a profit seems the most sacred American value - and even more astonishing to see how often it is the ostentatious christians who feel that way.

I feel a need to clarify for Americans what the Canadian health care system consists of. First of all there is ONLY govt run health care. It covers ONLY doctor visits, hospital stays, medications while in the hospital, diagnostic tests. It does NOT cover out of hospital medication, vision care, dental, massage therapy, chiropractic, podiatry, physio, etc. These extra things are paid for out of pocket or by extended health care through an insurance company – sometimes paid for by your employer. The basic doctor/hospital care is for everyone equally – it is not possible to PAY for this. So the President would have the same care as a street person. The hospitals are all government run and all doctors are paid by the government – by the patient/visit/surgery, etc The rates are set by the government so their salaries are in essence capped. This is why we lose many doctors to the US as their potential for income is unlimited. So there is positive and negative things with our health care but we NEVER need to worry about paying to survive or be health. I guess the private insurance companies would be the big losers if your country went with this type of system as they are out of the picture here.

Janice Bonnecaze, I can ans. your question as to why the man who cut his finger did not go to the doctors when he lost 80 lbs, CAUSE HE HAD NO MONEY. and no way to pay for tests, my nephew in OH does without insulin half the time and reuses his needles, he has no ins. and cannot get medical cause he has a house. go figure,wellcome to medical care in AMERICA.
These folks who advocate going to the Dr when you have no ins. is out of touch with reality, how can you visit A doctor who will then refer you to a specialist who then needs tests run. Bloodwork cost me abt 400 bucks here, thankfully I do have ins. myself, others are not so fortunate. Doctors around here do not do MRI'S for nothing. Folks are out the dying. Jane Boucher.

TO Dovie and all the folks on this site with their bad stories please tell these stories to your congressmen and senators, even if they never read them it will make you feel like you've done something, I go thru this with the uninsured in my family who have no access to medical care. I don't know of one single person who would not love to have access to medical care, who thinks if is fun to visit a ER room and sit for hours there. or knowing you can't pay. There are many good people out there suffering on a daily basis. THIS IS THE TRUTH. I don't care if its Gop plan or Obamas, just FIX IT. Jane

Health care reform the first time around cannot possibly be perfect. Under the current system, we have NO redress with the insurance companies-they refuse, deny, and will not even speak with you. if the new reform has flaws, at least with elected officials, we will have some one who will listen-because they want to be re-elected. There will be ongoing monitoring of the reform, and changes along the way. That is much better than the current system where the insured have no recourse.

I just want to ask, Who is right? Those on the left or the right?
I feel like the republicans are frighting us because of cost and
the democrats are not telling us everything. So, which is it?
I have a cronic condition called fibromyalgia. I want to keep
the healthcare & the doctor I have. I don't want to go back when
I first learned I had it. To make a long story short, it was a
nightmare, that I don't EVER want to live again.
Any information you could provide would be greatly appreciated.

This is a very complicated issue with many angles for all people... rich and fortunate and those with less and not fortunate. However, until we all realize that we are going to have to give up something to get more, we all want better health care but no one group wants to give up. I do have good health insurance, however, my husband works very hard, usually 65+ hour work weeks for the same company for 24 years and every year we contribute more to our health insurance than the year before. The numbers are staggering, however, I do not agree with one of your viewers comments that l"doctors are as greedy as those on wall street." We have several friends that are doctors and they are not greedy and they happen to be some of the most generous people I know. I think most are under paid for how much education they have and how hard they work.

I do agree with tying some portion of the insurance to the "choices people make about their health." ie smoking or being more than 20% over weight for their height, age, etc.

Costs need to be posted like on a menu at a restaurant, for all medical procedures, annual visits, etc. etc. People need to become comfortable asking their doctors what the cost is for the procedure and/or visit. And Doctors need to know the "ballpark" of the costs.

This is an enormous problem, however, I do not agree that the wealthy need to bear the brunt of the cost for this "proposal!" Let's find a solution that works together with the doctors, insurance companies, drug companies, patients, government, farmers and food suppliers. One of the large problems for low income families is that poor quality food is cheap, fresh good nutrition is more expensive and takes more time to prepare.

So much to think about but we as Americans have the ability to overcome this issue and remain on top of the health care field.

I know you love to interview people like Lance Armstrong, but did you do a program on the 2000 Americans this past week waiting in a field at daybreak in Wise, Virginia. They were begging for some small help. They had no healthcare at all, some in wheelchairs.

For this health reform to work, what is essential is to have task force that will look at where costs can be diminished. For example, why are so many fraudlent clames being able to pass the Medicare system? I've been helping doctors and dentists cut costs by implementing an EMR system to create better staff productivity and cut unnecessary costs.

http://paperfreeoffice.blogspot.com/

HEALTH CARE REFORM BILL.

For all you people getting info from emails and other people abt whats in the bill, some is misleading and some is downright lies.

go the the usgov.org and read the bill for yourself. I have found sayings out of context having the page and lines listed. I've checked abt 4 of these line item and pages numbers. some does not make sense what you get in email, one had page 126 with a line 26 and there was no line 26 on that page. so beware of misinfomation floating around READ THE BILL . Or check out what you are finding being sent to you. I HAVE A COPY of the bill in my files, its out there. Jane Boucher.

The numbers do not seem accurate when you consider all the young people who feel infallible and could care less about insurance as well as the illegal aliens that we are not responsible for...we need reform...not total overhaul....each piece should be added after full consideration. Sure we need to make health care affordable to everyone but why must it be government run? Put some constraints on the insurance carriers and pharmaceutical companies...Having worked in healthcare I can tell you that there are already many rules in place to make sure only medically necessary tests and procedures are done.
My biggest concern however concerns me....I am nearly 63 and have several serious health problems...does that mean I am headed to the guillotine?

It is very easy to place all the blame (or a large majority of the blame) on physicians. Many so-called experts have come out of the wood-works to weight in on health care without any formal training or prolonged exposure to the field. While they are all entitled to their opinions and to share their opinions, it is very dangerous to accept their opinions as fact. This problem goes all the way to the top – right up to President Obama.

He places blame on everyone but patients because placing any blame/need for responsibility on patients would be a political disaster for him. In particular, he seems very ready to scape goat physicians. I am very frightened by numerous examples of his obvious lack of knowledge of how medicine works. At the last "town hall meeting" he said that reimbursement is done in such a way that if you bring your child to the doctor for a sore throat, rather than going ahead with conservative medical treatment or dealing with possible allergies, the physician (who in this case would be a pediatrician) would elect to take the child's tonsils because he/she is paid more for procedures. I ask you – when was the last time you heard of a pediatrician doing a tonsillectomy? Pediatricians are not surgeons and therefore they do not do surgeries. In fact, a referral to the ENT to have such a procedure done would not benefit the pediatrician financially whatsoever and would only be done in the patient's interest. This goes to show yet another example of the fact that Obama really has no idea how medicine works, yet he feels he knows enough to dictate how medical practice should work.

He cherry picks his data and says that we spend more, but have no better medical outcomes. I would ask Mr. Obama to look at some confounders that may contribute to some of his claims. For example, obesity is a major problem that our nation faces. While many people believe that hypothyroidism is the cause of their weight problem (a “gland problem”), many studies suggests that this is not the case. Even if this was the case, one could have a simple blood test done and if they were found to be hypothyroid, they could take thyroid replacement therapy (levothyroxine) with the direction and guidance of their physician. The real problem with obesity in our nation probably has more to do with our lifestyle than hormonal imbalances. In fact, within the hospital that I train at, the one restaurant present (not including our cafeteria) is McDonalds. If one made the claim that they intend to eat at McDonalds and be healthy, they will be surprised to see how much more they will have to pay in order to eat healthy. The financial incentive at McDonalds and many other restaurants is to eat high fat, high sugar, high salt, high cholesterol meals, perhaps because it may be more expensive for McDonalds to maintain supplies of vegetables and fruits than frozen meat, french fries, etc. Now, let us look from a scientific perspective just why obesity is a problem:

1. Among the leading killers of adults in the US include heart disease, stroke, colon cancer and breast cancer.
a. Atherosclerosis: the deposition of fatty plaques into blood vessels. This deposition takes place in places like the abdominal aorta (which can lead to an abdominal aortic aneurysm that can rupture and rapidly lead to death), the coronary arteries which supply oxygen and nutrients to the heart (which can lead to a heart attack and/or heart failure), the carotid arteries (which can lead to a stroke), the mesenteric arteries (which can lead your intestines dying), medium and smaller sized vessels which supply other organs and your limbs (which can lead to peripheral vascular disease, a disease state where not enough oxygen and nutrients are delivered to areas such as the legs and feet that can ultimately result in ulcers, infections and the need for amputation). Among other causes, atherosclerosis is accelerated by high low-density lipoprotein, LDL, levels (the “bad” cholesterol), low high density lipoprotein, HDL levels (the “good” cholesterol because it can help remove some of the fatty plaques in the arterial walls), smoking and diabetes.

b. Colon Cancer: this is the third most common cancer in males and females separately, but is the second most common cancer killer when both genders are combined. The risk of colon cancer is increased by low fiber, high fat and cholesterol diets.

c. Breast Cancer: this is the second most common cancer among women and the second most common cancer killer among women. In a women who no longer has periods (post- menopausal), the amount of estrogen she has present in her body decreases. This is good because estrogen stimulates many tissues to multiply. Many studies have shown that increased exposure time to estrogen increases the risk of breast and gynecological cancers. For example, late menopause and early menarche (starting of having periods in adolescence) are risk factors for the development of cancer later in life due to the prolonged estrogen exposure. This includes breast tissue and other gynecological tissue. Fat has an enzyme present known as aromatase. This is the same enzyme present in the ovary that converts compounds into estrogen in the pre-menopausal woman. Therefore, the more obese a woman is, the more estrogen she makes and the more she exposes her estrogen responsive breast tissue. Therefore, obesity is considered a risk factor for the development of breast cancer.

These are just samples of the health impact of obesity. They can lead to deadly disease and also can lead to disability. For example, obesity contributes to osteoarthritis. Additionally, obesity causes insulin resistance and can result in the development of Diabetes Mellitus type 2. The result of diabetes is widespread. It is a leading cause of blindness in the United States. Additionally, it is a leading cause of kidney failure necessitating long term dialysis (which is a tiring and terrible experience for the patient), a kidney transplant (which requires long term immune system suppression therapy that predisposes to life-threatening infections and cancer) or death. Additionally, diabetes will accelerate atherosclerosis leading to an increased risk of heart attacks and strokes. Another common problem with diabetes is a lack of sensation at the feet and poor function of the immune system. The combination of the two previously mentioned results in diabetics being unaware that they have injured their foot and an immune system that cannot fight the infection that sets in. This results in the need for amputation of the toe foot or leg if the infection cannot be controlled by antibiotics. The main point about obesity is that it is an epidemic in the U.S. and leads to significant health problems which plague the lives of our patients and run up massive costs in terms of health care dollars. The initiative should not to ostracize obese patients, but rather to find a more effective way to reduce this problem.

1. I have personally seen many patients with chronic, treatable disease such as diabetes, high cholesterol, high blood pressure, etc who will not make life style modifications (exercise, better diet) and are not compliant with (or outright refuse to take) medication. These same patients come back time and time again with diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic non-ketotic syndrome, congestive heart failure, heart attacks or strokes. Many of these patients are on Medicare or Medicaid and so tax payers pay for their hospitalizations. These hospitalizations are largely reducible or even preventable with adherence to lifestyle modifications and medical therapy. In particular, during one month, I saw the same patient come in 2-3 times for DKA because he/she “could not figure out how to work his/her insulin.” Each time he/she came in, he/she spent at least one day in the intensive care unit which costs a considerable amount of money. Before he/she left, he/she had a meeting with a diabetic educator to teach about diet, monitoring blood sugar and using his/her insulin.

2. I have seen patients who cannot fit into the MRI scanner (diameter too large) or they exceeded the weight limit. As I previously mentioned, this is not a laughing matter. This is a major health concern for the patients.

3. I have seen uninsured, unemployed patients in the labor and delivery units having their 4th or 5th child. While we do not place limits on how many children a person can have (and should not), people need to take responsibility for their health and the health of their family.

4. I have seen drug users come in for overdoses or drug related problems and get caught using drugs in the hospital. Often, they use the same IV lines the doctors are using to give medicine to give themselves drugs.

5. I have seen alcoholics come in multiple times for their treatment only to return time and time again for more drinking related problems.

6. Smoking. This is the leading cause of lung cancer which is the most common cancer in the U.S. and is the biggest cancer killer for both men and women. Additionally, smoking accelerates atherosclerosis and is a risk factor for many other forms of cancer. Also, it is a major risk factor for COPD, another major killer in the U.S. However, I have seen many patients, both young and old, who refuse to stop smoking – or even consider stopping of smoking. Some even stand outside, plugged into their IVs smoking right outside of the hospital.

7. End of life care – this is the big topic that Obama dances around but never answers. Massive spending occurs for this part of one’s life. Many patients want everything possible to be done when it is them or their loved ones (which is understandable). In a setting where cost cutting taking place like being described, one place that will be certainly cut will be this area. If your outcome will be no better, you will not have the option to undergo such treatment. An example close to the heart of Dr. Gupta would be patients who suffer from glioblastoma multiforme. From what I have learned, the outcome is almost universally dismal and the radiation therapy, chemotherapy and surgery offer very minimal in terms of prognosis. However, they offer the patient and their family hope. Should we take that away hope and maybe a few more months of life from patients and their family to cut costs?

What all this means is one of the ways we can reduce costs is by providing financial incentive to patients being compliant with medical recommendations and strategies. For example, the patient with diabetes who takes their medications and make lifestyle changes that brings their hemoglobin A1c down into the range shown to reduce morbidity and mortality should get more health care coverage than another diabetic who decided to not be compliant and would rather just wait for emergency care when the disease has progressed. Additionally, the patient who refused to even attempt to quit smoking probably should not be entitled to the workup, diagnostic imaging, surgery, chemotherapy and hospice for their lung cancer. If a smoker makes continuous and honest attempts to reduce smoking or stop smoking all together, they should receive financial incentive in the form of better health care coverage. This strategy can be employed for many other disease processes and translates to a financially sustainable health care system and an overall healthier population.

This is not to say that some basic coverage should not be extended to everyone. Personally, I believe that non-self induced catastrophic medical treatment should be priority number 1 for the government. For example, a child with leukemia should be entitled to health care dollars before the 40 year smoker with lung cancer.

Electronic medical record keeping: It would save money for sure, but by cutting the jobs of administrative people in the medical community. For example, the people who used to type up physician dictations are being largely replaced by software that types the records as the physician dictates. This is what the electronic medical record push will result in – a reduction of overall costs to the consumer by cutting the salaries of people who used to work as administrators in medicine. However, duplication and waste could still exist if there is not a single computer program for all providers to use. The patient would have to have a copy of their complete medical records (including test results, imaging and doctor notes) on a portable mass storage device (that could be backed up on a central server in the event of a lost mass storage device) which could be plugged in and updated at each provider encounter. This would be ultimate efficiency, but security and privacy would become the new issue.

Lastly, to cut costs by paying physicians less, taxes need to pay for the medical student education. It is unrealistic to think that people would train for minimally 11 years after high school (to become a primary care physician) or an additional 5-7 years to be a specialist to work to pay off the massive education debt. To provide an idea, the cost of undergrad and medical school could be 20-40,000 USD/year. Assuming a 30,000 USD tuition cost, that is 240,000 USD for education not including living expenses or interest for the resident that, like his/her patients, wants to have a support their family. Also, to keep the good access to care, it would be wise to change medical care in all fields to shift work. This would dispel the use of the call system and could reduce hours to a more reasonable load which could reduce costs in paying physicians.

In summary, the best way to cut costs:
1. Have a system that financially rewards (though increased healthcare coverage) compliant patients and penalizes non-compliant patients.

2. Offer universal catastrophic healthcare coverage for non-self imposed medical castastophies.

3. EMR with a central database and a mass storage device the patient carries from provider to provider to reduce duplication of care

4. Raise taxes to pay for medical education

5. Change medical care schedules to shift work for all fields

6. Cap malpractice suits and strong tort reform which penalize patients and attorneys for frivolous cases

7. Strong campaigns in school (must start early) about the importance of maintaining a healthy lifestyle. This includes ensuring that all students are provided with a mandatory exercise time each day in school (PE has been cut in many schools).

8. Pay for drug research and development with taxes so that generic drugs can be made for the patients. This way, drugs can be made and released to the public not for profit which allows for cheap, newer and better medicine for all patients

9. Mandate that everyone contributes to the healthcare system

I just saw your comparison of Medicare and Private insurance coverage for health prevention items. You should note that Medicare coverage is primarily geared to 65+ persons and the frequency of some screening usually diminishes with age and a prior clean history.
Additional factors worth mentioning are the standards published by AHRQ Guidlines published by USPHS for these procedures.

I have been a medical writer for over 20 years for both pharmaceutrical companies and nonprofit research organizations. WEhen I listen to your reports and people's questions about national health care and "off-label" use of medications, I hear two different types of questions.

1. Will national health insurance cover the cost of prescription even if I don't have the illness that it's approved to treat by the FDA. One example comes to mind when I started to get migraine headaches in college. The current drugs for migraines didn't exist. The neurologist prescribed inderal, a drug for high blood pressure. The actgivities of this drug not only decreased high blood pressure, but a result of that activity happened to be prevention of migraine headaches.

Doctors can prescribe medications for problems different from what the FDA approved for the pharmaceutrical company, as long as they show "due diligence."

Will drugs prescribed off-label be coveed by national health insurance?

2. A second question concerns clinical studies. Of course, the study drug is provided at no cost by the pharmaceutical companies, but many related study costs are not. For example, patients may need blood tests, a chest x-ray, and an MRI as part of the study protocol. Will national health insurance cover these costs for those brave patients who take part in clinical studies?

Medical studen, a lot of good ideas, really, but what about the price we pay covering the uninsured and what to do with them. It cost 600 here to go to the ER, how abt more clinics to serve people and charge a reasonable price, Near here they have opened clinics and charge 45 for the visit. They can treat many problems, not all, but offer vaccinations and things like this for the uninsured. We pay much more in the US than other countries getting the same prescriptions, why?. Early prevention, like more screenings for cancer, colonoscopies, breast cancer etc. Needs to be done, people are dying. I have heard most of the free screenings for Breast cancer are for women over 40. I have a friend with 2 grand daughters both in their 20's with lumps in their breast, trying to find a place where get can get mammos at a reasonable price. this is insanity., they have tried the county and the american cancer society and other places., they are unisured. Jane Boucher.

The issue that I have with the proposed system is that it will turn out like what is currently in place for Veterans. The VA hospital does not have the best record for health care and the waiting list for certain items can last extremely long, my father went to one for treatment but due to the way he was treated we ended up paying for his medical ourselves.

I would like to know what type of guarantees are going to be in place to assure that this does not happen with this plan. Unfortunately, the VA Healthcare System is the only one that we can use as a judge for this type of care in the U.S. and shows what happens when politics are involved with a healthcare system.

I strongly support President Obama's plans to reform healthcare in our country, but have not heard enough about what will be done to hold insurance companies accountable for the rates they charge! Our healthy family of 3 currently pays nearly $14,000. a year in insurance preminums! We have never had a major illness or claim and this coverage is basically for major major illnesses with a $3500. deductible. We're fortunate to own a small consulting firm that pays for our insurance, if we had to purchase this policy on a personal plan it would be even higher! Something must be done to control insurance costs. My guess is that their profits would rival the oil companies, if they had to publish their financials.

You folks against health care reform, this could be you. My niece in her 40s just tried to overdose,WHY, cause she has a painful debilitating disease called Interstitial Cystitis, A bladder disease, She used to be a surgical assistant, and lost her job her ins. and Cobra and now losing her home, Her meds are up to 900 bucks and some medical professionals want money up front, she is constantly in the hospital due to bladder spasms that won't end , the disease has spread to her kidneys, the doctors accuse her of being hooked on Drugs, she has to Cath herself all the time. When you get this sick there is nowhere to go and no one to help. yes, she is in contact with others with this disease, most not as bad as her. As far as I'm concerned people who don't want the uninsured insured has no heart. This could be your daughter, mother or sister. Jane Boucher.

I work in the healthcare field, specifically in the revenue section. I see the money side but I also hear and see the patients that are sick. I also see the doctors and the hospital goals and motivations. I believe that this field has been so focused on money, (ie insurance companies and rx companies). Hospital and doctors are caught in the loop because they provide the services. Some hospitals and doctors are subject to billing for higher prices because the insurance companies are so eager to deny claims. Rx companies are also responsible for this, they help drive the money up by redeveloping prescriptions and charging $30 per pill when it doesn't take as much money to manufacture it. The worst part about it is that that's just the money portion, that's not even considering what patients are going through to get care, and not just ordinary band aide care, but top notch healthcare.

In respect to patients, I think the first thing is to have some restriction on rx companies and commercial insurances. They are the ones that are truly hijacking the prices. Once they get their reform then you can go after hospitals. Hospitals are subjected to government scrutiny more than people think. It's up to each hospital to work up to the guidelines set by the federal government, not only in basic health care and privacy but in funds as well, maybe those standards should be higher. Once those three aspects are put in place then doctors can be looked at. Doctor's do make a lot of money, but they also have school loans to pay off and long hours and high risk situations, they are supposed to be holding a person's life in their hands afterall. Doctor's should be completely patient focused, how they would get paid should be based on their patient care. This would lower prices for patients where they can afford healthcare without giving up their homes and filing for bankruptcies.

I also think that there should be a way to get Americans insured, but as a human being I can not forget the immigrants either. I can't stand idly by and know that when a man is in front of me having a heart attack or stroke that I would ask for citizenship status. It's not right. I can not, under any circumstance let people forget the poor or the immigrants. I do know about EMTALA (the law the prohibits discrimination in the ER) but what happens when their lives are saved and they have a $30k bill, that's just going to increase their stress putting them at risk for another heart attack/stroke. Some things can not be denied, human rights. Citizen or not, we're all human and have the right to basic rights, I believe healthcare is one of those rights.

that's my 2 cents.

I think that the health care premises are too simplified. I just saw housecall and am left wondering about why it is a given that a teenager's life is more worthy of saving than an 8o year old. The teen may be a crack head and the 80 year old may be a wonderful person, who may live another 20years,worked hard and paid into the system for years and years and doesn't want to die.

Dr. Sanjay Gupta:
It would be very beneficial if you could give your viewers a line by line, which items that are directly health care items in the government health bill, & which ones have very little or nothing at all to do with health care. An example of this would be where the health bill gives aid to those that are not even citizens of this country. The only place citizens have to find this kind information out are from an unbiased look from people like you. Thanks in advance for your input to this very complex issue.

Two things:

1) A huge waste of funds is the separation of the Mental Health system from the rest of the Healthcare system. Medicaid separates them, insurance companies pay for them differently, states/counties separate them – and it all leads to reproducing ineffective bureaucracies and tiered systems of care (RATIONING). Even in public systems, permission to even see a physician is often determined by a masters or bachelors degreed social worker and once patients are stratified to one level of care or another, it takes an act of congress to change the response to changing conditions. Diversion from some forms of care, including inpatient care, is Absolutely DENIED on the basis of forms of payment – a system that is patently illegal for non-psychiatric care. Patients are, indeed, forced against their will (sometimes in restraints) to go to one hospital vs another based entirely on payor preference (regardless of open beds at the PATIENT'S preferred hospital).

2) There is talk now about insufficient numbers of Primary Care Physicians (PCPs) to manage the new patients suddenly covered under any of the major healthcare reform bills working through congress. How should we respond to this? Force people to go to care providers with less training and experience (Nurse Practitioners and Physician Assistants?) NO. The answer is to stop allowing the federal government to keep paying for the training of every medical student who would prefer to go into a specialty field with a salary 2-10x that of a PCP! It is the federal gov't that pays most of the money for ALL U.S. medical training and it is the feds who determine how many specialist spots will be funded, and it is the feds who largely determine the baseline salary range (via reimbursement rates) for the graduates of specialty residency training programs (except for those few "cash" fields, like most cosmetic surgery). A lot more medical school graduates would become PCPs if the feds A) reduced the number of specialty training spots by 10% and subspecialty training spots by 20%, B) increased the pay for PCP residents in training, C) increased the reimbursements for PCPs and decreased the reimbursements for procedures by subspecialists. There is NO reason that a cardiovascular surgeon should be making more money on average than a cardiologist (an Internal Medicine specialty), esp since it is the work of the cardiologist that can keep the patient out of the cardiovascular surgeon's O.R. (though the patient's behavior has the MOST to do with it). The CV surgeon's decisions are no tougher, and the outcomes no more life-changing. In fact, I would argue that the cardiologists' decisions and difficulties are tougher than those of the CV surgeon.

gewisn,
county hospital psychiatrist

Real health care reform can be found at http://www.millionmedmarch.com
Check out the Mission statement – the physician's Mandate.
Get the government out of healthcare. Tort reform. Pharmaceutical reform. Individual control and responsibility. Insurance reform. Not fascism and union payoffs. This is a positive reform package.

Dr Gupta,

Please read the bill. You can google it and get it online and See Section 1145, Pag 272, see Section 1162, Pg 335-339, and Section 203, Page 85, Line 7. . It just takes a minute to pull it up and go directly to these sections. See what you think.

Also, for the sake of doctors you might be interested in Section 1501 Pg 659-670 and Section 2212, pg 875-891.

You can then decide for yourself. You are in a role that can influence others. I hope you will do the right thing

The answer to the Health Care Reform is right in front of Congress eyes. Put every one on the plan that the Congress, Senate, and all Staff has. Isn't that what we had heard during the campaign how great their health care plan was and that every one should be so lucky to have that type of coverage.

Hi: My 45 minutes foot procedure cost me $ 11,000. This was just the hospital part which does not included doctor/anesthesiologist, etc. fees. my husband’s 30 minutes procedure when he fell was $ 43,000. Again this was just hospital bill and he was charged for a lot of things he never got. His room did not even have towels or soap, the food was iced cold, etc. Health providers are out of control with the cost. A five minutes doctor consultation is $ 303 to get a prescription. Doctors see 10 patient an hour and charge a full amount for each. We are in the wrong line of work, right? In other countries like England and south America doctors must see a patient for at least 20 minutes and do a complete exam. Nowdays, doctors are pill pushers and they experience is based on how many over a million dollars houses or assets they have. Healing is not longer their purpose but making money. It is sad. Seniors cannot afford to see a doctor because we have to buy food or pay our utilities. Healthcare providers are out of control with the cost.. I am not rich nor a politician.

I am floored at all the talk about healthcare reform and one of the biggest problems with our current healthcare system is almost never mentioned. I am one of thousands who as a very nice career decause of the flaw that has a dramatic impact on cost for everyone who see's a doctor and there by all players including the goverment and insurers. There is almost no way for doctors to tell you how much your visit, surgery, or other service will cost because the cost is determined by a set of codes which can only be applied after the service is completed because is it based on what is done once the door is shut. Top that off with having to follow policies that are out of this world crazy written by politicians and you now need staff to determine this. If you are going to hire staff in this area you have to hire specail staff because if you hire someone that does not know what they are doing you could ruin your practice to the goverment for fraud and abuse. Which I do not beleive is intentionally as rampant as the government says but happens more often than not because the policies are so out of hand. How many of you are aware Medicare has an 8 page policy on cutting toenails?? Eldery on blood thinners or certian conditions should not cut their own nails but if a docotor does it there are at least 9 things they must put in their notes they need to code it and add modifiers all in the proper order and if they do it all correctly they will be paid $17. Crazy! We have over 40 coders in the practice i work for of 500 doctors. Good coders pay for themselves in revenue and peace of mind in case of an audit but they cost big money making anywhere from $15 to $45 an hour, Cutting the red tape, and simplif billing. Moving to a time based system of payment would reduce costs for everyone!

I have no idea of what is in the plans. But as wife of a physician working in community mental health, my observation is that the present system is broken. However, I don't really trust the congress to fix it. I have not heard anyone address the fact that HCFA determined fees based on precedures years ago eventually resulting in excesses of precedures. Doctors don't get paid for time spent with a patient to teach, encourage, console or engage in the art of healing. The demands of complying with the rules and regulations and the difficultly of getting reimbursed from insurance companies all adds to the cost of care. Older doctors sometimes just give up.

Dr. Gupta,

Preventive medicine is an important aspect of any healthcare reform. I'm an orthopedic surgeon and I started a FREE service that reminds people to take their medication with a text to their cell phone. 100 million people in the US are non-compliant with their meds, mostly because they forget. I'm trying to get the word out but as a full time surgeon with limited resources it is difficult. Do you have any ideas? The site is http://www.remindermed.com. Thanks.

Funding is already there- remove the CAP (TOP-HAT?) on Social Security FICA contributions and dedicate the money to:
1. A government-option plan for everybody without restrictions for (act of God?) pre-existing or genetic conditions;
2. Covering all of everybody's body: feet, teeth, eyes, ears, and brain- including "mental" health;
3. Annual comprehensive testing for every U.S. citizen at a one-stop diagnostic laboratory (with overnight motel-style accommodations) within 2 hours drive- catching H. pylori, urinary E. coli, systolic hypertension, alpha-1-antitrypsin deficiency, diabetes 2, etc. BEFORE running up costs for perforated ulcer, kidney failure, stroke, emphysema, blindness, etc.
4. Non-profit Cleveland style salaries for physicians- with generous bonuses awarded by a committee of their peers+patients' groups for outstanding reseach/diagnosis/performance; 5. An economic stimulus plan to build this chain of clinics and accessible hospitals (preferably with environmentally friendly energy;
6. "Body parts" above to include contraception before the whole world evolves into Homo insapiens, v. lemmus, devouring the last scraps of Soylent Green- at the present rate of growth scheduled for about 3010 of the Common Era.
(One of Charlton Heston's great performances,
Republicans please note.)

Uncapping the FICA contribution would go a long way to funding such a program. What, Dr. Gupta, do you estimate it would do for our health and life fulfilment?

Post-script to my previous comment (after reading more of previous postings):

Thank you, friends and neighbours from Canada!! On the issue of "foreigners" "aliens" etc., some years ago when my son was taking a summer course in French in Montreal, he became very ill. A Canafian classmate sent him to the nearest hospital, where he received excellent care, It is the job of the medical profession to cure sick people, It is the job of immigration officials to stop undocumented people from crossing a border.

As I see it there are 4 distinct issues with Healthcare reform. While interrelated, each is complex and must be dealt with separately. Insurance company reform, healthcare costs, high premiums and uninsured Americans.

The first issue is insurance company reform. A valid complaint, for instance, is that insurance companies drop patients once they are diagnosed with a disease. This cannot be allowed. Forcing the companies, though, to take all patients without preexisting clauses, would mean that no one would purchase healthcare until after they became sick.

The second issue is healthcare costs. Contributors are insurance companies, hospitals, physicians, lawyers, unhealthy patient behavior and ever increasing technological advances (drug and equipment manufacturers). Understand that cutting salaries or budgets will undoubtedly result in decreased access, like in Europe. For instance, the word HMO has become synonymous with poor care in most states. One can tax poor behavior, but no one seems to want a sugar tax or even more cigarette taxes. Regardless, though, the number one cause of rising costs is the technological advances. Understand that the Canadians do not get the latest drugs and have substantially limited access to care.

The third issue is high premiums for average Americans. Forcing small businesses to cover the entire cost of premiums will force them out of business as they will not be able to compete with the larger corporations. The larger corporations will not be able to compete with international corporations that rely on government supplied health insurance.

The fourth issue is the uninsured population. Since these individuals are more likely to be unhealthy, the cost of giving them healthcare benefits is difficult to estimate. Using the Canadian system as a model is not accurate, because the Canadian government does not track the costs associated with their citizens crossing the border to get their care here in the states. A better estimate of cost would be to look at our own VA system, which by the way is no more efficient than any private insurance plan. In any case, the increase costs for insuring these individuals would far exceed any cost savings measure proposed so far.

The bottom line is that there is no magic here. Physicians will not work for free; drug companies need profits to attract investors and patients will not change their behavior. So, perhaps President Obama should focus on a few small items here instead of trying to ‘fix’ everything at once. For instance, they could pass a few regulations for the insurance companies to make it fairer. They could allow for a few low cost plans, which would offer less care (with ever increasing technology everyone just cannot have all the care they feel that they deserve). Later, the government might look at expanding the VA system, which could include the low income Americans that cannot afford any premium regardless of the cost, but again, this will not be cheap.

Dr. Gupta,

I think one of the main issues of health care reform is to discuss and come to some conclusion of how we got to this place. I have been involved in health care and consult with medical clinics as a CPA.

I believe most people will say they can recieve good health care, but it is costly and costs are rising too fast for people to pay for insurance in the private sector. Over the years it has become it very clear to me that the reason health care continues to rise at a 10% to 30% a year is very simple.

Medicaid and Medicare is about 40% of the insured population. With the baby boomers coming on board and more and more people coming into Medicare and Medicad there is a significant cost shift to private insurance that has happened and will continue to happen. The reason is that on Medicaid and Medicare providers are paid from 30% to 60% of what the private insurers pay for the same procedure.

Thus with the growing population of medicaid and medicare, providers and insurance companies have to cost shift to private insurers to just break even from year to year. Doctors have to continue to raise rates to insurance because of the shift of population to Medicare and Medicaid and they do not want to take this client base on.

The reality is if medicaid and Medicare payments were comparable to private insurers payments to providers, health care cost would be significantly lower. Probably insurance would cost half as much in cost, but there has been a significant cost shift that the government has basically taxed the private market for many years by what they have done with Medicaid and Medicare.

I think we need to understand that Medicaid and Medicare, which are good systems, have the greatest impact on private insurer's health care costs. In addition, Medicare system is going broke.

So to blame insurance companies is probably not realistic. To blame medical providers is not the solution.

I would just like the government to assess why health care costs are high for private insurers and I guess this cost shift because of medicaid and medicare is a big reason.

The american people need to know how we got here and why and that would be good to understand before we go ahead with health care reform. IF continue to under fund Medicaid and Medicare the cost shift to a govt plan or private insurance will continue to happen.

Insurance Reform or Hospital Fee Fund
Health care reform is really not the issue. It's all about insurance, who can afford it who cannot. Our health care system is great,needs help no doubt. Why are we paying high cost insurance rates to large companies instead of paying our fees directly to the hospitals, care facilites directly? What is so wrong about that? Do we actually need a middle man controlling our health as well as our services? I noticed the long lines at the Forum in Los Angeles. I cannot recall the exact number of people in the long lines and waiting in the bleachers. Many could afford some type of care if paid like insurance, but directly to the health care system. We first don't really need to worry about the Government in health care. They have been there forever. VA Hospitals, Medicaid/Medicare, heck even our folks in Washington DC have the best ever. So no need to wrry about that. Health care should never be taxed. If we pay directly, we should get all that we need. So the real issue is simple.
This issue is to eliminate the position of middle men companies that require average citizens to pay fees for services with honesty and integrity, only never to receive such services when required. It is simple to go to a grocery store and pay for groceries you pick out individually and consume such products. To purchase a vehicle, drive it off a dealership lot and subsequently getting a use for the vehilce one has purchased. Many examples show of such purchasing power and we could go on forever. This issue is to quit paying insurance companies that deny one the right to obtain a service when needed. That is the whole purpose of insurance is to gather funds of many on a large scale basis for profit only to deny any services that in good faith are prepaid by many.
Doctors and those who work directly such as nurses, and all the employess in health care and education understand how well we can and will do and understanding the needs of each and every patient. These are not the people who refuse services that are paid for over many years and not given to those who do. It's the insurance companies who dictate what, how when services should be rendered and at what cost.
We all know that and agent sitting in a cubicle cannot diagnose any issue that a medical doctor can and should not be in a position of denial or authourity to do so. We don't pay for services NOT to be given. We are not getting what we pay for. It's that simple. We as consumers can change this very quickly and simply and get what we pay for. We do not need the government to intervene in doing so, but a simple regulation will help us all.
For the amount of money we now pay insurance companies we should pay directly into the hospital feed fund. The fee fund will be available to everyone in any given community in the United States as long as you are a citizen of this country. This must be the first requirement. If you are a military veteran you automatically qualify. If you pay directly into the fund as a citizen you will qualify. We will continue to deal with indigent and poor people and our government can and will help in that area as they do now (more on that later).
It should not matter where you live as long as you have paid into the fund you will get the services you need. It should not matter which part of the U.S. you live in you will get services. Imagine the billions of dollars pouring directly to hospitals. How quickly the researching methods, patient care,direct contact with paitients will improve because of the equipment, doctors etc., all go where the money flows best.
Hospitals can still do what they do best. If a hospital specializes in a certain field of service and the paitient is recommended by a doctor from an existing hospital to go to another, as long as he/she has paid for such services, they should receive them. Specialty doctors will get back to hospitals if they want simply make a living as the money will be there. Hospitals will hire more and better primary care doctors and nurses. This could help by not overworking them as well.
Many of us will not even need the services, but one should not be denied no matter what the situation is when we do. We should then be able tailor services as well and hospitals can add additional programs for wellness that can benefit us all.
The relationships between local community schools will be enhanced. High schools and secondary educational programs can turn their attention to new local programs that will benefit both our citizens by educating them as well as providing meaningful employment. The schools can and will develop more heathly programs for its students to entice a healthy community.
There are many issues that can be answered and here are a few as well.
Q1.What happens to all the money insurance companies take in now?
A1. Much of this money is being invested right now. Those investment dollars must be directed to the hospital fee fund directly. (We can certainly find out where the money goes now) This will stimulate jobs and services directly.
Q2. What will happen to those employees who work for the insurance companies now?
A2. Many of them can go to work making sure the services they used to deny in the past can be attainable. Since they know all of the steps to deny service, they can and will find steps to make sure a patient is not denied and qualifies for the patient.
Q3. Will we still pay for the indigent to receive care?
A3. Our tax dollars pay for some of it right now. It will not change. But we will have to introduce programs that can help those who can least afford to pay earn a way to pay for it as well. These are a few of the things that will have to be worked out.
Q4. Who pays the taxes?
A4. What taxes? We do not need to pay taxes on such services. If every one is paying into the fund, we do not need extra money out of ones pocket to pay taxes and the government does not need to step in and remove such funds for taxes. We are talking about the health and welfare of our people. We are overtaxed right now and look where our money is going.
This is and should be one service we should not ever have to worry about and or money should not go to industries that don't repsect their position by not helping those who give it to them.
Q5. Will this kill the insurance industry?
A5. No way. We have insurance companies for our vehicles, our homes (which must be next in line for changes) and many other requirements. Remember we need the services in which we pay for. It's amazing we pay for co-payments for much of our services and still get denied in the end when we really need it. Some of these co-payments can be lowered to help with the cost of medicines and prescription drugs. Currently we should wonder what happens to our money when we are denied what we pay for. We should not have to hire a lawyer to figure this out.
Q6. Lawsuits?
A6. We only sue when we know what has been given to us is wrong. We will have to give up something and on the other hand many doctors who are not qualified and those who are not doing a good job can and will be weeded out by the industry itself. Hospitals will employ only those today who don't carry the extra baggage. Having been sued and continuing to practice what kind of insurance do they carry?
Q7. If this does not work?
A7. Our government has the perfect program in place right now in Washington DC, from the president on down to everyone in congress,all of our senators and legislators on every level that we as citizens pay for. If we cannot get the Hospital fee fund direct. Then we must demand from our government the same that they receive and again that we pay for right now.
Q8. Wouldn't that be socialized medicine and or healthcare if we have the same programs as those who represent us?
A8. We all want better health care.We can call it whatever we want...we want simply a program that works.
These are a few of the questions and answers and we know now and that there are many more to come. The questions and answers can be simplifed by acknowledging the issues that exist and continue to move in a direction to abolish the wrong system in place right now that does not work. This is not a socialization or warehousing for care. We can have better health care if we can get it done correctly. We have to start somewhere.The rebuilding of our infrastructure actually begins with ourselves. If we can change this ourselves we can have a big change on the federal level to retool our economy. Just think if the government did not bail out the current industry (Like AIG) and gave the money directly to American citizens who would actually spend it and put it back into the economy, we would not have a few of these issues. We would instead be purchasing health care insurance ,automobiles (more insurance) and many other items we pay taxes for. We can develop more jobs if the money was given directly. Even if many americans save the money..it will be in banks credit unions as well. Right now our backs are against the wall and it does not matter what politcal party,your race or your sexual orientation. When it comes to health care and paying for it, we are all in the same old boat..... right now we are all sinking in this boat together.
Again why should we pay for a service only to be denied what you are paying for? This in itself is a gamble and the insurance companies make us put our money on the table knowing in advance we will not win or have a chance to even the odds!

Dear Dr. Gupta,
I would really like to see you re-visit that $200,000 hospital bill for the woman who had the pacemaker replaced. As anyone who has a hotel (I did) knows, room and board prices INCLUDE overhead, employees, administration costs, even empty unpaid rooms PLUS profit, or else you wouldn't make any money! Also, a pacemaker does not cost $72,000 dollars. Also, if they told you only $1000 was for the uninsured, that's BS.

The only legitimate concern over the health care reform is cost. Everyone who has ever worked in a hospital (I have) knows the uninsured get pretty much the same services for free. Who does everyone think is paying for them? We do: in our insurance premiums, in our hospital bills and in the price of our new car! We are already paying for those 44M uninsured. The major question is, when they become insured, will all the insurance companies and hospitals lower their prices or just continue to charge the same and keep the difference? What's your best guess?

I would REALLY love to see a whistle blower from: hospital administration, a medical insurance company and a pharmaceutical company tell how prices are determined. It will be as big a scandal as the bank bonuses when it all comes out. People are unaware and uncaring because their co-pay and their portion of their premium is affordable – just the same as the people who went into all these creative loans with banks were happy – until the foreclosure!

All the things people are concerned about with health care reform are already happening. Insurance companies already make life and death decisions, and it is based on PROFIT right now. If I have to choose, I think I would rather have a panel of doctors deciding. people trust you. Please go back to that hospital bill. Make them explain every single item. It would open a lot of eyes.

Kathleen Koziol

Dr. Gupta: You want a challenge? I have one for you. I have a spinal cord injury from a 60 foot fall rock climbing. I also have a shattered pelvis and fractured legs and feet. There is considerable internal injuries and I also have a hole in my heart that is inoperable. I live alone with pain that never ceases and never drops below a tolerable level. With all of these serious health issues that have forced me into disability I have seen the changes that the health industry will face with considerable trepidation and paranoia over loosing the bottom line. We are on the cusp of a massive healthcare revolution: where many physicians and healthcare administrators who have advanced their own personal wealth at the expense of the sick, weak, and insecure will be faced with having to actually serve the greater good. I have spent my life working and living with doctors and scientists and found that the public has given over the notion of "God complex" to someone who is no more than a technician for the human body. There is so much waste and corruption in the system that it needs to be completely revamped and restructured. The recent protests have nothing to do with healthcare, only social unrest and the resentment over the loss of power in some obscure political dichotomy. There is no question that I am dying from my injuries and I cannot be repaired, but I am intelligent enough and motivated enough to move beyond my paralysis and pain to release the anchors of material attachments. Now all I desire is knowledgeable medical information without the added cost of needless maternal nursing or administrative overhead to cover the added employees that do no more than move a piece of paper or take an X-ray from one stack to another in order to stay employed. The doctor needs to do medicine: and if that is accomplished then many other factors will be resolved. I am a disabled architect and physics research associate and understand the science of medicine, the rest is just a social contract that demands marketing of my health to support a base of too many workers trying to grasp a brief glimpse of the brass ring. It is appalling to see doctors living in near opulence while their patience scratch to buy a box of macaroni and cheese. There is plenty of guilt to go around.

I am afraid that we medicare beneficiaries will lose our ability to keep our current physicians under the proposed reform. Currently those of us who pay for good supplements can have our specific medical treatments cared for by excellent specialists. We have our cardiologists, ophthamologists, gastroenterologists and hemotologists who have been caring for us for years. With the proposed reform's change in the "method of distribution" we must have a primary doctor decide whether to give us a referral and who can send us to a specialist in his particular little group rather than to our current specialists. Why can't we do what some other countries do and have another option for those who want to pay for it where we keep our rightto choose and see our chosen doctors? Why should professionals and successful business people who have worked all of our lives to have a good quality of life be forced into an inferior system when we are willing to pay for quality care?