Ask Dr. Sanjay Gupta your health care reform questions

Dr. Gupta,
I just graduated from medical school with over $280,000 in debt. How do you think the Health Care Reform policies will impact doctor's compensation? Do you think there will be anything included in the bill to reduce the burden on young and future physicians?
Thanks

Recently, I left the Republican Party after 25 years, because I realized they don't care for the little guy, they are just about the rich people. And I say this as a Cuban-American that understand the price of liberty.

Now, I see that the democrats are just the same way.

We need Health Care reform, everybody knows that, but here we are, no excuse for the democrats, the own everything, from the White House to Congress, and still it looks like once again we, the little people, are going to continue without medical care.

I am so dissapointed, I feel like I don't want to vote again in my life.

I am not sure when the politicians talk about patient's choice-patients have to choose from a panel of physicians and the care is determined by insurance companies-not by physicians-As a physician I have seen a patient die of colon cancer as insurance company refused it-I was on a phone today for 1 hr.to get approval for kyphoplasty for vertebral fx.of a patient who was on plavix and needs it but could not get prior authorization still and have to wait for one more day and then scheduling it will take longer exposing this patient with high risk of thrombosis to embolic phenomenon.I am not sure the present system is patient friendly.
The current is good for greedy insurance company executives and the supporting politicians. They are creating unnecessary fear to common people-We need to understand that money spent is limited and to be used wisely-and it is good for govt. to compete with other insurance companies. I wonder if any senator is willing to wait one to two weeks to get pre-certification for a vertebral fracture and willing to get treated by some physician he does not know and has to go to a hospital of his insurance choice. Every time a patient's employer changes the insurance company, they have to find a new physician and it is difficult to go to a new physician for a chronic condition. Why are the insurance companies scared of Obama's proposals.How come they increase premiums, reduce benefits but not bonuses to executives-( I am not talking of salaries) My feeling is cutting patient's benefits are inversely proportional to their bonuses.
I am sorry this is long but as patient advocate I am fed up with insurance companies.

Dr. Gupta,
On a monthly basis I need Advair 500/50. Under present conditions I can not afford this medication nor do I have adequate insurance. I make too much money to receive any type of help from the govornment at any level and just don't know what to do except maybe stop breathing. What can I expect if health care reform passes and is there anything I can do in the meantime?
Thank you,
Judy in Florida

Will the new health care options cover birth control? Costs are out of control right now...my birth control costs over $70 a month now, and I simply can't afford it. I take birth control for other medical reasons, not for protection from pregnancy, but it's not even covered by a lot of insurance providers. I recently purchased some from Canada, because as an unemployed, uninsured American, I couldn't afford it. I got a three months' supply from a Canadian pharmacy for $84 because I was desperate.

When I was laid off from my job over a year ago, I was offered COBRA. The plan covered nothing, and the premium was $350. COBRA is a slap in the face of someone who's lost their job. I couldn't afford it, and have been uninsured for over a year. My previous insurance covered only a few dollars of my birth control.

The last administration cut funding to Planned Parenthood, which used to be a source of low-cost birth control options. I have many friends in their late teens and early 20s who are having babies because it's a cheaper alternative than birth control pills! (These kids should be using condoms, but the last administration also preached abstinence-only education, and they frankly don't understand the dangers of unprotected sex!!

Also...here's another thought I had yesterday. All these conservatives keep saying that you'll have a bureaucrat between you and your doctor. However, we have INSURANCE COMPANIES already between us and our doctor. I recently started working again, and now have insurance. I want to go to an eye doctor that I know and trust. They won't take insurance at all, because of the hassles. And my insurance company will only pay a tiny amount if anything. Therefore, my insurance company is standing between me and my doctor, and my only choice is to go to a "drive thru" eye doctor to the masses. I had a problem with pitting on my cornea, and I really need to see someone who is more specialized. But it's not covered under my medical insurance, and they're trying to force me to go to someone else. We already have no "choice," and haven't for years. We need real reform.

Do you see any attempt to stop the direct advertising from the pharmecutical companies to the consumer? We are constantly told to ask our doctor about a drug. Shouldn't we be informed of possible problems and related symptoms and then go to the doctor? Let him address the issues and then treat us? It would seem that the advertising costs associated with these ads drive up the cost of treatment. Will our health care system have to pay for these additional costs? Should it? The tail is wagging the dog.

What provisions are in the bill to re-evaluate outcomes when new research becomes available? Time, etc.

Thanks
Kathy

When will the medical legal climate be address in the health care reform? The high cost of health care is due in part to the uncontrolled law suits that occur. This has forced many doctors to practice defensive medicine so they can prove they did everything that was possible just in case they should get sued. The general public are unaware of the high cost of medical malpractice insurance and unaware that many doctors do not collect 100% of what they bill. Health insurance companies decide how much they will bill for a procedure. Patients do not always makeup the difference or pay their co-pays. The doctor absorbs the cost. When Medicare lowers the amount they pay, the private insurance companies generally follow. So, what will happen? When current physicians can not longer make a living, pay their employees and their bills, they will retire. Individuals considering becoming a physician will think twice and chose a different profession. Consider at family practice. Fewer and fewer medical students are considering this area because they can not earn enough to pay their bills. We already have a shortage of physicians and when this happens the entire health care system will collapse. A final note. I wonder if the average citizen knows how long it takes for someone to become a physician, a specialist and how much money it costs.

With respect to H.R. 3200 section1233, pg 424 & following. I understand that the government will make the ultimate decision after end life consultation. In your opinion is this true?

Dr. Gupta;
I am 39 years old and disabled, will this reform change things, like How many medications are paid for, I am a rare hemophiliac, as well as suffer from Celiac disease. I have a special diet I have to eat, Yet I get no help from anyone for paying for those foods. and I have to take over the counter Vitamins that no one seems to think i need covered as well.
I live in Arkansas, and Trust me what I get from SSD and SSi isn't enough to live on . as it is only 625 per month. I am church mouse poor! and in diar need of HELP!!!!!!!! now!. Please do answer these questions for me.
Thank You For Your Time
Ms. Lisa Osburn

One blog says that if you have conditions like Macular degeneration or need of a heart stint -diagnosed after 56, ins will not cover these conditions. Is that accurate?

Dr. Gupta;
I am 39 years old and disabled, will this reform change things, like How many medications are paid for, I am a rare hemophiliac, as well as suffer from Celiac disease. I have a special diet I have to eat, Yet I get no help from anyone for paying for those foods. and I have to take over the counter Vitamins that no one seems to think i need covered as well.
I live in Arkansas, and Trust me what I get from SSD and SSI isn’t enough to live on , as it is only 625 dollars per month. I am church mouse poor! and in dire need of HELP!!!!!!!! now!. Please do answer these questions for me.
Thank You For Your Time
Ms. Lisa Osburn

This morning (7-28), I saw the brief clip about what Medicare does and does not cover, and what the proposed health plan will or won't cover. I think it could be misleading to say that Medicare does not cover "virtual colonoscopy". I am sure that most viewers will confuse that procedure with the more traditional "invasive" colonoscopy, and wonder about a plan that won't pay for this diagnostic procedure. Frankly, I looked up the term, just to be sure I understood what your intended meaning was in the news clip. But I would guess that most of your viewers won't bother to make sure of your meaning, and may jump to a conclusion that Medicare doesn't cover basic and helpful medical procedures. R. Morris

My daughter was recently diagnosed with TMJ, which is excluded from my insurance coverage. If the pain and discomfort she experiences every day is real, how can an insurance company deny coverage of this medical condition? I am currently in the process of appealing the decision, which is also delaying any further treatment for my daughter. I understand that it is a common practice among insurance companies to specifically exclude TMJ disorders.

Today on CNN, you stated and displayed on the screen, that at this time, Medicare does not pay for PAP smears annually for a patient that has had a previous hysterectomy for a benign condition. Not true!! Please respond.
Thank you.

From SoCal:
For the past couple of years. my wife has been campaigning for single payer health care. Twice the California Legislature has passes it but Arnold has vetoed it. There is a bill in the congress for single payer health care, will you support it? From what I understand is that it would get rid of the insurance companies, and the state or feds would run the pool. More people in pool less costs, no high insurance co. profits. Many doctor groups and health care groups in ca. have supported this plan. It seens that every politico has his own plan. This plan has been debated and approved by California legis.

Your comments

The main concern of mine and other srs is the cost of drugs – my 4 scrips retail at $1100/mo. I pay $160 a month, drug plan pays balance of the retail until the total of copay and card coverage reaches $2750 – this covers just a couple of months; I get my scrips from Canada for less than $500 a month – a huge difference. Why has the governent succumbed to the Pharma lobbies and refused to allow negotiation of prices? This is criminal – a difference of $600. For srs on limited income, this involves serious choices. My doctor approves my source, The drug industry needs to be controlled.

Dear Dr.. Gupta,

The Medicare cuts will leave seniors with NO quality of life surgery, like knee and hip replacement. NO life saving surgery like, dialysis, chemotherapy, lung or brain surgery, etc. We all know that Medicare was going bankrupt, yet our government will find ways to cover the country, when 80% of Americans say they are happy with their health care, yet Seniors will "Have to learn to live with their pain." I don't know of anyone who wants health care reform. Pages 15-17 clearly states private health insurance will be phazed out. REPORT THE TRUTH FOR A CHANGE!

WHY IS IT THAT I RARELY...........IF EVER HEAR ANYONE USE

THE WORD....GLUTTON........., AND TO ME THAT IS ONE OF THE TRUE CAUSES IN OBESITY....

ANYONE HAS A BUILT IN DIET, AND THAT IS THE LENGTH OF THEIR ARM AND THEIR MOUTH.....

WE ARE IN THE AGE OF "FIX ME"...AND LOOK OUTSIDE OURSELVES RATHER THAN TAKE PERSONAL RESPONSIBILTY FOR ALL ASPECTS OF OUR LIVES.

I guess my comment...is all the people working for the goverment including the president going to have this coverage also? Or is it going to be like social security....it was good enough for the people but not the goverment...they had a different "program".
It looks like the health reform is going against the seniors of the nation.
Thank you
Mary Sullivan

Why do you keep focusing on how thew government will "come between you and your doctro"? This is done every day in every state. Below is a partial list of bills in the Virginia General Assembly last year that dealt with what would be covered by health insurance. The government is already neck deep in your health care.
HB 1977 Health insurance; mandated coverage for prosthetic devices and components.
HB 2024 Health insurance, basic; increasing availability thereof in State.
HB 2191 Health insurance; mandated coverage for telehealth services.
HB 2521 Health insurance; coverage for length of hospital inpatient stay for mother and newborn.

Dear Dr. Gupta,

I was diagnosed with a liver tumor January, 2009. I was "laid off" December, 2009 (18.4 yrs). My 6-months of paid COBRA coverage ends 8/31/09.

I am single and over 55 years old. The likelihood of finding "affordable" insurance at my age with this pre-existing condition is pretty slim. I am living on a small severance and unemployment checks at present while job hunting. Questions:

1) Can I extend my COBRA coverage to ensure I have something to cover the tumor, should it become malignant?
2) If so, who should I contact to arrange extended coverage at the discounted rate (I believe the government's discount is 65%)
3) Is there any insurance company that would insure me for a reasonable monthly cost as a single individual with a pre-existing?
4) If I start a small business, can you explain (again) how to form a "corporation or company of one" (for insurance coverage reasons).

My tumor is in a bad spot and surgery is risky. The surgeon has advised it not be removed unless it becomes malignant. How should I handle this ticking time bomb?

Thank you for your help.

Kat – Chicago, IL
katmeloney@gmail.com
312-339-0776
Website: http://www.laidoffandlivid.com

I can respect what's going on in the "fray" of the health care debate but its essential that the public has to understand that what we're getting from the news and most reporters are opinions. Some to tarnish the Republicans, some against the Democrats and especially the President, but I'm tired of the M/M of Federal Health Care, I can remember my parents saying that a surge of people in this country were applying for Medicare (M) and Medicaid(M), while they had to sit through insurance denials of care which resulted , of course in the death of my father because the lack of treament caused his cancer to spread, creating the single parent household that ships most Americans today to living inthe tumultous waters of POVERTY. What my questions is "For over fifty years our health care system has been crippling American household and killing the American "dream" of many immigrants, whats so wrong with the changes being sought by President Obama???" I'm a professional in industry yet, a dental visit can cost me a co-pay of over $300.00 for a single visit and thankfully my medical co-pays are less stringent, and I'm considered in great health. I wait expectantly for a balancing of care in this country. What I'd like from Dr. Gupta is an explanation of what I hesrd on CNN this morning; something referencing that a committee will be formed to alert the President when a patient has a doctor refer procedures that may be costly, does this committee plan to do this for each and every case, this sounds preposterous, PLEASE clarify!!!!

One point nearly everyone in the media seems to fail to address:
The INSURANCE COMPANIES are in control NOW of our health care NOT US OR OUR DOCTORS, and these insurance companies are there to MAKE A PROFIT!!! True health care reform would take the profit makers out of the middle of the system, and save millions of dollars for Americans. We could pay higher taxes if both citizens & employers did not have to pay exorbitant insurance premiums, co-pays & deductibles.
Please address these issues in your discussions to truly inform the public.
Thanks!

When you comment on Pap smear coverage in the course of a story in which you discuss ongoing studies re appropriate screening intervals, you should note that with Pap smears there is definitely agreement that in women over 65 with no history of nl Paps at least q3 yrs is safe, with the possibility that no further Paps need be done. This does not mean that pelvic exams do not need to be done yearly; that is part of an annual physical.

For years there have been stories about health insurance companies getting between the doctor and the patient. Now that we're struggling nationally with ways to insurance the American people, the argument has shifted to cries of government interference between doctors and patients. Why isn't anyone talking about the two side by side? Is it okay for insurance companies to tell doctors what they will and will not pay for, but it's not okay for the government?

Dear Dr. Gupta:
Did I hear you correctly that 'Medicare does not cover colonoscopy'? I have Medicare and use Kaiser Permanente provider. I just had sigmoidoscopy 5 days ago. It was covered by Medicare and I only paid five dollar co-payment ($5.00). My wife is going to have colonoscopy soon and I assume it will be also covered. Please clarify.
Thanks
Ky Nguyen, California

Did you say that there isnt enough research on healthcare prevention and what the outcomes would be?? Please clarify yourself

Quote, American College of Sports Medicine "Physical activity and exercise clearly prevent the occurances of cardiac events; reduce the incidence of stroke, hypertension, type 2 diadetes mellitus, colon and breast cancers, osteoporotic fractures, gallbladder disease, obesity, and delay mortality"

SECOND, FYI, the top three causes of death in the U.S. are heart disease 28%, cancer 22.7% and stroke 6.5%, 61% of total deaths are related to diet and 68% are related to lifestyle and not to mention we are the most obese country in the world. Dont mention anything about prevention, that dosent work, haha. Look up US Health and Human Services, USDA, National Institute of Science, AHA, ACSM, take your pick, there are thousands and thousands of pages of research on prevention.

is the health care system in the ststes going to be like the canada health care system. I'm from canada and like our health care system.

Hello Dr. Gupta,

I would like to know if this can be true. See below. Thanks.

This man was warded in the hospital and was constantly warned by the nurses not to leave food stuff by his bedside because there were ants about. He did not heed their advice. Ants finally got to him. His family members said that the man constantly complained about headaches. He died and a postmortem or autopsy was done on him. Doctors found a group of live ants in his head. Apparently, the ants had been eating bits of his brain.

Dear Dr Gupta,
It seems that the health care crisis is being portrayed as an either/or situation. Either private or public, free enterprise or government run. The CNN story comparing private insurance coverages to Medicare used cholesterol testing as an example for comparison, scaring people by saying that Medicare only covers cholesterol screening every 5 years. Truth is, I can get my cholesterol checked through my local health department, which offers screening twice a week at locations around our county. Other low cost preventative testing such as mammograms are also available periodically. Seems to me we can take a sort of combination approach and get the job done. Thanks for all you do, Terri

The American Medical Association (AMA) knows firsthand the devastating effects of our broken health care system. As the nation's largest physician organization, we feel it is imperative to take this opportunity to formally reiterate to you our commitment to meaningful health system reform. Progress has been made and common ground exists, but there are still difficult issues that must be resolved. We believe it is time for results, not rhetoric. America's patients and physicians deserve better. More information can be found at our health system reform resources community at http://www.ama-assn.org/go/reform.

I am the Practice Administrator of a primary care practice consisting of eight physicians with 30,000 patients. Our senior physician has written a letter to Senator Kay Hagan addressing healthcare reform from the perspective of physicians "in the trenches". I would like to share this letter with you if I could be provided an email address.

No hospital should be put in a position to decide policy with regards to medical care for illegal immigrants and bear the burden of the expense.

What if, as a matter of law, visitors to this country, along with their passports, visas, and green cards, are required to show proof of medical insurance when entering the country. Employers who hire foreign nationals must provide health insurance for foreign nationals and be able to show proof of such coverage. If a foreign national shows up in a hospital for medical treatment without proof of insurance, emergency treatment should be given and then, it should be the hospital's right to have the patient reported and subsequently returned to their country of origin.

We're having enough trouble providing care to our own citizens.

I don't know how you can go on CNN and tell people that Medicare does not pay for Colonoscopy screening. I have had one that Medicare paid for and my friend just had one because he changed doctors, and his private health plan paid for it. Please research your statements before you make them. That one is untrue and misleading.

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

My first choice is to have a health care system on a par with France or Canada; however, that is not going to happen. So, my second choice is to have a public option like Medicare for all but with dental, mental and vision included. Those are my wishes, but questions I've not heard addressed: 1. All the politicians speak of "no pre-existing condition exclusions. To my knowledge, that is already an option available, you just have to pay exorbitant fees for it. Has anyone addressed the issue of preventing all insurers from simply increasing their premiums to cover the costs of insuring pre-existing conditions? 2. It is a slippery slope to have one's employer involved in one's health care. HIPPA regulations are a nice thought, but then there is reality. Especially if there is this crossover of information from "wellness" programs with employer sponsored perks for participation in the "wellness" program as well as the pre-existing condition issue. What is to prevent employers from using those issues against existing or potential employees? By the by, I have great respect for your reporting – sensitive and informative. Thank you.

Are you familiar with the study by The Commonwealth Fund, that concludes health care reform with a public plan will NOT increase the budget and in fact yield a savings?

See: http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Jun/Fork-in-the-Road.aspx.

I just watched Dr. Gupta's report on differences between Medicare and private insurance benefits. I was very disappointed to see his failure to point out that the more limited Medicare benefits are consistent with evidence based guidelines. The United States Preventive Task Force recommends PAP smears every 1-3 years at the discretion of patient and physician and may stop screening at age 70. Evidence shows more frequent screening (yearly) in patients with regular normal PAP smears is of very unlikely benefit (about 1 in 250,000 PAP smears). Lipid screening in healthy patients is recommended every 5 years, not yearly. The Medicare guidelines do not appy to patients with abnormal conditions, only healthy patients. Patients need more information about the very questionable benefits of excessive screening and testing and not be scared that reform will prevent them from getting needed health care. Dr.Gupta shold have been much clearer about the rationale for the Medicare guidelines.

I've been a medical writer for over 20 years for the pharmaceutical industry. Perhaps people's questions about whether the new national health insurance plan would pay for off-label medications could be divided into 2 issues:

1. If a drug already on the market is prescribed for a patient who doesn't have the indication (what FDA allows pharm company to say the medication can do), but the doctor thinks it will help, would the national health insurance still pay for that drug. My own experience with migraines many years ago comes to mind. The neurologist prescribed Inderal, a drug for lowering blood pressure, to help prevent my headaches. I didn't have high blood pressure, but the drug's normaql activities helped prevent migraine headaches.

2. A second issue is whether the national health insurance program would pay for costs associated with clinical studies. Of course, the pharmaceutical company doing the research provides medicine at no cost, but there are blood tests, x-rays, perhaps MRIs and EKGs to pay for. Will national health insurance cover the costs of the costs related to new drug research?

I wonder if some of the resistence to nationl health care is actually from the fact that people already have to get authorization numbers, approval for certain prescriptions, call multiple times to make sure that they received the statement from the doctor and that the check is in the mail ... I have to do that all the time, and as a result, I now am not offered the best effective treatment for my painful physical condition.

The approved use for MyoBloc injections is cervical dysplasia–I have that. The insurance company requires that I get an authorization number for the treatment. I have to have these injections done at an ambulatory surgery center because I have a lot of hardware in my neck (from disc fusions) and the doctor requires fluoroscopy to perform these injections safely. That requires another approval number and a double-check that the ambulatory surgery center is "an approved facility."

Last year, the incompetent bookkeeper at the ambulatory surgery center was fired and the books redone. Whoops! All of the sudden, I was being harassed and inundated with mail demanding payment for almost $10,000. Even though I had made the calls, double-checked the approval numbers and made certain each time that the surgery center was an approved provider.

Now I'm the patient whose insurance doesn't pay its bills, and as a result, I am stumbling along with severe shoulder spasms and terrible tension headaches. I have to take benzodiazepines and narcotic pain medications, which take the edge off, but do not actually correct the cause of the spasms, which the MyoBloc injections did.

My husband and I are too terrified to report this insurance company to the state insurance regulatory agency because he might be fired.

I know MyoBloc injections are expensive, but what is in my best interest: to receive expensive but effective treatment that I only need every 3 months and function as a loving mom and wife, or to be forced to take narcotic and benzodiazepines, both of which are very addictive and just take the edge off because they do nothing to correct the problem.

P.S. I am very interested in finding out how national health insurance would support clinical research, which is vital to the development of scientific knowledge in our country. American medical schools and medical care in the United States are still the first options that s many students and people seek first.

To the medical student who just graduated with 280,000 dollars debt:

Too bad for you! Don't worry, you and your other greedy, procedure oriented, I dont care about the patient colleagues will pay that debt off during your residency and be driving a different Hummer each day of the week (when you are not sleeping on the golf course in the meantime).

OK, but really, I am a medical student as well and am very frustrated that people do not get this. There are many ignorant people out there who think that the above is true. Newflash to the people – in order to be a doctor:

1. 4 years undergrad, pricetag minimally 80,000 if not paid by family
2. 4 years medical school, pricetag minimally another 80,000 if not paid by family
3. In reality, most medical schools charge 30+ thousand annually for tuition alone
4. We work way more than any other profession; we take call overnight multiple times a week
5. We get paid 11 dollars an hour during residency while interest compounds on our loans
6. Medical school tuition is only increasing
7. The students in medical school had to be at the top of their class to get into medical school and must work harder than any other higher education student (law, business, english, etc)
8. Malpractice premiums can be tens of thousands of dollars annually for some specialties
9. If you change jobs, you have to purchase "tail coverage" which means you pay malpractice insurance for your old job (for a certain time in case someone from the previous job wants to sue you) and your current malpractice insurance

So lets use Obama's famous phase:

"Lets be clear..." It is incredibly difficult and time consuming and requires great sacrifice both personally and for your family to become and practice as a physician. It is not cheap to run a practice and with the politicians (who are mostly lawyers) looking out for their own self interest by refusing to seriously tackle tort reform, costs will keep rising. In other countries, medical education is paid for by taxes. Maybe we should increase taxes for all Americans so that we can pay for the education debt and then decrease the physician salaries?

Dr. sanjay gupta could you please tell me if breast cancer runs in your family can you eat and drink soy products. my sister was 80 years old when they found the lump.

Dr. Gupta, You should breakdown the proposed Obama health Care reform and present it as a CNN special to your viewers. (Similar to what Alley Velshi et al did for the economic melt down). We hear so many stories from the left and right that, we all are confused.

This question is in regards to the issue recently come to light in the wake of the arrest of New Jersey Government officials and religious members. It was reported that roughly 80,000 people in the U.S. are awaiting a KIDNEY FOR TRANSPLANT. Why such a large number, and how does that number compare to other developed and/or developing countries ??

Dr. Gupta,

I thought you mgiht be interested in seeing what General Electric has just announced to their employees regarding major changes to their health care benefits beginning January 2010. It appears that GE believes that health care reform is going to happen!

From: ~Corp US Employee Services
Sent: Tuesday, July 28, 2009 6:20 AM
To: Dudoff (GE, Research)
Subject: Important information about your health care benefits

Dear Colleagues:

In recent years the health care system has changed dramatically, health care costs have risen rapidly and we've entered a difficult economic environment.

As a result, in the fall we will introduce a new health care benefit plan for all US salaried employees that will replace GE Medical Benefits and GE Health Care Preferred beginning in January 2010.

This new plan will continue to provide you and your families with excellent medical care and coverage.

We know that keeping our employees healthy and detecting disease early is the best way to keep health care costs low. Because of this, the plan will offer expanded coverage of preventive care doctor's visits and screenings for you and your family at no cost. We will also provide you with state-of-the art tools and education to help you identify and address health risks, as well as new technology to help you manage your health expenditures.

Other new features of the plan include incentives and coaching to encourage you to adopt healthier behaviors. The plan will also offer increased benefits coverage for autism and infertility.

Under the new plan, how you pay for health care will be different. You will be offered three options, allowing you to select how much you pay out of your paycheck versus how much you will pay in a deductible when you seek care. (This is much like how car insurance works. You can pay less up front but have a higher deductible, or pay more up front to have a lower deductible).

Depending on the option you choose and the amount of medical care you need, some employees will pay more overall for their health care than they pay today and some will pay less. As with our plans today, in the case of a serious illness, GE will protect you financially from high medical bills.

More importantly, you and your family will need to take a greater role in managing your health and your health care spending. We will provide you with education, tools and transparency around cost and quality to help you become a more "active consumer" of health care services.

Many other companies have successfully implemented this type of plan and have had positive results in both employee health and health costs.

This will be a major change in how your health care benefits are provided. More information will be provided during September and October, and you will be able to make benefit selections during annual enrollment in November.

Please watch for and take advantage of the training and educational opportunities about this new plan that will be offered in the fall.

Thank you,

Robert S. Galvin, M.D.

Director- Corporate Health Care and Medical Programs

A copy of this information is included in the Focus newsletter which you should receive at home in the next few weeks.

I am soon to be 63 female. I have had fibromyalgia for over 15 years. Doctors gave me a antidepressant. When I took it, it made me useless, forgetful and still had pain. I asked for something else. Then my doctor of 30 years gave me xanax .25 mg 3x a day as needed. Then the insurance made me take generic brand. I kept a journal and everytime I had generic. Everytime I had generic. I had pain. I showed my doctor my journal and he made a copy and sent to insurance and now I can have brand name. But last 2 years I have been laid off and thru aarp I can get my medicince, (generic) $40.00 dollars. Brand name cost $200.00. I am in such pain. My arm is in a sling. my legs hurt and I can not even do yoga, which I have done for the last 10 years. I can not pick up my grandchildren or really do anything. They say their is no difference, BUT THEIR IS. So the pharmacy is making me sick because of cost. I really miss yoga. I did just finished going to school , thru unemployment for medical billing and coding, (I passed,) but now I can not really work. Please bring down the cost for brand name. Their is a difference. I even have permission from my doctor to wear Berkinstock shoes. (My sister brought them for me). They help my back. I was doing preventive care, but cost has put me down. Thanks for listening

It appears a lot of individuals do not understand insurance nor the current rush to a new government run health plan. Insurance should pay for the items you have paid to cover not everything you wish. If you don’t understand this basic concept you will never understand this government run health care plan. Ask your Rep. or Sen if they will be covered under this government run program and if they will give up their current plan? As sure as the sun will come up tomorrow NONE will give up their plan and take this new one.

As a new anesthesiology attending I find many parts of the president's plan disturbing. Of utmost importance is that he plans to extend Medicaid payments under the public option. Medicaid reimburses anesthesia only 33% from what private insurance does, whereas every other practice gets roughly 78% reimbursement. This has long been a problem, ignored by the AMA, but his plan not only will make it worse, it will cripple the field of anesthesia. The reimbursement simply won't pay for the cost of providing anesthesia. Also, anesthesia providers cannot "opt-out" as they are required by contract to provide care to the patient presented to them who requires anesthesia. To this end, the ASA has sent a strong letter to the AMA explaining that the ASA does not support the president's bill in its current form and that the AMA's continued neglect of the poor reimbursement for anesthesia services has strained the two organizations relationship more than ever.
Of course the effects will be obvious, the shortage of anesthesia providers will only grow, and on a practical level, with the massive cuts in reimbursement and salary, there will be no monetary incentive to be productive. I will always provide excellent care for my patients, but the days of fast-turnover OR's and scheduling cases into the night will quickly come to an end, as physician salaries become static, not based on workload, no one will opt to continue to work 60-80 hr weeks when they get paid the same as working a 40 hr week.
Will you please comment on how this plan will might cripple anesthesia, a service that no one elects to have, one they need, one that is as vital to operating rooms as any other. If nothing else, please let people know that this current plan would simply make providing anesthesia an economic impossiblity, create a dire shortage of providers, and let them know the ASA does not support the AMA on this issue! The ASA is not against health care reform, its likes many parts of the president's plan, it is against one that expands the pathetic 33% reimbursement for anesthesia services!

7.28.09
This morning you compared a couple of health coverages or lack of between a possible National Healthare Plan and Medicare. You indicated that a lipid test under Medicare is covered only every five years...that is incorrect. You also said that Medicare does not cover colonoscopy's. Again that is incorrect. I've had both recently and Medicare paid their normal 80% and I had to pay the balance along with co-pays.

I work in the healthcare industry and went without insurance for 9 years. I would venture to say that most people opposed to healthcare reform have never had to choose literally between groceries and taking a sick child to the doctor. Medicare and state Medicaid programs are government run programs. People who utilize these programs aren't complaining. Medicare sets the standard for commercial insurances. There are government agencies deciding ICD-9 coes, CPT codes, rates, HIPPA just to name a few. Any medical facility receiving government grants and funding of any kind are subject to government regulations. The government is already running healthcare. The bottom line is that it should available to everyone. Our tax dollars goes towards all that regulating whether we have insurance or not. At least I would get something out of the deal if I am allowed a universal plan. Other countries have made healthcare a priority. We make wars a priority and suddenly the funding is there. If healthcare is made a priority then the funding will be there too. It really is that simple.

Dr: Gupta, where you correct this morning in saying that Medicare pays for a Lipid test, only once every four years compared to private insurers once every year? I am in Medicare free and I get a lipid test cover 100% every four months, not 4 years. In addition, there were others statements made, that were false. Why are you taking the position against a public plan? Why are you so bad informed? Is Medicare a bad plan, is the VA a bad plan, pleased comment. I understand that some in the medical profession will not see any more the $500K annual salaries unless they get it from the rich people. We all must make sacrifices in order to take care of all of us. Talk about the end of year (very old sick people)solutions that we must go thru, we can not survive if we do not implement limits. Thanks.

THE CANADIAN SYSTEM OF HEALTH CARE WITH SMALL PREMIUMS BASED ON A PERSONS INCOME IS A COMPLETE HEALTH INSURANCE SYSTEM. NO CANADIAN IS EXCLUDED, EVER. NO CANADIAN WILL EVER HAVE HIS OR HER HEALTH NEEDS CANCELLED FOR ANY REASON. PRECONDITIONS DO NOT APPLY TO GETTING HEALTH CARE SERVICE IN CANADA. NO CANADIAN IS EVER DENIED HEALTH CARE SERVICE AT ANY TIME IN THEIR LIFE FOR ANY REASON. NO CANADIAN IS EVER BILLED FOR ANY HEALTH CARE PROCEDURE. ANY CANADIAN FOR ANY REASON HAS ACCESS TO HEALTHCARE ANY TIME THEY WANT. DON'T BELIEVE IT. JUST MOVE TO CANADA AND FIND OUT FOR YOURSELF. NO CANADIAN HAS EVER GONE BANKRUPT DUE TO HEALTHCARE SERVICES. NO CANADIAN HAS EVER BEEN BILLED FOR STANDARD HEALTHCARE . THERE ARE NO EXCESSIVE HEALTHCARE CHARGES IN CANADA. THOSE ARE THE FACTS. WAKE UP AND FIND OUT FOR YOURSELF.

Dr. Gupta, What will happen when there is free health care and there are not enough doctors to oblige all the patients?
If we had more doctors, many more, health care would be better and the cost would go down because everyone could have access to a physician. If medical school students had their tuition paid for, we would have doctors who would work off med school costs by working in a free clinic.

ps I meant to say medicare reimburses 33%, not medicaid. Sorry

I hear the latest main concern is lowering costs. Noone is being SPECIFIC about how. That's one of my complaints about President Obama "informing" us about health care reform. He always speaks in generalities. And all this talk about preventative care sounds well & good, but people are still going to get sick obviously. Let's not make the mistake of having an HMO type system with a different name.

As someone who has worked in the trenches of the health care field for almost 30 years, I truly believe the health care system is out of control and must be reined in immediately or it threatens to destabilize the whole economy of this country. In short, it is disproportionately frequent fliers who are over-utilizing the health care system due to their lifestyle related chronic conditions. There have to be limitations. We as a country must be brutally honest with ourselves and admit that we do NOT have unlimited resources, and the medical profession cannot continue acting as if we do. 97 year old ladies with terminal illnesses (and multi-organ failure) must NEVER be resusitated and placed on ventilators in the ICU; 695 pound men must NEVER be placed on ventilators in the ICU because their weight is giving them breathing difficulty; people in irreversible/vegetative states should NEVER be allowed to languish on total life support (ventilators, IV's, tube feeding, etc) indefinitely for months and years. End-of-life scenarios must be addressed openly and directly and there must be reasonable limitations. As for the immense cost of maintaining "ultra"-preemies in ventilators, etc in neonatal ICU's, I am not advocating withdrawing those life-saving measures, as the babies are innocent, but we need to discuss openly and directly the fact that drugs and lifestyle of the mothers are immense contributing factors. Something needs to be done in the way of preventative measures. By the way, since obesity-related health problems costs 10% of the total health care bill in this country, I would be all for the so-called "fat-tax." Something needs to be done. It's a small group of people who are destabilizing this country and making it hard on everyone. We need to get really honest and direct with ourselves as a nation.

I would like to know if Dr. Gupta, in the absence of a high-paying job from CNN, would want to practice medicine under President Obama's healthcare plan. My guess is no.

Dr. Gupta,

I would like to bring your attention to a study that was done in California several years ago. I believe it addresses the fears of what some call healthcare rationing and the history of access and use of healthcare without regard for it's reasonable limits. Thank you.

http://www.chcd.org/pub-reports.htm (Visible Fairness 2001)

Dr. Gupta,

My husband, a 68 years old Canadian Citizen with a US green card, is no longer insured in Canada (due to application for US residency) cannot seem to be insured in US without Medicare (although married to US Citizen and 68 years old, he cannot access Medicare with green card). How can we ensure health care insurance for him - He is currently covered under my family plan at work (group coverage) but I am planning to soon retire without health care benefits (I am 61 years old). How can we have my husband insured under these conditions? From your point of view, would the new health plan ensure that immigrants (especially older than 65 years old) receive health care insurance in the process of immigration.

I'd like to address the issue of health care access. I am a Process Improvement professional (Lean Six Sigma Master Black Belt) and I find it disgraceful that this issue is framed as entailing only one of 2 options, (1) either Tax and Spend, or (2) Limit Access to health care. People who do what I do for a living will tell you that NEITHER is necessary and that health care can easily be provided. Lean works for Toyota. Lean is why Toyota IS Toyota and not GM. Some hospitals and insurers are now (slowly) coming to the conclusion that Continuous Process Improvement (CPI) must be part of their makeup, but the health care industry is slow to move. From a Customer Value Added Perspective, Lean Six Sigma shows that virtually ALL operations are less than 10% efficient. Medical operations are no different. So, what I'd like to see is a REAL discussion of removing waste operations and the dramatic effect that Lean Six Sigma can have on this problem. To date, the entire Media has treated CPI as a caveat, when in reality, it is THE way. Framing the argument as either Tax and Spend or Limit Access is disingenuous.

On CNN you just discussed the gross miscalculation made in Medicare costs predicted at the start of that program in the mid 60's. You went on to say that in President Obama's plan for health care reform that the plan will realize significant savings from preventative health care and by encourage healthy life style practices. That will not occur! What patient population and in whose practice are they basing these predictions on? I am an ENT/Sleep specialist, most of my patients diagnosed with OSA are obese. Once placed on CPAP for their OSA I routinely discuss the advantages of weight reduction and recommend dietary changes – NOT 1% OF THEM LOSE WEIGHT! Our society is an unfit one, people do not and will not exercise will not give up unhealthy eating habits unless a pill is created that allows them to lose weight without exercise and without changing their unhealthy eating habits. It is irresponsible to not challenge President Obama's stance that their will be significant savings realized by preventative health care and the adoption of healthy life style practices. Amazing!

I just heard on your news segment your response to a viewer who is worried about rationing. I'm sorry that you missed the opportunity to remind everyone that we ration health care NOW, all the time. We ration by how much money you have and what kind of job you have (or don't have) as well as by pre-existing conditions, and all kinds of risk factors. This is truly rationing but it is not based on any assessment of medical need, just the opposite–those most in need of medical care are most often the ones who are denied.

And private health insurance companies ration services to their subscribers all the time, by deciding what they will and often will not cover.

PLEASE don't let the mention of rationing go by again without making these important points about how we ration now.

thank you.

My mother suffers from alzheimer and is in a nursing home under medicaid. Will this change in any way under Obama's thinking? I work part-time so I can help raise my grandchildren and had to buy my own help coverage which is expense ($213) a month when I only bring home under $700 a month. How will this new program help me?

With the talk of high prices for companies to maintain health care for its employees I wonder if anyone has mention the cost of vision care. I wear glasses and I have to get an exam every year even though I feel my eyesight has not changed. I can not get buy new glasses unless my exam was less then a year old. I feel that this requirement should be removed. It is only feeding the pockets of the Optometrists and adding to the cost of insurances. My personal prescription has barely changed over the years. I think I could have gone 10 years at a time without an exam. So why doesn't the government or whoever decides these requirements for exam have them dropped or moved to a 5 year requirement?

Today you've been mentioning the increased cost from a projected $9 Billion in the 1960s to somewhere in the $96 Billion range for Medicare decades later. Please add the information about WHY that increased. It was not because of government waste or government bureaucracy but because Richard Nixon (in taped conversation with either Haldemann or Erlichman) chose to let "insurance companies" make a mint of money off of our healthcare. They started the leaching of big business off of healthcare in general and that lapped over into Medicare.

The growth of layer upon layer of profiteering by HMO's, which basically didn't exist when Medicare was created, is an abomination that has virtually distroyed access to healthcare for millions of Americans and in many cases even those with HMO coverage can't get needed care because non-governmental HMO bureaucrats (some without medical degrees) decide who gets what care based purely on cost, profits, and bottom lines. Please go into this more extensively and please detail which congressmen that are tap dancing away from universal healthcare have HMOs supporting their elections.

Anderson cooper goes after the story no matter what, so since you are in the medical field, why does sweden give free health care to the citizens, just because they pay taxes in sweden?? please explain why does some of the european countries have policies that allow such and we who really pay for everthing, can not get something similiar??

Hi Sanjay,

I was disappointed with your piece this morning on whether health care reform would lead to the chain-mail fear being propagated that old people would be allowed to die. It would have been worth noting that this *has not* happened in any country that has created public health systems yet, despite those same chain-mail and anti-reform ads making those claims.

In fact, while living in Canada in this decade my neighbor was offered knee replacements by his doctor – at 93 years of age – regretted turning them down at 96 and passed away at 99 after receiving every possible bit of advanced medicine. My Canadian father in law is 83 and receives every medical service that could be expected, including a minor surgery recently on a toe.

As well, the "Daschle says old folks will have to suffer" chain-mail has already been debunked, worth sharing that on air as well:

http://www.politifact.com/truth-o-meter/statements/2009/apr/03/chain-email/daschle-didnt-say-seniors-seniors-should-accept-ra/

It would serve your viewers to clearly state what is within the realm of experience or fact and what is not...

I do have concerns about public healthcare, but in the end I have concerns with public education, too. Regardless, after debating the *real* concerns (which do *not* include old folks being allowed to die or any of the hyperbolic risks being promoted by political and insurance lobbies) I have concluded that we cannot "promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity" without it. The US has social systems to ensure equal opportunities for citizens to enact their liberty, and health care has become a necessary system.

-best

-chris blask

Dr. Gupta, I am a 34 year old Registered Nurse from Ohio, I have been unable to work in any capacity for over 1 year now and my 75 year old parents have had to step back in and take care of me again.(I live next door to them and vowed never to leave so that I could be here to help them as they aged). I have found myself in a position that I wouldn't want my worst enemy to endure. I have had 2 cervical neck fusions and a staff infection after the second fusion which has left my spine completely evicerated. Naturally, I don't want to return to this facility for obvious reasons. But 2 other local neurosurgeons will not help me saying that I have no choice but to return to this"clinic" which Pres. Obama visited just Monday I believe. Please tell me what you would do if YOU were in my position. Thank You, Heather

Why is my mouth not considered part of my health?

Dentists are about to get off the hook, they are bigger crooks because dental care is not considered part of health care. How did this separation of dental and health get started?

Why is dental insurance not considered part of health insurance?

What is the origins of this seperation? You have to wait for a tooth to become life threatening before it is considered health care.

Put that is the vegetable isle and smoke it.

The single most important issue in health care IS END OF LIFE CARE, this IS the issue that will make or break our health care budget. It is estimated to consume about 2 out of every 3 health care dollars in America. Again this IS the issue, however all we hear in the media is talk about how many payers or using cost-benefit analysis on procedures cover by Medicare.

One possible solution is to gradually reduce publicly financed health care benefits as we approach our life expectancy. This value does not need to be zero, but some figure well below that provided a person in mid-life. This formula can yield a value that we can afford and truly reform health care in America for the long term.

Just how do we get people in the media as well as Washington to begin discussing the real problem with our current health care system?

Yesterday I was shocked to learn from you that Medicare only covers a cholesterol test every five years instead of every year, like most other health insurance policies do. It sounds as though the federal government has decided to give only lip service to testing while leaving plenty of room for people to get heart disease and require some very expensive procedures which could have been avoided if people had received timely data and acted on them. This practice would enrich the medical profession while greatly damaging my health.

At least twice such timely discovery of my cholesterol levels has resulted in my implementing a substantial fix which returned my lipids to recommended levels.

What can be done to bring Medicare policy on cholesterol testing in line with accepted policy industry-wide, and are the health insurance bills working their way through Congress going to allow yearly testing of cholesterol and other parameters normally covered in a CBC?

I only saw one comment on tort reform.

This issue is a primary problem accross our economy. Insurance is based on tort law. Even the US Forest Service requirments increase operating expenses to my recreation, (ie, heart healthy hiking, biking, freash food) agri-tourism business costs are driven up by excessive insurance requirements.

Couldn't do without Medicare. However, there seems to be a ripoff lately. Not only do I get the Doctor's Bill, but I also get a bill for a facility charge. The charge for the use of his office space is nearly the same as his bill. Is this being done all over the country??

I am frankly disgusted by most of the media in the USA (CNN IS OKAY), I now live and have just started my second company here in the USA. I originate from the UK where they have (LOL) social medicine, what really scares me is that Americans have this preconcieved idea that social medicine is bad.
Hear are some facts for you to consider, America is ranked by the world health organization at 37th in the world for health care, the fact is that in real terms it is probably lower than that. America currently spends nearly 18% of GDP on health care, America experinces 5 9/11's per annum in deaths due to inadequate health care. (An old friend of mine just died due to inadequate health care)
America has one of the highest infant mortality rates in the western world, The cost for my family of four in America is $1,500.00 per month, then of course their is all the deductibles and co-pay to go on top of that.

So lets look at a social system and lets take the number one in health care as listed by the world health organization, namely France who spend 9% of GDP on health, they suffer no public discontent with their health care system, a family of four pay less than one third of what I pay per month in taxes to cover their health, their infant mortality rate is one of the lowest in the world.
On top of this and I know you may find it very difficult to believe, here in the US you can get a plumber at two in the morning; guess what you can get a doctor at your house at two in the morning in France, how amazing is that they rate a doctors call more important than a plumber.

The basic problem is education and Americans are just not getting that, after all only one in ten of you have a passport; so your judgement is frankly biased as you have not experinced any other form of health care, another example is my country the UK is currently ranked 18th in the world and it is lacking.
Therefore and beacause I could afford it I topped up my social system with a private plan at around $1,000.00 per annum, which meant if the social system could not take care of it then I had a back up.

Finally what you all need to think about is the interests some politicians have, and of course the health insurance companies. They do not want to see a social system because they will lose out financially, frankly as the man said I do not give a damn. They have had it so good for so long it is not funny, as far as I am concerned the fact that they place profit before health simply means they are sick too; in the head that is. So what you should all do is not just take my word for it, get on line and educate yourselves because no one here is going to inform you especially rip off insurance companies.

I am 72 years old. I am covered by Medicare and supplementary AARP. Will the president's plan affect me?

Dr. Gupta,

Is there any way to know how people currently on medical (not prescription) will be affected by the bill. I kinda assume since Medicare is haled as an example of what works that it will not change.

Thanks.

Couldn't do without Medicare, but am wondering if medical facilities all over the country are doing what mine recently started. Not only do I get the doctor"s bill per visit, but I now get an additional bill of almost the same amount for a facility charge. I guess that is the space I use in his office – sitting in a chair or maybe on the edge of the examing table. Is Medicare being ripped off?

I think you should do a story on the costs to Hospitals and other agencies that treat the uninsured because they come to the ER. These costs are passed along to insurance companies, for their insured clients are higher so the hospital can offset the cost of treating uninsured.

As someone who has fought the Health Insurance Industry for 30 years, I believe it would prudent for you to promote the fact that the public should worry more about the insurance company's "rationing" than the governments. Many people have died because an insurance company employee denied service. Another fact to emphasize would be that we already pay for the uninsured when they go to the ER and the hospital does not get paid. The third issue would be healthcare fraud. While there is no way to eliminate all fraud, the government could save countless tens or hundred of millions of dollars going after the many crooks billing the system.

Dr. Gupta;
I am a Clinical Breast Radiologist who practices in a small town in Northeast Michigan. I am in the process of trying to help a high cancer risk patient get her yearly mammogram paid for by her insurance company. Right now, against all accepted standards, they will only pay for a mammogram once every two years. This in commonplace and counterintuitive. It is much more expensive to treat an advanced breast cancer than to pay for a yearly mammogram.
As a physician I have excellent medical coverage through my State Medical Society and BCBS of Michigan. My monthly premium, however is $2300!!!! That works out to well over $25,000 yearly. Combine that with my $25,000 yearly malpractice premium!!!
Something needs to be done if a physician can no longer afford his own medical insurance!!!!

DEAR DR. SANJAY GUPTA,

THE FOLLOWING QUESTION IS WHAT YOU MUST ASK PRESIDENT OBAMA:
FROM THE TIME SENATOR EDWARD KENNEDY HAD A SEIZURE TO THE TIME HE FINALLY WENT HOME, HOW MUCH DID IT COST?
IS PRESIDENT OBAMA WILLING TO PAY PER PERSON, PER DISEASE, PER TIME, YES, OR NO?
IF YES, HOW WILL HE PAY FOR IT?
IF NO, WHAT IS THE DIFFERENCE BETWEEN HEALTH CARE IN AMERICA AND HEALTH CARE IN AFRICA?
MONEY YOU LIVE, POOR YOU DIE.

THANK YOU,
CHANDRA

Dear Dr. Gupta:

I am a faithful listener of CNN and I am following the health care reform in your country. I enjoy your discussions very much.

I am a 60 yr old Canadian woman who was diagnosed with breast cancer last year. I had the subsequent surgery and chemotherapy and all related medicines and I did not pay one cent! The cancer clinic is very busy no doubt but it is always extremely busy and all the patients get the same wonderful care I was given.Every person in Canada is covered by a heatlh care plan and in my case it is the Ontario Hosptial Insurance Plan. It is free for all Canadians. Each province has there own plan but one is as good as the other. I also have a private health care plan that pays for prescriptions, glasses etc.
I pay a little less than $30. a month. For prothesis one may need because of surgery the government pays half and the private insurance company pays half. I also have a dental plan and the coverage is very good.

I saw an ad on TV where a woman claims she had to leave Canada because she could not get treatment. I really doubt that was the case. There has to more to it.

It is possible that we in Canada pay for heatlh care through our taxes but my land tax and personal income tax does not indicate exhorbitant fees. I do not think anyone in Canada would be happy without our excellent coverage.

If we can do it, the US can do it.

Thank you,

This morning (July 29) you answered a question about rationing health care. The question dealt with a family whose father battled brain cancer while receiving excellent care from his health provider. The questioner wanted to know if his father would have received the same care with the new plan or would it force rationing of health care.

Well, the capitalist system already does force rationing. The wealthy or those with private health care get the standard of care his father got but those without healthcare or the means to pay get very little or inadequate care. My sister faced the same problem – a cancerous brain tumor which was removed with a poor prognosis. As long as her husband had healthcare with his work, she got good care. But when he lost his job, their house and their healthcare, she got very little. When she later suffered symptoms from post polio syndrome, she received no therapy or home care and very little hospital care. They couldn't afford it. When she broke her leg, no physical therapy so she ended up bedridden until she died at the age of 50. At the end she was in and out of the hospital with respiratory ailments and, on one visit, she was given a feeding tube because she could no longer swallow. After she pulled the feeding tube out several times, they advised us to let her die – peacefully. I am still haunted by that decision. Was she really unable to continue or did they just not want to spend the money?

So want so many are saying now is that they don't want rationing for themselves – just for the poor! It makes me sick. My sister was every bit as valuable as their father but, evidently, she didn't deserve to live or be given the care needed to fight. She was just written off. Now my 21 year old, who has mental health issues, does not have a job or health insurance and I'm worried of will happen to him someday.

Please, we need healthcare reform of some kind. The poor and needy should not have to die because they can't afford health care.

Jennifer Polifka

Why can't US decrease health care cost driven by physician charges by allowing foreign trained physician who has already undergone rigorous residency training in their country to tak sam evaluation as US trained physician, like boards and US licensing exams and if they pass offer 1 year or in surgical speciality 2 years residency training to increase more physician availibility there by decreasing cost due market forces of rapid rise in physician availibility.

Also most other developed country did use this route to solve their physician staffing like Britain, Canada, Germany and Australia.

Why are user of poor health habits charged a fee?:

I have good health insurance program through my employer and strongly believe we need health care reform. However, people with health insurance or the wealthy should be required to pay for the new program. New revenues should be drawn from the products which are directly increasing the cost of health care.

Let's add a tax to products which contribute to higher health care cost such as tobacco, liquor, sugar and fast food. A few pennies per dollar on these products will fund a state of the art and global model of health insurance program for all Americans. It places the cost at the foot of the origins for the rising health care cost. The user gets to directly pay for the use of these products which directly negatively impacts their health.

It’s the right thing to do…

Jaime Rojo

As a Radiologist I can honestly say that perhaps 30% of imaging such as CT and MRI are performed on a defensive medicine basis.Unfortunately TORT reform is essential to bringing down costs.
People are worried about "rationing " of health care,but should instead be afraid of gross overutilization.Costs are going up due to the replacement of common sense with inadvertent testing.

Dr. Gupta,

I saw this morning on CNN the segment about Jason’s question regarding rationing (with reference to his father who died of a brain tumor). Both you and the White House handled the question defensively, as if everybody could get anything without any limits!

That is overpromising falsehood, and flies in the face of the real goal of the reform, i.e., to do only such treatments that “work” and don’t waste money and time on those that don’t result in a positive outcome. When we move from a curative mode to a palliative mode we are “rationing” “rationally.”

I suggest that both you and the White House consider the following regarding these types of questions:

1. nobody is forced to choose the “public option” insurance, i.e., individuals may select their particular insurance menu that insurance companies offer and may choose to pay higher premiums for certain features of the coverage – but the truth is that there is lot of rationing in the current policies of the for-profit insurance companies (like pre-existing conditions) for the sake of profits, and the reform would make those unacceptable) – in other words, one has to worry first about the rationing by the for-profit insurance policies before worrying about the “public option”)

2. one has to be careful with such buzzwords as “rationing,” because those may be used provocatively (!) to imply that somebody was going to be unfairly deprived – such false implication may prevent “rational” discussion of the issues – so, the answer should be that nobody will be unfairly deprived of the treatment he/she needs to get better! (If there is no treatment that would make the patient healthier, then he/she would get the care needed to feel as well as possible.)

3. there is a great need for thoughtful and extensive national dialogue about definitions, goals and methods/strategies, because we also have to reform our thinking and attitudes both at the public and professional levels, and because not all the values of health care are monetary.

With best wishes,
Antal E. Solyom, MD, PhD, MA

I saw a blogger bunch report discussing the pros/cons of taxing junk food to lower obesity. Why not end the government's subsidy of corn? Most of the food that is bad for you contains some sort of high fructose corn syrup. By eliminating corn subsidies unhealthy food will become more expensive and those funds can be redirected towards subsidizing healthy foods. Additionally, the meat/dairy industries will no longer be able to feed corn to cows and will as a result have to feed cows grass and allow them to graze–what nature intended for them to do anyway. Feeding cows corn is unhealthy for them (they require more antibiotics to keep them alive) and unhealthy for those who eat them.

Dear Dr. Gupta:

I am very concerned about the health care reform because my husband has Interstitual Lung Disease and is currently getting excellent care from the National Jewish Medical Center in Denver. We drive there from Las Cruces New Mexico about every 3 months. We would both be devastated if we were not able to continue my husband's care with Jewish Medical. We were going to a pulmonologist in El Paso but the care was horrible. He more or less figured by husband had lived long enough (69 years of age). The doctors have no idea how he got this disease because he has never smoked or been exposed to anything, that we know of, that would cause this illness. He was a professor at U of A and NMSU for 30 years. We would like to be assured that we will be able to continue his care at Jewish Medical. He is doing great now that he is getting better care. Thanks so much for your time. Gloria

yes we need health care reform. health care cost reform, lawyer reform, hospital reform, doctor reform ,health insurance reform and people reform-because in order to have a national health system health care reform
has to start with EVERYONE! every one needs to contribute to a national health system and health care reform-- citizens ,the patients, family members, the government, hospitals ,Drs . & other health care professionals, pharmaceutical companies, lawyers ....
EVERYONE has to take personal responsibility for their own health!
If Mr and Ms tax payer lives a responsible healthy lifestyle & pays a fair share of taxes then they should benefit from their tax dollars helping to cover their health care / medication costs. why should mr or ms tax payers taxes pay health care for someone that has never had a job,contributed to the system & refuses to be compliant /responsible for their own health care–and when these individuals are in the hospital make ridiculous high demands for service and care from the hospital staff and always threaten to sue if they do not get the care they demand ........meanwhile when mr and ms responsible tax payer get really sick....they don't get the same access to health care ,their insurance blocks them from getting the treatment they need & are unable to afford the unreasonable hospital bills & they loose everything they have worked for their whole lives–because they can not afford the outrageous bills and their credit status is damaged.
every tax payer should get equal access to health care /medications without the worry of an outrageous bill that could drive them to bankruptcy or further illness due to the stress of mounting bills.

doctors/hospitals/ need to stop the outrageous waste /excess cost of healthcare. health care should be no frills- get just what you need -no more, no less–patients need to stop making excessive & unreasonable ,unrealistic demands.....you are in a hospital not a 5 star hotel, spa or resort- this is not the place to be a VIP–hospital staff does not have the time to cater to VIPs–they have peoples lives in their hands & shouldn't have to waste time /staff catering to patients who think they are more important then everyone else . health care for everyone should be equal and you get only what you need depending on the severity of your illness--drs need to stop ordering unnecessary tests,procedures, inappropriate admissions, stop keeping patients in the hospital for an eternity–when the hospital has done everything possible- the family needs to take responsibility for the care of the patient or make appropriate arrangements- many times the families unrealistic demands /expectations lead to excessive hospital costs. there are situations when patients are in the hospital for a very long time& the family doesn't want to deal with them or care for them but does not want them in a nursing home or other long term care facility–there is a huge gap and huge costs when the hospital can not discharge a patient to another facility or with the family because they refuse to care for the patient and the family says no to putting them in another facility or nursing home and threaten to sue the hospital when the hospital tries to discuss discharging or transferring the patient. the hospital is forced to eat the cost of caring for this patient. –and the family makes unreasonable demands on the hospital staff for daily care and service –the same care they refuse to provide for their very own relative. we definitely need health care reform to stop waste ,fraud ,abuse- provide no frills health care /medications for everyone , NO VIPs ,control health care costs, medication costs and should definitely control & put an end to health insurance companies that deny care and lawyers who only add to the waste fraud and abuse.

In response to Bhardwaj Desai,

Number 1: You are not hundreds of thousands in debt. You did not train at a US medical school so you have not debt. Simply allowing FMGs to take all the spots and drive salaries down will simply drive down the number of good, qualified, intelligent students from entering training at US medical schools. The reason why US medical schools charge what they do is because traditionally, US physicians make enough to pay back their loans. No one wants to force out all of the US grads because it is cheaper to outsource all US grads to a foreign country. Outsourcing is never the answer to help with domestic problems.

Number 2: Your training is not the same as the training we receive here. For that reason, Step 2 CS was created. Many people come here in hopes of securing higher salaries, but cannot speak English, are not familiar with the customs and, to be honest, have poor bedside manners (worse the AMGs) because they are not trained in bedside manners, unlike what is a part of every US medical school curriculum now. That said, there are plenty of great FMGs and I have worked with them. They enrich our nation, the US medical education experience and are often great people. However, they all admit that one of the reasons that they came here because the way we practice medicine is better here.

Number 3: Why are FMGs coming here in the first place? They are fleeing their country, their language, their family and their customs to come and practice medicine in the US? Lets be honest – they would be paid more here. Do not pretend like finances are not a concern to FMGs. In fact, I have worked with a number of FMGs during school and many of them are reluctantly pushed into primary care because they could not secure a more competitive specialist spot. Most of them are resentful of that and wish to switch to a specialist training.

Dr. Gupta, what is the average life expectancy of U S Citizens compared to other Western countries? What country has the longest life expectancy and how does healthcare in that country compare to our current system?

A link for people to read regarding the complications of obesity:

http://www.ncbi.nlm.nih.gov/pubmed/10696282?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

This is an article from Harvard Medical School. In the midst of health care reform, we probably need to take a look at some of the costs of rising health care and strongly considering provided increased coverage for those patients who comply with medical recommendations for the management of their long term illnesses. Otherwise, we will never truly control health care spending.

Dr Gupta,

I'm in my 4th year of residency training. I personally see ridiculous amounts of MRI, CT scans and ultrasounds ordered just because ER and primary care docs are afraid to get sued. It's ridiculous how much money is wasted everyday in every hospital across the country on unnecessary imaging and tests. Why is tort reform not a main topic of discussion?

Also most of the chronic diseases I see everyday are a result of obesity, smoking, drinking and unhealthy lifestyles. Why should I take a cut in pay and have to pay higher taxes to fund health care to treat such conditions?

Dr M

Question: What is ahead to assist family/spousal caregivers in their work?

Thought: Medical Health Care Reform Incentive: All legislators, major pharmaceutical, medical and hospital executives lose ALL health care coverage until all-inclusive plan takes effect... have to pay out of pocket, or, of course, qualify for Medicaid. Walk the walk.

Hi Dr. Gupta:
I'm directing this comment to you for consideration. If you think there might be some merit to it, please see it gets to the proper authorities. This is in reference to the crash that occurred on the Taconic and the mother who was driving south in the northbound lane causing a crash which resulted in eight deaths. There is a certain type of Migraine that can cause a sudden loss of vision or visual impairment. I think it's one possibility that should be investigated. Her behavior is so mystifying, there has to be a legitimate explanation. Thank you.
Irene Yellin

for the past four years I've been working in Taiwan where their universal health care system costs 6.2% of GDP. In Taiwan I'm able to go to any dentist, doctor, hospital or clinic of my choice. I can also choose Western or traditional medicine. If Taiwan can accomplish this why can't we?

With three children with autism, I cannot get private insurance that will cover them in the state I live. They qualified for SSI disability, which generally you gain Medicaid on, but the state revoked my children's Medicaid for budget cut reasons. We do have private insurance through work, but it doesn't cover autism or anything that could be autism related. That is the kicker, "autism related" is much like the 6 degrees to Kevin Bacon, everything can come back to autism, from my daughters seizures to Pica to breaking a leg all have been denied at one time or another becuase they are "autism related". As long as we allow for some things to be excluded insurance companies will continue to find ways to link all bills to that exclusion. So why if a disease is recognized and has been studied for years (autism was studied by Kanner in the 1940's) can insurance say it's uninsurable. When does insurance have to cover something? Insurance says there is no cure for autism so no treatment option, but they cover many disorders and diseases that aren't cured but are managable autism is in the same boat.

Dr. Gupta

Your piece on obtaining narcotics from pharmacies was quite interesting. I would like to invite you to familiarize yourself with the most advanced prescription tracking system (Pharmacare) in North America which serves the entire Province of British Columbia. I would be happy to put you in direct contact with the Registrar of the College of Pharmacists of BC.

Dr....

I don't understand why doctors, especially yourself, even take the Hypocratic oath. Does it even mean anything to you? Western medicine has turned into a money machine as doctors treat broken arms with bandaids by prescribing drugs for everything.
For instance, and I'm sure you are aware of this but not willing to use your stardom to promote it, why don't doctors put away all the meds being used on all gastro-intestinal issues and just have their patients squat on the toilet as opposed to sitting down? A whole century of Western society has passed with usage of the sit-down toilet. A dilemna has developed with all of the problems people have with their colons. These problems are almost non-existant in societies where squat toilets are common.
Today I read your article about your opinion on marijuana reform and I laughed out loud. What a hypocrite!

I saw your prescription abuse segment. I am a Dentist in Texas. If I am suspicious of a patient I start calling the pharmacies in town to get a narcotic history. This takes at least 45 minutes but I dont like getting taken advantage of. Seems like there should be some kind of centralized data base to instantly track all prescriptions.

Dear Dr. Gupta,
Thank you for providing so much useful information on your segments. I always listen to your advice.
My question has to do with our 20 year-old son who's starting his junior year in college. He has juvenile diabetes and will be covered under our health care through the end of his four-year degree. We are worried about his health care after he finishes. He wants to go on to get a Ph.D. but we don't know if he'll be denied coverage because of his pre-existing condition. We'll face this problem in almost 2 years. Thank you very much. Regards, Becky

Hello Dr. Gupta: My wife recently had surgery to repair a tear in her right shoulder rotater cuff. The surgery went well, the surgeon, a very experienced Doctor in his mid fifties, was excellent. On our last visit he sadly told us he was retiring early because he was too frustrated dealing with the medical group bureaucracy. The last straw? He was being denied the right to take his annual 3-week vacation. My question? If Doctors are so frustrated dealing with bureacracy now how will that improve with health care reform? We can probably afford to lose a few administrators, but not qualified surgeons.
Thanks, Bill Knowles,
Point Roberts, WA

Dr. Gupta,
As the health care reform debate heats up I have noticed a conspicuos lack of discussion on malpractice tort reform. Why aren't you keeping this issue at the forefront?
As a physician in clinical practice trying to keep my patients best interest forward, I am alarmed at the villification of physicians and a total lack of inspection of the health INSURANCE industry. I don't find many patients who have any issues with the type of medicine practiced in the US, it always comes down to how it is paid for. They all want the CT or MRI they simply are upset the insurance company won't pay for it until they've jumped through hoops. For example, no matter how severe or persistant a patient's back pain is, rarely will they be able to have an MRI paid for until they have had 4 weeks of NSAID treartment. I could site numerous examples of silly protocols driven by insurance companies that almost always delay or deny treatment or ultimatley cost more money.
Again, I would ask you to emphasize the imortance of tort reform and reform of the insurance industry over regulations to tie the hands of practicing physicians.

Dear Dr. Gupta,

Much talk is centered around "bending the curve" of health care costs. This is absolutely essential for any healthcare reform. But it is not clear to me HOW the curve will be "bent". What are the best ideas for reducing long-term healthcare inflation & which ones are actually in the current legislation.

Thanks!
Aaron

Dr. Gupta,
I understand that you have read all of the proposals for goverment health care. I would appreciate an answer since my HMO agent hasn't
received any nortification on the following matter.
Don't know if I just missed the point that does concern me and other seniors and disable people.
IF the goverment health care passes...what happens to seniors , & disable people that are now on medicare along with an approved HMO by the goverment? Are we going to be thrown into this pool and expected to pay more for coverage? What happens to Medicare and Medicad coverage?
Thanks..

Dr. Gupta, I am a 56 year old female with health insurance under the DOD Tricare system. I am a civilian, ex- Navy wife. Will the new proposed health pland change my insurance? Thank you, TYN

Dear Dr. Gupta:

Like Congress and President Obama, journalists and media are not including the expansion of Medicare or single-payer health insurance in this conversation. Today there is a rally in Washington, organized by Healthcare NOW, speaking out for reform. I haven't seen it reported on television, or on CNN's website. Single-payer was taken 'off the table' before it was even discussed. Why?

I do understand that socialized medicine and rationing will have to take place in this noew proposal. WHY???? I have lived in UK and Canada and our system was awful, as a matter of fact, we came here to get treatment much quicker – whats srong with that? The reason its the most expensive is because we have the best health and research team in the world. I worked for a pharmaceutical firm and invented a heart drug. Yes it cost alot, but its the best in the world. The uninsured, that is a separate issue to work on, leave the happily insured alone. Your thoughts????

Dr. Gupta,
I would like for you or your staff to publish Obama's Health Care Reform in the form of a product brief that will enable the average person to understand his plan. Perhaps someone could explain it on the air so a large number of people can view the program. Please include retired people in this program. Also, please include cost impact to groups of people in different circumstances. Please pass this on to management if you are not the person that will respond to the interested people. Thank you for the excellent job you are doing.
Regards,
Bill

I would like to see how the health system works in others contries. I know that Brazil uses Universal Health Care . It will be interesting for everybody to know what could be done here that is already working good in others democratics nations or maybe their mistakes in Health Care can help the USA develop a new concept of health system where it will be standard for others nations.

Dear Dr. Gupta

The "PRESCRIPTION" drug manufacturers advertise their products in detail with a caption "ask your Doctor whether it suits.you" in daily news papers, commercial journals, electronic media etc. at the cost of the patients. The prescription of drug is at the discretion of the Physician after assessing the illness of the patient. This universal practice and professional ethics accepted or established by the drug manufactures. . Patient is not the deciding factor as to which "prescription" medicine a patient should take over ruling physician. In view of these facts, what is the purpose of educating pulic or patient abourt their drug through news papers, commercial periodicals.and electronic media?

These are to be addressed to phycicians through the respective and concerned professional jourals. In certain countries advertisement of the scheduled (prescription) drug in dailies, commercial journal and electronic media are prohibited or consered as unethical to medical profession by Medical Association/ Drug manfacturers or Regulatory authoritiy.

Pharmacy deliver printed educative materials of the drug along with medicine supply to the patient. The same material, in a different format, is inserted in each packet of the medicine by the manufacturers. Once pharmacy provide the patient's name to manufacturer, they send the same, in a format of their liking, by post.

Discontinuation of drug promotion through dailies, commercial periodicals, and electronic media alone can reduce cost of drug.

P.B.Menon

Dear Dr. Gupta: I grew up with the Canadian health care system and after living in California for 15 years have witnessed the horror of uninsured and underinsured families and children, a shameful abomination in the developed world. I love the United States, but it looks to me like the powerful fear-mongers are manipulating the public for money, not out of concern for the best interests of the average American citizen. There are oodles of statistics showing how countries with nationalized medicine have healthier populations with longer lifespans than the US – it's time for us to give this a try!

Dr. Gupta,
I know that blood plasma alone is straw-colored, but the red blood cells change color depending on the state of the hemoglobin: when combined with oxygen the resulting oxyhemoglobin is scarlet, and when oxygen has been released the resulting deoxyhemoglobin is darker, appearing bluish through the vessel wall and skin, but what i want to know is if the droplets of blood experience any change itself just as a previously mentioned?

I just wanted to throw this out there for all the "Everyone else in other countries has better access to better care" routine...

Recently, I took the Step2 Clinical Skills exam. This is an exam where physicians and student doctors come to a designated site in the United States to meet with standardized patients who represent common illnesses to be encountered in practice and take a history, perform a physical exam and then make suggestions for diagnosis and additional tests needed.

Interestingly, many foreign medical graduates come to take this exam. I had the pleasure of meeting a few. One of the physicians had already completed a residency program on obstetrics – notoriously one of the most grueling, demanding and thankless professions. When I asked him why he would want to come here to the US to go through ANOTHER obstetrics residency, his answer surprised me. I thought it would be because physicians get paid more here. His answer was that it is because the American system is better and the care provided for patients is done right. He said in his country, they get a lot more practice (volume) but the quality is less. I then met a student doctor from Canada. He told me that Canada has a real doctor shortage because no one wants to work there. He said that they graduate far fewer students each year, pay them less and subsidize primary care such as family medicine only if you agree to practice in a rural area. The same is true here, but the salaries are high enough that one could expect to have less of a problem paying off their hundreds of thousands of debt here than in Canada. Furthermore, he said that a lot of his colleagues from Canada, including himself, want to come practice in the US because the system is better, care is better and contrary to what the media, Michael Moore and the far left tell you, access is actually better here in the US! I was shocked! He told me that most citizens do not have a family medicine doctor that they see regularly and that there is a two tiered system where patients with money go and see private clinic doctors. Shocking! Strangely, there were more foreign medical graduates at this session than American medical students. In talking with my classmates, many of them also had similar experiences. Each year, thousands of foreign trained medical graduates attempt to enter the US medical training system because they feel that the training here and the practice of medicine is simply superior here. Why would they do that if their care is so great in other nations?

Again, to all the people who think it is unfair that doctors get paid what they get paid, I understand your concern. If you want our salaries to come down, push you legislatures to raise taxes to pay for our medical education so that we, like you, are not hundreds of thousands of dollar in debt. Also, push your legislatures to cap malpractice awards and push tort reform so that physicians do not have to pay tens of thousands a year to protect themselves, their practices and their family from get-rich-quick schemers. Lastly, do no demand of your physicians to work the insane hours that we have to work now. No other profession regularly works 60-80 hours a week and often working 30 hours in a 48 hour period and neither should we. Furthermore, you do not want a physician treating you who works like that. Would you want a cab driver working like that (and falling asleep at the wheel as he drives)?

Will and others who push such anger at doctors – do not make such demands on us and we would not be paid what we are paid. It is that simple. Will, were you forced to take on hundreds of thousands in debt, to train for 14 years (like Dr. Gupta) and to work 80+ hours a week like Dr. Gupta? Do you pay thousands a year for malpractice insurance? We are people, too and the demands you and people like you are making are unfair and unrealistic.

HAPPY FRIDAY!! WOO HOO
I have a question regarding the proposed health insurance reform bill. I have coverage thru my employer. Over the years, like everyones employer benefits they have changed drastically. I now have to pay 30% for all charges except for MD visits and preventitive testing. It's very hard to come up with 30% for a MRI which for me was over $450.00 when you leave from paycheck to paycheck. Is there any relief for these types of situations or maybe the goverment sponsered plan could be better than the benefits your own employer offers?

Thank you for you valuable time spent reading this.
Have a safe and wonderful weekend.

Dr. Gupta – In all the healthcare discussion about the 'government getting between me and my doctor', how is this different than having some HMO giant (whose primary motivation is NOT my health) between me and my doctor? Frankly if I don't pay 100% of all my medical costs myself, there will be SOME entitiy involved. As a Gov't run program, Medicare seems to work (fraud and abuse aside) – or am I fooling myself?

I am a 60 year old woman with diabetes. I own my own business in North Carolina, so I qualify for a small business insurance policy, which is half the cost of a regular policy. So, I ONLY pay $1,250.00 a MONTH for health insurance, which is HALF the cost of what I was quoted for private insurance. While I can pay $15,000.00 a year for health insurance, it is a bit of a pressure point on my budget, and well over the 10% income top that a government plan would cost. The county that I live in has a below average income level, and I am often ashamed of the fact that I pay more for insurance than some of my neighbors make a year. I know that they are probably without insurance coverage, just because of the cost. Something has to been done to correct all of this!

My grandfather was a Dr. and he always said that his oath to serve mankind overrode his desire to be wealthy. Do Doctors today still take oaths and if so why don't they abide by them? Have the insurance companies hijacked the ethics in American medicine?

We have a HSA will this new health care program eleminate this?

I worked for many years in the cancer field ex-US and it was difficult–horrible to make it available to patients (much much worse than in US). I'm talking Canada, US, India, Latin America, Africa - all different health systems. A key learning - best way to provide access was to work within the existing system and try to find where it wasn't working and beef that up. The current proposal before Congress appears to be trying to revamp the entire healthcare system and all that will do is shift access problems around - I've seen that happen. Based on what I've seen work - they should steer clear of grandiose "solutions" at the 80,000 foot level and look at very specific problems they can fix - at least first. Both sides could claim victory and it would start helping provide access. The current proposal frankly creates a different health system and I've NEVER seen that work better for the long-term health of a nation. And I'm out of work right now looking for health insurance - but definitely not the one proposed before Congress.

Shona Holmes has recently been the featured Canadian in a commercial scaring Americans "If I'd relied on my government for heath care, I'd be dead". It has now been reported that she had been diagnosed with a Rathke's cleft cyst (initially in 1998). Is a Rathke's cleft cyst life threatening? As a Stage 3 breast cancer survivor who received prompt and excellent health care from the Canadian Health Care, I am afraid Americans are getting a false impression about a single-payor plan from someone who is misleading them into thinking she was months away from death by a cancer that she did not have.

I'm 47 years old, post-menopause, overweight, and suffer from several chronic conditions that have me in constant pain, including arthritis in cervical and lumbar spine, 4 bulging spinal disks, hip and knee problems (undiagnosed), pain in my heels that shoots up my legs after even minimal walking or standing (within 15 minutes), high cholesterol, a fungal infection, rotting teeth & gum disease (hereditary), and a newly developed sun allergy that has had my arms broken out in an itchy, bumpy rash for 2 weeks with no relief in sight (this was from just one episode of sun exposure lasting approx. 15 minutes).

I cannot have ANY of these conditions treated, nor can I get screenings for breast and cervical cancer, osteoporosis, or heart disease/circulatory problems. I can't even get the broken and loose teeth pulled, let alone replaced with a denture.

I have difficulty finding work because of my difficulties with walking/standing and even sitting in one position for too long. I also present a rather scary first impression with my lower teeth sticking up out of my gums so far that I can barely speak properly, let alone eat anything other than scrambled eggs and mashed potatoes (NOT the ideal diet for someone with high cholesterol and who wants to lose weight).

Why am I in such bad shape? I have no health insurance. My husband is disabled and gets Medicare. My son, who is 17, is eligible for SCHIP. I'm the caretaker for my family – but I'm also the one most likely to die suddenly of an undiagnosed illness simply because I can't even get a physical unless I can afford to pay out of pocket for the dr. visit, lab work, mammogram, xrays, etc. – which I can't do.

I've had 3 jobs since moving to PA several years ago. The first two were with small businesses that did not offer any coverage at all. The third, with a national temporary employment agency, had a plan available – but it was so limited, and excluded all pre-existing conditions, that it was effectively the same as no insurance at all for someone with my health issues. I was laid off in January, so now I've got a small unemployment check that would not cover the cost even if I could take advantage of COBRA to join the plan from my former employer.

By the way, I am not eligible for Medicaid, even though our family income is barely enough to keep the bills paid. In fact, when we first moved to PA and I had no job yet, we applied for Medicaid based on the fact that our monthly income at the time was only my husband's SSD of approximately $1500/month for a family of three. I was turned down even then because they claimed our income was too high.

Obviously, I support healthcare reform, and especially a public option that I could take advantage of no matter where I live or work, and where the monthly cost would be based on our income. But what bothers me is that I keep hearing that even if everything is approved the way Obama wants, that option won't be open to me until 2013 or 2014. I honestly don't know if I have that much time.

Is there anything in the current healthcare reform plans being proposed either in the House or Senate that will help me sooner than that?

My income is about $24,000 a year, and I am a single male.
Under the new health care bill; what would I have to pay for health care per year?

share this information. keep republicans and their allies the insurance companies host. what they don't want us to know.

http://www.pbs.org/moyers/journal/07312009/watch3.html

I am a Registered Nurse and would like to know how the new healthcare reform bill will affect nurse patient ratios, if medical assistants will replace LPN's and assume their scope of practice (i.e., medication administration, sterile procedures), and finally, will RN salaries be cut across the board.

Thank you for your time.
Stacy Wardell, RN
Washington

I was on an employer provided HMO plan. The doctors on that plan nearly let me die by diagnosing and treating me with for an on-going bladder infection. I joined Medicare and my doctor found that I had a stage 4 cancer.

Medicare saved my life.

I feel that all Amerecans should receive the same good treatment that I have gotten from the "Government Run" program, if they want it.

There are rumors that the new Oboma plan would cut the Medicare services that I now receive. Although I have emailed several governement enities, including the president with this question I have never received an answer. The DNC has asked me to help support the proposal but I am in the dark can you hepl please.

Please read. Could you not have people that make like $5 an hour & then$10hour,then$15 hour,etc,etc Pay say 50Cents a day if making $5 hour $1,a day,for $10 an hour $2 a day if making $15 an hour etc etc. And then have the company match that 3 to 1 .Now these prices are just an example .But would spread the burden evenly . This would give a great contribution to paying for health care , without putting the burden on all the rich people. The amount that you would have to pay could vary acording to how much you make . I really think this could be a way of solving the money problem . PLEASE get this into the right peoples hands before it is to late .

Can you comment on dr Kiran Tamirisa's post? I find it fascinating that we trust insurance companies and politicians that fight for their livelihood. We must wean ourselves off employer provided health insurance. It is bad for patients, bad for doctors, bad for businesses, bad for economy, bad for health of the nation, it is outright BAD.
Go with government run alternative! Republicans say they don't want it and actually admit that the reason is that it may actually work!!!

my husband is 29 years old and has DOUBLE COVERAGE HEALTH INSURANCE and is in DESPERATE need of two disk replacements (right now as we speak it is bone on bone) but can not get either one to cover the surgery,Every one comments on how most American people are satisfied with their health insurance,but what happens when they need a major surgery and are DENIED like my husband? WHAT DO WE DO?

Speaking of rationing health care; would people with more important jobs, better education etc., be given better health care? Would a cancer patient working at a convenience store be given less care than an engineer? On paper, this makes some ligical sense, but it makes me sick to my stomch to think bioethisists could someday rationize such actions.

I am a person living with HIV. I live in rural north Alabama and am covered under Ryan White insurance.I live 2 hours away from the clinic that provides me care as well as my life saving medication. Some months I wounder if I will have the gas to get to the clinic to pick up my medication. I have missed doctor appointments because of a lack of transportation. I work full time and would like know how the current bills being considere by congress will affect me. I would like to have the option to purchase health insurance that will allow me to see a local doctor. I would like to be able to pick up my medication at a local pharmacy. Will health care reform give me these two options? Or will I be forced to keep Ryan White insurance and continue to worry weather or not I can pick up my medication each month?

Who is to blame for the high cost of health care? A lot of blame is laid on insurance companies, but I see the charges from my doctors and for my prescriptions and they are extremely high. Insurance companies claim they add 10% cost to the system. Who is addressing the other 90% of the cost? How is the current reform going to curb these costs?

With healthcare reform, I'd like to know how it will impact nurse patient ratio, and coming from a surgery background, would like to know if patients who are having elective surgeries will be put on a waiting list. Further, how will the healthcare reform bill affect nursing salaries?

Dear Dr. Gupta,

I am a single, healthy, 23-year-old graduate student in Minnesota and I am still on my parents' health care plan provided for my mom by her employer. As far as I know, Minnesota allows insurance companies to drop my coverage when I turn 24 in December. I expect that our carrier will jump at such an opportunity.

Should I begin searching for another health insurance option now, expecting that my coverage will be dropped in December? If so, how likely is it that the government's health insurance plan will be available to me by then? Lastly, assuming the government plan isn't possible by then, how much should I expect to pay for a standard health insurance plan?

Thank you,

Gareth Armson,
Minneapolis, MN.

Dear Dr. Gupta,
I am a Medical Technologist at a conservative community hospital. Even in such a conservative organization, there is an amazing amount of wasted supplies, people with jobs that aren't necessary and general accepting of poor practices. I rarely hear any comments from politiciansabout reforming the alarming amount of .waste in medicine. Is this going to be addressed?

How Healthcare Should be Reformed

Medicare is Broke
Medicaid is Broke
Social Security is Broke
The Government can’t even run the Cash for Clunkers Program correctly
How can the Government (single payor) ever run something so complex as Healthcare?

Katherine Sebilius and the Senators with her in Hartford, CT got HAMMERED!

They keep harping on 47 Million Uninsured. They were called out as liars.
Even if it was so, it likely is true and likely underestimated, however, it still only represents 10% of the U.S. population.
So they will “reform” Healthcare to cover the 10% that likely will make things worse for the 90% who do have coverage.

Systems in place should be:
Cap on Insurance Company Profits

Anything in Excess of Profit should be turned around to fund the uninsured and underinsured

Catastrophic insurance, and subsidize it if necessary, should be the ONLY mandate

No demands on businesses to purchase insurance insurance for all employees.

Employer choice but tax credits to small to large businesses for contributions towards employer payment of Healthcare Insurance.

No pre-existing conditions should prevent patients from getting or changing insurance, but at the same time will have to make certain while the Insurance companies will have to accept all comers, they can not just set premiums at any price they want – must have premium controls otherwise all they will do is accept all people regardless of preexisting condition, or claim that of course they do so, but they control the premium costs which ultimately will still put insurance out of reach for those patients with preexisting conditions.

Improve reimbursement to Primary Care – Immediately, and increase this by 100-150% of present level. Only this will enable Primary Care to survive, thrive, reinvest and become
a career that would encourage future generations of quality Primary Care Physicians. Encourage quality by thoroughness and comprehensiveness of care, which can only also
be done by limiting Practice volume, Practice population size.

Subsidize Healthcare IT Adoption, Integration and ongoing support for All Physicians – but get this into the hands of Primary Care now (presently the biggest adopters of Healthcare IT at 24-27%, while the rest of medicine is still at 10-18%).

Medical School Students and College Student loan forgiveness to those who go into Primary Care and sign an agreement to remain in that field for a minimum of 3 years.

Allow Physicians to once again choose the best therapies for their patients. It does not mean that just because there is a Generic drug that “does the same thing” and that
it is cheaper, is the most effective and appropriate treatment for an individual patient. The converse also is true, just because there is a new brand name drug doesn’t mean
that it is better than the generic. This choice has to be left up to the Patient-Physician evaluation and NOT driven by Formularies who’s only reason to exist is to control
treatment choice and preserve Insurance Company Profits (directly) and increase Pharma Profits (indirectly), it is NOT controlling costs. Not every generic drug is as effective
as a brand name drug for a particular patient and may indeed affect outcomes. It is not enough to prescribe a Generic Beta Blocker, that does not get as good documented
blood pressure control than a Brand Name drug, or one for elevated Lipids. For if the patient suffers for a delay in adequate treatment what have you gained other than cost
savings at the risk of patient goals and in the case of pain meds as well, patient suffering. Is it fair to make patients wait through titrations of generic medications, to relieve pain or get them to goals that will prevent future illness and complications? I think only the patient and the physician in the exam room can truly make this choice.

Education of the public that every treatment all the time, every test, multiple second third fourth fifth sixth opinions is unreasonable and costly. This is not truly rationing just practical utilization of healthcare resources.

Education of the public to reduce poor, unhealthy behaviors (smoking, obesity, sedentary lifestyle, alcohol, drugs, dangerous activities, etc…) and promoting and ?rewarding healthy
behaviors.

Help physicians and the public accept appropriate standards for end of life care, futile care, terminal care treatments.

MUST have TORT reform.
Must have Medical Malpractice Premium price controls.

Must stop having Turf battles on Scope of Practice between Nurses (RNs, LPNs, CNAs), Medical Assistants, APRNs, Physician Assistants, Physicians etc.

Physicians have vastly different training and experience that can not be equated with the education and experience of these other Healthcare professionals.

If Nurses, APRNs, Medical Assistants, Physicians Assistants want their scopes of practice to reach into Medical Care at the level of Physicians, then they should apply to and go to Medical School and complete Residency Training Programs.

Capping Pharmaceutical Company Profits. Any excess, such as described above with the Insurance Companies, goes into funding the Uninsured and Underinsured.
Limit Pharmaceutical company direct advertising to Consumers.
Change the patent process for Pharmaceuticals. Decrease the length of time a medication can remain on patent, unless that product is show to meet certain standards
of being significantly outside the effectiveness (better) than most all other drugs in its group / class. But these drugs that remain on patent must decrease in cost
each year towards the end of the patent time frame.
Tax credits to certain limits for Research and Development.

I am sure there are a number of other issues that I will realize that I forgot once I post this, but we can get to them later.

Especially ways to handle Pharmaceutical, Insurance Company and Medical Device manufacturers processes.

Now how do we get this information in to the Media and into the Public Mainstream and up to the Governmental Levels?

Sincerely,
Alan T. Falkoff, M.D., D.A.B.F.M., F.A.A.F.P.
High Ridge Family Practice
30 Buxton Farms Road
Suite 210
Stamford, CT 06905
(203) 322-7070
http://www.HRFP.net

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Dr. Gupta,
In a recent interview you mentioned in response to a question about Doctor's fees that in some localities Medicare might pay $6000 to 17000 for the same surgical procedure. I am a surgeon and have never heard of this level of reimbursement. Can you please give an example of what procedure would pay so well? Also please let me know which state pays so well- I would immediately move there.

Ronald Holness MD Los Alamitos,CA

I AM 65 years old and a 12 year simultaneous breast cancer survivor. while i am legally blind and not allowed to drive i still volunteer with breast cancer. i have a question for you. mammograms are covered as preventative but lots of women in idaho do not get them either because of no insurance AND WOMEN;S HEALTH CHECK PROVIDES THEM FREE TO SOLVE THIS PROBLEM BUT WOMEN STILL WON'T GET MAMMOGRAMSBECAUSE IF IT COMES BACK 'BAD'" THEY CANNOT GET ANYTHING DONE ABOUT IT SO THEY WOULD RATHER NOT KNOW. HENCE, NO MAMMOGRAMS. THANK YOU IN ADVANCE, FOR YOUR FEDBACK IN THIS SITUATION.

Health care reform needs to be done, but there are way too many ideas on how, and even those who do not want it at all. I kinda like the idea of a public option, however I am wondering if this option would be anything like Medicare, Medicaid, or the Basic health plan, for one? Second, I wonder how much insurance companies are spending on negative ads for healthcare reform, lobbyist, and campaign contributions and if this money could be better allocated to cover larger portions of their insurance obligations to their consumers or to even add on consumers with preexisting conditions? Third, I want to know if the public option is anything like Medicare or Medicaid, and if so, how can we afford it when we already have Medicare going broke?

Hello Dr. Gupta, I was wondering if President Obama's health care plan will include TMJ? I am a professional violinist/teacher and have had TMJ since I was a teenager.
I have not found any dental or health insurance plans that will cover this problem and feel that I do need to have my jaw looked at by a health care professional before I develop more serious issues such as arthritis. My dentist suggests splints which start at $600 that may or may not work. I have a friend who is spending over $40,000 to fix her jaw and insurance does not cover any of her expenses. (not an option for me at that price)
If I was walking on my jaw, not only would I look funny but I am sure that I would not be able to walk at all. Why is TMJ not covered by dental or health insurance plans?
Thanks for all of your great insight on CNN. You are fantastic! Jennifer

Will the reform include reforming the antique
benefit evaluation scale for the military? The scale used now is not up to speed for illness/ disease that are coming out these days. I have malaria from military service, and can't get private insurance due to a pre-existing condition. The VA, says it is less than10%, and non-compensable. What now?

Dr Gupta, I am very concerned about the press I am hearing that the elderly will receive severely curtailed care under the proposed health care plan. Also will be forced to take end of life counseling every five years and more frequently if diagnosed with a serious illness. Can you sort out what it true versus what is political fear mongering?

ABOUT A YEAR AGO LEGISLATORS TRIED TO PUSH A BILL IN SUPPORT OF GREATER AWARENESS PREVENTATIVE AND INTERVENTIVE CARE FOR POP (PELVIC ORGAN PROLAPSE). AS A PATIENT WHO HAS SUFFERED LOSS OF A CHILD DUE TO NOT BEING GIVEN RHOGAM INJECTION DURING SECOND PREGNANCY AND AS A WOMAN WITH POSSIBLE NEED FOR UROGYNECOLOGICAL SURGERY; I WOULD LIKE TO KNOW HOW REFORM WILL ADDRESS ACCESS TO QUALITY CARE IN PROACTIVE RATHER THAN REACTIVE WAYS TO PREVENT UNNECESSARY LOSS OR INJURIES. I HAVE HAD DIFFERENT TYPES OF MEDICAL COVERAGE AND HAVE FOUND THAT GREATER CARE COMES ONLY AFTER SOME INJURY/LOSS/ SERIOUS RISK IS IDENTIFIED....I WOULD LIKE TO SEE MORE PREVENTION BUILT IN TO HEALTH CARE REFORM. SOCIOECONOMIC STATUS DICTATES TO SOME DEGREE THE LEVEL OF CARE ONE HAS ACCESS TO. THIS IS AN UNFAIR REALITY. EMPHASIS ON FRONT END COSTS IN SCREENING AND EDUCATION SHOULD BE INCORPORATED TO SAVE BACK END COSTS OF TREATMENT FOR ILLNESS OR INJURY THAT OS PREVENTABLE. I WOULD ALSO LIKE TO KNOW HOW REFORM MAY IMPACT PHYSICIAN EDUCATION PROGRAM STANDARDS/PRACTICE STANDARDS. THERE IS A GREAT NEED FOR BALANCE IN ACCESS TO QUALITY CARE AT THE APPROPRIATE TIME. FOR WOMEN ACCESS TO SCREENINGS AND EFFECTIVE DIAGNOSIS CAN PREVENT SO MUCH SUFFERING. PLEASE ADVOCATE FOR EQUITY ON BEHALF OF WOMEN'S HEALTH BEYOND BIRTH CONTROL/ABORTION.

Dr. Gupta,
First I want to thank you for the service you provide the USA. I have watched your show for as long as it has been on CNN and it is great. I also wish that you would have accepted the US Surgeon Generals position.

On July 10, PBS-TV host Bill Moyers interviewed former health insurance insider Wendell Potter. It was a most compelling show. Would you please consider bringing Mr. Potter onto your show. My hope is that this part of the health care story could be seen by a wider audience.

Thank you,
Frank

By any chance does health care reform include regulating the Long Term Disability carriers who arbitrarily deny well documented claims for patients with life altering disabilities and sometimes terminal diseases. At this point there are no penalties for insurance companies like CIGNA for repeatedly denying patients the benefits they paid for in the event they fell seriously ill. It's almost impossible to get anyone to listen to you unless you have an attorney. And getting an attorney – most don't work on contingency – at a time when bankruptcy is in your very near future because you have no income – is not realistic for most. The disabled need an advocate who will take up their cause. We were hard working individuals who contributed to society and by no fault of our own have been adversely affected by illness and then compounded by financial ruin. Please help. Thank you.

Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey ...(Betsy McCaughey is former lieutenant governor of New York and is an adjunct senior fellow at the Hudson Institute. The opinions expressed are her own.) ...
http://www.bloomberg.com/apps/news?pid=20601039&sid...

The above is the only qualified person who has read the bill three times and believes it is the worst bill to impose on free Americans. .Betsy McCaughey should be on the show every day with Dr. Gupta to answer questions. That is of course if you really DO want people to know the TRUTH about Government run Health Care. Let's just see what you want known.

What will the new health care plan do to Anesthesia reimbursement and why will it be any different than other medical specialties?

My first daughter was born on June 6, 2002 in Manhattan after a perfect pregnancy. However, day two of life she had 98% of her intestines surgically removed. The drs. told us she only had months to live – that the medications feeding her would result in end stage liver disease and death.

Some Dr’s suggested that we remove the lines that fed her and let her die of starvation – a fate far better than end stage liver disease – it was our choice to make.

Instead, my husband researched online and found that there were a few hospitals doing a new intestinal transplant. Knowing it offered hope for our daughter we chose this path and placed her on the organ waiting list in NY.

By the time she was 13 months old, we had been forced to move to Pittsburgh to receive care and as predicted, Acacia was dying of end stage liver disease and on life support.

At the time I was 8 months pregnant with my son, living out of state and helplessly watching my baby deteriorate – unfortunately these types of situations are not uncommon for families waiting for organs.

Then in September of 2003 after being given less than a week to live she received her transplant – a new liver, small bowel and pancreas – her second chance.

This gift was from total strangers – a family suffering from the loss of their own infant. Yet, in the midst of their grief they chose to donate organs.

My daughter calls those organs her “angel parts.”

Today she is in first grade in Chappaqua NY. She skis, surfs, plays T-ball and soccer. If you met her, you would never know what she had endured in those early years.

That donor family transformed my daughter’s life – my life.

Organ donation works – transplantation works – for solid proof you only need to look at my daughter Acacia

Everything was covered – which included the out of state birth of my son, almost a year and a half of ICU hospital stays and countless procedures in different hospitals and the mulitvisceral transplant – Would we have received the same level of care under the Obama plan?

Thank you.

Seems like those who are MOST interested in better health care and health insurance are either sick, destitute, or both, and aren’t as able to spend time and energy speaking out in favor of reform as the well-off are at speaking against it. The problem with health insurance is that by the time you find out you have a bad plan, you are already sick, you’re already getting billed a ton, and you can’t go and get a better plan because who will cover you now? Can’t we just try a different system for 10-20 years? If people really feel like there freedoms are reduced in the new system, they can vote an end to it.

Did you read proposed House Healtcare bill? Integrity is sacrosanct.

(1) Illegal Aliens Eligible for Public Plan. Section 246 applies only to “affordability credit” access, but does not
apply to anyone attempting to enroll in the public health insurance plan created by Section 221. Affordability
credits can be used to offset the cost of health care coverage for individuals who enroll in private insurance plans,
but there is currently no provision barring illegal aliens from enrolling in the taxpayer-funded public plan. An
amendment offered by Rep. Dean Heller (R-NV) at the Ways & Means Committee markup would have required
that enrollees in the public plan, or those seeking affordability credits, must verify eligibility with the Income
Eligibility Verification System (IEVS) and the Systematic Alien Verification for Entitlements (SAVE) system.
That amendment was rejected by the committee on a party-line vote. As currently written, the bill would allow
illegal aliens to freely enroll in the public plan.
(2) Section 246 Lacks Verification Requirements. Over the years, Congress has required various methods to
ensure that only eligible individuals receive federal public benefits. The most effective of these methods involves
the requirement that an agency or employer confirm eligibility with a verification database. Examples of effective
databases to verify eligibility include the SAVE system, which confirms an individual is a citizen or qualified
alien (as defined by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, more
commonly known as the “Welfare Reform Act of 1996”)2 and is therefore eligible for certain benefits; the IEVS,
which confirms income eligibility for purposes of certain means-tested benefits like Temporary Assistance to
Needy Families (TANF); or the E-Verify system, which confirms an individual is work-authorized in the United
States. A lesser method to screen for benefit eligibility would be to require applicants to self-attest eligibility,
subject to penalties of perjury, on a benefit enrollment form. This method is unreliable because it depends solely
on the honesty of applicants and also fails to actually determine an applicant’s eligibility. The health care reform
bill does not require the use of any verification database to determine eligibility for affordability credits.
Likewise, this bill does not require any screening or self-attestation by applicants to determine eligibility for
affordability credits. Instead, Section 246 bars illegal aliens from receiving affordability credits but contains no
enforcement method to ensure compliance so as to preclude ineligible individuals from receiving that benefit.
Where enforcement is lacking, we can expect compliance to be similarly lacking. Accordingly, Section 246 will
do nothing to actually preclude benefits from being improperly provided to illegal aliens.
(3) Government Studies Confirm: Bar on Benefits without Verification is Ineffective. Government research
confirms that a statute that limits the availability of government benefits is meaningless unless it is also coupled
with a vigorous method of ensuring eligibility in order to eliminate fraud and abuse. For example, the
Government Accountability Office (GAO) and other independent research have concluded that illegal aliens have
been a significant factor in the rise of Earned Income Tax Credit (EITC) disbursements despite the fact that illegal aliens are technically ineligible for the tax benefits.3 Likewise, the Congressional Research Service (CRS)
reported in May 2008 that illegal aliens receive significant federal benefits, notwithstanding numerous federal
laws designed to prevent this form of fraud.4 CRS cited studies from the U.S. Departments of Agriculture, Labor,
Health and Human Services, and a private organization to support the contention that a statutory bar alone will not
prevent illegal aliens from accessing government benefits.5 Accordingly, it is highly unlikely that Section 246
will operate to effectively prevent illegal aliens from receiving affordability credits provided for in the bill.
(4) Does Loophole Extend Health Coverage to Illegal Aliens Via Dependents? Section 246 may also be
rendered ineffective by virtue of Section 242(a)(2). 242(a)(2) states “members of the same family… shall be
treated as a single affordable credit individual eligible.”6 This raises the question of whether a family of illegal
aliens can qualify for the affordability credit because they have a single family member who is eligible. For
example, could an illegal alien woman receive the credit for herself simply by giving birth to a child in the United
States? If so, this exception would negate the general rule barring illegal aliens from receiving the credit and
would impose a significant cost burden on the American taxpayers.
(5) Recent Congressional Enactment to Limit Benefits for Illegal Aliens. In recent years, Congress has
enacted various provisions to effectively preclude illegal aliens from receiving taxpayer-funded benefits. For
example, the Welfare Reform Act of 1996 contained a number of reforms to ensure that only “qualified aliens”
(which excludes illegal aliens) would be eligible to receive “federal public benefits.” More recently, as part of the
Economic Stimulus Act of 2008, Congress precluded the issuance of stimulus rebate checks to illegal aliens by
limiting rebates only to persons with valid Social Security numbers (SSNs) while prohibiting checks for
individuals using individual tax identification numbers (ITINs) which can be used by illegal aliens.7 This
provision was effective in preventing the issuance of stimulus checks to illegal aliens. Likewise, the American
Recovery and Reinvestment Act of 2009 included language to preclude illegal aliens from receiving the bill’s
“Making Work Pay” tax credit.8
Conclusion. The health care reform bill lacks adequate safeguards to ensure that illegal aliens will not qualify for
the taxpayer-subsidized public health plan or affordability credits. The best way to protect the American taxpayers
is to require that each individual who enrolls in the public plan or who applies for an affordability credit to first
verify their eligibility using the IEVS and SAVE databases. Government studies confirm that statutory bars, like
Section 246, are ineffective by themselves to protect taxpayers. Congress has enacted effective language to
preclude illegal aliens from receiving benefits in recent years. The same willingness to adopt verification
requirements in the past is again necessary with respect to AAHCA in order to protect the interests of the
American taxpayers.

Dear Dr. Gupta,
I am living in Jamaica and would like to make a suggestion for health care reform in the U.S. Unfortunately, there is limited info on the proposed plan and as with many other bills I doubt if anyone has fully looked through the entire plan much less fully grasped it.
I would like to suggest that if the government makes it mandatory for all americans to be covered under the health care reform bill. It may be useful to set regulations such that the health insurance companies have to include the government plan in any package they offer. They will then pay the government the prescribed premium and the balance of the premium they would charge be used to cover the additional benefits they offer above the government. This, I believe would ensure that the majority will benefit and it will also most likely expand the client base of the health insurance companies which has been and will continue to decline giving the rising cost of living.
There are other issues to be addressed like regulation/accountability. I don't think the ability to chose a doctor/hospital should be an issue since both health insurance and government would use doctors based on similar guidelines as to cost and competence.
Sincerely,
Dr. Heron Edwards

In your broadcast this morning I was disappointed you did talk about the excessive profit that drives hospital costs up. Is there an barrier to charging $250,000 for a two day stay $300,000? It is unconscionable that we have let the system get this far out of hand. It reminds of the efforts now under way to look at excessive payouts for the financial industry. Does anyone bleived that there are no abuses in the medical industry, greed, excessive salaries, profits? We wouldn't be talking about national health care if the industry was not rife with greed and poor management. If we do not pass health care reform the system will collapse under its own weight.

What percentage of SALARIED physicians at the Cleveland Clinic have been subject to tort actions against them, as compared with the percentage for those doctors in private practice/hospitals under for-profit HMO arrangments?

Ways to reduce cost of healthcare:
1. Mandate catastrophic health insurance for everyone. There are uninsured who can afford healthcare but would rather spend the money on the new iphone or an expensive purse. YOU KNOW WHO YOU ARE. Expanding Medicaid is NOT the answer.
2. Have taxes in place for sin (s) smoking, alcohol, obesity. Obesity is taking this country by storm. Preexisting medical conditions is one thing but why should I have to pay for someone's health condition that is self inflicted.
3. PREVENTION! PREVENTION! PREVENTION.
4. End of life care and futile procedures and life support NEEDS to end. This should not be decided by family members or the patient. Let the dying process take place....we all DIE at some point.
5. TORT REFORM. Raise the bar in medical licensing...ie physicians that are dangerous or just plain stupid should not be practicing and should be judged by his or her peers.
6. Community or state resources for addicition and psyche issues or homelessness...the frequent flier who just wants Dialudid or a bed and breakfast.
7. Change the EMTALA law. Individuals should not abuse the ER because they can.

Tonight you stated that not everyone will be eligible for the public
health plan. This was the first time I've heard this. Who would be
excluded?

Why can't the reform on health care go more slowly until the government proves it can handle it? They have listed the main causes ($1.2 trilion ) in waste – obesity,smoking, too many tests, too many emergency room visits, high cost of paperwork, tort reform.Tackle these and see how well they do in solving these issues before tackling the entire mess.
Why can we not make sure only those who qualify get the care? Do other countries provide interpreters for patients as some want mandated here?
Secondly, why won't the administration try a program that has been tried and works, Lou Dobbs talks about one at 1/2 our cost, greater longeviity than Americans and has been working for years. Do we have to reinvent the wheel?

Thank you for your time.

Dear Dr. Gupta,
In listening to comments this morning, I noticed that we will be allowed to keep our current coverage if we so desire. However, I realize that not only will I be paying for my current coverage but I will also have to pay for those who either drop their coverage or have no coverage. It seems like we will be paying double and be penalized if we decide to keep what we currently have.
In the case of social security we all give but we know that we will be getting something in the end. I do not mean to sound selfish but money is tight nowadays.
It seems like this works one way only. Shouldn't those who are paying "double" be given at least some kind of a tax break?
Thank you

Dear Dr. Gupta,
I was against privatization of Social Security-I'm not much for a change over all I guess. Now I'm afraid about Medicare. If the health care bill passes without public option does it mean that Medicare has to be privatized? Maybe it is better to leave everything the way it is than risk having senior citizens like me without affordable coverage. I really cannot pay ant more.
Irene

Dr. Gupta,

I've seen much talk about "preventative medicine" in healthcare reform. But what concerns me is proper diagnosis when someone is sick. We seem to treat empirically, which was fine under blood culture the last 100 years. But why, especually with the advent of TEM-PCR, is there resistance for doctors to wait until the test results come back (next day) and then treat?

Also, my nephew took an H1N1 test on a Thursday and received definitive results on a Friday. The doctor said it was a new lab down in Huntsville, AL that was credited with helping to contain SARS in China. If we have this technology available, why would we not be hearing about it more often? My state (TN) doesn't even want to test for H1N1 because they can't determine results within the necessary time period.

Thanks.

I currently have my healthcare (PPO) through my employer. They pay about 50% of the premium. My fear/question is once the presidents bill passes, (he says that it will not effect my current coverage) but I can see my company coming out and saying, "good now since the government is paying the bill we are going to stop offering the coverage and let our employees go with the free benefits. (they've already took most of the benefits away already i.e... no 401K match, no more stock purchase discount, no more pay differential for working off shifts ect. ect. Is there any guarantees this won't happen?

Dear Dr. Gupta,
My husban has been diagnosed with a Grade IV Glioblastoma, he is 66 yrs old, diabetic and hypertensive. He was operated on the July29th, left temporal lobe. He is still in the hospital recuperating. He is off balance and his speech most often doesn't make any sense.
My question is that with all the info that I've read on the net, there doesn't seem to be a good prognosis for this disease. Should I put him through the suffering of radiation therapy and chemotherapy just to prolong his life for a year, maybe two? It is such a hard decision to make. Please help me make an informed decision. Thank you very much.

Dr. Gupta - I'm surprised that you have yet to touch on a topic that MUST be close to your heart when you've talked about health reform: TORT reform

as a neuro-surgeon, I can only assume that your malpractice insurance rates must be outrageous

is it a surprise that there's no tort reform when the President is a lawyer, his wife is a lawyer, most of Congress are lawyers, all their best friends are lawyers, and much of their election contributions are coming from the American Bar Association

but, one of the huge costs in our medical system is:

1) defensive medicine - doctors ordering tests and procedures that they KNOW aren't really called for - they KNOW that there's a one-in-a-million chance that the test/procedure might be necessary, but they fear that they are the one doctor who will be called to task when that test/procedure MIGHT have been called for

2) the LOTTERY attitude for crazy punitive awards in medical malpractice situations, even when no malpractice actually occurred - it's to a point that insurance companies pay "blackmail" from vulture lawyers rather than pay to defend the doctor/drug company - on your own CNN, every third commercial seems to be from some SHYSTER talking about "bad drugs" and how if you EVER took that drug, you could be the recipient of big $$

I can only assume that YOU have ordered tests/procedures that, in your heart of heart, you KNOW are unnecessary - but have done so to cover your butt against the miniscule chance that it might have been useful in a very small percentage of cases. I also assume that you have been victimized as being a "bad doctor", just because the outcome was not what the patient/family wanted. And that your insurance rates have unfairly increased because of it.

With that in mind, I find it incomprehensible that you have NEVER mentioned how the medical reform has not touched TORT reform. This will continue to add multi-billions to the cost of medical care.

I think that you should cover this topic in your continuing reports concerning the whole health reform issue.

Thanks in advance for your attention.

OK you guys! What is wrong with you people?

I am a Canadian who is scatching my head wondering why the American people would have a problem with a National Health Care System.

In Canada we can go to any Doctor of our choosing, get tests done as needed and recieve an adaquate diagnosis and treatment at NO cost to us!. That is right! We do not pay a monthly fee for heath care insurance, no fees for going to a Doctor, no fees for tests, no fees for hospital stays or sugery or anything. Also we dont wait for treatment as those trying to scare you away from a National Health Care System tell you we are.

I think you are all brainwashed by the big fat cats racking in all the dough from your current system. You know who they are. I guess you like paying $500.00 or more a month for an insurance plan that is still going to charge you a deductable when you go to a Doctor or have tests done or what ever. Having your HMO tell you what Doctor you can see, what tests and treatments are covered. Give me a break!

Be grateful for the gift that is being presented to you. Look at the facts and not the smoke and mirrors those making money from your insurance premiums and deductable charges are handing you.

Be informed, be smart, dont slap a gift horse in the mouth!

Well I guess you could continue to go broke paying for a health care system that is not working for you. You are working for it!

Louise

Good discussion on CNN Larry King tonight. Focus on behaviors that could affect health care costs. I can think of a couple of them that I haven't heard mentioned. 1. Alcohol consumption – how many deaths and illnesses are attributed to alcohol abuse/use? How does it compare to smoking? 2. Sexual behavior – with AIDS and other STDs on a rise, with millions of abortions every year - who is going to have the courage to say that we are obese, eat wrong, smoke, don't exercise AND we are permiscuous sexually AND we are drunk. Also ... I don't know what the solution is, but I sure would be interested in some facts about the profits that private insurance companies are making. As we watched our premium triple while our coverage declined, copay & deductible increase during the last 5 years - all to cover costs or just GREED? I don't know – it would be interesting. Thanks.

How much does health care contribute to the labor cost, and what does that do to force our jobs to other countries? We were taught that the US cannot compete in a world market because our industries have to pay health insurance in this country and other countries don't. Their health care is paid through their taxes or some other method. How much truth is there to that? Is it making us less competitive in a worldwide market? I wondered why other countries wouldn't want to be like us, but we seem to lose our insurance, and our jobs, when we get sick, so it doesn't really make sense to have our health care tied to our jobs.

Some jobs seem to go to other countries because they don't have as good of environmental laws as we do.

Cost is all about perspective. From whose perspective are you looking at the cost from? the insurance company? the employer? the physician? the hospital? the patient? They are all different. Have to be very clear about all of those different perspectives in the debate.

Very difficult to base individual health scenarios on population research that is highly specific and doesn't necessarily fit the individual in question. We need better quality research to make better decisions. Individualized medicine.

We are still going to need our doctors to make individual decisions...not based on populations studies so much, but more on real life situations. The mammogram missed my tumor. The first two biopsies missed it. The doctor said that it wasn't a guessing game, we need to know what that lump was. It was cancer. I caught it before it got into any lymph nodes. But, she said that from all of the information that she had, she had no reason to test further...and yet...we didn't have the answer. So, we did one more biopsy and it caught it. It seems unlikely to me that we can eliminate our doctors yet.

Dr. Gupta,
I was wondering about the healthcare for the Native Americans in our country and how that operates. I think that it is a form of government healthcare that we all pay for with taxes. How are their costs controlled and should that model of healthcare be looked into for the rest of us? I like it if you would address this question. Thanks.

I believe that Medicare seniors are being misled into believing that we will be able to keep seeing our current doctors when the reality is that with the proposed cuts in payments to doctors, only the least experienced and least successful doctors will be willing to treat Medicare patients. It is appalling that at a time when the aging baby boomers will greatly increase the number of seniors to be cared for, there is a proposal to cut $5,000,000,000.00 from Medicare funding. Surely there is a great deal of unnecessary expenditure in government which could be cut instead to fund care for the uninsured rather than taking good care from seniors at a time when it is most needed. Seniors have faithfully worked and paid into the system all of their lives and
should not be deprived of the care they have earned and deserve.

Also I am told that there is a limit to out-of-pocket expenses in the reform legislation. This should not be applied to voluntary spending by patients. Presently seniors have the ability to pay out-of-pocket for diagnostic tests and treatments not covered by Medicare. We can see doctors who do not take medicare at our own expense when we wish. This costs Medicare nothing and provides better care for many seniors. In our free American society we are able to spend our money on the best homes and cars we can afford, travel and even gambling. Why should seniors be prohibited from spending our own money on quality health care just because we have reached sixty-five?

Americans have always had the freedom to select the health coverage which fits their pocketbook and needs. Employer plans allow employees to select and contribute to paying for HMOs or more expensive PPOs. Private insurances offer us an array of plans. Like younger Americans, seniors have had the right to select a Medicare HMO plan or pay extra and take a supplement plan which provides better access to physicians and procedures. With my current Medicare and good supplement which I pay for I can go to the best specialists to treat specific medical problems. I don't have to wait to see a primary doctor who may not be qualified to diagnose and treat a problem in a specialized area and then wait until he is ready to refer the problem to a specialist and then wait again to see the specialist, often suffering a worsening of the prognosis due to the delay or incorrect initial treatment. The option to pay for and receive this quality of care which is available to younger Americans should not be taken away from us just because we have reached sixty-five. If medicare can no longer provide it under the current premiums we pay, seniors who can do so should have the option to pay more for their Medicare as we do for our supplement and continue our current quality of care. We should not be forced in our golden years into a lesser quality of care than we can afford?

Since allowing us to spend our own money for better medical care does not cost anything to the Medicare program, one wonders what is the real agenda behind stopping seniors from getting quality care to prolong our lives. Perhaps it is that shorter lives for seniors will reduce the number of beneficiaries of Social Security and Medicare. Maybe there is some political agenda in reducing everyone to the lowest level of care. Is it any wonder that seniors are fearful of this type of reform?

In search of true facts, please note the following:

CHICAGO–The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight.

Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.
Three weeks ago, the President suggested that a surgeon's decision to remove a child's tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what's right for the patient.
We agree with the President that the best thing for patients with diabetes is to manage the disease proactively to avoid the bad consequences that can occur, including blindness, stroke, and amputation. But as is the case for a person who has been treated for cancer and still needs to have a tumor removed, or a person who is in a terrible car crash and needs access to a trauma surgeon, there are times when even a perfectly managed diabetic patient needs a surgeon. The President's remarks are truly alarming and run the risk of damaging the all-important trust between surgeons and their patients.

We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.

I just found out that even though i have group coverage through my company's health insurance, I am being denied a claim for a routine checkup because the doctor wrote "deviated septum" in his report. Is this legal for them to do? I have not had a pre-existing condition, and I only mentioned to him that I had difficulty breathing out of my left nostril. Why has this been deemed a pre-existing condition and what can I do about it?

Ever since the start of managed health care (HMOs), the cost has INCREASED. HMOs were supposed to decrease costs by encouraging more preventive care. Today, too much of our routine medical care is covered by insurance, instead of just being paid out of pocket. The purpose of buying insurance is to protect against catastrophic costs. When insurance covers everything, it has to cost more. Now we have so many visits to the doctor charged to insurance that the premiums we pay keep increasing. Instead of pushing ahead with more insurance-covered care, why not DECREASE our insurance premiums by buying insurance with high dedustibles, and just pay for routine medical care out of pocket?

I asked my stepfather, who is a doctor, what percentage of people die in the emergency room as a result of stupid decisions that were totally preventable. He estimated 50%. I also asked his opinion on the percentage of people who sought treatment from the emergency room because they knew they could get away with not paying even though they could afford to pay. He estimated about 30%.

I asked a friend who is also a doctor, what percentage of patients would not need to see him for various health problems if they simply ate right and exercised. He said about 50%.

I eat very healthy and exercise every day. Because of my lifestyle, I'm in my mid-30's and have no chronic pains or illnesses. While I see other people's health deteriorate as they get older because of their poor lifestyle choices, I feel my body is better than when I was a teenager. I have medical insurance, but I never need to use it.

So when it comes to the idea of universal health care and health care reform, the question I have is why should I (or anyone else for that matter) be forced to pay for others who make poor decisions and live unhealthy lifestyles? Whatever happened to self-responsibility and dealing with the consequences of one's own actions?

My mother-in-law is extremely obese and is on high blood pressure medication. In the past, when she had me run her though exercise workouts. She lost a lot of weight and did not need high blood pressure medication anymore. However, she did not like the discomfort of strenuous exercise and eventually quit working out. Even though the doctor told her to continue exercising, she chose not to and chose medication to control her blood pressure rather than exercise. Why should anyone but her pay for her decision?

In regards to the Canadian who commented earlier....

Your system is great- as long as you are willing to pay sky high taxes. I have a friend who is Canadian and he mentions all the great benefits he has up there. He also mentions that he pays close to 60% when all the various taxes are added up.

Dr Gupta,

Hi, I am an undergraduate pre-med student enrolled in a seven year program, who is wondering about how the health care reform will affect those who want to become doctors. You may have answered this, I haven't seen a good explanation anywhere about this area of healthcare reform, but I estimate by the time I finish my medical program, I will be 200,000+ in debt from student loans. How will the health care reform bill affect how doctors will be paid? Don't get me wrong, I'm becoming a doctor to help people and irregardless I am still becoming a doctor whatever the outcome of reform will be, it's just I want to know if my desire will become a major financial burden.
Also concerning specialties, will the new bill cause all doctors to be paid equally? I'm only asking as it seems fair for a neurosurgeon or a cardio-thoracic surgeon to be paid more than say a general practitioner, as they have extra training and the work is more risky. I remember my primary physician mentioning how some specialties are declining and that concerned me. He said that it's becoming too costly in some areas such as OB/GYN that sky high malpractice and other fees are causing less and less to go into those fields.
Maybe I'm worrying a little too soon but does it really seem that unfair(to others) that a doctor whose has hundreds of thousands in debt, took 10+ years to train , works 60-80 hours and has sky high malpractice- should be paid a good wage?Or be paid more because they are in a harder and riskier specialty ? Thanks for reading and thank you for all that you do.

Hi dr Gupta!
i am a 40 year old working mother single mother without health insurance and applied for kids care for my children. How will health care reform affect my family?
Thank you

Dr Gupta,
85% of Americans presently have health care. Most of that 85% are presently opposed to a government take over of health care, but many, if not most, would change their position if the government take over could be shown to improve care AND lower their insurance cost.

The only way that health care can be improved AND the cost lowered at the present is to accelerate the research into the DNA Personalized Medicine where actual cures, not just treatments, become the majority.
Treatments (about 90% of present medicine) are nothing more than ineffective, expensive, stabbing around in the dark by Doctors.
Cures are exactly that, -CURES. Only the DNA based Personalized medicine can find true CURES for 4,000+ known ailments.

I reccomend that the government could be most effective by setting up methods to accelerate the DNA Personalized Medicine research.

The most likely and most effective method would be to offer monetary prizes for each disease so cured by the numerous organizations presently doing the research.

Otherwise, most persons think and see the government's frantic drive to seize control of healthcare as nothing more than a devious means of directing the $2.4 Trillion annual health care insurance money directly to the government, not for the purpose of improving health care, but for the government to use the income as an asset to increase the government's ability to borrow more money and increase its debt even further.

I appreciate this chance to ask you my questions about health care reform:

I am very concerned about the President’s statement that "you can keep your current plan and your current doctor". I think that this statement is as big of a myth as Palin’s comment about death panels. Please help me to understand how this statement is true.

If a public plan is instituted, I understand that the provider reimbursement structure will be similar to Medicare. If this is true or anything close to Medicare or Medicaid, that cuts payments to providers by at least 30%. This has the potential to be extremely disruptive to our current health care system and believe the following questions should be answered before anyone should support this plan:

How are private plans (including Michigan based plans like BCBS of Michigan, HAP, Priority Health, HealthPlus, Total Health Care and others) supposed to compete with a plan whose reimbursement structures are approximately 30% less? It has the potential to cut right through the private pay system at that level of differential in fees, even with the inefficiency of Washington run health care we see currently in Medicare.

And where does the tax revenue for our state associated with those plans as a business and employers, along with the premium taxes from their policy holders get replaced by? And how to the causes they fund to improve health in the state continue to be funded? We are talking about millions of dollars the drive the Michigan economy that have the potential to move elsewhere.

And why would an employer offer health coverage at a cost of $8,000 per employee per year when a likely cheaper public plan is available (see above) and they can opt out for roughly a $1000 penalty? What did employers do when Medicare D was offered? They eliminated retiree benefits because it no longer needed to be their burden. What facts does the Government have to support that employers won’t do the same and that I can really “keep my plan if I want to”?

And how are physicians and hospitals supposed to offset this loss in revenue? We need to spend less, but we need to find ways of using less health care not paying less for the same volume. Cutting funding without cutting services is not achievable for our health care providers. There is plenty of over treatment in our system, but it won’t go away with the reform on the floor: Tort reform is needed to prevent huge amounts of defensive medicine and changing the health of Americans so that we need less care for preventable conditions like heart disease, cancer, diabetes, hip/knee disorders etc. are the real drivers of health trend in the past decade. The system cannot withstand a drop in revenue of this magnitude and maintain its standards and keep hospitals open. It seems that we are at risk of lowering quality and increasing costs as a result. If not, help me understand how.

And how will we mandate that physicians and hospitals now accept a government fee schedule for services or can physicians chose to not accept that payment and only treat those that can afford more? If they are able to opt out and provide services to those who can afford to pay current fees, how do I know if I can keep my doctor if my employer no longer offers coverage and I can’t pay more?

Based on my understanding of the above, how can the President tell the American people that they can keep their plan and keep their doctor if they like them? It is only true if employers offer health coverage and if physicians accept the fee schedule that this plan will be structured on. Either my understanding of the above is wrong, or we have a right to be angry about this health reform.

I heard someone in Congress on the news over the weekend challenge whether we have the best health care system in the world, given our high costs and seemingly marginal outcomes when compared with other countries. I think this statement is misleading for the following reasons and want to know your opinion:

• Most of the world does not track outcomes like we do (example, infant mortality is grossly understated in most of the world).
• Most of the world does not treat disease like we do (for example in China most people would not receive Cancer treatment without cash to pay for it like ALL Americans do). People in most countries around the world simply die at home without the cost or poor outcome of any treatment, which changes the cost and reported statistics that we are comparing to.
• Most of the world is not as unhealthy as we are. We are less active, more overweight, and have more chronic disease than almost any other country. Until we prevent heart disease, diabetes, and cancer through LIFESTYLE changes, our health care costs will always cost more because we are using more services than the rest of the world.
• Lastly, many of the reasons that cause our mortality statistics to be off are significantly higher murder rates and vehicular crashes than the rest of the world which have nothing to do with our health care system.

I think the proposals on the floor of congress will take away the innovation in medicine that have continually benefited Americans, as well as everyone else in the world. It will increase costs without addressing quality. It is upsetting to have some of the media accepting statements that our health care system delivers low quality results and I'm just wondering what you think?

How is adding millions to the insurance roles and NOT DECREASING THE COSTS OF HEALTHCARE supposed to make this more affordable?
I can't comprehend the need to charge $10 for an aspirin, pay $3,000,000/yr for an administrator or $5000 for a 25 minute outpatient procedure.

Can you describe the political pusheback the Republicans gave to the original Medicare Bill when it was passed. IT sounds just like THIS debate and people would not give THAT up now...HISTORY help explain these things...Same for Soc Security we were told the world would end and the government would take over all kill us all etc...

Can you tell us how many people have to leave the US to get healthcare elsewhere? Because of Insurance denials or just excessive costs .And compare the outcomes better or worse for those people...ie better if they go to Germany or worse if they go to other poor countries...perspective would help.

Proponents of the "public option" say it is necessary to force insurance companies to compete with the lower costs. Opponents say it will force insurance companies out of the marketplace. Please comment.

Please comment on the following:

There is "Comparative Effectiveness Research" for our health written into the Feb. '09 Economic Stimulus Bill that President Obama wanted passed real quick!

Please explain this, and the reason why it was hidden in an Economic Stimulus Bill, instead of a Health Bill. This is not 'pork'.

I helped elect President Obama, but I won't help anymore! I thought he meant honest "CHANGE"...not this STRANGE CHANGE!

Why even think about a bigger health plan, when our govt. can't even work out govt. run medicare and govt. run medicaid?

Is Congress and this Adm. even willing to sell off their fleet of 24 luxury jets to help pay for better health care under those govt. run health plans...or are they just wanting to cut health care to our older population and those with severe health problems, raise taxes, and cut grants to those groups that help older Americans and those in need?

I don't see Congress and this Adm. sacrificing...like the rest of us!

I didn't even go on employment because my husband has a job...and I thought someone else would need that money more!

There is plenty of tax money for the U.S. citizens if our govt. would just spend it wisely! And this goes waaaaaaaay back...not just the Bush Adm.

By the way, did President Obama pay for his family and their staff to be with him on HIS BUSINESS TRIP to Europe, Africa, the Western USA...like former Gov. Palin had to? I thought that was a great idea!

And while I'm at it,

How dare the U.S. Senate pass a bill to use our Social Security for illegal aliens! If they want to help illegal aliens, they can use their OWN RETIREMENT MONEY!

Thank you for your time.

I have 2 questions for Dr Gupta,

This morning (8/16/09) you included an interview with a gentleman who used to work for Signa. You discussed terribly sad situations where insurance refused payment to people in life and death situations. My question is, would health care reform guarantee that all of these people would receive all of the treatment their doctors are requesting? And, if yes, would that include people of all ages?

Are there ANY guidelines from the government that would need to be followed by doctors when discussing end of life options with senior patients.

Thank you,
Mary, Florida

i am, 65 years old and i have diabetes that is under control. i
have been trying to get long term care but i have bad reports on
my kidnneys( protein in my blood). will the health care reform
bill cover any long care coverages .
please advise me it there is any hope for me so my family
doesnot have a chance to loss everything.
thank you
alan bart

I just read on MSN that the public option portion of the reform bill may be dropped due to public pressure. Is this true? if it is, then i am very disappointed and frustrated with President Obama. I feel he is backing down on one issue after another. I felt the 'dumbing of America' had occurred during the last 8 years and we were finally coming out of it. Now, i feel we are heading back into it. The Republicans had 8 years to improve things and failed miserably. Why is the President so conciliatory?

It is common knowledge that legal suits have added immense burden to US health care cost. This is a key difference from other developed countries. No one is perfect and there always will be few errant health care providers. However, ultimately it is the common population footing the bill. Life is priceless but our claims and legal costs have become senseless. Why are we not willing to cap these ridiculous compensations? Let me guess. Since majority of the politicians are lawyers by background, they lack the political will to go against their fraternity (??)

SOLUTION to Health Care Reform... one of many solutions...

I think we all are looking for reform, and I'm against government controlled health care.

Personally, I think there should be one health fund for the whole nation, and complete care for all, without the "ala carte" menu of services that most private insurance companies offer, etc. ...and be non-profit. The broader and bigger the fund, the more efficient it will be for paying out for services that are needed at any point in time, and premiums should shrink by more than half of what we are paying today. This fund would also cover all government sponsored health programs... OPM, TriCare, Veterans Admin, Medicare, Medical, and local government programs, etc.

Employers may be able to foot the whole bill, then. For the unemployed, they would pay their premiums on a "percentage" basis of what their pension, capital gains, or passive income is (approx.2%). Employers may be able to pay a percentage of an employee's individual wage, too. That would level the burden of the cost of health care... such as charge all revenues on the percentage basis.

Or, do something similar to what Mike Huckabee wanted to do with income tax... take a percentage out of the "sales tax"...like 1% or 2% and have the sales tax fund contribute to the health care fund account. This would take care of tourists and illegal aliens, too, who would receive only initial care for their illness in the United States under the health fund, and their government or their personal health insurance would pay for the rest, or have them deported to a medical facility in their country. They would be their government's responsibility.

Control should be done by the American people, because the fund would belong to the American people, since we would be paying the premiums into that fund. Sort of like a co-op, only on a giant scale. I think control should be done by committees representing the American people and audit agencies, with a government Inspector General to make sure that the American people have consumer protection. That would prevent,hopefully, what happened on Wall Street and AIG, etc., and bleeding of the health care funds account and fraud.

If a patient should want an especially talented doctor who charges more than what the plan would provide for, the additional difference in cost could be paid out of the patient's pocket, or through a private insured policy. The same would be for labs (if a particular lab charges more because of a better reputation) , meds (generic vs. brand name), medical facilities (like John Hopkins if they charge more), or comfort settings (like more luxurious quarters while being hospitalized), etc... Basic premiums should be low enough to enable patients to pay for additional private insurance policies if desired to cover the additional cost.

Everyone should be able to submit a claim for all medical care from the basic fund, and if necessary, have private insurance to pay for anything additional that the basic health fund will not cover.

Everyone should be able to choose from a "public facility" or their own private physician and still make a claim against the fund. Everyone should also be able to "mix and match" between services from the "public facility" or their own facility of choice.

There are many ways to make the system more efficient, such as purchasing power, etc., and the wage payment structure for health employees should be calculated by "cost of living allowance" for their area of employment, as well as all other financial payments (supplies, building structures, etc)

The above would be basic and too simple and too cost efficient, so it would never catch on... ... but that is my 2-cents

I have not figured out if Obama wants to have 100% government control over health care such as dictating what procedures you are allowed to have, or, if he is just looking to oversea the health care system to protect the consumers when they are at their weakest.

--------------------------–

Please go to this website and download the “The Federal Coordinating Council for Comparative Effectiveness Research (FCCCER)” report from: http://www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf
or from:
http://phiinstitute.org/arena-our-public-comments-may-are-part-fcccer-report
Read the report. Learn how the health care dollars will be saved.
Learn how the health care dollars will be allocated.
Learn how payments to doctors will be determined.
Learn how the distribution of H1N1 was determined!
Please explain to me how this is not rationing!!!
OH, that's right; the government does not ration health care!!!

Dear Dr.Gupta

This is a question to those oppose Public Sector Health Care Insurance option proposed by President Obama. US health care insurance Giants ilike AIG, Prudential ,Allianz etc. are in India. There are also Public Health Care Insurance companies like Oriental Insurance, General Insurance, United India Insurance.etc. Both co-exisit.

Similarly many US bankers like American Express, City Group etc. do exisit with Indian Public Sector bankers like State Bank of India, Bank of India, Punjab National Bank etc.

India is not a communist country.

P.B.Menon

I have tried to read as much as I can about this badly needed Health Care Reform Bill, as I have been in a uninsurable mess since birth. I've been covered under parents' group plans thru work, or spouses plan for over 25 years. I had one year inbetween that transition where I paid over $150.00/mo. for basic medical with the provision I could not have any claim for pre-existing orthopedic issues during a probationary period. Once married, I was on a group plan that allowed pre-existing issues.
I have recently been in situation where the private insurance hospital rep has been in my hospital room weekly telling me 'unless I improve, my insurance company won't authorize another week." That lasted fivemonths. I was discharged only after an appeal and after a four day extension so medical staff could teach me all I needed to know to be safe to discharge. I remember when I was a child, and I stayed in a hospital from June to November, as it was medically necessary, and the insurance company never hasseled my parents. That was pre-80's healthcare.
So, I have pre-existing conditions, and under current health care system, I AM UNINSURABLE once COBRA runs out. ( We are currently Unemployed) What senior citizen in USA doesn't have pre-existing conditions that require insurance before eligible for Medicare? I'm scared and I still in my 40's! I pray morality and common sence prevail when these provisions are voted on this year, and that no politician is swayed by the all mightly dollar from some insurance company whose profits are more important than the wealfare of it's clients.

How will TRICARE be affected by the proposed healthcare bills? TRICARE is the government plan covering military families (active duty and retired) and has many similarities to MEDICARE. Thank you.

A future doctor just 1 ½ yrs away from being a licensed practicing physician:
From a future doctor’s point of view:

The road to becoming a physician is one of the longest, most difficult in terms of both academics and social, most competitive and longest investment payout in all industries! Every year hundreds of thousand students with a dream of becoming an excellent physician go to interview where every school gets thousands and thousands of applicant and interviews only about 1000 of those and only accepts about 200-250 at most. Every year standards keep going up and up creating more and more qualified physicians. The investment that we have put into our education is one that only someone a little insane would do.

From an economical standpoint:
4 years of undergraduate education
4 years of medical school
4 year of residency where we make next to nothing in the hopes that soon we will make enough to one day pay off the debt that we have incurred in our education meanwhile the interest keeps on ringing and tacking on more money we are in the hole!
Avg debt of a graduating doctor = $250,000
Not to mention the interest that keeps going up every year on these loans where 10 yrs ago it was no big deal around 1-2% NOW its more like 6-8%.
SO we invest at minimum 12 year of our lives (the prime years 20s and early 30s) not to mention now we are $250,000 in debt where if we decided to not go to medical school and make $60,000/yr doing something else….
So we could have made $720,000 but instead we are now in our mid 30s 250,000 in the hole so that’s 1-MILLION dollars lost!!!!!!! Now we are a doctor making (if your lucky) $250,000….so just in terms to $ that means it will take another min 5YRS to break even so now we are almost 40yr old!!! That’s not even including taxes and living expenses…. consequently as a physician we wont be able to own our own home and vehicle until we are well in our 40s and almost 50 when most ppl start thinking about retirement we are just barely getting started!!!!!!!!!!

From a social standpoint:
We waist “the best years of your life” – typically, the 20s and 30s and some the 40s in pursuit of helping ppl. We spend (at least I did) min 5 hrs per day studying not to mention the 8hrs/day in lectures. Our social lifes are non-existent, trying to start a family or relationship is very hard if your sig other is not in the same situation. Normal ppl outside of professional school do not understand the commitment it takes to go through our medical education and it is a life long process. Not to mention when we have to study for National Board Examinations where I spent min 12hrs stuck in a small room with a table, laptop, fellow students and stack of books preparing so we can move on and get closer to graduating.

In conclusion doctors not only take a financial risk/investment but also sacrifice our livelihoods in hopes of obtaining our doctorate in medicine.

The government sees us as the problem in healthcare and we are under attack. Historically as a whole we have not been smart businessmen and we have allowed insurance companies and regulations to choke hold us into submission and handcuff us in giving the best healthcare possible. As a future physician I am worried about my own earning potential and if the government takes control and puts more regulations and more restrictions how will I provide for a family let alone myself? The focus is on the wrong guy, we are not the scapegoat here and we are not the problem! Take a look at insurance companies and how the keep reimbursing less and less every year! As a professional if you told an attorney that you are only going to give him 30% of the bill and he will have to live with that…NO they are able to charge what they want because they have earned the right.

Over the years there has been a shift of the earnings, insurance companies take to money that doctors earned (the pp that do the work) and take it as create a “administration fee” and now create positions in the company that make as much if not more than the physicians that did the job! The government needs to stop paying attention to the lobbyists that make sure bills against insurance companies do not get through and start talking to the ppl that provide the healthcare and ask them how to make the system work more efficiently and effectively!
1. Create legislation that protects doctors from lawsuits! One reason health care cost so much…every pts gets the “kitchen sink” workup B/C they are concerned about protecting from getting sued by the families we work night and day for! If the system allows physicians the ability to make calls on what diagnostic test/blood test/imaging studies to give the patient…it would cost less the patient would get the treatment sooner and pay the doctors what they earned and stop this steady decline of withholding payments by insurance companies. For example 10 yrs ago a surgeon would make $3,000 for taking out a gallbladder and NOW the only make $300 while the cost of time and supplies and overhead (ie paying the surgical techs/nurses..ect) cost more than that in some cases the surgical nurses and techs make more on a case than the surgeon himself and with that $300 it is their patients meaning if something happens and the patient sues the surgeon and NOT the techs/nurses/PAs on the same case. Doctors need to be compensated and insurance companies need to be regulated on what the feel like reimbursing the physicians for their job! NO other profession has a system where we can charge a fee and you can only pay a percentage of that price and the professional has to accept that as payment! If you only give a mechanic 30% of his charge they will sue and screw your credit as well…BUT not in the medical field when it comes to paying physicians!!

2. With the Obama’s plan on healthcare our incentive and earning potential that makes all the sacrifices worthwhile will be eliminated and there is no plan to 1. lower the cost of tuition 2. lower the interest rates on the loans and make more government loans available so we do not have to go to private grad-plus loans with even higher interest rates and make more subsidized loans where the government doesn’t allow the interest to build while we are in schools! If you lower the cost of education along with the earning potential it will lower the difficulties we face once we are out, one of the main reasons ppl go into specialties is because we have this huge debt to repay and family medicine will not cut it anymore! I think it will eliminate all incentive of being a good doctor and putting the patients needs first and instead create a field of doctors who’s main concern is seeing enough pts in a day to keep our heads above water with overheads and insurance.

State of Medicine:
From what I can see from the past 2 ½ yrs in school no doctor has the time needed because there are protocols that need to be done so they can get paid for the visit, there is no incentive to listening to the patient they just get the chief complaint and start the process with diagnostics/labs/other studies without even taking the time to do a good history and physical where we are taught 90% of all diagnosis can be made with a good history and physical exam. If we are reimbursed what we should get paid and put the power back into the doctors hands that would give us the freedom to make the diagnosis and go forward on treatments instead of useless test and studies that tax healthcare! The government who knows nothing about medicine is and what it takes to care for someone’s health should not try to institute a program that will put more restrictions on a doctor. The plan may work in the presidents eyes but the practicality of his system will not work, talk to any doctor and they will tell you the plan will not work and just create a system that might allow more people to have healthcare available to them BUT the quality of healthcare will go way down and over work physicians. Not to mention with so many more ppl in an already overcrowded office will not allow proper training of students and further downgrade the quality of physicians practicing!

From a concerned 3rd year medical student!

Dr. Gupta, in this reform does it cover all health issues, such as dental and mental, eyes. This is all related to your health, and it can make you very sick, such as infected tooth. thank you

I just viewed Anderson Cooper 360 "Health Care Reform".

I have two questions for you:

What do you believe is the best choice for the majority of Americans: keep the "system" we have, universal healthcare as proposed by Obama, or a socialized system. I understand each has its pros and cons but I would like your take.

Everyone talks about the U.S. healthcare "system" yet in truth healthcare is an industry of competing companies (insurers, soft and durable medical supply vendors, hospitals, physician groups, etc) that ultimately operates not to improve health but to make money. If there is no profitably in healthcare the industry collapses. The healthcare system we Americans talk about is an illusion...it doesn't exist. Perhaps if we could as a nation understand this, we would understand attempts to reform are difficult since our healthcare is entrapped in a free market, capitalist industry in which profitability and answering to shareholders is the goal.

Dr. Gupta,

I don't understand the words "free healthcare." If someone gives my a twenty dollar bill "free", it means that I did not have to produce anything to get it. However, this somebody had to do something in order for me to recieve it from him. Are doctors going to work for free - doubtful in most circumstances. Is the U.S. government going to start selling goods and services to produce funds for our "free healthcare"? Where will the funds come from and who will have control over how these funds are used?
Canada has agovernment healthcare plan, and from what I hear, there are too many patients using this benefit for things that arent absolutely ncessary clogging the lines of more essential care.

There does not seem to be enough emphasis on cost control in the healthcare debate. What is the cost of malpractice insurance in total and as a percentage of total healthcare expenses? How much wasted cost could be saved with liability caps?

Why doesn' the government allow me to use pretax dollars (IRS Section 125, or the commonly called "cafeteria plan" provision of the tax code) to purchase health insurance that is mine and not tied to my job? I would not have to fear losing my health insurance if I lost my job or fear having to pay a penalty in the form of COBRA, and I would not have to worry about "portability", previous condtions, or waiting periods. Right now I am penalized if I do not take my company sponsored health insurance even though I do not care for the plan or it's particular limits.

My mother has had 3 strokes in the last 2 yrs, under the age of 50. She had some scans done that revealed that she has a major vessel in her brain that is partially blocked and her neurologist says that this is the cause of her strokes. She needs surgery to correct this. Without the surgery she could have another stroke at any given time and it would likely cause even further permanant damage or worse, be a death sentance.
She is currently living on disability and gets state insurance . She just got a call stating that medicaid/medicare will not cover this surgery and that it is "too expensive". The neurologist is willing to waive all surgeons fees (do the surgery for free) but the hospital will not waive thier fees and my husband and I (or anyone else in my family ) do not have the 200,000.00 to pay for it.( we would, in a heartbeat, if we had the money)
I am afraid for my mom's lif and not sure if there is anything that can be done to get this surgery performed. Not sure where to turn, not sure if this is a fight that can be won? This isn't right. isnt there a committee or something , in which we could pleed our case?

The reason for the high cost of medical malpractice actice would seem to be the amount of malpractice that occurs:

*Doctors spend too much time as bookkeepers, and not with patients,

*Insurance company limitations prevent appropriate procedures,

*Competition, instead of cooperation, means that groups of salaried physicians like those who cinduct the Cleveland Clinic are not working together elsewhere to fully care for their patients.

he solution to tort reform, I would suggest, is to establish a true Hippocratic system that reduces the number of torts- instead of the hypocritical insurance insdustry that wants to subsidize them!

My question is why 30 or more other countries can handle having National Healthcare, yet our 'advanced' country cannot? I wonder If it's that we just don't care about 50 millionwithout health insurance? Or is it because business just won't allow a sensible everybody in-nobody out system to exist. With 14,000 losing their health insurance every day and the insurance companies doubling their premiums every ten years, it appears that we are ready for a grand crisis of crisis. This right about the time a panepidemic might very well occure. This issue is not going to go away after the meager Public Option or no change is brought in. People just won't put up with it. I'm hoping for honesty and support from the media to help get a fair and equitable health plan that covers all Americans.

Fortunatly, as part of my retirement I received free health insurance. Does the new plan affect this in any way or will I still have it?
Thank-you.

How will the different proposals affect t he situation where an employer provides the opportunity to buy health insurance but no subidy at all. It is pre-tax under a 125 plan, but unaffordable for most.

Will employers be required to provide some subsidy?
Will employees be able to choose a public option if they cant afford the plan available but too expensive thru employer?

I think that people definitely need greater access to healthcare, but the proposed plan is definitely a bad idea. Our national debt is already out of control. Our grandchildren should not be burdened with having to pay for this. There has to be a better way.

Nothing is free!! Either you pay for it once or you pay for 10 times!!

The best way to have a health care system that will take care of you is for you to pay for it; for you to take care of it. The more directly you fund your health care system the more directly your health care system can take care of you!!!

That is the REAL Free Market System at work... Anyone that tells you that they will take care of your health care if you pay him every month and that person is not YOUR doctor or, YOUR hospital that person is a crook!!!

ANYONE!!!!

I have a friend that has millions of dollars of hospital bills and still climbing. That sounds like a lot. It is for one person, but not for the nearly one million people who live in his county. That would be 2 dollars each. Now how many of that bill for millions of dollars are the result of letting the insurance company and Medicaid and Medicare dictate the price of health care?? Don't they need a high priced heath care system to justify their high premiums that your employer can no longer afford? Do you think they set the price high or low? Look close. Are they paying that bill or adjusting it away?

If each of us would pay toward the cost of taking care of the sick and injured among us, we all would be richer and healthier... he is not just your doctor he is your neighbor; take care of him so he can take care of you and your family if the need arises. He IS THE REAL GOOD NEIGHBOR. And he doesn't cost anywhere near as much if each of us pays him every month.

It is not that complicated. I am a small town boy in the big city. Maybe you city folk need to slow down and use a little third grade math. General Motor ain't suppose to go out of business. The only way that could happen would be somebody must be stealing....A LOT!

In the hospital all you see is doctors and nurses. No Medicaid, Medicare, or Insurance companies. Never seen a blue cross, or blue shield, never seen a Met Life, wouldn't know a Aetna if I did see one. United Health Care with its 122 million a year CEO never seen 'em.
All I see are tired doctors and nurses. Why not pay them? DIRECTLY!! You could save 90% of your cost right. No Medicare, no medicare, no insurance. We sent a man to the moon. We can do anything we decide to do!! We are Americans! We do no follow, we lead. Any nation with a national health care system will be bankrupt in 20 years, it is unsustainable!!

We need to change our approach. We are not helpless. We all have cell phones, that is an engineering marvel yet the majority of us can afford one or two or three. But we cannot afford to fund our hospitals? That is absurd!! We have billion dollar stadiums and arenas that are usually empty!!! Why can we not simply pay for our own health care like we pay for our own fire departments!! Directly!!!
The city provide the fire protection, so we pay the city, the hospitals provide the health care so lets pay them. It is just that simple. I don't know why no one else has thought of it... or have they??

I am a 62 year old female who has a history of breast cancer. Why is the pre-existing condition not valid for 5 years. People with pre-existing conditions NOW need insurance NOW not in 2014. Sure I can buy insurance but I have a 5 year waiting period and my premiums are sky high. Not old enough for Medicare to take care and can't afford the coverage. Why?????

Hello.......I have a friend that has millions of dollars of hospital bills and still climbing. That sounds like a lot. It is for one person, but not for the nearly one million people who live in his county. That would be 2 dollars each. Now how many of that bill for millions of dollars are the result of letting the insurance company and Medicaid and Medicare dictate the price of health care?? Don't they need a high priced heath care system to justify their high premiums that your employer can no longer afford? Do you think they set the price high or low? Look close. Are they paying that bill or adjusting it away?

onlineuniversalwork

How will the healthcare reform effect Physician Assistants

I retired @65 & 10 mos., My wife, never worked, was on my health ins. and is 4 yrs. younger. She went on Cobra, and is going to expire 4-1-10, and needs 10 more mos. of health ins. ( we're upset)
we were told when i retired that she would get 36 mos. of cobra, after two years they say she was done. we ask how come? and they said because when i turned 65 and it starts then, not when i retired. i will be 68, 4-24-10
Are they right?? In other words dose she get 36 months from my birth date, or when I retied which 1 yr later. I was working for 10 mos. after my 65 birthdate, and payed medical Ins. at work.