By Caleb Hellerman
CNN Medical Senior Producer

The fight over changes to the health care system has been so fierce for so long, the turning points aren’t always clear. But for me, the past two weeks answered a big question: Are Americans willing to sacrifice their health care to try to hold down costs? To me, it’s clear the answer is no.

This question has been hanging over the debate all along. President Obama and Democrats in Congress are selling the bill as cost-control. Health care costs have risen much faster than wages or inflation over the past two decades, and these Democrats (along with some Republicans) say that if we don’t get that under control – soon – it will crush the economy, and force drastic cutbacks for all kinds of health care. Supporters of the bills say we don’t have to sacrifice, as long as we emphasize preventive care – catch problems while they’re minor– and if we’re more “efficient,” avoiding unnecessary tests and treatments. Just like that, they say, we can save almost $500 billion from Medicare alone. The Congressional Budget Office, the definitive bean counter, agrees.

But one person’s “efficiency” is another person’s “rationing.” That led to accusations about “death panels” and unelected boards withholding vital care. In fact, the bills do set out a big role for government experts to shape what procedures are covered by insurance. Many people don’t like this, on ideological grounds. Others, right or wrong, fear the government will be stingier than private companies that currently administer insurance for two-thirds of the population.

We were reminded recently that we live in a democracy - and that Congress doesn’t like controversy. This tension started coming to a head with something that wasn’t even part of the health care bill: a recommendation from a federal health advisory panel that said most women can wait until age 50 to have regular mammograms – instead of starting at 40, as most doctors now recommend.

Opponents of the health care bill, mostly Republicans, called this evidence that the federal government is hankering to ration care. No matter that the mammogram panel has no power over insurance – for weeks, members of Congress have been jumping over one another to denounce its recommendations and to say – in effect – that only over their dead bodies will there be limits on mammograms.

A few jumped the shark into outright falsehood, like Florida Rep. John Shadegg, R-Arizona, who asserted that the health care bill would prohibit millions of women from purchasing mammogram coverage. But the result was a Senate vote, 61-39, to expand preventive health screenings for women, and a unanimous vote to prevent the panel’s recommendation from restricting mammogram coverage – a non-existent power in the first place.

The details of the mammogram debate are beside the point. The bottom line is that the recommendations were deeply unpopular, and so Congress stepped up to avoid even the hint of limiting coverage. That’s a good sign for democracy, but it doesn’t suggest we’ll be cutting the cost of care, any time soon.

To see how your senator voted on amendments to the health care bill, you can click right here.

Do you trust the government or private insurance companies more, to decide what treatments should be covered?

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

By David S. Martin
CNN Medical Senior Producer

Talking about health care costs in July, President Obama asked this question: “If there's a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well?”

Many ophthalmologists believe there is just such a blue pill out there. Only the red pill’s not twice as expensive. It costs almost 50 times much: $2,000 compared with about $45 for the alternative. And Medicare covers both.

What are the drugs? The expensive one is Lucentis. The other, Avastin. They’re not pills, really, but a medicine injected into the eye every four to six weeks to treat age-related, wet macular degeneration, a leading cause of blindness in seniors. With monthly injections, the annual cost difference is $24,000 versus $540.

It’s a difference that we, the taxpayers, underwrite. Lucentis cost Medicare $557.3 million last year, according to U.S. Centers for Medicare and Medicaid Services. That’s a figure that could rise as the population ages.

Many retina specialists think Avastin works as well as its more expensive rival, Lucentis, and roughly half of the wet macular degeneration patients are opting for Avastin, according to Dr. David F. Williams, president of the American Society of Retina Specialists.

Not surprisingly, Williams says, Medicare patients with supplemental insurance that covers the 20 percent co-pay are the most likely to choose Lucentis. (Medicare recipients ponied up $142.7 million in co-pays for Lucentis last year, according to government figures.)

Lucentis received FDA approval in 2006. The chemically similar Avastin was originally developed to treat cancer but its off-label use for wet macular degeneration predates Lucentis’ arrival on the market. To make this tale even stranger, both Lucentis and Avastin are made by the same company, Genentech, a division of the Swiss drug giant Roche. Can you guess which treatment the company advocates?

The National Eye Institute, part of the National Institutes of Health, is now conducting a head-to-head comparison of the two drugs. Initial results are expected at the end of next year.

Should the government require patients to choose the less-expensive drug? How about if the clinical trial shows no difference between the two?

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

By Ashley J. WennersHerron
CNN Medical News Intern

Breast cancer runs in my family; even my dad had it. I routinely do self-checks, always terrified that I'll find some indication of my worst nightmare.

Two weeks ago, I did. I found a lump the size of a pea buried in the skin between my right breast and my armpit. I paled, I cried, I panicked about the future, and then I did the sensible thing. I searched the Internet. Typing "Right Breast Lump and 20-Year-Old Woman" into Google didn't reveal anything. Neither did "Breast Cancer in 20-Year-Old Girl." I fruitlessly searched every site I could think of, turning up contradictory results.

An hour into my self-diagnosis, it occurred to me to call a doctor.

Living away from home and my usual doctors, I called my insurance provider. After 45 minutes on hold, an operator listed four doctors in Manhattan that would accept my insurance. The first three were booked through November. The fourth could see me the week before Thanksgiving.

The thought of not knowing for nearly a month was unbearable. Tears welled up in my eyes and fear was obvious in my voice when I confirmed a time with the receptionist. She must’ve heard how scared I was, she told me that they could squeeze me in early the next day.

The next morning, after arriving an hour early, I was told that the doctor’s office was out of network for my insurance. They’d take me, but I’d have to cough up almost $200 just to be seen, and I’d have to pay out of pocket for testing –up to $3,000.

I was shocked. Something was wrong with me and I was getting it checked. I was being responsible. I had called my insurance company, thinking they would send me somewhere I could afford. Not only was I worried about a potentially serious health problem, I was also concerned that I wouldn’t be able to have it looked at because it was too expensive. It turned out that the doctor’s office was willing to work with me. Maybe they just wanted to get me, crying and hyperventilating, away from their other patients out of their waiting room. But they took me; they didn’t turn me away.

The doctor examined the lump and sent me for a battery of tests.  After being poked and prodded and monogrammed and sonogrammed, I waited.

Eventually, I was told the good news—a benign cyst and an inflamed lymph node. Two completely harmless conditions that I could have agonized over for weeks and weeks, if I hadn’t known what it could have been.

If you are truly concerned that you might be sick, get it checked out.  A lot more doctors’ offices than you might think are willing to work out payment plans. It’s worth knowing what you are facing.

Hopefully, it’ll end up being nothing, but if it is something worse, catch it as early as possible.

Have you ever ignored a health problem, because you thought you couldn’t afford to get it looked at? Are you putting off going to see a doctor because you don’t want to know if you are sick?

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

By Caleb Hellerman
CNN Medical Senior Producer

Last week I traveled with Dr. Sanjay Gupta to Levittown, Pennsylvania, to meet Chris Brooks, a recent college grad who survived an unexplained cardiac arrest that stopped his heart for more than 15 minutes. That he survived – and without brain damage – is pretty incredible, and probably a tribute to the CPR performed by his father and the fact that he was cooled by emergency physicians at the local hospital, and at the University of Pennsylvania, where he was transferred afterwards.

What caught my attention the other day came when we asked Brooks whether doctors had figured out what caused the cardiac arrest in the first place. It’s a life-or-death question; Brooks now has a defibrillator implanted in his chest, and in the past six months it’s been triggered to shock him twice. In other words, his heart is stopping for no obvious reason.

But he hasn’t gone for a battery of tests that might provide an answer. The reason: no health insurance. He was covered by a family policy at the time of his cardiac arrest, but no more. “What we’re dealing now is insurance,” Brooks told us. “I’m 22 years old and not in college any more, so I don’t have insurance. I can’t see [my cardiologist] now. I want to, I guess, but I can’t.” His doctors are looking for a way to make it work, but in the best-case scenario it’s delaying those tests by two to three months - a reminder that even serious illness can slip through the cracks of the current health care system.

Health care bills moving through Congress might make life easier for Brooks; they would let people under 26 still be covered on their parents’ insurance. But the bills would also place a new burden on those 26 or older, by requiring them to purchase insurance or pay a penalty. Critics say people should be free to take the risk of going insurance-free, if they like – or if they can’t afford it.

Are you under 30 without health insurance? Do you have children in that boat? What would you do if there were a serious health crisis?

Programming note: See Chris Brooks’ story as part of Dr. Sanjay Gupta’s special, “Cheating Death,” October 17, 8 p.m.

By Ashley J. WennersHerron
CNN NY Medical News Intern

Come May 2010, I may be forced to trade in my health insurance for my college diploma. The results of the ongoing health care reform debate may determine what happens.

My current insurance carrier, TriCare Standard, is common for military families. I am coverd by them until I’m 23 years old, or until I can no longer classify myself as a full-time student. If I continue through graduate school, I can keep my health insurance for two more years. The problem is that when I finish graduate school, I’ll have to work to pay off any loans. With the current job market, my chances for finding long-term work that provides healthcare coverage, are slim to none. Not only will I have to worry about loan payments, I will also carry the extra concern of finding and paying for a health insurance plan.

My predicament is a familiar one for most college students. About 20 percent of us are uninsured, according to a report conducted by the U.S. Government Accountability Office. For the 80 percent of us with coverage, our insurance will turn to dust soon after we flip our tassels to the right side of our mortarboards in May.

However, we can protect ourselves. We must learn the details of our current plans, and our options for the future. Insurance regulations vary state to state, meaning a plan based out of Virginia may strip me of insurance the day after graduation, but the same plan in Florida may allow me to keep my insurance until the age of 30, as long as no one becomes dependent on me.

President Obama’s health care plan calls for a national age limit of 25 years old before a person is removed from his or her family’s insurance plan, which would provide the time necessary to find a job and make a dent in loan repayments. Students and recent graduates might also consider short-term coverage plans with catastrophic caps, to be used for unforeseeable health emergencies. It’s something, but that type of plan doesn’t provide for the every-day possibility of minor injuries or common illnesses.

Consider moving out of the college dorms the day after graduation: You can accidentally cut your hand with the scissors you are using to cut tape. That’s an out of pocket expense for stitches. You could drop a heavy box on your foot. That’s another expense. The dust you inhale from under your bed may induce an asthma attack. There’s the possibility of an ambulance ride and a hospital stay, none of which is covered in a short-term plan, because it’s a pre-existing condition.

Are you a college student, or a parent of a college student, worried about your future health care insurance options? Are you a recent graduate who can’t find a job that offers health care?

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

By David S. Martin
CNN Medical Senior Producer

President Obama is scheduled to address a joint session of Congress tonight in an effort to breathe new life into his health care overhaul. Critics have gone after the cost of his proposal and claimed the president’s plan is a first step in a government takeover of health care. Central to this second charge is the specter of a faceless government bureaucrat standing between you and your doctor.

I thought of this the other day when a neighbor approached me, his voice shaking with frustration. He had just received a letter from Blue Cross Blue Shield, rejecting his application for health insurance. The letter was signed, if that's the word, "Sincerely, Underwriting Department L 24.”

What makes this case curious is that Blue Cross Blue Shield had been insuring my neighbor and his family for the past 15 or so years through his wife's state job. When she resigned to stay home with their 1-year-old, he never dreamed Blue Cross Blue Shield would not accept his application to purchase private insurance. After all, he thought, the insurance company was familiar with his family’s medical history. There are no expensive chronic diseases such as diabetes or expensive life-threatening ailments such as cancer on their record. My neighbor says he occasionally suffers from allergies. That’s it. His 1-year-old is healthy. To further confuse matters, Blue Cross Blue Shield accepted his wife and teenage daughter for health insurance.

The whole story sounded strange. I asked him if he’d mind if I called Blue Cross Blue Shield. Here is the response I got:

To protect the privacy of our members and their medical information, Blue Cross and Blue Shield of Nebraska (BCBSNE) does not comment on the specifics of individual cases. In general terms, however, each individual application for medical coverage is reviewed thoroughly and carefully, based on standard criteria which differs between individual and employer group business. BCBSNE accepts most applicants, but there are occasional denials based on health conditions and eligibility requirements.

I asked Blue Cross Blue Shield about L 24 and was told that’s not a person but the code for the form letter my neighbor received. As we listen to the president make his case for health care reform, we should remember “L 24” and know that the government does not have a monopoly on faceless bureaucrats.

Has a faceless bureaucrat ever stood between you and your doctor?

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

By John Bonifield
CNN Medical News Producer

It's a loaded issue - will health reform include coverage for illegal immigrants? President Obama has said no, with a possible exception for children, and the plans being drafted by Congress bar illegal immigrants. However, opponents say that the House bill leaves loopholes that may allow undocumented residents to benefit.

"There's no system for verification," said Ira Mehlman, media director of the Federation for American Immigration Reform, a lobbying group that aims to reduce immigration.

"On the one hand, they have language in there that says illegal aliens are not going to be eligible, but at the same time they're getting a lot of heat from the Congressional Hispanic Caucus, from the Hispanic leadership groups, that say we want everybody covered including illegal aliens," Mehlman said. "They're trying to have it both ways here. They're saying to the public, 'Don't worry. Illegal aliens aren't being covered,' and they're turning around to these special interests and saying, 'Well, don't worry. There really is no system to prevent them.'"

In July, Democrats voted down an amendment to the House bill that would have required mechanisms to verify citizenship. The Congressional Hispanic Caucus, which advocates on behalf of Latinos, said in a statement to CNN that health reform should include legal immigrants who have followed the rules.

"The issue of undocumented immigrants is a separate one that is too often used to confuse the health-care debate. When it comes to undocumented immigrants, the caucus' priority is seeing comprehensive immigration reform enacted," said Rep. Nydia Velázquez, a Democrat from New York, chairwoman of the Congressional Hispanic Caucus.

That's something Obama has said he'd like to see as well - immigration reform that would provide a pathway to citizenship - and legal access to the health plan.

It's estimated that illegal immigrants and their children make up about 17 percent of uninsured people in the U.S., according to recent data by the Pew Hispanic Center. Long-term estimates by the Congressional Budget Office predict that 17 million people will remain uninsured under the reforms of the House bill. Nearly half of them are projected to be illegal immigrants.

Tell us what you think. Should health reform include coverage for illegal immigrants?

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

As a regular feature of CNNhealth.com, our team of expert doctors answers readers' questions. Here's a question for Dr. Gupta.

From Cindy in Covington, Georgia:

“Why doesn’t the government make mandatory prices for doctors and their services? That’s the problem. They all charge outrageous prices and vary from place to place. Will that change in the new plan?”

Answer:

Well, first of all, Cindy, you're absolutely right. It’s amazing, even within Medicare you have widely varied prices across the country. One operation in one state might cost $6,000, but in another state, the same operation might cost $17,000. So it does vary even for those covered under Medicare right now.

We are hearing some of the specifics of these health care bills. Nothing has been set in stone but we're hearing that there may be caps on out-of-pocket expenses and full coverage for preventive care.

What we are not hearing are specifics about is whether there will be a set price for various procedures and tests. We asked the White House specifically about that and we were told no, there is no plan in any of the bills so far to set prices across the board, across the country.

The idea is that the government would have a public option for some Americans. This option is for people who can't afford their health care right now. And it's based on a percentage of their premiums as compared with their income. If your current insurance premium is 11 or 12 percent of your salary or higher, you might qualify to buy into this public option. And in terms of overall costs, a public plan would in some ways compete with private insurance companies and may influence how prices are set overall.

The bill being considered now specifies two interesting points in terms of costs. One is that no payment rates would be lower than the Medicare rates right now. Also they would not be able to set prices higher than the average of all plans in the so-called insurance exchange. “Exchange” is the term used to describe the system of private insurance plans and the public option that would come with reform. So there is no direct setting of prices for doctors or hospitals, but a lot of potential influence over prices in the long run.

Critics of the House health reform bill argue that the government plan will always get the better deal. It will always be able to negotiate better prices than private insurers because there will be a larger pool of people. Therefore it would be able to negotiate prices that will not be as low as Medicare but will be low enough that private companies won't be able to compete.  The administration will say this assumption that Americans will flood the public plan is not necessarily true because not everyone will qualify.

One thing I can tell you is that the specifics of the bill are likely to change in the days and weeks to come. I'll continue to break down the details and give you both sides of the argument as Washington works to reform our health system.

By Stephanie Smith
CNN Medical Producer

Three words - health care reform - have transformed the national conversation. And with the vigorous debate elicited by those three words - in Congress, on newscasts, on blogs, in opinion pieces, average Americans are coming out of the woodwork to tell their health-care horror stories.

One of those stories came to our health blog from P.J. May of Ohio, who is the primary caregiver to her 87-year-old mother, who suffers from Alzheimer's disease. A few years ago, before taking on that role, May was working full time, and had what could be considered a decent health-care plan through her employer. However, as her mother's health deteriorated, May made the tough decision to cut her hours to part time to help care for her, and with that she lost her health benefits.

Next, May. did what many in her position would do - she shopped around for private health insurance. She found a plan, but for her budget, the payment was going to be steep. You see, working fewer hours, May brings in only $700 a month, and $213 of that goes toward private health insurance.

May’s situation probably sounds familiar to many Americans who purchase private plans. She's paying an exorbitant amount on premiums, and on top of that, out-of-pocket expenses. In her case, premiums alone constitute about one-third of her income.

She, and many other bloggers, viewers and tweeters writing to us want to know: Will a new public health care plan be affordable for me?

"I don't know if Obama's decisions are going to help me or make it worse," May wrote in an e-mail to CNN.

To find out more about the cost of health care under a public plan, we pored over the 1,000-plus-page health care bill currently in the House with policy expert Kenneth Thorpe of the Rollins School of Public Health at Emory University in Atlanta, Georgia.

Thorpe crunched the numbers, and what he found may not match most people’s idea of “cheap.”

The uninsured, along with small business owners, would get first crack at purchasing a public plan, with the government providing subsidies to reduce costs.

Under the House plan, as it is drafted today, May's entire health care bill would be subsidized by the government. She would not pay a dime out of pocket for health insurance. So, for her, the news is good.

As income creeps above the poverty line, the cost of health care would also creep up, on a sliding scale. So an individual making $21,660 a year, according to Thorpe, would pay $1,083 under the House plan, while an individual making $43,320 would spend $4,704 a year, which is $392 a month.

The same goes for a family of four. At the lower end of the spectrum, a family of four with an income just above the poverty line - $44,100 - pays $2,205 under the current House bill, while a middle class family, making $77,175 a year would pay around $77,15, which is about $650 a month.

Ouch.

A caveat, however, is that those figures include co-pays and out-of-pocket costs.

Still, even considering subsidies, the cost of the public plan is concerning to some legislators. They say that the cost burden on the middle class is too high.

But Thorpe says to keep in mind that on average a family of four today pays around $12,700 a year for health care - more than $1,000 a month.

"[The public plan] sounds expensive, but it's thousands less than what the average family of four pays right now," said Thorpe.

What do you think? Does the public option sound too steep for your budget, or is this alternative better than what you're paying now?

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

As a regular feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From iReporter Jason in San Antonio:
"Four years ago my father was diagnosed with terminal brain cancer.  [For] 18 months we fought that disease with everything we had because we felt like every day was precious, every day we kept him alive we were one day closer to a cure for that disease. I guess my question is, under a public option or government run health care system, would that type of care be possible? Is it something that 10 years from now we're going to have to sacrifice or come up with a tremendous amount of cash to pay for it because it would be rationed under our government run health care system?"

Answer:
First, Jason thanks for sharing that personal story. Our best wishes are with you and your family. The idea of rationing really strikes at the core of all that we are talking about with regard to health care - this idea of lowering costs, trying to increase access. The question is, will we have to ration health care as a result?

There was a New York Times editorial a couple of weeks ago by Peter Singer, a bioethicist at Princeton University, where it was put like this: "The death of a teenager is a greater tragedy than the death of an 85-year-old and this should be reflected in our priorities."  Think about that for a second. He's saying we should assign value of life differently in certain situations.

Jason, we took your story specifically to the White House and asked them to respond. They said, "Our heart goes out to Jason and his family. We know families across America are dealing with issues like this every day. There are a number of different bills making their way through Congress right now but we do know this: The reform bill that the President signs will not lead to rationing. It will be fully paid for and bring down costs over the long term." They went on to say, that the President won't sign a bill that doesn't guarantee coverage to all people of all ages regardless of  specific health conditions.

But as you're saying, Jason,  it may come down to numbers and whether estimates of the cost of  health care reform are accurate. When Medicare hospital insurance was conceived in 1965, the House Ways and Means Committee projected that in 25 years it would cost 6 billion dollars. The actual cost? 67 billion, according to the Centers for Medicare and Medicaid Services. You can see how far off costs for Medicare were, based on initial projections –much, much higher. Now the president says they'll add prevention programs and wellness programs, creating a healthier population and that will be a cheaper population with regard to health care costs. But who knows? You've got more people that you're trying to cover; more people, more tests, more screening. How that all adds up, we're just not sure.