Wednesday, June 06, 2007
Voting for better health care
Some of the biggest highlights from the Republican debate last night revolved around immigration and the war, and even religion. Lightning actually interfered with Rudy Giuliani's microphone as he answered a question about his support for abortion rights. That was a little unsettling. Still, something else caught my attention. Sen. Sam Brownback reminded us that "the leading cause of fear in America today is that you'll get cancer." He went on to say, "This one is actually within our reach and it something we can go at and we should go at, and it touches a lot of Americans." That is so true. In fact, it even touches a lot of presidential candidates.

Sen. John McCain had melanoma, and Elizabeth Edwards, wife of Sen. John Edwards, has stage 4 breast cancer. Giuliani has a history of prostate cancer that may have been the reason he dropped out of his senate race a few years ago. Sen. Hillary Clinton's mother-in-law died of cancer, and former Vice President Al Gore (who has not announced) lost his sister to cancer years ago. Former Sen. Fred Thompson, who is widely anticipated to enter the race, has a type of lymphoma.

Last night, we finally started talking about an issue that is a concern of millions of Americans - health care. Former Wisconsin Gov. Tommy Thompson had the numbers at his fingertips. We spend 2 trillion on health care, which is 16 percent of the gross national product, and 93 percent of those dollars go into caring for someone after they are sick. Less than 10 percent goes into actually keeping people well. Thompson's plan focuses a lot on shifting money toward preventive care to cut costs in the long run.

In the United States, we pay the most and get the least of any industrialized nation, with regard to our health. Most of the candidates have some sort of plan, whether it is heavy government subsidies, requiring employers to help finance health care or even raising taxes. Some even want to appeal to the pharmaceutical companies to drive down prescription drug costs. What do you think? We have had a broken health care system for decades. Is it fixable and how do we achieve that?
Hi Dr. Gupta,
Our health care system works really well if you have plenty of money! Medical insurance is outrageous and so are the cost for prescriptions, doctors, hospitals, and anything having to do with health care.
Last year I was climbing a mountain in Mexico where millions of Monarch butterflies migrate and I had an accident, falling and dislocating my shoulder and breaking my arm. I was rushed to a local hospital where I had to be taken into surgery. Since my insurance card was no good in Mexico, I gave them a credit card. YIKES! I just knew I would owe thousands and thousands of U.S. dollars but lo and behold, the total was only a little over $300!!! That was including emergency room, X~rays, anesthesia, O.R., meds, and doctor's charge!
What a deal! I spent more than that in one visit to my orthopedic surgeon back home and I also spent that much in one week out of six months of physical therapy even with medical insurance!
Health care in the U.S. must be available and afforable for all the people. I am not smart enough to know how to fix the problem, but you don't have to be a rocket surgeon to know it's broken.~
When talking about the broken health care system, I think that it is important to note that "health care spending" is an umbrulla term for the rising costs that are fueled by insurance premiums that have been rising at rates 2-3x the rate of inflation, asronomical pharmaceutical costs that pay more for advertising than for research and development, and the cost of frivolous liability law suits that have no legal standing and yet are filed anyway n the slim chance by lawyers for a big payout. Its no wonder that the costs of "health care" have gone up. How can we hope to curb the costs of health care when those costs are being determined by profit driven companies that have created an economic niche that is not determined by supply and demand, WE NEED HEALTH CARE! As long as these companies can continue to raise rates at their own discretion the costs wil continuew to go up, and who will take the blame, those who are actually health care providers that are the face of health care. Please remember that thse who provide health care are the good guys, they want what everyone wants, that is for every person in the U.S. to have access to quality afordable health care.
Unless we can achieve universal (state paid) healthcare, I believe the reforms need to begin with cost. A sliding scale that takes income into account would be a start for prescriptions and insurance. We also need federal legislation requiring protections for people with pre-existing conditions to be eligible for insurance coverage. We need the consumer-company relationship to be health conscious so a good consumer is a well-informed consumer. If I had my way, anyone who paid income tax would have health care coverage, and McDonalds would have surgeon general warnings about its risk to people's health. We live in a consumer-based, capitalist economy wherein only recently have corporations become aware of the fact that if they keep their customers alive, it's better for business. I think a revolution is possible and necessary for the improvement of healthcare in the US, and it will take a president who understands the bottom line to be the human cost rather than the gross cost to fix it.
Paging Dr.Gupta,
FYI Laura Bush is a smoker.
Health tips from her???
Although I do not personally have a plethora of stories to tell that relate to every single post, I will agree that the US seems to pay the most and get the least. I believe wholeheartedly in preventative medicine, but that requires quite a bit of work by the person, and last time I checked, a lot of people are pretty lazy.

Drive down drug costs? How about we figure out the cure for things as opposed to better ways to oppress the symptoms!? I'm aware that is the goal of many a research scientist; it is my personal goal as well. But I do not really believe that our system is fixable simply because it is corrupt. A complete overhaul is in order and I just do not see that happening- there is too much money to be made by the bigwigs. And they're awfully greedy.
Health Care needs to become more centralized where the top surgeons, hospitals account for the most volume. This will reduce costs across the board and allow for the most successful outcome to occur the first time around. Medical students will also be learning from the most competent and passionate doctors. St. Judes Children Research Hospital and the Mayo Clinic are excellent examples. We will be left with the most competent advice and results and when Cancer is the disease we all deserve nothing less but the best advice, doctors and researchers for care. The NIH's Research Budget needs to be dramatically increased as in the Hundreds of Billions of Dollars. That way many of these diseases end up being cured or managed. Universal HealthCare can be achieved going this route. If our elected officials can have healthcare then all of our citizens who elect and pay for these people should be entitled to the same exact policy choices and care. The American Public deserves nothing short of this.
I spend a lot of money on health insurance for my employees trying to keep them and their families healthy. If I could reduce those costs, I could use that money to invest in more equipment and facilities and hire more people. That would increase the income taxes and help pay for lower insurance rates (if it was applied to health care). Now the candidates want employers to finance more health care costs.
I'm not an economist, but that sounds counter productive to keeping people busy and paying taxes.
I agree with the last post, that the industry is driven by greed. I personally can't stand for the mentality 'what's in it for me.' But lately I think the government is interested in helping the rich get richer. Such as outsourcing jobs to other countries and yet they ban Americans from getting cheaper drugs from Canada. We'll just have to see how the next presidency goes since I don't think the current one won't make any good changes any time soon.
Well I'm glad the discussion is now starting to take center stage amongst our politicians. As a provider, I feel that delivering quality preventative health care will be at the forefront of this new health revolution. It will be a slow gradual transition but inevitably, the insurance and pharmaceutical companies will find new ways to slowly transition their profits into preventative health care. I'm actually quite curious to see how they are going to figure that one out.
Our health care system gives preference to people who can afford to pay. The question is, should health be a commodity that people can buy as it is in the US now?
There is not need to reinvent the wheel. All major industrialized nations have some from of universal coverage for their citizens. We should not be too arrogant to examine what works elsewhere and might be implemented here, might make a lot of trial and error unnecessary.
I really don't think we need to develop something from scratch. All other major industrialized nation have some form of universal health care. We should not feel too proud to shop around and see what works elsewhere.
There are socialized medicine programs, where the government basically runs health care as in Great Britain or social insurance systems like in Germany, where all citizens under a certain income are required to participate in a health plan, whose benefits are regulated by the government. Preventive care is encouraged there. Those are just two models I am familiar with. I am sure there are many other ways to assure health care for all citizens.
We don't need to reinvent the wheel and make all our own mistakes if the bugs have already been ironed out elsewhere.
I would like to commend CNN for having an asset like Dr. Sanjay Gupta on the team. I think he is utterly fantastic, and now after finishing up his book, I'm even more aware of what a great man he is! Of course, I feel like becoming an OvoVegetarian that only eats sushi coated in tumeric (of which I only eat 80% of) playing chess more than I already do, and getting off my motorcycle. THAT'S not likely to happen so I guess I'll just slow down. But I absolutely love his segments, I love his advice, I trust what he says because not only does he come across as being very well versed in what he is talking about, he comes across as a genuine human being who truly cares about other people and also wants to make them understand how to make their lives better.

I'd love to see more of Dr. Gupta on CNN! Of course, I'd also love to meet him in person (I don't think I'd be able to talk, which is a monumental thing to say about myself), but I live in New Jersey so that's not likely. My goal in life? To be a research scientist, to study the cause of mental illness. I'm a Chemistry and Biology double major right now, and one day, I hope to be as proficient in my job as Dr. Gupta is in his. To be able to help other people the way he does in both his practice and on CNN? Yes, that's exactly what I would want to do. Bravo, Dr. Gupta! I'm in your cheering section over here :)
It is not the government's place to provide healthcare to it's people. People should have the responsibility and accountability to take care of themselves. I totally agree that insurance and pharmaceutical companies are totally out of hand. If the government takes over the role of these companies it will only get worse. If you're unhappy with the government now, why in the world would you want to give them more money and more control over your lives? I don't want to be forced to pay for someone's healthcare who has sat on the couch and ate junkfood their entire lives. It's simply not our responsibility. It's our own responsibility to take care of ourselves. That's freedom.
Hi I was wondering if you could explain the universal health care system available in one of the present european countries. Why is it that they can do universal health care including Canada (?) and we can't??? Why isn't it possible to drive down prescription drug cost? why does drugs cost less in india and spain when compared to the us??
I am thankful that Senator Brownback brought up cancer in the GOP debate. However, most people are not aware that, he, does not hasten to boast that he is a cancer survivor, yet he does not back his words up with his voting record. Senator Brownback has consecutively voted against an increase of funding for the National Cancer Institute, which supports and fosters the latest discoveries in cancer research. Regardless if we fix the healthcare system, if we do not sufficently fund NCI and NIH, there will be no new treatments or prevention services for people to take advantage of. Senator Brownback has been a hypocrite and needs to start putting his votes where his mouth is.
I just spent an hour and a half last night in a forum presented by our past State Goverenor of Oregon, John Kitzhaber. For those of you who aren't aware, he is also an MD...what better reference could we have? He IS suggesting that we need to start over on our health care system. It IS outdated and becoming useless. It is expensive for us all, in one way or another. We are either paying high cash prices, if we can afford it, or, we are paying high health risks if we can't. I have to agree with him...CHANGE is necessary for our survival! The old "key" no longer opens the "new lock" on the health care door. We need to try another key instead of just working harder and sweating more to try to make the old one work! Dr. Kitzhaber says this doesn't take more money, just more creativity and initiative.
I retired a little early because of severe burn-out. I have two small pensions that I started receiving early (that means less money). The company I worked for offers what they call pre-retiree medical insurance. They pay some of the premium, and I pay the rest. For my wife and I, the new premium that I pay for us just went to $10,100.00 per year! I still have copays and so on above that. Thank God that my 401K did well! The premium takes all the pensions and then some. Where will it end?
I am a significant member of a significant household who lives on a significant street in a significant town. This significant town is in a significant county in the significant state of Tennessee, but the significant country of the US has forgotten to fund research for a significant disease called Cancer. I was amazed to read that cancer research has been “cut” by almost 12% in the last several years. What if cancer was a terrorist nation who had invaded us? What length would we go to rid ourselves of this terror? Cancer is my “War on Terror” and I am hear to tell you it is the war of several significant people in little and big towns all across this nation! I challenge anyone to find someone who does not know a person effected by cancer. My doctors told me ‘it could be environmental’. They said’ it could be in the foods we eat’! Is this not terror? I read that 1500 Americans die of cancer each day! Do we just except this number as part of life? What if a terrorist put something in our food or our environment that killed 1500 people a day? We would put BILLIONS of dollars into finding out what was killing Americans. Terror is every time you fill an ache or pain--- you have the thought that “it’s back”. Terror is trying to be strong when you are facing an enemy you can’t see and does not play by the rules. Terror is reading that Oncologists met in Chicago and the chemotherapy you have just finished --- nicknamed the “red devil” probably did nothing to prevent this terrorist in me from coming back--- but could have put me at risk for heart failure and leukemia. Terror is seeing people who can’t pay their medical bills. In these significant little towns, we have “benefits” for those people. These benefits raise $5,000 to $10,000---which is significant if you personally don’t know the cost of cancer treatment. We live in what is supposed to be the greatest nation in the world and we can’t keep a twenty-seven year old mother of a five month old from worrying about her bills while she is fighting. I keep hearing politicians saying, “we are fighting the terrorists over there so we don’t have to fight them in our own backyard”. Well wake-up Washington! We are fighting terror over here and it’s in the backyard of many significant “little” people all over this nation! Fund Health Care! Fund the real “War on Terror” ---Cancer Research!
Dear Dr. Sanjay Gupta,

Funding wise, all candidates explained health care reform very well. And structural explanation of health care reform is well too. I personally found that Hillary Clinton and Ex-Major Giuliani gave the best accurate and structural answers keeping in mind: 1. the health care administration & health care policy and 2. the free healthcare and pharmaceutical market. These two major elements guarantee the financial success and structure of the US health care system on state level (Ex-Major Guiliani has much more state experience than any other candidate).
Obama’s point of view on health care reform indicates a major shift in power structure in larger scale federal and nationwide level: not every State government in the US will successfully adapt to this major change overnight (example: Massachusetts and California), because each state differs in wealth distribution, employment and population structure (American citizens and illegal immigrants). Some health care administrators argue that it will drop the health care spending drastically and create shift in the type of quality of healthcare offered. Others believe that a National health care reform can only survive if it is adapted in a cumulative approach one or a few states at the time.
I have the unique perspective of having been a physical therapist and patient in two differing health care systems.

Ten years ago in the UK my experiences as a patient involved waiting much longer for care, not having immediate access to high tech diagnostic services or treatments, and not having some options available at all. I was transferred between three different hospitals before one was found that could manage my condition, and when I got to the third one, the only doctor that was familiar with my diagnosis was in the US at a conference. I shared a ward with many other patients (men and women being separated by a partial wall at the one facility) and shared one shower, two toilets and one phone with the entire ward. Though there was a definite lack of privacy, the staff and patients/patient families around me went above and beyond to help out the little american girl that didn't know she was supposed to provide her own toiletries and didn't have any family in the country to bring in some. I thought I would hate being in a ward right next to other patients, but actually found that the support and company was great. I almost never watched television and getting up to play cards and have tea with other patients was commonplace. I spent very little time laying in bed. At the end of the stay there was no bill and no insurance paperwork to fill out.

In the US I was admitted with the same diagnosis. The ambulance bypassed the small hospital closest to me and took me straight to the most appropriate hospital for my condition. I had immediate access to lots of high tech testing and the lastest in treatment. There were several physicians who had experience with my condition. I had a private room, my own bathroom and phone. It was more than a bit lonely, and I had minimal social contact other than the occasional visitor, rare and rushed interactions with nurses and physicians and no contact with any other patients. I spent much of my time in bed watching TV and becoming deconditioned. The hospital supplied tooth brush, paste, shampoo. The food, albeit not great was much better than that in the UK. There was lots of paperwork, negotiation with the insurance company, and a rather large bill showed up about a month after my discharge as my portion to pay.

As a care provider in the UK there were much lower expectations for the number of patients I would see a day (about half what I see here in the US). I regularly worked a 40 hour week and got breaks and lunch every day. The patient load expectation gave me the chance to spend a sufficient time with each patient and really meet their needs when I saw them. It was very difficult to get any special testing or equipment for my patients. The patients seemed to be happy with the care I provided and very understanding that the limitations were from the system. I never had a patient or family member scream or yell at me, I never felt threatened or abused. The pay scale was not a livable wage with my student loans from school here in the US, so though I would have loved to stay and continue to practice in the UK, it wasn't a doable thing for me.

In the US I regularly spend 50 to 60 hours a week at the hospital and still don't see all of the patients that are on my schedule to be seen. I regularly work through lunch. I do much of my charting at night at home after dinner. I have lots of equipment available for use, and can get specialty services and equipment easily for those patients with insurance. For those patients without insurance the options are limited and often depend on the generosity of others or the hospital shifting the cost of caring for the uninsured to the insured by increasing the bill for the services provided to them. Patients have a much higher expectation for the immediacy of their care, even for non-urgent issues, and are much less tolerant of sharing their space/equipment/caregiver time with other patients. For the most part patients are pleasant, but at least daily either myself or one of my co-workers are yelled at, verbally and occasionally physically abused by patients and family members.

If we really want to have heath care for all, then that may mean that we cannot provide all the care desired by everyone. In the UK care is rationed so that everyone gets something, but no one gets everything unless they are willing and able to pay out of pocket. In the US we ration care by having some people that can get everything and some people that get nothing. Though the UK system has it's faults, I had a much better experience there as both a patient and a caregiver than I have had in the hospitals I have worked at in the US.
There are a lot of people who do not have insurance at all. Americans are afraid to get medical attention when needed because of medical expenses. They do not seek medical attention for minor illnesses, and it turns into major illnesses. Even if they have medical insurance, they are overwhelmed with copayments, deductables, and things that are not covered by insurance. Sometimes, their insurance is even maxed out before they receive all of the treatment that is required.

If we had socialized medicine, people would get the care that is needed. Minor illnesses would be treated, before they become major. Therefore, it would cost less to treat them. Everyone would get the same care regardless of what kind of insurance they have. People would not be turned away, because they do not have insurance.

Taxes are taken out of our paychecks for medicare. This is to take care of the elderly. Instead, why not take it out of our paychecks so everyone has medical coverages? Other countries have it, so why can't we?

As far as I am concerned, the medical field is all about money. It is big business.
Tommy Thomson made good points as did Rudy Giuliani.Steve Case-founder of AOL and has undertaken a major effort in improving Health Care,motivated partially by his brother's tragedy.
The initiative of a 16 years old Ian Duncan is worth reading.The story appeared on 6/12/2007 in KC Chronicle.
Details: gives more information
Rudy's point that Government and Insurance co.have messed up Health Care in America--Preventive Care is not encouraged.
Katie Couric said in her evening news that 33 States get D or F grade for Insurance coverage of COLON CANCER.Preventive Care of Colon Cancer is far cheaper than terminal care.Inspite of Katie Couric's efforts--Colon Cancer Screening remains below 60%.What a shame!!!!
Hope you will cover Ian Duncan's Story as it shows a determination to "GET BETTER" and"LIVE FULLY".
Preventive Care needs to be given top priority---and initiatives like Ian Duncan's need to be encouraged.Here a 16 years old has undertaken a major effort on Crohn's Disease and has found sponsors like Dr.Tarun Mullick to fully support for CURE and PREVENTION.
There was an article in KC Chronicle on 6/12/2007 about Ian Duncan.
Dear Doctor Gupta,
I lost my mother very unexpectedly due to heart disease. Her symptoms were migraines and gastro-intestinal problems. She went from doctor to doctor, and they could find nothing wrong with her. They did not listen to her or take her seriously. Some of them even told her it was all in her head. She died at home, alone, and I found her on the living room floor. The autopsy found that she not only had severe hardening of the arteries, but a foramen ovulae as well. She was 58. Not a single one of them checked her heart. Heart disease is the number one killer of women, and this is why. The change I propose most is treating women equally, and giving them the care they would a man. If they had, she'd still be here today. Thank you.

Francesca Markus,
Scottsdale, AZ
The woman in Scottsdale,Arizona must have gone to "Wrong" doctor--my friend in that city also went to an Internist/FP--who misdiagnosed his illness to the the wrong cause--two months later--he went to MAYO Clinic in Phoenix,Arizona and they discovered that he had last stage LUNG CANCER--he died in 4 weeks.
Many FP/GP misdiagnose--and do not admit the fact that they should do other friend could easily afford those tests from his pocket,although he had medicare and United Health Care supplement.FP/GP was TRYING TO LOWER HEALTH CARE COST.
SO if you have money--unless you know a top doctor--you could meet the fate my friend did.THERE are GOOD DOCTORS and BAD doctors--THEY CHARGE the same--but they do not keep up with the new problems/testing/diagnosis.
One hears of horror statistics about 40% missed Stroke attack cases by ER and other GP/FP in most advanced country like US.
My suggestion is: to see a Neurologist or Heart specialist or Cancer specialist if you have a problem.For Stroke--ask for Neurologist--get a CAT Scan or MRI .
Health care is in trouble because of Insurance Companies emphasis for illnesses and NOT PREVENTIVE CARE.IF EVERY INSURANCE co. paid for an annual or once every two years complete Physical Exam--health care costs will go down.Prevention or Early Detection saves lives and expensive care is lowered.
Diabeties,Heart,Stroke,chronic illnesses account for over 60% of health care costs.
Health Care System in America has serious problems--Different people have different thoughts.
Tommy Thomson--Push for Preventive Care--I agree.
Michael Moore-Cut the middleman--put it between Doctor and Patient--I agree.30 years ago,we had a better system--between Doctor and Patient.Now doctor is being dictated and so is patient--like rules on precondition non coverage.
People are changing jobs more often due to changing Economy--so pre conditions become a nuisance.
Doctors are now programmed by middlemen and personal relation between Doctor-patient has become weaker.
Positive aspects--better technology,transplants,by-pass surgeries,better medicines.
Bad points--Dr.Grossman of Harvard found that he had to see 5 surgeons for his hand problem,before he got the correct diagnosis--first three were wrong-MRI's failed them--common sense helped the 4th young surgeon figure out the problem.Doctors have become bad listeners by the system.
Summarize: 1)Eliminate the middleman.
2)Push for Prevention.
3) Doctors should become better listeners.
4) Patients should take care of their health--Obesity,diabetis,heart condition,smoking,other chronic diseases can be controlled by listening to their doctor's advice.
5)Comparisons between French,Japanese with US will not help--they are not as obese and they listen to their doctors after standing in line for hours.
Get a behind-the-scenes look at the latest stories from CNN's chief medical correspondent, Dr. Sanjay Gupta, and the CNN Medical Unit producers. They'll share news and views on health and medical trends -- info that will help you take better care of yourself and the people you love.
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