Thursday, January 31, 2008
Candidate health care plans
By Dr. Sanjay Gupta
Chief Medical Correspondent

As I have traveled around the country, it seems everyone is concerned about health care. More people than not think the system needs a major overhaul. An estimated 47 million Americans have no insurance. For others, it's an enormous financial burden. Families USA, a non-profit focused on affordable health care, predicts 18 million Americans under 65 will spend more than a quarter of their family income on health care this year -- and that's before taxes. And for some, the costs of medical care are catastrophic. It's the Number One cause of personal bankruptcy in the United States.

So what are the candidates proposing to do about health care?

Democratic candidates Hillary Clinton and Barack Obama each promise they'll provide access to health care for everyone. They would do this by expanding coverage for children and Medicaid for the poor. Also, they'd require most companies to offer insurance to their workers.

The big difference: Clinton would require everyone who wasn't covered by work or the government to buy their own insurance. Obama says that's unfair because buying your own insurance is so expensive. As a result, Clinton claims Obama's plan would leave out 15 million Americans. Both agree: they do not want a government run system like Canada or several European countries.

In the interest of full disclosure, I was a White House Fellow, a non-partisan appointment, in Hillary Clinton's office in 1997 and 1998 - three to four years after her health care initiative had been defeated.

Republican candidates (Watch Video) say the Clinton and Obama plans are too expensive and would add red tape to already-large bureaucracies. They're proposing a different approach. They want to increase competition among insurance companies to bring down the price of health care insurance. They also want to give individuals who buy their own health insurance tax breaks. In short, they want to use the power of the marketplace to make health care more affordable.

The challenge for the Republicans, of course, is what to do with people who still aren't covered?

So, which do you think will work? Using the free market and enterprise or expanding existing programs to cover everyone?

Programming note: Watch "Broken Government: Health Care - Critical Condition" tonight at 11 ET on CNN. The hour also airs at 11 p.m. Sunday

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.
I do not feel we should expand existing programs ... we should use the free market.

My husband says that Newt Gingrich has a great plan ~ I believe it's in his book, Winning the Future.
Once and for all put these politicians on the hot seat and demand they answer the question of why they are entitled to the best healthcare coverage and not the people who pay the tab
We need to get the insurance companies out of the picture for managing the financing and underwriting of the healthcare system. The way that Gulf Coast victims of hurricanes Katrina and Rita were handled, gives rise to grave questions on whether the insurance industry is financially and morally capable of handling of a major cotastrophie of a bird flu pandemic, should this arise. Back in 1976, with the Hyatt Regency walkway collapse in Kansas City, the major trauma hospitals in the area almost went under from the crushing load, for which the insurance companies had to make emergency disbursement to prevent financial collapse. In that case, the number of fatalities were in the vincinity of 100, and serious to critical injuries in the thousands.

Back in the 1930's, the life insurance participated in public health initiatives, like Metropolitan life. It is sorry that the situation is not the same today.
I'm self employed & have 2 boys with Fragile X Syndrome (form of Autism). I've been denied by health insurers (ie. Humana) in the past & now I'm with Anthem BC/BS Blue Access, but am forced to pay 2x what an average family of 4 would pay, just because of the Fragile X. (nearly $1000/month). We do not use the insurance for anything more than what a normal family would & in fact, most likely much less! The boys receive the services they need from their schools (mainly learning issues). I feel like I'm being taken advantage of because of their Dx. & I'm slowly going broke in the process.

Which candidate would consider a case like mine & do the right thing to help with my costs?
(or legislate the #@!#* Insurance industry so that they can't keep robbing ALL of us!!)
(P.S.-According to my "agent" there is nothing else he can do--uh--yeah...)
This comment appears in a slightly different form under the last CNN health topic.

The problem with Republican hand-waving to fix our health care system is that there is no such thing as "free and open competition" in health care, nor will there ever be as long as "insurance" equals "access to care" (which is unlike every other use of insurance in the world).

a. Federalism prevents free and open competition between insurance companies. You can't buy the world's best health care insurance if they don't serve your state. Thus, there's no real pressure to bring down costs, and no real ability to encourage efficient effective health care.

b. There is no "free and open competition" between hospitals and doctors and drug companies to create the economic pressure to reduce costs. This is partially due to insurance equating access, and partially due to the fact that health care isn't a consumable commodity, but a public service that cannot go below certain minimums. EMTALA (the law that requires that hospitals stabilize all patients who enter their emergency rooms, regardless of ability to pay) is an example of why there cannot be free and open competition. It is not acceptable to the American people to go back to having people turned away from ED doors because they couldn't pay. But this is also why hospitals cut ED costs and staffing whenever possible, because ED's are the biggest money losers for hospitals.

The problem with Democratic hand-waving to fix our health care system is that universal unrestricted health care for everyone guarantees abuse of the system (look at Medicare fraud), guarantees shortages in critical areas (see Canada or the UK for their wait times and problems with access to proceedures), guarantees a lack of providers (see what happens to Medicare patients today, when they can't find a doctor who takes Medicare who isn't already booked solid for 6 months), and guarantees that people who need experimental or new procedures won't be able to get them at all.

If Democrats try to regulate a universal system, they talk about doing it from the top down. Ultimately, that means that the US government gets to tell the citizen how to live (which, again, is what happens now to some extent in Medicare, and is what happens when you see insurance denying people coverage for pre-existing conditions). Edwards admitted this when he pointed out that there would be an expectation that citizens would have to agree to lifestyle changes to continue to have coverage.

What would I like to see? I'd like to see basic primary care covered for everyone under a single administrative system (doesn't have to be run by the government, but does have to be just one). I'd like to see funding shifted from high cost erectile dysfunction drugs to public health - enabling people to get exercise, decent food, vaccinations, and basic meds (HBP, cholesterol, antibiotics). I'd like to see insurance dramatically throttled back to provide for catastrophic events (remember, you only need auto insurance for crashes, not for basic maintenance).

Yeah, and I'd like world peace, too. Unfortunately, world peace is as likely as a real reform in healthcare.
Dr. Gupta,

This is a debate our country has been listening to for sometime now and good you are bringing it to attention. I believe that the government should provide health care for each and every individual, no matter what.
Even today for those fortunate ones who do have insurance know the plight of dealing with the insurance companies and how these insurance companies dictate our health care professionals. It is to a point where a doctor-patient relationship has become almost robotic, losing human feelings whatsoever. If this is where we are headed with all the latest medical advances, then what good are they, one wonders ???
Dr. Gupta,
How would implementing Hillary's plan or Barack's plan impact the salaries of physcians and other healthcare specialists. There are obvious qualms with "universal healthcare" The first being that the quality will suffer. Simmilarily, what will be the incentive for people to continue with their private insurance plans under either of these systems? Will it be that easy for to convince insurance companies to reduce premiums? Why would people pay more for private insurance if they can simply by congressional insurance? Will a disparity in care develop?
My name is Carol,
I was working in a hospital as a Nuclear Medicine Technologist. In 1993 I was injured stopping a 230 lb. patient from falling. I hurt my back. I did everything that Worker's Comp and the hospital asked me to do. Their surgeon committed malpractice and told me I was crazy and needed a psychiatrist. I then went to another doctor to get the problem fixed and he committed malpractice too. I couldn't and wouldn't sue for malpractice. It was all to much and I was naive thinking I would be covered by Workers' Comp and the government would protect me. 15 back surgeries later after the repairs and getting proper pain management that wasn't a ton of drugs my son and I ended up homeless. I am still fighting the case even though the judge's have found me 100% disabled. I was 32 then and now I am 46. Medicare has covered a lot of the expenses but now the doctor's are not wanting to see me. I can't get physical therapy and the proper care and I have been homebound for the last 3 years. If it wasn't for a wonderful Social Worker in the Housing and Opportunities Commission I would still be sleeping in my car. I have tried to get a Medicare Supplement and no one wants to insure me. The judge's salaries in the Worker's Compensation Commission in Washington, D.C. are paid by the Big Businesses who are Self Insured like Washington Hospital Center where I worked. Washington Hospital Center fights every case to the end and does not pay the bills. The Worker's Comp Commission doesn't enforce their rulings. I have over $250,000 in medical bills that need to be paid. Medicare shouldn't have had to pay in the first place what they have paid. I went in the medical field to help people. I realized how little they care. I am very fortunate to have a few doctors who see me. I have no dental or eye insurance. I have a cracked tooth and it keeps getting infected. I can't take care of myself and I am lucky to get a shower once a week. Now the Washington, D.C. Worker's Comp Commission doesn't want to deal with my case. The lawyers for the hospital just overwhelm them with paperwork. I don't have any family who can help me. My teeth hurt, I haven't had a regular checkup, mammogram, etc... I can't keep going like this. I have found the money to get the Medicare Supplement but no one will insure me. I haven't had my regular checkups in over 7 years. I was in great health until after my divorce other than my back. Now my health has dwindled to nothing. I had a breast lump years ago and there is breast cancer maternally for the two previous generations. I could be doing something productive and now I am confined to my home. You lose a lot of friends and it gets very lonely. They have not only stole my chance and a decent recovery, but my dignity and have almost broken my spirit. My son had to give up going to college to help me. He is the only one I have to depend on and he is only 21 now. He needs a break. He has been dealing with this since he was 7. I still don't want to have to wait months to see if I can get the proper care. I finally get housing to where I can afford to get the Medicare Supplement and no one wants me. They come up with all kinds of excuses. I want to pay the money. I am not that old yet and I would like to get out of my house. It's criminal that the big Self Insured Companies and working for a hospital no less and this is how I am treated. If the Worker's Comp Commission and the Washington, D.C. Government had done what they were supposed to do I wouldn't be taking away from Medicare. The insurance companies that cover injured worker's do this all the time. They want you to just give in and go away. I refuse to give in and I plan on getting my health back one way or the other. I don't get out of the house, see friends, can't go to church, and I don't have a dime extra even to get a haircut for example. I get Meals-On-Wheels and I am very grateful. I would like to be able to cook my own meals. I am sorry but it is all about the money. Went I worked at the hospital and went in on an emergency call in the middle of the night to do a scan I had to do the paperwork for billing. The secretary could of easily done it in the morning, but when I had an emergency that was life and death I shouldn't have to worry about doing the billing. There are no programs to help disabled people between the ages of 18 and 65. I make too much to get Medicaid and not enough to buy a full policy on my own without Medicare. I think the Insurance Companies are dispicable, along with the candidates, etc... But, before you vote for universal health care I look at what they do in Britian and Europe closely first. I don't know the whole answer. I haven't gotten a raise in 14 years and I am supposed to once I am deemed 100% disabled. I haven't gotten one yet. I am grateful for Medicare but I think big business, self-insured companies are no better than the politicians. It's all about the money!!! I trusted the government and I was so naive thinking they would have my best interest at heart. Even being found 100% disabled by the Commission, the insurance carrier doesn't have to pay, and the judge's don't do their jobs. So why should we trust the government now?
Carol
Carol Kelly
Dr. Gupta,

I just finished watching your "Broken Government" segment.

I was disappointed that you didn't mention "medical fraud" not the kind that you can send someone to jail for but;

In 1965, while working a part time night shift in a local Catholic hospital in Waukegan, IL near the Great Lakes Naval Hospital, Lemuel overheard a conversation between two physicians in the canteen late at night. They had apparently just finished with an emergency cesarean. One was saying to the other, on that late spring night, that he had seen a boat at a local marine sales that he just had to have, but didn’t have enough for a down payment. “Would you believe it,” he said, “3 hysterectomies walked into my office on Monday.” One must question how many of these were necessary. Certainly the physician believed they were or he wouldn’t have mentioned them. And he didn’t give thought to how it must sound. Still, how much was his judgment colored by his financial need. And would the second, now scowling physician have done them.

And how about the $90.00 velcro elastic band my insurance company paid for from an emergency room for cracked ribs in September of 1990. At the same time I could have purchased a much better one, black in color with shoulder straps (maybe you remember seeing the UPS drivers wearing them) for $15.00. And as a physician, I am sure you are aware the generally accepted practice is not to bind the cracked ribs for fear of the onset of pneumonia.
Re: your broken government stories on healthcare.

If you were to investigate and report on the spread between the price of healthcare, what people must pay, and the cost of healthcare, the real costs of delivering without the markups, you might find some very startling results.

Investing in healthcare related issues from insurance, to healthcare organizations to pharmaceautical companies is considered very profitable.

America needs to control the price not the cost of healthcare. That is how other countries, with far surperior healthcare systems, manage their healthcare.

Glenn E., Dana Point California
As a healthcare professional for 20 years, I have seen many abuses of the system, but do believe that we MUST have some type of healthcare reform. My husband is a small business owner, employing 25-65 employees at any given time, and the costs of health insurance to him as an employer have risen astromomically over the last several years, with coverage decreasing. I consider my family to be in the upper middle class, but healthcare costs to our family and business are making it nearly impossible to keep afloat. I believe in a certain amount of benevolence as Americans, but it really makes me angry that there are so many stories of underpriviledged individuals being brought to America for specialty procedures/operations when we have so many ALREADY HERE and just as deserving, if not more simply by being CITIZENS of this country and poor to boot---where are our priorities????
The healthcare crisis in this country is so far gone that no politician could fix it. The Insurance and Pharmaceutical companies have had freedom to do whatever they wanted without anyone restraining them, that they have become MONSTERS, and no one seems to see it. Even American people are blind to it, because they are brainwashed into thinking that European type healthcare system doesn't work.But it does work, and it's not motivated by greed, like ours is. Here, human life is only worth how much money one has. Sounds harsh? People die because they can't go to doctor or don't have no money for medicine that costs often more then half of their paycheck a bottle! Talking about human rights abuses, here is one for sure. It is national disgrace and tragedy. And because the greed has been allowed to take such root in this country, there will be consequences that will have ripple effect for years to come.
No one can solve a problem they don't understand; the problem being how to pay for health care and control its overall cost. We must develop a comprehensive model of our health care system. Since money is the focus, I would start with a computer model of the flow of US health care dollars throughout the system and through time, say the post-WW II era. A Forrester style dynamic model will surely be required. $'s would flow like electric current from sources to sinks. This will cost money and take time, but no one would design and build an airplane without such a modeling effort.

That being said, there is one thing that should be done immediately: consolidate the delivery of health insurance. There are about 400 US health insurance companies, each with a Board, CEO, COO, CFO, VP1, VP2, ..., and they spend billions on advertising. All this overhead is an enormous, superfluous expense for something whose only function is to prepare insurance packages and process claims. The people that actually perform these functions would still be needed, but the elimination of management overhead and advertising would provide enormous savings.

Carter Waid,
Medicine Park, OK
I am not surprised why both democrats and republicans do not want to have a normal health care system like people in Canada , Europe or other countries have, it would minimize the profit for the government, in my opinion their proposals are simply inhumane.
The program last night "Broken Government: Health Care - Critical Condition" addressed important issues that many patients throughout the country are painfully aware of, including the role that pre-existing conditions have on an individual's ability to gain and maintain health insurance coverage. Legislation has been introduced in Congress to help eliminate barriers to healthcare that individuals with pre-existing condition face in our current system.

The "Preexisting Condition Exclusion Patient Protection Act of 2007" (HR 2833/S 2236) introduced by Representative Joe Courtney and Senator Jay Rockefeller and the "Children's Health Protection Act of 2007" (HR 2842) introduced by Representative Allyson Schwartz, would help patients with chronic, debilitating and life-threatening conditions access necessary healthcare. On behalf of patients, I urge Members of Congress and Presidential candidates to support this legislation and help patients with pre-existing condition access health insurance.
Unfortunately the US only addresses problems when a crisis occurs. Social Security and Medicare only happened because of social disasters in our country. Before Medicare, the elderly were on their own. Without Social Security and Medicare, the elderly were the poorest group in this country. Now the elderly are the richest group in our country.

Our medical system will creak along until a disaster occurs and the current system collapses. When Bin Laden is able to get a nuclear weapon from the Pakistan stock pile, he will use it against one of our cities: Washington or New York.
The medical system will have thousands of patient with no medical coverage and the system will collapse. The medical system in Europe was outgrowth of war; the same will happen here.
It never ceases to amaze me, the amount of energy that can go into a project just to avoid doing the right thing. The best, simplest, least costly, most effective thing we could do is expand what has been working so well for years, Medicare. You get sick, you get care, and the caregiver gets paid. Nothing could be simpler. But follow the money and you’ll find why the politicians don’t like it a bit. They get their money from insurance interests.

http://MoneyedPoliticians.net
After watching the program and reading all the prior comments, I really feel hopeless and certain the health care in American will only get worst. None of the candidates have the solution, maybe we all will survive at least 4 more years and the next round of presidential candidates will come up with the perfect solution.
As a middle-class voter, I think the issue on health care is about removing barriers to participation for those who have pre-existing conditions. Not a mandate.

Some people won't purchase health insurance under both plans.

Just as government isn't willing to foot the entire bill due to competing expenses, I may need to pay on a cash basis and forego monthly premiums in order to put extra money into my business to keep it from failing, or to bring my mortgage payments current, or make a payment on my daughter's tuition.

I need a government that trusts me to make the right decision based on my circumstances.

I do not need the added stress of being mandated to purchase ANYTHING. It’s starting to feel like a civil liberty issue to me.
I work with physicians and medical staff daily and part of the problem is the unnecessary medical tests, procedures, prescriptions, etc due to the fear of litigation. Many times they feel the preventive(?) recommendation is due more to fear of being sued versus actually being necessary, ie everyday tens of thousands of patients get hundreds of $ in preventive measures because if physician is wrong on 1 of 10 million the resulting lawsuit could end practice. Litigation reform could give medical professionals the latitude to make more prudent preventitive recommendations and the resulting savings wouldn't solve problem; but could make it easier to fix financially.
All this talk from politicians of letting the free market determine the price of health care, is hooey. It is not a commodity.
1)Who has the time and money (except the wealthy) to shop for a doctor? You can't shop doctors like a new TV. What employer is going to let you take off whenever you want? You can't just show up in the doctors showroom to check out his procedures or personality. If you don't like your doctor's care or price, what are the options? Try shopping around for a lower medical insurance plan. After a couple of month's, the insurance companies begin raising the premiums. It's a crap shoot, not healthcare.
2) What is driving up the cost of American healthcare? What makes it the most expensive in the world? Is our healthcare like a Rolls-Royce that only a few can drive?
3) What part of the free market makes the price of a doctor's services competitive?
4) I agree with the idea that our lawmaker Representatives in Washington should not have a better healthcare plan than those they represent.
5) Is there a moral debate on what basic healthcare we as Americans are entitled to?
There is nothing "FREE" about our present health care system.

Our CNN pundits use that word very freely when discussing the health care plans proposed by either Clinton of Obama. Get rid of the word FREE, it is misleading.

Have you ever had to be taken to the emergency room and had to WAIT for hours because the waiting room was filled with people who had aches and pains. Most of the people in those ER waiting rooms do not have health coverage. Persons who have health insurance and then who need health care in the emergency room have to wait their turn no matter how sick you are.

Someone has to pay for the health services provided those folks who are in the ER and don't have insurance. I understand why people do this, because they need care and can't afford to pay for insurance.

The problem is that NOTHING is FREE concerning health care even now. Let us get behind a universal health care for our citizens. We are a rich country and everyone has a RIGHT to have basic health coverage.
When I was a teen in the 1970s, our family doctor did not accept health insurance because the paperwork and hassle cost him too much. That was OK because my dad was self-employed and couldn't afford health insurance anyway. We paid for our visits up front which cost less than health insurance and probably less than it would have been at a doctor's office that dealt with health insurance.
When I see the doctor now, I also see many people on his payroll who are there just to deal with health insurance. What percentage of his overhead is due to this expense? 30%? 50%?
If dealing with insurance companies costs doctors so much, why do so many refuse to take patients who pay out of pocket?
My family is blessed with good health insurance now, but I often wonder how I would be treated by health care providers without it. For instance, when I see that the fee of giving an allergy shot to my daughter was $18, but the doctor is willing to accept $6 because I have insurance, I wonder why the doctor's fee is $18. If I had no insurance and the doctor was willing to take my child, would he be willing to accept $6? If I only had to pay what my insurance company pays, would I need insurance for most things?
If a doctor can run a practice taking the reduced amounts that insurance companies pay while having the expense of dealing with insurance companies, why not charge everyone only the amout he would get from an insurance company? Or does he charge others more to make up for what the insurance company doesn't pay?
It seems to me that a major reason for the high cost of health care is dealing with insurance companies. If the process were simplified so that the medical practices didn't have to pay so much dealing with insurance companies, the costs to all of us should go down.
The question that none of our politicians will answer is "How do we get 100% in healthcare coverage for a rock-bottom premium?" All they'll promise is 100% coverage for an "affordable" premium. Who are they kidding? Healthcare is expensive and it can't be obtained on the cheap. Somebody has to pay. Guess who???

Bob F
"Both agree: they do not want a government run system like Canada or several European countries."
Of course they don't. To have a system like Canada would take the "Big Business (read votes)" out of medicine. Your American system is all about money - that's all. I was diagnosed in October 2004 with esophageal cancer. By December 2004 I had major surgery. In 2005 (Mar - June) I underwent aggressive chemotherapy and radiation. Aside from gas money back and forth to the hospital and and time spent the grand total of my medical bills have been $35.00 for 2 prescriptions I had to pay out of pocket. Today I am a cancer survivor. If I had to pay what the type of surgery I had cost in the US and for my subsequent post-surgery treatment and care I would not be here. Through having this cancer I have come to know many people in the US with the same - some of them had to mortgage and re-mortgage their homes just to get to see a doctor who specialized in Esophageal Cancer. So before you knock the Canadian System perhaps you should talk to real Canadians who are still alive today because of that system. I understand that no system is perfect but here in Canada we do not let people die because they do not have the money to live. I find it almost dishearting that you, as a Surgeon and a Medical professional could say "the system doesn't work" (sic) without knowing how it really does work. Like I said - talk to real Canadians who are still alive thanks to the system that doesn't work.
Dr. Gupta, Thank you for your coverage of Broken Government, Health Care- Critical Condition. I have traveled and lived in France in the '80s. I was covered by the simple fact that I was in living in France. I observed just how much government is involved and how much the French retained their individualty. The people knew then that their taxes were high but they saw their taxes at work in their schools, their highways and in their heath care coverage. At the same time they were grasping the immigrant issue. Which was a rally point for all Frenchman. They have managed to carry on and retain their rights even among the Algerians at the time that were flooding their unemployment, and their health care coverage system.

As an American, I have been having this debate ten years running and Universal Health care or Single Payer system should amount to mandating insurers and drug makers.

I think thus far Clinton has had this debate and lost and I think it is time that a new, fresh-faced candidate that needs to represent a step towards universal health care is in the likes of a Barack Obama.
The US system is typically American: it caters to the top 1%, financially burdens the middle class and disregards the lower 40-50 million ppl.

Market equilibrium adjust to price ppl at their actuarially fair rates. Unlike most markets that base this on income however, Health Care (HC) economics 'effectively' bases this on people's state of health. For millions, that rate is set when they are born, be it with poor eyesight, autism etc. Thus we have market (and moral) failure.

Socially, lack of HC coverage inflicts incomprehensively massive damage to the psyche of this country - it destroys nationalistic pride. Economically, it distorts people's decision making processes and results in sub optimal outcomes in many areas, all of which are subject to a multiplier effect. Practially, people have lost trust in the quality and objectivity of HC providers due market abuse. Visit a dentist and you'll know how quickly their all aggressive, important, 100% necessary recommendations fleet once your insurance limit is met.
Essentially, HC cannot rely on market forces alone. It is a unique market which needs an intervening mechanism for innumerable reasons.
I only need to go to the doctor once a year. Hence, any payment of premium for an unnecessary service is too high (health insurance is an unnecessary service when I can afford to pay the doctor bill for one visit per year.) Clinton's proposal to garnish wages of workers who refuse to buy health insurance is a threat. The automobile insurance industry lobby requires purchase of insurance and the insurance does not always pay as needed. To impose the same requirements on workers for health care, not comparable to insurance for driving a vehicle on public roads, is an invasion of privacy. Abortion rights are part of the rights to privacy and I am surprised Clinton would propose a loophole for the anti-right to privacy people to legislate our bodies.
Why is is so complicated to for the average public to get a HSA account. I would rather save for when I need it than to give it to an insurance company for years just to have them tell you the condition is not covered or to get substandard treatment.
Peter suggests that the United States should review the public health systems of other countries, such as Norway, Canada and Great Britain to determine their strenghts and weeknesses.

I do not see any reason for dismissing universal health care when the United States ranks so low on nearly all wellness charts, withour assessing the consequences.

After all, if we can have social security for everyone, why not find out if we can afford health care for all?
Free market principles cannot be applied to health. Free market depends on consumers having choice and control. You can choose to buy a TV or not and therefore influence the market with price and competition. But you cannot choose if you are going to get sick or not and then if you do get sick you cannot choose which illness you are going to get. Single payer is not government run. Single payer is only government financed the way we finance our fire dept. police dept. The health care would still be delivered privately as it is now with Medicare, CHIPS and Medicaid. We wouldn't be paying excessive insurance premiums, co-pays, deductibles to fund those multi-billion dollar salaries of health insurance executives. Instead we would pay less in the form of a health tax and we would never ever be without health care. Even GM moved it's plant from the U.S. to Canada because it saved them so much money in health care costs - the taxes into the Canadian system were significantly less than paying premiums here. We wouldn't have long waits with single payer because we have so many more facilities, doctors, machines, etc that we have plenty already here ready to be used. The current system is unsustainable and frankly, immoral. Why should one child get care and another child just a few miles away not get care? Why should people go bankrupt because they got cancer - through no fault of their own. What kind of nation are we? Where is our trust that we can pool together our resources as a nation and have "we the people" finance our health care. Remember that we ARE the government. We would have much more control over government action than any insurance company that's only purpose is to make profit from not giving you health care. Don't be fooled by the fear tactics.
Is there any way some of these comments can be seen/addressed by any of the candidates? I would like to hear them comment to some of the issues.
I have heard the figures indicating that up to 20% of the uninsured population make $75,000 or more, and need to take expection that these people can easily afford it. Certainly, some can, but if you live (for instance) in New York City and have children, that $75K doesn't go very far, even if you send your children to public school; if you chose to live in a school district with higher testing schools, an already high rent will rise another 20% or more, and it's still a less expensive option than private school.

Rent and food are expensive, not just in New York, but in cities across the country. People live in big, expensive cities because that's where the jobs are, and because those same cities may offer more opportunities for kids. No one should have to chose between buying health insurance or school books, or be forced to raise children in suboptimal conditions or substandard housing in order to pay for health insurance, and a trip to the doctor should not cost most than a week's worth of groceries.
OK, so people say that if you make more than $75,000, you can afford health care. Well, I make nearly double that, but there was a time in my life (when I was making good money) that I did not have health care. The reason is that I was self-employed and, because I'm a diabetic with asthma, I was unable to GET health care. I got turned down time and time again. So affordability really was not the issue.

Now, I work for a Canadian company. Because Canada takes care of its citizens, there's no health care "plan" as we know it for me to participate in. Currently, I'm covered under my partner's health care through JPM Chase. But they're shipping jobs overseas at record rates....we're nervous about how long we'll have health care.

This is definitely an issue requiring resolution in this country!
Neither will work, because neither addresses the root cause. The problem is the cost of the health care, not the cost of the insurance. When the cost of health care drops, then the cost of insurance will drop. Part of the high cost of health care is the low quality, which causes medical "rework" and lawsuits. Address the following nine points (and maybe more), and you will be addressing the real problem:

1. What will they do about the high cost of medical schooling, which inhibits many people from entering the discipline and adds to our medical bills to help pay for the interest on our doctors’ school loans?

2. What will they do about the high rate of misdiagnoses and medical errors, both of which are not only a physical burden on the patients, but also a financial burden on the system?

3. What will they do about the high cost of hospital and diagnostic clinic care?

4. What will they do about increasing the number of nurses and reducing the burden on an overworked nursing corps?

5. What will they do about making our medical licensing boards more accountable to ensuring more doctors and high quality doctors are licensed?

6. What will they do about watching for price fixing within the medical and insurance community?

7. What are they going to do about practices that limit patient choice, such as insurance companies establishing preferred provider networks (a form of surreptitious, tertiary medical licensing) and doctors refusing to take some insurance?

8. What are they going to do about the reach of pharmaceutical companies into the doctor office to provide implied-quid-pro-quo benefits and incentives to doctors, creating a conflict of interest?

9. What are they going to do about pharmaceutical companies that bury negative research findings? To be fair, Congress just recently passed a bill requiring companies to post ALL research results for drugs going through FDA approval. Could more be done?
I'm tired of hearing Dr. Gupta say today that "20% of those who don't have health care make over $75,000 per year, so there are people out there who can afford it, but don't get it."

His cause-effect statement is faulty. Although we can say that the 20% statistic is true, we can't say why, and I'm dismayed by Gupta's faulty reasoning!

My annual household income is about double that... and I don't have health care. Not because I don't want it, but because my husband and I are self-employed and I can't get an insurance company to extend it to me AT ANY PRICE due to well-controlled asthma and an accident TWENTY YEARS AGO for which I received medical care.

Perhaps this 20% figure includes a lot of self-employed people. Perhaps not. Either way, Gupta needs to stop making interpretations of statistics without the supporting evidence.
I dissagree with "Anonymous said, Free market systems don't apply...."

Market forces do apply. Because we pay more when we are unhealthy there is no "market force" to make us healthy. The market force of "fear" allows wildly exaggerated costs.'

The solution is to chage the way we buy health care. HMO style but with bonuses for improved health and saticfaction in order to put the market forces to work. Bid contracts for areas to put competition to work.

We have to get "out of the box" in our thinking. Design a plan that goes for the goals instead of bandaids for the problems.
While I haven't studied their proposals in great detail, I would certainly side with the Democrats on this one. The best health care systems in the world (Japan, Italy, Brazil etc...) all have a government program installed.

Being a capitalist (and economist in training), I am quite fond of the free-market approach to solving market inefficiencies. However, health insurance is quite unlike other types of goods and services normally traded through the market.

Having several companies compete, actually, may make the situation worse. Why? Because every company would have a smaller pool of clients which, in turn, raises the average price per person (think diminishing marginal costs, as us economists like to call it). Furthermore, it would do little to deal with "cream skimming" (that is, when companies keep the healthier and less risky group) or "dumping" (when they drop those that are riskier or more expensive to insure). Finally, it's worthwhile to wonder WHY insurance is so expensive. Pharmaceuticals is a good part of the reason, as is the whole health care system. All these contribute to massive costs to the insurance agencies which, in turn, pass the costs to the insured.

Needless to say, many people would still be uninsured, as the price would unlikely go down.

On the other hand, the democrats propose a more social plan, similar to that of Europe, Canada, Japan etc..., while eliminating (or reducing) the whole "privatization" aspect. To me, this seems much more logical, as not only would having one insurer reduce the costs due to much lower costs per capita, but also there is no risk of cream skimming or dumping, as everybody is already included in the plan. Second of all, the monopolistic power may actually serve for the better (who would've known?), as it would be much more efficient to negotiate prices with pharmaceutical companies. Finally, it would eliminate the need for actuaries and underwriters as there wouldn't be any need to calculate risk.

Just a thought, now back to paying attention in class.
The cost of healthcare lies not only on the Insurance companies, but specially on the pharmacutical companies, who despite getting sued for marketing dangerous drugs, also rake in millions in profits. iF they cam be controlled on the drug cost, then the cost of coverage will coem down.
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