Tuesday, January 29, 2008
Dying for lack of insurance
By Dr. Sanjay Gupta
Chief Medical Correspondent

For the past several months, we have been investigating our broken health care system. Everywhere we go, people agree it is in critical condition. As part of our research, I met Mark Windsor and I profiled him for the documentary, which airs Thursday at 11 p.m. ET. Mark tells us a very important story. He reminds us that being uninsured in this country not only means the loss of a safety net, incredible anxiety and possible bankruptcy. It could literally cost you your life.

When Mark was 27, he learned he had cancer and doctors operated on a large tumor in his neck. At that time, he had insurance and was able to get the operation. Thinking he was cured, Mark pursued a passion of his, photography. In the process, he lost the insurance he had through his job. And, the cancer came back. (Watch Video)

Now uninsured, Mark was slowly dying. At first he found doctors who would do his operations for free, but that lasted only so long. He was not eligible for potential life saving treatment because of the expense - hundreds of thousands of dollars. Now his doctors are convinced he will most likely have an abbreviated life. In a desperate measure, Mark married a woman, who was simply a good friend, at least partly so he could get insured. It may be too late. His cancer has spread to his lungs.

The United States is at a crossroads with its health care system. While men with cancer are more likely to live longer in the United States as compared with any country in the world, that provides little solace to Mark Windsor. (source: OECD)

All week long, we are going to be discussing this topic and I will break down the various health plans from the presidential candidates. The question I would pose today to get the discussion rolling is how do we take care of people like Mark Windsor, pay for their care and make sure the United States continues to have the best outcomes in the world?

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.
Even if he did marry someone who could provide insurance, he'd still be lucky if it were covered, since his problems were preexisting.

I thoroughly believe we need to lower the actual cost to patients for basic things like yearly check ups and simple tests - enough so that these can be reasonably paid for out of pocket. Then insurance can be use as the safety net it's intended for.
I'm tired of hearing and reading about how broken our health care system is. When will we finally see some action? I know Hillary tried to fix it when Bill was in office but since then I've heard nothing. What I don't understand is, how can our government officials by law have insurance while we the citizens are left to fend for ourselves? Why do these insurance companies have so much power over even the doctors that treat us?
Just watched your coverage of a young man who left a well paying job with health coverage to free-lance as a photographer and is now cancer ridden and married just for the coverage.

First: This guy is the poster child for why we should never have taxpayer coverage.

Second: I hope her insurance company watched and will begin legal action against them for fraud.
Dear Dr. Gupta,
No, I'm not dying but I did want to comment on the health care issue. I had some shortness of breath and felt some chest pains when I went up some stairs last July. To be safe, my wife and I went to the emergency room at St. Joseph's hospital in Atlanta. They did a number of tests including a stress tests. The verdict was that I had some high blood pressure and high cholesterol. I spent one night in the hospital. The bill was over $10,000. I am just one of many thousands of people who can't afford to go to the hospital when they get sick. Forget about preventive doctor visits. For years our government has passed the buck on health care to subsidize the profits of insurance and pharmacutical companies. I'd like to see a consistent on-going series on the needs for health care reform. Lou Dobbs has influenced the government on the immigration issue by never letting up on the issue. If CNN would do the same thing on health care, maybe we could get the government to change. If, however they do a show or two and then drop it, nothing will change.
It is hard to believe that one of the wealthiest countries in the world has a broken health care system. Even if this man were to be eligibablle for Medicaid, it would probably not fund expensive surgery. I for one am Senior at college. Due to the many costs that I have (i.e) college tuition, rent, I can not afford my health care at the moment. It in a sense has become a luxury that I must hold off getting until I can afford it. Since I have athsma and did have precriptions from when I had insurance, I was able to buy my medications which out of pocket cost me 500 and without I would be constantly ill. It is no wonder that Americans have sought to buy thier medications through foreign online companies! If the government wants illegal buying online to stop , it will have to confront the countries embarrassing health insurance situtaion.
I am a single mom living on a limited income. My employer went up on my health insurance this January, so I was unable to continue with it. I had to decided if paying for insurance or buying groceries was more important. I am not a poor person. I am considered middle class. I have already decided that I will probably die of something very treatable just because I do not have access to health care. I plan on spending my final days in the parking lot of a major hospital as a protest of our American system of Health Care. To be middle class, working American and dying at the door of a hospital that will not treat me would be poetic.
Thanks for being the people's champion on humane, affordable health care.

I'm self-employed and have private insurance. I think twice and three times before I go to the doctor for fear of exceeding my benefits and being dropped. I fear that more than the diagnosis. Because if I am dropped, I know I'll never get insurance again.

We are allowing a 'what will the insurance company think' run our lives.

Mark's case is just the tip of the iceberg.
Every country in the modern, western world has a guaranteed health care system except the U.S. Opponents scream "SOCIALIZED MEDICINE", but no one sees anything wrong with every 6 year old in the U.S. going to school from the age of 6 to 17 at public expense. What is the difference between universal health care and universal public schools?
How in this day and age can we allow or accept the fact that we can not help our own people in our own country??? I believe that we as a nation are too concerned about other countries,and not concerned for our own people.If a person has cancer as I have had,they should be allowed the best care and science available!!! We need to be worried about this and not the almighty dollar!!! What do you think????
This story makes me want to cry.

There is an organization called Care Without Coverage ... Richard Marra is a contact ... but
I can't find the website anymore.
I will try calling him tomorrow, then I will be back if they are still around.

I will pray for Mark ~ I truly feel God is our only real hope.
Having a daughter with a rare (KTW) syndrome, I have found it's not so much the lack of insurance, but the cost of medical service. Like the couple profiled today (twin babies) my kid has been treated at Riley Hosp. in Indy. The big question is how do they justify $40-100K per day in ICU?
There is a misconception about insurance in this country. Insurance is a business, not a welfare system. Insurance is about risk management, not guarantees. To suggest that the medical system in this country is broken because everyone has a lifetime limit on their insurance brings to the surface a very important issue, healthcare insurance is about the allocation of a finite resource. Unlimited health insurance would financially break an insurance company, just as it has the potential of breaking this country. This country appears to be heading to some type of nationalization of healthcare in the form of health insurance and that is a good thing. But your story exposes the harsh a reality, insurance is not an open ended, unlimited guarantee of that no matter how much you want to spend everyone in the country is going to chip in and pay. Two million dollars was a pretty high limit and most likely does not represent the reality that most of us face. I cannot image the pain this couple feels to have lost such a little child, but there is a limit to everything, including the amount of money that society is prepared to spend on saving an individual, whether that individual is 80 years old or 18 months.
I am 23-years-old, almost 24. Unfortunately for me, on my 23rd birthday, my health insurance ran out. I was to get health benefits at work three months after starting, but my boss was a jerk and I quit. My Dad is trying to get me back on his plan. Until I am (and hopefully the insurance company will say yes), I can't afford to get sick or injured.

I am worried. I have to pay for my medicines with my own money.

Dr. Gupta, thanks for your attention to this matter.

Erin in Liverpool, NY
The housing bust has exposed the corruption associated with lenders and the mortgage industry - what is it going to take to expose the corruption with our healthcare? It is not just about costs - it is about quality of healthcare.
My brother-in-law went to his doctor for months trying to resolve some issues and the doctor kept giving him acid-reflux medicine. Finally, after my brother-in-law had lost a considerable amount of weight they decided to do a C-scan. You guessed it - moderate to invasive cancer. It then took over 3 months to get him into surgery at which point they determined there was nothing they could do. Oh, by the way, my brother-in-law is self-employed with no insurance!
I would like to view this as an isolated incident, but my own experience tells me it is not. We had a friend of ours die of a heart attack waiting for heart tests - waited well over a month! He had insurance!
We encountered some critical health issues over a 3 year period and ended up with thousands of dollars of just co-pays. The medical facilities and doctors got paid enormous sums (grateful for the insurance) but we had to dole out monthly payments to cover our co-pays! This has amounted to an additional $300-$500 more in expenses per month (and we are supposed to go out and spend money to help the economy!). The harrassment and interest rates are horrendous.
We will pay our bills and thankfully we are fairly healthy. But we think twice before we go to the doctor - and we have insurance!
This story is sad. But it also points to a reality about modern medicine. It is expensive to research, develop and administer so there will continue to be high cost involved period!! Anyone who thinks otherwise is fooling themselves. Government health insurance is the same. How do I know I have it and it also has lifetime limits and partial payments on a whole range medical conditions. My father had medicare (Government Insurance)--when he was diagnosed with lung cancer. The first thing he was offered was hospice care until we intervened unfortunately he died of MSRA before any cancer treatment began. Those who think that government control of the heath care system will make things better you need to think twice. You'll pay more for less, have politicians determining what kind of heatlh care you and ultimately have some unaccountable "caring bureaucrat" telling you what you can and can't do. In short if you get sick with a serious illness you'll have a duty to die.
I was convinced, by my doctor, at the age of 54, to have a colonoscopy.
Luckily, at the time I had insurance to covered the procedure. They found a polyp, removed it and found it was benign.

My husband since left the job that subsidized our medical insurance. We applied for individual insurance through the same company that provided our group insurance…just a different division dedicated to individual insurance. Since rates are so ridiculously high we opted for a high deductible ($10,000) and an HSA.

Even though the polyp was benign, the insurance company has disallowed coverage for any disease having to do with my intestinal tract. They will also not pay for another colonoscopy.

I called the insurance commission office in Atlanta to see if this was even legal. It seems this qualifies as a preexisting condition. Their definition of a preexisting condition in Georgia is “anything you have now or have ever had.” They legally have the right to deny coverage!
Literally dying from the inability to pay...in the United States of America. Very, very sad.

We hear every day about the 47 million citizens who are uninsured, but we can't ignore the millions of us with chronic diseases who are seriously UNDERinsured.

No access to group insurance and a chronic disease such as multiple sclerosis will force you to choose between your mortgage/rent or your medications, which are your only hope against the progression of a crippling disease.

We're talking about honest, hard-working taxpayers in the United States of America.

I'm not proud of my country's treatment of those of us with the misfortune to require medical care.

Guess it's every man/woman for himself.
I also am concerned with the cost of health care. I in 2006 I was told I had Chondro-sarcoma (a rare cancer). My wife was a stay at home mom with our 3 children. I had insurance through the company that I worked at. I since have been unable to return to work because I have limited use of my arm. We lost our home as well. I have had to go to cobra which is $332.00 a month for just me. My wife and children do not have insurance. We have very little income (from my disablilty insurance that I got at work). We have tryed several Government programs that say either we make to much money or other reasons. I do not understand why we can not find a way to handle this issue. Some one needs to help with this.
The medical establishment has a monopoly on medical care in this country. The monolopy is enforced by the Federal government. The purpose of the monopoly is to make money. I would say that the system is working as designed. Why would anyone with the power to change it, change it? Doctors who take the Hippocratic Oath will have to choose between their duty or their money. My guess is that they will choose the money.
It is amazing to me that we can "hold the hand" of the world and all it's problems but turn our back on American citizens. Congress doesn't think twice about sending large amounts of "relief" to other country's, but spend a dime on Americans with health care issues, no way. I do agree that in some cases problems are brought on by the person them self such as smoking and alcohol abuse, but for someone to get the door slammed in their face because of a lack of money is outrageous. I don't believe in a total government run medical system, but maybe a large portion of it backed by government would not be a bad idea.
The following statement was made:
"While men with cancer are more likely to live longer in the United States as compared with any country in the world, that provides little solace to Mark Windsor."

This statement is not true for most cancers. The reason for the decline in cancer death rates rest on these facts:
1. The decline in smoking has decreased most cancers; especially lung cancer.
2. Deaths from colon cancer has decreased due to early detection and treatment. Of course if you do not have medical insurance, this benefit is denied to you. Colonoscopy is probably the most effective treatment for a cancer that has been developed in the last 50 years.
3. Since 47 million people do not have insurance, this group of people are not being diagnosis until the cancer has metastases and they will die. The number of uninsured is increasing and thus the number of cancers detected will decrease. Sometime in the future the number of deaths from cancer will start to rise as these people start to die.

The National Cancer Institute projected that "1,444,920 new cases of cancer in 2007" and "559,650 cancer deaths overall". Basically if you are diagnosis with cancer, you have a 38% of dieing from it in the year that it is detected. Most doctors do not talk about curing cancer instead they use the term remission.
I wonder in the supposedly "richest" country in the world the one and only remaining super power why this is happening? How did we let it go this far and why do we allow it too continue? Health is not a luxury it is a necessaty right there is the difference between the medical industry and say the auto industry. I can pick an choose a car or choose NOT to purchase any vehicles. I can't do that with my health nor the when I have to choose for say my children. Since medicine does not follow the normal rules of the free market it should not benefit from the free market because there is not balance not "The customer is KING" ethic but rather "We are your GOD" and you will do as we say philosophy. This has to be stopped an stopped HARD. Nothing like this should stand in the United States of America and it is to all our great shame that a single citizen has suffered and or died in our so called GREAT nation for lack of money to pay for their health. How can we continue to allow this!?! Where did we get this idea that this was how is should be!?! Are well fools or sheep perhaps both.
I wish there was a way for those who are underinsured to buy secondary coverage with less restrictions and exclusions that'd cover things that the primary insurance doesn't.

The middle class is stuck. We make too much for any assistance, but not enough to afford non-covered expenses should anything arise. Honestly, I get more stress from making sure things are covered than seeing the accelerated progression of my progressive, genetic disorder.

It hurts me that due to the need for medical coverage, I'll never be able to advance my career and be a sole proprietor... just so I can have a group coverage. I can't take the chance of not being able to find/afford an individual coverage that'll cover even less and has no reason to cover pre-existing conditions.
And how much is the US spending on the war???
Poor US health system....
My heart breaks for Mark and for others who encounter this disgrace we call health care.

My daughter was diagnosed 2 years ago with a rare cancer. Today we are facing foreclosure on our home from the co-pays and medical bills we still face every day.

I have great insurance.

How does this happen in this country.

God Bless you Mark. Hopefully by documenting your case, others will not have to suffer what you have.
I work for a local public defender's office and have interviewed too many clients who have committed petty crimes such as shoplifting-- and turned themselves in because the WANTED to go to jail so they could get healthcare and lifesaving medications that they couldn't get on the outside. And before someone coldly says, "Well they should get a job"-- many of these people have jobs-- but they can't afford health insurance.

What's wrong with this picture?
I watched your special on health care in the United States with interest, as I am a Canadian. For several years I lived and worked in the US and was appalled with the state of your health care. One part of your story in particilar hit home..the young couple bankrupt by the medical care for their daugher. My grandaughter was born needed a liver transplant..her parents were both students at the time. Everything was covered by our health care system, including the anti-rejection drugs. Thirty years ago my own son was born with a severe
heart defect..all expenses including transportation from the far north into the wonderful children's hospital in Edmonton, were covered. Care was immediate and excellent..no waiting, no bills.
You took two statistics...that of success rate in treating men with cancer, and that published by WHO on consumer statisfaction, to "prove" that a for-profit, captialistic health system is superior. The fact that life-expectancy is better,and infant mortality rates lower,in countries with socialized medicine. Our system is superior to yours in accessibility and in prevention. It costs me nothing to get a mammogram and PAP smear, have my cholesterol monitored, my B/P checked, etc.
We might pay higher taxes, but are relieved of the burden of increasing health insurance premiums. There is no such thing as an uninsurable person in our society, and we offer state-of-the-art care in some of the best hospitals available. Perhaps the US rates highest in consumer satisfaction (for those able to get health care) How satisfied are the millions who can't access your wonderful hospitals? The one thing your system does not provide, and that is peace of mind. I can sleep well each night knowing that, should medical catastrophe hit any member of my family, that financial catastrophe will not follow. I am proud of the fact that every citizen in my country has the same access to needed medical care.
I am in need of a decompression surgery. I had insurance when I found out I had chiari, 2 weeks before ins cancelled surgeon denied probably because he wouldnt get paid. I am outraged at the medical care in this country. I have seen all to well first hand. I need to find a surgeon to help me. I now have to leave my state to find help. Chiari is so unknown , and I hope to bring awareness, no one should suffer like this.
For those who scream 'socialized medicine' every time someone thinks of trying to fix our medical system, think on this:

How much productivity is lost from people who are sick because they could not afford pre-emptory care? How much harder do you have to work because your employer cannot hire enough people because health care is so high? If you are a small business, how much is he current health care system holding YOU back from growth because it is hard to get and expensive, and if you don't have you won't get the good workers AND it takes money you could put to yourself or the business? How much are ALL of us paying when folks with no health care have to go to the emergency room?

No health care is perfect, but there are better far systems out there than the US.
The piece had some good points, but it left out far too many things that are wrong with this health-business (sorry, I can't bring myself to call it health"care" anymore).

I think the problem starts with the medical schools that charge an arm and a leg and teach these "doctors" more business than medicine. Most doctors are clueless - they can't diagnose anything more than a cold or high cholesterol. They send you to do a ton of tests and have no clue what's wrong with you. Nurses in other countries are better prepared than many of the American doctors.

Dr Gupta talked about the profits that pharmaceutical companies make, but conveniently left out the profits made by the insurance companies, and the pay their CEOs get (see former United Health CEO who got a package of $1.34 billion upon his retirement - yes it starts with a B, not an M).

Another issue that adds to the enormous cost is the hospital cost, which is one of the main reasons why many Americans file bankruptcy. We’ve all seen stories on the obscene amounts of money they charge all of us. Many of these hospitals are “non-profit”, whatever that means, but have huge profits – check out some tax returns on guidestar.org. Also, they are supposedly required by law to file their tax returns every year, but many of them only show the returns from 2004 or so.
Posted By Anonymous : 2:21 PM ET

You made a very good point...

the "for profit" hospital my baby was in (NICU/PICU) was paid $1600. a day and that included everything except doctors...

Stanford, the non profit hospital was paid $26,000 a day and that did not include xRays, labs and doctors.


Hum.....
The series on health care has been terrific. Like another writer, I hope this subject is pursued by CNN. I am afraid that the issue will be swept under one or another rug by Congress. It will be very expensive to insure medical coverage for all, but it is essental
I find this extremely sad... heart wrenching. Only a few months ago I left my job to take care of my young, dying mother. She had no insurance and we didn't have enough money, so she could not afford treatment options. Thus she was even less willing to put a 2nd mortgage on the house just to get basic tests done to determine the type and stage of cancer that she most likely had. My mom, my friend, my only family is now gone. I dream how she would be alive now, possibly even cured, if only we lived in UK, Canada, Netherlands or Norway.
My husband is English and is now a resident of the US. He was shocked that out of his paycheck goes $300/mo towards health insurance. "Blimey!"
Then when you go to visit the doctor for 5mins you pay a co-payment of $35. "Isn't that included in the monthly payments I've been making? Crikey!"
Then after the 5 min doctor visit you receive a bill to pay what the insurance does not cover. "Is this really worth paying $300/mo for? Wow, I will never complain about the NHS being slow again. What a crazy system for the world's richest country. Bugger!"
I applaude Dr Gupta for talking about the US health crisis. Hate to sound synical but it's too late. I've worked my entire life and medical bankrupted me, broke my spirit and has made me glad I never brought children into this fiaso. 3 hernitated disc, a blood disease slowly killing me and I just don't care anymore. I don't qualify for welfare as I WORK.
Like I said, hate to sound synical but I laugh (with heavy tears) that it's now an issue people are finally talking about.
Now others can see what it's like.
All I can say "That's Life--Oh well." Nobody came and saved my day and my heart goes out to the others that don't get a break.
But THATS LIFE! Our government will be talking about this long after thousands have gone homeless, and have long passed.
What's the point?
we pay about $50.00 weekly for health insurance, and yet they won't cover some meds we need most to live and they drag out paying the doctors and hospitals to the point it is a fight to get a bill paid. The whole system is a mess and it leaves many of us at the mercy of heartless insurance companies.
I am a Canadian who for many years lived in the U.S. and has seen the uneven treatment of those with health insurance and those without. I can state without a doubt that in Canada I have never had to wait for treatment or a diagnostic proceedure. I am quite willing to pay the extra taxes on items such as cigarettes and alcohol in order to sustain a National Health Insurance Program where everyone is covered. To my American friends I would say that you cant have a health program where the only reason to be in that business is to make a profit. In a modern industrialised society, health care like education and other social programs is a right - not a privilege for only those that can afford it.
We all face a moral medical dilemma. While we know how to cure or live with many medical conditions, the cost of doing so is often prohibitive for the individual.

Insurance transfers that cost to a group, so that it is less prohibitive for the individual. But there is a price to pay here: the group becomes the decider as to what care the individual may or may not received. And there is a second cost: on average, when people know they will not have to pay the full price of something, they will consume more of it. This drives up the total cost for all, in addition to the overhead costs of administering the insurance plan (both in the doctors' offices and in the insurance company).

In the end, the only person who can ethically make a fair cost/benefit tradeoff is the patient. If it is their money and their life, and they have a choice of seeking various levels of treatement, they may choose to not seek heroic treatment (of a late stage disease, for example) in order to preserve more of their financial assets for their family.

So, in the end, I argue that the only way to provide the most patients with the most morally satisfying outcomes is to implement a national Health Savings Account approach (mandatory contributions from every paycheck, just like Medicare), and let patients spend their own (inheritable) funds for their own health care.

HSA accounts should be backed up by catastrophic insurance which would pay for selected catastrophic events. However, once again, society does not have an obligation to take heroic measures for every catastrophic event. We need to discuss this conundrum openly for a while, and arrive at a national shared understanding of what catastrophic insurance will and will not cover so that such policies remain affordable to all, yet still complement an HSA approach.
I have found a great opportunity for savings. It is called AmeriPlan. I saved $146 on one pair of glasses which is more than one year of membership. I signed up at www.workingrebel.com. It cost $20 per month to cover myself & my son or the entire household.
I am an IT Contractor and do not have an employer who pays for my insurance. I'm 34 and have about $800 in medical expenses per year. If I want to, I can buy health insurance but GOOD insurance is about $300/month. I have migraines and will probably be diabetic in a few years. I'd prefer to just save the $300 and get interest on it rather than give it to a company that could drop me for a pre-existing condition or something else. Why feed a system that's broken?
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