Friday, February 01, 2008
Learning from universal health care proposals
By Dr. Sanjay Gupta
Chief Medical Correspondent

I am sure many of you watched the debate last night and noticed that the first 40 minutes (of a 90-minute debate) were all about health care. As a member of the audience, I saw both Senators Barack Obama and Hillary Clinton talk about how similar their plans were and the differences as well. As I blogged yesterday, there are some distinctions, which are important for you, the voter, to know.

What you may not know is that there was a recent proposal here in California to create a universal health care plan for all Californians. Governor Arnold Schwarzenegger, a Republican, along with members of the state Senate had put forward ABX1, which would create a system of universal coverage. Just this week, it was overwhelmingly voted down in the senate health committee by a vote of 7-1.

I find it interesting the two states that put forward concrete universal health care plans, a core Democratic issue, were both led by Republican governors - Mitt Romney in Massachusetts and Schwarzenegger in California. I also wonder if the members of the Senate Health Committee in California looked at the successes and failures of the Massachusetts plans before voting their own plan down. While more people than ever are covered in Massachusetts, the cost overruns have been more than $400 million.

So, here is the question. Looking at these two states, does their history make the argument that universal health care cannot be achieved in the United States or that it can be achieved, but only at the national level? What do you think we have learned about the country from looking at these two states?

Programming note: Watch "Broken Government: Health Care - Critical Condition" Sunday night at 11 ET on CNN.

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 am a Canadian living in the lower middle income bracket. The vast majority of Canadians love our health care system and for the most part it works great. I feel sorry for the lower income Americans or those in America who have health problems with little or no insurance. I would like to say I just don’t understand why Americans are so fearful of government run universal health care (UHC) but have recently witnessed first hand how much control big business has over people’s minds on issues like this. I refer to another issue that my company is involved with, where our products could benefit consumers but is being squashed by the well finance and organized industry giant.

The concept of government run UHC is being squashed with fear tactics like “once you start down the path of socialism all our freedoms will be lost”. This is simply not the case. At lease it sure isn’t in Canada. We do have a greater lever of government run programs but in my opinion only the good ones and the socialist wing of our government never grows past about 20%. On the whole, we as Canadians recognize the benefit of having a splash of socialism in our system but at the same time understand the danger or going too far down this road. Balance is the key, balance between people’s needs and industries needs.

Good luck and God bless all our American friends. We love you.

Yours truly,
A Canadian
I think the attempt to mandate coverage for everyone, via universal healthcare, without provisions to change healthcare business as usual will be folly and costly. This macro-economic problem has to include, tort reform.

Individuals and Attorneys that bring Frivolous law suits that loose should have to pay for all legal fees involved for both parties.

Mandate insurance carriers to accept all clients, no pre-existing clause.

In this era of Evidence Based Medicine, there has to be a means for the government and regulators to discontinue paying for treatments that have not been shown to be cost effective. Doctors should not be allowed to head down a treatment protocol without first exhausting less invasive, more cost effective options.

There should user fees for everyone for major procedures. Most of the Medicare diagnostic procedures have no user fees associated with them. If the Patient had to pay a small user fee for questionable testing, the patient may not consent to a endless array of testing that continues to run the Health Care Bill that we all pay.
My son is a second year med school student, air force, who says with universal health care our doctors will be less able to care for us due to a slowing of the system. (It will take 2 months instead of 2 weeks for MRI's ect...) A lot of Heath Care professionals say their careers will be ruined. Do you see this happening?

Laura Walley
I am a 62 year old widow. My annual income is less than $25,000. I pay $769.00 a month for health care. Needless to say my savings is dwindling. I have tried to get coverage with a different ins. company only to be denied. I have found that unless you are under the age of 40, have never had a health issue and at a weight that is approved by the ins. company you can forget it. Let me also say that I'm really healthy. So, I will probably have to cancel my insurance and hope for the best. Needless to say, the candidate I vote for president will need to think this issue is important. Thanks, Roxy
I believe that health care for everyone in the U.S. can be achieved if the entities providing the care make health insurance more affordable.

The primary reason cited by those without health care coverage in Massachusetts is cost. I am certain it was the same in California.

Despite a majority of the populace in Massachusetts having coverage, the cost overruns are skyrocketing.

I have not heard either Democratic party candidate suggest that health insurance companies reduce the amount charged annually for even minimal coverage. I live in a state which long ago passed a law that every driver must have auto insurance, and most everyone does, because the insurance companies have made it affordable. So I think that if health insurance companies provide coverage for all Americans, these companies should be required to make insurance affordable, not only for those without health problems but also for those with chronic conditions, many of which are hereditary (such as diabetes or multiple sclerosis) or the result of injury (auto and on-the-job accidents).

Some sort of account could be established to help American citizens (whether by birth or by law) whose earnings are too low (which they would have to prove) to pay their annual health insurance fee.

Perhaps the fund could come from taxes paid by those members of the population who earn more than $200,000 a year.

While I know that many people feel paying for insurance for everyone in America or taxing those who earn more than a certain amount is akin to "discriminating against those who earn higher wages", the fact is that when it comes to certain expenses incurred in life, particularly health care, currently those who earn more likely do wind up paying more than they should due to those who are uninsured and never pay a bill.

I don't hear many people who earn hundreds of thousands of dollars complaining that they are paying more for auto insurance, etc., because they are driving a more expensive car or because of drivers who remain uninsured.

If the U.S. government, the health insurance companies, and the American Medical Association (perhaps with the assistance of U.S. auto manufacturers) could establish a nationwide health care plan that relies on health insurance in a way similar to the way automobile owners rely on auto insurance coverage, I believe every U.S. citizen could have health care coverage.
Thank you for explaining the differences between the different presidential candidates when it comes to plans for health insurance in the US.

I am wondering, how come that we currently have, in the United States an expence for health costs of 6,000 dollars per capita, where as countries in Europe, for instance Norway has 4,000 dollars per capita. What causes this gross difference, and how come the runners in the presidential race don't explain these differences. And how is it possible that we have such high health expenses per capita when so many people are uninsured.

Something is obviously broke, and why is it that all the candidates, left and right are so opposed to the European model? Everyone is insured, and the costs of it is a lot less?

Britt McCary
Maggie Valley, NC
Health care should not be mandated for the following reason: There is a growing health-filled community leaving the medical& drug campaign and entering the whole food and prayer way of life.

Years ago (and still in other parts of the world), doctors look deep into the eyes & soals of their patients; where the root of their ailments lie. They truly healed w/o this common prescription for drugs, first. I subscribe to a more spiritual and successful means of remedy when I fall short of good health. My practical prayers, along with bed rest and whole foods, always brings me back to alignment. This is my right. And it is best. So why would anyone who finds solution to good health in this way wish to endorse manditory anything?

I'd like to mandate eliminating all TV and magazine commercial campaigns in support of selling drugs and getting into the peaceful states of minds they so rudely attempt to upset.

It is my right to choose not to hear them. Not to see them. But their campaign is so strong that even with diligence, the American people cannot avoid them.

This must be stopped with the same force Tabacco and Alcohol campaigns were forced to go elsewhere. None of these campaigns support self-sufficient health. They support a massive drug business; Legal, yet lethal, in my opinion. Enough is enough.

Everybody wants celebrity status. Doctors used to be unsung heroes.

They came on call to the immediate aid of humankind whether those who called had medical insurance or not. They asked questions inorder to learn where the trouble could be stemming from.........found between the lines of a patient's tesimony.

They sincerely cared for the human being they were treating; Holding their hands and looking deeply into their eyes.

No. This country does not need universal medical insurance. What it needs is the honest return to its ethics and morals. It needs to learn that the first truth about the state of well-being is within the individual's spiritual belief system. That system is strongest when morals are met and ethics are demonstrated by one principle; Good.

It is irresponsible to infiltrate our society (while it is down) with a barage of brainwashing advertisements. It is hypicritical and it will proliferate worsened results in general mental, emotional and physical health.

Please think hard on these ideas. Because your oath expects it.

I pray that Obama wins this presidential election because I will engage him in this new idea. And I think he will listen.
We learned nothing. The simple fact is that absolutely no one actually knows where all the money goes. Unless you can discover the biggest money pits in the way too expensive US health care system, you can't design an intelligent proposal to fix things. The candidate I could support would be the one who says, "I'm going to ask for legislation to allow auditing all health care related industries to discover the facts about where the money goes before I propose any specific plan." Unfortunately that candidate isn't running in either party or in any state :-(.
Forcing everyone to feed the beast that is the problem (profit-driven health insurers) will not solve the problem (is doomed to fail). So, yes, if we keep insisting upon "Universal Care Done Wrong" (Arnold, Mitt, Hillary, Barack) all we will prove is that it is unaffordable and unsustainable (and that our leadership has sold us out). Our current system is leaving us morally and fiscally bankrupt, so insisting upon more of the same is kind of silly. Doing "Universal Health Care RIGHT" however, by uniteing all Americans together into one very protective pool instead of remaining divided and conquered in myriads of apples-and-oranges insurer "risk groups", would not only save hundreds of thousands of innocent American lives every year (study published recently in Health Affairs) but also $350 billion wasted health care dollars (Physicians for a National Health Program). Unfortunately the corporate media is helping to mis-educate and mislead the public on this all-important issue of national importance. There is a lot at stake.
I am thinking that one very important group affecting our health care dynamics was left out of the discussion. That would be lawyers. Surely lawsuits, or the ever-present threat of them, must greatly drive-up our medical costs. I would be so interested in your comments on this.

Marjorie
Boise,ID
I am a Canadian, and I felt I had to comment on a statement made in Dr. Gupta's report on "Government Health Care". It's true that Canadians experience longer wait times than Americans, but this is due in large part to a shortage of doctors and nurses created by American for-profit medicine actively recruiting Canadian professionals. I live in a city of about 80,000, and I know that many family doctors and specialists have left their practices here to earn much larger amounts in the U.S.
If U.S. firms stopped this predatory hiring practice, I think the Canadian system would work even better than it does now.
You are absolutely correct Britt McCary.
And this is where Sanjay Gupta has fallen down in his responsibility.

I am downright angry at all the misinformation and outright lies that are put forth by ALL of the candidates AND the media. I have yet to see one reporter or a tv anchor/commentator ask the right questions. Maybe its been done but I have not seen it. At some point a sharp astute reporter will focus on the truth and make it public in such simple terms that the average person will understand it. In the meantime we will wander in darkness and ignorance because nobody has the integrity nor the guts to spill the beans. NOBODY GETS TO THE ROOT CAUSE OF THE SITUATION, THE CAUSE OF THE HIGH COST AND UNAVAILABILITY.

Here are some of the key questions that need to be asked:
1. Since the living standards in US and western europe are approximately the same WHY IS THE COST OF US HEALTHCARE DOUBLE OR TRIPLE that of western europe?
2. If the european pays approximately the same amount in income taxes and gets healtcare, long term care, education, etc for it - what does the American get for the same tax dollar?
3. Regardless of which candidate's healthcare proposal you look at they all promise to bring healthcare to everyone with one voodoo program or another - does not really matter which one - where will we get the medical and care staff to care for the additional 45 million without insurance that will burden the delivey system? It is already overloaded and there is a dire need for additional nurses, doctors, therapists, etc.
4. If you go to a single payer system- call it whatever you want - does anyone realize the number of people that will become unemployed and a burden on the rest of society?
5. If something is not done the US will continue to become increasingly uncompetitive in world markets due to the burden of medical care costs. So what to do? Something has to be done.

Anyway the Republicans offer absolutely no corrective action. Of the Dems, Obama and Edwards have no clue. Just talk. Clinton "probably" has a clue but can't come out with it because she got her fingers slapped years ago and does not want to make the same mistake now. And of course the MEDIA does absolutely nothing. Never asks the right questions - NEVER. Hasn't anybody ever looked into things?
The foreign financial markets are reflecting what the Americans are oblivious to - and healthcare costs are a contributor to it. They "get it" and we don't.

Due to my personal circumstances I went and looked into these issues and prepared a report on it. All of this misinformation about 50-60% tax percentages that socialized medicine would bring can be easily confirmed to be around 28-32% with an on line tax calculator.
This is from Finland. Go to the tax calculator for 2008.

You do not need to fill out the whole form; just the first few lines and then hit the calculate button at the bottom.
By simply altering the income amount say, upward, you can see immediately how much taxes they pay. Then wake up and smell the coffee.

http://www.vero.fi/default.asp?language=ENG&domain=VERO_ENGLISH

I have a complete report available for the asking.

John Saarikko
Sarasota, FL
A Tale of 2 Healthcare Systems -
January of 2006 2 things happened -I was scheduled in March to have a full hystectomy because of several medically doccumented problems -and I also found out my sister-in-law was getting remarried! (in July) Her best friend from Canada, who is the same age as myself, was also supposed to have a full hysterectomy. She said she wasn't sure when her surgery would be and might not be able to attend the wedding -I said "hey I'll be there because my surgery is scheduled for march & I will have recovered by then" WHAT FOLLOWS SHOWS HOW BROKEN OUR HEALTHCARE SYSTEM IS :
A week before my surgery the insurance company would NOT APPROVE it -they stated 'conservative medical treatment' must first be tried (although that wouldn't work for my condition) and I would have to wait a year. I was at that point too sick to function and then my doctor went out on maternity leave & I had to start the process all over -A Year later, with a different doctor I had a partial HX -and when I went in 3 days later to have the staples removed he told me NOW they had the documentation to do the FULL HX -but wait! now our insurance has changed so I have to wait for approval again! -TWO SURGERIES instead of one-TWICE THE RISK-_TWICE THE COST AND I AM GETTING SICKER & SICKER WAITING...
My Canadian friend had her surgery-recovered, is thriving -missed the wedding though but has no further problems and is not strugging-as we are -to pay for her surgery-
NOW YOU TELL ME_ WHAT SYSTEM MAKES THE MOST SENSE TO YOU?
It's simple arithmetic (I know politicians have trouble with that): you cannot cover 30% more people with the same or smaller budget. It would take 30% more money, other things being equal. So universal health care can only be achieved with additional tax revenue, and this is a spin-proof fact of arithmetic.
Forcing everyone to feed the beast that is the problem (health insurers) will not solve the problem (health insurance, not care, crises). Health insurers are bankrupting our country morally and fiscally, so forcing more of the same seems silly. "Universal Care Done WRONG" (Mitt, Arnold, Hillary, Barack) is designed primariy to try to prove that universal care is unaffordable, which is the opposite of the truth. "Universal Care Done RIGHT" (uniting all Americans into one very protective pool instead of leaving us divided and conquered in myriads of aptly-named insurer "risk groups") would save at least 101,000 innocent lives and $350 billion health care dollars (Physicians for a National Health Program) each year. The truth will not change, but with corporate media and politicians selling "we the people" out to the health insurance industry, it may cost billions of wasted American dollars and lives before our collective light bulb turns on. B. Spoon, Charleston, IL
The best solution to our health care crisis is total universal healthcare like that of Canada and France. The problem is the politicians, including the media are being bribed (lobby) by the insurance companies, AMA, drug companies, etc., to conduct black propaganda on this issue. The number of deaths of unisnsured patients will only increase in the present system. The Clinton/Obama plans will not work and solve the problem and republican plans are a disaster. The fear of tax increases for socilize medicine is another factor. But wether we like it or not there will be tax hike to meet the growing population and need for basic services. Its part of governing. Any politician who say he will not increase taxes is lying. Healthcare is the duty of the government thats why we pay taxes and its morally wrong and violation of human rights not to provide it to its citizens and let its people die in the streets and be homeless. And yet we the wealthiest nation and powerful nation in the globe. Many middle class Americans say why do they have to pay more taxes for free healthcare for the poor specially minorities, now this is blunt part racism too.A nation is like a family, if you do not want to help your unfortunate members of your family then your values and ethics have gone to the dogs and that is look like America has become and direction. And it will also cause its downfall.

Seattle, Wash
Dr. Gupta are you running for office? I'm wondering why you simply offer a summary and don't put forward any opinion of your own. Couldn't you at least provide some information with regard to the challenges of the plans put forward. 400 million over budget and counting in MA doesn't seem to forbode very well for a similar program nationwide.
As a practicing physician for 21 years, I have long desired to see health care coverage for all Americans. I fear that this will not ever be a reality until Americans realize that we cannot have "free healthcare for all" AND "unrestricted healthcare for all". There is not enough money in the world for all of us to get all the healthcare we want. Thus, there would have to be some limits (i.e no coverage for transplants, dialysis, etc.) so that there would be enough money to provide basic health care to all the rest.
Britt..in our country health care is a big business. In European countries it's treated a a humanitarian service. Once you take the profit out healthcare it'll be easily affordable.Thank you Marta
Doctorrazz is absolutely correct and Dr. Gupta made some very good points in his article as well. I am a nurse with 20 years experience in health care working for both civilian and military medical systems. The military system is as close as you can get to socialized medicine in this country and really isn't all that bad. With that said, many things need to happen FIRST before health care can be affordable for everyone. There is NO WAY we could offer universal coverage with the costs the way they are now. And, the legal system needs to be changed to control costs of malpractice insurance and claims which are absolutely ridiculous. Another reason costs are so high is because the public thinks doctors are miracle workers. They are good, but not that good. We also have a culture in this country of not accepting death, people fight it at all costs. I work in intensive care where roughly 40-50% of all hospital costs are generated. We keep people alive who are essentially gone or whose lives with not have anymore quality to them no matter what medication or surgery we give them. There needs to be a paradigm shift in this thinking that death is not ok. It is not giving up, it is a part of life.

Someone commented that none of the candidates mentioned cutting costs when in actuality that is exactly what Barack Obama proposes. He does not want to mandate healthcare, but make it affordable so everyone can get it if they want it. He does mandate coverage for children, which I agree with. Most folks I talk to think that universal coverage will mean socialized medicine and they don't want it. They want to be able to choose their own insurance. However, the cost of healthcare is so high because those who have insurance are paying for those who do not.

The health care problem is a huge one that will take many years to fix. It has to be achieved a little at a time. Hillary Clinton's plan to save money with electronic medical records is absurd in my opinion. I see it as another way for people to invade my privacy, just my opinion because I've seen it happen. It's not all it's cracked up to be. Every analyzer, every computer, every piece of equipment, etc. would have to be compatible with one another and linked to one another-a daunting task that will not save money any time soon, and if it does, I believe it will be miniscule compared to the funds needed to pay for universal healthcare.

I support Barack Obama's plan because I think it's a step in the right direction. The problems are too vast and implementation of plans like Hillary Clinton's have proven not to work in other states. There needs to be a working group established to carefully research how we should move towards universal coverage. Which, in the end, I think is the right thing for our country to do, but needs to be done slowly and systematically over a very, very long time.
As a physician caring for patients with complex and chronic medical illness, I am glad that Universal Health Care for all is again in the debate. I have studied and worked in Germany, Britain, USA and Taiwan and seen Universal Health Care work well for both patients and physicians. America needs a comprehensive reform to achieve what these countries have achieved: Universal Health care with better outcomes at a much lower price ! The death rate per year on hemodialysis is 23% in the USA but a much lower 12.5% in Germany, 8% in Singapore, 6% in Japan.
Central regulation is needed to merge our fragmented health care system to a system of excellence for all. As long as the central regulation is not run by private insurance industry and bureaucrats but by physicians and patient representative organisations, there is no need to fear for the quality of its outcome. The AMA and health industry have managed to vilify universal health care for selfish reasons and spread false rumors about Universal Health Care. In the countries that have Universal Health Care, it is never debated whether to return to a system like the USA for a good reason - people are in fact much too happy with its performance then consider doing away with it.

Dr. Walter Rohloff, MD
Kidney disease specialist,
Albuquerque, New Mexico
The success of the Canadian health care (I tremendously enjoy it)started 30 years before it became law. First the government gought all hospitals and clinics, one at a time. Only when the delivery of health care was under control that the cost of health care can be brought under control.
Leaving physicians and hospitals to charge whatever the traffic can bear is a recipe for disaster.
The fundamental reason market forces cannot work in health care is that being sick like having cancer is not a choice, like deciding to buy a car. Hence this is not a true marketplace in the Keneysian sense.
I finally poiint out that universal health care is a social concept. For Canadians, health care is a RIGHT, not a commodity.
The US constitution guarantee the right to happiness; how can you be happy if you are sick like a dog.
Unless everybody is protected, then nobody is secure.
Why do so many Canadians cross over to the United States for CAT scans, MRI's and major surgery?
They are tired of the wait time to be seen! Socialism: stand in line, wait your turn which may take months!
I am uninsured in Massachusetts and for the middle income this law is bad!$4000.00 deductables and I can't afford it so I am being fined!What's next Jail!Massachusetts has made being uninsured a CRIME!
I find it interesting that Americans worry about the high cost of providing health care to everyone, and bring up the spectre of "cost overruns" that have supposedly occurred in Massachusetts. Yet, none of you are concerned at all about the $700billion that your war in Iraq has cost. The Brookings Institute and other university sponsored studies estimate it would cost $300 billion to cover the uninsured in America. That is less than half of what your wars in Iraq and Afghanistan have cost. The issue is not financial, but spiritual and cultural. You are a warlike, militaristic people whose priorites are international conquest and power. Because of this, you will never solve your health care problems, your educational problems, or any of your other problems. Very sad. You had so much potential, and you have thrown it all away.

Jay Smith
Denver, Colorado
Okay, if the socialized medicine in Canada is so great; why are many Canadians going to brokers to get surgery and cancer treatments here in the United States??? The wait for a simple test may take months and if you have an aggressive form of cancer; can you afford to wait months or not at all? Nothing is free and certainly not health care, but someone must have an idea that will help millions of working, uncovered individuals get some kind of health care. So far I don't see the Democrats or Republicans have the answer. Maybe a private party?
The Canadian system might be a way to go. However, how are to deal with the already unbearable cost of Medicare/Medicaid? Entitlement commitments are into dozens of trillions of dollars. I do not see a way out, fiscally. My daughter's generation will receive no benefits, and will pay the highest taxes to date.

To Roxy: You say you are healthy, but how does a healthy person, even at your age, need to spend almost $800 a month on health care?

Costs tend to rise in two situations: Lack of competition, and over-regulation. In the USA, both problems exist.

I support state-run efforts at health care, if I am to support any government intervention in the industry. It makes no sense at all to me that somehow, by making the program bigger and more expensive, that it will get the job done. When exactly does bigger become better?
I am a truck driver in the US. I have made a point of interviewing several Canadian drivers and the overwhelming response I have received is that they are pretty happy with the system they have. If it can work for Canada, I don't see any why it can not work for us. Our government is is the back pockets of the wealthy who I believe are a Me rather than a We group of people. They are not interested in paying extra taxes to help offset the cost caring for those who are less fortunate than they are. Their needs are met and that is all they care about. It's pretty sad.
The Role of Tort Reform

No one talks about tort reform and its role in the escalating health care costs. A big part of the reasons health care costs so much in this country is that doctors and hospitals practice defensive medicine. You also have the cost of liability insurance built into everything from medical appliances, pharmaceuticals, visits, procedures etc.
This may be the achilles heels of the plans. No one wants to tackle the biggest lobby group in Washington: loyars. Half? of all congressmen are attorneys.
I am a practising physician here in America. Every body is aware how out of control the health care expenditure is. All the politicians are talking about how to pay for this. No one is talking why this has become so expensive. It is my opinion that the fundamental reason is practicing Defencive medicine-in other words just to cover your back. Physicians and hospitals are spending so much money and energy to protect themselves from the litigation. Unless the tort system is reformed there in no hope for the expence control of the health care. I guess none of the politicians want to talk about it because they may be funded by the Trial lawyers.
If we can minimise this wasteful practice of defencive medicine and control the drug company lobbying then we will not have this problem.
Your opinion is welcome.
The Ottawa Citizen had an article yesterday about the amazing longevity of Canadians, whose life expectancy for men is now 80.2 years, and even higher for women. The article focused on Peter Roberts, who just turned 90 years old. People over 80 are now the fastest growing age group in Canada, and the number of nonagenarians has more than doubled in the last two decades.

What's interesting about the article is that Peter Roberts is an American. He's a retired radio and TV broadcaster who spent most of his life in the United States, where he worked at network affiliates of NBC. So what is he doing in Canada?

A key reason that he left the U.S. in 1986 was because his wife "grew enamored of the Canada's public health-care system as her husband entered his golden years."

'A friend of mine in the States, her dad got sick and he was in the hospital for four months before he passed away. Even with insurance, the hospital bill came to $120,000. My friend's mother couldn't pay so the hospital put a lien on the house. Here in Canada, the whole system of medicare makes so much difference to our quality of life.'

I know that the people who profit from America's healthcare system say some pretty scary things to defend their interests, but all other essential services are already government-run. The government pays for the police because otherwise some people wouldn't be able to afford police protection. That would impair their right to life, liberty and the pursuit of happiness. It pays for the fire department so that everyone can afford their services. It pays for schools so that everyone can get an education. Healthcare is the only remaining industry that threatens Americans' right to life, liberty, and the pursuit of happiness. If I were an American, I wouldn't stand for it. I would say, "I'm an American, I deserve healthcare!" The richest country in the world can't afford universal healthcare?

Yes, countries with universal healthcare do pay higher taxes, but I've never gotten a bill for $120,000. We also manage to provide the same services for less than half the price as the U.S., per capita, because services are billed at cost! Half of the cost of U.S. medicare is the profit margin! My best friend's 19-year old daughter almost died of multiple organ failure recently, and will have to remain in hospital until she gets a new heart. He confided to me, "My wife and I are both working professionals. If we lived in the U.S., we'd have employer health coverage. But if we had to pay a percentage of her treatment, we'd have to get a second mortgage." He didn't have to say it, but the message was loud and clear: "Thank God we live in Canada."

I'm as healthy an ox, a former athlete with no medical conditions, but you couldn't entice me to move to the U.S. Every day, more and more Americans move to Canada to take advantage of a system that works! We can do it, and so can you.
Making Health care cheaper and affordable start by changing the school system, or allow more doctors in our free market economy. Doctors have created a monopoly and only allow well off kids to pay them self through a 8 year school program, where first four pre-med year does not relate their profession however relates to a Monopoly that allows fewer students to enter the field. We live in a free market economy however the doctors work like a socialize monopoly government. Politicians need to look at were the ridicules higher cost are, it sure starts with doctors first than the premium.

Jag from NY
After watching the presidential debate between Senator Obama and Senator Clinton, the difference between a conservative approach and a liberal approach to fixing our "Broken Government" was made clear. On the subject of health care, as well as college tuition, both candidates suggested more government aid. I asked myself why the solution had to involve more spending. Why can't the government set limits on how much hospitals, insurance companies, drug companies, and universities can charge American citizens? Yes, we pay too much for a migraine pill, yes we pay too much for a pack of gauze, yes we pay too much for an MRI. The question is: why? Senator Clinton and Obama don't seem to put much emphasis of this portion of our health care crisis. They only suggest spending more money and taxing more to pay these exorbitant costs. I feel that the real heat needs to be taken off of U.S. tax payers and put on drug and insurance companies who are doing quite well. There needs to be an increase in competition in the market to drive costs down. It would be silly for a pharmaceutical company to start charging less for their products if they are getting whatever amount they want from Medicaid and insurance companies. Let the people be the driving force behind this competition. Make health providers compete for American's business. The government should just serve as referee.
Sanjay, you need to come to Canada for a few days before you report any more about the pros and cons of universal health care. I am a Canadian physician who works in primary care and ER, and I am also a public health specialists, and an ethicist. I know that the Canadian system is by far, the best in the world. Unfortunately, our system would never work in the US, b/c Americans dont trust their governments, and often for good reason. Canadians do trust their government - and they have entrusted them to manage our 10 single payer systems which are efficient, egalitarian and excellent. Yes, we have 5 times fewer MRIs - but when my patient NEEDS and MRI for a cerebral aneurysm I can get one in 1hr flat...when my patient WANTs an MRI for his sprained ankle...he waits months...and usually doesn't show up for the appointment b/c the pain is long gone. The American consumer consciousness makes your health care expensive. Canadians trust their doctors like they trust their government. My patients beleive me when I say - its a virus, you dont need antibiotics. In the US, a patient would say, I'm paying you...write me a script! I teach me patients how to be healthy and how to distinguish between viral and bacterial illness to prevent them wasting time coming to see me. There is no unhealthy territorial competition between physicians so I freely refer to others when needed.
Not only is our system more efficient and more just...it produces better doctors - medical students and residents examine the patient, order all NECESSARY tests...and make decisions based on medical indications...NEVER based on ability to pay (which leads to inappropriate care for millionares and paupers alike). There is NEVER any rationing in clinical care. Our waiting lines are shrinking - and they exist for one reason only - b/c gov'ts of the 90's decreased med school enrolment so drastically that we have a huge doctor shortage. It has nothing to do with the system...but rather a small but significant miscalculation by some inept politicians.

I love practing here. I feel great when I treat the hospital CEO and a drug seeker in the same clinic, with the same respect..one after the other. If you want to know what its really like email me: followupmd@yahoo.com

Barry, MD MPH CCFP FRCP(C)
Another Canadian Viewpoint: My brother has spent the last 2 weeks in hospital for a bout of pneumonia, 3 of those days in ICU. He hasn't, and will not pay a penny for his care. He also has MS and gets government care...the family doesnt pay a thing. I have had 5 children in hospital and it never cost me a penny. My husband has diabetes and I have a thyroid disease, and we dont pay a penny all year after we have paid a limit of $150.00 for our medicines and drugs, no matter how much more we need. To be honest, we do pay our 'pennies' with our annual Canadian MSP Fees (Medical Services Plan), but it is very reasonable and affordable: our family of 3 pays 1,000.00 per year for coverage and we pay in monthly installments. This covers EVERYTHING....I could be in ICU for a year without paying a penny. It is all covered by MSP. Canadians dont take cash to the hospital, just our MSP card. Why cant the USA adopt our health care program? It is fair, affordable and humane. EASY!
Roxy,

You are right, Medical resources and staff will need to be expanded to take care of more people. Of course we can continue to let them die waiting in line for MEDICAID services....wait a minute...we take care of everyone now, don't we. Yes there is a wait in the MEDICAID line at the county hospital and whichever emergency room they can get into. And guess what, your taxes pay for this "single payer" insurance which houses a great deal of fraud, including subtle fraud of overcharging and unnecessary procedures that now one could go to jail for. As a former hospital accountant I can't tell you how much management appreciated physicians who would order extra days in the hospital for patients whose coverage would pick up the tab.

The only people left out are those dumb slobs that are too poor to buy coverage and don't want to give up their home, car and small emergency savings for care. They go to the emergency room and then stiff the bill for their care. And you pick up the tab when you pay your bill.
Denise,

The Canadian system, like the Japanese system is great. But it could be better.
Dr. Gupta I enjoyed "Health Care - Critical Condition" Its about time that these abuses to working families have seen the light of day. The problem with the California healh care bill was the estimated cost of more than $14 billion when the state is facing a shortfall of over $14 billion with a slowing economy. The problem I have with the Ca. bill and most of the proposed plans is lack of cost containment. State Senator Sheila Kuehl was the only lawmaker to have any language concerning cost containment in the early going when there where 3 healthcare bills competing for the spotlight. Well they killed that quick and early. Then we where left with this watered down unfunded healtcare bill ABX1 that destined to fail. Universal coverage can be achieved in Ca.,but it should be a national program, 50 states with different plans makes no sense. Follow the money and you will find why we do not have a national healthcare. Average 2006 compensation for health insurance CEO's was $9 million,pharmaceutical CEO's $4million, the CEO of Aetna Inc. Ronald Williams $32million.Why would they change a thing?? I am sorry but everyone buying there own plans and trusting the "freemarket"is what got us to this point in the first place.Healthcare needs to be"not for profit", with universal coverage,comprehensive and affordable. Dr.Gupta you have only scratched the surface keep going peel back the layers, follow the money, it will make you sick,American people are dying in the name of profits. B Fealy, NorCal.
The example of Mass. simply means that neither state-run nor federal-run health care coverage would work in this country. We have diverse classes and diverse needs. It takes federal government, states and individuals together to get it done. Obama is on the right track, not Clintons! I beleive that universal health coverage starts with inidividula states with back-up contributions from federal government. This takes political power that can be brought in only by a unifying figure.
Dr. Gupta, Too many candidates and you are talking about health "insurance" for everyone, not health "care" for everyone. My question for anyone:
What VALUE do the insurance companies add to the health care system?? I think anyone would realize the answer is NONE. The definition of "parasite":

1. an organism that lives on or in an organism of another species, known as the host, from the body of which it obtains nutriment.
2. a person who receives support, advantage, or the like, from another or others without giving any useful or proper return, as one who lives on the hospitality of others.

Until we remove these parasites from the system, the costs will continue to be exorbitant.

Also, these people talking about malpractice as a big deal, WRONG!! Only 2% of health care costs are attributable to legal and malpractice costs, that is miniscule compared to the 35% siphoned off by the insurance overhead and profits.
Sanjay:

It's sad that you are censoring opinions here. The truth is that what you are saying about Clintons' plan is from Clinton's persepective! YOu say that her plan covers 100% uninsured for 124 Billions and Obama's covers 50% for 102B. Yeah, that is what Clinton's adviser says, what a spin!

You also say that 20% of the uninsured makes $75000 and chose not to buy insurance even if they can afford it! How do you know they CAN afford? Are you saying they intentionally thrown the burden to us the insured?

The bottom line is that Clinton's plan was once defeated. There is no more will to let her waste another opportunity this time.
THE DREADED LETTER: WE NEED HELP. MY WIFE AND GOT GOT OUR MEDICAL INSURANCE INCREASE. IT WAS $1489.59 A MONTH NOW ITS GOING UP BY 20%. THIS IS ALREADY MORE THAN MY MORGAGE. HOW LONG CAN I KEEP BOTH IS THE QUESTION. SHOULD I LET THE HOUSE GO OR OUR INSURANCE. THAN MY WIFE WITH OUT HER MEDS WILL BE BED RIDDEN FOR THE REST OF HER LIFE. SHE ASK A MORPHINE PUMP IMPLANT.
Sanjay:

Thanks for the "Broken Government: Health Care -- Critical Condition." Since the US health care system is not very transparent, looks inside the system are, I would guess, a shock to many viewers.

One point, to reinforce the posting by "A Canadian" and a number of others. The Canadian system is not a federal, centralize health care system. It is a Provincial system supported by federal funding. In fact, the federal government is expressly prohibited from making health care policy.

In that light, if state-level health care programs in the US gain traction, the US and the Canadian systems could start evolving toward one another. And, each system is facing similar cost pressures, so work remains to be done even after universal coverage is available (echoing the posting from doctorrazz).

However, there are serious obstacles in the way of the State programs. The US Federal government could provide substantial help to get state programs (1) up and running and (2) able to sustain themselves through economic downturns.

A comparison of the US and the Canadian systems in addition to policy recommendations for state-federal interactions is available at:

http://www.springerlink.com/content/qqn583541278531q/?p=dc87536806e148d1977e298cb010ccf3&pi=1

Thanks again!
None of the candidates talk about real health care concerns and issues. I want to know how are they going to get the insurance companies and pharmaceutical out of the equation? I do not want to hear about the $130B We need to know Why are we paying more for health care than our mortgages? Why do insurance companies pick and choose which claim gets processed? I want to know why there was $850.00 late fee on my claim because my insurance did not process the claim. I want to know why they will not provide documents when we ask them especially, when they maintain incorrect medical files; I want to know why I cannot get an appointment with my primary care physician when I am really sick and end up in the ER? and lets not forget the pharmacy. I want to know why did they switch my BP meds to the generic and caused a medical emergency in exchange for their profits. These are the real issues and the real health concerns for all of us. What are they going to do about this? Fix the corruption first then talk about a health plan.
We already have universal coverage--only it is for Americans who are over 65. Medicaid is amazingly efficient. It works. Let corporations pay additional taxes to cover the costs--as they will benefit by not having to provide private health insurance. If private insurance companies can convince people to buy secondary insurance...fine. Otherwise, let them die.
Sandy&George- know how much a morphine pump implant costs? Sounds like you might be getting a deal. Googled and found a 2004 dated article: http://www.paulmdeutsch.com/forms/complications-CP.pdf

and although you can't always believe everything you read on the internet, it does state a morphine pump implant is $32K to nearly $36K (remember this is 2004 $$) and has to be replaced every 5 years. Maintenance runs $12K per year. So after 5 yrs, you've paid $89,400 ($1489x60) in insurance premiums and if the article is correct, you may have received benefits of $60K in maintenance and $32K for the unit cost. Plus the insurance premiums paid covers BOTH of you AND I would imagine you had additional claims paid for other issues/ailments/routine procedures. Yes, I'm sure you had copays, etc, but still why are you complaining?

Don't mean to attack you personally, but you don't need help. There is a cost to care. The person who stated

" until Americans realize that we cannot have "free healthcare for all" AND "unrestricted healthcare for all". There is not enough money in the world for all of us to get all the healthcare we want. Thus, there would have to be some limits (i.e no coverage for transplants, dialysis, etc.) so that there would be enough money to provide basic health care to all the rest" could not have summarized the issue better.
Perhaps Partisan politics prevails over practical decision making. But then again, the proposals brought forth in the northeast are largely a series of government subsidies to the healthcare industry.
If we as Americans are going to continue considering privatized healthcare, we must least look at the system in place currently in the Netherlands.
While I do agree that government should intervene in certain industries (like weapons manufacturing, energy, and automotives), government should stay out of health insurance.
I lived in Europe for 30 years before coming to US and I never heard the word "coverage" when talking about healthcare. This is an invention of the business, a smart one so they can have a shield to control their potential losses. I work for a multinational company and my friend in Ireland pays only 100$/month for healthcare and this represents a fixed percentage of his monthly salary. His coverage is 100%, in fact there is no word "coverage" in the national system. I pay 800$/month for my healthcare and my coverage is pretty good but far, far away from 100%.
When my friend from Ireland found out that I paid 200$ for 15 prescription pills he told me " You are insane". In Ireland every prescription costs no more than 6 euro, no matter the drug or amount. This is about 10$.
When I told him that the hospital bed in the USA costs about 2000$/night he was very upset: "This is legalized robbery".
Then he added:" I don't get a bill if I go to a doctor or I am hospitalized".
Why a national healthcare system is not the best option for all american people? Because will put some out of business.....
A straight talk about Universal Healthcare in United States is yet to be heard.

Almost everything nowadays is about the material benefit, in most cases just plain money.

Currently our Healthcare system is controlled by private Insurance and Pharmaceutical corporations with little or no oversight from Federal Agencies (where oversight is another subject of discussion).

I do not want to discuss all the “beauties” of current system, as you all know it and experience it every day, I’ll just summarize:

1. Insurance companies are not interested in your health, they would not cover you if you are sick, they would throw magic words at you such as “pre-existing condition” or they will cover you with your sickness at the highest possible premium and countless other conditions listed in their contract as not covered.
2. Pharmaceutical companies would be glad to toss all their new patented expensive drugs at you, let you try different flavors of it, all without letting you or your physician figure out the actual cause of your sickness, although they will let doctors treat side-effects of a new medication and then let doctors prescribe more and more drugs till you are really poisoned to death (Watching/reading news recently?!)
3. Where does it say “For Profit” in Hippocrates Oath?! Who is talking about values?

Let’s take private corporations out of the equation and incorporate all those dubious medical insurance premiums into taxes. What would we gain by doing so?
One would think that things will get worse, but look at it from another perspective:

First of all let us take a word “Government” out of the context as everybody seems to be scared of this word, let us patriotically call it “National”.

1. Nationally controlled Healthcare (do not be scared of this too!) will take care of you, after all Nation is nothing without its People. Do you really think that it is in your Nation’s interest to let you get sick, not work or work unproductively, and just die?! Nationally controlled Healthcare is Transparent at least it should be in a true democratic society! Ultimately you are in control not some bureaucrat!
2. Once again nationally controlled Pharmaceutical industry is transparent. You do not get a medication prescribed to you just because it is easier than to diagnose your sickness in time and treat the cause of a real problem instead of suppressing the pain and other symptoms.
3. Doctors will not be forced into submission to Insurance companies and they will work more for quality rather than for quantity.

And do not bring in an argument of increasing taxes and or long lines at the doctor’s office! We are already paying too much for our healthcare and I do not want it to sound too ominous, but some people are already paying with their life. Have you seen statistical data on who, where and for how long waits in the line? Let’s be honest, you will not see longer lines than they already are at your doctor’s office.
I'm so frustrated about the US health care system because I'm currently an uninsured college student. I constantly live in fear of getting hurt myself. I remember growing up in Hong Kong, where we had universal health care and dental care. Yes, it was a long wait to see a doctor sometimes the qualities was not the best. However, I did not have to constantly worrying about minor pain in my body in fear of expensive surgeries.

It seems like the health care in the US is complicated, especially for someone that is not familiar with the insurance policies.
I am an 18 year old high-school senior who is a prospective physician. During my high-school career, I have conducted research at Duke University Medical Center and volunteered at hospitals around the area. In addition, both my parents are in health-care professions, so I am very familiar with our current healthcare system and its pros and cons. In the United states, there is no doubt in my mind that our healthcare system is flawed. High costs of insurance are preventing all Americans from obtaining coverage. The solution, however, does not lie in socialized healthcare. Macroeconomic policies show one basic idea: supply and demand. As price decreases, demand increases. As price goes to almost nothing, demand is out the roof. Canada and Britain are poster children of this with 22 month waits for MRIs and radiation therapy waits so long that 10,000 people die each year simply because they did not receive treatment in a sufficient amount of time.
What we should do is focus on WHY our insurance premiums are so high: unhealthy habits in America, frivolous malpractice lawsuits, unnecessary billing to insurance etc. The reason that other countries live so much longer is not due to their healthcare, but to factors such as the high rates of obesity, deaths by motor vehicle, and murder in the US. Once these factors are taken into consideration, AMERICANS actually live longer.
Lawyers like John Edwards are driving up the cost of healthcare. Some doctors are sometimes paying in the upwards of $200,000 just for malpractice insurance. The majority of malpractice lawsuits is not justified and is frivolous. I wonder why the US have the most malpractice lawsuits in the world. Doesn’t that affect our cost of healthcare? The answer is yes.
Here is a MAJOR problem with our healthcare system. Read this example and relate it to our healthcare system. Say we all had grocery insurance. You have a premium and copay like health insurance. Each time you go shopping do you care how much you spend per pound on meat? Now we do. We look for the cheapest prices so we can save money, but if we had grocery insurance would we do the same? No! instead of buying cheap ground beef im going to buy filet mignon because I don’t care how much it costs! I just pay my copay and I can get as much food as I want and the most expensive if I choose. People do not care how much their treatments and prescriptions cost because they just have to pay a copay. If we SHOP AROUND for the BEST PRICES just like in every other type of shopping we do, we can make companies lower prices. We should also care about billing UNNECESSARY treatments/tests to our insurance. This just drives costs up. Americans need to learn how to properly use insurance because we have slowly started to abuse it.
With government in control, they limit what’s available because they are in control of the money for it! ITS NOT FREE. WE WOULD PAY HIGHER TAXES FOR IT. In Canada, for instance, they pay OVER 50% in taxes!!!! If we raise taxes to pay for health care in the US this will not help the poor. In national health care countries, people are doing their own dentistry, using superglue instead of buying dentures, and pulling teeth with pliers and vodka all because of wait times!
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