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SANJAY GUPTA MD
Special Live Edition: Health Care Reform
Aired March 27, 2010 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN HOST: I'm Dr. Sanjay Gupta. Welcome to a place, a special place where we're going to teach you today how to live longer and stronger.
We are live this morning talking about one of the biggest issues -- domestic policy issues -- that's affected our country in more than 45 years. Of course, we're talking about health care. We want to hear from you directly.
So, we're going to have a conversation today about these important issues.
First of all, talking about access -- how many people will ultimately be affected by this? How many people will have access to health care that don't right now?
Also, a big question for a lot of people: the quality of health care. If you have health care insurance, will your quality stay the same? Will it be reduced? Might it even go up?
And what about the new people who are coming to the system? What will the quality of health care be like for them?
And finally, the question of cost -- the question that gets asked all the time: what does it eventually going to cost to the country? What's it going to cost to you?
We got all the answers. Let's get started.
GUPTA: Now, I have been covering health care reform on this show for a long time, as you know, if you've been watching. I've read this 2,700-page bill twice. It's become law now.
You know, instead of printing out the entire thing and putting it on the table over here, like a lot of people have been doing for effect, go to our Web site instead, CNNHealth.com. Read about this yourself. It's really important to do so.
You know already that this week, history has been made. After more than a year of trying to get legislation passed, President Obama signed the bill that provides the biggest expansion of federal health care in more than four decades. It cost $940 billion and it's designed to help roughly 32 million uninsured Americans get health insurance. (BEGIN VIDEO CLIP)
BARACK OBAMA, PRESIDENT OF THE UNITED STATES: After a year of debate, after a historic vote, health care reform is no longer an unmet promise. It is the law of the land. It is the law of the land.
(END VIDEO CLIP)
GUPTA: Now, of course, all of that sounds good. But rest assured, as well, as we're going to talk about, some of this is not without controversy -- starting with the fact that unlike Social Security and Medicare in years past, Congress passed health care legislation without any Republican support.
Now, this deep political divide even spilled over into violence acts and threats. At least 10 congressmen on both sides of the aisle reported incidents. One congressman received a letter with white powder. Others received threatening e-mails and phone calls. Democratic and Republican Party headquarters in New York and Virginia had -- they had their offices damaged, including bricks being thrown through the windows.
You know, the fight over health care reform continues. Officials in at least 14 states right now -- as things stand now -- have filed lawsuits challenging the constitutionality of the health care law.
But, you know, right now, aside from all of that, let's get to what this means for you. We got a lot of questions from all sorts of people. Seniors, for example, worried about Medicare. They ask us questions more than just about anybody else. For example, do you know what a donut hole is? Well, donut holes might be disappearing. And that might be good news.
How's all of this going to affect your wallet? Well, the answer is: it depends.
Let's give you some details. Here's Tom Foreman.
TOM FOREMAN, CNN CORRESPONDENT: Reform may be the cure for health care's problems but different people will get different doses. Some are taking effect almost immediately, others in four years.
Let's start with a family making so little money that they cannot afford insurance. When this program is fully running by 2014, the government will help buy coverage for pretty much anyone making around $30,000 to $90,000 a year. The more you make, the less help you get. And if you don't buy insurance under those circumstances, you will be fined.
But what about grandma? Well, seniors on Medicare, no matter what kind of income we're talking about, will see mixed results. They will get some breaks for certain tests and drugs, but those who have purchased extra protections, so-called Medicare Advantage Plans, will find some of the government subsidies for that being phased out and some may lose that coverage.
Let's look at a middle class family making, say, $100,000 to $150,000 a year. They have insurance through their jobs and the bill says, keep it. But they'll still face changes which will affect everyone.
Look -- one child has a heart problem which she inherited from her mother who has the same trouble. They won't have to worry about being denied coverage based on those preexisting conditions. The insurance companies cannot limit how much it spends on their treatment and you can't be dropped for getting sick.
And finally, let's look at the family doing pretty well, more than $250,000 a year. They get the same protections as everybody else, but they're also going to see additional Medicare taxes coming out of their paychecks, rising from less than 1 percent to almost 2.5 percent. There will also be new, almost 4 percent taxes on their investment income.
And by 2018, anyone in any tax bracket who has a particularly generous health care plan through work will also be facing new taxes on that, too.
GUPTA: All right, starting to make some sense here. Thanks, Tom, for that.
How is this new law going to affect you? You know, they say it's going to affect everybody. And today's show is about answering your questions. Let's open up the phone lines. You can call us now, 800- 807-2620. Let's have a conversation.
We'll be right back.
GUPTA: All right. We are back with SGMD.
This week, obviously, the long controversial battle to broaden access to health care came to and. A bill has been signed into law.
Now, regardless of which side you're on on this whole thing, health care reform could affect you. But how?
We know you have lots of questions. Let's get right to them. Here's the phone number again, 800-807-2620.
Let's go to the phones now. I think we have our first caller.
John, are you there?
JOHN HUSKISSON, CALLER FROM ROCHESTER, NEW YORK: Good morning, Dr. Gupta. GUPTA: Good morning, sir.
HUSKISSON: My question is: with the new bills, will hospital providers have to cut costs or eliminate health care workers positions?
GUPTA: It's a great question. Let me just give you a, sort of, broad overview of all this. First of all, when it comes to the idea of paying for this, there's whole idea that you're going to have to cut some of the inefficiencies out of health care, and there's long been -- this belief, and I think on all sides, that we probably pay too much, John, for too little overall. Where are we paying too much and how do we cut down some of those costs? That's going to happen.
And if you look at Medicare, for example, specifically, you talk about the inefficiencies in Medicare, taking out $500 billion in that program over 10 years. Some of that is probably going to affect hospitals. A lot of that, hopefully, is going to affect hospitals in a way that they're paying for things that actually work.
But my guess is, you are going to see some differences overall in terms of what is more easily reimbursed versus what is not. So, you know, stay tuned a little bit for that to see how that's going to play out. But I think you will see some impact.
I think we have another caller, as well -- lots of calls coming in.
Eric in North Carolina, are you there?
ERIC SIEBERT, CALLER FROM BURGAW, NORTH CAROLINA: Yes.
GUPTA: Sir, good morning. Thanks for waking up. What's your question?
SIEBERT: I wanted to know -- I have a 24-year-old that I don't claim on my income tax. Would he be covered under the plan or not? Because I didn't claim him. He works, has a full-time job. And I didn't claim him on the thing.
GUPTA: OK. Well, good question.
What we're talking about specifically as Eric is pointing out, is that, as part of this bill, let's say you have a college student that finished college but they haven't had the first job yet, could you still put them on the plan? And the answer is yes. The idea was these people sort of fall into the cracks during that time period can be put on their parent's plan until their 26th birthday.
A couple of important points -- they do, Eric, in your case, and anyone else's, concerned about this, have to be a dependent on your tax return -- number one. You have to inform your insurance company, as well -- very important. You got to make sure to call the insurance company and tell them that your child is remaining on your policy as part of this new law, and all of it we're talking about here is going to take effect within six months from now So, you know, these are important points and, you know, I found myself in this exact same position after I finished school for a while. So, a lot of people out there who think you're young and immortal, you don't have to worry about this, here's an opportunity to actually be covered.
I got another question now I think.
Judith, are you there? I think you're calling from Arizona. So, happy early morning to you.
JUDITH MCHALE, CALLER FROM PHOENIX, ARIZONA: Thanks, Sanjay. Good morning to you.
GUPTA: Good morning. Thanks for calling.
MCHALE: It is early but glad to talk to you. I'm a licensed professional counselor and I'm wondering how the health care reform will affect people dealing with a mental health issues.
GUPTA: I'm so glad, Judith, you asked about this, because I don't -- I don't think we talk about this enough with mental health. Obviously, we're spending a lot of time on physical health.
First of all, Judith, as you probably know, but for other people listening, there's something known as parity. And basically, what that means, if you talk about mental health parity, it's this idea that you want to treat mental health the same way that you threat physical health -- in terms of how you treat it, how you reimburse it, how you pay for it. And mental health parity does seem to be part of this bill.
I'll give you some specifics on this but, you know, all of this, again, taking place within six months. So, it's not going to be right away.
In the past, there has been limited mental health parity -- meaning that you can get coverage, but it will only cover a certain number of visits, for example, with a mental professional like Judith or somebody else.
What we're hearing now is that mental health parity is going to exist in the bill, but the Department of Health and Human Services is still going to decide exactly what means, and still decide exactly how to implement that. So, I think there's going to be some details, Judith, that are still going to emerge on this. But I think it's good news for people who have focusing on this for some time that they are going to start thinking of mental health much in the way that they think of physical health.
Boy, time goes quickly here. We have a lot of questions, a lot of phone calls. Now, we're trying to get to as many as we can. So, we'll take those in the next couple of minute.
But these two men -- take a look here. They are doing their part to lower health care costs right now. We'll tell you why. Stay with SGMD.
GUPTA: We are back with SGMD.
I'm taking your calls. Phone lines are still open, 1-800-807- 2620. Lots to discuss.
Something I've been thinking about -- you know, this new health care law is meant to provide insurance for the 32 million Americans who currently don't have it. That's something you probably know by now, you should keep in the back of your mind.
But as a doc, you know, I also realize that simply having an insurance card may not be enough if you're not able to see a doctor, because there's simply not enough primary care physicians to go around. And most medical students, as it turns out, are choosing to be specialists, not family doctors.
You know, I really wanted to investigate this. I found a resident who's chosen to be a primary care physician and asked her, started off asking her why she's one of so few.
GUPTA: Why aren't more of your colleagues choosing this as a profession?
DR. NAKATO KIBUYAGA, MOREHOUSE SCHOOL OF MEDICINE: I think there are several reasons. One of the main reasons is that the prestige, the spotlight, is just not on family medicine physicians. We don't have the same reputation like some of the other doctors do in the subspecialties.
GUPTA: You know, it's been 17 years since I finished medical school, and over that time, the number of medical students choosing primary care has slipped by more than 50 percent.
(voice-over): Last year, the American Academy of Family Physicians predicted a shortfall of 40,000 primary care doctors. And that was before the signing of the health care bill.
LORI HEIM, AMERICAN ACADEMY OF FAMILY PHYSICIANS: We have nowhere near the number of primary care or family physicians that we need to take care of the public. Simply having an insurance card may not guarantee that there is a physician whose practice will be open to new patients.
GUPTA: So, why is that happening? One reason is plain and simple: it's money. The average primary care doctor makes $173,000 a year -- compare that to $419,000 for cardiologists, or $330,000 for oncologists treating cancer.
(on camera): How much of this is about money, just compensation? KIBUYAGA: I think that's a major reason why a lot of medical students aren't choosing family medicine. The potential for financial gain is just not the same as those other fields.
GUPTA (voice-over): Now, the health care bill tries fix that. There's a 10 percent pay bump to family physicians through Medicare, and even bigger increase for doctors taking Medicaid, low income patients. It expands the program to forgives loans to some medical students who go into primary care.
GUPTA: So, I mean, does that make sense to you? And if you have ideas, how to expand the number of primary care doctors, I'd love to hear about them. People are e-mailing us. SanjayGuptaMD@CNN.com. And we'll tell you, there are some encouraging news even since that report last week as match day, and when medical students around the country pick their specialties, the number picking primary care up was up for the first time in about 13 years.
We got lots of calls still coming in.
I think -- Kim in Georgia, are you there?
KIM, CALLER FROM GEORGIA: Yes, I am. Hi. How are you?
GUPTA: Good morning. I'm doing well. Thank you. What's your question?
KIM: Well, basically, I have a two-part question.
KIM: From a personal viewpoint and also as a small business owner.
KIM: My business being under 10 employees. First, from a personal standpoint, I have been with Blue Cross Blue Shield for eight years now, started out at $150 with a very reasonable deductible.
Now, as each birthday or each April the 1st rolls around, of course, it goes up. But I am looking at $5,000 deductible at $480 a month. They usually offer me an alternative that is somewhat reasonable. But this time, the alternative is a $10,000 deductible at $180 a month which is basically for catastrophe.
GUPTA: Right. They're trying -- they're trying to shift you from a more preventive sort of health care to catastrophe health care, just like you said.
KIM: Correct. And -- so, you know, I'm dealing with -- you know, have a short amount of time. I think I'm going to just -- I've been shopping around. But now that the health care bill is passed, I -- you know, my questions that I wrote in were, you know, inquiring about what kind of game plan I can develop owning my small business.
Now, at my small business, it's a small diner. And I unfortunately have not been able to provide health insurance. I have read that there's possibly a tax incentive from the government for small businesses under 25 employees ...
GUPTA: That's right.
KIM: ... that may help me get insurance for my employees and, possibly, I may be able to jump on with them. Because, you know, I think at the end of the day ...
GUPTA: You're trying to provide ...
KIM: ... we're going to be -- we're going to be paying for this bill somewhere anyway. So ...
GUPTA: Well, let me try to address a couple of important points that you're raising. I'm glad you brought this up.
First of all, given the size of your business, you're not required to provide health care insurance now. But you want to, and a lot of people do. Starting in 2014, if you have fewer than 15 employees, you don't have to do anything.
Now, if you have more than 15 employees in 2014, if you don't provide insurance, do you have to pay a fine, and if any of your employees obtain federally subsidized insurance your company has to pay a fine. This could help.
With regard to your business being a small business, if you provide health care insurance this year even, you can get a tax credit, of up to 35 percent. And by 2014, you can get a tax credit up to 50 percent. So, you can get a little bit of help there, Kim, and obviously, you would fall into that as well.
The whole idea, ultimately, is that you create more choice and competition within the various health care providers and that hopefully will bring some costs down ultimately. But, you know, it's a good question, obviously, Kim. You found yourself in a little bit of a tough spot here.
I will point out, again, as we did at the beginning of the show, that people right now who are watching who have some sort of medical problem and are uninsured or under-insured, difficult to find insurance for them, they may get relief more immediately.
Why? There's going to be these high-risk pools that come into play so that you can actually use, you know, join one of these pools, try and negotiate your health care insurance premiums down to a more affordable rate and get some help from the federal government. They're going to put about $5 billion in these pools to try and help you.
Kim, again, thanks for calling. Still to come, though, health care reform could soon impact your food choices as well. Kim owns a diner. How is that going to impact everyone who eats food out? We'll explain -- right after the break.
GUPTA: Welcome back to our special edition, live edition of SANJAY GUPTA, M.D.
We're taking your phone calls, having a conversation with you today.
Now, as part of this legislation, any restaurant with more than 20 locations are going to be required by the FDA to clearly list the number of calories and food items on the menu. It also applies to food sold on vending machines.
Now, supporters hope that the new laws can provide consumers with better information in the fight against obesity. But I will tell you, we investigated. The FDA still has to determine how exactly this play out, what the nationwide rules are going to be.
And here's something to consider. Healthier people could lead to lower health care costs. Think about that.
For years, we've been trying to do our part at CNN to make this country a fitter nation, because as much as we talk about health care reform, personal responsibility plays a big role in keeping us healthier and keeping those costs down -- which makes watching Ricky Williams and Stanley Saballett get ready for a triathlon all the more important.
Take a look.
RICKY WILLIAMS, FIT NATION CHALLENGE PARTICIPANT: Obviously, I want to see a physical transformation. I want to get on top of my fitness. I've let it kind of get out of control in the last few years.
GUPTA (voice-over): Ricky Williams was more than 100 pounds overweight when we first met. It's a number he was pretty embarrassed about. Our first workout together -- that was a struggle.
But now, it's two months closer to race day, and Ricky is unstoppable.
WILLIAMS: I'm noticing incremental change in every sport, run, bike and swim.
GUPTA: After kicking his fast-food habit, he tries to workout regularly, waking up at dawn most days.
It hasn't been easy, but Ricky is back in control.
WILLIAMS: I feel so much better about life and about exercise, and living than I did five weeks ago.
GUPTA: Fellow challenger Stanley Saballett has been training hard as well. When we started, he told me he wanted to race the New York City triathlon so he could help the teenagers he mentors get back in shape.
STANLEY SABALLETT, FIT NATION CHALLENGE PARTICIPANT: You know, part of the whole "Fit Nation" and what really encouraged me is the sense of community and the helping others.
GUPTA: Back in San Diego, he hit the gym four or five days a week, spin workouts and weightlifting to build some muscle. And every Friday, you'll find him hiking up this mountain with the teens in his program.
SABALLETT: Everyone that I invite to come to this mountain ends up coming to this mountain regularly.
GUPTA: For both men, adjusting to their new fit lifestyles hasn't always been easy ...
SABALLETT: I'm not going to lie. I have had fries here and there.
GUPTA: ... even when they're not working out.
WILLIAMS: My biggest obstacle for sure is between my ears, just the mental approach to training.
GUPTA: But Ricky and Stanley say, if they can do it, so can you.
SABALLETT: Get off your couch. Get off the fast-food diet.
WILLIAMS: Take a step. No matter how hard the step is, for me, it was just get moving. Find the will to move.
GUPTA: And don't stop.
GUPTA: And we're back. It's time for our "Medical Mystery of the Week."
The question everyone asked: why are medical bills so complicated? Let's try to unravel this mystery quickly, to help you better understand what's in your bill.
You've probably seen a lot of bills in your time, bills like this. This is the bill that people most commonly get -- it's sort of called the summary bill. Lots of information in here, but not quite enough to really decipher it, it just gives you sort of broad categories. And at bottom, usually a high number, which is your cost.
A couple things to sort of keep in mind: first of all, you can ask right away for an itemized bill. You can call your hospital, get an itemized bill that's going to look like this. People should do this, especially if you have concerns. Good place to start.
And as you're looking at the itemized bill, three things to sort of really pay attention to: pay attention to the quantity of things. Over here, it says 10 for a particular medication or I.V. bags. Did you really get 10? That's something you can ask your hospital about.
Also, look specifically at the wording. Now, look at what specifically you're being charged for, and see if that seems to make sense with what you remember from the hospital.
And finally, look at something like miscellaneous charges. That's something that comes up a lot. Miscellaneous charges can sometimes be something like a $2,000 toothbrush even. I don't think they cost that much for sure. Ask to have the odd charges explained to you.
Finally, you do have the right, as always, to negotiate your bill if you think you've been overcharged. Hope this helps you today.
Thanks for watching. I'm Dr. Sanjay Gupta.
More news on CNN starts right now.