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SANJAY GUPTA MD

Future of Medicare at Stake; Profits Over Patients?

Aired August 18, 2012 - 16:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, HOST: Hello there. And thanks for being with us.

A remarkable story today about a big hospital chain, one that you've likely heard of, accused of doing heart procedures that were unnecessary just to make money. Question for a lot of people: what can you do to protect yourself?

But first, I want to make sure you're up to speed on a very important fight over Medicare's future. Plans put forth by Mitt Romney and his running mate Paul Ryan -- one of the most divisive, important issues of the upcoming election. It's important for you to be educated on this, so we're putting them under the microscope.

Ever since it was signed into law by Lyndon Johnson in 1965, Medicare has been the safety net for Americans over the age of 65. It provides health insurance for 47 million Americans but now, big changes are on the table.

(BEGIN VIDEOTAPE)

MITT ROMNEY (R), PRESIDENTIAL CANDIDATE: The truth is we simply cannot continue to pretend like a Medicare on track to become bankrupt at some point is acceptable.

GUPTA (voice-over): Mitt Romney says his changes would not affect current seniors or anyone nearing retirement. But down the road, Medicare would be mostly privatized. He'd get a government voucher to buy your own insurance. You could pick the Medicare program like we have it now or you could buy private insurance.

And here's a key point. In the budget drawn up by Romney's running mate Paul Ryan, the size of the voucher would not grow as fast as health care costs have grown in recent years.

UNIDENTIFIED FEMALE: Great.

GUPTA: Even if that point doesn't affect seniors now, it does make some of them nervous.

THERESA WALKER, MEDICARE RECIPIENT: Is that voucher going to be enough to take care of your medical needs, with the costs going up, up, and up?

GUPTA: Theresa Walker is 67. In March, 2011, she discovered she had cancer. Medicare covered most of her chemo and radiation therapy. And today, she's back to her active self. WALKER: If I did not have Medicare, I don't know if I could survive. And when you're on a fixed income, you know, there are other things you have to pay for. And I wouldn't be able to live.

GUPTA: Democrats think this is a winning campaign issue but so do Republicans.

REP. PAUL RYAN (R-WI), VICE PRESIDENTIAL CANDIDATE: We want this debate.

GUPTA: And Romney and Ryan say competition, consumer choice, is the only way to push down costs so that Medicare can survive.

(END VIDEOTAPE)

GUPTA: Joining me now is Jonathan Cohn.

Welcome back to show, Jonathan.

He is a senior editor at the "NewRepublic", also author of the book "Sick". He is a supporter of the president's health care law. But, you know, he's been following this whole thing closely, trying to keep everyone honest, which is what we try and do as well, Jonathan.

So, welcome back. Thanks for being with us.

To be clear, because I think a lot of people are paying attention to this, they're not actually getting rid of Medicare. They say that there's no changes for anyone that's 55 or older but people beyond that are going to get a voucher from the government to buy their own insurance, but they can also stay on Medicare.

And my understanding is, and tell me what you think, the thought is that this will create a more competitive market and that could help lower costs.

JONATHAN COHN, NEWREPUBLIC: That is absolutely true. The theory behind what Ryan, what Republicans want, is that they believe, you know, changing Medicare from the single government program that most people will enroll in to a system of multiple plans competing with each other and then Medicare, the old Medicare program just as part of the mix is that competition by itself will reduce prices.

The question is, let's say the competition doesn't work. At that point, and let's say Medicare keeps getting more expensive. You have this voucher and the voucher is set at a certain value and is going to go up by a fixed formula every year. Let's say at some point that voucher is not enough to pay for a good insurance. Well, what happens then?

Because in the Republican approach in the Ryan approach that voucher is a fixed value and there is no changing that. Therefore, if the voucher doesn't pay for a good insurance policy, individual seniors are going to have to make up that difference somehow.

GUPTA: So for example, they say seniors on average pay about 25 percent of their health care costs now. It could go up to as high as 68 percent of their health care costs over the next 10 years.

But one of the things I keep hearing and again it's an important point, is that if people are not as insulated from their health care costs, they're more likely to pay attention to the health care costs and that's also an important driver to bring health care costs down.

Do you think that that's important and that would work?

COHN: I think there is a lot of evidence to suggest that the more you force people to pay out of their own pockets, the more careful they're going to be how they spend money. I think that's common sense, right? If you have to pay for something, you're going to think about it. Is this really worth it?

The question is, there is a down side to that also which is that -- well, if you start to make people pay more of their health care bills you run the risk they're going to skip the care that they need. They're going to say, oh, well that high blood pressure bill is expensive. I'm going to skip that.

That's a bad idea because they are a lot more likely to get a heart attack. And people who are really sick, right, the people with high medical bills, well, they're going to end up just over time paying a lot more for their medical bills.

So the trick here is how do you balance those two?

GUPTA: You almost get the sense that Congressman Ryan, to some extent Governor Romney, are thinking about that very question. They're saying they're not going to cut the safety net. They're going to find a way to cover those people who really can't pay. But I know you're skeptical of that. Why?

COHN: The problem is both of them have committed to an overall plan for the federal budget that calls for a cap on total federal spending. Basically they're going to say this is how much money the federal government is going to spend. It's an extremely low number. And if you sit and do the math, no matter how you change the numbers, no matter how you play with the different options, there is just no way there is going to be enough money to provide for everybody. The amount of money they are calling to cut out of the federal budget would require drastic cuts to Medicare over the long run.

GUPTA: And then, of course, Congressman Ryan keeps saying look. You know, I'm worried a program like Medicare won't exist at all unless we do something.

COHN: Right.

GUPTA: Let me ask specifically about this cap you just mentioned. Because, you know, President Obama also has proposed a cap on Medicare spending. In fact, if you look at the numbers it seems to be almost exactly the same cap as Paul Ryan. So the president's plan, the plan that exists right now would have the same effect as the Ryan plan would it not? COHN: They do have the same cost trajectory. But there is a key difference. This actually brings us back to the question of, is this ending Medicare or is it not ending Medicare?

You know, when I think of Medicare, when I think of what was created in 1965 it was a guarantee of benefits, it was a promise to the seniors that, look, no matter what happens you will get the benefits. You will be covered. And if it costs more money, we'll find a way to do it. Either we'll pay higher taxes, or run a higher deficit, take money from somewhere else. But no matter what happens, those benefits are solid.

And the way the Obama plan is structured is true to that promise. Nothing will change benefits. The Republican approach does not do that. What the Republican approach says is that no matter what this is how much the federal government is going to spend. And if health care gets more expensive, well, then something else is going to have to give and that something else could very well be that seniors have to take up the slack.

Now, you know, this is (INAUDIBLE), what's more important? Is it more important to say to seniors no matter what we're going to guarantee those benefits even if we have to pay more taxes, even if the deficit is higher, even if we have to take money from somewhere else, no matter what, we're going to give you those benefits? Or is it more important to say to the government and to the taxpayers that no matter what you're not going to pay more for this for Medicare? And that's really what this debate is about, is that where --- who gets the guarantee? And that's really where we are.

GUPTA: Yes. You know, it's interesting. You have Congressman Ryan, you have Governor Romney, and obviously President Obama all very focused on health care so I have a feeling we'll be talking a lot more about this in the weeks and months to come.

Jonathan, it's always great to have you on the show. Thanks so much.

COHN: Thanks for inviting me.

GUPTA: All right. See you soon.

We're going to stay on topic. Coming up: invasive heart procedures on patients who didn't need them. Stay with us.

(COMMERCIAL BREAK)

GUPTA: Welcome back to the show.

You know, there was a headline this month in "The New York Times" that was pretty unnerving. The story was about HCA, the largest for-profit hospital chain in the United States, and says the company revealed it is now under federal investigation. Investigators curious if some of its cardiologists were doing heart procedures such as catheterizations and placing stints that patients didn't really need. The allegation is the doctors were doing it to make money. My friend, my colleague, Elizabeth Cohen, is here. Her specialty, as you know, is reporting on ways patients can challenge and communicate better with their doctors.

It caught your eye as well. It caught mine.

First of all, does this seem pretty real? I mean, I know it's under investigation. Have you heard anything new on this investigation?

ELIZABETH COHEN, SENIOR MEDICAL CORRESPONDENT: What's interesting is that there have been studies that show that if this is true, this investigation is still going on, it's not actually that uncommon. You know, researchers have looked at catheterizations and whether they're really necessary in general not just at HCA. So, there was a "Journal of the American Medical Association" study that came out last year. They looked at half a million stenting procedures -- half a million, that's a lot. One in eight of them were deemed inappropriate.

And there was one hospital, Sanjay, that had a 55 percent inappropriate rate, more than half of them were inappropriate.

GUPTA: I mean, there is no question these things can generate a lot of money for the hospitals and even for the doctors specifically, depending on the relationship of the hospital. But how do you know that something is unnecessary, right? If you're a patient and you go to your doctor and the cardiologist says, you came in with some symptoms. I think you need a stent. What do you do?

COHEN: That is a tough one. And so, to answer it, I'm going to divide it into sort of two categories. If there is an acute need for a stent, you're having chest pain. It is bad enough it drives you to the emergency, you have to go to the emergency room and they do a test and they say, "Mr. Smith, you're having a heart attack, you need a stent." Do not argue.

And I'm going to say that again, because I want to be very clear about this. If you're told you're having a heart attack and you need a stent you need that stent and you should not go about asking questions and getting second opinions.

However, some stents are given electively. They'll say, you know what? We think you have a blockage. We're going to give you a stent. You haven't had a heart attack. We want to help you with your symptoms.

In that case you want to ask, do I have some time to make this decision? Do I have a couple days? Maybe you want to go and get a second opinion. Maybe you should get more tests done. Because as we've seen these inappropriate rates are relatively high.

GUPTA: And the second opinion, should it be in a different hospital, different practice all together? What do you --

COHEN: Yes. Most experts do recommend that because if you go to the person's partner that partner might feel compelled to agree with their buddy. Whereas, if you go someplace else, they don't feel compelled to agree necessarily.

GUPTA: Most things in public health, an area that you are familiar with, involves risk and reward. So, reward is obviously what the doctors telling you what you're trying to prevent, trying to prevent a heart attack, trying to prevent problems later and down the line -- down the road.

But risk of the stenting procedure, what --

COHEN: Interesting. Let's talk about the benefits for a minute. We were told by cardiologists that actually stents don't prevent heart attacks. They help you with your symptoms but they don't necessarily prevent a future heart attack. There isn't a lot of science to show that.

GUPTA: Right.

COHEN: And there are definitely are risks. So, for example, there is a risk of having a heart attack because of a stenting procedure. There is a risk of having kidney damage. There is a risk of having a stroke.

And when we talk, let's look at what a stenting procedure looks like. And I think people can better understand why that happens. You know, putting a catheter through an artery usually in the groin. You're going up to the coronary arteries and then putting that stent in. That stent can actually if it's not placed correctly cause problems and that is why you have the risk of heart attack and stroke. This is an invasive procedure.

GUPTA: How many of these are done every year?

COHEN: There's hundreds of thousands of these are being done every year. Most of them are done for acute reasons. You know, Mr. Smith, you've had a heart attack.

GUPTA: Right.

COHEN: But there are still plenty done electively, to hopefully make people's symptoms better. And that's the time, that's the case where you have some time to think about it.

GUPTA: Right.

And then the bottom line again you said if you're having symptoms, crushing chest pain, you go to the E..R., that is not the time to get a second opinion.

COHEN: Right, if they tell you you've had a heart attack, get a stent.

GUPTA: All right. Elizabeth, thanks so much.

COHEN: Thanks.

GUPTA: And coming up an 8-year-old girl who in many ways is already changing her world. And now, she has written a book.

(COMMERCIAL BREAK)

GUPTA: One of my favorite parts of the show, every week, we bring you the story of someone who has fought through adversity to achieve greatness in some way. Well, this week we have our youngest human factor yet.

Samantha Brownlie, she's just 8 years old and she was born with hearing loss. But she did something wise beyond her years. She saw it as a chance to help.

(BEGIN VIDEOTAPE)

SAMANTHA BROWNLIE, WROTE A BOOK ABOUT HEARING LOSS: It's mostly about my hearing aid, what I do in life.

GUPTA (voice-over): Samantha Brownlie is 8-years old and she's already a published author.

S. BROWNLIE: I have a hearing aid. I wear it in my left ear.

GUPTA: Her book, which she wrote at the ripe age of 6, is about how she copes with hearing loss.

S. BROWNLIE: Some people have it, problems, different problems that they have in life, but they don't really want to share it. But I like to share it.

GUPTA: Samantha and her 11-year-old brother, Sean, both were born with damage to nerves in the inner ear, permanent damage in both ears. But at an age when taunting from their peers could shatter their self- image, Samantha and Sean are undaunted.

LISA BROWNLIE, MOTHER OF SAMANTHA BROWNLIE: We never saw it as a disability. It's just a factor. I mean, I wear glasses. I don't have a sight disability. I just need help with my vision.

And, you know, they're hard of hearing, not profoundly deaf. So they need help with their hearing.

DES BROWNLIE, SAMANTHA AND SEAN'S FATHER: We always taught the kids if anybody asks just tell them, it's not -- if somebody asks what's in your ear, just say a hearing aid. No cover up. Don't be embarrassed.

GUPTA: Without the word "disability" weighing her down, Samantha found it in her to write and illustrate this book.

S. BROWNLIE: It helps me hear better because it makes the sounds louder.

GUPTA: It's called "Samantha's Fun F.M. Book." Her name is on the cover.

L. BROWNLIE: I was so proud of her. Amazed but no amazed, because she's pretty amazing. I just thought it was a wonderful, you know, project at first and then it sort of took on a life of its own.

GUPTA: A life of its own, including sales of Samantha's book on Amazon.com.

S. BROWNLIE: Fifty million in this country have hearing loss.

GUPTA: -- and this PSA from the Hearing Health Foundation.

L. BROWNLIE: And you can do anything and go anywhere, achieve anything, survive anything. If you get knocked down, you can get back up and that's what I want for my kids

GUPTA: It seems that that idea of achieving anything has caught on and though she has many years ahead of her, Samantha has advice for children and adults about how to overcome.

S. BROWNLIE: No matter what happens, I just try, try, try. You can help someone else with it.

(END VIDEOTAPE)

GUPTA: And Samantha says she's already planning her next book. In fact, she is planning her next four books. She says they're going to be about using hearing aids. It's also going to be about candy. She's 8 years old.

Well, coming up next, you can see a special visitor pulling up outside the CNN Center. It's Mr. Glenn Keller, who's one of our Fit Nation Lucky 7 athletes. He's just getting of the road from an 800 mile drive all the way from Texas. I'm going to go see if he is ready for the big triathlon, which is just a month away.

(COMMERCIAL BREAK)

GUPTA: He drives more than 3,000 miles a week in his truck. So when Glenn Keller submitted his video to the Fit Nation triathlon challenge, frankly, we weren't so sure he'd be able to fit exercise into that hectic schedule.

This week, though, he steered his truck to CNN to give us an update on how he's keeping up.

(BEGIN VIDEOTAPE)

GUPTA: Keller, hi. How are you?

GLENN KELLER, FIT NATION PARTICIPANT: Doing great.

GUPTA: This is your home away from home.

KELLER: Home away from home, the command center.

GUPTA: So, I get to take a ride in this?

KELLER: Yes, you do.

GUPTA: I've been wanting to.

All right. I have to ask. How have you been doing with the training? Going all right?

KELLER: We've been doing pretty good. In spite of my schedule recently I had a chance to set up something with a pool in Baltimore because I was getting to Baltimore every week and only getting to swim just when I was home. Now that I've made this little arrangement there I can swim on both ends now.

GUPTA: A lot of people have busy lives. And you just drove 800 miles. Is that right?

KELLER: Yes, sir.

GUPTA: And just fitting in time to exercise must be challenging.

KELLER: It's really challenging. It's kind of a thing where I really can't wait to find time. I've got to make time. I stop at the truck stop to fuel and before I go to bed or something when I first get up because by the time my day gets going I don't even know where I'm going to end up or where I'm going to stop or what the situation is going to be. So, I've got to -- OK. This is an opportunity and I'm going to do something.

GUPTA: You know, when we're in Hawaii swimming you and I talked about this briefly and I -- we have said, look. If you don't feel comfortable or safe by the time the triathlon comes around, we don't want you to swim.

KELLER: Exactly.

GUPTA: What do you think?

KELLER: At the time I was thinking, wow, to have been going through all this and get o Malibu and not be able to swim, that would be probably the biggest let down. So, it kind of nudged me to kind of concentrate and asking people questions.

GUPTA: Right now, you think you want to do the swim?

KELLER: I believe I'll be ready to do the swim, without a doubt.

GUPTA: A lot of people may not know this about you, but you were displaced after Katrina.

KELLER: Yes, sir.

GUPTA: And then you moved to -- and made your life there after that.

KELLER: I did. Yes, sir.

GUPTA: There is a church, Lower Ninth Ward I believe that has asked you to come back and be their pastor.

KELLER: Yes, sir, they have. GUPTA: I heard that today. That's really very flattering I'm sure. It's quite an honor.

KELLER: And I feel really honored. It's been quite an experience. We had a chance to have the first service there.

GUPTA: It's still being rebuilt.

KELLER: It is in the process of being remodeled.

GUPTA: You did the service outside?

KELLER: We actually did the service inside. I have an inverter that runs my stuff in the truck so I got an extension cord and ran it to the box and all the lights came on, ceiling fans, the wall sockets.

(CROSSTALK)

KELLER: Let there be light.

GUPTA: Let there be light, I love it.

Always great to see you. I feel -- I feel good about my job when I get to talk to you. I feel like we're making an impact. I appreciate that.

KELLER: I feel great being associated with you and your team, sir.

(END VIDEOTAPE)

GUPTA: This week's chasing life, we know how important a good night's sleep is. But you might be surprised by this. It's a new study of heavy snoring in children. It's not necessarily cute. In fact, it can be tied to some serious medical issues that are associated with chronic, poor sleep. There was a study in the Cincinnati Children's Hospital Medical Center that found that 2 and 3-year-olds who snored loudly at least twice a week had more problems with hyperactivity, aggression, and attention problems.

Snoring may also be a sign of breathing problems. Bottom line is if your child is snoring heavily more than once in a blue moon, don't ignore it. Talk to your doctor, find a way to get your child the rest, that restorative sleep that he or she needs.

That's going to wraps things up for SGMD. You can stay connected with at CNN.com/Sanjay. Let's keep the conversation going on Twitter as well @SanjayGuptaCNN.

Time now, though, to get a check of your top stories in THE CNN NEWSROOM.