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SANJAY GUPTA MD

Open Enrollment: Are You Covered?; Recipe for Controversy

Aired October 27, 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: Hey there, and thanks for joining us.

Well, there's some fascinating new guidance out there on fertility and freezing eggs. We'll sort that out for you.

Also, the top chef Tom Colicchio is stopping by to tell me how your vote in this election could help us all enjoy safer and healthier foods. Fascinating.

Also, Tom Joyner, he's going to come by as well with a healthy message everybody needs to hear out there.

But first, I want to put your health insurance options out there "Under the Microscope".

You know what happens every year around this time? Many of us are confronted with having to make some crucial decisions about our medical care, about our health insurance. You get those things in the mail.

I can tell you, even as a doctor, all that paperwork, all of those numbers can be overwhelming. It's a lot to sift through.

So here to help us navigate this sometimes mine field of open enrolment is "Consumer Reports" senior health editor Nancy Metcalf.

Thanks. Welcome back to the show.

NANCY METCALF, SENIOR HEALTH EDITOR, CONSUMER REPORTS: Hi. How are you?

GUPTA: You know, it's funny. I know you probably sift through this as a consumer, I do as well. The number of choices people have can vary. But for anybody with some choice in their health insurance, you say there are some key questions they have to ask their self, ask themselves, like what?

METCALF: Well, the first one is: don't base your choice on how you -- or what you do when you're healthy, because you're not going to need much medical care when you're healthy. You don't buy the homeowners insurance for all the days your health isn't on fire, you buy it for the day when your house burns down.

So you have to think about the worse case scenario. And this year, we have a new tool for that. It's something called the summary benefits and coverage. It's brought to you courtesy of Obamacare. It's basically a nutrition-packed label for health insurance, where every plan has to set out its main features in a standard way. You can compare them side by side, so you can really see what you're buying.

GUPTA: Right, right. Now, one thing I just want to clarify, when you talk about this worse case scenario, you're not saying that -- I mean, the idea of prevention and having the adequate care for prevention as well is obviously important. You want that to be part of your health care plan.

METCALF: Well, all the health care plans now have to cover preventive services. So that's not a problem. And, of course, you want to have your immunizations in your preventive visits.

But the real money in health care, the real expenses come if you get hit by a bus or get cancer or have a medical catastrophe. So what we're advising people to do is take this SBC that you're going to get, multiply your monthly premium by 12, and then look for the number on the first page of it, called an annual out-of-pocket limit. This is the most you'll have to spend a year on things like deductibles, co- pays and co-insurance. And it can add up fast if you get really sick.

So you want to add that out-of-pocket limit to how money you're going to be spending on premiums that year.

GUPTA: Sure.

METCALF: And that's your maximum outlay that you're going to have for the year for health care.

GUPTA: A lot of people, as you know, will look at the cost and say their basic monthly premium, that's what I'm basing it all on, and you've said this before, you say that's a bad idea. Why?

METCALF: Yes, it's a big mistake because there are so many other things involved. Look, insurance companies are not charities. They have to make their money some way. And if you have a choice of plans and one of them has a lot lower premium than others, you got to look again at the summary benefits and coverage and figure out why it is. Either it has a lot higher deductible, a lot higher co-insurance you might charge -- you might have to be paying 30 percent of your bill, instead of 10 percent or 20 percent, it might leave out certain things. It might only cover generic drugs.

So, that maybe OK with you but you really to understand what you're getting yourself into in change for that lower premium.

GUPTA: And something else that comes up quite a bit is prescription drugs. I mean, some people have to buy a separate plan for prescription drugs. Is that pretty clear when you're signing up for these programs, if you're going to need additional coverage that way?

METCALF: Well, most employer coverage incorporates prescription drug coverage. But again, the most important thing there is to make sure you've got all kinds of drugs covered. Don't make the mistake of only taking a plan that only covers generics because again, you never know what's going to come your way. And if you weren't taking notes, listening to what Nancy was saying, here are some questions that you can ask yourself when comparing these health insurance plans.

First of all, can I afford being in a catastrophe? The worst case scenario, as Nancy described, you want to plan for that.

Two, am I buying this based on a premium? Not a good idea.

Nancy said as well, does my policy include prescription drugs? Most of them do, but not all.

Always great information, Nancy, for our viewers. Really appreciate it. Thanks for being with us.

METCALF: Thank you.

GUPTA: There's big news in the world of fertility as well to tell you about. The American Society of Reproductive Medicine says that egg freezing should no longer be considered experimental. This could mean insurance will be more likely to pay. As you might examine as well, there's still some controversy around this.

The ASRN, the society, says that the technique is proven safe and effective. But they also say this: healthy women shouldn't freeze their eggs just to prolong fertility. They say the technology should only be used for women with fertility issues.

Now, many specialists disagree with that part of it. In fact, where's what Dr. Peter Nagy told me when I visited his IVF lab.

(BEGIN VIDEO CLIP)

DR. PETER NAGY, SCIENTIFIC DIRECTOR, REPRODUCTIVE BIOLOGY ASSOCIATES: Unfortunately, getting married later, having children later, facing more infertility problems, doing fertility preservation, prior preservation is an option for them today.

(END VIDEO CLIP)

GUPTA: That's worth pointing out that fertility is different for every woman. So, if you've got questions or concerns, talk to your doctor.

(COMMERCIAL BREAK)

GUPTA: Well, we've got election day coming up, as you know. And if you're looking for more reasons to vote for or against a particular candidate, I do want to tell you about a new score card. This actually ranks members of Congress based on how they voted, on something that's very important to me, food -- food safety, nutrition programs, farm subsidies, a lot more.

And joining me from New York is top chef Tom Colicchio, who is part of the group that came up with these new rankings. Tom, thanks so much for joining us. I'm a big fan of much of your work, and now this is very interesting to me, as well. The group is called "Food Policy Action".

TOM COLICCHIO, TOP CHEF: That's right.

GUPTA: And you just announced it this week. It's organized by my understanding is by the Environmental Working Group and several other activists and leaders, and nonprofits.

People who are paying attention for the first time, they may ask, how does Congress fit into this in terms of making a difference and how well we eat?

COLLICHIO: Sure, I think this is a real value issue. If you value and want to understand sort of where your food comes from, are really interested in food safety and if you are interested in farm and families and keeping them together, if you're interested in the environment, if you're interested in labeling food, then your values are, you know, if you lie somewhere in there, you want a place to go where you can check to see if your elected representatives are voting your values.

GUPTA: And the other thing you bring up, I read through some of this report, do you think that the government should subsidize or more subsidize growers of fruit and vegetables. There's not much subsidy. People don't realize that.

But how big a difference do you think that would make in terms of what people pay? That's the question they have.

COLLICHIO: Right, it would definitely drive the prices down. For instance, you know, if you want to feed your family organic, it's very expensive. It's definitely out of the reach of low income people. But yet, you know, a lot of us feel that nutritional foods should be easy and affordable to obtain.

And so if you're taking $20 billion a year and using it to subsidize corn, wheat and soy, sort of most things that could into how they process foods and artificially keep those things cheap. Now, if you take some of those subsidies and just move them over to small local farmers that are growing organically, hopefully it will drive those prices down and more people could afford them.

So again, that just makes good food policy.

But I don't think most people connect what they're eating, prices at your supermarket or in a farmer's market to decisions that politicians are making.

GUPTA: You know, you said at the beginning, food is not a partisan issue. I mean, I agree with that. But looking at the rankings, they do seem to clearly favor Democrats -- I mean, just looking at them. Why do you think that is?

COLLICHIO: You know, I don't know, that's not for me to figure out. But I think that, you know, possibly, you know, there's clearly a lot of votes in here for snap dollars and things like that that are usually things like food stamps that are usually championed by progressives. I say usually, because a lot of Republicans scored above average, as well. And so I think that's probably why.

But I think again, hopefully, that before our politicians are casting votes, they'll think about this and they know they're getting graded on it. So, you know, that's our goal here. We hope that people will vote with their constituencies. If their constituencies care about food issues, there's a place where they can go and get the information now. And hopefully, politicians will think twice before how they're voting these various food issues.

GUPTA: Yes. And you bring up the food stamp program. It's worth pointing out George McGovern died this past week, a liberal Democrat. But he helped to found the food stamps, or expand at least, with the help of Bob Dole as well.

COLLICHIO: Exactly. Exactly, with Bob Dole. And, you know, this goes back to the late '60s and early '70s. It's a film that they actually saw called "Hunger in America", that quite frankly embarrassed a lot of people and opened their eyes through some of the issues that were going on.

And very quickly, they reached across the aisle and got together and create the modern food safety net. So again, I don't think this is partisan at all. We fixed hunger back in the early '70s, it almost non-existence. You know, we could do it again.

This isn't an issue like global warming that is so difficult to figure out. A lot of people know how to fix this. Just we need to pay attention to it. We can definitely fix hunger in this country.

GUPTA: Yes. I mean, I can't tell as a parent, as a doctor, it certainly makes a lot of sense. And I appreciate you sharing some with us. We're certainly going to send people to the Web site as well, Tom. Thanks so much.

COLLICHIO: Thanks a lot. I appreciate it. Good talking to you.

GUPTA: A 22-year-old college senior, Paul Heddings, has spent years trying to put his life back together. You see, at 17, he dreamed to be a baseball player. Instead, he found himself facing this debilitating medical condition that's about to change his life forever.

But the thing is that Heddings refused to let it steal his dreams.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): As a drum major for Marching Mizzou, the University of Missouri's famed marching band, Paul Heddings is living his dream. It's a new dream because his original dream of playing professional baseball was disappearing.

PAUL HEDDINGS, UNIVERSITY OF MISSOURI DRUM MAJOR: September 7th, 2007, just barely into my junior year of high school.

GUPTA: The 17-year-old woke up and his world was changing.

HEDDINGS: Everything was just a little blurry. It didn't seem like anything was wrong.

GUPTA: But something was terribly wrong. His retinas had detached and started to tear apart in both eyes.

HEDDINGS: I didn't know how my life would change, what I'd be able to do, what I wouldn't be able to do. I could potentially go completely blind.

GUPTA: Paul says this was not caused by disease or trauma but by genetics.

HEDDINGS: This happened to my mom, my grandma, a couple uncles, even my little sister is having similar issues.

GUPTA: They didn't lose much vision. Paul, on the other hand, is now legally blind. Sight in his best eye can't be corrected beyond 20/200.

HEDDINGS: My left eye has blind spots. My peripheral vision is great, and that's why I'm so high functioning. The right eye is just kind of there.

GUPTA: He can read but not well by digitally scanning books into a computer that has screen magnification software. He said family, friends, and music saved his life. He joined the high school's drum line, taking it home, magnifying it, memorizing it.

HEDDINGS: I just strapped up my boots and went to work.

GUPTA: He made the Mizzou drum line first playing symbols and then after an extensive interview process, clinched the coveted drum major spot. Most in the band didn't even know he was legally blind. He suffered three detachments and cataracts in both eyes. One has now been removed. So far he's had more than 10 operations and countless laser procedures.

HEDDINGS: I could wake up tomorrow and lose more vision. I could walk away from here today and something could happen and I could lose vision.

GUPTA: Headings hopes his time on the ladder will change the perception of visually impaired people.

HEDDINGS: I want to be able to say when I leave here that I did something special. And that I didn't let this hold me back.

(END VIDEOTAPE)

GUPTA: And that is why we do the "Human Factor". Paul headings, just a great story. And another man who's doing something is special, Tom Joyner. He's a man with a plan to get more African-American men to visit their doctor.

We'll be back with Tom right after this.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: I had parents that died early, at an early age. And my thing is, is that I don't want to do that to my children. So if I can keep on top of my health, as much as I can, I'll be able to see my grandchildren.

(END VIDEO CLIP)

GUPTA: And who doesn't want that? I mean, I'll tell you, we talk about this on the show all the time, how important it is to go to the doctor to get that preventive care.

And the guy that you just saw was attending Tom Joyner's "Take a Loved One to the Doctor" health festival. That was in Philadelphia. And it's something Tom has been running, talking about for 10 years now.

Thanks for coming on the show. It's really nice to meet you and have you here in person.

TOM JOYNER, HOST, THE TOM JOYNER MORNING SHOW: Thank you, Dr. Gupta.

GUPTA: How did this all start?

JOYNER: I feel fine.

GUPTA: Good. Yes. You came for the check-up. Right. You look well.

JOYNER: Thank you.

GUPTA: How did this festival start, how this fair start?

JOYNER: Well, we started this 10 years ago.

The show tries to emphasize and take care of all of the issues that affect the African-American community. One issue that affects the African-American community disproportionately, is health. And so, in our community, we don't like to go to the doctor.

So we came up with a -- we came up with one day, and we said, OK, take a loved one to the doctor on this day. And whatever you have to do, if you have to drag them, if you nag them --

GUPTA: Sometimes you have to.

JOYNER: Yes. And so, that's -- that's the way it all started out.

GUPTA: You know, it's interesting, when you compare men and women. Men are 70 percent less likely to go see a doctor, versus women, just the gender gap. And then if you say African-American men, they are 10 percent less likely than to go see the doctor, even on top of that.

Why is that? I mean, this is an obvious question, but why do you think that is, if you drill down on this?

JOYNER: We're stupid.

GUPTA: They want help.

JOYNER: Yes.

GUPTA: I mean, on your show, people are thirsty for information and content. Why don't they go to their doctor?

JOYNER: We just don't want to go. We don't want to be stuck, prodded, opened up, looked at, and we're macho, and -- like I said, basically, we're just stupid, you know, because we know what we're supposed to do. But it takes a loved one, especially in the African- American community, women will go get checked.

GUPTA: Right.

JOYNER: Women will go get checked in the African-American community. Men, not so much. It takes a woman to get that husband, father, that son, that grandfather -- you know, come on, man, you got to -- there is something wrong with you.

GUPTA: You yourself are 62 years old, I know you have a busy schedule. I was just talking to you this morning on the radio, you're flying around now. How about you? How are you doing in terms of your health and taking care of yourself with that schedule?

JOYNER: I'm doing good. I do all the right things. I'm a vegetarian, I work out.

GUPTA: Is that right?

JOYNER: Yes, I have a lot of staff to --

GUPTA: People help you out. You said, every single day, I was (INAUDIBLE) between Dallas and Chicago for seven years, you racked up 8 million frequent flier miles.

JOYNER: That's why they call me the Flying Jock, because I would fly -- I would do the morning show in Dallas, get on the plane, fly go to Chicago, do the afternoon show and then fly back for the next morning show. And I did that for eight years.

GUPTA: That's an incredible schedule, and I have a lot of admiration, because I think I have a busy schedule until I meet somebody like you.

Real quick, when you go to the things in Philadelphia, for example, this past weekend, did you get a sense of you're making a difference?

JOYNER: Yes.

GUPTA: What do you hear?

JOYNER: I hear things like -- when we had 400 people to see -- our 60 dentists that we have, that 90 people had to make appointments for referrals, two or three people had to go to a clinic right then and there.

When we had somebody whose blood sugar was over 1,600 and had to be rushed to the hospital, right then, right there, at the health festival, that makes me feel real, real good.

GUPTA: Well, I hope you continue to beat the drum on this. We will do our part, as well.

JOYNER: Thank you.

GUPTA: It's a real honor to have you on the program again.

JOYNER: Thank you for what you do, Dr. Gupta.

GUPTA: Thank you.

And last but not least, "Chasing Life" to 100. Costs just a few dollars a month, takes less than a minute a day, it could add years to your life. We'll explain. Stay with us.

(COMMERCIAL BREAK)

GUPTA: Now, before you face plant into that Halloween candy stash -- I'm not just talking the kids here -- "Chasing Life" today is about the importance of flossing of your teeth. Every time go to the dentist, you're told how important this is. Most of you don't actually listen.

A proper flossing not only leads to a nice smile, it's also this real window into the overall health of your body. You can see your teeth as well. So, getting rid of the plaque lowers your risk of heart disease and maybe more -- according to one study -- excessive plaque may be linked to premature cancer death as well.

In case you're curious, the American Dental Association recommends flossing your teeth before you brush.

That's going to wrap things up for SGMD. Let's stay connected with me at CNN.com/Sanjay. Let's keep that conversation going on Twitter @SanjayGuptaCNN.

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