November 14th, 2008
03:48 PM ET

Brother can you spare $52 billion?

[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2008/images/11/14/art.flushot.jpg]

Elizabeth Cohen | BIO
CNN Medical Correspondent

All this week I’ve been trying to get my head around $52 billion is. How many flu shots is that, or appendectomies, or tongue depressors?

Fifty-two billion dollars is how much President-elect Barak Obama’s health care plan is estimated to cost, at least – it might be as high as $106 billion, according to factcheck.org. There’s no question something’s got to be done. Forty-five million Americans are uninsured, and we’ve all heard the horror stories of sick people who can’t get the care they need because they don’t have insurance, or they have lousy insurance. Everyone agrees that shouldn’t happen.

But where would this money come from? Obama says he’ll roll back a tax break President Bush gave to wealthy Americans. But will that be enough? Obama also says his administration will help get health care costs under control – there’s a lot of waste out there – and that this savings will be passed on to you and me. But will it really happen that way? Hospitals and insurance companies, if they manage to figure out ways to cut costs, might just keep the savings for themselves.

Lots of questions, and not a lot of answers. Here’s another one: will Obama tackle health care reform early on? It’s expensive, and our economy’s a mess. Plus, remember Hillary Clinton’s 1993 attempt at health care reform? It was a failure. Health care reform is no way to win a popularity contest. It’s tricky. You’re bound to get someone mad, whether it’s doctors, pharmaceutical companies, or consumers.

By the way, to get my head around that huge $52 billion number, I asked two of the smartest people on health care reform to break down the costs. Kenneth Thorpe, a professor at the Rollins School of Public Health at Emory University, and John Shiels, senior vice president of

The Lewin Group, helped us estimate costs for three big components of Obama’s health care plan.

Insuring all children: Between $6 and $9 billion.

Helping small employers provide health insurance to their employees: $6 billion

Developing health information technology (such as electronic medical records): $10 billion

That’s a whole lot of flu shots.

Filed under: Elizabeth Cohen • Medical News
soundoff (17 Responses)
  1. Liz

    I think one small step that could be taken right away is to require that doctors, laboratories, clinics, and hospitals post the price for their services. They should all be required to post their fees, or at least estimates, subject to change due to complications and all that legalese, for their 25 most common procedures/services/tests. This would force some transparency into the system so that we actually know what we are paying and what our insurance premiums are supposedly covering. This would help people to plan for their health care and decide how they want to pay for it and buy insurance according to their individual needs.
    All other industries naturally post their fees in order to attract clients. You can walk into a restaurant, a salon, or a car dealership and easily see what they charge and easily find out about the quality of their product or service, because they are competitive and thus have to be transparent about these things. The medical industry is clearly non-competitive and non-transparent, and anyone who has taken Economics 101 will tell you that that means that the industry is probably less efficient and more expensive than it should be.
    Another point: people have car insurance because it's required by law, so they shop for the best deal, and insurers compete to get clients, which drives down prices to where people can afford it. Couldn't health insurance be a similar situation?

    November 17, 2008 at 6:38 pm |
  2. Linda Gunsby

    Healthcare for all Americans should be a right enjoyed by all Americans. Not just the ones who happen to work for a decent employer that provides it. Anyway, what's 52 billion dollars between friends when we just gave 700 billion dollars to a bunch of crooks.

    Answer to Johnny Bee,

    I would like to ask, "Who do you think pays for the charity hospitals"? ...We do!

    November 17, 2008 at 4:50 pm |
  3. Barbara Reynolds

    If you would like to save some money, fix the Medicaid program. I worked in the ER in a children's hospital for 8 years and was stunned at the things children were brought in for (i.e. ingrown toenails, loose tooth) and so many other ridiculous things I am embarrassed to name. Lots of parents don't have primary doctors. The parents are asked to choose one, and if they don't one is assigned, but they still don't use them. One way to save is to limit the number of ER visits and force them to use a primary care physicians. An ER visit was cost a minimum of $500 to just walk, be triaged and registered. I think if they were being monitored and warned of being taken off the program, they would do better.

    November 17, 2008 at 3:12 pm |
  4. Johnny Bee

    I don't know if every state has them but I thought that, in Louisiana anyway, "Charity Hospitals" were where people without health insurance went for care. I have two sons who have had to use them. They both had jobs that did not offer health insurance and had to go to one of our Charity Hospitals for treatment. I say no to a National Health Insurance and say yes to using Charity Hospitals instead. If there is a National Health Insurance will those of us who worked for 50 plus years to have Health Insurance will get a monitary rebate to pay for our 50 plus years of work and commentment???????????

    November 17, 2008 at 6:07 am |
  5. Jim M

    You could definitely save money by eliminating the bureaucratic red tape of the Medicare / Medicaid system. Some states require reviews of cases on a 3 month basis, not when there is a change of status of the patient, just as a normal process.
    Currently, my wife has spent the last 6 weeks, away from home, re-filing Medicaid paperwork for her father. She is still in a holding pattern and has another meeting with the Social Security Office next week to review the submitted paperwork, which was reviewed 3 weeks ago.
    We, as a country, allow the Nursing Homes to take the lives of our elderly because we tire of the bureaucratic red tape and they bully us into pulling our family members out of their care or allow them to force the family into bankruptcy and then the Medicaid has to take over.
    Cut the reviews, cut the government personnel doing the reviews and if there is a great change in the disposition of a patient, perform a review at that time.

    November 17, 2008 at 1:12 am |
  6. Joanne, Solvay, NY

    In view of the bailouts, their cost, and the fact that $700B is indecisively allocated within the free market system. There must be more for health care. It would be wise to let GM go belly up, reorganize and use ingenuity in the financial sector, divert the funds to healthcare. That is, if we have the billions to spare?

    November 16, 2008 at 9:07 pm |
  7. Tyrone


    The government is going to make a mistake again! By bailing out Wall Street and the car company and looking to bail out the crooked mortgage companies! The money should go to the tax payers."AND THIS IS WHY" Capitalism rules this country and consumers rule capitalism! The government is rule by the people. The tax payers buys the products produce by the companies. There will be 11 million Americans out of work by the time President Obama takes office! If Americans are out of work WHO CARES! IF THE COMPANIES ARE BAILED OUT???? The government is trying to rule the people and capitalism. By disrespecting the order and rule of capitalism. Now I have a plan!
    1. $2,100 be issue to every American at birth.
    2. $2,100 would be issue to a bank of the American choice!
    3. $2,100 CAN NOT be touch until age 21
    $2,100 would be $100 for every year until adulthood. By the government doing this. It would create a money surge (Stimulus Package) in the country's consumer market and American institutions everyday! Now the only way this money can be activate. Is by reaching the age of 21 and a high school diploma and is register to vote!
    1. DEATH – If a American died before age 21 all money return!
    2. CAUSING DEATH- intenually or accidental. Half of the money goes to the government the other to the victim or victims!
    3. CONVICTION OF A FELONY- A $100 deduction (other then murder or treason) for a time felony before the age of 21. Second felony all money return.
    Ones a American give birth the parents would take the birth certificates to the bank. The bank would submit a application to the government ! The government would release the $2,100 to the bank account in the childs name! The $2,100 would earn interest for 21 years . You can add to the account and withdraw the money you added. But the $2,100 cannot be touch until age 21. In the childs name. Also the bank would register the child to vote and issue a Registration Card. Now for the adult over 21 ! If you already have a bank account. The bank would submit application to the government. The government would release the money to your account. If you don't have a account the bank would create one.

    November 16, 2008 at 9:43 am |
  8. Dave from Detroit

    You could probably save 52 billion by eliminating waste and fraud in the Medicare-Medicaid System. Harvard Business School is famous for cutting down on Management levels. The more that management is centered at the lowest level, the more efficient the business is! The Federal Government is High Management-they deal with forms that have been circulated from Caregivers through various channels and do not have personal contact with patients. The local HMO and PPO Health Insurance Companies do have patient contact and very strict rules for hospitals to follow and this reduces their costs! I think that the Federal Government should be the overseers of the Health System and not the Primary Caregivers. A retiree should pick their own Private Company and the fund deducted from his/her Social Security Check should go directly to the HMO or PPO and they are the Primary Caregivers! Care would improve and costs would drop!

    November 15, 2008 at 9:27 pm |
  9. Katte from Arkansas

    The only reason why HC's health care initiative was shot down, was that her father was very ill, and she got earfuls from hospital staff, physicians, and administrators about just how much it does cost to keep our health care #1 in this country. I am not about to put one pill in my mouth that hasn't been tested and approved by the FDA. They are not an albeit organization, but they are the best that we have.
    I think we all want progressive, appropriate and compassionate care when we or our loved ones are ill. To what price are you willing to pay for 'second best'?
    I have looked at Obamas plan, and some of it makes sense. But health care is not cheap, paid for by previous generations who have done the math, research and even the politics of health care.
    I personally just do not want socialized medicine............I like the freedom I have already with my health care. I do not want it compromised, nor do I want to be placed on a waiting list, at home/work in pain while I wait desperately for my number to come up before I can have surgery. Every age has rights to equality.
    As for the 'uninsured', yes, something does need to be done. The adult caring for the child needs health insurance as well. However, drug testing is severely underutilized. If you are going to get a check from Welfare ,benefit from health care prepaid by the government and are over the age of 16, food stamps, or disability, I think that a drug test 'spot check' would be appropriate to ensure that we are not 'assisting them' for their drug habit.

    November 15, 2008 at 6:12 am |
  10. CJfromMN

    Ms cohen, I got instanly mad at your piece of reporting beucase i think it is mindless to write about something that is not hard to do, giving the current state of affairs of our economic picture.

    The questions that should be asked is: when will the citizens of this country stand up and support putting a end to a war that cost HOW MUCH A DAY, WEEK, MONTH, YEAR.

    The question should be: When with the citizens demand the same amount of bail out money to support a new round of federal jails, state jails and county jails, So the revolving door with close.

    The questions should be when will the citizens stand with President OBAMA and say to congress and senate that CEO pay Should be capped and any divend bonuses go to the EMPLOYEES.

    My point in whining so much is that in simplest ways the money president OBAMA wants is a drop in the bucket compared to what is wasted now -

    and again like the election when we the people demand universal health care and demand that all law enforcement agencies are fully funded and executive pay is tied to employee job perfomance then maybe

    you wont have to write about silly questions that can be answered just by supporting IDEAS on the change we need for us to be a GREAT USA(with universal health care)–hummm

    November 15, 2008 at 6:02 am |
  11. J.V.Hodgson

    The drug companies, health insurance companies, Hospital charges and Doctors fees and drug store owners are all part of a national disgrace. I believe they all do very well compared with most of the population.
    The question is what to do to make it affordable to the nation.
    1) A maximum gross margin on any drug for the drug companies, and no more than double the price to any other market. Don't comply and the US national health authority will source it from the cheapest market and eliminate import duties, where it is cost effective.
    2) A fixed percentage fee for all drug stores, based on the medication price for each drug prescribed, and a lower percentage for those in need of repetitive drug needs like insulin, or old or under working age
    3)Health insurers exclusions are a nonsense, fix the premium based on the risks, its called actuarial assessment, and despite national smoking bans the "so called cause of all cancer" its difficult to be even covered for this, something wrong here. Profit greed?
    4) Set up a list of national hospitals and fix Fees they may charge for various surgical procedures, start with the top 100 and build from there, and give them Tax benefits for investment in the latest technology.
    So called private hospitals can function still as with BUPA type organisations.
    5) Government and individual funding,l government say 35 % of costs from salary deductions to the employee, 35 % from company contributions and the rest you pay as you go. The actuaries can work out the average annual cost per person, and cap contributions deducted from employees and employers, or fix a maximum of earnings on which it is charged.
    If you opt for private medical care and special facilities like private rooms or specific private treatment centres, you find a separate private health insurer to cover the extra cost and pay the additional premium yourself, and thru them whatever additional costs are charged.
    The largest problem is that longer term you need national health records accessible to all hospitals for each individual and special arrangements for the retired, under age and non working ( premium wise).
    The point is that there are many like myself and my wife who from graduating college, and to retirement never claimed a dime for state or government health care OTC medications only, and even paid fees to private institutions like BUPA partially funded by us and the company, and the companies insistence on annual medical checks, the latter being paid by the company as it was their insistence. In Japan as an example this government legislated and the company must pay and the tests needed and fee charged are fixed nationally based on the normal tests under 45 and over 45 additional tests. It is a separate business and very profitable.
    A complex problem, but a few genral ideas how to fix the issue in the USA. Look at the UK system where your medical records move with you from each General practitioner when you move house. If you do not tell him you are moving, the next GP or hospital asks for your medical records, before starting treatment other than in Emergency cases where you cannot tell them, but they can get access via your National health insurance number or US style Social security Number, which everyone has. Your problem is illegal immigrants. I thought the law was however ,no green card no social security number, no job. You have to hit those people breaking those laws and hard, part time, temporary or not, and watch illegal immigration decline heavily over time.

    November 15, 2008 at 1:40 am |
  12. JRQ La Habra, Ca

    Keep reporting on this Ms. Cohen because it just does not add up.
    Keep them honest Ms. Cohen.
    One example are flu shots....They are suppose to be free. They use to be free. But now the cost is for the Nurse who gives the shot. Not sure if we are charged for the needle. But legally they are FREE.

    And how much does one Tylenol cost these days in the hospital or ER? It was $10 a few years ago.

    Again, Ms. Cohen, Keep on this story!

    November 14, 2008 at 11:52 pm |
  13. Larry L.

    This "you cann't get treated if you don't have health insurance " is BULL !
    I KNOW people that have lived at the Salvation Army,had or gotten Cancer,and recieved the finest care at the best hospital,and were cured.There are lots of safety nets out there!Federal,State,County,funded FREE clinics all over the country. VA too.

    Most of the people that don't have health insurance have 3 TV's,2 cars,more house than they can afford,cable,cell phones,etc.,there health is not a priority until they have a problem, Then it's "oh my god" I cann't afford to go to the doctor"

    To get your vote the Democrats keep promising FREE HEALTH CARE
    We already have it !!The Dem's just want MORE,at who's COST–YOURS and MINE–Bankrupting us even more.

    So nice, so caring ,so idealistic,so naive

    November 14, 2008 at 7:40 pm |
  14. Mary V., Salt Lake City, UT

    No one said it will be easy, nor cheap. BUT.......its necessary. President-elect Obama mentioned that the healthcare would be identical to the healthcare that Congress enjoys now. With millions of people on board, the government will have quite a lot of 'pull' with health care companies and drug companies.

    Also, not every American will want the federal healthcare, some will continue with their own insurance. It will be a huge success for the Obama presidency if he is able to give every American who needs it healthcare!

    The number one reason for bankruptcy in our Nation, is healthcare costs!

    November 14, 2008 at 5:43 pm |
  15. deborah, OH

    I don't think the health care system can be fixed easily or cheaply. And, of course, the economy has to come 1st! But I do remember Pres.-Elect Obama saying it may take 2 terms to get things in better shape.
    However, I do wonder about the origin of the needed money

    November 14, 2008 at 5:24 pm |
  16. Cindy

    Oh I think that it is going to be extremely hard for Obama to get his health care deal done. I mean he's going to have a lot of opposition. Mainly I think from the pharmaceutical companies and also from insurance companies themselves when they see how much money they'll be losing in this deal. Because they won't be able to charge those sky high prices and get away with it.

    I really don't think he'll get it done in two years maybe even not in his whole first term. He has a lot more on his plate to worry about besides that. Our economy being number one.


    November 14, 2008 at 4:09 pm |
  17. Melissa, Los Angeles

    If my friends are able to purchase the same drug in Mexico that's cheaper then here by at least 3-4 times – then there is seriously something wrong with why were paying 3-4 times more than a 3rd world country. The problem is there is no affordable healthcare and the main reason for that are the insurance companies making money hand over fist and the expensive insurance doctors and hospitals carry in case of lawsuits. The illegals have also added another problem for us here in CA but that's a whole other topic. The point is I switched from a HMO to a PPO therefore I and my employer pays more for my coverage however I still have to pay upwards to $300 out of my own pocket since physicals are not covered by the insurance. What is the point for paying all that insurance and still not get completely covered for just a physical? Obama needs to address what crooks the insurance companies are and give the power back to the doctors.

    November 14, 2008 at 4:07 pm |

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