May 21st, 2009
11:55 PM ET

Dr. Sanjay Gupta: 'Real health reform requires the will of the people'

Program Note: Tune in to hear more from Dr. Sanjay Gupta on the challenges facing President Obama tonight on an AC360° special, “Extreme Challenges: The Next 100 days,” at 10 p.m. ET.

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Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Tonight, we are talking about a topic that I have been thinking about for nearly two decades. Health reform. In the early 90’s, as a medical student, I attended grand rounds where the topic might be spine fusion, but the side discussions were on federal entitlements. Over the years, I learned the perfect technique of removing a brain tumor and clipping an aneurysm, and spent my odd hour reading and writing about our health care system and its ability to provide very good health care to many, but certainly to the exclusion of some. When I worked at the White House in the Clinton administration as a Fellow, I saw firsthand how massive health reform might happen. It didn’t. And, now as a neurosurgeon, who has chosen to work at a county hospital, I spend my days taking care of people who are uninsured and as a result are sicker and more desperate – it is sad and heartbreaking. I have wondered out loud again how it might all be fixed.

I think it’s safe to say that no one thinks our health care system works well. I haven’t thought so, almost from the moment I entered it. Simplifying a bit, for the purposes of this blog, the two issues on the table are cost and access – and probably in that order. Having sat down with President Obama, I know he believes we should build on the current system. That is, people who have health insurance they like should be able to keep the same coverage. People who can’t afford it would be eligible for subsidies to help defray the costs. I have not heard anyone from the administration talk about completely overhauling the system or having it completely run by the government.

Cost seems to be the driving force behind most of this health reform. Here’s why: many people believe we cannot possibly afford to provide health coverage for everyone unless healthcare itself is less expensive. I believe we pay too much for too little. Decreasing costs means increasing the value and possibly making health care insurance more affordable in the process. And that is how cost drives access. The President has talked about things like increasing prevention, investing in health IT and realigning the incentives for hospitals and doctors as strategies to lower the costs. The costs and the potential savings are not measured in the millions or even the billions, but instead the trillions.

Like I said, I have been thinking about this for nearly 20 years, but health reform has been on the table since the days of Truman, maybe even before. If you were to ask me, I am more optimistic now than ever, because of the support of organized medicine, industry and even the insurance industry. But, it won’t likely happen, even now, without the will of the people.

So, what do you think? Do you like the health care plans on the table and what would you change if you had the chance?

soundoff (27 Responses)
  1. KC

    We live in a society where people want everything. They want to eat whatever they want, not exercise, and have the gov't provide their healthcare. It doesn't work that way. We have to be willing to work hard and sacrifice for those things that are important to us. There has to be more accountability for LIFESTYLE CHOICES in healthcare.

    May 22, 2009 at 12:26 pm |
  2. curt

    I can't understand a system where we talk about controlling costsand most Americans have no idea what any procedure costs until you get the bill. We all as Americans need to DEMAND to know what every lab test, every doctor visit, every dianosis, every drug costs at like a manufacturer list price so we can make an informed decision. Why can this be posted at health locations so we can comparison shop? That is what we do everywhere else.

    May 22, 2009 at 11:39 am |
  3. J.V.Hodgson

    America and Americans will never acceot the Models of France or UK national medical cover plans. For me that is sad but a reality as adding 40-50 m additional customers will allow the key elements of
    a) Reduced medication costs, why can i get over the internet in some cases prescription drugs at 30 sometimes 50 % less cost than if I went to a local doctor and pharmacy in the US. Something wrong here.
    b) As you have noted some can go to India for serious and expensive treatment and save noney against the deductible on Paid up policies andmedical insurance premiums.
    c) nothing wrong with a National Medical insurance number for all with the option at any time to opt in or out of private or national cover,but to do that fee rates have to set for surgical procedures in Hospitals, and long term preventitive medical treatments.
    Just a few thoughts, the current system is a failure as you say.

    May 22, 2009 at 6:23 am |
  4. Regina

    I really don't want a medical system run by the government. On the other hand Doctor's have became a greedy as Wall St.

    May 22, 2009 at 5:56 am |
  5. dlm (RN, IL)

    The basic question is whether health care will remain a privilege for those with means or employer provided insurance, or a basic right of citizenry. Will a business model or social justice prevail? The exorbitant profits in much of health care have troubled me for over 40 years. We pay taxes for police/fire protection, schools, & other services. I just don't see how/why health care differs. We expect these other services to be provided without incentives of big bonuses & huge profits for "failing to serve" as when insurance companies gain monetarily by limiting or denying care. This conflict of interest is a major ethical concern. We also are in dire need of common sense medical tort reform & malpractice caps to avoid losing health care providers to other states or even careers. Businesses are being crippled in the global economy by rising costs. US healthcare is ranked 37th in the world by WHO...not much to be proud of. Reform can't come soon enough!

    May 22, 2009 at 1:30 am |
  6. Luke Tervola

    House of Representatives bill # 676 "Medicare for All"

    (Sponsored by rep. John Conyers (MI)) – last year had over 90 co-sponsors (more than any other bill in the house)

    This is a single payer health reform bill. Single payer is reference to a financing structure, by which an entity (presumably government run) is the administrator, or "payer. This payer would collect health care fees, and pay out health care costs. It is important to note that THIS IS NOT SOCIALIZED MEDICINE for socialized medicine is government funded and government delivered, this bill does not call for government delivery of health care, simply a more justified way by which all persons in our country are cared for.

    What is wrong with the Massechussets plan? Or one of the first comment's suggestion that we FORCE persons to purchase health care? Well, for starters the U.S. pays per capita nearly $6,000/yr. for health care. For many persons this is an unrealizable amount of money. Second, the Mass. plan PENALIZES people for failing to purchase care (excluding people under 200% FPL). Yet, with employers pulling back on co-pays and deductibles at a rapid rate, even those above 200% FPL cannot afford these sky-rocketing costs.

    WHAT WE NEED IS A RIGHT TO HEALTHCARE, the media, politicians and insurance giants are responsible for sensationalizing cases of welfare, or persons using safety nets as props in order to pass an agenda that services, or rather BAILS OUT the insurance companies. Just as our country gives us the RIGHT to be protected from foreign and domestic enemies (police, military), the RIGHT to be protected against natural disasters like fire (the fire dept.), and the RIGHT to an education (though school financing has its own set of issues), we should have the:


    May 22, 2009 at 12:49 am |
  7. David

    There is much that can be done to reduce waste and lower costs in the healthcare industry. But as long as millions of Americans over eat all the wrong foods and/or refuse to exercise all the while assuming that someone else will pay for most, if not all the cost, we will never reduce the cost of healthcare to where it needs to be.

    May 22, 2009 at 12:41 am |
  8. Arpit Dave

    UT-Southwestern Medical Center, Dallas, TX

    Dr. Gupta, until we as a nation are willing to turn patients away from the Emergency Room, we must concede that, in reality, we believe health care is a right in this nation.

    And as long as that is the case, we must demand from our citizenry that with rights come responsibilities. The health care reform on the table may decrease cost (or it may not), but until we demand of Americans that with the right to health care comes the responsibility to look after our health, our system can never be solvent. But until we can shutter the McDonalds, Burger Kings, and ice cream parlors, I suggest the following:

    Health care reform 1) mandate (and fund) regular childhood care. I need not quote you the morbidity advantage enjoyed by healthy children. There is little doubt that there are likely massive health benefits to be had from higher educational standards as well as safer neighborhoods, but I digress.

    Reform must also 2) mandate catastrophic care policies for those not covered under childhood care programs. Within those policies, we must also mandate age-appropriate annual health screenings (i.e. colonoscopies for individuals >50 years of age – finding the first polyp is cheaper and easier to treat than metastasis to the liver).

    Of course there's more to it than that. We must deal with the externalities of poor health choices (i.e. taxing junk food – it's not quite right but it's a start) and address how to pay for chronic disease management.

    At the end of the day, though, true health care reform is about the patients first, and the cost second. We must never forget that.

    May 22, 2009 at 12:28 am |
  9. Sean

    Man I think we have all lost our way as a Nation...

    The sense of entitlement these days is stifling. "Entitled" to health care, universal access. Show me the suffering masses that are going untreated. Tell me where else foriegn leaders go whne they are sick and dying? Heck even ordinary Canadians flee here when they need a specialist.

    We already have the best care, don't let these liars (on right and left) tell you otherwise.

    So, we natinoalize it to make it better? Health care will be like the DMV in no time.

    Maybe now that we have Nationalized GM and Chrysler we are all entitled to a car every year (even if we can't pay)? Sounds good, probably get a lot of votes...

    GROW UP! There is no free lunch. The government is inhereently corrupt and NEVER runs ANYTHING well...

    May 22, 2009 at 12:15 am |
  10. Dr J in California

    While it's true that the insurance carriers spread the cost for discount government healthcare programs to others, they also spread the risk of insuring those who make unhealthly lifestyle choices that lead to chronic disease.

    Studies show that 80 cents of every health care dollar spent goes for a smoking-caused or smoking-related condition. Smoking is far more expensive and lethal than obesity, alcoholism and drug addiction together. Why then doesn't Obama stop smoking and support anti-smoking programs?

    Studies show that 80 cents of every health care dollar spent goes for a smoking-caused or smoking-related condition. Smoking is far more expensive by the sheer numbers, and lethal, than obesity, alcoholism and drug addiction together.

    Why then doesn't Obama stop smoking and support anti-smoking programs?

    May 21, 2009 at 11:53 pm |
  11. Dr J in California

    Elizabeth Edwards just drew gasps when she pointed out that one in $700 of health expenditures went to pay the CEO of United HealthCare a few years ago.

    Obama ought to shine light in dark corners like UnitedHealthcare executive salary and golden parachutes of hundreds of millions of dollars. Maybe the Wall Street profiteering UnitedHealthCare and other plans should be exposed, shamed, or taxed more.

    There will be no reform of health care until there are controls on the excesses and improper denials of the health insurance industry.

    The health insurance industry with its layers of middle men and lobbyists are high-priced parasites on system that control the purse strings and deny early cost effective healthcare including preventive medicine and early detection programs.

    Bear in mind that there's only one way health insurers make a profit: by keeping the difference between premiums received and claims paid out. Do the math. Where do the billions come from?

    May 21, 2009 at 11:52 pm |
  12. Shawn N

    As a US citizen living in Korea for a year I am seeing a big difference in health care between the two countries. I will admit that I am ignorant when it comes to knowing how the actual "health care" system works over here but let me say this: Korea health care has been way better in my experience. In Korea I pay (the equivalent to 40 us dollars a month) and I have received unprecedented care, not to mention very cheap medication.

    I feel that yes, in some instances the US is more advanced on certain medical practices, but shouldn't you be concerned mostly with how fast and efficient your care is? The US health care system is "ran" by drug and insurance companies and there will never be a fair balance of care between the countries poor and elite. Here in Korea you can go to any Dr or any hospital, rich or poor and get the same care.

    Everyone who thinks that the US health care system is in good shape let me ask you this...Why are we 15th in the world in Life expectancy? Why is our baby survival rate outside the top 10??

    I love my country but health care is something that definitely needs to be addressed.

    May 21, 2009 at 11:41 pm |
  13. Dawn: Calgary, Alberta

    My husband and I have been living in Canada for the past year, and "the grass is always greener on the other side" now comes to mind. Yes, we do have to pay a greater amount in taxes. However, it is nice to take my son to the clinic or eye Dr. and not pay a penny. There are also supplimental insurances that you can purchase to pay for diagnostics which may not be covered under governmental health care. Canadians appear to look at their system as taking care of one another, and don't have many complaints about higher income taxes. However, they also travel to the United States or other Provinces quite often if there is a procedure or treatments that have extreme wait times. It took us 2 months just to find a family practice Dr. who was taking new patients. Therefore, we have come to the conclusion that No system can be perfect. But, hopefully we Americans can find a good system that provides quality health care with some type of government backing. Paying the extra in taxes really isn't so bad. But what Americans need to keep in mind is that nothing comes for free...

    May 21, 2009 at 10:44 pm |
  14. Mary

    Quality Health Insurance at a cheap price starts With Personal Responsiblity. Although illness is often unexpected , you can have the mentality that you will go broke from not taking care of yourself then perhaps you may be inclined to change your behaviors. Thats preventive medicine . Would it make sence to take from Social security now in the first 25 years of your life as a advance payment to offset the cost of future ill health? So when your able to make steady money through your job, that you picked because every employer carried health insurance of some kind, you start with a health savings plan, the older you are the more comprehensive your choices are for picking a plan and costs. IF you have a disability then the government comes in to add to your health savings plan as a supplemental. Perhaps this empowers the employee and the employer to keep americans with diabilities. Quality in not just a good doctor but how you live it.

    May 21, 2009 at 10:31 pm |
  15. Osa Rafshodia

    Im a pediatrician worked for goverment at public medical facility at indonesia, i do know what dr sanjay gupta feel about health care system, my opinion is the US administration should have more budget for health than military to provide health cover to protect american people. Health care system should be provided by goverment to get most benefit for american

    May 21, 2009 at 9:55 pm |
  16. jim

    I am a family physician in a rural practice and I agree, change needs to happen. Too much of my day is spent in administrative busy work just trying to do my job. It seems I need to get someones permission every time I write a prescription, order a test, or make a referral. As for my patients without insurance it is a constant struggle for most of them to pay for even basic health care, much less the expense of working up a new problem. I don't see a fix to the system without some form of rationing, and to do that the government will almost certainly be involved. My life would be simpler with only one insurance company to deal with, but I also have reservations about a single payer system. I am disappointed about the leadership of organized medicine, they have become enamoured with the 'Patient Centered Medical Home' and are pushing it as the fix for the future. But if you look at the PCMH National Demonstration Project it is clear that a small solo practice such as my own would find it almost impossible to implement. In the long run a primary care based system with a strong emphasis on prevention and personal responsibility would be best, but how do we attract medical students into primary care when they graduate with such crushing debt?

    May 21, 2009 at 9:26 pm |
  17. mark

    Let's be honest, the reason that a single-payer system is not being considered is due to the power of the health insurance companies! Canada is able to cover all its citizens at far less cost than the United States and with better health outcomes. Indeed as numerous polls indicate, Canadians are much more satisfied with their system than is the case for people in the United States. The worse criticism directed at a politician up there is that he or she is trying to "Americanize" health care.

    May 21, 2009 at 9:12 pm |
  18. mharoun

    An interesting thought. It is in my personal experience an essential part of a self developing group of individuals who seek betterment.

    May 21, 2009 at 7:03 pm |
  19. Donna Orsborn, Las Vegas, Nevada

    Hmm. I'm sure that Obama and his family have health insurance. All americans deserve access to healthcare. He should be making this reform a very high priority.

    May 21, 2009 at 6:13 pm |
  20. enea ostrich: Seal Beach, CA

    having a national type insurance like Canada, for instance, is not viable because of cost. you mentioned that fact in your article. yes, I believe reform can happen in stages, and I believe that Obama is on the right track for this. he is directing studies on where it's needed most, and I feel that is what all government parties in the world should do. check and see where it's needed so you can reform that part first, then go on to the next one. by doing this it's not as overwhelming a task and America will get this health reform thing done correctly. no one said it had to be swift. nothing comes easy.

    May 21, 2009 at 11:53 am |
  21. Alex (NYC)

    Healthcare reform is necessary. I concur, Sanjay. I agree with cost and access being the 2 driving force in reforming healthcare. In my opinion, one national service provider wouldn't be feasible in our current system. Fusing socialized healthcare and our current system is the most feasible to ensure the gov't does not run out of money, promote responsibility among patients themselves, preserving autonomity among American people, competetiveness and healthy capitalism among healthcare businesses.

    May 21, 2009 at 11:39 am |
  22. Tracy

    I don't think the government should be int he business of providing health insurance, but we have to do something about its cost structure. What about about the government subsidizing the research of drug companies? Maybe not ideal but it would allow drug companies to lower prices on existing drugs and new drugs since neither would no longer have to carry the cost of research. What about malpractice insurance? There's got to be a way to reduce the cost and still hold doctors accountable. We have to think outside the box and get radicle. Sounds crazy but so did the changes of electing Obama. We're Americans we can do this.

    May 21, 2009 at 11:13 am |
  23. Mike Deist

    In a society that refuses to acknowledge right to death, providing health insurance will not solve any problems. We have madatory auto insurance, yet many Americans are driving around without insurance. Americans know that they will not be allowed to die, and therefore, many will opt out of health insurance, regardless of how cheap it is. A military or VA type system eliminates law suits, most of the fraud, can control access. and will certainly be cheaper since costs can be controlled. Quality is a function of the standards required for those getting the licenses to practice, and not whether it is provided by single payer or multiple insurance companies. The reason why many are opposed to a system that provides access to all is that everyone would have to sacrfice for the common good. Americans don't care about the common good. Its all about enriching ones self at anyone elses expense.

    May 21, 2009 at 11:11 am |
  24. Debbie

    You will never get healthcare reform without fixing the existing system. For decades federal, states and local governments have negotiated the best benefits with the lowest premiums and the least out of pocket employee expense while insurers have shifted the higher premiums to the private sector. Not only are tax payers funding benefits for government workers but their own insurance in the private sector is inflated because the insurance has to make a profit somewhere. You will also find that the claims experience for government workers tends to trend higher. They have great benefits but tend to appear to be sicker. So let's try to get some balance in the current system. Government workers are not so special that they should not have to contribute to their health plans at the same percentages of those of us that make it possible for them to have life long jobs and benefits.

    May 21, 2009 at 11:00 am |
  25. NNS

    Correction in the last comment: ripping them OFF, not ripping them up.

    May 21, 2009 at 11:00 am |
  26. NNS

    Health care needs to be provided by the government. A lot of people would benefit from this and I think Americans would finally feel as if the government isn't always ripping them up. On this issue, America is seriously lagging... many, many other countries already provide health care for their citizens. It's a shame that we are so backwards on this.

    May 21, 2009 at 10:59 am |
  27. SLM

    Health insurance needs to be affordable and available, but it should be available for everyone to PURCHASE, not be provided free by the government for some, while others pay. Kind of like Auto insurance, you have an auto you pay for insurance. We do NOT want socialized medicine, that would eliminate Quality and availability.

    May 21, 2009 at 10:36 am |