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Sanjay Gupta MD

H1N1: How Hospitals Are Preparing to Protect Children; Possible End of Medical Co-Pays: Some Changes to Employers' Health Insurance Plans; Interview With Mitt Romney

Aired October 31, 2009 - 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: Good morning. Welcome to HOUSE CALL, the show that helps you live longer and stronger. I'm Dr. Sanjay Gupta. Thanks so much for watching.

H1N1 -- we've been talking about it for a long time now. The number of cases are spiking and I've been traveling around the country. I can tell you that frustration is mounting as well. We're going to go straight inside an emergency room to see how hospitals are starting to prepare to protect children.

Plus, possibly the end of medical co-pays, at least as we know them. Personal finance editor Gerri Willis is going to give us some surprising changes to our employers' health insurance plan. You've got to listen to this.

And my exclusive interview with former governor of Massachusetts, Mitt Romney. You know, he's speaking as candidly as I think I've heard him talk about the successes and the shortcomings of a state health initiative he helped implement.

You're watching HOUSE CALL.

First up, though, the health care debate took on a new twist this week. We learned that the contested public option we've been talking so much about could possibly be in again. Senate Democrats are considering a bill that allows states to opt out of the public option.

Now, House Democrats unveiled a version of their own this week as well. It's important to point out that measure does not have an opt- out provision, but it would allow the government to negotiate directly with doctors and hospitals about how much money they get paid. Now, all of this means that both chambers must pass a single unified merge measure before sending it to President Obama.

Now, former governor Mitt Romney, now, he's someone who -- his name comes up a lot when talking about health care. Three years ago, he focused on a lot of these same concerns that many Americans have when he was talking about Massachusetts. He talked about cost, he talked about spiraling access. Romney lost his bid for the presidency in 2008.

As you know, I sat down with him this week for an exclusive interview to find out what he thinks President Obama should be doing to try and reform health care.

(BEGIN VIDEOTAPE)

GUPTA: Is there something about the Massachusetts model that you think Democrats, President Obama included, find just non-palletable, which is why they don't want to talk about it?

MITT ROMNEY, (R), FORMER MASSACHUSETTS GOVERNOR: You know, I don't know what they find difficult here except we have found that we can get everybody insured without breaking the bank and without a public option. There's no government insurance plan in our program here. We've got 98 percent of Massachusetts citizens insured, and there was no need for a government plan.

GUPTA: Do you think that that's the issue, because there is no public option that Democrats don't even want to talk about Massachusetts as being a model for the country?

ROMNEY: It could well be. I think there are Democrats that are intent on jamming in the public option even though the president himself has said that's not critical to the plan. We really don't need to have the government get in the insurance business any more than we say you know what, we need to have the government make an automobile for us. Government does a better job than the private sector.

That's bologna. Government does a terrible job and the only reason, the only reason people are insistent on the public option is because they so desperately want government to manage the entire health care system.

GUPTA: Are people, do you think, just misinformed? Is that why they're -- have such high satisfaction ratings with Medicare and so much in favor of the public option? Do they not fully understand it? Or -- why -- again, why is there that disconnect?

ROMNEY: I think people don't fully appreciate how enormous the burden is that we're leaving the next generation with our entitlement benefits. I don't think they recognize that there are tens of trillions of dollars and just how much money that is and the total economy of the United States is about $13 trillion. We're leaving a multiple of that as a debt for the next generation.

GUPTA: When you were first thinking about this, prior to 2006 when it got implemented, the two basic tenants (ph) were increase access and decrease costs. Which one of those was more important to you?

ROMNEY: Well, when we were looking at solving the health care challenge here in Massachusetts, our focus was on getting people who were uninsured insured and stopping the practice of passing their cost on to the rest of the population. We really were unable to deal with and didn't have any pretense that we would somehow be able to change health care costs in Massachusetts.

GUPTA: Should the president be looking at Massachusetts as a model of lowering health care costs? ROMNEY: No. Massachusetts is not the model with regards to the second problem. It -- Massachusetts is a model for getting everybody insured in a way that doesn't break the bank and that doesn't put the government into the driver's seat and allows people to own their own insurance policies and not to have to worry about losing coverage. That's what Massachusetts did.

GUPTA: I don't want to be one of those people who knocks the system in which I work and live, however ...

ROMNEY: (INAUDIBLE)

GUPTA: ...however, you know, I do hear these stories that are kind of heartbreaking where, you know, you hear about people who used to work in the insurance industry who have come forward and said we deny things because we knew that it would be cheaper, frankly, for the person not to get care than for them to get care. And it gets back to this issue again of if there is a profit motive at all within an industry that is responsible for the care of others, can it really work at the end of the day?

And the reason I bring it up again is that, you know, you see a lot of systems around the world that don't have that that aren't perfect by any means. They have longer waiting lines, but that profit motive is gone. It -- you don't have 47 million people without insurance, you don't have people turned away with preventable diseases. It's heartbreaking to see some of that stuff happen. And I just wonder still if the private insurance industry, the way that it is now can solve some of these problems.

ROMNEY: If people are concerned about the profit motive, there are places to go in this country and I don't know how -- what proportion, but it's got to be close to the majority if not the majority are not for profit. The profit motive is not the challenge in health care, and if you put the government in charge of health care and now, you're going to have government bureaucrats telling you what treatment you're going to get and what's going to be reimbursed, that's going to be a heck of a lot worse than having an insurance guy say oh no, you can't have that care.

Because with the insurance guy, you can say, I'm going to stop buying insurance from you guys. That's how markets work. People are able to move. Single pair means I've got only one option. When it comes to my health care, I've only got one place to go and for most Americans, that's a frightening thing and it should be.

(END VIDEOTAPE)

GUPTA: Now, as far as Romney's plans for the future, as you might expect, he is not ruling anything out. He has a book coming out this spring in fact, which many say serves as a template for what he might do as president if he decides to run again in 2012.

Now, dealing with the H1N1 virus, everyone's talking about this. I'm going to take you straight inside a hospital to see what they're doing to get ready for more sick patients. You're watching HOUSE CALL, stay with us.

(COMMERCIAL BREAK)

GUPTA: We are back with HOUSE CALL. You know, the entire country is now in a state of emergency because of H1N1. Let's give you the latest. The flu is widespread in 48 states. Centers for Disease Control and Prevention says that about 27 million doses of H1N1 vaccine are now available for distribution and the current death toll from the virus stands at more than 1,000 people nationwide. Two states that aren't widespread activity incidentally are South Carolina and Hawaii.

Now, since the H1N1 virus first emerged in April, 114 children are reported to have died from the virus. The president decided last week to protect his own daughters. Sasha and Malia were both vaccinated against the H1N1 virus along with other school children in the Washington area. And as H1N1 spreads, many parents are wondering how will this virus potentially impact their own children?

Let me get you some answers. I went straight inside a children's hospital in the emergency room to find out how the kids are being treated.

(BEGIN VIDEOTAPE)

GUPTA: So, you've got to put on the gown, the mask. There's still obviously a lot of concern here and we don't know exactly for sure that this is H1N1.

(voice-over): Children's Hospital Boston. Because of the H1N1 virus, this hospital is as busy as it's ever been and many of the kids look like Nate.

(on camera): So, we meet the child. The child has symptoms that just seems like all kids get.

DR. ANNE STACK, CHILDREN'S HOSPITAL BOSTON: That's right, all kids get. And the reason specifically that this child came to the emergency department because -- was because he was dehydrated.

GUPTA: OK.

STACK: Significantly dehydrated. And his name is Nate.

GUPTA: Nate, all right.

STACK: Dad, hi.

GUPTA: Hey, Nate. How are you feeling?

So, when someone like Nate comes here, what do you do and what are you thinking about as a doctor?

STACK: So, our first thoughts are to make him feel better, obviously make him comfortable, give him something to control his fever if he has high fever. And in his case, he wasn't able to take anything orally, so we were able to give him some rectal Tylenol to make him feel better.

GUPTA (voice-over): Nate's been diagnosed with H1N1, but is sent home just a few hours later. There's little the hospital can do for him than advise rest and to stay hydrated.

(on camera): Make no mistake, there is a worse case scenario in all this. Patients, kids, can get very sick and even die, which is why we're here in the Intensive Care Unit.

Take a look at this x-ray over here. This is really where it gets bad. I mean, take -- this area in here is the lungs. They should be black representing normal air. But instead, they're all white, sort of filled with some inflammatory fluid. That makes it hard for a child to breathe. It makes it hard for a child to get enough oxygen to ventilate well.

That is a real problem and that's when they might end up on a machine like this, sort of state of the art ventilator, giving 900 breaths per minute. And you can see it's being done on a mannequin here, but this is the kind of technology that's happening at Boston Children's Hospital preparing for the sickest patients of all.

(voice-over): So, ICUs are ramping up technology. But back in the emergency room, what they need: simply more beds.

(on camera): This is sort of interesting. What we're looking at here is what might happen if there's an overload situation. The hospital's over here, but patients might actually be shuffled across to this office building to go into a conference room, an alternate care site if the hospital starts to get overloaded.

It's fascinating, but they would actually flip this room over within a day or two to make room for extra kids if they simply get overloaded.

(END VIDEOTAPE)

GUPTA: Now, we're going to stay on this story of course. Be sure and check out the special H1N1 coverage on the new CNN.com website. We have all sorts of resources there to help you protect yourself as well as of course your family as well.

Now, it is open enrollment time as you may now at many companies and here's something that maybe you didn't. Your employer could drop you from its health plan in 2010 if you don't act quickly.

Stay with HOUSE CALL, we're going to keep you safe.

(COMMERCIAL BREAK)

GUPTA: We are back with HOUSE CALL. You know, for a lot of us with employer-sponsored health insurance, including myself, late fall is when we start to sign up for a new health insurance plan. But for some of us, the whole process is going to be different for 2010 and we got the best in the business, personal finance editor Gerri Willis to help talk us through it. And you know, I haven't been able to go to the meetings yet, describing, explaining some of this. I know you have, but it is confusing. What changes are we talking about here?

GERRI WILLIS, CNN PERSONAL FINANCE EDITOR: Yes. Hey there, Sanjay.

We've been studying this for a couple of weeks now and big surprise: your costs are going to go up as employers ship more of the health care cost burden onto our shoulders. Next year, you can expect to pay 10 percent more, that's $4,000, including co-pays and premiums. About 10 percent of employers will drop you from their health care plan if you don't ...

GUPTA: Wow.

WILLIS: ...participate in open enrollment. Previously, if you didn't make a decision, they just simply default you into last year's option. But this year, if you don't choose, you're going to be penalized.

Another new trend this year: companies are increasingly doing away with co-pays and introducing co-insurance. Co-insurance is the percentage a patient pays for a medical service generally after a planned deductible is met and it can vary by plan. And this is a big deal, Sanjay. A co-pay may cost you 25 bucks, right, but the average doctor's appointment or emergency room visit could run you 500 bucks or more.

Now, if your plan is moving towards co-insurance, make sure you call your doctors and find out what the average visit costs you without insurance so that you can figure out how much money you're going to be on the hook for. Employers are increasingly auditing who you cover under your health insurance plan to make sure your health plan doesn't cover people who are ineligible. And if your spouse is on a health plan but has other insurance options available, you could be paying more in premiums.

So, not a lot of good news here, Sanjay.

GUPTA: I know. When my most recent child was born, I had to show a lot of documentation to make sure that I get her on our exiting plan. So, it's pretty frightening, this idea that people could be dropped as well if they don't sign up. I hope a lot of people paid attention to what you were say there.

What -- you're famous for your tips. So, what are some of the best choices that we could possibly make this year for open enrollment?

WILLIS: Well, here's how you come to your decision about what plan you're going to choose. Look at the coverage you had last year. How much did you spend on co-pays and out-of-pocket costs. Did you see any doctors that were out of network for your plan? How long did your flexible spending account last? Now, most companies, they offer actual tools online that can help you analyze your health claims from last year. Ask if your company has this kind of estimator and make sure you take advantage of flexible spending accounts. This lets employees set aside pretax wages for certain medical expenses not covered by insurance. You have to use the money in that year or you lose it.

So, make sure you follow the guidelines. Again, this is not an easy thing to go through. But if you do the comparisons and really find out how you lined up against last year's plan and what it means for this year, you'll go a long way to choosing the right plan.

GUPTA: It's probably worth the time, it sounds like you're saying, and trying to at least anticipate what some of your health issues might be in any given year.

WILLIS: That's right, Sanjay. You've really got to figure out what you're going to need next year. If you're going to have a baby, if you're having a big life-changing event of some kind. Pay double, triple attention to what you're doing this year because it's really going to matter.

GUPTA: All right, Gerri. I -- can I call you if I -- when I'm filling out my forms? I could use some help.

WILLIS: Please do. We can go over it together.

GUPTA: I'm going to ...

WILLIS: You can give me a little advise, too.

GUPTA: ...do it this weekend actually. Right. This weekend for sure, I promise you. But I will call if I have questions.

Gerri, thanks as always.

WILLIS: My pleasure.

GUPTA: A woman's near crippling struggle with obesity. Now, get this: her insurers refused to pay for an elective procedure that could have helped her lose the weight. There's a lot to this story. She found another solution. It was cheaper, just as effective -- it was also far away from home.

We'll have that story. Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL.

You know, amid the many questions in the health care debate is the issue of elective procedures, whether insurance companies should pay for them or how they should pay for them. For one woman when her insurer refused to cover a surgery that might have reduced her near crippling obesity, she turned to Mexico.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): It's 10:00 a.m. in San Diego and Sharon Howell is just arriving on a flight from Atlanta, but she's not here for vacation. She's heading south to Tijuana to have laparoscopic banding obesity surgery.

SHARON HOWELL, BARIATRIC TOURIST: Well, I attempted to have the surgery back in the States, and the insurance company made it extremely difficult.

GUPTA: So, Sharon decided to become a medical tourist.

HOWELL: We all looked up the facility, the physician, saw that he was highly credentialed.

GUPTA: Her experience so far ...

HOWELL: Incredible.

GUPTA: And the price tag: about $6,000. That's less than a third of the cost in the United States without insurance.

PAULO YBERRI, DIRECTOR, HOSPITAL ANGELES TIJUANA: It's a different economy, different cost structure, insurance cost for the facilities, for the doctors. So, it's a bunch of different factors that if you add them up, sum up to a lower cost, but it does not in any way affect the standards of quality.

GUPTA: But there can be risks when seeking care abroad, so says Emory University's Dr. John Sweeney.

DR. JOHN SWEENEY, CHIEF OF BARIATRIC SURGERY, EMORY UNIV.: The issue is the long-term follow-up and continuity of care that is going to be difficult to achieve.

GUPTA: Also, it is important to research the types of certifications both the hospital and the surgeon hold. And patients should be prepared to pay out of pocket for complications that may arise once they return home. Those who receive poor or damaging treatment abroad often have no legal recourse.

But Sweeney does note just because a hospital is outside U.S. borders doesn't mean it's bad.

SWEENEY: We tend to be very closed minded and not realize that, hey, there's countries outside the United States that do this as well as we do or better.

GUPTA: As for Sharon, she says all the travel has been worth the cost savings.

HOWELL: I mean, I work at a hospital institution and this is very well run.

(END VIDEOTAPE)

GUPTA: I think medical tourism is going to continue to be a large part of this health care discussion.

And here's a question for you: could clenching your fists when you give blood be throwing off some important lab results? Could lead to some needless tests, as well. I'll tell you what's up; that's in "Ask the Doctor."

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. It's time for my favorite segment of the show, "Ask the Doctor. I get to talk directly to you.

Angelica in Hagerstown, Indiana writes this, "Lately, when I have blood drawn, they do not have me make a fist. Could you explain about the changing technique?"

Well, first of all, very perceptive, Angelica. You know, clenching your fists obviously causes your veins to pop out, makes them an easier target to hit as well. But it turns out that little bit of exercise in your arm could spike an extra release of potassium which could provide -- produce a false reading.

Now, it's important because you don't want to have your potassium reading be too high, you want to make sure that's accurate. High potassium levels in your blood can be a sign of chronic kidney failure.

Now, if you think that you may have gotten an abnormal result in the past, you can have your doctor check your blood again. Now, you don't want to undergo needless tests, of course, to look for kidney problems that you don't have. Best advice: just relax your hand, let them find that vein.

We have another question now from Charles in Harborton, Virginia. "Very little is discussed about prostate cancer, right, it's taboo with men. What is the survival rate?"

Well, first of all, you're right, Charles. This is a topic that makes a lot of men uncomfortable. We have talked about it on HOUSE CALL a few times. Let me give you some facts. The American Cancer Society estimates more than 27,000 men will die from prostate cancer this year alone.

Now, if this diseases spreads throughout your body, the survival rate is only 31 percent. Find it and treat this cancer early, and your outlook is really exceptional, five-year survival rate is 100 percent. So, there's a message in there as you might anticipate. Guys starting around age 50 for most men need to see your doctor for some screenings.

And we have advice if you happen to have cancer of any type. It turns out that certain foods can help ease the pain associated with cancer. We'll have them for you. Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Now, when you're battling cancer, foods may not taste quite the same, so I want to give you some great recipes from a new cookbook designed with cancer patients in mind.

(BEGIN VIDEOTAPE)

SUSAN HENDRICKS, CNN CORRESPONDENT (voice-over): While cancer- fighting drugs are killing your cancer, they can also mess up your sense of smell and taste.

COLLEEN DOYLE, AMERICAN CANCER SOCIETY: Right now, I'm making a tuna bean salad.

HENDRICKS: Registered dietician Colleen Doyle, editor of "What to Eat During Cancer Treatment," says patients often experience unpleasant side effects from chemotherapy and radiation.

DOYLE: Nausea is one of them. Diarrhea, constipation. They might have sores in their mouth and trouble swallowing. Taste alterations, things might taste very differently to them.

HENDRICKS: Food odors can make you feel queasy, so eating dishes at room temperature, like this yogurt parfait may help. Colleen also recommends snacking throughout the day instead of eating three large meals. The soft texture of the cooked fruit in this blueberry peach crisp helps ease mouth pain and the high calories keep people from losing weight.

DOYLE: Sometimes, thing have a metallic taste or a bitter taste and sometimes they can't taste things at all.

HENDRICKS: To help wake up your taste buds, this tuna bean salad recipe calls for strong flavors. Ingredients such as tuna, red peppers, onions and a tangy vinaigrette. Recipes chock full of key ingredients are critical to staying healthy when battling cancer.

DOYLE: You need energy, you need strength, you need stamina. And eating well can really help you do that.

HENDRICKS: Susan Hendricks, CNN, Atlanta.

(END VIDEOTAPE)

GUPTA: All right, Susan, thanks.

Well, unfortunately, that's all the time we have for today. If you missed any part of today's show, be sure to check out my podcast, CNN.com/podcasting. Remember, this is the place for the answers to all of your medical questions.

I'm Dr. Sanjay Gupta. Thanks for watching. More news on CNN starts right now.