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Sanjay Gupta MD

Your Vote Could Decide Your Health Care; Couples Faced With News Their Child May Have Down Syndrome: the Agonizing Choices

Aired November 01, 2008 - 08:30   ET


SANJAY GUPTA, CNN HOST: Welcome to HOUSE CALL, the show that helps you live longer and stronger.
This morning, your vote could decide your health care. We have senior members of both campaigns to tell you why their plan is better.

And couples suddenly faced with the news their child may have Down Syndrome. The choices can be agonizing.

Plus, with the time change this weekend, how much sleep do you really need? Find out later on HOUSE CALL.

We start, though, with the decision that could affect your health, your wallet and your family. Health care, the candidates are both vowing to make some sweeping changes, but in very different ways.


SEN. JOHN MCCAIN (R), PRESIDENTIAL CANDIDATE: I'll make sure you can keep the same health plan if you change jobs or leave a job to stay home. I will provide every single American family with a $5,000 refundable tax credit to help them purchase health care insurance. Workers who already have insurance from their employers, you'll keep it and have more money to cover costs. Workers who don't have health insurance can use it to find a policy anywhere in this country to meet their basic needs.


GUPTA: Now, some of the highlights of the senator's plan, a tax credit of $2500 for individuals goes along with that $5,000 for families. There's also a fast tracking of generic drugs to lower drug costs. And his plan would provide a guaranteed access plan for those with pre-existing conditions.

Now for Senator Obama.


SEN. BARACK OBAMA (D), PRESIDENTIAL CANDIDATE: My plan says let's work with employers who are doing the right thing and offering health care to provide them the ability to lower premiums by up to $2500 per family per year. And if you don't have health care, then let's make sure you can get health care that is as good as the health care I have as a member of Congress. And you will have a choice of doctors. (END VIDEO CLIP)

GUPTA: Now, the Obama/Biden plan would create a national insurance program that allows people to buy health care similar to what federal employees have. It would also require coverage for all children and allow the importation of medicines from other developed countries if the drugs are safe.

The question, of course, what does all of this mean for you? That's what we're trying to find out today. We went straight to the top to get answers about what you should expect from those health plans.

Douglas Holtz-Eakin is Senator McCain's top economic adviser. He's former head of the Congressional Budget Office. And Austin Goolsbee is Senator Barack Obama's senior economic adviser, professor of Economics at the University of Chicago. Thanks for joining us, both of you.



GUPTA: Doug, let me start with you because you made some news recently when Senator Obama picked up on some comments made about people getting better insurance from their companies than they would from using the tax credit. Now let's try to understand this a little bit. Does Senator McCain want to eventually shift us from a program of employer-based health care to one that's not so employer-based?

HOLTZ-EAKIN: No, the fundamental notion behind Senator McCain's plan is to give people more choices and more options.

GUPTA: But Doug, real quick, if you're a young, healthy person who does not have health problems already, what is going to happen to that person? Are they -- do you think they're going to leave their employer-based health care? Are they not going to leave it? Is it going to leave a lot of sicker people being covered by their employers? How is this all going to work?

HOLTZ-EAKIN: Well, there are really two key issues. I mean, number one for the young and healthy who are in an employer-sponsored plan, they're largely subsidized about a 70 percent rate. They're very unlikely to leave that employer-sponsored plan where they might get, you know, $5,000, $6,000 of coverage and then take a $2500 policy with the tax credit. So there's not a real danger to the employer- sponsored market here.

The big issue with young people has been getting them into insurance. And Senator McCain's approach, which is to say, look, here's $2500 toward a health insurance policy, let's get you in when you're young. That will help the risk pools. They'll have a policy that will by then be portable.

It'll go with them from worker -- from job to job, job to home. And because it's renewable, we're finally going to have the insurers caring about the long-run costs of that person. They'll pay for the prevention then. They'll pay for the wellness. And that's how you get better care at lower cost.

GUPTA: Austan, Senator Obama brought this up in one of the speeches. What is his concern specifically about what Doug is talking about, this idea of slowly shifting from this employer-based model?

GOOLSBEE: Well, I'd say there are at least two major concerns. The first is everyone knows that doctors, the businesses, and the patients know that the problem with the current system is that health insurance companies are competing by excluding people that are sick, rather than by giving you more coverage for less money the way other companies compete.

And this plan that McCain is outlining makes that worse. They're going to give you a $5,000 credit, paid for by taxing your health insurance as if it were cash income. And with that $5,000 credit, you're going to go out in the individual market and try to buy insurance.

Now, the average family paying costs $12,000. So there is something that fundamentally doesn't add up. And if you've ever been sick, or you've had a family member that's been sick, you're not going to be able to get coverage. And that's critically -- that is a critical problem in the system. And they just fundamentally don't fix it.

Number two, the experts have looked at this. And the reason Doug got in trouble talking and trying to explain why people wouldn't leave is that health experts have looked at this and said that up to 20 million people would lose their employer health -- provided health insurance because the employers are going to see costs go up. And so they would drop coverage.

And so those 20 million people, many of whom are already sick, are going to be thrown into the individual market, where the costs are extremely high, or where they may just be excluded because they've had a pre-existing condition. That is not possible under the Obama plan, but that's guaranteed under the McCain plan.

GUPTA: Senator Obama's plan, how is he going to pay for this? Where is that money going to come from? How much do you think it's going to cost?

GOOLSBEE: The total cost of the plan to the government is about $55 billion per year. That is paid for by a portion of letting the high-income part of the Bush tax cuts disappear and go back to the rates they were in the '90s.

GUPTA: Is that a tax increase?

GOOLSBEE: On people making more than $250,000 a year, the rates go back to what they were in the '90s, yes.

GUPTA: How about with Senator McCain? Is this plan expensive, his plan? And how is he planning on paying for it?

HOLTZ-EAKIN: Well, the heart of the plan is to get better care at lower cost. And we know that the big dollars out there in chronic disease. And we need a next generation of treatment models for those who have chronic diseases. We need to have medical homes and coordination of care.

So what Senator McCain's plan does is go to the heart of the treatment of individuals, give them a different kind of delivery of medicine, one that doesn't focus on acute care and bad settings like emergency rooms and hospitals, but really rewards prevention, rewards wellness, deals with chronic disease and the management of it.

And by doing that, you can get great savings, including in federal budget programs where between disease management, information technologies, faster use of generics, restriction and fraud, we can bring down the Medicare costs, Medicaid costs, save states about a half trillion dollars over the next 10 years.

That's a Lewin estimate. That's a budget neutral proposal. And it stands really in great contrast. I've never quite figured out how the Obama plan adds up because what Senator Obama has said is I want everyone who doesn't have health care to have health care as good as a congressman. That's 50 million Americans. It's about $7,000 per person. That's a $350 billion price tag. And they keep moving things around, but the money's got to come from somewhere.

GUPTA: We are going to have much more on this on our Web site as well for people watching at home. There are a lot of numbers being tossed around.

Let me say a couple things. Both candidates have talked a lot about prevention, which I think is a very good thing as a doctor, probably a direction we need to go. And we just have a very little time. Austin, let me just really quickly, you're both professors of economics. With all that's going on in the economy right now, are we going to -- are these things really going to happen if either of these -- when either of these candidates get elected? Austin?

GOOLSBEE: I think they will if Senator Obama is elected. He's identified it as one of his key, key priorities.

Now obviously, we have to deal with the economic crisis first, because it's in a crisis. But we can't forget that the squeeze on ordinary Americans, of which the massive rise of health care costs is a major component, is what led to people being in a situation they can't make payments on their houses and got us into financial crisis. So, if we don't address the health care system, we're setting ourselves up for another crisis down the road.

GUPTA: Douglas?

HOLTZ-EAKIN: Well, the top priority has to be the American family. And as you well know, this is a huge budgetary issue in every household. It's also a great disservice to Americans to continue to give them a health care system costs too much, doesn't deliver the quality they deserve, and that they have no control over.

So Senator McCain believes let's take the control out of Washington, which has failed us in so many ways, give better care at lower cost to every American.

GUPTA: Thanks for the smart, civil discussion, gentlemen. Thanks for getting up with us as well.

All right, is that helpful? Now you've heard their plans. What do you think? Go to our Web site Also, are you frustrated by the high cost medical care overall? Are you happy with your coverage? We're looking to hear from you with your e-mails and your i-reports.

GUPTA: And...


UNIDENTIFIED FEMALE: They give you a bleak picture. You go out there and you're scared. You don't know what to do.


GUPTA: There are parents making some tough decisions that are going to change their lives forever. Stay with us.



GOV. SARAH PALIN (R), VICE PRESIDENTIAL CANDIDATE: When I learned that my son Trig would have special needs, to be honest with you, I had to pray that my heart would be prepared for the challenges to come. It was a shock. I wasn't ready for this. I had to ask for that strength.


GUPTA: Of course, that's vice presidential candidate Governor Sarah Palin talking about her 6-month-old son, Trig, who has Down Syndrome.

Now, advances in genetic testing allowed Palin to know about her son's condition in advance, and to prepare for the challenges. But as Ted Rowlands shows us, for many parents, that same advance knowledge can lead to some pretty gut-wrenching decisions.


TED ROWLANDS, CNN CORRESPONDENT (voice-over): Faith Mitchell has Down Syndrome. And considering the statistics, she's lucky to be celebrating her birthday.

The fact is an overwhelming majority of parents who find out their baby will likely be born with Down Syndrome choose to terminate the pregnancy. Many people, including Faith's parents, believe doctors are partially to blame for the high rate of Down Syndrome abortions, which some studies put as high as 90 percent.

LISA MITCHELL, FAITH'S MOM: They give you a bleak picture. You go out there and you're scared. You don't know what to do because you have -- you think of all these great things. And it's all like taken away from you an instant.

ROWLANDS: The Mitchell's say during those gut-wrenching minutes after the diagnosis, they got the feeling that their doctors were pressuring them to abort Faith. The focus, they say, was on the medical difficulties many children with Down Syndrome have, like heart trouble and how hard they are to raise due to their learning disabilities.

L. MITCHELL: They even told me that it could be a burden on my son as he grows up.

ROWLANDS: The Mitchell's and others raising children with Down Syndrome say they want doctors to give expecting parents a more complete picture, including the positive points.

MICHAEL MITCHELL, FAITH'S DAD: They're special. They're the most loving people you ever meet in your life. And I think they deserve a chance.

BRYAN SKOTKO, M.D.: Doctors are not prepared when it comes to delivering that diagnosis.

ROWLANDS: Dr. Bryant Skotko, who has a sister with Down Syndrome, authored a 2005 study while he was in medical school that showed that most parents of children with Down Syndrome thought that doctors indeed focused on worst case scenarios. The medical community has heard the complaints.

JAMES GOLDBERG, DR., AMER. COLL. OF OBSTETRICIANS AND GYNECOLOGIST: As concerns of various groups are recognized, I think there is a tendency towards providing that information. And I think those guidelines are being developed to do that.

ROWLANDS: Joy and Jeff terminated a pregnancy more than two years ago after receiving a Down Syndrome diagnosis. They didn't want us to use their last names. They say the decision was very difficult for them, but they have no regrets.

JEFF: I did not feel any guilt about it. I don't think we did anything wrong.

ROWLANDS: They say they didn't get the feeling that their doctors pushed them in any one direction, but they say many people made them feel bad for deciding to have an abortion.

JOY: Here we were going through a loss. And you know, there are people out there that -- there are a lot of people out there who look down on what we chose to do.

ROWLANDS: Since then, they've had a child with no birth defects. The Mitchells say they never considered aborting Faith, but are very careful not to judge anyone who makes that choice because they say assure as they are that they made the right decision, they also know how difficult it is to have that decision to make.

Ted Rowlands, CNN, Los Angeles.


GUPTA: All right. Ted Rowlands, thank you very much.

You know, as women age, the risk of having a baby with Down Syndrome increases from about 1 in 250 at age 25 to 1 in 400 at age 35. By age 45, the risk is about 1 in 30.

You know, with more and more women over the age of 35 having babies, we decided to do something important. We're going to stick with this story and we're going to bust down some myths about Down Syndrome. Stay with us.


GUPTA: And as you can see there, Down Syndrome is one of the most common genetic birth defects, affecting about 6,000 newborns in the United States every year. Now with early intervention and therapy, children with the condition are living longer and contributing to the workforce, but they do often confront some frustrating stereotypes.

So to help clear up some of those misconceptions and perceptions, we're joined by Dr. Brian Skotko. He's a pediatrician with Children's Hospital in Boston. He's also a member of the National Down Syndrome Society. Thanks for joining us, Brian.

BRIAN SKOTKO, DR., CHILDREN'S HOSPITAL BOSTON: Thanks for having me, Dr. Gupta. I really appreciate it.

GUPTA: Doc, you just saw that piece as well before the break. Some families feel pressured when they receive the news that a child they're carrying may have Down Syndrome. It's pretty remarkable. I mean, I can't imagine what that pressure is like. You say that pressure is often due to misunderstandings even on the part of the doctors. Explain what you mean, doc.

SKOTKO: It's very true. I did a study where I asked mothers who got a prenatal diagnosis of Down Syndrome, what was it like? And many of them felt fearful, anxious. And many of them said that they were pressured by the information they got from their doctors.

And I think this comes from two reasons. Number one, doctors are saying they're not adequately trained. Nearly 45 percent of obstetrics fellows say that how to deliver the news in their training is barely adequate or non-existent.

And then we also know the second reason is that doctors oftentimes insert their own personal opinions...

GUPTA: Right. SKOTKO: ...into this very sensitive conversations. From one study, nearly one out of every four doctors say that they either overemphasized the negative information or actively urged parents to terminate in those very sensitive conversations.

GUPTA: Some very important messages here for families and for doctors as well. Dr. Skotko, medically speaking, what are the main challenges for parents of a baby with Down Syndrome?

SKOTKO: I think when parents are expecting to have a child with Down Syndrome, they should anticipate about one out of every two children with Down Syndrome will have a heart condition. And thanks to the advances in medical technology, nearly all of those heart conditions can now be fixed.

And they should also anticipate their child might need some additional therapies, like speech therapy, occupational therapy. And they should also, if there is a specialist in town, they should see a Down Syndrome specialist. And there are many Down Syndrome clinics around the country like the one at Children's Hospital of Boston that are providing that specialized care for children with Down Syndrome.

GUPTA: Really quickly, because I think a lot of parents maybe watching interested, what specific resources have you come across, doctor, that might be available to the parents of a child with Down Syndrome?

SKOTKO: There are a lot of national organizations that have quality, up to date information about Down Syndrome. The National Down Syndrome Society, the National Down Syndrome Congress, and Band of Angels Foundations are all organizations that have that information. And through their Web sites, these organizations can also connect parents with local groups.

For example, a Massachusetts, the Massachusetts Down Syndrome Congress have parents that are available 24 hours a day, seven days a week, willing to talk to new and expectant parents about the realities and the possibilities for children with Down Syndrome today.

GUPTA: All right, Dr. Skotko, thanks so much. An important topic. Glad to do it. Glad you're on as well. Thanks so much.

Now, getting those Z's, you know, we're changing the clocks this weekend. How much sleep do you really need? I'm going to have some answers coming up after the break.


GUPTA: And we're back with HOUSE CALL. It's time for my favorite segment of the show, "Ask the Doctor." We get to hear from you. And you've been writing in. So this is a chance for us to answer the medical questions on your mind.

Here's a question from Laila in Florida. She asks this. "I'm 27, and I would like to have a baby some day. I've heard of the importance of folic acid. What else is recommended to prep for pregnancy?"

GUPTA: Well, first of all, congratulations for thinking ahead, for sure, Laila. A great question. Experts suggest women begin prepping their bodies about four months before intending to get pregnant. You don't always know when that's going to happen, so that can be harder than -- easier said than done. But eat healthy, avoid drinking and smoking.

And here's something really important that we learned as well. Start taking a prenatal vitamin now to strengthen your immune system for later. Be sure to look for one that does contain at least one milligram of folic acid, as you mentioned. Also, drink less caffeine both before and during pregnancy. We recently reported on a study released earlier this year showing pregnant women who drank more than two cups of coffee a day had twice the risk of miscarriage as compared to those who didn't consume any. Good luck, Laila.

Here's another question.


UNIDENTIFIED MALE: How many hours of sleep do humans really need?


GUPTA: Well, a timely question and something to bear in mind, certainly as we move our clocks back an hour to standard time this weekend. Most of us need about seven-and-a-half to eight hours of sleep. You've been hearing for that years. But you also know that for too many of us, that's not happening.

The average is closer to about six-and-a-half hours. There is a term for this. It's called sleep debt. And experiments show for most people, sleeping just six hours a night for a week will result in mental lapses and sleepiness as severe as if you stayed up all night long.

So long term, a lack of sleeping increases the risk of heart attack, stroke, diabetes, weight gain. You've heard all this, so take advantage of that extra hour this weekend. Get some sleep.

Next, motivating yourself to work out.


UNIDENTIFIED MALE: I think this is one of the best parts of the gym in here. Like I said, takes your mind off all the work that you're doing.


GUPTA: And here's a reason to make it to the gym for anyone who's a big fan of going to the movies.

(COMMERCIAL BREAK) GUPTA: We are back with HOUSE CALL. Finally this weekend, Americans have purchased more than a billion tickets so far this year to Hollywood's top films. No doubt we love going to the movies. But for cinema fans, there's now a perfect excuse to go to the gym.


GUPTA (voice-over): Is it a movie theater? Or is it a gym? Well, actually, it's a movie theater in a gym.

JAMIE SMITH, GENERAL MANAGER: The cardio cinema, it's a cool, dark room. It's designed to be like you're at the movies. Instead of sitting in your typical seat, you're on a treadmill, you're on a bike watching the movie.

GUPTA: The theater here at the Gold's Gym in Charleston, South Carolina, is one of about 50 located in Gold's Gyms across America. And the clients here say it's a blockbuster.

MARVIN WHITSON, GOLD'S GYM MEMBER: I think this is one of the best parts of the gym in here. Like I said, it just takes your mind off all the work that you're doing.

UNIDENTIFIED MALE: Keeps your mind off running in place.

GUPTA: But taking your mind off the work at hand is only one benefit. The general manager Jamie Smith says it helps many of her newer clients take that first step.

JAMIE SMITH, GENERAL MANAGER: It's less intimidating. It just makes them feel more comfortable. Nobody's watching them. They don't feel like they're on display.

GUPTA: That's critical because in a recent survey by the American Council on exercise, more than 20 percent of non-gym goers said intimidation keeps them from doing regular exercise. In the case of this Gold's Gym, though, it's the movies that keeps the clients coming back.

BONNIE MARGIOTTA, GOLD'S GYM MEMBER: Twenty minutes has gone by already and I didn't realize it. But I could stay for the whole movie, but that's, what, an hour and a half? I might pass on that.


GUPTA: Catch up on your exercise and your movies at the same time. Exercise longer as well maybe.

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 on Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.