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June 15th, 2009
11:12 AM ET

Health Care: What you really pay

From CNN Senior Medical Correspondent Elizabeth Cohen

All this week, Tony Harris and I will be taking a look at the American health care system, what's broken, what works and what needs to be done to insure the 46 million Americans who don't have health insurance. Step one: figuring out the why health care in Miami is more than twice as expensive as it is in Portland, Oregon. Tony and I will break it down. In meantime, check out this interactive map from the Dartmouth Institute for Health Policy and Clinical Practice to see how much health care costs where you live.

Filed under: Tony Harris
soundoff (38 Responses)

    Give us a strong Public option. We need to join the rest of the developed world and get a single payer system. This system is bankrupting America. 60% of all bankruptcies are from health care costs. Can we focus on a system that enriches some and bankrupt and kills others. Can you please discuss a public option more. THe majority of people want sinlge payer. CNN will you please talk about the role of insurance companies blocking a public option.

    June 15, 2009 at 11:19 am |
  2. fotyc

    I do not believe we will see an increase in access and a decrease in costs for health care in this country until insurance companies are removed from their position of total control. Why does it seem to be acceptable to so many people for insurance companies to be the gatekeepers to health care? insurers are not doctors or patients. The point of the existence of the insurance companies is to make profit so that shareholders can gain wealth. Until shareholder profit is no longer the controlling factor, there will be no improvement in American health care. I can't believe businesses large and small are not clamoring for the burden of health care to be removed from their backs. How many new businesses would be started in this country if people did not have to risk the health of themselves and their families by giving up their jobs? It is a choice between insurance companies and a wealth of other businesses, between insurance companies and a healthy population. Why is this so hard?

    June 15, 2009 at 11:28 am |
  3. Tim Hendon, Hammond, LA

    1). I have had a major medical policy with Blue Cross of Louisiana since 1994 when the monthly premium was $64. My premium has increased each and every year since then and it is currently at $483/mo. The State of Louisiana does not have statutes in place that would regulate insurance rates to protect consumers.

    2). In order for the federal government to save money with Medicare, the program requirements in regards to additional insurances should be changed. Under the current policy, if a person becomes eligible for Medicare but already has a health insurance policy in place, Medicare automatically becomes Primary payor and the original policy rolls into the secondary payor category. This change in assignments (Coordination of Benefits COB) costs Medicare more money as First payor instead of as second payor, where Medicare would only pick up the less inexpensive difference.

    This guideline by Medicare also reduces the quality and type of healthcare that patient can receive because Medicare is now considered primary even though the private insurance policy contained more benefits. The patient loses the extra benefits from the private insurance company but still has the same monthly premium as before Medicare kicked in.

    June 15, 2009 at 11:33 am |
  4. Didi Wallace

    Wouldn't your report on regional differences in health care costs suggest there are "donor" states paying for health care costs? And if so, shouldn't the states voting for lower taxes, and against entitlement programs, know longer be recipients of donor money?

    Didi Wallace
    Portsmouth, NH

    June 15, 2009 at 11:37 am |
  5. Mrs. Eileen Curras widow to Hernandez (WWII)

    Your discussion with your fellow reporter on the analysis from Miami, FL is an example of the chaos that has being going on in America. Why Miami, FL feels in any way to abuse the system? The patients who are less fortunate economically are not benefiting in any way from these practices. Why this situation has not being brought to the attention? Who are the perpetrators?

    June 15, 2009 at 11:38 am |
  6. L. Reed

    You were approaching one of the biggest problems in health care costs, but there is another question you should ask
    Why are there more hospitals, specialists, etc in certain areas or cities? Who owns the speciality hospitals, imaging centers, rehab services, etc? Many doctors own or are invested in these medical services and see their practice as a way to increase their wealth, by refering patients for more and more tests, surgery, therapy,etc.
    I hope you will discuss The June 1 article "The Cost Conundrum" by Atul Gawande, in the New Yorker.
    FOR PROFIT Medical Care which in theory, several years ago, seemed to be a good idea is not working. Hospitals and other medical corporations have to make a profit for their shareholders, this comes at a cost to our ability to provide medical care to all.

    June 15, 2009 at 11:40 am |
  7. Mrs. Eileen Curras widow to Hernandez (WWII)

    How can it be any competition with this out of control practice? Not only are patients suffering of health control but there is no regulations being done for patients because it seems that this is completely optional. How can patients with chronic conditions benefit from this situation?

    June 15, 2009 at 11:40 am |
  8. Joe Crawford

    McCain could not be more wrong on this. A tax credit? He can't be serious. Before you can claim a 5000.00 tax credit, you need to be able to afford to pay out the 12,000.00 – 14,000.00 premiums to begin with. It's very easy for someone like McCain to hold this position when the taxpayers provide for his (and his family's) world class health care, plus the fact that his wife is a mega-millionaire. Sorry, John, you're off the mark. Again.

    June 15, 2009 at 11:46 am |
  9. Mrs. Eileen Curras widow to Hernandez (WWII)

    The American Medical Association seems to have a double standard. It has being a witness to a major situation of discrimination to American Minorities and they have not made a significant observation. I am shame to say that even Doctors from the Minorities Areas. It seems that the only who has stay focus in the topic is Del. Dr. Donna Christensen from the Virgin Islands. There are very few who have been outspoken.

    June 15, 2009 at 11:46 am |
  10. J Craig Fong

    Some say "Goverment can't run anything, let alone healthcare." These same people also say "Government healthcare option would drive pvt insurers out of business." If govt-provided care would be so bad, who would choose it? Why not have a government option, and let the market decide?

    June 15, 2009 at 11:47 am |

    I keep hearing the question on CNN: Can Private Insurance compete with a public option? Why are we so concerned with insurance companies. What about the people. How about we ask the question: Can people compete with Private Insurance Companies? 60% of all bankruptcies are from health care costs. Yet we see hours of television devoted to how a public option would effect private companies. How about more coveraage on how a private only option is bankrupting the PEOPLE of America. We need less sympathy for insurance companies and more sympathy for the vast majority of the population that wants a single payer system.

    June 15, 2009 at 11:48 am |
  12. CAROL

    Let's discuss insurance...malpractice ins. We have been told a huge lie re: malpractice insurance. A physician friend of mine pays $27,000 for malpractice ins. I would love to have his ins. bill. I own a nationwide transportation company. On six 18 wheelers I pay $36,000 a year in ins. My company net income (which is my income) is only $35,000 a year. You and I both know that my friend makes a hell of a lot more than $35,000 a year. We need PERSPECTIVE. Do a piece on ins. cost for small businesses (the doctor's office is essentially a small business). You and the nation will be shocked that the docs are getting off easy, yet they use their insignificant malpractice ins. cost as a reason for gouging us, their patients.

    June 15, 2009 at 11:51 am |
  13. Cindy G

    The study that Dartmuth did was interesting but did they do a study on the "executive pay" of these hospitals as well? I live in a small town in South Carolina and the CEO of the local hospital makes in excess of $700K. Will healthcare reform address this?

    June 15, 2009 at 11:53 am |
  14. Aria

    Iran has been an state of corruption for the past 30 years, the obvious fraud election was just a spark to people's anger over the years at a dictatorship regime, everyone is missing the real point here, this fraud election is just a tiny example of what has been going on in Iran since the revolution, and people are just fed up with it and they are using this election as an opportunity to let their voice be heard

    June 15, 2009 at 11:53 am |
  15. Mrs. Eileen Curras widow to Hernandez (WWII)

    In the present Health Care System there is not room for competition. There is only room for behaviors like the one from Miami, FL. Is this the new competition? Is this what the administration from Barack Obama patronizes? Not only are patients suffering of health control but there is no regulations being done for patients with chronic conditions because it seems that this is completely optional. How can patients with chronic conditions benefit from this situation?

    June 15, 2009 at 11:57 am |
  16. John Appleton

    Why are my comments not being posted?

    June 15, 2009 at 12:00 pm |
  17. Eleanor

    illegal immigrants comprise 15-22% of the estimated 47 million U.S. residents without health insurance. Most illegals are not insured and use american hospitals without paying the bill. This is passed on to the american taxpayer In the form or increase Healthcare cost

    You cannot have a legitimate story without taking illegal immigrants and the HUGEMEDICAL COST they create into consideration. I noticed both Places Ms cohen reffered to( Both Miami and Mcallen Texas) have large illegal Hispanic populations.

    I lived in Houston Texas an illegal immigration sanctuary city and witnessed at least 8 Hospital close their doors due to the large illegal population draining the hospitals finances by continually utilizing emergency rooms for private healthcare. Most never repay these bills. Also who pays for the Hospital Delivery of all these illegal immigrant babies. This is what CNN needs to do a story on!!!! Stop being so politically correct!!!

    E. Wiltshire

    June 15, 2009 at 12:00 pm |
  18. Mrs. Eileen Curras widow to Hernandez (WWII)

    Many Senators seem to be living in a bubble. I agree with Joe Crowford he cannot be serious before you claim $5,000.00 tax credit, you need to be able to afford to pay out $12,000.00 to $14,000.00, to begin with. It is easy for legislators and politicians like McCain to hold this position when taxpayers provide for his and his wife world class health care. I agree McCain is off the mark.

    June 15, 2009 at 12:02 pm |
  19. Eric Normand

    The debate about health care reform seems to be centered around insurance related issues and who will pay for that insurance. While I agree that the current system is broken and ineffective, it seems to me that we are all missing a bigger point. What is health care really? It should be thought of as the overall care for ones health. Instead, we have come to think of health care as what we do after we are sick, often treating avoidable illnesses with a wide range of synthetic, overpriced medicines that often have adverse side effects. We are an unhealthy nation. Obesity is now overtaking smoking as the number one cause of preventable illness. Currently, two thirds of the adult population is obese or overweight as are one third of our children. The CDCP estimates that one third of all American children born in the year 2000 will develop diabetes as a result of poor diet and lack of exercise. How have we let this happen? We have evolved into a sedentary lifestyle, we are poisoning ourselves with too much of the wrong kinds of foods, and then we treat those problems with drugs that are often even more toxic.

    While there will always be some people that get sick or injured because of circumstances beyond their control, there is a much larger percentage of our population that becomes unhealthy because of their own actions. We need a health care system that cares more about preventing illness rather than medicating it. We need better education about nutrition and a greater emphasis on physical activity as a society including a reform of P.E. in schools. We need to better understand the foods we eat and make better choices.

    Yes, we as the richest nation on earth should have universal health care that is fair and affordable for all, but there is an even more dire need for public awareness about how to live a healthy lifestyle in the first place. If we as individuals don’t learn to better care for our own health, our health as a nation will continue to deteriorate regardless of who pays for health care insurance or whether or not it's free for the masses.

    June 15, 2009 at 12:05 pm |
  20. Mrs. Eileen Curras widow to Hernandez (WWII)

    Clearly the American Medical Association seems to have a double standard. Don’t they have enough with writing off these expenses? In order to claim such loss they have to keep an accounting system. They have being a witness to a major situation of discrimination to American Minorities and they have not made a significant observation. I am shame to say that even Doctors from the Minorities Areas have not enunciations. Everything goes on with the AMA but the truth is that doctors cannot do without patients.

    June 15, 2009 at 12:06 pm |
  21. Dan H

    Thank you Elizabeth Cohen for pointing out that the AMA does not represent even a majority of doctors. Please mention the Annals of Internal Medicine poll last year that found that 59% of physicians support a National Health Insurance system.

    June 15, 2009 at 12:08 pm |
  22. Bernadette Loesch

    Dear Tony, What I hear from the AMA is that they are fearful of competition with the proposed plan from Pres. Obama. Well I say that competition is a good thing. People may not be aware of the fact that our medical coverage and care is very, very expensive compared to other countries. This is totally not necessary. We don't have to pay doctors for their lifestyles nor their outstanding medical school loans!

    June 15, 2009 at 12:10 pm |
  23. John Appleton

    Anyone else notice how this health care debate seems right out of the book 1984. We hear that in order to protect our right of choice in health care, we must not have a public option. So in other words "in order to protect our right to have choices we must not have choices."

    June 15, 2009 at 12:11 pm |
  24. Sara Presho

    I am an iranian student in the USA following the ellection. What Ahmdinejad did was a coup'deta. Mousavi has won the ellection. You can see it from al lthe protests in the streets. This is what bbc has written in its title : "Iran poll loser leads huge rally"
    this is the the most disturbing coevrage I have ever seen in a media.
    Please My friends and I ask you to let people know what is really going on in Iran as you are doing it right now. I have been watching cnn in the past 3 days and I appreciate your honesty. Please say about what BBC has done in its news coevrage.
    He has called Mousavi the looser of the elelction while he has won.

    June 15, 2009 at 12:21 pm |
  25. Patrick

    The real problem in America is the health of the average citizen. Yes, America spends more money per year than any other country in the world, but it's because we are the most obese country in the world. Reducing health care costs is directly linked to just being healthy. Excessive body weight is associated with various diseases, like the President said, particularly cardiovascular diseases, type II diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. As a result, obesity has been found to reduce life expectancy. The government needs to utilize the FDA to ensure that the foods we are eating are healthy. They need to better regulate the fast food and restaurant industries. Improving the average American's nutrition will improve America's health through prevention, thus reducing unnecessary trips to the doctor.

    From Fort Worth, Tx

    June 15, 2009 at 12:42 pm |
  26. Eleanor

    Has CNN heard of the concept of "Freedom of Speech". i noticed you still have my comments under awaiting moderation.

    One reason we will never get a handle of rising Healthcare cost is becuase this country has become so Politically correct that you can't even mention Illegal Immigration without being called a racist.

    Your own reporters have touched on the Negative impact of Illegal immigrations hidden cost to American Citizens. Not only Medical cost but the cost of ecucation. Local Government expeditures and many social services such as food stamps. welfare, housing.

    You have only to look at California ( Bankrupt) to see where the nation is heading if all reporters keep putting their head in the sand and refusing to acknwlege that illegal immigration is draining our economy in many ways.

    June 15, 2009 at 12:54 pm |
  27. RusRus

    moderator affraid of the truth? That crow wont caw...put my comments on or I block cnn from my tv.

    June 15, 2009 at 12:59 pm |
  28. Karen Zaytsoff

    Once again after listening to Mr Obama address the AMA,I am full of admiration for your president. You are so LUCKY!!! to have such a brilliant communicator and visiionary in charge at what seems like a crossroads for the U.S. So many things are coming to a head.... Mr. Obama is the man for the times, he gives the whole world hope. Just wanted you to know how fortunate I think you really are.

    June 15, 2009 at 1:22 pm |
  29. theresa

    In addition to my previous comment on Japan health insurance.

    When Japanese citizens reach retirement age prices are reduced and medical treatment and pharmasutical needs are never an issue!

    Perks in addition to wages when working mayby a private health insurance where the company would cover all or most costs.

    With Japanese health care, it is not free but affordable. In my case my premiums were about $350 per year and I spent on average $5 per co-pay including medicine.

    I have been in shock since I moved back to the United States and have heard so many horror stories. We have great police, firemen and public service that takes care of us. I believe all Americans deserve the same with healthcare.

    June 15, 2009 at 4:34 pm |
  30. Jo-Jo Clayton

    Obama has spoken numerous times and also spoke today about healthcare reform. Whoa to him...he acts as if this is a new topic for a new president. For 100 years practically this topic has been a prime conversational piece with no remarkable results. The American vet has had socialized medical care through the government for decades & I have utilized one form or another of the military medical plans steadily since 1974 (that's 35 years folks). Although not perfect, the military medical system has been overwhelming wonderful ... why not institute such a nationwide medical system. Plus, our 65+ year old folks use socialized medicine. Why not combine these two programs and utilize the best scenarios of each program to be utilized throughout the U.S. and our territories?! Our present medical care system is kaput. Few of us can afford to live day-to-day without medical insurance and yet can't afford it. Neither can we up and die either for that system of burial is kaput also.

    June 15, 2009 at 5:19 pm |
  31. Melinda Roberts

    ok – I'm getting a little fed up with the Democrats in Congress as they are "counting the votes" rather than pushing for what is right for all Americans – Universal basic preventive health care.
    I'm getting fed up with the right wing scare tactics saying "socialist" medicine like Canada would be bad. I know several Canadians of various income levels and they are quite saified with their health care system. And they can choose their own doctor. Richer people can opt for richer health care, but everyone gets basic and preventive health care.
    Third and most importantly I'm getting fed up with so called "newspeople" who will not ask any tough qestions. You are all acting like "balanced" news is giving equal time for both points of view to air their talking points without any challenges from you. The fourth estate is supposed to ask the questions that the people would ask if they had the opportunity.
    Corporations and their lobbies own the American political process hook, line and sinker. The only way out of the mess is public financing of elections – that would get all the special interest money out of politics. With politicians freed from the endless cycle of groveling for corporate donations for their next campaign and selling their soul to those corporations, they would be more likely to vote their real conscience and really represent the people of their state/district.

    June 16, 2009 at 12:22 am |
  32. Melinda Roberts

    Why is the question on CNN always portrayed that a public option would drive the Insurance companies out of business ? My answer to this false choice question is "so what". Like public education, police and fire protection (which by the way are all "socialist" functionalities), there should be no profit in health care. I'm all in favor for doctors making a great living, but for a third party middleman with profit motive making health care decisions for people .......
    There are 1300 hundred health insurers in the US, all making obscene profits, with who knows how many employees telling patients they are not covered for something or making them submit everything in triplicate. A single payer system would be more efficient and save enough money to provide basic preventive health care to the 46 million uninsured.
    My partner worked for a small two owner health care group that owned seven clinics. They made 15 million profit.
    United Health Care made five Billion in profit. That is obscene when so many people have no health care and when desperate have to use ER rooms as their default health provider. Unfortunately, the health insurance companies and the drug companies have enough money to buy Congressional votes and sway public opnion. It is sad that all those profits have come at such an ongoing cost to the people of ths country.

    June 16, 2009 at 12:45 am |
  33. Annette

    Hey! I know how to reduce health care costs. I just won't be Type I diabetic. I'll just refuse to have the side effects which killed my kidney, and have caused nerve damage in my feet and stomach and circulatory damage in my eyes. Mostly, I just won't be poor, or black, or especially American Indian, because evidently having one of those attributes means you don't deserve - or receive - decent medical care. BTW, govenrment provided medical care provided me with the transplants that saved my life. The only interference in care that I have run into is from the private insurance company that keeps trying to deny coverage of necessary medications.
    I am all for the government, with significantly less overhead costs, running medical coverage programs. I am all for cutting costs of care. One major way to do that is to make it possible for people to go to primary care physicians BEFORE they are forced to go to the ER, where the costs are triple for the same services. I do think it is absurd for Medicaid to require doctors to work for free - that is how they reduce costs, by not paying the doctor for time and effort and knowledge. Doctors have grocery bills and rent and car payments, too. Insurance companies making billions in profits is something I do have a big problem with. Pharmaceuticul companies being able to charge exhorbitant prices in the USA tht they do not charge in cost controlled countries such as Canada (and they still market their drugs there) is also something that does not seem right.
    A little "socialism" would be just fine with me. Market capitalism has not worked to influence anything the insurance companies do.

    June 16, 2009 at 11:55 am |
  34. Cheryl

    I have to question why there is such a huge difference in prices paid for procedures. I just looked up the cost for an MRI on and was shocked to see how much the price for the procedures varies. I can't believe that it cost any more to do the procedure on an uninsured person than it does on an insured person so why is this allowed to happen. I see this as a form of discrimination that keeps unisured people from being able to access the medical treatment they require.
    I have also seen many people expressing there view that people cause their own illness by the choices they make and in some instances that is true but there are also many people like myself who chose to get treatment for an illness and recieved a debilitating injury as a result of the treatment. I did not chose to be injured and now have to prove that I have an injury that cannot be diagnosed through any diagnostic testing no matter how much it cost. What are my choices now? Should I lose my home to pay for diagnostics that will not identify my injury or should I lose my home to prove it. That doesn't seem like much of a choice to me. My choice would be for the doctors to say yes I caused the injury so that I can get the treatment I need as a result of the injury without having to lose my home in the process.

    June 16, 2009 at 12:08 pm |
  35. Pam Burrows

    Public Health Insurancew vs. Private HMOs?
    The solution is simple.
    Do what Germany does. They have both. Benefits are identical.
    I know. I worked over there & had to select health insurance coverage. My employer paid the same price regardless of whether I chose private or public (If I switched employers, my health insurance followed ME.). I on the other hand, had a good paying job & private coverage was cheaper than public coverage.
    In other words, the cost & choice of coverage was based on income & employment. If I had no job & little money, public insurance would be cheaper for me than private; it could be as little as a token payment of $1. If I had a job, there would always be a private insurer that was cheaper than public converage. Thus public insurance could never cause private insurance companies to disappear
    As for choice, doctors that wanted to make more money, could opt out of being part of the insurance system. They could even chose to do somethings under insurance & other things that weren't covered (plastic surgeons would be a good example). While everyone living in Germany were required to have health insurance coverage, but they could chose to see a doctor that wasn't covered & pay out of pocket.
    I noticed no difference in the care I received in Germany or the USA. In fact, I could probably get to see a doctor sooner in Germany.
    I liked it very much. Especially how easy it was to use; all the paperwork was standardized & computerized. The insurer gave me a book of payment tickets & I only had to present a ticket to get treated; I NEVER filled out a form after the one that insured me. God, would I love not filling out forms again!

    June 16, 2009 at 12:26 pm |
  36. Stephen R. Troy

    We keep hearing that if people have good employer-provied coverage, they can keep it. There is debate pro and con over whether a "public option" would drive other insurers out of business. Nobody - not the President, not the politicians, not the experts, not the newspeople - is talking about the real problem. Businesses, especially small businesses, are struggling with the cost of providing employee health care. One tactic some employers are already using, if an employee has coverage under some other plan (such as military retirees), is to pay the employee to get care under the other plan. If a "public option" is made available to everybody, there is no reason for employers to continue offering health care coverage at all - so, even if you like your existing employer-provided coverage, it will probably go away.

    June 16, 2009 at 1:02 pm |
  37. Sandy

    Here's a better idea on funding healthcare...rather than taxing companies who pay for healthcare, let's take a hardline look at the premiums Americans pay to Healthcare Insurance Companies (HMO's). Rates go up, up. up with no truly justified costs. It does not go to Malpractice, it bypasses everything and into the deep pockets of Insurance Companies who dictate ALL our healthcare and what Doctors can do and what they will pay for and how much it will be. All resulting in higher costs for healthcare across the board. Hold Insurance companies who carry these policies accountable for their excelerated premiums and investigate "how" they get around it focussed on greed and not care.

    Exemptions on doctors who are primary care. Please don't listen to the "care" rhetoric of these insurance companies without verifying and reverifying and reverifying. Too many loopholes to even address.

    June 16, 2009 at 4:36 pm |
  38. Don, an American citizen living in Canada

    Tony Harris, why don't you make it clear on your show that the "public option" would not be government funded, but would operate entirely on premiums from those who chose to enroll.
    This is vitally important because most people think of the public option as government funded. This myth was perpetuated on your show by saying that "think of it as medicare". That scares people because of the financial difficulties Medicare is having and the amount it costs taxpayers. You and all other CNN news anchors have been negligent in not better informing listeners that the public option would not operate on taxpayer funding.

    October 23, 2009 at 12:08 pm |