My So-Called Life

Friday, July 06, 2007

Sicko, the movie

I haven't seen the movie yet, but this seems to be the most fair and unadulterated review to come across my desk thus far. I'm torn about this one, because I'm a fan of Michael Moore, but I also work in health care. I agree that the health care system in the U.S. is broken, but I don't think a single-payer system (universal health care) is the answer. I mean, I think the government has screwed up almost every job we've given them, so why would letting them run our health system be a good idea?

Editorial Observer
Some Thoughts on Sickness After Seeing ‘Sicko’
By PHILIP M. BOFFEY
Published: July 5, 2007, New York Times

As the author of many health care editorials, I was eager to see Michael Moore’s “Sicko,” a polemical attack on undeniable flaws in the way this country provides health care. The film is unashamedly one-sided, superficial, overstated and occasionally suspect in its details. But on the big picture — the failure to ensure that everyone who needs medical care gets it — Mr. Moore is right.

This is not just a matter of uninsured Americans, who now number some 45 million, forgoing needed treatment because it costs too much. There is some of that in the film, notably a vignette in which an uninsured man who accidentally lopped off the ends of two fingers on a power saw was told at the hospital that it would cost $12,000 to reattach one and $60,000 to reattach the other. He chose only the $12,000 option. A Canadian man had five fingers reattached without paying a dime.

For the most part, however, the film focuses on what happens to the 250 million Americans who do have health insurance. It delivers powerful anecdotes about middle-class Americans who are denied or can’t afford care even with their insurance and teary-eyed confessions from former insurance industry workers guilt-ridden over their role in consigning policyholders to severe illness or death.

A mother relates how she whisked her feverish toddler to the nearest hospital by ambulance only to find that her insurer would not cover treatment there. She was redirected to an in-network hospital where her child died shortly after arrival.

Although there are swipes at the pharmaceutical industry and at craven, industry-financed politicians, the main target is the health insurance industry, particularly the for-profit insurers and the managed care companies. A former insurance company “hit man” talks about combing through a patient’s past medical records and life history, looking for excuses to deny coverage. A young women says she was denied coverage because of a trivial yeast infection years earlier that she had not thought to mention when applying for coverage.

Yet it is hard to know how true the stories are — Mr. Moore never gives enough details to help viewers determine — or how common the abuses may be. The stories are told from the viewpoint of the victims, with nary a peep from the insurers and not much from doctors who might know whether the refused care was appropriate.

After all these depressing tales, the second half of the film ushers us into a nirvana of humane and caring treatment supposedly provided to the citizens of Canada, France, Britain and even Cuba, a needlessly provocative choice that detracts from the main message.

While Mr. Moore could find almost nothing good to say about American health care, he can find almost nothing bad to say about the government-run national health systems abroad. There is no acknowledgement of the months-long waits to see specialists in Canada and Britain, of the sick people who fall through the cracks in every system or of rising costs in virtually all countries.

The French system comes off as best, where the government dispatches home aides to help new mothers do the laundry and American expatriates extol the quality and promptness of care. We are left with the impression that these foreign systems are geared up to provide care, while our insurance companies are motivated to deny it.

As for Cuba, can it really be true that three volunteers who worked on the smoldering World Trade Center pile after 9/11 were unable to afford care in this country and had to visit Cuba to get it? The hospital they went to reportedly caters to dignitaries and foreign tourists and is hardly representative of health care for the Cuban masses.

Mr. Moore makes much of the fact that the World Health Organization ranked the United States 37th in an evaluation of health systems, only one notch above Slovenia. He failed to mention that it was two notches above Cuba.

Mr. Moore’s heart clearly lies with the single-payer, tax-supported, governmental health systems abroad. That solution would be hard to sell here, where suspicion of the insurance companies is matched if not exceeded by suspicion of the government. Yet the case for some form of universal coverage is strong. The claim that we provide the best medical care in the world is hollow; international comparisons rank us below other industrialized countries on measures of quality, access and clinical outcomes. Mr. Moore is right to ask how a country that spends so much more on health care than any other nation can’t take care of everyone who is sick.

4 Comments:

Blogger Matthew said...

Do most other industrialized nations have single-payer systems?

11:30 AM  
Blogger A. Lo said...

It seems to me that they do. At least, most of the countries I'm currently thinking of do. I know that Russia, for instance, has a type of single-payer system, but it's reportedly very corrupt; they're supposedly overhauling it now. I think they might have an even bigger problem than we do.

I think the problem with “universal health care” is that it sounds so great, sort of like No Child Left Behind. It’s named so well that we automatically assume that everyone who needs care will receive it in a fair and timely fashion.

However, we discover later that it is just another well-named system that in many ways rewards the rich and penalizes the poor. Universal health care is really not free, especially if you are hoping to receive what the government considers an “optional” treatment (like a hip replacement) that may greatly improve your quality of life but is not considered “trauma” or “emergent” care. If you have a slipped disk and can’t move, much less work, then you get in line for treatment and could be waiting for years before the problem is fixed.

I also think that Americans are too attached to the idea of choice--that is, choosing when, where, how and how much health care they receive--to be happy in a single-payer system. And, as I’ve said before, I don’t think they really trust the government to run the health care system (unless they’re die-hard Republicans, perhaps). If the government can’t fix our school systems, Social Security, welfare, the war in Iraq, or even Medicare, what makes people think they can fix the health care system? No, thanks.

You and I have talked a bit about Obama’s health care plan, and while I don’t agree with every point he makes, I think the idea of getting everyone insurance coverage makes sense. Rome wasn’t built in a day, and the health care system won’t be fixed instantly either.

12:09 PM  
Blogger Mr. Parker said...

"Do most other industrialized nations have single-payer systems?"

Yes, but most are in the midst of implementing reforms, i.e. adding more free-market based ideas into the system. What's Obama's gig? Like car insurance?

9:00 PM  
Blogger A. Lo said...

Well, Obama doesn't give all the dirty details, but he gives a lot of them. You can read about it here:

http://www.barackobama.com/issues/healthcare/

(click "Plan Details")

2:05 PM  

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