Memo To Michael: SiCKO and the Film I Wish You Had Made

MEMORANDUM

TO:            Michael Moore

SUBJ:       SiCKO - And the Film I Wish You Had Made

Michael, I'm a big fan of your films.  And, once again, we have a common interest: we both want to see all Americans get real coverage that gives them the care they need without breaking them financially or emotionally. Thank you for SiCKO --- it performs a valuable service by demonstrating the need for dramatic change in our health care system.

I think it was smart of you to focus on problems with private-sector health insurance rather than just concentrating on the problem of the uninsured. That approach highlights the way greed not only creates suffering but can actually kill people.   I thought you made the case for public insurance very effectively, especially in Canada.

But here’s the thing:  I worked in health care financing and management for many years, and I've seen the abuses - and the innovations - from the inside.  I've worked in twenty other countries, too, so I've seen how our system differs from theirs.  So I have to set notions of fandom aside and look at your film with a different eye.  And I've got to be honest: The segments on Great Britain and France went on a little long for me.  That time, which reinforced what many of us already believe, could have been used to bring up some of the common objections to national health insurance --- wait times, access to care, and the like ---- and then respond to them effectively.

There are problems with those systems.  That's why more than 12% of Britons have some form of private health insurance and France has the third highest level of private health insurance among developed countries, behind only the United States and the Netherlands (according to the an OECD - pdf file).  There most be some reason people are paying for private coverage.

Private health insurance is allowed in those countries because it takes some pressure off the public system, and because there is a demand for it. Think of the difference between the NHS and private-insurer BUPA in Great Britain as the difference between public transportation and private cars.

Michael, my mother lived in the UK for years.  She’s a committed leftist – to the left of me – who's had terrible problems with the NHS.  She almost died while waiting for “non-emergency” surgery. When I started writing about health reform she started collecting testimonials – NHS horror stories.  Somebody could use them to make a film like yours, but with the opposite message.  (That would be a misleading film, because the NHS has done great things for Britain- but it could be made, using some well-chosen anecdotes.) 

There are other reasons people are buying private insurance in these countries, too:  High copayments in France.  Problems getting dental care.  Difficulties getting referrals to specialists.  These systems do a great thing by providing universal coverage, but they're like any other in one respect:  When they work, it’s great.  When they don't, it sucks. 

A universal national health system in this country would have a lot more problems than these countries have seen, because we've built a huge medical economy around our system - one that allows not only insurers but doctors, equipment manufacturers, diagnostic facility owners, and many others to become wealthy.  A change to single-payer that wasn't well thought out would run into trouble from the beginning.   Many popular doctors would instantly drop out of the system and demand cash payments only (it’s happening anyway, even for people with insurance). Some hospitals would close, creating more access problems.   We either need to address these problems in advance or accept that there is probably a role for private insurance, as odious as that may seem.

There are longer wait times in these countries.  Is that an argument against a national system?  No.  First, as Ezra Klein points out, they're not nearly as bad as some have argued. Secondly, you can do what policymakers in Britain and France have done.  You can acknowledge that private insurance reduces pressure on the public system, especially for elective procedures.   

I know from Business Insurance that you told a "cheering crowd" that included some doctors "there is no room for profit when it comes to people's lives."   The two European countries you visited think there is.  And here's another reason those doctors may have been cheering:  A minority of physicians in this country are driving massive overtreatment.  Studies by Dr. John Wennberg and others have shown that the presence of specialists drives treatment more than medical need does. Studies have shown that many, if not most, back surgeries are unnecessary.  Some specialist physicians are getting wealthy by providing services that aren't necessary, inflict pain, and help bankrupt the system.

Yet here's what you told U. S. News and World Report: "Healthcare should be between the doctor and the patient.  And if the doctor says something needs to be done, the government should guarantee it gets paid for." With the profit motive putting so many patients through expensive and unnecessary procedures, that's a prescription for disaster.

I was glad you mentioned the key role the American Medical Association has played in preventing our country from providing health care to all its citizens.  You even mentioned Ronald Reagan and Operation Coffeecup.  The AMA is still blocking health reform and supporting half-measures that will actually make things worse, not better for most Americans.

I'm sorry you've been so quick to dismiss proposals from John Edwards, Barack Obama, and others.  Those plans aren't perfect, as I've been quick to point out, but they would be a very real improvement from what we have now.  (And they're less dependent on private insurers than Hillary Clinton's plan from the 1990's, which you seem to support.)

We have a trillion-dollar health care economy.  That's more than the entire GDP of Great Britain or France.  We may have no choice but to use an approach that's evolutionary, rather than revolutionary.  I wish I could be the fire-eyed radical in this debate, but I can't do that in good conscience – not when I see so many problems ahead. 

We could discuss other forces, too - the fast-food and pharmaceutical industries that create new demand for high-cost medical services, or our national disinterest in preventive care.  Then there's the environment.  While everyone focuses on a cure for cancer, we forget that we could prevent many cancers by reducing environmental factors that create them.  Teresa Heinz Kerry's funding some great work in this area.

You told Larry King that "18,000 people a year die in this country for no other reason other than the fact that they don't have a health insurance card. That's six 9/11s every single year in America."   I made exactly the same point last January, so clearly we see the problem the same way.  Today is opening day for SiCKO.  And today more than 50 Americans will die because they don't have access to health care. 

That's a tragedy nobody should forget.

(I have another piece on SiCKO up at the Huffington Post)

Comments

[BadTux]

The problem with retaining the current U.S. insurance industry is that it has proven itself to be utterly corrupt and unredeemable, in my opinion. My mother has worked in the health care industry for close to 40 years now, and has seen the results of the health insurance industry moving from the mutual model to the profit model first-hand. In my opinion, health insurance corporations which are publicly traded should be *OUTLAWED* as a menace to society, no different from cluster bombs and handguns in their ability to kill innocents. Because the moment you become a publicly traded corporation, your first allegiance is not to health care. Your first allegiance is now to your stock holders, who don't care about health care, they just want profit, moh profit, moh profit, and if you don't deny coverage of sick people in order to increase profit, you get fired and people more vicious get hired to replace you.

So retaining private insurance in the primary care business is, in my opinion, unworkable. Our insurance industry has become too corrupt, too wealthy, too willing to bribe Congressmen to do its bidding, for us to put together *any* health insurance scheme that includes them that will actually work at, like, actually providing universal health care. Via their venal behavior over the past two decades they have foregone any seat at the health care table, as far as I'm concerned. Let's just extend Medicare to *everybody*, allow health care insurers to remain as "Medi-gap" providers if they so desire, and otherwise get their venal butts out of our health care.

Medicare. If it's good enough for the prunes, it's good enough for the rest of us. Or do you say we're giving second-rate care to our old people?

- Badtux the Medical Penguin

[Ian Welsh]

What's the saying "can't convince a man of something that he's paid not to understand"?

Private healthcare is about jumping the queue.

And the NHS is a piece of crap.

But still, despite the NHS being crap, Brits have better health outcomes than Americans.

Even crap is better than the US system, in other words.

Unless you're rich, of course.

And the US sure does have a lot of rich people.

And if you aren't rich, well, who cares about what you need anyway?

[Jeffrey Dach MD]

What is the real solution, if Michael Moore’s government sponsored universal health care is not the answer?

The crux of the "SICKO" documentary is the disconnect between our expectations and the reality of health care. We are expecting compassionate care from another human being, and instead we get a faceless corporation. The person behind the desk or window is an agent of a health care corporation, which is not a human being, whose primary goal is to increase corporate profit.

This is America, and corporate profit is good, the profit motive forming the basis America’s greatness. The basic problem is that a corporation is not a human being. Therein lies the fallacy of replacing a corporation with a government agency, neither of which is a human being, when what we really want is a human being to deliver compassionate health care, and assist in serious health care decisions.

Ultimately we must at some point ration health care to avoid national bancruptcy. We can't provide everything for everybody. Moore's film, SICKO replaces the corporate health company with the government agency as the agent of this care rationing.

My major point here, is that the larger issue which is ignored by the SICKO film, is the control of medical information, which then determines expenditure and rationing patterns. The control of medical information controls the money. This is explained fully at:

Review of "SICKO", by Jeffrey Dach MD

Jeffrey Dach MD

[Stoneboiler]

You have to start somewhere. The big problem will be the whiners and the Natering Nabobs of Spiro.
Private insurance will go down the tube so fast and furious in this country that you will be able to do gonadectomies for three days with the tube.
Because of outsourcing and stagnant wages single payer will be a big hit.