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POLICY: Sicko and Healthcare Reform by Maggie Mahar with UPDATE

Sicko_film
Michael Moore’s “Sicko” does two things very well.

First, the film makes it clear that in the U.S., even if you have health insurance, this does not mean that you are “covered.”  Everyone knows that many Americans are uninsured. But now, millions of middle-class Americans are beginning to realize that they are UNDERinsured, and Moore drives that point home.

For-profit-insurers spend a great deal of time designing policies that will limit their “losses”—i.e. limit the amount that they have to pay out.  These “Swiss cheese” policies are filled with holes: for example, a policy may pay for surgery, but not rehabilitation after surgery. And this omission is deliberate. As a former claims adjuster tells Moore, when an insurer denies payment, “You’re not slipping through the cracks. They made the crack and are sweeping you toward it.”

Secondly, “Sicko” underlines the signal difference between healthcare in the U.S. and healthcare in other countries: the citizens of other countries take a collective view of the problem.  Or as Moore puts it, they realize that when it comes to sickness and dying, all of us are vulnerable. “In the end, we truly are all in the same boat . . . they live in a world of ‘we’ not ‘me.’”

Of course people in the U.K. Canada and France know that healthcare is not free. (And contrary to what some of Moore’s critics say, he does not pretend that it is.) But since they think of healthcare as a right—something we all deserve simply because we are human—it seems to them fair that, “You pay according to your means [through taxes] and receive according to your needs.”  In this, national health programs that are funded by taxes resemble Medicare: the higher your salary, the more you pay into Medicare. The sicker you are, the more you will take out in benefits.  If you’re lucky, you put in more than you take out.

What “Sicko” doesn’t do is focus on the waste in our system. As Jonathan Weiner observes below, we can’t afford to pay for everything that someone might possibly want. We need to be sure that we are getting value for our healthcare dollars.  In one case, Moore tells the story of a man dying of kidney cancer. Desperate to save him, his wife valiantly tries to persuade insurers to pay for new treatments –including a bone-marrow transplant that the insurance company calls “experimental.”  But the insurer refuses, and a few weeks later her husband dies. This is one of the saddest moments in the film—both husband and wife are very appealing.

Yet it is not clear that the insurer was wrong to refuse the cover the bone-marrow transplant. It is very difficult to tell from the few details given in the film whether it might have helped—but advanced kidney cancer is not curable. Even the newest drugs give the patient, at most, a few more weeks of life. At the same time, it is understandable that both the husband and the wife (and apparently Moore) assume that the insurer was merely trying to save money.

After all, when it comes to making coverage decisions based on medical evidence, for-profit insurers have a pretty spotty record. In the 1990s, when insurers said they were trying to “manage care,” many were simply “managing costs.” For example, some decided which drugs to  include in their formularies  based simply on whether the manufacturer would give them a deep discount. In return for the discount, the insurance company would assure the drug-maker that it would not cover a competing product.. This had nothing to do with which drug was more effective.

As I suggest below (see my most recent post on MedPac ) the public will always be suspicious of decisions made by for-profit insurers—even when their decisions are based on sound medical evidence. For-profit insurers just don’t have the political or moral standing to make these judgments. (By contrast, most patients are much more comfortable with Medicare’s coverage decisions—which is why we need a federal agency testing and comparing the effectiveness of new treatments. )

But if Moore skips over the problems of overt treatment it may be because he knows that this at this point more Americans are worried about undertreatment. And to be fair, no one could examine all of the problems in our dysfunctional healthcare system in a single film. What is important is that Moore says what he says loudly and clearly. He tells a vivid, memorable story—and in the process, he has managed to spur the national conversation about healthcare reform.

This is what scares people like Peter Chowka. If people begin talking about health care, they may begin to think about it. It may even occur to them that perhaps it wouldn’t be so terrible to borrow a few ideas from other countries. As Moore points out, “If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what’s our problem? “

"It’s conceivable, Moore suggests, that we might even learn something from Cuba, a country that spends 1/27 of what we do on care. Of course the film’s Cuban adventure is controversial—and purposefully so. I’ve written about it here  on TPM café where I recount a very funny story Moore tells about his experience with Standards & Practices at NBC– a tale which shows that he knew exactly what he was doing when he took part of “Sicko’s” cast to  Cuba.)
Looking back on “Sicko” Moore says, “I could have played it safe, I know. I could have gone to Ireland. . . . Everyone loves the Irish ….  But you know you have to get people’s attention.”

And, as usual, Michael Moore  has succeeded in doing just that.

UPDATE: A couple Moore on Sicko. A balanced enough review in the NY Times from Philip Boffey, and an interesting one (sadly firewalled) by Timothy Egan about whether Americans live better than Italians (My take has always been that rich Americans live better than rich Italians) — Matthew

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ClayLucy H.MSDavedrmatt Recent comment authors
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Clay
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Clay

As a veteran, I had to wait 8 months after I came back from OEF to receive sub-standard care for a minor injury, and now I believe universal health care isn’t something we should be paying for- it is a right to be treated fairly, especially medically. Between Medicare and the beauracracy of the Veteran’s Administration Health Care System, we are already paying a lot of the cost that could go to universal health care. If we also had a universal health care system, many of the individuals that don’t have health care would be paying into it anyways. There… Read more »

Lucy H.
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Lucy H.

As a first-year medical student, getting a combined MD/MPH degree, I am learning about and debating these same issues in my public health classes with my co-degree classmates. The decaying state of our nation’s health care system and the national burden of health spending is appalling and disheartening. From reading “To Err is Human” to discussing the different insurance and payer systems, we are learning the key basics to health services in the US, and how they differ from comparable foreign systems. What is even more shocking, however, is that my fellow medical students in my school and in schools… Read more »

MS
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MS

In a single payer universal healthcare system, a possible solution to the physician reimbursement question is to have most physicians salaried or to create a salary cap. Not popular for sure, but clearly effective in eliminating “overtreatment”. Such is the case in various provinces in Canada, for example.

Dave
Guest

Looking for some passionate people with web cams,
to join the debate answer this question, in a video.
The Federal Government should provide free health care for all Americans.
Do you agree? yes or no,
Tell us why, make a video. Use a web-cam or camcorder be funny be creative use animation, clay-mation, wear a mask, make a sock puppet or just stand in front of a blank wall and make your point. Post the link in the comment section on:
http://videodebater.com/?p=17
Health care | VideoDebater.com

drmatt
Guest

Funny, I always felt the same way. I opened a practice in a small town with the ideal that I was a community resource and if I provided the community with health care I would be taken care of. Two and a half years later I had to close (after about six months of paying myself $143/wk) because the reimbursement system is no where close to sports cars and six bedroom houses. To straighten out the numbers a bit, your average medical school student has a school loan debt of $250,000!!! that is about 2K a month in repayment. Because… Read more »

David Clopton
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David Clopton

I’m not sure this was covered, but I do want to comment on the MD salary in the USA, and why it is actually important to keep it high. Every country has a limited amount of natural resources, be it coal, gold, ability to grow crops, etc… Well one of these natural resources that is frequently over looked is the hard working brilliant mind. What we choose to do with these resources is vitally important to our way of life. If we squander our fuel sources we become increasingly dependent on foreign interests. If we let all our crops die… Read more »

Kevin Byrne
Guest

I agree with most of the review provided above. The key point that you and Moore point out is that “we are all in the same boat” (i.e. we’re all human and will get sick and die).
For our society, with all its power and money, to have 46 million uninsured people is absolutely insane.
Healthcare is broken. Can someone please develop a “needs to be radical” plan to fix it???

B. Tish
Guest
B. Tish

Health care fraud is a booming industry. Something needs to be done about it as we, the taxpayers, end up paying for all of it.
Here’s a great article on the newest form of healthcare fraud and scams – monopolistic in house laboratory and medical services – you need to read this as it will affect you:
New health care frauds and what to watch out for from Bestbraindrain.com
B. Tish

NYC EMS
Guest

In NYC it’s easy to get treated for anything you want.
All you have to say is one word………LAWSUIT.
Think I’m kidding?Half of the hospitals in NYC are now bankrupt.

Terri Shewczyk
Guest
Terri Shewczyk

I agree with Gooby. Health care in one thing (perhaps of many things) the for profit system cannot do right.
Doctors, CEOs, and all others at the top of this food chain make way more than they should.
The result, less care for more money. At least for the poor.
The biggest misconception I find at health-care reform meetings is this “We all pay for the unisured’s bills” Not true. I am unisured and believe me, most of us pay more than those with insurance. If you own anything, you will pay that bill in its entirety.

Gooby
Guest
Gooby

Wake up folks. We are supposed to be the greatest nation in the world and yet Europe is leaving us in the dust. We overwork our employees to the point of exhaustion. We give them little or no vacation (compare with Europe), we expect them to be ultra-productive and when we manage to squeeze more productivity out of our workforce + productivity = more work = more profit. In other words, we do not reward the worker, we find more work for them. Insurance is out of hand. Hard working people cannot afford the policies and if you have a… Read more »

ProtestHealthcare
Guest

As many emails my family and I have received across America, I can tell you one thing America needs healthcare reform. There are way too many people who have insurance and find they are not covered or better yet find they have a pre-existing condition…some can’t even afford healthcare. Isn’t it the moral thing to do and make sure all citizens of our great country get the healthcare they so desperately need? My family and I are actively trying to have H.R. 676 endorsed. If you believe every American has the right to healthcare please sign our petition! We are… Read more »

affordable health insurance
Guest

Thanks for the great article and information about health insurance. More and more employers are going with higher deductible plans to make health insurance costs more affordable. Some people still go with low deductible or HMO plans, but PPO is more popular lately.

Rick
Guest

Consumerism and Wellness Programs are the Solution to the National Healthcare “Crisis” “The topic that is currently receiving a large portion of media attention is healthcare” explained Rick Knox, Vice President of Knox Associates “I honestly do not look at our country as having a healthcare crisis; With one out of every eight national healthcare dollars being spent on the treatment and management of diabetes (estimated at $79 billion dollars) coupled with who knows how much is being spent on the treatment and management of heart disease – both conditions having a high percentage prevention rate – I look at… Read more »

JAB
Guest
JAB

I wonder if anyone would find it interesting to read the court decision regarding Michael Moore’s indictment of Kaiser Permanente? Look it up on the web under Dawnelle Barris versus Los Angeles County.
See, King/Drew hospital and the doctor on duty were found guilty of malpractice and “dumping” in the Mychelle Williams case. Mychelle mother, Dawnelle Keys (later Barris) won the case. King/Drew hospital is a government owned and operated facility. Wonder why Moore didn’t mention that?
Wonder why Moore didn’t mention many other facts too? Experimental treatments are no way to prove a case for UHC.