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POLICY: Debating SICKO’s Impact by John Irvine

Since opening a week ago, Michael Moore’s latest documentary has focused unprecedented attention on the U.S. healthcare system. The film has brought angry protests outside movie theaters. Standing ovations from audiences. And provoked angry debate in the nation’s editorial pages. It has also done fairly well at the box office, drawing far more viewers to theaters than many experts had predicted.  According to the Hollywood Reporter, the film finished second in per-theater gross last weekend, bringing in $11.3 million at 700 screens across the country — rather a respectable showing for a movie that specializes in disturbing subjects that Americans would generally rather not talk about. So far, Sicko has generated exactly the kind of controversy that the critics predicted it would.  Moore has  already had to deny that he is planning a trip to Iran next month to view the film at an Islamic film festival. (The story turned out to be a rumor spread by conservative opponents.  The filmmaker says he received an invitation from the Iranians but declined to accept.) This week he was on CNN, lambasting the network for its healthcare coverage and getting into a near shouting match on The Larry King Show with medical correspondent Dr. Sanjay Gupta over some of the stats used in the film.

Moore went on to accuse the network of colluding with the film’s
opponents, pointing out that one of Gupta’s researchers, Paul Keckley,
the former head of Vanderbilt’s Center for Evidence Based Medicine and
a current Deloitte consultant, has done a lot of work for big health
insurers and pharma companies
. (Something that could be said of a fair number of people working in the field, as THCB readers know all too well.) Could Keckley be censoring the network’s coverage?  Moore wondered out loud to himself and not-very-subtly. 

The theatrics aren’t a surprise to anyone who has followed Moore throughout his
career. Not surprisingly, the attack drew a rather hurt denial from Gupta on his
CNN blog
.

Meanwhile, Moore is living up to his reputation for drawing attention to himself. Earlier this week, the filmmaker published a leaked internal memo on his web site allegedly authored by
the Blue Cross communications department.  The document reviewed the film – acknowledging that the documentary is a slickly done piece of work. [Follow the link and scroll down to read the whole thing.] The review begins as follows:

"You would have to be dead to be unaffected by Moore’s movie, he is an effective
storyteller. In Sicko Moore presents a collage of injustices by selecting
stories, no matter how exceptional to the norm, that present the health
insurance industry as a set of organizations and people dedicated to denying
claims in the name of profit. Denial for treatments that are considered
"experimental" is a common story, along with denial for previous conditions, and
denial for application errors or omissions. Individual employees from Humana and
other insurers are interviewed who claim to have actively pursued claim denial
as an institutionalized goal in the name of profit. While Humana and Kaiser
Permanente are demonized, the BlueCross and BlueShield brands appear, separately
and together, visually and verbally, with such frequency that there should be no
doubt that whatever visceral reaction his movie stirs will spill over onto the
Blues brands in every market."

Will the public hold health care providers and insurers accountable for the lapses Moore documents in his film? That remains to be seen. For many Americans who haven’t been paying attention, the documentary is undoubtedly a wake up call. There seems little doubt that people will start to ask more questions when they walk into their doctor’s office or when they sit down to pick an insurer, which is certainly enough to make some people uncomfortable. There is also little doubt that the film has added to the already fiercely burning debate between supporters of a free market based system and a government run universal healthcare system.

PODCAST REVIEW: Here’s THCB contributor Dr. Eric Novack’s take on the film from his radio show last Sunday. Two thumbs up? Er, No. Here’s Part 1 and Part 2. Eric and I will get into this a little later on, we hope!RELATED: "Sicko and Healthcare Reform", Maggie Mahar’s piece on THCB drew thousands of readers  and led to excellent discussion.

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William HillGregory D. PawelskiHealth Insurance SitethoreauJohn Rarey Recent comment authors
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William Hill
Guest

SiCKO is a 2007 documentary film by American filmmaker Michael Moore that investigates the American health care system, focusing on its for-profit health insurance and pharmaceutical industry. The film compares the non-universal and for-profit U.S. system with the universal and non-profit systems of Canada, the United Kingdom, France and Cuba. SiCKO cites the United States as the only industrialized nation that does not provide universal health care to its citizens, highlights cases in which insured individuals were denied care, and condemns for-profit health care for maximizing profit at the expense of patient care. SiCKO opened to positive reviews, but also… Read more »

Peter
Guest
Peter

Health Insurance Site: “People I know, even while following the film, have said that they’ve been bothered by the feeling of “Is Michael Moore trying to pull one over on me?” Now from the Health Insurance Site: “The average 65-year-old couple retiring this year will need about $215,000 to cover medical costs, according to Fidelity Investments. People should not expect Medicare to meet all their needs.” I think as baby-boomers move through the system and affect costs on all fronts, cost control in healthcare will be a major issue. We will not get cost control from the insurance/drug/healthcare industries, not… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

I watched the movie online. Wow. I was less surprised at how inhumane our system is than how terrific the systems in Canada, England, France, and Cuba are. It was wonderful how our citizens got great healthcare in Cuba. I think the awareness of the propaganda machine that vilifies Cuba and France will make a huge impact on the unaware. For me, the contract between the foreign systems to ours is so humiliating. This country really should be very ashamed. This may Moore’s most important movie to date. I hope everyone in the country sees it. And yet it’s true.… Read more »

Health Insurance Site
Guest

I haven’t seen the film yet, so I can’t weigh in on its validity or politics. My problem is that Michael Moore is his own worst enemy. Even the people more passionate about health care reform are being very careful about this film. Moore’s abrasiveness and his carefree use of facts vs. opinion overshadow the issues at hand. People I know, even while following the film, have said that they’ve been bothered by the feeling of “Is Michael Moore trying to pull one over on me?” It’s a shame, but ultimately the exposure is good for future reform.

thoreau
Guest
thoreau

Matt G said, “Just too many other important issues in Washington right now besides health care.”
And that is the point the movie was trying to make over and over and over again. Health care needs to be the priority issue in Washington.
I tend to be a single issue voter and this next election cycle health care will be that issue.

Peter
Guest
Peter

“but having health insurance contracts be understandable, with adequate disclosures that recipients fully understand is not unreasonable.”
That would give the insured too much information. Why don’t the insurance companies start with understandable EOB’s. They use the “E” in explanation very loosely.
Barry, BCBS does pay for out-of-country healthcare and even has an office to handle it. The fight was never about them not having a contractual obligation to pay, it was the extreme run around, repeated lost paperwork, requests for endless and stupid technical follow-ups, failure to process, obfuscation of the facts, etc, etc, etc.

John Rarey
Guest

Barry,
To your question of regarding Medicare paying for services outside the US.
Source:
http://www.medicare.gov/Publications/Pubs/pdf/11037.pdf
“In most situations, Medicare won’t pay for health care or supplies that you get outside the United States(U.S.)”
What does “outside the U.S.” mean ? “Outside the U.S.” means anywhere other than these places: the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
John Rarey
http://www.cleverleyassociates.com

Tom Leith
Guest
Tom Leith

> I continue to presume you are > somewhat ‘tongue in cheek’ here Yes, somewhat. But only somewhat. One essential purpose of government state or federal is to provide for third-party enforcement of contracts by credible threat of violence. Of course. > Making sure that both parties are standing > on somewhat equal ground prior to signing > a contract is not big government either. Nonsense — this precisely is interference by government (read this as by force) in the process of contracting, and by Libertarian standards is the very definition of Big Government. They say it is not up… Read more »

jd
Guest
jd

Eric, whether “making sure that both parties are standing on somewhat equal ground prior to signing a contract” is big government depends entirely on what counts as making sure the parties are on equal ground. You would agree that government does not need to ensure that parties have comparable economic power, right? Because that would be very big government, indeed. Socialism, even. I thought that libertarianism wasn’t concerned with (re)distributive justice, but only with procedural justice. From a libertarian point of view, so long as there is no coercion involved and contracts are enforced consistently, government’s role is fulfilled. Ambiguous… Read more »

Eric Novack
Guest

Tom– I continue to presume you are somewhat ‘tongue in cheek’ here, but having health insurance contracts be understandable, with adequate disclosures that recipients fully understand is not unreasonable. This, of course, should not just apply to healthcare contracts. In the subprime mortgage (and regular as well) world, disclosure and understanding has clearly been a problem, as hundreds of thousands have found out. I refer you to this post (http://volokh.com/archives/archive_2007_07_08-2007_07_14.shtml#1184331779) about mortgage disclosures— I am fairly certain the results would be similar (or worse) for healthcare contracts. Government enforcing contracts is not big government. Making sure that both parties are… Read more »

Barry Carol
Guest
Barry Carol

Peter,
While I’m not certain of this, I don’t think Medicare pays for services incurred outside of the U.S. either. Does anyone know for sure?

Tom Leith
Guest
Tom Leith

I think the American Bourgeoisie could not care less whether every American has access to healthcare. But maybe, just maybe, in order to provide for their own security they can be persuaded to include everyone. Moore got it right — it had to happen eventually.
t

Peter
Guest
Peter

“that present the health insurance industry as a set of organizations and people dedicated to denying claims in the name of profit.” Well if my experience and the experience of other people I have talked is any indication, Blue Cross IS in the business of denying claims, or at least of frustrating the claimer to a point of giving up. Just before I cancelled my insurance with BCBS it took six months of fighting and letters to the (Useless) Department of Insurance to get them to pay a simple cataract surgery claim. I still believe the reason they frustrated my… Read more »

Matthew Guldin
Guest
Matthew Guldin

I can’t believe all the attention that Sicko is getting. Yeah it tells some heart-breaking stories but it is similiar in nature to many of the articles demonizing HMOs that appeared in the late 1990s. If Michael Moore haven’t done this documentary, it wouldn’t be getting nearly the attention. In fact, I would go as far as to say that it would barely make a blip outside some arthouse theatres in some of the larger urban cities. Regardless, I still think the impact of Sicko is going to be muted in the long term. Just too many other important issues… Read more »

Tom Leith
Guest
Tom Leith

Dear Dr. Novack, I find it interesting that someone who quotes Hayek wants to eliminate the ability for other people to have a contract to their liking. Very interesting. Once upon a time we had simple, understandable contracts that said “For $N per year, we will pay for anything a doctor is willing to do to you and you’ll lie still for, up to a lifetime maximum of $M. What happens after that is your problem.” As medicine became simultaneously less and less likely to cause harm and more and more likely to do at least a little good, more… Read more »