Tuesday, July 10, 2007

You Should Go See "Sicko"

I just returned from seeing "Sicko", the new movie about the state of healthcare in the US.
It shows how far down we have spiralled in this country, and then they go to visit Canada, England, France, and even Cuba and take a close look at how the free government-provided universal healthcare systems work in those countries.

Here in this review, I will try to cover both sides of the issue. First, I will support Michael Moor's position, then I will explore the other side of the argument.

The reviews have said that this is more 'even-handed' than Moore's previous films. I tend to agree. He has no personal partisan agenda here. He is exposing a system that is broken, rather than demonizing Republicans. Our broken healthcare system is a tragedy that we ALL share in, and it needs to be addressed NOW. He is not trying to play partisan politics here. He is showing a serious problem, and he is showing how other modern countries have solved the problem.

Our healthcare is now ranked 37th in the world - just slightly ahead of Slovenia.

We have the worst infant mortality rate of all countries in the entire western hemisphere. Also, enough people die from mistakes made in US hospitals to make up the equivalent of a fully-loaded 747 crashing every single day. The film opens with a video of a man with a wound on his knee, who is taking a needle and thread and sewing his own flesh back together, because he is one of the 50 million Americans that have no medical insurance at all. For these 50 million Americans, they might as well be living in the worst of the third world nations. But the film is not about them. It's really about the 250 million Americans who DO have medical insurance and STILL can't afford proper treatment because of all the extra fees, co-pays and deductibles, etc. Each year now, fully half of all personal bankruptcies (2 million per year)are due to medical costs that are not covered by medical insurance.

A friend of a friend of mine worked in the Army until he retired as a lieutenant colonel at 45. Then, he started his own business and made it successful, and ran it well and built it up until he sold it for 3.5 million dollars at age 60. This was his retirement nestegg. However, that very year, at age 60, he became ill, and had no insurance, and in the course of the following year of illness, his medical expenses exhausted his entire 3.5 million dollar fortune. He was left penniless.

America is a great country to live a good life, as long as you are young and healthy and strong. But if you get sick and need medical help - and we all do eventually - then this is not the place to be. In fact, it may be one of the worst countries to live in.

ALL other modern industrialized countries have better healthcare than we do, and even many so-called third-world countries do as well.

Cuba's healthcare system puts ours to shame - literally to shame. Go see the movie and see what Cuba did to help some poor Americans who were rescue worker heros at 9/11 but that were in need when our own government or system had failed them. He tried to take them to Guantanamo Bay Naval Base to get help, because he found out we were giving free medical care to Al Qaeda prisoners, but our government turned them away. So he just took them into Cuba, where they were given excellent first rate care - for free. In some cases, helping out with problems that American healthcare had not been able to solve for years. By the way, he went to a pharmacy and one woman who had some breather medicine replaced, said she pays $120 each three times per month for that. In Cuba, it sells for less than 5 cents each.

One particularly striking visual is to see Americans as the poor refugees from a disadvantaged country coming to Cuba to receive help. That just completely goes against the self-image that America has of being the best country in the world. We have been fed that propaganda for years. And one reason we believe it, is because of the immigration that America receives. This reinforces the idea in our heads that this is the place to be. But we have to remember that the people who come here were sold the same propaganda. Also, many Americans may not be aware of it (because it doesn't hit our news) but virtually all modern countries have immigration - AND immigration problems. Look up stories about England and Germany and France and find out about their immigration. People are just dying to get into those countries too. This is not the only place to be. And, from a medical perspective, it may not be a good place to be at all. Wait till you see the truth about the Canadian system, and the free healthcare systems in both England and France. They are far, far, FAR superior.

We here in the US, have been fed a pack of lies about what the other systems are like and how bad they are. We've been told for years that the government provided healthcare systems are poorly run, and that they provide terrible healthcare compared to ours. We tend to think they have old, out-dated equipment, risky medicine, and poorly trained doctors. We are led to believe that it is very risky to be treated in a foreign hospital, even.

All that is completely false. It is political rhetoric designed to scare us away from the whole idea of universal healthcare for everyone. Our system is worse. Not only far more expensive - but also worse. This is part because MD's cannot perform all the necessary treatments because their malpractice insurance does not insure them for all procedures. And it is partly because so many people are simply denied care. They are denied care because they have no insurance at all, or because the insurance companies have found a loophole to allow them to avoid coverage. They even hire private investigators to go looking for any hint of a pre-existing condition so that they can deny coverage for any medical problems now. One of these investigators is interviewed in the film and he tells it like it is.

Those politicians that opposed the universal healthcare idea called it "socialized healthcare" because they know that Americans are scared to death of anything "socialized" because they think it leads to an entire socialized system. Somehow, we don't call our police system "socialized police" - but that's exactly what it is. It is provided by the government, not private industry. So is our fire department. And the state-run school system. And the libraries around the country. And the trash pickup, and the water services. These, and many other things, are ALL "socialized services", but we don't call them that. So why would they single out healthcare insurance to call that "socialized" if the government provides it? Obviously because they are protecting the interests of the healthcare companies that make billions by leeching our system dry.

So, instead of calling universal healthcare "socialized healthcare", I think a better term is to call it "civilized healthcare".

Some people are afraid that universal healthcare would add too much to our taxes. Well, in my own personal case, I pay about $1,000 per month in medical insurance premiums and the copays and deductibles for an average healthy family of three. That's about $12,000 per year. That could be considered a tax. And that represents a significant extra tax. If we became actually sick, it would be a LOT higher than that. And yet, if we went to a universal system, then the 50 million other people would be added into the pay side of the equation, which would lower the costs. So in the end, I think we would be paying less than we do now.

But besides this, we need to lower the actual costs of the healthcare itself to the costs other countries pay. And we need to improve the quality of the care as well.

Moore also showed the newest tactic that hospitals in the US are now doing, which is called 'dumping'. Once a patient's insurance runs out, they cut off the hospital tags and put them in a cab - still in their hospital gown - and send the cab to a skid row clinic, and the cab dumps them at the side of the road in bare feet, and disoriented, and with no idea where they are or what is happening. Our system is far worse than simply too expensive - it's become immoral. People in the other countries mentioned are all healthier than us and live longer than us on average - so the end results are clear as well.

When Moore put out an ad looking for medical horror stories, he received over 25,000 stories in the first week. Our country is full of people desperately unhappy with the healthcare offered here. And many of the stories were not just from people treated badly by the system - but rather from people who are IN the system and who are forced by their employers to treat OTHERS badly. Denying coverage. Denying the care that they desperately need, in order to keep corporate profits up.

Moore interviews one healthcare insurance worker who breaks down in tears when she explains how it breaks her heart to deny the desperately needed help that her clients must have. The companies often quote "pre-existing condition" as the reason for denying coverage, and the list of pre-existing conditions in the book is the first 37 pages. The film lists them alphabetically in star wars scroll format. And some of the conditions are things like "yeast infection", which is common to almost all women, and "back pain" which almost everyone I've ever met has had at some point. Diabetes is a big one, and that affects a huge percentage of the population now. So this list allows the healthcare insurers to refuse coverage to just about anyone they please. Of course, they might choose to take them on as a customer, and start receiving premium payments every month, and only refuse coverage later when they actually try to USE their insurance.

Moore also interviews the senior physicians who are responsible for denying claims for healthcare. They are incented by their employers to keep the denials high. They have a minimum quota of 10% denials of service. If they deny enough claims, they can receive financial bonuses. In one case, the signature is a stamp used by clerks on behalf of the doctor, and the doctor has not even reviewed the cases at all. It's a shame that our system does not consider this criminal behavior. But here, cash is king. Profits are our religion. We have become the Farengi.

And Moore doesn't even cover some of the other aspects of the problem. For example, the incredibly high cost of healthcare insurance for employees is what causes our major companies to become unprofitable and uncompetitive with other companies around the world. For example, GM has to pay healthcare for over one million employees and former employees. This means that they are burdened with a cost that their competitors from countries like Japan, Germany, Korea, etc. are not. That makes them more expensive and less competitive. The other American carmakers are in the same boat.

Also, last year, Continental Airlines lost 400 million dollars. When they investigated, they discovered that they could have saved over 800 million dollars in healthcare insurance costs if they simply had a younger average age workforce. So they petitioned the SEC to let them report their annual earnings in two modes - the actuals, and what they WOULD have earned had their employees been younger. If this catches on, what do you think companies will start to do with all their older employees? How easy will it be to stay employed for someone over 50? What will all the baby-boomers do when they are left without work? That is a huge part of the population. Who will support them? Can you see how that might belabor the country's economy further? And then what? Will 40 become too old to employ? Will 30? We will end up with a thin layer of 20-somethings trying to work and pay the way for the entire population of children and those over 30, 40, 50, 60, 70, and 80? I think it should be abundantly clear by now that this system simply does not work. We need a better system. Perhaps a system like other modern countries have.

And one fascinating fact is that Moore seems to have actually found the precise moment that our system changed to this HMO nightmare we currently have. It was from a taped conversation between Nixon and Agnew, and Kaiser Permanente was trying to take over, and Nixon gave it to them, because he liked the idea of companies making money from providing less healthcare. Then, Moore also shows exactly how much each congressperson was paid for their votes to support privatized healthcare. Most were paid between $100K to $350K. Some were below $100K, but GWB was the highest paid. He received well over $830K from medical companies and pharmaceuticals.

Fundamentally, Michael Moore's argument is that the United States, the richest, most powerful country in the world, has a TERRIBLE healthcare system. The fact that we are unable to offer decent basic healthcare to our entire population is a shameful embarrassment by standards of any civilized country in the world. And yet we spend more per capita on healthcare than any other nation on the planet. The truth of all this is obvious and the arguments are irrefutable.

This is an excellent, informative film. I'm glad I went to see it. I think we all need to see this at least once. This message needs to get out. When it comes out on DVD, I will buy it and loan it to all my friends to make sure they see it too.

~~~ HOWEVER ~~~

So far, I have spoken in favor of Michael Moore points in the movie.

It does raise a lot of very good points about how our healthcare system and services have declined in this country, and then also how great the healthcare systems are in 4 other countries in particular.

But is there another side to the story?


I always like to be fair and impartial, and try to get at the balanced view. After seeing that movie, I was alarmed, and upset, and a little shocked at our system (even though my own experiences already told me much of the bad news) and very impressed with the systems in England and France, and Cuba. I think on the whole, Moore was correct - but incomplete.

He left out the bad news about their systems, and the good news and realities about our system.

First, the Canadian system. Republican Politicians here talk about how the delays for surgery are extensive. Test equipment and procedures are not always available right when you need them. And it takes months to schedule needed surgeries. Well, that is MOSTLY untrue, but not entirely. 18 years ago, my father had a triple bypass surgery. He was scheduled for it, and it was supposed to happen in 3 weeks. But suddenly, they shut down the wing of Sunnybrook Hospital in Toronto where it was scheduled, and they told him he had to find another place to have it done. Well, by that point, time had become an issue. He had become a lot weaker and needed the surgery right away. He couldn't work anymore, and no longer had the strength to even walk upstairs to go to bed and was sleeping in a chair downstairs in his house. We looked and no other hospital in the Toronto area or, that region of Southern Ontario could do the surgery quickly enough. So we ended up taking him to Harper's hospital in Detroit. They scheduled him in for surgery in 2 days, and he was in, out, and back home in about 5 days. So score one for the American medical system there.
On the other hand, OHIP, the Canadian healthcare insurance system, paid for it, so they get some credit too.

You see, the Canadian system is not like the European healthcare systems. Theirs are run by the government. Americans are mistaken when they think that the Canadian system is a government-run system. It's not. It is the exact same sort of private business healthcare providers that we have in the US. However, it's the INSURANCE provider that is run by the government. So you can go to whichever private doctor or hospital you choose, but then the government pays for it.

In England and France, it is all government-run as well as funded.

And in England, they have both a private and a public healthcare system. The private system has sprung up to exploit the gaps and failures of the NHS public one. Given a choice, many Brits would choose the private one, and they feel they will get better care there. But, naturally, it's expensive.

Canada also has a private healthcare system alongside the other. In other words, although all the doctors and hospitals are private, some will take the government insurance and some won't. For example, Shouldice Hospital in Thornhill (Part of Toronto area) is known as the best hospital in the world for hernia operations. Kings, queens, presidents, and important and wealthy people come from all over the world to Shouldice when they need a hernia operation. It is not covered by OHIP, the government insurance company in Ontario.

And in France, it is said that they have an excellent healthcare system. What Moore found in his documentary is very true. However, it has been stated that within the decade, the social programs will have bankrupted the nation. They are perhaps given too much. You simply can't have it THAT good for that long, apparently.
To give everyone free healthcare AND free sick time for months if needed, AND free housecalls AND almost free medicine AND free daycare for children, AND free in-home nannies to help take care of children, do laundry and cook meals when you are feeling sick, AND minimum of 5 weeks vacation AND generous retirement pensions, AND free university education.... well it's all too much. You need a productivity level that is impossibly high to pay for that. You simply cannot get that for a whole population just by taking some money from the wealthiest of people.
At some point the books have to balance.

So yes, Moore did tell the truth, their system is great - but it seems that it won't last forever. Their system seems ready to collapse within the next few years unless they take steps soon to mitigate losses by reducing the benefits they give their citizens. But for now - they get a pretty smooth ride.

As for the US system, yes, there are a lot of shortcomings, and a lot of them are due to denials of coverage by the health insurance providers. But why is that? Well, it's partly because of the fact that they are greedy and want to make huge multi-billion dollar profits, but it's also because the actual medical costs themselves are so expensive in this country. Blue Cross is a non-profit provider, but they are also very expensive because the costs are high. Why are the costs so high? Partly because doctors also want to make a lot of money - but also because medical malpractice insurance is so expensive. And why is that? Because the medical lawsuit settlements are huge. And why is that? Because lawyers get a percentage of the proceeds of the lawsuit as their payment. That fact right there drives a lot of the high cost of healthcare in this country to it's current ridiculous levels.

But if you look at the level of healthcare AVAILABLE in this country, it is awesome. All the equipment and procedures and doctors we could want. It's all there and all available - if we can afford it.

As far as going to live in any of these other countries, well, you have to look at the whole big picture. Generally speaking, the cost of living in those places is much higher than the US, so you typically have a better overall lifestyle here in the US. I know for a fact, that I could not have the house or cars or other things I have in my life here if I were living in Canada. Not unless I had a completely different way of making a living that paid 8 or 9 times as much gross income. The combination of lesser economy of scale for companies, AND therefore fewer job opportunities, AND higher taxes, AND higher costs for everything, reduces the lifestyle considerably compared to most places here in the US.

In Cuba, sure they have great healthcare, but did you see the buildings where people lived? Not exactly the American standard of living.

And in Canada, the good economic performance is laudable, but they exist at the pleasure of the US policy. The US seems to be pursuing a policy of devaluing the US dollar right now. Possibly as much as 30% over the next few years, in order to increase exports to reduce the trade deficit. If this continues, then Canada is in a SERIOUS situation.

80% of Canada's exports are sold to the US. A major portion of that is automobiles, for example. GM, Ford and Chrysler all placed major manufacturing facilities in Canada years ago as part of the Auto Pact (the precurser to the Free Trade Agreement - which pre-dated the NAFTA that eventually included Mexico) The reason they did this was two-fold. Partly, it was to allow the automakers to take advantage of the cheaper costs of operating in Canada. But the big reason, was to prevent any Canadian-based car companies from starting up and entering the market. That was the deal. We'll put our factories there and hire your local Canadian workers, if you agree not to go into competition with us by developing and marketing your own cars. With equal technology and yet cheaper cost structure, Canadian cars would have been very competitive. It was a shrewd and wise move on the part of American Car companies and the US government.
However, if the US dollar shrinks too low, against the Canadian dollar (They are almost at par right now), then the US car makers might find it too expensive to continue to operate in Canada and bring those operations into the US, shutting down the auto industry in Canada and crippling the economy. The same thing goes for the lumber and beef, and agricultural industries.
To put it bluntly, the US could shut down Canada in a heartbeat. And it's all pretty much within the control, (if not purview), of the US Federal Reserve Bank.

US financial policy can make or break most of the economies in the world. Other countries have their own value and some measure of control, but in reality, the US dollar is still the official currency of the world right now, and the US consumer economy drives the largest economic activity globally either directly or indirectly. Major changes here have ripple effects felt throughout the world.

If America coughs while facing north, Canada gets the cold.

It's a good thing they have a good healthcare system.

Back to the movie, If you've read the internal letters from execs at the HMO companies as they talk about the film and are trying to come up with defenses to counter this, you can see pretty clearly that they feel exposed here.

Personally, my impression is that Moore did only present one side of the argument, so there are a few points missing that would support the companies, and their side would have to be the following, I think:

HMO and other insurance companies might say:

1) The doctors charge too much
2) The doctors take too many tests to support themselves in case of a lawsuit, not because they are needed.
3) Pharmaceuticals charge too much for drugs.
4) People don't take care of themselves. They drink and eat too much and that makes them unhealthy and too expensive to maintain.
5) Hospitals charge too much.
6) They are publicly traded companies. Their stocks would drop if they didn't make the profits they make. Wall Street has high expectations.
7) They have to store cash away as a hedge against large litigation suits that may arise from unhappy customers.
8 ) Their premiums are based upon an assumption of 10% denials, which is probably appropriate since doctors try to schedule unnecessary tests and provide unnecessary care to some extent. If they were to approve every single claim, then they would have to raise their rates dramatically to compensate for that extra expense, and so they are actually helping to keep overall costs down by refusing SOME services and procedures.
9 ) They have to pay for expensive Washington lobbyists to press their interests to the congress members and the president.

The Doctors and Hospitals would say:
1) The malpractice insurance is too high, they have to compensate with high bill rates
2) Medical equipment and supplies are expensive
3) Medical assistants are expensive
4) The Lab costs are too expensive and that jacks up the bill.
5) The insurance companies always negotiate the fees down, so they have to jack them up higher to compensate
6) Medical school is expensive, they deserve to make at least $500K per year minimum for life. They used to make that before the HMO's came in, and these are the rates they have to charge to make that now (after costs of running a practice)
7) Hospitals have to provide some healthcare to the millions of people without insurance and so they pass those costs along in the charges for those that do have medical insurance. That makes the rates higher. If everyone paid for healthcare,m then the overall rates would be somewhat less.

The Pharmaceuticals would say:
1) The tremendous costs of developing a new drug is hundreds of millions of dollars.
2) The clinical trials, and the extensive testing to get a new drug approved by the FDA and onto the market are very expensive.
3) There is only a limited number of years before their exclusive right to sell a drug runs out and they will have to compete with the generic drug makers. They have to charge a lot because they have to make the entire product lifetime profit in that short window of time.
4) They are publicly traded companies. Theur stocks would drop if they didn't make the profits they make. Wall Street has high expectations.
5) They have to store cash away as a hedge against large litigation suits that may arise if the products fail in some way and a public health risk is identified later.
6) They have to pay for expensive Washington lobbyists to press their interests to the congress members and the president.

So there is no single culprit here. It's NOT just one guy doing all this bad stuff to people. This is NOT Bush's fault, for example. It's not even one company. In fact, it's not even just one industry. The problems are endemic to the entire system. The whole approach to running a profit-driven healthcare system like this is fundamentally flawed. It is the system that is to blame. And it is the system that needs to be fixed. And what's more - this system is not the fault of any one party. It has been going on since Nixon started it in the early 70's. We've had both Democrats and Republicans in office since then and no one has managed to fix it or even slow it down. Now it is clearly out of control and careening down the hill.

So Moore didn't present the above counter arguments that he might have if he wanted to be completely fair to all parties.

On the other hand, Moore also missed some other powerful arguments that would SUPPORT his position as well, such as:
1) Doctors that cannot offer complete or proper care because they are not insured to do certain procedures that are necessary. My own personal doctor was interviewed in the Dallas Morning News last year about this and he was telling about how sad it is that he can't administer anesthetic to the chest area anymore, and so if he is working on a chest injury, he has to put the anesthetic in the arm but try to get it as close as possible to the chest, and just hope that some of the anesthetic gets over to the wounded area. It's sad and ridiculous, but that's the kind of medicine our doctors are forced to by the insurance they are given.
2) American carmakers and other companies that cannot compete because of the extraordinary high costs of supplying healthcare insurance to their employees. Their competitors from other countries don't have this heavy burden because in their countries that government provides these services and bears those costs. That put America's manufacturers at an international disadvantage.
3) More than half of all personal bankruptcies are due to medical expenses now.

So, having a universal healthcare plan isn't merely a responsibility and an expense - it's costing a lot of money both privately AND on the large corporate scale to do it the way we do it today. It would cost us a lot less in taxes to pay for a universal system than we are paying right now in premiums, co-pays, fees, and deductibles, and in lost competition, not to mention lost productivity from poor health.

So this movie doesn't give the WHOLE picture of all aspects of the healthcare problems in this country, however, he only has about 2 hours, and he does manage to get across a lot of good points in the time he has.

I don't want to demonize any companies, or people, but I sure would like to see the problems get solved somehow. After looking at the kinds of systems that most other civilized modern countries have for healthcare, it seems that a profit-driven model might not be the best way to approach healthcare for a nation anymore. Maybe it was good at one time, but it seems that it's gone off the rails here.
Privatization generally brings quality and efficiencies to a process, but maybe privatization doesn't work well in this particular case. There is simply too much opportunity for abuse.
The purpose of a government is to correct that. To provide controls and safeguards to make sure these kinds of things DON'T happen. Instead, it's been left in the hands of profiteers, and that was a mistake.

If we left air pollution control in the hands of manufacturing companies to decide how clean they WANT to run their factories, I think we all know what would happen. In a free market profit-based system, companies will take shortcuts to improve profits. That is simple human nature. Because greed and short term gains always outweigh the responsible long-term view.
That's why it's the government's responsibility to take the long-term view that benefits and safeguards it's citizens.


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