Friday, June 29, 2007

June 29, 2007 - Sicko

I couldn't resist. This afternoon I go down to our local movie theater, and view Michael Moore's new documentary, Sicko – which is about our nation's broken health-care funding system – on the film's opening day.

I generally avoid movies on opening day. I don't like crowds. But, I'm so passionately concerned with the subject matter of this film, I don't want to wait.

Evidently, lots of other people feel the same way. The theater is two-thirds filled, at 3:15 in the afternoon on a Friday – for a documentary, for crying out loud! This is also the first movie screening I've been to, for a very long time, in which the audience actually applauds at key points in the film. (Biggest applause line: British Labour Party elder statesman Tony Benn – comparing America's bloated military budget with our paltry health-care expenditures – "If you can find money to kill people, you can find money to help people.")

I'll admit that Michael Moore's films are often over the top. He's not averse to taking the occasional cheap shot at his opponents, for comic effect. Sure, there are a few of these low blows in Sicko, but by and large he just lets the ordinary Americans he interviews speak for themselves. They speak powerfully indeed.

Moore asks, over and over, some very basic questions about why we do things the way we do, in this country. Why, for example, do we permit doctors who review medical-insurance claims to be paid literally millions in bonuses for denying people medical care? Why does the law require insurance companies to value their fiduciary responsibility to their stockholders more highly than their responsibility to their policyholders? Why do we, as a nation, consider it efficient for the government to run our firehouses, but not our hospitals? How is it moral to allow private companies to waste 14 cents of every health-care dollar on paper-shuffling bureaucratic overhead for people under 65, when Medicare does the same job for seniors, for just 3 cents? Why is it that, of the 25 leading industrialized nations, 24 of them offer their citizens universal health care (guess which one doesn't)?

Central to the film is a risky publicity stunt Moore engaged in: taking several ailing 9/11 heroes to Cuba by boat. First stop: the waters outside Guantanamo Bay, where Moore calls out through a bullhorn, asking the guards if his passengers can receive the same medical care the Al Qaeda inmates are getting from our government, gratis (which is significantly better care than these uninsured or underinsured people get on the U.S. mainland). Next stop: a Cuban hospital, in which these disabled rescue workers receive pulmonary treatment free of charge – care they were unable to get in the U.S., because they weren't New York City employees, but rather, patriotic volunteers. Having been to Cuba, I can appreciate what Moore's trying to do, but he failed to mention one important detail: that ordinary Cubans must suffer every day through a dreadful shortage of medicines. Yes, they have excellent doctors, but the Cubans have nowhere to take the prescription scripts their doctors write for them, because the pharmacy shelves are typically bare. (The U.S. trade embargo is partially to blame for that, and Cuban government inefficiency for the rest.) Yet, for all that, Moore's absolutely right in pointing out that the life expectancy of U.S. and Cuban citizens is about the same, and the Cuban infant mortality rate is actually lower.

In France, Moore interviews a group of American expatriates who have nothing but good things to say about the French government medical benefits they receive, free of charge. These Americans abroad sheepishly confess to feeling guilty that they have so much less to worry about, medically, than their family members back home.

In Canada, he takes his camera into a government health-clinic waiting room, and asks the ordinary people sitting there if they can confirm all the bad things he's heard about unreasonable waiting times and inferior care. None of that's true, the Canadians tell him, matter-of-factly. Their system works, and they're proud of it.

There's much more I could say about the film – a little of it negative, but the vast preponderance of it positive. Go see it, with an open mind. Listen to the stories of ordinary people, whose lives have been ruined – and who, in some cases, have lost loved ones – due to medical-insurance profiteering. Then, as Moore himself does in the film, ask the really tough question: which system – universal health care, or private insurance – is more moral?

Go see Sicko. It just could be the most important movie you see this year.

9 comments:

Vance Esler said...

Carl,

Thanks for the review. Saves me having to endure it.

It isn't hard to find much wrong with our current system and its many perverse incentives.

But rather than increasing the involvement of third parties (ie, socializing the system), we would all be better off getting the middle men out of between the doctor and the patient.

It's in the middle where most of the trouble lies.

Carlos ("Carl") said...

Well, Vance, I hope you DO go see the movie. It's a very, very important film, one that will be shaping our national dialogue on health-care funding for years to come. If you don't see it, you'll be missing out.

The part of the film I most wish you, as a doctor, could see is Michael Moore's interview with a British physician who works (as nearly all British doctors do) for the National Health Service. This doctor describes his everyday practice as precisely what you and I agree ought to be the goal: of physicians simply helping patients, without the "middle men" intruding. The virtue of the British system, as this doctor describes it in the interview, is that it does enable that direct, unfettered healing contact to happen, without somebody sitting in a cubicle thousands of miles away calling all the shots. (By the way, Moore asks the British doctor about his compensation, and he reports being very satisfied with it - he lives in a million-dollar house in London.)

I'm sure there are ways that British physicians are frustrated with government regulations. The movie doesn't touch on that subject. Such frustrations are inevitable, in any large system. I've lived in Britain, though, and have been covered under National Health. I know, from personal experience, that it has fewer problems than our bloated, overly bureaucratic system. (The only place I've ever had a house call from a doctor, since I was a very small child, was in Scotland.) Most Americans have absolutely NO idea how well the National Health system works (or the Canadian counterpart, either). They've been fed all kinds of lies, over the years, about it. Moore sets out to debunk those untruths.

As for "socializing" the system, that's an emotion-laden term, for many Americans, that causes us to immediately shut our ears to any proposal that hints of moving in that direction. Moore does a good job of debunking that red herring, as well. He makes the point that we have always had socialized fire departments in this country (or, at least, in our cities and larger towns) - in other words, the government runs them. We don't use the word "socialized" to refer to our professional fire departments, but that's what it is. Everything needed for firefighting - salaries, equipment, buildings - is paid for by the government and funded by tax dollars. We wouldn't dream of having a system in which people had to buy fire insurance from a for-profit company, in order that the firefighters would respond, first, to those who were insured. But that is EXACTLY what we do with medical care.

I hope you do go see "Sicko." It may make you mad, at points. But, it will make you think. Maybe you could see it, then write about it in your blog - I'd be interested to read your perspective! :)

Vance Esler said...

It isn't the topic that bothers me. It is Michael Moore. I do not find him credible. He makes a lot of money sensationalizing these types of topics. If he were doing it as a not-for-profit effort, I might be more interested.

I have already blogged on some of these topics, though not recently. My contention remains that the system is very screwed up. It is complicated, and everyone is at fault. There is no easy solution, including to simply federalize it.

Given the current climate, however, I believe socialized medicine is inevitable. Doctors won't mind it as much as patients will.

Carlos ("Carl") said...

Vance,

I hear you, on Michael Moore. He's a complicated figure - I find him brilliant at times, but also erratic. His forte is shaking things up, leading people to look at things in new ways. He's unabashedly opinionated, and approaches his subjects from his own, very liberal particular political slant - but then, he never pretends to be otherwise. His biases are out there, on his sleeve, for all to see.

What I like about "Sicko" is that he steps back and, like some stubborn pre-schooler, keeps asking the "why" question: until the "adults" stop, look at each other, shrug and say, "Maybe he's got a point there."

I still think you oughta see the movie. ;)
Carl

Vicky said...

I'm leary of Moore as well but I've been seriously considering seeing this movie myself and based on what you've written here, Carl, I am pretty sure I will do so.

Steve Brown said...

I went to see Sicko today after reading your blog. It's not what I expected, so I think it would be hard for anyone to critique it without actually seeing it. Most of the film is about people like me who already have health insurance and expect to be covered if something happens. I learned the truth when I got cancer.

My insurance company wouldn't pay for white blood cell boosters (Neupogen), even after my doctor said I couldn't continue chemo without them. They wouldn't pay for anything if I enrolled in a clinical trial--not even CAT scans that they normally would have given me anyway--so I couldn't afford the most promising treatment. I have to check every bill because they often charge me for "covered" items unless I complain. Last year my out-of-pocket expenses of $10,000 wiped out my savings. And there's no way to switch to a different insurance company after you get cancer.

Can you imagine a firefighter, policeman, or teacher saying "I can't serve you unless you have insurance"? We believe such vital services should be provided to every American regardless of income, and we don't call it "socialized."

The people of Canada, England, and France--in fact every modern country except the U.S.--believe health care is just as important. When I saw the level of medical care that they provide to every citizen, and I compared it to the images of the uninsured elderly being dumped on the sidewalks of L.A. still in their medical gowns, the injustice of it all was just too much to bear. I cried and cried.

Anonymous said...

Carlos,

I was going to post a message today urging everyone on PulaPlace to see "Sicko." You beat me to the punch!

I agree with you about Michael Moore; he is the biggest detriment to his own movies and messages. He really is part genious, part self-aggrandizing pain. I think it would have helped to show some of the negatives of the healthcare systems in other countries. You know there are some, and his not acknowledging that creates doubt about his own credibility -- at least it did for me.

I did have to give him his due for showcasing first, Hillary C.'s work on overhauling healthcare, and then second, revealing that she had accepted money from the healthcare lobby. I wish he had offered more of that kind of balance throughout the film.

I do think it's a film every American should see, regardless of political leanings or opinion of MM. If you are a Michael Moore hater, just hold your nose during the movie. It's worth the endurance.

For anyone who would like more information about this issue and/or ways to get involved, there are links on Moore's website: www.michaelmoore.com.

Take care,

Mary

Stushie said...

I'm from Britain, having spent my first 38 years of life there. Here's a few considerations for the melting pot.

35% was the tax rate when I was working over there. Health care and benefits were lumped into that tax. I've figured that what I pay in private health care insurance and what I paid in taxes would amount to the same, so I'd still be shelling out the monthly dues.

Emergency care costs nothing more, nor does cancer treatment. However, there are some limitations to what the National Health Service can do - for instance, I've known doctors to tell people in their late seventies that there's no point in having the treatment - effectively euthanizing the patients.

For non-emergency surgeries like knoe, hip or elbow replacements - people can wait about a year for that kind of surgery.

Some doctors still make housecalls. People call their doctors all of the time, so setting up appointments can soemtimes take weeks.

My last point is about Michael Moore. I'm presuming that he has opted for having no private health care whatsoever - otherwise he's being hypocritical and making wads of money from under privileged people.

Carlos ("Carl") said...

Stushie,

Most of what you say here I've heard before, about the National Health System in Britain. It's by no means a perfect system. I hadn't heard the bit about "effectively euthanizing" elderly patients - I suppose such cases would have to be analyzed individually, to see what was going on there.

As for Michael Moore's own health insurance, he mentions in the movie that he's got very good medical insurance, himself, through the Directors Guild, of which he's a member. I don't see how having private medical insurance himself would make him hypocritical. How would going without insurance himself in any way advance the cause he's advocating in the film?