Michael and Me
Michael Moore didn't want me to see "SiCKO," his pro-socialist, anti-private health care documentary. If you know anything about health care systems, he didn't want you to see it either. At least, not at first.
In the beginning, the only people allowed to view the film were reviewers who knew nothing about the subject. The apparent theory was: get it reviewed by people unlikely to spot all the errors and omissions before you open it to more discerning viewers.
The movie is full of errors and omissions, but that is almost beside the point. Since the whole purpose of the film is to compare the worst features of American health care with the best features of health care in Britain, Canada, France and even Cuba (!), who can complain about a few errors here and there?
The mistake reviewers are making is in thinking this is a movie about health care. It isn't. There is no attempt to objectively compare the merits and demerits of different health care systems. There are no interviews with any health policy experts. There is not a single, practical proposal any politician could adopt.
So what is the film about? It's about psychology. It is a perfect-storm intersection of three phenomena: left-wing politics, health care altruism and Hollywood. Here is what I mean.
The one thing that unites left-wing political movements all over the world, regardless of their differences and idiosyncrasies, is the belief that incentives do not matter. One and all, they believe that people at the top can formulate a plan that will be successfully carried out by people at the bottom, even when it is manifestly not in their self-interest to do so.
In my book, Regulation of Medical Care (Cato Institute, 1980), I described how organized medicine replaced for-profit institutions with nonprofit institutions in first half of the 20th century. First came medical schools, then hospitals, then insurance companies – until the only people left who were making a profit were doctors themselves. At the time, I implied that the motive behind all this was pecuniary. Since then I have discovered that there are an enormous number of people in the health care community who believe that incentives should not matter. To them, health care without altruism is a contradiction in terms.
The prevailing view in Hollywood is that incentives will not matter in a just society, if only people care enough. The song says it best: "All you need is love."
What is the one thing all three groups have in common? Rejection of the idea of incentives. Since economics is the science of incentives, this implies the rejection of economics. (To paraphrase Moore: Incentives are about "I"; the focus instead should be on "we.")
All three groups are divorced from reality to one degree or another. That is, when you are around them you are unlikely to hear about any of the principles you learned in Economics 101. However, Hollywood takes the rejection of reality to a whole new level.
Economists, like other scientists, study reality in order to adapt to it. Artists, by contrast, selectively focus on some facts and ignore others in order to recreate reality. For some, this subjective recreation doesn't cease just because the camera has stopped rolling. They keep right on going until the world they are living in becomes unrecognizable to the rest of us. (Rosie O'Donnell and Charlie Sheen come to mind.) I'm not sure if there is a technical term for this disorder. If not, I nominate the term, "Jane Fonda Syndrome."
For Michael Moore, the real tip-off is the trip to Cuba. Understand: No rational proponent of national health insurance would ever bring up Cuba. In the very act of bringing it up, he is telling us – in the only way he knows how to tell us – this film is not about health care. It's about Michael.
Sure there are good doctors in Cuba. It's also true that the average Cuban has to bring his own soap and bed sheets when he enters a hospital. What kind of mind would focus on one fact and ignore the other? A mind that thinks if he recreates the Cuban health care system on film, it will become reality.
But the fantasy doesn't end there. By implication, Moore is recreating all of Cuban society. If there is one fact all the rest of us know – indeed, almost everyone else in the whole world knows – it is this: If someone like Michael Moore actually lived in Cuba, he would be in prison in a matter of weeks. And his biggest problem would not be health care. It would be torture.
So what kind of mind are we talking about here? I don't think I want to go there.
For a comprehensive look at how the health care systems of Britain, Canada and other countries really work, see Lives at Risk.
Here are a few links for your viewing pleasure.
The trailer for "Shooting Michael Moore," a film by Kevin Leffler exploring who Michael Moore is and what motivates his filmmaking and political position.
The trailer for "Sick and Sicker," a film by Logan Darrow Clements, exposing the Canadian health care system. Look for me at the 2:39 mark.
Kudos to John Goodman for a sensible and responsible reaction to an IRRESPONSIBLE film. I propose we create an organized industrywide campaign to respond to Mr. Moore's "work of art". If the health system in the US costed us $2T to operate last year, how does Moore think the US govt can simply snap its fingers and reduce that number to say $1.5T. Single payor/universal healthcare absolutely will not work. Like many of you, I have my own thoughts for health care reform in the US. Maybe I should change the first bullet point to "make a movie about the REALITY of the US health care system." It makes me wonder how much Mr. Moore spends each year on weight management and fitness club membership to prevent obesity???
To Mr. Farrell: Nothing like critiquing an “irresponsible” film with an irresponsible tirade. If Mr. Farrell’s primitive understanding of obesity is indicative of his “understanding” of healthcare, then I worry for the those who hire him as a consultant. And I’d be willing to bet $2 trillion that Mr. Farrell’s carefully laid out and methodically argued point—“Single payor/universal healthcare absolutely will not work”—somehow will not change the minds of those of us who believe such a system can work, in part because we’ve actually read a thing or two about the issue. To Mr. Goodman: It’s hard to know what bothers you more—the fact that Michael Moore made a film advocating overhauling our healthcare delivery system or the fact that anyone would make such a film. I have not read enough of your commentaries to know whether some of your subjective and snide asides are tongue in cheek or FoxNews-inspired; regardless, you miss the point of the film. Americans have heard all they can stand from health policy experts, who thus far have been no better than nonexperts at fixing our healthcare system. Also, if filmgoers want policy wonks, they can always turn to The Online NewsHour…or The Daily Show. Whatever Mr. Moore’s shortcomings, whatever mistakes he made in constructing and presenting the film, the fact remains, many Americans agree with his diagnosis—our healthcare system is sick. We have a system that most of us could never afford without extensive insurance coverage. If you’re not one of those insured through an employer, you’re out of luck. If you’ve been diagnosed with anything more severe than a cough and you try to obtain insurance on your own, you’re out of luck. If you do have coverage, but your disease or condition is just a little too obscure (or expensive to treat), you’re out of luck. If you don’t happen to live near a major academic medical center and you have a stroke or a heart attack, you may be out of luck as well. Want to have a discussion with your physician about managing your heart disease or diabetes? Better be able to do it in the last 90 seconds of your 10 or 15 minute office visit. Need a specialist? Better be patient (and bring your wallet when you do get that appointment). Trying to reconcile the myriad invoices and statements in the wake of hospitalization? Better hire a health policy expert. Got the wrong medication or procedure while you were hosptialized? Don’t be insulted–you’re one of millions. I could go on, but those issues alone are certainly “incentive” enough for a radical change. Now, just exactly what type of system Americans envision as an alternative, and what the majority of us might one day agree on, I don’t pretend to know. But please, spare us the boogeyman “the socialists are coming from Cuba to ruin our healthcare system (and put us in jail)” doomsday soothsaying.
It is bad enough to be wrong, omit evidence that repudiates your theories, but even worse when you are able to get a bully pulpit to exploit your views.
I have not yet seen the movie, but just reading the article I can very well discern that one of John Goodman’s bookmarks is most certainly Fox News.
Open your mind…just a bit. There are 48 million people without health insurance. Insurance companies make astronomical profits. Doctors are in bed with device companies and insurance companies…but do not pick up the tab…the hospitals do; but, I am assuming as a healthcare “consultant” you know all of this.
No system is perfect — but, the American system is BROKEN!!! It is borderline criminal that millions of people go uncared for while insurance companies, device companies and big Pharma make zillions of dollars. Did this cross your mind while watching the film?!
This is great. It should be a WSJ editorial.
That is a good critique of Moore and other socialists. You are correct; they believe incentives do not matter, at least in the long run. They believe human nature will change; folks will beat swords into plowshares and individuals will give according to their ability and receive according to their need. That system of distribution may exist in some primary relationships, such as a well-functioning family, but not in a large society. No matter respond the socialists: we just have to await the emergence of the “new” man. the USSR waited 70 years, to no avail, and probably could have waited 700 to avail. The problem, as Keynes once remarked, is that in the long run we are all dead; people are dead in the short-run, too. I believe the reason is the misbegotten belief that incentives do not matter. Whey they find that, in fact, incentives do matter, they are force to apply, not the relatively gentle, passive incentives of markets and private property, but the harsh and many times fatal sanctions of the state or the party. One would think that socialists and central planners would have learned a lesson – alas, it was not to be. Heaven help us if the Michael Moores of the world, however well intentioned, prevail in the U.S.
Have you rethought your 1980 premise about physicians making all the money? I believe the current number is physician services are 20% of health care outlays.
I truly believe that ultimately, however we transform our private system, MD’s and patients should be in charge of health care — not regulators or bureaucrats.
Keep up your good work on behalf of all Americans!
There are always 3 sides to every story; (1) my side, (2) your side, and (3) the undeniable facts.
No matter what side you prefer; information and participation will benefit all.
Do physicians really make all the money? Medicare/Medicaid was signed into law in 1965; it resulted in a basic program of hospital insurance for persons aged 65 and older, and a supplementary medical insurance program to aid the elderly in paying doctor bills and other health care bills.
In finance terms we now call Medicare, RBRVS (Resource Based Relative Value System.) We all know the short-comings of funding Medicare; BUT most importantly, the way physicians are paid by commercial contracts is; a % of RBRVS.
BCBS for example will pay physicians 102% of current RBRVS for an office visit, Medicare pays $1.00, BCBS pays $1.02. Oh by the way, in my 25 years I have hardly seen a physician that spends less than 50% overhead trying to collect that $1.02.
Still think they make alot of money?
Dr. Goodman is about 15-20 years ahead of his time in regards to HSA’s, that dedication is enviable!
Information and Participation – Have a Nice Day.
DRB
USAHealthcareCosts.com
John, I usually tend to use your pieces on the MFC site almost without question. This time, I have made my own assessment of MM's film. While I strongly agree that Moore did his share of "cherry picking" in telling his story, i disagree that the gist of what he presented is misleading. The most devastating case he presented IMNSHO is the one of the lady who had inadvertently overlooked mentioning a simple yeast infection in her past, which did not appear on her app .. and was then used as a reason to disqualify her for coverage for more serious ailments, despite the fac that she had paid into the system faithfully for some time. If this kind of "guilt by omission" is considered an ethical business practice, and if there is indeed a whole segment of the health insurance industry devoted to nothing but finding ways to deny legitimate claims … the efforts of Michael Moore have a valid purpose in pointing this out! I have never been one of his fans, since I consider him a poor excuse for a documentarian, due to his penchant for time shifting, context dropping, etc. in order to eithere make his point, or entertain his throng. but in this case, at least on some levels, he has done a service. (his advocacy for singer-payer, gvovernment-run HC is of course nonsense, since he expects the same system that screws us now to work better with more power.)
[…] And what do you think “The Father of Health Savings Accounts“, John Goodman, thought of SiCKO? You’re not getting any hints. You’re going to have to read his post Michael and Me to find out. Oooh, the suspense! […]
I am in Canada visiting my Mom. She lives in a valley with one million residents which was previously served by one dermatologist. They were attempting to get the wait down to below 6 months, so they ordered a new doctor to set up here and now there is one for only 250,000 people and the wait time is between 4 and 6 months.
My wife had a bunion and waited 2 1/2 years for surgery. During that time the pain got worse and worse. Eventually she needed crutches to walk and had a lot of back pain. She gained wait from not being able to exercise for 2 years exacerbating the problem. This was in 2005
My son was hit by a car going 45 and his head went through the windshield. The car was totaled. He was rushed to Emerg and waited 4 hours for an x-ray. There was no CT or MRI machine available. Also 2005
My Mom was diagnosed with one very small lump in her breast in 1997. Because she lived in a rural area the only treatment available was a radical mastectomy. In Jan of 2007 she was recommended for a knee replacement, she is waiting on a list and hopes to have it by 2009. She was also diagnosed with skin cancer this year. Again, she lives in a small town of 150,000 in an area with 250,000 total serviced by only one dermatologist. She was lucky to get in in only 4 months. Just 2 years ago there was no dermatologist and residents had to travel 75 miles. The government finally ordered a new med school graduate to set up shop in this town, which is why they have been able to reduce wait times to 4 months.
I’m not sure if these stories are compelling enough for you. I now live in Paso Robles with my wife and our son lives in SLO, but all of the above stories happened in Canada . My Mom still lives in Canada and I am in Canada now desperately trying to get her treatment. You may not be aware, but it is a criminal offense to pay for private treatment in Canada unless it is for a family pet.
I am on vacation in Canada. My mother was diagnosed with cancer and was facing a long waiting list so I came up here. She lives in a city of 150,000 in a valley 100 miles long with a total of about a million people. They city she lives in is the second most expensive real estate market in Canada and the city is served by only one dermatologist. The whole valley has 2 of them, because one was ordered by the government to practice here. Today I met a senior who waited for 7 months to see the dermatologist, then finally went to a vet for treatment. Doctors only earn about $89,000 a year, vets earn 170,000 and dentists earn 250,000, so most of the brightest students become vets and dentists, and many people want the best when it's their health. You already know that our GDP per capita in the US is far higher than in Canada. They typical family earns $83,000 and pays $38,000 in taxes. Bu there's more! All of the utility companies; phone, electric and gas are owned by the government. They also own the car insurance company, the beer, wine and liquor distribution, the largest gas station just to name a few industries. A car that cost me $27,000 in CA costs $28,700 plus 13% sales tax here. A dozen beer is $27.50, a bottle of Grey Goose Vodka which is $25.99 in SLO is $109.95 here. Gas is $4.50 a gallon, a tent I bought at Costco for $89 is $249 here, and a 6 person spa that retails for $2,999 in CA is $5,799 here. It's also interesting to watch the cars here. I have seen one Lexus in a week, no Escalade, 2 BMW's, one Mercedes, no Lincoln Navigators, only the odd Camry, one Jag, over half of the pick up trucks are only 2 doors models, and the average age of cars on the road is 12 years old. So with our per capita GDP being 30% higher than Canada, and Canada's tax being way higher than ours, and their goods costing so much more Canadians have very little left at the end of the month. Despite this, they are still desperate for timely medical treatment. So desperate that they would go to a vet for treatment. The president elect of the Canadian Medical Association; Dr. Brian Day is a British doctor who opened the very first private clinic in Canada in contravention of the Canada Health Act. I wish you could experience this for your self. I guarantee, it would change your outlook! On another subject, I am happy to see our Insurance Commissioner back home standing up to the insurance companies. They need to be held accountable! See the link below Ralph
I think liberal health policy activists understand all too well the role incentives (particularly perverse ones) play in our health system. We want a system that gets rid of some of those perverse incentives and rewards people for doing the right thing. Just one example is the way our system punishes clinics that manage chronic illnesses well, thus reducing their opportunity to perform intensive high-cost procedures. Or the way our system, as alluded to above, provides incentives to insurers to deny claims just to see how many of their denials will stick. Incentives abound in our health system, and liberals know it. They just want a system with the right incentives.
This also appeared as a letter to the editor in the July 12th Wall Street Journal — ed.
As an immigrant who has lived in the U.S. since 1964, I still cannot figure out what makes Americans tick. On the one hand, they incessantly demagogue "socialized medicine" as the ultimate bogeyman of health reform. On the other hand, however, Americans reserve for their veterans, whom they claim to revere, a health system that is owned, operated and financed by government — the VA health system. Socialized medicine does not get purer than this. Medicare, Medicaid and Schip do not represent "socialized medicine" proper at all. They merely are forms of "social insurance" coupled with a largely private health-care delivery system.
Why do I never hear any Republican political candidate, or the editorial page of the Journal for that matter, openly advocate the abolition and privatization of the VA health system? Why are even the staunchest American conservatives, and the veterans themselves, so protective of the VA health system, if socialized medicine is so bad?
One explanation may be that the VA health system is generally viewed among health-policy experts as the cutting edge in the smart use of electronic information technology and of quality control in health care. The Journal itself featured an article on this point on its front page some time ago. In a peer-reviewed research paper published in the Annals of Internal Medicine (December 21, 2004), researchers of the RAND Corp. reported that the quality of care received by VA patients scored significantly higher overall than did comparable metrics for patients in the rest of the U.S. health system.
My point here is not to advocate a wholesale switch of the U.S. health system to a VA-style system. I am merely asking for help in my life-long quest to understand the complex cerebral processes that make Americans tick.
What would it take for people to know exactly what they are paying for in medical coverage, and let them mix and match to suit their own situation?
We do it with our cars and life insurance. Why not medical?
I think everyone should be covered, and everyone should pay for their coverage. If they go to the ER without coverage, throw them in jail. There ain’t no free lunch.
What is the current mood in Washington, and what can the citizenry expect in the future?
Thanks again for your work.
Your defense of the American health care system is typical of someone who either belongs to a employer subsidized group health insurance plan or who has ties to an insurance company or pharmaceutical company.
If you were self-employed and unfortunate enough to find yourself in need of health care, your tone would be different. My husband is self-employed. We average a visit to the emergency room about once every two years. Our premiums continue to rise, forcing us to raise our deductibles.
The American health-care system is not anywhere near as comprehensive as other civilized countries. Our public officials have sold out in favor of the insurance companies and pharmaceuticals. I am looking forward to seeing “Sicko”, and I hope it will force our policy leaders to deal with some real issues.
Your scare tactics will not work on me, because I am already scared. Waiting for health care would be better than bankruptcy.
Since when is Michael Moore’s responsibility to fix our broken health care system? you certainly did not offer any solutions. No matter how much people in other countries pay in taxes to receive their health care, at least they get some health care and the money they pay in taxes is going to support the system instead of the money we pay out for health care in our country that goes into the pockets of the insurance companies and the drug companies. That is why the richest country in the world cannot afford to provide even the minimum health care for their citizens, except for the rich that can afford to pay for it themselves. Instead of complaining about Moore, people like you should have the guts to come up with a solution to our problems. What are your suggestions for fixing the broken system?
If Michael Moore’s documentary Sicko is as fact filled as his other documentaries, they should be re-categorized as extreme fantasy.
Mr. Moore’s Bowling for Columbine won an Oscar for Best Documentary, while it is obviously a work of fiction, if he had any honor at all he would return the Oscar, but one has to consider the source.
Thanks for your rebuttal to Michael Moore's attempt to distort the positive side of the US health care system. I have a doctoral degree in public health from The Univ of North Carolina and, since retirement in 1998, I have become a pharmacy technician. Thus, I believe I have some understanding of the topic. Being 72 years old, I am also acutely aware of the problem. During 2004-2005, I spent about eight months in Vancouver, BC. According to a newspaper article in early 2005, the waiting time for an MRI there was 26 weeks. The BC health authority appropriated about $250,000 CDN to reduce the time by half — to a mere 13 weeks. The article cited several cases in which patients died before receiving an MRI or developed other serious, adverse consequences. There was no information about the possible wait to receive treatment that might have been based on MRI results. Many Canadians seek treatment in the US and other countries if they are able to pay for. And they do so quite willingly. The US health care system is not what it could be with a more rational expenditure of resources, but a governmental, single payer or single insuror system is not the answer.
Your article in the Dallas Morning News concerning the film Sicko is a typical right wing fear mongering article. If you were to tell all the people in Canada, Great Britain and France and all the other countries that offer Government run single payer systems that we are going to change your health care system from a National Health Care system to a system that we have in America you would get an almost 100% response that you will do no such thing. To defend the system here is to say that it is a “privilege” to have health care coverage and not a “right”. In almost every other western country in the world it is a “right” to have health care coverage and not, repeat not, a “privilege.
In every health care system there will be people who will complain but Sicko rightfully points out that the American system does not work for enough people. The American system spends twice as much per person on healthcare as almost every other country. We rank 37th in the world for healthcare and people in western European countries live longer than Americans.
Since I am British and have sampled both systems I reject your assertions that the American system is better. I am extremely healthy at 63 but have to pay more than $400.00 per month for a $5,000.00 deductible policy. This is the American disgrace.
Good op ed on “Sicko” in the DMN today, John.
In your article on Moore’s documentary you describe his technique as one-sided employing selective focus on facts. Your own arguments basically do just that. 90,000 people in New Zealand waiting for surgery and ‘other’ treatments. How useful is this statistic with no mention of for how long and how many for treatments of serious illness where time is critical.
If you’re going to counter Moore’s case for a universal health care system by criticizing his arguments and documentary film techniques, you’ll have to do better than this.
What a silly article you wrote. The Moore film is only meaningful in policy terms because it is stimulating discussion and raises questions. Excellent conversations are taking place all across America addressing whether it is proper for health problems to lead to bankruptcy or devastation of retirement savings, for instance. You point out Moore committed errors of omission. Of course, he did, as did you in your piece. Discussing the issue of waiting without mentioning triage is absurd and omitting what we face here when in need of quick assistance is also an oversight. Many such as my wife have been forced into expensive energency room treatment when the doctor was booked and couldn’t find time for days. She needed a doctor, not a hospital. We have issues. National health care may not be the answer but simplistic, dismissive posturing is not going to help us arrive at reasonable solutions.
So you think the U.S. is any better at providing timely treatment for patients in comparison to Canada or Great Britain? Maybe you should ask my mother-in-law, or any other Medicare patient, for that matter.
Try to find a family physician who will even take you as a patient because you have Medicare. But it’s the doctors who are pushing the system into oblivion, not the government. They claim that they are not getting paid enough for their time.
The Dallas Morning News just published an article last Saturday about how some oncologists didn’t use the drug Bexxar for lymphoma, despite its efficacy, because they didn’t get PAID enough from the drug company who makes it! But that’s another story…
Why don’t you check out France’s healthcare? Yes, they pay through the nose in taxes…as if we don’t. But our money is being spent killing people in Iraq instead of saving people here.
So do a bit more research about what things are REALLY like here because you think we have it better than some other country. Just ask a Medicare patient…
You go through your list of scary statistics, like the administration went through their list before the start of the Iraq war, remember WMD’s and Mushroom clouds? But ask any American and they will tell you our medical system is not working.
My married step-daughter and her two children live in Scotland. I have witnessed the excellent medical care they have received. I have marveled at how much better the care they are receiving is than anything my children and I received here.
You close your piece by saying, So what are we to make of Mr. Moore’s work? Economists study reality in order to adapt to it. Artists selectively focus on some facts and ignore others to recreate reality. I wonder if you don’t have it wrong. Perhaps economists and policy makers are selectively focusing on some facts and ignoring others to recreate reality. I know this strategy has worked for policy makers before but this time I don’t think it will. Too many people have direct experience with the health care system’s problems to be fooled. Also many people have friends or family members in different medical systems and they know that the scare tactics you are stating do not match what they are seeing and hearing for themselves.
My wife and I saw “Sicko” a couple of Sundays ago, and found it to be entertaining, interesting, and funny, as well as pathetic, in terms of the experiences reported by people, especially relating to the consequences of their interactions with their insurance companies. As I think about it, more of the really sad vignettes related not to issues confronted by uninsured people (though there was some of that), but instead they related to stories from people who thought they had insurance that would take care of them in times of need, but found that not to be the case.
At the end of the movie, the audience all applauded, something I last experienced when the female lead in “As Good As it Gets” delivered a diatribe on the difficulties she encountered with her insurance company in trying to get her son’s asthma care needs met. These reactions reflect a level of antipathy on the part of the public toward their current experience with healthcare that should not go unrecognized.
As I read your piece in this morning’s DMN, the thought occurs to me that there is a difference between how you (and most economists and policy makers) look at the health care mess, which I would call “the macro view of things” and how patients and families look at their situation, which I would call “the micro view”.
As a follow-on to “Sicko”, when I was in Canada last week I did a little micro survey of my own. Denny, the waiter at Hy’s Steakhouse in Winnipeg, married, father of two (both in college) and care giver to his elderly mother, rates his experience with the Canadian system as a “9”. My Cree Indian fishing Guide at Hatchet Lake, in Saskatchewan, Norman, a single man with a daughter and a girlfriend, who live in LaRonge, Sask., except during the fishing season, rates his experience as a “8-9”. I didn’t drill down to find out the basis for their rating their experience as they did. On the other hand, the owner of Hatchet Lake Lodge, George Flemming was having a lot of trouble with his knees, at age 65 or so, a few years ago. After a delay of many months to get an appointment to see his orthopedic surgeon in Prince Albert, Sask., he was told he would need joint replacements. The reply to his question regarding when he could have those procedures done, was “2 1/2 years”, so he came down to Rockford, IL, and an orthopedic surgeon friend who had been a guest at the lodge “did” both knees the following week, and George has done fine ever since.
Here is the problem, in my view. People experience life in the micro, and then vote that way, while policy makers must make decisions in the macro, and then vote that way. The two views are sometimes light years apart.
My entry into the practice of medicine occurred the year Medicare started, and, by and large, I have had no major complaints about the way the system has worked with respect to my practice as a radiation oncologist. Medicaid has had its problems, but wasn’t all that bad either.
My fishing friend (a lawyer) and I were seated last week with two ob-Gyn docs from Utica, NY, and got an earful about their negative experience, mainly with managed care and hmo’s. Administrative bureaucracy and reimbursement levels that have failed to rise to meet their rising costs were at the core of what they had to say. However, when I asked if they knew any docs on food stamps, they had to agree that they did not. The practice of medicine, in my view, remains a privilege, and a very rewarding calling, despite the fact that the Utica docs would not counsel their kids to enter the field. None of my kids went into the “family business” either, but it was not because I made any effort to dissuade them.
My biggest concern is not that we will get to a single payer system. It is that the insurance industry would be put in charge of it, and that it will not be even as effective as Medicare has been. The outrageous compensation of senior management at organizations like United Healthcare are in their way as large a tax on the consumers as is the tax bill paid by citizens in nations with single payer systems. Likewise, the business of cost shifting to meet the expense imposed on the system by uncompensated care, much of it a result of federal mandates under “EMTALA”, is a tax, and so is the higher cost of dealing with sicker people in the absence of appropriate attention to timely prevention and screening for conditions treatable at an earlier stage at a much lower cost. And, for Part D to pay for pharmaceuticals “at the market”, rather than at a negotiated purchase price reflects the power that industry has in the shaping and influencing of public policy.
Michael Moore is showing leadership in promoting a solution that is significantly better than the current system. The policy bluffs apparently have no policy to offer that will correct this rapidly deteriorating problem. Their only agenda is profit over people and criticism instead of admitting that with the savings from a single-payer system we could creatively solve all of the “defects” they have imagined!
Healthcare in America is a disgrace and needs a Medicare type program across the board without privatization.. Like energy delivery, healthcare is a necessity and should not be for profit. Take out the administrative costs that result from the involvement of private insurance companies, all advertising and subsidize drug prices Sure there will be additional “taxes” but the percentage paid for healthcare could be based on a fair series of dedudtibles, copays and family income. Incentives to discourage overutilization could also be useful in lowering costs. For those who want additional coverage there would always be insurance companies to step in for an additional charge.
In my experience Medicare is sufficient for even major health problems, the drug portion could be picked up by one governmental entity and not hundreds. Why are insurance companies involved in Medicare anyway? Nevermind, I know the answer.
Excellent article about “Sicko” – a film and filmmaker that make me angry by their propoganda, but I can’t articulate the needed response.
When is somebody going to truly expose this guy? He gets all the attention because the left love him so much.
Here was another article that I thought was well-written:
http://www.canada.com/nationalpost/financialpost/story.html?id=45d10bdf-a2ee-4f0a-ac53-580c9864c16d
Thanks for your work – let’s avoid the fool’s gold of socialized medicine and also free up our system from the government controls and sue-happy public that drive up the prices.
With the presidential election coming up, I think now is the time to recommend some big changes in our health care system. The band aid approach hasn’t worked. I have been a general community surgeon in Plymouth, Mass. for 32 years, having retired in 2004.
I could go on and on about the changes I think should be made. Here are a few:
1. We should have a single payer system. The private health insurances have taken advantage of physicians and patients. They are one reason why our health care system is in trouble. I have been a patient as well as a provider and know first hand how the insurances are wrecking their havoc. I would be happy to provide you with many examples, however this not the time.
2. Our medical profession has been divided and conquered by many forces. I was closely involved with the Mass Medical Society suit against Blue Cross Blue Shield in the 1980’s. As you know, we won in the courts and lost big time in the legislature. Since then, the health care profession at least as I know it in Mass. has changed from a fairly collegial caring profession that tried to answer the needs of the communities to one of competition with specialties jealously guarding their turf and physicians being trained to answer the needs of their specialties rather than the needs of their patients.
Physicians are not being trained to go to a community and do what they can do well. An article in the Harvard Medical Alumni Magazine spoke to this problem, when a cardiologist from Bangor [the head of cardiology] took a sabbatical and spent 6 months pushing a cardiac ultrasound machine incognito around one of the teaching hospitals.
In my solo practice, in Plymouth, I saw how the Boston hospitals were competing with each other and feeding all kinds of public relations to the public encouraging them to get the” best” care in the center. Consequently more and more patients were going into Boston for care that could be given just as well if not better in the community. The care in Boston is two to three times more expensive.
I was a member of the New England Surgical Society, as was my father before me. The relationships among the New England Surgeons were very different for my generation compared with my father’s. The relationships among the surgeons in Boston changed as well, as the Mass General Hospital paired up with Brigham and Woman’s and the New England Medical Center and other good hospitals were left out. Because buying health care is not like buying TV sets, this has led to tremendously increased costs of health care.
Another example of trends that are increasing health care costs can be seen in my efforts to answer the health care needs in my community. When I first came to Plymouth in 1972, there was no surgeon interested in caring for patients with hand trauma. I had been trained in my residency in treating hand trauma. So I made a big effort to take more training and be available for our emergency room. After about 25 years of treating hand trauma as well as common office hand and upper extremity problems, I called the American Board of Surgery and asked them if I could take the Hand Certificate examination. HMO’s were not willing to list my name as a hand surgeon. The ABS refused to let me take the exam because I wasn’t doing rheumatoid hand surgery, pediatric hand surgery, replantation, etc. With Boston 40 miles from Plymouth my community didn’t need me to do those kinds of hand surgery. Consequently, although I had been taking care of hand injuries for 25 plus years, I couldn’t be recognized.
Several years before I retired, a young woman trained as a hand surgeon came to our community; however she didn’t want to cover the emergency room more than three days a month. Now that I am gone, most of these patients are going to Boston, and in some cases are being admitted to the hospital for one to two days for problems that I would usually handle in our minor surgery dept. in one to two hours and then send them home.
These are just some of the issues that really need to be handled by the medical profession as a whole. Perhaps a political figure such as an American President should formally charge our large umbrella medical organizations like the AMA or the ACS to create a more affordable health care system. As you probably know, the IOM’s Crossing the Quality Chasm doesn’t even mention the word affordability. If you have read this far, thank you. I know there is no easy solution.
[…] The first voice is a familiar one, for regular MFC readers. From the blog of John Goodman, the self-proclaimed “father of health savings accounts” and President of the National Center for Policy Analysis, comes a June 29th entry. Archly entitled “Michael and Me.” Goodman begins by charging that “Michael Moore didn’t want me to see SiCKO … [and] If you know anything about health care systems, he didn’t want you to see it either. At least, not at first. In the beginning, the only people allowed to view the film were reviewers who knew nothing about the subject. The apparent theory was: get it reviewed by people unlikely to spot all the errors and omissions before you open it to more discerning viewers.” […]
Get this bullshit off my computer. Anybody with a lick of sense knows that for profit healthcare is not healthcare at all. It is a profit center that cares about nothing but making money. When will you idiots from the right get a brain?
I lived in Victoria, B.C., Canada in 1996 for my job.
Victoria is the Capital city of British Columbia, Not a large city by any measure, modern, educated, beautiful, with two major Hospitals.
While I was there it was report in the news that (at two separate incidents) a person died while waiting their turn at the ER to get medical attention…this is occuring all the time throughout Canada…Take a Number…no matter how sick you are?
I went to a local doctor in Victoria when I came down with a sore throat, he prescribed a generic antibiotic…my cost at a Canadian national discount drugstore in 1996…slightly over $55.00 cdn…at the time the exchange rate made it about $32.00 usd.
When I got back to Seattle I check with my local pharmacy as to what the same prescription would cost me…the Seattle price was $18.65 usd
There also an article in the Victoria newspaper during that year that A Duncan, B.C. man (about an 75 minute drive north of Victoria) who did very well in business and became extremely wealth wanted to give a gift of thanks to his old home town by buy a MRI machine for the local community hospital…he would pay for everything, the construction of a MRI room the supplies the wages and supplies to run the MRI for 5 years…Since it was about a 4 1/2 month wait to get a MRI done in Victoria…you could have a growing tumour…but you had to wait in line to get a MRI to get a full medical report.
Instead of the provincial government saying thank you and issuing a required liscence to build and operate the MRI unit, the goverment said no…NO LISCENCE!!! The reason why…the answer was the government said they did not know where they would get the funding to run the MRI unit after five years….can you imagine the Canadians were incapable of planning for funding 5 years out…so they said no thank you.
Another true Story, my reguarly medical provider in Seattle in the mid 1990’s was Virginia Mason Medical Clinic and Hospital.
One of the local TV news stations (I believe it was KING5 News a local NBC Affilate) they were doing a story on a woman from the Okanogan Region of British Columbia, she had a serious growing cancer in Canada she had to wait for about 6 MONTHS before she could begin treatment…by them the cancer might have progressed to far.
Lucky for them they had an additional insurance policy (non governmental) that allowed her to travel to the U.S. for treatment right away. The TV station showed the RV that her and her husband drove down to Seattle and he stayed in while she was in the hospital and then when she could leave the hospital but needed to stay locally for radition and chemo treatment they both stayed in the RV in a parking lot across from Virginia Mason.
The husband and wife were on TV thanking all the local people for helping them during the wife’s stay.
In B.C., they people have a saying that what really runs the country is the “5-P’s”…Corrupt Politians, Pot Growers, Pimps, Prostitutes and RCMP’s (Really Corrupt Mounted Police).
It’s a really beautifil country…but after doing business in Canada the last 23 years I have seen up close a government ran medical system that is totally broken.
A country rich in natural resources that the Federal and provincal governments sell to the outside interests for pennies on the dollars while at the same time destroying their natural environment.
Just look at the Tar Sand area of Northern Alberta the size of New York State and they are Strip Mining the entire area…it is fast becoming a huge enviromental diaster and the Canadian Government knows it. This is not a country whose example we want to follow in anything but Peace.
As a disabled veteran who suffers do to service in U.S Naval Air Intelligence I strongly suggest you all read Kaiser Foundation study of the V.A. system. They rate it as the best health care system in the USA.
It is socialized medicine at its’ best. I have used your for profit sytem also, and found nothing but greed, doctors only interested in running a factory to process patients like cattle.
I will take the VA solicized medicine system anytime, everytime. And if you are only concerned about money, it is very efficient financially. Costs much less than WAR.
I suffered an injury to my hand with one finger requiring 3 sutures. I went to the ER of my local hospital and waited in serious pain for over an hour to see a doctor. I was not even offered a cold pack or a glass of water. Luckily I had iced my hand at home. I stood around bleeding and dripping ice. 3 xrays of my hand were taken and after about another hour I was stitched up. This cost me more than $800 and I do not have insurance. I earn about $400 a week. There is no way on earth you can justify this cost to me.
What do you think about annuities? Do you know some good annuity products? Found that http://www.bankerslifeinsurance.com/ have good rates. Do you know something better?