Our "Sicko"
Health Care System
by Milt Shook
Last
night, I went to see Michael Moore's new film, "Sicko." Let me start off by
saying that I am not the most rabid Michael Moore fan ever. I think his style of
filmmaking, while compelling, does a disservice to the documentary genre in some
ways, because while his films are factually accurate -- there is never an
untruth in any of his films, as evidenced by his numerous offers to his
opponents to come up with one -- he does cherry-pick facts at times, choosing to
examine some thoroughly, while ignoring others. "Sicko" is no exception.
Moore
does himself an injustice with this method of filmmaking. Throughout the film,
Moore lauds the Canadian, French, British and even Cuban health care systems,
which are excellent systems, to be sure. But not once does he mention the
problems. I don’t know much about the Cuban and French systems, but I have tons
of anecdotal evidence (the same kind Moore touts in this film, which is not a
criticism; I'll explain further on) that there are not insignificant problems
with the Canadian and British systems. There are sometimes long waits for
necessary procedures, procedures are sometimes denied due to cost, causing
doctors to alter their treatment a bit, and in some of the poorer areas of these
countries, the care is somewhat less than stellar. For example, a really good
friend of mine from just outside London has been dealing with her mother's
bronchial treatments for several years, and she has occasionally waited for
hours in emergency rooms, doctors do sometimes give a cursory examination when
something more detailed is needed, and hospital personnel have been rude and
obnoxious at times; they do, after all, work for the government.
The
thing is, such problems pale in comparison to the problems found in our system,
which means their inclusion in Moore's film would have actually enhanced the
message he made.
Now
that I have gotten the criticism out of the way, I will just say that you must
see this film. The most striking thing you will learn from "Sicko" isn't that we
seem to be the only industrialized nation in the world without a national health
care plan, or that our health statistics put the lie to the ridiculous notion
that we have the greatest health care system in the world. It isn't even the
fact that we are afraid of our government. But before I discuss the most
striking thing, let's talk about the other concepts, which are actually pretty
important, and which I have been writing about for ages.
We have
the best medical training facilities in the world, and we train the best doctors
in the world. We have top-notch research facilities, and the best medicines.
There is no doubt that, if potential were reality, we would have the best health
care system in the world. But the fact that we have all of that, and sit 37th in
the world with regard to basic health statistics, means that we have an even
bigger problem than most third-world country with no resources. The problem is
simple, and it can be solved easily. I know; you keep hearing these people
telling us it's a complicated problem, but it really isn't.
Let's
face facts; while our medicine is the best in the world, our health care
financing system is the absolute worst. We spend more money on health care than
any other nation on earth, and have little to show for all of that money, except
for a bunch of really neat-o machines, and a slew of really good doctors who end
up going elsewhere to practice. Of course, we also create a lot of health
emergencies, which only become emergencies because the patients are refused
treatment at a time before the medical incident becomes an emergency.
Oh, and
our health care dollars create an awful lot of really rich people. We'll get to
that later.
It's
really difficult to believe that anyone (except those who have gotten rich from
it) could possibly think our health care financing system was a smart way to go.
Think about how it works for a moment, and then explain how great you think it
is. But for the few who think it's just super, explain why our "super" health
care system is failing so many people.
As I
noted earlier, the first thing you think about when you see "Sicko" is that
these are anecdotal cases, and it's easy to dismiss them as such. The problem
is, all of us have such cases. Here are two of at least a few dozen that I could
tell you about.
In one
instance more than twenty years ago, a friend of mine went into the hospital to
have a baby, and developed a gall bladder problem which required surgery. The
baby's birth was covered by the state, but the surgery was not, and she and her
husband couldn't afford insurance. About a month after that, the couple received
a bill for nearly $30,000. They offered to pay $200 a month, which was all they
could afford at the time, but the hospital refused to accept the arrangement,
and they were forced into bankruptcy.
A few
years ago, a woman I know well was diagnosed with gall stones. The doctors
wanted to use ultrasound to break up the stones, so that they would pass, and
could be removed more easily. The HMO, CIGNA, refused to allow the procedure,
claiming that it was "experimental." She appealed the decision, but while she
was waiting for the review, she had to be rushed to the hospital for emergency
surgery. The doctor assigned by CIGNA then botched the surgery, and a week
later, she needed another surgery. The total cost was well into the six-figure
range, precisely because HMOs routinely denies coverage for basic treatment, and
did so in this case. Of course, she could have died, in which case CIGNA would
be out nothing.
In both
of those situations, in their zeal to "save" money, the hospital in the first
case and CIGNA in the second ended up incurring greater costs to the insured
population, and damn near ruined one patient, financially speaking, and nearly
cost the life of the second patient. And in both cases, the insured picked up
the tab in the form of higher hospital costs and higher premiums.
The
fact of the matter is, there are no "anecdotal cases" when it comes to something
as important as health care. If your loved one or best friend who is at risk,
because they're being denied crucial care because some jerk in a dark suit
decides it's "too expensive," the system has failed. And it's failed whether
that happens to 1 million people per year, or 1 person per year.
Most
people have no idea how much they pay for health insurance, because most who are
covered receive their coverage through their employer. But if your pay hasn't
been rising as much as it used to, blame at least part of that on the immense
cost of health insurance. If you are a worker with a family, your monthly
premiums likely top $800 for an HMO, and $1000 for a PPO. Yet as "Sicko" makes
crystal clear, that's only if you don't get sick. If you get sick, your coverage
will be denied. Of course, the more people are denied, the higher the cost of
medical care, and the higher the premium. See how that works?
You
see, if you or your employer pays premiums, it's because the insurance company
has decided that you're the ones least likely to need health care. The insurance
companies and medical corporations have created a Catch-22 situation that causes
your premiums to rise every year at a rate far higher than inflation.
First
off, you can only get health insurance if you're healthy. Insurance companies
assess individual risk according to how likely they are to actually need
treatment. If you are likely to need more than one or two routine doctor visits
per year, you will either be rejected for health insurance altogether, or
offered a rate that is far higher than everyone else. That seems fair on the
surface, right? After all, those who are at higher risk should pay higher rates;
it's only fair. After all, those who get into a lot of accidents or receive a
bunch of tickets pay more for car insurance than safe drivers; why should health
insurance be any different?
It
should be different because driving a car is a choice, while getting sick is
not. But beyond that, at a certain point, many patients are entitled to care,
such as when they are in tremendous pain, or their life is at stake. When
someone's cancer has progressed to the point that their pain is immense, doctors
have an ethical duty to treat. If an uninsured woman shows up at the emergency
room with a gunshot wound, the hospital cannot turn her away. And they all cost
a hell of a lot to treat. Those who are sick do NOT pay into the system.
Essentially, those who are most likely to need
care don't pay into the system. That means that those of us with health
insurance pay into the system for them.
When someone is forced to show up at the ER with a less than urgent medical
condition because they have no choice, they clog the ER and make it more
difficult to triage, and treat people as quickly as possible. All of that costs
money, and most people don't have the money to pay cash on the spot for their
health care. In "Sicko," the patient is given the choice; have one finger
reattached for $60,000, or the other finger reattached for $12,000. How many
people without insurance have that kind of money lying around?
The
answer is, not many. I remember a friend of mine used to be a billing
administrator at a large hospital in a large American city. In 1992 (and I'm
sure the situation has gotten worse), we were talking about health insurance,
and he told me that approximately 30% of the people coming into his hospital had
no insurance, and no ability to pay, and that their bills averaged 4-5 times
more than the bills of those who came into his hospital covered by health
insurance. But just under 99% of the money the hospital collected came from
insurance companies. Now, the hospital was non-profit at the time, but they
still have to cover their expenses, so the result was always a significant
increase in the costs of procedures.
Think
about that a moment. The insurance companies refuse to cover an ever-growing
number of people; people who are most likely to need health care. Those people
are entitled to care at some point, and will receive it, but they probably won't
pay because they don't have insurance or the money to cover the cost, the prices
rise for the insurance companies. Of course, the insurance companies then turn
around and raise premiums to you. In other words, folks, you are already paying
for catastrophic health care for those people the insurance companies refuse to
cover. People with diabetes, people with AIDS, hemophiliacs; they will get care.
If they don’t have insurance themselves, guess who's footing the bill?
And
these aren't people refusing to pay, either. Sure, there are some healthy people
who opt out of insurance. But many of the people who aren't covered can't get
coverage. And many of those people who can't get current coverage, are folks who
paid into the health care system for years, and because they don't have coverage
for a few months while they change jobs, or because their employer goes under,
all of that money has been flushed down the drain. Imagine you've had family
coverage for 20 years at $1000 per month, and you’ve never used more than a
couple of thousand dollars in coverage during that time, and you get diabetes.
Where is the fairness when the insurance company decides to cut you off
altogether? Where is all of that money you paid in all of those years?
The
thing is, it is a system destined to get worse. The higher premiums go, and the
more diseases science discovers, the more people will be forced to opt out. The
more people opt out, the higher costs will go, and the higher premiums go. It's
an insane cycle, and one which has already hit critical mass, as "Sicko" so
poignantly demonstrates.
You
see, Michael Moore's movie isn't about the uninsured, exactly. It's about the
extent of the insanity that surrounds the system with regard to the insured. As
I pointed out, the financing system is insane. Insurance companies provide
almost all of the money and they understand just how insane it is, but it's a
cash cow for them, so rather than fix the system, they've created a new game,
called "deny, deny, deny."
You
see, as "Sicko" points out, most of us only go to the doctor once in a while, so
we really only THINK we have health coverage. The Health Maintenance
Organization, or HMO, is not the brainchild of a doctor, but the creation of
greedy corporate pirates. This is how it works, in a nutshell; The greedy
insurance company gives the greedy medical corporation a lump sum for every
patient it enrolls for their medical corporation. The greedy medical corporation
then gets to keep whatever it doesn't spend. So, there you have it; a health
care system in which hospitals get paid for NOT treating people. It kind of
reminds me of the jokes we used to tell back in the 70s, about the government
paying farmers to not grow certain crops, doesn't it? Now, when you go to a
doctor with an illness, he makes more money by giving you less treatment.
Imagine having a job like that, huh? Getting paid more for doing as little work
as you can get away with sounds great doesn't it?
The
result of all of this is that hospitals and medical corporations are required to
maintain huge administrative staffs (paid for with your premiums!) who do little
more than deny people treatment. They pretty much deny everything that isn't
absolutely routine, and then count on the fact that patients will sulk and think
there is nothing they can do. One of the most compelling scenes in "Sicko" is a
video of a deposition, in which a hospital administrator is asked about
documents denying coverage for patients. His signature appears at the bottom of
all of them, but he never looked at or signed any of them; the signature was a
stamp, applied to the letters by clerks, who were instructed to deny damned near
everything.
There
is also nothing insurance companies seem to savor than the concept of
"pre-existing condition." When you, the insured, walk into a hospital or medical
center, you'd better hope that there is no way to trace when you developed your
condition, because if you walk in with a finger dangling off, but you were
treated for a hangnail two years earlier, expect a fight on your hands, because
they will try to claim "pre-existing condition." As the film showed, they will
pay investigators big bucks to try and uncover some evidence that your hernia
may have existed before you walk into the doctor's office.
In
fact, I know of one person who went to the doctor to treat a hernia. The doctor
admitted him, fixed the rupture, and sent him home. Weeks later, he received a
notice from the insurance company that they had declined the procedure -- AFTER
he had already healed -- and insisted that he pay almost $7000. The reason? It
was a pre-existing condition. You see, he had worked for one employer for 13
years, and had been with his current employer for two years, and someone had
determined that he had ruptured himself more than two years earlier. They were
wrong, of course; he'd had it for only a few weeks. But that wasn't the odd
thing. The odd thing was that there had been no gap in coverage between jobs,
and his precious carrier was the same company!
You
see, that is the main thing I found striking about this film; the main thing I
got from it. Why are we so afraid of large corporations? Why do we allow a few
people with lots of money but no scruples run so much of our lives?
I
understand why people are afraid of the government; especially the one we have
now. Even before Bush, however, the wingnuts in charge have always tried to
intimidate us into compliance with their will. Is there anything more terrifying
than the prospect of an IRS audit? If you speak up against them about domestic
spying, will they hold it against you? How about that police officer driving
behind you on the way to work this morning? Or the multitude of signs along the
highway warning you of the use of radar? The government can be very scary, to be
sure.
I can
almost understand allowing people with boatloads of money run our gasoline
prices up to $3 per gallon; they lulled us into thinking that gas prices would
always be cheap, and got us to fall in love with vehicles most of us don't need.
(Seriously, every time I see a dark suited city dweller pull his pickup into the
yuppie condo parking garage, I shake my head and laugh.) That's our fault. I can
even understand the appeal of a corporate pirate like Wal-Mart, because even
though they devastate the economy on many levels, they bring low prices, which
seem to be the "shiny keys" the people in power use to distract us from what's
really going on.
But
when it comes to health care, large, greedy corporations are literally killing
people. They deny coverage to people who are sick, thus ensuring that they
remain sicker. They are denying treatment to people who have been paying for
insurance for years, by deeming said treatment as "experimental," and then
handing themselves huge bonuses for doing so. Greedy corporate pirates are
substituting their judgment for that of trained medical professionals, and they
are putting said medical professionals in the position of having to alter their
judgment to fit the realities of the insurance companies.
Should
we allow rich greedy corporations to run our lives, to the point of giving them
the power to decide who lives or dies? Do we honestly think that these
corporations are saving lives? I don't think we are, but we're afraid that if we
speak up, they might just look at our policy and find some reason to deny us
coverage. Do we think the pharmaceutical companies market their products with
our health in mind? Of course they don't. These companies don’t care about your
health; they only care about how many units of product they sell, and how much
money they make on each pill. The huge insurance companies only care about how
much money they can skim off before they hand money to the large medical
corporations, and the large medical corporations only care about making their
sugar daddies, the insurance companies, happy
Good
health should be a right for all people, folks; not a privilege based on your
wealth. We cannot call ourselves a "free country," when everything you work for
your entire life can be wiped away because you get sick and either don't have
insurance, or the insurance company denies your claim. We live in the only
country in the supposedly civilized world in which someone can die because they
don't enough money. We live in the only country in the world in which someone
else can pass on an illness to us, and that illness can cause us to lose our
house, or be forced to declare bankruptcy.
I
refuse to be so cynical as to believe that our health care system is a
reflection of the people living here. When tragedy happens elsewhere, we hold
out our hand and help however possible. Most of us do what we can to help when
we can. So, the question is, why do we have such a health care system in this
country. As Moore's film points out, most other nations take care of their
people, while we, the nation so many like to refer to as a "Christian nation,"
throw our sick out on the street, or don't take care of them at all, unless they
have lots of money. The system we have is immoral, it's destructive, and it's
costing the lives of so many of our friends and family. And all in the name of
greed. We are being screwed by our health care system, and the only solution is
a single-payer system. It's the one that has been proven to work all over the
world
Again,
I am not saying that single-payer systems are perfect. But the fact of the
matter is, there is a distinct difference between having to wait a few months
for non-emergency surgery, and being denied the surgery altogether. And
absolutely no one in those countries dies because they don't have "enough" money
for treatment. No one is refused treatment because they don't have insurance. If
they are sick, they go to the hospital. They are not considered weak because
they go to the doctor, they are not fired from their jobs because they happen to
become ill. They don't lose their credit rating because they're suddenly smacked
with a bill they can't afford to pay.
If we
covered everyone, then everyone who is paying now would pay less; far less. If
prices on equipment and drugs were negotiable, we would all save money on the
system. If people could go to the doctor of their choice, whenever they felt
they needed to, the only people in the emergency room would be people needing
emergency care, which would save us money.
More
importantly, we'd have a healthier, more productive nation. We wouldn't have
pockets in this country where the non-violent life expectancy is comparable to
the poorest areas of Africa and Asia. We wouldn't have bankruptcy courts jammed
with people whose only fault is that they became ill at a "bad time."
And
contrary to what the people who support the status quo will tell you, the greedy
insurance companies won't have to go out of business. A national health care
system should only cover those things necessary for a healthy life. Insurance
companies could sell insurance for health care that goes beyond the basic
entitlement. The rich will always want care that is far above that of the
average person, and of course, they should be entitled to that. There will be
plenty of opportunity for insurance companies to fleece people with money even
after single-payer coverage is passed.
Our
health care financing system is wrong, it is immoral, and it must be changed. As
Moore rightly points out, there are plenty of models out there; let's use one.
Our children are already being saddled with insurmountable debt; must we hand
them a broken health care system, as well?
Please;
everyone go see "Sicko" when it opens next week, and then write your
congresscritter and do something about it...
