Wednesday, July 11, 2007

"Sicko" For What Ails Us

Sicko opens in Pensacola this coming Friday, according to one local radio report we've heard. And it's coming soon to Gulf Breeze Cinema 4, although theater manager Neal Winkler isn't sure just when. It seems Michael Moore's latest documentary is such a box-office smash that the bigger theaters are getting first call on all the prints.

Meanwhile, nearly the whole of the Internet is buzzing about director Michael Moore's entertaining slap-down of CNN's Wolf Blitzer here (Part 1) and here (part 2) and his web reply to CNN's embedded sawbones, Dr. Sanjay Gupta.

Yet, almost surely the most detailed and knowledgeable review of the substance of Michael Moore's new documentary -- and, beyond that, of the troubled U.S. health care system and its many betters elsewhere in the world -- was broadcast earlier this week on WHYY-FM's "Fresh Air." Radio still does it better.


If they gave awards for the best interview on radio or TV, this one would win a Pulitzer. Everyone who wants to have a say in any future discussion about the U.S. health care system should give it a thorough listen.

Turn on your speakers, sit back, and click this link to hear the superb 41-minute interview conducted by Terry Gross of University of North Carolina's School of Medicinesocial medicine professor Jonathan Oberlander.

What did you think of Michael Moore's 'Sicko'? Terry asks early on. Prof. Oberlander answers, "He gets a lot right about the American health care system and really shows how the system doesn't work. He cuts a few corners and leaves a few things out which admittedly are hard to get in, in a two hour format."


There's more to the interview, a lot more. And that's the point. More about the Canadian system, the French system, the German system, and the Australian system; as well as a lot more detail about our own systemic health care ills. Every one of these nations, Oberlander says, "rations" health care in one way or another -- including us.

"We in the United States don't like to think that we ration health care, we pretend we don't ration." We indulge in the fantasy that the others have embraced "socialized medicine" -- a "meaningless" but politically powerful phrase, Oberlander says.

"But the truth of the matter is that we... ration medical care, too. We ration it according to your insurance status." That form of rationing, Oberlander adds, "is much more severe than any Canadian rationing."


If we ever grow serious about reforming the U.S. health care mess, the clear-eyed Oberlander says we needn't look far for a model to emulate: our own Medicare system. It works well. It has achieved much lower administrative costs than is achievable in the corporate-profits -obsessed private insurance industry. And, it has demonstrated over more than forty years an effective approach to universal eligibility that could be easily expanded to include everyone regardless of age.

However, because of what the professor delicately terms "political barriers" in the U.S., it seems unlikely any future Congress or president will achieve universal health care solely through expanding Medicare. This is because the real difficulty in reforming medical care in the U.S. is political, rather than medical or administrative or even economic.

As Oberlander describes Sicko:
One of the more amusing and also poignant scenes in the movie is where different members of Congress are walking into a room and Michael Moore puts price tags above their heads. The fact of the matter is the way we finance elections in this country allows the pharmaceutical industry and the health insurance industry and a whole lot of other health care interests to fund campaigns. They can put a lot of money in those campaigns and put a lot of money into political parties. And once you've given that money the question is, "What are you buying for that money?" And, I think it makes sense to assume in many cases that they are buying a sense of political obligation and a sense from those members of Congress that take the money that they're not going to rock the boat, they're not going to upset the status quo.
As for the American Medical Association, Oberlander tells Terry Gross, "organized medicine for most of the twentieth century was the number one opposition to national health insurance." They opposed not only universal health care, but also Medicare, Medicaid, and prenatal care and medical care for children programs.

These days the AMA has softened -- ever so slightly -- but it's no longer very organized, Oberlander says. It represents "only around forty percent of physicians. The result is the AMA doesn't really speak for all, or even most, American physicians any more."

Still, the AMA, too, remains a powerful special interest well-positioned to buy its share of politicians. Currently, the AMA is on record as favoring what Oberlander describes as an "incremental agenda" for expanding medical care. Better than outright opposition, perhaps, but --
one gets the sense that they are much more deeply involved in complaints over medical malpractice and fights over what Medicare is paying physicians than they are in advocating for the uninsured. If they would advocate for the uninsured with the same intensity that they advocate for medical malpractice reform we might actually be able to break the impasse."

Prof. Oberlander says that Moore's film effectively contrasts the over-priced, inefficient, and inadequate U.S. health care system with the foreign systems in Canada, France, Great Britain, and Cuba which he, too, has studied. But if we are someday to look overseas for models to be adapted here at home, he suggests U.S. corporate interests should find some more politically palatable than others. Those that retain a measure of the "status quo" for privately owned health insurance companies are least threatening, and therefore have the greater chance of gaining political favor.

Given the political reality that we citizens routinely reelect congressmen and senators who have already sold their souls to the 2-trillion-dollar-a-year health insurance industry, Oberlander says if Michael Moore ever makes a "Sicko II," he'd like to send him to Germany and Australia. Every nation's health care system is to some degree fashioned by its own history. But these two countries "do use private health insurance in their universal coverage systems" and their systems "are employment-based." Given the degraded politics of contemporary America, "if we're really going to get universal coverage... probably we're going to continue to have a mixed system" of private and public health insurance, Oberland concludes.

In Germany the insurance companies "are non-profit" and "highly regulated." They are forbidden from charging "sick people more." Insurance is tied to employment, but for the unemployed the government helps "buy" them into the system. In Australia, a "mixed system" of private and government insurance companies prevails. Everyone is entitled to basic health care, but the very rich remain free to buy additional private insurance.

To achieve universal health care in the U.S. under such a system, Oberland adds, the reforms would have to be "the kind of reforms Clinton wanted back in 1993. They're exactly the kind of reforms that we would have to have" if we went to a system like that in Australia.


A recent study by the McKinsey Global Institute mentioned in the Oberlander interview found that under the present American health care system the U.S. expenditures for administrative and associated "intermediation" costs total $98 billion per year. Oberlander says Michael Moore's film, Sicko, offers excellent illustrations for what that "staggering" number means in every day life (or death) to real people.

Another study Oberlander mentions, which we surmise is the oft-cited 2004 paper published in the New England Journal of Medicine by Woolhander, Campbell, and Himmelstein, found that 30 percent of all health care costs in the U.S. is spent on insurance company administrative expenses. Such expenses include the time, effort, and expense private insurance companies spend on "fighting" with customers who become sick, "figuring out how much they're going to charge people, figuring out how sick people are, figuring out whether they're going to insure them at all," and then marketing those policies.

It's all money that could, and should, go toward actual medical care. It's hideous to waste such vast sums.

In the health care systems of more advanced countries such expenses are dramatically lower. For example, the administrative costs of Canada's universal coverage system are "about 17%" of the total spent on delivering health care, or nearly half as much measured as a percentage of total health care expenditures.


The independent Portland Mercury sums up its review of Michael Moore's new movie, Sicko, this way:
He's recast the debate in terms we can all understand— explaining the problem as "[here is] what the greatest country ever in the history of the universe does to its own people, simply because they have the misfortune of getting sick."

But will Americans listen? And if they do, will they join Moore in demanding a solution?
We would sum up the Fresh Air interview with a familiar TV pharmaceutical sales pitch, not a question: Tell your physician, your health insurer, and most especially your congressman that you want some of that "solution" to cure what ails us.

1 comment:

Sicko said...

Click on my name to see the entire SiCKO online.