Friday, June 29, 2007

Sicko: A Michael Moore Film

Sicko: Lions Gate Films / The Weinstein Company, 122 min, PG-13

A Michael Moore Film.. Indeed.

One of the last lines in the film has a bit of pontification. Moore says something like, other western countries have learned to think about “we” instead of just “me”. He shows the good life in Canada, Britain, and France, emphasizing that not only, particularly in France, is health care socialized and universal, but so is day care, with lots of paid maternity or paternity leave, college education, and so on. They pay higher taxes and seem to have their cake and eat it to. One economic explanation is much lower personal debt, and greater social stability. Of course, conservative critics will be able to find a lot of things that are not so good in Europe (the disenchanted and unassimilated Muslims). But he raises a good question. This movie is about a lot more than health care policy. It is about our fixation on individualism and where individual responsibility as a component of freedom must fit.

In fact, in the U.S., where we have our own special heritage of the division between rich and poor (starting with slavery), we’ve developed a mentality whereby the individual proves that he “deserves” to be better off by competing with other people. Particularly by proving you can “compete” to have and raise a family better than other people. At least, that is how I perceive a lot of the attitudes. Europeans, whatever their history of royalty, have gotten beyond this it seems.

In fact, as Moore points out, the American big business benefits from keeping working people in a state of fear – especially in debt. That theme seems to underscore how the American health insurance industry behaves, where, as he points out, it has an inherent conflict of interest with taking care of people. The companies actually hire physicians to break their Hippocratic Oath and deny claims according to a quota.

Now I had covered some of this with the previews that had been aired on Oprah and on The View, at this link:
Moore says that this film is for those who "have" insurance. Indeed, in 1998 I had to go through the run around with Health Partners in Minneapolis to get credit for all the proper referrals after my acetabular fracture and surgery (I was taken to the wrong hospital, for openers, by the ambulance), but eventually I prevailed (by talking about getting another lawyer) and the final total bills, after in network discounts, were very reasonable indeed for the whole episode (about $14000 total).

The film – long for a documentary -- is quite funny, with continual ironies and wisecracks, and one-liners from president Bush where he seems to make a fool of himself. Visually, the filmmaking picks up steam toward the end with the trip to Guantanamo and Cuba, where three 9/11 volunteers get first rate medical care at the Havana hospital in Communist Castro Cuba. It is all bewildering, or is it just show.

Of course, we need to ask the right questions. What about the waiting lists in Canada (where there is doctor choice) and Britain and France (where medicine is totally socialized). The problem with single payer is that level of care has to be politicized. It would give the state a legitimate excuse to meddle in private behavior (sexual, tobacco, drugs) etc. (In Britain, government-salaried doctors are paid bonuses for getting patients to kick the habit.) In theory, if you have individual moral hazard, government has no reason to meddle. You let everyone take care of the self. And of his family. (You get into filial responsibility as a moral issue – to keep expenses of eldercare off public doles). But Moore maintains western Europe (and Canada) have gotten beyond that. We wonder why. In France, for example. singles and gays don’t seem to be burdened with subsidizing the childcare expenses of families through the workplace and taxes, partly just because the workweek is shorter and many services (not just health care, but public transportation) are better.

There is also the question, just how do we get the accurate information on health care. K-Street lobbyist support companies hold their numbers and tables to the vest, and with all the wonders of the Internet, it is still hard for the average person to figure out what is going on, with basic information about exclusions, retroactive cancellations, denials, and in more socialized systems, the rumored waiting lists. Moore never mentions that health care for overflow Canadians is big business in rust belt cities like Detroit, Cleveland, and Buffalo.

I wondered about the employees in the health insurance companies, making a living by doing what they know is wrong. One guy called himself a "hit man", paid to go back into a person's background and look for the most trivial mistakes in an application in order to cancel policies retroactively. Another woman who worked in a call center talks of knowing that many people will eventually be turned down. Something like this makes me glad that I am retired. Many people, it seems, have to do things they are not proud of to make a living and raise their families.

Maybe this is a good time to go back and rent the 1997 Francis Ford Coppola American Zoetrope (and Paramount) film of John Grisham’s novel “The Rainmaker” with Matt Damon and Danny De Vito, where Damon plays a young lawyer who helps a family with a teenager with cancer, after multiple denials set up by the insurance company.

The film did not cover two important ancillary areas. One is dental care, because dental problems can lead to major medical problems. Most employer-sponsored dental plans covered needed optimal treatment for many problems poorly.

The other is that Moore doesn't mention that even Britain and Canada don't cover long term custodial nursing home care for those with assets. Given demographics, eldercare has become potentially one of our most serious issues. It's easy to imagine a documentary on this, about abuse in nursing homes, problems in assisted living facilities, including the problems with staffing them given our immigration concerns. We do face the enforcement of filial responsibility laws down the line, and we haven't started debating that much yet.

Moore shows quite a but of the British National Health Service (NHS). It is remarkable that media sources now report a doctor shortage (despite the comfortable income and million dollar London flat of a British family doctor in the film), resulting in immigration of physicians without usual work visas. A few of the suspects in the London-Scotland plot and incidents this past June 30-July 1 weekend were Middle Eastern physicians or health care "professionals", supposedly adhering to a Hippocratic Oath.

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