Sicko diagnoses our sick political system

| June 30, 2007 | 16 Replies

What is it to be “sick”?   According to Merriam-Webster, there are two definitions:

1 : affected with disease or ill health
2 : spiritually or morally unsound or corrupt

This afternoon I viewed “Sicko.”  I was one of the many audience members at the theater who applauded at the film’s conclusion.  Sicko will serve provoke much-needed discussion regarding the American health care system.  Sicko invokes the second definition of “sick” as well.  My hope is that Sicko will also provoke desperately needed conversation, as well as substantive changes, to the American political system, where money acts as a virus and where the equivalent of white blood cells–the Media–has long gone into hibernation. 

I am not optimistic about any self-instigated change in the American political system, but perhaps Sicko will provoke the media to start digging into the millions of health care injustices in America.  These compelling stories are there for the taking.  Perhaps these many cases where health care is being unfairly denied to Americans will at least occasionally start showing up on the front pages of America’s newspapers.  Before Sicko was released, the undeniable fact that America is having a health care crisis was not considered newsworthy by the corporate media.  Nor has any real healthcare conversation occurred in this country since Hillary Clinton was bludgeoned into silence on the issue thanks to more than $100 million spent by healthcare corporations more than 10 years ago.

Our political system is wretchedly sick.  Moore makes this clear when he shows us a large room full of members of Congress, complete with little green tags superimposed to show how much money each of them has taken from big healthcare corporations.  

Sicko is not just about the uninsured.  It is also about those who have insurance.  For that reason, this film should be of interest to both the 50 million Americans who don’t have health insurance (18,000 of them die each year because they are uninsured) as well as the quarter of a billion Americans who do have insurance.

Our health care insurance system is horribly sick (again, in the sense that it is spiritually or morally unsound or corrupt).  American health care insurance is based upon the idea that you become highly profitable by denying claims to people who deserve reimbursement and who often happen to be dying.  They can always go to court, of course.  Then, when the jury renders a large judgment against the insurance company, the relatives of the now-dead insured person can enjoy the money.  How do those numerous healthcare claims get denied?  It’s easy.  Doctors hired by the insurance companies stamp their names onto denial letters that are cranked out en masse by insurance company computers. 

Keep in mind, that no insurance company executive needs to go around with horns or a pitchfork telling doctors to deny claims that they shouldn’t deny.  No one has to tell anyone else to screw the sick people.  All the insurance companies need to do is to put the right incentives in place.  In Sicko, Moore makes it clear that the insurance companies have implemented carefully crafted schemes along those lines.

As you might expect in a Michael Moore film, you will find some imaginative and effective ways of portraying complicated issues.  I don’t want to spoil the film by detailing any of these here.  Suffice it to say that you will get your money’s worth if you go to see the movie.

Moore attacks the “socialized medicine” bogeyman with gusto.  With some clever use of older video materials and historical political archives, Moore mocks those who would shoot down the idea of socialized medicine as un-American.  After all, what’s so bad about socializing a service that should be socialized?  For instance, we have socialized firefighters and socialized teachers working in our public schools. As has been well publicized already, Michael Moore spends considerable time exploring the socialized medical systems of Canada, Great Britain and France.  Many of the one-on-one interviews Moore conducts with those involved in those “socialize” ecosystems involve Moore at his best.

An interview with a British doctor is entertaining and edifying.  Moore carefully points out that in countries with “socialized” medicine, the doctors received bonuses if they can convince their patients to make better health choices such as giving up smoking and reducing their blood pressure.  This incentive program contrasts nicely with the scheme by which American insurance companies make money by endangering the health of Americans (through denial of services).  One thing and Sicko failed to do is to point out that American citizens really should bear more responsibility for their wretched health.  Many of our health issues are brought on by our own shortsighted behavior, including our over eating, our smoking, our excessive drinking and our lack of exercise. Then again, this responsibility comes full circle, because of the conspicuous lack of public health measures in the United States.  Americans would be more healthy if they were provoked to be more healthy in dramatic ways.  We need to compete with the huge advertising budgets of private corporations peddling their unhealthy goods and services to Americans.  We could make some progress if the federal government would fund prime time television announcements concerning public health, using videos created by the best minds of Madison Avenue.

I need to be careful about pointing out where Moore is at his “best.” He is strong with the one-on-one interviews with regular folks.  He is strong when he resorts to taunting those who are powerful and uncaring.  He makes effective use of statistics (according to CNN, Michael Moore’s facts are checking out quite well).  Moore is also strong when he discusses the proper purpose of government.  For instance, in one interview it is brought out that there are two ways to control people.  You can frighten them or demoralize them.  These are tactics that both succeed in keeping people from coming out and voting.

Although it is not specifically presented in Sicko, Michael Moore has issued a three-point Health Care Proposal that would provide free medical care for every resident of the United States.  Whether these aims can be accomplished in exactly the way Moore proposes is only a starting point for the discussion.  I believe that, at a minimum, there should be a basic level of healthcare guaranteed to every U.S. citizen that is funded by the government.  If you break an arm, if the baby has a high fever or if you have chest pains, for instance, it is in the national interest that medical care providers are funded by the government to provide that medical care, no questions asked.  

Thorny questions remain as to the extent the government should fund experimental treatment and extremely high-priced end of life treatment.  A government that is willing to spend all funds necessary to keep all of the Terry Schaivos of the U.S. “alive” would quickly bankrupt our system (there are as many as 40,000 such “people” in the U.S. at any given time).  The huge amount of money spent to maintain even one such person could go far to help many families needing primary or preventive care. Therefore, medical issues are interlaced with moral issues.   In the U.S. these issues are interlaced in a contorted and highly politicized way that ignores the plight of the numerous U.S. families desperate for basic medical care for their children.

As much as we might not want to think about it, we do need to allocate our limited budget dollars among many social needs, and medical care is only one of these critical social needs.  For instance, medical care tax dollars would necerssarily compete against education dollars.  Reasonable people might differ on how to best allocate money to these big ticket items.  It is important to note that the Canadian health care system Moore admires in Sicko does not cover all medical expenses.  Many Canadians supplement their guaranteed coverage with private insurance.

The point is that we do need to have a frank and national conversation on all of these issues so that there will not be a need to cause acute national embarrassment to our country (in five or ten years) with a film called Sicko II.

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Category: American Culture, Health, Medicine, Politics, Psychology Cognition

About the Author ()

Erich Vieth is an attorney focusing on consumer law litigation and appellate practice. He is also a working musician and a writer, having founded Dangerous Intersection in 2006. Erich lives in the Shaw Neighborhood of St. Louis, Missouri, where he lives half-time with his two extraordinary daughters.

Comments (16)

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  1. grumpypilgrim says:

    I've never understood how a country as rich as America could tolerate such abominable healthcare protection for its citizens. Among First-World countries, America doesn't even rank among the top ten when it comes to many measures of health (e.g., infant mortality, obesity, heart disease, etc.). In many cases, the U.S. even ranks below less-developed countries such as Cuba.

    The other thing I've never understood is why health insurance is so tightly linked to our employers. We don't get our car insurance or homeowner's insurance through our employers, so why should we depend on our employers for our health insurance? Why are Americans held hostage to their jobs for access to reasonably-priced healthcare? It just makes no sense. It makes people terrified of losing their jobs, which I suppose is why corporations remain silent about it: they have a strangle-hold on health insurance that keeps employees obedient and dependent.

    Furthermore, the economic argument against universal healthcare is nonsense, because so many European countries have both universal healthcare *and* a more robust economy (just check the exchange rate on the euro versus the dollar). If the Europeans (and even the Canadians) can provide universal healthcare without wrecking their economies, then why can't the U.S.? Conveniently, Republicans opposed to universal healthcare never answer this question; they merely declare that it would be a disaster without providing supporting evidence.

  2. A friend at work was commenting on this movie and it seemed his only concern was that we must not move to a universal system because of the time his relatives in England had to wait on a list for an operation. I thought he was missing the point. First we must admit that what we are doing is not working, then we have to figure out how to fix it. The profit motive in healthcare seems to have become it's only motive.

    http://www.naturalcures.com

  3. Erika Price says:

    Boondoggles such as these really slay me because of how self-perpetuating they become. Grumpy points out that the link between jobs and healthcare make many Americans slaves to their employers. This makes it nigh-unaffordable to quit or change jobs in many instances, especially if you want to venture into self-employment or entrepreneurship. As a result, most people remain locked to their big-company jobs, which just makes this big-company-dependence so powerful and inescapable. It comes as no surprise then that these big corporations "rule" so much of our lives.

    Companies have now begun to <a rel="nofollow" href="http://www.boston.com/business/articles/2006/11/30/off_the_job_smoker_sues_over_firing/"&gt; fire employees who smoke, because it raises health insurance costs to the company. I don't care how much you detest smoking, or even how much you detest the smoker's cost to the rest of us in insurance payments. The fact that a company can attempt to control our lives away from work terrifies me to the core. Where does loyalty to a company end and personal life begin?

  4. Erich Vieth says:

    As we appoach Independence Day, let us all remember that we're celebrating that we're not British. It's hard for me to celebrate, though, knowing that I pay $1000/month for medical and dental insurance for health care services that the British government provides to all of its citizens.

  5. "knowing that I pay $1000/month for medical and dental insurance for health care services"

    Is that the amount you have to pay when you are self-insured? Does it cover your family as well?

    I thought people in the States who don't work get Medaid (or was it Medicaid?)? What does "universal health care" mean exactly?

    "health care services that the British government provides to all of its citizens"

    If it's free, but not really good, it doesn't help much either. Brits for example do not seem to be known for good teeth.

  6. Ebonmuse says:

    "A friend at work was commenting on this movie and it seemed his only concern was that we must not move to a universal system because of the time his relatives in England had to wait on a list for an operation."

    Isn't this basically like saying that I want other people to be denied health care so that I can jump to the head of the line? If there is a waiting list, it must be because people need medical care, and if there's no list, then that may mean that people who need care aren't getting it.

  7. Ebonmuse says:

    By the way, I saw this movie in Lincoln Center last week, and Michael Moore was there in the theater afterwards. :) He didn't really give a speech, since he was being mobbed by a cheering crowd, but it was still a very cool experience. Okay, I'm done gloating now.

  8. Erich Vieth says:

    projektleiterin: My employer pays my health coverage. For me to cover my spouse and two children costs me $1000/month.

    I am fortunate enough to be able to make those payments. What's scary is that there is no possible way for many people to insure their families.

    Your comment didn't raise the following issue, but I need to address it. Many people out there are against "socialized medicine" because they'd rather engage in the blame game. In the minds of many people who oppose government provision of health care, the people who don't have health care all deserve their plight.

    Tens of millions of people have no meaningful access to health care. That's a fact. It's important to note that there are many types of people in that class. Yes, many of them have made bad financial decisions–had they made better decisions, they might have had some coverage. But there are also tens of millions of ininsured (I know some of them) who are working hard to eke out a living. If they paid for medical insurance, they wouldn't be able to afford their modest car or their modest apartment. And consider, what is the price someone should pay, when that person COULD have afforded health insurance, had they worked harder (maybe taken a second job)? Do we let them remain sick and sometimes die? Is that ever in the national interest?

    I can't help thinking about people with broken arms, babies with high fevers, people with horrible pain that they choose to live with even though they are still in that a tiny window of time where their condition is still treatable. I think of people feeling the throb of aching rotting teeth, month after month. A good friend of mine has two adult relatives who are mentally retarded now, because when they were babies, their young poor mothers couldn't afford the fee to take their babies to the health clinic. Is that ever in the national interest to have people not get basic treatment such as antibiotics? I think not.

  9. Devi says:

    projektleiterin: To answer your questions about Medicare and Medicaid:

    In the US, nearly all people pay about 7.5% of their earnings to a federal retirement and disability program, and their employer pays a matching amount. If you are self-employed, you pay both parts. Participation is NOT voluntary. There are a very few professions that are not covered, railroad employees being one and if I remember right, federal legislators do not pay into the system. When a person retires and collects a pension, they also get Medicare. They still have to pay a monthly premium, but it is very low (around $50), but it doesn't cover much in the way of medicines or any long term care like nursing homes. People who become disabled before the retirement age, if they have paid enough into the system, can also receive a pension, but the Medicare benefits do not begin until the person has been receiving the disability pension for two years. In other words, you work for years, become disabled before 65 (or 66, 67, the age requirement is increasing), you have no medical care coverage unless you can buy your own. Course, since you are disabled, no one will sell you health insurance, at any cost. I wonder if they hope the disabled person will die first. I have a friend who has cancer, was determined to be disabled 23 months ago, and has waited without treatment ever since. She will receive Medicare benefits in a month and can get treatment, but I'm worried that it will be too late.

    Medicaid is welfare. It is extremely limited, and is largely state controlled. So where you live can determine whether you qualify or what it covers. In many, many cases, doctors refuse to accept Medicaid patients because (1) the payments from medicaid are much less than the standard fee and (2) the government sometimes makes these health care providers wait many months for reimbursement. A number of years ago, the only doctor in town that could be counted on to accept new medicaid patients had to close his practice and declare bankruptcy because the state had not made a single payment to him in over a year.

  10. Erich Vieth says:

    Devi: Medicaid is also used by some folks you wouldn't think of a welfare-recipients. When elderly people can't take care of themselves in their own homes, they start looking at nursing homes. I'm amazed that the sticker shock doesn't just finish them off, frankly. $30,000-60,000 per year is a number often mentioned.

    This kind of expense can bankrupt many people quickly. Thus the topic of medicaid. There are lots of strategies for spending down your assets if you will be checking into a nursing home for the remainder of your life. But there are also hazards to doing this spend-down legally. If it's done correctly (this often occurs merely by the person paying the nursing home bill for a year), the middle-class person becomes a poor person and then medicaid kicks in to assist the "poor" person. This becomes especially tricky if the person going into a nursing home is still married and the spouse wants to remain in the family home. If you know anyone who needs to go to a nursing home permanently, I'd advise that you have that person see an attorney that specializes in issues relating to the elderly. See here for some more information: http://www.dhss.mo.gov/NursingHomes/SelectNH.html

    In the meantime, any real discussion of national health care should deal with the role that government will play in funding nursing home care.

  11. Vicki Baker says:

    Regarding Ebonmuse's friend, who was worried about having to wait in line for medical care in a British-style system – in Britain at least there is also private medical care and some doctors see both NHS and private patients. You can also buy private medical insurance.

    Another thought: I think most hospitals do provide care for life-threatening situations without reference to the patient's ability to pay. When the patient can't pay the bills, the cost gets passed on to the rest of us. So we already have socialized medicine, in a very stupid, inefficient form.

    I think the die-hard Adam Smith fans are just going to have to realize that the invisible hand of the market in the health care industry is not doing much to hold down costs or provide a reasonable standard of care. The insurance industry is just a giant parasite that siphons money out of the health care industry while providing no services besides another layer of bureacracy.

  12. Erich Vieth says:

    Here's an inspiring story of what happened in Texas after a showing of Sicko. Michael Moore is the kid who shouted "The Emperor has no clothes." This is going to end up being a pointed battle between lobbyist money and the will of the People. We could really use a Mainstream Media with balls now so that the good guys have a chance. http://www.cinemablend.com/new/Sicko-Spurs-Audien

  13. Dan Klarmann says:

    Actually, the FICA bite is over 14%, not 7.5%. The other half is hidden from employees as part of "benefits", unless you are self employed. A useful guideline is that it costs a company double your annual salary to have you work there. Employees don't directly see the costs of the FICA half, health, disability, and unemployment insurances, regulatory costs for the space you occupy, and so on.

    My largest single expense category (after taxes and direct business costs) is health insurance. And that's just for 2 adults.

    Insurance is basically gambling. People who get up in arms about a casino opening, don't think twice about regulations requiring homeowners to place a bet that their house won't burn down or float away each year, or that they won't have a car accident.

    When the local city hospital on the edge of the Projects closed last decade because so few patients had any means to pay, the once-flush Washington University/Barnes/Jewish/Children's hospital complex had to take up the slack.

    Their emergency room is now packed with runny noses and coughs of people who get free $500 Emergency care, but can't afford a $50 office visit. If the uninsured could get free regular doctor visits for ordinary ailments, then the medical industry could save a bundle.

    But insurance accountants with their eyes set on the bottom line for the next quarter can't see the 5 year savings of regular basic care.

    btw: The projects have since been razed, and the hospital building is being converted into trendy condos.

  14. Erich Vieth says:

    Michael Moore held a live chat on Huffpo. Lots of additional information/links, including a section on What Can I Do? http://www.huffingtonpost.com/michael-moore/exclu

  15. Erich Vieth says:

    More than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea, according to a survey published on Monday.

    http://www.reuters.com/article/latestCrisis/idUSN

  16. Erich Vieth says:

    Wendell Potter is a great illustration (in the context of Michael Moore's movie, Sicko) that many people who are intelligent, good and decent can be corrupted by money. http://www.democracynow.org/2010/11/23/the_fear_o

    Yet we continue to allow big money pour into our election system.

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