Sicko (the movie)

A.S.A.P · July 11, 2007, 12:19pm

My brother lived in Washington. This was about 12 years ago. Of course it’s the whole system. In my bros case, I, and the court, blamed the doctor because it wasn’t a case where the HMO denied payment - they were never consulted. The doctor put his profit (the extra money for non-referral)ahead of my brother’s health. It was especially damaging because the treatment he gave actually prevented a positve diagnosis of the cancer when the shaved biopsy was done, as the previous burning off of the mole hid the cancer underneath. Had he done the proper cone biopsy, it would have been found. That wasn’t done until a year and a half later, when the cancer had spread to a lymph node.
I want to add, that if anyone has never seen someone die a slow death from melanoma, it’s a very painful and tragic experience. My brother lived 5 excruciating years after the diagnosis. He would have lived another 20 that way if he could have, just to see his sons grow up.

A.S.A.P · July 11, 2007, 12:34pm

And in retrospect, of course my brother should have gone ahead and seen the dermatologist on his own, but he believed the doctor knew what he was doing. I think we are all aware these days that we are on our own, and we can’t trust any doctor to do the right thing by us. We used to be able to, though, before the HMOs took over the health care system. He and I grew up in a time when you could trust the doctor to make a decision based on his medical opinion, not one filtered through the lens of the bottom line.

collegialmom · July 11, 2007, 3:25pm

Often the insurance companies reimburse doctors less than what they pay for the actual immunizations. This has been happening for years. So if a doctor pays $65 to the wholesaler for a shot, and gives it, then the insurance company may then reimburse the doctor $55 and expect the doctor to absorb the difference. This is not possible financially for doctors to do, because not only is the actual cost not covered, but neither are the overhead expenses, including the person who gives the shot.

In addition, not all insurance companies even cover shots, and especially not something like Hep A in teenagers that is not given routinely.

This has actually become a crisis for primary care doctors. The reimbursements in general are so low for office visits, that to lose thousands of dollars a year (one large practice in Virgina calculated losses of well over $100,000 a year from this) in immunizations is just not feasible to stay open. So many pediatricians have to now refer to PH Departments for shots. And, by the way, if the doctor participates with the insurance, then s/he is not allowed to collect cash for most shots, and it is often very difficult to find out what company reimburses what per shots.

This is when the CEOs of insurance companies make upwards of $20 million a year, and the insurance companies produce billions in profits a year. And you can be sure that most of your favorite presidential candidates (see Hillary) are very tied into making sure that these companies stay strong and profitable, by having them administer a national health plan, if it comes about.

mini · July 11, 2007, 4:23pm

Not most of MY favorites! (I don’t make it a habit to vote for wives of mass murderers). Every major Democratic candidate favors a further give-away to the private health insurance companies by making employers legally obligated to pay them, or as in Romney’s soon to be debacle in Massachusetts, individuals as well. It is giant wealth transfer.

I’ll be happy to pay my money to a private insurance carrier - just take away their profit motive.

collegialmom · July 11, 2007, 5:08pm

“I’ll be happy to pay my money to a private insurance carrier - just take away their profit motive.”

Even the so-called “nonprofit” health insurance companies generate huge revenues for their CEOs and board members to partake in, as in multimillion dollar salaries and enormous perks. These really also need to be pared down, because all of this money is taken from patients and providers.

Is there any presidential candidate that you think has a cogent plan that does not profit the health insurance companies? Or does not just create a monstrous government bureaucracy that will also take money away from care?

I have not read any plan from any of them that is the least bit realistic. They all seem to be just reciting either what people want to hear, or even moreso, what insurance companies want to hear. The Clintons and both Dems and Republicans in general get enormous contributions from insurance companies.

mini · July 11, 2007, 5:16pm

From the July 11th Business Week:

"The health-care reform debate is in full roar with the arrival of Michael Moore’s documentary Sicko, which compares the U.S. system unfavorably with single-payer systems around the world. Critics of the film are quick to trot out a common defense of the American way: For all its problems, they say, U.S. patients at least don’t have to endure the endless waits for medical care endemic to government-run systems. The lobbying group America’s Health Insurance Plans spells it out in a rebuttal to Sicko: “The American people do not support a government takeover of the entire health-care system because they know that means long waits for rationed care.”

In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. Take Susan M., a 54-year-old human resources executive in New York City. She faithfully makes an appointment for a mammogram every April, knowing the wait will be at least six weeks. She went in for her routine screening at the end of May, then had another because the first wasn’t clear. That second X-ray showed an abnormality, and the doctor wanted to perform a needle biopsy, an outpatient procedure. His first available date: mid-August. “I completely freaked out,” Susan says. “I couldn’t imagine spending the summer with this hanging over my head.” After many calls to five different facilities, she found a clinic that agreed to read her existing mammograms on June 25 and promised to schedule a follow-up MRI and biopsy if needed within 10 days. A full month had passed since the first suspicious X-rays. Ultimately, she was told the abnormality was nothing to worry about, but she should have another mammogram in six months. Taking no chances, she made an appointment on the spot. “The system is clearly broken,” she laments.

It’s not just broken for breast exams. If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. “Waiting is definitely a problem in the U.S., especially for basic care,” says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy.

All this time spent “queuing,” as other nations call it, stems from too much demand and too little supply. Only one-third of U.S. doctors are general practitioners, compared with half in most European countries. On top of that, only 40% of U.S. doctors have arrangements for after-hours care, vs. 75% in the rest of the industrialized world. Consequently, some 26% of U.S. adults in one survey went to an emergency room in the past two years because they couldn’t get in to see their regular doctor, a significantly higher rate than in other countries.

There is no systemized collection of data on wait times in the U.S. That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public. However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada."

“Or does not just create a monstrous government bureaucracy that will also take money away from care?”

Medicare spends between 2 1/2 and 3% on bureaucracy, or at least did before Bush handed over a good part of it to private “managers”. This contrasts to an overhead average for the privates of between 22-36%. Monstrous? My mother gets her Social Security check every month like clockwork, there is never an error, and hasn’t been in 25 years. Find me a private company, ANY private company, that can make the same claim.

mini · July 11, 2007, 5:26pm

From Deborah Burger, today’s Huffington Post:

"What country endures such long waits for medical care that even one of its top insurers recently admitted that care is “not timely” and people “initially diagnosed with cancer are waiting over a month, which is intolerable?”

If you guessed Canada, guess again. The answer is the United States.

Scrambling for a response to the popular reaction to Michael Moore’s SiCKO and a renewed groundswell for a publicly-financed, guaranteed health care, single-payer health care solution like HR 676, the big insurers and their defenders have pounced on Canada, pulling out all their old tales of people waiting years in soup kitchen-type lines for medical care.

But, here’s the dirty little secret that they won’t tell you. Waiting times in the U.S. are as bad as or worse than Canada. And, unlike the U.S., in Canada no one is denied needed medical care, referrals, or diagnostic tests due to cost, pre-existing conditions, or because it wasn’t pre-approved.

U.S. waiting times are like the elephant in the room few of the critics care to address. Listen to what the chief medical officer of Aetna had to say in March.

Speaking to the Aetna Investor’s Conference 2007, Troy Brennan let these nuggets drop:

<ul>
<li>The U.S. “healthcare system is not timely.”</li>
<li>Recent statistics from the Institution of Healthcare Improvement document “that people are waiting an average of about 70 days to see a provider.”</li>
<li>“In many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable.”</li>
<li>In his former stint as an administrator and head of a physicians’ organization he spent much of his time trying “to find appointments for people with doctors.” </li>
</ul>

Brennan’s comments went unreported in the major media."

doubleplay · July 11, 2007, 5:41pm

After waiting 6 weeks already and worrying that thousands of dollars are going to go down the toilet in September if I don’t get a passport that I applied for in mid-May, I do NOT have any confidence in the US Government to get any suspicious moles or lumps checked out within a reasonable amount of time.

collegialmom · July 11, 2007, 5:50pm

Medicare may be better than nothing, but it is getting harder and harder to get doctors to paticipate, due to inefficiencies, threats if they aren’t conforming to its rules, delays in reimbursements, irrational billing rejections, crazy numbers of unnecessary audits of well-meaning doctors, and the incredibly poor reimbursements for routine care, including preventive care (as in no coverage.) Procedures and end-of-life care, sure, but otherwise, expect to wait or go to the ER.

You may get some great care for when you are fixing to die, but short of that, it’s not a model for middle-class Americans. There will have to be more choices.

mini · July 11, 2007, 6:00pm

“Medicare may be better than nothing, but it is getting harder and harder to get doctors to paticipate, due to inefficiencies, threats if they aren’t conforming to its rules, delays in reimbursements, irrational billing rejections, crazy numbers of unnecessary audits of well-meaning doctors, and the incredibly poor reimbursements for routine care, including preventive care (as in no coverage.) Procedures and end-of-life care, sure, but otherwise, expect to wait or go to the ER.”

You are absolutely right, but it isn’t because of “monstrous government bureaucracy” (which is, or was, under 3% of the total), but because while their budget is relatively fixed, dollars are siphoned off into the for-profit trough. Doctors have to go where they are forced to make decisions based on both their own and health insurers’ needs for profit. And if you want to look at “performance audits”, what do you think it is that prevents insurance-carrying individuals from even being referred to specialists to begin with?

Get rid of the profit trough and there could be all kinds of choices - single payer does NOT have to mean single provider. That’s just one of many options and (given the experience of Germany and France and Australia) not necessarily the best one.

I think Michael Moore got it absolutely right, and in three sentences:
– Free, universal health care for all residents, for life.
– No insurance companies.
– Regulate pharmaceutical companies like public utilities (which they are).

The rest is just details, and there is a huge array of choices.

bluebayou · July 11, 2007, 11:28pm

It’s been awhile since I took biology, but if I recall, in the order of human species needs, health care is not the top two or three. It seems that water is needed for cellular activity and it ain’t free. Sustenance (i.e., food) is also required for cellular activity, and it ain’t free. Others might put shelter high up on a list of basic human needs. So, the question has to be, mini, why health care over the other two or three items? Or, should they be “free, for life,” as well?

A.S.A.P · July 11, 2007, 11:58pm

There is a misconception from those who have not seen the movie that Moore means free in the sense of no one paying. That is not the case. He means free in the way our public schools, police department, fire department, most of our roads, are free-- paid through taxes. 
What he means is that no one should have to choose between health care and food on the table.
People find no problem with pooling our resources so that we can drive on decent roads and have police protection. But to pool resources for decent health care for all becomes “socialism.” 
Our “government” is very capable of administering a health care program - but those in charge of our government at this point in time are not. Mini makes the point that his mom’s SS checks arrive on time every month.
It can be done. But it can’t be done with insurance companies running the show putting their profits first.
It can’t be done if those running our government want it to fail.

A.S.A.P · July 12, 2007, 12:06am

And why is health care so important - important in the way that our roads and public schools are important? Because without one’s health, one cannot work or support a family, pay one’s mortgage, rent, buy food, or water.

bluebayou · July 12, 2007, 12:57am

asap:

people do choose between food and other item bcos food is NOT free. Of course, “free” means paid by taxpayers. But, my question is still reamins: if water and food are the basic necessities for biological life, why shouldn’t they be free as well, i.e, paid by taxpayers or the “other guy”?

btw: roads are paid thru user fees, i.e, gas taxes.

A.S.A.P · July 12, 2007, 2:58am

It is possible to get government aid if you can’t afford food or water. Our very poorest citizens are helped out by those of us better off, through our taxes. Food and water are already free for those who can’t pay.

Healthcare costs are far beyond what most people in this country can afford, wthout some type of insurance. I assume you have insurance. I wouldn’t be without it for a day. The question then is, are we satisfied with the status quo? Are ther problems that arise from a system that is based on profits to the provider? Is there a better way to achieve the same or better care? Is it possible to make it available to everyone? We are already paying, and quite a lot.

You’re asking if it’s desirable to make it available to everyone.
I happen to think it’s desirable if it’s possible. Just as I believe it’s important to feed a child breakfast who has no means to get a balanced meal in the morning , I feel it’s important help a mother by giving her the knee surgery that would allow her to work, or the heart stent to the dad which would allow him to live and continue to support his family.

This isn’t a question of paying for “the other guy.” We are the other guy. And we are already paying.

bluebayou · July 12, 2007, 9:08am

yes, it is possible to get government aid if you are poor, and a legal resident. But, that is NOT what MMoore and mini said. They specifically recommend “Free, universal health care for all residents, for life” which is different than giving a hungry kid breakfast. It also means giving the Trump’s, Kennedy’s, Bush’s and Gates’s free breakfasts (i.e., health care), for life. But, yet, we don’t give even give them free water.

northeastmom · July 12, 2007, 9:13am

Well, you currently provide free public education from k-12 to the richest Americans who attend public schools. Many go to private schools, but it is offered to those who wish to participate. Why not breakfast (health care) for those who want to participate?

bluebayou · July 12, 2007, 9:32am

back to my original question: water and food are THE two basic human needs (and maybe shelter is #3), but yet are not considered important enough to be provided free. And, to paraphrase asap, shelter “costs are far beyond what most people in this country can afford…” So, why not two or three of the really basic biological human needs? Why healthcare first?

collegialmom · July 12, 2007, 9:54am

“back to my original question: water and food are THE two basic human needs (and maybe shelter is #3), but yet are not considered important enough to be provided free. And, to paraphrase asap, shelter “costs are far beyond what most people in this country can afford…” So, why not two or three of the really basic biological human needs? Why healthcare first?”

That’s a very good question. Now the parallel would be that if Stalin could dictate in the USSR who lived where in government housing, and what anybody could have to eat or drink, whose to say that government controlled health care here would not be the same?

In other words, the government would decide who gets hip surgery, who get stents, what the criteria would be for a c-section, etc. They would do this by providng “guidelines” and then not reimbursing if they disagree. So, if a c-section is done under the best of intentions, but the government doesn’t agree, then the doctor and hospital won’t be paid. This is what they do now with their Medicare guidelines. With Medicare there is also a system of punitive consequences, under which the government and FBI can raid doctors’ officies and seize records.

I think also that what this will lead to is even more promising doctors being scared away from medicine, and from primary care if the government ties their reimbursements to procedures instead of diagnosis, as is the case now.

By the way, often these guidelines are produced by non-medical policy aides who know very little about medicine, or academics who have never practiced medicine.

northeastmom · July 12, 2007, 10:24am

It can be set up so that it is not this way. In “Sicko”, the French doc, I believe, stated that when he provides care, he does not need to get preapproval etc. He gets more money if he gets patients to stop smoking, etc. The more service that he provides, the more he is paid.

As far as food and water question, why do we provide free public education for our children and not free health care for all?

Sicko (the movie)

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