Quick review: Sicko, with health policy rambling
I’ve never seen a Michael Moore documentary before, but I wanted to see Sicko, because I’m obsessed with health policy issues. As others have pointed out, the film has a super powerful first hour and a somewhat less successful second hour. The first hour deals with the problems of Americans who have health insurance, but still can’t get the care they need due to red tape. It’s pretty unforgettable stuff, and Moore makes a very strong case that his anecdotal evidence is actually symptomatic of endemic problems. Some of the stories and faces of health-insurance victims are going to haunt me. One of the biggest fears with government-run health care is that we’ll have a faceless bureaucracy managing our care. And it’s becoming increasingly obvious that those of us lucky enough to have health coverage already deal with a faceless bureaucracy, just in the private sector.
But then the film veers off to look at countries that already have universal health coverage, and Moore’s sledgehammer approach becomes a bit of a liability. He never quite asks the tough questions, about scarcity of high-tech care, wait times for specialists and taxes. These are all questions with decent answers, but he doesn’t even bother to answer them.
On my way back from watching the movie, I was pondering: what would we have to do to get universal health care in America? The easiest answer: build a time machine, go back in time 60 years and start a universal program after World War II. The harder answer: expand Medicare to cover everybody today. But since Medicare already has skyrocketing expenses, this would only solve half the problem. Our health care is so expensive because:
- we have too many specialists and not enough primary care docs,
- we don’t provide enough preventive care, and then we spend jillions on heroic measures once conditions get out of hand,
- there’s a surplus of high-tech equipment, especially MRIs and other imaging scanners, which tend to be used a lot just to amortize the cost, and
- if you read through the Dartmouth Health Atlas, you get the sense that certain parts of the country have a ridiculously high rate of particular surgeries, just because there’s one surgeon who likes doing that procedure, and finds reasons to do it a lot.
In a nutshell, you couldn’t get true universal health coverage in the U.S. without basically putting the health insurers out of business AND drastically curtailing doctors’ incomes. Oh, and you’d probably have to make major changes to the Medicare drug plan to make it even remotely affordable. Taking on one entrenched interest would be bad enough, but this would basically be impossible. So, really, I think it’s probably best to get started on that time machine.
Another contributing factor to health care costs in the US is that the system has to float the costs of big buildings full of smart people working all day every day to find ways to pass the buck so that their organization isn’t the one that foots the bill for a given procedure. Insurers, hospitals, physicians’ private practices, cities, states, and the feds all have people on payroll figuring out how not to pay for things. It’s expensive.
You are right that the questions that Moore doesn’t ask do have decent questions, but he did ask Canadians about wait times, access to specialists and so on. I’ve lived in Canada all my life. I have no huge trouble with the taxes I pay. I may actually have a higher percentage of disposable income left than the average American – at least one who had a medical problem in a given year. This year my income tax payable was $0.00, because I’m self-employed and the money I put back into my business this year was all deductable.
I do have a chronic health problem, and so does my wife, and we need regular medical tests and are each followed by a specialist for our respective conditions. We hardly notice any of this to be honest. Our experience of the healthcare system is so smooth and seamless that it has almost no impact on our lives, although our illnesses, left untreated, would destroy each one of us.
I don’t perceive the waits in our system to be huge. I need to book appointments with my specialist 2 weeks in advance, which seems reasonable. There is no “big brother” telling me which specialist to choose. People here switch doctors if/when they want. Not all doctors accept new patients all the time, but again, that seems reasonable. There are only so many hours in a day.
My wife and I both come from large families, we know people of all ages, rich and poor, including some doctors and nurses. Nobody talks much about healthcare on a daily basis in any of my networks, though we all use the system. Why shouldn’t we? It’s ours.
There may be problems with our system, and horror stories, etc. But I don’t know anyone this happened to. The healthcare system is kind of like the sidewalk. It’s just there, maintained by the government, and doesn’t have to be worried about by ordinary citizens, who basically take it for granted as they go about their workaday lives.
It’s part of the infrastructure of society – a healthy, well-educated workforce, roads, courts, police, fire and the armed forces… don’t you think?
Unless some lobby manages to peel that infrastructure away and mine the pockets of the people to only give them scraps in return…
Hey there, Charlie –
I just wanted to let you know that you can remove my old blog from your sidebar. La Gringa & Co. is now defunct and has been inactive for a couple of months. I have a new blog that you’re welcome to link to if you like it. Go explore: http://theswivet.blogspot.com
Take care!
La Gringa