Like so many Americans -- especially those of us who have done serious battle with our health care system -- I have eagerly awaited the release of SiCKO. I am happy to report that I loved the movie, but with reservations. I hope that, by addressing my reservations here I, too, will make a difference by bringing these concerns to the attention of those who are working to change our healthcare system.
My reservations have nothing to do with the fact that Moore idealized the universal healthcare systems of England, Canada, France and Cuba. He never said he was making a true documentary. And he never presents both sides equally. That's simply not his modus. I love his films anyway. And I certainly would rather live in a country with universal healthcare -- even with long lines. Heck, let's not kid ourselves: we often have to wait a long time for care in America. That would mean little to me if we were all completely covered medically.
And I really love the fact that Moore, instead of making a film about the horrors of being uninsured in America, took an unexpected turn by exploring the problems suffered by the majority of us who feel (naively) confident because we are insured. If he'd concentrated his film on the uninsured -- as many assumed he would -- most Americans would have distanced themselves emotionally with: "Well, that could never happen to me."
But focusing on the insured -- the majority of us -- and the fact that we are not as safe as we think we are, was brilliant. It puts the fear of God into lots more people.
As well it should.
I wrote a letter to Michael Moore when, in February, 2006, he sent out his request for medical horror stories. In it, I told him how my husband, Tim, also originally from Flint, Michigan, had suffered a cancerous brain tumor in 1990 at the age of 40, and how for the next 15 years until his death in 2005, we battled both our insurance company and the hospitals.
I also told him how sub-standard I thought the care Tim received had been in some of the so-called best hospitals in our country.
I told him that we were insured, with what was supposed to be a "Cadillac" of policies, and that, as Tim's illness progressed, our insurance company kept raising our rates, until we were paying $1700 a month for a policy that left us with thousands and thousands of dollars in uncovered bills.
Just like several of the people featured in Moore's film, from the beginning, our insurance company tried to get out of paying anything for Tim's initial brain tumor surgeries, chemotherapy, radiation and numerous infections. They cited his tumor as a "pre-existing condition."
Why "pre-existing"? Because Tim had had a seizure 5 years earlier, which had been misdiagnosed by our doctor as a "sleep disturbance." Luckily, unlike so many people in Moore's movie, we won that first battle -- but not without the help of many people, and many hours spent by me, as well.
Our woes kept escalating. Like Donna and Larry Smith, the hardworking, 50-something couple in Moore's film, who were forced to move into their daughter's basement storage room because of high deductibles and insurance co-pays, Tim's visits to the hospital and the doctors continued, and our uncovered bills kept mounting. In addition, our $1700 per month "Cadillac" insurance policy only minimally covered the cost of Tim's numerous medications, which totaled several hundred dollars a month.
Although I was still working full-time, we were nearly broke.
But, here is a really important point -- and a point that Moore does NOT address in the movie: Our insurance company was not the only one who was rapacious. The hospitals and doctors, too, demanded their full "pound of flesh." Of course, I'm sure that most of them deserved to be paid, but they had already been paid very handsomely by our insurance company. (And remember, this was NOT an HMO.)
The problem was, in many cases, the hospitals and doctors charged more than the "usual and customary" amounts the insurance company was willing to pay. And although they had already received hundreds of thousands of dollars, both the doctors and the hospitals went after us for every last dime.
When there is a serious illness, many, many doctors are involved, most of whom neither Tim nor I had never seen or heard of, even though I was in his room almost all the time.
The prodigious efforts of these doctors' offices and hospitals to collect the many thousands of dollars remind me of Lee Einer, the insurance company "hitman" featured in SiCKO, who said it was his job to get money back from patients, no matter what he had to do to get it. "We go after this like it's a murder case," he said. Tim and I were down to one income (mine), and even though I was making payments the best I could, these folks called me nearly constantly at work; they sent collection notices; they harassed me. I told all of this to Michael Moore in my letter.
Which brings me to my most serious criticism of SiCKO.
To only attack the insurance and pharmaceutical industries -- and they are both pretty greedy -- is, I believe, a huge mistake. They certainly are not the only healthcare villains.
Moore points out in SiCKO that the AMA was behind the early efforts to block Medicare, because it was "socialized medicine." He pointed out that the AMA arranged coffee klatches, in which doctors' wives conducted an anti-Medicare "Operation Coffee Cup" campaign, aided enormously by a promotional recording by Ronald Reagan -- back when he was "just" an actor. It's priceless: Turn your speakers up and listen to it here! (I am indebted to Doug Hammond's Dirty World News blog for turning this recording up!)
Does Michael Moore think that America's doctors won't try to block all serious plans for universal health care now? Indeed, the AMA has already released its official reaction to the film. Read the statement. It's almost laughable, since it seems obvious that Edward L. Langston, MD, "Chair, American Medical Association," the person credited with having written it, most likely didn't actually see SiCKO, before putting pen to paper. (The AMA obviously thought the film was about those who are without insurance. Check it out.)
Moore humorously looks at the fact that there are more healthcare lobbyists in Washington than Congress people, and that many -- including Hillary Clinton -- are financially indebted to them. But he doesn't touch the fact that our doctors, too, are in the thrall of Big Pharma. All you have to do is read the articles about doctors' financial ties to drug companies. For instance, here are just a few of the many articles I was able to dig up on this topic: Dr. Adriane Fugh-Berman's New England Journal of Medicine piece, "Doctors must not be lapdogs to drug firms" ; the Associated Press's "Groups Question Doctors' Ties to Drug Firms"; and my personal favorite, MSNBC's "Cancer docs profit from chemotherapy drugs."
While Moore castigates the pharmaceutical companies for charging huge amounts of money for their drugs, he doesn't at all address the fact that we can't even be sure these drugs are safe, since so many drug companies hire doctors and universities to conduct their so-called "trials," and then to write about how successful these "trials" are. Many have blown this whistle.
Is it possible that Moore didn't know about this highly questionable practice? (See the wonderful 2000 article by Marcia Angell, published in the New England Journal of Medicine, "Is Academic Medicine for Sale?" -- and Slate Magazine's shocking "Rent-a-Researcher: Did a British University Sell Out to Procter & Gamble?" In 2006, the Wall Street Journal's David Armstrong blew the whistle on the American Medical Association (his article is reprinted here) by exposing the fact that the association's own professional journal, JAMA, had published the findings of a study, for which the doctors/researchers involved had a total of nearly 60 financial ties to Big Pharma! (I commented on this situation on HonestMedicine.com.)
And what about our hospitals?
On both Larry King and David Letterman's shows, Michael Moore stated that our hospitals and doctors are among the best in the world. While his movie clearly shows that our healthcare ranks pretty low in several arenas, he cites lack of insurance coverage as the main reason.
But he does NOT point out that American healthcare can also be pretty dangerous. Take the article, "Is US Health Really the Best in the World?," written by Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, and published in the AMA's own JAMA (July 26, 2000). It clearly delineates how dangerous US Healthcare can be -- especially the hospitals and doctors. In addition to pointing out that the US ranks pretty low in lots of areas, including 13th (last) for low-birth-rate percentages, 10th for life expectancy at 40 for females, and 9th for males, Dr. Starfield writes about the horrible "combined effects of errors and adverse effects that occur because of iatrogenic [doctor-caused] damage not associated with recognizable error." This article is truly eye-opening. I wish Michael Moore had read it before he made SiCKO.
So, are our hospitals and doctors really the best?
My final point is more of a worry about our country than a criticism of SiCKO. I, too, want universal healthcare, and I too, believe that, in order for us to have it, we'll need a single payer system. But, is our government up to the task? During the 15 years after Tim's initial brain tumor diagnosis, and especially after 2002, when he became totally disabled, I have personally had to deal with many government employees in order to obtain services for him. I can count on the fingers of one hand the number of government workers who were responsive, concerned, and seemed to know what they were doing. I won't go into the details here. But suffice it to say, I worry about the possibility of putting our healthcare in their hands.
And lastly, I worry that Moore's big concern -- that Americans have come to think in terms of "me" rather than "we" -- may prove to be the most serious problem of all. I don't think I will ever forget the reaction in SiCKO of Danny, the son of Donna and Larry Smith, the couple who ended up in their daughter's basement:
"What do we do about people like you guys? I mean, you're supposed to pay the deductible for $9000, which I understand. That's part of healthcare. But, what about the people like Cathy [his sister] and I that have to come up there and move you every 5 years, every 2 years, every year, because you don't have enough money to stay where you are?"
To which, Donna can only respond, "I'm sorry. It's not what we wanted to have happen. And we're doing what we can to make the change. You don't know what that feels like inside. At 50-some years old to have to reach out to my 20-something year-old for help."
Moore did not comment on this interchange.
But, if a son can treat his beaten-down parents this way, can we really expect Americans to be willing to do what it takes to help people they don't even know? I hope we can.
Make no mistake about it: Michael Moore's movie is an important -- even brilliant -- start. I was incredibly moved by it. And as you can see, it certainly got me thinking. I sincerely hope SiCKO signals the beginning of a really serious, productive discussion about healthcare, and that we can come up with a solution that helps ALL our citizens, and doesn't punish those of us who become sick.