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.
SiCKO “Hitman” Shares Insurance Industry Secrets With Honest Medicine
Lee worked in the healthcare industry from 1984 to 2004. The time he spent there still stays with him.
In my HonestMedicine review of SiCKO, I quoted Lee. Imagine my surprise when I received an email with the subject line, “I’m with you.” Lee had found my review and liked it!
So began a back-and-forth correspondence that resulted in a wonderful new friendship, and this enlightening, information-filled audio interview.
Below, you will also find "show notes," where I give a sense of the content of this interview.
DOWNLOAD LEE'S AUDIO INTERVIEW HERE.
INTERVIEW SHOW NOTES:
0:00 to 2:00 – Introduction. Lee’s background, from his days working in the insurance and healthcare industry, up to the present. He is now Features Editor of his local newspaper in Las Vegas, New Mexico, as well as the creator of some really beautiful jewelry.
2:00 to 7:00 – Lee describes our healthcare as a “labyrinthine,” for-profit system, where the patient is the biggest loser -- “like a piece of meat in the middle of a sandwich, with the insurance company and the healthcare provider squeezing him.” Lee talks about how, when an insurance company denies a claim, the healthcare provider invariably opts to go after the patient for the money, rather than battling the far-richer insurance company! Lee also worked for healthcare providers, and in that capacity, challenged insurance company denials, and got lots of insurance companies to pay. So he knows it can be done – if the providers would only try. (HINT: It’s a much less complicated process to go after the patient for the money!)
7:00 to 7:30 – Lee talks about the common practice healthcare providers (especially hospitals) use of putting liens on patients’ houses.
7:30 to 8:30 – Examples from SiCKO of several people with insurance, who were either denied treatment, or who got treatment, but still ended up owing huge bills, leading (in some cases) to bankruptcy. Examples: 18-month old Mychelle Williams, who was denied care and died, because the hospital the ambulance took her to was an out-of-network, non-Kaiser hospital. Also, the “fully insured,” middle-aged couple, Larry and Donna Smith, who were forced into bankruptcy because of large co-pays and deductibles. According to Lee, the main point here is that for-profit insurance companies will do everything they can to get out of paying large bills.
8:30 to 11:00 – Lee discusses the practice by which some CEOs and their top officers often get far better care and better insurance coverage from ostensibly the same plans as their employees. Also, how employer-funded (self-funded) plans are not true insurance plans; and how, with these self-funded plans, it’s not uncommon for there to be a separate set of secret (unwritten) instructions for the CEO and certain top management executives. Lee knows about these plans because he administered some of them. He was told that, if it’s for an employee, you pay by the book. But if it’s the company owner, or a certain officer, everything is to be paid.
11:00 to 13:00 – What shocked Lee the most was the degree to which denial of services is an organized affair, and the degree of effort that is expended to sink certain claims. He tells of one instance, when he was working as a medical investigator, when he was presented with a file of a patient who had just been in an auto accident. Told that the bill would most probably top $300,000, Lee was ordered to find any reason for the insurance company to DENY the claims. He was even authorized to HIRE A PRIVATE INVESTIGATOR, if he needed to. Instead, Lee resigned and never worked for an insurance company again.
13:00 to 16:00 – Pre-Existing Conditions and Other Misconceptions. Includes a discussion of a child with a pre-existing sinus condition, whose family was denied coverage for EVERY complication that resulted from the (uncovered) sinus surgery that failed.
16:00 to 17:30 – The Differences Between a Socialized Payer System and Socialized Medicine. Also, how confusing the multi-payer American healthcare system has become as a result of the many different kinds of policies and coverage patients have. In most cases, each healthcare provider has to hire an entire staff to handle all the details of the many insurance plans patients have, as well as to track receivables, and follow up on unpaid claims, etc. Lee says: “The paperwork burden is preposterous!”
17:30 to 20:00 – Lee discusses possible reasons why the AMA is so against a single payer system. He points out that SiCKO showed that many of our other services are government-run, including the fire and police departments and the military. So why not healthcare?
20:00 to 21:00 – The Veterans Administration vs. Medicare. While both are government-sponsored programs, Lee points out that there are many problems with the VA, most especially the fact that it is severely under-funded. The Medicare system is better: You can go to the doctor you want to go to, and they get reimbursed by Medicare.
21:00 to 22:00 – A discussion of why healthcare providers would find a Medicare-like system easier to deal with than what we have now: 1 set of rules, 1 phone number to call, 1 appeals process. Healthcare providers wouldn't need a whole staff (like they do now) to deal with this complicated mess.
22:00 to 27:00 – Insurance Scams and Rip-Offs – An in-depth discussion about the self-employed person’s so-called “insurance policy.” According to Lee, individual policies are the “bottom of the barrel” in the insurance industry, because they can’t really be true insurance. Why not? The concept of health insurance relies on SHARED RISK. Lee clearly explains this concept and why it works – if there is a large enough pool of people in the insurance plan. It’s totally different with self-employed policies, where there is NO shared risk, so the likelihood of these policies actually coming through for you if you become sick is slim. If fact, in order for these policies to be profitable for the insurance company, they almost HAVE to be a gyp, because you don’t have a pool for sharing the risk. If the insurance company is going to make money from you, the premiums you pay in MUST outstrip the amount they pay out for you.
27:00 to 28:00 – Lee discusses how this problem of coverage for the self-employed person is one of the major factors discouraging entrepreneurship in America, because people are afraid of leaving jobs they hate because they’ll lose insurance coverage.
28:00 to 32:00 – Fraud that healthcare providers perpetrate. Examples of some of the more common types of healthcare fraud: (1) upcoding, which occurs most often with equipment providers and doctors’ offices, and (2) unbundling, which occurs very commonly with surgeries and medical supply kits. One example of a possible surgery that is “unbundled” is given.
32:00 to 37:00 – Lee Becomes a Whistle Blower. Lee describes the situations where this happened, and why he felt compelled to report these companies he was working for. He tells about the Qui Tam provision of the Small Claims Statute, the statute under which Lee sued these companies on behalf of the Federal Treasury. Also, exactly how this provision works.
37:00 to 38:00 – How Lee still feels terrible about having worked in the insurance industry. In his opinion, if you're working for an insurance company, you're generally assisting the company in denying payment for things you know people need. He believes that, unfortunately, far too many people who work in the insurance industry do NOT feel at all badly about their behavior.
38:00 to 39:00 – Are Americans really more “me”-oriented than most? Also, a discussion of people who are willing to go public -- like Lee, Dr. Linda Peeno, and Becky Melke (in SiCKO) -- and expose the terrible things they did while in the employ of insurance companies. Lee feels that only 1 in 100 (or even 1 in 1000) people working for insurance companies feel enough concern to go public.
39:00 to 43:00 – Healthcare Waste, which Lee thinks results, in large part, from a for-profit mentality on the part of providers that emphasizes providing services for which you know you’ll get paid, rather than services a patient needs. Lee gives examples of healthcare products being provided to patients who don’t need them, because the provider knows it will get paid. Also, hospital waste, and how he successfully fought this practice when he worked for an insurance company.
43:00 to 46:30: Why we have to act like cops -- because these fraudulent practices are so rampant within our for-profit healthcare system. He thinks the government would do a better job of patrolling this healthcare fraud than is being done now. I ask Lee if it is possible that many healthcare providers don’t want a single payer system because they know that their fraud will be caught more readily.
46:30 to 49:00 – Ways the public can work to help get universal healthcare passed.
IMPORTANT POSTSCRIPT #1:
After this interview with Lee was recorded, I received two emails from people who work with Michael Moore's production company: Amy Cooke and Anna McHugh. Amy asked if I knew of any stories about people who are organizing "SiCKO Events" in their own communities, and Anna wrote to tell me about the "SiCKO Health Care Card," which Michael wants people to carry with them just in case their insurance company denies them coverage -- at which point they can whip out their SiCKO card and say that it guarantees them "coverage" by Michael!
Both of these women are working with Michael Moore to do what they can to help transform the movie into a movement -- so that universal healthcare will become a reality.
So, please feel free to download the "SiCKO Health Care Card," and to share your stories of SiCKO Events you are holding in your community, in the comments section below.
For some ideas from Michael Moore, check out this link. Thanks very much.
IMPORTANT POSTSCRIPT #2:
At the end of my interview with Lee Einer, I mentioned a book by Jamie Court about the insurance industry, but had forgotten the title. I promised to post a link to it in these show notes. The book is "Making a Killing: HMOs and the Threat to Your Health." It is printed -- I believe, in its entirety -- online. It's a great read! Author/activist Jamie Court is President of The Foundation for Taxpayer and Consumer Rights, www.consumerwatchdog.org, and author of another book, “Corporateering: How Corporate Power Steals Your Personal Freedom – and What You Can Do About It,” for which Michael Moore wrote the introduction.
Posted at 02:46 PM in Archived Articles, Audio Interviews/Podcasts, Correspondence: To Michael Moore, Movie Reviews, News/Commentary, PODCASTS / INTERVIEWS | Permalink | Comments (32)
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