What's Wacko about Sicko

August 29, 2007

Michael Moore wants socialized medicine in the United States. It would, as his film Sicko suggests, give us a system that better delivers health care to those who need it. Although Moore effectively documents some deficiencies in American health care, his message is undermined by misinformation, inconsistent rhetoric, and a disingenuous agenda. Moore's plan would result in worse, not better, health outcomes for Americans -- including the poor and underserved.

As a hand surgeon who treats many traumatic injuries, Moore's portrayal of a patient who amputated his middle fingertip captured my interest. He depicted this uninsured man as required to pay $23,000 to have his finger "saved." Moore lost considerable credibility here. Most hand surgeons would never consider micro-surgically replanting this table saw injury at the finger nail base. Rather, this unfortunate injury would have been comfortably and safely treated -- without reattachment of the severed bit of finger -- in an office procedure room for $1,000 or less.

In Sicko, Moore consistently equated lack of insurance with inability to obtain care. In Grand Rapids, Mich., where I practice, a sign on the front door of Blodgett hospital, in English and Spanish, indicates patients will not be turned away for lack of ability to pay. This is policy across the United States.

We hear a lot about the nearly 50 million Americans without health insurance. However, approximately half of them are insured six months later with new jobs, suggesting more of a problem with our employer based health care system than with affordability.

Moore harshly criticizes the U.S. government. Yet he is arguing for a centrally controlled allocation of health care resources. Who does he want to run health care in this country? Medical resources are not unlimited. The combination of aging demographics, technological advances and unconstrained consumption within our third party payment system has led to an unsustainable trajectory of ever increasing spending. It is already clear that price controls have created strong disincentives to debt-burdened students considering careers in primary care. Yet Sicko gives market oriented solutions no consideration.

Three individuals with ailments after admirably serving in New York rescue and recovery efforts after September 11, 2001, were transparently used in Sicko to promote Moore's agenda. This manipulation was as revolting as the stories of individuals egregiously denied care by insurance companies. Transported to Cuba, the three 9-11 patients were shown to Cuban doctors who (while cameras were rolling) appeared more than happy to provide care and subsidized prescriptions. This contrasted with a California hospital denying care to a child with a severe infection and a sick, elderly woman dropped off by a taxi in front of a rescue mission while still in her hospital gown. The latter two tragic situations were portrayed as illustrative examples of our domestic medical system.

There is no question we need major improvement in U.S. health care. To use a few outrageous anecdotes to argue for a socialized solution, however, is a non-sequitur. Despite ostensibly compassionate intentions on the part of its backers, greater harm would result from centrally planned and controlled health care. Canada and the United Kingdom provide contemporary models: rationing occurs by decree and delay. Even the Canadian Supreme Court, when ruling against Canada's single-payer law prohibiting private payment for health care in 2006, stated, "access to a waiting list is not access to health care … in some cases patients die as a result of waiting lists for public health care\... and many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life."

Pope Benedict XVI wrote in his recent encyclical Deus Caritas Est, "We do not need a State which regulates and controls everything, but a State which, in accordance with the principles of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need." Moore and his allies would do well to take this exhortation to heart. We now have unsustainable consumption of medical resources, with third party responsibility for health care expenses. A socialized system would increase state dependency and diminish motivation for charity. Greater government bureaucracy would increase inefficiency and waste compared to doctor-patient "two-party" interaction. Socialized medicine violates the social justice principle of subsidiarity by interfering with the family, churches, charitable clinics, and other intermediate organizations attending to those who are most in need.

The common good would be better served with medical insurance purchased, like other insurance, outside the workplace. Tax law changes could help improve insurance portability and affordability. Insurance industry reform, including measures increasing inter-state competition, could decrease premium cost. Greater competition from patients directly paying premiums would lead to stronger demands for quality and less egregious denials of care. With improved alignment of responsibility for personal health choices and medical care consumption, scarce health care resource allocation would improve. There is significant opportunity for recovery. Market oriented reforms, with compassionate consideration for those without means, deserve far greater consideration than Sicko's deceptive solution.

Comments

Cliff Washington: cliffordw00@email.phoneix.edu

The article is written very well however, with your Grand Valley MBA you must know and understand that it is NOT all false, right? We may hate to admit it yet we as American's should identify the truth and an act on it and trash the rest of the film.
Please do not jump on the "Shawn Hannity type of left vs right" mentaility of analysis becasue to do so WE THE PEOPLE lose and to do so would dimiminsh your Grand Valley MBA becasue you were taught much more than that during your studies there!

Joe Snyder: shatzbot10@sbcglobl.net

It is necessary, sometimes, to overstate a case, to prompt people to recognize and act on an issue. Mr. Moore may be guilty on this score. However, the persons seen suffering from the whim of insurers were real. Their stories and tears were real. The documented testimony of a former "Medical Director" was very real. And, I believe it is true, that insurance companies exist to make money (just ask their investors).

Johnny V Trejo: johnny66@csufresno.edu

I think we as a nation are better off staying away from the medical profession, because I feel that the way we are taken advanage of by fixing a problem by taking a pill is causeing more problems then when you first walked into a ficillity. You are safer and richer if you take care of the situation yourselve.

HST:

I watched SICKO and the woman who was 'patient dumped' on the street. How sad, because a patient cannot afford to pay, the hospital calls her a cab, and puts her on the street in front of homeless shelter, with the IV bag still attached. Yea Doc, what a wonderful American concept! And the good Doc quotes the Pope, what a laugh!

RParker: rebeccajill23@yahoo.com

I find it ironic that the ineptitude of the conservative government becomes an argument for further lack of governing. Should we apply these principles to the police and fire department and only protect those who can pay for it, or ask those whose houses are on fire if they can pay before the fire is put out? Thank goodness we have a "socialized" education system which provides education through high school for all regardless of ability to pay. Like many other Americans whose values have not yet been corrupted by greed, I feel that it is morally dubious for insurance companies to profit off of the suffering of the American people. Single payer is the only system that can efficiently deliver health care to all citizens, therefor assuring true liberty for all.

JB Anonymous: a2z@dolfina.org

This is a false article. I was injured at Borders Book Store when a large 3 volume set of books fell off the shelf and struck my neck. I went to the emergency hospital to make sure I did not injure myself more than the bruises and marks on my neck. That visit cost $3,000.

James Kraai: jim.kraai@indwes.edu

Buddy Q changes the premise of Dr. Conduit's article. The issue was not "reattaching fingers" but a $23,000 micro surgury on a finger tip. A complete reattachment such as a severed thumb can be two or three times that amount. A rationale discussion is impossible if the factual basis is changed during the rebuttal.

Chieko:

Dear Dr. Condit,
I appreciate very much that you took time to share the true situation in medical world.
There are so many "Sounds true and great" theories shouting at us.
It is very important for me to hear from someone like you who has the true charity in heart and knows what really needed.

Katie:

Way to go Dr. Condit.

Pangborn is proud of you.

Buddy Q: buddy@tangerinefiles.com

This is a well written article, however, I disagree with your position. You wouldn't have reattached his fingers? Why not? He wants his fingers and doctors have the ability to reattach them so why not? Sicko is a very real and true depiction of the health care system. At your hospital you say they have a sign saying that you get care even if you can't pay. This is not policy everywhere. That's precisely why the hospital was dropping patients, WHO CANT PAY, off on skid-row! I couldn't get health coverage no matter how much I was willing to pay because I had Post Streptococal Glumernianephritis (spelling..??) The symptoms were that my doctor thought I had Congestive Heart Failure. My heart checked out perfect. It had nothing to do with my heart at all. Yet, I was turned down because I had symptoms of CHF, even though they read that I'm fine. My mom, is 63 and does not have any insurance. She can't go to the doctor. She has colitis, depression, and other issues and is unable to have these looked at by a doctor. If you have no money and no insurance, who do you think will see her? She can't afford prescription medicines, she's on social security which barely pays the rent. Nobody wants to hire her because she's a risk so she can't get insurance. She has to wait until she turns 65 to get Medicare! That's a great system!

I think Moore's main point was that something needs to be done. The part you don't seem to get, probably because your a doctor, is that the health care system is considered and run as a business. Everybody pays in but you give them less and less health care. Like that lady in which the insurance asks for her to repay for surgery because she had a yeast infection?? Come on. You can't possibly think that's considered a serious ailment. What woman hasn't had a yeast infection at one point in her life?

You rich doctors just don't see it from the same side of the fence as regular people do so it's easy for you to knock it down.

Buddy

Greg Westcott: medsave1@comcast.net

What an excellent rebutal to the one-sided, politically motivated documentary, Sicko. I'm sure most Americans, given the chance to respond to it, would agree Sicko does not represent U.S health care accurately.
I'm in agreement Americans would be better served if health insurance were purchased and aquired outside of their employment. Dr. Condit wrote, "The common good would be better served with medical insurance purchased, like other insurance, outside the workplace." People can buy health insurance in America if they desire to do so. The vast majority of the 45 million uninsureds' have insurance available to them in the free market system we currently practice. Anothe large majority have state programs available to them if they meet "means" testing guidelines. Unfortunately, some Americans don't choose to make health insurance a priority. For those that do, plans are affordable and easy to get, especially here in Michigan.
The system can be improved by removing the government handcuffs that drown the insurance and medical industries. Allow free-markets to perform without impediment. Missouri just passed H.B. 818 allowing employers to financially help their employees buy individual, non-group plans in the open market. Non-group plans are a fraction of the cost of group insurance and the premium savings can be tremendous. It seems like a simple enough thing to do, but the states and federal lawmakers aren't interested in something so characteristically simple.
Putting the states or federal government in charge of medicine and health care is a terrible idea and Mr. Moore is dead wrong. Thank you for a great article, Dr. Condit.

David Pendleton: kawikapendleton@hotmail.com

Dr. Condit's article is a thoughtful and thought-provoking critique of Moore's misleading movie and more generally a devastating refutation of the statist solution to the health insurance challenge in the United States. Moore is correct that part of the problem re health delivery in this country has to do with the government. Yet it is perplexing that Moore's solution is -- you guessed it -- MORE government. Moore fails to explain that despite the problems we have in this country, the finest physicians around the world come to the US for medical training and the most sophisticated medical care is available here in the United States. Sure, health care in socialized countries is universally available so long as you can stay alive long enough to get it. The examples in the movie Sicko are ill-suited and poor examples because they are generally exceptions to the rule, not the general practice of hospitals. If government needs to do better, not just more. If anything, government incentives should promote wellness, not just treatment of illness. An ounce of prevention, as the old saw goes, is worth a pound of cure. "Repealing" market forces in the health care industry is impossible and makes no sense. We need to more carefully align governmentally sponsored incentives to work with market forces to ensure coverage for more and more efficient utilization of resources. Why is it that most insurance will cover dramatic surgery for those wieghing more than 100 lbs. than their recommended weight, but will not cover less expensive programs to keep individuals from attaining that state of obesity in the first place?

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