Response to: Commentary: What's Wacko about Sicko

Commentary: What's Wacko about Sicko
From Dr. Donald P. Condit, orthopaedic surgeon specializing in hand surgery in Grand Rapids, Mich. He also holds an MBA degree from the Seidman School of Business at Grand Valley State University. [My comments are in italics.]

Michael Moore wants socialized medicine in the United States.

Actually, he wants single payer or a Medicare for all system, not a socialized system such as Britain's.

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.


I argue that it is not his job to do a 12 hour mini-series. He had two hours to make his case, and he did. See this post for more details: http://cmhmd.blogspot.com/2007/07/sicko-heavily-doctored-by-kurt-loder.html

Moore's plan would result in worse, not better, health outcomes for Americans -- including the poor and underserved.

Please supply some evidence of this. Here is a bit showing you are wrong:
http://cmhmd.blogspot.com/search/label/US%2FWorld%20Health%20Care%20Comparisons
http://cmhmd.blogspot.com/search/label/Canada


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.

Doing a Dr. Frist, here, aren't we? Diagnosing and managing via a film clip? I am encoursged that you think this kind of thing wouldn't happen where you are.

In Sicko, Moore consistently equated lack of insurance with inability to obtain care.

See here: http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html
and here: http://www.newyorker.com/printables/fact/050829fa_fact
and here: http://cmhmd.blogspot.com/search/label/Rationing%20Health%20Care

I'd say the problem is grossly inadequate ability 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.

As John McEnroe might say, "You cannot be serious!" Does anybody really believe that having to show up in an emergency room, knowing that if you can't pay you'll be hounded for years to pay whatever you can, is equivalent to open access to primary care as is done essentially everywhere else in the industrialized world? No disincentive to comply with treatment there, is there?


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.

And another 50 take their place. This happened to my brother, an engineer, while between jobs. His wife took ill and he nearly filed for bankruptcy. He had a last minute generous help from his employer. Most are not so "lucky."

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?

Easy answer, here: NOT private health insurers! Not even "not for profit" ones!

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.

Unconstrained consumption? Really? How about delayed appropriate consumption resulting in later excessive costs due to inadequate treatment of manageble acute and chronic illnesses? How about the burden imposed on providers by private insurers? How about administrative costs? The lack of a national medical informatics infrastructure? The only place where I really do worry about consumption is in the last months of life. We do a lousy job of dealing with end-of-life care and our patients pay dearly for it with their suffering and angst, and society suffers under the burden of using resources inappropriately.

It is already clear that price controls have created strong disincentives to debt-burdened students considering careers in primary care.

That, and the ridiculously skewed compensation to procedure related specialties. Compared to the rest of the world, our PCP's income is comparable. It's in the procedure-intensive specialties where the big diference lies. Spread that money out more evenly and those price controls don't hurt PCP's so much.

Yet Sicko gives market oriented solutions no consideration.

What about the last fifty years makes you even a teensy optimistic?

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.

I think they were willing participants and understood what they were doing. I think it funny that people get exorcised that he "held up Cuba" as a fine example. I think his point was that EVEN Cuba, a communist dictatorship, pretended it had some universal healthcare. And still managed to only come in a couple slots lower than us in the infamous 37/39 slide.

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.

You're a surgeon. I bet given 15 minutes you can come up with a half dozen anecdotes about the stupidity and callousness of our 'system,' can't you?

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.

Agreed. And besides, in a contest of anecdotes, we'd lose. Badly.

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.

Rationing comes by under funding the system. That will be a serious danger here, too, when we move to Medicare-for-All. It is up to us to make sure it doesn't.

And of course, our rationing is economic. I find this indefensible and reprehensible.

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."

The Supreme Court decision was bad for a number of reasons, and since has been near universally derided in the Canadian press. Follow this link:http://www.pnhp.org/single_payer_resources/Canadian%20Supreme%20Court%20Ruling.pdf (Thanks to Nick Skal, of PNHP for this bit.)

Please click on the topic Waiting Lists on the right side of my blog for more info.

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."

I do not know the context of these remarks, but considering very other industrialized nation in the world has some form of universal healthcare, I expect he was specifically not talking about helathcare. But that's just a guess based upon my Catholic upbringing. And this, from Cardinal Bernadine, "Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right."


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

Violates social justice? You've got to be kidding, or, more likely, just defending a weary ideology not suited for this issue and rationalizing.

Cheers,

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