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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NEJM -- Healing Our Sicko Health Care System

NEJM -- Healing Our Sicko Health Care System:

"To get around this catch-22, we will need populist anger but also
political foresight. Moore heads abroad to show us that a single public insurer
is the only hope. But one need not travel to Canada, the United Kingdom, or
France (much less Cuba — Moore's most dubious destination) to see the virtues of
combining universality with public cost control. Medicare, our country's most
popular and successful public insurance plan, covers everyone older than 65 and
people with disabilities — groups with great need for coverage and little
ability to obtain it privately. Yet it has controlled expenses better than the
private sector, spends little on administration, and allows patients to seek
care from nearly every doctor and hospital. For some reason, Moore ignores
Medicare. He talks about the post office, the fire department, public education
— but not the one public program that most resembles the 'free universal health
care' he extols.

"That's too bad, because the Medicare model is the not-so-secret
weapon in the campaign for affordable health care for all. Today, many advocates
of national health insurance have wisely started calling for 'Medicare for All'
rather than their old rallying cry, 'Single Payer.' But moving to a national
insurance plan overnight, whatever the label, means threatening the private
coverage on which so many Americans rely and requiring our cash-strapped
government to raise the highly visible taxes necessary to fund a system now
financed largely by the hidden drain on workers' paychecks. We may be moving
toward the day when we are ready to clear these hurdles in one leap, but we are
not there yet. "

A fairly reasoned discussion in all, but we need leadership of the RFK variety:

"There are those that look at things the way they are, and ask why? I dream of things that never were, and ask why not? "

(Okay, wikiquote says he lifted that from GB Shaw, but, same spirit.)

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'Sicko': Heavily Doctored, By Kurt Loder - Movie News Story | MTV Movie News

'Sicko': Heavily Doctored, By Kurt Loder - Movie News Story MTV Movie News: "Jun 29 2007 12:34 PM EDT
'Sicko': Heavily Doctored, By Kurt Loder
Is Michael Moore's prescription worse than the disease?"

I think the chief straw man Loder has thrown up here is that Moore holds up the Canadian, French or British systems as "utopia," to use his word. SICKO showed some of the serious flaws in our system and showed some of the serious benefits to others. That really is the bottom line. I've been following the media coverage closely, interviews with various experts, MM himself in interviews, etc. There are lots of complaints about what he "left out." Well, it's only a two hour movie and I think it is not his job nor his role to be the health care czar and review every nuance of health care here and abroad. He had a lot of points to make and he made them very well, very humorously and sometimes heart-breakingly poignantly. If you see it, you'll know that he didn't tell the downsides of universal access in other countries, but, frankly, as we health care providers know (I'm a critical care physician) better than the average viewer, neither did he scratch the surface of the problems so widespread in our "system." But he always says in interviews that of course other systems have problems. Our goal should be to take the best parts of each of those systems and craft an American system better than all the others. But, he makes no bones that this needs to be a single payer system at its core. He seems to have no bone to pick with physicians - he believes the focus of reform should be getting rid of private health insurance as we know it.
And finally, if you want to make the debate solely on health care horror anecdotes, you'll lose. Badly.
Cheers,

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CNN.com - Paging Dr. Gupta Blog

CNN.com - Paging Dr. Gupta Blog:
Someone responding to Dr. Gupta's point from Larry King Live last night:
"Hello Dr. Gupta.

I watched your discussion with Micheal last night, which I thought was quite interesting as I have the good fortune to live in Canada where we do have universal health care. This is certanly an issue that needs to be discussed. I did want to comment on one of the points you brought up last night as i felt it did not seem exactly true with my experiences. I am an advanced life support paramedic in Alberta and often treat and transport patients needing urgent angiograms. Althought weight times are an issue with urgent unstable angina type patients, it seemed you were painting a picture of emergent AMI patients were waiting six days to recieve life saving angiograms.
My experiece is nothing like that. I am proud to say that our region EMS services around Calgary have developed a system in which in feild 12-lead ECG's are read by responding paramedics and if determined that the patient is having a miocardial infarct, the 12 lead is faxed to the trauma centre and the patient is transported directly to the catheter lab, by-passing the emergency department decreasing the door to cath time.
Many incidents have seen patinets arriving for angiogram /plasty in less than an hour of onset of symptoms.
It is important to note that this service is available to everyone. As a front line health care worker paramedics experience first hand many of the delays in our healhcare system in Alberta, however, emergency situations are always dealt with in a timely manner, with no bias or discrimination based on wallet size.

humbly yours,

K. Palmer
EMT-Paramedic
Banff, Alberta Canada "

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Sicko Spurs Audiences Into Action

Sicko Spurs Audiences Into Action:
"The talk gradually centered around a core of 10 or 12 strangers in a cluster while the rest of us stood around them listening intently to this thing that seemed to be happening out of nowhere. The black gentleman engaged by my redneck in the restroom shouted for everyone’s attention. The conversation stopped instantly as all eyes in this group of 30 or 40 people were now on him. “If we just see this and do nothing about it,” he said, “then what’s the point? Something has to change.” There was silence, then the redneck’s wife started calling for email addresses. Suddenly everyone was scribbling down everyone else’s email, promising to get together and do something… though no one seemed to know quite what. It was as if I’d just stepped into the world’s most bizarre protest rally, except instead of hippies the group was comprised of men and women of every age, skin color, income, and walk of life coming together on something that had shaken them deeply, and to the core. "

Gives you faith that America will right itself after these awful six years...

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NPR : Diagnosing U.S. Health Care — and 'Sicko,' Too

Terrific interview with a very knowledgeable healthcare policy expert.

NPR : Diagnosing U.S. Health Care — and 'Sicko,' Too: "Interviews
Diagnosing U.S. Health Care — and 'Sicko,' Too

Fresh Air from WHYY, July 9, 2007 · Jonathan Oberlander, a political scientist with an expertise in health-care politics and policy, discusses problems with the U.S. health-care system and considers how other countries handle health care. He'll also give us a critique of Michael Moore's documentary Sicko. Oberlander is an associate professor at the University of North Carolina at Chapel Hill."

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