Controversial Michael Moore Flick 'Sicko' Will Compare U.S. Health Care with Cuba's

Ludlow · Jun 13, 2007

Hey Darren!

I can tell you that Moore went to Canada and could not find one Canadian who would exchange their Canadian Health card for his Aetna card. He also said, as is the case, that no system is perfect.

The issue we can't get side-tracked away from is that our American system, as Shiela Kuehl says, is not a Health Care System because it is not about health or care. It can be fixed and vastly improved with a single-payer system like the ones proposed by congressmen Conyers and Kucinich and California State Senator Shiela Kuehl. But the for-profit mechanism has to go.

Ludlow · Jun 13, 2007

Oh and Darren, the numbers used about uninsured are government figures.

DarrenWright · Jun 13, 2007

You can't make an argument for socialized/single-payer based on whether or not a Canadian won't make a total exchange of the Canadian system for an Aetna card, and here are two reasons.

1. 75% of Canadians live within 100 miles of the US border and can participate in the Canadian program, and subsidize it with a US private plan. Many do.

2. Most Americans won't exchange the American system for the Canadian system either. And if a single-payer American system were implemented, Canadians would be scrambling for an alternative to fill in the fatal gaps that would appear once the American free-market access disappeared.

And there is no evidence that the American system will be improved at all, let alone "vastly improved" by changing to a single-payer system.

Yes, the numbers used to identify the uninsured are "gov't" figures, but the numbers do not represent a point in time. Instead, they represent a period of time...one or two years. This means that they are counting anyone who was not insured for as little as one day during that two-year time period to be uninsured. That would include anyone who changed jobs and went without formal insurance for even a few weeks, yet still remained eligible for COBRA, and had another job in the pipeline that would insure me.

I don't imagine that M.Moore revealed that numerical liberty. But hey, since we are taking that liberty, why don't we use three years? Or 10? We could then crank up the percieved number of uninsured to 60 million, or over 100 million!

http://www.therecord.com/home_page_front_story/home_page_front_story_1063557.html

Summary: Put on a three-month list for an MRI while suffering from seizures. Scan wait times for this hospital have increased 84% over the past two years. Came to the US for an $1,100.00 scan.

I don't want to trade my insurance for a "Wait Times Registery" such as can be found in Ontario.

RN4MERCY · Jun 13, 2007

For some reason, I'm seeing M. Moore chuckling all the way to the bank with these endorsements.
Does one not see the irony in enriching M. Moore for a message of activism while he criticizes others for making a profit for actually providing care?
Did the numbers on uninsured and per-capita expenditures come from M. Moore's movie?
Did M. Moore's film happen to mention that the Canadian Supreme Court is unable to serve all it's people?
"...prohibiting...ordinary Canadians to access health care...the government is failing to deliver health care in a reasonable manner, thereby increasing the risk of complications and death."

Please, see the film first because I think you're being intellectually dishonest in casting aspersions on the director and his message, and you're being pitifully offensive and callous toward the victims whose stories he carefully records. I don't believe that was your intent, was it? Mr. Moore also travelled to England, and France, and Cuba and recorded the stories of the people and the providers working in those countries. "Res ipsa loquitur." Workers deserve to be paid for their labor, by the way, and Mr. Moore happens to make his living creating documentaries. He's an artist and a journalist. Before criticize and judge Mr. Moore's motives for making the film and talk about him laughing all the way to the bank, you might find yourself crying and ashamed at the end of the movie for having spoken out of turn. I don't know that people would describe me as particularly religious, but there's an admonition from the Book of Isaiah...that warns, "woe to them who call good things bad and bad things good." Just a word of caution here...take it or leave it. I do believe what goes around comes around. Another of Mr. Moore's critics had to eat a little humble pie recently, yet Mr. Moore graciously defends the man's first amendment rights to his opinion too!

Would you consider the fact that since greedy insurers and HMOs, and unethical physicians and even some nurses who work for them, might be considering Canadians as their next opportunity to make a profit? I believe the case you mentioned is a calculated and strategic move by the "for profits" as the first step in exploiting a minor and relatively rare problem for the purpose of promoting and marketing their product for their own self interests. If a doctor is doing surgery in a private orthopedic clinic, then he's not available to do surgery on the patients in "the queue" for example. You can't squeeze the public health infrastructure by not fully funding it and then calling it a failure. Why pay third party middle man, the for-profit insurers who sell you promises that they're going to provide care? That's what's happened in this country. Individually, victims have no way to hold them accountable. They're only accountable to their share holders. (Claims denials is a $10 Billion dollar a year industry in this country. That's a lot of money that could and would help fund a single-payer system.) Politicians have been bought off by massive corporate campaign contributions from insurers and HMOs. When you take something from them, you owe them something; they've passed laws that have all but turned this country into a corporate welfare state where you're "entitled" to all the health care you can afford, instead of providing public health and safety benefits for the common good.

The overwhelming majority of Canadians are very satisfied with their healthcare. It's not a perfect system, but we can't stand by and allow the "perfect" to stand in the way of the incredible good for the overwhelming majority of people that a single payer health care system would provide for us as a nation. Glad you mentioned risks of complications and, speaking of death, there are 18,000deaths per year in this country attributable to lack of access to basic, medically necessary care. A lot more lives will be saved among the 47 million people in this country who have no access at all and who are "rationed" out of the system all together; time is of the essence and lives are hanging in the balance. We need guaranteed healthcare, not more insurance!

Until you see the movie, consider this, regarding your comment about the Canadian Supreme Court decision you refered to, before you post information out of context:

http://www.pnhp.org/news/2005/october/the_chaoulli_case_a.php

By Gregory P. Marchildon

Healthcare Quarterly

Vol 8, No 4, 2005

Abstract:

There has been considerable speculation about the potential impact of the Supreme Court of Canada's judgment in Chaoulli v. Quebec. Even if those who are most friendly - or most hostile - to Canadian medicare are exaggerating the impact of the decision, its impact will be large. While the decision does not strike down any existing single-payer medicare system in any province, including Quebec's single-payer system, it is certainly capable of becoming the Magna Carta for two-tier medicare through future judicial interpretation and extension. In any event, it has already become the battering ram of choice for medicare's most tenacious opponents.

In recent years, the critics of medicare have become more vocal about what they invariably describe as the monopoly of single-payer health care, often comparing Canadian healthcare to the command economy of the former Soviet Union. This perception is not only misleading - it is fundamentally wrong on a number of counts.

In the first place, Canadians are awash in choices when it comes to medicare. We have the freedom to choose our physician. Within our respective provinces and territories, we are free to choose our health institutions - one hospital over another, one clinic over another, depending on our personal preferences. And in contrast to the imagery of a single government bureaucracy perpetuated by the critics of medicare, almost all of our physicians are independent professionals working on fee schedules or contracts freely negotiated with provincial and territorial governments. Many of our clinics are private (not-for-profit as well as for-profit) and the majority of our hospitals are either private not-for-profit institutions or part of regional health authorities that have varying degrees of managerial autonomy from government. This contrasts sharply with the history of the National Health Service in Britain, in which hospitals and their employees all became part of a central government bureaucracy.

In the second place, medicare refers to a quite narrow range of health services - mainly hospital, diagnostic and physician services that are provided on a universal basis and without direct payment by the patient. These services constitute about 43 per cent of total healthcare expenditures in the country. Almost all other healthcare, including home care, nursing home care, prescription drugs, vision care and alternative medicines, are outside the medicare basket. In other words, the so-called monopoly covers less than one-half of Canadian healthcare and does not at all apply to mixed and private sectors of healthcare - sectors in which private insurance, user fees and direct payment are the rule rather than the exception. Moreover, the mixed and private sectors - comprising over 50 per cent of health expenditures - have contributed far more than the public sector to the high rate of growth in healthcare expenditures over the last decades.

Finally, we have always permitted two small exceptions to our single-payer medicare regimes - one private, the other public. On the private side, no one is prohibited from purchasing private health services as long as they pay out-of-pocket for those services from providers who have chosen to be non-participating members of a provincial medicare scheme. On the public side, workers' compensation health benefits predate medicare and were legally excluded from the operation of the Canada Health Act and provincial medicare laws. Of the two, at least until the Chaoulli decision, the public tier of workers' compensation has been more problematic in terms of its damage to the principle of universality by allowing a segment of the population preferential access to medicare services, occasionally through non-participating physicians and private facilities.

In contrast, the private exception based upon private payment never really developed in Canada for a number of complex reasons, particularly the refusal of provincial and territorial governments to subsidize private care or encourage physicians to work both sides of the public-private street at the same time. Although I know it is contentious to do so, I would add that the generally high quality of Canadian medicare has also prevented a large private market from developing. At any rate, the very few Canadians who have wanted such services have always been free to purchase them in the United States, where a ready market for privately purchased services has always existed because of the truncated nature of public health insurance in that country.

This brings us to the nub of the Supreme Court's decision. Despite the lack of evidence, opponents of Canadian-style medicare, including Dr. Jacques Chaoulli, have long argued that the inability to purchase private insurance for medically necessary health services has been the key factor in preventing a viable second tier from emerging capable of competing with publicly administered medicare for customers (Coffey and Chaoulli 2001). They often point to examples such as Australia, where public and private hospital and physician services co-exist. Of course, they conveniently ignore the fact that the Australian government has had to provide a huge public subsidy in the form of a 30 per cent deduction for private insurance premiums to keep the private system in business, an experience that seems common in countries with such two-tier systems. In other words, public funds are often diverted to the wealthier members of society in order to prop up the private tier where it exists.

Proponents of medicare have long argued that to preserve the universality of a system, with access based solely on need, government needs to discourage the emergence of a separate "upper" tier of care based on ability to pay. Most governments in Canada have done so because they wanted to prevent major exceptions to the principle that access should be based on urgency of need. They have also done so to prevent a parallel private system from robbing the financial and human resources needed to run a top-notch public system. To protect their single-payer systems, different provinces have selected different and various means to discourage a second private tier. These means include: not allowing non-participating physicians to charge more than the medicare fee schedule; refunding patients only the medicare portion of fees paid to non-participating physicians; and in the case of six provinces (British Columbia, Alberta, Manitoba, Ontario, Quebec and Prince Edward Island) prohibiting private health insurance for medicare services.

In Chaoulli, the Supreme Court decided that Quebec's prohibition on private health insurance is contrary to the Quebec Charter of Human Rights and Freedoms when an individual's lengthy wait for medicare services seriously compromises the health of that individual. The court provided little guidance, however, in helping governments, health organizations and physicians know at what point a waiting time is too long. Moreover, little or no consideration was given to the fact that many provincial governments and health organizations, through initiatives such as the Western Canada Wait List Project and the Saskatchewan Surgical Care Network, have focused their efforts at understanding and shortening wait lists. Indeed, while the degree of success varies across and within provinces, there has been considerable progress in reducing waiting times in many parts of the country in the last couple of years.

Contrary to the majority view of the court, which seemed to swallow the monolithic, monopoly view of the world, medicare is actually a highly local system depending on the management and decisions of individual physicians, hospitals and regional health authorities. It is up to these organizations, under a publicly administered framework provided by the provincial government, to balance the many priorities, from urgent to elective care, and from sickness care to illness prevention and health promotion. We must ask ourselves whether the court's concern with one waiting list problem in one city in one province is going to end up dictating the priorities of health organizations and governments throughout Canada, even further tipping the balance in favour of downstream illness care and away from prevention and promotion efforts that will keep us all healthier (and at less cost) in the long run.

So, what next?

In the face of this decision, those governments that support medicare should act now rather than waiting for the inevitable offensive driven by the powerful interests supporting the radical privatization of Canadian medicare. Individuals and groups within those provinces can strengthen the resolve of these governments by expressing their support for universal medicare, their opposition to allowing a private upper-tier of care, and initiating their own litigation to support the principles of medicare.

Those provinces that have prohibited private insurance should consider amendments that clarify the reasons for prohibition and the merits of a single-tier system of medicare. The legislative debates will force everyone to make their positions and assumptions clear and will provide an opportunity for medicare-friendly governments to set out the evidence supporting a single-tier system. Once enshrined in law, each government's legislative intent will have to be taken into consideration in future court rulings.

The provinces that have not previously prohibited private insurance have at least two options open to them. They can re-examine the combination of measures they have used in place of an outright prohibition on private health insurance to protect the integrity of their single-payer systems, and the extent to which their circumstances may be similar to, or different from, the provinces with express prohibitions. They can then amend their own medicare laws to make clear their legislative intent to continue to preserve the integrity of their single-payer systems.

Although unlikely because of the inherent cautiousness of the advice given by health bureaucracies to their political masters, it would be interesting to see at least one provincial jurisdiction carefully draft a new law prohibiting private health insurance for the express purpose of having it tested in the courts, perhaps through a reference case. I am quite sure that it would be relatively easy in such a case to demonstrate the broader point that the policy measures relied upon by any government to protect medicare are better determined by governments accountable to the public through the democratic process than by the courts.

The federal government could also take some long overdue action to enforce the Canada Health Act. There is a reason that Montreal has the largest number of private MRI clinics in the country - a market has been created because of the extremely long waiting lists in the public sector and the willingness of participating physicians to encourage their more well-off patients to jump the medicare queue by getting a private MRI. If the federal government had forced this issue into the public domain years ago through a (temporary) reduction in its transfer payments, the Quebec government might have better ensured timeliness of care through the public system and not relied so surreptitiously on its private release valve. In more general terms, while it is up to individual provinces to decide on how best to administer (and protect) their respective single-payer systems, the federal government needs to continue to ensure that it is effectively discouraging major exceptions to the fundamental principles of public administration, universality, comprehensiveness, portability and accessibility.

Finally, I would like to offer some unsolicited advice to Premier Klein of Alberta, given his comments following the Chaoulli decision. If he truly believes that the founding principles of medicare are fundamentally flawed, then this court decision should finally give him the courage of his convictions. If he truly believes that Albertans endorse his vision, then he should immediately introduce a two-tier system. He can bypass the Canada Health Act by simply refusing federal health transfers in the future. If Saskatchewan was able to go it alone for years when it first introduced medicare, then surely oil-rich Alberta can now afford to go it alone. Albertans could then pay directly out-of-pocket or indirectly through private health insurance for a portion of their medicare services. Access for the majority would be based mainly on "ability to pay," while access for the very poor (often defined as those on welfare) would be determined by a safety net type medicare program. Where the working poor fit into this picture is a little harder to determine but all Canadians outside Alberta would have a home-grown point of comparison on how the systems stack up against each other.

In the 1960s, this option was called Manningcare because Premier Ernest Manning was convinced of its merits compared to the universal medicare model. Personally, I would be confident that single-tier medicare would prove itself more efficient, effective and equitable in the comparison, just as it has done so relative to the American system. Whether a majority of Albertans would willingly go along with Premier Klein on this trip back to the past is highly questionable. Indeed, I suspect the majority of Albertans remains as opposed to a two-tier system as all other Canadians, a stubborn fact that explains the gap separating Klein's bravado from his government's timid actions on the ground.

We all know that the demand for healthcare services is potentially limitless. After protracted debates almost a half century ago, we decided that, at least for medicare services, rationing should be based upon urgency of need rather than ability to pay. Though the majority of Canadians continue to support that democratic decision and the founding principles of medicare, the Supreme Court through its Chaoulli Magna Carta is doing its best to force us back to the drawing board again.

About the Author

Gregory P. Marchildon, is Canada Research Chair and Professor Graduate School of Public Policy, University of Regina and Fellow, School of Policy Studies, Queen's University. Email: [email protected].

References

Coffey, J. Edwin and J. Chaoulli. 2001. Universal Private Choice: Medicare Plus. Montreal: Montreal Economic Institute.

smk1, LPN · Jun 13, 2007

I haven't seen the movie, but know from personal experience that our system is broken. For sure, "socialized" medicine has its drawbacks particularly when it comes to the issue of long wating lists for surgeries and tests, but honestly our system isn't much better in that respect. My friends little boy had to wait 2.5 months for MRI and neurotesting after a new onset of seizure activity (petite mal). I was just told that the main hospital group/clinic in our area has a waitlist that reaches until mid october if you need an endocrinology consult. That is utterly ridiculous. People could go into thyroid storm or DKA waiting that long. No system is perfect, but pretending that the U.S. system doesn't already have some of the drawbacks of socialized medicine is like wearing rose-colored glasses. I have been shocked to see the lack of care that lands people in the hospital. (insurances not paying for chest x-rays or CT scans for people who have been in and out of their PCP office with SOB and hemoptysis only to have to pay a far more expensive bill later when they end up admitted to ICU for PE). Or the ever present pyelonephritis from a UTI that wasn't treated because someone doesn't have insurance and is not an alien indigent or poor enough for medicaid. We shoudn't get side tracked on the is Michael Moore a good person debate. The fact is that he is bringing attention to a problem that warrants thorough discussion in this country.

cardiacRN2006, ADN, RN · Jun 13, 2007

Please, see the film....

Nope. Sorry. I can't believe a word that Micheal Moore says, and I certainly won't drop a dollar into his wallet.

ZASHAGALKA, RN · Jun 13, 2007

The average American is saavy. Investing in the dogma that MM speaks the truth actually hurts the underlying message for those that are pushing it. Most people, who care even mildly about such things, know that MM's schtick is to say the most obnoxious leftest thing the loudest, ala Ann Coulter for the right.

There is a distinct difference between truth and political spin. MM has shown a knack and skill for political spin, that is true. He has not proven responsible with the truth. He doesn't pretend to, either.

He doesn't pretend to make documentaries. This isn't one, either. This is a 'shockumentary'; a form of entertainment with all the liberties and licenses that hollywood allows such things. THAT is how MM describes his work. I would describe it in less publicly acceptable terms.

If you can't get past MM to advocate for gov't restricted healthcare, then your entire audience will comprise of George Soros wannabes.

Great, if you want an audience of core true believers.

Not so practical if the goal is to convert the masses.

MM detracts from the message.

Look, when I want to make a point stick in the political gap, I generally do not use Rush Limbaugh as my source, even if I think it's a credible source. It doesn't matter what I think; it matters what the person I'm trying to convince thinks.

No matter how bad you want it to be so, MM is not a credible source.

~faith,

Timothy.

icuwant2rn · Jun 13, 2007

Nope. Sorry. I can't believe a word that Micheal Moore says, and I certainly won't drop a dollar into his wallet.

:yeahthat: Completely agree with you. He is as extreme left as you get and would have us living in a communist state if he could. Can't believe a word of what he says. Of course there are instances where the health care system fails. Every system, including Canada, Europe, etc. have problems. I prefer working on what is in place and keeping our free market as opposed to socialist controlled HC.

pickledpepperRN · Jun 13, 2007

:yeahthat: Completely agree with you. He is as extreme left as you get and would have us living in a communist state if he could. Can't believe a word of what he says. Of course there are instances where the health care system fails. Every system, including Canada, Europe, etc. have problems. I prefer working on what is in place and keeping our free market as opposed to socialist controlled HC.

Most advanced western countries are not communist.

People voted for their health system.

What we have now is not acceptable.

We can and someday will do better.

I will do my part to help that someday be sooner rather than later.

Ludlow · Jun 14, 2007

In faith, Tim, the experiences that people tell about in SICKO are the facts on the ground about our health care system.

We can't have babies dying for want of hydration and antibiotics as they sit in an ER simply because it's an "out of system" hospital. That was baby Mychelle's story. Right diagnosis, right professionals who knew what to do, right place to be where all the right equipment was but wrong insurance. So an IV was not started and antibiotics were not given because the insurer would not pay for it. The baby sat in that ER and seized. Finally she was transported by ambulance to a "provider" hospital in time to be coded and pronounced. That is the experience told by the baby's mother. That's what in truth happened because our system is messed up.

Doesn't matter who tells the story. That story and the others in SICKO constitute true moral problems and embarrassments for all of us that we must work to correct.

One of the great values of SICKO is that everyone will have a chance to peek behind the curtain hiding the greedy profiteers that control our health care system. They will be able to see that they are not alone in likewise being screwed over by insurers and HMOs. And they, too, will want to figure out how to make the system better.

And just seeing the facts makes the answer pretty clear: for-profit has no place in Health Care.

HM2VikingRN, RN · Jun 14, 2007

I have yet to see a credible argument from opponents to single payer that shows the current "system" in America actually works.

The arguments for COBRA as a suitable medigap system for families and children are ludicrous to be kind. How will a family pay for 750 dollars per month for 18 months if the main breadwinner is disabled or unemployed. (13500 dollars is a lot of money to come up with on short notice.) I agree with spacenurse!

Ludlow · Jun 14, 2007

Yeah, hm2viking, once you can't work because of your illness, the system completely breaks down. My daughter, a teacher, couldn't work because of illness and wasn't eligible for disability because she hadn't been in the system long enough. How in the world can anyone pay for COBRA (her's was $400 a month) when they have no income? She still needed medical care and medicines.

Our system expects you to become destitute. I'm sure some people in similar situations without family support never recover.