December 21, 2007

 

Countering the sick in "Sicko"

From: Name Withheld
Sent: November 21, 2007 1:03:14 PM
Subject: Sicko the Clown - A useless film from Michael Moore.‏

I made the mistake of watching another Michael Moore film. Don't worry, he didn't get any of my money. Here's the rough brass of what I thought of it...

Ok, it's a little roasty at points. Very rambly, but here's a first take an hour or two after watching this thing... and of course taking a look around to check out what he says...

The first thing I noticed about this film is that Moore has departed from at least some of his earlier ways of doing things. There is less content to judge one way or another. It is much more like a late-night "infomercial" where the key points are hammered home using repetition of the juiciest points - i.e. - "health care is 'free' in Canada," "Health care is 'free' in Britain," "Health care is 'free' in France" "free free free, etc." "how much do you pay? Nothing." "What was your bill? Nothing." and so on.

Where I will credit Mr. Moore is that he does underline some very disturbing and possibly unfair specific cases from his own country. They are examples of horrible situations that we must work, be it privately or publicly or somewhere in between, to prevent from happening to anyone in our country.

I don't approach this film as somebody who approves of the systems or the overall interconnection of those systems in the US. It's not because I have a problem with private sector involvement in health care... far from it. It's because I think the incentives are slack and the patchwork has caused problems.

I am informed enough to realize that Moore is being extremely selective in what he shows in his film. I have dozens of relatives living in the U.S. They do just fine with their insurance companies and health coverage.

Still, I don't mind Moore pointing out real, serious, and legitimate faults that exist. He's right to point out the cracks and those who fall through them. We should remember to look for similar cracks here and fix them in the best ways we know how. As usual, Moore tries to make it seem as if the Americans are all on death's door or forced into the poorhouse by the systems there.

Where Moore ticks me off, as usual, is when he still feels the need to misrepresent the situation and even lie.

A few examples: He claims infant mortality is higher in Detroit than in El Salvador. Putting aside the fact that it's somewhat problematic to compare a country to a city, I don't think his claim is correct.

The 2006 UN Human Development Report shows that El Salvador's Infant Mortality Rate is 24 per 1000. The US rate is 7 per 1000. http://hdr.undp.org/en/media/hdr06-complete.pdf

Detroit's is indeed considerably higher than the US average, but it is well under 20. http://detnews.com/2004/specialreport/0412/20/A15-36503.htm

This probably points to some other serious social problems and there could be a whole other discussion about the best way to address some or all of those...

There are similar disparities right here in Canada too: http://www.statcan.ca/Daily/English/041109/d041109c.htm

Infant mortality in places like Nunavut and rougher Canadian cities are as bad or worse than Detroit's. Funny how Moore gave them all a miss...

My curiosity was also piqued when Moore started to make a series of conclusions based on the anecdotes he filmed plus the state of "50 million" Americans without health insurance...

Depending on who you talk to, the number appears to be somewhere in the neighborhood of 40 million, maybe more depending on your definition. Still, that's a lot of people. In this film, Moore seems to be constantly re-enforcing, or at least asserting, that uninsured Americans WILL forgo preventive care or receive a lower quality of care.

Yesterday, I stopped off at the land of Google and a few reputable university websites and publications to see if anyone had actually looked into what might seem intuitive and even gospel "post-sicko."

Helen Levy from the University of Michigan's Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, couldn't establish a "causal relationship" between health insurance and better health. There is, to use their words, "no evidence," that expanding insurance coverage is a cost-effective way to promote health. http://www.jcpr.org/wpfiles/levy_meltzer.pdf

Check out the New England Journal of Medicine - a study in there from last year found that although many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."
http://content.nejm.org/cgi/content/full/354/11/1147

Also, many death rates, including those for cancer in the US, are continuing to drop. This may be indicative of many things, but since Moore took time and chose to put faith in such indicators, he should paint a fuller picture...
http://www.cbc.ca/health/story/2007/10/15/us-cancer.html

I guess the point is - there are problems and there are people whose problems should be addressed but aren't being addressed in the US, but we would be likely wrong to make too many of the so-certain assumptions that Moore makes about insurance and the like.

I will say this for Michael Moore - he's getting a little more transparent with age. Large portions of his film depart nearly completely from the subject of health care policy and law and go over into the sort of stuff you usually see from one or another left wing flyer-distributing group... attempts to link everything from Nixon to pills to multi-job economy to changes in unionization together.

It doesn't quite go together, and one can be driven mad if one first takes his word that this isn't about ultimately socializing everything, but then asks oneself whether he thinks it's cool that the Brits are able to get all those drugs, including all the nasty supposedly unnecessary pharmaceutical products at a flat drug plan rate... and other such paradoxes...

During the part where he goes to Britain, it's like he took a break in the middle of the film to go speak to Tony Benn and film some old (and now largely discredited) Labour Party junk. Even Tony seemed more focused on solid (albeit twisted) values.

And if the objective was to get a credible Brit aimed at winning skeptical Yanks over to some version of NHS, why the hell would you go to Tony Benn?

Why not someone from New Labour? I'd bet even some Tories would love to speak on it too. But for Moore, that would be too limiting. He's still actually much more interested in driving at something else beyond health care.

It comes up in his trip to France too - where he spends as much time fawning over a system where they all but send someone to raise your youngsters for you and wipe your arse (if Moore's film is to be believed) at no cost of any sort, in any way, ever... then shows clips of people out in the streets bawling for more...

He seems to think France is idyllic because of its statism. Quite frankly, I found a lot of the things he claimed to be "good" to be almost offensive. Are families obsolete? I remember Bill Gairdnier warning us in one of his books from about 15 years ago about the senior Swedish civil service who were less than guarded about that being one of their goals.

All in all, I think Michael Moore lost an opportunity to have a film more specifically directed at fixing the problems he outlines and helping the people who fall through the cracks that he found. Instead he stayed true to character. He tried to paint the US system in that light, generalized it all (I guess to widen the audience appeal?), and then proceeded to make some comparisons to other countries.

I was most disappointed with his trip to Canada. If I was going to find some average Canadians and I was Michael Moore, I wouldn't go to my relatives. And I don't know if it's fair to suggest or imply that the average Canadian is terrified to enter the US without insurance. But Moore plays it that way anyway.

His wide travels within Canada apparently took him to two cities in Ontario. We can all appreciate the hilarity of this... then again he visited a low crime part of one town in Canada in Bowling for Columbine and pretended as if it was definitely representative of all of Canada, so that trick isn't new.

As for the wait times for people in Canada - not sure he's getting the full story. I had to attend a hospital outpatients non-emergency clinic the night before last and had to wait for 3 hours or so to see about basic prescription matters and other conditions. I have been trying to get a family doctor in CornerBrook since February 2007 and I still don't have one. Given the triage system, I think 3 hours - even in a crowded waiting room - isn't too bad, but it's certainly longer than the 20 minutes that Moore was trying to pass off as the 'Canadian' norm.

Wait times in Canada are much much higher than Moore would like to have us believe - http://www.cbc.ca/health/story/2007/10/15/waittimes-fraser.html

In fact, they have become such a concern that when the federal government changed hands, a wait-times strategy was put into place to try to address the problem.

I also think it's unfair (and unnecessary) to play up "it's free." I realize he's selling in the US where patient pays is more common, but is he really going to pretend as if there isn't a cost paid elsewhere? Does he believe the Yanks won't ask about taxes and fees and levies?

I think that Canada has a system that needs improvement, but I wouldn't pretend as if it doesn't cost me money or us money. In fact, the cost of the Canadian system continues to increase each and every year. The projections put the cost of health care at well over 50% of provincial revenues in over half the provinces in this country by 2020 or so.

Canada, France, and Britain have considerably higher taxes. I'm not saying that they don't all go to pay for certain services, but I think Moore should have gotten more specific.

http://www.oecd.org/dataoecd/43/63/1942474.xls
http://www.oecd.org/document/60/0,3343,en_2649_34533_1942460_1_1_1_1,00.html

It's a rough road to take when you start making claims of miracles about a system - especially the Canadian System.

Our systems are in flux. We had a ban on choice/access to private care that was unique to us and communist countries. It was overturned, rightly, because it affected our rights in a very very very serious way.

As our Supreme Court Justices (a generally very lefty liberal bunch) said: " ...The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness... "
http://csc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

Of course, Moore ignores this too. He ignores anything and everything that gets in the way of what he wants idealized. He did it when he tried to imply that all Canadians keep their doors unlocked. He did it when his representation of pre-2003 Iraq was kids happily playing in the streets in a free and safe country... he's doing it here again with health care.

His Cuban-approved portrayal of Cuba, while good in that it led to care for some select individuals he brought along, was very misleading.

First off, I think he should speak to Cuban exiles - of all 'classes' and means about what freedom meant pre-Castro versus post before he just assumes that the regimes pre and post "revolution" were comparable. He doesn't do that. He ignores the fact that even the basic internet liberties we enjoy right here on this forum are restricted in Cuba. It is hard to believe that this care would be given in this way without some careful direction and consideration of what would happen to all people portrayed should they do anything except showboat the country to the world.

What's even funnier is that even though Moore at one point cites the WHO study to point out that the US is ranked 37th in terms of its health system, he later tries to claim that CUBA has one of the best in the world, EVEN THOUGH, USING THE SAME RANKING, IT RANKS LOWER THAN THE US!
http://www.photius.com/rankings/healthranks.html

Moore also claims that Cubans have a longer average lifespan than Americans. According to the UN Human Development report, this isn't true. Americans have a higher average life expectancy than Cubans and infant mortality rates are different by 1 per 1000. Maternal Mortality rates (per 100,000) are 8 in the US and 34 in Cuba... Canadians DO live longer on average than Americans, but not quite as long as Moore claims...
http://hdr.undp.org/en/media/hdr06-complete.pdf

Canada only makes it to 30 on that WHO list. I'm sure many of the Public Monopoly Health Care Sacred Cow cultists are still scratching their heads on that one! Many of the countries ranked higher still have systems that allow private sector involvement. Moore ignores them too.

To be fair (and I have a hard time with such an unfair SOB on the other side) Moore also points out a few very quickly addressable problems in PARTS of his own country:

Senior's Care - this is a group that is defined relatively easily and even many of the Americans who might oppose state medicare could see why there needs to be an immediate effort and series of reforms aimed at making sure that each and every senior citizen is cared for somehow.

9/11 rescue workers - Though given that there are probably days when Moore would protest that the people at GITMO aren't getting fair treatment, etc. his Gitmo stunt was a little hypocritical.

I think the film also revealed something that is under-considered in Canada - the Brits have incentives and bonuses for doctors with patients they shift to better health practices and/or improved health indicators, etc. This may be something that health care providers should consider exploring.

No doubt, not unlike 'F-Height 9/11' and 'Bowling,' this film will be very popular with Canadians who want to have their belief that their system is significantly better than the American system or some other smug piece of perception of moral superiority. I think the most incorrect and ridiculous thing we could do is to fall into the trap of watching a film like this in this way and/or assuming that any move towards involvement of the private sector in any way must equal out to the bogeyman Moore-portrayed "US System."

Putting aside the fact that there are few generalizations we can honestly make about the "US system," there are countries that Moore didn't talk about that have indeed had private sector involvement, contracting out and other such things.

Even France, one of the ones he mentioned, didn't dare go so far as to try the ill-fated Canada private-hating ban on private service.

Norway, Sweden, and other countries have had even better health indicators and have at times done quite well with partnerships that realize some benefits in parallel systems.

We shouldn't rule out using more contracting or specialization or diagnostic clinics within the single-payer model. Heck, after our own Supreme Court pointed out the rights abuses of our system, the single-payer monopoly is probably not even a go.

So we're changing too. And so we should. Moore's film can tell us almost NOTHING about the Canadian system and maybe a few small things about parts of the "US system."

All in all, I wasn't that impressed.

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