The first person we meet in Sicko, Michael Moore’s new film about health care in America, is George W. Bush, who tells us that “too many OB-GYNs aren’t able to practice their—their love with women all across this country” (because trial lawyers are hounding them out of business). The second person we meet is Adam, who explains, as he matter of factly sews up a nasty gash in his knee, that “I don’t have a job and I don’t want to have any more debt than I already have.” There a lot more Adams in this country than there are OB-GYNs held back by trial attorneys from practicing their love.
Bush shows up again when he signs the Medicare prescription drug benefits legislation, otherwise known as the Big Pharma Welfare Act, and yet again as he congratulates a middle-aged woman who has to work three jobs to make ends meet and is worried about Social Security. “Uniquely American, isn’t it,” the vacation-happy president says in response to her revelation. “I mean that is fantastic that you’re doing that. Get any sleep?”
Raise your hand if you share the president’s enthusiasm.
Working multiple jobs while fretting about the security of your old age and the insecurity of your current one may not be uniquely American, but it’s unique to America among developed countries, as are the stories of the insured Americans to whom Moore introduces us in the film, whose lives are radically diminished by the failures of our system.
As Sicko percolates into wide discussion, we’ll be hearing a lot about the drawbacks of national health care in the countries Moore visited, particularly Canada. Opponents of the Canadian system will say it leads to unconscionable rationing of care and unacceptable waiting times for some treatments, including some surgeries, that prompt Canadians to come to the US for care. They’ll cite surveys showing substantial dissatisfaction with the system, and they’ll dredge up a horror story or two to bolster their case.
Much of this will be nonsense, and much of what isn’t nonsense is irrelevant; what they won’t do, because they can’t, is show any evidence that Canadians — or citizens of any country with guaranteed coverage — would trade their system for ours. That’s because no one wants to trade the possibility of quicker service for the possibility of no service.
Every health care system has waiting lists. That’s because every health care system has a finite capacity: there are only so many doctors and nurses, so many hospital beds, so many operating rooms, so many machines and so many people to operate them. Every system also has priorities, formal or otherwise: emergencies are treated first, then urgent problems, then ones that can wait without damaging the patient’s prospects for recovery. Every system has peculiarities that nudge providers in the direction of some treatments over others.
And every system has costs. When the government pays for medical care, the people who deliver it are at the mercy of the budget, which can mean that treatments such as elective surgeries get put on hold until the money’s there. When for-profit insurance companies pay for medical care, the people who deliver it are at the mercy of the balance sheet, which can mean that treatments are withheld if they threaten profits and the administrators can find an excuse to keep from paying for them.
For the tens of millions of Americans who either don’t have health insurance or are afflicted with a pre-existing condition exempted from coverage, a whole range of eminently treatable illnesses and injuries go untreated. In civilized countries, that simply doesn’t happen: there are no pre-existing conditions, and everyone is covered.
That’s the point to mark in any debate over health care. Whatever the drawbacks of national health care systems — and there are some — no one goes untreated; no one loses their home or their life because they can’t pay.
And that’s why countries that have national health care keep it, whether they elect conservative governments or liberal ones: the overwhelming majority of citizens in those countries prefer it to the alternative. Even Margaret Thatcher never dared attempt abolish the U.K.’s National Health Service (although both she and the Blair government have eroded it).
We’ll be looking at criticisms of national health care systems (and of Sicko) and at the political and social significance of a U.S. national health care system in forthcoming stories.
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It amuses me when people say they don’t want gov’t to control their health care. They rather have corporate/HMO control? RFOL!
I find the arguement about ‘socialized’ police, roads, and firefighting especially compelling.
Rationed care? Oh my. Thank goodness the private insurers wouldn’t think of rationing my care (and charge extra) for the bureacracy to ration it extra-effectively and redundantly).
Another excellent post.
As a Canadian expat currently living in Portugal, I can testify positively on behalf of the Canadian Health Care System.
Nevertheless, I believe the best Health Care system in the world, is easily the French (the Swiss and Dutch have similar systems).
It conjugates the best of common sense and social responsibility. Patients seek out and choose medical treatment providers at their pleasure and the government either fully reimburses the patient (if he paid for treatment), or pays the treatment provider for services rendered.
All medical practice is essentially private while government funded. The only drawback is controlling irresponsible over-billing. The French have been succeeding for decades.
No employer provided insurance (which is utter nonsense btw), no private avarice and no bureaucratic morass.
I’m a Canadian and I strongly dislike the Canadian system. I have severe lung disease that developed since childhood. Was born with it actually. Recently, it took from June 20th till July 2nd to learn that my chest x-ray had showed a pneumonia. Took another day to receive actual treatment – IV antibiotics. Now it will take much longer to recover. Our system is not that great and getting worse all the time. In the fall, I will start to come to the US for care that I’m not able to receive in Canada. My family and I are just so fed up with the Canadian healthcare system or lack of system. Have dealt with our system for many years and it just seems to get worse every year. One day I hope that we too will have a choice of receiving private care as opposed to public only.
Mary, thanks for stopping by. In the U.S., you would more than likely be unable to purchase health insurance as an adult because of the chronic, pre-existing condition, or you would find yourself paying monthly premiums that are beyond the reach of a great many people. I’m not arguing that the Canadian system is perfect, but simply being able to get a chest x-ray and treatment, even if it wasn’t timely, is a luxury many Americans can’t afford.
Hi Weldon,
In my case the delay likely has lead to increased lung damage that I can ill afford with my lungs. I also disagree that Americans go without healthcare. I’m friends with people that have cystic fibrosis and they are not rich and most have insurance. If they are too ill to work they have Medicare or qualify for care under other programs. They are receiving excellent healthcare in the US and even have access to equipment like the vest that we often Canada lack.
I’ve been fighting to get on a lung transplant list for almost 4 years (4 officially this December). I still say the Canadian system doesn’t work well. Many Canadians die, because they must wait too long for care. Unless you are coughing up blood like I have been and unable to breathe and cannot get a bed in hospital, because there literally are none available I guess that it would make it difficult to understand how bad Canadian health care can be and is for many Canadians.
My own mom was denied treatment for a severe cat bite infection and had to suffer for six months in pain and was never the same after that and I do blame our Canadian medical system for my lack of treatment and for the suffering my mom endured and also for the death of my friend’s father. We lost him to cancer. It took too long for him to receive a “timely” diagnosis in Canada. In fact, he was accused of seeking pain medication! He was in pain with a large tumour on his kidney.
I’m a fan of Stuart Browning’s films and one can visit his website at:
http://onthefencefilms.com/
He has some films like “The Lemon” (and others are available on Stuart’s site)and others that illustrate how bad Canadian healthcare is for many Canadians. I’d also recommend that one and all watch the movie trailer for “Sick and Sicker when the Government Becomes Your Doctor.”
http://www.sickandsickermovie.com/
I’m so annoyed with Michael Moore for making it seem that the Canadian system is almost perfect and that there are “no waiting lists.” I’ve waited up to nine months to see a lung specialist, up to seven for another, and have been fighting since December 2003 to get on a lung transplant list. I’ve had to fight for medications, one took two years to get, because it was deemed too expensive. American friends donated their child’s respiratory equipment to me which I was having difficulty accessing in Canada. I could go on and on about how bad the system has treated my family, friends, and me.
As for my waiting for the chest x-ray my American friends say that this would not gave happened in the US, I could have been another victim of the Canadian system. I’m very, very sick and require a double lung transplant and cannot afford to wait for care. Our system is not working.
I’ve been to the US several times and have always received excellent care and look forward to meeting my new doctor in Ohio. I’m also not wealthy by any means just desperate to receive good lung care for a change.
Thank you,
Mary
Mary, I’m one among the tens of millions of Americans doing without health care insurance, and consequently without health care, so I have to take issue with your sentiment that it’s readily available for everyone. It isn’t, and even people with insurance have widely varying experiences depending upon the level of their coverage and the nature of it. The problem here isn’t that care is poor; it’s that not everyone can get it, in which case it doesn’t really matter how good the care other people get is. Waiting lists don’t seem so daunting compared with being completely excluded from the process.
This isn’t meant to minimize or deny your experience. I suspect, though, that if Canada were spending the same money per person as we are, problems like you’re encountering wouldn’t exist. Even with problems like yours, the fact remains that we spend twice as much as Canada does and we still wind up with nearly 50 million people uninsured and millions more underinsured, and a million more going bankrupt every year because of accumulated medical bills. Whether or not the Canadian system is the ideal solution, it’s clear that for many people it would in fact be better than what we have now simply because it provides a basic level of care to everyone.
Hi Weldon,
I’m sorry that you are having difficulty accessing healthcare, but I have to disagree with you that its not available to you. ERs and hospitals are obligated to treat everyone in the US and there are said to be various programs to help those without insurance. I’ve had friends with CF pay hospitals only a few dollars a month towards their bill, because this is what they could afford. These people were never denied care. I have to say that I’ve received excellent care at Sutter Hospital in California for a severe asthma attack. The concern was on my health and not on how I would pay for the care. The doctors, nurses, respiratory therapists, etc were all top notch in the ER, ICU, and also on the medical floor. I am sure there is help available to you and others. Sutter is a non-profit hospital and accepts everyone including many on Medi-cal.
Whatever the US does I just hope that the Canadian system is not adopted, because if you think the American system has issues now the problems would be much worse under a Canadian style system. Please keep in mind that our Canadian healthcare is also not free. We are heavily taxed and often the care is substandard and many items like medications, dental care, etc are not covered. I even paid for a medication that was given to me in hospital, because it was not on the hospital’s formulary.
Thanks,
Mary
Mary, you’re denying reality. There really are nearly 50 million people uninsured in this country –that’s a fact. Emergency rooms are for emergencies, not for preventive medicine or continuing basic medical care. Medicaid and Medicare have qualifying guidelines which exclude many people. Medical bankruptcies are one of the largest single categories of all bankruptcies.
Yes, Canadian health care is paid for by taxes. That doesn’t change the fact that Canada spends a bit more than $3,000/person/year, and we spend about twice that, some of which comes from the government and some of which comes from the private sector.
Prescription medications are often not covered or only partially covered under many insurance plans here. Those of us without insurance pay, if we can afford it, as much as twice or more what Canadians pay for the same medications.
I don’t know why you’re sure help is available for those who can’t afford insurance or to pay for care out of pocket. The fact is that it often isn’t, which is what’s driving this whole debate. If everyone were able to get the care they need, we wouldn’t be talking about this at all.
Mary, I am sorry for your terrible illness, but American health care is a broken and greedy system. I’m not sure how you are paying for your US doctor, but if you lived here you would not qualify for health insurance. Your illness would exclude you. If you are self employed you cannot get health insurance if you have ever needed medical care in the past, they deny coverage for almost everything. I have a friend who denied insurance for LIFE because she had acne treated as a teenager.
I am self employed and was denied for a year due to a minor past illness (The doctor said it was minor and wouldn’t return.) I spent that year terrified, knowing I was one accident or illness away from financial ruin, illness often leads to bankruptcy, peoples lives are destroyed, their houses and businesses taken away.
My boyfriend has an HMO and routinely waits six weeks for a doctor’s appointment. He has been denied an effective medication because it was too expensive. It’s a balls out lie that American health care isn’t rationed, it’s done out of greed, not lack of money.
I don’t know of any hospital that allows people to pay a few dollars a month. If a person has the misfortune to need the ER, it’s not free. the bills will come and if you can’t pay, bill collectors will destroy your credit and lead you strait into bankrupcy and a destroyed life. I would happily pay higher taxes to insure everyone in this country. Although, for my income bracket my taxes would be less in Canada than the US which is true for most of the uninsured in the US.
I live near the border and if I could find a way, I would move and trade my US citizenship. In this country only the very wealthy matter anyway.
I’m sorry for your boyfriends 6 week appointment wait, but that is really a short period of time compared to a majority of my waits. For example, in Canada I’ve waited almost a year to see a specialist. Often only to receive the run around. I’ve also been denied expensive medications, was initially even denied oxygen (O2) despite qualifying for it. American friends donated their daughter’s medical equipment to me, because I was unable to obtain the necessary care and equipment at least initially for a very long, long time – well still not able to receive the necessary care by a specialist in Canada. Oh, the fights, I’ve had to obtain medications, care, etc. It always amazes me that everyone – even healthier Canadians automatically make the assumption that “free” Canadian healthcare means everything is covered, that the medical care is excellent. In truth we do not have a free healthcare system in Canada. Our system is not truly universal, because coverage varies and sometimes significantly by province/territory. From my own horrible healthcare experiences, to other family members, to friends who have received poor healthcare – the Canadian system is not the great system its assumed to be.
The reason that I’m coming to the US is that I cannot get care in Canada. I’m not being seen or followed at all by a respiratory specialist for a severe respiratory condition. In the US one may need to purchase insurance, but what you are all over looking is that you are able to access medical care – even if its necessary to pay out of pocket, and I’m unable to access specialised medical care in Canada. Not everyone receives care in Canada. Some of us simply fall through the cracks and do not receive the care we need, period. Whilst my visit to see a specialist in the US is going to be paid out of pocket. This visit allows me to see a specialist and to receive follow up care from a specialist that I will be pursuing. Yes, its expensive, and that’s hard, but its medical care, quality medical care, and that’s important. One can see that not everyone is receiving necessary healthcare in Canada despite paying very high taxes. I’d rather be receiving quality specialised care than going without any. This is indeed my current and long term situation in Canada.
Some of my CF e-mail friends have stated that they are indeed paying what they are able to afford to a hospital as opposed to paying a large bill all at once.
I’m very ill, on O2, and cough up blood at times due ti severe lung disease and cannot get the care and can say that the Canadian medical system has failed not only me, but countless others. Sure its helped some, but certainly not everyone. Your may think the American system is poor, but Canada’s in my opinion is certainly no better. Its seems to me that our system is many times worse.
Thank you,
Mary
HEALTH CARE SYSTEMS ARE BASED ON DIFFERENT PHILOSOPHIES, IE JOHN STUART MILLS;DECARETS ECT. CANADA HAS THE GREATEST GOOD FOR THE GREATEST NUMBER AND THEREFORE THE INDIVIDUAL TAKES A BACK SEAT AND SOME WILL NEED TO BE SACRIFICED FOR THE GREATER GOOD OF THE MAJORITY WHO ARE HEALTHY, IE IF YOU ARE 80 AND NEED DIALYSIS OR A TRANSPLANT OR ARE MENTALLY RETARDED IT AINT GONNA HAPPEN. USA IS BUILT ON THE PREMISE THAT THE INDIVIDUAL IS THE MOST IMPORTANT AND NOT THE GREATER MAJORITY. SO IF YOU ARE 80 YOU CAN GET DIALYSIS AND EVEN A TRANSPLANT AND ALL CARE AFFORDED TO THE YOUNGER AND HEALTHY.WHICH IS BETTER WHO KNOWS AND THE CANADIAN SYSTEM IS CHEAPER…BUT WE ALL KNOW WHICH ONE IS MORAL AND MORE HUMANE SO FU MICHAEL MOORE YOU FAT SLOB, PIECE OF SHI…MOVE TO CANADA OR UK OR CUBA YOU AHOLE!!! SE3E HOW MUCH MEDICAL CARE YOU GET THERE WHEN YOU GET DIABETES AND HEART DISEASE FROM ALL THE BIG MAC’S YOU BEEN SUCKING DOWN…SO STFU AHOLE!!
My father has colon cancer and he lives and pays his taxes in Canada. He is wating for his first visit with a doctor at the Surrey cancer center in BC and it has been over a month since he was diagnosed. Meanwhile the cancer does not sleep. The Canadian system has become so broken down that it is unethical what they are doing to patients in critical conditions now. He was unable to get a preventative colonoscopy 2 years ago when he requested one since he was 67, because he had NO SYMPTOMS. In the United States anyone over 50 can get a colonoscopy if they have insurance or can pay. In Canada nobody can get one even IF they try to pay for it! As a result Canadians die from one of the preventable cancers that we fortunate Amercians try to prevent! You are right that the American system works better, Canadians know that very well. My father was diagnosed with colon cancer at a US hospital since he was in pain and didn’t want to wait for weeks to see the Canadian doctor. He can’t afford treatment in the US so he has to suffer (and most likely die)under the Canadian system. I would NEVER suggest that the government take over healh care. If you think the HMO’s do a bad job just wait until the government takes over!!! When that happens you will have no choice about the care you receive!
Uhm, I live in California. My mom raised me on Social Security, about 1,100 dollars a month. I once thought I might I may have had some brain problem. Just because I was having what I guess were tension headaches. My doctor arranged it, and a month later I got a CAT scan. It showed that there was nothing wrong. My mom never paid a dime. And yes, she had me on one of those health plans for people who can’t afford to pay their own medical bills. Soma medical group.
The only reason I don’t have health care right now, is not because I don’t have the money. I know there are programs out there. I just don’t have the time to look into all the available options because I’m always working.
I would suggest to many of you that don’t have health care,that you just have not looked into all the available options. If you have the time, look into it. It’s out there.If you can’t afford private healthcare, then there are plenty of state run programs.
Hi, Matt. Thanks for your comment. There are many people whose incomes are too high to qualify for state or federal subsidies and can’t afford private insurance, or whose income is sufficient but are excluded from coverage because of pre-existing conditions. In your situation, you qualified for Medicare or Medicaid as the dependent child of a mother whose only income was Social Security. Generalizing from one’s own experience is often tempting but rarely accurate.