In America, unlike the rest of the industrialized world and much of the developing one, you get exactly how much health care you can pay for—and even then, not always. Call it a pre-existing condition: politicians bought and paid for by big medicine and bigger insurance. So, of course, we in America have the health care system that medical, pharmaceutical, and insurance industries want, not the one that’s best for us.
Michael Moore, the documentary filmmaker, is out to change America’s health care system. Starting with his new film, Sicko, and continuing with what Kevin Sack, writing in the New York Times, calls a “Barnumesque promotional tour” for single-payer, universal health care coverage. Policy hacks are mostly in agreement that Sicko will have considerable political impact, galvanizing the US citizenry’s frustration with the lack of accessible quality health care.
The film itself is—very much like Moore himself—a little rough around the edges, even a bit sloppy. And, like the rest of Moore’s creative output, it’s hyperbolic. But certainly no more so than the propaganda spewing from big insurance, big medical, big pharma and the politicians on their payrolls.
A little rough and a bit sloppy, for sure, but exceptionally powerful nonetheless. The opening scene shows an amputee without health insurance stitching up his gashed knee. Second up is an Oregon man without health insurance that severed the tips of two fingers on a table saw. The hospital gave him the choice of repairing the middle finger for US$60,000 or the ring finger for US$12,000. he chose the ring finger.
But Moore’s film isn’t about the 50 million uninsured Americans—it’s about the 250 million of us with health insurance.
Moore talks to an insurance company call center worker who outlines how insurance applicants are rejected because they’re sick, presenting a gargantuan list of conditions that will trigger rejection. The list—37 pages of typical insurance company fine print—scrolled only through part of the H’s.
Twenty minutes into the film is an interview with a medical doctor who was formerly a medical reviewer for Humana: “... you start looking for ways to deny or limit or save money—I mean that’s your goal—so you look to the language that says there’s an exclusion and you say, ‘ah ha,’ this is great, this is a technical denial. I don’t have to get into any of the muddy issues, I can just deny it…. Any payment for a claim is referred to as a medical loss.”
And just because you have insurance doesn’t mean you’re covered. That’s one of the central messages of Moore’s film. He profiles a Blue Cross customer whose operation was covered under her policy. But then, after paying for the procedure, Blue Cross investigated, found the woman, in the past, had a treated yeast infection she had failed to disclose and retroactively canceled her insurance. Blue Cross demanded return of its payment from the provider and told the provider to go after the patient for payment. For the record, insurance applications require the disclosre of any serious pre-existing conditions like, say, end-stage renal disease. A yeast infection is not a serious condition.
Insurance companies, we learn, actually hire whole squads of “hit men” to carefully review insurance applications and medical records for any reason at all for the company to cancel the policy and seek reimbursement from their customers. “We’re going to go after this like it’s a murder case,” one former “hit man” told Moore. “In some states it’s legal to have what’s called a prudent person pre-existing condition…. What that says is if prior to your insurance kicking in, you had any symptoms which would incline a normally prudent person to have sought medical care, then the condition of which that symptom was a symptom is excluded.”
The former Humana medical reviewer, in testimony before Congress, stated, “In all my work I had one primary duty and that was to use my medical expertise for the financial benefit of the organization for which I worked. And I was told repeatedly that I was not denying care, I was simply denying payment.”
The current health care system—doctors and health insurance companies actually being responsible for the deaths of patients—can be traced to an oval office meeting on February 17, 1971 between then-president Richard Nixon and John Ehrlichman, where Ehrlichman advises Nixon to endorse private enterprise as a solution to American health care using Edgar Kaiser’s Permanente organization as a shining example. “Edgar Kaiser is running his Permanente deal for profit,” Ehrlichman tells Nixon. “And the reason he can do it… All the incentives are toward less medical care because the less care they give them, the more money they make.” Nixon’s response? “Fine.” The very next day Nixon announced his new national health “strategy:” “I want America to have the finest health care in the world, and I want every American to be able to have that care when he needs it.”
Sicko then examines health care systems in other developed countries. Nothing new here, but it’s well presented and shows first-person examples of health care elsewhere. Moore, interestingly, makes no bones about unabashedly referring to a single-payer, universal coverage health care plan as socialized medicine. And he demonstrates how it’s working across the pond. The most compelling bits came from former Member of Parliament Tony Benn. “What democracy did was give the poor the vote, and it moved power from the marketplace to the polling station—from the wallet to the ballot…. And in 1948 the people asked, ‘if you can have full employment by killing Germans, why can’t you have full employment by building hospitals….’ If you can find money to kill people, you can find money to help people.”
And in this interview with Benn lies the crux of Moore’s message. “If you have power you use it to meet the needs of you and your community,” Benn tells Moore. “And this idea of choice—which capital talks about all the time; you’ve got to have a choice—choice depends on the freedom to choose and if you’re shackled with debt you don’t have the freedom to choose…. People in debt become hopeless and hopeless people don’t vote…. I think here are two ways in which people are controlled. First of all frighten people and secondly demoralize them. An educated, healthy, and confident nation is harder to govern.”
Of the latter parts of the film, I’m not sure which I found more disturbing: Kaiser Permanente dumping indigent patients on the streets of Los Angeles—taking care first to remove the hospital information from their identification tags on their wrists—or the three veteran first-responders of the 9/11 disaster who were refused health care. After all, these weren’t government employees, merely concerned individuals who took it upon themselves to try to help immediately after the disaster.
In the case of the 9/11 first-responders, Moore’s solution was simple in its elegance: take them to Cuba for the health care they need and are refused here. Once in Cuba, the patients were met with open arms and quality care, required to provide only their name and date of birth.
Ken Johnson, a senior vice president for Pharmaceutical Manufacturers of America, told the Times’ Sack, that the film was “going to energize activists, but I don’t think it’s going to change anybody’s party affiliation.” You think? Both sides are already bought and paid for. How do you think they shut Hillary Clinton up about single-payer, universal coverage?
It’s time to take back our government, and make it serve the good of the people instead of the good of the corporations. A single-payer, universal health care system is as good a start as any. As Moore says at the end of Sicko, “You know, if we ever did remove the choke-hold of medical bills, college loans, daycare, and everything else that makes us afraid to step out of line, well, watch out. ‘Cause it’ll be a new day in America.”
Go see the film; it opens on June 29. And then go out and step out of line.
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