Health Insurance: SiCKO Has the Right Idea
I had the chance to see Michael Moore's new documentary: SiCKO. I did not read any reviews before going in and did not go on his website before seeing the movie.
See this movie.
Getting an education in the mess we call health care is more complex than a degree in astrophysics from MIT but we all have to get it and we have to start somewhere. Whether you agree with Moore or not, see the movie. He is right about the one thing that a vast majority of readers of this blog were right about: The insurance companies are THE MAJOR reason we are in the mess we are in.
Since the movie came out there are a number of critics out there who have been trying to bring up all the accessory problems that health care has. Many, if not all of these are true. The problem is that whenever someone waters the arguments down with a claim about the quality of hospitals, the amount of money paid to hospitals and doctors, the grading of performance, the useless tests ordered, or medical malpractice is a problem one fact always will emerge. No problem in health care can be fixed without first a massive restructuring of the system with which we pay - the insurance system.
OK. We now know the problems. What are we going to do? It is about time the biggest lobby in the country - the American People - got it together to put an end to the insurance abuses. If you have been under a rock for the last 30 years here is what happens:
There is really only one solution. Reform the health insurance industry as we know it. Make it illegal to sell health insurance in America until every American is covered with a basic universal plan and then, and only then, insurance companies can sell gap-type insurance.
Here is the bottom line. There are a ton of real problems in health care. If you want to get a good idea of some of the issues I recommend you read the book Better by Atul Gawande. It is an excellent balanced view of how we can hope to improve American health care.
In the meantime, while we are looking for balanced solutions get your Congressman, Senator, or Presidential Hopeful to outline a plan for meaningful regulatory controls over the insurance industry and start working on a fair and open universal health care system that covers all Americans, allows doctors to opt out, but assures an acceptable quality of care for every citizen.
Doctor K
Related Topics: Technorati Tags: SiCKO, Michael Moore, health insurance, health care reform
See this movie.
Getting an education in the mess we call health care is more complex than a degree in astrophysics from MIT but we all have to get it and we have to start somewhere. Whether you agree with Moore or not, see the movie. He is right about the one thing that a vast majority of readers of this blog were right about: The insurance companies are THE MAJOR reason we are in the mess we are in.
Since the movie came out there are a number of critics out there who have been trying to bring up all the accessory problems that health care has. Many, if not all of these are true. The problem is that whenever someone waters the arguments down with a claim about the quality of hospitals, the amount of money paid to hospitals and doctors, the grading of performance, the useless tests ordered, or medical malpractice is a problem one fact always will emerge. No problem in health care can be fixed without first a massive restructuring of the system with which we pay - the insurance system.
OK. We now know the problems. What are we going to do? It is about time the biggest lobby in the country - the American People - got it together to put an end to the insurance abuses. If you have been under a rock for the last 30 years here is what happens:
- Insurance companies take your monthly premium payment. If you do not pay immediately, you are quickly canceled.
- Insurance companies decide on the premium based on the profit they want to obtain.
- Any profits from the system go to executives and shareholders and not back into health care.
- Insurance companies routinely and arbitrarily deny approval for necessary tests for patients.
- Insurance companies routinely and artificially deny payments to doctors and hospitals for services already approved and performed.
- Insurance companies have the goal to NOT PAY a claim.
- Insurance companies interfere with clinical decision making of physicians.
- Insurance companies have lobbyists that have heavily influence your Congressman and Senator.
- Insurance companies have no interest in "maintaining" your health. HMO's are designed for profit even when they call themselves non-profit.
- Insurance companies abide by their own rules of behavior.
There is really only one solution. Reform the health insurance industry as we know it. Make it illegal to sell health insurance in America until every American is covered with a basic universal plan and then, and only then, insurance companies can sell gap-type insurance.
Here is the bottom line. There are a ton of real problems in health care. If you want to get a good idea of some of the issues I recommend you read the book Better by Atul Gawande. It is an excellent balanced view of how we can hope to improve American health care.
In the meantime, while we are looking for balanced solutions get your Congressman, Senator, or Presidential Hopeful to outline a plan for meaningful regulatory controls over the insurance industry and start working on a fair and open universal health care system that covers all Americans, allows doctors to opt out, but assures an acceptable quality of care for every citizen.
Doctor K
Related Topics: Technorati Tags: SiCKO, Michael Moore, health insurance, health care reform
31 Comments:
Dr. K,
My husband & saw the movie on the 21st, and this was the first Michael Moore film I have ever seen. I can honestly say I'm an instant fan. The only people he really didn't address in the movie was our veterans. Given the recent news about Walter Reed Hospital I think vets should've been included in it, but I don't know when he started the film project. I think everyone who can afford the ticket should see this movie, and/or buy the movie when it becomes available.
For a few more facts/opinions on the Walter Reed fiasco please look at this blog entry:
http://www.addthis.com/bookmark.php?pub=betablog&url=http://blogs.webmd.com/mad-about-medicine/2007/03/walter-reed-dot-is-cross-ts-and-dig.html&title=Walter%20Reed:%20Dot%20the
Doctor K.
Dr. K,
Great article. Gotta love JCAHO. In all my years working in the DME industry, now with all the competetive bidding imposed by CMS, & after 20 yrs of service to our patients, we may not be able to submit our bids since JCAHO hasn't performed their survey as promised. I know we only have 30 more days for this little feather in our cap... The fact that Walter Reed passed with such a high grade made me think there's something really rotten in Denmark.
No fault for greedy doctors? See the article in NYTimes.
Yeah right, if all the people are universally covered, who do you suppose would be paying for it? That's right, the poor middle class citizens who are all ready paying way too much for health insurance. How about figures showing the percentage wage increases among phycisians versus the rest of the population. Sadly, they have gone from being true professionals to seeking wages the like of celebrities.
In response to anonymous:
"No fault for greedy doctors? See the article in NYTimes" -
How about EXACTLY!!!! (and I am not a doctor).
You should try going through medical school; place your social life on hold for 10-12 years by the time you are done with a residency and fellowship, try racking up $500,000 in student loans and then spending the next 10 years to pay them off. That would place you at about 40 years old before seeing the true benefits that you worked your ass off for. Doctors deserve to get paid for what they do, but more importantly what they have done just to be called "doctor". Should we pay doctors less? How much less? At some point, the best candidates for becoming doctors or surgeons might go into the financial field or the legal field if they were not paid accordingly. The bottom line is that doctors not only pay and invest more in their education than any other profession, but they also have the most liability and people's lives and health resting in their hands. They should be paid more.
Keep up the good work Dr. K!!!
I don't get how some people think that universal health care means we would be getting health care for free. It won't be free. It will come out of our paychecks the same way it does for people in Canada, UK and elsewhere. And it's a pretty good chunk of money. The same, if not more than what we pay now. The people in those countries never had the money so they don't miss it. Those of us that pay for insurance now won't miss it because we also never had it, only with a national health care system we'll now be forced to pay for inferior care. I can't wait to hear the outcry when everyone's paycheck shrinks even more and they have to wait months to see a doctor. One that they likely won't even get to choose.
As usual, as someone else pointed out, it's the middle class that will get screwed. It won't matter to rich people because they'll still be rich. And it won't matter to poor people because they'll still be poor. And the politicians that think this is such a wonderful thing will have their own set of rules whereby they'll get to go to whatever doctor they want, when they want.
I also don't know where people get the idea that doctors are making as much money as Hollywood stars. The average salary is not even close. Look it up online, it's not hard to find. But they absolutely should be getting paid a whole lot more than the average worker bee as should anyone that works that hard for an education.
One can only hope and pray that the average citizen and doctors will get to opt out of any universal health care disaster.
Swank, the middle class is screwed now. I'm self-employed and after four years of paying health insurance premiums that were more than my monthly office rent ($700/month for a healthy family of four), I had to take a second job solely for the health insurance benefits.
This is partly because we have a system that's employment-based and partly because the younger population fails to see the value of having health insurance and opts out, leaving a system of adverse selection in place.
I do not believe that universal coverage is free - I know better. I also know that if some basic,affordable, accessible coverage isn't in place for everyone, we're heading for healthcare bankruptcy, particularly when expenses for disabled veterans from Iraq begin to pile up in the Federal budget.
However, in order for any of this to work, there would have to be some radical reforms of the industry as it exists today. That means better management of delivery and payment of benefits and pharmacy costs, emphasizing wellness, and dismantling the incest that exists between CEOs of so-called not-for-profit insurance companies and related entities like pharmacy benefit managers.
"It comes out of our paychecks." A universal health care system like the one in Canada is not free.
I think it is naive to think that we don't pay for inferior care now. Instead of having access to preventative care, the uninsured often let little problems become big problems. That hospital bill you pay is padded enough so the hospital can provide charity care for those sick uninsured patients. Of course, you could just let the patient die in the waiting room to save money.
Hey Fried Liver,
I can tell you with certainty that I do not pay for inferior care now. I have some great doctors and several good hospitals within 25 miles. If I'm sick or injured I can call any one of my doctors and get an appointment within a day. I can get an MRI, CT scan or whatever within a week. I pay up the wazoo for it but I'm okay with that. I do without a lot of things because I believe my health is more important. I'm not willing to pay for a system like they have in the UK or Canada.
Lots of people let small problems turn into big problems. Even those with insurance. Most of my young coworkers never go to the doctor for physicals even though it would only cost them $10. People that tend to not go to the doctor will not go even if they have universal health care. And they're going to be pretty pissed off when they have to start paying for something they won't use.
Have any of the other posters here seen 'Sicko'? I think Michael Moore's message is that we need to fix our healthcare INSURANCE system. Not the healthcare system. We have most of the best technology around, but it's not available to everyone who may need it. He's not saying we have to have socialized medicine, but rather use some of the socialized medicine practices as a guide to help us revamp the money exchange between our premiums and whose pockets they're lining. Let's face it, where do you think the MILLIONS of dollars that the insurance bigwigs make comes from?Let's ask ourselves why do they need to make such an exorbitant income? Are they policemen? Firemen? Soldiers? Healers? No. They may have degrees or PhD's but I doubt if many of them have ever put their life on the line to help preserve our American lifestyles. Newsflash: the federal & state governments still pay more to healthcare providers than the commercial insurance carriers do, even with continuous cutbacks. It's amazing, since commercial premiums seem to never go down. So what's wrong with this picture and how do we fix it? See the movie for starters. However, I agree partly with Swank. People need to know their own bodies and take charge of their own health. However, there are many individuals out there who don't have the ability to do so. So who looks out for them? If their lucky, maybe they have willing family members. But there are thousands if not millions out there who don't.
Swank, with all due respect, I think "Fired Liver" was making a point against a national healthcare plan (such as in Canada). The point of Fried Liver's post was that hospital bills are padded on those with insurance and those who actually pay their bill.
An example would be a $259 charge on the hospital bill for my last knee surgery for "physical therapy". That "physical therapy" consisted of a hospital staff member handing me a pair of crutches (which did not include the cost of the crutches). On the same bill, there was a charge for "prescription drugs" which was actually for two generic oxycodone which probably cost the hospital $2.00 - the charge was $104.00.
These gouged prices are to make up for those (I'm not going to say illegal aliens and start a entirely new debate) who don't have insurance and as a result, use the emergency room as their primary care facility with intentions on scrapping the bill. The hospital has to make up that money, so they inflate ALL prices so those who do pay the bill (or have insurance) will make up the cost. Sure that last major knee surgery only cost me a $35 copay, but my 2007 premiums went up as well as my stand office visit copays.
Fried Liver is absolutely correct; those with insurance pay for the inferior care - they pay for it all, in the end. By having insurance, I have access to great doctors and hospitals. If we go to a national healthcare system as it is set up in Canada, I will still pay the same OR MORE; the only difference is that my paycheck will show they money being deducted in the form of taxes instead of insurance premiums. In addition, I will have to wait 18 months if I need another ACL reconstruction, maybe wait 2 months for an MRI authorization appointment when I can get authorization in 30 seconds now.
I'm in total agreement that the whole insurance industry is full of crooks and needs to be changed. And while hospitals and doctors over inflate prices, the insurance companies end up paying about half of what is charged. If you get your statements you can look and see what was charged vs. what was actually paid. I presume this all becomes a tax write-off for doctors and hospitals to cover their own costs. I don't get why those same prices can't be negotiated by an individual.
Illegal aliens are another subject that needs to be dealt with.
Then there's the problem of people that can pay but won't because they think someone else should be paying their medical bills so they can have a new boat. Trust me, these are the people that will scream the loudest when money gets drawn from their paychecks.
Right now the money drawn from my paycheck for me and my husband is taken out pre-tax. Between insurance payments, dental, flexible spending accounts and disability there's a big chunk of money that reduces my taxable income significantly. I doubt that will happen with universal health care.
You would have to wait 18 months for a new ACL. I would probably have had to wait 2 years for a partial knee replacement. Since I was only 48 it would probably be more life five years. People aren't going to go for that.
Any system that doesn't allow doctors to be in charge of our health care will be a disaster. That includes insurance companies or the government. Especially the government.
Good points swank, I didn't even think about the "negotiations" that my insurance company make. If I was to use an out of network doctor, they only pay 80% of "reasonable and customary" charges. So if a surgeons fee is $10,000 and the insurance company picks the number $1,200 out of a hat, they will only pay 80% of the $1,200 and I will get a nice invoice in the mail for the balance.
I also agree that I prefer the system where I pay for what I get, even though it is expensive. It is much better than a national healthcare system where I will be paying for what I don't get (similar to the current emergency rooms).
"You pay for what you get"
How many posters here can afford to pay for cancer treatment or maybe a serious accident without insurance.
And if you need expensive medical care and you have insurance, someone else's premiums pay for your care. Perhaps our health care crisis could be solved by only treating people with the money to pay. No insurance-you're on your own. We can relieve hospitals of their responsibility to treat those without money and just leave them on the streets to die.
Why should the healthy support the sick? I'm really tired of paying for Swank's great medical care.
And it's interesting how there is so little talk of caring for others. As a Christian nation, it seems ironic that we would rather horde what we have and convince ourselves those that need help don't deserve it.
I have the solution:
Everyone gets healthcare!!!! The government will tax the middle class to pay for it. Problem solved. Hey, while we are at it, the government should just take 100% of everyone's salary (everyone who works on the books, that is - we would not want the illegal aliens to gave to start paying taxes). The government then can use that money to "re-distribute" which will pay for healthcare for everyone, food, shelter, etc. as the government sees fit. Doctors, lawyers, teachers, police officers, sanitation workers, laborers; they all get paid the same after the re-distribution of wealth. That should motivate intelligent people to become doctors and will vastly improve the healthcare system.
Then while we are on a role, we can spray paint our American flag red and stencil a nice sickle on it.
The discussions on this blog is exactly what the insurance companies hope the public keeps on doing- arguing with each other to divert attention that THEY are and always were the problem.
No one doubts that insurance is important, the question is - how much and who pays. Either way, the insurance companies are PRINTING MONEY and producing NO PRODUCT. What a deal. They do it with little to no regulatory control.
Insurance reform first.
Spray paint? Not yet.
Doctor K.
Dr. K,
I thought there WAS a regulatory commission that was a watchdog over insurance companies to protect the consumers who pay the premiums. Isn't there some sort of oversight committee or something? One of my colleagues was just talking about it last week, but shame on me I can't remember the name.
amyjh,
Insurance companies are regulated on a by-state basis. Each state has an Insurance Commissioner who is either appointed or elected, and each state's insurance laws are just a bit different from the other's.
That's part of what makes health insurance such a monumental red-tape maze -- there are no standardized procedures nor is there one central agency responsible for regulating and watchdogging them.
I think they like it like that, personally.
Dr. K -- the problem with SiCKO is that I think it's optimistic to think that we can or would dismantle the system as it exists today in favor of a single-payer system. Yet, I can't quite bend my mind around the idea of putting the insurance companies in charge of a universal coverage system either. It's a quandary when there's really no agency/institution that's trustworthy and apolitical.
I agree with the above comment that the simplicity of SICKO was that some magical single payer system is the answer.
We do not have a hisotry of good quality government programs for social services.
Interestingly enough, the government excels in some very important areas- like NASA. The quality of NASA (excluding the recent drunken astrnautas) has been remarkable in its development and execution.
There can be a lesson for other government agencies in this.
The steps may include:
1. Regulate the current insurance plans to provide access and definable coverage
2. Regulate a method for a patient to have indemnity insurance that pays a defined benefit.
3. Allow for purchasing of Medicare as a benefit directly from the government.
Doctor K
According to :
http://www.msnbc.msn.com/id/20268763/
512,653 Americans with insurance filed for bankruptcy in 2001.
Aren't you glad your not one of them.
Fried Liver,
Right now I'm not one of them, but who's to say we can't become just like them. My husband & I have chronic health problems & live within our means. We also have thought ahead & stashed a nest egg in case an emergency arises (heaven forbid). Still, that's no guarantee, but I do feel blessed for what I have. What angers me is why do insurance CEO's NEED to be millionaires when their policyholders are dying from being denied medically necessary treatments? Everyone needs to make a profit to stay in business but come on, let's face it. Insurance companies got us by the short ones here. They make exorbitant incomes because they CAN. And as long as the state Insurance Commissions do nothing or very little to change this, healthcare providers are doomed unless they have a steady stream of private donations to keep them afloat.
P.S. to above comment...
I agree with Dr. K's last comment. I will be contacting our state reps & find out what, if anything, is being done at the state level for healthcare reform.
To the recent Posters (especially amyjh and Fried Liver):
amyjh said:
“What angers me is why do insurance CEO's NEED to be millionaires when their policyholders are dying from being denied medically necessary treatments.”
You are right and you are partially wrong. You are right when you say that the policy holders of patients with insurance are being denied care, being sold a bill of goods that the insurance companies have no plans to deliver on, the HMO’s don’t do anything about “preventive” care, and this is the reason why:
INSURANCE COMPANIES EXIST SO THEY CAN MAKE PROFIT BY COLLECTING MORE MONEY THAN THEY SPEND. THEY HAVE THE GREATEST INCENTIVE OF ALL TO BUT BARRIERS TO CARE.
What you were wrong about was the remark about CEO millionaires. For the record, if an insurance company executive made a million dollars or $30,000.00 a year but still had the same evil policies they would be the same low life individuals they are.
The answer is in Congress and right now your congressman and/or Senator has little knowledge of healthcare and greater knowledge of lobbyist groups. State senators and assemblymen are no better. There has been no progress for meaningful insurance reform for decades.
To Fried Liver: You are not quite on target with the comment on preventive care. The whole media push on preventive care is probably more hogwash produced by insurance companies to make the public think they are to blame. The most expensive diseases are not prevented by an “preventive medicine” program. Real preventive medicine starts early in life with a commitment to a healthy lifestyle, lower weight, no smoking etc.
A few more comments: Hospital bills are not padded. Hospitals rarely make profits and while the bill you see seems expensive you would be amazed as to the cost to deliver high tech care.
Doctor K
>>512,653 Americans with insurance >>filed for bankruptcy in 2001.
I personally know two of those people. They are still employed with the same employer and insured. They went bankrupt due to bad decisions and spending beyond their means. Now they are debt free, still have their lush homes and brand new cars. Meanwhile, I'm still paying my bills and have never bounced a check in my life. While some people went bankrupt through no fault of their own, most did not. And going bankrupt does not mean you are unemployed or uninsured.
More people will be trying to go bankrupt this year and next as the balloon payments on their homes become due. They will expect someone else to pay for their bad planning and mistakes. But they won't lose their jobs or their health insurance.
Swank:
It is a crazy world out there.
Everyone reaches poverty at a different level.
There is one thing for sure: There is no poverty like the poverty of having physical of mental disease. Sometime there are no resources even available to buy to get you out of that poverty. This is why healthcare solutions help everyone.
Doctor K.
Dr. K,
I never really looked at the insurance companies that way when you mentioned it wouldn't matter what the CEO's make; their policies are still evil, & you made a valid point. My anger was geared at the higher-ups that are rewarded higher wages by denying medically necessary procedures or treatments, as was shown in Mr. Moore's movie. That is the truly evil of the health insurance industry. You stated there has been no progess for meaningful insurance reform for decades. Check out Michael Moore's website (michaelmoore.com)-there are states that are at least making some attempts to raise awareness of the need for reform. I'm sure it will probably take several more years or even decades for any changes to take place, but I believe it will happen.
Awareness:
We need more than awareness of this issue. We need a defined leader in Congress that will help put this together.
No one appears on the horizen.
Doctor K
Michael Moore is an anti-American, lying, hypocrite. Anyone who would take his advice on anything is either stunningly uninformed or just incredibly stupid.
By the way, Cuba does not have the world's best healthcare, as Moore likes to promote. Talk to someone who escaped from that hellhole and find out.
Canada has waiting lists so long that those who can afford it are running south of the border (that's to the US, for those who can't read a map), to pay privately for their care.
Try reading the following article on cancer survival rates & notice which countries have the best and worst ratings. Then, try to figure out why that would be.
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/21/ncancer121.xml
Your link got cut off so hopefully this will work.
http://tinyurl.com/2o55a8
Speaking of cancer, an acquaintance of mine just returned to the US for a visit. She is currently living in Amsterdam. One of the things she is going to do here is have a mammogram. Over there the standard for the NHS is for women to have their first one at age 50. My friend is in her early 40's but has a strong family history of breast cancer with family members being diagnosed in their 30's and 40's. A relatively small percentage of women get breast cancer in their 40's but evidently the Netherlands is willing to sacrifice those women to keep costs down.
I was recently called back for a diagnostic mammogram. I had to wait almost a week for the second appointment. The stress of waiting even a few days was nearly unbearable. If I were in the Netherlands I'd still be waiting. I'd probably die from the stress in the meantime.
BTW, the diagnostic mammogram and ultrasound turned out fine in case anyone cares. But if it hadn't, and I was in the Netherlands I wouldn't have even known about it because I'm not 50 yet.
About Michael Moore:
To the above post: Michael Moore is not anti-American. He may be right, he may be wrong. He may be entertaining, he may be boring. Either way he is exercising the greatest of American rights- that of freedom of expression. To criticize the government is the greatest gift we have in this country. It separates us from fascist dictatorships and totalitarianism.
Just because you don't agree with Michael Moore does not make you more American than him. It just puts you both on different sides of an issue.
Many aspects of his film were probably "cooked up" and somewhat biased but there was nothing that was completely wrong.
In Canada, the system does work for many of the citizens, probably not all.
In Cuba, according to a recent book by Atul Gawande, "Better", they were one of the first countries to eradicate polio as a public health effort. Very impressive and led by Fidel Castro. This does not mean support of the Castro regime, it is just giving credit where credit is due.
We can learn a lot from Canada, Europe, Cuba and other places. It does not mean we need to do what they do- we can simply learn from what they have done.
Michael Moore is a great citizen- agree with his ideas or not- we need to hear more from him and other non-politicians.
Dr. K.
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