June 26, 2007

SickO: Starting the Conversation

Michael Moore is a very astute man. He knew exactly what it would take to make America sit up and listen to his argument about how our society should consider health care. As Maggie Mahar says, picking Cuba was no accident. Everything about using Cuba as an example shows what a master agitator and rabble rouser Moore is.

First he took the frankly disgusting Republican testimony about how wonderful the Guantanamo detainees were being treated because, by God, they had gold plated health-care while locked up in America's blackhole to make a point that perhaps all Americans should be able to expect good health-care. Once Moore and the 9/11 workers were turned away from Guantanamo, taking them to Castro's Cuba to get health care was another brilliant guerrilla tactic. After all, the US has been at "war" with Cuba for almost 50 years and obviously, we can't learn anything from them. Here's what Maggie says about Moore's using Cuba as his final example:

Moore is not trying to tell us that healthcare in Cuba is better than the best care in the U.S.: we spend 27 times more on healthcare. What he is showing is that in Cuba, care is considered a basic human right–like fresh air, or sunlight or water.

In Tracy Kidder’s Pulitzer-Prize-winning Mountains Over Mountains humanitarian physician Dr. Paul Farmer confirms Moore’s positive portrait of Cuban healthcare:

“Since its revolution, Cuba has achieved control over diseases still burgeoning ninety miles away in Haiti. . . . Cuba is a poor country, and made that way at least in part by the United States' long embargo, yet when the Soviet Union dissolved and Cuba had lost its patron . . . the regime listened to the warnings of its epidemiologists and increased expenditures on public health. By American standards, Cuban doctors lack equipment . . . but they are generally well-trained,” adds Farmer who has worked side-by-side with Cuban doctors in Haiti for 20 years.

“The most important contribution Cuba has given global health has been its example . . . the idea that you can introduce the notion of a right to health care and wipe out the diseases of poverty.”

In the U.S., healthcare is seen, not as a right, but as a commodity—something to be sold at a steep profit. This was not always the case. I think of Dr. Jonas Salk who, when asked why he didn’t patent his polio vaccine, said: “it would make as much sense to patent sunlight; this vaccine belongs to everyone.”

One of the reasons I'm waiting anxiously for this weekend, is I can hardly wait until I can see SickO. This film has the capacity to change our country's course for the better. I remember being so disappointed when Hillary's task force blew off single payer without even considering it. Maybe this time we can have a real argument about how best to fix our health care system in a way that finally makes it an affordable right for everyone. And that will only be done by breaking the link between work and coverage (employee-based health care) and greed-based insurance companies where the winners are the ones who best deny care.

If Kevin is correct, some conservatives agree with us that employee-based health care is a bad thing and think that it might be worth letting single payer come about simply to break that link.

Libertarian Arnold Kling talks about our recent healthcare battles. His conclusion:

I once wrote that "The original sin of America's health care system is employer-provided health insurance." The best outcome might be for America to abolish employer-provided health insurance, try single-payer, have it fail, and then experiment with the sorts of policies that I talk about in my book.

Okay. So let's try it. Medicare for everyone, not just the elderly. Let's see how that works. And if fails, then the free marketeers can try their experiment to fix the system and get rich by withholding care.

This time, the insurance company won't be able to dominate the discussion because Michael Moore has set the parameters for the conversation first. No wonder the health care insurance industry is scared.

For more, check out Michael Moore's interview on Democracy Now with Amy Goodman.

Posted by Mary at June 26, 2007 11:37 PM | Health/Medicine/Health Care | TrackBack(1) | Technorati links |

I watched Sicko last week (thanks, anonymous uploader to google video! [it's gone now, sorry]). And while I enjoyed it, it left me frustrated, like most Michael Moore's movies do. It depended too much on heart-wrenching emotional presentation of anecdotal evidence, and just about any argument can be proven or disproven through carefully selected & presented anecdotal evidence. As someone who strongly supports socialized medicine, I was frustrated how easy it was for me to punch some serious holes in a lot of his arguments.

But maybe that's what works. The right wing media makes all its arguments through punches to the gut, selling fear of others and the unknown to stiffle reform, and mocking intellectual rigor as eggheaded eitism. They shut down arguments by going straight for the emotion, and that's what Michael Moore does, very effectively.

I guess I wish more Americans were moved by the sort of high-minded films like An Inconvienent Truth, which presented a reasoned, well-rounded argument based on facts, statastics and placing a relatively high intellectual expectation on your viewer, vs angry, anecdotal, emotionally biased arguments of Mr. Moore's films. But I'll take whatever works, I guess.

Posted by: mike at June 27, 2007 09:55 AM

Germany: Universal Coverage, but NOT single payer!

I wish everyone would stop assuming that universal health care is equal to single payer health care. It is not!

In Germany, there is a two-and-a-half tier system of health care delivery. There is first the distinction between private health insurance and non-private health insurance. Private health insurance is basically the same as here in the U.S. The insurer is free to charge what he wishes and the purchaser can choose his coverage as he likes. The caveat is that in order to purchase private health insurance, you must have a certain minimum yearly income, the level of which is set by the government. When I was there a few years ago, the minimum was approximately €80,000 per year. If you earn more than that - you may purchase private insurance, if you earn less than that, you may not. Private health insurance in Germany is better than non-private in almost every way: front-of-the-line treatment by doctors, private hospital rooms, better coverage, etc. The downside is once you move into private insurance, you have to stick with it forever - even if your health deteriorates or you get old - either of which will send your premiums skyrocketing of course. As a privately insured individual, you may return to the non-private insurance system only if you are broke.

Most Germans don't earn enough to purchase private insurance, so they are in what I call the "non-private" system. I don't call it public insurance, because it isn't. Non-private insurers in Germany operate like credit unions in the U.S. They are medical co-operatives that pool health-related risk. There are many hundreds of these organizations. Any given individual will qualify for several of these medical co-operatives based on their profession, home address, religious affilation, etc., in much the same way that people qualify to join various credit unions here. You pick an insurance provider from among the co-operatives for which you qualify. You can choose based on coverage, rates (which may vary within certain boundaries), perceived "goodness" (usually related to how much they pay doctors - and therefore how much doctors like people covered by that co-operative), etc. Premiums in these medical co-operatives are based on a percentage of your salary, and deducted like payroll taxes - but they are not taxes: the money goes to your provider, not to the government. The higher your salary, the higher percentage you pay as your insurance premium - up until the above mentioned private health insurance minimum. When you earn more than that, the percentage of salary charged as a premium stays constant. This is to encourage people to stay in the non-private system even though they could afford private insurance.

With non-private insurance your medical experience will not be as nice as with private insurance - all the basics are covered well, but you will share a hospital room, and you will not be bumped to the front of the line, or have access to special appointment times. I was in this system and I found it entirely satisfactory. It didn't bother me that someone with private insurance could come to the doctor's office at 8 when appointments for the rest of us began at 9. But then again, I'm not a bitter jealous person.

Medical services for non-privately insured people are basically "free" at the point of service, but there is a co-pay of €10 to discourage frivolous doctor visits encouraged by completely "free" health care.

German health care provides universal coverage by making membership in the local government's medical co-operative available to people who don't have jobs, income, etc. Their premiums are paid by the government as a social welfare benefit.

Oh, and paying cash for medical services is entirely legal. I did it myself before I entered the German health insurance system.

By introducing a measure of market economics to their health care system, Germany provides universal care without the typical waiting lists and rationing that are a common feature of all socialist economic systems. In fact, German newspapers often run articles on the horrors of medical care in the British NHS - the awful stories that Michael Moore doesn't want to talk about, but that are all too common in Britain, but almost completely unknown in Germany.

In short, Universal Coverage: YES! Single Payer: NO!

Posted by: will s at June 29, 2007 02:11 PM