23 June 2007

Michael Moore's SiCKO

I saw an advance release version of Michael Moore's latest film, SiCKO, today. Even more so than other of Moore's films, this one is clearly a polemic, a propaganda piece, an outrageous, one-sided depiction of the worst of American health care, held up to ridicule in comparison with the health systems of countries such as Britain, Canada, and those two countries that Americans-in-power love to hate, France and Cuba.

And, if even one-quarter of what Moore portrays is true, it is a stinging indictment of how one of the mightiest, richest, and most privileged countries in history can go so terribly wrong with health care for its citizens.

As Moore points out at the beginning of the film, SiCKO is not primarily about those who do not have health insurance, although many of the stories that he relates involve those that do not (Heavens! Moore lies!). Moore relates the stories of people who supposedly have health insurance whose treatments are denied, whose treatments that are granted are inadequate, whose appeals are denied without proper medical diagnoses. He follows people with all types of ailments - many who do not survive their struggles with American HMOs - and those whose lives are ruined by the burden of health care costs.

In his inimitable fashion, he answers all the standard objections of publicly funded, single-payer systems by visiting Britain, France, Canada and Cuba, and painting them each as health care utopias. Living in Canada, I know that we have problems and issues with our health care system. None of Britain, France or Cuba are necessarily the ideal places to live as Moore glibly portrays (although France does sound pretty sweet. Say a villa somewhere in Provence...)

But, when it comes to health care, the system that was originally cooked up between Richard Nixon and Edgar Kaiser (as in Kaiser Permanente) has been a colossal failure, at least when it comes to the health needs of the populace. For private enterprise, it has worked remarkably well. As Nixon counsel, John Erlichman explains to the then-President,
Edgar Kaiser is running this Permanente deal for profit. And the reason he can do it ... is all the incentives are toward less medical care, because the less care they give 'em, the more money they make. ... The incentives run the right way.

Nixon: Not bad.

The next day, Nixon announces the establishment of HMOs, saying, "I want America to have the finest health care in the world. And I want every American to have that care when he needs it."

Moore's SiCKO strongly suggests that Nixon's espoused goals for the health care of his fellow citizens have fallen somewhat short (to say the least) in the intervening years. It is a call for a clear, non-partisan conversation about the realities of health care in America. And, for those of us fortunate enough to live in a country with universal health care, it is a warning for those policy makers and politicians who take their guidance from south of the border.

Go see SiCKO with someone who is on the opposite side of the health care debate from you. And then, go have a conversation.

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Anonymous said...

Is it just me, or is Kaiser a not-for-profit company.

Mark Federman said...

I think it's just you, Anonymous. From the Wikipedia entry:

The two types of organizations which make up each regional entity are:

* Kaiser Foundation Health Plans work with employers, employees, and individual members to offer prepaid health plans. The health plans are not-for-profit and provide infrastructure for and invest in Kaiser Foundation Hospitals and for-profit medical groups.
* Permanente Medical Groups are partnerships of physicians, which provide and arrange for medical care for Kaiser Foundation Health Plan members in each respective region. The medical groups are for-profit partnerships or professional corporations and receive funding from Kaiser Foundation Health Plans. The first medical group, The Permanente Medical Group, formed in 1948 in Northern California.

In other words, there is a not-for-profit shell that enables a whole bunch of for-profit activity.

Also, have a look at KaiserWatch:
Meaningful distinctions between private non-profits like Kaiser and for-profit health care corporations have all but disappeared. Kaiser uses the same management consultants as the largest for-profit corporations, the same economic advisors, adopts the same downsizing strategies, utilizes the same care denial and standard of care lowering programs as the for-profit health care sector, and dwarfs the financial empires of almost all other U.S. health care corporations.

Kaiser has abused its tax exempt non-profit status and used it to fuel its market expansion program while providing minimal community service. This report reveals a Kaiser radically different from the public service image it portrays in its bylaws and details how Kaiser is:

* Accumulating wealth and resources that make it one of the richest and most powerful medical corporations in the world.
* Launching a major expansion program focused on enhancing its managed care market dominance by draining resources from patient services.
* Lowering the standards of care by displacing its highest skilled caregivers and downgrading the skills of those who remain.
* Placing seniors and low-income populations at risk through a practice of Medical Redlining.

The net effect of these policies have combined to allow Kaiser to erode the standard of care and to misuse its non-profit status to portray itself as victimized by for-profit health care while diverting attention from the real victims - patients and their families.

As Nixon said, "not bad," except for, you know, the poor, the sick, those who actually need care. Sort of the point of Moore's film.

Ross B. Emmett said...

I've lived in both the USA and Canada. When asked to describe the Canadian health care system to Americans, I put it simply: Canada has a national HMO. Everyone's in the same HMO. It's that simple. And that bad.

Moore is right: the problem with an HMO is that someone else makes the decision about what health care you should receive. But that's the problem: you have no voice. And in Canada, you can't choose another HMO if you think your's is providing bad service (which the Canadian system usually does).

I never want to depend upon Canadian health care again. I'd be dead by now, given the undiagnosed problems the doctors didn't even think to check for.

Anonymous said...

Can you or Michael Moore explain why hearsay obtained via John Erlichmann (who worked for Nixon, for goodness sake?!) should be accorded evidentiary status? Edgar Kaiser's advice regarding the HMO Act is in the congressional record, and it's totally inconsistent with Erlichmann's characterization. Moreover, by the time that Erlichmann and Nixon got with their "design" for HMO-based healthcare, Kaiser Permanente didn't even qualify as an HMO! With respect to the information from KaiserWatch, that web site plays as fast and loose with the facts as Michael Moore. KP's health plan (the non-profit) was purposely separated from the physician groups in order to make SURE that accountants don't ever get to interfere with medical decisions (a serious problem with "regular" HMO's). The Permanente physicians are not employed by the health plan, and that's a GOOD thing! Lastly, with respect to labor policies and relations, KP has become a model - its decade-old Labor Management Partnership is a model for other healthcare organizations and industries. I'm not saying that KP doesn't have its share of problems, or that US healthcare isn't a mess (it is!). But Moore's movie is really uninformed and unfair with respect to Kaiser Permanente.

Mark Federman said...

The fact that "Edgar Kaiser's advice regarding the HMO Act is in the congressional record, and it's totally inconsistent with Erlichmann's characterization" is hardly surprising, in the same way that Nixon's public, for-the-record characterization of the HMO plan is inconsistent with his private musings.

For anyone to believe the veracity of public testimony given by anyone that will influence a policy decision, where that decision will benefit the person giving the testimony, is naive in the extreme. It doesn't take much in the way of critical theory (ie. who's got power? Who doesn't? Who is gaining the advantage? Who is being taken advantage of?) to figure out the dynamics in play in Nixon's time.

The issue with SiCKO is not whether Michael Moore plays fast and loose with the so-called truth in delivering his polemic. Rather, it is that Moore presents a bunch of facts in a way to create a deliberately imbalanced view of the problematic health care system in the U.S. in order to prompt a public debate on the problematic health care system. There are a lot of wealthy, self-interested parties who have the overwhelming voice in health care debates - doctors' associations, the pharmaceutical industry, and the health insurance industry. It takes someone like Moore, shouting very loudly with a film like SiCKO, to give voice to those without.

Anonymous said...

I appreciate your comments regarding the "veracity of public testimony", but there's an important difference between the public record of Edgar Kaiser's input into the HMO debate in the early 70's and Nixon's public pronouncements at the time. Kaiser's comments were part of a long and consistent record of advocacy regarding the value of prepaid medical care and universal health care coverage, a record dating back to the original partnership between Henry Kaiser and Sidney Garfield MD in the 1930's. A record, I might add, that made KP and it's model anathema to the American Medical Association for more than 30 years.

The importance of Moore's polemic as a means to "prompt public debate" is right on. Indeed, even KP acknowledges that (see http://xnet.kp.org/newscenter/leadership/hcreform.html). I just think it's a shame that, with so many genuine "bad actors" to take aim at in US health care, Moore chose to vilify what is arguably one of the most progressive organizations in the arena.

Unknown said...

do you work for kaiser, michael johnson? full disclosure please...

Anonymous said...

I'm a Michael Moore fan but aven't seen the movie yet. However I would like to comment about Kaiser. I have multiple health problems and the excellent care I have received from Kaiser has enabled me to enjoy an active life (I am 70 years old). My greatest healthcare fear is that someone will come along and take away the wonderful care I now have with Kaiser.

I have been diabetic for 40 years or so and have received excellent treatment Since 2000 I have had treatment (surgery and radiation) for breast cancer (with continued follow-up and medication), a bilateral total knee replacement (I continue to tapdance, hike, and garden), and carpel tunnel surgery on both hands (I was at a point where I couldn't even hold a pen to write...all is well now).

I see a diabetes specialist every 6 months and can call her and fax my meter readings at any time I feel the need. I just started with their cholesterol clinic. They have me tested at 3 month intervals and my new medication is working very well.

If it weren't for Kaiser's wonderful doctors I wouldn't be living the very full life I do now. Instead of traveling, volunteering for the Red Cross and the Sierra Club's Inner City outings program, and helping my husband build a log home, I would probably be an invalid...or dead!

Anonymous said...

A couple of items on this KP/Michael Moore thread.

First, I work for Kaiser (11 years) and I am a union steward with Local 30. Moore's overall message was correct, but what he did with Kaiser was bad. I don't say this as a KP employee, but rather as someone who believes there should still be integrity in journalism, since that is what Moore claims he is doing.

Check out the link below for the full story on the items Moore mentioned in "Sicko". Note also that the "Sicko" fact-checking website offers no listing of sources or facts for the KP stories. It should also be noted that KP has been at the forefront to make universal healthcare a reality, which is the same thing Moore wants. Moore couldn't say that in the film, because it would have ruined his message that the HMOs are all evil organizations out to kill people.

At any rate, check out the KP link below for more information. Thanks.



Anonymous said...

Mark quoted:

* Lowering the standards of care by displacing its highest skilled caregivers and downgrading the skills of those who remain.

I joined Kaiser as a patient three years ago, and as a physician two years ago, having worked as an architect, professor, and computer consultant, before this job [been around the block a couple times]. I have never worked with so many people committed to the health of their patients as these docs. I have NEVER had anyone tell me I couldn't order a test I felt was medically necessary for one of my patients. It is a mystery to me how the 'highest skilled' doctors have been displaced [to where?], or how my skills have been down-graded [what on Earth does this mean, really?]. Propoganda? Maybe. Untruths? Certainly. Terrifying that people devour Sicko as truth, like one more 'reality' TV show. Healthcare in America has been broken for a VERY long time -- but not at the hands of KP. Nothing could be further from the truth.