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American Sicko
Kendra Campbell -- I recently got a chance to watch Michael Moore’s latest film, “Sicko.” I’m not going to launch into a critique of the movie, but I’ll say a few things. I think that in general, it was a wonderful film. While I don’t necessarily agree that socializing the American healthcare system is the panacea for our healthcare problems, Moore did an exceptional job of bringing the issue of our healthcare system woes to the forefront. Honestly, I cried during a good portion of the film, because I take the problems with healthcare quite seriously, and I couldn’t help but empathize with the stories of all the people who had lost so much because of our fragmented system.
When I decided to enter medical school to become a physician, one of the issues on my mind was the current status of the American healthcare system. As someone who has worked in both hospitals and for a healthcare association (not to mention being a patient), I’ve seen the healthcare equation from many different angles. And none of the angles look very promising. The American system is broken. I don’t believe it’s hobbling along, or having difficulty, or needs a “fixer-upper.” No, it’s really broken beyond repair. It simply doesn’t work. It doesn’t matter if you’re rich or poor or black, white or purple, you will have to come in contact with the healthcare system at some point. And chances are, it won’t be a pleasant experience.
So, deciding to be an employee of a system that is failing just about everyone was a very difficult decision to make. In fact, it was one of the reasons that I hesitated even taking on this monumental task. But I eventually decided that crippled system or not, I was going to be a part of it. Honestly, I think it was the dreamer in me that decided to go for it. I wanted to believe that if I did everything I could possibly do, I might be able to navigate the system and still help everyone who needs help. Of course, every day that goes by I see the realities of the system (and I’m not even in my clinical years yet), and the dreamer in me is beginning to lose sight of my dreams.
I don’t know what the solution is to our broken healthcare system, and I don’t know if anyone really does. But at least most of us do agree that it is broken. I guess that is an important first step. Perhaps within my lifetime, I’ll see the next step. Hopefully, someone will find a way to cure the sick system, and do it with the same sense of urgency that they would to cure a sick patient.
July 18, 2007 in Kendra Campbell | Permalink
Comments
good to have a heart and a dream. its one way of telling yourself and others that you are alive and not dead and sicko!!
Posted by: | Jul 18, 2007 9:26:41 AM
I am a newly graduated doctor from Denmark (small country in Scandinavia) and I can tell you that even though our public healthcare system recently was recognized as being one of the most cost-efficient and best working systems in the world, I still see things everyday that makes me think "what do we - as a population - really want from our healthcare system?"
There's patients waiting for cancer treatment, hip and knee alloplastics and all kinds of elective treatments. Doctors are short and now we (like the US) have started "stealing" doctors from healthcare systems far worse than our own in the eastern europe and some third world countries. Something that ought to make you think as well - what do we leave behind? Even though I know M.Moores movie is biased I really hope you guys will stand united and try to change the system - step by step. Doctors in Denmark aren't very good at standing united and working together when it comes to politics - and as far as I understand then the doctors in the US are extremely competetive - something that might make a common goal harder to achieve. Anyway if you give up on your system come work here. hehe - we don't earn quite as much as you guys but hey - we only work 38-50 hours a week.. in other words - still time for friends, family and sports.. ;-) Cheers.
Posted by: Jacob E | Jul 18, 2007 2:32:40 PM
Single-payer medicine in the U.S. would look a lot like its father, Medicare.
It's a really sweet and charitable notion that people should get medical treatment for free. Doctors should voluntarily waive or reduce their fees when they think it appropriate. Many already do this.
Coercing doctors into performing this is equivalent to slavery and is morally and ethically wrong. Seizing money from others in order to pay for this through the use of force or threat thereof (taxes) is equivalent to theft and is morally and ethically wrong.
If care is not given but forced, it is not care at all.
Posted by: Nobody | Jul 20, 2007 8:38:45 AM
Nothing is free. Even medicare isn't free. When I worked in the US, before getting into Med School, I had a portion of my wages going to fund medicare. So, if we get universal coverage, we're going to have to have higher taxes.
Now, I for one, don't trust the US government in its current state, to take every cent they say they'll apply to Universal Coverage, and apply it to Universal Coverage--so I don't think I'll be getting a good deal.
But, the part that really makes me angry, is then the Fed Govt will be in the same arena that current insurance companies and HMO's are in. They will get to tell you who you get to see, and when--just based on what they'll pay and why. This amounts to rationing of Health Care. This will lead to a larger crisis.
So, I am glad that Michael Moore is bringing up the issue of healthcare in America, but the payment and rationing system that will likely occur with it--and that has happened in Canada and the UK (I don't know about other places) is something that he shied away from. I hope it gets brought into the debate in the future.
Cheers,
-j
Posted by: Jared | Jul 21, 2007 11:30:14 AM
The real "moral" and "ethical" question concerns not people and their pocket books, but which people have a right to be healthy: the poor or the rich. Poverty is not a singular issue of "pulling yourself up by your bootstraps" but multidimensional, involving education, race, and birth. Unless one believes in predetermination, it seems that the random nature of what neighborhood and family you are born into determines your right to be healthy. So, as "sweet" as pro bono work may be for many doctors, I find the fact that many go without care particularly un-sweet, and the notion that people would prefer unhealthy individuals to more taxes downright bitter.
Posted by: adam | Jul 21, 2007 3:00:07 PM
There is a difference between a right to be healthy, and a right to healthcare. I'm not entirely convinced that healthcare itself is a right. I believe it is a privilege based on many things, especially in a free-market economy.
However, I also believe that if American healthcare were allowed to have free market principles rule its billing, we would see many differences in how much it costs. I hope that at the end of the debate, we can pull away the curtains that hide how healthcare costs are produced, so that people can more easily decide where and how they want to spend their healthcare dollars. That's what I hope for.
-j
Posted by: Jared | Jul 22, 2007 9:06:28 AM
I agree with some of what J says. But if health-care is a privilege, then only the privileged receive it. And, again (as I am preoccupied with the notion that the craps shoot of birth indiscriminately decides who is privileged) is that fair? Is medical care akin to buying shoes or Laker's tickets. Should a kid with Leukemia from the colonias of Donna Texas have any more or less of a chance to health care, medications that make them feel better, procedures, etc, than one from Orange County. Health care (and thus the possibility of being healthy) in a free-market economy transcends nothing --it is the same as Laker's tickets, it is the same as money. So life, death, illness, and wellness can be as casually tossed looked upon as a stack of bills. That doesn't seem right.
Adam
ps. I appreciate the candor yet considerateness of these exchanges. It is a great way to test/change my thoughts.
pps. When people are sick, and treatment exists, isn't the right to be healthy and the "privilege" of recieving health care the same?
Posted by: | Jul 23, 2007 4:58:01 PM
Adam,
I think you are giving yourself an illusion that there is not a "uterus lottery" that every human child (actually, every mammal) goes through. But, I look at it in this way: were healthcare not a privilege defined by many things, such as technology, law, and access, it would look much different than it does.
For instance: we would cease to see things like patient dumping, patient responsibility shirking, and active health-reducing actions that we see in physicians, insurance companies, and people themselves. The responsibility of healthcare is not in the physician alone. Everyone has a responsibility.
But, the main thing is, there is a uterus lottery. And, I don't know about you, but I did well in it by being born in a good area of the US. Much better than had I been born in, say, Eritrea.
-j
Posted by: Jared | Jul 24, 2007 6:39:15 AM
The key points with Sicko is that the US is far from leading the world in health care, but is rather lagging much of the modern world. People can choose to respond to this observation any way they choose. First, they can resolve to catch up or maybe take the lead. What are the indications the US is lagging? The sheer number of people who are not able to receive care, or receive a niggardly care distributed by profit oriented companies. Other countries have evolved to a higher level. Does the US really want to be the laggard here?
Today I was learning about Russian serfdom. The serfs functioned as cash cows for their owners. The people were like herds of cattle to be bred and used for the sake of the owner's wealth. Maybe this system was functional for a while and the peasants could tolerate it. But then people started hearing of ideas such as the Enlightenment coming out of England and France. Catherine the Great talked like a liberal sometimes but in the end wanted no part of freeing the serfs. There was great resistance to be rid of the serfs, despite Enlightenment teachings.
The same thing is happening today in America, a land where people are supposed to consume products above all else. We can choose to evolve if we want to. Nobody is talking about enslaving doctors. In principle, medical profits are in a class by themselves and should be treated as such. Medical treatment is somewhat akin to effectively holding someone hostage for their life. You could almost exact any price you wanted, if you were in the posistion providing the healthcare that saved someone's life. But ethically, you have an obligation to make the price for treatement reasonable.
What better way to provide a stable job market for the entire medical communityy than implementing a single-payer system?
Peter Tocco
Columbia, MD
Posted by: Peter | Jul 24, 2007 5:55:41 PM
To those reading this and who have cared enough to write,
So far, I've enjoyed the dialog, but I think that we've just proven that as physicians, we've missed the point. As Jacob E (from Denmark) stated, we're a group divided and thus we can't stand to even begin to fix the problem. Yes, each individual in this society is partially responsible for our health care system. Yes, everything comes at a cost and must be paid for. Yes, those of us fortunate enough to have had a good education to prepare us to be able to become physicians by being born into specific families are "lucky" for those facts.
The problem exists because the health care system in the US is a huge money making industry focused primarily on making money...and they do a phenomenal job at it. It exists, because as a nation, our values are on individual's rights, liberties and money. I don't want to get into politics at all in this discussion, because I doubt that few if any of us trust our local, state or national government to act, on the issue of health care, in a manner that is truly in the best interest of its people, as health care recipients/patients. I also think that our political two party system has stagnated itself almost to the point of uselessness. Again though, enough about politics.
With that being said, the solution will not begin from outside of the health care system, simply because too much money is at stake for businesses and our government. Besides, money doesn't entirely solve issues in and of itself. The solution should come from us, physicians in training and our mentors. It needs our efforts; our time, our thoughts, our money and our skills. A far out idea, use the AMA as a platform to help create an organization that effectively competes with HMOs in providing services, yet with a sole goal of providing services and not making a profit. Realistically, we are all dreaming about a Utopian society and system. The best we can do now though is each begin working toward those goals.
Posted by: Dwight | Jul 24, 2007 5:58:00 PM
It's easy to abandon hope when things look bad, but it's also irresponsible. You can't change the entire system (unless you've got a thunderhead of clout) but you can certainly make your role in it a force for positive change.
Think positively! America is the land of innovation; let's make that true!
Posted by: Greg | Jul 24, 2007 10:19:07 PM
Dear all,
Neither do I belong to the US/EU/UAE but the thing is that, Dwight is very right in saying "America is the land of innovation". I can't understand Miss Campbell saying the "broken American Health System". Most of the books we study are from the US. Each time something new is to be done, people and countries face the America. This is the country which boasts the international organizations of fame and worth (yes, health related ones). you have the CDC, the WHO, the ROTARY, even this website has its roots over there and the chance to interact with you guys is through it only.
I would rather request you people to go through the health and disease situations in some developing countries and the difference will be clear. One thing you "frustrated ones" (sorry to use this term) can do is that choose these third world countries to gain great respect from the community and also get the self respect of working for a cause. My experience, though very little, says that it is these areas where you can work in a system which is far far away from saturation and the prospect of rising is very high.
This I am not saying as I have any emotional attachment to them, but a professional one. Another reason is that
many good Doctors from these needy countries moving out in search of better prospect (read more money). can we create a reverse brain drain?
Thanks and regards
Bipin
Posted by: Bipin | Jul 24, 2007 10:42:47 PM
Bipin,
I can understand how you are puzzled by the seemingly contradictory remarks regarding the American health system. Yes, we are still a great engine of innovation. Yes, we do already provide great care and great access to care.
But, the problems come when you look at how our healthcare costs are rising, and where the profits from these costs go. For example, physicians salaries are continually dropping with these rising healthcare costs. Why? Insurance companies bargain for group rates for different procedures with the hospital, or clinic group. Then, many times, insurance companies will refuse to pay for procedures for various reasons.
Also, Medicare, one of the government run insurance programs for the elderly, changes its billing codes every year--which creates a logistical nightmare for every physician.
Then, every year, each physician sees the incidence data on how often physicians get sued and lose their malpractice case for issues that have no merit.
When you add all of these together, it is no wonder that we speak of a healthcare crisis in America. There are even problems beyond that. The thing that causes me to wonder, is we speak of things like the free market having failed healthcare. But, since the advent of common insurance following WWII--we haven't had a free market in healthcare. So, instead of national healthcare, I would prefer to see an experiment toward free-market healthcare again.
-j
Posted by: Jared | Jul 25, 2007 4:02:38 AM
The problem with helping create a better health care system is so entrenched in with our society, not just the medical aspect, that it becomes hard to change. For example, we want all homeless civilians to have health care.. ok.. Were is the money coming from for their health care.. taxes most likely. And, most likely these taxes wont reduce over time because we will always have homeless civilians unless we change that aspect by sending people out to the homeless to find jobs for them, fix our horrible education system so it doesn’t matter were you live you receive a great education, and better educate our parents and future generations on the merits of education and support (a lot of families don’t support their children causing a fall in grades –sorry that this is so general… but I don’t have the time to go into details).
Second aspect on why we have the medicine system we have today is because we don’t practice preventive medicine as a civilization. Causing people to wait ‘till their latter years on detecting a problem in their body will lead to pharmacies jacking up their prices just because they can and they know people will buy them since that the only way they can stay alive. Plus, the procedures to help these individuals will be expensive. If these patients had early detection they wouldn’t have to pay so much and the pharmacies wouldn’t have such a big leverage over the health care. Furthermore, reducing the pharmacies ability to buy doctors to advertise for their companies will become improbable because of a lower company income. But then we come to the question, how to we create a universal preventive medicine health care? For one thing it will be expensive.. but then again, I’d rather pay up now then have a fully screwed up health care in the future and have to pay more to fix it.
Another factor is, as many people have talked about, the USA health care system has a hard time deciding anything! For example, a case came up in the hospital I work in on weather or not to put stars on the ceiling in the pediatric areas.. it took weeks for them to decide and there major complaint was that the stars wouldn’t make the hospital look uniform. If we have problems about stars in the pediatrics area, how much harder/longer will it take those in power to decide that the health care needs a change (or if they agree on that, then they’ll disagree on what they change should be *sighs*)
Also, another factor hurting out health care is that a major part of the government funding for health goes to the elderly and prolonging their life. I’m not saying they don’t deserve health care, but the funding is so unequal that it has or eventually will cause trouble in everything else but health care for the elderly (also the large amount of babies produced.. I think they’re called the baby boomers, will also force health care to be more centered on the elderly).
Well, this is all for now, but there certainly a lot more aspects in health care on what’s directly or indirectly effecting it, then what I just recently covered. But, I guess the first step to better health care is first to find what’s causing it to be terrible in the first place.
~sam
Posted by: Sam | Jul 25, 2007 2:42:12 PM
If you are not sick of the corrupt, money-hungry government/drug cartel, Sicko will make you sick!
The conspiracy of the media and drug cartel is sickening.
Nowhere in the world are incomprehensibly large sums of money spent on drugs as in the U.S. Nowhere in the world are most MDs in the hip packet of the drug cartel, like in the U.S.; not to mention the corrupt, criminal FDA!!!
Some of you are whining about "socialized medicine". You do not know what you are talking about; or, worse, you are diverting attention from the issue. The U.S. has (for many years already had) socialized medicine--one system for the 'haves', another for the 'have nots'.
Come to think of it, many countries that have the so- called socialized medical system can boast longer life expectancy, much smaller rate of infant death rate, significantly better quality of life than the proletariat in the "land of the free and brave". You are no longer free; you are no longer brave. You are slaves; and you don't even recognise it. You are totally brainwashed by the controlled media.
"Michael Moore Responds to CNN "Fact Fudging" Accusations
Michael Moore’s latest documentary Sicko is causing much stir in the mainstream press. As expected, media outlets including CNN have come out with reports that Moore has exaggerated or all-out “fudged” the facts.
Not taking the criticisms lightly, Moore has released a “point-by-point obliteration” of the CNN reports geared to buttress the credibility of the film.
For example, CNN claimed that Americans have shorter wait times than everyone but Germans when seeking non-emergency elective procedures, like hip replacement, cataract surgery, or knee repair. However, they didn’t bother to mention that out of six countries surveyed, only Canada had longer waiting times than America for sick adults, who are waiting to schedule a doctor's appointment for a medical problem; and delays in other countries affect only 3 percent of patients."
AlterNet July 10, 2007
Posted by: jm | Jul 25, 2007 8:32:43 PM
Regardless of what you have to say about rights and privileges or what is worth taxing for, in a purely greedy economic sense we'd all have more money if everyone had health care. The American economy loses billions of dollars a year because of people missing work from medical conditions that could be prevented or dramatically reduced if they had access to health care. If everyone had health care, the dow would be higher, so would GDP and the government would collect more tax revenue even with the income tax at the current level. Health is an investment that pays back better than it costs, like building roads and removing garbage and not like, say for instance, war.
Posted by: ryan | Jul 26, 2007 5:09:06 PM
Well Said Ryan!! I couldn't agree more!There are plausible solutions that will go a long way to benefit everyone . The poor, the rich, the government and even the greedy insurance and pharmaceutical companies. The disparities in care people receive in the US is quite depressing. I wish more people 'll get involve in this debate.
Posted by: Desire | Aug 12, 2007 11:42:27 AM
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