http://www.physorg.com/news102436601.html
"But one aspect missing from the film is the defense. Do not expect to hear anyone speak well of the care they received in the U.S. On the other hand, patients and doctors from Canada, Britain, France and Cuba marvel at their health care."
One of the things the authors don"t know is that judges and politicians (and other social non-rabble) from all over the 3rd world get extremely expensive insurance, paid with their countries" tax money, that cover treatment in the US. So the authors get into a bit of an ironic contradiction by the time they get to the last graph:
"trip to Cuba where Moore seeks care for a group of workers who have experienced health problems after responding to 2001 terrorist attacks. They are greeted with open arms at a hospital in Havana and given what appears to be top-notch care that they could not get in the U.S. The question left for viewers to ponder is whether Cubans are given such red carpet treatment, too."
Another thing that bothers me is the claim that Moore doesn"t acknowledge "the defense". I have been in the US for 26 years, been a citizen for 11 years, and I have seen no defense. This goes back to the first point, that providing health care to "leaders of the world" is so extremely lucrative that getting 18 million people "insured" in the US seems to be a feat of economic engineering.
Needless to say, I can hardly wait to see "Sicko".
Comments?
"Moore also noted the some of the elderly in the drug program could end up paying more for their prescriptions than they did before. That is true. But the vast majority do save because of the tens of billions of dollars in annual government subsidies to help cover the cost of their medicine."
Would be nice to know what "some" vs, "the vast majority" really are. I've seen some pretty twisted use of those pseudo quantities.
"That ranking is based on a 2000 report from the World Health Organization that some health analysts viewed as misleading. "
Who are "some health analysts"? Do they make money from any sources inside the health industry, or just by "analyzing" it? If they aren't purely analysts then I'd question the accuracy of their claims.
"Moore does not say that one of the countries he highlighted, Cuba, is ranked 39th, below the U.S."
While he does not call it out verbally in the film, a shot which zooms in on the list happens to include Cube in 39th place. Citing the US position on the list and highlighting Cuba is clearly consistent when you consider that there are multiple factors that contribute to the rankings. As he suggested in an interview with Larry King, Cuba gets some things right in its health system -- even if it is two places below the US in the rankings.
While I haven't seen more than clips of the movie, Moore acknowledged in the same interview that specialization within the US medical system is extraordinary -- the US has the highest percentage of specialists, by far, in the world. Hopefully he acknowledges this in Sicko as well.
His point seems to be that the ratio of primary care physicians to highly skilled specialists is imbalanced to the point that it detracts from the quality of primary care. In other words. so few medical practitioners want to enter the primary care field that medical facilities struggle to staff for and hence meet basic medical needs.
" Huge executive salaries are the norm in all of corporate America."
This is has no bearing on the the issues. Just because executive salaries are "the norm" does not mean the system is functional.It doesn't change the fact that these executives are given incentives to cut coverage and fight legitimate insurance claims. The point is these incentives come at the expense of those it insures. It also has its customers over a barrel -- either pay less for insurance which covers very little, or pay astronomic sums of money for private use of the medical system.
The point is a system which has no checks or balances and does not eliminate fundamental conflicts of interest is dysfunctional.
"Karen Ignagni, president and chief executive of the trade group America's Health Insurance Plans, said Moore does not identify the plan involved but that it is not a typical one. She said about 17 million people in the U.S. are insured under individual plans and an additional 200 million under group plans. "
I have group coverage with Kaiser -- one of the firms mentioned in the film. It does have a tome of fine print which lists conditions and exclusions that relieve them from providing coverage. My monthly insurance payment also doubled from last year.
'"If that list were true, none of those people would be getting health insurance," Ignagni said.'
I think this was precisely Moore's point.
"For example, 24 percent of Canadians waited four hours or longer to be seen in the emergency room versus 12 percent in the U.S. The difference was more acute when it came time to see a specialist. "
That further supports the notion that specialization is over-represented in the medical practitioner field.
"There was a big difference when it came time to see a specialist - 60 percent in Britain waited four weeks or longer."
An anecdote which suggests there may be a flaw in this reasoning: Several years ago I was forced to wait 4 weeks to see a specialist. At my appointment they immediately told me I had been directed to the wrong specialist and i had to wait another 4 weeks. Oddly enough, the surgery as a result of my visit took place much sooner.
"The question left for viewers to ponder is whether Cubans are given such red carpet treatment, too. "
Good point. Actually the same could be said for anyone taking a camera crew into any hospital (in the US or Cuba). There's naturally some uncertainty in the measurement due to the method being used to measure.
Would be nice to know what "some" vs, "the vast majority" really are. I've seen some pretty twisted use of those pseudo quantities.
"That ranking is based on a 2000 report from the World Health Organization that some health analysts viewed as misleading. "
Who are "some health analysts"? Do they make money from any sources inside the health industry, or just by "analyzing" it? If they aren't purely analysts then I'd question the accuracy of their claims.
"Moore does not say that one of the countries he highlighted, Cuba, is ranked 39th, below the U.S."
While he does not call it out verbally in the film, a shot which zooms in on the list happens to include Cube in 39th place. Citing the US position on the list and highlighting Cuba is clearly consistent when you consider that there are multiple factors that contribute to the rankings. As he suggested in an interview with Larry King, Cuba gets some things right in its health system -- even if it is two places below the US in the rankings.
While I haven't seen more than clips of the movie, Moore acknowledged in the same interview that specialization within the US medical system is extraordinary -- the US has the highest percentage of specialists, by far, in the world. Hopefully he acknowledges this in Sicko as well.
His point seems to be that the ratio of primary care physicians to highly skilled specialists is imbalanced to the point that it detracts from the quality of primary care. In other words. so few medical practitioners want to enter the primary care field that medical facilities struggle to staff for and hence meet basic medical needs.
" Huge executive salaries are the norm in all of corporate America."
This is has no bearing on the the issues. Just because executive salaries are "the norm" does not mean the system is functional.It doesn't change the fact that these executives are given incentives to cut coverage and fight legitimate insurance claims. The point is these incentives come at the expense of those it insures. It also has its customers over a barrel -- either pay less for insurance which covers very little, or pay astronomic sums of money for private use of the medical system.
The point is a system which has no checks or balances and does not eliminate fundamental conflicts of interest is dysfunctional.
"Karen Ignagni, president and chief executive of the trade group America's Health Insurance Plans, said Moore does not identify the plan involved but that it is not a typical one. She said about 17 million people in the U.S. are insured under individual plans and an additional 200 million under group plans. "
I have group coverage with Kaiser -- one of the firms mentioned in the film. It does have a tome of fine print which lists conditions and exclusions that relieve them from providing coverage. My monthly insurance payment also doubled from last year.
'"If that list were true, none of those people would be getting health insurance," Ignagni said.'
I think this was precisely Moore's point.
"For example, 24 percent of Canadians waited four hours or longer to be seen in the emergency room versus 12 percent in the U.S. The difference was more acute when it came time to see a specialist. "
That further supports the notion that specialization is over-represented in the medical practitioner field.
"There was a big difference when it came time to see a specialist - 60 percent in Britain waited four weeks or longer."
An anecdote which suggests there may be a flaw in this reasoning: Several years ago I was forced to wait 4 weeks to see a specialist. At my appointment they immediately told me I had been directed to the wrong specialist and i had to wait another 4 weeks. Oddly enough, the surgery as a result of my visit took place much sooner.
"The question left for viewers to ponder is whether Cubans are given such red carpet treatment, too. "
Good point. Actually the same could be said for anyone taking a camera crew into any hospital (in the US or Cuba). There's naturally some uncertainty in the measurement due to the method being used to measure.
Oh Linda. Your objectivity as a reporter has just been destroyed. You're
rebuttal of Michael Moore's film is as slanted as that of the famed director.
Why?
1. You say the movie claimed 50 million Americans were uninsured.
- The movie opened by claiming 47 million Americans were uninsured. Two
or three times later in the movie, the phrase "around 50 million" was used
to merely round the 47 million quote to a nice even number for easier visualization.
Based on a population of approximately 300 million, around 250 million are insured
and 50 million are not.
2. You then quote a very recent figure issued by the CDC and the Census Bureau
to rebut that number.
- Take a look at the 2005 number published by the Census Bureau. It was
46.6 million in 2005, published in August of 2006. That number was available at
the time the film was made.
3. You say Moore noted that about 18,000 people die each year as a result of the
lack of health insurance. You then rebut the statement by implying that actually 18,000
people die PREMATURELY as a result of the lack of care due to the lack of insurance.
- Tell me what's the significant difference?
4. You state Moore's statement of the estimated 10 year cost of 800 billion for the
Medicare Prescription Drug benefit plan (Part D) is "substantially" inflated because
the revised estimate is now only 729 billion.
- That's a whopping 8.8% reduction. Hardly substantial in relative terms.
5. You defend Part D by stating the vast majority of elderly participants in the Medicare
Prescription Drug benefit plan do save money.
- This is true. However, you fail to mention that those with the highest drug costs
may well end up paying more. Why? Because their annual cost of prescription drugs
exceeds $2,250, which drops them into the infamous doughnut hole. They must then spend
nearly $3000 out of pocket before the plan provides additional benefits. Those with
small or very large prescription drug costs benefit. Those in the middle do not. Read
and learn: www*washingtonpost*com/wp-dyn/content/article/2006/09/24/AR2006092400957.html.
6. You imply that the fact that Cuba ranks lower in overall health care ratings than the US
as justification that Moore's favorable portrayal of Cuba's healthcare system is inaccurate.
- The US ranked 37th; Cuba ranked 39th. The US ranked 9th in per capita GDP at $43,500.
Cuba ranked 136th at $3900. I consider it a major miracle that a country with a per capita
GDP 90% less than than of the US could have a health care system that is nearly the equal
of our own!
7. You imply that somehow the issue of hospitals dumping patients on street corners is a
thing of the past. It's under control.
- The point is that only after public embarrassment and public lawsuits did Kaiser come
to a settlement. Moore's point was that this should never have happened in the first place.
8. You rebut Moore's point that CEO's of health insurance companies are compensated annually
in the millions of dollars as "par for the course" among major corporations.
- That's true and is exactly Moore's point. Should it be "par for the course?" Aren't
insurance companies providing a public service? Does it make sense to reward the CEO based
on the profit the company makes or the quality of the services it provides? You tell me.
9. You use about the least objective source you could find to rebut Moore's point that
many, many preexisting conditions are used to disqualify applicants from becoming insured.
You imply that this must be an exaggeration limited to only that plan.
- Surprisingly you quote your source as being president and chief executive of the trade
group America's Health Insurance Plans. I wonder what will become of her "position" if
private health care companies were eliminated? If you could read fast enough, you would
notice that most of the conditions on the list Moore presented were chronic health
conditions. Most people do not have a chronic health condition. Moore was making the point
that virtually ALL chronic health conditions exclude one from being eligible for insurance
coverage. Any one of us could become victim to a chronic health condition at any age.
10. Finally you conveniently cherry pick figures from the Commonwealth Fund report.
- Michael Moore's web site publishes a much more comprehensive look at that report
that sheds both a favorable and unfavorable comparison with US clinics.
www*michaelmoore.com/sicko/news/article.php?id=9930
How much did it take to compromise your journalistic integrity?
rebuttal of Michael Moore's film is as slanted as that of the famed director.
Why?
1. You say the movie claimed 50 million Americans were uninsured.
- The movie opened by claiming 47 million Americans were uninsured. Two
or three times later in the movie, the phrase "around 50 million" was used
to merely round the 47 million quote to a nice even number for easier visualization.
Based on a population of approximately 300 million, around 250 million are insured
and 50 million are not.
2. You then quote a very recent figure issued by the CDC and the Census Bureau
to rebut that number.
- Take a look at the 2005 number published by the Census Bureau. It was
46.6 million in 2005, published in August of 2006. That number was available at
the time the film was made.
3. You say Moore noted that about 18,000 people die each year as a result of the
lack of health insurance. You then rebut the statement by implying that actually 18,000
people die PREMATURELY as a result of the lack of care due to the lack of insurance.
- Tell me what's the significant difference?
4. You state Moore's statement of the estimated 10 year cost of 800 billion for the
Medicare Prescription Drug benefit plan (Part D) is "substantially" inflated because
the revised estimate is now only 729 billion.
- That's a whopping 8.8% reduction. Hardly substantial in relative terms.
5. You defend Part D by stating the vast majority of elderly participants in the Medicare
Prescription Drug benefit plan do save money.
- This is true. However, you fail to mention that those with the highest drug costs
may well end up paying more. Why? Because their annual cost of prescription drugs
exceeds $2,250, which drops them into the infamous doughnut hole. They must then spend
nearly $3000 out of pocket before the plan provides additional benefits. Those with
small or very large prescription drug costs benefit. Those in the middle do not. Read
and learn: www*washingtonpost*com/wp-dyn/content/article/2006/09/24/AR2006092400957.html.
6. You imply that the fact that Cuba ranks lower in overall health care ratings than the US
as justification that Moore's favorable portrayal of Cuba's healthcare system is inaccurate.
- The US ranked 37th; Cuba ranked 39th. The US ranked 9th in per capita GDP at $43,500.
Cuba ranked 136th at $3900. I consider it a major miracle that a country with a per capita
GDP 90% less than than of the US could have a health care system that is nearly the equal
of our own!
7. You imply that somehow the issue of hospitals dumping patients on street corners is a
thing of the past. It's under control.
- The point is that only after public embarrassment and public lawsuits did Kaiser come
to a settlement. Moore's point was that this should never have happened in the first place.
8. You rebut Moore's point that CEO's of health insurance companies are compensated annually
in the millions of dollars as "par for the course" among major corporations.
- That's true and is exactly Moore's point. Should it be "par for the course?" Aren't
insurance companies providing a public service? Does it make sense to reward the CEO based
on the profit the company makes or the quality of the services it provides? You tell me.
9. You use about the least objective source you could find to rebut Moore's point that
many, many preexisting conditions are used to disqualify applicants from becoming insured.
You imply that this must be an exaggeration limited to only that plan.
- Surprisingly you quote your source as being president and chief executive of the trade
group America's Health Insurance Plans. I wonder what will become of her "position" if
private health care companies were eliminated? If you could read fast enough, you would
notice that most of the conditions on the list Moore presented were chronic health
conditions. Most people do not have a chronic health condition. Moore was making the point
that virtually ALL chronic health conditions exclude one from being eligible for insurance
coverage. Any one of us could become victim to a chronic health condition at any age.
10. Finally you conveniently cherry pick figures from the Commonwealth Fund report.
- Michael Moore's web site publishes a much more comprehensive look at that report
that sheds both a favorable and unfavorable comparison with US clinics.
www*michaelmoore.com/sicko/news/article.php?id=9930
How much did it take to compromise your journalistic integrity?
QUOTE
"The United States slipped to No. 37 in health care around the world, just slightly ahead of Slovenia," he said.
That ranking is based on a 2000 report from the World Health Organization that some health analysts viewed as misleading.
Moore does not say that one of the countries he highlighted, Cuba, is ranked 39th, below the U.S. Among the others, France is ranked No. 1, the United Kingdom ranked 18th and Canada ranked 30th. He does not give those rankings, either.
That ranking is based on a 2000 report from the World Health Organization that some health analysts viewed as misleading.
Moore does not say that one of the countries he highlighted, Cuba, is ranked 39th, below the U.S. Among the others, France is ranked No. 1, the United Kingdom ranked 18th and Canada ranked 30th. He does not give those rankings, either.
To help clear up the whole "rankings" issue, you are correct in saying that perhaps Moore should have been more overt in noting that Cuba, a country he upholds as one of his examples of a better healthcare system, has worth healthcare than the United States. But, in truth, anyone arguing against Michael Moore should be glad that he didn't cite those rankings, because they are only one step removed from the bigger point: relative to how much the U.S. spends on healthcare (by far the most for any developed country), it receives the worst return. Sure, Cuba is 39th.....but they don't spend like we do.
And despite your attempts to engage in statistical nitpicking (none of the numbers you cited really contradict what Moore has said), there is an entire qualitative area that you haven't touched. Don't underestimate how vital that is. The strength of, say, the Cuban healthcare system is not simply the numbers it churns out or a single anecdotal experience (as presented by Moore), but the fact that healthcare is thought of differently there. Patients are people to be treated, not avoided, etc. These amount to very significant differences in healthcare that no amount of money could ever gloss over.
I tried to sell medical insurance to the self employed in Texas for almost a year. Besides finding out that many self employed people are independently poor, I was also told many things about medical insurance companies, and how they rob self employed people.
You need to understand that insurance companies work on statistical certainties. And they simply design plans to match the prices their marketing people discover. There is no attempt to really insure people at all. The companies are looking for money only. They sculpt their policies to match statistics.
It’s very easy to pay premiums when you’re young. The companies will insure you as long as they think they won’t have to pay any claims. Women get free pap smears. Sounds nice, no? Of course, as soon as some problem appears, they boost your premium until you can’t pay. Or they just cancel the policy altogether. Several times in Texas, companies have come in, set up and run for five years or so, then they don’t pay any premiums and go out of business. If you were on one of their plans and got some disease, you wouldn’t be able to get insurance from any other company. The Texas Risk Pool has premiums like house payments. A few years later, the same people come in with another company or even the same company and do the same thing.
I saw a letter to a self employed woman who had just turned 50. Her premium had just changed from $350/month to $1100. That was more than the Texas Risk Pool wanted. There was no change in her medical condition, and she didn't smoke. Her age had been the problem. Even though they write in the policy that they can’t single out individuals, there are all kinds of things they can do which result in the same thing. They just manipulate the term “class”, and hide the definition. So your “class” could be everyone who had bought a policy the same day in your zip code or on your street. You don’t find out until you use the policy. If a chronic disease is involved, no other company will insure you after diagnosis. Go to Texas Risk Pool, Pay $1000/month, fall into poverty, do not pass “Go”.
Another neat trick is to write a policy with the clause in it that says that the policy won’t cover anything that would be or could be covered by workman’s compensation. Since the policyholder doesn’t have workman’s comp, he things he’ll be covered by his policy, and it makes sense not to be covered twice. It’s only when he gets really sick, like a heart attack, that the company will deny the big claim, since it will be judged “work related” and workman’s comp from the state pays for work related illnesses. Of course, the policy holder bought the insurance for such serious things. What about a serious auto accident during the week. Oops! Work related. Claim denied! The agent never tells the client, by the way.
Now you might wonder what the consequence of these things is. It’s to funnel people into jobs so they can’t be self employed. Figures. Slavery.
Here's a neat exercise to do. Go to your state's insurance website and look at the fines paid by insurance companies. Imagine the client who has to go get a lawyer to sue an insurance company. The companies know they have all the money, and the fines they actually do end up paying are just figured into the cost of business.
You need to understand that insurance companies work on statistical certainties. And they simply design plans to match the prices their marketing people discover. There is no attempt to really insure people at all. The companies are looking for money only. They sculpt their policies to match statistics.
It’s very easy to pay premiums when you’re young. The companies will insure you as long as they think they won’t have to pay any claims. Women get free pap smears. Sounds nice, no? Of course, as soon as some problem appears, they boost your premium until you can’t pay. Or they just cancel the policy altogether. Several times in Texas, companies have come in, set up and run for five years or so, then they don’t pay any premiums and go out of business. If you were on one of their plans and got some disease, you wouldn’t be able to get insurance from any other company. The Texas Risk Pool has premiums like house payments. A few years later, the same people come in with another company or even the same company and do the same thing.
I saw a letter to a self employed woman who had just turned 50. Her premium had just changed from $350/month to $1100. That was more than the Texas Risk Pool wanted. There was no change in her medical condition, and she didn't smoke. Her age had been the problem. Even though they write in the policy that they can’t single out individuals, there are all kinds of things they can do which result in the same thing. They just manipulate the term “class”, and hide the definition. So your “class” could be everyone who had bought a policy the same day in your zip code or on your street. You don’t find out until you use the policy. If a chronic disease is involved, no other company will insure you after diagnosis. Go to Texas Risk Pool, Pay $1000/month, fall into poverty, do not pass “Go”.
Another neat trick is to write a policy with the clause in it that says that the policy won’t cover anything that would be or could be covered by workman’s compensation. Since the policyholder doesn’t have workman’s comp, he things he’ll be covered by his policy, and it makes sense not to be covered twice. It’s only when he gets really sick, like a heart attack, that the company will deny the big claim, since it will be judged “work related” and workman’s comp from the state pays for work related illnesses. Of course, the policy holder bought the insurance for such serious things. What about a serious auto accident during the week. Oops! Work related. Claim denied! The agent never tells the client, by the way.
Now you might wonder what the consequence of these things is. It’s to funnel people into jobs so they can’t be self employed. Figures. Slavery.
Here's a neat exercise to do. Go to your state's insurance website and look at the fines paid by insurance companies. Imagine the client who has to go get a lawyer to sue an insurance company. The companies know they have all the money, and the fines they actually do end up paying are just figured into the cost of business.
I wonder why lists of those responsible for the American health system always start with "doctor?"
Any doctor appointed to a hospital or other corporate board has to sign an agreement to work in the best interests of the corporation, not the system, not himself, not for doctors generally, and not for the patients unless it also furthers corporate 'interests.'
It's phrased differently, of course. Interestingly, corporate executive pay is a corporate interest.
The system, if there is one, was clearly reformed to minimize doctor influence several reforms ago. It certainly was reformed to discourage incidental charitable care unless it creates an opportunity for favorable gee whiz publicity helpful to the corporate. That's not to say it doesn't happen, but it is a load many otherwise-willing practitioners can't shoulder as easily. Further, hospitals keep statistics on how much doctors are making for them, and how much they are costing them, and how. Sometimes, they use it to alter the way the doctor is treated by the administration. The don't control their doctors, but they can strongly influence their success or failure not to mention their stress levels. None of this is news to anyone working in Corporate America, but the details may be.
Other comments here regarding medical insurance seem accurate, but do not include the corporate difference between insurance pay-out services and pay-in services best illustrated by the long-time practice of long doctor office telephone queues lasting occasionally for hours for authorization for services, and the one-ring availability of a clerk for customer policy purchases. Don't forget also some doctors might have a one year contract with a particular insurance company or company which might not be renewed it the doctor 'costs them too much' in services-- even if authorized, with little appeal. We won't comment much on the venerable American business practice of stiffing the vendors, but it is alive and well among you know who.
One wonders who the doctor works for now. It used to be the patient.
Any doctor appointed to a hospital or other corporate board has to sign an agreement to work in the best interests of the corporation, not the system, not himself, not for doctors generally, and not for the patients unless it also furthers corporate 'interests.'
It's phrased differently, of course. Interestingly, corporate executive pay is a corporate interest.
The system, if there is one, was clearly reformed to minimize doctor influence several reforms ago. It certainly was reformed to discourage incidental charitable care unless it creates an opportunity for favorable gee whiz publicity helpful to the corporate. That's not to say it doesn't happen, but it is a load many otherwise-willing practitioners can't shoulder as easily. Further, hospitals keep statistics on how much doctors are making for them, and how much they are costing them, and how. Sometimes, they use it to alter the way the doctor is treated by the administration. The don't control their doctors, but they can strongly influence their success or failure not to mention their stress levels. None of this is news to anyone working in Corporate America, but the details may be.
Other comments here regarding medical insurance seem accurate, but do not include the corporate difference between insurance pay-out services and pay-in services best illustrated by the long-time practice of long doctor office telephone queues lasting occasionally for hours for authorization for services, and the one-ring availability of a clerk for customer policy purchases. Don't forget also some doctors might have a one year contract with a particular insurance company or company which might not be renewed it the doctor 'costs them too much' in services-- even if authorized, with little appeal. We won't comment much on the venerable American business practice of stiffing the vendors, but it is alive and well among you know who.
One wonders who the doctor works for now. It used to be the patient.
In case anyone wonders about the rankings:
http://www.photius.com/rankings/world_health_systems.html
http://www.who.int/inf-pr-2000/en/pr2000-44.html
Seems according to this France and Italy have the number 1 & 2 healthcare system.
???
Of course I'm having a hard time relating the measures to a valid means of rating the different countries healthcare system.
In many cases they are financial measures, and even the use of Disability Adjused Life Expectancy is bogus since that is affected by many other things besides health care. Does anyone think that Japan's No 1 ranking in DALE is because they have substantially better health care than the US (24)?
Arthur
http://www.photius.com/rankings/world_health_systems.html
http://www.who.int/inf-pr-2000/en/pr2000-44.html
Seems according to this France and Italy have the number 1 & 2 healthcare system.
???
Of course I'm having a hard time relating the measures to a valid means of rating the different countries healthcare system.
In many cases they are financial measures, and even the use of Disability Adjused Life Expectancy is bogus since that is affected by many other things besides health care. Does anyone think that Japan's No 1 ranking in DALE is because they have substantially better health care than the US (24)?
Arthur