[corp-focus] SiCKO, Part III: National Health Insurance -- More Humane and More Efficient

[robert weissman]

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SiCKO, Part III: National Health Insurance -- More Humane and More Efficient
By Robert Weissman
July 17, 2007

Michael Moore's extraordinary SiCKO makes the case for a single-payer 
national health insurance system -- a Medicare for All -- without 
bogging down in detailed policy debates.

Sure, there's quite a bit of data that Moore sneaks in, but SiCKO's 
basic approach is to rely on regular people telling stories about their 
healthcare experiences. In the United States, those stories are pretty 
rotten, and frequently heartbreaking. The experience of people living in 
countries with national health plans is much better.

This makes for powerful film-making, which is not to say there's no need 
for the nitty-gritty policy debates.

The health insurance industry and its allies have worked hard to respond 
to SiCKO by promulgating a series of deceptions. It's awfully hard to 
defend the current U.S. system, so their emphasis is on criticizing 
other countries' healthcare systems.

They have a lot of practice at this stuff. Get on a call with people 
like Sarah Berk of Health Care America and Sally Pipes and John Graham 
of the Pacific Research Institute, and they will compellingly recite 
three key misleading arguments:

* People in other countries have to suffer through long waiting periods 
before seeing a doctor or getting treatment.

* National health plans ration care.

* "Government-controlled healthcare" or "government monopoly healthcare" 
is inherently of inferior quality.

When you don't feel well, or need treatment, you want to see a doctor 
right away. So, the image of waiting lists to get treatment has some 
resonance.

But exactly how easy is it to see a doctor in the United States?

It turns out that the answer is the same as in other countries: It depends.

It depends in large part on what you need to see a doctor for.

Live in the United States and have a bad rash and need to see a 
dermatologist? Well, try not to scratch too much.

My colleague Sam Bollier called 20 dermatologists in the Washington, 
D.C. area, included under Care First/Blue Cross-Blue Shield or Cigna 
insurance plans. The average wait to get in the door is 36 days.

He called OB/GYNs and asked how long the wait would be for a woman who 
found a lump on her breast. The answer on average: 16 excruciating days.

In fact, wait times to see a doctor in the United States are worse than 
other industrialized countries -- all of which have national health 
insurance -- except for Canada, where the system has been starved of 
funding (but overall performance is still better than the United States 
on most key measures).

In 2005, the Commonwealth Fund commissioned phone surveys of sicker 
adults in New Zealand, Germany, Britain, Australia, Canada and the 
United States.

In the United States, 47 percent of those surveyed said that, the last 
time they were sick, they were able to get a doctor's appointment the 
same day or the next day. This was worse than every other country except 
Canada. In New Zealand, 81 percent reported being able to see a doctor 
by the next day.

Asked what happened the last time they needed care in the evening or on 
a weekend or holiday, and whether they could get care without going to 
the emergency room, a full third in the United States said it was "very 
difficult" and half said it was at least "somewhat" difficult. This was 
worse than every other surveyed country. In Germany, only 14 percent 
said it was very or somewhat difficult.

What about rationing?

It's awfully hard to take this argument seriously, though there's no 
question it resonates.

All insurance plans, if they have some budgetary constraint, must ration 
to some extent. The relevant questions are: who's doing the rationing, 
on what grounds, and how is the rationing allocated.

In the private insurance system in the United States, rationing is done 
by the health insurance industry, which rations with an eye both to 
health needs and the insurers' profitability.

And, of course, the worst rationing is imposed on the 45 million people 
in the United States without insurance.

Rationing is far worse in the United States than in other countries. In 
the Commonwealth Fund survey of sicker adults, 40 percent of people in 
the United States said there has been a time when they did not fill a 
prescription because of cost -- twice the level of the next worst 
performing country. Far higher numbers in the United States said that, 
because of cost, they did not visit a doctor when they had a specific 
medical problem, or that, again because of cost, they skipped a medical 
test, treatment or follow-up recommended by a doctor.

And then there is the matter of quality of care. There's no doubt that 
the United States often offers top-line care to those able to pay -- 
including "boutique" service for the super-rich at leading hospitals.

But in the aggregate, U.S. healthcare indicators are terrible, for worse 
than other industrialized countries -- all of which have national health 
plans.

With SiCKO heating up the debate, Business Week profiled the French 
health system, which is treated favorably in SiCKO. "To grasp how the 
French system works, think about Medicare for the elderly in the U.S., 
then expand that to encompass the entire population." But, notes 
Business Week: "the French system is more generous to its entire 
population than the U.S. is to its seniors."

Business Week lined up a comparison between the United States and 
France: No one is uninsured in France. Out-of-pocket spending in France 
is barely a quarter of what people in the United States pay. There are 
almost a third more doctors per capita in France. French life expectancy 
is two years longer for men, four for women. Infant mortality is 43 
percent lower in France.

On top of which, French health expenditures amount to 10.7 percent of 
the national economy. In the United States, it is 16.5 percent.

It turns out that national health insurance is not just more humane, it 
is far, far more efficient, about which more in my next (and final) 
piece on SiCKO.

There is one other argument that is regularly made against national 
health insurance, but this one comes from different quarters -- those 
sympathetic to national health plans. And that is that while national 
health insurance may be desirable, it is politically unattainable. More 
on this also in my concluding column on SiCKO.


Robert Weissman is editor of the Washington, D.C.-based Multinational 
Monitor, <http://www.multinationalmonitor.org> and director of Essential 
Action <http://www.essentialaction.org>.

(c) Robert Weissman

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