I just went to see Sicko, the new project, documentary regarding America's healthcare system, concieved and directed by  Michael Moore.  Overall it was an extremely interesting and surprising experience.

  To start with, it was being shown at the Varsity Theatre in downtown Chapel Hill.



This is the Varsity.  It's pretty much unchanged from when it opened, the Marquee is the original.  It is on Franklin Street, the main college drag if you will in Chapel Hill.  While it has been known to show some mainstream films, it caters to the less popular, more funky/artsy type films, not film noir, but not "Pixar" variety either.  It's one of the few places around that really doesn't care if you walk in holding a cup of coffee from next door.

    I went to a 4:30 matinee so I could have the "cheap (six dollar!!)ticket!.  I was immediately struck by the audience.  At least 80% were silver haired senior citizens.  As we found seats in the theatre, people were talking and waving to each other.  It's summer time, the time we townies let our hair down and there are relatively fewer students crowding the streets.  They started to show previews, and I found myself wanting to see You Kill Me, but not the others they previewed.  The projectionist accideently turned on the pre-views too early, had to cut them off, and wait 10 minutes to turn them back on, much to the attendees amusement. The theatre was packed to actually standing room only.   

    The the film started.  Being in health care, and working pretty much in Emergency most of my life, I have seen all sort of wierd medical horror stories.  So I was keenly interested in the film.  I have always pretty much believed in the American health care system.  I admit I voted for Clinton back in the day in hopes that we would have universal health care, but as that died a slow and quiet death, I felt like I enjoyed really top notch health care, but of course, I've pretty much always been insured one way or another.  This film, however, was about the insured in America.  I would also like to say that I have NEVER in all my years working in hospitals, seen a patient be sent to another hospital before they were stablized (as was apparently the case in the 18 month old who died.) Nor have I seen a surgeon discuss with a patient costs to reattach fingers before it was done.  (And we do a ton of limb replants emergently here because we have an excellent surgeon).  So that part stunned me, and made me wonder when these things occurred and how exactly.  The other one thing that I would like to mention is that Moore refers to infant mortality rates multiple times through the film.  He fails to mention/explain that US infant mortality rates will be higher because we are able to keep preemies alive outside of the uterus longer than a lot of developing countries, we are able to help many very threatened pregnancies deliver, and we sometimes deliver very sick babies.  The Infant Mortality rate county by county in my states is skewed in this way, both counties with the super-intensive care nurseries have higher infant mortality rates than some very poor counties with less facilities…all the very high risk pregnancies are transferred into those counties, so, I took issue when he stated that infants in some third world countries had better survival rates.  It's not the whole story.  Other than that, I found it to be chillingly accurate.

It's hard to say there is a plot perse to the film.  Essentially Moore describes health care practices in America and then shows health care practices in Canada, France, the UK, and Cuba…with that side trip to Guantanamo bay.

He manages to do this all while being very very funny.  I laughed a lot during the film.  I also cried a lot because the situation so depresses me.

     Using examples, Moore shows how American HMO's and insurance companies work.  This was not news to me, because of my Public Health Administration Education, the bottom line is the bottom line.  It is unfortunate though that the bottom line has to be so low, and harsh.  It is true that there is a lot of abuse and overuse of healthcare resources, however, I think it's truely unfortunate that Insurance companies rahter than Health Care Professionals are the ones deciding if I needed a test or a treatment, I mean where is the sense in that? Physicians who are preferred physicians are actually given bonuses for lowering costs.  This is true of physician reviewers who deny coverage (as is shown in the film) but also of physicians working in offices who make attempts to lower costs, perhaps by not ordering tests etc.(This was not shown in the film, but I know it because I was taught this in school.)

After this he shows one American attempting to illegally obtain healthcare in Canada.  He speaks with several Canadians about their experiences with the Canadian HealthCare system.  All of them appear pretty happy. 

He then goes to the UK and again, people are very happy with the healthcare. 

Similar in France….

After Canada and the UK i found myself wondering if the film was about over.  At first I thought it was just my ADHD tendencies kicking in, but then I realized that I was just simply uncomfortable because clearly these countries are doing a better job at delivering care to citizens, especially preventative medicine. 

It does seem odd to me that Moore found no one that had trouble with the systems in these countries.  I have had friends tell me they have had to wait weeks to see specialists, and months to be approved for physical Therapy in the UK.  They were none too pleased.  Similarly there have been problems of delayed care.  Mr. Moore asked people in a waiting room how long they had been waiting, but he didn't talk to someone who had  been on a waiting list. 

Still overall, It is embarassing that we do so poorly with healthcare in the US.

In the theatre we applauded loudly in the middle of the film when Tony Benn stated, " If you can find money to kill people, you can find money to help people."

The highlight of the film of course was the crowning moment when after hearing that the quality of medical care at Guantanamo Bay is higher than care that some Americans recieve in the us, Moore and several 911 rescue workers and other "sick people" board a boat and attempt to enter the Gitmo hospital.  Moore says, " I have 3 911 rescue workers here, they just want the same health care that Al-Quaida is getting here"  The sick people and Moore end up in a hospital in Havana, where they all recieve treatment free of charge.  A touching moment is when the 3 rescue workers are recognized by the Cuban Fire Department.  All of them state they are feeling better at the end of their stay in Cuba.

But…the biggest revelation for me was actually when Moore queried the British Physician about his quality of life. Most of the physicians I know say they could not survive Socialized Medicine due to the high cost of their educational loans.  This Family Physician  drove a very nice audi, and lived in a one million dollar home in London.  I could see that this argument wasn't going to hold water.  Moore, however does not address how this man obtained his education, or his debt status, so I am still not sure its comparable.  But…I see that it is possible to do quite well on a socialized medicine salary. 

I really started to cry and feel very upset during the film, because it makes no sense to me at all.  Why do we allow this in this country?  I just don't get it at all.  If Cuba can have universal health care, it makes no sense for America not to.   

This does give me another reason to head to Havana, if I ever get the chance.

I'll be curious to see what the reaction is to this film as it gets wider circulation. 

I for one, will be lobbying more for a Universal Healthcare system….

What do you think can be done to fix the problems faced by the US healthcare system??  



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9 thoughts on “Sicko……

  1. Interesting post. Andrew and I talk about health care from time to time. We recently switched dentists for a couple of reasons. One was because with Andrew's new benefits his dental plan changed and didn't include the person we were going to. We also switched because we were paying too much out of pocket. Basically the dentist was charing waaaay more than insurance would cover. The difference was paid by us. No wonder we got heated neck things when work was being done. No wonder they have digital x-rays and other perks. But we've also talked about the lack of preventative care in the medical field. In part that comes from the way society thinks. Don't do anything to prevent illness. Just go to a doctor when you don't feel well or something "breaks". Our experience with our doctors has been that they're willing to answer questions but not really willing to discuss preventative measures, especially if we don't ask. Many people are also looking for the miracle pill that makes them better. Drug advertising on TV and other places doesn't help. I think people these days are trying to self diagnose and doctors go along with them as long as the patient isn't going to do a lot of harm. Take a pill rather than exercise, eat right, or some other non-medicine solution. Not being in the medical profession or knowing much about the details and inner workings I'm not sure if doctors and companies that make medicines are in cahoots as far as prescribing a product and the doctor getting some sort or kickback. Same with referrals to certain specialists. This is really an interesting topic, one that has many layers and topics within.

  2. Great post! I may even watch this when it crosses the pond. I normally avoid his stuff because presenting one side of an argument and beating the hell out of it is very easy: Taking a balanced view and assessing and presenting both sides takes actual skill.
    It is interesting that he found no one in the UK who complained about the health system (just look for "NHS" at the BBC website – negative stories will massively outweigh the positive ones!)
    As for doctors quality of life, I will wait and see how that is presented but a £500K ($1M) house (especially in London) is not uncommon – an average family home outside London is around £300K. National Health Service doctors do make good money (around £100K according to reports) and those in the private sector make substantially more, but it would take a doctor many years to rise to that level of salary – they will be earning that money after many years of study, and many more years of hard graft. Also, salaries that "high" are really not that uncommon in and around London for any well driven/educated graduate after 10 or 15 years work.

  3. The kickbacks for prescribing certian medications are pretty much a thing of the recent past. At one point a Physician could be flown to the Bahamas etc by drug reps. But theres been a campaign against this and most ethical docs are now refusing this sort of aggregious stuff, but more subtle things, like sponsering dinners with educational talks at very expensive resturaunts still take place.
    And I do agree that a lot of people are looking for a magic pill in the US. We have many good preventative options, but people don't always take advantage of them. One example is the coping with diabetes classes….we offer them andthey are very very poorly attended…it seems many people don't want to make the lifestyle changes needed to properly control the condition…..this annoys me no end. Or when a chain smoker tells me he doesn't have the 8 dollars needed to fill a prescription, but that he is going to support his 2 1/2 pack a day habit instead…..

  4. I'll be interested to see what your take is on it. It is astounding to us that you can go to a hospital, deliver a baby and not pay anything…..absoloutely astounding!!!

  5. I have lived under both the US and Canadian systems and my entire family is still back in Canada so I get to hear about it now as well. I have always said that if I had an emergency or a really major problem that could be corrected/cured (like cancer or something that required intricate surgery) I would absolutely rather be in the US. I recently had a minor lump in one of my breasts and my doctor had me at the ultrasound 10 minutes later. I know that the treatment I would get here would be agressive, progressive and top of the line. I am, fortunately, insured. Now, if I had some chronic problem that would debilitate me but for which no known aggressive or curative treatment existed I would rather be in Canada because you'd get reasonable, make you comfortable without actually doing anything treatment that didn't bankrupt you. Similarly, if I were uninsured I'd rather be there.I'd also be very interested to know where in Canada Moore interviewed people. My parents live in a good sized town but in the middle of relative nowhere and the town has a serious lack of doctors. For anything more than a simple procedure you are often sent to Toronto (or even the US) because specialists do not exist or you will wait for years to see one. My father says you don't want any kind of emergency operation because he thinks they just lost their only anesthesiologist. This is a town with more than 100,000 people in it. My sister-in-law has suffered from major endometriosis and it's accompanying pains for years and only recently had surgery for it. If I had the kind of problems here that she had I'd have had that sorted out in a couple of months.I wish that the vast amounts of money spent on deal with catastrophic problems was better spent, mostly on preventative care. I don't know how to make that shift, but having a basic safety net in place in American so people could see a doctor for free once a year, even, would make a major difference in the costs to support care for major problems later on. But that isn't the American way really – people would rather take a diet pill that makes you crap your pants than they would just not eat those potato chips.

  6. interesting thing is that there are a ton of low cost to free clinics in operation in the US. I used to volunteer at one that had some excellent doctors. But it doesn't seem to work…I would like to see a base of free primary care/internal medicine and perhaps Private insurance for more invansive things…but how thats going to happen, well, I wonder.
    Moore was right over the border, and its obvious that the presentation wasn't scientific but more dramatic… it makes things difficult, but I still do wonder if we can't do better by our people.

  7. My ex-husband just called me this morning to tell me that he saw this film yesterday. He brought my 14 year old to see it too and she was very opposed to seeing something "educational" during her summer vacation. Long story short, it made both my ex-husband and my 14 year old want to do something about getting universal healthcare implented. America is really in a sad state of affairs with our healthcare being owned by HMO's. They really piss me off!
    I can't wait to see this film now too. I wish it was playing everywhere but it's not yet. We have to drive about an hour away to see it, but it may be well worth the drive!
    Great Post, Holly! I "dug" it too, btw…

  8. I haven't seen this film yet but it is good to get your pov on it, that of an experienced health care professional. I'll be able to view it a little more objectively when I do see it.

  9. Through The Power of The Internet I watched Sicko – very thought provoking, I even tolerated Micheal Moore for the duration of it! I think us brits see medical insurance as being a "nice to have", sort of an upgrade from Economy to Business, we don't really get how essential it is over there. It is just totally alien to us to consider how much care and medicines costs and who is paying for them – dealing with house/car insurance companies is frustrating enough but the thought of having to deal with those types of people, discussing payments linked to our own health, is frightening.
    What would be interesting is some sort of coverage of the quality of care given my the 2 different systems – something that the documentary steered clear of. That may balance things up a little.

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