FROM THE PRESIDENT
Ronald M. Davis, MD
Sense and nonsense from Sicko
Last weekend, my family and I went to see Sicko, Michael Moore’s documentary about the state of our nation’s health care system. The movie addresses some of the core issues the AMA has been working on for years, especially the plight of the uninsured and the abuses of corporations that put profits over patients.
The film resonated with the audience, which enjoyed Moore’s unique brand of humor and applauded after his most poignant jabs at our nation’s health care system. The power of the documentary comes from disturbing stories of patients who were disenfranchised by our health care system. Health insurers and managed care plans bear the brunt of Moore’s criticism for excluding patients with pre-existing conditions, for paying bonuses to claims adjusters for high denial rates, for outrageous executive salaries, and so on.
The chief flaw of the movie -- and it’s a huge one -- is the repeated omission of key facts that undermine or contradict Moore’s message. For example, Sicko condemns the AMA for its opposition to "socialized medicine" more than 40 years ago, but does not mention the AMA’s leadership during the past decade in developing a sound proposal for expanding health coverage and choice (http://www.ama-assn.org/ama1/pub/upload/mm/363/ehi1012.pdf). Nor does Moore mention that the AMA has joined forces with 15 diverse national organizations -- through the Health Coverage Coalition for the Uninsured -- in proposing a mix of public- and private-sector strategies to help cover the country’s uninsured, beginning with children in low-income families (http://coalitionfortheuninsured.org). In a media campaign to begin this fall, the AMA will ask patients and the public to add their voices to the chorus of those demanding action by Congress (http://voicefortheuninsured.org).
Sicko features visits by Moore to Canada, the United Kingdom, France, and Cuba, where he and his local hosts tout their national health care systems. He ignores or dismisses problems with those systems, such as long waiting periods for elective surgery and the rationing of care. In Canada, for example, the mean waiting period for knee replacements is seven months, and 10 percent of knee replacement patients wait 21 months or longer.1 In the U.K. and other countries, access to renal dialysis has been limited for older patients and those with comorbidities. One international comparison showed that patients with established renal failure had a much higher rate of acceptance into renal replacement treatment in the United States (334 per million population) than in Canada (143), the U.K. (101), and eight other industrialized countries.2
Moore does not mention that two-tiered health care typically exists in countries with national health care systems, whereby the wealthy can bypass queues and controls in the government-funded system. As explained by Paul Keckley, PhD, executive director of the Deloitte Center for Health Solutions:
In most developed health systems in the world, 15 to 20 percent of the population buys medical services outside of the system of care run by the government. They do it through supplemental insurance, or they buy services out of pocket.3
The camera in Sicko pans through the World Health Report 2000 ranking by the World Health Organization (WHO) of the best health care systems in the world. Moore decries the United States’ ranking at No. 37, just ahead of Slovenia. He does not discuss concerns about the validity of the WHO’s ranking methodology,4,5 and the camera zips past Canada (No. 30) and stops just short of Cuba (No. 39).
A health reporter for the Miami Herald takes Moore to task for his commentary on Cuba:
The final 22 minutes of the two-hour movie are devoted to Moore taking Americans to Cuba for treatment. One paid the equivalent of five cents at a pharmacy for an inhaler that costs about $120 in the United States. ‘There seems to be a doctor on every block,’ Moore tells viewers. In fact, repeated stories in the Miami Herald have related how Cuban pharmacies lack many drugs and patients rely on their relatives in Miami to send them to them.6
Another serious omission in Sicko is its failure to acknowledge that much of the sickness in our health care system is due to unhealthy lifestyles. This issue is relevant to the movie because the overall level of population health (which is affected substantially by unhealthy lifestyles) is one of five indicators that determine the WHO’s ranking of countries’ health system performance. The obesity epidemic, for example, is estimated to account for 27 percent of the increase in health care spending in the United States between 1987 and 2001.7 Grace-Marie Turner, president of the Galen Institute, has posed an interesting question: "If Michael Moore’s waistline ever puts him in the hospital for heart surgery, it will be interesting to see where he goes for medical care -- the Mayo Clinic, or Cuba?"8
Health care reform is already a leading topic in the 2008 presidential campaign, so please visit http://ama-assn.org/go/insurance-reform to read more about the AMA’s plan to expand health care coverage. Our nation’s health care system is far from perfect, but by building on its strengths and covering the uninsured, we can provide high-quality health care to all Americans.
P.S. Those interested in reading other critical analyses of Sicko can visit http://www.rottentomatoes.com/m/sicko/ to find links to many reviews of the movie.
References
1. Canadian Institute for Health Information. Waiting for health care in Canada: What we know and what we don’t know. March 2006. http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_07mar2006_e
2. Feest TG, Rajamahesh J, Byrne C, et al. Trends in adult renal replacement therapy in the UK: 1982-2002. QJM. 2005;98:21-28. http://qjmed.oxfordjournals.org/cgi/content/full/98/1/21
3. Gajilan AC. Analysis: ‘Sicko’ numbers mostly accurate; more context needed. CNN, June 30, 2007. http://www.cnn.com/2007/HEALTH/06/28/sicko.fact.check/index.html
4. Navarro V. Assessment of the World Health Report 2000. Lancet. 2000;356:1598-1601.
5. Almeida C, Braveman P, Gold MR. Methodological concerns and recommendations on policy consequences of the World Health Report 2000. Lancet. 2001;357:1692-1697.
6. Dorschner J. ‘Sicko’ film is set to spark debate. Miami Herald. June 29, 2007. http://www.miamiherald.com/103/story/154881.html
7. Thorpe KE, Florence CS, Howard DH, Joski P. The impact of obesity on rising medical spending. Health Affairs. October 20, 2004. http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.480/DC1
8. Turner G-M. Look at health data, not propaganda. Baltimore Sun. June 29, 2007. http://www.baltimoresun.com/news/opinion/oped/bal-op.sicko29jun29,1,1570837.story
