Healing Our Sicko Health Care System (NewEngJourMed)

[pinto]

Healing Our Sicko Health Care System

Jacob S. Hacker, Ph.D.

There is a scene in Sicko — Michael Moore's controversial new film about U.S. health care — that captures both the power and the limits of Moore's cinematic polemic. A mother is speaking about her 18-month-old daughter, Mychelle, who became ill one evening with vomiting, diarrhea, and a high fever. At the nearest emergency room, Mychelle is treated by a physician who suspects, rightly, that she has a life-threatening bacterial infection. But rather than give her antibiotics, the doctor calls her insurer, whose physician-gatekeeper tells him that Mychelle is not covered at the hospital and must be taken to another facility. The doctor repeatedly says that Mychelle needs care, and he is repeatedly told that she must be transferred first. Finally, nearly 3 hours after arriving at the hospital, wracked by seizures, Mychelle is taken to the approved facility. She dies 15 minutes later.

As Mychelle's mother, Dawnelle Keys, recounts this awful sequence of events, a swing hangs empty in the background. Even if we had not witnessed multiple tragedies already — a woman seriously injured in a car crash whose insurer denies payment because she doesn't obtain "prior authorization" to visit the emergency room, an elderly couple who move into their daughter's storage room because they cannot afford their medicine, an uninsured man forced to choose which of his two fingers to have reattached after an accident — we'd know how the story ends. And yet, when the moment comes, and Dawnelle Keys's voice cracks as she describes losing her daughter, the effect is still devastating. We can't but wonder how our rich, powerful country can let so many citizens face such unnecessary pain and loss. How could a government "of, by, and for the people" fail so miserably to protect the people from such vast and preventable tragedies?

We do not find the answer in Moore's movie — and that is its great limitation. The golden age of documentary has demonstrated the medium's clout. Along with Al Gore's global-warming warning, An Inconvenient Truth, Sicko may well be remembered as our generation's Silent Spring or The Jungle — propaganda, in the best sense of the word, that pricks our collective conscience about problems that are hidden in plain sight. The first half of Moore's movie is ruthlessly effective. With little commentary, the film moves from one outrage to the next. With the exception of two people in opening vignettes, everyone featured in the film has insurance. But we learn that insurance is not always enough. Insurers erect obstacles to care, hassle patients and doctors, or just fail to provide sufficient protection to keep families out of financial trouble. No wonder insurance companies have decried the film. "Moore wants a government takeover," Karen Ignagni, head of America's Health Insurance Plans, recently blustered in USA Today. "To make his case, he relies on one-sided anecdotes — some dating back to the 1980s — that grossly distort the role of health insurance plans in providing access to care to more than 200 million people."

It is certainly true that Sicko is not a careful accounting of the pros and cons of the U.S. insurance system. But the basic truth of Moore's indictment is undeniable. A recent survey by Consumer Reports found that nearly half of adults younger than 65 — most of them insured — say they are "somewhat" or "completely" unprepared to cope with a costly medical emergency in the coming year. A substantial share of the more than 1 million personal bankruptcies in the United States each year — perhaps as many as half — are due in part to medical costs and crises. In no other rich country are people even remotely as likely to report having trouble with paying medical bills or going without care because of the cost.4 These problems are long-standing — yes, "dating back to the 1980s" — and worsening. And they are largely due to our reliance on employment-based, voluntary private health insurance.

<more at>

http://content.nejm.org/cgi/content/full/357/8/733?query=TOC

Source Information

Dr. Hacker is a professor of political science at Yale University, New Haven, CT, and a fellow at the New America Foundation, Washington, D.C.

The New England Journal of Medicine is owned, published, and copyrighted © 2007 Massachusetts Medical Society. All rights reserved.

[necso]

1. It's time to cut the (American) health-"care" Gordian Knot --

or to concede that, as a people, we can no longer solve our own problems.