HFMA VIEWS

Pamela Waymack, FHFMA
Managing Director, Phoenix Services 

Michael Moore’s Healthcare Proposal

If you have not seen the movie SiCKO and are reading this post you need to get out and see it this week. Michael Moore’s latest documentary SiCKO has behind it an aggressive prescription for reforming the US healthcare system.  Moore’s film brings the heathcare industries’ failings under his microscope. His diagnosis is predictable—the system must be overturned. But his remedies are scary in their simplicity.

The documentary is an indictment of the private health insurance industry and indirectly indicts the rest of the healthcare system as guilty of not providing affordable and accessible health care.  At a time of national elections and precipitating concern for healthcare costs and access restrictions, all of us need to be paying attention to growing public concerns about healthcare.  For the 44 million uninsured, Moore’s documentary may have created a voice equal to or stronger than the political action committees that often set our policy agenda. It crystallizes the near universal sentiment today that it is time in America that healthcare coverage not be limited to those that have a preexisting condition of luck—being lucky to have a job with insurance coverage or a spouse with coverage, being lucky enough not to have been sick and disqualified from coverage on a direct policy, being lucky enough to have the income to pay for a policy if you are offered one.

Moore is circulating petitions that endorse a “Prescriptions for Change”; his diagnosis is that if the US takes each of the following three magic pills the entire sector’s problems will be cured.

Michael Moore’s healthcare proposal:

1. Every resident of the United States must have free, universal health care for life;
2. All health insurance companies must be abolished; and
3. Pharmaceutical companies must be strictly regulated like a public utility.

The unfortunate part of the documentary is in fact its strength, it reaches a simple solution for a complex problem. Moore’s documentary lays out three myths as facts that drive to his conclusion that the healthcare system needs to be turned over to the government. This post provides an alternative perspective to his commentary that can add realism to the ensuing public discussion that will shape our solutions nationally to the uninsured crisis. 

SiCKO—The Myth That There Is a Magic Pill to Cure Health Care’s Cost Escalation

Health care has been a target sector for outside scrutiny for decades but Moore’s documentary may be the unwanted attention that catalyzes change. When I graduated from the University of Chicago’s business school in 1979, health care was approaching 9% of the Gross Domestic Product (GDP) and industry pundits could not envision it ever exceeding 12% of GDP. By 1990 it did just that; national healthcare expenditures represented 12.4% of GDP that year. And it has not stopped in the ensuring decade and a half. Today health care is a $2 trillion sector of the national economy, consuming over 16% of the Gross Domestic Product and there is no end in sight. The nation’s appetite for healthcare appears to be insatiable and the inflationary trend line in healthcare spending is far from stabilizing. Health care in the US and abroad is a rapidly growing sector of the economy that is diverting dollars from other causes. As economists would recognize, our healthcare cost trends both here and abroad represent an unsustainable trend. At some point, there is a limit (although we have not found it yet) to how many more resources any nation will divert to health care.

The 21st century’s healthcare dilemma will always require tradeoffs. There is more that can be done clinically than there are funds with which to pay for the care. There will always be limits to what can be done financially. 

SiCKER—The Myth That Other Countries Have Solved the Healthcare Crisis

Mr. Moore’s research chose not to address how other countries manage with less healthcare expenditures. While their preventive care capabilities should leave us embarrassed as a nation, he chose to limit his review of access for high cost clinical capabilities. He did not ask how these other nations would address issues like bone marrow transplantation for the kidney cancer patient that was denied coverage due to its experimental nature. He did not explore access to more commonplace specialty service needs such as:

• dialysis (what are the age limits to access this service),
• low birth weight newborns (when are babies considered not viable and therefore not treated), and 
• disability (are there physical limitations that are not treated).

Part of what has allowed other countries to keep their healthcare costs lower than in the US is their willingness to engage in decisions about what treatments will not be available. In the US these cases are called denials; they are litigated or put into documentaries. In other countries denying services is accomplished by rationing care. Whether the rationing is implicit (through screening guidelines on age, weight…) or explicit (such as limited availability of technology such as MRIs or specialized services), these countries have addressed the need to rationalize health care’s continuing demand for more resources. They just say no. 

Is America ready to explicitly or implicitly limit access to what are considered routine care today?

SiCKEST—The Myth That Government Can Do It Better

At the end of the film, the only thing more disheartening than Moore’s depiction of the flailing US healthcare system is the impression he leaves that his magic pills can cure our healthcare financing and delivery ills. Some of the same countries that Mr. Moore spotlighted as successes are looking to the American market based systems for ideas to address their own challenges to control costs. If government had all the answers as Mr. Moore presumes, most US county health systems would not be dismantling their preventive services in the community and changing policy on an almost daily basis to react to their own fiscal ills. Come to Cook County to see a government-run healthcare system that will only make you sick to your stomach given its historic and continued mismanagement.

SiCKO—A Call to Action

Yes it is time in America to address spiraling costs and decreasing access to healthcare services by those most at need. Based on my own observations from other countries healthcare systems over the past 25 years, there is no simple solution to the 21st century’s insatiable appetite for healthcare services.  So let’s not believe there is a magic pill that Mr. Moore or anyone else can produce to cure what ails the US healthcare system. But in the end, SiCKO should serve as a wake-up call to all of us that it is time to start addressing the issues of cost and access before our healthcare system is dismantled by those that have the simple solution like Mr. Moore.

If we in the healthcare industry do not engage in active discussions and problem solving, we will find others dictating solutions.  This may be the SiCKEST possible ending to the film—realizing that we could abdicate our role in shaping the future of healthcare delivery and financing in this country because we remain silent. 

It is time we address the limited access that 44 million residents in the US experience every day.  We must actively support universal coverage and assure that it solves the problems in our healthcare system instead of replacing them with new problems. 

Start a dialogue among your friends, in your community and through your professional affiliations about the need for universal health insurance for all people in this country. All of us need to contribute to the discussions  and bring a dose of reality to them assuring that assumptions and conclusins are realistic and that critical information is not omitted from the offers of magic pills and simple solutions. While there is no magic pill for our spiraling health care concerns, there is an incredible opportunity to improve our unhealthy system today.