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spiveydog

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I saw the new Michael Moore documentary over the weekend and felt compelled to write about it and see if anyone else had thoughts on the film.

I thought the film was compelling and was a testament to how badly our medical "system" needs fixed. Mr. Moore presents an account of how our system is controlled by the pharmaceutical and insurance industries. He takes us to places like England, France, Canada, and Cuba to show how their systems are more encompassing, humane, and democratic. One scene followed a family doc (GP) in England and showed that physicians actually do pretty well financially in the "socialized" system. He interviews patients patients in these countries who seem pretty happy with their medical care. On the flipside, he follows patients in our country who get dumped on the street or die because an insurance company won't pay.

I understand that his account was one sided ( I have heard the horror stories of medical rationing/waiting for surgeries for many months in socialized medicine countries) and tended to demonize our capitalistic medical system. I also understand that the United States is not England, France, Canada or Cuba. But I believe the time has come to look into a single payer system for this country (not the government). Or at least swing the pendulum closer to this kind of system. Our medical system is broken and needs fixed. I know there are no easy answers.

I am wondering if anyone saw the film or has any thoughts on the above matters?
 
Universal coverage and single-payer are not synonymous. What most people seem to want is the former, not the latter. I don't think Michael Moore understands the difference, either.
 
I've got no less than 7 threads on this topic between the different Topic In Healthcare Forums if you want to put them all together.
 
Michael Moore is a propaganda artist, not a journalist.

For a good article on the realistic current state of health care in the US, read the Economist this week, "An Unhealthy Burden"

http://www.economist.com/finance/displaystory.cfm?story_id=9407716

Cuba has a better health care system? Whatever their system is like, it cannot justify the costs. Cuba was the gem of the Caribbean before Castro took over and stole all the public assets. Forbes ranks the fatigue wearing megalomaniac despot as one of the top 10 most wealthy of kings and dictators. (Castro angrily claims to have nothing).

http://www.forbes.com/2006/05/04/rich-kings-dictators_cz_lk_0504royals.html

According to the mayo clinic, which has a yearly conference on reform, there is currently enough money spent on health care. We do not need to spend more money, regardless of what the current socialist reformers are saying. We need to spend that money more intelligently. Government ownership of industry (including health care) does not solve any problems. Saying that profit motive should be removed from the health care system makes no sense. People benefit from profit motive. Even consumers and the economy in general. There is no other system out there currently that has the power to ensure prosperity for all. Government takeover would be a disaster for all involved, not least the patients, who would have bureaucrats and insurance clerks without medical degrees making health care decisions for them at increased social cost. (For some reason, hidden costs are not included in what most people assume to be "free" health care).
 
Agreed.

If not for the single reason that over the last 7 years very little was actually accomplished in the federal govt. They renamed some buildings.

What they have not been able to do is agree on anything. Imagine what would happen if we allow them to take over healthcare? Imagine the mess that would make.

Single payer VS Universal health ? Even the names don't sound the same.

If you have a single payer that would be called a Monopoly. The only way that could take place is if the govt. did it. Otherwise Monopolies are illegal in United States in private enterprise.

This problem won't be solved by the Govt. It needs to be solved in the private industry by physicians.

On another note. Isn't it interesting how a primary care provider in England, a socialized medicine country with no where near the wealth of the United States makes more than a primary care provider in the USA. I believe it was 200K + bonus. In the US the average is 165K.


Kthanksbye said:
Michael Moore is a propaganda artist, not a journalist.

For a good article on the realistic current state of health care in the US, read the Economist this week, "An Unhealthy Burden"

http://www.economist.com/finance/displaystory.cfm?story_id=9407716

Cuba has a better health care system? Whatever their system is like, it cannot justify the costs. Cuba was the gem of the Caribbean before Castro took over and stole all the public assets. Forbes ranks the fatigue wearing megalomaniac despot as one of the top 10 most wealthy of kings and dictators. (Castro angrily claims to have nothing).

http://www.forbes.com/2006/05/04/rich-kings-dictators_cz_lk_0504royals.html

According to the mayo clinic, which has a yearly conference on reform, there is currently enough money spent on health care. We do not need to spend more money, regardless of what the current socialist reformers are saying. We need to spend that money more intelligently. Government ownership of industry (including health care) does not solve any problems. Saying that profit motive should be removed from the health care system makes no sense. People benefit from profit motive. Even consumers and the economy in general. There is no other system out there currently that has the power to ensure prosperity for all. Government takeover would be a disaster for all involved, not least the patients, who would have bureaucrats and insurance clerks without medical degrees making health care decisions for them at increased social cost. (For some reason, hidden costs are not included in what most people assume to be "free" health care).
Click to expand...
 
It would be interesting to examin the medico-legal environment in these countries. People probably wouldn't like it if they were told they can't sue their doctors anymore, least of all the lawyers.

I have yet to hear anyone propose linking a single payer system with decreased medical school tuition or malpractice reform.

Under a single payer system there is zero incentive to ever change physician reimbursement. Under our current system if medicare fails to pay sufficiently for a procedure then a physician can chose to stop performing that procedure or to simply take only non-medicare patients. (I understand some may argue this is not a real choice b/c without medicare patients a practice has insufficient volume, but I argue if the standard medicare reimbursement dropped to $5/visit then yes, FP's everywhere would drop all of their medicare patients and only take privately insured or cash paying patients). At least there is a theoretical balance against medicare at the moment. This evaporates under single payer.

In my opinion the best system would rely on encouraging people to get catastrophic medical insurance and expect to pay for regular, expected services. Car insurance does not cover oil changes and new tires, why should medical insurance?
 
Dakota said:
In my opinion the best system would rely on encouraging people to get catastrophic medical insurance and expect to pay for regular, expected services. Car insurance does not cover oil changes and new tires, why should medical insurance?
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Exactly. 👍

Not to mention that overhead in most primary care practices would plummet if we didn't have to bill third-party payers for every nickel-and-dime service we provide.
 
KentW said:
Exactly. 👍

Not to mention that overhead in most primary care practices would plummet if we didn't have to bill third-party payers for every nickel-and-dime service we provide.
Click to expand...

👍

I agree and have made the exact same argument a million times. Touche 👍👍👍
 
Dakota said:
In my opinion the best system would rely on encouraging people to get catastrophic medical insurance and expect to pay for regular, expected services. Car insurance does not cover oil changes and new tires, why should medical insurance?
Click to expand...

This has always been my philosophy and the way my insurance was until my school forced me to go comprehensive. Unfortunately, judging by the amount of jankdified hoopties cruising the streets, I don't think it's an idea that will work (well) for the majority of people. The average Jane will avoid the Doc and his bill until something catastrophic happens. I think health maintenance/screening would suffer a serious blow with a subsequent increase in overall cost if health insurance worked this way.
 
Frijolero said:
I think health maintenance/screening would suffer a serious blow with a subsequent increase in overall cost if health insurance worked this way.
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It doesn't have to. Insurance could (and should, IMO) cover major things like Pap smears, mammograms, colonoscopy, and medically-necessary labs and imaging studies (deductibles notwithstanding). However, it's a gigantic waste to have people make an insurance claim every time they visit the doctor.
 
Or insurance could be dependent on individuals completing these exams to diminish risk in the pool, with individuals still having to pay for the exams. It would still be cheaper than paying a premium to get the insurance company to reimburse the doctor part of the money you just paid. In fact, tying coverage to adequate preventative medicine might actually get people to use it. The private sector has a strong incentive to do this, as it would diminish overall risk. I suspect the regulators would have a field day though.
 
Miami_med said:
Or insurance could be dependent on individuals completing these exams to diminish risk in the pool, with individuals still having to pay for the exams. It would still be cheaper than paying a premium to get the insurance company to reimburse the doctor part of the money you just paid. In fact, tying coverage to adequate preventative medicine might actually get people to use it. The private sector has a strong incentive to do this, as it would diminish overall risk. I suspect the regulators would have a field day though.
Click to expand...

That's how my wife's insurance plan works. Every six months, she has to pass some kind of "fitness test" in order to continue receiving a discount. I think it's a great idea.
 
Kthanksbye said:
According to the mayo clinic, which has a yearly conference on reform, there is currently enough money spent on health care. We do not need to spend more money, regardless of what the current socialist reformers are saying. We need to spend that money more intelligently. Government ownership of industry (including health care) does not solve any problems. Saying that profit motive should be removed from the health care system makes no sense. People benefit from profit motive. Even consumers and the economy in general. There is no other system out there currently that has the power to ensure prosperity for all. Government takeover would be a disaster for all involved, not least the patients, who would have bureaucrats and insurance clerks without medical degrees making health care decisions for them at increased social cost. (For some reason, hidden costs are not included in what most people assume to be "free" health care).
Click to expand...

I'm tremendously skeptical about socialized and/or single-payer medicine--I'm not opposed to the idea on philosophical grounds, but it would take a LOT of convincing to get me to trust the government to do it right. So don't take what I'm about to say as a defense of socialized medicine per se, but I think this statement above is a bit intellectually dishonest, or perhaps uninformed.

I don't know of anybody arguing that we need to spend more on healthcare. Rather, what I hear from proponents of socialized medicine is pretty much exactly what you are saying: that we're spending our money very poorly right now. They simply feel that the best way to solve that problem is to create some type of single payer system, and they point to waste and beauracracy that exists now precisely because the system isn't single payer in support of their argument. For example, health insurance companies currently spend large chunks of their revenues on things like sales, marketing, underwriters and claims reviewers (whose job is to try to find ways to deny claims, not to pay them), executive salaries and bonuses, and of course shareholder profits. In response, doctors have to employ a large staff of clerical workers to keep on top of the paperwork and negotiate reimbursement. All of this adds up to a lot of time and money wasted, which would be instantly cut out in a non-profit system.

Now being that this is SDN, let me just head off the flame storm that's coming by reiterating that I think socialized medicine has its own set of problems, and that I don't really trust our government to get it right. However, while I may disagree with their solution to the problem, I think that proponents of socialized medicine or single-payer systems have some valid points to contribute to the debate, the above being one of them.

Our system right now is really screwed, and some kind of change is probably going to come. Whether that change will be for the better is going to depend a lot on our (as in society's) ability to hold a fair and reasonable discussion of the issues. Unfortunately, right now we are extremely polarized and people seem to hold it as a virtue to villify their opponents, so I don't have a lot of faith that this is going to happen.
 
Pemulis said:
and of course shareholder profits.
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This is the kicker for me. Why doesn't anyone talk about how obscenely wealthy insurance companies are becoming? Or how lawmakers and politicians are in bed with all of them and their dirty little lobbyists? Did you know that actuaries make 500K a year? that's because defining risk is hugely important to insurance companies--it has a direct effect on their ever-expanding bottom line.

Meanwhile, we are in the trenches...
 
sophiejane said:
This is the kicker for me. Why doesn't anyone talk about how obscenely wealthy insurance companies are becoming? Or how lawmakers and politicians are in bed with all of them and their dirty little lobbyists? Did you know that actuaries make 500K a year? that's because defining risk is hugely important to insurance companies--it has a direct effect on their ever-expanding bottom line.

Meanwhile, we are in the trenches...
Click to expand...

But this is the problem. No one seems to blame the politicians who are taking the dirty bribes from the companies. We blame the companies that are blatantly for profit while ignoring the politicians that are supposed to be neutral. The companies are in business to make money. Progressive regulation of the insurance industry that comes from the government effectively restrict entry of new competition, which allows the existing companies to operate in an effective oligopoly with a government wink. Of course, these are the same politicians who would then set all healthcare policy in a socialized system. By limiting the government's intervention in healthcare, it would open the door to innovative competition. If they make a lot of money while doing a good job, that's fine. The problem is that the market is so restricted, that there are generally few good options left on the market, and a lot of these profits aren't earned legitimately. I have no problem with people getting rich by earning it in any industry.

My most recent article on blog is on this subject.
 
sophiejane said:
This Did you know that actuaries make 500K a year?
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Actuaries do make a lot of money, but the average is no where near 500k, at least any more so than the average physician makes 500k. According to salary.com (not the best source, I know) the median is $115k/year with an ASA certification and 8-10 years experience.

Actuarial science requires a very good understanding of math and involves a lot of difficult training. No one cruises into these positions.
 
Dakota said:
Actuaries do make a lot of money, but the average is no where near 500k, at least any more so than the average physician makes 500k. According to salary.com (not the best source, I know) the median is $115k/year with an ASA certification and 8-10 years experience.
Click to expand...

Just going from personal knowledge--a friend's brother is one and makes about that--don't know if it's the mean, apparently not. And I'm not commenting about the difficulty of the job. My job also requires a lot of difficult training and involves a very good understanding of science, but I'm not going to make anywhere near $500K.

They are paid very well because what they do affects the bottom line of insurance companies--and keeps the sick and old people who really need insurance from being able to get it or afford it.
 
Miami_med said:
But this is the problem. No one seems to blame the politicians who are taking the dirty bribes from the companies. We blame the companies that are blatantly for profit...
Click to expand...

So let's pose that since big business is concerned about its fat bottom line and believes that the guild of physicians should be cracked just as the unions were cracked in the 1940's. Isn't the way one would go about it, would be by infiltrating and emasculinating the AMA, our political action committee, and then by strengthening the political action committees on the side of big business?

I think we should declare war.
 
I think the best role for government is to intervene in the areas that have complicated medicine rather than in medicine itself. They should provide catastrophic insurance "universally" and limit punitive tort damages to 250k (or some reasonable amount that won't make an individual financially independent). Thus, both cottage industries currently making billions on the backs of our medical system become non-profit, just as in countries where care is socialized.

Government probably wouldn't even need to get near medicine at all, if they focused on these other areas. Doctors and the American medical system aren't the main problem. The problem is insurance companies and the cost of malpractice suits, settlements and risk-management.
 
And what about personal responsibility? No wonder MM is clamoring for someone else to pay for his health care. Rather than lose weight and get healthy, he'll just make a movie. If he's lucky, he'll get all of us to pay for his impending bypasses, chronic DM care and bilateral knee replacements.
 
One thing about Michael Moore, whether you love him or hate him (seems there is no middle ground here 😉 )...his movies make people discuss issues, and no matter what the outcome, if it gets people talking, that's a good thing.
 
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