The emotional punchline of Michael Moore’s film comes when the film profiles civilian 9/11 rescue workers who had to hold raffles for medicine. Being volunteers, the government refused to cover their ground zero-related illnesses. It hurt to watch these guys who stood up and answered the call, who sacrificed themselves for America, discarded like yesterday’s trash. One of them described his medical limbo as if the government was just holding off dealing with his problems, waiting for him to die.
It turns out that by drawing a line between these volunteers and paid government employees, Moore didn’t go far enough.
Almost six years after the terrorist attack on New York, the federal government still does not have an adequate array of health programs for ground zero workers — or a reliable estimate of how much treating their illnesses will cost — according to a federal report released yesterday.
The report, produced by the Government Accountability Office, an arm of Congress, concluded that thousands of federal workers and responders who came to ground zero from other parts of the country do not have access to suitable health programs.
These people represent everything that is good about America. Now, thanks to our glorious best-in-the-world health system, they lack even basic care. While a select few Americans get to choose their doctors (within the network of course) and get surgery when they want it (assuming that the claims manager, who is paid to refuse payment, approves), the heroes of 9/11 sit around without care, waiting to die.
There’s nothing particularly new about this news. Americans get turned away from hospitals every day. Patients pass on all over the country because keeping them alive costs more than delaying payment until they die. Americans like to hang up images of our heroes, pose for pictures with them and imagine in some way that we’re like them. In falling through the gaping cracks in our medical system the 9/11 first responders have indeed become quintessentially American.
***Update***
And again.
[Mike] Helms, 31, a civilian counterintelligence expert with the Army’s 902nd Military Intelligence Group, had been sent to Iraq in 2004 to help fill a critical intelligence gap in the area known as the Sunni Triangle. While in Iraq, he lived with soldiers and ate military rations, took fire from mortar rounds and small arms, and clocked hundreds of miles manning a machine gun on the back of a Humvee.Nevertheless, his status as an Army civilian would leave him stranded in the aftermath of the June 16, 2004, attack, when the bomb hit his Humvee so hard it blew his M-60 off its turret.
In the months that followed, Helms recalled, he was denied vital care for his wounds — ranging from shrapnel in his left arm to traumatic brain injury. Forced to rely on federal workers’ compensation and turned away from regular care at Walter Reed Army Medical Center and other military hospitals, Helms has faced years of frustration grappling with bureaucracies unprepared to help a government civilian wounded in combat.
Greatest health care in the world.
***Update 2***
Read this Washington Post story on the wonderful new trend of physcian profiling by the insurance industry. Doctors who run afoul of the algorithm get demoted to undesirable status and cost more for insured patients to visit. Yet some demoted doctors don’t have a history of poor care. Is there a problem with the algorithm? Who knows, the whole thing is proprietary.
But ask yourself a simple question – from the perspective of an insurance company, what is the most important question about a doctor? Insurance companies exist to make money. Patients might prefer doctors who offer better care, but insurance companies prefer doctors who cost them less money. It doesn’t take a genius to expect that the algorithm serves the entity that created it and keeps its details secret.
Redleg
But isn’t Michael Moore fat and didn’t he mean to imply that Cuba’s healthcare is better than ours? At least that’s what Sean Hannity told me when alluding to the “many inaccuracies” of Sicko. Funny thing is that neither Hannity or his AEI hack guest actually enumerated a single instance of untruthiness by Moore.
Jake
The health system must be taking its cues from Rudi “Sweep
’em up and dump ’em” “Guiliani. Or perhaps the folks at Walter Reed.
The US … no, I won’t take one ounce of responsibility for this shit … some high-ranking decision makers in this country both public and private, treat the heroes the way spoiled children treat their toys. Once they’re broken the little brats cast them aside and reach for a shiny new one. Shit, I know there was at least one big health insurance co in one of the buildings. Wouldn’t it be a swell idea and provide great PR to cover the care of people who at least tried to save your backside or the backside of some of your pals? Guess not.
I suppose I could go on a longer rant about how more and more this society is focused on appearance and unless you’re a fully functioning, preferably photogenic specimen, the pols don’t give a damn because they can’t use you in a photo op. But I won’t.
Zifnab
I think he called Bush Hitler. And I’m pretty certain Bush isn’t Hitler. But then I need to check my Limbaugh Letter to be sure.
Also, speaking of inaccuracies in reporting, I really don’t think FOX has room to talk:
Politicsal reporting is HARD!
Sojourner
It’s the duty of all Americans to put their lives on the line, without complaint, in the service of this administration.
HyperIon
ok, jake, but i will. here is something that is just stupid
that’s the POTUS *I* want…somebody who looks luminous!
i saw howard zinn on c-span over the weekend. boy, is he getting old. but he made a great point: americans are silly to believe that the most important thing is who is the POTUS.
Jake
The problem isn’t tracking quality of care (collecting data), that is actually a good idea because it’s linked to preventive care. All doctors should be aware of these initiatives. The problem is a) buggering up the information collected and not giving the doctors a chance to see/correct it and b) What the Ins. co. does in response to a “problem” doctor.
Docs already have to go through a credentialling process every 2/3 years to stay on a plan. That’s when the Ins. co. makes (or should be making) decisions about whether to drop doctors or change the terms of their contract. To do it mid-contract screws the doctors and the patients. In addition, unless you’ve got a doctor who is harming patients, it would be in the patient’s best interest to educate the doctor, maybe put him/her on probation if the doc forgets to do a pap smear more than X amount of times.
I guess there is also a c) Not having a trial period where doctors are aware the various plans are data-mining and they get a report but it doesn’t affect them or the patients. Medicare is conducting a non-mandatory quality initiative where doctors get a bonus for participating. Oh and d) lack of uniformity in rules.
Anyway, here is my prediction which I just pulled out of my ass:
As more doctors who are top-tier (and therefore cheaper) pick up the load of patients who are leaving their lower-tier doctors, their schedules will get even tighter. Some health plans require doctors to see patients within a given amount of time. But those doctors will be pushed to see all of their new patients, they’ll start forgetting things and it will be reflected in their medical record which the various plans will look at and eventually … no more top tier doctors = higher co-pays = ??? = profits!
Either that or the doctors will get so pissed the Ins. Cos will StFu.
Macmic
Ground Zero volunteers are going to die after having suffered decades of frustration, poverty and abandonment. This is the simple logical outcome of a society that rewards and fetishizes selfishness as “freedom”, and punishes altruism as “immoral” and disloyal to the home team (i.e. “socialist”). They will die. They will suffer until their death in ways we could assuage in a heartbeat, were we not convinced that selfishness is good, and altruism/mutual aid evil. Jesus would be so proud of us.
Michael Moore: “Tens of millions of our citizens have no health insurance. Tens of thousands of them will die in the next few years.”
The US Right Wing: “You’re such a fatso, and Cuba sucks!”
We are through the Looking Glass, down the Rabbit Hole, in the Matrix…
Doublespeak: Selfishness is good. Mutual aid is evil. (Repeat until thinking stops)
The Other Steve
Why do you assume that?
Insurance companies exist to make a profit. If doctors cost them more, say by calling for repeat visits, etc. The insurance companies increase their rates.
How else do you maintain growth when you can’t bring in new customers?
Tim F.
One way would be to intimidate doctors into self-policing lest they run afoul of the algorithm. Fewer claims coming in means less time spent denying them.
Pb
Wow, you could make a (bad) commercial out of this one:
The Algorithm. Don’t Ask.
croatoan
After a procedure paid for by the gov’t, prez complains about gov’t-run health care.
Cassidy
CNN had a good rebuttal to Moore’s criticism of their criticisms. Very interesting read.
Tim F.
Pan out, Cassidy. Are you arguing that we do in fact have the best healthcare in the world? Either that or you’re being a nitpicking pedant.
rachel
True, he enjoys health care provided free of charge to him by the taxpayers, but he could pay for it himself if he’d wanted to. That’s why it’s OK. /sarcasm
bernarda
When I first saw the article about data-mining on doctors, I misread it.
“And it shows how people such as Berkenwald are at risk of losing control of their reputations as corporations and other organizations mine electronic data to draw conclusions about them and post them online.”
I thought that it said,
“And it shows how people such as Berkenwald are at risk of losing control of their reputations as corporations and other ORGANIZED CRIME mine electronic data to draw conclusions about them and post them online.”
That would be a bit more accurate.
bernarda
I just want to thank you for this extremely informative post.
ConservativelyLiberal
When I was undergoing bi-lateral carpal tunnel/ulnar neuropathy operations in the 90’s, my surgeon was one of the top ones in the state. He was actually a plastic surgeon, schooled at the Mayo Clinic, did his residency there and worked for them for some time afterward. He had his own private practice for over 20 years, and one day I came in for a follow up appointment and he handed me a Time magazine that was opened to an article about insurance companies.
Boy was he hot! He left me to read the article and when he returned he asked me what I thought. I told him that I thought it was odd that these claim managers were basically practicing medicine without a license. He said that was exactly the point, and that he did not spend all of the years and money in college and residency only to be told what he could and could not do by some twerp who knew nothing about medicine.
He said that if it went the way he thought it was going to go, he would close up shop and quit medicine. Sure enough, less than two years later he closed shop, and now he runs a top notch restaruant. I talked to him about a year after him leaving his practice, and he said that while he misses his old line of work, the stress is much lower. He said that the insurance companies started dictating to him what he could and could not do, and that was the last straw for him.
I read about a month ago that doctors in California are opting out of Blue Cross/Blue Shield as the revised reimbursement scale makes Medicare look great. Blue Cross expressed concern that the doctors were over reacting, but from what I could discern the cuts of 30% and more were devestating to doctors.
Medical insurance companies are leeches, plain and simple. They profit off the plight of people who have little other choice, and they suck off $$$ from the system to enrich themselves. I am not against a fair profit, but they are getting as bad as the oil companies. Seems that everyone is looking for maximum profit, and we are the ones that they are squeezing it out of.
My wife and I have Blue Cross, and their coverage flat out sucks. Every year, they renegotiate the package with us, and it gets worse every year. I spend so much time on the phone with them every time one of us have to see a doctor, and it is a pain trying to get them to cover the simplest things that they used to cover in the past. Their list of approved formularies (drugs) is getting smaller and smaller every year.
The health care system in this country is a mess, and it is the fault of profiteers like BC/BS. Granted, there are doctors who are crooks, but this system penalizes everyone. Not the crooks. If anything, the insurance companies are the crooks now.
Cassidy
Neither. I was pointing out a good article about the subject. CNN usually covers medical issues fairly well, so I thought it would be a good read for those interested. I haven’t seen the movie, so I have no criticism in either direction for it. I do beleive Moore has a history of partisan bias and cherry picking, but he also makes some very good, solid arguments, so I judge each movie individually.
As for the best health care in the world? I think there are several factors to be discussed there. I do believe we have the best quality of care, and the best trained specialists in their respective fields. Our health care system definately has some problems, but I don’t think Universal Health Care is the answer. Our problems in the health care system revolve around insurace and HMO’s, not the quality of care available.
A lot of it has to do with the negotiated contracts. When you negotiate a contract with an isurance organization, they never pay you 100% of the cost. So, providers have to inflate their cost, to get a decent percentage paid to them.
Ex: Procedure A costs $100. The insurance company says they’ll pay no more than 35%. Provider charges $200 dollars for said procedure.
That’s a simplified version, but the normal SOP. Most of my experience though, is dealing with the military health care system, and that’s a completely different animal.
I think thier are a couple of different solutions. 1) Employee groups can negotiate their own health care. A large enough participation group can get a much better deal than what the company offers. 2) I think a move towards private hospitals, owned by the insurance companies would be a good move. Instead of negotiating contracts, a fixed establishment with a regular staff (something along the military MTF model) would provide a number of bonuses: better continuity of care, less co-pays to referred specialists, etc. With that kind of hospital, a corporation or union could negotiate a lower monthly cost and lower co-pays in exchange for exclusively seeking treatment at that hospital.
For more clarification, a military MTF has just about every specialty under the sun, from Family Medicine to OB and neurosurgery.
In the end, you get what you pay for. So while insurance companies definitely need to make a move to be more patient friendly, customers have to understand that you can’t get something for nothing. At a minimum, your Family Practice Physicians have gone through 4 years of Medical School and 4 years of residency training to be able to tell you, you’ve got the sniffles. If you’re building a house, you want the best and you’re gonna pay for it. Same goes for the health care field.
Cassidy
Somethign else to consider is the saturation of pharmaceuticals into the market. The general populace has convinced itself that it needs to be treated for every ailment, which is simply not true. The body is a fairly healthy system that will fight off infection fairly well. By going to the hospital all the time, for every little thing, you’re creating a resistance in yourself to certain medications, and you’re tracking stuff out with you. Right now, in the general populace around the base, cases of MRSA have increased exponentially. The more you go to a hospital, the more likely you are to leave with somethig worse than what you wen tin with.
Tim F.
Cassidy, as I understand it the nut of your point is here:
Well, great, I agree fully. Cut out the problematic areas of our healthcare system and we have left medicare, medicaid, military care and the VA. Just expand those somehow (compulsory military service might do the trick) and we don’t have the hidebound for-profit bureaucracies interfering with medical decisions anymore.
Kidding aside, you seem to have tremendous faith in the bargaining power of individual health consumers. That would automatically make you a powerful advocate of labor unions, right? If so I was fully right to tag you as a labor Democrat early on. Some of the more libertarian stuff had me wondering (e.g., you can’t simultaneously claim that regulation is always bad and then criticize others for having a manichean view of things), but that has me feeling right again.
The problem is that, obviously, collective bargaining only works when you belong to a large enough collective. Would you deny any care at all to the unemployed? Under your plan anybody running a small business or trying something novel (say, Bill Gates or Steve Jobs) would be positively screwed. No bargaining power would permanently leave them one appendicitis away from poverty. The massive risk premium would severely disincentivise small businesses and innovation, which you no doubt know are the engines of a strong long-term economy.
By insurer-run hospitals you apparently mean Kaiser Permanente, which does exactly that in the San Francisco area. That works fine unless they decide that they can’t squeeze any payment out of you, in which case they dump you on a distant curb with broken bones unhealed. It also poses a problem when a medical crisis forces you to take your kid to the nearest hospital rather than a participating hospital. During the time when the insurer refuses payment at the other hospital and arranges transport to a participating one, the kid dies. These aren’t made up stories and they aren’t crazy anecdotes either. They are simply the natural consequence of the system that you advocate.
Cassidy
I’m not really into compulsory military service. Now compulsory public service of some kind, sure, only because I think it would build character in our young adults, teaching them the value of serving.
Yes, I do beleive in labor unions. I think some of them are wrong in their actions, but those are exceptions. And yes, I do have libertarian leanings when it comes to gov’t involvement in private lives. The less gov’t regulation, the better. Any time you let the gov’t make a decision for you, that’s one less choice you have the freedom to make.
Well sure. I agree with that, but forming a collective wouldn’t be that difficult. I think if people were to start looking at non-traditional collectives, they could probably get somewhere.
As for the unemployed, I think the Universal Healthcare meme should be scaled back in scope to focusing on the unemployed as part of the social safety net. But once again, I think that should be a short term patch towards getting the customer back to a self-reliant status.
As for Steve Jobs, it depends. Do you want to take away his money because other people who didn’t earn it need it more, or let him keep it to pay for better healthcare?
Like I said, I was basing that off the military MTF model. With all the necessary specialties under one roof, and a comprehensive medical plan and negotiated flat co-pays, would be a good alternative for the patients.
Cassidy
I forgot to mention that with fixed facilities, like what I’m suggesting, the profit margin of the insurance companies would still be good. I’m not an accountant, so I can’t say it would improve with any kind of accuracy. But the long term income would balance out against immediate losses. In that vein, I think smaller business, while not able to negotiate a plan as good as a larger one, would still be able to negotiate well under a long term committment to treatment in a fixed facility.