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Monday, August 13, 2007

Half-Truths in Sicko?

 
Jim Giles reviewed Michael Moore's Sicko in the July 14th issue of New Scientist [Review: Sicko, directed by Michael Moore]. Like many reviews, this one conceded that Moore has a point about the shape of health care in the USA but was reluctant to admit that other countries are doing better. One paragraph mentioned "half-truths."
For the most part, Moore makes his case by absenting himself from the screen and allowing those who have been let down by the system to do the talking. Then he travels to the UK and France and finds that what conservatives in the US damn as "socialised medicine" actually works well. He does the same in Cuba, ferrying ill Americans to the island where they receive excellent healthcare at almost no cost. The result is a moving, funny and shocking film. It is a powerful call for change, despite its half-truths.
In last week's issue of New Scientist, a letter writer challenged Giles to produce his "half-truths," pointing out that the Sicko website documents every claim in the movie.

Here's how Jim Giles responded ...
The most obvious half-truths were the slanted depictions of the healthcare systems in the UK, France, and Cuba. The British NHS can be great, but waiting lists are often long and access to certain drugs can depend on where a patient lives. France's system is indeed highly rated, but Moore did not mention the very high taxes there. Cuba's public health is far above what would be expected for a country with limited resources and suffering the consequences of the US trade embargo, but it also restricts access to certain drugs and technologies.
Some of these sound very much like half-truths to me. Yes, waiting lists for non-lifethreatening procedures are often longer in countries with socialized medicine. That is, they are longer than the wait for similar procedures in a fully private system where people can afford to pay for it. On the other hand, the waiting time in the UK is a lot shorter than it is for Americans who can't afford decent health insurance, isn't it?

Access to certain drugs is restricted in all socialized medicine systems. For example, the system won't pay for drugs that don't work and haven't been approved. This is bad news for quacks who generally do much better under a private system. Socialized medicine often won't pay for expensive drugs if a cheaper alternative is available. Is this what Giles meant?

It's true that taxes are higher in countries that provide universal access to medical treatments. This isn't a half-truth in Sicko. As I recall, it's one of the main points. The US system is more expensive in spite of the fact that it's run by the private sector.

10 comments :

  1. Obviously socialised medicine isn't perfect, it isn't fair to say "these systems aren't perfect" without context. How do they compare with what's available with the average privately run health insurance plan in the US? Drug restrictions? Yep. Waiting lists? How about "indefinitely", because the doctors don't take your insurance, or because some bureaucrat denies coverage?

    I haven't seen Sicko yet, but does Moore really assert that these systems are perfect, or does he simply say that they are no worse than what the average insured person in the US has today? It isn't fair to compare socialised medicine with the top 5% of US insurance - after all, private insurance is available in countries with socialised medicine, isn't it?

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  2. AND, MC points out these, er, points... in just about every single interview.

    And no, MC doesn't say that any system is perfect. What he always says is that we should create our own system using the methods that work the best from other systems.

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  3. I think Michael Moore does mention that the French are drowning in taxes, but the premise of his movie is that healthcare in the US lags behind the standards set elsewhere because of the for-profit system. That said, I'd still take things that Michael Moore says with a grain of salt-- his idea of a middle-class family in France would be a good one.

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  4. Michael Moore doesn't exactly put it that way but the conclusion of it all is pretty simple:
    In the U.S. it is necessary to remove 42 millions people from the insurance logs and provide substandard coverage for the people on the logs in order for that model to be barely comparable to the Canadian, the British or the French one.

    Somebody ought to explain how these money making entities can say they are doing the job they say they are especially when in a situation of virtual monopoly. The public good is simply not served.

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  5. I'd like to see some real data showing that waiting times are much shorter here in the US, not just unsubstantiated claims. My experience and that of everyone I know is that our doctors' offices are heavily booked up and one can wait quite a while for a non-emergency appointment.

    As far as France goes (where, by the way, international comparative studies support the idea that there is every reason to believe that the average quality of care is BETTER than it is for the average INSURED person in the US), overall taxation is irrelevant in this context; the relevant comparison is total expenditure on health care. In that measure the French system is indeed very expensive- the second most expensive in the world, in fact. But still several percentage points of GDP cheaper than what we in the US spend on our marvelous "system", which has brought us the 42-best life expectancy and 41st-best infant mortality rate in the world.

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  6. As far as waiting times go, I can offer my personal experience after living in the US, Spain, and Germany, where the latter two have public health care systems.

    The waiting times in my experience have been similar, even possibly shorter in the public system. And the expense...not even comparable. I paid approx. 1/3 for the same quality care in Europe that I paid in the US.

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  7. Saying that you paid 1/3 of the price in Europe compared to the US is disingenuous, as the other two thirds or so is subsidized by the government. In order to discuss this correctly, one would have to compare the actual prices incurred (including subsidy) when one goes to a doctor in different countries.

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  8. Regardless of which pocket the money comes out of, it's a fact that the French system costs substantially less and provides much more. The waste in the US healthcare system- consisting mostly of bloated administrative costs and high profits siphoned off by for-profit middlemen- is criminal.

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  9. Dunbar,

    No, it's not disingenuous, unless you think I am lying. More likely you don't know what that word means. And no, we don't have to factor "subsidies" into it any more than I have to factor in the taxes I pay for the War on Terrorism into my feelings of security. Or do you plan on factoring in the huge amount of money wasted in medical bills that go to support a pointless bureaucracy for an HMO?

    Incidentally, my taxes were about the same in Spain and the health care was free, relatively fast, and modern. That's because they don't have a massive military budget or many of the other socially retarded mainstays of the US. How do you factor that in "in order to discuss this correctly"?

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  10. There is an object demonstration in the U.S. itself of government vs. private health insurance.

    The Medicare system (for those 65 and older, plus a small number of others qualifying due to disability or kidney disease) had been almost purely a government system. Legislation over the years, most notably in 1997, introduced private health insurance plans as an option for Medicare beneficiaries, on the theory that the "free market" system would allow the same quality of care to be provided more cheaply.

    As it turns out, far higher administrative costs for the private plans have made these substantially more expensive (an average of 12%) than the same level of care provided by the government. In fact, it is now law in the United States that these private plans *must* be paid more per beneficiary than the per-beneficiary cost for the government system.

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