Just watched Sicko, wanted to know if it is really the truth

Politics International Politics
1

Ok guys, as an European I am completely unaware of how US system works, so all the help is needed here.

I saw the documentary about the American Health System and it shocked me. Not to know that there are people having problems with the medical system, but that the system there is actually worse than in Portugal. As a son of a hospital worker, my health care as been always red carpet (only once I used a hospital different from where my mom worked, and still I was well treated cause of my VIP card (Health Workers Association)).

I know that the system in Portugal is made for people to waste all their money in drugs (doctors get bonuses from pharmaceutical companies based on how many drugs they can “sell”) and the left-wing government is trying to impose a generic-quota for hospitals in hopes to reduce the expenditure.

Can anyone just tell me, is it really like that in US… people get dumped away from hospitals cause they don’t have money??? People die cause hospitals refuse to give them care? Where is the oath all the doctors have to do? Don’t they do it in USA?

I’m completely shocked by how a country like the US can have this…

please, someone tell me this documentary is seriously flawed…

2

[quote=“mr_boogie”]Ok guys, as an European I am completely unaware of how US system works, so all the help is needed here.

I saw the documentary about the American Health System and it shocked me. Not to know that there are people having problems with the medical system, but that the system there is actually worse than in Portugal. As a son of a hospital worker, my health care as been always red carpet (only once I used a hospital different from where my mom worked, and still I was well treated cause of my VIP card (Health Workers Association)).

I know that the system in Portugal is made for people to waste all their money in drugs (doctors get bonuses from pharmaceutical companies based on how many drugs they can “sell”) and the left-wing government is trying to impose a generic-quota for hospitals in hopes to reduce the expenditure.

Can anyone just tell me, is it really like that in US… people get dumped away from hospitals cause they don’t have money??? People die cause hospitals refuse to give them care? Where is the oath all the doctors have to do? Don’t they do it in USA?

I’m completely shocked by how a country like the US can have this…

please, someone tell me this documentary is seriously flawed…[/quote]

I haven’t seen the shockumentary yet, but the US system is indeed seriously flawed. However, hospitals do not have the option of refusing emergency medical service to anyone, but what defines “emergency” is a matter of much legal debate. One of the problems with our system is that because we lack a national health care program, people who cannot afford to have their medical conditions treated wait and wait and eventually have no choice but to go to the hospital as emergency patients. Well that costs big bucks, and if they can’t afford it, the tab gets picked up by J.R. Taxpayer in the form of federal and state subsidies. Heard of those wacky laws in the US where the government forces drivers to wear their seatbelts and motorcycle drivers to wear helmets? Well it’s an economic issue. If people don’t wear their seatbelts and helmets they are more likely to require emergency treatement in the event of an accident, and inevitably some of that cost will be picked up by the taxpayer. The good folks over at Physicians for a National Health Program argue that it makes more economic sense to institute a national health program, so that there will be less emergency room patients driving up costs.

But I digress. Yes the system is flawed. Yes hospitals refuse treatment to financially insolvent patients whenever they legally can. Yes private insurance is a complete joke with its “waiting periods” and “pre-existing conditions”. Know what those are? When you buy health insurance in the US, the company will very likely have a waiting period for any pre-existing conditions you might have. That means during that period (usually six to eighteen months), your insurance will not cover any kind of treatment for that condition. For example I have asthma, and so whenever I get new insurance, I have to either tough it out until the waiting period is over, or get treated and pay for the whole thing myself. A couple of years ago I forced to do just that. Now all of this makes perfect sense, because medical insurance companies are in the business of making money, not ensuring I receive affordable health care. Likewise doctors and for-profit hospitals are in the business of making money, so why should they accept financially insolvent patients? That’s the system. Since I believe affordable health care is a right rather than a privilege, I believe the system is flawed.

Again, I haven’t seen the film. But if it is as overblown and factually-challenged as his other films, I wouldn’t take it too seriously.

3

It is a basically a free market service industry. Most of the well to do I know of these days are self insured in the US. Or they use their company insurance as a tax shelter. Employers are not mandated to have health coverage for their employees. The only regulation they have is that they must offer health insurance to all employees, but no rule on how much they need to cover on behalf of their employees. So they can offer them insurance and ask the employee to cover 100% of the cost.

Because it is a free market one can choose a various number of service levels. Full insurance, HMO, PPO, self insurance, etc.

Even speaking to doctors in the US, they have the view the insurance companies are keeping the profits for themselves. Since pay out for claims is about 85%.

So insurance customer feel cheated because their rates keep rising. And doctors feel cheated because they never get 100% of their claims.

If someone works in the insurance industry, perhaps they can enlighten people to why rates keep going up while doctors are making less in the US.

4

I just read through 5 pages (and skimmed the last three) of their “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” looking for the bits that made “more economic sense” and I wasn’t able to find any.

I would copy and paste parts from it to lowlight some of their ideas, but darn, they seemed to have made copying the PDF a password protected function (I wonder why…?)

I was hoping I’d read something cool, but what they are basically proposing is a fully planned (cough socialist) health care system. Getting rid of ALL private insurance companies, turning all hospitals to non-profits and… other socialist things.

I’m down for looking into alternatives, but that one is just plain ridiculous. Even if I “I believe[d] affordable health care is a right rather than a privilege,” I could not vouch for this system. I can understand having available to all perhaps dental stuff for kids, shots for certain things and some other basic things, but trying to force the wealthy to submit to government provided health services would be like trying to make everyone drive a government issued car.

5

[quote=“miltownkid”]I just read through 5 pages (and skimmed the last three) of their “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” looking for the bits that made “more economic sense” and I wasn’t able to find any.

I would copy and paste parts from it to lowlight some of their ideas, but darn, they seemed to have made copying the PDF a password protected function (I wonder why…?)

I was hoping I’d read something cool, but what they are basically proposing is a fully planned (cough socialist) health care system. Getting rid of ALL private insurance companies, turning all hospitals to non-profits and… other socialist things.[/quote]

By that standard, our educational system is socialist as well. We guarantee all children an education, in fact we make it compulsory, and the vast majority of those children will be educated in a government program. Even if we implement a voucher program, that will still be socialist, because the government is still subsidizing all children’s education; they would just be able to choose which school to attend.

Why? The doctors would remain private even when the hospital are non-profit (isn’t that the norm anyways?), and so patients would still enjoy the benefits of the doctors competing for their money (via NHI). The difference between that and the current system is that everyone would have NHI regardless of their job status and there would be no wrangling over pre-existing conditions.

I don’t think it’s necessary that all doctors/hospitals/clinics work for the government, in fact I would be opposed to such a system. Just like with the educational vouchers program, a government-run hospital that is doing poorly (or a private one for that matter) will lose patients and eventually fall, just like a poorly-performing school will have to close down if its students (and their vouchers) are drawn to better schools.

6

gao_bo_han,

Can you have a public school with private teachers in it?
What incentive would the hospitals have in keeping everything up-to-date if they are non-profit?

Even in clinics where doctors form a partnership, there is some profit taken to maintain the actual location where they practice.

Without the economics of profit what would motivate anyone to maintain the facilities to conduct high level of medical service.

7

[quote=“gao_bo_han”][quote=“miltownkid”]I just read through 5 pages (and skimmed the last three) of their “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” looking for the bits that made “more economic sense” and I wasn’t able to find any.

I would copy and paste parts from it to lowlight some of their ideas, but darn, they seemed to have made copying the PDF a password protected function (I wonder why…?)

I was hoping I’d read something cool, but what they are basically proposing is a fully planned (cough socialist) health care system. Getting rid of ALL private insurance companies, turning all hospitals to non-profits and… other socialist things.[/quote]

By that standard, our educational system is socialist as well. We guarantee all children an education, in fact we make it compulsory, and the vast majority of those children will be educated in a government program. Even if we implement a voucher program, that will still be socialist, because the government is still subsidizing all children’s education; they would just be able to choose which school to attend.[/quote]
I should probably take it to the other thread about public schools, but I have a bone to pick with them as well…

For example, I don’t think forcing a kid all the way through high school is the best way to do things. Let’em drop out and work full time if that’s what they want to do, or perhaps have more tech schools teaching usable skills (like plumbing, carpentry, etc.)

Why? The doctors would remain private even when the hospital are non-profit (isn’t that the norm anyways?), and so patients would still enjoy the benefits of the doctors competing for their money (via NHI). The difference between that and the current system is that everyone would have NHI regardless of their job status and there would be no wrangling over pre-existing conditions.[/quote]
But if you read the section about the payment structure, you would immediate see the flaws (I think.) People with sharp minds become doctors now because of the incentives of being a doctor ($$.) Take that away and you’re left with…

If what Tainan Cowboy said about there being a limit on how many new doctors can be certified each year is true, then removing that limit would naturally drive down the cost of seeing a doctor and the market could function the way it should. It’s hard to blame the market, when it’s not allowed to function in a healthy manner.

I don’t think it’s necessary that all doctors/hospitals/clinics work for the government, in fact I would be opposed to such a system. Just like with the educational vouchers program, a government-run hospital that is doing poorly (or a private one for that matter) will lose patients and eventually fall, just like a poorly-performing school will have to close down if its students (and their vouchers) are drawn to better schools.[/quote]
The way I read it is that they would want all hospitals run as non-profits controlled by the state. The way they make it sound, a hospital should never do poorly because the hospital will get it’s “board approved monthly amount” which will be enough to run smoothly (I’m serious, it’s in the paper.)

8

If that is the case then just let “foreign graduates” practice in the USA. The medical job market is highly protectionist against medical doctors educated and trained in other countries. Open the board certification to all the doctors in the world to practice in the US and I guarantee prices will be more competitive.

The question is are doctors willing to cannabalize their own industry.

But primary concern for doctors is cost of education. Bring down the cost of education and perhaps doctors won’t be burden with such a loan that forces them to charge high rates to pay off their loans.

I believe that most of the cost is on the insurance side. A typical clinic may need up to 10 programs to file claims with the various insurance company. Who knows what goes on in the insurance company once they get the claim.

However, if stocks can be traded on the open market at the cost of pennies by banks, surely there must be a cheaper way to process a claim in an insurance company.

And what is motivating the board to do a good job? There is no economic principle driving the process. Why would anyone be motivated to do a good or efficient job?

9

Doesn’t a hospital/doctor who turns away patients who have no insurance, or can’t pay, violate the Hippocratic Oath?

10

[quote=“ac_dropout”]I believe that most of the cost is on the insurance side. A typical clinic may need up to 10 programs to file claims with the various insurance company. Who knows what goes on in the insurance company once they get the claim.

However, if stocks can be traded on the open market at the cost of pennies by banks, surely there must be a cheaper way to process a claim in an insurance company.[/quote]
I’m not so well versed on the insurance stuff, but I’m pretty sure there are regulations that prevent the insurance industry from being market efficient.

:wink:

11

I think it only applies to “emergency” situations. Which is why the ER is health insurance for the lower class.

12

I think it only applies to “emergency” situations. Which is why the ER is health insurance for the lower class.[/quote] The ER is health insurance for the lower class. Man, I hope the HMO covers the cost of having a proctologist remove your head.

There’s an interesting quote in the film, from the Nixon Whitehouse tapes. I tracked it down here:

[quote=“About Kaiser”]Perhaps the best introduction to the Kaiser HMO and Kaiser Permanente Medical Care Plan is the summary by Mr. Edgar Kaiser that the less Kaiser does for patients the more money it makes. To get the full context one can go to the University of Virginia and review the presentation Mr. Edgar Kaiser (then Kaiser CEO) made to President Nixon through Mr. Erlichman — the less we do the more we earn. This convinced President Nixon to go forward with the HMO Act of 1973 with Kaiser as the template. The conversation is recorded below within the Nixon White House Tapes:

[quote="Nixon and Ehrlichman"]John D. Ehrlichman: “On the … on the health business …”

President Nixon: “Yeah.”

Ehrlichman: “… we have now narrowed down the vice president’s problems on this thing to one issue and that is whether we should include these health maintenance organizations like Edgar Kaiser’s Permanente thing. The vice president just cannot see it. We tried 15 ways from Friday to explain it to him and then help him to understand it. He finally says, ‘Well, I don’t think they’ll work, but if the President thinks it’s a good idea, I’ll support him a hundred percent.’”

President Nixon: “Well, what’s … what’s the judgment?”

Ehrlichman: “Well, everybody else’s judgment very strongly is that we go with it.”

President Nixon: “All right.”

Ehrlichman: “And, uh, uh, he’s the one holdout that we have in the whole office.”

President Nixon: “Say that I … I … I’d tell him I have doubts about it, but I think that it’s, uh, now let me ask you, now you give me your judgment. You know I’m not to keen on any of these damn medical programs.”

Ehrlichman: “This, uh, let me, let me tell you how I am …”

President Nixon: [Unclear.]

Ehrlichman: “This … this is a …”

President Nixon: “I don’t [unclear] …”

Ehrlichman: “… private enterprise one.”

President Nixon: “Well, that appeals to me.”

Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. And the reason that he can … the reason he can do it … I had Edgar Kaiser come in … talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because …”

President Nixon: [Unclear.]

[b] Ehrlichman: “… the less care they give them, the more money they make.”

President Nixon: “Fine.” [Unclear.]

Ehrlichman: [Unclear] “… and the incentives run the right way.”

President Nixon: “Not bad.”[/b]

[/quote]
The preceding transcription is from the University of Virginia for the clearest possible presentation (pathway discovered by Vickie Travis). Check - February 17, 1971, 5:26 pm - 5:53 pm, Oval Office Conversation 450-23. Look for: tape rmn_e450c.[/quote]

Kaiser’s response is here.

13

I think it only applies to “emergency” situations. Which is why the ER is health insurance for the lower class.[/quote] The ER is health insurance for the lower class. Man, I hope the HMO covers the cost of having a proctologist remove your head.[/quote]Jaboney -
Why the insult?
MTK isn’t the one posting an irrelevant 36 year old quote in another attempt at US-bashing.

14

Lets look at what one member of the private sector is doing to help with the ‘healthcare problem’.

[quote]Dr. Sam
By INVESTOR’S BUSINESS DAILY | Posted Wednesday, April 25, 2007 4:20 PM PT

Health Care: Medical costs got you down? Prescriptions too expensive? So fed up with our “system” that universal care is starting to look good by comparison? Before going that far, check what Wal-Mart’s up to.

The retail colossus announced this week that it will open as many as 400 in-store medical clinics in the next two to three years. By 2014, it said, clinics could be in as many as half its 4,000 stores.

The announcement followed deep price cuts on prescription drugs introduced by the company last fall at 65 Tampa, Fla.-area outlets. That program, which was not beaten back like Wal-Mart’s attempt to enter banking, has since spread across the country.

Wal-Mart’s advance into health care is a testament to private-sector industriousness. While others whine about America’s health care “crisis,” and back monstrous government programs to solve it, Wal-Mart is actually making care more affordable.

Yes, the same Wal-Mart that politicians and activists demonize because its pay and benefits supposedly are insufficient.

The clinics will be operated by local hospitals or other independent professionals, and will particularly help the poor. Company executives say prices for medical care in the clinics will mirror the low prices in Wal-Mart stores.

Already, Wal-Mart has brought low-cost health care by selling 30-day supplies of more than 300 generic prescription drugs at some stores for $4. Almost a third of those $4 prescriptions are bought by the uninsured. Customers have saved $290 million through the program just since September.

Cynics will say clinics and low-price drugs are a ploy to lure more shoppers into Wal-Mart. So? Is that wrong? The essential truth missing from their tirades about Wal-Mart’s rapacity is that it’s a company, not a charity. It must make a profit to stay in business, provide jobs and keep prices low.

If Wal-Mart thinks this latest plan will win the plaudits of its foes, it’s mistaken. Just Tuesday, the United Food and Commercial Workers union, which runs a nonstop anti-Wal Mart campaign via the Web, derided the company’s “disturbing” record on health care — a laughable assertion, given Wal-Mart’s record.

Opening clinics also will likely create new enemies: physicians and their staffs who fear that their practices will be harmed by the presence of price-cutting Wal-Mart clinics in their communities.

But the issue shouldn’t be about saving local medical practices any more than saving local retailers who always complain when Wal-Mart moves in. It should be about quality health care — and prescriptions, groceries, clothing and essential household items — at prices all Americans can afford. Wal-Mart does that.
ibdeditorials.com/IBDArticle … 3261527995[/quote]

I hope others see this and offer further efforts in this direction.

15

miltownkid,

Now if everyone was a son of a hospital worker, a solution could be found… :laughing:

16

Miltownkid’s post can only be taken as a joke. My response is made, and should be read, in the same jocular spirit.

17

I think it only applies to “emergency” situations. Which is why the ER is health insurance for the lower class.[/quote] The ER is health insurance for the lower class. Man, I hope the HMO covers the cost of having a proctologist remove your head.[/quote]Jaboney -
Why the insult?
MTK isn’t the one posting an irrelevant 36 year old quote in another attempt at US-bashing.[/quote]

None of which really answers the question.

Isn’t a doctor’s first priority meant to be to the patient? First, do no harm.

18

I don’t believe that doctors anywhere still (or ever really did) take the Hippocratic oath in any form, let alone explicitly.

It is certainly an urban myth that this happens in Australia, Britain and NZ.

Most modern doctors probably take the Hypocritical Oath instead. Except those who donate their time for six months a year for Medecins sans Frontieres…

19

because I know I had special treatment, I can assure you the medical system is completely flawed in Portugal. We have this stupid system where doctors send patients to private clinics owned by themselves instead of making the tests in the hospital because “it is faster”. They made the system slow, so that private medicine could make it to the pockets of the citizens. The best thing you do now, in my hometown, is to go to an hospital and ask for a spanish doctor - they can’t work on private clinics, so there is no interest for them in not doing things “normally”.

Another problem we have is with the cost of drugs. Like Walmart is trying to make them affordable by selling generics, we are trying to cut the costs of the medical care by making doctors prescription generics. But they don’t win compensation on sales of generics, unlike on the sales of normal drugs. Look at Finland, more than half of the drugs sold there are generics, and their health is still good. So Walmart is one of the few companies in America who can fight against the system, because of it’s own size. How will they be able to do practitioning at low cost is something to be seen. Another thing that stroke me in the movie was when Moore asked the question of “where are the bread and the butter?” in a Pharmacy.

20

When I was living in Taiwan, I came back to the US for a summer and had to go to the emergency room for follow-up care (I had severely sprained or broken my ankle in Taiwan a few days before returning – TW said “broken”, the US later said “sprained”. Anyway.) Not only did it cost me something like US$400 to have a cast taken off and an Ace bandage applied (they didn’t do X-rays, BTW) but I was also hit with an “uninsured patients fee” which is charged to every patient showing up at the ER – INCLUDING those without insurance, like me. On the other hand, as usual, I had paid for my acute care in Taiwan using mostly the loose change in the bottom of my handbag.

I keep joking to my husband that the main reason I married him was for his benefits – he works for the State of New York and they have the most incredible benefits package known to Man (rivalled only by the teachers’ package in New York State, as they enjoy an even better retirement deal). But it’s true. I had no insurance when I returned to the US (for good). I had no prospect of getting insurance. The State offers this “great” package for uninsured people in New York, but if you own a small business, you have to earn less than $28,000 a year or something like that. What sort of small business doesn’t earn more than that? A highly unsuccessful one, that’s what kind. The monthly cost of health insurance is prohibitive for individuals or small groups regardless of whether it’s available or not. Sure, you can find “insurance coverage”, but it will either break the bank or provide you with virtually no coverage at all. Your choice.

Fortunately I got married when I did, as I’ve had two major and two minor surgeries since.

But there are also puzzling aspects to insurance coverage here. For example, we are covered for IVF (in vitro fertilization). Great. We did that. We are not covered for oocyte donation, which is the next step if you fail in IVF with your own eggs. Donation involves doing the exact same thing with the exact same drugs (often less drugs, as the donor would be younger and more fertile) but to a different woman, up until the oocytes are retrieved at least, and so the insurance companies choose to consider it “experimental” even though there are years of results showing that success rates for that would be like 45% rather than 5% for own-oocytes after age whatever. We should really feel grateful that we were covered for IVF in the first place – most people are not, and pay anywhere from $10,000 to $20,000 per attempt – but we can’t help but feel that if you’re going to pay for treatments, why not pay for effective ones? Which then puts us in the position of having to choose whether it would be better to spend $14,000 for an attempt (45% success rate estimated) at donor oocyte IVF, or $25,000 to $30,000 to adopt a child. (I can see my next Taiwanted ad: “Learn English in the US! One-month course, free room and board, free English instruction and activities. Must be a healthy female under age 32 with no family history of strange diseases. College graduate preferred. Clinical experience to learn about the US health industry included in package cost.” Anybody? Anybody?)

Although in fairness it must be said I’d rather see everyone in the US have the insurance to keep them in good health before we go expanding coverage to these things. The only way to do that, IMHO, is to rescind Congress’ health insurance until they come up with a universal health plan. I predict two months’ time would do nicely in that event. :fume: