Mercenary medicine
By Max J. Castro Read spanish version
Last month, the Health Council of South Florida issued a report card on health care in Miami-Dade County. The grades in the eight areas rated ranged from failing to mediocre. The study accurately reflects the reality that the condition of health care in Miami is critical. The biggest problem is lack of access. More than one in four, 28.6 percent, of county residents do not have health insurance and “…an even greater number have difficulty accessing health services or obtaining quality care…” This results in “significantly higher rates of hypertension, low birth weight babies, diabetes, asthma, cervical cancer and low levels of access to oral health care and elders who have received influenza vaccination.” Further, “63.2% of individuals in Miami-Dade County reporting depression did not seek professional help,” which places “an enormous social and financial burden on the Miami-Dade community with consequences particularly effecting women, low-income individuals, Hispanics and Blacks.”
Miami-Dade is not atypical of the United States in the first decade of the twenty-first century, where between 45 and 50 million people lack health insurance. The high proportion of Hispanics and immigrants in South Florida — the two groups with the lowest health insurance enrollment rates in the nation — makes the problem somewhat more acute in Miami than in most other places. But the situation is worse in some inner-city areas in other cities, and nationwide the picture is almost as bleak as in Miami.
Topicality is only one of the virtues of “Sicko,” Michael Moore’s latest movie. A more important virtue is that it shows that while the woes of the uninsured are real and widespread, they represent only the tip of the iceberg of a thoroughly dysfunctional health care system. It is a system designed to maximize profits even at the expense of the well-being, and not infrequently the lives, of patients.
Anyone not in a state of terminal denial who has seen “Sicko” will have a hard time thinking of the current U.S. health care crisis as a problem that affects other people, mainly the improvident, the underclass, and the disreputable. That is because “Sicko” does not focus on the uninsured. Instead, Moore depicts case after heart-rending case of what happens to “good, decent, middle class people” with health insurance coverage when their medical conditions become an impediment to a bigger bottom line for their insurance companies. The devastation ranges from bankruptcy to loss of limbs to unnecessary death.
To Moore’s credit, “Sicko” does not stop at denouncing the inequities of the U.S. health care system. Rather, it shows convincingly, in myriad ways, and through a variety of narrative devices, that it definitively does not have to be this way. One segment shows what happened to a man in the United States who lacked health insurance when two of his fingers were partially severed by an electric saw: he lost part of his middle finger because he could not afford the $60,000 the hospital wanted to charge him to reattach it. A later segment shows what happened to a man in Canada who suffered a much worse accident in which all five fingers in one hand were severed. In the Canadian case, doctors successfully reattached the fingers; the patient retained his digits and paid nothing.
“Sicko” compares the health care system in the United States with that of Canada, the United Kingdom, France, and Cuba. The point that emerges from the comparison is that all of the rich countries of the world, except the United States, provide universal access to health care. Even Cuba (a country with a GDP per capita one tenth that of the United States) provides access to health care to all of its citizens, despite a tightening embargo and the economic crisis that afflicted the country after the Soviet collapse. Only the United States has a health care system based on a mercenary conception of medicine. Despite differences in ideology and level of development, the medical systems in Canada, the UK, France, and Cuba all are based on a notion of solidarity. Contrary to the propaganda widespread in the United States, the citizens of these countries — conservative, liberal, socialist, and communist alike — like their socialized system of medical care and would throw out any politician who threatened to destroy it.
The same could not be said of our own mercenary medical system. It is no wonder because Americans pay more for care and are less healthy than their counterparts in other developed countries. Many Americans die unnecessarily solely because our health care system is run for the purpose of profiteering by the insurance, pharmaceutical, and managed care industries.
That last point is driven home dramatically by archival footage of Congressional testimony by Dr. Linda Pino, formerly the medical director of a managed health care company. Pino called her testimony “a public confession.” What she confessed is that she denied life-saving surgery to a man in order to save her company $500,000. This decision earned Dr. Pino promotion and ever-higher compensation. The company even offered higher pay to those who denied more claims.
Pino’s testimony is supplemented by interviews with other contrite former insurance company hit men and women whose job it was to deny people insurance coverage and health care.
One of the film’s strengths, aside from the humor, is that it covers so many bases, from the ideological origins of our current medical mess to the criticisms usually leveled at the health care systems of such countries as Canada and the UK. There is even a taped 1971 conversation between Richard Nixon and John Ehrlichman, a Nixon aide later convicted in the Watergate scandal. It reveals the cynical logic at work at the very creation of what would become our medical-corporate complex: less care and more profits. “The less care they give, the more money they make,” says Ehrlichman about managed care. “The incentives are all in the right direction,” he adds, eliciting Nixon’s approval. This logic, the less care they give the more money they make, drives our mercenary medical system to this day, with devastating consequences.
Michael Moore’s relentless depiction of the awful consequences of a health care system run primarily for profit qualifies his latest documentary as a horror movie. Yet it is not exaggerated or inaccurate, and critics who have scoured the movie in order to discredit it by exposing factual errors have failed. Then there are those who would want to cast doubt on the central issues presented by quibbling with side questions, especially regarding the Cuban medical system. Some others who are sympathetic to Moore’s view nevertheless see the inclusion of the Cuba material as a mistake, one that gives Moore’s detractors much useful ammunition. Yet, they seem to have missed Moore’s point, the senselessness and puerility of the American proclivity for demonization — of British and Canadian socialized medicine, of the French more generally, of Cuba, that ultimate bête noire — in the face of our own shameful failure as a society to provide a decent level of care to so many of our own people in spite of the bountiful resources and the advanced technology that would enable us to do so.
“Sicko” is not a perfect film; at points Michael Moore succumbs to a tendency toward manipulation. But “Sicko” is head and shoulders above the usual drivel that comes out of Hollywood.
It will be good news if “Sicko” does even better at the box office than Moore’s earlier films. It would be even better news if it becomes a manifesto for a campaign to replace our mercenary system of medicine with one based on respect for human life and dignity. It will be a miracle if “Sicko” shames the Democratic presidential candidates into moving beyond the timid reforms they are now proposing.
Will that happen? Reviewers have rightly pointed out that “Sicko” is less strident and partisan than Moore’s other movies, implying a broader appeal. But there is a less optimistic scenario. Moore’s earlier films go after specific political or economic actors, such as the Bush administration, auto industry executives, and the NRA. Bush, Detroit, and the NRA are powerful, but there is a wide sector of the public that is skeptical or outright despises them. This is the audience for Moore’s films.
“Sicko’s” challenge, however, is broader and more radical. The film ultimately questions not just the insurance companies or even the U.S. medical care system as a whole. It dares critique more deeply rooted and very broadly held American modes of thinking: radical self reliance and the conviction that the United States is, in each and every conceivable way, the best country in the world if not best country possible. It is these modes of thinking, along with the ease with which money can be converted into political capital in the United States (in contrast to other Western countries) that allow the profiteers to defend and maintain a mercenary medical system at odds with basic humanitarian and ethical principles.
Americans may be sick of the insurance companies and increasingly angry at the whole medical system. But are they also ready to give up some of their individualism and the myth of American exceptionalism?
