A View From The Press Box

As a Canadian citizen who has had to utilize the system for both open heart surgery and cancer care, I can stipulate that the system worked for me.

I can, however, add that less urgent issues are dealt with at a snail's pace at best.

Michael Moore looked at our system through rose-colored glasses as thousands of Canadians on lengthy waiting lists for routine surgery will attest.Nothin's perfect and Mr. Moore is selective in his targets.

The one staggering statistic for me in this debate is that the U.S. is spending $6,000 per capita on health care each year while Cuba spends $229--yet the World Health Organization rates the quality of the systems comparable.

The high cost of health care is putting a squeze on U.S. competitiveness with businesses abroad that do not have to absorb these high costs.

It's also stifling entrepreneurship and innovation in the U.S. Creation of small business is down in part because would-be entrepreneurers are staying put in salaried jobs, fearful of losing their paid health benefits.

My organization's health premiums rose an average of 26 percent this year. When I asked for an explanation from our health plan, I was basically told "because we can."

"Sicko" may heighten awareness, but nothing likely will change. Corporate interests' stranglehold on Congress has never been tighter, and political courage has never been in such short supply.

Single-payer plans are not perfect, but what we've got is a mess--workers' comp, veterans medical group, medical through HMOs, PPOs, etc., millions not insured--just to mention a few issues.

All medical coverages put together, we overpay and get underserved way to often.

The private market system in medical care seems to guarantee a profit to business involved, but not proper care.

In talking about your New York friend, you say: "Medicaid financed first-class care for him at one of the city's finest hospitals, along with follow up home services, at no cost to him. Sounds like we must be doing something right."

That's just the point, isn't it? Medicaid (our government-run single- payer system works, and our for profit mess of private insurers wastes billions of dollars while creating havoc for providers and people.)

It's really pretty simple once you remove the insurer-promoted politics from the spin machine. A single-payer program--government-run or not--is simply much more efficient.

The selective vilification of people, such as Michael Moore, Al Gore, or certain government programs that are not the babies of conservatives does nothing to improve the lives of most real people--only those few that profit from the inefficiency that the spin machine sustains.

Single-payer is not better than what we have now. If someone is sick in America, they are treated at a hospital emergency room. When the bill comes, there are many programs for paying--if you can't make the payments yourself, charitable organizations are available to help.

No one is truly without coverage--this is America where we look out for one another, and we have some wonderful fundraisers. Pride and hopelessness will stand in the way--but that's a personal issue, not a public issue.

Having relatives in Canada and the U.K., I can't find anything good to say about single-payer systems other than, I have learned it is cheaper to go to other foreign countires for many major surgeries that just can't wait, like having the battery changed on a U.K.-installed pacemaker.

Many in America are finding that knee replacements and other similar surgeries work out to be less expensive, and you get a vacation in a foreign country with the healthcare. It's not bad.

But someone's going to argue that's too expensive for the uninsured. Medicare/Medicaid should consider reducing costs by sending some out of country for cheaper care. Single-payer plans aren't flexible enough to consider things outside the system they set up.

Second opinions are rarely available under single-payer plans, and who doesn't know of someone who had to shop around before finding a physician who could help them get over whatever was ailing them? That won't happen under single-payer. If you are ill and the physician who sees you finds nothing wrong, you have to live with it.

Competition works. The free market works. I don't think it is is fair to have everyone pool their resources for healthcare to fund everyone else's poor health choices.

At least there is an option today to opt out of the company health plan and get a Health Savings Account or other coverage. Is that going to be available under single-payer?

I haven't seen any government do any job well, other than national defense. And I am sure people can argue that, but that should be about all the national government provides. They mess up just about everything else.

SAM RESPONDS:

You raise some very valid points, and as you can tell from my blog entry, I am certainly far from being sold on single-payer.

However, I think you might be dreaming if you think no one is truly without coverage, one way or the other. They say healthcare expenses are the leading cause of personal bankruptcy today. That's just crazy.

At a minimum, people put off preventive care that could save big money down the line, as well as save their lives, because they cannot afford to see a doctor. We have an entire class of uninsured, working poor who make too little to qualify for Medicaid, yet cannot afford insurance premiums on their own income. That's also crazy.

For people to have to leave the country to be able to afford medical care is also insane. This is the United State of America--the richest and most innovative country in the world. We can do a lot better than this patchwork system we have in place now, don't you think?

JULLIE has the last word:

Because we are the U.S., we can't offer anything less than a patchwork.

You assume everyone wants health care insurance. That isn't the assumption one can make in any situation.

I realize there are a lot of people who do want more than what they have. That's true for a lot of people that make the news, but there are a lot who don't want health care insurance. That doesn't necessarily mean they don't have health care.

I live in an Amish community--most don't have health care insurance because they pool everything in life; it's an alternative health care insurance.

They also have a lot of health care problems, but there are genetics clinics and birthing centers in the area catering to their needs.

There are many other religious groups who shun medical care or aspects of it. And the non-religious--like my sister, who refused healthcare coverage because she has 'better uses' for the money and trusts fate as opposed to God. There are also homeopaths and others outside mainstream health care.

Poverty may mean you don't get to choose your health care provider, but you get emergency health care in any ER, and many cities have free clinics for adults and rural areas have 'well-child' clinics, immunizations and other
programs for free or very reduced-cost health care.

Bankruptcy is a separate issue. True, some people use it to avoid paying off debts--even medical debts. But just like any other debt, there are negotiations that can be made.

Hospitals and doctors, like any other commercial enterprise, will negotiate bills down to the network charges or even less, rather than getting nothing.

This 'class' of working poor: I don't know who defines it, but having worked in minimum wage jobs without health insurance didn't mean I had no health care.

When I had a scare, I went to a teaching hospital and got the same physician I still have on my insurance plan, but he had to walk a student through the process of gathering information and translating it--those were the most informative doctor visits I have ever had.

Granted there may not be teaching hospitals in enough of America, but there's no reason to limit optiions and label people because of traditional thoughts on health care and insurance.

Innovative health care may involve an out-of-the-country vacation. I don't think that is so crazy or out of the questiion.

Patchworks work to cover just as well, if not as warmly, as eiderdowns. If someone can't find coverage, pride or ignorance blinds them from all the options available.

I enjoyed your comments and agree that our American health system needs fixing.

However, I must take issue with one thing you wrote. Health care is NOT a right! No more than owning a home, a car or cell phone is a right. And, it is not the Federal government's job to provide it.

If we go to socialized medicine like Canada, England and France, we will be waiting for months or even years to see a doctor and get needed operations!

For everyone Mr. Moore finds that had a bad experience with our health care system, there are many more that can tell stories of long waits and uninterested doctors working in socialezed medical systems in Europe.

Government is not the solution. Government is the problem!

SAM RESPONDS:

I appreciate the feedback, but don’t agree.

I think basic health care is very different than owning a car, home, etc. It is more in line with the Constitutional right to have the state provide an attorney to someone charged with a crime if they cannot afford one.

I also am not necessarily calling for a change to complete socialized medicine.

But a system that leaves 50 million completely bare, and everyone else insured with huge gaps in coverage, and just one layoff away from being uninsured themselves, cries out for a better solution.

Are we saying as Americans we can do no better than the patchwork system we have today? I think not.

GARY CORBETT HAS THE LAST WORD:

Please show me in our Constitution where it says health care in a "right"! It doesn't.

Or, for that matter, where in the Constitution does it say the federal government should be involved in health care or education! These are things that should be handled at the state or local level, not at the federal level.

I will turn 65 this year, and remember as a child going to our family doctor or the hospital and my dad paid the bill. We were far from wealthy but this was never a problem!

In the 1940s and 1950s, the government was not involved in the health care business. People took responsibilty for themselves and their family.

I agree some insurance companies don't always do the right thing, and should be punished by the state insurance czar, not the federal government.

Yes, medical and drug costs are sky high, but much of that is due to government involvement. When has the federal government done anything efficiently?

We need more competition in the private sector, which would bring costs down.

Who will pay for this "free" medical treatment? Taxpayers, of course!

Sam, you did a great job of pointing out Mr. Moore's biased points, and yet giving him credit where he was right. I thank you for that.

I don't like Michael Moore. I am a conservative, and think he leans very far to the left, and he doesn't give a balanced picture.

I wonder, concerning our health care, if we have reached a point where the technology and advances in all parts of medicine have outstripped our ability to pay?

With many other services, the public can generally pick a level of service and levels of quality. A person can get the works or just settle for something lesser.

With health care nobody wants the Volkswagen, we all want the Cadillac.

If one of my children go in the hospital, I want nothing less than the best and I want the works.

I don't know if the drug companies and the doctors are the problem, or maybe the plaintiff attorneys, or all of them.

When my wife was pregnant several years ago, the doctor ran the sonogram every time we went for a visit. I felt he might be trying to pay for the machine by just running it every time, but at the same time if anything goes wrong with the pregnancy, the plaintiff's attorney will ask if the doctor ran the sonogram every time.

Seems we're stuck between the doctor and the plaintiff's attorney.

I truly don't know where this ends, I know there are a lot of people without health care, but there are a ton of people on the welfare rolls as it is--not because they can't work, it's because they don't want to work, and the health care goes with it.

I do know that if we think it is a mess now, if we let the government take over, it will be worse. If we think it's expensive now, wait till the government gets hold of it. They will bankrupt this country, although it may be bankrupt now.

We can't afford to pay for every person's health care. The government will waste more money than we can imagine, and by the time they wash it out in taxes, you will be better off paying for it privately.

And if you think the health insurers are rough, just try to get an operation or a drug you need if you don't fit in the beaureacrat's little box. You will die in the street before you get through to them.

As a long-time insurance agent, like most people I am interested in a solution to our current dilemma in health care.

Even if you could remove the politics from the equation, the problem is enormous and likely to take years to resolve.

It seems to me that at least for the short term we could reduce cost and improve the overall experience and affordability by doing the following:

--First, eliminate the hundreds or perhaps thousands of plans currently in the market place. Similar to Medicare, let's draft policy forms that offer only a few plans for individuals or groups.

Today there are so many policy forms out there that no one is sure what a particular plan covers.

Let's say we only have five plans to choose from basic to very broad. It would not take claims examiners or consumers long to figure out what is and what is not covered by a particular plan.

The longer-term idea would be to automate the claims process entirely and eliminate the many examiners that current sit on both sides of the issue--providers' staff trying to justify the charges and claims examiners trying to determine if coverage exist. Neither of which adds one dollar of value to the system.

--Second, put in place strong and enforceable laws to discourage providers from billing fraudulent or inflated charges. If a few providers lost their license and or went to jail, that should dramatically reduce the problem of fraudulent charges.

I'm not sure any of the above is possible without federal regulation and oversight.

While I am not necessarily in favor of federal regulation for all insurance products, it seems to me that for health insurance that would be the best option.

There are many things that can be done to help with our current situation. The two I mention would still allow choice, insurance company involvement and a way to reduce cost.

Unless we find a way to provide more affordable health care, the system will likely collapse. Every day more and more citizens lose health insurance either by choice or cost or by no fault of their own.

A common problem with the current environment is that when a carrier pulls out of a state, they non-renew everyone currently insured with them.

When a policyholder has a condition that prevents them from qualifying for coverage with a new carrier, they are then uninsured.

Michael Moore and I agree on the basic premise. Our system is broken and cannot be fixed incrementally. We need a massive overhaul. I believe universal care or coverage is needed.

The good news is that there is enough money in the system to take care of everyone today. We currently spend about $7,600 per capita for all our health care and care in the long term. Simultaneously we pay (for insureds) about $11,400 annually for a family of four.

If we chose to use an insurance model, we could provide Cadillac coverage for everyone and still spend less than we are paying now.

Also if everyone was insured the rates would drop because of a better spread of the risk and an elimination of uncompensated care in the ER that would be better provided in an office setting.

Of course such a model would require consolidation of Medicare, Medicaid, and private carriers. This would leave a lot of folks out of work--including the bureaucrats, lawyers and CPAs and MBAs that live (well) in the current system.

I believe Mr. Moore presented the worst of the American system and the best of the systems he visited. I don’t believe ours is as bad as he says, nor are theirs as good.

If we choose to have a health insurance-based system that is not universal, “pre-existing conditions” is a necessary element. Without such a “motivator” to get people to buy coverage when they are healthy, you wouldn’t have the “spread of the risk” that is necessary to make any insurance model work.

Without pre-existing conditions, only sick people would buy and the costs of premiums would be prohibitive.

I don’t think anyone would expect an insurance company to sell someone homeowners coverage after their house is on fire. Selling a new policy without restrictions to someone who has just been diagnosed with cancer is the same thing.

The lady in the film whose daughter died between MLK Hospital and Kaiser’s facility said they wouldn’t treat her at MLK. If you go to any emergency room in America, you will find signs guaranteeing anyone regardless of means the right to be seen by a doctor and to be stabilized before they must be moved to another facility.

Also, as you probably know the French just elected a conservative president who is a “fan” of the American system, and who is committed to some reforms of the French system because as I understand it, most believe their system isn’t sustainable.

I also believe that if we chose to bring ALL American troops home, we could have more money for more services for all Americans.

I suspect if such an idea was proposed, the rest of the world would “scream bloody murder.” I think the French would join the screaming.

If we actually did it, I’d like to see the results.

Maybe everyone would live in peace. Maybe they wouldn’t. Want to speculate on the result?

God bless America!

Thank you, Mr. Friedman, for your--I believe--unbiased commentary on Michael Moore’s approach to the health care situation in this country.

It’s a G-d blessed shame that in order to obtain sufficient health care in this country, one must be employed with a company health plan, or be healthy and have the financial means to afford individual coverage premiums.

Otherwise going bankrupt and having to rely on your state Medicaid program is your alternative.

We have a Medicare program in this country that provides the necessary medical coverage and should be expanded to everyone.

This availability of coverage to everyone--providing basic health coverage with the ability to acquire additional benefits through private supplemental programs--is presently in place and can be, I believe, implemented without massive new programs.

It’s time we address this issue as a nation immediately.

Your editorial starts with a typical premise of somebody in the payroll of lobbyists and big corporations. To title your editorial of July 16, "Sicko Offers No Cure" is a typical comment of an ignorant person who does not want to see beyond his nose.

It is not the job of a filmographer to give you "cures" or solutions, but to show you the realities.

I have been in this industry 27 years, and I have never seen so much abuse to the consumer public like in the last 10 years.

This system of "health UNcare" is broken, driven by impressarios that have absolutely no social conscience and promoted by ignorant people with provincial mentalities.

If you were a traveled man with some world understanding, then you can make true comparisons instead of reciting the official propaganda: universal health care is socialistic and anti-American.

I say to you BS, this system needs a complete refurbish. In many modern nations, the private insurance coexists with the government universal access that guarantees treatments and insurability.

A nation that can find 300 billion dollars for a [bogus] war of oil interests and cannot guarantee vaccination or health care for the children and the poor is DOOMED.

Wake up and keep your little job, because if you lose it (and your group medical benefits go) you might find yourself uninsurable because of pre-ex conditions.

Of course, you can always write a favorable article for Humana or UHC and get onto the good side of the chairman to approve you.

WAKE up and learn.

By the way M. Moore is one of the best when it comes to documentaries.

SAM RESPONDS:

Don't hold back, Jaime! Tell us how you really feel! LOL!

In all seriousness, if you examine my blogs on the week of July 9 on this topic, I believe you'll see we agree on more than we disagree. I certainly am no apologist for HMOs or health insurers. But Mr. Moore's portrayal is far from perfect, although I give him credit in my blogs for spotlighting the issue and sparking debate.

I guess the first thing I would say is that I have no intention of watching this film and putting one nickel in Mr. Moore’s deepening pockets.

Second, I would agree that the system needs to be repaired in order to improve upon a system of health care that draws people from around the world to seek treatment, surgery, and all-around last ditch efforts to cure some very dreaded diseases.

From what you point out, and from what I have heard other people say, is that Mr. Moore uses anecdotal examples. There are enough anecdotal stories out there to represent every viewpoint in this country.

I have filed claims over the years, and some 10 years ago, when my late wife was going through cancer treatment, the system in place did work.

Claims were paid, and special treatments were approved after discussions with some very compassionate claims examiners, underwriters, etc.

Most had no idea that I was “in the business.”

Finally, I do not want the government to “take care of me” with any type of single-payer system. I do not want in any way, shape or form a health delivery system that resembles our neighbors to the north.

As Americans, we would not tolerate the incredible waiting times, and perhaps never getting a much needed test or surgery that could lengthen life but instead hastens death.

Perhaps Mr. Moore should take care of himself and get some much needed exercise—he seems rather hypocritical if he needed life-saving treatment.

Health insurance is expensive because health care is expensive. Our technology is second to none, but follow Mr. Moore’s diatribe, and this country will take a very nasty spill backward.

I invite you to review www.nahu.com and make up your own mind on some of the major issues.

Whever there is discussion about health care, in almost any case that I read about, seldom are there any discussions with doctors about what can be done.

I see several doctors on occassion, and almost always their offices are full of people waiting to see them.

What if 40-to-50 million more were suddenly able to come to their office for consultation? How in the world could they handle it? They could not.

It seems to me that more doctors--twice or three times as many--would be a great answer. It might also bring down the price.

A girl in my office a few days ago was in an auto accident and had to have 17 stiches in her arm. Price--$26,000, plus $650 for the ambulance to bring her to the hospital, plus medicine, etc.