Sunday, July 01, 2007

I Saw Sicko

In the comment section to Roy's Mental iPhone post, Rach asked if we've seen Michael Moore's Sicko.

It wasn't on this weekend's agenda, but hey...Okay, so I couldn't resist (-- someone actually wants my opinion!!), and for Rach, I spent Sunday evening watching Sicko. My husband left the Red Sox with a tie score for this.

Okay, so Sicko. Michael Moore starts with the statement that he thought health insurance companies want to help people, and he's had this unnerving revelation that they want to make money. He has no trouble finding examples of people who've been denied coverage for the lamest of reasons (too fat, too thin, too too), or those who've been denied at the mercy of mis-managed care. He finds ex-industry employees riddled with guilt who pour tears. He villainizes everyone from John F. Kennedy, Jr. to Hillary Clinton (yup) to George Pataki. He finds people who've been dumped in the street by hospitals, delirious and still in hospital gowns, as well as Ground Zero heroes with no access to health care. It's one heart-wrenching sob story after another.

Where's it any better? What's the answer? Socialized medicine. It's better in Canada, England, Cuba, and even Guantanamo Bay, where the ratio of prisoners to health care workers is 1:4 and state-of-the-art-care is readily available. France doesn't just have great free health care where doctors make house calls in cute little vehicles, but workers get 100% disability pay, weeks and weeks of vacation, months and months of maternity leave, and the government sends out free nannies to do your laundry and cook dinner. Why would anyone live here if they could live there? And don't worry about physician reimbursements with national health insurance: the French doctor drives an Audi and lives in a million dollar home.

So what did I think? Gosh, it was nice of Rach to ask!

I guess I thought the story was one-sided. It sounded like no one in the US, even the well-insured, is happy and everyone is screwed by the health insurance companies who are digging into every last health record to deny the last surgical claim because the insured didn't reveal that once upon a time they'd had a yeast infection. It's not hard to find unbelievable health care stories, and Mr. Moore didn't seem to have any trouble trumping them up. I've heard them too (none involving dead children), but I've also heard people say their illnesses were completely covered without any battles, and that part of the story was not mentioned.

Sicko was engrossing, entertaining even, thought-provoking, rage-provoking, and there were several laugh-out-loud moments. Michael Moore is nothing if not clever. Is socialized medicine the answer? To read Dr. Crippen's NHS Blog or Shiny Happy Person's rendition of life working in the NHS, there's another story to be told. My opinion would be a random one. I've no experience in this arena, and I'd love to hear from our readers in Canada, Great Britain, France, Cuba, and Guantanamo Bay.

We all know the system's broken. I hope Michael Moore's sensationalized presentation will help to change things.
For the record, Psychiatry was totally ignored in Sicko. One Ground Zero hero had PTSD, but this was presented as a dental problem (he ground his teeth). Maybe in Mr. Moore's next movie?


Ladyk73 said...

Regarding Canada:

I live in the Buffalo and Niagara Falls area in New York State. West of here (WEST! not north) lies Niagara Falls, Ontario. I can ride my bike to Canada from my house. (yes, we can ride our bikes through customs). In addition, Toronto is a 75 mile drive (50 mile as the seagull flies). So I think I can talk a wee bit about the Canada thing.

YES! We do see Canadian patients here in Buffalo. All of the Hospitals here take payments from the Canadian government. WHY? Because the Canadian government is not STUPID! Why would the Canadian government send someone 75 miles to Toronto to see certain specialists, if they can travel 2 miles to the east to come to Buffalo?


We also see lots and lots and lots of Canadians who pay out of pocket for medical care to come to doctors here. There are incredible waits (months) for non-urgent care.

Another weird little thing.....Half of my radio stations (and TV before Cable) are Canadian. I once heard a commerical for supplemental medical insurance in Canada. I wasn't sure what I was hearing.

Ladyk73 said...

Regarding USA:

The USA already has socialized medicine.

Believe me?

In my last career, I was a controller for a community health clinic. I was the head accountant/ finance person for this organization. The term "clinic" is an important one. The federal government (thru the states) fund clinics. Medical practices that are
"clinics" and hospitals are funded to serve the uninsured and the underinsured (although some of the clinics are so great that they compete with the private sector and take insurance as well).

Okay my point?

My clinic was funded by state, federal, private fundraising, patient fees, and insurance payments (including medicaid and medicare as "insurance" payments).

So what do you think paid for these sliding fee office visits? State (that are mostly pass through Federal money) and Federal grants.

And do you know what these dollars come from?

Medicaid and TANF (welfare)

No NO NO no....
These people are not on welfare, or have medicaid.

So you go to the hospital right?
See them pretty walls, beds and bandaids? How are they funded? Yep, your insurance paid for them, and you paid a copay. But a large chunk may have been paid from MEDICAID dollars.

Medicaid pays for the intrastructure of our medicine here in America. Thats right...without the Feds, we would not have these great hospitals and stuff. say you go to private doctors...and they don't take medicaid....Where do you think your doctor was trained? A medicaid sponsored hospital. Any Hospital with an a medicaid supported hospital.

These grants could have lovely names. And they might be "Department of Health" grants. Just look for "Title XIX."

My point?


(and I am not even getting into the medical research funding)

Ladyk73 said...

I guess I am wired.

I just wished there was governmentally subsidized catastrophic insurance. There would be a lot less personal bankruptcies.

I am going to shut up now

Neil LaChapelle said...

I'm Canadian, middle-aged, with a chronic medical condition (well, two conditions, technically) and my wife also has a lifelong, chronic condition. We see specialists and get various tests quite often. We are in superlative health - both gym rats, in very good shape - even though we have illnesses that would have left us twisted-up, raving invalid beggars in a third world country...

Having lived here most of my life, my wife and I obviously know lots of people, young and old, rich and poor, doctors and nurses (my mother in law's a cardiac nurse). I can honestly say that I have never heard anyone complain about our health care system except on TV. So I'm sure the out-of-pocket Canadians flocking to the US do exist, but I would be extremely hard-pressed to find one among anyone I know...

I simply can't imagine a society where if you slip off a kerb and crack something important, you then have to deal with huge debt loads on top of dealing with the injury. It seems Dickensian... predatory.

Of course, with any universal system, you have a supply problem, and with any system that produces outcomes, there will be a quantity-quality tradeoff. I don't the the US is making the optimal tradeoff though, simply because money isn't being turned into health as efficiently as other countries do it.

In Canada, health care coverage varies by province. While core medical services are covered (family physicians , nurse-run public health programs and anything to do with hospitals), drugs are only covered for the poor, and in Ontario, optometry and most dentistry is not covered. So the supplementary health coverage ladyk73 heard about was for that. Many people get that stuff covered in group benefits packages at work, but if you don't have one, you can buy private insurance instead, to cover these services. These packages aren't that expensive if you are in good current health.

So we have found a compromise between state-supported and private/employer supported coverage to make costs manageable for our citizens, but the compromise needs to be re-visited and re-adjusted to deal with changing realities like the aging population, new/better but expensive treatments, and the like. You can't solve this problem once and for all, because the parameters (demographics, tax base, technologies) will always change. So you need some flexibility in the mix.

Anonymous said...

Oh how exciting - you'd like my opinion! The NHS can be great, daughter with concussion seen instantly at hospital, x rayed, excellent doctor all done within an hour. For non emergency it's a long wait to see a consultant, then wait until surgery, then hope they have a bed , usually have to ring up on the day to see if they can take you, that is hard emotionally. For psychotherapy there is about an 18 month-2 year waiting list which comes after the 6-12 month waiting for assessment, a long painful process before you get there. Psychiatrist clinics seem to be increasingly using locums who don't know anything about the person, one classic appointment
Psych: Have you eaten?
patient: since when?
Psych: last appointmnet
patient:3 months, have I eaten in teh last 3 months?
Psych: Yes
Psych: Have you slept?
patient: since last appointmnet?
Psych:Great I'll write to your GP & tell them you are doing well.
Patient leaves without saying anything.

I'd love to say it was a story, added to in my time, but sadly I was there

MT said...

The film argues why it doesn't have to do diligence to the weaknesses of the other systems: In a democracy, a national health care system, if and when it shows flaws, is readier to be brought in line with the general welfare than a system that simply emerges from a market competition between profit-driven, non-transparent, private enterprises. Moore's not arguing that the choice is clear, which would require technical details. He's arguing that it's a no-brainer, ala fire and police services. Or ala prisons and defense and schools. I'm with him. It's sort of a theoretical point I suppose, given how we don't even have fair elections, let alone democracy.

Anonymous said...

“Sicko” (aka “Cuba rocks!”)

• First, some semantics. This film is not a documentary. The dictionary defines the word as “presenting facts objectively without editorializing or inserting fictional matter, as in a book or film.” Sicko, like Michael Moore’s other films, is a one-sided rant. Yet Moore, the bulk of the media, and the Motion Picture Academy stick to the script that this is a documentary. Are they ignorant of the word’s meaning, or so biased in their politics that they wish to lend the patina of credibility to what is – and I mean this in the nicest way – socialist propaganda? Immediately, the intellectual honesty of the filmmaker is called into question.

• Moore does an excellent job of using both stories of personal tragedy and humor to highlight the view shared by most Americans that our health care system has major flaws. He then veers sharply from this consensus building to conclude that the only way to make it better is to blow up what we have and institute a government run health care system. Left unsaid is that the vast majority of Americans have ample access to a very high quality of health coverage – quite possibly the best care in the world. Could it be that this is something to build on rather than tear down? Moore’s proposition is that putting the government in the middle will produce better care for more people at a lower cost. In other words, the government will make the system more efficient. I suppose there’s a first time for everything.

• But wait, Moore says, it’s not the first time. Socialized medicine is a huge success in Canada, Britain, France and even Cuba. He is correct that government run health care is viewed as a sacred right there (think Social Security in the U.S.), but his utopian presentation of life in these countries – all with standards of living below the U.S. – borders on the absurd. There is no mention of the numerous documented cases of people dying while waiting for care, or those denied aggressive treatment because their survival odds are deemed too low based on government projections. The “R word” – rationing – is never mentioned. There are companies in Canada, dubbed the “underground railroad”, who arrange for Canadians to receive timely medical treatment in the U.S.

• Moore goes well beyond health care, treating us to the wonders of life under the loving care of the national nanny in France and Cuba. A real movie critic might accuse him of overreaching, but I give Moore credit for letting us see his broader agenda. He has called himself (verbally, not in writing) a socialist, and has stated that in Cuba there is “artistic freedom” and that the Cuban people may “freely speak their minds”. It is no surprise then, that in Sicko he acts as a useful propaganda pawn for the still repressive Castro regime.

• Meanwhile, his cup runneth over with jealous admiration for the extent of government largesse in France. The French, it seems, are deliriously happy with their station in life and haven’t a care in the world thanks to its benevolent government. Why, then, did the French just reject the Socialist Presidential candidate in favor of an economic reformer, with a similar result in Parliament? While Michele was taking French lessons, the populace there finally figured out that they aren’t working hard enough to earn the lavish benefits they enjoy, that their country is in long term decline, and that they have been stealing prosperity from their children and grandchildren. No worries for Mike, though. All that fulsome praise for the French paid off at the Cannes Film Festival.

• As with most socialists, Moore is deaf and blind to the realities of economics. Literally dozens of times, we are told that a particular medical treatment or other social service is “free” in these idyllic lands. Really? The typical taxpayer in Britain, France and Canada pays 15 to 20 percentage points more in taxes than the typical U.S. taxpayer (in other words, almost twice as much for middle income earners). If you believe that socialized medicine would eliminate insurance premiums and drastically reduce overall healthcare spending, you might think a huge tax increase is worth it. But don’t call it free. It’s a gamble – make your choice, and place your bets. We won’t even get into the negative effects of high tax rates in an entrepreneurial economy like the U.S.

• Moore, overtaken by his desire to create a socialist workers’ paradise, does not present some of the other very credible options for improving health care access, fairness and efficiency. They exist, but because they do not fit with his broader agenda of cradle to grave government coddling, he is silent. It is disappointing that someone as creative as Moore thinks that the best healthcare solution is to “copy Canada”. Nothing against our friends to the north, but why not try to do better?

Anonymous said...

hello ladyk73,

The Canadian gov't is sending those patients to your hospital, 2 miles east, and not 75 miles away to Toronto, not because it is so much more expensive to travel the extra 73 miles but because those people would be stuck in Toronto for 2 years waiting for the specialist and likely die. So the gov't spends more to pay for a US hospital, on a patient by patient basis, than to fix the system.
You also have to be really lucky to get sent because they don't like approving payment for treatments that work but are really expensive. If it is really expensive it will be called "experimental" even though it saves lives. I know more than one person who has gone for treatment in the US. I have read plenty of news articles about the province's decision not to cover care being overturned, but mostly people here just WAIT.
The Canadian Medical Association recently elected Brian Day as it's new prez. These are physicians voting. He is a contraversial guy;he has a web site and you can google him for his thoughts. He once said that a dog can get a hip relaced here in a week but a human would have to wait 2 -3 years. He has an agenda, to be sure. He was owner of private clinics that were shut down. Still, he is now the elected choice to head up the CMA.
Sure all Canadians are covered and that is better than not being covered as plenty are not in the US, but don't imagine that we do not pay through the tax system and don't imagine that just because a person is covered they will actually see a specialist in time.
Happy Canada day to us up here, eh?

Anonymous said...

Please put your country of origin at the beginning of your post!
It's a whole different take if someone from the US (or anywhere else in the world) is criticizing another country's Universal Health Care than if a local who lives with it has something to say. Not that we're not happy to listen to anyone rant here, I'd just like to know where you're from.

NeoNurseChic said...

Well, I've spent extensive amounts of time studying this issue - even from when I was much younger. In 7th grade, I participated in a Forensics Competition (Forensics as in a type of public speaking such as debate, speech, and other forms), and I won 1st Prize for giving a speech on comparing the US Health Care system to that of Canada, the UK, and Germany. At the time, those systems aren't what they were today. Today, I see that the UK system has actually fared okay for the most part, but the Canadian system seems far from what it was back then.

I know all systems have their flaws, but I would like very much to see a system in the US where every person was given some sort of basic coverage... Then, keep the competition of all the insurance companies for those who can afford or whose jobs will pay out (my fear is that if we go universal, companies will stop paying for private insurance and then people like me will be denied private insurance and then up a huge creek, falling down a waterfall - forget the paddle). But it would be nice if we could somehow get basic coverage for all in addition to what we have. Because let's face it - as bad as our system may be, it does work for some.

I've sat in both chairs in the US system. Right now, I'm quite lucky to have a PPO which ranks #2 in the nation. I pay large premiums out of my paycheck, but it's worth it. My employer actually offers 5 different health insurance packages, and I've opted to stay with the most expensive. However, I go to my appts - rarely having trouble finding doctors who accept my plan - pay my $15 to $25 copay, depending what physician I see, and go on my way. No referrals to be lost in the electronic or mail system, denying me access to my appts or forcing me to pay out of pocket and waiting for reimbursement...nada. My prescriptions have a variety of copays - all of which are reasonable. The only prescription that breaks my bank is the one that I have to get from Canada because it is not an FDA approved drug - so it costs me $90 for 3 months worth - which is a lot for me, but I need that medication.

What is the downfall to the system I have now? The system where I pay reasonable copays, have no need for referrals, and choose the docs I want - without having to go to my primary every single time? Well, for one, mental health. There may be some provision for it, but one would be hard pressed to find a provider who would accept it. They go with Magellan, and I've made calls - nobody takes it. I've ranted before about the fact that my psychiatrist went to medical school just like the rest of my docs - so why is he not compensated? I think it's pretty unfair... I'm fortunate that I can go for a greatly reduced fee - I even feel very guilty about it a lot of the time - as he has never raised my fee, and yet I continue to make more money - but have not been able to dig myself out of mountains of debt.

The reason for the mountains of debt is because for me, even with excellent health care coverage, I'm left with not enough money at the end of the month to buy groceries and other important items. Sure, my copays are cheap, but my health problems are many - so I dropped today alone, $48 between copays and parking, and I am waiting for 8 prescriptions to be filled - which is going to cost me a HUGE sum in the end. (Never filled all these at once before - I'm afraid to even know the total!)

The only other downfalls to my insurance are that I'm tied to having surgeries and hospital stays at my own hospital's network because I not only have the PPO but an additional incentive program to stay in our own hospital system. (Very clever!) I was upset to have to give up my specialist for AVN who did my bilateral knee surgery and has studied the disease extensively - all because if I had to have another surgery, I could never afford the $2000 deductible and then to pay 20% of the rest of the bills!

And the final downfall of a system like this is not something I've personally experienced much, but I can see how it could happen. This is that people will go from specialist to specialist without having someone manage their overall care/picture. I did have a problem with that for awhile, but only because my PCP was afraid to do anything without sending me to more specialists. However, now I do have a coordinating internal med physician, and she is phenomenal. I know the HMO system was invented to prevent people overabusing specialists, but next I'll talk about that...

But then, I've spent time on an HMO - a very well-known, well-advertised HMO at that. It was the worst 2 months of my life. I've seriously never come that close to having a nervous breakdown. My family thought we could save money if I went on the HMO offered through the University plan. Did we save money? No. I went bankrupt. And the reason being was because the insurance company didn't cover half of the meds I was on. It didn't cover my home oxygen that I use for cluster headaches. It wouldn't pay for the dexa scan to look for the osteopenia I got from the steroids I took. It required that I travel very far to get an MRI done, so I didn't have one - and wasn't diagnosed with AVN until after I went back on a PPO. I paid hundreds of dollars out of pocket for medications that I was never reimbursed for. It was one disaster after another. I had office staff yell in my face that I had a poor insurance that wouldn't cover any of the things I needed when I went to them for help with appeals and such. I had all the paperwork signed over for my parents to help advocate on my behalf, but still the insurance company would "loose" these papers, and give us a hard time. My sob story for those 2 months would be enough to write a book about - just 2 months and so much negative to say about it.

It's amazing how when I was on the PPO, I had everything I needed and then some. Nobody ever gave me a hard time. When I had the HMO, I went to the same doctors, the same offices, and yet suddenly I was a 2nd class citizen - I was dirt. I was yelled at, denied the treatments I needed, and so on. I saw a side of the health care system that I barely knew existed, and now I feel so badly for people fighting those same battles. I stand firm in my belief that when you are sick, if you have to fight these huge, stressful battles, you just get sicker. It traps you in a hellacious battle that you cannot win.

The HMO system was originally designed to mimic the UK tiered system, but by still keeping health insurance private. Well, it failed because this is a capitalistic society, and the UK's system cannot work here while everyone is still vying for top dollar. In the UK, you have your GP - and if you need a specialist, you are referred to one only after your GP has extensively attempted to treat the problem, and it just cannot be managed simply - so they send you off to a specialist. Many of the specialists then provide recommendations, and as my friends have told me, they don't repeatedly see the specialists every time - once they have the "plan", if it is working for them, they can go back to their GP. Even pediatricians are specialists in the UK. This is to cut down on overburdening the specialists with every day problems that can be managed by a GP. However, in the US, this system was used to deny coverage to people. You had to be in certain networks, and then you have to get imaging studies and lab work done at facilities who are connected to the GPs office and so on. HMOs most likely say "NO" far more than they say "YES." Oh and read the fine print, because even though I did, I still found out the hard way that many things weren't covered that I originally thought would be. DME - Durable Medical Equipment - is an entire separate clause that many policies do not include.

So in the time since I had my HMO disaster experience, I have always been available to friends to help them through some of their insurance battles, if they'd like. I learned my way through a few of the horrible systems, and I hate to see anyone flounder like I did. It darn near made me loose my mind! I feel very fortunate now that I have the insurance that I do - and that I very rarely receive "No's" now. This is helpful because none of my doctors request unreasonable things. I shouldn't be receiving no's for reflux and antiseizure drugs, and so on. But I was, on the HMO. Oh they weren't the "right" drug - and they didn't cover any of the Proton Pump Inhibitors - well, maybe some with special exception. It was the biggest disaster.....and as I said, I went bankrupt. I sold every share of stock I'd had in my name since birth, and I still had to ask for an extension on my rent.

I haven't watched the film yet, but I do intend to. And I'm sure I'll watch it with a grain of salt - because I know that it is one-sided. I've also heard horror stories coming out of the UK and Canada, even though I also know people living in both places with chronic conditions who get along just fine. The real shock to me was that in England, Helen told me that if I were injured or got sick there, I would be covered under the NHS - as an American! Who'd have thought? I'm glad I didn't need to test that, however!

Sorry to rant on - this is the first big long rant I've had here in awhile!! This is a topic that I tend to get very fired up about!

Take care,
Carrie :)
P.S. Dinah, I imagine that people always want to hear your opinion on things!! Not only are we here interested in what you have to say, but I'm sure your patients are as well. :) I look forward to reading the things you write!

Anonymous said...


Anonymous said...

at least the post that mentions Brian Day.

Rach said...

You weren't going to go see Sicko until I asked, Dinah? Seriously?

Check my blog... there's a nice long rant there... I'd write more but it's insanely gorgeous outside and I must go for a run.

More tomorrow when mortimer the mac is charged and ready to go.

Anonymous said...

i live in kalamazoo, mi, US.
i haven't seen the movie yet, but plan to because i appreciate his sense of humor. however, i have been reading differing opinions of his movie online and i found this on livejournal this morning:
consequently, i am even more interested in seeing it now, which i doubt was the original poster's intention.


Anonymous said...


Don't know what you charge per hour but here, a psychiatrist gets less per hour than a social worker or psychologist with the same years of experience can charge for therapy. That is becaue the latter can set whatever fee they like, whatever the market can bear.
The psychiatrist also has to pay for major malpractice coverage and other therapists do not have this burden. As a result, many shrinks cannot afford to do therapy. I know many in the US don't do it either but it has become like the docs cram as many as they can in for med checks. Not saying other professioanls can't provide the therapy but that would not be covered by government insurance and often only to a mlimeited extent by the private top up plans offered by insurance from work for example. Like anywhere else, if you are rich you are going to be able to pay for what you need and if not, you may get it and you may not.

Mother Jones RN said...

Here's my review of Sicko, but first, I must post this a disclaimer: I am a card carrying, tree-hugging liberal who hates all politicians who are in back pocket of Haliburton and HMOs. It’s not my intent to offend anyone, but I’m sure that I’ll offend people who think that Fox News is a refreshing source of fair and balanced information.

Sicko, Michael Moore’s movie about our failing health care system, is a standup and cheer movie for anyone who has been screwed over by his or her health insurance company, meaning that millions of people are going to really love this movie. Moore accurately portrayals the HMOs as a bunch of crooked, bloodthirsty companies that would rather see patients die before paying out expensive claims. Nurses see this kind of stuff everyday, and it sickens us.

Moore talks about socialized medicine. Many people point out that patients must wait for medical procedures that they need under a socialized medical system. Maybe that’s true for non-emergent cases, but unlike our system, at least patients eventually get the care that they need while needy Americans ultimately are denied care by their insurance companies. There is an old saying that goes “figures don’t lie but liars figure,” and insurance company executives are the most over paid bunch of liars and thieves on the planet. HMOs hire people who look for ways to deny claims and to screw patients over. That’s how HMOs can afford to pay their CEOs those huge yearly paychecks. There is no perfect system, but I have problem with a system that protects greedy insurance companies while inviting patients to rollover and literally die. I encourage everyone to see this movie.

That is all.

MT said...

"Documentary" is a loose enough label to cover what Moore makes and it's not likely to mislead. "Propaganda" does mislead, even if true to the original meaning of the word. Moore is a polemicist documentarian. He's speaking cherry-picked truths to power with reverb and a subwoofer--or capturing something true in a schematic form that makes it easy to see.

Anonymous said...

perhaps mt. but you give the average person too much credit. plenty will watch it and believe everything they see and hear. i believe that a word has been coined and that it is a good description of these films---docu-ganda

Anonymous said...

Not one of my patients, when requiring urgent care have been kept waiting. IN fact, usually they are seen, biopsied, treated and monitored so quickly that I'm taken aback. These days the attitude seems to be not to let the patient work themselves up into an emotionally bad place. Get them done quickly. I live in Toronto. Canada.

A couple of months ago I foolishly accidentally sliced my forearm open with a chipped blender jar. I didn't cut any arteries or big nerves. I went to the local emerg. A former mechanical engineer from Brazil who has now retrained to become a medical tech sewed me up. ah, I've seen nicer jobs. I think my body doesn't like these black nylon sutures. He was great though. The doctor was a snot.

I was in and out in an hour. No one asked me if I HIV or anything at all. That was somewhat bizarre.

All in all though, if you need care NOW, you get it.

Ladyk73 said...

I live in NYS. NYS Department of Health is alloted additional money from the NYS budget to supplement federal funding streams.

So in a is NYS, we do have a bit more "socialized" medicine. We have clinics: Primary health clinics, family planning clinics, OB clinics, Those living with AIDS clinics, Those with MRDD clinics...and mental health clinics.

Some here the word "clinic" and think "bad medicine." Our clinics are pretty good. And may even be held to higher standards (because of their funding) than private practice. However...these are NOT free to consumers. Sliding fees can leave an insured working class person paying $150 to go to a "free clinic."

I do go to private practice medical providers, and they are all really good. I had to fire a few, to get here, but I happy wiht my docs.

With the copay hell ($40 coapy for one RX???), things can be expensive for sick working class.

So...if you are poor and can get medicaid, or fall in the lower levels of a sliding can get decent low cost medical care (But if you get hospitalized....forget it!)
And if you have means....all is well.

It just sucks that we rely on the hope that our employers offer us decent medical coverage!

Sandra said...
This comment has been removed by the author.
Sandra said...

P.S. anonymous said "...those people would be stuck in Toronto for 2 years waiting for the specialist and likely die."


Health Council of Canada report:

"Approximately one in 10 Canadians sees a health care specialist each year, with many patients
reporting delays in accessing care. On average, Canadians reported waiting four weeks to see
a specialist, according to surveys done in 2003 and 2005. Although provinces and territories
report wait times in different ways, information shows median wait times for non-emergency
care have clearly declined for some services. For example:
• In British Columbia the wait time for cataract surgery has been reduced to 7.6 weeks
from 9.9 weeks;
• In Ontario the wait time for radiation for cancer care has been reduced to 4.4 weeks from
6.4 weeks;
• In Alberta the wait time for hip replacement has been reduced to 12 weeks from 16
weeks and for knee replacement has dropped to 17 weeks from 22 weeks."

My own experience is waiting for a non-urgent joint replacement for 1 year and still waiting. Experience is usually between the extremes, isn't it?

a psychiatrist who learned from veterans said...

I am eager to see 'Sicko.' If Michael will just send me $3000 to fly to los angeles and give me time to organize a trip to the theater and live for a few days in a style to which I would like to be accustomed. He has continued to remake 'Roger and me' which kind of buzzed me. Ever since Vickie Livesay was not excited to see me as a fellow cheerleader, I have been bothered by the effects of adverse selection. So I was pleased to see that MM was giving it to Roger X, chairman of GM, who really had no more right to be rich than any of the rest of us, yeah. By the way, I have some great news for some of you who haven't had time to keep up. We do have national health insurance; it is called Medicaid, also available in an upgraded version called Medicare, which by its EMTALA regulations gets you into any hospital in America with need for medical stabilization, no Cuban insurance card neeeded. And, as far as the copay is concerned, many of my patients tell me 'What a copay. We were never asked for a copay before.' Doesn't America need to be a nation of shoppers? Michael wouldn't adversely select me from seeing his movie just because he wants me to pay and not meet my perfectly reasonable conditions would he? Is he working for those greedy film distributors? Now wait.

Anonymous said...

Anon (Cuba rocks) said: Moore’s proposition is that putting the government in the middle will produce better care for more people at a lower cost. In other words, the government will make the system more efficient. I suppose there’s a first time for everything.

That's also the proposition of the rest of the industrialized world, where citizens' health is as good as Americans' at two thirds to three quarters of the cost per person. Look, if you vote for someone who says "government is the problem," he'll make it a self-fulfilling prophecy. This works in the other direction, too.

Learned from Veterans: Isn't the point of mandatory universal health care finance to do away with adverse selection, cost shifting and all the other bullshit that makes our system so wasteful and uneven?

a psychiatrist who learned from veterans said...

There are means and ends issues. Liberty provides for the greatest progress so is not a means only but obviously also a means that the 'workers,' economic managers of production (e.g. the insurance companies), doctors etc., providing service generally prefer. Focusing on disparities in access provides methods to improve social equity. The expansion of the VA in 1957 to include access for 'all non service connected veterans on a space available basis' under Eisenhower after the econmy grew in the fifties was one of the first expansions of government provided health care here. There is naturally some tension between 'liberty' in health care and 'social equity.' The proponents of nationalized health care seek a moral high ground by implying that they, and not those with whom they disagree, see value in 'social justice.' It is however appropriate to realize that there are competing and conflicting goods here and that both need to influence policy.