Health Care and Human Kindness

by Jonathan Wallace

Sicko is a typical Michael Moore film, polemical, funny, long on heart, short on analysis. The issue it raises lies at the heart of the question of American identity: what kind of people do we want to be?

Against the right wing commonplace that "socialized" medicine in countries like Canada, Britain and France is a failure, full of death and horror stories, Moore cleverly shows us residents of these countries talking about how contented they are with their system, and looking with compassion at Americans who may be financially ruined by an accident or unexpected health problem. One of the most funny and effective moments in the film come when we meet some Canadian relatives of Moore's, who are buying temporary travel insurance preparatory to entering the US for a single day to meet him in Michigan. They relate the story of a friend of theirs who was injured during a Hawaii vacation and had to spend $60,000 in medical expenses before being able to return home to canada, where the rest of his treatment was free.

Moore visits Canadian emergency rooms in which the wait is never longer than forty minutes, and in which comfortable, secure people tell him that free medical care is reliable and a part of the fabric of their lives. In Britain, he discovers that prescribed medication is also free, and that the cashier in a hospital exists only to dispense money to patients so they can get home. He interviews a doctor employed by National Health who is able to afford a million dollar home and drive a good car. This doctor wisely tells Moore that the main difference he sees between himself and American doctors is that some of them can afford the five million dollar home or own five cars.

In Paris, Moore interviews American expatriates who describe how lucky they feel to have free universal health care, and how benighted they have come to understand their own country is. He rides along with a French national health doctor making house calls.

Moore begins Sicko by introducing us to two people who had no health insurance when they experienced grievous injuries--then tells us that the movie will not be about them. The rest of the film then focuses on the way the for-profit system massacres the rest of us who have health coverage.

This got me thinking about my own experience. Most recently, I became a part time ambulance worker after five years of full time employment. This served as a termination; once I was no longer working thirty plus hours a week, I was no longer entitled to the cheap medical coverage I had had since starting the job, HIP HMO coverage for which I had contributed $60 a week out of my six hundred dollar weekly salary. (Many of my co-workers who lived much closer to the bone than I did felt they could not afford the $60 and went without coverage entirely.)

The COBRA law, passed by Congress many years ago, was intended to plug a hole in US health coverage: the tendency of people who lost their jobs to lose health insurance. COBRA forced the insurance companies to continue offering similar coverage to people who lost employment for any reason, at a price similar to the rates their employer was paying on their behalf. I felt extreme trepidation, because when I left another full time job at the Fire Department in 2005, the COBRA coverage I was offered had cost $1000/month for me and my wife, which was unaffordable. Who, leaving a $30,000 job, can afford $12,000 a year for continued health coverage? The ability of the insurance companies to charge these kinds of premiums undoes the intent of COBRA. What kind of protection is there in a mandated benefit no-one can afford?

This time, I felt that the system had mysteriously worked in my favor for once. The first bill I received was for $330/month for my wife and me. This went on about three months, when I received an incomprehensible "Adjusted Statement" which, after numerous deductions and add-backs, settled on a new, increased premium for us of $1000/month. I called HIP and after thirty minutes of conversation with the customer support person and his supervisor, still had no satisfactory explanation of what happened. To this day, I cannot tell you if the initial $330 premium was an error or if HIP simply felt entitled to raise it after a few months. But we are back where we started: mandating continued health insurance for workers who make $30,000 a year would be a Good Thing....if it didn't cost them $12,000, more than a third of the salary they no longer receive, to keep it in place.

In the six months I have been under the COBRA continuation of my coverage, here is my main encounter with the system. Since I just moved out to eastern Long Island, I was assigned to a new Primary Care Physician (PCP), and went to him for a check up. Since my last encounter with my old doctor had led to a revelation that my cholesterol was a little too high, I asked my new doctor to check my progress in bringing the levels down. He ordered a round of blood tests and made an appointment for me to come back in a few weeks.

. I went to have blood drawn in a lab in the same building where my PCP is located. When I went back to see him, he was horribly embarassed. "You're going to have to have your blood drawn again," he said. "Your insurer requires us to send your blood out to a particular lab which seems to be falling apart in recent times. They only did a blood count, not any of the other work I ordered." In addition to the cholesterol test, he had requested tests which would see if I was displaying any signs of heart disease, prostate cancer or Lyme.

I went back and had my blood drawn a a second time, and returned to the doctor to discover--wait for it--that the same thing had happened again. None of the requested tests had been done. I went down the hall to the lab and complained. They told me that since eight days had elapsed since the last blood draw, the infamous lab, with which they also had had many problems, would already have thrown my blood away. There was nothing for it but to come in and have my blood taken a third time. Three months had now elapsed and I was no closer to discovering if I had a cholesterol problem. In the meantime, I had paid $3,000 in premiums to a system which was not delivering me the most trivial, easily performed service.

I asked where they would send my blood if not required by HIP to send it to the failing laboratory. They replied that Southampton Hospital, a twenty minute drive from where we stood, had excellent testing facilities. Can you send my blood there next time? I asked. Yes, they replied, but it will cost you $200 which HIP won't reimburse.

It is clear to me that the system we have is a product of government-backed monopoly capitalism (the $1000/month premium, forcing me to use an imcompetent laboratory instead of permitting free competition among labs). I believe in a heartbeat that the "socialized" systems around us work much better. The US healthcare system is a scam, created by politicians who have been legally bribed via campaign contributions from doctors, insurance companies and pharmaceutical companies. They have created a monstrous, nonfunctional system purely in service of the ideal of the five million dollar house and five cars.

The horror stories which are quite routine in our country, of people who work hard for a lifetime and then are financially destroyed by the emergency surgery or the horrendously expensive heart medication, raise the core question of who we, citizens of the U.S., are as a people. The strange premise that health care is not one of the basic human services which should be provided free by government masks a depraved indifference to human life and reasonable outcomes.If you think about it, many more of us are endangered far worse by the prospect of asthma, diabetes or heart disease without adequate coverage than we are by Al Qaeda. Politicians who at this late date crow that they are saving us from "socialized medicine" are selling us a bag of shit.

Libertarians will respond that the true failure of the US health care system is not that it is dominated by monopolistic businessmen but that government is involved at all. These will be the naive libertarians, the ones who believe that all laudable social goals, are mysteriously accomplished by the invisible unfettered hand of the market. More seasoned libertarians, the old grizzled ones, know, but keep it to themselves, that in an unfettered system, only the wealthy will afford coverage and the rest of us will be left to rot and die. They are fine with that, but I am not, being one of those who would have to sell everything I have painstakingly acquired in order to weather a really bad illness.

I am ashamed of my country.