Oscar®-winning filmmaker Michael Moore takes on the healthcare industry in his eye-opening documentary, Sicko, released in June 2007. The film compares the American healthcare system with those of countries that support universal healthcare—and brings to light the hardships faced by patients who thought their needs would be covered by their insurance.
After Michael's first appearance on The Oprah Show, thousands of viewers wrote in to share their healthcare stories. "After seeing Sicko, I cried for hours, then became enraged," wrote a viewer named Teri. "While I'm searching for affordable healthcare, my daughter may die. Why can't we join together to change this? Where is the collective American heart?"
"Even though we have insurance, I cannot afford the medication for my rheumatoid arthritis," Kathy writes. "I have two sons in the military and feel it is a shame that my sons are willing to die for this country, and the same country cannot provide healthcare for their mother."
Oprah says the film changed the way she looked at the issue of healthcare in America. "It's an eye-opening experience, I think, for Americans, many who are like myself ... who feel like, 'Well, I'm taken care of. My family's taken care of, and we're okay,'" she says.
Michael says when Steve asked that question, everyone in the stadium stood up and cheered. "And [they weren't] just applauding you for having the courage to say what you said, but they're standing for themselves and for all the millions of others," he says. "That's our story, too."
After that emotional moment, Steve was contacted by a woman whose fiancé is the head of a medical group. "When she saw my interview, she talked to her fiancé, and his medical group is providing my wife with the first full physical she's had in seven years," he says. "And I'd like to thank them at this time and you for this show, because it's not about a retiree and his wife. It's about almost 50 million people in this country that are doing without."
Oprah says Sicko brings to light a question that could define us as Americans. "This film speaks to the question of, Who do we want to be?" Oprah says. "Where do we really stand on this issue?"
Lisa Ling decided to give it a try. Lisa spoke with three viewers, all of whom were having disputes with their insurance companies. Stewart, a 25-year-old insured oil and gas employee was diagnosed with leukemia in 2006. Doctors said his best chance for survival was a bone marrow transplant. To his relief, his brother was a perfect donor candidate, and Stewart prepared to undergo his treatment.
Then, just a few weeks before the procedure, Stewart says he received a call from the hospital. "[They said] he'd have to bring $250,000 cash because his healthcare policy would only cover $150,000 of it," Lisa says. Stewart had to delay the transplant, and he says his cancer returned. He is now blind in one eye.
Hoping for an explanation, Lisa put in a call to Stewart's insurer. According to Lisa, the company said it had approved the transplant but confirmed that they would only pay the $150,000 maximum listed within his policy. Since Stewart couldn't afford the additional costs, he has been searching for other ways to pay for the procedure.
A few weeks after this show taped, Stewart finally found a way to fund the entire operation. His bone marrow transplant was completed on September 21, 2007. Sadly, Stewart passed away due complications from leukemia on January 15, 2008. He was 26 years old.
According to Michele's doctor, a stem cell transplant is her best chance of regaining the ability to breathe on her own. But, Michele says, her insurance company denied her claim. Lisa called, and the company maintained their position that stem cell transplants are an unproven treatment for scleroderma.
However, Michele's doctor confirms that stem cell transplants have been benefiting patients with sclerorderma for more than seven years. Michele and Gary say they'll continue to raise funds in hopes of reaching the estimated $160,000 needed for the transplant.
Civia had the surgery—but her insurance company did not pay the full claim. "They said that getting one's tubes tied is 'elective' surgery," Lisa says. "So, now she's stuck with a $16,000 bill."
After Lisa called, Civia says she heard from her insurance company that they had made a mistake. After reviewing her case, the insurance company agreed to cover the cost of her bills.
"When you are sick, you are the most vulnerable," Oprah says. "To be put in a position when you are sick—when your body, your spirit, is at its worst—now you've got to be put in a position to take on the companies...that is the worst."
"Most people can't afford to fight these companies. I think we can't afford not to," he says. "If this can happen to me, it can happen to anyone."
In response to Michele's situation, in which she was denied payment for a stem cell transplant because it was "experimental," Karen says it is a catch-22 that many people face. "Employers don't purchase coverage for experimental procedures. Medicare doesn't cover experimental procedures. Many foreign countries don't cover experimental procedures," she says.
Karen says that if you think a mistake has been made in the claims process, you can dispute it. "If you have a decision that doesn't make sense to you that you think is wrong, you should be appealing," she says. According to Karen, you can call the phone number listed on the back of your insurance form in order to contact the company.
Although Karen admits that America's current healthcare system has its faults, she says a government takeover is not the answer. "There's no perfect system. What we need to do is craft something that's uniquely American. We have to take responsibility in insurance plans of doing a better job dealing with mistakes, dealing with people who are falling in the cracks, good physicians and good hospitals," she says.
Professor Reinhardt says people need to decide whether medical care should be like public education—where every American simply has a right to it—or if it should be treated like a luxury good. Currently, he says healthcare is like fine dining...if you have the money, you get it, and if you don't, you won't.
When hurricanes or other natural disasters hit, Professor Reinhardt says the government steps in to help victims. "That's social insurance," he says. "It's a natural disaster, and I would say if a lady in Mississippi has breast cancer, isn't that a natural disaster, too?"
As Michael points out in Sicko, Americans rely on many socialized services, like the police department, public libraries and the fire department. The U.S. Army even provides socialized medicine for all enlisted men. "I'd like to call it Christianized medicine because this is what Jesus would do, right?" he says. "He wouldn't let the child of a gas station attendant go without."
"God bless you for working with insurance. We need insurance. Car insurance? I have it. Homeowners' insurance? I have it. My house burns down, I hope you're there," he says. "But when it comes to human beings and their health, this is what I don't understand...where do you think that profit should play a role in this? Why should anybody profit from somebody who's sick? It doesn't seem moral."
Karen says every doctor's office, hospital and healthcare system around the world has to make a profit. "If you're in the red versus the black, in Canada and in other countries, as you know, when they run out of resources, they stop delivering care," she says. "We don't want that kind of system here."
A public healthcare system may not live up to the Utopian vision Michael is painting, Karen says. In fact, she says taxes would increase significantly.
"Actually, we pay more [now]," Michael says. "We just don't call it taxes."
Americans pay more money for health insurance because we get more, Karen says. "We have better cancer outcomes in the United States," she says. "We're getting access to the latest and the best much more effectively."
In her testimony, Linda said, "In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this because, in fact, what I did was I saved a company a half a million dollars for this."
Linda confessed that this denial secured her reputation as a "good medical director" and helped her career. In fact, she said she went from making a few hundred dollars a week as a medical reviewer to a six-figure income as a physician executive.
"In all my work, I had one primary duty, and that was to use my medical expertise for the financial benefit of the organization for which I worked," she said. "I know how managed care maims and kills patients, and I'm haunted by the thousands of pieces of paper on which I have written that deadly word: denied."
If Linda still worked for an HMO, she says she could stand before Congress today and give the exact same testimony. "The only thing I would have to add to it was that things are worse."
"Suppose I took you to [a department store], blindfolded you, pushed you through the door and said, 'Find yourself a nice blouse that fits you and make sure the price is right.' That's roughly how we buy healthcare," he says. "If you go to the hospital, what do you know about the prices? What do you know you will get? Have you ever picked your own anesthesiologist?"
It's time to simplify things, Professor Reinhardt says. In addition to current plans, he says the government should mandate that every insurance company offer the same standard package. "[Then] there wouldn't be any question of what is covered or what isn't covered," he says.
To get healthcare coverage for every man, woman and child in the United States, Professor Reinhardt believes it would cost about $100 billion in additional government spending. That's the same amount the government spends in nine months to fund the war in Iraq, he says.
It seems like a lot of money...until you look at what Americans are spending billions on every year. According to our research, consumers spend $3 billion a year on custom ringtones for cell phones, $45 billion on lottery tickets, $94 billion on beer and $537 billion in restaurants.
Karen points out that Medicare currently uses a single-payer system and has a 10 percent denial rate. She says the companies she represents only deny about 3 percent of claims and pay about 5 billion claims every year...but Michael challenges Karen's numbers.
"Five billion claims...there are 300 million Americans," he says. "Do the math. That means that every American goes to the doctor 20 times a year or has 20 operations a year?"
"You should explain that the insurance company counts that as a claim that they approve," Michael says. "If my car gets in a wreck, you pay for the car. Why don't you just pay for the whole operation?"
When deciding how much to allot for a procedure, Karen says insurance companies contract with hospitals that are considered "centers of excellence." "If you needed a bone marrow transplantation, you would not go to the facility down the street," she says. "You would go to the best place to get the bone marrow transplantation. You would go to a center of excellence. That's what we negotiate. They do it for a rate that we negotiate."
Since Linda's testimony in 1996, Karen says the industry has taken steps to change what's wrong with the system, but they still make mistakes. "Is everything going perfectly? No. No system public or private does everything," she says. "Can we do better? Yes."
Karen and Michael agree that no one should ever lose their home or go bankrupt because of mounting medical bills. "It shouldn't happen here, and there are ways to address that," Karen says. "We should have a helping hand to subsidize working families who can't afford it. There's no question about that. ... We have to find our way through this a uniquely American solution that balances public and private. I think that's what people want."
"I've got to say, as an American, if I need to wait an extra four weeks or eight weeks because my knee is hurting, and I might need a knee replacement, I'd rather wait those eight weeks if it meant that almost 50 million of my fellow citizens had health insurance," he says. "I'd be willing to do that."
Michael says it's time to ask ourselves, "Who are we as a people?"
Karen says Americans can start by urging their Congressional representatives to vote for children's healthcare legislation. "That's something very tangible we could all do as a society," she says. "We can do that today."
In October 2007, President Bush vetoed the Children's Healthcare Bill. Congress attempted to override his veto but fell 13 votes short. Months later, Congress presented a new bill, which President Bush again vetoed on December 12, 2007.
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