I found a great post by Dr. Val on dissecting Michael Moore's "Sicko" documentary. In this film Moore pushes a 100% socialized solution with universal federal medicare-type coverage, modestly salaried physicians, and no ability for people to pay for premium services even if they have the financial ability. Health-care's a mess, but we're not ready to throw the baby out with the bath water.

This idea of a complete socialistic medical system is a non-starter in our country IMO and Dr. Val has some interesting cultural observations on why this is so . She has the perspective of having lived in the Canadian & UK systems, while practicing here now in the USA. I agree 100% with her observations. If you impose the VA system on everyone (which is already an American micro-economic scale "Universal Health" system of sorts), you're going to have more people with basic coverage (a great thing) with better and more standardized medical records (another great thing), while at the same time alienating both Doctors and patients with the red tape, restrictions, and inflexible cost-containment measures those in the VA system are familiar with.

Dr. Val writes:

If they were served up the Canadian system, they’d scream at the tax rates, and become hysterical at the inability to trade up to a platinum level of care for those who have “earned it.” They would not accept the long lines for care and would immediately start a scheme for off-shoring medicine to circumvent the lines.

If Americans were offered the French system, they’d be immediately annoyed by the inconvenience of the office hours (months of vacation are taken at a time by all members of society, including doctors), they’d never use the preventive health measures (they don’t have time for that stuff), and although they’d be glad to receive home health aides for no more excuse than - “I just had a baby and I’d like a government worker to clean my house” – when they
saw the tax rates it would take to make this available to all, they’d find it unacceptable, especially with such high copays and out of pocket expenses..

Over at Slate.com there are some articles about "Sicko" as well. I found the comments by one of Sen. Barack Obama's health care policy guys very interesting. He dismisses Moore's call for a radical single payer system overhaul and astutely observes:

But the main problem with Moore's policy solution is that a national health system wouldn't fix one of our health care system's main flaws—one that people really hate—the denial of service. It just changes who decides, so that the government makes the call.

In one heart-wrenching case in the movie, a woman whose husband has kidney cancer is told by the insurance people that they won't allow an experimental treatment that might save his life. But that scene would likely play out just the same way in a nationalized health system. In those systems, cost-effectiveness decisions get made all the time. Care is rationed. That's what happens if you offer something for free—you have to make rules about who is allowed to get it. So, you forbid smokers from having heart bypasses, or, in a more recent debate in the U.K. about a new hay fever medicine, you just say the medicine is too expensive to be used.

So, to do as Moore wants in the United States, you would need to do more than just overcome the insurance industry. You would need to cut the salaries of doctors, reform the legal system, enrage our allies by causing their prescription drug costs to escalate, and accustom patients to a central decision-maker authorized to determine what procedures they are and are not allowed to get. Unless every one of these changes comes together, Moore's new system would end up costing an enormous amount of money.


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