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The Great Debate

Moore is less for healthcare reform

August 5, 2009

Peter PittsPeter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own.

In SiCKO, Michael Moore portrayed the British National Health Service and the Canadian health system as particular exemplars of excellence. He backed it up with a lot of statistics, but statistics, as the saying goes, are like a bathing suit. What they show you is interesting, but what they conceal is essential.

And what SiCKO concealed was that systems such as those in the United Kingdom and Canada are cost-based rather than patient-centric models. Facts, no matter how inconvenient to one’s argument, must not be ignored.

Citizens of countries with government-run health care systems experience long wait times, a lack of access to certain treatments and, in many instances, substandard medical care. For example:

• The five-year survival rate for early diagnosed breast cancer patients in England is just 78 percent, compared to 98 percent in the U.S.

• A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to The Fraser Institute.

• The average wait time for bypass surgery in New York is 17 days compared to 72 days in the Netherlands and 59 days in Sweden.

• More than half of Canadian adults (56 percent) sought routine or ongoing care in 2005. Of these, one in six said they have trouble getting routine care.

• Eighty-five percent of doctors in Canada agree private insurance for health services already covered under Medicare would result in shorter wait times.

• Approximately 875,000 Canadians are on waiting lists for medical treatment.

“Congress has an important role to play in healthcare reform” said United States Representative John Shadegg, (R-Arizona), who has introduced healthcare legislation in support of free-market competition. “We can help patient in this country, not by setting up a massive new government bureaucracy, but by empowering individuals to make the best choices for themselves and their families.”

If we’re going to look to other healthcare models for solutions, we must uncover and study their problems. Health care is too important to allow reform by sound bite. “Drugs from Canada” is as much a false promise as “free” healthcare.

Last autumn, my organization the Center for Medicine in the Public Interest interviewed people on the streets of New York City and asked them if they’d prefer “government” healthcare or “universal” healthcare. They overwhelmingly chose “universal” healthcare. But when we asked them to explain the difference between the two, they generally just shrugged their shoulders.

And when we asked them how much more in taxes they’d be willing to pay to support universal healthcare, they shook their heads and said, “No, we want it to be free, like in Europe and Canada.” Such are the fallacies that political rhetoric hath wrought.

Equally as prevalent is the notion of “free” or “low cost” drugs “like in Canada and Europe.” And here too we need to be honest and examine the other side of the coin — that of cost-savings for the payer (often in the guise of healthcare technology assessment programs such as Britain’s National Institute for Health and Clinical Excellence) versus care denied for the patient. What is overlooked is that price controls equals choice controls.

Our national conversation about health care has to go beyond vague concepts of reform and convenient political rhetoric. We must all be part of the solution and suspicious about false choices.

Comments
12 comments so far | RSS Comments RSS

I think the American citizens that shared their thoughts about public or universal healthcare, showed ignorance on their part when they stated they wanted it like Canada and Europe. They talk as though Europe were one country all with the same “free” healthcare. That is not the case! I urge everyone to take a look at both Germany’s and France’s healthcare system (also Japan’s) which are much better comparisons than England and Canada’s! Open your eyes and stop falling for the pitfalls of Canada; our system would not be like Canada’s!!!

Posted by Bonnie Neuer | Report as abusive
 

When Obama was asked if he would use the proposed health care system he didn’t respond. If the health care system passes then lets make sure all gov’t employees and the president have this plan!

Obama is the worst president ever!

Posted by Day Maker | Report as abusive
 

“Our national conversation about health care has to go beyond vague concepts of reform and convenient political rhetoric.”

How true. Perhaps you ought to try it some day.

Until then, with all due respect, Michael Moore you’re not: making that trivial video was a complete waste of your time, for which one assumes somebody with a vested interest must be paying; posting it to this site was a waste of Reuters’ valuable time and online resources; watching it and reading the accompanying rhetoric a total and utterly mind-numbing waste of time one might otherwise have spent eradicating mediocrity in American healthcare and duplicitousness on the part of healthcare deniers– uh, “providers”.

Of which there’s a spectacular amount needing the old heave-ho. Believe it.

Posted by The Bell | Report as abusive
 

As a practical matter, this country lacks the ability to address healthcare (and for that matter ANY problem), in a focused, direct, and coordinated fashion. It is also incapable of really planning much of anything of real value, at least not at this point in time. That type of activity does not fit within our governance model.

What you see here is an example of what happens when ANY entity is run by committee. We’ve known that as a society for a long time.

Our governance model is a “herding cats” governance model, where we let people and the entities they form have the freedom to do most of what they consider to be in their best interests, and we hope that it will also be in society’s best interests.

Sometimes that works for us, and other times it doesn’t. It will never yield consistency in approach, effort, and results. For us to think so is delusional in nature.

We (as a nation) lack the ability to rally around anything, unless it is perceived as An imminent threat to virtually all of us, and that’s not going to happen often. And so we become self-absorbed in thinking about our own personal, close to home minutiae.

There are some positive and negative ramifications associated with ANY alternate approach we might pursue, and the yelling and screaming will always loud and raucous.

As George Will often says, there is the “inertia” which is Washington. There is also the “inertia” which is the U.S. and its constituent parts.

Although this approach has served us well for most of the last 110 years, from a theoretical perspective, one has to wonder how long we can govern ourselves using the “herding cats” governance model, in light of our increase in size and complexity of our citizens.

If the US were run like a business, then every single day, its management team would assess whether its goals are being attained, bust their butts to achieve those goals, ensure that it was getting the maximum value and productivity out of those working for it, and make on the dime changes to most effectively and efficiently reach those goals. In other words, be nimble.

This country is not nimble, and can not be.

I’m not advocating a particular change, either left or right; just the recognition that EVERY governance model has its limitations, and this one is no different. However, for us to think that we can continue to use it and not have negative periods and poor, inappropriate responses to problems, is not reasonable. A country needs to know its limitations.

 

I find it disturbing, as a Canadian, how little Americans who comment on our healthcare system really know about it. If all you can muster is fallacious statistics from a neo-con thinktank like the Fraser Institute, that’s pretty sad. The reality is, that given the choice of paying $300k or waiting a couple extra weeks and paying nothing for service, I’m quite sure that most would be willing to wait.

People can claim longer wait times ad infinitum, what they fail to realize is that we use triage to determine who CAN wait, and who urgently needs service.

There are so many points that are totally misrepresented that a comment box in a blog reply can’t contain them all. It’s just disturbing that Americans would rather go bankrupt from getting cancer than waiting an extra week to start chemo and not paying a thing. But, hey, I guess in America it’s all about having choice, not whether any of the choices are reasonable.

One final thought… the story above claims that 875k Canadians are on waiting lists, that translates to about 2.5% of our population. Of the 47M Americans without health insurance (16% of your population) how many of those do you think would be happy to be on a list if it meant coverage. How many would rather pay $300k to start their chemo treatment a little earlier than pay nothing and get full and follow-up care that maybe starts a couple weeks later so that someone more sick than them could get helped first? Just a thought…

Posted by the Shah | Report as abusive
 

Healthcare is a failure because… if you took your car to a mechanic and he did not know how much it would cost to fix it and can make up any amount he wants…Then sends the bill to an insurance company and they have no idea what happened or what they really did. You have no input on the fixing of your car. Gee the costs would spiral out of control wouldn’t they. My mother had cateract surgery- 10 minutes @ $5,000. I had a vasectomy and my doc estimated that it would cost $1200 for a 1/2 hour procedure in his office (not a surgical suite). He only works on Fridays. He does a 1/2 hour consult and a 1/2 hour surgery. So he can get 5 surgeries a week x $1200= $6,000 a week x 4= $24,000 a month x 10(2 months vacation)= $240,000 a year working only 1 day a week doing a simple vasectomy. That is what is wrong with medicine in the U.S.

Posted by Science Boy | Report as abusive
 

That is the problem with Mr Moore.

The information he presents in his films are very important and worth knowing.

But it is also important to find out what information he neglects to mention.

Posted by Anon | Report as abusive
 

My uncle is a Canadian citizen who lives in the US. He used to go over the border to Windsor to get his medical treatments when he was doing poorly financially. He has horror stories by the dozen about delays in testing, diagnosis, treatment, and my favorite, the time he waited OVERNIGHT to even be looked at when he went in with an emergency.

The second he could, he switched to purely US care.

Posted by Detroiter | Report as abusive
 

I’d rather wait the few extra days or weeks than go without any health care at all. At least there, you have a chance. Here in the US, you might as well drop dead.

Posted by Mark | Report as abusive
 

And like you said, statistics are like a bathing suit. While you can claim all these “holes” in their systems, as in Australia you can opt to purchase extended healthcare at your own expense, which many people do.

You can claim that businesses will all switch to this new model, but then you will find competition in the workplace, i.e. 2 jobs that compete, one offers private, one offers only public. Which job will you take? The point is, public healthcare will not stop private healthcare, it will just cover those with nothing at all.

Posted by Justin | Report as abusive
 

Your article is like most articles about healthcare reform these days. Journalists and “Commentators” are forgetting the most important factor of framing a story; CONTEXT.
Let’s place your figures in the proper context:

• The five-year survival rate for early diagnosed breast cancer patients in England is just 78 percent, compared to 98 percent in the U.S.
—Figures like survival and contraction rates of disease are great headline makers! Really it does nothing to factor in things like obesity, diet, alcohol and drug intake, cultural and ethnic genetic predispositions; or for that matter quantify “early diagnosed”. —-

• A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to The Fraser Institute.
—”Theraputic” treatment? Like hangnails and wart removal? Discomforting I’m sure, but hardly cause for tears of sympathy. Under the US system, rather than waiting 18 weeks for treatment most uninsured folks won’t even bother with treatment. Of course even those low income people with health insurance more often than not can’t afford the premiums.—-

• The average wait time for bypass surgery in New York is 17 days compared to 72 days in the Netherlands and 59 days in Sweden.
—Quite simply, it’s easy to get on the ride if no one is waiting in line.—-

• More than half of Canadian adults (56 percent) sought routine or ongoing care in 2005. Of these, one in six said they have trouble getting routine care.
—So roughly 13% of the 56% percent had some issue getting “routine” care. To put that figure into context: This means that approximatly 7 people out of 100 had a complaint. Contrast this with the figures of between 18% and 33% of our US population that can’t afford to utilize routine care. These individuals often forgo “routine” procedures due to cost and end up coming in for lifesaving measures for illnesses that can be prevented by “routine” care. This cost is then most often passed on to our government through medicare claims. http://www.nchc.org/facts/coverage.shtml —-

• Eighty-five percent of doctors in Canada agree private insurance for health services already covered under Medicare would result in shorter wait times.
—Again, under private insurance that long waiting list would be shortened conciderably by immorally(if not downright illegally) denied claims and monumental insurance co-pays and premiums. So yes, the wait time would be shorter at the cost of human lives.—-

• Approximately 875,000 Canadians are on waiting lists for medical treatment.
—Yet another figure that is a generalization statement for shock value. Compare that to the 45 million Americans who can’t get medical treatment. A figure of that nature without breakdown for emergent, lifesaving, routine and outpatient care numbers is meaningless. What value besides partisan shock is there if you include 15000 odd folks waiting for a dermatologist appointment for acne, or 100,000 waiting for STD treatment?—-

Point being, if you can’t provide as a journalist a concise objective view of the truth you violate the basis of the 4th Estate as a whole. Take away from this your need to back figures up with relevant data. Such as:
-Number of folks waiting for treatment in a particular country(that will eventually recieve treatment)
VS
-Number of US Citizens that will go without treatment.
Or,
-Number of folks that die in a country from a particular condition
VS
-Number of US Citizens that died from the same condition
With:
The number or percent of those that died as a result of not having treatment for lack of health coverage.

You will make your point if the number of individuals dying without healtcare in the US is lower than the numbers of those dying of the same condition in nations with nationalized healthcare systems. The only problem with that condition is that it is impossible to state that case and still contend that the current privatized healthcare in the US is better than nationalized systems abroad.
That being the case, we’re America! If we aren’t the best at something, we work our butts off to become the best. Why should that performance ethic be any less prevalent when it comes to healthcare? According to the World Health organization:
“The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th.”

It’s high time we took a look at the top 10 healthcare systems in the world and built a system that utilizes the best parts of these systems in much the same way as America itself it built from the independant elements of these nations as a population.

Posted by Ash | Report as abusive
 

Mr. Pitts is actually a paid PR shill for big Pharma. The “Center for Medicine in the Public Interest” is in fact a PR front for Porter Novelli Public Relations, where Mr. Pitts works, whose clients are almost exclusively Big Pharma.

Our infant mortality rate is equal to Cuba’s and our life expectancy is comparable to Slovakia. Eighteen thousand Americans die every year because they do not have health insurance, according to the most recent study. A personal health crisis is the leading cause for bankruptcy in America, _even among those who have insurance_. All this, yet we pay more of our income for healthcare than anyone on earth.

We’re the only first-world country that doesn’t take a reasonable, preventative, humane approach to providing health care to our citizens. We’re the only country where a serious illness can result in you losing your home and everything you’ve worked for.

Let’s be sensible, folks. It’s amoral flaks like Pitts (extremely well-paid flaks) who are trying to undermine any kind of real reform, because they’re making a very good living off the broken system.

I’m amazed he has the gall to present himself and his paid-for arguments as coming from someone interested public good. The height of dishonesty. Or rather, the lowest of the low. For shame.

Posted by Matthew Timberlake | Report as abusive
 

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