More on Sicko: Integrator Advisers Manahan, Sportelli and Levin, plus Reviews from Shor and Barkley

Summary: Cathy Rogers, ND, suggested a forum on Michael Moore's Sicko would provide an interesting take on perspectives in the integrated care community. One set of perspectives were already published. In this second round, we hear from Integrator advisers Michael Levin, Bill Manahan, MD and Lou Sportelli, DC. Michael Shor, MPH, a business of integration expert then weighs in, as does prevention-oriented academic Geoff Barkley, PhD. What are your thoughts?

1.   Levin: "Creating outrage with the current situation is a good thing ..."

Michael Levin

Michael Levin, whose career has included stints as executives in both Big Pharma and the dietary supplement industry, is a frequent Integrator commentator on natural products issues. He was last seen here in the first part of a series on new Good Manufacturing Practices for dietary supplements as published by the FDA.

"Underneath the stunts and stats is Moore's core question: At a per capita cost of roughly $6500 - up from $2750 in 1990 - with patient dumping, claims denial, and cost-shifting are we delivering the best healthcare possible? Obviously not.

"Ours is primarily a system in which disease treatment is economically rewarded, rather than prevention. The current model is an unsustainable, economic train-wreck.

"If the movie accomplishes little more than to create outrage about the current situation, then it will serve as another catalyst for change. And that's a good thing."

2.   Sportelli: Look in the mirror, Michael ...

Lou Sportelli, DC

Lou Sportelli, DC, president of NCMIC Group, the first Integrator sponsor, was recently seen in an article on his 4 decades of jousting with self-annointed "quack buster" Stephen Barrett, MD.

"As for Sicko, I will not spend one cent to see this kind of nonsense, so I will simply read the reviews of others.  Ironically, Moore looks to be the epitome of an unhealthy individual, overweight, and not depicting the kind of image that would bolster confidence in anyone seeing a move about healthcare that he would produce.  Analogous to going to your overweight doctor who smokes for healthcare advice...just incongruous

"So I will leave Sicko to Michael Moore to demonstrate by NON-example why health care is in the shape it  is in. Look in the mirror Michael and take some responsibility for your own health and that is one of the basic problems with the system. No one is taking responsibility for anything. McDonalds made me eat their super sized Mac's.  Oh and make that 'diet' soda, so I can get artificial diabetes.  Antacids - just go and eat that pepperoni pizza and pop this pill.   The entire process of not taking responsibility for anything seems so pervasive the shock to the country will be felt like a tsunami ..."

3.    Manahan: "A probing look at who we Americans are as human beings ..."

Bill Manahan, MD

Bill Manahan, MD, has had leadership roles in "holistic medicine" for 30 years while balancing careers in community medicine and academic medicine. He was last seen here  expressing St. Patrick's Day ire over surgeries and procedures which are routinely performed without any solid evidence of their value.

"Sicko confirmed my belief that Michael Moore is a genius and a prophet. I thought it was a wonderful, provocative, thoughtful, emotional documentary. It was definitely not just about health care. It was a probing look at who we Americans are as individuals and as human beings.  Moore could have been talking about education, business, the environment or any other of  our systems.

"The key question asked in the movie is are we a nation that focuses on 'me' or a nation that focuses on 'we.' The answer is quite clear in the movie, and I think we all know the answer anyway.  Our greatest strength (in the past) of being strong individuals has been what made this nation great.  But like many of us in our personal lives - there comes a time when our greatest strength become our greatest weakness.  Beginning in the 80's, I believe the pendulum began to swing too far to the other side and we have failed during these 20 years to balance what will be good for the majority of our citizens with what is good for each individual. 

"Examples are corporate salaries that have become disproportionate to what the employees earn, pharmaceutical and insurance companies looking excessively at profits and ignoring the common good for many, etc.  In fact, in surveys of college students, the percentage of those saying their most important goal is to become wealthy has risen significantly in these past two decades. That, I believe, is quite scary.

"In summary, I think Sicko is wonderful documentary and should be required viewing for all Americans."

"When I wrote to you one hour ago, I had not yet read this week's Integrator Blog.  I just finished Eric Goldman's thoughtful review, and I enjoyed it a lot.

"The beauty of Al Gore is that he appeals to our brain (as Eric says in his review), and the beauty of Michael Moore is that he appeals to our emotions and our hearts.  Now if Al and Michael could get together and do a couple of documentaries on the environment and health care that appealed to BOTH our mind and heart, those would be some big-time, fabulous productions.

"I agree with Eric that life-style is an important factor in causing problems for our health care system, but the British and Canadians are not that different from us, and they seem to be doing a lot better in most health measurements.  What is going on do you think?  Does anyone really understand this remarkable difference?

"Anyway, I think Moore's movie serves a very important function.  That function is to open up the eyes and hearts of many Americans to the fact that we as a people should probably be doing some serious introspection and dialogue regarding who we are and how we treat each other."

Michael Shor, MPH

Michael Shor, MPH, has, as he writes, "lived much of his professional career in the belly of the beast." I assume he includes here the challenges he faced in the better part of a decade in the business of integrated care, running integrated clinics and working to create successful business models. I think his beer and pool reference is to a long evening at his home ...

"Went to see Sicko last night with Ms. Kate, our sophomore nursing student daughter. She made what was perhaps the most important comment about Moore. 'You know Dad...the best thing about a Michael Moore movie is forces people to talk about tough issues.'

"Having lived much of my professional career within the belly of the beast, Moore takes a bit more than a fair share of poetic license. Personally, when I sort through the good guys, the bad guys and the 90% who just show up, the calculation becomes frightfully simple. As long as public held companies are valued on their quarterly earnings rather than their social value, profit will be their driving motivation as long as newly minted physicians and allied health workers are saddled with crushing school debt, they will look for the green out of necessity...and as long as someone else is paying for my smoking/drinking and sloth like behaviors, there is little incentive for me to change my lifestyle.

"The other curious fact is that we are actually on an inevitable march to universal access. We cover the elderly...did I say that (I now think of them as mature) ... through Medicare. We cover the indigent through Medicaid. Several states are now covering children and the folks that fall through the cracks are the working poor or job tweeners. In Massachusetts we have just passed legislation that will require that everyone have health insurance, by no means a perfect law, but the realistic recognition that the status quo doesn't work.

"Sicko is simply another loud clarion call that we need to do better - every time premiums go up, another beat of the drum that we need to do better. But until we are willing to confront the perverse incentives created by the way public companies are valued, the cost of education, the lack of personal responsibility for stupid behavior and yes, the appreciation that death is as normal a part of the life-cycle as playing pool and drinking beer, we will muddle on.

"On a side note, I really thought that our generation would be different, thought we would change the world. I have come to the realization that for whatever reason those with money seem compelled to get more of it. Came to another conclusion, that no matter how much money any of us have, the size of a toilet seat does not change and somehow that seems to be the poetic equalizer and a fascinating visual."

Geoff Barkley, LCSW, PhD

Geoff Barkley, LCSW, PhD, at the University of Virginia, was last seen here commenting in a forum on fees for acupuncturists. Barkley works in health promotion.

"Sicko points out the main problem of our current healthcare system. Unlike every other developed country, the U.S. healthcare system is entrepreneurial, with one of its prime motivations being to make money. This brings about some benefits, such as competition to provide the best services and strong incentives to develop new drugs, surgeries and medical technologies. On the other hand, this system has many negatives. The U.S. spends significantly more of its' GDP than any other country, with poorer morbidity and mortality outcomes. There is a tremendous amount of waste (from administering the system, and replication of services) inherent in the system, and there are no financial rewards for prevention of disease and promotion of health behaviors.

"More importantly, with 50 million uninsured and many millions more with inadequate insurance, this system creates a tremendous amount of financial ruin and suffering in general. Where is the outrage that such suffering exists in our country due to our medical system? Every other industrialized country has some form of government run national health insurance, and if you ask the populations of these countries whether or not they would exchange their system of healthcare for ours, the answer would be a deafening 'no'.  Yet to overcome the forces that keep the current system in place will require a monumental political effort. Let's hope that one day this will be possible.

"Several of the comments noted that exchanging an entrepreneurial 'illness' system with a national 'illness' system doesn't address the underlying problems that are creating chronic illnesses in this country. This is of course true, but first things first.

"There also may be benefits for CAM in a national single payor system. A single payor system is a 'capitated' system, in which there are incentives for health promotion and disease prevention. Since taxes pay for healthcare, the healthier people are, the less they will need the very expensive higher levels of care traditionally provided by mainstream medicine. Therefore if health promotion and disease prevention can be clinically demonstrated through CAM methodologies, these methodologies have a better chance of getting funded as they promote health and ultimately save money.

"To sum up, though not perfect, a national health care system would be unquestionably superior to our current one. With all the pain and suffering our system creates in its' current form, it is unconscionable that it is allowed to continue. A national healthcare system also provides the economic and moral structure that could facilitate CAM integration."