More on Sicko: Integrator Advisers Manahan, Sportelli and Levin, plus Reviews from Shor and Barkley
Written by John Weeks
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?
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When Integrator reader Cathy Rogers, ND was scoping about the theater lobby crowd for the red baseball cap atop Michael Moore's head after the New York premier of Sicko in late June, she thought: Sicko could make an interesting Integrator forum. I posted an invitation last month and a first set of your comments 10 days ago. Here is another group. Have any thoughts of your own? Some female voices out there?
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."
Manahan then read the first round of comments on Sicko. he was particularly interested in the review by Eric Goldman, editor of Holistic Primary Care, and had some additional thoughts.
"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."
4. Shor: "Until we are willing to confront perverse incentives ..."
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."
5. Barkley: "There may be
benefits for CAM in a national single payor system ..."
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."
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