Michael Moore's Sicko: Another Round of Comments in the Reader Forum
Written by John Weeks
Michael Moore's Sicko: Three Additional Comment in the Integrator Forum
Summary: Michael Moore's movie about US healthcare, Sicko, stimulates strong response across the board. This third set of comments suggests that the integrative medicine and integated healthcare community is not without its own strong opinions. We hear from Daniel Redwood, DC, an associate professor at Cleveland Chiropractic College on potential CAM impacts; from Sue Haddow, MD, a Minnesota family physician with international experience who is a clinical faculty member at the University of Minnesota; and from Chuck Simpson, DC, a co-founder of a Portland, Oregon-based Complementary Healthcare Plans, on many of the confusions inside the discussion. Good stuff!
This set of comments continues a reader-initiated Integrator forum on Sicko. The first two sets of responses can be accessed here and here.
1. Chiropractor: Recognizing an illness is one thing, treating it another ...
Daniel Redwood, DC
Dan Redwood, DC, sent his comments with a preface that he "know(s) this is a bit long for the blog, but I feel there are major issues to
address regarding the coming national health insurance debate. Some were
touched upon in the comments you included in the current issue, but many (see
below) were not." Redwood is an associate professor at Cleveland Chiropractic College.
"Sicko is a profoundly
moving and highly informative film. It made me laugh, it may me cry, and it
really made me think.
"Few
people defend our current health care system any longer. Its inequality,
inefficiency and, in some cases, outright inhumanity (powerfully documented by
Michael Moore) have grown so glaringly obvious that they are recognizable
whether one is conservative or liberal, old or young, conventional or
alternative.
"But
as every health practitioner knows, recognizing an illness is one thing, while
judging how best to treat it is quite another. Specifically, one can endorse
universal coverage without endorsing a single payer system, a distinction Moore does not address.
For those of us in the various CAM disciplines, and for the patients we serve,
this is a crucial distinction involving patient access to CAM
services, and possibly involving professional survival, because with a
single payer system, any policy error automatically becomes a system-wide,
nationwide error.
"In 1994, during the last health care debate, a leading chiropractic policy maker
estimated that certain policy decisions then under
consideration could cause 40% of chiropractic practices to close. The stakes
could be that high.
- Dan Redwood, DC
"For
example, if federal policy under a single payer system (either in its initial
form or during a later budget crunch) mandated that there would be no coverage
at all for chiropractic, acupuncture, naturopathy, or massage therapy, or that
none of these services would be covered for more than a total of 4-6 visits and
only for certain specific acute or traumatic conditions, many of our patients
would be unable to pursue the courses of care necessary for maximum recovery.
For practitioners in these core CAM
disciplines (particularly chiropractic, which currently enjoys broader coverage
than its sister professions), the consequences could range from damaging to
catastrophic. No one knows in advance how severe the economic fallout would be,
but in 1994, during the last health care debate, a leading chiropractic policy maker
(one not prone to hyperbole) estimated that certain policy decisions then under
consideration could cause 40% of chiropractic practices to close. The stakes
could be that high.
"The
advantage of a more eclectic, mixed insurance system is that if a particular
approach (either therapeutic or economic) shows effectiveness and
cost-effectiveness on a small scale, it can be gradually expanded, ironing out
the inevitable kinks along the way. Those methods that fail to measure up in
small scale, pilot projects will not be foisted on the nation at large.
Universal access to a mixed insurance system would seem the best choice for CAM and for the nation.
"For
CAM professions, there will be serious battles
ahead for inclusion in whatever plan emerges. Those with the strongest evidence
bases will be in the best position to make the cut, although not without
applying whatever political muscle they can muster.
"In
closing … as we stand up for our natural healing principles and the professions
we love, it is important to remember that the health care debate now emerging
is, when all is said and done, about how best to serve the public. If our
approaches to health care are not included in whatever plan emerges, many
patients we could have helped will never find their way to our doors. To the
extent that we can hold the well-being of patients in our focus, and not be
guided solely by self-interest, we will grow and mature as our overall society
grows and matures."
Daniel
Redwood, DC Associate
Editor Journal
of Alternative and Complementary Medicine Associate
Professor Cleveland Chiropractic College—Kansas City
2. Family Doctor: Work abroad dissipates fears of government role
Susan Haddow, MD
Integrator advisory Bill Manahan, MD, sent his Sicko comments out to the Minnesota Holistic Medicine Interest Group. This which provoked a response from Sue Haddow, MD. Haddow is a family medicine doctors who teaches family
medicine residents, and provide
medical services at an alternative high school for pregnant and parenting teen girls.
"I echo the sentiments that this will fuel discussion and
hopefully action. Yes there is some glorification of Cuba, and are we
getting the full picture there? I don't know. But from Canada, England and France,
there is much truth. The Netherlands also has an excellent system.
"The US is such a huge country, which makes Single Payer
more daunting. However, I'm sure we could create regions and come up
with a creative approach. Let's put this on a national problem-solving
website for youth (middle-school on up) and I think we may see some action.
"Our country actually already has 5 national health
programs. Two are insurance programs - Medicare and Medicaid. Three are actually health care systems with employees.
- Susan Haddow, MD
"Our country actually already has 5 national health
programs. Two are insurance programs - Medicare and Medicaid. Three are actually health care systems with employees -
the VA, the Military and the Indian Health Service. I have friends who have
worked in all the 3 systems (and I have worked under IHS) and these were
essentially well-run and functional. Already more than 50% of our country is
on one of these programs.
"I have worked in New Zealand which has a system nearly
equivalent with England and as a general practitioner found it to be easy
to navigate, well-thought out and reasonably fairly distributed. For
example, many professional people would never consider buying
supplemental health insurance though if you could afford it you could buy it.
They felt well-covered by the public health system.
"There is no perfect system out there. I think we can all
appreciate that. But there are BETTER ones, more comprehensive and
well-distributed ones. Ones with less cost and better outcome for more people.
Again, we can be creative and innovative, can't we?
"I also agree with other bloggers about us looking at who
we are as a big nation, what is our national psyche about. I'm just gonna
get mine? Or can I get some and be honored and privileged enough to help you
get some too? Is it somehow evil to be interested in the 'community
at large'? Is that socialism or communism? Or, in looking out for everyone
are we not truly looking out for ourselves as well? Didn't someone say we
are only as strong as our weakest link (or something to that effect)? Making
sure there is enough time, money and teaching skill to adequately feed
and educate all the children living below the poverty level will make our
country so much stronger, creative and competitive in all the world
markets, if that is our country's stated goals.
"Now let's get out and support things like Physicians for
a National Health Plan, etc. and make sure we vote and help our friends and
neighbors get to the polls as we are able. I'm so glad to know about this
venue so thanks and I look forward to reading more."
Sue Haddow, MD
Minnesota
3. From the 'dark side" - getting clear on what we are talking about ...
Chuck Simpson, DC
Chuck Simpson, DC, is a co-founder a Complementary Healthcare Plans, a Portland, Oregon-based managed care firm. Simpson was interviewed here in the Integrator on his firm, and the state of managed CAM. He sent comments he'd amended from another forum.
"I do not hold myself out to be a health care reform expert, but I
have followed the discussions-ad-nauseum in the industry and in chiropractic
and CAM for many years. Having worked on
the 'dark side' of the insurance industry, I hold no particular brief for any
health care reform solution proposed to date. However, I would like to
offer a few observations and an opinion spurred by Sicko and the
reverberations.
"Observatons:
1. The terminology is uneven, inconsistent and often used incorrectly
by the discussants. It is important to distinguish 'universal coverage”'from 'single payer' reforms. They are not the same. Sicko
advocates a single payer model as in the British/French/Cuban system.
Medicare/Medicaid for instance is a single payer system, with some privatized
wrinkles. It is 'govermint' run health care. And already is nearly
40% of the health care $$ spent in this country. Universal health care, universal coverage (or 'access', to use the
industry lingo) does not require a single payer but can be achieved through the
current mess of many insurance companies. Massachusetts is the most recent example of
trying to stitch together universal coverage through mandating the purchase of
health insurance by everyone and subsidizing the insurance costs for those who
cannot afford it
2. Most health care 'reform' discussion is really only about reforming the financing of health care not about reforming health care itself.
IMHO, this aspect of the debate is rearranging the deck chairs on the
Titanic. Doesn’t matter how you slice it, the current state of health
care finance, no matter who pays, cannot be sustained in the long term.
The collision of the Baby Boomers’ getting older while the number of wage
earners is getting relatively smaller sets the course for some very hard times
ahead. I see no meaningful discussion among the political leaders or
talking heads about this.
Most health care 'reform' discussion is really only about reforming
the financing of health care, not about reforming health care itself."
- Chuck Simpson, DC
3. Some have observed that innovation in health care always leads to
higher costs as opposed to say the electronics industry where innovation
eventually produces more value (anybody remember the first Texas Instruments
calculators?). I’m looking at a new Dell desktop system for less than a
thousand bucks with more megs, gigs, bauds, dram and stuff than you can shake a
stick at. The same features were way more $$ just a few years ago and
only dreamed of a few years before that.
4. The crunch will come when our willingness or ability to shell out
dollars, whether through taxes to pay for Medicare/Medicaid or for premiums for
private health insurance, runs out. General Motors pays more for health
care than for steel to make cars. We have not had a serious discussion
about getting value for any of those health care dollars. Does the
million or so dollars spent in the neonatal ICU to help one 26 week old baby
survive into an uncertain and unhealthy life provide more value than that same
million spent on ______ [fill in your favorite health care expenditure of
choice]?
5. A few folks are talking about reforming the health care that is
actually delivered, but they are mostly on the fringes of the health care
community. CAM and integrative medicine providers see the folly in high
tech, high intensity care delivered to those who are really sick, at the end of
life, etc., and often at the expense of not delivering effective preventive
health care well before the conditions degenerate into serious health
problems…DCs taking care of back problems with low tech interventions rather
than surgery for example.
"And an opinion: I think chiropractic is well positioned in one sector of the
health care delivery system, musculoskeletal medicine, to provide significant
value. We do need the professional will and the political leverage to
succeed. I was very impressed with what I learned at the 2007 ACC RAC
about the work that DCs have done in the VA system. That is a model of
integration that can leverage what chiropractic can do best in taking care of
patients that have frustrated conventional medical providers since day one.
Sticking to business, developing a culture of quality and playing well
with others can lead us to being able to help more and more people. The
rest of the CAM/IM communities are distributed across a spectrum of opinion
that stretches from 'no insurance, no way, no how, not ever' to 'tell me more
about this integration thing,' to some very interesting innovations such as the
AMI group and the pilot CAM/IM project in Maine reported recently in this 'Blog'."
Chuck Simpson, DC Vice President and Co-Founder Complementary Healthcare Plans
Send your comments to
for inclusion in a future Your Comments article.