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!

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

"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

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

"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