Sicko and the Politics of Health Care

By RALPH NADER
June 26, 2007

He sat there dejected and indignant-twenty years ago-in our office. His position as editor of the monthly muckraking magazine, Mother Jones, had broken up. He was looking for a job that would allow him to bring his conscience to work.

We gave him a place and support to start Moore’s Weekly-a media critique.

Michael Moore has gone a long way since that short-lived publication. He went on to do documentary films, starting with Roger and Me-meaning of course, Michael Moore.

Rich, famous and Hollywood chic, Moore will open his latest film-‘Sicko’ in theatres around the country on June 29, 2007. To many of those who have already seen this indictment and conviction of the corporations that sell health care under an array of tricky conditions, it is his best move yet.

He was in Washington, D.C. last week, for a preview at the large Uptown Theatre and for testimony before a House Committee. The media followed him with a frenzy hitherto reserved for Paris Hilton.

But Michael Moore is no Paris Hilton from any dimension you wish to choose. He is a heavyweight reformer, pitching his film toward full Medicare for everyone. This also means displacing the health insurance industry the way Medicare partially did in the mid-Sixties for the elderly.

“I think one movie can make a difference;.I believe it will be a catalyst for the type of real change people want,” Moore told the New York Times.

Great movies and documentaries raise people’s latent indignation levels-for a short time. Norma Rae, The China Syndrome and The Grapes of Wrath had this effect. But films do not usually move either people or legislators to action. Their effect does not reach enough people. Their urgent 2 hour impact tends to diminish quickly, as compared with the omnipresent and powerful corporate or commercial interests determined to preserve the status quo.

Will ‘Sicko’ be any different? Certainly the giant HMOs, hospital chains and drug companies are firmly entrenched with all the sinews of power that have left this country, alone among western nations, without health care for all. They have endured easily many mainstream print and television exposés (see the New York Times, AP, 60 Minutes and the nightly evening news, for example) year after year.

Authoritative reports documenting over $200 billion a year in computerized billing fraud and abuse or the loss of 18,000 American lives yearly due to the unaffordability of health care (The Institute of Medicine) bounce off this two trillion dollar industry like marshmallows.

Having been a taught community organizer in Michigan, (see the new book, Citizen Moore by Roger Rapaport) Moore has prepared with all this in mind. He allied himself with the great California Nurses Association and their nationwide colleagues to demonstrate in favor of the film, contact legislators and other large unions.

The anticipatory media for the movie have been generous; citing the U.S. government’s move against Moore for what it claims was an unauthorized trip to Cuba. Right wing think tanks, funded by this hyper-profitable, subsidized industry, pour out inane rebuttals and offer quotes against Moore for reporters.

Unlike for other social justice movies, there is even a bill in Congress, H.R. 676 with 74 cosponsoring legislators, led by Cong. John Conyers (Dem. Mich.), to establish full Medicare for all.

That is a number of lawmakers considerably less that those who signed on to a similar bill in 1993.

There are 17 million more Americans uninsured today than in that year, totaling nearly 48 million without coverage in 2006. So you see where that trend is heading.

If Moore is serious about getting “real change,” as he phrases his goal, he will have to make at least two more contributions. First, he will need to make a comprehensive effort to get many of the 6 million or more people, who will see the film, to sign up as they enter or leave the theatres so that they can be given a chance to connect with each other for a cohesive change constituency.

Secondly, some of the millions he will make from this movie should be put into a full time lobbying organization in Washington and back in the Congressional districts to press for enactment of H.R. 676.

With all his super-rich Hollywood contacts and admirers, Moore should be able to multiply this proposed group’s budget several fold. Michael can even call it ‘Moore’s Miracle!’

By Christopher Lee
Washington Post Staff Writer
Thursday, June 21, 2007; Page A09

As the nation struggles to improve medical and mental health care for military personnel returning from Afghanistan and Iraq, about 1.8 million U.S. veterans under age 65 lack even basic health insurance or access to care at Veterans Affairs hospitals, a new study has found.

The ranks of uninsured veterans have increased by 290,000 since 2000, said Stephanie J. Woolhandler, the Harvard Medical School professor who presented her findings yesterday before the House Committee on Veterans Affairs. About 12.7 percent of non-elderly veterans — or one in eight — lacked health coverage in 2004, the most recent year for which figures are available, she said, up from 9.9 percent in 2000. Veterans 65 and older are eligible for Medicare.

About 45 million Americans, or 15 percent of the population, were uninsured in 2005, the Census Bureau reports.

“The data is showing that many veterans have no coverage and they’re sick and need care and can’t get it,” Woolhandler said.

Woolhandler’s findings are based on data from two national surveys — the Current Population Survey administered by the Census Bureau and the National Health Interview Survey administered by the Department of Health and Human Services. Veterans who said they had neither health insurance nor veterans or military health care were counted as uninsured.

Woolhandler is a well-known advocate of guaranteeing access to health care for all Americans through a government-run national health insurance program. Republican lawmakers seized on that association to question whether she was trying to advance that goal with her study.

“The difficulty would be that because of your desire for universal health care, that could influence how you felt about veterans,” Rep. Cliff Stearns (R-Fla.) said.

Woolhandler said the data are sound. She has firsthand experience with the issue as well, she said, because as a physician she has seen uninsured veterans with untreated high blood pressure, diabetes and other conditions.

“It breaks my heart,” she said. “The VA should be an important safety net for my patients, and it’s not.”

Nearly 8 million veterans were enrolled in the VA health system in 2006. The focus of the hearing was whether to open VA hospitals’ doors to so-called Priority 8 veterans, who have no service-connected disabilities and whose earnings generally are above 80 percent of the median income where they live. Doing so would add significantly to VA’s caseload and costs — estimates range from $366 million to $3.3 billion annually — and some veterans groups and lawmakers are concerned that it would make it harder for veterans with serious service-related health problems to get timely care.

Only about half of the 1.8 million uninsured veterans are classified Priority 8, Woolhandler said. The rest may technically be eligible for some VA care but live too far from its facilities for it to be a real option, she said.

Rep. Steve Buyer (Ind.), the committee’s ranking Republican, said Veterans Affairs should focus on its “core constituency” — veterans with service-related health problems, the indigent and those with “catastrophic” disabilities. “Some say the government is obliged to provide essentially free health care for life to anyone who served even a year or two,” he said. “I intend to protect the core constituency first.”

But Rep. Bob Filner (D-Calif.), the committee’s chairman, said taking care of veterans is a continuing cost of war. “All veterans should have access to ‘their’ health-care system,” he said. “This is rationing health care to veterans, those who have served our nation. And I think it’s unacceptable for a nation of our wealth and our ability.”

By PAUL KRUGMAN
New York Times
Published: June 15, 2007

Traveling through Europe recently, I’ve been able to confirm through personal experience what statistical surveys tell us: the perceived stature of Americans is not what it was. Europeans used to look up to us; now, many of them look down on us instead.

No, I’m not talking metaphorically about our loss of moral authority in the wake of Guantánamo and Abu Ghraib. I’m literally talking about feet and inches.

To the casual observer, Europeans — who often seemed short, even to me (I’m 5-foot-7), when I first began traveling a lot in the 1970s — now often seem tall by American standards. And that casual observation matches what careful researchers have found.

The data show that Americans, who in the words of a recent paper by the economic historian John Komlos and Benjamin Lauderdale in Social Science Quarterly, were “tallest in the world between colonial times and the middle of the 20th century,” have now “become shorter (and fatter) than Western and Northern Europeans. In fact, the U.S. population is currently at the bottom end of the height distribution in advanced industrial countries.”

This is not a trivial matter. As the paper says, “height is indicative of how well the human organism thrives in its socioeconomic environment.” There’s a whole discipline of “anthropometric history” that uses evidence on heights to assess changes in social conditions.

For example, nothing demonstrates the harsh class distinctions of Britain in the age of Dickens better than the 9-inch height gap between 15-year-old students at Sandhurst, the elite military academy, and their counterparts at the working-class Marine School. The dismal working and living conditions of urban Americans during the Gilded Age were reflected in a 1- 1/2 inch decline in the average height of men born in 1890, compared with those born in 1830. Americans born after 1920 were the first industrial generation to regain preindustrial stature.

So what is America’s modern height lag telling us?

There is normally a strong association between per capita income and a country’s average height. By that standard, Americans should be taller than Europeans: U.S. per capita G.D.P. is higher than that of any other major economy. But since the middle of the 20th century, something has caused Americans to grow richer without growing significantly taller.

It’s not the population’s changing ethnic mix due to immigration: the stagnation of American heights is clear even if you restrict the comparison to non-Hispanic, native-born whites.

And although the Komlos-Lauderdale paper suggests that growing income and social inequality in America might be one culprit, the remarkable thing is that, as the authors themselves point out, even high-status Americans are falling short: “rich Americans are shorter than rich Western Europeans and poor white Americans are shorter than poor Western Europeans.”

We seem to be left with two main possible explanations of the height gap.

One is that America really has turned into “Fast Food Nation.”

“U.S. children,” write Mr. Komlos and Mr. Lauderdale, “consume more meals prepared outside the home, more fast food rich in fat, high in energy density and low in essential micronutrients, than do European children.” Our reliance on fast food, in turn, may reflect lack of family time because we work too much: U.S. G.D.P. per capita is high partly because employed Americans work many more hours than their European counterparts.

A broader explanation would be that contemporary America is a society that, in a variety of ways, doesn’t take very good care of its children. Recently, Unicef issued a report comparing a number of measures of child well-being in 21 rich countries, including health and safety, family and peer relationships and such things as whether children eat fruit and are physically active. The report put the Netherlands at the top; sure enough, the Dutch are now the world’s tallest people, almost 3 inches taller, on average, than non-Hispanic American whites. The U.S. ended up in 20th place, below Poland, Portugal and Hungary, but ahead of Britain.

Whatever the full explanation for America’s stature deficit, our relative shortness, like our low life expectancy, suggests that something is amiss with our way of life. A critical European might say that America is a land of harried parents and neglected children, of expensive health care that misses those who need it most, a society that for all its wealth somehow manages to be nasty, brutish — and short.

New York, N.Y. — June 15, 2007 — Registered nurses, doctors, and other healthcare providers will be out in force Monday evening, June 18, when Michael Moore’s new film, SiCKO, premieres in New York City at the Ziegfeld Theatre.

More than 100 members of the New York State Nurses Association (NYSNA), Physicians for a National Health Program (PHNP) NY Metro Chapter, the New York City Central Labor Council, and the California Nurses Association/National Nurses Organizing Committee will arrive in front of the theater at 6:30 p.m. on the “Scrubs for SiCKO” bus. The bus will travel on to SiCKO premieres in Philadelphia; Washington, D.C.; and Manchester, N.H.

The nurses’ group, all wearing “Scrubs for SiCKO,” will gather outside the theater to talk about the need for universal health care both in New York and across the nation. They believe the message of the film — that health care in the U.S. is inefficient, inadequate, and unfair — will help build widespread support for a single-payer national health insurance plan.

“Health care is a right, not a privilege,” said Verlia M. Brown, RN, a critical care nurse at Kings County Hospital and president of NYSNA. “To make sure that every American has access to care, we must abandon a system controlled by for-profit, private insurance companies. We need a single-payer plan that covers everyone.”

Oliver Fein, MD, chair of the PNHP NY Metro Chapter and Professor of Clinical Medicine and Clinical Public Health at the Weill Cornell Medical College, said, “We’ve waited too long for a single-payer national health insurance system that provides comprehensive, high quality health care to everyone. We call on our political leaders to place the needs of the American people above those of the insurance and drug companies that have until now blocked real health reform.”

Rose Ann DeMoro, executive director of CNA, noted that SiCKO is “not just an indictment of an indefensible healthcare industry in the U.S. It’s an answer to those who think we can fix the problem by tinkering with an unconscionable system that puts us further in thrall to those who created the crisis.”

NYSNA, PNHP, and CNA all support H.R.676, a bill now before Congress that would establish a single-payer health insurance plan for all Americans. NYSNA also has testified at the State Capitol on behalf of the New York Health Plan (A.7354/S.3107), legislation that would create a statewide single-payer insurance system.

Contact:
Nancy Webber, NYSNA Communications Director; 518-782-9400, ext. 223
nancy.webber@nysna.org

Joanne Landy, PNHP Metro Chapter; 212-666-4001; cell: 646-207-5203
jlandy@igc.org

By David R. Francis | Columnist
The Christian Science Monitor

Filmmaker Michael Moore is making headlines again. His new documentary, “Sicko,” promotes a national healthcare program like Canada’s. The film, due to open in theaters June 29, got a big boost when the US Treasury Department sent Mr. Moore a letter acknowledging a probe into his trip to Cuba to obtain medical treatment for three 9/11 rescue workers — and film a segment for his movie.

An “appalling” form of harassment, declared Moore, saying his work as a journalist is protected by the United States Constitution.

Advocates of a single-payer national healthcare system welcome Moore’s movie. With millions of viewers likely to see the film, it’s “unquestionably” helpful, says a spokesman for Physicians for a National Health Program. PNHP, with a membership of 14,000 physicians, has been campaigning for a national system for 20 years. But the prospects of success for PNHP are not great yet, figures Henry Aaron, an economist at the Brookings Institution in Washington.

One reason is the power of various medical industry lobbies. Americans spend as much on healthcare today as the entire gross domestic product of France and Spain combined, notes one economist. If health-related costs continue to rise rapidly, spending could soon equal the entire GDP (that is, the output of goods and services) of Germany.

The $2.1 trillion the US spends per year on healthcare creates “strong interest groups,” notes Mr. Aaron. These include a host of politically powerful private health insurance companies and for-profit hospitals.

But a cofounder of PNHP, Steffie Woolhandler, a Harvard Medical School associate professor, is more hopeful for radical reform — though not under the Bush administration. That’s because she sees a slow-motion collapse of the present employer-based health insurance system.

Faced with globalization and severe competition from abroad, American companies are moving to reduce their health insurance costs. They are raising deductibles, requiring bigger copayments, and trimming the medical services covered. As these trends hit the middle class, the political result will be a “big storm,” Dr. Woolhandler predicts.

As it is, the US devotes about twice as much to healthcare as a proportion of GDP than do other rich nations with nationalized health systems.

Economists at the federal Centers for Medicare and Medicaid Services said last February that, if current trends continue, $1 of every $5 spent in 2016 will go toward healthcare. Today, healthcare takes close to $1 of every $6, or about 16 percent of GDP. “We must do something large and serious and soon,” says Alain Enthoven, a healthcare expert at Stanford University in California.

If a Republican president is elected in 2008, reform will be “relatively timorous,” says Aaron, possibly involving deductions for health insurance premiums on income and payroll taxes. Changes will probably most benefit the well-to-do, he says, and not much will be done to cover the 47 million Americans without health insurance.

If a Democrat is elected president, reform could be more ambitious. The “implicit taboo” on a large-scale health plan that followed Hillary Clinton’s failed effort in 1993 is gone, says Aaron. But no Democratic candidate is advocating a national health insurance plan, a move that would substantially redistribute national income and impact strong health-industry interest groups.

Aaron would like to see Washington help fund state measures to broaden health insurance coverage, such as the plan in Massachusetts. In California last week, Moore joined the Cali­fornia Nurses Association to push for a statewide, single-payer healthcare system at a legislative briefing and rally. But Gov. Arnold Schwarzenegger vetoed a bill in 2005 that would have broadened coverage in the state in favor of working with insurance companies.

So far, such Democratic presidential candidates as John Edwards and Barack Obama are advocating plans that keep the private health insurance industry intact. “Different flavors of the same plan,” complains a PNHP spokesman. Insurance companies would still strive to insure the healthy and exclude the sick, he says, noting this process adds to administrative and other overhead costs.

A study by Woolhandler and others published in 2003 calculated that, in 1999, health administration costs in the US amounted to at least $294 billion. That’s $1,059 per capita, compared with $307 per capita in Canada. By now, administrative costs are probably about $350 billion, a sum big enough to provide insurance coverage for uninsured Americans, reckons a PNHP spokesman.

Americans would like to have the federal government guarantee health insurance to everyone, especially children, according to a recent New York Times/CBS News poll. They say they’d be willing to pay as much as $500 more in taxes a year and forgo future tax cuts to do so. But a campaign against a national health insurance plan is already building.

Harry and Louise, the couple portrayed in TV ads by America’s Health Insurance Plans that helped kill Hillary Clinton’s health plan, may yet return.