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We're Number Two: Canada Has as Good or Better Health Care than the U.S.

We're Number Two: Canada Has as Good or Better Health Care than the U.S.

Despite spending half what the U.S. does on health care, Canada doesn’t appear to be any worse at looking after the health of its citizens

By Christopher Mims
Scientific American
May 03, 2007

Whether it is American senior citizens driving into Canada in order to buy cheap prescription drugs or Canadians coming to the U.S. for surgery in order to avoid long wait times, the relative merits of these two nations’ health care systems are often cast in terms of anecdotes. Both systems are beset by ballooning costs and, especially with a presidential election on the horizon, calls for reform, but a recent study could put ammunition in the hands of people who believe it is time the U.S. ceased to be the only developed nation without universal health coverage.

Gordon H. Guyatt, a professor of epidemiology and biostatistics at McMaster University in Hamilton, Ontario, who coined the term “evidence-based medicine,” collaborated with 16 of his colleagues in an exhaustive survey of existing studies on the outcomes of various medical procedures in both the U.S. and Canada. Their work appears in the inaugural issue of the new Canadian journal Open Medicine, and comes at a time when many in Canada are debating whether or not to move that country’s single-payer system toward for-profit delivery of care. The ultimate conclusion of the study is that the Canadian medical system is as good as the U.S. version, at least when measured by a single metric–the rate at which patients in either system died.

“Other people knew that Canadians live two to two and a half years longer than Americans,” says Steffie Woolhandler, an author on the paper and an associate professor of medicine at Harvard Medical School, citing a phenomenon that many attribute to differences in lifestyle between the two countries. “But what was not known was once you got sick, was the quality of care equivalent in the two countries.”

Americans Less Likely to Survive Treatment

According to Woolhandler, by looking at already ill patients, the researchers eliminated any Canadian lifestyle advantage and just examined the degree to which the two systems affected patient deaths. (Mortality was the one kind of data they could extract from a disparate pool of 38 papers examining everything from kidney failure to rheumatoid arthritis.)

Overall, the results favored Canadians, who were 5 percent less likely than Americans to die in the course of treatment. Some disorders, such as kidney failure, favored Canadians more strongly than Americans, whereas others, such as hip fracture, had slightly better outcomes in the U.S. than in Canada. Of the 38 studies the authors surveyed, which were winnowed down from a pool of thousands, 14 favored Canada, five the U.S., and 19 yielded mixed results.

Mortality Isn’t the Only Measure That Matters

Not all experts agree with the implication that the Canadian system is better than the U.S. system, however, or with the researchers’ methodology. Vivian Ho, who is the James A. Baker III Institute for Public Policy chair in health economics at Rice University in Houston and has spent time living and conducting research in both the U.S. and Canada, argues that the study’s focus on mortality could be misleading.

“When we look at health systems we look at other things than death,” Ho explains. In her own research on hip fracture, which was cited in Guyatt’s study, she found that the time a patient had to wait before surgery–which was significantly longer in Canada than the U.S. because of a shortage of operating rooms–made only a 1 percent difference in terms of mortality.

“But certainly if you ask people waiting in the hospital,” Ho notes, “They’re going to say I’d rather have the U.S. system…. Waiting means there’s a significant amount of distress for an elderly patient, and also higher complications for pneumonia because you have the patient immobile for so long.”

Patti Groome, an epidemiologist at Queens University Cancer Research Institute in Kingston, Ontario, said she believes that overall the paper was balanced. “But when you get into [the] meat of [the] paper they can’t sort out what’s going on…. There’s way too much heterogeneity in these studies to come to a conclusion about these systems.” In meta-analyses such as this one, “heterogeneity” in results corresponds to variations in the size of an effect across the studies being reviewed.

In other words, of the studies surveyed, some showed slightly better outcomes for the Canadian system and some showed slightly better outcomes for the U.S. approach, making it hard to draw any conclusion other than that, on balance, the two systems seem to yield only slightly different outcomes.

Money Doesn’t Necessarily Buy Health

The study’s authors highlight the fact that per capita spending on health care is 89 percent higher in the U.S. than in Canada. “One thing that people generally know is that the administration costs are much higher in the U.S.,” Groome notes. Indeed, one study by Woolhandler published in The New England Journal of Medicine in 2003 found that 31 percent of spending on health care in the U.S. went to administrative costs, whereas Canada spent only 17 percent on the same functions.

Ho believes, however, that there are also inefficiencies in the Canadian system. In her own work on hip fracture, she found that Canadian hospitals held patients for longer periods because there was no incentive to discharge them. “These patients are easier to take care of,” she explains, “and that helps [hospital administrators] justify their budget…. I think there is room for economic incentives [in the Canadian system].”

“Personally,” Ho adds, “my view is that the Canadian system is good for Canada and the American system is good for America. Neither side should switch, because the systems are a function of the population–the Canadian population believes much more in maintaining social safety nets.”

This research may already be having an impact on policy debate: According to Woolhandler, Ohio democratic congressman and presidential candidate Dennis Kucinich has plans to circulate the results of this study to Congress. Woolhandler herself would like to see this study play a part in a slightly different debate–one over whether it it is better to be sick and insured in the U.S. or in Canada. “I’d like to see politicians giving up on this mythology that the quality of care for sick people in the U.S. is unique.”

Young, Ill and Uninsured

By BOB HERBERT
NY Times Op-Ed
May 19, 2007

Fourteen-year-old Devante Johnson deserved better. He was a sweet kid, an honor student and athlete who should be enjoying music and sports and skylarking with his friends at school. Instead he’s buried in Houston’s Paradise North Cemetery.

Devante died of kidney cancer in March. His mother, Tamika Scott, believes he would still be alive if bureaucrats in Texas hadn’t fouled up so badly that his health coverage was allowed to lapse and his cancer treatment had to be interrupted.

Ms. Scott, who has multiple sclerosis, understood the grave danger her son would be in if he were somehow to be left without the Medicaid coverage that paid for his chemotherapy, radiation and other treatment. She submitted the required paperwork to renew the coverage two months before the deadline.

“I was so anxious to get it processed,” she said, “so we wouldn’t have a lapse of coverage.”

In Texas, as in many other states, there is a concerted effort to undermine programs that bring government-sponsored health care to poor and working-class children. It is not an environment in which bureaucrats are encouraged to be helpful, not even when lives are at stake.

“They kept losing the paperwork,” Ms. Scott told me, her voice quivering with grief. She submitted new applications, made dozens of phone calls and sent off a blizzard of faxes. Despite her frantic efforts, the coverage was dropped.

When the coverage lapsed, the treatment Devante had been receiving ceased. “They put us on clinical trials,” Ms. Scott said. “They changed his medicine, and he started getting sicker and sicker. After awhile it was like his body was so frail and he was so weak he could barely walk on his own.”

Four months after the Medicaid coverage lapsed, the mistakes were finally corrected and the coverage was reinstated. By then, there was no chance to save Devante.

“I believe he would be with me now if they hadn’t let his insurance lapse,” said Ms. Scott.

Across America children by the millions are being denied the health care they need and deserve — and some are dying — because the U.S. has no coherent system of health coverage for children.

Stories like Devante Johnson’s are not unusual. Three months ago a homeless seventh grader in Prince George’s County, Maryland, died because his mother could not find a dentist who would do an $80 tooth extraction. Deamonte Driver, 12, eventually was given medicine at a hospital emergency room for headaches, sinusitis and a dental abscess.

The child was sent home, but his distress only grew. It turned out that bacteria from the abscessed tooth had spread to his brain. A pair of operations and eight subsequent weeks of treatment, which cost more than a quarter of a million dollars, could not save him. He died on Feb. 25.

There’s a presidential election under way and one of the key issues should be how to provide comprehensive health coverage for all of the nation’s children, which would be the logical next step on the road to coverage for everyone.

That an American child could die because his mother couldn’t afford to have a diseased tooth extracted sounds like a horror story from some rural outpost in the Great Depression. It’s the kind of gruesomely tragic absurdity you’d expect from Faulkner. But these things are happening now.

“People don’t understand the amount of time and stress parents are going through as they try to get their children the coverage they need, in many cases just to stay alive,” said Marian Wright Edelman, president of the Children’s Defense Fund and a tireless advocate of expanding health coverage to the millions of American children who are uninsured or underinsured.

Medicaid and the State Children’s Health Insurance Program provide crucially important coverage, but the eligibility requirements can be daunting, budget constraints in many jurisdictions have led to tragic reductions in coverage, and millions of youngsters simply fall through the cracks in the system, receiving no coverage at all.

It is time for all that to end. American children should be guaranteed nothing less than comprehensive health coverage from birth through age 18. This can be achieved if an effort is mounted that is comparable to that which led to the first moon shot, or the Marshall Plan, or the postwar G.I. bill.

Keeping American children alive and healthy should be at least as important as any of those worthy projects.

Copyright 2007 The New York Times Company

Oh yes, he's got an agenda

Michael Moore’s new film about the US healthcare system must be seen in Europe as well as the US

Agnès Poirier
The Guardian
Monday May 21, 2007

In four tidy acts, Michael Moore spells out the facts. Act one: 50 million Americans have no health cover, and 250 million who think they do, through costly health insurance schemes ($2,000 per person a year), are often denied treatment when they need it. A guy without cover who chopped off two of his fingers in a bout of DIY was presented with an invoice for $12,000 to reattach his ring-finger and $60,000 for his forefinger. Being a romantic, and skint, he chose to get his ring-finger back.

Act two: when did it all start going wrong, asks Moore. The answer: in August 1971. President Richard Nixon and his adviser Edgar Kaiser plot to break the system. “The less care they give, the more money they make,” says Nixon, caught on tape. They? Their friends, the health industry moguls, the same ones who fund the political campaigns of US congressmen. Moore shows us the price tag on every single one of them. One in particular, Billy Tauzin, leaves Congress to become CEO of the drug industry’s top lobbying group, PhRMA, with a $2m a year salary.

Meanwhile astute national publicity campaigns have demonised the concept of universal healthcare by associating it with “socialised medicine”, which in American English translates as “Soviet medicine” – the kind such oppressive regimes as Canada, Britain and France have adopted for their citizens.

Act three: Moore pays these regimes a visit. Britain’s NHS is paid a well deserved tribute, with Tony Benn appearing as the country’s conscience. Then off to France. A mother of three explains that her state nanny does the family’s laundry while the creche down the street, with professionally trained staff, costs her 50p per hour. Moore concludes his French tour by asking: “Is there a reason why they want to make us hate the French? Are they afraid we might want to live like them?”

Act four, the most powerful: Moore decides to test the US administration’s claim that Guantanamo Bay prisoners get the best free healthcare in the world. He takes 9/11 volunteer rescue workers, whose health problems were not covered by the state because they weren’t on its payroll when they ran to help, to Guantánamo Bay in Cuba. At least he tries to. Arriving at the gates, Moore shouts through a loudspeaker: “I have 9/11 sick rescue workers, can you please open the gates?” A siren begins to wail. Moore and his troops make off as fast as they can – to Havana. Where they are treated immediately.

I know what you’re thinking, I know what you’re going to say. And so what? Yes, Michael Moore has an agenda. No, he isn’t among the giants of documentary film-making. No, he isn’t an ordinary journalist. He is, as he says, the op-ed variety, the kind who is constantly angry. He has issues with the way of the world and wants to set records straight. His goal is simply to put universal healthcare back at the centre of the American debate. And while Moore’s main objective is to reach his fellow Americans, his film should also make Europeans ponder on the system they too often take for granted. George Orwell would hate it. But forget about him for a minute. There may sometimes be such a thing as good propaganda.

Agnès Poirier, a journalist and film critic, is an independent adviser on British films for the Cannes film festival

agnescatherinepoirier@hotmail.com

"Sicko"

Michael Moore’s scathing, important look at the U.S. healthcare system has plenty to rile the far right — and a lot more to enrage the larger American public.

By Andrew O’Hehir
Salon.com

May. 20, 2007 | “I know the storm awaits me back in the United States,” Michael Moore told a wall-to-wall throng of reporters here after the Saturday morning press premiere of his new film, “Sicko.” Then he heaved a deep breath and added, “But this is just so pleasant.”

It was indeed another gorgeous, summery morning on the French Riviera, but the real heat was indoors. There wasn’t a single empty seat inside the Grand Théâtre Lumière — which holds more than 2,000 people — for “Sicko,” and dozens of stragglers were locked out on the sidewalk. Moore’s screed against the outrageous state of American healthcare was received with uproarious affection, but one might argue that Cannes provided the softest possible crowd. An American left-wing populist, attacking America’s profit-motive, private-sector ideology before a roomful of international intellectuals, at least half of them Europeans. May I introduce a new phrase into the Franglais dictionary? C’était un slam-dunk.

“Sicko” does not display Moore at his most cinematically inventive or imaginative. It presents a TV-documentary-style parade of episodes, characters and settings, bouncing from various American cities to Canada, Britain, France and Cuba (and yes, don’t worry, we’ll get to that). Moore plays a far smaller personal role in this film, appearing only occasionally in his comic-relief role as the clueless buffoon who can’t seem to grasp that healthcare in all those other countries is free, or virtually so. When he’s eating dinner with a group of Americans living in Paris who begin to list all the things they can have as free or nearly free entitlements — not just healthcare but an emergency doctor who makes house calls; not just childcare but a part-time in-home nanny — Moore puts his hands over his ears and begins singing “La la la la la.” (If you have kids or any kind of chronic family health problems, your reactions might include weeping in despair, slitting your wrists or booking a one-way ticket.)

Still, there is no mistaking the passion and political intelligence at work in “Sicko.” It’s both a more finely calibrated film and one with more far-reaching consequences than any he’s made before. Moore is trying to rouse Americans to action on an issue most of us agree about, at least superficially. You may know people who will still defend the Iraq war (although they’re less and less eager to talk about it). But who do you know who will defend the current method of healthcare delivery, administered by insurance companies whose central task is to minimize cost and maximize shareholder return? Americans of many different political stripes would probably share Moore’s conclusions at the press conference: “It’s wrong and it’s immoral. We have to take the profit motive out of healthcare. It’s as simple as that.”

“Sicko” purposefully does not focus on the 50 million or so Americans who don’t have health insurance, as scandalous as that is, but on the horror stories of middle-class working folks who believed they were adequately covered. There are so many of these they begin to blur into each other: the woman in Los Angeles whose baby was denied treatment at an emergency room outside her HMO network, and died as it was being transferred hours later; the woman in Kansas City whose husband was repeatedly denied various drugs his physician prescribed for kidney cancer, and who in the last stage of life was denied a bone-marrow transplant that could have saved his life; the woman who was told her brain tumor was not a life-threatening illness, and died; the woman who was told her cancer must have been a preexisting condition, and died.

One might respond that anecdotes like these have tremendous emotional power but little analytical rigor, but in this case I think we all know (and fear) that these worst-case outcomes exemplify the system perfectly. Moore interviews two healthcare whistle-blowers, both now plagued with guilt, who explain what should be obvious: The point of the system is to treat as few people as possible as cheaply as possible, and those who get ahead in the healthcare industry are those who find ever more devious ways to deny coverage. (For example, you can now be denied for certain preexisting conditions you didn’t know about, on the premise that you should have known about them.)

OK, let’s get to the headlines: Yes, in the film Moore travels with a group of ill and injured 9/11 rescue workers (along with several other of his film’s protagonists) to Cuba, where they receive free and apparently excellent medical treatment. It’s unquestionably another button-pushing Michael Moore stunt, designed to provoke controversy. It’s cheap but funny, dubious as evidence but affecting anyway. Moore does not even seem aware of the possibility that the Cubans were shrewd enough to see the propaganda value in this exercise, and put on a dog-and-pony show for his and our benefit. (For that matter, we don’t know how much of the visit was planned in advance with Cuban authorities.) All that aside, within the context of the film and the argument Moore is building, Cuba makes as much sense as anywhere else.

Moore begins his foreign odyssey in the film after meeting a 22-year-old Michigan woman who has moved across the Ontario border (not entirely on the up-and-up) because she’s been denied treatment for cervical cancer. He wanders around emergency rooms in London, Ontario, and London, England (where he discovers that the cashier’s window is for paying patients their travel expenses, not for settling the bill). He zips from one Parisian arrondissement to another with an on-call physician on the night shift. He dines with the aforementioned Americans abroad, who seem dazed and a little guilty about their escape from healthcare hell.

Much of this is played as comedy; Moore corners a young Afro-British couple with a wiggling bundle in the hallway of a London hospital and says cheerfully, “So — how much they charge you for that baby?” But Moore is trying to push us beyond the universally shared idea that something must be done to the slightly more controversial idea that something has been done, and that all we have to do is appropriate it. Americans have of course been conditioned for generations to believe that socialized medicine is first of all a disaster in its own terms, and secondly, the pathway to totalitarianism.

His portrayal of the Canadian, British and French systems is undoubtedly simplistic , and several Canadian reporters took that up with him at the press conference — although all of them admitted they wouldn’t trade their system for ours. But Moore’s overall point is, I think, inarguable: Flawed as they may be, those systems are a hell of a lot more humane and civilized than anything we’ve got. (Life expectancy is significantly higher, and infant mortality lower, in all of those countries than the United States. Whatever outdated stereotypes you may hold, these days poor people in Britain are statistically healthier than rich people in America.)

Addressing a series of questions from foreign reporters at the press conference, Moore said: “We should do what we always do as Americans, steal the best things you’re doing and make them our own. The Canadians do certain things very well. The Brits do certain things very well. The French have the best system in the world, and that’s not my opinion. That’s how the World Health Organization rates them. None of them is perfect, but it’s not my role to make criticisms. It’s my role as an American to say, why don’t we take the best elements you’re doing and blend them together, and call it the American system?”

Moore decided to go to Cuba, as he explains in the film, after learning the peculiar irony that detainees at Guantánamo Bay are entitled to something American citizens are not: free healthcare. In a brief and awkward scene, he tries to bring a fishing boat with his 9/11 refugees aboard into U.S. waters just off the naval base. They are refused entry (Moore is evasive about the details) and then seek treatment at the best hospital in Havana.

“The point of this was not to go to Cuba,” Moore said at the press conference. “The point was to go to Guantánamo Bay, to get the 9/11 workers the same medical care we’re giving to members of al-Qaida.” If the detainees had been at a U.S. base in Spain or Italy or Australia — all countries with universal healthcare — he’d have taken his 9/11 workers there instead. In fact, when Moore drops the jokes and political attitudinizing during the Cuba sequence, the pathos of the story makes his point for him: A poor Caribbean island, whatever its ideology, can afford healthcare for everyone while we do not. The only possible conclusion is that our society has chosen not to.

When asked about his potential prosecution for violating U.S. Treasury sanctions against trade with or travel to Cuba, Moore was uncharacteristically sober. “I know a lot of you have written things like, ‘How dumb are they?'” he said, “but I don’t take this lightly. The Bush administration may try to claim that my footage was obtained illegally. We haven’t discussed this possibility yet, but actions could be taken to prevent this film from opening on June 29. I know that sounds crazy to the Americans in the room. I guess it is crazy.”

When Americans do get to see “Sicko,” Moore says, “They will understand that this was about helping 9/11 rescue workers who’ve been abandoned by the government. They’re not going to focus on Cuba or Fidel Castro or any other nonsense coming out of the Bush White House. They’re going to say: ‘You’re telling me that al-Qaida prisoners get better medical treatment than the people who tried to recover bodies from the wreckage at ground zero?'”

When Moore interviews Tony Benn, a leading figure on the British left, his larger concerns come into focus. Benn argues that for-profit healthcare and the other instruments of the corporate state, like student loans and bottomless credit-card debt, perform a crucial function for that state. They undermine democracy by creating a docile and hardworking population that is addicted to constant debt and an essentially unsustainable lifestyle, that literally cannot afford to quit jobs or take time off, that is more interested in maintaining high incomes than in social or political change. Moore seizes on this insight and makes it a kind of central theme; both in the film and aloud, at the press conference, he wondered whether some essential and unrecognized change has occurred in the American character.

“I hope this film engenders discussion, not just about healthcare, but about why we are the way we are these days,” Moore told us. “Where is our soul? Why would we allow 50 million Americans, 9 million of them children, not to have health insurance? Maybe my role as a filmmaker is to go down a road we might be afraid to go down, because it might lead to a dark place.”

Moore’s last revelation in “Sicko” is sure to be endlessly debated in the right-wing blogosphere that is so obsessed with him (and may be of little interest to ordinary viewers). Some time ago, Jim Kenefick, proprietor of the especially bilious anti-Moore site Moorewatch, almost shut down his site to focus on his wife’s worsening illness and escalating healthcare costs. An anonymous donor then sent him $12,000 to cover his wife’s bills and keep the site running. (She has apparently recovered.) Now that donor has been revealed and, as Kenefick now says he suspected all along, it turns out to be Michael Moore.

“I want him to know that it was done with all the best intentions,” said Moore, adding that he planned to phone Kenefick personally after the press conference. (According to Kenefick’s blog, Moore left him a voice-mail message later on Saturday.) “I went back and forth about whether to use that material,” Moore went on. “I asked myself, would you be doing this if it weren’t in the film? I decided that I would, and I should, and that that’s the way I think we should live.”

Moore says he began exercising and lost 25 pounds while working on his healthcare film; “I’m actually a fairly skinny person for the Midwest,” he quipped. He says he’s tried to maintain a lower public profile since “Fahrenheit 9/11” and would like Kenefick and his many other critics to cut him some slack. “You know, I begin to hope that as I enter the discourse with this film, I might get some kind of a break. As far as the accuracy of my movies goes, I think the record speaks for itself. Maybe people will say: He warned us about General Motors, he warned us about school shootings and he warned us about Bush.”

We’re Number Two: Canada Has as Good or Better Health Care than the U.S.

Despite spending half what the U.S. does on health care, Canada doesn’t appear to be any worse at looking after the health of its citizens

By Christopher Mims
Scientific American
May 03, 2007

Whether it is American senior citizens driving into Canada in order to buy cheap prescription drugs or Canadians coming to the U.S. for surgery in order to avoid long wait times, the relative merits of these two nations’ health care systems are often cast in terms of anecdotes. Both systems are beset by ballooning costs and, especially with a presidential election on the horizon, calls for reform, but a recent study could put ammunition in the hands of people who believe it is time the U.S. ceased to be the only developed nation without universal health coverage.

Gordon H. Guyatt, a professor of epidemiology and biostatistics at McMaster University in Hamilton, Ontario, who coined the term “evidence-based medicine,” collaborated with 16 of his colleagues in an exhaustive survey of existing studies on the outcomes of various medical procedures in both the U.S. and Canada. Their work appears in the inaugural issue of the new Canadian journal Open Medicine, and comes at a time when many in Canada are debating whether or not to move that country’s single-payer system toward for-profit delivery of care. The ultimate conclusion of the study is that the Canadian medical system is as good as the U.S. version, at least when measured by a single metric–the rate at which patients in either system died.

“Other people knew that Canadians live two to two and a half years longer than Americans,” says Steffie Woolhandler, an author on the paper and an associate professor of medicine at Harvard Medical School, citing a phenomenon that many attribute to differences in lifestyle between the two countries. “But what was not known was once you got sick, was the quality of care equivalent in the two countries.”

Americans Less Likely to Survive Treatment

According to Woolhandler, by looking at already ill patients, the researchers eliminated any Canadian lifestyle advantage and just examined the degree to which the two systems affected patient deaths. (Mortality was the one kind of data they could extract from a disparate pool of 38 papers examining everything from kidney failure to rheumatoid arthritis.)

Overall, the results favored Canadians, who were 5 percent less likely than Americans to die in the course of treatment. Some disorders, such as kidney failure, favored Canadians more strongly than Americans, whereas others, such as hip fracture, had slightly better outcomes in the U.S. than in Canada. Of the 38 studies the authors surveyed, which were winnowed down from a pool of thousands, 14 favored Canada, five the U.S., and 19 yielded mixed results.

Mortality Isn’t the Only Measure That Matters

Not all experts agree with the implication that the Canadian system is better than the U.S. system, however, or with the researchers’ methodology. Vivian Ho, who is the James A. Baker III Institute for Public Policy chair in health economics at Rice University in Houston and has spent time living and conducting research in both the U.S. and Canada, argues that the study’s focus on mortality could be misleading.

“When we look at health systems we look at other things than death,” Ho explains. In her own research on hip fracture, which was cited in Guyatt’s study, she found that the time a patient had to wait before surgery–which was significantly longer in Canada than the U.S. because of a shortage of operating rooms–made only a 1 percent difference in terms of mortality.

“But certainly if you ask people waiting in the hospital,” Ho notes, “They’re going to say I’d rather have the U.S. system…. Waiting means there’s a significant amount of distress for an elderly patient, and also higher complications for pneumonia because you have the patient immobile for so long.”

Patti Groome, an epidemiologist at Queens University Cancer Research Institute in Kingston, Ontario, said she believes that overall the paper was balanced. “But when you get into [the] meat of [the] paper they can’t sort out what’s going on…. There’s way too much heterogeneity in these studies to come to a conclusion about these systems.” In meta-analyses such as this one, “heterogeneity” in results corresponds to variations in the size of an effect across the studies being reviewed.

In other words, of the studies surveyed, some showed slightly better outcomes for the Canadian system and some showed slightly better outcomes for the U.S. approach, making it hard to draw any conclusion other than that, on balance, the two systems seem to yield only slightly different outcomes.

Money Doesn’t Necessarily Buy Health

The study’s authors highlight the fact that per capita spending on health care is 89 percent higher in the U.S. than in Canada. “One thing that people generally know is that the administration costs are much higher in the U.S.,” Groome notes. Indeed, one study by Woolhandler published in The New England Journal of Medicine in 2003 found that 31 percent of spending on health care in the U.S. went to administrative costs, whereas Canada spent only 17 percent on the same functions.

Ho believes, however, that there are also inefficiencies in the Canadian system. In her own work on hip fracture, she found that Canadian hospitals held patients for longer periods because there was no incentive to discharge them. “These patients are easier to take care of,” she explains, “and that helps [hospital administrators] justify their budget…. I think there is room for economic incentives [in the Canadian system].”

“Personally,” Ho adds, “my view is that the Canadian system is good for Canada and the American system is good for America. Neither side should switch, because the systems are a function of the population–the Canadian population believes much more in maintaining social safety nets.”

This research may already be having an impact on policy debate: According to Woolhandler, Ohio democratic congressman and presidential candidate Dennis Kucinich has plans to circulate the results of this study to Congress. Woolhandler herself would like to see this study play a part in a slightly different debate–one over whether it it is better to be sick and insured in the U.S. or in Canada. “I’d like to see politicians giving up on this mythology that the quality of care for sick people in the U.S. is unique.”

Oh yes, he’s got an agenda

Michael Moore’s new film about the US healthcare system must be seen in Europe as well as the US

Agnès Poirier
The Guardian
Monday May 21, 2007

In four tidy acts, Michael Moore spells out the facts. Act one: 50 million Americans have no health cover, and 250 million who think they do, through costly health insurance schemes ($2,000 per person a year), are often denied treatment when they need it. A guy without cover who chopped off two of his fingers in a bout of DIY was presented with an invoice for $12,000 to reattach his ring-finger and $60,000 for his forefinger. Being a romantic, and skint, he chose to get his ring-finger back.

Act two: when did it all start going wrong, asks Moore. The answer: in August 1971. President Richard Nixon and his adviser Edgar Kaiser plot to break the system. “The less care they give, the more money they make,” says Nixon, caught on tape. They? Their friends, the health industry moguls, the same ones who fund the political campaigns of US congressmen. Moore shows us the price tag on every single one of them. One in particular, Billy Tauzin, leaves Congress to become CEO of the drug industry’s top lobbying group, PhRMA, with a $2m a year salary.

Meanwhile astute national publicity campaigns have demonised the concept of universal healthcare by associating it with “socialised medicine”, which in American English translates as “Soviet medicine” – the kind such oppressive regimes as Canada, Britain and France have adopted for their citizens.

Act three: Moore pays these regimes a visit. Britain’s NHS is paid a well deserved tribute, with Tony Benn appearing as the country’s conscience. Then off to France. A mother of three explains that her state nanny does the family’s laundry while the creche down the street, with professionally trained staff, costs her 50p per hour. Moore concludes his French tour by asking: “Is there a reason why they want to make us hate the French? Are they afraid we might want to live like them?”

Act four, the most powerful: Moore decides to test the US administration’s claim that Guantanamo Bay prisoners get the best free healthcare in the world. He takes 9/11 volunteer rescue workers, whose health problems were not covered by the state because they weren’t on its payroll when they ran to help, to Guantánamo Bay in Cuba. At least he tries to. Arriving at the gates, Moore shouts through a loudspeaker: “I have 9/11 sick rescue workers, can you please open the gates?” A siren begins to wail. Moore and his troops make off as fast as they can – to Havana. Where they are treated immediately.

I know what you’re thinking, I know what you’re going to say. And so what? Yes, Michael Moore has an agenda. No, he isn’t among the giants of documentary film-making. No, he isn’t an ordinary journalist. He is, as he says, the op-ed variety, the kind who is constantly angry. He has issues with the way of the world and wants to set records straight. His goal is simply to put universal healthcare back at the centre of the American debate. And while Moore’s main objective is to reach his fellow Americans, his film should also make Europeans ponder on the system they too often take for granted. George Orwell would hate it. But forget about him for a minute. There may sometimes be such a thing as good propaganda.

Agnès Poirier, a journalist and film critic, is an independent adviser on British films for the Cannes film festival

agnescatherinepoirier@hotmail.com

“Sicko”

Michael Moore’s scathing, important look at the U.S. healthcare system has plenty to rile the far right — and a lot more to enrage the larger American public.

By Andrew O’Hehir
Salon.com

May. 20, 2007 | “I know the storm awaits me back in the United States,” Michael Moore told a wall-to-wall throng of reporters here after the Saturday morning press premiere of his new film, “Sicko.” Then he heaved a deep breath and added, “But this is just so pleasant.”

It was indeed another gorgeous, summery morning on the French Riviera, but the real heat was indoors. There wasn’t a single empty seat inside the Grand Théâtre Lumière — which holds more than 2,000 people — for “Sicko,” and dozens of stragglers were locked out on the sidewalk. Moore’s screed against the outrageous state of American healthcare was received with uproarious affection, but one might argue that Cannes provided the softest possible crowd. An American left-wing populist, attacking America’s profit-motive, private-sector ideology before a roomful of international intellectuals, at least half of them Europeans. May I introduce a new phrase into the Franglais dictionary? C’était un slam-dunk.

“Sicko” does not display Moore at his most cinematically inventive or imaginative. It presents a TV-documentary-style parade of episodes, characters and settings, bouncing from various American cities to Canada, Britain, France and Cuba (and yes, don’t worry, we’ll get to that). Moore plays a far smaller personal role in this film, appearing only occasionally in his comic-relief role as the clueless buffoon who can’t seem to grasp that healthcare in all those other countries is free, or virtually so. When he’s eating dinner with a group of Americans living in Paris who begin to list all the things they can have as free or nearly free entitlements — not just healthcare but an emergency doctor who makes house calls; not just childcare but a part-time in-home nanny — Moore puts his hands over his ears and begins singing “La la la la la.” (If you have kids or any kind of chronic family health problems, your reactions might include weeping in despair, slitting your wrists or booking a one-way ticket.)

Still, there is no mistaking the passion and political intelligence at work in “Sicko.” It’s both a more finely calibrated film and one with more far-reaching consequences than any he’s made before. Moore is trying to rouse Americans to action on an issue most of us agree about, at least superficially. You may know people who will still defend the Iraq war (although they’re less and less eager to talk about it). But who do you know who will defend the current method of healthcare delivery, administered by insurance companies whose central task is to minimize cost and maximize shareholder return? Americans of many different political stripes would probably share Moore’s conclusions at the press conference: “It’s wrong and it’s immoral. We have to take the profit motive out of healthcare. It’s as simple as that.”

“Sicko” purposefully does not focus on the 50 million or so Americans who don’t have health insurance, as scandalous as that is, but on the horror stories of middle-class working folks who believed they were adequately covered. There are so many of these they begin to blur into each other: the woman in Los Angeles whose baby was denied treatment at an emergency room outside her HMO network, and died as it was being transferred hours later; the woman in Kansas City whose husband was repeatedly denied various drugs his physician prescribed for kidney cancer, and who in the last stage of life was denied a bone-marrow transplant that could have saved his life; the woman who was told her brain tumor was not a life-threatening illness, and died; the woman who was told her cancer must have been a preexisting condition, and died.

One might respond that anecdotes like these have tremendous emotional power but little analytical rigor, but in this case I think we all know (and fear) that these worst-case outcomes exemplify the system perfectly. Moore interviews two healthcare whistle-blowers, both now plagued with guilt, who explain what should be obvious: The point of the system is to treat as few people as possible as cheaply as possible, and those who get ahead in the healthcare industry are those who find ever more devious ways to deny coverage. (For example, you can now be denied for certain preexisting conditions you didn’t know about, on the premise that you should have known about them.)

OK, let’s get to the headlines: Yes, in the film Moore travels with a group of ill and injured 9/11 rescue workers (along with several other of his film’s protagonists) to Cuba, where they receive free and apparently excellent medical treatment. It’s unquestionably another button-pushing Michael Moore stunt, designed to provoke controversy. It’s cheap but funny, dubious as evidence but affecting anyway. Moore does not even seem aware of the possibility that the Cubans were shrewd enough to see the propaganda value in this exercise, and put on a dog-and-pony show for his and our benefit. (For that matter, we don’t know how much of the visit was planned in advance with Cuban authorities.) All that aside, within the context of the film and the argument Moore is building, Cuba makes as much sense as anywhere else.

Moore begins his foreign odyssey in the film after meeting a 22-year-old Michigan woman who has moved across the Ontario border (not entirely on the up-and-up) because she’s been denied treatment for cervical cancer. He wanders around emergency rooms in London, Ontario, and London, England (where he discovers that the cashier’s window is for paying patients their travel expenses, not for settling the bill). He zips from one Parisian arrondissement to another with an on-call physician on the night shift. He dines with the aforementioned Americans abroad, who seem dazed and a little guilty about their escape from healthcare hell.

Much of this is played as comedy; Moore corners a young Afro-British couple with a wiggling bundle in the hallway of a London hospital and says cheerfully, “So — how much they charge you for that baby?” But Moore is trying to push us beyond the universally shared idea that something must be done to the slightly more controversial idea that something has been done, and that all we have to do is appropriate it. Americans have of course been conditioned for generations to believe that socialized medicine is first of all a disaster in its own terms, and secondly, the pathway to totalitarianism.

His portrayal of the Canadian, British and French systems is undoubtedly simplistic , and several Canadian reporters took that up with him at the press conference — although all of them admitted they wouldn’t trade their system for ours. But Moore’s overall point is, I think, inarguable: Flawed as they may be, those systems are a hell of a lot more humane and civilized than anything we’ve got. (Life expectancy is significantly higher, and infant mortality lower, in all of those countries than the United States. Whatever outdated stereotypes you may hold, these days poor people in Britain are statistically healthier than rich people in America.)

Addressing a series of questions from foreign reporters at the press conference, Moore said: “We should do what we always do as Americans, steal the best things you’re doing and make them our own. The Canadians do certain things very well. The Brits do certain things very well. The French have the best system in the world, and that’s not my opinion. That’s how the World Health Organization rates them. None of them is perfect, but it’s not my role to make criticisms. It’s my role as an American to say, why don’t we take the best elements you’re doing and blend them together, and call it the American system?”

Moore decided to go to Cuba, as he explains in the film, after learning the peculiar irony that detainees at Guantánamo Bay are entitled to something American citizens are not: free healthcare. In a brief and awkward scene, he tries to bring a fishing boat with his 9/11 refugees aboard into U.S. waters just off the naval base. They are refused entry (Moore is evasive about the details) and then seek treatment at the best hospital in Havana.

“The point of this was not to go to Cuba,” Moore said at the press conference. “The point was to go to Guantánamo Bay, to get the 9/11 workers the same medical care we’re giving to members of al-Qaida.” If the detainees had been at a U.S. base in Spain or Italy or Australia — all countries with universal healthcare — he’d have taken his 9/11 workers there instead. In fact, when Moore drops the jokes and political attitudinizing during the Cuba sequence, the pathos of the story makes his point for him: A poor Caribbean island, whatever its ideology, can afford healthcare for everyone while we do not. The only possible conclusion is that our society has chosen not to.

When asked about his potential prosecution for violating U.S. Treasury sanctions against trade with or travel to Cuba, Moore was uncharacteristically sober. “I know a lot of you have written things like, ‘How dumb are they?'” he said, “but I don’t take this lightly. The Bush administration may try to claim that my footage was obtained illegally. We haven’t discussed this possibility yet, but actions could be taken to prevent this film from opening on June 29. I know that sounds crazy to the Americans in the room. I guess it is crazy.”

When Americans do get to see “Sicko,” Moore says, “They will understand that this was about helping 9/11 rescue workers who’ve been abandoned by the government. They’re not going to focus on Cuba or Fidel Castro or any other nonsense coming out of the Bush White House. They’re going to say: ‘You’re telling me that al-Qaida prisoners get better medical treatment than the people who tried to recover bodies from the wreckage at ground zero?'”

When Moore interviews Tony Benn, a leading figure on the British left, his larger concerns come into focus. Benn argues that for-profit healthcare and the other instruments of the corporate state, like student loans and bottomless credit-card debt, perform a crucial function for that state. They undermine democracy by creating a docile and hardworking population that is addicted to constant debt and an essentially unsustainable lifestyle, that literally cannot afford to quit jobs or take time off, that is more interested in maintaining high incomes than in social or political change. Moore seizes on this insight and makes it a kind of central theme; both in the film and aloud, at the press conference, he wondered whether some essential and unrecognized change has occurred in the American character.

“I hope this film engenders discussion, not just about healthcare, but about why we are the way we are these days,” Moore told us. “Where is our soul? Why would we allow 50 million Americans, 9 million of them children, not to have health insurance? Maybe my role as a filmmaker is to go down a road we might be afraid to go down, because it might lead to a dark place.”

Moore’s last revelation in “Sicko” is sure to be endlessly debated in the right-wing blogosphere that is so obsessed with him (and may be of little interest to ordinary viewers). Some time ago, Jim Kenefick, proprietor of the especially bilious anti-Moore site Moorewatch, almost shut down his site to focus on his wife’s worsening illness and escalating healthcare costs. An anonymous donor then sent him $12,000 to cover his wife’s bills and keep the site running. (She has apparently recovered.) Now that donor has been revealed and, as Kenefick now says he suspected all along, it turns out to be Michael Moore.

“I want him to know that it was done with all the best intentions,” said Moore, adding that he planned to phone Kenefick personally after the press conference. (According to Kenefick’s blog, Moore left him a voice-mail message later on Saturday.) “I went back and forth about whether to use that material,” Moore went on. “I asked myself, would you be doing this if it weren’t in the film? I decided that I would, and I should, and that that’s the way I think we should live.”

Moore says he began exercising and lost 25 pounds while working on his healthcare film; “I’m actually a fairly skinny person for the Midwest,” he quipped. He says he’s tried to maintain a lower public profile since “Fahrenheit 9/11” and would like Kenefick and his many other critics to cut him some slack. “You know, I begin to hope that as I enter the discourse with this film, I might get some kind of a break. As far as the accuracy of my movies goes, I think the record speaks for itself. Maybe people will say: He warned us about General Motors, he warned us about school shootings and he warned us about Bush.”

Health policy lessons from Indiana

Indiana passes health reforms, Medicaid pay boost for doctors

By Doug Trapp
American Medical News
May 21, 207

Indiana lawmakers approved a $206 million boost in the state’s cigarette tax to pay for various health initiatives late last month, including a health plan for low-income residents and a Medicaid pay raise for doctors.

About $155 million of the increase will pay for the Indiana Check-Up Plan, a health insurance program that will provide:

* Up to $500 annually in preventive care paid by the state.

* Personal Wellness Responsibility Accounts, similar to health savings accounts. Workers, the state and employers contribute $1,100 toward health expenses.

* Basic health coverage for enrollees who exhaust the $1,100 in their accounts in any one year.

Legislators used the same bill to expand eligibility for children in the State Children’s Health Insurance Program from 200% to 300% of the federal poverty level. The measure also creates tax credits for employers offering section 125 plans — those giving employees a choice between nontaxable benefits and cash — and for employers offering wellness benefits. Another provision allows small businesses to pool together to purchase health insurance.

Indiana Check-Up is expected to provide up to 130,000 low-income residents with health insurance. Although that is just a fraction of the 500,000 people in the state without insurance at any one time, lawmakers and others said the bill is one of the most significant pieces of health care legislation in many years.

“Even though it did not solve the problem of the uninsured in its entirety, most people felt this was the best they could get accomplished based on how much money was at the table,” Dr. Kora said (Vidya Kora, MD, president of the Indiana State Medical Assn.).

http://www.ama-assn.org/amednews/2007/05/21/gvsd0521.htm

And…

Health program may be hard sell

By Lesley Stedman Weidenbener
The Courier-Journal
May 20, 2007

An estimated 850,000 Hoosiers — about one in seven — are without health insurance.

But state officials and advocates for the poor acknowledge that finding the 350,000 or so who qualify for a new state health program — and persuading them to sign up — won’t be easy.

But one obstacle for participation could be the premium that clients must pay to join…

Also, the plan’s setup — a sort of health savings account for most initial medical costs — could be confusing to people who have little experience with insurance.

But there are a million details to work through and there will be some growing pains…

Adults with incomes between 23 percent and 200 percent of the federal poverty level are eligible for the program — as long as their employers don’t offer insurance.

Coverage is capped at $300,000 annually per participant, or $1 million over a participant’s lifetime.

The program — financed by a 44-cents-a-pack increase in the state cigarette tax — is not an entitlement. That means when the money runs out, no one else can sign up.

State officials estimate the plan can serve 140,000 people, but (Indiana Family and Social Services Secretary Mitch) Roob said he’ll be happy if 50,000 sign up the first year.

A participant’s contribution to the health-care account will come in the form of monthly premiums, which will be based on a sliding scale…

While that’s about the cheapest health plan available, (former state Health Commissioner Richard) Feldman said, it could still be a tough sell among low-income people already living paycheck to paycheck.

Under the program, companies can pay up to 50 percent of the premium for eligible employees. That could be attractive to small businesses that can’t afford to offer their own insurance plans…

The state still needs federal approval to offer the plan, which Roob expects is forthcoming. And he has met with insurance companies that will bid to administer the program.

“I’m not sure we’ll get this exactly right the first time,” Roob said.

http://www.courier-journal.com/apps/pbcs.dll/article?AID=/20070520/NEWS02/705200515

Comment:

By Don McCanne, MD

Each health policy principle used to patch together this program has serious flaws. Combined, they are a disaster.

Indiana likely will end up providing coverage for less than one-tenth of their uninsured residents, but with coverage that is inadequate and still unaffordable for most. Lack of a mechanism for automatic enrollment, continual changes in eligibility status, and a funding source which is capped will further destabilize the pool of individuals covered by this program. This patchwork program is not worthy of being labeled “reform.”

With all polls showing health care to be the number one domestic issue, doesn’t that mean that we want everyone to have access to all reasonable, beneficial health care services without the necessity of facing financial hardship? Doesn’t that mean we want truly effective, equitably-funded health insurance for everyone?

You know what? You don’t get there by patching together flawed policies and then pretending that these are incremental steps that will eventually get us to health care nirvana. We have been following that path, and all parameters are worse.

So how do we get there? (Whispered secret.) Oh, no. It couldn’t be that simple. If it were, our policymakers would have gotten us there long ago!

A Short American Life

By NICHOLAS D. KRISTOF
New York Times
Op-Ed Columnist
May 21, 2007

How’s this for a glimpse into America’s health care mess:

The student winner I’ve chosen to accompany me on a reporting trip to Africa next month is a superb medical school student named Leana Wen. She receives her M.D. this month, and will research health care access this summer at a Washington think tank.

I asked Leana about her health insurance coverage, just in case she catches leprosy on the Africa trip.

“Actually, I was going to become one of the 45 million uninsured for the summer,” she said. “The think tank does not provide insurance for ‘temporary’ employees, and my school did not allow extension of health insurance post-graduation. I still haven’t found a reasonably priced insurance plan for this period.”

Aaaaargh! When a newly minted doctor investigating Americans’ access to medical care has no insurance — then you know that our health care system is truly bankrupt.

Let’s hope that the presidential campaign helps lead us toward a new health care system. John Edwards has set the standard by proposing a serious and detailed plan for national health care reform, and other candidates should follow.

The medical and insurance lobbies have been busy blocking national health care programs since they were first seriously proposed back in the 1920’s — and the result has been millions of premature deaths in this country because of people falling through the cracks. Doctors fighting universal coverage have been saving lives in their day jobs while costing lives with their lobbying.

Over all, a person without insurance is less likely to have diseases diagnosed early, less likely to get routine preventive care — and faces a 25 percent greater chance of dying early.

Americans with good jobs and complex needs receive superb medical care. But a child in Costa Rica born today is expected to live longer than an American child born today.

The U.S. now spends far more on medical care (more than $7,000 per person) than other nations, yet our infant mortality rate, maternal mortality rate and longevity are among the worst in the industrialized world. If we had as good a child mortality rate as France, Germany and Italy, we would save 12,000 children a year.

It is disgraceful that an American mother has almost three times the risk of losing a child as a mother in the Czech Republic. According to a new report from Save the Children, a woman in the U.S. has a 1-in-71 chance of losing a child before his or her fifth birthday.

Some speculate that America’s high infant mortality rate is partly a result of greater honesty about neonatal deaths or of more in vitro fertilizations. But even if those are factors, they don’t explain why a woman is 50 percent more likely to die in childbirth in the U.S. than in Europe.

The existing medical financing system also creates perverse incentives for expensive procedures; that may be why Americans are far more likely than Europeans to get C-sections. Meanwhile, the burden of paying for these second-rate statistical outcomes is crippling American business. By next year, the average Fortune 500 company will spend more on health care than it earns in net income, according to Steve Burd, the head of Safeway. Mr. Burd and other executives have formed the Coalition to Advance Healthcare Reform, creating a corporate constituency for national health reforms.

There’s evidence that the most efficient financing system would be a single-payer structure, such as that found in most Western countries. Some 31 percent of U.S. health spending goes to administration, more than twice the rate in Canada.

So bravo to Physicians for a National Health Program, a group of 14,000 doctors and other health professionals that favors a single-payer system.

But universal coverage is only part of the answer. We also need far greater attention to public health programs focusing on prevention. Two of the most important life-saving health interventions in recent decades weren’t medical at all: the cigarette tax and laws mandating air bags and seat belt use. A national public health campaign on obesity (similar to the one Gov. Mike Huckabee started in Arkansas) should be an essential component of health care reform.

Even if a single-payer system isn’t politically possible right now, universal coverage is feasible through other mechanisms — as Massachusetts has shown. We need to hold the presidential candidates accountable, for universal coverage is an idea whose time came in the 1920s. We should insist we get it before the 2020s.

You are invited to comment on this column at Mr. Kristof’s blog, www.nytimes.com/ontheground.

California family physicians support single payer

Academy in Action eNewsletter

California Academy of Family Physicians
May 15, 2007

As a reader of Academy in Action, you likely know that we have been conducting a member survey to gauge your views on the components of the health care reform proposals being discussed in Sacramento. The preliminary results are in and here’s what you said:

* Your top two priorities for health care reform are health insurance for the uninsured and the adoption of a single payer approach to health care.

* A single payer approach to health care is supported by 59 percent of Academy respondents.

http://www.familydocs.org/

Comment:

By Don McCanne, MD

Although this is not a scientific poll, it does demonstrate strong support by family physicians for single payer reform.

Feasible or not, the revolution is coming.

MAINE AFL-CIO ENDORSES HR 676; 18th STATE FED TO ENDORSE

Bangor, ME — The Executive Board of the Maine State AFL-CIO has endorsed HR 676, single payer health care legislation introduced by Congressman John Conyers (D-MI). Maine is the 18th state AFL-CIO to endorse HR 676.

The Executive Board’s resolution, passed on May 16, was proposed by Peter Kellman, President of the Southern Maine Central Labor Council. The Executive Board sent a letter, on behalf of all the labor councils in Maine endorsing HR 676, to the state’s congressional delegation. The letter asked them to support HR 676 in the House and its equivalent in the Senate.

Four of five central labor councils in Maine have endorsed HR 676. The Maine Council of the United Steelworkers, made up of 22 USW locals, recently endorsed the Conyers bill and the Maine State Building & Construction Trades Council endorsed HR 676 last November.

Bruce Roy, President of the Maine Council of Steelworkers, who is a member of the State AFL-CIO Executive Board, said the AFL-CIO endorsement resolution passed unanimously and without discussion “because anyone here who doesn’t know about HR 676 has been living in a hole.”

#30#

HR 676 would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident.

HR 676 would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

HR 676 currently has 70 co-sponsors in addition to Conyers. Co-sponsors and bill text are here:

http://thomas.loc.gov/cgi-bin/bdquery/z?d110:h.r.00676:

HR 676 has been endorsed by 270 union organizations in 43 states including 74 Central Labor Councils and Area Labor Federations and 18 state AFL-CIOs

(KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN & ME).

For further information, a list of union endorsers, or a sample endorsement resolution, contact:
Kay Tillow
All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com

For Michael Moore, Controversy Is Marketing

By MERISSA MARR
The Wall Street Journal
May 18, 2007; Page B1

Filmmaker Michael Moore says on his Web site that his new documentary, “SiCKO,” “will expose the health-care industry’s greed and control over America’s political processes.”

Controversy has become a key ingredient of marketing Mr. Moore’s work, and the backers of “SiCKO” hope that the new movie will stir up emotions and help generate the kind of buzz that made his last movie, “Fahrenheit 9/11,” both a topic of national debate and an unprecedented blockbuster in the documentary genre. “Fahrenheit 9/11” had a budget of $6 million and grossed more than $100 million in the U.S. alone.

Mr. Moore’s formula is simple: Pick a divisive topic and goad opponents into a public debate before the movie opens. The question is whether his new film’s subject material — health care and insurance — will deliver the kind of heat that he generated for “Fahrenheit 9/11,” a movie about the Bush administration’s actions before and after the Sept. 11th attacks. “SiCKO” makes its debut at the Cannes Film Festival this weekend and opens in U.S. theaters June 29.

Movie producer Harvey Weinstein, who has worked on Mr. Moore’s previous movies and whose company is financing, marketing and co-distributing this one, predicts his new release “will ignite the country once and for all to deal with health care.” Unlike “Fahrenheit 9/11,” he says the movie will appeal to both ends of the political spectrum, though it may be difficult for Mr. Moore to win backing from conservatives he has previously lambasted.

Mr. Moore’s critics — like Canadian documentarians Debbie Melnyk and Rick Caine, who recently released a movie that slammed his style — say that he understands the appeal of a good brawl. “Michael knows the entertainment quotient trumps all,” says Ms. Melnyk.

“Fahrenheit 9/11” had a lucky break early on when Walt Disney Co. refused to distribute it, a point Mr. Moore and company used to generate enormous amounts of free publicity for the film.

To help build buzz for “SiCKO,” Mr. Weinstein brought back the “Fahrenheit 9/11” team, including political consultant Chris Lehane. Mr. Lehane is perhaps best known as an ex-adviser to Bill Clinton; he helped the former president navigate such crises as Whitewater and Monica Lewinsky.

As was the case with “Fahrenheit 9/11,” the team is overlaying its traditional marketing campaign with an aggressive online outreach, including postings and chat on progressive sites like Daily Kos and screenings for bloggers. But this time it’s a broader push, including conservative sites. Says Mr. Lehane: “The film has the potential to appeal to a broader audience because it is not red state versus blue state, but the little guy versus powerful corporations and a broken political system.”

In a classic move to heighten the suspense of the project, Mr. Moore has largely kept a lid on the contents of the movie. Still, the drug companies have already started taking the bait. When Mr. Moore was just beginning the documentary, some of them sent out warnings to employees not to speak to the baseball-capped documentarian.

Rumors started circling in the industry after the filmmakers showed the movie to key groups such as the nurses’ union and leading health-care experts. The producers of “The Passion of the Christ” employed a similar tactic by screening their movie in advance of the opening for religious groups and stoking interest among Christians. The “SiCKO” team also plans to cross-market premieres of the film with organizations with an interest in the subject. They declined to name the groups.

The trade group Pharmaceutical Research and Manufacturers of America (PhRMA), has already prepared a press release that it is sending out when asked for comment on the movie, even though no one at PhRMA has seen it yet. In the press release, the group says Mr. Moore has a track record for sensationalism and will not make a documentary that is “balanced, thoughtful and well-researched.”

The sensitivity is perhaps understandable, given that the drug companies are still licking their wounds from the 2005 drama “The Constant Gardener,” a fictional film which portrayed pharmaceutical firms in an unflattering light. The trade group America’s Health Insurance Plans (AHIP) hired William Morris several years ago to help improve their image in Hollywood.

Picking a fight with the opposition is a key component of Mr. Moore’s typical marketing plan. Depending on the response of the industry, the “SiCKO” marketers have created various tactics to fire back. That may include gimmicks such as placing logos of HMOs on tombstones in newspaper ads, according to people familiar with the situation.

Mr. Weinstein acknowledges that a shrill response from the film’s targets would play right into their hands. “If they want the movie to succeed, they should fire away,” he says.

Adds Mr. Lehane: “If someone throws a $1,000 bill at our feet, of course we’ll bend down and pick it up.” He noted though that health-industry companies are likely to rely on groups they fund and political allies to respond.

Ken Johnson, senior vice president for PhRMA responded: “No one should be surprised that Michael Moore is making baseless accusations designed to drum up publicity for his movie.” He added that Mr. Moore’s movie was not on their “top ten list of concerns.”

AHIP spokesman Mohit Ghose says they will respond to the movie once they’ve seen it, but they are already focused on improving quality access to health care and affordability.

Mr. Moore has mined other sensitivities. Details of a trip to Cuba to film part of the movie have been much discussed in the press in recent weeks. Mr. Moore took a group of 9/11 first-responders suffering from respiratory problems to Cuba, where they received treatment.

That provoked accusations that he used the workers as pawns. The U.S. government also piled in, saying it had launched an investigation into whether Mr. Moore violated a travel ban by filming in Cuba.

Shortly after receiving a letter from the U.S. Treasury Department, Mr. Moore posted a response on his Web site. People involved in the movie say the Cuba scenario has been misreported. Mr. Moore’s team declined requests to clarify the details. Mr. Lehane would only say: “People will be very surprised and provoked about the motivations for the trip to Cuba and what transpired on the ground.”

Mr. Moore uses his Web site to publicize daily reaction to his movie, including the latest stories on the “controversy.” Recent headlines include a news agency story about how Mr. Moore is hiding the copy of his movie from U.S. authorities ahead of the Cannes screening. This week, it also featured a section on former Sen. Fred Thompson, a possible presidential candidate, who jumped into the debate by criticizing Mr. Moore for going to Cuba.

Mr. Moore responded by scolding the Republican from Tennessee, citing a report about his fondness for Cuban cigars and inviting him to debate the subject of health care. In a video response, Mr. Thompson, cigar in hand, declined to meet Mr. Moore and said he should think about a mental hospital, which he claimed was where Cuba locked up one documentary maker.