by Paul Sorum, MD
Daily Gazette (Schenectady, NY)
July 29, 2007
You should see Michael Moore’s SICKO. You will both laugh and cry. You will feel disgusted both with our health care system and with Moore. It is, in Moore’s typical style, outrageous, one-sided, and contrived.
But its fundamental message–that the private health insurance industry is dangerous to our health–will resonate loudly with patients and physicians. Here is why:
* Private insurers impose on medical practitioners and their patients a huge financial and psychological burden of rules, paperwork, delays, and denials. Even their attempts to improve “quality” scores increase this burden.
* Private insurers add enormous extra costs to our already skyrocketing medical expenditures. These include both insurers’ administrative costs–the salaries of their highly-paid executives and armies of employees, their marketing expenses, and (in the case of for-profit insurers) their profits–and the billing-related costs imposed on providers. In 2001, we spent $351 per capita on administrative costs, while the Canadians spent only $54 and the French only $48.
* Soaring health premiums–caused in part by private insurers’ administrative waste–are causing employers to reduce or drop health insurance benefits and preventing individuals from purchasing adequate insurance. Not only are 47 million (15% of the population) currently uninsured and many more millions inadequately insured, but these numbers are rising inexorably.
* As long as health insurance is a market commodity, private insurers must reduce their costs as much as possible, i.e., must spend as little as possible of their premiums on actual health care. Even if individual medical directors and other employees are virtuous and well-meaning, they must avoid sick patients and deny care if their companies are to survive in the market.
* Private insurers cannot make the health of the population their top priority. They must, like other businesses, focus on short-term results, not on the long-term health of their enrollees (especially since these people are likely to change insurers and eventually switch to Medicare). Moreover, in marketing their products to select groups, they fragment the population and undermine our already-fragile sense of social solidarity: they reinforce people’s short-sighted inclination to refuse to pay for those with more health needs, and fewer means, than themselves. They encourage healthy people to forget that they might one day suffer major illness and injury and that they and society as a whole benefit if all people are as healthy as possible.
So what does Moore offer us as a solution? He takes us to other developed countries–Canada, Britain, France–where private insurers have greatly reduced roles. These countries have, of course, more problems than Moore shows us; no system can be perfect. But they provide high-quality health care to all residents, at half our cost. They have high levels of patient satisfaction (yes, in spite of complaints in Canada and Britain about waiting lines). They interfere in patient-physician decision-making less than do US managed care companies. Their health systems are based on the principle that all residents should have the health care they need.
But would a publicly-financed system be, in some way, un-American? As Moore points out, we already use public funding for other social goods like schools and fire protection. And we already have in this country a health program that is publicly funded, liked by patients, and efficient: Medicare. Recently, for-profit Blues spent 26.5% of premiums on administrative costs, commercial carriers 19.9%, not-for-profit Blues 16.3%, and Medicare only 3.1%. If we expand Medicare to provide comprehensive coverage for everyone, we will, therefore, not only improve the health of our population and eliminate the scandal of the uninsured, but also end up saving money!
What then should you do? See SICKO and bring our elected officials with you. Convince them that Americans’ health is too important to leave in the hands of the private insurance industry. Convince them that, like the Canadians, British, and French, we should provide our people with the health care they need, not what they can pay for.
Paul Sorum lives in Schenectady, is a primary care physician in Latham, and chairs the Capital District chapter of Physicians for a National Health Program.