As a regular commentator on the state of Disaster Preparedness and corporate healthcare responsibility in the United States as well as an ardent defender of healthcare professionals, their needs and their very lives, I was both honored and a bit taken back when asked by several medial journals to attend and review Michael Moore's documentary "Sicko". I was the immediate recipient of much ribbing from colleagues, even receiving a prescription, just 32 milligrams of Zofran to be taken immediately before the movie; this from an oncologist who reminded me that Zofran is the drug of choice in preventing chemotherapy related nausea and vomiting, "if it can handle chemo, it can handle Michael Moore."
By total coincidence and an ironic twist of fate, I served federal jury duty the day I saw the movie and took an oath to hear all evidence before me without prejudice or preconception. Having being released from jury service by noon, I girded myself in that oath and drove to the theater. Plopping down my $7.50 for the ticket and $10 for popcorn and a large water bottle, I strode in air conditioned comfort to theater 8. The theater itself was virtually abandoned, despite the fact that I had chosen to attend the movie at Walt Disney World's Downtown Disney AMC Theatre at the height of tourist season. I had expected the theater to not only be full but to be filled with people who are ardent supporters of Mr. Moore and his films. I must admit I would not be among them. Quite to the contrary, I had not seen a Michael Moore film in a number of years. I do enjoy the occasional documentary and own a copy of Super-Size Me which I still recommend to patients, but Mr. Moore's story telling style is, well let's say it is not to my taste.
Within the first moments I found myself confronted with an uncomfortable fact, Mr. Moore's movie was attacking the same Heavily Mangled-care Organizations (HMO's) that were in large part the very reason that I had left private to practice. Everything that Mr. Moore said about such large organizations as Aetna, Cigna, Humana and Kaiser were true. Of course in invertible Michael Moore fashion he told only one side of the story, paying only passing homage to the fact that five-sixth of the US population do in fact have healthcare coverage and that out of 300 million people in the United States, most of whom have Internet access, he received fewer than 80,000 replies to his solicitation for healthcare horror stories. Still, Mr. Moore was actually making sense.
Unfortunately, also in an inevitable Michael Moore fashion, he quickly snatched defeat from the jaws of victory. The totally incomprehensible detour to a cold war era campaign by the American Medical Association to speak specifically against the evils of socialists and communists in medicine was juxtaposed against the Clinton era's attempt at Universal Health Care. Mr. Moore seems to have missed the fact that now New York Senator Hillary Rodham Clinton stated emphatically throughout her term as chair of National Healthcare Committee that Universal Health Care was not a socialized healthcare system.
Mr. Moore also seems to have forgotten the historical context in which the American Medical Association launched its anti-socialist campaign in those early days of the cold war. Communist fears gripped the nation for over twenty years and every "respectable" professional or fraternal organization "did its part" to combat the so-called Red Menace. The American Medical Association's campaign against socialist medicine was a political statement against socialism and communism not against Universal Health Care.
Although I am a physician I do have the unique perspective of not being a member of the American Medical Association. In fact, at the same time that the American Medical Association was actively attacking socialists and communists in healthcare; they were also attacking my profession of osteopathic medicine and therefore if anyone would support Mr. Moore's attack on the American Medical Association it should be me, a member of the American Osteopathic Association. Just as I swore earlier in the day to objectively hear the case against the defendant in federal court I must now objectively evaluate the arguments made by Mr. Moore and in the case of the American Medical Association Mr. Moore's arguments fall far short of any form of reality.
Returning to the main theme of the movie (corporate greed as the oppressor of the people) Mr. Moore next attacked the profits and policies of the pharmaceutical industry. The donations to prominent congressional members and others in government were enlightening and even entertaining in their presentation, but there was no new news here. The Food and Drug Administration and even Congress itself has decried these practices for years.
Mr. Moore then took a brief trip around the existing Socialized Medicine Programs in Canada, Great Britain and France. He went to great lengths to describe their advantages, speaking to Americans who thought that they benefited from a socialized medicine system in which they had no need for insurance and no need to pay copay's. He also spoke with fully satisfied individuals living in Canada and Great Britain.
Mr. Moore's interview with one British doctor was quite enlightening. On screen I met a physician whose entire education had been paid for by his government and his government was generous enough to pay him a salary equal as a family practitioner equal to what I make as an emergency department physician. Although, I am board certified in family practice as well as emergency medicine, I never made as much in US dollar equivalents as this young man makes now. This London doctor lives in a four-bedroom home worth twice as much as my home and drives a car worth four times as much as my car. He has these benefits not because a socialized medicine system works better or even pays better but because he was the beneficiary of socialized education through graduate school. I labor under student loan payments that almost equal my mortgage payment and will do so for a thirty-year period of time. If I had the benefits of free education, I too could live in a home worth over a million dollars, although I would still drive my Saturn because quite frankly I like it.
Mr. Moore's tour then took an unusual direction clearly designed to draw publicity rather than make any specific point. Mr. Moore took several 9/11 survivors and delivered them to Cuba in order to receive treatment for 9/11 related injuries and illnesses. Mr. Moore claims he did this because he had found an American "socialized medicine" system at Guantanamo Bay, Cuba and just wanted 9/11 heroes to receive the same medical benefits as Al Qaeda. Why not take these heroes to a state prison in Florida? The almost every state correctional institution in the United States, inmates receive the same or better care than the detainees at Guantanamo Bay. Again Michael Moore missed the mark.
I find it curious that while in Canada, a country that is accustomed to American film makers and quite frankly Americans sneaking across the border to obtain free healthcare, Mr. Moore and his would be American patient for the Canadian system found it necessary to flee Canadian police at two separate clinics in order to avoid arrest, yet in Cuba, a country well known world-wide to embrace its tourists but to be highly suspicious of those with professional movie making equipment, Mr. Moore appeared to never encounter a police officer. In fact Mr. Moore was allowed to photograph throughout the state-run Havana Hospital, the very same hospital where Cuban leader Fidel Castro received his recent medical care. Further Mr. Moore was miraculously permitted to photograph in and around a Havana fire station, exchanging gifts and even souvenir badges with fire brigade members. I find it equally interesting that these badges were conveniently available.
Mr. Moore, who appears throughout the movie, to this point, to be very upfront with the challenges and special arrangements made in the production of his film seems to leave out the fact that he doubtless had special dispensation from the Cuban government allowing both for his film making and the care of Americans on Cuban soil.
Despite these glaring inconsistencies, I was thrilled when the Cuban doctors began to touch on the issue of the relationship between the system and the healthcare professional. I thought that Mr. Moore was finally going to disclose American Healthcare's greatest shame, the total annihilation of the nurturing relationship between healthcare professionals and their corporate masters. But alas, Michael Moore again shied away from the issue... why?!
An interesting conversation took place recently between a 45 year nursing veteran and her family. The topic of the day was the nursing shortage and the veteran nurse surprised all by announcing, "There is no nursing shortage, there is a hospital nursing shortage."
She went on to explain that in the home health and non-institutional nursing fields, there is an adequate supply of nurses willing to work for employers who respect and value their services. According to this nurse who had worked in hospitals for much of her career, the problem today is that hospitals and other institutions see nurses and other professionals as replaceable rather than precious.
"No nurse my age is going to work for some young supervisor who believes that you manage people by threatening them or their license. There are too many jobs out there to deal with that nonsense."
This veteran nurse struck on the key factor in any employee shortage, the relationship between employer and employee.
Healthcare has become a split marketplace with institutional care (hospitals and nursing homes) separated from non-institutional care. Nurses are gravitating to non-institutional care despite lower pay because of the factors that Intuit and others have come to appreciate. Employees care more about the relationships than the money. Veteran nurses remember being respected and appreciated for long hours and selfless dedication. It was not expected or required, it was given freely and accepted graciously. Even in a "materialistic society" people want to be loved and cared for, respected and valued.
There is no nursing shortage, there is a relationship shortage. This is the true problem with corporate healthcare in America.
All and all I will say that Mr. Moore's film was an honest review of the current state of the Heavily Mangled-care in the United States. Greedy insurance companies take from doctors in the form of Malpractice Coverage. They take some patients in the form of health coverage; they raise profits through denials of care, restrictive practices, penalties against physicians who place patient care and safety ahead of performance numbers and by seeking to exclude those who most need insurance.
Sadly, the majority of Mr. Moore's movie missed the point. American healthcare will not be served by the conversion to a socialized medicine system. Quite to the contrary most of the equipments seen in background of Mr. Moore's movie was invented, designed, manufactured, or funded by the America's private healthcare industry. American healthcare would be best served by rebuilding relationships with the most valuable resource in healthcare, the healthcare provider. All those Mr. Moore interviewed told stories of having a favorable relationship with a system which they respected and which respected them. Regardless of whether you are a healthcare professional or a healthcare consumer, the basis of the process of healthcare is a relationship based on mutual respect, the system delivering that healthcare must live by that standard as well.
Socialized medical systems certainly have their advantages for citizens of countries willing to live with different freedoms and different lifestyles than we prefer in America. A better system is out there, we need only have the resolve to find it.
Mr. Moore also falls significantly short in failing to make note of the reasons that so many Americans require so much healthcare. Even a man with only a high school diploma such as Mr. Moore must ask himself if five-sixth of the United States population have health insurance, then why do individuals in other countries live longer than we do. Perhaps it is because we also have an excess of food, an excess of cars, an excess of conveniences. United States longevity for it's citizens and disease rates among its most vulnerable are so high not only because people put off necessary healthcare for fear of incurring debt, but because they chose instead to indulge in fast foods which are too high in salt and fat, drive rather than walk or bicycle for short errands, play video games rather than exercise, and finally watch movies about what others do rather than going out and doing something themselves.
As I watched the corpulent Michael Moore striding down the streets of London and France being passed by much thinner Europeans, I could not help but be struck by the fact that it is not our healthcare system, but our societal values that are truly "Sicko." It is time we all put down our popcorn, take our water bottles and go outside to exercise with our children.
Dr. Maurice A. Ramirez is the founder and president of the consulting firm High Alert, LLC.. He serves on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. Board certified in multiple specialties, Dr. Ramirez is Founding Chairperson of the American Board of Disaster Medicine and serves the nation as a Senior Physician-Federal Medical Officer in the National Disaster Medical System. Dr. Ramirez has a new book: You Can Survive Anything, Anywhere, Every Time. His website is http://www.High-Alert.com
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