Friday, October 26, 2007

Sicko crosses the pond

Michael Moore's film Sicko is finally being shown in British cinemas*. I'm sure many Brits will take this as an opportunity to gloat and to bask in the reflected glory of the sacred status of the National Health Service. Apparently, Mr Moore paints an overly rosy portrait of the NHS.

Don't get me wrong. I'm like many who can say "At least it's there." I've used the service for the normal, the chest infections and the sprains. I've used it for the stupidly self-inflicted wounds (I got glass in my eye from an art project gone wrong). I've used it during my pregnancy and emergency c-section. And through all that, I've never paid a penny for services and I've paid very little for prescriptions. Although, of course, I have paid. I pay through my taxes.

I've probably experienced some of the worst of the NHS. London gets a raw deal from most national services. We really don't get what we pay for. I could complain a lot about my maternal care. I didn't have a continuous relationship with any single person on the obstetrical staff. The conditions in the post-partum ward were extremely unpleasant (lack of privacy, noisy, hot and piss-poor decor**) and I rarely saw the same professional twice. But on the upside, they supported my home birth until I passed out of their clinical guidelines (baby was 16 days late). I could have chosen another, prettier hospital. But the hospital I chose was across the street from our house and is a center of excellence for obstetrical emergencies. And, at least, it was there.

And I never had to worry about how I was going to pay or what it was going to cost.

I never had to skip appointments because I couldn't pay. I never had to negotiate a payment plan with a hospital and hope it didn't go to c-section because then I'd have a bill I couldn't afford. This happened to women on the American baby discussion forum I participate in. Some folks on this forum even now have worries about their babies' health but are putting off visits to a pediatrician because they're waiting for new insurance to kick in.

We all know that there are problems with American health care, but there are problems with the NHS, too. Just different problems. Problems which Michael Moore didn't raise: From Peter Bradshaw's review of Sicko in The Guardian.

By way of contrast, Moore visits those countries with free healthcare: Canada, France and Britain. And this last visit is the one to make us sit up. With much elaborate comedy and saucer-eyed cod-acting, Moore visits the NHS hospital of Hammersmith in London, and deploying many a gasp and double-take, refuses to believe that the sick folks aren't charged hundreds and thousands of dollars. He doesn't mention the waiting lists, the filth, the degrading mixed wards and the MRSA that are a staple of all media coverage of the National Health Service. So perhaps he's got a starry-eyed view of our healthcare.

And he goes on to suggest that maybe Mr Moore has the right idea:

But isn't it obtuse to focus so excitably on what goes wrong with our health service, when so much more routinely goes right and when, incidentally, there are those with a vested interest in promoting these scare stories as an excuse for privatising it? Isn't it, for all its faults, exactly the miracle that Michael Moore portrays it?

Actually, no. The NHS is not the miracle that Mr Moore portrays. It's a system, designed by humans. Humans with good intentions, but humans who get things wrong. Like all systems it has its flaws. And when we ignore the flaws and make the system sacrosanct then we have no chance to learn from other systems and to correct those flaws, to innovate and improve.

The same with the American healthcare system. It's not the envy of the world any more. It's inadequate and does not provide the American people what they pay for. It's the most expensive health care system in the world and it's no longer delivering the best outcomes.

But yet, there are some really good things about American health care. There are some wonderful things that need to be kept and nurtured. Americans, like the British, need to look with a clear eye to their health care, keep what's right and fix what's wrong.


*I won't be seeing it - at least not in the cinema. I don't like the cinema and what with the baby and all, it's not really easy. But I anxiously await the DVD release.

** You can say that this matters little, but I think that people do fare better in nicer surroundings. Partly things were bad because I gave birth in June - and a new maternity ward was due to open in September.


jen said...

the nhs isn't perfect by a long shot, and i've been lucky enough to not really need it for much. but i still thank goodness it is there.

i read an op-ed piece by a british journalist which basically calculated costs and tried to argue that actually buying private healthcare in the US is cheaper in the long run.

and maybe it is... until you can't afford it.

and then it's not cheaper at all.

i'm not a socialist - but in a modern society, no one should have to made tradeoffs for their health.

Vol Abroad said...

I can't believe that it really is cheaper. I'd like to see that piece. I'd assume that he or she is factoring in costs to the UK like delayed treatment for the economically active. Problem is - the economically active in the US sometimes never get treatment. Sometimes the economically active in the US are stuck in dead end jobs because they can't change their insurer.

The truth is that the better off will always have better health care. Just a fact. But having no health care is despicable in a wealthy society. People landed with unpayable bills because they were a victim of a crime is disgusting.

Chris in Oxford said...

Well said. I don't agree with all your points, but it's a well reasoned argument. I'm personally a big fan of the NHS, yes it has flaws and it can be an annoying organization/ But it beats the chaos of corporate run health care in the States any day. As far as Moore, he definitely distorts the facts, but so does the other side. I think he's just trying to play their game.

As far as paying for it - I know that we who work pay for the NHS the same way that we would pay for health insurance in the States. What makes me feel better is that I'm also paying for people who can't afford to pay for it. It seems like a lot of people in the States have forgotten that it feels good to help the less fortunate.

Vol Abroad said...

The thing is Chris, I don't think we're getting the same thing. Scotland gets the best of it and your NHS is almost certainly a lot nicer than my NHS. London's health care is generally not in a good place - unless you get access to specialists.

But I totally agree America's health care is broken. And the medical and insurance lobbies spread pernicious lies to keep profiteering.

Michael Moore is full of it though - couldn't stand him since he dissed Johnny Cash in Stupid White Men.

Furrow said...

As I left my last day at work today before beginning my maternity leave, my coworkers jokingly made me promise that I would come back in a few months. I told them of course I'm coming back. My husband's job doesn't offer health insurance. Then I laughed and said, no, of course, I love this job. That's why I'm coming back.

But seriously, I have to go back. I'd love national healt insurance, just to have greater job choice.

Still, I won't watch anything of Michael Moore's. The pompous jackass just really gets on my nerves.

Anonymous said...

I work in the American health care system and know that we do NOT turn people away for inability to pay. I was a nurse in a large OB ward with beautiful private rooms and the best care. When there was an unexpected intervention (c-section or baby in ICU), the parents were connected with the CHARITY care caseworker if they didn't have insurance. And they pay what they can afford. I now work for a large corporation that provides insurance at a very reasonbale rate, but people CHOOSE not to purchase it (the cost of 2 packs of cigarettes a pay period) because they can get our version of National Health Insurance (medicaid) if they really get sick.
There are definitely things that could be better on both sides of the pond, but Michael is an ignorant SICKO not qualified to give an accurate portrayal of either system (by the way- he would have a private doctor if he belonged to a country with NHS because he can afford it).
In America, my taxes do pay for the poorest, neediest citizens (and non-citizens, but that's another issue). I pay for their children's education, food, shelter and healthcare. The picture of America in other parts of the world is very skewed. Our definition of poor is very different than say, Africa or Asia. So much of the sensationalism that occurs about how bad our health care is comes from people who think they should be able to get a miracle cure or don't understand what their options really are, or not willing to take the steps they need to take to access the resources available. They want someone to say, "oh, you poor, poor victim. I'll take care of everything for you" while they do nothing to help themselves. That is not the American way, even though some want it to be.

Vol Abroad said...

Anonymous - I've experienced both systems. That's the whole beauty of being an expat. I've been a patient in both and friends and relatives have been treated in both systems. So I do know.

People are NOT turned away for EMERGENCY care in the US. That's a very different thing than pre-natal checkups, pediatric check-ups, etc. And the reason that they aren't turned away is because the law suits and criminal prosecutions that resulted from people being turfed became prohibitive.

The very poorest in America can get care. They've nothing to lose. It's the marginally poor, it's the aspirational at risk of becoming poor that really get hit the hardest. These are the people who may not have adequate coverage or jobs with any coverage. And don't tell me people get landed with what they can afford - who decides what's affordable?

And these days even the smallest incident can turn into a financial catastrophe. I remember my own $6 hospital tylenol - and that was back in 1988. Contrast that with my current experience - because I still have maternal NHS coverage my prescriptions cost NOTHING til sometime next year. My child's prescriptions cost NOTHING until he's 16.

And puhhhlease don't tell me that the entrepreneurial and the unfortunately unemployed don't get screwed. Privately purchased health care - even with really limited coverage is astronomical - and even then you're screwed on the pre-existing. I know because I've been uninsured in America. It sucks.

And yes, Michael Moore would have a private doctor in the UK. The beauty of it is that because doctors are in competition with the US and don't have vast bloated insurance bureaucracies to support private medical care is a lot more affordable here. But if Mr Moore got in a wreck - he'd have NHS emergency care just like everyone else.