Loading ...
Sadly our blog is not yet of the status that means we get free invites to star-studded premieres, so I had to go and buy a ticket to see it at my local multiplex. Perhaps for the next one I’ll be able to give you anecdotes of strolling down the red carpet while Tom Cruise explains to me about Xenu.
I’ve always enjoyed Michael Moore’s work. His movies aren’t perfect; Moore has been known to massage the facts in order to fit the argument, and his narration style can be more than a little preachy. Even so, I can’t help but feel that anyone who inspired such incandescent rage among members of the American Right must be performing some sort of useful public service.
Sicko doesn’t seem to be filling cinemas quite so much as his previous film Fahrenheit 9/11 did, which is a shame because in many respects I think this is a better movie. For one thing, the slightly irritating preachiness is much less evident on Sicko. This is mainly because Moore seems more keen to allow those he interviews to tell their own story without any interjection from him. And the stories they tell are often extremely harrowing ones.
I was aware that the US has large numbers of its own citizens without any health insurance (45.8 million in 2004), and certainly several American friends of mine have told me that they found it impossible to find affordable insurance. However, what I wasn’t aware of – and what really shocked me in this movie – was the stories from people who did have health insurance, and were denied care on often spurious grounds. Among those interviewed were:
A woman who was refused payment for the blue-light ambulance ride after being pulled out of a car crash, because the ambulance journey had not been pre-approved with the insurance company.
A mother who rushed her 18-month-old daughter to hospital with a raging fever, only to be told by her insurance company that she could only be treated at one of their affiliated hospitals. She got her daughter over to the affiliated hospital just in time for her to go into cardiac arrest and die.
A girl who was going deaf whose parents were told that only a cochlear implant in her left ear would be paid for, as putting one in both ears would be “experimental treatment”. After the parents informed the insurance company that Michael Moore was taking an interest in their case, the company decided that a cochlear implant in both ears wasn’t so experimental after all, and reversed the decision.
A woman refused payment for life-saving cancer surgery because when she took out her insurance policy she had failed to disclose that years beforehand she had been treated for a yeast infection.
But most shocking of all to me was the CCTV footage of confused, elderly, sick women who, no longer able to pay their hospital bills, had been bundled out of a hospital and into a taxi, to be then unceremoniously dumped on the doorstep of the local homeless hostel. For all the (many) faults of the NHS, I can’t imagine the shabbiest, most understaffed, MRSA-riddled NHS ward abandoning an ill and confused person in such a horrific way.
Which leads me onto the second half of the movie, in which Moore compares the US experience with that of patients in Canada, Britain, France and, most controversially of all, Cuba. As I mentioned previously on this blog, the US currently ranks 37th in the world in the WHO ranking of healthcare systems, in between Costa Rica and Slovenia. Meanwhile the UK, which spend significantly less per capita on health than the Americans, ranks a respectable 18th. The number one spot, incidentally, goes to France.
Critics have accused Moore of glossing over the flaws in the healthcare systems of those other countries, and it’s true that when he features the British NHS he doesn’t discuss waiting lists, or nurse: patient ratios, or rates of hospital-acquired infections, but focuses on the main selling point of the NHS – that it’s available for all and free at the point of use. Moore seems particularly shocked and befuddled by our fixed-rate prescription charges. “£6.65?” he asks an increasingly amused British pharmacist, “But what if there’s 60 tablets in the packet instead of 30? 120 tablets? Still £6.65? What if it’s a brand-new HIV drug? Still £6.65?” Good job he didn’t go to Wales, where the prescription charge has been abolished altogether. He’d have been so weirded out he’d be in dire need of some Lorazepam. Still, he’d be able to get it for free.
By contrast a 9/11 rescue worker, brought to Cuba by Moore to receive the treatment she was denied in the US, breaks down in tears after being offered a Salbutamol inhaler for the equivalent of 5 cents. She reveals that despite needing two of these a month, she has been having to pay $120 (about £80 if my memory of the exchange rates is correct) per inhaler. An appalling amount of money to ask of a woman unable to work, particularly as a result of injuries received while trying to rescue people from the rubble of the Twin Towers.
Overall the film is a shocking account of the way in which untrammelled corporate greed has been allowed to systematically undermine US healthcare services, with tragic results for the people who depend on them. It also left me with a feeling that, however much we complain about the flaws of the NHS – and we do, at length, particularly on this blog – its fundamental principles are ones that are worth defending. Rather than trying to adopt the US model, we should stick with our own system and try to make it work properly.
And if we don’t succeed….well, we could always move to France.
Bloody intersting Z. I have long held a personal pet theory that the percentage of people unable to provide a reasonable standard of living for themselves was static in the USA, whereas it is increasing generation upon generation in the U.K as the welfare state provides a viable option to working for a living. I had no idea that 45,000,000 people in the U.S exist without any form of health insurance ( assuming that`s correct, Mr. Moore isn`t averse to a bit of propoganda ). I think we need to have a damn good look at what`s going on in France !.
The 45 million figure didn’t actually come from Michael Moore. I just googled it. I forget what figure Moore says in the movie.
Though personally I was more horrified by the stories of people who were insured and still didn’t get the healthcare, because the insurance jumped on spurious excuses to deny the payment.
[chide]
Naughty Zarathustra.
In Europe, don’t we have the Cannes Film Festival?
In the UK we watch Film Four on the television?
Our national museum is the National Museum of Photography, Film & Televsion too.
So, in the UK, we have films.
In the USA they got rather excited about moving pictures (movies) and after silent film, they even have talkies. Cooo. Fun times.
Given we’re not in the USA, what’s with the “movie” and not “film” thing you’ve got going on here?
Much badness
[/chide]
Sorry Shrink. I was too busy jaywalking off the sidewalk outside the movie theatre to notice the Americanisms. I’m off to get my meds from the drugstore.
That would be movie theater, I assume zarathustra?
Moore is a huge, bloated ego-monster. Ever since I found out he has shares in Haliburton, I couldn’t take him seriously. Not that there’s anything wrong at all in having shares in Haliburton, but there is if you’ve spent mahoosive amounts of time droning on about Iraq and evil old America’s hypocrisy.
I’m not so sure we can clutch our pearls about the US healthcare system when our own NHS is still failing people so dreadfully. Confused elderly women may not be dumped outside the local homeless hostel, but they sure are left in their own shit for hours on end, or ferried about nursing homes because of ‘rationalisation’, or left languishing in medical wards for weeks on end, or killed off with C diff. People may not be denied treatment because their insurance won’t cover it, but try and find an NHS dentist within 5 miles of your own home, or decent out of hours care. Children may not be required to attend an insurance company’s affiliated hospital, but we’ve all heard tragic stories of overworked medical staff missing some pretty obvious signs of meningitis.
The horror stories of the US healthcare system are often told in order to make us grateful for what we’ve got. But countries with Bismarckian systems of healthcare funding beat us hands down every time.
I’m not saying the NHS doesn’t have its problems (it has many), but if our system is so much worse…
- why does the WHO rank the British healthcare system as 18th in the world and the US system at 37th?
- why do we have higher life expectancies than the US? (80.97 years for a woman, 75.15 years for a man in the US; 81.3 years for a woman, 76.23 years for a man in the UK)
- why do we have lower infant mortality rates? (6.37 deaths/1,000 live births in the US; 5.01 deaths/1,000 live births in the UK)
(The above figures from the CIA World Factbook)
…and this despite the fact that in 2003 the US spent $6,711 and the UK spent $2,317 per capita on healthcare spending. In other words we have slightly better life expectancy and infant mortality for just over a third of the cost.
(source here)
Meanwhile, of course, those perfidious French are doing better than both of us. Life expectancy at birth of 84 years for a female, 77.35 years for a male. Infant mortality rates of 3.41 deaths/1,000 live births .
The French spent $3,048 per capita on health in 2003. Significantly more than we did, but still less than half the US figure.
What those figures suggest to me is that socialised medicine works. The only reason it isn’t working here is because we aren’t funding it properly.
Don’t get me wrong, z, I’m not saying our system is worse than the US one; I’m simply pointing out that we often snigger up our sleeves about the US system, imagining ours is so much better when, in many respects, it’s just as crap but in a different way.
Moral of the tale: Let’s all move to France.
France would be great if it wasn’t for all those French people.
Ahhh, the French seem to do so many things better than us – socialised medicine, sex, fashion, sensible drinking, sensible eating…not sure why they seem to have a blind spot about decent public toilets though.
Last time I was in France the thing that annoyed me most about the place wasn’t all the French people so much as all the sodding Brits. All these upper-middle class Nigels and Nigellas who’ve bought their second home there and want to pin your ears back and tell you at utterly tedious length about French lessons, car boot sales and the lovely patio they’re adding to their gite…they just go on and on and ON until you have to pin them to the floor and beat them to death with a rolled-up copy of the local English-language periodical. Twunts.
But I’m digressing here…
‘Ere – are you slaggin’ off the lovely Nigella wot does the cookin’ now eh EH?! Cos if you are, you’ll ‘ave me to contend wiv, geez.
Nigella is a GODDESS and don’t you forget it.
We may be 18th and the US 37th but the real point is that the health system in France is ranked 1st. So between between the extremes of our socilaised health care system which is only a little bit crap and the American system of privatised health care which is really crap there is a third way (The French/ German/ Dutch) way which is actually rather good. I like French food which is better than British food when can I have a French system of Health care too?
In some respects it could be argued that the NHS has done remarkably well when we compare outcomes to the proportion of GDP spent on health.
Think about the huge ACCUMULATIVE difference in %-terms over the last decade – the UK has ALWAYS lagged behind the big two [France/Germany] and miles behind the Swiss who spend a higher percentage of GDP than any other country in Europe.
A bit more cash has been pumped into the NHS recently but still not enough to bring us into line with the Franco-Prussians.
Less than 10yrs ago the NHS was spending a meagre 6.7% of GDP according to data from the Institute of Fiscal studies – while in comparison the US was spending almost twice that amount
http://www.ifs.org.uk/bns/bn21.pdf
So how has the NHS managed to perform so well given the substantial differentials in expenditure ?
Well, to a certain extent the NHS has never been constrained by costs associated with administering various insurance schemes.
And before the EWTD junior doctors in the NHS were expected to routinely work a 100 hrs week – which other profession would give over 50% of it’s time gratis ?
More recently the NHS has been at the forefront of role expansion for nurses [psych liaison nurses, ENPs, etc, etc] – a catastrophe in some peoples eyes, although these fears have not been borne out in research terms strangely enough.
Meanwhile Thatcher and then Bliar have been shitting on the grunts for well over a decade now – despite this I’ll bet most of the contributors on this thread see themselves as part of the solution rather than part of the problem ?
A bit more cash!!!!!
NHS spending is now at £90 bn pa. Since 2002, it has increased by nearly 50%, or £43.2bn. That’s a real terms growth of 7.4% pa, and takes us close to the EU average for health spending as a percentage of GDP. So despite being hosed down with money in recent months and with spending at or near the EU average we still have a health care system that only ranks 18th in the world.
To be fair, lots of that money has been sucked up by – mostly – pay and reforms. Oh those reforms! I think a lot of money (and goodwill) has been wasted by this government as it seems to me we’ve gone right round the houses to come back to where we started with the recreation of an internal market.
18th in the world ?
Yes, the NHS creeps into the top 10%, arguably not too bad given the history of CHRONIC UNDERFUNDING [sorry, if this is starting to sound a bit like Top of the Pops.....and at number 3 we have, Sweden, etc].
Beakie has already pointed out that a fair proportion of the extra dosh went on pay: the new consultant contract, revised arrangements for GPs, vast sums squandered on Agenda for Change, etc.
The marketeers might argue that NHS staff are no longer value for money, and perhaps they should be replaced with docs/nurses who speak with a French or German accent – but hang on, aren’t we well down this road already, if we look at the sizeable percentage of NHS staff trained outside of the UK ?
If the NHS is being hosed down with money which services are akin to the type of hospital one might come across in a telly advertisement for Bupa – certainly not the c-diff infested wards in Kent, that’s for sure.
I’ll bet many staff on the acute psychiatric wards would also prefer more space, individual rooms, and yes, OK the type of coffee maker to be found in Starbucks, or Costa ;o)
And there are still far too many occassions when acutely disturbed psychiatric patients are stranded in A&E for too long [irrespective of the 4hr-target] while staff search franticly for an ECR bed, even though many of the wards in London continually “hot-bed”.
These cases are a logistical nightmare, since they invariably involve trying to sort out faxes, suboptimum telephone hand overs, RGN nurse escort [nowhere near as knowledgeable as RMNs when it comes section papers, significance of subtle symptoms, etc], trying to organise an urgent ambulance – while all the time worrying about patients becoming increasingly frustrated with an ever present risk of absconding.
So if there is so much money swirling around nowadays, it’s either not being directed to where it is most needed, or staff are mismanaging acute psychiatric beds, as well as elderly care wards ?
I suppose the point that leaps out at me is that if we have roughly the same life expectancy and child mortality rates as the US, but only spend a third of the money, then if nothing else the NHS system gives you much more healthcare for your cash, even though both systems are clearly failiing people on a regular basis.
Which does beg the question of what our NHS would be like if we spent the exact same amount of cash per capita as the Americans. I’d be willing to wager it would be absolutely first rate.
I don’t think the problem comes down to cash alone. The fact that Gordo has flooded the NHS coffers with cash proves that to be the case. I think there is something in the very nature of the NHS that militates against its success.
Its status as a state-controlled organisation means it too often becomes a political football – hence the rafts of reforms, initiatives, diktats and policy documents from the centre, all aimed at giving the NHS an election-friendly gloss. It also means it becomes a bit like a well-loved old car – it doesn’t really work properly any more, but nobody wants to dump it because they’re so fond of it.
I also think the fact that there really is no proper accountability for failure means that poor performance and functioning at all levels can go on for years without being addressed.
The US system isn’t the answer, but we really do need to investigate the French model. Administration costs might actually be higher, but the rewards seem so much more – er – rewarding.
It would take a brave politician to tackle the NHS, but somebody will have to do it in the very near future.
An article here about the French model of healthcare: http://www.iht.com/articles/20.....dutton.php
The money Gordon the moron flooded the NHS coffers with,went straight in the pockets of all those consultants he’s brought in to make the NHS more american and of course the 40% pay increase for those hard working GP’s and consultants and that that lovely disaster of a computer system which won’t work.
Talking of the french system,I had a french patient who was some enamoured with it he came over here for his psychiatric treatment,which possibly indicates something about their mental health system.Im sure their physical treatments are excellant but as people have said no countries health care is perfect.If we would spend as much as the french we would be much bettrer off but unfortunatly the whole system is being geared to the american model,so american companies can come in and make loads of money and then when Gordon is kicked out he can join the ex prime ministers public speaking tour of the USA.
There’s still lots of finger wagging even for the so-called best system in Europe ?
http://news.bbc.co.uk/1/hi/wor.....423159.stm
http://www.heatisonline.org/co.....ethod=full
I am an American ICU nurse. I have, personally, fixed patients: I have given meds and complex dressing changes and respiratory treatments and have consulted with physicians upon on how to improve their health and finetune their meds or whatever…. And then I put them into a wheelchair, taken them to a cab parked outside the ER.
Sometimes, the case manager has had the time to find a HUD flophouse apartment for this person, and the cab goes there. Most of the times, the cabs go to homeless shelters or to wherever the patient says they “live”. More than once, the HUD flophouse apartment has called the unit to ask where the patient is…they were expecting them. We call the cab company, and the cabbie says the patient wished to be dropped off at a bar.
This doesn’t even make news in America because it happens every day in every hospital at least once or twice a week per unit.
My hospital has helped a lot of patients in the community by providing these uninsured people with, say, a week’s worth of Zyprexa. I’m sure that nurses in this community can appreciate how helpful a week of Zyprexa is to a psychotic patient with no support system. One who likely washes said Zyprexa down with a 40.
I haven’t seen this movie yet….and now I will.
Moore’s statistics do not at all sound like an exaggeration to me. I myself have been uninsured and uninsurable because I “have a preexisting condition”: asthma. Ergo, because I was diagnosed with this, unless I get health insurance in bulk through an employer who offers it, I cannot go see a practitioner to have the asthma treated.
The new prescription meds coverage for the over 65 set that is government-run Medicare WILL bankrupt this country completely. If it’s not a totalitarian police state first.
I’m sorry, my dear, dear Brits. Your NHS is not perfect, I’m sure. But you cannot possibly think it’s worse there because I’m telling you it cannot be. People in Zimbabwe have a health care system that’s worse than ours. Probably Robert Mugabe isn’t big on providing vaccinations for school children or blood pressure screening for adults. Much less acknowledging that HIV exists and is rampant death and creating a society of orphans who will rise up and be the Lord of the Flies in his country.
Compared to them, the US has no room to bitch.
Thirty four percent of the people in my state are uninsured: 1.4 million people. They receive no routine, preventative care. They go untreated for hypertension, cannot afford a glucometer or strips and syringes to measure their blood glucose and so wind up in the ER with diabetic ketoacidosis and on my unit.
One third of Colorado’s population’s only option is an extravagantly expensive visit to certain emergency rooms in town that will take them. My hospital is one of two left in the Denver metro proper that will admit them inpatient. Other metro hospitals in town are required by law to take them in the ER, and then they will ship patients that require hospitalization to beds in MyHospital or our County Hospital.
The other hospitals, over the past seven years (after being bought by EvilConglomerate I or EvilConglomerate II), have moved to the suburbs. Fewer mentally ill or chemically dependent people found sleeping on benches there. Fewer elderly people. Fewer other-than-English-speaking groups.
MyHospital and County Hospital are the ONLY hospitals in the east/mountain region (my state alone is larger in size than the entire UK…and the Rocky Mountain regional population is about 12million…1/5 of the UK population) that are medical and have inpatient psych.
(I don’t have any statistics on whether people here are relatively crazier than they are there, but I’m guessing we may well be less sane than you.)
Our state psychiatric facility must ship psych patients who develop medical conditions to MyHospital and County. Specifically, to my ICU and County’s ICU. MyHospital’s inpatient psych has such a demand and is always wall-to-wall full that they refuse to have anyone on 1south who has even the sniffles. Why should they? Go fix the sniffles, and in the meantime, that bed can be used for another deeply suffering bastard who doesn’t have sniffles.
So I have taken care of patients who are from the County Psych Hospital with medical conditions and those are the lucky ones. Because I fix them medically and ship them back to County Psych. They’ve been on their meds for their time there and they are, while not functional, in FAR FAR FAR better shape than the ones I get from the ED.
They’re so lucky that County Psych sends a behavioral tech person as a sitter so that I can actually focus on what I need to do clinically.
The unlucky ones are those I (me and four of my closest male nurse friends, usually) have to emergently hogtie the patient to the bed before I can assess them. Then I get to beg for a psych eval that very frequently never comes. It’s left to the internal med guys to not only fix whatever Axis I the patient has goin on, but to somewhat arbitrarily pick a psych drug for what Axis II the patient might have exhibited in the 7 – 8 minutes that MD got to assess the patient. Psych drugs we start them on, give them consistently for two or three days, obtain a clinically useless blood level, then we put them back in the cab.
You guys are right to find it unjust that you can’t get adequate treatment for patients who need psychiatric care. I hope my ranting doesn’t sound like I don’t think you’re right to advocate for better care for your people. You go. You fight for them. They need every one of you.
In America, we can’t get adequate care for patients who come into the ER without a pulse. They need me. And I don’t know what the hell to do for them.
Soapbox removed. Thank you.
We need some French nurses to comment.
/justcallmejo
Hi Jo. Thanks for dropping by.
I have to say, some of those stories you’ve just related are shocking, and to this namby-pamby Brits, utterly incomprehensible. One thing we certainly don’t do over here is put sick people into a cab and send them off to the nearest homeless hostel. If people need aftercare, they stay in the hospital until a care package is in place. This does cause a lot of problems with “bed-blocking” though, and is a major contributor to the size of our waiting lists. Though on balance I think I’d rather we try to deal with that problem rather than just start putting patients into cabs.
Thirty four percent of the people in my state are uninsured: 1.4 million people. They receive no routine, preventative care. They go untreated for hypertension, cannot afford a glucometer or strips and syringes to measure their blood glucose and so wind up in the ER with diabetic ketoacidosis and on my unit.
Again, I have to say that’s something that’s inconceivable over here. It sounds like for all the many flaws of the NHS, we do at least manage to do preventative medicine effectively.
Good luck with getting some treatment for your asthma. If all else fails, I’m sure we could use another ICU nurse over here. You’d probably have to take a big pay cut compared to US nurse salaries, but you’d get your inhalers for £6.65.