Readers Write

Gary Baldwin, for HealthLeaders Media , August 28, 2007

Thanks to the numerous folks who wrote me in response to my recent analysis of the film "Sicko" by Michael Moore. The mail ran pretty evenly divided, and I have excerpted several for this week's column. I'm not going to comment on them, but will say from my perspective as a journalist that lopsided storytelling serves mainly to preach to the choir and sheds little light on complex issues.

Many of you inquired as to how much my recent ED trip cost. Here are the amounts billed to the insurance company: $3176.77 for all hospital and physician services; $408 for the ambulance ride. Judging from the letters below, I'd say the only consensus around such fees is that there is no consensus as to why they are so exorbitant.

The system is broken

Only a representative of our entrenched healthcare factions could write that kind of review.Our healthcare system doesn't work . . . at all. We have poor outcomes as compared to most if not all other developed countries. We spend more and don't get the adequate return on that investment. Our system is profitable, for the consultants, for-profit facility flippers and overpaid professionals (non-clinical) that populate our facilities. While anyone could find some fault with some of Moore's claims, you have to look at the overall message, which is effectively delivered.

Too many people fall through the cracks, our system costs too much, and it really isn't as great as we claim it is. Hey, look at all the IT spending we make (joke) and how effectively it measures quality. By the way, can the public compare ANY data? Sorry for the aggressive tone, but you're chugging the Kool-Aid.

Anthony J. German

Candor appreciated

I appreciate your candor and overview of "Sicko." Please keep publishing the extraordinary efforts that healthcare workers (including administrators) make everyday to take care of patients in the struggling healthcare marketplace.

Justin Perkins
Project Coordinator
Scott & White Hospital
Temple, Texas

Is Vermont dreaming?

Enjoyed your article about Michael Moore. What does he do for his health not to become a burden on our medical system?Your article referred to the English medical system and the problems they have implementing an electronic medical record program. Cost overruns and delays.

Now, the Vermont legislature has funded a proposal that concludes that Vermont should implement a health record system that will cost an estimated $62,000 per physician in the state and be ready by 2014! They must be dreaming.

S. Erik Skoug
President, Skoug Group

"Widening gap" in U.S. politics

Thanks for the direct, but humorous slam on the wayward Michael Moore. He is most illustrative of the widening gap in America when it comes to political views and how to fix complex and serious issues.

As someone who has worked with hospitals and physicians for more than 23 years, I know that the system is disjointed and there is chronic overconfidence that technology will solve all of the problems. However, you cannot solve the problems as you point out when people are becoming huge and sue over all issues.Keep up the great work.

Kenneth R. Carr
Vice President Consulting Services
McKesson Corporation

HMOs put profits first

There are many facets to the problems that are leading us to a healthcare crisis in this country. You have brought up some of these factors. You have stayed away from the so-called money saving organizations that were brought on due to carriers trying to make more money (as opposed to cutting healthcare costs to consumers).

When pharmaceutical adjudicating companies that were created over the last decades bring in offers to purchase in the $20 billion dollar range, you have to agree that these so-called innovative money saving companies created for our commercial healthcare system may be siphoning off more then they may be saving.

Our HMO system was based on denial of benefits. When I started in this industry 18 years ago, I looked at HMOs as a wonderful, innovative idea of controlling health thru regular checkups and education. I worked in a capitated, multi-specialty geriatric clinic. Our philosophy was if we keep our patients healthy, we will make money.

Unfortunately the companies who controlled our revenues (the HMOs) wanted to make more and the revenues started to become smaller and smaller. The nation's insurance companies that were given the financial guardianship over healthcare expenditures abused their responsibility. I now run a 10-physician pediatric group whose physicians see up to 65,000 children a year (only about twenty percent Medicaid).

Our latest crisis is trying to figure out where we can come up with monies to renovate an office that we have not done much with over the last 20 years. So where is the money? Our largest carrier increased premiums 85 percent over the last five years yet their reimbursements to us are lower in most E/M codes then they were 10 years ago. The large carriers who control the most covered lives should be shuttered for the sake of America's health. You should do a little more research into the spiraling devastation they are creating.

Harvey Brownstein
Practice Administrator
Clarkstown Pediatrics

Government is not the answer

Being a healthcare consultant for over 30 years, I, too, came away with basically, the same impressions that you did. My wife and I saw the movie, and it became evident that director Michael Moore's message is that universal healthcare is the answer. And my thought was, "If you like our postal service, you'll love government-run healthcare." The culprits of our healthcare crisis are attorneys, insurance companies, managed care, government regulations/reimbursement, pharmaceutical companies and other vendors who gouge the system. It's not the providers and caregivers who are there, 24/7 and 365 days a year. Keep up the good work.

Bill MacFarlane,

Principal, Cardinal Consulting, Inc.

Serious flaws in the system

I found your review of "Sicko" to be quite unsatisfactory. I'd like to see you re-edit it without the ad hominem attacks on Mr. Moore's weight. He is trying, as noted on the Diet Blog. But clearly this is beside the point. Moore does not hold up the Canadian, French or British systems as utopian solutions. "Sicko" showed some of the serious flaws in our system and showed some of the serious benefits to others.

That really is the bottom line. There are lots of complaints about what Moore "left out." Well, it's only a two-hour movie, and I think it is not his job, nor his role, to be the healthcare czar and review every nuance of healthcare here and abroad.

He had a lot of points to make, and he made them very well, very humorously and sometimes heart-breakingly poignantly, as you acknowledge. He doesn't tell the downsides of universal access in other countries, but, frankly, as we healthcare providers know (I'm a critical care physician) better than the average viewer, neither did he scratch the surface of the problems so widespread in our "system."

But he always says in interviews that, of course, other systems have problems. Our goal should be to take the best parts of each of those systems and craft an American system better than all the others. But, he makes no bones that this needs to be a single payer system at its core. He seems to have no bone to pick with physicians. He believes the focus of reform should be getting rid of private health insurance as we know it.And if you think "Conspiracies, and bad guys, and greedy corporations" are only "the stuff of Hollywood," then you are really not paying attention.

Christopher M. Hughes, MD
Co-Director, Critical Care Services
St. Clair Memorial Hospital
Pittsburgh, PA

Trivializing the complicated

Thank you, thank you for putting into perfect words how many of us are reacting to this movie! I absolutely felt sorry for the players in "Sicko," but dismayed that Moore could trivialize the solution for something so complicated. Ya think people haven't thought about universal healthcare before? Weighed the pros and cons? Clearly, as you described, we have bigger issues that universal healthcare cannot solve that start with ourselves.

I'm afraid many people who watch it will be too swayed by the drama and fantasy of universal healthcare in this country to look at reality and understand how much more complicated it is!

PS--I have a number of family members in Canada, and I guarantee universal healthcare is NOT the heaven Moore claims it to be. It has its own set of issues and challenges that I don't think our country, which is 10 times bigger and more consumptive, can handle.Renae Virata
Major Account Executive

Fear of the unknown

As a physician, I would strongly disagree with your assessment of both the movie "Sicko" and the need for universal healthcare in this country. A lot of the dialogue about universal healthcare is driven by fear of the unknown, or the assumption that "the devil I know is better than the devil I don't know."

Right now, we have approximately 48 million uninsured individuals in this country, the richest, most powerful nation on the planet. I count many friends among those who either are or have been uninsured, and even my family and I have been uninsured for as long as a year. It isn't that people are choosing luxury items over health insurance, it's that health insurance costs are exorbitantly high.

And then there are the games that insurance companies play, such as denial of coverage due to a preexisting condition. I have done work in a managed care company, and what sickened me was how focused the company was on restricting their payouts, rather than emphasizing excellence in disease management or preventive care.

Yes, we are a nation of people who do not generally do well in terms of not smoking, drinking, maintaining a normal weight or other healthy lifestyle measures. But this is exactly the sort of thing that could be aided by a universal system in which preventive efforts were encouraged to a greater extent than they are under MCOs.

Just consider the situation from a business perspective: We're spending more per capita on healthcare yet derive far fewer returns than any second-world country out there. A decent CEO would recognize this and change course to something proven, and judging from the experiences of many other countries, UHC would seem to be proven. Is it perfect? Of course not, but even with its limitations, it would seem preferable to our current broken system.

David Toub, MD
Vice President, SciFluent Communications

Stick to the facts

I loved your take on Shtick-o. It's amazing how loosely Michael Moore throws around the term "documentary" and expects the public to consume it as fact.

Dave Anderson
Dodge Communications

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at

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