29 October 2007

Michael Moore vs The Trillion Dollar Health Rip Off.

Americans spend almost as much on healthcare as the entire GDP of the UK economy and will soon spend more than our entire economy (currently 15% of US GDP - and spending is out of control. US health spending is set to rise to 20% of GDP by 2017). Over 44% of this spending comes from US taxes. US taxpayers contribute more per capita to health costs than we do in the UK.

Moore's argument against the...
US system is not just about fairness, it is about efficiency. The US system is a mess. Even an extremely rightwing blogger like Devil's Kitchen has moved to the left on this issue and will not defend their health system anymore.

Michael Moore's new film - Sicko, is not about the 50m Americans who have no insurance, it is about the poor health cover the 250m insured Americans get for their money.

The following results are what you get, when you hand over healthcare decisions to insurance companies whose only motivation is profit;

i) Masses of money spent on administrators and lawyers to find any excuse to deny care to patients.

ii) Doctors promoted and receiving bonuses for denying care to patients.

iii) People without peace of mind, even if they have comprehensive insurance, it is sometimes not worth the paper it is written on.

iv) The premiums can be too high for those who need cover the most and people are never at their most financially sound when ill or injured.

v) An absurdly bureaucratic system run for the benefit of health care insurance directors and shareholders NOT the benefit of patients.

vi) Profits so large that bribery and corruption of elected officials to maintain the status quo becomes inevitable and commonplace. Moore shows dozens of congressmen bought off. Even the well intentioned Hillary Clinton was bought for $800k.

The irony of those on the right who attack universal 'socialised medicine' as some sort of communist plot, is that the US healthcare 'industrial complex' like the 'military industrial complex' of both the US and cold war USSR is self sustaining and a cancer on society. The US healthcare industry's corruption of Congress has more in common with the corrupt Politburo than any 'socialised medicine'.

As Moore points out in his film, France, Canada, the UK and even poverty stricken Cuba can provide fantastic universal cover at much less cost than the US system.

The biggest criticism of any Moore film is its polarisation of the issues and overly sentimental argument. This is very true of this film. Being talked to like a 3 year old does grate after 120 minutes. However he does manage to entertain and make funny an issue that could be very dull indeed in a lesser film-maker's hands. Moore's film is excused some artistic licence, as it is a polemic aimed at the highest possible audience (do not expect BBC4 impartiality and depth) and he succeeds in making the film highly entertaining and funny, though not as funny as his earlier successes. Moore highlights outrageous cases of hard working fully insured Americans being denied care for ridiculous bureaucratic reasons. He contrasts this with the universal cover every other industrialised nation provides for its citizens.

This film will make every British citizen so pleased they have the NHS and should make us more determined to try and protect it from the insurance company corruption that has engulfed the US. Much as Tony Benn says the NHS is untouchable, we already know how dentistry for example has been salami sliced away.

Moore paints such a bleak picture of US healthcare (ill patients dumped on the sidewalk for not paying bills), it is very heartwarming to see the inside of an NHS hospital.

Inevitably, the subject of taxation is raised. Moore's film is aimed at reassuring the US middle class, so he shows how even the lifestyles of the highly taxed French middle class can be very comfortable to counter the vigorous lies of the US media that infer communist armageddon will occur if ever the US had universal healthcare.

Overall the amounts of profit involved seem to make the prospect of change in the US very remote, no matter how much the electorate demands it. So from this point of view Moore's film is very depressing. But at least there is someone high profile making the case, and for that his film deserves to be widely seen. The case for universal healthcare is very compelling when you compare it to the despair of millions that results from the alternative. As Moore asks 'how did we get to this?'. It seems that once in that parlous state, it is very difficult to change. We in the UK should bear that in mind when we go about handing over NHS care to profit making companies.


16 comments:

  1. To be fair, I have never been a particularly loud cheerleader for the US system as its deficiences are so very obvious.

    But Cuba is not the paradise that Moore paints it to be either; let's face it, the man is a charlatan, a liar and a fraud.

    DK

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  2. Americans spend almost as much on healthcare as the entire GDP of the UK economy

    Please sort out stat's before quoting them blindly. One tillion dollars = £500 billion = about 40% of UK GDP.

    In any event, Neil, I thought we had agreed on a thread a few weeks ago that health-vouchers worth the NHS-equivalent cost were maybe not such a bad thing?

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  3. So Mark, what happens when the vouchers worth the NHS-equivalent cost run out and the patient still needs care? As someone who has had to visit hospital year because I inadvertently cut the tendon in my index finger and had to have micro surgery to repair it, I just want to know that I will be seen in a timely fashion and the care will be competent. Beyond that, I am not interested in 'choice' or in choosing where to spend my vouchers. When I am ill that is a distraction I can do without.

    I am no fan of Moore - I think he is a dishonest propagandist - but I am convinced that we do not want to replicate US healthcare here. People talk disparagingly about money going on adminstrators in our system. But the situation is even worse in the US where you have a layer of health insurance companies which make absolutely no contribution to clinical care.

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  4. Mark, The US spends just under TWO trillion dollars ($1.98tr) on healthcare (I used trillion in the title for simplicity). UK GDP is 2.35 trillion dollars, so the US spends the equivalent of 85% of our GDP on healthcare alone. I think this qualifies as 'almost'. As their health spending is set to rise to 20% of US GDP within 10 years, it is reasonable to assume that it will soon surpass our entire GDP.

    Stephen, As for Moore being dishonest? Yes he only shows the good side of universal healthcare and only the bad of the US system. But he is making an argument, not pretending to be impartial. Moore is a reaction to the right-wing partiality of the US media. I am not saying it is a good thing, but he is an understandable counterweight and the points he makes about the unfairness and inefficiency of the US system in comparison to ours are valid.

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  5. Neil, my bad on the stats. That is a staggering amount of money, $2 trn ÷ 300m population = over £3,000 per person per year. The NHS costs about £1,500 per person per year.

    Stephen, I agree on insurance companies being a waste of time. When I say 'vouchers' I mean taxpayer-funded. They will never run out.

    If you have to have your finger sewn up, then your doctor says to you "You can have it done at your local hospital, which will cost the taxpayer £x,000. Or if you can find somewhere private that'll do it quicker/better, we will pay them up to £x,000 and if it costs more than that, you pay it yourself". Fair 'nuff?

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  6. Neil, I wasn't talking specifically about Moore's dishonesty with respect to 'Sicko' as I haven't seen it. But I note that Lord Winston, called it a dishonest film, and I would incline to trust his judgement. Bowling for Columbine and Roger & Me *were* dishonest. Their distortion of fact went well beyond what could be justified under editorial control.

    I might have sympathy for some of the ideological stances Moore strikes. But you cannot defend lying and that is why Moore is - a liar. If you start defending lying because the liar presents a favourable picture of your political position then you end up like this government, unable to to tell where truth ends and propaganda starts. Surely you must see how the spin culture has eroded public trust in the political process.

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  7. Stephen, Moore does exagerate his case by misrepresenting some facts, but I cannot think of any example where he actually lies. Can you give me an example?

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  8. Mark, The US does spend a staggering amount of money on healthcare for very patchy and in a lot of cases very poor results.

    If the US health system demonstrates anything, it demonstrates that 'just privatising it' can be as bad as 'nationalising it'. I don't think Americans will ever get universal cover. The best hope is perhaps a law to rein in the worst excesses of the insurance companies. How about, once they accept cover, they cannot then back out of it on a technicality afterwards. This leaves the onus on them to find any non-disclosure before they offer the policy, not after they have took the premiums (or alternatively they have to give a full refund + interest on any previous premiums paid if they decline cover). This should at least partially protect those who are covered, although it does nothing for the 50m they refuse to insure or who cannot afford insurance.

    As for vouchers, no party has offered what you suggest. They all stipulate a limit less than the NHS cost, which is why all voucher schemes end up penalising those or cannot afford to pay and subsidising those who can. Our society is unequal enough without making it worse with taxpayers money.

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  9. As for vouchers, no party has offered what you suggest. They all stipulate a limit less than the NHS cost ...

    Neil, perhaps I forget to mention that, in my manifesto, these vouchers are just an alternative to NHS. If you are happy with NHS then great, go there for free.

    Quite possible, the NHS would only lose 10% of its business to competing providers. But a small competing provider is often enough to keep the market leader on its toes.

    The gimmick about having them for less than full NHS cost is just to prove the point that the NHS is inefficient, and that the private sector can do it better for less - like in State education, where average spend per State pupil is now higher than the fees of the cheaper private day schools. This is a different issue.

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  10. 'If you are happy with NHS then great, go there for free'.

    Mark, vouchers don't work like that! What happens is, the only people who end up using the NHS are those that cannot afford the extra cost to go private. Meanwhile all that taxpayers money has been siphoned out of the NHS budget (making the NHS worse) to subsidise well off people to go private. This of course leads to a spiral of decline as more people get desperate to go private as the NHS is starved of resources.

    The only way I could support a voucher scheme is if people were not allowed to pay extra above the voucher cost. That is difficult to achieve in practise and anyway makes a voucher scheme pointless. If we want people to have access to private facilities, the way to do it is to have the NHS bulk purchase services - which is what already happens.

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  11. Neil *sigh* we have done this before.

    That is why I originally suggested (on an earlier thread) that the vouchers be set at less than full NHS-cost so that, all things being equal, the NHS ends up with more money per remaining patient. Kerching. Money for nothing. But you have now rejected that.

    And what is wrong with top-up fees? The NHS does this anyway. At my local maternity hospital, you can pay £20 extra a night for being in a two-patient room, or £50 extra a night for a single room, and so on.

    I see not even any intellectual merit in the unenforceable idea that providers can't charge more.

    To maximise number of patients most will offer a service with no top up fees. And unless these providers are better/quicker than NHS they won't get any patients, nobody is forced to choose NHS or non-NHS it is a CHOICE, FFS.

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  12. Y'see Neil, your whole politics is based on "not making things better for the rich" so you automatically reject any policy that is primarily aimed at making things better for the non-rich, if, as is usually the case, this policy would make things better for the rich (as defined) as well.

    That is not how it works on Planet Wadsworth. I worry about the little guy. If you can make things better for him (or her, indeed), then that is a good result. If the Big Guys benefit as well, so what?

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  13. Mark, my whole politics is based on making things better for everyone (including the rich). The problem with your voucher scheme is; I can see no benefit for those who cannot afford to 'choose' and crucially a lot of negatives for them, as NHS services are run down. When it comes to a choice between making the poor worse off or the rich worse off - the rich can afford to lose out, the poor cannot. Inequality in a few room perks is not critical, inequality in healthcare is. At the end of the day, the NHS will lose support (and funding) the more people go private. If the extra money was going into more doctors, more operations, more resources for healthcare for the poorest. I could support it, but it is not. There are limited resources that are going to be more unequally distributed.

    A few questions for you.

    When someone goes private, will they care as much about a fall in quality of NHS care? Will they be more interested in tax cuts at the expense of the NHS?

    Why do private hospitals not train any doctors, nurses etc?

    Are you not creating perverse incentives for the NHS if you apportion them more money per patient for every patient they lose?

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  14. When someone goes private, will they care as much about a fall in quality of NHS care?

    Probably not, so what? If overall standards increase?

    Will they be more interested in tax cuts at the expense of the NHS?

    Both the vouchers and the NHS will be taxpayer funded. Daft question.

    Why do private hospitals not train any doctors, nurses etc?

    Doctor and nurse training is not paid for by the 'NHS', it is paid for by the TAXPAYER. Whether these people go on to work in NHS or in non- NHS is of no concern or interest to anybody.

    Are you not creating perverse incentives for the NHS if you apportion them more money per patient for every patient they lose?

    Look, it is you that is twisting and turning on this one. You aren't happy with the idea that vouchers are only 90% of full NHS-cost (which would increase funding-per-NHS-patient) and you are not happy with vouchers being 100% of NHS funding. I personally couldn't care less whether it is 80% or 120%. You make up your mind first, and then we'll re-start negotiations.

    Bu good questions though!

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  15. Mark, you fail to see how choice that relies on wealth is not real choice. Not being able to afford an IPOD is not that bad, but not being able to afford healthcare is life and death. It is inevitable that private healthcare uses limited taxpayer funded resources for the benefit of the well off rather than the poor. This is critical. When we fund private healthcare and encourage its use (for those who can afford it) through voucher schemes, we reduce support for the NHS and inevitably the support for its funding. This impacts on the poorest the most, who rely on the NHS.

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  16. It is inevitable that private healthcare uses limited taxpayer funded resources for the benefit of the well off rather than the poor.

    As opposed to the NHS, which uses limited taxpayer resources to treat the well-off?


    This is critical. When we fund private healthcare and encourage its use (for those who can afford it) through voucher schemes, we reduce support for the NHS and inevitably the support for its funding. This impacts on the poorest the most, who rely on the NHS.


    Well, yes and no. You are arguing that if middle-class voters don't have to use the NHS, they won't care about its quality, and so will be less likely to support higher taxes to fund the NHS.

    Mark's proposal, as I understand it, is that the voucher would be proportional to the NHS treatment cost. As such, if the middle classes all vote to cut funding to the NHS, they will be voting to cut funding to their vouchers, too.

    In this case, I think your funding argument is neutralised.

    There remains an argument about quality of care - things like hospital cleanliness, whether nurses wash their hands between patients and so on are more issues of management than issues of funding.

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