THE BLOG

SiCKO, Part III: National Health Insurance -- More Humane and More Efficient

Jul 17, 2007 | Updated Nov 17, 2011

Michael Moore's extraordinary SiCKO makes the case for a single-payer national health insurance system -- a Medicare for All -- without bogging down in detailed policy debates.

Sure, there's quite a bit of data that Moore sneaks in, but SiCKO's basic approach is to rely on regular people telling stories about their healthcare experiences. In the United States, those stories are pretty rotten, and frequently heartbreaking. The experience of people living in countries with national health plans is much better.

This makes for powerful film-making, which is not to say there's no need for the nitty-gritty policy debates.

The health insurance industry and its allies have worked hard to respond to SiCKO by promulgating a series of deceptions. It's awfully hard to defend the current U.S. system, so their emphasis is on criticizing other countries' healthcare systems.

They have a lot of practice at this stuff. Get on a call with people like Sarah Berk of Health Care America and Sally Pipes and John Graham of the Pacific Research Institute, and they will compellingly recite three key misleading arguments:

* People in other countries have to suffer through long waiting periods before seeing a doctor or getting treatment.

* National health plans ration care.

* "Government-controlled healthcare" or "government monopoly healthcare" is inherently of inferior quality.

When you don't feel well, or need treatment, you want to see a doctor right away. So, the image of waiting lists to get treatment has some resonance.

But exactly how easy is it to see a doctor in the United States?

It turns out that the answer is the same as in other countries: It depends.

It depends in large part on what you need to see a doctor for.

Live in the United States and have a bad rash and need to see a dermatologist? Well, try not to scratch too much.

My colleague Sam Bollier called 20 dermatologists in the Washington, D.C. area, included under Care First/Blue Cross-Blue Shield or Cigna insurance plans. The average wait to get in the door is 36 days.

He called OB/GYNs and asked how long the wait would be for a woman who found a lump on her breast. The answer on average: 16 excruciating days.

In fact, wait times to see a doctor in the United States are worse than other industrialized countries -- all of which have national health insurance -- except for Canada, where the system has been starved of funding (but overall performance is still better than the United States on most key measures).

In 2005, the Commonwealth Fund commissioned phone surveys of sicker adults in New Zealand, Germany, Britain, Australia, Canada and the United States.

In the United States, 47 percent of those surveyed said that, the last time they were sick, they were able to get a doctor's appointment the same day or the next day. This was worse than every other country except Canada. In New Zealand, 81 percent reported being able to see a doctor by the next day.

Asked what happened the last time they needed care in the evening or on a weekend or holiday, and whether they could get care without going to the emergency room, a full third in the United States said it was "very difficult" and half said it was at least "somewhat" difficult. This was worse than every other surveyed country. In Germany, only 14 percent said it was very or somewhat difficult.

What about rationing?

It's awfully hard to take this argument seriously, though there's no question it resonates.

All insurance plans, if they have some budgetary constraint, must ration to some extent. The relevant questions are: who's doing the rationing, on what grounds, and how is the rationing allocated.

In the private insurance system in the United States, rationing is done by the health insurance industry, which rations with an eye both to health needs and the insurers' profitability.

And, of course, the worst rationing is imposed on the 45 million people in the United States without insurance.

Rationing is far worse in the United States than in other countries. In the Commonwealth Fund survey of sicker adults, 40 percent of people in the United States said there has been a time when they did not fill a prescription because of cost -- twice the level of the next worst performing country. Far higher numbers in the United States said that, because of cost, they did not visit a doctor when they had a specific medical problem, or that, again because of cost, they skipped a medical test, treatment or follow-up recommended by a doctor.

And then there is the matter of quality of care. There's no doubt that the United States often offers top-line care to those able to pay -- including "boutique" service for the super-rich at leading hospitals.

But in the aggregate, U.S. healthcare indicators are terrible, for worse than other industrialized countries -- all of which have national health plans.

With SiCKO heating up the debate, Business Week profiled the French health system, which is treated favorably in SiCKO. "To grasp how the French system works, think about Medicare for the elderly in the U.S., then expand that to encompass the entire population." But, notes Business Week: "the French system is more generous to its entire population than the U.S. is to its seniors."

Business Week lined up a comparison between the United States and France: No one is uninsured in France. Out-of-pocket spending in France is barely a quarter of what people in the United States pay. There are almost a third more doctors per capita in France. French life expectancy is two years longer for men, four for women. Infant mortality is 43 percent lower in France.

On top of which, French health expenditures amount to 10.7 percent of the national economy. In the United States, it is 16.5 percent.

It turns out that national health insurance is not just more humane, it is far, far more efficient, about which more in my next (and final) piece on SiCKO.

There is one other argument that is regularly made against national health insurance, but this one comes from different quarters -- those sympathetic to national health plans. And that is that while national health insurance may be desirable, it is politically unattainable. More on this also in my concluding column on SiCKO.