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SICKO's Cure 

Local health-care experts say Michael Moore's new movie makes a good argument for national health care.

Walter Lane's voice didn't project much enthusiasm. Lane, a professor of economics at the University of New Orleans who researches health-care economics, was asked if he would be willing to see Michael Moore's latest film, Sicko, which condemns the U.S. system of managed care and private insurance while trumpeting the high notes of socialized medicine. Lane paused, and you could almost hear his shoulders shrug when he replied: "All right, but Michael Moore makes my skin crawl." Lane was willing to put aside his disdain for Moore because he believes that if not for the war in Iraq, health care "would be the No. 1 political issue in the United States." He isn't alone in this view.

Dr. Karen DeSalvo, division chief of general internal medicine and geriatrics at Tulane University's School of Medicine, also accepted an invitation to see the film. While Lane saw the double-digit increases in health insurance as out of control, DeSalvo found there are boundaries of "mistrust and fear" in the current system.

U.S. Rep. John Conyers Jr., D-Mich., couldn't make it to New Orleans to view Sicko since Congress is in session and as House Judiciary Committee chairman, he is heading an investigation into the U.S. attorney firings scandal. No matter. Conyers has already seen the movie and even screened clips of it to some of his congressional colleagues. Moreover, he is the author of House Resolution 676, "The United States National Health Insurance Act," which would give every American "universal, best quality standard of care." The bill is currently in committee.

Conyers, contrasting Lane, likes Moore, a fellow Michiganer, and thinks the filmmaker has raised the problem of health care in America to "another level." For Conyers, Sicko has brought to light a crisis that legislators and the American public can no longer ignore, no matter how happy they might be with their own health care. Moore accomplishes this in a number of ways, some of which will be debated by critics and bloggers ad nauseum, but the following facts he plainly states might be the most effective arguments for change:

According to the World Health Organization, the United States spends the highest portion of its gross domestic product, 16 percent, on health care, but the country only ranks 37th in the world for overall health care.

The Centers for Disease Control reports that in the United States for 2006, 43.6 million persons of all ages (14.8 percent) were uninsured at the time of the report. In addition, 54.5 million (18.6 percent) had been uninsured for at least part of the year.

18,000 Americans will die this year simply because they're uninsured (Insuring America's Health: Principles and Recommendations by Institute of Medicine of the National Academies, 2004)

All three experts contacted for this article share an opinion that something has to be done about the way health care is delivered in this country. Even though they don't necessarily agree on the solution, they all believe that Moore is correct in his belief that universal care is something this country needs and deserves.

As DeSalvo walked out of SICKO, she admitted: "After that, it feels kind of humiliating to be a member of the health profession." At one point during the film, she cried, overwhelmed by the compassion portrayed by doctors in Cuba, which has universal health care. DeSalvo thinks that often, doctors in the United States aren't allowed to have that kind of sympathy for their patients because physicians have to worry about the bottom line — what tests, procedures and treatments are allowed by insurance companies — as well as patients' welfare. It doesn't matter if a doctor knows a certain assessment is necessary to complete a diagnosis — what matters is that the insurance company approves it.

"Even with our own health insurance at Tulane, for people employed at the university, physicians were denied tests that they needed to diagnose something," DeSalvo says. "And they (Tulane employees) turned out to have cancer and that's with our own circle of doctors and our own health-insurance plan."

DeSalvo holds a master's degree in public health and was a member of the Louisiana Health Care Redesign Collaborative, a statewide committee charged with developing a blueprint for an improved health-care system in Louisiana. Although the state legislature hasn't acted on the committee's recommendations, DeSalvo thinks it was a successful process because it enabled the committee to focus on what could be done to make health care in the state dramatically better. What DeSalvo and the others decided was that this wasn't just a matter of dollars and cents.

"We need systematic reform and that includes financing, reimbursement and the delivery of health care," DeSalvo says.

Under the current state system for the uninsured, private practice doctors aren't reimbursed for care to the indigent. Recently, 381 physicians at West Jefferson Medical Center (WJMC) filed a lawsuit against the state for failing to pay the doctors for services they rendered to the uninsured at WJMC following the closure of Charity Hospital, where many of the area's uninsured formerly received care. DeSalvo says this has to change; all medical care should be paid for regardless of the physician or patient. Additionally, DeSalvo advocates a change in the way doctors deliver health care, shifting away from an incentive plan that reacts to a disease and toward a model that prevents disease.

"In the U.S., the sicker you are the more I get paid," DeSalvo says. "If I don't treat your diabetes and you end up having dialysis and an amputation, the doctor makes more money. But if I keep your diabetes under control or work with you to do it, I don't make any money. It's perverse."

DeSalvo promotes a model in which people have medical homes, primary-care facilities that patients will automatically contact for any health-related matter, whether it's a routine checkup, a rash, a cold or a chronic disease like diabetes. In this scenario, a primary-care doctor knows a patient well and is paid to keep him well.

"We have to pay for primary care in this country," DeSalvo said.

Lane agrees with DeSalvo that primary and preventative care make sense, but he is concerned about how other countries pay for it. A self-described "free market kind of guy," Lane isn't enamored with government solutions, but he doesn't realistically see any other way.

"Everybody's cheaper than us," Lane says. "Even if we were insuring everyone — uninsured and underinsured — nationalized care would still be cheaper."

After studying the methods various countries use to pay for universal care, Lane thinks that the French system, which combines private health insurance with government assistance, is the most efficient. Unlike Moore, Lane considers the British system, which he refers to as "truly socialized medicine" with government hospitals and government doctors, to be a failure that has gone through five complete revisions in the past 20 years. Still, in the same WHO report that ranked the U.S. 37th in the world for health care, England came in 18th.

Lane isn't a big fan ofCanada's single-payor system in which the government is the sole health-insurance provider that pays health-care costs. Canadian hospitals remain private, but they are allotted a fixed budget (through a tax fund) each year for medical care. Once the money runs out, services are reduced and, as Lane points out, "Canadians (hospitals) do turn away people in droves."

He believes France's universal care system, which the WHO report considers No. 1 in the world, would translate best in the United States. It preserves private health insurance although the companies become mostly claims processors because the government sets health-care rates, doctors and hospitals remain private, and people are allowed to choose their own physician (unlike the German health system, which assigns doctors). Anyone who does not have private insurance gets insured by the government. The system is paid for by a combination of employee private insurance payments and taxes.

Lane cautions that transitioning to any national health system will necessitate higher taxes. He feels that it's worth it, however, because doctors will no longer have to worry about who and what is covered. Rates are fixed, far less paperwork is required and, overall, the system is much more efficient. "Once you get there, it works much better," Lane says.

Conyers, a 21-term Congressman, knows that his health-care proposal, even with 74 cosponsors (all Democrats), doesn't stand much of a chance in the current Congress. Since the bill has been around for six years, that doesn't worry Conyers. The bill is building momentum, and Conyers says he's encouraged that Republicans have begun inviting him to publicly discuss the issue. During the next Congress, he thinks there will be "more hearings and more learning" about national health care. Considering the tough opposition forces of health-insurance lobbyists and others, Conyers expects it will be a formidable battle.

"The people that are benefiting and profiting from this system are the ones that don't want to give it up," Conyers says. "It's a very profitable arrangement for a number of businesses and individuals, but further than that, there's a reluctance to move to a whole new system after this one has caved in. There are people who are appropriately cautious, but the majority of people have said they want universal health care, and they've even said that they'd pay more than they are now to get it."

There's no question that Sicko illuminates many of the already glaring problems in this country's health-care system, with lack of coverage being the biggest. His solution might appear to be a simple call for socialized medicine, but this is a case where the message — that the U.S. health system is broken — is bigger than the messenger. More and more experts are willing to explore national health care as an option and say that with costs skyrocketing, it's no longer acceptable to dismiss it as something foreign.

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