Just How ‘Sicko’ Is Our Health Care System?

Sicko, Michael Moore’s film commentary about the American health care system, is reaping lots of attention. There’s no question our health care system has its shortcomings, and that having millions of uninsured people in a nation that spends more money on health care than any other is outrageous. The examples of insured patients being denied coverage for reasonable claims reveal a system that can be heartless and deceptive.

But are we as bad as he says?

Health care is one of the nation’s top domestic priorities, so anything that focuses attention on the issue and promotes dialogue is good. But as a physician practicing for many years and having seen the film, I suggest that our health care system isn’t nearly as ill as Moore contends, and those he praises in other countries may not be as idyllic as portrayed.

Moore has grabbed our attention with the right subject at the right time, but the film comes across as more propaganda than documentary. He shows us a world of mostly villains and victims, and he portrays everything American as bad and everything foreign as good.

The fact is that paying for quality care is a problem the world over. Issues of access are acknowledged in Great Britain and Canada, where waits of several months for needed surgery are routine. There are fewer doctors per capita in Great Britain than in the U.S., and hospital beds and specialists are even less accessible. Moore paints a picture so rosy in France that it appears too good to be true, which it is. Although he shows us unlimited, instantly accessible care that is “free” and a disability system that offers a young man six months of paid disability while he is shown partying at the beach, a conversation I had with an expert in international health systems revealed a different picture.

France provides insurance for all, but it’s not complete. Some costs must be borne by citizens, and most buy private coverage as well. The French system is running out of money, and it is actively looking at U.S. managed care for ideas to control expenses. And although the patients Moore brought to Cuba received “free” care, the Web site for Havana Hospital portrayed in the film has a substantial price list posted for procedures.

Moore reminds us that the U.S. ranks 37th in health care in the world (according to the World Health Organization). He does not mention that two of his examples of ideal systems rank similarly: Canada at 30 and Cuba at 39. And while pushing hard for a single-payer, government-controlled system, he also fails to mention that one of the largest single-payer, government-controlled systems in the world already exists in the U.S. It’s Medicare. Yet Medicare has its financial problems, too.

He attacks the American Medical Association (the “establishment”) as being against progress when, in fact, its original objection to nationalized health care was that it could place government and third parties between doctors and patients — the very thing Moore criticizes.

Moore’s greatest failing, perhaps, is that he does not make it to Massachusetts, where we are demonstrating that our system is not incompatible with the spirit of solidarity that he rightly notes is needed to heal our health system.

Our efforts with health care reform, to insure all while preserving the choice and access that Americans find so desirable, are well on their way. The inevitable bumps in the road will be smoothed, and Massachusetts will set an example for others to follow.

The health care system has some substantial flaws, and many are not realizing the benefits that they should. Fixing this requires a sense of community and commitment. I believe that we have what it takes here in Massachusetts.

Dr. B. Dale Magee, a practicing physician in Shrewsbury, Mass., is president of the Mass. Medical Society.