What a great segue from Sick to Sicko. Upon Sicko’s release, I refrained from immediately offering comments. I tend to heavily regurgitate what I see into what I write; and so the slight delay was to prevent spoiling your viewing pleasure. You have been forewarned.
To fend off any reactionaries: absolutely, Michael Moore did not give a holistic view of the fragmented health care system. However, just as an element of truth lies within each joke, the most egregious health care issues precipitate from documentary exaggeration. Not that the viewer should take the movie with the grain of salt, but rather the viewer should see how that grain salt fits into the entire health care ecology.Moore highlights well-documented and debated issue amongst health care professionals in the past decade. He places an emphasis on health maintenance organizations (HMOs) which use an array of cost and utilization control.
HMO tactics such as coinsurance, copays, and deductibles from the cost side and primary care provider referrals, pre-authorizations, and prescription drug formularies from the utilization side are widely recognized “blunt” instruments that have unintended and dire consequences. These instruments lack the precision of helping the purchaser decide whether or not he or she truly requires health care services.
For example, many insurance policies have a copay starting at $50 or at least a 20% coinsurance for emergency room visits that do not proceed with hospital admittance. Reading between the lines, this payment structure tempts the purchaser to evaluate his or her onset of ill symptoms and decide if an emergency visit is warranted. Can the person wait for an appointment? Or will the symptoms ease over time?
Now if a child has flu like symptoms, how does a parent know if he or she can simply drop by the nearby drug store and purchase flu tablets? What if the child has meningitis and requires immediate attention? The latter warrants an ER visit, but the potential out-of-pocket costs leads the parent to think twice.
Why should a parent think twice if a child exhibits unhealthy symptoms of unknown illness? The parent may not be a licensed medical professional to make that judgment, but the insurance company makes a presumption that the purchaser believes the parent can make that choice.
The policy is not sensible.
Well this policy did not stem from insurance companies greed. Before cost and utilization management policies existed, emergency room costs were a large portion of the hospital’s operating expenses and potential profit centers. The easy access to a multitude of ERs led to abuse. Too many people visited for non-emergent and unnecessary services. Impatient people simply wanted a quick fix and could not wait for the next available outpatient appointment. Some people could not determine the difference between emergent, urgent, or non-emergent-urgent symptoms. And some people went for the sake of attention. This is what the out-of-pocket insurance policies were trying to deter. If the medical attention was serious enough, insurance companies thought that purchasers were smart enough to decide between an out-of-pocket fee and the price of life.
Well any decision is affiliated with out-of-pocket costs, warrants someone to think twice. Fifty dollars to treat a sniffle or $50 for this week’s lunch money. Healthcare socioeconomics studies show that some parents pocket the $50 for next week’s tangible and immediate living necessities. If indeed the child had an unsuspecting case of meningitis, the copayment or coinsurance policy created an unintended decision, and the ill-decision may directly lead to irreparable brain damage for the child.
The insurance company then prevents from paying out $1,000+ for the ER visit and now may have to fork over more money to treat brain damage. With the existence of Sicko anecdotes on denial of treatment, the possible vicious cycle of denials may ensue for the child’s treatment.
As long as anecdotal stories like this exist, our health care system is sick. What Sicko does not point out is the shift from HMOs to PPOs and other insurance mechanisms. Unfortunately, Moore brings up issues that persistent even in the back shift from HMOs to Point-of-Service (POS) plans and Preferred Provider Organizations (PPOs). Fortunately insurance companies under the POS plan and PPO operations are shifting attitudes and practice, which Moore did not even highlight. Unfortunately, the shift is too slow for consumers to notice.
In addition, there was no mention of nearly universal health care coverage in Hawaii, the single state that mandated employers to offer health care coverage since 1974. Hawaii was the only State that narrowly escaped from the Federal government’s Employee Retirement Income Security Act (ERISA) also passed in 1974. Although Hawaii’s Prepaid Health Care Act mandates employers to offer health care coverage for employees that work more than 20 hours a week for at least four consecutive weeks, this is a tremendous stride for small companies and mom and pop stores to be able to set their commercial prices in order to offer coverage for their vulnerable employees. Hawaii would be a great documentary case study of a state with high health insurance coverage and health care access. California and Massachusetts are moving towards that direction, with risks of violating ERISA.
Hate the current system? Then form a health insurance coalition with policy driven by sound medical advice and peer review. Why wait for the government to form a single payer system? By the way, the single payer system is a non salient term to push health care burden onto the government. If policy makers require buy-in, stay away from mentioning single payer system. Just coin another catchy term. Otherwise, the words single-payer-system will be instant death on any politician’s or policy maker’s career.
Despite the lopsided view, Sicko does end with a beauty in living a society of “we” instead of “me.” The health care industry needs to hire talent with a strong sense of compassion for others. And there needs to be an impetus to re-prioritize our values.
