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Sicko: The United States Health Service

John Simkin

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Good review of Michael Moore's film Sicko in yesterday's Guardian by Peter Bradshaw:

Last week in this paper, Seumas Milne reported on the boa-constrictor-sized parasites of US private health insurance seeking to get their fangs into the British NHS. This magnificent new film from Michael Moore is a timely reminder of the grotesque mess that Americans have made for themselves with healthcare, and how insidiously easy it would be for the same thing to happen to us, little by little. Sicko is a full-throttle polemic, teeming with tremendous flourishes of showbiz sentimentality, gloriously outrageous stunts and exquisitely judged provocations. He shows how the American public - especially its hardworking middle classes - have been taken for mugs by the corporate fatcats of health insurance, particularly the inventors of an intensively marketed form of lower-priced insurance called the health maintenance organization, or HMO.

Their sleek executives have gorged on the premium cash income from provident people obediently putting something by every month in case of sickness. They then find excuses not to pay out on claims, chiefly by citing instances of allegedly undeclared medical conditions that invalidate the policy, or, incredibly, instances of the patient allegedly neglecting to detect prior warning signs of these conditions themselves. It's a vast corporate-legal industry dedicated to avoiding claims and maximising profits, and it depends on lobbyists buying off senators and persuading the media and political classes that free universal healthcare is a silly, outdated piece of nonsense.

By and large, Moore isn't talking about what the Victorians robustly called the undeserving poor. He begins with a gut- and heart-wrenching story about a thrifty, professional middle-aged couple who endured calamity in their late 50s: the husband had a number of heart attacks and the wife got cancer. It could happen to anyone. But their insurers refused to pay out and the couple had to sell their home; Moore shows them having to move into a crowded spare room of their daughter's house, and this daughter has money worries of her own. It is an almost unwatchable scene of neo-Dickensian pathos and humiliation.

Moore has many such stories to tell, about a swathe of Americans pauperised by the health racket that devotes its formidable energy and ingenuity to refusing their claims. And who are the politicians who have allowed these crooks to prosper so mightily? Moore has President Richard Nixon on the White House tapes first giving the nod to the creepily named pioneer outfit, Kaiser Permanente. But he saves his fiercest scorn for Senator Hillary Rodham Clinton, who was tasked by Bill in his first term to do something about it, but failed and has now rolled over for the health-insurance mobsters with just as much puppyish enthusiasm as the rest.

By way of contrast, Moore visits those countries with free healthcare: Canada, France and Britain. And this last visit is the one to make us sit up. With much elaborate comedy and saucer-eyed cod-acting, Moore visits the NHS hospital of Hammersmith in London, and deploying many a gasp and double-take, refuses to believe that the sick folks aren't charged hundreds and thousands of dollars. He doesn't mention the waiting lists, the filth, the degrading mixed wards and the MRSA that are a staple of all media coverage of the National Health Service. So perhaps he's got a starry-eyed view of our healthcare. But isn't it obtuse to focus so excitably on what goes wrong with our health service, when so much more routinely goes right and when, incidentally, there are those with a vested interest in promoting these scare stories as an excuse for privatising it? Isn't it, for all its faults, exactly the miracle that Michael Moore portrays it?

Moore pulls off his funniest and most splendidly irresponsible coup back in the US. In response to claims that prisoners at Guantánamo are being mistreated, the Bush administration trumpeted the fact that they get the best attention from the best doctors. Like a skilled judo warrior, Moore uses his opponent's weight against him. He points out that Guantánamo is now an island of free universal health care on US soil, and charters a boat from Miami, filled with sick people duped by their insurers. Shouting at bemused soldiers through a megaphone, he pleads for them to be allowed to land and partake of this bounteous health utopia: "We don't want any more than what you are giving the evildoers!"

Perhaps the most gripping moment comes when Moore shows Tony Benn unrepentantly reading aloud from the famous 1948 pamphlet that crisply outlined what the new National Health Service was going to provide. But here is my only quarrel with the film. One of the things that pamphlet promises is free dentistry; Benn doesn't notice the irony and also claims that no politician would dare damage the NHS because the people would rise up. But the politicians are already permitting the salami-slicing of the free healthcare principle and no one is rising up. The plain fact is: poor old Britain is still basically free from the privatised healthcare scam. The price of that freedom is eternal vigilance. Mr Moore's excellent new film is a wakeup call.

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Here is the article by Seumas Milne refered to in the review of Sicko:

Seumas Milne

Thursday October 18, 2007

The Guardian

UnitedHealth is the largest healthcare corporation in the US, making billions of dollars a year out of cherry-picking patients and treatments, squeezing costs and restricting benefits to 70 million Americans forced to get by in the developed world's only fully privatised health system. Its chief executive, Bush donor William McGuire, paid $125m in 2004, had to step down last year in a share-option scandal.

Last month, UnitedHealth agreed with insurance regulators in 36 states to pay out $20m in fines for failures in processing claims and responding to patient complaints. That follows a string of other fines over delayed payments, Medicare fraud and "cheating patients out of money" in New York State.

Other major US health corporations, such as Aetna and Humana, have also faced repeated fines for shortchanging doctors, using unlicensed agents, payment delays, failures to give information to claimants or fraud. In one case of a cancer patient who was refused payment for a failed experimental treatment its own doctors recommended, Aetna was ordered to hand over $120m damages after it was found by a California jury to have committed "malice, oppression and fraud".

All three companies figure prominently in Michael Moore's new film Sicko, a compelling indictment of the US health system - under which 18,000 Americans die a year because they are uninsured. Hardly the ideal players, you might think, to take a central role in the reform of the National Health Service.

But it is precisely these three corporations, along with 11 other private firms including KPMG, McKinsey and Bupa, that the government this month announced have been lined up to advise on or even take over the commissioning of the bulk of NHS services. Primary care trusts, which control most of the NHS's £90bn budget, will now be encouraged to buy in advice from the 14 selected companies on health needs, contracts and local provision. Potentially, these corporations could take over the management of the heart of the NHS.

For the first couple of months after Gordon Brown became prime minister, it had seemed that the new administration was pulling back from the privatising excesses of the Blair years. One of Alan Johnson's first moves as the new health secretary was to announce that there would, after all, be no "third wave" of controversial private surgery and diagnostic units, known euphemistically as independent sector treatment centres.

But the award of a framework primary care contract to the 14 privateers - only mildly watered down from an earlier incarnation - and Johnson's backing for a key private-sector role in 150 new health centres and 100 new GP practices, have set the seal on the Brown government's commitment to the continuing market-driven reconstruction of Labour's greatest social achievement.

Under the banner of choice and reform, New Labour has struggled to create an artificial market in health and turn an integrated system of universal provision into a tax-funded insurance system tailored to the private sector. The move to outsource service commissioning will now pave the way for private companies to decide the range of services provided and use their access to information to pick the most profitable services to bid for in other areas. Allyson Pollock, head of Edinburgh University's international health policy centre, calls it the "last piece in a jigsaw" that opens the door to a US-style health maintenance organisation model - dominated by corporations like UnitedHealth.

Ministers have always insisted that using private companies is all about improving services and value for money. But the evidence is that far from making better use of the extra cash pumped into the health service, privatisation has been expensive, inefficient, destabilising, unaccountable and led to closures, cuts and job losses.

The costly and underfunded private finance initiative, which has landed the NHS with a total bill of £50bn for new hospital buildings, is already milking £700m a year from NHS trusts and fuelling the financial crisis across the service. The private treatment centres used for elective surgery are not, as the Commons health select committee found, more efficient than NHS units, nor have they mostly increased capacity; they are in fact more expensive, have heavily underperformed their contracts and often ended up taking over NHS staff.

Add to that the huge transaction costs of administering the new market system and it's hardly surprising Labour's own conference last year declared that the "major cause" of the financial crisis in the NHS was the "move to a competitive, market-based system" and "the continued use of PFI". Meanwhile, it's become clear that bargain-basement contract cleaning has been a key factor in the rise of hospital infections. In Wales, where cleaning is now carried out in-house rather than by contractors, MRSA infection is less than half the English rate.

Given the evidence on cost and inefficiency, and its unpopularity among medical staff and voters, the government's determination to press on with privatisation and marketisation might seem baffling. Why insist on heading off in the direction of a health system with the highest per capita cost and inequalities while courting its main beneficiaries? The only sensible explanation has to be that what New Labour derided as the influence of producer interests has been replaced by corporate capture: a mixture of market dogma, business lobbying and a revolving door syndrome that saw Simon Stevens, former adviser to Tony Blair and a succession of New Labour health secretaries, move effortlessly on to become European president of UnitedHealth.

The risk is now that with a continuing patchwork privatisation and cash squeeze, public support for the principles of the NHS could erode, opening the way to charges, top-up fees and private insurance. Both the Tories and Liberal Democrats either accept private provision or are gagging for more of it, so not much help can be expected there. But Wales and Scotland have mostly resisted the worst of the health service's English disease - and support for the kind of socialised health system Michael Moore lauds in Sicko is deeply rooted in Britain. What's needed now is to turn that sentiment into pressure for a real change of direction.


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  • 1 month later...

I hope that those of you who live in the UK and Europe do everything you can to keep your governments from going to privatized health care. I am one of the millions of American citizens without any health insurance and live with the fear that something will happen to me. No one should have to live with that fear. Health care is a basic human right denied to US citizens and I am sick and tired of listening to people who say universal health care is either communism or no better than what we already have. I've gotten into arguments with relatives who tell me the system in the UK is so horrible because people have to wait long periods of time to get treatment. Well tell me, which is worse? Waiting or not being able to go to a doctor at all because you can't afford to pay $100 to see the doctor for 2 minutes--just long enough for him/her to look at you and write you a prescription (which will cost you another $100 or more without insurance)? I'd take the long waits any day!

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