A Sick System

When Michael Moore’s documentary about the U.S. health care system, Sicko, opened in theaters last June, I wasn’t feeling too well myself. In fact, I was sitting in my bedroom waiting for a visit from the home health nurse. Two weeks earlier, I had endured open-heart surgery to replace a congenitally defective aortic valve and a good bit of my ascending aorta. My cardiovascular system now sports a mechanical valve and a section of Dacron hose, so you can call me the Bionic Columnist.

But enough about me. I did finally get to see Sicko in a theater—in our small-town multiplex, no less. And, as you probably know by now, it is a masterful, funny, gut-wrenching, and ultimately touching appeal for Americans to radically change the way health care is financed and distributed in our country.

The film is replete with muckraking stories of the human damage caused by a health care system driven by greed. But like all of his work, from Roger & Me onward, Sicko is, at its core, Moore’s rumination on what’s been done to his people—the multiracial American working class—and how they might find a way to do something about their shared plight.

Fortunately, I didn’t suffer the fate of Sicko’s health care victims. Although I am covered by an insurance company that is indicted for murder in Moore’s film, I am also a state government employee. As things go these days, my family policy is a relatively good one. But we do have all the usual co-pays and 20 percents. So while I did deep-breathing exercises and read a biography of I.F. Stone, my wife, Polly, watched carefully as the bills rolled in.

Among other things she noticed was that it is almost impossible to determine the true cost of any medical item, service, or procedure. Repeatedly, we received statements from medical billing services with huge, eye-popping, gut-churning four-, five-, and six-figure numbers at the bottom. These were followed a couple of weeks later by “explanations of benefits” from our insurance company, which will remain unnamed, showing that it was paying far less than half of the original amount charged. The rest was magically “written off.”

We came to realize that these “discounts” are the result of the bargaining power that accrues to a health care giant with millions of customers and a soaring stock price. We learned this because, on the day of my discharge from the hospital, a manager at a wholesale pharmacy took us into a windowless back room and, in hushed tones, explained the secret. This was after we raised questions about a charge for blood-thinner injections that was four times the figure we expected.

And speaking of drug companies—their hegemonic influence on the health care system is one of the most startling things I’ve witnessed in my brief career as a patient. I’ve now seen what I had only read about before. Big pharma’s business model is based on inventing expensive, hastily tested treatments that, above all, must be taken every day for the rest of your life. The next step, of course, is persuading, bribing, or cajoling doctors into prescribing those potions. And when that doesn’t work, they can always use advertising to brainwash patients into demanding those daily, lifelong prescriptions.

We’ve all seen those “ask your doctor about …” ads that clutter the network news programs. But you must hang around doctors’ offices to see the other side of the picture. The tan, stylishly-dressed drug company sales reps are always there. And they all look like Ken and Barbie. “The perfect people,” one of my nurses called them.

On the other hand, my recent experience with the health care industry also proved to me that America’s actual health care providers—the doctors, nurses, and physician assistants—are mostly not part of the problem. The ones I dealt with were, to a person, smart, skilled, compassionate, and good-humored. They were every bit the equal of their counterparts in Canada, Britain, France—or even Cuba. They deserve to work in a system in which their knowledge and caring is not prostituted for the biggest return on a dollar.

Danny Duncan Collum, a Sojourners contributing writer, teaches writing at Kentucky State University in Frankfort, Kentucky.

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