Saturday night at the movies: is SiCKO about Christianized medicine?

Since SiCKO is now out on DVD no Adventist has to risk angel-abandonment to engage this film.

By Heather Isaacs Royce, a hospice chaplain in Napa, CA.

Documentary. 113 min. PG-13. Now available on DVD.

The ever present good-girl, eldest child in me reeled in horror as I watched Michael Moore’s latest film SiCKO. Important lessons my parents taught me (and I have dutifully followed) about taking responsible care of one’s self—including working a “good job” where your health insurance needs will be met—were undone frame by frame by Moore’s clever and troubling examination of the American health care system. Because, as Moore states in the first five minutes of the film, this is not a movie about the sizable population in the United States who are not insured; this is a movie about people like me who are. Adding to my sense of discomfort, I walked away from the film wondering about my profound ignorance on the state of health care in my own country—never mind the health care systems of other countries. What made bearable the unsettling experience of having my assumptions tested and my ignorance probed was the realization that I am not alone in either case. Apparently, on this issue at least, I am a fairly normal citizen of the United States; that is, I have been grossly uninformed about the state of our health care system. Or, even worse, misinformed.

Moore’s approach in SiCKO is to build his argument for universal health care by linking together stories of personal loss and tragedy resulting from an irreparably broken, even corrupted, American health care system; juxtaposing those stories against an alternative vision of health care being lived out in other countries: Canada, Britain, France, and, most surprising of all, Cuba; and positing systemic change by appealing to the greatest common denominator: a deep regard for human life and dignity that transcends political affiliations and defines American ideals.

The success of Moore’s film is that he manages to keep the human dimension of the health care plight in full view while exposing the terrible brokenness of the American system itself. He could have easily fallen in the direction of making a maudlin tear-jerker of a film or, in the other direction, a spewing cauldron of angry polemic. But the balance he achieves between heart and head results in a compelling argument grounded in personal and political realities. Even my husband, who somewhat reluctantly joined me in seeing the film given his historical distaste for Moore’s insinuating, rhetorical style, was compelled by the sense of truth-telling that characterizes SiCKO.

Smartly, Moore anticipates the questions and concerns that are frequently raised in a discussion of universal health care. The scary world of “socialized medicine” is made a little friendlier with a playful musical aside pointing out that libraries, public schools, firefighters and police are funded by taxes much in the same way as universal health care would be. And the commonly held belief that universal health care compromises the quality and availability of medical treatment is dispelled with evidence to the contrary in cinematic trips to emergency rooms, hospital corridors, and home calls in countries where universal health care is a fact of life. Witnessing the happy and healthy faces of the beneficiaries of these foreign health care systems provided a stark contrast to the litany of horrors voiced from our own: a mother recounts the death of her young daughter after a battle to obtain emergency treatment at a hospital not covered by her insurance provider, a wife mourns the death of her husband after he was denied a life-saving treatment because it was deemed “experimental” by their insurance company, a former medical director at an insurance company confesses her role in denying medically appropriate care to patients for the purpose of saving money and competing for a bonus, a surveillance camera records an ill and disoriented woman in a hospital gown being dumped by taxi at the curb of a shelter because there is no room for her at the hospital.

These and other stories evoked feelings of disbelief and outrage as I began to consider how my country, the wealthiest nation in the world, could allow—even create—these injustices when other countries of supposedly lesser means are able to meet the health care needs of their citizens. And I was humbled as I watched 9/11 rescue workers with serious and chronic health care issues receive free, competent, and humane treatment in Cuba. The cognitive dissonance I experienced was palpable: How could this be Cuba? You mean, a third-world country led by a dictator is able to provide inexpensive, quality health care to its people and my own country can’t? Seeing this reversal of roles, the strong becoming the vulnerable, the enemy becoming the friend evoked a sense of hope and compassion that I would best describe as a movement of the Spirit.

And if SiCKO convinced me of anything it is this: our crisis of health care is not only a political issue, it is a spiritual one. Perhaps if Americans began to engage in the health care debate with this truth in mind, the necessary political corrections would follow. Other countries have already taken the lead in aligning universally shared spiritual values of compassion and human dignity with political will and action. One Canadian woman interviewed by Moore in a hospital emergency room reflected on the health care system of her country, saying, “it’s a fabulous system to make sure the least of us and the best of us are taken care of.” In this and other statements in the film, it is hard not to hear echoes of Matthew 25 where Jesus’ definition of righteousness is to simply serve the “least of these.” But as Moore points out, it is not simply the “least” of us who are in need; where health care in America is concerned, most of us are in need.

Comments

[arlyn]

"Lofty talk about “non-economic values” too often amounts to very selfish attempts to impose one’s own values, without having to weigh them against other people’s values. Taxing away what other people have earned, in order to finance one’s own fantasy ventures, is often depicted as a humanitarian endeavor, while allowing others the same freedom and dignity as oneself, so they can make their own choices with their own earnings, is considered to be pandering to “greed.” Greed for power is more dangerous than greed for money and has shed far more blood in the process. Political authorities(and well meaning grassroots movements-my addition) have often had “revolutionary values” that were devastating to the general population." Thomas Sowell

All government run benefits have trade-offs.

A good discussion of what those trade-offs may be will be far more illuminating and a more meaningful discussion than cloaking such details under ideological mantles of humanity,compassion,biblical faithfulness, prophetic burden,appreciation for human dignity, etc. etc.

Fact: our health care system can and should be vastly improved.
Question: In what aspects and what will we gain and what will we lose?

Empirically comprehensive evidence should eclipse Michael Moore's very selective tour of the top tier of the Cuban Health Care system reserved for tourists and government officials and inaccessible to Cuba's own citizens.

[Heather Isaacs Royce]

The World Health Organization publishes statistics on infant mortality, life expectancy, total health expenditure per capita (among other indices). I've included the link for Cuba below though I understand that there may be some sharp argument about the statistics given that they are apparently reported by the government itself.

But Arlyn, I think Cuba might be a red herring in this conversation.

I'm more interested in discussing the state of health care in our own country. And it does not seem disingenuous (a conclusion I base on your language of "cloaking") to examine our core beliefs and values about health care and how those are or are not in alignment with our spiritual beliefs and practices. These are the premises on which further reasoning about policy is based.

http://www.who.int/countries/cub/en/

[arlyn]

Wonderful how language thwarts the ability of people to realize they are standing on the same plank. (irony)

We are standing together in the belief that examination of our core beliefs and value about healthcare and assessing it's alignment or lack thereof is valuable. (true agreement) I happen to think that most Americans are rather SIMILIAR in these values and most want healthcare to be more accessible to those who need it.

Maybe others don't think this is true and that is why they keep railing on as if everyone else is so different from themselves and a cold hearted selfish ogre.( Why else would they keep saying "We need to be more compassionate, support human dignity,blah blah blah" unless they thought others were uncompassionate, despised human dignity,didn't care for the poor, wished to avoid biblical principles, wanted to be un-christlike and unlike the prophets?)

At least on this blog, there were at least 3 conservatives who also wanted compassionate healthcare coverage for the needy, but were cautious about the methods. Methods have far reaching consequences that dwarf the original intent and can bring about the opposite effect from the one hoped for.

So, my energies have been directed at evaluation of options and how they fufill what I already assume my colleagues (both liberals and conservatives) and I agree with- compassionate, accessible, healthcare and education for all americans. Can we move on to that now? Carefully and cautiously? (not rashly and emotionally whipped up by MM shock propaganda)

Or am I moving on too fast? And do we still need to hear more sermons?

[Daneen Akers]

It seems like we might need a few more sermons judging by the general inaction so far. Have you seen this film Arlyn? I know Michael Moore can get people salivating on sight, and I agree that his methods can be obnoxious, but this film is his best to date.

I came away wondering why Americans don't do more when something is as broken as our health care system. Why is it that we are more afraid of our government than our government is of us? What will it take for us to protest (on any issue facing us today)? The partial answer I came away with after this film is that we don't do anything because we are bogged down in debt, tied to our jobs that provide our healthcare, and generally too tired to imagine a better future and take action to make it happen. Happy, satisfied people take action to keep their way of life (witness how often the French protest).

The spirit of individualism that made this country a success, the pioneer attitude brave enough to cross into hostile territory is starting to be a disservice on issues like healthcare. As Moore concludes, until we can put "we" in front of "me," nothing will change.

I also just returned from a summer spent living in France, a trip motivated partly by this film and the desire to see how people live in a more socialized society (France and England are spotlighted in the film for their universal healthcare). My conclusion? They actually live! Life is slower, deeper, and fuller--and this fullness comes not from material possessions or external signs of wealth and success, but in connecting to the people around you. My husband and I experienced a sort of conversion living in Paris. It's funny how much we've heard the French reviled (especially during the whole "Freedom Fries" episode of recent history). It makes me wonder if we've been sold a line so we'll look down on their lifestyle instead of coveting it.

[David Hamstra]

To me the root of the question is should provision health insurance in the US be provided by the government or by businesses. Your knee jerk reaction will tell you which side of the political devide you are on, but it won't tell you the facts. The facts are that the US government has been running a socialized health care experiment years, called the Veterans Administration hospitals, and the rest of us are the control group.

The results you can read for yourself here.

[arlyn]

1. correct, and having worked at verterans administration hospitals, it has colored my stance strongly.

2. As for France, my favorite city in the world is Paris. However, I realize that there is always the honeymoon period with any new experience. I loved every country in Europe and was impressed with many aspects of them- we see the good first usually. But with a sister in law from Germany who emigrated 7 years ago and still goes back and forth- we can more accurately assess that their health care system has it's flaws too, just in different areas.

3. Inaction? perhaps too slow for you. I think it is already a major issue in the presidential race so there are many models on the national level to discuss and analyze and with Massachusetts trying out a hybrid model as of this year- there is real action on the local government level to taste.

[arlyn]

1. Back to VA's. Correct in that the nationalized computerized system of information has changed the dinosaur of VA's (look at older stats- I knew them well)to now, a modernized competitor. So, that's the whole truth- socialized medicine as embodied in the VA system was POOR in itself for DECADES, but this recent revival spurred by their recent expose' (who remembers it anymore? I do.)and advancing technology (which should be adopted by every hospital)has done the transformation. It's a good thing now. It wasn't so for most of it's lifespan. and that's the whole truth.

[arlyn]

" France Tries to Save its Ailing National Health Insurance System"

Sorum, Paul Clay
ABSTRACT

France has provided universal health care through employment-based health insurance funds. As its governments have increasingly used tax revenues to supplement payroll levies, they have assumed a larger role. Faced with widening deficits in the funds' accounts, the National Assembly adopted in August 2004 legislation designed to decrease health expenses, increase revenues to the funds, and improve quality of care. The apparent impacts of the so-called Douste-Blazy law are to reaffirm social solidarity and equality of access; to reinforce central control rather than relying more on decentralized and market forces; to give the now-unified funds a stronger director, shielded not only from labor and business but also, possibly, from the central government; to allow French private physicians to retain their unrivaled freedom of prescription; and to continue France's reliance on taxes as well as payroll levies to finance its health care.

Journal of Public Health Policy (2005) 26, 231-245.

The fundamental problem in France was that the growth in health care expenditures persistently surpassed the growth of the economy. Consequently payrolls were increasingly unable to provide the monies required to pay for the health care consumed. By 2004, payroll levies accounted for only 62% of the general regime's receipts (33). Since 1991, a supplemental income tax, the "general social contribution," had supplemented the payroll levies; in 2004 it was set at 7.5% of income (6.2% for retirees), of which 5.25% went to health care. It financed 36% of the general fund's expenditures in 2004. Yet the deficit in health care continued to rise and was projected to be 11 billion euros in 2004, 29 billion in 2010, and 66 billion in 2020 (not counting debt service)

...in light of the continued slow growth of the French economy; the unlikelihood that such measures as the "Raffarin euro," the monetary penalty for lack of referrals by the "treating physician," and the institution of computerized and accessible medical records will generate the hoped-for savings; and the absence of global budgets for private physicians, France still seems, in spite of the reforms, less able than neighbors like Germany and the United Kingdom to deal with the upward pressures on health care expenditures. Uncam will, therefore, need continued, if not increased, tax-based financing."

Look at the historical financial trends before we all say "hey, they spend less on health care than us, so not only is it better, it's cheaper!- problem solved- France found it!" (at what cost?)

[David Hamstra]

Arlyn:

Agreed, that socialized health care isn't necessarily better. But when it's done right, it's better than the system we currently have, and, frankly, I don't know how we could fix the current system. Also, I'm of the belief that a health care system should provide for the poorest of us, and I don't see how a for-profit system can do that.

On another note, the other advantage to socialized health care is less-expensive drugs.

[arlyn]

Dear David, I appreciate your sound concerns. Here are my thoughts on those.

1. Health care should be minimal or free ="for the poorest of us".

It cannot be free- the financial cost is just distributed across all workers(income earners) or citizens(through other forms of consumption taxes). How much is the mainstream american willing to pay to government to achieve this goal? That will be played out. (And in typical US/liberal fashion, I bet we will tax the "rich" disproportionately since there's fewer of them to protest. This is immoral, but it works well. And we must never forget- those of us who have experienced indigent patients in county hospitals and clinics-free care and meds is almost always associated with poor compliance and high demand of the latest expensive tests-stemming from their anxiety that since they can't pay, they aren't getting the best possible care- with litigation as their only leverage.

2. "the other advantage to socialized health care is less-expensive drugs."

Yes, of the drugs that are obtainable by the local government formulary-which does the negotiating in Italy and in Britain. Whether you have reimbursed access to certain drugs will depend on where you live. Some cost savings will have to exist in paring down offerings even with large quantity negotiations. For instance, in certain parts of Italy, one generic drug exists for a chosen condition- if you have side effects from that particular brand, too bad. You pay out of pocket to obtain another drug for yourself. And since government does the choosing, some old folks do die from sloppily classified drugs. Here's Britain:

"Access to lifesaving drugs across Britain can also depend on where patients live. Decisions on which drugs to buy are made by local authorities so that cancer drugs approved in one part of the country may not be available in another. That has led to what critics call ZIP code lotteries.

"The NHS is full of inequity," said Dr. Karol Sikora, a professor of cancer medicine at London's Hammersmith Hospital. "Whether or not you get cancer drugs to save your life can come down to where you live." Boston Globe June 30,2007, Maria Cheng

3. "But when it's done right..." Yes. yes. I am perhaps more pessimistic than you are toward government run activities. However, there's hope in looking at the VA system's recent revival- tempered with the fact that it is also struggling financially -being stretched thin with huge backups in disability claims due to this present War on Terror- watching it try to stay afloat will be instructive.

Trade-offs. What are our most primary values and what are we willing to sacrifice? Saving money for less choices? Easy access for wasteful utilization? Virtually free healthcare for overutilization- thereby making for long waits? Free prescriptions that minimize the need for changing one's lifestyle? It's a valuable discussion of how we prioritize.

[arlyn]

How about a little understanding on the often quoted uninsured (without health insurance)number in the US?

46 mill were uninsured in 2005. (15.9% of the nation)

1. only 1/6 of that above number lacks health insurance for two years or more. that brings the long-term uninsured to 2.65% of the nation. Not bad!

2. 1/5 of the total are not American citizens. Will they benefit from Universal Health Coverage plans? How much is the working american willing to share his income to cover them?

3.1/3 of the above are eligible for public-assistance programs (especially Medicaid) but haven't signed up. That's 15 million who can and should be covered within our existing systems, but don't.

4. 1/5 of the total earn more than $50,000/yr and choose not to buy coverage. that's 9.2 million who happen to be primarily young adults under 35 and don't feel they need it.

Facts extracted from "Health Care in Three Acts" by Eric Cohen and Yuval Levin in commentary magazine Feb. 2007.

(yes, Alex, it is a secular Jewish neo-con entity that started out as a liberal entity. So I quote only their facts for educational purposes.)

Crisis? hmmm.

[arlyn]

correction- in point #1. 7.6% is the correct number of long term uninsured. not 2.65%. (typing error)

[arlyn]

correction correction- 7.6 million== 2.65%.

[David Hamstra]

That's 7.6 million more than there are uninsured in Canada.

But to Arlyn's points...

1. But you see, I believe taxing the rich more than the poor is very moral, if not quite Biblical. The modern version of gleaning as it were.

2. I've live in Canada, and I've never heard that type of complaint. Again, when it's done right...

3. I'm actually fairly pessimistic when it comes to government run activities, such as the present War on Terror. But there's certain essential services I think are better off being run by the government, fire departments for example. It used to be that you had to buy in with a particular fire company, and only their fire trucks would help in case of a fire. Our current for-profit health care provision is equally archaic.

[arlyn]

Dear David,

1. I like your points! There was provision for the poor in the OT, both freewill charity and not pennypinching in business (agriculture-reaping once, beating fruit trees only once) which allowed for gleaning and for going into orchards and picking up leftovers.
What I absolutely love about the gleaning concept is that- it is an opportunity that requires some initiative and work on the part of the receiving end! Very, very healthy and empowering to the helpless. (here, in Michigan our cheap U-pick-it farms echo a little of that opportunity- and the Andrews student families are grateful!)

At the same time, we have the ten talents where the one talent that was not utilized was taken away by the master (God?) and given to the one who had multiplied his part- all the servants complained about that unfairness, but the Master insisted anyway. Capitalism of talents/resources/ money- is at it's root- risk, initiative, in face of uncertain returns.

How to keep both principles alive and healthy is the wonderful challenge before us. In Health care-perhaps we should take away all risk and accept the loss of options and the high financial cost and the effect on economic growth that security brings. That is a valid mindset. And that is the socialist mindset.

Yet, we Americans do love risk and freedom as a value too- it has fueled our drive to excel for most of our history. Where shall we extinguish that drive and trade it in for security? Healthcare?

2. As for that data tidbit- 2.65% chronically uninsured-that figure includes those eligible for public assistance and those above average income young people who won't be getting insurance anytime soon by choice. So the "crisis" just gets smaller and smaller.

Even one uninsured-- is too much? Shall we force everyone to buy insurance- like car insurance? And why do Canadians ever want to come here for care? And why are private clinics outlawed in Canada? And why do canadian animals have shorter waiting times for MRI's than humans?

(still, do not mistake these critiques as a sign of not wanting to improve our system, or arrogantly thinking it is adequate. Just testing the waters before we jump into another pond and get eaten up by new dangers)

[arlyn]

Oh, taxing one person's income more than another is moral? That is not gleaning, that is not charity-which has at it's heart true uncoerced generosity- that is enforced taking by majority vote.

On what moral basis do we draw the line of who gets hit more by taxes?
a. If it is on the basis of utilization- consumption tax- it is fair.
b. If it is on the basis of hurting the general public-enviromental tax based on objective data- it is fair.
c. If it is on the basis of self-willed charity- the rich like celebrity status and buy it with money, it is fair to buy publicity with money.

But just because they can pay more? They ought to be punished more? Perhaps it is just a sentiment of covetousness- "Because it's "obscene"." (a teacher in my SS used that term for CEO salaries) And it is not obscene to pay for one's pet causes with another's unwilling money. (sarcasm)

[Joselito Coo]

How will socialized medicine impact Adventist-managed hospitals/clinics in the USA if Americans were to follow the example of the Canadians? British? French? What is it like at the Sydney Adventist Hospital?

In Ghana, West Africa they've been experimenting with the Cuban model.

[arlyn]

A good starting point is "Health Care systems" on Wikipedia where a brief summary of many nations describes the many hybrids of public/private funding paradigms for healthcare available throughout the world.

As for clinical indices- I have a hard time trusting some. Cuba's doesn't match with the real life memories of those who escaped from there.

[David Hamstra]

Arlyn:

On the contrary, gleaning was very much coerced, since it was part of the law, even though the exact amount given to the poor was left to the discretion of the owner. I'm not saying that our modern system of taxation works (or should work) exactly the same, but the principle that wealth should be redistributed from the rich to the poor is the same. In a similar way, the sabbatical year teaches us that individuals should not be put under debt forever.

Freedom v. Security is the eternal political debate. The fact is governments need to offer both, because security is necessary for freedom and without freedom security implodes. Your car insurance analogy is a good one, because with out mandatory insurance we would lack the freedom to drive securely on the roads. I see health insurance as providing a secure base on which people can take risks, and therefore as a necessary part of government infrastructure.

[Pat Travis]

Political/Financial considerations- 25 years ago I was in a professional study club meeting with Newt Gingrich as the guest speaker. I expressed the feeling that the present multi-party "business/employee/insurance deduction tax provider" system would gradually "direct, motivate and create" a two tier system and the modus operandi to socialized medicine. He glossed over previous congress' "tax deduction" mandates (Rep. and Dems.) that created our present system post WW2. Today the "two tier" reality is recognized by this President who chooses to offer an equal deduction or credit to all citizens.(often those who receive a deduction do not see the inequity from those that don't receive it...but why should buisiness' be the only payer that get's the deduction at 100%?)
It is my view that we are at a "crisis" point in third party payer history where we have ultimately two, possibly three choices. Allow no tax deductions and this would require personal responsibility for one's health and this would lead to the most efficient utilization of health care dollars.( Ouch!-one has not been finacially motivated to take care of ones health for 30+ years.)
Personal insurance (without tax deduction or all at the same rate...if receiving tax deductions they should be required to accept all applicants, if not accept who you will) could be made availiable to individuals. The less fortunate and "uninsurable" could be treated under medicare and medicaid and state agencies.
The other choice is ultimately mandated socialized care for all. It isn't always as bad as it could be but there will be waiting list in any system where demand will exceed resource capability provided by tax dollars.(I hope all recognize limited resources will ultimately always the case). Of course bandaides "Cuba style" may be readily availiable but not open heart surgeries, hip relacements and other complex procedures etc.
Hong Kong in the 80's offered a third way. The government system and the private sector. Citizens could always have access to the government facility but if they chose for any reason one could seek the private provider and self-pay.(no tax deductions)
I believe the free market (presently skewed by the tax code-third party providers and payers) offers the best source for advancement in medical care...and individual provider and user choice...but maybe choice is no longer "morally" important? It can not alone decide however how to deal with the "truly less fortunate."(Remembering there are always some who choose other material goods to wanting to pay for healthcare).
I personally think the Hong Kong model is the best...but there are always those who will object on what they perceive as the "unequal" moral grounds of two systems...what isn't unequal in life?
Oh... the continual trials in the debate of the rights of the "one and many." Come Lord Jesus!

PT

[Dr. Thomas J. Zwemer]

There must be some world travelers following this blog. If so, please list in order of priority in which country you would want to get deathly ill?
How far down the list would be the Loma Linda Medical Center? Tom

[Zachary Royce]

What planet do some of you live on? Some facts obvious to all, but somehow overlooked: Private health insurance is a business. It is not profitable to insure people who are already sick, or likely to become sick, at least at a level that all can afford; thus SOME people can not afford health insurance. True, they are theoretically not denied emergency care; but even then they are held responsible for paying for this care, unless a provider decides that efforts at collection are not worth the return. It’s generally not free, as frequently implied.

But all this talk about emergency care is disgustingly beside the point. We have all known people who need surgery for any number of non life-threatening disabilities. If you have a good job and good health insurance, it’s really easy to pay a doctor $300 to sign off $10,000 worth of MRIs, and then $50,000 in surgery for a messed-up back or knee, and then smugly tell the anonymous masses not able to afford this kind of healthcare that they can just go to an emergency room, no problem; and insinuate in the same breath that their lack of healthcare must be the result of laziness or financial irresponsibility.

First of all, to gratify this insinuation, if anyone here believes that past laziness or financial irresponsibility constitutes just cause to deny any level of healthcare, I dare them to state it openly and reveal a little bit about themselves.

Secondly, I doubt whether the most perfectly upright and healthy-living readers here, living in the most insulated upper-middle-class Adventist bubble, is not personally acquainted with innumerable examples (most of them very exceptional, and seeming to be aberrations from normalcy, but strangely constituting the norm) of hard-working, financially responsible people being absurdly and horribly screwed by the mechanics of the private healthcare system in ways that they wouldn’t be in a public system. Just a few months ago, a friend of mine suddenly received a massive salary cut from her psycho boss when her husband was diagnosed with cancer, because he knew that she needed her employer-provided health insurance and couldn’t quit now.

You do not need to lecture me in economics, either. I am well aware that private enterprise generally operates more efficiently than government enterprise, and will, for the sake of present argument only, allow that private healthcare would cost more per unit-of-service delivered than public healthcare (although the answer to this question is so complex that even an army of economists can only speculate in the grossest manner); and will further allow the equally unpredictable proposition that the money to be made in private healthcare produces better doctors, better drugs, and better treatments, and that a government run system would thus have to pay doctors, pharmaceutical companies and scientists at least what they make now to make saving and improving lives worth their time.

And I will temporarily forget how inefficiently the private healthcare system actually works—how bags of salt water cost $700 each and a Tylenol $50, how records seem always to be either missing or incorrect or unnoticed, how nobody knows anything but the legal fine print, and how compassion is artificially scripted into every telephone conversation with some bored, mumbling, idiot reading off of a computer screen.

Granting these economic arguments, which absurdly over-simplify an impossibly complicated subject, the same level of healthcare that currently exists could be provided to all citizens, though at higher total cost, and paid for with tax dollars rather than the myriad of other ways it is currently paid for in the private sector. Of course, some lazy people (and their families) would get away with getting their healthcare for free, while hardworking people would carry their weight. For this, you would deny me, my friend’s husband, and probably your own friends and family, and certainly masses of responsible Americans the healthcare you happen to enjoy by your privileged status in life.

[arlyn]

such anger against those who sacrifice to pay health insurance is not warranted. The middle income and above still pay the same high premiums or higher, not less-and we all across the income spectrum face the uncertainty of having our insurance tied to our jobs.

Yes, and one of our employee's new husband had a history of cured cancer and everybody else in the company watched their premiums shoot up. The pain was shared all around. We kept her and just dug deeper into our pockets as a consequence. Is that fair?-for her or for everyone else? It's reality.

Here's a good point for you- Doctors in Australia, France and Germany do get paid much less than in the United States. the lowliest doctors (full-time) in the US get about $150,000/yr (which automatically puts them in the top 10%) and any specialist gets 200-300/yr with surgeons about 300-500. since the top 1% bracket is at 338/yr- cut their salaries. Yes, I know that we all worry that the brightest minds will then go into law or business tracks to make more money, but then again, I am not sure that Australian (who earn about 30% of what our US MD's do), German or French doctors are worse for the general public than american ones. At least their clinical indices=real results (reliable reporting)seem comparable or better.

One last point- more than the 16% of the US without insurance- is the fact that 30% of Americans between 18-34 are uninsured. And insurance companies have a hard time attracting them-(they are the ideal candidates for a risk-adverse business). So, let's force them to share the pain with mandated insurance. (sarcasm)

[Dr. Thomas J. Zwemer]

Does anyone remember way back to Carter days and HSA's. I was a board member. The Center Savannah River Area 600,000 had more cat scanners than the entire
nation of Mexico. The HSA's were to control the increase based on need/access. Well the big guys always got the second one before the remote guy even got in the door. The point is we keep score on size, money, power, and very seldom on need. Tom

[Joselito Coo]

Nobody picked up the question I asked about the impact of socialized medicine on Adventist managed care. My guess: church-run hospitals will be a thing of the past because, in effect, everyone shall become state employees. This might be a good thing. (No sarcasm implied.)

[mom2twoboys]

Pat Travis,

I currently live in Hong Kong, and the system continues very much like you mentioned. There is a public system of hospitals which, for emergencies, is very good and cheap. If you have a HK ID card, it will cost you $100 HKD (about $12 US) for whatever emergency treatment you need (including medicines, x-rays, etc), and $100 per night if you have to be admitted. Yeah, you'll have to wait a couple of hours if your emergency isn't dire, but it's generally competent care. (though this week there was a chilling article about an instrument being washed in water in between 4 surgeries at one of the public hospitals.)

OTOH, the waiting time for prostate surgery is something like 3 years, and other surgeries have similar wait times (there have been several articles lately, but I can't remember the details). To get in to see a specialist, you will have to wait 6-12 months.

But, as you mentioned, there are the private hospitals as well. There are two Adventist hospitals as well as numerous others. They offer as good of medical care as you'd get in the states for a fraction of the cost. Yes, you do have to pay, and compared to public hospitals it is more expensive, but compared to the US it is dirt cheap. I am constantly amazed at the prices here.

My husband recently had to have a surgery. He wanted to check the price at a public hospital so that he could save our employer money (we have subsidized health care). Turns out, he couldn't see a surgeon for over a year at the local public hospital, for a procedure his Dr. said should probably be done in the next 3 months. So he went back to the private hospital and had it done there.

M

[arlyn]

Joselito,

Your question is not easy to answer because public hospitals have public employees. Adventist hospitals will probably remain private (even if not very Adventist- and how is Adventist care different from Methodist care outside of diet? but that's another topic) and as my recommendation to look at the Wikipedia site shows- most countries will have a place for private care. How much of the actual private hospital budgeting and standard of care will be affected by government controls also is dependent on how much power the people give the government for oversight over all healthcare institutions.

It may be little change- if the hospital treats unfettered and collects from the patient, who is then reimbursed by government funds. It may be immense in that all hospitals are mandated to follow algorithms of workup and treatment, with built in negative financial incentives for going outside the "box" and inability to set separate prices for it's treatments.

mom2twoboys in Hong Kong illustrates the hybrid system with customer choice still available- clinically recommended timelines were not possible within the public and cheaper route- the more expensive, private route was taken.

SDA Hospitals would probably offer the second independent option as long as possible.

[arlyn]

from the ending of the original article that started this blog by Royce.

"But as Moore points out, it is not simply the “least” of us who are in need; where health care in America is concerned, most of us are in need."

Really? --- "in a 2006 poll, the Kaiser Family Foundation found that while a majority proclaimed themselves dissatisfied with both the quality and cost of health care in general, fully 89% said they were satisfied with the quality of care they themselves receive. A modest majority, 57% were satisfied even with its cost.

In the same poll, 90% considered the number of Americans without health insurance to be a serious or critical national problem. Similiarily, a majority of those with insurance of their own fear that they will lose their coverage if they change jobs..."
Eric Cohen and Yuval Levin, Commentary Feb 2007 (again, just the facts of where our real concerns are.)

"Most of us are in need?" our own responses belie this. Most of us want better? yes - for all.

[Pat Travis]

Joselito,
If the "Hong Kong model" was adopted, that is, allowing for private care as well as a government system then they would continue but on a smaller scale. I worked at HK Adventist (private) hospital in the 80's and 90's. See my above post concerning "third option."
However, Often governments don't allow a private system choice to coexist.
Actually,In some ways this might keep both systems "honest" in patient care cost and quality.In HK private care was much more expensive but it was not unusual to see families practice "delayed gratification" in order to get private care.

PT

[arlyn]

Dear David,

Mind if I deviate into economics a little from your intriguing references?

1. "On the contrary, gleaning was very much coerced, since it was part of the law, even though the exact amount given to the poor was left to the discretion of the owner."

Harvesting only once was part of the law, (how was it enforced?) and interestingly this sets up the more efficient farmer as the one going against the principle of the law- to be generous, albeit a little purposefully sloppy. But how in the healthcare system can we find a way to help the poor become engaged responsibly in their own care when they don't pay hardly anything? Gleaning required harder work than first time reaping. So they "deserved" directly the fruits of their labor.

2. "I'm not saying that our modern system of taxation works (or should work) exactly the same, but the principle that wealth should be redistributed from the rich to the poor is the same."

Correct, in following Christ's example of sacrifice voluntarily. Whether through outside coercion or not --is the burning question. Is enforced charity, charity? or stealing? Ask a bandit. or better yet, ask a politician.

3. "In a similar way, the sabbatical year teaches us that individuals should not be put under debt forever."

a.The Jubilee or anything set up like it today (periodic cancellations)would be taken into every lender's agreement so, nothing would extend past Jubilee (for that would be stupid on the part of the lender), nothing would need to be forgiven.

b. Secondly, we have bankruptcy which is not dependent on the calendar but on the state of the debtor- much better idea.

c.Third, as in Jubilee and bankruptcy, the history of those who may have enjoyed the benefits of huge debt forgiveness (which hurts the other person- the lender)) will follow them to the next lender and restrict their ability accordingly.

d. Perhaps a statute of time limitations on debt dependent on when it was taken on- would be similiar to Jubilee. But then the collection agencies would be whipped into a fervor within the allotted time- more harrassment over shorter periods.

Finally,I do appreciate your motives. And I enjoy thinking through realistic scenarios from your springboards.

[Pat Travis]

Thanks Mom2two boys-
It was to stay the same for 50yrs.after 1997 return to China. Thanks also for the confirmation of "both" system outcomes.
If you need private dental care in HK, The Costello brothers at mid-level are as good as you can find!

PT

[David Hamstra]

Joselito:

That's what happened in Canada. Bye, bye Branson Hospital. But wasn't the Adventist health message supposed to be about prevention rather than acute care anyway?

Zachary:

My theory on why for-profit health care is less efficient: they've got us by the cojones. What's your health worth to you? It's priceless, so they can charge as much as they can get away with.

[David Hamstra]

Oops, I missed your comments Arlyn.

1. On the notion of gleaning, I think it's the welfare state we're debating here. I think you're right to call for some activity on the part of the poor, apart from standing in line or walking to the mailbox, in order to receive welfare. I think Clinton called this "workfare".

2. I also find in the principle of gleaning that the wealthy do not have absolute rights to their wealth. However it may or may not have been enforced, the principle of gleaning tells us that some (if not most of us) need a civil law to get us to give some of our wealth to the poor. Consequently, I do not see income bracket taxation schemes as "stealing".

3. Agreed that bankruptcy is the modern equivalent of the Sabbatical/Jubilee year. I have, however, heard an Adventist pastor council a member not to go into bankruptcy because it's "stealing".

[David Hamstra]

Arlyn:

p.s. I'm certainly discussing this from an idealistic perspective, and appreciate your realist approach. For the U.S. I do advocate a two-tier system, and a see a place for for-profit involvement in health care in the R&D sectors. How else would we encourage innovation in drugs, equipment, and practice?

[Dr. Thomas J. Zwemer]

Insurance is a betting game in which the odds are calculated on the worst case scenario. Under our present system, patient and provider are on the wrong end of the odds. There is no doubt adding the government as the primary risk taker will increase cost. It will improve eligibility but not necessarily accessibility. SDA hospitals will do just fine, Hospital administrators will continue to just fine. The primary care provider will be squeezed and the patient will be standing in line. Tom

[Pat Travis]

Since people often try to use the Bible as a source for socialism, communism and "absolute free enterprise" I thought I would make a few comments suggesting NO present system can be 100% supported by scripture.
OT law made the land the primary socio-economic instrument...it could not be lost in perpetuity.
Every 50 yrs. it would go back to the original family owner.(who does that in any system today?)Wrong behavior had long lasting consequences if their was no kinsman redeemer...up to 50 years.Every 7 yrs.debts were to be remitted to fellow Israelites (but not to the foreigner)The 7 yr. release and the 50 yr were at a set time. However there is no indication either was practiced and this is part of the reason for the 70 year captivity.
It simply is not possible to state absolutely that any social system today, in part or whole is an "application" of that system that performed as a holistic unit...not I like this priciple but not that one! I am a believer in "free enterprise" but recognize it's modern day fault lies in the absence of a 50 yr. return of the land. Socialism as an ongoing redistrubution enterprise on the other hand ignores individual rights of the "One in favor of the many." All systems are bound for failure, thus the history of nations. It is my belief that "free enterprise" offers the most "justice" to a pluralistic people of different social and religious backgrounds.Generally, I suggest, as you forfeit economic and social liberty historically you also begin to see a lessening of religious liberty. I personally believe we will see that in our country. Hitler and National Socialist Germany sought the aide of the church ("German Christians") in the area of administering social benefits until the time he felt them no longer necessary.The "Confessing Church" led by Bonhoeffer resisted the use of the church by the Nazi's. I would suggest that it is just as dangerous, if not more, for the church to be associated in "liberal social" policies as it is in "moral behavior" policies. Let each individual vote and act as he sees fit but the "church" as an official spokesman to political interest should not exist..."left or right." Christianity is not to be obsessed with the kingdoms of this world but the "kingdom of God."That's my take for what it is worth.

PT

[Faye]

'I asked about the impact of socialized medicine on Adventist managed care. My guess: church-run hospitals will be a thing of the past because, in effect, everyone shall become state employees...'

Joselito,

Denominational health care and hospitals are compatible with socialised medecine, at least in the Canadian model.

While the model may vary from province to province, I can provide some information about the governance model of Catholic Health Care Organizations, known as Providence Health Care, within the province of B.C.

The Provincial Health Services Authority (PHSA) is one of six boards responsible for health care delivery within the province. Five of the boards serve geographic regions of the province, while the PHSA's primary role is to ensure that all residents have access to a co-ordinated network of specialised health care services.

The PHSA operates provincial agencies, such as Children's Hospital, the BC Transplant Society, and so on.

Providence Health Care is a non-profit organization that provides services in partnership PHSA, Vancouver Coastal Health Services, and the University of BC.

Frome their website:

"PROVIDENCE GOVERNANCE

Providence Health Care is a non-profit organization that provides services in partnership with the Vancouver Coastal and Provincial Health Services authorities. It operates under an agreement between the Province of BC and the Denominational Health Association. The agreement recognizes the rights of owners of denominational care facilities to own, manage, and operate their respective facilities and carry out their respective religious missions. It obligates the owners to meet provincial standards and national accreditation for health care, meet the condition of any agreements with teaching facilities, and plan and deliver health care services in collaboration with other health bodies."

David,

My understanding is that Branson Hospital closed due to the proximity of the larger North York Hospital and the economics of continuing to operate both.

[arlyn]

Dear David,

I have no problem with being taxed to provide basic necessities (this, I agree with) as long as it is a flat tax or proportional %. But to be taxes way out of proportion? from 20% up to 40% depending on one's tiered income?

Please unpack for me how bracket taxation schemes are just according to the bible, or general morality, or economics? There's got to be some rational logic you know about this, that I am missing. (sincerely)

[Joselito Coo]

Health care in Canada appears to be the single payer (government) type.

I'm neither Canadian nor American and my experience has been elsewhere. Historically, Adventist health care missions abroad seem to have followed the American free market model. Consequently, unanticipated change in the health care structure of each of the countries involved, mandated by the state, has frequently thrown our church out of kilter. By and large, denominational leaders have been unable to provide clear guidance to Adventist professionals so they could better adapt to the new situation.

[Pat Travis]

Joselito,
Even if the US evolved into a total government system, I feel you are looking at 15-20 yrs for that transition. The politics would be enormous and tedious. More likely is a dual system at minimum as a transition system.

PT

[David Hamstra]

Faye:

That is correct. Thank you for your more detailed explanation.

Patrick:

I do you see any limit to this statment, "Christianity is not to be obsessed with the kingdoms of this world but the 'kingdom of God.'" What happens when the concerns of the kingdoms of this world intersect with the concerns of the Kingdom of God? Should Christians agitate for religious liberty? What about anti-smoking legislation?

Arlyn:

My logic begins with the assumption that individuals do not have absolute rights to their wealth, and that the state has the right to take some of that wealth and use it to establish a secure society. As Bible believer, I also assume that the Old Testament law has some continuing relevance for us today (Matthew 5:17-19).

I see in the concept of gleaning a system in Old Testament law which redistributed wealth from rich to poor (regardless of whether this law was ignored). Income tax brackets are a system with redistributes wealth from rich to poor. Therefore, I do not see them as "immoral".

Of course, as Pat points out, there's no straight across correspondence between gleaning and tax brackets, but the purpose is the same.

I should say that I think a 20%-40% difference in bracket is a relatively crude way of redistributing wealth. I think the Biblical system of gleaning was better because it required some "work" to get the food, and Paul says that of the NT church welfare system that the one who doesn't work shouldn't eat. Also, I think if we adjusted our economic/financial system that's leading to a new "gilded age", we could shrink if not eliminate the bracket system.

But bringing this back to health care, I think there's even better correspondence between gleaning and the rich contributing to the health care costs of those who cannot afford them. Both food and health care are necessary for life. Both are obligatory for a just society to provide to those who are unable to provide for themselves.

[Pat Travis]

David ( I think):
Not being obsessed does not mean not interested or on occassion involved. What are the priorities of the "church"?(as opposed to individual citizenship)
It is my belief that some church organizations are so involved in various "legislation" left(social liberals) and right(post mil.theonomist), that they imply this is the future "kingdom." To me the "church" through the Spirit is to convict the world of it's sin and bring people to Christ and be a co-partner with the Spirit in maturing them in "the kingdom of Christ" as it's primary role. Priorities cause us to recognize that the kingdoms of this world will never "mature" into the kingdom of God/Christ...they ultimately always oppose it.
I sometimes think Liberty Mag.overstates it's "Religious liberty" position by usually harping on the religious right(who probably are quite often in line with the intent of the majority of the signers of the Constitution (Religion was not to be banned in public conversation...but not finacially supported) but rarely speak of the religious left's political/social agenda(i.e.global warming, universal healthcare etc,).Why is the "moral behavior" imperative wrong and the "social vision" ok in regards to "religious liberty?" I am not personally convinced anymore anti-smoking legislation is a priority in today's world. The secular world is applying enough overkill. "Informed choice" seems the way to go to me for the church.(you know, the way we all kinda want to grow in sanctification with our own personal difficulties)

PT

[arlyn]

Minimal food and shelter are necessary for life.

Healthcare isn't.

Health is tied to quality of life. But healthcare is not health. Blurring that distinction is why Americans won't eat less and exercise more for their own sake- but wants healthcare to keep them alive.

As if Healthcare is an inherent God given right.

If given by the government- which it can choose to do- it is an entitlement. Which is more accurate and honest.

Bread and circuses, anyone? (sarcasm)

[arlyn]

healthcare is not a right. a job(though somewhat closer to a necessity for life)is not a right. transportation is not a right. clothes are not a right.

Rights spring from God, not government.

[David Hamstra]

Pat:

I agree for the most part with your analysis. The kingdom of God will certainly not come about through legislation.

Arlyn:

Is life a right? If so, does it come from God or government? If from God, then why does God use governments to defend this right.

[David Hamstra]

Pat:

I agree (for the most part) with your analysis. The Kingdom of God will not be brought about by the legislation of the right or left's social agendas.

Arlyn:

Is "life" a right? If so, why does God rely on governments to defend this right?

[David Hamstra]

Sorry about that doppleganger post. I got an error message and thought I had to retype it. (No, I'm not trying to spam your comments, Alexander ;).)

[Daneen Akers]

I hope this conversation entices folks to rent the DVD. One of the scenes I loved had to do with a British doctor. Moore intended to explode this myth about doctors in single-payer systems making a pittance. Turns out a GP (family doc) in the UK makes over $200, 000 (that's more than the 150k quoted above for the average US, non-specialist physician), lives in a fabulous home, and drives a very nice car. Now, he admits that if he wanted four really nice cars and three really nice homes he'd need to move to the U.S. But, he thinks he lives quite nicely--and that's enough.

The concept of enough is one I don't think we pay enough attention too. Hence our obsession with material attributes of success.

The other major take-away I got from this same scene in the film is that in the U.K., doctors make more money when their patients get healthier (rather than a scene in congress where an insurance company doc testified that she got paid more the more claims she denied). If this doctor got his patients to quit smoking, lose weight, or do some other preventative measure, he got a bonus at the end of the year. What an idea! Pay people for helping them get well, not for denying their care or looking for excuses to renouce their insurance once they actually need it.

Back to Zachary--great point about our healthcare model being for profit. The scariest moment in the film is hearing the Nixon White House tapes when Kaiser first got his for-profit plan approved. I'm paraphrasing, but Nixon wasn't so sure about this whole HMO thing. His assistant said, "No, the idea is to make money." I'm not sure how we wrapped our minds around the idea that healthcare should be a money-making venture. What if firehouses operated this way? God or government given, there are some rights that shouldn't pad corporate pockets.

[arlyn]

Life is a right. So is liberty and the pursuit of happiness.

healthcare? the founders never heard of it.

Protecting life= national security and a justice system. This was also a recognized role for government that the founders believed in.

But healthcare? Even Benjamin Franklin (one of the foremost liberals) who established cooperative firehouses and libraries and postoffices didn't establish a medical system that I know of- maybe someone can enlighten me on this.

This is a modern value- that healthcare for all at a certain level is worth whatever the cost. Not a bad thing, but not a right nor a government role by the constitution.

(Proposed script: say "yes, you're right, but who cares? let's make it so!")(I can respect that kind of honesty)

[Dr. Thomas J. Zwemer]

arlyn

Isn't the pursuit of happiness an umbrella concept. How many sick people do you know who are happy in or with their physical aor mental status? Are they not "pursuing" health in order to add to their happiness? Wouldn't "well-being" be a synonym for happiness? Just think of the word disease-- dis- ease or not at ease or not happy! Didn't the Spanish comb Florida for the fountain of youth? Health is the sum of life and happiness! See John 3:2. We can disagree about process but not end-point! Didn't God use dis-ease to vex Pharaoh? (make him unhappy enough to let His people go? Tom