Criticisms of SICKO by alicejenny


									           Some Sources…
• “The Healthcare Mess” – Julius B., Richmond,
  M.D., Rashi Fein, Ph.D., 2005
• “Healthy, Wealthy, and Wise: Five Steps to a
  Better Health Care System,” Kogan, Hubbard,
  Kessler, 2005
• “Can We Say No? The Challenge of Rationing
  Healthcare,” Henry J. Aaron
• “Business of Health,”by Robert Ohsfeldt,John E.
• Jesse Larner
 Criticisms of SICKO… Note: criticism are in black and
               responses to criticisms are in red…

• Sicko doesn’t say who           • Moore does in fact
  will “pay” and falsely            mention that the
  claims that British,              French are “drowning in
  French, Canadian                  taxes” … and that
  healthcare is “free”              single-payer healthcare
                                    systems are paid for by
                                  • BUT… Moore doesn’t
                                    explain what
                                    percentage of taxes are
                                    used to pay for
Income Tax rates by Country based on Organisation for Economic Co-operation and Development, 2005 data (includes
employer payroll tax contributions that some countries impose for programs like social security and healthcare.
     Criticisms of SICKO…Cheeseburger
• The U.S. cannot be compared to • the United States does not stand out
  other industrialized countries               in the quantity of care, as measured
   – “We Eat More Cheeseburgers”               by such indicators as the number of
        argument – our unhealthy lifestyles physicians, nurses, and hospital beds
        offset our superior care…              per capita.
   Source: Ezra Klein of The American Prospect
                                       Source: Paul Krugman, The Healthcare Crisis – NY Review of
                                            Books, 2006

                                       • Nor does the US stand out in terms of
                                         the quality of care: a recent study
                                         published in Health Affairs that
                                         compared quality of care across
                                         advanced countries found no US
                                         advantage. On the contrary, "the
                                         United States often stands out for
                                         inefficient care and errors and is an
                                         outlier on access/cost ba
                                       Source: Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner,
                                            and Hugh R. Waters, "Health Spending in the United
                                            States and the Rest of the Industrialized World," Health
                                            Affairs, Vol. 24, No. 4 (July/August 2005 ),
                                                Criticisms …
• Sicko misrepresents the Canadian
  Medicare system:                                          • Only 3% of Canadians suffer
    – Canadians endure long waits, 4.5 months
                                                               Source: Gera ld Anderson, Johns Hopkins Health study
      for appointments
                                                            • Longer lines/waits are,
    – Canadians endure waits of 4 to 12 hours                 overall, a justified “cost”
      for basic care
    Source: California Association of Health Plans/Op-ed…        – Long lines are evidence of
    – These long waits result in needless deaths                   Canada’s moral commitment
      (ie – film regarding brain cancer patient…)                  to serving all…
    – Increasing numbers of Canadian patients                    – 24% of Americans simply
      and MDs are now coming to the U.S. for                       avoid healthcare due to $$$
      treatment frustration                                        (vs. 5% in Canada and 3% in
    – My friend/relative (fill in here) lives in                   the U.K.)
      Canada and hates their system…              •            According to a Gallup poll in
    –                   the Toronto Sun, only 2% of
      gery.php                                                 Canadians stated a
                                                               preference for U.S. style
             Criticisms of SICKO…

• OMISSION - Europe is starting to move away
  from government healthcare:
  – U.K. is now privatizing surgeries, etc.
  – Sweden will outsource 80% of its primary care and
    40% of its total healthcare dollars
  – Germany has a universal but private insurance
           Criticisms of SICKO…
• 12.5% in the U.K. wait     • Ranking for non-elective
  over a year for surgery…     MD appoint wait-times
• Wait times for care are      (% are for same day
  longer elsewhere than        appts)
  in the U.S. …                 –   1. New Zealand
                                –   2. Britain – 71%
                                –   3. Germany – 69%
                                –   4. Australia – 66%
                                –   5. U.S. – 47%
                                –   6. Canada – 36%
                    Criticisms of SICKO…
• OMISSION - Our drugs and technology
  are the best in the world due to
  market-driven medical innovation
  made possible by the Orphan Drug Act
  of 1983. This act uses tax incentives
  and 7 years of market exclusivity to
  incentivize drug production…
• We in the U.S. benefit from new drugs
  – we get “first launches” of drugs
  which cost approx. $1 billion per drug.
Source: Manhattan Institute/Washington Post
Criticisms … Moore’s worldview is anti-American, socialist
               and dangerous to the U.S.…
 • Tony Benn is an old-school socialist…
 • Moore wants “French freebies on the government dime”
 • Moore prefers class-conflict to American individualism and personal
 • If se have socialized care, our society will lose it dynamism
 • Moore is “more French” than the French – even the French are
   abandoning their socialist ideas with the election of Sarkozy…
 • Liberals desire government programs because liberals want us to be
   weak and dependent on the government…
 • U.S. exceptionalism – we are the greatest country and thus have the
   best healthcare system and thus Moore, by criticizing our system is
 • French “protests” are protests by privileged middle class sectors of
   society that seek to keep their cushy benefits yet exclude immigrants
   from Africa, Turkey, and those from the former eastern bloc…
 • Source: Rich Lowry, National Review
• Response – The argument that “SICKO shows that liberals are are
  anti-American pinko’s/commies” is a strawman (the left does not
  agree); it is ad hominem (instead of addressing the issues he
  raises, conservatives such as “National Review magazine” simply
  resort to red-baiting or name calling; and questionable premises
  (ie – the French do not want to give up their socialized, single-
  payer healthcare…)
• In regards to the strawman fallacy, even “The Nation” – a well-
  known leftist, U.S. magazine criticizes Moore’s ode to Marx:

•   "The film's final half-hour, in which Moore takes 9/11 rescue workers to Cuba,
    serves only to reinforce the decades-old slander that equates social democracy
    with repressive socialism. It's a major miscalculation and nearly squanders the
    first hour and a half of the film in which Moore so deftly guts arguments that
    socialized medicine represents the vanguard of Marxism.“ Source: Christopher
    Hayes, The Nation
                   Some questions
• Should we ensure – whether via free market or socialized
  care – provide everyone with healthcare?
   – Basic care? Elective surgeries? Non-elective surgeries?
   – Is rationing of care ever morally permissible?
   – Are we obligated to provide healthcare to those who have
     “unhealthy” lifestyles?
• Are all forms of insurance the same?
   – Fire insurance
   – Car insurance
   – Medical insurance?
• Are healthcare products analogous to cellphones, etc?
   – X-rays vs. automobiles, cars, cellphones…
                       Some terms…
• Socialized medicine version 1 – government pays but the
  private sector delivers
• Socialized medicine version 2 – government pays and
  government delivers (V.A.)
• Single-payer – government pays; one private sector insurance
  companies pays
• Free-market – consumer pays, health provider delivers
• 3rd party (84% of U.S. costs) vs. 1st party payment/delivery…
   – taxes to 3rd party government
   – premiums to 3rd party insurer
   – Out of pocket payment at “point of delivery” to party healthcare
     provider by consumer
   – Criticism of 3rd party payment: MDs and patients don’t act rationally
     in light of actual costs…
   Brief History of Health Insurance in the U.S.
• WW II – due to labor shortage (and wage caps by
  gov’t), employers offered health coverage to
  employees in order to attract workers (a “work
  around” to price controls on wages…)
• Health insurance was relatively inexpensive given low
  medical costs, technology, drugs, etc.
• Health insurance is a non-taxed benefit offered by
  employers which, if taxed like wages, would net $150
  billion in additional tax revenues.
• Health insurance now costs employers, on average,
  $10,000 to insure a family of four…
         Causes for rising costs in U.S.

• Fragmentation of healthcare
    – Medicare (single-payer system for seniors)
    – Medicaid (single-payer for the poor)
    – Healthcare delivery systems – private insurers, for-profit
      hospitals, gov’t…
    – 50% of spending is by U.S. gov’t, 50% by private sector
• 1960 – 5.2% of GDP vs.2004 – 16% of GDP
• New technology, drugs, therapies are costly.
• MDs paid much more in the U.S. than elsewhere
• 30% of each private healthcare dollar spent on
  administrative fees and profit
• Rise in MD insurance premiums (
             Malpractice Insurance?
• Malpractice jury awards increased 4 percent annually
  between 1991 and 2003 or 52 percent overall since
  1991, but only 1.6 percent a year since 2000.
• The increases are roughly equivalent to the overall rise
  in healthcare cost
• Malpractice insurance premiums for internists, general
  surgeons, and obstetricians have skyrocketed since
  2000, jumping 20 to 25 percent in 2002 alone. Some
  specialists, such as obstetricians, now pay almost
  $100,000 annually for their malpractice insurance.
   Source: Rising doctors' premiums not due to lawsuit awards; Study suggests insurers raise
      rates to make up for investment declines; by Liz Kowalczyk, Globe Staff | June 1, 2005
                    Malpractice Rates?
• Malpractice insurance companies have increased
  rates to compensate for falling investment
  returns (1998-2000) due to bond losses which
  make up 80% of their portfolio
• Malpractice insurance rates vary widely
   – Dade County, Florida – increased 75% (to
     $174,300) from 1999 to 2000 vs. 2%
     (%10,140) for the same specialty in Minnesota.
   – Minnesota’s largest insurer increased rates for
     the same specialty by 2%
  Source: The Health Care Mess – Julius Richmond, M.D., Rashi Fein, Ph.D.
Adverse Reaction Cycle –
the problem with
Employer-based Health
          Advantages of Single-Payer
• It’s ethical – no “adverse selection” – all are covered.
• Removes competitive penalty on small businesses.
• Single-payer is more efficient
   – Medicare’s administrative overhead is 2% of total costs vs.
     13% of private insurance companies.
   – Medicaid - $9,600 avg/person vs. $14,800 if in private
     sector. Source: Medicaid: A Lower-Cost Approach to Serving a High-Cost Population," policy brief by the Kaiser
       Commission on Medicaid and the Uninsured, March 2004.

   – Taiwan – switched to universal, single-payer in 1995 with
     better quality yet only slightly increased costs.
   – Stronger drug-bargaining position (Medicaid & V.A. get
     “Canadian rates” from U.S. pharmaceuticals…)
    Free-market voucher approaches?
Proposals                                       Questions…
• South Carolina – a free-                      • Who decides on voucher costs?
  market voucher system                         • Who provides (and pays for) the
• Consumer-directed                             • Is “healthcare consumption”
  approach –eliminate “3rd                        analogous to “appliance
  parties” – whether it be                        consumption”?
                                                    – How will patients “shop around
  insurance companies or                              and compare” during emergency
  government and instead let                          situations?
                                                    – How will information regarding
  patients barter directly with                       healthcare quality be
  physicians and hospitals                            communicated?
  with vouchers.                                • Will vouchers address increasing
                                                  costs due to technology, drugs,
•   Source: “Healthy, Wealthy, and Wise” – D.
    Kessler, Hubbard                              etc?
Free-market tax-credit proposals…
    Proposals                    Questions

• Remove tax advantage that      • Do the wealthy need taxbreaks
  favors health insurance over     of this kind?
  “out of pocket” by taxing      • Will this reinforce adverse
                                   selection? – those who are
  some employer based              healthy will adopt savings
  health benefits OR cut taxes     accounts and opt out of
  on out-of-pocket.                company insurance plans…
• Tax advantage health           • Rand study: we don’t make
                                   wise healthcare choices if out-
  savings accounts – tax free
  shelter for healthcare.
                                 • This will not address expensive
                                   treatment that is 80% of

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