SICKO Part One

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Three movies in my entire life have moved me to tears, and Michael Moore’s SiCKO was one of them.

(The other two? Walt Disney’s Snow White–I was four, the witch–and at 25, Star Wars, utter boredom).

Last month I saw–twice, in fact–this devastating critique of the American health insurance industry and its collusion with the federal government. Health insurance is a very sensitive issue for me. Every hour of every day the endless confrontation of doctors and their patients with the health insurance industry increases everyone’s stress and interferes with decent medical care.

Because I believe SiCKO is one of the most important documentaries ever made, I’ll be devoting several health tips to my own suggestions on coping with your health insurance and the incredible greed and unfairness of the healthcare industry.

For 15 years, before I got into integrative medicine, I was medical director of a very large Chicago medical group, supervising the doctors who cared for almost 20,000 HMO and PPO patients in 16 citywide clinics. As most HMO and PPO members will tell you, the insurance coverage is great as long as you stay healthy, but woe betide your financial future if you develop a serious and/or chronic medical condition.

Director Michael Moore wonders aloud why Americans are so fearful of government-funded universal health care, especially when they so easily accept schools, libraries, and police and fire protection, all of which we consider our “right” as citizens.

In fact, as a good comparison to the current state of our health insurance system, imagine if firefighter service were “privatized” like health care. Fire houses and firefighters would be in networks (like doctors)–Humana, Cigna, and so forth–and even though your local firehouse was down the street from your home, if you had an emergency you’d have to contact someone in your firehouse network or face serious financial consequences (just like people in HMOs and PPOs).

Worse yet is your attempt to purchase “firefighter insurance.” You might be poorly rated or not eligible for coverage at all if you once had a fire in your home even during childhood (“pre-existing condition”). Unable to get individual coverage for firefighter insurance, and certainly unable to afford the thousands of dollars you’d have to pay out-of-pocket were you to need a bevy of fire trucks to extinguish a fire, you go to work for a corporation that offers firefighter insurance as a benefit.

Then the dark day comes when your house catches fire (you get very sick). You quickly search for your insurance card, call the 800 number, punch through an agonizingly slow phone tree until you get someone who tells you that you’ll have to answer a few questions before you can get pre-approval to release the fire trucks (get medical treatment).

In the meantime, the fire is spreading.

Finally, the helpful firefighter insurance person agrees to send trucks from the “network” fire station, but that crew is currently busy with another fire. They’ll be with you in an hour. You scream that there is a fire station down the street and you can see the trucks sitting there. She says that you’ll be going out-of-network and that you run the risk of non-covered benefits (like HMO/PPO patients), but that the decision is yours. You’ll be obligated, of course, for the higher deductible.

You race down the street, scribbling a huge check while running. The firefighters arrive, but it’s too late. Your home is in smoldering ruins. A few weeks later, living in a motel, you get more bad news. The out-of-network coverage wasn’t approved because they claim the in-network fire trucks were on the way.

And so, with a real story of illness instead of a fire, begins SiCKO. A married couple thought they had health insurance, but when a crisis struck they had to pay tens of thousands of dollars in out-of-pocket expenses, lost everything (home, retirement savings), are bankrupt, and moving in with their children.

More to come.

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