Sunday, September 2, 2007

Sicko - Why Michael Moore is flat out wrong about healthcare...

by Mark Hyman, M.D.

I just watched Michael Moore's new movie, "Sicko." Today, I'd like to talk about what I saw.

This is not my usual solution-oriented blog about health problems.

But stay with me, because I want to help you understand what has to happen for meaningful change to occur in our "sick" healthcare system.

And it is NOT what Michael Moore suggests.

Now back to the movie.

I must say I was disappointed. I was hoping for a novel look at the problem of not only access to healthcare, but of the type of healthcare that is practiced.

Don't get me wrong.

I'm all for more access to healthcare, better healthcare, and lower costs.

But I am not for getting more people access to a broken healthcare system that creates more problems than it solves.

Consider this.

Our healthcare system itself is the leading cause of death overall, followed by heart disease and cancer!

If our healthcare system is responsible for more than 700,000 deaths a year from medical errors, hospital infections, bed sores, surgical errors, drug reactions, and more, which lead to an extra $250 billion in costs, do we want more people to be exposed to this type of care?

I don't think so!

Moore's answer to all our healthcare woes is to have a single payer system, like Canada.

I went to medical school and internship in Canada -- and I can tell you, the picture is not as rosy as it seems. I worked with a poor family doctor who had to see more than 50 patients a day just to earn a basic living.

And when the doctors went on strike because they were unhappy with the system, the death rate actually went down.

If the Canadian healthcare system is so great, why have so many of my medical school class migrated south of the border to the US?

Universal coverage may be part of the solution -- or not -- but Moore really missed the whole point.

If we improve a broken system just by reorganizing how it is paid for, we still have a broken system.

He didn't address that in any way.

In fact, Moore's movie is a distraction from the real problem.

The type of medicine we are practicing is antiquated, often dangerous, and based on the wrong premises and outdated approaches.

Instead, it must be founded on the laws of biology that help us address the true causes of disease, not just find better drugs or procedures to deal with them once they occur.

Getting more people access to the wrong treatments does not help us in the long term to create a sustainable model of health for society.

The thing Moore misses is a direct discussion and analysis of the lack of QUALITY in our healthcare system.

And quality is defined as the health of our population, which is clearly worse than almost every developed nation and worse than many third world countries. We are 45th in life expectancy, coming after Bosnia and just ahead of Albania!

I do not dispute the inherent problems in healthcare, where the whole system profits from reducing access to care, denying care, avoiding preventive care, or shifting costs to employers.

When Starbucks pays more for the healthcare of its employees than it does for coffee beans, then we know we are in trouble.

What Michael Moore ignores is that the entire ecosystem of business and products and services related to the health of our population has its whole orientation backwards.

You see, the healthcare industry and the food industry profit from us being sick and fat. All the incentives are backwards.

==> Until it is PROFITABLE for everyone to help create health rather than disease, we will not thrive as a society.

So we need to find a way to line up all the incentives for everyone involved in healthcare:

* For the insurers (or government, which actually pays 60 percent of all healthcare bills through Medicaid, Medicare, the VA, tax deductions, and other incentives);
* The pharmaceutical industry;
* The hospital industry;
* The food industry, where the sale of products that support health would bring in more profits than foods that destroy health; and
* The doctors, who would be paid more for creating health than doing procedures.

Marion Nestle, PhD, professor of Nutrition and Food Studies at New York University says:

"It is difficult to think of any major industry that might benefit if people ate less food; certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries. All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating." (1)

Clearly, something needs to change.

"Sicko" did have some interesting points.

The best part of the film was the part where a British doctor described how he was paid more for helping people lose weight, stop smoking, improve their blood sugar, and lower their cholesterol.

If an American doctor does that, he or she LOSES money. The British doctors actually get a BONUS for keeping people healthy!

The American doctor gets paid thousands of dollars for doing angioplasties and stent procedures and maybe 30 dollars for talking to someone about their cholesterol.

Though doctors are generally well meaning, well-intentioned people, the healthcare system appeals to their dark side.

Do more procedures, provide more invasive care, and get paid more -- EVEN if it ultimately does not benefit the patient.

What is absolutely frightening is that the system of payment for care and the system as a whole almost NEVER address the issue of VALUE of the care we get.

Value is the benefit and improved outcome of care, divided by the cost of the care. (VALUE = OUTCOME/COSTS).

Think of it this way.

If you paid for a fancy new car but it had no engine or no tires or didn't run when you put the key in the ignition, the car company would go out of business.

But in medicine in America today, we have a shiny new system that just doesn't run very well despite paying 40 percent more for healthcare than any other nation in the world.

That's almost $7,000 per person, or close to $2 trillion total (one-third of which is for administration costs).

In American healthcare, the outcome of that care is mostly ignored -- namely, the health of the patient!

In a landmark 2001 report from the Institute of Medicine called "Crossing the Quality Chasm: A New Health System for the 21st Century," the authors said:

"Between the healthcare we that we have now and the healthcare that we could have lies not just a gap, but a chasm."

So what is the real solution?

Even though I know where we need to end up, I don't have all the answers.

But I do know this.

We have to change the competing needs in the healthcare industry and related industries.

Promoting and treating sickness should not generate more profit. Creating health should.

So how can we, as a society, line up all the needs and interests of all stakeholders in our "sick" healthcare system?

If we follow the trail through our healthcare forest, it will be clear that an alignment of values, needs, and interests must occur if there is to be meaningful change.

It will also be clear that no one component can be separated from any other and that if we create change in one area of the system, often negative forces will fill in the blank space.

Let's follow the trail of a simple soda and French fries, for example.

The government subsidizes farmers to grow corn and soy crops with $30 billion a year, which fuels the fast and junk food industry with high-fructose corn syrup and trans fatty acids, which are used to produce energy-dense, poor-quality, disease-creating foods such as soda and French fries. (2)

At the same time, funds for local schools are limited. So they cannot provide students with quality food choices and physical education.

Then the food industry steps in, encouraging children to subsist on nutrient-poor, energy-dense foods from vending machines for their breakfasts and lunches.

The marketing for these products exceeds $30 billion a year (more than $13 billion of which is aimed at children), increasing demand.

These are tax-deductible expenses to corporations, which are in effect further subsidies by our government.

These children, then, become obese and diabetic in their 20s and require care for heart disease and amputations before they are 30, for which the government in part must pay.

So what is the answer?

I know that with the creative intelligence and ingenuity of this country, we can find a solution. I don't know exactly what it is, but I do know this.

As long as the any one party has to lose for another to win, we are doomed to failure. In order for things to work, everyone has to win!

We have to make it profitable to improve the quality of our food supply, to encourage physical activity and to reduce stress in our lives.

When a hospital diabetes prevention program is so successful in helping patients improve their health and reduce amputations and complications of diabetes that it has to be shut down because the hospital LOSES money by charging only $60 for a nutrition consult instead of getting $6,000 for a toe amputation -- then we know something is seriously wrong with our incentives.

We have to make it profitable to help patients get healthy, and have business MAKE money by providing preventive care and lifestyle programs that create health.

The politics of food, agriculture, environment, and education cannot be divorced from the traditional healthcare stakeholders: patients, providers, insurers, employers, payers, and government.

We have to address the roots of the problems and create a system where everyone involved thrives.

And despite Michael Moore's laser focus on a single payer system as the answer to all our healthcare problems, we need a much broader and bigger change in healthcare.

What should those changes involve? I think this topic is so important that I'll be discussing it in next week's blog, too. Stay tuned!

Now I'd like to hear from you...

Have you seen "Sicko" yet?

What did you think?

What parts of the healthcare system do think need fixing most?

What ideas do you have for fixing our healthcare system?

What do you totally agree or disagree with?

Please click on the Add a Comment button below to share your thoughts.

To your good health,

Mark Hyman, M.D.

(1) Nestle, M. Food Politics: How the Food Industry Influences Nutrition and Health (California Studies in Food and Culture, 3). Berkeley, Calif: University of California Press; 2003.

(2) Bitton A, Kahn JG. MSJAMA: Government share of healthcare expenditures.
JAMA. 2003;289(9):1165.