I finally got to see "Sicko", Michael Moore's tirade against the American Health Insurance industry. It is, of course, a polemic rather than a documentary and therefore it can't be expected to tell the truth, but it does make some valid points.
One point was that being part of what Americans call a socialized medicine system doesn't have to impoverish doctors. Cuban doctors may work for cents but British doctors are very well paid. There are certainly multi-millionaires, but most of these have a private practice income outside the NHS. Nevertheless, there are a lot of NHS doctors taking home $200,000 a year or more.
He raved about the French system, but French taxes are very high and you have to put up with the natives taking to the streets every so often and disrupting public services. If you want a government servant to come and do your laundry during your maternity leave you have to pay for it some way.
One of the cases that he highlighted was the unwillingness of an insurance company to pay for a bone marrow transplant in a man metastatic kidney cancer who had failed high dose interleukin-2. They claimed that it was an experimental approach. Well, you can be certain that it is not available on the NHS unless it is as an experimental approach. Should Insurance Companies be expected to pay for medical experiments? I know that the NHS stem cell transplant program does fund the large transplant centers at a rate so that they can do a certain number of experimental procedures every year. The NIH also has a program of experimental transplant procedures at no cost to the patient. But such programs are run under the direction of the doctor in charge and there is no obligation that any particular patient should be taken on. In answer to the question, "Are you doing this for me, doctor, or am I doing it for you?" the answer is very much the latter. As an aside it is very unlikely that the patient would even have got high dose IL-2 under the NHS since this is not a NICE approved treatment and no-one in the UK is doing any research on it.
He also showed a case of a citizen of Detroit hopping across the border to take advantage of the free Canadian system by pretending to be the 'common-law' wife of a Canadian citizen. The first visit had to be aborted as the cops turned up. And why not? Moore seemed to be endorsing a criminal offence. Defrauding the Canadian taxpayer is no way to improve US medicine.
The truth is that whatever system of health care you have, there are flaws in it. Pharmaceutical companies have produced drugs that are more expensive that people can afford. We should see these drugs in the same way that we would see any other expensive product - a house or a yacht, for instance. I could afford a yacht if I really wanted one. I would have to arrange some way of paying for it over a period, and I would have to work out how much I would use it. Perhaps I would do it as a timeshare or perhaps rent one when I needed one.
For medicine I would also work out whether it was value for money. It is a certain as snow in Greenland that one day I am going to die. If someone offered to extend my life, I would want to know for how long, what the chances were and what it would cost in both suffering and cash.
In the UK NICE has declared that if you get a year of good quality life with a 100% certainty for $60,000 then the community will pay. If it is more expensive than that it won't. Though it is not so overt as that elsewhere, I believe that a similar value is put on human life in other Western communities. In a free market it should be possible for someone to put a value on their own life and if necessary to pay the difference, or if they can haggle with the supplier.
In reality, most communities enter into an arrangement that spreads the cost. Only a small proportion of the people will ever need Herceptin, but it might be you. Therefore, you a buy a ticket for the lottery hoping you never win, but if you do, you won't be left unable to cope. Those who don't buy a ticket are taking a risk. The trouble is that there are lots more products like Herceptin and therefore a lot more lotteries. Some people can't afford all the lottery tickets that they need. Even when the lottery organizations (insurance companies) offer you deals (ten tickets for the price of seven) there are still many people priced out of the market and some people who buy a cheaper product that quibbles when required to pay out (you didn't buy it from a recognized agent; you didn't tell us you had two left feet; you never said your grandmother was a communist). So the government steps in with safety net provisions. The argument for a national system is that if the government is going to have to underwrite the thing anyway it is going to turn out cheaper to run the whole thing than to licence a load of crooks to skim off the profits and leave you to pick up the difficult cases.
I have spent today haggling with a car dealer over a replacement for my 15 year old Mitsubishi Space Wagon. The trouble is that I want a particular model and I can't find another one nearer than 75 miles away and that is no cheaper. The dealer knows that, of course, which is why he has priced the car where he has. It's like that with Big Pharma. They know that there is a $60,000 threshold, so they price their drugs a bit above that. They are trying to drive prices up. The only thing that will bring them down is competition, but if they have a unique product why would they want to reduce their price? You might say, "You'd be better off selling some drugs for $60,000 than none at all." but they might reply, "Very well we'll sell it in Germany."
In fact, while the American market is so profligate, prices will never come down. Even if you can beat them down to $60,000, they are likely to make up the difference by raising the price for a different product that currently retails for less than $60,000.
'Sicko' over-eggs the benefit of other systems of health care and unfairly criticises the American system and there is absolute no need to. The following piece of doggerel exemplifies the attitude:
You cannot hope to bribe or twist
Thank God, the British journalist,
But seeing what the man will do
Unbribed, there's no occasion to. (Humbert Wolfe)
Michael Moore is a journalist and the three rules of journalism are : Make it juicy; Make it brief; Make it up.