A real problem

Currently, 11.2 percent of children in the U.S. have no health insurance. This is disgraceful.

In his observations of Cuba’s health care facilities “now mired in neglect,” Dr. Sainsbury might just as easily have been describing Walter Reed Hospital.






A real problem
Claims about care for the uninsured deserve a response
(A response to Dr. Sainsbury's review of the Michael Moore documentary, "Sicko")


By Dr. Steve Pittelli


Dr. Steve Sainsbury’s review of Michael Moore’s documentary, “Sicko” [“That’s sick,” October 2007], read more like the usual hit piece on Michael Moore than a review of the substance of his documentary (yes, all documentaries have a bias, but that doesn’t make them “nondocumentaries”). First of all, the movie was not about uninsured Americans. Most of the individuals featured actually had health insurance. Their lack of health care was DESPITE being covered by an industry that is focused on denying coverage to increase profits at the expense of the people they insure. Nevertheless, his claims about the uninsured in America are worth a response.
There are, in fact, many people who are uninsured because they can’t afford it. Unless you have the good fortune to receive health insurance through an employer (currently, 40 percent of jobs do not offer health insurance as a benefit, a number that has steadily increased over the past two decades), self-funded health insurance is quite expensive. An average family health insurance policy is $12,000 per year. If Dr. Sainsbury thinks that is affordable on a $50,000 per year income, then he must be very frugal. Currently, 11.2 percent of children in the U.S. have no health insurance. This is disgraceful.
It is certainly magnanimous of Dr. Sainsbury to treat everyone who comes into his emergency room and bill them later (leaving aside the fact that in many places, the emergency room and hospital patients go to is decided beforehand, based on whether or what kind of health insurance they have). As he states: “But unlike those other necessities, payment for emergency medical care is requested only after the care has been given. Try that at Vons or Mervyns—give me the food and clothing first, and I’ll pay you later.”
It might be comforting for a person to know that he or she will receive care before paying for it, but they are, of course, going to be sent a bill for services rendered. And like both Vons and Mervyns (where yes, Dr. Sainsbury, you can make purchases by credit card and pay later), they do eventually have to pay for it. Thus, they are often put in the position of weighing whether to seek care in the first place or take their chances. Living day to day with the fear that you might need medical care that you are unable to afford and could wipe out your life savings is more than enough stress to accelerate some of the very health problems that our $50,000 per year, uninsured, “between jobs,” “presumably healthy,” individuals might encounter when they “choose to spend their money elsewhere.”
Which brings me to the implication by Dr. Sainsbury that someone who is “presumably healthy” is not in need of health insurance. I suppose that’s true, in as much as one wouldn’t need life insurance if they were going to live a long life and one wouldn’t need automobile insurance if they were never going to get into a car accident. Of course, people get “insurance” because they don’t know how long they are going to live, whether they are going to get into a car accident or if they will remain healthy. Moreover, even healthy individuals often see doctors for routine checkups and receive treatment and prescriptions for non-emergencies.
I’d also like to say something about Dr. Sainsbury’s rather callous attitude toward illegal immigrants. It is easy to write off these individuals, but they are human beings who work for very low wages and will not be able to afford medical treatment if they fall ill. They will need treatment whether they can pay for it or not. If he seriously believes that they should not be in the country, may I suggest that he stops buying any food harvested by them or work in any hospitals cleaned by them; nor should he stay in hotels or eat in restaurants that hire them. If he treats them in his emergency room, he might also consider subtracting the cost of that treatment from his own paycheck, instead of expecting the taxpayer to cover the bill for him when the illegal immigrant is unable to pay.
Dr. Sainsbury also takes issue with Michael Moore’s depiction of the Cuban health care system. Moore actually acknowledges in Sicko that U.S. health care is superior to that in Cuba, when he points out that Cuba is ranked 38th by the World Health Organization, whereas the U.S. is 37th (despite the fact that the average lifespan is longer in Cuba and they have a lower infant mortality rate). The very fact that you have to make an argument about whether the U.S. health care system is superior to that of a Third World country that has been under economic sanctions for half a century is a sad commentary. Did Cuban officials make sure to provide top quality care for these Americans, because they knew it would appear in a movie? I imagine so, just as some of the featured health insurers in the U.S. suddenly found it in their hearts to cover medical procedures and treatments that they had previously denied, when faced with the threat of appearing in a Michael Moore documentary.
When Dr. Sainsbury discusses his trip to Cuba, where he found “dilapidated, ramshackle infrastructures—hospitals that at one time must have been truly impressive, now mired in neglect. Paint peeling from the walls, plaster dust laying everywhere, and huge piles of crumbling columns and bricks—pushed to the side so patients can walk by,” he might as easily made a trip to Walter Reed Hospital, where a recent Washington Post investigative report noted that one building was “rodent- and cockroach-infested, with stained carpets, cheap mattresses, and black mold, with no heat and water reported by some soldiers at the facility. The unmonitored entrance created security problems, including reports of drug dealers in front of the facility. Injured soldiers stated they are forced to “pull guard duty to obtain a level of security.” I would hardly call that supporting the troops.
I recently spent two years living in New Zealand, while working in their medical system. Like almost all other industrialized nations, New Zealand has a national health insurance system. I found a fine quality of care there. Prescriptions were quite affordable and wait times to access care were very small (especially when compared to San Luis Obispo County). In fact, when I came back to the U.S. for a visit, I had to get myself pricey travel insurance, so that I wouldn’t face the possible horror of falling ill in the U.S., my native country, with no health insurance.
You can’t have it both ways and say that it is too expensive to have national health care but then argue that the number of uninsured is negligible. If the number of uninsured in this country is such a small number, as Dr. Sainsbury implies, then why not just insure them? Otherwise, it’s time to admit that we have a real problem. §

Steve Pittelli, M.D., is an activist who writes from his home in San Luis Obispo.

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