SICKO: An Industry Insider's View

I saw Sicko yesterday and have to admit, I laughed when MM commandeered boats to Guantanamo to seek care for sick 9/11 heros and cried when he took them to Havana Hospital. Now the US Treasury Department and Michael Moore are investigating each other over this alleged infraction of US laws, and the people who went on the trip have signed privacy agreements so they aren't talking. 47 million uninsured Americans is wrong and we need to fix it. But Moore's film isn't exactly fair and balanced.

The Sicko doctors in managed care who were disgraced worked in one aspect of insurance called Utilization Review. I worked in insurance for several years but always refused to work in UR for the very reasons cited - UR denies "payment, not care." I preferred being one of the people who advocated care. One of the secrets of saving money that Moore did not go in to is that by providing the best possible care, health care costs go down. This has been proven over and over again in countless studies, and why there is such a big push in the health care - and insurance industry to adopt Evidence Based Medicine Practices and integrate IT. Insurance companies were willing to pay me good money as a consultant and as an in-house nurse to advise them on the best possible plan of care for their insureds.

I only bring up the issue of race because it was brought up in the film: When a black worker for a utility company suffered a catastrophic spinal cord injury in an industrial accident, the Director of the large Worker's Compensation insurer company repeatedly instructed me to make sure Mr. S. had the best possible care. I was given complete latitude to find the best doctors, therapists, transportation companies, surgeons to provide his care. I was to spare no expense coordinating getting a car that he could drive outfitted for him, or accommodations made to his home. Both he and his wife knew they could call me and talk about any problems they were having and any issues they were dissatisfied with and I would do everything in my power to make it right. The doctors, therapists, injured worker and his family and the insurance company were all happy with my work for them. That is what I strove for every day - to create a win-win for everyone.

Because I am bilingual in Spanish, I am often called in to coordinate care for monolingual Spanish speaking (often illegal immigrants) from Mexico and Central America who were injured on the job. Before any of you go freaking out about illegals, let me tell you that the patrons, or bosses, go down to these countries seeking cheap labor and bring them back to this country. Oh, yes. I know a lot. They go down and recruit young men with second or third grade educations who are functionally illiterate. They bring them up here to the US and put them in high risk jobs. They get injured. Duh. Our great health care system puts them back together again. Our Workers Compensation pays for it. I'd love to tell you about Mr. J. -put back together again by the Stanford Trauma team- but there is just too much to tell. It's another blog posting. Let's just say Mr. J got the best of care and a new Cadillac Escalade. And he deserved every bit of it. He lost so much. More on that story later.

Michael Moore's movie would have a lot more impact if he narrowed his focus. If he had focused on the Kaiser Permanente story from Nixon to patient dumping, to the little girl who died. Or if he had focused on the 9/11 heroes from the time they volunteered through their treatment in Cuba. His story gets diluted when he throws everything into the pot. His story seems a bit strident when he tells only the side he wants to tell. See Barbarian Invasions
for another take on the Canadian healthcare system. Interview some nurses who have fled the NHS system in the UK. Unlike the doctor who lives in a million dollar home, they claim to be underpaid. Or go to Nepal and fracture your ankle while hiking in the mountains. See what you think of that healthcare system. If you don't want to travel so far, go to Mexico. And someone please get him a good editor! Michael - if you want a great follow-up story, someone should do a documentary on Michael Ruppert. Here is a case where lack of health insurance truly trumped First Amendment Rights!

Speaking of Mexico, I was blessed to receive great care from a Cuban doctor while on vacation in Tulum a few years ago. My daughter had an asthma attack and the doctor came to our hotel room/cabana, delivered medications and a nebulizer machine and gave her a steroid injection. Total cost of care? $15.


Photo courtesy of Google Images.

Labels: health care, insurance, Michael Moore, Sicko, Workers compensation

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